Assignment Code: MCFT-007/TMA-7/ASST-7/2021-22

Course Code: MCFT-007

Assignment Name: Counselling and Family Therapy: Applications and Interventions

Year: 2021-2022

Verification Status: Verified by Professor

Maximum Marks: 100

Note:

(i) Answer all the questions in both sections.

(ii) Answers to questions of Section “A” should not exceed 300 words each.

Section A - Descriptive Questions

(10x6= 60 marks)

Q1. Is long term counselling/therapy better than short term? Substantiate your answer with examples. (10)

Ans) Those interested in offering cost-effective therapy are particularly interested in the dispute over long- and short-term counselling. According to Howard et al., 24 percent of clients improved after a single session, 30 percent improved after two sessions, 41 percent improved after four sessions, 53 percent improved after eight sessions, 62 percent improved after 13 sessions, 74 percent improved after 26 sessions, 83 percent improved after 52 sessions, and 90 percent improved after 104 sessions.

While the number of clients who benefited grew as the number of sessions increased, the greatest improvement occurred early in the therapy, with less and smaller benefits occurring later in the therapy in response to the provision of more sessions. Nearly half of the studies had a median of 15 or more sessions, which is significantly higher than the commonly stated averages. The following are some of the factors that influence the duration:

1. Severity of the Illness: If the illness is severe, more sessions may be required to achieve the desired result.

2. Individual Differences: Some clients require more time to form a therapeutic connection, and in these circumstances, longer therapy are recommended.

Is therapy better for certain kids than it is for others?

There is no single strategy that is beneficial to all youngsters. Individual variances in responsiveness are observed, with the type and characteristics of the problem, stage of development, and characteristics of the kid such as gender, age, and ability all significant variables. In a review of psychological and behavioural methods to school refusal, Blagg concluded that the treatment outcome for children aged 7 to 10 years is the same regardless of treatment strategy. For youngsters aged 11 to 16, however, the treatment method did matter.

Pharmacotherapy vs. Psychotherapy

Psychological intervention, according to Lambert and Bergin, is as beneficial as, if not more effective than, drugs. Studies have demonstrated that combining psychotherapy and pharmacotherapy improves a person's prognosis compared to solitary therapy. Psychotherapy is frequently combined with medication treatments to assist alleviate psychological issues. Pharmaceuticals may lessen the need for psychotherapy, while successful psychotherapy may reduce the need for drugs by allowing for lower doses and, hence, fewer side effects. If a drug's adverse effect is diminished mental functioning, it may interfere with the effectiveness of psychotherapy. Anxiety, depression, reduced cognitive functioning, and sleep disturbances are some of the psychological or emotional adverse effects of several drugs.

Q2. Briefly explain play therapy. (10)

Ans) Play therapy is a type of psychodynamic therapy that allows children to work through their emotional issues while also learning to control their externally troublesome behaviour. Play is employed in play therapy as both an auxiliary to and a channel for communication between the child and the therapist. The child is introduced to a specific play setting with various play materials with the goal of generating a therapeutic effect through the child's play with a cathartic resolution of conflict or stress.

Play facilitates the child's development and maintenance of a therapeutic relationship with the therapist. The therapist guides the kid's play in guided play therapy in order to assist the child attain psychological integration. Axiline's approach to play therapy is thought to be the most beneficial for youngsters. Axiline's play therapy is based on the Rogerian concept of "client-centered treatment," which employs play to reflect back to the child his feelings, wishes, or convictions without seeking to explain unconscious motives or conflicts.

Play therapists employ two different types of play therapy:

1. Directive Play Therapy: In directive play therapy, the therapist uses a hands-on approach to assist the child express themselves by leading them through directed play activities. They'll usually give the child precise instructions and supervise them while they follow them.

2. Non-directive Play Therapy: In non-directive play therapy, the environment is less controlled. The therapist allows the kid to engage in any play activities they love and express themselves freely.

Q3. What are common areas of conflict for young couples in the Indian context? (10)

Ans) Common areas of conflict for young couples are:

Expectations

Couples frequently marry before completely understanding and conveying their expectations of one another, or they refuse to change their expectations of one another after marriage. Popular misconceptions like mind reading ('He should know what I would expect') exacerbate the lack of communication regarding expectations. Because spousal needs are frequently unspoken or imprecise, expectations regarding these requirements, as well as the needs themselves, go unmet.

Finance

Most couples disagree about "How money should be earned" and "How money should be spent." Finance conflicts take the shape of disagreements about decision-making, positions, and career choices. Traditional power dynamics persist in dual-income households, with few wives using their co-provider responsibilities as leverage to demand domestic assistance from their husbands, and the kitchen remains the wife's domain. Dowry-related problems persist in educated middle-class households, and the wife is frequently forced to give data about her pay stubs, debts, and other financial matters. While respecting and embracing the viewpoints of their different families of origin, the spouses must negotiate financially and make common decisions.

