Demonstration of Empirically Supported Counseling Procedures

Suicide Counseling Session

For confidentiality purposes, recording of names will use abbreviations where CLR will represent Counselor/ Therapist while B. will represent the client.

CLR:Welcome B. to our first counseling session. My name is T. and I am happy to meet with you for this session. I look forward to working with you until the therapy is completed, and I’m sure we will be good friends as time goes on. I referred to you as B. because that is what the receptionist told me about your name when sending you in; am I free to call you by that name or you would like me to use another name during the sessions?

B:I am Ok with that. Most of my friends call me by that name.

CLR:Good progress, I am one of your friends from now on, aren’t I.

B:Yes you are.

CLR:Are you comfortable in this room before we begin, or should we find another place for our discussions?

B:I’d prefer that we are not heard by your colleagues in the other offices.

CLR:Nobody can hear what we are saying from outside, as you can see, there is no one near the windows and the door is locked. Just as you can’t hear what they are saying, no one can hear what we will discuss. If you are not Ok with that, we can find somewhere else. Let me see what we can do (standing to look for another place).

B:No. In that case we can use the room. It is only that I don’t want people meddling in my life anymore. I am Ok here.

CLR:I understand what you are saying. I assure you it is going to be safe here. Is there any other concern that we can handle before we proceed?

B:No.

CLR:Good. B, it is important that you become aware of a few session regulations. First, we will be following a timetable kind of a schedule that I will hand to you when we meet next. Secondly, we will observe time since we have a maximum of thirty minutes for a day’s session, unless otherwise stated in advance. Thirdly, professional code of conduct regulating counseling dyads restricts our relationship to purely professional purposes. Fourthly, we shall be guided by the principle of confidentiality throughout the therapy and nobody should be aware of what we discuss. I like the fact that you observed that we need to have a private environment where nobody hears what we discuss. Other regulations will be communicated in bits during our coming sessions.

B:Does it mean that I cannot ask for any favor from you outside my case questions.

CLR:Precisely! That’s right. I case there is a favor that you need from me, just ask and we will discuss if it will compromise the professional and client duties that we need to observe for the sake of the therapy’s success. Don’t hide any detail if we can discuss and clarify things out. I like your attitude in this matter and I promise you my assistance in the session. Is everything clear form there, B?

B:Yes. I appreciate your information. I have not been in a counseling relationship before.

CLR:Welcome. B we are now into the main agenda of the therapy process. First, I need to know the details of your challenge in your own words. Please feel free to tell me what has put you in the state that you are in now that you need professional help. Continue please. (Creating eye contact with a pen and paper to write important facts)

B:I have a problem with my family. Every body thinks that I am insensitive and careless in what I do. Many bad things have happened and I have been blamed by every one. Even those who don’t blame me don’t come to my rescue. My performance in school went down and I felt unwanted at home and at school. I thought it was time that I put this to an end once and for all. I wanted to take poison but my brothers found out from a suicide note that I had written and they reported me. That’s why my mother brought me here.

CLR:Wait a minute B. Sorry for that. That was too quick to make a decision, don’t you think so?

B:I think so. But I have my point to every one.

CLR:Can you tell me what bad things happened?

B:At one time, I was left at home alone because I had a cold. Everyone went to school and others to work. I went out of the room and forgot to switch off the heater and it caused a fire that nearly burnt our hose. Our neighbor’s gardener was quick to help me switch off the power and call the fire brigade. We called our parents and my mum was very mad at me like my elder brothers. My late dad calmed them down but they keep on mentioning it to me that I burned our living room and family treasures that were there. It is painful.

CLR:Sorry for that, B. Are there more bad things?

B:That is the main one. But there is another one. I went to walk our best dog, Milo three years ago, alone and I was still small. Unfortunately, I met two stray dogs on the road that usually met on other days without a problem. That day they got at me and our beautiful Milo, they attacked him biting very badly. I could only manage to pick him and rush him back home. It had cost our family so much money and it was very like. I called our parents from work. My dad came and he was angry at me and asked me to get in the car to take Milo to the animals clinic. He bled profusely on road and unfortunately died shortly after being placed on treatment. I cried and my dad consoled me. He understood it and promised to buy me another dog on the way home. We bought another dog that I named Milo but the rest of the family was not happy and painful memories of the dog’s death are blamed on me. Any security breach in the compound is directed at me since Milo was always alert to keep guard.

