NRNP 6645 - Midterm study guide
Legal and ethical considerations among individual, family, and group modalities of
therapy
Domestic violence & sexual abuse:
• Most states require professionals to report any suspicion of child abuse.
• Although reporting suspected abuse can jeopardize a therapeutic alliance,
sometimestherapy needs to take a second place to the interests of safety.
• If a clinician does not report suspected child abuse, they should
consider theconsequences of making a mistake.
• Perpetrators and victims of childhood sexual abuse don’t usually
volunteer thisinformation.
• Detection of this abuse is up to the therapist who may have to rely on indirect clues
• A child MAY show the following symptoms if they are being abused: sleep
disturbance,encopresis or enuresis, abdominal pain, exaggerated startle
response, appetite disturbance, sudden unexplained changes in behavior,
overly sexualized behavior, regressive behavior, suicidal thoughts or running
away.
Ethical Dimension:
• Therapy should be for the client’s benefit, not to work out unresolved
issues for thetherapist
• Clients are entitled to confidentiality, but limits of privacy must be imposed in
regards toprobation officers, parents, and managed care companies
• Therapists should avoid exploiting the trust of their clients (and students) and
must avoiddual relationships
• Professional are obligated to provide the best possible treatment, if they are not
qualified,they should refer the patient to someone else who is.
• When in doubt regarding ethical issues, its best practice to consult with a
colleague orsupervisor.
• Psychologists offer services only within the areas of their competence,
based oneducation, training, supervision or professional experience.
• When psychologists become aware of personal problems that might interfere
with theirprofessional duties, they take appropriate measures, such as
obtaining professional assistance and determining whether they should limit,
suspend or terminate their work-related duties.
,• Social workers should not engage in dual relationships with clients or former clients.
• Social workers should not solicit private information from clients unless it is
essential toproviding services
• Social workers should not disclose confidential information to third party
payers unlessclients have authorized such disclosure.
• Social workers should terminate services to clients when such services are
no longerrequired.
• Counselors are not allowed to maintain a relationship with current clients
through socialmedia
• Counselors must wait 5 years after the last clinical contact to have sexual or
romantic relationship with a former client or family member of a client. This
applies to both in-person and electronic interactions.
• The APA specifies that when a psychologist provides serves to several
people in arelationship (spouse or parents and children), they must
clarify at the start which individuals are clients and what relationship he
or she will have with each one.
• Additionally, if the psychologist is called on to perform potentially conflicting
roles (suchas family therapist and witness for one party in divorce proceedings),
he or she must attempt to clarify and change or withdraw from the roles as
appropriate.
• The NASW states that when a social worker provides services to a co ule or
family members, he/she should clarify with all parties what professional
obligations he or shehas to the various individuals receiving services.
• Also, the social worker should ask all parties to agree to each individual’s
right toconfidentiality.
• As a therapist one way to resolve ambiguous ethical dilemmas is to use your
own bestjudgement.
• When in doubt, clinicians should ask themselves two questions:
1) What would happen if the client or or important others found out
about myactions?
2) Can you talk to someone you respect about what you’re
doing (orconsidering)?
• The following are “red flags” which should signal potential unethical practices:
1) Specialness - believing that something about the situation is special and
that theordinary rules don’t apply.
, 2) Attraction - feeling intense attraction of any kind not only romantic but
also beingimpressed with the status of the client.
3) Alteration in the therapeutic frame - having longer or more frequent sessions,
engaging in excessive self-disclosure, being unable to say no to the client,
and otherthings that signal a potential violation of professional boundaries
4) Violating client norms - not referring someone in a trouble marriage for
couplestherapy, accepting personal counseling from a supervisor and
so on.
5) Professional isolation - not being willing to discuss your decision with
professionalcolleagues.
COGNITIVE BEHAVIORAL THERAPY
o “A collaborative process of empirical investigation, reality testing, and problem
solving between the therapist and the patient.”
o The basic premise is that depression is the result of cognitive distortions,
and these distortions are learned errors in thinking (Beck)
o CBT is “a system of psychotherapy based on a theory which maintains that
how an individual structures his or her experiences largely determines how
he or she feels or behaves.”
o Dysfunctional thoughts relating to self, world, and/or others are rooted in
irrational or illogical assumptions. The individuals view of self and the world
is central to the determination of emotions and behaviors and thus by
changing one’s thoughts, emotions, and behaviors can also be changed.
o Primary and secondary thinking. Secondary thinking views the social and
cultural world in determinate, positive, rational terms. Primary thinking
recognizes the indeterminate, negative, and irrational as a part of human action
forever.
o Clinical strategies are used to help the individual recognize the dysfunctional
nature of their thinking patterns and to help the individual change their
conclusions.
o Cognitive therapy advocates guided discovery rather than directly
challenging the patient’s views. Allowing the patient to find the answers to
their problems as much as possible.
