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TYPES OF COUNSELLING

Contents at a Glance

PREFACE page…. 1 INTRODUCTION 5 Chapter 1. Counselling the Child 19

Chapter 2. Counselling the Adolescent 43

Chapter 3. Counselling the Young Adult 55

Chapter 4. Counselling the Middle Aged 67

Chapter 5. Counselling the Elderly 83

Chapter 6. Counselling the Engaged 97

Chapter 7. Counselling the Couple 111

Chapter 8. Counselling the Family 135

Chapter 9. Counselling the Sick 143

Chapter 10. Counselling the Dying 155

Chapter 11. Counselling the AIDS Affected 175

Chapter 12. Counselling the Suicidal 185

Chapter 13. Counselling the Bereaved 199

Chapter 14. Counselling the Substance Abusers 227

Chapter 15. Counselling the Group 255

CONCLUSION 283

REFERENCES (END-NOTES) 287

BIBLIOGRAPHY 308

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TYPES OF COUNSELLING A Life-span Developmental & Situational Approach

(Developmental Psychology is Included)

D. John Antony, O.F.M. Cap.

ANUGRAHA PUBLICATIONS ASSISI ASHRAM, PAMPANVILAI

NAGERCOIL – 629 201, Tamil Nadu, INDIA

1996 **********

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Copyright 1996 By D. John Antony, O.F.M. Cap. First Edition: July 1996 Published by: Anugraha Publications, Assisi Ashram, Pampanvilai, Nagercoil – 629 201.

Tel. (0091) (4652) 251 477 and 251 766. Available at: Asian Trading Corporation, 58, Second Cross, Da Costa Layout, St. Mary’s Town, Bangalore, India – 560 084. E-mail: mail @ atcbooks. net

Books by the Author: 1. Dynamics of Counselling: Microskill Model (T.A. & NLP are included) 2. Skills of Counselling: Microskill Model (Kinesics & Focusing are included) 3. Types of Counselling : A Life-span Developmental & Situational Approach)

(Developmental Psychology is Included) 4. Psychotherapies in Counselling 5. Tamil Translation of Books # 2 and #3

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DEDICATED

TO ALL

THOSE WHO

SHARED THEIR

VULNERABILITY WITH

ME

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TABLE OF CONTENTS

PREFACE

INTRODUCTION 1. Types of Crisis 5 2. Developmental Crisis 5 1) Table of Developmental Theories 7 2) Developmental Theories 9 (1) Elizabeth Hurlock 9 (2) Robert Kegan 9 (3) Sigmund Freud 10 (4) Erik Erikson 10 (5) Abraham Maslow 12 (6) Jean Piaget 13 3. Situational Crisis 14 1) Experience of Stresses 15 4. Anatomy of Crisis 16

DEVELOPMENTAL CRISES AND COUNSELLING

Chapter 1 Counselling the Child

1. Introduction 19 2. First Three Stages: Prenatal – Infancy – Babyhood 20 1) Prenatal 20 2) Infancy (neonate) 22 3) Babyhood 22 (1) Physical Development 22 (2) Cognitive Development 23 (3) Language Development 23 (4) Personality & Social Development 24 i) Characteristic Traits 24 ii) Organization of Personality 25 iii) Socialization 25 iv) Self – display 25 v) Self – will 26 vi) Imitation 26

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EARLY CHILDHOOD 3. Early Childhood 27 1) Characteristic Traits 27 2) Counselling Situations 27 (1) Child Abuse 30 i) Causes of Child Abuse & Neglect 31 (2) Handicapped Conditions 32

LATE CHILDHOOD 4. Late Childhood 33 1) Characteristic Traits 33 2) Needs of Children 35 3) Counselling Situations 36 (1) Identified Patient 36 (2) Sibling Rivalry 37 (3) Unrealistic Expectation 37

(4) Identification 38 (5) Handicapped Children 38

(6) Counselling Techniques 39 5. Conclusion 41

2 COUNSELLING

THE ADOLESCENT 1. Introduction 43 2. Preadolescence 44 3. Adolescence 44 1) General Characteristics 44 2) Physical Development 45 3) Social Development 45 4) Grunt Stage 45 5) Alienation 46 (1) Effects of Alienation 47

