NURS 321 Flashcards
Interviewing/Coaching/Counselling/Psychotherapy
Interchangeable Terms about gathering data, objectively helping people to build on strengths, and focus on issues.
Intentionality
Importance of being in the moment and responding flexibly to the ever-changing situations and needs of clients
Cultural Intentionality
Acting with a sense of capability and flexibly choosing on action from a range of alternatives
Resilience
persons ability to recover from life’s challenges
Self-Actualization
Curative Force in Psychotherapy - human tendency to actualize themselves
Microskills
Specific communication skills that provide counsellors with many alternative ways to support clients
Emotional Regulation
Ability to control troublesome emotions and impulses
Prejudice
making a judgement in advance of due examination
Stereotypes
Fixed mental images of a group that are applied to all its members
Discrimination
Taking action against people because they belong to a category
Ethnocentrism
The tendency to regard one’s own ethnic group, nation, religion, or culture as better or more correct than others.
Oppression
Unjust or cruel exercise of authority or power
Posture of Reciprocity
- Identify cultural values embedded in our professional interpretations.
- Find out if members recognize these assumptions.
- Give respect to any cultural difference identified.
- Determine effective ways of adapting interpretations or recommendations.
Strengths Prespective
- every individual has strengths.
- we don’t know anyones capacity to grow and change.
- we best serve clients by collaborating with them
Mandatory Ethics
Ethical functioning at the minimum level of the professional practice
RAP
Recognize
Anticipate
Problem-Solve
Johari Window Model
Open/Free Area (known and known), Blind Area (known to others, not to self), Hidden area (known to self, not to others), Unknown (unknown and unknown)
Informed Consent
Right of clients to be informed about their therapy and to make autonomous decisions pertaining to it.
Freud
Founder of Psychoanalysis - says behaviour is determined by irrational forces, unconsciousness motivations, and biological/instinctual drives
Aspirational Ethics
Doing what is in the best interest of the client, a higher standard
Fear-Based Ethics
Acting in a way to avoid punishment
Concern-based Ethics
How can you be the best nurse possible?
Positive-Ethics
Practitioners focused on doing their best for their clients
Professional Code of Ethics
- Provides a basis for accountability
- Protect individuals from unethical practice
- Provide a basis for reflecting on and improving practice
Guiding Steps in Making Decisions (8)
- Identify the problem/dilemma
- Identify potential issues
- Consult Code of Ethics
- Consider Laws and Regulations
- Seek support/guidance
- Brainstorm possible solutions
- Consider consequences of different decisions
- Choose best course of action
Informed Consent
Ethical and Legal requirement which involves the right of clients to autonomy and decision-making. Included educating, empowering, and building trusting relationships with clients
Confidentiality
An ethical concept which is central to develop trust in a relationship
Western Therapeutic Models
Values of individual choice/autonomy are not congruent with cultures that value collectivism.
Individual and Environmental Factors
Not all are individual, important for counsellors to consider the clients community and challenges related to environmental realities.
Three Pillars of Evidence-Based Practice
- Looking at the best available research
- Relying on expertise
- Considering client preferences and culture
Dual or Multiple relationships
When a health care practitioner assumes multiple roles with a client
Nonsexual/nonprofessional
Supervisor and therapist, providing therapy to a friend, borrowing money from a client
Sexual relationship
Engaging in an emotional/sexual relationship with a current or former client
Professional Boundaries
Spaces between the nurse’s power and patient’s vulnerability
Boundary Crossings
Brief excursions across professional lines of behaviour that may be inadvertent, thoughtless or even purposeful while attempting to meet a special therapeutic need of the patient (ex. attending client’s wedding)
Boundary Violation
Serious Breach! Can cause harm AND is unethical. Can result when there is confusion between needs of nurse and patient.
Why are boundaries important in nursing?
