Tuesday, May 29, 2012

Ethical Biography

Ethical Autobiography

Bertrand Russell once said "without civic morality communities perish and without personal morality, their survival has no value" (Russell, Egner, & Denonn, 1961, p. 146).  Likewise, the counseling profession must bind itself to ethics and the law, or it will not thrive as a viable, trustworthy profession. Counselors, too, must bind themselves to the same parameters, or the value of the profession becomes null. Embracing the tremendous responsibility the profession has to humankind necessitates an overt, yet personal pact between the profession and each counselor, that they engage in growth and development that will contribute to their ability to follow legal guidelines as well as make moral judgments and ethical choices.

Moral and Ethical Influences in Early Development

I had the good fortune of being raised in an environment in which my parents' profession dictated their compliance with the Hippocratic oath. The greater fortune was that they did not simply follow this oath as one follows the rules of a game, but with a passion and fervor that filled my childhood home with thoughtful conversation and an evolving awareness of conscience and choice. We were taught the value of making appropriate choices, not simply choosing the prescribed right or wrong of ordinary decision making. Even as children, we became aware that decisions can bring benefit as well as harm, and embracing the multiple aspects of circumstances provided a foundation for the best outcome.

Mine was a democratic household in which conversations about war, poverty, and personal choice were dinner table discussions. My brother and sisters and I were not afraid of making mistakes, but dreaded the thought of making unconscious choices that merely accommodated personal ease or agendas. Worse was the thought of decision making without taking others into account or understanding in my heart of hearts (as my father used to say) that what I was about to do was the best course of action. My father told me that nations can be judged on how they treat their animals. At a young age, this stood out to me as the ultimate meaning of ethical behavior. The significance of caring for a dumb animal who could never tell on me was the precise essence of ethical behavior. It meant doing what is right, or, at least the most right, because that was what had to be done.

Counseling Issues and Related Legal and Ethical Guidelines

Although mental health counselors must contend with the issues of humans, rather than animals, they are, nevertheless, called upon to make choices that are right, or perhaps appropriate, given the unique circumstances of the situation. Several legal and ethical issues are common to the counseling profession: confidentiality and the duty to warn or protect, boundaries, transference and countertransference, and dual relationships. Although each is a common theme in the therapeutic process, the situations in which these issues manifest are as different as the clients themselves, and each one requires an ethical decision or a legal action specific to the circumstance.

Confidentiality and the Duty to Warn

Confidentiality and the duty to warn are critical issues in counseling (Remley & Herlihy, 2001). The American Counseling Association (ACA) (2005) Code of Ethics Standard B.1.c. and Standard I.A.2.a. in the American Mental Health Counseling Association (AMHCA) (2010) obligates counselors to keep client information confidential. Counselors must make exceptions for protecting clients from foreseeable harm (ACA, Standard B.2.a.), and when clients admit to having a communicable and life threatening illness (ACA, Standard B.2.b.). As advocates and protectors, mental health counselors must preserve privacy and simultaneously implement duty to warn or protect when there is foreseeable danger. Understanding the ethical and legal ramifications of duty to warn and protect in conjunction with preserving confidentiality is critical for the safety of the client, for the protection of the counselor's livelihood and the profession. As evident in the Tarasoff case (Simone & Fulero, 2005), the duty to warn is a critical decision that must be made by counselors.

In the state of Hawaii, Rule 503(d)(2) Tarasoff exception (Hawaii State Legislature, 2011) allows psychotherapists to break confidentiality in cases where duty to warn is necessary. Although a counselor has a legal obligation to warn in such cases, it is an ethical obligation to gather as much information as possible, notify the client of your ethical and legal obligations, and notify authorities in any case when the counselor is reasonably sure of impending harm by the client to self or others. The issue of the ethical obligation to gather information is personally significant to me.

A close friend of mine has been in therapy for chronic depression for over 20 years. Once, when she re-entered therapy, she had to use an alternative therapist. During the session, the counselor asked her if she ever considered suicide. She said she had, but she would never carry it out. It was simply thoughts, nothing more. After the session, she returned home to find the police waiting to take her to a facility for a 48-hour involuntary committal. This was extremely embarrassing for her, her family, and the therapist. The therapist later apologized and admitted she did not have enough information to support her decision to notify authorities. My friend maintains she will forever moderate what she says to a therapist.

