Case study of mental health services - Place2Be

https://www.place2be.org.uk/about-us/our-work/

Place2Be is a charity that focus on provide mental health services to young children that aged eight to twenty five years old. The charity worked with around five hundred schools across the UK and provide support to young children, parents and school staff. Apart from providing counselling services, Place2Be also organise talk service and art and music activities to children, helping them to deal with mental health issue before it’s too late. Since children are vulnerable, the charity established their safeguarding and child protection procedures to illustrate how they work with the schools when they’re aware of any low or high threshold safeguarding concern of any children. Place2Be will share the concerns with school staff and discuss what further actions is needed based on the findings of risk assessment. Parent or carer will also be informed, so that all parties can work together to deal with the issue. The area manager of the charity will also keep monitoring these incidents across the area and make sure the actions of the frontline meet the charity objective and protocol. 

I’d like to discuss how Place2Be assess the needs of the children and how it help the counsellors to do the work. Place2Be work with the schools closely and the school staff are trained to keep awareness of the children and they’re the first line to identify children that need help and Place2be will then interfere. If the issue is not crucial, then Place2Be will help them via the whole class activities and lite counselling service at recess time. If it’s recognised that extra support is needed, then the charity staff will hold a mental health assessment that called 'Strengths and Difficulties Questionnaire' to measure the mental being and determine what’s the best options to offer to the children. Depending on each children’s unique situation, cognitive behavioral therapy, individual or training that involve parent and children will be provided. The referral process is important to the charity, so that they can refer to appropriate parties in order to support the children. If Place2Be found that the children need additional support, they will then further refer to family practitioners or educational psychologists that work for Place2Be. The charity will also refer children to Children and Adolescent Mental Health Services, which is the NHS service that supports children who are experiencing poor mental health if needed. Moreover, Place2Be also works with various mental health associations and creative arts organization to provide creative expression sessions if those young people wish to explore their feelings and thought via drawings or music. 

I’d like to discuss the limitations of counselling, considering how Place2be work at a school setting. First of all, I think the effectiveness of the charity highly rely on the cooperation between school staff and their staff member. According to my understanding, they partner with school to prioritise mental health and wellbeing of the entire school community, so that children will be benefit from it. However, there maybe some tension between the two parties view of how to manage school daily operation. This may become very complicated if the school senior leadership team wish to have their own plan. On the other hand, I think the success of Place2Be heavily rely on the parents’ contribution. It’s unknown whether parents are aware of the importance of children mental health and they may have negative attitude towards the comment and suggestion from Place2Be. If the parent disagree with the assessment and refuse their children to attend counselling, then it’s hard for Place2Be to take further action.

To conclude, the above journal discussed how Place2Be work with the young children, what’s their referral way and what I think might be their limitation to work at school setting.

Progress - reflection about the level 3 study

Compare with last year, I feel like I’m more confident to apply counselling skills that I learned from the lessons to the skills practice sessions. Now I’m able to create a friendly environment that helpee is comfortable to share their feeling. Regarding the limits of proficiency, I think it’s related to how to deal with a series of conversation with the same helpee. The current triads that we did during lessons mainly work on a one-off session, which means the dialogue is within a short period of time and helpers do not have opportunities to discover the underneath feeling or thoughts via several rounds of dialogue. In real life, it's not realistic to expect all helpee to disclose themselves within such short time. It takes a few sessions for helpee to build a secure relationship with helper or counsellor before they feel it’s okay to share something that rarely share with the others. As a result, I only have limited experience of handling a continuous therapeutic relationship with a client. On the other hand, I think I need more experience of dealing with different types of people. I’m aware that people interaction is complicated and the chemistry reaction of people with different personalities are different. It’s not possible to learn from books solely but need to learn via more triads and real helping session. I wish to have more triad with different classmates and understand characteristics of different personalities via those extra triads. To enhance the learning, I think I can try to record the sessions and do some analysis afterwards. I can then listen the whole conversation again and see if there’s any key elements that I missed during the triad. I can also rethink if it’s workable to use other approach to run the session. I believe that is a good way to understand what’s doing well and what can be done better in the future.