Inspires confidence & trust
Demonstrates respect
Reflective of our ethical obligations
Uphold standards and legal requirement
Continuum of Professional Behavior
under-involvement - therapeutic relationship - over-involvement
Warning signs of boundary crossing
Excessive self-disclosure
Special Treatment/Favouritism
Believing that you are the only one who understands or help patient
Flirtation
Overprotective Behavior
Secretive behavior
Preventing Boundary Crossing
- Be aware
- Be cognizant of feelings/behaviour
- Be observant of behaviour of other professionals
- act in best interest of the patient
- Evaluate interactions and relationships
Life Instincts
Serve to ensure survival and orientate humans toward growth, development, and creativity
Death instincts
An unconscious with to harm yourself or others, accounts for the aggressive drive of the human experience
Structure of Personality (ID)
Impulses that are biologically driven and unconscious
Structure of Personality (Ego)
Mediates between the ID and the reality
Reality Principle
Logical thinking to create plans of action to satisfy needs
Structure of Personality (Superego)
Developed to protect us from the danger of our impulses, rooted in parent expectations
Unconscious
The mind that exists beyond awareness - needs and motivation are unconscious
Anxiety
Feeling of dread that results from repressed feelings, memories, desires, and experiences that emerge to the surface of awareness
Reality Anxiety
Fear of real-world danger
Neurotic Anxiety
Fear of instincts getting out of hand, fear of punishment
Moral Anxiety
Guilt felt by acting outside of your moral code
Ego-Defense Mechanisms
Repression, Denial, Reaction formation, Projections, Displacement, Rationalization, Sublimation, Regression, Introjection, Identification, Compensation
Freuds Psychosexual Developmental Stages
Oral: inability to trust, fear of love
Anal: Inability to recognize or express anger, lack of autonomy
Phallic: inability to accept sexuality/sexual feelings
Crisis
A turning point in life that must be resolved to move forward
Psychodynamic Therapy
More limited objectives, less likely to use couch, have fewer sessions, use supportive interventions, focus on here/now of relationship, focus on practical concerns
Maintaining the Analytic Framework
Maintain neutrality and objectivity, regular and consistent sessions, consistent fees, consistent environment
Free Association
Encourage client to say whatever comes to mind, opens door to the unconscious
Interpretation
Pointing out, explaining and teaching the meaning behind behavior, dreams,defenses
Latent conent
Hidden motives, wishes, fears
Manifest content
Dream itself
Dream Analysis
Helps uncover the meanings of the manifest content
Resistance
Client’s reluctance to discuss/develop awareness of repressed experiences
Jung’s Perspective
Focus on psychological changes that occur in midlife
Object-Relations Theory
Concerned with attachment and separation
Self Psychology
How we use interpersonal relationships to develop our sense of self
Relational Psychodynamic Model
Therapy = interactive
Silence
Therapist listens without comment to support the client in sharing whatever thoughts arise, silence is essential!
Nonjudgmental Approach
Aware of not invalidating client’s behaviours and experiences, frame interpretations as hunches as opposed to declarations of truth
Monitoring countertransference
Maintaining awareness of spontaneous reactions to what the client says or does
Psychoanalytic therapy and Multiculturalism Strengths
- everyone has background childhood experiences
- Erikson’s theory
Psychoanalytic Therapy and Multiculturalism Shortcomings
- Costly, western values.
- Ambiguity can be problematic for clients who expect therapist to take an active role
- Does not always address social, cultural and political factors that cause challenges
Leadership traits
Sense of identity, open to new experiences, stamina, committed to self-care, model effective behaviour, show vulnerability, use personal power and confidence
Trait Approach
Assumes leaders have inherent personal characteristics
Position Approach
Leadership that is defined by the authority of a particular person
Leadership-Style Approach
- Authoritarian Leader
- Democratic Leader
- Laissez-Faire Leader
Authoritarian Leader
Dictates the activities of members, has an absolute power over decisions, goals, and major plans
Democratic Leaders
Leader who seeks maximum involvement from group members
Laissez-Faire Leaders
Leader who participates minimally, little input
Distributed-Functions Approach
Every group member is a leader at times, nearly everyone can be taught to be an effective leader
Task Role Leader
Emerges in groups because they have the best idea and/or does the most to guide the discussion. Plays in aggressive role and may be disliked.
Maintenance Role Leader
Emerges in time of conflict, works toward group harmony, resolves tension, and works to strengthen bonds within the group
Conflict
Disagreement and/or discord among group members or different groups of people
Win-Lose Approach
an ineffective way to resolve conflict; increases distrust and decreases cohesion
No-Lose problem-solving
It is almost always possible for both sides to have their needs met”
1. All people have the right to have their needs met
2. What is in conflict almost never their needs but their solutions to those needs
Role Reversal
Each individual expresses their opinions AFTER restating the ideas and feelings of the opposing individual
Inquiry
Using gentle, probing questions to learn more about what the individual is thinking/feeling
“I” Messages
Decrease defensiveness and facilitate more open and honest communication
Disarming
Finding some truth in what the other individuals POV, then sharing agreement, even if you feel they are wrong
Stroking
Involves saying something genuinely positive to the person you are in conflict with
Mediation
Used to resolve conflicts between disputing groups - involves intervention of an acceptable and neutral party who has no decision-making power
Consensus
Majority agree to a decision
Simple Majority vote
highest # of votes win
Two-Thirds or Three-Fourths Majority vote
Same as simple majority but one side HAS to reach 66%
Delegated Decisions
One person is told to make decision (with parameters)
Multiple Voting
Involves several rounds of voting where alternatives become shorter and shorter
Polling
Helps gather feedback, opinions, preferences and insights from different individuals
Antecedent Conditions
Time pressure and stress, high cohesiveness and social identity, isolate from other sources of information.
