The second-level thesis of psychological counselor is as follows:
Title: Case Analysis Report on General Psychological Problems
Zhang, female, 14 years old, a junior two student, was depressed and anxious because she was dissatisfied with the scar left on her chest after heart surgery and worried that she was ugly. According to? The three principles of disease and non-disease can rule out serious mental illness; Neurosis can be ruled out according to whether the conflict that causes symptoms is normal. According to the degree of inner pain, the course of disease is less than 3 months and there is no obvious damage to social function, which can be diagnosed as a general psychological problem. After consultation with visitors, we decided to adopt rational emotional therapy and cognitive therapy, so that visitors can realize their unreasonable beliefs and wrong ways of thinking, gradually guide visitors to carry out self-behavior training, relieve the negative emotions of depression and anxiety, and finally achieve the specific and short-term goals of consultation and promote their personality and mental health.
Keywords: general psychological problems; Rational emotional therapy; Cognitive therapy
I. General information
1. Population data
Zhang, female, 14 years old, a junior two student, with a height of 153 cm, is an only child. He suffered from atrial septal defect (ASD) of congenital heart disease since childhood, but it was discovered late. He underwent thoracotomy and cardiopulmonary bypass during the winter vacation six months ago, and recovered well after operation. Normal growth and development, moderate figure. My father is in business and my mother is a civil servant. Family relations are harmonious. Grandpa, grandma, grandma and grandpa are all alive, but they live in different places. There is no history of congenital heart disease or mental illness in the family.
2. Personal growth history
The helper was born in a family with better economic conditions in this city. Since childhood, I have a cheerful personality, lively and active, strong acceptance, and can sing and dance well. After entering the school, I got excellent academic performance and served as a class cadre. I have a harmonious relationship with my classmates and like sports, especially swimming. I am a member of the school swimming team. I have won many places in the swimming competitions within and between schools. Father is handsome, upright, calm, tolerant and patient; My mother is plump, smart and capable, and she is a national cadre. She is anxious and easy to command, and sometimes she doesn't pay much attention to her way of speaking. When I was a child, my appearance and figure.
The materials follow dad and are often praised by people around him for their beauty. Mother also likes to dress her up in fashion and beauty, like to take her out to play, like to listen to others praise her children for their beauty, and often take pride in it. He began to learn dancing and swimming at the age of 4, and is the backbone of kindergartens and primary schools. In the second grade of primary school, he was chosen to join the children's choir in the city and perform in Europe. I usually practice dancing and swimming after school and during holidays. However, after a physical examination last year found that she had a congenital heart disease, her parents were worried and applied to the school for exemption from physical education class, so that she would not be allowed to take dance classes, let alone swim. After the winter vacation operation six months ago, I continued to be exempted from physical education class for three months according to the doctor's advice. After resting for three months, when she went swimming for the first time, she found many people staring at her chest with strange eyes. It turned out that after her heart surgery, she left a long scar in the middle of her chest, starting from the lower part of her neck and reaching the upper part of her stomach. Because she is still a scar, a scar exposed outside the swimsuit protrudes high on the skin surface, lying on her chest like a dark red meat worm as thick as a little finger, which is very conspicuous! Ugly, too! Sensitive, she feels embarrassed and self-abased! Later, she asked her parents to take her to many big hospitals, including plastic surgery hospitals, to see if there was any way to get rid of the scar. For this reason, she had another scar removal operation, but the effect was not satisfactory. There is still an obvious scar on her chest, but it is slightly smaller than the previous scar. From then on, she was depressed and had an inferiority complex. She never went swimming again. She even quit the school swimming team last month and was not in the mood to learn dance.
3. Mental state
Help-seekers are neatly dressed, wearing shirts and trousers instead of skirts. Behave well and be polite to others. Can concentrate, speak clearly and think quickly. Being depressed and sensitive to other people's eyes.
4. State of matter
He was healthy since he was a child, and he had never suffered from serious physical diseases before he discovered congenital heart disease. After three months of self-cultivation after the operation, the weight increased obviously. Recently, because of surgical scar, I feel depressed, unhappy, have a bad appetite and my sleep quality has declined.
