Category: Counseling

Introduction

This assignment is a discussion on the topic of adventure based counseling and its effectiveness in counseling adolescents with problems of self-esteem. The discussion starts with a general overview of counseling then goes on to look at the adventure based counseling and its effectiveness in counseling adolescents with problems of self-esteem.

In the discussion, it is argued that the method of adventure based counseling, which takes place in a group context is very effective in helping clients (adolescents) to increase the levels of awareness of themselves thus becoming more responsible and fully in charge of their lives through the integration of their experiences with those of the other group members.

Discussion

General Overview of Counseling

According to Carl Rogers, counseling is a series of direct contact between clients and counselors with an aim of assisting the clients to change their attitudes and behaviors which cause distress to them as well as helping them gain an understanding of themselves so as to take the appropriate positive steps in light of a new orientation.

According to Carl Rogers therefore, effective counseling should occur in an environment where the counselor and the client are able to interact without any barriers (Rogers, 1951).

Counseling is considered by psychologists as a helping profession. Just like other professions, counseling is guided by professional ethics and codes of conduct (Freeman, 2000). These are established to guard the public from unethical practices by quarks, who may pose as counselors. Counselors therefore undergo through intensive training where they acquire skills, techniques and competencies to use in their practice (Egan, 2007).

The techniques and skills which counselors acquire are unique and are aimed at helping different clients, who have different problems. Some of the techniques which they use in counseling include attending, effective listening and responding. The skills they use include reflecting, questioning, confronting, informing, teaching and interpreting among others (Burnard, 2005).

The goals of counseling include enhancement of self-understanding, communication, learning and behavior change, self-actualization and support by the counselor and or family members to the client (Geldard, & Geldard, 2005).

There are various types of counseling which are applicable to various clients and situations. The reason why there are many types of counseling is because clients are faced with various types of problems. Examples of counseling methods include client centered, behavioral, cognitive behavioral, group counseling, and adventure based counseling as well as indigenous methods of counseling.

All these types of counseling use different theoretical frameworks as guidelines in the interventions. In the following paragraphs, I have provided an overview of the adventure based counseling and its effectiveness in counseling adolescents with problems of self-esteem.

Effectiveness of Adventure Based Counseling on Adolescent’s Self Esteem

Developmental psychologists have differed on the definition of adolescence especially on the criteria of age. Some argue that it starts as early as 8 years while others argue that it may start as late as 12 years and end as late as 22 years. However, they tend to agree that for many people, adolescence starts at the age of 11 years and ends at the age of 19 years.

What is of interest here is however not the definition or the age at which it starts and ends but rather the changes which take place during adolescence and how they affect the adolescent (Damon, Menon & Bronk, 2003. pp.119-128).

One of the renowned developmental psychologists called G. Stanley Hall once described adolescence as a period of storm and stress. This means that many adolescents undergo through psychological changes which involve fluctuation of moods and emotions. Most of them usually start engaging in heterosexual relationships and also want to be independent from their parents (Damon, et al, 2003. pp.119-128).

Most of them also worry about their appearance, performance in school as well as their ability to attract friends of the opposite sex. Most of them therefore have problems related to self-esteem. One cause of such problems is the failure to secure attractive opposite sex friends as well as things like acne and general physical body characteristics (Damon, et al, 2003. pp.119-128).

The problems related to self-esteem may have very adverse effects on the adolescents because they may be ignored by their peers leading to feelings of inadequacy. This may in turn lead to a lot of stress which may interfere with their normal lives as well as their performance in school. This calls for their counseling so as to re-invent their confidence, trust and self-esteem so as to overcome the stress (Damon, et al, 2003. pp.119-128).

One of the commonly used methods of counseling adolescents with problems of self-esteem is the adventure based counseling. This method of counseling is based on the existential theory of counseling which focuses on the clients’ levels of awareness about themselves and their immediate psychosocial environments (Damon, et al, 2003. pp.119-128).

Adventure based counseling uses groups of clients who are affected by similar problems or challenges. With the problem of low self-esteem among adolescents, adventure based counseling can be used to bring them together so that they may share their experiences in terms of their history, their achievements, strengths as well as their weaknesses.

Through the method, adolescents can be helped to understand and identify their strong points as well as their weaknesses which may be causing feelings of low self-esteem to them. The group environment gives them an opportunity to complement each other’s strengths thus boosting their confidence (Damon, et al, 2003. pp.119-128).

The role of the counselor in adventure based counseling is that of a teacher as well as a facilitator. He or she relies on the discussion of the group members to shape the counseling sessions in manner that enables them to volunteer as much information about themselves as possible.

The more they volunteer information about themselves, the more they become open to each other which in turn increase their awareness of themselves. The increased levels of awareness about themselves enables them have confidence, trust and positive attitude towards each other and themselves which leads to increased levels of self-esteem (Damon, et al, 2003. pp.119-128).

The group environment also enables them to learn and acquire strong interpersonal skills, peoples’ skills as well as group skills which enable them to eliminate any negative attitudes, thinking or perceptions about themselves and focus only on their positive attributes. The complementarity effect within the group also enables them to understand that they are not the only people faced with such problems.

This further relieves them the burden of feelings of inadequacy. The end result is adolescents with increased levels of awareness who are responsible and able to take control of their negative emotions, perceptions and feelings and move forward as individuals who are fully in charge of their lives (Damon, et al, 2003. pp.119-128).

Conclusion

This dissuasion was about adventure based counseling and its effectiveness in counseling adolescents with problems of low self-esteem. In the discussion, it has emerged that adolescence is a period of storm and stress which emanate from psychosocial developmental process, especially those related to heterosexual relationships.

The adventure based counseling is appropriate for addressing self-esteem needs among adolescents because it brings them in a group setting where they are helped to realize and identify their strong points and ignore their weak points.

References

Burnard, P. (2005). Counseling Skills for Health Professionals (4th Ed.). Cheltenham, UK:Nelson Thornes

Damon, W., Menon, J., & Bronk, K. C. (2003). The development of purpose during adolescence. Applied Developmental Sciences, 7, pp.119-128.

Egan, G. (2007). The Skilled Helper: A Problem-Management and Opportunity-Development Approach to Helping (8th Ed.). Pacific Grove, CA: Brooks/Cole.

Freeman, S. J. (2000). Ethics: An Introduction to Philosophy and Practice. Belmont, CA: Wadsworth Publishing.

Geldard, D., & Geldard, K. (2005). Basic Personal Counseling: A Training Manual for Counselors (5th Ed.). Sydney: Pearson Education.

Rogers, C. (1951). Client Centered Therapy: Its Current Practice, Implications, and Theory. Boston:Houghton Mifflin.

This article explores ways of predicting premature counseling termination using scales from BTPI (Butcher Treatment Planning Inventory). The article is jointly authored by two practicing counselors and a university professor. According to the article, managed mental-health care has brought about sweeping changes to mental health assessment modalities. Managed mental-health care (MMHC) mostly affects institutions such as universities and mental-health institutions.

The constraints of MMHC have led counselors to look for the most effective assessment protocols that are considerate of cost and accountability. The article notes that failure of clients to keep their scheduled appointments leads to wastage of resources. In addition, it is noted that premature termination of counseling services affects both clients and counselors negatively.

The prevalence of premature therapy is estimated to be fifty percent across all counseling platforms according to the authors. The article continues by investigating premature termination’s variables focusing on the clients, the counselors, and institutions’ administrators. Some of the addressed variables include clients’ economic status, the counselor’s gender, client motivation, and self-efficacy. The authors concentrate on BTPI as the main assessment method in their study.

According to the article, BTPI is an evaluation tool that focuses on clients’ personalities. According to the authors of this article, BTPI is yet to be verified as an apt tool for predicting premature termination from counseling. Therefore, the authors sought to build on the functionalities of BTPI as a means of predicting premature termination from counseling.

This study focuses on the counseling centers in universities. Some of the scales that were used as predictors of premature termination from counseling include REL (Problems in Relationship Formation), CLM (Close-Mindedness), EXP (Low Expectation Benefit), and NAR (Self-Oriented/Narcissism).

According to the article, the participants of this study were sourced from the counseling centre of a moderately sized university in the United States. The sample of the study excluded those clients who were meeting with their counselors for the purposes of medication. Overall, a sample of 95 clients was picked for the purposes of this study. All these clients were involved in individual counseling sessions.

Furthermore, the study involved a total of twenty counselors who all performed some form of counseling services. Out of these twenty counselors, twenty four percent were licensed while seventy six percent were non-licensed counselors. The study utilized 210 true/false questions as well as 14 BTPI scales. The BTPI scales were interpreted using the BTPI manual.

The study’s procedure started with obtaining written consents from all the study’s participants. The next step involved a completion of the BTPI by all the clients involved in the study.

The counseling staff was informed about the purpose and the goals of the study. However, the study’s specific hypotheses were not revealed to the counseling staff to avoid instances of result-manipulation. According to this article, “the results of the study revealed that only 2 out of the 95 study’s participants did not receive termination-ratings” (Hatchett, Han & Cooker, 2002).

Moreover, out of the ninety-three participants who received termination classifications, forty eight point eight percent qualified as ‘premature terminators’. The article’s discussion notes that according to the study’s results, ‘BTPI is a valid tool in the prediction of premature termination from counseling’. Among the 16 scales that were used in the study, five scales emerged as the most reliable predictors of premature termination.

Reference

Hatchett, G. T., Han, K., & Cooker, P. G. (2002). Predicting premature termination from counseling using the Butcher Treatment Planning Inventory. Assessment, 9(2), 156-163.

Introduction

Drug addiction is one of the major issues that a number of American teenagers and young adults have to deal with. Though the problem is quite complicated on its own, it is often reinforced by the family members, who undertake wrong and, therefore, futile attempts to prevent the drug addict from taking illegal substances.

A recent case of Marci, a teenager, who is trapped between her drug addiction and the unbearable overprotection of her parents, need a dual intervention strategy and a complex therapy in order to get rid of drug abuse.

