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89 Cards in this Set

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presents as attending to others feelings and acknowledging them

If we empathize with our clients they may feel better for having been known by someone who cares (clinician)
Constitutes a subset of empathy, expresses itself as carefully considering the client's feelings as reflections of their beliefs, wishes, and state of mind and careful preparation for our undertaking skillful action with the goal of helping clients lead for a personally satisfying and productive lives. Compassion alleviates suffering and even the causes of suffering

if we relate to our client compassionately, our clients may be more likely to become better off for the rest of their lives.
"Ivey and Ivey"

Ivey and Ivey-

"acting with a sense of capability and deciding from among a range of alternative passions."

contrasts with intentionality

Ivey and Ivey - "The purpose of the counselor is to eliminate the stuckness and substitute intentionality"
Themes from "The Color of Fear"
Oppression, internalized racism, pain, color, ethnicism, power, racism, human beings, white experience, action against racism, anxiety and frustration
Clinical Interview
A serious conversation with a specific purpose
What is the process, content for us, expected outcomes of a clinical interview?
Process involves 2 parties, content includes objective and subjective information
How is a clinical interview typically structured?
Scheduled, Face to Face, or via phone
3 purposes of interviewing for SLPs and AUDs
Obtain info

provided release and support, encouragement/establish a working relationship..."the most fundamental method of establishing rapport is through casual conversation"

provide information
Shipley's 8 Fundamental Characteristics of Interviewing
1) is a serious conversation with a specific purpose

2) needs a purpose and a plan of action, plus good commun exchange

3) typically consist of 2 parties and address both objective and subjective types of info

4) typically involve getting info, giving info, or influencing, persuading, or counseling

5) there can be apprehension in either party

6) digressions often occur in interviews

7) conduct an interview only when necessary

8) every interview has a conductor/manager, it should be the interviewer
Clinical Interviewing/Case History Taking
-You are the manager
-Multicultural considerations
-Typical client risks and clinician fears
-"Traps" to be aware of

-Shipley and Wood's 6 basic suggestions for effective interviewing

-review the case info
-don't trust to your memory alone/use audio-recording
-verify or clarify inconsistencies/questions with the patient/other if need be
-determine and respond to the report writing requirements of your setting
Shipley and Wood's 6 Basic Suggestions for Effective Interviewing
1) be prepared and organized
2) arrange the setting for comfort and communication
3) provide a private, confidential setting
4) dress appropriately-like a professional, avoid being "dressed for the wrong party"
5) be punctual and use time effectively
6) keep appropriate records
Yalom's 8 Independent Curative Factors in Groups
1) Instillation of hope
2) Universality
3) Imparting the information
4) Altruism
5) Interpersonal learning
6) Group cohesiveness
7) Catharsis
8) Existential issues

3 Broad Categories
-Conveying content
-Affect release
-Personal Growth
Principles of Group Function
the counselor must treat the group from a humanistic point of view, with:

1) acceptance
2) genuineness
3) empathy
4) concern
6 common errors in attempting to respond to another person's communication
1) denying response
2) agreeing response
3) minimizing response
4) responsibility - taking response
5) blaming response
6) avoiding response
Offering appropriate support- Questions to consider:
- what is my role in this situation?
- what kind of support with i offer this person?
- what am i responsible for in this situation?
-what resources can i offer/suggest/recommend in this situation?
Yalom's Leadership Functions
-emotional stimulation- Mod.
-caring- High
-Meaning attribution - High
-executive functioning - Mod.
Establishment of Group Norms
Procedural norms
Interactional norm
Initiative norm
Confrontational norm
Here-and-now norm
Respecting individual needs
a complex set of skills that often results in a clients examination of core issues

it rests solidly on listening and observing

a supportive challenge

"going with" the client
3 major steps involved in confrontation
1) identify mixed messages, discrepancies, and incongruities

2) point out these issues clearly to clients and help them work through the conflict to resolution

3) Evaluate the effectiveness of your intervention on client change and growth
5 levels of change
1) Denial or "stuckness"
2) Partial examination
3) Acceptance and recognition, but no change
4) Generation of a new solution
5) Transcendence
Stages of Group Development
1) Group at inception
- dealing with introductions, procedural norms, no new topics occur thereafter, the trust level emerges, group members come to value the group experience

2) the working group
-cohesiveness, conflict, and by redefining the leader, anger may also be directed toward the leader if no outsider exists in the group

