Counselor Toolbox Podcast

Jungian Archetypes A CEU course for this podcast can be found at https://www.allceus.com/member/cart/index/search?q=jungian ~ Define Archetypes ~ Explore where they come from ~ Learn about each archetype and how to best serve them in counseling ~ Explore the type/archetype connection ~ Define each personality type and potential “stuck points” Collective Unconscious & Archetypes ~ Archetypes are innate, universal, and hereditary and function to organize how we experience certain things. ~ The collective unconscious, Jung believed, was where these archetypes exist. ~ Jung rejected the concept of tabula rasa ~ He believed that the human mind retains fundamental, unconscious, biological aspects of our ancestors which serve as a basic foundation of how to be human. Archetypes ~ Archetypes symbolize basic human motivations, values, and personalities. ~ The Persona ~ The Shadow ~ The Self ~ Anima/Animus ~ Each archetype played a role in personality, but felt that most people were dominated by one specific archetype. ~ The actual way in which an archetype is expressed or realized depends upon an individual's cultural influences and unique personal experiences. Persona ~ The persona, derived from the Latin word for “mask” is how we present ourselves to the world. ~ Represents all of the different social masks that we wear among various groups and situations. ~ This social mask to contains all of the primitive urges, impulses, and emotions that are not considered socially acceptable in each social situation. ~ Becoming too closely identified with this archetype can lead people to lose sight of their true selves. Shadow ~ The shadow is an archetype that consists of the sex and life instincts, composed of repressed ideas, weaknesses, desires, instincts, and shortcomings. (Dark side) ~ The shadow forms out of our attempts to adapt to cultural norms and expectations. ~ It is this archetype that contains all of the things that are unacceptable not only to society, but also to one's own personal morals and values. Anima/Animus ~ The anima is a feminine image in the male psyche ~ The animus is a male image in the female psyche. ~ The anima/animus represents the “true self” rather than the image we present to others ~ The collective unconscious may contain notions about how women should behave while personal experience contribute to more personal images of women. ~ Jung suggested that this discouragement of men exploring their feminine aspects and women exploring their masculine aspects served to undermine psychological development. The Self ~ The self is an archetype that represents the unified unconsciousness and consciousness of an individual. ~ Creating the self occurs through a process known as individuation, in which the various aspects of personality are integrated. ~ Who you “should be” the persona ~ Your repressed “dark side,” the shadow ~ Your masculine and feminine identity, anima/animus ~ Creating the self occurs through a process known as individuation, in which the various aspects of personality are integrated. Jung and Personality ~ Jung proposed three fundamental, innate, dichotomous ways by which individuals take in information and make decisions, in order to achieve individuation ~ An individual can use either “side” of each of the following dichotomies, but will prefer and tend to use one “pole” over the other. ~ Carl G. Jung (1875-1961) wrote that what appears to be random behavior is actually the result of differences in the way people prefer to use their mental capacities. Type and Archetype ~ Type is more descriptive of how we

Acronyms for Mental Health Recovery Instructor: Dr. Dawn-Elise Snipes Executive Director: AllCEUs Counselor Continuing Education Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery CEUs are available for this presentation at  https://www.allceus.com/member/cart/index/search?q=acronyms Objectives ~ Review some quick tips and tools to help people better manage their emotions ~ Explore why each concept is necessary in recovery ~ Identify ways to use each acronym to form the foundation for a group (or homework) Fear FEAR ~ False ~ Expectations ~ Appearing ~ Real FEAR ~ Face ~ Everything ~ And ~ Recover ~ Emotional vs. Factual Reasoning ~ Facts for and against   Halt HALT ~ Hungry ~ Angry ~ Lonely ~ Tired HALT ~ Honesty (Mindfulness) ~ Acceptance ~ Loving (Compassion) ~ Tolerance FINE FINE ~ Freaked out ~ Insecure ~ Neurotic ~ Empty FINE ~ Faithful ~ Involved ~ Nimble ~ Experienced Ego-Driven vs. Purpose Driven EGO ~ Edging ~ God (Good Orderly Direction) ~ Out PURPOSE ~ Present-Focus ~ Understand what you need ~ Review your goals ~ Purposeful action (choose) ~ Observe the effects ~ Seek support ~ Evaluate Handling Urges URGE ~ Unpleasant ~ Reactive ~ Gravitate ~ Extreme THINK ~ Thoughtful ~ Honest ~ Intelligent ~ Necessary ~ Kind Mindfulness: RAID & SCAN ~ Recognize ~ Allow/Accept ~ Investigate ~ Decide how to improve the next moment   ~ Survey ~ Compassion ~ Awareness ~ Needs Distress Tolerance: ACCEPTS ~ Activities ~ Contributing ~ Comparisons ~ Emotions (Opposite) ~ Pushing Away ~ Thoughts (Happy) ~ Sensations Distress Tolerance: IMPROVE ~ Imagery ~ Meaning ~ Prayer ~ Relaxation ~ One thing at a time ~ Vacation ~ Encouragement Sleep: SHADES ~ Sleep routine ~ Hydration ~ Alcohol & Antihistamines (eliminate) ~ Darkness ~ Ergonomics ~ Stimulants (eliminate) Relaxation: RELAX ~ Recreate ~ Exercise ~ Laugh ~ Attitude adjustment ~ eXplore new hobbies, interests and places Self-Esteem: SELF ~ Strengths ~ Encouragement ~ Love ~ Friendship Relationships: FAVOR ~ Fair ~ Aware of each person’s perspectives and needs ~ Validate ~ Opportunity (Compromise) ~ Respect Communication: LOUD ~ Listen ~ Observe ~ Understand ~ Describe   Summary ~ Each of these acronyms can be used to increase awareness, trigger the use of new skills and reduce stress ~ To use these in group ~ Choose an acronym ~ Explore why that concept is important in recovery ~ Have clients identify how they operationalize or define each term ~ Create an infographic for each

