counseling 407 community counseling dr. jeffrey k. edwards, lmft room 4054 1-773-442-5541 ...

Counseling 407Counseling 407Community CounselingCommunity Counseling

Dr. Jeffrey K. Edwards, LMFTDr. Jeffrey K. Edwards, LMFT Room 4054Room 4054 1-773-442-55411-773-442-5541 [email protected]@neiu.edu or or [email protected]@aol.com Office hours are Wednesdays 4-7 and Office hours are Wednesdays 4-7 and

Thursdays 1-4. Thursdays 1-4.

mailto:[email protected]

mailto:[email protected]

Counseling 407Counseling 407Community CounselingCommunity Counseling

Day one – Introduction Day one – Introduction Counseling research – Review or new?Counseling research – Review or new? Community Counseling - DefinitionsCommunity Counseling - Definitions Prevention - ModelsPrevention - Models

Counseling KnowledgeCounseling Knowledge

Well-known facts that most therapists either Well-known facts that most therapists either overlook, forget, or were never told. Or, why overlook, forget, or were never told. Or, why counseling/psychotherapy myths about who counseling/psychotherapy myths about who is better prevail. is better prevail.

Arm yourself with this information and you Arm yourself with this information and you will be an unstoppable Community/Family will be an unstoppable Community/Family Counselor.Counselor.

Counseling KnowledgeCounseling Knowledgethis will wake you up.this will wake you up.

Counseling and or Psychotherapy are Counseling and or Psychotherapy are comparatively the same thing. They are comparatively the same thing. They are simply different names for doing the same simply different names for doing the same activities. However, there are many activities. However, there are many professionals who have been trained to professionals who have been trained to believe that doing psychotherapy is more believe that doing psychotherapy is more scientific and rigorous, and should only be scientific and rigorous, and should only be provided by certain professions. (For a provided by certain professions. (For a comprehensive review see Neukrug, 2003)comprehensive review see Neukrug, 2003)

Counseling KnowledgeCounseling Knowledgethis will wake you up.this will wake you up.

Counseling/Psychotherapy works. More Counseling/Psychotherapy works. More than 40 years of outcome studies have than 40 years of outcome studies have demonstrated effectiveness (Hubble, demonstrated effectiveness (Hubble, Duncan and Miller, 1999).Duncan and Miller, 1999).However, nearly 50% of clients drop out of However, nearly 50% of clients drop out of treatment. There are few predictors of treatment. There are few predictors of premature dropout, except substance premature dropout, except substance abuse, minority status, and lower education abuse, minority status, and lower education (Prochaska, 1999).(Prochaska, 1999).


Smith et al. (1980) found that at the end Smith et al. (1980) found that at the end of treatment, clients were better off than of treatment, clients were better off than 80% of a control group that did not have 80% of a control group that did not have treatment.treatment.Two studies showed that about 75% of Two studies showed that about 75% of clients significantly improve after 26 clients significantly improve after 26 sessions (six months) and that 50% show sessions (six months) and that 50% show significant improvement after only 8 to 10 significant improvement after only 8 to 10 sessions.sessions.


In fact, the average length of stay in In fact, the average length of stay in treatment is around 8 to 10 sessions, with treatment is around 8 to 10 sessions, with a modal number of 1. a modal number of 1.

In a famous research project at Keiser In a famous research project at Keiser Permenante 80% of those clients who Permenante 80% of those clients who dropped out after one session, however, dropped out after one session, however, reported that they had received the help reported that they had received the help they needed after that one session.they needed after that one session.


Certain types of client problems are more Certain types of client problems are more likely to relapse, notably those with likely to relapse, notably those with substance abuse problems, eating substance abuse problems, eating disorders, recurrent depression, and disorders, recurrent depression, and personality disorders (Asay and Lambert, personality disorders (Asay and Lambert, 1999).1999).

It seems, however that change is more likely It seems, however that change is more likely to last, if the client attributes their changes to last, if the client attributes their changes to their own efforts ( Lambert & Bergin, to their own efforts ( Lambert & Bergin, 1994). 1994).

When therapy succeeds, the When therapy succeeds, the convention is to attribute the convention is to attribute the positive outcome to the therapy positive outcome to the therapy or ministrations of the therapist. or ministrations of the therapist. In contrast, when therapy goes In contrast, when therapy goes awry, or at least yields awry, or at least yields disappointing results, it has disappointing results, it has been customary to place the been customary to place the failure in the client or the client’s failure in the client or the client’s personality (Hubble, Duncan, & personality (Hubble, Duncan, & Miller, 1999).Miller, 1999).


