beliefs we hold about what constitutes right conduct. Moral principles adopted by groups & indiv to provide rules for right conduct.
concerned with right and wrong conduct. Involves and evaluation of actions based on cultural context.
highest standards of thinking and conduct professional counselors seek. Requires more than just meeting the letter of the ethics codes.
counselors act within minimal standards acknowledging the basic "must" and "must nots"
Also referred to as "mores." Ultimately become the legal criteria for determining whether practitioners are liable for damages. Reasonable behavior.
has a relationship with ethical behavior. Possible to practice unprofessionally yet not be unethical.
set of obligations that focus on moral issues. Focus on acts and choices. Ask the question: What shall I do? Is this situation illegal?
focuses on character traits of the counselor and non obligatory ideals which the professional aspires. Am I doing what is best for my client?
doing good to others and promoting the well being of clients. Also, doing good for society.
professionals make realistic commitments and keep these promises. Fulfilling one's responsibility of trust in a relationship.
Feminist Model for making ethical decisions
involves maximum involvement of clients in stage. Power should be equalized in the therapeutic relationship
Social Constructive Model for making decisions
focuses on the social aspects. Interactive. Involves negotiating, consensualizing, and arbitrating.
Transcultural Intergrative Model for making decisions
focuses on the need to include cultural factors
Reasonable Person Standard
ask the question what would a professional in your community with 3 years of experience do in this situation
a part of counseling programs that provides students with the opportunity to share their values, life experiences and personal concerns with a peer group.
projections by the therapists that distort the way they perceive and react to a client
process whereby clients project onto their therapists past feelings and attitudes they had toward significant people in their lives. Origin is in childhood
a form of stress. themes of loss, grief, traumatic stress. happens when stories mirror their own.
a state of physical, emotional, intellectual, & spiritual depletion. Feelings of hopelessness and helplessness.
the counselor directly attempting to influence a client to adopt their values, attitudes, beliefs, and behaviors
a person has made the decision to end his/her life because of extreme suffering involved with terminal illness.
Speeding up the death process by withholding or withdrawing treatment or life support
career - developmental approach (life stage structure, developmental tasks, career patterns, career rainbow)
formed ASGW Assoc. for Specialists in Group Work (division of ACA) (1970s)
group leadership influences members/aggressive leaders= group casualitiesdevelpmtal group counseling to teach basic life skills (1980s)
definition of a group
collection of 2 or more individuals
meet in face2face interaction
awareness of belonging to group
purpose to achieve mutually agreed-on goals
to reach their mutual goals, which may be intrapersonal, interpersonal, or work related.
The goals of the group may include:
the accomplishment of tasks related to work, education, personal development, personal and interpersonal problem solving, or remediation of mental and emotional disorders.
Purpose of group before 1900s
primarily to distribute information to immigrants, poor, & those mental challenges
philosophy of treatment that emphasized treating mentally ill people with compassion and understanding, rather than shackling them in chains (before 1900s)
social worker and leader in the settlement house movement; she founded Hull House in 1889 (Forerunner to T-groups) which helped improve the lives of poor immigrants in Chicago, used to help them understand selves & environment. Now is known as group social work
Boston physician, formed the first formal not education/task but counseling/therapy group 1905-1923; formed group with issues of tuberculosis
the principal of Grand Rapids High School in Michigan designed 1st children's group to stress the funtionality of a group as an environment in which students learn life skills, values, & citizenship. 1907
Army Alpha and Beta intelligence test
psychological group test (1909-1919)
groups were used to treat fatigued soldier
J. M. Levy
actually Jacob Moreno published paper on group methods under that name, stressed the psychoanalytic/social psychological perspectives of individuals working together
Adler (1920) child guidance group in Vienna, group approach to understand child's problem were related to family issues
WWII produced shortage of counselors in US hence term 'group therapy' & 'group psychotherapy' (1931),
father of psychodrama (1920s), found that individuals involved in theatric productions w/o scripts (role-play) had cathartic reaction (curative): "act out feelings"
founder, American Society of Group Psychotherapy & Psychodrama (ASGPP) (1940s)
Alcoholic Anonymous (AA) formed
group guidance & educational publications increased
"guidance hour" in schools to establish friendly relationships, discover needs & abilities, & develop right attitude toward home, school, & community
group work recognized as a specialty
Trigant Burrow (leader) studied how social forces affect behavior, stressing biological & interactive principles of group behavior (phylo) (1930s)
beginning of psychoanalytic group therapy
Originally an engineer, but eventually developed group therapy using play therapy.
Founder of American Group Psychotherapy Association (AGPA)
Is credited with the term 'group dynamics'
his approach field theory ( interaction btwn individuals & their environment) interested in what motivated individuals. (1940s)
help establish basic skills training group which evolved to T-groups (training groups)
applied feedback to group work
Gestalt psychologists "here & now"
group discussions superior to individual instruction for changing people's ideas & behavior
focused on group cohesiveness and group dynamics that promoted the progression of a group.
broke away from Freud such as family is basic group
characterized emotional patterns as work group "W" or basic assumption "BA" anti-work group (1940s)
Adler's student, first to discuss the use of group therapy in private practice; also introduced Adlerian principals to the treatment of children - parent groups
was often empathic with the family. She identified five styles of relating with a family. To explore relationships within the family, she used techniques such as family sculpting and taking a family life chronology. (1950s)
The theory of psychodynamic family counseling, was concerned with the internal feelings and thoughts of each individual as well as the dynamics between then. Prior to Ackerman, it was considered inappropriate to include family members in analytic treatment sessions.
cure dysfunction (1950s)
Carl Rogers personal growth groups emphasizes personal development (1970s)
also sensitivity group focuses on individual's awareness of emotions & behavior of others
help individuals to become more honest, real, genuine w/self George Bach & Fred Stoller (1960s)
Institute established in the 1960s to explore human potential Fritz Perls - Gestalt therapy in group setting
father of Transactional Analysis (TA) - who put Freud in everyday lingo with Parent ego [Superego], filled with shoulds, oughts, and musts to guide morality. (1960s)
illustrated through group work those individuals can take care of their interpersonal needs for inclusion, control, and affection through groups and stressed the use of nonverbal communication such as touching or hugging in groups. (1960s)
studied competitive & cooperative behaviors as contagious in groups; behavior in 1 sparks behavior in others (1960s)
Yalom 11 Curative Factors (1971)
-Installation of hope
-Development of social interaction techniques
Irving Janis created the term to emphasize the detrimental power that groups may exert over member to force them to conform (1971)
general (group) system theory
James Durkin (1980s) examines how circular causality (systemically) as opposed to linear causality (cause &effect) can be used in groups
dialectic behavior therapy
Marsha Linehan (1990s) CBT therapy involves skills training in problem-solving techniques, emotional regulation, and interpersonal skills; relatively new treatment for borderline personality disorder and related conditions involving dysregulation and impulsivity
cooperative learning groups
a method of instruction that has students working together in groups, usually with the goal of completing a specific task. (1990s)
small groups of people (representative sample) brought together to talk about issues or candidates. (1990s) Too small to provide estimates of public opinion, but they are useful for testing the appeal of ads, terms, slogans, ect.
group leader training
focus on intentional modeling
identifying critical incidents for members
examining event & member reaction
deriving meaning & self-understanding from events
applying new understanding towards personal change
3 primary contact groups
group guidance: preventive & growth engendering
group counseling: preventive, growth, & remedial
group psychotherapy: remedial
Gazda states group move on continuum
delineates group process & management and types of specialty groups
nature of management (x-axis): facilitation to leadership
nature of group process (y-axis): task achievement to process enhancement
TRAC model quadrants
Contacting: process & catalytic function
Acquiring: access & expansion of info and awareness
Relating: restructure/rehearsal new behavior
Tasking: control, efficiency, achievement
A model of mutual understanding that encourages disclosure and feedback to increase our own open area and reduce the blind, hidden, and unknown areas.
