Mental health is a complex challenge and a public health concern affecting individuals, families, communities, and society. An index of 301 diseases conducted in 2016 found that mental health problems accounted for 21.2% of years lived with a disability making mental illness one of the main causes of disease burden globally (Mental Health Foundation, 2016). The World Health Organization (WHO) survey reported around 35% and 50% untreated cases of severe mental health problems in developed countries, and 76 – 85% cases in developing countries (Demyttenaere et al., 2004). Mental health problems cases are expected to rise (McCrone et al., 2008). Mental and physical health is interdependent, calling for urgent action for treatment and prevention (Mental Health Foundation, 2016). Overcoming barriers to treatment and prevention of mental health problems will help to promote well-being.
This study will use a Person-centred approach, also known as Rogerian therapy of counselling. In the 1940s, Carl Rogers developed Person-centred therapy. Unlike the traditional model where the therapists were experts, it uses a nondirective, empathic approach that aims to motivate and empower the client during the therapeutic process (Murdock, 2008). Rogerian therapy believes humans can fulfil their potential (McLeod, 2019). The person-centred therapy empowers humans to recognize their potential and help facilitate behaviour change; therefore, the therapist follows the client’s lead when possible by offering support, guidance, and structure to ensure the client comes up with personalized solutions (Murdock, 2008). The following key factors identified by Rogers that stimulate the growth of an individual to help fulfil their potential: therapist-Client relationship is important to achieve positive change, client vulnerability depending on self-image and past experience causes fears and anxieties which client might be unaware, therapist congruence make them self-aware and genuine which will help build a better therapeutic relationship, therapist Unconditional Positive Regard (UPR) enables the therapist accepted the client’s experiences without conditions to allow client open up without fear of being judged, therapist empathy enables the therapist to experience and recognize clients emotions without being emotionally involved, and client perception of the therapist help promote effective communication (McLeod, 2019). Rogerian therapy recognizes individuals know what is right for them.
This session will be conducted in a private setting. Private counselling has become more affordable and time-saving for clients who can skip the NHS therapy queue (Morgan, 2021). The following are some benefits: private counselling session makes therapist view one as a client, not a patient, because clients play a major role in deciding when to start, stop or continue with the sessions making clients feel in control over the therapy journey and personalized needs are focused on, private counselling setting allows clients to choose the therapist they prefer in terms of demographic characteristics, language is spoken, level of training, experience and counselling approach, allows clients to choose therapy timing If need be clients can increase the length and frequency of the session unlike in NHS where the session is limited due to resources available and helps clients to see a therapist privately without worrying that their mental health problems will appear on their medical records (BACP, 2015). Private counselling setting supports autonomy, choice, and empowerment, which can be therapeutic for clients.
This case study will review a case of a male aged 59 suffering from schizophrenia and depression. The client resides in London and belongs to the Black Minority Ethnic (BME) group. The client’s country of origin is Bangladesh, and he has resided in the UK for the past 15 years. The client is a businessman who owns a grocery shop in London but has difficulties managing the business due to his mental health problems. The client’s mental problems were diagnosed in his native country, but the illness has deteriorated since he arrived in the UK. After all, he had to work for long hours because he was his family’s breadwinner and had a small social circle. The client also reported having difficulty adjusting to the new environment and culture. The client is in a supportive marriage and a father of one daughter, but his wife has diabetes. The client is having difficulty providing for his family with the failing business and is also angry because his daughter isn’t willing to take over his grocery shop because she is working as a fashion designer.
The therapeutic relationship is my primary intention in the early stages of therapy. The therapeutic relationship is the interaction, connection, and rapport that are vital during the therapy process (Saxon, Firth and Barkham, 2016). The therapeutic relationship enables the therapist and client to know each other and clarify therapy needs and purpose (Jayasinghe, 2020). The therapist can improve therapeutic relationships through unconditional client regard, prioritizing the client’s needs, collaborating with the client, understanding the client’s problem, preparing treatment, and empowering the client (Morgan, 2021). A successful therapeutic relationship will create a strong foundation for effective dialogue during the therapy. When I first met the client, he felt the loss of life purpose, loneliness, sadness, and anger. The client’s feelings made me evaluate my emotions, and I found out that his feelings provoked a feeling of loss of life purpose and loneliness. Although we shared a different history, I related to his loss of life purpose and sadness because I experienced similar emotions when I was involved in an accident that had incapacitated me for several months.
In the initial sessions, it was clear that failing business triggered most of the emotions he had because I could feel the anger after he had invested a lot of time and effort in the business; the client dint also understands why the daughter didn’t want to continue with the family business. As I followed up on what he thought would be the future of his business, the client’s disorganized speech and repetitive, involuntary movement of his arms were observed. The behavioural changes during this stage were a clear symptom of deteriorating schizophrenia. At the initial stage, I noted the client needed support and a safe setting where I could collaborate with other professionals for the best intervention. Still, the client didn’t support my attempts to involve other professionals and his doctor for better care. It was clear that I was the only trusted option he had due to the confidentiality I afforded. I probably used a person-centred approach, giving him time and a chance to be open about what he feels without judgment. The client could freely open up and even share some occasions where he lost self-control when attending to his customers. For my well-being and better client care, I shared my thoughts, feelings, and client’s information with my supervisor and strong therapeutic relationship with the client.
