1 Case Presentation Running head: CASE PRESENTATION Alicia: A Case - - PDF document

1 Case Presentation Running head: CASE PRESENTATION Alicia: A Case Presentation Christine S. CNSS 561 Holy Family University

2 Alicia: A Case Presentation Who is involved? In addition to the student client, Alicia, there are several others who are involved in her case. At school, those who are involved include: me, her counselor (my supervisor), and the teachers on her grade level team. Although I have taken on primary responsibility for this case, my limited presence at Shafer Middle School necessitates my supervisor’s continued involvement in the case either as a consultant or simply someone to take phone messages. Alicia’s teachers are involved both as consultants, but also as individuals who take on a significant amount of responsibility for implementing recommended interventions. At home, both Alicia’s mother and her older sister have played a role in creating some of Alicia’s concerns, but also can be critical to bringing about positive

• change. Alicia’s mother functions primarily as a consultant and a source of encouragement for
• Alicia. Her sister, on the other hand, as a teacher, can be utilized as an additional source of support

as well as a functional resource. What is the problem? Alicia is a quiet and sweet thirteen year-old African American girl. Despite average academic performance in the past and being considered by many as bright, Alicia has been struggling academically since the beginning of the school year. Initially she was able to maintain a C average, but as the school year progressed into the second and third marking periods, concerns were raised about declining grades, an apathetic attitude, disorganization, and procrastination. At the team meeting in late January when I first was introduced to Alicia’s case, Alicia’s teachers described her as a quiet student who avoids classwork and frequently employs excuses in order to explain incomplete and missing homework assignments. Her grades on tests can also be very unpredictable. On one test she may get a 98 percent, but on the next test she could get as low as a 53 percent. Alicia loves to read and has excelled in classes that offer the opportunity for independent study. She was even

3 Case Presentation placed in a reading section that was designed for gifted students. Despite her love of reading, however, Alicia’s worst subject is English. She also does poorly in science. Her grades are only marginally better in social studies and math. Alicia describes the classes in which she performs poorly as boring, particularly when they involve repetitive tasks like worksheets or writing rough

• drafts. This could mean one of two things: Alicia is capable of better work but is unmotivated due

to boredom and instruction that does not match her preferred learning style or Alicia is lacking skills that lead her to adopt an attitude of indifference. Thus, as a result of consulting with Alicia’s team teachers, reviewing Alicia’s past academic record, and speaking with her several times, it is my

• pinion that Alicia’s primary presenting problem is academic underachievement due to a lack of

motivation and self-confidence. In addition to these academic concerns and a potential contributor to Alicia’s low self- confidence, is Alicia’s shy demeanor. Having observed her in classroom settings, in the hallway, and in the lunchroom, Alicia keeps to herself and interacts with only a small group of friends. In my conversations with her, she sometimes has difficulty making eye contact and seems to be somewhat self-conscious. Yet, I have found that once she is comfortable, Alicia is actually very charming and

• cooperative. Still she often speaks of the anxiety she feels when she perceives others as judging her

whether it is her peers or her teachers. Moreover, recent conversations have led me to believe that immaturity may be a factor in Alicia’s academic underachievement. Specifically, Alicia may view failing eighth grade as a means of avoiding moving to the high school next year, which is something I believe she fears. In conclusion, Alicia’s shyness, self-consciousness, and immaturity often manifest in avoidance, which prevents her from living up to her potential. Some of Alicia’s concerns may be attributable to her home life. Alicia is close to both her mother and older sister who care about her and are interested in seeing her do well in school. Alicia’s

• lder sister is a teacher and is always pressuring her younger sister to do better in school. In fact,

4 despite having a close relationship with her sister, Alicia seems to feel as though she is often in her

• shadow. In terms of her mother, Alicia has a good relationship with her mom even though they
• ften do not have a lot of time to spend together. Mom tends to say all the right things in phone

conversations, but fails to follow through on recommendations made by myself as well as Alicia’s

• teachers. Alicia’s mother has also failed to show up at two scheduled parent-teacher conferences.