1.1. Counseling/Psychotherapy models all Counseling/Psychotherapy models all have the same effectiveness, more or have the same effectiveness, more or less (see comprehensive reviews in less (see comprehensive reviews in Hubble, Duncan and Miller, 1999; Hubble, Duncan and Miller, 1999; Seligman, 1995).Seligman, 1995).

2.2. This has been called the Dodo effect, This has been called the Dodo effect, by Luborsky et al. (1975) - from Alice by Luborsky et al. (1975) - from Alice and Wonderland, “Everyone has won and Wonderland, “Everyone has won and all must have prizes.” and all must have prizes.”

Counseling KnowledgeCounseling KnowledgeEffective therapy can be achieved in shortEffective therapy can be achieved in short

periods of time (5 to 10 sessions) with at leastperiods of time (5 to 10 sessions) with at least

50% of clients seen in routine clinical50% of clients seen in routine clinical

practice. practice.

A sizable minority (20% to 30%) requiresA sizable minority (20% to 30%) requires

treatment lasting more than 25 sessions. Thosetreatment lasting more than 25 sessions. Those

clients who are more likely to fail at brief therapy clients who are more likely to fail at brief therapy

efforts are those who are poorly motivated, hostile, efforts are those who are poorly motivated, hostile,

have poor relationships with others in their life. have poor relationships with others in their life.


Techniques that are critical, attacking,Techniques that are critical, attacking,

rejecting, blaming etc. Are less effectiverejecting, blaming etc. Are less effective

treatments (Najavits & Strupp, 1994)treatments (Najavits & Strupp, 1994)

Therapies that focus on the future, instill Therapies that focus on the future, instill hopehope

early on, and enhance the clients hope andearly on, and enhance the clients hope and

placebo effect are more effective (Asayplacebo effect are more effective (Asay

& Lambert, 1999)& Lambert, 1999)

OK now, what does all this mean OK now, what does all this mean to you?to you?

How does this How does this change the way you change the way you will practice?will practice?

What ideas do you What ideas do you have for changing the have for changing the way you thought you way you thought you might work?might work?

What excites you What excites you about these concepts?about these concepts?


If techniques are not that important, then If techniques are not that important, then whatwhat

are the factors that contribute to positiveare the factors that contribute to positive

outcome? There are four:outcome? There are four:

1.1. Client Variables (40%);Client Variables (40%);

2.2. The Therapeutic relationship (30%);The Therapeutic relationship (30%);

3.3. Expectancy and Placebo Effect (15%);Expectancy and Placebo Effect (15%);

4.4. Technique (15%).Technique (15%).


Common Factors in Counseling

Technique15%

Expectancy (placebo

Effect15%

Extratheraputic Change

40%

Theraputic Relationship

30%

Client Variables (40%)Client Variables (40%)

1.1. Severity of Symptoms (both Severity of Symptoms (both psychological and physical);psychological and physical);

2.2. Motivation;Motivation;3.3. Psychological mindedness;Psychological mindedness;4.4. Ability to identify a focal Ability to identify a focal

problem (Lambert and problem (Lambert and Anderson, 1996).Anderson, 1996).


1.1. Such things as insight, and Such things as insight, and acquisition and practice of new acquisition and practice of new behaviors are also components behaviors are also components of the therapy that can and of the therapy that can and should be attributed to the should be attributed to the client, perhaps upping the 40% client, perhaps upping the 40% as high as 70% of the variable.as high as 70% of the variable.


““a withdrawn, alcoholic client, who is a withdrawn, alcoholic client, who is ‘dragged into therapy’ by his or her spouse, ‘dragged into therapy’ by his or her spouse, possesses poor motivation for therapy, possesses poor motivation for therapy, regards ,mental health professionals with regards ,mental health professionals with suspicion, harbors hostility toward others, is suspicion, harbors hostility toward others, is not nearly as likely to find relief as the client not nearly as likely to find relief as the client who is eager to discover how he or she has who is eager to discover how he or she has contributed to a failing marriage and contributed to a failing marriage and expresses determination to make personal expresses determination to make personal changes” (Asay and Lambert, 1999). changes” (Asay and Lambert, 1999).

