This chapter reviews the theories of child psychotherapy and the associated treatment interventions as the next step of integrating theories of developmental psychology into clinical practice. It provides an overview of specific psychotherapies that are significant to the treatment of children; psychodynamic, cognitive behavioral, experiential, family systems, and integrative approaches. The chapter also reviews some of the diagnosis-specific treatment protocols. Trauma-focused cognitive behavioral therapy (TF-CBT) combines cognitive therapy, behavioral therapy, and family therapy in a specific treatment protocol focused on psychotherapy with children who have experienced trauma primarily from abuse. The chapter suggests that case conceptualization in eye movement desensitization and reprocessing (EMDR) with children can include both directive and nondirective roles from the therapist depending on the phase of the EMDR protocol and the individual needs of the child. EMDR is based on adaptive information processing (AIP) theory.
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In our success-oriented culture, optimal development of giftedness often is construed as fulfilling one’s potential for greatness. In humanistic psychology, optimal development has been conceptualized differently. Self-realization can be understood in terms of Maslow’s self-actualization, Dabrowski’s secondary integration, Jung’s individuation, or other theoretical perspectives of human development. The goals of inner development involve deepening the personality, overcoming conflicts, and actualizing one’s potential for becoming one’s best self. Many parents of the gifted complain that their children are the ones exerting the pressure. Their speed of learning and quest for knowledge often exceed their parents’ comfort level. The purpose of parent guidance is to foster “optimal development” through early intervention and prevention of social and emotional problems. Assessment can act as a prelude to family therapy. Family therapy usually involves a commitment to several successive sessions to deal with family interactions.Source:
It is critical to distinguish between how to approach medical crises and how to approach emotional crises. By contrast, emotional crises during drug withdrawal are best handled with supportive psychotherapy or family therapy, without resorting to medication, so that the individual’s opportunity for medication-free mastery and growth are maximized. A medical crisis often stirs up an emotional crisis. In addition, many physical illnesses can cause cognitive and emotional dysfunction by directly impairing brain function or by producing physical exhaustion. An evaluation is likely to disclose stressors or conflicts that have caused or contributed to the acute emotional distress. The Non-Emergency Principle or nonviolent communication requires the clinician to be self-confident and self-controlled, and react in an empathic manner, despite provocations or emotional turmoil emanating from the other person. During acute withdrawal, psychotherapeutic interventions should usually be limited to reassurance and guidance.
Wrapping up a solution-building session is about trusting the clients and trusting the process. Reflection teams play an important role in solution-focused therapy at the Brief Family Therapy Center in Milwaukee, but by taking a break to develop well thought-out compliments and suggestions for a couple, individual therapists can act as their own reflection teams. Using the couple’s own words is the most important step in formulating helpful feedback. It requires that the therapist pay close attention to the language used throughout the conversation and to stick with it. Feedback should be related to the couple’s strengths and the traits that have the potential to lead them away from their problem toward the preferred future. In early family therapy literature as well as early solution-focused literature, making suggestions and invitations was referred to as assigning tasks.
This chapter includes the guiding tenets of solution-focused therapy (SFT). Solution-focused (SF) practice differs from other therapeutic approaches in its use of solution building rather than problem solving. The solution-building process is about creating what is most desired by the couple, and not about problem solving. For a couple to be seeking therapy together, there has to have been a time in the past when the relationship was working better for both the parties. By focusing on the relationship and the skills that each partner uses to contribute to the relationship, the therapist conveys a level of hope to the couple. Solution-building conversations must be co-constructed with input from all participants. Motivation should never be in doubt, even if one member of the couple claims that he or she is only there because the other partner “made” them come to therapy.
This chapter presents a framework from which to assess how individuals approach relationships based on power, gender, and the social context. It addresses how to conceptualize individuals in terms of their orientations to relationship. Four relational orientations are described: position directed, rule directed, individuality directed, and relationship directed. Relational orientations are internal ways of experiencing oneself in relation to others. Relational Assessment demonstrates how relational orientations are context-specific and also shows that it can be valuable to help clients distinguish between their preferred orientations and what may actually be happening. The Contextual framework can also help family therapists keep relationships central and bridge the gap between individual and systems/relational assessments. The framework raises issues regarding our ethical responsibility when gender and power push relationships out of balance. Another set of ethical concerns involves who does the assessment and who sets the clinical goals.
One of the most trying aspects of training professionals to work with couples using solution-focused therapy is expecting professionals to go slowly and to develop a connection with their couples before moving on. In fact, the therapist is working to uncover the positive aspects of the couple’s life, and how they were living before their problem. Lipchik calls this process listening with a constructive ear probing for evidence of strengths, resources, and past success, learning what life was like before or without the problem, what the clients want, or anything at all that can be reinforced as a positive aspect of the client’s lives going forward. Every couple comes from a past when the relationship was working much better. The therapist listens for clues about how the relationship was built to understand what worked in the past and continues to work today.