Alicia’s mother seems to be responding in this way due to a combination of stress and a lack of

• time. As a result of her mother’s lack of engagement with the school, it is possible that Alicia may

not be receiving the emotional support and encouragement she needs to improve. Several interventions have already been applied to Alicia’s case. In addition to parent-teacher consultation, a behavior plan is in place as well as regular individual counseling sessions with me. Alicia’s teachers keep a daily log that keeps track of classwork completion, classroom behavior, homework completion, use of her assignment book, and a list of missing assignments. In our weekly sessions, Alicia and I would view this behavior chart. We discuss what worked and what else could be tried. I also work with her on setting goals, organization, and we often talk about social and emotional issues as well. Although some progress has been made as a result of these interventions, Alicia continues to hand in homework assignments and has failed several quizzes and tests. Based on all available information, including the results of existing interventions, it is possible to gain a clearer understanding of the problem in this case. Accordingly, the primary presenting problem in Alicia’s case is academic underachievement. Her continued poor grades and irresponsible behavior appear to stem from a lack of motivation as well as feelings of inadequacy. Why am I involved? I became involved with Alicia’s case at the start of the second month of my internship at Shafer Middle School. Having attended a team meeting in which Alicia was discussed, I volunteered to take her on as part of my caseload. My first official act in this role was to meet with Alicia

5 Case Presentation individually in order to establish rapport and to get her point of view of the problems her teachers presented during the team meeting. I also worked with Alicia on developing some basic study skills, including helping her clean out her locker. From this first meeting, I have worked with my supervisor and the team to develop and monitor a behavior plan. This plan is easily accessible on Google Docs, which allows teachers to update the chart quickly and without worrying that the student will lose it in transit. My current work with Alicia includes monitoring this plan, weekly individual counseling sessions, regular consultation with her teachers, and periodic communication with her mother. The ultimate goal of these interventions is to provide Alicia with the support and structure she needs to improve academically. How do you conceptualize this case? Identifying data. Alicia is a thirteen year-old African American female who lives with her biological mother. Alicia also has an older sister who works as a teacher who does not live with the family, but she does visit often and plays a significant role in Alicia’s life. Alicia’s maintains regular contact and visitation with her biological father, stepmother, and two stepsiblings. Alicia comes from a lower middle class family. She dresses casually and can often be seen wearing jeans and a hoodie. Physically, she is normal in terms of body weight and is approximately 5’3” tall. Alicia is introverted and thus is not very expressive. However, once she gets to know someone, she is less self-conscious and is able to open up more. She can be incredibly sweet and has a good sense of humor. Alicia is currently not on any medications. Presenting Problem. Alicia is failing or close to failing many of her academic classes. Her academic underachievement is the result of a lack of motivation, low self-confidence, and the goal to avoid failure. These underlying concerns manifest in poor class participation, inadequate homework completion, and inconsistent test grades. Although behavior is not a problem, teachers have indicated that Alicia often requires a lot of prompting to complete activities and worksheets in

6

• class. Alicia also is quiet and only has a few friends. She is self-conscious and becomes anxious in

situations where she anticipates judgment. Alicia has admitted that she is often bored in her classes and would prefer to engage in more independent learning activities. Environmental Factors. Alicia has a loving and supportive family. Although she lives with her mom, she has a relatively good relationship with her dad. Alicia describes her family as one of the things she is most proud of in her life. Both her mother and her older sister have high expectations for Alicia, but these expectations are rarely linked to any support. This is partially explained by her mother inability to spend much time with Alicia due to long work hours. However, from Alicia’s perspective, it is her older sister’s success that has put the spotlight on her. Alicia and her mom are relatively new to the Bensalem School District having transferred there last year after living in Philadelphia all of her life. At school, Alicia is in standard level classes with an average of 25 students in a class. Most of her teachers utilize a teaching style that relies heavily on direct instruction, worksheets, and rote practice of skills. Her teachers have made several attempts to motivate Alicia to improve her grades through standard practices like checking her assignment book

• r calling home, but few of Alicia’s teachers have developed a relationship with her. Alicia’s only

connections to the school are through her reading teacher and through me. Outside of school staff, Alicia has made connections with a small group of friends. Although bullying is frequent at school, Alicia has never been a target. Culture is another environmental factor that could be contributing to Alicia’s presenting problem of academic underachievement. In general, many of the students in Alicia’s classes are not motivated to achieve academically. This attitude is partially explained by developmental factors associated with early adolescence, but overall Alicia occupies a school environment in which many

• f her peers do not value education. Academic success, therefore, could be viewed as “uncool” by

Alicia’s peers. Furthermore, as an African American, it is possible Alicia’s academic difficulties could

7 Case Presentation be partially explained by what Steele (1999) referred to as “stereotype threat.” According to this theory, African American students who are highly capable and who personally value academic achievement ultimately fail to achieve their potential due to anxieties that interfere with performance

• n academic tasks.

