Family, Group & Crisis Counselling: Models, Skills & Plans

Core Concepts: Definitions and Frameworks

1. Family Counselling: Systems Theory in Action

Family counselling views problems as interconnected patterns within a family system, not isolated individual issues. The systems theory framework (Bowen, Minuchin) emphasizes:

• Circular causality: Problems arise from feedback loops (e.g., a parent’s criticism → child’s rebellion → parent’s stricter control → child’s withdrawal).
• Homeostasis: Families resist change to maintain balance (e.g., a sick role in a dysfunctional family).
• Boundaries: Enmeshment (over-involvement) vs. disengagement (emotional distance).

graph TD
    A["Parent: Criticizes Child"] -->|"Triggers"| B["Child: Acts Out"]
    B -->|"Escalates"| C["Parent: Punishes Harshly"]
    C -->|"Reinforces"| A

Worked Example: Nepal’s Child Marriage Crisis In a family where the eldest daughter was married off at 16, the parents justified it as "tradition." A counsellor using structural family therapy would:

1. Map the system: Draw a genogram (family tree with emotional patterns).
2. Reframe the problem: "Your daughter’s education is being sacrificed for family ‘honor’—what are the long-term costs?"
3. Shift roles: Encourage the father to advocate for her schooling, disrupting the cycle.

2. Group Counselling: The Power of Peer Support

Group counselling leverages universality (shared experiences), altruism (helping others), and social learning. Key models:

Process Stages of Group Cohesion (Tuckman):

Exam Tip: Groups often stall in Storming—counsellors must normalize conflict and model resolution.

3. Crisis Intervention: The ABC Model

Crisis counselling follows the ABC model (Sundberg et al.):

1. Assess lethality/risk (e.g., suicide ideation).
2. Bridge to safety (e.g., hospital referral).
3. Cope with immediate distress (e.g., grounding techniques).

Real-World Example: Pathao Driver Stress A Pathao driver in Kathmandu, overwhelmed by traffic and customer abuse, might:

• Assess: "Are you planning to quit driving?" (Risk of depression).
• Bridge: Connect to a mental health hotline (e.g., +977-1-4222222).
• Cope: Teach diaphragmatic breathing to reduce road rage.

Comparative Analysis: Family vs. Group Counselling

Specialized Approaches for Crisis and Trauma

1. Existential Approach to Grief Counselling

Used for loss (death, divorce, job loss), this approach focuses on:

• Meaning-making: "How does this loss change your sense of purpose?"
• Death anxiety: Addressing fear of one’s own mortality.
• Isolation: Combating loneliness post-loss.

Worked Example: NEPSE Investor After Market Crash A client who lost savings in the 2020 NEPSE crash might be asked:

• "What story did you tell yourself about money before this?"
• "How might this loss reveal what truly matters to you?"

2. Narrative Therapy for Couples

Helps couples reauthor their stories by:

1. Externalizing the problem: "The conflict isn’t you—it’s the ‘distance’ between you."
2. Unique outcomes: "When did you two last feel close?"
3. Reauthoring: "What’s a new chapter you’d like to write?"

## In the Real World

1. eSewa’s Customer Service Crisis Teams

   • Idea Used: ABC Crisis Model
   • How: During the 2021 fuel shortage, eSewa’s helpline trained agents to:
     • Assess: "Are you feeling hopeless about the queue?"
     • Bridge: Redirect to mental health resources.
     • Cope: Provide stress-relief scripts (e.g., "Breathe in for 4 seconds...").

2. Khalti’s Employee Burnout Groups

   • Idea Used: Task-Centered Group Counselling
   • How: Khalti’s HR runs weekly "Resilience Labs" where employees:
     • Share one stressor and one coping strategy.
     • Use role-play to practice saying "no" to unrealistic deadlines.

3. NTC’s "Yuba Kendra" for Exam Anxiety

   • Idea Used: Psychoeducational Group Counselling
   • How: Students learn:
     • Cognitive restructuring: "This test ≠ my worth."
     • Group study hacks: "Pair with someone who panics less."

## Exam Tip: How to Score Full Marks

1. For Definitions:

   • Psychoeducation vs. Psychosocial First Aid:
     • Psychoeducation: Teaching skills (e.g., "How to manage diabetes").
     • First Aid: Immediate support (e.g., "You’re safe; here’s a blanket").
   • Visualize: Draw a flowchart showing first aid steps (e.g., safety → calm → refer).

2. For Counselling Plans:

   • Structure: Use the SOAP format (Subjective, Objective, Assessment, Plan).

flowchart TD
    A["1. First Aid: Immediate Support"] --> B["2. Safety Check"]
    B --> C["3. Calm the Client"]
    C --> D["4. Refer to Professional"]
    
    E["SOAP Format for Counselling Plans"] --> F["Subjective: Client’s Words"]
    F --> G["Objective: Observed Behaviors"]
    G --> H["Assessment: Problem Analysis"]
    H --> I["Plan: Intervention Strategy"]

• Example: For substance dependence, include:
  • Behavioural approach: Contracts, relapse prevention.
  • Existential twist: "What would sobriety free you to do?"

3. For Comparisons:

   • Use tables (like above) to contrast models (e.g., family vs. group).
   • Memorize: Key terms like "enmeshment", "universality", "ABC model".

4. For Case Studies:

   • Tie to Nepal: Always ground examples in local contexts (e.g., child marriage, traffic police stress, NEPSE volatility).
   • Show, don’t tell: Include a genogram or group seating diagram in your answer.

Final Visual Checklist: ✅ Family: Genogram + circular causality diagram ✅ Group: Cohesion stages + seating arrangement ✅ Crisis: ABC model flowchart ✅ Real World: eSewa/Khalti/NTC examples with labelled diagrams