WEBVTT 00:00:00.000 --> 00:00:07.000 music 00:00:07.000 --> 00:00:09.000 So my name's Sharon Reddy I 00:00:11.000 --> 00:00:12.000 different things we're just 00:00:12.000 --> 00:00:13.000 going to talk briefly about 00:00:16.000 --> 00:00:18.000 counseling -- and I'll just give you 00:00:18.000 --> 00:00:19.000 a little bit of background 00:00:19.000 --> 00:00:21.000 about myself and then we're 00:00:21.000 --> 00:00:22.000 gonna talk about some ethical 00:00:22.000 --> 00:00:24.000 dilemmas and case studies 00:00:24.000 --> 00:00:26.000 around -- diversity and 00:00:26.000 --> 00:00:28.000 values so feel free to ask 00:00:28.000 --> 00:00:30.000 questions at any point -- 00:00:30.000 --> 00:00:32.000 the second half I -- I'm gonna ask 00:00:32.000 --> 00:00:34.000 for some participation -- and 00:00:34.000 --> 00:00:36.000 some insight from you guys so 00:00:36.000 --> 00:00:39.000 my clinical practice I do a 00:00:39.000 --> 00:00:40.000 lot of outpatient work I work 00:00:40.000 --> 00:00:42.000 primarily with adults as well 00:00:42.000 --> 00:00:43.000 as adolescents occasionally 00:00:43.000 --> 00:00:45.000 but when I first started I 00:00:45.000 --> 00:00:47.000 really felt like -- counseling 00:00:47.000 --> 00:00:49.000 really meant sitting in a room 00:00:49.000 --> 00:00:50.000 having your client in there 00:00:50.000 --> 00:00:51.000 and you talk to them for an 00:00:51.000 --> 00:00:53.000 hour and then they leave and 00:00:53.000 --> 00:00:54.000 then hopefully they come back 00:00:54.000 --> 00:00:56.000 and then you get to see again and I 00:00:56.000 --> 00:00:58.000 learned very fast that that's 00:00:58.000 --> 00:00:60.000 not really how it works -- 00:01:00.000 --> 00:01:02.000 so I've -- expanded and have 00:01:02.000 --> 00:01:03.000 done a variety of different 00:01:03.000 --> 00:01:05.000 things like I said majority 00:01:05.000 --> 00:01:07.000 of my time is outpatient work 00:01:07.000 --> 00:01:08.000 I've also done some residential 00:01:08.000 --> 00:01:11.000 work and I work mostly in a 00:01:11.000 --> 00:01:13.000 clinic based setting and when 00:01:13.000 --> 00:01:14.000 you work in a clinic based 00:01:14.000 --> 00:01:16.000 setting you don't really get 00:01:16.000 --> 00:01:17.000 the luxury of sitting in a 00:01:17.000 --> 00:01:19.000 room and just seeing your client 00:01:20.000 --> 00:01:22.000 consultations it also requires 00:01:22.000 --> 00:01:23.000 a lot of care coordination 00:01:23.000 --> 00:01:26.000 so I jump between outpatient 00:01:26.000 --> 00:01:27.000 and residential mental health 00:01:29.000 --> 00:01:31.000 setting -- so I go into 00:01:31.000 --> 00:01:34.000 primary care visits as well 00:01:36.000 --> 00:01:39.000 and cardiology patients -- so 00:01:39.000 --> 00:01:40.000 when they're in treatment and 00:01:40.000 --> 00:01:41.000 there might be some lifestyle 00:01:41.000 --> 00:01:44.000 adjustments or -- transition 00:01:44.000 --> 00:01:46.000 out of that treatment I see them in 00:01:46.000 --> 00:01:49.000 that dynamic -- and then when 00:01:49.000 --> 00:01:50.000 I transition from there I 00:01:50.000 --> 00:01:52.000 also do some community based 00:01:52.000 --> 00:01:54.000 work -- so this could be 00:01:54.000 --> 00:01:55.000 integrating an individual into 00:01:55.000 --> 00:01:56.000 the community and connecting 00:01:56.000 --> 00:01:59.000 them with resources -- after 00:01:59.000 --> 00:01:61.000 whatever treatment plan or 00:02:01.000 --> 00:02:03.000 schema that they have and then 00:02:03.000 --> 00:02:05.000 I also do consultations so 00:02:05.000 --> 00:02:07.000 consultations can be a 00:02:07.000 --> 00:02:08.000 variety of different things 00:02:08.000 --> 00:02:10.000 so this could be consultation 00:02:10.000 --> 00:02:12.000 with your peers and your teams 00:02:12.000 --> 00:02:14.000 on shared clients that you 00:02:14.000 --> 00:02:16.000 have or it can be consultation 00:02:16.000 --> 00:02:18.000 where you get invited by an 00:02:18.000 --> 00:02:20.000 agency or a team because you 00:02:20.000 --> 00:02:22.000 have expertise in the area 00:02:22.000 --> 00:02:24.000 that is needed for a group of 00:02:26.000 --> 00:02:29.000 or an individual -- programmer 00:02:29.000 --> 00:02:31.000 project that they're doing the 00:02:31.000 --> 00:02:32.000 other thing that's very 00:02:32.000 --> 00:02:34.000 common for consultation is 00:02:34.000 --> 00:02:36.000 getting invited to care teams 00:02:36.000 --> 00:02:37.000 are you guys familiar with 00:02:37.000 --> 00:02:40.000 what a care team is yes okay 00:02:40.000 --> 00:02:43.000 so care team -- coordination is 00:02:43.000 --> 00:02:46.000 interesting because it requires 00:02:46.000 --> 00:02:49.000 that you are able to understand 00:02:51.000 --> 00:02:53.000 that might arise in that 00:02:53.000 --> 00:02:55.000 platform because you might have 00:02:55.000 --> 00:02:57.000 anywhere from three to four 00:02:57.000 --> 00:02:59.000 up to ten different clinical 00:02:59.000 --> 00:02:61.000 providers from different areas 00:03:01.000 --> 00:03:02.000 of practice sitting in the 00:03:02.000 --> 00:03:04.000 same room trying to create 00:03:04.000 --> 00:03:06.000 their own treatment plans and 00:03:06.000 --> 00:03:08.000 get this individual to make 00:03:08.000 --> 00:03:10.000 progress and you have your 00:03:10.000 --> 00:03:11.000 own ethical code that you have 00:03:11.000 --> 00:03:13.000 to practice by and live up to 00:03:13.000 --> 00:03:14.000 and keep everybody else in the 00:03:14.000 --> 00:03:15.000 room accountable as well as 00:03:15.000 --> 00:03:17.000 yourself right so this requires 00:03:17.000 --> 00:03:19.000 a lot of consultation outside 00:03:19.000 --> 00:03:21.000 of work as well so I give 00:03:21.000 --> 00:03:23.000 consultation but I also receive 00:03:23.000 --> 00:03:24.000 consultation in -- part of 00:03:24.000 --> 00:03:26.000 consultation groups to ensure 00:03:26.000 --> 00:03:27.000 that I can make sure that I 00:03:27.000 --> 00:03:30.000 am abiding by ethical codes 00:03:30.000 --> 00:03:32.000 the second thing is teaching 00:03:32.000 --> 00:03:34.000 teaching can be workshops that 00:03:34.000 --> 00:03:37.000 you do a lot of -- LPC interns 00:03:37.000 --> 00:03:38.000 choose to do this right out 00:03:38.000 --> 00:03:40.000 of grad school what workshops 00:03:40.000 --> 00:03:41.000 look like is you pick either 00:03:41.000 --> 00:03:43.000 a population or a topic that 00:03:43.000 --> 00:03:45.000 you're very much interested in and 00:03:45.000 --> 00:03:46.000 are spending a lot of energy 00:03:46.000 --> 00:03:48.000 on and you offer it to the 00:03:48.000 --> 00:03:50.000 community -- or offer it to 00:03:50.000 --> 00:03:51.000 other professionals based on 00:03:51.000 --> 00:03:53.000 what your comfort level is 00:03:53.000 --> 00:03:55.000 they're typically fairly low 00:03:55.000 --> 00:03:57.000 cost workshops -- but it's an 00:03:57.000 --> 00:03:59.000 opportunity for you to -- 00:03:59.000 --> 00:03:61.000 gain experience but also to 00:04:01.000 --> 00:04:02.000 introduce yourself into the 00:04:02.000 --> 00:04:04.000 community and most people who 00:04:04.000 --> 00:04:06.000 are thinking about going into 00:04:06.000 --> 00:04:07.000 private practice this is a 00:04:07.000 --> 00:04:09.000 great platform because it's a 00:04:09.000 --> 00:04:11.000 great way to get new clients 00:04:11.000 --> 00:04:12.000 because they kind of have a taste of 00:04:12.000 --> 00:04:14.000 your style and your techniques 00:04:14.000 --> 00:04:16.000 it's also a great way to get 00:04:16.000 --> 00:04:17.000 referrals -- because you now 00:04:17.000 --> 00:04:19.000 have become an expert in this 00:04:19.000 --> 00:04:21.000 area and other clinicians can 00:04:21.000 --> 00:04:23.000 refer to you -- the third way 00:04:23.000 --> 00:04:25.000 workshops work really well 00:04:25.000 --> 00:04:27.000 is -- it engages you in 00:04:27.000 --> 00:04:29.000 speaking arrangements so if 00:04:29.000 --> 00:04:30.000 you're somebody who's wanting 00:04:30.000 --> 00:04:32.000 to do private practice or 00:04:32.000 --> 00:04:33.000 even voc rehab but you 00:04:33.000 --> 00:04:35.000 want to travel as well -- and 00:04:35.000 --> 00:04:37.000 explore different communities 00:04:37.000 --> 00:04:38.000 and areas that's a great way to do 00:04:38.000 --> 00:04:41.000 it because you get invited by 00:04:41.000 --> 00:04:42.000 a bunch of different agencies 00:04:42.000 --> 00:04:44.000 to come travel and talk and do 00:04:44.000 --> 00:04:45.000 all these workshops for their 00:04:45.000 --> 00:04:48.000 teams right so this is a way of 00:04:48.000 --> 00:04:50.000 you expanding and exploring a 00:04:50.000 --> 00:04:52.000 little bit -- and also growing 00:04:52.000 --> 00:04:53.000 private practice if that's 00:04:53.000 --> 00:04:54.000 ultimately your goal at some 00:04:54.000 --> 00:04:57.000 point you can also offer CEUs 00:04:57.000 --> 00:04:58.000 right out of grad school 00:04:58.000 --> 00:04:59.000 you can't really do that on 00:04:59.000 --> 00:04:60.000 your own you would need to 00:05:00.000 --> 00:05:01.000 have a clinical supervisor but 00:05:01.000 --> 00:05:02.000 if you're going to be working 00:05:02.000 --> 00:05:05.000 towards a LPC license you 00:05:05.000 --> 00:05:07.000 would have one anyway -- 00:05:07.000 --> 00:05:08.000 so you can always partner with 00:05:08.000 --> 00:05:11.000 your supervisor to create CEUs 00:05:13.000 --> 00:05:15.000 a great way to give income but 00:05:15.000 --> 00:05:16.000 it's also another great way 00:05:16.000 --> 00:05:18.000 to build you know some report 00:05:18.000 --> 00:05:19.000 in the community and get 00:05:19.000 --> 00:05:21.000 your name out there and then 00:05:21.000 --> 00:05:23.000 supervision this is years and 00:05:23.000 --> 00:05:25.000 years after practice you can 00:05:25.000 --> 00:05:26.000 really create some work around 00:05:26.000 --> 00:05:29.000 supervision you can take in new 00:05:29.000 --> 00:05:31.000 LPC interns and supervise them 00:05:31.000 --> 00:05:32.000 or you can provide supervision 00:05:32.000 --> 00:05:35.000 of supervision so your supervisor 00:05:35.000 --> 00:05:36.000 your clinical supervisors 00:05:36.000 --> 00:05:37.000 also receive supervision 00:05:37.000 --> 00:05:38.000 to make sure that they are 00:05:38.000 --> 00:05:40.000 accurately supervising you 00:05:41.000 --> 00:05:43.000 down the road -- but that's also 00:05:43.000 --> 00:05:45.000 an option for what you can 00:05:45.000 --> 00:05:46.000 do out of those I do all of 00:05:46.000 --> 00:05:48.000 them besides supervision for 00:05:48.000 --> 00:05:49.000 consultation and workshops I do 00:05:49.000 --> 00:05:51.000 a lot of crisis work workshops 00:05:51.000 --> 00:05:52.000 and interventions -- outside 00:05:52.000 --> 00:05:55.000 of outpatient treatment so 00:05:55.000 --> 00:05:57.000 kind of a lengthy way of 00:05:57.000 --> 00:05:58.000 introducing myself 00:05:58.000 --> 00:05:60.000 and what I do do you guys 00:06:00.000 --> 00:06:01.000 have questions about any of 00:06:01.000 --> 00:06:04.000 these areas of career paths or 00:06:04.000 --> 00:06:06.000 interest that I could answer 00:06:06.000 --> 00:06:07.000 what agencies am I affiliated 00:06:07.000 --> 00:06:09.000 with and -- kind of how 00:06:09.000 --> 00:06:11.000 much freedom I have to work 00:06:11.000 --> 00:06:13.000 in these different areas -- 00:06:13.000 --> 00:06:14.000 so I work at Kaiser Permanente 00:06:14.000 --> 00:06:15.000 in a outpatient addiction 00:06:15.000 --> 00:06:17.000 medicine treatment right so 00:06:17.000 --> 00:06:19.000 my work there is very much 00:06:19.000 --> 00:06:22.000 there I can't cross paths in 00:06:22.000 --> 00:06:23.000 any way -- because it is a 00:06:23.000 --> 00:06:25.000 care coordinated agency it's 00:06:25.000 --> 00:06:27.000 also a medical based agency 00:06:27.000 --> 00:06:28.000 so anybody I see I only