Chapter 10

Question 1

Developing a counseling style

Answer 1

• ideally, the theoretical approach you use to guide your practice is an expression of you as a person and is the result of intense stud, reflection, and clinical experience
• theories of counseling are based on worldviews, each with its own values, biases and assumptions of how best to bring about change in the therapeutic process
• many of the assumptions of contemporary theories are inappropriate for evaluating clients from cultures that focus on interdependence, downplay individuality, and emphasize being in harmony with the universe
• practicing counseling without an explicit theoretical rationale is somewhat like trying to sail a boat without a rudder
• theoretical orientation is not a rigid structure that prescribes specific steps of what to do in a counseling situation
• —-rather it is a set of general guidelines that counselors can use to make sense of what they are hearing and what they need t change

Question 2

The division of responsibility in theapy

Answer 2

• one way to clarify the shared responsibility in a therapeutic relationship is by a contract which is based on a negotiation between the client and the therapist to define the therapeutic relationship
• contract encourages client and therapist to specify the goals of therapy and the methods likely to be employed in obtaining these goals
• a therapist who works with managed cafe context need to discuss with the clients how being involved with the managed care will influence division of responsibility between the HMO, the client, and the therapy

Question 3

Deciding on the goals of counseling

Answer 3

• both client and therapist should clearly understand the goals of their work together and the desired outcomes
• aim of therapy are specific to a particular culture’s definition of psychological health
• no single approach is equally effective in working with all client populations
• in managed care goals need to be highly specific limited to the reduction of problematic symptoms and often aimed at teaching coping skills
• in crisis intervention goals are likely to be short term and functional and you may be more directive
• in schools, you may combine educational and therapeutic goals
• in serving older adults residing in assisted living communities you may stress coping skills and ways of relating to other residents

Question 4

Techniques in Counseling

Answer 4

practitioners need to function with intentionality

• -they must have a clear understanding of the techniques they employ and have a sense of the expected outcomes of their interventions
• some specific techniques appear to be more effective with the particular symptoms and disorders esp for certain behavioral disorders
• the techniques counselors employ although important are less crucial to therapy outcomes than are the interpersonal factors operating in the client-counselor relationship

Question 5

Diagnosis as a Professional Issue

Answer 5

Key terms:

• -medical diagnosis
• -psycho diagnosis
• -differential diagnosis
• -DM-5

Question 6

Theoretical perspectives on assessment and diagnosis

Answer 6

Psychoanalytic
Adlerian therapy
existential therapy
person-centered therapy
gestalt therapy
behavior therapy
cognitive therapy
reality therapy
feminist therapy
postmodern approaches
systemic approaches

Question 7

DSM-5

Answer 7

rather than utilizing the multiaxial system that has been in place for some time the latest edition of the DSM-5 has moved to nonaxial documentation of diagnosis

Question 8

DSM-5

Answer 8

in the DSM-5 revision process the APA paid consideration to:

• -developmental issues
• -gaps in the current system
• -disability and impairment
• -neuroscience
• -cross-cultural issues

Question 9

Arguments for Psychodiagnosis

Answer 9

• No third party reimbursement without an acceptable diagnosis
• difficult to formulate a treatment plan without defining the problem
• provides team members with a common frame to reference
• allows the therapist to rule out medical conditions
• used to assess whether clients pose a danger to self or others
• provides a framework for research
• may be min standard of care for some licensed professionals
• may seldom have a choice about diagnosis
• may be critical to determine therapeutic success
• helps to normalize a client’s situation

Question 10

Arguments against psycho diagnosis

Answer 10

• emphasis of DSM is on pathology
• can minimize the uniqueness of the client
• ignores natural capacity for self-healing
• can lead people to accept self-fulfilling prophecies
• ignores natural capacities for self-healing
• can lead people to accept self-fulfilling prophecies
• assumes that distress in family is a result of individual pathology
• many therapist are not competent to use DSM diagnosis properly
• DSM has been criticized (reliability, and validity questioned, failure to predict treatment outcomes

Question 11

Ethical and Legal issues in diagnosis

Answer 11

• some practitioners who are opposed to a diagnostic framework take the path of least resistance giving every client the same diagnosis
• presenting an acceptable but inaccurate diagnosis is both unethical and fraudulent
• it is an ethical and sometimes legal obligation of the therapists to be mindful that a medical evaluation is many times indicated
• competence in using the DSM appropriately is an ethical issue