NURS 321: Lecture 7 - Community, Special Populations, and Trauma-Informed Counselling and Postmodernism Therapies

What is upstream thinking?

A way of thinking that addresses the root cause of the problem.

What is the focus of a community-oriented approach in health care?

Helping more than one individual by examining the community surrounding individuals to achieve greater effectiveness in assistance.

Define 'community' in the context of health services.

A number of people who share a distinct location, belief, interest, or characteristic that differentiates them from those not sharing it.

What is a community agency?

Any institution designed to provide social and psychological services to the community.

Who are community workers?

Human service and community health workers with diverse education and training, whose primary duties revolve around serving their community.

What does community orientation involve?

A shift in thinking of the community as the client and designing interventions that extend beyond the individual.

How can focusing solely on individuals contribute to social injustice?

It can maintain the status quo, reinforcing social injustices, inequalities, and discriminatory treatment of certain groups.

What is the primary focus of the Community Mental Health Movement?

Addressing human problems rooted in failures in the social system, particularly for marginalized and underserved communities.

What must be prioritized before exploring personal growth in clients?

Basic human needs must be met first, such as stabilization over exploration.

It is important to change the people first before changing the conditions that affect the people (True/False).

False

What is the role of an advocate in community work?

To speak on behalf of marginalized communities and assist clients in overcoming institutional barriers.

What is the role of a change agent in community work?

To confront and bring about change within systems and assist clients in developing power to bring about change.

What does a consultant do in community work?

Encourage people to learn skills and help design preventative programs to reduce the negative impact of racism and oppression.

What is the role of an advisor in community work?

Initiates discussions with clients about ways to deal with environmental problems contributing to personal issues.

What is the role of a facilitator of Indigenous support systems in community work?

To encourage clients to make use of the resources in their communities.

What is the role of a facilitator of Indigenous healing systems in community work?

To recognize mistrust between Indigenous clients and traditional practices and refer to a healer of their choice.

What is the focus of direct client services in community intervention?

Outreach activities targeting populations at risk for developing mental health issues.

What is the focus of indirect client services?

Client advocacy and empowering disenfranchised individuals through advocacy.

What is the focus of direct community services?

Preventative education geared to the population at large.

What is the focus of indirect community services?

Changing the social environment to meet the needs of the population by influencing public policy.

What is the purpose of outreach?

To help those in need without waiting for them to come in seeking help.

Outreach has to be practical for the community and the practitioner (True/False).

True

What is the purpose of educating the community in mental health?

To reduce stigma related to mental health and raise awareness of available resources.

What are two key things to remember when dealing with involuntary group members?

Refuse to give in to negativity and don't take attacks personally.

What strategies can be used when working with involuntary group members?

- Model respect

- Allow venting

- Establish meaningful goals

- Utilize conflict resolution techniques

- Empower clients

What is intimate partner violence (IPV)?

Abuse or aggression that occurs in a romantic relationship, varying in frequency and severity.

An intimate partner refers to a current spouse (True/False).

False

What should individuals experiencing IPV be counseled about?

Developing a safety plan for rapid escape when abuse recurs.

What is the role of individual therapy for survivors of IPV?

To address guilt, shame, and stigmatization, and to empower survivors to recognize and choose productive life options.

What are common symptoms that IPV survivors may address in therapy?

Symptoms of depression, anxiety, somatization, or PTSD.

Under what conditions should family therapy be considered for IPV situations?

Only if the perpetrator has undergone individual therapy and demonstrated change, and both parties agree to participate.

What is the purpose of group therapy for IPV survivors?

To counter self-denigrating beliefs and confront issues of secrecy and stigmatization.

What is the therapeutic factor of universality in group therapy?

The realization that others have had similar experiences, which can be beneficial for survivors.

Who are at high risk for suicide?

Men, survivors of suicide loss or attempts, prisoners, Indigenous youths, and all Inuit regions.

What are the main assessments and interventions for someone with suicidal ideation?

- Closely monitor

- Ask key questions

- Avoid asking why

- Provide immediate crisis support

- Ensure careful referral and follow-up

What is the focus of trauma-informed counseling?

To provide a pragmatic and action-oriented approach that addresses trauma and promotes healing.

What are the 2 major phases of trauma counselling?

Working through initial trauma and appropriate follow-up and counselling.

What are the four core principles of trauma-informed care?

- Trauma has widespread impacts

- Recognizing signs and symptoms of trauma

- Integrating trauma knowledge into all systems

- Avoiding re-traumatization.

What are the 5 values of trauma-informed care?

Safety, trustworthiness, choice, collaboration, and empowerment.

What are the steps to resilience?

Safety, calming and caring, normalizing, debriefing the story, assessing strengths and resources, action and advocacy, and follow-up.

What should therapists do to support clients in recounting their trauma stories?

Listen actively, paraphrase, summarize, and reflect feelings.

What is a key question to ask clients in trauma-informed care?

What do you need now?

What should be avoided when discussing trauma with clients?

Overpromising or providing vague answers.

What is the postmodernist view?

Social constructionism.

What does social constructionism value in therapy?