see 00:06:28.000 --> 00:06:30.000 there -- and I do a lot of 00:06:30.000 --> 00:06:33.000 this work for them as well -- 00:06:33.000 --> 00:06:35.000 outside of that -- I work for 00:06:35.000 --> 00:06:37.000 a couple different agencies so I 00:06:37.000 --> 00:06:38.000 also have a private practice 00:06:38.000 --> 00:06:40.000 through which I do workshops 00:06:41.000 --> 00:06:43.000 community agencies like -- 00:06:43.000 --> 00:06:44.000 Northwest Human Services is one 00:06:44.000 --> 00:06:46.000 of them and I do consultation 00:06:46.000 --> 00:06:48.000 work for them around -- crisis 00:06:48.000 --> 00:06:51.000 work -- so most of the time 00:06:51.000 --> 00:06:52.000 you have a lot of freedom to 00:06:52.000 --> 00:06:54.000 engage in any of these areas 00:06:56.000 --> 00:06:58.000 are really there -- would be 00:06:58.000 --> 00:06:60.000 if you're working for an agency 00:07:00.000 --> 00:07:01.000 and your contract says that 00:07:01.000 --> 00:07:03.000 you can't do certain things 00:07:03.000 --> 00:07:05.000 for other agencies that would 00:07:05.000 --> 00:07:07.000 be a limitation -- and then 00:07:07.000 --> 00:07:09.000 self care is the other piece 00:07:09.000 --> 00:07:10.000 of it right you need to make 00:07:10.000 --> 00:07:13.000 sure that you can balance all 00:07:13.000 --> 00:07:14.000 of these moving pieces and 00:07:14.000 --> 00:07:16.000 commit energy around that so 00:07:16.000 --> 00:07:18.000 we're going to jump in and 00:07:20.000 --> 00:07:22.000 concerns if you have watched 00:07:22.000 --> 00:07:25.000 this I ask that you don't 00:07:25.000 --> 00:07:27.000 answer the following question 00:07:27.000 --> 00:07:28.000 but you're gonna take a look 00:07:28.000 --> 00:07:30.000 at this video watch carefully 00:07:30.000 --> 00:07:33.000 and see what you come up with 00:07:33.000 --> 00:07:35.000 matter -- you're actually 00:07:35.000 --> 00:07:38.000 gonna look at this video and see 00:07:38.000 --> 00:07:39.000 how many changes you notice 00:07:39.000 --> 00:07:44.000 music 00:07:44.000 --> 00:07:46.000 clearly somebody in this room 00:07:46.000 --> 00:07:48.000 murdered Lord Smithe who at 00:07:48.000 --> 00:07:49.000 precisely 3:34 00:07:49.000 --> 00:07:52.000 this afternoon was brutally 00:07:52.000 --> 00:07:53.000 bludgeoned to death 00:07:53.000 --> 00:07:55.000 with a blunt instrument I want 00:07:55.000 --> 00:07:57.000 each of you to tell me your 00:07:57.000 --> 00:07:59.000 whereabouts at precisely the 00:07:59.000 --> 00:07:61.000 time that this dastardly deed 00:08:01.000 --> 00:08:04.000 took place I was polishing the 00:08:04.000 --> 00:08:07.000 brass in the master bedroom I 00:08:07.000 --> 00:08:08.000 was buttering his Lordship's 00:08:08.000 --> 00:08:11.000 scones below stairs Sir I 00:08:11.000 --> 00:08:13.000 was planting my petunias in 00:08:13.000 --> 00:08:15.000 the potting shed 00:08:15.000 --> 00:08:18.000 Constable arrest Lady Smithe 00:08:18.000 --> 00:08:20.000 but -- but how did you know 00:08:20.000 --> 00:08:22.000 Madame as any horticulturist will tell you 00:08:22.000 --> 00:08:23.000 one does not plant petunias 00:08:23.000 --> 00:08:26.000 until May is out take her away 00:08:26.000 --> 00:08:28.000 it's just a matter of 00:08:28.000 --> 00:08:30.000 observation the real question 00:08:30.000 --> 00:08:34.000 is how observant were you 00:08:38.000 --> 00:08:41.000 and action 00:08:41.000 --> 00:08:43.000 clearly somebody in this room 00:08:43.000 --> 00:08:46.000 murdered Lord Smithe who 00:08:46.000 --> 00:08:47.000 at precisely 3:34 00:08:47.000 --> 00:08:49.000 this afternoon was brutally 00:08:49.000 --> 00:08:51.000 bludgeoned to death with 00:08:51.000 --> 00:08:52.000 a blunt instrument I want 00:08:52.000 --> 00:08:54.000 each of you to tell me your 00:08:54.000 --> 00:08:56.000 whereabouts at precisely 00:08:56.000 --> 00:08:58.000 the time that this dastardly 00:08:58.000 --> 00:08:62.000 deed took place I was polishing 00:09:02.000 --> 00:09:04.000 the brass in the master bedroom 00:09:04.000 --> 00:09:06.000 I was buttering his Lordship's 00:09:06.000 --> 00:09:09.000 scones below stairs Sir 00:09:09.000 --> 00:09:11.000 I was planting my petunias in the 00:09:11.000 --> 00:09:15.000 potting shed Constable arrest 00:09:15.000 --> 00:09:17.000 Lady Smithe so the reason I 00:09:17.000 --> 00:09:19.000 show this video is twenty one 00:09:19.000 --> 00:09:20.000 changes I didn't even catch it 00:09:20.000 --> 00:09:22.000 the first time I had to watch it 00:09:22.000 --> 00:09:23.000 a couple times before I caught 00:09:23.000 --> 00:09:26.000 all of them this happens in 00:09:26.000 --> 00:09:28.000 clinical work all the time 00:09:28.000 --> 00:09:30.000 right somebody comes in with 00:09:30.000 --> 00:09:32.000 hey I have anxiety or I 00:09:32.000 --> 00:09:34.000 have whatever life issue and 00:09:34.000 --> 00:09:36.000 as a clinician we just hone in 00:09:36.000 --> 00:09:38.000 on that and kind of go tunnel 00:09:38.000 --> 00:09:41.000 visioned and look just at that 00:09:41.000 --> 00:09:43.000 right part of it is our own 00:09:43.000 --> 00:09:45.000 intention to really try to 00:09:45.000 --> 00:09:46.000 help that individual and get 00:09:46.000 --> 00:09:48.000 them to their goals and success 00:09:48.000 --> 00:09:50.000 right but because we do that 00:09:50.000 --> 00:09:53.000 we miss larger pictures all 00:09:53.000 --> 00:09:55.000 the time every single day you 00:09:55.000 --> 00:09:56.000 will miss this because it's 00:09:56.000 --> 00:09:58.000 impossible for us to notice 00:09:58.000 --> 00:09:60.000 every single aspect of what's 00:10:00.000 --> 00:10:01.000 being brought into the room 00:10:01.000 --> 00:10:03.000 right because this happens 00:10:03.000 --> 00:10:05.000 ethical dilemmas occur all the 00:10:05.000 --> 00:10:08.000 time because of this reason 00:10:08.000 --> 00:10:11.000 so our hope is can we really 00:10:11.000 --> 00:10:12.000 hone in and help this client that 00:10:12.000 --> 00:10:14.000 we're working with but can we 00:10:14.000 --> 00:10:15.000 also take a step back at times 00:10:15.000 --> 00:10:16.000 and really look at the larger 00:10:16.000 --> 00:10:18.000 picture right by doing 00:10:18.000 --> 00:10:20.000 that we can really alleviate 00:10:20.000 --> 00:10:22.000 or prevent some ethical 00:10:22.000 --> 00:10:23.000 dilemmas and if there are some 00:10:23.000 --> 00:10:25.000 ethical dilemmas that arise 00:10:25.000 --> 00:10:27.000 we can kind of take a step back and 00:10:27.000 --> 00:10:28.000 understand what our next steps 00:10:28.000 --> 00:10:30.000 are okay so kind of want you guys 00:10:30.000 --> 00:10:32.000 to have this framework as we 00:10:32.000 --> 00:10:34.000 talk today so I'm going to give 00:10:34.000 --> 00:10:36.000 you guys some case examples 00:10:36.000 --> 00:10:37.000 that I've done or I've worked 00:10:37.000 --> 00:10:39.000 with my colleagues on so for 00:10:39.000 --> 00:10:40.000 confidentiality purposes I've 00:10:40.000 --> 00:10:43.000 generalized -- some of it I 00:10:43.000 --> 00:10:44.000 haven't put any identifying 00:10:44.000 --> 00:10:45.000 information and then some 00:10:45.000 --> 00:10:46.000 of the specific details that 00:10:46.000 --> 00:10:47.000 give you some insight into the 00:10:47.000 --> 00:10:49.000 case study I've altered a little 00:10:49.000 --> 00:10:51.000 bit and I've embellished it 00:10:51.000 --> 00:10:52.000 a little bit too so that you 00:10:52.000 --> 00:10:54.000 guys have -- a easier way of 00:10:54.000 --> 00:10:55.000 understanding what's happening 00:10:55.000 --> 00:10:57.000 if you're going into voc rehab 00:10:57.000 --> 00:10:59.000 or mental health those two 00:10:59.000 --> 00:10:61.000 things overlap if you think 00:11:01.000 --> 00:11:03.000 they're separate they're not 00:11:03.000 --> 00:11:04.000 right you need to be able to 00:11:04.000 --> 00:11:06.000 kinda interchange both of them 00:11:06.000 --> 00:11:07.000 because that's part of your 00:11:07.000 --> 00:11:09.000 role as a clinician our code 00:11:09.000 --> 00:11:11.000 of ethics say that we need to 00:11:11.000 --> 00:11:13.000 be able to incorporate family 00:11:13.000 --> 00:11:15.000 friends support networks -- in 00:11:15.000 --> 00:11:17.000 order to help somebody reach 00:11:17.000 --> 00:11:18.000 some sort of progress towards 00:11:18.000 --> 00:11:21.000 their treatment plan however this 00:11:21.000 --> 00:11:23.000 creates some ethical issues one 00:11:23.000 --> 00:11:27.000 is -- consent right so if we 00:11:27.000 --> 00:11:29.000 have an adolescent they're old 00:11:29.000 --> 00:11:32.000 enough to consent right fifteen or 00:11:32.000 --> 00:11:33.000 older depending on what state 00:11:33.000 --> 00:11:35.000 you are -- they can consent to 00:11:35.000 --> 00:11:37.000 mental health treatment they 00:11:37.000 --> 00:11:38.000 don't need a parent present 00:11:38.000 --> 00:11:40.000 or guardian present our code 00:11:40.000 --> 00:11:41.000 of ethics say that we need 00:11:41.000 --> 00:11:43.000 to do our best to encourage 00:11:43.000 --> 00:11:45.000 and incorporate the parents or 00:11:45.000 --> 00:11:47.000 the guardians -- and inform them of 00:11:47.000 --> 00:11:49.000 care just so that we are aware 00:11:49.000 --> 00:11:51.000 of the full picture and we're 00:11:51.000 --> 00:11:53.000 also taking some ethical steps 00:11:53.000 --> 00:11:55.000 towards that as adults this 00:11:55.000 --> 00:11:57.000 question comes up and I always 00:11:57.000 --> 00:11:60.000 ask this is from APA cultural formulation 00:12:00.000 --> 00:12:01.000 interview so if you're ever 00:12:01.000 --> 00:12:02.000 doing an assessment you'll 00:12:02.000 --> 00:12:04.000 be asking a variation of 00:12:04.000 --> 00:12:05.000 this are there any kinds of 00:12:05.000 --> 00:12:08.000 support that somehow improve 00:12:08.000 --> 00:12:10.000 the current issue or worsen 00:12:10.000 --> 00:12:11.000 the current issue that you're 00:12:11.000 --> 00:12:13.000 coming in with right so you 00:12:13.000 --> 00:12:15.000 ask adults these questions 00:12:15.000 --> 00:12:17.000 because this is encouraged 00:12:17.000 --> 00:12:19.000 you also enter this area of 00:12:19.000 --> 00:12:21.000 the ethical dilemma how do 00:12:21.000 --> 00:12:24.000 you differentiate when family 00:12:24.000 --> 00:12:25.000 support our friend support 00:12:25.000 --> 00:12:26.000 should be incorporated and when 00:12:26.000 --> 00:12:32.000 it should not how do you know 00:12:32.000 --> 00:12:34.000 benefit to the client 00:12:34.000 --> 00:12:35.000 benefit to the client 00:12:35.000 --> 00:12:37.000 ask the client 00:12:37.000 --> 00:12:40.000 ask the client how would you 00:12:40.000 --> 00:12:42.000 as a clinician know that it's 00:12:42.000 --> 00:12:46.000 a good time to offer this 00:12:46.000 --> 00:12:50.000 as an option okay so somehow 00:12:50.000 --> 00:12:51.000 supporting to alleviate some 00:12:51.000 --> 00:12:52.000 obstacle in their treatment 00:12:52.000 --> 00:12:55.000 process okay okay so road 00:12:55.000 --> 00:12:56.000 blocks and then how do you 00:12:56.000 --> 00:12:57.000 incorporate some support so 00:12:57.000 --> 00:12:58.000 that they can move forward 00:12:58.000 --> 00:12:62.000 right okay -- all accurate 00:13:02.000 --> 00:13:03.000 valid kind of things that you 00:13:03.000 --> 00:13:06.000 would do -- one other time 00:13:06.000 --> 00:13:08.000 that I would kinda encourage 00:13:08.000 --> 00:13:10.000 it is if a client comes in and 00:13:10.000 --> 00:13:11.000 they're telling you the same 00:13:11.000 --> 00:13:14.000 thing over and over again and 00:13:14.000 --> 00:13:16.000 you're thinking you know what 00:13:16.000 --> 00:13:18.000 everything is doom and gloom 00:13:18.000 --> 00:13:20.000 everything is always bad there 00:13:20.000 --> 00:13:22.000 has to be something else in 00:13:22.000 --> 00:13:23.000 this picture that I'm missing 00:13:23.000 --> 00:13:25.000 