answer to peers

Christina T

RE: Theory and Ethics

I am curently conducting my internship at Wellmore Behavioral Health which is an IOP group setting. Open access is available daily for self-referrals who need group. I am currrently co-facillitating the women’s IOP group which consists of about 5 females. All of the females currently have substance abuse issues and DCF involvement. One particular female client stands out because she was living out of her car with her boyfriend of seven years who is also using. She was instructed by DCF to get into treatment and improve her situation if she wants to remain having custody of her 3 year old daughter. In her case person centered psychotherapy has been relevant for group therapy. Each client has their own goals, directed to meet their specific needs. This clients were instructed to set current realistic and humanistic goals for themselves which are attainable. This client stated that she wants to change to be a better person for her daughter and for herself as a mother. Person Centered Therapy is a humanistic for of psychotherapy that is very affective (Sapp,2010).  In Person Centered Therapy clients can change if they set the goals and take action towards negative behaviors. Within two weeks this client stopped living out of her car with her boyfriend and decided to make amends with her family. The client is now living back home with her family and seeing her daughter on weekends. The clients’ boyfriend has been popping up at her house with her family. Person centered therapy also allows clients to determine therapys’ direction (Sapp,2014). Last week the client was not on my list for a urine but she wanted to provide a sample anyway to continue to hold herself accountable. Client stated that she is determined to get her daughter back and do eveything that she can.

One ethical issue that I may encounter during my practicum/intership is  protecting clients from saying something that may harm them emotionally or psychologically. This specific facility is focused on group work. ACA A.9.b Protecting Clients states “In a group setting counselors take reasonable precautions to protect clients from physical emotional or psychological trauma (ACA,2014).” This writer is learning to do more listening and letting the clients process things and do more talking. The women’s IOP group is three hours in which they all must check in and talk about how they are doing and feeling. 

American Counseling Association.(2014). ACA Code of Ethics.

Sapp, M.(2010). Psychodynamic affective and behavioral theories to psychotherapy.Charles C. Thomas.

Susan Y

RE: Theory and Ethics

An important part of working with clients is being able to apply theoretical knowledge to your professional practice. Please discuss a situation in which you were able to use a theory in your work with a client. Be specific about the theory and techniques used, along with how it was appropriate for this client.

After reviewing the ACA Code of Ethics, what is one ethical issue that you may encounter in your work? What can you do to minimize your risk or ensure that you are handling the issue in an ethical manner?

Dr. McKinney and Class,

The theory that I am embracing for my professional development and professional competency is one that has transformed my life, polyvagal theory. Although polyvagal theory has been gaining widespread acceptance since its inception in the early 1970s, it does not have the hefty evidence-base for clinical efficacy that has been built for other therapeutic concepts like cognitive behavioral therapy. But rest assured… it will. 

Huttunen & Mednick (2018) believe that polyvagal theory can be used to explain how prenatal stress can increase the sensitivity of children for traumatic experiences and their risk for major psychiatric disorders. Porges (2009) shares that neural evaluation of risk (neuroception), does not require conscious awareness and that polyvagal theory helps to explain how the nervous system, independent of cognitive thought, continuously evaluates risk through the processing of sensory information from the environment and the viscera. Austin, et al. (2007) provided a study showing how the unique characteristics of autonomic regulation can be found in patients diagnosed with Borderline Personality Disorder (BPS) and shared that faulty neuroception of the environment provides invalid indicators of risk for those with BPD. Kirby Reuter (2021) writes “polyvagal theory has thus far provided us with the best working model of how trauma affects the brain and the body.” So it behooves me as to why we don’t have more emphasis on managing the dysregulated individual and less emphasis on diagnosing disorders. 

Dana, (2018) discusses how hierarchy, neuroception, and co-regulation are the three organizing principles of polyvagal theory and shares that “Hopefulness lies in knowing that while early experiences shape the nervous system, ongoing experiences can reshape it.” But until the time when I can branch out and begin establishing my own evidence that polyvagal therapies work to correct autonomic dysregulation, I am forced to continue delivering talk therapies (cognitive solutions) to a neuroceptive (subcortical sensing) distortion.