6) Identity Vs. Role Confusion (1) Identity Status 48

7) Cognitive Development 48 4. Counselling 49 1) Educational Counselling & Guidance 49 2) Problem of accepting one’s changing physical self 50 3) Sexual Relationships 50 4) Juvenile Crime 51

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(1) Substance Abuse 52 i) Link between Adolescence & Substance Abuse 52 ii) Reasons for substance Abuse 53 5. Conclusion 53

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COUNSELLING THE YOUNG ADULT

1. Introduction 55 2. Characteristics 56 1) Settling down Age 56 2) Reproductive Age 56 3) Physical Strength 56 4) Psychosocial Development (Intimacy Vs. Isolation) 57 5) Commitment Age 58 6) Value change Age 58 7) Cognitive Development 59 3. Social Relations 59 1) Family 60 4. Personal Identity & Work 61 1) D.E. Super’s Theory 61 2) J.L. Holland’s Theory 62 5. Counselling Situations 63 1) Physical Disorders 64 2) Career Planning 64 3) Financial Planning 65 4) Conjugal Relationship 66 6. Conclusion 66

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COUNSELLING THE MIDDLE AGED

1. Introduction 67 2. Characteristics of Middle Age 68 1) Physical Condition 68

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2) Vocational & Grand parenting Adjustment 68 3) Success of Middle Age 69 4) Midlife Crisis? 69 5) Intelligence 69 6) Career pattern & Work performance 70 3. Levinson’s Theory of Adult Development 70 1) Early Adulthood 70 (1) Novice Phase 70 (2) Settling Down Phase 71 2) Middle Adulthood 72 4. Burnout 72 1) Signs & symptoms of Burnout 72 (1) First Level Symptoms 73 (2) Second Level Symptoms 74 (3) Third Level symptoms 74 2) Burnout Prone Candidates 75 3) Handling Burnout 76 5. Retirement 78 1) Patterns of Adjustment 79 2) Psychological Process of Adjustment 80 6. Conclusion 80

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COUNSELLING THE ELDERLY

1. Introduction 83 2. Physical Condition 84

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3. Developmental Tasks 84 1) Psychosocial Adjustment (Erik Erikson) 84 2) Psychological Adjustment (Robert Peck) 85 (1) Ego differentiation Vs. Work-role Pre-occupation 85 (2) Body Transcendence Vs. Body Preoccupation 85 (3) Ego Transcendence Vs. Ego Preoccupation 86 3) Transition period (Daniel Levinson) 86 4) Comparison of Developmental Task 87 4. Successful Aging 87 1) Personality Types Theory of Neugarten 87 (1) Integrated Type 87 (2) Passive- dependent Type 88 (3) Armoured-defended Type 88 (4) Un-integrated Type 88 2) Personality Types Theory of Reichard 88 3) Disengagement Theory 88 4) Activity Theory 89 5) Comparison of Theories of Successful Aging 89 5. Psychological Maladjustment 90 6. The Institutionalised Elderly 91 7. Counselling situations 92 1) Depression, Loneliness & Lack of Initiative to Live 92 (1) Causes of Depression 93 i) Biological Factors 93 ii) Psychosocial Factors 93 2) Lack of Intellectual Capacity to Manage One’s Own Affairs 93 (1) Senile Dementia 94 (2) Multi-infarct Dementia 94 (3) Delirium 94

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8. Counselling 94 1) The Depressed 94 2) Patients of Dementia 95 3) Patients of Delirium 95 9. Conclusion 95

SITUATIONAL CRISES &

COUNSELLING ********* Chapter 6

COUNSELLING THE ENGAGED

1. Introduction 97 2. Premarital preparation Counselling 98 3. Historical Background 98 4. Attitude Towards Marriage 99 5. Stage Model of Courtship (Wheel Theory of I.L. Reiss) 100 1) Rapport 100 2) Self- Evaluation 100 3) Mutual Dependency 100 4) Intimacy Need Fulfilment 100 6. Goals of premarital preparation 101 1) Encouraging Interpersonal Dialogue 101 2) Providing Information 101 3) Correcting Faulty Information 102 4) Making an Evaluation 102 (1) Maturity 102 (2) Compatibility 102 (3) Marital Happiness 103 5) Completing Administrative Details 103

