Introduction to Counseling and Therapy PDF

 11/3/24 Introduction to Counseling and Therapy, A Lecture 1: Who is a counselor? Dr. Gali Weissberger Overview Review Syllabus Introduction to Counseling and Therapy Who is a therapist? Qualities of a therapist...

 11/3/24 Introduction to Counseling and Therapy, A Lecture 1: Who is a counselor? Dr. Gali Weissberger Overview Review Syllabus Introduction to Counseling and Therapy Who is a therapist? Qualities of a therapist Starting out 1  11/3/24 Course Goals Gain foundational knowledge of the different approaches to psychotherapy and counseling Understand basic ethical issues and assessment techniques involved in psychotherapy Be able to apply the techniques learned to different psychopathological disorders Be able to identify strengths and weaknesses of the different psychotherapy and counseling techniques Lesson Date Topic Required reading Assessment No. 1 5/11 Course Schedule Introduction: Who is a (readings in bold font are required) Corey Chapter 1-2 Students pick lecture date for counselor? which to post multiple choice questions to forum 12/11 No in-person class 2 19/11 Ethical Issues and Corey Chapter 3 Considerations 3 26/11 Evidence Based Practice Spring, 2007 in Psychology 4 3/12 Clinical Interviewing and Assessment 5 10/12 Psychoanalytic Therapy Corey Chapter 4 6 17/12 Psychoanalytic Therapy Corey Chapter 4 Quiz 1 due by 23/12 at 23:59 7 24/12 Jungian Analytical Theory Capuzzi & Stauffer Chapter 4 8 31/12 Adlerian Therapy Corey Chapter 5 9 7/1 Existential Therapy Corey Chapter 6 10 14/1 Person Centered Therapy Corey Chapter 7 11 21/1 Gestalt Therapy Corey Chapter 8 Quiz 2 due by 27/1 at 23:59 12 28/1 Review for exam 2  11/3/24 The Textbook Theory and Practice of Counseling and Psychotherapy, 10th Edition. Corey, G. https://b- ok.asia/s/theory%20and%20 practice%20of%20counseling %20and%20psychotherapy Surveys 11 approaches to therapy All have pros and cons Grade Breakdown Final Exam 60% of grade Multiple choice Two quizzes in Lamda 20% of grade (10% per quiz) Check syllabus for deadlines Some questions will appear on final exam Course assignment: 20% of grade 3 11/3/24 5  11/3/24 Class Guidelines Participation in class is always encouraged Start in English but you can move to Hebrew if you need help finding a word Your English does not need to be perfect (my Hebrew certainly is not) Please respect your peers! Turn off your phones, listen attentively Class attendance is required - students who miss 2 or more classes without justification will be at risk of failing the course A 5-minute break will be given during each class [email protected] WHAT IS THERAPY? WHO IS A THERAPIST? 6  11/3/24 MISCONCEPTIONS A therapist is a person that gives advice Therapy is for weak or “crazy” people A therapist is like a friend Therapy is just a time to talk Therapists sit behind a desk and take notes while you lie on a couch A therapist will blame my current problems on my past and my upbringing Therapy: A Collaborative Approach Collaboration between therapist and client Allow the client to help you Listen to client! Information from client will tell you how you need to individualize the therapy Establishing a good working relationship is crucial Building trust is key! Consider your own reactions to therapeutic techniques 7  11/3/24 Characteristics of A Therapist Not just a technician, but an artist Important qualities Compassion Empathy and sensitivity Listening skills and presence Honesty and authenticity Openness and adaptability These qualities build a trusting relationship These qualities serve as a model for the client Other Important Qualities Respect of self Sense of humor Appreciate influence of culture Sincere interest in welfare of client Passionate Enjoying the work and avoiding burnout! 8  11/3/24 Sure these qualities are important, but the therapist’s skills and approach are most important, right? Research studies show that the therapist client relationship is the strongest predictor of positive outcomes in therapy Burnout Definition: emotional exhaustion that results from excessive demands of the job Frequent occurrence in mental health professionals Likely to occur when therapists are over-worked and lack control over outcomes in work-setting Also common when therapist feels helpless with client’s progress Results in: subtle (or more obvious) negative reactions towards clients; detachment 9  11/3/24 Burnout Contd. Warning Signs Preventing Factors Uncharacteristic angry outbursts Positive feedback Apathy towards clients Role clarity Chronic frustration Sense of autonomy Depression (independence) at work Emotional/physical exhaustion Social support Hostility Realistic criteria for client outcomes Feelings of malice/aversion Personal accomplishment towards clients Realistic awareness of strengths Reduced and weaknesses as a therapist effectiveness/productivity Self Care! https://online.csp.edu/resources/article/employee-burnout/ 10  11/3/24 131080 It 4 Targeting burnout at work Mentorship programs Experienced employees