Systems of Psychotherapy Final exam

Managing difficult clients

Step 1: adjust your mindset

The approach of setting aside personal feelings to focus entirely on resolving the clients issues and maintaining a professional, supportive attitude

Managing difficult clients

Step 2: Active Listening

the most important step in the entire process, A communication technique where the therapist fully concentrates, understands, responds, and remembers what the client says

Neutral statement

a non- defensive, non-blaming phrase used to open dialogue and invite the client to share their concerns. Ex: "Let's go over what happened"

Managing difficult clients

Step 3: Repeat their concerns

once the client is finished speaking, repeat their concerns so you're sure that you're addressing the right issue. if needed, ask questions to make sure you've identified the problem correctly, use objective wording

Managing difficult clients

Step 4: Be empathetic and apologize

once you're sure that you understand your clients concerns, be empathetic, show that you understand why they are upset, and make sure that your body language also communicates this

Managing difficult clients

Step 5: Present a solution

offering a resolution either by suggesting a fix based on the client's needs or asking them directly what outcome they desire

Managing difficult clients

Step 6: Consider Terminating the Client

ending the therapeutic relationship when a client repeatedly presents challenges that interfere with effectiveness or consume excessive time and resources

Managing difficult clients

Step 7: review and learn

reviewing the client afterward to evaluate what went wrong, what could be improved, and how similar issues can be prevented in the future

dealing with angry clients

listen, build rapport through empathy, be sincere, lower your voice, stay calm, don't take it personally, remember that you are interacting with a human

what to do when clients scream

stay calm, acknowledge their feelings, wait for the calm, listen actively, use facts, and end with a clear plan.

setting boundaries with difficult clients

respect and protect your time, set boundaries with clear working hours, be very up front about your needs, do not allow clients to take advantage of you to suit their schedules, learn how to say no and let clients know when you're out of office

Geriatrics

a branch of medicine that deals with the problems and diseases of old age and the medical care and treatment of aging

geriatric mental health is focused on the psychology and emotional needs of individuals over what age?

60

Geriatric counseling

mental health services for people ages 60/65 and older aimed at enhancing quality of life and addressing emotional, mental, and physical health issues related to aging

Geriatric mental health

an area in need of attention, as nearly one out of five elderly Americans experience at least one mental health disorder (most often severe depression)

According to the World Health Organization,

around 15% of the geriatric population worldwide has a mental health disorder

The high rates of psychological problems among older people are related to

declining health and mobility, cognitive impairment, financial stress, chronic pain, elder abuse, and loneliness

Inadequate mental health treatment in the elderly

the outcomes of risk factors like isolation and loss lead to disproportionately high rates of depression, anxiety, and substance use in older adults. Unfortunately, adequate mental health treatment is less likely among elderly individuals with psychiatric problems, making increased understanding of how to access and treat those issues critically important

Old age people are often prone to develop feelings of neglect, loneliness, worthlessness, and helplessness due to

the lack of adequate support system

ageism

discrimination based on a person's age, which can lead to forced retirement, disregard of personal wishes, and lower self- worth in elderly individuals

______ is one of the most prevalent and serious mental health issues faced by the elderly

depression

aging

a natural process that represents many challenges for some individuals and their families. Although many older adults look forward to moving from middle age into their later years, it may be difficult for others. The goal of the therapist is to ease this transition

common issues for the elderly

transition from employment to retirement, new frailty or medical conditions, finding enjoyable, meaningful activities if they do experience physical challenges that limit their mobility, facing mortality, especially when friends, peers, or spouses and partners pass on, isolation in the wake of many deaths of loved ones, attending to basic needs in the presence of declined memory, alzheimers disease, or other forms of dementia which affect approximately one in ten americans of retirement age

Three addional major areas of difficulties with the elderly include

ageism, violence, and finances

According to the United Nations population survery,

37% of adults over the age of 60 reported experiencing age discrimination in the last year, and 43% were afraid of personal violence. Only 49% of these adults reported being treated with respect, and more than half of adults over the age of 60 found it difficult to pay for basic services, 66% wished they had an opportunity to work, an 47% worried always or very often about money

medical issues of aging

one of the challenges older adults may experience is distinguishing the normal effects of advancing age from signs of actual physical or mental illness

common experiences of mild decline include areas of:

visual and verbal memory, visuospatial abilities, immediate memory, or the ability to name objects, hearing and vision, bodily strength, and appetite and energy level

Clinicians who are for older adults can help reduce the impact of these issues by using certain strategies to allow for varying degrees of impairment

use plain language and focus on important details rather than unnecessary information, clearly communicate directions and use written reminders as memory aids, provide written information in an easy to read format, speak clearly and face to face

research indicates therapeutic support has a significant effect on

the overall functioning of the elderly

statistics show that about ______ of adults over the age of 60 have a mental health condition