The Therapeutic Relationship (30%)The Therapeutic Relationship (30%)Spontaneous ImprovementSpontaneous Improvement

““a significant number of people are a significant number of people are helped by friends, family, teachers, and helped by friends, family, teachers, and clergy who use a variety of supportive clergy who use a variety of supportive and HOPE instilling techniques. and HOPE instilling techniques. Howard et. al (1986) estimated that Howard et. al (1986) estimated that about 15% of clients experience some about 15% of clients experience some improvement before the beginning of improvement before the beginning of treatment” (Asay & Lambert, 1999).treatment” (Asay & Lambert, 1999).

The Therapeutic Relationship (30%)The Therapeutic Relationship (30%)Spontaneous ImprovementSpontaneous Improvement

is influenced byis influenced by

1.1. Length of time the problem has been Length of time the problem has been evident;evident;

2.2. Underlying personality disorder;Underlying personality disorder;

3.3. Quality of social support, especially the Quality of social support, especially the marital relationship (Andrews & Tennant, marital relationship (Andrews & Tennant, 1978; Mann, Jenkins, & Belsey, 1981).1978; Mann, Jenkins, & Belsey, 1981).

The Therapeutic Relationship (30%)The Therapeutic Relationship (30%)

The Necessary and sufficient The Necessary and sufficient conditionsconditions

Accurate EmpathyAccurate Empathy Positive RegardPositive Regard Non possessive warmthNon possessive warmth Congruence and genuineness.Congruence and genuineness.

These are client-perceived rather These are client-perceived rather than objective raters’ perceived. than objective raters’ perceived.


There is significant research to show There is significant research to show that years of experience are not that years of experience are not necessarily correlated with effectiveness necessarily correlated with effectiveness (Christiansen & Jacobson, 1994), while (Christiansen & Jacobson, 1994), while some studies have shown that self-help some studies have shown that self-help literature are in some cases of equal literature are in some cases of equal benefit as therapy (Gould & Clum, benefit as therapy (Gould & Clum, 1993). 1993).


It seems that the following components are It seems that the following components are important to the therapeutic alliance:important to the therapeutic alliance:

Client’s affective relationship with the therapist;Client’s affective relationship with the therapist; Client’s capacity to work purposefully in Client’s capacity to work purposefully in

therapy;therapy; Therapist’s empathic understanding and Therapist’s empathic understanding and

involvement;involvement; Client-therapist agreement on goals and tasks Client-therapist agreement on goals and tasks

of therapy (Gaston, 1990). of therapy (Gaston, 1990).


In the NIMH Study of Depression In the NIMH Study of Depression Collaborative Research Program Collaborative Research Program (1996), a comparison between (1996), a comparison between psychotherapy and active and placebo psychotherapy and active and placebo pharmacology found that the therapeutic pharmacology found that the therapeutic alliance had a significant effect on alliance had a significant effect on outcome. So what do you think about outcome. So what do you think about that?that?


During a demonstration of “bad” During a demonstration of “bad” therapy techniques I did at Wheaton therapy techniques I did at Wheaton College, I demonstrated bad posture, College, I demonstrated bad posture, bad eye contact, etc. When done, I bad eye contact, etc. When done, I asked the class to evaluate, and they asked the class to evaluate, and they were correct in their perceptions of my were correct in their perceptions of my techniques, however, the “client” saw techniques, however, the “client” saw things differently. She said it was the things differently. She said it was the most profound experience of her life!!most profound experience of her life!!

Expectancy and Placebo Effect Expectancy and Placebo Effect (15%)(15%)

Frank (1973) has suggested that people only Frank (1973) has suggested that people only seek help when they have become seek help when they have become demoralized because of their own inability to demoralized because of their own inability to solve their problems. They feel powerless solve their problems. They feel powerless over their own life situations. over their own life situations. Consistent research has demonstrated that a Consistent research has demonstrated that a large portion of improvement occurs during large portion of improvement occurs during the first 3 to 4 weeks of therapy, with 40 to the first 3 to 4 weeks of therapy, with 40 to 60% change occurring before the client has 60% change occurring before the client has their first interview (Weiner-Davis, deShazer & their first interview (Weiner-Davis, deShazer & Gingrich, 1987).Gingrich, 1987).

