टू-वे एनोवा: एक परिचय

परिभाषा 

    टू-वे एनोवा, जिसे दो कारक एनोवा के रूप में भी जाना जाता है, एक सांख्यिकीय तकनीक है जिसका उपयोग निरंतर (Continuous) निर्भर चर (Independent variables) पर दो श्रेणीबद्ध स्वतंत्र चर (Categorical independent variable) के प्रभाव का विश्लेषण करने के लिए किया जाता है। यह वन-वे  एनोवा के सिद्धांतों को उन स्थितियों तक विस्तारित करता है जहां परिणाम को प्रभावित करने वाले दो स्वतंत्र चर या कारक होते हैं।

कारक: टू-वे एनोवा में, दो कारकों या स्वतंत्र चर का अध्ययन किया जाता है। ये कारक विभिन्न उपचारों, स्थितियों या स्तरों का प्रतिनिधित्व कर सकते हैं जिनका किसी प्रयोग में प्रतिभागियों या विषयों को सामना करना पड़ता है।

मुख्य प्रभाव (main effect): टू-वे एनोवा दो मुख्य प्रभावों का आकलन करता है: आश्रित चर पर एक कारक का प्रभाव जबकि दूसरे कारक की अनदेखी करना, और इसके विपरीत। उदाहरण के लिए, यदि एक कारक आहार का प्रकार है और दूसरा व्यायाम का स्तर है, तो मुख्य प्रभाव यह आकलन करेगा कि प्रत्येक कारक व्यक्तिगत रूप से वजन घटाने को कैसे प्रभावित करता है।

इंटरेक्शन प्रभाव (interaction effect): मुख्य प्रभावों के अलावा, टू-वे एनोवा इंटरेक्शन प्रभाव का भी मूल्यांकन करता है, जो यह पता लगाता है कि क्या एक कारक का प्रभाव दूसरे कारक के स्तर पर निर्भर करता है। इस अंतःक्रिया (interaction) से पता चलता है कि आश्रित चर पर दो कारकों का संयुक्त या सम्मिलित प्रभाव है या नहीं। उदाहरण के लिए, दवा की प्रभावशीलता पर एक अध्ययन में, यदि दवा की प्रतिक्रिया रोगी के आयु समूह के आधार पर भिन्न होती है, तो अंतःक्रियात्मक प्रभाव दिखाई देगा।

मान्यताएं/धारणाएँ (Assumptions): अन्य पैरामीट्रिक सांख्यिकीय परीक्षणों (parametric statistical tests) की तरह, टू-वे एनोवा कुछ मान्यताओं पर निर्भर करता है, जिसमें डेटा की सामान्यता (normality of data), समूहों में भिन्नताओं की एकरूपता (homogeneity of variances across groups) और प्रदत्तों की स्वतंत्रता (independence of observations) शामिल होती है। इन मान्यताओं का उल्लंघन परिणामों की वैधता (Validity) को सार्थक रूप से  प्रभावित कर सकता है।

परिकल्पना (hypothesis): टू-वे एनोवा में शून्य परिकल्पना (Null hypothesis) बताती है कि दो कारकों के विभिन्न स्तरों या उनकी परस्पर क्रिया में आश्रित चर के साधनों में कोई महत्वपूर्ण अंतर नहीं है। वैकल्पिक परिकल्पना (alternative hypothesis) से पता चलता है कि इनमें से कम से कम एक साधन दूसरों से काफी भिन्न है।

स्वतंत्रता की डिग्री (degree of freedom): टू-वे एनोवा में स्वतंत्रता की डिग्री को प्रत्येक कारक के लिए स्वतंत्रता की डिग्री, उनकी अंतःक्रिया (interaction) और स्वतंत्रता की अवशिष्ट डिग्री (residual degree of freedom) का प्रतिनिधित्व करने वाले घटकों में विभाजित किया गया है।

वर्गों का योग (Sum of squares): टू-वे एनोवा में वर्गों के कुल योग को प्रत्येक कारक, उनकी परस्पर क्रिया और अवशिष्ट भिन्नता (residual variation) के कारण भिन्नता का प्रतिनिधित्व करने वाले घटकों में विभाजित किया गया है। वर्ग मानों (values of sum of squares) के इन योग का उपयोग एफ-सांख्यिकी (F-statistics) की गणना के लिए किया जाता है।

