Counseling Exam Review

013 Defense Mechanisms

2010-12-23T11:57:00.000-05:00

Defense Mechanisms:

1. Compensation - Defenses against feelings of inferiority and inadequacy growing out of real or imagined personal defects or weaknesses.

2. Conversion - Somatic changes expressed in symbolic body language. Psychic pain is given a location in some body part.

3. Denial - Avoidance of awareness of some painful aspect of reality.

4. Displacement - Investment of repressed feelings in a substitute object.

5. Association - Anna Freud’s altruism; obtaining gratification through association with, and helping, another person who is gratifying the same instincts.

6. Identification - Process whereby an individual becomes like another person in one or several respects. A more elaborate process than introjection.

7. Introjection - Taking in of an idea or image so that it becomes part of oneself. An assimilation of object representations into the self representation whenever the boundaries between self and object are blurred.

8. Inversion (turning against the self) - Object of the aggressive drive or impulse is changed from another person to the self. Operative especially in depression and masochism.

9. Isolation of Affect - A splitting off of ideas from the feelings originally associated with them. The idea which remains in consciousness is therefore deprived of its motivational force so that action is thwarted and guilt avoided.

10. Intellectualization - The psychological binding of instinctual drives in intellectual activities. Adolescent preoccupation with philosophy and religion is one common example.

11. Projection - Attributing a painful impulse or idea to the external world.

12. Rationalization - An attempt to give a logical explanation for painful unconscious material to avoid such feelings as guilt and shame.

13. Reaction Formation - Replacement in conscious awareness of a painful idea or feeling by its opposite. The unconscious material remains along with the conscious presence of its opposite.

14. Regression - A retreat to an earlier phase of psychosexual development.

15. Repression - The act of obliterating material from conscious awareness. A special, unique defense, capable of mastering powerful impulses.

16. Reversal - A form of reaction formation aimed at protecting oneself from painful effects.

17. Splitting - External objects are either “all good” or “all bad. “ Sudden shifts of feelings and conceptualizations about an object may occur from one category to the other.

18. Sublimation - The deflection of the energies of instinctual drives to aims that are more acceptable to the ego and superego.

19. Substitution - The substitution of one affect for another; e. g. rage used to mask fear.

20. Undoing - A ritualistic performance of the opposite of an act a person has recently committed in order to cancel out or balance the evil that may have lurked in the act.

21. Identification With the Aggressor- Child introjects some characteristic of an anxiety-evoking object and so assimilates an anxiety experience which he has just undergone. Child is thus able to transform himself from person threatened to person who makes threat.

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013 Sullivan

2010-12-23T11:44:00.001-05:00

SULLIVAN

Interpersonal Theory of Psychiatry

Personality is the product of interaction with other individuals. The need to relate is as basic as biological needs.

Individuals go through seven stages of personality development during their lifetime to try to maintain a balanced psychological outlook as their lives change. He believed that the individual was influenced by expectations of others.

The concept of PERSONIFICATIONS is related to the individual’s perception of THEMSELVES and perceptions of OTHERS. When there is a conflict between these two, the individual must strive to resolve the conflict and bring his/her self-concept into balance.

Sullivan’s Concepts of Interpersonal Relationships

PERSONALITY, according to Sullivan, consists of the characteristic ways in which a person deals with other people in his interpersonal relationships.

Personality is basically the result of interaction with significant other individuals. Sullivan believed that the need to relate to others is as important and necessary as our other biological needs.

Sullivan builds his approach to psychiatry on the study of personality characteristics which can be directly observed in the context of interpersonal relationships.

Personality is formed by the interpersonal relationships an individual has, especially with close persons, during his entire lifetime.

Patterns of behavior are modified during aging process, but the basic core remains.

Anxiety is one of the central concepts of interpersonal psychiatry. Sullivan employs this term in a special way. He has a very broad concept of anxiety. By anxiety he means basically all basic types of emotional suffering; thus, anxiety includes anxiousness, guilt, shame, dread, feelings of personal worthlessness, etc. Anxiety can be viewed as a warning signal. All causes of anxiety have one thing in common. They threaten the individual’s feelings of personal worth and competence; they erode his concepts of himself as a capable, esteemed person. Hence, anxiety has a tendency to bind a person in whatever unhealthy interpersonal patterns he has.

Anxiety is always interpersonal in origin. It always arises from long-term or short-term unhealthy relationships between people.

The major task of psychiatric treatment is to decrease the various kinds of emotional discomforts grouped under the term “anxiety,” and thus, to facilitate better interpersonal adjustments.

Eventually, the individual develops a concept of himself called (SELF-DYNAMISM) . This is accomplished by developing and stressing characteristics which meet with approval from significant others and de-stressing aspects which meet with disapproval.

SECURITY AND SECURITY OPERATIONS

Security is the opposite of anxiety. It is a state of relaxed comfort in which an individual feels no apprhensiveness, self-doubt, guilt, inadequacy, or any other kind of emotional distress. People seek security as a result of the prolonged period of helpless experienced in infancy.

A security operation is a kind of interpersonal action or attitude (which we are often unaware of) a person seeks to abolish anxiety and to become emotionally at ease.

Healthy security operation achieves its goal of diminishing anxiety and increasing security without interfering with the individual’s interpersonal competence.

An unhealthy security operation, on the other hand, reduces anxiety and increases security at a certain cost to the individual. The kinds of costs are extremely varied. They may be limitations in the person’s interpersonal capacities, or they may consist of some kind of emotional discomfort.

It is important to remember that each security operation whether healthy or unhealthy, is interpersonal in nature; it occurs in the context of an individual’s relationship with another person or with a group of persons. It is not an unobservable process going on in something called the “mind.”

One of the most common, and easily defined, healthy security operations is sublimation. In sublimation, a person discharges and gives expression to uncomfortable feelings in interpersonally acceptable ways.

Another security operation, which often works in a healthy way, is selective inattention. In selective inattention, an individual (in ways of which he is not aware) fails to observe a stressful or emotionally repulsive thing that is occurring in an interpersonal relationship in which he is involved. He simply blots it out from his perception.

Another security operation, which may operate in healthy or unhealthy ways, is called by Sullivan the “as if” process. In an “as if” security operation, an individual behaves “as if” he were someone other than himself in an interpersonal situation. He adopts and acts out a role; the role is false, but it nevertheless makes practical and comfortable an otherwise painful interpersonal situation.

Unhealthy security operations cause a large number of the states which are labeled psychiatric illnesses.

THE SELF-SYSTEM

The word self-system is more accurately conveyed by the term self-protecting system. The self-system is composed of all the security operations by which a person defends himself against anxiety and seeks emotional security. Restated in different words, the self-system is composed of all a person’s characteristic, customary interpersonal devices for protecting himself against emotional distress and for seeking more emotional comfort. Sullivan acknowledged this is not observable however the security operations are. (the black hole )

Most people get along fairly well with most other people much of the time. Thus, Sullivan says, there is a basic tendency toward emotional health and sound interpersonal functioning. If other things do not interfere, personalities tend to grow in healthy ways, and interpersonal relationships tend to proceed in a sound manner.

AWARENESS AND UNAWARENESS

Awareness and unawareness are fundamental concepts in Sullivan’s system of psychiatry, and they differ much from the concepts of “consciousness” and ‘unconsciousness” of Freud, Jung, and others. Sullivan feels that the “un-conscious mind” is a metaphorical concept which Freud invented and that its existence can no more be demonstrated than the existence of other metaphorical concepts. However, a person’ s awareness or unawareness of something can be objectively demonstrated by talking. Moreover, a matter of common observation is that every person is unaware at each moment of many aspects of their behavior. If a person has a high degree of awareness of his personality structure and how it was influenced by the experiences of his early life, he may, in essence, be able to say, “I am aware that the way I was brought up leads me to be very tense and often irritable when things go wrong in ways that undermine my self-confidence and self-esteem.

A person who is unaware of the nature of his interpersonal experiences learns nothing from them; he says that a person who is unaware of something in his interpersonal life simply does not experience it.

The cause of unawareness is anxiety. Abrupt confrontation with the things he excludes from his awareness usually makes a person feel anxiousness, guilt, shame, loathing of himself, or some other form of emotional discomfort.

A psychiatrist’s role is to participate, as an expert in interpersonal relationships and emotional functioning, in observing and helping a person who has problems in these areas; the therapist is not watching from the audience but up on the stage with the client.

PARATAXIC DISTORTIONS

A parataxic distortion occurs when an individual treats another person as if he were someone else, usually a significant, close person from the individual’s past life.

CONSENSUAL VALIDATION

The process by which unhealthy interpersonal patterns are corrected. In consensual validation, a person arrives at a healthy consensus with one or more people about some aspect of his feelings, through individual interpersonal relationships, and this consensus is validated by repeated experiences which emphasize its soundness.

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012 Delirium

2010-12-16T10:46:00.001-05:00

DELIRIUM:

Diagnostic Features

The essential feature of a delirium is a

(1) disturbance of consciousness that is accompanied by a change in cognition that cannot be better accounted for by a preexisting or evolving dementia.

(2) The disturbance develops over a short period of time, usually hours to days, and tends to fluctuate during the course of the day.

(3) There is evidence from the history, physical examination, or laboratory tests that the delirium is a direct physiological consequence of a general medical condition, Substance Intoxication or Withdrawal, use of a medication, or toxin exposure, or a combination of these factors.

(4)The disturbance in consciousness is manifested by a reduced clarity of awareness of the environment.

(5)The ability to focus, sustain, or shift attention is impaired (Criterion A). Because of these problems, it may be difficult (or impossible) to engage the person in conversation.

(6) There is an accompanying change in cognition (which may include memory impairment, disorientation, or language disturbance) or development of a perceptual disturbance (Criterion B).

h) (Dementia) Alzheimer's symptoms and causes (DSM IV, pgs 133 143)

WHAT IS ALZHEIMER'S DISEASE? CAUSES?

Specific Cufture, Age, and Gender Features

Late onset (after age 65 years) of Dementia of the Alzheimer's Type is much more common than early onset. The disorder is slightly more common in females than in males.

