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Tina's Term 1 Final
Professional Development - Therapeutic Relations Part 1 (2nd half)
| Question | Answer |
|---|---|
| Main influences in boundary development ? | Environment, family, teachers, schools, neighbours, culture, religion, media, and the world as a whole. |
| What are two main types of boundaries? | Concrete. Abstract. |
| Give an example of each of the two main types of boundaries | Concrete: Timing issues. Abstract: Intention of touch. |
| Benefits of clearly defined boundaries. (a) | Defining(2), Identifying, Facilitating, Building. Defining limits of client-therapist relationship. Defining appropriate conduct. Identifying expectations. Facilitating conflict resolution. Building client - therapist trust. |
| Benefits of clearly defined boundaries. (b) | Ensure, Prevent(3) - > Ensure relationship remains professional. - > Prevent being triggered by client. - > Prevent over-identifying with client. - > Prevent projection of personal beliefs:race, gender, sexual orientation, body size, diseases. |
| Give an example where therapist might feel less powerful than the client. | Therapist treating another healthcare therapist such as a physician, may feel intimidated by superior expertise. |
| What are some examples of issues arising when therapist feels less powerful than the client? | May violate boundaries by deferring on issues of *payment,*scheduling *extension of sessions, or * even treatment. |
| Therapist must pay special atttention to the needs of the person with less apparent power. and must not take advantage of clients, physically, mentally, emotionally, financially or professionally. Give three examples of violations. | Asking legal Q's of client who is a lawyer. Soliciting funds for a charity. Asking for special introduction to someone in position of power. |
| Client's Role: How client (with apparent lesser power) may respond to the other (therapist) use of power | Difficulty saying "No". Not speaking up. May become overly compliant, fearing being seen as disrespectful > poor service. May resent th's perceived power, undermining Tx May agree to something fearing loss of connection w' therapist. |
| Define Transference | The projection or transfer of a client's unconscious or unresolved feelings, needs and issues to the therapist. |
| Positive transference | "Crush". (Therapist as hero or saviour). |
| Signs of positive transference | Passivity. Client may not speak up. Captivity: Client may feel trapped during Tx Dependency: unhealthy dependency on therapist. |
| Signs of negative transference: (Therapist as villain). | Nervousness, distrustful: client appears anxious, asking more than normal Q's. Rudeness: for no apparent reason. Demanding: unusual demands - eg. door open, lights on. |
| Dealing with Transference: | Refer Be respectful. Do not take personally. Be aware if it is personal - Must take care not to affect client's feelings. Have clear boundaries. Do not take advantage. Empower client! |
| Counter Transference | Projection or transfer of the therapist's unresolved feelings and personal issues to the client.. |
| Signs of positive counter-transference | Treating client as special. Wanting client to improve faster; allowing late payments. Hoping the client will call. Sign therapist may be enamored. allowing longer sessions: making excuses as why the client should have longer sessions. |
| Signs of negative counter-transference. | Anger: strong feelings surface for no reason Chronic annoyance: just seeing client's name on appointment sheet raises feeelings of annoyance. Unexplained uneasiness. as client enters room or at mention of client's name. |
| Dealing with counter-transference. | Refer. or... Be aware of personal feelings: knowing self is the key in every relationship. Establish a routine so that exceptions are noticeable. Get outside help. peer, or mental health professional |
| Action if therapist feels a boundary is being crossed. | Distract, ask client to concentrate on Tx. Invite feedback..... pressure, response to area. Remind that the relationship is professional. Rather than give advice beyond scope of practice. Admit beyond scope and offer to refer. |
| Dual relationship | Preserve integrity of profess'l relationship. Client or therapist may develop minor expectations: delineate boundaries. Blurring of roles (confidentiality/power)- best to avoid. High risk: Dating! |
| Dual relationship in Financial arrangements: | Barter, Exchange of services, Employment. |
| Dating ex clients? | Complex issues. key factor is elapsed time. Another factor is if relationship was one of dependency eg. Th. helped in overcoming physical or emotional pain. |
| Tools for maintaining boundaries. | Clear from outset. Policies should be: > Posted in a clearly visible area. > Explained by therapist. > acknowledged as read and understood by client. Fees, Timing, Right to Refer. |
| 5 Types of Abuse | Verbal, physical, emotional, sexual, financial |
| Sensitive areas | Must explain proposed treatments: draping, positioning, risks, benefits, alts. to treatment or draping, right to refuse throughout care plan. Signed consent not valid without on-going informed consent. |
| Policy regarding referrals to unregulated professionals | Is there a standard certification? What is required for professional regulation? Association? Disciplinary procedures? Where can one obtain further information? |
| Before referral is made: | Advise/inform client of usual and conventional treatment options:-risks / benefits. Ensure that information or opinion provided to client is not misrepresented. Ensure no conflict of interest or financial gain involved in referral. |
| Time Management skills | Focus on results not on being busy: 80:20 rule Pareto principle (Italian economist Vilfredo Pareto) Joseph Juran 80% of effects come from 20% of causes. 80% of unfocussed effort generates only 20% of results |
| Time Management | Purpose of Plan: Clarify** Focus** Research > Provides logical framework within which to develop & pursue strategies. > Offers a benchmark - measure act. performance Set goals and clear objectives Prioritizing. Scheduling Allocating |
| Time Management Allocating - B.A.L.M. | B - Break down broader terms into specific individual tasks. A - Analyze and list competencies involved. L - List competencies of each member. M - Match individuals to task competencies. |
| Time Management - Delegating | |
| Research definition | The systematic investigation into and study of materials and sources in order to establish facts and reach new conclusions. |
| Although boundaries may be obscure, research can be: | Exploratory - identify problem not yet defined. - Constructive - develop a solution to existing problem. - Empirical - tests feasibility of solution using "knowledge" - (observation, experience, analysis) |
| Randomized Controlled Trial uses/ types | Test safety and efficacy of healthcare services. |
| Non-blind RCT: | Non-blind(open label) researchers and participants know which treatment is being administered. |
| Blind RCT: | Some persons prevented from knowing certain info that might lead to conscious or unconscious bias |
| Single Blind: | Only experimeter knows full facts. Problem: unconscious or conscious bias. |
| Double Blind: | Attempts to eliminate bias. Neither experimenter nor subjects know who belongs to control group. Info kept by third party. |
| Non Randomized Trial (quasi-experiment) | lacks random element. Problem: cannot eliminate possibility of bias |
| Observational Study: | Draws a conclusion by comparing subjects against a control group. - no independent variable |
| Longitudinal : | study over time |
| COLPRT: | Cohort, Observational, Longitudinal, Prospective, Retrospective, Time-series |
| Cohort study: | A group of people who share a common characteristic or experience eg. PTSD, MS |
| Cohort-Prospective study | Group of similar individuals who differ with respect to certain factors under study, before study and follows over time. |
| Cohort-Retrospective study | researcher collects data from past records - does not follow up as in prospective study. |
| Cohort- Time-Series | Forecasts future events based on known past events. |
| Ecological study | Population rather than individual eg. look at relationship between smoking and lung cancer deaths in different countries |
Created by:
Robin Grant
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