INTRODUCTION

In this case study the writer will present a client with multiple issues.
The writer will get eclectic. Over the years different counseling models have been developed and
eclecticism is one of them which is quite often being applied do deal with a myriad of issues.
Psychologists believe that the best hope for a truly comprehensive therapeutic approach lies with
eclecticism.
The aim of borrowing from multiple theories, styles and ideas is to gain complementary insights
into a counseling case.

Counseling goal
The main goal is to help the client to deal with her issues by accessing her personal resources in
order to deal with feelings and share her experiences.
The counselor will help the client too access her untapped strengths and resources so that she can
be a fully functioning person in all the major areas of human functioning.
Another goal would be to help the clean work on her social skills and have the wisdom
interpreting what is normal and what is not normal in terms of developmental tasks. As we work
on this with the client she will gain wisdom for holistic functioning and even the need to put her
house and her life in order as far as family life is concerned.
The counselor would also want the client to see sense in the dangers associated irresistible urge
to sleep with men without considering the dangers associated with this behavior including the
impact of this behavior on her integrity.
By having the objectives its like the counseling relationship has a direction and the counselor
has in mind what he wants to achieve, these are mutually agreed on with the client, its also like
starting with an end in mind such that sessions can come to an end the moment both the client
and the counselor are in agreement that the objectives have been achieved.
These goals can only be achieved with the determination from both the client and the counselor,
its therefore important that the two agree on logistics in terms of commitment based on time : the
client has indicated his commitment to attend sessions at agreed times and incase of unavoidable
circumstances shall communicate.

Counseling sessions
We had a common agreement with Amina on convenient days of the week and time(Thursdays
from 5:30pm-6:15pm).
The sessions are held in a friends office after id talked to her about that, although the office is
not convenient for counseling, I make few adjustments every time we have a session. Barriers
such as unused tables and other items are always packed in another room until the session is
over. This is done to be in tandem with the requirement of a counseling room which needs to
have limited barriers and should appear as conducive as possible. This leaves the office with only
two chairs, which are of the same colors and make.
The counseling office is on the extreme end of the building meaning that distractions are well
managed. Its well lighted and ventilated .I designed a tag SESSION ON DONT DISTURB..
which I normally put on the door when sessions are on to caution any one who would w2ant to
accidentally get into the room. The rest of the staff have also been informed on counseling
activities on Thursdays this also has helped a lot in minimizing interruptions.
During sessions I usually stand to meet the client to accord him the customary warm welcome,
wearing a smile, to make her feel at ease the ask her to occupy a seat of her choice( Schultz &
Schultz 1990 ).

CONTRACTING
I introduced myself to the client- Amina that I am a counseling student at Kenya Association of
Professional counselors Kisumu campus, taking a 2years course in Diploma in psychological
counseling.
I inform Amina that one of the requirements for a successful completion of the course is doing a
case study presentation. I assure her of confidentiality that in as much ill do a presentation of our
interaction with her I will use a pseudo name but again are more other measures that are there to
ensure her safety including the fact the institution and its practitioners operates under a very
strong ethical codes and practice.
Corey( 2005) says confidentiality is the obligation of the counseling practitioners to keep clients
materials safe without them getting into ears of people that will not be of benefit to the clients.
He identifies the following to be some limits on confidentiality in counseling:

If you tell your counselor you were abused as a child, and you are under 18 years of age
at the time you tell your counselor, the counselor must report the abuse to a county Child
Protective Services agency.

If you are over 18 when you tell the counselor, but there is a child currently at risk by the
same abuser, then the counselor may be required to make a report to a county agency.

If you tell your counselor about being sexually assaulted, the counselor is not required to
make a report unless you are under 18 at the time you tell the counselor.

If you tell your counselor about elder or dependent adult abuse, the counselor may be
required to make a report.

If you pose a danger to yourself, the counselor may be legally obligated to take whatever
actions necessary to protect you from harm.

If you tell your counselor that you intend to do imminent harm to a specific person(s),
your counselor is required by law to inform the authorities, intended victim(s) and take
additional action if necessary.

If a court of law orders a therapist or counselor to release information, that person is

bound by law to comply with such an order.

