Counseling Exam: Development, Culture, and Ethics, Exams of Nursing

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Developmental & Cultural Considerations Misunderstanding the impact of culture on the process of counseling - ANS: -Holding mistaken assumptions about cultural assimilation and acculturation -Making stereotypical generalizations: ethnic gloss *Ignoring: -Cultural beliefs influence dx & tx -Dx differ across cultures -Sx differ across cultures -Clients express sx differently across cultures Multicultural Counseling - ANS: ✤ Culturally sensitive practices: counseling interventions ✤ Disconnect between cultural backgrounds of counselor & client may elicit differences in counseling process ✤ Clients have their own cultural perspectives; counselors do too ✤ Client's concerns are based on their cultural backgrounds ✤ Might have different perceptions of counseling process & outcomes of treatment Racial/Cultural Identity Development Model (Conformity) - ANS: Dominant group considered superior to ethnic group Racial/Cultural Identity Development Model (Dissonance ) - ANS: -Questions previous beliefs, struggles with discrimination -Positive views of own ethnic group Racial/Cultural Identity Development Model (Resistance and Immersion) - ANS: -Appreciation for own ethnic group

-Diminished valuing of dominant group Racial/Cultural Identity Development Model (Introspection) - ANS: Flexibility with both ethnic and dominant culture Racial/Cultural Identity Development Model (Integrative Awareness) - ANS: Both ethnic and dominant culture have positive and negative aspects Acculturation & Assimilation (Traditional) - ANS: Traditional Embraces traditional beliefs and values Acculturation & Assimilation (Transition) - ANS: Transition Holds on to traditional and dominant culture Acculturation & Assimilation (Biclutural) - ANS: Bicultural Accepts and is accepted by both dominant and traditional cultures Acculturation & Assimilation (Assimilation) - ANS: Assimilation Accepts only the dominant cultural beliefs and values Ethnic self-identification - ANS: Categorize self as member of an ethnic group Ethnic constancy - ANS: Acknowledge that ethnic characteristics are constant across time/place Ethnic role behavior - ANS: Take part in behaviors that reflect cultural values, customs, language Ethnic knowledge - ANS: Understand that some of their characteristics are relevant to own ethnic group

Ethnic feelings and preferences - ANS: Emotional response to own ethnic group! Skills of cultural competence - ANS: -Must acknowledge the reality of the cultural influences -Recognize differences as differences, not as deficiencies -Avoid stereotyping and an ethnocentric perspective African American Children - ANS: ✤ Encourage youth to talk about themselves, their families, and their experiences ✤ Focus on strengths ✤ Ask about social class status rather than making assumptions ✤ Ask for descriptions of holiday celebrations, kinship networks, and role of religion in their lives ✤ Solicit their concerns; gain their perspectives American Indian and Alaskan Native Children - ANS: ✤ Knowledge of & respect for Native American worldview is essential ✤ Individual's problem is seen as a problem of the community ✤ Sensitively and openly address issues of ethnic dissimilarity ✤ Consider degree of acculturation ✤ Consider having open-ended sessions free from time constraints ✤ Include family members and tribal elders (consultation) Asian American Children - ANS: ✤ Recognize difficulty of self-disclosure and meaning of restraint as an attribute of emotional maturity ✤ Recognize an individual's problems may be seen as shaming the family ✤ Keep questions relevant to the problem; avoid asking too many personal questions ✤ Focus on present time and on resolutions ✤ Work to gain an understanding of nonverbal communication Latino/a Children - ANS: ✤ Introduce yourself in a respectful, warm, and mutual manner ✤ Less acculturated youth: counselors considered an authority

