ASSESSMENT COMMENTS & MARKING PAGE (YEAR 2)

CASE STUDY (2500 WORDS)

Student number: 2190424 Tutor marking:

Word Count: 2744
Date: 03/04/24

Topic Title: Case Study

Student’s General Assessment Comment:

Assessment Criteria Student Comment

Understanding of the client and the
client’s presentation in terms of COMPLETE
counselling theory
Theoretical understanding of what the
counsellor did and why you did it, COMPLETE
applying theory to practice
Understanding and examination of the
impact of cultural identity (of the client EXPLORED
and counsellor) in the therapeutic
relationship
Identification and exploration of any EXPLORED
ethical issues
Awareness of issues you might take to
supervision or class discussion and your EXPLORED
learning from them
Awareness of your limitations of
competence and experience and
EXPLORED
identification of what might have been
done differently

Presentation and referencing DONE

Mark: ……..……. % Grade:

Tutor’s Assessment Comment:

Date:

BA (Hons) Person-centred Counselling

& the Psychotherapeutic Relationship
ASSESSMENT COMMENTS & MARKING PAGE (YEAR 2)
CASE STUDY (2500 WORDS)

CASE STUDY

My client, Margaret, (name changed for confidentiality purposes), a 19-year-old female,

referred herself to my counselling placement due to feelings of low mood and self-esteem,
depression, mental health. I saw my client for 8 sessions in total. On the beginning session,
undertaken online, Margaret appeared sitting on her bed twitching her fingers, showing signs
of nerves and anxiety and seemingly child-like. At this point it was clear to me this client was
experiencing the first therapeutic condition of being in a state of incongruence, being
vulnerable and/or anxious (Rogers, 1957).

Margaret was dressed in casual clothes (pyjamas) and sat hunched as the session began. I was
very respectful to the client’s emotions and anxiety and reflected empathically, “I have
noticed your body language and understandably I can see that this is hard for you”. This
aimed to show the client empathy and unconditional positive regard (UPR) thus meeting two
of Carl Rogers’ core conditions deemed necessary and sufficient for therapeutic change.

Margaret responded with “I guess so. I’ve never had counselling before, so I don’t know
what to expect but I hope it helps”. I explained the process of counselling, remaining
empathic and friendly, attempting to alleviate some of her nerves. I also asked Margaret
whether the counselling set-up was comfortable enough for her to help her feel relaxed and to
begin building a therapeutic relationship and trust from the start. The client nodded somewhat
nervously and remained silent for a few minutes sporadically. I allowed her silence and time
to feel and gage her emotions before opening the session and not rushing into it.

First Session

After the initial contracting and explaining the counselling procedure and completing a
CORE-10 form, I asked Margaret what had brought her to counselling. The first core
condition of psychological contact seemed to be present early in the therapeutic relationship
after the client explained understanding the contract, the paperwork and joked she was happy
I was a brown (skinned) counsellor as that is what her mother wanted. The client explained
that she was a university student, born in the UK, but felt she was torn between what she felt

BA (Hons) Person-centred Counselling

& the Psychotherapeutic Relationship
ASSESSMENT COMMENTS & MARKING PAGE (YEAR 2)
CASE STUDY (2500 WORDS)

was her parents’ culture and her own, which was a mix of theirs with the rest being what she
described as British. She explained she worked part-time in a low paying job which she felt
she did not deserve having been brought up here and lived with her boyfriend, making her a
‘rebel’ and therefore seen as being ‘low’ in her parents’ eyes. The way in which Margaret
experienced the world was therefore a result of how she responded to it, deriving sense from
her ‘unique mixture of needs, history and expectation’ (Tony Merry, 2011, p18). The client’s
experienced perception or her ‘frame of reference’ seemed to agree with Carl Rogers’ 19
propositions, proposition 2 explaining that the ‘organism reacts to the field as it is
experienced and perceived. The perceptual field is “reality” for the individual’ (Rogers,
1951). In other words, Margaret’s view that she had a job and lived with her boyfriend and
brought up in the UK consequently made her a rebel.

