Counselling and Therapy Credentials

Introduction

I’m about a year (8 courses in fact) away from wrapping up my Bachelor of Professional Arts in Human Services from Athabasca University. This has led me to explore potential graduate schools on my path to becoming a therapist in the future. One thing I’ve discovered is that there’s a lot of confusion around different credentials and what they entitle one to do.

This post is focused on Social Work, Psychology, and Counselling, with an added bonus of identifying distance learning schools where individuals may take these programs.

College Diplomas

College diplomas include 2-year Associates degrees in the United States and Colleges of Applied Arts and Technology CAAT) diplomas in Canada. Examples include:

  • Associates in Human Services
  • Associates in Social Work
  • Social Service Worker, an online version is available through Durham College
  • Community Service Worker

These are entry-level credentials to give you the basic skills to work in the social services. Some of these credentials, such as the Social Service Worker diploma, allow you registration into a professional college (e.g. the Ontario College of Social Workers and Social Service Workers) but most do not.

These programs provide training and experience in assessment (such as suicide risk assessment) and provide training in basic counselling skills but do not prepare students to diagnose or provide therapy.

Job titles for college diploma holders may be:

  • Intake Worker
  • Case Manager
  • Program Manager
  • Shelter Worker

Bachelor’s Degrees

Bachelor’s degrees are the 4-year degree most common in the US and Canada. A 4-year degree may be in Human Services, Psychology, or another discipline. If you earn a Bachelor of Social Work (BSW) you are usually eligible for registration with the appropriate Board of Social Work or College of Social Work. On the other hand, a credential in Psychology or Human Services will not entitle one to registration.

Job titles for Bachelor’s degree holders will be similar to college diploma holders, with the added component that Bachelor of Social Work holders are entitled to the protected job title “Social Worker.” Bachelor’s holders with training may perform assessments and other tasks.

Online programs include Athabasca University’s Bachelor of Professional Arts in Human Services, or Liberty University’s Bachelor of Science in Social Work program.

Bachelor of Professional Arts in Human Services

This is the program I’m completing at the moment. Because I completed a Social Service Worker (SSW) diploma from Durham College (see above), I received 2 years/20 courses of transfer credit towards the 4 year degree, requiring 20 courses to finish.

These courses can be completed online, with no specific semester start and end dates. Instead, if you pay your courses yourself you have 6 months in which to complete them; if you are receiving financial aid (such as through the Ontario Student Assistance Program) you have 13 weeks in which to complete each course.

The fee (approximately $600 CAD for a student in Alberta, $800 CAD for a student elsewhere in Canada and $1000 CAD for a student outside Canada) includes all the course materials including textbooks shipped to you to complete the course. This makes it a very economical option for a Bachelor’s degree.

Examples of courses in the BPA Human Services that are required:

  • Social Work and Human Services
  • Ideology and Policy Evolution
  • Critical Reflection for Practice
  • Professional Ethics
  • Practice and Policy in the Human Services

Master’s Degrees

Here’s where it starts to get complicated. There are a number of Master’s degrees that one may use to enter the counselling or therapy professions. These include a Master of Arts in Counselling Psychology, Master of Counselling, Master of Education in Counselling Psychology, Master of Education in School Psychology, Master of Social Work.

Master of Arts (MA) in Counselling Psychology

The MA in Counselling Psychology may be a practice degree, allowing one to register as a Licensed Mental Health Counsellor (LMHC) or it may be a step on to a PhD or PsyD in Clinical Psychology. Individuals may qualify for registration as Psychological Associates or in Alberta as Psychologists.

Examples of online programs includes Yorkville University‘s program, which is based out of New Brunswick.

Master of Counselling (MC)

The Master of Counselling degree is offered by Athabasca and provides similar training as other counselling degrees such as degrees in Counselling Psychology or other. Athabasca offers specializations in Art Therapy, Counselling Psychology and School Counselling.

Examples of courses taken in the MC degree include:

  • Models of Counselling and Client Change
  • Intervening to Faciliate Client Change
  • Devleoping a Working Alliance
  • Professional Ethics
  • Assessment Processes

This program qualifies for registration with the Alberta College of Psychologists.

Master of Education (MEd) in Counselling Psychology

The Master of Education (MEd) degree in Counselling Psychology is offered through a school’s Faculty of Education rather than a Faculty of Social Work or Faculty of Psychology. One example is University of Toronto’s MEd. This program is designed as a terminal degree to train counsellors and therapists. Courses in this program include:

  • Theories and Techniques of Counselling
  • Critical Multicultural Practice: Diversity Issues in Counselling
  • Group Work in Counselling
  • Ethical Issues in Professional Practice in Psychology
  • Career Counselling and Development: Transitions in Adulthood

Because these programs are in the Faculty of Education they are more likely to cover school counselling and be designed to train counsellors or therapists that work with students and young adults. One example of an online program is the University of Massachusetts–Boston’s MEd in School Counselling.