✤ Describe counseling process and roles of counselor & client ✤ Solicit their concerns: gain their perspective ✤ Assess acculturation levels; influence of culture on worldviews ✤ Consider including family members (consultation) ✤ Reassure youth that sessions are confidential and information will not be released to government agencies Biracial and Multiracial Children - ANS: ✤ Develop a trusting relationship in counseling ✤ Understand that presenting problem may mask a deeper ethnic identity concern ✤ Assist in building self-esteem ✤ Understand the link between ethnic confusion and other developmental concerns ✤ Involve the family (consultation Ethical decision making model - ANS: o Develop an ethical sensitivity o Identify and define the problem - o Consider your own emotional reaction to the situation o Apply ethical principles and theories to the situation o Refer to professional standards, relevant laws and regulations and current ethics research o Consult with colleagues and or experts o Involve client in decision-making process o Identify desired outcomes and action to achieve those outcomes o Consider different courses of action o Choose an action o Reflect on the actions taken · *Principles of professional ethics: competence o Possessing adequate or better ability to complete some task physically, intellectually, emotionally or otherwise o Completion of appropriate program of study and attainment · * Autonomy and self-determination

o We maintain the dignity of all with whom we work o We respect the right of persons to participate in decisions affecting their own welfare o Encourage parent participation in child's educational programming o Obtain parent consent prior to establishing counselor-client relationship § They can have a chance to consent to or deny proposed services § Moral, political, religious differences - we have a moral obligation to allow the family to choose how to live their lives Parent consent - ANS: o Required when providing the following services § Psychological diagnosis § Assessment of eligibility of special education or disability accommodations § Ongoing counseling § Ongoing non-classroom therapeutic intervention - something that all kids are not receiving Parents have to "opt in" - ANS: o Must obtain written documentation o School district forms for spec ed assessment or services o Ongoing process § Parents should be informed of child's progress § Annual iep's § Informal check-ins with parents Components of informed consent - ANS: o Parent is fully informed about: § Nature and scope of services - what it is exactly - counseling, consultation, 1: § Goals and procedures § Foreseeable risks - pull out service - the risk is missing academic instruction § Cost of services - free § Benefits that can be expected o Limits of confidentiality o Who will receive information about the outcomes

o Possible consequences of services being offered o Available alternative services, if appropriate o Services provided by interns/practicum/trainees Bypassing parent consent - ANS: o Ethically permissible to bypass consent for the following services: § Emergency situations Student may pose a danger to others - ANS: · Student is at risk for self-harm · Student is in danger of injury, exploitation, or maltreatment Self-referrals · - ANS: · 1-2 session to determine nature and severity of presenting concern Ensure child's safety - ANS: · Does not establish therapeutic relationship · Child consent/assent o Assent refers to verbal or written permission - children under 18 cannot legally consent o Child can consent/assent to the following types of service Self-harm - ANS: § Suicide prevention § Chemical addiction or dependency § Sexual, physical, or emotional abuse o You may legally § Counsel the child without consent of parent or § Counsel child and then tell the parent even if the child doesn't consent to disclosure or § Rely on child's written statement that child has capacity to consent to tx w/o parental consent Principles of professional ethics: confidentiality - ANS: o We respect the right of persons to choose whether to disclose private information o Protect confidentiality of information

§ Students § Parents § Colleagues o Sexual orientation, gender identity, transgender status o Sensitive health information § Consult state laws & public health departments if potential health risk to others · E.g. HIV - some states require disclosure Privacy and confidentiality - ANS: o Inform boundaries of confidentiality at the outset § To parent - prior to onset of service § To client (student) - first session o Discuss and release confidential information § Only for professional purposes § Only to those who need to know o District specific forms for confidentiality Limits to confidentiality - ANS: o Threat to self and/ or others o Suspected child abuse and/ or neglect o Illegal bx o Court subpoena o If trainee for supervision purposes o Progress reports to parents and or school staff who work with child o Should obtain written documentation § Not legal mandate but ethical obligation o May require multiple reviews § Student whose confidentiality was breached previously § Student with trust issues § Student who is oversharing o May breach confidentiality if client consents to it

