Research on Counselor and Client Safety

Research on Counselor and Client Safety

A crisis occurs when a person is unable to deal effectively with an event that causes a significant life change. A crisis is defined by (James and Gilliland, 2013) as the perception of an event or situation as intolerable and one that exceeds the person’s immediately available resources and coping mechanisms. Unless the person obtains relief, the crisis has the potential to cause severe affective, cognitive, and behavioural malfunctioning. In Memphis, Tennessee, the first Crisis Intervention Team program was established in 1988. The model developed there has proven to be replicable across jurisdictions, and research evidence supporting its effectiveness is growing (Compton et al., 2014a; Compton et al., 2014b; Watson et al., 2012; Watson et al., 2008.). The interventions and response teams for crisis situations have increased over the years, providing more effective strategies and collaborations with the community, mental health professionals, and emergency response teams (fire department, law enforcement, EMT, etc. (Watson, Compton & Draine, 2017). (Watson, Compton & Draine, 2017).

Research on Counselor Safety

Individuals suffering from mental illness have been stigmatized, ostracized, and otherwise treated poorly for centuries; the same treatment can easily be associated with those suffering from developmental disabilities (Wahl & Aroesty- Cohen, 2010). Therapy can be a vulnerable time for anyone who is the client or providing treatment. When one is vulnerable, they are opening themselves off to another. Being vulnerable can lead to an individual being hurt or can be the start of a strong relationship. Therapists typically enter new clients who are dealing with sensitive issues with the expectation of finding the good in the midst of the chaos. That being said, personal safety is an ethical, legal, and professional response in counselling practice (James & Gilliland, 2013). (James & Gilliland, 2013). The safety of the therapist is just as important as the safety of the client. In any mental health setting, unwarranted attacks and victimization can occur (Bride, 2007). Therapy is provided in a variety of settings, resulting in a variety of experiences with regard to safety. Counsellors are expected to provide a safe zone for the client by meeting in a private setting with minimal distractions. Because of the patients and their perceptions of their concerns, inpatient facilities have the highest rates of victimization from client to therapist (Flannery, 2001). In most cases, when a therapist meets with a client for the first time, the client does not express any concerns about risks to the therapist. The therapist is often alone with clients that may have disturbance levels that are unknown at the beginning (Echterling et al., 2018). (Echterling et al., 2018). This could expose the counsellor to physical or psychological abuse from the client. Therapists and crisis workers also have their share of discomforting experiences. When working with people who have experienced sexual, drug, or alcohol abuse or neglect as children, crisis workers have faced a number of challenges. Work-related stalking and stalking-related behaviour were perpetrated by clients, coworkers, and acquaintances of clients. Respondents who treated clients for forensic, substance abuse, and sexuality issues, as well as sexual abuse, were more likely to be victimized (Storey, 2016). Some counsellors are recovering from similar issues as their clients and may find themselves in a professional situation where they have to confront their own abuse experience and its impact on their lives (Center for Substance Abuse Treatment, 2000). (Center for Substance Abuse Treatment, 2000). A study (Storey, 2016) found that less than 47% of respondents were aware of their increased risk of being stalked by clients. 50% of these therapists endorsed that a lack of clinical skills can heighten the risk of being stalked even more. Most crisis workers have no idea who their next client will be. Having in-depth training available for working through these situations specifically could lower the risk of a crisis worker being stalked or hurt. In another study, about 25% reported being the victim of stalking. The majority of mental health professionals are unaware of any laws against stalking in Canada. Education, support services, and problem resolution are critical in crisis response fields (Gadit et al., 2014).

Therapist safety can be more than just a physical harm threat. It can also cause psychological harm. They emphasize self-care and receiving therapy when needed in the field of working with crisis situations. Clients will try and manipulate the therapist into seeing them more often. Feeling a breakthrough with clients is a great feeling for any therapist. Therapists need to be aware of when they are being manipulated and spending most of their unassigned time with certain clients. When a therapist is overworked, it could cause the therapist to burn out, which can take away from the treatment of the rest of the therapist’s caseload. It is critical to monitor and protect their well-being, as well as take precautions to avoid burnout, compassion fatigue, and other work-related stressors. Most research used to explore the safety of crisis work indicates that a large percentage of crisis workers had been stalked, either stalked, assaulted, or experienced burnout due to client manipulation. Crisis workers of all sorts should seek to understand what to do if they find themselves in a situation of this magnitude.

