One area of concern in counselling is competence. Patients and clients are likely to visit counsellors who are appropriately reviewed by other clients. Therapist competence refers to the ability of a counsellor to demonstrate knowledge and skills in delivering treatment through meeting are the needed standards and achieving the expected outcome. To make competence, a therapist must follow key discipline elements such as theory, skills, and ethics ( Center for Substance Abuse Treatment, 2014) .
In therapy, the client must first be diagnosed and assessed so that a doctor or a counsellor can recommend the best treatment approach. Diagnosis of a mental problem such as substance use has all been documented in the DSM-5. Doctors and therapists know the best treatment method based on the outcomes of the assessment.
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Both assessment and treatment must be based on a theory. A theory is a pool of knowledge that the therapist must employ in helping a patient. The approach chosen must be applicable and meet the needs of the patient. The theory defines the steps that must be followed by the client to their way to recovery.
Therapists must have the skills to evaluate and help patients recover. For therapists, they must have extensive knowledge and skills. Skills demonstrate that the counsellors have the capabilities to transform the knowledge into action. It is a combination of education and skills that help the therapist provide the best of care to the patients.
Ethics guides every field that deals with helping other people. Moral philosophy is what the counsellors use to conduct all their actions. Codes of ethics must be maintained in these fields to silicate confidence and trust from the patients.
Comprehensive Exam – Group Counseling
Alcoholism remains a crucial challenge for many people in the United States. For many abusers, alcohol is something that they have tried to eliminate. However, because of the problem of addiction behaviour, it has become tough to stop abusing alcohol despite various treatments and rehabilitation.
When presenting the case, John mentioned that he could do anything to remain drunk. During diagnosis, John said that he had taken alcohol for eight years. During the last six years, John has been rehabilitated thrice, but after the rehabilitation, he goes back to drinking. John noted that he had been sacked twice for neglecting work or going to work late or drunk. John also indicated that he has been arrested for drunk driving and engaging in disorderly conduct. John's wife has threatened that she is going to divorce him if he is not going to stop the behaviour as she had had enough and has done enough to help John. The case is a clear representation of an alcohol abuser who will do anything to remain drunk.
Given that John has undergone rehabilitation thrice in the past six years. It is time to develop a different treatment plan. The plan for John is stabilization. Detoxification for john will involve both medication and therapies. Remedy will be to help remove the alcohol content in the blood and bring about a level of soberness. Besides, therapies will focus on modifying John's behaviour to help him recover from addiction. Therefore, the entire treatment will include assistance from professional doctors, a counsellor, and a counselling group. Group counselling will play an important role in John's therapy as he will share with other people who are alcohol and substance abusers. The counselling focus on John will also incorporate cognitive and behavioural therapy. John's treatment will be tailored to his specific needs.
The treatment objective is to help John recover from his drug abuse behaviour. The treatment aim at stabilizing the patient by detoxification and also modifying John's response. Research indicates that most alcohol abusers will go back to taking alcohol shortly after rehabilitation. The reasons for the behavior have been tied down to poor rehabilitation strategy and also lack of continuous support to the patient. Therefore the treatment strategy proposed here is to provide support to the patient through group counselling to help improve behaviour and understand the patient's problem.
The preferred modality for this case is group counselling. Research indicates that when people with alcohol abuse problems are brought together, it becomes easy to be open about their situation and can help each other grow from the problem. Through group counselling, it makes it possible to monitor the slow progress of the patient in the recovery journey and also learn new ways on how to help specific patients. Group therapy helps people talk about themselves and share their problems with others who face similar issues ( Corey, 2011) . The environment is facilitated by a therapist who is a part of the group and might share their personal experience with the clients.
Group counselling provides a conducive environment where clients feel that they are accepted ( Jacobs et al., 2011) . It also makes it easy for the participants to share about themselves and learn from other people. In this case, introducing the client into a group is giving them an environment where they are willing to open up about themselves.
Diagnosis
Alcohol use disorder requires a proper diagnosis for doctors and counsellors to device effective treatment plans. Over the years, the American Psychiatric Association (APA) has always developed standard assessment approaches for mental disorders. The new standard assessment code known as Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) was established in 2013 ( American Psychiatric Association, 2013) .DSM-5 develops diagnosis approaches for mental health conditions. DSM-5 was applied to John’s diagnosis.
