AGENDA For Unlicensed Data Base Training
Mental Health Code of Ethics Link: http://www.amhca.org/assets/content/CodeofEthics1.pdf
Study guide for the jurisprudence exam: http://www.gobookee.org/colorado-jurisprudence-exam-mental-health-study-guide/
The actual test: http://www.caap.us/pages/documents/JurisprudenceExam_000.pdf
Link to Prep Courses http://www.familyplaytherapy.net/The_Colorado_School_of_Family_Therapy_-_Exam_Workshops.html
Review state laws and rulings by the board and application for the unlicensed data base, go to www.dora.state.co.us. Remember, by Colorado law, if you are doing emotional work with a client, you must be on the unlicensed database.
You will need to develop a disclosure statement to hand out with each client that outlines their rights and your responsibilities and professional qualifications. A sample one has been included in your packet and there is a sample online through the state regulatory board.
Be clear about the confidentiality laws, regulations and requirements. Also know appropriate boundaries – especially because in ME-B Therapy therapeutic touch is often included. I put in my disclosure statement that touch is often part of ME-B Therapy and is never sexual and the client has the right to decline table work at any time.
In class you will review some ethical situations and you will have the opportunity to pass judgment as to if there has been an ethical violation. Please read the ethics regulations and know them inside and out.
Unlicensed Psychotherapist in the State of Colorado Still need to take Notes. Because of the latest legation around the privacy act, some professionals believe less is more. However, if you receive a grievance from a client, or are subpoenaed to court to testify on behalf of a client (such as a child custody case) there is a good chance they will want to look at your notes.
SOAP NOTES and DAP notes:
The S stands for what the client said.
The O stands for what you observed
The A is your assessment
The P is your plan for treatment.
Some people use this form for note taking. Others invent their own or they use DAP.
D stands for Data on the session.
A stands for Assessment of the session.
P stands for Plan.
Whatever version you use, just make sure you keep track of each appointment.
DO’S AND DON’TS OF SUICIDE INTERVENTION
On my intake-form, I always ask for an emergency contact person. This is to aid me in case there is a need for a client to be hospitalized as a result of a suicide assessment. Calling a taxi to drive the client or the emergency contact is a better strategy than you driving the client. Too much risk involved in using your own vehicle, especially if the person opens the car door and tries to get out in traffic or while you are driving.
If a client is psychotic or a teenager take special care with any discussion of suicide because they are more likely to follow through so make sure you do a close and deep assessment.
DO’s of Suicide Intervention
Contract for safety-ask if they have a gun and ask if they have a means.
Take a positive approach. Emphasizing the person’s most desirable alternatives.
Be direct. Simply asking them if, how, when they are contemplating killing themselves doesn’t make it more likely they will. It is important you are direct.
Sound Calm and understanding.
Use the Enlightened Observer! Hopefully you have been teaching them this skill and they will be able to use to bring themselves back to their core and out of defense.
Use constructive questions — separate and define the person’s problems so confusion is removed.
Do a table work or off the table positive resourcing session connecting them to his/her core self.
Check into the 1st Chakra – Life Task and Commitment to being here on earth. Invite the client to balance their energy system and shift to a more supportive place. If anger happens, allow them to have their emotional “NO” to life. Sometimes by allowing the word “no” and the anger around it to dissipate, they then can say “YES” to themselves. Be careful to access but not charge the emotion of anger.
Us the physical exercises taught in Class 5 to help ground them and expand their field so they are bigger than the negative energy that runs through them.
Help the person to see the situation clearly and rephrase important thoughts and restate them.
Mention the person’s family as a source of strength if appropriate.
Find outside resources of strength they can rely upon.
Practice doing the technique of feeling safety within taught in Class 4.
Emphasis how life is change – Rhythm of Reality – expansions and contractions. Teach them about the gifts of contractions and how if done properly, sets the energy for the next expansion.
Enlist the support of a Licensed Supervisor.
Understand the history of the client and any psychological diagnosis. For instance, did their mother commit suicide at age 34 and are they turning 34-years of age.
Don’ts of Suicide Intervention
Don’t go into defense, shock or annoyance.
Don’t stress embarrassment as something that might be an outcome.
Don’t get into a philosophical debate on the moral aspects of suicide.
Don’t hesitate to ask pointed and direct questions about the suicide.
Don’t hesitate to enlist the help of a licensed supervisor.
You don’t want to charge negative emotions or anger – only assess to shift. So don’t let them loop unhelpful emotions.
Don’t keep them from grounding.
Important Questions to Ask as Part of the Assessment
- Have you been thinking about taking your life?
- How would you kill yourself? Do you have a gun?
- Do you have a means available?
- Have you ever attempted suicide before – what is your history in this area?
- Has anyone in your family ever attempted suicide?
- What do you think the odds are that you will kill yourself?
- What has been keeping you alive so far?
- What do you think that the future holds in store for you?
- Do you feel alone?
- Do you use alcohol or drugs? How much?
Contract for Safety
If you feel the client does NOT immediately need to be hospitalized, but does need additional support, you can ask them to “Contract for Safety”. This is when they sign/date a statement that they agree to keep safe and not harm themselves.
If it is clear they are in immanent danger of hurting themselves, supporting them in being hospitalized is the next step. Calling their emergency contact (which should be listed on your in-take form) and having them take responsibility for getting them to the emergency room (ER) is recommended. Do not place them in your car. You can call a taxi if needed and then follow the taxi to the ER or have the emergency contact person meet them there.
If they don’t agree to hospitalization and run away you can call the police dispatch (usually not 911) and ask them to do a “welfare check” on them and/or have the police take them to the ER. Since you are not licensed, you might also want to enlist the support of your supervisor and/or the local mental health department’s crisis center.
At the ER, either the county mental health department crisis worker or someone from their insurance company will do a psychological assessment to determine what is in the client’s highest good.
Sometimes clients are hospitalized and placed on a 72 hour hold. This is when their rights are taken from them and they are forced to be in the hospital so they can be “watched” so that they don’t hurt themselves and to stabilize them. Usually this means stabilize them on medication.
Duty to Warn
If you think they maybe a harm to someone else, then you have a duty to warn the person they may harm. This duty to warn allows you to break confidentiality in order to protect another.
Heart-Centered/Spiritual and Spiritual/Compassionate body centered personality types are more likely to think about and even attempt suicide. This is why it is so important to support your clients in grounding and coming out of defense and into core.
ME-B Therapy clients are taught important skills in tracking and shifting back to their core self. As you better do our job, clients will at least be familiar with the concept of their Enlightened Observer, energy system, defenses and core self. These skills are very important in times of traumatic stress. Keep teaching your client the cornerstones of ME-B Therapy (1) Self-Awareness (2) Detachment (verses disassociation) so they know they are more than the energy that runs through them and they can connect to your Enlightened Observer (3) Naming that they are in defense, (4) Linking to the trigger of the past and (5) Transformation so they can shift the energy
Genograms are a quick and easy method to take a family history. I do a genogram on each of my clients as part of the in-take process. It provides the needed background data to assess potential therapeutic interventions and to assess the ego strength of a client. Sometimes I wait until the second or third session to take a comprehensive history if it feels more important to spend the first few sessions creating a deeper relationship with the client. Attached is a guide to symbols most used in Genograms taken from the book Genograms by Monica McGoldrick, Randy Gerson, and Sylvia Shellenberger. I strongly recommend using this book to further your understanding of genogams.