Introducing the Client and Presenting Problems

The clients are Penny’s family who are experiencing a range of problems and are interested in knowing the probability and applicability of couple, family and group counselling for her family. Sam is Penny’s husband of five years. They are of different cultural and backgrounds. Penny has a South-African and Australia background while Sam is of Chinese background. Penny is a part time nurse and Sam is a producer for a popular TV show. Due to Sam’s career, he is rarely at home as his work takes him across the world to shoot the show.

Both Sam and Penny have previously been married and Sam has a seventeen year old son, Peter, from a previous relationship. Penny also has two daughter from a previous relationship; Monique who is fifteen and Sarah who is twelve. Sam, Penny, Peter, Monique and Sarah live together. Monique and Sarah still see and talk to their father, Dal, who has since remarried with two children. Dal is from a Finnish background and lives in another city from Penny and Sam. Peter lost his mother to cancer about eight years ago. An addition to the family is Dawn, Penny’s sister, who frequently visits the family. She has been left with two sons, Tom who is seven and Tim who is five after a divorce.

There are a series of issues surrounding the family that is Penny’s concern. The first set of issues relates to the children of the family. Penny is concerned about Peter, who is in his final year at school but is not keen on his studies. He seems to spend a lot of time playing video games and will not communicate with his family members. Peter is also moody most of the time. Penny feels like she is walking on egg shells when dealing with Peter, a situation that puts pressure on her and the family at large. Dawn thinks that Sam should be more active in Peter’s upbringing. Penny has talked to Sam about this issue but he feels that Peter will outgrow this behaviour. Sam also tends to switch off from family pressure when he is around choosing instead to relax once he is back home from his regular trips. Penny is also concerned about Monique who has started spending significant time with her boyfriend. Penny thinks that she is still young to have a boyfriend. Penny has also recently discovered through her youngest daughter that Monique has sexting her boyfriend. Upon consulting with Sam on this issue, he told her to stop worrying too much. Sam on the other hand is concerned that Dawn visits the house often so as to take advantage of Penny for babysitting purposes.

The general theme is that the family is facing some issues largely based on the fact that there is poor communication within the blended family. There are also external people who may have a role in the presenting issues. The paper will look at the modalities of counselling that can be used on the family to develop a better relationship between all family members.

Modalities for the Counselling Sessions.

Since there are many issues involving different parties in the case study, family and couples therapy is best suited for this family. Group therapy may be suggested as an additional aspect to these modalities. Group therapy differs from family therapy in that the members of the group modality are not related to each other unlike in family counselling where the parties are related by blood or some form of intimate relationship. Group therapy is for unrelated people suffering from the same issues. Additionally, group therapy usually involves more than eight people.

Family Counselling

The case study presents various forms of families all which call for different goal setting and different therapeutic experiences. From the case study there is family by birth which is Penny and her sister Dawn, as well as Monique and her sister Sarah. There is also a blended family between Penny and Sam and their children from previous relationships. The fact that Sam and Penny are step-parents for their partner’s respective children will have an impact on the family. Lastly, there are external people to the family who contribute to the conflict in the family. Monique’s boyfriend is an external party to the family but his presence in Monique’s life is of concern to Penny. Dal, can also be seen as an external part to Penny and Sam’s family whose impact as Monique and Sarah’s father cannot be ignored. Due to the different parts within this family, different filial relationships can be discussed within the family counselling sessions.

Couples Counselling

This modality is proposed for Sam and Penny alone. The two are bringing up a blended family and this is usually accompanied with difficulties that need to be addressed by the parents. The reason why this couple session is important is because most of the issues in the presenting problems affect the two or are issues that can be solved by the two individuals.

Group Counselling

While group counselling may not be possible within the case study, it would be recommended for Peter, Monique and Sarah to join group counselling for children in blended families. This would help to meet with other children in their situation and be open to narrate their story away from their parents. I would also recommend group counselling for Sam and Penny to join other couples who are in blended families where the children are teenagers. In this group, both Sam and Penny will interact with other couples and this creates an avenue to learn how other couples deal with blended families. The group counselling sessions may work as a support system for the couple.

Goal Setting

The goral set for the different modalities are goals to improve the different relationships in the family and not for individuals. The goals are in line with what is expected to the result of the counselling sessions.