Intimacy

Young couples value closeness, companionship, and initiative, but disturbed couples' marriages are marked by a lack of connection and tenderness, as well as a fear of self-disclosure. Couple time is difficult to separate for spouses, and quarrels over displays of affection and intimacy are common. Furthermore, gender differences have a role in the concept of intimacy, and spouses must define these concepts so that one partner's sense of intimacy does not irritate the other. Closeness is generally defined by women as 'shared discussions,' whereas intimacy is defined by husbands as 'shared activities.'

Communication

Communication is a key source of conflict and misery in all relationships, and it is a common reason for couples to seek marital counselling. Misunderstandings and differences of opinion are all too common. One partner may also invalidate or dismiss the other's opinions and feelings. Fear of communicating one's true ideas and feelings, as well as the desire to win an argument, increases the likelihood that the couple's disagreement may spiral out of control, resulting in threats and verbal and emotional abuse. Communication is either predominantly conflictual with high noise levels among disturbed couples, or it is modest and need-based. There is a lack of communication regarding sentiments, which leads to psychological separation between the spouses. Good communication is necessary in marriage on three levels: between spouses, between the wife and the husband's family of origin, and between the pair and their families of origin and friends. Both spouses are responsible for ensuring that these conversations are kept up to date.

Q4. Differentiate between types of stresses. (10)

Ans) Stress is the body's and mind's reaction to any event that causes a change. When we are forced to perform anything, our bodies go through a period of discomfort known as stress. We may come across these scenarios at different times in our lives. It is critical to consider how we perceive these challenges and how we respond to them. There differences between these two types of stresses are:

Positive Stress (or 'Eustress')

This might "inspire a person to perform better, achieve goals, and maximise their potential." An athlete getting ready for competition, parents having their daughter married, a student getting accepted into college, or a farmer earning a favourable market price for his produce are all examples.

Positive Coping: These may assist the user in reducing stress while causing no negative side effects. Talking about the problem with a friend, relative, or teacher, joining self-help groups, relaxing through physical activity (walking, sports, yoga, and the gym), hobbies, or simply laughing it off may all be beneficial. Reduced stress can be achieved through altering our attitude toward the stressor, lowering our expectations, and prioritising our needs.

Negative Stress or Distress

This can have a negative impact on our bodies and minds, resulting in psychosomatic ailments such as backaches, peptic ulcers, headaches, skin issues, and lowered immunity. Often, there is a psychological issue at the root of them. Traveling on a packed bus, studying for final exams, a couple whose marriage is on the rocks, or a family member dealing with a terrible illness are just a few examples.

Negative Coping: Some of them smoke heavily, abuse substances/drugs excessively, take medication, and engage in aggressive behaviour (beating, shouting). Some behaviours, such as sleeping, procrastinating, and imagining, might become harmful in the long run.

Q5. How can the mental health problems in old age be addressed effectively? (10)

Ans) Doctors and policymakers are in charge of shaping the country's health-care system. Health-care services should be able to address the needs of people from all walks of life. Medicine must evolve to meet the needs of the growing number of senior citizens in our society. Despite the fact that this appears to be entirely rational, there appears to be little interest in this direction. Mental health issues are a leading source of morbidity and premature death among the elderly.

Dementia and depression are frequent late-life mental health issues that are becoming important public health concerns in ageing cultures like ours. With such a vast population, India will almost certainly have to respond to the requirements of a far larger number of elderly people with mental health issues than most other countries. Delirium is less common, but it is a medical emergency that can be misdiagnosed as another psychiatric issue. Delays in diagnosis can be fatal, however many instances can be reversed if caught early. The majority of the time, this is related to an underlying medical issue. In order to build responsive community-based services, there are three crucial measures to take:

1. The first step is to identify persons who are suffering from dementia or other mental health issues who require assistance.

2. The second phase is to examine the cases that have been discovered as well as the caregiver's needs.

After getting additional training, health workers will be able to conduct basic home-based interventions. The focus should be on increasing the patient's and carers' quality of life. Educating the family and carers about the condition and its management, as well as aiding the caregiver in managing uncomfortable symptoms, should be part of the intervention. Assessment and management of behavioural symptoms, as well as impairment in fundamental daily activities, should be given special focus. Simple, cost-effective intervention solutions will have a greater community applicability potential.

The creation of age-appropriate long-term care policies needs to be prioritised. Mechanisms for assuring the social protection of older people are required. Dementia and other forms of dementia are common reasons of reliance among the elderly. People with a wide range of debilitating and incurable diseases can benefit from community-based programmes. Such projects can be supervised and supported by a network of experienced nurses and doctors. As part of such programmes, dementia care can be provided.