Prevalence

Between 2% and 4% of the population over age 65 years is estimated to have Dementia of the Alzheimer's Type. The prevalence increases with increasing age, particularly after age 90 years.

Course

The course of Dementia of the Alzheimer's Type tends to be slowly progressive. A common pattern is an insidious onset, with early deficits in recent memory followed by the development of aphasia, apraxia, and agnosia after several years. The average duration of the illness from onset of symptoms to death is 8-10 years.

Familial Pattern

Compared with the general population, first degree biological relatives of individuals with Dementia of the Alzheimer's Type, With Early Onset, are more likely to develop the disorder.

Diagnostic criteria for Dementia of the Alzheimer's Type

A.        The development of multiple cognitive deficits manifested by both

(1)        memory impairment (impaired ability to learn new information or to recall
previously learned information)

(2)        one (or more) of the following cognitive disturbances:

        (a) aphasia (language disturbance)
        (b) apraxia (impaired ability to carry out motor activities despite intact motor function)
        (c) agnosia (failure to recognize or identify objects despite intact sensory function)
        (d) disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting)

B.        The cognitive deficits in Criteria Al and A2 each cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning.

C.        The course is characterized by gradual onset and continuing cognitive decline.

D.        The cognitive deficits in Criteria A1 and A2 are not due to any of the following:

(1)        other central nervous system conditions that cause progressive deficits in memory and cognition (e.g., cerebrovascular disease Parkinson's disease, Huntington's disease, subdural hematoma normal pressure hydrocephalus, brain tumor)

(2)        systemic conditions that are known to cause dementia (e.g., hypothyroidism, vitamin B12 or folic acid deficiency, niacin deficiency, hypercalcemia, neurosyphilis, HIV infection)

(3)        substance induced conditions

E.        The deficits do not occur exclusively during the course of a delirium.

F.        The disturbance is not better accounted for by another Axis I disorder (e.g., Major Depressive Disorder, Schizophrenia).

Treatment:

Group therapy with "revisiting" (memories, past activities, etc.)
Rx for depression
Utilize strict structural techniques
Family involvement

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012 Research

2010-12-16T10:34:00.001-05:00

RESEARCH

Association in bivariate data means a systematic connection between changes in one variable and changes in the other.

When an increase in one variable tends to be accompanied by an increase in the other, the variables are positively associated.

When an increase in one variable tends to be accompanied by a decrease in the other, the variables are negatively associated.

The correlation coefficient, r, makes sense as a measure of association; it is positive when the association is positive, and negative when the association is negative.

The correlation coefficient, r, always has a value between -1 and +1.

The extreme values of r= -1 and r=+1 indicate perfect straight line association. In particular, r=-1 means that all of the data points fall exactly on a straight line having negative slope. And r=+1 means that all of the data points fall exactly on a straight line with positive slope.

The correlation coefficient, r, measures how tightly the points on a scatter plot cluster about a straight line. That is, r does not measure association in general but only straight line association. Correlations near either +1 or -1 indicate that the points fall close to a straight line, When r>0, the scatter plot shows a trend from lower left to upper right, and the line about which the points cluster has positive slope. For r<0, the trend is from upper left to lower right and the slope is negative.

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011 Dependent Personality Disorder

2010-12-08T11:04:00.001-05:00

Dependent Personality Disorder

Diagnostic Criteria

A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1.        has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.

2.        needs others to assume responsibility for most major areas of his or her life.

3.        has difficulty expressing disagreement with others because of fear of loss of support or approval. Note: Do not include realistic fears of retribution.

4.        has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy).

5.        goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.

6.        feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.

7.        urgently seeks another relationship as a source of care and support when a close relationship ends.

8.        is unrealistically preoccupied with fears of being left to take care of himself or herself.

Associated Features

                Depressed Mood

                Anxious/Fearful/Dependent Personality

                Dramatic/Erratic/Antisocial Personality

Differential Diagnosis

Mood Disorders; Panic Disorder; Agoraphobia; general medical conditions; Borderline Personality Disorder; Avoidant Personality Disorder; Personality Change Due to a General Medical Condition; symptoms that may develop in association with chronic substance use.

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011 Values- Native Americans

2010-12-08T11:01:00.001-05:00

Values - Native Americans

1. Sharing-Honor and respect are gained through sharing.

2. Cooperation-Family and group take precedence over the individual.

3. Noninterference-They are taught not to interfere with others; observe as opposed to react.

4. Time Orientation-More involved in the present than in the future. Planning and punctuality is not really important.

5. Extended family orientation-Strong respect for elders and interrelationships between large numbers of people.

6. Harmony with nature-Native Americans practice acceptance as opposed to trying to control their environment.

7. Value differences produce numerous problems for the culturally diverse counselor, especially when they are judged from a non- Native Indian perspective.

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010 What is the DSM IV?

2010-12-06T11:58:00.001-05:00

What is the DIAGNOSTIC & STATISTICAL MANUAL OF MENTAL DISORDERS, FOURTH EDITION (DSM IV)?

The purpose of DSM IV is to provide clear descriptions of diagnostic categories in order to enable clinicians and investigators to diagnose, communicate about, study, and treat people with various mental disorders. (DSM IV, p. xxvii).

The DSM IV provides a means of classifying psychiatric and psychological disorders for treatment and research purposes (American Psychiatric Association, 1994).

The DSM IV employs a multiaxial classification system:

1. Axis I. Clinical disorders and other conditions that may be a focus of clinical attention

2. Axis II. Personality disorders and mental retardation

3. Axis III. General medical conditions

4. Axis IV. Psychosocial and environmental problems

5. Axis V. Global assessment of functioning

The clinical disorders included on Axis I encompass all mental disorders except personality disorders and mental retardation. The Axis I disorders are classified into 15 broad categories, such as mood, anxiety, and adjustment disorders. Nonpsychiatric conditions that may be a focus of clinical attention are noted on Axis I. These conditions include the V codes, which pertain to relational problems, bereavement, identity problems, phase of life problems, academic problems, occupational problems, and other issues often addressed in counseling. Each disorder is defined in terms of specific criteria.

Axis II differs from Axis I by focusing on personality disorders or mental retardation conditions that may underlie the presenting problem. Axis ll disorders are a maladaptive personality function.

Personality disorders (Axis II) refer to lifelong maladaptive behavior patterns that are often triggered by specific events in the person’s life. DSM IV defines a total of 10 personality disorders grouped in three categories as indicated below:

Cluster A: Emotional withdrawal and odd behavior includes paranoid, schizoid, and schizotypal personality disorders

Cluster B: Exaggerated, dramatic emotionality includes antisocial, borderline, histrionic, and narcissistic disorders

Cluster C: Anxious, restive submissiveness includes avoidant, dependent, and obsessive compulsive disorders

Personality disorders represent extreme forms of personality traits (i.e., enduring and pervasive patterns of behavior) that have become dysfunctional for the person. The trait is expressed in such a rigid or inappropriate manner that it interferes with that person’s adjustment.

People with personality disorders usually lack insight into the source of their difficulties. Clients do not usually seek counseling because of a personality disorder itself but because of difficulties associated with the disorder.

The third axis of DSM IV lists any current physical illness or cognition problem of the individual.

The fourth axis identifies psychosocial stressors faced by the client, such as problems with a primary support group or occupational problems.

The fifth axis rates the client’s general level of functioning on a 100 point scale at the time of evaluation.

The five axes together offer an integrated view of a client’s problems from the standpoint of a biopsychosocial model of human functioning.

Mental Disorders

        Inability to function

        Verbalizes in distress

        May be harmful to self or others

3 rules: Mental disorders are:

1. Not due to direct affect of a substance

2. Not due to a medical problem

3. Not due to a significant impairment in function

Affect is a subjective feeling that is overt and another person can see, the feelings change frequently, are transitory, short duration, goes and comes, not permanent.

Mood is more general and pervasive, sustained emotion that is heavy, lasts longer, and affects the body.

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010 Value Conflicts in Counseling Asians

2010-12-06T11:46:00.000-05:00

Value Conflicts in Counseling Asians

1. Differences between Asian patients and American Trained Therapist. Asians focus on the following:
1. Interdependence
2. Appropriate social relationships
3. Live in harmony with nature
4. Treatment short and rapid
5. Mental illness represents family failure

2. Physical complaints are common and culturally accepted means of expressing psychological and emotional stress.

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009 Dual Diagnosis

2010-11-30T10:50:00.000-05:00

WHAT IS MEANT BY DUAL DIAGNOSIS?

Dual Diagnosis refers to the co-occurence of mental health disorders and substance abuse disorders (alcohol and/or drug dependence or abuse).

Class Note: Dual Diagnosis is a diagnois given to an individual who has both a substance abuse/dependence disorder and a mental heath diagnosis - either Axis 1 or Axis ll.

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009 Statistical Tests for True Experimental Designs

2010-11-30T10:49:00.001-05:00

STATISTICAL TESTS FOR TRUE EXPERIMENTAL DESIGNS

T test typically used to test for significance when there are two groups as in the Post-test Only Control Group Design.

Analysis of Variance typically used to test for significance when you have three or more groups as in the Solomon Four Group Design.

Analysis of Covariance is typically used to test for significance when posttest means are compared using the pretest means as in the Pre-test/Post-test Control Group design.

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008 Dysthymia

2010-11-29T11:01:00.000-05:00

WHAT IS DYSTHYMIA?

A depressed mood that is chronic and relatively continual. Unlike major depression, dysthymia may last for years.

Dysthymic Disorder

Diagnostic Criteria

A.        Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.

B.        Presence, while depressed, of two (or more) of the following:

                poor appetite or overeating

                insomnia or hypersomnia

                low energy or fatigue

                low self-esteem

                poor concentration or difficulty making decisions

                feelings of hopelessness

C.        During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms in Criteria A and B for more than 2 months at a time.

D.        No Major Depressive Episode has been present during the first 2 years of the disturbance (1 year for children and adolescents); i.e., the disturbance is not better accounted for by chronic Major Depressive Disorder or Major Depressive Disorder, In Partial Remission.