DSM-5 was applied in the diagnosis of the patient. Under the DMS-5 approach, eleven key symptoms were examined. DSM-5 focuses on the history of the patient looking at specific patterns of alcohol use behaviours. The physician determined whether John had been consuming large amounts of alcohol than usual for an extended duration. John marked that the past eight years, his alcohol consumption had surpassed what for him was regular intake. The doctor asked John whether over the years he had a desire to control alcohol use or any unsuccessful efforts to cut down the use. John noted that he had tried to stop alcohol use in the past six years that were marked by 18 months of rehabilitation. Each rehab period lasted for six months ( APA, 2013) .
The physicians also enquired on time spent in activities that would help John access alcohol, use it or recover from its effects. John noted that most of his time is wasted while he is under the influence of alcohol. John also indicated that he had spent almost 18 months in rehab for the past six years trying to recover from the effects of alcohol use. John was asked about his desire to take alcohol. John noted that he has a strong desire to make alcohol. John's craving is so high that he as to keep a few alcoholic drinks in the house. The doctor also wanted to know whether alcohol use behaviour has resulted in a failure to fulfil obligations at home or at work. John noted that he had been sacked twice in the within the eight years for neglect of work ( APA, 2013) .
The physician also wanted to know whether John gave up some recreational social or occupational activities for alcohol use. John noted that in the past, he had several appointments such as his kids' games and failed to turn up for family gatherings because of his drinking. The care provider needed to know whether alcohol use led to physically hazardous activities. John was not sure but noted that he had been arrested for drunk driving and also had gained injuries after drinking. Besides, John had continued use of alcohol despite knowledge of psychological and physical problems that can occur as a result of alcohol use. John also noted that he had a high level of tolerance to alcohol as sometimes he had to take an extra amount of alcohol to get drunk. However, he stressed he did not have withdrawal symptoms from the use of alcohol ( APA, 2013) .
However, other differential assessment strategies could be used in understanding John's alcohol problem. A doctor can decide to carry out a physical exam on John. Physical exam followed by health questions to understand the patient's condition. The physicians would also asses the patient using a complete psychological evaluation ( Kranzler & Soyka, 2018) . A psychological assessment would include asking questions about the patients' thoughts behaviour patterns and feelings. Lab tests and imaging tests can be done to evaluate the impact of alcohol use on the patient.
For John's case, both a combination of DSM-5 criteria and psychological evaluation approach in the diagnosis of the alcohol use disorder. A combination of these approaches would go a long way in helping understand the behavioural problems and the effects of alcohol use over the years. The procedure would help in designing a treatment plan that would incorporate group counselling.
Theoretical Foundation
The theoretical orientation to be applied in is the person-centred theory that has primarily been used in group counselling ( Cain, 2010) . The client-centred approach is meant to convey empathy and warmth. Groups create an environment where the clients can feel warmth because they are accepted and that they can grow. Trust in the group setting is critical as it helps the participants develop their potential.
The success of person-centred theory in group counselling is based on the following theoretical points. Both the counsellor and the client are in psychological contact. The two must develop a relationship that will help deal with the client's situation. The client is in a state of incongruence, meaning that they are emotionally upset. The clients must be willing to be helped, meaning that they are angry with their situation, and it is the reason for seeking assistance to deal with the situation ( Cain, 2010) .
The counsellor has unconditional positive regard for all group members. Wholehearted positivity towards the patients helps creates a warm environment for the patient. Positive regards are ways of showing acceptance of the client by the world. The counsellor must demonstrate a robust understanding of the clients and also has an internal frame of references, and the counsellor looks to share the experience with the clients. The counsellor is supposed to be empathetic with the clients because they understand the situation and through that therapists, the counsellors share an internal frame of understanding with the patients to help them understand themselves and the reason for their behaviour ( Cain, 2010) .
The counsellors suing the person-centred theory must have a genuine awareness of their own feelings. The ideas are that a counsellor cannot help patients if they do not have a real understanding of themselves. The client must acknowledge the efforts of the counsellor to understand their situation. In turn, the client must turn to themselves and seek a full understanding of their job and be willing to change it accordingly ( Cain, 2010) .
The above theoretical foundation is appropriate for a group setting because it aims at developing an awareness of oneself and others, finding self-actualization, openness to experience and the most important is to change the behaviours of a person ( Chan & Thomas 2015) . The group aims at improving the behaviours of the patient and thus having a person-centred approach will help focus on individual patients and able to attend to their needs.
