Psychotherapy

Clinical psychology is just one of several subdivisions of psychology, focusing on mental disorders and emotional instabilities. A clinical psychologist prevents, evaluates, and treats these problems in individuals.

Clinical psychology is an important profession nowadays. Looking back, the thought of school shootings were unthinkable. Back then, the children who exhibited severe emotional/mental problems were identified and referred to for help. Now they are ignored until they come to school with guns and kill people. Then, instead of being seen as a mental health problem, it becomes a legal problem.

Unfortunately, it’s become quite difficult to prosper in this profession. Managed care has cut reimbursement for psychology to such an extent that private practice is becoming almost unfeasable. It is possible, though. Depending on the state, there are licensing requirements. Here in Ohio, that means taking a rigorous exam, and having the educational and supervisory requirements. For instance, one will need a Ph.D. and one year of supervised experience before being able to even sit for the exam. It’s difficult to receive a Ph.D. One must graduate college with virtually straight A’s, and then it’s 4-6 years of graduate school. Once the person is fianlly licensed, they can set up their practice.

The Federal Government recognizes education and experience in certifying applicants for entry-level positions. In general, the starting salary for psychologists having a bachelor’s degree was about $20,600 in 1999; those with superior academic records could begin at $25,500. Psychologists with a master’s degree and 1 year of experience could start at $31,200 . Psychologists having a Ph.D. or Psy.D. degree and 1 year of internship could start at $37,800, and some individuals with experience could start at $45,200. Beginning salaries were slightly higher in selected areas of the country where the prevailing local pay level was higher. The average annual salary for psychologists in the Federal Government was $66,800 in early 1999.

The working conditions for a clinical psychologist is the same as a psychologist in any other field of study. Clinical psychologists work in comfortable office settings, classrooms, or laboratories. Some that are in a private practice choose to set their own hours, but may have to work evenings and weekends to accommodate client schedules. For clinical psychologists that teach at places of education, they might divide their time between teaching, research, and administrative responsibilities.

The types of jobs available are working in counseling centers, independent or group practices, hospitals, or clinics. As you can see, there’s a wide variety of places to work, it’s based on the person’s preference.

In conclusion, clinical psychologists might have a rough time making it to the top, but once they do, it’ll be worthwhile in both pay and experience.

There are many models that provide healthcare professionals with a filter in how they view and asses occupational challenges that individuals encounter. The occupational adaptation (OA) model is based on the assumption that the more adaptable an individual is, in an ever-changing environment, the more functional they become (Schultz, 2014).

This assumption is what separates the OA model from other models (Schultz, 2014). The person-environment-occupation (PEO) model, for example, typically assesses environmental barriers which impede an individual’s functional performance and make modifications to the environment to improve occupational performance (Brown, 2014).

While the PEO model is successful in promoting the best fit between an individual, their environment, and their occupation (Brown, 2014), other healthcare professionals find success through the use of the OA model by promoting adaptability within the environment (Schultz, 2014).

History of Occupational Adaptation

The theory of occupational adaptation was developed by Janette Schkade and Sally Schultz in 1992 at Texas Woman’s University (Schultz, 2014). Schkade and Schultz were part of the faculty who was challenged by the dean of the program at Texas Woman’s University to develop a Ph.D. program in occupational therapy (Schultz, 2014).

It was agreed upon that occupation and adaptation were important concepts of occupational therapy (Schultz, 2014). When the Ph.D. program was established, occupational adaptation was foundational to their philosophy and research (Schultz, 2014). The focus of the theory of occupational adaptation is to enhance overall performance (Schultz, 2014). By developing this theory, Schkade and Schultz’s goal was to develop adaptive skills and successfully achieve personal adaptation. Furthermore, the theory of occupational adaptation is based on the relationship between occupational performance and human adaptation (Schultz, 2014).

Occupational Adaptation Theory

Occupational performance is defined as having the ability to carry out roles, routines, and tasks in response to demands of the environment (Ranka, J., & Chapparo, C. 1997). The OA theory emphasizes the influence of the interaction between the environment and an individual on occupational performance (Schultz, 2014).

Schkade and Schultz found that the more adaptive a person becomes, the more functional they are which improves overall occupational performance. Personal adaptation is defined as an ongoing change of order and disorder, and reorganization (Schultz, 2014). The environment is an area that is largely out of one’s control; to be functional in an ever-changing area, it is best to adjust to the given circumstance (Schultz, 2014). Schematic Schkade, J. K., ; Schultz, S. (1992)

Occupational Adaptation Process Model

In the occupational adaptation process model by Schkade ; Schultz (1992), the person is influenced by internal factors which demand adaptation and create a desire for mastery. An individual’s internal factors are influenced by the sensorimotor, cognitive, and psychosocial systems (Schultz, 2014). These systems are responsible for responses to the environment and challenges (Schultz, 2014).

The occupational environment poses external factors in which an individual’s roles and occupations take place (Schultz, 2014). The occupational environment creates a demand for mastery and is strongly associated with a person’s physical, social, and cultural background (Schultz, 2014). External factors largely affect an individual’s response and ability to adapt (Schultz, 2014). Through occupation, there is constant interaction between an individual and the occupational environment (Schultz, 2014).

Due to the consistent interaction between a person and his or her environment, occupational challenges arise and a press for mastery is created (Schultz, 2014). The occupational role expectation is contingent upon the environment and demands for adaptation in response to the occupational challenge (Schultz, 2014). When an individual adapts to changes in the environment, this is called the “occupational response” (Schultz, 2014).

