HIV Counseling

A Acquired when a person has obtained something he/she did not have before or not genetically inherited I Immune against infection D Deficiency when a person lacks natural protection S Syndrome a collection of different illness Aids is caused by a virus called HIV Human it only lives in the body Immuno deficiency lacking natural protection against infection Virus a germ Goals of HIV and Aids Education at work place Help people examine their problems Help people make changes Help people maximize opportunities of their lives Help people adopt safer sex practices Help in creating awareness Help people to accept and care for HIV positive.

Modes of transmission Sexual contact Mother to child transmission Intravenous use

Rape/occupational exposure Blades and needles

Impact of transmission Workplace Individuals Poor health status Psychological disturbances which include self pity, isolation, depression, suicidal tendencies, stigmatization, low morale etc Disinterested in work Absence at work Financial implication Job discrimination Poor relationship with friends, spouse, children and relatives Revenge and hate Poverty due to medical expenses Death Change of sexual behaviour The family Loss of bread winner Strained finances, medical and education High drop-out of children

Causes break-ups Children are deprived of parental care and support Future plans are disrupted Young children bear the responsibilities of heading the family Stigmatization by community through isolation Community Loss of many lives Increased number of widowers and widows Reduced life expectancy Erosion of community strength Diseases that were under control have now increased e.g. TB Low labour productivity Health facilities over stretch due to high occupancy of HIV and Aids patients Social cultural factors that hinder behaviour change in HIV and Aids Cultural emphasis on reproduction/submissiveness and children marriages Some communities use virgins for ritual cleansing Condoms are often not available and accessible especially for young people Lack of communication skills Stress caused by condom use Use of alcohol No alternatives, making it difficult for people to change their sexual behaviour

Peer influence Unsupportive sexual partners Social cultural norms e.g. ritual cleansing, wife inheritance, polygamy, re-unions after separation

Myths about HIV transmission Playing team sports Airborne routes Casual skin contact Pets or insects Restaurant or cafeterias Sharing telephones Normal dry kissing Living with Aids patient HIV and Aids is for the poor HIV is not caused by Aids Witchcraft/curse Having sexual intercourse with a virgin cleanses HIV American ideal of destroying sex

Why counsel

HIV is fatal There is conflicting information about HIV/Aids People have to learn modes of transmission There is need for good management of the illness There is need for information of new infection Young people need to be informed about HIV and Aids HIV affects differently

Pre and Post HIV test counseling Pre-testing counseling Purpose

To provide individual being tested with personal, medical, social, psychological and legal implications of being diagnosed with HIV

Find out why individuals need to be tested Find out nature of their risk behaviour Steps to be taken to prevent infection or transmitting HIV infection

1. Guidelines for HIV pre-test counseling Reasons for testing

Is it for insurance Anxiety Forced test Reason What behaviour symptoms causes concern Has client sought counseling before These questions help the counselor know the individuals perceptions of their own high risk behaviour

Reasons for wanting a HIV test

Partner request Marriage Rape Curiosity Plan to become pregnant Referred by STD or TB clinic Guilt Confirming a positive HIV test Involvement with an HIV positive partner

2. Assessment of risk

How much risk How frequently History of clients sexual risk Any other risk involved e.g. drug user, sex worker, TB or STD, prisoner etc Blood transfusion for instance organ transplant, blood products Tattooing Piercing Traditional male/female circumcision Work related

3. Beliefs and knowledge about HIV infections and safer sex Meaning of HIV presence Meaning of window period Reliability of testing procedures Positive result is confirmed with a second test How the person will be informed of the outcome Need for further testing if they practice risky behaviour

4. Implications of HIV test result (post test) Should be discussed before testing information about advantages & disadvantages of the testing given

Advantages of testing Reduces stress associated with uncertainty Preventive treatment can be considered Symptoms can be confirmed and treated Anti-retroviral treatment can be started Decisions on family planning and future plan

Disadvantages Stress and negative effects of secrecy Dismissal at work Enduring stigma Limitations on life insurance Rejection and discrimination Problems in maintaining and making new friends

5. Anticipate results Feeling about the negative or positive results Who to tell about the result? Why that person? Where to seek medical help? How the results will affect relationships?

Who will provide emotional support?

Confidentiality of test results

Stress on confidentiality of test result by the counselor should client refuse to reveal their status

Permission to be obtained before anyone can pass on any information about HIV status.

