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Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
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Sherry Cormier West Virginia University Paula S. Nuriu S University of Washington Cy Nthia J. o Sbor N Kent State University Interviewing and Change Strategies for Helpers 8e Australia ● Brazil ● Mexico ● Singapore ● United Kingdom ● United States Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
This is an electronic version of the print textbook. Due to electronic rights restrictions, some third party content may be suppressed. Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. The publisher reserves the right to remove content from this title at any time if subsequent rights restrictions require it. For valuable information on pricing, previous editions, changes to current editions, and alternate formats, please visit www. cengage. com/highered to search by ISBN#, author, title, or keyword for materials in your areas of interest. Important Notice: Media content referenced within the product description or the product text may not be available in the e Book version. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
© 2017, 2013, Cengage Learning ALL RIGHTS RESERVED. No part of this work covered by the copyright herein may be reproduced or distributed in any form or by any means, except as permitted by U. S. copyright law, without the prior written permission of the copyright owner. Library of Congress Control Number: 2015959070 Student Edition: ISBN: 978-1-305-27145-6 Loose-leaf Edition: ISBN: 978-1-305-86641-6 Cengage Learning 20 Channel Center Street Boston, MA 02210 USA Cengage Learning is a leading provider of customized learning solutions with employees residing in nearly 40 different countries and sales in more than 125 countries around the world. Find your local representative at www. cengage. com Cengage Learning products are represented in Canada by Nelson Education, Ltd. To learn more about Cengage Learning Solutions, visit www. cengage. com Purchase any of our products at your local college store or at our preferred online store www. cengagebrain. com Interviewing and Change Strategies for Helpers, Eighth Edition Sherry Cormier, Paula S. Nurius, Cynthia J. Osborn Product Director: Jon David Hague Product Manager: Julie Martinez Content Developer: Elizabeth Momb Product Assistant: Stephen Lagos Marketing Manager: Margaux Cameron Content Project Manager: Rita Jaramillo Art Director: Vernon Boes Manufacturing Planner: Judy Inouye Production Service: Charu Khanna at MPS Limited Text and Cover Designer: John Walker Cover Image: Garry Gay/Getty Images Compositor: MPS Limited For product information and technology assistance, contact us at Cengage Learning Customer & Sales Support, 1-800-354-9706 For permission to use material from this text or product, submit all requests online at www. cengage. com/permissions Further permissions questions can be e-mailed to permissionrequest@cengage. com Printed in the United States of America Print Number: 01 Print Year: 2016WCN: 02-300 Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
In memory of Sherry's parents, Bill and Edith Keucher, Sherry's spouse, Jay H. Fast, Paula's mother, Gwyndolyn Medley Garner, and Cynthia's parents, Noel and Emma Ruth Osborn; and in honor of Dick Mitchell, Cynthia's spouse, and Bill Garner, Paula's brother, with grateful appreciation and affection. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
v Sherry Cormier is Professor Emerita in the Department of Counseling, Rehabilitation Counseling, and Counseling Psychology at West Virginia University in Morgantown, West Virginia. She is a licensed psychologist in the state of West Virginia. Her current research and practice interests are in counseling and psychology training and supervision models, health, wellness, stress management, and grief recovery. She is the mother of two 30-something daughters and the grandmother of a 10-year-old granddaughter. She enjoys yoga, walks on the beach, and kayaking in her Chesapeake Bay community. Paula S. Nurius is the Grace Beals Ferguson Scholar, Professor, and Associate Dean in the School of Social Work at the University of Washington in Seattle. Dr. Nurius is a mental health specialist with research, practice, and teaching addressing perception and responding under conditions of stress and trauma. She brings particular concern for vulnerable, marginalized populations and toward fostering prevention and resilience-enhancing interventions. Her current scholarship focuses on childhood and cumulative life course stress, including impacts of maltreatment, nonviolent adversity, and poverty on physical, mental, and behavioral health disparities. She enjoys the outdoor life of the Pacific Northwest with her husband, daughter, and schnoodle pooch. Cynthia J. Osborn is Professor of Counselor Education and Supervision at Kent State University in Kent, Ohio. She is a licensed professional clinical counselor and a licensed chemical dependency counselor in Ohio. Her research, clinical practice, and teaching have focused on addictive behaviors and counselor supervision from the perspectives of motivational interviewing and solution-focused therapy. Additional scholarship has addressed case conceptualization and treatment planning skills and stamina and resilience in behavioral health care. She enjoys reading character novels and practicing yoga, and she and her husband together enjoy exercising and the company of their Bichon Frisé dog, Jake. About the Authors Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
vii Contents Preface xi Chapter 1 Building Your Foundation as a Helper 1 Learning Outcomes 1 The Chambered Nautilus 1A Practice Nexus for the Helping Professions 2Four Stages of Helping 2Core Skills and Attributes 4Effectiveness and Accountability 15Evidence-Based Practice 16Concerns, Critiques, and Caveats of Evidence-Based Practice 20 Multiculturalism and Evidence-Based Practice 21Adapting and Adopting Evidence-Based Practices 24Innovations with Integrity 25Chapter Summary 28Knowledge and Skill Builder 29Knowledge and Skill Builder Feedback 33 Chapter 2 Critical Commitments 35 Learning Outcomes 35Toward Skillful Practice 35Growing Into Professional Competence 36Four Critical Commitments 37Diversity Issues 45Multicultural Counseling and Therapy 47Practicing Idiographically 48Beyond Multicultural Competencies to Cultural Attunement 54 Ethical Practice 55Ethical Decision-Making Models 70Chapter Summary 71Knowledge and Skill Builder 73Knowledge and Skill Builder Feedback 75 Chapter 3 Ingredients of an Effective Helping Relationship 76 Learning Outcomes 76 The Importance of the Helping Relationship 76Empirical Support for the Helping Relationship 77Cultural Variables in the Helping Relationship 78Facilitative Conditions 79The Working Alliance 90Transference and Countertransference 93Chapter Summary 101Knowledge and Skill Builder 102Knowledge and Skill Builder Feedback 104 Chapter 4 Listening 105 Learning Outcomes 105Three Steps of Listening 106Listening to Clients' Stories 107Listening to Clients' Nonverbal Behavior 107Four Listening Responses 112 Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
viii Contents The Clarification Response: Listening for Accuracy 113 Paraphrase and Reflection: Listening for Facts and Feelings 114 Summarization: Listening for Patterns and Themes 126Listening to Diverse Groups of Clients 128Distractions and Distractability: Listening to Yourself 131Chapter Summary 133Knowledge and Skill Builder 136Knowledge and Skill Builder Feedback 138 Chapter 5 Influencing Responses 139 Learning Outcomes 139Social Influence In Helping 139Influencing Responses and Timing 140What Does Influencing Require of Helpers? 140Six Influencing Responses 141Sequencing of Influencing Responses In Interviews 141Questions 143Information Giving 146Self-Disclosure 149Immediacy 156Interpretations and Additive/Advanced Empathy 159Confrontation/Challenge 163Skill Integration: Putting it all Together! 170Chapter Summary 170Knowledge and Skill Builder 171Knowledge and Skill Builder Feedback 176 Chapter 6 Assessing and Conceptualizing Client Problems and Contexts 177 Learning Outcomes 177 Client Statements 177What Is Clinical Assessment? 177Our Assumptions About Clinical Assessment 178Functional Assessment: The ABC Model and Chain Analysis 186 Diagnostic Classification of Client Issues 193Limitations of Diagnosis: Categories, Labels, and Gender/Multicultural Biases 196 Mental Status Examination 197Diagnostic Interviewing 198Sensitive Subjects and Risk Assessment in Diagnostic Interviewing 199 Intake Interviews and History 201Cultural Issues in Intake and Assessment Interviews 205Putting it all Together: Evidence-Based Assessment and Conceptualization 207 Model Case: Conceptualizing 207Chapter Summary 212Knowledge and Skill Builder 213Knowledge and Skill Builder Feedback 214 Chapter 7 Conducting an Interview Assessment with Clients 215 Learning Outcomes 215 Assessment Interviewing 215Eleven Categories for Assessing Clients 216Limitations of Interview Leads in Assessment 232Model Dialogue: Interview Assessment 234Chapter Summary 242Knowledge and Skill Builder 243Knowledge and Skill Builder Feedback 250 Chapter 8 Constructing, Contextualizing, and Evaluating Treatment Goals 251 Learning Outcomes 251 Personal Reflection Activity 251Where Are We Headed? 251Beginning With The End in Mind 252Purposes of Treatment Goals 252Characteristics of Well-Constructed Treatment Goals 254Support for Goal Characteristics 258Cultural Considerations 258The Process of Change 261Collaborative Construction of Treatment Goals 267 Model Dialogue: Goal Formulation 269Contextualizing Treatment Goals 273First Things First: Prioritizing and Sequencing Goals 276 Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Contents ix Working With Resistance, Reactance, Reluctance, and Ambivalence 346 Solution-Focused Therapy 347 Model Dialogue: Deconstructing Solutions 355Motivational Interviewing 357Model Dialogue: Affirming, Emphasizing Autonomy, and Advising only with Permission 368 Applications of SFT and MI with Diverse Groups 370Chapter Summary 372Knowledge and Skill Builder 374Knowledge and Skill Builder Feedback 377 Chapter 11 Cognitive Change Strategies 379 Learning Outcomes 379 An Overview of the Theoretical Framework 380Reframing 382Reframing Components 383Reframing with Diverse Clients 386Cognitive Modeling Components 386Model Dialogue: Cognitive Modeling 389Cognitive Restructuring 392Cognitive Restructuring Components 392Some Caveats 406Cognitive Change Strategies with Diverse Clients 406 Model Dialogue: Cognitive Restructuring 409Integrative Interventions: Linkages of ACT and DBT with Cognitive Change Strategies 412 Chapter Summary 414Knowledge and Skill Builder 416Knowledge and Skill Builder Feedback 423 Chapter 12 Cognitive Approaches to Stress Management 425 Learning Outcomes 425 Stress and Coping 425Cultural, Socioeconomic, and Discrimination Variations in Stress 430 Spirituality Considerations 431Problem-Solving Therapy 432Problem-Solving Therapy Components 433Running Interference by Addressing Obstacles 278 Identifying Resources to Facilitate Goal Achievement 279 Evaluating Treatment Process and Outcomes 279What to Evaluate 280How to Evaluate 282When to Evaluate 285Treatment Evaluation Pointers 288Model Dialogue: Evaluating Progress 288Chapter Summary 293Knowledge and Skill Builder 295Knowledge and Skill Builder Feedback 301 Chapter 9 Clinical Decision-Making and Treatment Planning 302 Learning Outcomes 302 Treatment Planning Purpose and Benefits 302Common Factors and Specific Ingredients of Treatment 303 Factors Affecting Treatment Selection 304Evidence-Based Practice and Treatment Planning 311Models of Treatment-Client Matching 312Planning for Type, Duration, and Mode of Treatment 314 Cultural Issues in Treatment Planning and Selection 317Intentional Integration of Cultural Interventions 319The Process of Treatment Planning 325Model Dialogue: Exploring Treatment Strategies 329Chapter Summary 332Knowledge and Skill Builder 333Knowledge and Skill Builder Feedback 335 Chapter 10 Models for Working with Resistance 336 Learning Outcomes 336 Partnering with Client Experience 336Resistance, Reactance, Reluctance, and Ambivalence 336 Two Models for Working with Resistance 341Research on Solution-Focused Therapy (SFT) and Motivational Interviewing (MI) 342 Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
x Contents Research with Diverse and Vulnerable Groups 519 Virtual Reality 522Pharmacotherapy to Enhance Exposure 522Model Dialogue for Exposure Therapy 523Chapter Summary 525Knowledge and Skill Builder 526Knowledge and Skill Builder Feedback 527 Chapter 15 Self-Management Strategies 528 Learning Outcomes 528Terminology and Areas of Focus 528Steps in Developing Self-Management Programs 529Characteristics of Effective Self-Management Programs 531 Self-Monitoring Overview 532Components of Self-Monitoring 535Model Example: Self-Monitoring 540Stimulus Control Components 541Model Example: Stimulus Control 544Self-Reward Overview 545Self-Reward Components 546Caveats with Applying Self-Reward Strategies 550Model Example: Self-Reward 550Self-Efficacy Overview 550Sources of Self-Efficacy 551Summary 555Model Example: Self-Efficacy 556Applications of Self-Management with Diverse Groups and Types of Problems 557 Guidelines for Using Self-Management with Diverse Groups of Clients 559 Self-Management as a Professional Aide for Helpers 560Chapter Summary 561Knowledge and Skill Builder 562Knowledge and Skill Builder Feedback 563 References 565 Name index 621Subject index 641Problem-Solving with Diverse Clients 440 Model Example: Problem-Solving Therapy 441Stress Inoculation Training: An Integrative Clinical Approach 443 Stress Inoculation Training Components 443Model Dialogue: Stress Inoculation 450Chapter Summary 452Knowledge and Skill Builder 453Knowledge and Skill Builder Feedback 459 Chapter 13 Self-Calming Approaches to Stress Management 460 Learning Outcomes 460 The Physiology of Breathing and Stress 460A Focus on Diaphragmatic Breathing 461Caveats with Diaphragmatic Breathing 463Muscle Relaxation 464Muscle Relaxation Procedure 465Caveats with Muscle Relaxation 471Model Dialogue: Muscle Relaxation 471Meditation: Processes and Uses 472Mindfulness Meditation Procedure 475Caveats with Meditation 479Model Example of Mindfulness Meditation 481Applications of Meditation for Diverse Issues and with Diverse Clients 483 Chapter Summary 484Knowledge and Skill Builder 485Knowledge and Skill Builder Feedback 490 Chapter 14 Exposure Therapy for Anxiety, Fear, and Trauma 491 Learning Outcomes 491 What Is Exposure? 492Theoretical Background for Exposure 494Components and Processes of Exposure Therapy 497Gradual Exposure 505Intensive Exposure 512Collaborative Considerations in Conducting Exposure 514 Caveats about Exposure 517 Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
xi Preface The eighth edition of Interviewing and Change Strategies for Helpers reflects a number of changes. The new edi-tion represents a blending of our collective expertise in counseling, psychology, social work, and health and hu-man services. Our partnership in these interdisciplinary areas augments the book's responsiveness to the unique perspectives of each discipline while also working at the interface or nexus, addressing cross-cutting issues and commitments. This book is intended to be used by helpers who are trained in a variety of health and helping-oriented disciplines, including counseling, social work, psychol-ogy, human services, and related professions. We recog-nize that terminology varies across settings. You will see the term helper as well as practitioner, clinician, therapist, and service provider used throughout the book. One of the fundamental changes we have made in this edition is in response to continued requests for a streamlined book that can be used with relative ease in the parameters of several quarters or a given semester. Our Conceptual Foundation Our conceptual foundation, which we describe in Chapters 1 and 2, reflects four critical areas for helpers from various disciplines: (1) core skills and attributes; (2) effectiveness and evidence-based practice; (3) diversity issues; and (4) critical commitments and ethical practice. The core skills that we present cut across all helping disciplines and in this edition we present them in Chapters 3, 4, and 5. Diversity issues and ecological models are presented in Chapters 2, 6, and 7, and also are integrated throughout the book. Evidence-based assessment and its implementation in the interviewing process are described in Chapters 6 and 7. Effectiveness and evidence-based practice is introduced in Chapter 1 and presented again in Chapters 8 and 9. Chapters 10 through 15 give special attention to research supporting the application of change strategies to diverse groups and the importance of culture and context in applying these and other helping strategies. Recognizing the enormous influence of evidence-based expectations on contem-porary practice, we have incorporated current findings into each of our chapters on various change strategies (Chapters 10 through 15). Layered across all of this is the fourth area of our con-ceptual model: critical thinking and ethical judgment. We focus on this area specifically in Chapters 1 and 2 and explore these topics again throughout the remainder of the book because they permeate all of the decisions that helpers face at each phase of the helping process, from establishing the helping relationship, to assessing client problems, setting treatment goals, and selecting, using, and evaluating change intervention strategies. Many users of the text have indicated that combining major stages of the helping process with specific change strategies facili-tates integration within and across courses that aim for this bigger picture and is also beneficial for students. Built-In and Supplemental Instructional Guides: Features of the Book We have retained the specific features of the text that we have learned through feedback make it invaluable as a resource guide—and we have taken this emphasis a step further. We have worked to distinguish this teaching text by providing a rich array of built-in exercises, exem-plars, and tools to promote and evaluate student com-prehension. The book balances attention to conceptual and empirical foundations with an emphasis on real-life factors in practice settings and ample use of examples and how-to guidelines. In addition, consistent with the out-come emphasis of accreditation standards of counseling, Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
