COU102: You are working as a counsellor in a private counselling practice Penelope, 30-Year-old  graduate student who works full-time as a psychologist: Introduction to Counseling Case Study, Singapore

Case Study 1

You are working as a counsellor in a private counselling practice. Penelope, 30-Year-old  graduate student who works full-time as a psychologist, had come to seek counselling of her  own accord. During the first session, she shared that she had recently experienced a difficult  breakup. She has not been eating and sleeping well. Her mother had commented that she has  lost a lot of weight.

Some of her colleagues had asked her if she was alright as she has been observed to be sleeping at her desk frequently. Additionally, she had not been going for lunch breaks.

Penelope said that she prefers to stay in the office during lunch breaks to work on her reports.  Her boss had spoken to her during the last appraisal meeting that if she keeps up her good report writing, he would promote her within the year and would give her more training opportunities.

Penelope mentioned that she keeps to herself at work and in school because she thinks that nobody would understand her. In addition to her feelings of sadness due to her recent breakup, she talked about how stressed and anxious she feels about her graduate thesis. She said, “I’m a failure and I will never make it in the industry because my colleagues and supervisors are so much more experienced than I am”.

She was also afraid of disappointing her professor if she was not able to maintain an A average for her Master’s degree, which she had been doing so for the past year. When probed, she told you that her professor had mentioned in class that she is proud of her ex-students who had managed to maintain a B+  average as she knows how challenging that is.

Nearing the end of the session, Penelope told you that ex-boyfriend, Darren, was seeing a  counsellor in the practice which you were working in. She asked for his counsellor’s name and if she could speak to the counsellor who was seeing Darren as she wants to find out how he has been and if he has been telling his counselor the ‘real’ story about their breakup.

a) List FOUR (4) key assumptions in working from an approach using Cognitive Behavioural  Therapy (CBT).

b) Provide a brief description of the Cognitive-Behavioural Therapy’s “Four Domains”  assessment framework. Demonstrate your understanding of this framework by using it to assess Penelope’s case.

c) Describe how you would challenge THREE (3) of Penelope’s negative beliefs using  “Socratic Dialogue”, and craft THREE (3) realistic and healthier beliefs that might arise from the challenges.

d) Identify the ethical dilemma and issue presented in this case. State and discuss your stand with regard to the ethical dilemma. How might you explain your stand to Penelope?

Case Study 2

You are a counsellor working at a counselling center. Susie, an acquaintance whom you have  met during a recent conference has referred her best friend, Joe to see you.

Joe is a 38-year-old teacher at a secondary school. He has been under a lot of stress at work  lately due to changes to the curriculum and the recent merger with another secondary school.

Joe is a hardworking teacher, and is very well-liked by his students and colleagues. The Vice- Principal of the school has suggested that Joe take on more responsibilities as Joe is on track  towards becoming a Head of Department in the near future.

When Joe was in the Army, he had bouts of pain attacks and was seeing both a psychiatrist and a counsellor. He has not had a panic attack since he was 22 years old. Joe’s sister was diagnosed with social anxiety when she was in her teens. Joe’s parents are business owners, and are currently living in Hong Kong on their own due to the management of their business.

Last month, Joe’s father suffered a stroke. He is currently recovering well but Joe continues  to be extremely worried. His mother has asked Joe to quit his job, and to move to Hong Kong  to take over the business. He has been having quite a few sleepless nights due to his dilemma.

Joe talks about his feelings of sadness when he thinks about having to quit his job due to his  family commitments.  Joe shares with you that he frequently feels his heart-rate increasing and occasionally, he has  difficulty breathing. He further shares that he is fearful and anxious that he may experience  panic attacks again. In particular, he does not know how to de-stress and that he has absolutely no time to do so. He spends his weekends working, and he rarely goes out with his  friends.

This morning, Susie emailed you to ask about Joe’s well-being and if Joe has made a decision as to whether he is quitting his job. Susie said that Joe has not been replying to her text messages and she is concerned, thus she is writing to you.

a) Demonstrate your knowledge of case formulation by describing TWO (2) of Joe’s presenting issues, THREE (3) perpetuating factors and TWO (2) predisposing factor of his issues.

b) Suppose that while working with this client, you find yourself reacting to the client as you had reacted similarly to your brother in the past. Explain this unexpected occurrence in the session, and describe how you might manage it after the session.

c) With the Cognitive Behavioural Therapy’s core conditions in mind, how would you conduct yourself in counselling sessions with the client? Illustrate your answer with specific  examples.

d) Identify the ethical issue in the case study. Explain how you would respond to Susie by  applying the ethical principle of fidelity.

