Category: Counseling

Traditional ethics are often based heavily on reason, logic, and individual autonomy, with no stock put into human emotion or relationships as they can often be unstable in their permanency. Care ethics are also based on reason, logic, and autonomy, but allow emotional connections and relationships with other humans to guide decision-making when it comes to right and wrong. A recent struggle of ethics in healthcare revolves around addiction services. Traditionally ethical people might say that someone with a substance abuse disorder is able to make their own decisions and that they are not owed any extra care or compassion, often citing that they “chose this life.” Another, whose decisions are based on care ethics, might have a sibling who struggles with addiction, who knows that they do not always act in their own best interest, and who knows that this is not a choice. When addiction is recognized as a disease, the importance of helping and caring for those with substance abuse disorders starts to become easier to understand. In the same sense that one with a chronic or terminal illness could depend on others to act in their best interest, one with a substance abuse disorder should be able to expect the same. Basing addiction services on care ethics as opposed to traditional Kantian ethics allows for individualized treatment and encourages substance-abuse clinicians to connect with their patients, is more effective in terms of success with long-term sobriety and encourages integrated care, and helps to push society farther away from the inexact idea that addiction is a choice.

To understand care ethics in addiction services, there should be an understanding of addiction in general. Addiction is just as likely to impact the life of one human as it is another, no matter their situation, and every single person who struggles with addiction is at different points of their lives, with different circumstances, cultures, and experiences. Addiction services, including inpatient, outpatient, and medication-assisted treatment options, are able to be molded to fit specific patients’ needs if clinicians are willing to take the time and effort to do so. Care ethics takes this into account by placing importance on generating relationships with these patients and making an effort to understand all of the things that make them different from the next one. Addiction services are often coupled with mental health services, as they tend to be co-occurring disorders. Mental health services are typically very involved, meaning that the clinicians can truly get to know everything about their patients. Placing this type of relationship into addiction services is the most successful way to personalize treatment and encourage long-term success with sobriety by providing patients with a stable support system of professionals who show through effort that they genuinely care about them and are willing to work hard to make a difference.

The ability to care about someone stems from compassion for that person. Compassion and sympathy are two things that are integral to the success of long-term sobriety for those who struggle with addiction. As a result, care ethics is the most proof-driven theory to base these services and relationships on. One of the most important things that someone struggling with addiction can have to avoid a lapse or relapse is a stable and sober support system. If not found in their personal lives, whether due to familial discord or a variety of other issues, it is important that it can be found through seeking out treatment. A stable support system is one thing that someone can fall back on time and time again, either to avoid a lapse or to get back into recovery. Creating a supportive relationship like this cannot stem from anything other than care ethics. If the clinician just treats based on research and reason without forming a relationship with their patient, the trust needed for success in treatment will never be built. A trusted clinician also becomes a resource for someone with a substance abuse disorder, as they can be the person to ask about a variety of related issues, which again helps to encourage long-term sobriety. In an ideal setting, this leads to integrated or whole care for the patient, as the clinician’s compassion or willingness to help their patient can encourage the patient to seek change in other areas of their lives. Not only can it motivate the patient to find other clinicians or support systems that care about them, but it also encourages healthcare facilities to begin offering a larger variety of services available that would be useful to the patients. This is ultimately beneficial for both parties, as the facilities expand and drive more revenue, and the patients have easier access to necessary services. Things like primary care, social services, counseling, and psychiatric care are all things that are ultimately necessary for successful addiction treatment. If a patient is struggling with their mental health, or struggling with life stressors such as illness, relationship discord, legal issues, or financial issues, it becomes increasingly difficult for them to maintain sobriety. By providing these services in an integrated way, it encourages success in all facets.

By encouraging clinicians and service providers to engage with their patients in a way that will allow them to create the relationships needed for success, misunderstandings about substance abuse and addicts, in general, can begin to resolve themselves. Addiction treatment is always a collaborative effort between the clinician and the patient, requiring equal effort from both sides for long-term success. This working relationship garners an ever-growing understanding of addiction, leading clinicians who pass this empathy along to others through education. The only way that knowledge about addiction from a scientific standpoint can grow is through research and exposure. As long as there is a stigma revolving around substance abuse, addicts will always be hesitant to reach out for help, often because they blame themselves entirely for their addiction. Growing general knowledge about addiction and those who struggle with it will result in more people being exposed to addiction, which will result in less of a stigma about addiction services. This could eventually lead to more research, more available programs, more funding, and more education.

The American School Counselor Association’s (ASCA) purpose is to support school counselors in their efforts to help aid students in their academic endeavors, this includes future goals such as career planning and higher education. It also means providing the students an outlet to discuss their social and emotional expansion so that they may do the utmost best in their education and be prepared for the future. ASCA’s membership is diverse, made up of practicing school counselors, counseling and guidance Directors, supervisors, and other administrators in counselor educators. Also included as members are those engaged in activities that have an impact on student’s success and well-being at school, work, and at home Minkoff & Terres, 1985, p. 426). There are numerous professional development opportunities offered by the American School Counselor Association (ASCA) such as site-based training, districtwide training, coaching, webinar series, ASCA U specialist training, and annual conferences.

The membership benefits of being a part of the American School Counselor Association (ASCA) include but are not limited to discounted publications, liability insurance, free resources, and an extensive online community. However, school counselor trainees expressed frustration when they learn about the benefits of the ASCA framework but receive supervision in a school counseling setting that is not yet fully transformed into a developmental model (Studer & Oberman, 2006, p. 82). My future career goals are to focus my efforts on aiding both children’s and adolescent’s mental health and stability. My point of concentration on my future prospects has led to a slight intertwinement with the American School Counselor Association (ASCA). Although I do not wish to be a school counselor, I know my work will involve working with children and/or adolescents, which may involve an educational setting similar to that where a school counselor would normally reside.

The National Association for Addiction Professionals (NAADAC) was originally known as the National Association of Alcoholism Counselors and Trainers (NAACT) which originated in 1972. In 1982 it became the National Association for Alcoholism and Drug Abuse Counselors (NAADAC), until 2001 when it became known as what it is today; the National Association for Addiction Professionals (NAADAC). The purpose of this organization is to guide and encourage those in both addiction counseling and similar addiction concentration-related careers to succeed through ethics, education, support, and understanding. Benefits that come with being a member of the National Association for Addiction Professionals (NAADAC) circulate around education, advocacy, professional identity, and professional services. The opportunities provided for long-term professional growth include but are not limited to having access to the NAADAC career center as well as reduced liability and resources.

The demands placed on the substance abuse counselor today or four more difficult than they were in the past (Mustaine, West & Wyrick, 2003, p. 106). In my future counseling prospects, I know the possibility of encountering youths who have previously combatted substance addictions or are currently doing so. Adaptation to the National Association for Addiction Professionals (NAADAC) would be beneficial despite the difficulties that would ensue if it meant finding superior aid for my client, It takes a separate set of skills where the specifics of methods used derive from the substance addiction itself. These increased demands, together with the consistent failure of the field to maintain positive treatment outcomes, give rise to questions regarding the appropriateness of substance abuse counselor preparation requirements. Clearly, there is a duality in training expectations of counselors and substance abuse counselors (Mustaine, West & Wyrick, 2003, p. 106).

The American Counseling Association’s (ACA) purpose is to give aid to those cultivating the profession of counseling and be a supporter of the profession itself. Ensuring the ethical standards to protect those using such counseling services, including individuals of wide-ranging cultures. Some of the benefits of being a member of the American Counseling Association (ACA) or liability insurance, business solutions, and education. The opportunities for professional growth that come from this organization are specific to the different types of counseling such as; agent counselors, clinical professional counselors, career counselors, school counselors, and counselor educators. The problem of characterizing the professional counselor is made even more difficult because of variations in specializations, theoretical orientation, and post-degree professional development (Bradley, Sexton & Smith, 2005, p. 488).

The overlapping services provided by these professions (e.g., cancel, social work, applied psychology, and marriage and family therapy) can create confusion and blare the professional boundaries and identities as well as problems with purity in regard to status, access, and earnings (Sangganjanavanich & Reynolds, 2015, p. 48). In my efforts to become a counselor, it is common to be associated with the American Counseling Association (ACA) as it is the common base crown for nearly, if not every type of counseling, giving specific declaration to this profession. Counselors assist others entering the profession by serving as counselor educators or supervisors. In those roles, counselors model of values they are teaching as they interact with students, namely, justice, equality, competence, and caring (Ponton & Duba, 2009, p. 120). This can be seen as either a reward or a challenge for joining this counseling organization, depending on an individual’s point of view. Personally, I would see this as a benefit I would be able to give back to what I have been taught and put forth that knowledge to the next generation and observe from a new perspective.