because I'm giving fifty 00:13:25.000 --> 00:13:27.000 solution focused responses 00:13:27.000 --> 00:13:28.000 to this individual for what 00:13:28.000 --> 00:13:29.000 they can do and they're still 00:13:29.000 --> 00:13:31.000 not making progress what is 00:13:31.000 --> 00:13:32.000 missing in this picture that 00:13:32.000 --> 00:13:33.000 I've created right that would 00:13:33.000 --> 00:13:35.000 be another reason why we would 00:13:35.000 --> 00:13:37.000 incorporate that so this 00:13:37.000 --> 00:13:39.000 is an adolescent he's sixteen 00:13:39.000 --> 00:13:41.000 years old he comes in for an 00:13:41.000 --> 00:13:44.000 assessment with me just a two 00:13:44.000 --> 00:13:45.000 hour assessment with his father 00:13:45.000 --> 00:13:48.000 and he's coming in because he 00:13:48.000 --> 00:13:50.000 was at a school dance and drank 00:13:50.000 --> 00:13:52.000 some alcohol with a group of a 00:13:52.000 --> 00:13:54.000 couple other students and got 00:13:54.000 --> 00:13:56.000 caught by the principal then 00:13:56.000 --> 00:13:58.000 he got suspended and all of the 00:13:58.000 --> 00:13:59.000 students that were involved in 00:13:59.000 --> 00:13:61.000 this -- they got sent in for 00:14:01.000 --> 00:14:03.000 an assessment to determine if 00:14:03.000 --> 00:14:04.000 there is a substance use issue 00:14:04.000 --> 00:14:06.000 or other problems coming on 00:14:06.000 --> 00:14:09.000 and if they are then -- those 00:14:09.000 --> 00:14:10.000 students would have to engage 00:14:10.000 --> 00:14:12.000 in treatment at whatever level 00:14:12.000 --> 00:14:14.000 we deem appropriate by the time 00:14:14.000 --> 00:14:16.000 he sees me he's already come 00:14:16.000 --> 00:14:17.000 in for orientation has done 00:14:17.000 --> 00:14:20.000 paperwork knows confidentiality 00:14:20.000 --> 00:14:21.000 knows that he doesn't need to 00:14:21.000 --> 00:14:23.000 have anybody in session what 00:14:23.000 --> 00:14:25.000 the assessment is he has all this 00:14:25.000 --> 00:14:27.000 information so I see him he's 00:14:27.000 --> 00:14:28.000 sitting there with his dad I 00:14:28.000 --> 00:14:30.000 invite him in -- to my office 00:14:30.000 --> 00:14:32.000 and I ask him if he wants his 00:14:32.000 --> 00:14:34.000 dad there the entire time a 00:14:34.000 --> 00:14:37.000 portion of it or not at all -- 00:14:37.000 --> 00:14:39.000 and I give him some insight of 00:14:39.000 --> 00:14:40.000 like I'm gonna be asking quite 00:14:40.000 --> 00:14:42.000 a few personal questions this 00:14:42.000 --> 00:14:43.000 is kind of what it's gonna 00:14:43.000 --> 00:14:44.000 look like are you sure you're 00:14:44.000 --> 00:14:46.000 comfortable with your dad being 00:14:46.000 --> 00:14:47.000 there and he says nope I want my 00:14:47.000 --> 00:14:48.000 dad there there's nothing that 00:14:48.000 --> 00:14:50.000 I have to hide it's not a big 00:14:50.000 --> 00:14:52.000 deal right so dad comes in 00:14:52.000 --> 00:14:54.000 sits through majority of the session 00:14:56.000 --> 00:14:58.000 I use a ASAM so in addiction 00:14:58.000 --> 00:14:60.000 you use ASAM there's six dimensions 00:15:00.000 --> 00:15:02.000 it's really looking at every aspect 00:15:02.000 --> 00:15:03.000 of their life to determine if 00:15:03.000 --> 00:15:05.000 so if this this is an issue or 00:15:05.000 --> 00:15:07.000 need to be addressed right 00:15:07.000 --> 00:15:10.000 he gives me answers to all of 00:15:10.000 --> 00:15:11.000 the questions but is fairly 00:15:11.000 --> 00:15:14.000 vague right enough to answer 00:15:14.000 --> 00:15:16.000 the question but not really 00:15:16.000 --> 00:15:19.000 giving me any details we get 00:15:19.000 --> 00:15:21.000 to the end of it the dad tells 00:15:21.000 --> 00:15:23.000 me you know this is a great 00:15:23.000 --> 00:15:24.000 kid I really think that he's 00:15:24.000 --> 00:15:26.000 learned from his mistakes right 00:15:26.000 --> 00:15:28.000 he's not gonna do this again 00:15:28.000 --> 00:15:29.000 we've never had any behavioral 00:15:29.000 --> 00:15:31.000 issues there's no changes to his 00:15:31.000 --> 00:15:33.000 mood there's never had any 00:15:33.000 --> 00:15:36.000 issues my child is brilliant 00:15:36.000 --> 00:15:38.000 you know peer pressure all this 00:15:38.000 --> 00:15:40.000 stuff got him into trouble and 00:15:40.000 --> 00:15:42.000 I don't see any reason for why 00:15:42.000 --> 00:15:44.000 he would need treatment like 00:15:44.000 --> 00:15:45.000 this is there's no need I don't 00:15:45.000 --> 00:15:47.000 even know why he was even sent 00:15:47.000 --> 00:15:49.000 here for an assessment like 00:15:49.000 --> 00:15:50.000 I can vouch for him there's 00:15:50.000 --> 00:15:51.000 there's no issue right this 00:15:51.000 --> 00:15:54.000 really emphasizes that the whole 00:15:54.000 --> 00:15:56.000 two hours he's with me at this 00:15:56.000 --> 00:15:57.000 point I'm like I get the memo 00:15:57.000 --> 00:15:59.000 here right I know what you're 00:15:59.000 --> 00:15:63.000 trying to tell me and then I 00:16:03.000 --> 00:16:04.000 have to make clinical judgment 00:16:04.000 --> 00:16:06.000 right my two hours with this 00:16:06.000 --> 00:16:07.000 person is up I have to make 00:16:07.000 --> 00:16:08.000 a clinical recommendation 00:16:08.000 --> 00:16:11.000 of what I should do and 00:16:11.000 --> 00:16:12.000 what I should let the school 00:16:12.000 --> 00:16:13.000 know and then how do I move 00:16:13.000 --> 00:16:15.000 forward what is the ethical 00:16:15.000 --> 00:16:17.000 dilemma that I'm dealing with 00:16:17.000 --> 00:16:19.000 here so pretty much -- this 00:16:19.000 --> 00:16:20.000 adolescent doesn't want 00:16:20.000 --> 00:16:23.000 to change his father's view 00:16:23.000 --> 00:16:24.000 and perspective of him right 00:16:24.000 --> 00:16:25.000 might not be comfortable 00:16:25.000 --> 00:16:28.000 sharing and then it's also 00:16:28.000 --> 00:16:30.000 because it's apparent we really 00:16:30.000 --> 00:16:31.000 want to incorporate them 00:16:31.000 --> 00:16:33.000 in treatment planning but is 00:16:33.000 --> 00:16:34.000 it really appropriate for him 00:16:34.000 --> 00:16:36.000 to be there right what other 00:16:36.000 --> 00:16:39.000 ethical dilemma do I have yep 00:16:39.000 --> 00:16:41.000 say sixteen consenting age okay 00:16:41.000 --> 00:16:43.000 there's one other big thing 00:16:43.000 --> 00:16:45.000 that I'm missing in this ethical 00:16:45.000 --> 00:16:47.000 dilemma yes the father is 00:16:47.000 --> 00:16:49.000 talking and not the client 00:16:49.000 --> 00:16:52.000 itself so -- this was a huge 00:16:52.000 --> 00:16:54.000 ethical dilemma because after 00:16:54.000 --> 00:16:56.000 I did the assessment I was like he's 00:16:56.000 --> 00:16:59.000 a kid he made a mistake he is 00:16:59.000 --> 00:16:60.000 a minor shouldn't have been 00:17:00.000 --> 00:17:02.000 drinking but he does not have 00:17:02.000 --> 00:17:04.000 a alcohol dependence you know 00:17:04.000 --> 00:17:05.000 this person is telling me he 00:17:05.000 --> 00:17:07.000 only had one drink for -- one 00:17:07.000 --> 00:17:11.000 time in his entire life -- and 00:17:11.000 --> 00:17:14.000 that was it right I kind of have 00:17:14.000 --> 00:17:15.000 to take it and then I took 00:17:15.000 --> 00:17:17.000 a step back and I said mmm-mmm 00:17:17.000 --> 00:17:19.000 something's not right because 00:17:19.000 --> 00:17:22.000 this whole time this person 00:17:22.000 --> 00:17:23.000 has been really nervous in 00:17:23.000 --> 00:17:25.000 my session he's not really 00:17:25.000 --> 00:17:29.000 elaborating on anything right 00:17:31.000 --> 00:17:33.000 the dad repeatedly said is 00:17:33.000 --> 00:17:35.000 like I don't feel that mental 00:17:35.000 --> 00:17:36.000 health treatment is important 00:17:36.000 --> 00:17:39.000 and I said ahh seems like there's 00:17:39.000 --> 00:17:41.000 some stigma there right 00:17:41.000 --> 00:17:43.000 what perspective does dad have 00:17:43.000 --> 00:17:45.000 on what mental health is and 00:17:45.000 --> 00:17:47.000 what treatment would look like 00:17:47.000 --> 00:17:48.000 and what perspective this would 00:17:48.000 --> 00:17:50.000 put on his son if he were to 00:17:50.000 --> 00:17:53.000 engage right I ended up seeing 00:17:53.000 --> 00:17:56.000 the son individually and I told 00:17:56.000 --> 00:17:57.000 the dad like hey you know this 00:17:57.000 --> 00:17:58.000 is part of the assessment I really 00:17:58.000 --> 00:17:59.000 need to talk to him individually 00:17:59.000 --> 00:17:61.000 can you give us ten minutes in 00:18:01.000 --> 00:18:03.000 that ten minutes I could not 00:18:03.000 --> 00:18:06.000 get a word in this teen could 00:18:06.000 --> 00:18:08.000 not stop talking he complained 00:18:08.000 --> 00:18:10.000 about everything about his dad 00:18:10.000 --> 00:18:12.000 you could imagine right and 00:18:12.000 --> 00:18:14.000 it was all around I have a lot 00:18:14.000 --> 00:18:17.000 of anxiety right I have a hard 00:18:17.000 --> 00:18:19.000 time sleeping I have a hard 00:18:19.000 --> 00:18:21.000 time functioning in school -- 00:18:21.000 --> 00:18:22.000 and it's all because I don't 00:18:22.000 --> 00:18:26.000 want to disappoint my dad 00:18:26.000 --> 00:18:27.000 I really feel like I need 00:18:27.000 --> 00:18:30.000 support with my anxiety I have 00:18:30.000 --> 00:18:31.000 friends at school who go to 00:18:31.000 --> 00:18:34.000 therapy or take medications 00:18:34.000 --> 00:18:35.000 or do all these things and I 00:18:35.000 --> 00:18:36.000 think it would be helpful for me 00:18:36.000 --> 00:18:39.000 but I can't ask my dad because 00:18:39.000 --> 00:18:40.000 my family and my culture is 00:18:40.000 --> 00:18:44.000 completely not okay with it 00:18:44.000 --> 00:18:46.000 I do need help and I feel 00:18:46.000 --> 00:18:47.000 like I need to come and talk 00:18:47.000 --> 00:18:48.000 to somebody I don't have an 00:18:48.000 --> 00:18:51.000 alcohol problem I don't know 00:18:51.000 --> 00:18:52.000 what I should do but I can't 00:18:52.000 --> 00:18:57.000 tell my dad right so now I got 00:18:57.000 --> 00:18:61.000 two ethical dilemmas one is I 00:19:01.000 --> 00:19:03.000 have to incorporate dad son's 00:19:03.000 --> 00:19:05.000 not okay with it and then two 00:19:05.000 --> 00:19:07.000 dad doesn't want to engage and 00:19:08.000 --> 00:19:10.000 engage in treatment and then I 00:19:10.000 --> 00:19:11.000 have to think okay is this a 00:19:11.000 --> 00:19:13.000 neglect kinda issue and I said 00:19:13.000 --> 00:19:14.000 no it's not a neglect issue this is 00:19:14.000 --> 00:19:17.000 very much stigma oriented and 00:19:17.000 --> 00:19:18.000 really some strong values and 00:19:18.000 --> 00:19:20.000 perspectives around mental health 00:19:20.000 --> 00:19:21.000 right so it's not ill intent 00:19:21.000 --> 00:19:24.000 is just perspectives right -- 00:19:24.000 --> 00:19:26.000 so stuck I had to do a lot of 00:19:26.000 --> 00:19:29.000 consultation and we actually 00:19:29.000 --> 00:19:31.000 made it so this team could go 00:19:31.000 --> 00:19:34.000 and visit with primary care and 00:19:34.000 --> 00:19:35.000 a behaviorial health specialist 00:19:35.000 --> 00:19:38.000 and get sessions and some coping 00:19:38.000 --> 00:19:40.000 tools around anxiety without 00:19:40.000 --> 00:19:41.000 being in the mental health 00:19:41.000 --> 00:19:44.000 department right so he got 00:19:44.000 --> 00:19:45.000 the support he needed and the 00:19:45.000 --> 00:19:49.000 dad was engaged in it but we 00:19:49.000 --> 00:19:50.000 were also able to work with 00:19:50.000 --> 00:19:52.000 those family values right it's 00:19:52.000 --> 00:19:54.000 still mental health work but 00:19:54.000 --> 00:19:55.000 there -- there's stigma and that's 00:19:55.000 --> 00:19:56.000 something that we have to 00:19:56.000 --> 00:19:57.000 work with because I am not 00:19:57.000 --> 00:19:58.000 