This experience taught me that the ethical obligation to gather pertinent and accurate information for decision making may not be as critical as upholding the duty to warn, but it is crucial to have reasonable and reliable information. Without articulate orientation to the issue, I can neither act in clients' best interest, nor can I adequately respect and promote their dignity, privacy, and welfare (ACA, 2005, Standard A.1.a.). Standard B.1.c. states "counselors do not share confidential information without client consent or without sound legal or ethical justification" (ACA, 2005, p. 7) and further states in Standard B.1.d. counselors must use informed consent to notify clients of confidentiality's limitations and exceptions. The ACA (2005) Standard B.2.a. addresses the need for counselors to consult with other professionals when in doubt about exceptions to confidentiality. When counselors face ambiguous circumstances regarding the duty to warn or protect, implementing an appropriate decision-making model and consultation with peers and supervisors contributes to best case outcomes (Cottone & Claus, 2000).


The prescribed boundaries of a therapeutic relationship are not always well defined. Some boundaries are easier to cross than others, and some must be crossed because of a lack of alternate options (Remley & Herlihy, 2010). When boundary crossings are unavoidable, care should be taken because in a therapeutic relationship they can be detrimental to the client (Remley & Herlihy, 2010). Sonne (1994) explains when a counselor enters into a secondary relationship with a client, the therapist's needs in that relationship may affect the power differential of the therapeutic relationship as well as the conscious and unconscious thoughts and actions of both individuals. Secondary or dual relationships and boundary crossings with former clients are as potentially harmful as with existing clients. Any boundary crossing may result in ethical and legal infractions that have the potential to end in ethical hearings or criminal court (Remley & Herlihy, 2010).

Pope and Keith-Speigel (2008) suggest when counselors find themselves crossing non-sexual boundaries, taking various circumstantial factors into account prior to making an assessment, can help determine the crossing's usefulness. Additionally, the author's believe fostering one's ethical awareness, as well as a maintaining a cognizance of ethical codes and legal standards is crucial to ethical decision making. Aside from the prescribed parameters of making such decisions, it is wise for the counselor to consider internally conflicting feelings about boundary issues as well as intuitive experiences (Pope & Keith-Speigel, 2008).

The ACA (2005) Standard A.5.c. recommends avoidance of non-professional relationships with clients and others associated with clients, except as in Standard A.5.d. when such relationships may be potentially beneficial to the client. In this case, counselors must document the justification for entering into the relationship prior to its initiation (ACA, 2005). As mentioned in Comparing Codes of Ethics (Stone, 2012), I worked in end-of-life care in a hospice environment. In this capacity, I provided services for a woman and her family until her passing. Within a week after her death, the woman's husband called to ask me out to dinner. Although the man's motives were most likely driven by loneliness and a desire to return to familiar camaraderie, I recognized the gravity of his vulnerability and declined his offer. I did, however, recommend a counselor for him. In this case, developing a personal relationship with him would have been a violation of ACA (2005) Standard A.5.c. and AMHCA (2010) Standard A.3.a. Although my friendship could have been a potentially beneficial relationship to the man, his greater need was for a consistent and structured therapeutic relationship.

Transference and Countertransference

The client/counselor relationship plays a significant role in counseling, and contributes to the overall effectiveness of counseling, so understanding transference and countertransference is critical for the therapist (Burwell-Pender & Halinski, 2008). Transference occurs when clients redirect feelings from a significant person in their lives to the therapist. On the contrary, countertransference takes place when the counselor becomes emotionally intertwined with the client or when the counselor inappropriately redirects unresolved emotional issues onto the client. In therapeutic relationships, the client's transference is an expected part of therapy that when appropriately addressed, can benefit the relationship and provide insight into the client (Burwell-Pender & Halinski, 2008). With self-reflection and self-awareness, Burwell-Pender and Halinski (2008) suggest countertransference can provide counselors with insight into their personal unresolved emotional issues.

Most mental health counselors have unresolved personal issues, and if left unattended, can result in ethical infractions and other adverse counselor behaviors. It is important for counselors to understand that countertransference is a natural part of counseling. Pope & Tabachnik (1993) discovered over 87% of therapists had sexual feelings for one or more clients. Some countertransference is a natural part of developing a relationship, and it is not always detrimental to the counseling relationship. For best outcomes with clients, however, Gelso and Hayes (2001) state counselors must be aware of reactions to clients, especially when the reactions result from the counselor's unresolved issues. Although counselors cannot eliminate conscious and unconscious reactions to their clients, they must be aware of them.