Acceptance Tools Instructor: Dr. Dawn-Elise Snipes Executive Director: AllCEUs Counselor Continuing Education Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery Counseling CEUs for this presentation can be earned at https://www.allceus.com/member/cart/index/search?q=acceptance+tools Objectives ~ Accepting Failure ~ Accepting Isolation & Rejection ~ Accepting Loss of Control ~ Accepting Loss & Death Warm Up Practice ~ The Weather ~ The News ~ You wake up sick ~ Answer the following questions ~ What are the positives ~ What are the negatives ~ What is within your control ~ The situation ~ Your reaction to the situation Failure ~ When you try to do something but do not succeed ~ Identify what caused the failure: ~ Lack of realistic planning ~ Lack of knowledge ~ Lack of skills ~ Lack of focus ~ Actions of someone or something else ~ Identify what went well ~ Identify what you can learn ~ Explore the failure in terms of the big picture ~ Walk the middle path ~ I did not succeed AND I am going to be okay Failure ~ What does failure mean to you? ~ Failure is a loss ~ In what ways does failure cause you to feel ~ Angry ~ Hopeless and helpless ~ How can you integrate this loss into your life narrative? Isolation and Rejection ~ We all need to feel loved ~ By ourselves ~ By others ~ When you feel rejected ~ Who is rejecting you? ~ Other people ~ Yourself ~ Someone from your past ~ What are they rejecting? ~ You as a person ~ A particular behavior? (What is your part)   Isolation and Rejection ~ Combat Isolation ~ Define what it looks like to not feel isolated and make a plan ~ Tear down the walls / Allow other people in ~ Find common ground ~ Synergize ~ Combat Rejection ~ Know your worth ~ Separate rejection of ideas or behaviors from rejection of you as a person   Isolation and Rejection ~ When you feel rejected or isolated ~ Accept the feeling ~ Observe the facts ~ Appreciate differences ~ Remember that many times it has to do with the other person Loss of Control ~ You cannot control everything nor would you want to ~ Acceptance doesn’t mean you like it, just that you recognize you cannot control it ~ When you have a problem, you have 4 options ~ Change the situation ~ Change your response to the situation ~ Accept and tolerate the problem ~ Stay miserable Loss of Control ~ Make a list of all of the things that aggravate you because you cannot control them. ~ Circle each thing that is the results because of someone else’s thoughts or actions (Traffic, poor group performance at work, rude people…) ~ Highlight each thing that is an “act of God” (time passing, holidays, weather…) ~ Identify how you can radically accept or mitigate these things Loss and Death ~ With each loss comes some element of denial, anger, depression and acceptance. ~ All of these are normal emotions to feel, acknowledge and let go. ~ Losses come in all forms: Loss of childhood, loss of optimism/hope, loss of possessions, loss of/change in friendships (even after a move), and deaths ~ Some losses are voluntary, like moving or changing jobs. ~ Some are involuntary like death, graduation, divorce, layoffs ~ Think of losses as end-of-season cliffhangers when an actor leaves. How is the next season going to play out? Loss ~ Addressing Loss: Anger ~ Anger is a response to a perceived threat. ~ Identi

7 Habits for Effective Recovery Counseling CEUs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/710/c/ Objectives ~ Review the 7-Habits of Highly Effective People and how they apply to recovery from mental health and addiction issues Be Proactive ~ Be response-able ~ Your life (Vehicle) ~ What people things and activities are important to your life? What is your destination / Good Orderly Direction? ~ What thoughts, attitudes and self talk will help you move toward that destination? (Empowering, accepting, compassionate) ~ What actions will help you move toward that destination? (self-care, building support, therapy, new job…) ~ What challenges or adversities can you plan for and mitigate? (Illness, financial stresses, bad days, deaths, holidays…) Be Proactive ~ Be response-able ~ Your recovery (Engine) ~ What people things and activities are important to your recovery? What do you need to do to maintain your happiness? ~ How is your recovery important to your overall life goal or destination? In what ways does it impact the people and things that are important to you? ~ What challenges or adversities can you plan for and mitigate? Be Proactive ~ Focus on what is within your control ~ Imagine a blizzard or hurricane is coming ~ What is and is not within your control? ~ How can you minimize the distress ~ How can you maximize the happy and build your reserves ~ Make a list of things (including positive things) that are within your control Be Proactive ~ Develop skills to help you regulate your emotions, urges and actions and choose those that help you move toward happiness. ~ Admit and learn from mistakes ~ Practice the 3 finger rule ACT ~ Action ~ Changes ~ Things ~ What action can you take right now to start changing things for the better? Begin with the End in Mind ~ Most failures result from failure to envision/plan (within reason) ~ Going to the gym ~ Going to the grocery without a list ~ Going on vacation without a destination ~ Starting a project without a plan Begin with the End in Mind ~ Envision in your mind what you cannot at present see ~ If you were happy, what would be same and different? ~ What is your personal mission statement (revisable)? ~ What do you do? ~ How do you do it? ~ Why do you do it? ~ What do I really want out of life? ~ What am I uniquely put on earth to achieve? ~ What do I believe my purpose or mission is in life? Begin with the End in Mind ~ Envision in your mind what you cannot at present see ~ If you were happy, what would be same and different? ~ What is your personal mission statement (revisable)? ~ What do you do? ~ How do you do it? ~ Why do you do it? Begin with the End in Mind ~ Plan ahead and set goals ~ Specific ~ Measurable ~ Achievable ~ Time Limited ~ Realistic ~ Rewarding ~ Envision reaching your destination daily. ~ Keep track of progress toward your destination. Put First Things First (Purposeful Action) ~ Recognize that not doing everything is okay. ~ Prioritize by practicing mindful discipline ~ Remind yourself why you do the things you do ~ For new opportunities, ask “Does X get you closer to the things that are most important to you?” ~ Organization reduces stress and energy expenditure ~ Do you have energy and time to do it over if you don’t do it right the first time? (Outlining) ~ It's all right to say no or ask for help when necessary to focus on your highest priorities. Put First Things First (Purposeful Actio