Master of Social Work (MSW)

The Master of Social Work is the terminal degree for Social Work practice in Canada and the United States. These programs are either one year (for individuals who have already completed a BSW) or two year (for individuals who have not completed a BSW.) These programs qualify for registration with organizations like the Ontario College of Social Workers and Social Service Workers (OCSWSSW) in Canada or a State’s Board of Social Work in the US.

MSW degrees can be focused on macro (community) social work, or micro (individual) social work. Macro social workers are employed in community development, program design, administration and other areas while micro, individual or clinical social workers are employed as counsellors, therapists and other clinical mental health professionals.

An example 2-year online MSW program is that available from the University of North Dakota. Courses in that program include:

  • Human Behavior in the Social Environment I
  • Generalist Practice with Individuals and Families
  • Generalist Practice with Communities and Organizations
  • Social Policy
  • Generalist Research Methods and Analysis

Doctorate Degrees

Doctoral degrees prepare individuals for advanced clinical practice in the fields of Psychology and Social Work. Doctorares usually involve a component of research and practice. Some degrees not listed here (such as the PhD in Social Work) have no practice component and are designed chiefly to train researchers.

Doctorate of Philosophy (PhD) in Clinical / Counselling Psychology

The PhD in Clinical Psychology or PhD in Counselling Psychology are designed to train professional Psychologists. These programs are usually 5-7 years in duration and involve the completion of a PhD dissertation, a book-length research project. In addition to learning these fundamental research skills, Psychologists also learn how to administer and interpret psychological assessments like IQ tests and how to deliver therapy.

These programs are among the most competitive to get into, often admitting 5-10 candidates among the 100+ that apply for admission.

The differences between Clinical Psychology and Counselling Psychology are minor, but Clinical Psychology tends to focus on individuals with more psychopathology than Counselling Psychology.

Examples of courses in the PhD in Clinical Psychology at Ryerson University:

  • Ethical Professional Issues in Clinical Psychology
  • Systems of Psychotherapy
  • Cognitive Neuroscience
  • Community Psychology
  • Mood Disorders

Doctorate of Psychology (PsyD)

The PsyD is a newer program than the PhD, emerging to meet needs of individuals who primarily want to practice therapy and assessment rather than work as scientists or researchers. PsyD programs are offered by a larger variety of educational venues, such as by professional schools of Psychology (like the Chicago School of Professional Psychology) rather than a university.

The PsyD involves learning to utilize research rather than produce it. Because students in a PhD program are creating researcher, they are “paid” to do so, by having their tuition subsidized (often free), and by being given a living stipend, while PsyD students more commonly have to “pay their way” through their program, upwards of $100,000.

Otherwise, PsyD and PhD graduates learn the same skills and are eligible for licensure in the same way – as long as their programs are accredited by the American Psychological Association (APA). Although there are online PsyD programs such as those offered by Walden University and Capella University these are not eligible for APA accreditation and therefore are unlikely to result in licensure.

Examples of courses available in the Chicago School of Professional Psychology’s PsyD program:

  • Biological Bases of Behavior
  • Health and Dysfunction
  • Cognitive Assessment
  • Cognitive Behavioral Theory and Therapy
  • Personality Assessment

Doctorate of Social Work (DSW)

The Doctorate of Social Work is the newest doctorate program. This program is similar to the PsyD in that it is a practice degree rather than a research degree. One example of a DSW is that offered by Tulane University in Louisiana. This program is available online but has significant tuition attached to it, up to $70,000.

Reflecting the existing education of their students (all of whom have an MSW or similar degree accredited by the CSWE) these programs are shorter than a PhD would be, often running 3 years versus the 5-7 years for a PhD or the 5 years for a PsyD.

Examples of courses in the Tulane DSW:

  • Historical Approaches to Social Welfare
  • Social Work Theory, Practice Models & Methods
  • Applied Social Statistics
  • Measuring Social Phenomena: Social and Economic Problems
  • Advanced Clinical Project Seminar

The goal of the DSW program is to train practitioners who are experts in policy analysis, program design and development or implementation of specific therapies.

Cite this article as: MacDonald, D.K., (2017), "Counselling and Therapy Credentials," retrieved on May 29, 2017 from http://dustinkmacdonald.com/counselling-therapy-credentials/.
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Coping Skills Therapy for Managing Chronic and Terminal Illness

Introduction

I recently had an opportunity to read this excellent book written by Social Worker Kenneth Sharoff. It presents a model of therapy he calls “Cognitive Coping Theory” (CCT) and applies this model to working with individuals who have chronic (or life limiting) and terminal illnesses.