§ Written consent is not needed but write it up in case notes Reflect and follow up - ANS: o Would I treat other people the same in this situation? o Would I recommend this course of action to other counselors in similar situation? o How do I feel? Duty to report - ANS: o Mandated reporting of suspected child abuse o Must make a report when you suspect or have reason to believe that a child has been abused or neglected It is not our job to - ANS: o Determine what constitutes abuse and what doesn't o Investigate all details of suspected abuse/neglect o Inform parents or other school staff that a report has been made Mandating reporting in California - ANS: o Who: you (you can't delegate to other people) o When: written documentation within 48 hours of report o To whom: § Police or sheriff dept § County probation dept § Child protective services Duty to protect o Suicidal ideation - ANS: § Protect child from self-harm § Client's potential "dangerousness" · Level - mild, moderate, severe § Intervention and follow-up recommendations Inform parent - ANS: o Homicidal ideation § Protect others from harm

§ Assess level of risk: mild, moderate, severe § Interventions and recommendations depending on the severity of the situation § Inform parent about threat assessment · Tarasoff v Regents of the university of California - ANS: *** Duty to warn o The client's protective privilege ends when the public peril begins § Our obligation is to protect others o Tarasoff in California § Notify police § Warn intended victim and or § Take other reasonable steps to protect the threatened individual § Does not apply in all states FERPA Family Educational Rights and Privacy Act of 1974 - ANS: Federal law that protects the privacy of student educational records All schools that receive funds from U.S. Department of Education Right to review educational records n Right to request that a school correct records if misleading or inaccurate Must have written permission to release any information from student's educational record Psychoanalytic counseling (Freud) - ANS: -Theory: psychopathology is a result of unsuccessful progression through the developmental stages (getting "stuck") -Technique: Discuss client's childhood and bring client's unconscious motives to consciousness -Theory of personality -Determinism -Mental events are not random, haphazard, accidental, unrelated phenomena. They are causally related chains of events. Topography - ANS: All mental elements are judged by accessibility to consciousness.

Dynamic Viewpoint - ANS: The interaction of libidinal and aggressive impulses is biologically based and is more correctly defined by the term drives than by the term instincts Genetic Viewpoint - ANS: Psychoanalysts have empirically linked later conflicts, character traits, neurotic symptoms, and psychological structures to childhood events, wishes, and fantasies Id - ANS: -Present at birth, source of psychic energy (sex and aggression) -Pleasure principle - avoid pain, seek pleasure Ego - ANS: -Not present at birth but develops as the person interacts with the environment -Reality principle, can delay gratification and tolerate Superego - ANS: -Composed of the ego ideal (developed from what parents & others thought was good) and the conscience (from what parents & others thought was bad) -Moral, social, and judicial branch Defense Mechanisms - ANS: -Identification - development of role models to imitate or identify with (traits or total) -Displacement - redirecting energy from a primary object to a substitute when an instinct is blocked -Repression - forces a dangerous memory or idea into unconscious -Suppression - conscious effort to do same as repression -Projection - attributing one's own characteristics to others in the external world

-Reaction formation - development of attitudes or character traits exactly opposite of those repressed -Rationalization - justify one's behavior as worthy -Denial - refusal to face unpleasant aspects of reality -Fantasy - seeking gratification through imagination -Withdrawal - become passive to avoid being hurt -Intellectualization - separate the normal feeling from the unpleasant situation -Regression - retreat to earlier developmental stages that are less demanding -Fixation - remain at present level of development -Undoing - some form of atonement -Acting Out - reducing anxiety of forbidden desires by expressing them; act out to avoid accompanying feelings. -Compensation - covering up a weakness by emphasizing a desirable trait -Sublimation - redirect libidinal desires and energy into acceptable behaviors -Retroflexion - turning against the self; unacceptable impulse made acceptable by turning it against the self.

-Splitting - seeing as all good or all bad to deal with anxiety associated with ambivalence Psychosexual Stages - ANS: 1. Oral Stage - (birth - 18mos)

2. Anal Stage - (18mos - 3 yrs)
3. Phallic Stage (3-6 yrs)
4. Latency Stage (6-11yrs) - develop same-sex friends
5. Genital Stage (adolescence) shift focus to developing genuine relationships Psychoanalytically Oriented Approaches - ANS: -Insight-Oriented -For child with anxiety and internalized conflicts, who has age-appropriate ego development, shows evidence of internal conflicts, has the ability to trust adults, has some degree of psychological mindedness, and can use play effectively. -Goals are to help the child resolve internal conflicts and master developmental tasks Structure-Building - ANS: -For children with major problems developing good object relations, self/other boundary disturbances, and difficulty distinguishing fantasy from reality. -Therapist uses techniques that foster the development of object permanence, self/other differentiation, and modulation of affect. -Relationship with therapist more important than interpretation Supportive Approaches - ANS: -For children with externalizing disorders who usually have major developmental problems, a rigid defense structure, and less well-developed object relations than average.