Informed consent

The decision to be tested can only be made by the client Consenting has two elements i.e. information and permission Before a HIV test the client must understand the nature of the test No misleading or deceived into consenting to an HIV test

Information about giving the results and ongoing support Counselor should explain to the client; when, how and by whom the results of the test will be given

Assure personal attention, privacy, confidentiality and ongoing support Follow up interview should be arranged

Positive living Eating balanced diet

Acceptance Treat opportunistic infections early Exercise regularly Avoid re-infection

Aims of HIV counseling at work place

Helps focus on the person not the disease Helps the affected deal with anticipated grief Helps in understanding the importance of not spreading the disease Assist the infected and affected understand the disease process

When to counsel at work place

Those found HIV positive during routine screening Those diagnosed as having Aids Those with Aids related screening Counseling should be available at work place whether people are negative or positive

Alcoholism
Alcohol is a drug that depresses the nervous system and often changes the behaviour. Alcoholism is preoccupation with consumption of alcohol and impaired ability to recognize the negative effects. General effects of alcohol

Causes depression Fear traits Brain damage Heart diseases Loss of memory Negative influence Poor health Infertility Family dysfunctional Absenteeism at work place Know it all attitude Hostility in students e.g. indiscipline, uncooperative students, reduced interest in academic work etc.

Stages of addiction 1. Social use one is in charge and in control 2. Tolerance increases intake still in control but level of being in charge decreases 3. Dependence performance gets down i.e. cannot perform without alcohol or drug 4. Addiction entirely dependent on the drug 5. Abuse use of drug in process that was not intended

Social effects of alcoholism Increased risk of committing criminal offenses Domestic violence Rape, incest Loss of employment that may lead to crime and financial problems Loss of respect

Legal consequences Can be charged in court of law for public disorder or behaviour disorder

Alcohol withdrawal Alcohol increases the stimulation of GABA recipient, promoting central nervous system depression. With repeated heavy consumption, these recipients are desensitized and reduced in number resulting in tolerance and physical dependency thus when alcohol is stopped suddenly, the nervous system suffers from uncontrolled synapse firing which result into life threatening seizures, delirium tremors, hallucination and possible heart failure.

Management Total abstinence based on nil by mouth Harm reduction approach gradually reducing alcohol Focus on helping people discontinue using alcohol

Steps (a) Detox treating with drugs (b) Rehab (c) Training (d) Social support in order to resist return to alcohol

Theories Theories helps make sense of experiences. They give understanding of a particular strategy, counseling approaches and tools helping in determining how to use them.
1) Moral theory (Aristotle, 1930)

According to the moralists, alcoholism is caused by lack of will power or by moral deprivation. Moral will power and determination are sufficient to overcome addiction.

Limitations No research conducted Has tendency to belittle the abuser Family, culture, genetics was not considered

2) Diseases model (Jellinek, 1950)

Substance abuse is a disease with signs symptoms and disease progression. As a disease, substance abuse can be treated. Also believes the individual has the sole responsibility for recovery. Strengths

Removes stigma Relieves them from feelings of shame and guilt It gives hope for favourable prognosis Lays foundations for treatment programs and self-help groups It allows research

Limitations It can be misused by the abuser to avoid responsibility and treatment Critics argue that it is unscientific concept There is no difference between alcohol and other substance abuse in treatment

3) Genetic model (Goodwill, Picker) They look for biological reasons. Strengths Research has been done and this forms a foundation for further research and treatment Intergenerational studies give overview of trends in frequency in the generation

Limitation There is a dispute in research methods and conclusion

4) Behavioural theory Believes addictions are learned and socially acquired. Strengths Behaviours are easily observed Behaviours are easily measured Treatment goals are easily formulated

Limitations

Individuals are treated in isolation from the family and social system Does not address the biological aspect

5) Family system theory Alcoholism run in the family therefore children of alcoholics has a tendency of developing alcoholism. However, some children of alcoholics never become alcoholics. The family system change to accommodate the abuse with family members adopting to keep the family functioning e.g. wife takes husbands role, children take parents role.

Structural responsibility of alcoholic families 1) Alcohol families have rigid boundaries restricting conduct with outsiders. They use secrets to protect family from share 2) They form coalition where children take caretaking and parenting role
3) There are various roles played by children in alcoholic home/families

(a) Responsible child a hero who plays the structural role

(b) An adjuster (the lost child) normally withdrawn and to reduce strain

(c) Scapegoat absorbs blame for the family dysfunction (d) Clown (mascot) distracts family from pain by laughing Placate they never ask for help and spend time helping others Scapegoats they have a low self-esteem and self fulfilling profess that is they have self destructive tendencies and prone to addiction. Clowns (mascot) they party and they dont take themselves seriously. Humour helps them to avoid underlying conflict.

Strength

It identifies relationship that act as underlying factors in maintaining maladaptive behaviour

Parental predisposition of transmitting alcoholism can be addressed in therapy Sociological forces and relationship that influence development of addiction is considered

Counseling in alcoholism 1. Affective education Involves helping children, adults to identify their feelings Helps them feel valued and accepted and this builds self-esteem

2. Values clarification When values are clarified it assists in decision making skills

3. Alternative to alcohol abuse Teaching alternatives e.g. relaxation, meditation, exercises etc. 4. Social skills Teaching personal and social skills e.g. problem solving assertiveness saying no to alcohol, leadership skills, methods of resistance, recognizing peer pressure.