I offered Margaret immediacy (another necessary condition of congruence) by reflecting that

I understood how she felt having grown up in a similar background. The client explained, her
mother was always singling her out, in comparison with her other siblings, for verbal abuse
for varying reasons such the way she dressed, attitude and looked. Margaret described that
despite always looking out for her parents and their needs, she received the most abuse and
with the revelation that she had not spoken to her father in over a year, as she felt he just did
not want to know her. This deep reflection from my client, allowed myself to give my client
silence, allowing her to go at her own pace, to go where she needed to in a non-directive
manner. I reflected the client’s feelings back to her, when possible. These emotions involved
her feeling like everyone was against her despite trying to meet their needs and traditions,
whilst maintaining empathy and UPR. Further exploration during the remaining part of the
session revealed the client was failing at university and felt like she would be dismissed from
her job as she did not always pay attention to her duties and blamed her parents and boyfriend
for this. Blaming others for her failures could suggest the client was between stages 2 and 3
of Rogers’ seven stages of therapeutic change (Rogers, 1961). Carl Rogers believed a client
would go through seven stages to become ‘fully functioning’. At this point people find it
difficult to accept responsibility for their actions and what they go through and then tend to
blame others, feeling like victims in a hostile world rather than those partaking in it (Merry,
2011).

BA (Hons) Person-centred Counselling

& the Psychotherapeutic Relationship
ASSESSMENT COMMENTS & MARKING PAGE (YEAR 2)
CASE STUDY (2500 WORDS)

Sessions 2-5

For the duration of these sessions, Margaret began visibly opening up, highlighted by her
friendliness, openness of conversation and even her posture (body language). This
emphasised a ‘loosening of attitudes’, allowing her to reach stage 3 of Carl Rogers’ seven
stages of therapeutic change (Rogers, 1961). The client discussed her relationship with her
boyfriend in depth, explaining her lack of belief in the institution of marriage, despite
wanting to follow her parents’ culture and traditions. This made her accept the concept of a
traditional Asian engagement to “make my parents happy otherwise they will continue to hate
me”. This belief highlighted a ‘condition of worth’ (Rogers, 1959) and an introjected value,
as she felt that following her parents’ culture or tradition would them parents stop hating her
and love her instead. Interjecting, I explored this feeling with the client and my belief that,
perhaps, she felt she did not have worth in her own right and allowing the client time to
reflect, she seemed to agree stating she did not really want to get married or engaged for the
sake of it; she had goals to complete at university and would prefer to attain these before
considering marriage and that perhaps, she should not have thought it was the only way to get
her parents to love her. This highlighted that the client was beginning to show some
congruence towards her ‘self’ and her needs and therefore being true to her organismic self
and challenging her conditions of worth.

Margaret also explored her feelings around feeling like a ‘loner’. She explained that she does
have friends but does not feel a part of any group and explored feeling betrayed by her ex-
friend, who posted nasty things about her on social media, and how this has perhaps
negatively impacted her friendship circle and trust amongst herself and her current friends but
also the effects of this on her relationship with her boyfriend too. Constantly feeling like she
is being judged by others, and therefore feeling low, her emotions were regularly driven by
external locus or external opinions. “Sometimes I sit on my own because my boyfriend works
a lot and when he is here, I feel like he isn’t here because we don’t always talk”. I reflected
back to her, “that seems very lonely, I can sense the loneliness in your voice”, constantly
being present and offering UPR and empathy. Pondering over this, Margaret agreed, adding

BA (Hons) Person-centred Counselling

& the Psychotherapeutic Relationship
ASSESSMENT COMMENTS & MARKING PAGE (YEAR 2)
CASE STUDY (2500 WORDS)

that she had always felt loneliness since she lost her best friend and continued to explore the
impact this had on her, as she felt she no longer had anyone to share her thoughts with and
that counselling had started making her feel that she now could. Being able to reflect, in a
non-judgemental environment, with the therapeutic relationship not causing any threat or
harm to Margaret, she was able to ‘self-revise’ her feelings (Rogers, 1951).