-Many do not trust adults, not psych. minded Relationship with therapist is a major tx goal Projective Tests - ANS: *Rorschach *Thematic Apperception Test *Roberts Apperception Test *Drawings *Kinetic Family Drawing *House-Tree-Person *Bender-Gestalt *Sentence Completion Transference - ANS: A repetition of reactions originating in regard to significant persons of early childhood unconsciously displaced onto figures of the present Countertransference - ANS: The therapist's inappropriate reactions to his or her child client's and/or their parents during the treatment relationship Individual Counseling (Adler) - ANS: -Established the Society for Free Psychoanalytic Research, later changed to Society for Individual Psychology -Feelings of Inferiority are developed from early childhood due to dependence on parents -People behave in ways to give themselves feelings of perfection or superiority Teleological - ANS: -View of person as pulled by the subjective future rather than pushed by the objective past -People behave in ways to become the fictionalized ideal person they have established as a goal in their future, rather than reacting automatically to external events

Phenomenological - ANS: -Individual perceptions of events and relationships are governed by one's own unique view of the world. -Understanding one's relationship to others is the first step to understanding oneself Holistic - ANS: People are viewed as an indivisible entity Unresolved Problems - ANS: Unresolved problems of an individual may become problems for society if they are not treated. Neurosis - ANS: -An individual has a mistaken opinion of self and the world. The person has mistaken goals and a mistaken lifestyle. -The individual will resort to various forms of abnormal behavior aimed at safeguarding his or her opinion of self. -The individual is not consciously aware of these behaviors or processes. Lifestyle Types - ANS: -Ruling - Dominant in relationships -Getting - Expects things from others/ dependent on others -Avoiding - Shies away from problems -Driving - Wants to achieve; total success or nothingness -Controlling - Needs his/her own order -Victim - Suffering

-Martyr - Suffering -Being Good - holier than thou -Being Socially Useful The Counseling Process - ANS: Phase 1 - Establishment of the Relationship Phase 2 - Investigation of the Lifestyle Phase 3 - Interpretation of the Lifestyle Phase 4 - Reorientation Client-Counselor Relationship - ANS: In counseling, the client may fear: -Being Defective -Being Exposed -Being Disapproved of -Being Ridiculed -Being Taken Advantage of -Not being able to get help -Submitting to Order -Facing Responsibility -Unpleasant Consequences Specific Strategies: - ANS: -Basic Listening & Responding -Restatement -Reflection -Guesses -Interpretation -Nonverbal Behavior -Immediacy

-Confrontation Humanistic Therapies - ANS: o Person Centered Counseling (Rogers) *Child-Centered Counseling -Focus on child rather than the problem -Focus on feelings rather than thoughts & behaviors -Focus on present rather than past -Focus on understanding rather than explaining -Focus on accepting rather than correcting -Focus on the child's wisdom rather than your own wisdom -Core Conditions of Counseling: -Congruence -Unconditional Positive Regard -Empathy Child-Centered Counseling Process - ANS: 1. Individual comes for help

2. Helping situation is described as a chance to grow
3. Counselor encourages free expression of feelings about concerns
   4. Counselor accepts, recognizes, and clarifies those feelings
4. Client fully expresses negative feelings, then tentatively explores positive drive toward growth
5. Counselor accepts & recognizes positive feelings, which promotes insight & self-understanding
6. Understanding and self-acceptance becomes a foundation for change

