Building Counselling Relationships

Introduction

The most important element in a counselling relationship, whether a single session or long-term counselling, is the quality of the relationship between the counsellor and the client. For this reason, basic counselling courses spend a large amount of time on how to effectively build relationships.

There are five factors influencing the counselling process:

  1. Seriousness of the presenting problem (the more distressed a client is, the greater improvement they will experience)
  2. Structure (helping clients understand what counselling will involve, setting time limits and expectations, etc.)
  3. Client initiative or motivation
  4. The physical setting in which counselling occurs
  5. Client and counsellor qualities

Seriousness of Presenting Problem

The more distressed a client is when they first come in for counselling, the greater the reduction in distress they will experience during counselling. (Leibert, 2004)

Edwin Schneidman once said that the more intense the crisis, the less trained an individual needs to be to respond. This is why many individuals are talked down from bridges by totally untrained individuals while the management of low-level suicidal ideation requires extensive clinical training.

Structure

The structure of counselling helps build relationships by providing expectations. This involves setting practical limits like an understanding of the length of sessions, explaining what will happen during each session, letting clients know what they can do in emergencies or high-risk crisis situations, and other elements that impact the procedure of counselling.

Most clients experience anxiety before the counselling session so the more expectations will help.

Client Initiative

Clients may be reluctant to enter counselling or even mandated to attend because of the legal system, mental health treatment or other situations. Gladding and Alderson (2012) give several suggestions for how clients can help provide initiative to clients:

  • Anticipate the feelings a client may display
  • Demonstrate understanding, acceptance and a non-judgemental attitude
  • Try to persuade clients of the benefits of proceeding through counselling
  • Use of gentle confrontation (point out how client behaviours are moving them away from their goals)

Physical Setting

Pressly and Heesacker (2001) noted that physical elements in a counselling office can contribute to the development of the counselling relationship. For instance, brighter colours were associated with more positive emotions, while softer light was associated with more positive feelings than more intense light.

As well, physical barriers between client and counsellor (like a desk) has been associated with reduced perception of empathy.

 

Empathy

Empathy is the ability to enter a client’s world and understand their perspective. (Rogers, 2007) Empathy may be separated into two categories: primary empathy and advanced empathy. Primary empathy is the ability for a counsellor to respond in a way that shows they’ve understood the situation a client is experiencing. (Singh, 2015) This is the level of empathy that crisis line workers aim for. On the Carkhuff and Truax Scale this is level 3 or Interchangeable or Reciprocal Level of Responding.

Advanced empathy is a more indepth procedure, helping to bring elements the client was holding subconsciously or below their awareness. (Veach, LeRoy & Bartels, 2003)

Building an Effective Working Alliance

While a counsellor can use empathy during their conversation during a client to begin building the relationship they need to continue establishing the 3 components required for an effective working alliance identified by Horvath (2001). Working Alliance consists of three components:

  1. Agreement about what goals to be accomplished in therapy
  2. Agreement about tasks (how will those goals be accomplished)
  3. Bond between counsellor and client

Attending Behaviour

Attending behaviour is the physical and behavioural choices a counsellor makes in order to show a client that they are paying attention. The acronym SOLER (Egan, 2007) is one acronym to remember how to show attending in person. The SOLER elements apply only to those in Western (North American or other British cultures) – it is important to modify your approach for other cultural backgrounds.

  • S – Sit Squarely
  • O – Open Posture
  • L – Learn Towards the Client
  • E – Eye Contact
  • R – Relax

References

Egan, G. (2007) The Skilled Helper: A Problem Management Approach to Helping. 8th ed. Thomson Brooks/Cole: Belmont, CA.

Gladding, S. T., & Alderson, K. G. (2012). Building counselling relationships. In B. Brandes (Ed.) (2016), Introduction to counselling (2nd Custom Edition) (pp. 113–140). Toronto, ON: Athabasca University/Pearson Education Canada.

Horvath, A.O. (2001) The Therapeutic Alliance: Concepts, Research and Training. The Australian Psychologist. 36(1). 170-176. doi: 10.1080/00050060108259650

Leibert, T.W. (2006) Making Change Visible: The Possibilities in Assessing Mental Health Counseling Outcomes. Journal of Counseling and Development. 84(1). 108-113. doi: 10.1002/j.1556-6678.2006.tb00384.x

Pressly, P.K. & Heesacker, M. (2001) The Physical Environment and Counseling: A Review of Theory and Research. Journal of Counseling and Development. 79(2). 148-160. doi: 10.1002/j.1556-6676.2001.tb01954.x

Rogers, C. (2007). The necessary and sufficient conditions of therapeutic personality change. Psychotherapy: Theory, Research, Practice, Training. 44(3), 240-248

Singh, K. (2003) Counselling Skills for Managers. Prentice-Hall: Delhi, India.