Johari Window Quadrants
I. Open: info known to self & others
II. Hidden: info known to self & not others
III. Blind: unknown to self & know by others
IV. Unknown: unknown to self & others
education is treatment & perceptions may change
these groups provide education and skill building for growth and prevention, management, and remediation of problems.
structured by central theme/particular population
used in schools & community and by social services, mental health agencies, and universities,
focus on interpersonal process and problem-solving strategies that stress conscious thoughts, feelings, and behavior.
remedial, mild, & situational problems
outcome: growth & development, self-awareness
leader emphasizes "here & now" and encourages growth, helps set goals & create plan to obtain
It is depth-oriented remedial and rehabilitative for more serious problems. It is supportive, reconstructive, involves depth analysis, is analytical, focuses on the unconsious, emphasis on neurotics and serve emotional problems, and is long term.
reconstruct personality or character of members
lead by a professional with advanced training.
personal growth group
sometimes referred to as support groups, aim to help members cope with particular difficulties.
developmental issues that arise in transitions
less focused on personality of individuals
short-term and intensive for personal growth
leader technique increase open communication, increase emotional experience and self-awareness
Leaderless or nonprofessionally guided groups in which members assist each other with a specific problem, voluntary groups of people who share the same problem (overheating, gambling, drug addiction, etc)
- Members meet regularly, often with a therapist present to:
- Discuss problems
- Share solutions
- Give and receive support (ex: Alcoholics Anonymous)
task facilitation group
focuses on training & consciousness raising
help members develop skills to interact effectively w/ others in task-oriented interpersonal settings
leader techniques to increase self-awareness as it relates to sensitivity to others improve functioning
tasks center around problem-solving & decision making
Shuts its gates after the start of therapy (or after 1-3 sessions). Often these groups are brief therapy groups. Meet weekly for 6 month or less. Long term closed groups mostly in prisons, etc.
New members can join after the group begins, allows for more group stability. Disadvantage is groups members that are added late miss some information or experiences.
ideal length of session
1.5 hours, even if critical issues being discussed (for adults). Longer than this people lose attention span/fatigue group members. Children's groups should be shorter and meet more frequently (1hr)
the forces operating in groups that affect the way members relate to and work with one another. the process through which inputs are translated into outputs, influences individual behavior.
Lewin thought that many factors contribute to it
Refers to interaction (verbal & non-verbal) between the group members. Also includes the different roles that people assume in a group.
As the group develops more time is spent on process than content.
7 types of group processes
contagion, conflict , anxiety, consensual validation, universality, family reenactment, instillation of hope
an emotional/physical reaction from the group, one member cries other members cry, the communication of an attitude or emotional state among a number of people
checking one's behavior with others; done by questioning, confronting, & affirming individually or with a group
factors in preplanning a group
• clarifying of purpose: what is the group to accomplish
• group setting: an environment that's quiet, comfortable
•time & size: how long & how many
•membership: heterogeneous or homogeneous
•goals: expected or planned outcomes
•commitment: voluntary or mandatory
•openness: consideration of new ideas & actions
•risk taking: willingness to engage new thoughts & behaviors
•attitudes: how members & leaders perceive tasks & others
• What do we have to do?
• What do we need to do to accomplish our goals? *warm-up
• Differentiating: taking care of their needs by themselves
• Integrating: doing things with others
members constantly deciding to between the two. leader helps members balance between them.
• refers to both the physical setup of a group as well as the interaction of each group member in relation to the group as a whole
physical structure should be practical (circle, chain, wheel, Y, theatre style)
promote a positive atmosphere, used as a catalyst to activate groups, encourage members to take risk, provide learning to move group, help or shift focus, increase risk taking, increase comfortability
timing & instruction are everything
types of group exercises
verbal interpersonal activities - introducing oneself to the group and answering questions
non-verbal interpersonal - "changing seats"—asking select members or an entire group to change seats
Intrapersonal activities: an exercise is done alone at first and then shared and explored with others at a later time
verbal intrapersonal - draw a picture & share
non-verbal intrapersonal - body relaxation techniques
the way members relate to one another
•consists of nonverbal and verbal behaviors and the attitudes that go with them.
•The meaning of nonverbal behaviors cannot be assumed
• on a continuum, from extremely nondirective to highly directive
track who speaks to whom & how often member speaks, observe silence
• "a dynamic structure within an individual (based on needs, cognitions, and values), which usually comes to life under the influence of social stimuli or defined positions" (Munich & Astrachan, 1983, p. 20).
manifestation based on that individual's expectation of self and others and the interaction one has in particular groups and situations
roles do not define overall identity of individual; though, they influence how they act
adds to the functioning of the group in a positive way. initiators in the group
relationship building group behavior. Supportive, and constructive interpersonal relationships, helps balance
behavior that inhibits either team performance or that of individual members; anti group/outsider
conflict between the role and individual plays in the ouside world and the one experienced with the group ex. an active participant
member is given a role within the group that s/he does not want or is comfortable with
member does not know what role to perform; this usually happens in a leaderless group
member expected to move from one role to another as the group progresses and individual doesn't feel comfortable doing so
the first specialists in group work to delineate positive primary group variables based on research he conducted with others on therapy groups.
positive variables = 11 curative factors
Yalom's negative group variables
•avoiding conflict: silencing those who disagree w/group
•abdicating group responsibilities: takes no responsibility & place all on leader
•psychic numbing: anesthetizing to contradictions within the group
•becoming narcissistic: encouraging cohesiveness w/ hatred
ways to learn group dynamics
• Outdoor experiences
• Simulation games for team building
• Learning integration
Theory X - leader is the expert, tends to be rigid & conventional in their beliefs, controlling
structure: wheel b/c leader centered group
emphasis on personality of one giving that person much power & trust (leader-centered)
good during crisis or chaos
Theory Y - trust members to develop their own potential & others
cooperate, collaborate, & share power w/ members
self-awareness & develop the guru within (Rogers)
good for openness & establishing trust
leader does not provide structure or direction for group. group-centered focusing on members & interpersonal processes.
slow to establish agenda & set goals
used to decrease intimidation, increase like ability
usually leads to no accomplishment
Theory Z leader
leader that encourage members to participate & trust members to meet individual and collective goals thru interaction
group for mutual support, usually end creating some leadership style that is comfortable to the group
group leader skills different from individual
facilitating: open up communication
protecting: protect member for attack of other members
blocking: stop counterproductive behavior
intervention used to connect one member to one or more other members. connecting persons with one another by pointing out to them what they share in common.
leader identifies certain behaviors & categorizes it. based on leader observation (for example, observation of group blaming instead of productive). leader looks for ways to overcome these behaviors
designed to get potentially productive feedback from a group member. member gave negative feedback to the member; leader tries to persuade member to restate feedback constructively
insight, meaning, & synergy occur with it. leaders should be skilled in divergent in ways of thinking & behaving.
