Fun at Houston Residency

Duty to Warn

Duty to Warn

The first mandatory reporting issue is the duty to warn. This issue has placed a tremendous pressure and responsibility on counselors and the profession, especially since the Tarasoff case (Simone & Fulero, 2005). Andrew, Kent, and Dirikantraport (2009) believe the "ambiguity about how to fulfill the duty to protect can arise because of a lack of clarity about the laws of many jurisdictions, the conflict between a duty to protect and the duty of confidentiality to the client, and the inexact science of predicting violence (p. 26). This mandate requires reporting to the appropriate authorities when a client is a danger to him or herself, or others.

In the state of Hawaii, psychotherapists have a duty to warn foreseeable victims of their clients as well as a duty to warn when clients are a danger to themselves (Hawaii State Legislature, 2011). Failure to do so has been documented in cases such as Tarasoff when such failure is life-threatening or deadly. Andrew, Kent, and Dirikantraporn (2009) suggest when a threat emerges within an intervention setting, the counselor must thoroughly assess the gravity and seriousness of the threat. Legal ramifications include fines and incarceration when the professional fails to issue warnings (Hawaii State Legislature, 2011).

Reporting Elder Abuse

The second issue is reporting elder abuse. This issue is somewhat complex because often times elders are abused or neglected by their caretakers who are members of their family. In these circumstances, the abuse goes unreported. Sadly for vulnerable populations like the elderly, they have no options to resolve the issues themselves, and may continue for extended periods.

The state of Hawaii requires licensed or registered professionals of the healing arts and any health-related occupation to mandate reporting neglect including physical, psychological, and sexual abuse, financial exploitation, caregiver neglect and self-neglect (State of Hawaii, Executive Office on Aging, n.d.). Failure to report the abuse and neglect of any vulnerable population is unethical and guilty of a misdemeanor. Although a misdemeanor charge seems almost contemptible considering the nature of these abuses, the Adult Protective Services does monitor each case.



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

State of Hawaii, Executive Office on Aging. (n.d.). Guidelines for Mandated Reporting. Hawaii.gov, Official Website of the State of Hawaii. Retrieved April 30, 2012, from http://hawaii.gov/dhs/social_services/adult_services/APS%20Guidelines.pdf

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




Plagiarism:
Because I have recently been contacted by university instructors regarding their student's plagiarism of my work, I feel compelled to remind readers that using someone else's work is common (and good) practice, but please don't forget to give credit where credit is due.  If you use portions of my work, please reference it.  This blogsite comes up in plagiarism programs such as Turnitin, so for your own protection, please don't plagiarize!  This warning is, of course, for the very few individuals who have no interest in authentic scholarship.  Sadly, I must include this notice with every post.  

Maintaining Competence: Continuing Education and Peer Review

Maintaining competence is an important component to ethical counseling (Remley & Herlihy, 2010) and one whose maintenance necessitates a dimensional approach. As Remley and Herlihy suggest, "competency is a complex construct with many possible levels along a continuum" (p. 165). Standard C.2.a. tells us we must not practice outside the boundaries of our knowledge and experience (ACA, 2005). One of the ways to do this is to work at continuing education as well as being involved with reading contemporary research and doing research. Although I look forward to counseling individuals, I am equally excited about doing research. As new research becomes available, new information for future exploration opens up, too.

The greatest personal challenge will be time. I can see time management and creating priorities will become even more important than it is now. Yet another reason to create reasonable professional and personal boundaries. I find both continuing education and reading peer reviewed literature as well as taking part in its production exciting. I also find that membership in psychological associations helpful, especially the information that comes from specialty groups.

For example, in the ACA, there are divisions such as Counselors for Social Justice and the National Career Development Association, which both supply readers with new research and contemporary thought within the specialty. Personally, I find the APA magazine helpful, informative, and stimulating for new ideas and research as well as reviews of new research about which I may not have heard. As Remley and Herlihy (2010) mentioned about peer review, these articles offer a well of information about a wide range of information that may be impossible to keep abreast of as a busy counselor. The publications refine a huge amount of information into readable bits to which one can direct extended exploration. For example, the APA's Journal of Counseling Psychology publishes new studies related to counseling in this quarterly publication.