Phases of Escalation
- Trigger phase
- Escalation Phase
- Crisis Phase
Trigger Phase of escalation
an event that causes stress, begins the escalation phase
Escalation-phase of escalation
anxiety builds resulting in an emotional response
Crisis phase of escalation
client experiences loss of self-control and total loss of reason. Violence can occur
Escalating Emotions
Calm
Anxious
Agitated
Aggressive
Violent
Assessing for signs of agitation
words - what are they saying?
tone - angry or calm?
facial expression
demeanor
hands
other people
Carl Rogers
Father of psychotherapy research, focus on STRENGTHS
client-therapist relationship as the foundation of change
Existentialism
Humans are faced with anxiety of creating an identity in a world that lacks intrinsic meaning - focus on death, anxiety, isolation
Humanism
More optimistic, individuals have natural potential that can be actualized to find meaning
Maslow & Humanistic Psychology
TOP:
self-actualization
Esteem needs
belongingness and love needs
safety needs
physiological needs
BOTTOM
Self-actualization
achieving one’s full potential, including creative activities
Esteem needs
Prestige and feeling of accomplishment
Belongingness and love needs
Intimate relationships, friend
Self-transcendence
Seeking meaning and purpose beyond yourself
Who founded Positive Psychology
Martin Seligman
Congruence
Genuineness or realness
Unconditional positive regard
Acceptance and caring
Accurate empathetic understanding
Ability to deeply grasp the subjective world of another person
Growth-Promoting Climate
- Genuine behaviour
- Acceptance
- Empathetic understanding
PCT Group Goals
Provide a safe climate where members can explore their feelings and experiences
PCT Leader Roles & Functions
Facilitates the group as opposed to directing it.
Helps members follow their inner direction
PCT Degree of Structure
Leader provides little structure/direction and allows group to determine how time is spent
PCT Strengths
- Emphasis of truly listening and understanding the clients world from their internal frame of reference.
- emphasizes persons ability to find answers to their own problems
- importance on the counsellor as a person
PCT Limitations
- minimal structure
- non-directive nature may hinder productivity
- not all people do well when left to draw own intrinsic resources
Person-Centered Expressive Arts Therapy
Founded by Natalie Rogers
Extends PCT to creative expression
Gains insight through movement, art, writing, and music
Emotion-Focused Therapy
Person-centered approach that focuses on understanding how emotions affect human function and change
Main goal of EFT
Help individuals access and process emotions in constructive ways
Behavior Therapy
Focus on directly observable behavior
Criticized by psychoanalytic practitioners
Areas of development in behavioral therapy
- Classical Conditioning
- Operant Conditioning
- Social-Cognitive Therapy
- Cognitive-Behavior Therapy
Classical conditioning
Occurs prior to learning and creates a response through pairing
Operant Conditioning
Learning that involves behaviors that are influenced by consequences
ex) positive/negative reinforcement, punishment
Social-Cognitive Approach
Involves reciprocal interaction between environment, personal factors, and individual behaviors - assumes people are capable of self-directed behavior
Self-efficacy
Individuals ability to master a situation and bring about change
Key Concepts of Cognitive Behavioural Therapy (7)
- Rooted in scientific principles and procedures
- Behaviour can be operationally defined
- Deals with current problems, not historical
- Clients must assume an active, engaged role
- Change can occur without examining underlying issues
- Assessment is ongoing throughout treatment
- Interventions are tailored for each individual
Goals of therapy
Client-led, specific and measureable
Goals: concrete, clear, understood and agreed upon by client and counsellor
Ultimate goal is to increase personal choice and create new conditions for learning
Functional Assessment (ABC model)
(A): Antcedents: particular situation/event that elicits
(B): Behavior: problematic reaction that results in
(C): Consequences: events that maintain behavior
Behavior therapy “Bag of Tools”
- Operant Conditioning Techniques
- Progressive Muscle Relaxation
- Systematic Desensitization
- In vivo Exposure and Flooding
- Eye movement desensitization and reprocessing (EMDR)
- Social Skills training
- Self-management programs and self-directed behavior
Operant Conditioning techniques
- Positive reinforcement
- negative reinforcement
- extinction
- positive punishment
- negative punishment
Positive Reinforcement
Adding something valued by the individual to increase the targeted bahviour
Negative Reinforcement
When an individual employs a behavior to avoid an unpleasant condition
Extinction
Withholding reinforcement
Positive Punishment
Unpleasant condition added to help behavior decrease
Negative Punishment
Reinforcement stimulus is removed to decrease specific behavior
Progressive Muscle Relaxation
Specific, taught instructions on tensing and relaxing various muscle groups to help client cope with stress and achieve mental/muscle relaxation
Systematic Desensitization
Clients imagine anxiety-provoking events while simultaneously engaging in behavior that competes with anxiety. Clients become less sensitive to anxiety-provoking event, time consuming by effective
- for clients with severe anxiety and/or phobias
In VIVO exposure and flooding
Exposure to therapy that involves introducing clients to situations that contribute to problems
In vivo exposure
= live exposure - clients engage in brief series of feared events
Flooding
Similar to in vivo exposure, but involves prolonged exposure
Eye Movements Desensitization and Processing (EMDR)
Exposure therapy that involves assessment, preparation, flooding, and cognitive restructuring
Developed to treat PTSD
Involves use of rapid, rhythmic eye movements
Social Skills Training
Helps clients develop skills in interpersonal competence
