AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES AND THEIR USE IN SITUATIONS WHERE PERSONS HAVE EXPERIENCED ABUSE OR GRIEF AND LOSS by Catherine Mugure Karigey BA, Sociology, University of Guelph, Ontario, 1996 BSW, University ofVictoria, 1998 Practicum Report Submitted in Partial Fulfillment of the Requirements for the Degree of Master in Social Work The University ofNorthem British Columbia August, 201 0 © Catherine M. Karigey UNIVERSITY of NORTHERN BRITISH COLUMBIA LIBRARY Prince George, B.C. AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Abstract The need for effective counselling for abused women is a major concern for social workers and other professionals who have been responding to the plight of the mentioned individuals. There is a need to provide effective supportive counselling for victimized women who desire to be empowered in changing their situations by taking charge of their lives. In my approach to these women' s needs, I found the most helpful clinical therapeutic counselling methods to be those that have a strength-based approach such as the following : Murray Bowen's System Theory, and Berg and de Shazer' s Solution-Focused Therapy. In this report, I outline how I used the various methods of counselling and will conclude by explaining what I found to be the strengths and weaknesses of each method. 11 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Table of Contents Abstract .................................................................................................................................... ii Table of Contents ... .. ............................................... ................. ... ... ...................... ... ..... .... .. . iii Acknowledgements ............ ................. .. ............................. ... ..... ................. ..... ..... ..... ...... .. .. v Dedication .... .. ..... ... ................. ... ......... .... .. ............ .. ......... ... .... ..... ... .... ..... ... ... ........ .... ...... ... vi Chapter One: Introduction to Counselling .......................................................................... 1 The Role of Counselling in Social Work ............................... ...... .................... .. .................. 1 Reflective Journal. ....... .. ....... ..... ... ..................... ...... ...... ............ ..... .. ................... ................. 4 What Are Case Studies? .... .. ..... .. ................... ... ...... .... ....... .... ........ .. ... ... ... .................... ........ 4 My Practicum Placements .. ....................................... ............. ....... .. .... .. ...... ...... ............ ..... .. 5 My Models of Counselling .. ........ .... .... ........... .. ..... ..... .... ..... .... ..... .... ..... ... .... .... ....... ... ... ... ... 5 The Goal of the Practicum Report ......................... ...... .............................................. ... .. ..... 6 Abused Women ......... .. ......... ... ................................................................................. .. ..... .. 6 Chapter Two: Methods of Counselling ................................................................................. 8 Literature Review ............................................................. .................................................. .. 8 What is Solution-Focused Therapy? ............. ... ..................... .. ..... ... ........ .... ... ....... ............... 8 What is Family Systems Theory? ........................................... .... ... ... ... .. ...... ...... ......... .... ... 16 Process ofDiscovery .... .... ................ .. ...... ....................................................................... 22 What is Somatic Experiencing? .................................................... .......... ............. ... .... ..... .. 23 What is Unresolved Grief? ......... ............. ........ .... ........ .......... ... ........ ............ ...................... 25 Small Acts of Living: Everyday Resistance to Violence and Other Forms of Oppression ....... .... ....... ............. .. .......... ...... ......... .. ....................... ... ..... .... .. ....... ........... ........ ... ...... ..... 32 Anti-Oppressive Theory ..... ................... .... ...... .... ... .. ............ ........... ... ...... ... ...... ... ........... 34 Chapter Three: Description of Practicum .......................................................................... 39 Objectives ........... ... ..... .... ........ .... ...... .. ...... ... ......... .. ..... ... ......... ... ......... ............................... 39 Practicum Supervisor Relationship ..... ..... .... ..... .................... ... ... .. ............. ...... ................. . 40 Outline of Activities .. .................................................................... ..... ................................ 41 Description ofPracticum Agencies .......... ..... ..... ............ ... ................. .. ........................ ...... 42 1. South Island Centre for Counselling Society ........... .. .. .. .. .. ...... ... ..................... ........ 42 2. The Transition House ......................................................... .... .. ........ ... .................. ... 45 3. Community Adult Mentoring Program (CAMS) ....... .... ................. ... ...... ................ 49 lll AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Practicum Activities ... .. ............ ............... ...... ..... ..... ...... ... ......... ......... ... .. .... ....................... 50 Consultations .................. .. ........................ .. ........... ..... ... ......... .. ..... .... .... ... ... ....................... 51 Staff Meetings at South Island Centre for Counselling Society ..... ................................ 51 Staff Meetings at the Transition House ..... ..................... .. .... ....... ............. .... .................. 51 Three Practicum Case Studies .. .......... .... ................................... ....... ..... .. ........ .. .... ... ... ....... 52 Practicum Case Study 1 ...................... ..... ... .............. ..... ... ........................................... ... 52 Practicum Case Study 2 .. ............................. .... .. ...... ........ .. ................................ ....... ... .. . 55 Practicum Case Study 3 ....... .. ...... ... ... ... ..... .... ............ ... .. ..................... .... ...... ............ ..... 57 How Did the Different Techniques Work? ... .......... ... ........... .... ....... ... ............. .................. 58 Chapter Four: Discussion and Implications for Practice .................................................. 60 Acquired Knowledge ........... ... ..... .. ...... .... ............ ... .................. ...... ...... .. ... ...... .. ................ 60 Conclusion ..................................... ............................................................ ............. ....... .... 62 References .............................................................................................................................. 64 Appendix 1: South Island Centre for Counselling: Constitution and By-Laws .............. 67 Appendix 2: Symptoms and Behaviours of Unresolved Grief .......................................... 78 Appendix 3: Diagnostic Criteria for Unresolved Grief ..................................................... 79 Appendix 4: Genogram Symbols ......................................................................................... 81 lV AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Acknowledgements Throughout this challenging endeavour, I have received support, guidance, and encouragement from many people. I would like to acknowledge some of those people in particular: Dr. Glen Schmidt, my academic supervisor, who continually rekindled my faith in my own knowledge and ability when I was uncertain of it, Bill Cole, my practicum advisor and friend, who maintained an openness and commitment to my work and provided continued support and many learning opportunities; Dawn Hemingway, my third committee member, for availing herself to support me with helpful feed back in spite of her extensive commitments as the chair of the University of Northern British Columbia School of Social Work and other community commitments; My children, Josh, Dora, and Cynthia, who lovingly gave me the time, support, and encouragement to follow a dream. Thank you; My younger sister, Jane Wairimu, and her family for always being there for me and my children for the many years I went to school; David Turner, Julie Allain, Wambui Karanja, Anthony Muturi's family; My siblings, Wairimu, Mukami, Nyambura, Macharia, Nyaga, and many other friends who have been instrumental in increasing my confidence in my ability to complete the project. Finally, my fellow graduate students who accompanied me on this journey in search of eternal knowledge, and D. Turner, amongst others. v AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Dedication This Project is dedicated to my mother, Dorothy Kabura Kamau, and my aunt, Susan Nyambura Kariuki. Thank you for your love and support and for providing me with a desire to keeping on trying, to never give up and especially for teaching me that: Those who hope in the Lord Will renew their strength They will soar on wings like eagles They will run and not grow weary They will walk and not faint. Isaiah 40 v31 Vl AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Chapter One: Introduction to Counselling In this chapter I discuss the role of counselling in social work practice, and the particular benefits of using counselling skills. I discuss models of counselling theory which interested me during my practicum, and why they were of interest. I present background information about women who have experienced abuse, who were the larger population with whom I worked. I conclude this chapter by stating the goals which I had when I began my practicum. The Role of Counselling in Social Work In this section I explore the following questions: Do social workers need counselling skills? If so, how is it a benefit to social worker and client? How is a social worker different from a mainstream counsellor? Counselling in general is a process through which counsellors interact with clients to assist these individuals in learning and dealing with their challenging issues. A client' s environment, roles, and responsibilities are found in this interactive process. The role of the professional counsellor demands individuals who are skilled and knowledgeable in the process and theories that are fundamental to the profession (Capuzzi & Gross, 1991). If the counsellor is a social worker, there are additional interests and goals for helping (e.g., empowerment, advocacy, sharing power), which in my experience are not always shared by all mainstream counsellors. "Advocacy, counselling, and mediation are common social processes in our common struggle for human rights. They also provide professional pathways" in social work casework (Craig, 1998, p. 11). As well, more frequently, social workers will include the social context in how they view the issue to be worked on with the client. Seden (1999, p. 3) says that social work is focused on addressing "social inequalities, AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES injustice, and social exclusion." Counselling in social work has been "re-evaluated with regard to women, black people, lesbian, gay and bi-sexual people, and those who have been disabled" (p. 4). It benefits a social worker to examine his or her own social location because the role of counselling in social work is to work with a client in order to reduce oppression and other negative impacts in their lives. This involves an awareness of the social worker's location and how such can contribute to oppressiveness of the intervention through classism, racism, sexism, ableism, heterosexism, and other ways that human beings unfairly judge, rank, and deal with others. I am an African that worked with many marginalized persons and I am privileged by the position as a social worker. I hold a democratic socialist ideology and a theory of change that aims at transforming the society into a fairer, more equitable vision of social justice. In working with the marginalized groups of persons, I focus on their strengths and encourage clients to make their own goals in solving their own problem. Indeed, "the role of a social worker is so important that we link the personal narratives with the knowledge of how we must act politically to change the world" (hooks, 1989, cited by Turner & Moosa-Mitha, 2005, p. 6). Seden (1999) and Bond (1998), among others, provide some guidance as to the benefits of counselling skills in social work. Seden (1999) argues that "for all social work tasks it is important to have at least basic counseling skills" and preferably to have advanced skills, even though it is not necessary for all social workers to be able to counsel in depth (p. 9). "Counseling skills help the social worker to communicate and engage" (p. 19). Some basic skills that Seden mentions include active listening, summarizing, confronting, goal setting, avoidance of judging, boundary awareness, problem solving, and the ability to offer 2 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES feedback (1999, p. 10). Similarly, Marsh and Triseliotis (1996, p. 54) cannot see "how any sort of social work activity or interaction can take place without some form of ' counseling' taking place." One main difference between mainstream counselling and counselling in social work is that, in my experience, it is much more frequent for social workers to play an advocacy role than it is for counsellors. Seden (1999, p. 56-57) states: Advocacy is an activity which may follow an understanding of the client' s wishes in order to achieve their fulfillment. Advocacy may be used to help someone obtain something from another person or institution with more power .. . social workers frequently undertake advocacy activities for clients. She adds that accurate advocacy is based on accurate listening and responding (p. 57). During my practicum experiences, which I describe below, I frequently had opportunities to advocate for people whom I was helping. According to Seden, focusing on the strengths, resources, competencies, and social networks of our client leads to a process of empowerment (Gaiswinkler & Roessler, 2009). Empowerment, in counselling by social workers, requires that we help clients to see themselves as active agents in their own lives, ' causal agents' who can find solutions to their problems. Social workers who use the solution-focused approach can support a client to set and meet his or her own goals. At the same time, they are meeting the goals of the agency or organization ((Gaiswinkler & Roessler,2009.p. 224). Bringing about empowerment is achieved best if social workers can take a stance closer to being a "peer and partner in solving problems" (p. 43). For counselling in social work, using a solution-focused method, 3 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES "The client's goals drive the activities," says Berg (personal communication, in Gaiswinkler & Roessler, 2009, p. 216). Reflective Journal During my practicum I maintained a reflective journal which I completed after every counselling session with a client. The purpose of the journal was to record the experiences I had with the client and the technique of counselling I used, and which one worked best for each client. The reflective journal was a form of debriefing for me, apart from the normal consultations I had with my practicum supervisor. The reflective journal was also a research tool. It would later shape my own practice. Each situation was a learning experience that would allow for self-evaluation of what I did best and what else I could have done better in order to elicit more information from the client, or in defining their problem, empowering them to create a solution through their own goal setting. Since I did not have any formal research for my practicum, I view my reflective journal as a form of research tool and the case studies were the research methods that I used. What Are Case Studies? Rubin and Babbie (2005) state that the case study is an idiographic examination of a single individual, family or group. Its chief purpose is description. Case studies are generally seen as a qualitative approach to research. The mode of observation is used and it exclusively focuses on the particular case. The source of evidence includes existing documents, observations, and interviews. One of the logical rationales of using case studies is its evaluation of practice effectiveness. The case studies were derived from the reflective journal and as I evaluated each case I was able to conclude where each of the counselling techniques 4 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES had worked best. Therefore, for my future practice, I am able to know what method is most effective with a particular group. My Practicum Placements During my practicum experience, my mentor, Bill Cole of South Island Centre for Counselling, introduced me to two other agencies so that I could gain counselling hours within the time set to complete the exercise. These were the Cridge Transition House and CAMS (Community Adult Mentoring Service), a volunteer program by Corrections Canada that supports ex-inmates on parole in transitioning them back into the community. I gained most of my practicum hours at the Cridge Transition House where there were more counselling opportunities. I counselled women in individual and group-based settings who had experienced sexual, physical, and emotional abuse from their spouse. My report will focus on how critically important it is