15%

mental health concerns often experienced by older adults include

anxiety, depression, sexual dysfunction, sleep problems, behavior concerns, high suicide rates, alcohol and substance dependent

therapy for geriatric issues

manage their emotions, find new sources of enjoyment and meaning, find new support systems, help people face their fears of death, deal with grief as friends and family members pass on, assist family members who may be caretakers of their elder relatives, assist with communication issues which may be especially helpful if an elder has some form of dementia, provide community resources

a main goal of working with the elderly is to

promote active and healthy aging.

encouraging these has led to an increase in positive attitudes and overall living in the elderly

stay physically active, stay mentally active, be social, be creative, live your passions, enjoy music, spend time with animals, do gardening, help others, go out on fun outings, do fun things, share knowledge

five daily needs or seniors that must be met

staying mobile, getting personal care, managing medical care, getting proper nutrition and exercise, engaging in activities and recreation

specific methods for working with the elderly population

avoid micromanaging, be patient, ask lots of questions

positive reminiscence

an exercise designed to promote the skills of savoring and building positive emotions. It contains 3 steps

Positive reminiscence: Step 1

Think about a positive past event

consider an event that brought great joy or a sense of accomplishment. Look at inspiring reminders, such as photos

Positive Reminiscence: Step 2

Savor

The next step involves taking a few moments to relive a moment from the above event, including event details and associated positive feelings, have them be in the moment

Positive Reminiscene: Step 3

Relive the experience

Last, relive the experience by avoiding analytical thoughts about the event

Geriatric group therapy

an excellent way for older people to feel a sense of support and camaraderie with others dealing with similar issues. This may also help to reduct social isolation

what document in psychology outlines ethical standards for psychologists and identifies behaviors that deserve punishment

APA's ethical principle of psychologists and code of conduct

The APA's ethical principles of psychologist's and code of conduct consists of:

an introduction, preamble, 5 general principals, and specific ethical standards

introduction

discusses the intent, organization, procedure considerations, and scope of applications of the ethics code

preamble

what the ethics code is, includes, and stands for

5 general principals

goals to guide psychologists toward the highest ideals of psychology. Not enforceable rules but used in considering and arriving at an ethical course of action

specific ethical standards

enforceable rules for conduct. Goals to guide psychologists toward the highest ideals of psychology

5 general principals

Principal A

beneficence and nonmaleficence

5 general principals

Principal B

Fidelity and Responsibility

5 general principals

Principal C

integrity

5 general principals

Principal D

Justice

5 general principals

Principal E

Respect for People's rights and dignity

Specific Ethical standards

1. resolving ethical issues

cooperating with the ethics committee, reporting ethical violations, improper complaints, conflicts between ethics and the law, and ethics and organizational demands, etc.. you are ethically bound to report something, need to work to resolve the ethical issue

Specific ethical standards

2. competence

continued ed, delegation of work, personal problems, emergencies, using scientific knowledge. Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consolation, study, or professional experience

specific ethical standards

3. human relations

sexual harassment, discrimination, avoiding harm, multiple relationships, exploitive relationships, conflict of interest, cooperation with other professionals, informed consent, interruption of services

Specific Ethical Standards

4. Privacy and Confidentiality

maintaining, discussing the limits, recording, minimizing intrusions, disclosures, consultations with colleagues

Specific Ethical Standards

5. Advertising and other Public statements s

false or deceptive statements, descriptions of workshops, testimonials

Specific Ethical Standards

6. Record Keeping and Fees

documentation, maintenance of records, withholding records for non-payment, financial arrangements, bartering, accuracy of funding sources, referrals and fees

Specific Ethical Standards

7. education and training

refers to psychologists who teach, syllabus, accuracy in teaching, mandatory therapy, student disclosure of personal info, assessing student performance, sexual relationships

Specific Ethical standards

8. Research and publication

institutional approval, informed consent for participants, recording devices, images, deception, participants, debriefing, humane care, plagiarism, publication credit, results

Specific Ethical standards

9. Assessment

bases, use, consent, release of data, test construction, interpretation of data, assessment by unqualified persons, obsolete tests, outdated results, scoring and interpretation, explanation of assessment results and test security

Specific Ethical standards

10. Therapy

informed consent, couples and families, those already in therapy, sexual intimacy with present or former clients, former sexual partners, interruption, termination

ethical standards are broad to

allow professional judgement on the part of psychologists, eliminate injustice or inequality, ensure applicability across the broad range of activities conducted by psychologists, guard against a set of ridged rules that might be quickly outdated

"Reasonable meaning"

the prevailing professional judgement of psychologists engaged in similar activities in similar circumstances, given the knowledge the psychologist had or should have had at the time

Duty to warn

the clinicians responsibility to notify a potential victim of a client's harmful intent toward that individual

Where did the duty to warn originate from?

