This week, just like last week, we split up into small groups to discuss case studies in a simulation of a peer-supervision group.
I presented my second case study this week, a female in her mid-thirties, who came to counselling because she was feeling regret at not having settled down and felt she had focused on her career for too long. The focus of the sessions moved on to her eating habits, which is an area I was not experienced with. Unsure of how to proceed with her best interests in mind, and also questioning my inability to be empathic with her mindset and really understand her eating disorder, I brought the problem to supervision.
In our discussions Lisa reassured me that it’s ok not to feel empathy in some cases, and that she didn’t think it was a major problem that I couldn’t relate to my client’s issue, and it’s actually quite congruent to accept this rather than try and force it. We also agreed that my lack of knowledge and training in eating disorders would hold progress back – so we formulated a plan to pause her personal counselling, and signpost her on to an eating disorder specialist. Then, after that, if she feels like it, we can resume her personal counselling.
In Rosalina’s first case study, she brought a client, a female in her mid-forties, whom has recently lost her Mum. She has one son and a dog that she is clinging on to in a way to deflect from her wanting to go through the painful grief period. Rosalina had already signposted grief counselling, but the client had point-blank refused – we surmised that the client knows she needs counselling, but is scared of going through the pain of processing her grief. This is understandable, and we decided that it may take time for her to want to voluntarily do this. Because of this, she is stuck in a drama triangle with her son and various authorities. She mentions her son more than anything else, that’s all she talks about in her counselling sessions, and we felt that this is her way of trying to put her loss out of her mind. We discussed Rosalina losing her patience with the client, that her empathy was wearing thin, and she seemed stuck in a rut with the client – because of this, Rosalina was very ethical and working safely in bringing this issue to supervision at this time.
We decided that Rosalina was to try a session or two in which talking about her son was forbidden – but this is obviously quite tricky to do in a client-led, person-centred modality. We thought it would also be a good idea to give grief counselling another shot, and to possibly try some sand-tray therapy, see if that gets things moving.
We then talked about Steve’s first case study, in which he brought a male in his late fifties, who is a well presented and smart man, also an alcoholic. The client is also quite religious, and likes to study the Bible, get drunk, and then phone churches across the land to debate religious dogma. His keyworker suggested he come to counselling, and he reluctantly agreed. The goal is to stop drinking, but is having problems as he believes that God will save him.
We quickly realised that this was not the actual problem that Steve had brought to supervision, when he explained that the man’s religious beliefs are not only triggering unexpected feelings, but also physical reactions. We agreed that as this is clearly an unresolved personal issue for Steve, he should stop counselling this client immediately and pass him over to a colleague. Because of the reactions Steve was having, it would be impossible for him to work congruently and offer unconditional positive regard. We also suggested that Steve have some personal counselling. He did tell us about his early experiences with religion but to go deeper and develop an understanding of his issue he really should take some time with a trained professional counsellor – this would allow him to work safely with such topics in the future.
I think these case discussions are great because no two people’s perceptions of events are truly identical. Also, they really help you identify your blind spots or unconscious prejudices if you look at what you fill any gaps in the stories with. Developing self-awareness and noticing what you unconsciously assume to be true in a person’s story can help you stop assuming these things are true, which is useful as these assumptions are almost always wrong. I know you cannot do this in case studies where the client is not actually present, but it is always better to ask for clarification if you are not sure. The more clarity that a counsellor has about a client when they bring it to supervision, the better they can work together with a supervisor to come up with a plan of action.
These case study discussions also simulate peer-supervision in that no-one really leads the sessions, everyone’s input is valid, and it’s a learning, collaborative experience. It’s been said before that no-one knows as much as all of us, and in this respect, the pooling of a variety of knowledge and wisdom can sometimes be more beneficial than one-to-one supervision. Having a lot of different viewpoints, perspectives and ideas can be very beneficial. But to counter that, having too many opinions could be a hindrance. There are other ways in which peer-supervision may not always work as well as it should – strong personalities could control the group or some attendees may not feel safe enough to expose their practise in such a setting.
