Tag: mental health

Jay Adams, and the Dangers of Biblical Counseling

Almost fifty years ago, in 1970, Jay Adams wrote his controversial book, Competent to Counsel, insisting that Christians reclaim counseling from psychologists and psychiatrists and redistribute humanity’s problems into categories using labels that maintained a theological tone: sin, disobedience, and rebellion. The Biblical Counseling movement, ushered into Christian culture by Adams and his followers, declares that humanism (secular ideals and philosophy) establishes the foundation of professional counseling, creating blueprints for unstable soul repair.  For present day professional counselors this idea, aside from the obvious affront to psychology as a field of study, may seem dubious since the field of counseling is more complex than simply lumping all who counsel professionally into the field of psychology, or even psychiatry.  Regardless, Biblical Counselors see counseling belonging to a different authority altogether:  “Central to his [Adams] vision was the notion that human life is meant to be lived under benign authority—parental, pastoral, ecclesiastical, and, ultimately, immediate theocratic authority as articulated in the Bible—whose purposes were to transform human nature, not actualize it.” [1]  What is interesting here is that the line being drawn in the sand is over human nature—who gets to define it, have its say over it, and counsel in relation to it.  

Undoubtedly to the dismay of the American Psychological Association, modern day professional counselors are not required to study large quantities of psychology, nor are they mandated to specialize or equip themselves with a particular psychological model (i.e. Freudian Psycho-analysis).  Rather, modern day counselors study evidenced based practices for recognizing mental health disorders [2] (assessments) and evidenced based interventions (methods for treatment).  What is important to understand is there is a division in the secular world between professional counseling as underscored by the American Counseling Association and psychology as indicated by the American Psychological Association.  The American Counseling Association (ACA) describes the purpose of counseling in the following statement: “Counseling is a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals.  The American Counseling Association (ACA) is an educational, scientific, and professional organization whose members work in a variety of settings and service in multiple capacities.” [3]

The problem, aside from the various idealistic approaches to counseling—or, even defining the objective of counseling itself, is that at this very moment there are individuals who are suffering from mental health related issues (autism, bipolar disorder, trauma, PTSD, abuse (sexual, physical, emotional, and psychological, etc).  These individuals have grown up to believe that pastors, elders, and Sunday school teachers have been equipped with enough training to provide counseling on these matters.  Most mainline seminaries only provide one or two required classes in pastoral counseling.  Some pastors and teachers in the church have become certified in Biblical Counseling, but that is not particularly impressive.  One website I perused recently proudly offers a Biblical Counseling certificate to individuals who can part with $100 and attend 30 hours of training.  

On the contrary, a professional counselor who is licensed with the ACA is required to have a Masters Degree in counseling and included in the masters degree education a minimum of 700 hours of practicum and internship training is required.  After an individual graduates with his or her masters degree in counseling an additional 3000 hours of supervision are required before one can be fully licensed.  Built into a masters in counseling are classes that teach counselors about assessments, research studies, diagnosis, and evidence based practices and interventions.  

Consider the following two scenarios: If you just found out that your 14 year old daughter has been raped who do you want counseling her? A certified Biblical counselor with 30 hours of training or a licensed professional counselor, with a masters degree and over 3,000 hours of supervised experience?  If you just found out your 12 year old son has autism and is struggling in school, who is better equipped to help him and your family to work through it? The certified Biblical counselor or the licensed counselor?  

In both scenarios the licensed counselor will have immense resources for helping you and your family work through these very tough and gut wrenching problems.  The licensed counselor will not be surprised or overwhelmed because he or she will have had the training needed to meet you and your family in both of these situations.  But what is even more amazing about these two situations, is that the Biblical counselor will first, want to convert you or your son or daughter to Christianity prior to treatment—since treatment at its very start includes conversion.  “Adams did not think that either peace of mind or socially acceptable behavior prescribed an adequate goal for the “cure of souls.” He asserted instead that the church should understand the vast majority of problems in living in terms of an explicitly moral model.  Given this diagnostic framework, he established goals for the church’s counseling that employed the ingredients of the traditional Christian message. First, because “man’s greatest need is forgiveness,” the forgiving grace of Jesus Christ was essential to solving problems in living.” [4]

However, though it seems obvious, neither of these two situations have anything to do with a theological conundrum.  The Biblical counselor will set the agenda, drive the conversation, shaping it into whatever he or she thinks is best for the moment.  The licensed counselor will avoid imposing his or her values into the counseling session [5], having unconditional positive regard for the client (regardless of what he or she believes) and allow the client to bring up what he or she is struggling with and address it, in tandem with the client.  The client and the professional licensed counselor work together on setting the goals, the client and the professional licensed counselor work together through the issues—and together they find hope and healing.  

