Author: Jane Barry

A précis of the sessions is as follows. For ease of writing the Professional Counsellor is abbreviated to “C”.

In the first session, “C” asked some open questions to prompt Mary to start discussing her dilemmas. Mary was able to convey the events leading up to her problems clearly, although was reduced to tears when discussing her seemingly overwhelming feelings of being alone and unable to cope with her circumstances. “C” allowed Mary the time to cry and acknowledged her need to release her feelings. When she was more calm, “C” continued with gathering some of the background information.

Essential Case Information

Mary has been married for 13 years and has two daughters aged 9 (Christine) and 13 (Jennifer). About 9 months ago, Jennifer suffered a brain injury after a sporting accident. Since then, Mary and her husband have had to teach Jennifer to eat, walk and talk again. They have attended numerous doctors, and specialists appointments in regards to the treatment and rehabilitation of their daughter.

Jennifer is now able to talk again, however her speech is slurred and her vocabulary is still developing. She has difficulty walking unsupported and Mary helps her to shower, dress, eat, go up and down stairs, get out of bed, etc. Mary has quit her part-time work to stay home and look after Jennifer. Mary misses the opportunity to work and have contact with her friends there. Phillip has cut his work hours to part-time in order to help support their two daughters.

Mary states that she hardly recognises the girl that Jennifer used to be before the accident, the new Jennifer is more demanding, throws screaming tantrums, and seems to resist Mary’s every effort to help her. Mary grieves that she can no longer have the daughter she once had and she feels overwhelmed to think that Jennifer will remain this way for the rest of her life.

Lately, Jennifer seems to favour Phillip’s efforts more than Mary’s. She said that Phillip seems more able to convince Jennifer to shower and dress, whereas Jennifer has been refusing to dress or shower for Mary. Jennifer would have a screaming tantrum, whilst Mary directed her towards the shower. She has started to resent her husband’s apparent ability to control Jennifer and is very critical of her own ability as a mother.

Phillip had started to give Mary advice about how to handle Jennifer, to which Mary responded angrily. She thought that he should be supportive of her efforts, not give her directions, and this further reinforced her beliefs about being an inadequate mother. Mary feels that her husband is withdrawing from her, focussing more of his attention on his two daughters and his work.

Mary has had little time for her friends and other family. She has been dismayed to find that many of her friends and relatives have distanced themselves from her family. She hasn’t talked to her closest friends, feeling that she doesn’t want to burden them with her troubles.

Mary has not been sleeping well, as she lies awake wondering whether her life will be this difficult forever. She can’t see an end to the predicament and she is tired of feeling stressed, and having such conflict with her family.

Session Details

“C” let Mary discuss her issues fairly openly for the first session. “C” used active listening skills to let Mary know that her feelings and experiences were important. Mary had been experiencing insomnia and mood swings for the last 4 months and due to this, “C” believed that she was suffering from chronic stress. Mary described that initially she had coped well with the tragedy, as her attention was focused on the rehabilitation of Jennifer.

At the end of the session, “C” commented that Mary was showing signs of chronic stress and explained some of the symptoms to her. “C” validated Mary’s feelings of being unsupported, unable to cope and her grief as being normal responses to the tragedy of her daughter’s accident.

Mary indicated that she was feeling a little lighter, after talking about her issues with someone. Mary and “C” discussed some things that Mary could do before the next session to reduce some of her stressful feelings. “C” suggested some relaxation strategies for Mary to use, such as deep breathing and listening to meditation tapes. “C” also gave Mary some examples of positive affirmations she might use to calm her thoughts, for example: by clearing her mind and saying, “I am relaxed” when she breathes out.

Mary decided to visit her G.P. to ask about medication (and alternatives) that may help her to sleep a little better, as a short term solution. Mary also decided to organise some time to talk to a close friend about her predicament, as a means to re-establishing a support network for herself apart from her direct family.

In the second session, Mary told “C” that she had talked for a long time with her friend. Her friend had been very supportive and helpful, and Mary wished she had contacted her friend sooner. Mary’s friend had suggested a herbal sleeping remedy that Mary should try and also gave her some relaxation music to listen to before going to bed. Mary had been sleeping a little better since using the music and herbal remedy, so she decided not to see her G.P.

Since Mary seemed less stressed in this session, “C” conducted a Personality Need Type Profile for Mary. The test indicated that Mary was a type ‘B’. “C” explained about the high social needs of ‘B’s’ and Mary thought that this was true of her personality.

Mary said that her husband was pleased that she was seeing “C”. She explained that they were still arguing about Jennifer, as Jennifer was refusing to shower this week for Mary. Phillip had said to not push Jennifer to shower when she didn’t want to. Mary felt that Jennifer was just trying to be disobedient and upset her. Mary was visibly upset about the conflict with her daughter and husband.

