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 counseling 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 behavior. 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 in the presenting issues is that there is lack of communication within the family and within sub-groups existing in the family. The lack of communication has escalated to creating pressure within the household. To solve these problems, there is need to have multi-modality counseling sessions which will be explored in this paper.

Modalities for the Counselling Sessions and their Rationale

Since there are many issues within the case study, it will be important to have the counselling session with different sub-groups to capture any underlying issues that may be causing the pressure in the family.

Couple

One of the proposed modalities would be a session 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.

It is important to understand what each of the individuals feels is their responsibility in the relationship and especially in regard to the children. They both seem not to be too comfortable with the other partner’s children and this has affected how they address the issues around the children. It would be important for Penny to express what she feels about Sam being laid back when it comes to family issues and Sam would also have the opportunity to explain his reservations about Dawn.

Family

The whole family would also benefit from counseling sessions. It is from this session that I will be able to analyze the bonds and relationships within the family. In this session, the children would be encouraged to speak about what is going on in their lives and how the input of their parents affects them.

It would also be important to talk about Pater’s relationship with Penny and Monique’s and Sarah’s relationship with Sam.

Group

There are various groups in this case study that would be important to incorporate for counselling sessions.

The first group would be Peter, Penny and Sam. While Penny is concerned that he is not putting enough effort in school and that he is usually moody, Sam does not seem to be too concerned about this behavior. In this session, Peter would have an opportunity to express himself and also hear the opinion of his parents. Peter would also have an opportunity to express his thoughts about his future plans in regard to his education. It is in this session that the relationship between Jenny and Peter will become evident from their verbal and non-verbal cues.

Similar to the first group, the second group would be between Monique, Sarah, Sam and Penny. Just like with the first group, this will be an opportunity for the girls to communicate with Sam and probable discuss the way forward for a better relationship. The issue of Monique’s boyfriend can also be discussed in this session and she gets the opportunity to hear the concerns of her mother. When discussing the issue of her boyfriend, Sarah may be asked to step out as this is a problem facing Monique and not Sarah. It would be also encouraged to prevent painting her as the source of information of the sexting issue. It would also help for Monique not to feel embarrassed infront of her younger sister. With this group, it will be important to investigate any impact Dal has in the upbringing of his daughters which may put pressure on the new family set-up

The third group would be made of Sam, Penny and Dawn. Dawn is close with Penny but Sam has a reservation about the relationship. Dawn also has thoughts on how Sam should deal with his son. Both Dawn and Sam put Penny at a difficult position as she cannot choose between her husband and her sister. The three should therefore talk to each other and not place Penny at centre of their conflict.

Clarify counseling goals for Each Modality

Couple

The goals for the couple would be start having regular and meaningful conversations with each other about their family. It would also be important for the couple to organize family time and family activities where everyone participates. This will help the family in creating a bond and unifying the family.

Another goal for the couple’s therapy is to establish the impact of the long distance relationship when Sam is away at work. The couple will also discuss how to relate with Dawn in an acceptable way to both of them.

Family

The goal for the family session is to get everyone to open up and talk about their relationship with each other. It is also an avenue where the children communicate and bond with each other, even when Sam is away on work duties. The goal is to have the family functioning as one unit. It is important to create strategies where each family member knows how to relate with the other so the home becomes a safe zone where the children feel free to consult their parents on any matter.

Group

With the first group between Peter, Sam and Penny, the goal is to have them communicate with each other and especially their concern about his school performance. The counseling session would also be an avenue to understand what causes Peter’s moodiness and how to better communicate with his family. It is the aim of this group session to avail any emotions that Peter may not have processed about his mother’s death that would be causing the moodiness.

The goal of the second group to is enable the group to create an avenue of openness where the children can talk about issues of their relationships with their boyfriends and get insight from their parents.

The first two groups would be an avenue for the children to talk to their step-parent in a favourable environment where one of their biological parents is around. It would help eliminate any tension they may have with their step parent.

The third group will be an avenue for Dawn and Sam to express their feelings and find a way to relate to each other better.

Benefits, Risks and Limitations ofCounseling

Couple Counseling

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 counseling 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 counseling modality is that it allows the parties to gain the other person’s perspectivewhich would not happen in an individual counseling modality(Stephenson et. al, 2016). During the counseling 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 counseling 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 counseling.

Group Counselling

The biggest benefit of group counseling is placing people facing a similar problem together. During counseling 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 counseling session.

