Helping a Highly Stressed Client
A client comes to you having had to quit work due to a degenerative visual impairment. He has a 3 year-old child and his wife is expecting another baby. His sight may continue to deteriorate or it may remain at the current level. He is suffering stress, feelings of grief and loss and anxiety about the future.
How would you go about helping this client?
November 24th, 2007 at 6:03 am
The main issues are: stress; anxiety; loss and grief; loss of employment; and possible further deterioration of eyesight. Each of these issues could have underlying problems that may need to be explored.
Stress and anxiety will hinder the client’s ability to find solutions to the other issues. Therefore the first thing to do, is to teach the client relaxation methods and the importance of practicing them on a regular basis. Untreated stress can lead to other health problems, which could escalate the problem. If the client can learn to relax, then other issues will not seem quite as overwhelming and finding solutions will be much easier.
His feelings of loss and grief need to be handled carefully, I would therefore use a person-centred approach to allow full expression of the multitude of feelings he is experiencing. With careful observation, you can judge when he is ready to move on and explore options for dealing with the more practical issues he is facing. At this time, a solution-focused approach may be more suitable.
I would only use influencing techniques when absolutely necessary, in order that the client is allowed to find their own solutions. Whilst this is important in most counselling situations, in this particular case it is even more so. This client has lost control over his eyesight, his health, his employment and his dreams for the future. He needs to be given back a sense of having some measure of control over his own life.
It is possible that the disease is hereditary. I would therefore explore whether a relative of the client had to deal with this problem. The client’s fears about his own situation could be linked with that situation. For instance, if his father had the disease and lacked support services, the client may be afraid that he will face the same issues, without realising that services may well have improved. He may also be afraid that the disease will affect his children later on.
If he has never encountered this problem before, he may have a lot of unanswered questions and if I can give him this information, this could ease some of his anxiety. I would obtain this information by talking to his doctor or some other medical person, after obtaining the client’s permission to do so.
Furthermore, I would research what services are available to assist him with his eyesight-related issues. Retraining may be available to either enable him to continue in his former employment or to find a new direction.
In summary, I would focus on the client’s strengths by exploring how he has coped with adversities in the past and use reframing skills to assist him to see his family, including the expected child, as an asset, rather than a part of the problem.
November 24th, 2007 at 6:04 am
There would be several steps involved in helping this client and the best counselling service outcomes may be achieved by taking a case management approach. In the first assessment appointment I would ask the client to tell me about the visual disorder, any visual changes over time, the way in which he found out about the impairment and the effects that it has had on his life to date.
In subsequent assessment appointments I would be finding out how the visual impairment had impacted on him emotionally and psychologically, any anxiety history, relationship problems, effects the vision impairment has had upon his relationship with his wife and child, and his attitude towards his impairment and the future. It would be important that a positive approach to the client and his future, based on his abilities, would be adopted, and demonstrated towards the client, as the approach taken by all significant carers will influence the way he responds to his circumstances.
If the client is experiencing low vision, time would be taken to discuss appropriate support networks and he would be helped to find suitable services and to make contact with them. The state based Blind Association, for instance, may be able to assist this client and his family with financial concerns or practical services such as visual aids or a reading service. The client would be encouraged to contact a specialist visual rehabilitation centre, available in larger hospitals or universities (such as the Queensland University of Technology), for a multi-disciplinary assessment.
At such centres the client may access an optometrist, social worker and occupational therapist who together can provide an assessment of the client’s activity management. Information, advice and aids that may assist the client to maintain an independent lifestyle or improve life quality would also be provided. As with most degenerative disorders the client will benefit from having accurate and comprehensive information about his prognosis to enable psychological adjustment, planning and direction for rehabilitation efforts.
A Low Vision Support Group, available in capital cities and regional centres, or a telephone service such as the Vision Information Line, would provide emotional support. The client would be encouraged to contact Commonwealth Rehabilitation Services Australia, which assists people with injuries or other problems to rejoin the workforce. This service is free to people receiving a Centrelink benefit.
The client would also benefit from a medium term counselling program. The client would be asked to set his own goals in relation to his anxiety, stress management and grief reactions. These specific and measurable goals would be clarified, reality tested and discussed within a preliminary session alongside a discussion of counselling expectations, explanations and requirements. The client would be asked to participate in homework assignments including cognitive behavioural techniques of “mood monitoring” (evaluating mood on a numerical continuum and recording extremes and time of day), daily thought journal and activity journals.
This information would be particularly valuable in helping the client to manage his anxiety. Cognitive assessment would facilitate stress management also in helping the client to understand what thoughts and behaviours, triggers or experiences may coincide with the increase in stress symptoms.
Stress management techniques such as breath control, progressive muscular relaxation, guided visualisation, thought distraction and thought stopping would be taught to the client and the client would be encouraged to practice the techniques he finds most helpful. He would be encouraged to talk about his feelings of grief, his experience would be normalised or legitimised and the grief process would be discussed. The client would be encouraged to disclose his thoughts, feelings and experiences in a context of non-judgemental respect and acceptance, with appropriate challenging of feelings of hopelessness or helplessness.
After the relationship has been developed and the primary focus established the possibility of referral to relationship counselling would be explored. The adjustments required to manage stressful life circumstances, particularly one with far-reaching financial, occupational and family consequences, is likely to impact upon the client’s relationships and the wellbeing of the family.
Ongoing monitoring of the counselling process would be a consultative approach, with the client examining life situation and outcomes against counselling goals. The termination of the counselling process would also be carefully evaluated, as it is vital that the client understands that his visual impairment does not limit personal responsibility or coping ability. The termination process would commence when the client is displaying signs of being able to manage anxiety and stress symptoms independently, and has become more purposeful in future planning.