Diagnosis Impression

In the taxonomy provided by DSM-V, the problem that Marci is currently facing can be defined as a “Conduct Disorder” (American Psychiatric Association, 2013, p. 461), which, in its turn, falls under the category of “Parent-Child Relational Problem” (American Psychiatric Association, 2013, p. 715).

To be more exact, the issues of “engagement in dangerous, risky, and potentially self-damaging activities” (American Psychiatric Association, 2013, p. 780) resulting from the drug abuse and “inadequate parental control” (American Psychiatric Association, 2013, p. 715) must be mentioned when talking about Marci’s case.

Therefore, it will be reasonable to assume that the case in point is the exact representation of what is defined in the DSM-V as a dual diagnosis, with the elements of a “substance-related diagnosis” (American Psychiatric Association, 2013, p. 22) and “problems with primary support group” (American Psychiatric Association, 2013, p. 715–716).

Hence, the complexity of the issue concerns the fact that two problems must be addressed at the same time. As a result, the patient is diagnosed with two major issues, as well as the possibility of developing what the DSM-V defines as the “Major Depressive Disorder” (American Psychiatric Association, 2013, p. 22).

The urgency of the situation is also predetermined by the fact that the patient (Marci) is likely to develop a “Major Depressive Disorder” (American Psychiatric Association, 2013, p. 22) because of the despair that she experiences at present.

More to the point, the patient seems to have developed a Conduct Disorder (American Psychiatric Association, 2013, p. 726), which manifests itself in poor academic performance, unwillingness to comply with her parents’ requests and the lack of enthusiasm concerning her therapy sessions. Thus, the elements of an “Oppositional Defiant Disorder” (American Psychiatric Association, 2013, p. 815) can also be traced in Marci’s behavior.

Rationale

When it comes to defining the rationale for the intervention to be undertaken, one must mention the fact that, apart from the obvious drug abuse issue, Marci is suffering greatly from the environment, in which she lives.

instead of promoting a healthier lifestyle and allowing the young woman to cope with her problems as an adult, her family creates obstacles on her way, therefore, making it obvious that they do not treat her like a grown-up person. As a result, a severe backlash in the form of a protest and the following attempt to resort to drugs as a symbol of being independent emerges.

As it has been stated above, Marci is suffering from what is defined in the DSM-V as “problems with primary support group” (American Psychiatric Association, 2013, p. 715–716) on the Axis IV (Psychosocial and Environmental Problems) (American Psychiatric Association, 2013).

In other words, apart from her addiction to marijuana, Marci will have to handle the depression that is triggered by her emotionally devastating environment. Herein the rationale for the design of a unique intervention stems from.

Unlike typical situations, in which one develops drug addiction under the influence of a specific environment (e.g., the influence of marijuana smoking friends), in Marci’s case, the patient resorts to smoking pot as a response to stressors that come not only from her college, but also from her family.

The rationale behind the reconsideration of the case, therefore, is predetermined by the necessity to define the diagnosis of the patient in a more precise manner and provide the proper intervention based therapy that the patient needs at present.

Treatment recommendations

It should also be kept in mind that, apart from drug addiction, Marci is also facing the challenge of depression and anxiety, which she will also have to develop a coping mechanism for. Indeed, a closer look at Marci’s case will reveal that her parents have become increasingly overbearing to the point where they seem to deny their daughter any personal freedom.

As a result, Marci protests, and her unwillingness to follow her parents’ orders takes the shape of drug addiction and troublemaking. Therefore, among the therapeutic strategies to be suggested for Marci’s recovery, an efficient coping mechanism must be provided for her to deal with the stress that she is currently under. At this point, it will be necessary to bring up the issue of family involvement.

According to the latest researches, the cooperation of the family members allows for retrieving the desired result and allowing for a faster recovery of the patient, starting from her sooner realization of the necessity of the intervention.

Choosing an appropriate strategy for reducing stress for Marci, one might suggest the introduction of a role model for Marci, e.g., a family member, who is trying to quit smoking or get rid of another addictive habit. Thus, Marci will be able to take the process of treatment seriously and follow the therapist’s guidance (Copello, Vellemna & Templeton, 2005, p. 371).

An overbearing strategy of watching every step made by the patient, which the family is clearly following at present, should be prohibited. Therefore, the issue should be considered on the Axis IV (Severity of Psychosocial Stressors) of the DSM-V.

Apart from the inclusion of the family support into the list of strategies, an appropriate intervention for addressing Marci’s drug issue should be created. In order to help the patient realize the necessity to continue the treatment procedures, as well as prove the importance of interventions to Marci, it will be crucial to appeal to her desire to become an adult and be able to make adult decisions.

In other words, the intervention for Marci will have to be focused on acknowledging her as a grown-up individual. However, apart from helping Marci to get rid of her addiction, a major change in her parents’ strategy of upbringing their daughter should be carried out.

It will be crucial to convince her parents to stop being overprotective and start recognizing their daughter’s right to make her own choices. It is only by having an example of reasonable and responsible adults that Marci will be able to abandon her bad habit and become a self-sufficient and grown-up person.

Conclusion

As an in-depth study of the case in question has shown, the factors that trigger Marci’s unwillingness to abandon her habit of using drugs include not merely the physical dependency on drugs that Marci has developed, but a range of biopsychosociospiritual factors causing Marci to resort to smoking marijuana whenever she feels uncomfortable.

Reference List

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. DSM-V. 5th ed. Washington, DC: American Psychiatric Association.

Copello, A. G., Vellemna, R. B. D. & Templeton, L. J. (2005). Family interventions in the treatment of alcohol and drug problems. Drug and Alcohol Review, 24(4), 369 – 385.

Introduction

Research is a critical part of working as a counselor or social worker. This helps to ensure credibility and move forward the discipline with evidence-based practice while maintaining the professional competence of the counselor. This report is a comprehensive evaluation of the study Challenges of Developing an Observable Parent-Reported Measure: A Qualitative Study of Functional Impact of ADHD in Children and analysis for its use in counseling practice (Matza, Margolis, Deal, Farrand, & Erder, 2017).

Evaluation of the Research Problem

In pediatric clinical trials, the patient-reported outcome measures are most often completed by parents or guardians since children may not be able to provide valid answers adequately. These reports include both observable and nonobservable aspects. However, the International Society of Pharmacoeconomics and US Food and Drug Administration has released guidelines that the informant-reported assessment measures should focus on observable characteristics.

Evaluating the Significance of the Problem

The qualitative study is exploring the concept of observability based on an example of a child with attention deficit-hyperactivity disorder (ADHD). The competent and accurate observation of a child’s characteristics and social functioning is a critical matter in providing counseling for ADHD patients. Therefore, counselors can benefit from a multidisciplinary approach to this study. The author notes that informant-reported outcomes fail to observe vital behavioral characteristics of children with ADHD. The results of the study can help define the concept of observability and associated challenges, thus helping to enhance guidelines on the reported measures.

Evaluation of the Literature Review

The study does not have any literature review. The authors present basic background information on the topic in the introduction as they set up for their study. A qualitative study is mentioned which focused on creating parent-reported measures of ADHD, but it is described as ineffective since previous instruments have covered such areas of impact.

Evaluation of Research Purpose Statement and Questions

Research Design

It is a qualitative study that conducts concept elicitation semi-structured interviews individually with children and their parents. These interviews are meant to study the impact of ADHD on the behavior and function of children while parents were evaluated for the observability of these measures.

Research Purpose Statement

The research purpose statement of this study is to “provide an opportunity to explore the concept of observability and highlight the challenges of developing informant-reported outcome

measures that are limited to observable content” (Matza et al., 2017, p. 829). This statement is accurate and straightforward in identifying the purpose of the study. The author highlights the basic concepts and the issues which the research is meant to address.

Research Questions

There are no clear research questions identified in the study. Based on the interview questions, it can be assumed researchers attempted to determine the extent to which ADHD impacted children’s behavior and function. Furthermore, it was determined whether parents could effectively observe these impacts on their child’s life.

Evaluation of Data Collection Plan

Selection of Participants

Participants were selected from four clinical sites that specialized in childhood ADHD treatment. Children had to be between 6 and 12 years of age, with an official diagnosis of ADHD. Families were excluded if they had comorbid psychiatric diagnoses, participated in another clinical trial within the last six months, or had any impairment. Only one parent for each child participated and could be included even if the child did not respond. The sample size consisted of 30 parents and 24 children who participated in the interview. The sample could be improved by including both parents in the interview process since one parent can often contribute to or offer another perspective on the child that the other could not.

Gaining Permission

The interviewer obtained written informed consent from both parents and children before the interview. Before the study, an independent ethics committee reviewed and approved the study. This is a standard procedure for qualitative research and meets ethical standards.

Determining the Data to Collect

Researchers sought to collect the observed data on how ADHD impacts various aspects of a child’s life, including emotions. Parents were asked to evaluate this impact as well as provide examples of how they observe or learn specific factors. For some elements, such emotional impact of ADHD, parents were asked to explain how they knew there was an impact on their child. The data collected was appropriate since the researchers wanted to investigate observational measures as used in informant-reported outcomes.

Recording Data

The study does not describe how it recorded its data except for the outlines of the interviews. Since the interviews were semi-structured, all participants were asked a similar set of questions to determine results in certain areas of ADHD impact. Recording data in interviews consists of the use of transcripts, field notes, and audio recordings (Padgett, 2016). These protocols are effective for small-scale qualitative studies.

Evaluation of Data Analysis and Interpretation Plan

Preparing and Organizing Data for Analysis

This is not described in the report. I would have approached this by organizing all the interview notes and recordings based on the provided responses. I would have also sought to determine which aspects of ADHD behavior I wanted to focus on during data analysis.

Exploring and Coding the Data

Researchers deciphered the interviews and divided them into many distinct types of ADHD impacts. These were then arranged in a descending order based on parents’ frequency of observation f. It was an effective method of accurately analyzing the data to present evident inconsistencies in observational impacts.

