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Training included both classroom work and hands-on visits. The total visit duration for the entire 6-mo follow-up practice with mother-infant pairs in a hospital.

The corresponding mean duration for each home visit was suckling, feel of the breast after feeding , positioning and attachment 29, 30, and 22 min, respectively. Two research assistants, who were different in mo 1 to At the home, data were collected on onset of lacta- thereafter decreased to At 3 mo postpartum, A schedule was considered missed if compared with only At 6 mo, Research in IG1 and Statistical analyses.

The main outcome for the analyses was EBF yes or no. Three EBF variables were used based on whether the child received no food or liquid in 3 time periods: 1 over the previous month, 2 over the 24 h preceding the day of the monthly interview, and 3 over the entire 6-mo period this was deduced from answers to the first 2 variables.

A possible explanation for the high rates of EBF at 6 mo in the intervention groups in the trials in Ghana and Bangladesh 15 is that nonexclusive BF in these settings usually involves feeding of nonmilk-based fluids rather than the milk-based or energy-dense semisolid complementary foods used in Latin America 7.

Indeed, in sub-Saharan Africa and South Asia, a major problem is the late introduction of energy- and nutrient- dense complementary foods before infants are 9 mo old 7.

In this study, findings on intervention effect were very consistent regardless of the EBF definition used. This confirms that either EBF defini- months. Thus the lactation counseling intervention was as- hospitals and clinics in Ghana. This hospital has since This is the first study to demonstrate the effect of lactation been declared Baby Friendly. In the current study, women in and postnatal EBF lactation support provided. This result IG2 were seen within 48 h after delivery and were provided agrees with that of other randomized trials in which EBF rates with the needed BF education and support, which continued were higher when lactation support was provided 12— In through 6 mo postpartum.

In Mexico, the study had BF support within the perinatal period and through 6 mo 2 intervention groups with either 6 or 3 home visits and a postpartum to increase EBF rates. The role of additional pre- control group with no home visit In all 3 studies, initial EBF rates tended to be support.

However, EBF in the control group was Hawthorne effect because we did not include a group that had significantly higher in our study. This is consistent with na- no contact with study personnel during the follow-up period.

One important difference between our groups was due simply to continued contact or the Hawthorne findings and those in Bangladesh 15 compared with those in effect. The reason for this may be related to site differences in in Ghana. It was one that could be conducted easily in the necessarily have previous breast-feeding experience 16 ], the field.

Despite this, it functionally produced balanced groups intensity and timeliness of their visits i. Third, EBF was self-reported; thus we Mexico City had the least number of contacts , the way they cannot rule out the possibility that women in the peer coun- related to and gained the trust of the women, the much seling group may have been influenced by social desirability stronger breast-feeding culture in Ghana and Bangladesh com- bias.

Labbok, M. Institute for Reproductive feeding data. In addition, home interviews were unannounced Health, Washington, DC. Ghana Statistical Service and Macro International Ghana De- ing items or utensils that may indicate that exclusive breast- mographic and Health Survey Macro International, Calverton, MD. On the rare 9.

Institute for occasion when such discrepancies were found, women were Reproductive Health, Washington, DC. Tips are provided for working with their provider to reduce risks and learn about options. Download: Too Many Medications? A standard 8. Download: How's Your Sleep? Know the facts about recommended PTSD treatments to provide the best care to your patients. Veterans Crisis Line: Press 1. Complete Directory. If you are in crisis or having thoughts of suicide, visit VeteransCrisisLine. Visit date.

Visit dates are important since it serves as the baseline information and data of the patient. Address information. To ensure precise claim of the patient, also for sending follow up reports specifically for the patient. Birth date. This is to evaluate if the patient is of legal age to receive certain procedures, and some treatment may vary accordingly to age. Treatment may also vary according to gender of the patient.

Phone number. For followup, scheduling, rescheduling, and cancelling appointments. Demographic data. Also in this part of counselling interview, exploration of the problem is made; strategies and alternatives are sought by the client with the help of the counsellor.

This advance warning enables the counsellee to easily terminate his relationship with the counsellor. Counselling session lasts between minutes.

This however, depends on the nature of the problem. It should be neither too long nor too short. The counsellor prepare client for closure not to close abruptly to leave the client out-hanging e. Make the client understand that it is possible to come back to continue or with new problems. Once the counsellor finds that the counsellee has made sufficient progress to cope with his currently defined problem the interview or series of interviews should be closed.

Advantages of Individual Counselling 1. Free to express feelings 4. Easy to build relationship 2. Assurance of confidentiality 5.

Easy to follow up issues 3. Privacy is maintained 6. Easy for the counsellor to support and work with an individual Disadvantages of Individual Counselling 1.

It may consume a lot of time in dealing with one students 2. Compatibility: i. Clients must have common problem s e. The ideal number of clients should range from members d.

