Psych 6233 - Discussion post

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Memorial University of Newfoundland *

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6233

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Psychology

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Dec 6, 2023

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Week 1: DQ #1 A good counsellor is aware of cultural differences and ensures they continue practicing self- awareness. When working with individuals of different cultural backgrounds and with different beliefs and values, a therapist needs to consider the possibility of these factors influencing any assessment they administer. The Canadian Counselling and Psychotherapy Association (2020) states that a counsellor should consider all aspects, such as diverse factors that may be influential in determining appropriate accommodations and performance. Counsellors should proceed with taking precautions in the selection, administering and interpreting assessments as the results may not represent the client's historical background and presenting issues (CCPA, 2020). As a clinician who is aware of their clients' diversity, they need reliable resources. Hence, the client is more likely to have a successful therapeutic experience. For example, suppose a client and clinician have different first languages. In that case, the clinician needs to have availability to professional translators, assessment materials, and educational resources to ensure they are aware of the cultural differences. For example, a clinician will want to use these resources to help inform the client of therapeutic processes appropriate to their understanding (Hays, 2017). DQ #2 Hi Shannon! I enjoyed reading your response to this week's discussion. I currently just moved to Moncton, NB. Its diverse population continues to grow, which is excellent but can also be problematic when providing services. I work with VIVA, a therapeutic benefit for children with Autism. We have several clients whose families are moving to the province, and English or French is not their first language. As you have stated, this can be a barrier when providing services and developing a relationship with our clients. Finding an individual who can translate for us is difficult for many clients. We urgently need translators, but unfortunately, we do not have the funding for it. This makes it difficult to interact with families as language is a significant barrier, and sometimes the families are unsure of what we offer or express to them. Although I am not currently providing mental health counselling services to my clients, I still work with them and their families. I should be able to give accurate care to the children, but sometimes this gets lost in translation and becomes challenging. DQ #3 I enjoyed reading your post; it made me think of the significance of biases that can be implemented within therapy. Clinicians need to have self-awareness when interacting with clients. They may hold unconscious biases which can influence their connection with their clients. The unknown preferences can often impact clinical assessment, decision-making, and reasoning (cite). Aside from influencing clinical judgement, biases can often affect the development of a therapeutic relationship (note). Distorting conclusions can make clients feel misunderstood and affect their therapeutic success (reward). To help eliminate clinical biases, psychotherapists could use different techniques. Therapists

could continue to educate themselves on cultural diversity, use mindfulness or use personal reflection (cite). Having self-awareness is essential when working with any individual in a therapeutic setting. As clinicians, we want to refrain from unloading our beliefs or values on the client. The best way to do this is to continue working on self-awareness. Yager, J., Search for more papers by this author, Kay, J., Kelsay, K., Psychiatry, D. of, Send correspondence to Dr. Yager ([email protected])., J, M., K, P., Al., E., E, B., EH, F., L, D., J, Y., D, B., D, D., LE, B., V, L., Sánchez-Bahíllo, RD, S., … J, G. (2021, January 15). Clinicians’ cognitive and affective biases and the practice of psychotherapy . American Journal of Psychotherapy. https://psychotherapy.psychiatryonline.org/doi/full/10.1176/appi.psychotherapy.20200025 DQ #4 This process is like what we use at work when doing intake assessments. When working with families, we have a form that requires the parent's consent to allow the origination to communicate with other professionals involved with the child's intervention (i.e., Physiotherapist, Speech Language Pathologist, Paediatrician, Social worker, etc.). It is the only way to communicate with them and collaborate, if necessary, legally. Although my experience is from an ABA and communication standpoint, my experience can transfer over to a counsellor's perspective. Clinicians are legally obligated to take responsibility for their clients, regardless of context. It is essential that the counsellor protects the welfare of the client and maintains their trust and respect (CCPA, 2020). To help promote the client's interest, counsellors can work collaboratively with the client and other professionals to help develop a solid therapeutic plan that includes the client's needs, values, and essential contextual background (CCPA, 2020). Accepting consent for releasing information is not only important for the counsellor legally, but it can also help to work with other professionals to develop a plan best suited for the client. Sometimes you need multiple people to provide ideas to help give your best service in protecting the client's welfare. Week 2: DQ #1: Hi Spencer, It seems as though several people are interested in the topic of death by suicide and how to assess it during counselling sessions. Your post mentioned the SAD PERSONS Scale (SPS; Hays, 2017). You noted how Katz et al. (2017) indicated that it is a popular form of assessment used across many clinical settings. Although popular, you also mentioned that they cannot predict future suicidal ideations. As someone who experienced loss from death by suicide, I am not sure if there is an assessment to determine if someone will be suicidal in the future, but we can take precautions as counsellors and implement risk factor screenings. It may be a step we want to take with clients who express past and present ideations. For example, if the answers reflect conflict

