Counseling and Psychotherapy

Counseling and Psychotherapy History to Today - Historically things were more psychotherapy but today both are used. Today therapy is more short term and action focused due to insurance companies and people wanting a quick fix Theory - Therapy is guided by this-actions are guided by research and the theory used is determined by the patients need-each profession uses a different theory 1st force - Psycho analysis-Fued--Analysis od behaviors/thoughts-talk therapy-Helps client understand their position and what they bring to a relationship-see client multiple times a week 2nd force - Behavior Therapy- 1960's John Watson-environment shapes children-emotions are learned and therefore can be unlearned-Action oriented-once a week therapy- Exposure therapy 3rd force - Relationship Oriented Therapy-s-Carl Rogers-relationship between client and therapist is most important part of treatment-quality of relationship strongest predictor of if patient gets better 4th force - Multicultural Counseling- 1960-70's-got attention in late 80s-adjust counseling to be sensitive to different cultures-awareness/recognition, knowledge, and development of specific skills Advice - Therapists/ Counselors should not give advice because it blurs boundaries, therapists are supposed to be objective, and giving advice isn't teaching the patient how to solve their own problems Counseling - short term, focuses on action/ change and the present and is a collaborative relationship Psychotherapy - longer, focused on insight and making connections between past and present and therapist is the expe Short term - 6 months or less Clients - The people who get counseling are those who can show the 3rd party payers that they need it or those who can pay for it out of pocket. Therapy - is guided by research and and all treatments are based on successful research Theoretic Orientation - Each profession uses different types of therapy. Counselors use a cognitive orientation whereas social workers uses an integrative orientation Joint Commission - Study the treatment of people with mental illnesses- developed outpatient counseling using federal money to develop community of mental health center to provide support within the community- Influenced counseling because it changed counseling to be briefer therapies, working on a sliding fee scale, focused on outpatient counseling, and created crisis lines/centers. 3rd party payers influence - Not every problem will be compensated, Diagnosis/treatment plan have to come quickly, Treatment is much briefer, More paperwork for therapist, Increased emphasis on accountability, and More research based Technology - Mobile Therapy where the phone offers therapeutic exercises based on mood throughout day- like electronic therapist- Therapy provided through TV and Skype. They could be helpful because help people who are immobile or who live in rural areas that have to drive long way to get to counseling. It may be easier for patients to share their feelings through a phone not face to face. There are many concerns including boundary issues for when client emails you and liability issues if you don't see the email in time. Also confidentiality because you never know for sure who is sending or seeing the email. Non-verbal's and facials are lost which is an important part of counseling. Another problem could be with billing. How do you charge for sending an email? Boulder Model - Scientist-Practitioner Model in which stated that we need to train PhD in science and practice very rigorously and must use scientifically conformed practice. We still use this model today and it is the dominate training approach with a focus on science and practice. Eysenck - Meta-Analysis of the effectiveness of therapy and found that therapy doesn't work and psychoanalysis is worse than no treatment at all. This lead to much more research in the area of therapy because other scientists wanted to prove him wrong. Meta Analysis - Combines a bunch of studies on a single topic and by doing fancy statistics that allow you to come up with a summary result. Smith, Glass, and Miller - Their meta-analysis found that therapy works for most people and major approaches to therapy are about equally effective Process Research - looks at what happened in therapy and what specific behavior by therapist promoted a good relationship. Outcome Research - research on the outcomes of therapy and the kind of effects therapy has on patients Great Psychology Debate - Debate on the type of study we should use to asses therapy outcomes either true experiments or correlational studies. Research importance - Educate the public, Accumulate Evidence, Avoid harm and Improve Treatment, and Accountability Iatrogrenic Treatment - A treatment that causes harm Accountability - Therapists need to be accountable to insurance companies and corporations like United Way because it is funded by charitable services therefore they need to monitor to see if the therapy is working to see if they will keep giving money Educate Public - to reduce the bad stigmas around mental illness and help people realize there are a lot of people out there with this problem and to inform public about signs of mental illness to make more appropriate referrals. Counseling requirements - Cannot conduct counseling with bachelor's degree- you can do paraprofessional roles in helping careers. You could be a line therapist for the early autism program, work in early education, be a teacher assistant, be a resident assistant in a nursing home More education - More options and more money Psychiatrists - Degree in Medicine with psychiatric