Orientation and Ethics Final (Part 3)

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forensic clinical mental health counseling

  • Formal research, assessment, tx, and consultation undertaken with those interacting with courts of law as offenders, those at risk of offending, and victims of offenders

Counseling services related to the justice system

  • Conduct child custody evals
  • Provide expert witness testimonies
  • Conduct evaluations of competency

Ethical considerations associated with forensic work

  • Boundaries between client, counselor, and court system
  • Informed consent: nature of the eval and limits of confidentiality
  • Conflict of interest in multiple relationships
  • Objectivity in assessment
  • Explaining the benefits and risks of evaluation
  • Work within the legal scope of practice defined by your state

Training and Credentialing of forensic work

  • Currently no definitely training standards for forensic mental health counselors
  • Specializations offered in existing training programs
  • Post-licensure credentialing and training
  • Wide variety of credentials and specializations in forensic mental health

National board of forensic evaluators

  • Serves licensed Master’s level forensic mental health counselors
  • Only forensic credentialing body recognized by AMHCA and ACA
  • Supports the treatment of adolescents and their families through assessment and treatment planning
  • diplomat status certification

Requirements for Diplomat status certification

  • Three years post licensure experience
  • Minimum of 40 hours of training via classes, workshops, supervision, or publications
  • Support from three professional references
  • Written and oral examinations

Mental disorders and offending

  • Presence of mental dx is significantly higher in the incarcerated population
  • On average, person’s with serious mental disorders are three times greater in prison and jail than those in hospital

Common factors and symptoms in those offending with mental dx

  • Mania
  • Depression
  • Psychosis
  • Bipolar
  • Schizophrenia
  • Substance abuse/ addiction
  • High levels of co-occurring disorders
  • High levels of homelessness prior to incarceration
  • Low rates of employment prior to incarceration
  • Potential for violence

Roles performed by forensic mental health counselors

  • Assessment and evaluations
  • Child custody expert witness
  • Consultants for jury selection
  • Mediators
  • Risk assessment
  • Crisis management protocols
  • Research

Child Custody: Role of mediation

  • Work with couple to reach agreement on parenting and custody issues
  • Remain objective, maintain confidentiality, and facilitate effective communication
  • Remain neutral between both parties
  • Reach an agreement between the couple which will be enforceable by law

Child Custody: Role of Evaluator

  • Gather collateral information thru interviews, assessments, and direct observations from a number of sources
  • Prepare a report of eval for the judge which is easily understood, clear, and focused on behavior
  • Remain neutral, objective, and fair to both parties

Expert Witness

  • May be hired by court OR one of the other parties in the case
  • May be examined by attorney’s on both sides of the dispute
  • May act as researchers for the court on specific issues, such as child custody and adjustment issues

Competency in forensic CMHC

  • The Durham Test- states that a defendant is not criminally responsible if his unlawful act is the product of a mental disease or defect
    • Ambiguity of this has led to different adopted standards across the US

Person’s ability to stand Trial

  • Ability to aid in their own defense
  • Ability to understand and follow the court proceedings
  • Ability to understand implications and possible outcome of proceedings


using drug in large quantities, negative consequences



continued overuse despite negative consequences



compulsive substance use despite negative consequences. Physiological and psychological dependence



physiological and psychological symptoms when drug use ceases



use out of control. Escalating negative consequences in relationships, work, social


Phases of addiction

  • Phase 1: internal change
    • Relationship with drug replaces natural relationships. An addictive personality emerges
    • Self and addict, which propels into cycle of pain, need to use, use, pain from acting out, need to use
  • Phase 2: lifestyle changes
    • Cycle escalates, normal coping (Self) breaks down, “addict” wants isolation, “self” wants connections. Physical signs of breakdown
  • Phase 3: life breakdown
    • Symptoms of phase 2 escalate. All normal forms of coping (Self) break down. Resolving emotional issues works against addictive process

models of addiction

  • disease model
  • moral model
  • sociocultural model
  • psychological model
  • biopsychosocial model

