Week 9 Flashcards
Integrative Perspectives are important because:
- No single theory is comprehensive enough to account for the complexities of human behavior
- No single set of counseling techniques is always effective in working with diverse client populations
Integrative perspectives are characterized by
openness to various ways of integrating diverse theories and techniques
Integrative perspectives enhance
efficiency & applicability
When developing your own personal approach to counselling it is essential to
think about the theoretical frameworks first and recognize which approaches you connect with and work these into your practice
Your personal approach should reflect
Your values
Highlights of psychoanalytic theory
o little emphasis on relationship
o issues come from lack of development
o therapist seen as expert.
Highlights of person-centred theory
o strong focus on attitude and disposition of the therapist
o (congruence, unconditional positive regard and empathy)
Highlights of behaviour theory
o interventions and tools that have been empirically tested.
Highlights of CBT theory
o strong focus on the therapist as an expert and teacher
o learning new techniques to impact thinking and behavior
o Concrete, homework usage.
Highlights of RT theory
o 5 needs with love and belonging being the primary or most important.
o Strong emphasis on relationship
o WDEP technique
Highlights of SFBT theory
o strong emphasis on questioning techniques (the miracle question)
o brief interventions.
Highlights of NT theory
o Hearing the story and creating a new story.
13 goals of therapy
- Restructuring personality
- Uncovering the unconscious
- Creating social interest
- Finding meaning in life
- Addressing an emotional disturbance
- Examining old decisions and making new ones
- Developing trust in oneself
- Becoming more self actualizing
- Reducing maladaptive behaviour and learning adaptive patterns
- Becoming grounded in the present moment
- Managing intense emotions i.e. Anxiety
- Gaining more effective control of one’s life
- Reauthoring the story of one’s life
3 Types of interventions in therapy
o Cognitive (help clients in how they THINK about their beliefs)
o Affective (assist clients in understanding their feelings)
o Behavioral (translate the above insights into ACTION)
Integrative counselling works on
relationships
What is catharsis
Component of integrative counselling
giving people a place “to dump”
What does integrative counselling state is not enough?
Insight
What is needed with insight according to integrative counselling?
Action
According to integrative counselling, what is needed for people to take action?
Structure
Integrative Therapy states that
Nothing works with everybody
Goal of integrative therapy
What does the client want to happen?
Crisis
Critical life events that can lead to negative consequences.
Trauma
Pervasive reactions that impact’s all parts of a person’s life.
* Associated with many negative mental and physical health outcomes (ex. PTSD, depression, cardiovascular disease, cancer, chronic lung disease, liver disease.
3 Types of Crises
- here and now
- normal
- ACE
Here and now crises
- Demand rapid action.
- Examples: flood, fire, earthquake, sexual assault, school shooting, physical assault, serious accident, sudden diagnosis
Normal crises
- Considered part of life.
- Examples: Breakups, divorce, job loss, death of a loved one.
Adverse child experiences
- Crisis in childhood
- Often leads to long-lasting trauma
- Examples: bullying, parent illness/death, moving, parent divorce/remarriage.
Trauma counselling is the most ____ and _____ form of helping
pragmatic and action-oriented
Trauma counselling is concerned with:
action and useful result for the client.
2 Major Phases of trauma counselling
- Working through initial trauma
- Appropriate follow-up and counselling
Trauma Informed Care
- Delivering care that recognizes that any patient seeking healthcare may potentially have a hx of trauma and need a safe environment for care.
4 Core Considerations when providing 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, families, etc.
- Knowledge about trauma needs to be integrated into all systems.
- It is important to not re-traumatize patients, family members, and staff.
5 Values/Principles of Trauma Informed Care
- safety
- trustworthiness
- choice
- collaboration
- empowerment
What does safety refer to in TIC?
- What does the client need for safety and survival NOW?
- Offer verbal reassurance that the crisis is over.
- Connect them with immediate resources.
What does calming and caring refer to in TIC?
- Establish a therapeutic relationship.
- Show client you care and will listen.
- Do not minimize the crisis.
Normalizing in TIC
- Rather than “survivors” or “victims” – normalize the clients experience by recognizing that they are reacting in a way anyone would in such a difficult situation.
- Individuals have resilience to move forward, but this does not eliminate pain.
Debriefing in TIC
- Clients need to tell their stories again and again.
- Listen, listen, listen!
- Paraphrase, summarize, reflect feelings.
Action and advocacy in TIC
- Ask: “What do you need now?”
- Do not overpromise.
- Answer questions honestly and clearly, providing as much information as needed.
What is the use of rounds in working with involuntary group members?
an activity in which all group members are asked to participate by sharing a word, number, comment or phrase
Things to remember when working with involuntary group members
- Refuse to give in to the negativity: Instead, redirect it. The group process will be attacked. Stay positive and say that some members may find the group very helpful and even life changing.