xii Preface 2. The longstanding commitment of this book to valu-ing human diversity is commensurate with its estab-lished commitment to consulting and incorporating scientific research. In many ways, this edition reflects a healthy dialectic or tension between science and in-novation, empiricism, and improvisation. And it is this both/and approach, this practice of living and work-ing in between polarities, that has spawned integrative therapies such as dialectical behavior therapy (DBT), an evidence-based practice that we draw from through-out the chapters. 3. Chapter 1 showcases the symbolism of the cham-bered nautilus featured on the cover of the book and introduces readers to the practice nexus featured on the inside cover of the book. In the first half of the chapter, the first component of the practice nexus is discussed. Specifically, four core skills and attributes (self-awareness and self-reflection, mindfulness, self-care, and self-compassion) are presented and discussed as a means of promoting helper stamina and resilience. In the second half of the chapter, the second compo-nent of the practice nexus, effectiveness, is highlighted. In this section extensive discussion is devoted to evi-dence-based practice (EBP). This discussion includes criticisms of EBP as well as continued efforts to adapt EBP to culturally diverse populations. A listing of culturally adaptive interventions to EBP is provided, along with examples of such adaptation. 4. The third and fourth components of the practice nexus are the focus of Chapter 2: critical commitments (including ethical practice) and diversity issues. We dis-cuss four critical commitments professional helpers are encouraged to make to grow into clinical competence: commitment to lifelong learning; commitment to col-laboration; commitment to values-based practice; and commitment to beneficence. The section on diversity issues includes prominent and newer frameworks for working with culturally diverse populations, such as the more idiosyncratic focus on the intersection of multiple identities proposed by feminist multicultural scholars. The ethical issues section includes updates from profes-sional codes of ethics and a new section on telepractice, with a corresponding new learning activity. 5. Consideration of the therapeutic relationship has been expanded (Chapter 3) to include the ever-expanding empirical basis for various relationship conditions toward increasing effectiveness. New additions to this chapter include the additional evidence base for helper empathy, the working alliance, and relation-ship ruptures, as well as an expanded discussion of microaggressions and the therapeutic relationship and invalidating environments. psychology, social work, and human services, chapters are guided by learning outcomes and opportunities to practice with numerous learning activities and guided feedback. Model cases and dialogues are given in each chapter, as well as end-of-chapter evaluations (referred to as “Knowledge and Skill Builders”) with feedback de-signed to help assess chapter competencies. In addition, we have developed a range of supplemen-tary materials to enrich the teaching experience. These include an instructor's manual, a bank of test questions (which can be used by instructors for course exams or by students in later preparing for accrediting exams), and Power Point slides for each chapter. Brand new to this edition, Mind Tap® is the digital learning solution that helps instructors engage and trans-form today's students into critical thinkers. Through paths of dynamic assignments and applications that you can personalize, real-time course analytics, and an acces-sible reader, Mind Tap helps you turn your students into higher-level thinkers. Your students become practitioners of their own learning as they master practical skills and build professional confidence. Students will be engaged in a scaffolded learning experience designed to move their thinking skills from lower-order to higher-order by rein-forcing learned skills and concepts through demonstrated application. New to the Eighth Edition With sensitivity to the value of using a book within a semes-ter or two-quarter framework, we have worked for a more streamlined book in this edition. We have retained the same organizing structure and skill-building components that adopters have long valued, and provide some integrated and distilled content to provide an up-to-date compendium of interviewing and change practices applicable across a range of settings and clientele. Throughout, we aim to build on recent clinical evidence and to point to emerging develop-ments relevant to instruction in clinical services. 1. In this edition we increased this book's enduring commitment to working with diverse groups. This includes further attention to working with youth, older adults, and sexual minorities, in addition to diversity implications related to gender, race/ethnicity, religion, immigration, and disability. Although this book is focused predominantly on individual change (e. g., strengthening problem-solving, adaptive coping, self-efficacy, management of long-term problems or conditions), we have aimed to strengthen attention to the importance of context and the frequent role of environmental sources of stress and injustices. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Preface xiii amplify the discussion of the multiple levels of processes involved in the development and operation of schemas involved in psychological disorders. This material il-lustrates ways that biological factors such as genetics, brain functioning, and physiology are systematically linked with cognitive and emotional factors, which then interplay with interpersonal, environmental, and behavioral factors in both the development of and in-tervention with psychological problems. Here we also update information about schema development and schema therapy, about new intervention findings for cognitive change strategies with diverse populations, and about developments of cognitive strategies with acceptance and commitment therapy (ACT) and DBT. 14. Stress is among the universally shared struggles of clients. Therefore, we have emphasized stress as a criti-cal set of factors in the development of problems and in understanding ways that change strategies must address stress. In Chapter 12 we describe cultural, socioeconomic, and life course implications of stress. We update findings regarding neurophysiological pathways through which stress becomes embodied, leading to physical and mental health impairment. We update interventions applied with diverse groups, including attention to minority stress. We update de-velopment in stress inoculation and problem-solving therapies including incorporation of emotional mind-fulness techniques. 15. In Chapter 13 we have expanded attention to the growing evidence support for stress management, par-ticularly mindfulness-based practices. Here we provide an illustration of recent applications across a range of child and adult populations as well as settings (e. g., workplace) and contexts of helping. We also update ways that mindfulness constructs and meditation are being incorporated across a range of interventions, including mindfulness-based stress reduction, mind-fulness-based cognitive therapy, DBT, and ACT. 16. In Chapter 14 we provide updates on extension learn-ing and increased focus on prolonged exposure ther-apy, including applications with military veterans and cultural minority groups. This chapter also provides updates on virtual reality exposure therapies as well as additional coverage of clinical issues related to safety behaviors, return of fear, dropout, and fear tolerance. 17. In Chapter 15 we describe new uses of the Inter-net and technological devices to support longer-term self-management interventions, which are particularly valuable for clients with special needs, when people are more distant from services or support communities, or when access to immediate help is needed. This chapter includes numerous literature updates on each of the 6. Chapter 4 includes an expanded discussion of the processes of listening as well as updated evidence-based literature on the listening responses, particularly reflec-tion of feeling. 7. Chapter 5, Influencing Responses, includes an up-dated evidence base for the influencing responses, particularly self-disclosure. It also includes a new dis-cussion of the effects of self-disclosure and environ-mental settings, technology, and information giving, and a new section integrated into the chapter and the Knowledge and Skill Builder on Skill Integration. 8. Chapter 6 focuses more broadly now on both clinical and evidence-based assessment. The material on the person-in-environment model has been updated and the functional assessment model has been expanded and includes new examples and new content regard-ing chain analysis, which is a component of dialecti-cal behavior therapy. An entirely new section on the DSM-5 is also described in Chapter 6. This chapter also includes expanded coverage of conducting risk assessment in diagnostic interviewing and expanded coverage of mental status interviewing. 9. Chapter 7 describes the implementation of evidence-based assessment in the interviewing process. This chapter includes expanded coverage of clients' indi-vidual and environmental strengths and resources as well as functional analyses assessment queries. Case examples have been changed to reflect current DSM-5 diagnoses. 10. The purpose and process of developing treatment goals are described in Chapter 8, as are characteristics of well-constructed goals. Stage models (e. g., stages of change model) are introduced to assist with the se-quential and collaborative task of treatment planning. The process of further refining—or contextualizing—treatment goals is likened to preparing for a journey and includes references to easy-to-use and evidence-based client assessment measures. 11. Chapter 9 is devoted to clinical decision-making and treatment planning. Updates include an expansion of client and helper factors contributing to client change, references to the newest addition of The ASAM Crite-ria used to match clients to levels of care, and resources for intentionally integrating cultural interventions. 12. Strategies of working through various forms of re-sistance, as well as client ambivalence, are found in Chapter 10. These strategies are informed by solution-focused therapy and motivational interviewing, two approaches whose respective research base has been expanded in this edition. 13. The science underlying cognitive therapies is dem-onstrating increasing complexity. In Chapter 11 we Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
xiv Preface categories of self-management, illustrating the rapid growth in populations and problem foci to which they are applied, including helping professionals managing complex and stressful work environments. The instructor's manual is authored by Penny Minor, a Ph D degree candidate in Counselor Education and Su-pervision at Kent State University and a licensed profes-sional clinical counselor in Ohio. She also developed the test bank of questions for each chapter and the assessment that is available in Mind Tap. We also offer a resource that can be used for in-class or online teaching formats: a compendium of Power Point slides covering major points within each chapter. (These supplements are available to qualified adopters through the instructor section of the Cengage Learning website. Please consult your local sales representative for details. ) This edition also features Cengage Helper Studio training videos in helping skills which Sherry Cormier and Cynthia Osborn developed and produced as a part of Mind Tap. People We Acknowledge Over the years, we have been asked, “What is it like to put together a book like this?” Our first response is always, “We require a lot of help. ” For this edition we are indebted to a number of people for their wonderful help: to Penny Minor, Kent State University Ph D degree candidate in Counselor Education and Supervision, for preparation of the instructor's manual, test bank, and Power Point slide resources; Kelly Martin-Vegue (University of Washington MSW student) for her invaluable insights, recommenda-tions, and contributions from a consumer perspective; and to Dr. Daniel Mc Neil and Dr. Brandon Kyle for their col-laborative authoring of Chapter 14 on exposure therapy. We are very grateful to the staff at Cengage Learning, particularly to our current editor, Julie Martinez, for her commitment, enthusiasm, and wisdom. The final form of this book as you, the reader, now see it would not have been possible without the superb efforts of the entire Cengage Learning team, especially our content develop-ers: Mary Noel, Stefanie Chase, and Elizabeth Momb. We also acknowledge with gratitude the contribution of our manuscript reviewers, who include the following: Akira Otani, Ed. D, Spectrum Behavioral Health Center Edward Keane, Ph. D., Housatonic Community College Susan Adams, Ph. D., Texas Woman's University Jacqueline Persons, Ph. D., University of California, Berkeley Daniel W. Mc Neil, Ph. D., West Virginia University Brandon N. Kyle, Ph. D., East Carolina University To all of you: Many thanks! We could not have done this without your careful and detailed comments and suggestions. Sherry Cormier, Paula S. Nurius, and Cynthia J. Osborn Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
1 Building Your Foundation as a Helper The Chambered Nautilus The story of the sea snail or mollusk that makes its home in the spiral-shaped nautilus shell is fascinating and compelling. It captures well the primary message of this book—change and growth. An inside and lateral, or “sliced,” view of three empty nautilus shells is showcased on the cover of the book. We ask that you pause now to look at the designs of all three. Spend a few moments in-specting their shapes. Notice first the spiral formation of each shell, which has its beginning at the center. Also no-tice that the shell comprises successively larger compart-ments or chambers. Each chamber was where the mollusk lived at one time. As it grew, it created a new, larger living space. It is because of these chambers that this sea creature is often referred to as the chambered nautilus. The chambered nautilus is in the family of cephalopods that also includes the octopus and squid. Unlike some of its close relatives, however, the nautilus does not discard an outgrown shell in search of a larger one. Rather, it retains its shell throughout its adult life. As the mollusk grows, it forms a new and larger chamber to accommo-date its size. In other words, it builds on its foundation. In so doing, it seals off the last chamber. Its entire life is therefore dominated by the production of one new living chamber after another, each new chamber connected to earlier ones and a part of an ever-enlarging and stronger shell. How this is done remains a mystery. Nixon and Young (2003) state, “This process of forward movement is not understood but does involve the repositioning of the muscles that attach the animal to its shell” (p. 36). In other words, the growth and development of the cham-bered nautilus is ongoing and requires a firm foundation, strength, determination, perseverance, and flexibility. The mollusk lives in only one chamber at a time—in the largest and last chamber of the shell. It firmly anchors itself to the shell by a pair of powerful muscles. It moves around the ocean depths entirely by jet propulsion and uses the empty chambers it once called home for buoyancy. Despite this buoyancy that allows it to move laterally with the ocean currents, the nautilus is able to travel vertical distances of up to 2,000 feet per day. This is made possible by the mollusk using the muscles in its body and tentacles to draw in and expel seawater. It is quite the strong, resilient, and versatile animal! This is one of the reasons the nautilus has been referred to as the “survivor” (Boyle & Rodhouse, 2005, p. 50). We encourage you to spend some time viewing some amazing videos on www. You T ube. com of living nautiluses. Simply search by using the key words “chambered nautilus. ” Learning Outcomes After completing this chapter, you will be able to 1. Recognize, in writing, using dialogue from a counseling supervision session, one example each of the need for developing the core helper skills of: (a) self-awareness and self-reflection; (b) mindfulness; and (c) self-care and self-compassion. You also will be able to identify one specific activity for developing each of these three skills to promote stamina and resilience as a professional helper. 2. Define evidence-based practice (EBP) from a list of descriptors provided (what it is and what it is not), identify two of its in-tended benefits and at least two of its criticisms, and identify at least six methods for adapting EBPs for culturally diverse populations. chapter 1 Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
2 Chapter 1 nautilus and its spiral-shaped shell can inspire helpers and clients alike in the process of change and growth. A Practice Nexus for the Helping Professions During the approximately 35-year history of this book, we have learned quite a bit from our readers and from the changing fields of practice, and our approach has evolved as a result. In Figure 1. 1 we illustrate the unique nature of this text in terms of today's practice nexus—the interrela-tion, connections, and interfaces of our field. These might be likened to the interrelationships among the chambers of the nautilus shell. The figure depicts the relatedness and connection among the four major components of practice knowledge: (1) core skills and attributes; (2) effectiveness and accountability; (3) critical commit-ments; and (4) diversity. The components come together to define the central core of what you need for today's practice. So we focus on the interface—the area of over-lap among the components of practice knowledge—to provide a coherent and unifying foundation. As the figure shows, each component contains specialized content that you will pursue to greater or lesser degrees, depending on the need. And as you specialize, you will certainly find other components of practice that you will need to master. The totality of it all will develop over years of practice, ongoing training, receiving feedback from clients and col-leagues, and self-reflection. To begin, however, you need core content, an understanding of the interrelations, and practical as well as conceptual understanding. Four Stages of Helping The four components of today's practice nexus are ad-dressed in the 15 chapters of this book and are part of four primary stages of helping: 1. Establishing an effective therapeutic relationship2. Assessment and goal setting3. Strategy selection and implementation4. Evaluation and termination The first stage of the helping process, establishing an effective therapeutic relationship with the client, is based primarily on client-centered or person-centered therapy (Rogers, 1951). We present skills for this stage in Chapters 3-5. The potential value of a sound relationship As we have learned more about the chambered nautilus, we cannot help but make some comparisons to helping professionals, and to our helping professions. We believe skilled and effective helpers are part of a professional community yet are also one of a kind. Each helper is his or her own person, not a replica of a supervisor or some-one working intently to be just like Carl Rogers, Aaron Beck, or Marsha Linehan. In addition, helpers make use of their buoyancy to “go with the flow” as needed, for example, by cooperating with clients and supervisors and by implementing a recently learned evidence-based prac-tice (EBP). At the same time, however, skilled helpers also know when to “go against the current. ” This means that they stretch themselves by doing something uncustom-ary and perhaps uncomfortable at first, such as sitting in silence with a client or interrupting a client when needed. Like the chambered nautilus, the professional helper's vertical travel also suggests the deliberate use of clinically trained muscles in search of new ideas and better alternatives for clients, all the while remaining immersed in the necessity of ethical practice. An example of this is modifying an EBP to accommodate the cultural values, traditions, and needs of a particular client or client popu-lation, a practice consistent with the culturally affirmative services we discuss in Chapter 2. Just as the chambered nautilus retains its shell and builds on its former living compartments, effective helpers use their life experiences and graduate training to build a strong foundation on which to grow and fashion a level of expertise in their work. In so doing, they remain resource-ful and inventive. This parallels the forward movement of the nautilus, which involves the flexing and repositioning of its muscles to adapt to new living and work environ-ments. Professional helpers can be like the strong and resilient nautilus by concentrating on the present moment and the current living environment while leaning into and preparing for the next stage of growth. This means that retreating to previous chambers is not possible—they no longer fit. Likewise, sticking to (or remaining stuck in) customary practice and “same-old, same-old” ways of thinking results in a stifling work environment, in addi-tion to ethical vulnerability, burnout, and ineffective care. Just like the nautilus, we have no choice but to move on because change and growth are constant. The spiral shape of the nautilus shell suggests that the mollusk can keep growing forever. This also is true for professional helpers! We hope the skills, strategies, and interventions described in this book will assist professional helpers to guide their clients step by step in the construction of new, more ac-commodating, and healthier living spaces using existing re-sources and strengths. Perhaps the maturing and determined Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Building Your Foundation as a Helper 3 relationship part of therapy is necessary but not sufficient to help them with the kinds of choices and changes they seek to make. These clients need additional kinds of ac-tion or intervention strategies. The second stage of helping, assessment and goal setting, often begins with or soon after establishing a therapeutic relationship. In these first two stages, the practitioner is interested mainly in helping clients explore their concerns and wishes. Assessment is designed as a collaborative endeavor, a joint undertaking intended to help the clinician and client obtain a better picture, idea, or grasp of what is happening with the client and what prompted the client to seek the services of a helper at this base cannot be overlooked. Research has consistently noted that the therapeutic relationship accounts for a substantial amount of client change, approximately 30% (Lambert, 1992). This is understandable given that the relationship is the specific part of the process that conveys the helper's interest in and acceptance of the client as a unique and worthwhile person. It is the foundation for—or the container of—all subsequent therapeutic work. The helper's validation of the client can be empowering, generating hope the client may not have experienced in a very long time. For some clients, working with a profes-sional helper who stays primarily in this stage of help-ing may be useful and sufficient. For other clients, the relevance applicability practice practice vulnera ble, and underser ved populations environment Multiprofessional Multiproblem Evidence-based Collaborative Oppressed, Person in Ethics in practice Critical thinking Interviewing and Change Strategies fo r Helpers Critical Commitments Diversity Effectiveness and Accountability Core Skills and Attributes Figure 1. 1 A Practice Nexus for Today's Helping Professional Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