Note: There may have been a previous Major Depressive Episode provided there was a full remission (no significant signs or symptoms for 2 months) before development of the Dysthymic Disorder. In addition, after the initial 2 years (1 year in children or adolescents) of Dysthymic Disorder, there may be superimposed episodes of Major Depressive Disorder, in which case both diagnoses may be given when the criteria are met for a Major Depressive Episode.

E.        There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder.

F.        The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder, such as Schizophrenia or Delusional Disorder.

G.        The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

H.        The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

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008 Quick Statistics Tip

2010-11-29T10:56:00.000-05:00

Know the differences between:

Type I and Type II Errors

Hypothesis and Null Hypothesis

Inferential and Descriptive Statistics

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007 Albert Ellis and REBT

2010-11-24T12:54:00.001-05:00

ALBERT ELLIS AND RATIONAL EMOTIVE BEHAVIOR THERAPY (REBT)

HISTORIC ASPECTS OF REBT

REBT was first introduced in 1955 by Albert Ellis as Rational Therapy (RT). Later it became Rational Emotive Therapy (RET; Ellis, A., 1999). It finally changed to Rational Emotive Behavior Therapy (REBT) because it involves not only rationality and emotions but includes behavioral change as well.

Ziegler (1999) sets forth the argument that if REBT is to survive the 21st century, a base that has a detailed theory of personality needs to be developed. The theory needs to be broad-based and capable of being empirically tested. While this is an interesting proposition, we already have many defined personality theories. I'm not sure there is much left to be said regarding personality. It will be interesting to see if Albert Ellis is able to come up with new concepts relative to personality that reflect his REBT concepts.

BASIC CONCEPTS

REBT holds that human disturbance is composed of biological and environmental factors that manifest as irrational beliefs. The client is a whole person with the ability to think, feel, and behave. All parts of the person need to be addressed in therapy, especially the interaction with the environment.

According to Ellis (1998), early childhood conditioning is composed of musturbatory philosophies (the evolutionary origin of grandiose must's), verbalizations and self-talk (such as importantizing and sacredizing), and secondary disturbances or stressors. Reframing is an important tool in revisiting these irrational thoughts during adulthood. As an adult with broadened intellectual and emotional experience, the must's and should's presented in childhood can be addressed with new perspective.

APPLICATIONS

In a study looking at the relationship between rational thinking and intelligence in children, it was found that intelligence was not a significant factor. All of the 65 third graders were able to grasp the concepts behind REBT. Further, intelligence was not a predictor of possessing rational beliefs. They made no mention of whether higher intelligence was a predictor of irrational beliefs. This would be an interesting variable to measure.

REBT has been expanded to include grief therapy. In REBT, death is viewed as a negative and traumatic event that affects the belief system and relative consequences. There is a distinction between functional and dysfunctional grief. Dysfunctional grief is operationally defined as a specific focus on and ruminating of pain. The goal of REBT grief therapy is facilitating a functional, healthier course of grief.

Both REBT and CBT have been adapted for the elderly. Since the elderly is the fastest growing segment of our population, it is good that these powerful therapies can be used with them. Often the elderly feel abandoned. This can be an irrational belief that is based on the fear of being alone. Also, letting go of some of the rigid beliefs of the must's and should's will be useful when dealing with the elderly. The world and its values have drastically changed in the last 60-80 years. REBT would be a great help in the elderly accepting the behavior of the younger generation.

APPLIED TO VARIOUS DISORDERS

REBT has been adapted for use with many psychological disorders. DiGiuseppe and Mascolo (1999) developed a treatment model for the poly-substance abuser. In this case study, a 35-year-old male with alcohol and cocaine abuse had a moderate improvement with REBT. This study should have been longitudinal. I was left with not knowing if REBT could be helpful with this case study had it been longer.

Solomon (1998) found clients that suffered from recurrent depressive episodes have a trait-like irrationality as part of their personalities. Whereas, those that have singe episodes with major depression have a trait-like vulnerability. This study is very interesting in that it discovers trait instead of just measuring behaviors. The researchers used multiple measures of irrationality and compared depressed and never depressed individuals. They suggest that those likely to have depression may have irrationally primed negative mood states. REBT should be quite successful in addressing negative moods. This is a promising finding for treatment of depression.

Gandy (1999) used REBT to assist clients with disabilities to accept and adjust to their condition. This article just discusses the new model being developed for those with disabilities becoming more quickly adjusted. There is no data offered for our review. It seems reasonable that REBT would be useful in this arena.

Cowan and Scott (1997) conducted a pilot study with clients with anxiety disorders and found REBT to be successful in modifying the irrational beliefs and anxiety. This study was small, with only 17 subjects. The pre and post measurements indicate that REBT is useful in treating anxiety.

Tafrate and Kassinove (1998) found some improvement with REBT in situational anger producing experiences for men already in anger counseling. The therapeutic relationship and rehearsal techniques are credited for the change in irrational or irrelevant self-statements. This study worked with 45 men aged 20-56 years of age who received 12 sessions of repeated anger-provoking verbal barbs while they rehearsed rational, irrational, or irrelevant self-statements. Those who practiced rational self-statements measured less angry on a questionnaire and a dynamometer frequency machine. It appears that systematic desensitization may have been working here as well as REBT. I'm not sure what they were measuring, perhaps a confound is at work.

Aeschleman and Imes (1999) found only limited success with REBT in adults with traumatic brain injury. This is reasonable, since they would have compromised cognitive abilities and REBT requires keen cognitions.

COMPARISON TO OTHER THERAPIES

In a study that encompassed 6 sessions of both Person-Centered and Rational-Emotive Therapy, judges found no difference in the client emotional involvement achieved in either therapy. This study was interesting because the sessions were conducted by Carl Rogers and Albert Ellis respectively. The judges did agree that emotional involvement is an important factor for successful therapy. If the founders could not invoke differences, it appears we are free to use the type of therapy that most closely resembles the client's world view.

A dissertation compared Alcoholic's Anonymous (AA) to REBT. Although AA has been very successful for many alcoholics, there are some that do not succeed with the program. This study looked at locus of control as a possible explanation for the known lack of success in AA. The study found that those with an internal locus of control found the REBT more conducive to success than AA. This study could be useful in determining the course of treatment for an internal locus of control client from a new perspective. Perhaps locus of control should be measured before determining a specific treatment plan.

Bishop and Fish (1999) conducted a study with 115 undergraduates using Socratic disputing, REBT, and solution-focused questioning (the miracle question). All subjects preferred the collaborative style of the solution-focused questioning to the other two types of questioning. While REBT can be confrontational, it can also be used in a more collaborative style as well. This study may need to be expanded for additional data.

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REFERENCES

Aeschleman, S.R., & Imes, C. (1999). Stress inoculation training for impulsive behaviors in adults with traumatic brain injury. Journal of Rational Emotive and Cognitive Behavior Therapy, 17(1), 51-65.

Bishop W., & Fish, J.M. (1999). Questions as interventions: Perceptions of Socratic, solution-focused, and diagnostic questioning styles. Journal of Rational Emotive and Cognitive Behavior Therapy, 17(2), 115-140.

Cowan, D., & Scott, B. (1997). Group therapy for anxiety disorders using rationale emotive behaviour therapy. Australian and New Zealand Journal of Mental Health Nursing, 6, 164-168.

DiGiuseppe, R., & Mascolo, J. (1999). Thinking your way clean: Rational emotive behavior therapy with a poly-substance abuser. In E.T. Dowd (Ed.); L. Rugle (Ed.), Comparative treatments of substance abuse. (pp. 127-143). New York, NY: Springer Publishing Co., Inc.

Ellis, A. (1998). Early theories and practices of rational emotive behavior therapy and how they have been augmented and revised during the last three decades. Journal of Rational Emotive and Cognitive Behavior Therapy, 17(2), 69-93.

Ellis, A. (1999). Why rational-emotive therapy to rational emotive behavior therapy? Psychotherapy, 36(2), 154-159.

Gandy, G.L. (1999). Rational emotive behavior therapy (REBT): A cognitive-behavioral approach to acceptance and adjustment to disability. In G.L. Gandy (Ed.); E.D. Martin, Jr. (Ed.), Counseling in the rehabilitation process: Community services for mental and physical disabilities. (pp. 234-350). Springfield, IL:Charles C. Thomas Publisher

Solomon, A. (1998). Primed irrational beliefs of formerly depressed and never depressed individuals. Dissertation Abstracts International, 58(9-B), 5141.

Tafrate, R.C., & Kassinove, H. (1998). Anger control in men: Barb exposure with rational, irrational, and irrelevant self-statements. Journal of Cognitive Psychotherapy, 12(3), 187-211.

Ziegler, D.J. (1999). The construct of personality in rational emotive behavior therapy (REBT) theory. Journal of Rational Emotive and Cognitive Behavior Therapy, 17(1), 19-32.

007 Parsons' Trait Factor Theory

2010-11-24T12:41:00.001-05:00

PARSONS

Trait Factor Theory - concept of matching aptitude and interest profiles with requirements of jobs

Another name for the Trait Factor theory is ACTURIAL or “MATCHING”

What’s wrong with this idea?

Based on the early 1900’s theory of career guidance and the belief that traits are innate and stable over time. If you’ve watched Jerry Springer, you KNOW ‘nothin is stable over time and guess what--research for the most part backs this up....

It’s also a “no duh” that Parsons’ simplistic, deterministic theory just doesn’t fit in with the complex 21st society we live in.

Don’t dump the baby out with the bath water just yet, you still need to know about it for the exam. It was the beginnings of Career Development and relied on testing, testing and you guessed it--testing.

Trait/factor theory was the forerunner of SIGI, CHOICES and other computer systems that you probably took in college and indicated that you would be better suited working as a corn farmer in Nebraska than a therapist in the big city....

Well, if you don’t pass the exam this time, you at least have a direction for an alternative career. Shucking corn, can’t be THAT all difficult... Just kidding!

