Counseling with Cultural Competence

Cultural competence is, without a doubt, required of clinicians who provide therapy to culturally diverse clients.  The acquisition of both knowledge and skills, but moreover, the ability to deal with powerful emotional reactivity and unconscious biases associated with race are incumbent (Sue, 2010).  When counseling clients who are culturally different, the competent therapist must be aware of the possibility of being uncertain regarding therapeutic discussions of sensitive topics.  In order for a clinician to be culturally competent and provide effective therapeutic assistance, one must be knowledgeable of cultural needs, to include language, religion, food, racial identity, and customs (Allain, 2007).

Throughout your professional career a continual effort should be placed on seeking total cultural competence, especially concerning the cultures that will primarily comprise your clientele.  As I have not exactly nor assuredly settled into my foreseen client-base, for comparative purposes I will refer to Fairfield County, South Carolina in this composition, as this is the location of many of my relatives.  The demographics of this area (as interpreted from the United States Census Bureau) possess a different skew than the United States, as well as the state of South Carolina, in that African Americans at 59% of the population are the majority race, followed by Whites at 39%.  American Indian, Alaska Native, Asian and multiracial individuals comprise less than 2% collectively, while an estimated 1.5% of these individuals are of Hispanic origin.

In addition, the percentage of poverty in Fairfield County is 24%, whereas the United States average is near 15%.  While Fairfield County is diverse, it is so in its own right.  The dynamics of this population create cultural norms that are not necessarily reflected by the perception of American culture at large.  A therapist working in this area must understand the intricacies of the cultures, to include cultural beliefs and values based on race, poverty and the availability of resources.

Taking a look at Fairfield County’s majority.  When any helping professional provides counseling to an individual of African American culture, there are several factors one must keep in the forefront in order to reach successful therapeutic treatment.  The primary factor is that of cultural competence, as it would be when counseling a member of any culture.  However, the therapist’s cultural competence is vital to the treatment of African Americans as it is quite common for an individual from this cultural background to be misdiagnosed, and subsequently incorrectly counseled.  This is often the result of the impact their culture’s history, racism, and oppression have had on their individual personality, as well as to their entire group as a national minority.  Although the clinician, no matter their race, will be unable to dispel any opinions the African American individual may harbor regarding discrimination, it remains their responsibility to aid the individual in attaining cultural acceptance—within their cultural group, as well as all others—and ultimately establishing their autonomy.

Therapists should abide by an obligation to aid the client in constructing the framework leading to development of the client’s autonomy.  This is especially the case when counseling individuals in the African American culture, where it is vital for them to become self-aware and fully autonomous as this quality will allow them the capability of personally conquering the effects of discriminatory encounters and the spectrum of microagressions they are guaranteed to continue facing.  In order for a clinician to aid in the process of developing racial identity in persons of color, the therapist must guide them in establishing a passive acceptance of the self as inferior, and then facilitate the client to overcome internal racism and develop a self-affirming identity (Constantine, 2005).

When the minority is the majority, such as the case of African Americans in Fairfield County, the therapeutic approach and methodology to counsel these individuals cannot be based solely on their role as a United States minority group, but also their role as a regional majority.  The primary adjustment to therapeutic intervention regarding this cultural group involves understanding the effects of, and relationship between, the national and regional cultures through the eyes of the individual.

The national majority.  For a clinician to successfully treat members of the Caucasian American culture, they must again utilize their cultural competence when formulating the framework to develop the well-being of these individuals.  In regard to the general population of the United States, Caucasians are the majority culture group.  And in this light, the therapist’s objective would be to guide them in becoming more culturally aware, as well as to increase their own self-awareness.  This would allow them to gain understanding in their typecast role as “oppressor,” acknowledging their unearned assets that constitute White privilege, and adjust their viewpoint with the goal of eliminating any harbored microagressions.

The therapist should assist them in understanding that the source of their conscious or unconscious racism is a result of their culture’s attempt to earn societal prestige through the control and dominance of cultures dissimilar to theirs.  And, according to the Psychoanalytic approach, racism surfaces to serve as a defense mechanism of the ego and superego out of one’s fear of loneliness (Utsey, 2002).  For Whites, as well as other groups, the attribution of cultural differences to minorities is a hidden expression of racial prejudice (Vala, 2009).

The majority as a minority.  Often referred to as the majority, the Caucasian cultural group in many smaller communities represents the minority.  In these instances, therapeutic approaches need to adjust due to the fact that many of these individuals have difficulty dealing with the sense that they are seeking racial acceptance from the majority culture, while they are experiencing discrimination.  In many instances, one’s racial attitude is an attempt to manage an underlying anxiety associated with one’s intolerance of the dissimilar (Utsey, 2002).  A therapist in this situation may find members of the White culture to be anxiety-ridden due to their inability to control the majority culture—which will in fact be a national minority group.  Many of the areas where these inverted racial demographics exist are more likely to be impoverished.  With a poverty level higher than the United States national average, some of the predominant issues for Whites in these areas are the difficulties stemming from their socioeconomic status.  In these situations, it is likely that a great deal of Caucasian individuals are dealing with the denial of their Whiteness because of their shared socioeconomic status with African Americans and other national minority groups.

White privilege in these regions relies predominantly on one’s financial success; and because many Whites have not attained any substantial financial successes, it is more difficult to identify White privilege (Sue, 2010).  Also, when Whites are the minority group, they are likely to be self-conscious of appearing racist; for example, it is highly unlikely that one would exhibit overtly racist behaviors if they are one of only seven White children in a class of forty-five students.

The Hispanic population.  When functioning at a high level of cultural competence, a therapist treating an individual with a Hispanic cultural background understands the importance of being perceived as a knowledgeable and authoritative therapeutic professional.  Likewise, these individuals should be aware that Hispanics are a heterogeneous culture, in that it comprises Cuban, Mexican, Puerto Rican, and several more ethnic groups, each with their own cultural values.  Therapists must be knowledgeable of these various cultures, and that their primary similarity is that of sharing the same language; this makes effective intervention and treatment contingent upon understanding the dimensions of the specific client (Altarriba, 1994).  The culturally competent clinician is also cognizant of the importance of addressing familial issues with the father of the family system, as Latinos are a highly patriarchal culture.  In addition, the clinician should understand the significance of the structure of the entire extended family, as it is common for Hispanic households to include other family members, not solely the nuclear individuals.  This family environment also plays a large role in the socialization of the children (Altarriba, 1998).

The role of the therapist also includes being open to alternative approaches to therapy, such as prayer and incorporating priests, as often the role of religion has a significant impact on the Latino family.  It is also necessary for the culturally aware clinician to formulate the aspect of immigration into his or her therapeutic approach.  Even in cases where the family or individual currently seeking counseling may not have immigrated into the U.S., there is the possibility that they have family members residing in their native country which impacts their current emotions and viewpoints.  Furthermore, those who have immigrated have suffered through geographically separating themselves from many social or familial support systems which were previously established (Smart, 2001).

The therapist’s role, when working with Latinos, is also to aid with their assimilation with other cultures of the region, this includes the therapist and client being linguistically compatible.  In many instances, Hispanic immigrants deal with their own language barrier within their household, as the parents tend to prefer speaking Spanish in the home, and the children (especially if born in the U.S.) may primarily speak English.  The problem this presents to bilingual therapists is that the clinician tends to serve as merely the interpreter for both parties.  Another risk associated with the bilingual therapist is in the aspect of dialect—if the therapist’s predominant language is English and they had to learn the Spanish as a second language, they must be fluent in a manner that displays the same authority and competency while speaking in the client’s language (Sciarra, 1991).

Although Hispanics represent the largest minority group in the United States, there are communities where the Hispanic population is less representative such as in Fairfield County, SC where they comprise less than 1.7% of the population.  One objective for the therapist, when counseling a member of Hispanic culture, is to foster the client’s cultural awareness of their own cultural group as well increase their awareness of other minority and majority cultures.  In essence, the therapeutic approach should include efforts to establish their acculturation.  Hispanic individuals may need assistance from helping professionals simply because there is not a large preexisting population of Latinos where they reside, or in the surrounding areas.  The primary discriminatory encounters they experience will originate from their skin color, illegal immigration, and reliance on physical labor due to the persistent language barriers (Smart, 2001).  In areas where they are the overwhelming minority, the root of their cultural issues often resides in their constant search for acceptance and sense of belonging within the community, and among the other cultural groups.

