Category: Ethics

Therapy in “How I Met Your Mother”

“How I Met Your Mother” is one of my favorite tv shows.  That being said, a recent couple of episodes had me cringing and shouting at the tv the majority of the time.  I felt a little bit like my mother, who often gets frustrated with exciting hospital tv shows.  She was trained and worked for many years as a nurse in the emergency room, and readily picks up on the reality (or lack thereof) of the situations portrayed in television hospitals.  As a budding counselor, I felt a similar frustration with this portrayal of a therapist.

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This particular set of episodes of “How I Met Your Mother” involved one of the characters, Robin, seeing a therapist for a court-mandated session after assaulting a woman on the street.  The show unfolds through Robin’s telling of the scenario in a therapy session and frequent quips by the therapist (or psychiatrist or counselor, it is unclear) to hurry up her story (“Can we just get to the assault?”).  Throughout the show he also breaks confidentiality on several counts by describing his other clients (in one case, he describes how one of his other patients – mostly “disturbed felons” – sent him a bag of his own feces for the therapist’s birthday).  In the following episode, the therapist actually starts to date Robin.  Ted tells his friend Robin, “Robin, if you asked a hundred people who is the worst person you could possibly date, they’d all say your therapist.”  What the show fails to regard is the fact that therapists, and in fact, the American Counseling Association (ACA), agree with Ted and those hundred people he mentioned.  Dating a former client is prohibited for counselors for 5 years after the cessation of treatment, according to the ACA’s Code of Ethics.  While the tv therapist acknowledged that he was not supposed to date Robin, he continued on to do so without much apparent concern for this violation of ethics.

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I found the portrayal to be unprofessional and, while the therapist’s humor aided the ridiculous nature of Robin’s story, it was not so over-the-top as to be a satirical portrayal of a therapist.  In addition, this character only seemed to care for Robin’s well-being after he established a personal romantic interest in her; there was no demonstration of professional (and ethical) empathy.  While it may not be as interesting, humorous or contextually appropriate to have a caring and empathetic counselor in this situation, it is a shame that a counselor or therapist may be portrayed without ideal qualities (or even, some could argue, decent ones).  Unfortunately, for many who have never participated in a counseling session, watching this stereotype on television may be the closest they get to counseling.

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American Counseling Association. (2005). Code of Ethics. Alexandria, VA: Author.

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Thomas, C. & Bays, C.  Producer. (Producers). (2005).  How I Met Your Mother (Television series).  Los Angeles: CBS Broadcasting, Inc.

Online Counseling

Upon the death of Steve Jobs, a friend of mine* posted on Facebook, “Three apples changed the world: the one that Eve ate, the one that hit Newton on the head, and the one Steve Jobs offered us all.”  Jobs, the founder of Apple, certainly changed the way we use technology today.  It is more accessible, and constant, and personal. But how has Jobs (and his technology) impacted the world of counseling?

Well, in the trend of online counseling, he has enabled clients to literally keep their counselor in the palm of their hand.  Some counselors offer services via Skype or other live internet communication; clients can be in touch on their iphone or ipad while maintaining physical distance.  Some counselors also offer email communication (known as asynchronous communication, where the interaction does not occur in real time).  Clients also have access to lots of information about mental health, both accurate and inaccurate, through the web (Gladding & Newsome, 2010).

With email, counselors and clients can keep in touch conveniently and work with a flexible schedule, in a way that may even out the spread of power between client and counselor (each can communicate with a home court advantage).  However, email shares many risks with other internet counseling methods; namely crises in which the counselor is not present, issues of confidentiality and protecting privacy in a secure manner, as well as third-party payments (Gladding & Newsome, 2010).  In addition, there is a greater chance of miscommunication when technology is involved.  When videochatting, there is the potential for the connection to break up at a key moment.  In email, a sarcastic phrase may be taken as fact or adolescent slang may be difficult to decode.

In a recent New York Times article, one psychologist (Elaine Ducharme) discusses her long-distance practice. Ducharme uses Skype to videoconference with patients from her former practice, and is licensed to practice both in the state in which she counsels online and the one in which she lives.  She will only videoconference with a patient she has already met, and periodically returns to have face-to-face appointments.  “‘There is definitely something important about bearing witness,’ she said. ‘There is so much that happens in a room that I can’t see on Skype’” (Hoffman, 2011).  The article continues on to address the pitfalls and benefits of online counseling.

The National Board of Certified Counselors (NBCC) began putting together a task force to address technology-assisted counseling in 1995, an endeavor that tackles ethical and practical issues and led to today’s Standards for the Practice of Internet Counseling (Gladding and Newsome, 2010).  With the massive presence of the Internet in our lives, it is necessary to set these guidelines and enforce a standard in order to protect the professional integrity of counselors, both online and off.

