welcome to the overview for module two the topics covered in this module are related to counseling theories techniques and evidence-based practice knowledge domain which encompasses 11.3 percent of the questions on the CRC exam the information in this module is organized into three lessons the first is counseling practices clinical supervision and evidence-based practice the second is behavior and personality theories human growth and development and the third is Rehabilitation and counseling techniques for specific populations the ERC exam includes two major sections Rehabilitation and disability and counseling the learning objectives listed on our module page are organized based on this structure so for rehabilitation and disability by the end of this module you will be able to identify and Define Rehabilitation techniques for individuals with disabilities execute good practices that facilitate a client's ability to develop socialization skills in the workplace and Implement evidence-based psychosocial and psychiatric Rehabilitation interventions and Vocational interventions in Rehabilitation Counseling Practice for the counseling section by the completion of this module you will be able to demonstrate clinical problem solving and critical thinking skills interpret and apply individual counseling theories Define identify and execute individual counseling practices interventions and techniques describe substance use and treatment cultivate effective working relationships with clients recognize dual diagnoses and co-occurring disorders exemplify motivational interviewing use and skills perform treatment planning for clinical conditions recognize human growth and development Implement clinical evidence-based counseling and therapy for clients with clinical diagnoses or substance use interpret and operationalize theories and techniques of clinical supervision and identify and Implement evidence and research-based practices the learning objectives and topics covered here were generated based on information provided on the crcc website welcome to module 2.1 counseling practices clinical supervision and evidence-based practice the topics covered in this review include clinical problem solving and treatment planning and critical thinking skills establishing and maintaining effective working alliances with clients evidence-based psychiatric Rehabilitation practices individual counseling practices and interventions theories and techniques of clinical supervision and evidence-based practice and research utilization the first topic is clinical problem solving and treatment planning and critical thinking skills treatment planning is the process of establishing client goals and objectives and identifying appropriate interventions to help clients achieve their goals treatment objectives are goals that the counselor and client are attempting to achieve through the rehabilitation process and treatment interventions are specific approaches strategies and techniques used to guide Rehabilitation Counseling practices creating an effective treatment plan is a five-step process step one conduct an assessment and discuss the results with the client to determine which concerns need to be addressed step two discuss how each concern affects the client and explore how the client could use their own strengths to mitigate the concern step 3 establish a primary goal or outcome for each concern being addressed through counseling step four identify a series of objectives that need to be accomplished in order to successfully overcome the concern in step 5 select a series of treatment interventions that will help the client achieve their final goal counselors must possess critical thinking skills to come up with goals and objectives for the client and match those goals with treatment options that are appropriate for the client to Be an Effective counselor and coordinate services for clients VR counselors should be able to practice three main types of skills one communication skills the ability to transfer and receive information from clients as well as the professionals who serve them two concatenation skills the ability to ensure that clients have access to professionals who can provide necessary services and three continuity skills the ability to ensure all professionals involved are working together as a team toward achieving the client's goals in addition to these skills micro skills are a key trait of effective counselors micro skills are basic counseling skills and include attending skills which are verbal and non-verbal cues that the counselor is listening to the client non-verbal skills which include head nods gestures Etc verbal tracking acknowledging what the client is saying through restatement questions asking for more information details or to further explore an area of information encouragers small verbal or non-verbal gestures used to communicate active listening like head nods ahas repeating keywords Etc paraphrases short summaries and paraphrases of information the client has shared summarizations a more comprehensive summary and restatement of what the client has shared and reflections of feeling counselors reflecting upon what the client is stating and imposing feelings on the statement next is establishing and maintaining effective working alliances with clients the working Alliance is a theory with three components that are intended to build a positive working relationship the first component is goals the counselor and client collaborate to set goals for overall therapy as well as each session second tasks steps methods and techniques that need to be implemented to reach a client's goals these can either be activities you perform together or they can be assigned to the client and third bonds the relationship between counselor and client should be formed from trust and confidence that the tasks will move the client toward their goals next evidence-based psychiatric Rehabilitation practices when working with clients with psychiatric care needs the mental health recovery model is recognized as best practice mental health recovery is a process of change through which individuals improve their health and wellness live a self-directed life and strive to reach their full potential and that definition comes from the substance abuse mental health services Administration there are four areas of recovery one Health managing and or overcoming one's disease or symptoms to home presence of a safe stable living arrangement three purpose meaningful daily activities and or creative activities and forward Community relationships and social networks there are 10 guiding principles that provide the foundation of practice when working with clients with psychiatric care needs these are hope respect person driven holistic multiple Pathways to Recovery address trauma culturally informed services support of peers and allies relationships and social network support and individual family and Community strengths and responsibilities next individual counseling practices and interventions the following are basic fundamental counseling practices that can be utilized with a wide variety of clients who possess typical psychological counseling needs in this section the individual counseling practices are listed in bold in their subsequent interventions are listed in bulleted format below the practice they pertain to if you're following Along on our page the first practice is brief solution focused therapy and this was created by Steve deshazer and in Sue kimberg brief solution focused therapy or bsft helps the client identify barriers or problems and identify Solutions based on the resources and supports available to them the guiding idea of bsft is that the client has the solution to the problem and it is the counselor's job to help the client discover that answer there are five types of questions in bsft one coping questions these are designed to have the client share the status of their problems and how they have coped in spite of them two exception questions these evoke clients to share experiences where problems were not present and the reasons to why the particular situation did not cause the problem exception questions are designed to bring client awareness to the frequency of problems and exceptions to the problems