with family, sleeping issues, marital/job loss, or isolation (Steele et al., 2018), we could determine if suicide is something we need to go through with the client. If so, we must manage our approach as the least restrictive to keep the client safe (Steele et al., 2018). Hays, D. G. (2017). Assessment in counselling: Procedures and practices (6th ed.). American Counseling Association. Katz, C., Randall, J. R., Sareen, J., Chateau, D., Wald, R., Leslie, W. D., Wang, J., & Bolton, J. M. (2017). Predicting suicide with the SAD person scale. Depression and Anxiety, 34(9), 809– 816. https://doi.org/10.1002/da.22632 Steele, I.H., Thrower, N., Noroian, P. & Saleh, F.M. (2018). Understanding Suicide Across the Lifespan: A United States Perspective of Suicide Risk Factors, Assessment & Management. J Forensic Sci, 63: pp. 162–171. https://doi.org/10.1111/1556-4029.13519 DQ #2: Working in an outpatient setting in a largely populated area is swift pace and involves an extended amount of wait times. From personal experience working within Halifax and its surrounding areas, it can be overwhelming due to high demand and time constraints. Time management would be an essential factor in this type of situation. A counsellor wants to be able to provide appropriate services to the client, but time can be influential to that process. It would be beneficial to begin the process with a screener to work with time demands. Hays (2017) explains that a counsellor can obtain general information about the client and their presenting symptoms, as well as their significance of them, by using a screening tool. With the particular clientele I will be working with, a screener I would use for passive suicidality, I would introduce the PHQ-9 (Patient health questionnaire). This screener is a tool used for depression and addresses passive suicidal ideations (RHIhub Toolkit, (n.d)). To be more efficient, I can introduce the SCL-90-R. This screener takes 15 minutes to conduct and would be beneficial as it is used with diverse populations (Hayes, 2017). Hays, D.G., (2017). Assessment in Counseling: Procedures and Practices. American Counseling Association. We are screening for and addressing suicide risk in clinical settings . RHIhub Toolkit. (n.d.). https://www.ruralhealthinfo.org/toolkits/suicide/2/screening-tools DQ #3:

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Hi Danielle, I enjoyed reading your post. Dr. Rick mentioned that the structure may be best if a counsellor needs evidence in a law-suite situation. However, my viewpoint is similar to yours. In your post, you discuss providing the client with an opportunity to discuss relevant information a counsellor may not catch if they conduct a structured interview. Both have pros and cons, but it is up to the counsellor to determine which type of interview would be most beneficial in the given situation. Working with clients to develop a relationship where they feel comfortable and confident in their counsellor and the information they release is essential. When a counselling session feels natural, clients are more likely to provide more details because they feel a sense of safety. DQ #4 When considering cultural considerations, it is essential to remember that talking about mental health illnesses in some cultures is frowned upon, which can lead to more significant issues. We want to ensure our clients feel heard and their feelings are validated. To help advocate our self- awareness, we can make it evident during our sessions. Individuals who experience suicidal ideations do not always express it. They often deny or tell you what you want to hear, like they are okay. This can be relatable to feeling shame about their mental well-being, or they may want to avoid hospitalization, speed discharge, or it may be a defence against suicidal impulses (Oquendo & Bernanke, 2017). Another thing to consider is that some individuals may suffer transient but intense suicidal thoughts that are not captured within an assessment (Oquendo & Bernanke, 2017). Research suggests it may be beneficial to conduct evaluations that measure a patient's cognitive processing to gain insight into the client's risk of suicide (Oquendo & Bernanke, 2017). Week 3 DQ #1 Thanks for asking a question, including specific cultures. Although the question asked about modifying an assessment to reflect culturally detailed information, it brought my mind to one population, the Indigenous. As Canada's diverse population grows, it is also essential to note the Indigenous people. The NWA (Native et al.) is the first tool developed to measure the impact cultural interventions have on an individual from a whole-person and strengths-based view (Thunderbird, (n.d)). The assessment has been determined to be a reliable way to measure changes in wellness in several different areas, such as gender identification, cultures, and age (Thunderbird, (n.d)). The team that developed the assessment were individuals within the native community. The tool is a product of the Honouring Our Strengths: Indigenous Culture as Intervention in Addictions Treatment (Casl) (Thunderbird, (n.d)). The research team comprised community elders,