mentoring newer employees Employee compensation Recognition/reward systems Work-life balance Remote work; flexible hours Training and development Hiring into new positions from within the company Professional development programs to improve skills Therapist Values Values: core beliefs that influence how we act, both in our personal and professional lives Strive for objectivity Allow client to arrive at a goal that is consistent with the client’s values Don’t impose world-view on client Important for therapist to understand his/her own values Be open about your values Expose your therapeutic orientation to client Ask client about his/her own values and clarify 11  11/3/24 Therapist Values cont. Value imposition: directly attempting to define a client’s values, attitudes, beliefs, and behaviors This is unethical! The American Counseling Association’s Code of Ethics states: “Counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients, trainees, and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature. (Standard A.4.b.)” The Culturally-Competent Therapist Culture includes: client’s gender, race, ethnicity, socio-economic status, age, religion, sexuality, etc. Ethical obligation Recognize how culture shapes therapist Recognize how culture shapes client Recognize how these factors interact Tailor interventions to be consistent with client’s view 12  11/3/24 Three Dimensions of Cultural Competency (Sue & Sue, 2013) Beliefs and Attitudes Awareness of biases Personal biases/attitudes do not interfere with treatment Accepting of diversity Knowledge About client’s background About your own stereotypes Impact of being a minority Skills and Strategies Consult others Define and teach skills that are consistent with client’s culture and experiences 13  11/18/24 Introduction to Counseling and Therapy, A Lecture 2: Ethical Considerations Dr. Gali Weissberger Overview Definitions Code of Ethics Ethical Principles Case Examples 1  11/18/24 What does being an ethical therapist mean? Ethics general Traditionally: “branch of philosophy dealing with moral problems and moral judgments” (Koocher and Keith-Spiegel) Involves assigning judgments such as “good” and “bad”, “right” and ”wrong” But situations are not always “black” and “white” Psychologists will always be faced with ethical dilemmas 2  11/18/24 Two Levels of Ethics Mandatory Ethics Minimum level of professional ethical practice Fear-based ethics of losing license client what best for the Aspirational Ethics - Higher level of ethical practice to strive for Doing what is in the best interest of the clients Concern-based ethics AKA positive ethics Approaches to Ethics S Risk Management Approach Taking a defensive stance difficult Avoiding high-risk situations selfetection Avoiding high-risk clients Can in and of itself be unethical -don't have the skill to help Vigilant Ethics constantly being S - aware Protecting Primary rationale is NOT self-protection & the patient Maintaining high ethical standards 3  jacket ina nezas provid , pozyny due S o defensive - under fear , the client is clike dealing With a suicide ju lac und you mind yuic not dany a unle pla inelizaand X laziquia ebustio yet pic , 10out  11/18/24 Overview Definitions Code of Ethics Ethical Principles Case Examples Ethics Codes proffesionl organization Educate therapists about the responsibilities of the profession Accountability for practitioners Prevent clients from experiencing malpractice Basis for constantly improving clinical practice Many codes of ethics Israel Psychological Association Code of Ethics for Social Workers in Israel American Psychological Association American Counseling Association confidentially I teaching 4  11/18/24 All Codes Have Similar Themes Promote the welfare of consumers (clients) served Practicing within bounds of competence Protecting confidentiality and privacy Doing no harm Acting responsibly Ey's Avoiding exploitation 210410n') Upholding professionalism through exemplary conduct Israel Psychological Association Ethics codes ‫אבחון והערכה‬ ‫מקצועיות בפסיכולוגיה‬ ‫פסיכולוגיה ומערכת המשפט‬ ‫הרשומה הפסיכולוגית‬ ‫התערבות פסיכולוגית באמצעים‬ ‫סודיות מקצועית‬ ‫מרחוק‬ ‫הבניית הקשר המקצועי‬ ‫אתיקה בהדרכה‬ ‫ יחסים מקצועיים בין פסיכולוגים‬ ‫מחקר ופרסום מדעי‬ ‫ולקוחותיהם‬ ‫הצגה עצמית מקצועית ופרסום‬ ‫ יחסים בין עמיתים‬ 5  11/18/24 Class Activity Divide into groups of 3-4 I will assign each group a section of the IPA ethics code Go to: https://www.psychology.org.il/StaticContent/athics/index.html#1 Summarize (in English) in a few sentences the main themes of your section Present briefly to class Law and Ethics Morality and law are related, but separate entities Both attempt to facilitate harmonious living Laws are overturned because they are deemed immoral On the flip side, we cannot enforce people to be moral Misdemeanors (e.g., public nudity) will not result in expulsion unless they also violate an ethical principle But there is also some overlap Mental health professionals often face expulsion from professional organization and lose