Role of Occupational Therapist

The theory of occupational adaptation focuses on developing an individual’s adaptive skills through therapeutic use of occupation (Schultz, 2014). The therapeutic use of occupation uses occupational activities to promote the desire to adapt and succeed (Schultz, 2014). The techniques that are used to promote the desire to adapt are crucial for success or otherwise could provide the opposite results and inhibit the desire to adapt (Schultz, 2014).

Interferences that often impede an individual’s success are poor approach, repetition of ineffective exercises, depression, and frustration (Schultz, 2014). Therapists should grade activities using the “just right” approach so that a person feels successful, but is still challenged (Schultz, 2014). While some interferences can be overcome for success, deficits in sensorimotor, cognitive, and psychosocial systems place significant limitations on an individual’s ability to respond with adaptations (Schultz, 2014). The role of the therapist is not to take away a person’s challenges, but to help them to discover their ability to adapt (Schultz, 2014).

Application to Occupational Therapy

This theory can be successfully applied in intervention in schools, home care, inpatient and outpatient rehabilitation, and mental health (Schultz, 2014). Thus, there is a wide variety of individuals that could benefit from this model including children, people who have had strokes, post-surgery or injured patients, individuals with dementia, and caregivers (Schultz, 2014).

People who have had strokes, specifically, have been successful with this model because of the structure and focus that it provides (Schultz, 2014). Therapists have guided these patients using this model by providing adaptive strategies for their new roles (Schultz, 2014). Therapists have also found success using this model in rehabilitation interventions (Schultz, 2014).

Whether it is post-surgery or injury, therapists have found that their patients are more successful and engaged when the intervention plan includes strategies of adaptation within their daily occupational role (Schultz, 2014). In schools, this model has been successful when paired with the occupation of reading model for children who experience difficulty reading (Schultz, 2014).

The OA model was used to engage children in meaningful reading activities where they feel confident and successful (Schultz, 2014). Therapists found that when adjusting the reading level, children experienced relative mastery (Schultz, 2014). While the goal of most intervention is improved performance, the OA model focuses on promoting adaptability, which improves overall performance (Schultz, 2014).

Conclusion

The ecological model is similar to the OA model in that they both emphasize the influence that the environment has on an individual’s occupational performance (Schultz, 2014; Brown, 2014). While the OA model focuses on the importance of adaptability within the environment (Schultz, 2014), the ecological model focuses on modifying the environment for optimal performance (Brown, 2014).

The person-environment-occupation (PEO) model, specifically, relates function or dysfunction to a person’s fit to the environment (Brown, 2014). Dysfunction, according to the PEO model, is due to a poor person-environment fit and can be rectified by changing the environment (Brown, 2014).

The PEO model is based on the idea that therapists should focus on changing the environment to enhance performance rather than changing the individual (Brown, 2014). Consequently, an individual’s occupational success is then limited to the confines of the environment that has been adjusted to their capabilities (Schultz, 2014).

For example, a child that has difficulty attending to tasks in a loud room: changing the individual’s environment to a quiet room would result in improved occupational performance, but the child is then limited to functional performance within the means of a quiet environment. The OA model adequately prepares a person for an ever-changing environment that they can adapt to, therefore their occupations are not limited to one environment (Schultz, 2014).

For example, a child that has difficulty attending to tasks in a loud room: a child that is guided on how to adapt in a loud environment through the use of headphones will then be able to apply their new found adaptive skills in other environments. The OA model differs from other models through collaboration with the person and by instilling confidence as well as empowering them with skills that can be applied throughout all of their occupations (Schultz, 2014).

I feel most aligned with the OA model because it focuses on life skills that are important to be successful throughout life (Schultz, 2014). The OA model is limitless in the population and settings that it can be applied in, which creates stability and structure to help people thrive (Schultz, 2014). In an ever-changing environment that is inevitable, the OA model provides the necessary structure and guidance to function throughout life (Schultz, 2014).

References

• Brown, C. (2014). Ecological Models in Occupational Therapy. In Willard and Spackman’s Occupational Therapy (12th ed., pp. 494-504). Philadelphia: Lippincott Williams & Wilkins.
• Model of occupational adaptation process. (1992). In Occupational adaptation: Toward a holistic approach to contemporary practice (Part 1).
• American Journal of Occupational Therapy. Retrieved September 20, 2018, from https://ajot.aota.org/article.aspx?articleid=1875314.
• Ranka, J., & Chapparo, C. (1997). Occupational Performance Model (Australia). Retrieved September 1, 2018, from http://www.occupationalperformance.com/definitions/
• Schkade, J. K., & Schultz, S. (1992). Occupational adaptation: Toward a holistic approach to contemporary practice, Part 1. American Journal of Occupational Therapy, 46, 829-837. doi:10.5014/ajot.46.9.829
• Schultz, S. W. (2014). Theory of Occupational Adaptation. In Willard and Spackman’s Occupational Therapy (12th ed., pp. 527-540). Philadelphia: Lippincott Williams ; Wilkins.
• Schultz, S. , ; Schkade, J. K. (1992). Occupational adaptation: Toward a holistic approach to contemporary practice, Part 2. American Journal of Occupational Therapy, 46, 917-926. doi:10.5014/ajot.46.10.917

We must limit the number of young children who are administered antidepressants, as we do not have sufficient, if any, data regarding the effects of these drugs on the developing brain. Greater involvement from parents, teachers, ministers, and friends, as well as counseling and psychotherapy must all be used extensively before turning to the “quick fix” of antidepressants.