CLR:Any more bad things.

B:No. Just the events that crop from the blame placed on me.

CLR:Tell me whether this is what you are precisely saying; that you feel that the blame for the two mistakes and possibly others make you feel like everyone is on your neck.

B:Yes. This is not because I am not responsible but because they blow everything out of control. They make me feel like I am always walking on shells.

CLR:Give me your family background.

B:I have three elder brothers and sister younger than me. My dad passed away tow years ago. I felt like I lost a close family partner since only my dad understood me. Everything is unbearable since the demise of my dad. I miss him so much. (Sobbing)

CLR: I understand how you must be feeling. I am sorry for everything that has been disturbing you. (Leaning forward, hands a soft tissue paper to the client for wiping tears)

My closest friend had a similar challenge in his family when his dad died and felt that the rest of the family was incapable of fitting in his shoes. This happens when we are faced with loss and the grieving is shifted to the worries of the environment around us. I am sorry for the loss.

B: Thank you. From the bitter treatment that the family has given me, particularly from my mum and my brothers, I have been affected in my studies. I was an above average student but since then my performance is very wanting. I was almost discontinued last semester on grounds of poor performance but my previous performance assured the school management that I can turn things around and I got a second chance. I am afraid that my family background is not likely to improve. Every time I go back home I resume my troubles and I feel unwanted in this conditions. Nobody is concerned about me at school either. Since my dad’s death, I don’t have a personal mentor at home. (Sobbing.) All I have are enemies in disguise of family members (sobbing).

CLR:Sorry for that. Things will be different now. Could you tell me what was contained in the suicide note? Tell me what you had written, if you don’t mind.

B: Of course I don’t mind. It was a short note. I had stated that my school performance was embarrassing me and that my family was responsible for not giving the support and love that I needed. I also had included the death of my dad as a big loss that I cannot continue with in my life.

CLR:I want to add the other rule at this juncture concerning your suicide thoughts. It is terribly wrong for any one to think and attempt to take someone’s life. Including your own life and it is punishable by the law. B, I want you to understand that everyone is protected by the society that we live in as a custodian of our rights, the basic one being the right to live. In such cases, when a counseling client insists that they want to take their lives, we are under duty to report them to the authorities, thereby breaking the principle of confidentiality. I will continue asking you in the therapy sessions whether you still hold the suicidal resolve in order to clarify if I should report you to the police. What can you say about that?

B:Oh no! I don’t want anyone to be told about this. It has caused me enough trouble at school and home. I hate myself for being too harsh on myself. But I am confused. I am sorry and I beg you not to report me.

CLR:That is very positive to hear from you. I know what might be going on in your mind. You feel that everybody hates you. Do you think that your classmates hate you?

B:I have lost all of my friends because they don’t want to be associated with my failures. They make fun of me for failing in class. It is painful since most of those that make fun of me were not better than me.

CLR:Neither are they better than you now. It is only that you are undergoing three difficult situations. You are affected by deteriorated school performance and it appears you are affected this much because you are a performer like we are going to see. Secondly, the poor family relations are affecting you such that the environment is unsupportive. The third challenge that has been affecting you is the loss of a parent who appears to be your mentor and close friend. This is called attachment where a child feels specially attached to one family member or parent than the rest. We will address each of these at a time to assist you in finding a reason to avoid suicidal thoughts that rise form these challenges.

B:Does it mean that my performance will improve and I will feel love at home?

CLR:With your cooperation, that is very possible. How do you relate with your classmates.

B:I hate them. They laugh at me because they heard I wanted to commit suicide due to poor performance.

CLR:I would also like to put across an important remark that might assist us in finding a different perspective to the challenge ahead of us. Human beings have a very complex feelings perception and responses, particularly when dealing with the environment that they are dealing with. Both bad and good feelings from the environment are processed in our brains in various ways. In a counseling perspective known as rationale emotive therapy, clients’ minds are opened up to point at their defective thinking and they are assisted to think positively. In fact, every human being is capable of retreating into negative thoughts to think that they are hated, they are stupid and they are unlucky or doomed. Through a little intervention targeted at the wrong mindset, therapy achieves success that enables them to view themselves positively once again. Using negative descriptions for example, hate, don’t, foolish among others; it is very possible for us to retreat into our own negative perceptions. This is inflated into more serious problems such as suicidal thoughts. I think part of these challenges is contributed by that. If I may ask, what would be different if your dad will be alive today?

