Counselling- premarital,

marital and genetic

Khan Mudasir Qamar
M.Sc. Nursing 1st year
AIIMS, Jodhpur
Premarital counselling
INTRODUCTION:
Premarital counseling is a form of couples therapy that can help the
partners prepare for marriage. It is intended to help the partners discuss
several important issues, ranging from finances to children so that both
of the partners are on the same page. It can also help identify potential
conflict areas and equip the partners with tools to navigate them
successfully. Premarital counseling aims to help a couple build a strong
foundation for marriage.
Types of Premarital Counselling

 Psychoanalytic therapy
 CBT
 Group therapy
Gottman method
The Gottman Method, developed by Drs. John and Julie Gottman,
involves conducting a detailed assessment of you and your partner and
then using a therapeutic framework to address areas of conflict. This
form of therapy aims to improve the quality of friendship between you
and your partner, increase intimacy, and equip you with problem
solving skills that can help you build a stronger relationship.
Techniques

In the initial stages of premarital counseling, both partners may

be assessed, both individually and together. During the counselling,
both partners will be encouraged to share life experiences and events,
which can help shed light on your expectations and motivations in a
relationship. 
Assessing you and your partner

Premarital counselling often requires the partners to fill out a

questionnaire separately to determine how they feel about one another
and what they expect from their relationship. These questionnaires can
help the counsellor identify the strengths, weaknesses, areas of
compatibility, and potential problem areas of the couple. The counsellor
will also assess the dynamic between the partners during counselling
sessions and use those insights to guide the course of the therapy.
Sharing life events and experiences

Premarital counseling can also involve “identifying and exploring

significant life events and early childhood experiences, which impact
the relationship and how each partner relates to the other.”
Discussing important issues

Premarital counselling offers an opportunity to discuss several important aspects of a

marriage, including:
 Finances: Money can be a stressful and contentious issue for married couples, so
deciding how to manage your finances in advance can help prevent problems down the
road. 
 Beliefs, values, and religion: Sharing your beliefs, values, and religious
sentiments with your partner can help foster better understanding and respect. You can
also discuss the implications of these aspects on your daily life.
 Roles in the marriage: It’s important to discuss the roles you expect yourself and
your partner to play in your marriage to prevent conflicts later. 
Discussing important issues

 Activities and time spent together: You and your partner can discuss how
you plan to spend time together and what activities you enjoy doing together.
 Children: Couples sometimes realize after getting married that they are not
on the same page about whether they want to have children. Deciding in
advance whether you want to have kids and how you want to raise them is
important.
 Family relationships: Premarital counselling can offer you a chance to be
honest about your relationships with your own family as well as any
concerns you have about your partner’s family.
What premarital counselling can help with?

Premarital counseling can help you and your partner prepare for married life together.
Below are some aspects premarital counseling can help with.
 Understanding your partner: Premarital counselling can help you develop a better
understanding of your partner. It can help you understand your partner’s beliefs, values,
expectations, motivations, priorities, and routine.
 Setting realistic expectations: This form of counselling allows you to discuss all the
important aspects of married life with your partner so that you both know what to expect.
It also helps identify your strengths and weaknesses as individuals and as a couple.
 Planning for the future: Much like you and your partner would meet with a wedding
planner to plan your big day, seeing a premarital counsellor can help you plan your
marriage and your life together. 
 Benefits of premarital counselling
Premarital counselling is designed to equip you and your partner with tools to navigate married
life together. These are some of the benefits this therapy can offer:

 Learn constructive communication: A core aspect of premarital counselling

is communication, as “partners learn to convey their positions clearly without attacking or
arming the other.”

 Develop conflict resolution skills: Premarital counselling also teaches you and your partner
problem-solving and conflict-resolution skills. “Initially, communication often leads to
conflict, but with time, couples can have more constructive discussions.”

 Focus on the positive aspects: Premarital counselling can help you and your partner focus on
the positive aspects of your relationship rather than the negative.
 Eliminate dysfunctional behaviour: Premarital counselling can
identify unhealthy behaviours and patterns in a relationship and help you correct
them. 
 Build decision-making processes: Premarital counselling can help you and your
partner develop healthy and equitable decision-making processes.
 Alleviate fears related to marriage: If you or your partner are anxious about
what married life will entail, premarital counselling can help you discuss
important issues and give you some clarity.
MARITAL COUNSELLING

Introduction
• Marital counselling, which is also called ‘marriage counselling’ or
‘marital therapy’, is a form of counselling for married couples or
couples who are engaged and are on their path of getting married.
• There is difference between real and ideal life and sometimes striding
for ideal life can lead to conflict. Most of the conflicts in marriages
arise because either of the partner or both the partners strive to
maintain an ideal marriage. In marriage counselling, the counsellor
helps the couple understand each other’s behaviours and few aspects
of their personality, and most importantly they guide the couple to
accept their spouse as they are.
How does marital therapy work?

