I. General information
Li * *, female, 36 years old, undergraduate in Chinese Department of a university, archivist of a shipping company in a city; Normal height and posture, no history of major physical diseases; The family has no history of mental illness; Free love, parents don't accept their husbands before marriage, and they live in a family atmosphere that values sons over daughters since childhood. She claims to have a strong personality since she was a child. When I was 5 years old, my mother cooked fish and asked her to buy soy sauce alone. On the way home, she fell and hit the bottle. Her father called her "a girl is useless" and she was scared. When I was in the first grade, I once took my male classmates home for dinner. My father is very happy. He boasted that the way boys eat is really cute and he is full of energy. Unlike girls who eat slowly, he can't eat much. He appreciates the way the boys eat, but he is not convinced. My grades in primary school are very good, and my father will tell people face to face that my daughter is no different from her son, and she will definitely be admitted to college and will be happy in the future. Poor grades in middle school lead to inferiority complex; After graduating from high school, I was admitted to the university as I wished. I organized climbing Mount Tai once during my college years, but I wanted to join the activity group of male students twice. They disliked my short stature and wept bitterly. After graduating from college, I found a job three times. They all said that the writing was good and the appearance was good. Unfortunately, the woman was short and didn't want it. They are very angry. Later, I worked as the chief archivist in the office of a shipping company. Now my husband is free to fall in love and get married. At that time, I thought I just had to be good to myself. Because of their looks and jobs, their parents severely opposed them until they gave birth to the next generation. 1996, a boy was born. When my son was in grade one, he was once "confused" by his son's question and had to make a fool of himself. Although his son was cheated, he felt sorry for his son. He really felt that women were useless. A year ago, my newly promoted husband was diagnosed with mild cirrhosis in a physical examination, and he could not accept this fact. He often has dizziness, pale face, shaking hands, sweating, palpitations, insomnia and dreaminess. More than half a year ago, I was always afraid that my husband would die at home while she was at work, and then I started to be on tenterhooks every morning. I can't do anything at work. I walk around the office all day. I often call home to confirm that although the doctor said that her husband's condition is not so bad, it can still be controlled as long as it is treated properly, but it has never been controlled. Recently, because she made a mistake in the file, she was asked by the leader to talk and suggested that she do psychological counseling. I also thought I should go and have a look, so I came to consult.
Second, the chief complaint:
Insomnia, dreaminess, fear, difficulty in concentration, always fear and anxiety.
Second, the evaluation of psychometric scale
It shows that the diagnosis of anxiety disorder is valid.
In view of this situation, EPQ, SCL-90, SAS measurement and psychological test results were agreed by the helper:
1, EPQ: The test result is valid;
E: 40, n: 70, p: 60, it can be seen that the personality characteristics of the help-seekers belong to the introverted unstable and depressed personality type, with high psychological quality and poor social adaptability, and the value of n exceeds the normal range by a standard deviation.
2、SCL90:
The helper's SCL-90 (1-5) test results are as follows:
Total score: 174 positive
Number of events: 48 somatization: 2. 1 compulsion:
1.9 interpersonal relationship: 2.2 depression:
2. 1
Anxiety: 3.0 hostility: 1.5 terror: 1.9 paranoia: 1.5 psychosis: 1.5.
3.SAS: standard score: 75. Exceed normal value
Four. Evaluation and diagnosis:
Diagnosed as anxiety neurosis.
(a), the use of disease and non-disease three principles to distinguish between normal and abnormal psychology:
1. Unity between the subjective experience of the helper and the objective world: Although it shows excessive anxiety and worry, it is normal to deviate from unity and completely lose unity.
2. Help-seekers have the internal consistency of knowledge, emotion and meaning, which is manifested in anxiety and insomnia after her husband is ill.
3. The personality of the person seeking help is relatively stable, which conforms to the principle of stability. The research shows that the help-seekers are introverted, competitive, serious and responsible, and pursue perfection when they are young, which is consistent with their excessive worry and anxiety after their newly promoted husband falls ill.
(2) Distinguish neurosis from severe psychosis.
1, the self-awareness of the helper is intact, indicating that the helper feels very painful inside and can realize that his thoughts and behaviors are beyond the normal range. This is a complete self-awareness. Help-seekers take the initiative to seek medical treatment. Help-seekers are eager for psychological counselors to help them get out of trouble and return to normal. Judging from the above two points, it is neurosis, not severe mental illness.
