COVID 19 and the Lockdown\'s Effect on Mental Health

Verbatim Transcript counseling session analyst
Counseling Session Transcription and Analysis
Instructions: Place the counselors and clients verbatim statement in each row (Part I). Then identify the counseling skills that the counselor used and explain why that skill was used in the session. Note: each counselor statement or encourager must be identified (Part II.1). Next provide a alternative skill that could have been used and write the actual words you would use. Note: every counselor statement or encourager must have an alternative statement (Part II.2). Next, examine the transference (what the client reaction to the counselor) and the countertransference (counselor’s reaction to the client) reactions. Lastly, write a 1 page paper Transcript Video Critique and Analysis. In this paper you will discussed your critique yourself, skills, and theory used in the session (Part III)
Part I
Part II
Verbatim Session
(1). Counseling-skill used and purpose
(2) Alternative Skill, Counseling Statement, and purpose (please write the actual words you would use):
(3). Transference (unconscious reactions raised in the client by the counselor) and Countertransference Reactions (unconscious reactions raised in the counselor by the client):
What went well (add the start and end time)
Counselor:
Hi,Courtney Thank you for taking the time to meet me today. My name is Estefany. I'm a student at Mercy College. I'm working on my Master's in mental health counseling.
Welcoming client/Introduction.
Building report, establishing client counselor relationship
Warmer welcoming, Ice breaker. It’s a nice day outside. How are you this morning?
None.
Counselor:
Before we begin, I want to go over confidentiality. This is a safe place. Everything that you say here and any notes that I may take during the session are completely confidential. Um, if you state that you will harm yourself, harm someone else or someone is harming you, I'll have to, um, communicate it with my supervisor. Do you have any questions?
Client: No.
Counselor: Okay. Is that clear?
Client: It's clear.
Ethical practice, informed client limits of confidentiality
I could have added a privilege communication with a statement such as “Anything discuss here can’t be released without your written consent”
None
Counselor:
Okay. So, during the session today, I'll be asking you questions to get to know you a little bit better, and then I'll be listening to what you have to say. Um, throughout this journey, I want you to be self-aware and empowered to make the decisions, that are best for you. Okay?
Client: Okay.
Stated frame work aimed towards the goal of the counseling session.
Instead of saying “I want you to be self-aware and empowered” help the client to feel that way. It is not like turning on a light switch—the counselor should facilitate the empowerment by making sure needs are met, using Maslow’s hierarchy of needs as a guide. Better use of encouragers should be made here, for example, by asking, “Is there anything you need from me or are aware of needing before we begin?”
None
Counselor:
So, go ahead and tell me what brings you here today?
Door opener, minimal encouragement, asking for information directly
More direction: this is a wide open question and could go anywhere.
None
Client:
Um, I'm here because I'm finding difficult to balance a new lifestyle that we have due to the pandemic.
Counselor: Okay.
Client:
I think like, there's a few things that are, uh, insensitive, you know, just in terms of dealing, the new celebrity, I call it the new celebrity, like, first responders, or people on the front lines, you know, because there's more people on the front line than doctors and nurses and EMTs. So, you know, one thing that I struggle with is, um, loneliness because my boyfriend happens to be an essential worker that nobody speaks about. And um, he drives, he drives, um, tractor trailers. That's 18-wheelers, so he's going from state to state to state delivering all the goods that none of us would have, if it wasn't for his profession.
Counselor: Mm-hmm (affirmative).
Client: So, honestly speaking, the food from different places, like, you know, just yesterday he told me that he was in Virginia at the Quaker Oats factory, so that's like, oatmeal, everybody eats, you know, everybody eats some form of oatmeal, [inaudible 00:02:32], whatever.
Counselor: Right.
Direct and general response
Counselor could paraphrase to show that he is listening instead of just saying okay.