Expectancy and Placebo Effect Expectancy and Placebo Effect (15%)(15%)

In summarizing several studies, Lambert, Weber, & Sykes, (1993) have shown that the average client in therapy undergoing a placebo treatment will have a better outcome than 60% of a no-treatment group.

Expectancy and Placebo Expectancy and Placebo Effect (15%)Effect (15%)

In several studies with medications, the placebo effect has been demonstrated to be even greater than the 15% usually assumed (Benson & McCallie, 1979).


In a now classic study (Feldman, 1956) the effectiveness of chlorpromazine was prescribed by two groups of psychiatrists with the following results - Those who were enthusiastic had a 77% success rate, while those who did not (psychodynamic) only achieved a 10% success rate.


The finding that drug efficacy The finding that drug efficacy relates to prescribing relates to prescribing physician attitudes has been physician attitudes has been replicated repeatedly replicated repeatedly (Scovern, 1999).(Scovern, 1999).

Technique (15%)Technique (15%)

Basing the following on the consistent Basing the following on the consistent research findings that different types or research findings that different types or models of therapy have relatively the models of therapy have relatively the same outcome, a number of points are same outcome, a number of points are made. First, that training in specific made. First, that training in specific models and techniques is pointless models and techniques is pointless (Strop & Anderson (1997), and that (Strop & Anderson (1997), and that staying true to a protocol manual does staying true to a protocol manual does not prevent a wide variety of outcomes not prevent a wide variety of outcomes from the different therapists using them from the different therapists using them (Luborsky et al. (1985).(Luborsky et al. (1985).

Technique (15%)Technique (15%)

Of more concern, and reported more in the researchOf more concern, and reported more in the researchis the finding that staying true to a manual may causeis the finding that staying true to a manual may causeother factors such as flexibility, warmth, and theother factors such as flexibility, warmth, and thetherapeutic alliance (see Ogles, Anderson, &therapeutic alliance (see Ogles, Anderson, &Lunnen, 1999). These problems along with a Lunnen, 1999). These problems along with a multiplicity of others, causes a great deal of concernmultiplicity of others, causes a great deal of concernwhen one regards the current trends by the American when one regards the current trends by the American Psychiatric Association, Managed Care Psychiatric Association, Managed Care Organizations, and the American Psychological Organizations, and the American Psychological Association to use Empirically supported treatmentAssociation to use Empirically supported treatmentfor specific problems. for specific problems.

Models of Psychotherapy Used at Internship Sites National

N = 854

Narrative1%

Family Systems

13%

Jungian 0%

Structural1%

Adlerian1%

Brief Strategic8%

Client Centered

9%

Cognitive18%

Psychody10%

Reality6%

Solution19%

Behavioral 14%

Stages of ChangeStages of ChangeJames ProchaskaJames Prochaska

Precontemplation – Precontemplation – Contemplation –Contemplation – PreparationPreparation ActionAction Maintenance –Maintenance – Termination -Termination -

Precontemplation –Precontemplation –

are not intending to change, or take action, are not intending to change, or take action, usually in terms of “the next 6 months.”usually in terms of “the next 6 months.”

Are not fully informed, or aware of Are not fully informed, or aware of consequences. consequences.

May have tried to change in the past without May have tried to change in the past without success.success.

No inherent motivation to changeNo inherent motivation to change

Contemplation –Contemplation –

People intend to change within the next 6 People intend to change within the next 6 months.months.

Are aware of pros and cons of change vs. Are aware of pros and cons of change vs. no change.no change.

Profound ambivalence.Profound ambivalence.

PreparationPreparation

Plan to take action within the next month.Plan to take action within the next month. Have taken some action in the past year.Have taken some action in the past year. Have a plan for action.Have a plan for action. These are the best people to recruit for These are the best people to recruit for

action oriented treatment.action oriented treatment.

ActionAction

Have made specific, overt modifications in Have made specific, overt modifications in their lifestyles within the past 6 months.their lifestyles within the past 6 months.

Behavior change has been equated with the Behavior change has been equated with the action stage.action stage.

Outcomes depend on neither the duration of Outcomes depend on neither the duration of therapy nor the education or experience of therapy nor the education or experience of the therapist.the therapist.

Maintenance –Maintenance –

Working to prevent relapse, lasts from 6 months to Working to prevent relapse, lasts from 6 months to 5 years.5 years.

Failure usually is associated with being under Failure usually is associated with being under prepared for the length of time maintenance takes.prepared for the length of time maintenance takes.