Rational emotive behavior family therapy follows the principles and practice of rational emotive behavior therapy (REBT). REBT and cognitive-behavior therapy (CBT) have a good record as far as their basic personality hypotheses and claims for clinical effectiveness are concerned. The author began to do conjoint marital counseling and family therapy but found the techniques to be much more efficient and less time-consuming as he replaced analytical with REBT. Hassles and frustrations of living are the inevitable human condition. Parent or child one has to go along with many domestic restrictions, including room arrangements, money expenditures, meal scheduling, and a hundred other limitations. Family systems therapy tends to require an active-directive therapist who makes clear-cut interventions and who engages in a great deal of problem solving. Clients are held to be responsible for their attendance at family therapy sessions and for doing their homework assignments.
This chapter examines both the history and benefits of teaching specific models in Marriage and Family Therapy (MFT) supervision and then focuses on an integrative, moderate common-factors approach. MFT as a profession originated in the late 1950s and 1960s with a series of rebellious pioneers who rejected the dominant individual-based behavior and psychoanalytic models of the time in favor of something new. Supervisors who intend to integrate common factors into the supervisory experience and education have several tasks, possibly the most important of which is to provide education to supervisees about the factors that truly are common to all psychotherapy modalities. The chapter describes the seven common factors: client factors, therapist factors, the therapeutic alliance, hope and expectancy, allegiance of the therapist, feedback, and interventions, such as behavioral, cognitive, affective that cut across all models.
Murray Bowen Family Systems Theory attempts to explain life and the human phenomenon, rather than specific families. As with many early family therapists, the development of Bowen’s theory grew out of the decision to include family members in the treatment of patients diagnosed with schizophrenia. Bowen Family Systems Theory is based on the need for intrapersonal and interpersonal balance, with chronic anxiety and differentiation serving as the foundational constructs for the theory. These constructs are opposing: the former causing symptoms and the latter acting as the antidote. Bowen believed that family systems theory was describing life, not merely families, arguing that the constructs of his theory were universal to all genders and cultures. The implication of this belief is that culture-including race, ethnicity, gender, and the specific beliefs, values, and traditions that vary between people-does not matter and does not affect the ability for change to occur in therapy.
This chapter presents an overview of Marriage and Family Therapy (MFT) supervision was presented in a non-contextual format. The MFT profession has long recognized the pivotal role of supervision in preparing and socializing future generations of MFT professionals and in fostering the ongoing personal and professional development of both novice and seasoned MFT practitioners. The normative, socialization, educative, and evaluative functions are interrelated and intersect over the course of supervision. The functions represent a translation of the MFT profession’s ecosystemic perspective into a contextualized framework for supervision. Supervisors and supervisees bring their personal, family, community, cultural, and professional backgrounds to the supervisory encounter. The chapter explores the required tasks and structures to be developed, with a focus on multiculturally appropriate service at both the supervisory and therapeutic levels. It emphasizes the significance of an evolving contract and clear evaluation plan based upon self-assessment and reflectivity.
Feminist family therapy is a meta-philosophy: a group of feminist perspectives that can focus and expand psychotherapy models. This chapter reviews several feminist perspectives and how each can inform a feminist family therapy lens. It discusses the role of feminist clinicians, the process of change, specific feminist-informed conceptual and executive techniques, and the role of feminists as supervisors and trainers. Radical feminists paid most of their attention to gender but also acknowledged that racism, classism, and heterosexism also affected people in couples and families differently, and argued that overt attention to the origins and outcomes of power dynamics should be incorporated into the therapist’s work. Cultural feminism arose concurrently with the radical feminist critique and quickly brought into discussion the construction of social power as it intersected with class, ethnic identity, gender, age, physical ability, and soon thereafter sexual orientation.
The Emotionally Focused Therapy (EFT) supervision model is the first known empirically derived model of supervision in the field of couple and family therapy. This chapter presents the basics of the EFT supervision model, along with additional insights that have been gained by the authors since 2011. EFT is a humanistic, systemic, experiential model which posits that people and relationships can grow and change. The EFT therapist takes a collaborative stance and assumes that client emotions, experiences, and behaviors make sense in their context. An important part of EFT involves accessing, expanding, and reprocessing emotional experience. The EFT supervisor-supervisee relationship is one of collaboration and respect. Attuning to supervisees, like attuning to clients, demands flexibility and self-awareness. Recognizing the many levels of intervention-alliance, conceptual, experiential, and self-of-the-therapist (ACES)-provides a broad framework for the supervisor to meet the supervisee’s varying needs.