Multiracial groups.  Aside from the African American, Caucasian, and Hispanic cultures, one must also consider multiracial groups, as they hold 1.7% of the United States population.  Individuals in this group tend to have their own issues, to include having several identities and not being one-dimensional (Allain, 2007).  When requiring therapeutic assistance, they tend to bring a complex set of issues.  The concept of culture will remain critical to therapists, as cultural roots are often maintained through parental socialization (Leong, 2010).  When working with multicultural groups, therapists can generally model their approach by assessing the client’s racial and cultural identity development and forming a therapeutic alliance by gauging the client’s sensitivity to verbal and nonverbal cues.  The therapist also formulates his methodology by assessing how the client identifies themselves collectively, individually, as well as how one’s family values affects the client (Delgado-Romero, 2001).

Often, in order for a therapist to develop a financially successful professional practice, it is essential to provide adequate therapy to both majority and minority cultures as well as cultures which differ from their own.  To progress in doing this, it is necessary to conduct research to develop knowledge in a systematic way (Arzubiaga, 2008).  In therapists’ attempts to obtain cultural competence, many run the risk of being superficial and counterproductive if they remain underdeveloped in the area of cultural sensitivity.  The implementation of cultural competence and sensitivity offer a more rigorous and reflective methodology and therapists must keep that in mind.  It is not necessary to become an expert on any particular culture, but rather to concentrate on being aware of one’s own perspective.  As therapists, the utilization of critical thinking is vital to understanding how one’s own perspective can affect their ability to acknowledge and understand differing perspectives (Allain, 2007).  Finally, be aware that culture is not simply race, and it is my belief that economic status in many instances holds an equal, if not greater, effect on ones manifestations which define their cultural identity.

References

Allain, L.  (2007).  An investigation of how a group of social workers respond to the cultural needs of black, minority ethnic looked after children.   Practice, 19(2), 127-141.

Altarriba, J., Santiago-Rivera, A. L.  (1994).  Current perspectives on using linguistic and cultural factors in counseling the Hispanic client.  Professional Psychology: Research and Practice, 25(4), 388-397.

Altarriba, J., Bauer, L. M.  (1998). Counseling the Hispanic client: Cuban Americans, Mexican Americans, and Puerto Ricans.  Journal of Counseling & Development, 76(4), 389-396.

Arzubiaga, A. E., Artiles, A. J., King, K. A., Harris-Murri, N.  (2008). Beyond research on cultural minorities: Challenges and implications of research as situated cultural practice.  Exceptional Children, 74(3), 309-327.

Constantine, M. G., Warren, A. K., Miville, M. L.  (2005). White Racial Identity Dyadic Interactions in Supervision: Implications for Supervisees’ Multicultural Counseling Competence.   Journal of Counseling Psychology, 52(4), 490-496.

Delgado-Romero, E. A.  (2001). Counseling a Hispanic/Latino client—Mr. X.  Journal of Mental Health Counseling, 23(3), 207-221.

Leong, F. T. L., Leung, K., Cheung, F. M.  (2010). Integrating cross-cultural psychology research methods into ethnic minority psychology.  Cultural Diversity and Ethnic Minority Psychology, 16(4), 590-597.

Sciarra, D. T., Ponterotto, J. G.  (1991). Counseling the Hispanic bilingual family: Challenges to the therapeutic process.  Psychotherapy: Theory, Research, Practice, Training, 28(3), 473-479.

Smart, J. F., Smart, D. W.  (1995). Acculturative stress of Hispanics: Loss and challenge.  Journal of Counseling & Development, 73(4), 390-396.

Sue, D. W., Rivera, D. P., Capodilupo, C. M., Lin, A. I., Torino, G. C.  (2010). Racial dialogues and White trainee fears: Implications for education and training.  Cultural Diversity and Ethnic Minority Psychology, 16(2), 206-214.

Utsey, S. O., McCarthy, E., Eubanks, R., Adrian, G.  (2002). White racism and suboptimal psychological functioning among White Americans: Implications for counseling and prejudice prevention.  Journal of Multicultural Counseling and Development, 30(2), 81-95.

Vala, J., Pereira, C., Costa-Lopes, R. (2007).  Is the attribution of cultural differences to minorities an expression of racial prejudice?  International Journal of Psychology, 44(1), 20-28.

Atlas Concepts, LLC_Jordache WilliamsJordache Williams is currently based in Rock Hill, SC and is the Program Manager for Atlas Concepts, LLC. He is a Certified Life Coach and holds a Master’s Degree in Human Services.

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Mental Health for the Impoverished and Unemployed

I can stare in the mirror and recite, “Every day, in every way, I’m getting better and better,” and I will still experience my life as awful unless I also have opportunities to succeed or I live in a community where, by comparison, I am no worse off than others. Wellbeing is a social phenomenon (Ungar, 2014).

It is no secret that poverty and unemployment are highly correlated; however, it is somewhat less widely known that these factors mediate, and are influenced by, mental health.  Recent research suggests that socio-economic hardship precedes inferior mental health (Heflin & Iceland, 2009).  Commonly, mental health is associated with emotions and feelings including stress, depression and loneliness.  On the other hand, mental illness is reserved by many for diseases and disorders such as schizophrenia, bipolar disorder, posttraumatic stress disorder, etc.  The reality is that many diagnosable mental disorders are based on criteria regarding the factors considered by many to be a part of everyday life (i.e. stress, anxiety, alcohol, drug and even tobacco use).  The Mayo Clinic estimates that one in five adults experience mental illness in a given year (2015).  Furthermore, Kessler states that forty-six percent of Americans experience at least one mental disorder in their lifetime (as cited in Anakwenze & Zuberi, 2013, p.147).  In either course, the mental state of an individual, and societies at large, have vast socioeconomic implications.  Scholarly contributions from the United Kingdom suggest that the lowest wage-earners are twice more likely to experience mental health issues than average wage-earners and are more likely to experience unemployment (Kronenberg, Jacobs & Zucchelli, 2015).  In 1997, William Julius Wilson found a relationship between poverty and mental health, of which, he concluded that unstable work and low income decrease self-efficacy (as cited in Anakwenze & Zuberi, 2013, p. 148).  However, despite a rather lengthy history of research concerning the topic (which continues to be empirically vetted), there has yet to emerge a viable socio-economic prescription for mental illness.  This review of literature focuses on determining the key socioeconomic factors associated with mental illness, and adds clarity to the relationship between poverty, unemployment and mental health.

Finding a place in society

As a part of the Fair Labor Standards Act in the U.S., the Wage and Hour Division of the Department of Labor [DOL] authorizes employers to pay subminimum wages to individuals who possess disabilities that effect job performance (2008).  Mental illness is included among the list of impairments which qualify for a subminimum wage (DOL, 2008).  Regardless of the intent, these standards imply a degradation of value to those with mental illness.  The chasm between economical and humanistic thinking is evidenced by such government actions.  That is, economically, individuals lose their name and their very identity (i.e. self-efficacy) and are considered in conventional terms, “factors of production”, “government expenses”, “buyers and sellers”, to name a few.  Government intervention that provides a means for employers to pay individuals with mental illness less for jobs which they are less than qualified, does little to fix any economic or mental health dilemma.  Efforts may better be served by providing resources, such as research endeavors purposed with determining suitable employment options for those with specific mental illness.  Employing individuals in positions where their efforts and productivity are economically valuable to employers decreases the need for subminimum wage authorizations, and has potential to improve workers’ mental health and the business’ output.  One challenge to this effort may be that individuals with serious psychological distress are more likely to have less than a high school diploma (Heflin & Iceland, 2009).

Not only do mentally disabled individuals face difficulty fitting into the workforce, they also are more likely to face sub-quality living conditions.  In the United Kingdom, one in three households, housing a disabled person is considered to be substandard (Snell, Bevan & Thomson, 2015).  These substandard conditions not only create a sense of dissatisfaction for those residing in such dwellings but also increase their susceptibility to chronic illness (Snell et al., 2015).  These individuals’ increased susceptibility to illness is, in part, due to rising energy prices and the inability to afford heat and/or air conditioning (Snell et al., 2015).  Because many of these individuals lack employment, it is assessed that more time is spent in the home, thus exacerbating the amount of time they are exposed to substandard conditions (Snell et al., 2015).  Heflin & Iceland (2009) concluded that providing relief for energy costs and eviction prevention may have high social benefits, especially if provisions are extended to those within two hundred percent of the poverty line, as oppose to only those living in poverty.

The individual’s perception of their condition and the associated dissatisfaction both play a role in increasing the individual’s risk of experiencing depression (a degraded or impaired mental state) (Anakwenze & Zuberi, 2013).  Depression can aggravate an existing mental health condition or in itself become a mental illness.  The living conditions available to those with disabilities, including mental illness, is largely impacted by their ability to find and sustain employment providing the necessary income for suitable accommodations.  The condition they find themselves in (i.e. facing mental illness, unemployment and poverty) is a cyclically diminishing one.  It doesn’t take a John Maynard Keynes to understand that this cycle cannot recover itself efficiently.