responsible for changing the 00:19:58.000 --> 00:19:61.000 dads perspectives can't do that 00:20:03.000 --> 00:20:04.000 would be unethical for me to 00:20:04.000 --> 00:20:06.000 say that this adolescent didn't 00:20:06.000 --> 00:20:08.000 need anything he doesn't need 00:20:08.000 --> 00:20:10.000 substance you know treatment 00:20:10.000 --> 00:20:11.000 but he needs some support with 00:20:11.000 --> 00:20:15.000 his anxiety right so common 00:20:15.000 --> 00:20:16.000 ethical dilemma that happens 00:20:16.000 --> 00:20:19.000 with adolescents all the time 00:20:19.000 --> 00:20:21.000 right balancing when to and 00:20:21.000 --> 00:20:23.000 when not to incorporate family 00:20:23.000 --> 00:20:25.000 all the time okay the next 00:20:25.000 --> 00:20:28.000 one is a Persian male want to 00:20:28.000 --> 00:20:30.000 say he's about mid thirties he was 00:20:30.000 --> 00:20:32.000 supposed to engage in treatment 00:20:32.000 --> 00:20:33.000 due to a legal obligation but 00:20:33.000 --> 00:20:35.000 when he first came to me there 00:20:35.000 --> 00:20:37.000 was no legal obligation and he 00:20:37.000 --> 00:20:39.000 engaged himself he knew that 00:20:39.000 --> 00:20:41.000 he needed some support I saw him 00:20:41.000 --> 00:20:43.000 biweekly for about two and a 00:20:43.000 --> 00:20:45.000 half months -- for individual 00:20:45.000 --> 00:20:46.000 sessions and throughout this 00:20:46.000 --> 00:20:47.000 time he was also doing group 00:20:47.000 --> 00:20:49.000 therapy -- on a weekly basis 00:20:49.000 --> 00:20:51.000 it just wasn't with me -- but 00:20:51.000 --> 00:20:52.000 I had a pretty good idea of what 00:20:52.000 --> 00:20:54.000 he was discussing this entire 00:20:54.000 --> 00:20:57.000 two and a half months he was 00:20:57.000 --> 00:20:59.000 complaining about his wife 00:20:59.000 --> 00:20:62.000 and their interactions and his 00:21:02.000 --> 00:21:05.000 wife's kind of issues with him 00:21:05.000 --> 00:21:07.000 trying to fulfill his family 00:21:07.000 --> 00:21:09.000 obligations right allowing his 00:21:09.000 --> 00:21:11.000 family -- from overseas to come 00:21:11.000 --> 00:21:12.000 and stay with them for extended 00:21:12.000 --> 00:21:14.000 periods of time he didn't 00:21:14.000 --> 00:21:15.000 feel comfortable he wanted to 00:21:15.000 --> 00:21:16.000 really do that but she didn't 00:21:16.000 --> 00:21:18.000 feel comfortable with that 00:21:21.000 --> 00:21:22.000 he felt like he had all these 00:21:22.000 --> 00:21:24.000 obligations towards his family 00:21:24.000 --> 00:21:25.000 and his wife just wasn't able 00:21:25.000 --> 00:21:28.000 to understand that understand 00:21:28.000 --> 00:21:29.000 why he couldn't step away why he 00:21:29.000 --> 00:21:31.000 couldn't set some boundaries 00:21:31.000 --> 00:21:33.000 and then he would emphasize 00:21:36.000 --> 00:21:38.000 immediate family so his kids 00:21:38.000 --> 00:21:39.000 and his wife of you know I'm 00:21:39.000 --> 00:21:42.000 a provider I clean I work I cook 00:21:42.000 --> 00:21:44.000 I do all these things that any 00:21:44.000 --> 00:21:46.000 wife should be happy with why 00:21:46.000 --> 00:21:48.000 is she not happy why doesn't 00:21:48.000 --> 00:21:50.000 she understand that I had 00:21:50.000 --> 00:21:51.000 these other family obligations 00:21:51.000 --> 00:21:52.000 that I fulfill and it does 00:21:52.000 --> 00:21:54.000 not impede the quality of our 00:21:54.000 --> 00:21:56.000 life here in the United States 00:21:56.000 --> 00:21:59.000 right complains every session 00:21:59.000 --> 00:21:61.000 right every session there's at 00:22:01.000 --> 00:22:02.000 least forty five minutes where 00:22:02.000 --> 00:22:04.000 he's talking about this even 00:22:04.000 --> 00:22:05.000 though that was not his primary 00:22:05.000 --> 00:22:08.000 concern and then he goes on 00:22:08.000 --> 00:22:09.000 towords I want to say the 00:22:09.000 --> 00:22:11.000 last month of working with him 00:22:11.000 --> 00:22:13.000 saying that you know what this is 00:22:14.000 --> 00:22:16.000 emotional distress like I -- I 00:22:16.000 --> 00:22:18.000 don't feel I feel suffocated in 00:22:18.000 --> 00:22:20.000 my house I feel so overwhelmed 00:22:20.000 --> 00:22:22.000 that I have to walk outside and 00:22:22.000 --> 00:22:25.000 I'm crying and sitting in my 00:22:25.000 --> 00:22:27.000 car outside in the cold because 00:22:27.000 --> 00:22:29.000 I just can't go in and interact 00:22:29.000 --> 00:22:32.000 with my wife I just can't do it 00:22:32.000 --> 00:22:36.000 right what's going on here what's 00:22:36.000 --> 00:22:37.000 some ethical issues going on in 00:22:37.000 --> 00:22:40.000 this one I have his perspective 00:22:40.000 --> 00:22:43.000 of the story yep okay how do I 00:22:43.000 --> 00:22:45.000 alleviate this ethical dilemma 00:22:45.000 --> 00:22:47.000 so invite the wife and 00:22:47.000 --> 00:22:48.000 then figure out how we want to 00:22:48.000 --> 00:22:51.000 approach that session right how 00:22:51.000 --> 00:22:52.000 can I do this without damaging 00:22:52.000 --> 00:22:55.000 the therapeutic rapport so 00:22:55.000 --> 00:22:56.000 set some frameworks for the 00:22:56.000 --> 00:22:59.000 couple what's a cultural piece 00:22:59.000 --> 00:22:60.000 that's missing in this that 00:23:00.000 --> 00:23:01.000 I have to be very mindful 00:23:01.000 --> 00:23:03.000 of both of those things 00:23:03.000 --> 00:23:06.000 completely accurate okay 00:23:06.000 --> 00:23:08.000 the wife -- does not 00:23:08.000 --> 00:23:10.000 understand the gender roles the 00:23:10.000 --> 00:23:12.000 family obligations and the 00:23:12.000 --> 00:23:15.000 cultural expectations at all 00:23:15.000 --> 00:23:16.000 because her cultural background 00:23:16.000 --> 00:23:20.000 is completely different and 00:23:20.000 --> 00:23:22.000 his assumption was that now 00:23:22.000 --> 00:23:23.000 that we're married and now 00:23:23.000 --> 00:23:24.000 that she has a glimpse into 00:23:24.000 --> 00:23:28.000 my culture she must understand 00:23:28.000 --> 00:23:31.000 right so for this individual 00:23:31.000 --> 00:23:37.000 we did invite her in -- and 00:23:37.000 --> 00:23:39.000 she was willing to engage 00:23:39.000 --> 00:23:40.000 but instead of me seeing the 00:23:40.000 --> 00:23:43.000 individual I actually -- gave 00:23:43.000 --> 00:23:45.000 this couple a referral out 00:23:45.000 --> 00:23:47.000 to somebody who is -- has a 00:23:47.000 --> 00:23:48.000 better understanding of his 00:23:48.000 --> 00:23:50.000 cultural background and her 00:23:50.000 --> 00:23:52.000 cultural background and could 00:23:52.000 --> 00:23:53.000 collectively work with them 00:23:53.000 --> 00:23:54.000 in developing a framework of 00:23:54.000 --> 00:23:55.000 what their family would look 00:23:55.000 --> 00:23:58.000 like together okay there's two 00:23:58.000 --> 00:23:60.000 reasons why I did that one 00:24:00.000 --> 00:24:02.000 is because I've already been 00:24:02.000 --> 00:24:04.000 working with him individually 00:24:04.000 --> 00:24:06.000 to a certain extent and I 00:24:06.000 --> 00:24:07.000 have a somewhat of a skewed 00:24:07.000 --> 00:24:09.000 perspective at this point and it 00:24:09.000 --> 00:24:10.000 would have been very difficult 00:24:10.000 --> 00:24:12.000 for me to now switch that to 00:24:12.000 --> 00:24:14.000 a couple's session that happens 00:24:14.000 --> 00:24:16.000 in therapy a lot of times 00:24:16.000 --> 00:24:17.000 but you have to kind of make a 00:24:17.000 --> 00:24:18.000 clinical judgment of when that's 00:24:18.000 --> 00:24:20.000 appropriate to do the second 00:24:20.000 --> 00:24:24.000 piece is that -- his childhood 00:24:24.000 --> 00:24:26.000 and majority of his adult life 00:24:26.000 --> 00:24:28.000 was not in the United States 00:24:28.000 --> 00:24:30.000 right so when he moved here he 00:24:32.000 --> 00:24:35.000 point and so I was did not feel 00:24:35.000 --> 00:24:37.000 confident enough clinically to 00:24:37.000 --> 00:24:39.000 help with those issues along 00:24:39.000 --> 00:24:40.000 with everything else that I was 00:24:40.000 --> 00:24:42.000 working with him on right so 00:24:42.000 --> 00:24:44.000 a referral was necessary so 00:24:44.000 --> 00:24:45.000 that I wasn't working out of 00:24:45.000 --> 00:24:47.000 scope of practice for him so 00:24:47.000 --> 00:24:49.000 that was the route that we took 00:24:49.000 --> 00:24:52.000 okay the second ethical dilemma 00:24:52.000 --> 00:24:53.000 that comes up a lot is gift 00:24:53.000 --> 00:24:56.000 giving okay when I was in grad 00:24:56.000 --> 00:24:59.000 school I was told you don't 00:24:59.000 --> 00:24:61.000 share any personal information 00:25:01.000 --> 00:25:03.000 about yourself unless it's 00:25:03.000 --> 00:25:04.000 beneficial to the client 00:25:04.000 --> 00:25:08.000 and you never ever receive gifts 00:25:08.000 --> 00:25:10.000 right and that was like the first 00:25:10.000 --> 00:25:13.000 year and then second year well there 00:25:13.000 --> 00:25:14.000 are some exceptions but we 00:25:14.000 --> 00:25:15.000 never talked about what 00:25:15.000 --> 00:25:17.000 those exceptions were so then I 00:25:17.000 --> 00:25:19.000 started practicing and then I 00:25:19.000 --> 00:25:20.000 was like okay well there are 00:25:20.000 --> 00:25:21.000 exceptions but I don't know 00:25:21.000 --> 00:25:23.000 what these -- exceptions 00:25:23.000 --> 00:25:26.000 are and here we are right so our 00:25:26.000 --> 00:25:28.000 code of ethics say a couple 00:25:28.000 --> 00:25:30.000 different things that you have 00:25:30.000 --> 00:25:31.000 to have cultural awareness and 00:25:31.000 --> 00:25:32.000 you have to take appropriate 00:25:32.000 --> 00:25:34.000 steps to receiving gifts and 00:25:34.000 --> 00:25:36.000 then there's some frameworks 00:25:36.000 --> 00:25:37.000 around giving gifts as well as 00:25:37.000 --> 00:25:39.000 receiving gifts giving gifts could 00:25:39.000 --> 00:25:40.000 look like if you're doing 00:25:40.000 --> 00:25:43.000 group therapy and -- there's 00:25:43.000 --> 00:25:45.000 a graduation or there's some 00:25:45.000 --> 00:25:47.000 big accomplishment that one of 00:25:47.000 --> 00:25:49.000 the group members has and you 00:25:49.000 --> 00:25:51.000 want to celebrate that that 00:25:51.000 --> 00:25:53.000 can be a gift giving dynamic 00:25:53.000 --> 00:25:55.000 right how can you celebrate 00:25:55.000 --> 00:25:56.000 that without being partial to 00:25:56.000 --> 00:25:58.000 one of the group members right 00:25:58.000 --> 00:25:60.000 and how can you do that without 00:26:00.000 --> 00:26:01.000 overstepping your professional 00:26:01.000 --> 00:26:06.000 boundaries right this is a 00:26:06.000 --> 00:26:08.000 clinician specific rule that 00:26:08.000 --> 00:26:10.000 you create and it's also a agency 00:26:10.000 --> 00:26:12.000 specific rule so some agencies 00:26:12.000 --> 00:26:15.000 are very firm so nothing that 00:26:15.000 --> 00:26:17.000 you purchase it has to be 00:26:17.000 --> 00:26:19.000 these picked out items that we 00:26:19.000 --> 00:26:20.000 already have and this is all you 00:26:20.000 --> 00:26:22.000 can use and these are the frameworks 00:26:22.000 --> 00:26:23.000 so some agencies you get 00:26:23.000 --> 00:26:25.000 that luxury of you already know 00:26:25.000 --> 00:26:27.000 your framework most agencies 00:26:27.000 --> 00:26:28.000 don't do that they just kind 00:26:28.000 --> 00:26:29.000 of put a dollar amount you 00:26:29.000 --> 00:26:31.000 can't exceed this dollar amount 00:26:31.000 --> 00:26:32.000 and then everything else is on 00:26:32.000 --> 00:26:34.000 you the second piece is your 00:26:34.000 --> 00:26:36.000 comfort level too right how 00:26:36.000 --> 00:26:37.000 are you going to keep yourself 00:26:37.000 --> 00:26:39.000 accountable that you 00:26:39.000 --> 00:26:40.000 aren't being partial or 00:26:40.000 --> 00:26:43.000 biased