Τρίτη, 15 Νοεμβρίου 2011
Gianni Kallinikakis (Psychologist)
The family is contained of six members: the husband Nedim (age 51), the wife Suna (age 45), the elder son Mustafa (age 17), Nevrie (age 13), Hassan (age 11) and Figen (age 2). The live in a privately-owned house with a big garden, which is in an area close to the limits of the minority settlement.
Nedim and Suna got married by love 30 years ago. They were a quite affluent couple, as the husband had a steady job as a salesman. They’ve been trying to have a child for over 13 years and when, finally, their first child was born, Suna takes an oath never to have an abortion in her entire life. This decision of hers causes the first serious rupture with Nedim, who wanted to have only two children. The third child’s birth, despite the father’s strong insistence for abortion, leads, according to his sayings, the couple to separate. Because of that, Nedim creates an extramarital relationship with a girl 20 years younger. On the contrary, Suna thinks that they got separated exactly because of the husband’s extramarital relationship.
Suna and the 3 children are forced to live with Suna’s mother and her sister’s family. Suna blames her husband for “killing” her mother and sister, who died almost at the same time, of natural causes.
After a year’s time, the couple will get reconnected because of relative’s exhortations but also because of serious financial problems. Suna did not have a job and the husband owed a large amount of money in an insurance office
Furthermore, the husband also had to deal with serious health problems which gave him no option but to stop working. By the time the fourth child is born, Hasan (who was 9 then) develops, for the first time, crisis of Epilepsy which demand constant medical care and hospitalization to Pediatric Hospital Units from time to time.
By the time the Interference began, Nedim’s behaviour towards Suna was brutal while use of force and fighting has become daily routine. The crisis now affects every side of their family life. The elder son, unable to cope with the whole situation, decides to move to Athens and live with his uncle’s family (his father’s brother).
Suna is now the family’s cornerstone as her husband spends his days lying in the couch, unable to to work or offer any other kind of help to the family. Furthermore, he became addicted to the tranquilizers his doctors had prescribed him during his illness.
The second child has also gave up school while the third one has developed many difficulties to the learning process and his attendance at school has become sporadic.
From all the above it becomes clear that when the Intervention started, the family was experiencing a devastating change in their daily routine because of the husband’s condition (loss of the ability to offer, an important reduce of the family’s income, often brutal outbursts) and the third child’s illness (epilepsy). The most significant characteristics of this crisis were the intense feeling of control loss and the uncertainty as far as the future was concerned. Moreover, there was the mother’s deep melancholy and her intense anxiety for quite a long period of time (more than 5 weeks).
The particular Consultative Intervention model emphasises to Here and Now. It uses techniques, has structure and the intervention has short-range duration. The consultative relationship is considered to be cooperative.
The particular Model’s Principles:
The 5-point consultative approach
· Biological Background
· Thoughts ( the way of thinking)
According to this Intervention model, the 5 points that have been made above interact, while none of them can be considered to be more important than another.
However, in cases like this, stress is laid on feelings. This is because it is of great importance that both we and the service users of this Consultative Intervention recognize our and their feelings. In this way the service users would understand through this knowledge, develop and implement more suitable ways of dealing with their difficult situations in their life. Scanning and evaluating the way of thinking, but also changing the thoughts which are considered to be des-functional through certain procedures is also of high significance. Generally speaking, people in situations of Crisis are found to develop a way of thinking which is considered to be des-functional. They actually get brainwashed by thoughts of extra or complete severity that have as main element a destructive content. (An Example of such a way of Thinking is presented below).
Every session was strongly structured and this was very important for the process.
The main stage:
During the intervention process, 21 sessions took place, once a week and with 50’ duration each. The place where the sessions fulfilled was either the family’s residence or the settlement’s health care centre. We had asked the permission to use the place in order to offer individuate or group support to citizens and to organize social work and recreation groups with children.
Language of communication was Greek (a translator was not needed).
The members of the family were informed for the Model of Consultative Intervention in great detail and by using many examples.
The session’s structure is an element of great significance, in the case of the 5 points counseling intervention which is based on the principles of the cognitive approach and the theoretical statements of the behavioral Psychology. This is the reason why every gathering followed the structure below:
· Defining each session’s points for discussion (Agenda)
· Last week’s incidents (weekly items), a review of the last week’s incidents and feedback of the general topics of the previous session.
· Analyzing the most important daily points (Day’s topics): emphasis is given to current difficulties and to how these can be generalized and affect to the future. Also, emphasis is given to development and implementation of strategies in order to handle difficulties. Preparation of the Priorities list.
· Defining main points with which the couple will deal with, in the middle time among the sessions. Also determining strategies that will be followed, (for example: meeting with Hassan’s teacher, or reduse of violent behavior between the members of the family in order to define if the absence of the violence influent to the reduce (decrease) of the symptoms of the child).
· Feedback about the understanding of what’s been told during the session.
The initial request:
Hassan was referred by his teacher. Both Hassan’s mother and his teacher were worried that his frequent epilepsy crises were a burden to his school attendance. They wanted the child to be examined by a psychologist who could testify if it can de pressed to go to school whether due to the symptoms, it could be allowed not to have a regular attendance.
General tasks of the intervention:
The intervention’s tasks were defined with the cooperation and the agreement of the counselors and the service users.
1.Hassan should attend school regularly and his participation to the courses should be more active and creative.
2.The conflicts of every kind in the system of the family should be reduced.
Life events (Main problems)
Husband’s and third child’s health condition
Lack of husband’s capacity to work
Family’s financial condition was terrible, recourses shortage
Husband presented violent outbursts and he was often in conflict with his wife
The third child’s health condition aggravated
New and more powerful conflicts of every kind, in the system of the family
Example of father’s catastrophic way of thinking (catastrophic content):
· “I have no money and I believe nothing will change in the future, things are getting worse”.
