Reaction paper 2

Nova Southeastern University

Dr. Berger

June 3, 2017

Introduction Comment by Carolyn: APA style recommends using headers to keep your paper organized Comment by Carolyn: I didn’t see an introduction to the paper… I added this section so you can see how to do it for the next paper.

Insert intro here

Countertransference

Murphy (2013) explained that the concept of countertransference was originally developed by Sigmund Freud. This concept can be described as a largely unconscious phenomenon in which the psychologist’s emotions are influenced by a person in therapy where the psychologist reacts with countertransference. Carl Jung, a classical psychoanalyst, characterizes countertransference as a potentially problematic phenomenon that can inhibit psychological treatment if left unchecked (Murphy, 2013). Therapists are required to master the tendency to participate in unconscious countertransference by developing boundaries that are healthy. Therapists must also remain mindful of threats caused by countertransference.

The American Counseling Association (ACA) Code of Ethics Section A.4. details the responsibility of counselors to avoid harm and impose values. Specifically, Section A.4.a. notes that Counselors must conduct themselves in a manner that will help them to avoid impairing their clients, apprentices, and research contributors and to reduce or to remedy inevitable or unforeseen damage. Section A.4.b. outlines how counselors must be being aware of and avoid commanding their personal values, attitudes, beliefs, and behaviors on their clients. Counselors must reverence the multiplicity of clients, trainees, and research participants and try to find professional development in areas in which they are susceptible of imposing their values onto clients, particularly when the counselor’s values conflict with the client’s goals or are biased. Comment by Carolyn: Excellent job citing multiple codes and specifying which apply to values. However, I was a little confused as to the placement of this paragraph- it would go better in the second issue that relates to values. Comment by Carolyn: This code could apply to the #2 issue which was regarding values in counseling (see next section).

Many writers have made distinctions between positive and negative countertransference with some of them insisting that the feeling of the therapist should also be considered with regards to countertransference. Others restrict it to the therapist’s unconscious reactions. Distinctions between positive and negative countertransference have been presented in contemporary psychology with many psychologists sharing their own feelings openly with their patients by using countertransference in a positive manner to comprehend their own experiences and the experiences of their patients. Negative countertransference occurs when the therapist transfers misplaced feelings to a patient during therapy. Comment by Carolyn: Make sure to cite a reference here.

Over-identification with individuals is usually an issue I struggle with when communicating with patients. I try to take the lead during conversations, provide prompts regarding my previous experiences, and encourage patients to discuss their issues. This process often leads to me empathizing with the patient, but conversely makes the patient understand the effects that such experiences can have on other individuals. I am very attentive about ascertaining my feeling and fears when it comes to patients who have experienced trauma or stress that I may identify with. Comment by Carolyn: Thank you for sharing your own experiences and how that relates to countertransference.

The ACA Code of Ethics Section A.5.a. (2014) stipulates that, “Sexual and/or romantic counselor–client interactions or relationships with current clients, their romantic partners, or their family members are prohibited. This prohibition applies to both in person and electronic interactions or relationships”. In an effort to remain professional, I attempt to recognize any form of attraction between that a patient may have toward mea and deal with the situation in a healthy manner to prevent the development of any inappropriate relationship with patients. It has been easy for me to discourage any personal and inappropriate relationships with patients as per Section A.5.e. of the ACA Code of Ethics. Furthermore, I encourage my patients to be honest and speak freely during sessions if they believe that my countertransference is reflecting negatively during their therapy.

Values Comment by Carolyn: I was a little confused by this section (I labeled it “values” since that is the 2nd issue that was to be addressed in this paper after countertransference). It appears that you addressed the topic of burnout, which is important but just wasn’t directly assessed as a part of this paper. You shared some good insights and opinions regarding burnout, and compassion fatigue could definitely tie in to values of course. However, I’d like to see this direct connection made.