• Marital therapy is no magic. The couple needs to put in their 100 percent
for them to see the results. Most of the times, what we look at could be
the upper layer of the problem. The cause of any issue can be deep
rooted and uncovering that is what happens in a counselling session.
• In marital counselling sessions, different activities and talk therapy help
the couple to gain insight. Usually, the biggest issue in the life of a
married couple is ‘misunderstandings’, and conflicts arise due to
misunderstandings. In marital counselling sessions, the counsellor
paraphrases whatever the individual says, so that the exact emotion or
feeling reaches to their spouse, which then reduces the chances of
misunderstandings.
Goal of marital therapy

• The goal of marital therapy can vary from couple to couple depending
on what issue each couple is facing. If the couple is facing intimacy
issue, then finding its root cause and working towards creating a plan
where the intimacy issue can be discussed with both the partners can
be the main goal.
• Some of the essential goals in marital therapy can be guiding the
couple towards clear communication, making them empathetic
towards each other’s needs, reducing the defences between them,
discovering each other’s ‘self’, i.e., their individuality etc.
Why do couples seek marital therapy?

Marriage could be like a roller coaster. It can take you higher and higher
with full speed or take you down. It can also take you on a straight way
without the ups and downs. All in all, there can be unpredictable times
in a marriage. But when you start realising that you are continuously
scared or anxious on that roller coaster or are at shouting at full pace
while being on it, then it is time to seek help.
Why do couples seek marital therapy?

Marital counselling can be opted  Conflict regarding parental

for many reasons such as:
 Communication issue.
 Intimacy issue.
 Extended family conflicts.
 Infidelity.
 Separation or divorce.
styles.
 Failing to understand each
other’s point of view.
 Rigidity.
 Decision making.
 Anger management.
 Marital therapy techniques
There are different techniques used in these counselling sessions. The therapist
decides which techniques would be useful for the couple depending on the concerns
they are facing.  Here is a glimpse of some techniques which might interest you-
1. Emotionally Focused Therapy
Here, the aim of the counsellor is to make the couple talk about their feelings and
make them understand their underlying emotions behind those thoughts and
feelings and to convey it to their partner.
2. Cognitive Behavioural Therapy
The core of this therapy is to make one understand how thoughts influences one’s
behaviour. This helps the individual understand how their thoughts control their
actions and how this must happen with their spouse too. Here, the therapist focuses
on thought reversal.
3. Imago Relationship Therapy
The theory behind this therapy is that we project our concept of love, that we developed in our
childhood, onto our partners. The issues can be rooted in that area of life and that is where the
counsellor nudges and guides the individual to gain insight which can lead to resolving the issues.
4. Solution-Focused Therapy
At times, the couple is so focused on their problems, that however simple the solution is, they are
unable to reach to that solution. In such cases, solution-focused therapy works amazingly. Instead
of spending time on finding the root cause, the counsellor directly works on guiding the couples
to find the solution to their issues. 
5. Insight-Gaining Therapy
Insight means deep understanding of someone or something. It is a ‘Eureka’ or ‘Aha!’ moment for
the couple when a counsellor tries to provide insight to their issue and then they try to connect
dots.
6. Positive Psychology Technique
This technique can be beautifully applied on couples who feel they have lost the spark in their
relationship. This technique helps them to remember all great characteristics in their marriage,
reminisce their adventurous days and recreate it all over again!
Benefits of marital therapy

• Marital therapy is not only for the couples who are having issues in
their marriage, but it can also be beneficial for couples who want to
enrich their married life or want to ensure that they are, indeed, in a
happy marriage.
• It is said that you cannot change a person’s behaviour, but what you
can do is implement change in your behaviour or thoughts. Similarly,
if you are open to implement the changes, without being rigid, that
you feel are necessary after gaining insight from the counselling
sessions then you can see immense benefits of counselling.
 Benefits of marital therapy
Few of the most important benefits that the couple can get after or during the marital counselling
sessions are:
 Transparency in discussing any issue.
 Communicating clearly.
 Understanding each other better.
 Reaching to a decision collectively.
 Helps in achieving personal growth.
Marital counsellor helps the couple to understand that sometimes they just need to understand that
their partner is not just their wife or husband, but they are an individual too and understanding
that is the most essential benefit of marital counselling.
 When to seek marriage counselling?

