Mwisho wa mateso

The End of Torture (Mwisho wa Mateso) - 42

• Posted by GLOBAL on September 5, 2013 at 2:46am
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MATATIZO bado yanaendelea kuyaandama maisha ya msichana mdogo, Amelia. Dhiki, mikosi na mabalaa vinaonekana kuwa sehemu ya kawaida ya maisha yake kiasi cha kumfanya atamani kufa. Anafanya jaribio la kutaka kufa kwenye kimbunga hatari cha Agripina lakini inashindikana.
Amelia alifanyiwa vipimo mbalimbali na baada ya Daktari Mwashiga kuridhishwa na afya yake, alitoa damu. Baada ya zoezi hilo kukamilika, damu hiyo ilichukuliwa mpaka wodini ambapo daktari alianza kuiandaa kwa ajili ya kumuongezea mtoto wa Amelia.
Katika hali ambayo hakuitegemea, Daktari Mwashiga aligundua kitu kilichomshangaza sana kuhusu damu hiyo. Kulikuwa na tofauti kubwa ya vitu ambavyo kitaalamu huitwa ‘antigens’ kwenye damu ya Amelia ukilinganisha na mwanaye, jambo ambalo siyo la kawaida. Hata makundi ya damu zao yalikuwa tofauti lakini hilo halikumshangaza sana kwani inatokea mara nyingi mama akawa na kundi la damu ambalo ni tofauti na la mtoto anayemzaa. Kilichomshangaza ni utofauti wa antigens.
Daktari Mwashiga alirudia tena kuichunguza damu hiyo lakini majibu yalikuwa yaleyale. Ikabidi atoke na kwenda kumuita Amelia ambaye alikuwa wodini, akiwa amelala pambeni ya mwanaye.
“Nakuomba ofisini kwangu mara moja,” alisema daktari huyo na kumshika mkono Amelia, akaenda naye mpaka ofisini kwake na kumkaribisha kiti, akakaa na kuanza kumuuliza maswali mbalimbali, lengo likiwa ni kutaka kujua historia yake kwa ufupi na jinsi alivyompata mtoto huyo.
Hakuna jambo ambalo lilikuwa likimuumiza Amelia kama kuanza kueleza historia ya maisha yake. Kila alipokuwa akikumbuka mambo yaliyomtokea maishani, alikuwa akiumia sana ndani ya moyo wake.
Hata hivyo, kwa kuwa ilikuwa ni lazima aeleze ili daktari ajue nini cha kufanya, Amelia hakuwa na namna zaidi ya kumueleza ukweli. Akamsimulia historia ya wazazi wake kwa ufupi na jinsi walivyokufa na kuwaacha yeye na mdogo wake wakiwa yatima.
Hakuishia hapo, alieleza pia jinsi mdogo wake huyo alivyokufa kwa kukosa matibabu baada ya kushambuliwa na malaria kali. Alipofika hapo, alishindwa kuendelea kutokana na uchungu aliokuwa anauhisi, akawa analia kwa kwikwi.
Baada ya kubembelezwa sana na Dokta Mwashiga ambaye alikuwa akimpa maneno ya kutia nguvu na ushauri nasaha, Amelia alitulia na kuendelea kueleza jinsi alivyokutana na mwanaume mtu mzima, Mafuru ambaye ndiye aliyemjaza ujauzito baada ya kumrubuni kwa kipindi kirefu.
“Siku niliyomwambia kuwa nina mimba ndiyo ukawa mwisho wa kumuona, nimeteseka sana mwenyewe, faraja pekee ikiwa ni mdogo wangu kabla hajafa,” alisema Amelia na kufuta machozi, akashusha pumzi ndefu na kuendelea kueleza kuwa shida na matatizo aliyopitia yalimfanya atamani kufa.
“Serikali ilipotangaza kwamba kimbunga Agripina kinakuja, ujauzito wangu ulikuwa na miezi tisa, nikaona bora nife kwenye kimbunga na mwanangu kwa hiyo sikuondoka kama serikali ilivyotangaza,” alisema Amelia, jambo ambalo lilimshangaza sana Dokta Mwashiga.
Akakaa vizuri kwenye kiti chake na kuendelea kumsikiliza ambapo alieleza jinsi kimbunga hicho kilivyopiga na kumkuta akiwa kwenye harakati za kujifungua. Aliendelea kueleza kila kitu kilichotokea mpaka alipojikuta akiwa kwenye Hospitali ya Jeshi ya Lugalo.
Akaeleza jinsi alivyohangaika kumtafuta mwanaye hadi alipokuja kupatikana akiwa hai. Mpaka hapo tayari Dokta Mwashiga alishaanza kupata picha kwamba inawezekana kabisa mtoto ambaye msichana huyo alipewa hakuwa wake. Hata hivyo hakumkatisha, alimuacha aendelee kusimulia kila kitu mpaka alipomaliza.
Alipomaliza, na yeye alimwambia sababu iliyomfanya amuulize kuhusu historia yake ambapo alimueleza kwamba amebaini kuna tofauti kubwa ya antigens na makundi ya damu kati yake na mwanaye. Akamueleza kuwa damu aliyojitolea, haiwezi kumfaa mwanaye kwa sababu walikuwa hawaendani, kauli ambayo ilimshangaza sana Amelia.
Ilibidi daktari huyo aanze kumueleza kwa kina jinsi damu ya mama na mwanaye inavyotakiwa kuwa. Alitumia lugha nyepesi kumfafanulia mambo mbalimbali kuanzia jinsi baba na mama wanavyochangia damu ambayo baadaye ndiyo inakuja kuwa ya mtoto atakayezaliwa.
Hata hivyo, Amelia hakutaka kuelewa chochote, akawa anang’ang’ania kuwa huyo mtoto ni wake na huenda Mungu amempa maradhi hayo kwa makusudi ili kumpitisha kwenye majaribu. Akajiapiza kuwa atampenda na kuyapigania maisha yake kwa kadiri ya uwezo wake wote.
Kwa kuwa suala la msingi lilikuwa ni kupata damu ya kumuongezea mtoto huyo, Daktari Mwashiga alimruhusu Amelia arudi wodini kwa mwanaye wakati yeye akiendelea kutafuta njia nyingine za kumsaidia. Kwa bahati nzuri, ilipatikana damu ambayo ilikuwa ikiendana naye.
Akatundikiwa chupa ya damu ambayo ilianza kutiririka kwa kasi kuingia kwenye mishipa yake. Licha ya kuonesha msimamo wake mbele ya daktari huyo, Amelia aliendelea kujiuliza maswali mengi yaliyokosa majibu. Haikumuingia kabisa akilini mwake kuambiwa kwamba mtoto huyo hakuwa wa kwake.
Kwa jinsi alivyokuwa anampenda licha ya matatizo aliyokuwa nayo, aliendelea kujiapiza kuwa hata iweje, hawezi kukubali kutenganishwa naye. Chupa ya damu iliendelea kutiririka kuingia ndani ya mwili wa mtoto huyo na baada ya kuisha, aliongezewa ya pili.
Baada ya kuongezewa damu ya kutosha, hali yake iliendelea kuwa nzuri, akaanza kuchangamka, jambo ambalo lilimfurahisha sana Amelia. Siku zikawa zinazidi kusonga mbele huku afya ya mtoto huyo ikizidi kuimarika. Ile furaha ambayo ilitoweka kwa kipindi kirefu kwenye maisha ya msichana huyo mdogo ikaanza kurejea taratibu.

***
Nisingependa kumaliza hadithi hii ya leo bila kukumbusha jambo muhimu la kutoa maisha yako kwa Mungu. Maisha tuliyonayo hapa duniani ni mafupi sana, yanapita kama maua yachanuavyo na kunyauka. Wengi unaowafahamu wamekufa lakini wewe unapumua, ni vyema basi kufikiria maisha baada ya kifo.
Kila siku jiulize: “Hivi nikifa leo nitakwenda jehanam au peponi?” Kila mmoja wetu analo  jibu lake, bila shaka sote tungependa kwenda peponi. Kama hivyo ndivyo, basi tiketi ya kwenda huko ni matendo mema na kujiepusha na uovu.
Tukumbuke mshahara wa dhambi ni mauti, bali karama ya Mungu ni uzima wa milele.

Je, nini kitafuatia? Usikose Alhamisi ijayo kwenye Gazeti la Amani.

GUIDANCE AND COUNCELING

TED  401

TED 401 - TOPIC ONE LECTURE NOTES

TOPIC 1:      INTRODUCTION OF GUIDANCE AND COUNSELING

1.1         Definition of guidance and counseling

1.2         Basic principles of counseling

1.3         Basic prepositions in counseling

1.4         Origin and historical development of counseling.

1.5         Purpose of guidance and counseling in Tanzania today.

 GUIDANCE

The term has been defined in varied ways, depending on the culture and environment. At face value guidance has been derived from its root word ‘guide’ which means direct, pilot, manage, steer, aid, assist, lead, inform, and interact (Makinde, 1990).

Guidance is a term used to denote the process of helping an individual to gain self understanding and self direction (self decision making) so that he/she can adjust maximally to his/her home, school or community environment. (Biswalo, 1996).