It values the client's reality without questioning its accuracy.

According to social constructionism, clients are the experts of their lives, and there is no one right or wrong way to live (True/False).

True

What is the modernist view?

Objective reality can be accurately described and observed, existing independently of observation.

What is the primary focus of social constructionism in counseling?

To provide a wider range of perspectives and to deconstruct the power of dominant cultural narratives.

What are the 3 main postmodern therapies?

Solution-focused brief therapy, motivational interviewing, and narrative therapy.

What is the main goal of solutions-focused brief therapy (SFBT)?

To focus on strengths and resilience, helping construct solutions rather than problem-solving.

What is the belief of positive orientation?

People are healthy and competent, having the ability to construct solutions that can enhance their lives.

What is the therapist's role in positive orientation?

To help clients recognize their competencies and apply them to solutions.

According to SFBT, change is constant and inevitable, and clients want change (True/False).

True

History is very important to SFBT since that is the foundation for all change (True/False).

False

The emphasis of SFBT is on what's possible and changeable (True/False).

True

SFBT is a long-term approach that seeks to make a large amount of change in the client's life (True/False).

False

What are problems maintained by according to SFBT?

Expecting change by doing the same thing and expecting no change.

SFBT emphasizes problem-talk more than solution-talk (True/False).

False

What are the five steps in the therapeutic process of SFBT?

- Describe problems

- Develop well-formed goals

- Identify times when problems were less severe

- Provide a summary, feedback, and encouragement

- Evaluate progress

It is important that the therapist assumes a not-knowing position during SFBT (True/False).

True

What are the three types of client-therapist relationships in SFBT?

Customer-type, complainant, and visitor relationships.

What is a customer-type relationship?

The client and therapist jointly identify a problem and a solution to work towards.

What is a complaint relationship?

The client describes a problem but is not willing to take an active role in creating a solution.

What is a visitor relationship?

The client comes to therapy because someone else thinks they have a problem.

Effective SFBT questions focus attention on solutions (True/False).

True

What are some SFBT techniques?

- Pre-therapy change

- Exception questions

- Coping questions

- Reframing

- Scaling questions

- Therapist feedback

- Terminating

- Miracle questions

What are exception questions in SFBT?

Questions that direct clients to times in their lives when the problem did not exist.

What are coping questions?

Questions that explore how clients keep going in the face of adversity.

What do scaling questions in SFBT assess?

They assess the client's progress or commitment to finding a solution on a scale of 0 to 10.

What are the 3 components of therapist feedback in SFBT?

Compliments, bridges, and suggesting tasks.

In SFBT, the therapist should be mindful of working towards termination after a few counselling sessions have been completed and they have acquired their client's trust (True/False).

False

What are miracle questions in SFBT?

Questions that explore what it would be like for a client once all of their problems have been solved.

What are the key characteristics of motivational interviewing?

It is humanistic, client-centred, modestly directive, evidence-based, brief, applicable, and focused on client self-responsibility.

Which therapies does motivational interviewing share characteristics with?

Person-centred therapy and solution-focused brief therapy.

How is motivational interviewing different from person-centred therapy?

It is deliberatively directive while staying within the client's frame of reference.

What is the primary goal of the MI spirit?

To reduce the client's ambivalence to change and increase client motivation.

What are the 5 basic principles of Motivational Interviewing?

- See the world from the client's perspective

- Explore discrepancies and ambivalence

- View reluctance as expected

- Support client self-efficacy

- Strengthen commitment to change.

What are the 5 stages of change?

- Pre-contemplation

- Contemplation

- Preparation

- Action

- Maintenance

What is the precontemplation stage characterized by?

No intention of change anytime soon.

What is the contemplation stage characterized by?

Awareness of the problem and consideration of change, but no plans or commitment.

What is the preparation stage characterized by?

Plans to take action immediately, and small changes are noted.

What is the action stage characterized by?

Steps are taken to modify behaviour and solve problems.

What is the maintenance stage characterized by?

Work is done to consolidate gains and prevent relapse.

What is the DEARS technique in motivational interviewing?

- Develop discrepancy

- Express empathy

- Amplify ambivalence

- Roll with resistance

- Support self-efficacy

What is the RULE technique in motivational interviewing?

Resist, understand, listen, and empower.

What is the goal of Narrative Therapy?

To help clients see themselves as empowered and to re-author their stories.

What shouldn't a therapist do in narrative therapy?

Normalizing judgment and totalizing language.

What is double listening in narrative therapy?

Separating the person from the problem while listening to the client's story.

What is the role of the therapist in narrative therapy?

- Active facilitator

- Demonstrate care, interest, and respect

- Apply the not-knowing position

- Help the client create a preferred storyline

- Avoid language of diagnosis, intervention, and assessment

What are the therapeutic techniques for narrative therapy?

- Questions

- Externalization and deconstruction

- Searching for unique questions

- Alternative stories and reauthoring

- Documenting the evidence

What does externalization mean in the context of narrative therapy?

The person is not the problem; the problem is the problem.

What does deconstruction mean in the context of narrative therapy?

Dissassembling assumptions.