Ethics Final Exam

95%

• 51.1%
• a little less than a third

At least 13.8 million

• 78% have tried alcohol
• 53% tried illegal drugs
• 57% tried cigarettes
• 27% are current smokers

25%

• 443,000 die of tobacco products
• 365,000 die of improper diet and exercise
• 75,000 die of alcohol abuse
• 75,000 die of microbial agents
• 55,000 die of toxic agents
• 32,000 die of adverse reactions to prescription drugs
• 26,000 die of automobile accidents
• 29,000 die of firearms
• 29,300 die of homicide
• 20,000 die of sexual behavior
• 17,000 die of illegal drugs

• D1- Acute intoxication and/or withdrawal potential
• D2-  Biomedical conditions and complications
• D3- Emotional, Behavioral, or cognitive conditions and complications
• D4- Readiness to Change 
• D5- Relapse, continued use or continued problem potential
• D6- Recovery/Living Environment

• Level 0.5 Early intervention.
• --Early intervention is an organized service in a wide variety of settings.  Early intervention explores and addresses problems or risk factors related to substance use and assists clients in recognizing the harmful consequences of inappropriate substance use.  Clients who need early intervention do not meet the diagnostic criteria of either chemical abuse or chemical dependency, but they have a significant problems with substances.  The res of the treatment levels include clients who meet the criteria for psychoactive substance abuse or dependency.

• Level 1: Outpatient treatment
• Outpatient treatment takes place in a nonresidential facility or in an office run by addiction professionals.  Clients come in for individual or group therapy sessions, usually fewer than 9 hours per week.

• Level II: Intensive outpatient/partial Hospitalization
• Level II.1: Intensive outpatient treatment.  This is a structured day or evening program of 9 or more hours of programming per week.  The program has the capacity to refer clients for their medical, psychological, or pharmacological needs.
• Level II.5:  Partial Hospitalization.  Generally includes 29 or more hours of intense programming per week.  This program has ready access to psychiatric, medical, and laboratory services.

• Level III: Residential/inpatient services
• Level III.1:  Clinically managed, low-intensity residential services.  This is a halfway house.
• Level III.3:  Clinically managed, medium-intensity residential services.  This is a therapeutic community designed to maintain recovery. 
• Level III.5:  Clinically managed, high-intensity residential services. This is a therapeutic community designed to maintain recovery.
• Level III.7:  Medically monitored intensive inpatient treatment.  This residential facility provides a 24-hour structured treatment.  This program is monitored by a physician and is able to manage the psychiatric, physical, and pharmacological needs of its clients.

• Level IV:  Medically managed intensive inpatient treatment.  
• This 24-hour program has the resources of a hospital.  Physicians provide daily medical management.

MI is a goal-oriented, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. Compared with non-directive counseling, it's more focused and goal-directed. It departs from traditional Rogerian client-centered therapy through this use of direction, in which therapists attempt to influence clients to consider making changes, rather than non-directively explore themselves. The examination and resolution of ambivalence is a central purpose, and the counselor is intentionally directive in pursuing this goal.

• Client-centered interviewing that incorporates the following:
• Offer empathetic, objective feedback of data.
• Work with ambivalence.
• Meet the client’s expectations.
• Assess the client’s readiness for change.
• Assess barriers and strengths significant to recovery efforts.
• Reinterpret the client’s experiences in light of the current problem.
• Negotiate a follow-up plan.
• Provide hope.

• Precontemplation
• Contemplation
• Preparation
• Action
• Maintenance

• Description of the client
• Dress
• Sensorium
• Orientation
• Attitude toward the examiner
• Motor behabior
• Speech
• Affect
• Range of affect
• Mood
• Thought processes
• Abstractthinking
• Suicidal ideation
• Homicidal ideation
• Disorders of perception
• Delusions
• Obsessions
• Compulsions
• Intelligence
• Concentration
• Memory: Immediate memory, Recent memory, remote memory
• Impulse control
• Judgment
• Insight
• Motivation for treatment