According to Cain (2010), personal-centred therapy in group counselling advocates for openness, genuineness, acceptance warmth and congruence of the participants. Therapists in person-centred treatment participate in the group and share their personal struggles with clients. The aim is to change individual behaviour while attending to others. Therapists are also required to understand content and meaning, linking and conveying acceptance.
The general goal of person-centred therapy in a group is to facilitate personal growth and development of the client. In counselling, there is a responsibility to mitigate or eliminate feelings of distress in patients. Group counselling based on person-centred is meant to increase the clients' self-esteem and openness to experience ( Chan & Thomas 2015) . Person-centred therapy in a group aims at increasing self-awareness of personal behaviour. When one becomes their problems, it becomes easy to handle the problem they are facing. Person-centred therapy will help in John's case as through group john will be able to learn about himself and grow from his alcohol use disorder.
Counselling Skills and Techniques
Group counselling requires well-developed techniques and skills to manage the situation of the group. In a group, different personalities depict multiple communication methods. For example, some of the people are extroverts while others are introverts meaning some will be willing to open up or talk more while others will remain silent during a session. Thus, as a counsellor, it is vital to have individual group management skills and counselling techniques ( Jacobs et al., 2011) .
During group counselling, a counsellor has active listening skills ( Jacobs et al., 2011) . All counselling methods require the counsellor to listen. It is through listening that one can pick critical issues to address. Listening to content and voice speaks volumes to the counsellor as it is possible to tell how a person is feeling about their life or the situation they are going through.
Counsellors have a responsibility to scan for non-verbal clues in the groups ( Jacobs et al., 2011). The counsellor is required to keep eyes on the members for body languages such as facial expressions, body shifts, tears, and head nods. These clues speak enough for the counsellor to read how the members of the group feel. It can help indicate feeling such as anxiety, sadness, happiness, uncomfortable persons, and so forth.
A counsellor must depict managerial and leadership skills. A counsellor must know how to control, plan, organize and coordinate ( Chen, & Rybak, 2017) . All counselling sessions either personal or group require the person in charge to demonstrate managerial skills. Groups are like organizations and dealing with many people requires one to be a leader to guide the way. As a counsellor, each group session requires controlling, for example, cutting down when an individual speaks too much. Planning is vital as group members know when to come for the group and other things. Communication is critical from listening, cautious talking and observation. Counsellors have to delegate, make decisions and motivate the group members. As a counsellor, it is essential to deal with conflicts such as arguments and know how to cut off members. Managers must do a follow-up on the group members to ensure that all are making progress.
Counsellors have to understand the diversity in the group. Each group is made by people from diverse backgrounds, of different races, sex, age, and so forth. It becomes easy to deal with multicultural issues that arise from the group as a result of these differences. Counsellors can develop a conducive group's environment when cultural backgrounds are respected and well known ( Chen, & Rybak, 2017) .
Ensure total participation from all the group members. It achievable through rounds. Rounds ensure that all members participate in response ( Chen, & Rybak, 2017) . The counsellor should choose multiple starting points, and it is essential to avoid starting and finishing a group session with negative members. Such measures ensure that all members are actively involved in the group, which makes the work easy. Counsellors identify critical aspects of individual progress in recovery through contribution. It is through participating that counsellors learn the recovery period the patients are going through.
Therapy involves participating in reviewing the thoughts, ideas, emotions, and behaviours of the patients. In group counselling, the objectives of the treatment can only be achieved through sharing. It is the responsibility of the counsellor to learn the essential skills and techniques necessary to run a successful group counselling operations ( Jacobs et al., 2011) . The superior skills and methods I believe are crucial to the running of a group in our case. Such skills will are compatible with the above theoretical approaches.
Ethical themes
Participative ethical model
In group counselling, participants must contribute to the group. The model ensures that the participants understand the dilemma or the challenge at hand. In group counselling, the decisions are made by the members of the groups or the clients about their situation. Professional standards that are associated with group counselling include confidentiality, group policies, consent, and non-maleficence and benefice. The clients' principles must guide the model as the client must be treated in the way that they believe is appropriate. The therapist has a responsibility to review the desires, wanted outcomes, and emotions regarding the therapy approach to be used. The therapist must ensure that they must incorporate all ethical standards to ensure that they meet the Informed of the clients ( Lenssen et al., 2009) .
In the above model, four main themes will be applied in our case. Group policies are vital when the group comes together for the first time. It is essential to hosting a one on one discussion with each participant of the group before the group starts. Group members will be willing to uphold and abide by group policies if they feel that they own the by ( Welfel, 2015) . Group policies will help in maintaining group discipline and motivate the participants to play the part.