5. Formal social gatherings
There is no obvious decline in academic performance, and he still serves as a class cadre, and his interest in music, dance, sports and other cultural and sports classes is obviously reduced. The relationship between classmates is still good, with two good friends. I have a good relationship with my parents, and sometimes I complain about why my parents have to operate on her.
6. psychological test results: E 36 N 62 P 33 L 26, introverted, unstable and gentle.
SCL-90: the total score 148, obsessive-compulsive symptoms 2.0, depression 2.4, anxiety 2.5, interpersonal relationship 2.3, and other factors were all less than 2. The main symptoms are depression and anxiety.
SDS standard score: 59, mild depression.
SAS standard score: 63, medium.
Second, the chief complaint and personal statement
Chief complaint: upset, anxious, with a strong sense of inferiority, accompanied by nightmares at night, easy to wake up for more than a month.
The helper asked his father to accompany him to consult and stated his situation to the counselor:
In recent more than a month, I feel more and more ugly after the operation. The scar on my chest crawled on me like a big red meat bug, and I felt that the scar was getting bigger and bigger and more obvious. I feel very upset and anxious. I often have nightmares at night, as if something is pressing on my chest, which is easy to wake up. After waking up in the morning, I feel dizzy, tired easily and unable to concentrate. Daily study and life can be handled normally, but the conscious efficiency has decreased. I think the reason is that when I went swimming, I found many people staring at a scar on her chest exposed outside her swimsuit with strange eyes. She felt embarrassed and self-abased! Coupled with the unsatisfactory scar removal effect, the scar on her chest became a permanent pain in her heart. I think this scar will accompany her all her life, and I often sigh in my heart why God is so unfair to me. Sometimes I blame my parents. From then on, she was depressed and had a serious sense of inferiority. She never went swimming again. Last month, she even quit her favorite school swimming team and was not in the mood to learn dance. Since going swimming for the first time after operation, the helper has never worn a skirt, and wears a turtleneck T-shirt or shirt trousers regardless of the weather. She had a good relationship with her classmates. Once she saw several female students in the class whispering something together, so she went to listen to what they were saying. As a result, when everyone saw her coming, they suddenly dispersed and stopped talking, as if talking about her. She is sad because she is very sensitive. She thought they must be talking about her scar. After that, whenever classmates get together to talk about something, she thinks she is talking about her. She felt very hit by this, and her heart was bitter, and she gradually alienated from her classmates. Besides, my mother has high expectations for her swimming and dancing, so she is disappointed. Always nagging: alas, I have studied for so many years for nothing.
! Why did you give up swimming and dancing? That scar won't affect you Are you so headstrong? In this case, it makes the helper feel great psychological pressure and very inferior. After she stopped swimming and dancing, she was basically gone.
How much exercise is it? I go home early after school every day and sit on the sofa watching TV and eating snacks after finishing my homework, especially when I am depressed. Soon, she gained more than ten catties. She realized the problem herself, and felt more worried and anxious, but at the same time she didn't know what to do. The more worried she was, the more she wanted to eat it, but after eating it, she regretted it and felt very distressed. She often tries to lose weight by dieting. She eats an egg and a bag of milk every morning, one or two rice and half a dish at noon, and only a bowl of porridge for dinner, not meat. However, I was too hungry to sleep at night, secretly munching snacks in the middle of the night, and I felt a strong sense of self-blame and shame after eating. After such a long struggle, in order to weigh herself, instead of losing weight, she gained a few pounds and was extremely depressed. Not long ago, she went shopping with her mother, and met her mother's friend, who said with surprise? How did your daughter become so fat? I hardly recognized her! It wasn't like this before, was it? . Mother took the words and casually said? Isn't it? People say that the 18th National Congress has changed and become more and more beautiful. The family is getting fatter and fatter. She doesn't exercise all day, just watches TV and eats snacks, wasting so much money and time to learn swimming and dancing for so long. I really don't know what to do. . Then her mother took her aside to chat with her friends and aunts. When she saw her aunt listening to her mother, she glanced at her from time to time. Knowing that her mother must have told menstruation again, she couldn't help feeling a little resentful towards her. Meanwhile, I felt ashamed and ran home. From that day on, she never wanted to go out with her parents or go to public places. When it comes to dancing, music and physical education class, she always tries not to go to class, and sometimes even lies. I don't want to dance and swim in front of my classmates, especially the opposite sex. It seems that everyone will feel ugly when they look at their physical defects, which will damage their dignity. When I can't hide, I always feel that others are watching me, and I feel very uncomfortable and embarrassed. I don't want to listen to others talk about topics such as body appearance, but when others talk about it, I doubt that I am talking about myself. Thinking about this, it is easy to be distracted in class and the learning efficiency seems to be reduced. Now the third grade is about to face the senior high school entrance examination, and the homework pressure is great. I am worried that it will further affect my academic performance, which makes me feel irritable, anxious and depressed. I don't know how to change my state, find my former self, or face the future. I hope the counselor can help me and improve my mood.