• Problem 1:   *****
•    as evidenced by ****

• Goal A:  *****
•    1. Objective 1:   *****
•      Intervention:   ****
•      Responsible professional:  ****
•    2. Objective 2:  ****
•      Intervention:  ****
•      Responsible professional:  *****

Goal B:   (same)

• Include: 
•    The treatment plan
•    All treatment
•    The client's clinical course
•    Each change in the client's condition
•    Descriptions of the client's response to treatment
•    The outcome of all treatment 
•    The response of significant others to important events during treatment

• -Keep your progress notes short and write with a black pen only.
• -Must include just enough detail to describe what is going on with the client.
• -Description of client behavior to back up personal opinion or interpretation.  Use direct quotations.
• -Record client's progress in meeting goals and objectives on regular basis
• -Make notes understandable and a obvious for other counselors to see how the client is doing in treatment.

Changing clients movement (habits) to help them function better.  Practicing new behaviors until this becomes automatic.

• Using reinforcement or punishment
• Reinforcement: 
• 1.  It give the clients something positive 
• 2.  It allows the clients to escape from something negative
• Punishment:  
• 1. It introduces something negative  
• 2. It removes something positive

Cognitive Therapy corrects the thoughts and gets the clients accurate .  Cognitive therapy is a fearless search for truth.  Watching for minimization (distorts reality and makes it smaller than it actually is), Rationalization (making excuses or blaming), and Denial.  Challenge clients inaccurate thoughts (especially about drugs and self-images.)

• Correct inaccurate thoughts
• -Uncover thoughts and feelings
• -Score the inaccurate feelings
• -Getting the thoughts accurate

• Uncovering the Generalizations
• -get client to recognize from past why they feel their negative thoughts. (get clients thinking accurate)

• Solidifying Accurate Thinking
• -Clients carry note cards with accurate thoughts
• -Keeping a feeling log

Heals relationships and restores an atmosphere of love and trust. In recovery, clients are encouraged to love God, love others, and to love themselves. If one of these relationships isn’t healed, then the client will continue to feel uncomfortable and will be vulnerable to relapse  

• Interpersonal interventions: 
• -spirituality-innermost relationship with ourselves and all else. 
• -Building relationship with a higher power- be willing to accept some sort of a Higher Power is possible. 
• -Develop relationship with self-begins when clients treat themselves well.
• -They stop hurting themselves by stop using drugs and alcohol, stop staying bad things about themselves.
• -They eat 3 meals a day, sleep properly, and exercise.
• -They gain self worth.

Tools of recovery, learning what to do and when to do it

Trigger↪thinking↪feelings↪behavior↪consequences

It is the relationship between therapist/counselor and client.  Built on love, trust, and commitment.  Client knows that you are on their side, you are friendly, you are not going to blame, shame, or beat them up.

You show the client that they don't need to feel alone

SASSI: (Substance Abuse Subtle Screening Inventory) screen clients when defensive and in denial; measures defensiveness and the subtle attributes of chemical dependent person

Mast: (Michigan Alcoholism Screening Test) detect alcoholism

ASI: (Addiction Severity Index) structured interviews for adults and teens to get important information about the severity of the client’s substance abuse problem

• Intervention: provide truth- one or more people attempt someone to seek treatment/ professional help ·       
• "In house" Intervention: is where you gather the client’s family and concerned others together and have them tell the client why they want him or her to stay in treatment. Participants will write letters to their loved ones stating how the client’s addiction has adversely affected them. Participants need to tell the client exactly what they are going to do if the client doesn’t agree to stay in treatment.

• Codependency- focused on another person; Codependency is what happens to someone who is trying to control someone who is addicted.Codependent persons are obsessed with controlling the person who is out of control. They do not havetime for themselves and their own needs. They do not think about their own problems because they are two painful. They would rather think about other people.       
• Treated: help each family member realize that they have a problem; help identify the problems that they are having. Help them realize what they have been doing is maladaptive.
• recognizing honesty
• attending meetings
• turn the problem over to a higher power
• using good interpersonal relationshipskills.

