Case Study Example of Reflective Listening in Counselling

10 Apr 2018

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Case:

Savita is a 33 year old woman. Her marriage broke up more than 10 months ago. Prakash and Savita had been married for ten years, and had two children, Rakesh aged 6 and Rohan aged 18 months. Currently both children are with Savita. Savita came for counselling after being referred by her Family Doctor who thinks she has early signs of depression.

Background

Savita and Prakash met in college where they were studying BCS. After graduating they both worked in separate companies and were dating for many years before getting married. Savita continued her job after marriage until the birth of their first child Rakesh, Savita took a break and to work part time. Prakash worked full time and received a number of promotions.

Savita was working part time until the birth of their second child Rohan, then she again took a break to look after both her children. She got a new job and was about to start to work when one day Prakash shocked her by informing her that he was leaving her for another woman who worked at his office. A month later Prakash moved out of their home. He has not contacted Savita or the children since then. Savita has too depressed to return to work and is now in danger of losing her job with the company.

Session Details

Upon Savita’s arrival, the Counsellor spent some time developing speaking to Savita to make her feel comfortable and at ease.

Counsellor began the session by asking Savita whether she had any questions about the counsellor and answered them about her experience and work in counselling. Counsellor proceeded to ask Savita what had brought her to counselling.

Savita kept staring at the floor and after a few seconds started crying, “My husband left me. He likes another woman; I just can’t get over it.”

Counsellor responded with a paraphrase and reflection of feeling “You sound devastated by the behaviour of your husband Savita.”

Savita replied “Yes I am, but it was many months ago, I should get on with my life. I don’t know why I am still so upset. My family and friends are saying that I have to move on. But I miss Prakash so much and the children cry for him every day.”

Counsellor: “So, you and the children are still very sad and yet your family and close friends think that it is about time you started living again?”

Savita: “Yes, maybe I am taking too long to get over him. What do you think?”

Counsellor: “Let me ask you Savita. Do you think six months is long enough for your sadness about your marriage?”

Savita: “No I don’t.”

Counsellor: “And you’re the only one knows how you are feeling and whether you can get over your marriage with Prakash, Savita.”

Savita continued her story about her life with Prakash and how she has struggled for the last ten months without Prakash. Savita described the traumatic situation and how she is has looked after the children on limited income. She also spoke about her fears and uncertainty about her own and her children’s future.

Counsellor focused on Savita to encourage her to speak about her feelings and her pain.

Counsellor summarized Savita’s issues and said “Savita, you’ve just described a very traumatic time in your life you must have had to make a lot of adjustments to your life during this time. You have the responsibility of two children, you have to take care of the house and manage your finances. At the same time you are facing a lot of pain with regard to your marriage. That is quite a lot that you are managing in your life right now. ”

Savita: “Yes, my situation is very bad. It didn’t seem so bad when Prakash was living with us.”

Savita cried a lot and told the Counsellor about her childhood dream about getting married in a joint family how they show on TV and in the romantic Yash Johar family movies. She continued to cry about how she will never be able to fulfil that dream. She also spoke about her feelings of anger and blamed herself for not being able to deal with her situation and be a good parent.

Through open questions, paraphrases and thoughts, Counsellor was able to help Savita her feelings of anger and also helped he understand what being a ‘good mother’ meant to her. Savita spoke about her own mother who was a stay at home full time Mom.

They also spoke about different parenting lifestyles of the past and today. How the role of women has changed in the Indian society and how friends and relatives are treating Savita.

Savita said that she missed her job and the satisfaction it gave her to have a career. Counsellor helped reveal Savita’s feelings and understand what Savita liked about her work and her strengths and capabilities.

Savita: “I am thinking that , maybe I could talk to my organisation to get me to work part time for a while until I can get my life organised a bit better. I have a few family member and friends who might be able to help me out with the children.”

Counsellor smiled at Savita and helped her make up her mind for herself and her future.

Savita: “Yes, I will speak to my boss on about it.”

Then, Savita’s looked more relaxed and comfortable. Counsellor asked if there was anything else she’d like to talk about today. Looking at her watch said that the children would be waiting for her. She also said that if she needed to talk she would come back.

Counsellor replied that she was most welcome and wished her luck.

Session Summary

In the session, Savita was given the freedom to talk about her pain in a place full of empathy, genuineness and unconditional positive regard.

A Case Study 1

Samantha is a 38-year-old Anglo-Indian woman who had abused a number of substances, including cocaine, heroine, alcohol, and marijuana over the past 15 years. She left high school and worked as a prostitute for 5 years. Later she found a job as a sales clerk at a home furnishings store. Samantha had two children in her early twenties, a daughter who is now 15, and a son, aged 18. Because of her substance abuse problems, they lived with other relatives who agreed to raise them. Samantha was in treatment repeatedly and had remained substance free for the last 5 years, with several minor relapses. She had been married for 2 years, to Steve, a carpenter; he was substance free and supported her attempts to stay away from substances.

Few months ago she became symptomatic with AIDS. She was diagnosed with HIV-positive for 5 years but had not developed any illnesses related to the disease. Samantha had practiced safe sex with her husband who knew of her HIV status. Recently, after learning from the physician at her clinic about her HIV symptoms, she began to "shoot up," which led her back into treatment. Out of fear, she came to visit a counselor at the clinic one day after work who she was asked to meet by her physician. She looked all worried about her marriage and that her husband would be devastated by this news. She was afraid she was no longer strong enough to stay away from drugs since discovering the onset of AIDS. She was also concerned about her children and her job. Uncertain of how she would keep on living, she was also terrified of dying.