B:Things will be very different. I would be feeling his love. He was different from every one else in the family. When he died, I cried for several days alone in my room. No one felt that much pain. They told me to stop crying because I was making them sad. So I hid from them to cry. I still feel like it was worse for me than all of them. (Sobbing)

CLR:Sorry for that. (Handing soft tissue)

It is important that you feel free to cry out that feeling. Crying is important in overcoming loss and grief. There is a healing process that every body is supposed to follow without prematurely terminating the process in between the stages. Anger, denial and confusion make up some of the feelings that every client should time to come to terms with. There is nothing wrong with crying as long as you come out of it having known how to deal with the fat that some one you loved is gone and will never come. Moving out of anger may take time if one does not accept the facts of the loss. But with the cooperation that you have demonstrated to me, I am sure you will be out of that state. It happened to my closest friend like I had said before and I had to assist him with all my heart. I am ready to help you also since we are already friends. Aren’t we? (Smiling)

B:Yes we are. I will appreciate your assistance.

CLR:I appreciate that you are young and you have a lot of potential to make some of the discussions we will be having fruitful. I almost forgot but as we wind up, tell me about your relationship with a close person outside your family, like a boyfriend or a very close relative that you share your inside world with.

B:Honestly, I don’t have a boyfriend at the moment.

CLR:That means you had one before?

B:Yes. And we broke up.

CLR:When was that?

B:Exactly a year ago.

CLR:How long did the relationship last?

B:For slightly over a year.

CLR:What happened till you broke up, if you don’t mind?

B:He could not understand me in my difficult moments. He thought that I was oversensitive and I thought he was mean to me. Later I learnt that he was seeing another girl. I let him go.

CLR:And you can be honest that it hurts.

B:Exactly. But I don’t want to talk about that since I have had other serious issues than him.

CLR:Would you have him back, or get in another relationship?

B:With him again, no. I don’t think I am ready now for a relationship.

CLR:Ok, B. It is good to take time off. How about a close relative like an aunt, cousin or somebody else?

B:There is no one closer than my dad was. I don’t have any one to talk to.

CLR:I understand your condition because I also had nobody to talk to. But my social problems became lighter when I started to open up to a friend. A girl came into my life and she has been with me all this time. I hope that your relationship life is also affected due to the fact that there is difficulty in expression of inner feelings. We will work on that too, don’t be worried B.

Empirical Explanation of Interventions

Preparations, Techniques and Theory

Every therapist must take charge of a counseling session and making some rules known to the client is perhaps the first move to thump authority in the session, creating some order in the meetings. This is important at the preparatory stages for future sessions just in case clients become rowdy in the sessions. It is also important that the client is made comfortable with the environment in which the sessions will be taking place. Alternative locations should be made available for the client to choose from, if they are not comfortable with one of them. This is the reason why the client is made aware of the safety of the room since it was her main concern. The rules are also illustrated in the beginning of the session, which establishes the session’s standard based on safety to open up and maintenance of order assured too. According to Loesch and Vacc (2000), preparation for a session must demonstrate the professional duty that the counselor has for the client.

It is important that the professional obligation is important in the entire therapy period with particular emphasis on the counseling dyad features and the duties of each of the parties to the dyad. Similar session preparation information is contained in the work of Clawson, Hernderson and Schwieger (2003) to the effect that the counseling sessions must be prepared within the professional obligation perspective. Professional responsibilities of the counselor are more important since the counselor has to follow the expected professional code of conduct. Reminding the client about duties such as confidentiality and counseling dyad relationship regulation makes an important contribution in the establishment of the initial counseling setting (Fagan, 1966). When the client understands the responsibilities of the parties within the guiding professional framework, it is easy for the therapist to identify various interventions needed in the process.