Affording treatment

Well into the U.S.’s 2015 political debate season, a potential increase in minimum wage remains a pivotal topic.  Many Americans are in favor of increasing the minimum wage standards, suggesting a societal need for increased income.  To be clear, mentally healthy individuals making minimum wage claim to need more money.  How can poor, mentally ill individuals, earning a subminimum wage afford treatment?  The reality is that they likely cannot. But even if provided with income increases, mental health can only be improved by monetary gains if those gains are employed appropriately by the individual.

It has been suggested that an increase in minimum wage would improve mental health.  This is largely based on research which has found positive correlations between income and mental health.  Kronenberg et al. (2015) points out the expenses businesses can attribute to mental illness, such as absenteeism, and suggests that a minimum wage increase could improve mental health and productivity, thus becoming an affordable expense.  While this logic may hold some merit, it is not determined if individuals would invest additional income towards improving their mental health and, moreover, there is a lack of empirical evidence to support such assumptions.  It is determined, however, that disabled individuals, as compared to non-disabled individuals, face proportionally greater increasing living costs, are less likely to be employed, are less likely to be employed full-time (if employed), and receive lower wages (Snell et al., 2015).

In many instances, individual’s mental disorders go untreated.  While this in itself is tragic and sometimes fatal, in impoverished communities it is more likely that a mentally ill parent’s interactions with their children be harmful.  Not only do children in these situations grow up with the same economic insecurities, they are exposed to, and are affected by, the stress, anxiety, and depression present within the household.  These situations have a biological effect on the brain and require treatment (Anakwenze & Zuberi, 2013).  This needed treatment often doesn’t occur.  In many cases, mental illness coupled with poverty leads to criminal activity and imprisonment.  Harding suggests that a physiological mechanism exists by which the violence present within low income neighborhoods yields mental health concerns, such as chronic stress (as cited in Anakwenze & Zuberi, 2013, p. 150).  These mental health problems undermine individual’s self-efficacy and perpetuate further negative consequences.

The socioeconomic issues covered herein do little to scratch the surface of what seems to be a nearly silent epidemic.  Overshadowed by international threats, presidential debates and Hollywood shenanigans, the issue of mental illness has many socioeconomic implications.  I suggest further research is needed in many areas related to mental health reform, to include: the role of mental illness concerning violent and juvenile offenders, neighborhood disorder (i.e. perceived levels of social support and integration), and the relationships between depression, aggression, addiction and trauma.  The relationship between poverty, unemployment and mental health is complex, yet it can be reduced to a simple term, vicious circle.  I conclude that mental health care in the U.S. is a substantial component to economic stability.  Reformation of the economic strategy should include progressive government intervention in impoverished communities, to include crime prevention, education, job training and mental health rehabilitation and sustainment.  Such programs create a demand for jobs and supply qualified job seekers.  Long-term, such programs reduce crime rates and unemployment as well as have the potential to increase gross domestic product.

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References

Anakwenze, U., & Zuberi, D. d. (2013). Mental Health and Poverty in the Inner City. Health & Social Work, 38(3), 147-157.

Heflin, C. M., & Iceland, J. (2009). Poverty, Material Hardship, and Depression. Social Science Quarterly, 1051.

Kronenberg, C., Jacobs, R., & Zucchelli, E. (2015, Aug). The impact of a wage increase on mental health: Evidence from the UK minimum wage. Retrieved from http://www.york.ac.uk/media/economics/documents/hedg/workingpapers/1508.pdf

Mayo Clinic (2015, Oct 13). Mental Illness: Risk Factors. Retrieved from http://www.mayoclinic.org/diseases-conditions/mental-illness/basics/risk-factors/con-20033813

Snell, C., Bevan, M., & Thomson, H. (2015). Welfare reform, disabled people and fuel poverty. Journal Of Poverty & Social Justice, 23(3), 229-244. doi:10.1332/175982715X14349632097764

Ungar, M. (2014, Jan 12). Will a Higher Minimum Wage Make People Happier? [Web log comment]. Psychology Today.  Retrieved from https://www.psychologytoday.com/blog/nurturing-resilience/201401/will-higher-minimum-wage-make-people-happier

U.S. Department of Labor (2008, Jul). Fact Sheet #39: The Employment of Workers with Disabilities at Subminimum Wages. Retrieved from http://www.dol.gov/whd/regs/compliance/whdfs39.pdf

Atlas Concepts, LLC_Jordache WilliamsJordache Williams is currently based in Rock Hill, SC and is the Program Manager for Atlas Concepts, LLC. He is a Certified Life Coach and holds a Master’s Degree in Human Services.

Therapists Differ and so do Their Approaches

In the most basic sense, therapy is a form of treatment for disorders.  However, not every person that seeks therapy meets the full criteria for a clinical diagnosis, thus therapists are often engaging a client regarding presenting problems.  These issues may or may not lead to diagnosis, but more often than not, are affecting the individual’s overall functionality.  So, while you as a client may feel that you need therapy, understand that you may not be receiving treatment for a disorder. In many cases, at the request of the client, therapists seek to assist the client with restoring or increasing the client’s level of functionality (often recognized by the client as balance, happiness, meaning or fulfillment).  This process typically includes a clinical assessment of the client’s level of functionality, and a determination on whether or not the client’s thoughts or actions meet the criteria for diagnosis.

In order to provide therapeutic assistance, therapists use their experience and expertise, which may be derived from a variety of tools, techniques, theories and models.  Because of the vastness of the research, experiments and studies that have occurred over time, there are an abundance of valid (proven) approaches to therapy that may be chosen by a given practitioner.  While there is no identified “best” approach to therapy, the client’s situation and the therapist’s competence play a large role in determining which model the therapeutic engagement will follow.  If you are interested in seeking therapy, it may prove helpful to understand what specialties potential therapists claim, as well as what approach(es) to therapy they practice.  Below is a comparative look at a few popular therapeutic models.

Reality Group Therapy versus Structural Family Therapy

While applying the Reality Group Therapy method, the therapist focuses on the individual’s control of their behaviors.  The clinician aides the client in performing a self-evaluation in which they identify the quality of their behaviors, then determines what the contributors of their failures are.  The therapist’s role is to guide the client through the process of developing a plan of action to eliminate these behaviors, and then hold them accountable throughout the execution of the devised plan by confronting them and identifying any possible deterrents or reasons for any incapability of completing the plan.  The therapist and client work closely together to formulate the plan of action for the client to modify the behaviors causing their negative emotions in order to reach the desired outcome.  Whereas, in Structural Family Therapy, the therapist emphasizes the dysfunctions of the family as opposed to strictly the individual’s control of the issues.  Abiding by the Structural approach limits the therapist’s overall involvement as he is not used to establish intensive reparative for the family members, but to simply outline the framework, develop the foundation for reframing, and then encourage the family to continue a positive progression of growth.  The Structural therapist’s role is to be an active agent in the process of restructuring the family, emphasize clear boundaries, facilitate the unearthing of hidden family conflicts and then outline the manner in which the family can modify them.

Person-Centered Therapy versus Strategic Family Therapy

The Person-Centered therapist is one who is congruent, removing all sense of authority and de-masking of professionalism.  To be an effective Person-Centered therapist, it entails revealing personal information if it is an accelerant to the progression of therapy.  Typically therapists have the general understanding of the limitations when involving self-disclosure; however, in Person-Centered therapy the clinician is transparent.  Person-Centered therapy is client-guided as they explore their life experiences, and with the aid of the therapist, analyze their history and the result is the client resolving their own issues.  In this approach, it is vital for the therapist to exude unconditional positive regard, providing no criticism, guidance for behavior, or discouraging them from any behaviors.  In opposition, Strategic Family Theory requires the therapist to employ guidelines and directives, no matter how ambiguous.  The Strategic therapist pays extreme attention to detail and accepts only the positive, whereas the Person-Centered therapist must accept all aspects of the client—positive as well as negative.  Therapists abiding by the Strategic approach also develop a distinct outline for treatment involving defining the problem, investigating all solutions, defining clear change to achieve, and formulating strategy for change.