knowledge keepers, cultural partitioners, and decision-makers (Thunderbird, (n.d)). Each person who helped develop the tool is a crucial community member and has extensive knowledge of services outside academics. They understand their culture and experience generational trauma; because of this, they can help develop a beneficial tool to conduct psychological assessment. Native Wellness Assessment . Thunderbird. (n.d.). https://thunderbirdpf.org/native-wellness- assessment/ DQ #2 Hi Charlotte, this is a great post. I am happy you mentioned rural areas and their impact on the reliability of questionnaires. Rural areas often need more access to healthcare, which can cause challenges in receiving or implementing required assessment tools. I grew up in a small rural community in Newfoundland. Our town is so tiny that most procedures and appointments are done 2 hours away. In the case of mental health services, the city also has limited access. Some social workers provide counselling services to Port aux Basques and its surrounding areas. Another limitation of living in a rural area is funding and finical stability. Considering these realities, clients may be required to pay for their assessments (Turchik et al., 2007). This may not be an option in low-income communities and can cause clinicians to go against ethical regulations. Clinicians understand how vital these assessments can be for their clientele and want to provide the best service possible. In this situation, counsellors may feel tempted to consider circumventing copyright laws, using tests that are not new or psychometrically sound, or may administer tests they do not have the qualifications for (Turchik et al., 2007) Turchik, J. & Karpenko, V. & Hammers, D. & Mcnamara, J. (2007). Practical and Ethical Assessment Issues in Rural, Impoverished, and Managed Care Settings. Professional Psychology: Research and Practice. 38. 158–168. 10.1037/0735-7028.38.2.158. DQ #3 Modifying an assessment tool can cause inaccurate data collection and influence reliability. Psychological assessment tools are only beneficial when the scores are accurate. Modification can also influence the validity. Validity reflects the correlation of the measured object to the assessment tools. For example, when working with an individual who presents or specifies experiencing anxiety, we want to ensure that the device we use to measure pressure correlates with the symptom criteria (Hayes, 2017). If concerns are already presented, using a modified tool will have an inaccurate reading. Testing the device with the modifications included to ensure the validity is relevant to ensure the measurements represent the changes made and no other variables is essential. Hays, D. G. (2017). Assessment in counselling: Procedures and practices (6th ed.). American Counseling Association.

Week 4 DQ #1 Colleen explains that she is reluctant to speak with the school counsellor. As her counsellor, and knowing her low expectations, I need to develop a solid therapeutic relationship with her. I want to create a secure and empathic environment where Colleen feels understood and supported. It can be challenging to work with adolescents, so providing them with a trusting relationship with an adult is essential, as they may only have that in a school setting. Studies have suggested that providing a non-judgemental environment and encouraging collaboration between parties can benefit the client (Kirk et al., 2023, as cited in Jacob et al., 2022). To develop cooperation, the counsellor may want to chat about what Colleen said, such as her comments about her home community and her reflection on her intellectual abilities. These are two topics that would require a delicate approach. Showing Colleen genuine interest in her feelings, she may feel comfortable enough to share more with the counsellor (Hammer et al., 2003). Hammer, A. L., Savickas, M. L., & Phelps, S. E. (2003). Applying a life-span developmental perspective to career assessment. Journal of Career Assessment, 11(3), 248–278. Jacob, J., Stankovic, M. Spuerck, I. & Shokraneh, F. (2022). Goal setting with young people for anxiety and depression: What works for whom in therapeutic relationships? A literature review and insight analysis. BMC Psychology, 10(1). doi: 10.1186/s40359-022-00879-5 DQ #2 According to what we already know of Colleen, she already has low expectations for herself. During her session, she explains that due to past experiences on IQ tests, she is reluctant to collaborate with the school counsellor to discuss future career goals. This information shows us that Colleen limits her abilities based on test scores. Colleen feels she cannot succeed due to tests administered in high school. It is essential to provide a positive and supportive environment for Colleen. Although she came to the counsellor to discuss future career goals, their session became more. Before guiding them toward academic goals, working with Colleen on what she feels her limitations are and working on her self-doubt would be essential. Because of unnecessary testing, Colleen is now experiencing excessive self-doubt and feels stuck. There is a probability she is thinking, "Well, I am never going to be successful, so why try?" (Curletto., (n.d.)). A strategy that may help Colleen is focusing on effort (Curletto., (n.d.)). People can control the amount of effort they put into their learning, but no one has control over how "smart" they are