Burnout of counselors has been widely studied and defined in literature. Risk factors and potential vulnerability to burnout have been explored Lee, Cho, Kissinger, and Ogle (2010). Lee et al, (2010) define burnout as a state of mental and emotional depletion coupled with physical exhaustion resulting from high work demand and low job satisfaction in counselors. Resilience is an active approach that is asset based that helps individuals to respond successfully and creatively to their problems (Edhe, 2010). Lawson and Myers (2011) state that building resilience does not happen by chance, but is based on the active practice of decisions that will lead to wellness and health. When dealing with clients, I agree with the Lawson and Myers (2011) theory that the key to prevention of compassion fatigue is the discovery and reinforcement of “compassion satisfaction” those activities that yield satisfaction from working with clients. Resilience allows the patient to handle their sadness and emotional pain in a healthy way and reduce the likelihood of the patient’s pain and sadness from impacting in his or her daily function and life (Hartley, 2011). By encouraging patients to be resilient, they will be better able to understand how to adapt to significant stress because it is an interplay between the patients and their environment and a resilient patient is capable of using internal and external protective factors to deal with various stresses (Hartley, 2011). To help patients strengthen their resilience to traumatic experiences, I usually encourage them to first identify a support network and join because it is important to have help from others during times of difficulty. Next, accept change as an integral part of life because adverse situations prevent people from living a life they had imagined for themselves and to keep things in perspective, I encourage patients to consider a broader context when in challenging situations and to avoid blowing situations out of proportion. Also, I encourage them to acknowledge personal feelings and needs. Finally, my patients are encouraged to maintain hope and remember that there are still good times to come.

Diversity

ACA Section B.1. talks about Respecting Client Rights., B.1.a., Multicultural/Diversity Considerations Counselors, discusses how counselors must preserve cognizance and thoughtfulness concerning cultural significances of confidentiality and privacy. Counselors must respect opposing views toward disclosure of information. Counselors should also hold continuing discussions with clients as to how, when, and with whom information is to be shared. There was a call for the counseling profession to prepare culturally competent helping professionals to meet the challenges of a multicultural and diverse American society (Sue & Sue, 2013). From the historical and sociopolitical view of the United States, multiculturalism refers to race ethnicity and culture (Ginger, Argus-Calvo, & Tafoya, 2010). Cultural competency standards which were approved by the Association of Multicultural Counseling and Development in 1991 and adopted by the American Counseling Association provide guidelines on multicultural counselor training as well as the criteria by which multicultural training outcomes are assessed. To acquire cultural competency counselor must study the different cultures and get accredited by; Accreditation of Counseling and Related Educational Programs (CACREP Standards, 2009) and American Psychological Association (APA) accredited psychology programs (APA, 2003). Even though there are varied approaches from one program to another this training of counselors increases cultural awareness, knowledge, and cultural responsive skills (Tomlinson-Clarke, 2010).

Dickson and Shumway’s (2011) framework delivers effective multicultural training through three components; a culturally sensitive program environment, traditional, participatory, and experiential instructional strategies, and multicultural clinical instruction. Experiences that involve both didactic and experiential work will provide the opportunity to acquire and utilize attribute of multicultural competency. Being exposed to a variety of multicultural training experiences as well as differentiated training will provide the continual opportunity for my self-reflection and growth. According to Glockshuber (2011), counselors’ self-evaluated cultural competence was directly related to their cultural attitudes and beliefs. Attitudes and beliefs should be noted as separate attributes when acknowledging cultural competency. The importance of beliefs and attitudes should not be underestimated and are particularly relevant when considering the dynamics of the relationship between the counselor and the client. When working across cultures, by becoming self-aware, and examining my cultural beliefs, I will develop the cultural competency and increase my counseling effectiveness when interacting with culturally diverse clients. Comment by Carolyn: This isn’t in the reference list

Sue and Sue (2013) explain cultural knowledge as the understanding and sharing of the world’s view of clients through cognitive empathy rather than affective empathy. Limitation on cultural knowledge results in a reliance on a stereotyped generalization about racial-cultural groups and increases the likelihood of decisions made being inappropriate (Tomlinson & Clarke, 2010). Cross-cultural interactions will facilitate cultural knowledge and cultural empathy which will help in connecting with culturally diverse clients and understand and appreciate the uniqueness in their daily lives which will lead to recognition of the universal commonalities between the different cultures.

Informed Consent

Informed consent is the process by which a counselor informs a client, patient or research subject of the benefits, risks and the expected outcome of a medical procedure, medication, or therapeutic approach that they have accepted to take part in. Laws on informed content vary in different states with many of them specifying the elements that informed consent documents should contain. Doctors and medical practitioners usually provide informed consent forms for clients to sign prior to beginning treatment. The ACA Code of Ethics in Code E.3.a stipulates that prior to assessment, counselors explain the nature and purposes of assessment and the specific use of results by potential recipients. The explanation will be given in terms and language that the client (or other legally authorized person on behalf of the client) can understand ethical and logistical issues involved when designing an informed consent document.

