Detailed explanation of psychological counselor's examination case
General situation: male, 28 years old, graduate degree, Han nationality, department manager of a company, unmarried. Middle income and good economic conditions.
Self-report of the helper: I was introverted since I was a child, and I didn't like to talk. I lived in a very traditional family. My parents were both middle school teachers, and my feelings were harmonious, but I was very strict with him. From an early age, he was asked to be a sensible child, to do everything to the best, and to develop the habit of doing things step by step and pursuing perfection. When he meets something he didn't do well, he must do it again until it is done well. I don't have many hobbies, seldom play games with my peers, just concentrate on my studies. From primary school to university, I have excellent academic performance and have always been among the best. Once in a while, I failed the exam, so I was very sad and worried that I would be sorry for my parents. So in the eyes of others, he is an excellent child, and he can hardly pick out any shortcomings, which is enviable. After graduating from high school, I was admitted to a famous university with excellent results. Study and live as usual for the first two years. Junior year began to wash hands repeatedly, sometimes even a dozen times. I always check whether my name is written on the test paper, and even go to the teacher to check my name after handing it in. I know it's unnecessary, but I can't help it. I didn't feel relaxed until I finished it. I have a pair of dumbbells. I want to pick them up and hit others when I see them. I was always worried that I couldn't control them and felt anxious, so I threw them into the river. This situation has not been alleviated until now, but it has become more and more serious, delaying a lot of time, greatly affecting work and life, becoming withdrawn, indecisive, unwilling to associate with people, and having no good friends, which is very painful. Therefore, when you come to the psychological clinic, you are eager to get the help of a psychologist, eliminate problems and discomfort, and improve communication.
The counselor knows the situation: the client has been healthy since childhood and has never suffered from serious diseases. This happened when I was a teenager. Once I picked up chopsticks to eat because I didn't wash my hands. My mother reprimanded him severely and warned him that I had thousands of germs on my hands. If I don't wash my hands, I will get sick. Under the supervision of my mother, I am not allowed to eat until I wash my hands. From then on, I formed the habit of loving cleanliness, thinking that I would get sick if I was not hygienic. This matter has little effect on his life. When Wang was a junior in college, a classmate in his roommate was diagnosed with hepatitis. Because of this, she was associated with her mother's reprimand. She felt very nervous and worried that she would be infected. From then on, she began to wash her hands repeatedly, sometimes a dozen times, and she knew it was unnecessary, but she just couldn't help it. For this reason, a lot of time has been delayed and learning has been affected to some extent. Even so, the results were good, and I was recommended to study for a master's degree without taking an exam when I graduated. I washed my hands more often than before, but I still didn't have to finish my studies. After graduation, I worked in a big company, but I was competent. Because of my good performance, I was promoted to department manager two years later, and it has been one year since. Over the past year, in addition to the above symptoms, I have repeatedly checked whether the doors and windows are closed, repeatedly checking for fear of not doing things well, and minimizing contact with others for fear that others will know, which has seriously affected my work and life. I have poor sleep, dreamy dreams, inattention, poor memory, impatience, temper tantrums, frequent mistakes at work, complaints from leaders and colleagues, and I feel anxious and very distressed.
According to the above psychological counseling cases, please answer the following questions (with answers)
1. What are the main symptoms of help seekers? (10)
Will: Force (trying to hit someone with a dumbbell)
Behavior: compulsive behavior (washing hands repeatedly, checking the name of test paper, closing doors and windows repeatedly)
Emotion: anxiety
Social function: I often make mistakes in my work, and my leading colleagues have great opinions.
2. What is the most likely diagnosis in this case? What is the basis of diagnosis? (15)
The most likely diagnosis in this case is obsessive-compulsive disorder.
The basis of judgment is:
First of all, three principles are used to distinguish normal psychology from abnormal psychology.
(1) Subjective experience and the objective world are unified, and the subjective world can respond to the objective world. Although the intensity of the reaction deviates from the normal range, which is manifested by repeatedly checking the names on the test paper, it does not deviate from the principle of unity.
(2) Help-seekers are born with the same knowledge and practice, which is manifested in avoiding communication with others for fear of doing bad things, feeling anxious and painful, and having difficulty sleeping.
