Saturday, February 2, 2013

The Effects of Trauma on Clients and Mental Health Counselors

            It seems over the past decade there have been more acts of violence than in previous times.  This causes an increase in traumatic events that Americans are facing which in turn creates fears of the event reoccuring, or feelings of anxiety, depression over the event(s) (Bell, Friel, & Stacher, 2007).  Traumas have various effects on survivors, first responders, and even those who come to lend aid.  There are specific roles that a counselor needs to use when dealing with survivors and first responders.  They can fall into the same category, but they are different.  Lastly, it is important that mental health counselors do not devleop VT or STS when embarking on traumas and learn ways to counteract taking on a clients burden. 
Two traumatic events
Colorado Shooting
            Most humans have an understandable fear of Friday the 13th, but some Aurora dwellers might develop a fear of Friday the 20th.  Mid summer at opening night of Batman: Dark Night Rises, a crazed gunman came through the emergency exit door and opened fire on innocent and unexpected movie goers (Pearson, 2012).  Killing twelve and injuring fifty-eight others. 
Sandy Hook Elementary
             Fear and trauma can easily be addressed when looking at the Sandy Hook Elementay shooting that occurred in December.  Innocent children were learning ABC’s and 1,2,3’s while another crazed gunman decided to open fire on the school shooting twenty seven in attendance twenty of them being elementary students under the age of eight  (CNN, 2012).
Effects on Survivors and First Responders
            The two events that have been described certainly have an impact on survivors, and first responders.  Survivors of the Colorado Shootings all fifty-eight of them have the potential to develop PTSD.  First responders can be impacted as well because they arrive first to see the carnage that has befallen those simply wanting to see a movie on opening night, innocently enough not thinking that movie will forever impact their lives. 
            First responders of Sandy Hook Elementary could be deeply impacted not because they have not seen an incident like this, but rather because it involved innocent children.  CNN reported that this was the deadliest school massacre since the Virginia Tech shooting in 2007  (CNN, 2012).  The survivors are the parents of those youngsters, who have to wake up every morning and not make lunches, or help with algebra; the trauma from that experience will last indefinably, learning coping mechanisms is something a counselor can offer both first responders and survivors.
            Symptoms such as depression, anxiety, fear, PTSD, and vulnerability are all results of traumatic events, disasters or crises  (Bell, Friel, & Stacher, 2007).  A study was conduted by Bell, Friel, and Stacher explaining that 30 to 40% of any disaster survivor will experince some level of PTSD for a year after the event  (Bell, Friel, & Stacher, 2007),  on the same note, 10-20% first responders, and only 5-15% of those indirectly effected by the incident will be effected  (Bell, Friel, & Stacher, 2007).   The article goes on to explain that children are more suseptable to PTSD because children look to adults for guidance, and if they see or feel they are suffering they will dewell on the disaster  (Bell, Friel, & Stacher, 2007). 
The Counselor’s Role
            A trained professional counselor has the ability to understand the psychological effects of any disaster, monitor the long-term effects of the trauma in a given community, and provide crisis intervention  (Dingman & Ginter, 1995).  As the traumas continue to occur through out the world the media will cover them and show scenes directly from the site and spare no expense at what harm it could be causing its viewers.  Counsleing needs to be available for workers of the disasters aas well as the resucers. 
            After the September attacks in 2001, cousnelors thought coping sills that helped deal with anxiety and stress.  This created a normmilization when it came to emotions and created sheltered situations for those effected by the worlds largest act of terror  (Baldwin, 2012),  (Dingman & Ginter, 1995). Offering these kinds of approaches, counselors are able to aid in a survivor and first responder’s mental health.  A counselor can be invited to prepare for inpending catastrophic relief. 
Vicarious Trauma and or Secodary Trauma Stress
            Based on research, both secondary trauma stress (STS) and vicarious trauma (VT) have similar psychological concept.  "The cumulative transformative effects upon therapists resulting from empathic engagement with traumatized clients" is how Harrison and Westwood (2009, p.203) translate McCann and Pearlman’s definition.  The vicarious trauma definition to Biard and Kracen is "result of exposure to graphic and/or traumatic material", (2006 p.182).  Counselors that are in contact with clients who have been traumatized have the capability to indirectly experience the same trauma as the clients.  (Harrison & Westwood, 2009; Baird & Kracen, 2006).  Symptoms of secondary trauma stress can be viewed either directly or indirectly to a given traumatic event which has the potential to produce symptoms similar to PTSD. 
            A strategy that could possibly aid a clinician in stearing clear of potential vicarious traumas or secondary trauma stress would be awareness because they are normal and treatable  (Trippany, Wilcoxon, and White-Cress, 2004).  Emplamenting self-care and self awareness activities such as support groups and maintaining a healthy lifestyle can “minimizing potential ethical and interpersonal difficulties" (Trippany, Wilcoxon, and White-Cress 2004, p. 36).  One can only stress awareness as a way to mitigate vicarious trauma and secondary trauma stress, understanding how to defuse is up to each clinician, what works for one may not work for another and so on. 
            In trauma and crisis there is a potential for all counselors to live the trauma or crisis of a client.     In today’s society with wars and other issues that affect the world, counselors have vicarious trauma or secondary trauma stress because the interactions with clients are repetitive.  The role of the counselor is to help survivors and first responders deal with the on slot of issues one could encounter, so being able to help clients incorporate ways of coping will help ease the pain from the crisis of events such as the Colorado massacre or the Sandy Hook Elementary school shooting.  As counselors continue to see patients who are suffering, it is important to recognize when vicarious trauma or secondary trauma stress are occurring and take time to not be sucked in to living the trauma with the client. 