residency- send most of their time diagnosing and prescribing-Used to be more therapist now play more of the medical/medication role. Psychologists - PhD-historically started off for assessment then therapy, and now more supervision of master's people. They can teach in universities, do research, and do assessments Master's Level - Training emphasis is different between counselors, clinical social workers, and Marriage and Family Therapists- 2 to 3 years or 60 credits after bachelor's degree School Counseling - more associated with academics. Forces on scheduling, career plans and stress management School Psychology - assessment and counseling- Determine needs and plans for students with special needs School Social Worker - works with child abuse and family problems Licensing - comes from state and each state has different requirements for licensing. Certification - needed to work in schools in which you need to be certified by the DPI. Requirements differ by profession and by state. We do licensing to protect the public and to protect clients Certification Requirements - Common components are education/credentials, supervised experience, and tests. Counseling process - establishes and maintains therapeutic relationships, assesses concerns, assets, and outcomes, and uses information to modify conceptualizations, goals, and interventions as need. This is a process not stages because therapists are constantly doing multiple steps all at the same time. For example a therapist may be establishing the structure of the counseling relationship while assessing presenting concerns and establishing treatment goals. Therapy relationships importance - if the client doesn't trust and have a good relationship with the therapist they are not going to cooperate with treatment. Research has found that therapeutic relationship quality is one of the best predictors of how successful the outcome of therapy will be. Therapeutic Relationship - relationship between therapist and client-Freud would have client sit on couch with no eye contact where Person Centered Therapy would provide eye contact and person connections Assessment - Process of gathering information on the client-What brings them to therapy, assessing problems but also assets and strengths- Freud would do this by giving ink blot test or analysis of dreams whereas a behavior therapist might ask the client about the problem/cause and give personality test while focusing on observable behaviors Conceptualization - Therapists theory based explanation for the clause of the client's problems-Critical to everything else in therapy-behaviorist would say problem is caused by learned fear and can be solved by expose whereas Freud would say fear is due to phobia for early life Therapy Goals - an objective you are working toward, must be specific, measureable, achievable, realistic, and timely-goal to treating client will be different for different theories Therapy Interventions - Treatment technique-Theory decides what treatment technique is used but some theories will use same treatment, such as journalism to treat from multiple different approaches-importance of different techniques also varies by theory Evidence Based Practice - uses major psychotherapy approaches but also factor in your clinical expertise and the characteristics and preferences of client when selecting treatment Termination - The formal end to therapy-Depending on the theory-some therapist will decide when counseling is over and sometimes it will be a mutual decision Relapse prevention - explain to client that they might have re-emerging feelings of the things that brought them to therapy but therapy developed skills to deal with relapse-this is important to empower clients and make them feel in control of their feelings Assessment Techniques - Worshak ink blot test, dream analysis, IQ test, Personality Test Problem Focused goals - relate to clients particular issue-example: if have anorexia goal would be to decrease negative self-statements about appearance and decrease self-starvation behaviors General Goals - Same for all clients based on theory-Cognitive treatment goal would be for client to think more rationally SMART goals - Specific, manageable, achievable, realistic, and timely-these are important to therapy because it would be bad for a client to have a goal that they ultimately can't achieve-Can't make a goal about want other people to change, instead make a goal about how to change yourself Relationship in counseling process - Assessment leads to conceptualization which leads to goals and interventions- the cause of the problem is what the goals should be directed toward and the interventions should be geared around the goals. Ethical Codes - created by professional organizations (APA) so each degree has their own code-purpose is to establish standards to protect the public and to protect the reputation of the organization, they are enforces by the professional organization Mandatory Ethics - Minimum standards of ethical behavior-observable behavior-enforceable Aspirational Ethics - highest standards of ethical behavior- thoughts/beliefs-not enforceable Laws - created by each state therefore they differ by state, indicate exactly what needs to take place during practice, laws and ethic codes may be different, criminal laws also apply so a counselor could go to jail, get license suspended or be forced to practice under supervision. Legal Violations - Sexual or dual relationship, conviction of crimes, breach of confidentiality, fraud in application for license, improper record keeping-sanctioned by the state and forced to lose their