This book provides a comprehensive resource guide for Marriage and Family Therapists (MFTs), Approved Supervisors, and Supervisors-in-training. It looks at theories used in American Association for Marriage and Family Therapy (AAMFT) supervision and also at other important aspects of supervision. The book is divided into four parts. Part I focuses on supervision across time. The history and today’s trends have laid the foundation for the development of the process of supervision and show that the supervision process has to be flexible as the field changes and must be reflective of the field as it currently exists. The second part focuses on the nuts and bolts of supervision. Basic concepts such as how to get started in supervision, the various forms of supervision used by AAMFT Approved Supervisors, and the developmental readiness of the supervisor-in-training are dealt with here. Clinicians and researchers in the field are looking more critically, through empirical and other research, at how culture, race, and gender should be considered and addressed in the process of supervision. Part III focuses on theory-specific supervision. Various chapters cover the training imparted in structural therapy, strategic therapy, multigenerational family therapy, cognitive behavioral therapy, post-modern supervisor, systemic cognitive-developmental therapy, contextual therapy, the narrative therapy and others. The emotionally focused therapy supervision model is the first known empirically derived model of supervision in the field of couple and family therapy. Part IV deals with population-specific supervision. One chapter has been devoted to medical family therapy supervision and another to trauma supervision.
Adolescence is an extremely unique and critical stage of development. In order to provide the helping professional with a clear understanding of typical adolescent development, and to fill the gap many have in understanding adolescence in general, this book offers a concise, in-depth, scientific overview of adolescent development specifically geared toward those applying the information in the helping professions. The intended audience for the book is helping professionals such as psychologists, mental health counselors, social workers, marriage and family therapists, educators, and nurses. The book covers adolescent developmental theories that provide a basis for understanding observations about the nature of adolescents. These theories include the intrapsychic, cognitive, behavioral/environmental, and biological theories. Puberty is also the signal indicating the beginning of physical and neurological growth. The hormonal changes of puberty initiate drastic growth in the body and organs of adolescents. The book reviews several aspects of overall adolescent health, including the issue of adolescent sleep and its importance and how adolescent diet and nutrition impact development. In addition to the “hardware” transformation in an adolescent’s brain, adolescents undergo important changes in their ability to think. The book also examines Piaget’s adolescent stage of cognitive development, the formal operational stage, and how changes in the way adolescents think impact their interactions with others. It introduces the multiple social changes with family and friends that occur during adolescence and examines how adolescents interact with TV, media, and technology and deals with the issue of cyberbullying and reviews the most common adolescent problems, such as drug use, risky behaviors, eating issues, and depression. Each chapter integrates several features to guide helping professionals in applying adolescent development in practice.
Structural Supervision, adapted from the Structural Family Therapy model developed by Salvador Minuchin, is an effective supervision model used in Marriage and Family Therapy (MFT) training. This chapter discusses the components of using Structural Theory in supervision; the philosophical foundation of the theory; the use of techniques and modalities in supervision; the role of the therapist and supervisor; the process of change; and culture, gender, and diversity issues related to the use of this theory in supervision. It also includes a case example. Providing a theoretical foundation for supervisees is essential for the growth and development of Marriage and Family Therapists as well as for setting a standard for the profession. The primary goal in the Structural model of supervision is correcting the hierarchy. Creating healthy boundaries and an effective hierarchy are also an important process of change in Structural Theory.
The systems/dialectical model of supervision is based in emotional restructuring and isomorphic and developmental components. It consists of three simultaneously occurring stages or processes in which emotional, cognitive, and behavioral components interact to produce change: building relationships, breaking impasses, and orchestrating change. The systems/dialectical model of Marriage and Family Therapy (MFT) supervision was developed in a master’s-level program in order to apply a generic systems approach to supervision that would be compatible with various systemic approaches. Two guiding principles undergird the systems/dialectical model: the process of supervision is isomorphic with the therapy process, and developmental change occurs in both the supervisee and the couple or family. A systems/dialectical model proposes that the role of the therapist is to bring about change in the client using both implicit and explicit processes. A systems/dialectical perspective of cultural, racial, and gender factors in cross-cultural therapy is dialectical in nature.
The field of Marriage and Family Therapy (MFT) is on the fast track to becoming a prominent and competitive mental health profession, based on an expected growth in MFT jobs, as well as a growing body of clinical research. The Commission on Accreditation of Marriage and Family Therapy Education (COAMFTE) develops accreditation standards for graduate and postgraduate Marriage and Family Therapy training programs to ensure that students are getting a strong educational foundation in MFT. The COAMFTE focuses on the various aspects of MFT training, including the educational and practice regulatory requirements. Supervision for MFT students and postgraduates working toward licensure is generally provided by American Association for Marriage and Family Therapy (AAMFT) Approved Supervisors. Today’s fast-growing technology is affecting both Marriage and Family Therapy and supervision. Multiculturalism in a globalized society is important for marriage and family therapy students and supervisees as well as AAMFT Approved Supervisors.