Gelso and Hayes (2001) suggest countertransference can be managed with self-insight, self-integration, anxiety management, empathy, and conceptualizing ability. Counselors must develop an interrelated understanding of these factors as well as learning how to implement them into their personal and professional lives (Gelso & Hayes, 2001). Managing these aspects is part of counselors' self care that may include participating in counselor support groups, inspiring spiritual awareness in themselves and their peers, and encouraging appropriate rest and respite for themselves and other mental health counselors (Trippany, White Cress, and Wilcoxon, 2004).

One distinct personal experience of transference was when the company I worked for hired a new manager with whom I had to collaborate. His personality distinctly reminded me of my ex-husband, and it became difficult to separate my feelings about my ex-husband from those of the new coworker. I found myself thoroughly aggravated by the way he would respond to me or when he took too long to return a phone call. At one point, I thought it was likely my coworker, like my ex-husband, disliked animals. Eventually I realized the genesis of my feelings toward my coworker, which led me to reflect on my anger toward my ex-husband.

Dual Relationships

The codes of the AMHCA (2010) Standard I.3.a and the ACA (2005) Standard A.5.a and A.5.b. recognize the unethical nature of developing sexual or romantic relationships with clients, former clients, or with anyone associated with clients or former clients. The ACA (2005) prohibits counselors from entering into an intimate relationship for five years after their termination as a client, or according to state regulations. Standard A.5.c. recommends avoiding nonprofessional interactions or relationships with clients or former clients. Both codes do, however, recognize that some nonsexual dual relationships are unavoidable and have a potentially positive effect on the client/counselor relationship. Standard A.5.d. states if the counselor determines entering into such a relationship will not be harmful to the client, the counselor must document the rationale for the relationship, its potential benefit, and any foreseeable consequences. The client's consent should be obtained prior to entering into the relationship when feasible. The ACA (2005) Standard A.5.d. further obligates counselors to prove an attempt to reconcile any unintentional harm to the client from a nonprofessional interaction.

Section I.A.3.a. of the American Mental Health Counselors Association (AMHCA) (2010) directs counselors to "make every effort to avoid dual/multiple relationships with clients that could impair professional judgment or increase the risk of harm" (p. 3). Standard I.A.3.b. directs counselors to seek consultation and use a reasonable decision-making model prior to acting on a decision to enter into a dual relationship. Section I.A.3.c. suggests when dual relationships cannot be avoided, counselors should "take appropriate professional precautions such as informed consent, consultation, supervision, and documentation to ensure that judgment is not impaired and no exploitation has occurred" (AMHCA, 2010, p. 3).

Personal Meaning in this Assignment

This assignment has been more meaningful than I anticipated. Observing my journey through the gray areas of ethics has helped me perceive it more objectively. From childhood experiences through early and later adulthood, I was compelled to make decisions that made sense within the scope of the circumstance, even when there was no right or wrong. My choices were made, not solely from the purity of my intention, but sometimes out of fear of future repercussions for myself or others. Sometimes I made the decision believing someone was watching, even only if in spirit, encouraging my proper choice, like the proverbial image of conscience - the angel on one shoulder, the devil on the other!

Ultimately this assignment has helped me realize being ethical takes determination and a deliberate effort that must be developed over time. In any helping profession, individuals must make an ongoing attempt to implement moral judgment and ethical decision-making. I have reflected on information gained from an undergraduate class in ethics that claimed the American Psychological Association contends with thousands of ethical and moral infractions every year (Plante, 2011). Most of the offending individuals understood ethical behavior by its rules, not by its essence. Without personal ethics, an individual has only rule-following to guide them in professional and ethical conduct. Ethics must be understood deeply, like a secondary enculturation, similar to childhood experiences that remain foundational in one's worldview.

Adherence to Ethical and Legal Practice as an Influence of Social Change

Whether associating with one individual or many, people act according to intrinsic values and beliefs, and behavior changes with evolving ethical understanding. It seems far more beneficial to assist others in strengthening their ability to grasp wisdom and integrity rather than passing judgment on their ignorance. Wisdom and ethical character in humanly diverse situations create interactions based on integrity, honesty, benevolence, and justice. Personal ethical and moral interactions encourage similar interactions in others. In support of the pay-it-forward theory, as one individual navigates ethically and morally throughout life, others learn by imitation and by consciously choosing to act similarly. By doing for someone else what someone has done for them, people have the ability to teach grand lessons. In the human social context, kindness, tolerance, and consciousness seem to be as infectious as chaos, hatred, and ignorance. Inspiring the former encourages positive social change.

