Orientation and Ethics Final (Part 2)

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1

Consultation

  • Vehicle for problem solving
  • client centered or consultee centered
  • initiated by consultee or by orgs
  • Form of indirect intervention used to help support services provided by clients
  • Consultant will exit situation once purpose of consultation is resolved (Short term)
2

Supervision

  • Long term relationship (compared to consultation)
  • Hierarchical relationship providing developmental support for counselor
  • Collaboration involved direct services to clients
  • For ultimate welfare of client
  • superviser has legal liability/ responsibility for supervisee
3

Reasons for seeking consultation

  • skills
  • knowledge
  • confidence
  • objectivity
4

Dougherty’s model for consultation

  1. entry
  2. diagnosis
  3. intervention
  4. disengagement
5

1. Entry

  • ID problem and purpose of consultation
  • Establish expectations for consultation
6

2. Diagnosis

  • Consultant gathers/ analyzes info
  • Consultant estab. Goals and possible courses of action
7

3. Intervention

  • Consultant and consultee choose a course of action, implement it, and evaluate the outcome
8

4. disengagement

  • Consultant turns over the responsibility of the problem to the consultee
  • Consultation ends
9

Challenges to consultation

  • Having time
  • Intimidated by process
  • Intimidated by biomedical culture
  • Different ways of approaching problem
  • Confusion or misinterpretation of the profession of mental health professionals
  • Established power differential in relationship
10

Treatment teams & stakeholders and consultation

  • Client’s wellness holds primary status to stakeholders
  • Stakeholder only involved if effective and if interested
  • As number of stakeholders increases so does the resources required to manage the team
  • Treatment teams result in advantages for clients and stakeholders
11

Consultation roles

  • Trainer/ educator
  • Collaborator
  • Advocate
  • Expert
12

crisis

  • Critical incident- An event that is traumatic, or marked by fear, threat, and/or helplessness
  • result when subjective interpretation of the critical incident compromises the individual’s coping mechanisms, psychological defenses, ego strength, and homeostasis, with resulting distress
  • Immediate reaction: fight or flight continuum
  • Prolonged impact: adaptive functioning and coping, mental health disorder on a continuum
13

Basic skills of crisis counselors

  • Work with various frameworks (individual, group, teams)
  • Assessment: to ID tx
  • Understand effects, impact, and dynamics associated with crisis at diff. levels
  • Emotions and cognitive developmental models
  • Referral sources
14

Crisis counselors will focus on ___

  • Help client regain sense of control
  • Prepare client for critical incident
  • Foster social network of support
  • Help de-condition fear response
  • Help client make sense of traumatic experience
  • Avoid emotional and cognitive processing
15

Models of Crisis Intervention

  1. crisis in context theory
  2. psychological first aid
  3. preparation, action, recovery framework
  4. resistance, resilience, recovery model
  5. Robert's 7 stage crisis intervention model
16

crisis in context theory

  • model of crisis intervention
  • based on ecological approach; how individuals and communities experience critical incidents
  • layers of crisis (closer you are, the more effected you are), reciprocal effect (crisis impacts community, community impacts individual), mediation of time (time heals wounds)
17

psychological first aid

  • model of crisis intervention
  • contact/ engagement, safety/ comfort, stabilization, info fathering, assistance, connection with social support, info on coping support, linkage to collab services
  • when these things things are provided, a client can return to normal functioning
18

preparation, action, recovery framework

  • model of crisis intervention
  • goes from pre-crisis stage to post-crisis stage
  • assessment/ preparedness can reduce effect of trauma
  • CMHC as triage after event= we need to be ready
19

the resistance, resilience, recovery model

  • model of crisis intervention
  • uses a proactive approach
  • resistance (emotional immunity) and resilience (developed through this resistance and recovery) used positively
20

Robert's 7 stage crisis intervention model

  • model of crisis intervention
  • appropriate for responding to traumatic, existential, and psychiatric crises
  • a roadmap to guide client's recovery
  • 1. assess
  • 2. est rapport
  • 3. ID prob
  • 4. explore emotions
  • 5. ID coping mechanisms
  • 6. implement action plan
  • 7. follow up
21

crisis assessment: steps

  1. ID and clarify problem
  2. assure client is safe
  3. support throughout assessment process
  4. ID different possible alternatives
  5. make a plan for safety
  6. gain client's commitment to a plan for safety
22

crisis assessment: types

  • telephone assessment
  • in-person
23

Theories of suicide

  1. Not a specific disorder: impacted by biological, psychological, social, cultural factors
  2. Thwarted psychological needs and lethality are key elements
  3. Hopelessness primary factor for suicide
  4. Attempt to escape aversive self-awareness
  5. Lack of basic skills to build a life worth living; biological deficits, exposure to trauma, and inability to tolerate (-) emotion contributes to suicidal behavior
  6. Perceived ineffectiveness and resultant burdensomeness on others, thwarted belongingness, and an acquired capability for suicide. Interpersonal- Psychological Theory of Suicide (IPTS)***
24

Suicide in the US

  • More people in US die by suicide each year than by homicide
  • 3rd leading cause of death for young adults between ages of 15-24
  • Seconding leading cause of death for American college-aged students
  • Rates increase with age; highest among Caucasian elderly men over the age of 60
  • 90% of individuals who die by suicide had a diagnosable psychiatric dx at the time of their death
25

