The assessment process involved interviews with the client’s parents and teachers, observations of his play behaviour during counselling and at school, and an analysis of the transference and counter-transference. Based on this material a hypothesis was made about what might be causing anxiety for Sam. This included concerns about feeling unsafe and attacked – a common presentation for children from refugee backgrounds – as well as believing that he was overlooked in favour of others. The client managed this by alternating between being aggressive in school and by regressing developmentally (acting younger than his age).
The therapeutic aims included establishing a safe and responsive relationship; facilitating the expression of affect; building self-confidence in Sam’s skills and abilities; and enhancing connections to others. A major intervention strategy was to ‘enter the play’ and use metaphor to help reframe unhelpful coping mechanisms and to model more appropriate attachment relationships. An attitude of playfulness was critical to the success of therapy.
An evaluation of Sam’s psychological state revealed considerable improvement in his symptoms. Post-counselling, he was better able to tolerate frustration and related more appropriately to others. Sam also grew more confident in his own skills and abilities and learned more effective and appropriate ways to manage his anxiety.
