Case Study of the Initial Presentation of the Client, Key Movements in Sessions and Evaluation

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Case Study of the Initial Presentation of the Client, Key Movements in Sessions and Evaluation

The following case study is about an 18 year old white British male that shall be known as A for the purpose of this document. In our first session together, included in the contracting, was a discussion around case studies and verbal permission was given for our sessions together to be used. To date we have had ten sessions together with a view to end after two more. This case study looks at the initial presentation of the client, key movements in sessions and evaluation of where the client is currently at. The client presented as polite, confident and well-spoken and conveyed issues with low mood, difficulty sleeping, anxiety and low self esteem. The client talked of losing a Grandparent within the last year and his Father at age nine that he had seen every other weekend. The client did not come with any specific goals other that to alleviate the issues stated previously. He arrived for his first session accompanied with his mother, both were smartly presented and polite. A is of medium height and slight build and looks quite young for his age. The counselling sessions took place within an agency providing free counselling for young people aged between 12 and 25 and the client attended every session. This client has been taken to supervision on four occasions.

At our first meeting A struck me as a well brought up young man with good manners and respect for others and I immediately felt that I was given respect as his elder and as a female and that he was on his best behaviour at this point. The power dynamic was very evident in the room and there was a sense that this felt like a meeting with a teacher or a doctor etc. and nervousness around how this encounter may differ. There was a sense that there was a child sat opposite me despite the learnt polite behaviours demonstrated. A sat with an open relaxed pose but readjusted himself in the chair regularly. As I began the session with ‘what has bought you to counselling’ he began with a heavy sigh and muttered that he did not want to say too much too soon. There was a sense of holding everything together, not to lose control and become vulnerable and trust me too soon, it was as though this had been a thought process before the session and this was a reminder to himself. As A began to talk he demonstrated a deep thought process around the distress he felt and he was able to articulate and talk freely about his thoughts and experiences. I felt a tightness across my chest as he talked of the loss of his father and grandfather, there was a heaviness in what he was saying but not in his body language. There appeared to be a real disconnect between his experiences of loss and any emotion or the distress that he described, that they were irrelevant really.

At this point I experienced a lot of warmth for my client. I was aware of the desire to mother him and took this to supervision as I felt that A to wanted me to mother him. That if I had of offered advice he would have taken it but that this would lead quickly to a reliance I was unable to maintain and not offer any long term relief from the anxiety he was experiencing. At times I felt a frustration towards my client from a sense that some of what he was saying was forced and the motive behind what he was sharing was to hook me in or to maintain the connection or to appear how he perceived I was expecting him to. I wondered early on in our sessions whether his father had mental health issues and had past away due to suicide and considered whether A repeatedly labeling himself with depression and anxiety despite no diagnosis or contact with a doctor was an unconscious effort to connect with his father in some way. I considered whether this was an attempt to fill the gap in his identity left by an absent Father and many unanswered questions.

A described himself as being 18 now but not feeling or knowing how to feel like a man, as though something was missing. The word proud was repeated when he spoke of how he wished to be viewed by his significant others and the motivation behind his behaviours. He described his efforts as unseen and as relentless. A displayed emotion evident in his face and body language and verbalized his discomfort of sitting with the feelings saying he felt exposed and was desperate not to cry as he smiled and giggled nervously. When I challenged the issue with crying I was told that crying is a weakness.

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