Family Modality

The first goal for the family is to establish boundaries in the family. The first set of boundaries is with Dawn and Sam. Because Sam feels that Dawn is taking advantage of his wife while Dawn feels that Sam is not fully involved in his son’s life, it is important to set the boundaries to regulate their relationship. An example would be to agree on the frequency of Dawn’s visits to Penny and also to the matters around the Sam and Penny family that she can comment on. Sam will also try to set boundaries on how much he will be involved in the sisters’ affairs. Sam and Penny will also need to establish boundaries for the children. The limits should be set for how and when Monique should interact with her boyfriend. It will also establish the limits for the hours Peter spends playing video games and reading. The family should also establish boundaries that will guide Dal’s involvement with his daughters and the family as a whole. Establishing boundaries helps to create respectful relationships within the family and guide the behaviour of family members.

The second goal for the family will be to set the expectations within the family. Family relationships may be strained in a blended family and it important to set out expectations .Discussing the expectations will help the family know what to expect of each member and when that is not achieved, parties can be held accountable for their actions. Setting expectations will be useful for the parents to state what they expect from the children and vice versa.

Couples Modality

The first goal for Sam and Penny will be to set out ways to improve communication. It is evident that proper communication is missing with the couples and Penny ends up discussing family issues with Dawn that should be done with Sam. Better communication will help the couple solve most of the issues in their relationship and help to communicate with the children about their concerns. Better communication will improve the relations between the couple.

Secondly, the need to set out time for each other will be important during couple’s counselling session.  Sam being away from home for most of the time leaves Penny alone with the children. Sam is also reported to have a laid back approach to family matters. Setting apart time with penny after his work schedule will improve their relationship and create an avenue for the two to discuss matters affecting their family. The couple can use this time to discuss their expectations towards the running of the family.

Evidence of the Success of the Counselling Modalities

A study carried out on behalf of the Psychotherapy and Counselling Federation of Australia carried out literature research on the effectiveness of family and couples therapy modalities. This was done by reviewing articles on the various types of family and couples counselling methods and evaluating their effectiveness.  The study found that there is support towards the effectiveness of couples and family therapy using the multi-systemic family therapy and the family problem solving approaches to counselling (Evans et. al, 2012).

Another study looked at the effectiveness of couples’ therapy in terms of the outcome within 3 – 12 months of the counselling sessions. The study was on the look-out for improved outcomes in relationship satisfaction, depression and commitment to the relationship. The study found that couples therapy could start being effective for couples as early as 3 months into the counselling sessions. The study also found that certain types of couple’s therapy like behavioural therapy and cognitive behavioural therapy have been shown to be efficient in reducing distress in the relationship as measured by the marital adjustment scale (Schofield, 2012).

Benefits, Risks and Limitations of Counselling

Couple Counselling

The benefit of the couple’s therapy is that it allows Sam and Penny to have a conversation without paying attention to other parties in the family. This will give an opportunity for both of them to be candid about the issues they face and their thoughts on certain aspects of their family (Stephenson et. al, 2016). For this family, the counselling sessions may be one of the few avenues where they intentionally discuss their family problems seeing as the relationship usually becomes a long-distance one when Sam is off to work.

Another benefit of this counselling modality is that it allows the parties to gain the other person’s perspective which would not happen in an individual counselling modality (Stephenson et. al, 2016). During the counselling sessions Penny will understand Sam’s perspective on family and why he chooses to be laid back. Sam will also understand why it is important to Penny that he is involved in the children’s lives.

The risk and limitation of this modality of counselling is that both parties may not have time to attend the sessions especially when Sam is away for work. The couple’s modality does not also provide a full picture of the problems facing the family as a large part of the conflict relates to how they relate to their children.

Family Counselling

The family modality is beneficial as the counsellor sees the interconnections within the family (Schrader, 2017).  Non-verbal cues in this modality would be of benefit to the counsellor to understand the relationship between the parents and the children and also between the three children.  The modality also saves up on the time as all members are present in the session unlike having five individual sessions for each member of the family.

A risk and disadvantage associated with this modality is that it may require a lot of time to create a therapeutic experience where everyone feels comfortable enough to give their story during the session. There also runs the risk of family members interrupting each other during conversations which creates confusion and reduces the chances of a successful session. In a case where emotions ran high, there would be chances of parties leaving a session as enemies and therefore reducing the chances of coming to a solution through counselling.