Primarily, the competency level of the client must be considered. Words used in the informed consent will be simple enough to accommodate clients with different competency levels and the medical terms will be explained in layman’s language. Secondly, guardians will be required to authorize the treatment of patients experiencing delusions, dementia and other conditions that may interfere with the decision-making ability and may not be able to give fully informed consent. Also, the client will be informed of alternative treatments that are available and explain the side effects of the treatment being agreed on. Next, clients in mental institutions and correctional facilities who may not consent to treatment, treatment will continue without the consent of the patient if the treatment is necessary for the safety of the patient. Additionally, the client will be informed of statistics on the succession rate of the treatment without going into much detail in the failures. Finally, as per the ACA Code of Ethics Code B.5.b on the responsibility to parents and legal guardians, parents, and guardians of minors and those under the age of 18 will be required to give consent as the minors are not able to give informed consent.

Confidentiality

June a 33-year-old lawyer found out that she was HIV-positive five months ago and to make things worse she was pregnant. She had been faithful with her partner and was sure that it had to be her fiancée who had infected her. Her fears were confirmed when she confronted him and learned that he had been positive before they even met and had not told her. This led to June becoming depressed to the level of being hospitalized for three months. During recovery, she was assigned therapy lessons to help her accept and cope with the condition. From the sessions, I discovered that June was still in denial and see’s that her life has been destroyed. From my conclusions, Jane seems highly suicidal. The ACA Code of Ethics Code B.2.a stipulates that being of able mind, June had signed a confidentiality agreement that protects her privacy during our sessions and binds me to not revealing the contents of her therapy sessions to anyone. The expert opinion from our sessions that she might hurt herself and the baby are troublesome. There is a need to break the confidentiality agreement because she is a threat to herself and her unborn baby. The ACA Code of Ethics Code B.2.a stipulates that, “The general requirement that counselors keep information confidential does not apply when disclosure is required to protect clients or identified others from serious and foreseeable harm or when legal requirements demand that confidential information must be revealed”. Counselors consult with other professionals when in doubt as to the validity of an exception. Additional considerations apply when addressing end-of-life issue. I have to consult with the doctor treating her at the hospital to determine his view of her and inform him that there is a possibility that June is a danger to herself and the unborn baby and inquire of how the situation can be saved.

References

American Counseling Association, (2014). ACA Code of Ethics, 5999 Stevenson

Avenue Alexandria, VA 223004 Comment by Carolyn: See how the code of ethics are cited in the syllabus for correct APA style

American Psychological Association (2010). Guidelines on multicultural education,

training, research, practice, and organizational change for psychologists. Comment by Carolyn: I’m not sure if this is a book, an online document, or other. Make sure to follow APA style to make it clear the type of document you’re referencing.

Council for Accreditation of Counseling and Related Educational Programs. (2009).

CACREP accreditation manual. Alexandria, VA: Author

Clarke, D., & Tomlinson-Clarke, S. (2009). Creating non-traditional multicultural

learning environments through cultural exchange. International Journal of Learning, 16, 481-487.

Dickson, G. L., & Shumway, B. A. (2011). A framework of multi-faceted approaches

to multicultural training. Comment by Carolyn: Is this a book?

Edhe, D. M. (2010). Application of positive psychology to rehabilitation psychology.

In R. G. Frank, M. Rosenthal, & B. Caplan (Eds.), Handbook of rehabilitation psychology (2nd ed.; pp. 417-424). Washington, DC: American Psychological Association.

Ginger, L. D., Argus-Calvo, B., Tafoya, N. G. (2010). Multicultural counselor training

effects and perceptions of training among a sample of predominately Hispanic students. Counselor Education & Supervision, 49,247-265. Comment by Carolyn: Make sure to also insert volume # of journal and DOI if there is one.

Hartley, M. T. (2011). Examining the relationships between resilience, mental health,

and academic persistence in undergraduate college students. American Journal of College Health, 59(7), 596-604.

Lawson, G., & Myers, J. E. (2011). Wellness, professional quality of life, and career-

sustaining behaviors: What keeps us well? Journal of Counseling & Development, 89, 163-171.

Lee, S. M., Cho, S. H., Kissinger, D., & Ogle, N. T. (2010). A typology of burnout

in professional counselors. Journal of Counseling & Development, 88, 131-138.

Murphy, S. (2013, September 1). Attending to Countertransference. Retrieved

from http://ct.counseling.org/2013/09/attending-to-countertransference/.

Sue, D. W., & Sue, D. (2013). Counseling the culturally diverse: Theory & Practice

(6th ed.). New York, NY: John Wiley.

Kring, A.M, Johnson, S.L, Davison, G.C.,& Neale, J.M, (2010) Abnormal Psychology

Tomlinson-Clarke, S. M. & Clarke, D. (2010). Culturally-focused community-

centered service learning: An international immersion experience Journal

of Multicultural Counseling and Development, 38, 166-175