- Do not take attacks personally: Accept that you will be verbally attacked because mandated group members are frustrated or angry with the authorities who are making them attend.
6 Strategies for working with hostile/involuntary members
- model respect
- allow members to vent their unhappiness with forced involvement
- establish meaningful goals
- utilize disarming technique
- do not subject yourself to verbal abuse
- if abuse continues meet with supervisor to discuss option
Disarming
“involves finding some truth in what the other person (or side) 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
is abuse or aggression that occurs in a romantic relationship.
Intimate partner refers to
both current and former spouses and dating partners.
What populations commonly are victims of IPV
women
Of all reported violent crime more than one quarter (26%) resulted from:
family violence.
Almost 67% of family violence victims were:
women and girls
79% of police reported intimate partner violence is against :
women
Women were victims of intimate partner homicide at a rate ______ greater than men
4x
5 relational risk factors for IPV
- conflict/dissatisfaction
- male dominance in family
- economic stress
- multiple partners
- disparity in education attainment
Community and Societal IPV risk factors
- gender-inequitable societal norms (men linked to being aggressive)
- poverty/low socio status of women
- weak inter-marriage IPV legal sanctions
- Lack of women’s civil rights, including restrictive or inequitable divorce and marriage laws
- broad social acceptance of violence as a way to resolve conflict
- high violence levels in society
How does domestic violence start
often starts as emotional abuse and becomes physical later.
What may the partner may try to make the victim think
the violence is their fault. It’s not.
True or false: It is the responsibility of the victim to convince a violent or abusive partner to get help.
false
What is a safety plan for IPV
a plan for a rapid escape when abuse recurs
Interventions for IPV
- safety plan
- storing vital items near each other in packed bag
- keeping packed bag in area perp will not find
- given number of nearest shelter even if they decide to stay with partner
- referal numbers
Goal of individual therapy for IPV victim
- Empowerment
- the ability to recognize and choose productive life options
- and the development of a solid sense of self.
What type of therapy is used for IPV family therapy
Dialectical behaviour therapy (DBT)
Considerations before a family with hx of abuse begins family therapy
should take place only if the perpetrator has had individual therapy and has demonstrated change as a result and if both parties agree to participate.
8 causes of homelessness
- Poverty, unemployment and precarious employment
- Urban migration and shortage of affordable housing
- Withdrawal in funding programs
- Family issues- Divorce, relationship or family breakdown, or family violence
- Lack of support or transitional services
- Discrimination based on origins, age or sexuality
- Low levels of schooling, social isolation and low self-esteem
- Addictions, physical or mental health problems
True or false: all homeless people experience some degree of mental illness
False; not all homeless people are mentally ill, mental illness is widespread and common in the homeless population
What are the most common disorders affecting the homeless population?
Substance use disorder and depressions
What medical conditions does the homeless population tend to have higher incidence of
alcoholic liver disease, TB, AIDS, pain, diabetes, and hypertension
Social issues many homeless people suffer (3)
trouble maintain any sort of relationship, are socially isolated and and may have suicidal ideation
What services do homeless people tend to overutilize and why?
ER services and don’t have a family physician
4 interventions for therapy with homeless population
- engage patiently
- assess needs broadly
- shape interventions pragmatically
- retain arduously
Why and how must you engage homeless patients patiently?
- Most homeless people don’t trust the healthcare system. so meaningful engagement often develops slowly
- Empathy and persuasion are important therapeutic skills during initial encounters.
Why and how must you assess the needs of homeless patients broadly?
- During the initial evaluation ask about basic needs (safety, food, clothing, and emergency shelter) as well as psychiatric symptoms.
- The homeless patient may prioritize food and shelter than accessing mental
How can you shape interventions for the homeless populations pragmatically
- Advocate for samples rather than written prescriptions, simplified dosing regimens to once-daily
- Help the patient develop safe storage strategies for medications to prevent theft and exposure
Why and must you retain arduously with the homeless population?
- Expect treatment nonadherence, lost or stolen medications, missed appointments, sporadic follow-through with other services, and inconsistency in abstaining from alcohol or other substances
- Set limits and establish consequences to keep a homeless person in treatment rather than to justify terminationH
How many people die of suicide in Canada/year?
4500
12/day
200 attempts/day
For every death by suicide, at least _______ survivors are affected by the loss.
7-10
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
Increase in suicide r/t COVID
2.7% ideation to 4.2%
5 Assessment + Intervention for Suicide Risk
- Maintain a watchful eye/look for warning signs
- Ask key questions
- Avoid asking why
- provide immediate crisis support
- Ensure careful referral and follow up
3 Warning Signs of Suicide Rx
- actual threat to hurt/kill themselves.
- seeking access to pills, guns, etc.
- talking or writing about death, dying, suicide.
Key Questions to ask in suicide risk assessment
- Are you feeling hopeless about the present/future?
- Have you had thoughts about taking your life?
- Have you ever made a suicide attempt?