Ethical procedures to consider when a client is at risk to your health is Standard 10.10 in the American Psychiatric Association. This code speaks of when to abruptly terminate therapy with a client. Some termination reasons initiated by the therapist include the fact that she/he no longer possesses the necessary competence to assist the client (Westmacott and Hunsley, 2010). This can be due to a change in the client’s treatment needs, stress-related professional competence, distress, burnout, illness, or because the therapist believes that continuing treatment would be harmful to the client (APA, 2010). Most importantly, if the psychotherapist is threatened or otherwise endangered by the client, they may terminate the therapeutic relationship. When making these decisions, the therapist should consult with colleagues to ensure a plan for their own and the staff’s safety. Notifying law enforcement to make them aware of the potential threat but also point them in the right direction regarding what to do would be a great idea.

Research on Client Safety

Beginning therapy with clients, we inform them that the only time we must report to others for their safety is if the client is in danger of someone else, to someone else, or to themselves. Client safety is a huge determining factor on multiple levels when it comes to therapy. The client that feels safe is more likely to have a great relationship with the therapist. Psychotherapy is a two-way street in which both the therapist and the client are equal partners in the therapy process. The therapist must show this by allowing the client to share their feelings about how therapy is going. The therapist could communicate from a mutual rather than a commanding position. The client should feel that he can welcome disclose his/her feelings without the risk of being judged. When a client is in a crisis situation, their emotion can run high. This could lead to expressive behaviours such as outbursts of anger.

Clients that are seeing the therapist due to intimate relationship issues could be at risk in many ways. This particular population is a deep concern for the safety board (Kress, 2008). (Kress, 2008). When assessing these clients, the therapist should explain the importance of safety. If the client believes they are at risk of being abused in the relationship, they should speak up. As their therapist, their safety should be the top priority. The authors of The Average Predictive Validity of Intimate Partner Violence Risk Assessment Instruments recommend and explain the use of safety plans as a tool for promoting the safety of those clients in violent relationships (Messing & Thaller, 2013). (Messing & Thaller, 2013). A client in a violent relationship may not be open about it at first for fear of the partner discovering it. This is why the relationship with the client should start off well upon contact. The therapist should make the client feel valued, prioritized, cared for, and safe. Therapists should communicate this to their clients instead of assuming the client will simply figure it out (James & Gilliland, 2013). (James & Gilliland 2013).

Addressing clients with Suicide Ideations (SI) is another strong area that requires ongoing training. When addressing clients with SI, you must take everything being said and done seriously. SI is having thoughts and feelings about dying and ending one’s life. The first thing you should learn as a therapist is about suicide laws and being a treatment provider for a suicide victim. Some crisis workers reported difficulty in asking about or assessing suicidal ideation. SI, depressive thoughts, and self-harm are frequently confused (Da Silva, Mograbi, Bifano, Santana, Cheniaux, 2016). Knowing the risk factors, such as the client having a plan, social isolation, rehearsal, drug usage, etc., will help differentiate between the three.

During a crisis call, James and Gilliland (2013) address Cecily. Cecily felt the need to call the crisis hotline due to an event that had just occurred in her life. This tells me that she felt that she had nowhere else to turn and that she valued her life enough to seek help. When Cecily called, she was very emotional. She could barely be heard by the crisis caller. I have a strength of patience and the ability to calm clients down in a time of distress. People express their distress in a variety of ways and for a variety of reasons. Being able to show patients and speak to them even when they are unable to express their reason for calling is a strength. When a client is in distress, all they need to hear is that they are upset and that it is okay to be upset. Validating ones feeling in a critical situation can turn a person’s thought process around. The crisis worker worked on developing a plan for Cecily to follow in order to help her situation. He assigns her three tasks or smart goals to complete by tomorrow. By doing so, the therapist-assisted Cecily in developing a workable plan. This also gives the client some accountability. A school counsellor and therapist will help you set short-term goals that will lead to long-term success. When someone receives that sense of accomplishment, they tend to want more and build confidence in themselves. I feel like everything the crisis worker provided Cecily with was great and handled very well.

Key Risk Elements

When assessing risks in a crisis situation, the counsellor must be prepared to ask questions in order to determine the level of danger to all parties involved. When viewing a suicidal example, the counsellor must be prepared to assess access to means, lethality, and level of intent. The counsellor would most likely begin by assessing intent by asking questions like these: Do you have a plan? What is your plan? When do you plan to do this? The counsellor will then proceed to assess access to means by asking questions to determine whether the client has access to items that will harm them, such as the following: Do you have access to the pills? Have you been collecting the pills? Does anyone know you have access to these pills besides the people in the room or on the phone? If the client intends to use pills to commit suicide, the counsellor will assess the lethality of the plan by asking the following questions: What kind of pills? How many? How many do you intend to take? By asking these questions, the counsellor will have enough information to determine whether the client requires immediate assistance and the next steps to manage the crisis and develop a safety plan.