license for committing a felony 6  11/18/24 Overview Definitions Code of Ethics Ethical Principles Case Examples Informed Consent: an ethical principle and legal requirement Establishes the foundation for a healthy partnership between therapist and patient Client has the right to be informed about the therapy Allows client to make informed decisions Promotes cooperation Presented as a “Consent Form” prior to the beginning of therapy Therapist and client sign and date form 7  11/18/24 Things to Include in a Consent Form Goals of therapy Fees Responsibilities of therapist and Length of therapy of client Right to terminate sessions Confidentiality and limitations Contacts in case of Legal/ethical parameters that emergency define therapeutic relationship Risks/benefits of therapy Qualifications of therapist Supervisors involved? Confidentiality One of the ethical standards included in ethics code “Everything we talk about in session will remain confidential” 8  11/18/24 Exceptions to Confidentiality In some important cases, therapists must breach confidentiality Therapists are mandated reporters Legally required to report child abuse or abuse of a dependent or elderly individual A therapist who fails to report an instance of abuse is breaking the law Exceptions to Confidentiality contd. Intent to harm self or others Therapist decides whether to report to authorities There are ways to work with client who is suicidal before reporting to authorities Assess for intent, plan, and means Develop a suicide contract Get patient to turn him/herself in If patient is unwilling, call authorities 9  11/18/24 Dual Relationships: Are they unethical? Dual Relationships Therapists who assume two or more roles simultaneously with a client Therapists in a relationship with someone closely associated with or related to the client Therapists who make promises to enter into another relationship with the client or someone the client is closely associated with in the future They are not inherently unethical but they can increase the risk for unethical practice 10  11/18/24 Dual Relationships Sexual dual relationships are forbidden Non-sexual dual relationships can be ethical or non-ethical depending on the circumstances In some cases they are unavoidable Mutual trust must be present – can each person rely on the other to respect their boundaries and needs? Certain circumstances may render the dual relationship unethical Lack of objectivity Boundaries that are unclear Power differences between the therapist and client Examples of dual-roles Examples of potentially unethical dual roles: Supervisor and student + therapist and client Therapy to a friend Bartering for goods or services in exchange for therapy services Accepting an expensive gift from a client In some regions, these relationships are unavoidable E.g., rural areas 11  11/18/24 Sexual relationships = UNETHICAL, ILLEGAL, and UN- PROFESSIONAL Video: 50/50 Car Scene Consider these questions while watching: Is what you see unethical? What parts of the video raise concern for you? How can this lead to a more problematic (unethical) relationship? 12  11/18/24 Multiple Relationships And then this happens… 13  11/18/24 When dual roles are unavoidable… E.g., rural towns There may only be one therapist available! In these cases, consider ways to deal with a dual role Set boundaries, establish mutual trust Identifying Risk of Dual Relationships Kitchener, 1988 14  11/18/24 Ways to Minimize Risk Set healthy boundaries (e.g., informed consent) Involve clients in the discussion and decision making process Discuss expectations related to therapist-patient relationship, regardless of the nature of the other relationship Consult with colleagues for a more objective perspective Work under supervision Third parties can help identify risky situations Continue to self-monitor Document everything! Consider difference between boundary crossing vs. boundary violation Role of Ethics in Human Resource Management Human resource professionals can help an organization uphold its core values Goal: improve employee trust and relations What are some ethical issues in the workplace? Unfair employee benefits and compensation plans Discriminatory practices Biased recruitment practices Interfering with employees’ personal lives 15  11/18/24 Overview Definitions Code of Ethics Ethical Principles Case Examples Case Example: Treating Acquaintances “Jan Typer worked as a records clerk for a community mental health agency. Helmut Honcho, Ph.D., supervised her work. When Ms. Typer experienced some personal problems, she asked Dr. Honcho if he would treat her. He agreed. Ms. Typer later brought an ethics complaint against Honcho, charging him with blocking her promotion based on assessments of her as a client instead of on her performance as an employee” Koocher & Keith- Spiegel, 2008 16  11/18/24 Case Example: Accepting Gifts “Rich Rick Porsche gave his recently licensed therapist, Grad Freshly, Ph.D., a new car for Christmas, accompanied by a card stating, “To the only man who ever helped me.” Dr. Freshly was flattered and excited. He convinced himself that his services were worth the bonus because Mr. Porsche had churned through many previous therapists with disappointing results. Later, Mr. Porsche soon began to find fault with Dr. Freshly and he sued Dr. Freshly for manipulating him into giving an expensive gift.