Counselling Week 3 Flashcards
Ethics, working with families
Ethical issues (considerations)
*Principle of least restrictive alternative
-punishment only happens when we have exhausted
less intrusive alternatives (education, rewards,
cognitive therapies)
*Above all, do no harm
-difficult to ethically justify intervention if it is
reasonably likely to leave the client in a worse
overall state that they started with
*Principle of informed consent
-issue in counselling
-can someone REALLY be informed about the change
in behaviour post-intervention? (hard to be genuinely
informed for what the post state will look like, have
never been in psych state before)
*Who has the problem,? (Therapist or client? Therapist pathologises seeks problems, these problems may not be reported by client but evident to clinician)
*Does the client have right to “treatment” on request?
-e.g. accent reduction
-no-> not a shop front to sell these interventions
-just because treatment exists and it is likely to succeed, the client wants it and you are competent to provide it, you are NOT obligated to provide it
Confidentiality and disclosure
-Law
-NSW Health Administration Act, Federal Privacy Act
-In general: medical and paramedical staff won’t disclose information provided to them in course of professional relationship
*Strong interpretation: ANY material
*Weak interpretation: material RELEVANT to
professional treatment
-Different disciplines differ in terms of stronger/weaker interpretations (e.g. hairdressers, naturopaths)
-Case Law=legal duty to keep information confidential derived from three sources
(1) Contract (implied confidentiality)
(2) Tort (negligence breach of duty of care)
(3) Equity (preservation of justice/stability)
-Confidentiality from whom? (e.g. material presented to trainee-> assume to pass over to supervisor) (e.g. implied contract in multidisciplinary teams for sharing information)
-contract between client and professional (client may not be person across to desk)-> can be sued for disclosing info to third party, records are yours but can be subpoenaed
Confidentiality and disclosure
-Where do our presumptions of it come from?
- Hippocratic oath (cannot shared “holy secrets”)
- AMA code of ethics-> exception where health of others is at risk (ordered BY COURT to breach confidentiality)
- lawyers have strict/binding confidentiality (others need to navigate a series of trade-offs between client and public interest)
Literature about working with couples (themes, outcomes)
- Literature is very heterosexual and “marital”
- Presumptions about nature and history of relationship
- Principles assumed to generalise from from married heterosexual couples (BUT relatively little/late reconginition of the changing nature of relationships/families e.g. non-monogamous, same sex relationships
- OUTCOMES:
- still together “save marriage”
- still happily together “bring back the love
- successfully apart “learn to live apart
- Improvements on dyadic relationship measures
Considerations of working with couples in the 21st century 💑
💒 life expectancy is longer, so the avergae age for marriage is getting older and there is a longer period of time as a married couple before death
- reality is that people are increasingly likely to have more than one significant relationship during their lifetime
- implications: jealousy, comparison, nostalgia)
- more experience “doing” relationships: problem-solving, self-awareness, autonomy and assertiveness
Olson-Circumplex Model (families and relationships)
-three dimensions
(1) Cohesion 🔗
(2) Flexibility 🤸
(3) Communication 💬
Circumplex Model:
(1) Cohesion 🔗
- “togetherness” 🖇️
- emotional bonding/boundaries 🧱
- balance of separateness vs togetherness
- Four levels:
- disengaged
- sepearated
- connected
- enmeshed
Circumplex Model:
(2) Flexibility 🤸
- Change in relationships and “rules” 📜
- Four levels:
- rigid
- structured
- flexible
- chaotic
Circumplex Model:
(3) Communication 💬
- facilitating dimension 🧺
- Mechanism of negotiating 🗣️
- producing change on the other dimensions
- listening and speaking skills, tracking, continuity and response
What does the Circumplex Model look like?
↔️ Cohesion (L to R)-> disengaged, separated, connected, enmeshed
↕️ Flexibility (N to S)-> chaotic, flexible, structured, rigid
🟡Centre: all the two middle features: separated, connected, flexible and structured
*Ideally more towards the centre (tends to be more balanced towards midpoint)
Circumplex Model: Structured connected (midpoint)
- Moderate “coupleness” (connected)
- Stronger sense of roles and rules (structured)
- Traditional relationship
Circumplex Model: Structured separated (midpoint)
- lower “coupleness” (do their own thing) (separated)
- clear roles and rules (structured)
Circumplex Model: Flexible connected (midpoint)
- moderate “coupleness” (connected)
- equal power and negotiations, capacity to shift roles and expectations (flexible)
Circumplex Model: Flexible separated (midpoint)
- Lower “coupleness”, more independent and autonomous (separated)
- Capacity to shift roles and expectations (flexible)
Circumplex Model: Chaotically enmeshed (extremes)
- Fewer rules/expectations (chaotic)
- Little independent identity (enmeshed)
