Keywords: general psychological problems? Rational emotional therapy for anxiety.
I. General information
1, demographic data
Visitor: Zhao, male, 20 years old, Han nationality, living in Zhangjiakou. Parents, farmers and grandmothers have long died of illness. Grandpa died recently, and he has a younger sister. This family is poor and harmonious. Zhao is now a first-year undergraduate in the mathematics department of a university. He studies hard and is in good health. There is no history of major illness in his family.
2. Personal growth history
The tourist was born in a peasant family in Zhangjiakou, with a younger sister and a happy and harmonious family. Parents are very filial to the elderly. Due to the influence of family environment, Zhao is sensible and filial to his elders. Grandpa is ill in bed, and his parents are with him, never leaving. He often feeds grandpa, too. Everyone in the village praised him as a sensible child. There have been no major changes at home, but visitors are not very talkative and never mention trivial matters at home to others. Visitors study hard, and they still study hard after being admitted to the university.
3. Refined state
When consulting, I dressed appropriately, but my face was ugly, my heart was uncomfortable and my face was anxious.
4. Physical state
School physical examination, no major illness. For more than a month, I slept for 3~4 hours at night, and I didn't eat well, and sometimes I had a headache.
5. Formal social gatherings
Academic performance drops, communication with people is less, in the dormitory, a person is often silent, and the dormitory relationship is tense.
6, psychological test results
SAS test results: The total score is 52, and the standard score is 65, which exceeds the cut-off value of SAS standard score 15, and belongs to moderate anxiety.
The results of self-rating depression scale (SDS) test: the total score is 48, and the standard score is 60, which exceeds the cut-off value of SDS by 7 points, and belongs to mild depression.
Second, the chief complaint and personal narrative
1, chief complaint
I have been thinking about a problem for more than a month recently. What does my roommate mean by that sentence? I feel that what my roommate means is irony. Feel wronged, uncomfortable, emotionally unstable, and occasionally have a headache. I often have insomnia at night, and I can't listen in class. I feel like I'm falling apart.
2. Personal statement
On National Day, my grandfather died of illness. I helped with the funeral at home and went a week later than other students. I only asked the teacher for leave, but I didn't tell anyone in the dormitory. When I came back, I didn't tell them about grandpa's death. Once I had dinner with a roommate, and he asked me why I came back to class so late. I told him about grandpa's death. But he said, "Oh, your grandfather is dead, why didn't I see it!" " "At that time, I asked him what he meant, and he said nothing, just saying. But I'm particularly angry. I always feel that in the eyes of others, I am an unfilial person. I asked him many times, but he still said that there was no other meaning. I just don't understand why he said that about me. During this time, I have been uncomfortable in my heart. I can't listen carefully in class and often can't sleep well at night. I am in pain now, and I hope you can help me.
Three. What the consultant observed and learned.
1, what the consultant observed:
The visitor walked into the consulting room dressed appropriately and his face was ugly. I felt a little excited during the conversation. Especially when it comes to grandpa's death, what my classmates said was very painful, and I burst into tears. But the thinking is clear, the self-control is complete, and there is a strong desire for help.
2, dormitory students' reaction:
Zhao loves things seriously, is stubborn and stingy, especially cares about others' evaluation of himself, and has strong self-esteem. But my academic performance is very good, I work hard and I am very motivated.
Four. Evaluation and diagnosis
According to data collection, the current status of visitors is as follows:
1, mental state: anxiety, depression
2, physiological function status: sleep quality decline, occasional headache.
3. Social function status: academic performance is declining, and interpersonal relationship in dormitory is very stiff.
The initial diagnosis of visitors is:
General psychological problems
The diagnosis basis is as follows:
1. The psychological problems of this visitor are caused by real events. Therefore, tourists experience bad emotions. Depression, anxiety, pain, etc. )
The visitors' bad psychological state lasted for more than a month, but they still couldn't resolve it by themselves.
3. The visitors' bad emotional reaction has always kept their behavior normal, and they can basically maintain their normal life and study. Their social function has not been seriously damaged, but their efficiency has decreased.
4. The content is not general.
Differential diagnosis:
1. Differentiate from mental illness: the troubles caused by visitors have obvious life events, the subject and object observe the unity of the world, their mental activities are inherently coordinated, and their personality is relatively stable. Perfect self-awareness, active medical treatment, no abnormal perception, hallucinations, delusions and other symptoms of mental illness. So we can rule out psychosis.