to anybody in that group 00:26:43.000 --> 00:26:45.000 and how are you going to know 00:26:45.000 --> 00:26:46.000 when's the right time when is 00:26:46.000 --> 00:26:48.000 not because you can't really 00:26:48.000 --> 00:26:51.000 set these low boundaries for 00:26:51.000 --> 00:26:53.000 yourself of this is never 00:26:53.000 --> 00:26:54.000 going to happen or I will 00:26:54.000 --> 00:26:56.000 always do whatever right 00:26:56.000 --> 00:26:57.000 those are two extremes that 00:26:57.000 --> 00:26:59.000 you can't maintain the longer you 00:26:59.000 --> 00:26:60.000 practice those things are not 00:27:00.000 --> 00:27:03.000 maintainable okay -- and then 00:27:03.000 --> 00:27:05.000 receiving gifts people will 00:27:05.000 --> 00:27:07.000 bring you flowers they'll bring you 00:27:07.000 --> 00:27:09.000 chocolates and holiday times 00:27:09.000 --> 00:27:10.000 they bring you other things 00:27:10.000 --> 00:27:13.000 all this stuff happens right 00:27:13.000 --> 00:27:14.000 what's the ethical dilemma 00:27:14.000 --> 00:27:15.000 that comes up here that you 00:27:15.000 --> 00:27:17.000 need to be mindful of in terms 00:27:17.000 --> 00:27:18.000 of cultural awareness when it 00:27:18.000 --> 00:27:21.000 comes to receiving gifts mhmm what's 00:27:21.000 --> 00:27:26.000 their intention what else what 00:27:26.000 --> 00:27:28.000 is a big cultural component 00:27:28.000 --> 00:27:33.000 to the gift giving piece 00:27:33.000 --> 00:27:35.000 giving back is it how you 00:27:35.000 --> 00:27:38.000 accept the gift how you accept 00:27:38.000 --> 00:27:40.000 the gift absolutely can be 00:27:40.000 --> 00:27:41.000 right what does that look like 00:27:41.000 --> 00:27:44.000 what's the ritual around that 00:27:44.000 --> 00:27:47.000 or how to politely decline a gift 00:27:47.000 --> 00:27:50.000 how to decline a gift all of the above are 00:27:50.000 --> 00:27:52.000 correct okay -- so the culture 00:27:52.000 --> 00:27:55.000 component piece is that some 00:27:55.000 --> 00:27:58.000 cultures encourage gift giving 00:27:58.000 --> 00:27:61.000 as a way of saying thank you -- 00:28:01.000 --> 00:28:03.000 there's some ritual routine 00:28:03.000 --> 00:28:05.000 type of things behind it too 00:28:05.000 --> 00:28:07.000 some cultures when they engage 00:28:07.000 --> 00:28:09.000 in treatment or end treatment 00:28:09.000 --> 00:28:13.000 show respect right -- some 00:28:13.000 --> 00:28:15.000 cultures also do it as a way 00:28:15.000 --> 00:28:19.000 of -- expressing gratitude 00:28:19.000 --> 00:28:22.000 or success for themselves is 00:28:22.000 --> 00:28:24.000 they give gifts -- as way of 00:28:24.000 --> 00:28:25.000 having some kind of success or 00:28:25.000 --> 00:28:27.000 progress right so that's a 00:28:27.000 --> 00:28:28.000 cultural component -- and 00:28:28.000 --> 00:28:29.000 then there's the intention 00:28:29.000 --> 00:28:31.000 piece right so outside of that 00:28:31.000 --> 00:28:32.000 cultural component what is the 00:28:32.000 --> 00:28:34.000 intention that this individual 00:28:34.000 --> 00:28:36.000 has for giving you a gift 00:28:36.000 --> 00:28:38.000 okay the cultural piece one 00:28:38.000 --> 00:28:41.000 for me is the hardest because 00:28:41.000 --> 00:28:42.000 I don't know about every single 00:28:42.000 --> 00:28:44.000 culture out there nor will I 00:28:44.000 --> 00:28:48.000 ever right -- this one is one 00:28:51.000 --> 00:28:53.000 all the time because I have to 00:28:53.000 --> 00:28:54.000 figure out what their intention 00:28:54.000 --> 00:28:56.000 is and also be polite about 00:28:56.000 --> 00:28:59.000 it and then also know if it's 00:28:59.000 --> 00:28:60.000 appropriate for me to accept 00:29:00.000 --> 00:29:02.000 or decline and that all has to 00:29:02.000 --> 00:29:03.000 happen within like two minutes 00:29:03.000 --> 00:29:04.000 right because there's somebody 00:29:04.000 --> 00:29:06.000 standing there with a gift like 00:29:06.000 --> 00:29:07.000 this and you have to think of 00:29:07.000 --> 00:29:09.000 all of those things in that 00:29:09.000 --> 00:29:13.000 moment okay -- so I use a couple 00:29:13.000 --> 00:29:15.000 different criterias for myself 00:29:19.000 --> 00:29:20.000 value item I don't receive 00:29:20.000 --> 00:29:23.000 it right so if it's a store 00:29:23.000 --> 00:29:24.000 bought gift I typically don't 00:29:24.000 --> 00:29:27.000 receive it because that's a you 00:29:27.000 --> 00:29:28.000 know monetary thing they had 00:29:28.000 --> 00:29:30.000 to purchase out of funds that 00:29:30.000 --> 00:29:33.000 they have I try not to touch 00:29:33.000 --> 00:29:35.000 that area -- if they make me 00:29:35.000 --> 00:29:37.000 cards bring me flowers or baked 00:29:37.000 --> 00:29:39.000 goods I will typically accept 00:29:39.000 --> 00:29:41.000 them right because there's some 00:29:41.000 --> 00:29:43.000 intention and emotional value 00:29:43.000 --> 00:29:44.000 around that for individuals 00:29:44.000 --> 00:29:46.000 and I will accept them -- 00:29:46.000 --> 00:29:49.000 from a cultural standpoint -- 00:29:49.000 --> 00:29:52.000 the parts where I don't -- so 00:29:52.000 --> 00:29:53.000 I actually had supervision last 00:29:53.000 --> 00:29:55.000 night we talked about this 00:29:56.000 --> 00:29:58.000 had this occur with her it's 00:29:58.000 --> 00:29:60.000 occurred with me a couple times 00:30:00.000 --> 00:30:02.000 where -- I've worked with the 00:30:02.000 --> 00:30:03.000 individual and I can tell that 00:30:03.000 --> 00:30:05.000 they have some infatuation and 00:30:05.000 --> 00:30:08.000 have some interest and initially 00:30:08.000 --> 00:30:10.000 it was appropriate you know I 00:30:10.000 --> 00:30:13.000 didn't feel that way but now 00:30:13.000 --> 00:30:14.000 I'm like hmm there might be 00:30:14.000 --> 00:30:16.000 something there we need to 00:30:16.000 --> 00:30:18.000 understand and at that point I 00:30:18.000 --> 00:30:21.000 do not receive any gifts regardless 00:30:21.000 --> 00:30:22.000 of that cultural piece if 00:30:22.000 --> 00:30:24.000 there is a cultural piece 00:30:24.000 --> 00:30:25.000 that I need to be mindful of 00:30:25.000 --> 00:30:26.000 I communicate that of saying hey 00:30:26.000 --> 00:30:27.000 you know I know that this 00:30:27.000 --> 00:30:30.000 is important to you -- and 00:30:30.000 --> 00:30:31.000 this is what it means to you 00:30:31.000 --> 00:30:33.000 from what I understand but 00:30:33.000 --> 00:30:35.000 I have to decline because I 00:30:35.000 --> 00:30:36.000 don't think it's professional 00:30:36.000 --> 00:30:37.000 for me to accept gifts at 00:30:37.000 --> 00:30:39.000 this time -- and I know the 00:30:39.000 --> 00:30:40.000 gesture that you're trying 00:30:40.000 --> 00:30:42.000 to present and this is how 00:30:42.000 --> 00:30:43.000 we could do it or let's work 00:30:43.000 --> 00:30:46.000 a way to do it right that's 00:30:46.000 --> 00:30:48.000 an example of when there's a 00:30:48.000 --> 00:30:50.000 very firm boundary there right 00:30:50.000 --> 00:30:51.000 because sometimes you choose 00:30:51.000 --> 00:30:52.000 to terminate treatment right 00:30:52.000 --> 00:30:53.000 if that's appropriate there's 00:30:53.000 --> 00:30:54.000 a lot of consultation around 00:30:54.000 --> 00:30:56.000 that sometimes it's not 00:30:56.000 --> 00:30:58.000 appropriate to end treatment 00:30:58.000 --> 00:30:62.000 right -- and it's also -- 00:31:02.000 --> 00:31:05.000 messages okay that you have 00:31:05.000 --> 00:31:08.000 to be careful of -- this is 00:31:08.000 --> 00:31:10.000 something I missed very early 00:31:10.000 --> 00:31:12.000 on when I was seeing clients 00:31:13.000 --> 00:31:15.000 I had a clinical supervisor at 00:31:15.000 --> 00:31:17.000 that time who caught it -- for 00:31:17.000 --> 00:31:18.000 me so that I could backtrack 00:31:18.000 --> 00:31:20.000 really fast and catch it -- I 00:31:20.000 --> 00:31:23.000 was working with a family -- 00:31:23.000 --> 00:31:26.000 who had some DHS involvement -- 00:31:26.000 --> 00:31:27.000 they were already working 00:31:27.000 --> 00:31:30.000 with a behavioral specialist in 00:31:30.000 --> 00:31:33.000 the community -- to engage in 00:31:33.000 --> 00:31:35.000 some resources and services and 00:31:35.000 --> 00:31:37.000 then doing some parenting work 00:31:37.000 --> 00:31:39.000 and I didn't know why DHS was 00:31:39.000 --> 00:31:41.000 involved right because this was my 00:31:41.000 --> 00:31:45.000 second session with them and -- 00:31:45.000 --> 00:31:46.000 it was intended to be a couple's 00:31:46.000 --> 00:31:48.000 session but a five year old 00:31:48.000 --> 00:31:50.000 came in right first session and 00:31:50.000 --> 00:31:53.000 second session complained they didn't have 00:31:53.000 --> 00:31:55.000 a baby sitter he was just going 00:31:55.000 --> 00:31:56.000 to play in the room it wasn't 00:31:56.000 --> 00:31:61.000 a big deal and -- this five 00:32:01.000 --> 00:32:04.000 year old gives me a picture 00:32:04.000 --> 00:32:06.000 and says I drew it for you 00:32:06.000 --> 00:32:10.000 I want you to have it right 00:32:10.000 --> 00:32:11.000 there was a message there and 00:32:11.000 --> 00:32:12.000 if I wouldn't have accepted 00:32:12.000 --> 00:32:14.000 it what message could I have 00:32:14.000 --> 00:32:16.000 missed absolutely what's going 00:32:16.000 --> 00:32:17.000 on at home and projecting it 00:32:17.000 --> 00:32:19.000 yep so little kids through play 00:32:19.000 --> 00:32:21.000 and art can really be a very 00:32:21.000 --> 00:32:22.000 expressive of what's happening 00:32:22.000 --> 00:32:23.000 in the home or something that 00:32:23.000 --> 00:32:26.000 they've experienced -- so a 00:32:26.000 --> 00:32:27.000 lot of times when there's any 00:32:27.000 --> 00:32:30.000 kind of abuse or trauma we 00:32:30.000 --> 00:32:31.000 do a lot of art therapy and 00:32:31.000 --> 00:32:34.000 play therapy with them the 00:32:34.000 --> 00:32:35.000 kid was trying to tell me that 00:32:35.000 --> 00:32:38.000 something was happening at home 00:32:38.000 --> 00:32:40.000 and I almost missed it like 00:32:40.000 --> 00:32:41.000 I probably would have really 00:32:41.000 --> 00:32:42.000 had a really difficult time 00:32:42.000 --> 00:32:43.000 emotionally recovering from 00:32:43.000 --> 00:32:44.000 that if I would have missed 00:32:44.000 --> 00:32:47.000 that right so that's one of 00:32:47.000 --> 00:32:49.000 those ethical dilemmas where 00:32:49.000 --> 00:32:51.000 you have to be very mindful of 00:32:51.000 --> 00:32:52.000 why somebody is giving you a 00:32:52.000 --> 00:32:53.000 gift whether that's an adult 00:32:53.000 --> 00:32:56.000 or a child right there's always 00:32:56.000 --> 00:32:58.000 the sentimental value there's 00:32:58.000 --> 00:32:60.000 a cultural piece but are they 00:33:00.000 --> 00:33:01.000 trying to communicate with 00:33:01.000 --> 00:33:02.000 you about something that's 00:33:02.000 --> 00:33:03.000 happening that you might not 00:33:03.000 --> 00:33:06.000 be aware of okay this can also 00:33:06.000 --> 00:33:07.000 happen with adults who are in 00:33:07.000 --> 00:33:09.000 abusive relationships or 00:33:09.000 --> 00:33:12.000 family dynamics they might 00:33:12.000 --> 00:33:13.000 draw you something might give 00:33:13.000 --> 00:33:15.000 you a gift and you open it up 00:33:15.000 --> 00:33:17.000 and there's a note in there 00:33:17.000 --> 00:33:20.000 right or you open it up and you 00:33:20.000 --> 00:33:22.000 realize hey this thing shouldn't 00:33:22.000 --> 00:33:24.000 be with this person why are 00:33:24.000 --> 00:33:26.000 they giving it to me right what 00:33:26.000 --> 00:33:27.000 are they trying to communicate 00:33:27.000 --> 00:33:28.000 because sometimes you are the 00:33:28.000 --> 00:33:30.000 only contact that they have 00:33:30.000 --> 00:33:32.000 with the outside world because 00:33:32.000 --> 00:33:33.000 they're mandated to be there 