Counseling Aashita

7/31/2019 Counseling Aashita

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AN

ASSIGNMENT ON

COUNSELLING METHODS OF ORGANISATION

ORGANISATON SELECTED- AUSTRALIAN INSTITUTE OFPROFESSIONAL COUNSELLERS

CASE SELECTED- Counselling an Adult with an Intellectual Impairment

SUBMITTED TO SUBMITTED BY

Ms. Megha Aashita Arora

Lect in Counselling skills for managers Roll No. 35

9th Semester

07-UD-1135

INSTITUTE OF MANAGEMENT STUDIES, KURUKSHETRA UNIVERSITY

KURUKSHETRA


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The following counselling was done on Simone when her co workers witnessed changes in her

behavior. The case goes as follows

Introduction

Simones Employment Support Worker has arranged for her to receive counselling, with herconsent, to assist her day and residential service provider to ascertain the cause of her recent

behavior change. Staff have observed that Simone is increasingly lethargic and withdrawn. An

assessment by her GP eliminated any physical cause. The GP noted that while there was no

evidence of depression, Simone seemed to be "troubled about something" and referred her to theCounsellor. Despite attempts from staff and Simones family to help Simone express her feelings

and concerns, Simone continued to quietly deny that there were any problems.

Given that the purpose of the session was to assist Simone to identify her concerns so that herservice-provider could then address the issues, no distinct therapeutic approach was used. The core

conditions of counselling were applied, for example; empathy, unconditional positive regard, and

respect for the client to foster a secure and comfortable counselling environment in which theclient could safely explore and express her concerns.

The Counsellor utilised a visual language system to achieve the counselling goals. These

communication systems are often used with people with intellectual impairments where their

ability to understand pictures exceeds their ability to understand verbal expression. Various formalvisual systems exist. The Counsellor chose to use Picture Communication Symbols (PCS) to

represent the key questions.

For ease of writing, The Professional Counsellor is abbreviated to C.

Case Information

Simone is a 22 year-old female with a moderate intellectual impairment and spina bifida. She has a

visual impairment so appropriate sizing of the PCS was essential. If the symbols were too small,Simone would not benefit from using them as visual prompts and in addition may become

increasingly distressed by her inability to clearly identify the symbols. Given Simones reported

resistance to expressing her concerns, it was important that C did not create conditions that wouldfurther increase her anxiety and therefore her unwillingness to disclose.


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C visited Simone at her day service so as to conduct the session in a familiar environment in an

effort to reduce Simones anxiety.

Session Details

The session was scheduled for 60 120 minutes. Given Simones recent lethargy, C and

Employment Support Worker discussed, at the time of scheduling, the option of one 60-minute

session and a subsequent 60-minute session, at a later date, if required.

Alternatively the option of one two-hour session was also discussed in the event that Simonewished to "get everything off her chest in the one go" and provided that her energy levels allowed

this.

Session Summary

Stage 1

Simone had received counselling previously and was aware of the counselling format and her

rights as a client. C therefore started with open and simple questions to establish rapport andengender client trust; for example "Laura (the Employment Support Worker) tells me that you are

a very good artist. Tell me about your art work", and "Tell me what you like to do when youre notworking".

Stage 2

Once Simone appeared to be comfortable with communicating with C, C asked Simone if she

knew why Laura had arranged the appointment. Simone accurately indicated the reasons so C thenproceeded to introduce Simone to the visual language system.

Stage 3

Each of the following symbols were presented and Simone was asked to identify each emotion.


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Simone accurately identified each. C noted that Simone used the word "mad" rather than "angry"and so altered her terminology accordingly so as to work from Simones familiar language system.

Stage 4

C then drew a picture of a house and explained to Simone that "We are now going to look at your

home (pointing to "house" picture). What makes you happy (pointing to "happy" symbol) at home

(pointing again to the "house" picture)."

Simone immediately began identifying what she enjoyed about her home life so it was not

necessary for C to use additional prompts or even personal examples such as "I feel happy at home

when Im playing with my dogs".