4 Chapter 1 time. Think of this stage as the client and helper locating the horizon for the client's journey of change and also determining the compass to be used to indicate progress toward reaching the client's preferred destination. The in-formation gleaned from assessment is extremely valuable in planning strategies. It provides clarity and direction. It also can be used to manage resistance or occasions when client and helper do not agree or encounter an impasse. We describe assessment skills and strategies in Chapters 6 and 7. As the problems and issues are identified and de-fined, the practitioner and client also work through the process of developing outcome goals. The skill of treat-ment goal formulation is described in Chapter 8. Strategy selection and implementation is the third stage of helping. The clinician's task at this point is to help with client understanding and related action. Insight can be useful, but insight alone is far less useful than insight accompanied by a supporting plan that helps the client translate new or different understandings into observable and specific actions or behaviors. Insight also is a Western and individualistic concept that may not apply or be use-ful to many culturally diverse clients. Think of this stage of helping as the skill-building phase when clients, like the chambered nautilus, are learning about and using new or reconfigured muscles to sustain a healthier living environment or to construct a new one. Toward this end, the helper and client select and sequence a plan of action: intervention strategies that are based on the assessment data and are designed to help the client achieve the des-ignated goals. In developing action plans, it is important to select plans that relate to the identified concerns and goals and that are not in conflict with the client's primary beliefs and values (see Chapters 9-15). The last stage of helping, evaluation and termina-tion, involves assessing the effectiveness of interventions used—as well as the therapist's style in facilitating the process of change—and the progress the client has made toward the desired goals (see Chapters 8-10). This kind of evaluation assists you in knowing when to terminate the process or to revamp your initial action plans. Also, clients can easily become discouraged during the change process, realizing that transferring the skills learned in counseling to various aspects of their lives is a challenge. Social supports may not be in place, necessitating the development of new and healthier relationships. Clients often find observable and concrete signs of progress to be quite reinforcing. Our listing of evaluation as the last stage of helping can inadvertently suggest that gauging effectiveness comes near the end of counseling. This is far from the truth. If we are not making effective progress in developing a col-laborative, therapeutic relationship or in understanding the perspective of a client early on in our work, then we need to be aware of this right away. In reality, we need to be intentionally evaluating effectiveness throughout the helping process, sharing our observations with clients, soliciting their feedback, and negotiating a plan of care. These four stages of helping are not discrete. Actually, there is quite a bit of flow and interrelationship among the four stages. In other words, elements of these stages are present throughout the helping process, with varying degrees of emphasis. Change rarely follows a predict-able path. Clients encounter challenges and setbacks as they implement new behaviors. Symptoms may not abate quickly or respond well to preliminary interventions. A revision of the initial plan of care is not uncommon. The foci and tasks of each stage of helping thus are not confined to that stage. This also is true of the four com-ponents of the practice nexus. Their interrelationship is a constant throughout our work with clients. We ask now that you return your gaze to Figure 1. 1. T wo components of the practice nexus—core skills and attributes and effectiveness and accountability—are the focus of this first chapter. The remaining two compo-nents—critical commitments (including ethical practice) and diversity—are addressed in Chapter 2. All four com-ponents, however, are woven throughout the book. To be more precise, the nexus of these components throughout the four stages of helping is the foundation of the book. Core Skills and Attributes Think back to when you knew you wanted to become a professional helper. More than likely it was at a time when others had been telling you how good a listener you were. Even some might have said you offered helpful advice. It was not necessarily that you went out looking for people to help—they just seemed to migrate to you, asking if you could spare a moment, or, for others, not bothering to ask, but proceeding to divulge personal information and then waiting for your response. Your desire to become a professional helper also may have been propelled by witnessing the aftermath of tragedy in your school or hometown, or even experiencing first-hand debilitating fear, trauma, and injustices. Because of insuf-ficient care provided to those in need or, by contrast, the helping hand you received that allowed you to breathe again and learn how to persist and be resilient, you vowed to be a part of a solution rather than to perpetuate a problem. “Never again,” you may have said. “I want to help... and to do it right. ” Maybe you cannot remember a specific time or event that crystallized your decision to become a professional LO1 Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Building Your Foundation as a Helper 5 helper. Perhaps it had to do with looking back over your life and realizing that some kind of change was in order, that remaining on the same life path did not portend much excitement or even any hope. “It's now or never,” you may have said. “Something has to change... for the better. ” Regardless of the circumstances that brought you to the entrance of your graduate training program, you're ready for something different. Although questioning how this may all work out for you (in terms of time, finances, and extent of community involvement), you are eager to get started and venture into this professional realm. You want to be a part of change—for others and for yourself. And you are ready to begin learning and to continue learning what it takes to be a change agent. “Bring it on,” you may say. “Just give me the tools so that I can build my toolbox and get out there to help people. ” The analogy of the toolbox is one we hear often from our graduate students. It brings to mind the work of a car-penter or an electrician, the professional who is equipped with various instruments to build something new or fix something that is broken. Although students and new professionals may take comfort in having a figurative toolbox that they can carry with them to each encounter with a client, we caution them to not allow this anal-ogy to persist and remain prominent in their career. For one thing, a toolbox brings to mind something that is external to you, something like an appendage that is not you, that can be inauthentic. This is not to say that the “tools of the trade”—the strategies, interventions, guide-lines, and practice principles of the profession—are not important. They are! They are critical! But when they are not understood and are not incorporated into the helper's overall practice style, their potential for misuse increases. This is when they are applied out of context, when the helper is faithfully implementing an assess-ment protocol, for example, but is not mindful of how some of the standard questions have offended a particular client. The open-ended question, “How do you feel?” is considered an important tool, as is the “miracle question” in solution-focused therapy. But when they are asked without understanding their purpose for a particular cli-ent at a particular time, they may be interpreted by the client as disrespectful and intrusive and may result in the client's early departure. Tools, therefore, are not intended to be used in a mechanical fashion, only applied because the instruction manual says so. Because of this, we do not want to encourage helpers to continue to rely on tech-niques they do not understand, have not yet practiced and received feedback on, and have not incorporated into their overall style. Doing so over the course of one's career would be disingenuous and inauthentic. The analogy of a toolbox also suggests there is some-thing that needs to be fixed or corrected and that it is the helper who must fix, correct, or straighten out what is wrong in clients. This is not a helpful perspective. Reference to tools also implies that it is the tools, the instruments themselves, that are responsible for client improvement. It is as if the tools are imbued with some kind of power to effect change and, regardless of the client or the therapist, each kind of tool will work in a particu-lar way to fix what is broken. This is another example of using a tool out of context. Again, we do not find this comparison helpful. Thinking this way negates the con-tributions of the helper and the client! Our fourth and final reason for not encouraging the toolbox analogy is that it can prevent a discussion of helper skills. Although some may liken tools or counseling tech-niques to helper skills, they are not quite the same. Tools and techniques are often regarded as external to the helper (especially when learning to use a new tool), whereas skills comprise the helper's qualities, traits, and learned behav-iors. To speak of tools is to speak of something other than the helper; to speak of skills is to talk about the helper. The focus of the former is impersonal; the focus of the latter is the person of the helper and how he or she has learned to embody and demonstrate certain skills for the benefit of a client. A prime example of this distinction is found in what are referred to in person-centered therapy as the core conditions of the therapeutic environment: genuine-ness or congruence, unconditional positive regard, and empathic understanding. These are discussed in greater detail in Chapter 3. Notice that these are not impersonal “things” or tools—they are the qualities or attributes and skills of the helper, how he or she relates to another person to create the conditions for client change. It may be more accurate, therefore, to talk about the skilled helper (Egan, 2014) or the helper who prac-tices what is referred to in dialectical behavior therapy as skillful means (Linehan, 2015). Skills refer to and describe the way a helper practices and reflect how the helper has learned, made sense of, and integrated certain theories and techniques (or tools) of helping. In other words, skills reflect the person of the helper. A skilled and skillful helper is a professional, not a technician or what Skovholt and Jennings (2004) referred to as a “tech-nique wizard” (p. 140). Whereas learning a technique can take only a few hours, becoming a skilled professional and a wise person takes many years (see Rønnestad & Skovholt, 2013). Our focus on core skills and attributes throughout this book is in effect a focus on you as the helping professional—your qualities, traits, and learned behaviors—so that clients derive maximum benefit from services provided. It is a learning and growth process: Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
6 Chapter 1 from a mechanical and disjointed use of tools in the tool-box to practicing with skillful means. Like the way the chambered nautilus grows, this process can take place over many years, but its foundation begins now, with careful attention to matters of context and environment. We dedicate the remainder of this section to a discus-sion of three core skills and attributes that are essential throughout the stages of helping: (1) self-awareness and self-reflection; (2) mindfulness; and (3) self-care and self-compassion. These make possible the promotion of stam-ina and resilience, concepts that also are addressed in this chapter. Think of these as core skills and attributes from which to start your journey of growth and change as a professional helper. Just as the chambered nautilus began its development at the core or center of the spiral shell, we believe these skills and attributes are the foundation of your own development as a professional helper. Self-Awareness and Self-Reflection Being drawn to uncertainty is one precondition for thera-pist development. According to Jennings, Skovholt, Goh, and Lian (2013), helpers who “thrive... are comfortable in the seemingly paradoxical reality of searching for clarity while enjoying the ambiguity and confusion of the human condition” (p. 239). This means that the terrain of help-ing is not clear and the journey cannot be predicted. It also means that there is no one-size-fits-all “answer book” to consult so that you know what to do with clients each step of the way. Rather than getting clearer as you move through your graduate studies, it may be that this work of professional helping seems to be getting murkier as you go along. T wo of the 20 “hazards” of practicing as a profes-sional helper that Skovholt and T rotter-Mathison (2011) listed illustrate this murkiness: lack of concrete results and closure in our work with clients, and not knowing how to measure improvement or even effectiveness. What does uncertainty have to do with the core skills of self-awareness and self-reflection? Quite a bit! For one, it means that these skills are essential because there is no absolute “how to” manual out there for you to consult. In session with your clients, you are the one facilitating the conversation, establishing a connection with the cli-ent, assessing the case, and making decisions about client care. More often than not, no other professional is in the session to assume those responsibilities. You are the sole professional in the moment with clients. Understood in another way, you are the only active ingredient in that therapeutic encounter that you can control. More than likely other factors are beyond your control, such as cli-ent characteristics and the immediate treatment setting. Although you may be guided by a specific theoretical orientation or operating from an evidence-based treat-ment manual, that theory and those treatment protocols were not developed expressly for the client with whom you are working. Rather, you are the one in the imme-diacy of the moment to determine, adapt, and deliver services to each client. This is what it means to move beyond rote use of tools in a toolbox to developing skillful means. The tools are no longer disconnected from you; they now have become part of your routine functioning so that quality client care is maintained. This also is part of the professional development process, the forward move-ment similar to that of the growing chambered nautilus— developing from mere technician to a skilled and respon-sive professional. The instruction manual remains; its purpose is now understood. Just as the chambered nautilus must navigate through the murky waters of the deep sea, so must practitioners make their way through the ambiguous terrain of clinical practice. The skills of self-awareness and self-reflection make this possible. These are practices intended to keep the practitioner in check and also to monitor the quality of services extended to his or her clients. High self-awareness and in-depth self-reflection are primary characteristics of highly skilled, effective, or “master” therapists in the United States and four other countries (Jennings et al., 2013). Self-awareness is being highly observant of one-self, and self-reflection is a form of self-monitoring or self-regulation. Rather than being self-absorbed in a nar-cissistic manner, self-awareness and self-reflection are skills of introspection that consider yourself from differ-ent dimensions (e. g., verbal expression, demeanor, values) as you learn new skills and are exposed to professional guidelines. It might be helpful to think of self-awareness and self-reflection as consultation skills—that is, the ability to consult your inner compass as part of the clinical decision-making process. Your inner compass continues to be shaped as you learn more about theory, research, and professional standards. It could be said that your in-ner compass is what sits on the practitioner's stool, a stool Skovholt and Starkey (2010) described as having the three legs of practitioner experience, personal life, and academic research. These three legs are sources of knowledge for you to consult throughout your career. This must be done deliberately, such as setting aside time to read a self-help book and journal about what you have read, obtaining ad-ditional supervision, or attending an experiential profes-sional growth workshop. Your compass requires routine calibration, just as your stool needs to be balanced and leveled. Self-awareness and self-reflection are the skills you use to calibrate your inner compass by consulting theory, research-informed practices, supervisory directives, and Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Building Your Foundation as a Helper 7 ethical and other professional guidelines. These skills also are used to maintain balance as you operate from your practitioner's stool. Before reading further, we invite you to pause and participate in Learning Activity 1. 1. This activity is in-tended to heighten your self-awareness and make use of your self-reflection skills. Specifically, this activity is designed to help you explore your reasons for entering the helping profession, as well as what you hope to gain from your work as a helping professional. Because this is demanding work that involves substantial personal com-mitment, routine self-reflection is essential to effective practice. Mindfulness Related to self-awareness and self-reflection is the core skill of mindfulness. Think of it as a specialized and dis-ciplined form of self-awareness and self-reflection. It is an intentional practice that is central to dialectical behavior therapy (DBT; Linehan, 2015) and to acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 2012). Mindfulness also is a core skill in at least four other approaches. Jon Kabat-Zinn's (1990) mindfulness-based stress reduction (MBSR) initially was developed for persons with chronic pain and is now intended for persons with a variety of psychological and medical issues. It is group-based training conducted in 2. 5-hour weekly sessions for 8 weeks, with an additional 1-day meditation retreat. Mindfulness-based cognitive therapy (MBCT) for depression (Segal, Williams, & Teasdale, 2002) and mindfulness-based relapse prevention (MBRP) for addictive behaviors (Bowen, Chawla, & Marlatt, 2011) are designed based on the work of Kabat-Zinn. A newer approach is mindful self-compassion (MSC; Germer & Neff, 2013) that teaches self-compassion skills to the gen-eral public and is fashioned according to MBSR's format. Inspired by Eastern spiritual practices of meditation, namely Buddhism and Zen, mindfulness is understood as practicing focused attention, specifically, remaining aware of and deliberately attuned to the present moment. Although often confused with meditation, it is not. Rather than “zoning out” or retreating from the present moment, mindfulness is “a way of living awake, with your eyes wide open” (Dimidjian & Linehan, 2009, p. 425). This means that it is an attentional skill or a way of paying attention on purpose. It therefore is not “mindlessness. ” It is a heightened state of consciousness wherein the focus of attention is on in-the-moment perceptual experience, making use of as many senses as possible (e. g., sight, sound, smell)—and also attending to visceral functioning (e. g., breathing)—to be fully immersed in the textured detail of the concentrated now. In this way, mindfulness Learning Activity 1. 1 Survey of Helper Motives and Goals This activity is designed to help you explore areas of your-self that in some fashion will affect your helping. Take some time to consider these questions at different points in your development as a helper. We offer no feedback for this ac-tivity, because the responses are yours and yours alone. You may wish to discuss your responses with a peer, a supervi-sor, or your own therapist. 1. What is it about the helping profession (e. g., social work, counseling, psychology) that is attractive to you or enticing for you? 2. What do you look forward to learning and doing over the next 5 years? 3. What is anxiety-provoking to you about the work or lifestyle of a professional helper? 4. What are you cautious or hesitant about as you con-tinue in the profession? 5. If you had to select one event in your life or one per-sonal experience that contributed to your decision to pursue the helping profession you are now in, what would that event or experience be? 6. What have you learned about yourself by having expe-rienced tragedy, trauma, or types of personal pain and injustices at some point in your life? What more do you still have to learn about yourself as a result of such pain? 7. Which of your personal qualities do you believe will serve you well as a helping professional? Why do you believe this? 8. What aspects of yourself (e. g., being “rough around the edges”) do you still need to work on for you to be a helpful practitioner? How do you see yourself address-ing these traits? 9. How do you handle being in conflict? Being con-fronted? Being evaluated? What defenses do you use in these situations? 10. How would someone who knows you well describe your style of helping or caring? 11. What client populations or client issues do you enjoy working with or look forward to working with? For what reasons? 12. What client populations or client issues are difficult for you to work with or do you foresee as being difficult for you to work with? For what reasons? 13. What are three primary factors that contribute to being an effective helper? 14. How will you know when you have been an effective helper? Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