Traits = personal attributes, strengths, and weaknesses
Factors= conditions for success
True Reasoning = best decision

PARSONS = father of Vocational Guidance

Tripartite emphasis:
1. The individual
2. The occupation
3. The relationship between them

http://counselingexam.com

006 Histrionic Personality Disorder

2010-11-22T11:02:00.001-05:00

Histrionic Personality Disorder

Diagnostic Criteria

A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1.        is uncomfortable in situations in which he or she is not the center of attention

2.        interaction with others is often characterized by inappropriate sexually seductive or provocative behavior

3.        displays rapidly shifting and shallow expression of emotions

4.        consistently uses physical appearance to draw attention to self

5.        has a style of speech that is excessively impressionistic and lacking in detail

6.        shows self-dramatization, theatricality, and exaggerated expression of emotion

7.        is suggestible, i.e., easily influenced by others or circumstances

8.        considers relationships to be more intimate than they actually are

Associated Features

                Depressed Mood

                Somatic/Sexual Dysfunction

                Anxious/Fearful/Dependent Personality

                Dramatic/Erratic/Antisocial Personality

Differential Diagnosis

Borderline Personality Disorder; Antisocial Personality Disorder; Narcissistic Personality Disorder; Dependent Personality Disorder; Personality Change Due to a General Medical Condition; symptoms that may develop in association with chronic substance use.

http://counselingexam.com

006 Super Developmental Theory

2010-11-22T10:58:00.001-05:00

SUPER

Self-concept and life stages

SUPER - Developmental Theory

(life roles have an impact on career choice)

Super believed that there were five vocational developmental tasks. Like other developmental systems, the lower tasks must be resolved before the higher tasks can be accomplished.

Crystallization (14-18 years old)
Specification (18-21 years old)
Implementation (21-24 years old)
Stablization (24-35 years old)
Consolidation (35 years +)

The concept of vocational maturity is to the degree that a person has completed these vocational developmental tasks.

Super theories have been developed into a number of assessment tools:

1 CDI (Career Development Inventory) - by Super
2. CMI (Career Maturity Inventory) - by Crites

Vocational Developmental Stages:

growth (birth-age 14 or 15)
exploratory (ages 15-24)
establishment (ages $35.00-44)
maintenance (ages 45-64)
decline (ages 65+)

Super believed that people are both rational and emotional and that the best career counseling would ask the following kinds of questions:

1. What sort of person do I think I am?
2. How do I feel about myself as I think I am?
3. What sort of person would I like to be?
4. What are my values and needs?
5. What are my aptitudes and interests?
6. What can I do to reconcile my self-ideal with my real self?
7. What outlets are there for me with my needs, values, interests, and aptitudes?
8. How can I make use of these outlets?

Super’s cycle of interviewing:
1. Nondirective problem exploration and self-concept portrayal
2. Directive topic setting, for further exploration
3. Nondirective reflection and clarification of feeling for self-acceptance and insight
4. Directive exploration of factual data from tests, occupational pamphlets, extracurricular experiences, grades, etc., for reality testing
5. Nondirective exploration and working through of attitudes and feelings aroused by reality testing
6. Nondirective consideration of possible lines of action, for help in decision making

Super’s theory of career development, called (take a breath) differential-developmental-social-phenomenological psychology, is broader and more inclusive than Ginzburg’s (with a name like that, it had better be). Super said that Ginzburg did not have a meaningful definition of occupational choice and disagreed with the bright red line drawn between choice and adjustment. Instead, Super proposed intrinsic relationships between self-concept and career over time, using the following key concepts:

Life Stages -- Five developmentally different life stages, each with its own life-tasks, which are:

growth -- from birth to about age 14, this stage includes fantasy(ages 4 to 10), interest (ages 11 to 12), and capacity (ages 13 to 14). Primary tasks are creating self-concept and getting a fix on the world of work (harder if you’re dad is Ward Cleaver, since you’ll never know what exactly it is that he does for a living).

exploration -- from about ages 14 to 24, including the tentative phase (from approximately ages 15 to 17). The main concerns here are coming to, identifying, and working toward a vocational preference.

establishment -- from about ages 24 to 44, including stabilization (about ages 24 to 30) and advancement (about ages 30 to 44). The matters at hand here are firming up vocational preference and advancing in the work.

maintenance -- approximately ages 44 to 64. Now the trick is to hold on to gains and status without growing feet of clay.

decline -- from about age 64 on, including deceleration (about ages 64 to 70) and retirement (from about age 70 on). This is when the only thing left is to ease out work and into retirement. (Do you get another chance? No, sorry old sport, that was it).

Career development is viewed as an ongoing, continuous life long process with the career that an individual chooses an expression of their self-concept. As you grow and your self-concept becomes larger (better? closer to self-actualization?), you might find yourself changing jobs to better express your new and improved self-concept. Your McDonalds job might have been pretty cool at 16, but repeating “Would you like fries with that order” for the zillionth time at age 47 might indicate that Houston, we have a self-concept problem here....

Of course, cultural and economic factors are going to dictate job choices in relationship to individual needs, resources and life experience. Living in Utah on a sheep ranch your entire life might preclude your dream of being a world class surfer from coming true.

And of course your choice of a career, according to Super, is an expression of career maturity. If your desire to be one of the Spice Girls at age 8 is still a burning desire at age 44, you might want to talk to a career counselor to get a second opinion on what’s wrong with this picture. And if you’re a guy with this dream, well, gosh, there might be some issues you need to explore and resolve.

http://counselingexam.com

005 Mental Retardation

2010-11-18T11:28:00.001-05:00

Mental Retardation

(DIAGNOSIS OF MENTAL RETARDATION INVOLVES WHAT CRITERIA?)

1. IQ 70 or below

2. deficits in adoptive functioning

3. noticed prior to age 18

Mild 55-70 IQ most common, communication development in pre school, can achieve academic to 8th grade, can acquire social and work skills to survive.

Moderate IQ 35-55, social skills in childhood academics to 2nd/4th grade, learn semi skilled task in supervised setting.

Severe, IQ 20-35. Poor motor skills, don’t learn to talk until school age, learn only basic skills, simple task under close supervision.

Profound - need highly structured environment due to neurological condition.

Do better and live longer in community or home environment. With early training IQ can be raised 5%.

Etiology - biological or psychological or both, 40% don’t know the cause, 60% we do. Problems during pregnancy or medical condition during childhood. Early deprivation or another mental disorder.

TX - provide family support, maximize child’s potential, behavior modification for Impulsivity control, teach social/domestic skills.

http://counselingexam.com

005 Group Counseling Theory

2010-11-18T11:24:00.001-05:00

Group Counseling Theory

Theoretical approaches to group therapy and dynamics conveniently depend on what the group is and who’s doing the research, perhaps putting the lie to social science as the road to Shangri La. Cartwright and Zander gamely argue that many disparate theories merely validate each and propose (with the confidence of their Victorian forebears) that one day when we know more, a unifying theory will show us to the broad sunlit uplands of useful improvement.

Toseland and Rivas list the following five theories important to group practice:

psychoanalytic theory (Freud, et al.)
learning theory (Bandura)
field theory (Lewin)
social exchange or interaction theory (Blau; Homans; Thibaut and Kelly)
systems theory (Anderson; Olsen)

Cartwright and Zander add four others:

sociometric orientation (Jennings; Moreno)
general psychology orientation (looking at individual group members)
empericist-statistical orientation, or group syntality theory (Cattell)
formal models orientation (French & Snyder; Harary, Norman, & Cartwright; Simon)

Shaw includes the FIRO theory of interpersonal relationships (Schutz), along with group congruence theory (Benoit-Smullyan). While emphasizing the interworking of theory and research, Shaw quite sensibly sees each theory as adding its unique part to understanding group behavior.

Eclectic approach -- Corey & Corey suggest therapists take parts from various theoretical models to create a personal approach in tune with their own philosophies of helping and leadership.

Whole Group and Individual

Therapists choose between working with the group as a whole and working with individual members in the group.

Whole group -- This approach attends to group setting, relationship building, task, and process. According to Yalom, process comments serve to keep the group in the moment and help members appreciate how they relate to one another. This should maintain group awareness and goal orientation.

Individual -- As basically individual therapy in a group setting, this approach is sometimes called vertical intervention (as opposed to whole group, horizontal intervention). Kissen suggests that the same therapist may use whole group or the individual approach depending on a group’s internal dynamics.

Outcome and Process

Research into outcome seeks to find out how well groups work, while research into process investigates how they work. What studies there are suggest the heartening result that group therapy is better than no therapy at all, but there’s not enough research out there to definitively compare group to other therapy outcomes. From a research standpoint, it’s uncertain exactly how and why groups work as treatment.

http://counselingexam.com

004 Narcissistic Personality Disorder

2010-11-16T11:24:00.000-05:00

Narcissistic Personality Disorder

Diagnostic Criteria

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1.        has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)

2.        is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

3.        believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)

4.        requires excessive admiration

5.        has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations

6.        is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends

7.        lacks empathy: is unwilling to recognize or identify with the feelings and needs of others

8.        is often envious of others or believes that others are envious of him or her

9.        shows arrogant, haughty behaviors or attitudes

Associated Features

                Depressed Mood

                Dramatic/Erratic/Antisocial Personality

Differential Diagnosis

Histrionic Personality Disorder; Antisocial Personality Disorder; Borderline Personality Disorder; Obsessive-Compulsive Personality Disorder; Schizotypal Personality Disorder; Paranoid Personality Disorder; Manic Episodes; Hypomanic Episodes; Personality Change Due to a General Medical Condition; symptoms that may develop in association with chronic substance use.

http://counselingexam.com

004 Words of Encouragement

2010-11-16T11:20:00.000-05:00

Remember back in the days when you had just started your undergraduate
work and it was time for you first round of mid-terms? So many new
teachers, and you just werent sure of exactly what they were going to
ask, or how they were going to ask it. Would they try and trick you?
Would they make up unfair questions that really had no good answer?