Treatment 1) Medication helps to re-establish normal function and prevent relapse and diminish craving. Prescription for alcohol are disulfiram, acamprosale, naltrexone
2) Behavioural treatment (a) Modifying attitudes through communication skills, time management skills and

assertiveness
(b) Incentives use of positive reinforcement to encourage abstinence (c) Residential treatment where patients remain in residence between 6 12 months.

These are patients involved in long history of addiction. Impaired social function, involved in crime 3) Motivational interviews (high challenge) it motivates change

Wheel of change
1. Pre-contemplation (not taking drug) the individual is unaware they are addicted. Their

addiction is working for them. They can convince people that addiction is okay. They have no interest to change.

2. Contemplation (thinking loud) they start to think they are in problem. They start to weigh

pros and cons. Contemplation can appear quickly and disappear quickly, to change or not to.
3. Determination (transition period) the individual need confidence that it is possible to

change.
4. Action (decision period) the decision is made to change. Depression sets in, there is loss

and grief, there is a lot of free time, the addict re-invest and re-accept themselves in the new status. They need support and therapist must find ways of filling the void.
5. Maintenance the aim of the maintenance is to help the individual to maintain status quo.

Does not mean that the individual must be watched but therapist should be constantly being there. 6. Relapse when individuals return to old behaviours. They are ashamed, are embarrassed etc. relapse is a natural pass of a cycle as the client view it a failure. He/she may go back to contemplation.

Strength of the wheel of change 1. Works as a motivator

2. Acts as a framework provides a better understanding to the client.

Stress and Stress Management

Stress is a psychological reaction to any stimuli perceived to be difficult to handle or to cope with. It is the bodys reaction to anything that is psychologically. Basic components of stress (a) Stress agents stressors i.e. actual circumstances which produces stress (b) Stress response individuals reaction to stress (c) Distress psychological or physiological response of the body perceived to be demanding negative or difficult to handle (d) Eustress physiological or psychological response of the body to anything perceived to be positive, easy to handle and one which an individual is able to cope with e.g. promotions, weddings, graduation etc.

Causes of stress Internal causes factors within institutional which may cause stress (a) Conflicting choices i.e. choosing between two or more options causes stress due to difficulties involved.
(b) Individual circumstances i.e. involves being in a hurry concerning issues around you,

inability to predict the future (c) Self i.e. includes personally type especially type A which is associated with high levels of arousals leading to stress. Includes phobias and irrational beliefs.

External causes (physical or social environment) A person may be stressed due to

Untidy environment Plenty/lack of space High/low levels of noise Day to day frustration Stressful events

Signs and symptoms of stress Physical stress

Dry skin (lips, face, hands, face, scalp) Unkempt Fatigue Pain attacks Backache/shoulder ache

Excessive sweating Increased heart rate Tingling (pins & needles) Difficult in swallowing

Behavioural symptoms Trembling, aggression, insomnia Emotional outbursts

Cognitive symptoms

Confusion in thinking Lack of concentration Being irrational Negative thoughts Forgetfulness

Emotional symptoms Anger, depression, anxiety Emotional outbursts

Effects of stress Over eating Insomnia Excessive drinking Withdrawal Forgetfulness Increased heart rate Difficult in swallowing Muscle and backache Numbness Aggression Stomach ulcers Irregular menstruation High fever Asthma Migraine Diarrhoea Skin rashes

Personality and stress

Researchers have looked at different personality type and come up with the following: Type A personality

Includes being ambitious and they react more explosively to stressors They are stressed by challenges others would consider mild They are vulnerable to heart diseases, attack or stroke They also do several things at the same time

Type B personality They are more relaxed and approach life in a much less hurried style They are less frustrated by the flow of life events and seem to be in more control and tolerance N/B majority of people fall between A or B

Hardy personality View stressors as opportunity for growth. They have three attitudes called 3 Cs (i) Challenge they welcome change as a challenge not a threat
(ii) Commitment they make focused commitment to engage in purposeful activity solving

problems and meeting the challenges they face.

(iii) Control they have internal sense of control over their actions and experiences. The key to

hardiness is an ability to face stress with a smile.

Stress at work place

Occupations can be a source of chronic stress. Medical practitioners, doctors, nurses might deal with life and death at every single interval which can be very stressful.

Sources of stress at work

(a) Workload an overload of work is stressful that is having too much to do and very little

time to do it. It also applies in work where one has under load, having too little to do and a lot of time. (b) Clarity of job description the lack of clearly defined role and responsibilities or rigidly defined roles, calls for anxiety and stress. (c) Physical variables lack of enough space, noise, cold or hot temperature, pollution as well as confinement to a desk. (d) Job status people with low status jobs experience psychological discomfort.
(e) Mental challenge jobs that tax beyond their mental capability. They provoke feelings

of inadequacy. (f) Human contact people need varied degrees of human conduct, some jobs have no human contact while others have excessive contact. (g) Physical challenge depending on the physical activities some jobs can be stressful e.g. skyscrapers, construction work etc.

