The counselling stories told here are actually composites made up from a number of case histories. No real names have been used. I did this to protect the confidences of all my clients. Confidentiality is a very important issue in counselling and psychotherapy. All my clients can be assured that nothing about them is ever disclosed to any third party without their explicit consent. “What is said inside my consulting room stays inside my consulting room”. The only exceptions are UK legal requirements and serious threats to life and limb.
All my client work is carried out in accordance with the Ethical Framework of the British Association for Counselling & Psychotherapy, (BACP). Amongst other requirements, these standards regulate client confidentiality and professional accountability. You can find out more by contacting the BACP at www.bacp.co.uk
A TROUBLE SHARED
As Jean described her problem, it became clear that some of Jean’s difficulties might, at least in part, result from possible clinical depression. Jean also mentioned that she had had an operation on her thyroid a couple of years ago and that she felt that she had never got over it. I agreed to see Jean for an initial assessment session so that we could decide on what sort of help she was looking for. I also wanted to give Jean a chance to make sure that she really wanted to enter into counselling with me. In addition, I also took the opportunity to ask Jean if she had seen a doctor about any of her problems and so I was a little concerned to learn that Jean had not been to see her GP for about 12 months. I therefore strongly urged Jean to pop into the surgery for a check-up before she came along for her first counselling session.
When Jean did come along for the first session, some five days after she had initially made contact, she presented herself in a very dispirited and unkempt sort of a way. She was scruffily dressed, in a very low mood, and obviously not taking much care of herself. Jean said that she was now under a final warning at work. She also told me that she and her family lived more or less disconnected and estranged lives even though they all lived together in the same house; they were more like room mates than any sort of a real family. Jean described herself as lonely, sad, and so totally fed up that she could hardly be bothered about anything, or anyone, at all; especially about herself. During this first session, Jean cried a lot, often became silent and she seemed to find it hard to look at me when she spoke and didn’t really seem to want to talk to me. I asked Jean why she had come along to see me and she said that actually she had nearly not bothered to turn up. However, back at the time when she had first phoned she had been feeling a little bit better that day. Therefore, at that time she though that it might be possible to find someone who could make her, “better all the time”. Today, however, she was much less hopeful. Rather despairingly she ended her account of her troubles by saying that she didn’t think that she was worth bothering about anyway and that she was probably wasting my time.
When she next came to see me, Jean was obviously feeling a little bit better. She had taken a bit more care with her appearance and was able to look me properly in the eye and respond to whatever was said to her. She told me that the doctor had said that physically she was fine and that even the thyroid problem had cleared up. However, he had also said that she was very depressed and so he wanted her to take some medication. She had not yet started taking her antidepressants as she wanted to hear what I thought first. This was because she “knew that all counsellors are against people taking pills”. I told her that it was sometimes necessary for medication and counselling, (and GPs), all to work together and pointed out that this was exactly what it said in the information leaflet that came with the pills.
Finally I asked Jean what she thought might be the best thing for her now to do. Jean thought for a moment and told me that although she had initially resented me for encouraging her to go to the GP, she had later been surprised to find herself feeling quite relieved to realise that someone cared enough about her to be prepared to be seen as a bit of a minor bully, even if it was in her own best interests, “just like my Dad really- I do miss him so”. She decided that she would start taking her pills and that she wanted to carry on seeing me. When we next met, it seemed to me that her mood had lifted so much that it was almost like a stranger who had walked through the door. Jean’s counselling went on for a total of 8 sessions and at the end she was very much looking forward to her future.
DEALING WITH FEAR
Dean’s problems seem to have started when there was small fire at his firm’s main depot. He normally works from there and happened to be on site at the time the fire broke out. Dean, who is also a retained firefighter, helped to put the fire out. Nobody was hurt but at one time there seemed to be a good chance that the fire might rapidly spread and engulf a much wider area of the plant. Since then Dean had found himself feeling very anxious and angry whenever he had to go to the depot. He felt frightened, a bit sick, sweaty, and he could feel his heart thumping. As a result of all this, Dean tried to avoid going to that depot and a lot of the discord with his workmates arose out of their perception that he was “slacking off”.
At our first session, it seemed to me that Dean was suffering from a learned anxiety condition that was triggered by some automatic bodily responses that kicked in whenever Dean was exposed to the appropriate stimuli. In this case it appeared that realising that he was near to the location of the depot blaze that activated Dean’s emotional and physical reactions. With Dean’s consent, I contacted his GP to make sure that he did not have anything physically amiss that could explain his symptoms and to find out if he was taking any medication for any apparently unrelated conditions that might explain his anxiety reaction. I also checked out with Dean to make sure that he was not misusing any other substances, (including alcohol), that might cause him to feel excessively stressed. As there appeared to be no reason to think that Dean’s condition was anything other than psychological, I decided to use some psychotherapeutic desensitisation techniques to help Dean manage and control, his anxiety-based emotional dysfunctions and to offer him some supportive counselling while he came to terms with his problems.
The next two sessions seemed to progress quite well although I had a feeling that there was still something important that was being missed. I had no direct evidence for this; it was just a feeling that I had. At the end of session 3, I asked Dean if he was yet finding any benefits from our work together. He said that he thought that he might be getting a bit better but just as he was leaving, almost as an afterthought, he suddenly said, “…of course, none of all this helps with the screaming”. Although the session was actually over, I decided to give Dean another 10 minutes so that I could immediately respond to Dean’s “show stopping” statement. He told me that every night, when he went to sleep, he started screaming and shouting and that this was so bad that he and his wife slept in different bedrooms in different parts of the house. As he also told me that this had been going on for the last 25 years, I realised that this issue, although obviously very important, could be safely left to be dealt with at their next therapy session.
During the fourth session, I asked Dean to tell me more about his night-time screaming. It soon appeared that this behaviour had actually become quite normal for him and his wife and that they had long come to accept it as a routine part of life. However, as he told me all about his nightly disruptions it became apparent that Dean was actually starting to act in the here-and-now of the counselling room as if he was terrified of something. I challenged him about this and he said that he was only just then realising how scared he was. Being frightened had become so routine for Dean that he had actually forgotten about it. I asked him how long he had been so frightened and he said that he had felt that way for the last 25 years. Next I asked Dean to tell me where he was when he first felt so scared and he unhesitating replied, “the South Atlantic, 1982 when my ship caught fire”. It transpired that Dean had been a soldier in the 1982 Falklands War and that he had been one of the casualties from the Sir Galahad fire. I then realised that Dean was probably suffering from a long-term, major stress condition and that the recent fire outbreak incident at work and brought all of this extremely powerful emotional turmoil to the surface.
Dean told me that he felt so much better now that all this had come out into the open at last and that he was so relieved to hear that he had a diagnosable condition. He had long nursed his secret in case others found out that he was actually “worthless” or what he described as being “…just a weak and cowardly failure”. I therefore agreed to see Dean for 6 more treatment sessions with the proviso that we would use the last of those sessions as a therapy review to see how he was getting on and to talk about any other help that he might need. We worked together for a further 6 weeks and during that time Dean started to find that his relationships with both his family and his workmates were becoming less fraught. He also stopped being so terrified.