8 Chapter 1 is like stepping outside yourself, taking a meta-perspective on your own experience, so that you can consider your perception of the present moment with greater objectivity (Neff & Pommier, 2013). Mindfulness is the means by which an individual makes direct contact to immediate experience, not to abstrac-tions or concepts. Persons who practice mindfulness are able to control or focus their attention on the present moment. They do not control what is being attended to, such as deliberately trying to change their breathing or rid their mind of thoughts; rather, they control how they attend to what is happening in and around them in the here and now. In this way, mindfulness is unlike certain forms of prayer and is not to be confused with prayer. It is not a form of communicating with or connecting to a transcendent being. Furthermore, mindfulness does not seek to make something happen, such as relaxation or preventing certain kinds of behavior (e. g., fighting). Dimidjian and Linehan (2009) state, “Mindfulness has as its goal only mindfulness” (p. 425). Mindfulness is the polar opposite of multitasking. It does not mean, however, doing nothing or being nonpro-ductive. It does mean intently focusing on one thing at a time and doing so in the present moment. This requires effort! Although not intended to make something hap-pen or to control that which is the focus of attention, research suggests that persons who consistently practice mindfulness experience a greater sense of control over their feelings and mood, their behaviors (e. g., not acting on impulses), and their attitudes (e. g., more hopeful). For example, primary care physicians trained over 1 year in mindfulness skills reported improved personal well-being, including decreased burnout and improved mood (Kras-ner et al., 2009). They also experienced greater changes in empathy, a finding that seems to fit Greason and Cashwell's (2009) survey of counseling student interns. They found that these students' high mindfulness scores predicted greater empathy and greater self-efficacy. Coun-seling students who had taken a graduate level course that focused on mindfulness and self-care reported similar benefits (Christopher & Maris, 2010) and also spoke of the positive effects of mindfulness specific to their work with clients, such as increased calm and comfort with si-lence and reduced fears of inadequacy and incompetence. It appears that even though mindfulness is not prac-ticed for the specific purpose of changing mood, behavior, or attitude, the practice of mindfulness results in positive changes in these areas of functioning. Think of these changes as positive side effects or the benefits of mindful-ness. Davis and Hayes (2011) reviewed additional ben-efits of mindfulness from the research literature, including relationship satisfaction, improved physical functioning, and increased patience. These and other benefits seem to support Carmody's (2009) contention that the overall goal of mindfulness is the reduction of human suffering (p. 272). In both DBT and ACT, mindfulness is a skill taught to clients and is a skill practiced—and lived—by therapists. You do not have to be a religious or spiritual person to practice mindfulness. Consistent with our earlier discus-sion of skill and how it differs from technique, mindful-ness is how the helper interacts with clients—or, more precisely, how the helper is present with clients. The premise of DBT and ACT is that helpers cannot teach skills to clients that therapists do not practice themselves. Manuals are available to teach clients mindfulness skills (e. g., Linehan, 2015), but mindfulness cannot be learned simply by talking about it or lecturing on it. Mindfulness must be practiced in session and modeled by the therapist. The therapist who is purposefully attentive to the client in the immediacy of the counseling session is modeling for the client the skill of mindfulness. The therapist who routinely practices mindfulness in and outside of therapy also is able to guide the client through the process of learn-ing and continually practicing mindfulness. Mindfulness Skills In DBT, there are six specific mindful-ness skills divided into “what” and “how” skills. The three “what” skills are observing, describing, and participat-ing; the three “how” skills are remaining nonjudgmental, focusing on one thing at a time in the present moment, and being effective. Observing is the act of noticing what is in your awareness, using your sight, hearing, or tactile senses, for example. It does not label or categorize what is observed; it is simply the act of paying attention to what is taking place around you and what is being experienced inside you in the here and now. The skill of describing requires a kind of stepping back from the experience to identify what has been observed. This may include nam-ing the colors, sounds, and tactile sensations (e. g., soft, rough, warm temperature) observed and experienced. The third “what” skill is participating and refers to fully immersing yourself in the activity of the present moment. This has been described as throwing yourself into and becoming one with an activity or experience, and doing so without reservation or self-consciousness. This means that participating has the quality of spontaneity. Take, for example, the act of walking. When done mindfully, fully participating in walking means attending to your move-ments and the sensations as you walk, focusing on the act of walking, and immersing yourself in the activity. As its name implies, the three “how” skills of mindful-ness describe how the three “what” skills are used. First, observing, describing, and participating in the present Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Building Your Foundation as a Helper 9 moment is to be done nonjudgmentally. This means not evaluating the experience as either bad or good. This practice is similar to that of accepting, a core skill in ACT. It means assuming a noncritical or neutral stance by dis-carding the need to control what is, even that which has been experienced as unpleasant. To walk nonjudmentally means to not ruminate on your movements or to experi-ence them as “stupid,” “difficult,” or “painful. ” It does mean accepting your experience as is, and continuing to walk with your full attention on the present moment, the second “how” skill of mindfulness. This means not walking and thinking about your destination at the same time. This would be doing two things at once—a practice inconsistent with remaining in the present moment by doing one thing at a time. The third “how” skill of mind-fulness is being effective, which is doing what works or what is helpful. Being mindful is not about doing what is right and avoiding what is wrong. It also is not about following orders or simply going through the motions (like pulling out tools from a toolbox!). It is about using your attentional “muscles” so that you can tune in to your immediate experience, using your sensory resources. It's a way of becoming acquainted with you—with where you are and who you are in this present moment! Mindfulness that is effective becomes a welcome, inviting, and mean-ingful activity, not a scary, suspicious, or worthless one. Each of the six mindfulness skills is not to be taken lightly. The skills also are to be used carefully with clients, not in a haphazard fashion or only because mindfulness may be regarded as a popular clinical perspective and practice. Again, mindfulness practice requires discernment and effort! To help you practice your mindfulness skills, we invite you to participate in Learning Activity 1. 2. Even if you have learned about mindfulness prior to read-ing this book, we ask that you pause to “flex” and “tone” your mindfulness muscles. Think back to the mollusk that makes its home in the nautilus shell—to continue to grow and expand, it uses its muscles continuously. Doing oth-erwise would result in shriveling up or being swept away by the tide. If you are new to mindfulness practice, we ask Learning Activity 1. 2 Mindfulness Practice You can engage in this practice by yourself after reading through the activity. It can also be done in a group with one person volunteering to lead the practice, reading aloud the following activity. Find a quiet spot where you know you will not be dis-turbed for approximately 10 minutes. Turn off or mute any mobile devices you may have around you. Sit down in a comfortable position, either on a chair or on the floor. Sit upright, with your feet firmly touching the floor (if sitting on a chair), or, if sitting on the floor, extend your legs, or cross them with one of your ankles resting comfortably on the knee or thigh of the other leg. Take three or four deep breaths in through your nose, noticing how it feels for the air to come in through your nostrils, and also notic-ing how your chest expands as it takes in new oxygen. As you breathe out through your nose, notice how your chest subsides and the motion of air in your throat and nostrils. Now take your hands and rest them on your thighs, palms up. Keep them separate for now. Notice the palms of both of your hands, the lines or “creases” that make up the inside of your hands. Observe the length and the direction of these lines, notice how they change as you bend your fingers slightly and then extend your palms. See the detail of the lines, and how they criss-cross, as you move your hands slightly in the light. Pay attention to the detail across the surface of your palms. As you do, remind yourself that these palms and these fingerprints are yours and yours alone—unique and one of a kind. Now notice any other visuals on your hands, such as the blood vessels below the skin, markings on the skin, or rings that appear on the in-side of your fingers. Simply use your eyes to scan the open palms of your hands, the hands that have lifted objects for you, opened and closed doors, helped you write and type, and held the hand and cupped the face of a loved one. Now take one of your hands and its fingers and touch the surface, the palm, of the other hand; notice how this feels. Glide your fingers and its palm across the palm and the fin-gers of the other hand. Simply notice the touch, how your open hand feels when gently touched by one or several fingers of the other hand. Describe this sensation without judging it as good or bad. Suspend any criticism. Hold off on assigning to the sensation any positive evaluation as well. Simply give a name to how the motion, the sensation, feels. Keep the motion of your fingers on the other palm slow, gentle, and deliberate so that you are able to notice the detail or the intricacies of the sensation. Continue do-ing this for a few moments, doing your best to remain focused on the activity in the here and now. To close this activity, take three or four deep breaths, holding for just a moment each time before breathing out. As you gaze again at the palms of your hands and glide your fingers of one hand over the palm of the other, remind yourself of your uniqueness, that these hands are yours and one of a kind. Offer a word of gratitude to both hands, thanking them for being a part of you, making you unique, and for working for you. This might even include a warm shake between your two hands or a gentle clap. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
10 Chapter 1 that you enter into this exercise with an open mind, ready to try something new—a skill we believe is central to all forms of helping. You will have the opportunity to practice yet again your mindfulness skills in Chapter 4, so think of this activity as a warm-up! Developing Skilled Intuition We believe the deliberate practice of mindfulness can assist new helpers in making the transition from relying on only intuitive judgments (decisions that are automatic, involuntary, and almost ef-fortless) to incorporating deliberate judgments (decisions based on controlled, voluntary, and effortful activities). Although acting on your intuition or gut may have some appeal because it is thought of as genuine or authentic practice, it also suggests a dismissal of learned theory and skills. Think about it. If all it took to be an effec-tive helper was the use of instinct and gut, why would graduate studies be necessary? The truth is that effective helping requires the application of genuine yet sophisti-cated skills—skills that have been learned, practiced, and revised over a period of time. If you hear a supervisor tell you to “just go with your gut,” or “stop using your head and simply use your instinct,” ask him or her to explain. It may be that your supervisor is encouraging you to integrate the skills you have learned (“head knowledge”) into your natural style of interpersonal communication. His or her recommendation may be for you to practice what Kahneman and Klein (2009) described as skilled intuition, or the testing of your cue recognition skills. They proposed that skilled intuition develops only in an environment of regularity (e. g., meeting with clients on a routine basis and receiving supervision consistently) that makes it possible to validate your observational skills or cue recognition (e. g., discerning symptoms from client presentation). We believe that mindfulness is a form of skilled intu-ition. In this case, what your supervisor may be trying to tell you is that in session with your clients, you must attend to the present moment in a more focused and de-liberate manner, accepting what is without trying to force change. Now, that requires skill, doesn't it? Maybe that explains the practice of skillful means! Self-Care Another core skill for helpers is self-care (Norcross & Guy, 2007). Although mindfulness is a form of self-care (Wise, Hersh, & Gibson, 2012), self-care is a broader concept and practice and has been identified as an ethi-cal imperative for counselors (American Counseling As-sociation, 2014), psychologists (Wise et al., 2012), and social workers (Lee & Miller, 2013). This is true not only in the United States but also in other countries. For example, the Canadian Code of Ethics for Psycholo-gists (Canadian Psychological Association, 2000) regards self-care as an activity that fulfills the ethical principle of responsible caring. In its Ethical Framework for Good Practice in Counselling and Psychotherapy, the British As-sociation for Counselling and Psychotherapy (2013) lists self-respect (the practice of “fostering self-knowledge and care for self”) as one of six ethical principles. Professional associations and accrediting bodies based in the United States also have recognized the importance of professional self-care. For example, counseling programs accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP, 2009) must include in their core curriculum “self-care strategies appropriate to the counselor role” (Standard G. 1. D. ). In addition, the National Association of Social Workers (NASW, 2008) has a policy statement supporting the practice of profes-sional self-care, describing this practice as “a core essential component to social work practice” (p. 269). That self-care is an ethical imperative for all profes-sional helpers suggests four things: (1) it is not simply a personal matter or quality; (2) it is not an indulgence; (3) it is not optional; (4) it is not automatic; and (5) it is not to be practiced in a shallow or superficial man-ner. As a reflection of ethical conduct, self-care is a set of learned behaviors that must be demonstrated during graduate studies and throughout one's professional career. Just because you care for others does not automatically mean that you are able to care for yourself. More than likely, it is because you care for others that you are prone to not care for yourself adequately. It may be that for far too long you have prioritized the needs of others over your own, set aside your own goals to accommodate the goals of others, and sacrificed your own well-being to preserve your prize-worthy reputation as the devoted child, faith-ful spouse and partner, loving parent, generous friend, helpful neighbor, and dutiful employee. Although these are qualities many of us aspire to and would hope to have included in our eulogies and obituaries, they come with a price. And in the role of professional helper, you cannot afford what it costs to care for others while simultaneously ignoring caring for yourself. Baker (2007) stated that “self-denial or self-abnegation is neglectful not only of our real self-needs, but ultimately of the well-being of our clients” (p. 607). In other words, self-care must become routine practice for helpers for the sake of client well-being and remaining effective as a clinician—and we believe this practice must begin during graduate studies. It is meant to prevent helper impairment and inadvertent client maltreatment. Its purpose also is to Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Building Your Foundation as a Helper 11 strengthen helper resilience and well-being. Self-care was identified by a group of 24 mental health practitioners from diverse ethnic backgrounds in the United States and Canada as an adaptive response and an essential practice to “detoxify from frequent forms of racial microaggres-sions they experience in their jobs” (Hernández, Carranza, & Almeida, 2010, p. 206). Self-care activities described by this group included physical exercise, meditation, visu-alizations, massage, acupuncture, chiropractic treatment, thinking positively and avoiding negative thoughts, and taking pride in their ethnic heritage. Self-care thus has a dual purpose: prevention of ineffective or even harmful client care (i. e., doing no harm, the ethical principle of nonmaleficence), and promotion of beneficial care (i. e., doing good, the ethical principle of beneficence). In your work as a professional helper, you have no choice! You must practice self-care. And this is not self-indulgent, selfish, or narcissistic behavior. It also is not to be practiced in a shallow or superficial manner “'dumbed down' to socializing and recreational pursuits” (Putter-baugh, 2015, p. 54). Rather, as a stipulation for living and working as an effective professional helper, self-care is a deliberate, purposeful practice that involves quiet and deep reflection on our lives. How do you practice self-care? In a recent study of psy-chology graduate students, Myers et al. (2012) found that three self-care behaviors predicted lower perceived stress: (1) engaging in better sleep hygiene; (2) having strong so-cial support; and (3) regulating emotion through cognitive reappraisal (changing the meaning of an emotion-filled situation) and suppression (changing emotional expres-sion, as in not acting on anger). Surprisingly, physical exercise and mindfulness practice did not predict reduced levels of perceived stress, which the researchers attributed to varying opinions on the benefit of these behaviors and lack disciplined engagement in these behaviors by gradu-ate students. In T urner et al. 's (2005) study of psychology interns, engaging in pleasurable activities outside of the internship, using humor, getting a sufficient amount of sleep, and engaging in physical exercise were activities re-ported to be beneficial. When working at the internship, these same graduate interns reported that consulting with fellow interns, obtaining clinical supervision, diversifying internship activities, and setting realistic internship goals were beneficial self-care activities. T urner and colleagues (2005) encouraged graduate in-terns to be intentional about participating in self-care strat-egies because “self-care is a life-long process and not limited to the internship year” (p. 679). Similarly, Jenaro, Flores, and Arias (2007) emphasized the importance of an appro-priate balance between work and private life throughout one's career. Concentrating only on active coping strate-gies at work, they noted, may actually “exacerbate the psychological tiredness of the worker” (p. 85). Engaging in relaxing activities during one's leisure time is therefore important because these “off-the-clock” activities serve to address the emotional exhaustion that has been found to be the primary culprit of burnout (see Wallace & Brinkerhoff, 1991). It is assertive self-care over the career life-span that is essential (Skovholt & T rotter-Mathison, 2013). Self-Compassion A newer concept applied to professional helpers is that of self-compassion. It is a form of self-care, but it is a broader concept that encompasses self-care. Self-care refers to specified behaviors, whereas self-compassion is an overall, foundational, and transformational attitude or perspective (Patsiopoulos & Buchanan, 2011) that could be said to fuel self-care activities. Borrowing from Buddhist philosophy, Neff (2003a) proposed self-compassion as a healthier and more constructive self-attribution than self-esteem because, unlike self-esteem, self-compassion does not compare self to others and does not endorse the processes of separa-tion and individuation in human development. Rather, self-compassion balances concern for self with concern for others, meaning that self-compassion fosters concern for others, and vice versa. In recent research, Neff and Pommier (2013) reported a significant association between self-compassion and concern for others. There are three components of self-compassion (Neff, 2003a; Neff & Pommier, 2013): 1. self-kindness, or self-understanding rather than harsh judgment or self-criticism; 2. common humanity, the recognition that all humans are imperfect, that they fail and make mistakes, so that one feels connected to—rather than isolated from—others in the midst of personal struggles; and 3. mindfulness, referring to the acceptance of painful emotions and thoughts while not overly identifying with them. Note the integral role of mindfulness in self-compassion. We contend that mindfulness sustains self-compassion, making it possible for persons to be kind to themselves because of their humanity. Said in another way, it is the heightened and concentrated awareness of one's self in the midst of current activity and surroundings (includ-ing people)—accepting what is without changing what is—that cultivates self-compassion. Neff (2003a) defined self-compassion as being open to and moved by one's own suffering, assuming an Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
