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Issues and Ethics in the Helping Professions, 9th Edition
by Gerald Corey, Marianne Schneider Corey, Cindy Corey, and Patrick Callanan with Michelle Muratori, Johns Hopkins University © Cengage Learning. All rights reserved.
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Issues in Theory and Practice
Chapter 10 Issues in Theory and Practice © Cengage Learning. All rights reserved.
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Developing a Counseling Style
Ideally, the theoretical approach you use to guide your practice is an expression of you as a person and is the result of intensive study, reflection, and clinical experience. Ultimately, your counseling orientation and style must be appropriate for the type of counseling you do and the unique needs of your clients. © Cengage Learning. All rights reserved.
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Developing a Counseling Style
Theories of counseling are based on worldviews, each with its own values, biases, and assumptions of how best to bring about change in the therapeutic process. © Cengage Learning. All rights reserved.
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Developing a Counseling Style
Many of the assumptions of contemporary theories are inappropriate for evaluating clients from cultures that focus on interdependence, downplay individuality, and emphasize being in harmony with the universe. Practicing counseling without an explicit theoretical rationale is somewhat like trying to sail a boat without a rudder. © Cengage Learning. All rights reserved.
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Developing a Counseling Style
A theoretical orientation is not a rigid structure that prescribes specific steps of what to do in a counseling situation. Rather, it is a set of general guidelines that counselors can use to make sense of what they are hearing and what needs to change. © Cengage Learning. All rights reserved.
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The Division of Responsibility in Therapy
One way to clarify the shared responsibility in a therapeutic relationship is by a contract, which is based on a negotiation between the client and the therapist to define the therapeutic relationship. © Cengage Learning. All rights reserved.
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The Division of Responsibility in Therapy
A contract encourages client and therapist to specify the goals of therapy and the methods likely to be employed in obtaining these goals. Therapists who work within a managed care context need to discuss with clients how being involved with managed care will influence division of responsibility between the HMO, the client, and the therapist. © Cengage Learning. All rights reserved.
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Deciding on the Goals of Counseling
Both therapist and client should clearly understand the goals of their work together and the desired outcomes. The aims of therapy are specific to a particular culture’s definition of psychological health; no single approach is equally effective in working with all client populations. © Cengage Learning. All rights reserved.
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Deciding on the Goals of Counseling
In a managed care system, the goals will need to be highly specific, limited to reduction of problematic symptoms, and often aimed at teaching coping skills. In crisis intervention, goals are likely to be short term and functional, and you may be much more directive. © Cengage Learning. All rights reserved.
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Deciding on the Goals of Counseling
In schools, you may combine educational and therapeutic goals. In serving older adults residing in an assisted living community, you may stress coping skills and ways of relating to other residents. © Cengage Learning. All rights reserved.
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Techniques in Counseling
Practitioners need to function with intentionality. They must have a clear understanding of the techniques they employ and have a sense of the expected outcomes of their interventions. Some specific techniques appear to be more effective with particular symptoms and disorders, especially for certain behavioral disorders. © Cengage Learning. All rights reserved.
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Techniques in Counseling
The techniques counselors employ, although important, are less crucial to therapy outcomes than are the interpersonal factors operating in the client–counselor relationship. © Cengage Learning. All rights reserved.
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Diagnosis as a Professional Issue
Key terms: Medical diagnosis Psychodiagnosis Differential diagnosis DSM-5 © Cengage Learning. All rights reserved.
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Theoretical Perspectives on Assessment and Diagnosis
Psychoanalytic Therapy Adlerian Therapy Existential Therapy Person-Centered Therapy Gestalt Therapy Behavior Therapy © Cengage Learning. All rights reserved.
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Theoretical Perspectives on Assessment and Diagnosis
Cognitive-Behavioral Therapy Reality Therapy Feminist Therapy Postmodern Approaches Systemic Approaches © Cengage Learning. All rights reserved.
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DSM-5 Rather than utilizing the multiaxial system that has been in place for some time, the latest edition of the DSM has moved to a nonaxial documentation of diagnosis. © Cengage Learning. All rights reserved.
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DSM-5 In the DSM-5 revision process, the American Psychiatric Association paid considerable attention to: Developmental issues Gaps in the current system Disability and impairment Neuroscience Cross-cultural issues © Cengage Learning. All rights reserved.
