The following is a Case Report Form (CRF) I supervised for one of my NANC Counselor Candidate Students. He graciously granted me permission to post the report for you. The names, locations and some of the issues have been flattened out so anonymity could be maintained.
This CRF is a sample of what supervision looks like for candidates who desire to be supervised by Counseling Solutions. The counselor student’s information is in BLACK. My comments are in BLUE. The student has 12 questions to answer for each counseling session completed. Each candidate must complete 3000 minutes of counseling, or 50 hours, for this last phase of the program.
Case Report Form
Counselee: Sally Fields Date: May 18, 2009
Session: # 1 Counselor: Burt Reynolds Session Length: 70 min.
1. Significant background information.
Sally is a healthy, active 20 year old, from a supportive, Christian family. This sounds perfect! Of course it begs the question as to why she is in counseling. An active church attendee, Sally is going to a community college to pursue nursing. She has a history of multiple short term mission trips and has done extensive traveling. I had not given her a P.D.I. (Personal Data Inventory) prior to our meeting, so I learned all of this in our first meeting, although I did end up giving her a PDI and Counselee Consent Form as we ended our session, for her to fill out if she decided to pursue this further.
That is okay. I have not used a PDI Form in many years. I prefer not using one because I want to build relationally with the counselee and move away from the “professionalism” aspect of biblical counseling. My hope is to create a high view of the local church, among other things for my counselee, so I tend to move away from some of the standard practices used in para-church counseling ministries. Additionally, by taking the time to ask the questions in the session, you are building relationally. Jesus walked with his friends and talked with them. He did not give them a PDI. Please read my post, If I Had a Bridge I Would Tell You What I Am Thinking
2. Summary of reasons they came for counseling (presentation problem).
Her mother (who attends our church) called the day before.
- Where is the dad?
- Why didn’t he call?
- What is her relationship like with her dad? Sometimes a mom has more time to do such things as call, but I would want to unpack this a bit further. Sometimes there can be relational issues between kids and dads.
The mom stated that Sally had suffered a ‘breakdown’ of sorts and needed to see someone soon. A breakdown? This is interesting in light of the first sentence of this CRF regarding a “supportive Christian family”. What is a breakdown? Please read this post: Think and Respond in Biblical Categories. She was referred to me early Monday morning while I was on the way to the office. Sally’s mom shared that the day before, Sally had been at a commissioning service for her short term mission group’s upcoming trip to eastern Europe this summer, and that night had attempted suicide through OTC pain medications. Okay, even more odd in light of the first sentence of the CRF. They spent a good portion of their Sunday evening at the ER, and took her home with them in the early morning.
As we met, she was tired and emotional, understandably. She stated that she was feeling overwhelmed by her current life, and empty inside. Ouch. This is not good. She felt hypocritical for going on the mission trip, as people in her life were supporting her and she felt so distant and torn about her motives for going on the trip. Make sure she understands this as sin, not just a “bad idea.” Watch out for fear, anger, guilt, bitterness, control, self-sufficiency, self-righteousness and comfort as some of her sin issues. These sins will get at some of her underlying motives. She shared that she had only signed up for the trip to make her boyfriend mad, and that now, she realized how poor her motivation was and her sense of hypocrisy was eating at her. Excellent confession. However, this is also sin. Some of the sin patterns in bold, above, are tied to your last sentence. This led to much discussion about the nature of her relationship with her boyfriend (a believer as well, but with issues evidently). She shared a lot of past issues that still grieved her, such as the death of her grandmother while she was out of state, and a friend that had committed suicide during the last couple years.
What causes quarrels and what causes conflict?, James asked in 4:1. She is conflicted in her soul. Look for anger. Pay attention to anger patterns toward God, though she may not see this. But ultimately God is our Sovereign Ruler over all things and, intuitively, all Christians know this. Though we do not typically say we are angry at God, we are in such cases as this.
Her fear or unresolved grief is an indication of a lack of trust and rest in God. This is unbelief. Though most people do not intuitively connect these dots, there is something missing in her relationship with God.
And I would also want to unpack her relationship with her dad. More on that later.
3. What changes were made by the counselee since last session (as a result of applying last session’s counsel and performing last session’s homework)?
Not applicable, as this was our first session.
4. What main problems were discussed in this session?
We discussed at length her anxiety, her suicidal thoughts and episode the previous evening, guilt she felt regarding her grandmother’s passing and in regards to her boyfriend. How did you come to this conclusion of guilt? I don’t disagree. I think it is insightful. Just wondered how you connected this dot. We also spent significant time talking about hypocrisy and what that meant for her in regards to her relationship with God. Excellent!