Both the participants of a group and the counsellor should understand informed consent in a group. Before joining a group, each of the members must give consent to be counselled, which involves providing personal information. Clients must understand specific terms such as confidentiality before consenting to a group. Informed consent helps the counsellor and the clients of group counselling to know how much can be said about them in a group ( Welfel, 2015) .
According to Tenbrunsel (2006), confidentiality is essential to group counselling as it is too personal or individual counselling. The theme of privacy must be emphasized in a group. People will be willing to participate and tell their stories in a group when there is an assurance that their secrets will remain only with the group members. In the above model, confidentiality will help the participants get involved without the fear of others looking over them. Ideally, privacy means that group members agree not to disclose information such as names, identifying details, life circumstances and information shared during a session.
In a group, the therapist must ensure that clients are not subjected to any harm and also must work towards the benefits of the client. These are the definition of non-maleficence and Beneficence, which are critical to any form of treatment of a patient. In a group, counselling therapists must observe these ethical themes to ensure the safety of the patient. These two ensure that the clients do not encounter harm in the process of seeking help. These themes help the client develop trust with the counsellor as they know that their information will be kept safe.
The ethics of an open group are similar to that of a closed group. In any form of therapy, the therapist must ensure that participants are willing participants and thus consent necessary. Nobody should be forced into treatment as it is not going to work. Confidentiality creates trust and confidence and therefore, must be adhered in all groups. Ethical codes of counselling must be implemented in all forms of advice. Therapist's responsibility in group counselling to ensure there is trust that is assured by confidentiality ( Tenbrunsel, 2006) .
Social Justice Issues Based On Multicultural Themes
In a group, there are different parties from multicultural backgrounds. As a result, various social justice issues can quickly arise from the group. Examples of social justice issues that can arise from a group include religion, nationality, age, sexual orientation, race, gender, and personal behaviours. It is, therefore, essential for the counsellor to have multicultural competence (Constantine ensures 2007). Counsellors must possess a certain level of skills, knowledge, and self-awareness when working with people from different backgrounds.
Reviewing social justice issues such as racism, genders and sexual orientation in a group ensures that all group members are able to participate in the group. Social justice aims at achieving total participation from the group members (Ratts et al., 2015). It is the responsibility of the counsellor to ensure that there is no discrimination or oppression of any client, which will increase the participation of all members.
The rights of all members in a group counselling must be respected. A participant in a group counselling whose rights are not recognized or are oppressed is unlikely to actively participate in the group (Constantine et al., 2007). When clients have the freedom to exercise their rights in a group, there is a sense of respect and belonging, which makes it easy to engage these parties.
According to Ratts et al. (2015), clients must be treated equally no matter the race, gender, sexual orientation, age, and other social issues. Equity in a group makes the members feel that they are all equal. Despite the differences that may occur in their lives in a group, all members are identical as they are brought together by almost similar challenges. Equity ensure that participants treat each other with respect.
When providing counselling, it is essential to ensure that each member has access to the resources (Ratts et al., 2015). Dealing with social justice issues in a group provides that clients will be willing to take part in the group. Engaging in the group provides access to help and supporting resources to help the clients recover. Social justice issues hinder access as group members may be unwilling to take part in a group when they feel that social justice rights are being violated in the group.
In group counselling, it is essential to know how to deal with racism and ethnicity. It is the responsibility of the counsellor to poses knowledge of how addressing problems that might arise as a result of ethnicity or racism. Self-awareness of the counsellor helps in the cognition of the participant's cultures which can help address challenges such as oppression and discrimination. Knowledge of ethnicity and racism refers to the competence that the counsellor has on multiple world views, marginalization and specific values of a given culture (Constantine et al. 2007). Such skills make it easy to balance and eliminate racism and ethnicity in a group.
The different group members come from different backgrounds meaning that that multicultural themes must be dealt with before the beginning of a group consoling. If these problems are not anticipated and addressed before the start of a group, they might hinder the success of a group meaning that it becomes hard to operate the group. Social justice issues are known to inhibit organizations, as some people see themselves superior to others. It is the role of the counsellor to tackle such issues while operating a group. Having knowledge, skills, and self-awareness on social justice issues helps the counsellor in anticipating and finding remedies to problems that can occur as a result of cultural diversity in the group (Constantine et al., 2007).
References
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