COMMUNITY COUNSELING & CONSULTING:Community Counseling

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Theory and Practice of Counseling - PSY632

Lesson 43

COMMUNITY COUNSELING & CONSULTING

Background

· The emergence of both communities counseling and consulting came as a result of the final report

of the Joint Commission on Mental Illness and Health in 1961 and Community Mental Health

Centers Act of 1963. As a result of the mental health center legislation, helping professionals were

encouraged to move toward more developmental and preventive interventions and away from

remedial interventions. Major changes proposed by the legislation included the construction of

2,000 community mental health centers and the gradual reduction and elimination of the

overcrowded state mental hospitals.

· The Commission on Mental Health developed a formula that encompassed most mental health

efforts:

Organic factors + Stress

Incidence =

Coping skills + Self-esteem + Support groups

The incidence of mental disorders in an individual is equivalent to the presence of difficult life

circumstances over available resources and strengths. Problems occur whenever the numerator is

greater than the denominator. Effective efforts to alter factors in the numerator or denominator

alter incidence at the other side of the equation. This is rooted in the public health tradition in

which incidence of a physical disease is reduced either by increasing the resistance of the host

(strengthening the factors in the denominator) or by reducing or eliminating the noxious agent

(reducing factors in the numerator).

Community Counseling

Community counseling is a multifaceted approach combining direct and indirect services to help

community members live more effectively and to prevent the problems most frequently faced by

those who use the services.

Their interventions are aimed primarily at populations who are most in need of mental health

services and usually most excluded from receiving them, such as ethnic minorities and the poor and

elderly. Community counselors' strategies reach out to the community and include:

Identifying and working with groups who are at risk for certain problems such as substance

abuse; poor health; physical, emotional, and learning disabilities; poverty; and emotional and

physical abuse in order to reduce their incidence.

They also attempt to empower and increase the amount of coping skills of their target

populations through:

Education

Client advocacy

Political involvement such as influencing policy makers.

Different Forms of community counseling

The following are some of the ways counselors work to meet the mental health needs of the community:

Substance Abuse Counseling

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Gerontological Counseling

Health Counseling

Rehabilitation Counseling

Crises/and Disaster Counseling

Client Advocacy

Substance Abuse Counseling

Substance abuse includes the abuse of all drugs, including alcohol. The definition even includes foods

such as sugar when the foods are used to alter a person's mood or psychological state, usually for the

purpose of avoiding dealing with difficult situations.

Interventions:

Detoxification and medical treatment

In many cases the problem may be so severe that detoxification is necessary, preferably under

medical supervision. Medication may also need to be provided as part of a treatment plan.

Group and family counseling approaches

In most cases of substance abuse, medical treatment alone is not sufficient; generally many types of

counseling services are offered. These services include group and family counseling, both of which

may be extremely important in helping a person decide to change an undesirable behavior pattern

and then to maintain the new behavior. Groups like psychodrama and marathon sessions are quite

popular. The group leader establishes rules, screens and prepares members for admission, educates

clients about drugs, and tries to ensure that the group norms are followed. The support of the

group allows for individual resolution to give up alcohol or other drugs.

Supplemented by support groups

For the best results, counseling is usually supplemented by support groups, such as Alcoholics

Anonymous or Overeaters Anonymous, to help maintain the desired behavior for life. Exercise and

relaxation programs are often prescribed to improve physical well-being and establish positive

addictions

An area of specialization related to substance abuse counseling is working with the adult children of

alcoholics (ACOAs). Alcohol abuse causes problems for the abusers and their immediate families

and also for the adult children of the abusers regardless of whether they drink themselves. Having

been part of a dysfunctional family has left the ACOAs with deficiencies in coping and in

relationship skills that have a significant impact on their personal and emotional development.

Counseling processes include working with grief and shame and helping clients learn to accept

themselves, express their needs, and have fun without guilt.

Methods

· Interventions might include instructional lectures, discussions, deep analytic explorations, hypnosis,

and confrontation.

Substance abuse counselors often participate in specialized programs and in some cases can receive

special certification as drug and alcohol abuse counselors.

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Gerontological Counseling

Another area of growth in the counseling field is gerontological counseling, the counseling of older

citizens. In a survey of counseling education in USA, Daniel and Weikel (1983) found that the

primary trend identified was an increase in gerontological counseling as a specialty.

This movement toward working more with the older members of society was highlighted in 1988,

when the Association for Adult Development and Aging (AADA) became a division of ACA.

In 1900, life expectancy was 49 years; today it is 76 in USA and in 60s in Pakistan. Schlosberg

(1995) pointed out that the life expectancy is expected to continue to inch up slowly and in the next

20 to 30 years we will probably see more people between 100 and 110 years of age. This is more

likely in the developed countries because of the developments rapidly taking place in the medical

field. With the increasing number of people living longer, there has been a corresponding increase

in interest in working with the aged in a variety of settings, such as community centers, retirement

centers, nursing homes, and hospice programs.

Health Counseling

Another major speciality area for trained counselors is health counseling. "Health counseling uses

the skills of the counselor to help clients make the kind of lifestyle changes that enhance their

physical health" (Lewis et al., 1993).

Rejecting the medical model that focuses on the diagnosis and treatment of disease, Thoreson and

Eagleston (1985) prescribe an educational model that emphasizes training people to think, make

decisions, and solve problems. These skills are considered necessary for the ongoing prevention of

disease and the maintenance of wellness. Such an approach requires an educated, informed public.

Skilled counselors may be employed in a variety to settings to work with health-related issues of

men, women, and children of all racial and ethnic groups to ensure that these skills are learned. This

area includes the concept of wholistic counseling, an approach that looks at the total person and

works to integrate the physical, psychological, and spiritual dimensions of a person's life.

Uses and Techniques?