to have the knowledge and counselling skills in dealing with women who have experienced all forms of abuse. I will also comment on grief and loss work done through the CAMS program by way of case studies. My Models of Counselling Bowen theory, solution-focused, and anti-oppressive theories were the basis of counselling in the practicum agencies. They were of personal interest too because of their similarity with my cultural background. The Bowen theory is closely related to families and the emotional aspect that close family ties have on each member. In my African, Kikuyu culture, families play a large part in moulding one ' s values as people support and draw from each other. In my counselling practice, I will need to understand further issues that relate to family dynamics, hence, the need to practice the model in my practicum. The solutionfocused and anti-oppressive approaches to counselling are key in working with abused 5 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES persons as the aim is to encourage clients to recognize their own strengths and to help them learn to make positive goals for their lives as they understand how resilient they also are. The Goal of the Practicum Report In this paper I will focus on giving a report on my experience as I worked in South Island Centre for Counselling, Cridge Transition House in the city of Victoria, BC, and in the CAMS program. In order to illustrate the practical aspects of clinical counselling, I will provide a detailed account of my practicum experiences without disclosing the name of the particular clients for confidentiality purposes. In the final part of my practicum report, I will discuss my counselling experience and the implications for practice. Abused Women For 2006, Statistics Canada reports that eight out of ten victims of spousal violence were women across all the Canadian provinces (The Daily, October 9, 2008). Family violence is also stated to account for about 23 percent of all police reported violent crime in 2007. The most frequent type of assault includes pushing, slapping, and punching, and the next major assault involves use of a weapon that results in bodily harm. In 2008 , there were 569 shelters across Canada providing residential services to women and children escaping abusive situations (The Daily, October 15, 2009). Statistics Canada Centre for Justice Statistics Transition Home Survey 2007/2008 reported that 73 percent of the reported spousal violence incidents resulted in charges being laid. Other information was that, in 2007, almost four times as many women were killed by a current or former spouse than men. It is important to support women who have been in abusive relations and prevent further victimization of women as the research above indicates. 6 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES In Canada, domestic violence is a real problem and research also shows that women who have been physically and emotionally abused have long term multiple health problems (Campbell, 2002). The violence and the stress from non-physical forms of abuse (i.e., verbal and emotional abuse) increase the use of services and raise health care costs. As many as 60 percent of abused women experience post-traumatic stress syndrome. Violence from intimate partners is a predisposing factor to HIV/AIDS and long-term physical problems such as arthritis, chronic pain, and neurological damage (Heise et al., 1994; Heslet & Koss 1992, cited in Morrow & V arcoe, 2000). Furthermore, when intimate partner abuse occurs within a family, children are negatively affected in regard to their development; they are less able to focus on their education, and they face increased risks of suffering abuse or perpetrating it in their own future relationships (Morrow & Varcoe, 2000). Child abuse is 15 times more likely to occur in homes where domestic violence is already taking place (Friend, 2000). Another study found 4 7 percent of children from families experiencing domestic violence had experienced physical abuse, and found that the children were at high risk for externalized behavioural problems (O'Keefe, 1995). As a result, knowledge that would improve a survivor's chances of achieving positive change would benefit survivors, their children, and the society as a whole. 7 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Chapter Two: Methods of Counselling Literature Review In my literature review, I include information that relates to my special interest in counselling abused women including: Solution-focused therapy, family systems, somatic experiencing for trauma victims, counselling for grief and loss issues, and pastoral care work. I also provide a review of Allan Wade' s article on the health resistance to therapy by some clients. I chose to examine the above listed areas in my practicum for the following reasons: Anti-oppressive theory relates to the empowering of the oppressed groups and the women in the transition house that I worked with needed to be more empowered so that they could help in setting their own goals and find their own solutions. I helped the women realize their own capacity through realizing their own strength and resiliency (Turner & Moosa-Mitha, 2005). The solution-focused model encompasses a way of thinking, a way of conversing with clients, and a way of constructing solutions interactively (Walter & Peller 1992). Solution-focused brief therapy focuses on the solutions and goals and looks at the present and not on the past which may be very traumatic for some abused women. What is Solution-Focused Therapy? In the text Family Based Services, Berg (1994) describes solution-focused therapy (SFT) as a model of intervention that she and de Shazer and colleagues at Brief Family Center in Milwaukee developed. She refers to the model of treatment as different from other therapeutic models because of its view of change. Unlike the family therapy view, that the family unit is motivated by pressure to maintain a homeostatic balance and maintain its boundaries, SFT views change processes as inevitable and constantly occurring. Like the 8 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Buddhist view that stability is nothing but an illusion based on a memory of an instant in time, solution-focused therapy views human life as a continuously changing process (Berg, 1994). SFT focuses on solutions, not on problems. The therapy also includes the assumption that it is easier to repeat already successful behaviour patterns than it is to try to stop existing problematic behaviour. According to Insoo Kim Berg, clinical activities that help to enlarge those behaviours related to the exceptions to the problem provide the keys to fmding solutions. In Family Based Services (1994, p. 7), the basic premise of SFT is that exceptions to problems offer keys and clues to solving problems and that it is more profitable to pay attention to activities that centre around successful solutions rather than the problems themselves. When and if there are no past successes to build on, the client can be helped to forge a different future by imagining a "miracle" and identifying small but realistically achievable steps towards that event (Berg, 1994, p. 7). The miracle question is a way of indirectly asking a client about goals for therapy: Suppose a miracle occurs tonight while you are sleeping and the problem that brought you to the attention of child-welfare service is solved, you will not realize right away the problem has been solved. What do you suppose you will notice different the next morning that will let you know there was a miracle overnight? The miracle picture is used as a road map for figuring where the client wants to get to and for suggesting what needs to be done to accomplish the desired changes. 9 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Unlike the medical model where the professional becomes the expert whose roles lies in diagnosis, solution-focused therapy follows the client lead in setting goals for treatment and in laying out plans for the client to implement. For instance, when the client says to the therapist that one of her goals is to "get social services out of her life," the therapist agrees with the client that it is a worthy goal to work towards to, since the ultimate goal of the worker is to successfully terminate the contract with the client. When the goals are laid out by the client and not defined by the therapist, the client is more likely to be committed to achieving them (Berg, 1994, p.14). The author of Patterns of Brief Family Th erapy , de Shazer (1982), describes his clinical work as connected to a family of formal ideas that have been named " ecosystemic epistemology." He views research, clinical practice, and theory as inseparable and often as simultaneous processes. Therefore, de Shazer includes strategies of intervention, elegant formalisms, and patterns of inquiry. In the text, the presented ideas are a tradition that starts with Erickson and flows through Bateson and the group of therapists at the Mental Research Institute and therapists at the Brief Family Therapy Center in Milwaukee, and his wife, erg. In the development of a therapeutic model , "shattering the glass" becomes a new theory of change. A client seems to like the idea of staying behind a mirror with a therapist who then leaves to briefly consult with his team of experts who have been observing the ongoing session and who will return with a "complement" or set of interventions designed by the whole team. In the process, the client and the therapists have come to see themselves as a single unit, the family as a sub-system of a larger supra-system that included the therapy team system: An ecosyternic perspective. If there is a change in one element in this 10 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES conceptual model, the relationship between the rest of the elements changes, too. In his text, de Shazer talks about possible changes that can occur and their importance. In another concept, the "binocular" theory of change, de Shazer explains that the basic elements of the therapy situation become patterns involving families and the therapists. The two subsystems (family subsystem and the therapy team subsystem) interact in such a way as to form a supra-system or isomorphism- a tool that can be used for setting up interventions based on the descriptions of the family patterns. In his text, de Shazer uses various descriptive tools to explicate the binocular theory of change and the methods used to implement the theory. The multiple explanations and descriptions of the same processes follow Bateman' s notion that theory or more descriptions of the same processes provide more depth. He goes on to say that the therapy with each family, couple, or individual develops maps that are useful. It is only with the goals in mind that a therapist and the family can know that a therapy is successful. Even when a family has been unable to articulate goals, the therapist must have goals in mind to prevent the family from floundering. Reframing maps can help a therapist to describe what is going on in such a way that developing a different angle is seen as necessary for change. Although this mapping technique is the basic "behind the mirror technique," it can be used to describe initiating the reframing process for the theoretical maps. The family ' s response report is a communication about its way of coping. In Patterns of Brief Family Th erapy, de Shazer clearly illustrates how a change in one relationship affects other relationships. Therefore, the goal of any therapist needs to be able 11 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES to make interconnections between interventions and change conceptually "otherwise, the whole situation is meaningless" (de Shazer, 1982, p. 149). In Becoming Solution-Focused in Brief Th erapy, by Walter and Peller (1992), focus is on explaining the background of the brief therapy model of treatment. Accordingly, solutionfocused brief therapy is a total model; a way of thinking about how people change and reach their goals, a way of conversing with clients, a way of constructing solutions interactively. It also operates within 12 assumptions that are pragmatic, interrelated, and which act as a guide through the solution construction (p. 10) . The twelve assumptions are: 1. Focusing on the positive, the solution, the future facilitates change in the desired direction. Therefore, focus on solution-orientated talk rather than on problem-oriented talk. 2. Exceptions to every problem can be created by the therapist and client which can be used to build solutions. 3. Nothing is always the same, as change is occurring all the time. 4. Small change is generative, and leads to larger change. 5. Clients are always cooperating. They are showing how they think change takes place. 6. People have all they need to solve their problems. 7. Meaning and experience are interactionally constructed. 8. Recursiveness, meaning that actions and experience are circular. 9. Meaning of the message is the response you receive. 10. Therapy is a goal or solution-focused endeavor with the client as an expert. 11. Any change in how clients describe a goal (solution) and/or what they do affects future interactions with all others involved. 12 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES 12. The members of a treatment group are those who share the feelings that there is a goal and state their desire to do something about making it happen. The authors of Change - Watzalawick, Weakland, and Fisch ( 1974) - of the Brief Therapy Center at the Mental Research Institute at Palo Alto, California, describe change for clients as something that is brought by the unexpected and inexplicable success of occasional "gimmick" interventions. The authors have studied the subject of change and come to the conclusion that it occurs spontaneously and explain how it can be promoted. They talk about how psychotherapy is sought not because of enlightenment about the unchangeable past but because of the dissatisfaction with the present and the desire for a better future. According to the researchers, it is not always clear to the therapist or client how much change is needed only that a change in the current situation is needed. But small changes lead to snowballing effect to bring about other significant changes in accord with a client's potentials. The authors formulate theories on how people change, hence opening pathways to understanding how people become enmeshed in problems with each other and new pathways to expediting the resolution of such human impasse. Group theory gives a framework for thinking about the kind of change that can occur within a system that stays invariant, while the theory of logical types is not concerned with what goes on inside a class or between members but gives a frame for considering the relationship between members and the peculiar metamorphosis which is in the nature of shift between from an ecological level to one higher. The distinction between these two theories presupposes that there are two different types of change: One that occurs within a given system and one that remains unchanged (p. 10). For example, a person can have a nightmare but the action that follows cannot be changed unless one wakes up. 13 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES In his book, Keys to Solution in Brief Th erapy (1985), de Shazer proposes that solutions and problems deserve the primary attention in a therapeutic session. He contends that the treatment solution does not need to be as complicated as the presenting problem. He uses a simple metaphor that states that "the complaints that clients bring to a therapist are like locks in doors that open onto more satisfactory life" (p. 15). By the time the clients come to the therapist, they have tried everything they think reasonable based on their own reality, but the door is still locked. Mr. de Shazer states that in order to provide prompt solutions, it is useful to develop a vision or a description of a more satisfactory future, which can then become salient to the present. Furthermore, this "realistic vision" is constructed as one of a set of possible achievable futures : Clients frequently develop "spontaneous" ways of solving problems. This view of problem solving has also been mentioned by Watzalawick, Weakland, and Fisch (1974) in their study of change. And as in the model of change, the relationship between the client and the therapist is that of cooperation as the client comes to therapy seeking change. In Clues: A Solution-Focus Approach to Th erapy, de Shazer (1988) has given clues on how interventions to change behaviours do not need to be complicated. He uses two examples as demonstrated below. The Structured Fight An intriguing method of problem solving for couples who have constant complaints about each other. He invented this "structured fight" in 1974 for these troublesome situations, and it has some surprising results. This formula has been found useful in the process of promoting solutions for the couple. The ritual involves these steps: 14 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES 1. Toss a coin to decide who goes first 2. The winner gets to bitch for ten uninterrupted minutes 3. The other person gets a ten-minute tum 4. There needs to then be ten minutes of silence before another round is started, with a coin toss. This intervention is specifically designed to fit situations in which both partners complain about fights that are never resolved. It is not useful, in finding solutions for the wider range of complaints clients bring to the therapist, if only one of the spouses is complaining about the arguments. However, the transferability of the two "formula tasks" gives the idea that properly constructed tasks could be used again and again with little modification in