I was struggling whether good spoken language is the most important thing to develop effective working relationship, or it’s only one of the key qualities of being a helper. After a few months debate with different people, I come up with some new insights. I think verbal communication play an essential role throughout the whole process, but there’re other elements that are more critical. Firstly, I found that helpee are looking for a person that can create a safe and non-judgemental environment that allow them to express their feelings and thoughts. It’s hard to achieve at general social setting, that means helper need to show and maintain kindness and attention using non-verbal communication skills. Secondly, many helpee wish to share everything in their mind in limited time when they meet a nice counsellor. Since the nature of sharing is less well organised than writing, it requires helper to analysis and understand the underneath meaning and feeling of the whole sharing, and guide helpee to consolidate what they think and what kind of daily struggles or mental health issues that the helpee is facing. Some people may think helper is doing nothing but actually a lot of work was processed during the silent moment. Thirdly, I think it’s crucial for helper to develop their personal qualities. Apart from the counselling skills, helpers are helping the helpee using their empathy, patience, focus and other qualities throughout the whole therapeutic process. Some of the qualities are in-born, and some of them can be developed intentionally. I think helpers that aim to be a counsellor should spend sufficient time to cultivate these qualities. To conclude, good spoken language is important in the working relationship and this remains one of my goals to achieve, and there’re also other key elements that are recognized to be essential throughout the counselling process. I wish to establish these during the study journey. 

I was grown up in a monoethnic country and almost ninety percent of the population are the same ethnic group. As a result, I rarely have opportunities to speak with people that from other ethnic group. I found that I was affected by the above values and thus I never have intention to reach out people of other races. When I first came to London, I realised the variety of population of this big city and I came up an idea to learn at least a bit from different races and not to trap by the culture of my hometown. I had a lot of opportunities to speak with classmates that came from various nationality, beliefs and career background. I found that it’s great for me to understand everyone’s life journey via conversations within the classroom and triads. Although we grown up in different culture, we all face similar life challenges such as family relationships, work pressure and money worries, and we’re sharing similar emotions because of the above issue. I used to see how different we are before I have first hand communicatin with people from other ethnic group. The interaction within the classroom changed my mind and I started to find our similarities instead. I’m very thankful to have such experience because it helped me to face the hidden discrimination that I gained from my culture. Now I’m trying to unlearn it by maintaining interaction with other people and keep in mind that we’re all getting through similar life challenges and I can treat the others in a more friendly way. I believe the new mindset will help me to be a better counsellor when I work with people that’re different from me. I wish to carry on the positive experience and demonstrate unconditional positive regard when I work with them. 

For people that suffered from discriminatory responses, I’d suggest to use a combination of person centred approach and cognitive behavioural therapy (CBT). Firstly, it’s important to acknowledge the feeling of the client before doing any other things. I’d suggest spending some time to understand what he faced and what’s his feeling about those response from the others. A proper relationship when then establish gradually by active listening and the demonstration of respect. If the feeling is too strong, then probably longer time is needed for client to express. It’s not recommended to move on to next stage if client is still stuck with the emotions and is not ready to process the underneath thoughts and beliefs. Secondly, I will invite helpee to talk about his self-concept and try to find out why the others’ action or words bring such hard feeling to him. The step is critical because it’s worth to find out whether the feeling is mainly due to internal or external causes. There’re various possible reasons that causing client to feel discriminated and it’s not proper to assume it’s because of particular reason. The key is to believe client know himself the best and what he need is some open-end questions to guide him find out the answer. Once the cause is identified, I can then determine if it’s suitable to use CBT to deal with client’s dysfunctional thinking and assist him to adjust his thoughts and behaviors gradually. This can be done by assisting client to review his way of thinking towards other’s actions and direct him to adjust the way to a healthier way, so that he will not be irritated when facing the same situation. The above paragraph briefly explain how I’d suggest to deal with the case by using skills and theories from both person centred approach and CBT. The two approaches have their own strength and weaknesses, so it’d better to apply them in different stages. 

