Person Centred Case Study Examples

Maggie is a 35 year old woman who came for counselling six months after the break up of her nine year marriage to Michael, the father of her two children, Josh aged 6 and Joseph aged 12 months. Currently both children are in Maggie’s sole care. Maggie has been referred to counselling by her General Practitioner whom she has been seeing for a number of minor physical ailments and early signs of depression.

For ease of writing the Professional Counsellor is abbreviated to “C”.

Background

Maggie and Michael met at university when they were studying business computing. After graduating they were employed in separate companies and dated for a number of years before finally getting married. They both continued working until the birth of their first child Josh, when Maggie took a year off before returning to work part time. Michael continued in full time work and received a number of promotions over his years of continuous employment.

Maggie continued working part time until the birth of their second child Joseph, when she again took a year off to care for both children at home. She was about to return to work when Michael came home one night and said he was leaving her for a woman he had met at work. Two weeks later Michael moved out of the family home. He has not contacted Maggie or the children since. Maggie has not felt well enough to return to work and is now in danger of losing her position with the company.

Application of Person-Centered Counselling

The counsellor applying this approach is primarily concerned with communicating empathy and unconditional positive regard to the client. This includes the application of micro skills such as active listening, reflection of feeling and meaning and summaries in the context of a genuine interaction between the counsellor and the client. The counsellor’s role is specifically ‘non expert’ supporting the client to recognise personal strengths and to find answers that are congruent with her/his own values and beliefs.

Preparation

C’s preparation of the counselling room included placing chairs in face-to-face mode, checking the position of curtains to minimise glare, and placing a box of tissues within easy reach of the client’s chair. C also spent a couple of quiet moments clearing her mind of prevailing thoughts from the previous client in order to give Maggie her full attention.

Session Details

Upon Maggie’s arrival, C introduced herself and spent some time developing rapport in an attempt to make her feel welcome and at ease. This was done by asking Maggie to be seated and making general conversation about the weather, and about how Maggie’s day had been so far.

C formally began the session by asking Maggie whether she had received the counselling agency’s letter sent to confirm her appointment details and a brochure containing information about the counselling service including fees, hours of opening, qualifications of staff and map location. Maggie confirmed she had received the leaflet and said that it had been very useful and informative.

C then asked if Maggie had any questions not covered in the information brochure. Maggie replied in the negative and C proceeded to ask Maggie what had brought her to counselling.

Maintaining good eye contact and an open posture, C waited for Maggie to start speaking. After about 20 seconds of silence during which Maggie looked down at the floor, she finally spoke through tears. “My husband left me for another woman six months ago and I just don’t seem to be able to get on with my life.”

C observed Maggie’s emotional reaction and decided that Maggie would be best supported by a person centered approach which would allow her to voice her feelings surrounding the loss of her marital relationship.

C responded with a paraphrase and reflection of feeling “You sound devastated by the loss of your marriage Maggie.”

Maggie replied “Yes I am, but it was six months ago, I should be getting on with my life by now. That’s what my family and friends are saying anyway. But I still miss Michael so terribly and the boys cry for him every night at bedtime.”

C: “So, am I right in saying that you and the boys are still heartbroken yet friends and family think you should be over it by now?”

Maggie: “Yes, that’s about it. Maybe I should be over him by now. What do you think?”

C: “Let me ask you Maggie. Do you think six months is long enough to mourn the loss of a long-term intimate relationship?”

Maggie: “No I don’t.”

C: “And you’re the only one who knows how it feels to have lost your relationship with Michael, Maggie.”

Maggie nodded and continued telling the story of her life in the past six months, pausing occasionally to wipe her reddened eyes with a tissue from the box nearby. Maggie described the physical and emotional upheaval as she struggled to cope with looking after the children on limited income. She also voiced her fears and uncertainty about her own and her children’s future.

C continued to stay focused on Maggie emotionally and to use encouragers and reflections of feelings to confirm and validate her feelings.

After one of many silences, during which C had remained silent but attentive, Maggie looked up without speaking. C decided that this was an opportune time to summarize some of the issues Maggie had raised so far and said “Maggie, you’ve described a huge upheaval in your life in the past six months that has meant reorganising your life in many ways. You’ve taken on the sole responsibility for two children, managing the house and finances and at the same time dealing with the emotional loss of your marriage. That sounds like an awful lot to deal with at once.”

Maggie: “Yes, I suppose it is when you put it all together. It didn’t seem so daunting when Michael was there to help.”

Thereafter, through continued bouts of tears Maggie described her childhood dream of being married with children and the emptiness she now felt having lost that dream so suddenly. She also voiced feelings of anger and self-recrimination for not being able to cope with her new circumstances as a sole parent.

Through the use of open questions, paraphrases and reflections, C was able to explore with Maggie her feelings of anger and also clarified the meaning of what being a ‘good mother’ meant to her. Maggie talked about memories of her own mother who did not work outside the home and was always waiting for her when she returned home from school.