• Transference: clients responding to you with the same feelings, thoughts, and behaviors that they developed for other people in their lives.
• Countertransference: is you responding to clients in the same way that you responded to other people

We admitted we were powerless over alcohol—that our lives had become unmanageable.

We came to believe that a power greater than ourselves could restore us to sanity.

We made a decision to turn our will and our lives over to the care of God as we understood Him.

We made a searching and fearless moral inventory of ourselves.

We admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

Concerned with the prevention, early recognition, screening brief intervention, and appropriate management of substance use by young people; initiates professional and public education in this area; and makes appropriate policy recommendations to the membership.


The Committee is based on the idea that clients are constantly torn between the side of them thatwants to use alcohol and drugs and the side that wants to get clean and sober. It functions under the idea that it is important to label three voices defined by Freud's concepts of the id, the ego, and the superego. The id is referred to as the disease, the ego is referred to as the Higher Power, and the superego is referred to as the client.

Elderly people are vulnerable to becoming addicted to a variety of over-the-counter prescription medications and they tend to take a variety of medications without supervision.

• Any medication and or illicit drug tend to have 1/3 more powerful affects on the elderly because:
• -Decline in brain cells- resulting in higher concentration
• -Increased body fat- resulting in greater effect of drugs on CNS
•  
• Effects of depressions
• -Many elderly people have outlived their support systems
• -Loss of job and retirement
• -Self-esteem
• Mild Cognitive Defects
• -Orientation impairment
• -Concentration
• -Short-term memory recall
• -Abstract Thinking
• Risk Factors
• -Biological sensitivity
• -Loneliness
• -Pain
• -Insomnia
• -Depression
•  
• Symptoms are commonly overlooked due to blame on other illnesses

• Depression requires a clinical team and is treated in three ways:
• 1. with antidepressant medication,
• 2. with psychotherapy, cognitive therapy, and behavioral therapy, and
• 3. with interpersonal therapy.

• You must try to relate and understand the intense fear clients may feel. Client’s need gentle support and encouragement.  Teaching relaxation techniques is a common tool for clients with anxiety.  Also use individual cognitive therapy sessions
• Example: Client should keep a log of automatic thoughts and challenge these for accuracy
• Exercising for at least 20 minutes- helps to burn off excess stress hormones
• Help clients to recognize what triggers their anxiety

Personality is the way a person, thinks, feels and acts. Personality disorders are patterns of inflexible and maladaptive traits that cause significant impairment.

Borderline- tendency towards impulsivity and emotional instability characterized by rapid changing moods that are overly reactive

• Borderline Treatment 
• needs a lot of direction and input                  
• Need to be confronted on maladaptive behaviors                  
• Help clients to identify feelings and motivations behind acting out.                  
• Setting Limits:
• learning impulse control and development of skills for dealing with feelings                  
• Need a specific plan of action when they experience strong feelings

• Antisocial- diminished capacity to delay or inhibit action, particularly aggressive action
• Antisocial Treatment- revolves around teaching clients the consequences of their behavior and learning how to think in a new way.                   
• Use of an honestly log would be helpful to help with lying                  
• Power in group process- development of empathy

Narcissistic- grandiose sense of self-importance and capabilities.  Belief that they have special skills, beauty, power and abilities.  Does not tolerate criticism well

• Narcissistic Treatment- “ The best way of treating these clients is as if they really were the ruler. If you treat them as if the are they ruler and you are the servant, then you will go a long way toward getting them to listen.”                  
• Most important for these clients to get honest with their selves                  
• Need to spend time developing empathy for others                  
• Use of God

• Case by case basis- does NOT require any isolation techniques other than what should be expected for everyone - meaning use gloves when handling bodily fluids.

• • Other issues:
• • Uncertainty of diagnosis
• • Guilt- about previous lifestyle
• • Fear of death
• • Exposure of lifestyle
• • Changes in self-esteem
• • Alienation of friends and family
• • If possible refer to facility that specifically deals with Aids for continuing care.