three Miracle questions these evote clients to articulate a desired future where in their problem or problems do not exist four scaling questions invoke clients to rate how they are doing on a 1 to 10 scale scaling questions are designed to measure progress and can be used to facilitate discussions and five relationship questions these evoke the client to engage in discussion around how the client regards the perception of significant others on resolving the problem and whether the significant other's Viewpoint influences if and how the client succeeds in resolving the problem motivational and interviewing created by Miller and rollnick this is a direct non-confront confrontational counseling style designed to elicit positive behavioral change by focusing on the client's ambivalence to change some of the principles include empathetic understanding acceptance affirmation identification of discrepancies rolling with resistance the facilitation of self-efficacy and ores micro skills which is open-ended questions affirmations Reflections and summary statements person-centered Theory by Carl Rogers this Theory Works to create facilitate growth and movement towards self-actualization which is often distorted by one's own view of themselves the therapeutic relationship is key which includes genuineness and congruence the counselor is genuinely open integrated and authentic during counseling sessions unconditional positive regard the counselor is accepting caring and values the client an accurate empathetic understanding The Counselor is able to sensitively and accurately understand the client's experience and feelings existential Theory by Rolo may this Theory helps clients cope with fundamental issues related to The Human Experience including death isolation and existence the goal is to create awareness and confront issues associated with The Human Condition the primary technique is relationship focused with the ultimate goal being awareness Gestalt Theory by Fritz pearls this Theory Works to help the client understand themselves as the product of the interrelationship between thoughts feelings perceptions mind soul and Sensations some of the key components include assisting the client to focus on the Here and Now utilizing the empty chair technique to help clients move past any unfinished business helping clients use personal pronouns when talking about themselves which helps clients become more aware of their personal feelings and resist detaching share hunches wherein the counselor shares or helps the client share the potential meaning of a non-verbal message to help the client gain self-awareness and engaging in DreamWork wherein the client plays out roles or completes conversations that occurred in a dream behavioral therapy by B.F Skinner is a compilation of approaches used to reduce maladaptive behaviors and increase adaptive behaviors it emphasizes current rather than past behavior and relies on the scientific method to assess effectiveness classical conditioning which is the learning process which involves creating associations between environmental stimuli and naturally occurring stimulus in order to elicit an automatic reaction and operant conditioning satisfactory behaviors are reinforced and rewarded while unsatisfactory behaviors elicit dissatisfaction and are not reinforced cognitive behavioral therapy or CBT by Aaron Beck posits people's feelings and behaviors are based in how and what they think I.E psychological distress is a result of skewed thinking the components of this Theory are that psycho-education and developing skills to manage problems five common techniques are identifying dysfunctional and distorted cognitions self-monitoring negative thoughts identifying relationships between thoughts underlying beliefs and feelings identifying alternate thinking patterns testing personal hypotheses regarding the validity of assumptions about the self the world and the future rational emotive behavior therapy rebt by Albert Ellis is an active directive and problem-focused technique that works to replace irrational Thoughts with rational thoughts some of the components of this Theory include teaching ways in which consequences of irrational beliefs impact functioning common teaching techniques include confrontation disputing irrational beliefs and bibliotherapy confronting affective and behavioral aspects using imagery role-playing homework assignments and skills training and tools that can be used to help clients shift their thought patterns like questionnaires self-help forms and homework assignments psychoanalytic Drive Theory by Sigmund Freud this is a method of resolving unconscious desires and actions that have created unhealthy personality traits components include confrontation clarification interpretation and working through thoughts after an insight an individual psychology or adlerian Psychology by Alfred Adler this Theory Works to increase the social interest of clients by changing disruptive logic resolving inferiority or superiority complexes altering misguided goals to healthy goals in order to accomplish Health tasks in a healthy way components of this Theory include the Therapeutic Alliance lifestyle assessments private logic fictional finalism examining early Recollections for patterns and themes and examining how birth order may affect personality and how individuals approach conflict moving on to theories and techniques of clinical supervision clinical supervision occurs when supervisors such as a rehabilitation counselor with at least two years of experience use clinical techniques to observe and provide feedback on a supervisees professional and personal development and practices clinical supervision is used to ensure Client Services meet organizational goals and Professional Standards supervisory activities include support which is where supervisors Provide support by creating a safe environment where clients and practitioners can process anxiety fears uncertainty and confusion consultation which is working collaboratively with the supervisee to determine diagnoses interventions and treatment plans for clients counseling supervisors use empathy genuineness positive regard and more facilitative conditions to help supervise these through professional contexts training and instruction supervisors provide and tailor any training or instruction needs to further Advance the supervisee skills knowledge and counseling practices an evaluation for the supervisors provide supervisees with constructive feedback for professional development during clinical supervision supervisors assess the competencies of counselors in training and evaluate their client counselor interactions there are four basic methods for evaluating supervisee development one indirect delayed methods this includes self-reports of client progress case conceptualizations Reflections and documentation of interactions between counselor and client these evaluations may be shared through written documents notes case presentations or case reviews two direct delayed methods this approach uses audio or video equipment to directly monitor counselor client interactions this allows supervisors to assess how supervisees approach a clients presenting issues during counseling sessions examine how supervisees employ intervention strategies and make inferences about the supervisees counselor client interactions three direct present methods these involve live supervision wherein the supervisor is present in the counseling sections the supervisor evaluates the session in real time intervenes for the supervisee if needed supervisors and supervisees may even provide counseling services collaboratively to a client through co-counseling this gives the supervisee an opportunity to observe a more experienced counselor and four indirect present methods provides live supervision with direct observations if counselor client interactions but with less intrusiveness in the counseling session this is often achieved by a supervisee wearing an in-ear speaker during a counseling session where supervisors can provide input and feedback to the counselor in training and allow them to make adjustments without disrupting the client's session while traditional clinical supervision consists of an experienced counselor supervising