Psychology and education

Part I:

            Susan/client is an educated, white woman who suffers from an eating disorder that has impaired her personal perception, relations and overall quality of life. Among many reports of mixed feelings related to her eating disorder, Susan also reported that she was worried about her current weight (96 pounds) as not being low enough to meet the diagnosis criteria for Anorexia Nervosa. Client first noticed her eating disorder in grade school when she was sick and missed a few days. Upon returning back to school she reported that it felt good to receive compliments on her weight loss. The worst she has ever gotten was down to 87 pounds in her mid twenties. At her best she reported to be 118 ponds, when due to her accomplishments such as obtaining a Master Degree, a great job and with that financial independence her weight obsession diminished. Suzan is clearly presenting characteristics that define Anorexia Nervosa with cross-over between subtypes, restricting and binge/purging but more information is needed to clearly identify her eating disorder. 

Part II:

Client Statement # 1 (CS): I do not want to eat because it seems like I gain weight immediately I eat which makes me feel like I look fat or bulgy thus making matters worse. Even though there are times where I cannot help but eat, I always have the urge to purge or take laxatives.

CPP: Smiles while talking and at times posterizes with hands

TT: Although the client is aware of what she is doing wrong, she is not really concerned about stopping. She believes that her actions are justified because they help maintain the weigh she is comfortable with.

TA: The client is overly obsessed with her weight and is more concerned on how she looks than the effect that her actions has on her body.

 PS: you are really concerned over your weight and how it affects your image.

RF: You are worried and depressed that eating affects your body image negatively.

V: Although the approach you are taking to maintain your desired body weight is harmful to your health, the desire to not add weight is common amongst teenagers your age.

 

Client Statement# 2 (CS): Worrying about weight it gets really obsessive like getting on the scale 10 times a day.

CPP: Maintaining strong eye contact.

TT: she is just like any other teenager who wants to abide to the image portrayed by society as ideal.

TA: like most ladies, the only way she will be comfortable is if she maintains an image that is acceptable in society.

PS: you are really bothered by adding weight that you even try to lose it before it is gained.

RF: you are depressed and paranoid that any amount of food will result to you adding weight.  V: It is understandable that you want to lose weight; however, you could try more healthy ways to do it.

 

Client Statement# 3 (CS): Body- It feels fat. When I look in the mirror, especially around the stomach and hips, and the back, it just looks fat…it hangs, almost like I’m pregnant.

CPP: points at the various parts of her body that she believes are overweight and are causing her issues.

TT: I wonder if she will ever be satisfied with her weight. She is on a cycle where the more weight she loses the more she wants to lose.

TA: Like with all other eating disorders she feels as if her self-image is distorted

PS: she does not see the weight she has lost; she only sees what more she wants to lose.

RF: You are worried about something that you should not concern because being overweight is all an illusion.

V:No clear spoken validation.

 

Client Statement # 4 (CS): Since I cannot monitor what I eat, I end up eating everything on my plate.

CPP: Moving head and then finishing sentence with her gaze fixed at me.

TT:  the client was angry and frustrated because no matter how hard she wanted to reduce weight, she could not prevent herself from eating often too much. 

TA: The client was frustrated over the wrong thing. She is mad that she eats too much and blames herself for adding weight.

PS: she is not really mad that she eats too much but rather because she thinks it makes her overweight when it really does not.

RF: you are frustrated and angry but it is over the wrong thing.

V:  it is normal to be frustrated when you feel like something is getting in the way of all your efforts.

 

Example Client Statement # 5 (CS): There was a time when I thought I got it under control. I was not using the scale at all. I ate regular meals and weighed around 118 pounds.

CPP: Client uses a lot of hand gestures to show what she used to do in the past.

TT: She is aware of other times when she felt different and weighted more than she does now.

TA: Client ideal weight is 118 pounds.     

PS: Client has a target weight that she wants to reach

RF: None

V: None

Client Statement # 5 (CS): I didn’t think I would be sick enough to be anorexic

CPP: maintains eye contact

TT: the client is aware of the problem that obsessing about weight has caused for her.

TA: Client is aware of her problem and is willing to do something about it.

PS: Her decision to come see me was so that I could help her get the guidance she needs.

RF: Most people who accept that they have a problem that they are unable to resolve on their own often seek professional help.

V:None

 

Part III:

 1) What were your initial impressions of the client?  How did you form those impressions and what influence did they have on your ability to listen (to both content and process)?

We were viewing the video clip in class. I was concentrating on taking down statement notes for this assignment while watching. We only watched the video once. All I can say is that the setting was not ideal for me to be able to form a first impression. Then it is not in my nature to judge a book by it is cover. Although I feel pressured by this assignment to respond with my first impression, I would rather stay true to myself and see what I can learn from that. There is a high demand to report client’s appearances in our field and I should start paying more attention to “first impression” as I develop into my profession. First impression can be extremely deceiving. Unfortunately one’s presentation is the first thing others see and based on that first impressions are made. But for this assignment I would rather not discuss my perspective on first impression and state simply the facts. I was so focused on the writing down of client’s statements that I do not think my ability to listen was influence at all by my first impression.

2) Were you emotionally present throughout the session? Were you distracted by anything? What was your emotional response?

Although it involved taking a lot of notes, I tried to be as emotionally present as possible. I realized that by taking notes and keeping records, I was able to memorize better and understand what I am listening to. Writing also helped me to process my feelings and express myself better. However, one thing I found challenging was deciding which statements were worth noting down so as to remain significant and come up with informed solutions.  I was pushed towards an emotional reaction at some point in the session when the client was narrating her past and the trauma it had caused throughout her life. Although one cannot prevent themselves from having an emotional reaction, it is important to mind as less as possible so as to be opinionated and this is what is required of a professional therapist.

3) Were you able to remain client-centered and non-directive?  If so, how did you accomplish this, if not, what interfered?

To my best ability under circumstances I believe I was able to remain client-centered and non-directive.  Most attention was given to the client so as to identify what issues she was dealing with so as to come up with solutions that are based on well informed information. Rather than telling the client what to do, I guided the client down a path where she got to see the core of the problem on her own because only she could make the decision to solve it.

4) What did you do well? How can you continue to improve?

I did well under circumstances. I was able to take enough notes for this assignment while watching the video in class and remain somehow client-centered and authentic.

To improve I will need to be more assertive about my process of learning. I need to step up and ask to watch the video again if needed and have clarifying discussions with peers and teacher about the assignment in class. I would have done much better with extra time for this assignment and in general. I fell that there is not enough time to listen to our clients and instead of advocating for more time I find myself following the mainstream and not felling satisfy with my performance. Self-assertiveness and client’s advocacy is what I need to improve so I can better balance my practice.