Few guides exist that outline the use of contextual therapy theory as a supervision model for training systemic therapists. This chapter presents an overview of contextual therapy theory and its application to supervision, the role of the supervisor and supervisee, and the application of this supervision model to the given case example. The contextual therapy approach assumes an integrative, intergenerational stance, positing that both individual and relational realities constitute human existence. In order to examine both individual and relational realities in the supervision relationship, the contextual supervisor should incorporate the four basic tenets of the contextual therapy model into the supervision approach: existential facts/biology, individual psychology, transactional relational patterns, and relational ethics. The supervision relationship should also incorporate specific components related to ethics, such as fairness, trust, loyalty, and entitlement. The goals for training a contextual therapist mirror the goals put forth for the therapeutic relationship.
This chapter sheds light on how the managed care system works as well as the counselor's role in managed care and the importance of advocacy and issues related to payment and reimbursement. It offers a starting point to understand the system, and counselors must continue to seek more resources, join organizations and build networks with other counselors and change makers to become active members of the professional community. Managed care is an integral part of the healthcare system, and it is imperative for counselors to be able to understand the system in order to navigate it better. Counselors can anticipate the issues that are related to cost and payments and can provide more efficient service to the clients, if they understand how managed care system operates. The chapter demystifies the issues of payment for counseling services, specifically third-party billing, managed care, medical assistance programs, and other issues therein.
Angela was extremely excited to begin school as a kindergarten student and was matched with a supportive teacher for her first year in the rural community in which her family lived. She was lively and talkative around adults, and her parents worked hard to find opportunities for Angela to connect with kids her own age. However, in their small community there were limited possibilities for connection, and Angela often retreated physically behind her parents in public.
During the first parent–teacher conference for Angela, her parents were surprised at the teacher’s observations that Angela was reading well beyond the level of her peers. Not knowing many other children with whom to compare Angela’s abilities, they had assumed she was on par with most other kids her age. While there were no services available in their school system until the third grade, the kindergarten teacher remarked that the Lees might want to look into additional enrichment opportunities for Angela elsewhere. However, the teacher was eager to provide additional reading opportunities. Because reading was one of Angela’s favorite activities, this arrangement seemed to be a good fit.
It was during Angela’s third-grade year that challenges began for her at school. She often came home upset that she was reprimanded at school, and she rarely talked about positive interactions with her peers. She shared with her parents that she did not have much in common with many of the girls in her class, and that they often teased her about her friendship with a boy in the class they all thought was “weird.” This social tension was exacerbated when she was reprimanded for not showing her work in math class. She expressed her frustration with “Why do I need to write out all the steps for something when I just know the answer!” A friend of Angela’s parents worked in the school Angela attended and shared with them that contacting the school counselor might be the best next step.
This chapter provides a brief overview of models of clinical supervision. It also offers a brief discussion of best practices, common struggles, and a salutogenic- or wellness-based approach to supervision, emphasizing how the latter complements parallel treatment interventions with consumers. Self-care is an important part of a counselor's efforts to maintain general and mental health. The chapter urges counselor trainees to develop continuing education and continued professional development as a part of their career-pathway planning. The discussion emphasizes the importance of remaining current, concerning clinical counseling issues as an ethical issue that is inherent in being a professional. The chapter focuses on the practice and importance of clinical supervision and continuing education for professional counselors. It reviews some of the most common theoretical approaches to supervision and how they may be used. The chapter concludes with a discussion of the ethical mandate and benefits of continuing education for counselors.
School Counselors are uniquely positioned to work as individuals in educational settings to support children and their families, teachers, administrators, and other invested educators. This chapter reviews the school setting which presents distinctive legal and ethical challenges related to counseling minors. It discussed the various roles of school counselors’ within the school setting, as well as ethical challenges and considerations for practice. The chapter compares the ethical codes applicable to the practice of school counseling. It identifies strategies to maintain ethical school counseling practice. School counselors make significant contributions to the educational and personal development of students. When the law and ethics conflict or they cannot be clearly applied in the specific circumstances, school counselors seek consultation, consider ethical implications, apply an ethical decision-making model, and stay apprised of societal changes to make decisions ethically.
Counseling adults in transition is an exciting and challenging job that gives us an opportunity to function at many different levels. Advocacy, consulting, and program development are three ways that one can assist the clients with their transitions–through changing the situation, enhancing their sense of self, developing more supports, and increasing the strategies available to them. Some counselors now work in the corporate world, and others are community organizers; some counselors design programs in colleges and universities, whereas others develop workshops for senior centers; some walk the halls of legislatures as lobbyists, whereas still others talk about mental health on talk shows, on their own or others’ blogs, on twitter, or other internet sites and social media. This chapter talks about a variety of ways counselors can do these things, including consulting, developing programs, and advocacy.
