Reflective case study in counselling

Part I: Case Assessment Report

New Territories West Integrated Family Services Centre

Case Assessment Report

A. Basic Case Information

Name of Client: Madam CHAN

Sex/ Age of Client: F/36

Name of Worker: Dada Wong

Nature of case: Counseling

B. Presenting Problem

Madam CHAN reported that she has been suffering from low mood, loss of appetite, headaches and insomnia for over a month. She had also lost motivation in doing household chores and would cry sometimes without reasons.

C. Social History

1. Genogram

2. Family background

Case client, Madam CHAN, moved from Mainland China to Hong Kong 5 years ago. She married with her husband, Mr. LEE, in Mainland China. They have one son, two daughters in total, and living together. Son is 12 years old, will become F. 1 student in secondary school, and daughters are 8 years old and 3 months respectively. Madam Chan got pregnancy last year and Mr. Lee suggested Madam Chan to have abortion but she refused. She insisted to give birth of the youngest daughter because she thinks it belongs to her. She expressed husband does not put much cares, include physical and financial, on the youngest daughter. Madam CHAN reported their marital relationship was fine when lived in Mainland China, but conflicts increase when move to Hong Kong. Client complains Mr. LEE sends most of his income for his parents in Mainland China and does not give much money for their family. They have arguments about this issue always.

3. Emotional condition

Madam CHAN suffers from low mood, loss of appetite for over a month. She reported sometimes would cry without reasons and loss of motivation in doing housework at home. Emotional unstable when talking about her situation, she cried twice during the counseling process.

4. Health condition

Client expresses loss of appetite, headaches and insomnia for over a month. She feels tired and lack of energy when at home, but no problem at working.

5. Financial condition

Madam CHAN now works as a part-time waitress in restaurant, and responsible for taking orders and delivering dishes to customers. She earns around $5000 per month. Mr. LEE is an air-conditioner technician, earning around $12000 per month. Madam CHAN reports Mr. LEE does not contribute much income on own family, around $3000 per month, but gives most of money to his parents in Mainland China. She reported that most of the expenditures of family are supported by her own.

6. Supportive network

Madam CHAN pays around $1000 each month for her younger sister to take care the baby when she goes to work. She expressed the money also viewed as a help to sister’s family. Client mentioned that her younger sister and brother have their own financial difficulties, therefore, she also needs to take the responsibility of parents’ financial supporting. Madam CHAN said she only visited for her parents two times after move to Hong Kong in five recent years.

D. Case Analysis

1. Underlying problem

Based on the information collected from counseling Madam CHAN, it is believed that her headaches and insomnia symptoms are closely related to the stress on family financial situation.

Madam CHAN expressed worries of limited income from being part-time waitress, may not be sufficient for supporting the expenditure of whole family. She complained Mr. LEE giving most of the salaries for his parents in Mainland China but little for family expenditures and children. They argued for this issue many times after Madam CHAN moved from Mainland China to Hong Kong. She believes that family financial situation would be improved if Mr. LEE willing to share more monthly income to their family. She tried to ask for more financial supports from Mr. LEE but failed, and thought like begging from him. She feels angry about that and gives up trying anymore. For this reason, she believes she cannot reply on her husband. In addition, client complained Mr. LEE ignores the responsibilities of taking care of the children, especially the new born baby.

On the other hand, based on the information got from Mr. LEE during interview, the third child is not he expected and wished. He believed the third child is a real burden on family financial aspect. He expressed the major reason of argument with Madam Chan is money distribution.

2. Assessment

Counseling done. From the interviews, Madam CHAN presented the concern about the financial problem of family. She cried twice when talking about the issue of Mr. LEE sends most of the salaries to his family in Mainland China. She said, “Maybe our children are less valued than his family!”. That shows her anger about Mr. LEE behavior toward money distribution. She has expressed her worries about the maintenance of family income as one more child at home nowadays, expenses increase. She reported that feeling lack of energy when at home, suffering from low mood, headaches and insomnia for over a month, however, does not have these problems when working. It is believed that her physical discomfort symptoms like headaches and insomnia are due to the pressure and worries about family financial situation.

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From the interview with Mr. LEE, he expressed the new born baby is unplanned. He believes family situation in general would be better if without the third child. Mr. LEE expressed he has the money saving plan for children before, likes saving for their future study. That shows Mr. LEE willing to plan about the future of family. However, the new born makes the plan collapsed. He suggested Madam CHAN to have abortion but she insisted to preserve the baby. He was angry about that. Mr. LEE stated that Madam CHAN always ask for more money during the conversation. He has implied the new born may not belongs to him during the interview, but he did not explain further on this point.