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

Remley, T., & Herlihy, B. (2010). Ethical, legal, and professional issues in counseling (3rd ed.). Upper Saddle River, NJ: Merrill/Pearson Education.


Plagiarism:
Because I have recently been contacted by university instructors regarding their student's plagiarism of my work, I feel compelled to remind readers that using someone else's work is common (and good) practice, but please don't forget to give credit where credit is due.  If you use portions of my work, please reference it.  This blogsite comes up in plagiarism programs such as Turnitin, so for your own protection, please don't plagiarize!  This warning is, of course, for the very few individuals who have no interest in authentic scholarship.  Sadly, I must include this notice with every post.  

Social Change and Personal Theory

Conventional wisdom suggests what matters is what something is, not necessarily what it is called. This reminds me of the relationship between studying theory and the process of developing a personal theory and practice that will affect social change. As Walden University (2012) claims, its aim is to create scholar practitioners who can effectively promote such change. The process of developing a personal theory seems critical to becoming scholar-practitioners - it would be daunting to promote social change with a personal theory not infused by the spark of a personal resonance, passion, and self (Laureate Education, Inc., 2010). People do not usually maintain an interest in ideas or causes that are not inspired by a visceral passion and commitment. To be an effective counselor, there must be a personal resonance with the theories infused into practice.

I continue to value and appreciate Corey's (2009) notion that the personal nature of self is an essential tool in counseling. Beliefs, values, the accumulation of experiences and the unique nature of each counselor plays a role in counselors' development and the ability to thrive and affect social change. As Seligman suggests (Laureate Education, Inc., 2010), infusing the Self into personal counseling theory is rewarding and comforting, for the counselor as well as the client.

Upon reflection, my personal theory has not changed too much during this course. I have, however, been given the beginnings of a roadmap and guidebook of different ways to approach counseling, and a fundamental language with which to communicate with my colleagues. Learning the basic language of this profession neither makes me fluent nor adept at its practice. It does, however, plant a seed of knowledge that will thrive and develop as I begin to put my theory into practice. Certainly, during the course of this class, these theories caused me to reflect upon my own strengths and shortcomings and simultaneously taught me to identify and foster my abilities. To me, this is what social change is about.

Prior to making changes in myself, I must perceive my shortcomings and limitations. Only then can I foster growth where it is needed. Similarly, as I grow and develop as a person and counselor, I can encourage similar growth in others. Without such growth, encouraging others is merely a contrived part of counseling or advocacy. Coming full circle with this idea, to foster greatness in others, I must be able to foster it in myself.

Bertrand Russel said "an artist or a scientific discoverer may be doing what is of most social utility, but he cannot do his proper work from a sense of duty alone. He must have a spontaneous impulse to paint or discover, for, if not, his painting will be worthless and his discoveries unimportant" (Russell, Egner, & Denonn, 1961, p. 360). Although I do not believe our work is necessarily pointless without that visceral impulse, it is apparent that to affect social change, personal evolution is critical. As counselors, developing a personal theory is akin to affecting social change.



Corey, G. (2009). Theory and practice of counseling and psychotherapy (8th ed.). Belmont, CA: Thomson Brooks/Cole.

Laureate Education, Inc. (Producer). (2010). Building a Personal Theory [Steaming video]. Baltimore.

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

Walden University. (2012). Vision, Mission, and Goals. Walden University - Student Publications. Retrieved March 5, 2012, from http://catalog.waldenu.edu/content.php?catoid=61&navoid=9236

Plagiarism:
Because I have recently been contacted by university instructors regarding their student's plagiarism of my work, I feel compelled to remind readers that using someone else's work is common (and good) practice, but please don't forget to give credit where credit is due.  If you use portions of my work, please reference it.  This blogsite comes up in plagiarism programs such as Turnitin, so for your own protection, please don't plagiarize!  This warning is, of course, for the very few individuals who have no interest in authentic scholarship.  Sadly, I must include this notice with every post.  