license Values - might affect whether you feel you should report something, always unconsciously impacting actions and beliefs-Controversial whether counselors should be able to turn clients away because they did something against the counselors values. Common Factors approach - views most counseling approaches as effective because they share certain core therapeutic ingredients Managed Care - Counselors and therapists have to fight for their right to health care money. It is forming them to take the medical model to prove that their services are needed Multicultural counseling - increasing counselor's competence levels in dealing with minority and oppressed populations. Important because the minority population is increasing and counselors need to be able to counsel these people as well Cydnee Hill - Crises Counselor-does intake therapy and counseling for short periods of time in crisis situations Empirically Supported Treatment approach - does not assume all approaches are equally effective and calls for rigorous scientific research to determine effectiveness-will be paid by 3rd party payers Rodger D Herring - Counseling Educator Ann E Hackerman - Rehabilitation for Sever Disabilities EST - Empirically Supported Treatments-Treatments with at least 2 controlled clinical trials that demonstrate their efficacy Psychotherapy Future - Briefer with further space between sessions, only used for medically necessities, more standardized not specific treatment plan for specific clients, and dependent on technology Occupational Handbook - Salary, education needed, number of jobs, work environment, and job description Conscience Clauses - Opting out of doing something because it conflicts with your beliefs or values-Ethical issue because it is discriminating against the person who the counselor is refusing to see but if the counselor does see them they might let their beliefs or values impact the counseling session Ethical Dilemmas - When you values tell you it is something to report and your ethical codes and laws say it is against confidentiality to report the therapist runs into conflict Informed Consent - a process by which the therapist provides the clients with information about therapy, assessment, treatment procedures and therapists training. Therapist must make sure client understands info and can make an educated decision about services Included in Informed Consent - definition of therapy, relationship boundaries, confidentiality, fees insures-not same information for every therapist and client because different states require different info in the IC Competence in Informed Consent - client must be competent enough to inform to consent, if has been in bad car accident with brain injuries might not be competent-then therapist must get informed consent from parent and can get assent from client importance of informed consent - Client might be willing to share more because they know the information will not leave the office Confidentiality - The therapist's ethical and legal obligation to keep what is disclosed by clients to themselves. Therapist are bound by it. Report without permission - child/ dependent adult is being abused, court order form judge to release therapy records, imminent threat to self or others Duty to warn - If client makes imminent threat against someone else- shown in the Tarasoff Case by the CA supreme court Share with permission - Client signs a release, supervision and training purposes, Insurance requires information, and others Confidentiality importance - Client will in share more because they know it won't leave the room and client will form trusting relationship with counselor Competence - the ability of the therapist, based on training and experience, to use specific assessments or treatment procedures or to work with specific clients. Ethical issue because if not competence in treatment might not be treating client right therefore the client isn't protected Changes in Competence - get it through significant supervised clinical experience, can expand throughout career by continuing education and practicing under supervision, can decline if go for long period of time without working with certain client, treatment, or problem-none is competent to treat all mental health conditions States and Licensing Boards - define the boundaries of competence. They decide what competence is needed to be licensed in which areas to protect the client and make sure they are receiving best treatment Not Competent - refer client to someone else or ask client if it would be okay to practice on them under supervision where you could become competent Dual Relationships - having a relationship in addition to the therapist-client one-can be sexual or friend or acquaintance- ethical issue because client will be intentionally or unintentionally harmed by the power imbalance Multiple Relationships - if not sexual are not forbidden but are discouraged because in a small town there may not be any other counselors therefore you may have to counsel someone who belongs to same church as you Dangers of Dual Relationships - treat you differently, power differentials, and boundaries become hard to define- Also problem in judge/jury, teaching, and many others-Could affect the way you do your job Effectiveness Studies - answers board or narrow questions using a correlational design to see how clients changed from before treatment to after treatment Efficacy Studies - answers narrow questions about how specific effectiveness of specific treatment using a controlled experiment therefore can tell cause and effect -Can be proof for a Empirically Supportive Treatment