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(Curletto., (n.d.)). Colleen may respond well to directing her thought process toward the amount of effort she is making. It may help her feel more confident (Curletto., (n.d.)). Carleton, A. (n.d.). How to help students control their self-doubt . Stanfield. https://stanfield.com/how-to-help-students-control-their-self-doubt/ DQ #3 Hi Danielle, thanks for sharing your personal experiences. My future career goal in high school was to be an Orthodontist. I ensured I took all my science courses (Physics et al.). I needed more guidance when it came to academic support in school. Our vice principal and guidance counsellor provided minimal support to course offerings or even how to choose courses once we were accepted into university or college. As I am sure many people like me, my parents did not attend university. Without assistance from my sister, I do not know if I would have made it through my undergraduate degree. Many students are unaware of the many steps to apply for university and residence, how to pay for tuition, and even to pick course offerings. From my experience, I can understand why Colleen hesitates about her future. Like myself, she may not have parents who understand the post-secondary system. She may also feel that because her parents did not attend post-secondary, it is not in the cards for her either. This would also be something to uncover while working with Colleen. It may be more than just an IQ test acting as her limitation. DQ #4 A specific population that has my interest is Transgender and gender nonconforming (TGNC). We often discuss assessments for depression, anxiety, substance abuse, career interest, IQ etc. I am sure some of these assessment tools can also be used with this population, as many individuals experience mental health issues and are at higher risk of experiencing them (Shulman et al., 2017). Guidelines developed by the American Psychological Association for Psychological Practice with Transgender and Gender Nonconforming People and the World Organization for Transgender Health express medical care providers' importance and responsibility when delivering services to TGNC people (Shulman et al., 2017). Several different assessments are suggested, but like many other tools, there are limitations. A device must be developed to improve these individuals' quality of life, not their "Strength of Transgender Identity Scale." With a new focus, there can be an increase in appropriate research that can determine more concrete psychological services (Shulman et al., 2017). Shulman, G. P., Holt, N. R., Hope, D. A., Mocarski, R., Eyer, J., & Woodruff, N. (2017). A Review of Contemporary Assessment Tools for Use with Transgender and Gender Nonconforming Adults. Psychology of sexual orientation and gender diversity , 4 (3), 304– 313. https://doi.org/10.1037/sgd0000233 Week 5 DQ #1

If the client is uninterested in investing in counselling sessions, there could be multiple reasons why. They may need insurance or the finical means to attend or be ordered by law to attend services. Before cancelling services, a counsellor must offer the client all options. Counsellors must work with their clients to develop a plan consistent with their circumstances, needs, values, culture and contextual backgrounds (CCPA, 2020). No matter the reason the client is not interested in services, the counsellor is to make reasonable efforts to facilitate appropriate access to different resources and counselling services (such as free services, other professionals who may better suit their needs, or ending services when the client wants) (CCPA, 2020). There are only so many things a counsellor to do to work with the client. As long as the counsellor takes all steps needed to ensure they provide the best services to the client, then it is on the client to accept what is being offered. DQ #2 Hi Spencer, to further your input, I feel from my own opinion a counsellor can also discuss or explain how the results are interpreted before administering the assessment. I feel I would have a greater understanding of the assessment I was taking if I was provided with all the information, including what the scores mean. This is personal preference as I know how my mind works, and I would want a clear understanding of the significance of assessment. As you stated, Hays (2017) suggests counsellors should clearly explain the assessment to the client. Counsellors should also express how the results will be communicated to the clients beforehand. After the test results are collected, it may be beneficial to go over the pre-test steps and reexplain them. This may help eliminate stress for the client and provide reassurance as they may have forgotten what the clinician said prior to taking the test. DQ #3 Psych 6273 – Cultural competency Week 1: 1.1 - #1 To answer your question, it is essential to consider cultural competence. As clinicians, we want to provide the best possible care to the client. Before sessions, Things to consider are being open- minded and being willing to be educated. While working with culturally diverse clients, essential things to remember are the clients’ cultural traditions and preferences, language, values and beliefs (Stubbe, 2020). Patient-centred care should be a main priority. Establishing a collaborative partnership with a diverse client requires the clinician to be reflective and open- minded and use a centred approach to understand the client's strengths and difficulties to construct a treatment plan (Stubbe, 2020). To introduce cultural humility, a clinician may want to develop a partnership with individuals and groups who advocate for others. Individuals in a position of power need to advocate systemically, as cultural humility is more significant than oneself (Cooks-Campbell, 2022).

1.2 - #1 The counsellor can start working with the client by understanding how the client perceived the interaction with the professor. The counsellor may also want to provide the client with Canadian cultural information. The information about Canadian culture might include informal relationships between students and professors and understanding when something sees a situation as funny and genuinely not making fun of the person's behaviour (Yorkville University, n.d.). It is essential that the counsellor talks about these topics without making the client feel embarrassed of their reaction to the situation. They should validate the client’s thoughts and feelings and help transition them to the new culture they are experiencing (Yorkville University, n.d.). It may also be beneficial to provide information about programs and events occurring on campus that they can attend to interact with native students. This may help them to adapt to their new environment (Yale, 2017). As Collins (2018) noted, counsellors who ignore contextual factors can result in "victim- blaming by healthcare professionals who view the individual in isolation from the sociocultural and political contexts that negatively influence their well-being." It is essential to consider the client's cultural aspects, including their view of accepting mental health services.

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Psych 6233 - Discussion post

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