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Reading notes, Melissa H. Michalewicz...

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1 Corey notes Chap 3 Ethics Mandatory ethics are minimum level of professional practice Aspirational ethics are focusing on what’s in the best interest of the client Positive ethics are doing whatever you can to help the client, not just the minimum Ask yourself, “Who’s needs are being met in this relationship? My client’s or my own?” If ethics are being questioned in your mind, consult with colleagues, keep yourself up to date with laws and developments in your field, engage in honest self-examination Self-monitor yourself, but don’t be too concerned- overthinking about getting sued limits creativity and effectiveness It is a counselor’s duty to intervene if they sees sign of impairment in a fellow counselor Use ethics codes as guidelines to make the best judgements possible DOCUMENT your suggestions to the client and reasons behind it Informed Consent Client should be informed about their therapy Helps empower clients and build a trusting relationship with you Should include discussing fees Modern technology complicates things Limit email exchanges to basic info such as appointment times Young clients should be informed the limitations of confidentiality prior to the session (Parents will be notified if…) Confidentiality Confidentiality is an ethical concept- legal duty of therapist not to disclose info about a client Privileged communication is a legal concept- protects clients from having their private info revealed in court without their permission

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This legal concept does not apply to group therapies, or any therapies with more than 2 people in the room

Therapist must let their clients know the degree of confidentiality that can be promised- should be informed early in counseling Clients should be informed if certain details of relationship will be shared with supervisor or colleague Exceptions to confidentiality must be considered with the laws, institution where they work, and the clients they serve. Counselors must exercise professional judgement because some circumstances will not be clearly defined by accepted ethics codes -If questionable, seek consultation and DOCUMENT it Report:  When client under 18 is victim of incest, rape, child abuse, or other crime  When therapist determines that the client needs hospitalization  When information is made an issue in a court action  When clients request their records be released to them or a third party Multicultural Ethical Issues Western models of therapy have limitations when applied to non-white cultures  Methods need to be modified according to client’s cultural background(s) When counselors focus too much on the therapies that work for the dominant culture, they are at risk for practicing unethically  Must be mindful of diversity and social justice issues if I want to practice ethically and effectively Both individual and environmental factors must be accounted for Multicultural counselors see practice to only be effective if interventions are aimed at social change that is responsible for the problem rather than blaming the client for their condition  You can help clients deal with their responses to their environment Ethical Issues in Assessing Assessment is evaluating relevant factors in a client’s life in order to help them and make goals Diagnosing is identifying a specific mental disorder that matches the client’s symptoms

3 Corey notes Assess the clients problems, then once the problem areas are identified, work together to come up with goals, and a treatment plan can be created Ethical codes do not provide clear answer, just an idea DSM-5 can help, but just use this as a framework- an actual diagnosis may be detrimental to the client  Defines problems that reside in individual, not society  Doesn’t take into consideration political, economic, social, and cultural factors that influence client’s life Must consider that different cultures have different norms  Certain behaviors and personality styles may be labeled as crazy in a different culture Your theoretical perspective may also influence your treatment plan Assessment and diagnosis should be a path worked in collaboration with the client and the therapist Ethics of Evidence-Based Practice EBP is the integration of the best available research with clinical expertise Tend to emphasize interventions based on best available research Downside is that it may seem mechanic and doesn’t take into consideration the many dimensions and individual variability  Raises question of reliability and validity Managing Multiple Relationships Dual or multiple relationships happen when the therapist assumes 2 or more roles at the same time with a client  Could be sexual or nonsexual  Professional & nonprofessional Ethics codes suggests, not mandates, avoidance of all dual or multiple relationships Very difficult to only play one role in a therapeutic relationship Not always unethical, could actually be helpful to the client- but know the limit (Benefit should outweigh the risk)  Discuss with the client what you expect of them and what they can expect of you  DOCUMENT the nature of this relationship

