The Whole Armor of God

Finally, my brethren, be strong in the Lord and in the power of His might.
Put on the whole armor of God, that you may be able to stand against the wiles of the devil.
For we do not wrestle against flesh and blood, but against principalities, against powers, against the rulers of the darkness of this age, against spiritual hosts of wickedness in the heavenly places.
Therefore take up the whole armor of God, that you may be able to withstand in the evil day, and having done all, to stand.
Stand therefore, having girded your waist with truth, having put on the breastplate of righteousness, and having shod your feet with the preparation of the gospel of peace;
above all, taking the shield of faith with which you will be able to quench all the fiery darts of the wicked one.
And take the helmet of salvation, and the sword of the Spirit, which is the word of God, praying always with all prayer and supplication in the Spirit, being watchful to this end with all perseverance and supplication for all the saints --
and for me, that utterance may be given to me, that I may open my mouth boldly to make known the mystery of the gospel, for which I am an ambassador in chains;
that in it I may speak boldly, as I ought to speak.

Ephesians 6:10-20

A Look Back to Early Pregnancy

I am in my 27th week of pregnancy, but 26 weeks pregnant.
I am at a point in my pregnancy where I have the energy, motivation, and desire to do. Yes!

Taking a look back at the first trimester...
The first 12-15 weeks of my pregnancy, I experienced sickness that is incorrectly identified as "morning sickness."
Whoever created the term, "morning sickness" is continuing to mislead newly pregnant women.
The sickness should be called, "all day, anytime, even when you sleep sickness."
With this new term, women will know what to expect and will adjust much faster than the confusing term known as, "morning sickness." 
Moving on from the "sickness," my level of energy decreased as well.
I can recall going to my car to escape my internship and take a nap for 15-20 minutes so that I would have the energy to listen to people.
Balancing my internship, with graduate classes, newly married, living thousands of miles from my closest friends and family, adjusting to the "California culture" required more energy than my body was exerting during this time.
But as always, with strength from God and the support of family and friends, I managed to get through that time.

MOOD SWINGS! Okay, okay, okay, OKAY. I know I already have mood swings, hence the name of my blog.
However, the hormones produced during pregnancy are indescribable! Just ask my husband :-) Kristine and Mother, I think of you whenever one of these "pregnancy mood swings" sneaks up!

~ Miss Moody

It's been a minute.

Today is Martin Luther King, Jr Day.
MLK Jr quote:

"I refuse to accept the view that mankind is so tragically bound 

to the starless midnight of racism and war that 

the bright daybreak of peace and brotherhood can never become a reality... 

I believe that unarmed truth and unconditional love will have the final word."

I think it is important to know and understand what happened in the past, before we can truly live in the future. 

Knowledge is understanding.

When you know better, you do better. ~ Maya Angelou 

~ Miss Moody

Day Four: Counseling Grieving Children and Adolescents

"Often times children are the ones getting left behind." 

~ Mary Pat Warner, MFT 

Picture Info

 Children grieve differently than adults

• Experience of grief depends on cognitive development
• Children act more than speak
• Children mourn in "doses" - they do not grieve in predictable patterns or stages
• Children are at the mercy of those around them for care
• Children, particularly teens, may resist open mourning because they do not want to be different from their peers

Six manifestations of grief in children

1. Physical
2. Emotional
3. Mental
4. Social and Familial
5. Behavioral
6. Spiritual and Existential

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Infants are NOT to young to grieve

• Infants detect changes in emotional atmosphere 
• Infants can recognize the absence of a family presence
• Infants experience insecurity - they protest - changes in sleeping and eating - regressive behavior - apathy, detachment, and withdrawal

Children Age 2-5 years

• May seem unaffected by news of death
• Approach and avoid 
• Perceive death as temporary and reversible
• Magical Thinking
• Somatic complaints

Children Age 6-9 years

• Approach and avoid
• Better understanding of permanence of death
• Difficulty expressing and answering questions
• Strongly attuned to emotional state of key adults
• Fear of other attachment figures dying
• School phobias and separation anxiety
• Parentification

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Children Age 10-12 years

• Good understanding of permanence
• School phobias and separation anxiety
• Somatic complaints
• May stop expressing grief to "protect" others or appear "in control"
• Tend to identify strongly with deceased and adopt their habits, mannerisms, and interests
• Grief complicated by puberty
• Parentification

Adolescents

Picture Info

• Complicated by challenges of adolescence
• Ability to think abstractly allows for greater understanding of death and spiritual issues
• Fear of unknown mortality
• Risk of developing maladaptive behaviors to self-soothe
• Decrease in school performance
• May experience depression, guilt, and concerns about things said or unsaid
• Anger, tantrums, defiance, and withdrawal
• Parentification