8. Clarify possible decisions and courses of action
9. Small but significant positive actions
10. Further insight occurs
11. More positive action, less fear, more confidence
12. Client feels less need for help and recognizes the counseling relationship is nearing its end Gestalt Counseling (Perls) - ANS: -Psychological problems stem from being separated from important parts of themselves -Awareness of neglected parts of self -Restore, integrate, and balance -Value the here and now -Experience each minute fully -Embrace self-awareness and experience -Understand & accept all parts of self -Value wholeness and understand that life is a process -As we mature, we become more self-sufficient and self-understanding -Core Concepts *Awareness: -signifies emotional health -Inner self -External environment *Contact: -recognizing what's occurring here and now -Contact boundaries *Self: process of becoming -Always changing, transforming *Integration: -all parts of the person work in a well coordinated, wholesome manner

Focus on here and now, not on past or future - ANS: Self-awareness Integration & maturation are ongoing processes - ANS: New Gestalts are formed as new needs arise Therapeutic relationship - ANS: Supportive and confrontational techniques Goals - ANS: -Deeper awareness, which promotes sense of living fully -Integration Counseling Process - ANS: 1. Attend to the range of awareness

2. Commit to the here and now
3. Take responsibility for personal thoughts, actions, feelings, and sensations
4. Have meaningful communications
   5. Avoid questions
5. Take risks
6. Accept personal responsibility for change Layers of Neuroses - ANS: Phony layer Phobic layer Impasse layer Implosive layer Explosive layer Counseling Techniques: (Language ) - ANS: -Encourage use of "I" language -Won't vs can't -Avoid why questions

-Change questions into statements -Most questions are phony... we usually already know the answer -Take responsibility! -What percent of this situation is your responsibility Empty Chair - ANS: Goal: resolution of conflict within person or between people Variation: top dog vs underdog Resent, Demand, and Appreciate - ANS: Goal: integrate polarities & complexities of feelings Using the Body - ANS: -Identification -Locating emotions in the body -Repetition and exaggeration Solution Focused Brief Counseling (DeShazer) - ANS: -People do better when they concentrate on their successes rather than their failures -People have a tendency to focus on the negative

• Do more of what works -Stop doing what hasn't worked in the past -Problems result from not engaging in the whole range of possible behaviors/solutions -Small solutions lead to big changes -Counselors are not experts -Clients know themselves best -Focus on strengths, ideas, & solutions -Build client's confidence *Stages 1.Find a solvable problem 2.Determine goals

3.Plan an intervention 4.Draft strategic tasks 5.Focus on positive new behaviors and changes

6. Maintaining 7.Ending Techniques - ANS: -Scaling -Exception to the problem -Miracle question -Flagging the minefield -Writing a note Cognitive-Behavioral therapy (Beck) - ANS: Theory: cause & effect relation between cognitions, behaviors, and emotions Technique: change client's behaviors and cognitions to elicit changes in emotions Rational Emotive Behavioral therapy (Ellis) - ANS: ► People have powerful, innate tendencies to think irrationally ► People have both self-actualizing and self defeating tendencies ► We define selves as worthwhile if others do ► Emotional disturbance results in caring too much about what others think Musturbation

• Emotional Upsets largely stem from irrational beliefs: -Should, Ought, Must -Awfulizing -Self-damnation -I-can't-stand-it-itis

Assessing Emotions - ANS: -Assess emotional and practical problems Important to separate these two types of problems and explain the difference to the child -Assess all possible, different emotional reactions *lookout for

• irritation-anger-rage -concern-anxiety-panic -disappointment-sadness-down-depressed -Assess appropriate and inappropriate negative emotional reactions -Assess the intensity, duration, and frequency of different emotional reactions (thermometer) -Assess emotions in specific situations

• Rather than ask "How angry are you with your father?" ask"How angry were you when your father entered your room without knocking?" -Assess the behavioral consequences of different emotional reactions -Assess child's understanding of the connection between their emotions and behaviors often accomplished through motivation to try to change emotions -Assess secondary emotional problems -Assess emotional vocabulary ABC in REBT - ANS: (A) Activating Events, thoughts or feelings that happened just before I felt emotionally disturbed or acted self-defeatingly