3) The terminating group
-timing is critical, don't want abrupt, unexpected termination of the group
15 elements of professional practice
1) Knowledge and competence
2) Need for ongoing self-evaluation
3) Accurate self-evaluation
4) Privacy Issues
5) Human subject guidelines
6) Documentation
7) Financial issues
8) the referral process
9) Clinical reliability and validity
10) Cultural competency
11) non-discriminatory professional service delivery
12) Communication
13) Appropriate professional conduct
14) Risk management
15) Terminating services
Health Insurance Portability and Accountability Act (HIPAA)
-Increases consumer controls
-limits medical record release
-secures personal health info
-provides for increased accountability for medical records
A system of shared beliefs, values, and customs, behaviors, and artifacts that members of one group use to cope with their world
Cultural Competence
considered a developmental process because it requires a commitment to life-long learning and continuous enhancement of knowledge, skills, and attitude
Stages of Cultural Competence
1) KNOWLEDGE - the info or content that we need to know in order to become culturally competent
2) SKILLS - refer to what we should be able to do with our knowledge and how we should apply it in our practice of the profession
3) ATTITUDES - refer to focusing on the kind of professionals we wish to become while striving for cultural competetence
Overlapping stages of Cultural Competence
AWARENESS - clinicians must ID their own culture and reflect on their own beliefs, values, and stereotypes

APPLICATION - clinicians can begin to apply this knowledge through interviewing counseling and treatment approaches

ADVOCACY - this stage involves complementing knowledge and skills about diversity with an attitude of actively promoting diversity to become advocates, clinicians must make strategic shifts to create systematic change
Sources of Conflict - Diversity
Differing views about what is "important" - work or take child to speech therapy?

Differing views about how to approach problems

Differing views about "appropriate communication" - Pragmatics= how to communicate at an IEP meeting
Sources of Difference
-socio-economic status and difference
- social and political differences
- views on disability
- views on health care and treatment
-views on community vs. individual
The Three C's
What are you saying?
How are you saying it?
Are you being effective?

What is your client saying?
How is he/she saying it?
Are you understanding the words, the meanings, the intent?

Are you feeling it?
Are you showing it?
Are you acting on it?
Anxiety is excitement without adequate support of oxygen.

"If you are anxious and you don't know what the excitement is about, at least breathe!"
"Diagnostic Evaluation"
The term diagnostic is assumed
What is Luterman's bias re. evaluations?
Bias against the medical model aka the deficit model, through the medical model the client becomes passive
What is the "medical model" of evaluation?
tell me about what's wrong, we endorse parts of the medical model
What is diagnosis by committee?
done by the institution-centered diagnosis team

team of professionals, ea of whom administers tasks, do counseling as a team, ex) Clarke, Children's Hosp - Aug Communication Center
What is Counseling?
Counseling is THE critical part of the evaluation process
Client-Centered Diagnosis
What is involved from the clinician's perspective?

What is involved from the parent/client's perspective?

How to respond?

Should we/when should we enlist parents in testing process??
Other important issues
Pacing - we speed up when we get nervous, need to slow down, not too slow of a pace..child will lose interest

Asking pertinent questions - what do you need to know now?

Avoid trying to "cheer up" the person...why? because it invalidates their feelings
What does it mean when parents obsess about the search for a cause?
they are between blame and uncertainty

they are usually obsessed with their guilt - diagnosis shopping...looking for a better diagnosis
What is contracting about?
clarify the goals of the evaluation process

clarify how you practice

intake process
Luterman's 7 steps for a healthy client-centered diagnosis eval process
1) allow family to tell story
2) enlist family as co-diagnosticians
3) involve family and client actively in testing process
4) have client and family participate fully in final diagnosis
5) empower them by asking "what do you need to know now?"
6) listen and respond to the affect
7) set up another appointment
Institution-centered diagnosis
What does Luterman say about neonatal hearing screening? important to know early, false positives, believes info should be shared with the parents at least 24 hours after birth...because it may influence the birthing of the parents

About "failing" the screening?