In the last ten years, the psychiatric field has been flooded with a new group of antidepressants known as Selective Serotonin Reuptake Inhibitors, or SSRIs. Michele Laraia defines an SSRI as “a group of compounds that block the reuptake of serotonin by the pre synaptic neuron” (6). By adjusting the level of serotonin, the mood-altering chemical which our body naturally creates, that reaches the brain, we can control the stability of a person’s mood.

Tania Unsworth writes that “almost 600,000 children and adolescents in the US were prescribed SSRI antidepressants in 1996” (1). A more alarming statistic, reported by Joseph Coyle, is that “there has been a 10-fold increase in the prescription of SSRIs in the US for children under 5 years old between 1993 and 1997” (1). Parents, teachers, and psychiatrists across the country seem a little too anxious to jump on the antidepressant bandwagon. Apparently, many people are willing to turn first to the quick fix of drugs rather than the more time consuming approach of counseling and psychotherapy, although these have proven to be much more effective in the long run (McDougle 1).

The most common reason for the prescription of an antidepressant is depression. Until about ten years ago, depression was thought to be nonexistent in children. Depression is now found, using the same criteria used for adults, to be unquestionably diagnosable in children (Fishbein 1). Joyce Price notes that “the American Academy of Child and Adolescent Psychiatry puts the number of significantly depressed children and adolescents at 3.4 million” (1). The consequences of depression for children include social dysfunction, academic underachievement, impaired self-image, and suicidal and anti-social behavior (Laraia 1).

Depression is also commonly linked to other problems such as conduct disorder, attention deficit disorder, and anxiety disorder. In a survey done by Judith Asch-Goodkin, she reports that “of over 600 physicians surveyed, more than half (57%) had prescribed an SSRI for a diagnosis other than depression” (1). In some cases, of course, medication is really necessary in order to correct a persisting disorder or complex which, if left untreated, would continue to grow. However, in young children, drug use should be reserved for a final remedy, and even then used with great moderation.

The problem with most prescriptions given to children is that these drugs are used simply as a quick fix. Claudia Kalb writes that “experts say frustrated parents, agitated day-care workers and 10-minute pediatric visits all contribute to quick fixes for emotional and behavioral problems” (1). Parents seem too eager to find an “excuse” for their child’s behavior. The easiest excuse for a parent to digest is the suggestion that their child has a natural chemical imbalance, correctable by medication. This helps to put the parents mind at ease, assuring them that it is not their fault. In most cases the parents are so relived to find out that their child’s condition is not their fault that they do not bother to look into other ways of helping their child; instead they put their trust in their doctor and do whatever he first suggests.

Of course, the scariest thing about giving an antidepressant to a child is that less than 20 percent of the drugs used in children have been tested on children (Price 2). As a matter of fact, none of the drugs which fall in the category of an SSRI have been tested on children. However, since the FDA has approved them for use in adults, doctors can legally prescribe them to children (Crowley 1). The courts have always left drug treatment to the physician’s “best judgment” (Fisher 1). In fact, Rhoda Fisher states that “prescribing physicians do not need any scientific proof that a particular drug is effective for the patient they have in mind to treat” (1).

In addition, general practitioners and pediatricians do not, for the most part, have the psychiatric knowledge necessary for the prescribing of antidepressants. Determining which medication to use and when to use it can be a confusing task for these doctors (McDougle 1). Without the proper education, prescribing an antidepressant can be a shot in the dark. Rebecca Voelker found in a study of over 600 family physicians and pediatricians that “72% had prescribed an SSRI for a patient younger than 18 years. Yet only 8% of the physicians said they had received adequate training in the management of childhood depression, and just 16% said they felt comfortable treating children for depression” (182). Surely some method of regulating which physicians can prescribe antidepressants can be established.

Furthermore, the vast majority of evidence, so far, suggests that antidepressants do not help childhood depression (Price 1). The body of a child grows far too rapidly for the drug level to remain constant in their body. Fisher goes on to put it more bluntly in saying that “in view of their negative side effects and clearly demonstrated lack of therapeutic effectiveness, it is inappropriate to treat the younger segment of the population with antidepressant medications” (2). Almost 80 percent of children who are put on medications were referred to doctors for school problems, yet antidepressants have been proven to be ineffective in treating school problems or nebulous behavior problems (Asch-Goodkin 1). Once again, another case where frustration in a child’s behavior is put above the child himself. A quick and easy answer to everything does not always exsist. With no empirical evidence to support drug treatment in young children, many could argue that it is not only dangerous but unethical as well.

Even in cases where medication is absolutely necessary, psychotherapy should always be a big part of the treatment. The goal of the medication should be to help the child learn to deal with their condition, hopefully drug-free at some point. Too many times the medication is used as the sole treatment. Christopher J. McDougle points out that ” the American Academy of Child and Adolescent Psychiatry, the AACAP, recommends psychotherapy as the initial treatment for mild to moderate depression” (1). He goes on to say that “the AACAP notes that SSRIs are never sufficient as the sole treatment” (2). It has been proven time and time again that most children are just reaching out and need an adult to show actual one-on-one attention to them. This is why psychotherapy is so very important. Children need that human contact.

Of course, the primary concern in treating children with antidepressants is that we have absolutely no data on how these drugs affect the long-term brain development (Kalb 2). We are shoveling pills into the mouths of little children whose bodies and minds are at the most sensitive stages of their development, and we do not even know how these drugs will affect that. The pharmaceutical companies remain as the major funding sources for the study of various drugs and their effects on the body (Allen 6). The problem is that the law only requires them to test the drugs on adults. After that, it is up to the physicians who prescribe them. Allen explains their lack of ambition in pursuing such tests by claiming that “there is little incentive for the industry to conduct premarketing or post-marketing controlled treatment trials in children, since they are very expensive and raise liability concerns” (6). What is the key word here? Money. The pharmaceutical companies are not willing to shell out the extra money no matter what the costs.