Below I present some of the content from the book I found particularly useful.

Executive, Policy and Operational Beliefs

The first concept in the book, after the discussion of how CCT fits in with CBT and other therapies and models is the idea of policy, executive and operational beliefs. Policy beliefs are the most high-level, and roughly match what is called schema in other therapies. Examples of executive beliefs given in the book include:

  • My body should not interfere with my ability to pursue my career
  • Doctors must find a cure for my disease. Doctors and modern medicine should be able to cure me

Executive beliefs are often “shoulds” or “musts” that frame an individual’s approach to a situation. They dictate rights and beliefs about what an individual will experience – even when those things are out of that individual’s control. These policy beliefs are then carried out by executive beliefs, which explore how the policy belief is carried out.

One example is someone who wishes to join the Police Service even though they have found themselves paralyzed after an accident. They may hold policy beliefs like “I should be able to do whatever I set my mind to” and “My body should not interfere with my ability to pursue my career”, the resulting executive beliefs might look like:

  • Get angry at those around me who do not recognize my struggle
  • Continue trying to join the Service even though I am not able to
  • Vent my jealousy at individuals who are not limited in this way

The policy beliefs influence the Belief part of the Cognitive Behavioural Therapy ABC scale, while the executive beliefs influence the Consequences part:

  • Activating Event – I am not able to pursue my chosen career
  • Belief – I am inferior if I can’t pursue my dreams
  • Consequences – I feel worthless, angry, jealous, etc.

The last type of beliefs are known as operational beliefs. These are the most concrete thoughts that an individual has related to their illness. Examples include:

  • I am worthless
  • My life is awful
  • It’s not fair that I am experiencing this

These might be compared to the unconscious thoughts typical of CBT. Changing the executive beliefs, which dictate coping strategies, or responses is a key part of CCT.

Phases of Coping with Disease or Disability

Sharoff dictates five phases of coping with disease or disability. They are:

  • Crisis
  • Postcrisis
  • Alienation
  • Consolidation
  • Synthesis

Like most models, this is presented linearly but an individual may move back and forth among the phases as they proceed through their illness or disease.

Crisis Phase

In the crisis phase, the individual is first experiencing symptoms. They may be experiencing feelings of threat or loss, and experiencing a loss of self-esteem, self-efficacy, and increases in physical discomfort or other direct impact by the illness.

Sharoff describes “dream crush” – the feelings experienced by someone who has discovered that their plan for themselves is no longer possible because of their illness. He identifies “self-placement” as a significant component of this. Self-placement is the task of comparing yourself to where you want to be in life at a particular point in time; realizing that you are not “living up” to this ideal causes significant distress.

Changes in identity are also common in the crisis stage.

Postcrisis Phase

In the postcrisis phase, an individual has become accustomed to their situation. They begin to stabilize in that things become routine. As they resume as much of their previous roles as possible, the feelings of “anomie” end. The postcrisis state may lead to alienation if they have not are still experiencing negative emotions as a result of their illness’s effect on the body.

Alienation Phase

The alienation phase involves a psychological disconnection from the body. An individual struggling with a chronic disability or disease may actually disscoiate themselves from their body and see it as distant or distinct from themselves. This provides short-term coping but will not allow the individual to progress past this state.

Hostility or indifference towards their body is common, as individuals seek to separate themselves from their disease. The major tasks of this phase are to neutralize bitterness and to work on beliefs of disfiguration. If individuals believe they are disfigured, the negative beliefs that lead tot his will need to be worked on in order to avoid a loss of self-esteem or feelings of inferiority.

Consolidation Phase

The consolidation phase may be entered into directly after the postcrisis phase if the individual is coping adequately, or may require significant work in the alienation phase if they are not. An individual in the consolidation phase feels more in control of their life, and may experience increased self-efficacy.

Although an individual may experience a loss of meaning, they can develop new goals and behaviours that work within the limitations of their body. If they are able to do this successfully they will begin to move to the Synthesis Phase.

Synthesis Phase

The final phase of coping is the Synthesis Phase. This phase is marked by a blending of the old and the new, and a recognition that although an individual is changed by their illness they can still find a quality of life and activities that bring them happiness.

Skills Training

Sharoff suggests a variety of coping skills and strategies for each phase that an individual that will pass through. For instance, for individuals who have magical thinking or wish that they could control things like what activities they can perform now that they are limited by their disability, focusing on “area thinking” is one strategy to work on this. In area thinking, an individual considers each goal and whether that is within their control. If it is not, it is consciously replaced by a different goal that is within their ability to control.

