Counseling is a practice that involves the sharing with a person or persons with a view to helping them through challenging situations they are facing. It involves a wide array of issues from drugs and their abuse, depression, broken homes, trauma, sudden affliction with a disability, infection by diseases such as HIV/AIDS, rape and other forms of molestation. This paper undertakes to critically discuss the importance of marriage counseling and its evaluation based on the Donabedian?s framework of structure, process and outcome. Reflexive Analysis. The world is laden with challenges, social, economic and political. Apparently, none is ever mutually exclusive of the other: An economic challenge engenders a social or political challenge and similarly a social challenge a lot often begets challenges on either the political or economic fronts or both. The rate of crime in any given societal setting has a lot to do with the poverty and unemployment rates that prevail in the same setting. It is observable too that maintaining political stability is a greater challenge in impoverished nations relative to the affluent ones. Save for a few exceptions, the more societies are divided along lines of difference (religious, ethnic, racial inter alia), the greater the vulnerability to tensions and disquiet. One underlying fact is that almost every challenge gravitates around humanity. In effect, the principal unit to which every human being is attached- the family- is worthy of preeminence. I am of the opinion that every child across all walks of life is deserving of decent upbringing within the environment of a loving and caring family. This, however, is not always the case. It is estimated that the street children population across the globe stands at a staggering 100 million. In mid 2007 it was reported that the population of children aged 15 and below participating in wars as conscripted child soldiers was between 200,000 and 300,000. Such is the state in the world today. People have been lost to drug abuse, crime and all manner of social evils simply because in the centuries recently past, the family has increasingly become a unit under siege. Families are the corner stone of the society; a society bedeviled by rampant breaking of homes is a society on its knees. The world is essentially in a crisis of morality. Robbing people of their hard earned cash through ponzi schemes; government officials fleecing national coffers through corruption; people committing crimes against humanity such as genocides and politically instigated violence only to get away with impunity; escalation of the rates of unwanted pregnancies; peddling of drugs; the HIV/AIDS pandemic and many others are all issues born of the morals characteristic of many in the world today. A child?s first school is the home; its first teachers are its parents. The family provides the institution from which a child derives its beliefs of right and wrong, good and bad (Stroup; 1974).
In the event that this institution is inideal or incapacitated to provide sound moral guidance or lacking all together, the child is left to subscribe to the morals of the environment without. Of such significance is the family; a significance which is regrettably unappreciated. Overview of the Donabedian?s Structure, Process and Outcome Model. Though a lot often used in the evaluation of healthcare, the Donabedian?s Structure, Process and Outcome Model can be put to use in assessing the quality of services rendered to fields closely related to that of healthcare such as counseling. ? Structural measures of quality: These deal with matters relating to the organizational resources available for and the personnel?s professionalism for the provision of the service concerned. ? Process measures of quality: These are the services done for and to the beneficiary/patient by the personnel during the treatment. ? Outcome measures of quality: They are the end results of the processes carried out. Outcomes are twofold- technical and interpersonal. Technical outcomes entail any physiological aspects of the care administered. They may include matters such as the absence or presence of reaction to procedures. Interpersonal outcomes focus on the patient?s perception and view. They relate to matters such as patient satisfaction and the effect on their quality of life. Marriage and the challenges faced. The ever changing world has brought with it a greater necessity for stable families yet exposed marriages to greater challenges in ensuring the same. Marriages are widely perceived to be burdensome endeavours especially with issues such as infidelity, cultural differences, employment demands on either spouse or changes in the family?s financial state, changes in the state of health of either spouse, concealed past experiences, changes in personality and traits and domestic violence (McGinnis; 1967). Domestic violence and infidelity have been and remain key challenges and the reason for breaking of homes (Bach, George & Wayden; 1969). One major challenge that faces marriage counseling is the event that a counselor has his/her own beliefs concerning the couple being counseled. A counselor need not be narrow minded. He needs to be very open and needs to give each of the persons an equal chance to voice out their grievances with the other person. In the event that a counselor already has his own position on the couple and does not listen neither accord each of the partners an equal chance to voice their grievances, he may cause more destruction that the construction of the couple. Being biased might result to a further breakup or the eventual separation of the couple. Womwn, particularly, are greatly affected by the biasness of the male counselors (Chesler; 1972).