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Arguments for Psychodiagnosis
No third-party reimbursement without acceptable diagnosis Difficult to formulate treatment plan without defining problem Provides team members with a common frame of reference Allows therapists to rule out medical conditions © Cengage Learning. All rights reserved.
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Arguments for Psychodiagnosis
Used to assess whether clients pose danger to self or others Provides framework for research May be a minimum standard of care for some licensed professionals © Cengage Learning. All rights reserved.
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Arguments for Psychodiagnosis
May seldom have a choice about diagnosis May be critical to determine therapeutic success Helps to normalize a client’s situation © Cengage Learning. All rights reserved.
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Arguments Against Psychodiagnosis
Emphasis of DSM is on pathology Can minimize uniqueness of client Ignores natural capacities for self-healing Can lead people to accept self-fulfilling prophecies © Cengage Learning. All rights reserved.
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Arguments Against Psychodiagnosis
Assumes that distress in family is result of individual pathology Many therapists are not competent to use DSM diagnosis properly. DSM has been criticized (e.g., reliability and validity questioned, failure to predict treatment outcomes) © Cengage Learning. All rights reserved.
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Ethical and Legal Issues in Diagnosis
Some practitioners who are opposed to a diagnostic framework take the path of least resistance, giving every client the same diagnosis. Presenting an “acceptable” but inaccurate diagnosis is both unethical and fraudulent. © Cengage Learning. All rights reserved.
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Ethical and Legal Issues in Diagnosis
It is an ethical (and sometimes legal) obligation of therapists to be mindful that a medical evaluation is many times indicated. Competence in using the DSM appropriately is an ethical issue. © Cengage Learning. All rights reserved.
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Cultural Issues in Diagnosis
Cultural sensitivity is essential in making a proper diagnosis, and a range of factors need to be considered in interpreting assessments. What is considered healthy can vary greatly from one culture to the next. © Cengage Learning. All rights reserved.
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Cultural Issues in Diagnosis
There is a tendency for some practitioners to overdiagnose, underdiagnose, or misdiagnose clients from marginalized groups. Accurate assessment and diagnosis involves taking into consideration realities of discrimination, oppression, and racism in society and mental health disciplines. © Cengage Learning. All rights reserved.
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Cultural Issues in Diagnosis
Consider the ways in which clients’ socioeconomic and cultural experiences can influence behavior, including the presentation of symptoms. © Cengage Learning. All rights reserved.
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Using Tests in Counseling
It is important for counselors to: Be familiar with tests being used and take tests themselves Recognize limits of competence to use and interpret tests Know reasons why a particular test is being used Make clients aware that tests are merely tools that can provide useful information © Cengage Learning. All rights reserved.
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Using Tests in Counseling
It is important for counselors to: Select tests appropriate for client given their unique cultural, social, and cognitive factors Give test results, not simply test scores Be sensitive to ways clients respond to results Assure clients that test results will not be used against them Assure confidentiality unless consent is given Know the limitations of tests being used © Cengage Learning. All rights reserved.
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Evidence-Based Therapy Practice
APA Presidential Task Force’s Definition, 2006: “The integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences” © Cengage Learning. All rights reserved.
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Evidence-Based Therapy Practice
The three pillars of EBP: Best available evidence, clinician expertise, and client characteristics EBP should enhance public health, It remains unclear and controversial whether EBPs perform reliably better than practices not designated as evidence-based © Cengage Learning. All rights reserved.
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Findings From Psychotherapeutic Research
Therapy is helpful to the majority of clients. Most people achieve some change relatively quickly in therapy. People change more due to “common factors” than to “specific factors” associated with therapies. In general, therapies achieve similar outcomes. © Cengage Learning. All rights reserved.
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Findings From Psychotherapeutic Research
Most therapists learn more about effective therapy techniques from their experience than from the research. Approximately 10 percent of clients get worse as a result of therapy. The relationship between therapist and client is the best predictor of treatment outcome. © Cengage Learning. All rights reserved.
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Findings From Psychotherapeutic Research
Experts showed strong agreement that research does not support the following assertions: Placebo control groups and waitlist control groups are as effective as psychotherapy. Therapist experience is a strong predictor of outcome. Long-term therapy is more effective than brief therapy for the majority of clients. © Cengage Learning. All rights reserved.
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