Psychology class...

Given the commonality of blended families, how do you decide who should be included in family therapy?

·         Social Class position

·         Sexual orientation in the family and amongst its members

·         Religion inside the family; taking in to mind there might be different views

·         Identifiable race and ethnic identity ( I see my self as bi-racial some see me as Black or Hispanic and addressing me as such is not ok). Just ask when in doubt, people respect honesty before blatant guessing and assuming. This character will aid in finding out who should be involved from the blended family.

·         Individual assessment in family therapy.

According to Goldenberg, Stanton, and Goldenberg 2016, “The evolving view of cultural diversity recognizes that members of racial and ethnic groups retain their cultural identities while sharing common elements with the dominant American culture (Axelson, 1999 as cited in text on p. 64).  Simply inquiring is the best way to go in my opinion. Families that are in second and third marriages; a therapist may make the decision not to include old exes that are not in the current family dynamics and may cause  more issues than help.

What ethical considerations need to be made when determining who to involve in therapy?

The therapist's primary responsibilities are to protect the rights and to promote the welfare of his or her clients. The first is to consider the client that is seeking help for the family, ask the client to bring in who they want to be a part of the therapy. Have all sign an agreement on the  goals that are needed, and what and how much they want to share in family therapy. Allow the chance to walk away to all members if they feel uncomfortable. Out-right denying a family member access can be considered rude and pose ethical issues such as the client feels slighted, e.g., what family member not asked to attend by counselor. The loss of trust between the family and counselor could occur from decisions not made by the client.

Confidentiality is a big ethical concern because people divulge secrets in one setting and not in others. Communication between the family and counselor is important at this stage so all boundaries are clear and concise. So basically,

1.      Determine a policy that is compatible with his or her method of conducting therapy.

2.      Relay this to the family.

3.      Be clear about the method, using language the entire family can understand.

Informed consent and the right to refuse therapy is an issue and any family member has this right if not mandated by a legal order.

What are some ways in which confidentiality and third-party reimbursement challenges may be navigated?

The insurance companies are a big one. The client must agree to what information that is shared and unless this is a legal manner or refers to abuse of family members, e.g., children, or suicide, or murder, we must have permission to relay certain data. Only data that pertains to keeping the third party up to par with treatment is warranted. For example, if an insurance company wants to know information about sessions the information asked for must be placed in writing and presented to the client for signature and approval or disapproval.

Title X is an issue and HIPPA makes provisions for this that all counselors should be aware of. According to English, et al, 2017, “The HIPAA Privacy Rule also contains important confidentiality protections of particular relevance for Title X providers,” (p.1.)

Another third-party issue is if the client has a family member paying for their sessions and wants to know information. If the patient is a minor this can present issues. If it is an adult consent is needed.

References:

English, A., Summers, R., Lewis, J., Coleman, C., (2016). Confidentiality, Third-Party Billing, & the Health Insurance Claims Process: Implications for Title X. Retrieved from https://www.confidentialandcovered.com/file/ConfidentialandCovered_WhitePaper.pdf

Goldenberg, I., Stanton, M., & Goldenberg, H. (2016). Family therapy: An overview (9th ed.). Boston, MA: Cengage. ISBN-13: 9781305092969 http://www.gcumedia.com/digital-  resources/cengage/2016/family-therapy_an-overview_ebook_9e.php

Grandparents and counseling- raising the grandkids

Grandparenting can be highly rewarding. Many grandparents, though, unexpectedly become guardians and raise small children. How might this responsibility affect their normal course of adult development? What components might require transitions?