Rational Emotive Group Therapy versus Psychodynamic/Bowenian Family Therapy

Rational Emotive Behavior Therapy contends that individual’s belief systems are responsible for emotional consequences.  In theory, a client’s irrational beliefs could be effectively refuted by challenging them rationally and inevitably reducing the conflict.  In a group setting, the therapist takes a lead role in attempting to change the minds of the clients.  The therapist can accomplish this without fostering a “warm” relationship with the clients.  In a group setting, there is potential for judgments to be made of group members by other members of the group, which may prove of benefit or detriment to the therapeutic experience.  Rational Emotive Behavior Therapy holds that humans have the equal potential to be rational or irrational, and both preserving and destructive.  Therapists must promote clients to confront their behaviors as well as accept their faults.   Additionally, Rational Emotive Behavior therapists claim that it is possible to assist clients with changing their behaviors as a means to restructure their way of thinking.  In this light, the therapist must continue to encourage self-discipline as well as self-direction.  The primary similarity between Rational Emotive Behavior therapists and Psychodynamic therapists is that the principle focus of both is essentially for the client to reach full self-reliance, and operate at a high level of differentiation by exploring and developing their own autonomy.  The Psychodynamic therapist accomplishes this not through confrontation, but through examining the client’s family of origin, constructing and dissecting a multigenerational diagram, and guiding the client to remove emotionality from their family system and begin approaching it from an objective approach in order to identify its highest level of functionality.

Because these comparisons are very general it may prove helpful to conduct further research regarding any approaches that are of interest.  Additionally, understand that there are a multitude of other approaches to therapy as well and the best interpretation for you to have regarding any approach is the interpretation used by your therapist.  Understand that even though some therapist’s practices are based on the same principals, each therapist will inevitably approach therapy in their own manner.  This is to say that just because a certain therapy model was unsuccessful in the past with a specific therapist, you should not necessarily avoid seeking help from others utilizing a similar approach.

Atlas Concepts, LLC_Jordache WilliamsJordache Williams is currently based in Rock Hill, SC and is the Program Manager for Atlas Concepts, LLC. He is a Certified Life Coach and holds a Master’s Degree in Human Services.

Play Nice or Tell it Straight

Imagine that your employer always has nice comments to share with you about your work.  Sounds great, right?  You feel as though you must be doing a great job and you’ll certainly get a large bonus at the end of the year.

However, when the end of the year comes, others are getting promoted and you are not.  Others receive large bonuses…you do not.  You’re either broken or angry, but mostly confused.  You begin conjuring up conspiracy theories and may even begin looking for a new job.

While there are a multitude of possible reasons for this conundrum, it may boil down to a basic difference between you and your employer—that difference being the understanding of affirmation.  Your boss may be trying to empower you through affirmation, while you interpret her actions as confirmation.  Although her positive comments were meant to encourage you to excel, your interpretation led you to remain consistent.  To you, your complacency is holding you steady at A+ work, while your boss C’s you differently.

The reality is that individuals are different and, for one to truly impact another in an intended way, there has to be a certain level of understanding.  Sometimes people need to be told, with #nofilter, what they need to do, how they could improve and about their weaknesses.  Others need encouragement and positive words as motivation for reaching their potential.  Some need both.

Here are two models of group therapy, which help illustrate the utility of both approaches.

Person-Centered Therapy involves a self-directed evolution towards an individual’s full potential.  In a group setting, the group members dictate not only who the therapist is, but also control the nature of the session(s) as well as set their own individual and group goals.

The members of the group are responsible for monitoring their own progress and the progress of the group.  The therapist’s role consist of providing an empathetic and trusting environment.  The therapist must remain adaptive to the shifts in the group’s norms, and have the ability to evaluate group and individual progress without being intrusive or judgmental.

Additionally, the therapist must accurately perceive the groups’ meanings and feelings while consistently employing unconditional positive regard.  The Person-Centered approach claims that, through trust and genuineness, a therapist can inevitably improve a client’s self-concept and behavior.

Rational Emotive Behavior Therapy contends that individual’s belief systems are responsible for emotional consequences.  In theory, a client’s irrational beliefs could be effectively refuted by challenging them rationally, inevitably reducing the conflict.  In a group setting, the therapist takes a lead role in attempting to change the minds of the clients; the therapist can accomplish this without fostering a “warm” relationship with the clients.

Within groups, there is potential for judgments to be made of group members by other members of the group, which may prove of benefit or detriment to the therapeutic experience.  Rational Emotive Behavior Therapy holds that humans have the equal potential to be rational or irrational and both preserving and destructive.  Therapists must promote clients to confront their behaviors as well as accept their faults.   Additionally, Rational Emotive Behavior therapists claim that it is possible to assist clients with changing their behaviors as a means to restructuring their way of thinking.  In this light, the therapist must continue to encourage self-discipline as well as self-direction.

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The tried and true good cop, bad cop technique works, in part, because it addresses the spectrum of individuals discussed herein.  In this light, leaders, therapists and supervisors are oftentimes able to best serve more individuals when they understand the dynamics and exercise balance.

In this effort, it is necessary to understand how individuals perceive criticism, even constructive criticism.  It is also incumbent for you to understand how your personal attempts at either are perceived.  While an individual may confide in you that they enjoy or need constructive criticism, they may hold a different definition of such than you.

Understanding what triggers or prompts you as an individual towards progression is critical to your individual development but is also telling of how you may elect to treat others.  You cannot always rely on others to direct you, as in some instances they will fail.  Not necessarily because they don’t care, but perhaps because they don’t truly understand you.  Likewise, when you begin to understand how you prefer to receive information, you will also gain perspective regarding how you give it.

Reverting back to the opening scenario, emotional support and encouragement from leaders can be a benefit to the overall performance of those being led.  In this light, the employer hasn’t necessarily done anything wrong.  A clear understanding of goals and expectations, as well as continual evaluation of the progression towards those goals can complement such affirmation.

In many environments, such as in sports and within the workplace, leaders are under a certain amount of internal and external pressures often challenging their own reserve.  Therapists and counselors are typically at an advantage because they are trained and educated on empathy, and should be well-versed concerning dealing with their own pressures as well.

Helping professionals may choose to assist clients’ progress towards goals the clients set themselves.  Another lesson here is that individuals who are not internally motivated towards a goal may present a greater challenge than those who are.  Regardless of your role or environment, in most instances it’s best to ask the tough questions and find a nice way to tell it straight.

Atlas Concepts, LLC_Jordache WilliamsJordache Williams is currently based in Rock Hill, SC and is the Program Manager for Atlas Concepts, LLC. He is a Certified Life Coach and holds a Master’s Degree in Human Services.

Systemic Thinking versus Linear Thinking

Systemic thinking versus linear thinking

The distinguishing difference between systemic thinking and its linear counterpart is the basis on which each is derived, which is causality.  Linear causality takes a direct approach and is more scientifically driven with its emphasis on cause and effect.  This school of thought encourages the idea that one’s behavior results in an effect on either that individual or another closely related (i.e. nuclear family members).  Systemic thinking occurs at the opposite end of the therapeutic spectrum.  The primary concept for which systemic thinking is centered is that of circular causality.  Circular causality is in fact the antithesis of linear causality in that an individual’s behavior is not only the result of one relationship or event, but also the result of all emotional relationships with one’s system.  The basic cycle is that the functionality of the system has an affect on one individual, then that individual’s emotionality and behavior then has an affect on the system.  The systemic approach also takes into consideration the broad variety of possibilities for a client’s functionality—familial relationships, nodal events, social happenings, etc.  This is a predominant reason that, therapeutically, systemic thinking seems to be more beneficial as it is holistic, as opposed to the idea of simply treating one behavioral or psychological issue.  Also, by involving a client’s family of origin—whether present during therapy sessions or by dissecting a genogram—clinicians are able to aid the client in understanding the origin of the issue, how it has been perpetuated, and then properly guide the client through treatment allowing them to be objective in their system.  This results in a lesser likelihood of continuing or creating multi-generational patterns of behavioral or psychological issues.

So, how is the systemic approach applied to families? And how is it different from individual therapy?

When adhering to the avenue of systemic therapy, the clinician must tailor his therapeutic approach to an individual’s family, not simply the individual.  Commonly family systems therapists will have the client create a genogram depicting not only the individual’s family of origin, but also several generations of his or her familial lineage in order for them to begin to grasp the possible origin of their issue, as well as to signify any multi-generational behavioral patterns.  For example, after studying one’s genogram, it may become apparent that the client’s behavior could be attributed to the role one of their parents held in their own family of origin.  For instance, the client has developed an alcohol dependency to aid in coping with his mother’s deteriorating health.  The client’s mother was the oldest of five children in a family where both parents were alcoholics.  The inability of her parents to fulfill their parental roles left her as the primary caregiver.  She now has a husband who spends a great deal of time traveling for his employer, as well as four children of her own.  Again, being the primary caregiver in her home has inevitably resulted in her absorption of familial anxiety and has recently begun developing symptoms causing her health to rapidly decline.  This results in her child—who has a significant dependence on her—being unable to operate at a high level of differentiation, thus developing a substance abuse problem.  By the therapist uncovering this information, the client’s family of origin can now become involved in therapy to promote positive change in the entire family system.  Whereas, in individual therapy, the client may have solely been treated for the alcohol dependency, preventing the potential for an overall positive adjustment for the system, as well as increasing his risk for relapse as his level of differentiation has not been improved.