As a beginning student, I see myself working in a more traditional face-to-face practice, as opposed to using Skype or email as a central mode of communication.  There are already so many concerns in the practice of counseling as to how to best work with a client and act in their best interest, without worrying about a dropped videocall or a crisis thousands of miles away.  I recently read what constitutes malpractice, and sat staring wide-eyed at the textbook for a good five minutes, contemplating all the ways I could screw up.  I don’t feel I need to add any additional potential for disaster to the list.  I appreciate the momentous contributions of Steve Jobs and the impact of the growth of technology on my daily and professional life, but as a starting counselor I think I may check the technology at the door.  I’ve been spending a lot of time lately learning how to be with someone, how to listen and share time and space in a therapeutic manner, and I plan to put those skills to use by counseling face to face.  As I learned in my orientation, the only real technology you need in a counseling session is a box of tissues and a clock.

Gladding, S. & Newsome, J. (2010). Clinical Mental Health Counseling in Community and Agency Settings  (3rd ed.).  Upper Saddle River, NJ: Prentice Hall.

Hoffman, J.  (2011, 23 September). When Your Therapist is Only a Click Away. New York Times, pp. ST1.

*Thanks to Michael Fleischmann for sharing this popular post.

You too, Sir

Last Wednesday I arrived to campus at approximately 9:00am. After having a quick conversation with a fellow doctoral student I decided to take a walk on campus. While on my walk I was greeted by a familiar face, a service worker who I often have a 30 second conversation with, usually consisting of the weather and weekend plans. We had our conversation as usual and when the conversation ended I said, “Have a nice day” and began to walk off, when I heard him say, “You too, sir.” I almost stopped in my tracks because I was unsure as to whether this gentleman who appears to be my senior by at least 20 years would call me sir, but I just looked back at him and smiled. As I continued my walk through campus I began to wonder and think to myself, “Why did this man call me sir?” I tried to remember whether he called me “sir” in any of our previous interactions, and I do not believe he did. Why today? I usually dress the same I thought to myself. Today was a class day and I did have on a dress shirt, tie, sweater, and slacks, but was my attire the reason he called me “sir”? Did he think I was a professor, or perhaps an administrator? All of these things swirled around in my mind like a tornado in early spring in the Midwest.

Once those thoughts began to disappear another thought came to me. I guess I am privileged. I walk around the University campus usually dressed up and try to smile or speak to everyone I pass. I usually see several custodians and other service workers everyday as they complete their rounds throughout campus, performing routine services for all of us; however, many of us do not think much of it. The fact is that we have a group of service workers who clean up after us while we walk around smiling and holding conversations that I am sure many of us would consider much deeper, more philosophical, and of more important than the weather and weekend plans.

I must admit that it did bother me that someone I believed I should call sir, even if only out of respect of age difference referred to me as “sir.” Later that day I had a conversation with a colleague about the interaction and we discussed what we thought it might mean. One of the first thoughts we discussed was that of class issues – was it a social class issue? Did this man call me sir because he felt or believed he should, or that it was necessary? Or did he call most people “sir” regardless of where he is or to whom he is having a conversation?

Furthermore, all of these questions reminded me of critical theory which focuses on an individual’s response to social, political, and economic oppression and assumes that social life functions at various levels of meaning (LeCompte & Preissle, 1993). Did this service worker call me “sir” because of social oppression and pressures in our society? Do I appear or exhibit aristocratic characteristics that might give the impression that I need to be called or referred to as “sir”? Or does my dress and status as a doctoral student represent a “higher class,” thereby placing me in a social and/or economic oppressive group?

Finally, I understand that this interaction may not seem like a “big deal,” but I believe that social and class issues are important. In fact, some may argue that critical theory lacks objectivity and that it is a theory that argues that complex interactions and situations are reduced to simplistic explanations and conclusions. I realize that many of us may not have thought twice about the interaction as I did, however, to be called “sir” outside of a formal interaction by a service employee requires some extra thought on my behalf.

Education the great divider: School choice in urban centers

Education in today’s society is a definitive indicator of an individual’s earning potential and social mobility. In light of this reality, parents are constantly searching for ways to provide their children with a quality education that would afford them a greater earning potential and the possibility of upward social mobility. Unfortunately, however, access to a quality education is not equally distributed across all strata of the society.