In many cultures inside western society grandparents have become the parents of their children’s children. For example, the crack epidemic brought to the Black communities by the CIA rendered many fixed income Black grandparents to raise these kids because their moms and dads were in the streets smoking the glass pipe. This was in the 80’s, and I witnessed it personally. The CIA issue you can research on how this happened. The CIA wanted to Congress to give them money for weapons to give to a certain country and when refused, they found the cash in cocaine in which was funneled in the to the USA in the poorest neighborhoods.  For more information on this visit this university cite: http://wordpress.philau.edu/thevoice/2016/12/crack-the-cia-and-media-all-complicit-in-destroying-black-communities/

But I digress; In 2005, 2.5 million children were living with grandparents who were responsible for their care. By 2015, that number had risen to 2.9 million. Child welfare officials say drug addiction, especially to opioids, is behind much of the rise in the number of grandparents raising their grandchildren, just as it was during the crack cocaine epidemic of the 1980s and ’90s. An estimated 2.4 million people were addicted to opioids at last count, (PBS, 2016).

The ability to relax and enjoy their golden years was taken away. Vacations were not available anymore, food was hard to come by and the stress of a 65-year-old raising a 13-year-old is devastating and can lead to early death, due to stress. The development of the children is affected because of the huge generational gap where different thought’s and practices change. Technology in the grandparent’s house will usually not be as it would with their parents simply because this age group does not see the appurtenance of a child having access to the internet.

Many components will change as these “grand-families” take on this endeavor of raising children 3 to 4 generations behind them. Their schedules, the need to be in close contact with schools, the need to understand the attire these kids will wear and when to put the breaks on, and the correct discipline to put forward when facing issues the grandparents are not familiar with.

 How would a professional counselor encourage these older guardians in their new roles?

Counselors can do the following to aid the grandparents in raising their grandchildren and offer these resources:

·         HelpGuide.org is a nonprofit site that gives grandparents resources, tools and ideas on how to get help and make the most of raising grandchildren.

·         USA.gov is a site that can aid them in getting financial help for the grandparents. Many are on fixed incomes and this site is a life-saver.

·         Daily Strength is an online community with a special online support group for grandparents who are the primary caregivers of their grandchildren. This can also help them technology they need to bond with the grandchildren.

Many other cites are available but most of all the counselor can let them know that you do not need to be perfect, listen to the kids, talk with them and make family time count. Quality time is important for children and both can grow into these new roles together. Also, let the grandparents know it is ok to feel like throwing the towel in! We all get that way at times and it normal.

 Reference:

PBS, 2016. How drug addiction led to more grandparents raising grandchildren. Retrieved from https://www.pbs.org/newshour/nation/drug-adChild

Still at it psychology.. Dr. Harris Leigh Featherstone

You want clients to leave counseling with solutions for the dilemmas that initially brought them to counseling. You also want them to learn resiliency skills that will help them master future challenges. What are some skills or resources that you would like clients to learn in the counseling process? Explain how you might provide education, suggest, or even model these skills.

Assessment of resilience is needed to help the client move forward and onward in their path through life outside of counseling. Depending on what brought them in counseling will determine the actions and skills needed to assure they have the coping skills and resilience skills to stay on the path that led them to the positive outcomes in which they are able to leave counseling. Resources that will be offered are contingent with the issue they were first in counseling for and revelations made during counseling;

For example, an adult client who enjoys and shows competence in cooking, for instance, may benefit from enhancing this skill in the context of a community-based course or cooking group, as well as the additional structure, social contact, and possible support linkages that would evolve from such involvements. Adults can also be encouraged to volunteer in arenas that support their competencies, seek out relevant support or interest groups, grow their involvement in their faith communities or religious organizations, or take part in their neighborhood organizations, (Tedeschi & Kilmer 2005 p. 231).

According to Quattlebaum & Steppling, 2010, “Confident decision-making at dismissal also requires an understanding of all the external factors that  will have an impact on the termination of therapy, and the most important factors are the patient’s support network and information about the monitoring or follow-up options that might be available to the patient following dismissal,” (p.315).  Again, depending on why the client was in therapy will provide the unique skills needed to end therapy and having a follow session will do both the therapist and the client well. This will show if the client has went back into harmful behavior and an intervention can be made before the issue becomes critical.

