CMDS550: Counseling Final

Dr. Elmlinger's final exam over the course of CMDS550

Characteristics of Successful Clinicians:

• transparency and ability to describe feelings and capabilities

• regard each person as unique - unconditional positive regard

• regard differences as learning experiences, not threats or red flags for conflict

• ability to see patients as they are rather than who you wish them to be

• ability to accept clients are responsible for their own actions

Listening and responsiveness

• active constructive

• active destructive

• passive constructive

• passive deconstructive

Active Constructive:

meant to encourage a person to continue communicating

Active Deconstructive

provision of feedback specific interaction but discourages continued communication

Passive Constructive

meant to encourage a person to continue communication but with less specific feedback

passive deconstructive

provision of non-specific feedback that discourages a person from continuing communication

Complex emotional reponses:

anger, sadness, jealousy, frustration, anxiety, regret, grief, guilt, confusion, and disorientation

triggers can be ___ and ___

unpredictable; uncomfortable

True/False: Patients are always aware they’re experiencing a big emotion and can always predict a big emotional repsonse

False

True/False: Patients may feel as though emotions are not socially acceptable to display (ex. crying)

True

True/False: A solution to big emotions is always available

False

True/False: Some patients may prefer to process emotions alone

True

True/False: A patient may require comfort or a response that doesn’t always feel professional to a clinician

True

How do you improve your listening response?

• practice full body listening

• minimize distractions

• try to sit still and minimize fidgeting

• listen to both the surface and underlying message

• allow patient to express themselves in a mode they feel the most comfortable (Verbal, written, gestures, etc.)

• use other counseling techniques to confirm understanding

How do you direct the Rational Rider?

Direct the rider:

• follow the bright spots

• script the critical moves

• point to the destination

How do you motivate the Emotional Elephant?

• find the feeling

• cultivate a sense of identity and growth mindset

• break down the change needed in emotional state into smaller steps

True/False: For circumstances and behaviors to change, each individual doesn’t have to make changes to their response and their critical thinking to achieve success.

False

Clinicians can provide support through direction of the ___, ____ thought processes patients will need to ___

critical; rational; make a change

How can clinicians provide support through thought processes?

• follow positive moments - what’s working well?

• script critical moves - what mut be done to create a positive change?

• intentionally picture and describe destination - what is the goal?

how can clinicians provide support by helping work through emotions and improve motivation?

• find and be able to identify/describe feelings associated with communication

• break down changes into smaller steps

• help identify emotional support and a sense of identity through community.

How can clinicians help create a path for the client?

• make necessary changes to communication environment

• build good habits - habits allow less continued critical thinking and energy

• “Rally the Herd” - get regular communication partners on board with new, effective habits

What are Challenges when Communication Counseling with Parents?

• generational differences of communication styles

• families can have strong opinions on treatment and management, even if the approach they prefer isn’t evidence based

• parent/child dynamic can be difficult and include evidence of a power struggle that can influence clinical success

• strong emotional response to the patient, can often struggle with labels and diagnosing

• cultural difference

Counseling with Parents

• labeling

• allocation of resources from the parents/caregivers

• availability of support and resources for the families

• chronic v. conditions that are likely to resolve

• allowing a parent to tell their story

  • Sample prompts: “Help me understand” “What has changed/happened?” “Tell me about your child” “How would you describe a typical day?” “When do you or your child feel frustrated in communication?”

• Issues of concern to parents:

  • “Am I a good parent?” “What does the future look like, will my child ever…?” “How can I help my child find acceptance and their identity?” Negotiation and advocacy

What are some challenges a family might face?

• Navigating systems

• Family structure and dynamics

• Poverty

• Cultural and linguistic differences:

  • families that are immigrants and refugees

How do you counsel Families and Caregivers?

• Orienting to strengths

• parent perspectives and experiences

• open-ended, carefully worded questions

• influences in parenting style

• responding and supporting families through fatigue and difficult transitions

Counseling issues with kids who have communication disorders

• Attention: tasks need to be age appropriate and allow for movement and breaks

• Motivation: can be especially difficult with kids who are living in survival mode and not have their basic needs being met

• trust and building a relationship with the adult/child dynamic

• behavior and understanding the motivation for particular behaviors

• children may not understand why or how their communication is impacted (may believe they’re intelligible)

Management and working with kids with communication disorders: quiet technical skills

• maintaining expectations

• reframing behaviors

• waiting

• listening to their stories and their perspectives

• skills:

  • immersion, demonstration, expectation, responsibility, use, approximations, engagement

Challenges in patients who have had a stroke:

• dealing with a sudden loss of ability and grieving loss of skills

• sudden need to put significant effort into tasks that didn’t need it before

• dealing with near death experience, not a predictable health event

• no time to prepare for support that might be needed

• increased dependence on others for daily tasks

• financial hardship and unplanned medical expenses

• struggling with difficult emotions and fear of it happening again

Management of care with progressive disorders towards improvement

• intentional education on how to live well in a disabled state

• use a conversation in therapy

• meeting with community who have had similar experiences

• signature strengths and how they can be adapted to current abilities

• gratitude visit

• positive outcomes and consequences of experiencing something like this

• education and intentionally talking about secondary mental health issues that may arise

Conditions that are likely to deteriorate:

Parkinson’s, dementia, Huntington’s Disease, ALS, cancer

• cognition, behavior/personality, system failure, mobility, dysphagia and feeding difficulties, life expectancy, hearing, communication

Challenges associated with a progressive disorder where functions deteriorate:

• comfort: can decrease as function and independence changes

• motivation: might struggle with clinical intervention if they know prognosis is poor

• secondary mental health impact

• emotional wellbeing

• education and need for repetition

• financial concerns

• need for greater care as time goes on

• struggling with thoughts about death, dying, and impeding sense of doom

• feeling of hopelessness

• loss of independence

Management of patients with deteriorating conditions:

• recognize there’s no one right way to cope

• Use of humor to cope

• reinforce need and benefit of physical activity

• encourage use of respite care when available

• helping families accept and deal with loss

  • talking about concept of ambiguous loss

• help families identify ways to be proactive

• improving interactions with family, staff, etc.

• addressing issues with feeding

• aiding in making physical environment work

• focus on remaining skills

• identify ways to enrich life