[1]  Powlison, David. The Biblical Counseling Movement. Greensboro, New Grow Press: 2010. p. 3. 

[2]  I am aware that there are many in the Christian community who do not believe that mental health disorders exist.  This warrants a separate post on the matter, but for now you may want to consider my post on the making of the DSM-V 

[3] https://www.counseling.org/about-us/about-aca/our-mission

[4]  Powlison, David. The Biblical Counseling Movement. Greensboro, New Grow Press: 2010. p. 2

[5]  Standard A.4.b of the ACA Code of Ethics 

Regarding Some Misconceptions Regarding the DSM-5

Introduction

As a professional counselor in training, I have heard and seen some disconcerting assumptions asserted about the Diagnostic and Statistical Manual of Mental Disorders (5th Edition). I have encountered Christian professionals, both counselors and pastors, who argue with some contempt, that the DSM-5 does not offer “Christian” solutions to mental health issues. I use the term “mental health” lightly here, because I know that many pastors and Biblical Counselors reject the idea that there are “actual” mental health problems, preferring to use words like soul problems, human problems, sin problems, martial conflict, and so forth. In any case, this post is dedicated to the making of the DSM-5 and what the DSM-5 is designed to do.

Before I address the history, it is first necessary to recognize what the DSM-5 is designed to do. If a psychologist in Sweden, a licensed counselor in Germany, a medical doctor in Montana, and a psychiatrist in Canada were to sit in a room and discuss particular clients that all share the same symptoms they would use the DSM-5 as a point-of-reference, since the DSM-5 is internationally recognized as a reference and diagnostic tool. For example, a person diagnosed with Post-Traumatic-Stress Disorder from the DSM-5 will have either the same or very similar symptomatology of any other person (regardless of where they are in the world) as long as that other person has also been diagnosed with the DSM-5. They key point that I am trying to get at here, is that the DSM-5 is a diagnostic tool, listing certain sets of criteria that have to be met before someone can receive a particular diagnosis.

History of the DSM-5

The history of the DSM-5 began in 1999, which was initiated by the American Psychological Association (APA). The APA wanted a significant amount of collaboration on this project, so they recruited professionals from many different fields: internationally recognized clinicians, scientific researchers, and professional organizations. “Through this wide scale collaboration, the DSM-5 development process has involved not only psychiatrists, but also experts with backgrounds in psychology, social work, psychiatric nursing, pediatrics, and neurology” (APA, 2013).

A task force was created that included over 160 mental health and medical professionals who were leaders in their fields. From these 160 professionals, 13 work groups were created which comprised over 90 academic and mental institutions around the world. More specifically, within the 160 professionals collaborating on this project: “Nearly 100 are psychiatrists, 47 are psychologists, two are pediatric neurologists and three are statisticians/epidemiologists. In addition, also included are a pediatrician, speech and hearing specialist, social worker, psychiatric nurse and consumer and family representative” (APA, 2013).

In addition to the 160 mental health and professionals who were collaborating on this project, an additional 300 advisors came along side the project to help inform specific areas requiring additional expertise.

The American Psychological Association partnered with the World Health Organization as well as the World Psychiatric Association to help with the organization of the DSM-5. “From 2004-2008, APA, WHO and the National Institutes of Health supported 13 additional conferences involving nearly 400 participants from 39 countries, including 16 developing nations. The work resulted in 10 monographs, hundreds of published articles regarding the current state of knowledge and recommendations for additional research in many fields” (APA, 2013).

Committees also helped in the process, such as the APA Board of Trustees, which overviewed the content for the DSM-5 along with A Scientific Review Committee and A Clinical and Public Health Committee.

Additionally, public feedback was also requested, which brought in about 11,000 comments which impacted changes. Lastly, thousands of additional clinicians and professionals volunteered their time to over up their expertise, contributing to the making of the DSM-5.

Final Remarks

It is important to understand that the DSM-5 is not a “Christian” document. It’s purpose is to function as a diagnostic tool. It is it true that the DSM-5 does not offer Christian advice for how to address mental health issues, however the DSM-5 does not offer any advice on how to treat or medicate mental health issues. It is not designed to do that.

Reference

American Psychological Association (2013). The People Behind the DSM-5. PP 1-2. Click here for page location.

On The Efficacy of EMDR in Treating Children with PTSD

The Diagnostic and Statistical Manual of Mental Disorders (2013), indicates for those aged six and older, a diagnosis with post-traumatic stress disorder (PTSD) symptoms include but are not limited to the following: dissociation (i.e. flashbacks), nightmares, recurring, involuntary and distressing memory recollection. Additionally, the DSM-V (2013) indicates that a PTSD diagnosis is accompanied with negative thinking and mood alterations with regard to the traumatic event. Persistent avoidance of triggers associated with the traumatic situation is also common and one of the necessary requirements to receive a diagnosis of PTSD.