4 Corey notes Best option is to avoid non-professional relationships Develop appropriate and effective boundaries in your counseling practice Boundary crossing is departure from normally accepted practice that could potentially benefit a client Boundary violation is a serious breach that harms the client & is unethical Chap 4 Freud’s psychoanalysis Our behavior is determined by irrational forces, unconscious motivations, & biological and instinctual drives as these evolve through key psychosexual stages in the first 6 years of life Life instinct- we want to live, libido is the source of motivation that encompasses sexual energy + further Goal: Make the unconscious conscious Death instinct- sometimes people manifest their behavior through an unconscious wish to die or hurt themselves or others Id- the crazy, pleasure principle one strictly instincts, GREEDY ego- the “reality” one, BALANCE, the middle ground, traffic cop, realize that you have to balance the two out superego- the judge, ruled by moral principle, everything has to be done morally, unrealistic, do everything for others, strives for perfection, ALWAYS NICE The unconscious stores all experiences, memories, and repressed material  The aim of psychoanalytic therapy is to make the unconscious conscious Anxiety develops out of a conflict among the id, ego, & superego over control of the available psychic energy  Reality anxiety: fear of danger from external world  Neurotic anxiety: fear that instincts will get out of hand & will be punished  Moral anxiety: fear of one’s own conscience Ego defense mechanisms either deny or distort reality & they work on an unconscious level -All of them are on pg 62-63 Freud’s Psychosexual stages (pg 65)  Oral stage- inability to trust oneself & others; results in fear of loving & forming close relationships & low self-esteem

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Anal stage- pooping, inability to express anger, denial of one’s power as a person & lack of autonomy, aggression Phallic stage- inability to accept one’s sexuality & sexual feelings, difficulty in accepting oneself as a woman or a man Latency stage- socialization Genital stage- puberty, sexual energy, friendships, career

Erikson’s Psychosocial stages (pg 65)  Infancy: trust vs. mistrust  Early childhood: autonomy vs. shame & doubt  Preschool age: initiative vs. guilt  School age: identity vs. inferiority  Adolescent: Identity vs. role confusion  Young adulthood: Intimacy vs. isolation  Middle age: Generativity vs. stagnation  Later life: integrity vs. despair Classical psychoanalysis is based on id & believes that intrapsychic conflict are the basic factors shaping personality development Contemporary psychoanalysis is based on ego & doesn’t deny intrapsychic conflict, but also believes that ego strives for mastery & competence throughout the human life span -Blank-screen approach fosters a transference relationship in which client will make projections onto them  Therapist will become their “dad” they had issues with  client will become mad at counselor because he was mad at his dad  therapist listens to what is spoken & not spoken, infers the meaning of dreams & free associations A primary aim of psychodynamic approach is to foster the capacity for clients to solve their own problems Classical psychoanalysis- client sits on couch so they can’t see therapists face, counselor does not talk, only client (free association) Psychodynamic therapy is a shortened and simplified version of the lengthy classical psychoanalysis Countertransference- when therapists problems get projected on the client  therapists should get their own therapy Application:

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Free association Interpretation: pointing out, explaining & teaching the client the meaning of their behavior that is manifested in a verity of ways (dreams, defenses, etc.) Dream analysis. Latent content: hidden, symbolic, unconscious motives, wishes & fears. Manifest content: the dream as it appears to the dreamer. Latent content -> manifest content= dream work Resistance- anything that works against the progress of therapy

Countertransference in groups= counselor wants to be liked or she pushed clients onto her dominant values -Jung’s analytic psychology -Importance on psychological changes that are associated with midlife -creative expression His theory is based on the assumption that humans tend to move toward the fulfillment or realization of all their capabilities  Primary goal is achieving individuation (the integration of the conscious and unconscious aspect of personality Shadow- our dark side, primitive impulses such as greed and selfishness Dreams contain messages from the deepest level of unconsciousness, the collective unconscious  Archetypes- images of universal experiences contained in the collective unconscious. There are 3 most important ones: o Persona- the mask, or public face we wear to protect ourselves o Anima- represent the biological and psychological aspects of masculinity and femininity o Shadow- dark side Object-relations theory- attachment + separation Object satisfies a need, object=other, Other refers to an important person to whom the child, and the later adult, becomes attached. (usually mom) -Therapy used to be unequal between the therapist + client, but now working together Self psychology emphasizes how we use relationships to understand ourselves