Building Resilience Counseling CEs are available for this presentation at https://www.allceus.com/member/cart/index/product/id/709/c/ The Art of Resilience ~ Resilience is a process or lifestyle that enables people to bounce back in the face of adversity ~ “a dynamic process encompassing positive adaptation within the context of significant adversity” (Luthar, Cicchetti, & Becker, 2000) ~ Resilience develops over time as people are exposed to, and successfully navigate, stressors Resiliency Theory ~ The central principles of the theory include ~ Risk factors/mechanisms ~ Vulnerability factors ~ Protective factors/mechanisms. ~ Risk factors and mechanisms are the events or conditions of adversity that cause distress in early life ~ Poverty ~ Prematurity ~ Residential mobility / lack of family or community ties ~ Addicted or dysfunctional family environment ~ Illness (cancer, M.S., chron’s disease) The Art of Resilience ~ Vulnerability factors are traits, genetic predispositions, or environmental and biological deficits which may cause heightened response, sensitivity, or reaction to stressors. ~ Cognitive impairment (FASD) ~ Lack of social support ~ Emotional dysregulation ~ Ineffective coping skills ~ Mood or addictive disorders in the person ~ Poor physical health (pain, nutrition, hormones, sleep) The Art of Resilience ~ Protective factors and mechanisms are things which enhance or promote resistance, or which may moderate the effect of risk factors. ~ Rutter (1987) suggests that protective mechanisms may operate in one of four ways to allow overcoming adversity: ~ Reducing risk impact ~ Reducing negative chain reactions to risk factors ~ Promoting resiliency traits ~ Setting up new opportunities for success. The Art of Resilience ~ Fergus and Zimmerman (2005) identified two types of protective factors. ~ Assets are positive factors that reside within individuals, such as: ~ Self-efficacy and self-esteem ~ Social competence and communication skills ~ Resources refer to factors outside individuals, such as: ~ Social support ~ Opportunities to learn and practice skills ~ Wellness programs that support biological health 6-Cs of Resilience ~ 6-Cs ~ Coping ~ Control ~ Character ~ Confidence ~ Competence ~ Connection (resource)   Characteristics “Assets” of Resilient People ~ Coping: Can effectively balance negative and positive emotions and manage strong impulses. ~ Emotion Regulation / Prevent or mitigate vulnerabilities ~ Distress Tolerance ~ Problem Solving Skills ~ Control/Autonomy: A sense of personal identity and ability to act independently to exert some control over one’s situation ~ Who are you, and who and what is important to you? ~ What things can you change in this situation? ~ The situation? ~ Your reaction to the situation? Characteristics “Assets” of Resilient People ~ Character and a sense of purpose and future: ~ Purposeful Action: Make realistic plans for a meaningful life based on what is important to you ~ Take the steps necessary to achieve goals ~ Notice positive, forward moving thoughts and behaviors in yourself and others ~ Confidence in one’s strengths and abilities ~ What are your strengths? ~ In what ways does your response [to this stressor] make sense? ~ How did you get through similar situations? ~ What helpful or self-defeating thoughts are you telling yourself? Characteristics “Assets” of Resilient People ~ Competence ~ Ability to mitigate emotions and successfully problem solve

A Strengths Based Biopsychosocial Approach to PTSD Instructor: Dr. Dawn-Elise Snipes Ph.D., LMHC Objectives – Highlight the functional nature of most behaviors and reactions – Define PTSD – Examine the function and meaning of PTSD symptoms – Develop an understanding of why some people develop PTSD and others do not – Explore useful interventions for persons with PTSD Reward and Survival – Humans and animals experience reactions to prompt behavior – Anger/Fight – Fear/Flight – Reactions are responses designed to – Protect life – Achieve a reward/avoid punishment PTSD and Gradual Onset PTSD – PTSD: Traditional exposure to an event or multiple events – Military – Crime Victims – Gradual Onset PTSD: repeated exposure to horrific or threatening events causing a sense of helplessness – Law Enforcement – Military – Child Abuse/Neglect Definition – Exposure to a horrifying event in which there was a sense of helplessness – For each symptom that follows, we will identify – The function – What triggers that symptom or exacerbates it – How the person deals with/mitigates that symptom – Other things he or she could do Symptoms – Re-experiencing the traumatic event – Intrusive, upsetting memories of the event – Flashbacks (acting/feeling like the event is happening again) – Nightmares – Feelings of intense distress when reminded – Intense physical (panic) reactions to reminders Symptoms – PTSD symptoms of avoidance and emotional numbing – Avoiding reminders of the trauma – Inability to remember important aspects of the trauma – Loss of interest in activities and life in general – Feeling detached from others or emotionally numb – Sense of a limited future Symptoms – PTSD symptoms of increased arousal – Difficulty falling or staying asleep – Irritability or outbursts of anger – Difficulty concentrating – Hypervigilance (on constant “red alert”) – Feeling jumpy and easily startled Other common symptoms of PTSD – Anger and irritability – Guilt, shame, or self-blame – Substance abuse – Depression and hopelessness – Suicidal thoughts and feelings – Feeling alienated and alone – Feelings of mistrust and betrayal – Headaches, stomach problems, chest pain Triage – Similarity to the victim (or being the victim) – Proximity to your safe zones (home, work) – Social support after the trauma – History of mental health problems – Number of stressors in the past 6 months Assessment – If you were not the victim, how were you similar to the victim- – How are people around you similar to the perpetrators- – What was (or would have been) helpful for people to do after the trauma- – Who can you rely on to do those things now- Creating Safety – What can you do to take back your “safe zones” – How can your protect yourself from this in the future- – How did the experience change – How you view things- – What is important to you- – How you will live your life now- Sleep – Function – Balances neurochemicals – Helps reduce cortisol – May improve adrenal fatigue – Safety – Environmental (Feng Shui) – Common sense Sleep