12 Chapter 1 understanding and nonjudgmental attitude toward one's own shortcomings and failures, and recognizing that one's own experience is part of the common human experi-ence. This suggests that self-compassion promotes humil-ity rather than self-centeredness or narcissism. At the same time, it also demonstrates resilience and a striving toward psychological well-being. These hypotheses were supported when Neff (2003b) first administered to under-graduate students the Self-Compassion Scale she developed. As expected, she found an inverse correlation between self-compassion and symptoms of depression and anxiety, as well as rigid perfectionism. From this same study, self-compassion was associated with greater life satisfaction. In subsequent studies, self-compassion was found to predict mental health among adolescents and young adults (Neff & Mc Gehee, 2010; Neff, Kirkpatrick, & Rude, 2007), suggesting that self-compassion might be thought of as resilient humility or humble resilience. Specific to professional helpers, Patsiopoulos and Bu-chanan (2011) identified six overlapping dimensions of self-compassion from their interviews with 15 Canadian counselors. With an average of 14 years of psychotherapy practice, these counselors defined self-compassion as: (1) being gentle with yourself; (2) being mindfully aware; (3) having a sense that as humans “we are all in this together”; (4) the importance of speaking the truth to yourself and others; (5) the development of spiritual awareness; and (6) having an ethic of professionalism. Specific practices of self-compassion used during therapy sessions included assuming a stance of acceptance (e. g., recognizing the limits of helping, making appropriate self-corrections), mindfulness (i. e., nonjudgmental in-the-moment atten-tiveness) and not knowing (i. e., counseling from a nonex-pert stance), and participating in a caring and supportive work team as colleagues or supervisees. Counselors also described the importance of scheduling breaks in between therapy sessions and ending appointments on time as deliberate acts of self-compassion. According to the coun-selors in this study, these practices served to enhance their well-being, effectiveness in the work setting, and therapeu-tic relationships with clients. The self-compassion website (http://self-compassion . org) established by Dr. Neff posts updates on self-compassion research, includes informational videos, and provides information on trainings and workshops. One of these is the 8-week Mindful Self-Compassion program (Germer & Neff, 2013). Promoting Stamina and Resilience Given the many facets of practicing as a professional helper, it is understandable how such a lifestyle can be exhausting at times. It is! Skovholt and T rotter-Mathison (2011) said this loud and clear in their listing and descrip-tions of not one but 20 hazards of practicing as a helping professional. Among these are: (1) providing constant em-pathy, interpersonal sensitivity, and one-way caring; (2) realizing that one's effectiveness is difficult to measure and thus remains elusive; and (3) working with clients who are not “honor students” and whose readiness to change lags behind our own hopes and desires for them. These and other consequences of “emotional labor” (Wharton, 1993) may lead to burnout and compassion fatigue, or what Stebnicki (2009) referred to as empathy fatigue. Counselors who volunteered to help victims of natural disasters were found to have twice the rate of compassion fatigue and vicarious traumatization compared to other counselors (Lambert & Lawson, 2013). Burnout is a general term that describes emotional depletion, a lack of caring or empathy for clients, and a diminishing sense of personal accomplishment. The first two aspects of burnout describe what Skovholt and T rotter-Mathison (2011) termed caring burnout, whereas the third aspect of burnout, loss of meaning and purpose in one's work, is what they characterized as meaning burn-out. In broad terms, burnout can be understood as a lack of resilience and constricted coping abilities. Jenaro and colleagues (2007) characterized burnout “as an answer to chronic labor stress that is composed of negative attitudes and feelings toward coworkers and one's job role, as well as feelings of emotional exhaustion” (p. 80). Compassion fatigue can signal the onset of burnout and is regarded as mental and physical exhaustion resulting from taking better care of others than you do of yourself. Empathy fa-tigue can also be a precursor to burnout and describes the practitioner's diminished capacity to listen and respond empathically to clients whose stories convey acute and cumulative psychosocial stress (Stebnicki, 2009, p. 804). We may not have been fully briefed about the hazards of practicing as professional helpers before we submitted our own versions of informed consent and signed up for this career. It may not be until later in one's formal train-ing (e. g., during practicum and internship) that a novice helper actually experiences some of the stresses and strains that are part of this work. But knowing about all the chal-lenges may not have kept us away anyway, and perhaps some attraction to the challenge of this work spurred us to seek out this particular profession in the first place. It also may be that we are hardier than we realize and that it takes only a few reminders of our competence here and there—including some client success stories—to keep us going. Realizing that our experience of strain and exhaustion is not attributable to one thing or person but more than likely to an accumulation of factors over time, including Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Building Your Foundation as a Helper 13 ones beyond our control (e. g., vague and ambiguous ex-pectations in the work setting), can ease our tendency to self-blame. Likewise, reframing our goals as helping clients manage or otherwise live with concerns rather than fixing, curing, or even solving difficulties may help us remain invested in this important work. There are additional and specific things we can do to help cultivate our resilience and stamina for providing professional care to others. Osborn (2004) identified seven salutary suggestions for stamina for those who serve in the helping professions. These recommendations are intended to assist helpers not only remain vigilant about the hazards of professional helping, such as compassion fatigue, but also maintain their resolve for rewarding work. Based on a review of the scholarly literature and reflections on her clinical practice, Osborn's recommendations comprise a proactive rather than a reactive or preventive approach and are intended to shift attention from a deficiency or pathological per-spective (i. e., “burnout prevention”) to a strengths-based or competency-based orientation (i. e., “stamina promo-tion”). Stamina is likened to resilience, endurance, and flourishing-not despite hardship but in the midst of challenges. Each suggestion for stamina corresponds to the seven letters in the word stamina, thus creating the acronym STAMINA. These are presented and described with examples in Table 1. 1. Although stamina and resilience are close cousins, we differentiate the two by thinking of stamina as the fuel for resilience. Resilience therefore refers to a set of specific skills that Tjeltveit and Gottlieb (2010) stated can be taught and then “marshaled when psychothera-pists are faced with difficult situations” (p. 100). Spe-cifically, resilience develops from social relationships and support networks (e. g., clinical supervision), but TABLE 1. 1 Seven Ingredients of Helper Stamina Ingredients of Helper STAMINA Definition Examples Selectivity ● ●Intentionally choosing and concentrating your efforts in only certain areas, such as limiting your areas of expertise ● ●Undertaking daily activities and long-term endeavors with care and focused attention● ●Setting limits on yourself and maintaining healthy boundaries with others (e. g., clients, family members) ● ●Modifying high and perhaps unrealistic expectations you have of others and yourself ● ●Not trying to “do it all” or be a “jack of all trades” Temporal sensitivity ● ●Being mindful of the constraints on your time and working within these limits ● ●Using time wisely ● ●Focusing more on current resources and circumstances compared to past or even future challenges● ●Joining with clients in the present moment ● ●Beginning and ending counseling sessions on time ● ●Engaging in mindfulness practice Accountability ● ●Practicing according to justifiable, ethical, theoretically guided, and research-informed guidelines ● ●Able to understand and to verbalize to others (e. g., clients, treatment team members) decisions made and actions taken ● ●Credibility ● ●Practicing self-regulation or operating from an internal locus of control within the parameters of professional standards● ●Routinely consulting and learning from colleagues and supervisors ● ●Attending quality workshops and professional conferences ● ●Reading professional literature Measurement and management ● ●Protecting and preserving those things that are important and valuable to you ● ●Holding onto and accentuating the resources associated with choices you have made in your personal and professional life ● ●Engaging in routine self-care activities during the workday and your personal time ● ●Engaging in personal therapy ● ●Limiting the amount of your volunteer or pro bono services ● ●Generating realistic goals with clients ● ●Clarifying with your supervisor your exact role and responsibilities (continued) Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
14 Chapter 1 TABLE 1. 1 Seven Ingredients of Helper Stamina (continued) Ingredients of Helper STAMINA Definition Examples Inquisitiveness ● ●Curiosity about other people and intrigue about how they function ● ●Fascination with human development and change ● ●Honoring client uniqueness and originality● ●Practicing idiographic client care ● ●Referring to diagnoses as conditions clients have, not who they are ● ●Suspending judgment ● ●Engaging in routine self-reflection ● ●Routinely soliciting feedback from clients Negotiation ● ●Flexibility and adaptation ● ●Engaging in give-and-take without necessarily giving-in ● ●Responding to and cooperating with others while simultaneously remaining steadfast to and upholding professional guidelines and standards● ●Engaging in collaborative and coconstructive conversations with clients and colleagues ● ●Remaining open to new ideas from colleagues ● ●Revising over time long-held beliefs and practices that are no longer helpful ● ●Becoming more assertive on a treatment team to advocate for a particular client's needs Acknowledgment of agency ● ●Salutary or strengths-based orientation ● ●Recognition and promotion of human instrumentality, intrinsic motivation, and resilience ● ●Remaining confident in the undeniably persistent strength, resourcefulness, and will of the human spirit● ●Assessing and promoting client strengths and resources ● ●Conveying hope to clients ● ●Living a life worth living ● ●Implementing a recovery plan ● ●Pursuing with diligence a new area of expertise ● ●“Blooming where I'm planted” Source: Osborn, C. J. (2004). Seven salutary suggestions for counselor stamina. Journal of Counseling & Development, 82, 319-328. because it is multidimensional, Tjeltveit and Gottlieb (2010) also defined resilience as a set of relatively stable personal characteristics (e. g., virtues). Using the acro-nym DOVE, they identified four assets that enhance therapist resilience while decreasing therapist vulner-ability to ethical misconduct. These therapist assets or dimensions of resilience are: having a Desire to help others, creating and making use of available Op-portunities for personal enrichment and professional development, consulting and revising core Values, and approaching Education as lifelong learning. Among their eight recommendations for cultivating resilience to “move toward ethical excellence” (p. 108) are en-gaging in regular self-assessment and seeking psycho-therapy and structured supervision. The need for helper stamina and resilience is evident in the reflections of a bereaved father that Neimeyer (1998) shared and that are presented in Box 1. 1 on page 15. This man's story underscores the importance of walking alongside and waiting with our clients rather than trying to “fix” them or “solve” their concerns. Before reading further, take a moment to read this father's reflections. Having read this father's reflections, you may need to pause for a moment. Some of what he has to say is not easy to hear. His grief is quite evident. Once you have paused to reflect on his words (per-haps rereading his reflections), what thoughts come to mind about your intended style of helping? What wisdom might he be conveying to you as you prepare for the work and lifestyle of a professional helper? How would you propose to offer help to this man at this time in his life? What would you tell him if you were working with him? In addition, what ingredients of stamina and resilience might you need to make use of intentionally as you work with this father? What aspects of temporal sensitivity or negotiation, for example, might be especially helpful to you? What further education would you need to pursue? As we ourselves read and reflect on his words, it seems that this father's loss cannot be “fixed” and that he resents the well-meaning advice others have offered. As much as we'd like to think of ourselves as problem-solvers, we real-ize that some hurts and pains simply cannot be “solved. ” This father may experience living in the metaphoric three-sided house for some time, and no one can build a fourth wall for him—that is, his son will never be restored, will not be brought back to life. This father and all the clients we work with are in charge of constructing their own lives (the ethical value or principle of autonomy that we must honor when working with them); they are the carpen-ters. As professional helpers, we may be likened to their Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Building Your Foundation as a Helper 15 apprentices or at times consulting architects, but they themselves know best the constructed and reconstructed lives and houses that will fit them. In addition, clients need helpers who are “not daunted by the wreckage,” helpers who are able to deal with and make meaning from the “dust that clings” to them from the stories they (i. e., the helpers) have witnessed and in-directly participated in. Our clients deserve helpers who can demonstrate what Kenneth Minkoff characterized as “the courage to join them [clients] in the reality of their despair” (see Mental Illness Education Project, 2000). Incorporating the seven ingredients of stamina (see Table 1. 1) and the four dimensions of resilience (DOVE; see Tjeltveit & Gottlieb, 2010) may assist you in temper-ing the effects of this demanding work, work that is not for the faint of heart. Specifically, we encourage you to establish your own board of advisers with whom you can consult on a regular basis. These persons would include trusted friends, family members, a supervisor, respected colleagues, and your own therapist. Surrounding yourself with such a support system is essential. As you read the next section of this chapter, you may understand our decision to discuss core skills and at-tributes—self-awareness and self-reflection, mindfulness, self-care, and self-compassion, as well as stamina and resilience—prior to discussing issues of effectiveness, ac-countability, and evidence-based practice (EBP). Just as clients need to be equipped with certain skills (e. g., mind-fulness) before they can be expected to manage stressors and other symptoms effectively, professional helpers need to demonstrate core skills before they can be expected to deliver effective services. As we have already discussed, these core skills include self-care and self-compassion. Think of your clinical skills and your self-care activities as the provisions needed for the arduous journey of service delivery in an age of accountability and EBP. Only by mobilizing learned skills will you be able to hold yourself accountable for the client care you provide. Effectiveness and Accountability Today's practice continues to be highly influenced by regulatory requirements and ethical expectations regard-ing accountability. Use of empirically supported practice and evidence-based decision-making has become part of training accreditation requirements as well as work site expectations, although certainly not without issue. It is expected that in the next 10 years helpers will need to demonstrate the evidence base of practice decisions and outcomes and use practice guidelines in standard therapy, while at the same time conducting short-term and brief therapy (Norcross, Pfund, & Prochaska, 2013). It is for this reason that Putterbaugh (2015) reinforces the impor-tance of deliberate and purposeful practitioner self-care. Recent health care reform in the United States stipulates that all practitioners will need to demonstrate increased accountability for their work. In effect, this means that we as clinicians need to demonstrate that our work is safe and makes a difference in the lives of our clients. Goodheart (2011) made clear that insurers are now making decisions about allocating funds for treatment services based on a review of client outcomes rather than what had been a utilization review. This means that helpers increasingly will need to provide evidence that clients have improved while in treatment for services to be reimbursed. This certainly Steve Ryan, a bereaved father, wrote the following meta-phoric account of his life in the aftermath of the death of his 2-year-old son, Sean, from complications following a kidney transplant. I am building a three-sided house. It is not a good design. With one side open to the weather, it will never offer complete shelter from life's cold winds. Four sides would be much better, but there is no foundation on one side, and so three walls are all I have to work with. I am building this place from the rubble of the house I used to own... It had four good walls and would, I thought, survive the most violent storm. It did not. A storm beyond my understanding tore my house apart and left the frag-ments lying on the ground around me... And so I must rebuild. Not, as so many onlookers would suggest, because I need shelter once again. The storm now travels within me, and there is no shelter from the tempest behind doors or walls. Who can show me how to build here now? There are no architects, no experts in designing three-sided houses. Why is it then that so many people seem to have advice for me? “Move on, ” they say, quite convinced that another house can replace the one I lost... I grow weary of consultations based on murky insight, delivered with such confidence.... [And yet] among those who wish to see my house rise again[,] there are real heroes too. People who are not daunted by the wreckage. It is not a pleasant role for them to play because the dust clings to those who come to see and it will not wash off when they go home... Above all they know how difficult this task is, and no suggestion comes from them about how far along I ought to be. Box 1. 