In his studies, McDougle found that “children and adolescents are more likely to have behavioral side effects; younger children being the most vulnerable” (5). Common side effects that are popular with younger patients are gastrointestinal distress, nausea, and anorexia (McDougle 3). Others common side effects are headaches, tremors, jitteriness, and nervousness (McDougle 3). Also, for some children hypomania, mania, and psychosis have all occurred (McDougle 4). On the other side of the mania disorders are the many different sleep disorders caused by these drugs. McDougle”s studies go on to show that “SSRIs, like virtually all antidepressants, alter sleep architecture, decreasing total sleep time, sleep efficiency, and the total duration of rapid-eye movement sleep” (3). The result of this is children who suffer daytime sedation, insomnia, and vivid, frightening dreams. In one of McDougle”s study groups, 42 percent had wild, vivid dreams that resulted in the subjects injuring themselves enough to require hospitalization (5).

Another concern, reported by Rhoda Fisher, is the scattered cases of children dying “suddenly and unexpectedly” (2). This may be linked to Serotonin Syndrome, a condition which can be derived from just one seronergic agent (McDougle 5). Children suffering from Serotonin Syndrome will experience fever, muscular rigidity, and a drastic mental status change. Also, they may be affected by hyper pyrexia (temperature above 105 degrees farenheight)mandating aggressive cooling, muscular paralysis, and intubation (McDougle 3).

The time has come when we must demand that the pharmaceutical companies, physicians, and psychiatrists be better regulated. The changes made would be minimal but their outcome would be incomparable to anything else. Certainly, we must protect the health and the rights of young people who may not be able to do so for themselves. Medication is just a part, and a small part at that, of the therapeutic process.

All options outside of medication should be thoroughly exercised before moving on to the next phase. Parents, teachers, and ministers must first do their part before recommending a child for professional care. After that, strict regulations must be put on doctors and psychiatrists to ensure that only those knowledgeable enough to prescribe antidepressants to children can do so. Furthermore, the pharmaceutical companies must be forced to test their products on any age group that might have access to these drugs. It is critical to the future of our society that we stop drugging are youth and look for more natural approaches.

Counseling children/adolescents can look very different than counseling adults due to many aspects. Adults have their way of life set In a way that Is hard to change as they get older, but kids are learning who they are and are more open to change. Children start their life depending on others as adults have learned how to live independently. Children and adolescents also cope with their hardships and do not realize that they need help as they have not learned who they can go to if they are having problems.

Counseling children/adolescents need certain training and skills to each a level of success that we are looking for in a session. The way of thinking for an adult and a child are deferent in so many ways. The adult brain in adults is fully developed and they are set in their ways that can be hard for a counselor to change. It is hard to transform an adult person when they have gone their whole dealing with issues In a way that may be harmful to themselves or others. Adults have gone their whole life learning who they can trust and who they cannot trust which makes It difficult for the counselor to gain that trust In an adult client.

Children have an easier time trusting as It often takes Just a few minutes to open up to a counselor. Changes in the brain structure and function occur during childhood and adolescence (Henderson & Thompson, 2010). Since their brain is still developing they have not learned their way of handling certain emotions as mentioned in Jean Piglet’s four stages of cognitive development. Counselors have to work In a different way when dealing with the thinking processes of adults versus children. Dependency changes to an independent frame of mind as a person gets older.

Kids depend on their parents for the basic needs as stated in Measles hierarchy of needs which are physiological needs, safety needs, love and belonging, self-esteem, and self- actualization. These needs must be met for us to become self-actualization and reach our full potential In all areas of development (Henderson ; Thompson, 2010). Adults that did not meet the lower level of physiological needs such as food, shelter, water, and warmth, may not have met their higher order needs such as self-esteem or love and belonging.

People that do not have their basic needs met when they ere younger, may have a hard time with their feelings about themselves or others later on in life. Adults realize that certain things in their lives are not going as they would like, so they wonder whether a counselor could help them. If they realize that they have a problem, they decide on their own to request a counseling session. Children however, never realize that they are having trouble and never think of asking their caregiver to request help for them.

Children live with their issues, no matter how serious they may be, and they don’t have the Ingenuity to go see a oneself. Instead, the parents or other people close to them notice something Is wrong. Counseling children that do not realize that they need help, makes It harder for the counselor to explain to the person why they are In the session. This can place. Adults usually go to counseling because they have made the choice to go there on their own. Having the client realize that they need help makes it easier on the counselor in the session, but this can come with some push back when dealing with children.

Counseling children can come with some adversities which unsolder new to the profession may not be ready for and lack the skills needed to take on these challenges. I feel that building a solid foundation with a kid is important early on in their counseling experience and I would like to learn more about strategies and conversations that would help build that relationship. I have built great relationships with my students at school, but that did take some time which I will not have that much time in a counseling session.

Having conversations about their troubles may be hard for a kid to put into works or expressions, so I need o learn how to have a conversation with a child that allows expressing their feelings. I would also like training on the legal issues on what needs to be reported to certain agencies so that I know what to legally do in certain situations. Kids these days are getting their hands on drugs that are new developed each day and I would like training on drugs that I need to be aware of so that I am keeping up with the latest drugs that a client may be trying out. In conclusion, counseling children and adults have their differences.