“Many youth (possibly up to 50%) who have experienced sexual and physical abuse may display PTSD” (Kearney et al, p. 410, 2012). Research indicates there is difficulty regarding clinicians’ ability to identify and diagnose PSTD in children (Racco, 2014). Consequently, there is confusion concerning comorbidity of symptomatology, which leads to difficulty in identifying the best intervention. Rubin (2007) indicates it is difficult to estimate the outcome of treatment for PTSD with short-term interventions such as Eye Movement Desensitization and Reprocessing (EMDR) which is due to the number of comorbid symptoms of PTSD (i.e. anxiety, depression, substance abuse, and personality disorders).

The portion of the brain that is deeply affected by PTSD is the prefrontal cortex. The individual diagnosed with PTSD may experience a series of debilitating physiological responses as a result of the prefrontal cortex being affected by a traumatic experience. Physiology of that portion of the brain that is affected includes but is not limited to fight or flight, inhibition, planning and anticipation (Blankenship, 2017). The Bilateral eye movement is one of several methodologies of EMDR.  Verbalization and cognitive reframing appear to be the key methodological aspects in EMDR, however, cathartic healing, where painful experiences lose their ability to provoke traumatic memories, resulting in intense emotional responses is EMDR’s primary function in trauma healing (Smith, 2004). This suggests the methodology of EMDR has flexibly as an intervention to meet the needs of those who do not meet the formal criteria of PTSD. The tension in the research thus far indicates EMDR is being tested on both those who have received a diagnosis of PTSD and on those whose trauma is enough to indicate PTSD but not quite specific enough for an actual PTSD diagnosis. This review seeks to answer the question: What is the efficacy of EMDR in treating children and adolescents with PTSD?

EMDR Methodology and Protocol

According to Hensel (2008) EMDR methodology includes using bilateral movement of the therapist’s fingers in the air. The client is asked to watch the fingers move back and forth while also concentrating on the memory of the worse part of their traumatic experience. Then the therapist asks the client what he or she noticed the most. Whatever came about from the first set of eye movements is now the material for the new focus of the second set of eye movements. This routine continues until the client is able to report that the distressing memory no longer has power and is able to report a healthy perspective concerning the memory.

One of the interesting features of EMDR is how quickly it begins to help a person who has had a traumatic experience. Adding to this neurological mystery, EMDR works with little to no talking on behalf of the therapist or the client, which does not necessitate cognitive reframing to occur in order for EMDR to work (Smith, 2004).

EMDR was developed by Francine Shapiro (Greber et al, 2012) and includes the bilateral eye movement methodology for an intentional eight phase approach to treatment. Research indicates that these eight stages are able to be manipulated depending on the age and setting of the client. For example, in a study conducted by Jarero, Artigas, Uribe, & García (2016) the eight phase protocol for EMDR was utilized in group therapy. EMDR has a group therapy adaptation: Integrative Group Therapy Protocol (EMDR-IGTP) which allows the eight phases of individual EMDR to be applied in a group setting. A case study from the group therapy concluded that a cancer patient, Eva, diagnosed with severe PTSD, EMDR-IGTP demonstrated its effectiveness in reducing her symptoms from minimum to none.

It should be noted that the majority of the research literature uses the term “bilateral” to refer to the kind of eye movement stimulation that occurs in EMDR. However, Shapiro (2018) uses the phrase “bilateral dual attention stimulation” (p. 2). For the sake of clarity the author of this article will use the phrase, “bilateral” in reference to the eye movement portion of the EMDR protocol.

A review of the literature indicates a diagnosis of PTSD frequently accompanies comorbid symptoms and diagnoses.

EMDR and Comorbidity of PTSD Symptoms

While in tandem, a child who has PTSD symptoms but does not meet the criteria for a PTSD diagnosis, there remains the option to undergo EMDR therapy for trauma related symptoms. However, according to Fleming (2012), regardless of differences in symptomatology both children and adults may be diagnosed with PTSD (an anxiety disorder) after a traumatic experience. Some researchers utilize two categories of PTSD: Simple and Complex. Simple PTSD would refer to a singular traumatic experience whereas complex PTSD would refer to a repeated traumatic experience (Blankenship, 2017).

Comorbidity, once explored in relation to other mental health disorders, helps clarify the role in which EMDR might play in mental health wellness. The DSM-V (2013) indicates those with a PTSD diagnosis are 80% more likely to have another mental health disorder such as depressive, anxiety, bipolar; in the case of males they are more likely to have conduct disorder and substance use disorder. However, Shapiro (2018) reports that children can exhibit symptoms similar to adults who suffer from complex trauma. These symptoms include but are not limited to lying, stealing, aggressive behavior, and defiance.

