FCW-4 Counselling: Theory and Practice Unit 4

1. FCW-4Counselling: Theory and PracticeUnit 4 Dr. Jaimon Varghese Counselling: Theory & Practice

2. Learner Objectives 1. Develop holistic understanding of counselling as a tool for help 2. Acquire knowledge, skills and attitudes for counselling 3. Develop insight in need and areas of counselling in different situations 4. To develop counselling competencies in students for working in various specialized set ups Counselling: Theory & Practice

3. Unit - 4Counselling Practice in different set ups 1. . Marriage and Family counselling – Divorce, marital / live- in, domestic violence 2. Child guidance and counselling 3. Planned Parenthood – Parenting, MTP, Infertility, Adoption Counselling: Theory & Practice

4. Unit - 4Counselling Practice in different set ups 4. De-addiction 5. Terminal illness 6. Employee counselling 7. Rape and sexual violence 8. HIV-AIDS 9. Trauma and disaster Counselling: Theory & Practice

5. Unit - 4Counselling Practice in different set ups 1. Marriage and Family counselling – Divorce, marital / live- in, domestic violence (Unit 3.4) Counselling: Theory & Practice

6. 4.2 Child guidance and counselling • Child Guidance Clinic (CGC): CGC provides remedial as well as preventive guidance and counselling services to children, parents, teachers and other care givers of children; • Counselling and Guidance is an applied field of psychology (Counseling Psychology) • Counselling tasks are information giving, test interpretation, referral, managing counselee hostility, and parent conferences. • Purpose of guidance is to help one to adjust one’s abilities and interests to the needs of the society. Counselling: Theory & Practice

7. 4.2 Child guidance and counselling • There are different forms of guidance programme. They are: • Educational guidance • Vocational guidance • Social guidance • Economic Guidance • Leadership guidance • Leisure-time guidance Counselling: Theory & Practice

8. Child guidance and counselling • Counselling is sometimes referred to psychotherapy. • Common types of psychotherapy include art therapy, behaviour therapy, cognitive therapy, cognitive behaviour therapy, dialectical behaviour therapy, exposure therapy, interpersonal therapy, play therapy, psychodynamic psychotherapy and psycho education • Counseling Psychology is a psychological specialty that facilitates personal and interpersonal functioning across the life span with a focus on emotional, social, vocational, educational, health-related, developmental, and organizational concerns. Counselling: Theory & Practice

9. Child guidance and counselling • objectives of guidance and counselling • a. Prevention of maladjustment (personal & social) • b. Promotion of psychological health • c. Protection of social harmony and industrial peace • main types of guidance and counselling • a. Educational guidance and counselling • b. Vocational (career) guidance and counselling • c. Psychological (personality) guidance and counselling Counselling: Theory & Practice

10. Child guidance and counselling • Needs addressed by CGC • a. Needs of the children • i. Learning difficulties • ii. Problems of indiscipline and truancy • iii. Need for day care when the parents are away for work • iv. Personality development needs (emotional, intellectual and social) Counselling: Theory & Practice

11. Child guidance and counselling • Needs addressed by CGC • a. Needs of the children • v. Prevention of child abuse and harassment • vi. Prevention of child labour • vii. Entertainment, recreation and physical activity (playing together with peers) • viii. Behaviour disorders (referral) Counselling: Theory & Practice

12. Child guidance and counselling • Needs addressed by CGC • b. Needs of the adolescent and the youth • i. Development counselling for the adolescent • ii. Educational guidance for under achievers • iii. Career and vocational guidance • iv. Pre marital counselling • Leadership training for personality development child welfare

13. Child guidance and counselling • Needs addressed by CGC • b. Needs of the adolescent and the youth • vi. Supplementary, remedial, alternative and non formal education • vii. Sex education • viii. Training in human relations skills • ix. Personality counselling (emotional needs) • x. Value education Counselling: Theory & Practice

14. Child guidance and counselling • Needs addressed by CGC • c. Needs of the Parents and Guardians (Care givers) • i. Teaching discipline to the children • ii. Supervision of the young in their play and work • iii. Overcoming stress and worries about the children • iv. Good parenting and helping the children to choose right education and career • Imparting moral and value education to the children Counselling: Theory & Practice

15. Child guidance and counselling • Needs addressed by CGC • c. Needs of the Parents and Guardians (Care givers) • vi. Respecting child rights (survival, protection, development and participation) • vii. Helping children to learn, live and grow without guilt, shame and anxiety • viii. Teaching children civic sense and responsible decision making • ix. Managing the time and daily routine of the children • x. Enabling the older children to be self dependent Counselling: Theory & Practice

16. Child guidance and counselling • Needs addressed by CGC • d. Needs of the Teachers and Schools • i. Overcoming the behaviour problems of the children • ii. Helping the underachievers to improve their performance • iii. Overall personality development of the children • iv. Understanding the intellectual development of the children and application of the appropriate pedagogy (teaching methodology) • v. Problem of indiscipline • Career and vocational guidance Counselling: Theory & Practice