Six Reconciliation Needs of Children

1. Acknowledge the reality of the death
2. Move toward the pain of the loss while being nurtured physically, emotionally, and spiritually.
3. Convert the relationship with the person who has died; from the one of presence to the one of memory
4. Develop new identity without the person who died
5. Relate the experience of death to a context of meaning
6. Experience a continued supportive adult presence in future years

Helpful Hints

• Accept all feelings and emotions
• Careful not to judge or criticize
• Provide safe place
• Reassure death is not their fault
• Be open about the grief process
• Communicate with children about death - differentiate between sickness and terminal illness
• Avoid euphemisms like: "Eternal rest" or "Rest In Peace" or "Went Away"

Recommended Reading List from Bo's Place Website:

Professionals:

• Children and Grief: When a Parent Dies by J. William Worden
• Companioning the Bereaved: A Soulful Guide for Counselors & Caregivers by Alan D. Wolfelt
• Grief as a Family Process: A Developmental Approach to Clinical Practice by Ester R. Shapiro

Adults:

• Guiding Your Child Through Grief by James P. Emswiler and Mary Ann Emswiler
• Healing Your Grieving Heart by Alan D. Wolfelt
• Healing a Child’s Grieving Heart by Alan D. Wolfelt
• Understanding Your Grief: Ten Essential Touchstones for Finding Hope and Healing Your Heart by Alan D. Wolfelt

Grieving Children:

• Don't Despair on Thursdays!: The Children's Grief-Management Book (The Emotional Impact Series) by Adolph Moser (Author) and David Melton (Illustrator)
• The Fall of Freddie the Leaf by Leo Buscaglia
• Healing Your Grieving Heart: For Kids by Alan D. Wolfelt
• How I Feel: A Coloring Book for Grieving Children by Alan D. Woolfelt, Ph.d
• Lifetimes: The Beautiful Way to Explain Death to Children by Bryan Mellonie (Author) and Robert Ingpen (Illustrator)
• Sad Isn't Bad: A Good-Grief Guidebook for Kids Dealing With Loss (Elf-Help Books for Kids) by Michaelene Mundy (Author) and R. W. Alley (Illustrator)
• Tear Soup by Pat Schweibert, and Chuck DeKlyen, Illustrated by Taylor Bills
• When Dinosaurs Die: A Guide to Understanding Death by Laurie Krasny Brown and Marc Brown
• When Someone Dies by Sharon Greenlee

Grieving Teens:

• Fire in My Heart, Ice in My Veins: A Journal for Teenagers Experiencing a Loss by Enid Samuel Traisman, MSW
• You Are Not Alone: Teens Talk about Life after the Loss of a Parent by Lynne B. Hughes
• Healing Your Grieving Heart: For Teens: by Alan D. Wolfelt, Phd
• Straight Talks About Death for Teenagers: How to Cope with Losing Someone You Love by Earl A. Grollman

Dignity Therapy - Day Three

On the afternoon of day three, a psychologist that works at my internship site introduced a new therapy called Dignity Therapy. I will get into the nuts and bolts of Dignity Therapy, but before I do, I was amazed to learn that San Diego Hospice is the only hospice in the United States using Dignity Therapy. Wow! What are the odds, right? My internship site - again, I felt incredibly grateful and humbled to be training and working at such comprehensive site. One of the major themes with Dignity Therapy is how to help patients "die with dignity?"

Picture Info

Dr. Harvey Chochinov, University of Manitoba

• originator of Dignity Therapy
• Professor of Psychiatry
• Palliative Researcher since 1990
• Fellow of the Royal Society of Canada
• For more information on Dr. Chochinov 

Dignity Therapy

• Novel Intervention
• Psychosocial and existential distress at the end of life
• Palliative care patients
• Brief, individualized psychotherapy for adults
• Provides a Life Review
• Four Sessions
1. Consultation
2. Life Review
3. Editing Session
4. Final Review

 For more detailed information on Dignity Therapy, please click here for the journal article.

Day Three: Nice to meet you, Shaag Mr Socs!

When I decided to embark on a master's degree in counseling, the idea of law and ethics being a part of the curriculum or my career did not exist. I did not consider how much legal and ethical issues are intertwined in the career of counseling. Of course I was aware of confidentiality and HIPAA, but there was so much more to learn about law and ethics in counseling. My graduate class in Law and Ethics was amazing! I began to see how important it is for me to know certain court cases and statutes. Recently, in my third day of training at my internship, my knowledge of law and ethics expanded, as I began to see how each state has certain codes that I need to know as well.

SHAAG MR SOCS is an acronym used to help remember the important legal and ethical concepts in counseling. So, what does it stand for?

• S - Self Harm and Suicide
• H - Harm to Others
• A - Abuse of Person
• A - Abuse of Substances
• G - Gravely Disabled
• M - Minors
• R - Releases
• S - Scope
• O - Office Policy
• C - Confidentiality
• S - Special Considerations

If you notice, the terms in blue are crisis issues, the terms in green are legal and ethical issues, and the terms in red are ethical issues.