2. Different from serious psychological problems:
The psychological problems of visitors lasted for more than a month, but the study efficiency decreased and the dormitory relationship was tense, which did not seriously affect the social function. And the problem is only confined to my roommate's sentence, and there is no obvious generalization. However, serious psychological problems have a strong reaction, and the reaction has been generalized, which has a great impact on social function, and the course of disease is more than two months. So we can rule out serious psychological problems.
3. It is different from anxiety neurosis.
Anxiety neurosis is a kind of neuroticism that lacks clear object and specific content, including exercise anxiety and autonomic nervous dysfunction. Although visitors also have anxiety as the main symptom, it does not seriously affect social function and logical thinking. Psychological conflict is normal, without generalization, and lasts only over a month. So we can rule out anxiety neurosis.
cause analysis
1, biological factors: strong and healthy, no family history of mental illness.
2. Social factors: misunderstanding the meaning of roommate's speech, poor communication with others and lack of social system support.
3. Psychological factors: visitors are introverted, sensitive and serious.
Verb (Verb's abbreviation) Formulation of Consulting Objectives
Based on the above assessment and diagnosis, after consultation with visitors, the following consultation objectives are preliminarily determined:
1, specific targets and near-term targets:
Change the cognitive model of visitors, help them understand the meaning of roommates correctly, and reduce adverse emotional reactions. Promote its sleep quality to be improved.
2, the ultimate goal and long-term goal:
Improve the human nature of visitors, learn to empathize, understand problems from the perspective of others, and enhance social adaptability.
Formulation of consulting scheme for intransitive verbs
Through consultation with the visitors, according to this case, we decided to adopt reasonable emotional therapy to treat the anxiety symptoms of the visitors.
1, principle and method:
Rational emotional behavior therapy was founded by albert ellis, a famous American psychologist, in 1950s. According to his theory, it is not external events that cause people's emotional distress, but people's attitudes, opinions, evaluations and other cognitive contents. Therefore, to change the emotional distress, we must change our cognition, and then change our emotions by changing our cognition. He believes that external events are A, human cognition is B, and emotional and behavioral responses are C, so its core theory is also called ABC theory. ?
The psychological problems of the visitors in this case seem to be caused by their roommates' unfriendly words and opinions about themselves, which lead to anxiety. In fact, the real reason is the unreasonable view of the visitors themselves and the idea of either or. For example, the visitor exists: "When he said that, he meant that I was unfilial." "Why do you say that about me? I have always been very filial. " Wait, some unreasonable beliefs. Therefore, using reasonable emotional therapy can help visitors to replace unreasonable beliefs and cognition with reasonable cognitive thinking mode and help visitors to reduce negative emotions and behaviors.
2. Responsibilities, rights and obligations of both parties
(1) Responsibilities, rights and obligations of visitors
responsible
A. Provide real information related to psychological problems to psychological counselors.
B. actively discuss with the consultant the ways to solve the problem.
C, complete the work agreed by both parties.
correct
A. Have the right to know the training background and professional qualifications of the consulting company.
B, have the right to know the specific methods, processes and principles of consultation.
C, have the right to choose or replace the appropriate consultant.
D. Have the right to submit or suspend the consultation.
E. Have the right to know, negotiate and choose the contents of the consultation plan.
accountability
First, comply with the relevant provisions of the advisory body.
B. observe and implement all aspects of the agreed consultation plan.
C respect the consultant, observe the appointment time, and inform the consultant in advance if there are special circumstances.
(2) Responsibilities, powers and obligations of consultants
responsible
I. Abide by professional ethics and abide by relevant national laws and regulations.
B, help visitors solve psychological problems.
C, strictly abide by the principle of confidentiality, and explain the confidentiality exceptions.
correct
A, have the right to know the psychological information related to the psychological problems of visitors.
B, have the right to choose the right visitors.
In a responsible attitude towards visitors. Have the right to make a referral or suspend consultation.
accountability
A, introduce your training background to visitors, and show your business license, qualifications and other relevant certificates.
B, comply with the relevant provisions of the advisory body.
C. observe and implement all aspects of the agreed consultation plan.
Respect visitors, observe the appointed time, and inform visitors in advance if there are special circumstances.
3. Time and cost of consultation
(1) Consultation time: 50 minutes per week 1 time.
(2) Consultation fee: there is no charge for on-campus consultation.
(3) Psychological test: There is no charge for the on-campus test.