Sexual abuse matters need to be addressed in individual sessions. The goal for working with these clients is to ultimately see past events in a new context and attempt to forgive themselves and their offenders. Client will need to tell their story many times- possibly including the events before, during and after the trauma. The client will decompensate as the material comes out.

• Create an individualized program that is tangible and concrete- set in the current situation 
• Use social skill trainings such as communication and problem solving
• Provide and advocate
• Frequent rule reminders
• Use encouragement and praise to offset problems
• Oral presentation instead of written

• Minimization- making reality smaller than it really is
• Rationalization
• Denial

• • The clinical staff. The staff usually meets once a day to discuss the client’s status. 
• • A treatment team is a group of staff working with an individual or family create goals, objectives, and interventions. It takes clinical skill to decide exactly what the client needs to do to establish a stable recovery.

The staff keeps written record of the client’s progress through treatment. Each progress needs to beidentified with one or more treatment objectives.

The Diagnostic and Statistical Manual of Mental Disorders is used by clinicians and psychiatrists todiagnose psychiatric illnesses. Until May of 2013, the DSM-IV-TR was the most recent version of themanual. The DSM is published by the American Psychiatric Association and covers all categories of mental health disorders for both adults and children.

In the course of practice is our client is causing or has caused physical or significant emotional harmto or has engaged in sexual abuse or sexual exploitation of a client, must promptly provide that information to their supervisor, or the appropriate place.

• 1. The first thing the family needs is support- they need to feel listened to and like you understoodthem.
• 2. They need to be encouraged to share the reality of their lives. They also need to feel safe enough toexpress themselves.
• 3. In treatment the family members will need to realize that they have a problem. Each member of the family will work through the codependency index (appendix 26)
• 4. They need to practice the tools of recovery in the family groups
• 5. Help families understand that they are powerless to the disease and that their lives have been unmanageable.
• 6. The family members need to admit to the client that they have problems too and they need to identify exactly what the problem is.
• 7. Addiction is a family disease, everyone is affected and everyone needs to bear some responsibility.
• 8. Each family can write a letter to the client stating how they are feeling and they ask for what they want to see happen. You can share these letters during a group session.
• 9. Help the family get in touch with reality (inability to know feelings) pg 217
• 10. Continue to work on developing healthy communication between family members.

• • Also: found in November 19th
• 1. Always involve the family.
• 2. Make contact with family as soon as you have consent.
• 3. Introduce family to al-anon for their own recovery.
• 4. Present family with dates on family program at treatment facility.
• 5. Stay in touch with family during treatment of client.
• 6. Helpful to include family with client in groups at treatment facility.
• 7. Family group sessions can be strictly educational.
• 8. Families need to talk about death, losses, divorces, and abuse.
• 9. Families need to learn about codependency and enabling.
• 10. Families need to learn about relapse and how they can support the client through one. handout: The Family & Recovery;

• The most important thing that occurs in adolescent treatment is the change in perceptions, attitudes, and behaviors that revolve around addictive chemicals. The clients must come to realize that they have a problem, come to understand the problem, and develop recovery skills. This is KEY: Adolescents must be habilitated rather than rehabilitated. They have never developed the skills necessary to lead a normal sober lifestyle.
• • Rules: Adolescents will constantly test the rules and each staff member.
• • Communication Skills: Adolescents need to focus on developing communication skills. They need to practice identifying their feelings and sharing their feelings with their treatment peers.
• • Honesty: Adolescents need to practice honesty. Just because they understand the principle does not mean that the behavior changes.
• • Exercise: Adolescents need activities to show that they can do things that they thought they could not do. Many of these kids have never done any healthy activity, such as a hike or picnic, so it is a new world for them where they can succeed and work together to accomplish goals.
• • Fun in Sobriety: Adolescents need to learn how to have fun in sobriety. One of the things that they are worried about is that they will not be fun if they stop using drugs and alcohol.
• • The Reinforcers: Adolescents are very concerned about how they look and how they get along with their friends. Adolescents desperately want to be loved and appreciated. Many of these children come from such severe abuse and neglect, that given an environment of love, they will flourish.
• • Spirituality: Adolescents have more difficulty with spirituality than do adults. They have their health and they are not as ready to surrender. Adolescents will explore spirituality if they do not feel as though they will be shamed by their peers. A peer further along in the program is an excellent model.
• • Group Therapy: Group therapy with adolescents is different. They are inexperienced with sharing their deeper feelings. Having older members of the group share, paves the way for new members.
• • Peer Pressure: Peer pressure is vitally important to adolescents, and they can easily be swayed to use drugs by their peer group. The adolescents need to spend a lot of time role playing drug refusal exercises.
• • Continuing Education: Continuing education is necessary for adolescent-even those who have dropped out of school. They should have a thorough educational assessment, including an examination of school records and psychological testing.
• • Continuing Care: During the discussion of the treatment plan, it is a good idea to begin continuing care planning, including a 5 year follow up plan run by the continuing care case manager.
• • Parents Support Group: As the adolescents are going through treatment, the parents attend at least two groups per week.