REACTION PAPER THE WOUNDED PLATOON Kevin Shields, a 24-year old Army Soldier, went out drinking with three Army buddies on November 30, 2007, from Fort Carson, Colorado, a base close to Colorado Springs. A few hours later, he was dead. He was shot twice in the head at close range and left by the side of the road by his army buddies. Shields’ violent murder accentuated one of many violent attacks committed by the three Army buddies, who are now serving time in prison for Shield’s death and other crimes as well.

Since the Iraq war began, a total of 18 soldiers from Fort Carson have been charged with or convicted of murder, manslaughter or attempted murder committed at home in the United States, and 36 Army soldiers have committed suicide. In the movie The Wounded Platoon, FRONTLINE investigate a single Fort Carson platoon of infantrymen, the 3rd Platoon, “Charlie Company” 1st Battalion, 506th Infantry, and finds that after a long period time away from home, serving their country, a group of young men changed by the war in Iraq and suffering from a range of psychiatric disorders that many blame for their violent and self-destructive behaviors.

Since returning from Iraq, three members of the 3rd Platoon have been convicted on murder or attempted murder charges; one was jailed for drunk driving and another for assaulting his spouse; and the other one has attempted suicide. They could not stop bragging about the amount of innocent people they have murdered and they have gotten away with it. “There’s a whole bunch of people in the unit that killed people they weren’t supposed to,” according to Bruce Bastien, who, along with Louis Bressler and Kenny Eastridge, is now serving time for the murder of Kevin Shields.

In a stunning confession recorded by police interviewers and shown for the first time on television, Mr. Bastien admits to his role in the murder of two U. S. soldiers and the stabbing of a young woman during a robbery in Colorado Springs, thefts and murders are being committed in our own backyard by our own Army soldiers whose work is to protect us and our country. Mr. Bastien also makes claims about more murders committed in Iraq during the surge. “It’s easy to get away with that kind of s**t over there. You can just do it and be like, ‘Oh, he had a gun,’ and nobody really looks into it. ‘F*** it, it’s just another dead

Haji. ‘” But that excuse did not go too well for them here. While the Army has concluded that there is no evidence to back up Bastien’s allegations of soldiers killing innocent Iraqis, PBS, Fontline also speaks with platoon member Jose Barco, who makes a similar claim. “We were pretty trigger-happy,” he says of the soldiers’ time in Iraq. “We’d open up on anything. We usually rolled three or four trucks, and if one of them got hit and there was any males around, we’d open up, and we’d shoot at them. They even didn’t have to be armed. ” They have extended their behaviors here at home and even turned on their own Army buddies.

ScienceDaily (Sept. 15, 209) The Veterans’ Administration should expect a high volume of Iraq veterans seeking treatment of post traumatic stress disorder, with researchers anticipating that the rate among armed forces will be as high as 35%, according to the Management Insights feature in the current issue of Management Science, the flagship journal of the Institute for Operations Research and the Management Sciences (INFORMS®). 35% of our soldiers suffer from PTSD. The VA system which is already experiencing significant delays for PTSD treatment provision, urgently needs to vamp up its mental health resource capacity.

Our soldiers are becoming mass murderers abroad and at home. Is it PTSD, boredom or just because they can get away with it? Anything less than manditory PTSD therapy upon return should be considered less than acceptable to the American public. We ask these personnel to put their ordinary lives on hold, commit unspeakable acts of valor and return to America without support and understanding. We can not begin to imagine the horrors these people have witnessed or experienced. With manitory treatment by psychotherapists, the stigma would be removed and maybe they would have a regained sense of morality. Being from N.

C. and witnessing the struggles of returning military personnel from wartime, we need to do so much more for them. This was an excellent film and is exactly what I expected from Frontline. No opinions or hidden agendas. Just the facts and the room for us to interpret. I think we need to step back and remove the original problem, which is waging illegal wars in other countries. We are sending our people in there to be damaged, then trying to “fix” them, most of the time so they can become functional enough to go back on a deployment and do violence upon others and be re-traumatized. That is insanity.

Did you notice how the assistant chief of staff to the army talks about the soldiers as though they are products or commodities to be shipped to the front based on “supply and demand? ” That is, indeed, exactly what they are. Just another pair of boots on the ground, just like any iraqi is “just another haji, like cattle or a dog. ” These soldiers are de-humanized in the same way they have de-humanized the alleged “enemy” and that may be the moral lesson for them all. This should give any person a lot of pause before they voluntarily (and remember everyone, it is voluntary) signs up for this irrational, cowardly work. This should give any person a lot of pause before they voluntarily (and remember everyone, it is voluntary) signs up for this irrational,cowardly work. ” You need to jump back with your bad self,you and like minded others are as much to blame as the incompetent system I’ve had to deal with because of my own issues,you reek of the snide arrogant sort who spend the day blaming America for every wrong in the world before going home to sleep at night under that blanket of safety provided by better men than you,the same men you call cowards.

You’re not fit to lick the mud off any of my brother’s boots What ‘blanket of safety’ did the War in Iraq provide for anyone? It was and is a complete disaster that has cost us over 4,000 soldiers lives and $1 trillion to US taxpayers. It was waged based on lies by ‘chicken hawks’, men like Dick Cheney who got 5 deferments when it was his turn to fight in Vietnam yet has no problem sending young American men and women to die for ‘weapons of mass destruction and liberating the Iraqi people. What a joke. The ‘support the troops’ campaign is nothing but a Pentagon marketing strategy to take the onus off of the government’s awful policies. If you really want to support the troops, look at the policies themselves and the terrible decision making that when into waging them and make sure it never happens again. We can support the troops by avoiding the needless deaths of 4,000 soldiers and the countless wounded. Thats real patriotism, saving American lives from needless death.