Atlas Concepts, LLC_Jordache WilliamsJordache Williams is currently based in Rock Hill, SC and is the Program Manager for Atlas Concepts, LLC. He is a Certified Life Coach and holds a Master’s Degree in Human Services.

Therapy Models That Work

Atlas Concepts LLC_Fields of Knowledge Blog_Therapy ModelsDespite a therapists’ ability to categorize issues, disorders and presenting problems, it is largely agreeable that all clients are unique. There are a plethora of reasons why a therapist may seek to gain familiarity with a specific therapeutic approach. Sometimes that reason is based simply on the therapists’ effort to best serve a local service population.

Herein are a few examples of how various therapeutic models may be used in particular instances. If you find yourself working with clients whose presenting problems are similar to the issues described in the examples, it may be beneficial to take some time to learn a little more about the model presented in that example.

Several approaches to therapy are very broad-based and may be used in a variety of contexts. It is possible for a therapist to become comfortable in such an approach, most likely because it works. Yet it is critical to understand that it is your responsibility as a helping professional to continually educate and professionally develop yourself.

The most basic benefit of researching other approaches is to build your knowledge-base.

However, through new understandings you are actually afforded opportunities to increase your level of experience. This process enables you to become a better therapist…efficiency via competence. While you don’t necessarily need to change your “style”, a new tool or technique may come in handy. Perhaps, take a look at some of the “classics” for inspiration…

A husband and wife are unable to agree on how to discipline their two small children. The wife grew up in a family where there was violence and child abuse. The husband’s father had a very demanding job and his mother was socially engaged.

Due to the distinct family of origin issues described, Bowen Family Therapy may be a viable approach to assist this family.

Using Bowen therapy, both parents should be assessed to discern if they have a healthy level of differentiation. Because they are having difficulty disciplining their children (a process in which the children are likely involved), they may run the risk of perpetuating the lineage of negative multigenerational transmissions. The conflict between the parents in regard to disciplining the children can result in triangulation as well as cutoffs.

In addition, because there are two children involved, therapy may include dealing with sibling position; in the event that this concept is budding while the children are “small” it would be prudent to address the issue in a timely manner.

Having the parents construct a genogram of their respective family of origin may prove helpful in a reasonably short amount of time. Through assisting these clients in dealing with unresolved issues, I believe that they would also find the disciplining of their children more agreeable and, in effect, they would be empowered to control their family’s multigenerational patterns.

An 8-year old girl has been wetting her bed for the last four weeks. Her parents began to argue frequently several months ago concerning the family budget. They are both frustrated by the bed wetting and desire an immediate solution.

Behavioral Family Therapy has its origin in parent’s modification of children’s actions. Not only does it appear at a glance that the parent’s discourse is responsible for the child’s bed wetting, but it seems that they have a problem with it as well. The parents need to know that they harness the ability to foster an environment for change, and, through training and empowering the parents, the therapist can allow the parents to take credit for working together to resolve the bed wetting issue.

By simply defining the problem behavior and then explaining the behavioral patterns to the parents, both the therapist and parents can monitor that behavior and as well monitor the child’s bed wetting habit as a means of marking progress.

It is foremost irrational that the parents believe that their child’s behavior can stop immediately; however, when concentrating on the dyadic parent relationship they will find that the family in its entirety will benefit.

A 12-year-old boy began displaying temper tantrums around the time his divorced mother announced she was going to remarry. She and her new husband are having a difficult time dealing with the situation.

One may lean upon the experiences of Minuchin (Structural Therapy) to assist the family in this scenario. By observing the patterns in this family, the therapist would hope to gain knowledge of the family’s structure. As well, it may be important to determine what may be different about the family structure once the mother remarried.

It is apparent that the divorce and second marriage were stressful times for the child. The child’s outcry could be in part due to the demolition of a coalition with his father. Though the family underwent a marital (or legal) restructuring, it may be necessary to restructure the “living” system in an effort to make the family stronger.

It may be plausible to address any incumbent boundaries caused by the marital shift. Due to the new “executive” system that is in place, it is necessary to evaluate the cohesion of that system and examine any residual effects. Additionally, this parental union may have to be alerted of the signs of triangulation as well as the methods for its avoidance.

The structural approach involves the technique of reframing, which can also be useful in assisting the child with coping with his “fits”. In short, there is a basic need for this family to redefine its boundaries to deal with the relevant stage of development. If appropriately applied, the Structural Approach may prove to be of assistance to this family.

A 34-year old female physician began getting anxious in elevators about 7 months ago. She became progressively more anxious in a variety of situations. Now she cannot cross bridges or go out to crowded places.

Cognitive-Behavioral Therapy, having roots in the social learning theory, would be a solid approach to this scenario. Cognitive restructuring may be a beneficial technique to accomplish modifying the client’s behaviors.

It is plausible that the client is dealing with issues regarding her beliefs and reasoning in a fashion that has affected her behavior. Through desensitization the client may be able to overcome the unnecessary anxiety that is associated with the situations described in the vignette.

By enhancing the client’s problem-solving and behavior-change skills she may be empowered to overcome her anxiety through a self-renown confidence. Additionally, a specific technique such as shaping could be employed, as it appears that the client has reached an extreme level of anxiety. It may require the client to take gradual steps towards such goals as crossing bridges and going into crowded places before she can achieve these feats.

A 43-year old male, recently unhappy with his career, sees himself as a failure and has begun to isolate himself because of a lack of confidence.

In dealing with this man’s career issue, one may employ the Strategic approach. In the vignette there is a clear problem that needs to be resolved or removed. It is beneficial to begin by defining the problem and then moving towards evaluating what the client has done to fix the issue.

By defining the necessary change and implementing a strategy for achieving that change, the client could be propelled to a more virtuous cycle. Additionally, the client could benefit from the reframing techniques practiced in Strategic Therapy.

By emphasizing positives and assisting the client through encouragement and direction, he may also begin to see his career in a different light. It seems the issue is rooted in his malcontent with his employment. In this instance I believe the lack of confidence may be a residual effect of his job situation. However, through combating his isolation through actions, he may be able to perpetuate his own confidence and gain a new awareness of his ability to acquire a job that may be more conducive to his happiness.

Another way the Strategic Approach may prove helpful is by utilizing the ordeals technique; in this instance the client may discard his isolated ways as he realizes that this behavior is not constructive.

A 24-year old male who is high functioning with no obvious diagnosis is confused about his goals in life.

Due to the over-functioning nature of the male depicted in the vignette, I believe that Experiential Therapy may be of most benefit, especially considering that there is no “obvious diagnosis”.

The Experiential approach is helpful because it relies on the personality of the therapist more so than that of the client. In this case, there is not much known about the client thus, the Experiential approach allows for the therapist to guide the therapeutic environment in an effort to learn more about the client. One manner in which the therapist can begin to assess the client is by evaluating the client’s level of individuality. An Experiential therapist can achieve this by fostering a warm climate in which the client feels respected and accepted.

As well, it is important for the client and therapist to work towards determining the nature of the client’s confusion (i.e. what about his life goals is confusing). The therapist has the ability to help the client see his confusion as meaningful. The client should be led to understand that it is productive to have goals and that his confusion pertaining them may only be a result of his personal growth.

By utilizing alternatives to reality, the therapist can allow the client to assess whether or not his goals are feasible, thus eliminating goals that are too vague or nested in improper judgments. The more excitement the therapist shows for the client’s progress, the greater stimulation the client is likely to experience, in turn providing the client opportunity for personal existential encounters.

While I may not be able to teach you more than you already know about these approaches, my effort is simply to remind you of the validity and importance thereof. If graduate school is the last time you encountered one of these models, consider this written for you.

Atlas Concepts, LLC_Jordache WilliamsJordache Williams is currently based in Rock Hill, SC and is the Program Manager for Atlas Concepts, LLC. He is a Certified Life Coach and holds a Master’s Degree in Human Services.