Bridging the divide between urban and suburban school districts

An Akron, Ohio woman recently made national headlines after she was charged and sentenced for defrauding the neighboring Copley-Fairlawn City Schools of over $30, 000 in her attempt to secure a better quality of education for her two daughters. A comparison of the Copley-Fairlawn City School District’s report card for academic year 2009-2010 to the Akron Public Schools’ report card for the same academic year indicates that Copley-Fairlawn students received better scores in two key achievement areas, reading and mathematics, while Akron students received comparably lower scores in these two achievement areas. Additionally, yearly progress in overall school accountability standards was met by Copley-Fairlawn compared to Akron Public Schools that failed to meet yearly progress.

The inequalities and inequities in the education system necessitate the continuation and expansion of school choice policies. Whether it is the existence of charter schools, voucher programs or urban-suburban programs, school choice policy is needed to allow urban parents opportunities to provide a quality public education for their children. Of course, Kelley Williams-Bolar (accused Akron parent) was found guilty for falsification of government document. But can we villainize her for trying to provide her daughters with an education that is unavailable to them in their home district—an education that is elusive in many urban areas, yet readily available to suburbanites? I am not suggesting here that the laws of the land be flouted. However, I am suggesting that adequate investments be made in school choice policies (eg. urban-suburban programs) that are continuously in danger of termination due to the lack of adequate funding. This should enable urban students, the majority of whom are of a lower socio-economic status, the opportunity to receive a quality public education.

Without attempting to litigate on the legality of Williams-Bolar’s action, it is prudent that we examine the gross inequity between these two neighboring school districts that prompted her to seek a quality education for her children outside of their struggling school district. The present hiatus between Akron and Copley-Fairlawn schools continue to disenfranchise many vulnerable children on the premise of their zip code, despite their parents paying local, state and federal taxes that generally fund schools. I am of the opinion that if Williams-Bolar could have afforded to send her children to a private school, she might have done so, or already voted with her feet for a more effective school district. Can some acts be avoided when one is stripped of choice? Poverty cannot be the reason for a poor education. I wonder what Horace Mann would say about this sad inequity?

References

Akron Public Schools (2010). 2009-2010 School Year Report Card.

Copley-Fairlawn City School District (2010). 2009-2010 School Year report Card.

Treatments in Mental Health: A Brief History

Note: In case you missed my last post, I mentioned that with every entry I am going to include a picture from my personal life.  Whether related to the week’s topic or not, I hope to give you a small glimpse into who I am.  In honor of Sunday’s running of the Chicago Marathon, this week’s picture features “the bean.”  As mentioned previously, I traveled to Chicago for the first time this past August and fell in love with the city.

This week I am taking a small break from the topic of school counseling to share with you some interesting information I recently learned.  In a lecture by our Problem ID Teaching Assistant, Ari Elliot, we reviewed a brief history of psychiatric and mental health treatments and interventions.  It’s important for us to remember the history of mental illness treatment both because it was not very long ago, and because it is up to us to ensure that treatment continues to improve and does not revert to the horrible situations of the past (during the lecture, I could not help but make connections to the treatment of Randle Patrick McMurphy in One Flew Over the Cuckoo’s Nest). I am going to summarize some of what we reviewed in class to emphasize my point:

Europe in the 1600’s: Those considered mentally insane were chained in dungeons with criminals, vagrants, and people with disabilities. They were beaten, given little food, and had no clothing.

Europe in the 1700’s to early 1800’s: Medical treatment was both a remedy and a punishment.  Treatments included bloodletting, purging and induced vomiting, cold water dunking (water torture), and the “swinging chair,” a contraption designed to spin the patient at high speeds.  The chair was thought useful in helping patients to vomit, evacuate the contents of their bladder, and lull them into a tranquilized state of mind.

Europe in the late 1800’s: Concern for the mentally ill increased.  The use of chains and shackles was forbidden.  Patients were removed from dungeons and allowed to stay in sunny rooms and walk outside.

The U.S. in the 1800’s: Mental patients were chained in basement cells.  Public viewing of patients was allowed for entertainment purposes.

1812: Benjamin Rush, a founding father of psychiatry, writes Medical Inquiries and Observations, Upon the Diseases of the Mind. Saw mental illness as psychological and believed the cause to be abnormal blood circulation. Continued the use of bloodletting, spinning therapy, and the “tranquilizer chair,” a device used to control blood flow to the brain, reduce motor activity, and reduce the force and frequency of pulse.

The U.S. in the Late 1800’s: Moral treatment of patients was finally considered.  Spinning devices were banned and patients were given food and clothing.  Patients were trained to act in a civil manner in exchange for certain privileges.

The U.S. in the early 1900’s: The Era of Institutionalization.  Patients kept in massive, overcrowded asylums.  Treatment deteriorated.  The Eugenic movement led to viewing mental patients as contaminants of the gene pool.  Laws were enacted concerning compulsory sterilization.