Monopolistic and bullies tendencies should be avoided where one or two individuals tend to grab all the chances of explaining the problem to the counsellor. In group session one hour is an ideal length for the counselling interview process. Psychotics and psychopaths should be removed from the group lest they disrupt the meaningful discussion g.

Members of the group must be mature and mentally sound to be able to talk about and tackle their common problems. Criteria used on group formation i. Age: Closed related age show social maturity of the group member. Size: members for effective participation iii. Sex: boys or girls only or mixed iv. Personality composition type. It is recommended that personality type should be mixed heterogeneous. Duration of session: this varies depending on the age. The Advantages of Group Counselling i.

It is efficient. It saves time when dealing with many students at a time ii. Students get an opportunity to share their experiences. It provides a social interpersonal context in which to work on interpersonal problems. Client learn interpersonal communication skills iv. Gives opportunity to give and receive help v. It stimulates discussions after the counselling session vi. It helps to solve common problems easily Disadvantages of Group Counselling i.

Lack of freedom of expression ii. There exists a lot of disagreement and lack of information iii. Lack of trust which may cause some clients to avoid sharing their feelings, attitudes and values.

It may be difficult to manage the group if the counsellor lacks adequate skills for group counselling. It needs a bigger space vi.

To a certain extent, it lacks confidentiality, so some students may not like it. There is a potential possible for psychological destruction as well as potential psychological growth Methods of Group Counselling Specific methods of group counselling according to Biswalo include: 1.

Brainstorming: A short and clear statement on some real problems is presented to the students clients who get involved in an intensive discussion on the presented problem 2. Case discussion: A specific problem is discussed with the group working as a team 3. Free Group Discussion: the group controls, while the counsellor observes and guides. Role Play and Simulation: students can demonstrate their problems by role-playing and imitating Group counselling goes through four stages, which are involvement, transition, working and termination.

Goals of Group Counselling i. To move towards authenticity and genuineness ii. To find ways of solving personal problems iv. To explain hidden potentials and creativity v. To become sensitive to the needs and feelings of others When not Recommended Group Counselling i. When the client is in the state of personal crisis ii. When confidentiality is essential in protecting the client iii. If a client has unusual fear of public speaking v.

If a client is ineffective in the area interpersonal relationship skills vi. Listening: effective listening e. Being in the Lookout for Feedback: the counsellor should provide descriptive feedback and not evaluative feedback d. Linking: Linking points out the similarities between the experiences of various group members so as to encourage more interaction within the group.

Using progress Skills: Asking group members what is happening or has happened during the session and then commend on the progress. Williamson is the chief exponent. The counsellor assumes the major responsibility of solving the problem.

Counsellor identifies, defines, diagnoses and provides a solution to the problem. Counsellor directs thinking by informing explaining, interpreting and advising. Counsellor-oriented Emphasis is on the problem. The data needed for an adequate understanding of the problem the client is facing. Synthesis - interpreting and organizing data to reveal students assets, liabilities, adjustments etc.

Diagnosis - identifying the nature and cause of the problem. To determine the effectiveness of the counselling given NB: In stages the counselor works without involvement of the client.

The client comes after the prediction stage Merits Time saving and economical Gives happiness to the counselee as he gets a solution to this problem Emphasis is on the intellectual rather than the emotional aspect. Counsellor asks a few questions, so as to think about the solution of the problem. Counselors who advocate eclectic or selective counselling believe that there are strengths and weaknesses in any counseling method. Begins with directive but switches over to non-directive or vice versa as demanded by the situation.

Name the types of counselling with their exponents. Differentiate between Directive and Non-Directive counselling. Why is Eclectic Counselling preferred to Directive and Non-directive counselling? You have received a client with whom you have learned that you can only help by using counselor-centred method. Identify the stages you will need to go through to handle the problem. Each of these theories of counselling generates a set of techniques; a way of working that is consistent with that particular perspective.

Most counselling theories can be classified as psychoanalytic, humanistic, behavioral, cognitive and Family systems Therapy. Classification of Counselling Theories There are several ways of classifying counselling theories.

But in this course we are going to focus on only three major classifications. Directive or Non-Directive If the process is controlled and directed by the counsellor Counsellor- Centred it is directive.

If the process is directed and controlled by the client client-Centred it is non- directive. Insight-oriented or Action-Oriented Insight-Oriented is based on how people learn to change. Do people learn by first understanding their current behaviour then learning to change that behaviour? Action-oriented is based on Practice. Do people learn to change by practising the new behaviour under the guidance of counselor regardless of their past and present understanding of that particular behaviour?

Affective, Cognitive or Behavioural Approaches Affective approach to counselling focuses on the feelings and emotions of the clients. Cognitive approach to counselling focuses on thinking or logical intellectual approach and behavioural approach focuses on the specific behaviours of the client. In this approach there are three major psychoanalytic perspectives; Freudian, Ego Psychology and Object Relations. These perspectives were delivered from the work of Sigmund Freud, the founder of Psychoanalysis Psychoanalysis is the theory of counseling and personality development.

