Developing a counseling orientation
-Should be an expression of you
-ROAD MAP- guiding your work with clients
-Balance- meeting clients needs, appropriate for he type of counseling you do
-Consider culture before you employ any approach
-What is your theory? Are you open to incorporating as
Who is responsible for client change?
Client and counselor.
-Address shared responsibility often
-informed consent
-setting goals and treatment plans
-Taking an relinquishing the lead
Who sets the goals in counseling?
-Mutual is best
-Based in -Theory (i.e. Behavioral)
-Setting (school vs
managed care)
-Presenting issue (Growth
vs. psychosis vs. marital)
-Ethical issues
Using techniques
-Based in theory and orientation
-Intentionality vs. willy nilly
-Training and a rationale
-No single technique is best
What leads to success in therapy?
-40% Extra-therapeutic factors (beyond therapists control)
-30% Therapeutic alliance
-15% Hope and positive expectations
-15% Counseling techniques
Medical diagnosis
Only done by a physician or psychiatrist for a neuropsychological problem
Psychodiagnosis
Psychological diagnosis- a general term covering the process of identifying an emotional or behavioral problem and making a statement about the current status of a client. Psychodiagnosis might also include identifying a syndrome that conforms to a diagno
Differential diagnosis
the process of distinguishing one form of mental disorder from another by determining which of two (or more) disorders with similar
symptoms the person is suffering from. The DSM-5, which has recently replaced its predecessor the DSM-IV-TR (2000), is the
Diagnostic and statistical manual of mental disorders
The official guide to a system of classifying psychological disorders. Both assessment and diagnosis are intended to provide direction for the treatment process.
Diagnosis
-The process of understand the client
-A system of classification that the counselor uses to establish goals and select the most advantageous base for promoting healing
-The importance of accurate diagnosis. It is not for pigeon-holing
-Purpose-nothing sp
BASIC ID
How to diagnosis by looking at the clients whole picture.
B-Behavior (What would you like to start/stop doing?
A-Affect (What makes you angry/sad?)
S-Sensation (What do you like/dislike to hear, taste, ect?)
I-Imagery (What do you picture yourself doing i
How a diagnosis occurs?
Potential sources of error+Clients actual characteristics= Observed clinical judgement
Potential sources of error
-Clinician-expectations, theory,
biases, accuracy, logic
-Client-inconsistencies, SES,
attitudes, personality, culture.
Why is diagnosis important?
-To make predictions about client behaviors (e.g. dangerousness)
-To summarize client issue
-To determine unique personality dynamics
-To identify skill deficiencies
-To understand the significance of behaviors
-To create working hypotheses
-Plus:
-Reimbu
Cautions and Concerns
Diagnosis can...
-lead to the use of psychobabble
-Provide an excuse for remaining helpless
-Promote the idea that same labels=same problems
-Stereotype, stigmatize & dehumanize
Plus some professionals are not competent
Ethical Issues with Diagnosis
Should clients be informed of their diagnosis? YES
Pitfalls with diagnosis
-The "identified patient"-family/marital
-Finding a diagnosis that fits rather than seeing the whole person
-Culture Bound syndromes and the DSM (a client may fit a DSM diagnosis w
Using tests in counseling
-Be familiar with tests
-Recognize limits of competence
-Test intentionality
-Impacts on clients
-Tests are merely tools
-Assure confidentiality
-Give results, not simply scores
-Integrate results into therapy
Ethics and Research
Issues involved
-informed consent
-deception
-withholding treatment
-cultural diversity
The Florida Laws and Rules
The Florida Board"- Board of clinical social work, marriage and family therapy, and mental health counseling.
Chapter 394-Florida mental health act
Chapter 491-Clinical, counseling, and psychotherapy services
Rule 64b4- Florida administrative code
Florida Laws & Rules Chapter 394
Florida mental health act-commonly known as the "Baker Act," allows the involuntary institutionalization and examination of an individual. The Baker Act allows for involuntary examination for up to 72 hours (what some call emergency or involuntary commitm
Florida Laws & Rules Chapter 491
Clinical, counseling, and psychotherapy services. Includes definitions, intern/licensing requirements, continuing education, confidentiality standards, record keeping standards, violations.
Rule 64b4
Florida administrative code-definitions, licensure requirements, continuing education ect
Ethical standards in couples and family therapy
-Professional competence and specialized training
-Clinician values
-Confidentiality and informed consent
-Ethical issues in marital/family counseling
-Ethical pitfalls/dilemmas
Professional competence and training
-personal characteristics
-Self-knowledge is critical
-Training and supervision
-Didactic and experiential methods
-Values in couples and family therapy
-Counselor's value system impacts:
1. Formulation and definition of
problems
2. Treatment planning
3.