एफ-टेस्ट (F-Test): एफ-सांख्यिकी की गणना कारकों के माध्य वर्ग (mean square) या उनकी परस्पर क्रिया (interaction) को अवशेषों के माध्य वर्ग (residual mean sum of squares) से विभाजित करके की जाती है। यह एफ-परीक्षण यह निर्धारित करता है कि समूह के साधनों के बीच देखे गए अंतर सांख्यिकीय रूप से महत्वपूर्ण हैं या केवल संयोग के कारण हैं।

पोस्ट-हॉक टेस्ट (Post-hoc test): यदि समग्र एफ-परीक्षण महत्वपूर्ण परिणामों को इंगित करता है, तो Tucky's Honestly Significantly Different (एचएसडी) या बोनफेरोनी परीक्षणों जैसे पोस्ट-हॉक परीक्षण यह पहचानने के लिए किए जा सकते हैं कि कौन से विशिष्ट समूह एक-दूसरे से काफी भिन्न हैं।

व्याख्या: दो-तरफ़ा एनोवा परिणामों की व्याख्या में मुख्य प्रभावों और अंतःक्रिया प्रभावों के महत्व का आकलन करना शामिल होता है। इसमें यह समझना होता है कि प्रत्येक कारक स्वतंत्र रूप से आश्रित चर को कैसे प्रभावित करता है और जब कारक परस्पर क्रिया करते हैं तो क्या कोई संयुक्त प्रभाव होता है।

अनुप्रयोग: मनोविज्ञान, जीव विज्ञान, अर्थशास्त्र और समाजशास्त्र सहित विभिन्न क्षेत्रों में प्रयोगात्मक और अवलोकन अनुसंधान में टू-वे एनोवा का व्यापक रूप से उपयोग किया जाता है। यह शोधकर्ताओं को एक साथ दो कारकों के प्रभाव पर विचार करते हुए कई समूहों के बीच साधनों की तुलना करने की अनुमति देता है, जो जटिल संबंधों में मूल्यवान अंतर्दृष्टि प्रदान करता है।

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Two-Way ANOVA: An introduction

 Definition 

    Two-Way ANOVA, also known as Two-Factor ANOVA, is a statistical technique used to analyze the influence of two categorical independent variables on a continuous dependent variable. It extends the principles of one-way ANOVA to situations where there are two independent variables or factors affecting the outcome.

Important Paradigms of Two-Way ANOVA

1.    Factors - In Two-Way ANOVA, there are two factors or independent variables being studied. These factors can represent different treatments, conditions, or levels that participants or subjects are exposed to in an experiment.

2.    Main Effects - Two-Way ANOVA assesses two main effects: the effect of one factor on the dependent variable while ignoring the other factor, and vice versa. For example, if one factor is the type of diet and the other is the level of exercise, the main effects would assess how each factor individually affects weight loss.

3.    Interaction Effect - In addition to main effects, Two-Way ANOVA evaluates the interaction effect, which examines whether the effect of one factor depends on the level of the other factor. This interaction reveals whether there is a combined or joint effect of the two factors on the dependent variable. For instance, in a study on medication effectiveness, the interaction effect would show if the response to medication varies depending on the patient's age group.

4.    Assumptions - Like other parametric statistical tests, Two-Way ANOVA relies on certain assumptions, including the normality of the data, homogeneity of variances across groups, and independence of observations. Violations of these assumptions may affect the validity of the results.

5.    Hypotheses - The null hypothesis in Two-Way ANOVA states that there are no significant differences in the means of the dependent variable across the different levels of the two factors or their interaction. The alternative hypothesis suggests that at least one of these means differs significantly from the others.

6.    Degrees of Freedom - Degrees of freedom in Two-Way ANOVA are partitioned into components representing the degrees of freedom for each factor, their interaction, and the residual degrees of freedom, which reflect the variability not accounted for by the factors.

7.    Sum of Squares - The total sum of squares in Two-Way ANOVA is partitioned into components representing the variation due to each factor, their interaction, and the residual variation. These sum of squares values are used to calculate the F-statistic.

8.    F-Test - The F-statistic is computed by dividing the mean square of the factors or their interaction by the mean square of the residuals. This F-test determines whether the observed differences among group means are statistically significant or simply due to chance.

9.    Post-Hoc Tests - If the overall F-test indicates significant results, post-hoc tests such as Tukey's Honestly Significant Difference (HSD) or Bonferroni tests can be performed to identify which specific groups differ significantly from each other.