According to Kochhar (1993), guidance has the following characteristics when dealing with students:

i)             It is a process. It helps every student to help himself, to recognize and use his/ her inner resources, to set goals, to make plans, to work out his own problems of development.

ii)            It is a continuous process: it is needed right from early childhood, adolescence, and adult-hood and even into old age.

iii)           Choice is the distinctive concern of guidance: here the student’s unique world of perceptions interacts with the external order of events in his life context where problems are constantly faced and require effective decisions for one to move forward.

iv)           It is assistance to the individual in the process of development rather than direction of that development: the aim is to develop the capacity for self – direction, self-guidance and self- improvement, through an increased understanding of one’s own problems and resources.

COUNSELING

The ordinary meaning attached to counselling is that of consultation, discussion, deliberation (consideration, care).

Counseling is a service designed to help an individual analyze himself by relating his capabilities, achievements, interests and mode of adjustment to what new decision he/ she has made or has to make (Makinde, 1990).

UNESCO (2008) counseling is a learning-oriented process, which occurs usually in an interactive relationship, with the aim of helping a person learn more about the self, and to use such understanding to enable the person to become an effective member of society.

Counseling takes place when a counsellor sees a client in a private and confidential setting to explore a difficulty the client is having , distress they may be experiencing or perhaps their dissatisfaction with life, or loss of a sense or direction and purpose (British Association for Counseling and Psychotherapy, 2001).

Counseling as a profession has its own features, as follows:

i)     Counseling as a professional is a facilitative activity. Counselor creates conducive situation to the client so as to solve the problem

ii)    Counseling assures confidentiality.

iii)   There is assurance of flexible relationship between a counselor and client (it is relatively non hierarchical relationship.i.e in the first place client is your boss because he/she knows more than you about the problem.

iv)   Counseling is mainly guided by exploration of the problem, therefore intensive use of interview is required

v)    Problem solving is based on understanding the client as an individual.

vi)   Make sure the client accept and own the problem for effective counseling to occur.

vii) The client should fully engage in finding solutions of the problem.

viii)                The client should voluntarily seek the counseling rather than being brought for counseling (it is always essential to apply attending skills which help you to be accepted by a client e.g welcoming skills.

Differences between Guidance and Counseling

	GUIDANCE		COUNSELING
i.	Process of helping students to achieve the self-understanding and self-direction necessary to make informed choices and move toward personal goals	i.	Counselling is based on the understanding of the client’s subjective world. It should create the opportunity for exploration.
ii.	Guidance program is a system of services designed to improve the adjustment of each and every person for whom it was organized	ii.	Counseling session often takes place in settings with privacy such as an office or small therapy centre
iii.	The guidance goals and programs attend to the person’s developmental needs	iii.	It can be short, cheaper and more accessible. counseling takes place over a shorter period of time
iv.	Guidance is meant for every one, people with problems and people without problems can all benefit from these services.	iv.	Counseling is post-problem, meaning a problem has already been identified and therefore the counselor helps to address the problem but not to solve it
v.	The act of making decisions for another person to help them get somewhere or help them to have a better future.	v.	Counseling activity adds up to a situation that faced a client.

Guidance is broader than counseling. It is a generic term, which embraces counseling, information services, appraisal services and guidance oriented research services. In all these interrelated services, counselling is the most important. It is the brain as well as the wheel of guidance and the two are inseparable.

The key to counseling is communication and the nature of the relationship between the client and the counselor.

Counseling depends solely on communication, hence counselling is said to be a ‘talking cure’. Its relationship between counselor and client is different from those of teacher/ student, doctor/ patient relationship, father/child relationship due to this focus.

However counseling is different from other relationship because it needs special skills to build that kind of relationship. It is also different from other skills because counseling does not allow advice giving to the client. Client has to take responsibility to in solving his/her problem.

Three Basic Prepositions in Counseling

The philosophy of counseling as profession can be expressed in three basic propositions:

i)             Seek to facilitate human development: counselor help the client develop awareness of their psychosocial selves so as to attain higher level of functioning.

ii)            Take into account the social, psychological and physical environment of the client: the counselor can utilize the concept of social roles and behaviors, coping behaviors and developmental tasks in helping clients master their environments.

iii)           Seek to facilitate a dynamic balance between person and environment: when counselors see that clients’ problems arise from the community, the counselor may intervene in the wider environment for remediation as well as prevention, thus improving the person-environment balance.

HISTORICAL DEVELOPMENT OF COUNSELLING

Origin of counseling as a professional Activity:

Counseling by professional helpers is unique to the 20^th century (Wallace and Lewis (1998).

The origin has been traced back in industrial period in Europe (McLeod, 1998). Counseling was needed during industrialization. Counseling was introduced to help people cope with new life style and culture of working in industries different from subsistence farming.

African Context:

Counseling in the traditional African societies became necessary when a member of the community found it difficult to relate with him/herself as well as with others in the community and displayed unusual social, intellectual or psychological behavior. Counseling was done to prevent degeneration of one’s personality and the consequences such as violence, madness, suicide, homicide etc.

The counselor in the traditional society was a person who was trusted and respected by both the client and the society. In African countries counselling is a very new helping profession, it becomes popular now.

Counseling Services in Tanzania:

In Tanzania is even newer. It started in schools due to the deterioration in student behavior. Since the introduction of western education, students became divorced from their traditional culture, which had provided guidance, and helped whenever they encountered problems

Following the increase of social problems and HIV/AIDS pandemic, the Ministry of Education and Vocational Training made efforts to institutionalize guidance and counselling services within the education system (e.g. introducing career master/ mistress though there was no proper training given).

The ever growing complexity of the society, coupled with social problems such as HIV/AIDS and the rapid development of science and technology, place a heavy demand on education. Before this epidemic there was no counsellig in Tanzanian Hospitals or communities as there were no professional counselors, and no formal system for educating counselors existed. Currently counseling is becoming more popular not only in HIV/AIDS but also for many other human problems as well.

Purpose of Guidance and Counseling in Tanzania

      i.            Guidance and counselling services are important for determining career and profession of learners.

  ii.            Information and advice play in improving the efficiency of education systems and its utility in the labour markets.

iii.            Career education has an important role to play within education in laying the foundations for lifelong career development.

iv.            Guidance and counselling are particularly important in post compulsory education. Here, wider curriculum choice results in more diverse and complex routes into later stages of education, into employment, or into both. This can help to:

·         Reducing dropouts from and back-tracking within education systems, and thus improve internal flows.

·         Improving flows between different levels of education, thus raising national levels of educational attainment

·         Improving transitions from education to the labour market.

These outcomes help to make better use of educational resources, and to increase both individual and social returns to investments in education.

REFERENCES:

Achieng, A. A (2007). Guidance and Counseling: An Introduction. Nairobi: Exact Concepts Publishers.

Mutie, E.K. & Kyungu, S.P.M. (2011). Guidance and Counseling for Schools and Colleges. Nairobi: Oxford University Press.

Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21, 93–103.

Sima, R (2010). Educational Guidance and Counseling. In I.M. Omari. Educational Psychology for Teachers. Dar es Salaam: Oxford Press.

Tan, E. (2004). Counselling in Schools: Theories, Processes and Techniques. McGraw-Hill Education (Asia).

TED 401 - GROUP WORK ASSIGNMENTS

GROUP WORK 

ASSIGNMENT ONE:

INSTRUCTIONS:

      i.            Write your answers in at least three (3) pages per question, in Microsoft word, times new roman (12 font size), single space and justified.

  ii.            A group MUST not exceed 10 members.

iii.            Attempt TWO questions, ONE from each TOPIC as appear in the list of questions.

iv.            Citation and references in APA format.

SUBMISSION:  ALL group works shall be submitted with the portfolio by end of May, 2014.

TOPIC ONE:        INTRODUCTION OF GUIDANCE AND COUNSELING

QUESTIONS:

1.   What do you think is the most important characteristic of a counselor?

2.   What are the differences between a therapist and a school counselor?

3.   One of the roles of teachers as counselors is shaping of the individuality of the learner. What are common features of secondary schools students in Tanzania in counseling services?

4.   Taking TEKU as your case, what would you consider as strengths and/or weaknesses in guidance and counseling services.

5.   What is confidentiality and how does it apply to the school counselor? What forces counselor breach confidentiality? 

6.   Critically review stressors experienced by University of Dar es Salaam students as presented in S.A. Seif thesis. (Available in, Seif, S.A. (2011). Stress and the coping strategies of students in higher learning institutions in Tanzania: The case of university of Dar es Salaam main campus. Journal of the Teofilo Kisanji University, 2, 16-32)

TOPIC TWO:              THEORIES OF GUIDANCE AND COUNSELING

QUESTIONS:

1.   Using knowledge and skills learned in course, show how you will make use of guidance and counseling theories in the following settings:

a.    Complex life in High School due to problems related to transition into adulthood.

b.   A student undergoing the divorce of parents and his/her stress affect participation school. 

c.    An attempt to alcohol or trying drugs in order to get peers' approval. 