Stages of workplace stress 1. Honeymoon stages It is characterized by euphoric (excitement), enthusiasm, challenge, motivation and pride to a new job. After sometime crisis may arise which can be marked by dysfunctional processes or behaviours that rob energy reserves in coping at adapting to new environment?

2. Full throttle stage Feelings of loss fatigue and confusion arise because of rapid depletion of energy reserves. Other symptoms include dissatisfaction and sleep disturbances. 3. Chronic stage The person enters into a crisis. It is characterized by escapist attitude e.g. overeating, drinking or smoking. 4. Hitting the wall Characterized by long chain of stress that robs energy reserves. This results into burnout and can result into one reaching the end of their professional career. Burnout is a state of depleted energy reserves characterized by disinterest, dissatisfaction, lowered immunity and inability to function. It is a result of unmanaged stress and lack of energy reserves.

Stress management strategies and techniques

Strategies 1. Social support allowing self nourishment and maintaining a number of people at home, work or in the community that can be counted for emotional support.
2. Assertiveness develop competence of saying no in order to decrease other demands and

stress from your relationship.

3. Exercise it helps to maintain a healthy body and mind. They allow individuals to expand nervous energy built up to achieve home tasks. 4. Nutrition a healthy diet is necessary 5. Sleep adequate sleep that is essential for feelings of competence, emotional functioning and self-worth.

Techniques Cognitive techniques

Maintain positivity and accept things you cannot change Modify expectations and be flexible Thinking and acting constructively develop a strategy that will help maintain focus Cultivating a sense of humour a few minutes of laughter is healthy Taking control taking charge when the environment is controlling you

Know your prime time for working (morning, evening, afternoon)

Find time to relax and do one thing at a time

Concentration techniques Meditation a way of telling your mind to be quiet

Deep breathing it quietness and changes rapid breathing effective for on spot stress Bio feedback mechanical monitoring of stress responses through sweating, heart rate, skin

temperature or muscle tension. Time management techniques

Time management is about self management. It requires discipline. Time management

include identify your own time wasters, prioritize your activities, prepare a time schedule,

learn to say no, avoid procrastination (delaying) postponing and listing activities according to its importance.

Conflict management
Conflicts are a fact of file. It can be seen as a situation in which interdependent people express difference as they experience interference from each other.

Types of conflicts
1. Interpersonal conflict conflict between two people generated by differences e.g.

differences in perception
2. Inter group conflict it is between two different groups where each group adopts a position

directly opposed to each other e.g. tribes, departments

3. Inter organizational it is between schools, organizations, companies and countries 4. Structural conflict this are caused by forced external to the people in dispute, geographical

constrains, limited resources, time organization.

Conflict management strategies

1. Avoiding (lose/lose strategy)

Pretending conflict does not exist Being uncooperative Down playing disagreement Withdrawing from the situation (being neutral at all costs)

When avoiding is best used When the issue is trivial

When there is no possibility of resolving the issue

When potential damage is likely to out-way the benefits of resolutions Implications No one acquires their desires
Temporal or peaceful co-existence result in reoccurrence in future

Underlying reasons remain unresolved

2. Controlling (win/lose strategy)

Involves use of future Being uncooperative but assertive Working against the wishes of the other party Disregard of the consequences Implications The issue is not addressed Similar problems are likely to arise in future
One party achieves their desires at the expense of the other

When controlling is best used When the matter borders indiscipline

 When quick decisive action is vital

3. Accommodation (loose/win strategy) One party yields to another usually to protect and preserve the relationship. Involves being cooperative, letting the wishes of the other party rule. Implications Root cause of the problem is not addressed There is grumbling due to suppression When accommodation is best used Used as a stop gap measure When the issues involved are considerably more important to one party When continual competition could damage the relationship

4. Compromise (win/min. lose strategy)

Involves moderate cooperation and preserving the interpersonal relationship as much as possible Implications Neither party is completely satisfied Ground is left open for a similar conflict in future When compromise is best used When the goal of the outcome of the conflict is not worth time or energy When a quick and temporary settlement is acceptable

5. Collaboration/problem solving (win/win strategy) Confronting issues Being both assertive and cooperative Recognizing there is a problem to be saved N/B It is most desired style Implications The problem is likely to be solved once and for all The origin of the problem is addressed Genuine relationship is established The parties are likely to be satisfied When collaboration is best used When no party has a good solution When concerns are too important for compromise

Keys to resolving conflicts Stimulation of communication between two parties Correction of misperceptions Enhancing accurate perceptions

Communication and conflict resolution

Communication plays a major role in conflicts. It is the identifying tool of groupings and it

is the medium through which conflict is created It is the basis of power and the interaction between individuals It is used in resolving conflicts It assists in expressing feelings

Techniques of conflict resolutions Short term techniques 1. Intervene (step in) the key is to communicate you are these 2. Separate consider territorial orientation. It should be done in a way that reflects integrity
3. Listen and hear do not leave anything to chance, be firm and flexible, allocate enough time

to each party. Explore in depth, neutralize irrelevant comments and do not blame, take action and draw agreement.
4. Explain explain the reason for agreement and your reason and role in the helping,

dont promise.
5. Consult check your line of authority and communication. Keep to the facts and do not

underestimate the importance of the conflict.

