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The case study presents two individuals who had to experience particular difficulties. The client, Glenys, states that she is afraid of her son’s harassment and refuses to go home because the harassment might continue. Two theories (cognitive behavioural theory and emotion-focused therapy) are chosen as applicable to the case study.
The cognitive behavioural theory is often utilized by social workers, psychologists, counsellors, and other professionals when working with clients. The theory emerged from two particular approaches: while behavioural theorists pointed out that depression could emerge due to the “high rate of punishers and low rate of reinforces” in the person’s environment, psychodynamic theorists stated that the unresolved issues in our unconscious mind shaped our behavioural and thinking patterns (Lehmann & Coady 2016, p. 224). Eventually, the theories were transformed into cognitive behavioural therapies. In this case study, both aspects (irrational beliefs/negative environments) need to be addressed.
The classical conditioning, discovered by Pavlov at the beginning of the XX century, is a theory that can explain the emotions Glenys faces when confronted with or discussing her son. Since Glenys started to relate Emmanuel’s visits to his threats, harassment, and violence, she developed the fear/arousal responses discussed by Lehmann and Coady (2016). Since Emmanuel’s visits only increase the anxiety in Glenys, she begins to believe that she will not be able to cope with the injury at home.
Glenys links her home to Emmanuel’s visits, and those visits often result in fights; eventually, Glenys’ perception of her home became negative because it could only relate to Emmanuel’s demands for money and various treats.
Other issues that should be addressed are Glenys’ hopelessness and worries related to her injury (i.e. broken leg). According to the case study, the client states that she can no longer cope with the crutches and she begins quietly to cry. In order to address this problem, the client’s inability to cope, her anxiety and fear, the emotion-focused theory can be used. Emotion-focused theory understands emotions as key processes that guide people in the world and help individuals understand whether the current situation or environment can meet their needs or not (Lehmann & Coady 2016).
According to Elliott (2012), emotions can help individuals to process the incoming data to produce the appropriate actions depending on the individual’s needs (e.g. connection, protection, etc.). Emotion-focused theory utilizes three major concepts: “emotion schemes, emotion response types, and emotion regulation” (Elliott 2012, p. 109). Emotion schemes consist of several elements: experienced emotions (fear, depression, anxiety), perceptual/situational elements (home-> threats, violence), bodily/expressive elements (tiredness, crying, sleeping difficulties), symbolic elements (none so far), and motivational/behavioural elements (wants the harassment to stop).
Emotion response in Glenys was fear at first (primary), then sadness, depression, and hopelessness (secondary), while crying when asked about the crutches can be seen as maladaptive response (because she cannot cope with the situation at home and feels she cannot cope with crutches either; that is why she feels anxious and depressed). Emotion regulation is the last element; Elliott (2012) divides emotion regulation difficulties into over-aroused and under-aroused. Glenys is over-aroused to complete the task; once she is at home, she will be overwhelmed with fear, anxiety, and depression to cope with her injury and crutches. The counsellor’s goal is to work with client’s emotions, help accept, reflect, change, and transform them, whereby the client becomes more self-reliant and empowered (Lehmann & Coady 2016).
The limitation of the EFT is that it can be challenging for those clients who experience difficulties accepting and being open about their emotions. The theory also is incapable of working with serious or major traumas, and if the client has such an experience, the EFT will be ineffective (Carr & McNulty 2016). At to the cognitive behavioural therapy, it can negatively influence the client by either letting her believe that the recent problems arise due to her negative thoughts about them or making her even more anxious after the reflection sessions about her own anxiety (Kendall & Hollon 2013).
The EFT’s efficiency was proven in different researches; Johnson and Wittenborn (2012) point out that EFT is effective in treating anxiety and depression disorders. According to the authors, EFT in women with major depressive disorder was as effective as pharmacotherapy alone (Johnson & Wittenborn 2012). At the same time, it should also be noted that therapist’s emotional presence is also crucial since it can evoke emotional experiencing (Johnson & Wittenborn 2012).