Personality Characteristics. Alicia is of average intelligence. On last year’s PSSA tests, Alicia scored in the Proficient range in Reading and in the Basic range in math. On both tests, she scored highest on measures that required analytical skills, but scored lowest on basic skills like numerical

• perations. She has received satisfactory grades in the past, but is struggling to pass many of her

classes this year. She is quiet and cooperative. Although she is sweet, funny, and friend, Alicia prefers doing a lot of things by herself. Her shyness often prevents her from asserting herself such as asking questions in class that may facilitate understanding critical concepts. She is disorganized at school, but her bedroom at home is an oasis of order. Alicia’s favorite subject is English/Reading and one

• f her hobbies is modeling. Alicia wants to open a salon when she grows up, and really likes the idea
• f owning her own business. Overall, Alicia presents with a positive affect. She recognizes that she

has a problem and expresses disappointment in her inability to improve. She exhibits no psychosomatic symptoms and does not have any health problems with the exception of a few food allergies.

• Conceptualization. Alicia is experiencing discouragement due to both the anxiety she associates

with performance related tasks and the boredom she experiences in many of her classes. This discouragement has negatively affected her inability to achieve academically and has resulted in an attitude of indifference that serves to facilitate avoidance of failure. Alicia’s anxiety and self- consciousness is also exacerbated by irrational beliefs and negative thoughts. Alicia’s feelings of inadequacy in relation to her older sister serve to perpetuate this anxiety and discouragement. Finally, with so much focus on her deficits, Alicia and many of those involved in her case continue

8 to ignore what is working well for Alicia, which may be a valuable key to building critical self-

• confidence. Thus, as you can see, this conceptualization is primarily formed from the confluence of

three theoretical orientations: Adlerian, cognitive-behavioral, and solution-focused. One of the key principles associated with Adlerian theory is the concept of goal-directed

• behavior. All behavior, for example, is motivated by the need to overcome feelings of inferiority

(Corey, 2005). Consequently, when an individual like Alicia perceives herself as inferior, she becomes

• discouraged. Ultimately, in order to compensate for those feelings, Alicia pursues mistaken goals of
• behavior. Since Alicia views herself as inferior in the academic domain, she compensates for those

feelings by avoiding failure through procrastinating and adopting an attitude of apathy and

• indifference. Birth order is also a central tenet of Adlerian theory (Kelly & Lee, 2007). In Alicia’s

case, the fact that her older sister exemplifies the oldest child paradigm of someone who sets what may seem to be impossible standards for success appears to have resulted in some of the typical problems associated with being the second child. For example, if the first child is good, the second may become bad. Therefore, since her sister was successful in school, Alicia does not do well in school because she feels uncertain about herself and her abilities. In addition, due to her sister’s apparent success and the pressure she puts on Alicia to similarly excel, Alicia’s academic underachievement may contribute to feeling as though she does not

• belong. Although she has a small group of friends, Alicia’s shyness also disconnects her from her

peers and teachers at school. It is possible Alicia’s shyness is related to unresolved adjustment issues associated with being relatively new to the school, but it could also serve as a means of avoiding social interactions in which there is the potential for scrutiny. Still, the absence of a strong sense of belonging to the school either socially or academically, indicates a need to facilitate new connections that build self-confidence. Finally, since Alicia has not only developed a reputation for not doing her

