Normative issues are those based on intrapersonal and interpersonal concerns that could be expected to occur in the course of a life. When people think about issues that might compel someone to seek professional help, they often envision severe and potentially even life-threatening issues such as major depression, extreme anxiety, addiction, mania, debilitating phobias, and suicidality. These issues obviously deserve the attention of mental health professionals, and it could even be said that “social permission” is implicitly—and sometimes even explicitly—granted to attend counseling based solely on the severity of the difficulties experienced. Clients who are experiencing severe difficulties rarely question their “right” to be in counseling. However, numerous others could benefit from an objective counseling experience as they endeavor to cope with the struggles of everyday living. Some normative issues are developmentally based and could become more problematic for different people at different points in their lives.
This entry provides a brief overview of intrapersonal and interpersonal normative issues that could occur for individuals, couples, and families. While some individuals do seek counseling for severe and diagnosable mental illnesses, many more individuals experience aspects of these normative issues that are emotionally distressing and reduce satisfaction with daily life. These normative issues can also be resolved through counseling.
Many of the normative issues that occur in counseling are intrapersonal issues. Intrapersonal may be defined as occurring or originating within one’s self. The following section outlines some of the more common individual presenting problems in counseling. Although the focus of counseling may be on the identified client, it remains important to consider the systemic and developmental context of the client’s struggles.
Beginning school requires transition, and normative academic issues could be expected when children begin preschool or kindergarten. For some parents, the early school years may be the first time they realize that their child is not mastering specific skills at the same pace as other children. Parents may understandably feel reluctant or resistant if a kindergarten or first-grade teacher suggests that their child be tested for a “learning disorder.” There is often misunderstanding about the definitions of learning disabilities, and mental health professionals may be able to assist parents to obtain accurate assessments, diagnoses, and information about potential learning issues.
Academic concerns are not limited to diagnosable learning disorders. School difficulties may involve other systemic and contextual issues, and multiple psychosocial factors may interfere with children’s abilities to perform in a school setting. When a child enters school, the structure of attending school requires adjustment for families and children. Time management issues suddenly become more prominent as parents attempt to accommodate their work and family life to the school schedule. The structure of school also requires that school staff act as surrogate guardians, and parents may feel uneasy with the idea of other adults disciplining their child (or they may realize that their parenting philosophies differ widely from the teacher or school philosophies). At this stage of life, children are also challenged by a fear of separating from parents, and this may cause feelings of stress or “school phobia.” Counselors can assist with school-related issues by acting as advocates for parents and children in the school setting, by providing consultation for school staff, by facilitating parent-teacher communication, and by providing recommendations for interventions based on the needs of the child, family, and school.
Another transitory and potentially stressful turning point in academic life occurs when young adults enter college. Both academic and social issues produce stress for college students. In particular, incoming freshmen face academic pressures related to grades, test scores and grade point average, difficulties with time management, and the need to use new learning and study strategies to master large amounts of complex material. Undergraduates must also cope with social issues related to adjusting to a new environment, leaving home, and forming new relationships with peers and faculty. Some researchers have suggested that low social support is associated with psychological stress and negative perceptions of the college experience. College counseling centers are ideally situated to assist in the adjustment to college by developing programming to facilitate social interactions among college students and by providing counseling services for those in need.
Anger is a fundamental and basic emotion common to the human experience. Feeling angry is a natural and typical reaction to many life events, and it is sometimes healthy to express anger in constructive ways. Unexpressed anger is linked to increased susceptibility to illness, high blood pressure, and low pain tolerance as well as depression. Although it may be important to express anger in some situations, anger can be problematic if it is experienced as a chronic emotional state or if it is expressed in destructive, hurtful, or violent ways. Therefore, anger management is a prevalent reason for people to seek counseling. Anger management refers to a set of strategies or interventions clients can learn in therapy in order to identify, acknowledge, express, and contain their feelings of anger.
Difficulties with anger management may be an issue for multiple age groups. Young children may exhibit behaviors such as scratching, biting, throwing tantrums, or destroying toys. Parents may attend counseling to learn and practice parenting strategies to effectively decrease aggressive behaviors of children. During grade school and high school, bullying occurs. Bullying refers to intentional acts of aggression displayed by one student against another student. Overt acts may include name-calling, pushing, shoving, or hitting, whereas covert acts of bullying may include spreading gossip or ostracizing students from social interactions. Dawn Newman-Carlson and Arthur M. Horne suggested that counselors may be able to intervene with bullying by implementing school-wide programs to increase teachers’ abilities to manage acts of anger in the classroom. Adults may also seek or be court ordered to counseling due to anger issues expressed in road rage situations, domestic violence, aggression in the workplace, or abuse of children. Adults may benefit from individual, group, or couples counseling to learn about ways to assertively express anger in healthy and constructive ways.
Stress is the body’s physiologic response to perceived threats. When individuals experience stress, heart and respiratory rates increase, blood pressure rises, and digestive processes are accelerated. This is termed the fight-or-flight phenomenon and refers to the way the body prepares to either confront or flee from perceived danger. Stress results from the perception of external threats and pressures, and some amount of stress is necessary for survival. However, stress may become a counseling issue when it occurs frequently or for prolonged amounts of time. Chronic stress may interfere with the ability to cope with daily events, it may cause somatic symptoms, and it results in feelings of irritability, worry, or sadness. Ongoing, repeated exposure to stress increases susceptibility to disease and it may increase risk for depression.