a counselor in training there are five basic formats of clinical supervision which can be practiced for varying reasons one self-supervision counselors review their own clinical work assess areas of weakness and ask for intervention from other counselors when needed two individual supervision experienced counseling professionals monitor evaluate and Mentor counselors and training this is what many May identify as traditional clinical supervision three team supervision professionals from multiple disciplines who are working within the same treatment team consults about their shared clients for group supervision counseling professionals consult with other counseling professionals this approach allows professionals to present cases and receive feedback about their clinical work and five peer supervision often occurring in private practice counseling businesses counselors confer with peer practitioners and request consultation on clinical cases now moving on to evidence-based practice and research utilization research utilization is the use of research to guide decision making and practices in order to promote change in continuous development research utilization involves locating evidence-based studies and reviewing the information in relation to the amount of evidence in the study evaluating study findings to determine if they are applicable to the specific counseling organization developing a protocol for using study results sharing study information with organizational staff members implementing new protocols and evaluating any resulting changes research utilization is the basis for evidence-based practice evidence-based practice is a method of integrating Research into clinical practice and decision making processes evidence-based counseling should invite involve applying evidence-based principles to the assessment case conceptualization and intervention practices of client counseling counselors should first employ research utilization when exploring a new potentially useful counseling intervention technique additionally counselors employing evidence-based practices when incorporating a new counseling intervention should regularly assess what processes or techniques of the intervention work best estimate what population this potential new intervention would be most effective for evaluate if specific intervention techniques work better for particular clients and determine who should receive this new Intervention Program and for how long the code of professional ethics for rehabilitation counselors requires Rehabilitation counselors to utilize evidence-based practices when providing counseling services module 2.2 behavior and personality theories and human growth and development topics covered in this module include behavior and personality theories debates sounding surrounding human developmental processes human growth and development and special considerations response to disability starting with behavior and personality theories Behavior theories believe humans develop direct responses to environmental conditioning responses actions and internal emotional processes are shaped by conditioning one of these theorists is Ivan Pavlov he believed in classical conditioning which is the process of forming an unconscious reaction to a stimuli through negative reinforcement negative reinforcement according to Pavlov is engaging in an action or behavior to avoid a negative result like engaging and putting on a seatbelt in order to avoid the negative results of a potential car accident or ticket the next theorist is John Watson he also believed in classical conditioning and based on Pavlov's previous work Watson expanded research on classical conditioning he posed that classical conditioning shaped all aspects of human psychology nature versus nurture Watson posed that a child's environment is the main factor that shapes their behavior rather than their genetic makeup or factors of upbringing I.E nurture creates personality rather than nature BF Skinner believed in operant conditioning this is similar to classical conditioning it employs the use of rewards and punishments for behavior modification Skinner Incorporated punishment in addition to reinforcement as methods to increase or decrease behaviors strategies used to increase desired responses a positive reinforcement is supplying a positive reward when the desired behavior is performed thereby increasing the likelihood of the behavior occurring again negative reinforcement according to Skinner is removing an adverse stimulus in response to performing a desired Behavior in order to increase the likelihood of repeating the desired Behavior strategies used to decrease or suppress undesirable responses positive punishment supplying a reward when undesirable Behavior does not occur in response to a stimulus which previously elicited the behavior a negative punishment is removing a positive stimulus when an undesirable Behavior occurs in response to a stimulus Harry Harlow did work on attachment and bonding through his work with rhesus monkeys Harlow showed that an infant's desire for Comfort touch or cuddling is an inherent need and not a learned trait the effects of isolation the infants deprived from any parental contact can develop physical problems and dysfunctional behaviors autistic abnormal behavior is the direct result of isolation according to Harlow Renee Spitz this work looked at behavioral differences between male and female children the isolation of children spits studied children who were isolated from their parents as a result of hospital care spitz's findings were consistent with those of Harlow moreover Spitz recorded two illnesses that occurred as a result directly from isolation hospitalism children who fail to thrive as a result of being raised in an impersonal environment at IA hospital and therefore developed psychomotor retardation and language impairment anaclitic depression children deprived of contact crime or have difficulty sleeping and are more prone to illness Spitz also discussed behavioral differences between male and female children male developing children have better visual perceptive skills than developing females commit suicide more often than females and are punished more often than females and female developing children use more feeling words at an early age than developing males they're better able to understand people in situations in non-verbal environments and they attempt suicide more often than boys moving on to personality theories the first theorist is Sigmund Freud his theory was psychoanalytic theory known as psychoanalysis this is a way of discovering the subconscious mind in an effort to free the person from neuroses complexes anxieties and dysfunctional Behavior some methods for psychoanalysis were hypnosis dream therapy free association and transference the id ego and superego referred three categories of human psychology and cognition the ID seeks to satisfy Basic Instincts and drives towards gratification and pleasure the ego is a complex of defense mechanisms that seeks to achieve and accomplish real world goals by suppressing the ID and delaying gratification in the superego the overall mechanism that governs the ego Freud also positived the Oedipus and electra complex this is derived from a child's relationship with their parents during the male's child's phallic stage of development the child bonds with his mother and experiences sexual attraction toward her the male child then becomes jealous of the father and is seen as a rival for the mother's attention Freud referred to this set of relationships as an Oedipus complex an electro complex is the same relationship but where a female child becomes jealous of her mother's relationship with her father and Views him as a rival for attention defense mechanisms are strategies created by people unable to cope with problems in life there are several defense mechanisms that people use compensation occurs when a person attempts to cover negative thoughts feelings or actions by improving thoughts feelings or actions in a different area of life displacement occurs when a person attempts to cover negative feelings by shifting blame from the origin problem to a person or object who has no connection to the origin problem projection occurs