a variety of similar cases. The same solution can be used over and over again without specific regard to the details of the complaint (p. 122) Do Something Different This task was invented in 1978 to fit one specific case. But the results by the family prompted de Shazer to develop versions for other similar cases. The criteria for use of the formula were quickly recognized. One person is complaining about the behaviour of another, and having tried "everything" (p. 122), has become stuck, reacting in the same way over and over while the troublesome behaviour continues. The message the family is given by de Shazer is to do something different to change the behaviour of the defiant person if the old ways of intervention are not working. The therapists do not need to know specifically what the "something different" was, only the outcome. de Shazer reported that a "spontaneous" (p. 12) small change has prompted solutions. Simply, solutions involve doing something different from what was done before that did not work. 15 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES What is Family Systems Theory? Murray Bowen (1913-1990) was the first and only psychiatrist to describe a theory explaining human behaviour. He trained at the Menninger Institute, and in 1954 became the first director of the Family Division at the National Institute of Mental Health (NIMH). His research record and theory are well known. Bowen Family Systems Theory is a theory of human behaviour that views the family as an emotional unit and uses systems thinking to describe the complex interactions in the unit. Bowen believed that the emotional systems that govern human relationships had evolved over millions of years. The cornerstone of Bowen theory is the eight interlocking concepts that influence the counterbalance between togetherness and individuality. No one concept can be explained by another concept. No one concept can be eliminated or isolated from Bowen theory. Emotional, biological, and environmental influences are considered as the individual adapts within the family unit over generations. Bowen summarized his theory using eight interlocking concepts: 1. Differentiation of Self (the most important concept) 2. Nuclear Family Emotional System 3. Triangles 4. Family Projection Process 5. Multigenerational Transmission Process 6. Emotional Cutoff 7. Sibling Position 8. Societal Emotional Process 16 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Differentiation of Self Differentiation of self refers to one' s ability to separate one' s own intellectual and emotional functioning from that of the family. Increasing one's differentiation is thought to be a lifetime proj ect in which one grows in a capacity to better manage one ' s own connection as well as independence from one's family of origin and other close relationships. Individuals with "low differentiation" are more likely to become fused with predominant family emotions (a related concept is that of an undifferentiated ego mass, which is a term used to describe a family unit whose members possess low differentiation and therefore are emotionally fused.) Those with low differentiation depend on others ' approval and acceptance. They either conform themselves to others in order to please them, or they attempt to force others to conform to themselves. They are thus more vulnerable to stress and they struggle more to adjust to life changes. To have a well-differentiated "self' is an ideal no one realizes perfectly. They recognize that they need others, but they depend less on other' s acceptance and approval. They do not merely adopt the attitude of those around them but acquire their principles thoughtfully. This helps them decide important family and social issues, and resist the feelings of the moment. Thus, despite conflict, criticism, and rejection they can stay calm and clear-headed enough to distinguish thinking rooted in a careful assessment of the facts from thinking clouded by emotion. What they decide and say matches what they do. When they act in the best interests of the group, they choose thoughtfully, not because they are caving in to relationship pressures. Confident in their own thinking, they can either support another' s view without becoming wishy-washy or reject another' s view without becoming hostile. 17 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Differentiation, therefore, is the capacity of a person to manage his or her emotions as well as thinking; their individuality as well as their connections to others. Differentiation has also been defined as the measure of one' s emotional maturity. Triangles In family systems theory, the triangle describes the dynamic equilibrium of a threeperson system. The major "influence" on the activity of a triangle is anxiety (Kerr & Bowen, 1988). According to Bowen, whenever two people have problems with each other, one or both will "triangle in" a third member. Bowen emphasized people respond to anxiety between each other by shifting the focus to a third person, triangulation. In a triangle, two are on the inside and one is on the outside. For example, a mother caught in intense conflict with her son, may actively recruit the father to deal with the son. When he attempts to do so, conflict erupts between father and son and mother withdraws. The son may counter this move by attempting to precipitate conflict between his parents. He may plead with the mother to get the "harsh" father off his back (p. 138). When the anxiety subsides, the mother and son again get close and father is excluded from the togetherness. In either example, though anxiety is reduced, neither father or mother resolve the source of their anxiety. Triangles usually have two individuals or entities in conflict and another entity or individual uninvolved with the conflict is brought in. When tension is not high, the relationship between the first two individuals is desirable. The two original people of the relationship or conflict are the inside positions of the triangle. The insiders bond when they prefer each other, but in the case of conflict, another entity or individual (the outsider) is brought in by one of the fust individuals in effort to either diffuse and avoid the situation, or team up against the other insider. The insiders may actively exclude the outsider when 18 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES tensions are not low between the insiders. Being excluded may provoke intense feelings of rejection and the outsider works to get closer to one of the insiders. Like musical chairs, the positions are not fixed. If mild to moderate tension develops between the insiders, the most uncomfortable insider will move closer to an outsider. The remaining original insider then switches places with the outsider. The excluded insider becomes the new outsider and the original outsider is now an insider. Predictably, the new outsider may move to restore closeness with one of the current insiders. At a high level of tension, the outside position becomes the most desirable. If the insiders conflict severely, one insider opts for the outside position by getting the current outsider to fight with the other insider. If the maneuvering insider succeeds, he gains the more comfortable position of watching the other two people fight. When the tension and conflict subside, the outsider will try to regain an inside position. Emotional Cutoff The concept of emotional cut-off in Bowen Family Systems theory is one of the most important concepts. It describes the way people use physical or internal emotional distancing to handle their unresolved emotional attachment to their parents and other family members (Titelman, 2003). To avoid sensitive issues, they either move away from their families or rarely go home. If they remain in physical contact with their families, to avoid sensitive issues, they use silence or divert the conversation. Though cutoff may diminish their immediate anxiety, these unresolved problems contaminate other relationships, especially when those relationships are stressed. Generally, cutoff may be seen as short term gain in relief of stress. However, it may lead to patterns of cutoff in successive generations rather than strengthened 19 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES differentiation in important and sometimes difficult relationships (B. Cole, personal communication, April28, 2010). Sibling Position Research on sibling position conducted by Toman (1961), was incorporated into family systems theory in the early 1960s (Kerr & Bowen, 1988). Toman's theoretical premise is that "certain personality characteristics are determined by the original family configuration in which a child grew up" (p. 314). An older brother with a younger brother, for example, tends to be a leader who works hard and endures hardships. It is natural for him to accept responsibility, and to assume that tasks will not get done unless he does them himself or sees to it that someone does them. A younger brother with an older brother does best when others are looking out for him. It is not natural for him to assume leadership and to accept responsibility as it is for an older brother. Charm is often one of his strong points. An older sister with a younger sister wants to stand on her own and take care of others. Toman also defined predictable personality characteristics associated with other sibling positions, "such as an older brother with a younger sister, a young brother with an older sister, an older sister with a younger brother, an older sister with a younger brother, a younger sister with an older brother, an only child, and a twin. Middle children may reflect the experience of growing up in 'two' sibling positions: younger than the older sibling and older than the younger sibling"(p. 314 ). Spacing of the siblings is important. Five or more years difference between siblings usually reduces the predictability of the characteristics associated with each position. According to Toman, an individual's personality is shaped, to some extent by being in a certain functioning position in the family. The profiles of sibling positions predict aspects of personality fit of marriage partners. If an older brother who grew 20 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES up with a younger sister marries a younger sister who grew up with an older brother, there will be mirror image aspects of their personalities that contribute to the emotional complimentarity of their relationship. In contrast, if a younger brother who grew up with an older brother marries a younger sister who grew up with an older sister, there is less complementarity. Both are youngest children and neither is accustomed to living with a peer of the opposite sex. Toman clearly states that the concept of functioning position in family systems theory predicts that every family emotional system generates certain functions. These functions are performed by specific individuals in the system. When one individual performs certain functions, other individuals will not perform them. By virtue of being born in a specific position, the individual takes on the functions associated with it. An individual's personality is shaped, to some extent, by being in a certain functioning position in the family. An oldest child, for example, will function in certain predictable ways in relationship to his parents and younger siblings. The nature of his functioning shapes the development of his personality, and as his personality develops, it shapes the nature of his functioning. According to Toman, although people grow up in different families, different social economic class, different cultural backgrounds, and different levels of differentiation, they can grow up in identical functioning positions in their respective families. System theory predicts, therefore, that all oldest children will have important personality characteristics in common. According to Kerr and Bowen (1988), Toman's research proved that the "predicted relationship between personality development and functioning position exists" (p. 315). 21 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Process of Discovery Bowen studied psychoanalysis for several years at the Menninger Foundation in Topeka, Kansas. While at the Menninger clinic, he studied patients with schizophrenia and discovered a unique relationship between them and their mothers (Kerr & Bowen, 1988). This led to Bowen' s concept of differentiation of self, which is the autonomy from others and separation of thoughts from feelings. From there he moved on to the National Institute of Mental Health in 1954 where he began work on expanding the mother-child relationship to include fathers and thus sparking the idea of triangulation . He believed that the triangle was the basic molecule of an emotional system and the smallest "stable" unit in a relationship unit (p. 134). In 1959 he moved to Georgetown University Medical Center and began more extensive work on family systems and how they relate to one another during therapy. He believed that family members adopt certain types of behaviours based on their place in the family. He obtained a great deal of information while at Georgetown, including the need to make a hard effort to remain an objective party. He first attempted to have sessions with families and staff on the assumption that togetherness and open communication would be therapeutic. His staff began to become pulled in different directions and the same effect carried through when he attempted these multifamily meetings alone. He decided that families needed to be met with one at a time. During this time he also coined the previously, discussed term emotional cutoff This refering to the natural mechanisms people use to counter high anxiety or high emotional fusion, from unresolved issues with family. Cutoff can look like physical or emotional withdrawal, avoidance of sensitive topics, physically moving away from family members, and rarely going home. 22 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES His final large contribution was that of his own personal discovery: the idea of differentiation. Bowen postulated that differentiation among family members produced variation, as individuals became more or less mature from one generation to the next. In cases where multi-generational transmission of differentiation among family members becomes progressively lower, this can also generate clinical symptoms. He developed an extended family systems therapy with the goal of increasing the individual family member's level of differentiation through better emotional contact with those in the nuclear and extended family. This effort requires knowledge of the emotional system and how to manage and define self in relationships. What is Somatic Experiencing? Somatic Experiencing is a form of therapy aimed at relieving and resolving the symptoms of post-traumatic stress disorder (PTSD) and other mental and physical traumarelated health problems by focusing on the client's perceived body sensations (or somatic experiences). It was introduced by Levine and Fredericks in their 1997 book Waking the Tiger. In this work, Levine discusses at length his observations of animals in the wild, and how they deal with and recover from life-threatening situations. He concludes that their behaviour gives us "an insight into the biological healing process" (p. 98), and that "the key to healing traumatic symptoms in humans lies in our being able to mirror the fluid adaptation of wild animals" (p. 17-18) as they avoid dramatization in reacting to life-threatening situations. The procedure, which is normally done in a face-to-face session similar to psychotherapy, involves a client tracking his or her own felt-sense experience much as is done in Gendlin's Focusing (Levine, 2005). According to Levine, practitioners of Somatic 23 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Experiencing are often also psychotherapists, Rolfers, or Body Workers. Certified practitioners must complete a training course that spans three years. The procedure is considered by its practitioners to be effective for Shock Trauma (see below) in the short term (typically one to six sessions). It is also considered effective for Developmental Trauma as an adjunct to more conventional psychotherapy that may span years. Somatic Experiencing attempts to promote awareness and release of physical tension that proponents believe remains in the body in the aftermath of trauma. They believe this occurs when the survival responses (which can take the form of orienting, fight, flight or "freeze") of the person are aroused but are not fully discharged after the traumatic situation has passed. If the situation calls for aggression, a threatened creature will fight, if it cannot win the fight, it will run off. These choices are thought out; they are instinctively orchestrated by the reptilian and limbic brains (Levine, 2005). Somatic Experiencing uses procedural elements that have been said to work anecdotally, but have yet to be subjected to a double-blind study. The process involves a guided exploration of the nature and extent ofthe physical dysregulation that is harboured in the body as a result of trauma. Techniques include "titration" of the client' s experience. That is, in the initial steps of the procedure, barely perceptible changes in the body (a slight loosening of tension in the chest, for example) are attended to at length (Scaer, 2005). Another idea is that the client's experience should be "pendulated." Pendulation refers to the movement between regulation and dysregulation. The client is helped to move to a state where he or she is believed to be somewhat dysregulated (i.e., is aroused or frozen), and then helped to return to a state of regulation (loosely defined as not aroused or frozen). 