PSYCHOLOGICAL COUNS PSYC 3083
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EXAM 1 STUDY GUIDE PSYCHOLOGICAL COUNSELING PSYCHOLOGY 3083 Exam 1 Monday 9 29 14 Exam 1 will cover the assigned readings lecture material and related handouts and videos covered in the Introduction Counseling Skills Ethical amp Legal Issues and AssessmentInterviewing only up to lecture slide 32 sections There will be 50 multiple choice questions on the exam Please bring a small scantron and a 2 pencil to the exam to record your answers INTRODUCTION RELATED READING amp MATERIALS Text Chapter 1 IMPORTANT TERMS amp CONCEPTS Clinical psychology 0 Based on scientistpractitioner model research and applied skills 0 Covers every aspect of human life 0 Integrates science theory and practice to understand predict and alleviate maladjustment disability and discomfort and promotes human adaptation adjustment and personal development Focuses on intellectual emotional biological psychological social and behavioral aspects of human functioning Counseling psychology 0 Similar to clinical but requires doctoral degree in o Stresses certain theories of therapy and works wg relatively nondisturbed clientele I Life problems career plans relationship issues academic choices etc I Career Counseling Marriage and Family counseling 0 Some work in private practice clinics hospitals student counseling services School psychology 0 Requirements vary from state to state 0 Have had teaching experience and have master s degree at least 0 Work in schools participate in eval and intervention w pupils groups teachers administrators etc o EducationalPsychology o Requires an EdD Doctor of Education degree training available from schools w graduate school of education Paraprofessional o Aka peer counselors may have littleformal education but receive special training in counseling skills to enhance natural helping abilities Work in community agencies treat special populations underserved by usual mental health institutions Often member of underserved group themselves ex druggie helping current druggie Psychiatric nurse 0 Associate or bachelor s degree work in hospital units sometimes outpatient clinics I Basic understanding of medspsychiatric meds Psychiatry 0 Most prestigious and powerful 0 Physicians who have specialized in psychiatry utilize medical model 0 Diagnosis identify disorder search for underlying cause 0 Highly effective for physical diseases but controversial when applied to psychologicalbehavioralsocial problems 0 Requires MD medical doctor degree internship 3 year residency in psychiatry o Prescribe medicine may emphasize drug treatments I Also may prescribe ECT occupational or art therapy etc 0 Many work in private practice or associated w hospitals also work in outpatient mental health clinics Psychiatric technician o In a hospital requires 2 years of college 0 Perform protectivecustodial services in hospital wards some engage in individual group counseling with patients Social work 0 Bachelor masters and doctoral degrees in sw available masters requires 2 years of work and experience after bachelors degree 0 Work in variety of settings 0 Private practice hospitals agencies 0 Most do intake interviews make treatment plans conduct individual and group therapycounseling 0 Specialties 0 School social work child welfare protective services family services etc o Interventions more likely to include providing concrete infodirect assistance to clients by helping find a shelter apply for public assistance search for jobs etc 0 Generally rank lower than psychologists Psychoanalysts 0 Have medical degree receive special training at psychoanalytic institute independent of medical schools 0 May see patients individually several timesweek for one to several years Most hold medical degrees can prescribe drugs and hospitalize patients if necessary 0 Fees that of psychiatrists Work settings related to each profession 0 Huge variety of employment settings I Private practice hospitals public agencies businesses universities military I Teaching research assesstreat kids teens adults families groups smokers prisoners lots Vail ConferenceModela Boulder ConferenceModel 0 Boulder model 1949 I Scientist practitionermodel I Clinical psych requires 1 academic research skills dissertation and 2 applied helping skills internship o Vail model 1973 I Pro essional model I Eliminates academic research requirement for clinical psych Jerome Frank39s quotcommon factorsquot of counselors amp therapist 0 Commitment to help clients adjust o Inspire faith hope I People come in at their worst most don t return after first session Advocates for the client do things for the client heshe needs Listen empathically from client s perspective Helps client understand suffering 0000 Be actively involved in change process Gottman39sothers39 counseling amp counselor de nition 0 Trained ro essionals Knowledge base and proven techniques Don t rel on olk wisdom intuition Are aware of current developments OOO Process vs content in therapy 0 Process I How you do something tone of voice body language etc 0 Content I Actual techniqueinformation 0 Ex if another professor were teaching 3083 the content would more than likely be the