Margaret Mahler-> contemporary object-relation theory -Believes that individual starts with psychological fusion with mother & progresses gradually to separation

7 Corey notes -Then, object relations of later life build on the child’s search for reconnection with the mother -First 3-4 weeks is normal infantile autism- inability to differentiate from mother - Next phase is symbiosis- dependency on mother, 4-5 months -Then, separation-individuation. Independence/ dependence from mother  Children who do not experience opportunity to differentiate may later suffer from narcissism  People with borderline personality disorder have moved into the separation process but have been thwarted by parental rejection of their individuation Brief psychodynamic therapy (BPT)- pre-established time limit (10-25 sessions) -not suited for all clients Some cultures may expect things from a counselor that you don’t have planned Psychoanalytic approach can be criticized for failing to address social, cultural, & political factors that result in a person’s problems Low income families may not be fond of the psychanalytic approach My summary of the psychoanalytic approach: looking at dreams, interpreting, free association, transference Chap 5 Adlerian Therapy We are motivated by social relatedness, behavior is purposeful & goal-directed, & consciousness is focus on therapy Inferiority feelings motivate us to strive for mastery, success (superiority), and completion Genetics & heredity are not as important as what we choose to do with the abilities & limitations we posses People change through social learning, but it’s recognized that biology & environment may limit us It’s a subjective approach focused on reeducating individuals and reshaping society A client’s subjective reality includes their perceptions, thoughts, feelings, values, beliefs, convictions & conclusions Adler chose the name Individual Psychology to understand the person as a whole, and not parts like the ego, id and superego (Holistic concept) We all have a goal, and most of our decisions are directed towards it (how we feel, think, act)

8 Corey notes Adler’s concept of striving for perfection implies not only striving for greater competence for oneself, but the greater good of others When we feel inferiority, we are pulled by the striving for superiority -The goal of success pulls people forward towards mastery & helps them overcome obstacles **superiority does not mean rank above others- it means moving from a perceived lower level to a perceived higher level in relation to oneself - To unique ways people to this is individuality or lifestyle Lifestyle- our perceptions regarding self, others, and the world- the way we think, act, feel, perceive, and live - An individual’s beliefs and assumptions through which the person organizes his/her reality and finds meaning in life event -We create our own world -Interpretations of events shape our personalities -We can reframe childhood experiences and consciously create a new lifestyle of living Social interest & Community Living are Adler’s most significant concepts -An individual’s awareness of being part of a community, & they’re attitudes in dealing with the social world Social Interest- Being just as concerned with others as you are with yourself We must master 3 life skills: 1. building friendships (social task) 2. establishing intimacy (love-marriage task) 3. contributing to society (occupational task) More often than not, when people seek therapy, it’s because they’re struggling with one of these tasks - Goal of therapy is to encourage clients to increase their social interest and modify their lifestyle “The Question”: What would you do if you were quite well? Birth order affects how life is seen: oldest, second of 2, middle, youngest, only -Affects a person’s life experiences -relationships with our families are the earliest & most influential social system Adlerian counseling rests on collaboration & reorienting the client toward developing the clients sense of belonging with community feeling & social interest