Seven. Negotiation process
According to the specific situation of the visitors, through the communication with the visitors, the introduction of the theory and methods of psychological counseling, and through consultation with the visitors, we decided to adopt reasonable emotional therapy for counseling.
1, the consultation process is roughly divided into three stages:
The first stage: the diagnosis stage
The second stage: the consultation stage
The third stage: consolidation stage
2. Specific consultation process:
(1) First consultation
Time: 20 16 12 1
Purpose:
1, collecting data
2. Establish a positive and trusting consulting relationship.
3. Identify the main problems of visitors.
4. Conduct psychological test and preliminary psychological diagnosis for visitors.
5. Establish consulting objectives and work out consulting plans with visitors.
Methods: Psychological tests were conducted by interview.
Process:
1, fill in the consultation registration form and consultation record form, ask about the basic situation, and introduce the relevant matters and regulations in the consultation. Clarify the responsibilities, rights and obligations of both parties, and emphasize the confidentiality principle of consultation content to visitors. Establish a preliminary consultation relationship with visitors.
2. Talk with visitors on admission, collect clinical data, and discuss the main psychological problems of visitors and change their wishes through respect, enthusiasm, sincerity and positive attention.
3. After consultation with the visitors, psychological tests were conducted, including self-rating anxiety scale (SAS) and self-rating depression scale (SDS).
4. Explain the results of the psychological test and give a preliminary analysis according to the preliminary impression.
5. After consultation with visitors, * * * determine the consulting objectives and make consulting plans.
(2) Second consultation
Time: 2016 65438+February 8th.
Purpose:
1, enter the consulting relationship merger.
2. The consultant explains the basic principle and treatment process of rational emotional therapy to the visitors, and the visitors should understand it correctly.
3. Guide visitors to realize their unreasonable beliefs. Make visitors realize that they have some unreasonable ideas and concepts, and the direct cause of their boredom and anxiety is these unreasonable ideas and concepts. And guide visitors to change the wrong cognitive model.
Methods: Role-playing method of rational emotional therapy.
process
1. The consultant introduces the basic principles and specific steps of rational emotional therapy, and explains the theoretical model of rational emotional therapy, so that visitors can really understand it.
2. Guide visitors to truly understand the relationship between cognition A, B and C, and think about their unreasonable ideas and wrong cognitive models in combination with their current problems.
Dialogue (excerpt)
Counselor: The classmate said, "Your grandfather passed away. Why didn't I see it? " What are you thinking about? "
Visitor: I think what he means is that I am unfilial. The implication behind his words is: your grandfather died, why can't you see that you are sad? Without sorrow, it must be unfilial. Filial children, grandpa died, will certainly show it. I feel very wronged. I am very kind to grandpa, and everyone in the village knows it. What makes you call me unfilial? I feel angry. How could you do this to me?
Counselor: Do you think this sentence of your roommate has a second meaning?
Visitor: No.
Consultant: Now, let's play back the scene at that time, shall we? You play your roommate and I'll play you. The more serious you play, the better. We'd better make the scene real. I hope you can understand what your roommate said, ok?
Visitor: OK.
Scene reappearance: in the corner of the restaurant, visitors and roommates are eating. Suddenly, your roommate asks you, "Are your family all right?". Why did you come back to school so late? " A: "My grandfather died and was delayed for a few days." Q: "Your grandfather died? Why didn't I see it? " The visitor asked, "What do you mean?" A: "Nothing, just saying." )
Consultant: Well, you acted very well. Do you think our performance is highly similar to the situation at that time?
Visitor: Well, not bad. That was probably the case at that time.
Counselor: So you just played your classmate. How do you feel?
Visitor: I don't think he wants to laugh at me now. I don't understand now. Are you confused? (meditating)
Visitor: I have asked him many times. What does he mean? He always explains that there is no other meaning. You think too much. But I always feel that what he said is not true. Later, I asked him several times, and he said it was just a simple question, with no other meaning. He took my hand and said, "Please, don't ask, it really doesn't mean anything else." But I (silence) ...
Counselor: You don't seem to trust him.
Visitor: Well, I always feel that he is calling me unfilial. I thought it would be all right in a few days, but I don't know why, and I feel bad at the thought of his words. I also wonder if everyone in the dormitory thinks I'm as unfilial as him. I feel greatly insulted. I need to adjust as soon as possible, and the exam is coming soon. I'm anxious. I hope you can help me.
Counselor: It seems that you care about what others say about you.