24 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES This process is done iteratively, with progressively more levels of dysregulation believed to be resolved by the client in successive pendulations (Scaer, 2005, p. 255). Somatic Experiencing is considered by its practitioners to be useful for two broad categories of trauma: Shock trauma and developmental trauma. Shock trauma is loosely defined as a single-episode traumatic event such as a car accident, earthquake, battlefield incident, etc. Developmental trauma refers to various kinds of psychological damage that occur during child development when a child has insufficient attention from the primary caregivers, or an insufficiently nurturing relationship with the parent (Levine, 1997). What is Unresolved Grief? Rando, in Clinical Interventions for Caregivers (1984), based on relevant research on grief and dying, discusses the issue of unresolved grief. (This was relevant in my practicum.) This is a grief that is not normal. But, first and foremost it is important to describe the meaning of the term grief Rando defmes grief as "a universal experience that is repeatedly encountered" (p. 15) She explains that it is the process of psychological, social, and somatic reactions to the perception of loss. This implies that grief is manifested in each of the psychological, social, and somatic realms and is the natural and expected reaction of many kinds of losses, not only death, and is based upon the unique, individualistic perception of loss by the griever. According to Rando, "mourning" is another term used interchangeably with grief (1984, p. 15). In 1917, Sigmund Freud published his classic paper Mourning and Melancholia in which he defmed the process of grief as the reaction to the loss of a loved person, or the loss of some abstraction which has taken the place of one, such as one's country, liberty, an ideal, and 25 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES so on ... .It is also worth noting that although mourning involves grave departures from the normal attitude to life, it never occurs to us to regard it as a pathological and to refer it to medical treatment. Expectations for Grief According to Theresa Rando (1984 ), there are many false expectations in our society about the nature of the grief process and the therapist's work is to help the bereaved gain a realistic view of how grieving will change over time and how long it will take for them to recover. Time is known to be a healing factor if the griever is dealing with the loss and not denying, inhibiting, delaying or working through the loss. The research by Rando (1984) suggests that bereavement symptoms may initially subside with time and, even with grief work done successfully, the sense of loss will be there but the pain will be more in memory than experienced at the moment. Anniversary reactions are to be expected. Basic Tasks of Grief In Grief, Dying and Death, Rando (1984) cites the experience of the grief process as presented by Lindemann, 1944; Parkes and Weiss, 1983; and by Worden, 1982. There are three tasks that Lindemann views as constituting grief work. They can be used for the loss of a loved one or any type of loss and are as follows: • Emancipation from the bondage of the deceased • Readjustment to the environment in which the deceased is missing • Formation of new relationships. According to Lindemann (1944), grief work requires both physical and emotional energy. The work entails grieving for the actual person, hopes, dreams, and unfulfilled expectations that the griever held for that person and the relationship. The complicating 26 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES factor that may prevent the work of grief from being accomplished is due to the resurrection of old issues (Rando, 1984). The symptoms and behaviours of unresolved grief are to be found in Appendix 2. Another view on how an individual deals with loss of a loved one has been outlined by Kubler-Ross (1969) as having five stages as follows: • Denial and isolation: This a period of shock that acts as a buffer against the overwhelming reality of the situation • Anger • Bargaining, in which pleas are made to God or the doctor to forestall the loss or behaviours are undertaken to avoid grieving over it after it has occurred • Depression • Acceptance Reasons for Unresolved Grief Jackson (1957) feels two conditions may provoke difficulties in accomplishing grief work and thus predispose the mourner to unresolved grief. In the first condition, the mourner is unable to tolerate the emotional distress of grief and resists dealing with the necessary tasks and feeling of grief. Secondly, a condition occurs when the mourner has an excessive need to maintain interaction with the deceased; in this case the mourner denies and fails to appropriately decathexis from the deceased. There are also psychological and social reasons for failure to grieve. Psychological factors in unresolved grief are • Guilt: The act of grieving may bring up negative acts or feelings they had neglected to do for the deceased. 27 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES • Loss of extension of self: When a person is so dependent on the deceased, they may refuse to grieve in order to avoid the reality of the loss. • Reawakening of an old loss: Someone may refuse to grieve his divorce because it resurrects the memory of his mother whom he never appropriately grieved. • Multiple loss: If it is a loss of a family or sequential losses within a short period, there comes of difficulty in grieving because the losses are too overwhelming and they are suffering from a "bereavement overload" (Kastenbaum, 1969, cited in Rando, 1984, p. 47). • Inadequate ego development: Mourning appropriately requires that the individual to have achieved the state of object constancy and functions. Without these prerequisites, the individual responds to loss and separation with serious ego regression. Consequently, people with severe ego impairments (e.g., borderline personalities) are often unable to adequately complete the grief process because they cannot meet the necessary psychological tasks. Instead, they experience feelings of intense hopelessness, rage, frustrations, depression, anxiety, and despair and may have psychotic behaviour when their primitive defense mechanism fails. • Idiosyncratic resistance to mourning: These are individuals who do not permit themselves to mourn because of specific psychological issues that interfere with the process. For example, some people will not grieve for the fear of losing control or appearing to be weak. 28 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Social Factors in Unresolved Grief • Social negation of a loss: This is when the loss is not socially defined as a loss, e.g., an abortion, miscarriage, infant adoptions. There is normally inadequate social support for these symbolic psychosocial losses. • Socially unspeakable losses: In deaths such as overdose, murder, or suicide, the social system tends to shy away out of ignorance or moral repugnance. • Social isolation and/or geographic distance from social support: Geographical distance from support is becoming common as individuals have become increasingly mobile. There is also the breakdown of the nuclear family and the decline in primary group interactions with consequent depersonalization and alienation all accounting for lack of social support. • Assumption of the role of the strong one: Some people are designated to be "the strong one" and are required to bolster the morale of others, as they make the funeral arrangements and are required not to show any emotions. • Uncertainty over the loss: As in cases of child kidnapping or lost persons, the grievers and social systems are often unable to commence grieving until they know the precise status of the lost person (Rando, 1984). Therapies for Unresolved Grief The book Focal Psychotherapy provides a model that involves assessment of the particular form of pathological bereavement response and specific treatment to manage it and address the etiological process involved. Its goal is to convert the pathological bereavement response into which the individual is able to grieve more appropriately (Raphael, 1983). The optimal time for preventative intervention is probably between the first two to eight weeks or 29 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES even three months after the death. In the first weeks, people are so preoccupied with practical tasks and family matters that they are not ready to talk or go through the process of grief. However, it is important to intervene before the griever develops maladaptive grief responses. This is consistent with crisis theory, which states that a little help rationally directed and purposefully focused at a strategic time will be more effective than more extensive help given when the person is less emotionally accessible. Strategies for three types of unresolved grief follow : Inhibited, Suppressed, or Absent Grief The therapist must explore why the bereaved cannot accept the death. The principle task will be to identify the griever' s defenses, which will be revealed through repeated reviews of the griever' s relationship with the deceased. An absence may be due to the mourner' s fear of releasing emotions. In this grief, suppression or inhibition of grief exist along with powerful distortions. The person will have extreme anger or extreme guilt. This often happens following the loss of a dependent relationship or when there is sudden or unexpected death for which someone is blamed. Particular emphasis in the treatment will be on assisting the bereaved in working through the problems created by the loss of a very dependent relationship or one that symbolized something special and irreplaceable for the griever. In treatment, the therapist must refrain from reassuring the griever that she/he did their best for the deceased. The therapist will need to help the griever to come to terms with the loss and learn to live with it by exploring the origins of the anger and believed relationship with the deceased. If the guilt becomes unmanageable, psychiatric help is sought. 30 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Chronic Grief This is acute grief that is prolonged following the deaths of individuals with whom the bereaved were in dependent and irreplaceable relationships, those that were unexpected, and those of children. It usually indicates that extraordinary and possibly pathological emotional investment had been maintained in the deceased. Many individuals in this type of grief are not motivated to relinquish it as it assists them in keeping the deceased "alive." Specific treatment goals are to explore why the relationship had such a special meaning and cannot be relinquished. It will be critical to explore the roles and the identity that the griever had in terms of the deceased, since decathexis means "the mourning has quite a precise psychical task to perform: its function is to detach the survivor memories and hopes from the dead" (Freud, 1913, p. 65 , cited by Rando, 1984). This act normally results in the adoption of new roles and identity by the griever. The therapist may want to establish a set of concrete tasks for a chronic griever to complete, such as sorting the deceased effects or going to the cemetery. Another form of therapy for the chronic griever is Re-Grief Th erapy, which is a short term therapy and the griever is usually seen four times a week to intensify therapy. In the process, the griever is helped to form boundaries demarcating oneself from the deceased through the taking of a detailed history of the deceased and the lost relationship (Volkan & Showalter, 1968, cited by Rando, 1984). Sometimes a photo of the deceased is brought in to clarify the differentiation. The griever is helped to understand why she could not permit the deceased to "die." The circumstances of the death are carefully examined. Next, the therapist focuses on the griever' s "linking objects" which are highly symbolized objects representing the deceased and providing contact with him. The therapist asks the griever to bring the 31 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES objects to the session and these are used to stimulate memories and make the griever aware of the magical ties with the deceased. The concepts that are symbolized by linking objects are identified and interpreted to loosen the griever's contact with the deceased. Further review of the circumstances of the death is conducted and emotional release is encouraged. Behavioural therapies for dealing with chronic grief include modified flooding technique of confrontation with pain evoking stimuli breaking down denial and evoking the affects of grief which can then be desensitized and extinguished (Gauther & Marshall, 1977, p. 111). In other studies, guided mourning was described as treatment in which individuals with unresolved grief were exposed to both imagination and in real life to avoided or painful memories, ideas, or situations related to the loss of the deceased. They were encouraged to repeatedly describe such thoughts, feelings, or ideas until the distress that had initially prompted the phobic avoidance response was diminished. Individuals were encouraged to say goodbye to the lost loved one by writing notes or visiting the cemetery. They were given instructions to write about the deceased, think about that person, force themselves to face grief, and look at a photo of the deceased each day. When compared to a controlled group that had been encouraged to avoid thinking about death or the deceased, those who had received guided mourning intervention evidenced modest improvement as compared to the controlled subjects (Rando, 1984). Small Acts of Living: Everyday Resistance to Violence and Other Forms of Oppression Allan Wade describes an approach to therapy which is based on the observation that whenever persons are badly treated, they resist. That is to say that, alongside each history of violence and oppression, there runs a parallel history of prudent, creative, and determined 32 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES resistance. The article by Wade ( 1997) stipulates that any psychological or behavioural act through which a person attempts to expose, withstand, repel, stop, prevent, abstain from, strive against, impede, refuse to comply with, or oppose any form of violence or oppression (including any type of respect), or conditions that make such acts possible is a form of resistance. Resistance also includes imagining or attempting to establish, a life based on respect and equality, on behalf of one's self or others, including any effort to redress the harm caused by violence or other forms of oppression. (p. 32) The phrase "small acts of living" captures the spirit and quality of many forms of resistance that are literally small tools of everyday communication which become important devices for the expression of resistance by the victim (p. 32). Wade describes an approach to therapy that can completely transform the self image of a client who is recovering from traumatic experiences of abuse. The approach arose from the assumption of brief and solution-focused therapy that a client has pre-existing strengths (de Shazer, 1985, 1988; White & Epston, 1990; White, 1992, 1995, cited in Wade, 1997). Following Wade' s approach, therapists ask clients how they responded to violence, rather than how they were negatively affected by the violence. Clients become engaged in dialogue concerning the details of their own resistance, with the goal of uncovering the implications of their resistance behaviours. As a result, abuse survivors begin to realize their strengths, insights, and abilities in the past. A single act of resistance can reveal many diverse strengths, often unrealized by the client. Clients begin to experience themselves as being more capable of responding 33 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES effectively to the issues that brought them to therapy. One of Wade' s clients stated clearly that, by knowing she resisted, she could feel pride and increased self-worth. She found she regained her dignity and her sense of being valuable (Wade, 1997). Anti-Oppressive Theory Anti-oppressive practice theory (AOP) is one of the social theories that does two things: describes or provides an explanation of social relations or social reality and attempts to redress these through visions of social justice. Perceptions of the true nature of social relations are therefore deeply inter-related to visionary claims of social justice. Moreover, ontological or visionary claims are also dependent on particular knowledge claims. There are ten premises that give shape to AOP and practice. These key components of anti-oppressive practice are gleaned from a variety of sources, from the literature of colleagues, and from experience (Turner & Moosa-Mitha, 2005). Premise 1 - AOP is focused on theorizing on the basis of social identities and experiences, especially those of marginalized persons. The lived experiences and "knowledge" that is indigenous to marginalized groups becomes the basis of anti-oppressive theorizations, as does the contestation and deconstruction of the mainstream or dominant views of these groups. The social identities of marginalized groups are constructed as being inferior by dominant groups, as is currently evidenced by the treatment of Americans troops towards Iraqi prisoners of war "where the construction of people as terrorists serves to sanction abuse and torture" (Turner & Moosa-Mitha, 2005 , p. 5). Premise 2 - AOP is focused on the components of power in human interactions and conflicts. Power is a crucial component of any conflict. It is the use of power which is our focus , and as Lum Lee' s (1994) feminist statement says: "power in a patriarchal society is 34 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES most often exercised through the use of exploitation and force, manipulation and competition" (p. 5). AOP theory explores the complicated power dynamics, how it is being employed and its impact on the oppressed. Lee further states To make empowering interventions, we need to assess the manifestations of oppressions, including discrimination, disempowerment, powerlessness or power shortages, inequality, conflict caused by acculturation and loss of cultural solutions, and the presence of stereotyping and bias in a client' s life. (p. 137) Premise 3 - AOP deals with the experience of self as social worker/conflict intervenor and the oppressed person, the melding of experience forms coalitions for survival and resistance. Moosa-Mitha states that anti-oppressive practice requires "entering the lives of our clients in a deep way that allows the client' s story to invade ours." She also defines oppression as "the involuntary or voluntary silencing of an individual or group for a variety of reasons ... fear, overwhelmed by power, not reflected in political structures or marginalized through classism, racialism, ableism, homophobia and so on" (p. 5). She believes an anti-oppressive practice is driven by experience of the oppressed person and not by the social worker, advocate, or mediator. Indeed these may be unwitting agents of oppression. Seeing the world through the experience of the marginalized gives hope for resistance to oppression" (Turner & Moosa-Mitha, 2005, p. 3). Demonstrating both compassion for the experienced of the oppressed person and a willingness to share one' s experience is required. 