       I’m not unfamiliar with the ACA Code of Ethics. I think the issue that is most important to me right now is the respect for confidentiality and the protection of client information. In my position as a crisis counselor for youth mobile crisis intervention services delivered under the Emergency Mobile Psychiatric Services (EMPS) program in Connecticut, the youth/child is our client, yet they are typically under the guardianship of an adult caretaker. It is a slippery slope to navigate when you are called to respond to a suicidal child. We need to develop, and quickly develop, a therapeutic alliance with the client so they will provide truthful information about their suicidality. We need to do that in confidence, yet create a crisis management plan to be shared with the child/youth and their caretaker, to try and create and maintain an environment of de-escalation that will provide crisis stabilization for the child/youth, without violating privileged conversation capture in the diagnostic interview. This is where I believe science becomes art.

References

Austin, M.A., Riniolo, T.C., & Porges, S.W.(2007). Borderline personality disorder and emotional regulation: Insights from the polyvagal theory. Brain Cognition, 65(1), 69-76. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC20820…

Dana, D. (2018). Polyvagal theory in therapy; Engaging the rhythm of regulation. W. W. Norton

Huttunen, M.O., & Mednick, S.A. (2018). Polyvagal theory, neurodevelopment and psychiatric disorders, Irish Journal of Psychological Medicine, 35, 9-10. DOI:10.1017/ipm.2017.66

Porge, S.W. (2009, April). The polyvagal theory: New insights into adaptive reactions of the autonomous nervous system, Cleveland Clinic Journal of Medicine, (76)2, S86-S90. doi:10.3949/ccjm.76.s2.17

1. Reutter, K. (2021, September 14). Trauma stabilization through polyvagal theory and DBT. Psychology Today, https://ct.counseling.org/2021/09/trauma-stabiliza…

Emotional Dysregulation.docx (23.951 KB) 

1. Morreo G

RE: Theory and Ethics

Behavioral modification is the basis of Cognitive Behavioral Therapy.  I was privy to assist in a group counseling session in which the theory of Cognitive Restructuring was instituted.  Crum shares that “cognitive restructuring refers to the aim and process of an intervention to supplant dysfunctional cognitions with more adaptive ones, and the predominate means by which to facilitate this cognitive change are verbal intervention strategies”, (2021).  During this particular session, this client began to verbalize anxiousness, inabilities to rationalize and did not trust the current medications prescribed by the Md. Upon completing her Behavioral Health Assessment, the client presented with convincing notion that she would once again be subjected to the addiction of oral meds and ruin the sobriety that she had fought so hard to attain.  Her fear, in which I understood and was very compassionate, empathetic, and sensitive to was warranted.  Because I understood her hesitancy allowed me to connect with her on an interpersonal as well as intrapersonal level.    She verbalized increased anxiety, paranoia, and she verbally stated that because of her history of substance abuse, that she refused to become addicted to any, “pills again”.  

By utilizing Cognitive restructuring technique, (2021),  I was able to not only identify adverse and destructive thinking, but worked to reassure the patient, based on her previous medical history that she responded quite well to the oral dosage along with the clinical in person sessions during previous visits.  By utilizing cognitive restructuring, I was also able to interrupt this clients pattern of adverse and negative thinking by providing her with clinical evidence of past visits that there were no mental distortions or neurotic patterns of thinking when she followed the required regimen of clinical sessions along with the taking her oral meds.  

The interventions applied during this session was to have the patient began a consistent regimen of taking her oral medications, refrain from overgeneralizing her current disposition, reinforce her positive effort with words of affirmations, and that we would follow up with her in 4 weeks to perform a reassessment of the intervention practices that were put in place.  After reassurance and positive words of affirmation, along with “I statements”, the crisis in which the patient had been experiencing was averted.  

Crum, J., (2021).   Understanding Mental Health and Cognitive Restructuring With Ecological Neuroscience.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8249924/