Grief models

  • **Kubler-Ross
  • **Parker
  • **Worden
26

Kubler-Ross Model

  • denial, anger, bargaining, depression, acceptance
  • grief model
27

PArker model

  • Alarm, searching, mitigation, anger, guilt, new ID
  • grief model
28

Worden model

  • acceptance, pain, adjusting, enduring relationship
  • grief model
29

Factors effecting the processing of grief

  • Circumstances surrounding death
  • Social stigma surrounding the person’s death
  • Depression and pain
  • Religiosity/ spirituality
30

specific interventions for crisis

  • CBT
  • Gestalt experiential activities (Empty chair)
  • Consider value of ritual in grief support
  • Symbolic gestures to remember or move on
  • Trauma subjectively defined and developmental
31

Risk factors for suicide

  • Psychiatric disorders
  • Past suicide attempts
  • Symptoms risk factors
  • Sociodemographic risk factors
  • Environmental risk factors
32

Protective factors for suicide

  • Internal: ability to cope with stress, religious beliefs, frustration tolerance
  • External: responsibility to children or beloved pets, positive therapeutic relationships, social supports
33

Warning signs of suicide

IS PATH WARM

  • Ideation
  • Substance abuse
  • Purposelessness
  • Anxiety
  • Trapped
  • Hopelessness
  • Withdrawal
  • Anger
  • Recklessness
  • Mood changes
34

psychosis

  • inability to perceive/ test reality
  • difficulty communicating clearly
  • trouble managing everyday living
  • subtypes: catatonic, disorganized, paranoid, residual, undifferentiated
35

Counselor's role in medication

  • In a position to first assess a need for meds.
  • Determine side effects of med
  • Educate clients about meds
  • these can be moderately controversial roles
36

Amygdala, Orbitofrontal Cortex, Insula and Cerebral Cortex and Medication

  • Alleviate anxiety, agitation and fear
37

Hippocampus, Spinal Cord and Medication

  • responsible for areas of mental confusion, amnesia and antiepileptic actions
38

Cerebellum and Brain Stem and Medication

  • mild muscle relaxing effects
39

Nucleus Accumbens and Medication

  • abuse potential and psychological dependence
40

Problems with transmission of messages

  • Initial neuron malfunctions and does not send message to next neuron
  • Receiving neuron malfunctions and does not receive messages
  • Messages become trapped in synapses
41

Barbiturates

  • Fast acting
  • Nonselective effect
  • Side effects
  • Increasing tolerance
  • Complicated withdrawal process
  • Easy to overdose
  • Seldom used today
42

Benzodiazepines

  • Most popular
  • Varies half-life
  • Prone to tolerance
  • Some withdrawal issues
  • Librium, valium, Ativan, Restoril, serax, xanax
43

Nonbenzos

  • Less potent
  • Low chance of addiction
  • Dew withdrawal symptoms
  • Benadryl, Vistaril, Inderal, buspar
44

Hypnotics

  • Not commonly used in US
  • Ambien
45

Monoamine oxidase inhibitors (MOAIs)

  • Attacks the enzyme that breaks down the amines promoting the “feel good” symptoms
  • Multiple side affects
  • Dietary restrictions
  • Not first choice of drug
  • Nardil, parnate
46

Selective serotonin reuptake inhibitors (SSRIs)

  • Block the reuptake of NTs from the synapses allowing optimum use for lowering depressive symptoms
  • Side effects
  • Not addictive
  • Low toxicity
  • Preferred drug of choice
  • Celexa, Lexapro, Prozac, paxil
    • Celexa and Lexapro are exactly the same except for one chain.. celexa causes sexual dysfunction and lexapro doesn’t
47

Heterocyclic antidepressants:

  • Impact multiple NTs
  • Combination of affects from tricyclics and SSRIs
  • Cymbalta, Strattera, Wellbutrin
48

Lithium

  • (mood stabilizers)
  • Highly effective for symptom relief but very narrow therapeutic window
  • Patient must be closely monitored
  • Patients are usually prescribed lithium as a first choice and other their life time
49

Anticonvulsants

  • Work to slow brain down and calm symptoms of mania
  • 3 mains ones: Carbamazepine, Valroic Acid, Lamotrigine
50

Typical antipsychotics

  • Neuroleptics, effective in treating positive symptoms but increase negative symptoms due to side effects.
    • These include “first generation antipsychotics” e.g. Haldol, Thorazine, Prolixin (long lasting but has severe side effects).
51

Atypical antipsychotics

  • Fewer side effects compared to typical antipsychotics but very expensive.
    • These include “second generation antipsychotics” e.g. Clozaril, Zyprexa, Risperdal Consta (long lasting)
    • New “third generation antipsychotics” include Abilify and Zyprexa. Fewer side effects than second generation antipsychotics.
52

Pharmacodynamics

  • How medication affects the body
  • Agonists drugs: increase body’s response or natural state
  • Antagonist drugs: block normal responses
53

Medication to treat anxiety

  • Antianxiety meds increases the inhibitor effect of GABA (put the breaks on in the brain)
  • barbiturates
  • benzodiazepines
  • nonbenzos
  • hyponotics
54

medication to treat depression

  • MAOIs
  • SSRI
  • heterocyclic antidepressants
55

medications to treat bipolar

  • lithium
  • anticonvulsants
  • atypical antipsychotics
56

medications to treat psychosis

  • typical antipsychotics
  • atypical antipsychotics
57

Why do counselors discuss medication use with their clients?

  • psychoeducation
  • anxiety: risk of dependency; short term vs long term symptoms management
  • depression: meds don't work fast, multiple side effects, impacts of medication on sexual functioning