· “I can’t help neither my self nor my children”
· “I am a useless human being both as a husband but also as a father”.
It is obvious that when the way of thinking is dominated by so absolute thoughts, what follows are negatives feelings such as sadness and guilt that cause anger and high tensed anxiety.
As organic symptoms, the father has developed often headaches, appetite reduction and stomachache.
As far as the Behavior level is concerned we can point out: worries, easy fatigue, difficulties at sleep (insomnia). Also he tends to deal with lone activities which do not demand the development of special abilities. There is a decreased interest for social gatherings (Most of the time he preferred to stay laid down on the couch and have a blanket all over him).
Consequences: Thoughts related to general demerit and lack of trust towards himself. Remotion to his wife and children. Arrangements to sell his truck and give-up from every professional activity. Alienation from his friends and relatives and tendencies for isolation for long periods of time. Absence of plans for the future.
These consequences lead to vicious circles and empowers even more his already bad mental condition but also the already existing family’s morbid condition.
It is obvious that the mother developed almost the same Behavior, with few differences related to her personality but also her role in the family (as a system).
The intervention was mainly based on the principle of the counselor’s neutrality. By the term neutrality, it is meant that the emphasis of the intervention was not to examine who or which member of the family was responsible for the crisis situation. On the contrary the counselor tends to keep similar distances with each family member.
· This counseling attitude significantly assisted to the father’s involvement in the process
· To developing the mother’s trust in the counseling process and to see the counselors as a professional that could help her and her children.
· It was also an encouragement process for Hassan who was considered as a “normal” boy. He was encouraged to act like anybody else in his age and his epilepsy crises any more but his persistent school attendance and participation in the recreational and social work groups organized by the project.
The approach towards Hassan could be named as a “de- pathologization” and “de-medicalization” process.
By this it is not meant that he had no medical treatment. On the contrary the family was encouraged to have more regular contacts with the Children’s Hospitals and the pedo - neurologists. (in Komotini, Alexandropolis and Athens). The counseling intervention team (doth the Psychologist and the Social worker), kept close contacts with Hassan’s curing doctors.
The reason why those three Hospitals involved was partly due to the mother’s anxiety whether Hassan’s crises could lead him to die. The General Hospital in Komotini did not have a pedo- neurologist department. However, whenever Hassan had an epilepsy crisis he was taken as an emergency case to the local General Hospital. Some regular blood tests which were needed were done in the Alexandropolis University Hospital but for the specific exams he was examined twice a year by the Doctor’s team in the Pediatrician Athenian University Hospital.
Through the counseling intervention one of the aims was to persuade the mother and the father that they should keep strongly the appointments they have with the Athenian doctors in the university Hospital and they should only visit other doctors in the case of emergency.
Another important element of the counseling intervention was the “dealing” with the family system every day needs and assisting them with practical issues. This was done with the co- operation of the Social worker. This part of the intervention significantly influenced the father’s development of trust to the team of counselors and he got involved in the counseling process.
Consequences related to the intervention’s process and outcomes
1. At the case of this family the nature and principles of the Counseling Model seemed to have had a great impact despite the variation and range of difficulties it faced. More specifically, we consider that focusing on here and now, the joint making of decisions with the service users, honesty and clarity of the intervention method were the most significant advantages along the process of building trust and the necessary Consultative relationship with the service users.
2. Framing the session helped to establish and delimitate the Counseling relationship. It has also encouraged the focus on the service users effort to achieve the tasks they had set up at the first stages of the Counseling procedure. According to the mother: “What we discuss about with you is much different to what we discuss with our relatives and on the other hand, it is a relief just talking to you”. The husband agrees with her: “No other (specialist) had never talked to us or even tried to listen to us so that we have a chance to explain what we need or want. Everyone just prescribed medicine”.
3. Many elements of the mother’s character have assisted the empowerment and encouragement of the other members of the family in order to achieve harmony and develop some kind of unity according to the particular characteristics of this method of intervention. Besides, she developed co-operative skills and became motivated to introduce change.
4. The professional team’s Inter-disciplinary character was also of major importance. It offered a holistic perspective of the situation and allowed a multi – level intervention to the family. This assisted not only to a better understanding of the family’s situation but it also led to more appropriate strategy designing of solving problems.
The good co-operation between the professionals and the fact that they were one male and one female working together became arole model for the couple in their attempt to resolve conflicts.
5. Furthermore, the Social Worker’s knowledge and her guiding assistance to networking and appropriate use of resources, but also her mediating skills, significantly contributed to solving practical issues. She was very successful into making the appropriate use of resources and welfare benefits, a fact that increased the family’s trust and their motivation to the counseling intervention.
6. Note: The intervention was mainly based on the principle of the counselor’s neutrality. This principal attitude significantly assisted to the father’s involvement in the process and to developing the mother’s basic trust in the counseling process and to see the counselors as a professional and not as a friend.
When, what was called the intervention period lasting for 21 weeks was over, a post- intervention (follow up) period started. This lasted for a six months period, through which there were meetings scheduled once a month. The wife during that period appeared to be feeling strong to take decision about her life. The couple decided to get a “friendly” divorce. This decision was accepted by the husband without particular objections. Today Suna lives with her children in a new house that she rents, and works as a cleaner with a satisfactory income. The father lives alone by an allowance he receives on a disability benefit and his children visit him whenever they wish. The elderly son has come back to live with his mother and his brothers and works as a painter. The elder daughter also works on a part time job, and Hassan has very good marks at school and a regular attendance.