Second-level thesis of psychological counselor 1
On the cases of psychological counseling and treatment by using systematic desensitization and cognitive therapy
Through the practice of a male junior high school student's psychological counseling case, combined with the counseling process, this paper analyzes the causes of the psychological problems of the clients, and uses systematic desensitization and cognitive behavioral therapy to treat the anxiety symptoms of the clients and achieves success, which shows the use and effect evaluation of the related technologies of systematic desensitization and cognitive therapy.
I. General information
Mou Wei, male, a sophomore in junior high school. Height 1.68m, with regular facial features and good health. My parents are university teachers and my family is harmonious. Excellent academic performance in primary schools, sudden high fever during the primary school entrance examination, failed to enter key middle schools. His parents have been very strict with him and criticized him for failing the exam. After that, I will be nervous and anxious every time I take the exam, and I always feel that I am going to fail the exam again. Especially in the past six months, I have been shrouded in a tense study atmosphere, and I often feel upset, and my academic performance is sometimes good or bad. I often think of the senior high school entrance examination, and I feel stronger. The heartbeat is much stronger than before, thinking is out of control, and it is difficult to concentrate. Start fidgeting a few days before each mock exam; I often dream about exams and my grades are not ideal. I often imagine what to do if I don't do well in this exam. When the exam is approaching, my stomach is uncomfortable and I want to go to the toilet more than usual. My heart beat faster when I heard the bell of the exam. During the exam, if the invigilator walks back and forth or watches by himself, he can't answer the questions; I often find my fingers or legs shaking during the exam; I often read wrong questions in exams. I feel very painful about this and hope to overcome this problem before the middle school entrance examination.
Second, the chief complaint and personal statement
Wei said: I will be very nervous before the exam and I will lose sleep for a few days. I can't sleep. I'm often too nervous to examine the questions carefully during exams. During the exam, my heart beat very hard and I had a headache. Problems such as careless calculation and wrong reading have also come out. I'm anxious. Every time I look for reasons in my learning methods, the problem still exists. ?
Thirdly, what the consultant observed.
1. Psychological counselor's observation impression: the visitor looks pale and thin, his legs keep shaking when he speaks, his hands are clenched, he bows his head most of the time, his voice is small and trembling, sometimes he looks up, his brow is locked and his expression is painful.
2. Parents complain: Recently, children don't eat much, communicate less with their parents and teachers, and have fewer friends than before, just studying alone in the room. I don't want to mention the exam, but it seems a little annoying to mention it.
Four. Evaluation and diagnosis
According to the collection of clinical data, the intelligence level of the help-seekers is normal; Introversion, depression, anxiety about study and exams, anxiety about one's own future, anxiety about not meeting parents' expectations, disorder of physiological mechanism, and weakness.
Comprehensive analysis of clinical data, analyze and judge the nature and severity of the problem of help seekers; According to the results of psychological test and the history of physical illness, family history of mental illness and typical psychological and abnormal manifestations, mental disorders, such as brain organic mental disorder, pathological anxiety disorder, depression and other mental disorders, are excluded.
Diagnosis: The abnormal psychological behavior of help seekers is manifested as non-pathological emotional response, which belongs to the category of psychological problems and is anxiety caused by exams. According to the three principles of judging normal and abnormal psychological activities, the form and content of psychological activities of help seekers are consistent with the objective environment, consistent with the principle of unity, and various psychological processes are coordinated; His personality is stable, and the cause of the problem of asking for help is the realistic stimulus of failing in the primary school entrance examination. Its duration and severity can not meet the diagnostic criteria of neurosis, so it belongs to serious psychological problems.
The main questions are:
1. There are cognitive biases between learning strategies and learning motivation.
2, physiological mechanism disorder, such as biological clock disorder, eating less, weak body and so on.
3. Among the social factors, parents lack the correct concepts and ways to educate and guide their children, lack friends in schools, and lack teachers' guidance on his learning methods and examination methods.
Determination of consulting goal of verb (abbreviation of verb)
Based on the above assessment and diagnosis, after consultation with customers, the following consulting objectives are determined:
1, specific goals and short-term goals: ① learn the method of self-relaxation. ② Reduce test anxiety. (3) Ensure normal diet and sleep and improve physical weakness.
2. Ultimate goal and long-term goal: ① Change the view of seeking help for further education, and influence parents' view of further education from the side. (2) Change the bad cognition of the help seekers in learning methods and approaches.
Formulation of consulting scheme for intransitive verbs
1. Main consulting methods and applicable principles
1 Allen? Baker cognitive therapy;
The psychological problems of help seekers are mainly anxiety about exams. Test anxiety is a psychological state that is stimulated by certain test situations, restricted by individual's cognitive evaluation ability, personality tendency and other physical and mental factors, and manifested in different degrees through emotional reactions. Under normal circumstances, it is normal for exams to cause appropriate anxiety. But there is excessive anxiety and serious emotional, physiological and behavioral reactions, which are psychological problems. There are several important concepts in Baker's theory: * * empathy, automatic thinking and rules. The so-called * * * empathy refers to the tools people use to solve problems in daily life, which is actually a process of perception and thinking. If people can't use this tool correctly, and can't properly explain and evaluate external information, it will cause cognitive distortion, which will lead to wrong ideas and eventually lead to inappropriate behavior. When people's wrong judgment, reasoning and thinking form an automatic reaction, that is? Automated thinking? In the process of thinking, some wrong ideas form fixed habits and are preserved, which makes it impossible for individuals to reflect and criticize these wrong cognitive ideas. Baker also believes that individuals follow certain laws in the process of understanding the real world. However, if individuals ignore objective conditions and act according to the rules too much, their behavior will be out of harmony with the real environment, resulting in emotional distress and unsuitable behavior. Baker believes that the most direct way to change dysfunctional emotions and behaviors is to correct incorrect and dysfunctional thinking. Psychological counselors teach clients how to confirm these distorted and dysfunctional perceptions through an evaluation process, and teach clients to identify, observe and supervise their own thoughts and assumptions, especially those negative automatic thoughts.