References

1. Bradley, L. J., Sexton, T. L., & Smith, H. B. (2005). The American Counseling Association Practice Research Network (aca-prn): a new research tool. Journal of Counseling & Development, 83(4), 488–488.
2. Enos, G. (2017). Naadac members seek broader skill sets, and wider recognition via credentialing. Alcoholism & Drug Abuse Weekly, 29(38), 1–6. https://doi.org/10.1002/adaw.31722.
3. Minkoff, H. B., & Terres, C. K. (1985). Asca perspectives: past, present, and future. Journal of Counseling & Development, 63(7), 424–427. https://doi.org/10.1002/j.1556-6676.1985.tb02824.x.
4. Mustaine, B. L., West, P. L., & Wyrick, B. K. (2003). Substance abuse counselor certification requirements: Is it time for a change? Journal of Addictions & Offender Counseling, 23(2), 99–107. https://doi.org/10.1002/j.2161-1874.2003.tb00174.x.
5. Ponton, R. F., & Duba, J. D. (2009). The “aca code of ethics”: articulating counseling’s professional covenant. Journal of Counseling & Development, 87(1), 117–121.
6. Sangganjanavanich, V. F., & Reynolds, C. A. (Eds.). (2015). Introduction to professional counseling. Counseling and professional identity in the 21st century. Sage Publications Inc.
7. Studer, J. R., & Oberman, A. (2006). The use of the as a national model® in supervision. Professional School Counseling, 10(1), 82–87.

Abstract

In this assignment, we will find out what methods are used for counselling in primary schools and what methods are really useful. There are many different ways of counselling in primary schools and one of them is play therapy. I am going to discuss how kids react to play in situations and how their brain works and how play can help them demonstrate their issues and their attitudes and behaviors towards specific situations and as per their response a counselor can derive a conclusion and plan his or her work on that basis.

INTRODUCTION

Counselling is a process that helps an individual look into his or her own self by the help of counsellor that they somehow are not able to look at. Counselling is also a process that helps an individual change his or her behaviors and attitudes that are challenging in their present life or possibly their future. Primary school counselling is a process that helps students overcome their social, psychological and educational challenges that can affect their future. School counselling plays a critical role in helping student solve their issues and concentrate on their studies and choose the stream that would possibly work best for them as per their interest and hobbies and their skills.1

CONTENT

A counsellor is a psychological doctor in learning the nature of a human being and learning about the issues or problems they must be facing in their lives just like a medical doctor tries to understand and help solve physical issues. A counsellor is professionally trained to diagnose people, predict and understand the situation, interpret the trouble that someone is dealing with and not understanding and able to fix it, and plans a solution that can fix the issue for the future of the individual. It is best if the issue is detected and counselled at an early age so that when a child is growing up, he is not suffering with poor mental health. This is why school counselling is considered an important element. School counselling helps improve and evaluate the psychological health and fitness of a child.2

Another reason behind primary school counselling is to guide and assist kids in a direction that is right and which they can benefit from in their later life. When we look at the example of Mental treatment facilities and prisons in Nigeria, they are full of individuals who had issues and questions in the early part of their life and if they would have been helped out and guided, their situation would have been so much better. If someone is guided properly at an early age, many crimes and issues from major to minor like gun shooting, lout and thug, riots, drug addiction, abusive behavior, bullying or issues like these can be controlled. These issues are the outcome of many untreated social, psychological, educational or broken family issues that have been left untreated in the early years of an individual and when that person is guided or helped with these issues he/she acts such.3

Primary school counsellors help children focus on their hidden skills and evaluate it and flourish themselves by the strength of that skill or quality. Many children experience issues like depression, broken families, abusive parent/s, trust and relationship issues, medical issues, frustration, lack of emotional needs, bullying and so on.4

Play therapy in Primary school aims to provide assistance in psychological, emotional, behavioral, social and physical development. Play therapy involves toys. Different types of toys are used to interpret different types of behaviors and natures of different kids. In Primary School, children themselves are not matured and comfortable enough to discuss their issues with the therapist or counsellor. Teachers usually collaborate with the counsellor and they work together to solve issues of kids and find out what type of nature they possibly have. Young children can’t usually describe their feelings and emotions in words rather play method can really be helpful to find out how they demonstrate things and then a conclusion can be derived accordingly. Children play what they are thinking, how they are thinking, how they see people around them behave, how they see people close to them and around them react to different situations and how they are treated on their actions. It is easier to diagnose and solve issues and guide young kiddos in appropriate way at an early age, so that they can have a good understanding of what is right and what not.

Many studies have been conducted to see what are the conclusions of these play therapies and almost all researches and studies found out that play therapy is a long term process but it does make difference in the behavior of kids. e.g. kids showing tantrums due to attention deficiency, lack of emotional support, rebellion, bullying, etc. Play therapy not only reduces such aggressive behavior from kids, but also reduces the tension and stress from parents.5

A play therapist observes a child playing with toys. Let’s look at a couple of examples below.

• Kids being in abusive households or being rebelled most of the times – when such kids are given permission to play with toys, they go to guns and stuff because of the anger and aggressiveness built in them.
• A boy growing up in an household where men don’t study much and he is said that even if you get low marks, it is okay, no need to take stress and he tries to keep distance from books and school environment and feels like it is okay not to study because that gives stress.
• A little girl being sexually harassed, picks up a doll and undresses the doll and does what has happened with her with the doll and the therapist immediately gets the problem.6

These problems affect the psychological issues and they are inter connected with their impact on studies. That is why counselling is an essential part of schooling and more importantly primary school.

CONCLUSION

Kids are emotionally very tender when they are little, they pick up things very fast and they act upon the things they see around them. They act just how they are being treated. And they cannot verbalize every emotion. So it becomes necessary for us to find out what is making them nervous or why do they act in a particular way and counselling in primary schools help a lot with filtering negative effects from kids.

References

1. British Journal of Education – Vol.3 No.6 July 2015 Need for Guidance and Counselling At The Primary School Level : Early Intervention Strategies for School Children. Page 3-4 By Dr. John O. E. Egbo
2. IOU – Guidance and Counselling (EDU 206) Modules 7-8 slides : Why the Primary School Child needs Counselling – pages 16-19
3. Thespark.org.uk – Children + Young people : Counselling in Primary Schools
4. British Journal of Education – Vol.3 No.6 July 2015 Need for Guidance and Counselling At The Primary School Level : Early Intervention Strategies for School Children. Page 13-17 By Dr. John O. E. Egbo
5. Whiteswanfoundation.org – Healing through play : How does play therapy work

Life is a journey that reflects an individual’s experiences, choices, decisions, and mistakes. However, the past is not what defines a person, it is the personality that an individual has developed and the lessons that life taught to become what they are today. Humans, unlike other creatures, are intelligent with a gift of metacognition, if used righteously can make wonders in overcoming daily hitches in life. We must find ways and strategies to overcome them healthily with the consideration of differences in individuals, situations, cultures, and society. Every aspect of life and the problems associated with it holds interrelated connections which requires a general code of conduct to minimize the harm and hurtfulness to others. This universal code is namely known as ethics (rules, norms, morals, and regulations).

This assessment is based on a current ethical dilemma in Maldives and the strategies used by a counselor to overcome the situation. The process of decision-making in this crisis will be focused on an ethical perspective.

The dilemma – James VS Mr. Brown

Mr. Brown, 58 years old is a successful businessman in Maldives. He owns a famous business and with his wealth, he has influential control over politics. At age 55 he handed over the responsibilities of his business to his one and only child James when he was 27 years old with 15% of the company share. Over the past few years, James has mastered the art of business and has doubled the company’s profit. James also became famous and had influential power in the government sectors. James feels like he owes at least 75% of the business now as he is the only one maintaining the business now. On the other hand, his father denies and is not willing to give him further than what he has given as he fears that James might abandon him from the business.

The heightened stress and tension of the demanding company and the fight for a better position in the business share have provoked traits of depression which led him to seek help through counseling. The counselor has an impression that James might forge and take over the business. In one of the sessions, James admitted that he might have to take fraud action to get hold of the business. He also confessed that he has almost finished with the documents and will be legally binding the agreement. He also believes that his actions will benefit the company as he will be motivated to work even harder to reach as far as he can to extend the business.

One of the qualities of a counselor is to have an empathetic understanding, which provides insight into the client’s issues. However, the counselor should not attach in any way to the client either emotionally or physically. The number one priority of a counselor must be to follow the code of ethics to avoid unnecessary conflicts or problems and to resolve ethical dilemmas. Lindsay et.al, 1999, defined an ethical dilemma as a situation encountered as a result of confusion between two or more outcomes or options. In this situation, it is difficult to decide and choose an option for the betterment as the existing provisions cannot be met by present replacements (as cited in (Akfert, 2012)).