Well, lucky for you this test will be nothing like those tests! There
are really no trick questions on the exam; it is objective, and there are
actually the correct answers are there in each question! You also have
6 or 7 years of extra schooling behind you this time!

My point is: dont sweat the small stuff

You have been preparing for this exam for some time now, and you are
more prepared than you think you are. Think back to the days when you
thought transference was something you did to your bank account, and
Synchronicity was a song by the Police. You have come so far since
then. Don’t forget that when you walk into that testing site. You are
armed with years of knowledge and great test taking skills, and this is
the beginning of the rest of your illustrious career!

Take care and God bless!!

It’s in there,

Linton

http://counselingexam.com

003 Obsessive-Compulsive Personality Disorder

2010-11-11T10:45:00.000-05:00

Obsessive-Compulsive Personality Disorder

Diagnostic Criteria

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1.        is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost

2.        shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met)

3.        is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity)

4.        is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)

5.        is unable to discard worn-out or worthless objects even when they have no sentimental value

6.        is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things

7.        adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes

8.        shows rigidity and stubbornness

Associated Features

                Depressed Mood

                Somatic/Sexual Dysfunction

                Guilt/Obsession

                Anxious/Fearful/Dependent Personality

Differential Diagnosis

Obsessive-Compulsive Disorder; Narcissistic Personality Disorder; Antisocial Personality Disorder; Schizoid Personality Disorder; Personality Change Due to a General Medical Condition; symptoms that may develop in association with chronic substance use.

http://counselingexam.com

003 Cognitive Theories- Lewin

2010-11-11T10:42:00.000-05:00

Cognitive Theories

Cognitive theories hold that people react to different things and events according to different individual perceptions of them.

Lewin -- saw behavior arising from the individual and his or her psychological environment, or life-space.

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002 Paranoid and Schizoid Personality Disorders

2010-11-09T11:17:00.000-05:00

Paranoid Personality Disorder

Other Personality Disorders may be confused with Paranoid Personality Disorder because they have certain features in common. It is, therefore, important to distinguish among these disorders based on differences in their characteristic features. However, if an individual has personality features that meet criteria for one or more Personality Disorders in addition to Paranoid Personality Disorder, all can be diagnosed. Paranoid Personality Disorder and Schizotypal Personality Disorder share the traits of suspiciousness, interpersonal aloofness, and paranoid ideation, but Schizotypal Personality Disorder also includes symptoms such as magical thinking, unusual perceptual experiences, and odd thinking and speech. Individuals with behaviors that meet criteria for Schizoid Personality Disorder are often perceived as strange, eccentric, cold, and aloof, but they do not usually have prominent paranoid ideation. The tendency of individuals with Paranoid Personality Disorder to react to minor stimuli with anger is also seen in Borderline and Histrionic Personality Disorders. However, these disorders are not necessarily associated with pervasive suspiciousness. People with Avoidant Personality Disorder may also be reluctant to confide in others but more because of a fear of being embarrassed or found inadequate than from fear of others malicious intent. Although antisocial behavior may be present in some individuals with Paranoid Personality Disorder, it is not usually motivated by a desire for personal gain or to exploit others as in Antisocial Personality Disorder but rather is more often due to a desire for revenge. Individuals with Narcissistic Personality Disorder may occasionally display suspiciousness, social withdrawal, or alienation, but this derives primarily from fears of having their imperfections or flaws revealed.

Paranoid traits may be adaptive, particularly in threatening environments. Paranoid Personality Disorder should be diagnosed only when these traits are inflexible, maladaptive, persistent, and cause significant functional impairment or subjective distress.

Diagnostic criteria for Paranoid Personality Disorder DSM-IV, Pg.637

A. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

(1)        suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her

(2)        is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates

(3)        is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her

(4)        reads hidden demeaning or threatening meanings into benign remarks or events

(5)        persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights

(6)        perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack

(7)        has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner

B.        Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, or another Psychotic Disorder and is not due to the direct physiological effects of a general medical condition.

Note:        If criteria are met prior to the onset of Schizophrenia, add "Premoroid," e.g., "Paranoid Personality Disorder (Premorbid)"

Schizoid Personality Disorder

Diagnostic Criteria

A.        A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

(1)        neither desires nor enjoys close relationships, including being part of a family

(2)        almost always chooses solitary activities

(3)        has little, if any, interest in having sexual experiences with another person

(4)        takes pleasure in few, if any, activities

(5)        lacks close friends or confidants other than first-degree relatives

(6)        appears indifferent to the praise or criticism of others

(7)        shows emotional coldness, detachment, or flattened affectivity

B.        Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder and is not due to the direct physiological effects of a general medical condition.

Note: If criteria are met prior to the onset of Schizophrenia, add "Premorbid," e.g., "Schizoid Personality Disorder (Premorbid)"

Associated Features

Odd/Eccentric/Suspicious Personality

Differential Diagnosis

Delusional Disorder; Schizophrenia; and Mood Disorder With Psychotic Features; Autistic Disorder; Asperger's Disorder; Personality Change Due to a General Medical Condition; symptoms that may develop in association with chronic substance use; Schizotypal Personality Disorder; Paranoid Personality Disorder; Avoidant Personality Disorder; Obsessive-Compulsive Personality Disorder.

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002 Mahler (Object Relations Theory)

2010-11-09T11:10:00.000-05:00

MAHLER (Object Relations Theory)

Based on psychoanalytic concepts with four stages of development:
        Fusion with mother
        Symbiosis Period
        Separation-Individuation Period
        Constancy of self and object

The psychosocial perspective is comparable with the psychosexual view of development.

In object-relations theory, there is an emphasis on early development as a decisive factor influencing later development.

Children who do not experience the opportunity to differentiate self from others may later develop a narcissistic character disorder.

Heinz Kohut is a leading contemporary psychoanalytic theorist.

Analytic therapy is oriented toward achieving insight.

Object-relations theorists focus on matters such as symbiosis, separation, differentiation, and integration.

http://counselingexam.com

001 Personality Disorders

2010-11-04T16:18:00.000-04:00

PERSONALITY DISORDERS

Note: These are coded on Axis II.
Note: Mental Retardation is also in the Axis ll catagory

1.        Paranoid Personality Disorder

2.        Schizoid Personality Disorder

3.        Schizotypal Personality Disorder

4.        Antisocial Personality Disorder

5.        Borderline Personality Disorder

6.        Histrionic Personality Disorder

7.        Narcissistic Personality Disorder

8.        Avoidant Personality Disorder

9.        Dependent Personality Disorder

10.        Obsessive-Compulsive Personality Disorder

In addition, Personality Disorder Not Otherwise Specified (NOS) is a diagnostic category for individuals who meet the general definition, but who do not fit neatly into any of the 10 categories.

Personality disorders represent extreme forms of personality traits (i.e., enduring and pervasive patterns of behavior) that have become dysfunctional for the person. The trait is expressed in such a rigid or inappropriate manner that it interferes with that person's adjustment.

People with personality disorders usually lack insight into the source of their difficulties. Clients do not usually seek counseling because of a personality disorder itself but because of difficulties associated with the disorder. For example, a person with a dependent personality disorder might seek counseling because of loneliness or indecisiveness, but not for dependency. The counselor needs to look beyond the symptoms to find the personality disorder.

According to Fong (1995, p.636), any of the following signs may suggest a client with a personality disorder:

Counseling comes to a sudden stop in progress after initial success.

The client is unaware of the effect of his or her behavior on others.

The problems are acceptable to the client.

The client is underresponsive or noncompliant with the therapeutic regime.

The client enters into intense conflictural relationships with institutional systems.

http://counselingexam.com

001 Problems with American Indian Children and Adolescents

2010-11-04T16:11:00.000-04:00

Problems with American Indian Children and Adolescents

1. American Indian children not only face developmental problems, but are faced with exposure of two very distinct cultures; they struggle with meeting their parents' expectations and that of the majority culture simultaneously.

2. American Indians have higher truancy rates.

3. Failure in school is higher than the national average.

4. Drug and/or alcohol use is high among Indian youth.

5. The suicide rate is statistically twice that of the national average.

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Experiential Family Therapy (e.g. Carl Whitaker)

2007-08-07T15:11:00.000-04:00

A) Assumptions

1. Based on a pragmatic stance with the belief that theory can hinder clinical work
2. Each family member has the right to be themselves
3. Based on the belief of the family being an integrated whole, not as a collection of discrete individuals
4. Familial togetherness and cohesion is associated with personal growth
5. Emphasis on the importance of involving extended family members in treatment (especially the expressive and lively spontaneity of children)
6. Basis of this bold and inventive approach to family therapy was the result of Whitaker’s spontaneous and creative thinking
7. Stresses the importance of genuineness
8. Techniques are secondary to the therapeutic relationship
9. Whitaker believed in this a theoretical approach based on the assumption that many times, theory is way for therapist to create distance from clients; it also helps to control the anxiety of therapists by allowing them to hide behind their “theory”.
10. Emotional expression is thought to be the medium of shared experience and the means to fulfillment (personal and family).
11. Whitaker suggested that self-fulfillment depended on family cohesiveness.

B) Why People Do What they Do? (What Motivates Them?)

1. To be authentic and able to freely express oneself
2. Being autonomous while also feeling they are a part of the family
3. To have intimacy
4. Self-actualization and self-determination

C) How Do People Get In Trouble?

1. Symptoms and interpersonal problems stem from the lack of emotional closeness and sharing among family members.
2. The needs of the family may be suppressing the rights of the individual.
3. Keeping family secrets can lead to the dysfunction of family members.
4. The family has infringed upon its individual members’ growth and freedom.
5. Personal choice has been comprised.
6. Families put on a façade which restrains its members from being authentic.