Using a Strengths-Based Biopsychosocial Approach to Addressing Anxiety Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Objectives ~ Define a strengths based approach ~ Define a biopsychosocial approach ~ Explore the symptoms of anxiety ~ Identify potential causes of and biological, psychological and social interventios for those symptoms Why I Care/How It Impacts Recovery ~ Anxiety can be debilitating ~ Low-grade chronic stress/anxiety erodes your energy and ability to concentrate ~ Anxiety is a major trigger for: ~ Addiction relapse ~ Increased physical pain ~ Sleep problems What Does Strengths Based Mean ~ It is easier (and more effective) to build upon something that already works to some extent. ~ Strengths-based approach helps people identify how they are already trying to cope and builds on that ~ There are two types of strengths ~ Prevention/Resilience Strengths ~ What you do on a daily basis to stay healthy and happy ~ Intervention/Coping Strengths ~ In the past when you have felt this way, what helped? ~ What made it worse? What is a Biopsychosocial Approach ~ Bio-logical ~ Neurochemicals ~ Nutrition ~ Sleep ~ Sunlight & Circadian Rhythms ~ Psycho-logical ~ Mindfulness ~ Distress Tolerance ~ Coping Skills ~ Cognitive Restructuring ~ Social ~ Improving self-esteem and your relationship with self ~ Improving relationships with healthy, supportive others What is Anxiety ~ Anxiety is half of the “Fight or Flight Response” ~ It is an excitatory response ~ It’s function is to protect you from danger ~ It can become a problem when it is ~ Overgeneralized ~ Overly intense/uncontrollable ~ Constant due to brain injury ~ Like depression, it can be caused by excess serotonin Serotonin: A Common Neurobiologic Substrate in Anxiety and Depression. EISON, MICHAEL S. PhD Symptoms of Generalized Anxiety ~ Generalized anxiety disorder symptoms can vary. They may include: ~ Persistent worrying or obsession about small or large concerns that's out of proportion to the impact of the event ~ Inability to set aside or let go of a worry ~ Inability to relax, restlessness, and feeling keyed up or on edge ~ Difficulty concentrating, or the feeling that your mind “goes blank” ~ Distress about making decisions for fear of making the wrong decision ~ Carrying every option in a situation all the way out to its possible negative conclusion ~ Difficulty handling uncertainty or indecisiveness Symptoms of Generalized Anxiety ~ Generalized anxiety disorder symptoms can vary. They may include: ~ Physical signs and symptoms may include: ~ Fatigue ~ Irritability ~ Muscle tension or muscle aches ~ Trembling, feeling twitchy ~ Being easily startled ~ Trouble sleeping ~ Sweating ~ Nausea, diarrhea or irritable bowel syndrome ~ Headaches Symptoms of Generalized Anxiety (Kids) ~ Excessive worry about: ~ Performance at school or sporting events ~ Being on time (punctuality) ~ Earthquakes, nuclear war or other catastrophic events ~ A child or teen with GAD may also: ~ Feel overly anxious to fit in ~ Be a perfectionist ~ Lack confidence ~ Strive for approval ~ Require a lot of reassurance about performance Biological Interventions ~ Your body thinks there is a threat. Figure out why ~ Supportive Care ~ Create a sleep routine ~ Helps the brain and body rebalance ~ Can help repair adrenal fatigue ~ Improves energy level ~ Nutrition ~ Minimize caffeine and other stimulants ~ Try to prev

ACT and the Matrix What Every Counselor Should Know with Dr. Dawn-Elise Snipes Executive Director, AllCEUs Host: Counselor Toolbox & Happiness Isn’t Brain Surgery CEUs based on this video are available at https://www.allceus.com/member/cart/index/product/id/519/c/ Objectives ~ Review the main points of Acceptance and Commitment Therapy ~ Review how to apply the matrix ~ Identify the shortcut question The Main Principles of ACT ~ The goals are to: ~ Create a rich and meaningful life, while accepting the pain that inevitably goes with it. ~ Learn to perceive difficult thoughts and feelings as harmless, even if uncomfortable, transient psychological events. ~ Take effective action guided by your deepest values and in which you are fully present and engaged. (No autopilot) Control is the Problem, Not the Solution ~ Clean Discomfort: When emotions and reactions are accepted, it leads to a natural level of physical and emotional discomfort ~ Dirty Discomfort: Once you start struggling with it, your “struggle switch is turned on” and discomfort increases rapidly. ~ Struggle switch is like an emotional amplifier—switch it on, and you can have anger about your anxiety, anxiety about your anger, depression about your depression, or guilt about our guilt. Experiential Avoidance ~ The more time and energy spent trying to avoid or get rid of unwanted feelings in general, the more we are likely to suffer “Quicksand” ~ Anxiety (Fear things won’t get better) ~ Anger (Frustration things aren’t getting better) ~ Depression (Hopelessness and helplessness—resignation that things can’t get better) Changeable Variables in Context ~ Emotions are a natural way your body prompts you to act. ~ Focus on changeable variables in the context in which the issue occurs ~ Physical vulnerabilities (sleep, nutrition, pain) ~ Relationships (boundaries and communication) ~ Thoughts (Distress Tolerant) ~ Behaviors (DBT/CBT)   Six Core Principles of ACT ~ Values Awareness ~ Contact with the Present Moment ~ The Observing Self ~ Acceptance ~ Diffusion ~ Committed Action Clarifying the Destination Values & Goals Awareness ~ A lack of clarity about values can underlie much of people’s distress or keep them “stuck.” ~ Like going on a road trip without a destination ~ They can get caught up spinning their wheels trying to fight against something or use that same energy to work toward something. ~ “What is the most effective use of your limited energy and time to help you achieve your goals?” Clarifying the Destination Values & Goals ~ Clarifying ~ Relationships: Who is most important to you? ~ Which people? ~ What do you want those relationships to be like? ~ What events, things, experiences are meaningful to you? ~ Work ~ Health ~ Personal Growth Clarifying cont… ~ Values ~ What values do you want to embody (Choose 5)? ACT Matrix: Destination Identification • Values Awareness • Contact with the Present Moment • The Observing Self • Acceptance • Diffusion • Committed Action The Observing Self The Audience ~ Fly on the Wall /Scientist/Nurse doing bed check ~ Curious ~ Objective ~ Nonjudgmental Mindfulness in the Present Moment Awareness of What Is ~ Contact with the Present Moment/Bringing full awareness to your here-and-now experience ~ How do I feel? ~ What are my thoughts, wants and urges? ~ What physical sensations am I experiencing? ~ Describe the environment—smell, temperature, colors, objects, people,