About the relationship between the pediatrician and the institution and the audiologist or SLP? Be able to tell the physicians - who you are, what you do, what you don't do
How to counsel so parents can hear, listen, and understand?
-create an evaluation folder or binder
-use graphics as appropriate
-check for emotional state
-provide release and support to parents/client
-repeat, reiterate, summarize, review, recap
are problems in body function (physiological or psychological functions of body systems) or structure as a significant deviation or loss
is a particular restriction or problem an individual may have in the manner or extent of involvement in life situations
is an activity limitation or difficulties in performance of activities or the performance of a task or action by an individual
Counseling in Consulting
Who is the customer when you are consulting?

Who is the client when you are consulting?

What responsibility/ies do you have to the customer?

What responsibility/ies do you have to the client?

Who might you be consulting to?
Documentation Issues
Complete the referral cycle
Follow up promptly
Multicultural Counseling Theory (MCT)
-a cultural metatheory
-Sue and Sue (1990)
-Sue, Ivey and Pederson (1996)
-6 propositions and 47 corollaries
a preconceived opinion about something or someone
negative attitudes, beliefs, judgments about a group of people
the values of one's culture are considered as more important than those of another ethnic culture
an overgeneralization about a group of people
Multicultural Counseling Theory (MCT) 3 Major components
AWARENESS of one's own biases, beliefs, values

KNOWLEDGE about one's own biases and cultures

Acquisition of multicultural SKILLS...
which skills are important?
.counseling/communication skills
.systems-intervention skills
.interviewing skills
.evaluation skills
.skill in working with individuals and groups
Racial Identity Theories
White Racial Identity Models (Helms, 1996)

3 Types of Racism:
Multiple roles of SLP or AUD
Community member
Specialist in one's COMDIS discipline
What is racial identity?

What is the importance of learning about racial identity?
viewed as normal development process int he US

Process involves moving through stages toward a positive racial identity
Helms' White Racial Identity Theory (1996)
Development of a positive White identity consists of 2 processes:

1) Abandonment of racism
2) The development of a non-racist White identity
Helms' Model of White Identity (1996)
Ongoing, linear process
Additional factors to consider
Effects of each stage on attitudes and behaviors
People of Color Racial Identity Theory (Helms, 1996)
Personal Identity
Reference group orientation
Ascribed identity
What is the relationship between Racial Identity and MC competencies?
Models can increase one's awareness and knowledge

One can achieve a higher level of racial identity
Top 10 Strategies for understanding bias
1) Bias is part of the human condition
2) Good vs. bad?
3) Examine one's bias
4) Work to change bias
5) Actions speak louder than words
6) Non-guilty approach
7) Take an active approach
8) Remember 4 response possibilities
9) Remember there is a connection between shame and violence
10) It is an ongoing, long-term process
Caregiver stress-Contributing factors and stages
-change/deterioration in patient's condition
-inability to use previous coping strategies due to changing conditions
Lichtenberg's 4 stages of caregiving
1 Detection
2 Current caregiving
3 Transitional caregiving
4 Post caregiving
Paradigm shift in family quality of life issues and supports
-shifting paradigm from "fixing the individual to supporting and accommodating across all environments
-shifting family assumptions
-shifting family support
Additional stressors and demands for caregivers
the prevention and and/or mgt of medical crises once they occur

control of symptoms

completing prescribed regiments and problems associated with that

dealing with social isolation

responses to changes in disease course

attempts at normalization


confronting problems

physical health, aging, ethnicity, coping strategies and perceived stress in the caregiver
Caregiver support group functions
provide respite from caregiving, reduce isolation and loneliness, provide opportunities to share feelings in supportive context, provide caregivers with understanding, affirmation, and validation of thoughts and feelings, instill hope, universalizes and normalizes caregiver's experiences, educates caregivers about coping strategies, helps caregivers to ID the problem/s, relief of emotional stress, reduction of guilt about one's anger or resentfulness toward the situation, aid in redefining roles, result in positive outcomes
Rewards of Caregiving
Increase in self-esteem-builds character, increase in sense of self, deeper understanding of family member's condition, greater appreciation of one's own health, increase one's awareness of one's own mortality, maintain quality of life for pt and family members, maintenance of family roles and dependability, permits and promotes family bonding, greater insight into the pt's life, development of new skills, pt is a constant role model, built in support group for caregiving and other personal issues
The Clinical Relationship
What is our purpose in counseling?