D) How To Help People

Goals of Experiential Family Therapy
• The primary goal of experiential therapy is to reduce defensiveness and unlock deeper levels of experiencing by freeing the clients from their impulses.
• Goals for the family
o improved communication and reduced conflict
o growth, not stability: symptom reduction is secondary to greater freedom of choice
o increased personal integrity (congruence between inner experience and outer behavior)
o less dependence,
o expanded experiencing
o emphasis on the feeling side of human nature
o improved autonomy for each member
o improved agreement about roles
o merger of needs for individual growth and strengthening the family unit.
1. The therapist’s active and forceful personal involvement and is the greatest way to bring about changes in families with the goal of promoting flexibility among family members.
2. A goal of therapy is to help family members open up and more fully be themselves by freely expressing what they are thinking and feeling.
3. The therapist conducts a family therapy session with the intent of it being a growth experience for him/herself, thereby inspiring the family to do the same; therefore, the therapist helps family members focus on the here and now by the therapist “being with” the family.
4. Focus on expanding immediate personal experiences and increasing the family’s awareness by achieving a higher level of intimacy.
5. Unmask pretense, create new meaning, and liberate family members to be themselves.
6. Aim for authenticity as there is no right or wrong way to be.
7. Attempt to unmask and tap into family secrets.
8. Guide the family through three specific phases: engagement (the most powerful), involvement (dominant parent figure, adviser) & disentanglement (more personal, less involved).

E) What Techniques And Skills Are Used?

1. Whitaker pioneered the use of co-therapists as a way to maintain objectivity.
2. Incorporates highly provocative techniques/interventions intended to create turmoil, turn up the emotional temperature, and intensify what is going on here and now in the family while then coaching the family how to get out of the turmoil.
3. Believed in doing therapy with a “crowd” in the room.
4. The therapist is active and directive to help create an intensified affective encounter for family members which allows for the family’s own healing and self-actualizing processes to take hold.
5. Therapist takes a theoretical stance as a way to intensify what the family members are presently experiencing and encourage them to reach into their unconscious to understand what is really going on in the family.
6. Facilitation of individual autonomy and a sense of belonging in the family.
7. Encourage spontaneity, creativity, the ability to play, and the willingness to be “crazy”.
8. The therapist's role is more of a facilitator. Through the use of reflection, he/she exposes the process of family interaction while joining the family process as a genuine and non-defensive person.

F) What Are The Limitations On Those Skills Or Techniques?

1. A great limitation is that this approach de-emphasizes theory and the use of “one-size, fits all” techniques.
2. Therapy follows a subjective focus and centers around the subjective needs of the family members (leaving room for bias or skewed perceptions).
3. This approach relies on a highly involved therapist model where the therapist must be visible, take risks, and get involved with family in the sessions.
4. Since success depends on the collaboration of several people, drop-out rates are high.

G) What Are The Professional Implications?

1. Whitaker typically relied on his own personality and wisdom, rather than any fixed therapeutic techniques to stir things up in families, so it is a hard theory to “teach” in terms of technique.
2. Whitaker believed in a confrontative approach which may not work well with fragile families.
3. This method incorporates an intuitive form of therapy which lower-functioning families/family members may not grasp.
4. He also acquired the reputation as the most disrespectful among family theorists since he often attacked or sought to overthrow traditional or popular ideas in family theory.
5. Some families may not appreciate the unrestrictive, intuitive, non-interventionist, and sometimes outrageous nature of this approach.
6. Rather than focusing on alleviating symptoms, this approach focuses on enhancing the quality of life of the family members. Although some focus on changing the family system may develop, it is not the primary goal. Therefore, this method may not be well suited for families who are looking for crisis management.

Individually based theory and therapy models 01

2007-07-17T10:42:00.000-04:00

Psychoanalysis- Freud/Erikson/Mahler

Role of Therapist

■ Invisible- Blank Screen (detachment)
■ Fosters transference
■ Focus on Resistance

Therapeutic Goals

■ Bringing the unconscious to the conscious
■ Strengthen the ego

Key Ideas

■ Deterministic- problems are rooted in the first six years of life and trapped in unconscious motivations
■ Reality Principle- maximize gratification minimize punishment
■ Biological Drives- sex and instincts
■ Parts of Personality- Id/Ego/Superego
■ Id- Pleasure principle, “Demanding Child,” deterministic, unconscious, satisfy basic survival
■ Ego- Reality principle, “Traffic Cop,” mediator between Id and Superego
■ Superego- Moral Principle, “The Judge,” strive for perfection

Psychosexual Stages of Development

■ Oral Phase- 0-1 years, greedy, mistrust, unable to form intimate relationships
■ Anal Phase- 1-3 years, anal retentive, aggressive
■ Phallic Phase- 3-6 years, identity disturbance (Oedipal/ Electra complex)
■ Latency- 6-12 years, Socialization stage
■ Genital- 12+, Interpersonal relations freedom to love/work

Techniques

■ Brief psychodynamic therapy (BPT)- treating selective disorders within an established time.
■ Hypnosis
■ Dream Interpretation
■ Free Association
■ Projective Techniques
■ Freudian Slips

The Impact of Developmental Disorders on Family Systems

2007-07-10T10:48:00.000-04:00

Symptoms of Developmental Disorders

■ Aggression and perhaps violence
        o Work with family on behavioral issues, reinforcing appropriate behaviors.
        o Work with family on parental coping skills with difficult situations.

■ Alienation of parents, caregivers and authorities
        o Educate family on the symptoms of disorders and what to take as a symptom rather than a person attack.
        o Processing how to handle isolation moments, what the client shares as input on how they would like to b addressed or left alone until ready to return to family participation.

■ Antisocial attitudes and actions
        o Insight and reality therapy with clients on what impact their behaviors have on the family- natural consequences.
        o Make sure family has consistent discipline for inappropriate behaviors.

■ Behavioral and learning problems at school
        o Encourage family to be in close communication with school figures to prioritize school goals and continue strengths.

■ Cannot express trust, intimacy and affection
        o Educate clients on the realities of the disorder and behavioral symptoms.
        o Work with families to process feelings in regard to having a loved family member who has not yet developed these essentials of relational interaction.

■ Lacks empathy, compassion and remorse
        o Parenting skills enhanced to encourage the education and modeling of these skills in the home to promote it within the client.

■ Needy and clingy, or pretends independence
        o Behavioral methods encouraged by all family members to make sure enabling is minimized and support for growth is promoted.

■ Withdrawal and perhaps depression or psychosis
        o Work with family to ensure the therapy treatment and medications are attended to.

Potential Ethical Violations

2007-07-02T10:54:00.000-04:00

■ YAVIS- Counselors tend to prefer clients who are young, attractive, verbal, intelligent, and successful, but the most influencing factor is similar cultural backgrounds and experiences.

■ Viewing clients from the counselors perspective
        o The following can be misinterpreted as “problems” in counseling, causing the therapist to see the client as resistant or non-responsive
                ■ Silence
                ■ Lack of eye contact
                ■ Deference to authority
        o Client defensiveness or non-disclosure may be termed “healthy cultural paranoia”
                ■ For many clients the majority cultural environment is hostile and therefore a defensive stance is a                 rational response.
                ■ The counselor must acknowledge that the problem may not lie in the client but rather the                 environment in which the client lives as a minority member

■ Stereotyping clients by group
        o May be unintentional in that the counselor researches the “group” and what the group beliefs are according to research but in so doing generalizes and may miss something about the individual sitting in front of them.

■ Inappropriate Selection of techniques
        o Counselors often depend on high level of verbal exchange to achieve therapeutic progress.

■ Inappropriate Selection of Tests and Measurements
        o Many test reviews have only been done on the majority population type and may not be applicable to all cultures, skewing “normal” results.
        o There should be an investigation of possible differences in validity for ethnicity, sex, or other sub-samples that can be identified when test is given.
        o What is considered an objective assessment instrument within a majority culture may not be so within a minority culture or a different cultural orientation.
        o It is an ethical duty to be aware of this research prior to administering assessments.

Anticipatory Trauma

2007-07-02T10:16:00.000-04:00

◆ Reactions to anticipatory trauma:
        o Emotional
                ■ Fear
                ■ Anger
                ■ Confusion
                ■ Hopelessness
                ■ Loss of control
                ■ Numbness
                ■ Moodiness
                ■ Irritability
                ■ Guilt
        o Behavioral
                ■ Social withdrawal
                ■ Disruption of daily activities
                ■ Easily startled or jumpy
                ■ Easily cry
        o Cognitive
                ■ Thoughts preoccupied with anticipation of trauma
                ■ Difficulty concentrating
                ■ Low self esteem
                ■ Indecisiveness
                ■ Poor memory recall
        o Somatic
                ■ Muscle tension
                ■ Headaches
                ■ Gastric problems
                ■ Irregular sleep and appetite
                ■ Fatigue

◆ Treatment Techniques
        o Social support:
        o Physical self-care
                ■ Exercise
                ■ Eating healthy
                ■ Regular sleep
        o Spirituality
        o Meditation or Guided Relaxation
        o Positive self talk
        o Humor

Use of Technology

2007-06-22T16:08:00.000-04:00

⋅ Everyone uses some form of new technology in their practices. All sources must be secure and confidential.
        o Examples include: personal computers to write and store case notes; fax and email attachments to transmit confidential data; and confidential conversation on wireless phones.
        o It is ethically acceptable to use phone for crisis situations.

Secure computer:

o Do not permit unauthorized access to information
o Retains a record of communications to and from the system
o Prevents alterations in or loss of data entered
o Recovers completely and effectively from unexpected disruptions

Internet Counseling Relationship

o A system must be in place to ensure counseling not violated by imposter, on both the part of the therapist or the client.
o When counseling minors online, parent or guardian must consent and identity must be verified.
o Counselor is responsible for explaining to client how to reach therapist in cases of emergency when counselor is not online.
o Plan must be in place to continue counseling during times of technical difficulty to ensure there is no possibility of client neglect.
o As part of the counseling orientation process, the Internet counselor explains to clients how to cope with potential misunderstandings when visual cues do not exist.
o Local crisis assistance must be identified prior to beginning counseling.
o Therapist website must be a barrier-free for clients with disabilities.
o Cultural awareness is still an important issue.