‫״‬ Koocher & Keith- Spiegel, 2008 Case Example: Avoiding Dual-Roles “Timothy Vulnerable, age 10, was enrolled in psychotherapy with Carla Carefull, Psy. D. by a state welfare agency and the foster parents with whom Timmy had been placed following a significant physical beating by his substance-abusing mother. After several months, the agency began to plan for a reunification with the mother, who would soon graduate from a drug rehab program. During a session, Timmy asked Dr. Carefull, “Where do you live?” When she inquired why he wanted to know, Timmy replied, “I thought maybe if my mom started hitting me again, I could come over to your place. She told Timmy, “You’re right! You do need a plan if things get bad at home. I’m not always home, so it will be better if we figure ways that you could get help any time.” Dr. Carefull then informed Timmy of emergency resources and how to reach them” Koocher & Keith- Spiegel, 2008 17  11/18/24 Summary Therapists are bound by strict ethical standards Laws and ethics often diverge Confidentiality and limits of confidentiality must be discussed in depth at start of therapy Clear boundaries between therapist and patient should be set to avoid ethical dilemmas Removed 18  11/18/24 Steps for Making Ethical Decisions Identify the problem: is it ethical, legal, professional, clinical? Identify possible issues: consider the rights, welfare of all involved Use ethics code for guidance Consider laws and regulations: how do they impact your ethical dilemma? Seek consultation Brainstorm courses of action: include client in this Reflect on implications of each decision Document everything!! Your patient invites you to her wedding. You have been treating her for over a year now. Do you go to the wedding? 19  11/18/24 Ethics Organizations as Enforcers There are a long list of acts that are considered legal but blatantly unethical. However, membership in ethics organizations is voluntary Professional organizations have no jurisdiction over non- members! Licensing boards can prevent a harmful individual from practicing Evaluate entry-level qualifications required to offer mental health services to the public under protected titles such as “psychologist” and “psychiatrist” Often they adopt the ethics codes of their professional organization Mechanisms of Protecting Consumers Criminal and civil laws Ethics committees (APA, ACA, etc.) Profession-specific legal controls via licensing boards Professional review committees associated with third party payers (e.g., insurance) Civil litigation Federal and state laws and regulations 20  11/18/24 Drawbacks of Having Many Mechanisms Diffusion of responsibility Inadequate examination of the matter Poor communication channels among the sources of control None of the arenas are swift Can take months to a year to resolve complaints Very costly to maintain an enforcement committee that is adequate Other Functions of Ethics Codes Enhancing public confidence of the profession Clarifying profession’s critical mission Spell out which principles members who are “morally responsible” should follow Clarify use and misuse of skills General guides to making decisions in practice Educating next generation of professionals Rules for judging those whose actions are called into question Weeding out unethical members 21  11/18/24 Ethics Codes Examples American Psychological Association American Counseling Association 10 section headings 8 section headings Competence The Counseling Relationship Human Relations Confidentiality, Privileged Privacy and Confidentiality Communication, and Privacy Advertising and Other Public Professional Responsibility Statements Relationships with Other Record Keeping and Fees Professionals Education and Training Evaluation, Assessment, and Interpretation Research and Publication Supervision, Training, and Teaching Assessment Research and Publication Therapy Resolving Ethical Issues American Psychological Association “Psychologists are committed to increasing scientific and professional knowledge of behavior and people's understanding of themselves and others and to the use of such knowledge to improve the condition of individuals, organizations and society. Psychologists respect and protect civil and human rights and the central importance of freedom of inquiry and expression in research, teaching, and publication. They strive to help the public in developing informed judgments and choices concerning human behavior. In doing so, they perform many roles, such as researcher, educator, diagnostician, therapist, supervisor, consultant, administrator, social interventionist and expert witness. This Ethics Code provides a common set of principles and standards