What is below is just a few of the many skills, subskills and microskills contained in each category. They are accompanied by detailed explanations and demonstrations of the skills and other tools to make them as useful as possible in therapy.

Assimilation and Rejection of Suffering

Assimilation of suffering means to cope with suffering and to accept that some degree of discomfort, pain or suffering is a necessary part of the process of coping. It is expressed by complaining and expressions of powerlessness, with an undercurrent of magical thinking that if one rejects or denies their reality or the future that it will go away.

This involves acceptance of the reality (without enjoyment of it), forbearance (accepting showing “patience, tolerance, and restraint” with themselves demonstrating endurance as a personal goal), and forgiveness of one’s body, self, their deity or others they may blame for the illness.

Other coping skills that may be used include guided imagery, therapeutic metaphors (such as David versus Goliath) deep breathing, self-encouragement and substituting automatic thoughts when they occur. Outcome enactment is borrowed from solution-focused therapy and asks clients to identify when they do not suffer, and then to note what thoughts or feelings underlie that lack of suffering.

Discomfort and Frustration Management

Sensory diversion training is used to cope with physical discomfort. It involves choosing a sense like sight, smell, or touch and mindfully focusing on an item involving that sense. For instance, if someone who is experiencing pain focuses on an object they can see, and follows it with their eye, tracing it and creating a mental map. Then, moving to the next object, continuing this process until they are no longer aware of their negative physical symptom.

“No Mind No Thing” is a technique borrowed from Buddhism to deal with frustration or other negative experiences by attempting to clear the mind of conscious thought. This is a meditative technique that involves staying in the present and taking in all sensory input. Use of a white noise machine may be helpful in this regard.

Self-instruction training involves using positive self-talk by examining the positive aspects of thinking well and maintaining mantras. Managing activities can help an individual avoid frustration but running up against the wall created by their illness.

Identity Management

An individual’s identity can be challenged by the onset of their illness. Identity is measured by one’s belief in their membership in a group, such as men, military veterans or construction workers. For instance, a woman who believes that in order to be a woman she must have breasts will experience distress when she loses a breast to a mastectomy as a part of breast cancer treatment.

Identity adulteration describes the process by which an individual’s identity has changed as a result of their condition. Identity alienation is indifference towards the individual’s changed body, while identity loss is the recognition that an individual has (rightly or wrongfully) lost their membership in a chosen group.

Reconciling identity involves realizing that we often adopt restrictive definitions of what it requires for membership in a category. Continuing the example of the woman missing her breast, reconstructive surgery may allow her to feel like she belongs to the group again, or seeing other elements of womanhood like nurturing behaviour.

This is especially important for men who often put high standards on themselves, believing a very narrow definition of manhood. Expanding that definition to include stability, being a provider, being confident and assertive, and other “soft skills” may help reduce the distress an individual feels when they cannot participate in their former vocation, if they are physically not as imposing as they were, or are experiencing other symptoms as a result of their illness.

Self-Support Training

Self-support training involves the reduction of self-criticism and building a strong internal support network so that individuals do not have to rely on others who may be inconsistent in their ability to provide support. Self-support training involves focusing on strengths (known as becoming a self-booster), holding self-compassion, self-advocacy and exoneration training.

Exoneration training is a skill that may be used when someone holds themselves responsible for their shortcomings. For instance, someone who cannot pursue a hobby of running because of their multiple sclerosis may blame themselves for that outcome – even though they have no control over it.

Sharoff recommends instead, staging a “mock trial” in an individual’s mind. Stack all the evidence for the belief, against all of the evidence against. Play prosecutor and defense, in order to stimulate a protective instinct in the client. If they steadfastly hold to their belief that they are responsible, he recommends taking it further and having them determine guilt or innocence, and even prescribe punishment! The reason for this seems paradoxical, but punishing themselves for their own maladaptive beliefs helps them to realize the futility of their thought processes and may enable them to begin moving towards a less blameful attitude.

Uncertainty Tolerance

Uncertainty is at the heart of chronic illness, disability and disease. Although an individual’s disease course may stabilize, in many cases there is an uncertainty about the future. Self-monitoring is suggested in order for clients to recognize when they are feeling uncertain.

Deep breathing and other relaxations exercises can be used to cope with high levels of anxiety, along with “worry management” where an individual decides to limit their thoughts about their illness to a certain time per day (such as 15 minutes in the morning and 15 minutes at night.) This management gives them permission to push those thoughts out of their mind at other points in time, and apply thought-stopping when necessary.

Bitterness Disposal Training

Bitterness is an extremely common part of coping with a chronic illness or disease. Bitterness can be experienced inwardly (such as bitterness with your illness or your body) and outwardly (such as challenges with friends or family.) Examining one’s identity as perceived by others is an element of this process, followed by comparing that image of others to one’s self-image in order to determine if others are making unrealistic demands on them.