group leader roles
traffic director: make members aware of behaviors that promote or inhibit communication
modeler of appropriate behavior:
interactional catalyst: promote interaction w/o saying it (ex. may look at member when needs to respond)
communicator facilitator: leader reflect feelings & content
withdrawal from conflict
leader distance from conflict & postpones interventions. good for further observation to collect data w/o becoming overly involved. help to avoid taking sides
disadv: conflict may escalate & ineffective in dealing with crisis
down play conflict when issues are minor & unimportant and relationship is more important.
disadv: doesn't resolve issue & feeling may erupt later
leader may be seen as weak or insensitive
consensus is the idea; get all members to reexamine a situation & identify points of agreement. (ex. mediation -3rd party hears conflict & render decision)
increase group commitment
disadv: very timely to implement & resistance of members set aside own goals for the group
use of compromise to resolve conflict
giving up a little to avoid conflict. win-win in cooperative behavior & collaborative efforts.
good when resources are limited & members are flexible (ex. negotiation)
disadv: individuals may inflate wants for larger gain & final outcome may ineffective or less desirable
use of power to resolve conflict
imposition of one will over another. power is based on status or personality. position power (immature relationships) personal power (mature relationship) individual uses ability to persuade.
good to solve problems quickly (limited time) and save relationships & alleviate resentment & revenge
Sharing of leadership between two therapists: needed when there are a lot of group members
The goal is to increase observations, knowledge and skills, model effective behaviors
works best they have similar philosophy & group style
advantages of co-leadership
ease of handling difficult situations
use of modeling
feedback from different perspective
helps avoid burnout
shared specialized knowledge
pragmatics: ability to cover for one another
limitations of co-leadership
lack of coordinated efforts
too leader focused
competition between leaders
collusion: co-leader form alliance w/ group member to address disliked qualities of the other leader
used to stop members from continuing to ramble & help focus "you seem to be repeating yourself, see if you can make a sentence & let's hear from someone else." making sure that new material is not introduced into the group too late in the session for the group to deal with it adequately
directly invites members to comment or give input; used to encourage participation or go deeper "What your thoughts about that"
helps members focus on specific topic or person for a length of time. "Let's conclude our focus on risk-taking before we move on"
Corey stages (9)
formation, orientation/exploration, transition, working, consolidation/termination, follow-up/evaluation
Gladding stages (9)
forming/orientation, transition (storming/norming), performing/working, mourning/termination
steps to forming a group
Step 1: Developing a Rationale for the Group
Step 2: Deciding on a Theoretical Format
Step 3: Weighing Practical Considerations
Step 4: Publicizing the Group
Step 5: Screening and Pre-training and
Step 6: Selecting Group Members
Step 7. Selecting a Group Leader
Tasks of beginning a group
Dealing with apprehension: anxiety
Reviewing members' goals and contracts: individual and/or group; restate purpose & have members state goal
Specifying more clearly or reiterating group rules (summarizing): rationale behind each rule
Promoting a positive interchange among members so they will want to continue (Weiner, 1984
screening of group members
essential to screen to determine if the group is right for the individual at the particular time.
prescreening for group:
identify needs, expectations, & commitment
challenge myths & misconceptions
ideal candidate for group
individual who has a specific goal, who has lessen the fears of a group, who are comfortable with their role & surroundings, must be willing to contribute, mature (immature, self-centered, hostile, closed individual are not ideal for group)
heterogeneous vs. homogeneous group
hetero: best for intensive group therapy with focus on personality change
homo: best for support & have focused; task groups
group leader skills - promoting positive interchange
holding the focus on interesting topics
shifting the focus when irrelevant/uninteresting
cutting off hostile
subtle ways or not so use of feelings & behaviors members use to get what they want. angry & unresolved issues of control
fix: reframing destructive acts in positive way
angry or frustrated & don't wan to participate, act as barriers.
fix: drawing out and/or confront & interpret in a reflective manner
dominates the conversation of the group, not allowing others to participate
fix: cutting off
sign of hostility or shyness, nonassertive reflecting or delay in assessing feelings.
fix: drawing out, & acceptance by group
users of sarcasm
mask of feelings with smart language; help member express anger more directly & get feedback from other members
opening a group
known as the critical incident in the life of the group general lead, opening statement with purpose, intro exercise...Q&A
beginning a group - structure
promotes group cooperation, decreases anxiety, inclusion, but restrict responsibility & freedom
question is what degree of structure
members look to lead for structure & answers
beginning a group - involvement
structured exercises are creative way to do it. discussing info & specific concerns to the group helps
beginning a group - group cohesion
we-ness, expressive arts best to help; doesn't fully manifest until norming. universality helps also.
the process by which members connect with one another psychologically and physically - icebreakers
clarifying the purpose
Sometimes members unintentionally bring up material that is not appropriate for a beginning session or the overall purpose of the group
members begin to compete with others to find their place in the group, involves struggles over power & control, can be overt (e.g., arguing) and covert (e.g., withdrawal), Associated with a lot of fears
form of avoidance of conflict, may get stuck if conflict is avoid or dwelled on. then conflict become destructive.
conflict can be positive, needs to be direct towards a constructive dialogue. helps overcome resistance, release tension, strengthen relationships
behavior that moves the group away from conflict, discomfort, conflict, or potential growth. leader should not react with resistance & defensiveness
using questions to disguise statements "safety net" leader can ask members to make "I" statements and phrase questions as a statement
misuse of support; overly supportive of others to avoid fully expressing own emotional pain
encourages band-aiders & advice-givers, present themselves as helpless & incapable but will not receive feedback
attack on the leader
most direct form of resistance, contribute to subgrouping, could be justified. leader should address immediately & determine underlying variables in a non defensive, open manner
working thru storming
leveling: draw out silent members & bring understanding to overly active members
talk thru as a group
feedback (informal - verbal or formal - rounds, logs)
conflict management orientations
rules or expectations of the group; may be unclear, confusing, ambiguous, restrictive. based on input of everyone
relationship in norming
here & now experiences: best to help group make progress to deal w/ immediate feelings & interactions
hope, cooperation, collaboration, cohesion
task processing in norming
goals for members to reach agreement on norms from which the group will operate, also commitment
supporting, empathizing, facilitating, self-disclosure
results of norming: members feel connected & ready to move on to be productive, have guidelines to operate, feel about themselves & the group
focuses on achievement of goals (individual & group) productivity and movement into unified & productive system
40-60% group time
willing to try new behaviors & strategies
task processing in working stages
rounds: equal input to express ideas & concerns
role-playing: focus on behaviors & consequences
***trust & care vital in role-playing
homework: practice outside group setting
incorporation: personal awareness & appreciation for the group & accomplishment
problem in the working stages
racial & gender issues: conflict result of this
group collusion: self-preservation (ex. agrees with the boss to keep from being fired. fix: devil's advocate procedure
individuals who hold cultural stereotypes & hold to them and act based on those
signs of working stage
sense of trust & cohesion, work in the present, take risks self-disclosing, deal with conflict, open & honest communication & feedback w/o fear, accept responsibility for their role
assisting in working stage
modeling by leader, exercises
group observing group: fishbowl procedure
brainstorming, nominal-group technique (NGT): comes with individual ideas then create system to choose collective idea
synectics: excursion - members take a break to engage in fantasy, present ideal situation to group
group processing, teach skills
outcome of working stages
achieved goals, combined group vision, learning & sharing of ideas & info among members. humor is helpful in the working stages
corrective emotional experience
another benefit of the working stage. member takes risk to express strong emotion, group helps member recognize inappropriateness of certain feelings & behavior or avoidance of it.
primary activities of termination
reflect on their past experiences
evaluate what has been learned
process memories, acknowledge ambivalent feelings
engage in cognitive decision making (Wagenheim & Gemmill, 1994)
practice how you want to say "good-bye" you get to have a choice about how you want to say "goodbye"
Proper preparation for ending a group begins in the planning stage.