Managing Risks

Based on the research discussed above, there is not much research supporting eliminating the risks of crisis situations. However, some research suggests that using de-escalation techniques, safety planning, support systems, and crisis hotline numbers can help to reduce the risks of a crisis situation. Counsellors must be aware of the warning signs, have proper training, be knowledgeable, and be well-supervised in order to best serve their clients. Part of my work as a crisis counsellor is having good supervision and collaboration with other professionals in the field. It can be incredibly important for the client that the crisis counsellor has a professional support system that they can consult with the cases on so that they feel most confident about their recommendations for their client. As far as collaboration, counsellors need to be open and collaborative with other key players involved with the client. According to research, clients frequently end up in crisis situations because one or more of their basic needs are not met. This would imply that, following the assessment, the crisis counsellor would incorporate resources or connections to other key players that could assist in meeting those basic needs into their safety plan. Even though crisis situations cannot be eliminated immediately, if the counsellor is present with appropriate knowledge, skill, supervision, and resource connections, then this could set the client up with an extremely well-done safety plan to minimize the impact of their situation.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Publisher.

American Psychological Association. (2010). American Psychological Association ethical principles of psychologists and code of conduct. Retrieved Aug 1, 2016, from http://www.apa.org/ethics/code/

Brian E. Bride, PhD, LCSW, (2007) Prevalence of Secondary Traumatic Stress among Social Workers, Social Work, Volume 52, Issue 1, January 2007, Pages 63– 70, https://doi.org/10.1093/sw/52.1.63

Centre for Substance Abuse Treatment. (2000). Substance Abuse Treatment for Persons with Child Abuse and Neglect Issues. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2000. (Treatment Improvement Protocol (TIP) Series, No. 36.) Chapter 4—Therapeutic Issues for Counselors. Available from: https://www.ncbi.nlm.nih.gov/books/NBK64902/

Centers for Disease Control and Prevention. (2014). National Suicide Statistics. Retrieved fromhttp://www.cdc.gov/ViolencePrevention/suicide/statistics/index.html

Compton, M. T., Bakeman, R., Broussard, B., Hankerson-Dyson, D., Husbands, L., Krishan, S., & Watson, A. C. (2014a). The police-based crisis intervention team (CIT) model: I. Effects on officers’ knowledge, attitudes, and skills. Psychiatric Services, 65(4), 517- 522.

Compton, M. T., Bakeman, R., Broussard, B., Hankerson-Dyson, D., Husbands, L., Krishan, S., & Watson, A. C. (2014b). The police-based crisis intervention team (CIT) model: II. Effects on level of force and resolution, referral, and arrest. Psychiatric Services, 65(4), 523-529

da Silva, R. D. A., Mograbi, D. C., Bifano, J., Santana, C. M., & Cheniaux, E. (2016). Correlation between Insight Level and Suicidal Behavior/Ideation in Bipolar Depression. Psychiatric Quarterly, 1-7.

DeAngelis, T. (2019, November). Better relationships with patients lead to better outcomes. Monitor on Psychology, 50(10). http://www.apa.org/monitor/2019/11/ce-corner- relationships

Despenser, S. (2017). Some thoughts about personal safety for therapists. Retrieved from http://www.theprofessionalpractitioner.net/index.php/articles/19-article-some-thoughts- about-personal-safety-for-therapists-by-sally-dispenser

Echterling, L. G., Presbury, J. H., & McKee, J. E. (2018). Crisis intervention: Building resilience in troubled times. San Diego, CA: Cognella.

Flannery RB, Jr, LeVitre V, Rego S, Walker AP. (2001). Characteristics of staff victims of psychiatric patient assaults: 20-year analysis of the Assaulted Staff Action Program. Psychiatric Quarterly. 2011; 82:11–21. doi: 10.1007/s11126-010-9153-z.

Gadit, A. A. M., Mugford, G., Callanan, T., & Aslanov, R. (2014). Reported Experiences of Stalking Behavior from Patients towards Psychiatrists from the Atlantic Provinces of Canada. British Journal of Medicine and Medical Research, 4(22), 3990-4003.

Gilliland, B. and James, R., (2013). Crisis Intervention Strategies. 7th ed. California: Cengage Learning.

Groves, C. (2015). When client rights and safety concerns collide: Ethical considerations with severely mentally ill or intellectually or developmentally disabled clients. Journal of Human Behavior in the Social Environment, 25(7), 756–765.

Karakurt, G., Anderson, A., Bradford, A., Dial, S., Korkow, H., Rable, F., & Doslovich, S. F. (2014). Strategies for Managing Difficult Clinical Situations in Between Sessions. The American journal of family therapy, 42(5), 413–425. https://doi.org/10.1080/01926187.2014.909657

Kress, V. M. (2008). Counselling clients involved with violent intimate partners: The mental health counsellor’s role in promoting client safety. Journal of Mental Health Counseling, 30, 200-210.