Group Counselling

The biggest benefit of group counselling is placing people facing a similar problem together. During counselling in such a set up the patients give and receive support from each other (Len, 2018). This support does not mean parties can weigh in support of a statement or argument but rather, they are supportive of each other so that everyone is able to share their thoughts in the session. The feeling that they are all suffering from something common makes it easy to share experiences within a counselling session.

Group counselling recommended for the couple to mingle with other couples of blended families will help them learn on how to manage such a family and be free to discuss issues among people facing the same problem. It also creates openness in solving the problem as each party will give their views on the problems and also allow for collaborative setting of goals for each group.

The risk and limitation associated with this modality is that it takes a lot of time to carry out the session especially where there are large numbers of the people in the group. Giving a chance for the contributions of every member in the session can be time consuming for the counsellor and fellow participants. It can also be time consuming if certain members in the group counselling do not meet their goals which will delay the entire group. There also runs the risk of conflicts escalating to shouting matches of complete shut down by the parties which derails the success of the sessions.

Ethics of Counselling

All modalities of counselling call for some form of ethical consideration. The reason for having the ethical code of counsellors is to allow professionalism and stability in counsellor associations. Ethics also help to protect the profession from interference by the public and the government. Lastly the ethical code of conduct helps to reduce malpractice issues and protect clients from incompetent counsellors (Kabir, 2017).

Confidentiality on counselling is a central part of the ethical code of counsellors. Confidentiality requires that the information a client gives the counsellor cannot be revealed to third parties. The obligation placed on counsellors for confidentiality is not absolute as there are certain circumstances where the counsellor can reveal client information(Kabir, 2017).

Respect for people’s rights and dignity is an important ethical consideration for counsellors. Counsellors should respect the diversity of their clients caused by their cultural, race, gender, religion, sexual orientation and socio-economic status. It is important for counsellors to make sure that their bias does not reflect on their clients during their counselling sessions (Kabir, 2017).

Developing a Therapeutic Alliance

The therapeutic alliance is similar for all modalities as it involves creating patient centred care in all the counselling modalities. Therapeutic alliance requires the counsellor to create an avenue that allows all parties involved to engage freely for better outcomes of the counselling sessions. The therapeutic alliance allows the counsellor to act as a facilitator as parties in the session express their feelings (Lambert, 2015). A good therapeutic alliance will allow the patient to participate during the counselling sessions.

The first way to create a therapeutic alliance is to ensure that there is a bond between the patient and the counsellor and it terms of group sessions, it is important to create a bond between all the parties in the counselling sessions (Fernandez et. al, 2016). This can be achieved by reiterating that the counselling session is a safe zone for all parties to express themselves. Therapeutic alliance can also be achieved by rephrasing what the patients are saying so as not to miss any details from the session. It is important that the counsellor does not appear judgmental or appear to take sides with any parties in the session (Lambert, 2015). The counsellor should be able to make the parties feel relaxed even when there is animosity between them as is likely to be experienced during the interaction between Dawn, Sam and Penny.

Listening skills are important for every counsellor in creating a therapeutic relationship. A counsellor has to be attentive to what is said during the sessions so that they are able to moderate the sessions and have a collaborative session. The counsellor will be attentive to both works and non-verbal cues presented by all parties present (Drab, 2015). Non-verbal cues are important as some clients may not be very expressive with words. Cultural and personality implications may also make some clients less likely to be talk but their non-verbal cues will portray their feelings. When employing the listening skills, open questions are helpful to explore different thoughts of the patients. Open questions encourage the patient to delve deeper into their thoughts. This is especially helpful for quieter patients who are not too keen to talk much(Drab, 2015). The counsellor has to be careful not to make the questions sound like an interrogation as this will dissuade the patients from talking. Asking open questions in the case study may be effective for the children. The counsellor can also mix the open questions with self-disclosure where they reveal their experiences with the patients. Self-exposure is limited to where the counsellor feels there is a pressing need for this skill. It would be beneficial with the children so that the counsellor is relatable to the children for them to open up during the counselling sessions.

A counsellor can also create a therapeutic alliance by suggesting a way-forward for the parties. A counsellor cannot impose an intervention on the parties but can guide them on reaching necessary interventions (Lambert, 2015). The shared decision making process helps to create a bond between the counsellor and the clients. In the case study, the counsellor could help the parties create a communication plan of how to express themselves within the family set-up. The could also guide the family on how to set up time for activities that would help the family spend time together and in the process bond with each other.