Involves assessment, direct instructions, coaching, modeling, roleplaying and homework
ex) anger mgmt training
Self-management programs and self-directed behavior
Therapist sharing their knowledge and skills to help clients develop skills and strategies to deal with their own problems without being dependent on experts
Cost-effective
Self-Management Strategies
- Teaching clients how to create realistic goals
- Teaching clients how to translate goals to behavior
- Teach clients how to evaluate progress and self-monitor
Multimodal Therapy
Grounded in social-cognitive learning therapy, focus on specific relationship requirements and treatment strategies will work best for client
Who developed Multimodal therapy
Arnold Lazarus
Mindfulness and Acceptance-Based Approaches
Part of third generation behavioral therapy, includes mindfulness, acceptance, therapeutic relationship, spirituality, values, emotional expression
Examples of Mindfulness and acceptance-based approaches
Mindfulness-based stress reduction (MBSR)
Mindfulness-based cognitive therapy (MBCT)
Dialectical Behavior therapy (DBT)
Acceptance and Commitment Therapy (ACT)
Key characteristic of group conselling
- Therapist starts sessions with a behavioural assessment
- Treatment goals are collaborative and clearly defined
- Specific strategies/interventions are chosen based on goals
- Outcomes are objectively evaluated
Relaxation Techniques
Helpful for anxious and stressed clients
Works immediately to help client feel better
Accessible on smartphones and easy to apply
Self-Management Strategies
Helps client learning coping skills that can be applied in real life settings
Empowering
Mindfulness
Promotes positive mental health
Accessible on smart phones
Helps people manage distraction, intrusive thoughts, enhance compassion for self and others
Strengths from a Diversity Lens
Some people like more structure
Not always acceptable to show emotions
Task oriented, deals with the present
Increased “buy-in”
Focus on environmental conditions
Limitations from a diversity lens
Therapist must be aware of influence of race, gender, ethnicity and sexual orientation
May examine client too closely and miss environmental and sociopolitical factors
Could be consequences to client changing behaviour
Cognitive-Behavioral Therapy
oriented toward cognition and behavior and stresses role of thinking, deciding, questioning, doing and re-deciding
Aims to identify dysfunctional thought and behavioral patterns and replacing them with more positive patterns
Key Concepts of CBT
Thought: how we think affects how we act/feel
Behavior: What we do affects how we think and feel
Emotion: What we feel affects what we think and do
Elements of CBT
Active
Motivational
Directive
Structured
Collaborative
Problem-Oriented
Psychoeducation
Solution-Focused
Dynamic
Time-Limited
Active element of CBT
Client must be actively involved in the therapy as a core and key participant
Motivational element of CBT
Therapist must motivate the client towards collaborative change
Directive element of CBT
Treatment plan must help client to understand and contribute to the recovery
Structured element of CBT
therapy follows structure that approximates treatment plan with beginning, middle and end
Collaborative element of CBT
Therapist must work with the client collaboratively for successful outcomes
Problem-Oriented element of CBT
Focus on specific problems rather than vague assumptions and goals
Psychoeducation element of CBT
teaching by client instruction, modeling, and role-playing
Solution-Focused element of CBT
Works to generate solution and not simply gain insights
Dynamic element of CBT
Help client identify and modify schema (basic template for understanding one’s world)
Time-Limited element of CBT
Each session should stand alone
Subtypes of CBT
Mindfulness-based cognitive therapy (MBCT)
Dialectical Behavioral therapy (DBT)
Acceptance and Commitment Therapy (ACT)
Rational Emotive Behavior Theraly (REBT)
Rational Emotive Behavior Therapy (REBT)
Emphasizes importance of creating and maintaining unconditional acceptance of one’s self, others and life
REBT Basic Assumptions
People contribute to thier own psychological problems by rigid and extreme beliefs they hold.
Cognitions, emotions, and behaviors interact significantly
3 Basic musts (irrational beliefs) that lead to self-defeat
- I must do well to be loved and gain approval
- Others must trust me fairly and be kind
- My life and world must be comfortable, gratifying and just in order to provide me with all my needs.
ABC Model of Personality
A - ACTIVATING Events
B - individuals BELIEF about A
C - emotional CONSEQUENCE
Goals of Therapy
Challenge and confront faulty beliefs with contradictory evidence that is gathered and evaluated
Goals of Therapy: assist clients in…
Achieving:
1. Unconditional self-acceptance
2. Unconditional other-acceptance
3. Unconditional life-acceptance
Therapist’s Function & Role
- Point out and dispute irrational thoughts clients have
- Demonstrate to clients how they are continuously reindocrinating themselves with these thoughts
- Help clients change thinking and minimize irrational thoughts
- Encourage clients to create a rational philosophy of life
Cognitive Therapy Techniques
- disputing irrational beliefs
- homework
- bibliography
- changing language and thinking patterns
- psychoeducational methods
- socratic dialogue
Emotive Therapy Techniques
- rational emotive imagery
- humor
- role playing
- shame-attacking exercises
Putting Theory into Practice ABCDE model
A: ACTIVATING event of adversity
B: BELIEFS about event or adversity
C: the emotional CONSEQUENCES
D: DISPUTATIONS to challenge self defeating belief
E: EFFECT or consequence of challenging self defeating belief
Role-Playing
Therapist takes on role of someone with issues similar to the client. Client works to address the unhelpful thoughts/emotions the therapist is having and come up with life-enhancing beliefs
Shame-Attacking
- helpful for those hwo seek approval
- clients encouraged to do something to attract attention from other while practicing positive self-talk.