Psychopharmacology and Mental Health Counseling

It seems that the more human development changes, the more there is a demand to understand the role of pharmaceuticals in daily life with regard to mental health.  In the article, The Mental Heath Practitioner and psychopharmacology, "a growing challenge for mental health counselors is to understand the potential benefits and limitations of many different types of drugs"  (Dickinson & Kaut, 2009 p. 204-205).  Incorporating a thorough treatment plan, which might include the use of prescription drugs (Anderson & King, 2004). 
Recommending or Prescribing Medication
            It is imperative for today’s mental health counselors to understand their boundaries and roles when it comes to pharmacology and the patient.  Having a clear and concise understanding of the benefits as well as the risk is an asset to the client, the prescribing professional, and the client (Anderson & King, 2004). 
Legal Limitation
            Counseling professionals that only have reached the master’s level of education do not possess the adequate training or knowledge to suggest medications to clients.  This is why it is imperative for a licensed professional administer.  A counselor may collaborate with a prescribing professional since he or she has an understanding of circumstances behind the recommendation.
Ethical Limitation
            Consulting with clients as well as various medical professionals are in the client’s best interest particularly when a psychoanalyst feels that his or her condition stems from biological factors.  Ethically a well-trained counselor will recognize the need for medications and will recommend him or her to visit an appropriate physician to responsibly write the correct dosage, and amount of times that it is needed to be administered. 
Counselor’s Role in Educating Clients about Medication
            Psychology is a self-educated trade, because not every client is in need of the same therapy.  That said, this is why Dickinson and Kaut have proposed that there needs to be specialized training in pharmacology and done so on a case-by-case basis (2007).  There needs to be continual upkeep with regards to pharmacology and mental health, as well as a clear understanding of its implications to the client  (Anderson & King, 2004).  A counselor’s role is to "understand(s) prescription medication (or other psychoactive drugs/substances) in order to capably address client concerns or therapeutic issues" (Dickinson & Kaut, 2009 p. 216).  Any therapist is capable of providing clients with the necessary information about treatment and prescription drugs and its possible side effects.  In some cases, medical personal can disregard some explanation therefor it is left to the counselor to answer questions about possible side effects from a certain drug because the client will be seen more frequently by the mental health professional than he or she would be by his or her issuing physician  (Dickinson & Kaut, 2009). 
Appropriate Referral Source
            A client can be referred to any medical professional with prescribing rights, usually a primary care physician will allow a patient to come in and under the advisement of a counselor be open to write a script for medications.  If someone needs a specialization drug for example an anti-seizing medication, a neurologist might need to be called in for a consult.  The right avenue of approach needs to be determined by the client’s issues  (Borresen, Gunn, & Ruddy, 2008).          Another road that should be considered is the collaboration with all of the clients medical professionals and have a clear "past history or contextual circumstances" (Kaut & Dickinson, 2007, p. 218).  Counselors might relay ethical information to a physician to provide adequate pharmacological treatment.  The ultimate goal is for the client’s best interest to be considered by both the physician and the mental health professional. 
            "Health care professionals must receive training in how to work together productively" and "must work toward developing interdisciplinary relationships"  (Borresen, Gunn, & Ruddy, 2008 p. 123).  The role of a mental health counselor is critical when communicating with any prescribing professional since it "maximizes client outcomes where integrative therapies are involved"  (Dickinson & Kaut, 2009 p. 218).  Because the psychotherapist is in contact with the patient, he or she has the opportunity to join forces with others in the medical profession and be their eyes and ears to the appropriate professionals.  As the treatment continues the mental health counselor re-assesses both the effects of treatment.  Overall, the focus is on the client’s best interest  (Anderson & King, 2004). 
            Based on the readings and information provided by scholars it is imperative for psychologists to communicate with both the client as well as the prescribing physician. Ethical and legal reasons are for the safety of the patient, thus resulting in trained professionals to administer any drugs felt required by a psychologist.  This is for the patient’s safety and concern.  A clinician will be in more contact with a patient so he or she will be able to ascertain if there are any complications arising from the medications.  Clinicians can educate and train those who require medications so he or she is aware of possible side effects.  Lastly, it is vital for the referral to work appropriately there could be a history that a physician could be unaware of that is needed to be know that a patient could not tell him of.  Maximizing the client is the outcome of any therapist and if it has to be done with the use of pharmaceuticals, then a client should be accepting to that option.  