same but process would vary Doctor ofPs cholo de ree s D o Takes 46 years after bachelor s degree requires research component Doctor of Philosophy degree EhD o Requires doctoral or masters degree 0 Can be a PhD or PsyD o PhD Doctor of Philosophy completion of a research dissertation I Requires year of internship 3 years of additional coursework I 5 year minimum postgrad work Psychotherapy vs counseling 0 Counseling 0 Less intensive prevention focus goals focus on education educational setting fewer number of sessions 0 Oriented in present emphasis on quotnormalquot short term 0 Psychotherapy 0 Intensive reparative intervention focus goals are remedyingfixing problems hospitalsprivate practice more sessions 0 Reconstructive indepth oriented in past long term BASIC COUNSELING SKILLS RELATED READING amp MATERIALS Parrott 1997 IMPORTANT TERMs amp CONCEPTS Neukrug39s characteristics ofthe effective counselor o The characteristics of a counselor affect the outcome of the patient s therapy 0 Being empathic I Putting yourself in the client s shoes builds rapport understanding elicits information helps client feel understood I Empathic responses accurately convey the AFFECT feeling and emotion and CONTENT 39 39 of quotreflection of feelinq and 39 39 content NOT GIVING GUIDANCE 0 Ex You feel frustrated because you re trying to make all of these changes and things aren t getting better 0 Being genuine I Or transparent some believe a therapist cannot possibly help the client unless they themselves are genuine the client can tell 0 Being accepting I quotunconditional positive regard not condoning the behavior relates to positive client outcomes separate the person from the behavior 0 Being openminded nondogmatic 0 Being mentally healthy 0 Being competent Discussion ofthe quottherapy environmentquot 0 How the therapist presents himherself o Convey personal warmth and acceptance to client 0 Dress professional but not stuffy match the client s language 0 Office 0 Quiet comfy confidential pretty much neutral o If you were Freudian everything blank as possible 0 Nonverbal behavior 0 Warm vs cold nonverbal cues 0 Can be as much as 80 of what we convey to others ll Kleinke39s types ofguestion lineal circular strategic reflective o Lineal o Attempts to expose cause and effect 0 Circular 0 Direct and continual attempts to zero in on a suspected problem area 0 Strategic o Gently challenge the client and may have a hidden agenda 0 Reflective 0 Encourage client to go within reflect and consider new ways of being Tolerance of ambiguity 0 One of the eight most important qualities in an effective counselor 0 Clients are often vague and there is no single way of approaching a therapeutic issue the quotpath of healing is unique to each client 0 Uncertainty ofjourney requires stamina poise and high tolerance ofambiguity eginning therapist common pitfalls 0 Trying to solve a problem before it is fully 0 Difficulty setting their own personal limits 0 Ex repeat calls from clients not paying fees missing appointments may put question into clients mind 0 Fear of silence interrupting o Interrogating I Relying too heavily on asking questions instead throw in openended questions 0 Impatience I Pushing unprepared clients into treatment strategy before they re ready 0 Moralizing I Not being openminded o Reluctance to refer I Shortage of time skill or capacity to be emotionally present should lead to referral Listening skills hindrances to listening 0 Listening skills 0 Talk minimally concentrate on what s being said don t interrupt don t give advice accurately hears content and feelings ask clarifying questions doesn t interpret o Hindrances to listening 0 Preconceived notions about client anticipation of what s going to be said what you re going to say personal issues strong emotional reaction to what s being said distraction ETHICAL amp LEGAL ISSUES RELATED READING amp MATERIALS Text Chapter 16 Pope amp Vetter 1992 Informed Consent to Therapy handout IMPORTANT TERMS amp CONCEPTS I r I I r Shared values of ethical for social work 0 Protect consumers further professional standing of organization 0 Mark maturity of the profession serve as llprofessional identity Guide professionals toward behaviors that reflect values of profession Offer framework in decisionmaking process Defense if sued for malpractice APA s ethical standards General principles 0 Competence integrity professional and scientific responsibility respect for people s rights and dignity concern for other s welfare social responsibility Ethical standards for therapy 0 Therapy 0 Structuring the relationship Discuss nature of course of therapy fees confidentiality When work is supervised the supervisor has legal responsibility for the case and the client knows this or if there s a student intern Provide oralwritten info using reasonable language Informed consent for therapy 0 Obtain consent using reasonable language o If person is legally incapable of getting consent get consent from legally authorized person 0 These patients are informed of the procedures in a manner equal to their psychological capacity I Too much disclosure could lead client away but they must be told confidentiality could be broken Tarasoff