In a mixed methods case study, Grey (2011) utilized the Beck Depression Inventory-II (BDI-II) for pre, mid, and post treatment of EMDR for a female participant in her thirties, who was employed, married, and of Euro-American descent. She was diagnosed with major depression disorder and panic disorder with agoraphobia. However, the diagnostic criteria was not met for PTSD. Similarly, children can have trauma related symptoms that do not meet the criteria for a PTSD diagnosis (Fleming, 2012). However, in the study conducted by Grey (2011) after twelve EMDR sessions this study indicates the possible efficacy of EMDR in decreasing emotional symptoms in an expedient way. This case study exemplifies a review of the research that indicates, for persons (children and adults) struggling with comorbid depression and anxiety, EMDR may be helpful.

Though children and adults may experience trauma differently, symptomatology does not appear significantly different between the two populations. Because the research literature for EMDR as an intervention in children is being utilized, the following section will explore trauma and PTSD in children.

EMDR Interventions in Trauma and PTSD in Children

Brief therapy, such as EMDR, is recognized as an empirically supported intervention by the International Society for Traumatic Stress Studies (Rubin, 2007). For children, EMDR protocol can be adjusted, as in a study conducted by Hensel (2009). An age modified EMDR therapy for children was used and the study concluded EMDR was effective in treating PTSD symptoms in children. Shapiro (2018) claims children who have encountered trauma in relation to assault or natural disasters are healed from their symptoms as a result of going through EMDR.

Two particular studies have been included in this review because they are examples of evidence based research demonstrate the efficacy of EMDR in the treatment of PTSD in Children. Regarding trauma, a mixed-methods study was created by Turunen, Haravuori, Pihlajamäki, Marttunen & Punamäki (2014). They conducted a study of survivors of a school shooting where survivors were given the opportunity to participate in therapeutic sessions. Of the original sample (N=389, n=236) responded to surveys aimed at gathering the therapy experiences of participants regarding the perceived efficacy of the treatments they received. More professional therapy was given to students with severe trauma, which included regular psychotherapy meetings. Twenty percent of these regular meetings included EMDR therapy. Feedback from the students, analyzed in this study, demonstrates that the students felt the availability of psychosocial therapy was helpful.

In a mixed methods case study, Aranda, Ronquillo & Calvillo (2015) used EMDR as an intervention for an eighteen year old woman, named Sophia, who was single and of Mexican origin. She had been diagnosed with PTSD due to childhood sexual abuse. Neuropsychological and physiological measures were triangulated against psychological inventories providing data to measure improvement. Using biofeedback, this study indicates that Sophia’s decreased heart rate between the baseline at the start and end of the EMDR treatment yields evidence for the treatment’s effectiveness. EMDR treatment resulted in significant improvement of Sophia’s scores on the Paced Auditory Serial Addition Test (PASAT). The PASAT measures working memory and improvement in attention. Additionally, a one year follow-up conversational session with Sophia revealed she had stabilized and no longer demonstrated PTSD symptoms. It should be noted that researchers were unable to gather third-party confirmation of Sophia’s change of behavior.

Due to the complex nature of PTSD symptomatology and the variety of EMDR approaches to trauma, there is a need to review research methodology in order to ascertain the various approaches to applying evidenced based practices to using EMDR in therapy.

Strengths and Weaknesses of Research Methodologies

A review of the research literature indicates some tension regarding methodical testing as well as the usefulness of particular aspects of EMDR methodology. Yet, withstanding this tension, the efficacy reports of EMDR as an intervention for PTSD in children and adolescents remain positive. However, a weakness in research literature reported in a review by Greyber (2012) demonstrates a lack of evidence from random control trials that indicate EMDR is an effective intervention for children who have experienced trauma. Additionally, the review indicates small sample sizes and the use of control groups, which he states does not allow for the placebo affect. Yet, Blankenship (2017) indicates in his literature review that EMDR is an integrative therapy with over twenty random control trials demonstrating its efficacy in treating trauma. Though there is a five year interval between these reviews, the enigmatic quality of results despite methodical approach provides evidence for EMDR as a treatment for trauma related symptoms.

A strength in the research literature indicates an increase in quantitative studies since 2012 regarding the efficacy of EMDR in the treatment of children. For example, a meta-analysis by Brown, et al., (2017) reviewed thirty-six research studies including 3,541 children and youth participants with regards to efficacious treatments for PTSD. This study concludes that EMDR is one of several interventions that has shown to be effective in treating children after a mass traumatic event. However, it should be noted the quality of these studies was not assessed independently.

