Effective Counseling:
Personal & Professional Issues

Terminology

• "Psychotherapy, therapist, patient"
• Medical model
• Psychiatry & clinical psychology
• More severe impairment
• More indirect; analytical

Terminology

• "Counseling, counselor, client"
• Educational settings
• Student or vocational emphasis
• Less severe impairment
• More direct; guidance/advice

Terminology

• "Patient" can seem pejorative (weak, defective, passive victim being taken care of by powerful, omnipotent doctor)
• "Client" sounds more egalitarian (consumer, buyer, patron, shopper, user)
• Nevertheless, therapy is a special relationship (more than fee-for-service); and there is a power differential that should be acknowledged

Terminology

• Terms are often interchangeable, but be aware of their historical significance and the subtle nuances of language
• What would be your preference?
• Why?
• What is the client’s preference or reaction?
• Clinical example

Mental Health Professionals

• Psychiatrist (M.D.)
• Clinical Psychologist (Ph.D., Psy.D.)
• Counseling Psychologist (Ph.D., Psy.D.)
• School Psychologist (Ph.D., Ed.D.)
• M.F.T. (Master’s in Counseling)
• L.C.S.W. (Master’s in Social Work)
• Master’s Level School Psychologist

Personal Characteristics of Effective Counselors

• Sense of identity
• Know who they are
• Know what they are realistically capable of
• Know what they want out of life
• Have a clear sense of values and priorities
• Live by internal standards
• Willing to reexamine their values and goals

Personal Characteristics of Effective Counselors

• Self-respect
• Respect themselves
• Have strong, realistic sense of self-worth
• Able to give and receive love and support from others
• Do not isolate themselves from others
• Are not self-destructive

Personal Characteristics of Effective Counselors

• Power
• Recognize limits of their own power
• Do not misuse power for personal gain
• Not narcissistic, grandiose, or in constant need of mirroring (admiration)

Personal Characteristics of Effective Counselors

• Flexibility
• In touch with themselves (not defensively blocking out experiences)
• Open to change
• Not rigid
• Have the willingness and courage to leave the security of the known if they are not satisfied with what they have

Personal Characteristics of Effective Counselors

• Ambiguity
• Can tolerate uncertainty and lack of clarity
• Can tolerate the fact that life is not simply "black and white"
• Can tolerate not knowing
• Able to acknowledge that sometimes there are no right or wrong answers

Personal Characteristics of Effective Counselors

• Empathy
• Can see things from another person’s perspective, without getting over-involved or overwhelmed

Personal Characteristics of Effective Counselors

• Authenticity
• Authentic
• Genuine
• Honest
• Sincere
• Do not hide behind masks, defenses, roles, facades

Personal Characteristics of Effective Counselors

• Active
• Committed to living rather than settling for mere existence
• Take an active stance toward life

Personal Characteristics of Effective Counselors

• Humor
• Able to admit mistakes
• Can acknowledge imperfections

Personal Characteristics of Effective Counselors

• Present-oriented
• Generally live in the "here and now"
• Do not dwell on the past or always look to the future

Personal Characteristics of Effective Counselors

• Socio-cultural
• Aware of socio-cultural influences
• Sensitive to individual differences and diversity

Personal Characteristics of Effective Counselors

• Sincere interest in the welfare of others

Personal Characteristics of Effective Counselors

• Derive meaning from their clinical work

Personal Characteristics of Effective Counselors

• Able to maintain healthy professional boundaries
• Know how to say "no" and set appropriate limits
• Recognize that being an effective counselor does not involve unbounded giving and altruism
• Alert to signs of burn out
• Do not carry their patients’ problems around with them during leisure time

Personal Characteristics of Effective Counselors

• Do not use patients to meet their own unresolved needs

Personal Characteristics of Effective Counselors

• Negative Life Experiences: Asset or hindrance?
• How might the following experiences influence a person’s desire to become a mental health professional or their clinical work with patients?
• Parental divorce
• Substance abuse/dependence
• Eating disorder

Personal Characteristics of Effective Counselors

• Sexual/physical abuse
• Other?

