1. Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning Chapter 10 Issues in Theory and Practice

2. Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning 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. 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. Issues and Ethics - Chapter 10 (1)

3. Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning 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. 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. Issues and Ethics - Chapter 10 (2)

4. Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning 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. A contract encourages both 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 the division of responsibility between the HMO, the client, and the therapist. Issues and Ethics - Chapter 10 (3)

5. Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning Deciding on the Goals of Counseling Both therapist and client should clearly understand the goals of their work together and the desired outcomes of their relationship. 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. 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. Issues and Ethics - Chapter 10 (4)

6. Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning Deciding on the Goals of Counseling In crisis intervention, goals are likely to be short term and functional, and you may be much more directive. In schools, you may combine educational and therapeutic goals. As a counselor to the elderly in an institution, you may stress coping skills and ways of relating to others in this environment. Issues and Ethics - Chapter 10 (5)

7. Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning 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. The techniques counselors employ, although important, are less crucial to therapy outcomes than are the interpersonal factors operating in the client–counselor relationship. Issues and Ethics - Chapter 10 (6)

8. Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning Diagnosis as a Professional Issue Key terms: –Medical diagnosis –Psychodiagnosis –Differential diagnosis –Diagnosis and statistical manual of mental disorders (DSM- IV) Issues and Ethics - Chapter 10 (7)

9. Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning Theoretical Perspectives on Assessment and Diagnosis Psychoanalytic Therapy Adlerian Therapy Existential Therapy Person-Centered Therapy Gestalt Therapy Behavior Therapy Issues and Ethics - Chapter 10 (8)

10. Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning Theoretical Perspectives on Assessment and Diagnosis Cognitive-Behavioral Therapy Reality Therapy Feminist Therapy Postmodern Approaches Systemic Approaches Issues and Ethics - Chapter 10 (9)

11. Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning 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 Used to assess whether clients pose danger to self or others Issues and Ethics - Chapter 10 (10)

12. Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning Arguments for Psychodiagnosis Provides framework for research May be a minimum standard of care for some licensed professionals May seldom have a choice about diagnosis May be critical to determine therapeutic success Helps to normalize a client’s situation Issues and Ethics - Chapter 10 (11)

13. Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning 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 Assumes that distress in family is result of individual pathology Many therapists not competent to use DSM diagnosis properly DSM has been criticized (e.g., reliability and validity questioned, failure to predict treatment outcomes) Issues and Ethics - Chapter 10 (12)

14. Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning Ethical and Legal Issues in Diagnosis Some practitioners who are opposed to a diagnostic framework take the path of least resistance and give every client the same diagnosis. Presenting an “acceptable” but inaccurate diagnosis is both unethical and fraudulent. It is an ethical (and sometimes legal) obligation of therapists to be mindful that a medical evaluation is many times indicated. If practitioners do not possess the competence to use DSM diagnosis appropriately, this raises an ethical issue. Issues and Ethics - Chapter 10 (13)

15. Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning Cultural Issues in Diagnosis Cultural sensitivity is essential in making a proper diagnosis, and a range of factors need to be considered in interpreting the assessment process. What is considered healthy can vary greatly from one culture to the next. Accurate assessment and diagnosis involves taking into consideration the realities of discrimination, oppression, and racism in society and also in the mental health disciplines. Consider the ways in which clients’ socioeconomic and cultural experiences can influence behavior, including the presentation of symptoms. Issues and Ethics - Chapter 10 (14)

16. Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning Using Tests in Counseling It is important for counselors to: –be familiar with tests being used and taking tests themselves. –recognize limits of competence to use and interpret tests. –know the reasons why a particular test is being used. –make clients aware that tests are merely tools that can provide useful information. –Select tests that are appropriate for your client given his or her unique cultural, social, and cognitive factors. Issues and Ethics - Chapter 10 (15)

17. Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning Using Tests in Counseling It is important for counselors to: –give test results, not simply test scores –be sensitive to the ways in which clients respond to test 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 Issues and Ethics - Chapter 10 (16)

18. Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning Issues and Ethics - Chapter 10 (17) Critical Ethical Issues in Managed Care Informed consent ConfidentialityAbandonment Utilization review

19. Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning Financial Incentives in Managed Care Financial incentives inherent in managed care tempt both practitioner and payor to: Deny and limit access to long-term therapy Narrow the clients’ choice of a therapist Disrupt the continuity of care Rely on less qualified providers to provide services Issues and Ethics - Chapter 10 (18)

20. Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning Financial Incentives in Managed Care Use less qualified providers to review care Breach client confidentiality by giving reviewers too much personal information about clients Base practices on a business ethic instead of a professional ethic Issues and Ethics - Chapter 10 (19)

21. Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning 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” The three pillars of EBP: –best available evidence –clinician expertise –client characteristics EBP should enhance public health, yet it remains unclear and controversial whether EBP’s perform reliably better than practices not designated as evidence-based Issues and Ethics - Chapter 10 (20)

22. Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning 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. The relationship between therapist and client is the best predictor of treatment outcome. Issues and Ethics - Chapter 10 (21)

23. Corey, 8e, ©2011, Brooks/ Cole – Cengage Learning Findings From Psychotherapeutic Research Most therapists learn more about effective therapy techniques from their experience than from the research. Approximately 10% of clients get worse as a result of therapy. 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 Issues and Ethics - Chapter 10 (22)