Research also indicates that case studies have much to offer regarding the efficacy of EMDR treating PTSD. The strengths of the method in the literature often involves mixed methods models in which the participant is tested and also has a follow-up conversations regarding his or her improvement. In Grey (2011) a mixed methods, single case study approach was conducted with a participant (in her thirties) who took 12 EMDR sessions condensed into one month and then was assessed by the Beck Depressive Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI). Though generating objective data, the single case study design, is weakened by it’s lack of universality of results. However, the profit of the mixed methods single case design is supported by the literature—consistent results for effective treatment of EMDR for PTSD symptomatology. In addition to the quantitative data that has been reported, more mixed methods and single case studies with children and adolescents would help the body of efficacious evidence in support of using EMDR to treat PTSD in youth.

A limitation recognized in the research literature indicates a further need for training in EMDR as wells as a lack of knowledge about its efficacy. A study conducted by Edmond, Lawrence, and Schrag (2016) investigated the perceptions and use of EMDR therapy in rape crises centers. Their study indicated that there remains a great deal of uncertainty among counseling staff at Rape Crises Centers regarding EMDR as a treatment for sexual trauma. Additionally, they discovered in their study many of those using EMDR at rape crises centers are doing so without basic training in EMDR. A pattern has been recognized in the research literature that indicates few studies identify the amount and type of EMDR training received on behalf of those doing research regarding the efficacy or effectiveness of EMDR in treating PTSD in children.

Ethical and Culturally Relevant Issues

When deciding on treatment options for a client with a PTSD diagnosis, a primary concern is using an intervention that is evidence based. By consensus in the counseling community, when treating trauma survivors, a PTSD diagnosis is alleviated when the trauma survivor is to work through the traumatic event. EMDR therapy and trauma-focused cognitive-behavioral therapy (CBT) are both recognized as the primary two effective treatments that have empirical support for treating PTSD (Shapiro, 2018).

Research indicates that EMDR is effective in treating PTSD symptoms in children to such a degree that they either have minimum symptoms or are asymptomatic (Fleming, 2012).

Shapiro (2018) indicates that EMDR is a treatment that is effective throughout the lifespan and has successfully been used as intervention with a child as young as age two. Additionally, nine random control trials indicate positive effects for treating trauma related symptomatology in children with EMDR. However, research also indicates criticism towards aspects of EMDR’s bilateral eye-movement, saying the benefits of EMDR are due to it functioning as a kind of exposure therapy (Rubin, 2003). Yet, Maxfield, Lake, & Hyer, (2004) clarify by reporting that subjective distress experienced by participants at the end of EMDR sessions was much lower than that of an exposure therapy session. Ethically, this is important, as the level of emotional distress that may be experienced by a client in therapy needs to be communicated to the client prior to an EMDR intervention.

Shapiro (2018) indicates after a comprehensive client history is taken (Phase 1), then EMDR may be considered as a possible intervention and the client would be prepared for the targeting of memories that may bring emotional disturbance (Phase 2). Ethically, this process first considers the client’s needs, then informs the client regarding how EMDR may affect the client. As a result, veracity, nonmaleficence, beneficence, and autonomy, values of the ACA Code of Ethics (2014) are being upheld.

Concerning multiculturalism and EMDR, therapeutic interventions, particularly with children, therapists may consult the Cultural Formulation Interview (CFI) in the DSM-V (2013) for reference in reviewing applicable questions for their particular client population. In study conducted by ter Heide, June, Mooren, Knipscheer, & Kleber, (2014) on using EMDR for refugees, the authors state that the efficacy of EMDR has been found in participants from non-Western cultural environments. In particular they note that language barriers may be lessoned because speech is not always necessary in EMDR protocol and that EMDR does not have homework assignments.

Future Research

A review of the literature indicates an increase in random control trials from 2012 to 2018 for the efficacy of EMDR in treating children with PTSD, however a few gaps in the literature are as follows: (1) Fidelity to EMDR protocol is at times neglected or altered to fit a study’s research design. Further research is needed to identify the value of each phase of the EMDR protocol. Present research indicates using correct EMDR protocols leads to better treatment outcomes (Hensel, 2009). (2) Qualitative research is needed for exploring post-treatment analysis as well as participants’ feelings experiences regarding EMDR as a treatment. Additionally, questions that explore how the client felt at each of the eight phases of the EMDR intervention would provide insight as to where clients might need further clarification and insight from their therapist. (3) There is also a need for more longitudinal studies to measure the efficacy of EMDR on PTSD over greater periods of time. (4) Organizations offer differing criteria for training in EMDR, which results in non-standard approaches and techniques. Research is needed to explore the efficacy of different EMDR training programs in teaching therapists how to efficaciously treat PTSD in their clients. Additionally, there are both online and physical location programs for training. A correlational study would serve to provide greater detail on which of the two educational formats has efficacious results. (5) Further research is needed to explore complex PTSD in children and the efficacy of EMDR in treating prolonged trauma. (6) Some skepticism remains regarding the use of bilateral eye stimulation in EMDR methodology and protocol (Greyber, 2012). Further research is needed to identify why the bilateral eye stimulation is efficacious in EMDR and how it works as an efficacious tool for desensitization of traumatic experiences.

