Psy 214 Psychological Intervention Paper
Fathima Bibi Khan
3225457
Psychology 214: Psychological Interventions
Assignment
Introduction
The case concerns a 14 year old adolescent girl I have been counselling for the past three months. Her home background has been unstable due to a conflictual family life. Her situation has been exacerbated by her poor nutritional health. She complained of severe depression and shared her intent to end her life. She sought advice from me in terms of the means to execute her wish to terminate her life. This was communicated in confidence and I was specifically asked not to divulge this information as she felt ashamed that she was not coping with her life.
The case
Following the initial introduction, the client was informed of the basis …show more content…
of the counsellor-client relationship and the ethical responsibilities on the part of the counsellor, including the aspect of the degree of confidentiality. Due to the establishment of a trust relationship, the client shared information of a personal nature and also the emotional aspects that had a bearing on the case.
The dilemma that I am faced with revolves around the following : 1 what recommendation should I make to the client 2 the ethical aspects relating to trust and confidentiality 3 who do I need to consult with
The approach
1 What recommendation should I make to the client ?
The first thing I would do is to re-assure the client that her feelings were understandable and that a treatment approach would help in resolving the issues experienced by the client. That is, I would affirm the aspect of hope to the client.
Due to the severe depression, I would suggest treatment such as Cognitive Behavioural Therapy (CBT) or interpersonal psychotherapy, in addition to one or more medications. I would introduce the client to the concept of CBT as a treatment method. I would talk about the equal, collaborative relationship that this form of therapy requires. This would reinforce the need on the part of the client to feel in control and to work with me rather than expect me to 'cure’ her.
Page 1
Treatment with medication and an evidence-based psychological treatment (ie, CBT or interpersonal psychotherapy) increases the likelihood of improved symptoms and relationships with family and friends; it can also improve self-confidence and the ability to cope effectively.
Depending on the findings by the Clinician, the client has to be informed of the possible need for hospitalisation for a short period of …show more content…
time.
Depression treatment often includes medication management, individual, group and/or family therapy. Other activities may include physical exercise, art/music therapy and school work.
The client needs to be re-assured of the treatment approach and the fact that she is not alone as there will be a team comprising of the psychiatrist, psychologist, social workers, etc.
The client needs to participate in activities that improve her self-esteem and sense of mastery. Coupled with this, there is a need to adjust the nutritional side to build up the client’s health.
According to Tkachuk and Martin (1999), the importance of a healthy lifestyle (i.e., participating in regular physical activity, eating healthy foods) in maintaining a sense of well-being. In particular, regular physical activity can have a beneficial impact on depressed mood and should be discussed as an important element in any comprehensive treatment plan for adolescents with depressive symptoms.
2 The ethical aspects relating to trust and confidentiality
The fact that it is only of late that the client started to express the suicidal feelings cannot exclude the possibility that these feelings have been developing for some time prior to my engagement as the counsellor. The client may have held back expression of these feelings until the period where a sufficiently favourable client-counsellor relationship was established.
As regards the very serious possibility of a suicide attempt, I would have to inform the client that I am obliged to inform my Supervisor and the client’s parents and relevant parties of her intent to end her life. This has to be done from a legal and ethical consideration of the situation. I would explain that under normal circumstances, I would have respected the confidentiality; however, given the possibility of real harm to my client, I have no other choice.
Page 2
This disclosure aspect is in line with the Health Professions Council of South Africa requirement. Parents almost always have the legal right to information about their adolescent.
It is important for there to be a shared understanding that the adolescent’s communications to the psychologist are not legally protected. This critical point was covered in the earliest interaction with the client and parents.
A useful approach on breach of confidentiality is discussed by Duncan, Williams and Knowles (2013) in which thorough considerations are made before any decision is made in this regard. The authors stress the importance of following a defined process to assist in the decision making. Reference is also made to special circumstances under which psychologists are permitted or required to disclose confidential information. These include situations in which there is a legal obligation to do so, where there is an immediate risk of harm that can only be averted by disclosing information, or when colleagues or supervisors need to be consulted (Australian Psychological Society, 2008). This tool will be referenced as an aid in this particular case.
3 Who do I need to consult with?
Establishment of the immediate risk to the client would take priority as the client is at the stage of suicidal intent, having passed the stage of suicidal ideation. This consideration is in line with the terms of the requirement for special care in the case of children 14 years of age and younger in the HPCSA code of conduct.
I would engage with the following support personnel :
Engagement with the Social Worker to determine next steps in assisting the client. The need to inform the parents and/or educators and relevant role players would have to be decided. The possibility of enlisting the assistance of a Family Counsellor would have to be decided after consultation with the Social Worker.
Consultation with a Clinician (Clinical Psychologist, Psychiatrist) for assessment and diagnosis as regards the suicidal tendencies.
Page 3
Engagement of the services of a Dietician or Nutrition Specialist to address the poor nutritional health of the client.
All the above consultations are in line with the requirements of the HPCSA rules of conduct.
Family education is also important before decisions are made about the client’s treatment plan. In adolescents, treatment for depression is most successful when the parents are involved.