5. What unbiblical habits of thinking and /or behaving are you seeing in the counselee (preconditioning)?
She is very concerned with how people see her. SIN: Fear of man. Proverbs 29:25 – and I am thinking that fear of man is strong with her. I would agree. You need to unpack this for her if she does not see it. And if she does know this, then you need to walk her to the bottom of it so she can see how this is a lack of trust in God, which means she has some sinful thought patterns toward God. Here are three possibilities regarding her issues with God: (1) She is afraid of him, (2) She is angry with him, (3) She is ignorant of him. She probably struggles with some combination of all three. Her view of God and his sovereignty are an issue. Yes, I completely agree. At some point you will need to unpack her relationship with her dad. He would be the coupler between her and the Father. There is something not right with her relationship with her dad, more than likely. And we spent some time discussing Rom. 8:28-29 Excellent text: I would take her through the rest of the chapter as well. Beginning at v. 32… in light of what God is sovereignly taking her through currently.
She considers herself a bit of a perfectionist.
Put this in a biblical category for her: Self-sufficiency, Self-deception, Self-righteousness? Once you get her there, you will find these sin issues as part of her functional idolatry of the heart. Listed below is part of her “Worship Structure”
- Self-sufficiency
- Control
- Pleasure
- Comfort
- Self-righteousness
- Anger
- Bitterness
- Guilt
This will get at some of the “conflict of soul” that James is talking about. She has also struggled with cutting (self-harming) off and on in her life since her junior high years. When she feels like she isn’t measuring up and feels ‘fake’, she has resorted to this. This is where dad is tied into this somehow. What does encouragement look like in the home, as it pertains to her past?
When asked whether or not she felt God was in control of her life, she answered categorically “no”… Go back to “anger” “fear” or “ignorance” of God. These are some of the reasons she is resisting him.
6. What idols and/or heart issues are emerging? (“I must ____________.”)
Here we are asking for specific, one/two word biblical categories of sin in the heart or heart idolatry. I have identified some of them in previous comments: Control, Pleasure, Comfort, Self-righteousness, Anger, Fear, Self-sufficiency would be a short list. Note the sin categories in BOLD above.
She described her relationship with her boyfriend as one where “she was trying to fix him”. This is works-righteousness, or a lack of grace as well as an unwillingness to trust God. I get the impression from her comments that she sees herself as a real fixer, and her own poor self-perception has led to some serious pride. This is correct. This self-perceptions is also called, biblically, self-deception. Her whole relationship with him was couched in a lot of ‘must’ phrases.
Pleasing her parents and keeping up that (false) image is also a matter of concern as far as her motives. This is also called lying, biblically.
7. What Biblical solutions were presented in this session (tie in with #4)?
She continually referred to her life as ‘out of control’ and beyond her to handle. Yes, the idol of control would be huge for her. I had her read Rom. 8:28-29, and we specifically camped out on the word “all”. That if she were indeed a child of God, and loved him, that ALL things in her life were working for good. Given her extensive church background, I asked what it meant to her to say and believe that God was sovereign, and in light of that verse, how He was working ALL those things in her life for the good. She confessed that she had never stopped to consider that some of the trials and challenges she was facing could be part of God’s sovereign plan for her good. Jerry Bridges’ work on Trusting God Even When Life Hurts, would be helpful for her.
I also sensed a panicked sense of hopelessness, and along that line, shared II Pet.1:3, and that as a believer we have all things we need for life and godliness, through the knowledge of Christ who has called us. I asked and challenged her to dig into what she already knew from her training, so that instead of being led by her emotions, to cling to the truth of God’s word in her circumstances. If she continues to come for more counseling, I can see the biblical view of emotions being a big issue for her. However, she needed hope and while her recent events seemed very large, I tried to give her a bigger picture of a God who was in control and wanted to be her source of hope, and had provided for it. HUGE! My words to her were, “you are very close to living in the truth, much closer than you think. God and His word are very near to you, and that is for your good.”
8. What homework was given and how did it specifically apply to the problems (tie in with#4)?
I shared the above passages with her, and spent considerable time getting background information and giving some hope. My homework for her was to fill out the P.D.I. and if she chose to continue, make an appointment with our offices here at the church. I also encouraged her to read Rom. 8:28-29 for the next few days. In retrospect, I wonder if I gave her enough homework, but since I had not really elicited a commitment to the counseling process from her yet, it didn’t seem appropriate to do so at the time. I feel like the stage is set to give her more if she chooses to follow up, however.