As a counselor, it is always important to analyze the situation before making a decision. The process of ethical decision-making is a collaborative procedure between the client and the counselor (Gerald Corey, 1998).

1. Identifying the problem

To identify a problem, the first step is to gather information through different sources as much as possible. The information being collected must be precise and unbiased, therefore source of information should be reliable and authentic. The counselor should know to filter the enormous chunks of information provided through the sources and in case further elaboration is needed, the counselor will use different techniques such as probing questions to dig deeper into areas of focus.

2. Identifying the potential issue/dilemma

This stage greatly focuses on the pillars of ethical principles (autonomy, trustworthiness, non-maleficence, and justice) to confront the dilemma to ensure the welfare, responsibilities, and the rights of people involved.

The counselor must be aware of self and competency. It is vital to keep in mind to seek help when needed or when in confusion to avoid being biased and to overcome personal influences such as beliefs, morals, culture, etc. The counselor must at all times abide by the ethical guidelines in dealing with any situation.

3. Refer to ethical codes

As a counselor being on the right track needs time constant cross-checking with the code of ethics for similar problems to be reviewed as guidelines in reaching a positive, unbiased outcome (Miller, 2016).

4. Becoming aware of the law and regulations

A dilemma not only creates tension between the involved circle, but rather it also creates solidity for the counselor. At this point, the counselor needs to gear up in the area of law regarding the case. It is important to understand where the problem stands in law and consider the possible consequences. This includes checking for any laws and regulations bearing the situation, federal laws that apply to the dilemma, and the laws, strategies, and rules relating to the counselor’s workplace.

5. Obtain consultation

In other words, this stage prepares the counselor where and how to seek help regarding the case. The counselor should be fully aware of the procedure and the steps to be followed in case help may be needed.

6. Possible causes of action

Guiding people through their difficult times is not an easy task, it is risky and needs preparations in advance. In this stage, the counselor identifies ways to invent possible causes of actions to be justified and tested in reality. This includes methods to analyze the ethical responsibilities and their result. Through various interactions, the counselor is familiar enough with the client to fully understand the client. Based on the situation and the client, the counselor involves the client in discussions regarding the possible actions. If the client is not in such a situation, the counselor needs to have strategies planned for carrying out courses of action.

7. Enumerate the consequences of various decisions

This stage is based on estimating the possible consequences for each possible cause of action and ways to implant the actions. With a thorough analysis, the counselor decides whether or not to involve the client in discussions regarding the implications. This stage also allows the counselor to be mindful of the ethical principles and to build a framework to be used in the evaluation of consequences for the actions. It is important to study the consequences of the action on the client, the counselor, the profession, and others involved in the dilemma.

8. Decide on the best cause of action

This is the last stage of the ethical decision-making procedure. The long journey of planning has come to an end by finalizing the best possible decision to be used in the dilemma. However, it is important to articulate an action plan to be implanted with feedback from superiors or colleagues. The counselor also needs to have a backup plan in case additional actions are needed.

The procedure for ethical decision-making has been discussed and fully understood. According to the American Counseling Association after outlining the procedure the counselors are projected to be involved in a cautiously valid ethical decision-making process. The process will be discussed in the previously discussed case of James VS Mr. Brown. This process involves four steps.

1. Understanding the situation

• List of relevant facts
  • Unjust company shares.
  • More responsibility compared to the authority.
  • Forgery.
  • Fraud.
  • Illegal actions against the law.
  • Ethical concerns and the result

Forgery, fraud, and illegal actions against the law raise ethical concerns as they affect the imparts of harm to the client which may result in legal actions by law and also harm the third party.

The resulting harm may include a long period in jail.

• Stakeholders
  • James, Mr. Brown, and the company.

2. Major ethical dilemma

Informing Mr. Brown about James’ unlawful acts.

3. Analyzing alternatives in step 2 in an ethical manner

• a. If action is taken for step 2, who will be harmed?

James, because Mr. Brown might report the case to the police or he might abandon James from the business share and family problems may arise resulting in a long-lasting conflict.

• b. If action in stage 2 is not taken, who will be harmed?

Mr. Brown, because through illegal procedure his business Is being ripped away from him. He will lose what he has gained all his life.

• c. Which option (a or b) will result in the least harm?

Option ‘a’ will have the least harm.

• d. If action in step 2 is taken who will benefit?

James will benefit, even though it may seem like an unjust decision for now, but it will in the long run allow him to think rationally about the wrongdoings he has committed and their possible effects.

• e. If action is not taken, who will benefit?

James, as his dream of having the majority of business share came true.

• f. Which option (d or e) holds the maximum benefit?

Option ‘d’ will result in maximum benefit.

• g. Rights and duties of stakeholders.

Dealing with a dilemma is not an easy task. It often involves the rights and duties of several individuals, which need to be considered and analyzed in advance to avoid harm and minimize the impact.

It is the right of Mr. Brown to be aware of his son’s decision to change shares and provide an understanding of James’ expectations. On the other hand, James deserves what he claims but by proper means. Mr. Brown must be fair and just by all means to James and trust him the way he merits to be trusted. At the same time, James must respect his father’s decision and should try to come to an understanding between both of them by other means rather than illegal actions. James needs to analyze the cause of his father’s decision with empathy to deal with the situation healthily. The following are the steps to overcome an ethical dilemma (Atiqah, 2017).

4. Concluding a decision and developing a plan

• a. Defensible ethical decision

Sealing a decision and implanting a plan need defensible strategies and ethical decisions to be referred. This step requires to identify the best response in step 3 to support the counselor’s response. The counselor needs to add arguments to justify why the counselor chose to make that decision with the help of ethical principles.

The decision the counselor took in this case is to inform Mr. Brown about the forgery and illegal procedure James has chosen to change the share.

• b. Specific steps to implant the decision in step ‘a’.

The counselor needs to find ways to approach Mr. Brown, without startling him which may trigger a bad impact on the whole situation. The counselor can try to manipulate him to understand the situation James is in by creating empathetic and a thoughtful tactic. At the same time, the counselor needs to change the irrational thinking of James and replace it with a positive approach, which will help James to understand the situation in a broader perspective leading to cooperativity.

• c. Affects on stakeholders by these actions

The effects of decisions may be traumatizing for both stakeholders. James may feel betrayed by the counselor and may have negative outcomes such as using the powers he has through the government or may dip into depression and other associated risks. On the other hand, Mr. Brown may completely lose his trust in James, resulting in complete neglect, and may abandon him from business share. There are also possible family conflicts that may long last if not taken appropriate measures.

• d. Long-term changes for prevention

This stage may include trust building between both of them and having an empathetic understanding with one another. In case of a conflict or disagreement, consider involving a third party for guidance.

• e. Avoiding the dilemma

This dilemma could have been avoided in the initial stage if Mr. Brown understood and considered James’ feelings, thoughts, and concerns leaving his egoistic nature.

In the case of James VS Mr. Brown, the counselor chose to inform Mr. Brown about the forgery, fraud, and illegal documentation process to change the business share. In doing so, the counselor has analyzed, evaluated, and prepared action plans guided by an ethical framework to minimize the impact on both the stakeholders and the counselor.

Abstract

In the US, postpartum depression (PPD) is an intricate and multiple factor that affects a mother, her child, and her family. Depression in the postpartum period has been linked to poor parental bonding, child abuse, and neglect. Furthermore, poor bonding has been found consistently with more cesarean births than vaginal. For years, researchers have been searching for a correlation between obstetric method of delivery and incidence of PPD. Many theoretical research questions have arrived such as: how does the incidence of PPD vary after cesarean section versus normal delivery? The purpose of this paper is to provide a program based on Beck’s PPD theory to help alleviate, reduce, and treat the symptoms of postpartum depression through education, exercise, and an increase in mother-baby bonding. In following this program’s guidelines educational programs can be implemented to improve nursing care of pregnant women with PPD and provide the basis for mothers in the community to be prepared for self-monitoring for symptoms of depression and know what steps to take if they do experience depressive symptoms.

Evaluating postpartum depression theory about cesarean deliveries, mothers are placed in high-stress situations because they are not in control of their bodies or the situation during cesarean delivery. The risk of higher chances of developing post-partum depression in cesarean deliveries remains a sensitive and controversial subject. According to Hui Xu et. al, when compared with women having spontaneous vaginal or forceps deliveries, women having a cesarean section had more than six times the risk of developing postnatal depression postpartum (2017). Nurses are involved throughout all phases of the patient’s care and can make huge impacts on the well-being of every one that he/she encounters. Cheryl Beck, a nursing theorist, dedicated her life to researching and studying this theory to evaluate mood disorders in pregnant and postpartum women. Using the middle-grounded theory approach, Beck structured her modern theory using a postpartum depression screening in predicting whether a woman will develop postpartum depression based on her postpartum screening score (PDSS), history, and current circumstances using various groups of women in her study (Alligood, 2018).

