Prevention, characteristics of counselling

Prevention, characteristics of counselling

• 1.
  PREVENTION Over the years, most mental health efforts have been largely restorative, geared toward helping people only after they have already developed serious problems. Unfortunately, the causes of many mental disorders are either not sufficiently understood or specific enough to enable practitioners to initiate targeted preventive programs. As a result, prevention in the mental health field is still based largely on hypotheses about what works rather than on substantial empirical research. Nonetheless, many professionals believe that preventive mental health efforts are worthwhile. In the past the concepts of primary, secondary, and tertiary prevention were widely used in public health efforts to describe general strategies of disease prevention. These terms were derived from public health strategies employed for understanding and controlling infectious physical diseases, and were thought to provide a useful perspective in the mental health field as well. Primary prevention Primary prevention is directed at reducing the incidence (rate of occurrence of new cases) in the community. Primary prevention efforts are directed at people who are essentially normal, but believed to be at risk from the development of a particular disorder. In primary prevention we are concerned with two key tasks: seeking out and eradicating conditions that can cause or contribute to mental disorders, and establishing conditions that foster positive mental health. Thus it includes biological, psychosocial, and sociocultural measures. As Kessler and Albee (1975) have noted, “everything aimed at improving the human condition, at making life more fulfilling and meaningful, may be considered to be part of primary prevention of mental or emotional disturbance” (p. 557). Primary prevention may be subdivided into universal, selective and indicated prevention (Gordon, 1983). Universal prevention measures are those regarded as desirable for everyone, and the decision to implement them is taken if their benefits clearly outweigh the costs and risks of implementing them (e.g. seatbelts, encouragement of safe drinking, reduction of cigarette smoking, healthy eating and exercise). Selective prevention measures are agreed to be appropriate when an individual is a member of a subgroup of the population (e.g. age, gender or occupation) whose risk of becoming ill is above average. Examples are good antenatal and perinatal care in pregnant women; health interventions in young unsupported teenage mothers; and social support for socially-isolated elderly people.
• 2.
  Indicated prevention measuresare undertaken for groups at high risk, such as for schizophrenia when a genetic susceptibility is strongly suspected, or for groups that have experienced severe, clearly defined, emotional stress, such as children exposed to disasters or violence. Physical measures. Here primary prevention begins with help in family planning and includes both prenatal and postnatal care. A good deal of current emphasis is being placed on guidance in family planning-how many children to have, when to have them in relation to marital and other family conditions, and even whether to have children at all. Psychosocial measures. In regarding normality as “optimal development and functioning” rather than as mere absence of pathology, we imply that the individual will require opportunities for learning needed competencies - physical, intellectual, emotional and social. A second crucial requirement for psychosocial health is that the individual acquire an accurate frame of reference-in terms of reality, possibility, and value assumptions. We have seen repeatedly that when people’s assumptions about themselves or their world are inaccurate, their behaviour is likely to be maladaptive. General sociocultural measures. The relationship between the individual and the community is a reciprocal one, a fact we sometimes forget in our prizing of individualism. We need autonomy and “space of free movement” to be ourselves, but we also need to belong and contribute to a community. Without a nourishing community, the development of individuals is blighted. Secondary prevention Secondary prevention involves efforts to reduce the prevalence of a disorder by reducing its severity and duration. Thus, secondary prevention programmes are directed at people who show early signs of disorder, and the goal is to shorten the duration of the disorder by early and prompt treatment. It emphasizes the early detection of maladaptive behaviour in the individual’s family and community setting. Thus it requires knowledge of the incidence and scope of maladaptive behaviour in specific populations, facilities for the early detection of such behaviour, and available treatment facilities in the community. Epidemiological studies. Science has found that most contagious physical diseases can be brought under control once their distribution and modes of communication are discovered by way of epidemiological studies. Epidemiological studies are also helping investigators obtain information concerning the incidence and distribution of various maladaptive behaviours in our society. Comprehensive community mental health centers. These are of particular significance because they mark a distinct trend away from the traditional state mental hospital approach. These centres offer at least five types of services: (a) inpatient care for persons requiring short- term hospitalization; (b) partial hospitalization, with day hospitalization for patients able to
• 3.
