Reference no: EM132268026

Lecture.

As school counselors, you will all have different types of ways to use techniques to work with your counselees. One of those things are practitioners, in your case, school counselors, need to function with intentionality. In other words, they must have a clear understanding and a sense of expected outcomes of their interventions. Also, some specific techniques appear to be more effective with particular symptoms and disorders, especially for certain behavioral disorders.

So unless you're working with counselees that have behavior disorders or what have you, those techniques may very well be a little bit different for a population, and in some cases may even be the same. The therapeutic alliance enhances the quality of the working relationship. In other words, the better the rapport that you have with a counselee, the quality of the working relationship will be strengthened.

The techniques counselors employ, although important, are less crucial to therapy outcomes than they are interpersonal factors operating in a client-counselor relationship. Now, as this text is more so written to clinical mental health counselors, for school counselors, you have to think about the interpersonal factors that are operating within your relationship with your counselee. So from your own personal counseling style, from your own culture, understanding your world view, to also understanding the world view of the counselee.

And much of your technique will also depend upon the rapport that you have which your counselee, the type of school setting you're in, for example, in a high school, you might not have as much time because of the subject matter courses that high school students have and how important it is for standardized tests to be passed and for students be academically successful. And you may have a little bit more time in an elementary setting, where they may come to your office for 10 to 20 minutes.

But those techniques you use will be based specifically on the type of rapport you have with that counselee, the type of school you're in, the resources you have to you, and then yourself being observant of your counselee to see what works best with the person you're working with and where you are.
End of Lecture....

Discussion Question #1

Talk about your school counseling style. Especially discuss how cultural competence impacts your counseling style. How could your personal counseling style affect ethical conduct? How could your counselees be affected?

Answer should be between 100 words.

Lecture

The DSM-5, better known as the Diagnostic and Statistical Manual number five, have move to a nonaxial documentation of diagnosis. Before, when we used the DSM-4, we had, what was called, axial. So we connect this particular behavior to that particular behavior. That meant that you had this particular mental disorder or in the group of mental disorders.

Today we go from a nonaxial documentation of diagnosis. So in the revision process, what the American Psychiatric Association paid considerable attention to was one, developmental issues, which you may find among your counselees in schools, gaps in the current system, disability and impairment, neuroscience, and cross-cultural issues. So they've changed some of the focus of the DSM-5.

And it also lacks an operational framework for assessing distress when diagnosing a mental disorder. Also, an increasing number of phenomena that were previously considered clinically unremarkable are now labeled as mental disorders and are likely to be treated pharmacologically, in other words, with medication. And the authors of the DSM-4 have critiqued the authors of the DSM-5 for expansions that they believe will cause harm from over-diagnosis and false positives in practice.

In other words, those things they might not have thought about in terms of behaviors of persons, in your case students in K-12 schools, now have been expanded out to other issues that, again, may give a false positive. So it might not be as-- in the DSM-4, it might not have been as extensive. But now in the DSM-5, oh, we're going to consider these things. And what it may do for your counselees is make them look a little bit more dysfunctional, if you will. And they really aren't.

So again, as we talk about cultural encapsulation, mores, your worldview, those things absolutely have to be taken into consideration, even though you're not going to diagnose a student, because you're not a clinical mental health counselor. And the National Institute of Mental Health announced its plan to develop its own psychiatric nosology, the Research Domain Criteria, which would classify mental disorders based on specific functional analysis of certain cells, genes, neural circuits, and behavior.

So now we're adding more criteria before we come out and say, OK, this person has attention hyperactivity disorder. Or this person is bipolar. They're adding more factors, as opposed to some surface factors that say, OK, now you are this disorder, and this is how things should go.

So the case with psychodiagnosis, used to assess whether client, and in your case counselees, pose a danger to themselves or others. As we talked about this before with informed consent and duty to warn, as a school counselor, these are things you might need to notice, but not necessarily things that you can diagnose, because you don't have the scope of practice to do so.

It also allows therapists to rule out medical conditions, provides team members with a common frame of reference. So you have a foundation and a framework, can assist in conceptualizing a case, difficult to formulate a treatment plan without defining the problem. And again, you will not be assessing or diagnosing as a school counselor. Provides a framework for research and may be critical to determine therapeutic success of the client or counselee.

The case for psychodiagnosis continues. May seldom have a choice about diagnosis. So your counselees, or your clients in that matter, OK, these factors are here. They're evident. This is your diagnosis, which can lead to maldiagnosis and maltreatment. It may be a minimum standard of care for some licensed professionals and no insurance reimbursement without an acceptable diagnosis.

So now all these criteria are being put in place to almost have a sure shot as to, this is the diagnosis. Now we will give you care, because you show all these things. And that's where the evidence-based practice comes in, in terms of diagnosing persons with mental disorders. But here, again, as a school counselor's scope of practice, you will not be diagnosing any of your counselees.

So here's the case against psychodiagnosis. What should we consider here? Done by an expert observing a person's behavior and experience from an external viewpoint can minimize the uniqueness of the client. Just because they're exhibiting certain behaviors, doesn't necessarily mean that they have this disorder.

Ignores the natural capacities for self-healing. Your counselees come to you, clients come to other types of counselors, with the mindset that they are normal and that they have the ability to solve their own problems. They ignore natural capacities for self-healing. Emphasis on the DSM is on pathology, as opposed to trying to help the counselee.

Can lead people to accepting self-fulfilling prophecies, assumes that the distress in the family is the result of the individual pathology, not really paying attention to the individual themselves, but just the environment. It does not adequately consider contextual, social, and cultural factors. So if this is the behavior, this is it, but not really considering how other aspects of that person's life may impact their behaviors, which others may say, oh, this is a mental illness just because these things are present.

Many therapists are not competent enough to use a DSM diagnosis properly. And it has been criticized, for example, for reliability and validity questioned, failure to predict treatment outcomes. In other words, not enough factors to really just say, hey, this is what's actually happening, but also not being careful to separate the person from that. Say, OK, well, what's actually going on with this individual in lieu of these things that we see that may end up being criteria?

So what are some of the ethical and legal issues of diagnosis? Some practitioners are opposed to diagnostic framework, take the path of least resistance, giving every client the same diagnosis. Particularly with this funding involved, in some agencies, this is what works. This is what gets reinforced. This is what we're going to do.

So that person may not be schizophrenic. They might just be suffering from depression and mood disorder. But since schizophrenia pays the bills, guess what? That's what that client is going to be diagnosed as. Presenting an acceptable but inaccurate diagnosis is both unethical and fraudulent, so same type of thing. Schizophrenia is what pays the bills. It's acceptable. But if it's inaccurate, that is unethical.

It's an ethical, and sometimes legal, obligation of counselors and therapists to be mindful that medical evaluation is many times indicated. And competence using the DSM appropriately is an ethical issue, because at the end of the day, many times, it's at the discretion and the judgment of that counselor or therapist to make that diagnosis based upon either what the criteria is or what they actually believe.
End of Lecture..

Discussion Question #2

School counselors' scope of practice prohibits diagnosing counselees for a possible mental disorder. However, you may recognize symptoms of mental illness. Discuss how ethical conduct is important when school counselors' scope of practice limits and/or prohibits counseling based on mental illness.

Answer should be between 100 words.