The use of counseling technology and electronic communication between clients and counselors has received increasing attention. While there is great potential in using the internet to deliver counseling services, it is critical that counselors are aware of the ethical implications whenever they use technology to interact with clients. The chapter focuses on the ethical use of counseling technology and provision of distance counseling services. It identifies common ethical tensions underlying the decision to use technology when providing counseling services. The chapter promotes the critical-evaluative thinking underlying e-professionalism and technology ethics as necessary habits in the digital age. A focus on accessibility is critical because we are all dependent on digital technology as a necessary form of assistive technology to function in a digital society. Social media has become the way people communicate, and thus counselors need to inform clients about the inherent threats to privacy and confidentiality.
This chapter explores how pastoral counselors might work with queer-identified persons. It reviews theories of sexual orientation and literature establishing gay/lesbian-affirming approaches to pastoral counseling. The chapter considers emerging theories regarding “queer” identities and how such identities are related to prevailing constructs of gender and sexuality in psychotherapeutic discourses. Pastoral counselors working with queer-identified persons especially in couples and family therapy are challenged to critically reflect on and intentionally deconstruct the ways in which dominant discourses of gender and sexuality have become embedded in operative psychotherapeutic approaches. It is critically important for queer-affirming pastoral counselors to clearly identify the theological, scientific, psychological, anthropological, and sociological conclusions about human sexuality because each of these assumptions shapes the clinical practice. Pastoral counselors are encouraged to seek continuing education and specialized training before working with persons who are transgender, especially those who are actively seeking gender transition.
This chapter provided an overview of the possible effects that the work of counseling may have upon counselors themselves. It has long been recognized that exposure to the distressing experiences and feelings of others can cause similar distress in those who listen and provide intervention. We also recognize that counselors can derive benefit and grow from the work that they do with their clients. Finding approaches to the work of counseling that enhance the potential for growth while minimizing distress is significant part of maintaining successful counseling practice. The chapter addresses issues related to counselor self-care and maintaining a healthy ability to continue with the work of counseling. The issues that are addressed include vicarious responses to trauma (both positive and negative), a biopsychosocial systemic approach to counselor wellness, strategies for engaging in wellness-focused self-evaluation, techniques and tools for stress management, and approaches for maintaining a healthy work/life balance.
This chapter explores the issue of parental involvement in the internet addiction of their adolescent children. It describes familial and parental factors of adolescent internet addiction. The chapter then explores the relationship between parental mental health and their children’s Internet addiction taking into consideration parental Internet addiction, the mental health of the children, as well as the genders of parent and child using a structural equation modeling approach. There are many suitable instruments for assessing parent-and-child mental health problems and internet addiction, as well as their ways of coping such as Depression, Anxiety, Stress Scale (DASS), Internet Addiction Test (IAT), and Ways of Coping Revised (WOC- R) Questionnaire. The family therapy approach should be considered as a front line treatment option in handling adolescent internet addiction. Particular attention should be paid to the identification and treatment of any mental health issues within the family including parents and children.
Counselors and clients are immersed in a social and cultural context and embedded in multiple systems and subsystems, such as family, workplace, community, and society. This chapter addresses system views, integrated care, barriers to treatment, multicultural issues, and the use of multicultural and social justice skills in the provision of clinical mental health counseling. Specific topics include a discussion of systems, holistic care, barriers to healthcare, and culturally competent counselors. The chapter further explores the connections between culturally competent care and the potential role for clinical mental health counselors in ascertaining the systemic need for new agency- and integrated healthcare-based programs. The student is introduced to basic tenets of system worldviews, developing integrated new programs aimed at meeting the clinical mental health needs of diverse and varied clients, and the application of multicultural and social justice skills in clinical mental health counseling.
Our professional roles have evolved over time, and there is a great variety among the roles and functions of clinical mental health counseling (
CMHCs) in each and every different system of work. However, there are also great commonalities that continue to define our identity as professionals. This chapter takes an in-depth look at the variety of functions, counseling and administrative roles, and tasks that may be required of counselors in clinical mental health settings. Pertinent issues include balancing consumer care with administrative duties, balancing employee well-being with productivity standards/financial concerns, ethical marketing and recruitment, and remaining current in the field while in nonclinical roles. The chapter helps the reader to discuss the clinical tensions experienced among CMHCsin relation to their job roles and synthesize an understanding of the complex role a CMHCserves in relation to best practices, professional ethics, and legislative regulations.
