Intro to Counseling Quiz 4

ch 19-25

Case conceptualization

Taking the various pieces of data that we’ve collected and compiling them into a full “picture” of the client

Helps the counselor better understand the client, establish a “blueprint” for future work

first occurs during our first interaction with client

key questions in conceptualizing

• What brought the client to counseling at this time?

• What is the context of the client and his /her problem?

• What is getting in the way of the client changing?

• What reactions are coming up for me in relation to this client?

types of risk

• Suicidal ideation

• self-harm

•  Homicidal ideation and harm to others 

• Abuse (Physical, sexual, emotional)

• Substance use and/or abuse

• Psychosis

• Other compulsive/risky behaviors (gambling, spending, sexual behaviors)

What if our client attempted suicide by taking an overdose of ibuprofen? What is our clinical read of this behavior?

They may not be fully committed to killing themselves

Passive suicidal ideation

Imagining without action

“Sometimes i feel like i’d just rather not be here…i’d rather not wake up”

this is the most common form

its sometimes used as a coping mechanism…imagining yourself not existing/in pain may make the pain go away slightly in the moment

Active suicidal ideation

Ideation with intent, plan and/or lethal means

Immediate predictors of suicide: ideation, plan, intent, means

suicidal gesture

An action or suicide attempt that has little chance of being successful

May be serving an alternate purpose

Suicide attempt

An action with the intent to end one’s life that could be successful

Suicidality- risk factors

personal/family history of suicide ideation/attempts (especially multiple)

Symptoms of depression

Substance abuse

Certain psychiatric disorders

what is one of the biggest risk factors counselors want to be aware of

hopelessness

Self harm

Cutting or burning oneself in an effort to relieve emotional pain

Be thoughtful of clients wearing long clothes in warm weather

Compulsive behaviors

risk factor

Associated with manic episodes

Remember that clients will udnersell how much they drink and/or use substances

Harm to other/homicidality

Clients begin actively desirous of harming another to the point that they could die

Abuse

We are mandated reporters of abuse or neglect of children and vulnerable adults

If you have reason to believe that your client is aware of abuse, either in the past or present, of themselves or another, you are required to ask about it

ts pertinent to assess for abuse of all forms, but we do not report these if they occur with adults or are not likely to cause serious harm

What type of abuse do we never report

emotional abuse

risk assessment

ask about harm to self and others during the first session

Attempt to ask about risk in contexts in which the topic would naturally arise (“Sometimes when people are feeling as low as you are now…)

If you cant fit the questions in based on context, ask as one clearly identified segment

ask about present and past

specific questions about abuse

• Use general and behavioral questions

  • “Are you experiencing any type of abusive treatment, either now or in the past?”

• Physical abuse

  • “Either currently or in the past, has anyone kicked, shoved, hot or otherwise physically harmed you in any way?”

• Sexual abuse and assault

  • “Have you ever been sexually assaulted?”

  • “Either currently or in the past, has anyone ever touched you sexually in a way that made you feel uncomfortable or unsafe?”

• Emotional abuse

  • “Have you ever felt like you were being mistreated verbally or emotionally by someone, either now or in the past?”

In what ways is group counseling different from individual work

could provide more support and a sense of not being alone

can be cheaper

lack of confidentiality due to there being a group

group counseling

Yalom

A form of therapy in which a therapist or therapists work with a group of individuals to achieve a particular therapeutic aim

Generally time-limited, structured, consisting of 8 to 12 weekly sessions

Based on various theoretical orientations

types of groups

• Psychoeducational groups 

• Group psychotherapy 

• Task groups 

• Process groups 

• Marathon Groups 

Psychoeducational groups

Educate well-functioning group members on some specific area

Group psychotherapy

Aims at remediation of serious psychological problems 

Is more about how the clients live with the psychological problems

Task groups

Achieving a task or work goal

Process groups

Group members work with each other in the here-and-now to process their experience and grow as people

Dont have a subject…nothing specific to talk about

Marathon Groups

An intense encounter group over a long duration, a whole day or multiple days

Therapeutic factors of group counseling: Universality

Feeling of having problems similar to others, not alone

Therapeutic factors of group counseling: Altruism

Wanting to Help and supporting others

Therapeutic factors of group counseling: Instillation of hope

Encouragement that recovery is possible

Example: an older person in recovery showing you can improve

Therapeutic factors of group counseling: Cohesion

Feeling of belonging to the group, valuing the group

Therapeutic factors of group counseling: Catharsis

Release of emotional tension

Has been shown to be important in terms of change

Therapeutic factors of group counseling: Existential factors

Life and death are realities, personal responsibility

Groups with grief or mourning…especially young people with terminal illnesses

Therapeutic factors of group counseling: Corrective recapitulation of family of origin issues

Identifying and changing the dysfunctional patterns or roles one played in primary family

Therapeutic factors of group counseling: Interpersonal input/learning

Finding out about themselves and others from the group

Stages of groups

• Forming 

  • Members are generally polite, anxious, often quiet

• Storming 

  • People “start getting real”