• Every couple fights. But when the fight turns into a war or a cold war between the
couple, then they can take a step forward and consider marital counselling. The
couple can seek counselling when they feel they have grown apart, in cases of
infidelity, or when they are going through a big transition etc. It is mandatory to
seek counselling in cases of divorce.
• “A great marriage is not when the ‘perfect couple’ comes together. It is when an
imperfect couple learns to enjoy their differences.” – Dave Meurer. Sometimes,
thriving for perfection can lead to distress and thriving for happiness can lead to
wellbeing. Know which path your marriage is going on!
 GENETIC COUNSELLING

According to The American Society of Human Genetics, genetic counselling is a communication

process that deals with human problems associated with the occurrence or risk of occurrence of a
genetic disorder in the family
WHAT IS GENETIC COUNSELING?
• Genetic counselling gives you information about how genetic conditions might affect you or
your family. The genetic counsellor or other healthcare professional will collect your personal
and family health history. They can use this information to determine how likely it is that you or
your family member has a genetic condition. Based on this information, the genetic counsellor
can help you decide whether a genetic test might be right for you or your relative.
 REASONS FOR GENETIC COUNSELING

Based on your personal and family health history, your doctor can refer you for genetic
counselling. There are different stages in your life when you might be referred for genetic
counselling:
• Planning for Pregnancy: Genetic counselling before you become pregnant can address
concerns about factors that might affect your baby during infancy or childhood or your
ability to become pregnant, including
1. Genetic conditions that run in your family or your partner’s family
2. History of infertility, multiple miscarriages, or stillbirth
3. Previous pregnancy or child affected by a birth defect or genetic condition
4. Assisted Reproductive Technology (ART) options
 During Pregnancy: Genetic counseling while you are pregnant can address
certain tests that may be done during your pregnancy, any detected problems, or
conditions that might affect your baby during infancy or childhood, including
1. History of infertility, multiple miscarriages, or stillbirth
2. Previous pregnancy or child affected by a birth defect or genetic condition
3. Abnormal test results, such as a blood test, ultrasound, Chorionic Villus Sampling
(CVS), or amniocentesis
4. Maternal infections, such as Cytomegalovirus (CMV), and other exposures such
as medicines, drugs, chemicals, and x-rays
5. Genetic screening that is recommended for all pregnant women, which includes
cystic fibrosis, sickle cell disease, and any conditions that run in your family or
your partner’s family
 Caring for Children: Genetic counselling can address concerns if your child is
showing signs and symptoms of a disorder that might be genetic, including
1. Abnormal newborn screening results
2. Birth defects
3. Intellectual disability or developmental disabilities
4. Autism spectrum disorders (ASD)
5. Vision or hearing problems
 Managing Your Health: Genetic counselling for adults includes specialty areas such as
cardiovascular, psychiatric, and cancer. Genetic counselling can be helpful if you have
symptoms of a condition or have a family history of a condition that makes you more likely to
be affected with that condition, including
1. Hereditary breast and ovarian cancer (HBOC) syndrome
2. Lynch syndrome (hereditary colorectal and other cancers)
3. Familial hypercholesterolemia
4. Muscular dystrophy and other muscle diseases
5. Inherited movement disorders such as Huntington’s disease
6. Inherited blood disorders such as sickle cell disease
CANDIDATES FOR SCREENING
 Women over 35 years
 Family history of neural tube defects
 Previous baby born with neural tube defects
 Previous child with a chromosomal anomaly
 One or both parent’s carrier of sex-linked autosomal traits
 A mentally retarded child with or without congenital anomaly
 History of recurrent abortion
 STEPS OF GENETIC COUNSELING:
1. INITIAL INTERVIEW

The geneticist does not always know what additional information is needed until after the
assessment process, the interview, and the histories are completed. Usually, there is more than one
session anticipated, with information gathered first and a relationship is established first and
plans made to collect other needed data on which to formulate diagnoses or recurrence risks. The
nurse or counselor often conducts the initial interview:

 Obtain an initial appraisal of family interaction or dynamics

 Get the reason they are seeking counseling

 Find out their expectations of genetic counseling.