2.   One of your teenage students tells you that she is pregnant. Critically, describe how are you going to handle such a problem in order to make her schooling effective?

3.   A fellow teacher comes to you concerning a learner with the following behaviors: aggression; poor peer relations; inattention to learning; will not accept adult authority or responsibility for behavior.  Provide your professional concern on how you would handle this situation.

4.   In the developed world numerous programmes are in place to help schools and counselors in addressing the needs of these at-risk students. In your opinion, what programs are essential for Tanzania, and suggest at least four programmes for any level of education of your choice.

Posted by Elimu Maarifa at 5:49 AM No comments:

TED 401 - TOPIC TWO LECTURE NOTES

TOPIC 2:        THEORIES OF GUIDANCE AND COUNSELING

         2.1     Psychoanalytic theory

         2.2     Existentialism theory

                2.3      Humanistic (client or personal centered theory)

2.4                 Rational emotive behavioral  theory

 THEORIES OF GUIDANCE AND COUNSELING

What is a counseling theory?

A theory is a formulation of the underlying principles of certain observed phenomena that have been verified to some extent. A criterion of the power of a theory is the extent to which it generates predictions that are confirmed when relevant empirical data are collected. The more a theory receives confirmation or verification, the more accurate it is. Facts strengthen rather than replace theories.

Functions of counseling theories

What do counseling and therapy theories do? Why are they useful? Counselors cannot avoid being counseling theorists. Counselors make suppositions about how clients become and stay the way they are and about change.

Three of the main functions of counseling theories are:

·         They provide conceptual frameworks,

·         They serve as languages for communication in counseling, and

·         They are sources of research.

Theories as languages of counseling

Swiss psychiatrist Carl Jung (1961) used to emphasize that, since all clients are different individuals, counselors require a different language for each client. Another function of theories is similar to that provided by languages. Languages are vocabularies and linguistic symbols that allow communication about phenomena. Like the major spoken languages of English, Kiswahili and Arabic, the different theorists develop languages for the phenomena they wish to describe, for instance: cognitive, psychoanalytic or person-centred languages.

Language can encourage communication between people who speak the same language, but discourage communication if they do not. Each theoretical position has concepts described in unique language. However, the uniqueness of the language may mask common elements among theories, for example: the meaning of conditions of worth in person-centred counseling overlaps with that of super-ego in Freud’s psychoanalytic counseling, though you would not know this from the language.!

The counseling process is a series of conversations requiring languages. In any counseling relationship there are at least four kinds of conversations going on, namely:

·         Counselor inner speech

·         Counselor outer speech

·         Client inner speech and

·         Client outer speech.

All counselors who operate out of open counseling theoretical frameworks are likely to talk to themselves about clients in the language of that framework. In varying degrees their counseling practice will match their language. Counselors do not always act according to how they think.

Four key theories of guidance and counseling include:

      i.            Psychoanalytic,

  ii.            Client centered/personal centered/non directive counseling theory, and

iii.            Existentialism theory,

iv.            Rational emotive behavioral theory

PSYCHOANALYTIC THEORY

Psychoanalysis was perhaps the first specific school of psychotherapy, developed by Sigmund Freud (1856-1896) and others through the early 1900s. The major objective of Psychoanalytic theory is to help the individual achieve an enduring understanding of his own mechanism of adjustment and thereby to help him resolve his basic problem. Psychodynamic therapies aim to help clients become aware of their vulnerable feelings which have been pushed out of conscious awareness.

The Psychodynamic approach states that, “everyone has an unconscious which holds painful and vulnerable feelings which are too difficult for the person to be consciously aware of.” In order to keep painful feelings, memories, and experiences in the unconscious, people tend to develop defense mechanisms, such as denial, repression, rationalization, and others. According to Psychodynamic theory, these defenses cause more harm once the vulnerable or painful feelings are processed. While defence mechanisms are normal and form the basis for most of our responses when we are anxious, excessive use of defence mechanisms can lead to certain psychological problems. 

Some example on how EGO defense system, which may be distorting reality

      i.            Repression: Blocking unpleasant/unacceptable thoughts by pushing them into the unconscious, e.g. forgetting events of the painful childhood.

  ii.            Regression: Reverting back to a stage that was satisfying, e.g. a teacher showing temper tantrums like a child or acting like a baby.

iii.            Displacement: Redirecting the expression of unwanted desires or impulses to a substitute rather than the actual target, e.g. older student beating younger/weak student when he/she cannot express anger toward the teacher.

iv.            Rationalization: In order to justify one’s behavior, one develops a socially acceptable explanation or reasoning, e.g. cheating in tests saying that everyone is doing the same. A student who gets a D and three F’s may rationalize and say that this was due to the fact that he put too much effort in studying for the D and thus the final result.

   v.            Denial: Refusing to acknowledge or accept anxiety provoking thoughts or impulses e.g. being a heavy smoker but saying ‘I am an occasional smoker’.

vi.            Projection: Attributing unwanted thoughts and impulses to others e.g. a student stealing a book in a library and accuse teachers for not giving them enough notes.

vii.            Sublimation: Converting unwanted impulses into socially approved thoughts, feelings and actions e.g. disliking the class-mate but behaving in a very friendly manner. A lady who is sexually frustrated may take to washing the house, dishes or other household chores.

Theoretical Assumption

• Human  behavior is determined by unconscious forces( the forces that take place  while you are not aware) which influence human behavior
• Sex drives are principle dominant of human behavior.
• Adult behavior is greatly influenced by early development in childhood especially in early 6 years.

Principles of Psychoanalysis

 1) Psychoanalysis mainly involved with discovering the ways of the mind and the thought processes.

2) Psychoanalysis maintains a specific set of ideas with regard to human behavior.

3) Psychoanalysis is a form of therapy for the treatment of various emotional and psychological disturbances.

Psychoanalysis and Human personality

A successful use of psychoanalysis theory needs to be applied together with the knowledge of the human personality which has three systems/components, i.e, ID, EGO and SUPER EGO.

·         The Id

This is the inherited part of our behaviour and includes biological drives and instincts. These energize all our actions and their aim is the satisfaction of needs or impulses including the need for food, sex and sleep. Biological drives and instincts are inborn and are completely divorced from the outside world. They are completely illogical and amoral. They are not in our conscious control hence the term unconscious.

·         The Ego

The Ego develops from the id and acts as a “go between” the id and reality. It controls the instincts and impulses. It operates on the reality principle which says "take care of a need as soon as an appropriate object is found." It represents reality and reason. It imposes delays in satisfying needs as a result of environmental necessity. It uses logic and reason to evaluate information according to external and internal experiences.

·         The Super ego

This develops from the Ego and it represents the influences of society upon the individual. It incorporates the standards of the society and acts as a regulator for the amoral Id. It, in turn has two components namely Conscience which determines what one cannot do and if one goes against it, they feel guilty, and Ego ideal, that is, which is perfection. The super ego is formed early in childhood as the child identifies with the parents. The parents initially represent the ego ideal and help the child form an internal authority or morality.

Goals of Counseling in Psychoanalysis

·         To  make unconscious behaviors  conscious so that you can deal  with it realistically

·         To strengthen the EGO. Ego operates in the principle of reality it must control  the client  from reasoning, thinking etc  and at the end of this is the modification of the clients’ behavior

·         To modify behavior of the client a counselor is working out for reconstruction of behavior.

Functions of the Counselor

·         To help the client to acquire the freedom, to decide what he/she wants to be.

·         To assist the client in achieving self awareness so that to deal effectively with the anxiety.

·         To establish the working relationship with a client. You must listen well whatever client is saying to detect the gap, the contradictions.

·         To reduce the use of defense mechanisms and face reality.

Techniques of Psychoanalysis Counseling

i)     Free association – A technique which allows patient’s thoughts and feelings to emerge without trying to organize or censor them. Client to talk about each and everything which comes in mind (especially any early trauma/shock) regardless of how is painful or irrelevant.

ii)   Interpretation – A counselor’s response to the clients’ free association. It is intended to help the client gain new insights. Interpretation is grounded on the counselor assessment in the clients’ personality.

iii)  Dream analysis – During the course of analysis the client may report dreams, which often recapture childhood experiences. These dreams help in understanding clients problems. As a counselor you need to learn resistance of the client.

iv)  Transference – This include reactions  of previous relationship with other people in the presence of the counselor.

Contribution of Psychoanalysis in Counseling

• It makes counselor aware of the significance of any childhood behavior in adulthood personality in the whole process of counseling
• Also understanding the past helps the client to understand him, herself

Limitations of the Theory

• It is only work properly with a well trained counselor
• It takes too much time, therefore counseling session takes a lot of time
• Many clients need quick solutions of their problems; therefore this can cause boredom to the client.
• To cure a person is very expensive. (it is doubtful that behavior is determined by a reservoir (pool) of psychic energy
• Too much stress is placed upon early childhood experiences

HUMANISTIC THEORY

Humanistic psychology emerged out of a desire to understand the conscious mind, free will, human dignity, and the capacity for self-reflection and growth. An alternative to psychoanalysis and behaviorism, humanistic psychology became known as “the third force.”