Cognitive Therapy (CT)
Set out to develop evidence-based therapy for depression.
Goal is to help clients become aware of negative thinking that influenced depression
Cognitive Therapy (CT) Developer
Aaron Beck
Aaron Beck’s Cogitive Triad
- One’s SELF: “I’m worthless and hate myself”
- The WORLD/ENVIRONMENT”: “why does no one care about me”
- The FUTURE: “things will never get better”
Cognitive Distortions
When we think about things in distorted wats we experience distorted emotional and behavioral reactions
Examples of Cognitive Distortions
Arbitrary Inferences
Selective Abstraction
Overgeneralization
Magnification/Minimization
Personalization
Labelling/Mislabelling
Dichotomous thinking
Arbitrary inferences
Conclusions drawn without evidence (ex. catasrophizing)
Selective abstraction
Forming conclusions on isolated detail or while ignoring other information
Overgeneralization
Holding extreme beliefs based on one incident
Magnification/Minimization
Viewing something in greater or lesser light than the actual event
Personalization
Relating external events to yourself, even if there is no basis for the connection
Labeling/Mislabeling
Portraying yourself based on imperfections/past mistakes
Dichotomous thinking
Categorizing experiences as either–or extremes
Characteristics of a Group
People see themselves as members
Interaction among members
Shared goals
Two or more people
Principles of Group Dynamics
- members must have a strong sense of belonging to the group
- barrier b/w leaders and members must be broken down
- more attractive a group is to its members, greater influence it has on its members
Aspects of Group Process (membership)
Satisfaction (reward), problems, influence upon others (social pressure), each member influencing others (reciprocal or mutual control), cohesiveness, compatibility, norms and social climate, morale, reference group
Factors affecting group activity
size of the group, threat reduction/degree of intimacy, distributive leadership with focus of control, goal formation, flexibility, consensus/degree of solidarity, process awareness and evaluation
Group norms
spoken or unspoken rules that guide how team members interact, collaborate effectively and work efficiently
Group norms three functions
predictive: basis for understanding behavior of others
relational: some norms define relationships
control: regulate the behavior of others
Components of Cohesiveness
more participation, more conformity, more success, more communication, more personal satisfaction, more productivity
Benefits of Group counselling
cost-effective, focus on narrow goals, aimed at symptoms relief (problem-solving, interpersonal skills), realistic
Structured Groups
Educational focus, designed to deal with info deficit, teach skills for effective living
Counselling groups
Focus on interpersonal process and problem-solving related to thoughts, feelings and behavior. Helps members resolve problems in their own ways. Emphasizes discovering inner strengths
Universality
when groups members are able to see similarity in the human struggles of others with their own struggles
Group leader musts in groups (feedback)
create a climate of safety, encourage honest feedback, ensure feedback is given with care and compassion, act as a role model
Pre group stage
group theme, proposal, member recruitment, member selection
Stages of a group session
Initial stage
Transition stage
Working stage
Final stage
Initial stage of group sessions
Involves orientation and explanation
Members may be anxious/insecure
members can bring expectations and concerns (group norms, fears, identifying personal goals, clarifying personal themes, creating a safe space)
Group leader functions (Initial stage)
teach members how the group works, discuss confidentiality, develop rules/norms, assist members to express fears, develop trust, open and present, degree of structure, establish concrete personal goals, address issues openly, teach and encourage basic skills
Transition stage of group counselling
members may have anxiety/reluctance/defensiveness and conflict. Members need to take risks. Leader has to deal with resistance and provide encouragement
Group Leader functions (transition stage)
Teach how to recognize anxiety and defensive reactions. Create a safe climate. Be a role model, encourage members to share.
Working stage in group counselling
Productiveness. Mutuality and self-exploration increase. Focus on behavior change.
Group Leader functions (working stage)
reinforce positive behaviours, look for themes, provide opportunity for feedback, support members in risk taking.
Final stage in Group counselling
Identify what was learned and how it can be applied to daily living. Activities (terminating, summarizing, integrating, interpreting group experience) - bring closure.