Pivotal Forces in Personal Development

One of the more significant central themes to my life has been an intense curiosity to understand purpose of existence and a meaning to human life.  Because of this curiosity and drive, I am drawn to include, at least in part, the existential approach in my personal counseling theory.  Although initially driven by personal inclinations, I have found research suggesting that my curiosity, drive, and interest in the relationship between psychological health and a sense of purpose, contentment, and well-being is scientifically supported.  Ryff and Singer (1998) correlated purpose and meaning to contentment and well-being.  Brassai, Piko, & Steger (2011) found that meaning in life is relevant and is directly correlated with well-being and purpose in life.  Chamberlain and Zika (1998) found an inverse relationship between individuals who expressed having a sense of meaning and purpose in life and psychological health.  Steger, Oishi, & Kashdan (2009), Steger et al. (2010), and Wadsworth & Baker (1976) all found a similar connection between mental health and developing purpose in individuals’ personal life.

Neuroticism and other negative personality traits have been found inversely related to having deeper life experiences and meaning (Steger 1998).  Consequently, the foundations of my personal theory are predicated on the notion that others like me are compelled, whether consciously or otherwise, to gravitate toward maintaining or revitalizing an intrinsic sense of purpose and meaning.  I believe, then, that finding meaning and purpose in life is central to psychological health and must be a definitive component in healing.

I have always found value in human connection, especially during stressful experiences and significant loss or challenge.  Corey (2010) states that a caring and responsive counseling relationship gives clients a safety zone within which they feel free to self-explore and develop self-understanding and self-appreciation.  I do, however, see the importance of borrowing techniques from other approaches and perspectives, such as the emphasis of cognitive awareness in the cognitive behavioral approach, or exploring the interconnectedness of family members in family systems therapy.  After watching Perls in the Gloria videos at the Houston residency, I have even considered the value of the intensity and confrontation of Gestalt therapy.  All in all, though, considering my personal beliefs and values, I found great pleasure in Diener and Seligman’s (2004) findings.  They found that individuals who, through deep self-reflection and self-understanding, believe their own life matters, have a stronger and better defined sense of well-being.        

Rethinking Maslow’s hierarchy, my personal belief is that we all seek to fulfill basic human drives - not necessarily Freud’s darker, sexually, or mortally driven drives, but simply an intrinsic resonance to something less linear than the common physicality of human life.  Some people are able to progress via healthy internally driven responses, others must rely on maladapted ones that work as self-preserving mechanisms to move the Self forward to an often subconscious or unconscious goal.   I agree with Maslow, though, as he believed that humans strive for self-actualization or some personal translation of that goal. 

Ultimately, I find personal and professional support in Steger’s (1998) suggestion that "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" (p. 9).

Brassai, L., Piko, B. F., & Steger, M. F. (2011). Meaning in Life: Is It a Protective Factor for adolescents’ psychological health? International Journal of Behavioral Medicine, 18, 44-  51. doi: 10.1007/s12529-010-9089-6

Chamberlain, K., & Zika, S. (1988). Religiosity, life meaning, and wellbeing: Some relationships in a sample of women. Journal for the Scientific Study of Religion, 27, 411-420.

Corey, G. (2009). Theory and practice of counseling and psychotherapy (8^th ed.). Belmont, CA: Thompson Brooks/Cole.

Diener, E., & Seligman, M. E. P. (2004). Beyond money: Toward an economy of well-being Psychological Science in the Public Interest, 5, 1-31.

Steger, M. F. (1998). Experiencing meaning in life: Optimal functioning at the nexus of well-being, psychopathology, and spirituality. In The human quest for meaning: A handbook of psychological research and clinical applications (2nd ed., pp. 1-19). Mahwah, NJ: Erlbaum.