35 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Premise 4 - assumes AOP deals with both the personal and political. hooks (1989, cited by Turner & Moosa-Mitha, 2005, p. 6) states that "we must link personal narratives with knowledge of how we must act politically to change and transform the world. " Premise 5 -invites social workers to take responsibility for their complicit role in colluding with an unequal society. This demands that social workers as conflict intervenors adopt a self-reflective stance, as Moosa-Mitha cites Dominelli (1998) states: "the responsibility for dismantling society' s racist edifice belongs to white people who enjoy the privileges emanating from it" (p. 46). According to Moosa-Mitha, the anti-oppressive approach of the social worker as a conflict intervenor is not only transforming personally but also societally (Turner & Moosa-Mitha, 2005). This transformative approach requires that social workers have an ethical obligation to challenge those oppressive societal structures in concert with other groups involved in political actions for change. This includes questioning social work practices which subordinate others and perpetuates unequal social relations. Premise 6 - AOP calls upon social workers to focus on an oppressed person' s strengths. Social workers regard emotions relating to oppression to all parties as crucial; it is the interaction of mind/body not the separation which is the focus . Survival skills and fighting back are strengths. Social workers should reframe "victims" as "survivors" and assist them along the road to being "resistors" or "warriors." This premise suggests that a sense of support and solidarity are prerequisites for effective action. This sense may derive from the worker, from friends/allies, or from a support group . Premise 7 - AOP encourages social workers and oppressed persons to become partners in political action. Oppressed persons appear to derive major strength when they are encouraged to take political action themselves with support of social workers as allies. 36 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Political actions becomes essential because the entrenched nature of oppression in society and the fact that it often becomes accepted as normal. Premise 8 - AOP deconstructs the notion of the experts. Social workers are "helpful." Privilege and expertise are used to demystify power and challenge when it is abused. Anti-oppressive practice means living with the contradictions and complexity of power and marginalization, and not assuming there are right answers. Moosa-Mitha states it means saying "no" to a subjective/objective dichotomy and binary thinking (Turner & Moosa-Mitha, 2005). Rather, there is an interrelationship between the objective and the subjective, and the nature of that relationship is important. It increases the complexity and enriches the textures of human interactions. Premise 9 - states that AOP is empowering oppressed persons at all levels, individually, as a class, and at a broader political level. These strategies are intertwined to maximize impact on the oppressive structures. Premise 10- indicates that AOP works across differences. It invites the social workers to enter difficult spaces, create bridges and share in the reinforcing of resistance to oppression. Working across differences means that indigenous and cultural ways of knowing need to be used. AOP obliges social workers not to impose prescriptive models of conflict intervention but to assist persons, especially those from the margins, to use their own ways of dealing with conflict. In concluding, the literature review has provided studies that are related to the models of counselling relevant to the population I worked with in my practicum and to those I hope to work with in my future practice. The studies provided a deeper understanding of the family systems, solution-focused approaches, grief process, and the resistance that clients 37 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES may have towards change in their lives from their current situations. The information provided is helpful in providing me the right tools for my practice. At my practicum, I was able to try out the different tools or counselling techniques and recognized that, as a social worker, regardless of what technique I used, the fundamental requirement that brought any lasting change was the promotion of empowerment and the need to focus on the resources and the strength of a client for any lasting change to occur (Gaiswinkler & Roessler, 2009). 38 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Chapter Three: Description of Practicum In this chapter, I will describe my practicum objectives, practicum supervisor working relationship, description of the practicum agencies, practicum activities, and how I achieved my practicum objectives and the case studies that exemplify the use of my counselling techniques. Objectives I will outline my goals of learning and the expected outcomes in the practicum setting as follows: 1. Increase knowledge and practical counselling skills. Observe experienced counsellors in contact with clients Provide counselling to clients Consult with the supervisor and senior counsellors Observe selected tapes of clinical sessions 2. Become especially familiar with Bowen theory and Solution-focused theory. Read representative material and observe training tapes Demonstrate familiarity with the literature and therapeutic techniques 3. Learn the process for file recording in a counselling agency. Demonstrate awareness of legal and liability issues Demonstrate clear, concise file recording practice Maintain up-to-date reports and notes 4. Learn about advocacy in a counselling agency. Make appropriate referrals Demonstrate an awareness of when to act on behalf of clients 39 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES 5. Learn about the operational aspects of a non-profit agency. Read annual reports and financial statements Read by-laws and policy documents Practicum Supervisor Relationship Prior to embarking on my practicum at the South Island Centre for Counselling (SICC), I met with the director who interviewed me after perusing my resume. I prepared a proposal of my learning objectives. These objectives were confirn1ed after a conference call with my practicum and academic supervisors and after discussing my needs with the agency. A Memorandum of Agreement between the University ofNorthern British Columbia and the South Island Centre for Counselling outlined the responsibilities of each organization as regards learning, working conditions and the fact that, for insurance purposes, the university would maintain third party liability during the practicum. In selecting a practicum setting, I was particularly concerned that the agency of choice would have a generalist practice, as that is my area of interest, and a strong Mentor such as Bill Cole, who has about 13 ,000 hours of counselling over a period of 23 years. South Island Centre uses therapy models for interventions that fit with social work principles of empowerment, feminism, and anti-oppression as the primary focus in helping individuals gain control of their lives. These models include Solution-Focused and Bowen's Family Systems theories in their counselling practice. The agency is non-profit and provides professional counselling services to individuals, families, and organizations. They address the following issues: • Trauma or distress • Depression 40 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES • Relational conflict • Self-esteem issues • Emotional, sexual abuse, and physical abuse issues • Issues related to faith and spirituality • Grief and loss • Addictions (substance, gambling, and pornography) • Marriage preparation • Marriage conflict Outline of Activities The practicum supervisor at SICC planned that the required 560 hours by UNBC would be best achieved through diversified counselling sessions; he had done so with previous graduate students. He inquired if I would be interested in counselling with women at a transition house in Victoria, and with the Corrections Canada Community and Adult Mentoring Support Program that works with ex-inmates who are on parole. These inmates live in half-way houses around the city of Victoria, require help with integrating back into society, and need counselling for grief and loss. I realized that my practicum experience would be enriched by such an exposure to different counselling needs. Interestingly, most of my counselling hours were gained from the transition house and my focus in counselling is now on women who have experienced various forms of abuse and emotional issues. 41 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Description of Practicum Agencies 1. South Island Centre for Counselling Society South Island Centre for Counselling (SICC) is a non-profit counselling and training agency funded by donations, fees, and grants of community well-wishers. They have served Victoria communities since 1975; Bill Cole is the third director since its creation. He has a team of qualified counsellors and he also provides mentorship to practicum students. Besides counselling services to individuals and families, the Centre provides training in pastoral care, grief and loss, Bowen' s Family Systems theory, and Solution-Focused techniques, as well as consultation for clergy and professionals. The organization's mission is to provide affordable counselling services to those in need: facilitating personal, relational, and spiritual wholeness in the community at large. The main focus of the counsellors at the Centre is to offer services for persons dealing with trauma or distress, depression, relational conflict, self esteem issues: emotional, sexual and physical abuse issues, issues related to faith and spirituality, grief and loss, addictions in substance abuse, gambling, and pornography, marriage preparation and marital conflict. Payments for services are fifty dollars per hour or at the rate of one percent of a client's gross yearly income. However, SICC does not turn anyone away as exceptions are made for those who cannot afford to pay the one percent and those who have no income at all. Mission Statement In the South Island Centre for Counselling (SICC) Constitution and By-Laws (2008) is a listing of its guiding core values, as follows: 42 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Service: They provide affordable service to their clients and the community and deliver services with professionalism and compassion in a supportive and non-threatening environment. Inclusivity: Although SICC practices are grounded in Christian faith, they provide non-biased, non-judgmental counselling and training services to people of all faiths and ethnic backgrounds, and welcome diversity amongst clients in their practice. Integrity: In interacting with others, SICC demonstrates at all times respect, authenticity, and honesty with the intention of building trust in relationships. Ethical practices: In interacting with clients, members of the community, and with each other, SICC states that it demonstrates a commitment to its values and accountability for their practice and is always mindful of the professional ethics to which they subscribe. Growth: SICC strives to facilitate personal growth in their clients, encourage and support professional growth in the staff and is committed to organizational growth at a board level in terms of effectiveness, efficiency, and quality programming. Effective leadership: SICC endeavours to demonstrate the leadership qualities of excellence, collaboration, discemment, empowerment, creativity, healing, and mentorship at every level of the organization. Code of Ethics: Staff at SICC are guided by the following code of ethics (Constitution and By-Laws, Societies Act of BC, Canada): 1. Shall not misrepresent their actual qualifications 2. Shall not use their position to secure unfair personal advantage: shall avoid exploiting the trust and dependency of a client: will not engage in harassment, 43 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES abusive words or actions including sexual behaviour or harassment even when a client invites or consents to such behaviour. 3. Shall respect integrity and protect the welfare of the client, ensuring the safety and confidentiality of clients ' records. Confidentiality may be broken when there is a reasonable evidence of abuse of minors, the elderly, the disabled, the physically ally or mentally incompetent or a felony committed. 4. Shall respect the religious convictions of those they serve showing sensitive regard for the moral, social and religious standards of clients and communities. 5. Shall maintain an active, official and responsible affiliation with their own Christian denomination. 6. Shall not abandon or neglect clients. If a counsellor is unable to continue with clients they will make every effort to see they get continued treatment. 7. Shall foster responsible professional relationships with other members of the helping professions. 8. The counsellor shall commit to regular collegial (and supervisory) relationships. These are necessary to avoid the loss of perspective and judgment. 9. Shall be accountable to a professional body and the director and/or supervisor of SICC. 10. Shall maintain integrity on fees . They will be discussed openly with the client. 11 . Shall manage their own personal life in a healthy fashion seeking appropriate assistance for personal problems and conflicts. They are encouraged to continue an ongoing process of self discovery awareness. 44 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES 12. Shall establish and maintain appropriate professional relationships boundaries with students, supervisors and colleagues. 13. Shall not malign colleagues or other professionals. 14. Shall not offer ongoing clinical services to persons currently seeing another therapist without informing the other therapist with the client's consent or the client formally ending the prior therapeutic relationship 2. The Transition House This agency is managed by a contractor who has an agreement with the Province of British Columbia, renewed on a yearly basis, subject to satisfactory contractor performance and budget availability. The transition house provides temporary safe shelter and support for adult women and their dependent children who have experienced or are at risk of abuse, threats, or violence. The program is not intended for women with problems related to their mental health or alcohol or drug use. The Cridge Transition House has 18 beds for women in Victoria (Cridge Transition House Policy and Procedure Manual, 2010), and provides the following services: 1. Crisis intervention and referral support 2. Three nutritious meals per day 3. Bedding, towels and essential toiletries 4. Use of laundry facilities and when resources permit: 5. Local transportation as required, such as for medical emergencies, legal, or social services appointments and accompaniment and advocacy support services. 