Adhering to a legal counseling practice protects counselors, clients, and society, and promotes a sense of trust in a relatively new profession that has founded itself upon ethics and the law. Legal statutes create a standard for the profession as well as a foundation for a safe experience for those who rely upon the psychological professions (Remley & Herlihy, 2010). Furthermore, such a practice contributes to a profession that will continue to offer a viable service and the profound ability to care for the well-being of the human spirit. This, I think, is the true meaning of social change.

Revisiting Personal, Ethical, and Social-Political Values

This class has been both thought- and anxiety-provoking, although an extremely valuable learning experience. Incorrect assumptions and unreasonable resolutions I made at various times disturbed my sense of self-efficacy. I am confident, however, in my introduction to the ACA (2005) and AMHCA (2010) ethical codes as a foundation with which I will navigate future ethical dilemmas. I have long been a proponent of collaboration - to help others as well as to gain knowledge. I will not hesitate to consult on any issues that defy my ability to find resolution and clarification. In most ethical decision-making models, consultation is a key component (Cottone & Claus, 2000). Additionally, I have a new and keen awareness that I cannot neglect the growth of my character and that growth must be an ongoing and deliberate undertaking. Certainly this class has shown me that quick fixes are neither realistic nor are they a plausible solution in ethical decision making.

My closest friends would say I tend to see the grayer areas of life rather than the simplistic perspective of black and white, especially when determining right and wrong. I think of myself as a spiritual diplomat, of sorts, always taking into account the various aspects in any situation. Ethical decision making is difficult because the situations are neither linear nor superficial. They are multidimensional and broad, so much so that it can become difficult to embrace the whole and perceive its entirety without subjective interference. In my estimation, although many ethical decisions will be made easily according to the prescribed ethical guidelines, some will be far more difficult and perplexing.

Overall, I take pride in what I have learned from this class. I have a renewed perspective of how I affect others, and how I might modify and refine those influences to the benefit of my future clients and colleagues. In addition to applying reason to circumstance, or perhaps ethics to circumstance, I have a retooled goal to develop a keen intrinsic ability to understand ethics, not only by the profession's guidelines, but by its essence. Considering the abundance of gray area in the full range of ethical decision making, understanding the essence of ethics as well as the ethical codes of the profession should enable my resolve of challenging decisions and ethically ambiguous situations.

Pennsylvania State University (2010) supplies a personal code of ethics for its students: be honest, courteous, and responsible. Have integrity, give credit where credit is due, be respectful, trustful, and live harmoniously. Additionally, do not change the wonder of who you are to please others. Be happy (Pennsylvania State University, 2010). In retrospect, this class has compelled me to re-evaluate each of these standards in a more meaningful way, not simply as a conclusive way of life, but as a starting point on a grander curve of learning that will foster a profound understanding of ethical values. As a counselor, these standards take on professional meaning as well, and an understanding that ethical decisions have a tremendous effect on people's lives.


As mental health counselors, the depth and quality of ethical decision making and the development of fundamental values and beliefs upon which these decisions rely, must reflect the foundational aspects of counseling ethics and the law. Developing a sense of justice, beneficence, non-maleficence, fidelity, autonomy, respectfulness, and self-reflection and awareness must be a deliberate and lifelong process. In the first week of this class I wrote, "It is not simply according to law and ethical codes that counselors practice ethical behavior; such behavior emanates from personal and professional values". Mental health counselors have a tremendous responsibility to humankind, offering resolve, reconciliation, reorganization, and the renewed ability to pursue happiness. Laws and ethical codes are references that ensure counselor's decisions and actions are based on sound legal, professional, and moral judgment rather than prejudice, bias, rationalization and self-interest. Without these foundations, the profession could neither inspire nor contribute to the crucial need for positive social change.


American Counseling Association (ACA). (2005). 2005 ACA code of ethics [White Paper]. Retrieved from the ACA website: http://www.counseling.org/Files/FD.ashx?guid=ab7c1272-71c4-46cf-848c- f98489937dda

American Mental Health Counselors Association (AMHCA). (2010). 2010 AMHCA code of ethics [White Paper]. Retrieved from the AMHCA website: https://www.amhca.org/assets/news/AMHCA_Code_of_Ethics_2010_w_pagination.pdf

Burwell-Pender, L., & Halinski, K. H. (2008). Enhanced awareness of countertransference. Journal of Professional Counseling: Practice, Theory & Research, 36(2), 38–51.