Third, observation and reflection of others.
1. Consultant observation
The helper is accompanied by his father, with a fat figure and normal development; Regular facial features, delicate facial features and fair skin. Comb a sports head and wear shirts and pants. I looked nervous when I walked into the clinic. After sitting down, I was absent-minded and bowed my head.
Dare to look into the consultant's eyes and not take the initiative to speak. After the counselor asked, he began to describe, speak clearly, answer to the point, have a moderate tone and locate accurately. The whole narrative process is focused, with quick thinking and good intelligent memory. Mood swings, sometimes tears, and I have good expectations for the consultation results.
2. Father's reaction
The child has stopped joking recently and always walks away from people. Cold relationship with your mother. As soon as your mother talks, you walk away and avoid talking to her. I have a strange temper now. I lose my temper easily and don't eat. I like watching TV. I used to like watching dance programs. Now as long as there is a dance, I will change the channel. I study very hard and get up early in the morning, but my efficiency drops and I am often distracted. I always like to wear a turtleneck T-shirt or shirt trousers, and all the skirts I used to love are put away. I don't care about the outside world. I always sigh and sometimes secretly cry. After communicating with teachers and classmates, I found myself getting lazy at school, unwilling to take swimming and dancing classes, and even lying. I don't answer questions actively in other classes, but my homework can be completed in time, and the class cadres are willing to undertake the work.
Four. Evaluation and diagnosis
(A) the assessment and diagnosis of mental state
Judging from the comprehensive data collected by visitors, visitors are psychologically unhealthy in the normal psychological category, which can be diagnosed as general psychological problems and belong to the category of psychological counseling. The diagnosis basis is as follows:
1. According to the three principles of judging normal and abnormal psychology, the negative emotions of the clients are caused by objective social events (explicit or implicit), and the psychological activities are unified with the objective environment in content and form; The psychological processes such as knowledge, emotion and intention of help seekers are coordinated; Personality is relatively stable, and there is no obvious and fundamental change in personality. Self-knowledge, worrying about their trapped psychological state, taking the initiative to ask for help, and eager to relieve their troubles and anxiety, without showing symptoms of mental illness such as hallucinations and delusions, can rule out mental illness.
2. Help-seekers show symptoms such as worry, anxiety, depression and depression. Judging from the severity standard, the response intensity of help seekers is not very strong, and the response is limited to dissatisfaction with scars after physical surgery and fear that others will see their own defects, which does not affect logical thinking and intelligent memory. , will not have a serious impact on social function. According to the course standard, the course of disease is only 1 month, which can rule out serious psychological problems and neurotic psychological problems.
(2) Differential diagnosis
1, differentiated from mental illness
According to the three principles of judging mental illness, the characteristics of mental illness are that the patient's knowledge and practice are not unified and there is no self-knowledge; The subjective and objective world reflects disharmony, which is often manifested as hallucination, forgetfulness, logical thinking disorder and abnormal behavior; A radical change in character, etc. The knowledge and feelings of the helper are in harmony with the subjective and objective world; Have self-knowledge and take the initiative to ask for help; No hallucinations, delusions and other mental symptoms, you can rule out mental illness.