The average American drinks, eats, smokes, and The average American drinks, eats, smokes, and takes drugs to manage distress (Mellinger, Balter, takes drugs to manage distress (Mellinger, Balter, Manheimer, Cisin, and Perry, 1978). Manheimer, Cisin, and Perry, 1978).

People struggling to overcome chronic conditions People struggling to overcome chronic conditions will be at the greatest risk of relapse.will be at the greatest risk of relapse.


Medications Medications

Beecher (1955) reviewed 15 single or doubleBeecher (1955) reviewed 15 single or double

bind studies that looked at the effects ofbind studies that looked at the effects of

placebos on a variety of conditions. Heplacebos on a variety of conditions. He

concluded that on average and acrossconcluded that on average and across

studies, placebos produced ‘satisfactorystudies, placebos produced ‘satisfactory

relief’ in 35% of those treated (Scovern, 2001)relief’ in 35% of those treated (Scovern, 2001)


Since the mid 1980’s there has been an Since the mid 1980’s there has been an 275% increase of persons who have 275% increase of persons who have trained and provide trained and provide counseling/psychotherapy.counseling/psychotherapy.

There still has not been a reduction in any There still has not been a reduction in any of the psychological or psychiatric of the psychological or psychiatric “illnesses.” “illnesses.”

A Community Counseling A Community Counseling ModelModel

The Upstream ModelThe Upstream Model

A Model of Community A Model of Community CounselingCounseling

This is the story of the Jeffrey’s River –This is the story of the Jeffrey’s River – Once upon a time, there was a river named Once upon a time, there was a river named

Jeffrey. Jeffrey.

I wonderwhy?


One day …someone came floating ..One day …someone came floating ..


down the river, almost drown.down the river, almost drown.


A good Samaritan saw the drowning personA good Samaritan saw the drowning person

Help!


helped him out and saved his life.helped him out and saved his life.

Thanks


Soon, another person came floating down Soon, another person came floating down the river, almost drown.the river, almost drown.

Help!


and he too, was helped out and had his life and he too, was helped out and had his life saved.saved.

Thanks


soon there were lots and lots of people soon there were lots and lots of people coming down the river drowning.coming down the river drowning.

Help!Help! Help!Help!

Please!!


The Samaritan needed some help. So he The Samaritan needed some help. So he asked a friend.asked a friend.

Help! Help! Help!Help!Please!!


And soon there were lots and lots of people And soon there were lots and lots of people helping all those other people coming down helping all those other people coming down the river drowning.the river drowning.


Soon they were building hospitals, and Soon they were building hospitals, and clinics….clinics….


And then they had supervisors and And then they had supervisors and administrators…administrators…


And they had overseers who told them how much And they had overseers who told them how much they would pay…called Managed Care.they would pay…called Managed Care.


And then one very smart person decided to And then one very smart person decided to go up stream to see…..go up stream to see…..


what or who was causing all those people to what or who was causing all those people to fall in the river. fall in the river.

It is me. I like to push them into

the drink.


And he told him to stop. So, he did!And he told him to stop. So, he did!

Hey, stop that!

OK, I will.


And that is how a Preventative Public Health And that is how a Preventative Public Health model was born….model was born….

Thanks.

You are welcome.

The Dawn of a New DayThe Dawn of a New Day

Salaries for therapists Salaries for therapists went through a shift. went through a shift. During the “Golden During the “Golden Days” (1980’s) of Days” (1980’s) of psychotherapy, the psychotherapy, the cost of a service hour cost of a service hour went to around $90.00. went to around $90.00. Now, the rate has Now, the rate has changedchanged

"if you look up the creek in any weather, "if you look up the creek in any weather, your spirit fills, and you are saying, with an your spirit fills, and you are saying, with an exulting rise of the lungs, "Here it comes!" exulting rise of the lungs, "Here it comes!" There must be something wrong with a There must be something wrong with a creekside person who, all things being creekside person who, all things being equal, chooses to face downstream. It's like equal, chooses to face downstream. It's like fouling your own nest.fouling your own nest.For this and a leather couch they pay fifty For this and a leather couch they pay fifty dollars an hour?...Look upstream Just dollars an hour?...Look upstream Just simply turn around; have you no will? The simply turn around; have you no will? The future is a spirit, or a distillation of the spirit, future is a spirit, or a distillation of the spirit, heading my way. heading my way.