  • Conflict between people’s styles

• Norming 

  • Members find the informal roles and rules of the group

• Performing

  • Members work together toward an end goal, working through conflicts and issues that arise together

Psychoanalytic group theory

Focus on transference and interpersonal processes amongst group members

Existential therapy group theory

Goal in group therapy is to help members accept responsibility and become meaning-makers

Promotion of universality in the contect of esistential isolation

Person-centered therapy group theory

Acceptance of self and other group members

Group cohesion serves as foundation for self-exploration and increased awareness of blocks to growth

Behavior therapy group theory

as a group identifying goals and then assessing along the way

Can include a range of elements, including mindfulness, systematic desensitization, relaxation techniques, etc

Narrative therapy group theory

Can also co-create new stories with other group members

Group members offer each other support, kindness, care, and also an alternative, “objective” perspective as they hear the stories be retold each week

CBT group theory

Group leaders combine empathy with technical competence in establishing their relationship with members to better understand how their thoughts create their issues

Highly psychoeducational

often seen in schools

Primary issues for children

• Inter-child conflict

• Intrapersonal conflict

• Lack of information about environment

• Lack of skill 

• Adjustment from trauma or change

what does using appropriate language mean when counseling childre?

Avoid jargon and other language that will put your client on the defensive

Be direct and simple

Use the client’s language when at all possible!

Developing a therapeutic relationship with children

Trust and closeness…Focus on the environmental concerns that might impact your work or your client’s ability to feel confident

Collaborative and supportive

Be cognizant of resistance in clients who were sent to therapy by parents

Theory and counsling minors

• Theory

  • Prioritize behavioral and cognitive theory and related techniques  

  • Psychodynamic and other insight-oriented approaches may be confusing to child clients

• Expressive arts

• Play therapy 

  • A range of approaches

  • Generally provide child clients with a range of toys and work with them to make meaning of their play

Consent and assessment with minors

Children cannot give informed consent…in this setting, the parents/guardians are technically the client, not the child/minor

Assent: still inviting the kid to be understanding of what they are doing in therapy, and getting their approaval that thats what you will be doing together

If parents want information…

• See if the client wants to share the information with their guardian 

• See if the guardian can be convinced that the information would be best kept hidden 

• Schedule a joint session 

• Inform the client, and then disclose to guardian 

• OR secure approval from supervisor/administrator and do not disclose (remember the adult may have a legal right to the information…)

Confidentiality in schools

• Counselor MUST inform the parents/guardians if a minor client is at risk to seriously harm herself or others

• School counselors generally do not have a legal obligation to obtain parental consent before providing counseling

child abuse

Defined as physical injury (not necessarily visible), neglect, sexual molestation or exploitation, impairment of a child’s mental or psychological ability to function.

There then must be credible evidence that has not been satisfactorily refuted that physical abuse, neglect or sexual abuse occurred before reporting

Reporting child abuse

Health care, human services, education, and law enforcement professionals are mandated reporters when they suspect child abuse or neglect ~ “in good faith”

Oral report must be made ASAP; written report within 48 hours of disclosure

All Maryland citizens are asked to report

What happens after the CPS call is made?

Intake worker will ask a series of questions

Details provided are “screened in” or “screened out” based on completeness of information and consistency with legal definition of child abuse and neglect

If “screened in”, cases may be assigned to one of two pathways:

• Alternative Response ~ lower risk; family assessment and engagement  

• Investigative Response ~ higher risk; forensic assessment resulting in a finding

when all family members are not at the same level of investment…

Option 1: Offer services only when the whole family is ready.

Option 2: Encourage the reluctant member(s) to come for 1-2 sessions; if they still refuse, provide referrals for willing members to individual counseling.

Option 3: Proceed with family counseling for willing members only

Structural family therapy approach

Focus on internal structure like subgroups and identify boundary issues

Strategic family therapy approach

Brief approach focusing on solutions

Experiential family therapy approach

Absurd and atheoretical, with the counselor using confrontation and humor

Adlerian family therapy approach

Focus on education and empowerment

Six principles of emotion processing

• Awareness and naming

• Emotional expression

• Regulation of emotion

• Reflection on experience

• Transformation emotion by emotion

• Corrective experience of emotion through lived experience

moral model of addiction

• Alcohol drug use as a personal choice, and therefore a “weakness”

• “Youre a bad person and weak, therefore you use a substance”

• Religious view

Harm-reduction model of addiction

Example: prodividng clean needles to addicts

Come under a lot of fire…conservatives dont like it

models of addiction

Moral model

Sociocultural model

Medical/disease model

Abstinence model

Harm-reduction model

Evidence-based treatments

• Behavioral 

  • Antabuse

    • Substance that makes you throw up if you drink

  • Use of chips

• Cognitive-behavioral

  • Dialectical behavioral therapy (DBT)

    • Very strict protocol…for anything that is life threatening (substance use and eating disorders, for example)

• Person-centered

  • Motivational interviewing