Gender sensitive counseling
-Challenging traditional gender roles
-Gender stereotypes
-Feminist perspectives on family
counseling
-Demands for change
-Valuing women's request for
change
-Valuing expression of emotion and
nurturance
-Challenging patterns of
dominance and subordinatio
Confidentiality and informed consent in family counseling
-Exceptions to confidentiality are the same as in individual counseling. i.e. duty to warn, duty to protect, harm to self, abuse
-Informed consent is similar to individual counseling
-Rights of each member is
considered
-Members can withdraw
Ethical issues in marital/family counseling
Responsibility to clients
-dual relationships
-abandonment
-Prejudice
-Exploitation
-Continue treatment without benefit
-Sexual intimacy
Ethical pitfalls/dilemmas for couples and families
-Whose agent is the counseling (which member?)
-How truthful can the counselor be?
-Who wants/does not want counseling
-How informed in informed consent?
-How does the counselor deal with value issues
-How important are counselor values in interpretation?
Ethical Standards in group counseling
-Professional competence and training
-Working with school aged children and adolescents
-Co-leadership pros and cons
-Ethical issues in group counseling
-The counseling process
-Techniques
Professional competence and training in group
-Personal characteristics of group counselors
-Self-confident, flexible, risk-taker,
creative, disciplined, honest,
compassionate.
-Training, supervision, and clinical experience
-Didactic and experiential methods
-Recommendations
-Personal psychotherapy
Ethical principles for group counseling with children
-Placement based on benefits
-Leadership training
-Setting the group rules
-Confidentiality
-Focus on those in the group
-information for parents
-No visitors
-Working in the system
-asking a member to leave
-Member termination
-Professional conduct
-Code
Co-Leadership Advantages
-Better group coverage-content vs. process, schedule changes
-Compatibility-diffusing antagonistic relationship dynamics
-Shared responsibility-both in and out of group
-Support-allies, venting
-Increased role-modeling opportunities
Co-leadership cautions
-Sometimes you can pick 'em, sometimes you can't
-Working together with different styles and theoretical orientations
-inconsistencies and arguments
-power struggles
Ethical issues in group membership
-Informed consent
-Screening and selection
-Preparing group participants
-Involuntary participation
-Freedom to leave group
-Psychological risks
-confidentiality in groups
Managing multiple clients
in some instances an intervention that
serves one person's best interests could burden another family member or even be counter-therapeutic. Therapists avoid becoming agents of any one family member, believing that all family members contribute to the pro
AAMFT
American Association for Marriage and Family Therapists
Necessary competencies in marital and family therapy
Family therapy practitioners must make a paradigm shift from an individual context to a systemic way of thinking. Clinicians trained to deliver individual psychotherapy are not competent to make interventions from a systemic perspective without further tr
AAMFT membership and licensure
Licensure is LMFT-Licensed marriage and family therapist.
-Masters in counseling
-36 hours of coursework
-180 hours (direct contact in family counseling) school-based internship
-1500 hours-(2 years) post masters supervised experienced with a LMFT supervi
LMHC Licensure
-Masters in counseling or related (CACREP bonus)
-60 hours of coursework
� Human sexuality
� Substance abuse counseling
-900 school-based internship (600 if CACREP)
-1500 hours of supervised experience (2 years if post masters)
-100 hours of face-to-face
Kottler discusses countertransference. What are some common feelings? Does he believe that we treat all clients in the same manner?
-We experience intimacy, discomfort, and countertransference reactions that permanently alter our perceptions and internal structure. The more clients talk about subjects that touch on our own unresolved issues, the more insecure and uneasy we may feel ab
According to Kottler, which cases do most therapists find difficult to work with and why?
Part of being a therapist involves working with those individuals who, for a variety of reasons, will test your patience, flexibility, and resourcefulness in ways you've never imagined were possible. In some cases, they push your buttons and ignite a whol
Kottler's view of boredom. What are some of the reasons for this? What can you do to "cure" your boredom?
-Nothing is more difficult than the challenge of staying energized about one's work. If burnout is caused by an overload of stimulation, then boredom is caused by its absence�at least in terms of subjectively perceived experience.