3. Intervention

It is believed that the emotional problem of Madam CHAN may due to the stresses on worrying about not able to take care of the children and maintain the family income at the same time. According to the information got from interview, Cognitive Behavior Therapy (CBT) Approach would be appropriate to adopt in the intervention. CBT addresses the interactions between how we think, feel and behave (Somers, 2007). It believes that the peoples’ feelings, emotions, thoughts are the responses to the outside world. Therefore, one’s behaviors could be changed from changing their perception and cognition of the situation from the process of therapy (Somers, 2007). According to Hall & Iqbal (2010), CBT could reduce the stress and anxiety level, and the related symptoms would be relieved when go through the therapy or treatment. CBT states that behaviours could be changed by changing perception. Therefore, the stress related symptoms of Madam CHAN, such as headaches and feeling lack of energy, are expected be addressed if using CBT approach.

E. Recommendation for Follow-up

I would like to refer Madam CHAN for psychiatric consultation, to have medication treatments. It is necessary to relieve the physical discomfort of client immediately. Referral for psychiatric consultation was sent out.

After addressing the problem of physical discomfort syndromes, it is recommend Madam CHAN to join education group about stress management in centre after having individual counseling, in order to learn the skill of handle stress in life.

Counseling services in centre for Madam Chan keeps on for monitoring. CBT approach would be used on changing her perception about worrying the financial difficulties.

For long term goal, joint interview and counseling of Madam CHAN and Mr. LEE is suggested for them. As both of Madam CHAN and Mr. LEE have plans on family future, thus, the joint interview would focus on encourage effective communication between each other, to discuss how to do the better distribution of family income.

Signed by Intake Worker: _________Signed by Supervisor: _________

Date: _________ Date: _________

Reference

Hall, K. & Iqbal, F. (2010). The Problem with Cognitive Behavior Therapy. London: Karnac Book Company.

Somers, J. (2007). Cognitive Behavioural Therapy: Core information document. Vancouver: Centre for Applied Research in Mental Health and Addiction, Simon Fraser University. .

Part II: Self-evaluation

From the role-play practice, it was a good experience for me to feel the dynamic between worker and client. Within the practice, several communication and counseling skills have been used.

Several basic communication skills have been used in the counseling practice, such as Questioning, Reflection of feeling, and Paraphrasing and Clarifying. During the counseling process, open and closed also have been used. For the closed question, such as “Have you discussed with your wife about the income distribution of family?”, in order to know whether Mr. LEE and Madam Chan ever talked about the core problem. As Mr. LEE answer “No”, and following an open question of “Why?” to Mr. LEE, in order to know the reason and the dynamic between them. In addition, Reflection of feeling can let me to know the exact feelings of clients, to distinguish the feeling of disappointment or angry with Mr. LEE. The skill of Paraphrasing and Clarifying also help me to clarifying the meaning of Mr. LEE as he implied some wordings like he doubted about the baby is not belongs to him. I think it is important to clarify from him as it might be another core family issue in this case.

Empathy is also one of the important elements has been used during the counseling process because it can let me to engage with Madam CHAN. Once she feels I am a person who could understand her feelings, she becomes more willing to talk and share with me about real difficulties she is facing. Therefore, empathy is one of the core elements within the intervention process.

On the other hand, I had made a mistake in the intervention. I presumed the client emotion and attitude would be gradually better after each session. I anticipate Madam CHAN would turn to understand and appreciate Mr. LEE who has planned about their family future in last session. Therefore, I prepared a lot of suggestions based on Madam CHAN who is ready for consensus with Mr. LEE. However, my expectation failed. Madam CHAN does not want to agree with Mr. LEE, my suggestions were not suitable for client and seems I was not able to engage with her. It may due to I ignored the factors that they may have dynamic interaction during the week between sessions. From this mistake, I have learned that, as a worker, we should not presume the behavior and attitude of client. We could not include all the factors outside the intervention session. Also, behaviors are changeable. It was a good opportunity for me to learn, worker should prepare for changes every moment

Generally, I have urged client to change her mind and perception and ignore the emotional needs of client. As I would like to use CBT to be my intervention approach, to make client believes that the situation is not really bad and would like her to understand that Mr. LEE also planned for family future, I hope to change her mind as soon as possible. Thus, I may ignore the emotion needs of client, such as addressing her anger about feeling unresponsive of Mr. LEE. From this role-play, I have learned that, do not only focus on the intervention process but also need to cater and care about the feelings and emotions of client. It was a good experience for me to prepare the case work in the coming future.

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