2. According to Professor Xu Youxin's three-dimensional diagnosis method of neurosis clinical evaluation, the course of disease is 2 points between three months and one year, the degree of mental pain is 2 points, and the moderate damage to social function is 2 points, totaling 6 points. The diagnosis of neurosis can be established, and the symptoms of this case have met the conditions.
(3) According to CCMD-3, the symptoms of visitors meet the diagnostic criteria of anxiety neurosis.
Symptom standard
(1) meets the diagnostic criteria of neurosis;
(2) Persistent primary anxiety symptoms are the main symptoms and satisfy the following two items:
(1) Frequent or persistent fear or anxiety with no definite object and fixed content: specifically, patients are always in fear and uneasy.
② Accompanied by autonomic nervous symptoms or exercise anxiety.
Severe standard social function is damaged, and patients feel pain because they can't bear it and can't get rid of it.
The course of the disease meets the symptom standard for at least 6 months.
Exclusion criteria
(1) Eliminate the secondary anxiety of hyperthyroidism, hypertension, coronary heart disease and other physical diseases;
(2) Exclusion of withdrawal reaction of stimulant drugs, hypnotic and sedative drugs, or anti-anxiety drugs, and anxiety related to obsessive-compulsive disorder, phobia, hypochondria, neurasthenia, mania, depression, or schizophrenia.
Verb (Verb's abbreviation) Formulation of Consulting Objectives
Based on the above assessment and diagnosis, the following consultation objectives are determined in consultation with those seeking help:
Specific goals and short-term goals: relieve anxiety experience, relieve insomnia and restore social function;
Behavior goal:
1. Learn to think about events in life in a more effective way.
2. Correct the tendency of over-enterprising, perfectionism and excessive demands on life and work caused by perfectionism.
3, return to normal work, reduce the number and frequency of errors.
Emotional goals:
1. Reduce her anxiety in life.
2. Reduce the resistance caused by prejudice.
Cognitive goal (goal to be corrected):
1. Women are useless.
I must do everything well. My family can't have any problems, even if my husband is ill.
Ultimate goal and long-term goal: the ultimate goal of making help seekers look at themselves correctly, accept themselves, and move towards self-knowledge and self-realization
Formulation of consulting scheme for intransitive verbs;
1. Main consulting methods and applicable principles:
Rational Emotional Therapy (RET) was founded by A. Ellis in the United States in 1950s. Rational emotional therapy is a kind of cognitive psychotherapy, because it also uses some methods of behavioral therapy, so it is called cognitive behavioral therapy. The basic theory of rational emotional therapy is mainly ABC theory, and its theoretical viewpoint is that emotion is not caused by an induced event itself, but by the individual's interpretation and evaluation of this event. ABC comes from the prefix of three English words, a refers to induced events; B refers to the corresponding belief of an individual after encountering an induced event, that is, his view, explanation and evaluation of this event; C refers to the result of an individual's emotion and behavior in a specific situation. ABC theory points out that induced event A is only an indirect cause of emotional and behavioral reactions; And B-people's beliefs, opinions and explanations about the induced events are the more direct reasons for people's emotional and behavioral reactions. When people persist in some unreasonable beliefs and stay in a bad emotional state for a long time, it will eventually lead to emotional disorders. Unreasonable beliefs have three characteristics: absolute requirements, excessive generalization and extremely bad. Absolute faith is usually associated with words such as "must" and "should", such as "I must succeed", "others must be kind to me" and "life should be easy". People with this belief are prone to emotional distress. Generalization tends to think that you are "useless", "worthless", "useless", and so on. Evaluating yourself as a whole and your value as a human being by the results of one or several things you have done will often lead to self-blame, inferiority, self-abandonment, anxiety and depression. Another aspect of over-generalization is the unreasonable evaluation of others, that is, with a slight mistake, others think that they are bad and worthless, which leads to blind accusations and hostility and anger. Terrible is an idea. If something bad happens, it will be very terrible, very bad and a disaster. This kind of thinking will lead individuals to fall into a vicious circle of shame, self-blame, anxiety, pessimism, depression and other extremely bad emotional experiences. Let's see why people who ask for help have such a strong emotional reaction.