I’m sure many Americans are scared of the same thing happening to their soldiers coming home in their hometown who are now in Afghanistan. So far our media has not really made any connections between crimes at home and PTSD. It will only be time. I’m also sure that our Military is keeping quiet. Sending our young men into combat result to PTSD, Madness, and violence backhome. The VA will ne er have enough resources to take care of the broken minds and bodies that wars have created.

Collaboration implies working together for the greater good, but it actually encompasses far more. Several preconditions must be in place in order for collaboration to be successful. As a nurse in a health care setting, collaboration is very important to facilitate better patient outcomes. During my practice in the hospital communication is vital for collaborative nursing to be successful. Team work is the key for all staff member. Working together requires communication. As healthcare professionals, we need to look at the whole picture and meet all of the needs of our patients.

As nurses, it is essential that we give up some power and trust that other members of the team are just as important in providing comprehensive, quality care. With that in mind, we will always do what is best for our patients, even when that means relinquishing some control. In my experience I rely on the nursing aids as my eyes and ears because they are in the frontline but maintaining professional roles. In the role of teacher, I am frequently asked health, medication and growth and development questions.

He or she also often provides additional details on a diagnosis not quite understood by patient or family members, the nurse helps clients learn about their health and the health care procedures they need to perform to restore or maintain their health. I assess the client’s learning needs and readiness to learn, sets specific learning goals in conjunction with the client, enacts teaching strategies and measures learning. Another form of role is a Nurse educator, combine clinical expertise and a passion for teaching into rich and rewarding careers.

These professionals, who work in the classroom and the practice setting, are responsible for preparing and mentoring current and future generations of nurses. I have been in the academe for 4 years as a Nurse educators I have a pivotal role in strengthening the nursing workforce, serving as role models and providing the leadership needed to implement evidence-based practice. As a nurse educator I express a high degree of satisfaction with my work. Watching future nurses grow in confidence and skill as the most rewarding aspects of this job. The nurse is a caregiver first and foremost.

Nurse Caregiver is the one who give love and care to the people that need someone that can care not only physical and also the emotional and also the love that needed of the people with special needs and also to the aged person. I can definitely relate to this role because I have been a care giver before and it gives me much fulfillment as a nurse to see someone smiles and give gratitude for the tender loving care that you give them. Counselling is a process of helping a client to recognize and cope with stressful psychological or social problems, to developed improved interpersonal relationships, and to promote personal growth.

It involves providing emotional, intellectual, and psychological support. In my practice as a nurse I encountered lots of situation wherein a patient or family member needed counselling regarding health related issues. As a counsellor I give information regarding their health related issues and assess how effective are the patient coping with it, based on my assessment that I patterned my intervention. Sometimes the nurse must serve as patient advocate in helping loved ones make difficult decisions. Providing education and detailed information regarding treatment options is only the beginning.

The nurse asks for input from patient and families. That, in addition, to his/her own observations about each patient – and the knowledge from caring for hundreds of other patients – allows the nurse to best create an individualized care plan. As a Client advocate I acts to protect the client. In this role the nurse i represent the client’s needs and wishes to other health professionals, such as relaying the client’s wishes for information to the physician. I also assist clients in exercising their rights and help them speak up for themselves. Communication is an integral to all nursing roles.

Nurses communicate with the client, support persons, other health professionals, and people in the community. In the role of communicator, nurses identify client problems and then communicate these verbally or in writing to other members of the health team. The quality of a nurse’s communication is an important factor in nursing care. In my practice I usually communicate with other health professional regarding the most effective intervention for the client, like referring them to a specialist or to a social worker, helping the client achieve the optimal health status possible.

The nurse has significant responsibility as a supervisor of delegated or assigned activities. Each person involved in this process is accountable for his or her own actions or inaction and is potentially liable if competent and safe care is not provided. Certainly, the educational preparation and demonstrated ability of the person who will perform the designated act must be evaluated by the nurse making the decision to delegate tasks to others. In my practice decision to delegate essentially involves the use of the nursing process, i. e. appropriate assessment of the circumstances (staff available and patient acuity), planning, implementation, and evaluation by the delegator. It is up to me to make a professional judgment based upon the information available for me in each specific situation. Every day, nurses are responsible for the health and well-being of their patients. Regardless of specialty or work setting, perform basic duties that include treating patients, educating patients and the public about various medical conditions, and providing advice and emotional support to patients’ family members.

Doing this roles of nurses are basically the same in any work setting, with my education and experience I am very confident that I can do this roles when I practice as a registered nurse here in Canada, although there are some anxiety involved regarding the whole process, but I feel confident that I can do the job because I already have the experience being a licensed practical nurse first then moving up to becoming a registered nurse plus my previous experience as a registered nurse in the Philippines. The management and leadership competencies that I currently possess, and comfortable of using is communication.

Because I am a type of person that is very organized and to be able to achieve this is to have a good communication with other members of the team, and I am very comfortable in speaking the English language because back home in the Philippines we are use to using English as a medium for instruction so there not much adjustment on my part. Barriers for this competency that might challenge me is the possibility of sending or receiving incorrect messages. So it is essential that we know the key components of the communication process, how to improve our skills, and the potential problems that exist with errors in communication.