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7. Premarital counselling 103 1) Chronological Immaturity 104 2) Wide Chronological Age Difference 104 3) Wide Gap in Education 105 4) Divergent Racial or Cultural Background 105 5) Vast Status Difference 105 6) Divergent Religious Background 106 7) Pregnant Bride 106 8) Grieving or Rebounding Partner 107 9) Serious Physical, Emotional & Mental Handicap 107 10) Serious Drug Involvement 108 11) Psychopathic Personality 108 12) Financial Insecurity 108 8. Counselling Format & Techniques 109 9. Conclusion 110

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COUNSELLING THE COUPLE

1. Introduction 111 2. Characteristics of Coupling 112 1) Voluntary Nature of Coupling 112 2) Balance in the Couple’s Relationship 112 3) Temporal Aspects of Coupling 113 4) Merging Systems as part of Coupling 113 5) Giving & Receiving Support as part of Coupling 113 6) Maintaining Separateness & Individuality 114 3. Marriage as a social System 114 1) Couple as a Subsystem of the Family 114 2) Stages of Couple Development 115

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3) Rules and Boundaries Governing Couple Relationship 116 4) Homeostasis within Couple Relationship 116 4. Areas of Symptom Formation in Couple Relationship 117 1) Economic Issues 117 2) Companionship- Intimacy 118 3) Work & Recreation 119 4) Parenting 119 5) Household Chores 120 6) Relationship with Extended Family 120 7) Religion 120 8) Friends 121 9) Substance Abuse 121 10) Communication 121 5. Stages of Marital Conflicts 122 1) Stage of Typical Adjustment Conflicts 122 2) Stage of Disrupted Covenant 122 3) Stage of Private Misunderstanding 123 4) Stage of Social Involvement 123 5) Stage of Threats of Attempts at Separation 123 6) Stage of Legal Separation 123 7) Stage of Divorce 123 6. Characteristics of Marital Conflict 123 7. Counselling 124 1) Impact of Couple Counselling 124 2) Approaches to Marriage Counselling 124 3) Counselling Stages 125 4) Relationship Satisfaction 125 5) Family Systems Counselling 126 (1) A Systems Model Approach 126 (2) Circularity 126

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(3) Family Homeostasis 127 (4) The Double Bind 127 (5) Circular Causality 127 (6) Strategic Approach 127 6) Communication Enhancement 128 7) Behaviour Contracting 128 8) Interactional Therapy 129 9) Strategic Therapy 129 10) Sex Therapy 129 11) Psychoanalytic Therapy 130 12) Intergenerational Therapy 130 13) Structural Therapy 130 14) Behavioural Therapy 131 15) Marital Enhancement Programmes 131 16) Divorce Therapy 131 17) Guidelines for Enriching Marital Relationship 131 8. Counsellor 132 1) Role of the Counsellor 132 2) Approach of the Counsellor 132 9. Conclusion 133

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COUNSELLING THE FAMILY

1. Introduction 135 2. Types of Families 136 3. Family as a Social System 136 4. Conjoint Family Therapy as a Systems Perspective 137

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5. Goals of Family Therapy 138 1) Communication 138 2) Focusing on Relationship 138 3) Mutual Need Satisfaction 138 4) Nourishing Self- esteem 138 5) Growth Opportunities 139 6) Self- actualizing Ways 139 7) Conflict as Growth 139 8) Integration of Embeddedness Vs. Autonomy 139 9) Growth- engendering 139 10) Being Open to Supportive Relationships 140 6. Right Brain Method 140 7. Family Root System Therapy 141 8. Conclusion 141

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COUNSELLING THE SICK

1. Introduction 143 2. Body-mind Interdependence of Illness 144 3. General Types of Illness 145 4. Sickness in Hospital Setting 145 1) Nutritional & Digestive Disorders 145 2) Excretory Disorders 146 3) Skin Diseases 146 4) Heart Diseases 146 5) Neural Disorders 147 6) Genitourinary Disorders 147

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5. Hospitalization 147 1) Psychological Reductionism 148 2) Disease – Dis-ease Parallelism 149 3) Trauma of Surgical Patients 149 6. Counselling 150 1) Hospital Conduct of the Counsellor 150 2) Attitude & Procedure 152 7. Conclusion 153