20th Century Asylum Medication: Treatments included Insulin-induced coma, electro-convulsive therapy, lobotomy, and anti-psychotic medications.

Today, we use the Diagnostic and Statistical Manual of Mental Disorders to help diagnose patients.  While the DSM says nothing about treatment, there is hope that a proper diagnosis will lead to proper treatment.  Research is continually changing what we know about the causes and treatments of mental disorders.  I take what I learn about the history of mental illness and hope to always remember to respect and protect the person who may be suffering.

Semester 1: What I’ve learned

December first: Thanksgiving decorations are put away, the smell of Douglas Fir fills the air, and fittingly, we had our first snowfall this morning in Rochester.  Not to be forgotten: final projects are due next week!  As we approach the end of Fall, I have started to reflect on what I’ve learned during my first semester at Warner.  I can’t believe it’s over already!  Time has never passed as quickly as it has in the past few months.  It seems so long ago that I was an undergraduate at Geneseo, anticipating both graduation and what was in store for my future.  Along with making new friends, I now feel a part of the school counseling world and have a handle on basic counseling skills.  Below, I will outline some of the take-home-messages that I’ve learned so far this semester.

School counselors need to be leaders.  In the old counseling paradigm, people were unsure of what the role of the school counselor was.  Now, counselors are the eyes and ears of the school.  They see and hear what is going on, and they advocate for change to better the experience of all students.  It is the role of the school counselor to collaborate with teachers, administrators, parents, outside resources, janitors, bus drivers, and every stakeholder in the school to create a climate that fosters learning and personal growth.

Basic counseling does not require you to know specific techniques or tricks to magically make a client feel better.  You can help make an improvement in a client’s life simply by treating them the way you would treat any loved friend or family member.  Express sincere empathy, be genuine in all your interactions, and hold unconditional positive regard for all your clients.  These are the basic tenants of any counseling theory (and should be the basic tenants of any loving relationship in our lives).

Finally, I’ve learned that I have chosen the right profession.  I recently spoke with a practicing school counselor who told me the two keys to becoming a successful counselor.  One, you must love kids.  Two, you must have a realistic view of what you can change and influence.  This reminded me of why I chose to be a counselor in the first place; I love working with high school students.  Their passion and potential is unmatched in any age group.  While I am aware that the problems faced by high school students transcend what goes on in a school building, I am optimistic about the positive changes I can make.  With all that I’ve learned since September, I look forward to what next semester brings!

Discussing Suicide

Talking about suicide is taboo. In a culture where traditional norms are being questioned and integration and acceptance are becoming the new themes, it’s hard to believe that so many people are afraid to talk about the subject.   In my Assessment and Appraisal class with Dr. Irene Garrick, we spent a good amount of time watching a very informative video about suicide (“Suicide Assessment and Prevention” by John Westefeld).  I want to discuss some key points that I was previously unaware of in order to get the conversation going and get this taboo topic out in the open.

  • First of all, predicting and preventing suicide is tough to do.  Often times, the depressed individual has not made up their mind as to whether they want to commit suicide, so for a counselor to predict it is difficult.  However, that does not mean that suicide should not be prevented.  Providing a suicide workshop can have a positive influence on people suffering from depression or suicidal thoughts.
  • It is beneficial to consider the message behind the behavior. Often times, when a person tries to commit suicide, they are asking for help.
  • Often times, a person considering suicide feels as if they are isolated, have no one to talk to and feel as if they have no way to ask for help.  For this reason, simply getting a suicidal patient into therapy is crucial.
  • No-harm contracts: This is a controversial issue.  Often times, therapists will make a contract with patients in which the patient agrees to not harm him or herself, while the therapist agrees to do everything he or she can to make the patient better.  This may be a good thing in forming a therapeutic alliance between counselor and patient.  It also provides some structure: usually, if a patient does not willingly sign a contract within 24 hours, they will be hospitalized.   However, some people may feel as if the therapist is simply covering their butt if a lawsuit should come about.  This is something that should be considered.
  • Often times, depressed individuals will speak of losing their faith or no longer practicing their religion.  If their spirituality or religion was important to them previously, it is imperative to restore belief in that individual.
  • If a therapist is particularly worried about a client, it may be beneficial to see them twice a week, with one of the days being Friday.  Sometimes, weekends can be particularly hard for people who are depressed.
  • It is beneficial to make an “emergency plan.”  This means that if the client is not with the therapist and is worried about him or herself, he or she have a number they can call and talk to someone immediately.

For more information, please visit the American Association of Suicidality at http://www.suicidology.org/web/guest/home.