I would recommend she read C. J. Mahaney’s work called The Cross-Centered Life. It deals with legalism, guilt and condemnation in a concise way. It’s less than 90 pages. And don’t let “not coming back” be an issue. If she does not come back, she can still read the book if she wishes. This way you are allowing her to “take her counselor home” with her. You’re “extending” the counseling session. Read this: Wiki-Counseling: Take Your Counselor Home With You
Read this blog post as well and consider this kind of post-counseling follow-up, sculpted to her of course: Post Counseling Follow-Up.
Again, consider pursuing her via email.
9. If someone asked the counselee right after the session, “What did you learn that you needed to change,” what would you want him to say?
“I can’t live by my feelings” - As I observed her, she was very dramatic, and her emotions were pretty raw. By the end of our time, she was much more settled and I was able to say, “emotions are powerful, but they are driven by what we believe – about ourselves and God.” This is the bottom line and where you’re going to have to go with her, as you know. I think that is something I would hope she would have been able to say after our time together.
“God is in control of all things” - Another important thing I wanted to convey to her was to filter her life’s circumstances through God’s sovereignty … this could make her AFRAID or ANGRY, as noted above … and goodness … this could be related to IGNORANCE, as noted above. Even as she lamented about not being able to ‘properly grieve with her family’ over her grandmother’s death, I asked the question – what would that have changed for you? I just posed the question, could God have had purpose and reason for you to be somewhere else rather than at your grandmother’s bedside saying goodbye? I’m pretty sure she thought that would have made the whole situation ‘right’ if she could have been there, but the truth is, it wouldn’t have changed any of the actual circumstances, and I think she hadn’t thought through that. Even feeling cheated ANGER toward God. by not being where she thought she OUGHT to have been, is God still in control then, or just in control during the perceived good times.
“I can’t ever be ‘good enough’” - I also challenged her view on sanctification and her description of ‘hypocrisy’ biblically. Her thoughts and words continually pointed to a works-based-sanctification that she knew she wasn’t attaining, and it was killing her. Yep, self-righteousness, motivated by fear. The cutting comes into play here as well. I began to ask her on what basis she was accepted and loved by God. And while we didn’t get too far in that discussion, I plan on coming back to it. Excellent!!
God is an encouraging God. See Romans 2:4 – “the kindness of God leads to repentance.” This is where you will need to unpack her relationship with her dad. I would suspect that encouragement was not appropriately part of his parenting model. Read this: I Caught You…Again
10. How was hope or encouragement given in this session?
She really struggled with God’s control over her seemingly ‘bad’ circumstances. The idea that God was actively at work in this seeming turmoil seemed to give her some hope or at least perspective. She was so worked up that the act of talking through who God was and where God had brought her, to this point seemed to ground her a bit, and give her hope. I continually pointed to the Word as our source of hope, and I believe that she found some solace and hope in that as well.
Also, as I gathered data from her life and family, I was able to objectively state God’s obvious blessings in her life in such a way that she was somewhat forced to acknowledge how God had provided for her up to this point. Somehow ‘everything’ wasn’t so bad when she was taken by the hand and encouraged to look at the bigger picture, which she had truly lost sight of. Huge missing piece in her life.
11. How is the overall counseling process progressing? What issues have been sufficiently addressed by you and changed by the counselee?
Not applicable, yet!
12. What are your goals for future sessions?
A) Discuss a biblical view of emotions.
B) Look at how her human relationships (specifically her boyfriend) affect her walk with Christ and what she believes about God and her world.
C) Give her (more) specific biblical handles and Scriptures to deal with her life circumstances.
I would spend a lot of time introducing her to the Gospel, not so much from a soteriological perspective, but regarding her sanctification. Her main three idols are: (1) Fear; (2) Anger; (3) Ignorance. The Gospel answers these questions and gives her the hope and the rest she longs for.
For example…
- Fear: The Gospel demonstrates effectively that, “If God is for us, who can be against us?” Christ died for her on the Cross. What more can be said?
- Anger: The Gospel should dispel all anger. If He was willing to execute His Son to save her soul, there is no reason for her to be angry with Him.
- Ignorance: The Gospel, when rightly understood, dispels our ignorance and brings us into a greater awareness of who God is. Nothing in the bible communicates more effectively the nature, character, care and love of God than the Cross of Christ.
Take some time to read my counseling notes from another counseling session. This should serve you well.
RELATED ARTICLES
- A Note From a Reader
- A Counseling Case Report Form turned in by a Counselor-in-Training
- Post-Counseling Follow-Up Email, After the Counseling Session
- Actual Notes from a Counseling Session
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