To make more rows, use tab key
Client:
You know. And, I mean, that's what he's doing, so, I just feel like when it comes to the government, when I say being insensitive, is they just make it seem like the only front line workers are the only people that need assistance, and um, childcare and you know, places to stay to quarantine are city workers and that's not true. So that becomes frustrating because in a way I'm sacrificing, and he's sacrificing, happiness just like everybody else, and togetherness, and wholeness with family, to do a job that equals service.
So that's hard for me to deal with along with this pandemic [inaudible 00:03:21] somebody all the time, or every weekend, you know, you're going from doing something to not doing anything at all, and you can't see the person. It's really tough. And then I felt like the, the whole first responders is like a dagger in the heart, because they're not the only people, you know, that are on the front lines.
Counselor:
Okay. Do you feel concerned about his safety?
Direct question
I would summarize the feelings of the client and paraphrase what has been said to show I have heard her instead of launching right into a query.
Potential countertransference here with the counselor asking if she fears for her boyfriend’s safety. Trying to show concern for him as essential worker to possibly placate the client
Counselor:
I'm not concerned about his safety because he is no-touch freight, which basically means that he doesn't touch anything, he just pulls up and backs into the garage, receiving dock, whatever, they take everything off, he gets paperwork and he leaves. And they're being very, very cautious of contact, so, no. He has a number that he can call when he gets there, and everything's handled that way. It's just these, I'm just like, you know, I'm lonely that I'm frustrated because now I'm here to deal with my kids by myself. And that's tough. I have two boys, one is a preteen, one is five, so the 12-year-old, everything's a challenge, you know, because boys like to challenge their mothers for some reason and not their fathers, so-
The client is seeking validation, recognition that her feelings of vulnerability and not being recognized as making sacrifices are valid.
I would be more affirmative here and let the client know that her feelings are valid and that she is indeed making sacrifices as she states and that it must be difficult adjusting to the new challenges.
None
Counselor: Mm-hmm (affirmative).
Minimal encourager
Not a satisfactory response, however; I would offer more encouragement by repeating back what I have heard and affirming that, yes, dealing with kids by yourself is a challenge. This would show sympathy and build trust.
The patient is looking for understanding and support, which she cannot get from her boyfriend because he is always on the road, so is seeking it from the counselor
Client:
Um. Hopeful-... my kids, their dad is not really involved so my boyfriend picked up in that area, and now that... at first it was tough, then it got a little easier because he came, he helped out, the male presence was here, the respect became, you know, a norm and now it's like, you know, the challenge is back, little by little. And dealing with homeschooling.
Absence of male figure; the client is addressing the root of the problem now
Counselor: Mm-hmm (affirmative).
Minimal encouragement
The counselor is showing that she is listening and is letting the client talk, which is good, but the client should be able to hear back what she is saying so that she knows she is being heard.
None
Client:
There's no, there's no room for challenge, you know what I'm saying. When you have to help two kids in two different grades with homework. And then I also go to school, so I started my Master's this year, um, in February, January. And, um, the reason why I started it is because my little son wasn't as dependent on me anymore, and my older son was self-sufficient... is self-sufficient, and he could take himself to school and he knows how to make a sandwich or eggs or something, you know, to eat and um, he's able to move back and forth on the bus.Um, so I had a little bit more wiggle room and flexibility to go back to school because I had the eight hours in a day that the kids go to school or whatever, eight to 10 between traveling, breakfast program, in school, after school program, so they was in school for a good 12 hours, from 7:00 to 7:00.
Client is shifting to her personal ambitions now and rationalizing her return to school.
Counselor: Okay.
Minimal encouragement
I would definitely summarize at this point, because a lot of ground has been covered and some important points need to touched upon and reiterated before moving on.
None
Client:
So, um, I would usually pick them up at 6:00, or pick up my little one at 6:00, so now I was, I'm stripped of those 12 hours [inaudible 00:06:24]. And those 12 hours is a major difference in day-to-day. I'd get to have a few moments of peace in those 12 hours, I get to work, I'm a hairdresser. So I get to work and interact with adults, I can't do that anymore, because we're in, we're sheltered in place, so, we have to stay home. So everything that I'm used to doing has been literally taken away from me.