(3) The personality of the person seeking help is relatively stable, which conforms to the principle of stability. It shows that the helper is introverted, earnest and pursuing perfection when he is young, which is consistent with his pursuit of perfection and fear of not doing well when he grows up.
Second, distinguish neurosis from severe mental illness.
(1) The self-knowledge of the helper is intact. The performance is that the helper feels very painful and can realize that his behavior is beyond the normal range. This is a complete self-awareness.
(2) Help-seekers actively seek the help of consultants, and have the motivation to take the initiative to seek medical treatment. The help seeker urgently hopes that the psychological counselor can help him get rid of his troubles and return to normal.
From the above two analysis, help-seekers do not belong to severe mental illness.
Third, the symptoms of help seekers meet the diagnostic criteria of obsessive-compulsive neurosis.
(1) meets the diagnostic criteria of neurosis.
(2) Obsessive intention and behavior are the main symptoms.
(3) Conscious self-compulsion and anti-compulsion coexist, and the conflict between them makes the help seekers feel anxious and painful.
(4) The obsessive-compulsive symptoms of the help-seekers originate from their own hearts and are not imposed by others or external influences.
(5) The client is also aware of the abnormality of obsessive-compulsive symptoms, but he can't get rid of it.
(6) The social function of the party concerned is impaired.
(7) Symptoms have been present for at least 3 months.
3. What caused the problem of the helper? (15)
1. Physiological reasons: There is no obvious physiological reason.
Second, psychological reasons.
(1) introverted personality
(2) Pursuing perfect personality characteristics
Third, social reasons.
(1) Childhood experience and negative emotional experience
(2) Students in the same dormitory found hepatitis.
4. From what aspects do you usually judge the severity of psychological disorder of help seekers? (15)
Usually according to the following points to judge the severity of psychological disorders:
(1) Clinical symptoms
(2) the helper's self-awareness
(3) the degree of social function damage
(4) the pain of those who seek help.
(5) the duration of the problem
(6) Is the question general?
(7) Evaluation of psychometric scale
5. According to this case, what scale do you think you need to choose to conduct psychological test on the client? (10)
In this case, choose Scl-90 and SAS test.
6. What are the proposed consultation objectives? Combined with this case, evaluate the effectiveness of the proposed consulting objectives? (15)
Negotiate with the helper to determine the consulting objectives. If the negotiation cannot be determined, the goal of the helper should be the main goal. The proposed objectives of the consultation are:
(1) Short-term goal: Relieve anxiety and gradually reduce the number of compulsive behaviors (agreed times) until the obsessive-compulsive symptoms disappear. Using SCL-90 and SAS test, the anxiety score and obsessive-compulsive score decreased to the normal range.
(2) Long-term goal: to make help seekers treat themselves correctly, accept their imperfections, and move towards the ultimate goal of self-knowledge and self-realization.
The effectiveness of the above consulting objectives is reflected in:
(1) Specific: Focus on eliminating symptoms in the near future.
(2) Feasibility: It is a step-by-step process for help seekers, so it is feasible.
(3) Quantifiable: compulsive frequency and psychological test scores are used as quantitative evaluation indicators.
(4) Conforming to multi-level unity: giving consideration to the short-term goal of eliminating symptoms and the long-term goal of self-development and self-cognition, and effectively combining them.
(5) Conforming to psychological principles: solving the emotional, intentional and behavioral problems of help seekers belongs to the category of psychology.
7. What aspects are usually used to evaluate the consulting effect (10)?
(1) Self-evaluation of counseling effect by clients
(2) Psychological counselor's evaluation of the counseling effect.
(3) the improvement of the social living conditions of the parties.
(4) The evaluation of the helper's improvement by the people around him.
(5) Comparison of psychological test results before and after counseling.
8. What problems should we pay attention to when communicating with help seekers by means of ingestion conversation? (10)
(1) Attitude must be neutral.
(2) Avoid asking mistakes
(3) In addition to asking questions and guiding, don't digress.
(4) Don't use accusations and critical predictions to organize or reverse the conversation of help seekers.
(5) Never give an absolute conclusion after ingesting the conversation.
(6) The ending tone is sincere and polite, and you can't end it with blunt words.
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