The description of the client’s case
The client is a well-educated, talkative, and quite attentive Italian attorney between the ages of twenty and thirty who is addicted to cocaine. He uses cocaine almost every day after work, 5-6 times a week, and claims that it helps him focus and keeps him productive. The client has a very stressful job. He has many things to do and tasks, so two hours of sleep is what he has. As for relations with his family, he rarely communicates with relatives once a month, and they do not know about his addiction. The client has a partner who is not happy with the drug use.
The presenting problem from both the counselor’s and the client’s perspective
From the client’s point of view, he does not have a drug addiction. He is not ashamed of this and considers the situation normal because he is full of energy and continues to work. Moreover, the client believes that everyone in the law field uses coke, including his father, and this is the culture of the sphere. According to the client, his condition is under complete control. Thus, the client claims that using cocaine after work is not an addiction but a way of working. However, the client is open to receiving help and working with a social worker. The only reason for this is his partner’s dissatisfaction with his addiction. At the moment, the client is ready to communicate with a social worker but does not see any benefits in this.
From my point of view, the client has a pronounced drug addiction. Cocaine stimulates the sympathetic nervous system, thereby increasing the level of energy in the body. The body begins to overexcite, and all metabolic processes proceed very quickly, which leads to a state of euphoria. It explains the client’s ability to multitask while sleeping is limited to two hours. Moreover, during the session, the frequent use of various mechanisms of psychological defense was noted. The client appealed to rationalizing his behavior for an acceptable interpretation of drug addiction, for example, by referring to stressful work. There was also a tendency to attribute drug addiction to a significant number of legal workers, which reduces or relieves the feeling of guilt for his behavior. Thus, the client does not understand that he has a rather serious addiction, which manifests itself in the use of cocaine almost daily.
How the counselor attempted to facilitate the therapeutic alliance
To achieve a therapeutic alliance, I used some psychological tools. First, at the beginning of the conversation, the client was concerned about privacy issues. Therefore, we entered into a verbal agreement on the confidentiality of our sessions, and I convinced him that no one could receive any information without his written consent. Secondly, my listening was empathic, as evidenced by my active verbal and non-verbal response to the client’s story, including facial expressions, nodding, and individual phrases such as “Sure,” “OK,” and “Yes.” Third, at the questioning stage, I accepted the client’s concept. I did not argue with the client and did not persuade him of his drug addiction so as not to provoke a defensive response in him. Fourthly, I allowed the client to express his thoughts as fully as possible. At first glance, there may seem an inappropriate pause between the client’s response and my reaction to this, but this was done so that the client could express everything he thinks about.
Goals in the session
As such, we did not discuss the goals with the client. The primary purpose of our session is to increase the client’s awareness of his addiction. To do this, at the end of the session, I instructed the client to think about how we would move his treatment. It seems that such methods and recommendations will guide the client toward realizing his problems. Moreover, the client’s partner should continue to convince the addict about the need for treatment, speak more about his feelings, and not be afraid to talk about his fears. Therefore, the only communication that is not oppressive and without threats, both from me and the client’s partner, can help form motivation to start treatment.
The challenges and risk factors the client may face in their ability to engage in treatment
There is a specific category of clients who do not consult of their own free will. Among them is my client, who came to the consultation only because of the negative attitude of his partner toward his addiction. Although during this session, the client expressed a desire to interact, a lack of motivation can be expressed in missing appointments, being late, indifferent, and refusing to accept responsibility for the counseling process.
Moreover, after analyzing everything said by the client, I can conclude that he has many features of an obsessive personality. It is evidenced by the dogmatic style of thinking (drug use – the culture of the legal sphere) and adherence to strenuous, vigorous activity without relaxation (sleep 2 hours a day). Also, an obsessive personality usually asks for help not because of specific problems but because of tension and anxiety in interpersonal relationships or family life. In my case client expressed his partner’s concern as the reason for our sessions. The difficulty of working with such individuals is that many obsessional clients participate in counseling only physically and psychologically withdraw themselves. Thus, special techniques will be required to deal with these clients.
The counselor’s feeling as to the role play
In my opinion, on the whole, I coped with my task. As I mentioned above, I have applied the necessary tools to build a therapeutic alliance. Furthermore, at the end of our session, the client expressed a desire to interact with me despite the low level of motivation and lack of understanding of the scale of his problem. Thus, the main goal of this session has been achieved.
The areas of improvement
After reviewing the video of our session, I felt like I was missing eye contact with the client. In some moments, I looked away when it was essential to look at the client. Moreover, I still need to keep working on not experiencing the client’s problems as my own. Antony and Barlow (2020) note that if the professional technique dominates the consultation, the conversation will turn out to be formal, dry, and artificial. In turn, if the session turns into a process of empathizing with the psychologist with the client, the results will not be achieved. Thus, I mustn’t take the client’s problems too close to my heart so as not to get upset, burn out, lose inner balance, and not fully implement psychological assistance to my client.
The “Five P’s” in the role play
In this case, the “Five P’s” model looks like this:
- Presenting problem(s): The client said that he uses coke 5-6 times a week to stay in good shape while sleeping 2 hours a day.
- Predisposing factors: The client stated that his father also works in the same industry and uses drugs. In fact, he said that everyone in the law field uses cocaine, and that is the culture of the sphere.
- Precipitating factors: The client does not feel that he is in trouble and the only reason he attended the session is that his partner told him that he needs help.
- Perpetuating factors: The client’s work is stressful, he has a lot of responsibilities and tasks, and cocaine helps him stay productive.
- Protective factors: The client’s willingness to consult because of the desire not to upset the partner.
Therefore, using the “Five P’s” helped me understand the client’s strengths and difficulties in terms of his understanding of things, social circumstances, relationships, life events, and history and development.
Reference
Antony, M. M. & Barlow, D. H. (2020). Handbook of assessment and treatment planning for psychological disorders (3rd ed.). Guilford Publications.