Emerged in reaction to the perceived limitations of psychodynamic theories, where psychologists like, Carl Rogers and Abraham Maslow strongly felt that the approaches prevalent at that time could not adequately address issues like the meaning of behavior, and the nature of healthy.

The humanistic approach includes a number of other theories with the same or similar orientation e.g., ‘existential’ and ‘phenomenological’ psychology.

Assumptions of the Humanistic Approach

• In order to understand behavior we must consider the subjective experience of the person.
• Neither past experience nor current circumstances constrain the behavior of the person.

Carl Rogers (1902-1987)

One of the founders of the humanistic approach, Rogers was one of the most influential therapists in the 20th century. Born in 1902 in Oak Park, Illinois, a suburb of Chicago, he underwent a strict upbringing as a child who later turned out to be rather isolated, independent, and self-disciplined.

Abraham Harold Maslow (1908-1970)

American psychologist and leading exponent of humanistic approach. He founded a comprehensive theory of motivation.

Maslow and the Theory of Motivation

Psychology and the psychologist should look at the positive side of the human beings. People’s needs are not low level and base. We have positive needs that may become neutral in the worst cases, but will not turn negative or base.

Human behavior does respond to needs but we will be wrong in saying that all our needs are only physiological in nature. Needs motivate human action; such needs are very few in number.

Maslow’s Hierarchy of Needs

This is basically a stage theory.  The needs at one level have to be met in order for one to move on to higher order. The needs at the lowest/primary/base level are the physiological needs, whereas the highest order needs are the self-actualization needs.

Rogers and the person-centered approach

Rogers founded the person-centered approach since the ‘person’ was the main figure of importance. He believed that the most powerful human drive is the one to become “fully functioning”.  Fully functioning means, a person becomes all that he or she is capable of.

The success of person-centred counseling is based on three core conditions: genuineness, empathy and unconditional positive regard:

              i.        Congruent or genuineness on the part of the counselor means that he/she is transparent about his/her feelings and thoughts. The counselor expresses feelings and that he/she actually experiences rather than those he/she thinks will help the client open up. In this regard, the counselor may, sometimes, share his/her personal experiences with the client. This make client become comfortable and fully express him/herself.

            ii.        The counselor must also be empathetic towards the person/client. This empathy must be genuine, accurate and well-directed in terms of response. Empathy is the ability to position the subjective world of the client and how he/she feels.

           iii.        Unconditional positive regards means that the counselor respect and accept the person/client. He/she should show care and appreciation towards the client regardless of the client’s attitude or behavior.

Focus of the person-centred approach

It focuses on the subjective view of human experience. Rogers also placed the responsibility of the client in counseling and explains the positive relationship between the client and the counselor. If the outcome of the counseling is positive the relationship will also be positive and vice-versa.

Basic assumptions of the person-centred approach

• People have potentials for understanding and to solve their problems.
• People are capable of self directive quality and quality for relationship.
• A person can grow or experience new thing without anxiety. Anxiety is not necessary for the people to grow. It is the only different between existentialism theory and personal centered theory.
• People are trust worthy, capable of self directed goals involve in therapeutically relationship, i.e. we don’t look for answers to help people but they have answers on themselves.

The six necessary conditions for constructive personality change

In person-centered counseling, treatment is the relationship between the counselor and the client. If that relationship is characterized by the following six “necessary and sufficient” conditions, then constructive personality change will take place (Rogers, 1957):

      i.            Two persons (counselor and client) are in psychological contact.

  ii.            The client is in a state of incongruence, being vulnerable or anxious.

iii.            The counselor/therapist is congruent or integrated in the relationship.

iv.            The counselor/therapist experiences unconditional positive regard for the client.

   v.            The counselor/therapist experiences an empathic understanding of the client’s internal frame of reference and tries to communicate this experience back to the client.

vi.            The communication to the client of the therapist’s empathic understanding and unconditional positive regard is to a minimal degree achieved.

Goals of counseling of the client-centred approach

• To help client towards a great degree of independence and integration of him/her self
• Not only to solve the problem but it goes further to assist the client in growth process that can the client  cope with present and future problems
• To provide a climate conducive for the client to become a fully functioning person. A fully functioning person has the following characteristics:

                              i.            openness to an experience

                          ii.            trust for him/her self

                       iii.            to become rational source of evaluation, ability, to evaluate yourself

                        iv.            willingness to continue growth

Important counseling techniques in client-centred approach

a)    Listening    

b)    Acceptance

c)    Respecting

d)    Understanding

e)    Responding

Contribution of the theory

• To empower the client to have the sense of worth living through counseling
• It created a lot of research on counseling
• It has beneficial to people of any culture

Limitations of the theory

      i.            It only focuses on techniques of attending or reflecting without explaining the clients’ problem.

  ii.            It is very easy that anybody can do it looks human being as very simple and we human being are not easy like things.

iii.            It does not believe in diagnosing; yet the counselor is committed to using medical, psychological, and vocational evaluations.

iv.            It is relatively unconcerned with the external environment; yet the rehabilitation counselor is in constant interaction with the real world and spends considerable time coordinating community resources and delivering concrete services to the client.

EXISTENTIALISM THEORY

The proponents of this theory were Rollo May (1909-1994) and Victor Frankel (1905-1997). This theory is a philosophy and deals with the meaning of life.

Existentialism views the world as meaningless and that human beings are here by chance. So people must find meaning in this chaotic world. Existentialists believe that psychology and psychiatry should be directed towards growth and potentialities of human rather than mental illness and cure (a matured person does not need cure rather needs a sense of calm enough to face struggles and problems and strong enough to find a center of strength within the self.

Person is a being in existence/reality and not a being in essence/spirit, he/she is totally free and responsible for acts and actions, he/she is dynamic process or is changing, he/she is searching, thinking and feeling, he/she is growing and is choosing goals.

As a psychology it objects to the concepts of causality (the cause and effect). For human being there is nothing like cause and effect, instead there is motivation which controls human being (e.g wind forces window to close but human being are motivated to close the window). They deny that there is the force behind the phenomenon. They object treating human being like a thing or an object, they argue that if you treat human being like an object you’re dehumanizing him or her.

Philosophical Assumptions

• The existential approach characterizes human beings as creatures of continual change and transformation, living essentially finite lives in a context of personal strengths and weaknesses as well as opportunities and limitations created by their environment.
• Existential counseling maintains that disturbance is an inevitable experience for virtually everyone; the question is not so much how to avoid it as it is how to face it with openness and a willingness to engage with life rather than a tendency to retreat, withdraw or refrain from this responsibility

• Human being existence depends on the number of choices her/she has. Then to them if you don’t have choices you’re like a thing
• External forces make it difficult for you to make choice
• The choices are sometimes ambiguous they are not clear
• Making no choice means  you are making choice therefore you can’t avoid to make choice
• If choices are outside your life are not yours ( if you want to come for lecture and you are at town if you don’t have money you can decide to  come on foot)

Five propositions of the existentialism

• Human beings have capacity for awareness especially self awareness. To them counseling is done to help client to be aware and make choices on what to do and what to be
• Human being has got freedom and responsibility. They are free to decide what to do Freud sad that human being are controlled by sexual drives or forces.
• Individual strive for identity and relationship with others. People are always concern with perceiving their uniqueness and at the same time go outside to learn from others or have connection   with others. the function of the counselor is to help people to make social ties with others
• Searching for meaning. As distinctive of human being is to struggle for meaning, purpose and significance. One can ask these questions, who am I? Why am I here? The role of the counselor produces a lot of questions about the client such as are pleased with this life, what do you want to be etc.
• Anxiety and fear are conditions for living. They see anxiety and fear as potentials source of growth because it is an appropriate response to an event to be faced. Counselor has a duty to help client to grow by going through anxiety

Counselors’ Functions

• The counselor’s basic task is to enter the client’s World and participate in its realities
• To understand the subjective world of the client in order to help the client into new options
• To employ different methods of counseling. They don’t have specific method for counseling
• To establish effective relationship with the client. The I/Thou relationship (Bubber, 1972). I and You or counselor and client relationship.

Counseling Techniques and Procedures

Be creative i.e. you change from session to session. However the counseling can be done in Three Phases:

                              i.            To assist the client to clarify and identify the assumption about the world because most of the   problems are caused by misconception. Many people do not know the role they play in their own problems they tend to blame others

                          ii.            To help the client to have deeper understanding of inner forces\insights on their value and attitudes

                       iii.            To help the client to put into action what he has learned in the session

Contribution of the Theory

• It emphasizes human quality relationship  i.e people has got the ability to change
• The approach will appeal to clients who are interested in the search for meaning and in deeply personal philosophical investigations counseling.

Counseling will probably find less value to Clients who are less inclined to examine and explore their personal assumptions and ideals, or who would like to achieve immediate relief of specific psychological symptoms as well as those who would like advice or diagnosis from their counselors.

RATIONAL EMOTIVE BEHAVIORAL THEORY OF COUNSELING (REBT)

The founder of this theory was Albert Ellis (1913-2007), who was a clinical psychologist. REBT views human beings as 'responsibly hedonistic' in the sense that they strive to remain alive and to achieve some degree of happiness.