Using Codes to Build Description and Themes

The theme of the study suggests that parents report a greater extent of ADHD impairment than their children. Some of the concepts, such as emotion and self-efficacy, which were widely reported by parents, were rarely mentioned by children, which suggests that one of the groups may have an unclear perspective on the issue. Researchers built these themes by reviewing common outcomes reported by parents in the observational reports.

Representing and Reporting Findings

The data was presented in a tabled listing all types of ADHD impact and then displaying two columns with percentages of parents’ and children’s reported observation on the topic. It is an efficient way to demonstrate the difference amongst reported statistics. However, it seems significantly limited within the context of the in-depth interviews that were conducted.

Interpreting Findings

The researchers provided an in-depth discussion of the usefulness of their study’s findings. An interesting aspect was to highlight that parents cannot effectively observe a child’s behavior outside the home environment, and it may be inaccurate to base such observations on the reports from other people. Therefore, an inherent challenge arises as part of the observable behavior framework suggests for informer-reported outcomes. Furthermore, the study includes suggestions on how the reporting measures can be modified to include content that parents do not observe but can collect from other people. It has been found that the use of multiple informants can be more efficient in identifying children as high-risk for ADHD rather than just a single parental informant (Güler et al., 2014). The authors note that limitations include a small sample and children lacking the comfort level to speak with unfamiliar interviewers who can distort responses.

Validating the Accuracy of the Findings

The authors note that further research is necessary to assess observability measures and pediatric assessment techniques. It is not effective but an appropriate measure to validate findings. A large portion of this study’s findings deals with content validity and its implication in observation research. The authors note that parent-reported measures should be developed with the knowledge that observable content may be limited as a sole instrument of determining a child’s function under ADHD.

Evaluation of Ethical and Culturally Relevant Strategies

The authors took standard steps of obtaining consent. No other ethical measures were mentioned. This is appropriate for small scale research studies. I would have made sure to include a step that, despite the information not being published, interviews would remain confidential. Furthermore, it may have been helpful to ensure that the stressful interview did not negatively impact the children in the aftermath of the study. Qualitative research implies a researcher-participant relationship which calls for certain adult expectations from child subjects. A responsible ethical and cultural approach would be to use a research framework such as a Mosaic Approach, which would offer flexibility, engagement, and a sense of control for the children with ADHD participating in qualitative research (Tucker & Govender, 2016).

Conclusion

The overall quality of this qualitative study was moderate. It lacked critical aspects such as a literature review on the topic or an adequate explanation of its data collection or analysis methods. This study highlights the critical but complex challenges of observation for ADHD behavior. In counseling practice, subjective perceptions of ADHD behavior can impact coping mechanisms, treatment adherence, and emotional reactions, both from parents and children. The observational capacity and understanding of how ADHD impacts function leads to better outcomes (Wong, Hawes, Clarke, Kohn, & Dar-Nimrod, 2018). Therefore, counseling practice strongly benefits from such studies that evaluate a difference in perceptions and observational abilities of parents and children with ADHD.

References

Güler, A. S., Scahill, L., Jeon, S., Taşkın, B., Dedeoğlu, C., Ünal, S., & Yazgan, Y. (2014). Use of multiple informants to identify children at high risk for ADHD in Turkish school-age children. Journal of Attention Disorders, 21(9), 764-775. Web.

Matza, L. S., Margolis, M. K., Deal, L. S., Farrand, K. F., & Erder, M. H. (2017). Challenges of developing an observable parent-reported measure: A qualitative study of functional impact of ADHD in children. Value in Health, 20(6), 828-833. Web.

Padgett, D. K. (2016). Qualitative methods in social work research (3rd ed.). Los Angeles, CA: SAGE Publications

Tucker, L. A., & Govender, K. (2016). Ethical considerations for research involving boys diagnosed with attention-deficit/hyperactivity disorder. Early Child Development and Care, 187(7), 1147-1156. Web.

Wong, I. Y., Hawes, D. J., Clarke, S., Kohn, M. R., & Dar-Nimrod, I. (2018). Perceptions of ADHD among diagnosed children and their parents: A systematic review using the common-sense model of illness representations. Clinical Child and Family Psychology Review, 21(1), 57-93. Web.

Counseling of older adults has become an important concern for mental health professionals in the past few decades. Indeed, because of the increased life expectancy, the share of elderly people in the community has grown substantially and will continue to grow in the future. However, despite the advancement of healthcare that allowed for improving life expectancy, older adults still experience a range of health problems that can affect their quality of life. Chronic illness is particularly prevalent in this age group and often causes disability. Still, living an independent and fulfilling life is one of the key goals for the elderly. Rehabilitation counseling can help older adults with a disability to enjoy life and live more independently, thus facilitating enhanced well-being and quality of life. The present paper will focus on rehabilitation counseling of older adults with disabilities, discussing their developmental issues, needs, and the role of appropriate interventions in enhancing their lives.

Development of Older Adults

Aging is an essential developmental task that presents multiple challenges to individuals and their families. According to Erikson’s theory of personality development, the central developmental crisis experienced by older adults is integrity versus despair; by resolving this crisis successfully, older adults obtain wisdom that is critical to healthy aging (Perry, Hassevoort, Ruggiano, & Shtompel, 2015). As older adults experience individual challenges related to physical and emotional well-being, their families also have to adjust to the changes. Duvall’s family development theory is composed of eight developmental stages (Martin, 2018).

Older adults usually present an example of aging families. This stage of family development lasts from retirement to the death of both partners. During older adulthood, there is a significant shift in family roles as children face the need to care for their aging parents. This creates a challenge for the entire family since older adults often develop chronic physical and mental health conditions that affect their daily life and social functioning. Children and other young family members become informal care providers to the elderly, assuming control over some tasks, such as financial management, household duties, and medical assistance (Morgan & Brazda, 2013). The need for family support increases with a disability, and it is necessary for counselors to provide guidance to family members taking care of disabled older adults.

Older age is also characterized by cognitive challenges, which cause changes in learning and personality. According to Love, Ruff, and Geldmacher (2015), aging is associated with neurobiological changes, including cortical and white matter volume loss and impaired cerebral functional connectivity. These changes affect cognitive abilities, causing difficulties in learning new information and personality changes. Some neurodegenerative disorders, including Alzheimer’s disease, cause dramatic shifts in behavior and self-efficacy, thus putting more pressure on older adults and their families.

Counseling Intervention

Rehabilitation counseling can offer help to older adults with a disability, as it provides essential tools and support for developing coping mechanisms and improving the quality of life. Thus, individual rehabilitation counseling can help older adults and their families to progress through the last developmental stage seamlessly. The proposed intervention for the population of interest (older adults with disabilities) is tele-counseling.

Tele-counseling is a relatively new concept in healthcare technology, which includes providing counseling services at a distance. Sessions are carried out using a phone, a tablet, or a computer, and can include either a voice-only conversation or a video chat, which makes it ideal for patients who find it difficult to attend face-to-face sessions due to their chronic illness or disability (Ali, Gillespie, & Laney, 2017). Tele-counseling can also be a useful alternative for people living in rural areas, as stated by Bryant, Garnham, Tedmanson, and Diamandi (2018). The focus of the intervention should be on individual counseling, although it would be useful to add close family members to the sessions from time to time. Tele-counseling can provide numerous benefits for disabled older adults. Most importantly, it can help older adults to adjust to their new status and cope with their disability. As noted by Fortmann et al. (2013), “telephone-administered psychological interventions improved QOL, coping skills, community integration and depression in individuals with SCI and other acquired (permanent) physical disabilities” (p. 485). Besides, tele-counseling is an important opportunity for disabled older adults, as sessions can be carried out in the comfort of their home. The tele-counseling intervention for the population of interest would include weekly 60 to 90-minute sessions focusing on developing coping mechanisms, reintegrating into the community, and communicating with younger family members.

Crisis or Trauma Intervention

At times of crisis, older adults with disability face serious challenges that impact their physical and psychological recovery. They might experience physical injuries, loss of family members or loved ones, or develop increased stress or anxiety due to the impact of the crisis on their community. To promote recovery following a disaster or a major crisis, it is equally important to focus on the physical and mental well-being of older adults. Developing adequate coping mechanisms and building resilience should be the focus of rehabilitation counseling following disasters.

In later life, resilience is a vital quality that can help older adults to recover from traumatic events. There are three primary models of individual, family, and couple resilience that are relevant to older adults. First of all, the compensatory model presents a resilience factor, which counteracts the risk factor, thus creating resilience (Zimmerman, 2013). In older adults experiencing trauma or a disaster, family and social support can become a substantial resilience factor. Secondly, the protective model of resilience states that there are specific protective factors mediating the effect of risk exposure (Zimmerman, 2013). Similarly, social support can act as a strong protective factor; however, other factors protecting older adults from risk exposure include their health condition, socioeconomic status, and community resources available. In the context of trauma, family resilience reflects individual resilience that is strengthened by the network of relationships evident in the family (Walsh, 2016). Thus, in order to ensure successful disaster or trauma recovery for older adults, it is crucial to focus on building individual resilience as well as strengthening family relationships.

A necessary counseling intervention following a traumatic event should include both individual and family therapy. Group counseling is a useful opportunity to bring the family together in a joined recovery effort. It would be helpful to start the intervention as soon as the first response to the traumatic event is finished and actions have been taken to attend to the direct victims of the event. Ideally, the group counseling intervention should include weekly meetings with the counselor. For older adults with a disability, additional individual meetings should be carried out, as they might not be affected by the event in the same way as their family members. The counselor should also include cultural considerations in planning the intervention. For instance, people from certain cultures might have specific customs or traditions that would help them in obtaining community support. People from other cultures, on the contrary, would be more prone to internalizing trauma instead of attempting to overcome it in a healthy manner.