There are typical life events that may cause stress at various points in life. Both positive and negative events may invoke a stress response. Starting a new job, a death in the family, having a baby, moving, and financial difficulties are all examples of common events that may induce the experience of stress. Stress results from both the event and the meaning that individuals assign to the event. Individuals may experience similar life events, but appraise the events differently to result in unique stress experiences.
As individuals struggle to cope with stress, counseling may be a beneficial place to learn skills and strategies to increase relaxation. Multiple interventions may be effective, including breathing strategies, progressive muscle relaxation, cognitive exercises to decrease negative self-talk, and time management.
In contrast to stress, anxiety is often characterized by a generalized feeling of excessive fear and worry. The anxious feelings are not necessarily associated with any particular life event, although stressors may trigger or exacerbate anxiety. People who experience anxiety typically realize that their worries are in excess of what might be considered reasonable by others; however, they find it difficult to control their fearful thoughts. Anxiety may be chronic and pervasive in multiple aspects of life, and it can become debilitating because it impairs the ability to function at home, school, work, and/or in social settings. Anxiety may cause symptoms such as irritability, muscle tension, digestive problems, and/or sleep disturbance.
Mental health professionals often think of anxiety disorders as a group of diagnosable conditions with very specific criterion. Counselors use the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) to diagnose mental health disorders. In relation to anxiety, the DSM-IV-TR outlines conditions such as phobias, obsessive-compulsive disorder, generalized anxiety disorder, and stress disorders related to extreme trauma. Panic attacks are sometimes associated with anxiety and include somatic symptoms related to breathing, cardiovascular functioning, digestive difficulties, and feelings of dizziness. Panic attacks are sometimes mistaken for heart attacks, and this may cause clients to fear that they are dying.
Interventions for clients who experience anxiety disorders may include psychoeducation about the differences between stress and anxiety, work to reduce negative self-talk which may induce anxiety, breathing strategies, progressive muscle relaxation, or guided imagery, among others.
Sleep is a complex process guided by the body’s hormonal and neurological responses to light and darkness. On typical nights, humans progress through multiple stages of sleep including a period of rapid eye movement (REM), which is when dreams commonly occur. For health reasons, sleep should progress successively through each of these stages, and a healthy sleeper will usually cycle through all of the stages 4 or 5 times per night. Difficulties arise when sleep is disrupted, shortened, or limited. The impact of sleep deprivation is cumulative across time and the consequences of sleep deficit are staggering. People who are consistently sleep deprived are at high risk for heart disease, cancer, and early death. Sleep deprivation is linked to slowed reaction time, impaired cognitive functioning, and difficulties with emotion regulation. Many work-related accidents and injuries are due to fatigue, and car accidents are often linked to sleep-related issues. Therefore, sleep deprivation is a normative concern that is often a critical issue for clients.
Sleep dilemmas can occur across the life span for multiple reasons and are presenting issues in counseling sessions. Adolescents are often sleep deprived due to discrepancies between their circadian rhythms and the demands of school schedules. People between the ages of 13 and 25 often experience a delay in their sleep patterns in which they have difficulty falling asleep prior to 11 p.m. However, most high schools require that teenagers arrive at school early in the morning. This disparity often creates issues of sleep deprivation for high school students. In college, time management difficulties are a frequent difficulty for first- and second-year students, and thus “pulling an all-nighter” is a common undergraduate experience. In adulthood, new parents often have difficulties adjusting to newborn sleep schedules because infants typically are unable to sleep through the night until approximately 6 months of age. Working adults may suffer from sleep deprivation due to challenges involved in balancing work and home life, requirements to do shift or night work, or jet lag from business travel. As adults age, their sleep patterns begin to change, and this may cause difficulties or concerns for older adults.
Counselors might provide assistance for sleep-deprived clients by providing psychoeducation about the importance of sleep and information about sleep hygiene. Counseling sessions may be used to develop strategies to combat insomnia, and mental health professionals can assess for more severe sleep disorders such as sleep apnea, narcolepsy, or sleepwalking.
All of the above intrapersonal issues could be reason enough to seek out counseling, yet these issues may be exacerbated in the context of a relationship with another person. Furthermore, there are also issues that arise from simply being in a relationship with another person, whether or not there are intrapersonal issues in the mix. The following section will cover some of the more common interpersonal issues that bring individuals, couples, or families to counseling.
Understanding, both being understood and understanding the other, is one of the keystones to any good relationship. Clarity in communication and positive communication brings people closer and provides a space for intimacy, shared goal development, and relationship satisfaction. Thus, difficulties in communication may result in more than misunderstanding; they can cause severe breaches in trust and intimacy within relationships.