Case Study 3

Mr Lim, aged 35, has been experiencing emotional and behavioural problems in different  areas of his life.

on the work-front, Mr Lim works as a Primary School Teacher. Over the last six months,  there have been several complaints from the student’s parents, stating that Mr Lim would lose  his temper and shout very loudly in class whenever students do not follow his instructions.

There were also occasions when he would hit the whiteboard in the classroom very hard to  vent his anger and frustration, and such behaviours greatly frightened the students. Even Mr  Lim’s colleagues noticed that Mr Lim’s temper has been rather explosive during the last six  months, especially during examination marking periods.

On the home-front, Mr Lim has been married for five years and he and his wife, Mrs Lim,  have two children, aged 4 and 2 years old. Mrs Lim has reported that Mr Lim likes to argue with her over small things, and she also mentioned that Mr Lim has been making rather personal remarks such as, “What kind of mother are you!

You are a terrible wife! These remarks were made especially when things at home were not done according to his standards,  and they have greatly saddened Mrs Lim. Mrs Lim also reported that there were several
occasions when Mr Lim would shout and even slap her when she did do what he wants, such  as household chores and cooking meals.

a) Imagine you are Mr Lim’s counsellor, use the A-B-C Theory of personality functioning to  explain the emotional and behavioural problems that Mr Lim is facing.

b) Imagine that you are Mr Lim’s counsellor, develop TWO (2) suitable therapeutic goals  you would like to work on with Mr Lim.

c) Imagine that you are Mr Lim’s counsellor, develop TWO (2) Cognitive and TWO (2)  Behavioural interventions you can use to help Mr Lim with his emotional and behavioral problems.

Case Study 4

You have been assigned Sue’s case. Sue is a 21-year-old undergraduate student. She was  referred by her concerned mother for counselling. Mother has shared that Sue has been  increasingly negative recently, e.g. She would call herself “stupid”, “worthless”. Mother also  shared that recently, she has been hearing SUE purge herself secretly in the bathroom after  eating occasionally, and this has happened in the past when Sue was in secondary school.

Sue’s father passed away six months ago unexpectedly due to a heart attack. Sue was alone at home with her when it happened.  You met with Sue and she shared multiple concerns of her own. She talked about how stressed and anxious she feels most of the time when she attends classes, and when she does assignments at home. She shared that since primary school, she has always been worried and stressed about her academic performance, and how her grades are only “mediocre”. She sees herself as a failure and said that no matter how much effort she puts in, she “never does well”. You found out that she has an average grade of A- and is ranked in the top 5% of her  class.

Sue also shared that since her father has passed away, she feels most comfortable keeping to  herself in the room. She feels safe there as she could stare into space and could cry whenever  she wants to, as much as she wants to. She does not enjoy the company of her friends  anymore, and she has stopped dancing. She has been a ballet dancer since she was seven, and was on her way to becoming a professional ballet dancer.

When you tried to explore the purging behaviours, Sue said they never happened and her  mother must have been mistaken.  When you explored Sue’s experience of her loss of her father, Sue Looked at you blankly and
said she could not remember what had happened on the day her father passed away.

She talked about her father fondly and shared how her father had been her inspiration and strength all these years. Sue has been climbing into her mother’s bed in the middle of the night on many occasions, claiming that she is scared to be alone.

a) In the case study, Sue presents with multiple concerns. Identify TWO (2) key counseling issues and provide justifications for your answers.

b) Identify THREE (3) of Sue’s defense mechanisms illustrated in the case and provide explanations for your answers.

c) Demonstrate your understanding of the cognitive-behavioural technique of Socratic dialogue by providing a brief definition and highlighting the key aim of this technique. Give  TWO (2) examples of Socratic questioning you may use in your work with Sue, and explain how may help Sue.

d) Evaluate the limitations of solely using cognitive-behavioral techniques in working with  Sue, and propose how many create a more holistic intervention plan for Sue.