17. Child guidance and counselling • Needs addressed by CGC • d. Needs of the Teachers and Schools • vii. Friendship building among the students • viii. Occupational and recreational therapy for hyper active children • ix. Inculcating self discipline, self direction, good habits and character building among the students • x. Teaching morality and values to the children • xi. Sex education of the students • xii. Regularity and punctuality of students in the school Counselling: Theory & Practice

18. 4.3. Planned Parenthood – Parenting, MTP, Infertility, Adoption (Unit 3.4) Counselling: Theory & Practice

19. 4. 4. De-addiction Counselling • Alcohol is the commonest abused drug in industries and the success rates of alcohol de-addiction are higher than treatment of abuse of other substances. • A professional team for de-addiction includes Psychiatrist, Medical Officer, Counselors/ Social Workers, nurses and yoga therapists • The counseling in substance abuse treatment involves Screening, Assessment & Intervention (motivation interviewing, goal setting, and other strategies of intervention) Counselling: Theory & Practice

20. 4. 4. De-addiction Counselling • Screening: Alcohol Use Disorders Identification Test (AUDIT), the Drug Abuse Screening Test (DAST), Michigan Alcohol Screening Test (MAST) • Assessment: specific substances used, frequency, quantity, social context and age of first use, age of beginning of regular use (Level of dependence), Physical & Mental health problems and client’s level readiness or motivation for change (identify the resilience, strengths, and skills of the clients and their environment systems) Counselling: Theory & Practice

21. 4. 4. De-addiction Counselling Stages of change: Stage 1: The emergence of addiction • a) Initiation: The substance use begins • b) Substance use produces positive consequences • c) Adverse consequences develop but remains out of awareness Counselling: Theory & Practice

22. 4. 4. De-addiction Counselling Stages of change: Stage 2: The Evolution of Quitting • a) Turning points: the shift between unencumbered substance abuse and the realization that this abuse is directly responsible for the presence of profoundly negative life circumstances. • b) Active Quitting begins • c) Relapse Prevention Counselling: Theory & Practice

23. 4. 4. De-addiction Counselling Strategies of Intervention: Motivational interviewing/Motivation Enhancement Therapy (FRAMES model) • Feedback about personal risk or impairment • Responsibility for change lies with the individual (client) • Advice on changing the drinking • Menu of alternatives and change options • Empathy on the part of the practitioner • Self-efficacy or optimism on the part of client, facilitated by practitioner Counselling: Theory & Practice

24. 4. 4. De-addiction Counselling principles of motivation interviewing • Express Empathy • Develop discrepancy: that the current life style & future goals of the client do not match • Roll with resistance: avoid argument & help the clients to move on and try new strategies; resistance is the indication for looking for alternative strategies • Support self efficacy: foster the client’s belief in the ability to initiate change; client is responsible for choosing and carrying out personal change Counselling: Theory & Practice

25. 4. 4. De-addiction Counselling Goal Setting • goals to improve life style, • harm reduction goals, and • goals concerning substance use; set goals to choose between abstinence and moderation. Counselling: Theory & Practice

26. 4. 4. De-addiction Counselling strategies for working on the goals of the clients • Refusal skills and assertiveness training • Problem Solving Skills training • Recognize when a problem exists • Generate a variety of solutions to the problem • Select the most appropriate option and generate a plan for enacting it • Be able to evaluate the effectiveness of the selected solution • Cognitive Therapy: altering thoughts and enhance self esteem; Biblio-therapy Counselling: Theory & Practice

27. 4. 4. De-addiction Counselling strategies for working on the goals • Relaxation Training • Behavioural self management • Involving Concerned Others: couple therapy, family counseling • Self help groups (support from people with same goals) • Pharmacotherapy • Relapse Prevention: balanced lifestyle; develop methods of coping with cognitive distortions & negative emotional states Counselling: Theory & Practice

28. 4. 5. Terminal illness • The dying have needs that are unique and complex • When confronted with a diagnosis of terminal illness, there are a range of emotions to cope with - denial, shock, fear, anger, and sadness • many people are determined to fight and conquer their illness Counselling: Theory & Practice

29. 4. 5. Terminal illness • strength of will and refusing to give up easily is an admirable quality that very often influences the course of the disease and treatment • Some of the dying eventually reach a point of acceptance • acceptance is not about giving up, but about finding peace Counselling: Theory & Practice

30. 4. 5. Terminal illness • Once a patient is convinced that they have done everything in their power in the hope of beating the disease and getting their health back, accepting the inevitable can help patients to make the most of the time they have, focusing on the quality, rather than quantity of their remaining days. • Play therapy, art therapy, peer support and support groups can all be helpful in allowing children with serious illness to live their lives as normally as possible Counselling: Theory & Practice

31. 4. 5. Terminal illness goals of counselling the terminally ill • to enhance patient understanding of the disease and its expected course • to assist the dying person to face the reality of death by educating them about the dying process • To assist the dying to make best use of the remaining life in peace & joy Counselling: Theory & Practice

32. 4. 5. Terminal illness goals of counselling the terminally ill • to identify the strengths and coping strategies of the client and individual family members • address the client’s physical, emotional, social, spiritual, and practical needs Counselling: Theory & Practice