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COUNSELLING THE DYING

1. Introduction 155 2. Phenomenon of Death 155 3. Elizabeth Kubler- Ross’ Stage Theory 156 1) Shock 157 2) Denial 157 3) Anger 158 4) Bargaining 159 5) Depression 160 6) Acceptance 160 4. Edwin Shneidman’s Cluster States Theory 161 5. E. Mansell Pattison’s Process Theory 161 1) Acute Phase 161 2) Chronic Living –Dying Phase 161 3) Terminal Phase 162 6. Fear of the Dying 162 1) Fear of Pain and Mutilation 163 2) Fear of Isolation 163 3) Fear of the Loss of Control & Independence 163

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4) Fear of the Future of the Loved Ones 163 5) Reflected Fear 163 6) Fear of the Unknown 163 7) Fear of Meaninglessness of Life 164 7. Old People’s Concern about Death 164 1) When Will I Die? 164 2) What is likely to Cause my Death? 164 3) How can I have a Good Death? 165 4) Euthanasia 165 8. Dying involves Suffering 165 1) Responses to Suffering 166 9. The Dying know their Death 166 10. Facts about Dying Persons 167 11. The Dying Experience 169 12. Counsellors in the Context of Death 170 13. Counselling 171 14. Conclusion 173

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COUNSELLING THE AIDS- AFFECTED

1. Introduction 175 2. Development from HIV to AIDS: 176 1) HIV: Initial HIV Infection 176 2) PGL: Persistent Generalized Lymphadenopathy 176 3) ARC: Aids Related Complex 177 4) ADC: AIDS Dementia Complex 177 5) AIDS: Full- Blown AIDS 177

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3. Common Infections due to AIDS 177 1) Cryptococcal Meningitis 178 2) Central Nervous System Toxoplasmosis 178 3) Pneumocystis carinii Pneumonia 178 4) Cryptosporidiosis 178 5) Kaposi’s Sarcoma 178 4. AIDS Test 178 5. Means of HIV Transmission 179 6. Harmless Associations 180 7. Psychological Reactions to AIDS 180 1) AFRAIDS 180 2) Fears & Anxieties 181 8. Behavioural Reactions to AIDS 181 9. Counselling 182 10. Conclusion 183

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COUNSELLING THE SUICIDAL

1. Introduction 185 2. Suicidal Potentiality 186 3. Sociocultural Factors 189 4. Clues to Understand Suicide 189 1) Verbal Clues 190 2) Behavioural Clues 190 3) Situational Clues 190 4) Descriptive Clues 190 5) Symptomatic Clues 191 6) Resource Clues 191 7) Cultural Clues 191

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5. Suicide among the youth 191 1) Precipitants of Suicide 192 2) Predisposing Conditions 192 3) Warning cues to Suicide 192 6. Suicide among Young Married Women 193 1) Dowry Harassment 193 2) Husband’s Attitude 193 3) In-law’s Problems 194 4) Personality Factors 194 7. Suicidal Intent 194 8. Communication of Suicidal Intent 195 9. Suicidal Notes 195 10. Counselling 196 1) Empathetic Listening 196 2) Assessing Suicidal Danger 196 3) Distancing from the Means 197 4) Non-Suicidal Contract with Pacing 197 5) Preventing Imminent Attempt 198 6) Dealing with Underlying Issues 198 11. Conclusion 198

13 1. Introduction 199 2. Stages & Psychological Implications of Funeral 200 1) Separation 201 2) Visitation 201 3) Funeral Rite 201 4) Procession 201 5) Consigning 201

COUNSELLING THE BEREAVED

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3. Nature of Loss 201 1) Avoidable & Unavoidable Loss 201 2) Temporary & Permanent Loss 202 3) Actual & Imagined Loss 202 4) Anticipated & Unanticipated Loss 202 4. Types of Loss 202 1) Material Loss 203 2) Relationship Loss 203 3) Intrapsychic Loss 204 4) Functional Loss 204 5) Role Loss 204 6) Systemic Loss 205 5. Emotional Reaction to a Loss 205 1) Modelled on Elizabeth Kubler-Ross’ Stage Theory 205 (1) Shock 205 (2) Denial or Disbelief 206 (3) Emotional Reaction 206 (4) Physical Reaction 207 (5) Acceptance 208 (6) Remembering 208 2) George Engel’s Three Stages 208 3) Colin Parkes’ Four Stages 209 4)Comparison of Stage Models 209 6. Common Elements of Grief 210 1) Numbness 210 2) Emptiness, Loneliness & Isolation 210 3) Fear & Anxiety 211