After I graduates from nursing school and gets my Registered Nurse (RN) license in the Philippines, somehow I got to possess some fundamental leadership skills to apply to direct patient care. I would identify more to a directive autocrat type of leadership, because for me it would be more effective to direct each team member to do a specific task to complete, ensuring that command and supervision as to what to do, and see to it that it gets completed accordingly. Positive side of this type of leadership is that the nurse leader tries to ensure that the whole unite works as a team to get the tasks done.

I will present a summary of both approaches followed by critical reflection upon their exceptive origins, similarities, differences and usage in practice. Carl Rogers, originator of the person-centered approach, conceived it in the late 1 sass at a time when the therapeutic establishment was dominated by psychoanalysis, which holds that psychological problems result from childhood fixations and biological drives buried in the unconscious mind, and behaviorism, which focuses on the annalistic mechanism of habits developing as a reaction to stimuli.

Rogers disagreed with these approaches’ conception of the client as ‘weak’ or ‘broken’ and the therapist as the expert with the tools to ‘fix’ him Cashmere, 201 1). Conversely, the person-centered approach is thought to be rooted in three interrelated philosophies (Cashmere, 2011 humanism, existentialism and phenomenology. Humanism is fundamentally a belief in the dignity and worth of each individual, and that each person is engaged in a struggle towards ‘self-actualization’, I. E. Fulfillment of potential in some way, which should be acknowledged and respected.

Existentialism holds that there is no objective truth or meaning and that humans are therefore ‘condemned to be free’, with total responsibility for creating meaning in our individual lives, and homogeneity is a related method of social/philosophical enquiry concerned with understanding the subjective reality experienced by each individual. Drawing on these influences, Rogers developed a number of key tenets of person-centered counseling, three of which he dubbed the ‘core conditions of therapeutic change’.

These are that, firstly, the therapist experiences ‘unconditional positive regard’ for the client; the client is made to feel that everything he feels and expresses is equally acceptable, important and valued. Secondly, the therapist experiences an ’empathic understanding’ of he client, which means that as the client is talking, the therapist accurately senses his feelings and personal values – including those he may not be directly aware of.

Thirdly, the therapists unconditional positive regard and empathic understanding must be effectively conveyed to the client (Rogers, 1957, cited in Ballasting Dyke’s, 2010). Page 1 of 6 These tenets serve to emphasis the role of the therapist in facilitating the client’s achievement of ‘self-actualization’ -becoming a psychologically mature adult who is at ease with their experiences and trusts their own inner sources to help them cope with difficulties. As in phenomenology, the therapist is concerned with understanding the world as perceived by the client.

To work within the ‘core conditions’, a therapist must act as another human being rather than an ‘expert’ and must avoid projecting his own personal meanings onto the client’s situation at all costs, although he should remain aware of them as part of his own humanity. Rogers’ theory is that the therapeutic relationship, rather than any specific technique or treatment, will itself facilitate change. He believed that any diagnosis or goal-setting only objectifies clients, and that individual meanings should be treated as the “highest authority” (Ballasting Dyke’s, 2010).

The person-centered approach also offers a theory explaining the origins of unbearable emotional distress. Where there is a conflict between how a person feels, or is (the ‘organism self’) and how he thinks he should feel, or be (the ‘self-concept’), the result is ‘incongruence’. When a person is incongruent, he is experiencing thoughts and feelings that are unacceptable according to his self-concept. This results in the employment of deference mechanisms such as repression, distortion or menial of feelings, alongside escalating confusion and unhappiness.

In person- centered counseling, the therapist models congruence – he is being himself and his experiences match what he communicates to the client – and his ‘unconditional positive regard’ is intended to help the client begin to accept all aspects of himself and thus move towards congruence (Ballasting Dyke’s, 2010). Mindfulness, contrastingly, is not primarily a therapy in itself (although there are types of therapy based solely upon Buddhist teachings) but rather a method of dealing with suffering which has been integrated into several types f therapy, notably cognitive-behavioral therapy (CB).

An integral part of Buddhist philosophy, mindfulness is a translation of a Pail word meaning ‘recollection’. To ‘recollect’ an awareness of the present moment means observing, without judgment, present thoughts, feelings, sensations and wider context. Crucially, this includes any kind of emotional discomfort or suffering. It is posited that many people strive to keep themselves feeling safe, protecting themselves from the things they fear and trying to attain the things they value and desire.

People crave what they don’t have and grasp onto what they do -? forming emotional attachments to ideas, possessions or people in order to distract themselves from the reality of life, which is that it involves suffering and will end in death (Barker, 2010). Hayes (2005, cited in Barker, 2010) uses the phrase ‘psychological quicksand’ to describe the way we can “sink deeper into our feelings” when we try to struggle against them. To struggle Page 2 of 6 against uncomfortable feelings, whether by distracting ourselves or by trying to force them to change, only deepens and exacerbates conflict and anguish.

Furthermore, when controlling or avoiding feelings does not work and we are arced to acknowledge them, we may over-identify with them, view them as permanent and feel trapped within them. Acceptance is the first essential element of mindfulness; instead of “feeling sad about feeling sad”, the alternative is to accept difficult feelings, gently and curiously, as only part of the whole moment. ‘Being present’ is the second element; this involves striving, through practice, to focus our attention upon the present moment.

Ruminating over the past may result in our processing current thoughts and feelings as part Of an overall narrative, which impedes our understanding hem purely for what they are, and focusing on future goals prevents us from seeing that we will never be fully satisfied; happiness can only be in the endeavourer, in the present moment. The third element is awareness. Becoming deeply aware of thoughts and thought processes means that we avoid becoming ‘carried away’ by automatic processes at the expense of reason and control.