Health professionals work with current cases and strive to prevent future occurrences through

encouraging community education, starting AIDS support groups, establishing hotlines, and

counseling AIDS' victims and their families. Research into a number of areas has produced results

indicating that some chronic diseases are not as inevitable as once feared. These diseases include

lung cancer, heart disease, and adult-onset diabetes.

Rehabilitation Counseling

Rehabilitation counselors are specialists who help clients with disabilities overcome deficits in their

skills. Disabilities can manifest themselves in many different ways. Even though a major objective

of a rehabilitation counselor is to help a client learn to cope with specific mental or physical

disability, such as deafness, the full goal is wholistic in nature: to help the client become fully

functioning in all areas in spite of any disability or limitation.

Uses:

In addition to its applicability to clients with physical disabilities such as blindness or loss of a leg,

rehabilitation counseling is necessary for prisoners after release from prison, for psychiatric patients

after release from mental hospitals, and for people with developmental disabilities. Much substance

abuse counseling might be considered rehabilitative. People who have lost their jobs after many

years of employment also need to go through a rehabilitative process. Many companies and unions

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have established counseling programs for workers who have lost their jobs as a result of plant

closings or downsizing.

In USA, certification as a certified rehabilitation counselor (CRC) can be attained through the

American Rehabilitation Counseling Association (ARCA), a division of ACA.

Crises/and Disaster Counseling

Many counselors have responded to events that devastate communities, such as storms, floods,

fires, earthquakes, and riots.

On a smaller scale, counselors regularly become involved in local crises, such as working with the

victims of a school bus accident or of a shooting at a fast food restaurant. Crisis intervention

research shows that if interventions are made quickly by helping professionals when these events

occur, those affected will recover quickly.

One fast intervention of psychological first aid is critical incident stress management (CISM). It was

originally developed in USA to treat public service workers exposed to extreme levels of trauma.

Currently it has found widespread application in a variety of settings for treating anyone exposed to

natural or manmade disasters.

Client Advocacy

Often counselors engage in client advocacy for those who do not have the awareness or resources

themselves or who are disenfranchised, such as rape and child abuse victims, oppressed minorities,

neglected elderly populations, and homeless persons, such as rape and child abuse victims,

oppressed minorities, neglected elderly populations, and homeless persons.

Consultation

Consultation involves one person (the client) who has a problem with a person, group,

organization, or community but lacks the knowledge or skill for its solution and who turns to

another (the consultant), a specialist who has the requisite ability to aid in the problem's solution.

The consultant's goals are to help consultees deal with their current work problems and to provide

information or teach skills that help them to deal effectively with similar problems in the future.

Types of Consultation

Client-Centered Case Consultation

In client-centered or clinical consultation, a referral is made to a specialist who provides direct service

to the client. The service may be in the form of an examination and diagnosis with recommendations

for treatment, or the specialist may take over full responsibility for subsequent treatment of the client.

For example, a counselor may refer a client to a psychiatrist for a medical evaluation and the possible

need for drug therapy.

Consultee-Centered Case Consultation

In consultee-centered case consultation, the consultant works with the consultee's difficulties in dealing

with a particular client or groups of clients. The consultant may work to resolve a specific problem that

the consultee is having with a client, expand the consultee's overall skill in dealing with a particular type

of client, or improve the consultee's skills in general. In each instance, the focus of the consultant is on

the consultee's work and would rarely, if ever, involve firsthand service to a primary client. Because the

consullee is directly involved, there is a distinct advantage in this approach. Consultees may learn

information and skills that will allow them to work effectively with similar clients in the future without

the help of consultants. The consultant's roles include being an educator and a facilitator, for example, a

counselor working with a teacher on classroom management skills is a consultant.

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Program-Centered Administrative Consultation

In program-centered consultation, the focus is on working with a specific program or organizational

structure and not on the consultee's difficulties with the program or structure. For instance, a

consultant might be employed to make recommendations to a college counseling center that is

contemplating making programmatic changes. Professionals performing this type of consultation are

often referred to as organizational consultants and are concerned with organizational development

(OD).

Consultee-Centered Administrative Consultation

In consultee-centered administrative consultation, the consultee's difficulties in working with a program

or organization form the primary objective; the various components of the program or organization are

secondary. For example, a consultant might work directly with an administrator on leadership or

management skills.

Consulting Skills in Business & Industry

Human Resource Development (HRD)

HRD consists of a process by which the employees of an organization are helped, in a continuous,

planned way, to acquire or sharpen capabilities required to perform various functions associated with

their present or expected future roles.

Career Development Programs

Business organizations do not deliberately remain static, and working from within an HRD framework,

employees are not expected to either. Career development has been defined as a process of human

development that involves self-investigation, learning, information gathering, decision making and

change on the part of the individual. The basic philosophy of providing for career planning is based on

the belief that employees who arc working satisfactorily within their career goals and expectations are

more likely to be productive. A few developmental programs are as under:

Training and Education

Training includes making assessment of employee's needs as far as knowledge and skills are required.

This objective can be achieved by providing instructional material and conducting training sessions.

Organizational development (OD)

OD specialist works to maintain a psychological climate within the company that is conducive to

high productivity. Experts help organization to deal absenteeism, low production, or interpersonal

conflicts.

Employee assisted programs (EAPs)

To help employees who may have personal difficulties that could be interfering with their

productivity on the job. Personal difficulties could include money, marriage, or substance abuse.

The recent focus of employee assistance has shifted from intervention to prevention.

Quality of work-life programs

Focus on making the place in which employees spend 40 hours or so a week a generally positive

and attractive environment; experts work on improving physical conditions, plan recreational

facilities, fringe benefit packages, health and medical benefits, to help develop the sense of

belonging, and loyalty to the company, that in the long run benefits all.

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