Other Recommendations

In order to develop interventions for older adults with a disability, it is essential to have a framework for understanding their specific personality traits, competencies, and other factors affecting counseling. Such framework should address the individual’s developmental stage, history of family relationships, medical information, and causes of the disability. Any alternative interventions should take into account this information and build upon it to assess the patient’s needs, goals, and existent psychological patterns, such as resilience or coping mechanisms. Depending on this information, the counselor can choose between different intervention types and counseling methods, applying strategies that can assist the patient in achieving his or her developmental goals, cope with trauma, and adjust to life changes. A successful intervention should seek to improve the individual’s quality of life and help him or her to reintegrate into society at an appropriate pace.

Conclusion

The present paper focused on older adults with a disability and their options for rehabilitation counseling. As shown above, older adulthood is a critical stage of individual and family development that presents some challenges. Older adults with physical or mental disabilities may find some of these challenges overwhelming, and thus need additional support from their family and community. Tele-counseling can provide numerous benefits to older adults with disabilities by improving their coping mechanisms, preventing depression, and assisting them in gaining social support. During the times of crisis, many older adults with disabilities experience significant trauma, which requires individual and family resilience. Therefore, it is vital for counselors to use different strategies depending on the individual’s needs, goals, and current situations. Successful rehabilitation counseling can help older adults to become more independent and improve their quality of life, all the while preventing adverse psychological outcomes.

References

Ali, N., Gillespie, S., & Laney, D. (2017). Preliminary validation of telecounseling for depression in patients with Fabry disease. Molecular Genetics and Metabolism, 120(1), 19-20.

Bryant, L., Garnham, B., Tedmanson, D., & Diamandi, S. (2018). Tele-social work and mental health in rural and remote communities in Australia. International Social Work, 61(1), 143-155.

Fortmann, A. L., Rutledge, T., McCulloch, R. C., Shivpuri, S., Nisenzon, A. N., & Muse, J. (2013). Satisfaction with life among veterans with spinal cord injuries completing multidisciplinary rehabilitation. Spinal Cord, 51(6), 482-486.

Love, M. C. N., Ruff, G., & Geldmacher, D. S. (2015). Social cognition in older adults: A review of neuropsychology, neurobiology, and functional connectivity. Medical & Clinical Reviews, 1(1), 6-13.

Martin, T. F. (2018). Family development theory 30 years later. Journal of Family Theory & Review, 10(1), 49-69.

Morgan, L. A., & Brazda, M. A. (2013). Family support and diminished control in older adults: The role of proxy control. Journal of Applied Gerontology, 32(6), 651-668.

Perry, T. E., Hassevoort, L., Ruggiano, N., & Shtompel, N. (2015). Applying Erikson’s wisdom to self-management practices of older adults: Findings from two field studies. Research on Aging, 37(3), 253-274.

Walsh, F. (2016). Family resilience: A developmental systems framework. European Journal of Developmental Psychology, 13(3), 313-324.

Zimmerman, M. A. (2013). Resiliency theory: A strengths-based approach to research and practice for adolescent health. Health Education & Behavior, 40(4), 381-383.

Abstract

The case is made that personal experience and social life are inherently meaningful. The presence of meaning in human affairs requires all participants to develop interpretive skills if they are to understand what is happening. Researching social life is greatly helped by methods that acknowledge the hermeneutical quality of interpersonal experience. The use of qualitative research methods to investigate all aspects of counseling is therefore highly appropriate. To illustrate the use of qualitative research designs and methods of analysis, a study of family members’ views of family therapy is briefly described.

Dilemmas of researching human experience

Although the debate over whether the social sciences can be objective and explanatory in the manner of the natural sciences is now well-rehearsed, the outcome is still far from clear (Hollis, 1994). The cause of the problem is the self-conscious and self-reflective nature of human beings. Disciplines and practices that study and deal with human behavior and experience have to grapple with some deep philosophical questions to do with the nature of being, knowledge and the methods we might use to investigate them. Is human behavior and experience determined and, if so, by what? To what extent are people able to act freely and be agents of their own destiny? Can we explain to other people, or should we aim to understand them? Whereas the objects of natural science are inherently meaningless, the content of human experience and social intercourse is inherently meaningful.

Thus it appears that those who wish to examine people’s behaviors and actions need to develop methods of inquiry that attempt to get on the inside of human experience. Simply observing and measuring what people do certainly generates useful information, but it fails to reach the vast domain of interior experience that most people believe represents the essential nature of their true selves. Those of us who wish to understand social life at the level of the personal and interpersonal feel that as well as to measure and test behavior we must also seek to explore human experience from within. Moreover, to be a human being is, in a deep sense, to be a social being. The subjective tradition aims at an ‘interpretive’ or ‘hermeneutic’ social science:

‘Its central proposition is that the social world must be understood from within, rather than explained from without. Instead of seeking the causes of behavior, we are to seek the meaning of action. Actions derive their meaning from the shared ideas and rules of social life, and are performed by actors who mean something by them’ (Hollis, 1994, pp. 16-17; emphasis added).

The insistent nature of these opening paragraphs is deliberate. In the eyes of many researchers, the only good research in the field of therapeutic practices is scientific, naturalistic and experimental. A condition is measured before treatment; sufferers of that condition are randomly allocated to an experimental procedure, to a comparison treatment, or to no treatment at all; and finally, the condition is measured again after the various procedures and treatments have been completed. This works well for physical ills, but is much more problematic for psychological and social conditions such as unhappy relationships, personal distress, unacceptable behavior and interpersonal conflict.

As a powerful complement to quantitative scientific methods of investigation, the use of designs that employ qualitative methods has allowed researchers both to appreciate and to develop understandings of what the processes and outcomes of counseling and therapy mean to those involved. What does it feel like to be distressed? What kind of help are people looking for? How do clients evaluate the help received? What do people find most helpful and least helpful? In short, what do clients have to say about their experiences of being on the receiving end of counseling and therapy? Answers to such questions help researchers to understand the subjective meaning of other people’s experiences. And as the quality of subjective experience is a fundamental aspect of personal life, it seems appropriate that counselors and researchers should seek to understand clients’ views and experiences of the counseling process and its outcome. This shift in research perspective parallels moves many counselors away from a positivistic scientific outlook towards a more humanistic orientation. Rather than seeking to change experience by modifying behavior, the preference is to alter behavior by changing experience.

Seeking the client’s view of family therapy

In the mid-1980s I was asked by a team of family therapists to evaluate their practice. It was agreed that the central strand of inquiry would be to seek ‘the consumers’ view’ of the therapeutic experience (see Howe, 1989). The family therapy team worked with around 30 to 40 families a year. The families were referred to the team by social workers and other professional groups. Most families identified the difficult behavior of a particular child as their main problem. The family therapists worked within a systemic framework using brief, focused methods of intervention. Treatment episodes would last a maximum of six one-hourly sessions.

I interviewed all families who had either been offered family therapy and refused, or who had been offered family therapy and accepted, during the space of one calendar year. After a ‘case’ had been closed or the treatment completed, one of the agency’s managers wrote to the family asking if they would be willing to participate in the research. It was made clear to the families that the researcher was independent of the treatment agency and that their personal views would, if reported, remain entirely anonymous. A small fee was paid to the families in recognition of their time and co-operation.

During the 12-month period of study, 34 families had been offered family therapy. Eleven families had either declined the offeror failed to keep their first appointment. Ten of these eleven agreed to be interviewed. Twenty-three families had accepted the offer of therapy, 22 of whom agreed to be interviewed by the researcher.

The aim of the research was to explore with family members how they perceived, understood, experienced and felt about family therapy. The interest was not so much in whether the presenting problem had been ‘cured’ in some objective, measurable sense, but rather in whether or not people felt they had been helped. All family members who had attended treatment were interviewed together as a group in the family home within 4 to 8 weeks after the final treatment session. The interview was guided by a series of broad, open-ended questions and prompts. In their reflections and comments, families talked about all stages of their involvement from the time that they felt they needed help to the point of case closure. Interviews typically lasted between two and three hours. They were audio-tape-recorded and subsequently transcribed.

The research design meant that all respondents volunteered their views and experiences. Personally, in the case of willing informants, I have no qualms about asking clients to revisit old therapeutic experiences. Professional service providers, including counselors, often argue that they need to protect clients from the potentially disturbing impact of researchers opening up difficult subjects. So long as the researcher is honest and clear about the nature and purpose of his or her inquiry, I see no ethical problems in asking clients if they are willing to help. The anxieties, if they exist, usually lie with the counselor or counseling agency. It is the experience of most qualitative researchers that clients are normally only too willing to talk about and discuss being ‘on the receiving end’. They often say not only that they were pleased to be given the opportunity to express their views, but also that they found the research interview both interesting and helpful. In the case of the family therapy research, the greeting I received from the very first family I interviewed was fairly typical. Standing on the doorstep clutching my tape-recorder, I was quickly ushered in by the father and enthusiastically introduced to the rest of the family. ‘Right’, he said, ‘sit down. We’ve been wanting to talk about this family therapy business to someone for some time. We’ve got a lot we want to say, so get that machine of yours going.’ And almost before I had chance to catch my breath and rehearse the research, its purpose and the interview framework, the family were in full voice.

Analysis of qualitative data

One of the most difficult and demanding stages of qualitative research is the analysis of the data. Faced with hundreds of pages of interview transcripts, there is a tendency to under-analyze data. Under-analysis often results from a failure to understand the nature of qualitative data. Although placing a light level of descriptive order on the material can be interesting, this approach fails to generate the depth and insight that is to be discovered in such data. The researcher’s task is to enter the frame of reference of the people whose world and experience are being investigated. He or she must attempt to understand the meaning that others give to their experience. Accepting the subjectivity and inter-subjectivity of human interaction, qualitative research has no choice but to embrace the ‘double hermeneutic’ that is entailed in the study of social life. This means that not only do the subjects of the inquiry interpret the meaning of their own experience but those who study them engage in a second level of interpretation as they, in turn, attempt to make sense of what is being said, felt and one-man interpretation of an interpretation’ (Hollis, 1994, p. 146). However, the social scientist’s interpretation, unlike that of the non-social scientist, is developed using a variety of systematic and disciplined procedures which attempt to analyze the subject’s interpretation in an organized and orderly way. For example, Tesch (1990) has identified four basic approaches to qualitative research, where the interest is in:

• the characteristics of language,
• the discovery of regularities,
• the comprehension of the meaning of text or action,
• reflection (see also Robson, 1993, pp. 371-372).