Group leader functions (final stage)
deals with feelings of separation, address unfinished business, review experience, identify coping mechanisms, build support clarify meaning, recognize grieving as normal
Guidelines for Forming and Leading a group
homework, planning a session, relaxing before you start the meeting, cues upon entering the room, seating arrangements, introductions, clarifying roles, agenda
Opening a group session
- ask people to state what they want out of the session
- give members a chance to express thoughts
- encourage people to report progress and difficulties
- encourage to share what the group means to them
- makes observations about previous meetings
- use structured exercise that can assist members identify concerns
Community Agency
Any institution designed to provide social and psychological services to the community
Community workers
Human service and community health workers, with diverse education and training, whose primary duties revolve around serving their community
Becoming a skilled community practitioner
become familiar with resources in community, have cultural knowledge of clients, use strengths-based perspectives, alter interventions to meet client needs, teach clients, connect with community
Roles of community worker (advocate)
speaking on behalf of others, helps clients effectively deal with institutional barriers that impede personal, social, academic and career goals
Roles of community worker (change agent)
confronting and bringing about change within the system. Assist clients in developing power to bring about change
Roles of community worker (consultant)
encourage people from diverse cultures to learn skills. Help design preventative programs
Roles of community worker (advisor)
Initiates discussions with clients about ways to deal with environmental problems that contribute to personal problems
Roles of Community workers (facilitator of Indigenous support systems)
Encourage clients to make use of the resources in their communities
Roles of community worker (facilitator of indigenous healing systems)
recognize mistrust that exists and refer clients to healers of their choice
Community interventions (direct client services)
outreach activities in a population at risk for developing mental health issues
Community intervention (indirect client services)
Focus on client advocacy, works to empower disenfranchised groups
Community intervention (community services)
Focus on preventative education, geared to population.
Community intervention (indirect community service
Attempts to change social environment to meet the needs of the population as a whole
Outreach
Not waiting for people to come in seeking help - practical
Educating the community
Helping community become aware of resources and find ways to mitigate barriers to treatment and reduce stigma
Mobilizing community resources
Helpers wishing to mobilize resources should possess certain knowledge and skills
10 Axons of choice theory
- only person whose behavior we control is our own
- all we can give another person is info
- all long-lasting psychological problems are relationship problems
- problem relationship is always part of our present life
- what happened in the past affects today but we can only satisfy our current needs
- We can satisfy our needs by satisfying pictures in our quality world
- All we do is behave
- all behaviour is total behavior made of 4 components (acting, thinking, feeling and physiology)
- All total behavior is chosen but we control acting and thinking
- All total behavior is designated by verbs and named by recognizable part
Reality Therapy
Based on choice theory - humans are social in nature and behavior is goal centered
Who started Reality therapy
William Glasser and added to by William Wubbolding
Glassers belief of reality therapy
unhappiness is a result of the way people choose to behave
View of Human nature
we are born with 5 genetically encoded needs that drive us
these needs vary in strength
as a social being we must give/receive love (primary need)
When we feel bad, one of the 5 needs are not being met
we do not satisfy needs directly
From birth we build info in our mind of anything we want
We develop an inner album of specific wants
People we are closest to are the most important to our quality world
5 Basic Needs
- Survival (food, shelter, safety, urge to reproduce)
- Love and belonging (connectedness and relationships)
- Power (competence, achievement, and internal control)
- Freedom (autonomy, ability to make choices)
- Fun (pleasure, enjoyment, knowledge)
Key concepts of reality Therapy
Focuses on PRESENT not past
Avoid discussing symptoms and complaints
Understand total behavior (only thing we can do directly is act and think)
Total behavior is acting, thinking, feeling and physiology
Seven deadly habits (reality)
criticizing, blaming, complaining, nagging, threatening, punishing, bribing or rewarding to control
Seven caring habits (reality)
supporting, encouraging, listening, accepting, trusting, respecting, negotiating differences
Process of reality therapy
- establish supportive relationship
- explore clients needs, wants & perspectives
- Evaluate how effective they are in getting what they want
- Make a plan to do better
- Commit to plans
Goal of Reality therapy
To help clients be connected/reconnected with people that satisfies them and to consistently live in QUALITY WORLD or a place where they wanted to live
Procedure of Reality therapy (WDEP)
W - wants and needs
D - direction and doing
E - Self-evaluation
P - Planning
Reality Therapy Planning (SAMIC)
S - Simple
A - Attainable
M - Measurable
I - Immediate
C - Controllable
Choice therapy founder
Robert Wubbolding
Choice theory vs reality theory
choice - train track (directs where you go, underlying concepts)
reality - train and delivery system (practicality)
Explanation of behavior in choice therapy
everything we do is chosen from within ourselves, emphasizes thinking and acting (form of CBT), behavior is purposeful and designed to close the gap between what we want and what we perceive we are getting.