The effectiveness of cognitive behavioural study is examined by Hofmann et al. (2012). According to the authors, CBT is as effective in patients who have depression as other psychological treatments. Moreover, it is more effective than psychodynamic therapy (Hofmann et al. 2012). Pharmacotherapy and CBT were equally effective for patients with chronic depressive symptoms.
One should also bear in mind that CBT is seen as an effective approach when treating anxiety disorders and secondary symptoms of these disorders such as sleeping difficulties/insomnia and anxiety sensitivity (Hofmann et al. 2012). Thus, as it can be seen, CBT is suitable for treating the client’s sleep difficulties, anxiety, and depression related to the experienced situations. Although Hofmann et al. (2012) point out that CBT is more effective with pharmacotherapy when treating depression, it is possible that the client will refuse to take medicine. Thus, the counsellor’s options include non-medical interventions that will still effectively address the client’s fears and difficulties.
Both CBR and EFT need to be utilized to ensure sufficient results because these theories address different problems the client experiences. While CBT focuses on client’s depression and sleeping difficulties, as well as fear related to son’s repeated harassment, EFT will help her overcome the assumed inability to cope with the injury.
Clients and Stakeholders
Various stakeholders will approach the individuals in the case study as potential clients. For example, Mental Health Foundation Australia will see both Glenys and Emmanuel as potential clients due to their mental health issues (anxiety/depression in Glenys and addictive behaviours, inability to control anger in Emmanuel). At the same time, SMART Recovery Australia will consider Emmanuel as their client since the program assists people with behavioural problems such as addiction to alcohol, gambling, shopping, etc.
Family Relationship Service Australia and Australian Association of Family Therapy will consider both Glenys and Emmanuel as clients since they work on the resolution of difficulties and issues in family relationships. The desired outcomes will be various as well: specific interventions (e.g. CBT) will be necessary to resolve mental health issues in Glenys and Emmanuel (MHFA), while SMART RA will demand to work with Emmanuel only to help him overcome his addictions (CBT also possible).
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FRSA and AAFT will demand family counselling; the counsellor might use EFT for couples and families to provide the desired outcomes. Narrative theory (separation of the problem from the person) or strategic therapy (patterns in relationships) can be used by the counsellor to address the issues in family relationships between Glenys and Emmanuel.
Micro-Skills and Problem Solving
To address the client’s problems, the counsellor needs to engage their micro-skills to ensure collaborative work towards the established goals. Micro-skills are a set of specific skills that counsellors use when interviewing their clients. The skills include attending behaviour, open and closed questions, observational skills, encouraging, paraphrasing, a reflection of feelings, focusing, self-disclosure, feedback, and others (ACA 2015; Geldard & Geldard 2016). Attending behaviour (eye contact, proper body language) and a reflection of feelings are crucial parts of EFT that require empathy and understanding from the counsellor. At the same time, observational skills and open-ended questions are frequently used in CBT, allowing the counsellor to notice conflict, specific behaviours, patterns, etc.
Building rapport (empathic relationships with the client) is essential because its effective establishment will possibly determine the client’s future interest in seeking counselling; inefficient rapport will discourage the client to take part in follow-ups (ACA 2015). Rapport is the primary basis of counselling relationship; if the client does not feel they have an established trusting relationship with the counsellor, the following work on determined goals will most likely be unsuccessful (ACA 2015).
The counsellor needs to be very attentive to client’s problems and her description of it to ensure that no mistakes are made (Geldard & Geldard 2016). Since counselling is a collaborative work and can only be effective when both actors take part in it, the counsellor should also understand the client’s expectations from the counselling sessions (Geldard & Geldard 2016). Many people who attend a counsellor for the first time believe they will get a direct advice and precise, explicit instructions (Geldard & Geldard 2016). However, the counsellor’s aim is not to operate the whole process by themselves but to work with the client together, empowering them to find the solution by themselves, and the counsellor’s main goal is to “promote, amplify and extend the possibility of change” (Geldard & Geldard 2016, p. 120).