00:33:33.000 --> 00:33:34.000 for example if there's DHS 00:33:34.000 --> 00:33:38.000 involvement right so sometimes 00:33:38.000 --> 00:33:42.000 have to communicate with it is 00:33:42.000 --> 00:33:43.000 a gift but you have to be very 00:33:43.000 --> 00:33:45.000 aware so it wasn't a family that 00:33:45.000 --> 00:33:47.000 I continued working with but 00:33:49.000 --> 00:33:51.000 we realized almost immediately 00:33:51.000 --> 00:33:52.000 that there were some abuse 00:33:52.000 --> 00:33:54.000 because there was some very 00:33:54.000 --> 00:33:55.000 descriptive images that this 00:33:55.000 --> 00:33:57.000 kid had drawn -- so we actually 00:33:57.000 --> 00:33:59.000 did not let the child leave 00:33:59.000 --> 00:33:61.000 the clinic that evening -- and 00:34:01.000 --> 00:34:03.000 the child was able to see 00:34:05.000 --> 00:34:06.000 figured out there some abuse 00:34:06.000 --> 00:34:08.000 happening at home -- and even 00:34:08.000 --> 00:34:10.000 though the DHS involvement was 00:34:10.000 --> 00:34:11.000 related to something else there 00:34:11.000 --> 00:34:12.000 was this and so we had to do a 00:34:12.000 --> 00:34:15.000 mandatory report and there's a 00:34:15.000 --> 00:34:16.000 whole process there's a whole 00:34:16.000 --> 00:34:18.000 care team process for that so 00:34:18.000 --> 00:34:21.000 wherever you work right you 00:34:21.000 --> 00:34:23.000 will always know who your go 00:34:23.000 --> 00:34:25.000 to is when that situation occurs 00:34:25.000 --> 00:34:26.000 and if there's a child involved 00:34:26.000 --> 00:34:28.000 we typically do not let them 00:34:28.000 --> 00:34:30.000 leave right because once 00:34:30.000 --> 00:34:32.000 they leave you no longer have 00:34:32.000 --> 00:34:34.000 contact with them even if you 00:34:34.000 --> 00:34:35.000 know where they live you still 00:34:35.000 --> 00:34:37.000 don't have contact termination 00:34:37.000 --> 00:34:39.000 and referral love doing 00:34:39.000 --> 00:34:40.000 referrals termination is really 00:34:40.000 --> 00:34:43.000 hard for me so it's unethical 00:34:43.000 --> 00:34:44.000 for us to not refer when we 00:34:44.000 --> 00:34:47.000 need to refer it also says 00:34:47.000 --> 00:34:49.000 that as a counselor we should 00:34:49.000 --> 00:34:51.000 not be referring somebody 00:34:51.000 --> 00:34:54.000 solely based on our own values 00:34:54.000 --> 00:34:57.000 or beliefs and we also need 00:34:57.000 --> 00:34:59.000 to be mindful of diversity 00:34:59.000 --> 00:34:61.000 of this individual and make 00:35:01.000 --> 00:35:03.000 sure that our own values 00:35:03.000 --> 00:35:04.000 and beliefs are not impeding 00:35:04.000 --> 00:35:05.000 their success and we're not 00:35:05.000 --> 00:35:07.000 imposing our own beliefs and 00:35:07.000 --> 00:35:10.000 values onto the individual so 00:35:10.000 --> 00:35:12.000 if you're in a room with two 00:35:12.000 --> 00:35:14.000 people you have two different 00:35:14.000 --> 00:35:16.000 perspectives values beliefs 00:35:16.000 --> 00:35:18.000 all of those things you as a 00:35:18.000 --> 00:35:19.000 clinician and counselor are also a 00:35:19.000 --> 00:35:21.000 person therefore when you're in 00:35:21.000 --> 00:35:22.000 that room your bias is always 00:35:22.000 --> 00:35:25.000 there right there's no way 00:35:25.000 --> 00:35:27.000 to erase that ever absolutely 00:35:27.000 --> 00:35:29.000 never right we try to be very 00:35:29.000 --> 00:35:31.000 aware of it we try to be very 00:35:31.000 --> 00:35:33.000 mindful of it and make sure 00:35:33.000 --> 00:35:36.000 that our bias is not guiding 00:35:36.000 --> 00:35:38.000 how we move forward with our 00:35:38.000 --> 00:35:40.000 clients but it's still present 00:35:40.000 --> 00:35:42.000 right so we have to be mindful of that 00:35:45.000 --> 00:35:48.000 you to share can share as 00:35:48.000 --> 00:35:52.000 little or as little or more 00:35:52.000 --> 00:35:53.000 whatever feels comfortable 00:35:53.000 --> 00:35:56.000 for you -- you're gonna have like 00:35:56.000 --> 00:35:57.000 a quick thirty seconds to answer 00:35:57.000 --> 00:35:61.000 this question -- APA 00:36:01.000 --> 00:36:02.000 and our code of ethics say that 00:36:02.000 --> 00:36:04.000 whenever we assess the client 00:36:04.000 --> 00:36:07.000 we have to ask them about culture 00:36:07.000 --> 00:36:09.000 right so I'm gonna ask you the same 00:36:09.000 --> 00:36:10.000 question that every client gets 00:36:10.000 --> 00:36:12.000 to answer and they have thirty 00:36:12.000 --> 00:36:13.000 seconds to answer because 00:36:13.000 --> 00:36:15.000 you kind of move on right 00:36:17.000 --> 00:36:19.000 your cultural background 00:36:19.000 --> 00:36:21.000 so my cultural background is a blended culture 00:36:21.000 --> 00:36:28.000 of -- European and -- Native American 00:36:37.000 --> 00:36:38.000 Caucasian 00:36:38.000 --> 00:36:39.000 Hispanic 00:36:39.000 --> 00:36:42.000 I'm -- Iranian American 00:36:42.000 --> 00:36:45.000 I'm Caucasian -- 00:36:45.000 --> 00:36:48.000 my cultural background is 00:36:49.000 --> 00:36:51.000 would be white or Caucasian 00:36:51.000 --> 00:36:52.000 but I would say that I also 00:36:52.000 --> 00:36:54.000 come from a bigger family 00:36:54.000 --> 00:36:57.000 which impacts my culture 00:37:03.000 --> 00:37:04.000 and Highland Scot 00:37:04.000 --> 00:37:10.000 and I'm also -- LGBTQ identified 00:37:10.000 --> 00:37:13.000 and I'm Asian but I immigrated 00:37:13.000 --> 00:37:16.000 to the US -- twenty years ago 00:37:16.000 --> 00:37:17.000 you guys have been together for what five 00:37:17.000 --> 00:37:19.000 weeks now why didn't you know 00:37:19.000 --> 00:37:21.000 that about each other you 00:37:21.000 --> 00:37:22.000 probably all assumed what 00:37:22.000 --> 00:37:24.000 the other person was right 00:37:24.000 --> 00:37:25.000 we assume about race all the 00:37:25.000 --> 00:37:27.000 time we assume about cultural 00:37:27.000 --> 00:37:32.000 background all the time why don't we ask 00:37:32.000 --> 00:37:34.000 sometimes it's rude sometimes it's rude 00:37:34.000 --> 00:37:36.000 or can be rude right yeah 00:37:36.000 --> 00:37:39.000 based on how you ask it yep 00:37:39.000 --> 00:37:41.000 okay this is a ethical 00:37:41.000 --> 00:37:45.000 dilemma issue because -- I 00:37:45.000 --> 00:37:46.000 would encourage all of you 00:37:46.000 --> 00:37:48.000 right you guys are first -- this 00:37:48.000 --> 00:37:50.000 is first term so it's fine but 00:37:50.000 --> 00:37:52.000 as you progress you should 00:37:52.000 --> 00:37:54.000 be having this conversation 00:37:54.000 --> 00:37:55.000 about who you are as a person 00:37:55.000 --> 00:37:56.000 because culture is not about just 00:37:56.000 --> 00:37:58.000 race it's about many other 00:37:58.000 --> 00:37:60.000 things so you need to be able 00:38:00.000 --> 00:38:02.000 to develop comfort not only 00:38:02.000 --> 00:38:04.000 understanding your own cultural 00:38:04.000 --> 00:38:05.000 background but also being 00:38:05.000 --> 00:38:08.000 able to communicate it right 00:38:08.000 --> 00:38:09.000 because you as a clinician 00:38:09.000 --> 00:38:10.000 are going to be asked all the 00:38:10.000 --> 00:38:12.000 time by your clients in that 00:38:12.000 --> 00:38:15.000 room because your cultural 00:38:15.000 --> 00:38:17.000 background is if I was a 00:38:17.000 --> 00:38:19.000 client and I was sitting in that 00:38:19.000 --> 00:38:21.000 room I would like to connect 00:38:21.000 --> 00:38:23.000 with you in some capacity and 00:38:23.000 --> 00:38:25.000 to know that I am going 00:38:25.000 --> 00:38:27.000 to be able to relate or that 00:38:27.000 --> 00:38:31.000 understand something about me 00:38:31.000 --> 00:38:33.000 right this is something that 00:38:33.000 --> 00:38:35.000 creates a lot of ethical 00:38:35.000 --> 00:38:37.000 dilemmas for clinicians 00:38:37.000 --> 00:38:38.000 across the board not just in 00:38:38.000 --> 00:38:40.000 mental health but any helping 00:38:40.000 --> 00:38:42.000 profession okay because your 00:38:42.000 --> 00:38:44.000 cultural background determines 00:38:44.000 --> 00:38:46.000 what you're able to do in that 00:38:46.000 --> 00:38:47.000 room as well as what you're 00:38:47.000 --> 00:38:49.000 able to do outside of that room 00:38:49.000 --> 00:38:51.000 you can't create a treatment 00:38:51.000 --> 00:38:52.000 plan if you don't have an 00:38:52.000 --> 00:38:53.000 understanding of their cultural 00:38:53.000 --> 00:38:56.000 background you can't create 00:38:56.000 --> 00:38:57.000 a treatment plan if you don't 00:38:57.000 --> 00:38:58.000 have an understanding of your 00:38:58.000 --> 00:38:60.000 own cultural background because 00:39:00.000 --> 00:39:01.000 you're gonna have all these 00:39:01.000 --> 00:39:03.000 biases present that you're not 00:39:03.000 --> 00:39:05.000 even aware of right because 00:39:05.000 --> 00:39:07.000 those two things exist you've 00:39:07.000 --> 00:39:08.000 already created an ethical 00:39:08.000 --> 00:39:10.000 dilemma without you knowing 00:39:10.000 --> 00:39:12.000 anything about your client 00:39:12.000 --> 00:39:13.000 there is an ethical dilemma in the 00:39:13.000 --> 00:39:17.000 room okay now you all shared 00:39:17.000 --> 00:39:21.000 less than ten seconds right 00:39:21.000 --> 00:39:22.000 but if this was an actual group 00:39:22.000 --> 00:39:23.000 therapy or if this was an 00:39:23.000 --> 00:39:25.000 assessment I should have been 00:39:25.000 --> 00:39:27.000 prepared to respond to whatever 00:39:27.000 --> 00:39:30.000 you said as well and that 00:39:30.000 --> 00:39:32.000 creates ethical dilemmas -- 00:39:32.000 --> 00:39:33.000 like Katie mentioned it could be 00:39:33.000 --> 00:39:35.000 rude right the way that I ask 00:39:35.000 --> 00:39:36.000 it or the way that I respond to 00:39:36.000 --> 00:39:38.000 it can be rude and right there 00:39:38.000 --> 00:39:40.000 I've not only broken rapport 00:39:40.000 --> 00:39:42.000 but I might have touched on 00:39:42.000 --> 00:39:43.000 some value sets that are very 00:39:43.000 --> 00:39:45.000 important to that individual 00:39:45.000 --> 00:39:47.000 right there's stigma around 00:39:47.000 --> 00:39:49.000 mental health across the board 00:39:49.000 --> 00:39:50.000 and then on top of that if 00:39:50.000 --> 00:39:51.000 you're violating some -- 00:39:51.000 --> 00:39:53.000 a value that a client has 00:39:53.000 --> 00:39:55.000 you've also damaged it even more 00:39:55.000 --> 00:39:57.000 right you can't prevent it every 00:39:57.000 --> 00:39:59.000 single time but you want to 00:39:59.000 --> 00:39:61.000 do the best that you can to 00:40:01.000 --> 00:40:03.000 prevent it when you can okay 00:40:03.000 --> 00:40:05.000 so for this one this is a kind of a 00:40:05.000 --> 00:40:09.000 lengthy one I have a female who's 00:40:09.000 --> 00:40:11.000 twenty six years old and she's 00:40:11.000 --> 00:40:13.000 been in sessions with me for a 00:40:13.000 --> 00:40:15.000 period of one year but they're 00:40:15.000 --> 00:40:16.000 shorter increments so she'll 00:40:16.000 --> 00:40:18.000 see me for maybe two months or 00:40:18.000 --> 00:40:19.000 three months and then stop go 00:40:19.000 --> 00:40:20.000 away then come back see me 00:40:20.000 --> 00:40:22.000 for a month go stop come back 00:40:22.000 --> 00:40:23.000 right it's been happening for 00:40:23.000 --> 00:40:26.000 a year she's been in therapy 00:40:26.000 --> 00:40:29.000 for about two or three years 00:40:29.000 --> 00:40:31.000 but just not with me other 00:40:31.000 --> 00:40:33.000 clinicians that she had been 00:40:33.000 --> 00:40:35.000 with she'd do the same thing and 00:40:35.000 --> 00:40:37.000 either she'd get terminated or 00:40:37.000 --> 00:40:38.000 they would say that there's no 00:40:38.000 --> 00:40:40.000 clinical necessity for her to 00:40:40.000 --> 00:40:43.000 continue or she would feel like 00:40:43.000 --> 00:40:44.000 