Disease model of addiction

  • (medical)- progressive deteriorating disease, managed but not cured, loss of control, abstinence only option of control
    • Advantages/ disadvantages- removed stigma of addiction, clear goals, associated language. Removed responsibility, ignores other factors
    • Pedagogical activity – abstinence contract

moral model of addiction

  • moral weakness, flawed character, poor decision making, bankrupt spiritual life, punishment
    • Advantages/ disadvantages- instills choice and responsibility, empowers. Judgmental, minimizing complexity of addiction, stigmatizing, therefore builds resistance to recovery

psychological model of addiction

  • addiction driven by psychological stress, coping mechanism, addictive personality, address internal psychological pain
    • Advantages/ disadvantages- assuage guilt and shame, conceptualize underlying causes, range of helping interventions and strategies, addiction can be cure. Blame issue for addiction, not taking responsibility

sociocultural model of addiction

  • familial, peer, and cultural influences, examine individual in context. Drugs facilitate social interaction, time out, group solidarity, and repudiate middle class values
    • Advantage/ disadvantages: systematic look at addiction and abuse, community takes initiatives, value exploration. Displace responsibility, stereotyping cultures

biopsychosocial model of addiction

  • combines elementals of all of the models, addiction has many causes, tx is holistic and addresses underlying issues
    • Advantages/ disadvantages: all potential causes “captured” in one model, flexibility in care. Treatment can be overly complex, inefficiency and bewilderment in treatment process

Types of addiction disorders

  • substance use dependence with tolerance and/or withdrawal
  • substance use dependence without tolerance and/or withdrawal
  • substance induced intoxication
  • substance induced withdrawal

Substance use disorders

  • type of addiction disorder
  • can manifest as substance abuse and substance dependence
  • Substance dependence with tolerance and/or withdrawal—specified as “with psychological dependence”
  • Substance dependence without tolerance and/ or withdrawal—specified as “without psychological dependence”

substance induced disorders

  • type of addiction disorder
  • manifests as substance intoxication and substance withdrawal
  • Specifiers: early full remission, early partial remission, sustained full remission, sustained partial remissions, “on agonist therapy,” and “in a controlled environment”


  1. cut down (have you tried to cut down?)
  2. annoyed (are you annoyed when you can't have it or others tell you to cut down?)
  3. guilty (have you ever felt guilty/ ashamed about your use?)
  4. eye-opener (do you use substance as an eye opener in the morning?)

Treatment method and interventions for addictions

  • Select addiction model or integrated model
  • Therapy: individual, group, family
  • Counseling strategies: atheoretical (no particular theory) or theoretical (specific theory). Motivational interviewing
  • Empirically support treatments- recommendations by NIDA

42 CFR

  • Federal guidelines
  • any agency or professional receiving federal funding for substance addiction services must comply with 42 CFR. Confidentiality of client is protected, even though client is using illegal substances—except with written consent or in emergencies


  • losing control of one’s substance use after a period of no use. Very common
    • Different from lapse- this is one time use after a period of sobriety

types of internet counseling

  1. asynchronous counseling
  2. synchronous counseling

Asynchronous counseling

  • time gap between communication (e.g. email, bulletin board)
  • Email: counselor and client have time to reflect on writing before responding
    • Drawbacks: emails go astray, trustworthiness of sender and info, confidentiality, breakdowns, miscommunication, safety of client
  • Bulletin board or list-serv: anonymous and public posts, limited issues, moderated, reach multiple individuals at the same time

Synchronous counseling

  • no time gap between communication (e.g. chat-based, video-based communications)
  • Chat or text messaging: real time discussions, attend exclusively to dialogue, greater level of reflection, less inhibition, client sets pace of counseling, communication stored, more accountability
    • Precautions: ensures programs has complete and extensive encryption, for both counselor and client
  • Video: most closest to face-to-face counseling, video conferencing, free web-based video (e.g. skype) encrypted video chatting and audio chatting, visual cues and nuances
  • Virtual reality: participating and integrating in a three-dimensional world through an individual avatar. Client simulation, behavioral rehearsal, and other therapeutic benefits. Secure, potential for future

Establishing an online counseling practice

  • webpage
  • social networking
  • web-based practice management systems
  • technological competencies and skills

ethical and legal issues associated with internet counseling

  1. no oversight
  2. confidentiality and privacy
  3. misinterpretations
  4. management client crises
  5. identity
  6. therapeutic relationships
  7. lack of empirically validated techniques
  8. professional standards and accreditation
  9. professional standards are accreditation

examples of jurisdiction issues associated with internet counseling

  • problems with practice compliance because laws change over states
  • theoretical and legal belief that counseling happens in location of counselor. However, increasingly believed as counseling happening in state of client…confusion at this stage

examples of misinterpretation issues associated with internet counseling

  • due to lack of non-verbal cues
  • use emoticons
  • educate clients of limitation and ways to overcome barriers

examples of issues of managing client crises associated with internet counseling

  • cited as one of the greatest ethical concern for internet counseling
  • be aware of limitations to respond in emergency and duty to warn situations
  • differences in laws governing counselor and client locations

examples of identity issues associated with internet counseling

  • it is the counselor’s responsibility to take measures to secure the identity of the client and to provide self identification

examples of issues associated with internet counseling and the therapeutic relationship