Cottone, R. R., & Claus, R. E. (2000). Ethical decision-making models: A review of the literature. Journal of Counseling & Development, 78(3), 275–283.

Erickson, S. H. (2001, July). Multiple relationships in rural counseling. The Family Journal, 9(3), 302–304.

Gelso, C. J., & Hayes, J. A. (2001). Countertransference management. Psychotherapy: Theory, Research, Practice, Training, 38(4), 418-422. doi: 10.1037/0033-3204.38.4.418

Hawaii State Legislature. (2011). Rule 504.1 Psychologist-client privilege. Hawaii State Legislature. Retrieved March 26, 2012, from http://www.capitol.hawaii.gov/hrscurrent/vol13_Ch0601-0676/HRS0626/HRS_0626- 0001-0504_0001.HTM

Herlihy, B., & Corey, G. (2006). ACA ethical standards casebook (6th ed.). Alexandria, VA: American Counseling Association.

Pennsylvania State University. (2010). Personal Code of Ethics. Penn State Student Website. Retrieved March 1, 2012, from http://www.personal.psu.edu/users/l/f/lfs5011/code%20of%20ethics.html

Plante, T. G. (2011). Contemporary clinical psychology (3rd ed.). Hoboken, NJ: John Wiley & Sons.

Pope, K. S., & Keith-Spiegel, P. (2008, May). A practical approach to boundaries in psychotherapy: Making decisions, bypassing blunders, and mending fences. Journal of Clinical Psychology, 64(5), 638–652.

Pope, K.S. & Tabachnick, B.G. (1993). Therapists' anger, hate, fear, and sexual feelings: national survey of therapist responses, client characteristics, critical events, formal complaints, and training. Professional psychology, research and practice. 24(2), 142-152.

Remley, T. P., & Herlihy, B. (2010). Ethical, legal, and professional issues in counseling. Upper Saddle River, NJ: Merrill Prentice Hall.

 Russell, B., Egner, R. E., & Denonn, L. E. (1961). Basic writings of Bertrand Russell, 1903-1959. New York: Simon and Schuster.

Simone, S. & Fulero, S. M. (2005). Tarasoff and the duty to protect. Journal of Aggression, Maltreatment & Trauma, 11(1/2), 145–168.

Sonne, J. L. (1994). Multiple relationships: Does the new ethics code answer the right questions? Professional Psychology: Research and Practice, 25(4), 336-343. doi: 10.1037/0735- 7028.25.4.336

Stone, D. (2012). Comparing codes of ethics (Week 2 application). Walden University.

Trippany, R. L., White Cress, V. E., & Wilcoxon, S. A. (2004). Preventing vicarious trauma: What counselors should know when working with trauma survivors. Journal of Counseling & Development, 82, 31-37.

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Personal Theory of Counseling or Psychotherapy

Personal Theory of Counseling or Psychotherapy

One of Paul Gaugin's most famous paintings, Where Do We Come From? What Are We? Where Are We Going? reflects a basic human desire to understand existence. The ability to do so has been correlated to contentment and well-being (Ryff & Singer, 1998). From this foundational theory, I believe finding meaning and purpose is central to psychological health and must be included in counseling applications that encourage healing. The approach described herein is predicated on evidence that suggests finding meaning and purpose in one's life is central to one's psychological health and healing.

Basic View of Human Nature

"Meaning, by its very nature, appears to be an integrating factor in people's lives, drawing together the threads of their efforts to achieve happiness, withstand distress, and attain transcendence beyond their solitary selves" (Steger, 1998, p. 1). Frankl (1963) found a sense of purpose supportive in challenging circumstances. In human nature, meaning and purpose promote health, psychological well-being, and perhaps, happiness (Ryff & Singer, 1998). People are inherently good and have the fundamental ability to grow and evolve when conditions are appropriate for this type of growth (Corey, 2009). In addition to the intrinsic capacity for reflection, self-awareness, and psychological development, people have self-preserving mechanisms, such as maladaptive reactions that enable survival in less than optimal conditions (Wickens, 2005). People have the ability to positively influence the course of their lives. They will accomplish this whether in a healthy state of well-being or in a state of continual maladaptive reactions. The former supports maintaining a healthy sense of purpose and well-being, the latter contributes to the degradation of people's overall condition, rendering them estranged from a sense of purpose and meaning (Frankl, 1963).

