MARITAL COUNSELLING:

INTRODUCTION:
Differences and conflicts are a part and parcel of married life, be it a love or an arranged marriage. However, if it
reaches a stage where the couple is finding it hard to cope, it can strain and even break the relationship.
Therefore, it’s important to deal with issues before it assumes alarming proportions. Marital counseling helps
address these issues, and along the way it can provide direction for the couple to better cope with conflict. A
couple must consider marital counseling when it becomes difficult for them to resolve differences among
themselves.

DEFINITION:
Marital counseling, also called couples therapy, is a type of psychotherapy. Marital counseling helps couples of all
types recognize and resolve conflicts and improve relationships. Through marital counseling, you can make
thoughtful decisions about rebuilding your relationship or going your separate ways.

Marriage counseling is generally provided by licensed therapists known as marriage and family therapists. These
therapists provide the same mental health services as other therapists, but with a specific focus- a couple’s
relationship.

PURPOSE OF MARITAL COUNSELING:

A couple must consider marital counseling when it becomes difficult for them to resolve differences among
themselves. Having tried earnestly, it’s better to consult a marital counselor rather than delay it and strain the
relationship further.

Marital counseling can be used to address many specific issues, including:

1. Communication problems
2. Sexual difficulties
3. Conflicts about child rearing or blended families
4. Substance abuse
5. Financial problems
6. Anger
7. Infidelity
8. Divorce
9. Physical or mental conditions
10. Same-sex relationship issues
11. Cultural clashes
12. Unemployment
13. Infertility
14. Changes roles, such as retirement
15. Domestic violence

PROCESS:
For the first several sessions, the therapist will attempt to evaluate the relationship. She will try to figure out.

1. What keeps you together

2. What stresses your relationship
 3. The nature of your conflicts
4. Behavior and communication patterns
5. Your strengths and weaknesses
6. The power structure
7. What qualities are missing or dysfunctional in your relationship

She/he also will study the partners as individuals. Together, they will set realistic goals, which could be anything
from learning how to be empathetic to figuring out new ways to negotiate problems to decide how to share
household and parental responsibilities.

1. Changes the views of the relationship: Throughout the therapeutic process, the therapist attempts to
help both partners to see the relationship in a more objective manner. They learn to stop the “blame
game” and instead look at what happens to them as a process involving each partner. They also can
benefit from seeing that their relationship takes place in a certain context. For example, couples who
struggle financially will be under different kinds of situational stresses those who are not.
2. Modifies dysfunctional behavior: Effective couples therapists attempt to change the way that the
partners actually behave with each other. This means that in addition to helping them improve their
interactions, therapists also need to ensure that their clients are not engaging in actions that can cause
physical, psychological, or economic harm.
3. Decrease emotional evidence: couples who avoid expressing their private feelings put themselves at
greater risk of becoming emotionally distant and hence grow apart. Effective couples’s therapist’s help
their clients bring out the emotions and thoughts that they fear expressing to the other person.
Attachment- based couples therapy allows the partners to feel less afraid of expressing their needs for
closeness. According to this view, some partners who failed to develop “secure” emotional attachments in
childhood have unmet needs that they carry over into their adult relationships. They fear showing their
partners how much they need them because they are afraid that their partners will reject them.
4. Improves communication: Building on previous principles, this communication should not be abusive, nor
should partners ridicule each other when they do express their true feelings. Couples may, therefore,
require coaching to learn how to listen more actively and empathetically.
5. Promotes strengths: Effective couples therapists point out the strength in the relationship and build
resilience particularly as therapy nears a close. Because so much of couples’s therapy involves focusing on
problem areas, it’s easy to lose sight of the other areas in which couples function effectively. The point of
promoting strengths is to help the couple derive more enjoyment out of their relationship.

ADVANTAGES OF MARITAL COUNSELING:

1. One can learn how to resolve conflict in a healthy manner. In marital counseling you will learn
communication skills that will help you not only listen to your spouses but, to also process what your
spouse is saying.
2. Stating needs clearly and openly without resentment or anger.
3. Learning how to be assertive without being offensive. Both spouses need to be able to talk about their
issues without fear of hurting the other spouse.
4. Learn that one can get what they need without having to make demands and engage in conflict.
5. Learning to process and work through unresolved issues.
6. Marital counseling offers a safe environment for expressing any unhappiness feelings. Greeting your
feelings out into the open with the help of a trained professional may be all you need.
7. Developing a deeper understanding of who your spouse is and what his/her needs are.
GENETIC COUNSELING:

DEFINITION:

It is a process of communication and education that addresses concerns relating to the development and/or
transmission of a hereditary disorder.

Genetic counseling is the process of helping people understand and adapt to the medical, psychological and
familial implications of genetic contributions to the disease. The process integrates the interpretation of family
and medical histories to assess the chance of disease occurrence or recurrence, education about inheritance,
testing, management, prevention, resources and research and counseling to promote informed choices and
adaptation to the risk or condition (NSGC, 2005)

PURPOSE:

 To make the client understand about the medical diagnosis and I’s implications in terms of prognosis and
possible treatment.
 The mode of inheritance of the disorder and the risk of developing and /or transmission it
 The choices or options available for dealing with the risks.

