Copyright holder: Tyndale University, 3377 Bayview Ave., Toronto, Ontario, Canada M2M 3S4 Att.: Library Director, J. William Horsey Library Copyright: This Work has been made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws of Canada without the written authority from the copyright owner. Copyright license: Attribution-NonCommercial-NoDerivatives 4.0 International License Citation: Poon, Vincent H.K. “Model of Counseling for Family Doctors.” Canadian Family Physician 53, no. 6 (June 2007): 1013-1014. ***** Begin Content ****** TYNDALE UNIVERSITY 3377 Bayview Avenue Toronto, ON M2M 3S4 TEL: 416.226.6620 www.tyndale.ca Note: This Work has been made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws of Canada without the written authority from the copyright owner. Poon, Vincent H.K. “Model of Counseling for Family Doctors.” Canadian Family Physician 53, no. 6 (June 2007): 1013-1014. Model of counseling for family doctors Vincent H.K. Poon MD PsyD FCFP, AAMFT Approved supervisor I define 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 devel- oped and realistic life goals achieved. Since the efficacy of counseling has been proven, it has become an impor- tant 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 vari- ous life crises. Furthermore, a family physician will often intentionally guide patients to move forward in their mat- uration 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, psychologi- cal, 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 biologi- cal growth; therefore, the family environment and the sociocultural setting play a crucial role in shaping emotional, psychological, social, cultural, and spiri- tual 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 sys- tem is derived from learning and processing observations and lessons from family and culture, education (includ- ing 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 deci- sion. If the outcome of the decision is positive, the sense of self will be reinforced, and the individual will feel content [ continued on page 1014 ] Table 1. A tool for family doctors interviewing individuals 1. Dependent phase • What was your experience growing up like? Overall, was it positive (eg, a nurturing environment), neutral, or negative (including trauma, abuse, and neglect)? • Are family members enmeshed, detached, or connected? • Do power imbalances exist in the family in which you grew up? Indicate any unusual family structures, events, or patterns (eg, deaths, illnesses, absent family members, migrations). 2. Independent phase • When did you see yourself as autonomous, having a good sense of self, individuality, a belief system, and freedom to make life decisions? Was this process easy or hard, and how did it come about? • As a result of such independence, what sort of life path and goals have you chosen so far for yourself (eg, in career or vocational choice; in friends, life partners, and other relationships with relatives; in ministry or service for your faith, if you have a religious or spiritual orientation)? • How did your culture or environment affect the development of this phase? • If you feel that you have not achieved an independent state, what do you think are the contributing factors or obstacles? Do you have some ideas about how these could be overcome? 3. Interdependent phase • At this point in your life, do you feel that you have achieved a healthy interdependent state as you relate to others? What do you think are some of the key ingredients of healthy relationships with others? • What kind of difficulties, if any, have you encountered in moving toward this life phase? • Would you like to maintain this balance between isolated individualism and total collectivism (interdependent state) in the future? If so, how will you do it? Based on your responses to the above, are there areas in your life you would like us to work on? [ Page ] 1013 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 adult- hood, 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 con- nected with and relating to others (Augsburger calls it responsible dependence).4 This state represents a good balance between 2 extremes: total isolated individu- alism (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 pas- sage) in that family. We will explore how these factors have affected the person's present life state. The questions dealing with the independent phase are aimed at determining the manner in which individu- als 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 inde- pendent 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 relation- ships 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 inter- view, we will have a good understanding of the individ- ual'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, par- ticularly 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 phy- sicians interested in doing effective counseling. Dr Poon is in private practice, is an Assistant Professor in the Department of Family and Community Medicine at the University of Toronto, and is a Professor of Counseling at Tyndale University College and Seminary in Toronto, Ont. References 1. Poon VHK. Short counseling techniques for busy family doctors. Can Fam Physician 1997;43:705-13. 2. Pinsof W, Wynne L. The efficacy of marital and family therapy: an empirical over- view, conclusions and recommendations. J Marital Fam Ther 1995;21:585-613. 3. Poon VHK, Bader E. The individual and family life cycle: predicting important transition points. In: Watson WJ, McCaffery M, editors. Working with fami- lies: case-based modules on common problems in family medicine. Toronto, Ont: Working with Families Institute, Department of Family and Community Medicine, University of Toronto; 2003. p. 17-25. 4. Augsburger DW. Pastoral counseling across cultures. Philadelphia, Pa: Westminster Press; 1986. p. 87-91. 5. Poon VHK. The family in general practice—the challenges in the late 1990s. Hong Kong Pract 1995;17:199-207. 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." [ Page ] 1014 ***** This is the end of the e-text. This e-text was brought to you by Tyndale University, J. William Horsey Library - Tyndale Digital Collections *****