Accounting for Changes in Behavior

"Valuing one’s life, having a sense of direction and purpose, and being able to comprehend one’s experience seem contradictory to many manifestations of psychological distress" (Steger, 1998, p. 9). Chamberlain and Zika (1998) demonstrated an inverse relationship between having meaning in one's life (specifically, religiosity) and psychological well-being. Steger (1998), as well, found personality traits like neuroticism inversely related to experiences of meaning and purpose. The approach described herein is predicated on the belief that humans tend to minimize meaning and purpose when such constructs become secondary to self-preserving maladaptive responses. Eventually, these responses disable the capacity to perceive meaning and purpose and the individual learns to rely on maladaptive responses, which consequently cause psychological ill health (Steger, 1998).

The Therapist-Client Relationship and Its Relative Importance

The therapist-client relationship is pivotal in psychological healing. It is intimate in its ability to support clients' exploration into challenging and deeply affective personal belief systems and self-preserving mechanisms. The therapist deeply understands and validates client's unique circumstances and provides unconditional care and encouragement (Corey, 2009). The safe therapeutic relationship enables clients to revitalize latent claims to deep meaning that have been lost because of early childhood and later life experiences, challenges, and trauma. The therapeutic relationship is an ideal vehicle in which clients can safely confront dysfunctional maladaptions and challenge thoughts and behaviors that derive from the lack of definitive individual purpose.

Key Functions and Role of Therapist

The therapist's responsibility is to collaborate with clients to develop the goals and boundaries for the therapy, specifically to help clients re-establish meaning and purpose in their lives. The therapist provides a safe, deeply encouraging, therapeutic environment, in which clients can develop self-awareness and reflect on experiences that caused them to deviate from their original well-being. Therapists define and explain the client-therapist relationship that includes financial arrangements, confidentiality, legal responsibilities, and any other administrative and ethical aspects of counseling. They respect clients' unique cultures, listen attentively to their life stories, and develop an objective narrative of clients' lives, and provide logical understanding of circumstances that provoked a loss of self-purpose. The therapist instills in the client an understanding of how the eventual loss of purpose and meaning directly contributed to the client's inability to cope with present circumstances.

Goals of Therapy

Diener and Seligman (2004) state people who believe their life matters, have a sense of purpose and a deeply reflective understanding of their lives, have a greater sense of well-being. A primary goal of therapy is to assist clients in the reevaluation and reorganization of their lives to include the forgotten sense of purpose and meaning. Uncovering intrinsic meaning and purpose are the primary tools for this accomplishment. The therapeutic process helps clients gain a narrative perspective of their lives and where, and for what logical reasons, specific maladaptions became essential to thriving and self-preservation.

As clients remember and revitalize personal meaning and purpose, maladaptive mechanisms are replaced by a greater capacity for logical thought and a positive self-perspective. The safe encouraging environment of therapy supports clients' self-exploration and engages them in deep self-reflection, and an appreciation of their strengths and virtues. Clients learn self-correcting techniques to re-evaluate and reorganize their thoughts in challenging circumstances. From this understanding, clients gain greater self-esteem and self-efficacy, and a stronger sense of self-acceptance, meaning and purpose.

Personal Techniques and Procedures

Rather than focusing on techniques and procedures, it is important for the therapist to deeply understand the client's experience. This caring and responsive counseling relationship will provide clients with an environment within which they can reflect upon their history and develop self-understanding and self-appreciation (Corey, 2010). The therapist may borrow techniques from other approaches and perspectives, specifically those that emphasize cognitive awareness. The client/counselor relationship is central to this approach.

As part of this approach, clients revisit events in their lives to gain perspective of how these circumstances decreased their intrinsic ability to sustain purpose and meaning throughout their development. The therapist helps clients reframe their maladaptive responses as a tremendous self-preserving effort that was needed to navigate destructive influences, loss, abuse, or sadness during their development. These self-preserving mechanisms supported their psychological survival, although disturbed their ability to maintain well-being. The therapist encourages the revitalization of spiritual beliefs and goals to re-ignite clients' sense of purpose and meaning with a variety of techniques including deep self-reflection, and discussions about future goals and ideals.