References

American Counseling Association. (2014). ACA code of ethics. Retrieved from https://www.counseling.org/resources/aca-code-of-ethics.pdf

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, D. C.: American Psychiatric Publishing.

Aranda, B. D. E., Ronquillo, N. M., & Calvillo, M. E. N. (2015). Neuropsychological and physiological outcomes pre- and post-EMDR therapy for a woman with PTSD: A case study. Journal of EMDR Practice and Research, 9(4), 174-187. http://dx.doi.org/10.1891/1933-3196.9.4.174

Blankenship, D. M. (2017). Five efficacious treatments for posttraumatic stress disorder: An empirical review. Journal of Mental Health Counseling, 39(4), 275-288. https://doi.org/10.17744/mehc.39.4.01

Brown, R. C., Witt, A., Fegert, J. M., Keller, F., Rassenhofer, M., & Plener, P. L. (2017). Psychosocial interventions for children and adolescents after man-made and natural disasters: A meta-analysis and systematic review. Psychological Medicine, 47(11), 1893-1905. https://doi.org/10.1017/S0033291717000496

Edmond, T., Lawrence, K. A., & Schrag, R. V. (2016). Perceptions and use of EMDR therapy in rape crisis centers. Journal of EMDR Practice and Research, 10(1), 23-32. https://doi.org/10.1891/1933-3196.10.1.23

Fleming, J. (2012). The effectiveness of eye movement desensitization and reprocessing in the treatment of traumatized children and youth. Journal of EMDR Practice and Research, 6(1), 16-26. Retrieved from http://proxy112.nclive.org/login?url=https://search.proquest.com/docview/922392629?accountid=12544

Greyber, L. R., Dulmus, C. N., & Cristalli, M. E. (2012). Eye movement desensitization reprocessing, posttraumatic stress disorder, and trauma: A review of randomized controlled trials with children and adolescents. Child & Adolescent Social Work Journal, 29(5), 409-425. http://dx.doi.org/10.1007/s10560-012-0266-0

Grey, E. (2011). A pilot study of concentrated EMDR: A brief report. Journal of EMDR Practice and Research, 5(1), 14-24. Retrieved from http://proxy112.nclive.org/login?url=https://search.proquest.com/docview/858829446?accountid=12544

ter Heide, F., Jackie June, Mooren, T. T. M., Knipscheer, J. W., & Kleber, R. J. (2014). EMDR with traumatized refugees: From experience-based to evidence-based practice. Journal of EMDR Practice and Research, 8(3), 147-156. Retrieved from http://proxy112.nclive.org/login?url=https://search.proquest.com/docview/1559070317?accountid=12544

Hensel, T. (2009). An intervention study. Journal of EMDR Practice and Research, 3(1), 2-9. http://proxy112.nclive.org/login?url=https://search.proquest.com/docview/222692641?accountid=12544

Jarero, I., Artigas, L., Uribe, S., García, L. E., Cavazos, M. A., & Givaudan, M. (2015). Pilot research study on the provision of the eye movement desensitization and reprocessing integrative group treatment protocol with female cancer patients. Journal of EMDR Practice and Research, 9(2), 98-105. http://dx.doi.org/10.1891/1933-3196.10.3.199

Maxfield, L., Lake, K., & Hyer, L. (2004). Some Answers to Unanswered Questions about the Empirical Support for EMDR in the Treatment of PTSD. Traumatology, 10(2), 73-89. doi:http://dx.doi.org/10.1177/153476560401000202

Kearney, C. A., Wechsler, A., Kaur, H., & Lemos-miller, A. (2010). Posttraumatic stress disorder in maltreated youth: A review of contemporary research and thought. Clinical Child and Family Psychology Review, 13(1), 46-76. http://dx.doi.org/10.1007/s10567-009-0061-4

Racco, A., & Vis, J. (2015). Evidence based trauma treatment for children and youth. Child & Adolescent Social Work Journal, 32(2), 121-129. http://dx.doi.org/10.1007/s10560-014-0347-3

Rubin, A., & Parrish, D. (2007). Challenges to the future of evidence-based practice in social work education. Journal of Social Work Education, 43(3), 405-428. Retrieved from https://search.proquest.com/docview/209794776?accountid=12544

Rubin, A. (2003). Unanswered questions about the empirical support for EMDR in the treatment of PTSD: A review of research. Traumatology, 9(1), 4-30. http://dx.doi.org.proxy112.nclive.org/10.1177/153476560300900102

Shapiro, F. (2018) Eye Movement Desensitization and Reprocessing Therapy: Basic Principles, Protocols, and Procedures. Third Edition. New York: Guilford.