Collaboration between the patient and counsellor in every step of the process is essential in creating a therapeutic alliance. Setting short and long term goals should be done collaboratively. Goals that are set in a collaborative exercise are likely to be successful as the patient owns the goals unlike when they are set by the counsellor. The goals set should be along activities that the parties like to do so as to increase the chances of success. It is important for the goals to be measurable within a certain time frame so that it is easy to mark the progress of the patients.

Verbatim Examples of the Therapeutic Alliance

I would state by stating that the counselling sessions are open and safe spaces and anything said would remain confidential. I would also administer the Norcross Inventory of Preference to know the preferences of the client which will inform the way I carry out the counselling sessions and the types of therapeutic alliance that is required for the participants.

Family Modality

• How do you interact with each other at home, for example who is the easiest to approach in the family and why?
• What is the family’s day routine like?
• What are your favourite memories as a family?

Couples Modality

• How is your communication like?
• Are you open to trying out setting apart at least an hour a day to discuss the family situation and the issues surrounding he family?
• What do you like best about your family?

Group Modalities

• What do you find most difficult to adapt to in the new family you are in?
• What aspects of the blended family do you enjoy?
• What would be done to help you be more involved in the blended family?

Management of Client Preferences to Cultural Diversity Issues

Cultural diversity is common especially in the twenty-first century and counsellors should be ready to handle patients in a way that is in line with a client’s cultural preference. Culturally sensitive therapy is one that emphasizes the need for the counsellor to understand the ethnicity, belief system and background of the patient. Understanding cultural sensitivity will make the counsellor gain cultural competence to understand their own culture and how it influences the relationship with the patient so as to understand and respond to the patient’s culture (Asnaani and Hofmann, 2012). The counsellor may also want to understand the cultural implication of a patient to know their preferred mode of carrying out the counselling sessions.

The family in the case study consists of various cultures and the counsellor must be aware of the impact of these diverse cultures in carrying out the counselling session. Research has shown that Chinese patients prefer a directive approach in therapy. This means that they prefer counsellors who analyze problems, give homework for review for subsequent sessions and discuss strategies that have previously been successful with other patients (Ng and James, 2013). The counsellor would find this preference useful when dealing with Sam and Peter who have a Chinese background.  Penny’s family is a blend of about three races and the directive approach might not work for everyone in the family.

There is also the cultural impact related to how parents and children relate. In some cultures, children cannot talk freely about their feelings with their parents. Others may feel that their parents cannot relate to what they are going through and therefore choose to confide in friends or teachers. For Penny’s family, the situation may be difficult especially with Peter talking to Penny or with Monique and Sarah talking to Sam. The counsellor has to be on the look out to create an environment where that cultural hindrance between parents and children does not hinder the success of the session. The impact of culture on the parent-child relationship may require the counsellor to recommend group counselling for Peter, Monique and Sarah with other teenagers in blended families in the absence of their parents.

Another cultural hindrance would be related to the fact that the case study is a blended family. The interaction with step children is one that would require special attention from the counsellor. The children may be accustomed to different upbringing styles before Sam and Penny blended their families. This conditioned may be worsened by the fact that Sam works far from home which will have an impact on the family.

There is also a cultural impact on the counselling session based on male and female habits. Culturally men are less likely to visit a counsellor and are also less likely to divulge personal information. Women on the other hand are more ready to discuss in depth various details in the session. It is therefore likely that in the group session between Sam, Penny and Dawn that Sam may be overshadowed by the conversation between the sisters and the counsellor should be alert when this happens so as to moderate the session in a way that everyone speaks.

The importance of understanding cultural diversity, cultural preferences and the impacts of culture on the session is so enable the counsellor prepares for the right therapeutic alliance that will make app parties comfortable during the counselling sessions.

Conclusion

The multi-modality approach to counselling is important where there are different levels of conflicts within a family set up. This is because the parties involved in the conflict have varying degrees of involvement in the conflict and having only one time of modality runs the risk of not fully comprehending the conflict. The counsellor has to be keen to provide the right therapeutic alliance for each modality so as to get the parties as comfortable as possible to participate in the sessions.

The cultural background of the parties is of importance to the success of the sessions and the counsellor has to put cultural impacts into account during any counselling session. It is important in such situations for the counsellor to put aside their cultural bias to different matters so as to be able to successfully incorporate the parties in a collaborative manner in creating goals and strategies that fit their situation.

References

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