Husband's illness can be used as a stimulus (a), causing anxiety and fear (c). Why doesn't everyone have such a reaction? Obviously related to Li's belief (B). Li's belief holds the unreasonable belief that "I must have a perfect family life". Living in a patriarchal environment since childhood, I feel inferior (I always grew up with the negative idea that women are useless, and I accepted this idea when I grew up), but I have a strong personality to pursue perfection and hope that my marriage and family life will be perfect, and I also have a strong emotional experience when I can't answer my son's questions. This absolute request caused a strong negative emotional reaction, not the fact that her husband was ill.
Therefore, reasonable emotional therapy is used for consultation.
2. Rights and obligations of both parties
In the process of consultation, the rights and obligations of the client:
Rights:
1. Help seekers can choose consultants according to their own wishes.
2. If you are not satisfied with the consultation process, you can ask to change the consultant.
3. The right to know, negotiate and choose the consultation scheme, consultation fee and consultation time.
Obligation:
1, in line with the relevant regulations of the consulting organization:
2. Observe and implement the agreed consultation plan, consultation expenses, consultation time and other regulations.
3. The helper should respect the consultant, be late for the appointment according to the agreed time, and notify the consultant in advance if there are special circumstances.
In the process of consultation, the rights and obligations of the consultant:
1. Love one's job, firmly believe in contributing to society, study hard professional knowledge, enhance skills, improve one's own quality, abide by national laws and regulations, and establish an equal and friendly consultation relationship with help seekers.
2. Psychological counselors shall not discriminate against visitors because of their gender, age, occupation, nationality, religious beliefs and values.
3. Before establishing the consulting relationship, the consultant must let the visitors know the nature, characteristics, possible limitations of the consulting work and the rights and obligations of the visitors themselves.
When cooperating with clients, counselors should discuss the key points of their work with clients and reach an agreement.
If necessary (such as using certain therapies), a written agreement should be reached with the person seeking help.
Psychological counseling is suitable for people seeking help, and no relationship can be established except counseling. Try to avoid double relationships (try not to establish consulting relationships with acquaintances, relatives and colleagues)
It is even more forbidden to use the trust of the helped person for personal gain, especially not to have indecent words and deeds to the opposite sex.
6. When the counselor thinks that he is not consulting the helper, he should explain clearly to the helper in a responsible attitude and introduce him to another suitable counselor or doctor.
7. Psychological counselors always strictly abide by the principle of confidentiality.
3. Consultation time and cost
Consultation time: once a week, 60 minutes each time.
Consultation fee: RMB 80 yuan for each consultation.
Psychological test fee:
EPQ: 60 yuan
SCL 90: 50 yuan
SAS: 10 yuan
Seven. Consultation process:
The consultation stage is roughly divided into:
1, diagnostic evaluation and consultation relationship establishment stage
2. Psychological help stage
3, the end and consolidation stage
4. Specific consultation process
The first time was 20041October 23rd 10.
Purpose:
1, to understand the basic situation.
2. Establish a good consulting relationship.
3, determine the main problems
4. Explore the willingness to change
5. Consulting and analysis.
Methods: Interview and psychological test.
Process:
1, fill in the consultation registration form, ask about the basic situation, and introduce the relevant matters and rules in the consultation.
2、EPQ、SCL90、SAS
3. Determine the consulting objectives.
4. Collect clinical data and explore the causes of biological, social and cognitive problems.
5. Through consultation between the two parties, the consultation scheme is made, and the basic theoretical model of RET (ABC model) is introduced simply and easily.
Second time: 165438+20041October 6.
Purpose:
1, deepen the consulting relationship
2. Vent long-term depression and learn to relax.
3. Analyze unreasonable beliefs according to ABC theoretical model.
Methods: Talk and rational emotional therapy.
Process:
1, in this part of the consultation time, it has been the help seekers who constantly vent all the helplessness, pain and depression that have been suppressed in their hearts since childhood.
2. Point out to those who seek help that their way of thinking and beliefs are unreasonable; Help them figure out why it has become like this, how it has developed into this, and explain the relationship between unreasonable beliefs and their emotional distress. It is a deeper understanding of the basic principles of ABC theory by help seekers. And pointed out to the help seekers that the reason why their emotional troubles continue to this day is not because of the influence of their early life, but because of their unreasonable beliefs, and they should be responsible for it.