9 Case Presentation schoolwork, but also has failed to turn in so many assignments that it seems there is no way of ever getting ahead, encouragement based on the systematic achievement of short-term goals is essential. The theoretical concepts associated with Cognitive Behavioral Therapy and Rational Emotive Behavioral Therapy are also useful in conceptualizing Alicia’s case. More specifically, irrational beliefs seem to be contributing to Alicia’s school-related anxiety. For example, in several conversations with Alicia she has suggested that she believes that if she gets a question wrong on a homework assignment or answer a question incorrectly in class, she will be viewed as stupid. She thus avoids these kinds of tasks to escape feelings of inadequacy. Alicia also has a tendency to engage in selective abstraction (Merrell, 2008). Instead of focusing on her successes, such as a perfect score on a math test or positive feedback she received on a poem written for English class, she sees only her mistakes. In addition, Bandura’s theories of social learning and self-efficacy beliefs help to explain Alicia’s indifferent attitude towards academics (Bandura, 1977; 1982). From a social learning perspective, Alicia is in an academic environment in which many of her peers do not value academics so there is an absence of positive peer pressure to encourage academic achievement. Self- efficacy beliefs are also a factor in perpetuating Alicia’s academic difficulties. Prior and repeated experiences with failure have convinced Alicia that she cannot do the work. Relocating from Philadelphia to Bensalem, for example, seems to have been a difficult transition. Perhaps Alicia is accustomed to a particular teaching style or pace, and thus she was unprepared to cope with the academic demands of this school district. This initial adjustment problem may have had a lasting impact of Alicia’s sense of her own self-efficacy. Solution-focused theory can be applied to Alicia’s case as well. Alicia has become accustomed to repeated failure. Yet, little attention has been paid to what is working for Alicia. For example, what is it about her reading class that enables Alicia to succeed compared to her other classes? How was Alicia able to get an A in an independent studies class, but continues to fail

10 English because she does not complete any work? The answers to these questions provide some compelling ideas for potential interventions. These classes have two important things in common: they are more challenging and they allow for more independent study. Alicia feels less anxiety and self-consciousness when she is able to be a self-directed learner. Although she is capable of understanding critical concepts and has the skills necessary to succeed in her other classes, she learns these concepts and skills differently and is best able to demonstrate her understanding in ways that do not include worksheets and multiple choice tests. There is even more evidence that looking to these exceptions provides valuable insight (Metcalf, 2008). Recently, as a result of an individual counseling session with Alicia in which she shared this information about how she learns best, she asked one of her teachers to move her seat to a quieter place where she could do her work more independently and without distraction. Since her seat has been moved, Alicia has improved her classwork completion. From this orientation, what interventions or plan of action did you take? Since the conceptualization of Alicia’s case includes elements of Adlerian, CBT/Behavioral, and solution-focused orientations, the interventions that were applied to this case included strategies and techniques from each of these orientations. From the Adlerian orientation, these interventions have been used include: encouragement, private logic, paradoxical intention, reframing, and

• reorientation. Cognitive-behavioral and behavioral interventions involved teaching positive self-talk

as well as some relaxation and assertiveness training. Solution-focused interventions relied primarily

• n exploring exceptions and experiments. Finally, there are several interventions that were useful or

may be useful in my work with Alicia, but these interventions do not necessarily align with a particular orientation. For example, recommendations for tutoring, psychoeducational evaluation, and teaching study skills are not confined to a specific theory.

11 Case Presentation As an Adlerian-oriented counselor, many of my interventions with Alicia were based in Adlerian theory (Carlson & Slavik, 1997). Although it is not unique to Adlerian counseling, I began my work with Alicia by establishing rapport. This initial part of the counseling process incorporated techniques associated with client-centered counseling, however. For example, active listening, unconditional positive regard, empathy, and congruence were several of the skills that allowed me to build rapport with Alicia. These skills also helped me to gather information about Alicia that led me to better conceptualize her lifestyle, which is how a client views his or her world, according to Adler. I asked questions relating to Alicia’s early memories, family constellation, and birth order, for

• example. I also used “The Question” and reframing to get a clearer picture of the problem and

illuminate Alicia’s private logic. Specifically, I asked questions like, “You’ve mentioned some of the bad things that happen when you don’t do your assignments in class, but what are some good things about not doing work?” A question like this helped Alicia to more clearly articulate that failing to complete assignments allowed her to avoid being evaluated. It was from this foundation, that I was able to begin employing specific Adlerian strategies in future sessions. Since, in my view Alicia’s academic underachievement was the consequence of inferiority feelings and discouragement, my number one priority was to provide her with encouragement from several sources including myself, her teachers, and her family. Encouragement took the form of positive feedback that focused primarily on effort or improvement rather than outcomes (Evans, 1996). So, for example, I asked her teachers in a team meeting to provide Alicia with statements of encouragement when she demonstrated even minimal effort or improvement. I offered several examples of encouragers such as: “I think you can do it” and “You put a lot of effort into your work.” I provided similar direction to Alicia’s mother during a phone conversation. Added to the use