Reference:

Tedeschi, R. G., & Kilmer, R. P. (2005). Assessing Strengths, Resilience, and Growth to Guide Clinical Interventions. Professional Psychology: Research and Practice, 36(3), 230-237. doi:10.1037/0735-7028.36.3.230

Quattlebaum, P., & Steppling, M. (2010). Preparation for ending therapeutic relationships. International Journal Of Speech-Language Pathology, 12(4), 313-316. doi:10.3109/17549501003759239

DBT may be used to treat suicidal and other self-destructive behaviors. It teaches patients skills to cope with, and change, unhealthy behaviors. A unique aspect of DBT is its focus on acceptance of a patient's experience as a way for therapists to reassure them -- and balance the work needed to change negative behaviors (Dialectical Behavioral Therapy, 2005-2018).

2.    Two of the key elements of client-centered therapy are that it: Is non-directive. Therapists allow clients to lead the discussion and do not try to steer the client in a particular direction. Emphasizes unconditional positive regard. Therapists show complete acceptance and support for their clients without casting judgment. According to Carl Rogers, a client-centered therapist needs three key qualities: Genuineness, Unconditional Positive Regard, and empathetic understanding (Cherry, 2018).

3.    Cognitive-behavioral therapy (CBT) is a form of psychotherapy that treats problems and boosts happiness by modifying dysfunctional emotions, behaviors, and thoughts. Unlike traditional Freudian psychoanalysis , which probes childhood wounds to get at the root causes of conflict, CBT focuses on solutions, encouraging patients to challenge distorted cognitions and change destructive patterns of behavior.  (Cognitive Behavioral Therapy, n.d.)

4.    Motivational Interviewing is a clinical approach that helps people with mental health and substance use disorders and other chronic conditions such as diabetes, cardiovascular conditions, and asthma make positive behavioral changes to support better health. The approach upholds four principles— expressing empathy and avoiding arguing, developing discrepancy, rolling with resistance, and supporting self-efficacy (client’s belief s/he can successfully make a change) (Motivational Interviewing, n.d.).

Cherry, K. (2018, April 26). Client Centered Therapy. Retrieved May 10, 2018, from Very Well Mind: https://www.verywellmind.com/client-centered-therapy-2795999

Cognitive Behavioral Therapy. (n.d.). Retrieved May 10, 2018, from Psychology Today: https://www.psychologytoday.com/us/basics/cognitive-behavioral-therapy

Dialectical Behavioral Therapy. (2005-2018). Retrieved from Web MD: https://www.webmd.com/mental-health/dialectical-behavioral-therapy#1

Motivational Interviewing. (n.d.). Retrieved May 10, 2018, from Samhsa: http://www.integration.samhsa.gov/clinical-practice/motivational-interviewing

The Featherstone Method working with the elderly in counseling

What are some considerations for working with elderly clients who may have cognitive memory impairment? Include at least three communication methods.

The aging with disability group includes people who either have lifelong or early onset communication disorders as a result of cerebral palsy or multiple sclerosis (MS) and age in the context of the already-existing disability. Regardless of the trajectory, the burden of communication disorder is cumulative; it grows with age and has important implications for health care providers, (Yorkston, Bourgeois, & Baylor 2010).   Some considerations include how to communicate with them effectively, and with compassion. In people over 65 according to Medicare statistics 42% reported hearing problems, 26% had writing problems, and 7% had problems using the telephone; all of these present issues for therapist. Another consideration is the next wave of people entering the elderly realm is generation “baby Boomers”, this is a large group coming in.  Other issues include the following:

• ·         Aging with a Preexisting Communication Disorder
• ·         Onset of New Communication Disorders in Old Age
• ·         Maintaining Social Roles
• ·         Access to Health Care
•  Severe Depression bringing on a “waiting to die” type of thinking
•  Communication methods with the elderly include:
•  A quiet room with furniture that allows eye to eye contact
•  Know the patient’s communication strengths and weaknesses
•  Make sure that sensory aids (eg, eye glasses, hearing aids, communication devices, memory aids) are available and used 
• Use living room language not medical terminology
• Speak slowly and in adequate tones
• ·         Use humor in communications
• ·         Show empathy and respect, e.g. respect your elders, (this goes a long way)
• ·         Be familiar with their background life, how they grew up, e.g., some may come from the era of racism at its worst and may be off put if the counselor is not of the Caucasian persuasion- sadly this is a real issue in America
• ·         Supplement verbal descriptions with pictures and writing
• ·         Make sure the client understands you by using teach back methods
• ·         Do not try to overload them with information in each session. Take it slow and tackle one issue at a time
• ·         In the beginning get to really know them with light-hearted conversation that includes them telling you all about them and what they can remember of their life and how they are feeling in the present about their situation
• ·         Assign take home materials that they can use out-side of the sessions and bring back

.

The Featherstone Method (My Idead)…

I came up with a method I would try with patients suffering from depression, memory issues, and still are mobile either in a wheel chair or walker or walking on their own. I would buy disposable cameras and give them to the client on day 1. I would tell them to take pictures of what ever they find interesting out-of-session and bring camera back on the next session. I then would have them write down what they remember of what pictures they took. The third session I will have developed the film and ask them again to look over what they wrote down last session and have them add to it if they need to. Then I would show them the pictures they took and compare it to what they remembered, and all of this done in a humorous environment, emphasizing that even I forgot some as well. I think this would give them something to look forward to in each session and the homework would be enjoyable. I would continue to do this throughout all the sessions. It would become a regular “thing-to-do.

Reference:

Yorkston, K. M., Bourgeois, M. S., & Baylor, C. R. (2010). Communication and Aging. Physical Medicine and Rehabilitation Clinics of North America, 21(2), 309–319. http://doi.org/10.1016/j.pmr.2009.12.011

Sexual Dysfunction Disorders...

Do you feel that a client with a sexual dysfunction disorder would respond to therapy differently than a person with a paraphilic disorder? What are unique issues related to treating each disorder?

The short answer is yes…Sexual dysfunctions include delayed ejaculation, erectile disorder, female orgasmic disorder, female sexual interest/arousal disorder, Genito-pelvic pain/penetration disorder, male hypoactive sexual desire disorder, premature (early) ejaculation, substance/medication-induced sexual dysfunction, another specified sexual dysfunction, and unspecified sexual dysfunction. Sexual dysfunctions are a heterogeneous group of disorders that are typically characterized by a clinically significant disturbance in a person’s ability to respond sexually or to experience sexual pleasure. An individual may have several sexual dysfunctions at the same time. In such cases, all of the dysfunctions should be diagnosed. These are not the same desires in Paraphilia cases. This therapy can be done and if right can help in most of these causes. Medical attention also used in this type of help because if a person has endometriosis this can be handled through a Gynecologist.

 If a paraphilia causes distress or impairment to the individual or if its satisfaction entails personal harm (or the risk of such harm) to others, it is considered a paraphilic disorder. This criminal behavior at times and has to be treated with therapy and legal means. People with paraphilic disorders may be difficult to interview because of guilt and reluctance to share information openly with the interviewer. It is essential to establish rapport with these patients to allow them to talk more freely about their disorder. In other words, they will feel more embraced by their behavior then a person with a sexual disorder because of the acts they commit to get off. (Sorry for being so blunt).

Reference

DSM-5 Library 2017. Sexual Disorders. Retrieved from https://dsm.psychiatryonline.org/doi/10.1176/appi.books.9780890425596.dsm13?code=dsm-site

Fiction of a couple in counseling - pure fiction- rough draft

A Case Study

Crystal L. Featherstone

Grand Canyon University: PCN-530

February 21, 2018

Introduction

            This is a case study of two people experiencing the effects of becoming a romantic couple in a world they had to fight to even be recognized in as a couple. The actions of our leaders and people in general have caused negative issues to arise. When infidelity is introduced the couple experiences stages of resentment, anger, jealousy, and a host of other negative emotions. The issues are vast in ranging on if this couple will survive. The characteristics of the romantic relationship are similar to those of heterosexual couples if not the same. The outside influences are different in only one way. The way our society views them and if this is an aspect in their relationship. This is a fictional case.