• The addiction professional shall behave in accordance with legal, ethical and moral standards for his or her work. To this end, professionals will attempt to resolve ethical dilemmas with direct and open communication among all parties involved and seek supervision and/or consultation as appropriate.When ethical responsibilities conflict with law, regulations or other governing legal authority, addiction professionals should take steps to resolve the issue through consultation & supervision. When addiction professionals have knowledge that another counselor might be acting in an unethical manner, they are obligated to take appropriate action based, as appropriate, on the standards of this code of ethics, their state ethics committee and the National Certification Commission.
• • When an ethical dilemma involving a person not following the ethical standards cannot be resolved informally, the matter shall be referred to the state ethics committee and the National Certification Commission.
• • Addiction professionals will cooperate with investigations, proceedings and requirements of ethics committees.

Being overly confrontational can cause a client stress and cause a lapse/relapse in substance use. Thiscan also drive the client away from treatment due to feelings of being unwelcome at the facility, guilt, hopelessness, and judgment from the therapist

• Instillation of Hope   
• Imparting of information    
• Imitative behavior   
• Interpersonal learning
• Altruism   
• Catharsis
• Direct Advice
• Developing of socializing techniques  
• Existential Factors   
• Universality

• According to the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct, multiple relationships can include “a psychologist [who] is in a professional role with a person and at the same time is in another professional role with the same person.”
• Examples
• -Having sex with a client
• -Doing business with a client
• -Becoming friends with a client post-therapy

• Tarasoff v. Board of Regents of the University of California mandates that clinician protect individuals from the threat of serious violence by their patients. 
• You have to tell someone if the client threatens someone’s life.
• NEVER DO SO ALONE. ALWAYS CONSULT WITH YOUR SUPERVISOR.

• 30-60% of drug abusers have a concurrent mental illness. If clinicians are not adept at treating mental illness, they are responsible for referring patients to another professional. Similarly, clinicians should be cautious not to overlook a medical issue or to offer suggestions that fall outside of their training.
• If patients inform clinicians that they are having medical problems, it is the clinician’s duty to refer the patients to a physician.

• Concurrent substance use and mental health disorder.
• addicted to *** and having *** personality disorder
• alcohol addiction with panic disorder

• People in this population are more likely to be medically involved and at increased risk of death from both medical and behavioral-health-related causes, as well as from accident and violent means.
• Further, they experience feelings of helplessness, hopelessness, and frustration, and are often experiences negatively, acquiring labels such as “antisocial, manipulative, borderline, med-seeking, and sociopath”.

• Are Caring
• Love Their Work
• Do Not Become Overly Involved
• Good Counselors Do Not Lie
• Good Counselors Are Gentle
• Like Themselves
• Are Supersensitive
• Have A Sixth Sense
• Do Not Become Overly Emotional
• Are Active Listeners
• Do Not Talk Too Much
• Maintain Boundaries
• Are Client-Centered
• Have Effective Relationship Skills
• Have A Sound code of Ethics