Theoretical assumptions of the REBT

·         Events do not force people to have emotional behavioral reactions. It is rather interpretation about events that precipitate emotion and behavior. Therefore the target for change in psychotherapy is those thoughts, attitudes, believes and meaning that create emotional behavioral disturbance.

·         Human have capacity to interpret reality in a clear, logical and objective fashion and avoid unnecessary emotional behavioral distress or sadness, but also says that humans are predisposed to irrational interpretations.

·         Human are born with both potentials of rational and irrational thinking. When he/she thinks rationally, we experience all good things such as love, happiness, communication growth. When she/he thinks irrational we expect bad things and need for the counseling, e.g self blame or personal destructions.

Goal of Counseling in REBT

·         To help client minimize their emotional disturbances.

·         To help client reduce the tendency of blaming him/her self or others on what is going wrong in life and learn ways to reduce the future difficulties.

·         The counselor should work with client towards client specific goals i.e self interest, social interest, self direction, tolerance, flexibility, acceptance uncertainty, commitment, scientific thinking, risk taking, self responsibility for disturbance.

Functions of Counseling in REBT

·         Encouraging client to discover a few basic irrational ideas that motivate much for disturbed behavior.

·         Challenging the client to validate their ideas.

·         Demonstrating to the client the illogical nature of their thinking.

·         Using logical analysis to minimize the irrational believes of the client

·         Showing how beliefs are in operative and how they lead to future and emotional behavior disturbances.

·         Explaining to the client how the irrational ideas can be replaced with ideas that are empirically grounded.

·         Using several cognitive, emotional and behavioral methods to help client work directly on their feeling and to act against their disturbances

·         Helping client avoid self-condemnation always try to show the client that his/her ideas are wrong.

Stages of Counseling in REBT

·         Focus is on building rapport. This will encourage client to talk freely once the relationship has been established.

·         Identify the problem and goals setting. You must know what the client wants to e at the end of counseling, e.g, stop smoking.

·         Client identifies beliefs, feelings or attitudes that are to be acquired or increased.

·         The client is then oriented in basic principle and practices for the approach. Home work is careful designed and agreed upon aimed at getting client to carry out positive actions and reduce negative attitudes and actions

·         Towards the  end of counseling client reviews his/her progress, make plans and identifies strategies to deal with continue or potential projects

REFERENCES

Achieng, A. A (2007). Guidance and Counselling: An Introduction. Nairobi: Exact Concepts Publishers.

Mutie, E.K. & Kyungu, S.P.M. (2011). Guidanceand Counseling for Schools and Colleges.Nairobi: Oxford University Press.

Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21, 93–103.

Sima, R (2010). Educational Guidance and Counseling. In I.M. Omari. Educational Psychology for Teachers. Dar es Salaam: Oxford Press.

Tan, E. (2004). Counselling in Schools: Theories, Processes and Techniques. McGraw-Hill Education (Asia).

ANSWER TO QN NO 2 TOPIC 2

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        Skills for EducatorsAll Skills for Educators

        Abstinence Education: What Are My Options?

Advocating for Changing Social Norms Associated with Condoms and Condom Use

Answering Preteens' Questions About Sexuality

Classroom Management to Promote Learning

Designing Asset Building Strategies for Girls

Facilitating Positive Sexuality Dialogue with Students

Guidelines for Handling Disclosures of Child Sexual Abuse

Guiding Large Group Discussions

Helping Young People Make Healthy Decisions About Drugs

How to Implement a Social Marketing Poster Campaign

Look Around! Tips for creating a body positive learning environment

Managing Small Groups

Meeting the Needs of Diverse Youth

Options Counseling for Pregnant Teenagers

Partnering with Communities of Faith to Discuss Sexuality Issues

Preparing to Use a Curriculum

Preventing and Responding to Controversy in Sexuality Education

Role Play for Behavioral Practice

Sharing Values about Sexuality

Teaching Sexuality to Developmentally Disabled Youth

Teaching Youth about Emergency Contraception

Use of Critical Thinking Skills to Analyze Health Disparities

Values Clarification Exercise for Staff

Why We Need to Address Lesbian and Gay Issues in Our Schools

Working with Young Children: Using Teachable Moments to Respond to Children's Questions and Behaviors about their Bodies       

Options Counseling for Pregnant Teenagers

 This educator skill is an overview of how educators, counselors, and health care providers can help young women make informed decisions about their options once they know they are pregnant. This is NOT a substitute for formal training in options counseling. Instead, it reviews key points and issues to help professionals who interact with sexually active teenagers provide immediate support and, if needed, additional referrals.

This educator skill begins with an introduction, which is followed by the goals of pregnancy options counseling, a brief review of the counselor's role, and information and counseling points that address each of three options a pregnant teenager faces:

continuing the pregnancy and raising the child herself,

continuing the pregnancy and placing the child for adoption, and

terminating the pregnancy.

A list of Resources is included at the end.

See this month's Learning Activity for a decision-making model that will help a counselor and a pregnant teen consider all the options — and the next steps.

Introduction

 In the United States, four of every ten young women become pregnant at least once before they turn 20, leading to approximately one million teen pregnancies a year.1 About half of all pregnancies are unintended, but among teenagers, the proportion is higher — 80 percent. Not surprisingly, about 79 percent of teen pregnancies occur among unmarried teens.2

Many complicated reasons converge to contribute to these rates of teen pregnancy. For some young couples, lack of basic knowledge leads to pregnancy. In others, the knowledge may be there, but myths and wishful thinking prevail: "It can't happen to me …" "It can't happen the first time …" "It can't happen if we're standing up."

Even those teens who have knowledge about how to protect themselves and the best intentions to do so may not have access to contraception, or may not use it correctly every time. Even when they use contraceptives properly, they may experience the failure rates that are built in, to some degree, to every form of protection except abstinence. And for a tragic minority, none of these reasons apply, for they are victims of rape or incest.

Finally, even though 80 percent of teen pregnancies are unintended, at least 20 percent are wanted in some way — because of a desire to be a mother and a grown-up, pressure from a partner, or simply a quest for love from an adoring baby.

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The Goals of Pregnancy Option Counseling

 Studies that compared adolescents who raised their children, placed the children for adoption, or had an abortion found similar levels of satisfaction. Teens in these studies generally believed they made the right choices.3,4 "Central to this expressed satisfaction," notes Michael Resnick, who reviewed the studies, "was a sense of ownership over the pregnancy decision, and the belief that the outcome was not forced on the adolescent but arrived at through a careful process of evaluation and decision-making."5

That's exactly what options counseling aims for: a careful process of evaluation and decision-making, after which the teenager feels that she made the right choice for her particular circumstances. By definition, this means that the same choice will not work for every teenager. The task for the pregnant teenager — and the counselor or educator trying to help her — is to discover what the right choice is for her particular situation.

Specifically, effective pregnancy options counseling should:

Reduce anxiety so that the pregnant teenager can concentrate on the decisions she has to make

Create a safe environment in which she can discuss her hopes and fears about her decision

Impart knowledge and facts about the various options and their implications

Identify the teenager's strengths and support systems

Clarify her choices and her feelings about her choices

Help her make the decision that is right for her

Help her accept responsibility for her decision

Help her act on her decision, with referrals as needed, and

Support her decision

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The Counselor's Role

 To give a pregnant teenager a true sense of the options, counselors must provide information about each option. However, they must remain neutral and non-directive, letting the teenager reach a decision that is right for her. This is a difficult challenge for anyone trying to help a pregnant teenager. We may have strong opinions about what life holds in store for her and her baby, or negative views about adoption or abortion. But our opinions as counselors and educators do not deserve center stage in this situation. The teen's opinions – informed, supported, and thought through with our help – do.

For most teenagers who find out they are pregnant, the situation is a crisis with serious implications for their current relationships, their immediate futures, and their overall lives. These adolescents need caring, compassion, and options, not judgments. In your counseling role, if you do not feel you can provide unbiased information to a teen in this situation, the fair thing to do is to refer her to someone who can.

The counseling part of options counseling means using techniques such as open-ended questions and reflective listening to help the pregnant teenager understand her feelings and explore what she can do about her situation. Remind her that she has three choices:

She can have the baby and raise the child herself

She can have the baby and place it for adoption or foster care

She can end the pregnancy.

Emphasize that there is no right or wrong choice that applies to everyone. Only she can decide which choice is right for her, but it is not an easy decision. Your job is to help her think it through.

General questions to consider are:

Which choices could I live with?

Which choices are impossible for me?

How would each choice affect my everyday life?

What would each choice mean to the people closest to me?

What is going on in my life now?

What are my plans for the future?

What are my spiritual and moral beliefs?

What do I believe is best for me in the long run?

How would my choice affect me financially?6

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Option A:

 Continuing with the Pregnancy and Parenting the Child

 If the teenager expresses an intention to continue with the pregnancy and parent the child herself, the discussion can cover her reasons for wanting to do so, as well as some of the outcomes — both positive and negative — if she does so. These questions can help:

Why does she want to continue the pregnancy? (Teenagers who make this choice may have vastly different reasons for doing so, with different implications for their next steps. For example, they may feel pressure from family members or the baby's father. They may be afraid of pursuing other options. They may have longed for a baby.)