Smith, J. (2004). Reexamining psychotherapeutic action through the lens of trauma. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 32(4), 613-31. Retrieved from http://proxy112.nclive.org/login?url=https://search.proquest.com/docview/198142358?accountid=12544

Turunen, T., Haravuori, H., Pihlajamäki, J.,J., Marttunen, M., & Punamäki, R. (2014). Framework of the outreach after a school shooting and the students perceptions of the provided support. European Journal of Psychotraumatology, 5. http://dx.doi.org/10.3402/ejpt.v5.23079

A Brief Compare and Contrast Analysis of the ACA and APA Codes of Ethics

The American Psychological Association’s (APA) code of ethics focus on the medical model and the American Counseling Association’s (ACA) code of ethics has its focus on mental health in relation to the client’s wellbeing.  Both ethical codes contain a preamble, a general description of  the organization’s ethical principles, and ethical standards.  However, there are subtle and blatant differences between these two documents.  What follows in this paper is a comparison and contrast between the APA and ACA codes of ethics with a guided focus on answering the following question: How do these ethical codes address the significance of the client-counselor relationship?

Critical Analysis 

“The APA Code of Ethics” (2010) is a document with a five part ethical principles section, lettered A – E, and are as follows: “Beneficence and nonmaleficence, fidelity and responsibility, integrity, justice, and respect for people’s rights and dignity” (p. 2).  Notably in the APA these ethical principles are declared as unenforceable rules, but rather they are to serve as a guide “to guide psychologists toward the highest ideals of psychology” (p. 3).  In contrast, the “ACA Code of Ethics” (2014) lists six ethical principles which are as follows: “autonomy, nonmaleficence, beneficence, justice, fidelity, and veracity” (p. 3).  However, these ethical principles are provided after a list of five values creating a “conceptual basis” for the ethical principles (p.3).  The ACA code (2014) derives its ethical standards on its values and principles, stating: “These principles are the foundation for ethical behavior and decision making” (p. 3).  While it may be a subtle distinction, it remains noteworthy that the APA utilizes the word “guide” while the ACA code uses the word “foundation” to describe the function of the ethical principles in relation to ethical decision making; as a way to approach the ethical standards themselves.

The reason the word “foundation” is of significance, especially in contrast to the word “guide” is the overall importance being established for the ethical standards themselves.  The implication being, that the word “foundation” offers a concrete recognition that they values and ethical principles within the “ACA Code of Ethics” permeate the standards in such a way that their existence can in no way be separated from their intended social pragmatism.  It is not that the ends justify the means, rather it is the means that inform the ends.  The emphases on a foundational system of values and principles in the “ACA Code of Ethics” communicates an overarching theme of protecting the client and making sure the counselor is clear on how, as well as why, he or she should do so.

Thematic Differences 

The emphases on the client in the “ACA Code of Ethics” is substantially greater than the “APA Code of Ethics.”  For example, in the ACA ethical code the words client or clients is used 293 times, as opposed to the 67 times the same words are used in the “APA Code of Ethics”.  The ethical standards of the “APA Code of Ethics” are truncated by a lack of particular values (as opposed to ethical principles) that center around the client.  For example, when a search is conducted for the word “counseling” in the “APA Code of Ethics” the word is used 4 times, as opposed to the 157 times the “ACA Code of Ethics” refers to it.

The terminology differences are significant because they highlight two particular paths that in some regards parallel each-other, yet have differing ultimate purposes.  The APA is focused primarily on Psychology (it’s study and implications), whereas the ACA is focused on counseling (the client-counselor relationship) with an added emphases on the client’s rights.  To be more specific the APA is based on a medical model, whereas the ACA is based on a wellness model. This is important for recognizing the way each of the codes approach the client-counselor relationship.  The “ACA Code of Ethics” (2010) deals with “the counseling relationship” in the first section of its code, which introduces the subject as priority, upfront (p. 4).  The “APA Code of Ethics” places “ethical standards” as the first section of its code (p. 5).  The obvious conceptual difference is the ACA code has a cohesive platform directing the counselor in its formatting of the codes towards a client-centered approach.

Contrasting Views on “Values”   

A blatant difference between the codes of the APA and the ACA regards the role of values in the counseling or therapy relationship.  Section A.4.b. of the “ACA Code of Ethics” (2010) states the following:

Counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients, trainees, and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature (p. 5).

