The client is a Caucasian female dressed in a short maroon dress with high heels. She looks inebriated and her speech is full of slurs. She is very argumentative but respectful. Generally, she looks disturbed, anxious but firm on her opinions.
The client articulates that she has been having frequent arguments with her partner because she drinks execessively. She describes herself as a social drinker who consumes between 3 and 6 bottles in each of her 2-3 drinking sessions a week. She started drinking when she was 13 in the company of her cousin and older school friends. In her junior and senior years, she became a lesbian. She and her partner Angie moved together in an apartment. Later, they decreased their drinking habits as a result of finances and interests in their careers. However, as they became involved with older lesbians, they increased both their frequency and quantity of drinking.
The client is eloquent about her ideas but does not seem to understand some of the things she says. She forgets quickly and sometimes has to contradict her own views. She does not maintain eye contact, especially when talking about lesbian relationship. She deploys a very shy and anxious demeanor when discussing her alcohol intake. Her voice rises when she starts to talk about her history of alcoholism. The client becomes restless when speaking about the nature of her relationship with her partner. Her body posture is that of a person who does not care about how she is dressed. She lacks decency in her sitting position and does not care.
Assessment of Progress
The client is experiencing a generalized anxiety disorder (GAD) based on assessment using the DSM-5. In specific, she has an excessive anxiety and worries about a variety of issues including her relationship and alcoholism. Additionally, her worrying is challenging to control. Moreover, both the anxiety and the worry are accompanied by restlessness and impaired feeling which make the client feel as though her mind goes blank. Using the Generalized Anxiety Disorder 7-item (GAD-7) scale, the client fits most of the criteria as she is anxious and not able to control her worries (Cuijpers et al., 2014). Additionally, she becomes easily irritable with questions about her alcohol history.
Plans for the Next Session
Short Term Goals
Some of the short-term goals which will be accomplished are to reduce the overall frequency as well as the intensity and duration of anxiety so that the client's daily activities are not impaired. In the short term, the focus will be on the development of trust with the client and provide her with support and empathy so that she can feel safe expressing her GAD symptoms.
Long Term Goals
The long term goals will ensure the client is taught about calming relaxation skills such as progressive muscle relaxation, mindful breathing, and applied relaxation. The second goal will be to assign the client homework for her to practice relaxation exercises daily. The client will also be assisted in analyzing her worries and removing any potential biases such as those to do with the worst possible outcomes.
During clinical supervision for their first new clients, new counselors experience various challenges related to the gaps in knowledge between clients, and lack of proper counseling skills. In specific, different clients have different levels of education and knowledge which makes it harder for new counselors to understand their problems (Borders, 2014). Moreover, lack of practical skills makes it hard for new counselors to accurately read the verbal and non-verbal actions of clients. As such, clinical supervisors have the role to support the new counselors by assisting them develop practical skills which make them more competent and hence provide better counseling services. Lastly, they should support them with various ways in which they can read their clients and the most effective way to apply theory in supervising clients.
Borders, L. D. (2014). Best practices in clinical supervision: Another step in delineating effective supervision practice. American Journal of Psychotherapy, 68(2), 151-162.
Cuijpers, P., Sijbrandij, M., Koole, S., Huibers, M., Berking, M., & Andersson, G. (2014). Psychological treatment of generalized anxiety disorder: a meta-analysis. Clinical psychology review, 34(2), 130-140.
NIAAA. (2018). Case Examples. Retrieved from https://pubs.niaaa.nih.gov/publications/social/Teaching%20Case%20Examples/Case%20Examples.html
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