1. The Role of the Counselor
Last week
? Ted talk?

2. True Empathy is always free of any evaluative or diagnostic quality
True Empathy is always free of any evaluative or diagnostic quality. This comes across to the recipient with some surprise. “if I am not being judged, perhaps I am not so evil or abnormal as I have thought.”

3. How does this relationship vary from:
In relation to:
Friend
sponsor
Recovery coach
counselor
Boundaries
Closeness
Mutuality
Care-taking
Shared experience
Assumption of level of experience, training, professional ethics
friend- equal exchange, sponsor- exchange, acknowledgement one has more expertise than other, no privacy requirement, Recovery- para profess- paid service, to share lived exp and meet ct where they’re at goal of getting to more prof tx vs
Counselor- paid, unequal rel, bound by rules of employer, ethics, standards of prac, full focus on CLIENT welfare

4. The counselor role in the relationship is:
Ready
self-awareness in one’s own personal, prof, cultural life
Structured in time and space
Limited by time and reimbursement
Limited access
Does not extend beyond the professional relationship or beyond the (office)
Bound by laws of confidentiality and professional ethics
Counselor is there solely for good of the client
“professional objectivity” – or no ulterior motive

5. The client’s role:
The counselor is paid; Client has no obligation in reciprocating, except payment
Obligations are centered on rules of the tx setting, which client agrees to upon entrance into the tx relationship
No obligation of privacy
No obligation of care-taking

6. The client has a right to:
A relationship where their needs are primary
A professional that meets ethical standards
Privacy
A professional that in not impaired by: (p. 254)
By substances
Overwhelming life circumstances that interfere with ability to do the work
Burnout/ compassion fatigue, vicarious trauma
(self-care is needed when it’s vice-versa)

7. Would you? exercise Shake a client’s hand
Have a graduated client call you at the program to check –in
Loan a client bus money to get to a meeting
Loan a client money to buy a Xmas present for their child
Loan a client money for cigarettes
Hug a client
Have a graduated client call your cell phone to check-in
Hang out with or make social plans with a graduated client
Sponsor a client
Accept a gift from a client
Give client a gift
Practice when tired, distressed
Give client a peck on cheek
Go to the funeral of client’s mother
Have sexual contact with a former client
Have sexual contact with a current client
“boundaries”- usually organizations have rules along with ethics- ie: not accept gifts over $50
Gifts can have cultural significance- IE Portuguese home I visited

8. Ethics are based on a profession's Code of Ethics, and are not considered law. However, the Code of Ethics for your profession is important because many state licensing boards adopt them as the standard of conduct and standard of practice for the profession. This means that if you violate them, you can be sanctioned by the licensing board. Sanctions may include suspension or revocation of your license to practice. Additionally, with some ethical violations there can be grounds for legal/criminal action as well.

9. Code of Ethics establishes the boundaries of competence based on:
Required training
Education
Supervised experience
Competence means that you practice within the scope of your profession or field and within the limits of your education, training, and experience. You may apply a broader scope of practice under the supervision of an experienced colleague.
Malpractice is a legal concept describing a form of negligence. It means failing to provide professional services with the degree or skill that is ordinarily expected of other professions in similar situations. This substandard care results in injury or loss to the client.

10. What’s the number 1 cause for malpractice claims & disciplinary action against therapists?
Improper financial agreements
Breach of confidentiality
Sexual and other dual relationships
Lack of competence
C- sexual
43% of ethics complaints, 21% of malpractice suits

11. scenarios
Introduction to NAADAC/NCC AP Ethical Standards
Principle I: The Counseling Relationship
Principle II: Confidentiality and Privileged Communication
Principle III: Professional Responsibilities and Workplace Standards
Principle IV: Working in A Culturally-Diverse World
Principle V: Assessment, Evaluation and Interpretation
Principle VI: E-Therapy, E-Supervision and Social Media
Principle VII: Supervision and Consultation
Principle VIII: Resolving Ethical Concerns
Principle IX: Publication and Communications
p. 259

12. Privacy/Confidentiality
What is my client has broken the law?
What if my client says “if I tell you something; promise not to tell anyone else”
What if know my clients kids are being left home alone?
…. Or with someone who’s high?
What if the police come to the program looking for my client?
What is my client threatens to hurt themselves?
…Or someone else?
Should I with my client? Text? Social media?
What is my client wants to ready their record? Or wants a copy?

14. Privacy
Client’s right to confidentiality; client is owner of the information in the record, without permission; no release/ disclosure can occur, This right includes not only clinical info, but also any identifying info to ANYONE, even police
42 CFR HIV status, drug/ alcohol legal regulation
Exceptions:
*signed authorization to release info
*for treatment planning or supervision purposes
*safety and duty to warn
Ethical vs. Legal responsibility
*mandated reporting
*court orders
*minor child to parent or guardian
Client right to confidentiality- the client IS the owner of the record- not the folder; but all the info inside and they have a right as to say what is said about them and what is not.
Counseling relationships are based on trust- best way to keep trust is to be clear on the privacy rules and keep confidential info. Clients sense when we lie or cover up- they are experts and can see it in others. Don’t violate their trust with other clients, family members.

