PCN 500 Discussions

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Feb 20, 2024

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Understanding ethical guidelines and counselor’s responsibilities are key to providing clients with the best possible service. By understanding the counselor’s responsibilities and their ethical boundaries, counselors can continue to be the gatekeepers of all information that their clients supply them with. Ultimately, when working with our clients, we should strive to provide the best services and if we question our practices, we should reach out for help rather than to continue down a path that possibly could be detrimental to our overall wellbeing. The ACA Code of Ethics (2014) acknowledges that, in areas that a counselor is thought to be weak, they must notify the proper supervisor, notify clients when they are new to a specialty, ensure that they qualified to be able to assist the client, continue their education and continue to maintain ethical, sound treatment processes whilst monitoring whether their techniques are helping their client. American Counseling Association. (2014). ACA Code of Ethics. Alexandria, VA: Author. The ACA’s Code of Ethics section B.6.c., states the following in regarding to attaining permission to record “counselors obtain permission from clients prior to recording sessions through electronic or other means” (2014). Understanding ethical guidelines and counselor’s responsibilities are key to providing clients with the best possible service. By understanding the counselor’s responsibilities and their ethical boundaries, counselors can continue to be the gatekeepers of all information that their clients supply them with. Ultimately, the recording of a session should be beneficial to the client. Supervision has been overall extremely helpful during this period. My supervisor allows me the freedom to learn how to be a counselor. She does not brood over me and offers insight respectfully. Because of my background, my supervisor I believes is somewhat comfortable with me working, especially with juveniles. I worked as a juvenile counselor in a mental health facility for four years and I have been a mentor for over 15 years. I enrolled in grad school to attain my licensure and get just pay for my services. I was doing all the work of a counselor at the site I volunteered at but could not be hired on due to not having my masters even though I had the experience. My supervisor assists me with learning the in’s and outs of private practice, which I had no previous experience with prior to practicum. One aspect in supervision that I did not think I would have to learn was billing and coding. Thus far, I have been mainly utilizing individual supervision but recently I have had a few group supervisions and I honestly liked them better. I enjoyed learning some techniques from others and being able to listen some instead of babbling on and on. Supervision can get somewhat redundant. I believe if we were in the office more, instead of utilizing telemental services, supervision would be more interesting and thought provoking. I have my goals in place and I am continuously working on my skills set, in addition to trying to ensure that I am providing quality services to my community and clients. Do you "clean up" your client interactions in presenting them at supervision? If so, why? If not, what are your thoughts on this topic? I do cleanup my supervision conversation with my supervisor and in my notes. For my notes, my supervisor noted that everything can be subpoenaed and some information is not needed for client

notes. I like to try to maintain privacy with my clients and in the previous course, it was suggested that I maintain client-counselor confidentiality. I was originally giving a play by play of each session and I have since stopped that but rather when I have concerns, I’ll address the issues directly during supervision or outside depending on the nature. For instance, I had a client attempt suicide. I was comfortable in my skills and the outcome with my client however I felt compelled to let my supervisor know of the incident. I have tried to catch myself from utilizing adjustment order. Adjustment disorder covers soooo much though. I am going more indepth with utilizing the DSM-V and when working with clients, I am now applying my impression to the clients notes in Theranest. On days of supervision, my supervisor goes over my choices. I try to articulate as best as I can what led me to choose the diagnostic codes for my clients. I am still working on ensuring that I decipher subtypes as well. Adjustment Disorder can be chosen as an option, but I can leave it unspecified or specify the emotional and behavioral symptoms as well. Adjustment Disorders in hospital settings are can reach to 50% of the clients whilst outpatient facilities diagnose Adjustment disorders less at rates of 5-20% of clientele (American Psychiatric Association, 2013). As I am learning more, I want to ensure that I develop better skills with my diagnostic impressions of clients. I don’t want to do cookie cutter diagnosis. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5 ed.). Washington, D.C. I have not had any experience utilizing this tool. With Theranest, we have the tools in the program built in. My clients are sent questionnaires to fill out prior to coming to their sessions. If a client does not complete their assessment, then we will complete them during the session. As a counselor, there is no one size fits all model that is going to fit each client, after all we are all individuals and treatment should be developed on an individual level. I will ask my supervisor about this screening tool to see if it is something that I need to utilize in practice. I agree that overdiagnosis does not serve any purpose in therapy. When working with clients, counselors can utilize the DSM to provide assistance when attempting to develop treatment plans for their clients and checking the symptoms presented for diagnosis. Through understanding how to utilize assessment tools, counselors can begin the process of screening, assessment, and treatment plan development. Without the proper screening a client, a diagnosis cannot be formed for a client. Having the proper diagnosis helps to provide the best form of therapy to fit the client’s needs I actually have a client now who has multiple personalities, suicidal ideations, and a diagnosis of schizophrenia. This will be my first clients to have known comorbidities. I have to ensure that assessments are continued throughout counseling and therapy to ensure that my client is gaining the necessary skills to recover and achieve set goals. Whilst completing on-going assessments, due to my clients diagnoses, I may have to intervene during crises to provide immediate insight, change treatment plan, give referrals, and a host of other options. With my client, I have to