Steger, M., Oishi, S., & Kashdan, T. (2009). Meaning in life across the life span: Levels and correlates of meaning in life from emerging adulthood to older adulthood. The Journal of Positive Psychology, 4(1), 43-52. doi: 10.1080/17439760802303127

Ryff, C. D., & Singer, B. (1998). The contours of positive human health. Psychological Inquiry, 9, 1-28.

Wadsworth, A. P., & Barker, H. R., Jr. (1976). A comparison of two treatments for depression: The antidepressive program vs. traditional therapy. Journal of Clinical Psychology, 32, 445-449.

Plagiarism:
Because I have recently been contacted by university instructors regarding their student's plagiarism of my work, I feel compelled to remind readers that using someone else's work is common (and good) practice, but please don't forget to give credit where credit is due.  If you use portions of my work, please reference it.  This blogsite comes up in plagiarism programs such as Turnitin, so for your own protection, please don't plagiarize!  This warning is, of course, for the very few individuals who have no interest in authentic scholarship.  Sadly, I must include this notice with every post.  

Family Systems Approach

Using a Family Systems Approach with Lois, Client Profile 4

Strengths

Family systems therapy is useful in marital stress as well as with communication problems between family members (Corey, 2009). This approach respects and integrates each member of the family into the intervention, promoting a change in family dynamics during the therapeutic process. Lois will benefit from her husband's involvement in the therapy since he plays a contributing role in her issues (Kazak & Segal-Andrews, 1992; Laureate Education, Inc., 2006). In family systems therapy, each family member begins to change and integrate new patterns of response to each other. This approach supports changes in the family, enhancing their overall functioning (Corey, 2009). Another benefit of this approach is that neither an individual nor the family is blamed for any dysfunction - rather the family learns to communicate more effectively and introduce healthier patterns in their interactions.

Limitations

It will be important for the therapist to consider any disparity between the family's beliefs and values and those of family systems therapy. Some of the concepts of this approach, such as individualism, self-actualization, self-determination, independence, and self-expression may not coincide with the beliefs and values of the family's Hispanic, Catholic background. Another limitation might be the husband's open involvement in the therapy. If he believes family matters should be kept within the family, or if he is simply resistant to change within the family, the therapist will have difficulty including him in the therapeutic process (Corey, 2009).

Cultural/Gender/Age Issues
Lois is a Latina who may have learned roles specific to her gender, religion, and ethnicity, such as the subservient role she seems to have taken with her husband and throughout her life. From her self-description, she cannot cope with being alone, and she has always focused on caring for and pleasing others (Laureate Education, Inc., 2006). Addressing any cultural component to Lois' role expectations will be an important consideration in therapy (Kazak & Segal-Andrews, 1992). Because Catholicism may perpetuate female roles similar to those of Lois' heritage, her beliefs may exacerbate her inclination to fill subservient roles.

Ethical or Legal Issues to Address

Two issues that must be addressed immediately are Lois' depression and her husband's potential abuse. If Lois is depressed, the therapist will need to fully assess her for suicidal ideation or a definitive plan for hurting herself. Since she has mentioned her previous alcohol abuse, it will important to continually re-assess her to make sure she has is not using alcohol as a coping tool. The second issue is the husband's verbal (and potential physical) abuse of Lois and her mother. Her mother is a member of a vulnerable population and any suspected abuse must be reported (Remley & Herlihy, 2010).

Overall Therapeutic Goal

The therapist will focus on verbal and nonverbal communication within the family and between each of the members to gain a perspective of the negative symptoms of their interactions (Laureate Education, Inc., 2006). As each member gains a greater awareness of how and why they interact, they can begin to change how they relate to each other and how they function as a whole. From this awareness they will learn new ways to interact with each other.