Recognizing that the disease is the cause of their feelings may help them externalize those thoughts. Cognitive restructuring allows an individual to compare their thoughts and expectations about those around them with the reality, by examining the other person’s identity (the husband or wife, the brother or friend) and how that affects their behaviour.

Constructive mourning allows an individual to grieve the changes in their life, by allowing that person to ventilate those emotions.

Body Accommodation and Disfigurement Neutralization

Body accommodation is the process of recognizing that one’s body has changed and setting softer standards to accept the body as it is rather than rating it or comparing it with a previous body or someone else’s body. This can be a difficult process as it involves realistic expectations and changing negative attitudes.

Positive self-talk before engaging in activities can help mitigate automatic thoughts of weakness or worthlessness that may occur as a result of the disability.

Disfigurement neutralization involves evaluating the client’s beliefs about themselves, and the words that they use. Assigning meaning to those words as a severe negative evaluation, that can be changed. New beliefs about an individual should be proposed, that see the body objectively, the result of the illness and not the individual’s decisions.

Meaning-Making

Meaning-making is the process of making a new plan for one’s life after the onset of an illness. This can be because depression or physical/emotional limitations have caused an individual to be unable to pursue their dreams or because the onset of a terminal illness makes them feel like their existing plans are no longer powerful enough to satisfy their desire for meaning in their life.

This process involves deciding on new goals, starting from the very small (like waking up at a specified time or engaging in basic hygiene) to larger goals, like exploring new options. Instilling hope will help the client stay curious and continue to move towards their new goals.

This may also involve helping clients learn to be “alone” with themselves to stimulate creativity, and allow clients to explore new options.

Limitation Management

Finally, limitation management involves activities to help clients cope with their “new self.” Limitations caused by illness can create a feeling of helplessness and a lack of control that can cause depression, anger or other sensations. This involves skills previously discussed like deep breathing and relaxation, forbearance, and acceptance of things that one cannot change.

Focusing on elements that are within an individuals’control may help move individuals closer to the things that bring them happiness.  Self talk can also be helpful in this regard.

Cite this article as: MacDonald, D.K., (2017), "Coping Skills Therapy for Managing Chronic and Terminal Illness," retrieved on May 29, 2017 from http://dustinkmacdonald.com/coping-skills-therapy-managing-chronic-terminal-illness/.
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Sequential Intercept Model

Introduction

The Sequential Intercept Model was developed by Mark Munetz and Patricia Griffin (2006) to help communities understand the way people with mental health issues interact with the criminal justice system and to target interventions to prevent people from getting deeper involved in the system.

The Sequential Intercept Model is usually focused around 5 broad target points, or areas where people with mental health issues may find themselves in contact with police or legal officials.

The five Intercepts are:

  1. Law Enforcement
  2. Initial Detention / Court Hearings
  3. Jail / Court
  4. Re-Entry
  5. Community Corrections

The model was based on ensuring that people with mental health issues are not forced into the criminal justice system at greater rates than people without mental health issues.

Law Enforcement and Emergency Services

Noting that up to 10% of police calls by patrol officers involve mental health issues (Cordner, 2006), the first interception point is front-line police and emergency services workers. Munetz & Griffin (2006) describe several strategies to help intervene at this point:

  • Mobile Crisis Teams of mental health workers
  • Employing mental health workers as civilians in the Police Service
  • Pairing police officers with mental health workers to go on patrol calls
  • Specially trained mental health police officers

All of these approaches involve combining front-line policing with mental health support to ensure that sensitivity is respected. Emergency services may also respond to mental health issues where individuals are psychotic or otherwise struggling with a connection to reality, which can put these staff in danger.

Initial Detention / Court Hearings

After an individual has been arrested, the next interception point of the sequential intercept model is initial detention and hearings post-arrest. Individuals may be diverted at this point to programs for non-violent, low level crime (such as petty theft or trespassing) based on the symptoms of their mental illness.

Diverting this individual to mental health treatment can avoid exacerbating their mental health issues. Additionally the court may “employ mental health workers to assess individuals after arrest in the jail or the courthouse and advise the court about the possible presence of mental illness and options for assessment and treatment, which could include diversion alternatives or treatment as a condition of probation.”

Jail / Court

Individuals who have mental illnesses and get involved in the criminal justice system are likely to spend a significantly longer jail term than individuals with the same charges who do not have mental illnesses. (Hoke, 2015) For this reason, the third intercept point is the jail or court system, where many individuals with mental illness are managed.

One important opportunity is the establishment of Mental Health Courts set up specifically for people with diagnosed mental illnesses relevant to their crimes.