Symptoms of postpartum depression including extreme sadness, low energy, anxiety, crying episodes, irritability, and changes in sleep or eating patterns affect about 1 in 9 women, according to the Centers for Disease Control and Prevention (ASA, 2018). Postpartum depression can lead to lower rates of breastfeeding and poor bonding with the baby. After a child is born, regardless of the delivery method, every mother deserves to have bonding sessions with their newborn. The literature suggests immediately begin skin to skin contact to initiate the mother-child bonding moment (Ludington-Hoe, 2015). The first hour of life is considered the best opportunity for bonding. This process is evidenced through socio-emotional, sensorimotor, and physical indicators (Hui Xu et. al, 2017). Both the mother and the father can support positive bonding, beginning during pregnancy. Multiple factors may negatively affect the bonding process. These can include a lack of support, the riskiness of pregnancy, and responding to discussions about bonding in a less than socially desirable way, such as refusing bonding moments in cesarean deliveries by using the excuse of being under anesthesia to deny bonding needs.

In the U.S., nearly one in three women give birth by cesarean section. According to The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, cesarean birth is too common in the United States and has increased greatly since it was first measured in the 1960s (Centers for Disease Control, 2018). It is critically important for all involved in the childbirth process, from parents to staff to educators to be aware of the importance of bonding in cesarean births. Positive bonding and attachment can be supported by encouraging contact and facilitating a positive emotional mood. The beneficial outcomes that result from creating a positive bonding experience support the importance of creating an environment in healthcare today that encourages positive attachment for the infant and parent. The ultimate result is a happier, warmer, healthier baby less stress, and fewer chances of developing depression for mom. The purpose of this paper is to propose a program aimed at preventing or controlling post-partum depression resulting from stress, anxiety, and poor mother-baby bonding associated with the effects of cesarean deliveries.

Overview of the program

The goal of this community-based program is to lower the risks of developing post-partum depression in women who undergo cesarean deliveries. The program will address the need to reduce pregnant mothers’ stress and anxieties associated with cesarean births resulting in postpartum depression. Participants in the program consist of any pregnant woman of various backgrounds at risk for emergency C-section or scheduled for a C-section, those with or suspected mood disorders, including depression, maternity blues, and a history of anxiety must be at least 22 weeks pregnant, and be willing to participate from 24 weeks up to 1-year post delivery. This current program is not intended to replace or precede a midwife or obstetrics’ recommendations and medicine prescriptions; it is proposed to provide additional suggestions for therapeutic purposes only.

The therapeutic program consists of an initial screening between 24-28 weeks of pregnancy. 6 weeks of low to moderate exercise such as yoga as tolerated, 3-4 times a week, and at least 30 minutes a day. Education will be provided through means of meetings or classes on bonding with the newborn, stress relieving factors intra and post-partum, and managing anxiety and depression with immediate visits from researching staff post-delivery to encourage and assist with first-hour bonding. The mothers will follow up post-delivery after three months and 1 year for further evaluation of postpartum depression.

The expecting mothers were notified by flyers in several OBGYN offices and community health clinics. The initial meeting began with an information session and discussions about the program, its risks, and benefits. Informed consent was obtained at this time. Expecting mothers discussed their willingness to participate and follow up as needed including the inclusion of a nursing research staff to assist with bonding during the hour of delivery. The initial assessment includes filing out a PHQ-2, followed by the PHQ-9 for those with a score of 2 or higher (CDC, 2013). They were introduced to the Edinburgh Postnatal Depression Scale (EPDS) and Postpartum Depression Screening Scale (PDSS) which they will be completing at their 3rd and 12th month postpartum.

Between the 24th and 28th weeks, mothers will be attending a structured exercise program selected by the community-based clinic, which they will attend 3 times a week, on Mondays, Wednesdays, and Fridays or Saturdays for 30 minutes. The exercise program contains Yoga and one other low-moderate exercise activity, mother’s choice, swimming or dancing. There will also be a 4-hour class on a Saturday during the 32-36 weeks where the mothers learn about early bonding and its effects. They will practice skin-to-skin contact using dolls and learn methods to relieve and alleviate stress and anxiety.

After delivery, one assigned staff will be available to assist mothers with skin-to-skin contact and other methods of bonding with newborns. Researching staff will be available for questions after hospital discharge to help with the ongoing support of the mothers and their new babies. At the three-month post-partum meeting, mothers will complete the PDSS and the results will be discussed with patients. At that time referrals will be made as needed and other assistance will be provided as necessary.

The 12-month follow-up will consist of another PDSS form completion, parents will reflect on the program and their progress at this time. Each and everyone will be asked to reflect on their experience, the staff availability for support, and whether their needs and expectations were met. Parents will be asked whether they think the program helps to reduce their anxiety, stress, and depression levels and increase their involvement with their birthing experience and bonding moments. The program will come to an end after the last meeting.

Overview of the theory

Cheryl Beck has focused her research on postpartum mood disorder and anxiety for at least two decades. In 1993, Beck published her middle-range theory on postpartum depression, titled Teetering on the Edge. Beck completed a literature review on postpartum depression (PPD), and she realized that there was limited qualitative research available on her research topic. Her main goal was to produce research where pregnant women of all backgrounds were included in PPD research and treatment (Marsh, 2013). Beck believes theory is the foundation of nursing and is essential to the profession. As a profession, nursing applies conceptual frameworks to guide practice by describing and predicting specific behavior. It is through the use of guided phenomena that one can expand concepts via research; ultimately, advancing knowledge regarding concepts, experience, and application to practice (Marsh, 2013). It is with this belief that Beck developed this theory by addressing postpartum depression on mother-child interactions, postpartum panic, posttraumatic stress disorders, and birth trauma to tease out differences among post-partum mood disorders (Alligood, 2018).

Multiple analysis was conducted to differentiate predictors of postpartum depression relating to infant temperament, mother-infant interactions, and mothering multiples (Alligood, 2018). Beck discovered women dealing with postpartum depression had difficulties coping with the problem of loss of control through the four-stage process she used in her research on teetering on the edge. The four stages were, encountering terror, dying of self, struggling to survive, and regaining control (Marsh, 2013). Stage one includes anxiety attacks, obsessive thinking, and fogginess. Stage two entails alarming unrealness, self-isolation, and contemplating and attempting self-destruction. The third stage includes feelings of battling the systems, where they feel everyone is against them, praying for relief, and seeking solace at support groups. The last stage discusses unpredictable transitioning, mourning a loss of time, and a guarded recovery (Alligood, 2018).

Beck discovered the concept of PPD far beyond the analysis of symptoms and definition of major depressive mood disorders because she experienced working with pregnant women. She discovered that PPD was not a diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) (Alligood, 2018). She decided to forego a qualitative study designed to investigate specific social psychological problems of PPD and the social psychological process used to resolve PPD. She did this by receiving the assistance of 12 women participant observation in a PPD support group over 18 months. Continually 12 in-depth taped interviews were conducted with mothers who had attended the support group. Loss of control was found to be the basic social psychological problem in PPD (Marsh 2013).

Use of the Theory to Guide Program Development

Postpartum depression (PPD) affects 10%-15% of mothers within the first year after giving birth (CDC, 2008). The CDC analyzed data from the Pregnancy Risk Assessment Monitoring System (PRAMS) for 2004-2005 which is the most recent data available to assess the prevalence of self-reported postpartum depressive symptoms (PDS) among mothers by selected demographic characteristics and other possible risk factors for PDS (2008). Unplanned caesareans may have a particularly negative psychological impact on mothers because they are unexpected, usually mentally and physically stressful, and associated with a loss of control and unmatched expectations (Science Daily, 2019).

Using what Beck called the “ripple effect” in meeting with the women in different aspects during their pregnancy and post-natal to make the necessary connections for effective treatments (Alligood, 2018). The program will incorporate the postpartum depression theory as a basis to help women suffering from this condition especially those undergoing cesarean sections that feel more uncontrol during delivery and are unable to touch or bond with their babies immediately after birth. Depending on their circumstances, some women may not even see their babies for hours post-delivery which creates an increase in anxiety levels, a sense of loss of control, and feelings of inadequacy. As a caring profession as nursing, we must care for all patients and provide all with a sense of wholeness including psychologically. Stressful events such as giving birth where women may be vulnerable to mood disorders is the perfect time for nurses to step up and intervene, and that is why this program is being created, to help these women achieve a happier and more fulfilling pregnancy and delivery. Identifying the symptoms and risk factors before they appear has a greater chance of preventing and alleviating months of suffering (Alligood, 2018).