Learning about depression is an important component of depression treatment. However, if the conflictual family situation is not resolved first, it would be prudent to delay the parental involvement to a later stage or until improved compliance is achieved.
An assessment would have to be made whether family interactions would be constructive or if the client needs protection from such interactions for the time being.
From a personal point of view, it is important for me to be aware of any emotional bias on my part due to the sensitive and traumatic situation that my client is
in.
Page 4
Reference
Children’s Act 38 of 2005. Chapter 2.7, Best interests of child standard., Chapter 9.150, Child in need of care and protection.
Corey,G. (2013). Theory and Practice of Counselling and Psychotherapy (9th Edition). California: Brooks/Cole
Duncan, R., Williams, B. & Knowles, A. Breaching Confidentiality with Adolescent Clients: A Survey of Australian Psychologists about the Considerations that Influence Their Decisions. Psychiatry, Psychology and Law. Volume 20(Issue 1), 2013.
Health Professions Council of South Africa, Form 223. Professional Board for Psychology. Rules of Conduct Pertaining Specifically to Psychology. Chapter 1, Point 6, Extraordinary circumstances, Chapter 2, Point 20(b), Professional relations, Co-operation with other Professionals. Chapter 3, Point 29(2) Legally Dependent Clients.Chapter 3, Point 27(e) Disclosures.
Nichols,J. (2001). Helping Depressed and Suicidal Women with Cognitive-Behaviour Therapy. [On-line]. Available: http://www.rational.org.nz
Spirito,A., Esposito-Smythers, C., Wolff, J. and Kristen,U.(2011). Cognitive-Behavioral Therapy for Adolescent Depression and Suicidality. [
On-line]. Available: http://www.ncbi.nlm.nih.gov/pubmed/21440850
Trower,P., Casey, A. & Dryden, W. Cognitive-Behavioural Counselling in Action. London: Sage.
Appendix 1
Consideration
How would the family respond if told about their child’s risk behaviour? Will the adolescent talk to his/her parents if I do not breach confidentiality? Does the adolescent understand why a breach is necessary? How competent is the young person? What protective factors does the young person have in his/her life? How old is the young person? What is in the best interests of the young person? Did I provide an initial explanation about limits to confidentiality? What is the policy of my workplace? What sort of rapport do I have with the young person? What potential harm could come to the young person if I do breach confidentiality? What is the level of previous parental knowledge about the child’s behaviour? What is my duty of care to each individual involved Is family therapy an option?
Is there a family history of risk behaviour and/or suicide? What is the previous history of the young person? Is this a well thought-out decision?
3225457
Psychology 214: Psychological Interventions
Assignment
Introduction
The case concerns a 14 year old adolescent girl I have been counselling for the past three months. Her home background has been unstable due to a conflictual family life. Her situation has been exacerbated by her poor nutritional health. She complained of severe depression and shared her intent to end her life. She sought advice from me in terms of the means to execute her wish to terminate her life. This was communicated in confidence and I was specifically asked not to divulge this information as she felt ashamed that she was not coping with her life.
The case
Following the initial introduction, the client was informed of the basis …show more content…
of the counsellor-client relationship and the ethical responsibilities on the part of the counsellor, including the aspect of the degree of confidentiality. Due to the establishment of a trust relationship, the client shared information of a personal nature and also the emotional aspects that had a bearing on the case.
The dilemma that I am faced with revolves around the following : 1 what recommendation should I make to the client 2 the ethical aspects relating to trust and confidentiality 3 who do I need to consult with
The approach
1 What recommendation should I make to the client ?
The first thing I would do is to re-assure the client that her feelings were understandable and that a treatment approach would help in resolving the issues experienced by the client. That is, I would affirm the aspect of hope to the client.
Due to the severe depression, I would suggest treatment such as Cognitive Behavioural Therapy (CBT) or interpersonal psychotherapy, in addition to one or more medications. I would introduce the client to the concept of CBT as a treatment method. I would talk about the equal, collaborative relationship that this form of therapy requires. This would reinforce the need on the part of the client to feel in control and to work with me rather than expect me to 'cure’ her.
Page 1
Treatment with medication and an evidence-based psychological treatment (ie, CBT or interpersonal psychotherapy) increases the likelihood of improved symptoms and relationships with family and friends; it can also improve self-confidence and the ability to cope effectively.
Depending on the findings by the Clinician, the client has to be informed of the possible need for hospitalisation for a short period of …show more content…
time.
Depression treatment often includes medication management, individual, group and/or family therapy. Other activities may include physical exercise, art/music therapy and school work.
The client needs to be re-assured of the treatment approach and the fact that she is not alone as there will be a team comprising of the psychiatrist, psychologist, social workers, etc.
The client needs to participate in activities that improve her self-esteem and sense of mastery. Coupled with this, there is a need to adjust the nutritional side to build up the client’s health.
According to Tkachuk and Martin (1999), the importance of a healthy lifestyle (i.e., participating in regular physical activity, eating healthy foods) in maintaining a sense of well-being. In particular, regular physical activity can have a beneficial impact on depressed mood and should be discussed as an important element in any comprehensive treatment plan for adolescents with depressive symptoms.