Termination occurs on two levels in groups: at the end of each session, and at the end of a certain number of group sessions
Elicit and support hope, optimism, possibility of change.
Look for strengths in client and bring to forefront.
Believe that your client is capable of change.
Talk about similar situations that changed their behavior
Clients need to believe that their long-term success starts with a single step forward.
Education can increase self-efficacy
Assist client in enhancing their self-efficacy by allowing them to see baby steps.
Help promote self-efficacy.
"That must have been very difficult for you."
"That's a good suggestion"
the client uses blame, excuses, or pessimism to express unwillingness to recognize problems, cooperate, or accept responsibility.
the client shows evidence of ignoring or not following th clinician by being inattentive, not answering, or sidetracking.
Can occur when clients experience a conflict between their view of the "problem" or the "solution" and the counselors.
Principals of motivational interviewing
Express Empathy - seeing the world through the clients eyes.
Develop Discrepancy - help clients see where they are and where they might want to be.
Avoid Argument and Direct Confrontation - convincing clients that they have a problem may cause resistance.
Roll with Resistance - there will be times of resistance, be prepared.
Support Self-Efficacy - clients belief that change is possible and that they can make those changes even in difficult situations.
Autonomy and what holds control
Having a self-directing freedom; moral independence. It is what happens when clients makes their own choices. The client holds control.
Spirit of motivational interviewing
It is not a technique.
Collaborative, Evocative, Honors Autonomy
Clients have motivation and they also have doubt.
Ambivilance was once thought to be a sign of resistance.
Ambivilance is a "natural state".
When a client shows ambivilance giving advice is the last thing a counselor should do., instead meet them where they are and respect their freedom.
Eliciting change talk
Counselor must learn to elicit change talk because it doesn't always happen.
For example: "If you were going to change your heroin use, why would you do it?"
"How important would you say changing your smoking is right now?"
Having "mixed" feeling about someone or something; being unable to chose between the two (usually opposing) courses of action.
"I want to lose weight but I'm not sure if I want to give up sweets"
What things impact an individuals drug use physiologically?
Receptors in the brain.
Homeostasis, Rebound and Withdrawal, Age, Gender
What occurs when a drug has receptor affinity without efficacy?
Allows the drug to occupy the receptor and block neuro-transmission.
What is the difference between intra-muscular injections, inhalation, intra-venus injection & oral ingestion?
Muscular injections is rapid due to the greater blood supply in muscles.
Inhalation, drugs move from lungs to bloodstream through capilary walls
Intravenous involves putting drug directly into the bloodstream.
Oral ingestion, drugs from GI tract travel through veins first to the liver, where they may be metabolized.
What are two physiological processes of the drug user?
Pharmacokinetics - body's obsorption, distribution, metabolism, and excretion of a drug.
Pharmacodynamics - the neurological functioning of the user.
What is effective dose?
The dose required to produce a particualr effect in a certain proportion of the population.
What is the difference between efficacy and affinity?
Efficacy is the stimulatory power of the drug on the receptor.
Affinity is the drug's ability to attach itself to , or bind with a receptor, or site of action.
What is determined by the efficacy and affinity of a drug?
Whether or not the drug will have an effect on the user.
What is the term used to describe the desired affect of a drug or the reason it is used?
What are some factors that affect a drugs effects?
Characteristics of the drug.
Physiological functioning of the user.
Psychological state of the user.
Sociocultural environment in which the drug is used.
What do we call short term treatment centers that are designed to oversee the clients safe withdrawal?
What two broad catagories are discussed in your text and slides that counselors might work with clients with chemical dependent issues?
General Community Settings and Specialized Substance Abuse Settings
What ways might counselors have to advocate on behalf of their clients?
Negotiating service systems
Helping clients gain access to resources
Identifying barriers to clients' well being
Developing and carrying out action plans for change
Working to influence public policy
Which two conditions leads to which when talking about addiction?
Substance abuse can lead to addiction (and not the other way around).
What four theories emphasize the importance of the social context and clients?
1. Social control theory
2. Behavioral choice theory
3. Social leaning theory
4. Stress and coping theory
Social Control Theory
emphasizes the degree to which "strong bonds with family, school, work, religion, and other aspects of traditional society motivate individuals to engage in responsible behaviors and refrain from substance abuse.
Behavioral Choice Theory
Sees substance abuse as less likely to occur when the individual's environment provides reinforcements that serve as alternatives to the reinforcing effects of substance use.
Social Learning Theory
Emphasizes that the modeling effects of drug-related attitudes and behaviors are prevalent in teh individual's environment.
Stress and Coping Theory
Explains that stressors in the social environment can lead to substance abuse in teh absence of healthier coping skills.
What skews the ways in which people explain human behaviors?
Human beings overestimate the importance of fundamental character traits and underestimate the importance of situations and context when they try to interpret other people's behaviors.
What is the definition of Substance Abuse?
A condition in which an individual exhibits one or more of the following behaviors over a 12 month period.
What kind of process is it that helps the clients progress towards mutually approved treament goals?
A collaborative process
The Multiaxial System of Diagnosis
Axis I - Clinical (anything listed in the DSM - excl. Axis II category)
Axis II - Personality and Mental Retardation
Axis III - Medical Diagnosis (may influence a psychiatric condition)
Axis IV - Psychosocial and Environmental considerations
Axis V - GAF (Global Assessment of Functioning)
Panic Disorder - Diagnosis
Both (1) and (2)
(1) recurrent unexpected Panic Attacks
(2) at least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:
(a) persistent concern about having additional attacks
(b) worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, "going crazy")
(c) a significant change in behavior related to the attacks
ALSO: The Panic Attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).
ALSO: The Panic Attacks are not better accounted for by another mental disorder, such as Social Phobia (e.g., occurring on exposure to feared social situations), Specific Phobia (e.g., on exposure to a specific phobic situation), Obsessive-Compulsive Disorder (e.g., on exposure to dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., in response to stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., in response to being away from home or close relatives).
Panic Disorder - Symptoms
A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reached a peak within 10 minutes:
1) palpitations, pounding heart, or accelerated heart rate
3) trembling or shaking
4) sensations of shortness of breath or smothering
5) feeling of choking
6) chest pain or discomfort
7) nausea or abdominal distress
8) feeling dizzy, unsteady, lightheaded, or faint
9) derealization (feelings of unreality) or depersonalization (being detached from oneself)
10) fear of losing control or going crazy
11) fear of dying
12) paresthesias (numbness or tingling sensations)
13) chills or hot flushes
Post Traumatic Stress Disorder - Diagnosis
DSM-IV Criteria for Posttraumatic Stress Disorder
A. The person has been exposed to a traumatic event in which both of the following have been present:
(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others (2) the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.
B. The traumatic event is persistently reexperienced in one (or more) of the following ways:
(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma
(2) efforts to avoid activities, places, or people that arouse recollections of the trauma
(3) inability to recall an important aspect of the trauma
(4) markedly diminished interest or participation in significant activities
(5) feeling of detachment or estrangement from others
(6) restricted range of affect (e.g., unable to have loving feelings)
(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
(1) difficulty falling or staying asleep
(2) irritability or outbursts of anger
(3) difficulty concentrating
(5) exaggerated startle response
E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than one month.
