THE CASE STUDY OF SALLY
The following case study is written with my clients permission. Names and some facts have been changed to protect my client’s personal identity and to give her anonymity.
Brief description of the client:
Sally is a 47yr old heterosexual female who is a carer by profession. She is of white origin and comes from a working class background. She has two grown up children and had been estranged from her violent drug addicted husband for two years at the commencement of our work together.
Client’s presenting issues, as expressed by the client during the initial assessment:
Sally was abused by her husband, Mother and boyfriend.
She was experiencing feelings of low self esteem, panic attacks, reactive depression and as a result had been prescribed Prozac medication by her GP.
She expressed feelings of guilt, stating that she was to blame for the violence and abuse she was being subjected to and felt concerns that she should have left the relationship sooner.
The session content and process
When Sally first walked into my counselling room I felt a chill as if the mood of the room had changed. The feeling of sadness washed over me, it was almost tangible, I could not feel happy in her presence. My mood change felt instantaneous, it was projected onto me and there was little I felt I could do about it.
She approximately 5ft 2” in height, of slim build and her attire was black from head to foot, as if in mourning and as she looked at me there was a look of expectation and despair. I would come to know that look very well over the coming sessions. The look implied, ‘give me the answers and take away the pain’. I knew I could not give her the answers and at times I was not even sure I could do much to alleviate her pain.
Sally was very tearful in the first few sessions as she described the violence she endured for many years from her drug crazed husband. Then she spoke of the violence from her Mother and her Boyfriend.
Her whole life had been spent taking care of those who abused her. She was a compulsive ‘care taker’, even her paid work was that of a carer, taking care of others and working way beyond her required hours. The more I learnt of my client, the more amazed I was that people could be so cruel to her. For my client’s part in all this cruelty, she only considered others and never herself.
My admiration grew for my client, she had survived so much injustice and I wanted to help her. I felt anger towards her abusers, she had done so much for them and yet they had abused her. I told her how angry this made me feel (This anger was actually my clients anger that she could not allow herself to feel, but instead had to project it onto me and in hope that I would be able to both feel it and contain it for her).
When sally was eight years of age her mother made her do chores for the neighbours for money on weekends. When she returned home she had to cook a meal for the whole family including older sisters. The money she earned, which would have paid her bus fare and school dinners was usually taken from her by her mother, so she had to walk to school and go without food. Her Mother constantly threatened her that if she did not do what she was told ‘God would punish her’. She would be made to stand in the garden for hours on end as punishment. Her Mother was still being violent towards her at the start of our sessions as was her boyfriend.
Several sessions into our work, my client became less tearful and was having fewer panic attacks. I felt there was some improvement. She appeared a little happier; less agitated and was managing to sleep a bit longer. She had gone out with a friend and was trying to reduce her work load. I felt we had built up a good relationship which was confirmed by my client saying she felt comfortable in the sessions. She stated “You are the first person that has ever taken the trouble to listen to me”. I knew this to be the case for many clients.
Session eight was different; I sensed that Sally was feeling very nervous. She spoke of a recurring nightmare of a man coming out of the darkness. I said I had a feeling that she knew this man. I sensed this because as she described him her face was a picture of fear as if she were reliving something.
I felt butterflies in my stomach, a sense of foreboding. I asked Sally if this was how she was feeling she acknowledged this and confirmed that she did know the man and then broke down into floods of tears.
From the age of eight to eleven years old, Sally was sent to stay with her uncle and aunt every other weekend. Her auntie would drink to excess and fall asleep. The uncle would then bath Sally whilst sexually molesting her and whilst her aunt slept. If she resisted he would punch her in the stomach. She felt she could not go to anyone for help, least of all her Mother.
Sally was tormented by the memories of what took place and would blame herself that it happened. She could even smell this man in her dreams. The images would not go away. At times I was concerned for her safety as she found the pain almost too much to bear, she said she wanted it all to end. I took this to my clinical supervisor# and asked if it would be appropriate to give her my mobile number. My supervisor asked if my client might abuse this, I was adamant that she would not. My client phoned me on three occasions and each time we spoke for ten to fifteen minutes.
I began to have serious doubts for my client and her working through her process. Of course this was a good thing for her, but wondered whether she wished she had never started her journey. This echoed in her words. Above all I felt such a deep sense of sadness for her and at times I too found it difficult to control my emotions in the sessions. I told myself this is my clients pain not mine, I needed to be strong for her.
Sally found it increasingly difficult to sleep as she felt she had to watch the door in case the uncle returned. She would ask me what the point of life was, why did she have to suffer? A question that only she had her answers to.
My client and I discussed her concerns at work, she was having panic attacks and forgetting what she was doing. We talked about her worries that she might make an error with a patient and she decided to take some time off work. She thought of nothing else all day than her uncle, she was reliving the experience. Sally was riddled with guilt, believing that she had not done more to fight off her uncle.
In later sessions she told me that she could not understand why she spoke to me about the abuse as she had never told anyone before.
One day Sally walked into the room and smiled and I recognised that she had turned a corner. I felt a huge wave of relief sweep over me, she had trusted the process but had displayed some serious doubts along the way. The chill I used to feel when Sally walked into the room had lifted. I felt the main change was her outlook on life. She was now living in ‘the here and now’. My client had started to look to the future and see a point to her life and was ready to move on and not let the past haunt her or dictate anymore. Up to now her life had been very much stuck in the past and dreading the future. She had a few set backs but never appeared to go back to that dark place.
The following sessions had felt on a different level, there was a deeper trust. I believe my client felt safe, we communicated, even in the silences we were together. I had little awareness of time or silences, it was just an intense experience. I felt there was a connectedness, mutuality. Not only did I feel at one with my client, I was aware that she was responding differently to me. She appeared at ease and comfortable even though she was sharing such pain.
Evaluation:
Working with this client was an ultimate test. It demonstrated how imperative it is for the counsellor to be emotionally present and empathic within the working alliance. My previous clients, although successful, had appeared to experience much less pain in their process (Although not all counselling work is ‘painful’, if it taps into childhood issues, then invariably it will be harder). I could see that my client felt safe and could trust me with her darkest secrets and know this to be because she knew that I would not judge her.
She chose what to talk about and when to bring it, so the pace was entirely hers. Finally when she explored her worst nightmare she was not alone..... we went there together, I was by her side, metaphorically....I held her hand. As to her process, she did survive her pain and there was no short cut to her working through that pain. She had to re-experience it, to take back the power.
Thank you Sally for trusting in the process and sharing your most intimate fears.......
Foot notes
#All practicing counsellors are required to have clinical supervision under BACP guidelines.