Response Guidelines
Raymoni69
ResponseGuidelinesunit6.docxResponse Guidelines
Read the posts of your peers and respond to at least two. Try to choose those that have had the fewest responses thus far. For each response, identify other community resources that might be available in a case like the one your peer described. What crisis and confrontation skills might be necessary in assisting with the case presented?
Peer one’s posting
Discuss, while protecting confidentiality, a case example of codependency, dual diagnosis, addiction, or substance abuse you have encountered during your clinical field experience.
Client is a 55-year-old African-American male. He is widowed and currently resides alone. Last year he lost his wife to cancer. The client was diagnosed with HIV approximately 25 years ago but indicated that his wife was not “positive.” The client indicated having multiple concerns with his ability to eat, sleep, function from day to day, and that he is oftentimes afraid of what he might do to himself. Client was asked and also assessed for suicidal ideations, and was administered a PHQ-9 to assess if client should be further evaluated for depression or to determine if current symptoms are a result of “normal” grief. The client also expressed that he has a known opioid addiction to prescription pain pills. While in therapy, the client repeatedly expressed how much he was currently in pain.
Utilizing information from the course readings, describe the approach you used when working with these presenting issues, and how do you determine which approach would be most effective?
The intern and supervisor let the client express himself and his reasons for coming into the facility, as he presented himself to be in a crisis. One particular approach that the intern attempted to use with the client was motivational interviewing by expressing empathy, offering reflective listening, attempting to help the client develop self-efficacy, and attempting to understand where the client is and where he would like to be. The intern wanted to determine and help to strengthen the client’s motivation overcome his addiction in order to link him to other services, such as that could help provide pharmacological treatment, address physical health needs, and locate other social support systems that can be beneficial to helping his current presenting issues.
However, the client came to therapy and dropped out of therapy after the first session and did not keep his follow-up appointment for his HIV care, per the client’s primary physician. Thus, it is hard to decipher if the patient came to therapy because he wanted help dealing with his mental incapacities and his physical health or whether this was an outcry for an attempt to retrieve pain medications. Although Koehn and Cutcliffe (2012) suggest that instilling hope in individuals with addictions is a necessary component for clients to stay in therapy, Wachholtz, Ziedonis, and Gonzalez (2011) suggest that it is oftentimes more difficult to treat patients with comorbid chronic pain and addiction because they are most likely to have serious medical, psychological, or social issues compared to individuals who are currently in addictions programs or those who are non-comorbid chronic pain patients.
Discuss the personal reactions or feelings you had when working with this client. Discuss methods you used to address any countertransference.
To be honest, it was a bit overwhelming working with this client, but the intern and counselor supervisor tried to stay in coalescence with the client in order to ensure that we helped the client to our fullest potential while he was there and not cause further distress to the client.
Group Supervision
This week, we discussed some of our current or past sessions and encounters with clients, different interventions and techniques used, and whether they were deemed as effective in working with those particular clients. It was interesting to hear alternative suggestions for interventions that others felt would be effective in working with those clients. It was also expressed how psychoeducation can also play an important role in providing information to clients in order to help them better understand what they are going through, that they are not alone, and how they can better use this information to cope with their illness.
Kimberly
Koehn, C. & Cutcliffe, J. R. (2012). The inspiration of hope in substance abuse counseling. Journal of Humanistic Counseling, 51(1), 78-98
Wachholtz, A., Ziedonis, G., & Gonzalez, G. (2011). Comorbid pain and opioid addiction: psychosocial and pharmacological treatments. Substance Use & Misuse, 46(3), 1536-1552. doi: 10.3109/10826084.2011.559606
Peer two’s posting
Charlene, 49, experiences chronic, mild depression, with a sudden increase in symptoms. She identifies her live-in boyfriend as the source of her recent emotional downturn, reporting that he is emotionally abusive and drinks until he is intoxicated every day. Charlene says that she knows they “love each other,” and upon investigation, reports that “the whole thing is my fault.” The therapist recognizes codependency and refers Charlene to Al-Anon, which she tells Charlene will help with “dealing with an alcoholic partner.” Charlene's therapist provides Charlene with plenty of opportunity to express her feelings and needs and encourages Charlene to do so, validating Charlene’s experience and allowing her freedom to cry, laugh, and verbalize her thoughts.The therapist helps Charlene check her beliefs about herself, her boyfriend, and relationships generally, pointing out that Charlene cannot possibly rescue her boyfriend, and that people are responsible for their own behavior.
I have never had a case that dealt with codependency but during supervision we often talk about the different issues that come with codependency including taking on the addict’s responsibilities for them, their overdue bills, cleaning their house, filling their car with gas, or buying them groceries, telling lies for the addict, such as ‘calling in sick’ for them when they are actually too hung over to work, Bailing the addict out of jail or financial difficulty. Other examples include Finishing a project that the addict failed to complete on his or her own, threatening to leave or kick the addict out of your home if he or she uses again, but failing to follow through on your threats and Cleaning up after the addict. Perhaps they throw a tantrum, throwing things around and breaking them, and you clean it up.
A humanistic approach can be used as well because it helps the individual recognize their potential and allows them to make changes to their lives and come closer to what it is that they need to live a happier life. The counselor can also help the client connect with their special spirituality which is also important through this approach. Counselors can creating atmosphere that discusses spirituality providing books and videos to help them clarify their spiritual life and explore the 12-step program. For some just a thought that someone greater than themselves is comforting and gives them a sense of hope. (Koehn & Cutliffe, 2012)
Psychotherapy can help people understand why they overcompensate, fulfill everyone’s needs but their own, or put themselves last. Family therapy and cognitive behavioral therapy are both well suited to treating codependency, although any form of therapy is likely to help. A therapist can help a person identify codependent tendencies, understand why the behaviors were adopted in the first place, and develop self-compassion in order to heal and transform old patterns. Some interventions that I would consider using are the need for self-care. This would be important since the individual counseling we taking care of others and not themselves. Setting boundaries would be important at this time because the individual could learn how to invest more time in themselves and not in others.
Some feelings that come to mind is the inability to sympathize with the alcoholic boyfriend because I personally feel that taking responsibility for your behavior is important. So this is something that I definitely need to talk to my supervisor about because I'm not sympathetic towards those that are not able to take care of themselves and use others to their advantage. I had experienced this with my sister she actually went through this with someone that was an alcoholic and I lost a lot of respect for him after that.
A.4.b. Personal Values Counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients, trainees, and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature. (ACA,2014)
This week's discussion was about how we were doing at our site and her present cases that we were having issues with. I express that had a case about a Hispanic 14 year old girl the head of diagnosis of major depressive disorder. The client was having issues with her boyfriend and seems to be okay right now but also had external issues with her family possibly being deported for being in the United States illegally. Most of our faces sounded very challenging and Dr. Warren encouraged us to be to our site supervisors about these cases on a regular basis.
Koehn, C., & Cutliffe, J. (2012). Inspiration of hope in substance abuse counseling. Journal of Humanistic Counseling, 51(1) 78–98.
American Counseling Association. (2014). 2014 ACA Code of ethics [PDF]. Retrieved from http://www.counseling.org/Resources/aca-code-of- ethics.pdf