F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Acute: if duration of symptoms is less than 3 months
Chronic: if duration of symptoms is 3 months or more
With Delayed Onset: if onset of symptoms is at least 6 months after the stressor
Post Traumatic Stress Disorder - Symptoms
Re-experiencing symptoms include ways in which the person persistently re-experiences the traumatic event. These symptoms may include the following:
- Intrusive memories of the traumatic event
- Recurrent, distressing dreams about the traumatic event
- Acting or feeling as if the traumatic event is reoccurring
-Mental and physical discomfort when reminded of the traumatic event (e.g., on the anniversary of the traumatic event)
Avoidant symptoms are ways in which the person tries to avoid anything associated with the traumatic event. These symptoms may also include a "numbing" effect, where the person's general response to people and events is deadened. Avoidant symptoms include the following:
- Avoiding thoughts or feelings, people or situations (anything that could stir up memories) associated with the traumatic event
- Not being able to recall an important aspect of the traumatic event
- Reduced interest or participation in significant activities
- Feeling disconnected from others
- Showing a limited range of emotion
- Having a sense of a shortened future (e.g., not expecting to have a normal life span, marriage or career)
Symptoms of increased arousal may be similar to symptoms of anxiety or panic attacks. Increased arousal symptoms include the following:
- Difficulty concentrating
- Exaggerated watchfulness and wariness
- Irritability or outbursts of anger
- Difficulty falling or staying asleep
- Being easily startled
A) anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected or situationally predisposed Panic Attack or panic-like symptoms. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone; being in a crowd, or standing in a line; being on a bridge; and traveling in a bus, train, or automobile.
B) The situations are avoided (e.g., travel is restricted) or else are endured with marked distress or with anxiety about having a Panic Attack or panic-like symptoms, or require the presence of a companion.
C) The anxiety or phobic avoidance is not better accounted for by another mental disorder, such as Social Phobia (e.g., avoidance limited to social situations because of fear of embarrassment), Specific Phobia (e.g., avoidance limited to a single situation like elevators), Obsessive-Compulsive Disorder (e.g., avoidance of dirt in someone with an obsession about contamination), Posttraumatic Stress Disorder (e.g., avoidance of stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., avoidance of leaving home or relatives).
The main symptom of dysthymia is a low, dark, or sad mood on most days for at least 2 years. In children and adolescents, the mood can be irritable instead of depressed and may last for at least 1 year.
In addition, two or more of the following symptoms will be present almost all of the time that the person has dysthymia:
Feelings of hopelessness
Too little or too much sleep
Low energy or fatigue
Poor appetite or overeating
Criteria for Abnormal Behavior
2. Social Deviance
3. Faulty Perceptions or faulty interpretations of reality
4. Significant personal distress
5. Maladaptive or self-defeating behavior
Abnormal behavior pattern that involves a disturbance of psychological functioning or behavior.
The branch of psychology that deals with the description, causes and treatment of abnormal behavior patterns.
A biological perspective in which abnormal behavior is viewed as symptomatic of underlying illness.
US Surgeon General on Mental Health
MH reflects the complex interaction of brain functioning and environmental illness. Treatments exist for most MH disorders including psychotherapy, counseling and psychopharmacologic or drug therapies. (Treatment is most effective when both are combined).
15% of American adults receive some form of help each year, many who need help do not receive it.
Mental Health is best understood when we take a broad view and consider the social and cultural contexts in which they occur.
The Demonological Model
1. Historically, abnormal behavior was thought to be caused by the inhalation of evil spirits.
2. Treatment: TREPHINATION - drilling the skull to provide an outlet for the spirits.
3. This idea remained until the Enlightenment era.
Origins of the Medical Model: ill humor
(Hippocrates and Galen)
1. Illness was caused by natural causes. (not possession)
2. Health depended on the balance of body fluids. (humors)
3. Imbalance caused abnormal behavior. (very important in today's understanding chemical imbalances).
1. increase in supernatural beliefs as a cause of abnormal behavior.
2. Possession by evil spirits or the devil (Roman Catholic Church)
3. Treatment was exorcism, prayer, incantations, waiving a cross at the victim, beating, flogging, starvation and torture (rack).
1. Amounted to the massive persecution of women.
2. Church officials believed witches made pacts with the devil, practiced satanic rituals, ate babies, and poisoned crops.
3. In 1484, Pope Innocent VIII decreed that withches be executed.
4. Manual for Witch Hunting "Malleus Maleficarum" (The Witches Hammer).
5. The Water-float Test: damned if you do, damned if you don't.
Bedlam: 18th century. The patients at St. Mary's of Bethlehem Hospital in London were a source of entertainment. The public could buy tickets to watch. The conditions were appalling, patients were chained to the beds, and were forced to lie in their own waste.
(Jean-Baptiste Pussin and Philippe Pinel).
1. Wanted Humane Treatment.
2. Moral Therapy - to restore functioning.
3. Similar reforms were beginning to be practiced in England (William Tuke) and in the US (Dorothea Dix).
4. Benjamin Rush - the father of American Psychiatry. He recommended bloodletting, purging and ice-cold baths.
The Community Mental Health Movement
1. 1963 congress enacted a nationwide system to offer alternatives to custodial care.
3. Phenothiazines (antipsychotic drugs) reduced the need for indefinite hospital stays, increased independent living.
4. Some MH hospitals were closed as a result.
Contemporary Perspectives on Abnormal Behavior
a) Biological: Wilhelm Gresinger + Emil Kraeplin. Biological defects. Focus on treatment, not punishment.
b) Psychological: Martin Charcot. Organic factors alone do not explain all abnormal behavior. (used hypnosis + influenced Freud).
c) Freud reasoned that if hypnosis works, then abnormal origins must be psychological.....(outside conscious awareness). Developed the Psychodynamic model. (Personality)
The Sociocultural Perspecitive
1. The causes of abnormal behavior may be found in the failures of society rather than the person.
2. Unemployment, poverty, family breakdown, injustice, ignorance and lack of opportunity, gender, social class, ethnicity and lifestyle.
3. Former practices are concerned with labeling and alienation.
The Biopsychosocial Approach
1. Abnormal behavior is best understood by taking into account multiple causes representing the biological, psychological and sociocultural domains.
Ellis (ABC Model)
A = Activating Event
B = Belief
C = Consequences
A cognitive approach. Interpretation of events determine the emotional state. Albert Ellis and Aaron Beck believe that distorted thinking patterns can lead to maladaptive behavior.
Diathesis Stress Model
Abnormal behavior problems involve the interaction of a vulnerability or predisposition and stressful life events and experiences.
Inherited predisposition (Diathesis) + Environmental stressors (Stress) = Psychological Disorder (development)
The Nervous System
....is made up of neurons (nerve cells that transmit messages).
1. Every neuron has dendrites that receive messages from adjoining neurons.
2. Every neuron has an axon - which can extend several feet.
controls muscle contractions and formation of memories. There are reduced levels of ACh found in patients with Alzheimer Disease.
regulation of muscle contractions and mental processes involving learning, memory and emotions. Overutilization of dopamine in the brain may be involved in the development of Scizophrenia.
mental process involved in learning and memory. Irregularities of norepinephrine are linked with mood disorders such as depression.
regulation of mood states and sleep. Irregularities are implicated in depression and eating disorders.
Major Defense Mechanisms in Psychodynamic Theory
1. Repression - expulsion from awareness of unacceptable ideas or motives. (a person is unaware of harboring hateful or destructive impulses toward others).
