20 records of mental health counseling

These 20 records are desensitized versions of real cases compiled by me during my three years of front-line work in a community psychological service station. They cover common psychological distress in all age groups from 6 to 55 years old. They include a comparison of intervention ideas from the three mainstream schools of cognitive behavior, psychoanalysis, and humanism. They also record 7 typical pitfalls that I have encountered in practice and 11 repeatedly verified implementation skills. There are no templates and clichés. All content comes from real counseling scenes and can be directly used as a reference for front-line counselors, social workers, and even ordinary families to deal with psychological distress.

When I first wrote down these things, I didn’t even think about categorizing them. I just sat at my desk after each consultation and typed them out casually while my memory was still warm. Even the order was arranged according to the consultation time, and I didn’t specifically divide it into a youth group, a workplace group, and an elderly group. But when you really want to look through it, you can find many interesting commonalities - for example, the troubles written in the diaries of a 52-year-old menopausal aunt and a 14-year-old rebellious junior high school student are essentially "no one sees me."

The client in the third article is a boy in the second grade of junior high school. He bit his nails until the nail bed oozed blood. His mother forced him to come here. At first, I followed the process of cognitive behavioral therapy and gave him aversion intervention. I put on bitter nail polish and put rubber bands on his wrists. After two weeks, it didn't work at all. Later, when I looked through the case collection of psychoanalysis, I suddenly realized that his nail-biting behavior was not a "bad habit" at all. It was caused by his parents throwing things and quarreling at home every day. He didn't dare to say or hide, so he could only chew away his anxiety by biting his nails. Later, I stopped asking him to bite his nails. I taught him to count his breaths every time he put his fingers in his mouth. If he counted to 10 and still wanted to bite, he could bite. Two weeks later, his mother sent a message on WeChat saying that the frequency of biting had dropped by 70%. I wrote a long reflection in the notes of that article, saying that don’t just use technology to trick people, first understand what the symptoms are used for, which is more important than anything else.

At the previous industry exchange meeting, some people also told me that this slow and slow way of finding the root cause is too inefficient, and it is useless when encountering a visitor who needs to solve the problem in a hurry. This is true. The senior high school student I took care of last month wanted to relieve his pre-exam anxiety. I simply used progressive relaxation training + refutation of unreasonable beliefs. His problem with diarrhea as soon as he took the exam was cured after two times. To put it bluntly, there is no right or wrong in technology, it just depends on whether it is suitable or not. I have attached the intervention ideas of different schools in the side notes of the corresponding records. You can choose which one you want to use without worrying about political correctness.

Oh, by the way, don’t think that these records are all successful examples. I have highlighted 4 of them in red, and they are all messed up. The one that impressed me the most was the 8th chapter. The girl who had just entered college had fine scars all over her arms. I had only been in the industry for half a year. She opened her mouth and asked, "Doesn't it hurt when you cut yourself?" The girl took her bag and left on the spot, and even canceled the next scheduled consultation. After reviewing it with the supervisor three times, I finally realized that those words didn't sound like concern at all, but an accusation from a commanding height - she originally felt that she was an abnormal alien, and my words directly put me on the opposite side of her. Now there is a red note written by my supervisor on the header of that record: "First stand under her umbrella, and then talk about the rain." I have to look at it twice every time I read it.

The one that surprised me the most was the 17th article. The retired middle school teacher suffered from menopausal pain and went to the hospital to find out the problem. His daughter forced him to come over. The first thing he said when he sat down was, "I'm not sick. I don't believe in these magical things." I didn’t talk to her about the concept of somatization of anxiety, so I chatted with her about how she used to be a class teacher and taught students. I also talked about how the poor student she used to teach is now a doctor. During the Chinese New Year, she brought fruit to see her. Her eyes were as bright as stars. Later, I gave her an idea and asked her to work as a volunteer counselor at the community committee to help the children who had no one to pick up their homework after school. After only half a month, she sent me a voice message saying that her shoulder pain was much better and she even slept soundly. I wrote a blurry sentence at the end of that record: "Sometimes the best intervention is not technology at all, but to help people find their own place." It still feels right when I read it now.

When I was sorting out these records last month, I came across the messy digressions written at the end of several articles. One of them was "I really want to quit my job today" after being scolded by someone after counseling. Another was "The ice powder sold downstairs is too sweet" in the summer when the air conditioner in the consulting room was broken. There was also one at the end of one article that was "I am going to buy sugar-roasted chestnuts from the alley after get off work." Looking at it now, I can still think of the scent of osmanthus floating in the corridor that day. Anyway, this is not a perfect academic material, but a real trace of an ordinary consultant's struggles. If you are new to the industry and are not sure how to communicate with visitors, or if you have children at home who are upset or old people who are confused and don’t know how to persuade them, you might be able to find a useful method after some research. After all, there is never any standard answer to the human heart. The one that can catch it is the right one.