The Therapeutic Process

The Beginning

During the initial sessions, the therapist will invite Lois' husband, and perhaps her mother and her daughter into therapy. It is important for the counselor to gain an accurate perspective of how the family system interacts and how these interactions affect each member. The therapist will make note of cultural expectations and gender perspectives, and provide interventions that help Lois and her family change the context within which they interact with each other (Kazak & Segal-Andrews, 1992). For example, if Lois' husband yell's in her face, she may find her safest reaction is to take a subservient role. If he learns to control his anger, she may learn to take a different role in the family system (Laureate Education, Inc., 2006).

Goals of Therapy

One of the goals of therapy for Lois and her family will be enabling them as a family and as a cohesive group of individuals, to change the dynamics of their family system so it has less stress on each of its members (Corey, 2009). The therapist may choose to work from one or more of several lenses. For example, a behavioral lens might help each member act and react differently in their interactions, or a teleological lens, may help the members of the family understand how their reactions serve as communicative mechanisms that are self- or family- protective. The overall goal is enabling the family to change in ways they believe will be beneficial for them (Corey, 2009).

Specific Strategies and Techniques

Techniques used will be specific to systemic viewpoints in family therapy. For example, using Haley and Madane's strategic family therapy, the therapist will help the family members reframe or re-interpret their behavior as a reflection of unhappiness or need rather than anger. Amplifying, as well as pretending and enactments might also be used to help develop an awareness of how the family members interact with one another (Corey, 2009).



References

Corey, G. (2009). Theory and practice of counseling and psychotherapy (8th ed.). Belmont, CA: Thompson Brooks/Cole.

Kazak, A. E., & Segal-Andrews, A. M. (1992). Women and families: Individual and family systems issues related to theory, therapy, and research. Journal of Family Psychology, 5(3-4), 360-378. doi: 10.1037/0893-3200.5.3-4.360

Laureate Education, Inc. (Producer). (2006). Case study: a CBT/behavioral therapy perspective In Counseling and Psychotherapy theories [Streaming Video]. Baltimore: Author.

Remley, T. P., Jr., & Herlihy, B. (2010). Ethical, legal, and professional issues in counseling (3rd ed.). Upper Saddle River, NJ: Merrill/Pearson Education.


Plagiarism:
Because I have recently been contacted by university instructors regarding their student's plagiarism of my work, I feel compelled to remind readers that using someone else's work is common (and good) practice, but please don't forget to give credit where credit is due.  If you use portions of my work, please reference it.  This blogsite comes up in plagiarism programs such as Turnitin, so for your own protection, please don't plagiarize!  This warning is, of course, for the very few individuals who have no interest in authentic scholarship.  Sadly, I must include this notice with every post.  

Ethics and Supervision

Qualities of an Ethical Supervisor

The Association for Counselors Education and Supervision (ACES) (1993) lists several characteristics and competencies of effective supervisors. They must monitor client welfare, encourage supervisees' compliance with ethical and legal standards, monitor the supervisees’ performance and professional development, and evaluate supervisees (ACES, 1993). To adequately perform in a supervisory role, counselors must have an articulate understanding of ethical codes and decision making to inspire a firm knowledge of these codes and models within the supervisee.

Remley and Herlihy (2010) describe ethical supervisors as those who value and respect their clients as well as their supervisees, give fair and accurate feedback to their supervisees, and are committed to the best practice ideals set forth by legal mandates and the ethical codes of the profession. Furthermore, they are self and culturally aware and achieve credibility by acting honestly, consistently, and ethically. They should have "theoretical and pedagogical foundations for their work and aim to be fair, accurate, and honest in their assessments of counselors-in-training" (American Counseling Association (ACA), 2005, p. 13).

Ethical supervisors should have the appropriate training in supervision prior to engaging in supervising counselors. They must engage in and inspire ethical behavior and decision- making and work toward developing similar behavior in supervisees. They should review supervisee's work via audio or videotape, meet with supervisees regularly, and provide them with ongoing feedback (ACES, 1993). When supervisees fall short of expectations for certification, licensure, or training program, the supervisor should provide the supervisee with written as well as verbal notification so the supervisee has an opportunity to resolve any inadequacy or impairment.