Personal Characteristics of Effective Counselors

• Personal therapy (therapy for the therapist)
• A debated issue
• Once thought to be essential (especially in psychoanalytic programs)
• Not required by most doctoral programs today, which are primarily cognitive-behavioral

Personal Characteristics of Effective Counselors

• Advantages:
• Opportunity for self-exploration/growth (don’t need to be "sick" to benefit)
• Therapist can only take the patient as far as they have taken themselves
• Therapist as model of healthy living
• Helps therapist explore their motivation for wanting to help others and do clinical work

Personal Characteristics of Effective Counselors

• Helps therapist see blind spots (patterns/issues they are unaware of)
• Builds empathy and compassion for the process (to know what it’s like to self-disclose; be on the other side of the couch)

Clinical Referrals

Values in Psychotherapy

• Q1: Is the purpose of psychotherapy to teach patients your values, or to teach them to discover their own values?
• Q2: Can psychotherapy ever be "value-free"?

Values in Psychotherapy

• Suggestion:
• Be aware of your own values and how you might be prone to try and influence others
• Unexamined values can lead to unintentional persuasion

Values in Psychotherapy

• Handling value conflicts
• Know yourself and your values
• Know and adhere to your professional role (psychotherapist)
• If you practice in a way that is outside mainstream psychology (e.g., Christian counseling), you should mention this in your Informed Consent document

Values in Psychotherapy

• Respect your clients’ right to have values that differ from your own
• Discuss value conflicts if they begin to impact treatment
• Seek consultation
• Refer patient to another provider if there is an unworkable situation

Counseling and Diversity

• "Culture" = the values and behaviors shared by a group of individuals
• Includes: Ethnic/racial heritage, age, gender, religion, sexual orientation, physical and mental ability, SES
• We live in a diverse society
• It’s important to welcome and respect diversity

Multicultural Competency (Stanley Sue)

• Be aware of your own cultural background, beliefs, and identity assumptions
• Accept differences
• Do not believe your own cultural heritage is superior to others’
• Seek to understand the world from the client’s perspective

Multicultural Competency (Stanley Sue)

• Learn about other cultures’ historical backgrounds, traditions, and values
• Be knowledgeable about community characteristics, resources, and support systems
• Develop skills in working with culturally diverse populations
• Seek out interactions with diverse people (make it part of your life)

Ethical Principles and Code of Conduct

• Written by the American Psychological Association (APA), 2002
• Available on the APA web site
• Primary goal = to protect the welfare of individuals and groups with whom psychologists work
• Secondary goal = to provide a common set of values upon which psychologists build their professional and scientific work

Issues Pertinent to Psychotherapy

• Boundaries of competence
• Don’t provide services you are not competent to perform

Issues Pertinent to Psychotherapy

• Personal problems and conflicts
• Seek consultation, personal therapy, possibly refer clients elsewhere

Issues Pertinent to Psychotherapy

• Multiple relationships
• Occur when a psychologist is in a professional role with a person and (1) at the same time is in another role with that same person or someone close to that person or (2) promises to enter into another relationship with those persons in the future

Issues Pertinent to Psychotherapy

• Avoid such relationships when they could impair your objectivity, competence, or effectiveness; or exploit or harm people

Issues Pertinent to Psychotherapy

• Sex with current clients
• Is unethical
• Do not terminate therapy to circumvent this

Issues Pertinent to Psychotherapy

• Sex with relatives, guardians, or significant others of current clients
• Is unethical
• Do not terminate therapy to circumvent this

Issues Pertinent to Psychotherapy

• Sex with former clients
• Do not engage in this behavior for at least 2 years after termination of services
• After 2 years, do so only in the most unusual circumstances
• Burden of proof will always be on the clinician to demonstrate no exploitation or harm

Issues Pertinent to Psychotherapy

• Therapy with former sexual partners
• Is unethical

Issues Pertinent to Psychotherapy

• Informed consent
• Fees, scheduling, procedure, risks, alternatives
• Make sure the client knows what to expect and makes an informed decision to work with you

Issues Pertinent to Psychotherapy

• Confidentiality
• This is essential to establishing and maintaining a strong therapeutic relationship
• Keep information private
• Don’t gossip about clients

Issues Pertinent to Psychotherapy

• Discussing the limits of confidentiality
• Discuss this up front
• Danger to self
• Danger to other
• Child or dependent abuse

Issues Pertinent to Psychotherapy

• Disclosure of confidential information
• Only with signed release

Issues Pertinent to Psychotherapy

• Record keeping

Issues Pertinent to Psychotherapy

• Termination