Depression is far more common than dementia, and it is also far more treatable. Primary care must be equipped to recognise and treat depression and other late-life mental health issues. As a priority, older people's health care should be included in outreach activities. It should be attempted to link outreach programmes with primary care and expert psychogeriatric treatment. Community health professionals that are well-informed can help scale up services.

Q6. Discuss analytically the critique of child therapies. (10)

Ans) The critique of child therapies:

Is Therapy Effective?

In a study, Bergin and Lambert discovered that the rate of spontaneous remission is lower, and that significant changes occur during the first eight to ten sessions of psychological treatment, rather than the two-year time period for spontaneous remission. Bergin found 37%, Meltzoff and Komreich found 80%, and Luborsky found 78% in terms of studies confirming the efficacy of psychotherapy. As a result, Lambert and Bergin concluded that psychological treatments are unquestionably useful in the long run, even if not everyone benefits to the same extent. Psychotherapy alone may not be enough to treat mental or emotional problems, and psychiatric medication may be required. Reluctance to obtain and use appropriate medication may contribute to symptoms worsening or an increased risk of bad outcomes.

Is One Kind of Therapy More Effective than Another?

The rapid development of behaviour therapy within the field of clinical psychology in 1960 posed the logical question of whether these novel therapies were more effective than verbal therapies, for example. The findings of a UK study by Shapiro et al. compared cognitive-behavioural therapy with psychodynamic interpersonal therapy over two time periods and found that CBT had only a slight edge over IPT on the Beck Depression Inventory but not on any other measures. The 'equivalence paradox,' as it is now known, states that technically dissimilar medicines provide broadly equivalent effects. It is also undeniable that CBT has some advantages over other therapies, but the magnitude of these advantages is minor.

Is Long Term Counselling/Therapy Better than Short Term?

The argument over long and short-term counselling is a hot topic among people who are interested in offering cost-effective therapy. The following are some of the factors that influence the duration:

1. Severity of the Illness: If the condition is severe, more sessions may be required to achieve the desired result.

2. Individual Differences: Some clients take longer to form therapeutic alliances, and longer sessions are acceptable in these instances.

Is Therapy More Beneficial for Some Children than for Others?

There is no single strategy that is beneficial to all youngsters. Individual variances in responsiveness are observed, with the type and characteristics of the problem, stage of development, and characteristics of the kid such as gender, age, and ability all significant variables. In a review of psychological and behavioural methods to school refusal, Blagg concluded that the treatment outcome for children aged 7 to 10 years is the same regardless of treatment strategy. For youngsters aged 11 to 16, however, the treatment method did matter.

Psychotherapy versus Pharmacotherapy

Psychotherapy is frequently combined with medication treatments to assist alleviate psychological issues. Pharmaceuticals may lessen the need for psychotherapy, while successful psychotherapy may reduce the need for drugs by allowing for lower doses and, hence, fewer side effects. If a drug's adverse effect is diminished mental functioning, it may interfere with the effectiveness of psychotherapy. Anxiety, depression, reduced cognitive functioning, and sleep disturbances are some of the psychological or emotional adverse effects of several drugs.

Section B - Short Answer / Objective Type Questions

(40 marks)

Q1. Write short notes (in 150 words each) on the following: (5x8=40 marks)

i) PTSD

Ans) Patients with post-traumatic stress disorder may benefit from many types of cognitive behaviour therapy. Individual counselling may be more beneficial than group therapy. Survivors of trauma may develop Post Traumatic Stress Disorder. Children develop PTSD later in life as a result of ongoing stress; adults, on the other hand, develop PTSD in response to individual traumatic events or a series of traumatic events. Hyper vigilance, free floating anxiety (dysphoria), hyper startle, hyper arousal (always "on guard"), and other PTSD symptoms include hyper vigilance, free floating anxiety (dysphoria), hyper startle, hyper arousal (always "on guard"), and so on. Trauma and PTSD symptoms include:

1. Depression that comes and goes.

2. Anxiety, panic, and phobias are all symptoms of anxiety.

3. Poor self-esteem, and a sense of being damaged and/or useless shame.

4. Syndromes of somatic pain.

5. Thoughts and/or actions that are self-destructive.

6. Abuse of substances.

7. Relationship and intimacy issues: bulimia, anorexia, and compulsive overeating eating disorders: bulimia, anorexia, and compulsive overeating eating disorders: bulimia, anorexia.