So that's working, having a moment to myself, getting to go be, you know, do things with my boyfriend and my family and can't, like, they're gone. My boyfriend is gone, working [inaudible 00:07:04] and he does not want to come back in the house because he's been in the street, he's been, he's been in other states, you know, and he, he, he cannot deal with the fact that this thing is around and he doesn't know if he has it, he don't have it, and coming here, home, for 24 to 48 hours just to sleep and go back to work, is dangerous.
Circling back to the impact of lockdown on her personal mental health and inability to socialize; she has the kids full time now whereas school used to have them; she is finding it difficult to adjust to all these responsibilities.
Counselor:
Okay. So, I feel like you are overwhelmed, uh, with the situation. Tell me what feelings are contributing to... what thought are contributing to those feelings?
Attempting to summarize with a reflection of feelings (“overwhelme, uh, with the situation”). Door opener to more introspection and reflection with next question
Poor attempt at summarization and reflection of feelings. No paraphrasing. It sounds like the counselor is only barely listening. I would highlight the pain points and bring those to the fore so that they can be focused on and explored in a more meaningful and productive way.
Possibly the counselor is feeling overwhelmed by the situation and is not knowing how to proceed.
Client:
Well, the thoughts that I'm having when it comes to my loneliness is just is, I just miss my boyfriend, I wish he was here. And then I understand why he can't be here, I just, I... and it makes it a little easier because I understand that he's being cautious and trying to protect his family.
And the frustration comes in... that's another feeling, because I'm frustrated at this remote learning with my kids, and myself, in college, and, um, and I'm also frustrated with the, the wording of everything in news, in the media, like, I'm frustrated with the fact that they want to make it seem like first, first responders are the only important people. And they are the only people that need help.
And they're the only people... like, yesterday, I watched the news, which I try not to do too often, but then, you know, Governor Cuomo said that mental health counseling is free for the doctors and the nurses. Well, what about everybody else? What about the women that are... Domestic violence went up 30% since Ap-, since February, since March. What about those women or those men or those children that need help? Why do we only care about the first responders, like, that shit's crazy to me. I don't understand
Forced to repeat herself because the counselor has not properly summarized and paraphrased.
Client:
So, that, that brings me frustration. They get free services, but there's people out there that need the help. There's people out there who do not have insurance. There are people out there that, you know, don't have jobs, you know, that don't have childcare or that have jobs, like, this worker I seen in the [inaudible 00:09:38] and works in Rite-Aid. And she was crying because she was about to get fired because literally she had no childcare, to come work in the pharmacy. But that's not a frontline worker.
Frontline workers, frontline workers, literally, they want to categorize into FDNY, EMT, doctors, nurses, policemen.
Counselor: Right.
Minimal encouragement
No summarization, no paraphrasing, the counselor is basically not responding to the client and should be doing more to show that he is hearing what the client is saying by repeating these feelings back to the client.
Transference: Again, the client is feeling obliged to seek recognition from the counselor because none is forthcoming.
Client:
You know? But you've got truck drivers, you have people working in supermarkets, you have people who work in the pharmacy. People working in the dollar store. Stores that you want to keep open. You know, so it's just like, it's frustrating, because politics is... politics shouldn't be in this. So, that was a rant, but it's just how I feel.That, that causes me frustration. It also causes me anxiety, because, you know, as soon as I get a, like a, like a newsflash to my phone, I'm just like, what now. So.