upon which psychologists build their professional and scientific work.” 22  11/18/24 Assessing Suicidality Intent “I want to kill myself ” “I think about suicide but I would never do it because I care too much about my kids” Plan Jumping off a bridge, pills, drowning Means Access to bridge, pills, etc. Reporting Suicidality If not a “high-risk”, can make a contract Something patient is held accountable to Include coping strategies Include therapist’s contact info and emergency numbers E.g., suicide hotline Call 911 If “high-risk” Will patient go willingly? If yes, make sure patient has an escort If not, involuntary hold: 51/50 23  11/18/24 Involuntary hold: 51/50 Section of the California Welfare and Institutions code “…an application in writing stating the circumstances under which the person’s condition was called to the attention of the officer, member of the attending staff, or professional person, and stating that the officer, member of the attending staff, or professional person has probable cause to believe that the person is, as a result of mental disorder, a danger to others, or to himself or herself, or gravely disabled” Allows an officer or clinician to involuntarily confine a person who is danger to himself or others Officer or clinician can request the confinement after signing a legal document Exceptions to Confidentiality: Intent to Harm Others Not discretionary, like intent to harm self Mandatory to report Tarasoff v. Board of Regents (1976) Supreme court ruling of a “duty to protect” third parties against dangers posed by a patient Must have an identifiable party 24  11/18/24 A Case Example “Euthan Asia was full of remorse when he came to his initial appointment with Oliver Oops, Ph.D. After asking and receiving assurance that their conversations would be confidential, Mr. Asia disclosed that, 2 months earlier, he had murdered his wife of 50 years out of compassion for her discomfort. Mrs. Asia was 73 years old and suffered from advanced Alzheimer’s disease. Mr. Asia could not stand to see the woman he loved in such a state, so he gave his wife sleeping pills and staged a bathtub drowning that resulted in a ruling of accidental death by the medical examiner.” Koocher & Keith- Spiegel, 2008 Confidentiality vs. Privileged Communication Confidentiality is an ethical construct that is limited by laws Privileged communication is a legal construct Certain relationships enjoy protection from disclosure in legal proceedings Some states consider the therapist-client relationship to be a privileged communication Clients can waive this privilege but they can not chose what will be presented in court 25  11/18/24 Court case: Jaffe vs. Redmond (1996) Redmond: police officer seeking therapy after killing man on duty Jaffe: Estate manager of man killed who requested access to therapy materials Redmond and therapist refused but Jaffe won the case Supreme Court later overturned this ruling, upholding the existence of a privilege to patients of licensed therapists “The mere possibility of disclosure may impede the development of the confidential relationship necessary for successful treatment” Koocher & Keith- Spiegel, 2008 Malpractice Complaints If a patient complains to the APA (American Psychological Association) ethics board, therapist must relinquish records The records get reviewed by ethics committee, and its members are also bound by confidentiality 26  11/18/24 Multicultural Ethics Consideration of whether your theoretical orientation and the techniques are applicable to client’s cultural group Being flexible and adapting techniques to clients of diverse backgrounds Suicide as an example Suicide from a Multicultural Perspective Suicide and depression manifest differently in different cultures Some cultures tend to somaticize E.g., emotion is expressed by physical distress in China “xinhuang” = heart panic, “xinfan” = heart vexed Some populations do not have moral taboos related to suicide Statistics of suicide differ by culture In US, men > women; in China women > men 27  11/18/24 Case Example “Trevor Tanaka was the eldest son of a proud Japanese family; he was sent off to attend college in the US at age 17. He had some difficulty adjusting at the large state university and failed midterm exams in three subjects. Mr. Tanaka sought help at the college counseling center and was seen by Hasty Focus, M.A., an intern. Mr. Focus became misled by Tanaka’s excellent command of English, Western-style fashion consciousness, and tendency to nod in seeming assent whenever Focus offered a suggestion or interpretation. Focus failed to recognize the subtle, but stressful, acculturation problems or to detect the growing sense of depression and failure Tanaka was experiencing. Tanaka was apparently unwilling to assert his concerns over the interpretations of the “expert” in an impolite or unseemly fashion. After five sessions and 6 weeks, fearing failure on his final exams and disgrace in the eyes of his family, Tanaka committed suicide” Koocher & Keith- Spiegel, 2008 28