Re-Entry

After an individual has exited the court system (if on probation) or jail (if sentenced to serve time), it is time for them to re-enter society. Transition points like this are times where an individual may be feeling the least supported and at greatest risk of suicide (Pease, Billera & Gerard, 2016) or of reoffending. (Caudill & Trulson, 2016) Discharge planning is common in hospitals but not in jail, which can make continuing care difficult for clients who are released from jail.

One potential model for solving this noted by Munetz & Griffin is the APIC (Assess, Plan, Identify, and Coordinate) Model by Osher, Steadman & Barr (2003). This plan “highlights the importance of collaboration among multi-sectoral community partners to ensure that the community is committed to the transition process.” (Evidence Exchange Network, 2014)

Community Corrections

The final intercept in the Sequential Intercept Model is community corrections, which is probation or parole. Since mental health treatment is often a condition of staying out of jail, these individuals represent an excellent opportunity to help those in the criminal justice system continue to access care, despite the adversarial nature of the parole/probation relationship.

References

Evidence Exchange Network for Mental Health and Addictions. (2014). “The Assess, Plan, Identify, and Coordinate (APIC) Model.” Retrieved on March 15, 2017 from http://eenet.ca/wp-content/uploads/2014/04/APIC-summary-addendum_March2014.pdf

Caudill, J. W., & Trulson, C. R. (2016). The hazards of premature release: Recidivism outcomes of blended-sentenced juvenile homicide offenders. Journal Of Criminal Justice, 46219-227. doi:10.1016/j.jcrimjus.2016.05.009

Cordner, G. (2006) “People with Mental Illness”. Center for Problem-Oriented Policing. No 4. Retrieved on March 17, 2017 from http://www.popcenter.org/problems/mental_illness/print/

Pease, J. L., Billera, M., & Gerard, G. (2016). Military Culture and the Transition to Civilian Life: Suicide Risk and Other Considerations. Social Work, 61(1), 83-86. doi:10.1093/sw/swv050

Hoke, S. (2015). Mental Illness and Prisoners: Concerns for Communities and Healthcare Providers. Online Journal Of Issues In Nursing, 20(1), 1. doi:10.3912/OJIN.Vol20No01Man03

Osher, F., Steadman, H. J., & Barr, H. (2003). A Best Practice Approach to Community Reentry From Jails for Inmates With Co-Occuring Disorders: The APIC Model. Crime & Delinquency, 49(1), 79.

Munetz, M.R. & Griffin, P.A. (2006) Use of the Sequential Intercept Model as an Approach to Decriminalization of People With Serious Mental Illness. Psychiatric Services. 57(4) Accessed electronically on March 25, 2016 from http://ps.psychiatryonline.org/doi/pdf/10.1176/ps.2006.57.4.544

Cite this article as: MacDonald, D.K., (2017), "Sequential Intercept Model," retrieved on May 29, 2017 from http://dustinkmacdonald.com/sequential-intercept-model/.
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Financial Social Work

Introduction

Financial social work is an under-valued component of a counsellor or social worker’s activities, however with the average debt level in the US (including mortgages) above $130,000 and credit card debt above $16,000 (El Issa, 2016), financial issues are a significant component of many individual’s negative emotional health.

Money problems are a leading cause of divorce (Dew, Britt, & Huston, 2012), anxiety (Archuleta, Dale & Spann, 2013) and suicide (Coope, et. al., 2015; Hempstead, et. al., 2015). Poor financial skills can cause even an individual with a high income to experience stress, much less low-income individuals who may find themselves accessing counselling or community social work services.

What is Financial Social Work?

Financial social work or financial counselling is the process of working with clients to “provide practical, sustainable skills for controlling and managing finances…and create real behavioral change in your clients.” (Center for Financial Social Work, n.d.) This is a comprehensive process of assessing an individual’s financial situation and building lifeskills of budgeting, responsible use of credit and debt management.

Financial social work is often performed by non-profit credit counsellors, Marriage and Family Therapists (MFT) and may be performed by social workers in other capacities, such as those who work as case managers with individuals on a low-income or struggling with substance abuse issues.

Assessing Financial Anxiety

Archuleta, Dale & Spann (2013) discuss the Financial Anxiety Scale (FAS), a tool that can be used to assess the impact of financial counselling or financial social work’s on an individual well-being. As they proceed through their treatment, their anxiety reduces.

Financial Anxiety Scale (FAS)

Each item on the FAS can be rated either yes/no (with a cut-off score of 4 or higher) or on a Likert scale for clinical purposes.