One common model for communication is the active listening model, which is based on the active listening that is done by a counselor when he or she is working with clients. This model of communication originated in the therapeutic work of Carl R. Rogers, a proponent of demonstrating unconditional positive regard, acceptance, and empathy for clients. By demonstrating active listening through reflective statements, “I-statements” that indicate a nonblaming stance, paraphrasing both the content and feeling behind what was said, and exhibiting a nondefensive posture both verbally and nonverbally, all individuals can improve their communication skills. Active listening is often taught to individuals in the workplace and to couples as they attempt to work through conflicts. When couples employ nondefensive and nonattacking active listening techniques in their communication, they are more likely to be able to work through their difficulties without anger or causing further damage to their relationship.
The active listening model has been criticized for not translating from the therapeutic relationship to a romantic or work relationship as easily as had been hoped. The difficulty is that the active listening model primarily emerged out of “one-way” therapeutic relationships where the job of the counselor was to be nonjudgmental and nondefensive. The critics of the active listening model reflect that in most two-way relationships it is very difficult to maintain a completely nondefensive stance. Thus, although active listening skills may be present, people may not use them in the midst of conflict. Still, teaching the basics of active listening can help with moderately conflictual communication and communication skills training is often part of non-crisis-oriented counseling.
Being in close relation to another person romantically can be one of the most fulfilling and wonderful events in a person’s life. Yet, having a partner also involves negotiating the challenges of sharing one’s life and knowing someone else intimately. Coming from different families with unique ways of approaching conflict, household chores, money management, parenting, emotionality, and displays of affection can produce different expectations for individual behavior in the couple and a sense of a “right” way of being in a relationship. Furthermore, relationships can also be challenged by developmental transitions and unplanned situations. For example, negotiating dual career issues, the transition to becoming parents or the discovery of infertility, parenting adolescents, coping with the “empty nest” when children leave the home, infidelity, sexual issues, and medical illnesses are all issues that could lead an individual or a couple to counseling. These challenges can cause great distress, as they affect not only the couple but also the family, work, and friendships.
John M. Gottman used outcomes from his extensive research into couple relationships to delineate indicators of problematic relational styles. Specifically, he proposed that it is not the simple occurrence of negative interactions that cause distress, but rather the type of interaction. He outlined four problematic ways of interacting that he termed the Four Horsemen of the Apocalypse: criticism, defensiveness, contempt, and stonewalling. Additionally, he discussed the concepts of positive sentiment override and its opposite, negative sentiment override. Positive sentiment override means that if the predominant feeling within a relationship is positive, then small slights or relational errors are overlooked or categorized as unimportant. Conversely, negative sentiment override occurs when the predominant emotion in the relationship is negative, then even an outpouring of positive expression is unlikely to affect the overall well-being of the couple. His studies have revealed that functional relationships exhibit a 5 to 1 ratio of positive to negative interactions within the relationship. When this ratio becomes unbalanced, conflict becomes the main way of communicating and neither partner is satisfied.
The ultimate result of continuing conflict in a relationship is the dissolution of the relationship in either a break-up or divorce. Different people approach grieving the loss of a relationship differently. For some, especially those who did not initiate the separation, the loss of a primary relationship is a devastating event. Others, who are able to make the dissolution of a relationship fit with their views of themselves, do not find the separation as traumatic. One factor that can influence how one reacts to the loss of a relationship is when in the life cycle that the break-up occurs.
For example, a college-age or early marital break-up, while painful, may be considered less devastating than a divorce when there are young children present or after a lengthy partnership.
Difficulties with sexuality can present themselves at almost any point in the life cycle. When couples are first forming their relationship, negotiating sexual intimacy and the presence or absence of past sexually intimate relationships can be problematic. Once the relationship is formed and the couple decides to have children, research has shown that sexual satisfaction plummets with the birth of children and does not improve for several years. Once the children reach adolescence, the sexual concerns of the family turn from the parent couple to the adolescent children and their developing sexuality. Parents are often concerned with protecting children from falling prey to external influences rather than making good personal choices about sexuality. Once the children leave home, the midlife parent couple faces the challenges of getting to know themselves and their sexuality again. Finally, in later life, issues such as menopause, medical issues, general physicality, and the pervasive influence of negative stereotypes regarding elder sexuality can have an extreme impact on sexuality.
Many couples experience difficulty or discomfort as they attempt to discuss their own sexual concerns or as they attempt to discuss sexuality with their children. Therefore, it is not surprising that it is often difficult for clients to openly discuss their sexual concerns with a counselor. Difficulties with sexuality can happen at any point in the sexual response cycle (i.e., excitement, plateau, climax, and resolution), and these difficulties can change based both on internal factors such as stress, low self-esteem, depression, or anxiety, and on external factors such as relationship difficulties, career issues, or balancing the multitude of daily demands and the tasks of everyday living. Additionally, many couples and individuals feel that only medically diagnosable sexual problems—for example, vaginismus (painful contraction of the vagina), erection difficulties, dyspareunia (painful intercourse)—deserve the attention of a counselor and do not realize that counseling can help with sexual enrichment. Yet, counseling can be very helpful for teaching couples to talk openly about their wants, desires, and difficulties, and for educating parents and children in the delicate sexual discourse that is necessary as adolescents began to discover their own developing sexuality.
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