-Boredom involves a loss
Kottler's view of burnout and some of the signs
Burnout is commonly described as having several features:
(1) emotional
depletion or exhaustion
(2) negative attitudes toward clients (deperson-
alization, cynicism, critical judgment),
(3) a perception of diminished
personal and professional accomplishme
Kottler-Games therapist play and some of the lies which we deceive ourselves.
� Counterfeit Intelligence
-Another self-deception is the most universal among therapist frauds. There we sit among our diplomas and memorabilia acting as if we know exactly what we are doing.
-I lie to myself and to my patients to feel the confidence I n
Kottler's view on therapy for therapists
90% of therapists who have entered therapy as a client report that it was incredibly helpful along a multitude of areas. This helped them not only to learn new approaches to their own clinical work but also to realize what not to do in the future. They al
Kottler- When therapists talk to themselves
Talking to ourselves as we would to clients is the most direct and effective cure. This self-administered therapy is especially advantageous in those situations in which we may be needlessly worrying about clients or having difficulty separating ourselves
SLAP Assessment
Used to assess immediate risk
Specificity-details of the plan. Have they thought about a place, time, or deadline. Have they made special arrangements.
Lethality-How lethal? Likelihood of being successful. Can methods be reversed (pills vs. gun) Can they
Multicultural counseling competencies
A set of knowledge and skills that are essential to the culturally skilled practitioner. Gaining proficiency should be an ongoing process.
1. Counselor awareness of own cultural values and biases.
2. Understanding he client's worldview
3. Developing cultu
Multicultural
______counseling can be operationally defined as the working alliance between counselor and client that takes the personal dynamics of the counselor and client into consideration alongside the dynamics of the cultures of both of these individuals.
Multicultural and diversity issues
In dealing with diversity, counselors need to:
-acquire academic and experiential multicultural training
-Develop working therapeutic relationships
-be flexible in applying theories
-be open to being challenged and tested
-be aware of their own value syst
Unhealthy boundaries
-Inappropriate touch
-Role confusion/reversal
-over involvement
-over identification
-over responsibility
-excessive self-disclosure
-being manipulated by client's unreasonable demands
-responding to inappropriate, personal questions
-social media connect
Exploitation of clients
sex=exploitation
-top 2/3 of major ethical infractions committed by therapists in all diciplines
-Offenders:
� usually male offenders
� usually older than victims
� limited success in being
rehabilitated
� has no defense
-Victims
� usually female victims
Continuum of sexual contact
� Psychological abuse
Client is put in the position of becoming caretaker of counselor's needs
� Covert abuse
Counselors intrudes into client's intimacy boundaries by sexual hugging, professional voyeurism, sexua gaze, over-attention to client's dress and
Types of sexual abuse in therapy
�Sexual touch as therapy
�"Learning to love" as therapy
�Exploring sexual identity
�Becoming romantically involved
�Brief loss of control
�"Bonding" and other types of closeness
Sexual abuse effects on clients
�Suicidality
�Psychiatric hospitalization
�Cognitive dysfunction
�Rape
�Emotional liability
�Identity, boundary, and role �confusion
�Sexual confusion
�Mistrust of others
�Emptiness and isolation
�Guilt
�Reluctance to re-enter therapy
�Depression
�Seconda
Sexual abuse of client-effects on counselors
�Propensity for other ethical violations
�Rationalization of behavior
�Increase in malpractice premiums
�Media coverage
�Guilt
�Loss of self-esteem
�Disruption in personal relationships
�Job loss
revocation / suspension of license to practice
�Personally
Managing your feelings
-Dealing with sexual attraction
�Acknowledge the feelings
�Explore the reasons for attraction
�Never act on feelings
�Consult with experienced colleague/supervisor
�Seek personal counseling if necessary
�Monitor boundaries by setting clear limits
�If unab
Boundary crossing
a departure from commonly accepted practices that could potentially benefit clients
Boundary violation
a serious breach that results in harm to clients and is therefore unethical
Role blending
combining roles and responsibilities
Slippery slope phenomenon
a gradual erosion of boundaries--once a counselor crosses a boundary, the tendency to engage in a series of increasingly serious boundary violations can lead to progressive deterioration of ethical behavior
Gift giving
�What is the monetary value of the gift?
�What are the clinical implications of accepting or rejecting?-->is this a display of power/ influence/ dysfunction/ manipulation?
�Where are you in the therapy process?