Conclusion

The stigma of women being expected to feel, look, and act happy during and after pregnancy has silenced many women from voicing their feelings of depression. Many believe that motherhood is a natural feeling, once given birth it’ll automatically suit a woman’s personality; according to Beck, these are assertions that continue to psychologically affect women (Alligood, 2018). Identifying symptoms early through careful screening using this current program can help treat women appropriately.

The use of Beck’s theory on postpartum depression is a pertinent tool for any provider, whether midwife, family nurse practitioner, childbirth educator, or nurse, to provide the best care to pregnant and postpartum patients. Providers that provide care to potential postpartum depressant patients for any amount of time need to be meticulous in recognizing signs and symptoms of PPD and be familiar with at least the Edinburgh postnatal depression scale (EPDS) and the Postpartum Depression Screening Scale (PDSS). Not only do providers need to be able to recognize PPD but also adequately educate patients regarding PPD and the potential emotions that may be experienced along with methods of seeking help with the appropriate referrals.

References

1. Alligood, M. R. (2018). Nursing theorists and their work.
2. American Society of Anesthesiologists (ASA). (2018, October 14). Postpartum depression linked to mother’s pain after childbirth: New study underscores the importance of managing pain during recovery. ScienceDaily. Retrieved from www.sciencedaily.com/releases/2018/10/181014142700.htm.
3. Centers for Disease Control and Prevention. (2013). Depression Among Women of Reproductive Age.
4. Hui Xu, et al. (2017). Cesarean section and risk of postpartum depression: A meta-analysis. Department of Epidemiology and Health Statistics, Volume 97, pp. 118-126. Retrieved from: https://doi.org/10.1016/j.jpsychores.2017.04.016
5. Marsh, J (2013). A Middle Range Theory of Postpartum Depression: Analysis and Application. International Journal of Childbirth Education. Vol. 28 (4). Pp.50-54.
6. Ludington-Hoe, S. (2015). Skin-to-Skin Contact: A Comforting Place with Comfort Food. MCN, The American Journal of Maternal/Child Nursing. 2015. Vol.40(6); pp.359–366. Retrieved from: DOI:10.1097/NMC.0000000000000178.
7. University of York. (2019, January 23). Emergency caesareans put new mothers at higher risk of developing postnatal depression. ScienceDaily. Retrieved from www.sciencedaily.com/releases/2019/01/190123105845.htm.

 

As systematic reviews have been conducted for psychotherapy for Shopping Addiction/ Compulsive buying, the evidence base is more credible and established compared to that for Pharmacological interventions which are more commonly based on single case studies. For instance, a systematic review of multiple treatments for Compulsive buying has found that the most effective Psychotherapy is the 12 session group therapy CBT (Leite, Pereira, Nardi, & Silva, 2014). This 12-session CBT, encompasses thought restructuring, self-esteem, stress management, relapse prevention, and more. The goal of this particular CBT is to control excessive buying behavior through the development of healthy shopping patterns, and not total abstinence from shopping, since this would not be possible. Other goals also include the identification and restructuring of unhealthy thought patterns and negative emotions associated with buying.

However, there are some rules that clients must abide by when they enroll in this 12-session CBT (Astrid & Mitchell, 2011). The three rules include (1) destroying all credit cards from their possession and using other payment modes instead, (2) having a 24-hour rule in which clients must wait for at least 24 hours before purchasing something that they want to purchase but did not plan on buying before their shopping trip, (3) shopping rules such as formulating a shopping list in advance before heading out to shop.

During CBT, clients would be taught various cues to better understand the triggers that lead them to shop compulsively and to develop effective strategies to avoid acting on these cues and ending up spending excessively. For instance, (1) social cues that trigger excessive buying include social isolation and boredom, (2) situational cues include watching advertisements of desired items, (3) physiological cues include bodily fatigue or stress, and (4) mental cues include mental images of buying desired items.

Clients are also taught about the consequences of their shopping addiction, to help them bring these consequences to mind to control their shopping urges (Astrid & Mitchell, 2011). While compulsive buying can give rise to short-lived positive consequences, long-term negative consequences can set in after that. Positive consequences tend to be short-lived and some examples are a distraction from aversive tasks and feeling more attractive, whereas negative consequences tend to be more long-term and some examples include financial problems, negative self-evaluation, and guilt (Astrid & Mitchell, 2011).

During CBT, clients are also taught some alternative behaviors that they could adopt besides shopping compulsively, and these include short-term measures such as listening to music, and long-term measures such as planning to go to a movie with a friend (Astrid & Mitchell, 2011). Additionally, before the end of the treatment, clients are encouraged to view lapses as opportunities to learn and as such, to not feel overly discouraged. They are also taught some strategies to prevent lapses from occurring.

Abstract

In the US, postpartum depression (PPD) is an intricate and multiple factor that affects a mother, her child, and her family. Depression in the postpartum period has been linked to poor parental bonding, child abuse, and neglect. Furthermore, poor bonding has been found consistently with more cesarean births than vaginal. For years, researchers have been searching for a correlation between obstetric method of delivery and incidence of PPD. Many theoretical research questions have arrived such as: how does the incidence of PPD vary after cesarean section versus normal delivery? The purpose of this paper is to provide a program based on Beck’s PPD theory to help alleviate, reduce, and treat the symptoms of postpartum depression through education, exercise, and an increase in mother-baby bonding. In following this program’s guidelines educational programs can be implemented to improve nursing care of pregnant women with PPD and provide the basis for mothers in the community to be prepared for self-monitoring for symptoms of depression and know what steps to take if they do experience depressive symptoms.

Evaluating postpartum depression theory about cesarean deliveries, mothers are placed in high-stress situations because they are not in control of their bodies or the situation during cesarean delivery. The risk of higher chances of developing post-partum depression in cesarean deliveries remains a sensitive and controversial subject. According to Hui Xu et. al, when compared with women having spontaneous vaginal or forceps deliveries, women having a cesarean section had more than six times the risk of developing postnatal depression postpartum (2017). Nurses are involved throughout all phases of the patient’s care and can make huge impacts on the well-being of every one that he/she encounters. Cheryl Beck, a nursing theorist, dedicated her life to researching and studying this theory to evaluate mood disorders in pregnant and postpartum women. Using the middle-grounded theory approach, Beck structured her modern theory using a postpartum depression screening in predicting whether a woman will develop postpartum depression based on her postpartum screening score (PDSS), history, and current circumstances using various groups of women in her study (Alligood, 2018).

Symptoms of postpartum depression including extreme sadness, low energy, anxiety, crying episodes, irritability, and changes in sleep or eating patterns affect about 1 in 9 women, according to the Centers for Disease Control and Prevention (ASA, 2018). Postpartum depression can lead to lower rates of breastfeeding and poor bonding with the baby. After a child is born, regardless of the delivery method, every mother deserves to have bonding sessions with their newborn. The literature suggests immediately begin skin to skin contact to initiate the mother-child bonding moment (Ludington-Hoe, 2015). The first hour of life is considered the best opportunity for bonding. This process is evidenced through socio-emotional, sensorimotor, and physical indicators (Hui Xu et. al, 2017). Both the mother and the father can support positive bonding, beginning during pregnancy. Multiple factors may negatively affect the bonding process. These can include a lack of support, the riskiness of pregnancy, and responding to discussions about bonding in a less than socially desirable way, such as refusing bonding moments in cesarean deliveries by using the excuse of being under anesthesia to deny bonding needs.

In the U.S., nearly one in three women give birth by cesarean section. According to The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, cesarean birth is too common in the United States and has increased greatly since it was first measured in the 1960s (Centers for Disease Control, 2018). It is critically important for all involved in the childbirth process, from parents to staff to educators to be aware of the importance of bonding in cesarean births. Positive bonding and attachment can be supported by encouraging contact and facilitating a positive emotional mood. The beneficial outcomes that result from creating a positive bonding experience support the importance of creating an environment in healthcare today that encourages positive attachment for the infant and parent. The ultimate result is a happier, warmer, healthier baby less stress, and fewer chances of developing depression for mom. The purpose of this paper is to propose a program aimed at preventing or controlling post-partum depression resulting from stress, anxiety, and poor mother-baby bonding associated with the effects of cesarean deliveries.