there's just no rapport and 00:40:44.000 --> 00:40:45.000 understanding and so she would 00:40:45.000 --> 00:40:47.000 choose to terminate services 00:40:47.000 --> 00:40:48.000 right so either direction so 00:40:48.000 --> 00:40:49.000 this has been happening for 00:40:49.000 --> 00:40:51.000 awhile her primary concern 00:40:51.000 --> 00:40:53.000 is anxiety and it's causing 00:40:53.000 --> 00:40:55.000 loss of sleep appetite issues 00:40:55.000 --> 00:40:58.000 she's also having really 00:40:58.000 --> 00:40:59.000 hard time focusing while at 00:40:59.000 --> 00:40:61.000 work right so she's not getting 00:41:01.000 --> 00:41:03.000 her tasks done she just really 00:41:03.000 --> 00:41:04.000 doesn't have a desire to engage 00:41:04.000 --> 00:41:06.000 in activities even though 00:41:06.000 --> 00:41:07.000 she feels like she needs to 00:41:07.000 --> 00:41:09.000 because it's a work obligation 00:41:09.000 --> 00:41:12.000 over this you know year time 00:41:12.000 --> 00:41:13.000 frame she's disclosed some 00:41:13.000 --> 00:41:15.000 information but primarily in 00:41:15.000 --> 00:41:16.000 the past two months she's 00:41:16.000 --> 00:41:18.000 disclosed information about her 00:41:18.000 --> 00:41:20.000 boyfriend who she feels very 00:41:20.000 --> 00:41:22.000 committed to she will talk in 00:41:22.000 --> 00:41:25.000 detail about this is what I 00:41:25.000 --> 00:41:27.000 see my future like we're gonna 00:41:27.000 --> 00:41:28.000 get married we're gonna have kids this is 00:41:28.000 --> 00:41:29.000 what our house is gonna look 00:41:29.000 --> 00:41:30.000 like this is how we're gonna 00:41:30.000 --> 00:41:32.000 do holidays I mean you know 00:41:32.000 --> 00:41:34.000 every long term relationship 00:41:34.000 --> 00:41:35.000 she has thought about and has talked 00:41:35.000 --> 00:41:38.000 about and is very compassionate 00:41:38.000 --> 00:41:39.000 and hundred percent into this 00:41:39.000 --> 00:41:42.000 relationship and then she will 00:41:42.000 --> 00:41:44.000 describe some interactions with 00:41:44.000 --> 00:41:46.000 her boyfriend of maybe a 00:41:46.000 --> 00:41:50.000 argument a dispute or 00:41:50.000 --> 00:41:51.000 you know they go somewhere 00:41:51.000 --> 00:41:53.000 something happens and it 00:41:53.000 --> 00:41:55.000 becomes apparent to me as a 00:41:55.000 --> 00:41:56.000 clinician that this person 00:41:56.000 --> 00:41:58.000 is abusive her boyfriend 00:41:58.000 --> 00:41:60.000 is abusive okay -- he's 00:42:00.000 --> 00:42:02.000 emotionally and verbally aggressive 00:42:02.000 --> 00:42:05.000 he has these bursts of anger 00:42:05.000 --> 00:42:09.000 where he'll throw things bump 00:42:09.000 --> 00:42:11.000 into her accidentally push 00:42:11.000 --> 00:42:12.000 her but he has no intent to 00:42:12.000 --> 00:42:15.000 harm her he was just really mad -- 00:42:15.000 --> 00:42:17.000 and accidentally hurt her and that 00:42:17.000 --> 00:42:18.000 was never the intention and he 00:42:18.000 --> 00:42:19.000 would never do that knowingly 00:42:19.000 --> 00:42:21.000 right so there's always 00:42:21.000 --> 00:42:22.000 this framework around that 00:42:22.000 --> 00:42:24.000 discussion as a clinician it's 00:42:24.000 --> 00:42:25.000 very apparent to me that the 00:42:25.000 --> 00:42:27.000 anxiety and the symptoms that she's 00:42:27.000 --> 00:42:29.000 discussing is very much related 00:42:29.000 --> 00:42:31.000 to this abusive relationship 00:42:31.000 --> 00:42:33.000 and every clinical intervention 00:42:33.000 --> 00:42:36.000 that I have suggested around 00:42:36.000 --> 00:42:37.000 anxiety has not been successful 00:42:37.000 --> 00:42:39.000 and I think it's because of 00:42:39.000 --> 00:42:40.000 this abusive relationship and 00:42:40.000 --> 00:42:43.000 even when I talk about how 00:42:43.000 --> 00:42:44.000 we can combat this abusive 00:42:44.000 --> 00:42:46.000 relationship we haven't had 00:42:46.000 --> 00:42:49.000 progress -- we've talked about 00:42:49.000 --> 00:42:50.000 safety planning we've talked 00:42:50.000 --> 00:42:52.000 about working around barriers 00:42:52.000 --> 00:42:53.000 so that she can be in a safe 00:42:53.000 --> 00:42:54.000 environment even if she's there 00:42:54.000 --> 00:42:58.000 we're still not making progress -- 00:42:58.000 --> 00:42:60.000 and she hasn't really engaged in 00:43:00.000 --> 00:43:02.000 any treatment recommendations 00:43:02.000 --> 00:43:03.000 not even around this abusive 00:43:03.000 --> 00:43:04.000 relationship even just the 00:43:04.000 --> 00:43:06.000 minor things right try to go to 00:43:06.000 --> 00:43:08.000 bed at the same time at night 00:43:08.000 --> 00:43:10.000 or -- drink more water I mean 00:43:10.000 --> 00:43:13.000 just basic self care things 00:43:13.000 --> 00:43:15.000 she's not even following right 00:43:15.000 --> 00:43:16.000 so and she leaves and comes 00:43:16.000 --> 00:43:18.000 back leaves and comes back 00:43:18.000 --> 00:43:21.000 now as a clinician I should 00:43:21.000 --> 00:43:22.000 probably terminate her she's 00:43:22.000 --> 00:43:23.000 not making progress there's 00:43:23.000 --> 00:43:25.000 no clinical necessity but I 00:43:25.000 --> 00:43:26.000 have some ethical dilemmas 00:43:26.000 --> 00:43:29.000 happening here what are they 00:43:29.000 --> 00:43:30.000 okay so Devon's mentioned a 00:43:30.000 --> 00:43:31.000 couple things and I'm gonna respond 00:43:31.000 --> 00:43:34.000 to you -- with them so one is 00:43:36.000 --> 00:43:39.000 to treatment right and she is 00:43:39.000 --> 00:43:40.000 because she keeps coming back 00:43:40.000 --> 00:43:42.000 right so there's some level of 00:43:42.000 --> 00:43:43.000 engagement there but maybe not 00:43:43.000 --> 00:43:45.000 engaged in the recommendations 00:43:45.000 --> 00:43:47.000 the second one is -- is it 00:43:47.000 --> 00:43:49.000 safe and appropriate for her 00:43:49.000 --> 00:43:51.000 to be removed or for this 00:43:51.000 --> 00:43:52.000 individual to be removed so 00:43:52.000 --> 00:43:54.000 that there's that piece -- 00:43:54.000 --> 00:43:56.000 and then the third piece is 00:43:59.000 --> 00:43:60.000 is this really what that 00:44:00.000 --> 00:44:01.000 individual wants to do right 00:44:01.000 --> 00:44:03.000 so we can't tell a client what 00:44:03.000 --> 00:44:06.000 to do and you know is it our 00:44:06.000 --> 00:44:08.000 motivation or there's right 00:44:08.000 --> 00:44:10.000 so there's that piece okay so let's 00:44:10.000 --> 00:44:12.000 fast forward and say that she 00:44:12.000 --> 00:44:14.000 has been in treatment with me 00:44:14.000 --> 00:44:16.000 three years with the same story 00:44:16.000 --> 00:44:18.000 and the same issues now is it 00:44:18.000 --> 00:44:19.000 appropriate for me to terminate 00:44:19.000 --> 00:44:23.000 if she's not making progress 00:44:23.000 --> 00:44:24.000 yes or no raise your hand 00:44:24.000 --> 00:44:28.000 if it's a yes raise your hand if it's 00:44:28.000 --> 00:44:29.000 a -- so we have a partial 00:44:29.000 --> 00:44:32.000 two for yes -- we have two 00:44:32.000 --> 00:44:36.000 for yes how many for no 00:44:36.000 --> 00:44:39.000 okay who is a maybe I don't know we got 00:44:39.000 --> 00:44:42.000 a depends okay so we got a couple 00:44:42.000 --> 00:44:45.000 things okay so one is -- 00:44:45.000 --> 00:44:46.000 keeping somebody for treatment 00:44:46.000 --> 00:44:48.000 for three years unethical 00:44:48.000 --> 00:44:50.000 if they're not making progress 00:44:50.000 --> 00:44:52.000 with the same issue because 00:44:52.000 --> 00:44:54.000 it could be that I am not 00:44:54.000 --> 00:44:55.000 clinically doing what I need 00:44:55.000 --> 00:44:57.000 to be doing and I don't have 00:44:57.000 --> 00:44:59.000 confidence in the area three 00:44:59.000 --> 00:44:61.000 it could be that there 00:45:01.000 --> 00:45:04.000 is some stagnation that's with 00:45:04.000 --> 00:45:06.000 this therapeutic relationship 00:45:06.000 --> 00:45:07.000 it could be with individual 00:45:07.000 --> 00:45:09.000 I could be with me I don't 00:45:09.000 --> 00:45:11.000 those things right so there's 00:45:11.000 --> 00:45:12.000 some ethical stuff going on 00:45:12.000 --> 00:45:13.000 somebody seeing you for three 00:45:13.000 --> 00:45:15.000 years you can no longer make 00:45:15.000 --> 00:45:17.000 a clinical justification 00:45:17.000 --> 00:45:20.000 right the third piece is if 00:45:20.000 --> 00:45:21.000 she's there with insurance 00:45:21.000 --> 00:45:22.000 her insurance is not going to 00:45:22.000 --> 00:45:24.000 approve it so you can make the 00:45:24.000 --> 00:45:25.000 clinical recommendation but her 00:45:25.000 --> 00:45:26.000 insurance is not gonna approve it 00:45:26.000 --> 00:45:28.000 and you can't say that here are the 00:45:28.000 --> 00:45:29.000 reasons when those reasons don't 00:45:29.000 --> 00:45:31.000 exist right because that's 00:45:31.000 --> 00:45:33.000 insurance fraud right so those 00:45:33.000 --> 00:45:35.000 all those things would factor 00:45:35.000 --> 00:45:37.000 into termination without your 00:45:37.000 --> 00:45:38.000 desire to terminate right so 00:45:38.000 --> 00:45:40.000 this individual might terminate 00:45:40.000 --> 00:45:41.000 because those resources aren't 00:45:41.000 --> 00:45:46.000 there for the person okay -- 00:45:46.000 --> 00:45:48.000 there's a huge ethical dilemma 00:45:48.000 --> 00:45:50.000 and it says it's up there 00:45:50.000 --> 00:45:51.000 it says it's become apparent 00:45:51.000 --> 00:45:55.000 to me as the counselor that 00:45:55.000 --> 00:45:57.000 the boyfriend is abusive 00:45:57.000 --> 00:45:60.000 she's not saying it's abusive 00:46:00.000 --> 00:46:02.000 right I also don't have 00:46:02.000 --> 00:46:04.000 clarity as to exactly what's 00:46:04.000 --> 00:46:07.000 going on that would say that 00:46:07.000 --> 00:46:10.000 it's abusive right and then 00:46:10.000 --> 00:46:11.000 it's a fine line I'm not an 00:46:11.000 --> 00:46:12.000 investigator so it's not my 00:46:12.000 --> 00:46:14.000 job to determine if abuse is 00:46:14.000 --> 00:46:17.000 happening or not right but 00:46:17.000 --> 00:46:19.000 I am also imposing my values 00:46:19.000 --> 00:46:21.000 then right if you're in an abusive 00:46:21.000 --> 00:46:23.000 relationship I as a clinician 00:46:23.000 --> 00:46:24.000 wanna be protective and get 00:46:24.000 --> 00:46:26.000 you out of that situation to 00:46:26.000 --> 00:46:28.000 the best of my ability because 00:46:28.000 --> 00:46:30.000 I want you to be safe that 00:46:30.000 --> 00:46:33.000 is my bias and my value set 00:46:33.000 --> 00:46:34.000 if it was a minor it would look 00:46:34.000 --> 00:46:36.000 really different if it was 00:46:36.000 --> 00:46:37.000 a vulnerable population it would look 00:46:37.000 --> 00:46:41.000 very different right but I 00:46:41.000 --> 00:46:43.000 have a snapshot of this story 00:46:43.000 --> 00:46:44.000 I can't terminate her because 00:46:44.000 --> 00:46:46.000 she's not making progress 00:46:46.000 --> 00:46:47.000 because she's not aligning 00:46:47.000 --> 00:46:49.000 with my value set I can't 00:46:49.000 --> 00:46:50.000 terminate her because she's 00:46:50.000 --> 00:46:51.000 not meeting with the treatment 00:46:51.000 --> 00:46:53.000 goals because those treatment 00:46:53.000 --> 00:46:57.000 goes are mine not hers 00:46:57.000 --> 00:46:60.000 okay I also can't create a 00:47:00.000 --> 00:47:02.000 safety plan if she does not 00:47:02.000 --> 00:47:04.000 want to leave my safety plan 00:47:04.000 --> 00:47:07.000 has to be about safety alone 00:47:07.000 --> 00:47:08.000 not regarding what steps she's 00:47:08.000 --> 00:47:11.000 going to take all of those are 00:47:11.000 --> 00:47:14.000 ethical issues right that's not 00:47:14.000 --> 00:47:17.000 how I addressed it but was I 00:47:17.000 --> 00:47:18.000 thinking it absolutely right 00:47:18.000 --> 00:47:19.000 I was like I'm gonna