• f encouragement, I have also used confrontation. For example, Alicia admits that she often does

not complete or hand in assignments because she does not think her work is good enough. So my

12 next step is to confront her with the idea that by not handing in the work, she will get a bad grade anyway, which will ultimately create the exact impression she is trying to avoid. I have also tried the “as if ” and “catching oneself ” technique. Both required Alicia to try out an experiment in one class. For the “as if ” technique, Alicia was encouraged to try handing in all of her homework in one class for a week while the “catching oneself ” technique required Alicia to observe her thoughts and feelings when she has a completed assignment in her locker, but does not turn it in. Adlerian theory emphasizes the importance of increasing the social interest of a client in

• rder to form critical connections and encourage belonging. Due to the fact that one of the

concerns presented by Alicia’s case is her limited connections to her peers and the school. She and I explored ways she could make friends and get involved such as sports or clubs. In addition to developing connections with peers, I also talked to Alicia’s reading teacher who she identified as being her favorite to see if this teacher could serve as a mentor of sorts. This has only been in place for about two weeks, and at this point consists mainly of daily check-ins at the end of the day. As of right now, Alicia has not really emerged out of her shell, but she is making some important first steps to making positive connections at school. As you can see, many of these interventions are similar to CBT techniques. In many cases, the results of these experiments led to sessions in which positive self-talk and relaxation strategies were taught as a means of stopping the negative thoughts and irrational beliefs that feed Alicia’s discouragement and ultimately her academic underachievement (Corey, 2005). The relaxation strategies were specifically taught as a simple way for Alicia to decrease some of her test anxiety. Deep breathing, progressive muscle relaxation, and even guided imagery were presented and

• practiced. Alicia and I also worked on identifying some of her negative thoughts and developing

alternative positive statements to combat those thoughts. I provided Alicia with a list of ideas she can use whenever she has negative thoughts related to school. In addition to addressing Alicia’s

13 Case Presentation irrational beliefs and negative thoughts, I also provided her with self-monitoring checklists so she is aware of what she needs to complete homework tasks and I even did some very brief assertiveness training to encourage Alicia to be more comfortable expressing her needs to her teachers and to her

• mom. Perhaps the most significant intervention that emerged out of this theoretical orientation was

a behavior plan. This plan was developed in concert with Alicia’s teachers by identifying target behaviors and brainstorming intervention strategies as well as consequences for compliance and non-compliance. Some of the strategies that were included on the plan were requiring Alicia’s assignment book be signed and working with me to get organized. Alicia’s behavior was monitored through the use of an online document program called Google Docs. However, it was discontinued after 30 days after little to no improvement was noted. Although my primary orientation is Adlerian, and many of the interventions I use center around that theory and complementary interventions from the cognitive-behavioral orientation, I also frequently rely on solution-focused techniques. Solution-focused strategies are best for building

• n a client’s strengths by identifying exceptions (Metcalf, 2008). In Alicia’s case, it was important for

us to identify what sort of conditions, teaching styles, and accommodations were most conducive to task completion and decreased performance anxiety. As the result of one solution-focused conversation, for example, Alicia suggested that sitting somewhat separately from the class in an area

• f the room without distractions and the possibility of more judgmental eyes made it easier for her

to pay attention and get her work done in math class. After this exception was identified, Alicia asked to have similar accommodations in her other core subject area classes. Teachers were asked to

• ffer encouragement when they observed positive behaviors, and since Alicia has moved her seat,

nearly all of her teachers have commented on her ability to concentrate and get work done in class. Alicia has also identified independent study as an exception so currently I am working with Alicia