Overview of the program

The goal of this community-based program is to lower the risks of developing post-partum depression in women who undergo cesarean deliveries. The program will address the need to reduce pregnant mothers’ stress and anxieties associated with cesarean births resulting in postpartum depression. Participants in the program consist of any pregnant woman of various backgrounds at risk for emergency C-section or scheduled for a C-section, those with or suspected mood disorders, including depression, maternity blues, and a history of anxiety must be at least 22 weeks pregnant, and be willing to participate from 24 weeks up to 1-year post delivery. This current program is not intended to replace or precede a midwife or obstetrics’ recommendations and medicine prescriptions; it is proposed to provide additional suggestions for therapeutic purposes only.

The therapeutic program consists of an initial screening between 24-28 weeks of pregnancy. 6 weeks of low to moderate exercise such as yoga as tolerated, 3-4 times a week, and at least 30 minutes a day. Education will be provided through means of meetings or classes on bonding with the newborn, stress relieving factors intra and post-partum, and managing anxiety and depression with immediate visits from researching staff post-delivery to encourage and assist with first-hour bonding. The mothers will follow up post-delivery after three months and 1 year for further evaluation of postpartum depression.

The expecting mothers were notified by flyers in several OBGYN offices and community health clinics. The initial meeting began with an information session and discussions about the program, its risks, and benefits. Informed consent was obtained at this time. Expecting mothers discussed their willingness to participate and follow up as needed including the inclusion of a nursing research staff to assist with bonding during the hour of delivery. The initial assessment includes filing out a PHQ-2, followed by the PHQ-9 for those with a score of 2 or higher (CDC, 2013). They were introduced to the Edinburgh Postnatal Depression Scale (EPDS) and Postpartum Depression Screening Scale (PDSS) which they will be completing at their 3rd and 12th month postpartum.

Between the 24th and 28th weeks, mothers will be attending a structured exercise program selected by the community-based clinic, which they will attend 3 times a week, on Mondays, Wednesdays, and Fridays or Saturdays for 30 minutes. The exercise program contains Yoga and one other low-moderate exercise activity, mother’s choice, swimming or dancing. There will also be a 4-hour class on a Saturday during the 32-36 weeks where the mothers learn about early bonding and its effects. They will practice skin-to-skin contact using dolls and learn methods to relieve and alleviate stress and anxiety.

After delivery, one assigned staff will be available to assist mothers with skin-to-skin contact and other methods of bonding with newborns. Researching staff will be available for questions after hospital discharge to help with the ongoing support of the mothers and their new babies. At the three-month post-partum meeting, mothers will complete the PDSS and the results will be discussed with patients. At that time referrals will be made as needed and other assistance will be provided as necessary.

The 12-month follow-up will consist of another PDSS form completion, parents will reflect on the program and their progress at this time. Each and everyone will be asked to reflect on their experience, the staff availability for support, and whether their needs and expectations were met. Parents will be asked whether they think the program helps to reduce their anxiety, stress, and depression levels and increase their involvement with their birthing experience and bonding moments. The program will come to an end after the last meeting.

Overview of the theory

Cheryl Beck has focused her research on postpartum mood disorder and anxiety for at least two decades. In 1993, Beck published her middle-range theory on postpartum depression, titled Teetering on the Edge. Beck completed a literature review on postpartum depression (PPD), and she realized that there was limited qualitative research available on her research topic. Her main goal was to produce research where pregnant women of all backgrounds were included in PPD research and treatment (Marsh, 2013). Beck believes theory is the foundation of nursing and is essential to the profession. As a profession, nursing applies conceptual frameworks to guide practice by describing and predicting specific behavior. It is through the use of guided phenomena that one can expand concepts via research; ultimately, advancing knowledge regarding concepts, experience, and application to practice (Marsh, 2013). It is with this belief that Beck developed this theory by addressing postpartum depression on mother-child interactions, postpartum panic, posttraumatic stress disorders, and birth trauma to tease out differences among post-partum mood disorders (Alligood, 2018).

Multiple analysis was conducted to differentiate predictors of postpartum depression relating to infant temperament, mother-infant interactions, and mothering multiples (Alligood, 2018). Beck discovered women dealing with postpartum depression had difficulties coping with the problem of loss of control through the four-stage process she used in her research on teetering on the edge. The four stages were, encountering terror, dying of self, struggling to survive, and regaining control (Marsh, 2013). Stage one includes anxiety attacks, obsessive thinking, and fogginess. Stage two entails alarming unrealness, self-isolation, and contemplating and attempting self-destruction. The third stage includes feelings of battling the systems, where they feel everyone is against them, praying for relief, and seeking solace at support groups. The last stage discusses unpredictable transitioning, mourning a loss of time, and a guarded recovery (Alligood, 2018).

Beck discovered the concept of PPD far beyond the analysis of symptoms and definition of major depressive mood disorders because she experienced working with pregnant women. She discovered that PPD was not a diagnosis listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) (Alligood, 2018). She decided to forego a qualitative study designed to investigate specific social psychological problems of PPD and the social psychological process used to resolve PPD. She did this by receiving the assistance of 12 women participant observation in a PPD support group over 18 months. Continually 12 in-depth taped interviews were conducted with mothers who had attended the support group. Loss of control was found to be the basic social psychological problem in PPD (Marsh 2013).

Use of the Theory to Guide Program Development

Postpartum depression (PPD) affects 10%-15% of mothers within the first year after giving birth (CDC, 2008). The CDC analyzed data from the Pregnancy Risk Assessment Monitoring System (PRAMS) for 2004-2005 which is the most recent data available to assess the prevalence of self-reported postpartum depressive symptoms (PDS) among mothers by selected demographic characteristics and other possible risk factors for PDS (2008). Unplanned caesareans may have a particularly negative psychological impact on mothers because they are unexpected, usually mentally and physically stressful, and associated with a loss of control and unmatched expectations (Science Daily, 2019).

Using what Beck called the “ripple effect” in meeting with the women in different aspects during their pregnancy and post-natal to make the necessary connections for effective treatments (Alligood, 2018). The program will incorporate the postpartum depression theory as a basis to help women suffering from this condition especially those undergoing cesarean sections that feel more uncontrol during delivery and are unable to touch or bond with their babies immediately after birth. Depending on their circumstances, some women may not even see their babies for hours post-delivery which creates an increase in anxiety levels, a sense of loss of control, and feelings of inadequacy. As a caring profession as nursing, we must care for all patients and provide all with a sense of wholeness including psychologically. Stressful events such as giving birth where women may be vulnerable to mood disorders is the perfect time for nurses to step up and intervene, and that is why this program is being created, to help these women achieve a happier and more fulfilling pregnancy and delivery. Identifying the symptoms and risk factors before they appear has a greater chance of preventing and alleviating months of suffering (Alligood, 2018).

Conclusion

The stigma of women being expected to feel, look, and act happy during and after pregnancy has silenced many women from voicing their feelings of depression. Many believe that motherhood is a natural feeling, once given birth it’ll automatically suit a woman’s personality; according to Beck, these are assertions that continue to psychologically affect women (Alligood, 2018). Identifying symptoms early through careful screening using this current program can help treat women appropriately.

The use of Beck’s theory on postpartum depression is a pertinent tool for any provider, whether midwife, family nurse practitioner, childbirth educator, or nurse, to provide the best care to pregnant and postpartum patients. Providers that provide care to potential postpartum depressant patients for any amount of time need to be meticulous in recognizing signs and symptoms of PPD and be familiar with at least the Edinburgh postnatal depression scale (EPDS) and the Postpartum Depression Screening Scale (PDSS). Not only do providers need to be able to recognize PPD but also adequately educate patients regarding PPD and the potential emotions that may be experienced along with methods of seeking help with the appropriate referrals.

References

1. Alligood, M. R. (2018). Nursing theorists and their work.
2. American Society of Anesthesiologists (ASA). (2018, October 14). Postpartum depression linked to mother’s pain after childbirth: New study underscores the importance of managing pain during recovery. ScienceDaily. Retrieved from www.sciencedaily.com/releases/2018/10/181014142700.htm.
3. Centers for Disease Control and Prevention. (2013). Depression Among Women of Reproductive Age.
4. Hui Xu, et al. (2017). Cesarean section and risk of postpartum depression: A meta-analysis. Department of Epidemiology and Health Statistics, Volume 97, pp. 118-126. Retrieved from: https://doi.org/10.1016/j.jpsychores.2017.04.016
5. Marsh, J (2013). A Middle Range Theory of Postpartum Depression: Analysis and Application. International Journal of Childbirth Education. Vol. 28 (4). Pp.50-54.
6. Ludington-Hoe, S. (2015). Skin-to-Skin Contact: A Comforting Place with Comfort Food. MCN, The American Journal of Maternal/Child Nursing. 2015. Vol.40(6); pp.359–366. Retrieved from: DOI:10.1097/NMC.0000000000000178.
7. University of York. (2019, January 23). Emergency caesareans put new mothers at higher risk of developing postnatal depression. ScienceDaily. Retrieved from www.sciencedaily.com/releases/2019/01/190123105845.htm.