Specific Populations for Designed Approach

Populations and Issues Best Suited

This approach is well-suited for individuals who have a natural proclivity toward self-awareness and questioning how and why they arrived at their current psychological state. The process of this approach uses self-reflection and awareness as tools for discovering and strengthening a deeper sense of meaning and purpose. Clients must be willing to explore self-preserving adaptations that enabled their development within their unique life contexts. This approach is appropriate for people experiencing grief or loss, facing death, or in the midst of major life changes, as well as coping with life-altering circumstances. It is also beneficial for people who want a greater sense of well-being in their lives.

Populations and Issues Least Suited

For populations with acute symptoms, the initial goal must be to determine the severity of symptoms as well as relieving their most immediate needs (Corey, 2009). This therapeutic approach can have immediate results for this population, although cognitive-behavioral interventions may be more appropriate for some clients with acute symptoms (Corey, 2009). In some cases, client needs may include psychopharmacological therapy as well as in-patient care. This approach is not suitable for clients looking for self-therapeutic tools similar to those provided by cognitive and behavioral therapies. Furthermore, because of the emphasis on self-awareness and self-reflection, it may not be effective for individuals from cultures that value collectivist rather than individualist ideals. Additionally, this approach may not be successful for individuals who prefer to seek expert advice as a solution to psychological issues.


Research has determined that meaning in life is relevant and does correlate with well-being and psychological health (Brassai, Piko, & Steger, 2011; Hicks, Jason, William, & King, 2012; Steger, Oishi, & Kashdan, 2009; Steger et al., 2010; Wadsworth & Baker, 1976). Focusing on revitalizing meaning and purpose in therapeutic interventions may have a meaningful and long-lasting affect on clients.

Diener, E., & Seligman, M.E.P. (2004). Beyond money: Toward an economy of well-being. Psychological Science in the Public Interest, 5, 1-31.
Ryff, C. D., & Singer, B. (1998). The contours of positive human health. Psychological inquiry, 9, 1-28.

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Saturday, May 26, 2012

Schizophrenia and Psychotic Disorders Matrix

Schizophrenia:  Patterns of severe cognitive and behavioral symptoms, such as delusions and hallucinations, characterize this disorder that significantly interferes with normal functioning and persists for six months or more (Hansell & Damour, 2008).


Positive or Type I Symptoms

Positive symptoms are those by which pathological excesses are evident such as exaggerations and distortions of normal behavior, and delusions, hallucinations, and disorganized speech, thoughts and behaviors.  Positive symptoms are the presence of characteristics or symptoms that are normally absent (Hansell & Damour, 2008)

Negative or Type II Symptoms

Negative symptoms refer to the absence of specific behaviors or deficit aspects such as a chronic maladaptiveness, flatness of affect, and absence of developed interpersonal relationships or social skills.  It can also include apathy, withdrawal, poor concentration, and lack of emotion.  Negative symptoms are the absence of functions normally present (Hansell & Damour, 2008).

Psychotic Disorders:  Psychotic disorders are characterized by a distinct loss of contact with normal reality.  Common forms of psychosis include hallucinations and delusions (Hansell & Damour, 2008).


Schizoaffective Disorder

Schizoaffective disorder is a condition that causes both a loss of contact with reality (psychosis) and mood problems.  Schizoaffective disorder is specified as bipolar type or depressive type, depending on the character of the mood symptoms.


Schizophreniform disorder is the manifestation of psychosis with all the features of schizophrenia, but has not lasted the six months required for a diagnosis of schizophrenia.  Approximately 65% of the cases of schizophreniform disorder become schizophrenia after six months.  The diagnosis of this disorder is provisional if it is made before six months have elapsed (Hansell & Damour, 2008).

Brief Psychotic Disorder

A brief psychotic disorder diagnosis is made when an individual has a psychotic episode that presents like schizophrenia, although last between one day and less than one month.  Usually the individual returns to normal functioning after the brief psychotic episode.  Brief psychotic disorders and schizophreniform disorders are diagnosed less often than schizophrenia in the United States, although are more frequent in developing countries (Hansell & Damour, 2008).

Delusional Disorder

Delusional disorder is diagnosed when an individual has nonbizarre delusions that last at least one month.  Delusions are "fixed, false, and often bizarre beliefs" (Hansell & Damour, 2008, p. 455).  Delusional disorders are on a spectrum between more severe psychosis and overvalued ideas.
Bizarre delusions manifest in severe types of psychotic illnesses such as schizophrenia (Chopra, Soreff, & Khan, 2009).