Perhaps the most important preparation stage regarding the therapy itself is based on the requirement to have the client give their own account of the story all over again even if it might be reported at the reception in bits such as names. Understanding the client’s historical and family background should be established in the first session in order to assist in diagnostics and detecting the actual case presenting challenges. This is important in the formation of an understanding of the client’s challenge, which assists the therapist to find the appropriate techniques for the therapy, which are founded in theoretical approaches (Nelson-Jones 2005).

A number of counseling techniques are applied in the session in order to capture various interventions as guided by theory. Therapists are guided by counseling techniques in order to manipulate theoretical tools in driving the therapy process towards a certain desired end. The client may be informed at some points of the technical application if the therapist feels that the client will understand and related well with the technicalities of the therapy as applied. Using one technique is inadequate since there are several interventions that the client needs for the presenting challenges.

Firstly, the session applied eye contact technique from the beginning of the client’s narration, since the therapist needed to establish some communication agenda. Eye contact is important in therapy as it enables the therapist to demonstrate the importance of the client’s narration. By shifting eye contact, a client may get the perception that their story is not important to the therapist (Geldard and Geldard, 2008). This is a form of communication tool that the therapist uses to enhance trust in the client that they are important in the sessions. By establishing trust through communication signals, the sitting position is important to the therapist. Observing the sitting position of the client and gestures enables the therapist to manipulate the techniques in order to bring the client back into the session with all the attention. This is important for the therapy.

Additionally, as mentioned before, the client’s sitting position is a useful cue in determining the level of concentration in the therapy but the sitting dynamics for the therapist are important too. In the session, the therapist is reported to be leaning forward towards the client in an emotional episode whereby another action is also facilitated by handing a soft tissue to wipe off the tears. This is important in the demonstration of understanding the client’s emotions and moving towards assisting them further creates an important communication impact. Brown (1957) reckons that communication for emotionally disturbed persons should be handled sensitively, which is done by offering tissue sends an image of being cared for, especially for a sensitive client who has negative ideas of being under the threats of others other than their care and love. Trust is eventually created which is important in the development of therapy foundations.

Alternatively, facial expressions such as smiles being spread throughout the therapy are important in changing the mood of the client in order to manipulate and invoke further important developments of the session. Gestures such as nodding may be used to enhance this perspective which moves the attention of the client from one mood to another. Invoking humor may complement the mood changing aspect that is very important in communication during the session (Nelson-Jones, 2005). Furthermore, probing and questioning the client in an attempt to reveal details of their feelings and case facts is important in formulation of conclusions. Without asking the necessary questions to the client may prove to be prejudicial and judgmental in end, since conclusions may be made on wrong facts about the client. This is important in alleviating biases and wrong conclusions, which is human and inherent in many decision making processes. Wrong conclusions are avoided by paraphrasing the client’s statement in the session, in order to clarify areas of misunderstandings (Sanders, 1996). In addition, giving examples that the client associates with such as of a close friend and of the therapist’s own relationship life enables the therapist to further strengthen the counseling dyad relationship. Trust is built when a client understands that the therapist is willing to share their own experience in dealing with the client’s challenge. Use of sympathy and empathy is important on the client’s perception about the process.

Theory

There are a few instances of mention of rationale emotive therapy (RET) in the session which has been explained to the client since the therapist feels that the client will grasp the meaning of the technical perspective (See, 2007 and Dryden, 2003). To supplement to RET, the session applies cognitive therapy (CT) perspectives in dealing with the clients perceptions about their environment in order to correct wrong thinking regarding self worth and esteem. The application of these two perspectives is similar since the establishment of their application is based on personal thinking and cognitive behavior (Maddux

Smaby, 2011). Grief and loss therapy theory has also been invoked in the session and equally explained to the client regarding the healing process. Relationship issues relating to the client’s environment have been approached from a behavior therapy (BT) perspective which pays attention to the facts on the client’s environment and context.

Understanding the theory of suicide therapy is important in determination of how to assist clients with guilt to cope with their feelings, for instance in an environment where they feel judged. According to Worden (2003), dealing with fears that the client has for having been associated with a serious social vice must be facilitated. Confronting thinking likely to aggravate fear and feelings of rejection from the family and friends leaves the client in a sensitive perception which is almost always wrong. The youthful thinking of the client must be confronted to assist the client in shaping up their perceptions about their relationships with others (Schuster, 1999).

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