Veach, P.M., LeRoy, B.S. & Bartels, D.M. (2003) Responding to Client Cues: Advanced Empathy and Confrontation. In: Facilitating the Genetic Counseling Process. Springer, New York, NY

Cite this article as: MacDonald, D.K., (2017), "Building Counselling Relationships," retrieved on November 23, 2017 from http://dustinkmacdonald.com/building-counselling-relationships/.
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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 November 23, 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 November 23, 2017 from http://dustinkmacdonald.com/coping-skills-therapy-managing-chronic-terminal-illness/.
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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 November 23, 2017 from http://dustinkmacdonald.com/financial-social-work/.

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Using the Sex Offender Risk Appraisal Guide (SORAG)

Introduction

Following up on my article about how to use the Violence Risk Appraisal Guide (VRAG), this article reviews how to use a tool that is bundled with that tool, the Sex Offender Risk Appraisal Guide (SORAG). Like the VRAG, this is an actuarial tool that can be used to predict the risk of re-offending among sex offenders.

Before reading about the SORAG, it is helpful to review the VRAG post as many of the elements that are covered in that post are required before proceeding to the SORAG items. It is recommended that any completion of the SORAG be preceded by a completion of the VRAG as this will save you a significant amount of time.

Completing the SORAG

Like the VRAG, the first step is to complete the Childhood & Adolescent Taxon Scale (CATS) worksheet and the list of Conduct Disorder Symptoms.

Cormier-Lang Criminal History Scores

In order to answer item 5 on the SORAG, Criminal History Score for Non-Violent Offenses Prior to the Index Offense, it’s necessary to complete the Cormier-Lang Criminal History worksheet also provided on the SORAG. This worksheet is completed by filling out the number of non-violent offenses and applying the weight to them noted on the sheet.

Sex Offender Risk Appraisal Guide (SORAG) Items

The SORAG itself has 14 items that are similar to those found on the VRAG.

  1. Lived with both biological parents to age 16 (except for death of parent)
  2. Elementary School Maladjustment
  3. History of alcohol problems
  4. Marital status (at the time of or prior to index offense)
  5. Criminal history score for nonviolent offenses (from Cormier-Lang system)
  6. Criminal history score for violent offenses (from Cormier-Lang system)
  7. Number of previous convictions for sexual offenses (pertains to convictions known from all available documentation to be sexual offenses prior to the index offense)
  8. History of sex offenses only against girls under 14 (including index offenses; if offender was less than 5 years older than victim, always score +4)
  9. Failure on prior conditional release (includes parole or probation violation or revocation, failure to comply, bail violation, and any new arrest while on conditional release)
  10. Age at index
  11. 11. Meets DSM criteria for any personality disorder (must be made by appropriately licensed or certified professional)
  12. Meets DSM criteria for schizophrenia (must be made by appropriately licensed or certified professional)
  13. Phallometric test results
  14. 14. a. Psychopathy Checklist score (if available, otherwise use item 12.b. CATS score)
    14. b. CATS score (from the CATS worksheet)
    14. WEIGHT (Use the highest circled weight from 12 a. or 12 b.)

You’ll note that many of these items are available from the VRAG. The tool indicates where there are overlaps in order to save you time filling out the worksheets and tools.

Determining Risk Level of Sex Offenders

After completing the tool, you must take the total score of the SORAG and compare it to the below levels.

  • A score of -17 to +2 indicates an individual is at Low risk for re-offending
  • A score of +3 to +19 indicates an individual is at Medium risk for re-offending
  • A score of +20 to +34 indicates an individual is at High risk for re-offending

An individual who is on the border between these two levels should have that indicated. For instance, someone who scores at +1 or +2 should be noted as “Low-Medium Risk” to highlight that they are at the edge of the established risk level.

Recidivism Rates using the SORAG

Rather than grouping an individual into low, medium or high risk categories, it is often more illuminating to examine the recidivism rates. These come from Violent Offenders as well.

Probability of Recidivism
SORAG score 7 years 10 years
< − 9 0.07 0.09
−9 to -4 0.15 0.12
-3 to +2 0.23 0.39
+3 to +8 0.39 0.59
+9 to +14 0.45 0.59
+15 to +19 0.58 0.76
+20 to +24 0.58 0.80
+25 to +30 0.75 0.89
> +31 1.00 1.00

References

American Psychological Association. (2006) Quinsey, V.L., Harris, G.T., Rice, M.E. & Cormier, C.A. (2006) 2nd Ed. Violent Offenders: Appraising and Managing Risk. Washington D.C: American Psychological Association.

Cite this article as: MacDonald, D.K., (2017), "Using the Sex Offender Risk Appraisal Guide (SORAG)," retrieved on November 23, 2017 from http://dustinkmacdonald.com/using-sex-offender-risk-appraisal-guide-sorag/.
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