2 The ethical aspects relating to trust and confidentiality
The fact that it is only of late that the client started to express the suicidal feelings cannot exclude the possibility that these feelings have been developing for some time prior to my engagement as the counsellor. The client may have held back expression of these feelings until the period where a sufficiently favourable client-counsellor relationship was established.
As regards the very serious possibility of a suicide attempt, I would have to inform the client that I am obliged to inform my Supervisor and the client’s parents and relevant parties of her intent to end her life. This has to be done from a legal and ethical consideration of the situation. I would explain that under normal circumstances, I would have respected the confidentiality; however, given the possibility of real harm to my client, I have no other choice.
Page 2
This disclosure aspect is in line with the Health Professions Council of South Africa requirement. Parents almost always have the legal right to information about their adolescent.
It is important for there to be a shared understanding that the adolescent’s communications to the psychologist are not legally protected. This critical point was covered in the earliest interaction with the client and parents.
A useful approach on breach of confidentiality is discussed by Duncan, Williams and Knowles (2013) in which thorough considerations are made before any decision is made in this regard. The authors stress the importance of following a defined process to assist in the decision making. Reference is also made to special circumstances under which psychologists are permitted or required to disclose confidential information. These include situations in which there is a legal obligation to do so, where there is an immediate risk of harm that can only be averted by disclosing information, or when colleagues or supervisors need to be consulted (Australian Psychological Society, 2008). This tool will be referenced as an aid in this particular case.
3 Who do I need to consult with?
Establishment of the immediate risk to the client would take priority as the client is at the stage of suicidal intent, having passed the stage of suicidal ideation. This consideration is in line with the terms of the requirement for special care in the case of children 14 years of age and younger in the HPCSA code of conduct.
I would engage with the following support personnel :
Engagement with the Social Worker to determine next steps in assisting the client. The need to inform the parents and/or educators and relevant role players would have to be decided. The possibility of enlisting the assistance of a Family Counsellor would have to be decided after consultation with the Social Worker.
Consultation with a Clinician (Clinical Psychologist, Psychiatrist) for assessment and diagnosis as regards the suicidal tendencies.
Page 3
Engagement of the services of a Dietician or Nutrition Specialist to address the poor nutritional health of the client.
All the above consultations are in line with the requirements of the HPCSA rules of conduct.
Family education is also important before decisions are made about the client’s treatment plan. In adolescents, treatment for depression is most successful when the parents are involved.
Learning about depression is an important component of depression treatment. However, if the conflictual family situation is not resolved first, it would be prudent to delay the parental involvement to a later stage or until improved compliance is achieved.
An assessment would have to be made whether family interactions would be constructive or if the client needs protection from such interactions for the time being.
From a personal point of view, it is important for me to be aware of any emotional bias on my part due to the sensitive and traumatic situation that my client is
in.
Page 4
Reference
Children’s Act 38 of 2005. Chapter 2.7, Best interests of child standard., Chapter 9.150, Child in need of care and protection.
Corey,G. (2013). Theory and Practice of Counselling and Psychotherapy (9th Edition). California: Brooks/Cole
Duncan, R., Williams, B. & Knowles, A. Breaching Confidentiality with Adolescent Clients: A Survey of Australian Psychologists about the Considerations that Influence Their Decisions. Psychiatry, Psychology and Law. Volume 20(Issue 1), 2013.
Health Professions Council of South Africa, Form 223. Professional Board for Psychology. Rules of Conduct Pertaining Specifically to Psychology. Chapter 1, Point 6, Extraordinary circumstances, Chapter 2, Point 20(b), Professional relations, Co-operation with other Professionals. Chapter 3, Point 29(2) Legally Dependent Clients.Chapter 3, Point 27(e) Disclosures.
Nichols,J. (2001). Helping Depressed and Suicidal Women with Cognitive-Behaviour Therapy. [On-line]. Available: http://www.rational.org.nz
Spirito,A., Esposito-Smythers, C., Wolff, J. and Kristen,U.(2011). Cognitive-Behavioral Therapy for Adolescent Depression and Suicidality. [
On-line]. Available: http://www.ncbi.nlm.nih.gov/pubmed/21440850
Trower,P., Casey, A. & Dryden, W. Cognitive-Behavioural Counselling in Action. London: Sage.
Appendix 1
Consideration
How would the family respond if told about their child’s risk behaviour? Will the adolescent talk to his/her parents if I do not breach confidentiality? Does the adolescent understand why a breach is necessary? How competent is the young person? What protective factors does the young person have in his/her life? How old is the young person? What is in the best interests of the young person? Did I provide an initial explanation about limits to confidentiality? What is the policy of my workplace? What sort of rapport do I have with the young person? What potential harm could come to the young person if I do breach confidentiality? What is the level of previous parental knowledge about the child’s behaviour? What is my duty of care to each individual involved Is family therapy an option?
Is there a family history of risk behaviour and/or suicide? What is the previous history of the young person? Is this a well thought-out decision?