�What are the therapist's motivations for ac
Bartering
-Advantages of bartering
�Accessibility of counseling
�cultural/ community norms
-Problems with bartering
*Therapist has the burden of
proving it is ethical
-Client dissatisfaction
�Undervalued
�Limited recourse of
complaint
�Employee of the
counselor
-Co
Prior to bartering
-Evaluate whether it puts you at risk of impaired professional judgement
-Determine the value of goods or services in a collaborative fashion
-Determine the appropriate length of time for arrangement
-Document arrangement
-Consult with experienced colleag
Minimize the risk of malpractice
-Set healthy boundaries from the outset
-Secure informed consent of clients
-Discuss both potential risks and benefits
-Consult with other professionals to resolve any dilemmas
-Seek supervision when needed
-Document in clinical case notes
-Examine your o
Relationships with former clients
-controversial
-trouble with defining "former client"
�was therapeutic
relationship ended to have
a relationship
�how much time must pass
�confidentiality applies for
forever
�records must be kept for
27 years
-sexual desires must not have started during
Code of Ethics for sexual relationships with former clients
-used to be 2 year
-now is 5 years between -ending of therapy and beginning of relationship
Consider the impact upon current therapy knowing that a future romantic relationship may develop.
Burden of proof is on the therapist
Harmful effects of sexual relationships with clients
-Erotic contact is totally inappropriate, is always unethical, and is an exploitation of the relationship by the therapist
-When sexual intercourse begins, therapy as a helping process ends
�Problematic consequences
�Isolation
�Stronger distrust
�Fear
�De
Legal Sanctions of sexual relationships with clients
-Being the target of a lawsuit
-Being expelled from professional organizations
-Losing their insurance coverage
-Losing their jobs
-Placed on probation
-Required to undergo their own psychotherapy
-Closely monitored if they are allowed to resume their pra
Non-erotic touching with clients
Controversial
-Can eventually lead to sexual exploitation
-Touching might be done to gratify the therapist's own needs? must carefully assess the appropriateness of touching clients
-Can be appropriate and can have significant therapeutic value
-Can be a
Ethical considerations with non-erotic touch
-Touch should be employed only when it is likely too have a positive therapeutic effect
- Touch should be used in accordance with therapist's training and competence
- Essential that therapists create a foundation of client safety and empowerment before u
NBCC
National Board Certified Counselor
National Certified Counselor (NCC)
CACREP
Council for Accreditation of Counseling and Related Educational Programs
Mission- "to promote the advancement of quality education program offerings"
Specialized accreditation-Counselor Education Programs
Why is accreditation important?
-Quality- meets th
ACA
American Counseling Association
National Association for the Counseling Profession
Founded in 1952
56 branches and 20 divisions
Liability insurance
Ethical Code and Standards of Practice
Journal of Counseling and Development- flagship journal of the couns
Treatment modality
How we deliver services.
-Group counseling
-individual counseling
-family counseling
-couples counseling
Scope of practice
Intended client/population
-Gerontological counseling
-child-adolescent counseling
-addictions counseling
-career counseling
-developmental counseling
-guidance counseling
The differences in professional identity
-Psychiatrists-diagnosis and medical treatment of mental disorders as a physician
-psychologist-assessment
-social workers-link clients to community resources
-psychiatric nurse-management of health care within a hospital setting
What sets counselors apart?
The best perspective for assisting individuals in resolving their emotional and personal issues and problems is the wellness model of mental health
The issues and problems individuals face in life are developmental in nature, and understanding the dynamic
Medical Model
Goal: return patient to the level of functioning prior to illness
Developed by physicians to treat physical illness
The helper diagnosis and "cures" illness
Success: patient goes on about life
If another illness negatively affects patient, she/he returns
The Wellness Model
Goal: positive mental health possible for everyone (wellness vs. cure illness)
Mental health continuum (very mentally healthy- dysfunctional/mentally ill)
Most problems are developmental in nature, are normal, are natural
When prevention is possible, coun
Licensure
Governs professional practice
Licensure acts specify what the holder of the license can do and what others cannot do
Highlights uniqueness of an occupation
Restricts both use of title and practice of occupation
Generic in nature- holder of license is assu
Certification
Voluntary attempt by a group to promote professional identity
Certification confirms that the practitioner has met a set of minimum standards established by the certification agency
Attempts to verify qualifications
set s minimum standards
Does not assure
Similarities between licensure and certification
Assure the public that practitioners have completed minimum educational programs
Assures public practitioners have had a certain number of hours supervised training
Assures practitioners have gone through some type of evaluation and screening
Protect the
Competence
Ethical perspective- competence is required of practitioners if they are to protect and serve their clients