After understanding the client’s mental health needs and different approaches under supervision, we could come up with the best treatment options available. Using National Institute for Health and Care Excellence (NICE) guidelines, different conditions are treated differently. NICE guidelines to diagnose and manage schizophrenia in adults aim to improve care through early diagnoses and treatment, long-term recovery focus, and checking for coexisting health problems (Saxon, Firth and Barkham, 2016). The client reported receiving psychiatric help and currently reaching out for further help. NICE recommends cognitive behavioural therapy (CBT) for schizophrenia treatment and recommends interventions for anxiety disorders, depression, personality disorder, or substance abuse (NICE, 2014). CBT for people with schizophrenia teaches the client to change beliefs or behaviours that cause negative emotions. CBT therapy has two key parts: a cognitive component (helps to change thoughts about a situation) and a behavioral component (helps to change reactions) (NICE, 2014). CBT is a problem-focused approach that teaches schizophrenia patients coping skills to help them manage their reactions to difficult situations. During CBT, clients learn to recognize thoughts, feelings, and behaviours, modify negative thoughts reactions to test thoughts and perceptions reality, ignore mind voices, reduce symptoms severity, develop problem-solving and social skills, and lower relapse risk (Saxon, Firth and Barkham, 2016) . Clients with schizophrenia also get medication intervention like antipsychotics to reduce psychosis symptoms. In person-centred therapy, therapists respond congruently to be able to offer the core conditions without therapist responses getting in the way. This client was fully aware of his actions. Person-centred therapy believes that therapists must be warm, genuine, and understanding for positive results. From this therapy, I have observed how this person-centred therapy help in understanding own issues and potential.
The private setting enabled the client to get counselling when he needed it. Waiting times at NHS counselling facilities can vary depending on the level and type of therapy needed and available resources (Mental Health Foundation, 2016). England’s annual report for 2013/14 showed that 61% of referrals waited for 28 days, 28% waited up to 3 months, and the rest more than three months to get seen for their first appointment (BACP, 2015). A longer waiting period between referral and intervention makes some problems get resolved or mostly worsen (Demyttenaere et al., 2004). A private setting enables the client to begin therapy within a few days of contacting a private therapist. NHS services require a diagnosis before treatment, for they are based on the medical model (BACP, 2015). Clients visit private settings for issues that do not always warrant referral to NHS psychiatric services. Private settings help people resolve issues before they worsen to prevent severe symptoms and for early intervention, which is significant for individual and societal well-being. People considering counselling may be concerned about confidentiality. Many clients see counsellors prefer friends, work colleagues, family, or even their GP not to know. Clients referred to a counsellor by GP will have their mental health problems permanently recorded on their medical records (BACP, 2015). Some clients are concerned about the impact mental health problems records could have on their career since the information is available in occupational health checks. Private setting counsellors are not obligated to inform anyone about their clients, making clients prefer private settings for confidentiality. NHS often has strict policies on clients who feel suicidal or engage in risky behaviours and may take action with or without consent as long as the risk is significant (BACP, 2015). Unlike private setting, this has discretion and still helps clients even though it’s considered risky.
This client would not have received enough attention if he were in a public setting because clients are referred to NHS counselling services according to their needs. Clients requiring lower intensity intervention are usually offered online, or group interventions and those requiring higher intensity interventions are offered face-to-face counselling. This is different from a private setting where clients are not grouped, but services are offered per the client’s request. The client would not have much control over the type of intervention approach he prefers because NHS counselling services use the CBT approach mostly. Client choice of intervention is not always possible in NHS services.
In contrast, a private setting uses a more therapeutic approach and can tailor intervention options to meet their client’s needs and expectations. A public setting normally limits the number of sessions for a specific period, unlike private setting where clients have the freedom to share their wishes in terms of session length and numbers. The NHS does not always refer all cases for counselling services due to the growing number of mental health cases. The public setting considers issues like grief, breakup, homesickness, adjustment difficulties, and anxiety as normal reactions to difficult situations. Unlike public settings, private settings believe that counselling can help clients cope and positively adjust to difficult situations before the hard times significantly impact people’s lives. The public setting does not give clients the freedom to confidentiality. Diagnosis of a mental health problem in a public setting is recorded permanently of the client’s health record. The client discussed in this case study required confidentiality. Using a public setting would deny the client discretion he needed.
