NRNP 6645 - Midterm study guide

Legal and ethical considerations among individual, family, and group modalities of therapy Domestic violence & sexual abuse: • Most states require professionals to report any suspicion of child abuse. • Although repor ...

Legal and ethical considerations among individual, family, and group modalities of therapy Domestic violence & sexual abuse: • Most states require professionals to report any suspicion of child abuse. • Although reporting suspected abuse can jeopardize a therapeutic alliance, sometimes therapy needs to take a second place to the interests of safety. • If a clinician does not report suspected child abuse, they should consider the consequences of making a mistake. • Perpetrators and victims of childhood sexual abuse don’t usually volunteer this information. • Detection of this abuse is up to the therapist who may have to rely on indirect clues • A child MAY show the following symptoms if they are being abused: sleep disturbance, encopresis or enuresis, abdominal pain, exaggerated startle response, appetite disturbance, sudden unexplained changes in behavior, overly sexualized behavior, regressive behavior, suicidal thoughts or running away. Ethical Dimension: • Therapy should be for the client’s benefit, not to work out unresolved issues for the therapist • Clients are entitled to confidentiality, but limits of privacy must be imposed in regards to probation officers, parents, and managed care companies • Therapists should avoid exploiting the trust of their clients (and students) and must avoid dual relationships • Professional are obligated to provide the best possible treatment, if they are not qualified, they should refer the patient to someone else who is. • When in doubt regarding ethical issues, its best practice to consult with a colleague or supervisor. • Psychologists offer services only within the areas of their competence, based on education, training, supervision or professional experience. • When psychologists become aware of personal problems that might interfere with their professional duties, they take appropriate measures, such as obtaining professional assistance and determining whether they should limit, suspend or terminate their workrelated duties. • Social workers should not engage in dual relationships with clients or former clients. • Social workers should not solicit private information from clients unless it is essential to providing services • Social workers should not disclose confidential information to third party payers unless clients have authorized such disclosure. • Social workers should terminate services to clients when such services are no longer required. • Counselors are not allowed to maintain a relationship with current clients through social media • Counselors must wait 5 years after the last clinical contact to have sexual or romantic relationship with a former client or family member of a client. This applies to both inperson and electronic interactions. • The APA specifies that when a psychologist provides serves to several people in a relationship (spouse or parents and children), they must clarify at the start which individuals are clients and what relationship he or she will have with each one. • Additionally, if the psychologist is called on to perform potentially conflicting roles (such as family therapist and witness for one party in divorce proceedings), he or she must attempt to clarify and change or withdraw from the roles as appropriate. • The NASW states that when a social worker provides services to a co ule or family members, he/she should clarify with all parties what professional obligations he or she has to the various individuals receiving services. • Also, the social worker should ask all parties to agree to each individual’s right to confidentiality. • As a therapist one way to resolve ambiguous ethical dilemmas is to use your own best judgement. • When in doubt, clinicians should ask themselves two questions: 1) What would happen if the client or or important others found out about my actions? 2) Can you talk to someone you respect about what you’re doing (or considering)? • The following are “red flags” which should signal potential unethical practices: 1) Specialness - believing that something about the situation is special and that the ordinary rules don’t apply. 2) Attraction - feeling intense attraction of any kind not only romantic but also being impressed with the status of the client. 3) Alteration in the therapeutic frame - having longer or more frequent sessions, engaging in excessive self-disclosure, being unable to say no to the client, and other things that signal a potential violation of professional boundaries 4) Violating client norms - not referring someone in a trouble marriage for couples therapy, accepting personal counseling from a supervisor and so on. 5) Professional isolation - not being willing to discuss your decision with professional colleagues. COGNITIVE BEHAVIORAL THERAPY o “A collaborative process of empirical investigation, reality testing, and problem solving between the therapist and the patient.” o The basic premise is that depression is the result of cognitive distortions, and these distortions are learned errors in thinking (Beck) o CBT is “a system of psychotherapy based on a theory which maintains that how an individual structures his or her experiences largely determines how he orshe feels or behaves.” o Dysfunctional thoughtsrelating to self, world, and/or others are rooted in irrational or illogical assumptions. The individuals view of self and the world is central to the determination of emotions and behaviors and thus by changing one’s thoughts, emotions, and behaviors can also be changed. o Primary and secondary thinking. Secondary thinking views the social and cultural world in determinate, positive, rational terms. Primary thinking recognizes the indeterminate, negative, and irrational as a part of human action forever. o Clinicalstrategies are used to help the individual recognize the dysfunctional nature of their thinking patterns and to help the individual change their conclusions. o Cognitive therapy advocates guided discovery rather than directly challenging the patient’s views. Allowing the patient to find the answers to their problems as much as possible. Socratic Dialogue o “Mutual discovery in which the therapist guides the patient through a series of questions and answers to elicit automatic assumptions and examine the logic and evidence that relates to them.” o Involves the therapist asking specific questions derived primarily from restatement of the individual’s own words as the major technique leading the individual to self-discover insight leading to subsequent changes. https://www.youtube.com/watch?v=hsm6qJUwfM o 7 types of questions for SD: exampleslocated on p316 in book. History, memory, translation, interpretation, application, analysis, and