There now exist a number of sophisticated procedures to help the social researcher analyze qualitative data (e.g. Strauss, 1987; Strauss & Corbin, 1990; Miles & Huberman, 1994). Essentially these depend on very careful reading and basic coding of the transcript material in which meaningful elements, significant interpretations and important understandings uttered by respondents are identified and recorded. These basic coding categories form the first layer of analysis:

‘A code is a symbol applied to a group of words to classify or categorize them. They are typically related to research questions, concepts and themes. Codes are retrieval and organizing devices that allow you to find and then collect together all instances of a particular kind’ (Robson, 1993, p. 385; emphasis original).

Codings represent the earliest phase of the researcher’s ‘interpretation of interpretations’. The researcher’s interpretation attempts to respond and remain close to the meanings, interpretations and understandings of the subjects under study. These basic codings are then available to be re-worked and re-ordered into increasingly high levels of abstraction (Carney, 1990; Miles & Huberman, 1994, p. 92). Thus beneath any one level of abstraction exists a ‘tree’ of lower-order themes, regularities, codes and categories, culminating in the actual words and understandings of individual respondents whose specific utterances exemplify a particular interpretation and concept which has been generated by the researcher. This way of handling the data depends heavily, though not exclusively, on inductive methods of analysis: categories, themes and concepts are drawn out of the data, ‘grounded’ in the raw material of the interview. In practice, my own method of analysis tolerates the presence of a small amount of preconceived conceptual material that is already part of my theoretical repertoire, particularly if such concepts seem to provide particularly powerful frameworks of organization and interpretation.

The analytical concepts and themes generated by the researcher are much more than simple descriptions of what respondents have said. They offer a way of ‘making sense’ that was not previously available or apparent to the research subjects. It is the global analysis of what all respondents have said individually that generates new understandings and ways of seeing personal experience and social life. The findings and interpretations are then represented back to social life. They add to the ‘way of seeing and understanding’ that are part and parcel of the dense fabric of language, meaning and interpersonal experience. If the researcher has generated new understandings out of the experiences of subjects that do make sense both to the subjects and others, then he or she has added to that culture’s repertoire of ideas that help people understand, interpret and cope with experiences of that kind. For example, women who had relinquished a baby for adoption (often a difficult and painful experience), whom we interviewed as part of a research project, upon reading the book based on our findings would typically exclaim: ‘The way you described and reflected on things was really helpful; it has helped me make sense of what happened to me’–even though the findings were fundamentally based on what the women said to us in the first place (Howe et al., 1992).

In the case of the families who had been offered and experienced family therapy, detailed coding, categorizing and theme construction produced a broad framework within which the finer interpretations could be contained. The major categories of the framework were defined by two parallel dimensions: one chronological, the other psychological. This produced three higher-order categories:

1. To be engaged.
2. To understand.
3. To be understood.

These themes will be familiar to both counseling researchers and practitioners alike, but it remains interesting that so much of what family members had to say about their experiences of therapy concerned whether or not they felt engaged by the therapists, understood what was happening during treatment, and felt understood by the therapist and the treatment team. One standard split that nearly always runs through ‘user views’ research is between clients who were satisfied and those who were dissatisfied. This offers a neat, simple further sub-divide of the major analytical categories. The family therapy research also developed further, lower-order levels of analysis that supported the three major conceptual themes. I shall trace one analytical line in a little more detail here to illustrate the links between abstract concepts and clients’ actual words; the interested reader might wish to turn to the full report to gain a fuller picture of the research and its findings (Howe, 1989).

From verbatim quotes through basic codings to conceptual abstraction, and back again

We have already heard that before families felt able to proceed with therapy, they first had to become ‘engaged’ in the treatment process. It is worth noting that although some families remained in therapy, in practice they never felt engaged by or committed to family therapy. To be engaged, therefore, emerged as an important first stage in the therapeutic process. ‘Engagement’, write Masson & O’Byrne (1984,p. 28), ‘involves careful, thorough self-introduction and a full and repeated explanation of the roles of the worker and the family, of the purpose of the involvement and the manner of proceedings’. Families with problems feel vulnerable and wary. They feel anxious about both the problem and the treatment. The normal response of people who feel anxious is to withdraw or escape from the cause of the anxiety. Families who remained very anxious about the treatment process either withdrew from treatment or stayed in therapy but failed to become engaged. It was possible to place the families into one of four ‘engagement’ categories:

1. the non-takers who were offered therapy but did not accept;
2. the early leavers who began therapy but withdrew after one, two or three sessions;
3. the ambivalent who remained in therapy but were not fully engaged (although they still held out the prospect of being helped);
4. the relaxed and satisfied who became fully engaged and remained in treatment.

Each of these four categories was further analyzed. For example, the analysis of the early leavers revealed that family members experienced considerable anxiety over three particular aspects of treatment. Their failure to overcome these anxieties contributed to the family’s early withdrawal from therapy. As treatment progressed, levels of anxiety tended to increase rather than decrease. Three features of the treatment technique appeared to raise anxiety: the machines, the method, and the manner. The therapists operated as a team. One therapist remained with the family in the treatment room. Both the family and the therapist were observed, via a video (and audio) link, by the remainder of the treatment group who acted as treatment supervisors. In counseling terms, the treatment technique was relative ‘high-tech’. These families (the early leavers) felt bothered by the camera (machines), the unseen group of observers who communicated only with the front-line therapist (method), and the brief and systemic method of treatment employed by the therapists (manner).

Taking the families’ anxieties about the method of treatment as an example of the next level of analysis, it is at this point we can begin to make liberal use of the clients’ own words. However, even at this level it was possible to recognize three further sub-divisions. As far as the families were concerned, the place of treatment mattered (home rather than clinic). The style of practice was of concern. And the participation of children and non-problem siblings unsettled some parents. We now follow the analytic branch down the practice line.

The style of questioning, the use of supervisors who remained unseen and unheard in an adjacent room, and the formulation of hypotheses about possible relationships between the symptom and the operating characteristics of the family’s system, all served to raise the family’s feelings of anxiety. Families fantasized about the supervisors, projecting all kinds of fears and worries onto their unseen presence. The camera only added to the threatening atmosphere of the occasion. For example, Mr and Mrs Spree were having difficulties with their 14-year-old daughter, Rachel. This is how they recalled their first session (Howe, 1989, pp. 53-54):

• Mr S: ‘Well first, what I felt like was that it was them against us. There was no relationship at all. The panel in the next room could feedback to the person in the room with us, but we had nothing directly to do with them. They were like “Big Brother” out there. I found it very disconcerting.’
• Mrs S: ‘We didn’t even know who was in there.’
• Mr S: ‘It could have been anyone.’
• Mrs S: ‘I mean, if they’d given us a cup of tea, that would have been helpful.’
• Mr S: ‘The panel kept interrupting. It was very off-putting, very confusing. We never seemed to get anywhere.’
• Mrs S: ‘He’d say something like… er… after he got a message from the panel, “Oh, I’ve got to bring in Rachel now” and you were cut short. I felt like a guinea pig.’
• Mr S: ‘I did actually, too. We were like puppets and it was like they were experimenting with us, because they’d found this new thing, this camera and things, and could try out certain techniques of interviewing.’

Many parents felt that they were being accused of failing to be good parents and that they were to blame for the family’s troubles. But the Kafkaesque quality of the occasion became even more pronounced in the case of Mrs Kay (Howe, 1989, p. 54) who felt that she did not even know of what she was being accused of:

• Mrs K: ‘They looked at you funny. They seemed more interested in my past than Darren’s. I felt that I was the one in the wrong, like it was me on trial, you know, like they were saying “you’re the guilty party”.’
• DH: ‘Guilty of what?’
• Mrs K: ‘Ah, that’s it you see! I don’t know. You never know!’

This journey from broad levels of abstraction down through increasingly more concrete themes to the actual words of particular respondents in fact reverses the analytical process, which begins with basic coding of the raw data and slowly examines ways of bringing higher levels of conceptual order to the data. Out of this process, which can be one of the most demanding stages of the research enterprise, emerges the logic and order of the analytic framework.

Qualitative analysis, meta-analysis and theory

Implied in this analysis of client views of a therapeutic intervention is that we are unable to make sense of experience without employing theoretical constructs to organize, order and relate perception–an epistemological position known as ‘idealism’. This idealist position has it that meaningful perception of experience is a consequence of our ability to conceive and theorize experience. The structures that pre-exist in language and culture furnish us with the ability to participate in and make sense of social life in a competent manner. But as all social experience is driven by the ‘double hermeneutic’, mentioned earlier, interpretation of both one’s own and other people’s experience is a constant feature of the world of the interpersonal and the inter-subjective. We have no choice but to make sense of experience, but that sense can change, evolve and re-form as we constantly interact and engage with other people. The deliberate and formal attempt by social researchers to make sense of particular aspects of social life (in our case, client experiences of counseling and therapy) requires them to be self-conscious and systematic interpreters. The theories that they produce to make sense of other people’s experiences have to be rigorously and explicitly crafted. And if at the end of this process people have been helped to make more interesting, practical or effective ways of making sense, then the exercise may count itself successful. In this sense, not only has the research added to our understanding of an aspect of social life: it has also helped, in its small way, to roll the hermeneutic cycle along through the ceaseless history of thought, language and social action.

What clients say appears as verbal outcrops, hinting at deeper orders of meaning and understanding. The research interview offers an incomplete map that has to be carefully analyzed and interpreted before the theoretical substructure can be hypothesized. It is in the coding of the raw data and the search for greater abstraction that the researcher must remain creatively alert to the possible connections and relationships which could help to make theoretical sense of what is being said. This is why the analysis of data remains–and must remain–the most demanding and arduous stage of the qualitative researcher’s enterprise.