Supervision BACP requirement to ensure therapists in practice using up to date skills and ensure they work in safe environments and in an ethical way. Supervision is part of the counsellor’s professional requirement by the Ethical Framework for the Counselling Professions. Supervision enabled me to share counselling sessions with my supervisor, who gave feedback and insight to improve my performance and acted as an opportunity to learn skills and find alternative ways to support the client. Debriefing enabled me to objectively analyse issues raised in the counselling session and my response to them. My supervisor ensures I don’t get too involved to maintain professional boundaries. My supervisor supported in case of ethical dilemmas to ensure professional and ethical standards are maintained. The supervisor was always on the lookout to observe any symptoms of stress to prevent burnout.
Ethically, it is the therapist’s role to prepare clients for the end therapeutic work. The end of therapeutic work offers the client and the therapist an opportunity to engage in the termination process, involving treatment evaluation, support in the client’s future plan, and ending the sessions (Bhatia, 2016). Ending a therapeutic relationship can naturally cause feelings of loss and grief, which might require an adjustment period (Kress and Marie, 2019). This case study will use termination-as-transformation, which views termination as an opportunity to personalize growth and transform therapeutic relationships by giving clients feedback about themselves (Bhatia, 2016). The ethical ending of a therapeutic relationship can help emphasize counselling benefits, can empower clients to use their experiences and in facing different situations, provides an opportunity for clients to grow (Jayasinghe, 2020). This case study will prepare for termination by introducing termination in an informed consent process. Discussing termination at the beginning of counselling helps to motivate and help them view counselling as a temporal goal to achieve set objectives. Transparency about termination at the initiation of counselling will encourage the client to reach their goals and empower them to end the therapeutic relationship whenever they are ready (Kress and Marie, 2019). The end of a therapeutic relationship can trigger emotions in the therapist; therefore, an adjustment period should be given to the therapist to offer space for self-supervision by evaluating their performance and efficacy with the client (Jayasinghe, 2020). During the adjustment period, the therapist can reflect on the strength and identify areas of potential growth. Despite introducing termination during the initial stages, therapist should frequently assess the client’s termination readiness and encourage the client to use the coping and emotional regulation skills they acquired during counselling to manage termination emotions. Termination is an essential part of the therapeutic process despite the type of intervention used. Studies show that the ending is crucial because clients who complete a therapy process improved by six more points than clients who dropped out; only 12 % of patients who dropped out of therapy recovered, and 60 % for clients who completed treatment recovered (Saxon, Firth and Barkham, 2016). During termination, should continue being warm and compassionate to empower clients, which will promote their self-worth and help them perceive termination as a gateway for a new beginning.
During the therapy process, I learned that clients perceived therapist genuineness and empathy are related to good outcomes. Therapists’ acceptance of their patients is related to better therapy outcomes. The therapeutic relationship is the primary determinant of successful therapy. I have learned that asking for help and support is crucial to avoid burnout; therapists should also take care of themselves first before taking care of others to ensure energy and strength. Working with clients is a privilege because of the therapeutic relationship shared that others haven’t experienced because the client-centred approach enables therapists and clients to work as collaborators. Implementing a client-centred approach and cognitive behavioural therapy had improved my skills on when to use a method and when not to. I learned that different theories fit different clients. Instead, I developed creative and innovative counselling techniques to ensure my client’s benefit. A good therapist is a good learner and listener. Listening to the client will help the one understand if I am helpful and on track. I learned from the person-centred approach that the client’s best interest should be the priority in any legal, moral, or ethical decision. The therapist’s role is to support the client in coming up with their solution, not to impose change. I learned that having a supervisor or mentor whose values and actions we aim to emulate and whose inspiring visions will help clarify our roles and the responsibilities to foster personal growth. I learn it is also essential to consider the ethical aspects and confidentiality concerning the patient throughout the therapy process.
Personal experiences during the therapy process have helped me have a better understanding of one’s emotions, incongruences, and thoughts. I was able to understand and let go of my past feelings through wanting to change my past through finding the answers; I was able to feel comfortable and accept my past. This client also enabled me to embrace being genuine. Being genuine is fundamental for therapists. I also learned that being you is crucial to helping one maintain self-respect and integrity. Coping with this client enables one to be resilient in even tricky situations in life-promoting personal and professional growth. This client allows for one to stay honest, help and give back, take risks, enjoy, eliminate fear and work toward removing ego. A better understanding of the patient in a holistic manner enables the therapist to realize the importance of treating patients with dignity and on an individual basis.
Comprehensive care addressing social, medical, psychological, economic, occupational, cultural, and physical issues will help treat schizophrenia and depression. Family and friends should also be included in the therapeutic process for moral support with the client’s consent. And as discuses in this paper, a supportive therapeutic relationship with health caregivers should be established for better outcomes. Private counselling setting had played a critical role in both the prevention and intervention of mental health problems in the general population. For the more significant benefit of patients, the public and other professionals should refer and empower clients with the knowledge of how to access private settings per the client’s needs. Private settings have several evidence-based interventions to provide better-personalized care, especially with the growing numbers of mental health globally.