When it comes to the school, my son is over with school next week. I'm over school next week. The little one still has school, but at least those two things is like, like, close to the finish line. So, I have relief in that. That is relief. And they did not say anything about keeping the city closed yesterday. They supposed to reopen the city on the 15th, so, I'm, I'm optimistic there, because even though it's, you know, it's a crazy world and it's scary, I would like to get back to work, 'cause in my line of work, I don't get unemployment or you know, sick leave or some type of family leave act, or any of that. I work for myself and if I'm not doing hair, I'm not making money.
The client continues to repeat herself because the counselor is not providing any indication of actually hearing her.
Counselor: Right
Minimal encouragement
This is unsatisfactory and the counselor should be more responsive.
Client:
So. That makes it difficult, you know, that puts stress and strain on things, too, when it goes from two incomes, two lucrative incomes, to one.
Counselor:
Okay. So I feel that you're taking not only the frustration of your situation but, you know, the overall situation, like the social,situation, which may be a lot at this time, um, with your own situation on top of, you know, the world and how we're evolving and changing things by minute. But I see you're feeling positive, too, right, you feel, you know, that at the end things will get better
Far too vague in summarizing the client’s issues and no paraphrasing here. The counselor is attempting to reflect the feelings of the client but this is not a good job. There is nothing specific stated here, no reference to the boyfriend, the lack of recognition from the media, the challenges of being a single mother out of work—there is no indication that the counselor has heard anything. The counselor attempts to redirect with a positive note.
The counselor should have been paraphrasing and repeating back to the client what he has heard all along. Now all he has to offer is a vague sense of the problem, and the counselor’s redirection rings phony. I would be showing more empathy by highlighting the issues, validating them for the client and then working with the client to focus on activities and thoughts that could be helpful in the face of the triggers that stimulate negative thoughts and feelings. This needs to be done to facilitate cognitive behavioral theraphy.
Counter-transference: the counselor is now projecting confusion and indifference onto the client and hoping for a positive return.
Client: Yeah.
Counselor:
Now, tell me about that positivity, what else is there. You're optimistic, you know, like, tell me about how you feel optimistic about everything else.
Door opener here for more positive thoughts, but it is forced and not very well executed.
The counselor assumes that the client is optimistic even though the client has given no indication of optimism. I would rephrase this differently and ask the client if there is anything positive in her life now that she can point to and build on that.
Counter-transference: the counselor is transferring his own optimism onto the client instead of helping her to identify her own.
Client:
Um, I'm, I'm optimistic [inaudible 00:12:38] looking forward to increased happiness with going back to work and allowing, you know, that would allow my boyfriend to be able to maybe stay home for a week, you know, and not have to just be on the road, be on the road, be on the road. You know, to make sure that everything here is upkept.
Part III: Transcript Video Critique and Analysis (#5 assignment in the syllabus)
The counselor was too lax in affirming the client’s sense of feeling marginalized and unsupported. There was no effective summarization or reflection of feelings made, no paraphrasing used, and only minimal encouragers like, “Mm-hm” and “Right” and “Okay.” These are effective at keeping a client talking, but they are not the only tools to use to help the client process the negative feelings. In behavioral and existential therapy, triggers of negative feelings need to be identified, and the client did this but the counselor did nothing to touch on them. The media was one trigger and that should have been discussed. The boyfriend’s absence was another trigger and that should have been discussed in a more positive and helpful light—for instance, in terms of how the client could overcome the challenge of his absence: what tools are available to bring him into their lives even though he is away. Perhaps through frequent Face Time using the Internet while he is driving, or sending video messages to let him know he is missed, and getting the kids to say hello. Types of digital communication like this are good ideas for overcoming the time and space challenge. The problem of school and work being closed is another challenge, but this too could have been addressed with questions about what the client does during the summer months when school is out and how she adjusts during that time. The counselor showed little to no ability to actually engage with the client and help her to begin working on positive thoughts and actions to help counter the negative triggers. More could have been done to empathize with and validate the client’s feelings through simple re-stating of them back to the client, but instead time was wasted by having the client repeat herself all over again at the end. The counselor was not actively engaged and was far too passive.