Self Harm and Suicide

• Confidentiality - one of the ways confidentiality can be broken is through suicide
• Standard of Care - defined retroactively by a judge - think about would everyone (counselors) be doing the same thing? Be consistent with counseling services. Be aware of the SOC for your scope of practice.
• Documentation - document what you do and what you don't do. Document, Document, Document

Picture Info

• Assessment of Suicide Ideation - signs of depression, anxiety, impulsively, insomnia, substance abuse, hopelessness, aggression, anhedonia, ambivalence - Is there a pre-existing psychiatric diagnosis? Past suicide attempt? What are the precipitants? What is the timing? Consequences and medical severity? Are significant others involved? What is the client's assessment of past attempts? Is there past psychiatric treatment? Past relationship with therapist? Medical history? Family history? Strengths and vulnerabilities? Current stressors - are they acute or chronic? Use direct questions - Do you want to be dead or do you want your life to be better?
• Questions about the SI - Nature. Frequency. Timing. Extent: Specific Plan. Interpersonal relationships and situational context.
• Questions about the plan - Is there a plan? Conditional? Is there intent? Is there a means? Is there a time line? 
• Assess degree of severity - motivation? seriousness? lethality?
• Protective factors - what keeps people alive? Children in the home. Responsibility to family. Pregnancy. Religious. Life Satisfaction. Reality testing. Coping Skills. Problem Solving. Social Support. Strong Therapeutic Relationship.

Harm To Others

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• Duty to Warn and Protect: "Tarasoff" Client directly reports to the therapist a serious threat of physical violence against a reasonably  identifiable victim.
• CA Civil Code Section 43.92  
• Ewing I and Ewing II (Dr. Goldstein) - Court of Appeal, 2nd District - Communication from family is considered patient communication. 

Abuse of Person

Picture Info

• Reasonable Suspicion
• CPS - Child Protective Services - remember time line to immediately call and write a written report within 36 hours California CPS

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• APS - Adult Protective Services - goal is to keep family together because the family may be unaware what constitutes elder abuse (i.e., isolation; cultural differences) - remember time line to immediately call and 2 working days for written report - Elder Abuse: 18-64 years old with disability or 65 years and older. California APS

Abuse of Substances 

• Assess...assess...assess...always!

Gravely Disabled

• Person who, as the result of mental disorder, is unable to provide his or her basic needs.

Minors

• Parental Consent
• Caregiver Consent
• Minor Consent
• Minors can seek treatment without parental consent if: they are at least 12 years old, victims of abuse, there is potential for harm if counseling is not offered, they are an emancipated minor that is established through the court - 14yrs old - military service - legally married
• Document attempt to get parental consent

Releases

• Always obtain release of confidential information when clients are receiving treatment from another mental health provider

Scope

• Practice
• Agency
• Competency - education, training, and supervision 

Office Policy

• Fees
• Parking
• Cancellations
• Scheduling
• Informed Consent
• Availability

Confidentiality

• Ethical concept
• Be aware of the Patriot Act 2001 and Renewal 2006

Special Considerations

• Culture
• Countertransference
• Dual Relationships
• Sex with Clients
• Boundaries
• Self-Care

Picture Info

HIPPA

• Confidentiality - ethical
• Privilege - legal - no one can disclose confidential information without the client's expressed permission

Ethical Principles

• Fidelity - faithfulness - duty to relationship
• Autonomy - allowing the client to make their own decision
• Beneficence - do good - never harm client intentionally
• Ethical Obligations 
• Provide safety
• Obtain informed consent
• Determine level of care
• Scope of practice
• Countertransference 

Principle of Double Effect

• Bioethical principle
• Therapy can have good and bad effects
• Intent is for the good effect 

5Ws

 

                                             

Who: The Center for Grief Care and Education (CGCE) at The Institute for Palliative Medicine (San Diego Hospice)

What: CGCE is a clinical training and internship program that offers comprehensive training in grief and loss counseling. Grief care is offered to patients and families before and after death in the form of assessments, counseling (adults, children, adolescents, families, and groups), and outreach services. CGCE provides more than 60 hours of training, continuing education, three hours of weekly supervision, and other opportunities such as expressive arts and play therapy training.

When: Internship opportunities are offered throughout the year beginning in April and July for one year. My internship opportunity began in July 2010 and will end August 2011.

 

 

                                                              

Where: Counseling services are offered in the homes of patients and offices in the San Diego area of California.
 






Why: As a requirement of the M.A. in Community Counseling, I am required to complete a one year clinical internship.

 









For more information, please check out the following links:
San Diego Hospice
The Center for Grief Care and Education