10.    Interpretation - The interpretation of Two-Way ANOVA results involves assessing the significance of main effects and interaction effects. It entails understanding how each factor independently influences the dependent variable and whether there is a combined effect when factors interact.

11.    Applications - Two-Way ANOVA is widely used in experimental and observational research across various fields, including psychology, biology, economics, and sociology. It allows researchers to compare means among multiple groups while considering the influence of two factors simultaneously, providing valuable insights into complex relationships.

References:

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Counseling with special cases: HIV/AIDS & Terminal Illnesses

What is HIV / AIDS/Terminal Illness Counselling? 

            HIV/AIDS and terminal illness counselling is an active process of communication and dialogue between a trained counsellor and the client who presents with problems related to HIV/AIDS or is terminally and in a view to assist the client to deal with these problems adequately and appropriately.

Broad Aims of HIV/AIDS Counselling

1.         Prevention of HIV transmission

Ø  Determining whether the lifestyle of an individual places him or her at risk

Ø  Working with an individual so that he or she understands the risks

Ø  Helping to identify the meanings of high risk behaviour

Ø  Helping to define the true potential for behaviour change

Ø  Working with the individual to achieve and sustain behaviour change

2.         Providing support to those affected directly and indirectly by HIV.

Ø  Individual, relationship, and family counselling to prevent and reduce psychological morbidity associated with HIV infection and disease

Terminal Illness

            Terminal illness is used to describe patients with advanced disease and a drastically reduced lifespan, with perhaps months or weeks to live. Inevitably the range and

The severity of physical symptoms will have increased, and will be having a profound effect on how the patient lives his life.

Different Psychological Responses to an HIV Positive Test Result.

Ø  Shock - Recognition of mortality, loss of hope for the future etc.

Ø  Fear and anxiety - Lifelong medication and treatment/treatment failure, isolation and abandonment and social/sexual rejection, infecting others and being infected by them, partner’s reaction etc.

Ø  Depression - Adjustment to living with a chronic viral condition, absence of a cure, limits imposed by possible ill health, social, occupational, and sexual rejection if treatment fails etc.

Ø  Anger and frustration - Adopt to new and involuntary health/lifestyle restrictions, incorporating demanding drug regimens, and possible side effects.

Ø  Guilt is the result of interpreting HIV as a punishment - for example, for being engaged in unprotected sex, using drugs, and anxiety caused to the partner/family.

Best Strategy to Deal with the Prevention of the Spread of HIV/AIDS

Behaviour modification

Counselling Suggestions to Counsellor of HIV/AIDs Patients

1.         Counsellors should have deep knowledge of HIV/AIDS (What it is, ways and means of spread, psycho-physio-socio consequences of HIV infection and other relevant information.

2.         Identify the cause of HIV/AIDS through intensive and humane interaction with the patient.

3.         Identify the present stage [Asymptomatic, Symptomatic and End stage] in which the patient is.

4.         Counsellor should clear all misconceptions to the patient’s family members in the patient’s presence.

5.         Open all communication channels with patients regarding their conditions, and provide honest, factual information about them.

6.         Facilitate the expression of important emotions and help patients learn to manage these emotions under the present circumstances.

7.         Initiate quality interaction between patients and other significant people, such as family, friends, and medical staff.

8.         If possible, apply biofeedback and self-hypnosis, which help control the distressing emotions of the patient.

9.         Family therapy is one of the best tools for HIV/AIDS, and terminally ill patients; it helps family members adjust to the changes that the progression of a loved one’s illness has on the family structure and dynamics. Hence, the counsellor is advised to apply it.

10.       The counsellor should allow ventilation of various feelings such as fear, anger, despair etc.

 

What counsellor should know?

It is an organic fact that AIDS cannot be cured; the counsellor should share coping strategies such as learning to live with the morbidity, adding quality to life, extensive participation in discussion programs with HIV-infected people, leaning towards spirituality, engaging in family and social networks, use of technology to learn something new daily, use of alternative therapies, strengthening self-control, self-suggestions through constructive monologue, taking an active part in awareness campaigns, sharing ordeal with fellow beings and narrative therapy, i.e. diary writing.

Counselling Paradigms for Different Stages

Ø  Asymptomatic stage - At this stage, the counsellor must remember to treat the patient on food and nutrition, support, and treatment with antiretroviral drugs prevention of onward transmission.