“C” talked about some of the cause and effect relationships that were involved in Mary’s predicament, such as:

  • Traumatic accident causing:
  • Grief about the obvious changes in Jennifer
  • Pressures on Mary’s ability to cope
  • Lack of contact with people, due to friends and family’s inability to relate to what had happened to the family
  • Confusion for Mary about how to deal with an incident she has no experience
  • Change in lifestyle for Mary – having to quit her job and stay home as a full-time carer
  • Lack of social contact

Jennifer’s temper tantrums and refusal to be helped causing:

  • Feelings of frustration to accept Mary’s assistance
  • Feelings of inadequacy as a mother

Criticism / Advice giving from husband causing:

  • Feelings of inadequacy as a mother
  • Anger about the perceived lack of support from husband
  • Feeling alone in her attempts to cope with her situation

Feelings of inadequacy and inability to cope causing:

  • Hopeless feelings about the future for herself and her daughter

Attitude that she is alone in her predicament causing:

  • Her B type personality needs to not be met
  • Stressful feelings

Separation from friends, social activities causing:

  • Her B type personality needs to not be met

These are some of the main cause and effect relationships that “C” outlined for Mary in her situation. “C” then asked Mary what she wanted to focus on in the counselling process. Mary wanted to work on how she could cope better with Jennifer and re-establish the bond between herself and her husband.

“C” explained to Mary that “C” was not qualified to give advice about how to deal with Jennifer’s behaviours given that she had an acquired brain injury (ABI). “C” explained that damage to certain parts of the brain can cause changes in behaviours, and Mary would require the advice of trained professionals (ie: cognitive psychologists) to suggest appropriate behaviour modification strategies.

“C” provided Mary with a number of health and community organisations who specialised in treating and providing information about ABI. “C” also suggested that Mary ask these organisations about support groups for parents with children with ABI. “C” explained that as a type ‘B’, Mary would probably enjoy being involved in such groups and it would enable her to have more social contact. Mary said she would definitely try to find a support group to join and was planning to ask Phillip to attend them with her.

In the meantime, “C” talked to Mary about possible causes for Jennifer’s non-compliance. They discussed Jennifer’s need to do things unaided and the effect of the disability on Jennifer. If Jennifer thought that she wanted to do things unaided and Mary thought that Jennifer needed assistance, then the conflict may be occurring over their differing attitudes. Mary and “C” discussed Mary’s attitude of what a good mother is.

“C” and Mary developed some mediating responses for Mary to use when her daughter did not want to be assisted. Mary could say to herself “I am a good mother and I recognise my daughter’s need to do things independently and when she wants” or “I love my daughter, I let her shower when she chooses”. “C” and Mary also developed some visualisations such as: picturing herself remaining calm when Jennifer had a temper tantrum and dealing with Jennifer’s issue when both were calmer.

“C” also suggested that Mary talk to Phillip about handling Jennifer if Mary did not feel able to remain calm in the situation. In this way, Mary and Phillip could work together in parenting their daughter and help ease Mary’s fears of being unsupported by her husband.

“C” also mentioned that Mary could try to praise and reinforce Jennifer’s attempts to do things for herself.

In the third session, Mary reported that she and her husband had, had a long discussion about Jennifer. Mary talked to him about her changing her attitude about how she should be supporting Jennifer. She also told him about her feelings of inadequacy and that she feared that he also thought she was a terrible mother. She explained about her type ‘B’ needs for his company and attentions. Phillip told her he thought she had always been extremely supportive of Jennifer and reminded Mary of all the effort she had put into her daughter’s rehabilitation.

He had noticed lately how angry and critical Mary had seemed, when he had attempted to help her with Jennifer. He thought she was trying to force Jennifer into patterns that Jennifer wasn’t happy about. He also admitted that he didn’t really know how to cope with Jennifer’s behaviours all the time either. Mary reported that Phillip was unsure as to how to help her, and was concerned about her stress. He had withdrawn himself because he thought she did not want his opinions.

Mary stated how relieved she was to hear Phillip’s support for her and she understood why he had distanced himself from her. She also understood how her anger and feelings of insecurity about her capabilities had effected Phillip’s behaviour.

Mary talked to “C” about the possibility of having counselling for herself and her husband, to which “C” agreed. Mary said that Phillip was interested in improving their communication with each other, however he wanted to meet “C” before he committed to any counselling. Mary commented that Phillip expressed interest in attending groups or courses to learn more about ABI. “C” reinforced to Mary that these strategies would also help to fulfil her type ‘B’ needs for social contact.

In summary, “C” asked Mary about her current stress levels and what strategies she was using to combat these. Mary said that sleeping was easier and she would continue to use her herbal remedy and relaxation music. She was starting to develop quite a collection of tapes! “C” also suggested some exercise to help combat the effects of the stress. Perhaps walking with her husband in the evening, as a means of taking the time to talk to each other. “C” also reminded Mary to keep in contact with her friends and to try and build up some social support for herself, in order to meet her personality need for social contact.

In future counselling sessions with Mary and Phillip, “C” suggested they may like to discuss their feelings of grief and loss about Jenny’s accident and the issues that it brought into their life. They could do this in conjunction with improving their communication skills.

“C” also reinforced Mary’s decision to join a group of parents who had similar experiences in raising a child with ABI. The group could provide her with support and understanding about the experiences she had. She may also learn new strategies to cope with her daughter’s disability from those who were also in the same situation. “C” also reinforced that Mary and Phillip should seek assistance from a psychologist to help them develop strategies to manage their daughter’s behaviour.

Mary felt that she now had some direction to follow and did not feel so hopeless about the future. She realised that she had been experiencing stress from the change in her daughter’s life and her perceived inability to cope. Mary was still faced with the same struggles and problems in her life, though she realised that she could change her approach to these, in order to reduce the stress she suffered and to feel better about herself and her family.