Monday, May 25, 2015

Ethical Practices with Culturally Diverse Clients


■ Current ethical codes are based on individualism which is a Western characteristic.

■ There is significantly less focus on the role of family, group identity, lifestyle and religious beliefs which have equal importance to individuality in other cultures.

■ The AAMFT code of ethics states “therapists do not discriminate against or refuse professional service to anyone on the basis of race, sex, religion, or national origin.”

■ It is ethical for counselors to know their own biases and how they may impact service delivery.

Cultural Competence
o Recognize cultural diversity
o Understand the role that culture and ethnicity play in the sociopsychological and economic development of diverse populations
o Understand that socioeconomic and political factors significantly impact the psychosocial, political, and economic development of ethnic and culturally diverse groups
o Help clients to understand, maintain, or resolve their own cultural identification
o Understand the interaction of culture, gender, and sexual orientation on behavior and needs

Implications for Clinicians
o Many ethical codes have not yet adequately dealt with some cultural issues related to technology and assessment or the counseling relationship with culturally diverse clients.
o Ethnic minorities will continue to underutilize services, prematurely terminate, or fail to show positive treatment outcomes if remedies are not applied and enforced.
o Goal is to learn how to identify, understand, and accommodate the needs of differing clients.





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Monday, May 18, 2015

Potential Ethical Violations


YAVIS- Counselors tend to prefer clients who are young, attractive, verbal, intelligent, and successful, but the most influencing factor is similar cultural backgrounds and experiences.

Viewing clients from the counselors perspective
o The following can be misinterpreted as “problems” in counseling, causing the therapist to see the client as resistant or non-responsive

  • ■ Silence
  • ■ Lack of eye contact
  • ■ Deference to authority

o Client defensiveness or non-disclosure may be termed “healthy cultural paranoia”

  • ■ For many clients the majority cultural environment is hostile and therefore a defensive stance is a rational response.
  • ■ The counselor must acknowledge that the problem may not lie in the client but rather the environment in which the client lives as a minority member


Stereotyping clients by group
o May be unintentional in that the counselor researches the “group” and what the group beliefs are according to research but in so doing generalizes and may miss something about the individual sitting in front of them.

Inappropriate Selection of techniques
o Counselors often depend on high level of verbal exchange to achieve therapeutic progress.

Inappropriate Selection of Tests and Measurements
o Many test reviews have only been done on the majority population type and may not be applicable to all cultures, skewing “normal” results.
o There should be an investigation of possible differences in validity for ethnicity, sex, or other sub-samples that can be identified when test is given.
o What is considered an objective assessment instrument within a majority culture may not be so within a minority culture or a different cultural orientation.
o It is an ethical duty to be aware of this research prior to administering assessments.





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Monday, May 11, 2015

Standardized psychological assessment tests


● Achievement and aptitude tests o Seen in educational or employment settings
o Attempt to measure either

  • ■ Achieved knowledge- particular subjects
  • ■ Aptitude or ability to master material in a particular area.


● Intelligence tests o Measure basic ability to understand the world, assimilate to functioning, and apply knowledge to enhance the quality of life.
o Intelligence is a measure of a potential, not a measure of what one has learned (as in an achievement test)
o It is supposed to be independent of culture.
o However, most intelligence are not culturally unaffected.

● Neuropsychological tests o Measure deficits in cognitive functioning- ability to think, speak, reason which may result from brain damage, such as a stroke or a brain injury.

● Occupational tests o Match personal interests and talents with the interests and talents of persons in known careers.

● Personality tests o Measure basic personality style
o Most used in research or forensic settings to help with clinical diagnoses.
o Two of the most well-known personality tests are

  • ■ Minnesota Multiphasic Personality Inventory (MMPI), or the revised MMPI-2,
  1. ◊ Composed of several hundred “yes or no” questions
  • ■ Rorschach (the “inkblot test”),
  1. ◊ Composed of several cards of inkblots
  2. ◊ Clients give a description of the images and feelings experienced by looking at the blots.


● Psychological tests o Administered and interpreted by a psychologist
o Counselors who have appropriate academic courses and supervision may administer occupational tests or achievement and aptitude tests.





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Monday, May 4, 2015

The Impact of Developmental Disorders on Family Systems

Symptoms of Developmental Disorders



■ Aggression and perhaps violence
  • o Work with family on behavioral issues, reinforcing appropriate behaviors.
  • o Work with family on parental coping skills with difficult situations.


■ Alienation of parents, caregivers and authorities o Educate family on the symptoms of disorders and what to take as a symptom rather than a person attack.
o Processing how to handle isolation moments, what the client shares as input on how they would like to b addressed or left alone until ready to return to family participation.

■ Antisocial attitudes and actions o Insight and reality therapy with clients on what impact their behaviors have on the family- natural consequences.
o Make sure family has consistent discipline for inappropriate behaviors.

■ Behavioral and learning problems at school o Encourage family to be in close communication with school figures to prioritize school goals and continue strengths.

■ Cannot express trust, intimacy and affection o Educate clients on the realities of the disorder and behavioral symptoms.
o Work with families to process feelings in regard to having a loved family member who has not yet developed these essentials of relational interaction.

■ Lacks empathy, compassion and remorse o Parenting skills enhanced to encourage the education and modeling of these skills in the home to promote it within the client.

■ Needy and clingy, or pretends independence o Behavioral methods encouraged by all family members to make sure enabling is minimized and support for growth is promoted.

■ Withdrawal and perhaps depression or psychosis o Work with family to ensure the therapy treatment and medications are attended to.





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Monday, April 27, 2015

Addiction treatment modalities

Outpatient Care

⋄ Techniques vary by clinician but typically include :

  • o cognitive-behavioral therapy
  • o problem-solving groups

⋄ Low success rate with heavily addicted individuals.
⋄ Moderate addicts may find that this level of treatment is enough to end their drug abuse problems.



12 Step Programs

⋄ Clients attend meetings.
⋄ Preferable after or in conjunction with some other form of drug treatment
⋄ There is the belief that they will never "recover" from their drug addiction.
⋄ This type of program may leave many feeling powerless (one of 12 steps is to accept powerlessness) over ever ending their battle with drug addiction.
⋄ This type of program may work for some, but has low success rate.


Inpatient Short-Term Rehabilitation

⋄ Substance abuse treatment that lasts typically for 30 days.
⋄ Overseen by medical professionals and trained counselors, often Certified Drug Addiction Specialist.
⋄ Goals are primarily physical stabilization, abstinence from all use, and lifestyle changes.
⋄ Primarily founded in a modified 12-step approach.


Inpatient Long-Term Rehabilitation

⋄ Inpatient long-term residential program is a 24 hour a day 7 days a week treatment.
⋄ Duration can be from several months to a year or more.
⋄ Residential treatment is conducted in non-clinical settings known as therapeutic communities.
⋄ May also include additional treatment strategies such as social education.


Methadone Maintenance Treatment

⋄ For clients with a dependence on heroin or other morphine like drugs.
⋄ Methadone decreases the feeling of pain and reduces emotional responses to withdrawal symptoms.
⋄ A dose typically suppresses an addict's symptoms for 24 hours.
⋄ Downside:

  • o Clients are physically dependent on
  • o They may find themselves using it for many years after they start treatment.
  • o Methadone may be more difficult to withdrawal from than heroin.
  • o Maintenance involves more time, pain, and expense than heroin withdrawal.





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