45 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Additional services provided are: 6. Counselling service for children and women in transition 7. The following outreach services: • Develop and maintain relationships with related services (e.g. , counselling programs, neighboring transition houses and safe homes, social services, the RCMP, other outreach services, alcohol and drug services, etc.) to identify and address the service needs of women. • Develop and deliver culturally appropriate public education initiatives to raise awareness of the effects of violence against women, of violence prevention, and of services available to women who have experienced abuse, violence and threats . • Provide supportive counselling individually or in groups for residents and former residents of the transition house and women in the surrounding area who have experienced violence, abuse or threats. • Facilitate a women' s understanding of her experience and the emotional and psychological impact of trauma resulting from abuse or violent experiences while respecting a woman' s rights to her own values, beliefs, culture and choices. • Assist women who have experienced abuse, threat of violence through referrals to appropriate services such as affordable housing, etc. • Provide outreach services for 14 hours per week. 46 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Service Principles When providing services, the contactor will consider as primary the following principles: • Women' s safety • Respect for the right of women to make choices based on their own understanding of their options, needs and goals, and • Respect for the individual situation, perspective, and needs of the women. Service Guidelines When providing services the contractors will apply the knowledge • Of power imbalances in our society that lead women and children being exposed to abuse or violence • Of the impact and dynamics of abuse or violence, and, • The perpetrators are responsible for their actions. Reporting The contractor will submit to the province: • Monthly data collection of the services in a form specified by the province. The form must be postmarked or submitted on line no later than the 1Oth of the following month that is being reported • Annually, upon request by the province, a budget projection for the services (Annual Budget) for the contractors ' fiscal year in a form specified by the provmce 47 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES • Annually, upon request by the province, an expenditure report for the services (Actual Spending Summary) for the contractors ' previous fiscal year in a form specified by the government. Policy and Procedures Manual The transition house maintains the above document and contains the following stipulations: • Professional and ethical conduct for employees and volunteers who work at the transition house • Telephone policy and procedures • Office administration procedures • Home security procedure • Emergency preparedness • Cooperation with the justice system and a flow chart for responding to the police • Residents' procedures on how to screen, and admit them to the house • Residents' policies for their files boundaries and rules while at the transition house • Staff procedures for shifts, time sheets, pay cheques, holidays, staff development and benefits, occupational health, meetings groups for clients, new beginnings start up kits for residents (Cridge Centre for the Family, 20 I 0). 48 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES 3. Community Adult Mentoring Program (CAMS) This is a Community Integration program, one of Corrections Services Canada programs, that contributes to a safe reintegration of offenders back to the community Other programs are in the areas of mental health, education, employment, national offender treatment, and national substance abuse treatment as well as anger management and parenting skills programs. The service strategy in developing the current menu of national programs has drawn heavily on state-of-the art theory that is supported by empirical findings. Indeed, each national program has been developed following a thorough review of the existing scientific literature. The evaluation of the effectiveness of these programs in assisting offenders to successfully modify their behaviour is a key aspect of each program area. For instance, each program area has a built-in evaluation component and methodology that facilitates the collection of both quantitative and qualitative information to review and monitor the programs currently in operation. In addition, the evaluation component is intended to assist program managers in evaluating the effectiveness of the program in contributing to offender's successful integration. Results from the evaluation are used to revise and improve programs as part of the integration programs division's overall program evaluation cycle. The Community Integration program deals with important issues related to reintegrating back into the community such as: • finding a job • money management (budgeting) • finding a place to live and maintaining a household • being with family again 49 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES • buying groceries • surviving in the kitchen • healthy nutrition • health and nutrition • dealing with issue of grief and loss Community Adult Mentoring and Support (CAMS) has an 8-week, one-hour training for volunteers who are taught how to help the offenders on parole integrate back into the community, develop much needed social skills, make wiser choices and more informed decisions, and realize that they are not alone in the community. Other topics that are covered are confidentiality, dress code, boundaries, prison culture (which treats staff with suspicion), manipulation by offenders, and rules on personal safety and relationship with offenders. After the training for the volunteers, they are matched with the offenders based on their area of expertise (Sylvain & Mongrain, 2004). Practicum Activities My first counselling session at the SICC was a meeting with my practicum supervisor. In the transition house, I was able to be an observer to my mentor for individual and group sessions for a few sessions. While with the CAMS program, I met the ex-inmates in a designated location in the Salvation half way house alone. Besides meeting with clients at SICC, I also attended counselling training sessions for pastoral care and grief and loss, read texts related to counselling, and watched counselling tapes which were an addition to my knowledge in theories and counselling practice. 50 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Consultations I also achieved my learning objectives at practicum settings through clinical consultations with the practicum supervisor when I reported back on my work with a client, for feedback purposes and growth. In some instances, I was reminded of the need to allow the client to be responsible for suggesting their own solutions and of my role as guide in the counselling process. Staff Meetings at South Island Centre for Counselling Society I had the opportunity to attend several staff meetings at SICC during my practicum. These were very beneficial as they involved case presentations and follow-up discussions by the counsellors. In the brainstorming for ideas on how to best approach a certain challenge posed by a client, I was able to gain more knowledge on how I could also meet the needs of clients more effectively, by interacting with the experienced counsellors. Staff Meetings at the Transition House The staff meetings at the transition house involved a debriefing session, for all the staff, with a somatic counsellor. I came to understand that this is a method of counselling used for individuals who have experienced trauma and I found it very calming. I realized its potential with women who have had the trauma of domestic violence. It was evident that, besides assisting the staff in dealing with possible individual stress created by the nature of their work, there was also a learning component on how we could also utilize the Levine and Fredericks' approach to problem solving for our clients at the transition house. 51 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Three Practicum Case Studies Case studies are generally seen as a qualitative approach to research. This is a research method that emphasizes depth of understanding and the deeper meanings of human experience, through observation and open-ended questions. By using the case study method and the open ended questions, Bowenian, solution-focused, and anti oppressive counselling approaches, I gained a rich and broad understanding of my clients' situations. According to Rubin and Babbie (2005), the case study method of research is also used to evaluate practice effectiveness. Today, as I review the case studies, I am effectively able to evaluate my performance and recognize which counselling method was successful. The protection of clients ' identities, their personal information, interests, and personal well being is an important ethical consideration. In the case studies, I have been sensitive to confidentiality and anonymity. The two terms have been defmed by Babbie and Rubin (2005) as follows: "Anonymity is an arrangement by the researcher that makes it impossible to link the participant to the research data, while confidentiality is a commitment not to share clients' information without their consent" (p . 745). In my three case studies, I have been able to provide anonymity and confidentiality for my clients by replacing their names with aliases as well as altering their ages and the actual locations of my meetings with them. Some aspects of the circumstances surrounding their particular situations have also been altered and modified to further protect anonymity. The transition house approved my request to use aliases in place of clients ' names for the sake of confidentially. Practicum Case Study 1 The following case study demonstrates what Mullaly (2002) describes as a form of oppression caused by a state of "powerlessness" (p. 44), which also causes a lack of decision- 52 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES making power, and results in an individual being at the bottom of a social ladder leading to inhumane and disrespectful treatment. A good example ofthe meaning of Mullaly's statement is demonstrated in my first assignment at the Cridge transition house. It was my first evening at the home and I was responsible for taking Mary to the hospital's emergency room so that her badly twisted shoulder could be x-rayed and the right treatment provided. Her husband had tried to break her arm by twisting it behind her back when she would not give him her car keys. Mary was suffering from severe pain on her shoulder after an assault- and the pain killers were not assuaging the pain anymore. She needed an x-ray to determine if it was broken. As another colleague and I drove Mary to the hospital, she informed us that she was afraid of hospitals and had suffered trauma as one doctor had labelled her a pain killer addict due to her constant visits when her husband had injured her. This time she did not want to be given more pain killers but to have a diagnosis of this painful left shoulder. She requested that we stay with her as she met the doctor so we could provide her with support and advocate for her. In this interaction, my colleague, and I worked from a solution-focused perspective and supported Mary in making her decisions. As we reached the triage with Mary, the nurse indicated that she could not assure us that we could accompany Mary as she met with the doctor, as that was not the norm, but she said she would try. My colleague and I decided to go to the parking lot to move the van to a parking spot that would give us more time at the hospital, as it was clear that it was a busy night and we might have to stay for a few hours. However, as we returned back to the triage, we found that Mary had already been taken in. Looking ahead, we saw her coming out crying and very upset. We inquired what had happened and were shocked to hear that the doctor had 53 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES refused to allow her support to come in with her. He had practically thrown her out of the examination room when she refused to talk to him without us. My colleague and I sought out the doctor and he was totally adamant that he would not give her another chance to meet with him as she had declined treatment when her chance came up. We tried in vain to explain to the doctor that Mary was an individual who had gone through serious physical abuse and had experienced negative experiences in hospitals and was in need of support from us and could he give her another chance. He categorically refused and proceeded to call the hospital security guards to escort Mary and us out of the hospital claiming that we were a nuisance. Mary went back to the transition house crying and we had a tough job explaining to her that the treatment she had received was a form of prejudice that was unacceptable and we were going to report the incident to the transition house director. We hoped to ensure that no other woman from the transition house would ever have to endure the kind of humiliation and disrespect that she had gone through that night. By using an anti-oppressive approach we encouraged Mary to go ahead and meet the doctor reassuring her that we would be there to support her (Turner & Moosa-Mitha, 2005). She felt empowered and seemed relaxed by the time we reached the hospital. Mary' s positive attitude towards the hospital seemed to agree with Turner and Moosa-Mitha's statement when they say that "Oppressed persons appear to derive major strength when encouraged to take political action themselves with support or social workers as allies" (p. 6). Before she met the doctor, Mary felt she was part of a change for equal justice and social change rather than a victim. In meeting the doctor, he refused to let us in the examination room stating that it was not necessary for her to have supports. We tried explaining that Mary had negative experiences in hospitals when the doctor did not believe her to be a genuine patient and we 54 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES wanted to support her. Unfortunately, he acted as Mary had feared and Mary was very upset and stormed out of the hospital without treatment that night. But, on the way back to the transition house we encouraged her to go back the following day informing her that she had the same right to treatment as anybody else. The next doctor allowed her to have a social worker beside her and she got her x-ray and the necessary medications for her arm. Today, Mary is in a community college aspiring to be a social worker so that she can be a part of the social change and social justice for others in the future. In this example, my work and role involved counselling, support, advocacy, and also being an ally and an agent of change. You can see those diverse tasks and roles in the case study describing my work with Mary. In my report to the transition house director, I stated that the doctor would not respect that Mary, as a victimized woman, needed the presence of her social workers for support. As a result, the transition house director spoke to the hospital authorities and doctor. She reported back to my colleague and me and to Mary that there was an apology from the hospital authorities. Furthermore, a protocol was set up concerning the need to allow support people to accompany women as they meet the doctor in the examination rooms. Our success in creating change in the structural level of the society is a clear indication of how critical anti-oppressive social work is beneficial in "reducing inequalities and marginalization by policies and practices that promote social inclusion" (Barry & Hallet, 1998, cited in Payne, 2005, p. 271). Practicum Case Study 2 In this situation, Lucy, a 25-year-old mom with a two-year-old son, came to the shelter to get away from an abusive spouse. She was also addicted to crack cocaine and had 55 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES been sexually abused as a young child by a close family member. While in the transition house, for two months, Lucy maintained sobriety and, with individual counselling, she came to understand the cycle of abuse and was clear that she would not return to her husband agam. Lucy had an aunt in Kelowna who helped her in getting second stage housing. However, she also had a sister in town who had taken an interest in being friends as Lucy was no longer living with a drug dealer. Lucy was fearful of losing this bonding if she moved out of town. Therefore, when her time to leave the shelter came up, she decided to move into a most unsuitable motel to be close to her sister, rather than move to Kelowna, where she would be able to start afresh with her aunt' s support and supportive second stage low cost housing. It is clear, given what Kerr's study on human family revealed, that the functioning of an individual is heavily influenced by relationships in the family (Kerr & Bowen, 1988) and not necessarily for positive outcomes. There are many concerns for Lucy when she moves into a downtown motel with a clientele who may cause her to derail from sobriety or even go back to her abusive husband. The whole situation also brought to the fore how we as counsellors can brainstorm for solutions with clients, but the final decisions regarding their lives belong to them. Looking back, I remember supporting Lucy to realize her strengths, using a strengthbased perspective from solution-focused theory. I assisted her to recognize her strength by the act of leaving an abusive relationship and maintaining sobriety from crack cocaine for the two months at the transition house. I also pointed out the strengths that she had demonstrated 56 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES through her goal setting and her ability to follow through with them week after week while at the shelter. Practicum Case Study 3 John had sought counselling for grief and loss issues. He had been incarcerated when his mother passed away and had attended her funeral during his last year in prison. He met with me because he needed to discuss the grieving that he didn' t do and had not had a chance to do. According to John, he feels angry and guilty that he never had a chance to be a support to his mother when she was ill. Now he never will be able to make it up, as she died without his emotional or physical help. John blamed himself for his mother' s demise in distorted grief (Rando, 1984). He was unwilling to accept that his mother had a terminal illness and she had no chance of recovery. The more we talked, I realized that John had many regrets regarding his life of crime that had kept him in prison for 20 years, and had cost him the loss of his wife and daughter, too. By using a solution-focused approach and the miracle question, John made it clear that he