2. Regression - the return of behavior that is typical of earlier stages of development. (eg, suddenly becomes totally dependent on others).
3. Displacement - transferring unacceptable impulses away from their original objects onto safer or less-threatening objects. (slamming the door after an argument....is not angry with the door!)
4. Denial - refusal to recognize a threatening impulse or desire. (refusing to acknowledge an addiction, or, a person who nearly chokes someone and acts like it is no big deal).
5. Reaction Formation - behaving in a way that is the opposite of one's true wishes to keep them repressed. (a sexually frustrated person goes on a personal crusade to stamp out pornography).
6. Rationalization - the use of self-justifications to explain away unacceptable behavior. (cancer doesn't run in my family - to justify smoking)
7. Projection - imposing one's own impulses or wishes onto another person.
8. Sublimation - channeling unacceptable impulses into socially constructive pursuits.
Freud - Id, Ego, and Superego
Id: the unconscious psychic structure, present at birth, contains primitive instincts and is regulated by the pleasure principle. (Unconscious)
Ego: the psychic structure, that corresponds to the concept of the self, governed by the reality principle, and characterized by the ability to tolerate frustration. (Preconscious)
Superego: the psychic structure that incorporates the values of the parents and important others and functions as a moral conscience. (Unconscious)
--> Freud believed the unconscious is the repository of our basic biological impulses or drives (instincts). They are primarily sexual and aggressive instincts.
Pleasure Principle (ID)
.....the governing principle of the id, involving demands for immediate gratification of needs.
Reality Principle (EGO)
.....the governing principle of the ego, which involves considerations of social acceptability and practicality.
Defense Mechanisms (EGO)
....the reality-distorting strategies used by the ego to shield the self from awareness from anxiety-provoking materials.
Freud's Stages of Psychosexual Development
1. Oral - first year of life. (sucking and biting is a source of both sexual gratification and nourishment).
2. Anal - second year. (sexual gratification is experienced through contraction and relaxation of the sphincter muscles).
3. Phallic - around 3rd year. (unconscious incestous wishes for the parent of the opposite gender/ rival same-sex parent) Oedipus + Electra complex.
4. Latency - (6 - 12 yrs) (sexual impulses are in a latent state, interests directed towards school and play activities.
5. Genital - (begins at puberty) - sexual gratification through intercourse.
..... in Freudian Theory, a constellation of personality traits associated with a particular stage of psychosocial development, resulting from either too much or too little gratification at the stage results in fixation.
....modern psychodynamic approach that focuses more on the conscious striving of the ego than on the hypothesized unconscious functions of the id.
B.F. Skinner, Ivan Pavlov, John Watson - focused on studying behavior that was observable. Abnormal behavior is learned maladaptive behaviors. (Pavlov's dogs, Classical Conditioning; Operant conditioning,)
Social Cognitive Theory
Bandura, Rotter, Mischel, Rogers
Learning is obtained through observing and immitating. (Modelling)
Maslow's Hierarchy of Needs = Self Actualization
Rogers believed that people hurt one another or become antisocial in their behavior only when they are frustrated in their endeavors to reach their unique potentials
> self discovery
> self acceptance
1. relies on the medical model
2. recognizes that causes can be social/psychological as well as biological in nature.
3. Mental state is assessed according to the five axes
Axis I: CLINICAL DISORDERS
MENTAL DISORDERS: syndromes, includes anxiety disorders, mood disorders, schizophrenia and other psychotic disorders (anything in the DSM excl. axis II)
Axis II: PERSONALITY DISORDERS AND MENTAL RETARDATION
....maladaptive ways of relating to others and adjusting to external demands. (antisocial, paranoid, narcissistic, borderline personality disorders and pervasive intellectual impairment)
Axis III: GENERAL MEDICAL CONDITIONS
All medical conditions and diseases that may be important to the understanding and treatment of an individuals mental disorder. (Some medical complaints can contribute to mental health decline, depression....)
Axis IV: PSYCHOSOCIAL AND ENVIRONMENTAL CONDITIONS
consider the social, environmental situation.
Housing, income, employment......
Axis V: GLOBAL ASSESSMENT OF FUNCTIONING (GAF)
.....is a rating scale of client's current level of functioning. Higher score = higher level of functioning.
a maladaptive reaction to an identified stressor, characterized by impaired functioning or emotional distress that exceeds what would normally be expected.
substances secreted by endocrine glands that regulate bodily functions and promote growth and development.
General Adaptation Syndrome (GAS)
The body's 3-stage response to the states of prolonged or intense stress.
1. Alarm Reaction: heigtened sympathetic activity (fight or flight)
2. Resistance Stage: the body's attempt to withstand the stress
3. Exhaustion Stage: lowered resistence, increased parasympathetic activity
Type A Behavior Pattern: (TABP)
...is characterized by a sense of time urgency, competitiveness and hostility.
refers to behaviors or feelings that are perceived to be natural parts of the self. (I'm just bad).
Impulse Control Disorders: Coded on Axis I
Intermittend Explosive d/o
>>>Schizophrenia is also coded on Axis I because it does have an organic cause......it is NOT a personality disorder.
Personality Disorders: Clusters
Cluster A: (odd, eccentric)
1. Paranoid Personality d/o - unusual beliefs, suspicious of others.
2. Schizoid Personality d/o - no interest in personal relationships.
3. Schizotypal Personality d/o - wider range of odd beliefs.
Cluster B: (dramatic, emotional, erratic)
1. Antisocial Personality d/o - (psychopath/sociopath) violates the rights of others, breaks society's norms, large proportion are in prisons. Lack of guilt/remorse. Predominately men.
2. Borderline Personality d/o - instability in relationships,alternates between personal identity extremes, fear of abandonment. (all is either great, or awful). Usually women.
3. Histrionic Personality d/o - excessive emotionality, needs to be the center of attention. Usually women.
4. Narcissistic Personality d/o - "self love", lack of empathy for others. Usually men.
Cluster C: (anxious, fearful)
1. Avoidant Personality d/o - fear of rejection, unwilling to enter relationships.
2. Dependent Personality d/o - overly submissive, common with victims of abuse, feelings of inadequacy.
3. Obsessive Compulsive Personality d/o - DIFFERENT FROM OCD! orderliness, meticulousness, preoccupied with perfection, difficult to express feelings. Is more common in men.
Pervasive Developmental Disorders (PDD's)
Aspergers Syndrome (does not have the language or cognitive delays associated with autism)
Autism Spectrum - is the fastest growing disability in the US. No single cause or cure.
Downs Syndrome (IQ of less than 70 to be diagnosed, life expectancy = 49)
Fragile X Syndrome
Expressive Language disorder
Mixed receptive/expressive language disorder
Childhood Anxiety and Depression
childhood depression (girls are twice as likely as boys)
suicide in children and adolescents - 3rd most common cause of death in 15 - 24 year olds.
Enuresis - failure to control urination after one has reached the expected age for attaining such control
Encopresis - lack of control over bowel movements that is not caused by an organic problem in a child at least 4 years old.
The Global Assessment of Functioning (GAF) is used to......?
evaluate and individual's overall psychological, social and occupational functioning.
Acute is used to describe symptoms that are.....?
relatively short in duration, usually under six months.
Risk Factors for Childhood Disorders
Boys are at a greater risk for developing many childhood disorders, ranging from autism to hyperactivity to elimination disorders and difficulty forming peer relationships/attachments.
Paranoid Personality Disorder"
Pervasive suspiciousness/excessive mistrust
Tendency to interpret other people's behavior as deliberately threatening or demeaning.
