1.

Introduction

1.1 What is Counseling?
Counseling is a collaborative effort between the counselor and client. Professional
counselors help clients identify goals and potential solutions to problems which cause
emotional turmoil; seek to improve communication and coping skills; strengthen self-
esteem; and promote behaviour change and optimal mental health.
Source: http://www.counseling.org/

1.2 What are the Types of Counseling available?
It has long been recognized that it can be extremely difficult for individuals to maintain their
psychological well-being in todays high stress world on their own. Hence, there are
different types of counseling professionals are available in the society, who can help
everyday individuals who are struggling in a variety of areas. The following are some of the
major types of counseling that are available.
Marriage Counseling - marriage counseling helps couples to learn effective ways of
resolving their conflicts and how to break out of negative cycles that are affecting their
marriage.
Grief Counseling - grief counseling helps individuals to work through grievances such
as the loss of a parent, spouse or child through effective coping mechanisms.
Family Counseling - family counseling helps the affected family members to come out
of negative family dynamics and helps them how to work, live and love together in a
more positive way.
Relationship Counseling - marriage is not the only type of relationship that may require
healing. Boyfriends and girlfriends, brothers and sisters, even business partners may
need help developing coping methods that will enable them to interact effectively.
Relationship counseling provides this assistance.
Mental Health Counseling - there are many reasons why an individual may need mental
health counseling. They may have a chemical imbalance that is making it difficult to
function, which can be aided through drugs but may also require some form of talk

therapy. They may have deep seated family issues which are pervading adult life. There
may be unresolved trauma that is plaguing an individual. In nearly any case where a
psychological issue is making daily functioning a problem, mental health counseling can
help.
Group Counseling - in group counseling, a single therapist works with multiple patients
in order to help them resolve troubling issues. Group counseling can be effective for
people who are not comfortable in a one-on-one setting, who have social anxiety issues,
or who do not find it financially feasible to pursue individual counseling.
Substance Abuse Counseling - people who are in the grips of an alcohol or drug
addiction need a special type of counseling. Substance abuse counseling uses
professionals who are trained in understanding the workings and pathology of addiction
and helping patients learn how to manage their addictions.
Teen Counseling - teen counseling helps teens deal with issues such as understanding
their sexuality, dealing with the temptations of drugs and alcohol and relating to their
parents.
Divorce Counseling - divorce counseling helps make sure that the break between the
two individuals is clean. Some divorce counselors can even mediate the separation so
that the process does not stretch out unnecessarily and cost both parties excessive
amounts of money.
I ndividual Counseling - individual counseling is a direct, active and personal approach
that focuses on increasing your individual self-awareness, understanding, and
adjustment. Individual counseling can help you identify the most effective ways for you
personally to achieve your desired goals for this stage in life, as well as provide you with
the tools to cope with difficult circumstances that may arise along the way.


1.3 What happens in a Counseling session?
Counselor and the client sit in a private place and engage in an active conversation. The
counselor encourages the client to express their feelings and thoughts in order to understand
the clients mindset and provide necessary assistance accordingly. Each session typically
lasts between 50 minutes to one hour. Sometimes just a single session is sufficient for a
client's needs, but more usually the counseling sessions continue for a several weeks, even
months.

2. What is Violence against Women?
Violence is an act to intimidate, humiliate, hurt or destroy by the use of force. It includes all
action taken by one against another with the intention to dominate. Rape is a form of sexual
violence. Violence can also be verbal or emotional. Therefore calling someone disparaging
names or telling them they are stupid is a violent act, which can hurt as such as a physical
attack.
Gender-based violence is a form of a discrimination that seriously inhibits womens ability
to enjoy rights and freedom on a basis of equality with men. Traditional attitudes by which
women are regarded as second grade to men or as having labeled roles to perform in the
society encourages violence, such as family violence and abuse, forced marriage, dowry
deaths, acid attacks and female circumcision. The effect of such violence on the physical
and mental integrity of women is to deprive them of the equal enjoyment, exercise and
knowledge of human rights and fundamental freedom.
2.1 What is Domestic Violence?
Domestic violence, simply described, is an act of physical, mental, emotional, sexual or
economic violence committed within the limits of the household by persons living in that
household. Domestic violence is often considered a private matter between two or more
parties who have a relationship with each other be they husband and wife, partners, parent
and child or employer and domestic help.
Domestic violence is a widespread problem in Sri Lanka. According to the UN Rapporteurs
report, more than 60% of Sri Lankan women are subjected to some form of domestic
violence. In Sri Lanka, the legal system addresses gender based violence through the
provisions of the Penal Code (codified in 1883) and the Prevention of Domestic Violence
Act (2005). Many offences against women fall within the general offences of assault, hurt,
sexual abuse, prostitution, murder and kidnaping. However, psychological abuse and
economic abuse in the absence of physical violence does not constitute a substantive
offence. Hence, this leaves out the majority of women in Sri Lanka who experience
psychological abuse and economic abuse in the domestic scenario on a daily basis,
vulnerable to various forms of psychological disorders.