2. Different from serious psychological problems
Serious psychological problems have strong reaction intensity, and the reaction has been generalized, which has a serious impact on social function, and the course of disease is more than 2 months. However, the psychological problem of this helper is not very serious, nor is it generalized, and it has no serious impact on social function. It lasts less than 2 months and can eliminate serious psychological problems.
3. It is different from anxiety neurosis.
The symptoms of anxiety neurosis are mainly anxiety, which can not be solved with persistent pain, and has a serious impact on social function and is extensive. The reaction has nothing to do with the initial event itself, but is accompanied by obvious autonomic dysfunction and psychomotor anxiety, which lasts for more than 3 months or more than half a year. Although the main symptoms of this helper are anxiety and worry, it has not seriously affected social function and logical thinking, and it has not been generalized. The duration is only 1 month, which can rule out anxiety neurosis.
(d) Cause analysis
1, biological reasons:
Thoracotomy for congenital heart disease leaves scars on the chest after operation, and scar constitution leads to obvious scars, which is a common phenomenon after operation. However, because adolescent girls' interest in self-awareness is first manifested in their concern about their body image, their image before operation is better, and after operation, because scars affect their image, there is a big contrast between before and after, resulting in anxiety.
2. Social reasons:
(1) had negative sexual life events, such as giving up swimming because of scar problems, quitting the school swimming team, and even giving up learning dance.
(2) There are some problems in family rearing patterns. My father is tolerant, but he is busy with work and lacks communication. Mother's vanity and incomprehension have a great influence on the personality formation and development of help seekers.
(3) Lack of help from social support system, such as being talked about by classmates behind their backs and rarely communicating with teachers.
3. Psychological reasons:
(1) has obvious irrational thoughts and wrong ways of thinking. I care about others' evaluation of myself, and I want to get the recognition of everyone around me, especially my mother's love and appreciation. There is a thinking mode that generalizes and exaggerates one's own shortcomings or defects.
(2) Worried by worry, anxiety and inferiority, lacking effective behavior patterns to solve problems.
(3) Avoidance in interpersonal relationships reduces communication with people, even close family and friends, which leads to loneliness and accelerates the vicious circle of negative emotions.
(4) Personality characteristics: aggressive and demanding perfection. Sensitive, suspicious, easily influenced by the outside world, with strong vanity.
Determination of consulting goal of verb (abbreviation of verb)
The Consultant and the Client * * * agree to establish the following consulting objectives:
(1) Specific objective: to relieve anxiety, depression and anxiety, and reduce inferiority complex.
(2) Short-term objectives:
1, change the irrational concept of the helper. First of all, the consultant uses professional knowledge to make the client correctly realize that postoperative scar is inevitable, but with the passage of time, the bulge of scar will gradually flatten out and the color will gradually fade, thus becoming less obvious. Secondly, let the help-seekers rationally look at the evaluation of the scars on their chests by the people around them, and promote the normal interpersonal communication between the help-seekers and the people around them.
2. The standard score of 2.SD S test dropped from 60 to below 53.
3. The standard score of 3.SA S test dropped from 62 to below 50.
(3) Ultimate goal and long-term goal: On the basis of achieving the above goals, we will finally seek to promote the mental health and personality development of the parties.
Formulation of consulting scheme for intransitive verbs
(A) consulting methods and principles
In order to achieve the counseling goal, reasonable emotional therapy and cognitive behavioral therapy are proposed.
1, rational emotional behavior therapy.