1 Story of the Three-Sided House Source: Neimeyer, 1998. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. 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16 Chapter 1 raises ethical concerns, but it also suggests that, more than ever, professional helpers will need to deliver services that are consistent with current and established guidelines. No longer can personal experience suffice as the sole or primary standard for justifying treatment decisions (Beutler, 2009). Although the helper's personal experience influences how he or she makes treatment decisions, it is only one source of influence. As discussed earlier in the chapter, Skovholt and Starkey (2010) identified it as one of three sources of knowledge that inform clinical expertise, with the other two being professional experience and academic research. Together, these represent what they referred to as the three legs of the professional helper's learning stool. A one-legged stool will not suffice! All three must be securely in place to supply a firm foundation and a balance of practice. Evidence-Based Practice The delivery of evidence-based practice (EBP) or the provision of empirically supported services is the expecta-tion of contemporary clinical and behavioral practice, not only in the United States but also in many other coun-tries. Thyer (2009; Thyer & Myers, 2011) noted that the major contributors to EBP, particularly in medicine and social work, were British and Canadian. Some might say it is only recently that U. S. health care providers are catch-ing up with their Canadian, European, and Australian counterparts. This may be true in light of recent health care reforms in the United States, primarily the Patient Protection and Affordability Care Act signed into law in March 2010 by President Obama and upheld twice by the U. S. Supreme Court. This means that translating research findings into everyday clinical practice and substantiating treatment decisions made in the throes of an emergency or during routine work are now the global norm for health care providers. Although psychologists have been at the forefront of EBP in the United States since the 1980s, what Thyer (2009) referred to as science-informed practice is not new to social work. He explained that it was this positivist focus that dis-tinguished social work from its beginnings in the late 1880s as faith-based ministerial outreach and as a charitable orga-nization. “Scientific charity” and “scientific philanthropy” actually were two of the original names for the social case work movement in the United States, leading Thyer (2009) to reinforce that “the principles of EBP are congruent with central core descriptions of social work dating back to the beginnings of our field” (p. 1117). Yet it has been the psy-chology profession in the United States that in many ways has framed the current conversation about EBP. LO2The Staying Power of EBP It is evident that EBP is here to stay. The Evidence-based Behavioral Practice project (www. ebbp. org) claims that “all major health professions now endorse the policy of evidence-based practice. ” Many of these same organiza-tions have developed what are known as evidence-based clinical practice guidelines, what Hollon et al. (2014) define as “a systematic approach to translating the best available research evidence into clear statements regard-ing treatments for people with various health conditions” (p. 214). The use of such guidelines in treatment planning is discussed in Chapter 9. Many states have adopted the practice of evidence-based policymaking, which includes performance-based budgeting. This entails cost-benefit analysis so that only programs that have demonstrated effectiveness continue to receive state funding. These programs include child welfare and corrections. Fourteen states facing economic difficulties have partnered with the Results First Initiative, a project of the Pew Charitable T rusts and the Mac Arthur Foundation, to help them identify ineffective programs to budget only proven programs (see www. pewtrusts. org). One of these states is Illinois, whose governor established in February 2015 a criminal justice commission to reduce the state prison population by 25 percent by the year 2025. To do so, “evidence-based programming” will be pursued such as diversion programs (i. e., drug and spe-cialty courts, intensive probation). Straus, Richardson, Glasziou, and Haynes (2010) argued, however, that evidence-based medicine is not necessarily a cost-savings endeavor because “providing evidence-based care directed toward maximizing patients' quality of life often increases the costs of their care and raises the ire of health economists” (p. 8; emphasis added). This serves as a reminder that EBP should not be regarded as strictly or only a way to save money; rather, EBP should be used to provide quality care. In the context of eco-nomic realities, the point is to use limited resources wisely. As Miller, Zweben, and Johnson (2005) noted, “It makes good sense to give priority to [evidence-based treatments], particularly within this era of fiscal austerity. We owe it to our clients to provide the best treatment that we can offer them within available resources” (p. 274). Discredited Therapies Some have stated that rather than identifying so-called best practices or effective practices, EBP has helped to iden-tify treatment interventions that are not effective (with-out effect or inert) or are potentially harmful. As Beutler (2009) indicated, “It appears to be easier to identify a Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Building Your Foundation as a Helper 17 bad treatment than a very good one” (p. 310). Although defining what exactly constitutes harm and what is directly responsible for harm in psychotherapy is a complicated endeavor (Dimidjian & Hollon, 2010), it seems that one contribution of EBPs is that they have been able to weed out certain practices—despite their recognition, appeal, and popularity—that actually have been found to be harmful to service recipients (i. e., clients are worse off after receiving these interventions than before). These practices include rebirthing therapy, boot camp interventions for juvenile offenders, critical incident stress debriefing, and drug abuse and resistance education (or DARE; see Lilienfeld, 2007, for a listing of additional potentially harmful treatments). T reatments such as these are regarded as discredited thera-pies (Norcross, Koocher, Fala, & Wexler, 2010; Norcross, Koocher, & Garofalo, 2006), therapies that have undergone testing over time and have been found not to make a dif-ference or to exert a negative effect, in other words, to exert harm (e. g., exacerbated symptoms at follow-up, or even death as a direct result of treatment). It is thus important to recognize the reasons for EBP because helpers who do not “may fail to appreciate how readily they can be fooled by ineffective or harmful treatments” (Lilienfeld, Ritschel, Lynn, Cautin, & Latzman, 2013, p. 884). Avoiding the use of discredited and harmful therapies or interventions actually is an ethical imperative. Sec-tion C. 7. of the ACA Code of Ethics (2014) stipulates the types or quality of techniques, procedures, or modalities counselors are to use with clients. Specifically, only those practices “grounded in theory and/or have an empirical or scientific foundation” (Section C. 7. a. ) are to be consid-ered. Furthermore, Section C. 7. c. is explicit in its state-ment that “Counselors do not use techniques/procedures/modalities when substantial evidence suggests harm, even if such services are requested. ” Discredited therapies must be differentiated from therapies that have yet to be tested or whose effects remain unknown or inconclusive—therapies that may be inert, beneficial, or detrimental but for which con-sistent and substantial evidence from methodologically sound investigations is absent. Solution-focused therapy (SFT) is one example. Although it is a popular therapy that has been practiced for more than 30 years, in many countries SFT has not been subjected to the rigorous testing that other therapies have undergone, such as motivational interviewing (MI). Unlike MI, SFT has not gained the recognition as an EBP. Recent efforts to examine the effects of SFT in more sophisticated ways are encouraging (see Franklin, T repper, Gingerich, & Mc Collum, 2012), and we discuss these research findings—and those of MI—in Chapter 10. Affirmative Therapies As with SFT, affirmative therapies developed specifi-cally for lesbian, gay, and bisexual (LGB) individuals (see Chernin & Johnson, 2003; Kort, 2008), transgender and gender nonconforming individuals, and lesbian, gay, bi-sexual, and transgender (LGBT) couples and families (see Bigler & Wetchler, 2012) have yet to establish a strong research base and to be recognized as an EBP (see Johnson, 2012). This has not thwarted their promotion by various professional associations (e. g., the American Psychological Association's 2009 Resolution on Appropriate Affirmative Responses to Sexual Orientation Distress and Change Efforts; see APA, 2011) and their depiction as synonymous with culturally competent therapy (Johnson, 2012). The APA (2012) also has developed Guidelines for Psychological Prac-tice with Lesbian, Gay, and Bisexual Clients and guidelines for working with transgender persons are forthcoming. It is because affirmative therapies endorse a strengths or empowerment perspective (see Boes & van Wormer, 2009) and represent a humanistic and nondiscriminatory practice that they are viewed today as the ethical alter-native to so-called conversion therapies. Conversion or reparative therapies have been determined to cause more harm than benefit to LGB individuals and to society as a whole because they reinforce stigma and prejudice. The APA (2011) has referred to “the emerging knowledge on” culturally affirmative therapies as “a foundation for an ap-propriate evidence-based practice with children, adoles-cents, and adults who are distressed by or seek to change their sexual orientation. ” The APA (2011) policy statement on affirmative therapies illustrates very well Thyer and Myers's (2011) contention that “EBP involves not just a consideration of research evidence but also of other factors... such as individual clinical expertise, patient preferences, values and circumstances, and no one of these elements is af-forded primacy over the others” (p. 18). In other words, determining what constitutes the “evidence” for an EBP should not be confined to the outcomes of randomized clinical/control trials (RCTs). Perhaps this is what Good-heart (2011) meant in her statement that EBP does not privilege certain types of data. Although RCTs are consid-ered the gold standard in medical research, the clinician's expertise, the client's culture and preferences, and ethi-cal standards of professional associations must also serve prominent roles in determining the “evidence” of an EBP. Defining EBP It should be apparent by now that there are many ways to define EBP. Given our review of the research literature Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. 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18 Chapter 1 and the proceedings of professional associations, we en-dorse the APA definition: EBP is “the integration of the best available research with clinical expertise in the con-text of patient characteristics, culture, and preferences” (APA Presidential Task Force on Evidence-Based Practice, 2006, p. 273). Derived from the definition of evidence-based medicine (see Straus et al., 2010), this definition of EBP highlights the essential contributions of clinicians and clients to what is considered evidentiary practice. In other words, EBP is not—or should not be—a top-down mandate from researchers to clinicians, but rather is—or should be—a dynamic discourse among clients, clinicians, and researchers. This exemplifies the contention made by Thyer and Myers (2011) that EBP is a process and there-fore is a verb, not a noun. This notion of process seems to be supported by Goodheart (2011) when she described EBP as that which incorporates new clinical phenomena, research, theory, and professional consensus (e. g., ethical codes) to provide clients with individualized and benefi-cial care. She and colleagues (Wampold, Goodheart, & Levant, 2007) also stipulated that EBP is not prescriptive but descriptive and serves as a guide in that EBP offers recommendations for the selection and implementation of treatment services. Lilienfeld et al. (2013) discussed other misconceptions of EBP. These are listed in Box 1. 2. Note that our discussion here is about evidence-based prac-tice, not evidence-based treatment. This is a very important distinction (La Roche & Christopher, 2009; Littell, 2010; Thyer & Pignotti, 2011; Westen, Novotny, & Thompson-Brenner, 2005). The former is inclusive of client and helper factors (e. g., client cultural diversity), treatment interven-tions and setting, and research findings (consistent with the 2006 APA definition); the latter is concerned only with interventions or techniques—the tools that we discussed earlier in this chapter that are external to the helper and therefore do not equate with helper skills. Furthermore, as Thyer and Myers (2011) noted, EBP is a dynamic process, a verb, whereas evidence-based treatment—or what have been referred to as empirically supported treatments, or ESTs (Chambless & Hollon, 1998)—is a static noun. This implies that EBPs are fluid and susceptible to revision and cultural adaptation, whereas ESTs are absolute fixtures that are resistant to change and can be mistaken for the once-and-for-all solution for all clients. Given these distinctions, it is extremely important that as an emerging professional helper you see yourself as an influential ingredient in the process of client change. This means that you not look to a specific treatment, technique, or tool as the sole answer to or the only source of healing for your clients. Thinking that all that is needed for client improvement is your selection of the best tool from your toolbox is thinking like a magician and investing power in a magic wand. In this era of EBP, magicians and magic have no place. Rather, the focus is on you as a skilled practitioner and your use of skillful means, which includes your ability to: (1) learn from and work in a collaborative fashion with each of your clients; (2) consult and critique empirical research findings; (3) understand the standards of professional ethics; (4) participate in and contribute to constructive dialogues with your clinical supervisor and other skilled practitioners in your profession and in related professions; and (5) adapt your therapeutic style over the course of your career based on what you have learned from these various constituents (i. e., clients, research literature, professional standards, supervisors and colleagues). It is this focus on skillful means—in the context of EBP—that we suspect contributed to Beutler's (2009) (re)definition of psychotherapy as “[t]he therapeutic management, control, and adaptation of patient factors, therapists' factors, rela-tionship factors, and technique factors that are associated with benefit and helpful change” (p. 311). Becoming Familiar with EBP To help you develop and calibrate your skillful means—your therapeutic management, control, and adaptation Evidence-based practices (EBPs): 1. Stifle innovation and the development of new treat-ments and practices 2. Require “cookie-cutter” and “one-size-fits-all” ap-proaches to treatment 3. Do not include nonspecific influences or common fac-tors in therapy 4. Do not generalize to clients who have not participated in re-search studies, including randomized controlled trials (RCTs) 5. Neglect evidence other than that obtained from RCTs 6. Are unnecessary because all treatments are equally ef-fective. 7. Are inherently limited because therapeutic changes cannot be measured or quantified 8. Are erroneous because human behavior defies predic-tion with certainty Box 1. 2 Eight Misconceptions of Evidence-Based Practices Source: Lilienfeld et al., 2013 Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Building Your Foundation as a Helper 19 of various clinical factors—we encourage you to consult the lists, registries, and reviews of EBPs that are avail-able currently from a number of professional organiza-tions. Although EBP lists have been criticized (Beutler & Forrester, 2014; Thyer & Pignotti, 2011; Wachtel, 2010), we believe they offer professional helpers the opportunity to learn more about and to scrutinize approaches heard about only in passing. They also may provide helpers with information not offered to them by superiors during mandated training on a recently instituted EBP. Seven online sources are presented in Table 1. 2. These include reviews of EBPs. The contents of these electronic sources are updated periodically as new research findings are introduced or new selection criteria implemented, so it is best to check these sites every few months to determine what, if any, changes have been made. Bear in mind that none of these lists is exhaustive and that each site may use different criteria for what it deems to be an EBP. Therefore, we recommend that you use your critical thinking skills as you read the reviews of a selected intervention or practice on one of these lists. Read carefully the purported benefits as well as the criti-cisms. Look for how often and how recently each prac-tice has been reviewed and updated. Take careful note of how the practices listed attend to cultural factors, such as the availability of treatment materials in languages other than English and the flexibility of extending or ab-breviating services to accommodate specific client needs and preferences. As you learn more about a specific practice and its interventions on one of these lists, you may wish to compare it against each of the nine ideal features of a mental health intervention proposed by Bond, Drake, and Becker (2010). According to their definition, the ideal features of a mental health intervention are that it should: 1. Be well defined2. Reflect client goals3. Be consistent with societal goals4. Demonstrate effectiveness5. Have minimum side effects6. Have positive long-term outcomes7. Have reasonable costs8. Be relatively easy to implement9. Be adaptable to diverse communities and client subgroups In addition to consulting the lists, registries, and re-views of EBPs, professional helpers will soon be con-sulting evidence-based clinical treatment guidelines (see Hollon et al., 2014) mentioned earlier in this sec-tion. Described as recommendations for psychological interventions for specific disorders, Goodheart (2011) reported that these guidelines are intended to “facilitate TABLE 1. 2 Registries, Lists, and Reviews of EBPs Registry Name Sponsoring Group Date Established Website National Registry of Evidence-Based Programs and Practices Substance Abuse and Mental Health Services Administration 1997 www. nrepp. samhsa. gov Cochrane Reviews The Cochrane Collaboration 1995 www. cochrane. org/cochrane -reviews Research-Supported Psychological Treatments Society of Clinical Psychology, Division 12 of the American Psychological Association2008 www. psychology. sunysb. edu /eklonsky-/division12 What Works Clearinghouse U. S. Department of Education 2002 http://ies. ed. gov/ncee/wwc Social Programs that Work Coalition for Evidence-Based Policy 2001 http://evidencebasedprograms. org The Campbell Collaboration Library of Systematic Reviews The Campbell Collaboration 2000 www. campbellcollaboration. org /library Results First Clearinghouse Database Pew-Mac Arthur Results First Initiative 2015 www. pewtrusts. org/en/multimedia /data-visualizations/2015/results-first-clearinghouse-database Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