The counsellor engaged in reflective listening, his words were of acceptance to Samantha and her past, and he clarified her current situation and feelings. He was empathetic of her emotions and feelings and was in complete congruence with her mood and thought flow. As Samantha developed trust in the counsellor, he began to emphasize her positive characteristics and her potential to make meaningful choices to become the person she wanted to (and could) become. The counsellor also helped her develop sufficient insight so that she could make choices that reflect more closely the values and principles to which she aspired. During this time, she mentioned her will to tell her husband about her symptoms and try to strengthen her marriage.

During the session, when Samantha began to feel guilty about her past as a prostitute, the counsellor demonstrated appreciation of her struggle to accept that aspect of herself, highlighting the fact that she did eventually choose to leave it. He mentioned that she did the best she could at that time and underscore her current commitment to choose a better life. He counselled Samantha, that she would be supported and accepted, not criticized. She was completely engaged with the counsellor. She expressed her fear of death and the effect this fear had on her. Samantha happened to mention that this was the first time in her life that someone was unconditionally accepting of her or focused on her strengths rather than her failings. What was noticed was that she had the ability to solve problems, which was reflected by her return to counselling and her insight about needing help. She mentioned that by being understood and accepted, her self-esteem and sense of hope begun to increase and her shame begun to decrease. She had felt supported in making critical choices in her life and more confident to resume her recovery.

A Case Study 2

Shashank was a 36 year old man who worked as an admin employee for a small family business. The business was failing and Shashank was worried that he would probably have to begin the process of “winding it up” in the near future. His commitment to the business and his friends, the business owners, had intensified the level of stress he was feeling as a result of the business collapse. He had taken a week off work on sick leave and felt too “stressed” to return to work. Revati, Shashank’s wife, had contacted the counselor because she was greatly concerned for her husband. She was worried that Shashank was depressed as he was refusing to go to work. She stated that he had agreed to attend counseling if she organized an appointment, however he did not think it would help him. Shashank attended four sessions with the counselor over a ten week period. Shashank had reported the following symptoms: decreased motivation particularly in relation to his work, unusual outbursts of anger, anxiety whenever he thinks about his work or attends his workplace, and difficulty sleeping. He stated that these symptoms commenced when he realized that the business he was working for might begin to fold and have increased to the point that he is finding it difficult to complete his usual tasks and “doesn’t want to do anything”. At the first session, the counselor engaged in reflective listening, his words were of acceptance to Shashank and his situation, and he clarified his current situation and feelings. He was empathetic of his emotions and feelings and was in complete congruence with her mood and thought flow. As Shashank developed trust in the counselor, he began to tell the counselor a lot of facts that were lying deep within him. He told the counselor that he had worked as an admin employee in small businesses for the last twelve years. About eight years ago he was working with another business that required him to close it down. He described that experience as extremely distressful. He felt that the process had involved a loss of loyalty from organizations associated with the business and that he saw this as a “personal attack” against him. He also felt he had been exposed to people who would do everything they could to get as much as possible from a “crumbling company”.

In the next session, Shashank reported that he felt he was “depressed” (using his own understanding of the term). He stated that the depression began as the retail business he was working for started deteriorating. During that time he felt betrayed by people he had trusted and he felt “conned” and tricked by many “colleagues”, and as a result, he had felt like a failure. He stated that he was now experiencing an extreme fear of having to go through the same experience again. The counselor identified the seriousness of the events that had led to his level of stress and normalized Shashank’s reaction. To manage the current level of stress that Shashank was experiencing, the counselor recommended he continue his temporary respite from work and that he had to implement some relaxation strategies like regular exercise, doing things that he enjoys and things that he finds relaxing. Shashank was very concerned about what he should do about his return to work. He said that he did not feel that he could go back. The counselor suggested that he try not to think about the decision concerning his return to work until the next session which was in two weeks In the following session, Shashank reported that he felt “more relaxed”, although he continued to feel unmotivated to return to work. He described walking regularly and avoiding worrying too much about work. He also said that he had gone into work for two brief periods during the two weeks and had experienced a high level of stress and frustration when he did, although he reported some comfort from the use of the relaxation methods.

The counselor used a four step decision-making model to assist Shashank to come to a decision about his work.

Step One: What is the problem?

Step Two: What are the options and what are the relevant issues associated with each one?

Step Three: What is the best option?

Step Four: What do you need to do to implement the best option (include possible contingency plans)?

The counselor suggested that Shashank had to develop a written plan for managing and balancing all the aspects of his life (relaxation, enjoyment, hobbies, family relationships, and work) that would be reviewed at the next appointment.

In the third session, Shashank explained that he had taken a holiday for a week with his wife and had returned “refreshed” and with new insights into his life. He also stated that his stress continued to reduce. He described a “new conviction” to balance his life more. At that point, he felt he might be able to return to the workplace full-time, or he might decide to resign from his position and move to another area to start again. He said that he realised that when he has no clear direction and feels out of control, he gets very stressed. He described these things as the triggers for the stress he has felt in this situation and similar situations in the past. He therefore decided to ensure that he always has a sense of direction and control in the whole of his life by taking the focus away from work. The counselor supported and encouraged his continued self-reflection and determination. This move is based on his decision to balance his life more and he was excited about his family’s plans. He had commenced playing a sport with friends one night a week and was walking regularly. He stated that he had realised it would take some time to change his measure of success / failure, however, he would continue to address it.



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