Amin a kept on asking me about her safety at the disclosures and I had to assure her moment
after moment that all class members are presenting and therefore no one will focus any student
or tend to get inquisitive over any client presented, both the class members and the supervisor are
Committed to upholding confidentiality.
I brought to her attention that sessions will take Forty five minutes to One hour every time we
meet.
When the counselor feels he understands the gist of what the client is communicating, the
counselor can proceed with questions. These questions can pertain to feelings, thoughts, beliefs,
expectations, past experiences, preferences, or other details relating to the issue.

The client may express a goal they wish to achieve. The counselor and the client may want to
explore the ultimate objective behind the goal. They may explore other options in addressing the
ultimate objective and the real issues behind the desired goal.
After further discussion, the counselor may choose to explain the benefits of holistic health,
developing one's identity, and the concepts of self-responsibility. The counselor must realize that
information given to the client may take time for the client to effectively implement into their
lives. The counselor and the client should discuss how these concepts relate to the client's issues.
The counselor should encourage the client to ultimately draw their own conclusions and choose
the direction they want to take in resolving the issue. The counselor may challenge the client to
formulate a behavioral goal to address the ultimate objective. The counselor may need to ask the
client how confident they feel in achieving the particular goal. The client will judge the
plausibility of particular behavior based on their perceived benefit of the behavior and on their
confidence of successfully achieving the behavior. Goals may need to be scaled down,
implemented in a gradual manner, or modified altogether to optimize adherence. Creativity
should be exercised to make the new behavior as rewarding as possible. Other techniques that
may be implemented to increase adherence include: behavioral logs and contracts, peer or family
support, friendly competition, and verbal recognition. A future appointment can be agreed upon
by the counselor and client to reevaluate the outcome of the behavioral goal. Goals may be
modified and other issues may be discussed in these later sessions.
In summary, the ultimate goal as a counselor is to help others understand themselves and their
existence, so they both may live to fully experience what it is to be human.

PRESENTING PROBLEMS

The following are some of the problems presented by the client

Married off at 12 years

Was sodomized by the husband

Angry at her father who didnt do anything to help her

Expressed anger at being taken to an approved school which she believes was not meant
for her

She is mad at recalling how her mother put cigarettes in her bag so that she could be
punished.

Involved in commercial sex work- prostitution and sometimes even the mother could also
bring her men to sleep with.

Inability to form and maintain intimate relationships

Depression

No interest in life

COUNSELING PROCESS

The Process of Counseling: The experience of counseling or psychotherapy varies depending

on the counselor, the client, and the particular concerns which the client brings. There are a
number of different approaches which may be used to help with the concerns you hope to
address. In general, the process involves the client speaking about her issues openly and
honestly, while the counselor listens attentively and respectfully, asks you questions, and works
with you collaboratively to address your issues. The client should expect to be able to discuss
with the counselor any concerns they have. While your counselor will help you meet your goals,
he or she might not tell you what to do. Rather, you will both work to energize your strengths
and to help you make the best decisions and take action to improve your life. If you do not feel
satisfied with the progress that you are making in counseling, or with any aspect of the
counseling process, share your concerns with your counselor. She or he needs to know your
concerns in order to be helpful to you.
The process of counseling often takes time, and it is rare for people to feel that their problems are
solved in one or two sessions. However, after one or two sessions, your counselor should be able
to offer you some initial impressions of what the work will include and what methods could be
used. Since counseling can involve an investment in time and energy, you should use your own
judgment to assess your level of comfort working with your counselor. If you have any questions
or doubts about the process, you should feel free to discuss them whenever they arise. If your
doubts persist, your counselor will be glad to refer you to another counselor at the Counseling
Center or off-campus. Your counselor knows that a good counseling relationship is a necessary
condition of counseling and will be supportive if a referral to another counselor would be most
helpful to you.

PSYCHOANALYSIS

.
Psychoanalysis is a form of psychotherapy used by counselors to treat patients who have a range
of mild to moderate chronic life problems. It is related to a specific body of theories about the
relationships between conscious and unconscious mental processes
Psychodynamic refers to a view of human personality that results from interactions between
conscious and unconscious factors. The purpose of all forms of psychodynamic treatment is to
bring unconscious mental material and processes into full consciousness so that the patient can
gain more control over his or her life.
Classical psychoanalysis has become the least commonly practiced form of psychodynamic
therapy because of its demands on the patient's time, as well as on his or her emotional and
financial resources
Description
In psychoanalysis, the therapist does not tell the patient how to solve problems or offer moral
judgments. The focus of treatment is exploration of the patient's mind and habitual thought
patterns. Such therapy is termed "non-directed." It is also "insight-oriented," meaning that the
goal of treatment is increased understanding of the sources of one's inner conflicts and emotional
problems. The basic techniques of psychoanalytical treatment include:
Therapist neutrality
Neutrality means that the analyst does not take sides in the patient's conflicts, express feelings
about the patient, or talk about his or her own life. Therapist neutrality is intended to help the