Medical Error Prevention in Comprehensive Integrated Systems of Care 2017 Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP Executive Director: AllCEUs Counselor Education Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery CEUs are available on demand for this video at https://www.allceus.com/member/cart/index/product/id/698/c/ Objectives ~ Identify medical errors common in a comprehensive integrated system of care including pain management ~ Discuss how pain influences the comprehensive treatment process ~ Identify causes of errors ~ Describe effects of medical errors on the patient and family ~ Identify common documentation and communication errors in multidisciplinary teams ~ Define “medical error” ~ Identify the factors in a credible root cause analysis ~ Identify major signs and symptoms of a medical emergency ~ Describe other interventions designed to prevent harm and to protect patient safety commonly utilized by therapists Definition of “medical error” (NIM) ~ Diagnostic errors ~ Error or delay in diagnosis ~ Failure to use indicated tests ~ Use of outdated therapy ~ Failure to act on results of monitoring or testing     ~ Treatment ~ Error in the performance of procedure, test ~ Avoidable delay in treatment or in responding to an abnormal test ~ Inappropriate (not indicated) care ~ Type ~ Intensity ~ Breadth/Diversity ~ Duration Medical Errors in Counseling ~ Counselors often work with teams of specialists and support personnel ~ Psychiatrists & Psychologists, Mental health professionals ~ Physicians, Physician’s assistants & Nurse practitioners ~ Nutritionists ~ Physical and occupational therapists ~ Pain management specialists ~ Certified addiction professionals ~ Pastor/ religion/faith leaders ~ Relatives More Medical Errors ~ Prevention ~ Failure to consider multiple causes of symptoms ~ Failure to provide preventative treatment ~ Inadequate monitoring or follow-up of treatment ~ Other ~ Failure of communication ~ Equipment failure ~ Other system failure Documentation & Communication Errors ~ Short hand ~ Poor communication between teams ~ Documentation quality ~ Content ~ Lack of a single point of contact ~ HIPAA Violations ~ Making assumptions without clarification or confirmation ~ Reasons for medications the patient is taking ~ Causes of pain or distress   Error Causes ~ Multiple professional involvement. (Too many cooks without a Chef) ~ Misdiagnosis or assignment of a false diagnosis ~ Intimidation ~ Over-treatment ~ Relay false client/patient or their own personal information ~ Inappropriately share or distort information ~ Attempt to treat out of the realm of expertise ~ Do not consult with medical professionals Error Causes ~ Do not thoroughly collect background histories or complete assessments ~ Provide inadequate safety or security of physical environment ~ Recommend inappropriate or dangerous treatment protocol Medical Error Effects ~ Loss of trust  drop-out, relapse or symptom worsening ~ Loss of trust that accurate, complete information will be passed ~ Reversal or relapse of mental health and other physical conditions ~ Take incompatible medications due to a lack of communication by the patient’s various providers ~ Abuse medications or take inappropriate medications when multiple causes for emotional or physical pain are not considered Medical Error Effects ~ Lose importan

Assessment Tools  ASAM, FARS, LOCUS Counseling CEU courses which include this podcast can be found at https://www.allceus.com/member/cart/index/search?q=patient+placement+criteria Objectives ~ Differentiate between level of care guidelines and patient placement criteria ~ Learn about the Functional Assessment Rating Scale (Required in some states) ~ Learn about the ASAM (Required by most insurers) ~ Learn about the LOCUS (Often an alternate to the ASAM ~ Discuss why these tools are used and how they can benefit clinician and client Patient Placement vs. Level of Care ~ Patient placement criteria suggests a treatment intensity level that meets the needs of the client ~ Level of Care Guidelines are defined by: ~ Insurance Providers ~ State Law (in some states) Why Use Them ~ Provides a biopsychosocial approach to care management ~ Assists in defining potential strengths and obstacles to the recovery process as the client sees them ~ Helps guide treatment planning for ~ Biomedical Issues ~ Cognitive/Emotional/Behavioral Issues ~ Motivational Issues ~ Recovery Environment (including social supports) ~ Assists in providing Specific, Measurable, Achievable, Realistic, Time Limited Goals FARS ~ Functional Assessment Rating Scale ~ Not a placement guideline per se ~ Helps more clearly define anchors for behavioral observations FARS FARS FARS ASAM– Assessment, Reassessment & Discharge ~ Physical ~ Acute Intoxication/Withdrawal Potential ~ Biomedical Conditions ~ Emotional/Cognitive ~ Emotional/Behavioral Conditions ~ Treatment Acceptance/Resistance (Readiness for change) ~ Behavioral ~ Relapse or Continued Use Potential ~ Social/Environmental ~ Recovery Environment ASAM Levels ~ Level .05: Early Intervention (Relapse Prevention) ~ Level I: Outpatient (<9 hours per week) ~ Level II: IOP (9-19 hours per week) ~ Level II.5: PHP (20+ Hours per week) ~ Level 3: Residential ~ Level 4: Medically Managed Intensive Inpatient Services LOCUS Dimensions ~ Risk of Harm ~ 1-Minimal ~ 2-Low ~ 3-Moderate ~ 4-Serious ~ 5-Extreme ~ Functional Status ~ 1-Minimal Impairment ~ 2-Mild Impairment ~ 3-Moderate Impairment ~ 4-Serious Impairment ~ 5-Severe Impairment LOCUS Dimensions ~ Medical, Addictive and Psychiatric Comorbidity ~ 1-No Comorbidity ~ 2-Minor Comorbidity ~ 3-Moderate Comorbidity ~ 4-Major Comorbidity ~ 5-Severe Comorbidity Recovery Environment ~ Level of Stress (A) ~ 1-Low ~ 2-Mild ~ 3-Moderate ~ 4-High ~ 5-Extremely Stressful ~ Level of Support (B) ~ 1-Highly supportive ~ 2-Supportive ~ 3-Limited Support ~ 4-Minimal Support ~ 5-No Support LOCUS Dimensions ~ Treatment and Recovery History ~ 1-Fully Responsive ~ 2-Significant Response ~ 3-Moderate or Equivocal Response ~ 4-Poor Response (goals not achieved or gains not maintained) ~ 5-Negligible Response LOCUS Dimensions ~ Engagement ~ 1-Optimal (Action) ~ 2-Positive (Preparation/Determination) ~ 3-Limited (Contemplation) ~ 4-Minimal (Contemplation) ~ 5-Unengaged (Precontemplation) EXAMPLE Guidelines LOCUS Placement ~ Level 1 LOCUS Placement (up to 3h/week) ~ 1. Risk of Harm – clients with a rating of two or less ~ 2. Functional Status – clients should demonstrate ability to maintain a rating of two or less ~ 3. Co-morbidity – a rating of two or less ~ 4. Recovery Environment – a comb

