Responding to a Serious Mental Health Problem

Person-Centred Dialogues

Richard Bryant-Jefferies

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781315342566
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

This book uses narrative to describe powerfully what is happening, interspersed with the counsellor's thoughts and reflections. Sessions of supervision are also described and linked to what is occurring in the therapy. The first part of the book focuses on a client struggling to cope with her son who has mental health and drug problems. The second part describes the son's experience of entering into a therapeutic encounter after having reached a crisis point. Cultural differences are also explored. Included in this volume is material to inform the training process of counsellors and many others who seek to work with people experiencing these relational dynamics. It is intended as much for experienced counsellors as it is for trainees. It provides real insight into what can occur during counselling sessions.

The book will also be of value to the many healthcare and social care professionals who, whilst they may specialise in other areas, will find that the issues dealt with in this volume have impact on the work they are doing. For them, the text demystifies what can occur in therapy, and provides useful ways of working that may be used by professionals other than counsellors. Potential clients will also gain an insight into the process.

PART 1

A mother seeks counselling

Chapter 1

First contact

Fareeda was struggling. She knew things were getting out of hand but she could not see any way of being different. It seemed that so much of her life had been a succession of demands, and in many ways she was OK with that, it was the struggle that she felt she had with the healthcare system that got her down. At times it left her feeling so alone and doubting of what she believed, of what she knew to be true. Her faith had sustained her. Prayer had been an important part of her life as she sought reassurance and support from Allah (Arabic for God) in what she felt was right for her to do for the best for her eldest son, Ali.

She had realised some years ago that something was not quite right with her son. At first it had seemed that she was the only one to notice that he was always just that little bit louder, more intense, than his friends. She had noticed, too, how difficult at times he seemed to find it to settle down, and yet at other times he would seem so withdrawn. She could remember the first time that she had said to her sister that it seemed like he was two different people. At the time she did not really think much more about it, rather it was simply a passing comment. And yet…

As she looked back now she was so aware that in fact she had recognised something that was so much closer to the truth than she could then have imagined. The past four years had been a period of progressive difficulty; she often referred to it as like walking a tightrope, and yet not feeling able to step off it. It was as if she no longer had control over life, it was governed by whatever mood her elder son happened to be in at the time.

Fareeda was sitting at home looking at a card that a friend had given her. It didn’t say a great deal, other than the name of a counsellor and the contact details, and the fact that she offered something called person-centred counselling. Fareeda didn’t know what that was but the friend who had given her the card was quite insistent that she was good and came recommended.

The truth was that Fareeda was desperate. She wanted to talk to someone. She did not get much support at home. Her husband, Chris, Ali’s father, tended to be distant. He didn’t seem to have the same sense of family that she did. This had been, and still was, a disappointment to her, and something that she knew she found difficult. Chris also found it hard to accept and cope with Ali’s difficulties. They didn’t often discuss the situation, not in a meaningful way. Any discussion tended to descend quickly into argument, with Chris taking the view that he should be kicked out. He didn’t believe that Ali had a mental health problem, but rather that he was idle and needed to get himself a proper job and get his act together. Ali was now 19, soon to be 20, and Fareeda wondered and worried about what his future would hold for him.

It hadn’t helped that there had never been a clear diagnosis so treatment was witheld. Right the way through, the professionals had thought that Ali was simply being a teenager, maybe extreme, but nevertheless, that he would change once he got older. Fareeda had fought this view, convinced that there was something more deep-seated. At weaker moments she had wondered whether she should accept the notion that he was simply being a difficult teenager, and that maybe it was the will of Allah for it to be the way that it was, being his way of testing her. But she couldn’t feel comfortable with that. She knew instinctively something was not right, and the mood swings and the erratic behaviour remained. She knew she had to keep trying to help him.

Fareeda often spoke to her sister but she was always rather too good at giving advice. Fareeda felt she wanted someone to listen to her, not keep telling her what to do, which was often to accept things. She didn’t accept things and she didn’t want to be told what to do. She knew what she had to do. She was Ali’s mother and she had to be there for him, wanted to be there for him. Now, she just wanted someone to talk to about how she was feeling. She wanted to unload. Her friend had told her that was what she had needed when she had been to see this counsellor whose name was printed on the card that she was now sitting and holding in front of her. Her friend had been quite persuasive as to how helpful it had been to just go and unload it all on a counsellor, a stranger, someone who wasn’t going to keep giving you opinions and advice. Fareeda had thought about it. She trusted her friend, but she also was unsure as to whether she should be seeking out a Muslim counsellor. That did have an appeal, and yet she knew how much this counsellor had helped her friend – who was not a Muslim – and having someone recommended like that did somehow feel easier. She knew she had to make a decision, and the card was in her hand, and she knew she had to talk.