The research into the user’s view of family therapy, and the pointers it gave to possible deeper mechanisms operating within the therapeutic relationship, prompted me to examine the findings of other researchers who had looked at client experiences of counseling and psychotherapy. This produced a ‘meta-analysis’ that explored what clients in general found helpful. It then went on to ask why similar consumer messages were reported in study after study (Howe, 1993). Analysis of some 80 client perspective studies abstracted the following idealized psychotherapeutic sequence: formation of a therapeutic alliance right arrow talk and dialogue right arrow making sense right arrow controlling the meaning of experience right arrow coping better with life. Heavily distilled, this meta-analysis of client views says: clients seek to control the meaning of their own experience and the meanings that others give to that experience (Howe, 1993, p. 195).

The point of this brief excursion into the wider waters of consumer research is to indicate the potential of qualitative research designs to contribute to theory-building in counseling and psychotherapy. Practices such as counseling and counseling research, that are immersed in the business of language and relationships, profit hugely if they are linked to ontologies, epistemologies and methodologies which acknowledge the hermeneutical nature of social life. Seeking to understand subjective and interpersonal experience using qualitative methods of inquiry is likely to produce thoughts that will speak loud and clear both to counselors and to their clients.

References

CARNEY, T.F. (1990) Collaborative Inquiry Methodology (Windsor, Ontario, University of Windsor).

HOLLIS, M. (1994) The Philosophy of Social Science (Cambridge, Cambridge University Press).

HOWE, D. (1989) The Consumers’ View of Family Therapy (Aldershot, Gower).

HOWE, D. (1993) On Being a Client: Understanding the Process of Counselling and Psychotherapy (London, Sage).

HOWE, D., SAWBRIDGE, P. & HININGS, D. (1992) Half a Million Women: Mothers Who Lose their Children by Adoption (Harmondsworth, Penguin).

MASSON, H. & O’BYRNE, P. Applying Family Therapy (Oxford, Pergamon).

MILES, M.B. & HUBERMAN, A.M. (1994) Qualitative Data Analysis (2nd edn) (Thousand Oaks, CA, Sage).

ROBSON, C. (1993) Real World Research (Oxford, Blackwell).

STRAUSS, A.L. (1987) Qualitative Analysis for Social Scientists (Cambridge, Cambridge University Press).

STRAUSS, A.L. & CORBIN, J. (1990) Basics of Qualitative Research: Grounded Theory Procedures and Techniques (Newbury Park, CA, Sage).

TESCH, R. (1990) Qualitative Research: Analysis Types and Software Tools (London, Falmer).

Summary

As a young youth pastor, Dr. Wright was at the center of a crisis in which one youth (Phil) died during an excursion (Wright, 2011). Being a young minister just from the seminary, he was helpless and distraught. Crises are inherent in our daily lives and as such, preparation to deal with them when they show up is necessary. Jesus Christ is the best counselor who ever lived (Wright, 2011). Anyone who seeks to counsel others effectively has to adopt Jesus’ approach wholesomely through applying relevant Biblical principles, which depict Jesus’ life and ministry.

After establishing that an individual needs counseling or guidance, these Biblical principles come in handy. Losing someone throws people into crises and in some cases, they cause trauma. Helping a person who has suffered a loss to accept it and move on underscores what counselors should endeavor to achieve. The same applies to grieving persons, as for them, the most difficult thing is to overcome the grief, let go, and move on. When an individual’s ability to cope with a situation is exceeded, that individual falls into a crisis (Wright, 2011). Crises fall into phases, which counselors have to distinguish in a bid to handle a counselee appropriately as some activities are only appropriate in particular phases.

Some unpleasant experiences are just repressed over long periods, but they are never resolved (Wright, 2011). Certain elements bring them to the forefront, thus affecting the concerned persons. Counselors need to wake up to the view that time does not heal all wounds and that such wounds could be responsible for a current crisis in a person’s life. Death is one of the major crises that people find themselves in, as it robs them of their loved ones. In the event that death occurs, the bereaved find it difficult to accept the loss at first, but when it dawns on them that it is true they have lost a loved one, anger takes over (Wright, 2011). Several other emotional and psychological shifts occur, but the bottom line is that the counselor has to be conversant with the changes for effective assist as some deaths are inevitable. Suicide is another major crisis, which like death, affects the victim and family members. It involves shifts in the psychological and emotional realms, which counselors have to be aware of and address adequately in a bid to assist victims and family members.

Children face numerous crises due to their innocence, which limits their ability to understand certain phenomena. Death, divorce, abuse, and abandonment are just but a few of the crises that children find themselves in (Wright, 2011). These occurrences affect their emotional and psychological development, and thus they need to be assisted to deal with the same. Guiding them by exposing them to some coping mechanisms can be very helpful. Introducing the concept of God can help reassure them that despite the unfortunate occurrence, someone still cares and loves them, and thus not all is lost. Understanding the characteristics of suffering children such as abused children is a huge step towards helping them.

Adolescents are another vulnerable group, which is often hit by numerous crises. At their transition stage, their emotional stability is volatile because they peg it on peer acceptance (Wright, 2011). This aspect causes them to consider trivial issues as crises. Understanding them in this sense is vital especially for someone who seeks to assist them in overcoming their crises. In all these endeavors, God’s word and His ability to help needy situations should not be overlooked as it adds a very important dimension to the entire process crisis resolution.

Concrete Responses

Dr. Wright’s book, “The complete guide to crisis & trauma counseling: what to do and say when it matters most!” is a guide that connects with anyone who reads it in some way. The book is so detailed and comprehensive that it is difficult to find anyone who reads it and fails to come across a portion of it that directly connects with an experience. Personally, it connected with numerous experiences in my life. However, the most outstanding is the case of my mother’s demise. She was one person I dearly loved and had never imagined a life without her. I literally adored her. Intriguingly, thoughts of her demise had started crossing my mind before it actually happened, but every time these thoughts would surface, I would push them right out of my mind.

When she actually died, it was shocking because her illness lasted only three days and she was gone. I was not in a position to make it to her bedside before she died so when the news of her death reached me, I was devastated. The heavy feeling of helplessness that descended upon me came to mind when I read the introductory portion of this book. As the youth pastor in charge of the excursion in which a life was lost, Dr. Wright was helpless and he did not know what to do or say. My first reaction was not to tell my colleagues because I did not believe that such a thing could happen. I firmly told myself that I could only believe the news after seeing her body.

Intriguingly, after receiving the news, my colleagues knew right away that something was not right. On informing them about my mother’s death, the first reaction was silence. Shortly afterwards, messages of condolence started flowing in. The messages from my friends broke me down as I must admit, some of them did not know what to say, yet they felt obliged to say something. My closest friend stayed away from me until I left for the funeral arrangements. At the time, I did not take such an action lightly and even though we talked about it after the funeral, I still did not understand why he chose to stay away when I thought I needed him most. However, through Dr. Wright’s book, I now understand the dilemma he was in at the time, as he did not know what to say.

Reflection

Dr. Wright’s book addresses many questions that have bothered me for a long time insofar as overwhelming situations such as the brief account of my personal loss several years ago are concerned. However, in the process of reading the book, other questions come up. For instance, though most counselors may have a Christian orientation, it is not obvious that all counselors subscribe to the Christian doctrine. The question that arises from this realization is whether I would understand the deeply rooted Biblical principles that the author espouses and apply them to real life situations if I were a non-Christian. If this move is not possible, the issue of concern becomes whether it is safe to assume that non-Christian counselors cannot be effective. This concern stems from the view that according to Dr. Wright, Jesus is the best counselor known to humankind and anyone seeking to counsel others effectively has to emulate Jesus both in his approach to counseling and personal life (Wright, 2011).

The author suggests that counselees who find it difficult to control their tears when they recall an unfortunate occurrence can be assisted by helping them to set aside a designated crying time (Wright, 2011). The suggestion sounds easier said than done because normally, the crying and the tears are involuntary by products of painful memories. Under circumstances where a counselee finds it difficult to initiate the crying process at the designated time, how can the counselor go about it? Apparently, the crying time should not be part of the counseling sessions, which implies that the counselee has to do it on his/her own at home or so. This area could do with a bit more creative ways of making it happen. It might even seem outrageous to suggest to a counselee to set aside a designated crying time and adhere to it regardless of the preceding activities or mood.

Despite these two concerns, I strongly agree with the author that in cases of death, the first reaction is denial and it is followed by anger, which can turn to bitterness. These emotional and psychological shifts often take place when the affected individual is confused or even in shock. The author’s exhortation to counselors to be vigilant and sensitive when dealing with such persons is right on point as like in my case, my friends’ ‘consolation’ broke me down to tears. Knowing exactly what to do or say is vital under such circumstances.

Application

In retrospect, there are numerous occasions in which I said things I was not supposed to say, or did things that were not right under the given circumstances. A good example is when in the middle of a death crisis, I told someone that there was no need to make it so much of an issue because eventually, a similar fate awaited all humanity. While such comments might easily come from people, the effect they might have on a grieving person can only be imagined. The weight of a losing a loved one is known only to the person who suffers the loss. Those who condole with the bereaved and console them might be out of touch with what such a person feels and might take it lightly in a bid to cheer up the victim.

A number of lessons have been learnt through reading Dr. Wright’s book. For instance, it is not right to assume that the feeling of helplessness that engulfs people during crises is normal. Though crises and traumatic events are often met with shock and disbelief among other reactions, Dr. Wright points out that there is a need for people to prepare for the same (Wright, 2011). The preparation is necessary as it helps us in knowing what to do or say when a crisis hits. I intend to be more careful and considerate with words and gestures in the face of crises for I have learnt that words and actions are critical during counseling and in the face of crises.

Another key lesson that stems from Dr. Wright’s book for me is that it is important to intertwine personal life with the counseling approach that one takes. According to Dr. Wright, Jesus is the best role model in counseling (Wright, 2011). He thus exhorts counselors to counsel like Jesus did and he is keen to point out that it can only be achieved through following the lifestyle of Jesus Christ. I intend to make the Bible a benchmark for my personal life where my relationship with people shall be guided by the relevant Biblical principles. This way, my personal life will improve for the better because I will be in a position to handle life’s challenges with understanding and patience.