20 Chapter 1 the integration of science into practice, offer a framework for clinical decision making, provide benchmarks for eval-uating treatments, benefit patients by promoting quality improvements and discouraging harmful practices, iden-tify gaps in research and care, and give clinicians flexible tools to support their work” (p. 341). She stipulated that these guidelines are decision aids and are not to be viewed as prescriptive protocols or a substitute for clinical judg-ment. Unlike practice guidelines that are practitioner-focused, these treatment guidelines are client-focused. Concerns, Critiques, and Caveats of Evidence-Based Practice EBP has become big business. You will likely find fre-quent references to practices or interventions that are “evidence-based” as you scan the issues of recent schol-arly journals, peruse the titles of new books for profes-sional helpers from a variety of publishing companies, and browse the listings of workshops offered at professional conferences. As we mentioned, this appeal of EBP is due in part to the belief that adopting an EBP will save time and money, apparent in the mandates of state legisla-tive bodies in the United States. Morales and Norcross (2010) also discussed the trend among federal agencies that, to be considered for grant funding, applications must include an intention to implement one or more EBPs. Third-party payers and other funding sources—as well as accrediting bodies—thus have been known to latch onto certain evidence-based treatments because they are viewed as cost-effective and hence “successful. ” Short-term cognitive behavior therapy, for example, may be heralded by certain insurance companies as the “best” treatment for all their providers to practice because, in the long run, it is not as protracted or long-term (and hence expensive) as, say, certain types of expressive-supportive therapies. However, marketing EBPs as the solution to cash-strapped state and federal budgets exemplifies what Gambrill (2010) described as propaganda. In other words, it is misleading. It reflects a one-size-fits-all ap-proach (see Bernal, Jiménez-Chafey, & Rodríguez, 2009) that Wachtel (2010) described as “the Walmart approach to mental health care” (p. 264). As we stated, Straus et al. (2010) noted that evidence-based medicine actually is not an effective cost-cutting tool. For certain interventions to be effective, they noted, longer and more intensive care may be necessary. We believe this is also true for mental health and addictions treatment. The hype surrounding EBP therefore requires careful scrutiny and the EBP bandwagon must be approached with caution. Although EBP in social work is, accord-ing to Thyer (2009), differentiated from “impulsive altruism, the efforts of faith-based social missionaries, or unsystematic secular efforts aimed at helping others” (p. 1116), EBPs as a whole are not “magical answers for complex questions [or] over-simplistic approaches to complex problems” (Sexton & Kelley, 2010, p. 85). Healthy skepticism is in order. This includes inspecting what is meant by “evidence. ” For example, should only the findings from randomized clinical/control trials (RCTs) constitute the evidence for treatment practice? Or should findings from studies conducted in applied settings (e. g., a community mental health agency) following normal, routine clinical procedures also be included? The first type of research comprises studies conducted in the most ideal experimental conditions (e. g., controlled and manu-alized treatments, random assignment, selected clients and helpers), usually comparing one type of treatment to another or to a control group (e. g., clients on a wait list), or both. These are referred to as efficacy studies. The second type of research comprises effectiveness studies and does not adhere to the strict (or some might say “sterile”) laboratory research standards of RCTs. Effectiveness stud-ies exemplify what has been referred to as “pragmatic, utilitarian research” (Sanchez & T urner, 2003, p. 126) and may emphasize more idiographic than traditional nomothetic subject research. A concern about efficacy studies is that their findings may not easily transfer to actual, everyday practice (Beutler & Forrester, 2014). In a similar vein, a concern about effectiveness studies is that their findings may not be generalizable to other practitio-ners, treatment facilities, or clients. Hence, the evidence derived from the research question, “What works for whom under what conditions?” may have limited utility from either an efficacy or an effectiveness perspective. In addition to the overreliance on RCTs (i. e., efficacy studies) as the gold standard for determining what con-stitutes an EBP, EBPs have been criticized for confining themselves to a single diagnostic category. It is true that many EBPs were developed for clients presenting with specified diagnostic disorders. For example, motivational interviewing (MI) is an EBP for persons with substance use disorders, and dialectical behavior therapy (DBT) is recognized as an EBP for persons with borderline person-ality disorder. According to Wachtel (2010), the solitary diagnostic confinement of EBPs dismisses the majority of persons with more than one disorder (i. e., comorbidity) and does not account for persons in therapy who do not fit the minimal criteria for any mental health or substance use disorder (i. e., at a subthreshold for a diagnosis). These are valid concerns. However, a greater number of EBPs Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Building Your Foundation as a Helper 21 now are being applied to persons presenting with a range of concerns. Seeking Safety (Najavits, 2002), for example, is intended for persons with a history of trauma and substance-related problems. Likewise, DBT now is con-sidered appropriate for persons with multiple diagnoses (e. g., eating disorder, substance use disorder, and bipolar disorder) and concerns (e. g., chronically suicidal), and MI has expanded its application to include persons with a va-riety of health problems such as diabetes, high cholesterol, and obesity (Rollnick, Miller, & Butler, 2008). EBPs also have been criticized for an overreliance on manuals. It is true that many if not most EBPs have a treatment manual and perhaps a separate training man-ual. To be included in the U. S. Substance Abuse and Mental Health Services Administration's (SAMHSA) Na-tional Registry of Evidence-Based Programs and Practices (NREPP), for example, recognized programs need to have developed training and support resources, implementa-tion materials (e. g., treatment manual), and quality as-surance procedures, all of which are ready for use by the public. The development and use of a treatment manual is an example of internal validity, allowing the interven-tion to be distinguished from and compared to other treatments in RCTs. T reatment adherence is referred to as fidelity and allows researchers to determine whether the intervention being tested was faithful to its design or purpose. The concern about treatment manuals is that the practice can become “manualized,” resulting in an approach that is too rigid and objectifies clients (Littell, 2010). Clinicians themselves can feel “manualized”—that is, feel coerced and confined to one type of treatment—resulting in a restriction of their autonomy, flexibility, and creativity. According to Overholser (2010), adhering to a treatment manual can compromise clinical expertise, such as inhibiting clinical judgment/decision-making and complex reasoning skills. This is a valid concern and ex-plains Barkham, Hardy, and Mellor-Clark's (2010) prefer-ence for practice-based evidence or the pursuit of effective care based on the “evidence” from routine clinical practice (consistent with effectiveness studies), whether or not a treatment manual is followed. This illustrates the practice of what Scott and Lewis (2015) refer to as measurement-based care wherein client feedback is routinely solicited. A resolution to these criticisms and concerns of EBP is premature. We suspect that the controversies surround-ing EBPs will continue for some time. Although it is frustrating for helpers and researchers alike (perhaps for different reasons), we believe there has been merit in this controversy over the past 20 to 25 years. For one thing, the debate has opened lines of communication between practitioners and researchers. Second, such conversations perhaps have helped to keep the focus on what is in the best interest of the client, including prioritizing client experiences of treatment by soliciting their feedback (see Lambert, 2010). Third, discussions about evidence-based practices appear to have ushered in a more integrative or both/and perspective about client care, consistent with the APA (2006) definition of EBP. One example of an integrative approach to EBP is that of cultural adaptation, an overdue initiative given that racially and ethnically diverse participants historically have not been included in RCTs (Bernal & Sáez-Santiago, 2006; Comas-Díaz, 2006; Whaley & Davis, 2007). We discuss the role of culture in EBP in the following section. Multiculturalism and Evidence-Based Practice T raditional psychotherapy and EBPs for the most part have been developed, validated, and promoted by white European Americans for use with a predominantly white European American client population. The research to support these approaches has been conducted with a similarly privileged client population—that is, white Eu-ropean American, middle class, and heterosexual. The evidence to substantiate that these approaches are appro-priate for culturally diverse and nondominant/minority group clients therefore is lacking, and implementing an EBP for clients for whom the EBP was not developed could potentially harm ethnic minority clients (Bernal et al., 2009). Thus, the challenge is to conduct method-ologically sound research of culturally specific practices and interventions and adapt existing EBPs to fit the needs of culturally diverse clients. Doing both represents the in-herent tension or dialectic of EBP: maintaining scientific soundness/rigor while ensuring clinical relevance. This dialectic is evident in Morales and Norcross's (2010) con-tention that “Multiculturalism without strong research risks becoming an empty political value, and EBP without cultural sensitivity risks irrelevancy” (p. 823). Morales and Norcross (2010) describe the relationship between multiculturalism and EBP as transitioning from “strange bedfellows” to “fast friends. ” This suggests that cultural adaptation of EBPs or the integration of EBP and multicultural therapy is a promising initiative. However, Hwang (2009) noted that this focus must shift from sim-ply being a set of abstract ideas about cultural competence to an emphasis on developing specific helper skills and strategies that can be implemented effectively with cul-turally diverse clients. This is not an easy task. It does not Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
22 Chapter 1 mean simply using existing EBPs with culturally diverse clients. And it involves more than a helper simply learning about a particular cultural group of which the client is a member or matching culturally diverse helpers with cli-ents of their same cultural group (e. g., African American helpers working with African American clients). Accord-ing to Helms (2015), EBPs must be culturally responsive by considering client and helper racial socialization (e. g., racism), client responses to EBPs, and client-helper cul-tural dynamics. Culturally Adapted EBPs Considerable attention has been given to what are referred to as culturally adapted EBPs. This involves systematically modifying, supplementing, or sequencing an interven-tion (e. g., thought-stopping technique) or intervention protocol (e. g., cognitive behavior therapy for anxiety) to accommodate or to be compatible with the client's cul-tural patterns, meanings, and values (Bernal et al., 2009; Morales & Norcross, 2010). According to Bernal and Sáez-Santiago (2006), this includes, among other things, a consideration of: (a) interdependent value systems (i. e., family system) rather than individualistic value systems; (b) spirituality in the healing process; and (c) poverty. Benish, Quintana, and Wampold (2011) emphasized understanding and explaining illness from the client's cultural milieu and adapting interventions to fit this ill-ness explanation. Their research found that when helpers were able to do this, racial and ethnic minority clients benefitted more from culturally adapted EBPs than from conventional psychotherapy approaches. Aguilera, Garza, and Muñoz (2010) further noted that adaptation is a fluid process that must take into account not only broad ethnocultural values (e. g., family system) but also local and specific elements that are part of each client's social reality (e. g., level of acculturation, substance use, access to health care). Culturally Adapted CBT One EBP, cognitive behavior therapy (CBT), has been adapted to various cultural groups because of what Hays (2009) noted as the “remarkable number of assumptions” (p. 355) shared by CBT and multicultural therapy. These include the emphasis on: (a) tailoring treatment to the unique strengths and needs of each client; (b) empower-ment; and (c) conscious processes (e. g., observed behav-iors) that can be verbalized and assessed fairly easily. The latter emphasis, she stated, is suitable for persons whose primary language is not English or who do not share belief systems that are common among European Americans. In their work with American Indians and Alaska Na-tives, Big Foot and Schmidt (2010) acknowledged that CBT principles complement many traditional tribal heal-ing and cultural practices such as storytelling and express-ing emotions in ceremonies. Bennett-Levy et al. (2014) reported that Aboriginal Australian counselors trained in CBT found CBT useful with their Aboriginal clients for several reasons. These included that CBT: (a) is prag-matic (simple interventions can be effective for complex problems); (b) highly adaptable and useful as a preven-tive measure (e. g., mental health hygiene); (c) provides structure that maintains focus; and (d) is empowering and promotes self-agency. One CBT method reported to be most useful with clients was the use of visual diagrams. Aboriginal counselors also found that CBT enhanced their skills and confidence, as well as their well-being (i. e., protecting from burnout). Specific examples of culturally adapted EBPs based on CBT principles include: Aguilera et al. 's (2010) 16-week group CBT in Spanish for adults with depres-sion; Nicolas, Arntz, Hirsch, and Schmiedigen's (2009) 8-week adolescent Coping with Depression Course for Haitian American adolescents; Big Foot and Schmidt's (2010) program for American Indian/Alaska Native chil-dren who have experienced trauma, Honoring Children, Mending the Circle (see www. icctc. org), an adaptation of trauma-focused CBT (Cohen, Mannarino, & Deblinger, 2006); and Cunningham, Foster, and Warner's (2010) adaptation of multisystemic therapy (MST; Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 2009) specifically for African American youth and their caregiv-ers (e. g., parent, grandparent) to address the adolescents' delinquency and substance misuse. In all three of these culturally adapted programs, importance is placed on: (a) the use of culturally and clinically relevant language (e. g., reference to proyecto personal or “personal project” rather than “homework”); (b) maintaining a strength fo-cus; (c) routinely soliciting feedback from clients and their caregivers or other family members about the helpfulness of therapy (including the formation of an advisory board comprising cultural experts to help develop a culturally relevant program before it is implemented); and (d) prac-ticing reinforcement of positive behaviors, validation, and empathy among therapists as well as among clients (e. g., promoting simpatía or healthy social interactions among group members). Evidence for Culturally Adapted EBPs Evidence suggests that cultural adaptation of therapeu-tic approaches results in significant client improvement across a range of presenting concerns and conditions Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Building Your Foundation as a Helper 23 and according to a variety of outcome measures (Benish et al., 2011; Griner & Smith, 2006). But as Morales and Norcross (2010) contend, adaptation presumes that the helper “is competent in the cultural and linguistic aspects of the client and has experience in integrating these vari-ables in a culturally competent and congruent manner” (p. 826). This means that a prerequisite for the cultural adaptation of any EBP is competence in multicultural counseling and therapy and, specifically, the ability to understand and empathize with the client's unique cul-tural identity and context. This means, for example, that helpers should not assume that all tribal and native people have similar traditions, a reminder offered by Big Foot and Schmidt (2010). This also means that helpers are able to appreciate the meaning each client has rendered to the intersection of his or her multiple identities, such as age, gender, sexual orientation, and race/ethnicity. These overlapping “selves” comprise the client's own cultural identity (a concept we discuss in more detail in Chapter 2), requiring the adaptation of any EBP to be tailored to that particular client. This constitutes an idiographic EBP adaptation rather than a nomothetic EBP adaptation. The former is tailored to a specific client, whereas the latter is considered applicable to persons who are members of a certain cultural group, such as lesbian, gay, bisexual, and transgender (LGBT) persons or persons of Latino/ Hispanic descent. Duarté-Vélez, Bernal, and Bonilla (2010) provide a helpful clinical example of an idiographic adaptation of an EBP (in this case, CBT) for a gay Latino adolescent male who was raised in a Christian home. Griner and Smith (2006) reviewed 76 studies published through 2004 to determine the effectiveness of culturally adapted treatment interventions. They identified 10 com-mon types of cultural adaptations used in these studies. To their list we have added (number 11) the one recom-mended by Benish et al. (2011): 1. Explicitly incorporating cultural values/concepts into the intervention (e. g., storytelling of folk heroes to children) 2. Matching the client and helper according to race or ethnicity 3. Providing services in the client's native language (other than English) 4. Providing services in a treatment facility specifically targeting clients from culturally diverse backgrounds (e. g., Africentric programming for African American youth in a substance abuse treatment facility) 5. Collaborating/consulting with individuals familiar with the client's culture (e. g., family members, elders, tribal leaders) 6. Engaging in outreach efforts to recruit underserved clients 7. Providing extra services to increase client retention (e. g., child care, transportation) 8. Orally administering written materials for illiterate clients 9. Conducting cultural sensitivity training for profes-sional staff 10. Providing referrals to external agencies for additional services 11. Understanding and explaining illness from the cli-ent's cultural beliefs and adapting interventions to this illness explanation From their meta-analysis of outcomes reported in these studies, Griner and Smith (2006) found, overall, that clients improved significantly as a result of having received at least one culturally adapted intervention. One noteworthy finding was that groups of same-race clients who received services tailored specifically to their cultural group (e. g., older Cuban Americans seeking help for depression) improved considerably more than clients who were in mixed-race treatment groups (e. g., African American and Hispanic adolescents attending the same facility and receiving services for substance abuse). This reinforces the contention that optimal ben-efit is derived when services are tailored to a specific cultural context. Greater improvement was also found among older clients compared to younger clients (pos-sibly due to the protective effects of lower accultura-tion levels among older clients) and when clients were matched with a therapist based on language (other than English) compared to clients who were not as-signed to therapists who spoke their native language. An unexpected finding was that clients matched with therapists of their own race or ethnicity fared no better than clients who did not work with a therapist of their own race or ethnicity. The failure of client-therapist ethnic matching by itself to effect positive change in clients is consistent with previous studies, however (e. g., Knipscheer & Kleber, 2004), and suggests that therapist multicultural competence and organizational cultural competence (referred to as cultural congruence by Constantino, Malgady, & Primavera, 2009) is a mul-tifaceted construct. To investigate the effects of cultural adaptations of specific interventions and EBPs in general, research meth-ods other than RCTs need to be used (Helms, 2015). One is the participatory action research method used with Aboriginal Australian counselors by Bennett-Levy Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