Ø  Symptomatic stage - At this stage, the counsellor must remember to help the patient with the HIV-related management of nutritional effects; treatment of HIV related infections, medical care and psychological support.

Ø  End of the life stage - In this stage, the counsellor’s role is critical because the counsellor also helps the patient and the family. As the patient and family are under depression and grief. The counsellor should make the patient emotionally intense for the truth (death) and prepare him for death by which he/she not only enables the family to accept the fact of life and help the patient live the remaining life to the fullest.

Common Interventions

1.         Help the client to learn healthy communication and conflict resolution strategies (If you can solve a problem, Why worry? Strategy).

2.         Reduction of intensity and frequency of expectations.

3.         Identification of self-worth, focus on growth, celebrate the success of growth, and move on.

4.         Reframing perception (for example, taking failure as an opportunity) helps in enhanced self-esteem and core motivation.

 

Different HIV Counselling Programs and Services

ü  Counselling before the test is done

ü  Counselling after the test for those who are HIV positive and HIV negative

ü  Risk reduction assessment to help prevent transmission

ü  Counselling after a diagnosis of HIV disease has been made

ü  Family and relationship counselling

ü  Bereavement counselling

ü  Telephone “hotline” counselling

ü  Outreach counselling

ü  Crisis intervention

ü  Structured psychological support for those affected by HIV

ü  Support groups

 

 

  

Counseling with special cases: Physical and Sexual Abuse

Physical and Sexual Abuse 

Physical abuse - It means any act or conduct which is of such a nature as to cause bodily pain, harm, or danger to life, limb, or health or impair the health or development of the aggrieved person and includes assault, criminal intimidation and criminal force. It includes verbal and emotional abuse which includes: -

(a) insults, ridicule, humiliation, name calling and insults or ridicule specially with regard to not having a child or a male child; and

(b) repeated threats to cause physical pain to any person in whom the aggrieved person is interested.

Sexual abuse - It includes any conduct of a sexual nature that abuses, humiliates, degrades or otherwise violates the dignity of a woman.

 

Consequences of Physical and Sexual Abuse Clients

1.         Occurrence of emotional and behavioural issues relating to anxiety and depression.

2.         Genital injuries and frequent urinary tract infections.

3.         Increased risk of drug and alcohol abuse.

4.         Trauma has a long-term detrimental effect on the brain and heart.

5.         Increased risk of eating disorders, sexual dysfunction, self-harming, suicidal ideation and severe preoccupation with physical appearance.

6.         Flashbacks, guilt and nightmares.

7.         Survivors become very expressive (anger, sadness), disoriented (disbelief, denial), or controlled (distant, calm).

 

Counselling Physical and Sexual Abuse Clients

            Counselling with special cases, such as physical and sexual abuse, is a challenging experience. Counsellors who work with these populations must be well-trained and experienced in trauma-informed care. They must be able to create a safe and supportive environment for their clients, and they must be able to help their clients process their experiences and develop coping mechanisms.

 

Assessment Prior to Psychological Interventions

It is important to obtain a detailed history and assessment of the child, including information on family and school context, developmental level and functionality, emotional and behavioural issues (pre- and post-sexual abuse), circumstances of the alleged abuse, the child's experience and understanding of the abuse and other related problems.

 

Objective of Assessment

The objective of the Psychosocial and Mental Health Assessment is to establish that abuse has occurred and to know the nature of abuse, i.e., contact versus non-contact, penetrative versus non-penetrative abuse with a view to making decisions regarding medical interventions, as well as posttraumatic stress disorder (PTSD) interventions, as necessary.

 

Introduction and rapport building

            During this phase, it is imperative for counsellors to maintain a high level of empathy to create an environment of acceptance and comfort. Many survivors of sexual assault struggle with feelings of shame, guilt, embarrassment and defectiveness, and have a decreased level of trust in others who are outside their identified support systems.

1.         Greet the client and tell him/her your name and then, ask his/her name

2.         Engage in neutral conversation few minutes for example what did you eat in the morning today? How did you come here today? Who are these people who have come with you?

3.         Introduce the space and the purpose of the client being there, including your role.

4.         Explain the need for a video camera/microphone (in case you are using such equipment) – “As you can see, we have a video camera and microphones here. They will record our conversation so I can remember everything you tell me. Sometimes, I forget things and the recorder allows me to listen to you without having to write everything down.” (In case you are taking notes, you may provide a similar explanation to the client).