Aside from the study of theories of counseling and psychotherapy, there is probably no other area of study that is more related to the everyday practice of counseling that than the area of professional ethics. This chapter defines terms related to the ethical practice of counseling and psychotherapy such as an “ethics”, “morality”, and an “ethical dilemma”. It differentiates professional versus philosophical ethics. The chapter outlines mandatory versus inspirational standards of practice. It also addresses professional credentialing issues, along with the need for ethical sensitivity in decision making. The chapter explains the system of ethics governance in counseling and defines skills necessary to become a professional decision maker. Decision making is a cornerstone of professionalism. Counselors must be viewed, and must view themselves, as intellectuals. They must also invest in their profession and be actively engaged in professional activities that better the profession and those served by the profession.
Children who have suffered attachment trauma due to maltreatment, neglect, separations, losses, and caregiver changes have difficulty trusting adults, accepting comfort, recognizing and managing their feelings, and managing their behaviors. The family therapist strengthens attachment security by helping the parents understand the traumatic roots of the children’s behaviors and respond to their children’s emotions with greater sensitivity. The Eye Movement Desensitization and Reprocessing (
EMDR) therapist implements EMDR Therapy resource development exercises to strengthen attachment security and self-regulation and addresses memories, triggers, and future templates, depending on the insights discovered and communicated by the family therapist. This chapter provides case studies that have shown EMDR Therapy to improve symptomology and attachment in adults with complex trauma. Attachment resource development (ARD) and Self-Regulation Development and Installation (S-RDI) with parent involvement during the preparation stage increase the child’s sense of security and capacity for self-regulation.
Documentation and record keeping are not only legal and ethical mandates, they are also instrumental in providing competent, quality care to clients. This chapter discusses the importance of the record keeping and documentation processes for clinical mental health counselors. Specifically, it reviews record keeping practices and policies. Also included are legal and ethical issues related to appropriate documentation and record keeping, including the Health Insurance Portability and Accountability Act, subpoenas, and court orders. The chapter helps the reader to distinguish the content of clinical records and identify what is included in a client's clinical file. It helps to recognize the ethical obligation of professional counselors related to record keeping; and appreciate the legal elements of record keeping and how professional counselors can adhere to the laws regarding clinical documentation. The goal of counseling is to facilitate change for the client; quality record keeping is an instrumental element of that process.
Counselors hear stories about what might have been, about what should have been, and about what did not happen. Yet much research and counseling advice has been focused only on marker events such as marriage, childbirth, changing jobs, divorce, or being fired. Most of these events are observable; many have rituals and celebrations attached to them. Counselors have enormous power to help clients exchange heartbreaks for heartmends. Counselors need to help clients deal with nonevents. Thus, this chapter focuses on specific suggestions and strategies for counselors to use with their clients. It suggests a three-step program for counselors to use as they help clients work through their nonevents. The three steps are counselors need to use are: understand the concept of nonevents as a way to listen with a third ear; develop specific strategies for clients to use as they cope with nonevents; and teach lessons for life literacy.
Grief counseling refers to the interventions counselors make with people recent to a death loss to help facilitate them with the various tasks of mourning. These are people with no apparent bereavement complications. Grief therapy, on the other hand, refers to those techniques and interventions that a professional makes with persons experiencing one of the complications to the mourning process that keeps grief from progressing to an adequate adaptation for the mourner. New information is presented throughout the book and previous information is updated when possible. The world has changed since 1982; there are more traumatic events, drills for school shootings, and faraway events that may cause a child’s current trauma. There is also the emergence of social media and online resources, all easily accessible by smart phones at any time. Bereavement research and services have tried to keep up with these changes. The book presents current information for mental health professionals to be most effective in their interventions with bereaved children, adults, and families. The book is divided into ten chapters. Chapter one discusses attachment, loss, and the experience of grief. The next two chapters delve on mourning process and mediators of mourning. Chapter four describes grief counseling. Chapter five explores abnormal grief reactions. Chapter six discusses grief therapy. Chapter seven deals with grieving for special types of losses including suicide, violent deaths, sudden infant death syndrome, miscarriages, stillbirths and abortion. Chapter eight discusses how family dynamics can hinder adequate grieving. Chapter nine explores the counselor’s own grief. The concluding chapter presents training for grief counseling.
- Go to chapter: A Context for Understanding and Beginning the Practice of Clinical Mental Health Counseling
It is important for beginning Clinical Mental Health Counseling (
CMHC) students to understand that their engagement in the CMHCspecialty is one part of the larger professional counseling framework. This chapter provides a historical overview of the counseling profession and its developmental trajectory, emphasizing the origins of mental health treatment and the reemergence of counseling as a wellness-based approach. It offers discussion concerning the push toward a pathogenic model of conceptualizing mental illness and the subsequent, current resurgence of a strength-based notion of care. The chapter provides an overview of the major theories of counseling as a means for understanding the development of counseling as a unique and separate field from psychology, psychiatry, and social work. It identifies the specializations within the counseling field, the range of employment opportunities and the current labor market, and how counseling is integrated within a system-of-care approach.