6. Monitor visibly monitor the progress of the agreement. Go through procedures if

necessary.

Long term techniques 1. Monitor progress

2. Improve the structures 3. Improve lines of communication 4. Market a sense of shared values and aims
5. Stop the conflict from resurfacing

Enemy and enemification An enemy is a value laden emotionally charged person who is a recipient of a specific negative value and meanings. Opponent is one who is against something and competes or argues against the different view or tries to change it. Enemification is a process of creating negative value associations thus process of creating enemies. Involves injection of power into conflicts.

Characteristics of enemy and enemification Cruelty Judgmentalism Categorizing Division that brings out distinction between them Language that is dehumanizing

Importance of enemies Helps create history It is the fuel that drives human social behaviour Provides something around which group members can rely on Helps to know feedback and our blind spot

Causes of hatred
Desire to harm which requires justification through creating enemity

To divert attention from individual problem e.g. political leaders who blame unstable previous and past regimes Claims of superiority e.g. race, religion Lack of human contact
Identity in that if it is threatened the results is enemity

Authoritarian Restrictive environs

Process of enemification
(a) Threat it may be real or unreal but the perception matters (b) Distortion meanings are forced on situations in an attempt to adapt or protect (c) Rigidification hardening of everything construed as true to build a wall of protection. At

this stage, me/him, us/them emerges

(d) Coalition both parties find needs and are satisfied by the conflict

Collective behaviour It is actions of a large group of people responding in a similar way to an event or a situation. Collectives are large and organized gatherings springing spontaneously and existing for a brief period before they fade away.

Examples of collectives (a) Rumours Rumours are unclear, unfounded reports on a subject, issue or a person especially the leader. They may be spread through an assembly of people or be transmitted among people who are geographically dispersed. In workplace, they are spread through grapevine (informal channel). Rumours may contain some element of truth but people have the tendency to add whatever pleases them before they pass on the rumour to the next person so that the final product is either outrageous or absurd. Rumours thrive when tension is high and once it starts it does its rounds until it is countered with authoritative information to the contrary. Sources of rumours Individuals Print and electronic media Internet/media

(b) Gossip Unlike rumours, gossip is about individuals, peoples life and affairs. People may gossip about people they know or do not know. People do not bother to find out whether there is some truth in

the gossip and what they hear about. At work place gossips revolves around leaders and their families or generally leadership. Benefits of gossip 1. Proper behaviour in social settings can teach you how to act when you find yourself in social gathering.
2. Helps relieve stress in that having a gossip with a friend can actually help unwind. 3. It promotes social bonding. We gossip with people we can trust. 4. Gossiping helps you change. Most people mend their lives because they were not getting

positive feedback from friends, workmates and family members. Disadvantages It causes hate, problems between people harm and pain to others It damages the personal reputation It decreases morale and it is a waste of time

Religious opinion Christian finds it guilty and equals it to murder. Judaism gossip is a sin even if what is stated is true. Islam prohibit both speaking and listening to gossip it equals backbiting to eating flesh of ones dead brother while untrue remarks about people is a major sin.

How to deal with gossip at workplace (techniques)

1. Make the values of the organization clear. Clear with what will not be tolerated. Provide a

suggestion box (confidential).

2. Teach employees how to address gossip on their own e.g. confrontation + diplomatic +

confrontation gossiper will retreat if they are confronted.

3. Keep communication lines open whereby be willing to listen to issues from subordinates

and divulge information as well. Being in front of the problem first by getting information to your staff about a problem. 4. Do not shoot the messenger. Do not take a negative action against the person who raises an issue you kill any thoughts your staff might have of doing the same thing in future thus they will complain among themselves causing a vicious cycle of gossip. 5. Refuse to be drawn in. This is a good way of stopping gossip. Try to change the subject subtly. If they gossip about Mary, talk about Marys child instead.
6. Focus on solutions not problems. A group of works might be concerned about an issue, ask

the group for solutions other than joining in the gossip. Focusing on solutions will take away the urge to gossip.

Loss/bereavement and counseling skills Loss Greif is ongoing experience and goes through stages. It is a process of experiencing psychological, social and physical reaction to loss.

Mourning is the conscious and unconscious process of gradually undoing the psychological ties that bound the person to their level. It helps a person to adopt to his/her loss. Helps a person to learn to live in a healthy way without the other person. Bereavement is the state of having suffered a loss. Anticipated grief is where one goes through the grief process in advance. Complicated grief is when all the signs of grief are exaggerated e.g. wailing as though the person is alive. Delayed grief is post and suppressed. It is activated by another persons death. Prolonged grief is hidden in psychosomatic problems e.g. ulcers, high blood pressure.