Messing JT, Thaller J. (2013). The Average Predictive Validity of Intimate Partner Violence Risk Assessment Instruments. Journal of Interpersonal Violence; 28(7):1537-1558.

Storey, J. E. (2016). “Hurting the healers: Stalking and stalking-related behaviour perpetrated against counsellors.” Professional Psychology: Research and Practice 47(4): 261-270.

Centers for Disease Control and Prevention. (2011). Suicide and Self-Harm. Retrieved from http://www.cdc.gov/nchs/fastats/suicide.htm.

Wahl, O., & Aroesty‐Cohen, E. (2010). Attitudes of mental health professionals about mental illness: A review of the recent literature. Journal of Community Psychology, 38(1), 49-62 doi:http://dx.doi.org.ezproxy1.apus.edu/10.1002/jcop.20351

Watson, A.C., Compton, M.T. & Draine, J.N. (2017, September). The Crisis Intervention Team (CIT) model: An evidence-based policing practice? Behavioral Sciences & the Law, 35(5-6), 431-441.

Westmacott, R. and Hunsley, J. (2010), Reasons for terminating psychotherapy: a general population study. J. Clin. Psychol., 66: 965-977. https://doi.org/10.1002/jclp.20702

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

---

Case Study

Sally contact you as a referral from a colleague who felt Sally needed psychotherapy to address her problematic substance use. An overdose of prescription opioids was the precipitating event that pushed Sally to seek professional care although she had been in denial about her problem for many years. Sally was a high-functioning client with a bachelor’s degree in psychology working as an executive producer of a well-known real-life television series on addictions. She had just moved to New York City from the West Coast after a failed marriage in which she and her husband had engaged in infidelity. Sally had no children and felt relatively isolated given that her only living relatives were her mother and father—both of whom had a mental illness—living 2,000 miles away. Sally had many resentments from her childhood as her father had untreated bipolar disorder and “put us through hell.” Throughout the course of treatment, Sally came to share with you that much of her adolescence was spent moving around the country with her depressed mother in an attempt to escape her father. She developed rather superficial relationships with people and had very few friends; that pattern followed Sally to New York.

At the time you meet Sally, she is 38 years old and identifies herself as an “existential thinker” who questioned “the purpose” of her life. She had no higher power and did not believe in God, nor did she suspect that the universe had any sort of energy that influenced her existence. Sally had an overwhelming sense of guilt and shame about being addicted to prescription opioids, which she had started using about a decade prior to treating her migraine headaches. She would commonly refer to herself as an “undercover addict.” There was a degree of paranoia that she would be “found out for a fraud” and had even requested that the initial screening be performed via a private, untraceable application on a smartphone.

At the beginning of treatment, it was clear that Sally did not like who she was at her core. Although her mother was physically present, she was overly anxious and controlling during her childhood. Sally often assumed the parental role given that her mother had frequent decompensations for which her mother was hospitalized. Sally developed poor patterns of self-regulation yet wanted to control her life without any assistance. She was a lonely person with a tough exterior facade. Sally felt guilty about her infidelity and more guilty about not being able to control the substances she consumed. In fact, during her course of treatment, she would try to manage her own medication regimen by changing her doses and had poor boundaries, often approaching me as her coworker rather than her therapist.

Sally reports having difficulty with self-control, has made attempts to abstain-believing that abstinence is the ultimate self-control, experienced relapse, struggled with further guilt and shame, and suffered the consequences of subsequent use. Throughout the course of treatment, the door was never closed and Sally has left treatment with you and returned about five times.

INSTRUCTIONS

Construct a Psychotherapy Note based on one hypothetical session with this client.

SOAP NOTE INSTRUCTIONS

The SOAP note is a problem-focused method to document patient care.

DO

·  Use facts, not opinions.

·  When quoting the patient, use quotation marks.

·  The note should be concise and clearly written.

·  Be as thorough as possible.

·  Before you write, consider what you want to say.  The record may be

·  Use professional language and only approved standard abbreviations.

Subjective (S)

(What did the patient say?  It should be quoted verbatim.)

HISTORY OF PRESENT ILLNESS (HPI)  (OLDCARTS OR PQRST)

-OBJECTIVE

(What did you observe?  You will include laboratory values, vital signs and diagnostic tests pertinent to your problem.) Including abnormal labs.

-ASSESSMENT ( MAIN DX AND 3 DIFFERENTIAL DX)

– PLAN ( LABS, PHARMACOLOGICAL TREATMENT, NON-PHARMACOLOGICAL TREATMENT, EDUCATION, AND REFERRAL)

– 2 pages

no plagiarism

include references 2-3 no older than 5 years

– due date MARCH 24, 2023