Confidentiality in Internet Counseling

o The Internet counselor informs Internet clients of encryption methods being used to help insure the security of client/counselor/supervisor communications.
o Clients must be informed of how long online information is saved.
o Session data may include
        ⋅ Internet counselor/Internet client e-mail,
        ⋅ test results,
        ⋅ audio/video session recordings,
        ⋅ session notes,
        ⋅ counselor/supervisor communications.
o Authorization releases are still applicable.

Effects of addictive behaviors on individual and family system

2007-06-22T16:06:00.000-04:00

⋅ Any activity, substance, object, or behavior that has become the major focus of a person's life to the exclusion of other activities, or that has begun to harm the individual or others physically, mentally, or socially is considered an addictive behavior.

⋅ There is similar impact on the family between physical addiction to various chemicals in drugs and alcohol, and psychological dependence to behaviors including: gambling, sex, work, and eating disorders.
o These behaviors may produce the endorphins in the brain, producing a “high” sensation.
o When addicted, people continue these behaviors in order to get that endorphin rush, despite the detrimental effects on their work and family.

⋅ Addicts may still crave their addiction behavior even after remaining abstinent for long periods of time. Some therapeutic modalities believe this craving will be a lifelong challenge and a continual stress on the addict’s support system.

⋅ Withdrawal symptoms when behavior is ceased can cause feelings of irritability, agitation, and depression which affect the entire family system.

⋅ During active addiction many clients live in denial and hurt their families so building trust back and healing wounds caused in the family is important to keep in mind during therapy.

Effect of substance abuse & dependence on individual and family functioning

2007-06-20T11:42:00.000-04:00

⋄ Chronic substance abusers tend to be isolated from their families after a long period of damaging relationships.
⋄ Substance abuse affects more than the immediate family.
⋄ Extended family members often report feeling abandoned, embarrassed by, ashamed of, and withdrawn from the substance abusing family member, often choosing to break relational ties.
⋄ Different family structures in which abuse affects the family relationship:
        o Client who lives alone or with a partner.
⋄ Both partners need treatment.
⋄ Groups are offered both for addicts and for non-addict partners of addicts.
⋄ The treatment of either partner will affect both.
⋄ Often, codependence is an issue.
⋄ Enabling may have to be explored
        o Client who lives with a spouse (or partner) and minor children.
⋄ Parental substance abuse has a detrimental affect on children.
⋄ There may be triangulation or enmeshment issues if children are either placed in the middle or if non-using parent is overly protective and bonded with children due to the substance abuser’s lack of responsibility.
⋄ Issues of neglect or trauma may be present if both parents are abusing drugs.
        o Client who is part of a blended family.
⋄ Substance abuse can intensify already shaky ground of newly blended families and become an impediment to integration and stability.
        o An older client who has grown children.
⋄ As with child abuse and neglect, elder maltreatment can be subject to statutory reporting requirements for local authorities.
        o Client is an adolescent and lives with family of origin.
⋄ Non-using children may find themselves neglected or ignored emotionally due to the focus of parents on the using child.
⋄ Often, at least one of the parents uses as well..
        o Someone not identified as the client is abusing substances.
⋄ Issues of blame, responsibility, and causation will arise.
⋄ Scapegoating may be an issue.
⋄ Therapist must work towards uncovering the underlying motivations for substance abuse and other behavioral issues that bring the family into counseling.

Reference materials regarding medication side effects and classification

2007-06-20T11:37:00.000-04:00

AllPsych Online

http://allpsych.com/meds.html

⋄ One of the largest psychology websites on the Internet.
⋄ Holds over 920 individual, cross referenced, web pages and an estimated 3000 pages of printed material.
⋄ It is referenced by over 100 colleges and universities in ten countries.
⋄ It provides:
        o Drug name
        o How they work
        o What they treat
        o Possible side effects

SEDBASE

http://library.dialog.com/bluesheets/html/bl0070.html

⋄ This is a full text database that critically analyzes the published drug side effect literature on drugs currently in use.
⋄ Drug class chapters are prepared by recognized authorities who critically assess published literature each year.
⋄ The goal of the database is to document every drug known to have a side effect reported in the literature.
⋄ It is organized by drug class chapters and does not contain any speculative or unsubstantiated statements.
⋄ Some of the specific areas covered include:
        o adverse drug reactions
        o drug interactions
        o drug toxicity
        o special risk situations
        o pharmacological or patient-dependent factors associated with the occurrence of side effects.

Managing Transference and Countertransference

2007-06-20T11:30:00.000-04:00

Transference

⋄ Feelings client projects onto the counselor.
⋄ Have to do with relationship client has experienced in the past.
⋄ Intensity of feelings has to do with unfinished elements of client’s life.
⋄ Client may identify in the therapist characteristics that are reminiscent of the person they are transferring their emotions from.
⋄ Feelings can be productively explored so client becomes aware of how they are keeping an old pattern functional in other present time relationships.
⋄ Therapy becomes an ideal place to become enlightened to patterns in relationship of psychological vulnerability.
⋄ Clients gain insight into how their unresolved issues lead to dysfunctional behavior.
⋄ Group therapy may provide a microcosm of how people function in general social settings.
⋄ Ask client to tell more about how the therapist has affected them to elicit additional information about how the client developed the transference.
⋄ Do not become defensive.
⋄ “I wonder if I remind you of anyone you have had similar feelings with?”
⋄ There is potential for rich therapeutic progress!
⋄ Carefully take on a symbolic role and allow the client to work through their unresolved conflict.

Counter-transference

⋄ Feelings aroused in the counselor by the client.
⋄ Feelings have to do with unresolved conflict from other past or present relationships rather than the therapeutic relationship with this particular client.
⋄ Discuss how you are affected by certain clients in supervision on with a colleague.
⋄ Get other’s perspectives on whether you are maintaining unconditional positive regard.
⋄ Self-knowledge is the basic tool in dealing with Counter-transference.
⋄ Unacknowledged, this can lead to an unproductive group. If leaders are not willing to deal with their own issues, how can they expect clients to do so?
⋄ Counter-transference in groups can be indicated by exaggerated and persistent feelings that tend to recur with various clients of different groups.

Crisis Intervention Models

2007-06-20T11:19:00.000-04:00

Crisis intervention with date rape, school violence, substance abuse, adolescent suicide, marital abuse, HIV positive, and hospital intensive care clients.

Step #1: Listen
- Establish therapeutic relationship.
- Identify precipitating problems.
- Explore emotions.

Step #2: Assessment
- Determine the severity of the crisis.
- Assess potential lethality or physical harm to the person or others.
- Identify past coping skills, strengths and supportive resources.
- Suicide/Homicide assessment
- Determine client’s perception of reality.
- Discuss cultural beliefs about handling trauma.
- Find out if family and social resources are potential resources. Are the resources positive or negative?

Step #3: Treatment Plan
- Selectively choose and use appropriate approaches to action planning.
- Modify or eliminate past coping skills.
- Create a contract or have client sign treatment plan.
- Identify useful referral resources.
- Use three basic approaches:
        i. Start by being non-directive.
        ii. Be collaborative by working together on a joint plan.
        iii. Be directive if the person does not or will not make a plan.
- During crisis, have only short term objectives.

Step #4: Termination
- Review progress on treatment plan.
- Plan for expanding resources and support system.
- Schedule a follow up session.

Risk factors and relational patterns of endangerment

2007-06-20T11:10:00.000-04:00

Risk factors for Victimization

o Being female
o Young age
o Being a minority
o Drug and alcohol use
o High-risk sexual behavior
o Exposure to victimization as a child
o Low education level
o Unemployment
o Low SES
o Little or no support system
o Low self esteem
o Adolescence or developmental transition period
o Having a verbally abusive, jealous, or possessive partner
o Couples with income, educational, or job status disparities
o Dominance and control of the relationship by the male
o Weak community sanctions against victimization (e.g., police unwilling to intervene)
o Traditional gender norms (e.g., women should stay at home and not enter workforce, should be submissive)

Risk Factors for Perpetration

o Low self-esteem
o Low income
o Low academic achievement
o History of delinquency in youth
o Drug and alcohol use and abuse
o Depression or other psychological diagnosis
o Anger management issues
o Axis II disorders
o Past history of abuse
o Social isolation
o Unemployment
o Emotional dependence or codependence
o Belief in strict gender roles
o Abuse of power and control
o Past history of victimization
o Marital conflictfights, tension, and other struggles
o Marital instabilitydivorces and separations
o Unhealthy family enmeshment or blurred boundaries

DSM and ICD Health Problems

2007-06-11T12:08:00.000-04:00

Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Statistical Classification of Diseases & Related Health Problems (ICD)

Diagnostic and Statistical Manual of Mental Disorders (DSM)

o Handbook for mental health professionals.
o Includes all categories of mental disorders and their corresponding diagnosable criteria.
o Intended to be used by those with clinical training.
o In accordance with the American Psychiatric Association.
o Uniform criteria for diagnosing.
o Includes sociological, psychological, biological, criteria.
o Each revision has discarded some previously diagnosable disorders such as pre-menstrual dysphoric disorder and masochistic personality disorder to show the manual is contemporary with social times.
o It now no longer includes homosexuality as a mental disorder, replacing it with sexual orientation disturbance, though still controversial.

Diagnosing Categories

o Axis I: Clinical disorders, including major mental disorders, as well as developmental and learning disorders
o Axis II: Underlying pervasive or personality conditions, as well as mental retardation
o Axis III: Acute medical conditions and Physical disorders.
o Axis IV: Psychosocial and environmental factors contributing to the disorder
o Axis V: Global Assessment of Functioning GAF score
o A scale from 100 (good functioning) to 0 (several dysfunction)

International Statistical Classification of Diseases and Related Health Problems

o Abbreviation ICD.
o Classification system for diseases including a directory of symptoms complaints, and external causes of injury or illness.
o Published by the World Health Organization.
o Used by hospitals and healthcare facilities to best describe clinical assessment of a client.