Session 6-7

Throughout these sessions I felt a dramatic positive shift in the therapeutic relationship.
Margaret had now begun to discuss deeper feelings and therefore moved to stage 4 in the
therapeutic process, beginning to describe ‘deeper feelings, usually those that happened in the
past’ (Tony Merry, 2011, p60). Exploring awareness of her loneliness and ways to work
around it, I explored her relations with her colleagues at work, to which the client told me she
would sit on the tram everyday, on her way home to work, and not talk to her other
colleagues, choosing to sit on her own. Margaret had now decided to sit next to her colleague
on the tram which was met with friendliness and enthusiasm by her colleague and created a
new friendship. “I realised I always had a resting bitch face unintentionally and made myself
unapproachable”. This change in her self-view brought about a glow and smile on her face
and as she was visibly excited, I reflected this back to her and her more upright, body
language that perhaps also highlighted this change. There was visible growth, in my eyes, and
the rigid Margaret at the beginning of our sessions was being replaced by an “increased
openness to experience” (Rogers, 2004, p115).

Margaret also shared, although she felt her partner loved her, he had been verbally abusive to
her, affecting her mental health, with him constantly putting her down, calling her
unattractive, and not introducing her to his parents even though they were discussing
engagement and potential future marriage plans. She felt that he may be ashamed of her, the
same way her mother felt about her. I reflected her feeling her boyfriend was ashamed of her,
back to her, and challenged her to think how she thought of herself. This interaction allowed
the client to reflect and came to the realisation that she still felt unintelligent and unworthy
although adding “no one gets me the way you do”. The client felt down or unworthy as a

BA (Hons) Person-centred Counselling

& the Psychotherapeutic Relationship
ASSESSMENT COMMENTS & MARKING PAGE (YEAR 2)
CASE STUDY (2500 WORDS)

result of her boyfriend’s negative feelings towards her. Margaret’s feelings towards her ‘self’
was formed through her boyfriend’s feelings towards her. Knowing the inherent tendency
towards becoming fully functioning is more frequently thwarted, instead leading to
psychological distress and dysfunction (Rogers, 1959) I made sure I would show compassion
and understanding. My congruent ‘self’ iterated “you should not blame yourself for your
boyfriend’s behaviour towards you. You are intelligent, friendly, and attractive”.
Continuously offering UPR, Margaret reflected upon this in silence and stated that she loves
him and felt he had moments of weakness and that she also said nasty things to him too. She
reflected on how far she had come so far in her counselling. Margaret also discussed in depth
her opinion of how having a counsellor from the same culture helped and that I looked like
her boyfriend which helped her talk to me “without the judgement”.

Culturally speaking, I believe the therapeutic relationship was enhanced due to my

similarities with Margaret. As I was able to understand her frame of reference, I believe I
understood the context of things she wanted to say much faster. Exploring feelings such as
the pressure of marriage, parents and even certain words she chose to utter in my mother
tongue, Urdu, helped enhanced Margaret’s and my experience and growth of this
relationship. Coming from a group collective where our culture frowns upon being an
individual, it helped me to understand Margaret’s need to step away from the cultural norms
in order to feel like an individual or a human being in order to work on her ‘self’. With a
promotion of respect and trust, the therapeutic relationship began with the client feeling a
sense of belonging, with our shared experiences helping to grow the relationship. This
superpower in my therapy toolbox ensured our sessions felt like they progressed deeper,
faster, and even helped iron out misconceptions of therapy – that people of brown skin can
come to therapy without being judged even though it is seen as ‘crazy’ within Pakistani
culture.

Session 8

I saw a massive change in Margaret in this session. Her appearance was the first thing I
noticed, with her posture much more upright than the original hunched position she was
during the first session to now seemingly much more confident and comfortable. I

BA (Hons) Person-centred Counselling

& the Psychotherapeutic Relationship
ASSESSMENT COMMENTS & MARKING PAGE (YEAR 2)
CASE STUDY (2500 WORDS)

commented on this change, and she told me she felt happier, more confident and did not feel
alone. I felt that this was a vital moment considering how she had felt at the beginning of our
sessions and felt better about herself. I was happy she felt good about herself and was valuing
herself. We spent the session discussing her progression and feelings from the weeks before.
The client seemed like she has moved to stage 4/5 of Rogers’ therapeutic process. She
informed me that she has told her parents her counsellor was from the same background and
although they did not believe therapy, it was easier for them to accept it. She informed me
she would be travelling soon and would tell her parents she does not want to get married just
yet, which I reflected, showed strength. Margaret agreed and said she felt confident knowing
she could say what was on her mind. She was becoming more confident in recognising and
choosing to trust her needs rather than those of others.