Medical Error Prevention Understanding Serotonin Syndrome Instructor: Dr. Dawn-Elise Snipes Executive Director: AllCEUs Counselor Education Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery CEU course can be found at AllCEUs.com Objectives ~ Define Serotonin Syndrome ~ Explore the drug interactions that often cause serotonin syndrome ~ Explore risk factors for serotonin syndrome ~ Discuss why mental health clinicians need to know about serotonin syndrome ~ Learn about treatment for serotonin syndrome Understanding SOME of the Serotonin Receptors Ways Serotonin is Increased ~ Increase in serotonin synthesis ~ L-Tryptophan (esp. supplementation) ~ Reduction in serotonin breakdown ~ MAOIs: Isocarboxazid (Marplan) and phenelzine (Nardil) ~ Increase serotonin release ~ Amphetamines (ADHD medication, MDMA) ~ Anorectics (appetite suppressants (dexadrine)) ~ Anti-migraine medications such as triptans (Axert, Amerge, Imitrex), carbamazepine (Tegretol) and valproic acid (Depakene) Ways Serotonin is Increased ~ Stimulation of Post Synaptic Receptors ~ Buspirone ~ Lithium ~ Pain medications such as opioid pain medications including codeine (Tylenol with codeine), fentanyl (Duragesic), hydrocodone meperidine (Demerol), oxycodone (Oxycontin, Percocet, Percodan) and tramadol (Ultram). Ways Serotonin is Increased ~ Serotonin Reuptake Inhibitor ~ SSRI Antidepressants (Paxil, Prozax, Zoloft) ~ Ultram (SSRI + mu-receptor activation) ~ Trazadone (SARI: Serotonin Agonist and Reuptake Inhibitor) ~ Tricyclic Antidepressants (i.e. Elavil (amitriptyline), Tofranil (imipramine), and Pamelor (nortriptyline )) ~ Serotonin and norepinephrine reuptake inhibitors (SNRIs), antidepressants such as duloxetine (Cymbalta) and venlafaxine (Effexor) ~ Bupropion (Wellbutrin, Zyban) antidepressant and tobacco-addiction medication. Norepinephrine-dopamine reuptake inhibitor (NDRI)   Other Drugs That Act To Raise Serotonin ~ Illicit drugs, including LSD, Ecstasy, cocaine and amphetamines ~ Herbal supplements, including St. John's wort, ginseng and nutmeg, 5-HTP ~ Over-the-counter cough and cold medications containing dextromethorphan (Delsym, Mucinex DM, others) ~ Anti-nausea medications such as granisetron, metoclopramide (Reglan), droperidol (Inapsine) and ondansetron (Zofran) ~ Linezolid (Zyvox), an antibiotic ~ Ritonavir (Norvir), an anti-retroviral medication used to treat HIV/AIDS http://www.mayoclinic.org/diseases-conditions/serotonin-syndrome/symptoms-causes/dxc-20305673 CAN Identify ~ C = Cognitive changes including agitation, confusion, euphoria, insomnia, hypomania and hallucinations ~ A= Autonomic changes including tachycardia, fever, arrhythmias, sweating, dilated pupils ~ N= Neuromuscular changes including tremor, rigidity, incoordination, seizures Other Symptoms ~ Confusion ~ Agitation or restlessness ~ Dilated pupils ~ Headache ~ Changes in blood pressure and/or temperature ~ Nausea and/or vomiting ~ Diarrhea ~ Rapid heart rate ~ Tremor ~ Loss of muscle coordination or twitching muscles ~ Shivering and goose bumps ~ Heavy sweating Life Threatening Stage ~ In severe cases, serotonin syndrome can be life threatening. If you experience any of these symptoms, you or someone with you should seek medical attention immediately: ~ High fever ~ Seizures ~ Irregular heartbeat ~ Unconsciousness Risk Factors ~ There is an increased risk of serotonin syndrome if the person: ~ Recently started taking or increased the dose of a medication kno