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Marriage counseling seeks to address these and many more challenges. It does with a focus on: ? Availing room for confidential communication in the presence of a third party. ? Allow each person to express themselves unreservedly. ? Offer professional advice on how the couple can empower itself and assist it in determining a way into reconciliation of differences. Marriage counselling vis a vis the Donabedian?s Structure, Process and Outcome Model. Analysis of marriage counselling in this context will be best carried out through posing of a number of questions. Structural measures of quality: What sort of professionalism and facilities best position a counselor for addressing marriage challenges? Credentials are of great importance. One ought to have the required counselling knowledge and experience to best attend to the needs presented by couples. However, a lot will depend on the disposition of the counselor. The ability to listen patiently and empathize impartially and intuitively decipher the underlying issues facing the couple is irreplaceable. Counselors ought to be able to aptly discern the key source of negative emotions ad reactions and the extent to which they recur. A counselor?s objective is never to take sides or occasion a cycle of shifting blame (Maslow; 1968). The focus should be laid on the fact that the couple is afflicted with differences irreconcilable without the intervention of a third party. Amicably bridging differences through arrival at a point of genuine acceptance should be the pursuit of every counselling undertaking for the counselor. The environment in which the counselling sessions are carried out should be serene and conducive for the couple concerned. It should away from all manner of disturbance that may create a sense of lack of privacy. Process measures of quality The services done to the patient in this case is simply listening and providing advice. It is said that a problem shared is half solved. Although the patients are not prescribed and given drugs to help them sort their issues, they have an area where they can talk and be listened to. They are also able to share their problems with each other and get professional advice. Outcome measures of quality The success rate of a counseling session is totally dependent on the couple being counseled. It is upon them to reach an understanding and find a suitable way of resolving their problems. However, a marriage counseling session has its own aims. If the aims of this session are not met fully (or majority of the aims are not adhered to) then the counseling session was ineffective. If the aims are met and adhered to, not in totality but majority, then the counseling session was effective and the success rate can be said to be high. It is, however, difficult to gauge ones success rate on the implementation of the advice he/she gave to other people and how it was implemented by the people. How is marriage counseling achieving its stated aims? The aims of marriage counseling have been addressed briefly in the subtitle marriage and challenges faced. Among the aims of the counseling are to avail room for confidential communication, allow each person to express themselves freely and to offer professional advice to the affected couple (Clinebell H; 1966). These are just an overview of the aims of marriage counseling. Other concrete aims of the counseling are identifying the problem, becoming aware of the surviving satisfactions and strengths, stating ones needs clearly and directly and finally attempting to meet more each of the persons needs. Marriage counseling has made great efforts and strides in trying to meet these aims. In as far as identification of the problem goes; the confidentiality and the opening up will help resolve this issue. It is mainly up the couples to try and open up so as to identify the problem with clarity. It is important for the counselor to know what the cause of alarm is in the marriage so as to help them effectively. This exercise has been of great effect and has been very successful. Many at times when couples decide to visit a marriage counselor, they normally are willing to share their problems with the counselor (James;1973). It is therefore very logical that the couple ends up opening up to the counselor so as that he can help them resolve their issues. The other aim of marriage counseling is to become aware of the surviving satisfactions and strengths. Again, this is mainly up to the couple as they do most of the work in as far as fulfilling this bit of the counseling process is concerned. This section involves finding out the positives of the marriage. Normally it is brought in after tempers have risen and everyone has laid their cases on the table (Brill; 1973). The aim here is to find out whether the couple stills looks up to something or if there is anything left that can still hold the couple together. This is one aim that is often achieved through the counseling session. Many parents will not want their children to suffer the consequences of their separation and therefore many of the responses on what holds the marriage together ends up being the children. For this reason, many of the parents might not opt for separation and will therefore reconsider their decision. The sex life of the couple also plays a major role in determining whether the couple will separate or not (Alex; 1972). The effectiveness of this aim of counseling is rated as the most successful. This is because, it is through this bit that couples really understand the importance of staying together or resolving their disputes. The other aim of counseling is stating the needs clearly and directly. This is similar to the aim of identifying the problem.
The only difference here is that the issues are addressed more directly and clearly. It is more of a question of ?I Want? in this session. It has also proved to be a very successful exercise as many of the direct attacks on the issues lead to the direct tackling of the problem. The final aim is the meeting of the persons at a focal point. This is probably the most difficult of the aims of marriage counseling (Clinebell C; 1973). Getting the couples to understand each other and make them agree on one point has proved to be very tasking. In fact, many marriages are saved based on the second aim of marriage counseling than this one. Ion as far as the success rate of marriage counseling goes with regards to this aim, it is not very successful. Conclusion Marriage counseling is important for many couples in the world today. Majority of the couples in the United States alone end up divorcing or separating as a result of unresolved disputes. Counseling provides each partner in the relationship with a chance of opening up and airing out their views in the most appropriate manner. Apart from giving people this chance of resolving their issues it also helps save the marriage and therefore it looks into the best interest of the child (Otto; 1969). Statistics have shown that many of the children who are raised by single parents end up being more disturbed as compared to their counterparts who have been raised by both parents. As a result, many of them end up getting involved in the social vices such as crime and others that may not be warranted by the society. Religion regards marriage as a holy sanctity. It is therefore imperative that people strive to ensure that they stick to their marriages (Daly; 1973). A question therefore arises as the possible reasons why many marriages are divorcing or separating in modern day society. Bernard Jessie, asserts that marriage in the future (modern day) will not be grounded on the principles of a true partnership but it will be more of a formality (Bernard; 1972). Perhaps this is the main reason why many marriages are breaking up today. Many couples commit themselves into a marriage for the basic reason that it is part of the passage of life. For this reason, I believe that marriage counseling should not only be a post marriage affair but it should also be a pre marriage factor to consider. People who are getting married need to be counseled and informed or educated of what they are about to get into (Lederer, William & Jackson; 1968). Limiting counseling to only the people who are already married will do more damage than good to these couples. It will be more of a reactive measure, than a proactive one. All in all, it is imperative to understand that a marriage without communication fails to be regarded as a marriage in the end (Mace, David & Vera; 1974). Communication will prevent further actions to be taken such as counseling.