Counselling Therapy: Systemic Therapies

Summary of session

The counselling session in the video provides insights into the issues faced by the client. The client is a married woman who states that she often gets late in her work and cannot organise her daily tasks correctly. Whenever her routine changes, she develops anxiety and cannot manage things. The thought of being late freezes her mind, and she develops confusion regarding how to initiate the task. Different questions posed by the counsellor helps in knowing her state of mind and what exactly happens when she develops anxiety. She has to travel a lot and things like booking tickets, getting on time always run in her mind. But still, she gets up late in spite of putting an alarm. When she develops this kind of anxiety, she tries to relax herself by relaxation techniques. Finally, after all, the questioned posed by the counsellor is answered by the client, the counsellor advises her regarding how she can sort things and make it more systematic to avoid tension. She teaches her breathing techniques as a form of relaxation during anxiety.

Method of counseling and purpose

As a counsellor, I need to maintain a particular level of therapeutic relation with the client. To deal with the client, I utilized narrative therapy to counsel the patient and knew about her psychological problems. It

In the case of the client in the video, I wanted her to narrate her stories and know her view regarding the issue. The Same story can be looked at differently by a different person (McMahon & Watson, 2012). I wanted to know client’s story to judge how she looks at things and problems in her life. It might be possible that another person with the same situation may react differently if they face similar conditions in life. Therefore, every person involved in an incident has their own perspective regarding the reality of that situation (McMahon & Watson, 2012), and I wanted to know her perspective regarding the challenges she faces every day in life due to her anxiety.

Principles and skills of narrative therapy

I was interested in helping the client to recognize that her approach to a situation can be different than what she thinks. The fundamental principles of narrative therapy are:

• Getting to know the problem or story
• Externalizing the problem
• Thickening the story or deconstructing dominant plots
• Redeveloping the narrative (Epston et al., 2012).

I first started with asking the client to narrate her problems in her own words. While she answered to my questions one by one, I was exploring how the issue has influenced client’s life. When asked about what problem the client faces, she explained in detail that she experiences nervous breakdown due to her inability to organize things and not being able to do daily activities on time in spite of planning to do. The client narrates that often she sets the alarm for 5 a.m, but still she sleeps till 7 a.m. When she wakes up, all of a sudden managing household work and getting the tasks done become difficult. When asked about what exactly happens to her at such times, she narrates that her mind freezes for a time being, and she has to push herself to work. This story about the client helped me realize that she had a problem with anxiety, and I tried techniques to define the problem in client’s own word and languages. This was my approach to externalize the problem (Denborough, 2014). 

I used my counselling skills to thicken the story by questions like:

When did the problem start to trouble you?

How does the problem continue to trouble you in life?

What is affecting you right now at this stage?

During what situation this pattern of thinking starts?

When did this thing start?

Asking all the above questions enlightened me with inner layers to the client’s story. The client told me that she first faced this problem when her husband has to suddenly rush to his parents because of sudden illness. Since then the problem has started to trouble her. I was able to know that the patient has to travel a lot and so she continues to face problem whenever her normal routine changes. Rushing to do things on time, booking a ticket, arranging the house, etc. acts as a stressor for her. Therefore, I realized that she develops this anxiety and unusual thinking pattern when her daily routine changes all of a sudden. This kind of activity can be influenced by the culture inherited by the client (Madsen, 2013). In this case, the client had a problematic story to narrate. I was able to deconstruct her dominant stories. It is the belief of the customer that tends to shape their problems in life. Once her attitude towards the situation changes and she starts thinking in a positive way to solve problems, she can add new meaning to her life (Helmond et al., 2014). I also identified that the client’s life centered round her issues and she forgot about her positivities in life. Therefore, my approach towards treating the client was to distract her from her own perspective of the problem during the interview and show her how she can manage the same situation in a better and positive way (Freedman, 2014).

I explored the client's dominant story in depth. I asked influencing questions like-

Can you explain what is the effect of these problems in your life?

What exactly happens when you develop anxiety due to disorganization of task?

What techniques have you adopted to tackle such situations?

Have you shared your problem with your husband?

When asked about the effects of the problem in the client’s life, she answered that she experienced pain in hand and legs when her anxiety and nervousness increases. The client narrated that tries to tackle the situation by relaxing herself and lying down for some time. Then she exerts and pushes herself to complete the task. I also got to know that the client was reluctant to share her problems with her husband. I found this strange and I felt that she should have discussed this problem with her husband. The interview session helped me to deconstruct stories during my counselling session to interpret new meanings of the narration. It is an approach to separate the problem from the client and implement ways to overcome the problem (Ricks, et al., 2014).