According to this theory counseling is a philosophy of human nature and a method of therapy. Psychoanalysis is the major influence of all other formal systems of counseling. All other theories are extension, modification reaction and borrowed the aspect of it. The theory has the longest history in terms of counseling. The focus of the theory This theory pays attention to unconscious factors related to infantile sexuality in the development of neurosis. The theory based on insight unconscious factors that influence our behavior with the belief that the current behavior of any human being is influenced by the first six 6 years of life.

No negotiation to the environment because it is a biological need. No other component. The Ego: This is the psychological component. It is the part of human nature which attempts reality on the environment. There is a contact with other external aspect.

The ego controls and regulates personality, remaining in touch with reality while formulating plans of action to satisfy needs. Id, Ego and Superego work unconsciously but what we see is the human behaviour when the third part of the superego fail to adjust people into norms or values is when the person use Defense Mechanism.

Defense Mechanisms: are normal behaviours that help an individual to cope with anxiety. Defense mechanisms are physical or psychological coping mechanisms or unconscious behavior patterns that help an individual to maintain a favorable self-concept or avoid harmful event or action. It is a complex interplay of perception; stressful event the psychological meaning attributed to the mind; the physiological responses associated with that meaning. Defense mechanisms are used to protect people themselves psychologically.

Defense mechanisms also operate under unconscious levels. The mind monitors all external and internal environments by employing the use of variety mechanisms or active problem solving devices.

It is shifting impulses from a threatening object to a safer or weaker object. Example 1: When the father is harassed by his boss can direct impulses to the children or wife at home.

Example 2: a man who is angry at his sister, he breaks his drinking glass by throwing it against the wall. People distort reality in order to justify something that has happened. Explaining away to justify a specific behaviour. So it is not a big deal I cheated this time. If I had wanted to try hard, I could have done it too. People refuse to accept or acknowledge anxiety-producing piece of information.

People divert unwanted impulses into socially approved thoughts, feelings or behaviours. Example 1: A person a person with strong feelings of aggression becomes a soldier. Distract attention from the weaknesses. Psychological counterbalancing perceived weaknesses by emphasizing strength in other arenas.

Example 1: Weak in school, excellent in sports, Class clown etc. Use childhood coping mechanisms. People behave as if they were at the earlier stage of development. Ubaya unalipwa kwa wema. Pretending Example 1: Wanting to look good and pretending to yourself that you are one of the movie stars you read about. Example 2: Making up stories about how successful you are, rather than working on your success. Repression: Keep painful thoughts and feelings away from consciousness.

Burying a painful feeling or thought from your awareness through it may resurface in symbolic form. Sometime considered a basis of other defense mechanism. Unacceptable or unpleasant impulses are pushed back into the unconscious. Example 1: A woman is unable to recall that that she was not raped.

Early abuse. You said that they hate you. Why do you think they do so. Silence has several meanings. It is wise to let the client assume responsibility for breaking silence when this silence is client initiated. Generally, this basic insight is still important, despite its reductionism, sexism, obsession with early childhood sexuality and other serious limitations.

A second major contributor to Existential theory is Rollo May who, like Frankl, developed his approach through extreme experience. The motive of the theory is to react against the system of viewing counselling in a well defined principles, techniques or formality. The theory suggests that counselling should be viewed on the basic foundation of human existence i. In other words the theory focuses on the self-determination, the quality of person to person therapeutic relationship.

The stress is on the subjective world of the client. The mandate is on the client. The counsellor should enhance self-awareness because the greater the awareness the more the freedom of choice. Others go to counselling because they have lost the meaning in their life. The counselor should help the client to realize the meaning of life.

I THOU relationship e. The relationship between the client and the counselor is the core factor in existential theory it should be strong to stimulate positive change. Hence counseling is creativity of the counselor. Counseling is not a liturgy. Presence plus respect. Carl Ranson Rogers Rogers developed the theory in as the reaction against psychodynamic and other directive theories the prevailing assumption that the counsellor knows best.

Client-centered therapy emphasizes understanding and caring rather than diagnosis, advice and persuasion. Effective therapist must be genuine, accepting and empathic. In this situation the client will be less anxious and more willing to reveal themselves and their weaknesses Biswalo, , p.

This theory is divided into 4 different phases: 1st Phase Non-directive approach It was known as non-directive approach and it focused on methodology.

In this phase Rogers emphasized that the client knows better; so the counsellor is just the listener. He was against advising, suggesting, persuading, directing, teaching, diagnosing, and interpreting. Rogers, as the father of "client-centered therapy," said that the counselor is to be "nondirective" in the sessions.