3. The Story of Sumana
Sumana is aged 32. She got married at the age of 24 to her longtime sweetheart from school
days, Gunasoma. A year into their marriage, Sumana was conceived with their first child.
Gunasomas behaviour towards Sumana started to change. He started picking fights with
Sumana for no reason. Be it for the taste of the meals she cooked or the laundry that she
could not fold. Sumana tolerated his words of abuse and continued with her daily household
work.
Sumana gave birth to their first child, Nimal, who is 6 years of age now. After Nimal was
born, the situation at home worsened. Sumanas mother came over to help her with her new
born child, which Gunasoma did not like. He fought with Sumana endlessly which drove the
mother to leave the house. Sumana was left at home with an infant and no one to help
around with her child or house work. Gunasoma never offered any help to her but he did not
hesitate to fight with her for not cooking what he likes to eat or not ironing his shirt for work
etc.
Gunasoma did not like Sumana talking to any men in the neighborhood and restricted her
from associating any neighbours. She was not allowed to go out of the house without his
prior permission. The only few places Sumana was seen in public was the weekend village
fair where she went to buy the weekly provisions for the house or to Ajiths school to attend
parents - teachers meetings. Gunasoma did not like Sumana associating with her own family
members either. Sumana was stuck inside the house, most through the day, with nobody to
talk to.
Months went by. Gunasomas behaviour towards Sumana continued. Sumana had their
second child, Anoma, who is 4 years now and the third child, Piyal, who is 2 years now.
Sumana was burdened with house work and the work of her children.
Gunasomas monthly earnings were barely sufficient to cover the household expenses and
the expenses of their three children. However, Gunasoma fought with Sumana questioning
her on what she spent the money on and blaming her for wasting money. Sumana was
constantly at stress trying to manage the household finances, manage the household chores
and raise her children, with no help whatsoever from Gunasoma and no one to share her
grievances with.

Sumana started to feel lethargic all the time, she felt lightheaded and tired while she was
attending to her chores. And with her physical aches and pains and the constant
psychological abuse by the husband, she started to feel depressed and suicidal and became
insomniac which worsened her situation.
One weekend on the way back from Ajiths school, she met one of her school friends.
Seeing Sumanas poor physical appearance, the friend was concerned. Sumana told her
briefly about her situation, fearing that Gunasoma could be watching her from somewhere.
Her friend told her about WIN and gave her WIN contact details.
Next weekend on her way back from the village fair, Sumana called WIN and she was
directed to WINs senior counselor, Mrs. Patabendige. Mrs. Patabendige made Sumana
understand the importance of receiving psychotherapy to improve her condition and
managed to convince Gunasoma to allow her to attend the counseling sessions.

4. Theoretical background behind Sumanas story and the Psychotherapy
provided to Sumana


4.1 What is Family Counseling / Family Therapy?

Family therapy, also referred to as couple and family therapy, marriage and family therapy,
family systems therapy, and family counseling, is a branch of psychotherapy that works with
families and couples in intimate relationships to nurture change and development.
Source: http://en.wikipedia.org/wiki/Family_Counseling

As stated in the above definition, family therapy is a form of counseling which specializes in
treating family relationships. Marriage and family therapists can work with every
combination of family relationships such as the whole family or a couple, or parents with
children or individual members to assist a family to function in more comfortable and
effective way, maintaining a peaceful, harmonious and a stress-free environment at home.