Shared Delusional Disorder

Shared delusional disorder is characterized by the development of delusions in a person closely related to an individual who has been diagnosed with a psychotic disorder.  This disorder is more common when the affected individuals live together and are socially isolated (Hansell & Damour, 2008).

Lifespan Development and Disorders of Childhood:  Childhood disorders, often labeled as developmental disorders or learning disorders, most often occur and are diagnosed when the child is of school age. These disorders can adversely affect educational performance, and normal childhood development and functioning (Hansell & Damour, 2008).

Mental Retardation

Characteristic of mental retardation is significantly below average intellectual functioning, and includes the description of mild, moderate, severe, or profound.  Such a diagnosis includes limitations in communication, the ability to care for oneself, social and interpersonal skills, normal daily functioning in the home, work, play, health, safety and the ability to self-direct.  Mental retardation is evident before the age of 18 (Hansell & Damour, 2008).

Learning Disorders

Learning disorders are characterized by deficiencies in the child's ability to understand, remember, and respond to new information.  Individuals may have difficulty listening, paying attention, speaking, reading, writing, or doing mathematics (National Institutes of Health, 2011).  Skills are measured against other children of similar age and academic experience (Hansell & Damour, 2008).

Pervasive Developmental Disorders

Pervasive Developmental disorders are characterized by profound and persistent impairment in many areas of normal functioning.  These disorders are unlike mental retardation and learning disorders because children diagnosed with such disorders fail to learn normal social skills and the ability for average communication.  Affected children do not participate in typical childhood behaviors and activities. 

Autism is one of the most commonly diagnosed disorders within the group of pervasive
developmental disorders and is characterized by severe impairment in many areas of development.
Autistic children are impaired socially and lack communication skills.  They display rigid and patterned behaviors (Hansell & Damour, 2008).

Attention Deficit and Disruptive Behavior Disorders

Disruptive behavior disorders is a diagnostic category that includes attention deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder.  Central to the disruptive behavior disorders are disobedience and/or dangerous behaviors.  Attention deficit/hyperactivity disorder characteristically involves a deficit in paying attention, hyperactivity, and impulsivity (Hansell & Damour, 2008).

Separation Anxiety

Separation anxiety is characterized by excessive anxiety when separating from home, parents, or others of significant relationship.  Children may experience severe distress that can delay social, emotional, and academic development and interfere with normal functioning of the child (Hansell & Damour, 2008)

Motor Skills Disorders

Children with this disorder cannot process visuospatial information which causes problems or delays in complex motor activities (EMedicine Health, n.d.).

Elimination Disorders

These disorders include encopresis, which is defecating in inappropriate places, and enuresis or urinating in inappropriate places (Hansell & Damour, 2008).

Communication Disorders

This group of disorders includes expressive language disorder,  mixed receptive expressive language disorder, phonological disorder, and stuttering.  These disorders can affect the child's ability to speak and communicate effectively (Hansell & Damour, 2008).

Tic Disorders

Tic disorders include Tourette’s disorder, chronic motor or vocal tic disorder, and transient tic disorder.  Tics are sudden, rapid, nonrhythmic, stereotyped, involuntary movements (Hansell & Damour, 2008).

Feeding and Eating
Disorders of Infancy or Early Childhood

These disorders include pica, which is characterized by eating nonfood substances, and rumination disorder characterized by regurgitating and re-chewing food (Hansell & Damour, 2008).

Chopra, S., Soreff, S., & Khan, R. (2009). Delusional disorder. Medscape Reference. Retrieved May 24, 2011, from http://emedicine.medscape.com/article/292991-overview

EMedicine Health. (n.d.). Motor Skills Disorder Causes, Symptoms, Diagnosis, and Treatment on eMedicineHealth.com. Retrieved May 27, 2011, from http://www.emedicinehealth.com/motor_skills_disorder/article_em.htm

Hansell, J., & Damour, L. (2008). Abnormal psychology. Hoboken, NJ: Wiley.
National Institutes of Health. (2011). Learning Disorders: MedlinePlus. National Library of Medicine - National Institutes of Health. Retrieved May 23, 2011, from http://www.nlm.nih.gov/medlineplus/learningdisorders.html

PubMed Health. (2010). Schizoaffective disorder. Retrieved May 12, 2011, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002517/