33. 4. 5. Terminal illness Needs of the terminally ill • Physical needs: physical comforts • Emotional needs: Coping with intense emotions such as shock, fear, guilt, anger, delirium and grief; • Depression & Suicide • Anxiety (agitation, insomnia, restlessness, sweating, tachycardia, hyperventilation, panic disorder, worry, or tension) Counselling: Theory & Practice

34. 4. 5. Terminal illness Needs of the terminally ill • social needs: settling old disputes, communicating with long-term friends, and asking forgiveness are all important to the dying individuals’ peace of mind Counselling: Theory & Practice

35. 4. 5. Terminal illness Needs of the terminally ill • spiritual needs: help clients find meaning in their lives and in the illness practical needs • guiding clients to construct their own personal definition of a good death • help clients transcend death Counselling: Theory & Practice

36. 4. 5. Terminal illness Needs of the terminally ill • practical needs: • bequeathing possessions, • settling financial affairs, • creating wills and trust funds, and • pre-funeral planning Counselling: Theory & Practice

37. Counselling the terminally ill child five stages in children's understanding about their illness 1. learns, after diagnosis, that s/he has a serious illness. 2. learns the names of the drugs, their use and side effects. 3. learns the goals of treatment and the particular procedures used to minimize side effects of medication. Now the child understands the link between each procedure and the corresponding symptom. Counselling: Theory & Practice

38. Counselling the terminally ill child five stages in children's understanding about their illness 4. realizes that there is a sequence of remissions and relapses during the course of the illness; recognizes that s/he can get ill repeatedly and that the medicines are not always effective. 5. In the fifth and final stage the child understands that the amount of medicines available is limited and when treatment becomes ineffective, death is imminent. Counselling: Theory & Practice

39. Counselling the terminally ill child five stages in child's changing definition of himself or herself 1. before diagnosis, the child perceives herself as well/not seriously ill. 2. sees herself as seriously ill, but thinks she will improve. 3. realizes that she is constantly ill but still has faith she will become better. 4. realizes that she very ill and will not become better. 5. recognizes that she is dying Counselling: Theory & Practice

40. Counselling the terminally ill Communicating bad news - a six step protocol (annexure) 1. Getting Started: study the illness 2. Finding Out What the Patient Knows 3. Finding Out How Much the Patient Wants to Know 4. Sharing the Information 5. Responding to Feelings 6. Planning (action plan) & Follow-up Counselling: Theory & Practice

41. 4. 6. Employee counselling • Issues for employee counselling • Stress: personal & professional (job related) • Absenteeism • Time management • Job security (stress) • Substance abuse & alcoholism • Lack of motivation (frustration) • Labour turnover (migration) Counselling: Theory & Practice

42. 4. 6. Employee counselling Stress • Stress is a condition or feeling experienced when a person perceives that demands exceed the personal and social resources the individual is able to mobilize. • Stress, a matter of judgment: firstly they must feel threatened by the situation, and secondly they must doubt that their capabilities and resources are sufficient to meet the threat. Counselling: Theory & Practice

43. 4. 6. Employee counselling Stress • How stressed someone feels depends on how much damage they think the situation can do them, and how closely their resources meet the demands of the situation. • This sense of threat involves perceived threats to our social standing, to other people’s opinions of us, to our career prospects or to our own deeply held values. Counselling: Theory & Practice

44. 4. 6. Employee counselling Stress • Just as with real threats to our survival, these perceived threats trigger the hormonal fight-or-flight response, with all of its negative consequences. • Much of our stress are job related things like work overload, conflicting priorities, inconsistent values, over-challenging deadlines, conflict with co-workers, unpleasant environments and problem of commuting Counselling: Theory & Practice

45. 4. 6. Employee counselling Stress • Stressors of personal life are illness or death in family, marital problems, financial loss, personal illness, developmental crisis, other failures and frustrations • Stress reduces our performance as we divert mental effort into handling them. • They can also cause a great deal of unhappiness and illness Counselling: Theory & Practice

46. Counselling: Theory & Practice

47. 4. 6. Employee counselling Impacts of stress • Hans Selye identified the ‘General Adaptation Syndrome – Alarm Phase, they reacted to the stressor; • Resistance Phase, the resistance to the stressor increased and this phase lasts for as long as the animal could support this heightened resistance; • Finally, the Exhaustion Phase, and resistance declined substantially Counselling: Theory & Practice

48. 4. 6. Employee counselling Impacts of stress • When under pressure, some people are more likely to drink heavily or smoke, as a way of getting immediate relief from stress. • Others may have so much work to do that they do not exercise or eat properly. They do not take time to see the doctor or dentist when they need to. Counselling: Theory & Practice

49. 4. 6. Employee counselling Impacts of stress • Effect on job performance: decrease in quantity & quality of work, decline in motivation, avoidance of job tasks, increase in mistakes, establishment of perfectionist standards, avoidance of job task and obsession with details Counselling: Theory & Practice

50. 4. 6. Employee counselling Impacts of stress • Effect on interpersonal relationships: withdrawal from colleagues, impatience, decrease in quality of relationships, poor communication, subsumed by own needs and staff conflicts Counselling: Theory & Practice