when a person assigns their own personal negative characteristics onto others in reaction formation occurs when a person behaves in a manner opposite to the way they truly feel next is Abraham Maslow he posited the hierarchy of needs human growth and development is the process of moving from a basic physiological need to self-actualization actualization is the process by which human beings grow to their fullest potential and have all their needs met in his theory the hierarchy of needs is a pyramid the top of the pyramid is actualization second from the top is esteem the middle is love and belonging second from the bottom is safety and the bottom of the period pyramid is physiological next Eric Erickson his psychosocial theory of human growth and development developed eight stages of human development in each of these stages the individual is faced with a conflict that they in their environment must either choose to resolve forced to come to the first stage is trust versus mistrust lasting from birth to 18 months old children must decide if they can trust their caretakers or determine if trust cannot be formed children who develop trust will maturely secure move into this next stage while children who develop mistrust will interpret the world with fear anxiety and mistrust the second stage is autonomy versus shame and doubt lasting from 18 months to 3 years old children must decide if they can behave independently or if they must rely on others to act for them children who develop autonomy will mature securely into the next stage while children who develop shame and doubt in their actions will continue to doubt their abilities and form low self-esteem or feelings of Shame the third stage is initiative versus guilt lasting from three years old to six years old children must decide if they are capable of asserting control over their world through social interactions or if they are incapable of asserting control and influencing the world and events around them children who develop initiative will develop self-confidence and feel a sense of purpose while children who fail to develop initiative will form self-doubt and feelings of guilt over their actions the fourth stage is industry versus inferiority lasting from 6 to 12 years old children must decide if they feel pride and accomplishment in their achievements or if they feel inferior and inadequate in comparison to their peers children who develop industry will feel secure in their accomplishments while children who do not develop industry may form an inferiority complex the fifth stage is identity versus role confusion lasting from 12 years old to 18 years old adolescents must consciously reflect and ask themselves who they are I.E develops self-image or be apathetic and choose not to make a conscious search for self-identity adolescents who successfully explore self-identity will develop a strong sense of self and will be able to remain true to their core beliefs in the face of adversity while adolescents who are apathetic about their self-identity will experience a weak sense of self and eventual role confusion the sixth stage is intimacy versus isolation seen from early 20s to early 40s adults must choose if they will share their life with others or if they will move through life closed to close personal relationships adults with a strong sense of self and a positive self-concept will typically form intimate relationships who have not developed a strong sense of self or positive self-concept may be unable to achieve intimacy thereby existing in isolation and may experience feelings of loneliness or emotional isolation note Intimate Relationships includes friends family and other significant individuals Intimate Relationships is not exclusive to romantic Partnerships the seventh stage is generativity versus stagnation lasting from early 40s to Mid 60s adults must choose if they will find meaning in their life's work and contribute positively to society or if they will work and live without intention of contributing to society or development of the Next Generation adults who engage in generativity gain positive experiences and personal fulfillment from their contributions while adults who choose stagnation may experience little connection with others and a reduced interest in productivity and self-improvement the eighth stage is integrity versus despair lasting from mid 60s to end of life adults will reflect upon their life and either feel a sense of satisfaction or a sense of failure individuals who feel satisfaction in their life will feel proud of their accomplishments and often face the end of their life with few regrets and a sense of Integrity individuals who feel despair often focus on what they would have should have or could have done and been and often face the end of their life with bitterness depression and despair next is Carl Young his work focused on DreamWork and imagery young would attempt to decode his clients Dreams by separating objective reality from subjective reality and relating dream images to waking experiences next is Jean Piaget his work looked at stages of Child Development and he posited four stages of the child's cognitive development the first stage is sensory motor stage lasting from birth to about two years of age the child is focused mostly on their own senses and understands the world only through their five senses children in this stage do not have object permanence and therefore believe when objects are not seen they do not exist additionally children in this stage are beginning to develop cause and effect understanding stage two pre-operation stage lasting from two years to seven years the child does not understand that the outside world operates independently of themselves and tends to believe people and objects act solely in relation to them referred to as egocentrism children in this stage use symbols to interpret the external World internally stage 3 is the concrete operation stage lasting from seven years to 11 years the child learns reversibility and conservation during this stage the child understands that ice can be melted and turned back into water reversibility and that eight ounces of water in a short glass will still be eight ounces of water even when poured into a taller glass conservation Additionally the child Masters logical operations hierarchical structures and rule-based operations and environments in stage four the formal operations stage lasting from 11 years of age into adulthood the child develops an understanding of abstract Concepts like fairness truth justice hope and love children and adults in this stage have the capacity to understand scientific principles and apply abstract thinking to various situations and environments foreign next is Lawrence kohlberg he had an epigenetic view a word derived from embryology the study of human cell growth beginning with egg fertilization and continuing into the complete formation of an adult of any species epigenetic view is the idea that each subsequent stage builds upon the preceding stage and kohlberg came up with three stages of moral development in children the first is pre-conventional operations or morality children at this stage for Morality on what will bring punishment versus what will not bring punishment the second stage is conventional operations of morality children at this stage for Morality by conforming to the rule and expectations of the society they are living in and the third stage is post-conventional operations or morality children at this stage form morality based on the abstract principles and ethics even if they supersede or oppose the rules of society and finally we have Fritz pearls he came up with figure ground relationship the way this is the way in which a person perceives a specific event or chain of events in their experience certain people and events will be more Vivid and provide greater emphasis while other people and events will be perceived and remembered as less important often individuals are unable to face the most traumatic or important aspect of an event the figure and will move these traumas or important aspects to their background of the event Fritz believed the figure ground relationship was in constant flux and individuals would not be able to progress past their trauma until they