5.         Encourage clients to provide detailed responses early in the interview as this enhances their descriptive responses to open-ended prompts in other parts of the interview, particularly those related to the abuse incident. [It is very important that you tell me everything you remember about things that have happened to you. You can tell me both good things and bad things].

 

Abuse Enquiry

Now shift to substantive issues to enable the client to provide you with the narrative by using open questions such as:

“Now that I know a little about you, I want to talk about why (you are here) today”

“I heard you talked to “X” about something that happened – tell me what happened”

“I see you have (a bruise, a broken arm, etc.,) – tell me what happened”

“I heard you saw (the doctor, a policeman, etc.) last week – tell me how come/what you talked about”

“I understand someone might have troubled you – tell me what happened”

“I understand someone may have done something that wasn’t right – tell me what happened”

“I understand something may have happened at (location) – tell me what happened”

 

Psychological Interventions (Counselling)

Cognitive Interventions 

1.         Identify thought patterns that lead to self-deprecating perceptions and triggering responses. Some of the cognitive distortions that clients commonly reported are “I am damaged”; “I will never be the same”; “I should have done something different”; “Nothing good ever happens to me.”

2.         Work toward positive and realistic reframes while continuing to focus on developing coping skills.

3.         Ask them to keenly observe their thought pattern and remain aware of it as long as you can.

4.         Once awareness is practiced, then encourage the client to begin with slight modifications in their thought patterns. The modification of thought patterns should not be sudden rather it should be gradual. Sudden modification is likely to relapse.

5.         Finally, ask the client to remain focused on her new thought process. Engage yourself in it more often, combine it with relaxation therapies [explain some relaxation therapies] and remain self-motivated.

 

Psychological Interventions (Counselling)

1.         Gestalt interventions – These are primarily focused on bodily sensations and re-experiencing physiological reactions. For this focus, encourage clients to practice body scanning on a regular basis but especially when experiencing more intense emotional reactions. The purpose is to have clients become better acquainted with specific aspects of their emotional functioning and the associated feelings linked to their bodies. This intervention allows in-the-moment understanding of how certain emotions manifest physiologically and encourages increased awareness of clients’ specific responses to emotions in triggering conditions.

2.         Trauma narrative - Encourage survivors of sexual assault to begin writing out their trauma narratives, which occurs in session. Retelling their stories has been empirically proven to decrease the severity of the trauma response. It also allows clients to apply new meaning to their experiences and incorporate new and positive self-views and language. A client may feel hesitant to write about painful experiences and consequently store them. Ask her/him to write but if you don't like it then tear it away. 

3.         Art-based therapy – In this intervention technique the survivor is encouraged to draw whatever you feel like to draw using different colours. At the outset, the survivor may face cognitive resistance to do this but gradually she/he may take up the job. This helps in the identification of survivors thought process and perception. This can technique can also be used during the assessment process. Art provides psychological ducts for expressing without narrating. It helps in freeing the survivor from the guilt of confession.

 

Common Interventions

1.         Help the client to learn healthy communication and conflict resolution strategies (If you can solve a problem, Why worry? Strategy).

2.         Reduction of intensity and frequency of expectations.

3.         Identification of self-worth, focus on growth, celebrate the success of growth, and move on.

4.         Reframing perception (for example, taking failure as an opportunity) helps in enhanced self-esteem and core motivation.

 

 

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Counseling with special cases: Domestic violence

What is domestic Violence (DV)? 

            Domestic violence also known as relationship abuse, intimate partner violence, domestic abuse, or battering is the willful intimidation, physical assault, battery, sexual assault, and/or other abusive behaviour as part of a systematic pattern of power and control perpetrated by one intimate partner against another. It includes physical violence, sexual violence, psychological violence, and emotional abuse. It is often accompanied by emotionally abusive and controlling behaviour.

            Domestic violence can also include abuse by other members of the household, including parents, siblings, relatives, or roommates

            ‘Domestic violence is not simply an argument. It is a pattern of coercive controls that one person exercises over another. Abusers use physical and sexual violence, threats, emotional insults and economic deprivation as a way to dominate their victims and get their way’ (WHO, 2007).

Introduction: Domestic Violence?