The Genogram

Atlas Concepts LLC_Fields of Knowledge_Genogram

If you are anything like me, you have spent a great deal of time in your life trying to figure out “why you are the way you are.” From your athletic ability to your thought processes, from your aptitude to your allergies. Many of us claim to remember where we came from, but fewer of us actually take the time to study the intricacies of the root and subsequent growth of the branch.

While events of significance such as being the victim of a crime, achieving a major accomplishment or the death of a loved one do shape who we are, it is often the small, monotonous and mundane which are not given much thought. While there are a myriad of avenues to approach the looking glass, in November of 2011 I took a look at my family history in search of answers, specifically outlining my family dynamics with the assistance of a genogram. To have an objective, I purposed this effort with discovering how my family of origin may impact my ability to assist clients in a clinical therapeutic setting.

I found that my family of origin provides me with both advantages and disadvantages in regard to my ability to provide therapeutic assistance to others. The complexities concerning my mother and father, both as a married couple and individually, provide such examples.

My mother has had a long history of mental illness and instability as well as multiple bouts with drug, alcohol and a variety of health issues. One may have a valid case depicting her as the quintessential candidate for therapeutic assistance. Though throughout my childhood I did not necessarily equate my disturbed relationship with her with the multitude of personal issues she had; however, it is relatively easy in hindsight to see how her issues played a role in the problems within our nuclear family.

My mother and father divorced when I was two years old and I did not have a relationship with my father from that point. My mother raised me until I was eight years old, at which time I became a tenant of a children’s home until the age of eighteen. Utilizing my own experiences with divorce and separation, I feel that I may be able to display certain empathy towards clients dealing with the same. Likewise, clients who have experienced an upbringing without a “standard” nuclear family may find it comfortable to discuss these matters with a person with a similar history. In this instance, having the experience of divorce and separation will give me the advantage of asking relevant questions, and implementing an array of techniques, concerning such.

Adversely, when working with clients of a “standard” nuclear family, I will likely rely on client input and professional research while having little life experience to guide me through the therapeutic process.

Also applicable to my family of origin is the concept of differentiation. When examining my role within my family system, it becomes clear that there was limited enmeshment, resulting in my centrifugal force propelling me towards differentiation. It is my aspiration to utilize my own processes for attaining differentiation to assist others who are dealing with fusion to gain flexible and adaptive traits as a means of conquering their dominant auto-emotional system.

I am the youngest of the three children born to my mother–one half-sister and one half-brother; as well I share my father with two half-brothers. No two of us grew up in the same household; however, starting in my young adulthood I was fortunate to begin establishing solid relationships with both of my maternal siblings; to date no significant relationships have been developed between myself and my paternal siblings.

Although I never experienced “sibling rivalry” with them, my relationships with them have exposed me to the concept of sibling position and how apparent it is that many of our personality traits can be attributed to our respective position. By growing up separately and then forging our sibling relationships as adults, I have the advantage of viewing my family more objectively; and this quality will prove to be quite beneficial as a clinician when attempting to have clients separate themselves from the emotionality surrounding any familial issues for which they are seeking treatment.

The hierarchical roles regarding the structure of my family provide another avenue for which I will have the ability to identify with families who need reframing. As a child, my sister was adopted and raised by my maternal grandparents, so in many ways she has fulfilled her role in the hierarchy not only as a sister, but also an aunt, and at times a parent.

Considering the nature of my relationships with the individuals in my family of origin, I did not necessarily notice any previously undiscovered factors based on the completion of the genogram. However, one notable aspect of Psychodynamic Therapy of which I had not previously considered is that of invisible loyalties as pertains to my relationship with my mother. I believe it would take some outside assistance to discern if this concept applies, but in my own assertion, it may explain why I have been able to reestablish my relationship with her after such an absence.

I understand that I felt resentment for her as a youth as a result of our separation; however, as an adult I have become more understanding, and in turn our relationship closed significant distance. Taking the time to use the genogram on myself has provoked me to redefine my family of origin in order to truly encompass my “family.” To accomplish this, I need to further this undertaking by way of including the relationships that occurred outside of my biological family of origin.

Based on my evaluations, I will move forward to construct a new “genogram” that includes other relationships that I believe to have been “like” family. In this plight, I hope to attain a greater understanding of whom my family really consists.

In summation, the structure of my family, my relationships with each member of the system, and how I grew up, are the primary reasons I possess such a significant interest in Marriage and Family Therapy. I acknowledge that it will be my responsibility to conduct as much research as possible regarding treatment for the entire spectrum of “family types.” However, I already hold the position that every patient will be different, and no two families will ever be identical.

My family and life experiences will allow me to identify with non-traditional families in a unique manner of which I hope to be both sensitive and therapeutic. Also, by exposing descriptions of my family life with clients, they will be comforted by understanding my competency in treating them, it will also allow for a greater level of professional trust, which will significantly progress treatment.

Finally, as I continue my efforts to become credentialed to provide Marriage and Family Therapy, I believe that taking the time to explore and become familiarized with the tools available to the profession is critical to establishing who I will be as a professional. During my graduate education, Family Systems was one area that I enjoyed studying, thus the efforts such as the one mentioned above, I believe will help me transition my interests into practice, even before I am able to sit face-to-face with a client.

I have utilized a similar approach to familiarizing myself with items such as the Myers-Briggs Type Indicator and the Taylor-Johnson Temperament Analysis.

Continue to follow this blog to learn about my experiences with these personality assessments and other therapeutic tools.

Atlas Concepts, LLC_Jordache WilliamsJordache Williams is currently based in Rock Hill, SC and is the Program Manager for Atlas Concepts, LLC. He is a Certified Life Coach and holds a Master’s Degree in Human Services.

Case Notes: Task or Tool?

Fields of Knowledge_Case Notes

If you have been providing therapy to clients with any longevity you have at some point questioned whether your approach to a given case was the culprit responsible for therapeutic stagnation. You may have chosen to switch your approach, integrate tenants of other models or refer the client(s) elsewhere.

You’re not alone in your desire to be the one who gets to witness a client’s transformation. However, most therapists understand that there is inevitably a time where they are not adequately equipped to handle a specific case. Unless there is an ethical dilemma with a particular client, therapists should (using good judgment) accept the clients that arrive for help.

I believe this because the person seeking help is present and in action. Any time a client leaves there is no guarantee that they will be back. Likewise, once a client is turned-away there is no guarantee they will contribute a similar effort again.

With this said, it is incumbent upon therapists to be equipped to supply the demand. At the least, the consultation process should include active listening, empathy and the sharing of hope and optimism. Whether the next step is session number two or a referral, therapists should feel that they have done everything possible to leave the client with a realistic impression of the therapeutic process.

Sometimes it’s further along than the initial consultation when therapists come to the realization that they are in over their head. Before throwing in the towel, therapists may seek guidance and advice from colleagues, mentors and other helping professionals.

Therapists can often learn a great deal from understanding how their colleagues’ approaches differ from their own. Even when colleagues share that their approach would have been the same, they may still be able to provide suggestions for your consideration.

I suggest that this dialogue, which is essentially a version of professional development, involve evaluating the effectiveness of your approach to tell the client’s story. In essence, this is a method for understanding how your therapeutic approach depicts your client(s). If your approach does not tell the client’s story, perhaps you can make a special effort to address the gaps in future sessions.

With the permission of your client(s), have a colleague review a version of your case notes, which outlines what approach and tools you have used and the effects that you hoped to, have gained. Have your colleague explain (back brief) the family’s situation as they see it as described by your notes, almost as if they were introducing you to the client(s) or transferring the case to you.

The picture they paint of the family may give you insights on the validity of the therapeutic model and techniques you have employed. Here are two examples using differing therapeutic approaches addressing a single vignette. Do the respective approaches to therapy tell the same story about the family? As we all know, there is rarely a single approach that can be considered “best”. However, you are always making the right decision when you approach a given case ethically, efficiently and effectively.

So while the model of therapy you have chosen to work with may not be wrong, you may be employing it ineffectively and thus having little effect assisting the client with positive change. These types of reviews assist clinicians with evaluating the effectiveness of their approach, and can be accomplished with a colleague or alone.

Example Case Notes – A

By implementing a structural approach, I understood that the relationship hierarchy needed to adjust significantly before the family’s optimal functionality could be attained. As a combined result of Jack devoting so much of his time at work, and Jill being the parent who has been more consistently present, of course Johnny would develop a more closely emotional relationship with his mother. However, this relationship is magnified because Jill has spousified Johnny in order for her to fill the emotional vacancy caused by Jack’s frequent absence, so obviously a large portion of Johnny’s anxiety results from his mother’s “need” for him to be present for her own functionality in the family. Also, a possibility for John’s extended absence could be the result of the fact that, with all of the children now away at school, he is experiencing his own anxiety as this will be the first time in twenty four years that he and Jill have been the sole members of the household.