8. Addictions and avoidance of sexual activity are examples of sexual dysfunction.

9. Time slippage, memory lapses, and a sense of disbelief.

10. Trauma-related flashbacks, intrusive thoughts, and images.

11. Heightened vigilance.

12. Nightmares, insomnia, and sleepwalking (alternate states of awareness or personalities) are all common sleep disorders.

ii) Sexual harassment

Ans) Sexual harassment is unwelcome sexual behaviour that's offensive, humiliating or intimidating. It can be written, verbal or physical, and can happen in person or online. When it happens at work, school or uni, sexual harassment may amount to a form of discrimination. Sexual harassment is intimidation, bullying or coercion of a sexual nature or the unwelcome or inappropriate promise of rewards in exchange for sexual favours. Sexual harassment includes unwelcome sexually determined behaviour (whether directly or by implication) through physical contact and advances; demand or request for sexual favours; sexually coloured remarks; showing pornography; and any other unwelcome conduct of sexual nature. Sexual harassment or exploitation of women at work place is on a rise with women entering the work force.

iii) Couple conflict

Ans) Couple conflict is a risk factor for a wide range of mental and physical health issues in both adults and children. Because of its linkages to relationship unhappiness, divorce, domestic violence, work functioning, parenting, and child outcomes, it has gotten a lot of attention in the couple research field. When a couple's conflict is at the level of an issue or a disagreement, it can be resolved. When the conflict is more serious and involves concerns such as extramarital affairs, physical or verbal abuse, or severe marital dissension, the couple should be sent to a competent marital therapist who may be able to assist them in determining their marital future.

iv) Parentified child

Ans) If a parent suffers from a chronic disease, the older children are likely to assist with caregiving and share certain family tasks. In the event of a progressive disease that results in a high level of incapacitation, a permanent shift in roles is likely to occur, perhaps resulting in a parentified child who is forced to act as a parent for younger siblings and, in some situations, also for the ill parent. The parentified child may feel as if he or she has been robbed of his or her youth or adolescence. This is significantly more likely to occur in a home with traditional gender norms. In a family where the mother is ill, the eldest daughter may be expected to shoulder her obligations before looking into how the father might assist. Similarly, if the father becomes ill, the eldest son may be expected to drop out of school/college to operate the family business or find work, rather than the mother seeking employment outside the home. Therapists can help parents renegotiate inflexible gender boundaries and encourage them to adopt more flexible gender roles in such situations.

v) Kubler-Ross’ stages

Ans) Elisabeth Kubler-Ross, a pioneer in working with dying patients, has categorised her observations of persons suffering from a terminal disease into stages that they typically go through while coping with the crisis. Denial (I don't have the sickness; the diagnosis is incorrect), rage (why me? ), bargaining (with God: if you make me well again, I'll do this for you), depression, and acceptance are the stages (exactly the opposite of denial). Denial, anger, bargaining, sadness, and acceptance are the five stages that make up our learning to live with the one we've lost. They're aids in framing and identifying what we're feeling. They aren't, however, pauses on a linear chronology of mourning.

vi) Crisis counselling

Ans) It takes time to recover from a traumatic event, and everyone heals at their own speed. The following are the trauma-related behaviours/symptoms that need to be addressed more thoroughly. Children and teenagers must confront and resolve uncomfortable sensations and memories that have been avoided for a long time in order to recover from psychological and emotional trauma. The duration of crisis counselling is usually between one and three months. Single or recurring difficulties that are overpowering or upsetting are the emphasis. Education, guidance, and support are all provided via crisis counselling. For children and adolescents who require and are not receiving intensive or long-term psychiatric care, crisis counselling is not a substitute. Crisis counselling does not have to be limited to hospitals and can include outreach and community activities. The method by which a crisis counsellor can help children/adolescents address and get past unpleasant and traumatic experiences in their life has universal "components."

vii) Disaster risk management

Ans) Disaster risk management is the use of disaster risk reduction policies and techniques to prevent new disaster risk, reduce existing catastrophe risk, and manage residual risk, all of which contribute to disaster resilience and loss reduction. A disaster management method that focuses on the underlying conditions of the hazards that lead to disaster occurrence. The goal is to improve capacities for successfully managing and minimising risks, lowering the likelihood and scale of disasters. Systematic management of administrative choices, organisation, operational skills, and abilities to implement policies, strategies, and coping capacities of society or individuals to mitigate the effects of natural and linked environmental and technological risks.

viii) Vulnerability

Ans) A set of prevailing or consequential variables made up of physical, economical, and/or political aspects that make catastrophe response more difficult. Vulnerabilities can be physical, social, or psychological in character, and they can be primary or secondary. Risk is reduced by strategies that lessen susceptibility.

Early loss or separation from parents, bad relationships with parents, or childhood maltreatment are all long-term vulnerability factors. Although sexual abuse has long been linked to self-harm, emotional or physical abuse also plays a role. Psychological qualities that persist over time, as well as other mental issues, must be identified.

Short-term vulnerability factors include present relationship troubles and a lack of social support, work or health-related issues, drug and alcohol abuse, or a worsening of psychological disorders.