Socratic Dialogue
o “Mutual discovery in which the therapist guides the patient through a
series of questions and answers to elicit automatic assumptions and
examine the logic and evidence that relates to them.”
o Involves the therapist asking specific questions derived primarily from
restatement of the individual’s own words as the major technique leading the
individual to self-discover
, insight leading to subsequent changes.
7 types of questions for SD: examples located on p316 in book. History, memory,
translation, interpretation, application, analysis, and evaluation questions.
o Basic Rules to SD located on page 317 in book.
o Labeling of Distortions- patients are helped to identify “dysfunctional or
irrational” thoughts as a type of self-monitoring for more accurate
descriptive
o Questioning the Evidence- this technique assists the individual in questioning
the factsrelated to their cognitions and conclusions. It investigates whether their
information is based on facts or assumptions.
o Examining Options and Alternatives- this technique involves the
development of all possible alternative explanations to learn the skills in
generating options rather than “only one way” thinking.
o Reattribution- in individuals with the habit of accepting all or most of the
blame for outcomes, this is an excellent technique for redistribution of
responsibility. This is also helpful for individuals with personality disorders
that place the blame squarely on the shoulders of others for most outcomes
o Decatastrophizing- catastrophic thinking is one of the hallmarks of anxious
individuals. These individuals tend to focus on the most negative possible
outcome of any given situation. Decatastrophizing allows for balance and
realistic focusing by examining the “worst possible outcome” and developing a
plan of action.
o Advantages and Disadvantages- for individuals who appear to be stuck
between two options, examination of the advantages and disadvantages of
certain situations helps them to develop alternative perspectives. This breaks
the “all or nothing” mindset and permits a more balanced view of the situation.
o Paradox or Exaggeration- this technique should only be used by the very skilled
therapist; otherwise, the patient may view this technique as sarcasm or belittling.
Whenused appropriately, the therapist takes an issue to the extreme to help the
person see the absurdity of their sometimes-overinflated viewpoints.
o Turning adversity to advantage- making lemonade out of lemons. The
individual is helped to identify how to use what appears to be a negative
situation to his or her advantage.
o Cognitive rehearsal- prior to making a behavioral change, it is sometimes
less threatening to “practice” the new behavior through visualization and
discussion.
o Automatic thought records- patients are asked to complete columns, identifying
a troubling situation, resulting emotion, and thoughts associated with both. The
therapist and patient work on clarification and development of “rational”
responses to debate orchallenge the original reaction.
Legal and ethical considerations among individual, family, and group modalities of
therapy
Domestic violence & sexual abuse:
• Most states require professionals to report any suspicion of child abuse.
• Although reporting suspected abuse can jeopardize a therapeutic alliance,
sometimestherapy needs to take a second place to the interests of safety.
• If a clinician does not report suspected child abuse, they should
consider theconsequences of making a mistake.
• Perpetrators and victims of childhood sexual abuse don’t usually
volunteer thisinformation.
• Detection of this abuse is up to the therapist who may have to rely on indirect clues
• A child MAY show the following symptoms if they are being abused: sleep
disturbance,encopresis or enuresis, abdominal pain, exaggerated startle
response, appetite disturbance, sudden unexplained changes in behavior,
overly sexualized behavior, regressive behavior, suicidal thoughts or running
away.
Ethical Dimension:
• Therapy should be for the client’s benefit, not to work out unresolved
issues for thetherapist
• Clients are entitled to confidentiality, but limits of privacy must be imposed in
regards toprobation officers, parents, and managed care companies
• Therapists should avoid exploiting the trust of their clients (and students) and
must avoiddual relationships
• Professional are obligated to provide the best possible treatment, if they are not
qualified,they should refer the patient to someone else who is.
• When in doubt regarding ethical issues, its best practice to consult with a
colleague orsupervisor.
• Psychologists offer services only within the areas of their competence,
based oneducation, training, supervision or professional experience.
• When psychologists become aware of personal problems that might interfere
with theirprofessional duties, they take appropriate measures, such as
obtaining professional assistance and determining whether they should limit,
suspend or terminate their work-related duties.
,• Social workers should not engage in dual relationships with clients or former clients.
• Social workers should not solicit private information from clients unless it is
essential toproviding services
• Social workers should not disclose confidential information to third party
payers unlessclients have authorized such disclosure.
• Social workers should terminate services to clients when such services are
no longerrequired.
• Counselors are not allowed to maintain a relationship with current clients
through socialmedia
• Counselors must wait 5 years after the last clinical contact to have sexual or
romantic relationship with a former client or family member of a client. This
applies to both in-person and electronic interactions.
• The APA specifies that when a psychologist provides serves to several
people in arelationship (spouse or parents and children), they must
clarify at the start which individuals are clients and what relationship he
or she will have with each one.