ensure that I work with my supervisor as well and let her know if working with this client is beyond my scope at any time, I feel uneasy. Max Points: 5.0 How can you, as a therapist, avoid becoming "stuck" in a particular theoretical framework? Identify specific ways that you can ensure you continue to grow. By understanding that “within each discipline, theory and practice differ” (NCBI,2004). As a therapist, understanding that many techniques and theories share many common traditions and approaches, yet differ in noteworthy philosophical and practical ways, affect therapy techniques and goals for treatment. By keeping up to date on theories, maintaining a relationship with licensing board and fellow therapists, and continuing education, a therapist can avoid becoming stuck in one theoretical framework. One of the major ways that I believe that will be beneficial to me is ensuring that I fulfill my continuing education credits, once I am in my career and that will assist me in keeping up to date. knowledgeable, and competitive amongst my peers. Center for Substance Abuse Treatment. Substance Abuse Treatment and Family Therapy. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2004. (Treatment Improvement Protocol (TIP) Series, No. 39.) Chapter 3 Approaches to Therapy. Available from: https://www.ncbi.nlm.nih.gov/books/NBK64259/ As a counselor, there is no one size fits all model that is going to fit each client, after all we are all individuals and treatment should be developed on an individual level. I think that as counselors, we should use the theories that best fit our clients and match our expertise. Professional aptitude is what matters the most to me. The ACA Code of Ethics (2014) acknowledges that, in areas that a counselor is thought to be weak, they must notify the proper supervisor, notify clients when they are new to a specialty, ensure that they qualified to be able to assist the client, continue their education and continue to maintain ethical, sound treatment processes whilst monitoring whether their techniques are helping their client. We are ethically bound not to work outside our areas of expertise. I wonder what else the insurance company would have you to do instead. American Counseling Association(ACA). (2014). ACA Code of Ethics . Alexandria, VA: Author. As a counselor, there is no one size fits all model that is going to fit each client, after all we are all individuals and treatment should be developed on an individual level. I think that as a counselor, I would utilize narrative therapy for sure. Narrative therapy describes the type of therapy I would like to receive if