Characteristics of counsellor

In this journal, I’d like to talk to talk about what kind of characteristics that’s beneficial to build a good therapeutic relationship between helper and helpee. I think patience is one of the key characteristics. Nowadays people’s mind is manipulated by social media algorithms and people are chasing for excitement and instant gratification such as likes and short comments. Now the culture is promoting a culture of didn’t read something would require too much time to understand, people are used to obtain summary or conclusion. It’s understandable why such culture is popular, but I don’t think it’s good to interpersonal relationships. It’s becoming harder and harder for people to slow down and pay attention to listen the other’s life experience, and that’s why people are looking for helpers or counsellors to share their struggle and feelings. They know that these people are all eyes and are willing to concentrate to listen with patience. Another characteristic that’s always mentioned with patience is non-judgemental. The rise of social media and instant gratification culture not only encourage a norm of restlessness, it also lead to another phenomenon, which is making judgement quickly. Now more and more people are keen on expressing their opinion and making judgement, despite they only listen a brief summary about what’s happened. Since people are used to comment on everything online, this also impact how they interact with other people in their daily life, causing more quick judgement after a short conversation. The quick response did not bring any good to people, it harm the relationship because people are judged, not being listened. As a result, non-judgemental is becoming more and more important, especially to helpers. People that are looking for having counselling relationship wish to have a non-judgemental space for them to talk about their own life experience. Some of those experience maybe full of pain and tears, and they have a great need of being listened instead of being judged. 

In the next paragraph, I’d like to discuss the three stages in the counselling process. The use of three stages outline what’d be done throughout the counselling sessions, which is very important to new counsellors and layman that rarely have counselling experience, so that both sides have a clearer picture about what to be expected. In the first phase of exploration, helper will explain what kind of rules that he will follow and details of the session will also be explained. This step is an invitation to helpee to take accountability of the upcoming sessions and understand the possible outcome about what helpee is going to share. After contract is agreed, helper will then try to explore what the helpee is struggling with by using various skills such as attending and silence. The aim is to assist helpee to find out what they’d like to talk about or what they wish to work on during the sessions. After that, it’s time for helper to further understand the feeling and underneath thoughs of helpee. Since helper have already talk about the issue briefly at the previous stage, helper will then work on identifying what’s mentioned frequently and whether there’s any patterns that worth further elaboration. After the above phases, helper and helpee should have a very fruitful dialogue. Helpee should be able to relief part of the emotions and understand himself in terms of thinking pattern, emotions, etc in a better way. Helper can then summarise what’ve been discussed and highlight key findings before ending the session.

Mixed anxiety depressive disorder

In this journal, I’d like to talk to talk about mixed anxiety depressive disorder (MADD), one of the most common mental health problems in England. It’s a condition where a person experiences the symptoms of depression and anxiety. It’s described as a diagnosable illness when a person continually worry and feeling low in mood and is hard to enjoy life. It’s quite common to have this situation because of the stress of living in London, a highly competitive city of Europe. The pressure at work and living make people feels it’s hard to face daily challenges and hard to relief during the rest time or annual leave. People will gradually lost their interest in their interested activities and probably feel they’re hard to fall into sleep easily. If the situation continues, they may also tiredness all the time and feel other negative body symptoms such as muscle tension and quick heart rate. In fact, it’s very common in primary care system and it leads to numerous impact to the whole society. According to NHS England, it is estimated this health issue affecting approximately 16% of the population of England, and it leads to a decrease of England’s national income by around 4%, which is about £80 billion. This reduction is due to high turnover rate, temporary work and reduced productivity. Although the National Health Service and therapeutic organization are aware of the impact, not all of the public understand the impact of MADD and some patients were stigmatised since somatic disorders is easier to be accepted than psychiatric disorders. I think it’s essential that work should be done to educate the public regarding the details of MADD, how to deal with stress and anxiety in daily life and how to help friends and family members. I think that early interference will prevent an exacerbation to a more serious condition. 