    “Violence against women is a manifestation of historically unequal power relations between men and women, which have led to domination over and discrimination against women by men and to the prevention of the full advancement of women…” states the United Nations Declaration on the elimination of Violence against Women, General Assembly Resolution, December 1993.

    Domestic violence is a family problem affecting individuals in every community, regardless of age, economic status, sexual orientation, gender, race, religion, or nationality. It can result in physical injury, psychological trauma, and in severe cases, even death.

Counselling of Domestic Violence Victims?

            Counselling is an important part of the healing process for people who have been affected by domestic violence. Counsellors provide support, guidance, and help to clients to develop coping mechanisms. They help clients to understand the dynamics of domestic violence and to make decisions about their future.

         Counselling for domestic violence individual is a typical task. It involves lots of patience, understanding, empathy and the type, intensity and severity of domestic violence. The counsellor should have sound knowledge of legal issues involved the domestic violence.

            There are many different types of counselling available for domestic violence survivors. Some counsellors specialize in working with women, while others work with men. Some counsellors focus on individual counselling, while others offer group counselling or family counselling.

Domestic Violence Counselling Process

1.       Assessment - The first step in the counselling process is to assess the client's needs. This includes gathering information about the client's history of domestic violence, their current situation, and their goals for counselling.

2.         Safety planning - Once the client's needs have been assessed, the counsellor will work with the client to develop a safety plan. This plan will outline steps that the client can take to protect themselves from their abuser.

3.      Emotional support and validation - The counsellor will provide the client with support and guidance throughout the counselling process. This support can take many forms, such as providing emotional support, helping the client to develop coping mechanisms, and helping the client to make decisions about their future. They help clients process their emotions, such as fear, guilt, shame, and anger, and work towards rebuilding self-esteem and self-worth.

4.         Psycho-education - The counsellor will also provide the client with education about domestic violence. This education can help the client to understand the dynamics of domestic violence and to develop a better understanding of their own situation.

5.         Coping strategies and empowerment - Counsellors assist clients in developing healthy coping strategies to manage the emotional and psychological impact of the abuse. This may include teaching relaxation techniques, stress management strategies, assertiveness training, and boundary-setting skills. Empowerment is emphasized to help clients regain control over their lives and make informed decisions about their future.

6.     Referrals - If the client needs additional services, the counsellor will refer them to other resources, such as legal aid, housing assistance, or job training.

7.    Follow-up and aftercare - The counselling process typically involves regular sessions, and counsellors may conduct follow-up assessments to monitor progress and adjust the treatment plan if needed. Aftercare support is essential to ensure that clients continue to receive the necessary assistance and have access to ongoing support even after the counselling process concludes.

Therapies for Domestic Violence Counselling

According to Dr. Sullivan

1.         Individual counselling - It addresses a person’s unique needs and on one to one settings. It recognizes that not everyone experiences abuse in the same way, that the impact of abuse differs among individuals, and what individuals need to move forward also varies.

2.         Support group Counselling – This therapy focus on the shared experiences domestic violence victims the knowledge that victim is not alone provides a cognitive comfort. The shared understanding and sense of universality among a group of peers can promote well-being.

3.       Universal therapies such as yoga, meditation, and mindfulness.

4.      Creative arts therapies that involve artistic modes of expression such as music, visual art, drama, dance, writing, poetry, or play.

5.    Helping to overcome PTSD through empowerment (HOPE), a form of therapy that aims to empower survivors who have developed PTSD due to domestic violence.

6.         Eye movement desensitisation and reprocessing (EMDR)

and core motivation.

7.         Help the client to learn healthy communication and conflict resolution strategies (If you can solve a problem, Why worry? Strategy).

8.         Reduction of intensity and frequency of expectations.

9.         Identification of self-worth, focus on growth, celebrate the success of growth, and move on.

10.     Reframing perception (for example, taking failure as an opportunity) helps in enhanced self-esteem and core motivation.

Probable Outcomes of Domestic Violence Counselling

• 1. Counselling helps in processing the trauma of domestic violence and to begin to heal.
• 2. Counselling helps in understanding the dynamics of domestic violence and to develop coping mechanisms.
• 3.    Counselling helps in making decisions about the future, such as whether or not to leave the abuser.
• 4.    Counselling helps in connecting with other survivors and to feel less alone.
• 5.    Counselling provides a platform to realign the life with mainstream.