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I needed therapy. Narrative therapy gives clients the option to utilize their personal skills while the therapist "does not act as the expert, but rather helps clients see how they are the experts regarding their own life and, as such, can uncover the dreams, values, goals, and skills that define who they really are, separate from their problems"(Psychology Today, 2018). Professional aptitude is what matters the most to me. The ACA Code of Ethics (2014) acknowledges that, if their areas a counselor is thought to be weak in they must notify the proper supervisor, notify clients when they are new to a specialty, ensure that they qualified to be able to assist the client, continue their education and continue to maintain ethical, sound treatment processes whilst monitoring whether their techniques are helping their client. . American Counseling Association(ACA). (2014). ACA Code of Ethics . Alexandria, VA: Author. Psychology Today. (2018). Narrative Therapy. Retrieved from https://www.psychologytoday.com/therapy-types/narrative-therapy Out of the three types of therapy listed, I believe narrative therapy would be the one I would most likely use if given an oppurtunity. Feminist theory to me seems divisive rather than incorporating ideals that you would think would fall into place in most forms of therapy now. I do not see the need for a therapy solely dedicated to gender as realistic for me. Solution based therapy seems to be in general what most people come to therapy for, to find a solution to their problem, but it seems as if it's merely been given a title to a part of therapy that is practiced in multiple theories. With narrative therapy, I fet to learn more about the client and how we got to the point we are at. Narrative therapy in a nutshell describes what I personally would like if I needed a therapist. With Narrative therapy the therapist "does not act as the expert, but rather helps clients see how they are the experts regarding their own life and, as such, can uncover the dreams, values, goals, and skills that define who they really are, separate from their problems"(Psychology Today, 2018). Bibliography Chavis, A. M. (2004). Genograms and African American Families:Employing Family Strengths of Spirituality,Religion, and Extended Family Network. Michigan Family Review, 9(1), 30-36. Retrieved from https://quod.lib.umich.edu/cgi/p/pod/dod-idx/genograms-and-african-american-families-employing- family.pdf?c=mfr;idno=4919087.0009.104;format=pdf Psychology Today. (2017). Gestalt Therapy. (Sussex, Producer) Retrieved December 19, 2017, from https://www.psychologytoday.com/therapy-types/gestalt-therapy#when-its-used Psychology Today. (2018). Narrative Therapy. Retrieved from https://www.psychologytoday.com/therapy-types/narrative-therapy

How could the family genogram be applied to the treatment of a family with addiction issues? Please apply this to a hypothetical family Genograms are utilized to provide a visual aid to the client that represents their family linage, much like a family tree, with notes about the members as it advances. “ Genograms have been used to help practitioners understand the family context, to trace behavior and problems of family members, and to identify patterns and issues within families” (Chavis, 2004). I could use this example within my family. I have several members of my family that are addicted to alcohol and drugs. My family’s genogram would immediately start with conflict due to my grandfather having two sets of children. From the start of our genogram you would start to see patterns flowing throughout about alcoholism and drug usage. I believe that had this system been in place and used it might have assisted in possibly preventing the death of my beloved cousin due to cirrhosis of the liver. There are visual learners who would benefit from seeing a diagram showing the on-goings of their lineage. My family tree started with scandal in the backwoods country and I believe there is without a doubt a correlation of self-harming behaviors due to how our family came to be and genetically predisposition. I took note of this whilst in an anthropology class in undergrad and changed my alcohol consumption habits out of fear and observation. In my family they tend to just say “we’re cursed” instead of trying to understand what is going on and how our upbringing or lack of upbringing influenced and still is influencing our choices. With this type of documentation counselors will often go back three or more generations to help identify strengths and points of weakness within a family. References Chavis, A. M. (2004). Genograms and African American Families:Employing Family Strengths of Spirituality,Religion, and Extended Family Network. Michigan Family Review, 9 (1), 30-36. Retrieved from https://quod.lib.umich.edu/cgi/p/pod/dod-idx/genograms-and-african- american-families-employing-family.pdf?c=mfr;idno=4919087.0009.104;format=pdf Psychology Today. (2017). Gestalt Therapy . (Sussex, Producer) Retrieved December 19, 2017, from https://www.psychologytoday.com/therapy-types/gestalt-therapy#when-its-used Michigan Family Review, 9, 1, 30-36, 2004 © Michigan Council on Family Relation Max Points: 5.0 What are the main differences between Bowenian, structural, and strategic family systems theories? Bowen's theory focuses on the emotional systems created within families. Emotional problems are cross generations until the members can successfully deal with unresolved emotional ailments. Structural therapy, by Minuchin, focuses on decreasing dysfunctional symptoms by assisting families change their transactional rules and develop appropriate interpersonal boundaries. A client’s symptoms cannot be improved until structural changes occur in the family interactional patterns in which the client participates. Structural therapy views individual and family problems as symptoms of underlying problems whilst Strategic Family Systems, by Haley, view problems not as symptoms but as the