Types of losses
1) Physical loss loss of body organs; breast, uterus, arm, leg etc. Loss of a person, pet or

property e.g. demolished buildings. 2) Symbolic divorce, status, demotion 3) Human development childhood, beauty, physical strength, children getting married
4) Competency loss graduating from a class, end of therapy session, children leaving home.

Phases of grief (a) Shock and numbness The time immediately after receiving news. It comes as a shock. The news may not seem real. Others deny to protect themselves from pain. (b) Guilt

People may experience sense of failure. They may search for forgiveness. There is a sense of if only. (c) Anger It is a normal reaction. It is usually directed to a person who has died. It has to be expressed so that it does not cause depression. (d) Depression A natural response related to sadness. It is normally a difficult time and people should be given time to get over it. (e) Resolution It is marked with acceptance, able to move on and develop relationship with others.

Counseling interventions 1. Create a conducive environment 2. Allow clients to cry 3. Provide them with time to grieve 4. Help client acknowledgement their feelings 5. Examine defenses and coping styles 6. Given them continued support

***************************** The self concept This a persons internal view of self relation to the experiences of being and functioning within the environment. The healthier the self conceipt the higher the self-esteem. Body image: - How we think our body looks is always acceptable to us. Self Image: - it explains who and what we are of mothers, teachers, counselor Self esteem: - it revolves around the way we value ourselves. Ideal self- what we would like to be. Role of Counselor To have no role To provide a conducive environment

Role of client To be open to themselves To trust in themselves To have internal evaluation To allow themselves to be.

GESTALT German word (whole) (Fredrick Solomon Frits Peris) Focuses on heightening the individual awareness of responsibility for his behaviour; feelings, thoughts including those he may be unaware of.. Key concepts 1. View of human nature Each person is responsible for his own destiny. Focuses on clients reality People have the capacity to be good or bad People have the capacity to change given the opportunity.

2. The here and now Nothing exists except in the now and the future. Is yet to come but now is here the past is gone and the future is yet to come. 3. The figure and the ground People engage life on figure which is the most object min our awareness and ground focuses on what is needed now. Figure is the pressing need and requires the ground now; not fulfilling this now brings frustration and disturbance. 4. Unfinished business Unfinished business includes, anger, hurt rage pain, grief resentment. Unless unfinished emotions or situation are recognized, they keep on interfering with the present awareness e.g. transference.

5. Avoidance It is related to the means people use to keep themselves from feeling and facing uncomfortable situation. Most people would rather experience painful emotions that do what is necessary to change therefore they get stuck and are unable to grow.
6. Polarities: - Is when a person is emotionally unstable. Gestalt goal is to bring a person to

balance.
7. Energy block: - Blocked energy is a forth of resistant. Fritz said that verbal is foreign but

mob-verbal is real. Sign clients are energy blocks and transform them into more adaptive behaviour.

PEELING THE ONION Layers of neurosis Heartbeat of gesture whereby individuals must strike of five layers of neurosis in order for them to achieve psychological maturity
1. Phony layer Playing games Shallow communication Living in fantasy Covering real emotional pain

2. Phobic layer
Avoiding emotional pain Fear of being rejected Use of defense mechanism e.g. reaction formation, projection, self-blame (Introjection)

3. Impasse layer People feel stuck

Not sure of survival They convince themselves that may have no energy to move beyond dark points. They feel emptiness. They manipulate the environment by playing helpless games, confused, lost and stupid expecting others to see, hear, feel and decide for them. It is important to feel the emptiness instead of denying or running away from it. 4. Implosive layer We fully experience our deadness. Feeling dead inside air cut from former oneself.

5. Explosive layer

People expose their defense They begin to set in touch with the true person The person realizes he has the potential therefore becomes a live.

Techniques of Gestalt i) Dialogue exercise Clients dialogue with their parts so that they can become whole ii) Empty chair technique Helps the clients to express their unfinished business iii) Dreams The clients are asked to act all the parts which were on the play. They are experience the dreams in here and now. iv) Rehearsal technique

Help clients become more aware of degree to which they want to be approved, accepted and liked and the extent to which they go to attend this dysfunctional goal. v) Taking responsibility Helps clients accept their feelings instead of blaming and projecting them to others. (Making rounds)
vi) Staying with the feeling making the clients stay and feel the unpleasant mood and wound

want to forest. Helps them endure the pain, making way for newer levels of growth. Role of therapist Focus on energy block and avoidance to create awareness. Help client transit from external to internal support Challenge client to learn to use their causes and get touch with their body message. Focus on clients feelings and awareness in the present.

Ego defense mechanisms (Gestalt) Retroflection: - Directing an action toward oneself rather than others. Deflection: - Failing to make contact with self and others as individuals. Confluence: - The client identifies with another person so much that the clients psychosocial boundary with the other person becomes blurred. Projection: - Disowning certain aspects of self and putting on to others those attributes of personality. Introjections: - Assimilating standards, concepts and attitudes and beliefs imposed by the people.