could move their figure to the foreground he came up with five layers of neuroses and defense mechanisms which must be Stripped Away during Gestalt therapy the first layer is the phony layer at this layer people live according to rules imposed from the outside world and get frustrated that others do not see or understand who they really are the second is the phobic layer at this layer a person will present an image of what others think they should be the third is the impasse layer at this layer phony role playing is intensified and a person and could become an obstacle of growth fourth is the implosive layer at this layer a person presents a willingness to expose their true self and fifth is the explosive layer at this layer a person has let go of the unreal and false personality built up by reactions to outside expectations Now we move on to debates surrounding human developmental processes nature versus nurture the nature versus nurture debate involves questioning the degree to which environmental factors and or innate characteristics influence development the nativist perspective or nature states that biological genetic factors and innate characteristics are the primary influences on development and behavior whereas the nurturous perspective Nurture states an individual's environment shapes their development and behavior more than their biology or innate characteristics do there is a combined perspective which states that both nature and nurture influence human development and behavior the combined perspective states that individuals have natural genetic or biological capabilities and limitations which can either be fostered or diminished by the individuals surrounding environment most developmental psychologists accept and utilize a combined perspective of human development continuous versus discontinuous development human development has been conceived in terms of continuous or discontinuous development patterns continuous development suggests that human development is a smooth gradual process which produces incremental but steady change BF Skinner and Albert bandura were proponents of continuous human development discontinuous development suggests that human development occurs in stages which have clear-cut beginnings and endings each stage will produce Dynamic changes in growth and development that can be readily observed as being lacking at the beginning of a stage and being fully present at the end of the same stage Sigmund Freud and Eric Erickson were proponents of discontinuous development genetic counseling genetic counseling relates to the practice of determining the likelihood of genetic or biological conditions being passed down to biological children as well as providing support counseling and information to promote informed decision making moving on to human growth and development we start with Freud's stages of psychosexual development Freud proposed five stages of psychosexual development wherein individuals are faced with developmental tasks that must be mastered or conflicts that must be resolved before the individual can advance to the next stage each stage is a stage in psychosexual development is driven by the sensitivity of a particular erogenous zone of the body Freud believed the first six years of life were critical developmental period and a precursor to later personality failure to master or resolve conflicts which within each stage will hinder normal development in the next stage and affect personality formation the first stage is the oral stage from birth to two years old the focus is on the mouth and digestive tract the primary interaction with the world is fostered through activities associated with the mouth and digestive tract eating teething and oral stimulation the conflict or challenge is that individuals must learn to rely on and Trust caregivers to provide nutrients additionally individuals must learn they can achieve oral satisfaction independently through chewing or mouthing on items the resolution individuals must develop trust that the world will fulfill their needs and that an individual can achieve satisfaction independently second is the anal stage which is two to three years old the focus is on the bowels and digestive tract individuals gain satisfaction through bowel movement control and tension release the conflict or challenge is self-control over bowels and toilet training conflicts occur with parents over toilet training reactions and responses from parents during these conflicts affect the individual's personal view of positive or negative self-image and the resolution is the ability to successfully control bowels independently and begin developing control over behavioral impulses and urges the third stage is the phallic stage from four to five years old and the focus is on the genitals individuals gain satisfaction through genital stimulation awareness of the presence or absence of a penis develops during this stage the conflict or challenge is sexuality with real in relationships with same-sex and opposite sex parents the edible complex the boy wants to possess the mother father is seen as a rival and the elector complex where the girl wants to possess her father and the mother is seen as a rival can develop during this stage castration anxiety and penis envy may occur in this stage the resolution is the ability to form positive relationships with the same-sex parent the fourth stage is the latency stage from 6 to 12 years old the focus is on the decrease or repression of sexual interest sexual energies are suppressed and redirected to socially and cultural acceptable objects the conflict or challenge is the development of Social and communication skills and building self-confidence and the resolution is the ability to maintain healthy fulfilling non-sexual relationships and the fifth and final stage is the genital stage which is 12 years old to maturity the focus is on genitals and sexuality the conflict or challenge is that Sexual Energy begins to be redirected towards sexual relationships friendships Leisure Career Development and psychological balance and the resolution is the ability to form successful long-term relationships next Ericsson psychosocial stages of development Erickson proposed eight stages of psychosocial development where an individual is faced with a developmental conflict that must be resolved if healthy development is to occur and we've discussed that previously in this module next is Piaget's cognitive stages of development Piaget proposed four stages of cognitive development that classify a child's level of intellectual development these stages are not strictly age specific but all children proceed through these stages in a linear fashion children build schema which is a set of related ideas or concepts that are used to function and respond to environmental situations and are required to adjust and reform these schema to advancing cognitive development children reform these schema through assimilation which is taking new knowledge and interpreting it so that it fits with an existing schema or accommodation developing a new schema or changing existing schema to fit new information resulting in a new understanding of the world the process of creating new schema occurs when children are faced with information that does not fit into current schemas Children First experience disequilibrium awareness that current observations do not fit with existing schema and use assimilation or accommodation to reach equilibrium which is an adaptation of new or existing schemas to fit existing and new information thank you bandura's social cognitive theory or social learning theory formerly referred to as social learning theory bandura proposed that children can learn through observation called observational learning rather than trial and error Bender observed that children were likely to perform a behavior if the behavior has been modeled for them I.E they watch the behavior occurring children are more or less likely to perform a modeled Behavior based on the consequences they observe that are related to the behavior of performance negative consequences mean the child is less likely to perform the behavior and positive consequences mean the child is more likely to perform the behavior there are four conditions