Each emotion was progressively targeted in the same way. Simone struggled with identifying "sad"

aspects so C prompted her with "See if you can tell me two things (holding up two fingers) that

make you sad at home". As Simone identified the first aspect C had one finger remaining tovisually indicate that Simone needed to identify "one more". Using this prompting process, Simone

then proceeded to identify more than two aspects.

Stage 5

C then drew a picture to represent "work" and the process was repeated, with Simone progressively

identifying the aspects of her work that elicited the various emotions.

Stage 6

The final stage of the emotion sorting process was to identify Simones feelings towards her life in

general. C drew a picture to represent "general" with Simone responding to the following

questions, "What makes you happy?", "What makes you mad?", "What makes you sad?" and"What makes you scared?". This step was useful in not only identifying additional factors but also

in reinforcing issues that were earlier identified.


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Stage 7

Simone was asked if she had any additional feelings or thoughts that she wanted to share. She told

C that she had "got everything off my chest" and that she felt "happy now". Simone was requiredto return to work following the session so C facilitated her through deep breathing and

visualisation techniques to clear her mind and restore her energy levels after a lengthy (2-hour)session.

Outcome

Simone had consented to the release of a report to Laura. The report contained Simones responses

and a number of subsequent recommendations. Included in these recommendations were the

following-:

1. Development and rehearsal of a visual prompt card representing Simones "Helpful Hand" so

that she can self-manage an appropriate response when something is troubling her. An example of

the "Helpful Hand" is shown below-:

The Helpful Hand is a laminated card that the client can carry with them at all times and provides

direction as to who they can speak to with regards to various lifestyle issues. This also assists the

person with an intellectual impairment to maximise their privacy as it directs them to the most

suitable person/s to talk with about particular issues.

Each finger on the hand represents a different person that the client can talk to. Pictures, or text,

can be used to represent what issues the client can talk to that person about, for example Simonemay have "Mum and Dad" on the first finger followed by a symbol representing "anything". Laura,

her Employment Support Worker, may also be on the hand with the "work" symbol following her

name. It is important to not put too much information on the hand or it may become confusing for

the client and therefore ineffective. A simplified method would simply be to put a name on eachfinger as people the person can talk to about anything, without distinguishing between the types of

issues. Professional persons such as "The Police" and "My Counsellor" can also be included in this

way.


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2. Implementation of the problem-identification and problem-solving sequence (also known as the

"newspaper formula") to assist Simone to effectively communicate her concerns.

Problem-Identification: This involves prompting Simone to sequentially answer each of thefollowing prompts which will enable her to give a thorough explanation of her concern -: When,

Who, Where, What, and Why.

Problem-Solving: Once the issue has been identified the same method can be used for identifying

solutions.

Verbal prompting may be sufficient however a visual language system (ie. pictorial representation)

could be utilised to further enhance Simones understanding. An example is shown below however

this could be modified to be more age appropriate.

Conclusion

The goal of counselling in this instance was to simply identify the issues. No formal therapeutic

model was therefore utilised as "treatment" of issues was not required. Should Simones service-

provider pursue counselling to assist Simone to deal with the issues a Cognitive-Behaviouralapproach would be employed.

The emphasis of the counselling session was on the organisation and expression of the client's

feelings. Given the client's reported reluctance to share this information with familiar others andthe presence of an intellectual impairment, it was important to utilise a method that was easy for

the client to understand, non-threatening, and provided concrete prompts to help her to categorise,


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and hence express, her feelings. The visual language system satisfied this criterion and effectively

achieved the counselling goals.

Additional issues associated with providing effective counselling to people with disabilities, ashighlighted in the case study, include:

A. The use of familiar language to assist understanding and encourage participative

communication exchange (for example "mad" rather than "angry");

B. The use of concrete language systems to facilitate the client's identification and expressionof issues (in this case PCS);

C. The accommodation of attention span and energy levels in scheduling the duration of

sessions;D. The inability to use the Personality Needs Type Profile and other non-standardised

assessments as a source of needs analysis and goal planning; and

E. The benefits of counselling within a familiar environment to reduce client anxiety

Documents

Counseling Aashita