duty to warn o MUST BE DOCUMENTED Couple and family relationships 0 Clarify relationship the therapist will have with each Providing mental health services to those served by others 0 Keep in touch with all other doctorsservices to stay on the same page Sexual intimacies w current patients or clientsduh Therapy with former sexual partners 0 Sexual intimacies w former patients 0 At least 2 years after ending services 0 Most don t at all except unusual circumstances 0 Interruption of services 0 Make plans if you re leaving town 0 Termination of professional relationship 0 Don t abandon your clients but terminate when client is no longer benefiting or is being harmed 0 Discuss termination suggest alt services transfer responsibility Confidentialiy and Privilege o f quot 39 39 quot is the ethical quot quot39 of 39 39 39 to safeguard info they receive in practice 0 Privileqe is the LEGAL riqht of of medical legal and therapy services to control info about themselves holder of privilege decides whether info is revealed to others I Licensed therapists cannot be forced to testify about confidential info 0 Both are based on 2 assumptions I 1 Successful treatment of consumers rests on full disclosure by the client of potentially harmfulembarrassing info I 2 Consumers will not disclose important info unless they re sure it won t be revealed Discuss limits of confidentiality o Forseeable uses of info relevant limitations on confidentiality group marital family etc maintain confidentiality minimize intrusions on privacy maintain records disclose confidential information for legal purposes consultation 0 don t share confidential info when consulting w client 0 share info only to extent necessary to achieve purposes of consultation keep info in databases confidential disguise confidential information preserve records in case of withdrawal incapacity or death of psychologist psychologists may not withhold records for payment and make sure records are available to the extent needed to serve the best interest of the patient Licensing of professional psychologists 0 License is issued by state to those who have demonstrated competence in their field by academic achievement and passing tests set by licensing board License protects the public 0 Certification is seen as weaker form of control Common ethical dilemmas reported by psychologists in the Pope amp Vetter article 0 Confidentiality despite the fact that it s considered one of the most fundamental principles 0 Blurred dual or quot39 39 39 39 39 39 bt clients and therapist Payment sources plans settings and methods 0 Insurance coverage Academic settings teaching dilemmas concerns w training Forensic psychology 0 Giving false testimony for money for example Resea rch Conduct of colleagues Sexual issues Assessment questionable or harmful interventions competence ethics codes and committees school psychology publishing helping financially stricken supervision being gquotg r advenisig39 39 r 39 industrialorganizational medical issues termination ethnicity treatment records Laws affecting psychologists Duty to warn mandatory reporting of child abuse 0 Duty to Warn Tarasoff 0 Must alert authorities and person in danger 0 Must let patients know you may have to break confidentiality in such a case 0 Mandatory reporting of child abuse or neglect elder abuse ASSESSMENT amp INTERVIEWING RELATED READING amp MATERIALS Chapter 3 Chapter 4 p 6775 8797Handouts Intake Interview and Suicide Assessment IMPORTANT TERMS amp CONCEPTS Psychological assessment de nition 0 Process of collecting information in a systematic objective empirical way about individuals intellectual functioning behavior or personality so that the clinician can make predictions and decisions about them Interviewing purpose format on handout and assigned in portfolio assignment 3 0 Things to keep in mind 0 A good interview obtains information and builds rapport7 Use good listening skills amp empathic responses Various formats Most have basic sections 7 history medical history presenting problem current functioning psychological testing and summaryrecommendations Take notes 7 Prepare client describe questions quotI need to askyou afew more questions which we ask all clients If the client exposes too many traumatic details they may feel vulnerable and not return 000 n 0000 0 Interview Sections 0 Reason for Referral 7 referred by Dr so and so at the neuromedical center and wants more information about depression or thinks he she could benefit from group therapy I Could be selfreferred 7 mother and friends suggest she receive treatment because they ve noticed signi cant weight loss and depression 0 Background Information age marital status employment living situation ethnicity I Don t make assumptions about sexuality ethnicity important because of cultural differences 0 Behavioral ObservationsMental Status Exam behavior thinking feeling sensorium symptomatology 0 Previous treatment Have you had any treatment prior to today what did you like about your previous treatment Mental status exam ALL aspects covered in class and on handout know what is being assessed and how vou would go about getting the information 0 Behavior 0 Appearance I describe dress how