necessary for Effective modeling one the child must be paying attention to the model two the child must be able to remember the behavior that was modeled three the child must be able to reproduce the modeled behavior and four the child must be motivated to repeat or reproduce the Model Behavior social cognitive theory proposes Behavior as a continuous and reciprocal interaction between cognitive behavioral and environmental influences children must be able to cognitively process social experiences in order to develop mental operations that will influence and shape their future Behavior next vygotsky's Social Development Theory similar to Piaget's social cognitive theory vygotsky proposed children learn through social interactions these social interactions influence cognitive growth and rely heavily on culture language and the zone of proximal development the child's surrounding culture impacts cognitive development in that it creates the core framework through which the child constructs meaning the child's surrounding language interactions with parents others in society as a whole and use of personal language influences a child's cognitive understanding of the world vygotsky proposed that children have three forms of language one social speech which is external communication with others to private speech which is internal self-directed speech and three silent inner speech inaudible private speech that serves to help the child self-regulate each of these three forms of language serve to influence the child's cognitive development which in turn influences and directs Behavior as culture and language primarily shape a child's cognition and interpretation of their environment the zone of proximal development is the primary developmental element which shapes a child's cognitive and behavioral growth the zone of proximal development is the distance between the child's actual developmental level and the potential next level of development through temporary support and assistance from others called scaffolding children learn new skills and understandings that bridge the gap of their zone of proximal development and allow them to advance to the next stage of cognitive developmental or physical abilities next is special considerations response to disability individual response to disability there are several different models or ideas related to individual response to disability so first we're going to talk about is rights somatocycle psychological approach and acceptance of disability rights approach places importance on recognizing the influence of the environment when attempting to understand the individual's response the distinction between the individual with a disability and the individuals around them without disability and the transformation of values after the onset of a chronic illness or disability rights approach uses a transformation of values framework to describe the changes associated with accepting disability a individuals enlarge their scope of values and recognize values other than those affected by the disability be individuals accommodate disability effects and limit the impact of the condition see individuals subcoordinate their physique and begin seeing their body as something other than a symbol of worth and desirability indeed individuals transform comparative status values into asset values and focus their assets rather than comparing themselves to others another model is the stage or phase model this looks at adoption adaptation and adjustment to disability through a stage or phase model and the process of adjustment is seen as a gradual process of assimilating changes in the body self-concept and person-environment interactions the individual will pass through several stages though not all individuals will progress linearly some may skip stages or revert back to previous stages in some stages are not universally experiences the stages include shock denial anger depression and acceptance and adjustment then we have ecological or integrative models these models of adaptation propose that adjustment depends on the balance between the individuals available personal social and environmental resources and the demands on those resources in the individual's environment the adjustment process is seen as a mediation between the individual's inherent characteristics and their surrounding environment these models also propose considering the personal impact of disability including the effect the disability will have on the individual's personal economic psychological and social resources as well as their social cultural and physical environment individual variables counselors should include the individual's gender age ethnicity assets resources and education personality variables counselors should consider including the individual's level of family and social support and coping styles environmental variables that counselors should consider include the individual's family response and relationships with the family family support social support community and financial resources available of assistive technology resources for modification and the physical environment the individual lives and works in and disability specific variables that counselors should consider include the time type course and prognosis of the disability as well as the level of controllability or predictability treatability visibility the perceived cause and potential Associated stigmas severity functions impaired pain and potential lethality and we have quality of life models which suggests that adaptation can be assessed and understood in terms of the disability's effect on quality of life and the process by which an individual attempts to restore or maintain their quality of life and finally family response to disability the family's adaptation to a chronic illness or disability involves the ways in which the family responds to stress or crisis with their current available resources and coping strategies the family's response may be affected by the characteristics or prior experiences with the disability their family members immediate and long-term response to their disability and the existing and previous characteristics of the family such as demographics socioeconomic status socio-cultural elements patterns of relationships and communication within family members families will it need to adapt to a caregiving role which requires the use of coping strategies that help alleviate the increased responsibility and stress associated with the new family dynamic two primary coping strategies have been found to be successful for family and caregiver coping problem focused coping this is focused on taking actionable steps to directly mitigate elements causing stress like making a plan of action and a motion focused coping which is focused on decreasing the negative emotions associated with the elements causing stress like reframing a mix of problem focused and emotion-focused coping strategies has been found to be associated with more positive long-term outcomes module 2.3 Rehabilitation and counseling techniques for specific populations topics covered in this review include Rehabilitation techniques for individuals with psychological disabilities treatment planning for clinical problems substance abuse and use treatment evidence-based canceling for alcohol and drug abuse counseling for workplace socialization skills and evidence-based psychological psychosocial and Vocational interventions and Rehabilitation Counseling Practice Rehabilitation techniques for individuals with psychological disabilities individualized placement and support or IPS is a model of supported employment for individuals with severe mental illness or psychological disabilities this is a place and train model where the individual is first placed in a job and then trained in the position as opposed to train and place model where the individual is taught skills and then must find a job in which to utilize them these individuals will most likely receive additional supports such as job coaching or follow-along supports cognitive behavioral therapy or CBT this involves teaching individuals to identify incorrect or negative thoughts or beliefs and replace them with correct or positive thoughts for example a client believes no one is going to