4.2 How does Family Therapy work?

Family systems theory proposes that we as individuals first learn about ourselves, our
emotions and how to manage close relationships from the experience we have growing up in
our family of origin. This personal experience influences how we tend to function in all
other relationships we may have throughout our lives. As we come to better understand
ourselves in our family emotional system, and work to heal our natural, anxious reactions to
it, we can become more flexible in our marriages, our parenting, and our work and
community relationships.


4.3 What kind of therapy does Family Therapy use?
While some forms of family therapy are based in cognitive, behavioural, experiential or
psychodynamic psychology, the most commonly practiced methods of this therapy are based
on family systems theory. Family therapy developed its theoretical foundations fifty years
ago from the developing, cross disciplinary body of knowledge called systems theory.
Systems theory proposes that everything we experience in the world is interconnected to its
context, and cannot be fully understood without it. When it comes to human beings, then, we
do not know who we are without understanding the relationships we have. Those
relationships include the ones we have with family, our friends, our neighborhood and
cultures, our work and school environments, and those we may have with the larger systems
of language, gender, nationality, or religion.

4.4 Cognitive Therapy
People have dark thoughts when they are in a bad mood. With depression, the thoughts can
be extremely negative. They can also take over and distort ones view of reality.
Cognitive therapy was developed in the 1960s as an alternative way to treat depression.
According to cognitive therapists, depression is maintained by constant negative thoughts.
These thoughts are known as automatic thoughts. That means they occur without a
conscious effort. The depressed person distorts or exaggerates the reality of the situation.
This negative distortion helps fuel the depression.

With cognitive therapy, a person learns to recognize and correct negative automatic
thoughts. Over time, the depressed person will be able to discover and correct deeply held
but false beliefs that contribute to the depression.

4.5 Behavioural Therapy
Behavioural therapy refers to a collection of techniques based on the principles of classical
conditioning and operant conditioning. Behavioral therapy or behavioural psychology
differs in several ways from other kinds of therapies.
Behavioural therapy concentrates on behaviour. It seeks the problematic behaviour and
changes it over a brief period of time. Hence, behavioural therapy will only last a few
months or less.
Behavioural therapy seeks to intervene and alleviate symptoms. If a person experiences
depression, then depression needs to be alleviated. And behavioural therapy is very
directive. Even though the therapist interacts with the client, it is essentially the therapist
who formulates the treatment plan. The client then follows the therapist's treatment plan, and
when the goal is reached the therapy ends.

4.6 Cognitive Behavioural Therapy (CBT)
CBT is a way of talking about how you think about yourself, the world and other people and
how what you do affects your thoughts and feelings.
CBT can help a person change how they think ('Cognitive') and what they do ('Behaviour').
These changes can help the person feel better. Unlike some of the other talking treatments, it
focuses on the 'here and now' problems and difficulties. Instead of focusing on the causes of
the distress or symptoms in the past, it looks for ways to improve the state of mind now.

CBT has been shown to help with many different types of problems. These include: anxiety,
depression, panic, phobias, stress, bulimia, obsessive compulsive disorder, post-traumatic
stress disorder, bipolar disorder and psychosis. CBT may also help if a person has
difficulties with anger, a low opinion of themselves or physical health problems, like pain or
fatigue.


4.7 Counterconditioning Technique
In Counterconditioning, a particular response to a certain stimulus is replaced by a new
response. This new response is supposed to deter the person from the stimulus. For example,
a person may feel positive feelings towards smoking. Through a behavioural therapy
technique they would learn to feel negatively about their smoking.
The two techniques that are used in Counterconditioning are aversion therapy and
systematic desensitization. In aversion therapy the client is taught to experience negative in
the presence of the stimulus, with the aim that the client will eventually feel repelled by the
stimulus. In systematic desensitization, the therapist seeks to help the client fight anxiety and
other troublesome responses by teaching the client a set of relaxation techniques.


4.8 Relaxation Techniques
In general, relaxation techniques involve refocusing your attention on something calming
and increasing awareness of your body. It doesn't matter which relaxation technique you
choose. What matters is that you try to practice relaxation regularly to reap its benefits.
Deep techniques include autogenic training, progressive muscle relaxation (PMR), and
meditation. Brief techniques include self-control relaxation, paced respiration, and deep
breathing. Brief techniques generally require less time and often represent an abbreviated
form of a deep technique. Other relaxation techniques include guided imagery, deep
breathing/breathing control, passive muscle relaxation, and refocusing. Applied
relaxation involves imagination of relaxing situations with the intention of inducing
muscular and mental relaxation. Another popular technique is progressive relaxation, in
which the individual is taught what it feels like to relax by comparing relaxation with muscle
tension. Progressive muscle relaxation (PMR) is said to require several months of practice at
least three times per week in order to be able to evoke the relaxation response within
seconds.