  • relationship is different from that of FTF but evidence suggests a sufficient relationship can be created
  • increase in disclosure and honesty in internet-based counseling relationship

Informed consent and client contracts with internet counseling

  • Thorough understanding of benefits and risks of internet-based counseling
  • Counselor liability same as for FTF counseling
  • Client must be able to demonstrate understanding, not just ticking a box
  • Disclose modality is emerging, insufficient empirical evidence
  • Confidentiality and impact of technology

Online counseling skills

  • Current counselor training based on a FTF counseling modality transfers directly to online counseling
  • However, many of the online counseling modalities require these skills to be refined to adapt to the opportunities and limitations these modalities pose
  • Communication
    • Bracketing- inserting counselor thoughts, feelings, observations
    • Descriptive immediacy- describing the setting
    • Spacing and pacing- control pace of session
    • Boundaries of disclosure- greater and easier disclosure from both counselor and client

Bracketing skill

inserting counselor thoughts, feelings, observations in internet counseling


Descriptive immediacy skill

describing the setting in internet counseling


Spacing and pacing skill

control pace of session in internet counseling


Boundaries of disclosure skill

greater and easier disclosure from both counselor and client in internet counseling


Supervision definition

  • Intervention provided by a more senior member of profession to a more junior ember of members of the same profession
  • Relationship is evaluative and hierarchical, extends over time, has the simultaneous purposes of enhancing the professional functioning of the more junior person(s)
  • Monitoring the quality of professional services offered to the clients that she/he/they see
  • Serving as a gatekeeper for those who are to enter the particular profession

Roles of the supervisor

  • Advisor
  • Teacher
  • Mentor
  • Coach
  • Evaluator
  • Consultant

Who are supervisors

  • Counselors with training and experience who supervise
  • Voluntary national supervision credentials which includes at last 2 years post-Master’s degree counseling experience
  • Exact requirements are determined by each state as they are for licensure
  • NBCC provides a full directory of supervisors by state along with their qualifications

Two types of supervision

  • Clinical supervision: supportive and educative activities to improve application of counseling therapies and techniques directly to client
  • Administrative supervision: usually a managerial role over supervisee in which parts of the job relating to the delivery of services is addressed

Supervisory responsibilities

  • Monitor’s client’s welfare
  • Encourage and compliance with the legal, ethical ,and professional standards for practice
  • Monitor clinical performance and professional development
  • Evaluate and certify current supervisee performance e.g. academic, screening, selection

How to become a LPCC-S in Ohio

  1. One year and fifteen hundred hours of clinical experience post Ohio LPCC licensure.
  2. Document a minimum of twenty-four hours of academic preparation or board approved continuing education coursework in counselor supervision training including training six hours in each the appropriate areas
  3. Log onto the Board’s e-License system to apply for the supervision endorsement:

Supervision contract

  • Legal document
  • Extensive: includes all aspects of the working relationship
  • Supervision contracts for each student are developed to define roles and responsibilities of the faculty supervisor, site supervisor, and student during practicum and internship

Forms of supervision

  • individual
  • triadic
  • group

individual supervision

  • most preferred and cornerstone of counselor’s professional growth
  • you get this before you get your LPC in OH
  • you can get individual supervision when you're working towards your second C

triadic supervision

  • one supervisor and two supervisees, comparable to individual supervision. Time-efficient. Promotes vicarious learning, modeling, multiple perspectives, and role play different roles. Split-focus and single- focus forms
  • you can get triadic supervision to get your second C

group supervision

  • one supervisor and 6-8 supervisee. Time efficient. Benefits include reality testing self-perception, eliminating self- defeating behaviors, practice skills, and understand group dynamics, empathy, and social interests Fosters independence and universality within the learning process
    • **you will see this in prac and internships

The supervisee’s role

  • Self-assessment of one’s interest
  • Motivation for receiving supervision
  • Make informed selection of supervisor when there is opportunity for choice, e.g. fit specialty interests, location, and cost

supervision methods

  • self report
  • video tape/ audio tape
  • interpersonal process recall
  • reflective process
  • reflective teaming
  • live observation
  • live supervision

Video-tape or audio-tape supervision

  • offers supervisor direct access to supervisee work. Hear and see complexity of interaction and supervisee can view him/ herself as counselor

Interpersonal process recall supervision

  • supervisor and supervisee watch video of session together. Advantage of exploring underlying issues but interpersonal dynamics can become distorted

Reflective process supervision

  • socratic questioning to promote problem solving

Live supervision

  • interactive with counseling. Supervisor acts as coach; bug in ear, in vivo, phone-ins, consultation breaks, computer and television interactions