The Importance of Ethical Supervisors

Ethical supervisors are a crucial component in counselor development and for the preservation of the profession’s ethical standards. Supervisors are held accountable for the ethical and professional actions of the supervisee, and provide gatekeeping for the profession. "Supervision provides feedback about performance, offers guidance, supports alternate views about client dynamic and interventions, refines supervisee identity, and serves as a base for learning" (Crespi & Dube, 2005, p. 120). In their supervisory role, supervisors function as models for ethical and professional behavior (Remley & Herlihy, 2010). The ACA Ethical Codes (2005) devotes an entire section to counselor education and supervision (Herlihy & Corey, 2006). Because supervisors serve as gatekeepers to the counseling profession, they must adequately and ethically evaluate supervisee's performance, and must "exercise sound ethical judgment when establishing boundaries with supervisees within and outside of the supervisory relationship" (Herlihy & Corey, 2006).

Unethical Supervisors: Appropriate Actions

Upon discovering a supervisor's ethical violation, counselors-in-training have the same obligation as counselors to adhere to the standards of the ACA Code of Ethics (Herlihy & Corey, 2006). Standard H.2.b. of the ACA (2005) Ethical Codes advises counselors to attempt an informal resolution to ethical dilemmas, when doing so does not violate confidentiality rights. If the supervisor is not responsive to an informal resolution, the counselor-in-training should seek help from the supervisor's manager or supervisor, a department head, or other individual in a supervisory or managerial role. In any work environment, it is important to follow specific protocol for reporting grievances. If counselors-in-training find no resolution for the grievance after following protocol, they can file a formal complaint with the ACA Ethics Committee. In circumstances in which substantial harm has occurred, has the potential to occur, or when the ethical issue is not appropriate for informal resolution, the counselor in training should seek the help of a local or state ethical committees, licensing boards or institutional authorities (ACA, 2005).

Although the power differential between counselors in training and their supervisors makes it difficult to confront supervisors, the ACA Ethics Committee can help with regard to ethical violations and offer support and valuable information for the resolution of such issues (Herlihy & Corey, 2006). As with any ethical dilemma, counselors-in-training should not hesitate to seek help from colleagues, peers, and other professionals, and when necessary, file a formal complaint with the Ethics Committee. Counselors-in-training are conscientious when filing formal ethics complaints and do not "initiate, participate in, or encourage the filing of ethics complaints that are made with reckless disregard or willful ignorance of facts that would disprove the allegation (ACA, 2005, p. 19).



References

Association for Counselor Education and Supervision (ACES). (1993). Ethical guidelines for counseling supervisors [White Paper]. Retrieved from the ACES website: http://files.acesonline.net/doc/ethical_guidelines.htm

Crespi, T. D., & Dube, J. M. B. (2005). Clinical supervision in school psychology: Challenges, considerations, and ethical and legal issues for clinical supervisors. Clinical Supervisor, 24(1/2), 115-135.

Herlihy, B., & Corey, G. (2006). ACA Ethical Standards Casebook (Sixth ed.). Alexandria, VA, USA: American Counseling Association.

Remley, T. P., Jr., & Herlihy, B. (2010). Ethical, legal, and professional issues in counseling (3rd ed.). Upper Saddle River, NJ: Merrill/Pearson Education

Plagiarism:
Because I have recently been contacted by university instructors regarding their student's plagiarism of my work, I feel compelled to remind readers that using someone else's work is common (and good) practice, but please don't forget to give credit where credit is due.  If you use portions of my work, please reference it.  This blogsite comes up in plagiarism programs such as Turnitin, so for your own protection, please don't plagiarize!  This warning is, of course, for the very few individuals who have no interest in authentic scholarship.  Sadly, I must include this notice with every post.