Legal perspective- incompetent practitioners are vulnerable to malpractice suits
Formative assessment
developmentally informed process that provides useful feedback during one's training and throughout one's professional career
Summative assessment
an endpoint evaluation typically completed at the end of a professional program or when applying licensure status
Need to be able to make an objective and honest assessment of how far you can safely go with clients and recognize when to refer clients to o
Systematic procedures in evaluation of student performance
Informed consent- students have a right to be clearly informed of the procedures that will be used to evaluate their performance
Faculty have the ethical responsibility to ensure that you are qualified to enter the profession of counseling after you gradu
Codes of ethics on competence have common themes
Counselors practice only within the boundaries of competence, based on
- Education
- Training
- Supervised experience
- State and national professional credentials
- appropriate professional experience
Certifications
National Certified Counselor (NCC)
School counseling- National Certified School Counselor (NCSC)
Supervision- Approved Clinical Supervisor (ACS)
Substance abuse counseling- Master addictions counselor (MAC)
Mental health- Certified Clinical Mental Health
Florida Counseling Association
State association for counselors
Focuses on state issues
Promote the profession through:o Public awareness
- Professional development
- Advocacy
Legal aspects of supervision
Liability- failure to follow acceptable standards of practice
o Direct liability- when the actions of a supervisor are the cause of harm
o Vicarious liability- being held liable for any negligent acts of the supervisee
Informed consent
Confidentiality and
Rights of Supervisees
Sessions free from distractions
Knowing the supervisor's approach
Confidentiality with regard to clients
Continual access to records
To seek consultation from other professionals
To provide feedback to supervisors
Duties for supervisors
Make expectations and approach clear
Monitor one's own behaviors in relation to:
o The power differential
o The therapy- like quality
o Conflicting roles
Establish a good working relationship
Supervisor competence
Competence is demonstrated by:
o A compre
Ethical Standards for consultants
o The goal is empowerment
o A written contract should be established
Goals of the consultation
Time frame
Consultant's responsibilities
Services to be provided
Methods to be used
Time to be committed to agency
Evaluation process
Payment agreements
Values
Code of Ethics & Standards of Practice
supervisor will insure the supervisee understands the ACA Code of Ethics and legal responsibilities
Dual relationships in supervision
o Since a power differential exists in the supervisory relationship, the supervisor shall not utilize this differential to his or her gain
o Since dual relationships may affect the objectivity of the supervisor, the supervisee shall not be asked to engage
Due process supervisioin
during the initial meeting, supervisors provide the supervisee information regarding expectations, goal and roles of the supervisory process
Evaluation
during the initial supervisory session, the supervisor provides the supervisee a copy of the evaluation instrument used to assess the counselor's progress
Informed consent supervision
the supervisee informs the client she is in training, is being supervised and receives written permission form the client to audio tape or video
Vicarious liability
the supervisor is ultimately liable for the welfare of the supervisee's clients
Direct Liability
when the actions of supervisor are the cause of harm
-the supervisor does not
have to carry out the
intervention
ex. The supervisor says not to report something, tells the supervisee to apply a technique that causes harm ect.
Consultation
the supervisor consults with peers regarding supervisory concerns and issues
Termination of supervision
the supervisor discusses termination of the supervisory relationship and helps the supervisee identify areas for continued growth and development
Discrimination Model
Supervisor assumes a blend of three roles
o Teacher role- involves the delivery of content
o Counselor role- assists supervisees in identifying "blind spots"
o Consultant role- offers supportive guidance o In order to grow the supervisee's clinical muscle
Developmental Model
Four levels of supervisees
o Dependent- supervisees tend to be rigid, shallow, and dependent on supervisors (Prac 1 students)
o Dependency-autonomy- supervisees move toward more competence & self-assurance (prac 1 and 2 students, resistance is common)
o C
Blending the Discrimination and Development Models
The supervisor uses each role (teacher-counselor-consultant)
To match the developmental needs of each supervisee
And finally, there are orientation specific models (e.g. Adlerian, Solution-focused, Behavioral, and Psychodynamic, etc.)
Multiple roles and relationships
-occur when a supervisor has concurrent or consecutive professional or nonprofessional relationships with a supervise in addition to supervisor-supervisee relationship
Supervisor
o Should not form social or intimate relationships with supervisees
o Are aw
Risk management practice or supervisors
Don't supervise beyond your competence
Evaluate and monitor supervisees' competence
Be available for supervision consistently
Formulate a sound supervision contract
Maintain written policies
Document all supervisory activities
Consult with appropriate pro