STEPS OF GENETIC COUNSELING:

1. Establishing diagnosis
2. Risk assessment
3. Communication
4. Discussion of options
5. Long-term contact and support

Establishing diagnosis
 Most crucial step
 It includes taking a history, carrying out an examination and undertaking appropriate investigations.
 A genetic nurse counselor can obtain a detailed family history , present/past history, obstetric history
including still births and any exposure to teratogens.
 Chromosome and molecular studies as well as referral on to specialist in other fields will yield an
appropriate diagnosis.
 A 3 generation pedigree diagram withy their age, sex, and state of health.

Calculating and presenting the risk

 Quantification-the numerical value of a risk: calculating and communicating recurrence risk may be
straightforward if pedigree is clear, even if the precise diagnosis is not. Quantifying of risk can be either in
odds or percentage.
 E.g.: a risk of 1 in 4 for autosomal recessive disease can be presented as an odds ratio of 3 to ] against or
numerically as 25%;that is each pregnancy carries the same risk
 Qualification-nature of a risk: studies shown that the numerical value is a less important factor than the
nature or burden of health issues associated with the diagnosis
 Other factors such as whether the problem is associated with pain and suffering, and whether there was
experience of bullying in childhood, may all be relevant to decision making
 Placing risks in context: a genetic counseling clinic should be provided with information that enables them
to put the risk in context so as to be able to decide for themselves whether it is high or low.
Communication and support

 The ability to communicate is essential in genetic counseling and is a two-way process.

 Apart from providing information, the counselor should seek to be receptive to patient’s fears and
aspirations, expressed or unexpressed.
 The information should be presented clear, sympathetic, and appropriate manner, with cultural sensitivity

THE COUNSELING INVOLVES FACTORS SUCH AS:

 Psychology of the patient

 The emotional stress under prevailing circumstances
 Attitude of family members towards the patient
 Educational social, and financial background ¢ Gaining confidence in subsequent meetings during follow
up
 Ethical ,moral and legal implications involved in the process
 Questions should be answered openly and honestly
 Good listening skills are vital to the consultation
 Counseling session may be intense and the information may be overwhelming, so additional written
materials can be given

Above all, communication skills to transmit facts in an effective manner i.e.; making them more acceptable and
palatable.

TYPES OF GENETIC COUNSELING

1. Prospective Genetic Counseling
2. Retrospective Genetic Counseling

1. Prospective Genetic Counseling

This allows for the true prevention of disease.
This requires identifying heterozygous individuals for any particular defect by screening
Explaining to them the risk of their having an affected child if they marry another heterozygote of the
same gene e.g.; sickle cell anemia, thalassemia

2. Retrospective genetic counseling

Most genetic counseling at present is retrospective .The methods which could be suggested under
retrospective genetic counseling are
 Contraception
 Pregnancy termination
 Sterilization

AREAS OF GENETIC COUNSELLING

 Prenatal genetic counseling

 Pediatrics genetic counseling
 Adult genetic counseling
 Cancer genetic counseling

 1. Prenatal genetic counseling
Prenatal genetic counseling is offered to woman who are pregnant and at risk of having a child with
chromosomal/genetic abnormalities. Adequate information must be provided to a mother before,
during and after any screening and diagnostic tests.

2. Paediatric counseling
Families or paediatricians seek genetic counseling when a child has features of an inherited condition.
Any child who is born with more than one defect, mental retardation or dysmorphic features has an
increased chance of having a genetic syndrome.

3. Adult counseling
Adult may seek genetic counseling when a person in the family is decided to be tested for the
presence of a known genetic condition, when an adult begins exhibiting symptoms of an inherited
condition, or when there is a new diagnosis of someone with an adult onset disorder in the family. In
addition, the birth of a child with obvious features of a genetic disease leads to diagnosis of a parent
who is more mildly affected.

4. Cancer genetic counseling

A family history of early onset of breast, ovarian, colon cancer in multiple generations of a family is a
common reason a person would seek a genetic counselor who works with people who have cancer. A
genetic counselor is able to discuss the chances that the cancer in the family is related to a dominantly
inherited gene.

Psychological and Ethical Aspects of Genetic Counseling:

 Cultural and religious considerations
 Economics consideration
 Effects on family functioning
 Informed consent

Role of Nurse in Genetic Counseling

 Guiding a woman or a couple through prenatal diagnosis
 Helping parents make decision in regard to abnormal prenatal diagnostic results
 Assisting parents who have a child with a birth defect to locate needed services and supports
 Coordinative services of other professionals, such as social workers, physical and occupational therapist,
psychologist and dietician.

Reference:
1. Townsend M. Psychiatric Mnetal Health Nursing. 8th edition. Jaypee Publishers.Page no. 188-194
2. Nayak R. Rai Sharda. Gupta. A Textbook of pathology and Genetics for Nurses. Jaypee Publishers. Page
no. 368-371