I further intend to conduct an in-depth self-assessment to determine if some wounds in my life have not healed with time and follow Dr. Wright’s step-by-step guide to resolve them and let them heal. If need be, I will seek professional assistance over the same. I realize that I might not have moved on from the loss I suffered because I have always repressed any thoughts that remind me of the same. My eyes water with tears whenever I observe a loving mother relate with a son or daughter, but again I feel a sense of relief whenever I witness fighting between a mother and her son or daughter. Reading through the book has made me realize that there might be something I have not done right yet.

Additionally, prayer stands out in Dr. Wright’s book as a vital component of every activity we undertake. At the end of his book, he talks about how prayer fits into the counseling process. Prior to that, he mentions prayer on several occasions within the text especially in cases where a situation seems to be overwhelming for the counselor as well. The author supports this line of argument by noting that Jesus was a prayer warrior and nothing less is expected of us. I thus intend to incorporate prayer in my personal endeavors to experience the power of God in my tasks.

Reference

Wright, H. N. (2011). The complete guide to crisis & trauma counseling: what to do and say when it matters most. Ventura, CA: Regal/From Gospel Light.

Introduction

Cognitive model initially developed alongside cognitive psychology. Since its development, cognitive model has gotten lots of contributions from scientific fields which include, but limited to, artificial intelligence and machine knowledge. Before getting into deep discussion it is important to understand the term cognitive. Cognitive is a term used to refer to the totality of processes used by the human sensory cells to transform input. Moreover, during the transformation, the input is reduced, convoluted, picked up, and put to use. Cognition is concerned with the processes even when such processes actually operate in the absence of appropriate stimulus, for example in the case of hallucinations. It is therefore, perceptible that cognition is concerned with all the aspects of human individuals. It is assumed that every psychological aspect of human beings is a cognitive object (Thagard, 205, p. 57).

The key features of cognitive model

The cognitive model is an approximation made to the cognitive processes, primarily in human beings, for reasons of understanding and predictions. Scientifically, a cognitive model can be constructed within or outside what is known as cognitive structure; however, both cognitive model and cognitive architecture cannot be distinguished with ease. Cognitive model is biased towards dealing with just a single process or object. It also focuses on studying the mechanisms through which more than one processes interact with one another; this may include visually seek out and the decision making process. Cognitive model is also concerned with behavioral prediction of particular tools and or tasks (Eysenck and Keane, 2005, p.527).

Cognitive model comes in various types amongst which are box-and –arrow illustrations and computational models. Nonetheless, the assumptions of this model is that human beings are rational and will, under normal circumstances, always make decisions and choices that they feel make most sense for them. Therefore, the cognitive model is used to diagnose individuals’ problems and find solutions to those problems. The other important feature of cognitive model is that it concerns itself with stimulus and response in which the mental process play a major role. It supports the notion that solutions to problems faced by individuals include rules not necessarily comprehended but seem to give hope in finding solutions and also certain rules that are necessarily comprehended but may not offer solutions to the problems (Gray, 2007,P.415).

Cognitive model is differentiated from other psychological model in that it acknowledges the adoption of scientific techniques as the most appropriate methods of investing a problem and it basically does not agree to the notion of introspection. Furthermore, the cognitive model accepts the existence of beliefs, inspiration and desire which constitute the internal mental states (Gray, 2007, P.417).

Cognitive model of depression is one with the most pragmatic evidence that is used in offering appropriate solutions to depression. According to cognitive model, the individual behavior and emotional statuses are greatly determined by an individual’s cognition. The cognitive factors that contribute to the behavior and emotions of an individual include, amongst others, beliefs and personal thought. One of the proponents of cognitive model is Aaron Beck. Aaron beck argued that the symptoms of depression come about in situations where individuals’ attribution for external processes or events is linked to maladaptive attitudes and or beliefs. According to Aaron Beck, the cognitive model of depression has given adequate scientific evidence to serve as the premise on which assumptions that maladaptive cognitions come before and cause disorder (Beck, 1979, p.300)

The client’s scenario: Angela

Cognitive model can be used to understand Angela’s scenario since her case is cognitive. Angela is guided by what she believes is right. Angela was involved in drinking just to please and conform to her boyfriend, who she hoped to marry. However, she had the belief that too much drinking was getting her out of control, in view of this, it became important that she separates with her boyfriend. Angela’s emotions emanates from the fact that she has been forced by circumstances to separate with her boyfriend who she believed would marry her and finally have children together and a home. This scenario has made her to have a total behavior change that is quite different from the way her friends knew her before.

Angela’s friends knew her as somebody who was interesting and they freely went out with her, a fact that is no longer the case. It is the inability of Angela to adopt to her new situation of joblessness, not having a boyfriend of her choice and the fear of facing her parents and siblings that makes her experience what Aaron Beck refers to as depression in the context of cognitive model.

Within the context of cognitive model, Angela suffers from issues related to cognitive triad and schema. She is experiencing from a pattern of reportable depressive thoughts actually entails negative thoughts about her situations. For instance, she is jobless, has no boyfriend and is living with a friend and not a house of her own. For that reason, she feels self inadequacy and hence a burden to her friend. Angela is also concerned with her future life in which she longs to be independent. All these factors have made Angela to have a total behavior change. Instead of being jovial with her friends, she is deeply involved in thoughts of finding a job as a nurse and be able to avoid possible concerns of her family members about her life and career.

Angela also suffers from schema, which includes certain maladaptive attitudes and beliefs. Back in England, she used to work as a nurse in a hospital and it is the same kind of job she is looking back at her home country. However, she has a negative attitude towards the kind of hospitals in which she is looking for a nursing job. She seems not to be ready to adopt to the hospital environments where there is lots of smell of drugs. In this case, the most appropriate thing for Angela to undertake is to seek the intervention of a therapist who can help her consider her maladaptive interpretations of her situations and the conclusions she makes about herself as testable hypotheses. The therapists should then help her find alternative workable interpretations and solutions to her problems.

How the model would work with the client

The main objective of applying this model to the client, Angela, is to get her out of both negative thoughts about herself and attitude she has towards her situation. In this case, the client needs to undergo the process of cognitive therapy. The therapy would help her overcome the difficulties she is facing by helping her single out, one by one, and change the dysfunctional kind of thoughts, behavioral traits and her emotional responses. This process would help Angela to develop certain skills that would help her to adjust her personal beliefs, her distorted ways of thinking, the way she is currently relating to her friends and her significant others and changed behavioral traits. Angela’s treatment would be based on the cooperation between her and the therapist and also on the tests of her beliefs. The therapy test may include the examination of the assumptions which she makes and also identify how some of her normally-unquestioned thoughts get distorted. After the distorted thoughts have been identified and challenged through the therapy process, Angela’s negative thoughts and attitudinal feelings about her situation would be more easily subjected to positive change. The behavioral therapy would help Angela to avoid adopting further negative though6s and attitude that would be severely detrimental to her health and even her future career.

Why cognitive model is preferred to systematic model

In the cases where solving problems at individual level is required, cognitive model is the most appropriate since it is concerned with internal factors that influence the behavior and attitudes of the person in question unlike systematic model where problems and solutions are considered in the context of social relationships, which is external. Cases such as that of Angela, where problems emanate due to personal beliefs and perception of the world around an individual only require the application cognitive model as the appropriate source of solution. Such cases cannot be solved in the context of social relationships since they are not involving the victim with other members of the society even though their causal factors may be external.

Cognitive is rather concerned with what happens within a person that finally manifests through behavioral change in an individual. In the process of finding solutions, it seeks to challenge the negativities within and presents the victim with an opportunity to realize neither his nor her problem and thereby consider adjusting his or her behavior and or attitude in order to solve the existing problems (Alford and Beck, 2009, p.365).

Advantages and disadvantages of cognitive model

Cognitive model has many advantages over other available models. One of the advantages is that it is the most appropriate model to use in finding solutions to individual problems that affects the thought process, personal beliefs and emotions of an individual. It examines the cognition of an individual in relation to his or her perception of the world around him or her and the context of the problem. Research done in the past has also indicated that this model can be used successfully in treating some individuals with mental conditions. Cognitive model is highly structured and can therefore be used indifferent formats with clients; the formats used with this model may include books for personal self-help, software which can be used in the computers and well prepared training materials. However, cognitive model has its own disadvantages when compared to other models.

Cognitive model requires that a considerable level of involvement commitment be ensured and maintained in order to tap from its benefits. Taking into account its high structural nature, it is most likely not to be appropriate to used with individuals who have mental health statuses that have become more complex. The implication of this is that the cognitive model can only be appropriately applied in situations where a victim has less complicated mental health needs. The model has also been criticized on the ground that it only lays its focus on finding solutions to the current problems. Moreover, it has also been faulted due to the fact that it focuses on very explicit issues. Finally, cognitive model does not take into consideration the possible fundamental factors that may be responsible for an individual’s mental health problem; an example of such factors is sorrowful childhood (Ikeda et al. 2006, p.170).

Difference in theoretical basis of cognitive and systematic model

The first theoretical difference is found in their applicability. The cognitive model is rather applicable at an individual level and tends to be mainly concerned in solving the current problems with total disregard to the future. In addition, cognitive model presents an exclusive combination of cognitive modeling and intelligent systems. The proponents of this model have argued that human beings develop cognition during their growth process. Moving to systematic model, it is important to note that its theoretical applications are based on systems; in other words it considers social interactions in terms of systems and also attempts to solve problems in a systematic context (Riva, 2004, 700).

The similarity and difference in the application of the models

The similarity in the application is that they represent holistic, interactive and non-pathological approaches to counseling of people, both at individual and group level. They are also cultural sensitive in their application process. On the contrary, both modes have some differences in terms of their application. Cognitive model is mostly applied with individual people and mainly deals with the cognitive factors that contribute to a person’s problems. On the other side, systematic model first assumes that individuals are systems and hence, deals mostly with social factors that affect individuals (Willis, 2005, p.79).