 

 

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Counseling with special cases: Substance abuse

 Substance Abuse 

            Substance abuse is defined as the categories classified in the Diagnostic and Statistical Manual V (DSM-V) as Substance-Related Disorders and Substance-Induced Disorders. These disorders include the active use and/or dependency on any mood-altering substance. Substances include alcohol, sedatives, amphetamines, cannabis, cocaine, hallucinogens, inhalants, opioids, caffeine, nicotine, and prescription drugs, as well as legal drugs.

Substance Abuse Counselling

            The trained professional provides psychological support to clients who abused the substances to the level where they are labelled as drug addicts. Substance abuse counsellors are also known as addiction counsellors. They are trained in human behaviour, chemical dependency and therapeutic methods and play the role of a change agent. This class of psychologists focus their attention on the psychological and emotional issues that influence substance use disorder. Counsellors of clients with substance abuse problems often find the counselling process difficult because of the chronic nature of interrelated destructive attitudes and coexisting disorders these clients often bring to counselling.

 

Definition

            Substance abuse counselling is a combination of treatment and support to help people break free from drug or alcohol addiction. This specific type of therapy is often a key part of rehabilitation programs so clients can overcome substance dependence mentally and emotionally.

Counsellors are expected to be aware of the following dimensions prior to engaging in substance abuse counselling: -

1. The available referral options
2. Withdrawal symptoms associated with a specific type of substance
3. Cultural settings
4. Intensity and frequency of substance abuse
5. Clients in treatment for substance abuse may act rebelliously or violently and resort to physical assault on the counsellor

Process Factors of Substance Abuse Counselling

These factors include:

Ø  the counsellor’s establishing an open, trusting, collaborative relationship,

Ø  facilitating client cognitive learning through reframing,

Ø  feedback, insight, and

Ø  assisting the client in behaviour changes through behavioural regulation, reality testing, and successful experiences.

What Counsellors can do?

1.         The counsellors are required to create and maintain a safe environment in which clients can explore and address issues.

2.         Counsellors should communicate and enforce ground rules about how clients can safely and appropriately deal with anger and other feelings of discomfort. Ground rules are: -

ü  maintaining members' confidentiality and not sharing any information outside the group,

ü  no threats or acts of violence,

ü  no verbal abuse,

ü  no interrupting other members, and

ü  no disruptive behaviour.

3.         Counselors can help clients learn how to express their feelings constructively by validating their affect but not their expression.

4.         The counsellor should ask clients to explore rather than act out anger or disruptive behaviour.

5.         The counsellor should categorically inform the disruptive clients that their feelings are acceptable as long as their behaviour remains appropriate.

6.         Clients are allowed to have angry feelings--and verbally express them-but they are not allowed to hit anyone, throw things etc. In this way, clients can be helped to separate their feelings from their actions

7.         Counsellors should remember that constant rage can be a symptom of manic depression or bipolar disorder.

8.         The counsellor must take care to avoid joining in the client's disruptive behaviour in any way. 

9.         The counsellor's role is to help clients understand their vulnerability to re-victimization and to empower clients.

10.       If a counsellor cannot work with a particular client, he should refer the client to a counsellor who is better suited to that individual's needs. 

 

Some Important Therapeutic Strategies Used by Addiction Counsellors

1.         Cognitive Behavioral Therapy (CBT) - A type of therapy used to treat a wide range of mental health conditions and identify the specific behaviour and mindsets that may contribute to addiction.

2.         Dialectical Behavioral Therapy (DBT) - this is a subset of CBT that aims to help people evaluate their inner feelings and thoughts, accept and tolerate change and practice mindfulness.

3.         Interpersonal Therapy - commonly used to treat dysthymia and depression, this therapy focuses on improving communication with others and oneself.

4.         Family Therapy - family can be a huge source of support and care for someone struggling with substance use disorder. Family therapy may be especially useful for those with co-occurring disorders, as it balances therapeutic practices with familial care.

5.         Eye Movement Desensitization and Reprocessing (EMDR) - EMDR helps clients recover from traumatic experiences that result in symptoms and distress. Utilizing “dual stimulation” exercises to discuss past trauma while simultaneously engaging other parts of the brain through bilateral eye movements, tones, or taps, EMDR helps heal the brain’s information processing system and promotes emotional stability and symptom reduction.

6.         Rational Emotive Behavior Therapy (REBT) - REBT helps clients identify, challenge, and replace their destructive thoughts and convictions with healthier, adaptive thoughts.