does person look I dress and appearance consistent with age occupation SES etc I Patient dressed appropriately for interview and hygiene good or underdressed for a CEO something like that Do NOT comment on attractiveness 0 Interview behavior I What is client actually doing during the interview 0 Sitting and seem closed off keep jacket on and zipped up all the way was polite but not forthcoming with information guarded etc good eye contact good attention extrapyramidal dymptoms consistent with parkinsons disease 0 Thinking o Judgement able to make effective social amp personal decisions 0 May be assessed by I Wechsler Adult Intelligence Scale WAIS questions 0 What would you do ifyou 0 were in a theatre and saw a re 0 quotfound a letter that someone had dropped that had a stamp on itquot I your own questions What would you do if your friends had been drinking and offered you a ride home responses to other parts of the interview eg quotHow have you tried to solve your problemquot 0 Thought Contentiwhat does person seem to be thinking about Check for I delusions 7 beliefs with no substantial reasoning paranoid grandiose etc I obsessions imost common I homicidal ideation I suicidal ideation 0 Thought Processe572 aspects of interest I FORMgdegree of logic and organization ex speech thinking I thought process seems goal directed speech is clear and organized Tangental Circumstantial7 going on a tangent but bring it back to the topic of conversation Word salad 7 disorganized no grammatical structure I RATEiare thoughts slow Racing Could express speech problem manic depression etc 0 Intellectual Functioningiseveral aspects I concrete vs abstract thinking often checked by asking meaning of proverbs I ability to concentrate digit span or by serial 7s I information e g Name 3 presidents of the US after 1900quot o Memoryi3 types of memory immediate recent and remote are checked lImmediateidigit span or by repeating last question you asked Please repeat the following series of numbers 357139 2Recentinormally includes last 6 months 3Remoteianything longer than 6 months 0 Feeling o AFFECT what emotion client is conveying in session 7 what you observe in the patient patient appeared anxious reported mood as fine 0 MOOD what they are reporting note degree or intensity of affect 0 Data Gathering Apparatuses o Sensorium75 senses functioning adequately hearing impairments or blindness examples 0 Perceptual processesipresence or absence of hallucinations are noted 0 Auditory gustatory I can taste poison in my food 7 they re trying to kill me olfactory visual tactile 0 quotPeople often have unusual experiences when they are under stress as you have been has anything unusual happened to you lately quot can follow up with o quotFor example some people in crisis see or hear things that other people don39t has anything like that happened to you 0 Symptomatology o Psychological symptoms or any physical symptoms which might have their basis in psychological functioning Because of their severity and or frequency one especially notes depersonalization derealization phobias other anxiety states depression eating disorders or drug abuse 0 depersonalizationderealization feeling like you re watching yourself from above out of body Suicide assessment 1 What is history of previous attempts 2 What is the frequency of the suicidal ideation igenerally someone thinking about it x per month at less risk 3 What is the nature of the suicidal ideation vague vs speci c 4 What is the typical duration of the ideation Long duration higher risk 5 How strong is the person39s ego o capable of resisting dangerous impulses 0 exhibit con dence in their judgments 0 appear confused 6 Is there a social network which the person perceives as caring o Assumption is that clients who commit suicide are not well connected 7 What is the individual39s assessment of hisher likelihood of committing suicide 0 quotWe39ve been talking for awhile today about your fears that you might kill yourselfiis this something you might actually do or is it more that you are trying to say how bad things arequot 8 Is there a plan 9 Is the plan speci c 10 Are the means readily available 0 eg patients who have collected enough medication vs those who just started 11 How lethal is the plan 12 How likely is rescue 13 What has been the person39s coping style in similar situations 14 What is the person39s perception of the effects of suicide on others 15 What diagnostic category comes closest to describing the person 0 Substance abuseibecause increases impulsivity o Psychotic depression bipoloar depression 0 Psychotic with command hallucinations 7 voices telling you to do something 16 Is the person psychotic 0 makes prediction more dif cult 17 Are there behavioral suggestions of suicide 0 making a will 0 giving away possessions o checking insurance policies 0 organiZing business affairs 0 even seeming less depressediapathetic 18 To what degree are helplessness hopelessness and exhaustion present 0 no control over what happening to them 0 no hope things will improve 0 tired from struggle 19 Can the client identify any reasons why shehe wants to live 0 people with something positive to quothang ontoquot generally at less risk