Further exploration through paraphrases and reflections highlighted the significant differences in parenting lifestyles of the past and today, with many parents now assuming the onerous task of undertaking responsibilities of homemaking, parenting and external work.

Maggie then said ” Yes, I suppose being a mother has changed a lot since my Mum’s time.”

C: “That’s for sure Maggie.”

Maggie then went on to describe how much she missed working outside the home and having a career. C reflected Maggie’s feelings (expressed explicitly verbally and implicitly though non verbal signals such as frowns, smiles and wistful glances at the ceiling) and used open questions to explore what Maggie liked about her work including her strengths and capabilities.

Maggie: “You know, maybe I could negotiate to return to work part time for a while until I can get my life organised a bit better? I have a few friends who might be able to help me out with picking the boys up from childcare if I need to work late occasionally.”

C (smiling): “So you think working part time with some childcare support from friends might be the way to go Maggie?”

Maggie: “Yes, I think I’ll put the idea to my boss on Monday.”

From then on, Maggie’s talk slowed and she assumed a more relaxed posture sitting back in her chair. C asked if there was anything else she’d like to talk about today. Looking at her watch Maggie replied that she would need to get going to pick up the boys up from the childcare centre. She also said she would like to come back again the following week.

C replied that she was most welcome to come back anytime and wished her luck as she left looking tired, but definitely more relaxed.

Session Summary

In this session, Maggie, given the freedom to voice her emotional pain in an atmosphere of empathy, genuineness and unconditional positive regard was able to acknowledge that the expectations she was placing on herself were unrealistic and was able to begin to consider other ways of managing her new life.

The use of the Person Centered Approach to counselling in this initial session was well suited to a client such as Maggie who was able to articulate and explore her feelings associated with the loss of her marriage and future uncertainty.

The key concepts of Person Centred Therapy applied in this session were:

  1. The creation of a non-directive and growth-promoting climate wherein the client feels nurtured and respected.
  2. A congruent and empathic approach by the counsellor that emphasises and promotes self worth and empowerment encouraging clients to find answers that are congruent with her own values and beliefs.

Author: Liz Jeffrey

Related Case Studies: A Case of Grief and Loss, A Case of Grief Using an Eclectic Approach, A Case of Acceptance and Letting Go

By Douglas TurnerI believe that if you feel there is someone listening carefully to you with some respectful understanding of your feelings then you begin to believe you are worth hearing that you deserve some attention; that you are worth it.

I approach counselling in the belief that you have the answers to your unhappiness and in telling me about what is wrong you will hear the beginning of a way forward.

Together we can build on that beginning until your world changes from an unhappy to a more hopeful place, And in that hopeful place you have some coping skills should you need them again.

About Counselling

If you are physically ill there is usually a good chance you can be cured with the right diagnosis, correct prescriptions and careful nursing. If an accident leaves bits of you broken then bones can be set, plaster support applied and in time therapeutic exercises will enable those parts to function again. This we understand, can observe and test.

However, we do not give the same attention to the invisible hurt that can accompany illness and accident, loss and unhappy life history. The invisible hurt is not as straightforward as physical illness but it is as real. There is emotional internal bleeding going on long after the event that triggered it. There is an equivalent to scar tissue that restricts movement and numbs feelings. There is a whiplash effect of panic, depression and self-doubt.

Counselling seeks to address this invisible hurt: to heal, restore, renew. Counselling like medicine is a broad church. lt has its own jargon and contention within its ranks about the interpretation of symptoms and what makes for effective treatment.

For me, the most deceptive, the most demanding and the most effective form of counselling is called Person- Centred.

It is most deceptive because it sounds easy. It is not built on a vast theoretical base. It values instinct and attitude alongside intellectual ideas. Because it has no prescriptive formula but instead an insistence on rigorous integrity it is particularly demanding. Its success depends on the counsellor removing the equivalent of the surgical mask, the rubber gloves and some of the professional distance.

So what might it be like for you on the receiving end of Person- Centred counselling? Mixed feelings I’d guess, some unexpected. perhaps anger and frustration because you are hurt and want advice and answers and you do not get them. Maybe frustration that this listener is not critical of those that have hurt you and not shocked by what you have done. Sometimes surprise that in the first time in a long while you are being listened to carefully and your feelings are being taken seriously. Eventually even a bit amazed that your life can be changed because you were able to talk and putting feelings into words for another to hear is the beginning of managing them for the better.

This is what you and your counsellor will work towards- the outcome, the product. But there is also something else going on that affects the healing – the process. This is the time you spend with your counsellor, what goes on between you. The message you should be getting from this safe stranger in this secure place is an assurance that you are worth taking seriously, that your concerns are real ones. Here is someone who sees strengths in you when you cannot and is optimistic about your future when you do not believe you have one. And yet you believe this counsellor is sincere and has some insights. So maybe you begin to realise they are seeing in you someone you dimly recognise from way back before you were so knocked about. Someone with a little more confidence, a little surer of where they are going.