Goals of therapy 1. Create awareness

2. Helps client take responsibility of their decisions and choices

3. Helps client deal with their unfinished business and release their potential 4. Helps clients reach for their psychological health and live a fuller life

PSYCHOANALYSIS Structure of personality ID biological component of personality It is demanding It is illogical It never thinks but only wishes It is largely unconscious Ego the executive that governs controls and regulates personality and therefore it is called reality principle. It represents tradition value of the society. It inhibits the ID impulses to persuade the ego to substitute moralistic goals. Super ego it is the judicial branch of personality. It is a persons moral code and its main concern whether an action is wrong or bad. It represents traditional values and ideas of the society as they are handed down from parent to children. Consciousness and unconsciousness The unconscious cannot be studied directly. Very little of what exists in our mind is not in the awareness. The greater part of what is on our mind lies in the unconscious while the tip of it is in the consciousness (just like an iceberg). The unconscious is one of the greatest Freuds contribution and stories up all experiences, memory and retraced material. ID just rape Ego negotiate, seduce Super ego get married and have sex legally Ways of getting material from unconscious (techniques) 1. Dreams symbolic representation of unconscious wishes and needs

2. Slip of the tongue and forgetting 3. Free association allowing the client to speak whatever gets into their mind without censorship
4. Projective technique materials we get from projective e.g. hand, clouds

5. Post-hypnotic (hypnosis) Anxiety It is a state of tension that motivates actions or behaviour. It serves to warn of impending danger. Types of anxiety 1. Reality anxiety it is the fear of danger of external world 2. Neurotic anxiety it is the fear that instinct will get out control and cause one to do something that is punishable. This comes from the ID.
3. Moral anxiety it is the fear of ones own conscience. It leads to quit.

Ego defense mechanism These are normal behaviours that protect the ego from being overwhelmed. Characteristics of defense mechanisms

They deny reality They distort reality They operate at unconscious level They help the ego to cope with reality by helping the ego to buy time and see what is realistic

Examples of defense mechanism Repression process through which threatening thoughts are excluded from awareness Denial closing ones eyes to reality Projection attributing to others ones own unacceptable desires and impulses Reaction formation replacing unacceptable feelings with the opposite. Hate may be replaced by love Rationalization justifying beliefs and actions by given reasons to explain failure or loss. It helps in softening the wounds connected with disappointment Sublimation diverting sexual or aggressive behaviour into creative behaviour

Psychosexual stages of development Development of personality

1. Oral stage (0 1years) mouth and lips are pleasure zones. There are two characteristics

i.e. oral incooperative behaviour and oral aggressive behaviour. If there is ingratification, the person becomes aggressive e.g. hostile, gossipers, insulters, sarcastic. They fear loving and affection, they fear reaching out to others, they have low self-esteem and they are withdrawn.
2. Anal stage (1 3years) the challenge is becoming independent. The one who is scolded

because they didnt control their bowel. Develops anal aggressive tendency i.e. they become disorderly, cruel and display their anger anywhere. The one who was congratulated develops anal tentative i.e. they are stingy, they like being productive and they have extreme orderliness.
3. Phallic (3 7years) the ID impulse transfer to the genitals and the child finds pleasure in

genital stimulation. The boy develops Oedipus the mother becomes the love objects for the boy. The girls develop Electra complex she imagines the mother cut of her penis. She competes with the mother but later realizes she cant compete. If they do not identify, they may have problems. There is fixation of homosexuality, suffer from guilt, low self esteem, may have severe conflict and masturbation.
4. Latency stage (7 11years) sexual instincts die. There is calmness, they acquire new

social values outside the family. They develop peer relations if not allowed to play they develop low self-esteem, withdraw etc.
5. Genital stage (12 18years) impulses of genital stages may appear. They are now able to

love. They are free to work or develop a career. If development has been successful during stage it leads marriage and raring of children. Person centered approach (Carl Rodger) View of human nature Human beings are like plants and when nurtured well they thrive

Human beings can develop in a positive and constructive way if the climate of respect and trust is established

Actualizing tendency It emphasizes that clients have the necessary resources for dealing effectively with their own problems

Maslows hierarchy of needs Abraham Maslow worked with Carl Rodger but differed a bit. He came up with a series of activities which he believed gave satisfaction, purpose and meaning of life. They include

Self Actualization

Self Esteem
Relationship needs Sense of belonging

Sociological factors Security safety

Physiological needs The core conditions

Food, shelter, clothing, sex

Genuineness willingness to be real and honest. There is no hypocrisy and the counselor need to know themselves first. Purpose of genuineness Help facilitate a therapeutic process A genuine therapist is able to effectively listen and attend to the client Empathy ability to understand identification with a client Purpose of empathy

Helps clients to recognize and resolve their conflicts

 Encourages clients to dig deeper into their material The counselor is able to reflect UPR (Unconditional Positive Regard) positive attitudes the counselor has towards the client. Complete acceptance of the other person. Value and price the other person, respect the client. Purpose of UPR The client digs deeper when the counselor respects their feelings