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4) Guilt and shame 211 5) Anger 213 6) Sadness & Despair 213 7) Somatization 213 7. Patterns of Grieving 213 1) Searching for the Lost Object 214 2) Immoderation 214 3) Grieving is Spiral 214 4) Time Distortion 214 5) Grieving is Self-oriented 215 6) Grieving Never Wholly Ends 215 8. Goals of Grieving 215 9. Depression as a Grieving Process 216 10. Counsellor’s Intervention in Grief 216 11. Healing the Grieving by Rituals 217 12. Completing an Unfinished Business 217 13. Depression 218 1) Nature of Depression 218 2) Characteristics of Depression 219 (1) Affect 219 (2) Behaviour 219 (3) Physiology 219 (4) Cognition 220 3) Difference between Grief & Depression 220 4) Counselling the Depressed 220 (1) Affective Intervention 220 (2) Behavioural Intervention 221 (3) Physiological Intervention 221 (4) Cognitive Intervention 222 14. Conclusion 224

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1. Introduction 227 2. Addictive Personality 228 3. Personality Field of Addict, Player & Labourer 228 4. Drug Dependence & Abuse 230 1) Psychological Dependence 231 2) Physiological Dependence 231 5. Kinds of Drugs 232 1) Narcotics 232 2) Depressants 234 3) Stimulants 234 4) Hallucinogens 235 5) Cannabis 236 6) Unconventional Kinds 237 6. Causative Factors of Drug Dependence 237 1) Primary Cause 237 2) Secondary Cause 237 7. Signs of the Adolescent Addict 238 8. Comparison of Alcoholism & Brown Sugar 238

ALCOHOLISM 9. Effects of Alcohol 240 10. Pet Theories of Alcoholics 241 11. Stages in Alcohol Dependence 241 1) Early Stage Symptoms 241 2) Middle Stage Symptoms 242 3) Chronic Stage Symptoms 244

COUNSELLING THE SUBSTANCE ABUSERS

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12. Characteristics of Alcoholism 245 13. Alcoholic Games 245 1) Drunk & Proud 245 2) Lush 246 3) Wino 246 14. Alcoholic Women & Homosexuals 247 15. Treatment of Alcoholism 247 1) Biological Measures 247 2) Psychological Measures 248 3) Psychosocial Measures 248 4) Follow-Up 249 16. Counselling the Alcoholics 249 1) Hurdles to Recovery 249 (1) Unwillingness 249 (2) Psychiatrics Disorders 250 (3) People with Psychopathic Trends 250 2) Overall Approach 250 3) Stage-wise Approach 251 17. Conclusion 253

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1. Introduction 255 2. Group Counselling/Therapy 255 3. Types of Group Therapy 257 1) One-to-one (Vertical Interventions) 257 2) Interactional Here-and-Now (Horizontal Interventions) 258 4. Traditional Group Therapies 259 5. Intensive Group Expressions 259

COUNSELLING THE GROUP

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6. Encounter Group Therapy 260 7. Group Process in Encounter Groups 262 8. Group Process in Terms of Dynamics 263 9. Stages of Community Making in Group

Therapy according to Dr. M. Scott Peck 264 10. Advantages of Group Therapy 269 11. Casualties in Group Therapy 272 12. Risk Factors in Group Therapy 273 13. Group Selection 274 14. Self- Disclosure in Facilitator 275 1) Self- Disclosure in Facilitator 275 2) Self- Disclosure in Participants 276 15. Facilitator’s Role 277 16. Conclusion 280

CONCLUSION 283 REFERENCES (End Notes) 287 BIBLIOGRAPHY 308

*************** DEVELOPMENTAL PSYCHOLOGY

(TABLE OF CONTENTS) 1. Prenatal 20-22 2. Infancy 22 3. Babyhood 22 – 26 4. Early Childhood 27 – 30 5. Late Childhood 33 – 36 6. Puberty 44 7. Adolescence 44 – 49 8. Young Adulthood 54 – 63 9. Middle Age 68 – 80 10. Old Age 84 – 91

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Types of Counselling by

D. John Antony

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