② Systemic desensitization therapy:
Systematic desensitization therapy originated from the study of experimental neurosis in animals. In the late 1940s, psychiatrist volpe electrocuted a cat in a small iron cage in the laboratory. After many experiments, as long as he sees the iron cage, even if he is not electrocuted, the cat will have obvious autonomic nervous reaction. He told the cat to fast for a few days, and then sent it back to the iron cage with fresh fish. Although the cat is very hungry, it refuses to eat fish. Volpe believes that this is due to the general defensive conditioned reflex of cats to the experimental environment, that is, experimental neurosis. Then volpe fed the cat and approached the laboratory from far and near. At first it was unnatural for cats to eat, but they soon got used to it. Finally, the cat can live in peace when it returns to the cage. Volp believes that this is a mutual inhibition effect. Cats get satisfaction and pleasure after eating, which can suppress anxiety and tension. For humans, muscle relaxation technology has the effect of fighting anxiety. The basic principle of systematic desensitization therapy is to repeatedly expose a stimulus that might cause slight anxiety to the helper, and at the same time, the helper counteracts it in a completely relaxed way, so that the stimulus gradually loses its anxiety-causing effect.
2. Rights and obligations of both parties:
(1) Responsibilities, rights and obligations of helpers:
responsible
(1) Provide real information related to psychological problems to psychological counselors;
(2) actively discuss with the consultant the ways to solve the problem;
③ Complete the work agreed by both parties.
correct
(1) Have the right to know the training background and qualifications of consultants;
(2) Have the right to know the specific methods, processes and principles of consultation;
(3) Have the right to choose or replace suitable consultants;
(4) Have the right to submit or suspend the negotiation;
⑤ Have the right to know, negotiate and choose the contents of the negotiation scheme.
accountability
(1) Abide by the relevant regulations of the consulting organization;
② Abide by and implement all aspects of the agreed consultation plan;
③ Respect the consultant, observe the appointment time, and inform the consultant in advance if there are special circumstances.
(2) Responsibilities, rights and obligations of consultants
responsible
① Abide by professional ethics and relevant national laws and regulations;
(2) Help the clients to solve their psychological problems;
(3) Strictly abide by the principle of confidentiality and explain the confidentiality exceptions.
correct
(a) the right to know the personal data related to psychological problems of the parties;
(2) Have the right to choose suitable helpers;
(3) In line with the attitude of being responsible for those seeking help, have the right to make referral or suspend consultation.
accountability
(1) Introduce the training background to job seekers, and show their business licenses, qualifications and other relevant certificates;
(2) comply with the relevant provisions of the advisory body;
③ Abide by and implement all aspects of the agreed consultation plan;
(4) respect the helper, abide by the agreed time, if there are special circumstances, inform the helper in advance.
3. Consultation time and cost
Consultation time: once a week, each time 1 hour.
Consultation fee: each time 100 yuan.
Psychological test fee: SCL-90 60 yuan.
SAS in 50 yuan.
Seven. Negotiation process
The consultation is roughly divided into three stages.
(1) The stage of establishing the relationship between diagnosis, evaluation and consultation;
(2) psychological help stage;
(3) the end and consolidation stage.
Specific negotiation process
(1) The stage of establishing the relationship between diagnosis, evaluation and consultation.
The first consultation was held on February 6, 2006.
Purpose:
(1) Understand the basic situation (including demographic data)
② Establish a good consulting relationship.
③ Determine the main problems.
(4) Explore the change will of the helper.
⑤ Consultation and analysis.
Method:
(1) conversation method
② Psychological test
Process:
(1) Fill in the consultation registration form and ask about the basic situation; Introduce the relevant matters and rules of consultation, as well as the rights and obligations of both parties.
(2) Talk with the help-seekers in hospital, collect clinical data, discuss the psychological problems of the help-seekers and change their wishes.
③ Wechsler Adult Intelligence Test, Self-rating Anxiety Scale and Self-rating Depression Scale were conducted on the visitors.
(4) Feedback the test results to the help-seekers, and make a preliminary analysis based on the initial impression.
⑤ Homework assignment: Let the helper go home and recall the people or things that had a great influence on him in his own growth experience.
(B) the stage of psychological help
The second consultation was held on 6-7 February 2006.
Purpose:
① Deepen the consultation relationship.
② Evaluate the degree of subjective anxiety.
③ Learn to relax and train.
Methods: Behavioral therapy (systematic desensitization therapy) and cognitive therapy (cognitive correction).
Process:
① Feedback the homework of the last consultation, and think that the failure of the primary school entrance examination and the critical attitude of his parents after that may be the reason for his excessive psychological pressure.
(2) through simple explanation, help seekers learn to measure their anxiety level and give a relatively suitable score as much as possible. Scores are usually measured by five points. 0 points, 1 point, 2 points, 3 points, 4 points, 5 points, anxiety increases in turn, 0 points is peaceful and calm; A score of 5 indicates extreme anxiety and discomfort.
③ Relaxation training
Let the helper sit on the sofa with all parts of the body in a comfortable position, and the counselor will dictate instructions. This method allows the helper to train under the guidance of the counselor, master the essentials, and then go home and practice by himself.
④ assign homework.
Do relaxation training after returning home, and strive to achieve complete relaxation and use freely.