Fareeda reached for the phone and dialled the number on the card. The phone rang four times, there was a click and then a voice. ‘Hello. This is Carla. Please don’t hang up. I am sorry I cannot get to the phone just at the moment, but if you would like to leave your name and number I will call you back as soon as I can. If you are calling about the counselling service, please be assured that this answer machine will only be checked by me and therefore your message will be confidential. Thank you for calling.’ A tone sounded.

‘Ahm, er, hello, my name is Fareeda and I’ve been given your card by a friend who has seen you in the past. Um, I would like to talk to you about counselling. Can you call me, please …’. Fareeda gave her number and signed off with a ‘thank you’, and ‘I hope to hear from you soon’. She hung up. She realised her heart was thumping. It felt good to have made that call, like she had climbed over some kind of hurdle in doing so. She wondered how long she would have to wait.

It was later that evening that her call was returned. Carla had picked up the message on her return from her afternoon counselling session at a GP surgery. She had spaces for private clients whom she saw at home.

‘Hello, is that Fareeda? This is Carla returning your call.’

‘Oh yes, hello. Thanks for calling back so soon.’

Carla noted the accent but couldn’t quite place it. ‘That’s OK. How can I help?’

‘Well, you’ve been recommended to me and I need someone to talk to about problems I’m having with my son.’

‘Mhmm. Have you had counselling before?’

‘No.’

‘OK, well, what I would usually suggest is that we meet up for an initial session to discuss what you are looking for from counselling, and I can explain how I work and we can see whether we feel we can work together. I can answer any questions you might have. There is no charge for that introductory session and I suggest about half an hour, and then we decide where we want to go from there.’

Fareeda asked about fees and how often they would need to meet. Carla confirmed her fee and indicated that frequency of sessions was something they would negotiate. They agreed to meet up the following Wednesday in the afternoon. This suited Fareeda as it was her day off. She worked four days a week. She was a team leader at an insurance company. She really valued this. It helped to put more money into the family and was important for her. She also liked her work, the challenge of each day, managing staff and problem solving. She liked to problem solve, but she felt she was facing problems with her elder son that she had no answers to. Fareeda had not worked for periods when the children were younger, but now she appreciated the opportunity of being out of the house, although she was very aware of Ali being in her thoughts.

She also felt guilty as well, wondering whether she was giving up on her family in some way, and whether it was God’s will that she made this choice. The tension between what she felt she needed to do, and the question of what she was meant to do, was a constant one.

On a practical level, the job was also important for her because whilst Ali had worked, he didn’t contribute much. He tended not to hold jobs down for long. He hadn’t really engaged at school, seemed to lose interest in his early teens around the time that Fareeda believed his mood problems to have begun to develop, although he’d been withdrawn for a while before then. Just recently, Ali had begun to spend more time at home, in his room, cutting himself off from people, only going out occasionally in the evening. It had contributed to the tension at home and her own sense of helplessness.

Introductory meeting with the counsellor

Fareeda had rung the doorbell and was waiting for an answer. It was quite a busy street and she was glad that the driveway had room for her to park. Carla had indicated that roadside parking couldn’t be guaranteed, but that she could park in the driveway. It wasn’t a big house, but there was space for two cars. She waited on the step. A few moments later and the door opened.

Carla saw a dark-skinned woman dressed in a light-coloured suit. ‘Hello, you must be Fareeda. I’m Carla. Please come in.’

‘Thank you.’ Fareeda entered and waited for Carla to close the door.

‘Find your way here OK?’

‘Yes. I don’t live too far away. I know the area quite well. I’ve parked in the drive – hope I’m not going to be in anyone’s way.’

‘No problem. Come on through.’ Carla led the way to the counselling room, which was a little way along the hall on the right. It was a small room, with two comfortable-looking high-back chairs, a small table, a kind of primrose-yellow emulsion on the walls and a light blue carpet. The curtains matched the colour scheme.

Fareeda took off her coat.

‘Here, let me hang this up for you.’ Carla took Fareeda’s coat and hung it on the peg on the back of the door.

‘Thank you. Where should I sit?’

‘Wherever you like, whichever appeals.’

Fareeda chose the seat closest to the door. She hadn’t thought about it in that way, she just instinctively chose it.

‘Does that feel comfortable; I’m not too close or distant?’