patient stay focused on issues rather than be concerned with the therapist's reactions., the patient
and therapist usually sit in comfortable chairs facing each other.
Free association
Free association means that the patient talks about whatever comes into mind without censoring
or editing the flow of ideas or memories. Free association allows the patient to return to earlier or
more childlike emotional states ("regress"). Regression is sometimes necessary in the formation
of the therapeutic alliance. It also helps the analyst to understand the recurrent patterns of
conflict in the patient's life.
Therapeutic alliance and transference
Transference is the name that psychoanalysts use for the patient's repetition of childlike ways of
relating that were learned in early life. If the therapeutic alliance has been well established, the
patient will begin to transfer thoughts and feelings connected with siblings, parents, or other
influential figures to the therapist. Discussing the transference helps the patient gain insight into
the ways in which he or she misreads or misperceives other people in present life.
Interpretation
In psychoanalytic treatment, the analyst is silent as much as possible, in order to encourage the
patient's free association. However, the analyst offers judiciously timed interpretations, in the
form of verbal comments about the material that emerges in the sessions. The therapist uses
interpretations in order to uncover the patient's resistance to treatment, to discuss the patient's
transference feelings, or to confront the patient with inconsistencies. Interpretations may be
either focused on present issues ("dynamic") or intended to draw connections between the
patient's past and the present ("genetic"). The patient is also often encouraged to describe dreams
and fantasies as sources of material for interpretation.
10

Working through
"Working through" occupies most of the work in psychoanalytic treatment after the transference
has been formed and the patient has begun to acquire insights into his or her problems. Working
through is a process in which the new awareness is repeatedly tested and "tried on for size" in
other areas of the patient's life. It allows the patient to understand the influence of the past on his
or her present situation, to accept it emotionally as well as intellectually, and to use the new
understanding to make changes in present life. Working through thus helps the patient to gain
some measure of control over inner conflicts and to resolve them or minimize their power.
Although psychoanalytic treatment is primarily verbal, medications are sometimes used to
stabilize patients with severe anxiety, depression, or other mood disorders during the analysis

COGNITIVE BEHAVIORAL THERAPY

Cognitive behavioural therapy is a talking therapy that can help you manage your problems by
changing the way you think and behave.
It is most commonly used to treat anxiety and depression, but can be useful for other mental and
physical health problems.
CBT cannot remove your problems, but it can help you deal with them in a more positive way. It
is based on the concept that your thoughts, feelings, physical sensations and actions are
interconnected, and that negative thoughts and feelings can trap you in a vicious cycle.
11

CBT aims to help you crack this cycle by breaking down overwhelming problems into smaller
parts and showing you how to change these negative patterns to improve the way you feel.
This approach is quite significant for the case of Amina because she has a negative self talk.
Some skills and strategies would be

Psychoeducation
An important first step in overcoming a psychological problem is to learn more about it,
otherwise known as psycho-education.I take Amina through her issues and how they might
have impacted in her life without her knowing. Learning about your problem can give you the
comfort of knowing that youre not alone and that others have found helpful strategies to
overcome it.
One may even find it helpful for family members and friends to learn more about her problem as
well. AMINA may find that just having a better understanding of her problems is a huge step
towards recovery.
I dedicate time to provide helpful information regarding some problems presented by Amina
such as alcoholism, smoking , prostitution etc, but I also encourage Amina to find more
information through reputable sources like books and internet..
Calm breathing and systematic muscle relaxation
Calm breathing, which involves consciously slowing down the breath, and Progressive Muscle
Relaxation, which involves systematically tensing and relaxing different muscle groups. As with
12