How do significant others in her life — parents, partner — feel about it? (Or, if they don't know yet, how will they feel?)

What are her plans for prenatal care during her pregnancy? Does she have access to insurance and a health care provider, or will she need referrals? Does she need help from you to obtain these services, or is there someone else she can turn to?

What are the immediate tasks and challenges for the next few days (e.g., telling her partner, parents, or others)?

How will the pregnancy and parenthood affect her education? (Will she be able to continue to attend school in the same school, or transfer to an alternative school or program for pregnant teenagers?)

Where will she live during the pregnancy? Will she be able to live at home during the pregnancy, or does she plan to live with her partner or on her own, or at a shelter?

Where will she live after the pregnancy?

What will her partner's role be in helping to support her and the baby — financially and with child care and other support?

How will the baby affect her plans for the future and her partner's plans?

Who will take care of the baby while she works or completes her education?

What are other options that she is considering? What are their pros and cons?

How do these other options compare with the option of continuing the pregnancy and parenting the child?

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Option B:

 Placing the Baby for Adoption

 As recently as 50 years ago, 95% of unmarried and pregnant teenagers who gave birth placed their babies for adoption. Today, the figure is less than 5%.7 What led to this reversal? In part, some of the stigma of single parenting has faded, and young pregnant women have more options. Some researchers believe that adoption is viewed so negatively by society at large — and by health and social service professionals in particular — that it is rarely presented as a viable option to pregnant teenagers. Some studies of the decisions made by pregnant teenagers also indicate that teenagers themselves shy away from adoption.

One of the signals of how adoption is viewed is the language used to describe it. Over the years, adoption has acquired a vocabulary that subtly (and sometimes not-so-subtly) reinforces the idea that adoption is an unnatural, desperate, and substandard family experience for everyone involved. To counter this, the Positive Adoption Language (PAL) movement has suggested terms that do a better job of respecting the birth parents, adoptive parents, and adoptees. Here are some highlights to consider:Previous Terms         Preferred PAL Terms

Real parent, natural parent (implies that adoptive relationships are artificial or that blood relationships are the most important relationships)

        Birth parent, birth mother, birth father (describing the man and woman who conceived and gave birth to a child)

 Parent, mother/mom, father/dad (describing the people who raise and nurture a child)

Surrendered, released, relinquished, gave up, put up … the baby for adoption

        Placed the baby, chose adoption, made an adoption plan

Kept the baby

        Chose to parent/raise the baby

In discussing adoption options with a pregnant teenager, use the more neutral terms suggested by PAL.

Types of Adoption

In the past, almost all adoptions were what is now called "closed" adoption. In a closed adoption, the records about the birth parents are sealed — sometimes forever, and sometimes until a child is a certain age or seeks information through court actions to unseal records. In a time when pregnancy outside of marriage was judged much more harshly than it is today, closed adoptions were deemed the best recourse for the birth parents, the child, and his or her adopted family.

Today, a growing movement has emerged that is known as "open" adoption. In open adoption, the birth parents and adopted parents have a relationship that they establish. The birth parents choose the family that will raise their child. Both sets of parents meet and talk, agreeing to some type of ongoing contact. Existing research suggests that children accept these relationships. One of the reasons may be that their curiosity about their birth parents is satisfied early on in their development.

Adoptions can be arranged in several different ways: through a private adoption agency, by individual county adoption services, by non-profit adoption agencies, or independently (by attorneys, doctors or nurses, or clergy).

Birth mothers and fathers have certain legal rights that differ depending on the type of adoption. Fathers must give permission for adoption; if the father is not available, his parental rights may be terminated, but only after a court hearing. The birth mother must tell the court, agency, or attorney who the child's father is, but she need not tell anyone else (including her parents, her doctor, or the adoptive parents).

In private adoptions (e.g., through an attorney, doctor, or member of the clergy), a birth mother may change her mind up to six months after signing adoption papers, or until the adoption is finalized in court. In an agency adoption, the period is much shorter – after the birth mother and father have signed papers and they have been filed with the state (typically, within a week).

If a pregnant teenager is interested in adoption, refer her to a local adoption resource that meets the needs she has identified.

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Foster and Kinship Care

Foster care places children who cannot be with their birth parents in another home and family. In some cases, the situation is permanent or at least open-ended because the birth parents have harmed or neglected their children. In other cases, foster care provides a temporary solution. At some point in the future, the birth and foster parents plan on reuniting the children with their birth parents.

Kinship care is a variant of foster care in which a relative — a grandparent, aunt, uncle, or other adult — cares for children whose birth parents are temporarily unable to do so. While these arrangements are often informal, they can be put in place more formally through a state's foster care agency.

In some cases, these may be viable solutions worth exploring for pregnant teens.

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Option C:

 Terminating the Pregnancy

 An abortion is a procedure in which a developing fetus is removed or expelled from the woman's uterus. Almost 90% of the 1.3 million abortions that take place annually in the United States occur during the first 12 weeks of a pregnancy.

Access to Abortion Services

 Abortion has been legal in the United States since 1973, when two landmark Supreme Court cases — Dow v. Bolton and Roe v. Wade — were decided. The two Supreme Court decisions state that the decision to have a first-trimester abortion (within the first 14 weeks of a pregnancy) must be left to a woman and her physician. In the second trimester (15-24 weeks), the state can regulate abortion procedures to protect a woman's health. In the third trimester, the state may regulate or restrict abortion, except when necessary for the mother's health.

Because the trimester distinction is important in terms of the availability of abortion services and the type of procedure used, an important first step in counseling a pregnant teenager who is considering an abortion is to find out the date of her last menstrual period.

In the United States, opposition to abortion has made it more difficult for women to obtain abortions. In 1996, 85% of U.S. counties had no abortion provider — a proportion that has increased steadily since the late 1970s. (In rural areas, the figure was 94% of counties.) In 17 states, a mandatory delay or state-directed counseling is required. In 32 states, pregnant women under the age of 18 must obtain parental consent or must notify their parents.8

In states where parental involvement is required, young women have the option of seeking a court order exempting them from notifying their parents, if they can demonstrate to the court that they are mature enough to make an informed decision and that the abortion is in their best interest.

Most abortions are provided in abortion clinics — clinics where at least half the patient visits are for abortions. During the first trimester, the cost of an abortion typically ranges from $300 to $500. (The cost is higher for abortions in the second trimester.) Eighteen states cover the cost of abortions for Medicaid-eligible women, but the federal Medicaid program pays for abortions only in cases of life endangerment, rape, and incest.

If you or your colleagues are counseling young pregnant women about this topic, be sure you know where abortions are available in your area and whether or not your state covers any of the costs through Medicaid.

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Abortion Methods

Surgical Methods

 During the first trimester, the most common method used is vacuum aspiration. In a vacuum aspiration, the cervix is dilated (usually with local anesthesia), and a vacuum curette is introduced into the uterine cavity. Any products of conception are removed from the uterus. This procedure can be done in an office throughout the first trimester (and up to 16 weeks after gestation).

A less common method is called dilation and curettage (D&C). In a D&C, a curette replaces the vacuum and is used to remove any developing tissue from the uterus. It is less commonly used because it requires a larger dilation of the cervix and is associated with more pain and bleeding.

When done in a doctor's office, a first-trimester abortion is considered an extremely safe medical procedure. Possible complications include infection, cervical or uterine trauma, or excessive bleeding. D&Cs are associated with slightly higher risk of uterine or cervical damage than vacuum aspirations.

In second-trimester abortions, the cervix is gradually dilated and a dilation and evacuation (D&E) is performed. A D&E is a combination of the vacuum aspiration and D&C methods described above. Typically, this technique is used between 13 and 16 weeks of gestation. The risks of complications from second-trimester abortions are similar to those for first-trimester abortions, but there is an increased risk of severe complications.

Because of the possibility of complications, it is important that patients undergoing an abortion understand possible warning signs of potential problems, such as fever, chills, aches, pain, cramping, tenderness, discharge, or bleeding.

Medical Abortions

 Medical abortions, as opposed to the surgical ones described above, use combinations of drugs to cause an abortion. Two methods, both used early in pregnancy (within the first nine weeks or sooner), include combining Misoprostol (a prostaglandin) with either Mifepristone (RU-486) or Methotrexate (a drug used to treat ectopic pregnancies, among other things).9

These drug combinations have advantages and disadvantages compared to surgical abortions. Women who have had medical abortions report that these methods can feel more "natural" than invasive surgery — more like a heavy period, for many women. For others, the bleeding, cramping, and nausea caused by the drugs are more severe.

Although surgical abortions are very safe, they do pose a small risk of perforating the uterus or causing infection; medical abortions avoid these particular risks. However, medical abortions have other potential disadvantages. They are 95% effective within the first seven weeks of pregnancy, but are less certain than surgical abortions — especially later in the first trimester. Women who choose a medical abortion must visit their physician several times and may have to wait several weeks before they know whether the drugs have worked.10

A woman contemplating an abortion should know about both surgical and medical options so that she can weigh their advantages and disadvantages herself and make an informed choice.