‘No, that’s fine. Thank you.’ At some level Fareeda was grateful that Carla was taking the trouble to check this out, and also how she had taken her coat to hang it up. Little things that conveyed a sense of caring and attention, and yet they could mean so much. There seemed to be an intention to care and attend to detail.

‘So, where would you like to begin? Do you have any particular questions?’

‘Well, I’m wondering how counselling can help me. And you say that you are a “person-centred” counsellor, and I don’t know what that means.’

‘OK. Well, it’s a particular approach to counselling. Let me say a little bit about what it means.’

Fareeda nodded. She sat back in the chair a little. The focus was off her, which helped her relax.

‘Counselling, for me, is about offering someone space in which to explore themselves and become more self-aware. I hope that if we decide to work together we can create a trusting environment here in which you will feel increasingly able to be open with yourself, and with me, about what you are experiencing. The person-centred approach is more to do with creating a healthy, therapeutic relationship and for the client to then adjust to that experience, perhaps thereby questioning themselves, but that is something to emerge as and when it happens.’

Fareeda was listening. She liked the idea of space and of trust. She felt good about Carla, the way she spoke, the fact that she seemed quite relaxed and yet had a kind of professional manner as well. But she also felt that reluctance to expose not only herself, but also family issues to a stranger. Her family were Muslim and her experience had been very much that you kept problems within the family, that kin would pull together and do what was necessary to help each other. However, she had adjusted to a different way of life, to some degree, and with only her sister in England she couldn’t turn to family in the same way, particularly as she didn’t find her sister able to respond in the way that she would have liked. Nevertheless, she regularly said prayers, and read passages from the Koran most days, seeking guidance and direction as to how she should live her life. She had her beliefs, which she was comfortable with. Family was an important part of the Muslim tradition and this had certainly made a strong impression upon her. Chris, however, didn’t have that same focus. She put it down to his own cultural background and experience. And perhaps his being an only child had contributed to it as well.

There had been a sense of family, at least, it had seemed more present in the past, but things had changed, and Chris wasn’t as she had hoped and expected him to be. She was also aware that her generation was probably not the same as the previous generation, and that for her sons things were different again.

She listened to what Carla had said but was unclear about something. ‘What do you mean by a “healthy, therapeutic relationship”?’

‘That’s really at the heart of it. For me it is about my being able to really listen and hear you – the two are not the same. I want to feel affected by what you want to bring to counselling, and I want to feel able to be honest and open in my responses with you. We call it congruence, but that can sound a bit like jargon. I want to be genuine, honest, transparent, if you like, so the therapeutic relationship we create is two people being genuinely present and increasingly free to be themselves with each other.’

Fareeda nodded again, ‘That sounds quite a challenge, to be really open with a, well …,’ she hesitated slightly before continuing, ‘with a stranger.’ Her thoughts were partly around the sense of ‘stranger’ but again still with that sense of it being somebody outside of her faith.

Carla nodded, ‘And it is unlikely to happen immediately. Trust has to be earned. But my hope is that you will find yourself increasingly able to talk about the difficult areas of your life and your experience – but only if that is what you want to do. For me, therapy is about helping a person become themselves, become more able to freely move around within their personhood, to in effect be more fluid and less fixed in attitude or in particular behaviours and reactions, many of which we may have learned from others rather than being direct expressions of our own essential nature, or that are our own freely chosen way of being.’

Carla is in information mode and has not responded empathically to Fareeda’s comment about how challenging it would be for her to be open with a stranger. This is acceptable in the context of an introductory session, perhaps; although an opportunity has passed for Carla to in effect demonstrate her sensitivity and responsiveness to Fareeda. Sometimes in a first contact session like this, the power and nature of the person-centred approach can be best conveyed by its application than by talking about it.

Carla mentions the notion of a person becoming more fluid and less fixed. This is drawn from Rogers’ comments concerning his definition of ‘Seven stages of process’ (1961, pp. 132–59), ‘by which the individual changes from fixity to flowingness, from a point nearer the rigid end of the continuum to a point nearer the “in-motion” end of the continuum’ (1961, pp. 132). So, for instance, the first stage he defines in the following terms. That ‘there is an unwillingness to communicate self. Communication is only about externals’ and that ‘feelings and personal meanings are neither recognized nor owned’. He suggests that at this stage the client regards ‘personal constructs’ as ‘extremely rigid’ and that ‘close and communicative relationships are … dangerous’. He further suggests that the client does not perceive or recognise problems; ‘there is no desire to change’ and ‘there is much blockage of internal communication’.

In contrast, at stage seven, Rogers emphasises the following, that ‘new feelings are experienced with immediacy and richn...