hire someone with a disability CBT Works to replace this thought with someone will hire me brief solution focused therapy or bsft helping the client identify barriers or problems and identify Solutions based on the resources and supports available to them The Guiding idea of bsft is that the client has the solution to the problem and it is the counselor's job to help the client discover that answer treatment planning for clinical problems clients with disabilities are in an increased risk of depression due to ongoing life changes and experiencing increased stress depression can interfere with a client's ability to cope with an acquired disability so it is especially important to create a treatment plan to address clinical problems in addition to disability specific problems treatment options include Lifestyle Changes which encourage participation in exercise programs social activities and hobbies which bring personal joy and fulfillment life skills training helps the client learn new self-help skills that can help them cope with their disability in daily life encounters and activities and cognitive behavioral therapy CBT which encourages the client to use rational thought as a method of altering skewed Perceptions in maladaptive Behavior substance use and abuse treatment terms related to the treatment of substance use and abuse are addiction a condition in which a person has become dependent upon a particular substance and continues to take more to avoid withdrawal dependence of physical or psychological condition wherein a person has taken so much of a substance over a period of time that the body now requires the substance in order to function tolerance a decrease in the ability of a substance to affect a person as the person develops tolerance they will need to use a greater volume of substance to achieve the desired effect and withdrawal a set of symptoms a person experiences if they stop using a substance they have become dependent on models of substance abuse and addiction several models exist which attempt to explain the occurrence of substance use and addiction the moral model proposes that substance abuse and addiction disorders are a choice that the individual has made and that they are capable of making alternate choices this model is based on an individual's beliefs of right and wrong and acceptable versus unacceptable behaviors unfortunately this model is still prevalent in public policy attitudes the disease model views substance abuse and addiction as a result of genetic predisposition or a pathological Metabolism from an acquired disease and caused by repeated exposure this model views substance abuse and addiction as chronic incurable primary disease with Progressive and irreversible stages this model proposes abstinence from substance use and abuse as the primary goal of treatment rather than being cured thus the term recovering is used to describe individuals who have overcome their addiction rather than the term recovered genetic and biological models of a substance use and abuse proposes that an individual's biological and genetic construction predispose an individual to substance dependency the neurobiological model suggests that neurotransmitters facilitate chemical changes in the limbic system of the brain and leads to an increased likelihood of addiction there are several psychological models of substance use and abuse the cognitive behavioral model proposes that individuals derive satisfaction and reinforcement from substance use and the resulting addiction is caused by the individual's inability to control their reward system the learning model proposes substance use and abuse as a result of poor learning and that substance use reinforces repeating behaviors thus leading to an addiction this model also suggests that social or environmental conditions May trigger Behavior the psychodynamic model proposes substance abuse as a symptom of other Psychopathology and problems with self-regulation of affect resulting from inadequate parenting ego deficiencies attachment disorders and other issues the personality theory model proposes that certain personality traits such as dependency immaturity and an inability to express anger lead to substance use and abuse there are three main programs used to treat substance use and abuse one a drug-free outpatient program these programs typically do not use medication to treat substance abuse but employ counseling and other Support Services to treat substance use and abuse two methadone outpatient program these programs use methadone and other medications in addition to counseling to treat substance use and abuse and three residential therapy programs these programs allow individuals to live in a safe community of other people working to overcome their substance abuse problems residential therapy programs employ Counseling in addition to various activities and methods of confronting addiction evidence-based counseling for alcohol and drug abuse in addition to the previous methods clients with alcohol and drug abuse concerns May benefit from different counseling approaches including cognitive behavioral therapy clients learn to monitor themselves and identify and avoid at-risk situations and Cravings by working to identify triggers and develop coping strategies to change their thinking process motivational enhancement therapy utilizes a reward system to help control negative behaviors by providing incentives for positive behavior family behavioral therapy involves the client and their significant other in behavioral strategies wherein the significant other provides rewards and reinforcement for positive behavior from the client the matrix model encourages participation in self-help programs by teaching the client about addiction and relapse support and encourages to gain and maintain abstinence from the substance motivational interviewing a person-centered goal-directed method of enhancing intrinsic motivation by exploring reasons for ambivalence and proposing methods to resolve actions four key principles for Effective facilitation of change through motivational interviewing are one rolling with resistance rather than confronting it to expressing empathy three developing discrepancy between current behaviors and desired future and for supporting client self-efficacy evidence-based counseling for clients with PTSD clients with post-traumatic stress disorder or PTSD have been exposed to traumatic events and experience stressful reactions to those events trauma focused counseling has been found by the U.S Department of Veterans Affairs to be the most effective counseling approach for PTSD this includes cognitive processing therapy or CPT this works to change the way an individual thinks about themselves or an event counselors help individuals identify stuck points and negative thoughts and work to change the thought process around those stuck points and negative thoughts eye movement desensitization and reprocessing EMDR the client concentrates on some type of back and forth movement I.E flashing lights or a sound like a click in one ear and then in the other ear at a rhythmic Pace while focusing on an upsetting memory this continues until stress has decreased typically about 30 seconds over time the individual is able to focus on positive feelings while still recalling the memory and prolonged exposure this helps the client overcome fears by practicing controlled exposure over an increasing period of time the client can also retell the event express feelings or listen to a recording of the event until it elicits less of a traumatic response counseling for workplace socialization skills workplace socialization is the ability to function and interact with others in the workplace many individuals with disabilities will need counseling or assistance in building these socialization skills some strategies to develop workplace socialization skills are assess the work environment job tasks and socialization organization to provide information to the client before they begin work and help them practice necessary skills provide practice in giving and receiving feedback provide practice in working with groups educate the individual on group dynamics as well as conflict resolution discuss workplace boundaries including personal interactions