15. Mandatory Reporting
51A Law- if you suspect a child is being abused or neglected.
Report / call to DCF
24 hours a day
Followed by written report
Other required reporting
Disabled persons/ DPPC
Elderly / Elder Abuse hotline 60+
Urgent matters= police
Only suspect- you don’t have to have proof.
It’s DCf’s job to determine if it happened- you will not be held accountable if you are wrong. But you can be held accountable if you do not file.
What is abuse? Neglect?

16. How do I know when information is to be kept confidential or if something is an exception???...
You don’t have to remember all this information.
You don’t have to and shouldn’t make these decisions alone.
Consult your supervisor or your program’s medical records department.
Always document any time you have released/ disclosed client information
Same rule applies- if you don’t feel comfortable telling others how you handled information - you should consult with your supervisor.

17. Exceptions to privacy Authorization to release
For supervision/ case consultation
“Duty to warn” / duty to protect
Court orders
Safety:
Homicide
Suicide
Mandatory reporting
Tarasoff vs Univ of Ca – 1974-
Podder met tatina tarsoff In dance class in 1968 dated. She later refused his offers to be more serious. He began to stalk her. He entered emotional crisis; became depressed, isolated. When he saw tarasoff in public- would record her conversations to attain why she didn’t love him.
Podder saw a psychiatrist at UCLA berkeley. And disclosed his plan to kill tarasoff who had him detained. But was later released. Poddar stopped seeing psychoiatrist and later killed tarasoff. Duty to protect/ warn came about in the lawsuit; that included duty to warn the intended victim of impending threat, not just detain perpetrator.

18. Counselor Qualities Psychological contact Counselor congruence
Counselor being genuine and real
your feelings match what your saying
Unconditional positive regard
Counselor cares about the client as a person with potential
Respectful and non-judgmental
Competence in treating different populations/ 10A
Culturally different, Sexual orientation, Class difference, Hx of justice problems, Co-occurring disorders, teens/ adults

19. Cultural Competence
Agreed upon necessity; but no consensus exists on what that is
What is known is that the counselor should understand how to work with someone outside their own culture and strive to understand the specific culture of the client
Specific- do not assume certain stereotypes – ask for clarification. IE difference between a foreign born and US born. May identify with more “american “ identity than other country

20. Counselor Qualities Empathic understanding
Seeing things through eyes of the client
And communicating that experience, so that the client knows the counselor understands
One of the strongest predictors of counselor’s effectiveness (FIT)
Improvement and relapse rate were direct correlations to empathy level from 100% compared to 25%
“recovery” status is not correlated to counselor effectiveness
Sometimes a counselor in recovery can experience countertransference or early recovery challenges
Empathy skill is the ability to listen to your client, and accurately reflect back to them the essence and meaning of what they said
Sympathy is something you HAVE for others vs Empathy is something you provide/ do. Convey your understanding through reflective listening. Sympathy can be blocking “I feel so bad for you’- inhibts people telling you more.
3 questions.

21. Empathy- is it only held by those who have a personal experience?
Empathic understanding skills:
the ability to listen to your client, and accurately reflect back to them the essence and meaning of what they said
Active Listening- purposes
Allows you to pressure test your understanding of the client’s statements
Communicates respect, understanding and acceptance
Helps clients clarify their own internal processes and experience them in a non-judgmental place
Research shows whether or not the counselor is in recovery is unrelated to effectiveness. Having the skills has the biggest impact.

22. Counselor Qualities Empathic understanding skills: Concreteness
Assisting the client to focus on specific behaviors as related to the addiction
Immediacy
Interpretation as to what the client’s behaviors mean
Confrontation
Presenting the client with their own behavior and pointing out discrepancies in that behavior (ie: holding up a mirror)
Studies show the more the client is confronted directly about their drinking= the more the client drank

23. Case scenarios- A, B, C

24. Continuum of role/dependency
Allow ct self-actualization
Provides active/ authority role (confrontation)
Gestalt – people have the inherent growth tendency. “if you build it; they will come” approach. Ct holds the motivation to solve their own problems if provided with an accepting positive counseling relationship. Counselor’s presence has no direct impact. When theyre ready; they’re ready. Ct sets the goals and wait for the client to change. Vs
Concreteness, immediacy, confrontation
CBT/ Ellis
Believe counselor is an expert and ct cannot resolve alone
See counselor as being responsible for assessment and tx planning
Ellis believes in homework, - waiting for the client to change. (maybe too blaming or – if they don’t change; it’ on them)

25. Self-actualization
Counselor responsibility ends at setting up proper external conditions:
Empathy
Positive regard
Then wait for the client to change

26. Active role Clearly defined treatment objectives Homework
Gives the client more responsiblity

27. Best practice in recovery counseling:
Include both components
Come from understanding that addictions cause denial, loss of control= overriding poor choices to repeat self-defeating lifestyle
Skills of empathy and genuine care don’t matter if we never address or confront the addiction (esp. if client is in pre or contemplation phase)
Early stages of change= more active approach

28. Necessary tasks in addiction tx
Active direct, didactic approach, clear plan of action.
Assessment, tx planning, referral
Intervention to help client see substance
See confrontation as being genuine & honest
Clear understanding in difference between accepting a person vs accepting the behavior/ disease
Person is always worthy of help
Hold the hope for the client and see the opportunity to change

29. 12 core functions
Review examples in back of chapter- questions

30. First session Role Expectations Purpose Confidentiality
Early tx planning
The “are you in recovery” question

31. Empathy- gieco commercial
All about the nail