14 and her teachers to see if she can be evaluated using alternative forms of assessment that permit for more self-directed learning. Theories provide a wealth of interventions, but there are some interventions that are not attached to any theory that were applied to this case or should be applied to this case. Recently, I have begun to consider the possibility that Alicia should be evaluated. If she is able to earn a high A grade in an advanced reading class yet is failing English, perhaps it is the higher level work that is what makes the difference. So I think it is possible she is gifted, but perhaps she is gifted with a learning disability. In addition to an evaluation, some other non-theoretical based interventions that have been used include: teaching study skills and consulting with Alicia’s mom to suggest tutoring in

• rder to address any knowledge gaps created by the transition to the district and to generally help

Alicia catch up. It has been suggested that Alicia’s older sister, who is a teacher, provide this tutoring to save money. Where is this student developmentally? (Intellectually, Morally, Socially) In terms of Alicia’s intellectual development, she appears to be in the formal operations stage, according to Piaget (Broderick & Blewitt, 2006). This conclusion is based both on my sessions with Alicia and from conversations with Alicia’s reading teacher about her participation in class discussions that require critical thinking skills. This assessment of Alicia’s cognitive development is also based on her high scores on the analytical questions found on the PSSAs. Unfortunately, there are no IQ scores to enrich this interpretation. Morally, Alicia is still in the conventional stage as described by Kohlberg (Broderick & Blewitt, 2006). Alicia is considered to be conventional rather than post-conventional because she interprets moral decisions based on the goodness or badness of an individual’s motives, but does not consider the possibility of moral relativity based on the interaction between the individual and society as a whole. She is also concerned about how others perceive her and group approval. Finally, in terms of psychosocial development, Alicia is in the

15 Case Presentation identity/identity diffusion stage (Broderick & Blewitt, 2006). Alicia is considered to be in this stage

• f psychosocial development because she is in the process of solidifying her identity by exploring

various roles and making commitments. She is exploring career options, for example. Alicia is also experiencing many of the common emotions and cognitions associated with this stage, especially inferiority feelings, immaturity, and susceptibility to peer pressure. Are there any ethical considerations? State specific guidelines that may help or be in conflict. As of right now, there are only a few ethical considerations associated with this case. Confidentiality as well as parents’ rights and responsibilities were considered in my work with Alicia (ASCA, 2005, A.1, B.1, C.2, B.2). In addition to Alicia, there are many stakeholders involved in her

• case. I have consulted and collaborated with both Alicia’s teachers and her mom while at the same

time maintaining confidentiality. In consultation with Alicia’s teachers, for example, I do not share anything that Alicia has not specifically said I could share with them. For the most part, I discuss with them some of the things Alicia has shared work for her. There are some times when I will let them know that Alicia is trying something different so they should keep an eye out in order to provide encouragement. I have also had to consider how to best communicate with Alicia’s mother. The most frustrating aspect of working with Alicia has been working with her mother. Out of two attempts to hold a parent-teacher conference, her mother has still not been able to attend any one of

• them. Our communication has therefore been limited to a few brief phone calls and a couple of

short letters sent home with Alicia. All of the information that has been shared has either been explicitly approved by Alicia or consisted of very general details about her progress. Diversity issues were also taken into account (ASCA, 2005, E.2). More specifically, I considered the role of stereotype threat and peer pressure (i.e. fear of being perceived as “acting white”) as contributing factors in Alicia’s academic underachievement (Fordham, 1988).

16 How did you organize and conduct the session? Typically, Alicia and I meet once a week during the last period of the day. This period is called Enrichment and is specifically designed to provide time for enrichment activities, time to get help from teachers, or time to simply get a jump on the night’s homework. After we both sit down, I ask some general questions about her day and her week just not only so I can reestablish rapport, but also so I can determine if there is anything else that may be interfering with Alicia’s academic performance or if there is a need for additional intervention. Following this brief check in, I will ask Alicia some follow-up questions about “homework” assignment from the week before. For example, if we previously set up a schedule for organizing study time at home, I will ask how well the schedule worked. I will also review Alicia’s assignment book with her to see if there are any