  return home evenings,or night hospitalization for patients able to work but in need of further care; (c) outpatient therapy permitting patients to live at home and go about their daily activities; (d) emergency care, with psychiatric services around the clock; and (e) consultation and education for professionals who have contact with members of the community. Crisis intervention. Crisis intervention emerged as a response to a widespread need for immediate help for individuals and families confronted with especially stressful situations (Golan, 1978; Rosenbaum & Beebe, 1975). Often such people are in a state of acute turmoil and feel overwhelmed and incapable of dealing with the stress by themselves. They do not have time to wait for the customary initial therapy appointment, nor are they usually in a position to continue therapy over a sustained period. They need immediate assistance. To meet this need, two modes of therapeutic intervention have been developed: (a) short-term crisis therapy involving face-to-face discussion, and (b) the telephone “hot line.” Consultation and education of intermediaries. Community mental health professionals, such as psychologists and psychiatrists, are able to reach a larger group of individuals in need of psychological attention by working through primary care professionals, such as teachers, social workers, and police personnel. Here the mental health professionals identify a population at risk for the development of psychological disorder and then work with personnel in community institutions who have frequent contact with the members of this population. Tertiary prevention Tertiary prevention is designed to reduce the disability and handicap associated with a particular disorder. It is preventive in that by reducing disability and handicap, it prevents many of the associated squeal of chronic illness. Tertiary prevention involves prompt and intensive inpatient treatment for patients whose disorders require it. Its double aim is to prevent the disorder from becoming chronic and to enable the individual to return home as soon as possible. It includes assessment, therapy, and provisions for aftercare following release. CHARACTERISTICS OF COUNSELLING Counselling denotes a professional relationship between a trained counsellor and a client. This relationship is usually person-to-person, although it may sometimes involve more than two people. It is designed to help clients to understand and clarify their views of their lifespace, and to learn to reach their self-determined goals through meaningful, well-informed choices and through resolution of problems of an emotional or interpersonal nature. (Burks and Stefflre 1979: 14)
• 4.
  Counselling as aprofessional occupation, therefore, derives not from the clinic but from more social settings. It focuses on helping persons resolve problems or role issues related to work or school or family matters. In this setting, the counsellor is a “problem solver” who through direct advice or non-directive guidance helps the client make rational decisions. The following can be said as the characteristics of counselling: 1. Counselling as a Relationship Counselling is sufficient for constructive changes to occur in clients (Rogers, 1957). The counselling relationship is characterized by core conditions namely empathy, unconditioned positive regard, and genuineness. 2. Counselling as a Repertoire of Interventions In counselling several questions (like which, when, and with what client) are answered and while interventions are decided an attempt is made to have a match between the client and the counsellor. 3. Counselling as a Psychological Process i. Goals of counselling have a mind component. ii. Counselling Process is psychological. iii. Underlying theories are psychological: Some psychologists like Rogers, Albert Ellis and psychiatrists like Berne and Beck have contributed enormously to counselling theories. For example, information about human nature has been derived from psychological theories. iv. Some people argue that counselling is not a profession as it is used in so many disciplines in so many sphere of life, e.g., loan counsellors, business counsellor, etc., but the difference is that professional counsellors work according to some theoretical model. v. Psychological research contributes both to creating counselling theories and to evaluate counselling process. 4. It is concerned with “normal” problems rather than mental health problems. 5. It is concerned with role functioning, with choices to be made, and with actions to be taken. 6. It is more concerned with present events than with past events. 7. It is more concerned with conscious, rational thinking than with unconscious functioning.
• 5.
  References: James C. Coleman, James N. Butcher, Robert C. Carson (1980). Abnormal Psychology and Modern Life, Sixth Edition. Illinois: Scott, Foresman and Company. Royal College of Psychiatrists (2002). Prevention in psychiatry. London. Richard Nelson-Jones (2005). Practical Counselling and Helping Skills, Fifth Edition. New Delhi: SAGE Publications India Pvt Ltd