  1. I feel anxious about my financial situation.
  2. I have difficulty sleeping because of my financial situation.
  3. I have difficulty concentrating on my school/or work because of my financial situation.
  4. I am irritable because of my financial situation.
  5. I have difficulty controlling worrying about my financial situation.
  6. My muscles feel tense because of worries about my financial situation.
  7. I feel fatigued because I worry about my financial situation.

Money Personalities

Money personalities (Mellan, 1995) describe an individual’s approach to working with money, and what makes an individual happiest or unhappiest as they work with money. Brief descriptions of the money personalities are below:

  • Amasser – an individual who prefers to have large amounts of money but may also struggle with significant anxiety as they try to do this
  • Avoider – an individual who avoids working with money because of the negative emotions involved, because of feelings of inadequacy or overwhelm
  • Hoarder – an individual who likes to save money. In extreme cases a hoarder may literally hoard money in their house or other areas instead of investing them
  • Money Monk – an individual who is afraid of money, considers it unclean or dirty, and tries to avoid having a relationship with it at all
  • Spender – an individual who likes to spend money and gets immediate satisfaction from spending

Financial Social Work Qualifications

In order to practice financial social work or credit counseling it is important to receive training in this area. Rappleyea, et. al. (2014) discuss a curriculum for financial social work training that was designed for Marriage and Family Therapist (MFT) students. Some of the many topics suggested in this paper that are valuable to learn include:

  • Money personalities (described above)
  • How to track expenses
  • How to live within your means
  • How to spend money in a way that leads to happiness rather than guilt or unhappiness
  • How to understand emotions created by money

Financial Social Work Certification

The Center for Financial Social Work provides the Certification in Financial Social Work. It provides 20 CE credits, workbooks and curriculum on financial planning, credit, debt, savings and spending plans and investing. The whole package costs $595. There is also information available from the Center on how to develop financial support groups to help individuals make better choices.

Financial Social Work Jobs

Financial social work job titles include Case Manager, Credit Counsellor, Financial Counselor, and Marriage and Family Therapist (MFT). All of these job roles may involve elements of financial counselling or financial social work either as a primary or secondary function of the role.

Financial Self-Care

It’s important that social workers recognize that financial health is a part of their own development and self-care. If you are worried about money, it’s difficult to be fully present for your clients. Developing a budget, reducing and eliminating debt, and investing are valuable skills for both your clients and yourself.

Taking care of these things will help reduce your burnout and make you a more effective social worker.

References

Archuleta, K. L., Dale, A., & Spann, S. M. (2013). College Students and Financial Distress: Exploring Debt, Financial Satisfaction, and Financial Anxiety. Journal Of Financial Counseling And Planning, 24(2), 50-62.

Center for Financial Social Work. (n.d.) “Become Certified in Financial Social Work”. Retrieved on March 8, 2017 from https://www.financialsocialwork.com/financial-social-work-certification

Coope, C., Donovan, J., Wilson, C., Barnes, M., Metcalfe, C., Hollingworth, W., & Gunnell, D. (2015). Research report: Characteristics of people dying by suicide after job loss, financial difficulties and other economic stressors during a period of recession (2010–2011): A review of coroners׳ records. Journal Of Affective Disorders, 18398-105. doi:10.1016/j.jad.2015.04.045

Dew, J., Britt, S., & Huston, S. (2012). Examining the Relationship Between Financial Issues and Divorce. Family Relations, 61(4), 615-628. doi:10.1111/j.1741-3729.2012.00715.x

El Issa, E. (2016) 2016 American Household Credit Card Debt Study. NerdWallet. Retrieved on March 8, 2017 from https://www.nerdwallet.com/blog/average-credit-card-debt-household/

Mellan, O. (1995). Money Harmony: Resolving money conflicts in your life and relationships. New York, NY: Walker & Company.

Rappleyea, D. L., Jorgensen, B. L., Taylor, A. C., & Butler, J. L. (2014). Training Considerations for MFTs in Couple and Financial Counseling. American Journal Of Family Therapy, 42(4), 282-292. doi:10.1080/01926187.2013.847701

Hempstead, K. A., & Phillips, J. A. (2015). Research Article: Rising Suicide Among Adults Aged 40–64 Years. The Role of Job and Financial Circumstances. American Journal Of Preventive Medicine, 48491-500. doi:10.1016/j.amepre.2014.11.006

Cite this article as: MacDonald, D.K., (2017), "Financial Social Work," retrieved on May 29, 2017 from http://dustinkmacdonald.com/financial-social-work/.

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Coping with Flashbacks and Dissociation

Introduction

There are a variety of situations where a client or helpline caller may experience negative emotions and need to use coping strategies to help themselves cope. These can include flashbacks to abuse or trauma (such as in child sexual abuse or Post Traumatic Stress Disorder), dissociation, or simply intrusive thoughts or memories of a variety of painful experiences.