24 Chapter 1 et al. (2014) and praised by Hays (2014). Other research methods include naturalistic, quasi-experimental process-outcome studies (e. g., assessing in-session client-helper behaviors through audio or video recording or third-party live observation and rating) and single-case or N = 1 stud-ies. As an example of practice-based evidence, Mc Millan and Morley (2010) described the process of conducting single-case quantitative research, which necessarily in-cludes repeated measurement of client concerns and goals after baseline. We discuss these assessment practices in Chapters 7 and 8. Big Foot and Schmidt (2010) described the cultural adaptation of EBPs as “the blending of science and indig-enous cultures” (p. 855). They posited that the success of this blending or integration “is the translation of not just language but also core principles and treatment concepts so that they become meaningful to the culturally targeted group while still maintaining fidelity” (p. 855). Adapting and Adopting Evidence-Based Practices Most EBPs began as innovations in that they represent the integration of two or more therapies. For example, dia-lectical behavior therapy (DBT) is an adaptation of CBT in its incorporation of Eastern philosophy, namely Zen, and mindfulness practice. The balance of behavior change and acceptance—the fundamental tension or dialectic of DBT—is a treatment goal and reflects the innovative style of DBT. Although DBT is an EBP for borderline person-ality disorder, it must continue to undergo adaptation for it to be relevant and remain clinically useful for helpers and clients alike (see Dimeff & Koerner, 2007). This is true for all EBPs. If, as Thyer and Myers (2011) noted, EBP is a verb or a dynamic process rather than a static noun, and if, as Wampold et al. (2007) stipulated, EBPs are guidelines rather than absolutes and mandates, then EBPs must be subjected to ongoing modifications (e. g., cultural adaptations) that are able to demonstrate benefi-cial effects for clients and their families using a variety of sound measures. Only in so doing will EBPs shed their notoriety as reflections of what Wachtel (2010) termed “a poverty of imagination” (p. 254). It is from the (healthy) tension between science and clinical practice/expertise that innovations and future EBPs are born. As innovations, adopting EBPs and implementing them into routine clinical practice (a process known as diffusion or technology transfer) is not a simple task. Klein and Knight (2005) discussed several reasons why innovations are difficult to implement. Among these are that many innovations are unreliable and imperfectly designed, a concern raised by De Los Reyes and Kazdin (2008) with respect to inconsistent findings among evidence-based interventions. They noted, however, that “some evi-dence, although inconsistent, is clearly better than none” (p. 50). Innovations also require prospective users to acquire new technical knowledge and skills—a time-consuming and often costly endeavor—and to change their roles, routines, and norms. Practitioners accustomed to meet-ing clients in an office setting, for example, would likely have difficulty transitioning to and adopting the EBP of multisystemic therapy (MST) because MST services are provided to adolescents and their caregivers in their natu-ral environments, such as their school and their home. In addition, the decision to adopt an innovation is typically made by persons in authority. We discussed this earlier in the chapter with respect to state legislative bodies in the United States limiting funding only to those state-supported agencies that implement EBPs. The final rea-son innovations are difficult to implement, according to Klein and Knight, is that organizations (e. g., treatment fa-cilities, schools, local communities) are a stabilizing force and therefore any change that disrupts stability, status quo, and homeostasis is not necessarily “welcomed with open arms. ” This might explain why certain discredited practices (e. g., DARE) continue to be popular despite the evidence that they are ineffective and potentially harmful. It also might explain why some in the scientific commu-nity remain skeptical of culturally adapted EBPs because they did not derive their evidence from RCTs. The likelihood of adopting an innovation, such as an EBP, increases when it meets certain criteria. In his sem-inal book, Diffusion of Innovations, sociologist Everett Rogers (1995) identified five attributes of an innovation that, when perceived by members of a particular group (e. g., clinical team), determine whether or how quickly the innovation will be adopted and implemented into routine practice. The five attributes of an innovation are: 1. It must be perceived as having a relative advantage; that is, it must be viewed as being better than or an improve-ment on current practice. This advantage might be the perceived convenience, prestige, or cost of an EBP. 2. It must be perceived as being consistent with the adopter's experience, values, and goals; in other words, for a helper to use an EBP, it must be compatible or resonate with his or her own values and beliefs as well as previously introduced ideas and practices (e. g., theoretical orientation, cultural competence). 3. It must be easy to understand and use; it must be per-ceived as simple rather than as complex. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Building Your Foundation as a Helper 25 4. Potential users must be able to sample or try it out on a limited basis before making a decision. This is the innovation's attribute of trialability and can be lik-ened to test-driving a car before making a purchase. A trial period is designed to dispel uncertainty about a new idea. 5. The benefits of adopting an innovation must be visible to others. This is the attribute of observability. In the case of EBPs, this is not limited to reading or hear-ing about research findings; it also includes—perhaps more so—helpers being able to directly witness and testify to the beneficial effects of the EBP for their clients. This appears to support the efforts of practice-based evidence. Researchers and health care administrators cannot ex-pect helpers to automatically and enthusiastically embrace EBPs simply because “the research says so. ” Rather, adopt-ing and then implementing these practices is a process that requires time, involvement of and collaboration with clinical staff, provision of staff support (e. g., training, on-going supervision, financial compensation), and evidence beyond research findings. Just as clients engage in a pro-cess of personal change—moving through various stages of readiness to change over time—practitioners also par-ticipate in a professional change process when introduced to new practices. Miller et al. (2006) likened this process to learning any new skill, which often entails three aids: ground school or basic training (e. g., graduate school, reading, attending workshops), practice with feedback, and coaching or supervision to reinforce correct practice and cultivate enhancement. We believe that researchers, clinical directors, and supervisors need to engage practi-tioners (as well as the systems or organizations they repre-sent) in a similar stage of change process when attempting to disseminate innovative approaches. As you learn more about EBPs in your coursework and in your clinical practice (e. g., from in-service training, pro-fessional workshops), we encourage you to consider each EBP you are introduced to according to the five attributes that Rogers (1995) identified. For example, be willing to ask, “How is this EBP intended to benefit clients in ways that that are currently not available?” and “Will I be able to explain this EBP to clients in a way they can understand, in a way that is simple and not confusing to them?” Innovations with Integrity T wo therapies recognized as EBPs exemplify the benefit of a comprehensive and integrative perspective result-ing from ongoing discussions between scientists and practitioners. They have become familiar practices in certain sectors, and the concepts that undergird and guide their respective approaches are not new. However, only in recent years have assertive community treat-ment (ACTx) and dialectical behavior therapy (DBT) gained wide prominence. An integration of ACTx and DBT also has been proposed (Reynolds, Wolbert, Abney-Cunningham, & Patterson, 2007). We discuss each of these EBPs briefly and encourage you to com-plete Learning Activity 1. 3 on page 26 once you have familiarized yourself with ACTx and DBT. Assertive Community Treatment According to Bond, Drake, Mueser, and Latimer (2001), assertive community treatment was first developed in the 1970s as an intensive and holistic approach to the treat-ment of persons with severe and persistent mental illnesses (e. g., schizophrenia, bipolar disorder). (In this chapter we abbreviate assertive community treatment as ACTx to dif-ferentiate it from the acronym ACT that designates accep-tance and commitment therapy mentioned earlier in the chapter. ) Key features of ACTx (see Box 1. 3 on page 26) are that integrated services (e. g., medication management, vocational rehabilitation) are provided not by one person but by a group of professionals (e. g., substance abuse counselor, case manager, nurse) who work as a team. All team members, therefore, share responsibility for caring for the same clients. It is highly unlikely that persons with severe and persistent mental illnesses initiate and maintain active involvement in formal services. Therefore, the ma-jority (approximately 80%) of ACTx services are delivered in the field or in vivo (i. e., in the community rather than in a clinical setting) to engage and remain connected with persons challenged by a multiplicity of concerns and prone to frequent relapses and overall instability. In this manner, ACTx is regarded as a proactive, assertive, and persistent treatment approach. It is a “living-systems” alternative to hospital and residential care (see Ellenhorn, 2015) that often is described as “a hospital without walls. ” Specific ACTx services target what some might con-sider basic client needs, such as obtaining housing, food, and medical care as well as managing finances. Although it resembles case management, ACTx is different from and far more comprehensive than intensive case manage-ment in that a range of services is delivered directly to the client (rather than linking the client to other service providers) by members of a team (rather than one case manager). In addition, ACTx services are tailored to the individual client, include individual counseling and crisis intervention, and are unlimited. The most encouraging and compelling aspects of ACTx are that it has been Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
26 Chapter 1 found to contribute to reduced psychiatric hospital stays, increased housing stability, and engaging and retaining clients in mental health services (Bond et al., 2001). Compared to case management or to a standard treat-ment, a review of research found that ACTx services specifically for homeless persons increased their engage-ment in medical, mental health, and substance use treat-ment services (Nelson, Aubry, & Lafrance, 2007). Early engagement and retention in ACTx also was found for older persons with severe mental illnesses (Stobbe et al., 2014). For helpers (specifically case managers), the ben-efits of ACTx participation include a decrease in burnout and an increase in job satisfaction (Boyer & Bond, 1999). The Assertive Community T reatment Association (www. actassociation. org) was founded in the late 1990s and sponsors an annual conference. Dialectical Behavior Therapy Dialectical behavior therapy (DBT) was developed by Marsha Linehan (2015) as a highly structured, multi-modal treatment program for suicidal clients meeting the criteria of borderline personality disorder (BPD). It is informed by cognitive behavior theory, biosocial the-ory (i. e., biological irregularities combined with certain dysfunctional environments), and Eastern philosophy, namely Zen. Although DBT is now regarded as an EBP Learning Activity 1. 3 Compelling Evidence Exercise This activity is intended to assess your own motivations for adopting and implementing an evidence-based practice. It can also be used as a classroom activity to generate discus-sion. As you complete the activity, consult the five attri-butes of an innovation identified by Everett Rogers (1995) that are listed and defined on pages 24-25. Consider for a moment that you are on the clinical staff of a community-based mental health facility primarily serving a low-income population, many of whom have severe and persistent mental illnesses (e. g., schizophrenia, personality dis-orders). In response to the accrediting body's new policy that all accredited treatment facilities adopt and deliver evidence-based practices as standard service, you have been informed that you will soon become a member of a new assertive com-munity treatment (ACTx) team and will need to attend training in dialectical behavior therapy (DBT). Given what you know about ACTx and DBT, what “evidence” will convince you that these two treatment approaches will be worth the investment of your time and energy? What information will compel you to adopt and begin implementing these two practices? Check all of the following that apply, and add two of your own reasons, too. 1. ____ Learning about research findings from published clinical trials that justify both ACTx and DBT's designa-tion as evidence-based practices. 2. ____ Knowing that I will be receiving close supervision and training tune-ups in the first few months of using these two approaches. 3. ____ Receiving training from seasoned practitioners who themselves have used both ACTx and DBT. 4. ____ Learning that my salary will remain the same and that I will have to pay for half of the DBT training costs. 5. ____ Knowing that I will be part of a team of other clini-cal staff who will meet at least once per week not only to review client cases but also to offer one another support. 6. ____ Learning that after 6 months of implementing ACTx and DBT, our facility saved the county mental health board several thousands of dollars due to our clients needing fewer psychiatric hospital bed stays. 7. ____ Hearing the stories of (and even being able to interact with) clients of other treatment facilities who have participated in ACTx and DBT and are now man-aging their symptoms fairly well. 8. ____ Receiving training from prominent researchers who have studied ACTx and DBT for a number of years. 9. ____ Learning that I will be provided with a mobile phone (at no expense to me) so that I can be on-call 24 hours once per week. 10. ____ Knowing that my current caseload will be reduced and that all members of the ACTx team (approximately six to eight) will assume responsibility for the same clients (approximately 50 to 60). 11. ____ Knowing that DBT is a highly structured approach that holds clients accountable for their behaviors while validating their experiences and circumstance in a nonjudgmental and empathic manner. 12. ____ Learning that after 6 months of implementing ACTx and DBT, approximately one-third of the clients our team serves have taken their medications as pre-scribed and have not been actively suicidal. 13. ____ Learning that client-helper collaboration is a pri-ority in ACTx and DBT, and this resonates or fits with my own belief system of effective therapy. 14. ____ After 6 months of implementing ACTx and DBT, hearing one of my previously hostile and unstable clients describe a recent incident in which he was able to keep his cool after practicing one of his mindfulness exercises. 15. ____ ________________________________________ 16. ____ ________________________________________ Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
Building Your Foundation as a Helper 27 for the treatment of BPD, recent adaptations of DBT have expanded its application to persons with eating disorders (Wisniewski & Kelly, 2003; Wisniewski, Safer, & Chen, 2007), comorbid personality disorders (i. e., paranoid and obsessive-compulsive personality disorders; Lynch & Cheavens, 2008), and comorbid substance use disorders (i. e., substance use and borderline personality disorders; Lee, Cameron, & Jenner, 2015), whether or not BPD or suicidal intent is present. For adolescents with repeated suicidal and self-injurious behavior, DBT has been found to be effective in reducing those and depresssive behaviors (Mehlum et al., 2014). DBT also has been modified for deaf individuals (O'Hearn & Pollard, 2008), an example of a culturally adaptive EBP. DBT is based on behavior theory and includes the prin-ciples of acceptance, mindfulness, and validation (Neacsiu, Ward-Ciesielski, & Linehan, 2012). Although it is highly structured and calls for the implementation of specific helper skills and client behaviors, DBT is not a rigid or prescriptive approach, and it fits well with the helper skill of flexibility discussed earlier in the chapter. Helpers are instructed to provide individualized care and there-fore tailor specific practices to the needs of each client. For example, for persons with bulimia nervosa, Hill, Craighead, and Safer (2011) incorporated appetite aware-ness training into the first 4 weeks of DBT and modified the DBT diary card to include appetite monitoring. A guiding premise of DBT is that a convergence or synthesis of what appear to be opposing forces is possible. This process of balancing and regulating conflicting feel-ings and behaviors is what is meant by dialectical in the name DBT. Take, for example, an adult woman with a history of sexual and physical abuse who has attempted suicide on several occasions (symptoms or characteristics often associated with BPD). Although she may interpret the violations she experienced as “proof” that she is “not fit to live,” she also has a strong desire to experience an in-timate connection with another human being, to be loved (a need that might be interpreted by some as an “attach-ment disorder” or traits of “dependency”). It is not that one experience is “wrong” and the other is “right. ” Rather, both have validity, and in her work with a professional helper this woman would strive to acknowledge and ac-cept both experiences, live with the tension or paradox (i. e., “not fit to live” vs. someone deserving of love), and arrive at a synthesis of the two polarities (e. g., “I have been violated and I am a survivor worthy of love”). As a comprehensive approach, DBT offers an array of behavioral strategies, including problem-solving, skills training, contingency management (e. g., behavioral contracting), exposure-based procedures, and cognitive modification. These are complemented by what Linehan (2015) refers to as acceptance-based procedures, such as validation, mindfulness, and distress tolerance. Validation and problem-solving strategies form the core of DBT, and all other strategies are built around them. Validation conveys to the client that the choices he or she has made and the behaviors he or she has engaged in make sense and are understandable, given the client's life situation (i. e., history, current circumstances). Problem-solving is un-dertaken only after validation has been conveyed (it may need to be repeatedly conveyed), and it includes clarifying the primary concern at hand and then generating alterna-tive solutions. One such strategy, chain analysis, involves the development of “an exhaustive, step-by-step descrip-tion of the chain of events leading up to and following the behavior... [so as to examine] a particular instance of a specific dysfunctional behavior in excruciating detail” (Linehan, 1993a, p. 258). This exercise not only informs the helper about the client's cognitive schema (e. g., the specific details that are remembered) but also teaches the client important self-observational and self-assessment skills, as well as the connections among many different variables, and it teaches that the client has the ability to exert control over those linkages and create new patterns of behavior. We believe that both ACTx and DBT warrant further consideration by practitioners and scientists/researchers alike. They not only have compelling empirical evidence to justify their continued practice but they also have ● ●Multidisciplinary staffing ● ●Integration of services ● ●Team approach ● ●Low patient-to-staff ratios ● ●Locus of contact in the community ● ●Medication management● ●Focus on everyday problems in living ● ●Rapid access ● ●Assertive outreach ● ●Individualized services ● ●Time-unlimited services Box 1. 3 Key Principles and Practices of Assertive Community Treatment (ACTx) Source: Bond et al., 2001. Copyright 2017 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the e Book and/or e Chapter(s). Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it. | Interviewing and Change Strategies for Helpers -- Sherry Cormier Paula S_ Nurius and Cynthia J_ Osborn -- 8th 2017 -- Cengage Learning Inc -- 7ad765f70d931446a1a204fea013935b -- Annas Archive.pdf |
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