Diagnostic interviewing techniques

2007-06-06T10:26:00.000-04:00

Questioning:
o Client asked direct questions in areas determined by interviewer
o Questioning may be open or closed.
Open= unlimited answer options
Closed= Yes, No, or one word questions

Reflection:
o Restate the clients cognitive or emotional material
o Demonstrate empathic understanding
o Rogerian Client-Centered Therapists rely heavily on reflection
o Overuse is counterproductive - important areas are left unaddressed

Restatement (Paraphrasing):
o Rephrase what client says.
o Demonstrates active listening.
o Reflection is type of intervention, clarifies and joins themes.

Clarification:
o Accompanied by utilizing other techniques such as questioning, paraphrasing, restating
o Shows understanding of client in the interview
o If done from a not knowing stance, should not invoke defensive response.

Confrontation:
o May be used to call client out on discrepancies
o Is often used with substance abusers in order to break denial and/or rigid defenses
o This may increase anxiety and avoidance but is necessary and can be constructive.

Self-disclosure
o The sharing of personal experiences by the therapist to the client relative to the session with the purpose of helping.
o Intended to facilitate client disclosure.
o Should be used minimally
o Must be careful not to cross boundaries.

Silence:
o While this may occur unintentionally there are many benefits if used correctly.
o Provides both client and therapist time to process what is being understood.
o Timing is essential
o Promotes introspection

Exploration:
o Therapist test the limits of what client is willing to process.
o May be used to determine clients level of insight.

Reframing (Cognitive reframing):
o This allows for a different perspective
o Used to challenge negative self concepts and harmful thinking patterns.
o The purpose is to lead to behavioral change.

Statutes, case law and regulations

2007-06-04T10:20:00.000-04:00

Professional disclosure statement tells clients about:
o the education and qualifications of the therapist
o the nature of the therapeutic process
o Informed Consent
o Document that the client reads about the specifics of therapy treatment
o Client consents to treatment by signing the form
o Procedures and goals of therapy
o Potential harms or risks to client
o Reasonable benefits of therapy
o Qualifications and policies of therapist
o Theoretical orientation of therapist
o Ability to terminate treatment at any time
o Reassurance of referral sources for treatment (3 is standard)
o Fee disclosure

Confidentiality
o Ethical obligation of therapist to keep communications between themselves and client private.
o May be charged in contempt of court if therapist refuses to testify about a client.

Exceptions:
o Child abuse reporting laws: mandated to report the suspicion of child abuse or neglect. (in some states this is required of all citizens not just counselors)
o Duty to warn: if therapist establishes there is a likelihood that client will cause harm to him/herself or to someone else and the therapist knows who that victim may be.

Privilege- Legal right, owned by the client, which is an exception to the general rule that the public has a right to relevant knowledge in court proceedings. This means information revealed in session is not permitted in court.

Appropriate standard of care- how most therapists would treat a case under similar circumstances. Those who do not follow this are at risk for malpractice.

Dual relationship- occur when therapist does not keep appropriate boundaries and thereby blends personal or business relationships with the therapeutic relationship.

Secret policies- written statements about how information shared privately will be handled by the therapist. Must be signed by both parties.

Risk factors for and patterns of abuse

2007-06-04T10:17:00.000-04:00

Recognizing sings of abuse

In the child:
o Sudden changes in behavior or school performance
o Not medical attention for problems brought to parents attention.
o Learning problems, difficulty concentrating, that cannot be attributed to specific disabilities.
o Tends to be watchful, expecting something to happen.
o Lacks adult supervision.
o Overly compliant, passive, or withdrawn.
o Comes to school or other activities early, stays late, does not want to go home.

The Parent:
o Shows little concern.
o Denise existence of, or blames the child, for problems at school or home.
o Asks teachers to use physical discipline.
o Describes child as bad or burdensome.
o Demanding high levels of academic and physical performance.
o Relies on child for care, attention, emotional needs.

Parent and Child:
o Do not look or touch each other.
o View of relationship is only negative.
o State they do not like each other.

Pattern of Abuse

Tension building
o Anger builds.
o Poor communication.
o Victim feels the need to keep the abuser calm.
o Tension mounts.
o Victim constantly feels weary of abuser.
o Abuse (physical, emotional, or sexual) takes place.
Making up:
o Apology may be made.
o Promise of the last time.
o Victim blaming.
o Denial of abuse.
o Calm
o Abuser acts as if nothing has happened.
o Some promises may be met, during this time.
o Victim may believe the abuse is truly over.
o Abuser may give gifts to victim.

Integrative Couples Therapy

2007-06-04T10:10:00.000-04:00

History

1969 Richard Stuart introduced behavioral elements into couples therapy.
1970s couples therapy was based on behavioral change.
As couples theories evolved, behavior and adjustment techniques used to adjust social skills were introduced.
1980s communication skills became and integral part of the healthy functioning couple
Couples therapy began to incorporate family intervention elements in addition to behavioral elements and communication skills building.
1993 Jacobsen and Anderson founded the Integrative Couples Therapy Model.

Theoretical Foundations

Eclecticism
o A mix of different counseling methods
o More freedom because not limited to one theoretical view.
Theories commonly used:
o Problem-focused
o Narrative
o Brief/Solution-focused
o Cognitive Behavioral
o Bowen Family Systems Theory

Core Premise

Circular Model of Causation
o The foundation of Integrative Therapy is the idea of a circular process of assessment, goal setting, interventions, maintenance, and validation.
o It is a non-linear model
o Any one of these concepts can be revised throughout the session at any given point.
The focus is to create a blame free therapeutic environment.
Integrative Therapy emphasizes that the couple work together to overcome their difficulties giving them a common goal.

Codes of ethics

2007-06-01T13:12:00.000-04:00

Ethics= the study of what constitute s good and bad human conduct, including related actions and values. Ethical practice by a therapist is when a therapist has good moral sense, follows the code of ethics, is up to date on the existing laws that impact their clients, and have good clinical expertise.

Professional code of ethics functions
Define the role of the profession
o Codes express dominant morality of the field
o Define values and goals of the profession.
o Define the standards that both the professionals and users of the professionals services can expect in professional interactions.
Ethical codes guide the conduct of profession and can provide specific guidance about conduct in form of advice or mandates.

Moral Foundations
Autonomy- people are allowed the freedom of choice and action.
Nonmaleficence- above all else, therapist will do no harm.
Justice- humans should be treated fairly with equal distribution of good or bad.
Fidelity- value of honoring commitments and promoting trust.
Veracity- importance of truth telling
Beneficence- refers to promoting good.

Malpractice claims- legal actions taken against therapist for actions that are believed to fall below the appropriate standard of care and cause injury to client

Common types of malpractice include:
Misdiagnosis
Practicing outside area of competence.
Failure to obtain informed consent treatment
Negligent or improper treatment
Physical contact or sexual relationships with patient
Failure to prevent patient from harming themselves or others
Improper release of hospitalized patients
Failure to consult another practitioner or refer a patient
Failure to supervise students/interns
Abandonment of patients

General Systems Theory

2007-05-31T10:51:00.000-04:00

Developed by Ludwig von Bertalanffy in 1968.
Explains how organisms thrive or die in accordance with their openness or closedness to their environments.
Focus changed from linear causality to circular causality- idea that events are related through a series of interacting loops or repeating cycles.

System
Set of elements standing in interaction.
Each element is affected by whatever happens to any other element.
System is only as strong as its weakest part.
System is greater than sum of its parts.
Boundaries are more or less permeable depending on the amount and type of feedback received.

Risk factors, stages and patterns of grief response

2007-05-23T22:38:00.000-04:00

•        DSM Diagnosis under Other Conditions That May be Focus of Clinical Attention, V62.82, Bereavement- used for death of a loved one.
•        Depression in this case is considered “normal” but individual my be seeking treatment to relieve symptoms such as insomnia or anorexia.
•        Expression of “normal” bereavement time is relative to different cultures.
•        Major Depressive disorder is not diagnosed unless symptoms last longer than two months after loss.

Stages of Grief:
•        Denial
•        Anger
•        Bargaining
•        Depression
•        Acceptance

Reactions commonly seen in children:
        o        Disbelief- children may act as if it did not happen.
        o        Complain of headaches, stomachaches, or fear of their own death.
        o        Anger- concern over own needs and about being alone, or with God.
        o        Guilt- feelings of causing death, or not having been “better”
        o        Anxiety/Fear: may become clingy and need validation of love.
        o        Regression: revert to bed wetting or thumb sucking
        o        Sadness: lethargy and isolation

Short Term Treatment Goals
•        Express fear and anger, grieve in a healthy way.
•        Loss and Grief Counseling Group
•        Recall fond memories
•        Create a phone list of supportive people to call
•        New coping techniques
•        Find a “safe place” to spend limited time thinking about deceased
•        Exercise regiment
•        Relaxation techniques- progressive muscle relaxation, guided imagery

Long Term Treatment Goals
•        Reach a point of coping without being overcome with grief.
•        Regain normal activity.
•        Reduce feelings of guilt and anger towards self, others, and God.
•        Re-mature over regressed behaviors
•        Understanding of death and life.

Therapeutic Interventions
•        Writing Activities
        o        Letter to deceased for closure
        o        Journal of thoughts (may be shared in counseling, in group, or with family members)
•        Art therapy:
        o        Finger paints are useful in expressing feelings
        o        Draw pictures of activities enjoyed with deceased (useful with children).
        o        Collage on a theme
        o        Splatter room: area where (particularly children) are free to throw violent splotches of paint to get anger out.
•        Play Therapy:
        o        Model clay or dough to vent anger or create ritual objects
        o        Puppetry- to express feelings
        o        Sand tray to play out themes, “burry” deceased for closure, or rake sand for relaxation or meditation.
•        Bibliotherapy:
        o        Appropriate self help books
        o        Books related to symptoms client is displaying
•        Loss Graph or Timeline:
        o        Used to discuss types of loss
        o        Used to recall fond memories and celebrate life
•        Storytelling:
        o        Fantasy monologues
        o        Mutual storytelling
•        Therapeutic Metaphors
        o        Helpful in understanding concept of death
•        Empty Chair
        o        Gestalt technique
        o        Imagine deceased in chair and speak to them for closure