 

 

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Counseling for the specially-abled and health impairments

 Specially Abled: Meaning-cum-Definition 

            "Specially abled" is a term used to describe individuals with physical, intellectual, or developmental disabilities or impairments that may affect their mobility, sensory perception, communication, or cognitive functioning. The term "specially abled" is often used instead of "disabled" or "handicapped" to highlight the unique abilities and strengths of individuals with disabilities, rather than focusing solely on their limitations. It means that someone has different capabilities from the average person. It’s an umbrella term and can be used to describe a wide spectrum of disabilities.

Health Impairments: Meaning-cum-Definition.

            "Health impairments" refer to a range of medical conditions that can impact an individual's physical, mental, or emotional health, and may limit their ability to carry out daily activities. For example, chronic illnesses such as diabetes, heart disease, or cancer, as well as mental health conditions such as depression, anxiety, or schizophrenia etc.

            Health impairments also include physical disabilities such as mobility impairments, hearing or vision loss, or chronic pain conditions.

Points to remember for the Counsellor.

1.         Avoid language that “pities” people with disabilities.

2.         Always use non-offensive language.

3.         People learn in many different ways, and people have many different abilities.

4.         Remain calm, quiet and have lots of patience.

5.         Be an active and genuine listener.

6.         Be mindful of general counselling principles.          

Strategies for Counselling

1. Build trust - The trusting relationship with the client is important in dealing with a chronic or serious medical condition. Building trust requires active listening, empathy, and validation of their experiences.
2. Focus on strengths - Encourage clients to identify their strengths, talents, and coping strategies, even in the face of health challenges. This can help them feel more empowered and confident in their ability to manage their health.
3. Address emotions - Health impairments can trigger a range of negative emotions, such as anxiety, depression, anger, or grief. Acknowledge and address these emotions carefully.
4. Family and Friends – Train family and friends, if possible, to have empathy rather than sympathy. Ask them to promote inclusiveness, give responsibilities include in family and friend discussions, desist from giving special treatment and listen to her/him.
5. Encourage self-care - Encourage clients to prioritize self-care, such as eating well, exercising, getting enough rest, and managing stress. Provide practical tips and resources to support their self-care efforts.
6. Active collaboration with medical professionals - A collaborative action with medical professionals involved in the client's care, such as physicians, nurses, or social workers ensure a speedy recovery.
7. Flexible and accommodative approach - Health impairments can often impact the client's ability to attend counselling sessions, so be flexible in scheduling and providing alternative options for sessions, such as phone or online counselling.
8. Family and Friends – Train family and friends, if possible, to have empathy rather than sympathy. Ask them to promote inclusiveness, give responsibilities, include in family and friend discussions, desist from giving special treatment and listen to her/him.

Real Life Strategies

1.         Engage or suggest the child in traditional recreational play and games, in psychological jargon this technique is known as play therapy. Play and games promote all the domains of development. For example, fine motor and gross motor skills, visual-motor coordination, kinesthetic and tactile skills are essentially exercised in play, thus ensuring their promotion and development.

2.         Artwork – Art is excellent communication tool. Helps in expression of thought, feelings, perception and reaction to the environment. Drawings are used for current psychological functioning and for expressing present concerns and conflicts.

Some of the art themes

Ø  Draw yourself and your family doing something you enjoy doing together.

Ø  Draw a picture of your most important festival.

Ø  Draw your picture when you play.

Ø  Draw your picture at school. What do you like about school?

Ø  Draw a picture of what you want to be when you grow up.

3.         Use of specific forms of punishment paradigms such as ‘time-out’ and ‘response-cost’. These paradigms are more often used for suppressing undesired or problem behaviours. For example, in ‘time-out’, whenever the child throws a temper tantrum, he is removed from the company where he throws his tantrum and sent into a room where he is isolated for a brief period of 5–10 minutes. Or whenever an aggressive child hits people, he loses his privileges (such as chocolates), which he has earned through good behaviour as the ‘response cost’.

4.         Counsellor must carefully assess whether to address the situation or the child. It has been observed that slight modification in the situation is sufficient to evoke desired results.

5.         Reassurance, encouragement, and genuine praise help restore faith in the Self and strengthen internal motivation.

6.         Share the strategies which allow the individual to focus on strengths rather than weaknesses. One of the best strategies is to transform weakness into strength.

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