5. Counseling Approach to Assist Sumana
When the Counselor first met Sumana, she was in a confused, grief stricken and depressed
state and she had had enough of her life. She thought if she committed suicide that would
relieve her from all her suffering. The only thing kept her from putting her thought into
action was her 3 children. She did not want to leave her children in a place where there
would be no one to look after them and keep them safe.
To assist Sumana, first step was to make her understand her situation. Why she is feeling
depressed and suicidal, the reasons for her current psychological and physical condition.
The next step was to guide her to overcome these disturbing thoughts and feelings and also
get her the necessary medical attention to strengthen her physical condition.
First, the Counselor used Cognitive Therapy to assist Sumana to understand her situation.
Cognitive therapy suggests that most problems have several parts. Those parts include:
o the problem as the person sees it
o the person's thoughts about the problem
o the person's emotions surrounding the problem
o the person's physical feelings at the time
o the person's actions before, during, and after the problem occurs
The way cognitive therapy works is the patient learns to take apart the problem into these
various parts. Once a person does that, problems that seemed overwhelming becomes
manageable.
Through Cognitive Therapy, the Counselor helped Sumana to understand her problem.
Understanding the problem helped Sumana to realize the necessity to receive appropriate
therapy to overcome her problems.
The Counselor used Cognitive Behavioural Therapy to help Sumana to make small changes
in her thinking and behaviour in her day to day life. Changes, such as time management, to
systematically organize and carry out her daily chores. Practicing proper time management,
Sumana was able to finish her chores in a more relaxed manner and she had more free time
to spend with her children and help Ajith with his school homework. Sumana also learnt to

manage the household finances better by making a grocery list for the week to categorize the
essentials etc and by record keeping of all her expenses.
In addition to providing Sumana with necessary psychotherapy, the Counselor also directed
Sumana to the General Hospital Clinic to receive the required medical treatments for her
physical ailments.
While Sumana was receiving her therapy, the Counselor requested Gunasoma to attend a
few counseling sessions as Gunasoma played a critical role in Sumanas recovery
progression.
First session was a one on one session with the Counselor, which helped Gunasoma to air
out his thoughts. Then the Counselor conducted a session for both Sumana and Gunasoma to
share their thoughts and issues they have with each other, their expectations of each other
and how they wanted to move forward in their marriage. The Counselor made them
understand the importance of a marriage and a family unit. How their issues led Sumana to
feel suicidal and why it is important to be supportive to each other as a family unit and how
these problems could affect the children.
The Counselor also used Deep Relaxation Techniques such as self-control relaxation,
paced respiration, and deep breathing with both Sumana and Gunasoma to help them calm
their selves down, control their thoughts / feelings / actions and relax. Especially Gunasoma
with him bad temper, this technique helped him to relax his mind and handle things in a
more peaceful manner.
The Counselor conducted 15 sessions of counseling altogether, first individual sessions with
Sumana and then coupled up with Gunasoma. Sumanas sessions were conducted once a
week at the beginning and then once the Counselor noticed positive results in Sumana, the
frequency of the sessions became once in two weeks. When Sumanas mindset was healthy
enough to lead a normal life, the Counselor advised Sumana that she was not required to
attend regular counseling anymore, however, the Counselor conducted follow up sessions, at
first once in two weeks, then once a month and later on once in 3 months when it was
absolutely positive that the counseling had helped both Sumana and Gunasoma to lead a
peaceful family life.


6. End Note
The story of Sumana is one good example of how counseling can positively help the
individuals who experience difficulties in dealing with various issues in their day to day
lives.
The Counselor guided Sumana through the process of counseling to help her understand her
situation and take the necessary measures to overcome her psychological and physical
weaknesses. Counseling helped Sumana to change her mindset and behaviour through small
changes in her everyday life. And practicing these small changes over a period of time, it led
to a lasting improvement in both her psychological and physical condition.
















7. References
http://psychology.about.com/
http://www.mytherapistmatch.com/
www.mayoclinic.com/