(B) Beliefs or Irrational Beliefs about (A) (C) Consequence or Condition - disturbed feeling or self-defeating behavior- that I produced and would like to change

• DE - ANS: (D) Disputes for each Irrational Belief (E) Effective Rational Beliefs Assessing Cognitions - ANS: *Assess Errors of Inference (conclusions, predictions) -automatic thoughts

• faulty conclusions and predictions that a student makes about past, present, and future external events as well as misattributions of cause-effect relationships Assess Errors of Evaluation (irrational beliefs) - ANS: The manner in which the student appraises the significance of the initial interpretation or inference of reality and are typically manifested in absolutistic statements Inductive Awareness - ANS: help the child reveal his or her error of inference and then challenge each Inductive Interpretation - ANS: encourage the child to explore and collect a list of thoughts they have when experiencing disturbed emotions, many of these will be errors of inference Inference Chaining - ANS: Do not challenge errors or inference, instead accept as true and probe further to assess how the client evaluates the interpretations. Use conjunctive phrases (and, because) to follow line of reasoning Deductive Interpretation - ANS: When too young for inference chaining, suggest to the child what he or she might be thinking using suppositional language and directly ask for feedback on the accuracy. Know you could be wrong and use the child's comments to form new hypotheses Cognitive Change Methods (Disputing) - ANS: -Based on scientific method

-Involves a close examination of specific thoughts and beliefs of a student to determine the extent to which they are true (factual evidence to support them), sensible (logical), and helpful (leading to goal- directed feelings and emotions) Philosophical Disputation - ANS: - Best for clients over 11yrs of age, formal operational thought -Engage the client in a consideration of the logicality, empirical basis, and semantic meanings of irrational beliefs expressed as broad generalities and not tied to specific situations Disputation of Irrational Beliefs in Specific Situations - ANS: -Good with younger clients -Examine musturbating statements -Use self-concept tools, catastrophe scale Disputation of Inferences - ANS: -Empirical disputation -Teasing out whether there is objective evidence to support their conclusion -For example, to dispute the thought that "everyone is teasing me," make a class list and go over it REBT Cognitive Change Methods - ANS: -Rational Self Statements -Model the use of rational self-statements to replace irrational ones Play Therapy - ANS: -Structured, theoretically based approach to therapy -Intentionality -Ideal for children who struggle to express themselves using words -Typically 3-10 years old -Children with disabilities

-2 broad goals: *Decrease or elimination of symptoms *Enhanced development and future growth Related goals: - ANS: -Self-acceptance, self-confidence, self-reliance -Explore & express feelings -Alternative views of problems & relationships GROUP PLAY THERAPY - ANS: -Up to 6 children per adult, no more than 10 children and 2 adults -Range of functioning, but not too diverse -Social skills development -Research suggesting importance of ability to get along with others Play therapy Effective for - ANS: -Aggression, anger management -Attachment issues -Grief and loss -Divorce, family dissolution -Crisis/trauma -Behavioral disorders (anxiety, depression, ADHD) -ASD -Academic/social development -Learning disabilities -Conduct disorder TECHNIQUES - ANS: -Describe what the child is doing

-Keep descriptions vague -No interpretations or assumptions -Summarizing, reflection of feelings -Responsibility, self-reliance, self-confidence, feelings of control -"You feel..." rather than "... makes you feel..." -Allow children to take action or make decisions -Point out child's strength -Setting limits *Protect from harm (self or others) *Damaging property or play setting *Keep play media in the play setting *Session time limits -Techniques for setting limits *State the rules clearly *Reflect child's feelings *Encourage child to come up with alternative behaviors *State the consequences Storytelling - ANS: Exploration of emotions Identification of alternate endings/solutions Art - ANS: - Access to the unconscious Symbolic of emotions -Nonthreatening -Expression: re-creation of past, current or anticipated events -Free expression of feelings, needs -Content: stories, symbolism Puppets - ANS: -Play out their feelings Reenact events Try new behaviors -Tell stories -Play out their fantasies