Modernist Approach
Objective reality can be described and observed
objective - known through scientific method
client seeks therapy when faced with a problem
Postmodernist Approach
clients are experts of their lives, there is not one right or wrong way to live life
Social contructionism
values the clients reality without questioning its accuracy
History of Social Constructionism
Focus on diversity, multiple frameworks, and integration, provides a wider range of perspective in counselling practice, change begins by deconstructing power of narratives
Not-Knowing Position
Therapist retain their expert knowledge BUT enter conversation with client curiosity and interest in discovery - ENTER CLIENTS WORLD
Collaborative Language Systems Approach
Not-knowing position
Intent isn’t to challenge, but to assist in telling and re-telling
Solution-Focused Brief Therapy (SFBT)
Future focused goal-oriented, focus on strengths, constructing solutions instead of problem solving
SFBT Basic Philosophy
Change is constant and inevitable
Clients are experts & define goals
Future oriented
Solution Focused
Emphasis on what is possible & changeable
Short-Term and small changes needed
CHANGE-TALK
SFBT Key Characteristicsq
Average length of therapy is 3-8 sessions
Most common length is ONE session
Main goal: help clients efficiently resolve problems and move forward as quickly as possible
SFBT Basic Assumptions
Clients have resources/strengths to resolve complaints
Therapist - identify & amplify change
Small change is all that is needed
Focus on what is possible and changeable
Positive orientation
Based on assumption that people are healthy and competent and have the ability to construct solutions that can enhance their lives
Therapist: recognize competencies they already possess
SFBT Therapeutic Process
- Client describes problems
- Therapist helps clients develop well-formed goals
- Therapist asks about times when problems were not present or less severe
- At the end, therapist offers clients summary feedback, and give encouragement
- Therapist and client evaluate progress made using a rating scale
SFBT Therapeutic goals Criteria
- Start-based: positive terms, what client wants
- Specific: concrete, observable, detailed
- Social: what significant others would notice and how they might respond - how do these responses affect the client
SFBT Therapist Role
Not-Knowing Person
Clients are experts
Create climate of mutual respect, dialogue, and affirmation
Help client imagine how they would like life to be different
SFBT Client-Therapist Relationship Possibilities
- Customer-Type relationship
- Complainant relationship
- Visitors
Customer-type relationship
Client and therapist jointly identify a problem and a solution to work toward
Complainant relationship
A client describes a problem, but is not able or willing to take an active role in constructing a solution
Visitors Relationship
Clients come to therapy because someone else thinks they have a problem
SFBT techniques
Pre-Therapy Change
Exception questions
Miracle question
Scaling questions
Coping questions
Reframing
Formula First Session Talk (FEST)
Therapist Feedback
Terminating
Pre-Therapy Change
What have you done since you made the appointment that has made a difference in your problem?
Exception Question
Direct clients to times in their lives when the problem did not exist (reminds clients that all problems are not “all powerful”)
Miracle Question
If a miracle happened and the problem you have was solved, what would be different in your life?
Scaling Questions
On a scale of 0-10, where are you with respect to…
Coping Questions
Ask about how clients somehow manage to keep going in spite of the adversity they face
Formula First Session Talk (FFST)
A form of homework a therapist might give clients to complete between their first and second session
Therapist Feedback
A summary provided to the client - strengths noted, signs of hope, commentary on what the client is doing well to work toward goals
1. Compliments
2. Bridges
3. Suggesting tasks
Terminating
Therapists assist clients in identifying things they can do to continue the changes they have already made
Who founded Motivational Interviewing
William Millar and Stephen Rollnick
Who founded Solution-Focused Brief Therapy
Steve de Shazer and Insoo Kim Berg in the 1980s
Motivational Interviewing (MI)
Humanistic, client-centered, psychosocial, modestly directive
Brief and applicable across a variety of problem areas - similar to PCT and SFBT
MI basic philosophy
Clients possess abilities, strengths, resources, and competencies
How does MI differ from PCT
Deliberatively directive while staying within the clients frame of reference
Goal of MI
Reduce client ambivalence to change and increase client motivation
MI Basic Principles
- Therapists strive to see the world from clients perspective
- Designed to evoke and explore discrepancies and ambivalence
- Reluctance is viewed as an expected part of the process
- Therapists support client self-efficacy
- Once client’s are ready for change, therapists focus on strengthening commitment and implementing a change plan
MI Stages of Change
Precontemplation Stage
Contemplation Stage
Preparation Stage
Action Stage
Maintenance Stage
MI Precontemplation Stage
No intention of changing behavior anytime soon
MI Contemplation Stage
Awareness of problem, consideration of change, no plans or commitment
MI Preparation Stage
Individuals plan to take action immediately and small changes are noted
MI Action Stage
Steps are taken to modify behavior and solve problems
MI Maintenance Stage
Work is done to consolidate gains and prevent relapse
MI Techniques
Nonpathological, health-promoting emphasis
Reframing resistance
Use of clients strengths and resources
Skills improve with deliberate practice
Narrative Therapy Founder
Michael White and David Epston
Narrative Therapy (NT)
Strengths-based approach
Emphasizes collaboration between client and therapist
Goal is to help clients see themselves as empowered