The counsellor will need to list all the problems together with the client using micro-skills such as open-ended questions, observations, summarizing, focusing, encouraging, and paraphrasing (ACA 2015). There are six detected problems: the inability to cope with the injury (crying), hopelessness and anxiety related to her son’s threats and harassment, sleeping difficulties, refusal to take Apprehended Violence Order against her son, lack of money to attend social events and communicate, refusal (fear) to go home and desire to stay in the hospital. The client wants harassment and threats to be ended.
Glenys’ problems are not caused by the client directly because she is abused by her son and has (as of now) little control over this situation. Since the counsellor cannot contact Emmanuel and the client is Glenys, it is crucial to ensure Glenys’ safety and evaluate every decision carefully. Glenys’ self-reliance needs to be improved; as Geldard and Geldard (2016) state, encouraging the client to be self-reliant is usually more efficient than giving advice.
Furthermore, the counsellor’s attention and wish to listen and perceive the client’s problems can also positively influence client’s perception of the issue. Thus, the counsellor’s role, in this case, is not to solve the problem by themselves but to “help the person sort out their own confusion” (Geldard & Geldard 2016, p. 9). The counsellor needs to help the client communicate with her son effectively and ensure her safety.
To address the first four problems, the counsellor can use externalizing, i.e. separating the problem from the person. This approach will help Glenys understand that the problem and the individual are not the same and improve her control over the situation (injury and inability to cope). To address Glenys’ hopelessness related crutches, the counsellor can use the “here and now” experience to raise Glenys’ awareness of what is happening and bring the change into client’s emotions and perception of the situation. It is essential to facilitate cognitive change by focusing on the person’s strengths, helping her to recognise she is able to cope with this situation (crutches) (Geldard & Geldard 2016).
While the CBT might focus on the client’s depression and sleeping difficulties, EFT will promote the empathic relationship between the counsellor and the client, also allowing the client to evaluate their emotions about the injury and harassment and transform them. Solution-focused therapy can help the client draw attention to those times when her undesirable behaviour did not occur (Geldard & Geldard 2016). The counsellor can ask Glenys how she felt and acted before her son started visiting her, how she controlled her life, and how she coped with other difficulties.
The client can also be asked about her wish to get help from Centrelink and find any free events for the elderly. To ensure client’s safety, the counsellor can suggest Glenys a stay in a women’s shelter for a short period of time.
In this case study, CBT, EFT, solution-focused therapy, externalizing, and focus on positive changes and behaviour can help the client resolve her problem and successfully cope with the situation. However, the counsellor should focus on collaborative work with the client and understand how the client’s self-reliance and empowerment can be improved. At the same time, the counsellor needs to ensure Glenys’ safety and be aware that client’s wishes and choices are to be respected. An empathic and understanding approach towards the client is necessary; establishing rapport with the client is one of the major goals because the follow-ups will depend on its efficiency.
ACA 2015, The ACA encyclopedia of counseling, John Wiley & Sons, New York, NY.
Carr, A & McNulty, M 2016, The handbook of adult clinical psychology: an evidence based practice approach, Routledge, London.
Elliott, R 2012, ‘Emotion-focused therapy’, in P Sanders (ed), The tribes of the person-centred nation, PCCS Books, Ross-on-Wye, pp. 103-130.
Geldard, D & Geldard, K 2016, Basic personal counselling: a training manual for counsellors, Pearson, Frenchs Forest.
Hofmann, SG, Asnaani, A, Vonk, IJ, Sawyer, AT & Fang, A 2012, ‘The efficacy of cognitive behavioral therapy: a review of meta-analyses’, Cognitive Therapy and Research, vol. 36, no. 5, pp. 427-440.
Johnson, SM & Wittenborn, AK 2012, ‘New research findings on emotionally focused therapy: introduction to special section’, Journal of Marital and Family Therapy, vol. 38, no. 1, pp. 18-22.
Kendall, PC & Hollon, SD 2013, Cognitive-behavioral interventions: theory, research, and procedures, Academic Press, Cambridge, MA.
Lehmann, P & Coady N 2016, Theoretical perspectives for direct social work practice: A generalist-eclectic approach, Springer Publishing Company, New York, NY.