From the case of Tarasoff v. Regents of the university of california, 1969

What is the most extreme form of violation of the therapeutic relationship?

sexual intimacy with clients, this is explicitly forbidden in the ethical codes of the mental health profession

It is also prohibited to become sexually involved with a client for how many years after treatment continues?

at least 2 years

Health insurance portability and accountability act of 1996 (HIPPA)

a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patients consent or knowledge. Also governs the way all records are maintained and fees for services are charged

What is the most critical step in healing and moving on?

Forgiving someone who has done us harm or forgiving ourselves when we have made a mistake

Helping clients to forgive themselves and others can put them on track toward what?

self healing, self empowerment, and self liberation

forgiveness

it is not about forgetting or condoning the harm that has been done; instead, it is letting go of the need for revenge and releasing negative thoughts of bitterness and resentment

Methods of forgiveness: a more passive approach

allow time to pass as the injury becomes less relevant to everyday life

method of forgiveness: second method, a form of strength psychology

this uses the idea of radical forgiveness, in which the injured person makes a deep commitment to releasing the past

radical forgiveness

involves a dual notion of taking concrete steps to forgive the offender, while also surrendering to the flow of life and ascribing meaning to the suffering experienced.

Compared to passive forgiveness, radical forgiveness....

can occur more rapidly and concretely, but it also takes more energy and guidance

Forgiveness in strength psychology

is about freedom for the injured person. Through gaining a more balanced view of the offender and the event, the individual can let go of the weight of negative emotions and the desire to punish and avenge

What is the goal of forgiveness?

It is not necessarily to restore the relationship or achieve reconciliation, rather to restore personal wellbeing and balance to the injured persons life

forgiveness therapy

a subtype of therapy that focuses specifically on helping clients forgive and move on.

process based forgiveness

can take place over a more extended period and use cognitive, behavioral, and affective strategies

decision based forgiveness

significantly shorter (sometimes only one session) and involve primarily cognitive strategies and a commitment to do the work of forgiving outside of the session

three ways to forgive yourself:

1. recognize and acknowledge that humans are complex and flawed beings

2. reframe self forgiveness as a step toward self improvement (second best interpersonal forgiveness)

3. consider self forgiveness as a second best to interpersonal forgiveness

useful tips for forgiving yourself

1. remember that self forgiveness is an act of strength, not weakness

2. self forgiveness is always an option, even when someone will not forgive you

3. self forgiveness does not need to come at the expense of other actions, such as making amends or learning from your mistakes. it may increase your ability to take these steps

issues with death and dying in clinical setting may involve working with:

those who are terminally ill, the loved ones of those who are terminally ill, those who are grieving the loss of a loved one, those who are experiencing issues with their own mortality (age, midlife crisis, near death experience, etc.)

When working with clients who are experiencing difficulty with their own mortality, it is important to have what?

a strong awareness of our own issues of mortality

what does awareness of our mortality help us realize?

that our actions do count, that we do have choices concerning how we live, and that we must accept the final responsibility for the way we are living

In 2005, Who gave the commencement address at Stanford University?

Steve Jobs, the late CEO of Apple Inc. and Pixar Animation Studios

What is the key element when working with clients struggling with mortality and regrets?

Life is precious and we are here for a limited time, so we should think about what changes we are willing to make in the way we are living, especially if we are not satisfied with out present existence.

Important questions to ask clients (and yourself)

What do you want to accomplish before you die? How much progress are you making in achieving this goal? What is getting in our way? What control do you have in removing barriers and are some out of your control?

the dying person is one who is seen...

to be in a life threatening condition with relatively little remaining time, with little or no hope of recovery

the labeling of a person as a "dying patient" identifies that person as

belonging to a special category of humanity, and creates profound changes in the emotional, social, and spiritual climate of therapy.

the goal of therapy with a dying person

-aims to "normalize" the patients life as much as possible. Patients need to remain as fully engage in the routines of living as they can

how can a therapist help a client find their power in a situation that deems to be powerless?

Focus on what they can do in their remaining time, help them remain positive, and to do as many things as possible that will give them positive experiences during their remaining time

Kubler- Ross: Stages of death and loss

denial, anger, bargaining, depression, acceptance

Psychological responses

include fear, sadness, confusion, anger, and low self esteem, and the risk for clinical depression and anxiety

Psychological needs are interconnected with

physical needs

psychological support

the psychological care of a dying person, takes the form of emotional, spiritual, social, and practical help

Psychological support can..

help alleviate anxiety and depression to ensure that people who are dying enjoy the best possible quality of life in the time that remains

The goal of the clinician in psychological care of a dying person

to provide a relationship in which patients can experience support in the confrontation with death.

grief

involves the constellation of internal thoughts and feelings we have when someone we love dies