Inducing event A: Husband is sick
Unreasonable belief b:
Generally unreasonable belief: "I must have a perfect family life"
Certain irrational beliefs:
Dad always treats me with the attitude of "women are really useless"
-I also think women are really useless.
-My family must be perfect. I want to show it to my father and everyone.
Emotional and behavioral consequences:
Depressed, pessimistic, self-deprecating, competitive, and have excessive expectations for their marriage and family life. Even if it is acceptable to most people at ordinary times, it will also cause strong psychological conflicts-how can I not answer my son's question? My husband just became a section chief. Why did he get sick again?
2. During the rest of the meeting, let the helper lie in the easy chair and help her with simple relaxation training with soothing music.
3. Homework: Talk to my father about the troubles of growing up in a patriarchal environment and understand his real thoughts.
When you feel anxious, nervous and unable to sleep, listen to music and relax.
The third time in 2004165438+1October 20th.
Purpose:
1, continue to find out the extremely bad events that make you laugh at yourself (A)
2. Analyze and dig out my own explanations, comments and opinions on the induced events, that is, the belief (b) caused by it and the negative emotions and behavioral consequences caused by it.
3. Strengthen reasonable emotions
Talk, rational emotional therapy
Process:
Discussing with the help seekers, my father's thinking mode of belittling my "women are really useless" has influenced my self-deprecating concept when I grow up-I think women are really useless, but my father gave her some positive affirmations when her academic performance was good, which made her have an absolute self-requirement, thinking that she must do everything well, and when she did not meet this absolute requirement, she had a strong psychological conflict and negative emotional experience. Therefore, in the process of consultation, help the seekers realize that we have no way to control the world and others, and they may or may not want to change their feelings and behaviors. However, if she changes her self-deprecating and extremely bad beliefs, she can at least make herself feel better and let them seriously consider it, instead of plunging herself into an unchangeable fact with such absolute requirements-gender is not one of the factors that determine usefulness; It is normal not to answer your son's question, and it has nothing to do with usefulness. Husband's illness is just a normal physical illness, which has nothing to do with family happiness or not.
2. Homework: Continue to explore unreasonable beliefs, draw your own table and classify according to ABC mode.
The fourth time: February 4, 2004 +65438.
Purpose:
Strengthen reasonable emotional experience
Method:
Talk, rational emotional therapy
Process:
1, through the treatment technology mainly refuting unreasonable beliefs, help the help-seekers realize the irrationality of their beliefs, and then give up these unreasonable beliefs, and help the help-seekers change their cognitive level. This is the most important part of the treatment.
2. We should not only help the help-seekers to understand and give up some unreasonable beliefs, but also start with changing their common unreasonable beliefs, and help them learn to represent unreasonable ways of thinking with reasonable ways of thinking, so as to avoid becoming victims of unreasonable beliefs again.
3. Imagine reasonable emotions (excerpt):
Close your eyes and imagine that when you go home with soy sauce and your father blames the girl for being useless, you are depressed and angry with yourself. Imagine how you are not a boy! Because I am a girl, I can't even make soy sauce well. I feel really lost, depressed, disappointed and anxious. These are your reactions to every negative life event or even everything. You should be responsible for your unreasonable beliefs. ...
2. Homework: Continue to explore unreasonable beliefs, draw a table and classify it according to ABC mode, and imagine that you have reasonable beliefs.
The fifth time: June 65438+February 65438+August 2004.
Purpose:
1, consolidate the consulting effect.
2. End the consultation
Method:
discuss
Process:
1, feedback operation
2. Point out the direction of continuing efforts: self-monitoring and control.
3. basically end the consultation. Set cognitive goals and strengthen self-analysis and understanding.
Eight. Evaluation of consulting effect
1, self-evaluation of help seekers
"Now I can sleep, and I'm not so upset." "I don't think it's useless because of women." "I'm a little worried about my husband's death." "There are few mistakes at work."
2. Consultant's assessment:
Through return visit and follow-up, it was found that the consultation basically achieved the expected goal; Anxiety is basically relieved, physical condition is improved, self-exploration and self-analysis can be actively carried out, and then some bad beliefs can be changed, and the consultation process is relatively complete.
References:
1. Qian Zhu Psychological Counseling and Psychotherapy Peking University Publishing House 1999 1 P89-94.
2. Wang Dengfeng People's Education Press of Clinical Psychology 1 September 19991Edition P270—278.