problems themselves. Structural and Strategic Family Systems are very similar and sometimes when certain aspects are combined in practice, the practice will be referred to as Structural-Strategic Family Therapy. (Grand Canyon,2014) Grand Canyon University (2014). Family Systems Theory and Therapies (lecture notes). Retrieved from https://lc-grad2.gcu.edu. The textbook indicates that choice intervention strategies are a central element of reality theory. How might these strategies be used in conjunction with other counseling theories? This discussion question meets the following CACREP Standard: 2.F.5.a. Theories and models of counseling. Choice theory is driven by internal motivation and satisfying our basic needs, which are genetically structured. “Love/belonging, freedom, power, fun, and survival” (GCU,2017) are needs that must be fulfilled accordingly to reality theory. While reading over reality theory, it made me reflect back on to Maslow’s hierarchy of needs. Maslow’s needs were set on the foundation of fulfilling our basic needs first and moving on to more fulfilling needs. I wonder if Glasser built his theory from Maslow because at first look I thought they were one in the same. The variation is as to what are they key needs in each theory. The epitome of Maslow’s theory was self-actualization needs which is fulfilling their “calling” and is attained by fulfilling the lower levels of needs. Without a solid foundation, you can not fulfill Maslow’s hierarchy. By fulfilling the needs of reality theory you become more conscience of self and your decision making, you learn from your past and grow from it. Glasser and Maslow remind me of building a solid foundation. When we are moving through these two theories, a foundation must be set to build upon or the individual will not grow. Matthew 7:24-27 speaks of what happens when we have a solid foundation. With a solid foundation a person can withstand what ever is before them. Grand Canyon University. (2014). PCN500 lecture 5 [HTML document]. Retrieved from http://lc.gcu.edu/ REBT has a direct and more aggressive approach than CT. CT’s process utilizes open-ended questions from the counselor, to assist clients in making their own reflection of self about their delusional and ill- suited thought processes. In both types of therapy, the clients are over-bearing about the incidents in their lives, which are misconstrued. While REBT is taught as a client is thoughts are solely irrational, CT’s therapy refers to the clients thought processes and how they influence their personal mental status directly. Teaching a client another way to think about their decision making process allows the client to

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have greater freedom with dealing with their current issues. CT’s therapy is great for short term therapy and there are plenty of readily available materials for individuals, who may not even be in therapy, to utilize. (Murdock,2017) Murdock, N. L. (2017). Theories of counseling and psychotherapy: A case approach (4 th ed.). New York, NY: Pearson Education, Inc. Psychology Today. (2017). Gestalt Therapy . (Sussex, Producer) Retrieved December 19, 2017, from https://www.psychologytoday.com/therapy-types/gestalt-therapy#when-its-used I most certainly could try to provide all of these attributes to the clients that I serve. If I am struggling with providing genuine, empathetic, and accepting care I would speak to my supervisor to see if there was anything that I should work on or what I should do to ensure that I don't cause potential harm to my clients. As a counselor, I have to be intune with myself and aware where my shortfalls are. Self-care is a key component to preventing burnout amongst counselors and if I am unable to provide the care my clients need, I may need to ensure that I am taking to proper measures to ensure that I am at my healthiest (Barnett,2014). The difference among objective positivist neoanalytic writers and relativistic/constructivist neoanalytic writers is flexibility. Sigmund Freud is who should come to mind with thinking of objective positivist neoanalytic writings due to the writings being so rigid and pure analytical in nature. The approach can seem cold and does not encourage the therapist to interact with the clients giving them advice or nurturing. Relativistic neoanalytic writers provide therapist with the ability to get to know their clients on a more personal level, advising them and fostering their growth not solely on early incidents from birth nor solely on sexuality. Relativistic neoanalytic writings allow for each client to be accessed individually and their treatment plans tailored to them versus objective positivist writers perform somewhat like rote learning, simply following the same patterns for each client. According to Adler, what is the difference between biological and psychological birth order? Describe how Adler's theory of psychological birth order (the family constellation) shapes the family member. Adler held that “humans have an innate tendency to strive for perfection and that this striving is the most important motivator of behavior” (A. Adler, 1929/1969). According to Adler, people seemingly want to be known socially and that is part of what shapes individuals, whether they be good or bad. Without social interactions, it would be impossible for individuals to flourish in society and detrimental to their overall wellbeing. Adler, did not base his theory on behavior solely on heredity but rather a combination of our environment and heredity. Perception of the world shapes how individuals develop inside a family. How one perceives the world is not solely based on their parents but rather a combination of all influences and interactions from early on in development. By showing a child potential, they can receive and reciprocate those ideals into