any other skill, the more these relaxation strategies are practiced, the more effectively and
quickly they will work. Other helpful relaxation strategies include listening to calm music,
meditation, yoga and massage.
Realistic thinking
Effectively managing negative emotions involves identifying negative thinking and replacing it
with realistic and balanced thinking. Because our thoughts have a big impact on the way we feel,
changing our unhelpful thoughts to realistic or helpful ones is a key to feeling better. Realistic
thinking means looking at yourself, others, and the world in a balanced and fair way, without
being overly negative or positive.
I support Amina to have a realistic and positive view of her self and to stop self -defeating
patterns
PERSON CENTRED THERAPY
The counselor applied the core conditions to create relationships and as being the major
theoretical background from which I go out to borrow concepts and techniques from behavioral ,
psychoanalysis and cognitive behavioral theory.
Basically I was eclectic in my approach because of my tendency to borrow concepts and
techniques from other theories
.
Dimensions of Nonverbal Communication
As well as the verbal content of the discussions between counselor and client, the two are

13

communicating to each other nonverbally through the following dimensions.

Time: parameters of session, amount of time spent on different topics
Body Language: posture, facial expressions, gestures. eye contact, touching
Voice: tone, rate of speech, loudness
Use of Environment: distance between client and counselor, arrangement of furniture,
clothing
Basic Communication Skills
Minimal verbal response: The counselor uses "umm hmm", "oh", "yes" to communicate
to the client s/he is listening without interrupting the client's train of thought.
Probes: The counselor uses open-ended questions to solicit additional information about the
client's, thoughts/feelings/behaviors.
Silence: The counselor can tolerate appropriate silences in facilitating client progress.
Paraphrase: Without changing the meaning, the counselor states in fewer words the content of
what the client has previously said.
Reflection: From either verbal or nonverbal cues, the counselor accurately describes the client's
affective state.
Summarization: The counselor combines two or more of the client's thoughts, feelings of
behaviors into a general theme.
Clarification: The counselor has the client clarify vague or ambiguous thoughts. Feelings or
behaviors.
Advanced Skills used
Confrontation: The counselor highlights incongruities between the client's verbal and nonverbal
communication or within the client's verbal communication.

14

Self-disclosure: The counselor briefly and appropriately discloses information about him/herself
in a facilitative manner.
Immediacy: The counselor briefly and appropriately discloses his/her immediate reactions about
the client to the client.

CONCLUSION
Counseling is both pain and joy. Pain ;in the sense that people who come for sessions are people
who are tunneled in the perceptions and are stagnated in many aspects of their life.
Amina came wounded but as sessions went on she started seeing a sense in the sessions, she
blames herself why she had to take that long before coming for therapy.
Her issues have different interpretations based on different theories. She is really committed in
seeing that the objectives we drew on the first day of our session are met.
We are still continuing with sessions and so far the changes can be quantified

15

References
Conduct Problems Prevention Research Group (1999a). Initial impact of the fast track prevention
trial for conduct problems: I. The high risk sample. Journal of Consulting and Clinical
Psychology, 67(5), 631-647.
Conduct Problems Prevention Research Group (1999b). Initial impact of the fast track
prevention trial for conduct problems: II. Classroom effects. Journal of Consulting and Clinical
Psychology, 67(5), 648-657.
Conduct Problems Prevention Research Group (2002). Using the fast track randomized
prevention trial to test the early-starter model of the development of serious conduct problems.
Development and Psychopathology, 14(4), 925-943.
Kazdin, A. E., & Weisz, J. R. (2003). Evidence-based psychotherapies for children and
adolescents. New York: Guilford Press.
16

McIntyre, T., & Tong, V. (1998). Where the boys are: Do cross-gender misunderstandings of
language use and behavior patterns contribute to the overrepresentation of males in programs for
students with emotional and behavioral disorders? Education and Treatment of Children, 21(3),
321-332.
Minke, K. M., & Bear, G. C. (2000). Preventing school problems - Promoting school success:
Strategies and programs that work. Bethesda, MD: National Association of School
Psychologists.
Quay, H. C., & Hogan, A. E. (1999). Handbook of disruptive behavior disorders. New York:
Kluwer Academic/Plenum Publishers.
Thomas, A., & Grimes, J. (1990). Best practices in school psychology. Silver Spring, MD:
National Association of School Psychologists.
Walker, H.M., Colvin, G., & Ramsey, E. (1995). Antisocial behavior in school: Strategies and
best practices. Pacific Grove, CA: Brooks/Cole Publishing Company.

17