Online Counseling Dr. Dawn-Elise Snipes Ph.D., LMHC, LPC-MHSP Charles Snipes IT Director AllCEUs.com & DataTriangle.com Overview ~ History of Online Counseling ~ Reasons for Online Counseling ~ Methods of Online Counseling ~ Ethics of Online Counseling ~ The Business Aspects – Choosing a Virtual Office – Possible Features – How much to charge – Marketing: Making a Place in Cyberspace History ~ 1970s several hospitals linked via video feed to provide doctor-to-doctor consultation ~ 2000 the first independent practitioners started making a name for themselves ~ 21st Century people have begun communicating more by text/IM ~ 2006 several states passed laws indicating that telehealth must be compensated at the same rate as face2face ~ 2010 – The majority of insurers are compensating for telehealth services – Florida created a state-certification for e-therapy. Reasons ~ Access experts on a particular problem worldwide (must be licensed in the state of practice and the state where the client resides) ~ Often more cost effective for the practitioner and the patient ~ Provides a degree of anonymity making many people feel more at ease ~ Enduring record ~ Many of the youth of today prefer etherapy…You lived on the phone as a teen, they live on their iphone or text. ~ An adjunct to traditional therapy Methods /Ethics / Cultural Appropriateness ~ Phone – Benefits – Drawbacks ~ Text/IM – Benefits – Drawbacks ~ Video – Benefits – Drawbacks ~ Email – Benefits – Drawbacks Ethics ~ Who and Where ~ Verifying identity ~ Assessment ~ Treatment Issues – Addictions – Anxiety – Depression – Bipolar – OCD – PTSD Ethics- Informed Consent ~ Verifying Identity ~ Who will have access to the information ~ How to handle power or internet outtages ~ How to handle mental health emergencies ~ How to schedule and reschedule ~ Payment policies – Fees – What shows up on credit card – Alternate payment methods (checks / money orders) ~ Releases of information ~ Information Security and Risks ~ Methods for protecting privacy (clearing cache / deleting recent history, etc.) Ethics ~ Handling disinhibition – Suicidal threats – Flaming – Repeated calls/texts/emails ~ Information about expected response time for – Text – Email The Business Aspects ~ Choosing a Virtual Office – Virtual office vs. a web presence – Partnering with someone else vs. Independent Office  Advertising/Marketing  Commissions  HIPAA  Payment Business Aspects cont… ~ Possible Features – Web presence – Interactive online appointment book – Fillable assessment and intake forms – Secure IM/Text chat (imbedded or downloadable) – Secure email – Secure video chat (imbedded or downloadable) – Instant services Business Aspects ~ How much to charge ~ Marketing: Making a Place in Cyberspace – SEO optimization – HTML vs. Blog or CMS – Designing your website (colors, usability) – Finding a niche Online Therapists and Social Networks ~ Keep your personal social networks separate from your clinical / practice network ~ Add clients only to your clinical network if you have one ~ Know whatever you say / put out there can possibly be seen and interpreted person

Online Counseling Business Practices 2 Hours Dr. Dawn-Elise Snipes, PhD, LPC-MHSM, LMHC Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Objectives ~ Provide information about website development ~ Discuss search engine optimization ~ Identify ways to attract clients and market ~ Review methods for accepting payment and setting appointments Website Development ~ Website development services. ~ TherapySites.com ~ Wix.com ~ Choose your domain name ~ GoDaddy.com ~ Domains.google.com ~ Any other site where you can purchase a domain ~ Identify who is going to do all your IT stuff ~ Identify your web host (where your website will “live”) Web Development ~ Video and Other Client Services ~ Must provide a BAA..Just having HIPAA compliant standards is not enough. ~ Video (required for insurance reimbursement) ~ As of 2017 some companies which offer this service include… ~ Vsee ~ Thera-link ~ Luxsci ~ Email ~ SMS/Chat programs Choosing the Format for Your Website ~ WordPress ~ Blog type format ~ Easily updated ~ Very little programming knowledge needed ~ Purchase pre-constructed themes ~ HTML ~ Purchase pre-constructed themes ~ Cannot be updated on the fly (static presence) ~ Must use software on your computer or login to the website host to modify your website Site Development ~ Keep it clean. Less is more ~ Review other well ranked similar sites for ideas ~ Use relevant (optimized) pictures ~ Pay attention to the tone your colors set ~ Get 3 friends to review ~ Target visual zones using the 1-Mississippi test ~ Figure out what your customers want and ask your beta testers to find it Required Content ~ Home page (your “lobby”) ~ About Us ~ Why would a client want to choose you ~ What is your approach ~ Hours and location (link to Google, yahoo maps) ~ Services and Fees ~ What you offer ~ Cost of services ~ Insurances accepted (in or out of network) Content cont… ~ Policies ~ Informed consent ~ HIPPA/HITECH policies ~ Emergency after-hours number and/or procedure ~ Contact us ~ Phone number ~ Secure email form (with disclaimer) ~ Mailing and physical address Content cont… ~ General information and articles ~ Provide useful content ~ Become an affiliate of companies who offer related products (books, biofeedback devices, essential oils…) ~ Use descriptive links to direct people to useful self-help and support websites SEO Optimization ~ Page key word density ~ Pay attention to current search engine optimization trends (i.e. what Google, yahoo and other search engines like and don’t like) ~ Don’t gray out a list of random key words ~ Try to focus on less than 30 key words ~ Use metatags and descriptions. ~ Google “keyword selector” or “Keyword picker” to find current tools ~ Pay attention to page titles ~ Provide frequently updated, relevant, UNIQUE content SEO Cont. ~ For more information ~ https://moz.com/beginners-guide-to-seo ~ Google “overview SEO” for the most up to date articles ~ Hire a consultant Marketing ~ Twitter ~ Instagram ~ Pinterest ~ Google AdWords ~ Facebook Advertising ~ Facebook Page ~ Facebook Group ~ United Way Information and Referral ~ Specialty Organizations (PTSD, Addiction, etc) ~ Psychology Today Payment ~ Paypal ~ Invoice ~ Prior to purchase ~ Credit Cards ~ Merchant Accounts (Stripe, Autorize.net, etc) ~ Paypal ~ Insurance ~ In Network ~ Out of Network