I also used methods to redevelop the narrative of the customer by using different depth of question. I used this technique because it helps in removing filters so that the hidden part of the experience of customers comes to the forefront. I realized that the client had marginalised her problems, and this might be due to her cultural boundaries (Freedman, 2014). This is evident from the fact that as married women she is expected to fulfill all her duties regarding looking after household work, family as well as in-laws. The responsibility of the family, work and in-laws had affected the client's state of mind and led to her nervous breakdown in life. I was able to get a vivid description of the problems faced by the client through a range of different questions related to her story. 

Solution to the client’s problem

Finally, I helped the client to redevelop her story by showing her a new perspective of dealing with the problem. I remained actively engaged with the customer throughout the counselling session and advised her that she should make a list of things that she will do on a given day. Secondly, she notes the time before which she will do the task. The first few days she will have to put extra efforts to get up on the planned time. I suggested that before starting the task, she should give herself 5-10 minutes time to relax herself by adopting releasing techniques. It would mean doing deep breathing exercise to relax oneself and engaging in fun activities like listening to music, having a chat or wandering around for some time. This technique will help in relaxing the patients and accomplish her planned task efficiently (Armfield & Heaton, 2013).

However, by the end of the session I realised my weakness in counselling skills. I was able to view the client’s problem from a large sociocultural context, but I could not identify what is absent but implicit in the presentation of problem. I should have explored the impact of the problem by questioning the client regarding what is truly valuable to them in a broader context beyond the problem. This would be an influential step to help the client prioritise her choices in life in order to manage things in a better way. Often people forget their values when they navigate a new terrain. This approach would have helped the client to understand their experiences in life and gains skills to address problem scenarios in the future (Oshman & Combs, 2016).

Implications of narrative therapy

Thus, narrative therapy is a very useful technique to help the client become the author of their own story and instill in them new positivity to tackle life situations. This theory will have useful implications for treating patients with different problems. This is because it recognises the fact that people face natural competency skills that guide them to bring new changes in life (Ribeiro et al., 2016). The approach to separating problems from individuals and externalizing sensitive issues work well in healing the patients and change their perspective towards the problem. This strategy mitigates resistance and allows a person to address and manages their problems in a productive and efficient manner (McParland, 2015).

Reference

Armfield, J. M., & Heaton, L. J. (2013). Management of fear and anxiety in the dental clinic: a review. Australian dental journal, 58(4), 390-407.

Denborough, D. (2014). Retelling the stories of our lives: Everyday narrative therapy to draw inspiration and transform experience. WW Norton & Company.

Epston, D., Stillman, J. R., & Erbes, C. R. (2012). Speaking two languages: A conversation between narrative therapy and scientific practices. Journal of Systemic Therapies, 31(1), 74.

Freedman, J. (2014). Witnessing and positioning: Structuring narrative therapy with families and couples. Australian and New Zealand Journal of Family Therapy, 35(1), 20-30.

Ha, T. H., & Baek, H. G. (2015). A study on curing the wounded heart applications development and effect analysis by utilizing narrative therapy techniques. Journal of Digital Contents Society, 16(2), 207-218.

Helmond, P., Overbeek, G., Brugman, D., & Gibbs, J. C. (2014). A meta-analysis on cognitive distortions and externalizing problem behavior associations, moderators, and treatment effectiveness. Criminal Justice and Behavior, 0093854814552842.

Johnstone, L., & Dallos, R. (2013). Formulation in psychology and psychotherapy: Making sense of people's problems. Routledge.

Madsen, W. C. (2013). Collaborative therapy with multi-stressed families. Guilford Press.

McMahon, M., & Watson, M. (2012). Story crafting: Strategies for facilitating narrative career counselling. International Journal for Educational and Vocational Guidance, 12(3), 211-224.

McParland, J. (2015). Narrative therapy in a learning disability context: A review. Tizard Learning Disability Review, 20(3), 121-129.

Oshman, L. D., & Combs, G. N. (2016). Integrating motivational interviewing and narrative therapy to teach behavior change to family medicine resident physicians. The International Journal of Psychiatry in Medicine, 51(4), 367-378.

Ribeiro, A. P., Braga, C., Stiles, W. B., Teixeira, P., Gonçalves, M. M., & Ribeiro, E. (2016). Therapist interventions and client ambivalence in two cases of narrative therapy for depression. Psychotherapy Research, 1-13.

Ricks, L., Kitchens, S., Goodrich, T., & Hancock, E. (2014). My story: The use of narrative therapy in individual and group counseling. Journal of Creativity in Mental Health, 9(1), 99-110.