NT Basic Philosophy
Focus on respectfully listening to clients stories
Searching for times in clients life that they were resourceful
Avoids labelling and diagnosing
Dominant stories (events that clients internalized)
NT Key Concepts
Stories
Listening (normalizing judgement, AVOID totalizing language, double listening)
Normalizing Judgement
Judging someone on what is deemed the “normal curve” (ex. mental health, intelligence, normal behavior)
Totalizing Language
Reducing the complexity of the individual by assigning an all-embracing, single description to the person
Double Listening
Separating the person from the problem while listening to the story
NT Therapeutic Process
Collaborate with client to name problem
Personify problem and attribute oppressive tactics to it
ID how problem has disrupted, dominated, or discouraged the client
Discover moments of strength and resilience
NT Therapist Role
Active facilitators
Demonstrate care, interest, respect, openness, empathy, fascination
Apply the “not-knowing” position
Help clients create a preferred story line
Avoids language of diagnosis, intervention and assessment
NT Therapeutic Techniques
QUESTIONS
Externalization and deconstruction
Searching for unique outcomes
Alternative stories and Reauthoring
Documenting the evidence
Integration
To combine, mix, blend or coordinate different elements into a whole
Integrative Perspectives
Characterized by openness to various ways of integrating diverse theories and techniques
Enhance the efficiency & applicability
Types of Crises
Here-and-Now
Normal
Adverse child experiences (ACES)
Here-and-Now Crises
Demand rapid action (ex. flood, fire, sexual assault, school shooting, sudden diagnosis)
“Normal” Crises
Considered part of life (ex. breakups, divorce, job loss, death)
Adverse child experiences (ACES) Crises
Crisis in childhood
Often leads to long-lasting trauma (ex. bullying, parent illness/death, moving, parent divorce/remarriage)
2 Major Phases of Crisis/Trauma counselling
- Working through initial trauma
- Appropriate follow-up and counselling
Crisis/Trauma Counselling
Most pragmatic and action-oriented form of helping
Concerned with action and useful result for the client
4 Core Principles of Trauma-Informed Care
- Trauma has widespread impacts and there are many pathways to recovery
- It is important to recognize the signs and symptoms of trauma in patients and families
- Knowledge about trauma needs to be integrated into all systems
- It is important to not re-traumatize patients, family members, and staff
Values/Principles of Trauma-Informed Care
Safety
Trustworthiness
Choice
Collaboration
Empowerment
Safety in Trauma Counselling
What does the client need for safety and survival NOW
Offer verbal reassurance that the crisis is over
Connect them with immediate resources
Calming & Caring in Trauma Counselling
Establish a therapeutic relationship
Show a client you care and listen
Do not minimize the crisis
Normalizing in Trauma Counselling
Not “survivors” or “victims” - normalize experience by recognizing that they are reacting the same as anyone in the situation would
Resilience does not eliminate pain
Debriefing the story in trauma counselling
Clients need to tell their stories again and again
LISTEN
Assessment of Strengths and resources in trauma counselling
Watch for signs of strength and resilience
Action and Advocacy in trauma counselling
Do not overpromise
Answer questions honestly and clearly - provide info
Follow-Up in trauma counselling
Arrange to meet for a debrief
Strategies for working with hostile or involuntary members
Model respect and treat with respect
Allow members to vent their unhappiness over their forced involvement in the group
Establish goals that are meaningful to them
Utilize the disarming technique
Do not subject yourself to extensive verbal abuse
If abuse continues, meet with supervisor to discuss options
Disarming
Involves finding some truth in what the other person is saying and then expressing your “agreement” even if you feel that the other person is largely wrong, unreasonable, irrational, or unfair
Intimate Partner Violence (IPV)
Abuse or aggression that occurs in a romantic relationship
Risks IPV (relationship factors)
Conflict or dissatisfaction in the relationship
Male dominance in the family
Economic stress
Having multiple partners
Disparity in educational attainment
Risks IPV (community and societal factors)
Gender-inequitable social norms
Poverty and low social and economic status of women
Weak legal sanctions against IPV within marriage
Lack of womens rights
Broad social acceptance of violence as a way to solve conflict
Armed conflict and high levels of general violence in society
Interventions for IPV
Priority = safety plan (phone/keys/legal documents, packed bag hidden, # of shelter, referral numbers)
Considerations for Individuals who are homeless
Mental illness is common in homeless population (especially substance use and depression)
Tend to have significant medical conditions (liver disease, TB, AIDS, pain, diabetes, HTN)
Many have trouble maintaining relationships of any type
Positive WOMEN: exposing injustice
factors people bring with them into health care setting
barriers to building relationships
marginalization
complex multifaceted considerations
power of understanding
needs for relationships, connection and beneficial communication
Risk factors for suicide
Severe anxiety, depression, alcohol/drug use, sleeplessness, hopelessness, employment problems, relationship loss, physical/sexual abuse, serious health issues, financial issues
High risk populations for suicide
Men and boys, individuals serving federal sentences, survivors of suicide loss or attempts, indigenous youth, all inuit regions in Canada
Assessment and Intervention for Suicidal clients
Look for signs of: actual threat to hurt/kill themselves, seeking access to pills/guns, talking/writing about death.
Avoid asking “WHY?”
IMMEDIATE crisis support