 

As systematic reviews have been conducted for psychotherapy for Shopping Addiction/ Compulsive buying, the evidence base is more credible and established compared to that for Pharmacological interventions which are more commonly based on single case studies. For instance, a systematic review of multiple treatments for Compulsive buying has found that the most effective Psychotherapy is the 12 session group therapy CBT (Leite, Pereira, Nardi, & Silva, 2014). This 12-session CBT, encompasses thought restructuring, self-esteem, stress management, relapse prevention, and more. The goal of this particular CBT is to control excessive buying behavior through the development of healthy shopping patterns, and not total abstinence from shopping, since this would not be possible. Other goals also include the identification and restructuring of unhealthy thought patterns and negative emotions associated with buying.

However, there are some rules that clients must abide by when they enroll in this 12-session CBT (Astrid & Mitchell, 2011). The three rules include (1) destroying all credit cards from their possession and using other payment modes instead, (2) having a 24-hour rule in which clients must wait for at least 24 hours before purchasing something that they want to purchase but did not plan on buying before their shopping trip, (3) shopping rules such as formulating a shopping list in advance before heading out to shop.

During CBT, clients would be taught various cues to better understand the triggers that lead them to shop compulsively and to develop effective strategies to avoid acting on these cues and ending up spending excessively. For instance, (1) social cues that trigger excessive buying include social isolation and boredom, (2) situational cues include watching advertisements of desired items, (3) physiological cues include bodily fatigue or stress, and (4) mental cues include mental images of buying desired items.

Clients are also taught about the consequences of their shopping addiction, to help them bring these consequences to mind to control their shopping urges (Astrid & Mitchell, 2011). While compulsive buying can give rise to short-lived positive consequences, long-term negative consequences can set in after that. Positive consequences tend to be short-lived and some examples are a distraction from aversive tasks and feeling more attractive, whereas negative consequences tend to be more long-term and some examples include financial problems, negative self-evaluation, and guilt (Astrid & Mitchell, 2011).

During CBT, clients are also taught some alternative behaviors that they could adopt besides shopping compulsively, and these include short-term measures such as listening to music, and long-term measures such as planning to go to a movie with a friend (Astrid & Mitchell, 2011). Additionally, before the end of the treatment, clients are encouraged to view lapses as opportunities to learn and as such, to not feel overly discouraged. They are also taught some strategies to prevent lapses from occurring.

Present Issues

One can identify a number of personal, academic, and career issues in the case of Janeen. First of all, Janeen’s personal and social problems can significantly affect her future career. The student’s gender identity can be defined as the central problem that may influence other aspects of Janeen’s life. Moreover, her social life is affected as well, as she reports being bullied because of her clothing and appearance. It is necessary to understand that the student’s issue with gender identity and presentation should be discussed with Janeen in more detail. The student may be transgender. According to Ratts and Pedersen (2014), the discrimination of transgender youth in schools can lead to transgender students facing issues in their studies and future career. Moreover, the emotional state of the student is also impacted by this situation. Janeen is clearly distressed by this problem. Her heritage may also define the student’s identity. Janeen is African-American, which can influence her outlook on life. However, the student does not express much anxiety about this particular aspect.

Currently, the issues of the student also affect her school work. The student regularly skips school and does not perform as well as she used to. It is an academic issue that may be further exacerbated by the student’s parents, who put additional pressure on Janeen’s academic performance. Moreover, the decision of the parents to transfer Janeen to another state may also contribute to her studies becoming worse than before. The detachment from a familiar environment may have various effects on the student’s mental health.

Finally, Janeen’s career issues are linked to the problems described above. It is possible that the student may not be able to attend a university if Janeen does not improve her academic performance. Moreover, she may experience discrimination in the future workplace, which is a frequent issue for many transgender individuals (Berman, 2014). Furthermore, Janeen is African American, which also affects the student’s career opportunities.

Family Issues

The student’s family puts psychological pressure on the student and creates some additional complications. The student’s academic performance is valued by the family that wants Janeen to study harder. The ultimatum that the parents of the student present to Janeen may further affect her mental health. The process of transferring Janeen to another school may be followed by a number of possible issues. Firstly, the detachment from the family may negatively impact the relationship between the student and her parents. Secondly, the lack of support from a familiar environment may lead to Janeen experiencing stress. The issue of a boarding school enforcing some additional restrictions for its students may also put Janeen in a challenging position. The student is afraid of her parents disowning her, which may show that Janeen has a rather strong bond with her family. While the change of environments may positively affect the student’s school situation, it is uncertain whether Janeen can face bullying in a new school as well.

Janeen is scared to tell her parents about her gender identity concerns as she does not want her parents to abandon her. This fear possibly stems from her father being religious and active in the church. This personal issue of the student also affects the whole family. According to Capuzzi and Stauffer (2016), spirituality can play an important role in the lives of African-American clients, along with their family dynamics and systems. Moreover, religious concerns often clash with gender nonconformity, which may further complicate the family relationship. Therefore, it is necessary to address the aspect of religion in the family and assess the student’s views on spirituality.

Risk Factors

There are many risk factors connected to the student’s case. Ratts and Pedersen (2014) state that people from minority groups facing discrimination on the basis of their cultural, socioeconomic, or visual differences often experience issues with their mental health and well-being. For instance, the personal issue of gender identity may lead to Janeen developing mental health problems such as depression or substance abuse. Thus, it is vital to assess this situation and prevent Janeen from engaging in risky behaviors. Moreover, the higher rate of suicidality among transgender individuals also puts Janeen’s life at risk (Riggs & Bartholomaeus, 2015). This particular risk factor is further aggravated by bullying that the student experiences in school.

Janeen’s decision to dress in masculine clothes at school may lead to more aggressive behaviors from the student’s peers, and it also puts Janeen at risk. Bullying is a serious issue that may result in the student experiencing both mental and physical health problems. As Johnstone and Dallos (2013) point out, bullying may create a history of trauma, which in turn can contribute to an individual developing various conditions. This risk factor may also be worsened by some racial implications of the bullies. It is unclear whether the student faces some level of discrimination based on her race. However, this aspect should not be overlooked. The bullying may be addressed at the school level if it is significantly harming the student’s well-being.

The family’s attitude towards Janeen’s education is a risk factor as well. The possible reaction of the student’s parents to her gender concerns is unknown. However, Janeen’s fear of telling her parents further contributes to her stress levels. Furthermore, the decision of the parents to pressure Janeen into studying by issuing an ultimatum may lead to Janeen experiencing even more pressure.

Legal and Ethical Implications

The case of Janeen has some legal and ethical implications. Janeen is underage, which limits the possibility of the student retaining full confidentiality of her counseling. While Janeen owns the moral rights to keep the information private, her parents may have the legal rights to address the discussed information (Berman, 2014). However, the parents should be informed about the confidentiality of these sessions. Janeen’s parents do not know about the student’s gender-related issues, and it is the counselor’s responsibility to talk with the student about the possibility of sharing this information with other people. However, the counselor cannot disclose the details of this case to other individuals, as it can breach the confidentiality of it. Privacy is the cornerstone of any counseling practice. Some ethical considerations may also include the condition of the patient. If the student expresses any thoughts about engaging in dangerous behaviors, it is possible to inform the parents about it. The counselor’s duty to warn limits the patient’s confidentiality.

The counselor is also required to treat all clients regardless of their cultural differences. Therefore, the ethical issue of diversity implies that one cannot refrain from treating students that have a different cultural background. While the lack of knowledge about one’s issue may pose some difficulties in creating a treatment, one should apply all existing knowledge and give the client the best care possible. Therefore, the student’s gender and racial characteristics should be discussed.

Therapeutic Relationship and Biases

Some possible biases of the counselor, in this case, may include one’s religious beliefs, gender, race, and occupation. It is necessary to keep in mind such considerations as the student’s race, age, and gender. Cultural differences should be taken into account and assessed with caution. One should not base his or her assumptions on these characteristics of the student and stay unbiased. For instance, the supposed connection of race to some mental health issues should be evaluated thoroughly (Johnstone & Dallos, 2013). However, addressing possible unique characteristics of the student’s family structure is necessary to understand the scope of the present issue fully. Therefore, the counselor should keep in mind the cultural background of Janeen while refraining from making discriminatory claims and suggestions. Moreover, the client is young, which may also complicate the dialogue between her and the counselor.