9 Corey notes Encouragement is most powerful method for changing a person’s beliefs- helps build confidence & courage (p.105) Therapists looks for major mistakes in thinking and valuing such as mistrust, selfishness, lack of confidence, and unrealistic ambitions When family constellation is summarized & interpreted, life story starts to form. Family has central impact on individual’s personality. (p 110) Counselor uses early recollections to assess (stories of SPECIFIC events that happened ONE TIME BEFORE THE AGE OF 10)- along with the feelings that came with them -aim is to provide a departure point for theory & understand their life story -shows how they view themselves, the world, life goals, motive, values, beliefs, & anticipations of the future -3 memories minimum, but as many as dozen  Helps assess client’s stance on counseling session  Assess convictions about self, others, life, and ethics  Verify the client’s coping patterns  Assess individual strengths, assets and inferring ideas This process of gathering early memories is called Lifestyle assessment In therapy, clients explore private logic, their bad thoughts that get in the way of social interest -learning how to correct them is central to therapy Relationship between client & counselor is collaborative, working equally towards goals Therapeutic contract sets forth goals 4 Phases of the therapeutic process: 1. Establish the relationship - start with client’s assets and strengths rather than their deficits -listen, respond, respect, care - More attention on the subjective experiences of client than techniques -work to understand client’s identity & experience of the world -verbal & nonverbal messages -provide structure, define goals, conduct psychological assessments, offer interpretations 2. Assess the individual’s psychological dynamics - understanding client’s identity & how it relates to the world -subjective interview (client tells his life story); empathic listening, “Is there anything else I should know about your concerns?”; “The Question” -objective interview (specific questions; p. 110)

10 Corey notes -These interviews are the beginning of lifestyle assessment (life story, how person copes with life tasks, uncover logic of that coping) 3. Encourage Self-Understanding & Insight -Understand their life motives -insight is a means to an end, not end itself Interpretation- suggestions presented tentatively in the form of open-ended questions that can be explored in the session -so clients don’t have to defend themselves & are free to discuss or even argue with counselor’s hunches 4. Reorientation & Reeducation -Putting insights into practice -Reorientation= shifting rules of interaction, process, and motivation -Clients modify their goals - Act as if they were the people they want to be -commitment is essential to reorientation -Push-button technique- bring up bad memory, poke left leg, bring up good memory, poke right leg (p. 116)  Helps client realize that they can regain a sense of control over their negative feelings Family counseling Group counseling:  Inferiority feelings can be challenged & counteracted effectively in groups  Group is a value-forming agent- fixes social & emotional problems  Provides sense of belonging, social connectedness, community  Altruism- helping others  Parallels social interest & community feeling  Brief approach to treatment (Adlerian brief group therapy)

Focus on multicultural and social justice issues -Focus on person in social context even though it’s called individual therapy -Clients are encouraged to define themselves within their social environments & to understand how those influence their lifestyle & health Can use a range of different techniques- adapt to each client’s situation Most counselors heavily focus on structure & dynamic of family (base their techniques on this) Culture affects subjective & experiential perspective of individual **SUMMARY: Help clients identify & change their suggestive, mistaken beliefs about self, others, and life in order to participate more fully in the social world.

11 Corey notes Therapists look at client’s best interests instead of putting clients into theoretical framework If clients change their thinking, they can change their feelings & behavior Chapter 6 Existential Therapy More of a way of thinking than a particular style of practice, no set of techniques Not really solution-oriented, more aimed towards removing roadblocks to meaningful living & helping clients assume responsibility for their actions Philosophical approach that influences the therapists practice Goal is to help clients with their exploration of the existential givens of life, how these are ignored or denied, and how addressing them can ultimately lead to a deeper, more reflective and meaningful existence. We are what we choose to be Therapist invites clients to explore their values and beliefs and take action that grows out of this honest appraisal of their life’s purpose. Early philosophers that contributed significant themes:  Kierkegaard: creative anxiety, despair, fear and dread, guilt, and nothingness  Nietzsche: death, suicide, will  Heidegger: authentic being, caring, death, guilt, individual responsibility, isolation  Sartre: meaninglessness, responsibility, choice  Buber: interpersonal relationships, I/Thou perspective in therapy and selftranscendence Ludwig Binswanger: Existential analysis- subjective & spiritual dimensions of human existence James Bugental: Life-changing psychotherapy- help clients answer how they’ve answered life’s existential questions & help them revise ...