Journal Entry 7

This week’s assignment has been an eye opener.  I have never been one to judge people because of who they are, where they’ve come from, or their education level.  However this week I have seemed to find that it is possible regardless of how much I want to retain that open mind, I see bias rearing its ugly head.  The multicultural self-assessment was not surprising.  I did as was instructed and was honest with my answers.  I have had to sit and do some reflecting because to many I fit the ‘other’ category and while the required readings and video links were of people from other nationalities, I am a Caucasian, I have a decent education, however, I am finding that this too poses some challenges.  As a result of my self-assessment, I plan on making several changes with me going forward by creating a statement of counseling identity.
Summarize Multicultural Self Assessment
            These self-assessment that are provided are designed to enlighten the individual responding to the questions asked only if they are answered honestly and without bias.  I came into this test on Monday with anger and distrust and knew that my answers would be reflected by my mood.  I took the test anyway.  Most were all one’s except a few where I felt I was honest.  After a few days of ‘calming’ down, I went back and took the same test again and the answers seemed a bit more honest of my true self.  In order for me to be a successful mental health professional, I need to be able to look past multi-cultural issues, and bias emotions so that I can make sound judgments for those I encounter in therapy.  
When I realized I Was “Other”
            Growing up I never felt that I was different; I had parents who loved me for the most part, had a small handful of friends I spent time with, however I never seemed to really fit in when it came to my immediate family.   I had the traditional blonde hair and blue eyes I was always dressed nicely, Mom spent hours on my clothes it seemed.  I recall a group of classmates were sitting on the stage in middle school and we were discussing families, and how one young lady looked similar to her mom, and another looked like her aunt.  Someone turned to me and said that I didn’t look anything like my mom or my dad.  I looked and said to them "No, I don’t I am adopted.”  One child responded with what your real mom didn’t want you?  That was the first time I had heard someone say ‘real mom’ and not biological mom.  For me Mama was my real mom, and Daddy was my real dad.  I had enough sense at 13 or 14 to be sort of mean back but I got my point across by saying unlike your family that you were born into, I was hand picked to be with my family.  From that day on, I have understood what minorities feel like not to fit in, what some feel when they are abandoned, and certainly what an adopted person is feeling.  Trying not to place people into that ‘other’ category is sometimes more difficult than just saying I am not bias.
My Reaction
            My reaction to being other has shaped me, I have used it to become who I am today.  I push myself to not let those who are being placed in the ‘other’ category feel they are there.  I feel we are a human race; that silly coke commercial from the 1970’s keeps popping in my where there are people standing on a hillside singing they’d like to buy the world a coke; you see a young blonde standing next to an African American, who is standing next to an Asian, and so on we need to stand united and not divided.  
            On the self-assessment part, I was shocked more at my first answers than the second set of answers that I did.  I have always heard that you get someone mad or give them too much alcohol and the truth will come out, that scared me that I can have those feelings going into the profession I am wanting a degree in.
Actions Going Forward
            I think that I have some work to do, as most human being would say if they were being honest with themselves on the assessment and they have a strong desire to change.  I need to really work on my asking questions until I am clear so I can understand what is being said.  I also want to work on being able to adapt to change; both of which I scored one’s in.  I don’t like change I think that stems from my childhood, however if I can accept change in me, then it will be easier for me to accept change in other situations. Another improvement I would like to make is being more social.  I know this comes from my childhood, and how I do not feel comfortable in new situations for fear of being judged by others, or somehow receiving pity from the life that I had.  I view a lot of people as ‘not good’ and let me explain that.  I don’t mean that everyone is a criminal or out to do wrong, I just generally have reservations when it comes to folks who I let into my inner circle.  I know that stems from bad adult choices. 
Statement of Counseling Identity
            Looking for the right words to put here can be challenging.  Using the examples provided I have found this defines my counseling identity best.
            As multicultural our nation is, I accept that I will behave in a positive manner and honor those who act in kind.  I am dedicated to helping those who face concerns in their lives regardless of ethnic background, gender, mental or physical abilities, or education level.  I am willing to guide clients based on his or her goals, and pull their strengths out with them and make them shine.  I vow to continue to seek knowledge though meditation, and education for things I am yet to understand. 
Importance of Multicultural Awareness in Mental Health
One look at the United States and one can see that our culture is becoming more and more diverse by the moment.  “In urban centers, almost two-thirds of the students are neither European-American nor middle-class” (Zion and Kozleski, 2005, p. 2).  As the population continues to grow, wars continue to battle on and the United States becomes a safe haven for those seeking refuse, I will see beliefs, behaviors, values and customs that are different from mine.  I recognize after this weeks reading that I will have to prepare myself with any one sitting across from me in a counseling session.  I need to be abreast of characteristics and skills that will allow me to be a proactive counselor.  This week I have been inspired to think outside of the box and seek new ways to bring counseling to those of a different culture than mine. 

