Helping Rose

Rose is the mother of a five year old girl who has difficulty with her daughters sleeping pattern. Rose's daughter became ill very soon after birth. This constant need for attention coupled with the fact that Rose was herself a new mother; meant Rose and her child immediately started a routine of dependency. Her daughter would cry out or scream, and Rose would go to her side or bring her into her bed. This would calm the child almost instantaneously, so much so that any attempt to return her daughter to her own bed would result in the resumption of screaming. This disruptive pattern would repeat itself several times a night, leaving Rose exhausted and frustrated the following day.

Several attempts to introduce reinforcement and reward to address this pattern were made by Rose who would tell her daughter that "Santa would not come", or "she could not go on school trips" if she did not sleep in her bed. While providing some short term gains, they did not achieve any lasting results. Once the incentives had run out her daughter would resume the routine of not wanting to sleep in her own bed. After having exhausted her own interventions, Rose sought counselling from Dr Berenson for a solution. The approach that was employed during the session by Dr Berenson however, warrants a closer review regarding his methods as a counsellor. These include such components as the client counsellor relationship, the effectiveness of the counselling techniques used and the effect it had on the therapeutic relationship between Rose and Dr Berenson.

Dr Berenson adopts a humanistic approach during this session. This approach involves using person-centred therapy. This places much of the responsibility on the client, and encourages the treatment to play out in a non-directive role for the therapist. During the session Rose expresses the love she has for her daughter, and she indicates how much she struggles when she screams out. She acknowledges that by allowing her to come into her bed she has prolonged the situation. Even so, Rose has understood a clear coalition of her daughters abnormal sleep patterns and the illness her child had soon after birth. Dr Berenson however fails to flag this critical aspect of the development of the issue, focusing instead on advising Rose on how to proceed. This advice is vague and strongly insinuates that Rose was not expressing enough love toward her child. He dismisses Rose's attempts telling her to take small steps and to "go with her heart". The sessions concludes with Dr Berenson stating to Rose that "he was not telling her anything she wasn't already aware of", and closes the session by completing her last sentence for her. By this point Rose has become submissive and her responses have turned quiet, she giggles and agrees with his assumptions and recommendations. (Australian Institute of Professional Counsellors, 2010)

The counselling session was quite short in time, and did not give Dr Berenson sufficient time to confidently form an action plan or diagnosis on Rose. The complexity of Rose's case is summarised by Dr Berenson as a relationship and emotional issue. Because of the unsuitable nature and the interview setting in which the session was being conducted. This may have impacted on the communication between the client and the counsellor. The communication is also compromised by Dr Berenson actually suggesting to Rose during the session his concern regarding if they are "messing up the interview or not".

In this artificial setting, it would be challenging to develop a therapeutic counselling relationship. The quality of this relationship can affect the successful outcome for therapeutic change. The fundamentals to strengthening the therapeutic relationship are believed to be Rogers' core conditions of empathy, unconditional positive regard, and congruence (Rogers, 1962)

These core conditions are vital to support change and improvement. One of these core conditions is empathy. It is characterised when the counsellor understands the words and feelings of the client and acknowledges their point of view, and can accurately recognize the client's intent behind what they are trying to express. This relays "acceptant understanding" back to the client. Empathy is a crucial element in establishing trust in the therapeutic relationship. Without trust the client is unlikely to be receptive to invitations from the counsellor to "engage in self-challenge" (Egan, 2009)

In the beginning of the session, Dr Berenson exhibited basic empathy when interacting with Rose. He showed this when Rose was explaining her story, by giving minimal responses such as "mmm" and exclamations like "boom!" to encourage her to continue talking. Dr Berenson also shows evidence when he replies to a comment made by Rose, by saying "...when there are these lapses, then it leaves you feeling kind of helpless". It is clear that Rose acknowledges this as her response "right, that's exactly what it was..." confirms Dr Berenson's assumption.

Nonetheless, Dr Berenson does not consistently show this basic level of empathy throughout the session. However, as the session progresses Dr Berenson attempts deep reflection also known as advanced accurate empathy towards Rose. This is a complex method of empathy and occurs when the counsellor can recognize that there are deeper issues below the client's level of conscious awareness (Dave Mearns, 2007).

Dr Berenson's attempt at deep reflection could have been detrimental to the therapeutic relationship. Statements such as "you're also searching because you want to discover what it is your daughter is testing in you" made by Dr Berenson were delivered too early, and their relationship was not strong enough. Dr Berenson's interpretations could be misconstrued as 'moralistic advice' and is contrary to the basic principles of counselling. Given that it was early in their relationship Dr Berenson should have given Rose the opportunity to explore these feelings on her own by asking questions to encourage her to discover these feelings. This alternative would have also been beneficial in employing the core condition of unconditional positive regard, as it would show assurance in Rose's ability of self-discovery (Yeo, 2007)

This unconditional acceptance is defined as the core condition of unconditional positive regard, and is essential in fostering a sense of security within the therapeutic relationship. When the counsellor accepts the client unconditionally, the client is open to exploring their feelings and may willingly divulge information about themselves without fear of judgement or censure. This freedom encourages self-discovery without any prerequisites or the pressure to meet behavioural criteria