Idefine counseling as the process of assisting people to overcome obstacles in their personal growth and in their interpersonal relationships.1 It helps clear away such obstacles so that one’s personal potential can be developed and realistic life goals achieved. Since the efficacy of counseling has been proven, it has become an important aspect of family doctors’ work.2 Doctors must assist patients and family members as they suffer from illnesses, as well as help them handle their emotions during various life crises. Furthermore, a family physician will often intentionally guide patients to move forward in their maturation process and personal development. While some physicians are trained psychotherapists, many would appreciate learning a counseling model to use in practice. In this essay, I offer a generic counseling model—with which family doctors can understand human personal growth and offer effective guidance to patients.
Indications and contraindications
Because this is a generic model, it can be adapted to other specific counseling schools. The indications are similar to those of most psychotherapies: it applies to almost everyone, except those with acute psychosis who cannot process thoughts.
Model
I created this model by adapting concepts from life-stage development theories3; Augsburger’s concept of dependence, independence, and interdependence4; and the whole-person approach to health, which includes counseling and treating the physical, psychological, social, cultural, and spiritual aspects.5 The basic assumption is that each individual goes through 3 life stages in physical, psychological, social, and spiritual development. The stages are dependent, independent, and interdependent.
Dependent stage
This stage begins after birth. The individual relies on the primary caregivers to provide nourishment and to nurture for physical and biological growth; therefore, the family environment and the sociocultural setting play a crucial role in shaping emotional, psychological, social, cultural, and spiritual perspectives.
Independent stage
Later on in life, the individual learns to be independent. Apart from physical independence, this stage involves the development of identity, self-esteem and confidence, and a belief and value system from which free decisions and life choices are made. The value system is derived from learning and processing observations and lessons from family and culture, education (including spiritual teaching), and society (including peers). The individual’s values form the filter system through which all life decisions are screened. When faced with a life choice, the individual collects the available data, processes them, and, based on the learned value system, arrives at a decision. If the outcome of the decision is positive, the sense of self will be reinforced, and the individual will feel content and satisfied. If the outcome is negative, the individual will have to reexamine the value system and make necessary adjustments. During this growth stage, which involves all aspects of the whole person, one will normally enter adulthood, and be engaged in establishing a career, developing new and existing relationships, selecting a life partner, and having a family.
Interdependent stage
In this stage, the individual has a healthy sense of self, while at the same time being connected with and relating to others (Augsburger calls it responsible dependence).4 This state represents a good balance between 2 extremes: total isolated individualism (private life) and total group-, community-, and culture-centred collectivism (social life).
How interview questions correspond to life stages
Table 1 shows the type of questions we should use in interviewing individuals. The first line of questioning deals with the dependent phase. The questions help us to understand the nature of the individual’s upbringing and the relational dynamics of family members, and to identify some important events (including rites of passage) in that family. We will explore how these factors have affected the person’s present life state.
A tool for family doctors interviewing individuals
The questions dealing with the independent phase are aimed at determining the manner in which individuals seek to attain maturity and a healthy sense of self in relation to both themselves and a wider community. We will understand how well individuals adapt and adjust to the environment and culture, and whether they have successfully completed tasks associated with the independent stage. If there are unachievable tasks in the independent stage, individuals are given the opportunity to identify and discuss potential obstacles and how they can be overcome.
The final set of questions deals with current relationships with significant others, be they in the family, in the workplace, or in the community. Again, both the strength and the growth areas are discussed with the individual.
After going through this set of questions in the interview, we will have a good understanding of the individual’s state, of the challenges and problems facing the individual, and of the individual’s desires for personal growth in the future. Our task is to reinforce positive life experiences, and to work on the growth areas and difficulties. If we and the individual agree that there are areas needing improvement, a counseling contract can then be arranged by mutual agreement.
My experience with this model
I have found this model very useful in my practice, particularly for those individuals who are searching for identity, “selfhood,” and life direction. The process takes roughly 30 minutes to complete. In the end, the patient feels understood, and a good therapeutic relationship has been established. I hope this will benefit those physicians interested in doing effective counseling.
Footnotes
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We encourage readers to share some of their practice experience: the neat little tricks that solve difficult clinical situations. Practice Tips can be submitted on-line at http://mc.manuscriptcentral.com/cfp or through the CFP website www.cfp.ca under “for authors.”
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