The primary objective has been to eliminate Johnny’s panic attacks regarding his beginning college by minimizing his anxiety about being separated from the home. With the ideal situation being that the foundation is established for all relationships in this system to progress toward a healthy functionality. To accomplish this, a restructuring of the family is necessary. The relationship between Jack and Jill must become more developed. Jill must allow Jack to fill his spousal role—the role that she has encouraged Johnny to occupy. This will be done by basically reacquainting Jack and Jill, as well as reestablishing what their needs and goals are in their marital relationship, not simply their roles as parents. Boundaries should then be determined in order to stabilize each newly restructured role. An aspect of this technique that would be beneficial to use regarding Johnny’s anxiety would be to strengthen his relationships with his siblings. Since both Sue and Carl have years of experience away from home and in a college environment, their guidance would be tremendously helpful for Johnny’s elimination of his separation anxiety.

Example Case Notes – B

I have chosen to utilize Psychodynamic/Family of Origin therapy with this particular family. In the most basic triangle of this family, Johnny and Jill are the closest relationship with Jack as the outsider. By having knowledge of Jill’s position in her family of origin, it is understood that her own emotional over-involvement with Johnny has resulted from her attachment to her own mother, whom she could never obtain an ideal relationship with as she was consistently vying for her mother’s attention against her step-father and other siblings, so she is now severely attached to Johnny—the most constant figure in the home. Jack’s position in his family of origin placed him as a likely caregiver and source of support for his younger siblings, so he most likely feels a strong sense of responsibility to provide adequately for his nuclear family. Thus, he allows himself to spend an increasing amount of time involved with work.

The overall goal would be to establish positive functionality for this system by developing each member’s differentiation of self, and adjusting the emotional triangles. The initial technique to implement would be to sketch a comprehensive genogram in order for each member to understand the origins of the system’s emotionality. This would allow Johnny, Sue, and Carl to objectively view Jill and Jack’s familial positions and relationships with their respective families of origin, and provide them with a new understanding behind their current system’s functionality. Jack, Jill, and Johnny will all need treatment to improve their levels of differentiation in order to prevent their emotional dependencies from creating a multigenerational pattern. I plan to have Jack, Jill, and Johnny voice what their wishes are for their relationships and then be confronted with aspects of their situation which they may be oblivious. I believe that this will be an effective technique for this family as it seems apparent that they may not currently acknowledge to themselves what their needs are in each of the relationships.

—–

You can see how, despite the use of varying approaches to working with this family, that items such as the family dynamics are synonymous in each. Adversely, the priorities, techniques and goals differ and in such light, differing details regarding the family are presented in each set of notes. These types of notes give enough detail to your colleague to enable them to relay back to you “how they see the clients,” and may spur a discussion involving “what I would try is….”

At any course, your colleague is immediately able to pick up on your therapeutic hypothesis and the techniques you have, or plan to employ, as well as the family dynamics, presenting problems, and direction of therapy.

It is through the dialogue that follows where you may learn from the assumptions about the family that your colleague makes based on your notes. Likewise, you may find that their concerns for the client(s) may not align with your own. Perhaps your colleague has questions for you regarding the client(s) of which you don’t have answers.

You may also be enlightened to the fact that your colleague or mentor would prioritize the goals of therapy different than you and the client(s) have. In addition to being used as a tool to garner support from other professionals, these types of notes are a great way to provide yourself with a summation of your and your client’s work.

Atlas Concepts, LLC_Jordache WilliamsJordache Williams is currently based in Rock Hill, SC and is the Program Manager for Atlas Concepts, LLC. He is a Certified Life Coach and holds a Master’s Degree in Human Services.

Locating an Internship Site

Fields of Knowledge_Locating an Internship Site

For graduate students who are required to display competency through a clinical experience, you will inevitably undergo an integration process at a site which will facilitate this chapter of your educational journey. If your academic institution has partnered or is contracted with a site (or multiple sites) guaranteed to facilitate your clinical experience, then consider yourself fortunate.

For many graduate students it is not that simple. In some cases, those institutions which do provide sites for students actually require that the student work with the site(s) provisioned. Not one scenario is necessarily better than the other, as all offer advantages as well as disadvantages.

So, if you are a student who has been provided a list of potential sites, been left to figure things out on your own, or are seeking a secondary site to supplement the experience of a site predestined by your school, here are a few thoughts from my experiences.

Review potential sites. If your advisor or other faculty present you with a list of potential sites, it’s probably a great place to start. At some point in time you’ll probably try an internet search engine or attempt to “show up” at a place you’ve heard about.

In this age, technology tends to seemingly ease the burden of learning about potential places to intern; however, the information provided by a computer or smart device is not always inclusive. So after you have tried 50-60 keywords in Google, a few hundred pages of opportunities on websites such as Monster.com, signed up for newsletters, participated in forums, reached out to groups on social media such as LinkedIn and prayed to the internet god for mercy…understand that you will at some point have to remove yourself physically from the comfort of your favorite chair and the soulful sounds of Kenny G.

My academic institution estimates that it takes 66% of its students 3-4 months to locate a suitable site and a willing supervisor, with the remainder having to search for over 6 months. With this said, understand that the effort may take time, so plan to be thorough and deliberate in your search.

Keep a sharp lookout for supervisor candidates. A great choice for a supervisor is a supervisor candidate. These individuals include those who are pursuing the Approved Supervisor designation with an organization such as the AAMFT. They are licensed professionals who are seeking opportunities to train, educate and, in essence, supervise individuals working towards a graduate degree or licensure.

The AAMFT provides a list of Approved Supervisors on its website; however, it is not as easy to locate candidates working towards fulfilling the requirements necessary for approval. Oftentimes by contacting Approved Supervisors you can accomplish a great deal.

You can inquire about opportunities to work with that individual in particular (who is “on paper” the quintessential supervisor), ask about opportunities they are aware of in surrounding communities and also ask them specifically if they are working with any supervisor candidates or are aware of any such candidates who may be of assistance.

Organize your effort. Make a list of potential sites, keep track of the “who, how and when” concerning your contact with each potential site. Keep records of individuals you have networked with including their contact information, how they may be able to assist you, where they work and/or volunteer and any leads they may have referred you to.

Additionally, look for ways to ensure that you stay relevant to individuals in key positions. This may be done by attending programs in which the individual is involved, joining them in volunteer experiences or stopping by to ask if there is anything you can do for them.

Prepare yourself. Yes, you are a student and you are locating a site to assist you with an educational experience, but I can almost guarantee that during the course of your search for a site and supervisor you will be asked questions pertaining to your personal interests and objectives, the models and theories which you plan to utilize with clients, any professional association affiliation and your level of participation with each, as well as inquisition pertaining to your level of experience. Yes, the last one got me too.

The first time I was faced with explaining my experience, I thought…“I’m a student, what experience do you think I have?” Preparing for such questions is critical to your ability to garner the support you need, and at the least can leave a good impression. You can always mention the experiences you have had during your academic coursework with classmates in mock sessions. Additionally, having experience in a counseling setting (even administratively), having personally attended counseling or having held a position (at a job, within an organization, etc.) which included coaching, teaching or mentoring are all great ways to build your credentials.

Liability insurance. From the moment an individual is identified as your supervisor, and throughout the course of that relationship, that individual is ethically and legally responsible for you. Though it is likely required by your academic institution, plan to, at a minimum, obtain liability insurance and keep it current throughout your internship.

One way to accomplish this is to join an association such as the American Association of Marriage and Family Therapy (AAMFT). The AAMFT offers malpractice insurance as a part of the benefits of student membership. Already being insured during the pursuit of your site and supervisor speaks to your level of commitment and proficiency, as well as your knowledge of the field.

Bring something to the table. Understand what you offer in addition to being able to articulate what you need. The sites you visit may not have opportunities posted for an internship or currently have a program specifically for interns. If this is the case, attempt to locate job postings at the organization to understand the type of information (e.g. curriculum vitae versus resume, background checks, etc.) that is required of potential employees. Think about it like this…if you qualify for a job (say minus the graduate degree) then you are in pretty good shape to be a candidate for an internship. Nearly any and everything you would do for a job…do for an internship. That includes over- versus under-dressing, updating your resume, brushing up on your interview skills and mustering up that necessary confidence needed to talk about yourself.