Visitor: Well, I'm particularly afraid of being talked about. I am particularly afraid that others will say that I am unfilial. My grandmother died a long time ago, and my grandfather has been raising my father and bringing me up. Do you think I'm unfilial? My parents are very filial to the elderly, and everyone in the village knows that.
Counselor: Well, I can understand how you feel. You must have been very sad when grandpa died.
Visitor: Well, I feel very sad. Parents are also very sad, so spend more time with your parents at home. When I got back to school, I pretended nothing and continued to study hard. I didn't expect such a thing to happen. (sobbing)
Step 3 assign homework
(1) Ask the visitors to make up a story about their own experience after they go back, talk to the people in the dormitory, and then ask what that sentence means. Then write it down and experience it again and again.
(2) When visitors are worried and anxious about this matter again, they can find a good friend, exchange roles, restore the scene at that time, and repeatedly understand the roommate's meaning.
(iii) Third consultation
Time: 20 16 12 15
Objective: To help visitors change their original unreasonable beliefs, establish reasonable beliefs and relieve their emotional troubles.
Methods: Rational emotional therapy.
Through analysis, it is found that visitors misunderstand some words, which leads to emotional distress.
Dialogue (excerpt)
Counselor: After a week of practice, do you have any new understanding of what your roommate said?
Visitor: After I went back, I finished the homework you assigned me. I asked my roommates, and they all said that the man thought too much. After repeated practice, I feel that my roommate really has no other meaning.
Consultant: I'm glad to see your progress. You are very clever. (smiling)
Visitor: Smile.
Counselor: Actually, this is the real reason for your emotional loss and anxiety during this period. Then you misunderstood what you said to your roommate.
Visitor: Now my relationship with my roommate has become very tense. He avoided me intentionally or unintentionally.
Consultant: Now we have found the crux of the problem. I believe you will go back in time. You are a clever man.
Visitor: Smile and nod.
homework
1, often keep a diary, including daily life and emotions, and constantly reflect. The specific contents include: date, induced events, unreasonable ideas, arguing with unreasonable ideas, and getting reasonable ideas and emotional changes.
2. Have a good chat with your roommate. I misunderstood that sentence. It's not about my roommate. I apologize to my roommate.
(iv) Fourth consultation
Time: 2016 65438+February 23rd.
Objective: To further consolidate the effect of consultation and strengthen the establishment of reasonable belief.
Methods: Interview and measurement.
Process:
1, feedback consultation work, should further strengthen the reasonable belief established by the help seekers and give a positive evaluation of their progress.
2. Discuss the understanding of filial piety culture with helpers. It is more helpful to give up his unreasonable beliefs.
3. Measurement data:
(1) Results of self-rating anxiety scale: the total score was 36, the standard score was 45, and the anxiety symptoms disappeared.
(2) Test results of Self-Rating Depression Scale: The total score was 30, and the standard score was 37, and the depressive symptoms disappeared.
Eight. Evaluation of consulting effect
1, visitor
Thank you for your help and encouragement these days. Now, my relationship with my roommate has returned to normal, and I will never pester that sentence again. Learning is on the right track, life is calm, mood is stable, and I am happy for my real relaxation.
2. Visitors and roommates:
He took the initiative to talk to me and said to me. . Our relationship is getting better again, and we can have dinner together as usual.
3, psychological test results:
(1) SAS test results: the total score was 35, the standard score was 44, and the anxiety symptoms disappeared.
(2) Test results of Self-Rating Depression Scale: The total score was 30, and the standard score was 36, and the depressive symptoms disappeared.
The test shows that the anxiety and depression of visitors have been obviously improved. Both have returned to normal levels below the critical value.
4. Consultant evaluation:
Through the telephone call back, it is obvious that the visitors are very happy and completely eliminate unreasonable beliefs. The relationship with roommates has also become very harmonious and life has returned to normal. Basically achieve the consulting goal.
refer to
[1] Guo Nianfeng, editor-in-chief: National Vocational Qualification Training Course-Psychological Counselor (Basic Knowledge), Ethnic Publishing House, first edition in August 2005.
[2] Guo Nianfeng, editor-in-chief: "National Vocational Qualification Training Course-Psychological Counselor (Level 3)", National Publishing House, August 2005, the first edition.
[3] Guo Nianfeng, editor-in-chief: "National Vocational Qualification Training Course-Psychological Counselor (Level 2)", Ethnic Publishing House, August 2005, the first edition.