The gender of the student is also a complex issue that should be examined further. The establishment of a therapeutic relationship is impossible without a level of trust from the student (Capuzzi & Stauffer, 2016). Therefore, one should consider including the discussion of these concerns in the dialogue with the student. The issue of spirituality should be addressed as well. While the counselor and the student may not share the same views on some aspects, it is the former’s job to maintain professionalism and refrain from imposing his or her views on the latter. Therefore, while it is vital to discuss these concepts with the student, it is also necessary not to criticize the other person’s opinions. Moreover, any racial bias should be eliminated in order to provide the best treatment. The ability of the counselor to avoid making biased conclusions should encourage the student to participate in the consultation and respond more positively to the proposed intervention.

Possible Interventions

One can suggest a number of possible interventions for the student’s case. First of all, a consultation with Janeen’s parents is essential to the well-being of the student. It is vital to assess the parents’ relationship with Janeen and learn about their views on gender and transgender individuals. Furthermore, some advice should be given about the possible ways of dealing with underperforming children. According to Capuzzi and Stauffer (2016), family-based therapy may strengthen the relationship between the student and the parents and create a more neutral foundation for discussion. The issue of gender may be discussed with the student’s approval. Therefore, this type of intervention can mitigate the outcomes of Janeen talking to her parents and relieve her fear of abandonment. It is important to remember that the student’s parents do not have any apparent knowledge about their child’s existing concerns. Thus, their education is necessary in order to create a more comfortable environment for the client.

Collaboration with teachers and school staff may improve the issue of bullying. According to Marx, Roberts, and Nixon (2017), gender nonconforming students often face bullying from their peers, which may need to be addressed at the school level. Here, the support of the counselor can play a crucial role in the student’s well-being. Therefore, some instructions about treating Janeen’s concerns may be implemented. It is possible to ask Janeen about her time at school and infer about the positive and negative experiences. Following that, one can create a narrative that Janeen would support. For instance, Janeen may express the need to change personal pronouns. The consultation of parents may involve the discussion of these scenarios. The case of Janeen needs attention from the student, the parents, and the school in order to deal with all the presented issues.

References

Berman, P. S. (2014). Case conceptualization and treatment planning: Integrating theory with clinical practice (3rd ed.). New York, NY: Sage Publications.

Capuzzi, D., & Stauffer, M. D. (Eds.). (2016). Counseling and psychotherapy: Theories and interventions (6th ed.). Alexandria, VA: John Wiley & Sons.

Johnstone, L., & Dallos, R. (Eds.). (2013). Formulation in psychology and psychotherapy: Making sense of people’s problems (2nd ed.). New York, NY: Routledge.

Marx, R. A., Roberts, L. M., & Nixon, C. T. (2017). When care and concern are not enough: School personnel’s development as allies for trans and gender nonconforming students. Social Sciences, 6(1), 11.

Ratts, M. J., & Pedersen, P. B. (2014). Counseling for multiculturalism and social justice: Integration, theory, and application (4th ed.). Alexandria, VA: John Wiley & Sons.

Riggs, D. W., & Bartholomaeus, C. (2015). The role of school counsellors and psychologists in supporting transgender people. The Educational and Developmental Psychologist, 32(2), 158-170.

Overview

Theory suggests that the complexities surrounding the Jewish women’s identity and perceptions of life are unique, thus having implications for counseling. The Jewish woman’s identity is informed by ethics such as, world repair, history, culture and people-hood.

Largely, Jewish women comprise of two ethnic groups, the Ashkenazi and Sephardi. Nonetheless, the identity of the Jewish women is not typical because each Jewish woman is diverse in terms of socioeconomic class, race, religion, culture or nationality.

Fundamentally, these complexities potentially lead to the misunderstanding of Jewish women during counseling.

Considering that the complexities are theoretical, Ginsberg & Sinacore (2013) undertake an evidence-based, qualitative-phenomenological study on self reports of 12 non-Orthodox and Ashkenazi women of the Jewish American origin.

They examine their perceptions of the Jewish identity and the world view to inform counselors about the Jewish women.

Methodology

The researchers use qualitative-phenomenological method, which employ purposive selection to get a portion of participants that represents the phenomenon being investigated.

Markedly, the respondents constitute of the Jewish American women aged 30 years and above because Jewish women acquire a self-determined identity at 30 years of age. The researchers gather data from the entire research team, including psychologists.

Participants sign informed consent, fill a demographic sheet and undertake a 60 to 90 minute audio taped interview. Eventually, data is analyzed using the phenomenological data analysis approach.

Results

Data analysis reveals the two major themes (a. and b.) noted below.

Jewishness

Under Jewishness, four sub-themes emerge as noted below.

1. Jewish ethics. Respondents attest that Jewishness is informed by the ethical tradition of charity (Tzedakah) and doing good deeds (mitzvoth) aimed at fostering world repair (Tikkun Olam). This propels them to have a strong view about equality and social justice for all people.
2. The Jewish community life and family. Participants note that their community and families have taught them how to be Jewish. This is in regard to maintaining Jewish values and adhering to Tikkun Olam since they were young.
3. Gender roles. According to the respondents, the Jewish family life determines what constitutes a Jewish woman. This is informed by culture, including the ideal of a romanticized woman of valor based on a Hebrew prayer. The Jewish women’s identity is also informed by their marginalizing religion. Women are denied the chance to engage in religious activities in favor of men. This angers them and makes them feel marginalized in the Jewish society.
4. The Jewish people. A sense of belonging to the Jewish people is crucial to Jewishness. As participants acknowledge, it gives them a sense of familiarity, cultural sense and establishes a connection to Jews all over the world. However, they perceive the association of Jews as “a chosen” people to be offensive and isolating.

Being A Jew In A Wider Societal Context

Under this theme, there are four sub-themes as noted below.

1. Being a minority. As a minority religious group, participants feel differentiated from majority groups and a sense of being the ‘other.’ This makes them feel that no one understands them, but yet provokes them to be sensitive and compassionate towards other minorities.
2. Anti-Semitism and Jewish stereotypes. Marginalization is compounded by the anti-Semitic stereotyping. According to participants, stereotypes, such as the rich Jew, selfish and the Jewish American princess are troubling. This makes them theorize the cause of anti-Semitism negatively, thus making them feel threatened.
3. Personal anti-Semitism experiences. These include violent, explicit and implicit anti-Semitism. The experiences affect their self view and identity because they know that they are not welcomed everywhere and cannot just go anywhere.
4. The Holocaust. Participants reveal that being a minority and experiencing anti-Semitism is complicated by being perceived as “post-Holocaust” Jews. The holocaust experiences are imparted from one generation to another. This makes Holocaust a lived psychological experience that affects the participants’ personalities and determines how they perceive the world.

Discussion

The results reveal consistency with the theory in terms of Jewishness being a complex factor that is crucial to the worldview and identify of Jewish women.

The respondents highlight the multi-faceted factors that inform Jewishness, including cultural expectations as informed by Jewish ideals and morals.

The nature of Jewish morality is exposed when participants highlight their involvement in social activism to counter discrimination and inequality.

The results also reveal how a Christian society complicates the anti-Semitism they face and intense traumatizing effect of the Holocaust that makes them unsafe.

Limitations/implications for future research

The methodology reveals several limitations. The geographical area is confined to Midwestern U.S., an area where Jews are less compared to other areas. The study also fails to attend to denominational differences and only focuses on a defined age group.

This makes generalization of the findings limited. Nevertheless, the study provides insight regarding the Jewish identity from Jewish women accounts.

The research sets a foundation for future research, which could focus on Jewish men and women who are of different denominations, sexuality, ethnicity and age. In addition, this research acts a checklist for assessing study results of Jews in other countries.

Implications for counseling

Essentially, the study highlights the need to include anti-Semitism, and Jewish religion and history in counselor education to enable counselors counter Jewish-related issues during Jewish counseling sessions. Among other benefits, this would enable counselors to conceptualize Jewishness identity.

This also goes for acknowledging traditional gender roles, such as women’s role in keeping a home as crucial for Jewish women to understand their lives and as sources of conflict.

More so, counselors would understand how the “other” concept works with Jews; how Jewish women perceive themselves for being a minority in a Christian, anti-Semitism dominated society. This would enable counselors understand the Jews’ lack of trust in non-Jews counselors.

In essence, the overall implication is that counselors need to understand Jewish women in the context of the Holocaust, anti-Semitism and other factors discussed to increase their sensitivity towards them during counseling.

Reference

Ginsberg, F., & Sinacore, A. L. (2013). Counseling Jewish women: A phenomenological study. Journal of Counseling & Development, 91, 131-139.