In these situations, there are a variety of techniques that can be taught to clients to help them stay grounded and cope. They are summarized below.

Physical Techniques for Coping with Flashbacks

Physical techniques focus on using your physical body or space to reduce your flashbacks or dissociation.

  • Plant your feet on the ground or grasp the arms of a chair
  • Repeat one’s name, age or location
  • Go to a safe space (e.g. home), a place where you feel calm and safe

Behavioural Techniques for Coping with Flashbacks

Behavioural techniques are actions that you can take when you feel stressed or overwhelmed. Ways of expressing yourself can give you a sense of control that will make it easier to cope.

  • Journal or writing
  • Verbalizing emotions
  • Calling a crisis line or mobile crisis team
  • Going to the hospital
  • Taking a walk

Cognitive Techniques for Coping with Flashbacks

Cognitive techniques are those things that involve your thoughts. These may be more challenging than the other techniques but with practice will become easier to use when you are feeling overwhelmed. Because these are hard to summarize they’ve been listed with more detail than the above techniques.

Identify Internal Cues

Internal cues are those things that prompt you to think that you are going to dissociate or experience flashbacks. Sometimes they come on randomly, but for other individuals there is a period of feeling flushed, having a racing heart, feeling anxious or restless, or other symptoms that precede the flashbacks or dissociation. When you recognize these occurring, using the other techniques on this list can help you cope.

Identify Associational Cues

Associational cues are those things that you associate with safety and security. These can be objects, sources of support like pets or other things that remind you that things will be okay. The association between the item and the positive thoughts it brings can help ground you.

Safe Space (Mind)

Going to a “safe space” mentally and remembering that what you are experiencing is temporary can be helpful. Guided imagery (described below) can help you find this safe space, which can also be a place in your own memory where you felt safe and protected.

Meditation and Guided Imagery

Meditation is a very common strategy for coping with flashbacks and dissociation. Meditation takes practice, but by using slow and steady breathing and trying to clear your thoughts when you are not in a state of dissociation or flashbacks, you will build this skill up to where you can implement it when you sense you are going to dissociate.

Guided imagery is similar, but rather than meditating or focusing on your own breathing, you focus on a guided story that will help keep you grounded.

Label Emotions

Labeling your emotions can be a very effective way of reducing immediate stress. This can be both to yourself (merely talking out loud), or to a support like a friend, a pet or a crisis line. Many people who experience trauma have difficulty labeling their emotions and this exercise (especially when practiced as part of comprehensive therapy) can help keep you grounded.

Cognitive Restructuring

Cognitive restructuring refers to techniques of identifying and challenging automatic or maladaptive thoughts. The simplest way to do this is with an ABC (Action, Behaviour, Cognition) worksheet. An ABC worksheet lists actions that made you feel bad, behaviours or results from that, and the cognitions that went along with that.

For instance,

  • Action: A girl didn’t smile at me when I smiled at her
  • Behaviour: I felt bad
  • Cognition: I’m not attractive

This is an example of a common ABC scenario. The goal is to identify other possible cognitions so that you can “rewrite the script.” An example of a different script:

  • Action: A girl didn’t smile at me when I smiled at her
  • Behaviour: I realized she probably didn’t see me
  • Cognition: Nobody has judged my attractiveness yet

This process is best accomplished with a therapist, but can be done in a self-help format. The book Mind Over Mood utilizes many of these techniques.

General Self Care for Coping with Flashbacks

  • HALT – Hungry, Angry, Lonely, Tired. These are the 4 states that make it harder to regulate your emotions and increase your impulsiveness.
  • Eating Healthy
  • Exercising
  • Medical Evaluation

5-4-3-2-1 Coping with Flashbacks

This technique is a very popular technique for coping that focuses on what you identify as real and also serves as a form of meditation.

  1. In 5-4-3-2-1 coping, you begin by thinking about five things that you can see around you. Listing them off out loud can help you with this exercise. Study them and describe them to yourself. Performing deep breathing (a slow inhale over 5 seconds, holding for 5 seconds, and exhaling over 5 seconds) can help with this as well.
  2. Next, describe 4 things that you can feel, such as your heart beating, your feet on the floor or your back in your chair.
  3. Next, 3 things that you can hear, like a television in another room, traffic outside or birds singing.
  4. After that, 2 things that you can smell – or two smells that make you happy, like fresh baked cookies.
  5. Finally, end with one thing you can taste. Your saliva, gum, or food you ate recently? Some people also substitute “One thing you like about yourself” for this exercise as well.
Cite this article as: MacDonald, D.K., (2017), "Coping with Flashbacks and Dissociation," retrieved on May 29, 2017 from http://dustinkmacdonald.com/coping-flashbacks-dissociation/.
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