• Additionally, if the psychologist is called on to perform potentially conflicting
roles (suchas family therapist and witness for one party in divorce proceedings),
he or she must attempt to clarify and change or withdraw from the roles as
appropriate.
• The NASW states that when a social worker provides services to a co ule or
family members, he/she should clarify with all parties what professional
obligations he or shehas to the various individuals receiving services.
• Also, the social worker should ask all parties to agree to each individual’s
right toconfidentiality.
• As a therapist one way to resolve ambiguous ethical dilemmas is to use your
own bestjudgement.
• When in doubt, clinicians should ask themselves two questions:
1) What would happen if the client or or important others found out
about myactions?
2) Can you talk to someone you respect about what you’re
doing (orconsidering)?
• The following are “red flags” which should signal potential unethical practices:
1) Specialness - believing that something about the situation is special and
that theordinary rules don’t apply.
, 2) Attraction - feeling intense attraction of any kind not only romantic but
also beingimpressed with the status of the client.
3) Alteration in the therapeutic frame - having longer or more frequent sessions,
engaging in excessive self-disclosure, being unable to say no to the client,
and otherthings that signal a potential violation of professional boundaries
4) Violating client norms - not referring someone in a trouble marriage for
couplestherapy, accepting personal counseling from a supervisor and
so on.
5) Professional isolation - not being willing to discuss your decision with
professionalcolleagues.
COGNITIVE BEHAVIORAL THERAPY
o “A collaborative process of empirical investigation, reality testing, and problem
solving between the therapist and the patient.”
o The basic premise is that depression is the result of cognitive distortions,
and these distortions are learned errors in thinking (Beck)
o CBT is “a system of psychotherapy based on a theory which maintains that
how an individual structures his or her experiences largely determines how
he or she feels or behaves.”
o Dysfunctional thoughts relating to self, world, and/or others are rooted in
irrational or illogical assumptions. The individuals view of self and the world
is central to the determination of emotions and behaviors and thus by
changing one’s thoughts, emotions, and behaviors can also be changed.
o Primary and secondary thinking. Secondary thinking views the social and
cultural world in determinate, positive, rational terms. Primary thinking
recognizes the indeterminate, negative, and irrational as a part of human action
forever.
o Clinical strategies are used to help the individual recognize the dysfunctional
nature of their thinking patterns and to help the individual change their
conclusions.
o Cognitive therapy advocates guided discovery rather than directly
challenging the patient’s views. Allowing the patient to find the answers to
their problems as much as possible.
Socratic Dialogue
o “Mutual discovery in which the therapist guides the patient through a
series of questions and answers to elicit automatic assumptions and
examine the logic and evidence that relates to them.”
o Involves the therapist asking specific questions derived primarily from
restatement of the individual’s own words as the major technique leading the
individual to self-discover
, insight leading to subsequent changes.
7 types of questions for SD: examples located on p316 in book. History, memory,
translation, interpretation, application, analysis, and evaluation questions.
o Basic Rules to SD located on page 317 in book.
o Labeling of Distortions- patients are helped to identify “dysfunctional or
irrational” thoughts as a type of self-monitoring for more accurate
descriptive
o Questioning the Evidence- this technique assists the individual in questioning
the factsrelated to their cognitions and conclusions. It investigates whether their
information is based on facts or assumptions.
o Examining Options and Alternatives- this technique involves the
development of all possible alternative explanations to learn the skills in
generating options rather than “only one way” thinking.
o Reattribution- in individuals with the habit of accepting all or most of the
blame for outcomes, this is an excellent technique for redistribution of
responsibility. This is also helpful for individuals with personality disorders
that place the blame squarely on the shoulders of others for most outcomes
o Decatastrophizing- catastrophic thinking is one of the hallmarks of anxious
individuals. These individuals tend to focus on the most negative possible
outcome of any given situation. Decatastrophizing allows for balance and
realistic focusing by examining the “worst possible outcome” and developing a
plan of action.
o Advantages and Disadvantages- for individuals who appear to be stuck
between two options, examination of the advantages and disadvantages of
certain situations helps them to develop alternative perspectives. This breaks
the “all or nothing” mindset and permits a more balanced view of the situation.
o Paradox or Exaggeration- this technique should only be used by the very skilled
therapist; otherwise, the patient may view this technique as sarcasm or belittling.
Whenused appropriately, the therapist takes an issue to the extreme to help the
person see the absurdity of their sometimes-overinflated viewpoints.
o Turning adversity to advantage- making lemonade out of lemons. The
individual is helped to identify how to use what appears to be a negative
situation to his or her advantage.
o Cognitive rehearsal- prior to making a behavioral change, it is sometimes
less threatening to “practice” the new behavior through visualization and
discussion.
o Automatic thought records- patients are asked to complete columns, identifying
a troubling situation, resulting emotion, and thoughts associated with both. The
therapist and patient work on clarification and development of “rational”
responses to debate orchallenge the original reaction.