In the next paragraph, I’d like to discuss how counselling can promote a positive mental health. For people that are living with high pressure, it’s hard for them to find a way out because they’ve already spent most of their time and effort to deal with the existing situation and thus they don’t have capacity to process their emotions and struggles, and those stress can’t be reduced in a proper way. I think counselling can contribute by assisting people to understand their situation and relief their stress via the talking therapy process. People can then find out possible ways to deal with their own situation with the assistance of the counsellor and start to plan their future. Counsellors are not acting as a person to teach clients what’s the best way. Instead, they’re guiding the people to understand their personality, what’s in their mind and how it can be achieved. In some cases, the situation may take a long period of time to improve. If people can find a way to deal with the stress in a proper way, then they can gradually realise their potential, find their own work-life balance and their own understanding of meaning of life. 

Self disclosure in a therapeutic relationship

In this journal, I’d like to talk about the case number five and discuss whether Michelle’s way of approaching is beneficial to the therapeutic relationship. Firstly, I agree that self disclosure is a good way to establish therapeutic relationship with the client. It’s useful when client experienced similar life moment. However, the disclosure must be within boundaries, so that both the counsellor and the client can have an appropriate relationship, like what’s mentioned in the BACK ethical framework. The case mentioned Michelle keep disclosing her own situation and turns out the focus of the session twisted to Michelle’s life story instead of dealing with client’s needs, I think that is a bad example of not putting client first. If possible, I think Michelle should consider how much she should disclosure at the beginning and make sure the purpose of disclosure is to demonstrate empathy to Paula’s situation instead of becoming a channel to express Michelle’s own feeling. Besides, it’s common that client is curious and wish to know more. When Michelle encounter that at first instance, she should deny the request and explain the reason gently, so that Paula understand it’s to protect interest of both sides. Michelle should also guide Paula to talk about her own experience that she wish to explore, so that she can apply the counselling skill and demonstrate good practise through the session.

Understanding life event using CBT

In this journal, I’d like to apply concepts of Cognitive Behavioural Therapy to understand my life event. I was working at the supply chain team of an educational equipment company during the pandemic period. At that moment, the marine logistics is unstable and thus causing great pressure to myself. And the management announced bonus of six months’ salary will be given to staff a few months later. I was very struggle because I got severe eczema and backpain for the whole year, but I wish to have those money for the expense of upcoming wedding and emigration. When I look back to the history, the anxiety that’s affecting me is the uncertainty of future, and I jumped to the conclusion that having more money is the best way to deal with it. I did noticed my body situation at that moment and I thought I should carry on because that’s a huge money and I think I deserve it as a reward of working at the company for eight years. To deal with the cognitive distortion of ‘should’ statement and jumping to conclusions, I initiated self-talk and asked myself is it worth if I earn those extra money but forfeit my health. After a while, I realised that I still wish to have those money, but health is more important to myself and my partner. So I decided to quit the job and spend some time to rest and prepare for the future journey. 

In the next paragraph, I’m going to explore how I develop and maintain my relationship with my former colleague. I was promoted to a higher role to handle the development of new produces because of my performance. As a result, I have to work with colleague that I’m not used to deal with. The whole team promoted a 7/24 working style and expected the team member should work even they’re on annual leave. And they tried to justify this and asked me to follow. My new manager said that everyone else is doing it, so I as a new member must do the same thing. Since everyone were following that norm and agreed with that, I had no choice but to follow this irrational work style. At the beginning it’s fine and I justified this with the mindset that I should try my best to be part of the team. A few months later, I found that I’m exhausted and I no longer able to rationalize the work that occupy all of my time. I found that one of the greatest barriers that prohibit me to rebel was about the relationship with those colleague. I was taught that keeping good relationship with people is important and I always do whatever I can do maintain good relationships. I was worries about how the colleague would judge me, thus I pushed myself to stay in the role for a longer time. I decided to report that to the director when there’s a time that I couldn’t enjoy the time with my friends during weekend. I realized the cost of pleasing my colleague and that’s not healthy to my other relationships including family and friends. So I decided to abandon the idea of pleasing the others and strike a balance of work and my life. When I look back, I noticed the impact of “should” statements in my life. In my life, I was taught a lot of values and what I should follow. Now I have better understanding and that allows me to make correct decision to interact with different relationships. 