Reluctance to confide in others.
Overly sensitive to criticism.
Hold grudges when they think they have been mistreated.
Have few friends/intimate relationships.
Deny Blame and may launch lawsuits
DOES NOT HAVE DELUSIONS - SCHIZOPHRENIA
Types of Anxiety Disorders
Generalized anxiety d/o
Agorophobia without panic d/o
Obsessive compulsive d/o
Acute stress d/o
Post-Traumatic Stress d/o
Treating Anxiety Disorders
Psychoanalysis: puts awareness on how clients fears symbolyze their inner conflicts, so the ego can be freed from expending its energy on repression. (little documentation for usefulness).
Systematic Desensitization: (Joseph Wolpe, 1958). This is a gradual process in which clients learn to handle progressively more disturbing stimuli while remain relaxed. Is based on the assumption that phobias are learned, therefore they can be unlearned.
Gradual Exposure: gradually approaching the object/situation they fear.
a method of helping a person with a problem by focusing on the immediate priorities of the client and the small steps involved in realizing, or seeking to realize, the ultimate goal.
an attempt to create, in a timely fashion, a plan for a child that will return him or her safely to the family of origin or legally free the child to be adopted.
a commitment to provide the resources and supports that can hold together or reunite a family unit, especially to provide stability to the children.
an updated list of all available resources in a human service area, with notations about the special characteristics or qualifications of each.
an attempt to put oneself in the shoes of another person, to feel or think of a problem from another perspective, even before encountering a client, to sensitize the worker.
personal opinions about the client's attitude, situation, and behavior that may or may not be objectively true.
an initial verbal or written statement that explains the reasons a client is being sent to or has chosen a specific resource, person, or agency.
an interview (form) that solicits relevant information before the delivery of a service begins.
health maintenance organization (HMO)
a healthcare institution or an association of doctors that contracts with its members to collect a fixed sum of money monthly or yearly in exchange for doctor visits, tests, medications, hospital care, and preventive services, as needed.
fee for service
a prearranged amount of money that will be paid to a health care provider each time he or she delivers a specific service to a plan member in accordance with the plan's criteria for that service.
a person in a health plan organization who decides whether a prescribed medical service will be paid for, based on its set of criteria for care.
Elizabethan Poor Law
The Act of Relief of the Poor (1601), also known as the Elizabethan Poor Law. It created a national poor law system in England and Wales. To pay for this, taxes were raised to support the system. If an individual's family were unable to care for the individual, then the government would get involved in their care.
1. The impotent poor (people who cannot work) were to be cared for in almshouses, or poor houses.
2. The able bodied poor were sent to work in a "House of Industry"
3. The Idle Poor were sent to a "House of Correction", or prisons.
4. Pauper children would become "apprentices"
Increase in Human Service Field
1. developed from an increasing number of problems in the world.
Increased dependence on drugs and substance abuse
An aging population
Isolation and Alienation
Rising stress levels
is a goal of the human service worker.
1. Provide enough care and support to lead the client to be financially independent.
2. Client empowerment.
3. Permit the client to assume responsibility for themselves.
4. Encourage the client to believe in themself.
Hopelessness = Helplessness! Negative believes about the self is difficult to overcome.
People can meet their needs but did so in a way that violates social norms. (Judicial System)
Psychology: Study of mind and behavior. Looks at the client as an individual.
Sociology: Looks at society, culture and how it affects individuals. Assesses a relationship between the two.
Anthropology: Looks at how problems are changing and the frequency of problems over time. Pays attention to cultural, physical and social development and variations over time.
Common Ethical Dilemmas
1. Multiple role relationships (conflict of interest)
2. Informed Consent
3. Confidentiality and Privileged Communication.
Limits to Confidentiality
1. Client request for release of information
2. Court orders for release of information
3. Danger to self
4. Danger to others
assisting the whole person requires the Human Service worker to obtain detailed information including;
Current level of functioning/ skills/ knowledge
Environment/support system/ family
The Human Services worker is part of a larger network and may be involved with personnel from other professsions.
Welfare to work, community outreach, child care, rehabilitation, housing, legal aid, education, substance abuse, mental health and criminal justice.
Responsibility for Mental Illness
Prior to the 1500's the church was responsible for the mentally ill, thereafter responsibility went to the government.
4 Principles of the Poor Law in the United States
1. Poor relief was a public responsibility
2. Began to look at residence - assistance was at the public local level.
3. Public Aid was denied to those who had a family.
4. Children were assigned as apprentices, (orphans in employment, so they won't be dependent forever).
....were places for orphans to live. The first Almshouse was in Mass. 1662. By the 1800's an entire system of almshouses were developed.
Franklin developed the first institution in Pennsylvania for Mental Illness but did not look at it from a medical perspective/ or try to treat.
Three Social Philosophies
Individualism: Hard work = success! Individual is blamed for failure and poverty is a sign of spiritual weakness.
Laissez-Faire: "to leave alone" Less government is more desirable. Nothing should be done to help the less fortunate.
Social Darwinism: to create a society of the fittest people, nothing should be done to help the less fortunate.
Dr. Benjamin Rush
Father of American Psychiatry
began to integrate occupational therapy and regular excercise
Launched an investigation into the treatment of the mentally ill.
Pushed for national government responsibility
1843 - 1853 studied 9 state hospitals
1854 got the states to accept financial responsibility for the mentally ill
Mid 20th Century
The focus of serving those in need emphasized the governments commitment to treating mental health. Kennedy called for a national plan to investigate the causes of mental health problems and to training professionals.
Community Mental Health Centers Act 1963
1. Grants were made available for staffing and educational facilities.
2. Inpatients, outpatients and emergency services were established.
3. Services for the mental health of children.
By 1975, Congress had authorized 609 multi service centers.
Scheuer Subprofessional Career Act of 1966
Personnel shortage had led to this act.
Allowed for poor people and minorities to provide mental health services. Training was mostly in-service. After Kennedy's assassination, Johnson followed the same philosophy.
1965 State of the Union Address
Johnson declared a "war on poverty".
Many schemes were introduced;
College Work Study
The aim was to provide ways for the poor to improve their own economic conditions.
Is a move to spend less to get the same results.
1. External Reviews (to ensure efficiency of services)
2. Authorize services (must be approved by insurance companies)
3. Approve the quality of services (checks the credentials of the professional and the establishment).
Insurance companies influence the "Standards of Practice" by defining the "best practice".
Level of Care
1. Must be the least restrictive environment for the client.
2. Not more treatment is given than is needed.
Trends in the Human Service Field
1. By 2030 the aging population will double
2. Services will address physical, social, mental and emotional decline.
3. Other issues will include; housing, depression, confronting death and dying.
Human Services in Rural Areas
1. Losing population
2. More likely to be elderly population
3. More likely to be members of disadvantaged minority groups
4. Lack of services to Human Service professionals
.....has changed the way we network.
1. More information, faster. (email, listservs, teleconferencing, cell phones, pagers).
2. Improved resources, internet research, blogs, infosites.
3. Electronic records management = sharing info (challenges confidentiality)
4. Client management (goals/progress checks) = maintaining communication.
5. Provide online counseling services.
6. Some agencies use technology to provide services (skype, teleconference).
Defining a Problem
1. It is difficult to predict what an individual will experience as a problem.
2. The individuals perspective is part of the problem definition.
3. Individuals often lack the resources/skills to solve problems.
There are no guarantees that an individual will seek help.