 Elicit preliminary concerns

 Discuss the usual elements and procedures involved

2. OBTAINING HISTORY AND PREPARING PEDIGREE
• The family history gives the counselor a chance to observe family interactions and
to provide clues for effective approaches when discussing risks and options. It is
very helpful to have both the members of a couple of presents when the history is
taken as one person rarely has precise information about both sides of the family.
3. ESTABLISHING A DIAGNOSIS
• Family history is the first step in the establishment of a diagnosis . Diagnosis
should be confirmed where possible When no diagnosis has been established, then
one of the roles of geneticists is to recommend appropriate testing so that one can
be made. Carrier status should also be established if it is relevant and possible.
4. CALCULATING AND PRESENTING THE RISK
•  In some counseling situations, the calculation of the recurrence risk is relatively
straightforward. However, many factors such as delayed age of onset, and the use
of linked DNA markers, can result in the calculation becoming much more
complex.
• Specialists have developed methods by which they calculate the risk of genetic
diseases.
5. DISCUSSING THE OPTIONS
•  Having established the diagnosis and discussed the risk of occurrence/recurrence,
the counselor is then obliged to ensure that the consultants are provided with all of
the information for them to make their own informed decisions. This should
include details of all the choices open to them. For example, the availability of
prenatal diagnosis should be discussed together with the details of the techniques,
limitations and risks associated with the various methods employed. Alternative
approaches to conception, such as artificial insemination (Al), the use of donor
ova and preimplantation genetic diagnosis.
6. COMMUNICATION AND SUPPORT
• Communication is a two -way process. Often an individual or a couple will be
extremely upset when first made aware of a genetic diagnosis, and it is very
common for guilt feelings to set in the individual or couple. They may look back
and scrutinize every event and happening. Genetic counselors need to take into
account the complex psychological and emotional factors that can influence the
counseling .The setting should be agreeable, private and quiet, with ample time for
discussion.
 ROLE OF NURSE:

 Active listening  Facilitate discussions with other family

 Attend closely to the verbal and nonverbal
messages conveyed by the patient; clarify
messages with follow-up questions.
 Provide privacy and confidentiality during
assessments and conferences
 Review relevant diagnostic procedures.
 Provide information about alternatives
 Assist patient in identifying advantages and
disadvantages of options
members.
 Provide reassurance, acceptance, and
encouragement during the decision-making
process. Be non-judgmental and convey
empathy (non-directive approach).
 Record details of conferences and include
relevant patient quotes.
 Prepare referral forms.
 Guiding a women or couple through prenatal
diagnosis
 Coordinate services of other professionals
 RESEARCH ARTICLE
Effectiveness of premarital sexual counselling program on sexual satisfaction of recently married couples
BilginKirayVural 1, Ayla BayikTemel

Affiliations expand.

 PMID: 19653960

 DOI: 10.1071/SH08065

Abstract
• Background: Through its ability to address and remove fear and misunderstanding and the resulting sexual
reluctance and related problems, pre-marital sexual education and counselling can contribute to sexual satisfaction.
• Methods: This quasi-experimental research conducted in a pre-test-post-test control group design aimed to
examine the effectiveness of nursing interventions on a premarital counselling program and its impacts on the
sexual satisfaction of couples (36 couples in the experimental group and 35 couples in the control group).
Results: Although no difference was detected between the experimental and control
groups in terms of the level of knowledge on pre-test point averages, the difference
between them in terms of post-test knowledge gain averages was statistically
significant. Approval rates for sexual myths in the pre-test were 27.87% in the
experimental group and 37.03% in the control group; in the post-test they were
23.51% and 36.66% respectively. In the experimental group, 80.6% of the women
and 63.9% of the men, and in the control group, 77.1% of the women and 71.4% of
the men were established as having a problem-free sexual life.
Conclusions: It was also discovered that levels of sexual satisfaction were shown to
be higher among women and men in the experimental group who had attended
premarital sexual counselling education than the women and men in the control
group. A recommendation to encourage engaged couples to attend premarital sexual
counselling is made based on the findings. It is thought that an intervention plan
prepared within the framework of the Information, Motivation, Behavioural Skills
theoretical model will help nurses guide recently married couples to greater sexual
satisfaction.
Summary
So we have discussed about premarital, marital, and genetic counselling
and a research article.
Conclusion
Premarital and marital counselling prove as a useful tool for improving
married relationships and help couples to deal with the hassles of
married life.
References
1. https://www.verywellmind.com/premarital-counseling-definition-types-techniques-and-efficacy-5189767
2. https://www.waitt.in/blog/marital-counselling-types-benefits/
3. https://www.cdc.gov/genomics/gtesting/genetic_counseling.htm
4. https://pubmed.ncbi.nlm.nih.gov/19653960/

5. Jacob A. A Comprehensive Textbook of Midwifery and Gynaecological Nursing. 3rd edition. Jaypee
Brothers Medical Publishers (P) Ltd;2012

6. Raman AV. Reeder’s Maternity Nursing. 20thedition. Wolters Kluwer;2020

7. Konar H. DC Dutta’s Textbook Of Obstetrics. 9THedition.Jaypee Brothers Medical Publishers (P) Ltd;2018
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