would like to wake up one day and cry for his mother's demise as he had not shed tears yet. We discussed how he could use a journal to write out his feelings but he was not able to do that. Therefore, after our third session, he terminated our meetings through his probation officer, who reported to me that this behaviour of resistance to deal with his losses was very characteristic of John. The action left me wondering if there was another method of counselling that would have been more successful in helping him grieve properly for his losses, and consequently overcome the anger and guilt he experiences on a daily basis. On reflection, John had been very close to crying as he desired the grieving of his mother' s demise. Paradoxically, crying was both desired and yet unsafe in his mind. I felt 57 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES that was why he backed off. Later, his probation officer confirmed that John has a habit of requesting grief and loss counselling but when he reaches a certain point, he withdraws from the sessions. This report assuaged my fears that I had might have been the cause of John' s walking away from the counselling sessions. Another learning from this experience was that I went away reflecting on ways I could have intercepted John' s "walking away" behaviour by recognizing that sometimes clients leave with the work interrupted, as well as how "unfinished " work feels for the counsellor. In this chapter, I have described my practicum objectives, practicum supervisor working relationship, description of the practicum agencies, practicum activities and how I achieved my practicum objectives, case studies. It is out of these experiences that I had my first stint as a clinical counsellor and have been able to devise my own practice style as with different clients. How Did the Different Techniques Work? It was obvious to me that, for most shmi term stay clients in the transition house, the miracle question (de Shazer, 1988; Berg, 1994) seemed to have more meaning and positive results than the Bowenian technique, which requires more sessions before a client has any positive feedback. I found the family systems approach beneficial to the long term transition house clients and the ex-inmates from Corrections Canada. By using genograms - graphic depictions of how different family members are biologically and legally related to one another from one generation to the next; maps with figures and lines delineating relationships (see Appendix 4)- in family assessments, the clients were able to better understand family relations, and the impact of each member on each other (McGoldrick & Gerson, 1985). Some 58 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES of the clients were no longer interested in having close relationships with family members who had hurt them emotionally, physically or sexually. I explained to them that they had decided to have emotional cut off and it was viewed as a positive thing by defining the meaning of the term to them. I explained it as a process between the generations through which "people separate themselves from the past in order to start their lives in the present generation" (Bowen, 1978, p. 32). The clients were able to understand how emotional cutoff from family members is sometimes useful in reducing acute anxiety generated by intense contact- stuck together fusion - with the family of origin. Emotional cut off is emotional distance that regulates the discomfort of emotionally stuck together fusion between generations. It can be manifested internally or geographically (Titelman, 2005). In future practice it is evident that, for short term counselling interventions, solutionfocused will be a very helpful tool while for long term, I will use the Bowenian practice. It is apparent, in grief and loss situations at the transition house, both solution-focused and family therapy complemented each other and worked very effectively as techniques of interventions. 59 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Chapter Four: Discussion and Implications for Practice The social work profession has been described as a process through which social workers interact with clients to assist them with learning to deal with issues that have impacted their lives. The role of the professional social worker requires a clear understanding of the different models of therapy and the knowledge of which one works best for different client situations. I developed my practice by reading about the theories of various researchers, watching tapes on their styles of counselling, and observing my mentors at the practicum agency. Thus I began creating my own method of practice. Acquired Knowledge While completing my practicum at the South Island Centre for Counselling, the transition house, and at the Community mentoring program of Corrections Canada, I gained valuable practical counselling experience with clients as I used Bowenian and Solutionfocused approaches. In Chapter Three, I provided case studies about how I used the two counselling theories. I had hoped to use pastoral care theory but the opportunity did not arise. Therefore, in my future practice, my guiding principles in social work counselling will be mainly led by Bowen's and solution-focused theories. In my critical analysis of my theories of choice, it has struck me that, while Bowenian and solution-focused theories can work independently of each other, in most cases they tend to complement each other, with better effect. For example, in Case Study 2, I was able to understand that Lucy's dilemma was influenced by the family system; hence she was unable to make the necessary positive changes in her life, such as leaving her current city for another city where more supports for her and her son were available. Instead, she chose to stay behind so that she could be in close proximity to her sister who could provide emotional 60 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES support only. Staying meant that Lucy would have to live at risk, in a downtown motel with her son. If Lucy had been able to access further counselling from me, by using Bowen's explanation of the differentiation of self and the meaning of triangulation (Kerr & Bowen, 1988), I would have been able to educate her to understand family dynamics and how they affect decision making on most days, but not necessarily for positive outcomes. As Kerr and Bowen state "Giving up some togetherness does not mean giving up emotional closeness" (1988, p. 107), I would have explained to Lucy that her leaving town would not necessarily sever the emotional bond between her and her sister but instead it would give her a chance to finally make her own decisions with the help of experienced and knowledgeable supports that she would find in the new city. From my practicum experience, I now have a better understanding of how people find it difficult to leave their families of origin even though the relationships may be unhealthy. It is more clear to me that the role of the counsellor is to guide and support individuals without overwhelming them. But at the same time one needs to be aware that, it is not possible to remove family support without replacing it with "something." And this is where Bowen's system theory is well complemented by the strength-based solution-focused counselling method which states that each individual and family are capable of solving their problems and the responsibility is on us to be flexible to facilitate change toward what they want (Walter & Peller, 1992). In my social work practice, I will continue to improve my understanding of Bowen and Solution-focused as well as other methods such as Somatic, cognitive behaviour therapies, and I will aim to use the most suitable approach to meet an individual or family's needs. My goals will be achieved through the following means: attending counselling 61 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES workshops, seminars, conferences, readings, volunteer activities, and debriefings with experienced counsellors. Conclusion Counselling has been described as a process through which social workers interact with clients to assist clients in learning to deal with issues that have impacted their lives. The role of the professional social worker requires a clear understanding of the different models of therapy and the knowledge of which one works best for different client situations. I based my practice on reading about the theories of different researchers, watching tapes on their styles of counselling, observing my mentors at the practicum agency, and thus creating my own method of practice. I was inspired by the reports I received from the clients at the transition house- after several sessions, to fmd that my work with them had empowered them to an increase in selfesteem, boundaries of self-confidence as well as the ability to take positive steps in their lives. My practice has been inspired by Wade's article (1997) that describes an approach to therapy that can completely transform the self-image of a client who is recovering from the traumatic experience of abuse; the assumption by the brief and solution-focused therapy that a client has pre-existing strengths (de Shazer, 1985, 1988; White & Epston, 1990; White, 1992, 1995, cited in Wade, 1997). My mentors were also my inspiration as they shared some of their success stories with past clients. Indeed, the work of a therapist is critical in transforming lives of those who seek a change in dire situations in their circumstances. In my practice at the practicum agencies and in interacting with various clients, I realized that both family systems and solution-focused therapies are tools that can only be deemed as pathways for constructing solutions but not as 62 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES panaceas. Clients have the final say in what happens to them. In my view, my goal in my practice will be that of guiding clients to think and to assist them with the process of developing their own solutions. I will continue to maintain a reflective journal as a method of self-evaluation, with the goal of making each session a way to improve my aspirations for empowering and focusing on the strength and the resources of the client. 63 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES References Berg, I. K. (1994). Family based services: A solution-focused approach. New York: W.W. Norton. Bond, T. (1998). Chapter 2: Counselling. In Y. Craig (Ed.), Advocacy, counselling and mediation in casework. Philadelphia, PA: Jessica Kingsley Publishers. Bowen, M. (1978). Family therapy in clinical practice. New Jersey: Jason Aronson Inc. Campbell, J. (2002). Health consequences of intimate partner violence. The Lancet, 359. 1131-1136. Capuzzi, D., & Gross, D. R. (1991 ). Introduction to counseling: Perspectives for the 1990 's . Boston: Allyn and Bacon. Craig, Y. (Ed.). (1998). Advocacy, counselling, and mediation in casework. Introduction. Philadelphia, PA: Jessica Kingsley Publishers. Cridge Centre for the Family (2010). Policy and Procedure Manual. Victoria, Canada: Published by author. de Shazer, S. (1982). Patterns ofbrieffamily therapy: An ecosytemic approach. New York: Guildford Press. de Shazer, S. (1985). Keys to solution in grief therapy. New York: W.W. Norton. de Shazer, S. (1988). Clues, investigating solutions in brief therapy. New York: W.W. Norton. Friend, C. (2000) . Aligning with battered women to protect both mother and child: Direct practice and policy implication. Journal ofAggression, Maltreatment and Trauma, 3(1), 253-267 . Gaiswinkler, W., & Roessler, M. (2009). Using the expertise of knowing and the expertise of not-knowing to support processes of empowerment in social work practice. Journal of Social Work Practice, 23(2), 215-217. Gauthier, J., & Marshall, W. (1977) . Grief: A cognitive-behavioral analysis. Cognitive Therapy and Research, I, 39-44 Government Publication. BC Societies Act Constitution & By-Laws. Revised July, 2008. Jackson, E. N. (1957). Understanding grief Its roots, dynamics, and treatment. Nashville: Abingdon Press. Kastenbaum, R. J. (1977). Death, society and human experience. St. Louis: C.V. Mosby. 64 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Kerr, M. E., & Bowen, M. (1988). Family evaluation: The role of a family as an emotional unit that governs individual behavior and development. New York: W.W. Norton & Company. Kubler-Ross, E. (1969). On death and dying. New York: Macmillan. Levine, P. (2005). Healing trauma. Apioneeringprogramfor restoring the wisdom ofyour body. Boulder, CO: Sounds True Inc. Levine, P. , & Fredrick, A. (1997). Waking the tiger: Healing trauma. Berkley, CA: North Atlantic Books. Lindemann, E. (1944). Symptomatology and management of acute grief. American Journal ofPsychiatry, 101, 141-148. Marsh, P., & Triseliotis, J. (1996). Ready to practice. London: HMSO & Scottish Office. McGoldrick, M., & Gerson, R. (1985). Genograms in family assessments. New York. W.W. Norton & Company. Mongrain, S. J. (2004). Corrections Services Canada- Re-integration Programs Division Manual, Version 2. By author. Morrow, M., & Varcoe, C. (2000). Violence against women: Improving the health care response. Victoria, Canada: Ministry of Health. Mullaly, B. (2002). Challenging oppression: A critical social work approach. Toronto, Oxford University Press. O'Keefe, M. (1995). Predictors of child abuse in martially violent families. Journal of Interpersonal Violence. 10(1 ), 3-25. Parkes, C., & Weiss, R. S. (1983). Recovery from bereavement. New York: Basic Books. Payne, M. (2005). Modern social work theory. Chicago: Lyceum. Rando, T. A. (1984). Grief, dying, and death: Clinical interventions for caregivers. Champaign, IL: Research Press Raphael, B . (1983). The anatomy of bereavement. New York: Basic Books. Rubin, A., & Babbie, E. R. (2005). Research methods for social work (5th ed.). Belmont, CA: Thompson Learning Inc. Scaer, R. C. (2001). The body bears the burden: Trauma dissociation, and disease. Binghampton, NY: The Haworth Press, Inc. Scaer, R. C. (2005). The trauma spectrum: Hidden wounds and human resiliency. New York: W.W. Norton & Company. 65 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Seden, J. (1999). Counselling skills in social work practice. Buckingham: Open University Press. Statistics Canada (n.d.) The Daily Retrieved from http:/ jwww.statcan.gc.cajdaiquojindex-eng.htm Titelman, P. (2003). Emotional cutoff: Bowen family systems theory perspectives. New York: Haworth Press, Inc. Turner, D. , & Moosa-Mitha, M. (2005). Challenge for change: An anti-oppressive approach to conflict resolution. Victoria, BC: Sedgwick Society, University of Victoria, BC. Wade, A. ( 1997). Small acts of living: Everyday resistance to violence and other forms of aggression. Contemporary Family Therapy, 19(1), 23-39. Walter, J. L., & Peller, J. E. (1992). Becoming solution-focused in brief therapy. New York: Brunner/Mazel Publishers. Watzlawick, P., Weakland, J. H., & Fisch, R. (1974). Change: Principles ofproblem formation and problem resolution . New York: W.W. Norton & Company. 66 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Appendix 1: South Island Centre for Counselling: Constitution and By-Laws The South Island Centre for Counselling agency is a non-profit organization registered in the city of Victoria, and is incorporated under the Society' s Act of the Province of British Columbia, Canada, with the following guidelines: Constitution 1. States that the name of the society is: South Island Centre for Counselling. 2. The centre believes that Jesus Christ is the Lord, the scriptures of the Old and New Testament are the full authority in matters of faith and practice, confessing the historic Christian faith, the purposes of the society throughout the province of British Columbia are: a) Assisting clergy in their pastoral care and counselling, though providing consultation and training experiences b) Providing pastoral counselling for persons of the general public: c) Offering pastoral counselling to persons of the general public d) Providing training in helping relationships; and e) Doing everything incidental and necessary to promote and attain the foregoing objectives throughout the Province of British Columbia In pastoral counseling, and individual, giftedness is recognized by the Christian community and refmed through professional training comes alongside persons to help them grow toward wholeness. 3. The operation of the society will be chiefly carried on in the city of Victoria, in the Province of British Columbia 4. The society will be carried on without purpose of gain for its members and any profits or other accretions to the society shall be use for promoting its objects. 67 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES 5. In the event of winding up or dissolution of the society, funds and assets of the society remaining after the satisfaction of its debts and liabilities, shall be given or transferred to such organization or organizations concerned with promoting the same objectives of the society, as may be determined by the members of the society at the time of winding up or dissolution and if effect cannot be given to the aforesaid provisions, then such funds shall be given or transferred to some other organizations provided that such organizations referred to in this paragraph shall be charitable organizations, charitable corporations, or charitable trusts recognized by the Department ofNational Revenue of Canada as being qualified as such under the provisions of the Income Tax Act of Canada from time to time effect. 6. Clauses 4 and 5 are unalterable in accordance with s.l7 of the Society's Act. By-Laws There are twelve articles with each containing its rules and guidelines as follows: Article 1 1. There shall be the following classes of members who shall subscribe to the constitution: a) Individual members, b) Honorary members and c) Group members. 