How do we accomplish this?
Relationship between Fear and Social Avoidance
Benefits of Group Rehab
Increases social contacts

Use info to question AUD
ABCX Model
Social model of family reaction to stress

A= demands -3 types
B= resources - 2 categories
C= family's definition/explanation of stressor event
X= change in stressed family

3 types of demands = hardships, additional stressors, negative consequence of coping

Resources = internal and external

Stressor event/s = ??
Counseling Issues for parents of children who are cochlear implant candidates
FDA candidacy criteria

Children's Implant Profile (ChIP)

Other questionnaire/s

Explanations, descriptions, comparisons with hearing aids, pros and cons

Discuss parental expectations, goals, need for understanding of / commitment to the process

Referral to another implanted child and family for discussion
Important areas to consider
Luterman's 5 characteristics of an optimal family

Luterman's 4 characteristics of a successful family
Working with Sibs of children with communication disorders
How does the disability affect the child, the sibs, the parent, the grandparents?

Sibs need to share their feelings

Level of severity matches to sib's responses

Inform he sibs at their level of understanding
Counseling objectives for SIBs work
Clarify concerns of sibs
Id their needs
Explore their feelings
look at their knowledge of the disability
explain aspects relating to structure and function for the whole habilitation process
Sibs Fears
"catching" the disorder
loneliness and isolation from peers and family
anger toward disable sib, parents, peers and society
resentment toward parents for spending more time with disabled sib
embarrassement in public and social situations
role confusion in family and about their needs
jealousy with disabled sib re attention
pressure to achieve or care for sib
guilt about emotions
frustration re establishing a "normal" relationship with sibs and parents
Simone Roach's (1997) Attributes of caring
Adult-Onset Hearing Loss
***Counseling technique according to Luterman***
counseling technique should not be bound to a particular philosophy.

As a counselor, you should wait to hear what issues are on the client's mind before making a clinical judgment of how best to proceed

What do you need to know?
What is of most concern for you right now?
How can I be of service to you?
How can we use our time during this session?

There are no stupid questions, only ill-judged responses

The counselor's approach will greatly impact the future course of the relationship between the counselor and client

The counselor needs to determine which response would be most facilitative in the context of client interaction
The time of a response is critical
if we listen carefully the client will tell us what is needed - Milton Erickson

Allow the client to tell you what he/she needs...listen
6 types of responses
Content response
-What happens initially?
-What happens later in the relationship?

-people seldom want advice
-counterquestion forces the person to reveal his or her position
-it forces the learner back onto her own resources
-confirmation ques are also used to forestall rejection

affect response
-is very potent in building a counseling relationship
-it greatly increases the intimacy level in the relationship
-Rogers="emphatic listening"
-requires considerable follow-up
-is more appropriate in initial stages of contact and dx

reframing (scaffolding)
-timing of reframing has to be precise and it cannot be used too frequently
-reframing encourages responsibility assumption
-try to reframe all "mistakes into nuggets of gold"
-an ill-timed or ill-delivered reframing response can be very offensive

sharing self
-if we can always seem in control, clients tend to feel very inadequate
-sharing self reveals our authenticity as fellow human beings
-the timing of this response is critical- if done too early, one loses credibility
-the sharing response should usually emerge later in the relationship and with clients who have a relatively high degree of self-esteem

-very often the client just needs a sounding board
-the "uh huh" response
-there are no right responses, only different roads to travel
-if something is important, it keeps coming up
-a feeling is seldom lost; it gets reworked and emerges again
The Therapeutic Relationship
Clinical Interviewing/Case History

Taking in Evaluation and Treatment

Dealing with difficult emotions intelligently
Individual Counseling
Working with difficult situations
-basic principles
-the Clinician's task
-potentially challenging behaviors
what do resistance, denial, and some forms of questioning have in common?
they are similar or related to active defense mechanisms...tardiness, subtle inattention, silence, disagreement, failure to follow up on assignments
When does resistance occur?
early in a relationship

when people fear change/when they are uncertain about the situation
Bramer (1993) on resistance
-ease of receiving/asking for help
-difficulty in committing to change
-challenge of letting go of control and submitting to a helper
-issue of trusting and sharing openly with a stranger
-challenge of seeing one's problems clearly at first
-challenge of the problem itself with respect to sharing it
-cultural taboos on going outside the family, clan, tribe
Shipley (1997) on Denial
-a defense mechanism that people employ when they are not ready to admit that a problem exists and begin remedying the situation
-"s/he will outgrow it"
-people need time, awareness, knowledge, skills, and support to help them acknowledge and cope with solving their problems