society versus the inferiority complex, while a natural occurrence, they are unable to respond positively to society and its interactions. The superiority complex lacks any feelings of inferiority and gives the individual false heighten level of significance. An example of superiority complex would South Park’s Cartman as an officer doting on his peers to “respect my authority” even when he was in the wrong. Adler’s theory suggests that birth order plays a role in how we fair in society. Biologically he favored “first, middle, last or only” child as descriptors for birth order over ordinal and in addition to biological age, there is psychological age which is where a child is mentally in comparison to the others. For example, a family’s first born child could be born with a defect that effects their mental capabilities. Later, the family has another child that is considered “normal.” The second child psychologically would be considered the first born in the family constellation. Adler bases his ideas on a mother and father parental unit in the home, teaching their children and nurturing them. I do not know how well this would fit today but reflecting on the reading, as the eldest with siblings 14 years my junior, I have first hand knowledge being the first born and an only child. I notice that the middle child is moreso like a first born to our youngest sibling, who does actually try to keep up with either me or the middle brother. (Murdock,2017) Murdock, N. L. (2017). Theories of counseling and psychotherapy: A case approach (4 th ed.). New York, NY: Pearson Education, Inc. Max Points: 5.0 Some might argue that a therapist’s theoretical orientation is irrelevant in the counseling process, and that only client outcomes matter. Others might argue that specific factors common across models of therapy-not specific theory or an approach endorsed by a counselor create a positive outcome. What do you think? Why? Professional competence is what matters the most to me. Per the ACA Code of Ethics (2014) counselors are to acknowledge their areas that they may be weak in, notify clients when they are new to a specialty when counseling, ensure that they qualified to be able to assist the client, continue their education and continue to maintain ethical, sound treatment processes whilst monitoring whether their techniques are helping their client. Each counselor has their own ideas and must be able to adapt to the everchanging needs of the population that they serve. As a counselor, there is no one size fits all model that is going to fit each client, after all we are all individuals and treatment should be developed on an individual level. I think that as a counselor, we should be careful not to get into a “cookie cutter” mode of counseling. Cookies take a lot of work and you can follow the same recipe every time yet there is always a batch (individual) that comes out different from the rest that does not follow the order of the recipe. Sure, as bakers (counselors) we might be discouraged but we learn from our mistakes and make the proper adaptations to ensure our product (clients) do not suffer.

American Counseling Association(ACA). (2014). ACA Code of Ethics . Alexandria, VA: Author. Max Points: 5.0 What are your personal assumptions about: How do people develop the kinds of psychological distress that bring them to counseling? What constitutes "good mental health" or "a good life?" How do people change, grow emotionally, develop better coping mechanisms, or change destructive behaviors? There are a variety of reasons that people seek out counseling. From personal experience, I have met people who sought out counseling prior to marriage, family issues, court order, mental health issues and a host of other reasons. Everyone has their own reasoning to seek out counseling and for some this may not be an easy task. Having a good life or good mental health is subjective to whom you ask. Societal norms play a role as to what could be considered “good.” What might be tolerated in one location, amongst a group of individuals, many other groups can vary and acceptance into said group may have variants that allow an individual access to the group. For example, an abused child may look at their classmate who comes to school happy, dressed nicely, and appearing to have a loving family as having a “good life” whilst the “good life” child may look at the abused child and see a child who is knowledgeable to more than them. People change by seeking out growth and applying the knowledge that they attain. By applying knowledge to their issues, people are able to work through them and avoid destructive behaviors.

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