References

1. Alford, B and Beck, A (2009). Depression: Causes and Treatment. Pennsylvania: University of Pennsylvania Press.
2. Beck, A (1979). Cognitive therapy of depression, Guilford clinical psychology and psychotherapy series. New York: Guilford Press.
3. Eysenck, M & Keane, M (2005). Cognitive psychology: a student’s handbook, (5th ed). New York: Taylor & Francis.
4. Gray, W (2007). Integrated models of cognition systems, Volume 1 of Oxford series on cognitive models and architectures. New York: Oxford University Press.
5. Ikeda, M et al. (2006). Intelligent tutoring systems: 8th International Conference, ITS 2006, Jhongli, Taiwan, 2006: proceedings. New York: Springer.
6. Riva, G (2004). Cybertherapy: internet and virtual reality as assessment and rehabilitation tools for clinical psychology and neuroscience. New York: IOS Pres.
7. Thagard, P (2005). Mind: introduction to cognitive science. (2^nd ed). London: MIT Press.
8. Willis, G (2005). Cognitive interviewing: a tool for improving questionnaire design. New York: Sage Publishers.

Introduction

Group counseling is where people benefit from experiences that they share together in a group. It is a form of therapy where people meet in order to address the problems that they are facing as individuals. These individuals then share their problems in order to look for solutions.

According to gestalt theoretical approach, people involved in the group counseling are assisted to be aware of what they are currently working on; the way in which they are doing it; and activities which they can engage in to facilitate a change to their lives, as well as other peoples’ lives. Group counseling makes people develop skills and increase their confidence.

The group of people involved also becomes empathetic and supportive to one another to address the challenges they are facing in life. Group counseling is commonly used in schools, colleges and universities, mental health clinics, and other human service agencies. Normally, group counseling is aimed at focusing on a certain issue such as stress management.

The manager of the group counseling is a therapist who manages the group, but all members make their contributions that are taken into consideration. This is because they are part of the group and that they share the same issues. Gestalt theoretical approach makes an individual believe to be a potential health person with all material that can be used to give satisfaction in life (Corey, 2012).

In group counseling, the leader should be able to reach everyone, both at individual and group levels. This makes every group member feel comfortable and confident while sharing or addressing a certain problem.

Some ethical issues involved in group counseling

There are major issues that should be done in group counseling that demonstrate ethics and enhance continuation and strength of the group. These issues are helpful to individual members of the group.

Demonstration of respect and honesty to all members of the group from the leaders is one key issue which promotes cooperation. Anyone leaving the group must have a concrete reason and should do so after issuing a notification to the group.

Another key ethical issue is that the responsibilities of each group member should be emphasized by the leaders. Some of these responsibilities are openness in the group, being able to provide feedbacks, punctuality and regularity in attending whenever there is a meeting held. Finally, the group members should observe confidentiality in the group with issues that are shared by friends (Ehly & Dustin, 1989).

Gestalt approach in group counseling

In accordance to gestalt theory, the members are taught on how to accept themselves in the way they are as well as giving value to themselves. Gestalt theoretical approach applied in group counseling has been proved to be one of the most effective in situations where time is a limiting factor.

It is majorly applied in different situations among individuals from all walks of life. Group counseling provides opportunities to these groups of people for experimenting with ideas, behaviors or personality quirks (Woldt & Toman, 2005).

Counseling techniques using gestalt theory

In gestalt theory, there are various techniques that are used in order to achieve the objectives of the counseling group. The leader of the group should use certain techniques that create awareness within the group. One of them is making observations within the group.

One of the major counseling techniques is the empty chair technique. This involves the client addressing an empty chair as though there was a person sitting on it. This technique focuses on assisting a client to explore him or herself. It is made use of by therapists in order to assist patients in self adjustment.

The use of unfinished business is a technique whereby anything that concerns about the past is not expressed during counseling. This is where things like rage, hatred, pain, anxiety, grief, guilt, and abandonment, as well as resentment are not expressed.

This is because they take the client to deep thought or increased stress. This may make the counseling session difficult such that the client cannot express herself to share out his or her problems.

The other counseling technique is the exaggeration technique. In this case, counselors involved in counseling session exaggerates mannerism of the client or asks the client to exaggerate mannerism in order to make the client aware of true feelings (Ash, 1995).

Challenges and opportunities in group counseling

Challenges in group counseling occur both to the client and the counselor. There are several challenges that arise in group counseling. One of the major challenges faced by counselors is the failure of the client to open up to speak his or her problem.

The openness of the client during a counseling session depends on the counseling technique used and the level of experience of the counselor. For example, beginners may face a lot of challenges because they may not have enough experience to handle different types of clients (Gazda, 1978).

Also, the technique used determines whether the client will open up or not. Counselors should have different ways to approach clients so as to encourage them to share their problems. This will enable them get their solutions. This creates difficultness in the counseling session as the counselor will not be able to know how to handle the client.

Some of these are; unaware assumptions, attitudes and beliefs created on other group members including the group leaders. Another challenge in counseling is insufficiency of knowledge by the counselor.

This limits counseling in that the client may not be able to get solutions to his or her problems hence goes back with the same problem. In this case, counselors should ensure that they have adequate knowledge in counseling so as to help clients.

Other challenges include time limitation, where the counseling session may be too short for the counselor to carry out effective counseling. Lack of privacy and confidentiality with the counselor may discourage clients from sharing their problems.

Lack of respect between the counselor and the client may lead to ineffective counseling. This is common with male counselors who may be handling female clients. The counselor may use ways to console the client which may be unethical and hence may make the client lose confidence with the counselor of vice versa (Houston, 2003).

On the other hand, counseling has enhanced several opportunities in the society. For example, counseling done by professional has improved from performing to active provision of education and mental health care to clients who possess different capabilities.

Counseling has aided in the provision of respect for human dignity and diversity in most of the professional activities. Counseling has also provided employment opportunities because it has now become a profession (Corey, 2012).

Conclusion

From the discussion, it can be concluded that counseling is a critical aspect of life that assists individuals who undergo several problems. The problems that arise in counseling should be addressed so as to assist individuals in the society.

Educators also should give enough knowledge to the counselors to avoid insufficiency in counseling sessions. It is also important to address some of the ethical issues to be practiced during counseling to avoid the clients losing confidence.

Reference List

Ash, M.G. (1995). Gestalt psychology in German culture, 1890-1967: Holism and the quest for objectivity. Cambridge: Cambridge Univ. Press.

Corey, G. (2012). Theory & practice of group counseling. Belmont, CA: Brooks/Cole, Cengage Learning.

Ehly, S.W. & Dustin, E.R. (1989). Individual and group counseling in schools. New York: Guilford Press.

Gazda, G.M. (1978). Group counseling: A developmental approach. Boston [u.a.: Allyn and Bacon.

Houston, G. (2003). Brief Gestalt therapy. London: SAGE.

Woldt, A.L. & Toman, S.M. (2005). Gestalt therapy: History, theory, and practice. Thousand Oaks: Calif.

It is evident from the first case study that John is suffering from depression. There are quite a number of symptoms in this case that lead to a conclusion that John is actually depressed. To begin with, John feels hopeless and helpless and is no longer excited by anything that used to excite him. John has lost interest in his daily activities such as attending to his goddaughters. The other depression symptom exhibited by John is loss of appetite because he eats less food and claims that it has no taste. The other symptom is insomnia where John is not able sleep at night because of his worries. John has evidently lost energy and motivation to fulfill his responsibilities as an employee and a godfather. Despite the fear that John has about the side-effects of medication, he still needs psychopharmacological intervention to cure him from this depression.

The antidepressant medication is the most appropriate for treating depression symptoms. This treatment should only be administered by a mental health professional qualified to advice the patient appropriately (Beck, 2009). Antidepressants are supposed to bring the serotonin levels in the brain back to the normal levels. The theory behind antidepressant is that low levels of a brain chemical known as serotonin causes depression and therefore the antidepressant medication is supposed to bring the chemical back to normal levels (Beck, 2009). There are chances that the antidepressant treatment can come with side-effects but the treatment has been proven to be effective in the treatment of depression symptoms. It is important to note that the antidepressant medication may not cure all the symptoms of depression because some of them may require lifestyle changes and therapy to completely heal (Greden, 2008).

Counselors have a critical role to play in sensitizing depression patients on depression medication and the possible side-effects (Greden, 2008). Counselors should ensure that depression patients are completely informed about the antidepressant medication and are psychologically prepared to deal with its possible side-effects (Greden, 2008). A counselor should explain to the patient all the possible side-effects of antidepressants for them to make informed decisions. It is the role of a counselor to advice the patient on how to deal with some of the expected side-effects of the antidepressant medication. Despite the role played by a counselor in preparing a patient psychologically for the depression medication, a psychiatrist is the one who is allowed to make recommendations on the type of treatment that the patient needs (Beck, 2009). The role of a counselor is to give some emotional insights to patients that can help them to respond positively to medication. Counselors provide therapy treatment to depressed patients in a case where the psychiatrist does not recommend the antidepressant medication (Beck, 2009).

The initial challenges of psychopharmacological intervention can be dealt with if the counselors play their role effectively (Beck, 2009). The most common challenge is the fear and anxiety expressed by depression patients as a result of the likely side-effects. A counselor can help address this challenge through psychological preparation of patients before they begin their treatment (Greden, 2008). The other challenge in the initial stages of psychopharmacological intervention is in finding the right drug and dosage for a particular patient. It can take up to six weeks for a particular antidepressant medication to have some effect on the patient and this can be a big challenge in a case where the depressed person in not patient (Greden, 2008). Counselors need to inform the patients on the likelihood of some treatments to take long before they begin having any therapeutic effect on the patient (Beck, 2009).

References

Beck, A. (2009). Depression: Causes and treatment. New York, NY: University of Pennsylvania Press.

Greden, J. (2008). Treatment of recurrent depression. New York, NY: American Psychiatric Pub.