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Pre-Abortion Counseling

If a teenager wants to end her pregnancy and has rejected the other options — raising the child herself or placing the child in adoption or foster care — it is appropriate to discuss the types of options available to her to end her pregnancy. As noted above, a key factor will be the current length of her pregnancy, as determined by her last menstrual period.

Making the decision to have an abortion is never an easy one. For young women in particular, a number of factors may make the decision even harder. Money and lack of access to health care can play a role. Some young women are in denial, trying to convince themselves that they are not really pregnant. Others may not know the signs of pregnancy, or may not feel many symptoms. Fear — of the reactions of parents, boyfriends, and other relatives — is another common factor. State laws requiring parental consent (or judicial exemption) may add pressure. Some may have religious beliefs that are against abortion — or be part of families where those beliefs are strong.

Because of these factors, it is especially important to explore the pregnant teenager's support system and to confirm that she herself wants to end the pregnancy (i.e., that she is not doing so under pressure or coercion).

After a pre-abortion counseling session, she should understand the types of procedures available to her and how she can access them. She should know what to expect before, during, and after the procedure.

Post-Abortion Counseling

Topics to be covered in a post-abortion counseling session include:

symptoms that may be signs of a post-abortion complication (such as infection or hemorrhage)

future contraceptive plans to avoid another unplanned pregnancy

assessment of the teenager's emotional state and support system

referrals to any needed services

scheduling a post-abortion check-up.

Resources

The American College of Obstetricians and Gynecologists (ACOG) offers a variety of patient education brochures that explain pregnancy, prenatal care, childbirth, and postpartum care. Order them from ACOG's web site (www.acog.org) or resource center (202-863-2518).

The Child Welfare League of America (CWLA) (www.cwla.org) offers manuals for both parents and counselors on managing the grief and loss that can arise with adoptions. The CWLA web site has links to open adoption publications and sites.

The National Council for Adoption (www.ncfa-usa.org) includes information on how to choose an agency or attorney as well as an annual adoption factbook.

The Planned Parenthood National Hotline (1-800-230-PLAN or www.plannedparenthood.org) can connect teenagers to a nearby Planned Parenthood clinic that can offer options counseling and adoption referrals.

The National Resource Center for Foster Care and Permanency Planning is housed at the Hunter College School of Social Work on behalf of the Department of Health and Human Services (DHHS), Administration on Children and Families (ACF). Their web site (www.hunter.cuny.edu/socwork/nrcfcpp) provides links to many resources on foster and kinship care.

For abortion referrals, contact the Planned Parenthood National Hotline (1-800-230-PLAN or www.plannedparenthood.org) or the National Abortion Federation Hotline (1-800-772-9100).

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See the Learning Activity Making Difficult Decisions for a decision-making model and worksheet to help teenagers who are struggling with the decision about how to handle an unplanned pregnancy.1 National Campaign to Prevent Teen Pregnancy. http://teenpregnancy.org

2 Ibid.

3 Kalmuss, D., Namerow, P.B., and Cushman, L.F. Adoption versus parenting among young pregnant women. Family Planning Perspective. 1991. 23(1):17-23.

4 Resnick, M.D., Blum, R.W., Bose, J., Smith, M., and Toogood, R. Characteristics of unmarried adolescent mothers: Determinants of child rearing versus adoption. American Journal of Orthopsychiatry. 1990. 60(4):577-584.

5 Resnick, M.D. Adolescent pregnancy options. Journal of School Health. 1992. 62(7):298-303.

6 Adapted from Planned Parenthood of Connecticut, Inc.

7 Resnick, op. Cit.

8 Henshaw, S.K., Tew, S., and Keating, A. An overview of abortion in the United States. Slides and data prepared by Physicians for Reproductive Choice and Health (PRCH) and the Alan Guttmacher Institute (AGI). 2002.

9 Cates, W.C. And Ellertson, C. Abortion. In: Hatcher, R.A., et al. Contraceptive Technology. New York: Ardent Media, Inc. 1998. 679-700.

10 Ibid.

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Psychoanalysis

by Saul McLeod published 2007

Psychoanalysis was founded by Sigmund Freud (1856-1939).  Freud believed that people could be cured by making conscious their unconscious thoughts and motivations, thus gaining “insight”.

The aim of psychoanalysis therapy is to release repressed emotions and experiences, i.e. make the unconscious conscious. 

Psychoanalysis is commonly used to treat depression and anxiety disorders.

It is only having a cathartic (i.e. healing) experience can the person be helped and "cured".

Psychoanalysis Assumptions

• Psychoanalytic psychologists see psychological problems as rooted in the unconscious mind.
• Manifest symptoms are caused by latent (hidden) disturbances.
• Typical causes include unresolved issues during development or repressed trauma.
• Treatment focuses on bringing the repressed conflict to consciousness, where the client can deal with it.

How can we understand the unconscious mind?

Remember, psychoanalysis is a therapy as well as a Freudian theory.

In psychoanalysis (therapy) Freud would have a patient lie on a couch to relax, and he would sit behind them taking notes while they told him about their dreams and childhood memories.  Psychoanalysis would be a lengthy process, involving many sessions with the psychoanalyst.

Due to the nature of defense mechanisms and the inaccessibility of the deterministic forces operating in the unconscious, psychoanalysis in its classic form is a lengthy process often involving 2 to 5 sessions per week for several years.  This approach assumes that the reduction of symptoms alone is relatively inconsequential as if the underlying conflict is not resolved, more neurotic symptoms will simply be substituted. The analyst typically is a 'blank screen', disclosing very little about themselves in order that the client can use the space in the relationship to work on their unconscious without interference from outside.

The psychoanalyst uses various techniques as encouragement for the client to develop insights into their behavior and the meanings of symptoms, including ink blots, parapraxes, free association, interpretation (including dream analysis), resistance analysis and transference analysis.

1) Rorschach ink blots

The ink blot itself doesn’t mean anything, it’s ambiguous (i.e. unclear).

It is what you “read” into it that is important.

Different people will “see” different things depending on what unconscious connections they make.

Click here to analyze your unconscious mind using ink blots.

The ink blot is known as a projective test as the patient 'projects' information from their unconscious mind to interpret the ink blot.

However, behavioral psychologists such as B.F. Skinner have criticized this method as being subjective and unscientific.

2) Freudian Slips

Unconscious thoughts and feelings can transfer to the conscious mind in the form of parapraxes, popularly known as “Freudian slips” or slips of the tongue. We reveal what is really on our mind by saying something we didn’t mean to.

For example, a nutritionist giving a lecture intended to say “We should always demand the best in bread”, but instead said “bed”. Another example is where a person may call a friend’s new partner by the name of a previous one, whom we liked better.

Freud believed that slips of the tongue provided an insight into the unconscious mind and that there were no accidents, every behavior (including slips of the tongue) was significant (i.e. all behavior is determined).

3) Free Association

A simple technique of psychodynamic therapy is free association in which a patient talks of whatever comes into their mind. This technique involves a therapist reading a list of words (e.g. mother, childhood etc.) and the patient immediately responds with the first word that comes to mind. It is hoped that fragments of repressed memories will emerge in the course of free association.

Free association may not prove useful if the client shows resistance, and is reluctant to say what he or she is thinking. On the other hand, the presence of resistance (e.g. an excessively long pause) often provides a strong clue that the client is getting close to some important repressed idea in his or her thinking, and that further probing by the therapist is called for.

Freud reported that his free associating patients occasionally experienced such an emotionally intense and vivid memory that they almost relived the experience. This is like a "flashback" from a war or a rape experience. Such a stressful memory, so real it feels like it is happening again, is called an abreaction. If such a disturbing memory occurred in therapy or with a supportive friend and one felt better--relieved or cleansed--later, it would be called a catharsis.

Frequently, these intensely emotional experiences provided Freud a valuable insight into the patient's problems.

Applications of Psychoanalysis

Psychoanalysis (along with Rogerian humanistic counseling) is an example of a global therapy (Comer 1995 p 143) which has the aim of helping clients to bring about major change in their whole perspective on life. This rests on the assumption that the current maladaptive perspective is tied to deep-seated personality factors. Global therapies stand in contrast to approaches which focus mainly on a reduction of symptoms, such as cognitive and behavioral approaches, so-called problem-based therapies.

Anxiety disorders such as phobias, panic attacks, obsessive-compulsive disorders and post-traumatic stress disorder are obvious areas where psychoanalysis might be assumed to work. The aim is to assist the client in coming to terms with their own id impulses or to recognize the origin of their current anxiety in childhood relationships that are being relived in adulthood. Svartberg and Stiles (1991) and Prochaska and DiClemente (1984) point out that the evidence for its effectiveness is equivocal.

Salzman (1980) suggests that psychodynamic therapies generally are of little help to clients with specific anxiety disorders such as phobias or OCDs but may be of more help with general anxiety disorders. Salzman (1980) in fact expresses concerns that psychoanalysis may increase the symptoms of OCDs because of the tendency of such clients to be overly concerned with their actions and to ruminate on their plight (Noonan, 1971).