School absenteeism refers to physical absence from school, but school refusal behavior refers more broadly to child-motivated refusal to attend school. This chapter focuses on child-motivated school refusal behavior. Youth with school refusal behavior evince substantial heterogeneity in behavioral characteristics or symptoms. This population is notably high in internalizing behavioral problems, such as general and social anxiety, fear, worry, depression, self-consciousness, fatigue, and somatic complaints. Interventions for school refusal behavior can be arranged along a multitiered system similar to a Response to Intervention (RtI) model. RtI involves problem-solving-based interventions that focus on prevention, early intervention for emerging cases, and intense intervention for severe cases. The chapter contains a step-by-step process for several evidence-based interventions that address school refusal behavior in youth, including child-based therapy that focuses on anxiety management, parent- and family-based therapy that focuses on contingency management, and a broader approach that incorporates school personnel and other professionals.
Working with families can be helpful for promoting long lasting change in individuals, as it provides the therapist with a glance at the system in which the problematic behavior emerged. This chapter focuses on working with families as an efficient method of creating long lasting change in individuals and in the systemic interactions of a family. It reviews the cases that are seen in private practice and in many agencies today, therapists are incorporating family therapy into treatment plans. The contribution of Shannon Semersky, a Licensed Marriage and Family Therapist, demonstrates the applicability of Virginia Satir’s family sculpting within a solution focused framework. The chapter shows how using the SFNT approach helps couples reconnect with the times when they met and felt attractive to each other, thus, introducing a lens through which even the most distressed couples are able to view who they were and who they could be.
Aside from the study of theories of counseling and psychotherapy, there is probably no other area of study that is more related to the everyday practice of counseling that than the area of professional ethics. This book is a major revision of the prior edition, providing continuity to faculty who has used the book in teaching courses on ethics in counseling, but with notable changes and additions. The new edition has a distinct and timely focus on counseling as a profession. A new section provides material that not only applies to mental health practice generally, but it applies specifically to specialty practice with chapters specifically titled and focused on counseling specialties. Many of the early chapters are updated versions of those that appeared in the earlier edition. The book has been organized to provide the developing mental health professional with a clear and concise overview of ethical issues in counseling and psychotherapy. It intends to provide a thorough and scholarly foundation, defining ethical concepts and practice, legal issues, methods for clarifying values, decision-making models, and contemporaneous and emerging issues. The book is broad in its coverage of the most practiced specialties in mental health practice, and provides an efficient and effective overview of the broad scope of particular areas addressed in counseling. The specialities addressed are: mental health counseling; school counseling; couple, marital, and family counseling; rehabilitation counseling; addictions counseling; career counseling; and group counseling. It is hoped that this book will inspire ethically sensitive counselors and psychotherapists who will reflect before acting and who will consult with educated colleagues at those moments when ethical dilemmas arise. Ethical counselors and psychotherapists are those who have the best interests of their clients at heart, and who also respect the rights that derive from being professionals.
This chapter provides an overview of how clinical mental health counselors work with crisis, disaster, and trauma issues. A focus is placed on the pragmatic, neurobiological, and existential natures of crisis, disaster, and trauma along with the ways that these dynamics are implicated in numerous counseling scenarios. The chapter presents the basic crisis intervention skills, discusses disaster response, and emphasizes the importance of understanding trauma. It anticipates that students will have an advanced course that covers these important topics more fully. The chapter provides an adaptation-resilience building framework for conceptualizing disaster response. It then discusses the issue of psychosocial trauma from a multidimensional perspective, and elaborates some of the key aspects of trauma. The chapter explores the most salient issues involving crisis, disaster, and trauma, with a focus on their implications for the clinical mental health counseling (
The field of family therapy has been moving ever onward toward attempting to address the complex, multidimensional, diverse, and multicultural needs of the profession. This chapter presents a summary of Systemic Cognitive-Developmental Supervision (SCDS) and integrates a case study to illustrate basic concepts and use of the SCDS supervision model. Systemic Cognitive-Developmental Supervision is a supervision model that was developed upon the same theoretical foundations as Systemic Cognitive-Developmental Therapy (SCDT). SCDS is a supervision model that is built upon the theory of SCDT and is grounded in integrative, developmental, co-constructive, holistic, and systemic assumptions. The intersecting domains of class, gender, race, ethnicity, ability, sexual orientation, spirituality, and so forth also provide important context to supervision and therapy. Although the general SCDS model provides an important framework as a beginning, value is added by a knowledge of the developing literature on culturally sensitive therapy and supervision.