Improving Cultural Competence SAMHSA TIP 59 Part 3 Instructor: Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Executive Director: AllCEUs.com Counselor education Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery Objectives ~ Review elements which constitute a culture ~ Define and explore the drug culture ~ Define and explore the recovery culture for addictions ~ 12-Step ~ SMART ~ Celebrate Recovery ~ Define and explore the culture of Mental Health Recovery ~ Theorize about the struggles clients experience when becoming acculturated to the recovery culture ~ Hypothesize interventions and methods which can help clients embrace the recovery culture   Worldview, Values, and Traditions ~ Culture can be seen as ~ A frame through which one looks at the world ~ A repertoire of beliefs and practices that can be used as needed ~ A narrative or story explaining who people are and why they do what they do ~ A set of instructions defining different aspects of values and traditions ~ A series of boundaries that use values and traditions to delineate one group of people from another Continuum of Cultural Competence ~ Stage 1. Cultural Destructiveness ~ Organizational and Individual Level: Negates the relevance of culture in the delivery of behavioral health services, holding a myopic view of “effective” treatment. (Abstinence, Harm Reduction, Happiness) ~ Stage 2. Cultural Incapacity ~ Organizational and Individual Level: Expects clients to conform to generalized services. Ignores the relevance of culture while using the dominant client population and/or culture as the norm for assessment, treatment planning, and determination of services. (Therapy Groups, 12-Step Based Treatment) Continuum cont… ~ Stage 3. Cultural Blindness ~ Organizational and Individual Level: At this stage, counselors uphold the belief that there are no essential differences among individuals across cultural groups—that everyone has trauma, mood, self-esteem and coping deficits which are causing the current state ~ Stage 4. Cultural Precompetence ~ Organizational Level: Have a basic understanding of and appreciation for the importance of sociocultural factors in the delivery of care. Counselors acknowledge a need for more training specific to the populations they serve. Continuum cont… ~ Stage 5. Cultural Competence and Proficiency ~ Organizational Level: Organizations are aware of the importance of integrating services that are congruent with diverse populations. Recognize the vital need to adopt culturally responsive practices. Cultural Identity ~ Cultural identity describes an individual's affiliation or identification with a particular group or groups. ~ Cultural identity arises through the interaction of individuals and culture(s) over the life cycle. ~ Cultural identities are not static; they develop and change across stages of the life cycle. ~ People reevaluate their cultural identities and sometimes resist, rebel, or reformulate them over time. (Remember High School; Midlife “crisis”) Acculturation ~ There are many forces at work that pressure a person to alter his or her cultural identity to conform to the mainstream culture's concept of a “proper” identity. ~ People may feel conflicted about their identities—wanting to fit in with the mainstream culture while also wanting to retain the values of their culture of origin. (Religion) ~ Sorting through these conflicting cultural expectations and forging a comfortable identity can be an important part of the recovery process ~ Many studies have found that increased acculturation are associated with higher rates of substance use disorders and mental health issues Culturally Responsive Practice ~ Culturally re

Improving Cultural Competence SAMHSA TIP 59 Part 2 Instructor: Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Executive Director: AllCEUs.com Counselor education Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery Objectives ~ Define “Clinical Worldview” ~ Discuss how clinical worldview impacts treatment, case formulation and rapport development ~ Explore questions to consider when developing the case formulation and treatment plan ~ Learn how mapping the client’s cultural views and influences can help clinicians (and clients) develop insights into current struggles and clarify culturally relevant goals Worldview: The cultural lens of counseling ~ The term “worldview” refers to a set of assumptions that guide how one sees, thinks about, experiences, and interprets the world. ~ Shaped by significant relationships, the individual's environment and life experiences ~ Influences ~ Values, attitudes, beliefs, and behaviors ~ Concept of time ~ Definition of family ~ Organization of priorities and responsibilities ~ Orientation to self/ family/community ~ Religious or spiritual beliefs ~ Ideas about success ~ Etc. Clinical World View ~ Influenced by education, clinical training, and work experiences ~ Counseling culture reflects ~ Counseling theories (Psychoanalytic, Humanistic, CBT) ~ Techniques and modalities (Individual, group, TAC) ~ General office practices. (Privacy, punctuality, Assessment/Intake) ~ This worldview and their personal cultural worldview shapes the counselor's beliefs pertaining to: ~ The nature of wellness, illness, and healing ~ Interviewing skills and behavior ~ Diagnostic impressions and prognosis. Clinical World View ~ This worldview, coupled with their personal cultural worldview, ~ It influences ~ the definition of normal versus abnormal behavior ~ the determination of treatment priorities ~ the means of intervention ~ the definitions of successful outcomes Cultural Awareness and Nonmalfeasance ~ Counselors must engage in self-exploration, critical thinking, and clinical supervision to understand ~ their clinical abilities and limitations regarding the services that they are able to provide, ~ the populations that they can serve ~ the treatment issues that they have sufficient training to address. ~ Cultural competence requires an ability to assess accurately one's clinical and cultural limitations, skills, and expertise. ~ Counselors risk providing services beyond their expertise if they lack awareness and knowledge of the influence of cultural groups on client–counselor relationships, clinical presentation, and the treatment process or if they minimize, ignore, or avoid viewing treatment in a cultural context. ~ Tennessee House Bill 1840 LEARN at Intake ~ Listen to each client from his or her cultural perspective, including perception of the problem and treatment preferences ~ Explain the overall purpose of the interview and intake process. ~ Acknowledge client concerns and discuss the probable differences between you and your clients. Take time to understand each client's explanatory model of illness and health. ~ Recommend a course of action through collaboration with the client including how much involvement he or she has in the planning process ~ Negotiate a treatment plan that weaves the client's cultural norms and lifeways into treatment goals, objectives, and steps. RESPECT Clients ~ Respect—Understand and reflect how respect is shown within given cultural groups through verbal and nonverbal communications. ~ Explanatory model—Devote to understanding how clients perceive their presenting problems issues, their origin, impact and treatment ~ Sociocu