Depression may be treated with a psychoanalytic approach to some extent. Psychoanalysts relate depression back to the loss every child experiences when realizing our separateness from our parents early in childhood. An inability to come to terms with this may leave the person prone to depression or depressive episodes in later life.

Treatment then involves encouraging the client to recall that early experience and to untangle the fixations that have built up around it. Particular care is taken with transference when working with depressed clients due to their overwhelming need to be dependent on others. The aim is for clients to become less dependent and to develop a more functional way of understanding and accepting loss/rejection/change in their lives.

Shapiro et al. (1991) report that psychodynamic therapies have been successful only occasionally.  One reason might be that depressed people may be too inactive or unmotivated to participate in the session. In such cases a more directive, challenging approach might be beneficial. Another reason might be that depressives may expect a quick cure and as psychoanalysis does not offer this, the client may leave or become overly involved in devising strategies to maintain a dependent transference relationship with the analyst.

Critical Evaluation

Fisher and Greenberg (1977), in a review of literature, conclude that psychoanalytic theory cannot be accepted or rejected as a package, 'it is a complete structure consisting of many parts, some of which should be accepted, others rejected and the others at least partially reshaped'.

Fonagy (1981) questions whether attempts to validate Freud's approach through laboratory tests have any validity themselves. Freud's theory questions the very basis of a rationalist, scientific approach and could well be seen as a critique of science, rather than science rejecting psychoanalysis because it is not susceptible to refutation.

The case study method is criticized as it is doubtful that generalizations can be valid since the method is open to many kinds of bias (e.g. Little Hans). However, psychoanalysis is concerned with offering interpretations to the current client, rather than devising abstract dehumanized principles.  Anthony Storr (1987), the well-know psychoanalyst appearing on TV and Radio 4's 'All in the Mind', holds the view that whilst a great many psychoanalysts have a wealth of 'data' at their fingertips from cases, these observations are bound to be contaminated with subjective personal opinion and should not be considered scientific.

Conclusions

· Psychodynamic therapies work well with mild disturbances.

· They are better than no treatment, but not necessarily better than other forms of therapy.

· It is not clear whether the clients that benefit from psychoanalysis would eventually get better anyway.

· Psychoanalysis may speed up the rate at which clients get better.

· The nature of Psychoanalysis creates a power imbalance between therapist and client that could raise ethical issues

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See More About

• psychoanalysis
• sigmund freud
• case studies
• defense mechanisms
• the unconscious mind

Sigmund Freud was the founder of psychoanalysis and the psychodynamic approach to psychology. This school of thought emphasized the influence of the unconscious mind on behavior. Freud believed that the human mind was composed of three elements: the id, the ego, and the superego.
Freud's theories of psychosexual stages, the unconscious, and dream symbolism remain a popular topic among both psychologists and laypersons, despite the fact that his work is viewed with skepticism by many today.
Many of Freud's observations and theories were based on clinical cases and case studies, making his findings difficult to generalize to a larger population. Regardless, Freud's theories changed how we think about the human mind and behavior and left a lasting mark on psychology and culture.
Another theorist associated with psychoanalysis is Erik Erikson. Erikson expanded upon Freud's theories and stressed the importance of growth throughout the lifespan. Erikson's psychosocial stage theory of personality remains influential today in our understanding of human development.

Major Thinkers Associated With Psychoanalysis

• Sigmund Freud
• Anna Freud
• Erik Erikson
• Erich Fromm
• Carl Jung
• Karl Abraham
• Otto Rank
• Sabina Spielrein

Key Psychoanalysis Terms

Case Study - An in-depth study of one person. Much of Freud's work and theories were developed through individual case studies. In a case study, nearly every aspect of the subject's life and history is analyzed to seek patterns and causes for behavior. The hope is that learning gained from studying one case can be generalized to many others. Unfortunately, case studies tend to be highly subjective and it is difficult to generalize results to a larger population.
Conscious - In Freud's psychoanalytic theory of personality, the conscious mind includes everything that is inside of our awareness. This is the aspect of our mental processing that we can think and talk about in a rational way.
Defense Mechanism - A tactic developed by the ego to protect against anxiety. Defense mechanisms are thought to safeguard the mind against feelings and thoughts that are too difficult for the conscious mind to cope with. In some instances, defense mechanisms are thought to keep inappropriate or unwanted thoughts and impulses from entering the conscious mind.
Ego - The ego is the part of personality that mediates the demands of the id, the superego and reality. The ego prevents us from acting on our basic urges (created by the id), but also works to achieve a balance with our moral and idealistic standards (created by the superego).
Id - The personality component made up of unconscious psychic energy that works to satisfy basic urges, needs and desires.
Superego - The component of personality composed of our internalized ideals that we have acquired from our parents and from society. The superego works to suppress the urges of the id and tries to make the ego behave morally rather than realistically.
Unconscious - A reservoir of feelings, thoughts, urges and memories that outside of our conscious awareness. Most of the contents of the unconscious are unacceptable or unpleasant, such as feelings of pain, anxiety or conflict. According to Freud, the unconscious continues to influence our behavior and experiences even though we are unaware of these underlying influences.

Criticisms of Psychoanalysis

• Freud's theories overemphasized the unconscious mind, sex, aggression and childhood experiences.

• Many of the concepts proposed by psychoanalytic theorists are difficult to measure and quantify.

• Most of Freud's ideas were based on case studies and clinical observations rather than empirical, scientific research.

Strengths of Psychoanalysis

• While most psychodynamic theories did not rely on experimental research, the methods and theories of psychoanalytic thinking contributed to experimental psychology.

• Many of the theories of personality developed by psychodynamic thinkers are still influential today, including Erikson's theory of psychosocial stages and Freud's psychosexual stage theory..

• Psychoanalysis opened up a new view on mental illness, suggesting that talking about problems with a professional could help relieve symptoms of psychological distress.

Id, Ego and Superego

by Saul McLeod published 2008

Perhaps Freud's single most enduring and important idea was that the human psyche (personality) has more than one aspect. Freud (1923) saw the psyche structured into three parts (i.e. tripartite), the id, ego and superego, all developing at different stages in our lives.

These are systems, not parts of the brain, or in any way physical.

The id (or it)

The id is the primitive and instinctive component of personality. It consists of all the inherited (i.e. biological) components of personality, including the sex (life) instinct – Eros (which contains the libido), and aggressive (death) instinct - Thanatos.

The id is the impulsive (and unconscious) part of our psyche which responds directly and immediately to the instincts. The personality of the newborn child is all id and only later does it develop ego and super-ego.

The id demands immediate satisfaction and when this happens we experience pleasure, when it is denied we experience ‘unpleasure’ or pain. The id is not affected by reality, logic or the everyday world.

On the contrary, it operates on the pleasure principle (Freud, 1920) which is the idea that every wishful impulse should be satisfied immediately, regardless of the consequences. The id engages in primary process thinking, which is primitive illogical, irrational, and fantasy oriented.

The Ego (or I)

Initially the ego is “that part of the id which has been modified by the direct influence of the external world” (Freud 1923).  The ego develops in order to mediate between the unrealistic id and the external real world. It is the decision making component of personality

Ideally the ego works by reason whereas the id is chaotic and totally unreasonable.  The ego operates according to the reality principle, working our realistic ways of satisfying the id’s demands, often compromising or postponing satisfaction to avoid negative consequences of society. The ego considers social realities and norms, etiquette and rules in deciding how to behave.

Like the id, the ego seeks pleasure and avoids pain but unlike the id the ego is concerned with devising a realistic strategy to obtain pleasure.  Freud made the analogy of the id being the horse while the ego is the rider.  The ego is "like a man on horseback, who has to hold in check the superior strength of the horse"(Freud, 1923, p.15).

Often the ego is weak relative to the head-strong id and the best the ego can do is stay on, pointing the id in the right direction and claiming some credit at the end as if the action were its own.  The ego has no concept of right or wrong; something is good simply if it achieves its end of satisfying without causing harm to itself or to the id. It engages in secondary process thinking, which is rational, realistic, and orientated towards problem solving.

The Superego (or above I)

The superego incorporates the values and morals of society which are learned from one's parents and others. It develops around the age of 3 – 5 during the phallic stage of psychosexual development.

The superego's function is to control the id's impulses, especially those which society forbids, such as sex and aggression. It also has the function of persuading the ego to turn to moralistic goals rather than simply realistic ones and to strive for perfection.

The superego consists of two systems: The conscience and the ideal self. The conscience can punish the ego through causing feelings of guilt.  For example, if the ego gives in to id demands, the superego may make the person feel bad though guilt.

The ideal self (or ego-ideal) is an imaginary picture of how you ought to be, and represents career aspirations, how to treat other people, and how to behavior as a member of society.

Behavior which falls short of the ideal self may be punished by the superego through guilt. The super-ego can also reward us through the ideal self when we behave ‘properly’ by making us feel proud.

If a person’s ideal self is too high a standard, then whatever the person does will represent failure.  The ideal self and conscience are largely determined in childhood from parental values and you were brought up.

References

Freud, S. (1920). Beyond the pleasure principle. SE, 18: 1-64.

Freud, S. (1923). The ego and the id. SE, 19: 1-66