Case Study 2 – Harry aged 13

Please note that for the purpose of confidentiality this Case Study has been annonymised.

CORE SCORE = Clinical Outcome Routine Evaluation which is a nationally recognized evaluation tool for measuring emotional and mental health issues in Children and Young People.

Background

Harry is 13 and lives with Mum and his older brother. He has no contact with his Dad and describes himself as “not having a dad.” It is thought that Mum is anti-education and refuses to come into school to discuss any issues and that school is the problem and not her.Mum didn’t attend school much when she was young and “it didn’t do her any harm.”

Reason for Referral

Harry was referred to the Counselling Service due to his anger towards staff members at having to be in school. His attendance was a huge concern and action about to be taken regarding this. Harry was very bitter as he thought his Mumshould not be in any trouble if he did not come into school. Harry felt things had been discussed behind his back. He would often display aggressive behavior toward peers and staff all of which was projected from his Mum to him. Mum was angry and often aggressive to Harry and this was brought into the school most of the time.

Core YP at beginning of counselling 32/40

  • High indication of distress/unhappiness and unable to go/stay asleep
  • Does not feel able to or have anyone to talk to about his problems
  • High indication of not being able to cope when things go wrong
  • High indication that his problems have felt too much for him

Session 1

Introductions were made and discussions around confidentiality and the limits of this were explained. As Harry was Frazer /Gillick Competent he could decide whether or not he would like his Mum informed he was attending for counselling. Harry decided he did not want his Mum to know. Together we looked at the reasons why Harry had been referred to counselling and what his expectations were. Harry knew it was because of his attendance and appeared frustrated thatMum could possibly be blamed. He felt betrayed by school and very worried about the outcome for Mum. He also felt very guilty that he had been the cause of this but it would be his Mum who had to face the consequences. Harry rated his level of distress as a 9 out of 10 (with 10 being very high) when he arrived for his introductory session. He presented as a very emotional young man and cried throughout the session.

When asked why Harry felt it so difficult to come to school, he opened up and went into great detail of a recent bereavement he was trying to come to terms with. He was very confused over the cause of death and described himself as re-playing events in his head continuously, which prevented him from being able to participate fully in school and therefore felt it easier to stay at home. Again, Harry cried continuously as he talked about this.

It was explained to Harry that we would initially schedule in about 8 sessions and plan a rough agenda so he would gain the maximum benefit from the sessions. We would review at session 8 and agree on further sessions should he feel that he needed this. He agreed on a first goal of getting his attendance back up as quickly as he could. It was also explained that when we lose a loved one, it is common to replay events over and over in our heads and that by getting these thoughts down on paper in the way of a creative scene (drawing events or listing events), this could relieve him a little of pressure in his mind as he would now be able to see it written down on paper and he wouldn’t have to keep it in his mind anymore. A useful cognitive technique to use when someone has lost a loved one.

Harry agreed to this rough agenda for the next few weeks and rated his level of distress as 0 out of 10 at the end of this first session.

Session 2

Information was presented to Harry on facts about attendance and he was also reassured that no-one had gone behind his back and it was nothing personal against him. This information appeared to settle Harry and he knew that if he kept up his attendance, this would also look positively towards his Mum. We looked at the “IF – THEN – BUT” method. Harry worked out that IF he stayed off school, THEN he would feel better as he wouldn’t have to face everyone, BUT his Mum could end up in trouble. This technique is unique in that it invites young people to explore both the positive and negative consequences of particular behaviors. Harry was determined to have full attendance from now on. I praised Harry on his positive attitude.

Harry agreed that he wanted to draw out the sequence of events that he was re-playing in his head regarding his Uncle’s death. He talked as he drew out scenes, getting upset during this process. At the end of the session, Harry decided he would like to start a scrap book about his Uncle the following week. He would bring in photos and special memories to include in his scrap book. The relationship with his Uncle was a very important one, as Harry had never known his Dad, and Mum refused to talk about him to Harry. It was put to Harry as perhaps it was too painful for Mum to do this which is why he may have never spoken about it. Harry seemed to understand this view.

A very positive session and again a very emotional one for Harry, but it appeared to be beneficial.

Sessions 3, 4 and 5

The next three sessions were focused on the scrap book work. Harry brought in photos and made up poems about his Uncle. The negative thoughts around his Uncle’s death were beginning to subside and Harry had even managed to talk to other family members about the uncertain conditions around his death. He was gradually piecing together bits of information and sharing them in sessions. As he shared his thoughts, his emotion lessoned. Towards session 4/5, his tearful emotions had also lessoned and his memories turned into happy, funny stories.

Each session congratulations were offered to Harry on his full attendance in school. He appeared progressively happier. Mum avoided any further action being taken too. Harry even began to talk about newly formed friendships at school.

Session 6

Harry continued to present happier than before and didn’t mention his attendance at all and talked about feeling like he had always been in school. He talked about his Uncle and how he could now talk to other family members about this which really helped him with his feelings. Together we made a poster on ‘worry’ and looked at different strategies to help him. Harry’s enthusiasm for life was infectious and we spent most of the session laughing. He had made some really good friends and told me of events he was looking forward to. Harry talked about how different Mum was with him and that there had been a remarkable change in their relationship. Not only was Harry feeling so much more positive, he was now enjoying being in Mum’s company. It was decided that following session could be the final counselling session due to the progress which had been made.

Session 7

Final session. Together we looked at the scrap book Harry had completed over the weeks and reviewed some strategies on worry. Harry was ready to detach from our therapeutic relationship and agreed to complete an evaluation form and do an end CORE YP. During this session Harry had talked about how much Mum was different with him and that he seemed happier and often asked how Harry was doing in school now. With Harry’s permission it was asked if it would help to invite Mum into meet with the counsellors so she may, if needed get help for herself as the service works with parents too. Harry agreed that this might be quite a good idea and arrangements were made to meet with Mum and invite her into school.

Outcome

Mum attended the invitation to meet with the service, she acknowledged the changes she had noticed in Harry and said “whateveryou’re doing it’s working”, we laughed about this and it was a good ice breaker. Mum began to tell us all about her own difficulties when she was young and that maybe she had been anti-establishment. We looked and explored ways in which as adults we often replay the messages we hear from our own parental figures and this is not always useful to us as when we are ‘adults’ in our own right. We explored the ways in which in Transactional Analysis theory, we have choices to act and think in our ‘rational’ Adult ego, rather than replay the messages of early life in ‘Child ego’. Mum said she would like to attend for another session saying “I may as well, I get where you’re coming from”! Mum continued to attend for several more sessions which appeared to have a positive effect both on her life and that of Harry’s. Harry kept up his full attendance and continued to thrive in school. He managed to release the negative emotions of his Uncle’s death and see the happier times they had shared together. By working on his bereavement, Harry managed to stay in school and make some good friends. His relationship with his Mum continued to improve as did his relationship with other extended family members. Sharing stories about his Uncle with his family managed to secure his attachment with them. Harry’s relationship with teachers improved significantly and his knowledge of the attendance system took away the blame he once directed at school. Harry was informed that he could come and talk to the counselling service in the future if he wished. Knowing that there is an accessible service in school is often very useful once a young person has reached this stage in their therapy.

Core YP end of counselling

6/40

  • No indication of any level of distress. Harry rated every area of the assessment as being a dramatic improvement with no more areas to cover.
  • A Tier 3 service referral was not required

Time 4 You School Counselling Service Ltd, Head Office at Freebrough Academy, Linden Road, Brotton, TS12 2SJ.

Tel. 07926 390 849

Company number: 07466733