According to this therapy, it is not the event itself that makes people sad and miserable, but the incorrect interpretation and evaluation of things. There is no good or bad thing in itself, but when people give it their own preferences, desires and evaluations, it may cause all kinds of unnecessary troubles and troubles. If a person has a correct concept, he may live a happy life, otherwise, wrong ideas and views that are inconsistent with reality can easily cause emotional distress. Therefore, only through rational analysis and logical speculation can we change the irrational concept that causes the emotional distress of help seekers and establish a reasonable and correct rational concept, so as to help help help them overcome emotional problems, create a life with a reasonable outlook on life, maintain mental health and promote the all-round development of personality. The specific method is to find out the specific manifestations of emotional distress and behavioral discomfort (c) and the induced events (a) corresponding to these reactions by talking with the help seekers, and analyze the unreasonable beliefs (b) between them, so that the help seekers can understand their own problems and the relationship with their unreasonable ideas. Psychological counselors use various skills to help clients correct or give up unreasonable ideas and replace them with reasonable beliefs, thus eliminating bad emotions and uncomfortable behaviors. [3]
2. Cognitive behavioral therapy
This therapy has the following characteristics: the relationship between helper and counselor is cooperative; Suppose that psychological pain is largely the result of cognitive process obstacles; Emphasis on changing cognition leads to changes in mood and behavior; It is usually a short-term and educational treatment for specific and structural target problems. This therapy is based on a structural psychological education model, which emphasizes the role of homework, endows clients with more responsibilities, enables them to play an active role both inside and outside the therapy, and pays attention to absorbing various cognitive and behavioral strategies in order to achieve the purpose of change. The specific method is: through an evaluation process, the consultant teaches the help-seekers how to confirm these distorted and dysfunctional perceptions, so that the help-seekers can learn to distinguish their own thoughts from the events in reality, understand the influence of cognition on their emotions and behaviors, and let the help-seekers learn to identify, observe and supervise their own thoughts and assumptions, especially those negative automatic thoughts.
(two) to explain and determine the responsibilities, rights and obligations of both parties.
(three) the consultation time and fee.
Once a week, each time is about 50 minutes, and the consultation is expected to be 6-7 times. It's free.
Eight. Negotiation process
(1) consulting relationship establishment and diagnosis stage (consulting 1-2)
1. Consultation 1:
By collecting the relevant information of the help-seekers through joining the club, we can understand their basic situation, mental state, behavioral characteristics and help-seeking motives. Through the skills of emotion, understanding and attention, psychological counselors initially establish a good consulting relationship with help seekers, so that they feel respected and accepted. Guide her to carry out EPQ, SCL-90, SDS, SAS and other related psychological tests, make evaluation and diagnosis, and introduce the essence and limitations of psychological counseling as well as related matters and rules in the counseling process.
2. Second consultation:
Consolidate the consulting relationship, determine the consulting objectives with the client, formulate the implementation plan, introduce the consulting methods, principles and processes, and sign a written agreement. Illustrate cognitive behavioral therapy and ABC theory with examples, so that help-seekers can realize the relationship between A, B and C, and think about their unreasonable beliefs and wrong cognitive models in combination with their own emotional and behavioral problems.
(two) the implementation of psychological help counseling stage (the third-fifth consultation)
1. Third consultation
According to rational emotional therapy and cognitive behavioral therapy, the psychological problems of help seekers are analyzed and diagnosed. Ask questions, guide seekers to recall their kindergarten and primary school days, and get praise from relatives, elders and neighbors.
And the induced events (a) corresponding to these reactions, and the unreasonable beliefs (b) between them. People who seek help understand that it is faith that leads to the consequences of emotions and behaviors, not the events themselves; You are responsible for your emotional and behavioral reactions; Only by changing unreasonable beliefs can we alleviate or eliminate various symptoms of our own existence. Let the helper go back and finish three homework. First, continue to think about what the counselor said in this consultation, analyze the root causes of his psychological problems, and make records. Second, let her choose a few representative figures from her classmates and friends to do a small survey, and let them write down their impressions of themselves, requiring more than 50 words. The third is to go to the hospital and ask some experienced doctors if the scar on their chest will always be like this. If possible, visit some people who have had surgery for a long time and see their scar status now. Show it to the counselor at the next consultation.
2. Fourth consultation:
Check and evaluate the helper's homework. The result of actual feedback is that the seekers have a better understanding of the root causes of their psychological problems. Through the investigation, the helper learned that people around her had a good impression on her, and most of them commented on her conduct and academic performance.