Personal blocks

Nowadays the society promotes the idea of diversity, equity and inclusion, many organisations and companies apply this in the recruitment as well. However, that doesn’t mean that discrimination doesn’t exist. It still exists in the workplace, but in a more hidden way. In my previous workplace, I belong to ethnic minority because there’re only two to three Asian staff. Most of the staff were friendly to me, but I can sense that some staff were quite hostile. When we’re working in a project jointly, I noticed that one colleague always criticises my language barrier. He’s aware that I’m not that familiar with popular slang or fashionable vocabularies, and he always explain the meaning to me exaggeratedly. It seems he tried to be friendly to a foreigner, but I though that’s a form of contempt. The tricky thing is that it’s hard to say it’s direct discrimination, but I can sense the unfriendly expression from his facial expression. The above experience enables me to understand the feeling of being treat unfavorably and I wish my client will never face this when we’re in a counselling relationship. It's inevitable that I will meet people that are from other background and they may have belief that completely different with mine. I will remind myself to demonstrate respect and congruence during the sessions, make sure they feel it’s comfortable to share their story and feeling with me. The key point is I don’t have to adopt their view in my own life, but I need to do what I can to listen and understand his ideas throughout the session.

In the next paragraph, I’d like to discuss what kind of personal blocks that will affect me to show empathy when developing a counselling relationship. The first one that I can think of is I’m hard to empathise with people that culturally promote machismo. I know that I should demonstrate underconditioned positive regard during the session, but I can foresee that I will feel very uncomfortable when I hear a male place woman into a lower standard and justify this in his own way. I grow up in a society that empathise gender equity and thus I own the value of treating the others fairly. If I have a chance to work with client that own different value, I guess I need very strong self-discipline to force myself not to argue during the session. Another type of people that I feel I’m hard to deal with are those with strong political views. I believe every people have their own frame of reference to see how the society operate, and people may have contrasting view because of their own experiences. I tried to understand my friend’s political view a few years ago. His sharing not only involved political beliefs, but also include strong negative emotions due to incidents happened in the society. I found that the conversation was very difficult because it’s a mixture of opinion and feeling, it’s difficult to differentiate them clearly during the conversation. When he mentioned some feeling due to a viewpoint that I disagree with, I found that I’m not able to show empathy, I was tempted to initiate the debate of that political point. Now I have more training and knowledge of counseling skills, but I still feel hesitate if I speak with a client with strong political belief. I’m not sure if I can focus on understanding his feeling instead of the political points. I think that’s still challenging to me at this moment.

Grief of an old widow

During the lesson, we spent some time to discuss a case regarding an old widow and her grief. During the discussion, some classmates suggested to find ways to assist the widow to regain interest to her hobbies and look forward to the future that without her husband. I understand their intention is to help the widow to get rid of the grief quickly, but I’m not sure if it’s too pushy. In the point of view of person-centred approach, I think the key is not to guide the widow to the direction we think is good to her, but to understand what she wish to deal with at the moment. I think what I should focus on is to demonstrate unconditional positive regard to her situation and try to understand what she wish to talk about. It’s understandable that she may not wish to talk too much because of the grief, counsellor have to try their best to demonstrate empathy via non-verbal communication as main channel. If she wish to share about her own situation, I will make sure enough time is spent, so that she have a space to talk whatever she wish to talk about, probably her feeling about the lost, what she thought regarding her children or other areas that she wish to share. Besides, the case mentioned Helen have signs of depression. I think it’s needed to consider referral if her situation is beyond the ability of a counsellor.




To conclude, I shared my understanding of the person-centred approach by sharing my comments about a case. I tried to apply the concepts of the approach and talk about what I think is appropriate to do when using the approach to the old widow.