2. Any person interested in or in any way connected with pastoral counselling ministry may apply to the board of directors for membership in the society as an individual member. 3. Any person concerned with and interested in the objectives of the society may be invited to become an honorary member on approval of the board of directors 4. Any group incorporated pursuant to the laws of the Province of British Columbia, or any other Province, or dominion of Canada, may apply to the board of directs for membership as 68 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES a group member in the society, if the group has one of its objects the promotion of pastoral counselling, or if its active in the field of pastoral counselling or a related field 5. Group members shall be entitled to one delegate for the group 6. Group members of the society shall be represented and vote at meetings of the society by their duly appointed representative. 7. The board of directors has the discretion to accept or reject an application for membership in the society 8. The membership fee for each class of members, if any shall be determined by the board of directors subject to review by members at any meeting of the members of the society 9. The board of directors shall determine the day in each year when the membership fees, if any from each member shall be paid. 10. Honorary members shall be entitled to speak at any meetings of the members of the society 11. It is the duty of each member, in order to remain in good standing in the society, to comply with the by-laws of the society and pay when due the membership fee, if any, for the current year. Article 11 These are conditions under which membership ceases: 1. Any member who desires to withdraw from membership in the society must notify the board of directors in writing to that effect and upon receipt of such notice the member shall cease to be a member 2. A person shall cease to be a member of the society on having been not in good standing for 12 consecutive months. 69 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES 3. An individual member, group member or its representative, or an honorary member may be expelled from the society by a special resolution of the members passed in the general meeting called for that purpose 4. At meeting described in Article 11 , clause 3, a member has a right to speak on his or on her own behalf. Article 12 - Meetings of membership Time of Annual General meeting: 1. The Annual meeting shall be held between May 1st and May31 st, inclusive each year at a place within the Province and on a day fixed by the Board of Directors. Notice of General and Special Meetings: 2. Every notice of an annual, general or special meeting of the society shall state the nature of the business of the meeting and such notice shall be given to every member fourteen days before such general or special meeting. The manner in which notice is to be given: 3. Notice of an annual general or special meeting of the society will be given in writing to every member. It will be deemed to be given to every member if a notice is advertised in any newsletter or regular mailing to the members of the society, according to article III, clause 2. 4. The board of directors or any two members of the board or ten percent of the membership, may call a special meeting of the society for any purpose 5. Within 21 days, after the date of delivery of notice of request for a general meeting, and the directors do not convene, the members requesting the meeting may convene within 4 months after the delivery of the notice of request for a meeting 70 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES 6. A general meeting convened by the members must be convened in the same manner as nearly as possible as general meetings convened by the directors. 7. The rules of procedure at annual general or special meeting shall be determine by the board of directors, or if any member objects, Bourinots rule of order shall apply Quorum for General meeting: 8. A quorum for the transaction of business at any annual, general or special meeting shall be ten percent of the membership as they appear on the membership rolls, but shall never be less than three members. Voting Rights of Members: 9. Only individual and group members ' representatives can vote and honorary members have no voting rights. Article IV - Directors and Officers 1. Director means a director within the lower Vancouver Island area of the Province of British Columbia, south of Ladysmith, British Columbia 2. The first directors of the society shall be the subscribers to this constitution and these By -Laws. Thereafter, the number of directors shall be determine at the annual meeting, but in no event shall the number of position on the board of directors be less than four Election of Directors 3. a) Shall be no less than four and no more than 12 and they shall be elected every three years b) Retiring president must remain in the board for one year in order to fill the position of the past president 71 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES c) After serving for six years consecutively directors will be required to resign from the board of directors for at least one year. d) Any vacancy in the board of directors or on a standing committee that occurs between annual meetings may be filled by directors until the next annual general meeting from a list presented by the nominating committee e) The annual general meeting will elect members to fill any un-expired terms through regular election procedures. 4. Representatives of group members of the society may be elected to the board of directors but not staff members. Senior staff person or his appointee shall be an e-official member of the board without voting rights. 5. A nominating committee composed of one member of the board of directors and two other individual members shall present the annual general meeting a list of nominees for election to the board of directors. Such committee shall be elected at the previous annual general meeting. 6. On recommendation of the board of directors, up to three corresponding directors may be elected for one year supplementary to the twelve directors. Corresponding directors shall have all the rights and privileges of resident directs. Duties and Powers of Directors: 7. The management and administration of the affairs of the society shall be vested in the directors. In addition to the powers and authority given by the By-Laws or otherwise expressly conferred upon them, the Directors may exercise all such powers of the society and do all such acts on its behalf as are not by the society or any of these by-laws required to be done by the society at a general or special meeting, and the board of Directors shall have full 72 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES power to make such rules and regulations as they deem necessary, provided that such rules and regulations are not inconsistent with the constitution of the society and these By-Laws. The president, Treasurer and one other director at large are authorized to sign contacts on behalf of the board of directors. Directors ' Meetings: 8. The meetings of the Directors may be called by the president, two or more board members of the Directors, or by two or more individuals ' members. Regular meetings of the Board of Directors shall be held at least every two months. 9. The Directors shall determine their own procedure, and a quorum at Directors' meetings shall be four Directors' Remuneration: 10. No voting members of the executive or Board of Directors shall receive remuneration or other financial benefits for their services to the organization, regardless of the type of service provided Removal of Directors: 11. Directors shall cease to hold office upon their ceasing to be members of the society. 12. Ten percent of the members can require the Directors to call a special meeting of the members of the society for the purpose of removing any members of the board of directors and /or substituting a new member in that position. This will be done by " special resolution. Officers of th e Society: 13 . The officers of the society shall consist of the president, the past president, the vice president, the secretary, the Treasurer, plus any other officers as may be determined at a 73 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES meeting of the members of the society. From time to time the offices of the treasurer may be served by the same person. 14. The executive, consisting of the president, the vice-president, and one other Board member, is empowered to act in emergencies. Any action by the executive must be ratified at the next Board meeting Election of Officers: 15. The membership shall elect at its annual General meeting, the president, vice president, Secretary, and the treasurer of the Board of Directors. Duties and Powers of Officers: 16. The secretary shall keep the records of the society and shall perform such duties as may be delegated by the Board of Directors, including keeping of minutes of all meetings of the society except those required to be kept by the treasurer. 17. The treasure shall be the custodian of the funds of the society and subject to the control of the Board of Directors, shall pay any and all Bills and also make available to the annual meeting an accounting of all monies of the society. Any of the following positions: Treasurer, president or Director of Services, shall co-sign all cheques drawn on the funds of the society. 18. The president shall be the chief Officer of the society. The president shall preside at all meetings of the society and of the Directors. The president shall be the chief Executive Officer and shall supervise the other officers in the execution of their duties. 19. The past president will, in the vent of the absence of both the president and the vice president perform the president' s duties and possess his authority 74 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES 20. The vice-president shall generally assist the president and shall in the vent of the absence or disability of the president, perform his duties and possess his authority. 21. The officers of the directors, if any, shall perform such duties as are determined by the membership, and Directors can delegate duties and powers to other officers of the Directors, if such duties and powers are not inconsistent with any resolution passed by the membership, or inconsistent with these by-laws or Society's Act. Officers Remuneration: 22. Officers of the society shall receive no remuneration for the performance of their duties. Removals of Officers: 23 . Officers of the society may be removed as officers by a majority vote of the Directors. Officers so removed shall remain members of the Board of Directors. Article V - Borrowing Powers 1. The society shall have the power to borrow or raise or rescue the payment of money in such manner as the society shall think fit and without limiting the foregoing, the society may issue debentures stock, perpetual or otherwise, charged upon any or all of the society' s present or future property, and purchase, redeem, or pay off any such security. No debentures shall be issued without sanction of "special resolution. " Article VI - Financial Affairs of the Society 1. The fiscal year of the society shall be January 1 to December 31 . The Directors shall present before the membership of the society at the annual meeting a report of an annual review engagement showing the income and expenditure, assets and liabilities, of the society during the preceding financial year. 75 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES 2. A budget committee, elected at the previous annual meeting and composed of one member of the Board of Directors and two other individual members, shall present to a special meeting for approval, a budget for the succeeding year. Article VII - The Seal Custody of the seal 1. The seal of the society shall be kept in the custody of the secretary of the society. Afftxing the seal 2. The seal of the society shall not be affixed to any documents or instrument unless authorized by the Directors and then only by and in the presence of such officers as the Directors may authorize, and such persons as shall be authorized to affix the seal of the society, and shall sign every instrument to which the seal is affixed in their presence. Article VIII - Maintenance of Minutes and other Books and Records 1. The directors shall see the minutes of members meetings and minutes of Directors meetings and all other necessary books and records of the society required by the by-laws of the society or by any applicable statute or law are regularly and properly kept. Article IX - Register of members 1. A register of all members shall be kept in one or more books by the secretary of the society who shall enter therein the names of the subscribers to the constitution and by-laws of the society, together with the following particulars: a) The full name, address and occupation b) The date on which person was admitted to membership c) The date on which any persons ceases to be a member d) Whether the member is a voting or non-voting member 76 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Article X - Inspection of Records of the Society 1. The books and records of the society shall b open to the inspection by the members at all reasonable times at the office of the society Article XI - Altering the By -Laws 1. The By-Laws of the society may be amended at any general, special or annual meeting of the society by special resolution adopted by a seventy five percent (75 percent) majority vote of the members of the society present at any special, general or annual meeting. 2. Notice to amend any by-law or to introduce a new one shall be given in writing at a meeting of the society previous to the meeting, or circulated to the members fourteen days in advance of the meeting at which it is intended to be considered. Article XII - Branch Societies 1. At any annual meeting or special meeting the members may by resolution set a branch office within the requirement of the Societies Act. 77 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Appendix 2: Symptoms and Behaviours of Unresolved Grief The following manifestations of unresolved grief reaction were put forth by Lindemann in 1944 (Rando, 1984): • Over activity without a sense of loss • Acquisition of symptoms belonging to the last illness of the deceased • Development of psychosomatic medical illness • Alteration in relationships with friends and relatives • Furious hostility against specific persons somehow connected with the death (e.g., doctors, nurses) • Wooden and formal conduct that masks hostile feelings and resembles a schizophrenic reaction in which there is a lack of emotion • Acts detrimental to one's own social and economic existence (e.g., giving away belongings and making foolish economic deals). • Agitated depression with tension, agitation, insomnia, feelings of worthlessness, bitter accusations, and obvious need for punishment and even suicidal tendencies. 78 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Appendix 3: Diagnostic Criteria for Unresolved Grief The following diagnostic criteria for unresolved grief were proposed by Lazare (1979). He states that, the more ofthe given symptoms and behaviours one has within the six months to a year after the demise of a loved one, six months to one year, the greater the likelihood of unresolved grief. The symptoms and the behaviours are as follows: • A depressive syndrome of varying degrees of severity since the time of death, frequently a very mild subclinical one often accompanied by persistent guilt and lowered self esteem. • A history of delayed or prolonged grief, indicating that the person characteristically avoids or has difficulty with grief work. • Symptoms of guilt and self reproach, panic attacks, and somatic expressions of fear such as choking sensations and shortness of breathe • Somatic symptoms representing identification with the deceased, often the symptoms of the terminal illness • Physical distress under the upper half of the sternum, accompanied by expressions such as "there is something stuck inside" or "I feel there is a demon inside of me. ' • Searching that continues over time, with great deal of random behaviour. Restless and moving around. • Recurrence of symptoms of depression and searching behaviour on specific dates, such as anniversaries of the death, birthdays of the deceased achieving the age of the deceased, and holidays (especially Christmas), that are more extreme than those anniversary reactions normally expected. 79 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES • A feeling that the death occurred yesterday, even though the loss took place months or years ago. • Unwillingness to move the material possessions of the deceased after a reasonable amount of time has passed. • Changes in relations following death • Diminished participation in religious and ritual activities that are part of the mourners' culture, including avoidance of visiting the grave or taking part in funeral rituals. • An inability to discuss the deceased without crying or having the voice crack, particularly when the death occurred over a year ago. 80 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Appendix 4: Genogram Symbols Relationships or Family Interactions It-------'0 Overly close Relationship Distant Relationship Cut Off ~-------~ ---fl--· Contlictual Relationship 81 82 AN OVERVIEW OF CLINICAL COUNSELLING TECHNIQUES Genogram Symbols (continued) How to Show Who Lives With Who I I I I I / ; .; , --------- .... , ..... '' '' \ \ D ' '' \ \ ' ' \ \ \ ~ ..... ..... ...... The Dotted circle shows how the family members are grouped ____ ,.,.. , .; .; / I I I I I