After returning from holiday, Margaret had decided she was confident enough to continue
without therapy and our sessions ended and would prefer face to face sessions if she were to
ever return to therapy in the future.

During the course of therapy, I had supervision for a range of issues as it “provides
practitioners with regular and ongoing opportunities to reflect in-depth about all aspects of
their practice in order to work as effectively, safely and ethically as possible” (BACP, 2018).
During therapy with Margaret, I discussed my client showing me affection and testing
boundaries. The client talked about her boyfriend a lot and showed signs of flirtation which
made me feel uncomfortable and it helped to talk about this in supervision as it made me
aware of how positive transference or transferring positive aspects of a client’s relationships
can be transferred onto the therapist and can be a good thing as it may show the client values
the counsellor as caring or thoughtful and therefore helping the therapeutic relationship.
Supervision has also helped me explore grounding techniques and interventions with clients,
if necessary, to help a client who becomes too overwhelmed and to help them look at their
emotions and explore them such as with an emotion wheel chart. Supervision has helped me
discuss my feelings during therapy and has also helped me to feel more confident in
expressing what is going on within me during therapy as I found it helped to discuss this with
Margaret such as what is going on with me when she talked about her negative feelings
towards herself. During supervision I also discussed my weaknesses such as silences and how

BA (Hons) Person-centred Counselling

& the Psychotherapeutic Relationship
ASSESSMENT COMMENTS & MARKING PAGE (YEAR 2)
CASE STUDY (2500 WORDS)

I can work better on them and how long they could or should be allowed and feeling
confident in myself. I discussed feeling downtrodden during DNA’s and possible reasons for
this and my feelings towards my therapy. My supervisor has also given my confidence by
assuring me I am doing a good job and helping nurture my skills such as working on silences.
I am now more confident making mistakes as I am aware without them, I cannot improve and
as I am finding my own way as a counsellor, I am confident to be able to explore the kind of
therapist I want to be and finding a way to work or a form of counselling that suits me. As I
did not get an ending with Margaret, I felt the therapy was left incomplete and my supervisor
helped me overcome this feeling.

During my sessions with Margaret, I was constantly making sure I would remain ethical and
brought this up in supervision with my supervisor to ensure my practice was following the
BACP Ethical Framework (2018). As a counsellor with limited competency ensured I stuck
to what I knew, namely, the person-centred approach of Carl Rogers. It is essential to
working within professional standards and one way of doing this is to work within
competency. As a counsellor I maintained the core conditions and whilst exploring family
relationships I did not attempt attachment or cognitive interventions which were out of my
scope of competency and to make sure the client’s wellbeing was always maintained. As I
gain a deeper knowledge of counselling and skills, I still maintain trustworthiness to deepen
the therapeutic relationship whilst remaining ethical and to allow the client autonomy.

BA (Hons) Person-centred Counselling

& the Psychotherapeutic Relationship
ASSESSMENT COMMENTS & MARKING PAGE (YEAR 2)
CASE STUDY (2500 WORDS)

REFERENCES

BACP (2018) Ethical Framework for the Counselling Professions [Online]. Lutterworth:
BACP. Available from: <https://www.bacp.co.uk/events-and-resources/ethics-and-
standards/ethical-framework-for-the-counselling-professions/> [Accessed 03 April 2024].

Rogers, CR(1951) Client-Centered Therapy: Its current practice, implications and theory.
Boston: Houghton Mifflin

Rogers, CR(1957). The Necessary and Sufficient Conditions of Therapeutic Personality

Change. Journal of Consulting Psychology, Vol. 21, pp. 95–103

Rogers, C. R. (1959). A Theory of Therapy, Personality, and Interpersonal Relationships: As

Developed in the Client-Centered Framework. In S. Koch (Ed.), Psychology: A Study of a
Science. Formulations of the Person and the Social Context (Vol. 3, pp. 184-256). New York:
McGraw Hill.

Rogers, CR (2004). On becoming a Person: A therapist’s view pf psychotherapy. Boston:

Houghton Mifflin

Tony Merry (2011).Learning and Being in Person-Centred Counselling. Second Edition.

Ross-on-Wyre. PCCS Book

BA (Hons) Person-centred Counselling

& the Psychotherapeutic Relationship