Annie Dillard, Pilgrim at Tinker Creek, 1974Annie Dillard, Pilgrim at Tinker Creek, 1974

Cost per capita for Individual Cost per capita for Individual Counseling Counseling

You do the math.If you can see 30 clients a week at $90 per hour, or see 100 client for four hours at $100 per hour, several times a week, who gets the better deal?

Community Counseling Community Counseling ComponentsComponents

A new model of mental health/behavioral A new model of mental health/behavioral health needs to be designed so that health needs to be designed so that services can be equitable for all.services can be equitable for all.

The community has all the resources The community has all the resources needed to provide for it’s members;needed to provide for it’s members;

Public Health ConceptsPublic Health Concepts

Is the mental health system set up to help Is the mental health system set up to help those who need it the most? Or is it set up to those who need it the most? Or is it set up to subsidize the upper and upper middle classes? subsidize the upper and upper middle classes? Community Counseling is set up to help those Community Counseling is set up to help those in need, and who are under-represented by in need, and who are under-represented by service deliveryservice delivery.. They way mental health They way mental health systems are set up now, is to provide services systems are set up now, is to provide services to the less needy, and to make more money for to the less needy, and to make more money for the providers of services. the providers of services.

This is not a just way of operating.This is not a just way of operating.

PreventionPrevention Public Health came about from the work of Public Health came about from the work of

Health Care professionals, like Physicians, Health Care professionals, like Physicians, Nurses and other professionals, who study Nurses and other professionals, who study epidemiology, and they then find ways to treat epidemiology, and they then find ways to treat groups who have similar problems. groups who have similar problems.

Epidemiology – Epidemiology – 1. a branch of medical science that deals with 1. a branch of medical science that deals with

the incidence, distribution, and control of the incidence, distribution, and control of disease in a population ;disease in a population ;

2 : the sum of the factors controlling the 2 : the sum of the factors controlling the presence or absence of a disease or presence or absence of a disease or pathogen .pathogen .

Examples of Epidemiology and Examples of Epidemiology and Prevention WorkPrevention Work

Snow, Edwin MillerSnow, Edwin Miller – – America's first professional America's first professional city medical health officercity medical health officer he, took on the serious he, took on the serious problems with problems with cholera epidemic of 1854 in cholera epidemic of 1854 in Providence, in which he investigated about 150 Providence, in which he investigated about 150 cases. There was no health authority in the city, so cases. There was no health authority in the city, so he personally undertook action to curb the he personally undertook action to curb the epidemic. He drew up a report sharply criticizing epidemic. He drew up a report sharply criticizing the city's complete lack of sanitary precautions the city's complete lack of sanitary precautions and recommended measures to deal with the and recommended measures to deal with the problem. problem.


SIDS – 50% reduction of deaths by placing SIDS – 50% reduction of deaths by placing babies on their backs.babies on their backs.

SIDS – with Native Americans – did not SIDS – with Native Americans – did not respond in kind, but further investigation respond in kind, but further investigation found that many mothers were also binge found that many mothers were also binge drinking, and by swaddling the babies in the drinking, and by swaddling the babies in the colder months so they get too hot.colder months so they get too hot.


The nations highways are safer now The nations highways are safer now because of epidemiology and Public Health because of epidemiology and Public Health concepts. The director of National concepts. The director of National Highways was a PH Doc, and he studied Highways was a PH Doc, and he studied the roadways where there were a the roadways where there were a preponderance of vehicular accidents. After preponderance of vehicular accidents. After serious consideration, the roads were serious consideration, the roads were banked to allow cars to travel at the existing banked to allow cars to travel at the existing speeds without running off of the road.speeds without running off of the road.

Community Counseling Community Counseling ComponentsComponents

Mental Health and Mental Illness: Mental Health and Mental Illness: A Public Health Approach – A Public Health Approach – Surgeon General Report:Surgeon General Report:

http://www.surgeongeneral.gov/library/menthttp://www.surgeongeneral.gov/library/mentalhealth/chapter1/sec1.htmlalhealth/chapter1/sec1.html