Case Study 5

Debbie is a 45-year-old lady who is going through a mid-life crisis. She is feeling depressed,  has insomnia and frequent crying bouts. She is stressed because her 70-year-old father had a  severe stroke half a year ago. He cannot move most parts of his body, and is bed-bound. She  is an only child, and her mother passed away three years ago.

Debbie is the main caregiver for her father, and is facing caregiver stress. She hires an  Indonesian domestic worker Siti, who helps her care for her father while she goes to work. As she is a very private person, she does not have many friends. She has one or two close friends whom she confides in.

She will benefit from practical and social support from agencies such as TOUCH Home Help or Hua Mei Mobile Clinic Services for her father, as she is rather socially isolated and feels lonely, physically and emotionally drained by the care that her father needs.

In the last few months, Debbie has been facing a lot of work stress and feels she is near breaking point. She is very hardworking lady who pushes herself very hard, working as a  Human Resource Manager in a small-medium enterprise. She often does not practice enough self-care as she often skips meals, works late into the night and does not exercise.

She likes attending concerts, listening to music, and gardening but has neglected these hobbies in recent months due to her father’s chronic illness and her heavy workload.  She is fortunate that she has a very supportive boss as the Chief Executive Officer of the company.

He is concerned that she may slip into clinical depression, and has asked her to meet you for counselling. He believes that she should have better work-life balance and better self-care, and he spoken to Debbie about it. Debbie wants this too but does not know how to attain it. She is open and willing to attend counseling. You work as a counsellor in a counseling center and will be counselling Debbie. The company will pay the counseling fees.

a) Using a Cognitive -Behavioural Therapy approach, state how you would apply Ellis’ ABCDE model to counsel Debbie as her counsellor.

b) What would be FIVE (5) co-created goals that you would set with her?

Case study 6

You are a counselor in a family service center and you are the assigned counselor for Casey.  Casey is a 66-year-old woman who lives alone in her one-room rental apartment. Last week,  you went to visit her on a home visit and had gathered the following information.

Casey has been living alone for the past six years since her husband’s passing. Casey receives food rations from the family service center and hence, she does not see the need to leave the house to shop for groceries. She keeps to herself because she thinks that nobody would care about an elderly woman like her and that she is better off being alone.

When you tried to ask her more about this, you looked at Casey and asked, “Why are you  looking so sad?” Casey mentioned that she does not know how to maintain friendships and she feels lonely at times. Her friends had told her in the past that she does not listen and that she cannot hold proper conversations without making the conversations about herself.

There were times when Casey had said hurtful things to her friends even though she did not mean them. Her friends had been angry with her since, and had mentioned that they would not visit her until she apologises. To this day, Casey thinks that she has done nothing wrong and she does not want to apologize to her friends.

a) Your supervisor has asked you to read up on relevant research to aid you in the selection of evidence-based approaches for your work with Casey. Identify this type of research and discuss its role in the field of counseling. Provide an example of a hypothetical research paper that would aid you in your work with Casey.

b) Identify TWO (2) defense mechanisms that Casey has exhibited. Describe these defense mechanisms and state the supporting evidence from the case.

c) In your conceptualization of Casey’s case, identify any THREE (3) perpetuating factors that are currently maintaining her problematic situations. Describe the Cognitive  Behavioural intervention techniques of “Socratic dialogue”, “Skills training”, and  “Homework tasks” and illustrate with specific examples how you would help Casey to address these perpetuating factors by employing a different technique for each of the perpetuating factors. (18 marks)

Question 6

Examine your own motivations and readiness in becoming a professional counsellor using the  concepts taught in the course. Your answer needs to incorporate analysis, insight and self- awareness, as well as understanding what are the key needs you are trying to meet and how  ready you are in this process of becoming a professional counsellor.

Question 7

a) How can counselors be mindful of the need for ongoing self-awareness and growth in their development as a counselor? List and elaborate TEN (10) ways they can develop continuous and going self-awareness and growth.

b) In a case where a client is seriously considering abortion, and your personal and religious values conflict with the client in that you have a pro-life stance. You feel that it is better for the client to keep the baby or give up the baby for adoption.

Discuss the five ethical principles and examine how you would employ these ethical principles to guide you as a counselor, in deciding how you would deal with issues that arise during the process of counseling the client on the topic of abortion.