evaluation questions. o Basic Rules to SD located on page 317 in book. o Labeling of Distortions- patients are helped to identify “dysfunctional or irrational” thoughts as a type of self-monitoring for more accurate descriptive o Questioning the Evidence- this technique assists the individual in questioning the facts related to their cognitions and conclusions. It investigates whether their information is based on facts or assumptions. o Examining Options and Alternatives- this technique involves the development of all possible alternative explanationsto learn the skillsin generating options rather than “only one way” thinking. o Reattribution- in individuals with the habit of accepting all or most of the blame for outcomes, this is an excellent technique for redistribution of responsibility. Thisis also helpful for individuals with personality disorders that place the blame squarely on the shoulders of others for most outcomes o Decatastrophizing- catastrophic thinking is one of the hallmarks of anxious individuals. These individuals tend to focus on the most negative possible outcome of any given situation. Decatastrophizing allowsfor balance and realistic focusing by examining the “worst possible outcome” and developing a plan of action. o Advantages and Disadvantages- for individuals who appear to be stuck between two options, examination of the advantages and disadvantages of certain situations helps them to develop alternative perspectives. This breaks the “all or nothing” mindset and permits a more balanced view of the situation. o Paradox or Exaggeration- this technique should only be used by the very skilled therapist; otherwise, the patient may view this technique as sarcasm or belittling. When used appropriately, the therapist takes an issue to the extreme to help the person see the absurdity of their sometimes-overinflated viewpoints. o Turning adversity to advantage- making lemonade out of lemons. The individual is helped to identify how to use what appears to be a negative situation to his or her advantage. o Cognitive rehearsal- prior to making a behavioral change, it is sometimes less threatening to “practice” the new behavior through visualization and discussion. o Automatic thought records- patients are asked to complete columns, identifying a troubling situation, resulting emotion, and thoughts associated with both. The therapist and patient work on clarification and development of “rational” responses to debate or challenge the original reaction. o Thought stopping- the patient interrupts his or her stream of thought with a sudden stimulus such as snapping a rubber band on the wrist,saying “stop it” out loud orsome other real or imagined stimulus and then changes his or her stream of thought. o Cognitive restructuring- use of an automatic thought record combined with other cognitive techniquesto effect changesin negative thinking patterns. Table 8.5 in book on page 321. Tune in…keep a thought diary. Focus on the words that are unhealthy. Stop the messages. Change the negative to positive. Behavioral Techniques o Assertiveness Training- prior to beginning the therapist needs to define the terms “assertive, aggressive, and passive.” Some individuals don’t perceive their behavior as aggressive and therefore educating the individual isimportant in modifying the behavior. o Behavioral RehearsalCh 1 Theorists: Elaine Miller-Karas says that one’s resilient zone (RZ) is an internal state of adaptability and "flexibility that is regulated by our nervous system. We feel at our best and can think clearly and deal effectively with life when we are in our RZ. She states that there is a natural biological rhythm of the autonomic nervous system between the sympathetic nervous system and the parasympathetic nervous system, and this corresponds to the RZ. The RZ is also referred to as the window of tolerance. Understanding, assessing, and managing anxiety is a cornerstone of Peplau’sInterpersonal Relations Model for Nursing (1991). adaptive information processing (AIP) model, developed by Shapiro as an explanatory theory for EMDR, is a metamodel for understanding mental health and psychopathology, and provides direction for planning therapeutic interventions Spielberger Trait Anxiety Scale; 22 on the Beck Depression Inventory, and a 27 on Dissociative Experiences Scale Psychotherapy interventions can be designed to target any or all areas of the dissociated memory or experience—behavior, relationships, beliefs, the body, images, and/or emotions—to facilitate healing and promote neurophysiological harmony Luhrmann (cultural anthropologist): Two schools of thought for psychotherapy. 1. The psychodynamic approach (nature vs. nurture and mental illness attributed to environmental and psychosocial issues) and the biophysiological model attributes mental illness to chemical imbalance (i.e., nature). The latter framework attributes mental illness to an imbalance of neurotransmitters in the brain, and the answer lies in correcting these imbalances, largely through medication. Epigenetics: Both genetic vulnerability and environmental influences play significant rolesin the development of mental illness Methylation: Methyl groups affix genes that govern the production ofstress hormone receptors in the brain, and this prevents the brain from regulating the response to stress. Telomeres, DNA protein structures, have been found to be shortened in the presence of trauma. Telomere length is associated with the production of destructive radicals and molecules, chronic inflammation, co-occurring psychiatric disorders, and a shorter life expectancy. Approximately 70% of adults worldwide experience at least one traumatic event within theirlifetime 25% of all adults have been physically abused as children. ACE (adverse childhood events) are associated with psychosis and that psychosis would be reduced by 33% if that risk factor were removed A diagnosis of PTSD plus depression and associated dissociative or borderline personality disorder appears to be a dose–response predictor for developing a chronic illness such as fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, chronic pelvic pain, and dysmenorrhea Treatment hierarchy framework for practice: Stabilization and Processing Stabilization (pg 30 APN book) strategies assist the person to be better able to make state changes, that is, to change one’s present physiology in order to function more effectively in the moment. List of strategies on pg 30 of APN book Processing: Processing is based on the idea that humans have an inherent information processing system that usually integrates experiences to a physiological adaptive state in which information can be taken in, and learning will occur. Pg 32 in APN book has list of examples. Both significant traumatic events and adverse experiences affect brain development and structure.