• utstanding assignments or upcoming projects that require attention. Each session is usually

different at this point. Sometimes I will help Alicia break down the steps needed to complete an assignment, I will explore exceptions as a means of addressing any problems that create barriers to learning, I will teach a new skill, or I will simply listen to Alicia’s thoughts and emotions as they relate to school or life as a whole. At the end of the session, I sum things up. I make sure to review with Alicia any homework assignments or experiments that I may ask her to do or try and I also ask if there is anything else she needs from me. What was the emotional and physical climate? The physical climate of my sessions with Alicia has changed regularly. I went from meeting her in one of the other counselor’s offices to the conference room and last to the school psychologist’s office. Fortunately, in each of these spaces there are comfortable chairs that allow us to face each other without any physical barriers. The emotional climate of my sessions with Alicia is typically comfortable and positive. There is a high level of trust and ease in our conversations, especially because I am able to break through Alicia’s shy side by using humor. Alicia and I also work

17 Case Presentation well collaboratively as problem-solvers. I will work with her on setting a goal, but she is usually capable of developing her own solutions. The only times the emotional climate has been tense was during our first session and sessions following the distribution of report cards or progress reports. Despite our work together, Alicia has only been able to bring up her grades slightly in only a few of her classes. When she does poorly, Alicia feels guilty. So even though I am also disappointed, I focus

• n the positive, look to the future, and provide encouragement.

What counseling style did you use or most often use? My natural counseling style is a combination of client-centered and solution-focused, but my conceptualizations of cases as well as many of the interventions I employ are Adlerian in nature. By adopting this counseling style, I am able to provide brief counseling to students that is strengths- based and that also facilitates building a strong counseling relationship. As with all of the students I work with, I use most of the basic interviewing skills, but I most frequently rely on open-ended questions, paraphrase, reflection of feeling, and occasionally confrontation. I am also a big fan of using humor in counseling, especially with adolescents. Moreover, to further build rapport, I like to use the language of the client. So I will often use or repeat these client-specific terms. I have also found it useful in working with Alicia to comment on here-and-now reactions such as facial expressions or my own response to the counseling relationship. Due to the nature of Alicia’s concerns, I frequently find myself in the position of educator. For example, teaching positive self- talk or explaining how best to use an assignment book. Thus my counseling style is informed by several theoretical orientations, but ultimately the outcome is a positive, safe, and even fun atmosphere that hopefully facilitates trust and change. What are your recommendations for the counselee? Alicia’s case requires a number of recommendations. My chief concern at this point is the limited progress Alicia is making despite mine and her teachers’ efforts. It seems as though whatever

18 progress that is occurring is limited to the school environment. Alicia has improved her rate of task completion in class and participating more in class discussions. Homework, however, remains a significant problem due to a combination of factors. Due to her hectic schedule, Alicia’s mom is not able to monitor her homework completion nor is she able to provide the emotional support that is necessary to build confidence. It is therefore my minimal recommendation that mom actually attend a parent conference. I also feel it is important to suggest at the next team meeting, that Alicia’s teachers provide minimal accommodations that will allow Alicia to achieve success based on smaller goal targets. Moreover, I believe Alicia would benefit from a tutor—whether it is her sister or an

• utside company—who will address any skill gaps Alicia may have in her learning due to her transfer

to the district. Finally, after I do some additional consultation about this case, I think it might be wise to consider completing a psychoeducational evaluation for Alicia. She is very bright and does well in difficult subjects. So she is capable of higher quality work if given the right conditions. I think an evaluation may help us rule out any other problems. Rate yourself and explain why (1-10) In my current work with Alicia, I would give myself a rating of 7. This rating takes into account the fact that Alicia still allows her anxiety, self-doubt, disorganization, and boredom to negatively impact her school performance. Yet, there has been significant improvement since I first began working with Alicia. She is not only more aware of her needs, but is more comfortable asserting herself in order to get the help she needs to succeed. I am disappointed, however, that I am unable to be available at school more consistently in order to maintain regular contact with Alicia and her teachers. I also believe the behavior plan that was initially put in place by my supervisor, was not as effective as it could have been because Alicia’s teachers failed to follow through with it after a few weeks. Despite these concerns, I am pleased with my progress with Alicia. She is more

• rganized, less anxious, and better able to cope with stress. She also knows how to set goals and

19 Case Presentation develop a plan to achieve those goals. Though she sometimes falls short, she is more willing to take risks and give something a second try.

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