Additionally, in section A.11.b in the “ACA Code of Ethics” (2010) counselors are directed to only give give a referral if their lack of knowledge in a particular subject warrants the client to see someone with more expertise on the subject.  The same section also deals with values in the following: “Counselors refrain from referring prospective and current clients based solely on the counselor’s personally held values, attitudes, beliefs, and behaviors” (p. 6).   The “APA Code of Ethics” is silent on the issue of “imposing values” and simply does not address the issue of making a referral based on values that are inconsistent with the client’s values.  The restrictive nature of imposing values in the counseling relationship as in the “APA Code of Ethics” once again reiterates and solidifies its position on safeguarding the client from harm, neglect, and discrimination.

In the “APA Code of Ethics” referrals, (Section 1.04, b) are appropriate when there is a lack of expertise.  Both the ACA and the APA codes have non-discrimination clauses, however the “ACA Code of Ethics” presents the concept that if one were to do a referral simply because of a difference in values with the client, the act of the referral itself is discriminatory.

Conclusion 

In conclusion, both the APA and the ACA have thorough codes of ethics, however they differ with respect to the kind of emphasis given on values and the degree to which the centricity of the client’s welfare should receive.   They are similar with regards to protecting the process of therapy / counseling, however the strategic formatting differences in the codes themselves reveal a visionary difference.  It may be observed that the ACA code reveals a relational approach to ethical values, principals, and standards whereas the APA code particularizes its focus on the role, function, and purposes of the psychologist.

References

American Counseling Association. (2014). ACA code of ethics. Retrieved from https://www.counseling.org/resources/aca-code-of-ethics.pdf

American Psychological Association (2010). APA Code of Ethics. Retrieved from https://www.apa.org/ethics/code/principles.pdf

*This post has yet to be updated for APA formatting.  It’s on my long list of improvements for this site.

Three Assessments for Suicide Prevention

This post offers three brief examples of assessments (non-standardized, norm-based, and standardized) for evaluating those at risk of suicide as well as determining factors that may play a role in reducing suicidal intentions.  The construct being measured, therefore, is suicide ideation and intention. In 2013 the average suicide rate in the United States was 113 people per day (Whiston, 2017, p. 153).   A community health assessment for Buncombe County, North Carolina in 2015 concluded that suicide in Buncombe county is rising and as of 2015 the suicide rate was higher than the North Carolina Rates (Buncombe County Community Health Assessment, 2015, p. 20).

With regards to suicide prevention, taking time to engage a client in a conversation about where he or she is at with regards to their propensity and trajectory towards suicidal thoughts may include the non-standardized assessment of discussing the mnemonic device represented in the the following phrase: IS PATH WARM.  Each letter of the phrase represents a guide for counselors in determining the potential risk of a client, please refer to figure 1.1 (Whiston, 2017, p. 154).

Screen Shot 2018-03-13 at 1.49.01 PM.png Whiston (2017) indicates that if the mnemonic assessment reveals there is risk for suicide for the client, the next step is to determine whether the client has a plan to carry out the his or her suicide.

The non-standardized approach of using the mnemonic IS PATH WARM assessment is helpful in providing a guide for the counselor in his or her discussions with a client so as to map out the direction their client seems to be heading with regards to suicide.  This may be considered the ground work or foundation by which other follow-up assessments may add to.  Though non-standardized and consequently subjective, this conversational approach to learning more about what the client is thinking may help build client-counselor trust and establish the client counselor relationship prior to bringing in more normative and standardized assessments.

With regards to a norm-based assessment for determining suicide potential in a client the Suicide Probability Scale provides a 36-item instrument the helps the counselors measure the risk of suicide.  “The scale includes sub scales that assess hopelessness, suicidal ideation, negative self-evaluation, and hostility” (Whiston, 2017, p. 157).  In order to utilize this scale, the counselor must have Masters related to-the-field degree.

An additional and more frequently used standardized assessment for determining suicide is the Beck Depression Inventory-II , which is an assessment focused on depression. “Ponterotto, Pace, and Kavan (1989) identified 73 different measures of depression that researchers or mental health practitioners use” (Whiston, 2017, p.159).  This is assessment may be a preferred standardized assessment as its focus concentrates around depression and it only take the client around 5 minutes to complete, allowing time for the client and counselor to discuss the results almost immediately.  To utilize this assessment also requires the clinician to meet certain educational standards and or certification requirements.

In conclusion, suicide prevention is something that needs awareness in both public and professional arenas in order that the symptoms of suicide do not go unnoticed and are given prompt attention by a professional counselor.

For further reading on the subject of suicide prevention I recommend:

References: 

Buncombe County. (2015). WNC Healthy Impact. Buncombe County Community Health Assessment. Buncombe County: Buncombe County Health & Human Services.

Brown, Jarrod & Salvatore, Tony. (2017). Raising Awareness of Suicide Risk. Counseling Today. Retrieved from http://ct.counseling.org

Whiston, Susan, C. (2017). Principles and Applications of Assessment in Counseling. Fifth Edition.  Australia: Cengage Learning.