Ways of Getting Help
1. Referral - self referral or by other professionals
2. Involuntary Placement - adolescents/judicial system (court mandated services)
3. Inadvertant Services - neighborhood watch/redevelopment
Barriers to seeking help
1. Financial/ practical
2. Preconceived notions/stigmas
3. Lack of information about services
4. Fear/ feel threatened
5. Counselor/ helper is a stranger
6. Culture / shame in the family
7. Prior bad experiences
8. Client expectations/ may want to be overly dependent
Friends as Helper
1. Not trained
2. Emotional involvement
4. Confidentiality issues
5. May not have best interests served
6. No ethical responsibility
7. Oversimplified expectations
Stages in the Helping Process PECIT
1. P - Preparation (review all available info)
2. C - Client arrives - ice breaking skills
3. E - explore the problem (locate source, assess severity)
4. I - Intervention (set goals)
5. T - Termination (services have been provided, goals are met, client has learned new skills)
1. Counts for more than 65% of any communication
2. Communicates thoughts and feelings
3. Can be misinterpreted
1. Actual spoken or written words
2. Cognitive and affective aspect
3. Connotation and denotation
Listening and Responding
.....is the main role of the helping professional
1. active listening
2. response is always purposeful
3. Paraphrase or rephrase
4. ask questions to get more information, create new insight in client
5. appropriate questions (interview/intake, request specific info, to clarify, to elicit examples of specific behavior, OPEN QUESTIONS WORK BETTER!
1. S - squared (face the client)
2. O - Open
3. L - Lean forward
4. E - eye contact
5. R - relaxed
1. Trust v mistrust: Virtue = hope (0 - 1 years)
2. Autonomy v Shame and Doubt: virtue = will (2 - 3 years)
3. Initative v guilt: virtue = purpose (4 - 6 years)
4. Industry v inferiority: virtue = competence (7 - 12 years)
5. Identity v role confusion: (who am i?) ( 13 - 19 years)
6. Intimacy v isolation: (20 - 34)
7. Generativity v Stagnation: Virtue = Care ( 35 - 65)
8. Ego Integrity v Despair: Virtue = wisdom (65+)
1. Psysiologica/ biological needs (food, shelter, water)
2. Safety Needs (protection, security)
3. Social Needs (acceptance, love)
4. Esteem Needs (recognition, independence)
Acceptance - be receptive to the client
Tolerance - be patient, not judging
Individuality - do not stereotype, accept differences
Self-determination - allow client to make up their own mind
Confidentiality - assure that information is secure
Stages of Problem Solving ICECAE
1. I - Identify the problem
2. C - Clarify Goals
3. E - Examine alternatives
4. C - Choose the alternative
5. A - Act (move to the course of action/goal)
6. E - Evaluate and re-act (how well did it go, alterations needed?)
The focus of assessment in rehabilitation
is to gather relevant data to assist in making useful recommendations for service planning
Assessment is defined broadly as
"any systematic method of obtaining information from tests and other sources, used to draw inferences about people, objects, or programs"
Measurement is defined as
"the assignment of numbers to attributes of persons according to rule stated explicitly"
Vocational assessment involves
exploring a person's strengths, weaknesses, and preferences and discovering how the individual's potential for vocational adjustment can be enhanced.
Assessment procedures can include
interviews, standardized tests, inventories, observations, job tryouts, simulated tasks, and medical examinations.
The focus of intake interviews should be placed on the following:
(1) determining the person's reason for rehabilitation services, (2) providing the individual with necessary information about the role and function of the agency, (3) developing adequate rapport, (4) initiating the diagnostic process, and (5) informing the consumer of any medical, vocational, or psychological evaluations that must be completed and the purposes of such evaluations.
Medical Evaluation is used to
(a) establish the presence and extent of the disability, (b) provide information on the physical functioning of the consumer, (c) determine the types of activities precluded by the disability, and (d) identify any additional medical evaluation necessary for achieving the first three purposes.
The medical examination provides information
a) clarifying the consumer's general health at present; (b) describing of the extent, stability, and prognosis of the present disability as well as any recommended treatment; (c) assessing present and future implications of the disability and its potential affects on performance of essential job functions; and (d) reporting the presence of any residual medical conditions that could impact the individual during the rehabilitation process
Psychological assessments yield information regarding consumer's
intelligence, aptitudes, achievement, personality, interests, and adjustment related to vocational functioning.
Psychological assessment results help to determine
(a) the appropriateness of long-term vocational training, (b) the need for adjustment services, and (c) the need to confront the consumer regarding unrealistic vocational choices
Vocational evaluations provide reliable and valid data to
(a) generate information about the consumer's current vocationally relevant levels of social, educational, psychological and physiological functioning; (b) estimate the consumer's potential for behavior change and skill acquisition; (c) determine the consumer's most effective learning style; (d) identify possible jobs the consumer can perform without additional vocational services; (e) identify education or special training programs that might increase vocational potential; (f) identify potentially feasible jobs for the consumer with further vocational services; and (g) identify the community support services that might augment job retention following successful consumer placement
Classifies, assigns numerals but does not distinguish size, amount (e.g., any categorical variable, such as ethnicity or gender).
Indication of ordering, but no indication of distances between objects on the scale (e.g., placing first, second, and third).
Validity can be understood as
the extent to which meaningful and appropriate inferences can be made from the instrument (Does the test measure what it says it measures?).
evaluation by subject matter experts of test items representativeness of the construct being measured.
Parallel forms reliability:
A parallel form correlation indicates consistency of scores of individuals within the same group on two alternate but equivalent forms of the same test taken at the same time.
An internal consistency statistic calculated from the pairwise correlations between items.
A standard score based on the normal distribution curve with a mean equal to 0 and a standard deviation equal to 1 (M = 0, SD = 1) is a:
According to the CRCC Code of Ethics regarding evaluation, assessment, and interpretation:
Prior to assessment, rehabilitation counselors are expected to explain the nature and purposes of assessment in the language and/or at the developmental level of the consumer, unless explicit exception has been agreed upon in advance.
E-S-F-P (Extroversion, Sensing, Feeling, Perception) is a possible score summary of a personality type on this well-known personality test based on the works of Jung:
Myers-Briggs Type Indicator
Started training groups (T-groups) in 1960s, referred to group cohesiveness as "positive valence"
Used to explain self-disclosure - there are 4 quadrants of information depending on whether it's known/unknown to self and known/unknown to others
Resisting behavior by member that slows group progress - often seen as silence or non-participation
Graphical representations of group member interaction patterns, shows the star, cluster and isolate members
Stage that includes testing boundaries and power structures, members compete for rank, form alliances, test the leader - also called "storming" stage
Risky Shift Phenomenon
Group's decision will be less conservative than the average members' individual decision; ex. group of teens wilder than an individual teen
Strategy that works with whole group - also called interpersonal because it focuses on interactions
Strategy that works with individuals within the group - also called intrapersonal
Moreno - technique where you act out situations in group - roles include director (therapist), protagonist (member who's re-enacting), auxiliary egos (members who assist)
Which quadrant of the Johari Window includes information known to others and self such as gender or what you're wearing?
Which quadrant of the Johari Window includes information unknown to others but known to yourself such as fear of failure, inadequacy?
Which quadrant of the Johari Window includes information known to others but unknown to yourself such as facial expressions?
Which quadrant of the Johari Window includes information unknown to others or self such as family of origin issues?
What kind of group is restricted to people with a demonstrated need in a themed area, such as parenting skills, addiction group for teens?
Which kind of group leader assumes little leadership and lacks structure or directiveness?