About the Author

Douglas Turner

After a wide experience of Further and Adult Education, I am now concentrating on Counselling, Training and Supervision in a private capacity.

My supervisory experience encompasses individual work with counsellors and Diploma students and group supervision in the voluntary sector.

I have taught counselling at certificate and diploma level and will shortly be moderating courses for the A.B.C. (Centra) Examining Body.

I have been counselling individuals for some ten years with a Person-Centred approach informed by T.A. and some Cognitive notions.

…it helps to be heard..
COUNSELLING
TRAINING
SUPERVISION
DOUGLAS TURNER M Ed. Dip.Ad.Ed.Dip.Counselling.
B.AC. Accredited Practitioner
Tel. 01926771447
Email: turner@oneill.spacomputers.com

Person Centred Counselling A Case Study

By Patience O’ Neil

Before I begin to work with someone, we have a meeting to check each other out in terms of what each of us is expecting & what the process could involve – me explaining how I work with the Person Centred approach, and how a counselling contract is framed, & our respective roles in the therapeutic alliance – the prospective client explaining what she is looking for, expects to happen & how the process may help or not. Also, importantly, as we sit in each other’s company, we get a sense of “does the face fit”; can I imagine trusting/ being trusted by this person?

At this meeting, we decide whether to begin working together or not. If not, I would make suggestions about other possible counsellors to contact. If yes, then we discuss & agree on the terms of our working contract, which includes the initial number of sessions, costs, cancellations, commitment, and confidentiality.

Here is a case study to illustrate how the Person Centred counselling process works. I shall call the client Jo, not her real name.

Jo came over as a calm, down to earth & practical person in her mid thirties.
However, as she began to tell her story what emerged was someone stuck in a deadlock with no spontaneous way forward. Jo was in the process of changing – in the way she experienced herself, how she felt about her role as worker & parent, what felt genuine – which was exciting & opened up new horizons. However, Jo’s family members hadn’t opted for her to change, in fact the opposite, they wanted the person they’d always known in her normal role. So familiar family routines became zones of tension, anger & recrimination.

Jo felt she was faced with an impossible dilemma. Should she give up on the newly found journey of self discovery in order to maintain the status quo with the people she loved & had built a life with? That choice would provoke feelings of pretence & resentment in Jo, which could undermine family life.

Should Jo pursue her personal journey & try to persuade other family members to change along with her? This choice would be perceived as provocation & lead to an escalating climate of anger at home, so that nowhere felt safe.

Person Centred counselling is built on various key ideas which we can link to Jo’s situation to explain the process. Firstly, the goal is to become a fully functioning person, harnessing the innate life affirming force within you– the self actualising tendency. Jo had absorbed messages during her growing up called conditions of worth – as many people do – saying you are only worthwhile if you do as you are told, or please your parents, or put other people first, for example. So, as an adult Jo can only feel good about herself when these conditions are met – she will have created adult relationships based on these conditions. Allied to this is the idea of locus of evaluation, which means the place where Jo evaluates herself from – does she have the power within herself to believe she is worthwhile? Or does she believe the learned childhood messages & feel that her partner has the power to define her worthiness?

In order for Jo to get in touch with her self actualising tendency, she needs to gain the power within herself to believe she is a person of worth & discard the learned conditions of worth. Then Jo can choose the best course of action for herself.
So how did the therapeutic process unfold? Our initial contact was for six sessions & then a further six.

In the first stage Jo told her story & I tuned in carefully to her world, her experience of it, her dilemmas & pain. This includes noticing what is not said, & contradictions. Part of the therapy is for Jo to tell me, a dispassionate ally, all about the turmoil that has been raging inside so that she can let go of it, gain some distance from it, explore the perspective of other people involved, and be affirmed as valid in having these feelings.

In the next stage, Jo & I return to the dilemmas, the “ought & “should”, so that Jo can explore within the safety of the counselling space, what would happen if… how would she feel if… what does feel most authentic… where do these learned messages come from & can she discard them now in the light of who she is now ? What are Jo’s emotional resources, & priorities?

In the last stage of our work together, we move towards an ending at an agreed date. So we review insights gained & current feelings & Jo has the opportunity to check out what she would like to do & is able to do. My role is ensuring that Jo has accepted her own capacity at this time to take up her chosen course of action.
And so we finish.

About the Author

Patience O’Neill

I have been a freelance counsellor & supervisor for ten years, working from a Person Centred perspective, informed by concepts drawn from a psychodynamic approach. My founding belief is that each person has the potential to become whom she or he would like to be & with the support of the therapeutic alliance can get in touch with that person.

I combine my freelance work with my role in a Further Education College co-ordinating a counselling training & a teacher-training programme. I consider that these two aspects of my work complement each other.

Qualifications:

BA Hons English & American Literature, PGCE, Diploma in Counselling, Certificate in Psychodynamic Psychotherapy & Group work.
Phone: 01926 771447

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