Applying Theory to Practice

            There are nearly a dozen theories that are available for psychologists to use in any therapy setting.  What type to use is decided upon by the therapist.  For example in my case, I think that using the psychodynamic theory, the humanistic theory, behavioral/cognitive theory and the systems theory would best work for my approach to mental health. 
Psychodynamic Theory
            In the psychodynamic theory, Sigmund Freud chose to look at problems facing human beings.  Today that theory has been modified to focus on the past, and one’s subconscious.  This is why many therapists use this as a foundation for therapy.  By using this theory, especially in the field with which I would like to venture,  this would help public service individuals to unlock possible areas of their lives that may have been repressed. 
            Incorporating Adlerian Psychotherapy uses holistic approach to help understand the individual.  Alfred Adler helped define psychotherapy a bit more by elaborating that most human beings are more conscious rather than unconscious as originally thought.  Adlerians feel that life problems are based from society.  Adlerian counseling seeks to correct mistakes in perception and logic that make people in their effort to fit into social relationships and to overcome feelings of inferiority" (Brown & Srebalus 1998).  
            Jungian theory also falls under the Psychodynamic approach.  It also can be referred to as ego psychology. Various adaptations of Jungian can be seen in use today, however most will see Adlerian and psychoanalysis. 
            Using the psychodynamic approach will be beneficial because it focus on the client and allows him or her to see the events from one’s past does not define him or her in their future as long as the or she is capable of change.  The psychodynamic approach is the most frequently used theory amongst therapists. 
Humanistic Theory
            The humanistic theory is defined as relationship orientated therapy.  In stark contrast to psychodynamic theory and its focus is on future and current functioning (Erford, 2010).  This theory relates deeply to the good that humans possess.  The humanistic approach assesses one’s choice and how it creates either negative or positive effects in ones life.  The humanistic theory also portrays how human beings allow other human beings to manipulate the value of one’s self worth.
            Humanistic theory  has also been criticized, because of its focus on the individual’s aptitude, which breeds the belief that humans are good which makes it more incomprehensible why some humans are capable of committing crimes. It makes it complicated to assess the client as clinicians only rely on his or her own opinion of their life experiences. 
            Using the humanistic theory in cooperation with psychodynamic can help the client see the changes that will lead to a more fruitful and productive life.  This theory resonates with me the most because it has been said so many times that a zebra never changes its strips, however if someone wants to change they will.  They have to find the courage to change.
Behavioral/Cognitive Theory
            Behavioral/Cognitive theory is based on information.  Cognitive theory relates to a person learning from his or her past.  Based on information provided by, (Conner, N.D.) “Behavioral instruction hinges on the use of observable, measurable, and controllable objectives.”.  Behaviorists feel that by changing our moods, improve relationships and decrease one’s stress and anxiety, we can change ourselves.  Behaviorists are endless optimistics always looking at a brighter world.    
            Behavior/Cognitive theory was selected because we are human beings and most of us learn from our past.  This theory can be beneficial to the client to help them see mistakes they may not have initially been aware of and strive to not make the same mistakes as before.  This too is a leader in the psychology field when asked what type of therapy is popular.
Systems Theory
            The systems theory is one that looks at how one cause can trigger a chain of events.  This can be something as simple and end up causing multiple effects.  This works in psychology very well.  A patient can see how one small event sends one down a road least traveled.  For example in my ideal job scenario; a police officer may be effected by an event he sees during his tour and while it doesn’t effect him at that moment six months to a year later, it could trigger him to have another associated event, and that event could eventually trigger another and so on until the officer is unable to preform his job duties.            
            Synergy is another aspect of the systems theory that is used in psychology.  It defined as when a group’s outcome is greater than its original members.  A great example of this was all of the federal agencies working together to achieve one common goal, which was to bring down Osama Bin Laden.  Along side synergy there is negative synergy.  Negative synergy is just the opposite where it has a negative effect on the group.  This could stem from one person that can lead to the entire group following the negative person.  An example of this could be a disgruntled employee bad mouthing a company which then leads to employee’s following the one negative person.  
            Lastly, using systems theory works very well in the profession I am seeking employment.  As officers they are a group and can be influenced by every day activities.  Everyday work events can trigger a landslide because of something they have witnessed.