In the pursuit of an internship, oftentimes it’s those who can give that get. As I stated earlier, some potential sites may not have a program in place for interns, and may even find that entertaining such would be more burdensome than beneficial. Through careful consideration of the site, you may be able to present yourself as an individual who can provide a relevant impact to the site. This impact may be through providing support for programs that the site currently sponsors.

You can present ideas for programs that you could organize and maintain, or volunteer to help out administratively. You may even offer to dedicate yourself to establishing an internship program at the site, by charting your experience and through research and evaluation of other programs. You first have to understand your own potential, personal/professional interests, desires and qualifications.

Next, find ways you can be of benefit to the potential site and/or supervisor and articulate these ideas concisely. You must understand that when you approach a clinical internship your presence is not associated with benefits such as free or cheap labor. You are a legal and ethical liability, an administrative burden and ultimately take time away from an individual who is likely otherwise paid for it. Yet and still, they have been in your shoes, so stick your chest out, hold your chin up, shake with a firm grip and present your essence.

Staying afloat. Lastly, have a plan that includes a sustainable income during both your pursuit of a site and your tenure at the site. The reality is that paid internships are not always available, couple that with the fact that your academic clinical experience likely lasts for a year (or more) and the understanding that locating a site may take a significant amount of time as well.

If you are already living on a strict budget, then the worst-case scenario includes having to pay for supervision. In some areas, this may be your only option. In any case, you must evaluate your living situation, means of income and your costs of living and plan ahead. The commitment you are about to embark on will likely change a great deal of your daily routine, absorb a significant amount of your energy and time. Prepare yourself, employers and loved ones and ensure you rally the necessary support from each.

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As mentioned earlier, each journey towards graduation in a helping profession is unique to the individual student, however each academic institution approaches facilitating education and evaluating competency in a specific manner. In this light, my particular experience with locating an internship site has been highly influenced by two facts: I attend an online academic institution which is located approximately 400 miles away and I am a relatively new resident of the area which I am seeking support. Notice that I refer to these two circumstances as “facts,” not disadvantages or excuses.

It is my personal belief that I learn through each of my experiences every day. The experiences I have had during my efforts to locate a site are no different. I have been granted an opportunity to question the very core of my pursuit, asking questions such as, “Why did I choose to pursue a career as a therapist?” and “Is this still really what I want to do?” These questions are warranted, as I actually began pursuit of my M.A. in MFT in the spring of 2007.

So here I am 7 years later, now with a wife, now with a daughter, now out of the Army, now a business owner, now a certified Life Coach, now having been awarded a Human Services graduate degree, still working towards the same goal. Perhaps I made compromises that have elongated this process; there is hardly a time when a person “could have done no more.” Yet and still, the desire exists and a certain priority remains incumbent to the same. In closing, I would like to encourage you to continue your effort at a steadfast and deliberate pace, while continuing to grow through the experience and achieve in other endeavors as well. No matter your course, be holistically prepared for the journey and understand that not all “helping professionals” are interested nor capable of helping you! Moreoverly, none can help you more than you can help yourself!!!

Atlas Concepts, LLC_Jordache WilliamsJordache Williams is currently based in Rock Hill, SC and is the Program Manager for Atlas Concepts, LLC. He is a Certified Life Coach and holds a Master’s Degree in Human Services.

Understanding the Clinical Training Required for your MFT Degree

That moment you realize that finding an internship site is much more of a daunting process than you imagined…

You feel like you have exhausted all options and the demands of life haven’t slowed down a bit. If you’re like me, you’ve amassed a great deal of lemonade from what seems to be an orchard of lemons. Now, if an opportunity actually does present itself, you’re worried that you’re too involved in other endeavors to attend to the demands of an internship with the necessary zeal. You are continuing to accomplish so many things, but the void left by what you ultimately equate to failure is notwithstanding.

As I continue in my effort to locate a site to complete the clinical requirements of the Marriage and Family Therapy (MFT) graduate program I attend, I can’t help but to question my own efforts as I reflect on the experience. It is my hope that in some way the information I present hereafter will prove useful to those wishing to pursue a graduate degree requiring a concomitant residency, others similarly situated and additionally serve as a calling to those positioned to supply the necessities of this demand.

Similar to most careers, becoming a helping professional is possible through a variety of avenues. Despite the source of your motivation, the resources and support you have accumulated and the advantages of your genetics, you can be assured that the licensure process will create challenges that, despite any preparation, will test your fortitude.

The licensure process is the stretch of the pursuit that canalizes candidates to evaluate competency.

In many cases, the consideration of a graduate program is one of the first steps towards garnering the competency necessary to embark on your journey. While you carefully consider your options you may be taking into consideration the programs offered, the institutions proximity to your home or place of employment, tuition and associated costs and even the school’s reputation.

This thought process is normal, and is closely related to the process you went through during undergrad; however, consideration of a graduate program (especially a counseling related program with a clinical training requirement) requires specialized thought.

So, while you’re mapping out the coffee shops on campus, make sure that you take a moment to get your hands on some extremely relevant information.

Clearly understand the following:

The accreditation(s) held by the academic institution. Regional accreditation by one of the regional accrediting agencies recognized by the U.S. Department of Education and the Council for Higher Education Accreditation, ensures that specific standards are upheld at the institution, and that credits earned are more likely to be transferrable to another institution. Furthermore, the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) is a specialized accrediting body within the American Association for Marriage and Family Therapy (AAMFT) which accredits MFT programs at academic institutions. The COAMFTE is purposed with evaluating the level of competence of the graduates of institutions which volunteer for accreditation.

The requirements for internship sites and supervisors as set forth by your institution. You may find that aligning these requirements for a particular site is more difficult than you imagined. You may have to compromise concerning one or the other, or both. For instance, you would ultimately prefer to work with an approved AAMFT Supervisor but may find that there are few, if any, located within a reasonable distance.

Often when you do locate such an individual you find that they cannot take on any more interns or limit their expertise to interns who already possess the requisite degree. Though as a graduate student you are obviously striving for excellence, understanding your academic organizations minimal requirements for both the site and the supervisor is key to complete and careful consideration of potential sites.

If the academic institution has partnered with local organizations to provide clinical sites for its graduate students, you should spend some time learning about those sites and what is offered and expected. Understand that many academic institutions cannot guarantee placement at an internship site even in cases where partnered organizations exist. Also note that it is not farfetched to intern at a qualified site under the supervision of a qualified professional who is not affiliated with the site you are located.

The expectations concerning competency and the academic requirements of the clinical experience. The academic institution likely requires both clinical experience hours and supervision hours for completion of your clinical training. Understand that the site you choose should be able to provide the hours you need for your degree within the confines of your academic semester. During this planning process you must consider the likelihood of the unforeseen such as no-shows, changes in personnel at your site and the stability of specific programs at your site which may affect your ability to accomplish your academic requirements. You may find that, in order to meet your goals and the academic requirements, you may require support from multiple internship sites concurrently.

Your state’s licensure board requirements. In many cases state licensure requirements are similar; however, it is critical that you understand the requirements in the state(s) which you plan to practice. Consider the application process and transferability of licensure in reference to neighboring states and states you may plan to reside in the future.

Don’t save a review of these requirements for a later date, thinking that they only concern those who already possess a degree and are seeking licensure. The reality is that states often have educational requirements that specifically pertain to your graduate work. Through careful consideration, it is possible to align yourself with an organization and/or supervisor which can support you, not only through your graduate experience, but also throughout the post-graduate licensure process as well.

While this information is structured for those seeking a MFT graduate program, the processes and structures are similar to those associated with other helping professions as well. If you have read this and are wondering why such a review and careful consideration is necessary by the student, it may prove helpful to understand that my MFT academic experience has been online.

Thus, in my case, the pursuit of a site and supervisor includes a great deal of footwork, phone calls, emails and, ultimately, networking. I chose to attend an online program during active duty with the military, and this approach was the best (and realistically only) method for continuing my education at the graduate level concurrently with my military obligations. I do not regret taking the time to pursue a higher education while serving in the military.

I will admit that there were challenges during the pursuit; none greater than having left service with only the clinical portion of my degree remaining. Despite the rise in popularity of online courses, certifications and degree programs and the growing acceptance of these forms of education, clinical degrees present specific, unique challenges regardless of the institutions mode of education.

Continue to follow this blog to learn more about finding an internship site, approaching potential supervisors, the advantages provided through innovative technology and the unforeseen challenges of completing the clinical training requirements of your online MFT graduate degree.

 

Atlas Concepts, LLC_Jordache Williams Jordache Williams is currently based in Rock Hill, SC and is the Program Manager for Atlas Concepts, LLC. He is a Certified Life Coach and holds a Master’s Degree in Human Services.