Cognitive Behavioral Couple Therapy: The Case Study

Winnie and Jessica have been together since highs school, e.g. 20 years. They have adopted two children, and recently since laws changed in California were married. According to "California Same Sex Marriage and Domestic Partnership Laws" (2017), the Supreme Court's decision in the DOMA case immediately provides full federal benefits to same-sex couples in the 12 states that have legalized gay marriage, and would apply in California with Proposition 8 overturned,” (Supreme Court Ruling: Hollingsworth v. Perry). This has an impact on the couple because of the past 20 years of hiding prior to this ruling. It seems that Winnie decided that because she could be open about her sexuality she took it o another level and seemed a relationship outside the couple’s relationship. Jessica found out through social media. Jessica also says that although Winnie is a loving mother, she rarely has any time to do things for the children. The partners are abrupt and irritable with each other and rarely discuss what is happening between them on a personal level.

Looking into their background we see the issues that have slowly raised in this union. The children have no issues with their home, yet Jessica feels Winnie does not go to the school enough because of being embarrassed of their union. Winnie feels Jessica refuses to forgive her. Communication is completely breaking down and the stress of the betrayal seems to be an underlying factor. Both express how 20 years ago they were so in love and excited that no one knew about them. Both express how they are willing to work on this relationship for the sake of the children and do not want them to live in a broken home. Both express their frustration with the way the children are disciplined, e.g. they do not agree on parenting. Jessica feels Winnie is too vacant and absent in discipline and Winnie feels Jessica is to strict and controlling.

Summary

“Nearly 70% of same-sex couples were meeting online (Rosenfeld & Thomas, 2012 as cited in Rathus, Nevid, and Fichner-Rathus, 2018 p. 243). The characteristics of a romantic relationship include the following:

·         Honesty- what underlying issues are stopping the other from doing what the other expects in terms with the children

·         Accountability Winnie needs to accept what she did and show Jessica that she is sorry, and she will work on the issues that are from the fall-out of infidelity

·         Being able to communicate efficiently- No more blaming each other and accepting each one’s roles in the relationship

·         The need to negotiate and compromise- The disciplining of the children can be worked out with compromise and negotiation

·         Both pulling their weight financially unless otherwise discussed and agreed on

·         Respect and shared power- It is helpful to note that others may see things differently, so communication is key and experimenting with actions in the home with children is a good thing. Agree to disagree yet remember parents need to be a united front.

·         Intimacy- Get back to loving each other. Let the pain go and work on what was initially there when they first were open and honest with each other.

·         Support- Remember the world is hard and when coming home we need a haven. Work toward supporting our mates in this aspect.

These are the issues I would address with this couple in a slow manner to get them back on track. Also understanding the outside influences, they will encounter is an issue to communicate and realize they will face different challenges than other different sex-couples.

           

             

References

California Same Sex Marriage and Domestic Partnership Laws. (2017). Retrieved from http://statelaws.findlaw.com/california-law/california-same-sex-marriage-and-domestic-partnership-laws.html

Halford, T. C., Owen, J., Duncan, B. L., Anker, M. G., & Sparks, J. A. (2016). Pre-therapy relationship adjustment, gender and the alliance in couple therapy. Journal Of Family Therapy, 38(1), 18-35. doi:10.1111/1467-6427.12035

Rathus, S., Nevid, J.S., & Fichner-Rathus, L. (2018). Human Sexuality in a Changing World (10th ed.). Retrieved from https://viewer.gcu.edu/Jh8Dz

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