Another benefit of the modality is that the parties to a group modality are those in the middle of a conflict. Unlike the couple’s modality which gives a general glimpse of the conflicts within the family, the group modality only allows those directly in a conflict to be in the session. For example, in the group modality between Penny, Sam and Dawn, the issue revolves around these three therefore making the group modality efficient in tackling a 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 divide parties into groups for the counseling sessions. The groups have to be arranged in a way that only those directly in conflict are put in the same group. With a large family like Penny’s with diverse conflicts, such groups may be too many such that they take up too much time making the progress of the sessions too slow. 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.

Therapeutic Alliance

The therapeutic alliance is similar for all modalities as it involves creating patient centred care in all the counseling modalities. Therapeutic alliance requires the counselor to create an avenue that allows all parties involved to engage freely for better outcomes of the counseling sessions. The therapeutic alliance allows the counselor 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 counseling sessions.

The first way to create a therapeutic alliance is to ensure that there is a bond between the patient and the counselor and it terms of group sessions, it is important to create a bond between all the parties in the counseling sessions (Fernandez et. al, 2016). This can be achieved by reiterating that the counseling 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 counselor does not appear judgmental or appear to take sides with any parties in the session(Lambert, 2015). The counselor should be able to make the parties feel relax even when there is animosity between them as is likely to be experienced during the group session between Dawn, Sam and Penny.

A counselor can also create a therapeutic alliance by suggesting a way-forward for the parties. A counselor 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 counselor and the clients. In the case study, the counselor 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 cousellor 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 counselor. 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.

Counselling Skills

The biggest ethical issue surrounding counseling is maintaining confidentiality of the information received. The counselor should remain ethical and make sure that information gathered in one counseling modality is not transferred to another modality. Also where the parties confide in the therapist, the source of information should not be exposed to the rest.

Listening skills are important for every counselor. A counselor 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 counselor 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. In the case study, it can be inferred from Sam’s personality and how he has dealt with the Peter and Monique issue that he is likely to communicate little with words. The counselor has to concentrate to understand what he says through his actions.

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 counselor 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 counselor can use the open questions to understand Peter’s moodiness and Monique’s thoughts on her boyfriend situation and the cause of her actions. The counselor can also mix the open questions with self-disclosure where they reveal their experiences with the patients. Self-exposure is limited to where the counselor feels there is a pressing need for this skill. It would be beneficial with the children so that the counselor is relatable to the children for them to open up during the counseling sessions.

Patience is a necessary skill for counselor especially dealing with different counseling modalities. Each group presents a different dilemma and the counselor will need to be patient to handle all modalities and coordinate them for a singular success story(Drab, 2015).. In the case study, the counselor has to be particularly patient to unearth problems that might not be on face value but that may affect Penny’s family. The  counselor has to be patient to unearth if the passing away of Peter’s mother still affects, if Penny’s ex-husband has any impact on her daughters and is Dawn’s divorce has anything to do with her constantly being at Penny’s house.

Just like patience, empathy is a skill required for counselors. Empathy allows the counselor to fit into the experiences of the patients. The counselor tries to fit into the situation of the patient to understand their situation. Empathy requires a counselor to recall bits of information throughout the session and use them back to the patient to create a sense of understanding of the patient’s situation. In the case study, it is important for the counselor to apply empathy to every modality of counseling(Drab, 2015). The family modality requires empathy to try and understand two people from various relationships becoming one. In the group modality, it is important for the counselor to be empathetic to Penny who is caught in the middle of her husband and sister. The counselor also has to be empathetic to the children in the group modalities who may be confused of how to relate within the family and the pressure of schools and evolving into young adults. In the family modality, the counselor has to be empathetic to the situation of different families trying to live as one.

The counselor has to have positive regard for the patients. This way, the counsellor will not be judgmental to anything revealed by the patients(Drab, 2015). It is unethical for counselors to impose their views on certain topics on the patients. Issues like Monique’s sexting may be frowned on especially by the older generation. The counsellor should not have any disapproving remarks of facial expressions as this is unethical and may ruin the therapeutic alliance that is the foundation of a successful session.

Management of Client Preferences to Cultural Diversity Issues

Cultural diversity is common especially in the twenty-first century and counselors 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 counseling 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 counseling session. Research has shown that Chinese patients prefer a directive approach in therapy. This means that they prefer counselors 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 further subdivide the group counseling to have a session with Peter, Moniqueand Sarah with the absence of their parents.Another cultural hindrance to a successful session may be the relationship between inlaws. Many cultures do not freely mix in-laws and in this way Sam may find it difficult to express his reservations about Dawn using Penny for babysitting duties. The counsellor must therefore ask the parties if they prefer to have a single sitting as a groupor singularly where the counsellor acts as a mediator.

There is also a cultural impact on the counseling 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 counseling sessions.

Conclusion

The multi-modality approach to counseling 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 f the sessions and the counsellor has to put cultural impacts into account during any counseling 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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