http://www.surgeongeneral.gov/library/mentalhealth/chapter1/sec1.html

http://www.surgeongeneral.gov/library/mentalhealth/chapter1/sec1.html

Definitions of PreventionDefinitions of Prevention

The classic definitions used in public health The classic definitions used in public health distinguish between primary prevention, secondary distinguish between primary prevention, secondary prevention, and tertiary prevention (Commission on prevention, and tertiary prevention (Commission on Chronic Illness, 1957). Primary prevention is the Chronic Illness, 1957). Primary prevention is the prevention of a disease before it occurs; secondary prevention of a disease before it occurs; secondary prevention is the prevention of recurrences or prevention is the prevention of recurrences or exacerbations of a disease that already has been exacerbations of a disease that already has been diagnosed; and tertiary prevention is the reduction diagnosed; and tertiary prevention is the reduction in the amount of disability caused by a disease to in the amount of disability caused by a disease to achieve the highest level of function. Surgeon achieve the highest level of function. Surgeon Generals Report, 2002Generals Report, 2002

The Institute of The Institute of Medicine Medicine report on report on prevention identified problems in applying prevention identified problems in applying these definitions to the mental health these definitions to the mental health field (IOM, 1994a).field (IOM, 1994a). The problems stemmed mostly from the The problems stemmed mostly from the

difficulty of diagnosing mental disorders difficulty of diagnosing mental disorders and from shifts in the definitions of and from shifts in the definitions of mental disorders over time. mental disorders over time.

Consequently, the Institute of Medicine Consequently, the Institute of Medicine redefined prevention for the mental redefined prevention for the mental health field in terms of three core health field in terms of three core activities: prevention, treatment, and activities: prevention, treatment, and maintenance (IOM, 1994a). maintenance (IOM, 1994a).

Prevention, according to the IOM report, is Prevention, according to the IOM report, is

similar to the classic concept of primarysimilar to the classic concept of primary prevention from public health; it refers to prevention from public health; it refers to interventions to ward off the initial onset interventions to ward off the initial onset of a mental disorder. Treatment refers to of a mental disorder. Treatment refers to the identification of individuals with the identification of individuals with mental disorders and the standard mental disorders and the standard treatment for those disorders, which treatment for those disorders, which includes interventions to reduce the includes interventions to reduce the likelihood of future co-occurring disorders.likelihood of future co-occurring disorders.

The Institute of Medicine report on prevention

And maintenance refers to interventions And maintenance refers to interventions that are oriented to reduce relapse and that are oriented to reduce relapse and recurrence and to provide rehabilitation. recurrence and to provide rehabilitation.

(Maintenance incorporates what the (Maintenance incorporates what the public health field traditionally defines as public health field traditionally defines as some forms of secondary and all forms of some forms of secondary and all forms of

tertiary prevention.)tertiary prevention.)

The Institute of Medicine report on prevention (IOM, 1994a).

Albee (1993) has suggested that Public Albee (1993) has suggested that Public Health measures have done more to Health measures have done more to provide the population with good health provide the population with good health and the eradication of disease than and the eradication of disease than conventional medical interventions. conventional medical interventions. Public health relies on larger scale Public health relies on larger scale preventions; no one-on-one therapy has preventions; no one-on-one therapy has ever eradicated a disease.ever eradicated a disease.

Critique of a medical definition of Mental Health Prevention

Those who are in power have decided that Those who are in power have decided that all human problems are organic (brain all human problems are organic (brain problems, either in structure or problems, either in structure or chemically) control how reimbursement chemically) control how reimbursement will occur (through the use of DSM) rather will occur (through the use of DSM) rather than seeing them as social, psychological than seeing them as social, psychological or interact ional problems (Albee, 1993). or interact ional problems (Albee, 1993).


The conventional medical system has The conventional medical system has much to gain financially by using the much to gain financially by using the individual treatment model (Albee, 1993).individual treatment model (Albee, 1993).The organicThe organic


Assignment for next week.Assignment for next week.

Read the first two chapters in your book.Read the first two chapters in your book. Do a library search on Ovid/PsychLit re: Do a library search on Ovid/PsychLit re:

Prevention in Mental Health limited between Prevention in Mental Health limited between 1980 and 2000 (20 years). Look for trends 1980 and 2000 (20 years). Look for trends and begin to look critically at the topics.and begin to look critically at the topics.

counseling 407 community counseling dr. jeffrey k. edwards, lmft room 4054 1-773-442-5541 ...

Documents

counseling knowledge

community counseling

clients personality

effectiveness hubble

counselingpsychotherapy

end of treatment

substance abuse problems

client attributes