The client is able to accept themselves and become more confident

Role of person centered therapy Help clients accept themselves Provide conducive environment Assist client in growth process Focus on the person not problem Limitations

The therapist has no role

There are no techniques The clients past not considered Not all clients are self directed Not effective in behavioural issues PSYCHOSOCIAL STAGES (ERICKSON ERICKSON) Erick Erickson investigated whether such characteristics such as feeling either competent or inferior appear to be learned based on support we receive when growing up. Although he was influenced by Freud he believed that the ego exist from birth. He felt the cause of development is determined by the interaction of the body that is genetic and biological programming. He organized life into eight stages:-

1. Trust Vs Mistrust (0 18 months) The main emphasis is on the mothers positive and

loving care for the child, if they fail to experience trust, they develop feelings of worthlessness and mistrust. The most significant relationship is with the mother or caregiver.
2. Autonomy Vs Shame and doubt (18 months 3 years)

They learn to master skills (walking walking) They learn toilet training They are very vulnerable.

If they are made to feel shame during learning skills and toilet training they may feel shame and doubt their capabilities suffer low-self-esteem. Most significant is with parents.
3. Initiative Vs guilty (3 5 years)

They experience the desire to copy the audits around them. The makeup stories with dolls, toy phones, toy cars and play out roles as they experiment. Erickson agreed with Freud that during this age group, the Oedipus struggle and it is resolved through social role identification. If individual are frustrated over natural desires and goals they may easily experience guilt. Most relationship is with the basic family.
4. Industry Vs Inferiority (6 12 years)

significant

Often called latency stage. They learn and accomplish new skills and knowledge, therefore developing a sense of knowledge. It is also a social stage and if individuals experience unresolved feelings of inadequacy serious problems and lack competence and self esteem. The most significant relationship is with the school and neighborhood not parents.

5. Indentify Vs Role confusion (13 18 years)

At this stage development depends on what is done unto us. Development depends on what we do. Here we try to find identify and life gets more difficult. The task is to discover who we are as

individuals. If we are unsuccessful in navigating this stage, we will experience role confusion. Most significant relationship is with peer group.
6. Intimacy Vs Isolation (18 35 years)

Individuals try to find mutually satisfying relationships through marriage and friends. When they dont find it easy to find friendship and relationship they can develop a defense of feeling superior to others. Significant relationship are with friends and marital.
7. Generativity Vs Stagnation (35,40 55,65)

At this stage, individuals tend to be occupied with creating meaningful work and with issues surrounding their families. They care for others and produce something that contributes to society (generativity). They fear meaningless and in activity. If they do not go through the successfully they become stagnant and self absorbed. Relationship is at workplace, the community and family. 8. Integrity Vs Despair (55/65 plus death) It is about recovering from middle adulthood. They can look back at their life with happiness feel fulfilled. A feeling called integrity. Some may reach this stage and despair due to failures. They may fear death wondering whether life was all with it.

Behavioural theory The 2nd force in counseling. It was started by JB Watson B.F Skinner Albert Bandura. It came as a departure from psychoanalysis. The psychologist argued that behaviour is observed and it can either be learned Unlearned Re learned.

They came up with (3 theories) of learning to explain behaviour

1. Classical conditioning (Ivan Pavlov)

He specialized in animal psychology He introduced meat to a dog and the dog salivated.

He introduced meat powder with bell ringing and realized every time the bell rung the dog salivated.

He observed that the bell had acquired the power to evoke a response from the dog. He generalized the theory to human beings.

2. Operant conditioning Consist of behaviour that exists in an environment to produce consequences. Behaviour will re occur if it is followed by reinforcement. In its absence learning cannot occur. There two reinforcement
a) Positive reinforcement: - Rewarding people because of gained pleasure or satisfaction. b) Negative reinforcement: - refers to removal of something undesirable to a person to bring

about change.

3. Social learning - (Albert Bandura)

He argued that learning takes place in social context. What we from environment determines our behaviour and also the change of their behaviour. Techniques Assertive training: - Clients are taught to be firm. They are encouraged to be confident and express themselves. Flooding: - Clients are put in most threatening situation, after they are successful in handling it they are able to overcome the behaviour. Relaxation: - it aims at muscle and mental relaxation. Role play: - clients practice a new behaviour until they are satisfied and able to leave the maladaptive behaviour. Aversive training: - Subjecting a client to unpleasant feeling to produce the desirable behaviour.

Systematic desensitization Way of doing things gradually starting from the least. Client is asked to describe his anxiety concerning his issue and rank it with related events. If the client is overwhelmed at each, particular stage, he produces relaxation exercises. Goal of therapy It eliminates mal-adaptive behaviour. Helps to unlearn the learnt behaviour and relearn a new one. Equips client with skills technique to deal with other related issue.

Role of therapists -

Helps the clients come up with desirable behaviour Be a role model Choose appropriate techniques. Exhibit warmth, genuineness and acceptance.

The role of the client They are to determine pursue and evaluate desirable behaviour. They must be motivated to perform therapeutic activities within the session and outside.