and social media behaviors and provide practice in different methods of reacting to and handling stress evidence-based psychosocial and Vocational interventions in Rehabilitation Counseling Practice there are many different evidence-based practices the first is job placement job placement refers to a set of activities that leads to locating and retaining a suitable job for individuals with disabilities job placement assistance consists of job seeking skills training direct placement job development supported employment and demand side job placement second job seeking skills training job seeking skills training is designed to provide training and practice for skills required to obtain and retain a job this includes providing information on how to conduct a job search and be aware of job leads teaching individuals how to explain their education existing skills and work history to interviewers coaching individuals on how to appropriately discuss disability issues and accommodation needs during a job interview explaining how to complete jobs applications prepare a resume and dress appropriately for interviews and provide accountability for regularly participating in the job search ultimately job seeking skills training is intended as an opportunity to teach clients about how to determine job suitability help clients identify their vocational strengths and limitations assist clients in preparing a resume and performing a job interview and aiding and securing job leads for clients foreign direct placement intervention direct placement intervention involves a counselor marketing the benefits of hiring individuals with disabilities to employers as well as providing employers with connections to individuals with disabilities who meet the employer's needs although useful when needing to place an individual in a job position direct placement intervention does not provide individuals with the opportunity to strengthen their job seeking or interview skills as the counselor is locating the job and making connections with employers on their behalf fourth supported employment supported employment is employment outside of a sheltered workshop this job type of job placement emphasizes job preparation therefore counselors must provide job assessment and job coaching related to both on-the-job skill and social skills supported employment focuses on the on-the-job training advocacy long-term job retention and access to regular follow-up services supported employment usually occurs in a commercial sector business that employs both individuals with and without disabilities there are different methods of offering supported Employment Services The Enclave model is where a small group of individuals with disabilities are trained and supervised together in a work environment with individuals without disabilities the dispersed Enclave model individuals with disabilities work separately in different areas of the business this is the most common model in service Industries the mobile work Model A group of individuals with disabilities provide services in a self-contained business the individual placement model and individual with disabilities is placed in an individual employment position they do not work with a group of others individuals with disabilities and a small business model a business May employ a small number of individuals with disabilities in various positions throughout the company counselors have two main methods of interacting and preparing their client to participate in the supported employment models described previously one is the train Place train follow-up this approach contains four major components one surveying potential employers to establish vocational and social skills that require training for the individual two training individuals so they can perform the vocational and social skills on the job three placing individuals in the competitive employment setting and four Supply and long-term follow-up services and training second is the place train follow-up model this approach contains four major components one job placement counselors perform Job searches seeking a position that fits their clients strengths to the job needs counselors interact with the employer on behalf of the client and arrange transportation for the client to the job site two job site training counselors will provide clients with training for vocational and social skills and communicate with the employer and other co-workers to Aid in adjustment three ongoing assessment counselors will ask for regular feedback on the client's progress and performance and may supervise the client during direct on-the-job observation client and family satisfaction with the job placement will be assessed for job retention counselors will regularly reduce the number of interventions and observations at the job site and occurrences of following up with the employer next a feedback interview conducting a feedback interview is a strategy used to help individuals develop workplace socialization skills or interview skills counselors conduct a mock interview or mock or replace conversation with the individual and provide feedback on their interaction there are four goals for a counselor when conducting a feedback interview one deliver information as effectively as possible two engage the client in discussion the client should be allowed to ask questions and provide input during the interview three ensure the client understands information as it is being discussed counselors should be able to answer any questions the client has and four gather enough information during the interview to create a plan for how the counselor and client will proceed after the interview job skills training this involves teaching or coaching an individual with disabilities about tasks they will be expected to perform in their job position in addition to training for job responsibilities job skills training can also involve workplace socialization training wherein individuals will be coached on what to expect from the workplace how to interact with co-workers and other professional behaviors job skills training can be provided on the job by a job coach or outside of the job setting at a community Rehabilitation provider location in a school setting or in other settings job coaching a job coach assists the individual with a disability in succeeding in their work environment by implementing workplace supports the job coach can help the employee with a disability learn their job tasks learn how to communicate with other employees and supervisors and may assist with transportation to and from the work site eventually the job coach should fade their supports and be replaced by natural supports in the workplace finally customized employment as defined by the federal Registrar of the U.S Department of Labor office of disability and employment policy odep customized employment is defined as individualizing the employment relationship between employees and Employers in a way that meets the needs of both it is based on an individualized determination of the strengths needs and interests of the person with a disability and is also designed to meet the specific needs of the employer customized employment is an approach wherein the individual with a disability and an Employment Specialist partner with a potential employer to create a job description that matches the abilities of the individual with the needs of the employer customized employment has four major components one Discovery in this stage employment Specialists talk with the individual their families and friends make personal observations and perform other evaluations to learn more about the individual strengths needs and interests two job search planning information gathered in the discovery stage is utilized to develop a job search plan and create a list of potential employers three job development and negotiation after identifying a potential employer the counselor individual and employer will work together to create a job position and negotiate on one's needs and demands on both the individual and employer's side and four post-employment support counselors will provide ongoing support and services by monitoring the individual's progress and ensuring job satisfaction for both the individual and the employer