Mindfulness is often practiced using meditation but can be employed as part of therapy or in the context of day-to-day activities (Barker, 2010). The most striking similarity to note IS the resonance between the mindfulness-related expression ‘psychological quicksand’ and the person- centered concept of ‘incongruence’. Essentially, both approaches locate the cause of suffering in the discrepancy between how people truly feel, or truly are, and how they believe they should feel or should be.

Accordingly, both approaches advocate acceptance and legitimating of all parts of the self, although the person-centered approach perceives this as being facilitated by the therapeutic relationship, whereas in mindfulness it occurs as a result of practicing ‘acceptance’, ‘being present’ and ‘awareness’ via techniques such as dedication. Shown (1996, cited in Barker, 2010) argues that it was the resonance between some humanistic and Buddhist ideas that led to Buddhism rising popularity in Western culture since the 1 sass; mindfulness theories applied in the West are thus at least somewhat related to the humanist approach.

Certainly the two approaches share a belief in phenomenological subjectivity and the harmfulness Of hierarchical, inflexible doctrines. However, at first glance, mindfulness may appear more ideologically-based. Where the person-centered approach focuses on the individualized ‘organism self’ failing to reach the self concept’, mindfulness takes a firmer stance in that it emphasizes the harmfulness of all ‘craving or ‘grasping, in all human beings, as a denial of the realities of suffering and death. Page 3 of 6 These aspects of the two approaches appear diametrically opposed.

Should suffering people focus on themselves, or should they move towards focusing on the whole context surrounding them in order to gain perspective? Mann Bazaar is a person-centered therapist who, more recently, has incorporated mindfulness techniques as part of his practice (Bazaar, 2009). He emphasizes the “erosion” of self that a mindful examination of the self can ring about: ‘What meditation eventually does to one person is to leave one’s identity… That destroys the very foundation of our western society which is founded on ego, on self, on acquiring…

The more I’m aware, the more I look around, the more I see the full implication of suffering’ (Open University, 201 AAA). Barker (2010) similarly argues that being in a state of mindful awareness is an appropriate foundation for action, and that letting go of ‘craving’ and ‘grasping’ lessens selfish behavior in relationships. The person-centered approach has attracted criticism for supposedly being “theory-thin” (Cashmere, 201 1). However, as has been shown, it is rooted in humanism, existentialism and phenomenology’, and was developed as a challenge to the authoritarian, dogmatic approaches that were prominent at the time.

Carl Rogers is overwhelmingly regarded as the most influential figure in the therapy field, even among practitioners of cognitive-behavioral therapy (Barber, 2007, cited in Ballasting Dyke’s, 201 0); regardless Of approach, most practitioners today recognize the importance of the relationship between therapist and client, as well as the need to create equilibrium within this relationship rather than allowing the therapist to Edgar him or herself as the ‘expert’ (Kowtow and Saffron, 2007).

Pinker (2011) argues that the evolution of value systems in the direction of humanism has been a momentous general historical trend. Person-centered counseling, which reveres the inherent worth and inalienable rights of the individual and disdains arbitrary authority in favor of a more egalitarian outlook, rose to prominence as part of this trend. Pinker contends that, since the end of the Second World War, humanism has been the unquestioned foundation of most Western people’s values; so much so that it is easy to forget it is a theory.

The historical significance of humanism in general, and Carl Rogers in particular, should not be discounted. However, since Rogers’ theories were developed in the sass, it seems timely to examine them and question whether they might be refined. Wood (2008) highlights some criticisms that have been made in recent years: May (1982, cited in Wood, 2008) ‘took Rogers to task for asserting the sovereign freedom of the individual and then blaming society for the individual’s woes”.

The person- centered approach, which takes an extremely positive view of human nature (all humans are engaged in a struggle towards self-actualization, and only deed Page 4 of 6 to be facilitated to achieve their potential), does not adequately address personal responsibility or the collective good. To value and revere an individual’s needs above all else is to ignore, for example, ecological problems that result from people proportioning their own wants and needs.

In my view, Rogers’ reverence of the therapeutic relationship is also problematic. To feel and communicate positive regard and empathic understanding to such an extent that the client feels transformed by it, may only be achieved in certain circumstances. Maureen Moore, a preconceived counselor, describes her allegations with a client who was feeling alienated from others as a result of being mixed-race: “I’ve experienced some of this myself, so in a sense I was able to be more empathic” (Open University, Bibb).

The success of the therapeutic relationship may at least partly depend on the therapists experiences and personality compared to the client’s, and while this criticism applies to all types of therapy, it is particularly pertinent in the case of an approach which venerates the relationship as the therapy, rather than any technique or process.

It may be that the person-centered approach works best n cases where a profound understanding does develop (perhaps as a result of shared experience between the therapist and the client) and/or where the client is new to the experience of being fully listened to and accepted. Overall, I feel more drawn to the mindfulness approach: the person-centered idea of accepting the whole self has been refined and conveyed more clearly, without the need for jargon such as ‘incongruence’, there is less weight placed upon the therapeutic relationship and it addresses the wider context rather than focusing on the self.

Additionally, mindfulness techniques have been hon. to have wide-ranging applications; dialectical behavior therapy, for example, is a variant of CB which focuses on patients’ cognitive styles while simultaneously teaching mindfulness strategies for management of their mental states, and which evidence suggests is effective for patients with borderline personality disorder. Mindfulness as part of a structured approach may be Of particular benefit to people with chaotic inner lives (Roth and F-Nagy, 2005).