Gao likes to associate with her, and people around her have written a lot of such words in terms of body image impression: handsome or not? 、 ? A symmetrical figure? 、? Beautiful? 、? Cute? 、? Good temperament? Wait a minute. The helper was very satisfied with the result of the actual verification and showed a bright smile on his face. She found that everyone didn't hate her. In addition, by going to the hospital to consult a doctor and visiting people who have been undergoing surgery for a long time, she got a satisfactory answer and found that things were not as exaggerated and bad as she imagined. The consultant and the helper analyze the homework together, and through further debate, let the helper correct or give up the original unreasonable beliefs and replace them with reasonable ones. Thereby alleviating symptoms. Continue to assign homework: let help seekers record their main emotions and behaviors every day of the week, and conduct self-analysis, find out the beliefs they support, argue with unreasonable beliefs, and learn to replace unreasonable beliefs with reasonable ones. And suggested inviting my mother to attend the next consultation with me.
3. Fifth consultation:
Under the guidance of the counselor, the helper and mother had a good communication. The helper asked her mother a question in her heart: If I really get fat and ugly, do you still like me? If I give up swimming and dancing, will it really disappoint you? After receiving a sincere and affirmative answer from her mother, the helper shed tears of joy. ? Then why do you say that? My mother replied emotionally: I have been strong since I was a child, and your grandmother always asks me for it.
I am very strict. Your father and I are now aware of the influence of our upbringing on you. We will try to change my unreasonable beliefs and communicate with you more. Forgive mom, let's work together! ? A heartfelt happy smile from the helper.
(3): Consolidation and conclusion stage (6th-7th consultation)
The purpose of consultation at this stage is mainly to summarize, consolidate and improve.
1. Sixth consultation:
Analyze homework, consolidate the achievements made in the previous stages, help clients get rid of the original unreasonable beliefs and ways of thinking, strengthen new concepts, and guide clients' communication skills, so that clients can use the psychological knowledge, methods and skills they have learned to deal with problems in future life after consultation, so as to better adapt to real life and improve their mental health.
2. The 7th consultation: The customer reported that it was easier to communicate with classmates, and they could stick to physical education class. I joined the school swimming team and began to learn dance. I realized that some of my original ideas were really unreasonable and unrealistic, and my understanding of myself was biased and distorted. I said I was in a much better mood recently. Counselors and seekers comprehensively review and summarize the whole consultation process, help seekers realize the transfer of knowledge and ability, and apply the methods and experiences gained in consultation to daily life. Conduct psychological tests, and evaluate the effect of counseling by comparing the tests at the beginning of counseling. End the consultation.
Eight. Evaluation of consulting effect
(1) Consultant evaluation:
The specific goals and short-term goals of counseling have been basically achieved, and the depression, troubles and anxiety of help seekers have been basically eliminated or alleviated. The cognitive, emotional and behavioral patterns of the help seekers have undergone positive changes, interpersonal relationships have improved, self-knowledge tends to be reasonable, and they can properly evaluate themselves.
(2) Self-assessment of help seekers:
Self-reported mood is much better, and the relationship with my mother has also improved significantly. No longer feel embarrassed to get along with classmates or appear in public. I thought many ideas were self-defeating, but now I feel much more relaxed.
(3) Psychological test results:
The total score of SCL-90 is 129, the total score is reduced by 20 points, and the scores of each factor are less than 2, which belongs to the normal range. The SDS standard score is 36, which shows that the depression of the help-seekers has been alleviated.
SAS standard score of 42 belongs to the normal range, which shows that the anxiety of help seekers has been obviously alleviated.
? ? References:
(1) edited by Guo Nianfeng. National vocational qualification training course: psychological counselor (basic knowledge) [M]. Beijing: Ethnic Publishing House, First Edition, August 249-323, 2005.
② Xu Youxin. Neurosis [M] Beijing: People's Health Publishing House, 1993.68- 76.
(3) Guo Nianfeng, editor in chief. National vocational qualification training course: psychological counselor (level 3) [M]. Beijing: Ethnic Publishing House, first edition, August 2005 1 14- 129.
(4) Guo Nianfeng, editor in chief. National vocational qualification training course: psychological counselor (level 2) [M]. Beijing: Ethnic Publishing House, First Edition, August 86-97, 2005.
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