This chapter discusses the differences among children, preteens, and adolescents and the implications for treatment planning and treatment goals for these groups. It also discusses the inclusion of family and individual therapy, the inclusion of the school as part of the milieu, and some unique problems that may need to be addressed. The patient in the child cohort is cognitively concrete, and the clinician interventions may be as much family based as they are individual. Although there may be some depression and suicidality present, impul-sivity and aggression tend to be more common problems. The successful group therapy approach is group play for socialization and art therapy for expression. Family therapy is important for addressing behavioral issues in the home and for monitoring progress. The child and adolescent cohort is the only partial hospitalization program (PHP)/intensive outpatient program (IOP) cohort for which both family and individual therapy are program expectations.
This chapter presents cognitive behavioral therapy (CBT)-based techniques specifically for practicum and internship students and other trainee clinicians. Problem solving is another staple of CBT. The methodology for problem solving is a little bit different if it is done with an individual kid or in a family session. In research looking at what mediates benefits in family therapy, communications training and problem solving come out on top. This is a monstrously helpful technique. And it saves individuals and families all kinds of time and distress. The author appreciates that a mental health professional (MHP) gets extra data and can also try to be helpful with a wider range of problems that could be affecting the identified child client. The factors to be considered to introduce communications training and problem solving in a family or an individual session are: age, maturity level, and psychological mindedness of the child.
Clinical supervision is a crucial and necessary element in the helping professions. Supervision is the primary resource that trains therapists/counselors and helps them gain practical skills as well as knowledge that will assist them in becoming ethical and effective helping professionals. One of the hallmarks of Marriage and Family Therapy (MFT) training is supervision, specifically “live” or “raw” supervision. This chapter outlines four modalities of supervision, including case consultation, online supervision, videotaped supervision, and live supervision. Case consultation is a broad methodology used to better understand the process of therapy. One of the major attractions of cybersupervision is the ability to meet with supervisors regardless of their geographical locations. Online supervision challenges that assumption as the implications of autonomy, nonmaleficence, and fidelity may be debatable. Videotaped supervision allows the supervisor the time to review and conceptualize the case without the time constraints of live supervision.
The practice of professional counseling is governed at the national and state levels by a variety of governing boards and regulatory agencies. This chapter focuses on the legal and ethical issues that are salient to clinical mental health counselors. Specifically, it discusses the American Counseling Association (
ACA) Code of Ethics, the American Mental Health Counselors Association ( AMHCA) Code of Ethics, state licensure and national certification, confidentiality, mandated reporting, duty to warn, and scope of practice. The chapter also focuses on the responsibility of counselors to engage in ethically based practice. In addition, the chapter connects the ACAand AMCHAethical codes and the Council for Accreditation of Counseling and Related Educational Programs standards to several topics in ethical practice, including values clarification, bias assessment, boundary awareness and maintenance, and self-reflection. The chapter concludes with a case scenario to illustrate chapter concepts and a section on resources to provide further information.
Groups have been around since the beginning of humankind and across all cultures. People have historically gathered into groups to create, achieve, and resolve matters that would be otherwise impossible. Besides the potential to accomplish tasks, groups are sources of meaning and belonging, meeting needs for personal contact and interaction. This chapter focuses on group counseling as a useful modality for facilitating transition work with clients. Groups are complex, requiring counselors to combine individual counseling and group-leadership skills. It begins with some general information about the unique value of groups and discusses factors that are relevant to group work, including therapeutic factors, cultural diversity, and multicultural competencies. It also illustrates the different types of groups designed for adults who are experiencing various types of transitions. The chapter turns to an examination of the value of groups in helping people assess their assets and liabilities in each of 4 S areas.
Most families exist in some type of homeostatic balance, and the loss of a significant person in the family group can unbalance this homeostasis and cause the family to feel pain and to seek help. Specific factors that affect the mourning process and influence the degree of family disruption have been identified. These include stages in the family life cycle; roles played by the deceased; power, affection, and communication patterns; and sociocultural factors. This chapter discusses how family dynamics can hinder adequate grieving. The concept of family therapy is based on the belief that the family is an interactional unit in which all members influence each other. The characteristics of individual family members help determine the character of the family system, but this family system is more than the sum of its individuals’ characteristics.
This chapter provides a theoretical background for Medical Family Therapy (MedFT) as the systemic approach to integrated care as well as unique considerations for supervision in the integrated care settings where MedFTs typically practice. It consists case example to offers a frame and illustration for the application of this important approach. MedFTs master the elements of a traditional mental health intake to assess any psychopathology, history of past treatments, use of medications, family and social history, and relational dynamics that influence the exacerbation or maintenance of individual, relational, and/or health problems. In integrated care settings, a course of treatment typically unfolds episodically because the patients and their family members will have onsite access to return to psychotherapy when the need arises again. For most MedFTs, clinical care and supervision occur in an integrated health care setting.