pick you 00:47:19.000 --> 00:47:21.000 up and I'm just gonna put you in another 00:47:21.000 --> 00:47:22.000 state so this guy's not around 00:47:22.000 --> 00:47:23.000 you like if I could do that I 00:47:23.000 --> 00:47:25.000 would definitely do that but 00:47:25.000 --> 00:47:28.000 I can't rate right I can do is 00:47:28.000 --> 00:47:32.000 say look you've been in and out 00:47:32.000 --> 00:47:34.000 of treatment for a long time 00:47:34.000 --> 00:47:37.000 and you're telling me that your 00:47:37.000 --> 00:47:40.000 primary concern is anxiety okay 00:47:40.000 --> 00:47:42.000 you're also telling me about 00:47:42.000 --> 00:47:44.000 boyfriend that is concerning 00:47:44.000 --> 00:47:45.000 to me but it seems like it's 00:47:45.000 --> 00:47:48.000 not concerning to you you keep 00:47:48.000 --> 00:47:49.000 coming back so that says that 00:47:49.000 --> 00:47:51.000 you trust me at a certain level 00:47:51.000 --> 00:47:53.000 or there's some rapport or you're 00:47:53.000 --> 00:47:55.000 hoping that I'm gonna refer you 00:47:55.000 --> 00:47:56.000 somewhere there's -- you have 00:47:56.000 --> 00:47:58.000 some sort of hope I need you 00:47:58.000 --> 00:47:59.000 to tell me what that hope is 00:47:59.000 --> 00:47:62.000 and what you're hoping to gain 00:48:02.000 --> 00:48:04.000 right I also need to tell 00:48:04.000 --> 00:48:07.000 her I'm concerned here's why 00:48:07.000 --> 00:48:10.000 I'm concerned this is what I 00:48:10.000 --> 00:48:12.000 would suggest because of my 00:48:12.000 --> 00:48:14.000 level of concern but you get 00:48:14.000 --> 00:48:15.000 to make decisions and you tell 00:48:15.000 --> 00:48:16.000 me what you want to do and 00:48:16.000 --> 00:48:18.000 based on that we'll figure 00:48:18.000 --> 00:48:20.000 out what's best whether that's 00:48:20.000 --> 00:48:22.000 with me or somebody else that 00:48:22.000 --> 00:48:24.000 discussion needs to happen 00:48:24.000 --> 00:48:26.000 if it doesn't I'm -- making 00:48:26.000 --> 00:48:30.000 some big ethical violations 00:48:30.000 --> 00:48:33.000 right 00:48:33.000 --> 00:48:34.000 another thing that I am doing 00:48:34.000 --> 00:48:37.000 in here is this person is in 00:48:37.000 --> 00:48:39.000 therapy for three years even 00:48:39.000 --> 00:48:40.000 if it's with other people and 00:48:40.000 --> 00:48:42.000 they've all terminated as a 00:48:42.000 --> 00:48:44.000 clinician I should probably 00:48:44.000 --> 00:48:45.000 go back and figure out why 00:48:45.000 --> 00:48:49.000 those terminations happened 00:48:49.000 --> 00:48:51.000 right because maybe they have 00:48:51.000 --> 00:48:52.000 the same value set but they 00:48:52.000 --> 00:48:53.000 had some other information 00:48:53.000 --> 00:48:56.000 that I don't have at this point 00:48:56.000 --> 00:48:57.000 okay so sometimes this could 00:48:57.000 --> 00:48:59.000 be asking the client if you 00:48:59.000 --> 00:48:60.000 think that you're gonna get 00:49:00.000 --> 00:49:01.000 a accurate representation 00:49:03.000 --> 00:49:05.000 to their medical records going 00:49:05.000 --> 00:49:06.000 back and you have the right to 00:49:06.000 --> 00:49:08.000 look at them -- sometimes you 00:49:08.000 --> 00:49:10.000 can ask for consent sometimes 00:49:10.000 --> 00:49:11.000 you can say you know what I am 00:49:11.000 --> 00:49:13.000 stuck right we're not making 00:49:13.000 --> 00:49:14.000 progress and I really want to 00:49:14.000 --> 00:49:16.000 help you and I think I'll be 00:49:16.000 --> 00:49:17.000 able to understand this case 00:49:17.000 --> 00:49:19.000 better if I have insight as to 00:49:19.000 --> 00:49:20.000 what happened with your other 00:49:20.000 --> 00:49:21.000 clinicians are you okay with 00:49:21.000 --> 00:49:22.000 that and can I have a release 00:49:22.000 --> 00:49:23.000 to do that so you can have 00:49:23.000 --> 00:49:27.000 that dialogue right but this is 00:49:27.000 --> 00:49:29.000 something that I have to sit in 00:49:29.000 --> 00:49:30.000 the room with with this client 00:49:30.000 --> 00:49:32.000 a lot of times I really want 00:49:32.000 --> 00:49:34.000 her to be safe and I'm pretty 00:49:34.000 --> 00:49:35.000 convinced that there's some abuse 00:49:35.000 --> 00:49:36.000 happening and that's a bias 00:49:36.000 --> 00:49:39.000 that I know is there for me -- 00:49:39.000 --> 00:49:40.000 so this is a case that I consult 00:49:40.000 --> 00:49:43.000 on on a regular basis right 00:49:43.000 --> 00:49:44.000 with my team and my clinical 00:49:44.000 --> 00:49:46.000 supervisor to say okay how much 00:49:46.000 --> 00:49:48.000 of this is Sharon bias and 00:49:48.000 --> 00:49:50.000 how much of this is accurate 00:49:50.000 --> 00:49:51.000 right just to make sure that I 00:49:51.000 --> 00:49:52.000 don't miss something because I 00:49:52.000 --> 00:49:56.000 probably will right I am very 00:49:56.000 --> 00:49:57.000 humble about that like I will 00:49:57.000 --> 00:49:59.000 miss things and every clinician 00:49:59.000 --> 00:49:60.000 will miss things because 00:50:00.000 --> 00:50:01.000 there's so much happening for 00:50:01.000 --> 00:50:04.000 this individual right -- and 00:50:04.000 --> 00:50:06.000 the last piece to this case 00:50:06.000 --> 00:50:09.000 is that a lot of times clients 00:50:09.000 --> 00:50:10.000 will come in and talk about 00:50:10.000 --> 00:50:12.000 oh I have this issue and that's 00:50:12.000 --> 00:50:14.000 not really why they're there 00:50:14.000 --> 00:50:15.000 they're there for something 00:50:15.000 --> 00:50:18.000 else but it's a progression 00:50:18.000 --> 00:50:19.000 so they might not be ready to 00:50:19.000 --> 00:50:21.000 work on what they're actually 00:50:21.000 --> 00:50:24.000 there for and you need to be 00:50:24.000 --> 00:50:25.000 able to give them time to do 00:50:25.000 --> 00:50:27.000 that it's not on your time 00:50:27.000 --> 00:50:30.000 it's on their time right -- 00:50:30.000 --> 00:50:32.000 and that's -- a balance that 00:50:32.000 --> 00:50:34.000 you have to kind of play and 00:50:34.000 --> 00:50:35.000 you practice and you get used 00:50:35.000 --> 00:50:37.000 to that it's something that 00:50:37.000 --> 00:50:38.000 doesn't naturally happen it's 00:50:38.000 --> 00:50:40.000 a lot of practice if there's a 00:50:40.000 --> 00:50:41.000 domestic violence situation you 00:50:41.000 --> 00:50:43.000 separate those individuals and 00:50:43.000 --> 00:50:44.000 looking at safety issues and 00:50:44.000 --> 00:50:46.000 risk assessment right -- 00:50:46.000 --> 00:50:49.000 it depends is the answer so -- 00:50:49.000 --> 00:50:51.000 the best way I could say it is 00:50:53.000 --> 00:50:54.000 for example and if that was 00:50:54.000 --> 00:50:56.000 ultimately what we're gonna do this 00:50:56.000 --> 00:50:58.000 individual -- has financial 00:50:58.000 --> 00:50:61.000 means has a job right has social 00:51:01.000 --> 00:51:02.000 support all of those things so 00:51:02.000 --> 00:51:03.000 the typical barriers that 00:51:03.000 --> 00:51:04.000 you would see in a domestic 00:51:04.000 --> 00:51:05.000 violence situation aren't 00:51:05.000 --> 00:51:08.000 really present like the most obvious 00:51:08.000 --> 00:51:10.000 ones right -- for individuals 00:51:10.000 --> 00:51:11.000 like this -- sometimes we can 00:51:11.000 --> 00:51:14.000 have a social worker -- or 00:51:14.000 --> 00:51:16.000 somebody who specializes in DV 00:51:16.000 --> 00:51:17.000 work to come in and work with 00:51:17.000 --> 00:51:19.000 the client and really talk 00:51:19.000 --> 00:51:20.000 them step by step into the 00:51:20.000 --> 00:51:24.000 process right -- sometimes it 00:51:24.000 --> 00:51:28.000 is -- finding a clinician that 00:51:28.000 --> 00:51:29.000 works only with the domestic 00:51:29.000 --> 00:51:30.000 violence and then I work with 00:51:30.000 --> 00:51:32.000 anxiety right if that's what 00:51:32.000 --> 00:51:34.000 she's there for -- just so 00:51:34.000 --> 00:51:36.000 that there's separation and then 00:51:36.000 --> 00:51:37.000 sometimes -- I will work with 00:51:37.000 --> 00:51:40.000 that individual okay this -- 00:51:40.000 --> 00:51:42.000 that whole mechanism happens 00:51:42.000 --> 00:51:44.000 based on the agency you work 00:51:44.000 --> 00:51:47.000 with right so Dr. Ni said 00:51:47.000 --> 00:51:48.000 that a lot of you are interested 00:51:48.000 --> 00:51:49.000 in voc rehab or will be doing 00:51:49.000 --> 00:51:51.000 that right so voc rehab gets 00:51:51.000 --> 00:51:53.000 this a lot -- because you're 00:51:53.000 --> 00:51:55.000 doing a lot of engagement to 00:51:55.000 --> 00:51:57.000 the community and resources but 00:51:57.000 --> 00:51:58.000 you're gonna deal with mental 00:51:58.000 --> 00:51:60.000 health right they coexist 00:52:00.000 --> 00:52:02.000 you can't separate those two 00:52:02.000 --> 00:52:04.000 so this is where you as an 00:52:04.000 --> 00:52:05.000 individual have to do a lot 00:52:05.000 --> 00:52:07.000 of consultation because you 00:52:07.000 --> 00:52:08.000 don't want to overstep your 00:52:08.000 --> 00:52:11.000 boundaries you can't sit down 00:52:11.000 --> 00:52:12.000 with this person and do safety 00:52:12.000 --> 00:52:14.000 planning around financial state 00:52:14.000 --> 00:52:17.000 safety and physical safety and 00:52:17.000 --> 00:52:18.000 then also work with them on 00:52:18.000 --> 00:52:20.000 whatever you're doing in voc rehab 00:52:20.000 --> 00:52:22.000 with them that's a 00:52:22.000 --> 00:52:24.000 dual relationship that becomes 00:52:24.000 --> 00:52:28.000 very dangerous right sometimes 00:52:28.000 --> 00:52:29.000 it's feasible like if you have 00:52:29.000 --> 00:52:31.000 a lot of supervision you can 00:52:31.000 --> 00:52:32.000 physically do that if you're 00:52:32.000 --> 00:52:33.000 the only one that person feels 00:52:33.000 --> 00:52:35.000 connected to a majority of 00:52:35.000 --> 00:52:36.000 those times those two things 00:52:36.000 --> 00:52:40.000 need to separate right -- 00:52:40.000 --> 00:52:42.000 because and then it becomes 00:52:42.000 --> 00:52:44.000 can you do a site visit can 00:52:44.000 --> 00:52:45.000 you go to their house can 00:52:45.000 --> 00:52:46.000 you do all this stuff is your 00:52:46.000 --> 00:52:48.000 agency gonna allow you to do 00:52:48.000 --> 00:52:51.000 that or not right that piece 00:52:51.000 --> 00:52:54.000 happens and then the biggest 00:52:54.000 --> 00:52:57.000 piece is -- clinicians across 00:52:57.000 --> 00:52:58.000 the board have this desire to 00:52:58.000 --> 00:52:60.000 give individuals a diagnosis 00:53:00.000 --> 00:53:01.000 because of the story that 00:53:01.000 --> 00:53:04.000 they're saying they might have 00:53:06.000 --> 00:53:09.000 might have you know they might 00:53:09.000 --> 00:53:10.000 have childhood abuse they might 00:53:10.000 --> 00:53:11.000 have whatever and we want to 00:53:11.000 --> 00:53:14.000 come up with this DSM specific 00:53:14.000 --> 00:53:16.000 criteria and label it and then 00:53:16.000 --> 00:53:18.000 hoorah we're done typically 00:53:18.000 --> 00:53:20.000 doesn't work that way I would 00:53:20.000 --> 00:53:21.000 discourage you from working 00:53:21.000 --> 00:53:23.000 only in that framework right 00:53:23.000 --> 00:53:24.000 and looking at the bigger 00:53:24.000 --> 00:53:27.000 picture because maybe what 00:53:27.000 --> 00:53:29.000 she's saying is not fully true 00:53:29.000 --> 00:53:30.000 but there something else that 00:53:30.000 --> 00:53:32.000 is true there's some validity 00:53:32.000 --> 00:53:33.000 around it somebody doesn't make 00:53:33.000 --> 00:53:37.000 up a story for no good reason 00:53:37.000 --> 00:53:38.000 there's something happening 00:53:38.000 --> 00:53:40.000 right sometimes people do 00:53:40.000 --> 00:53:43.000 storytelling they tell stories 00:53:43.000 --> 00:53:44.000 because it's easier to tell 00:53:44.000 --> 00:53:45.000 a story than it is to tell 00:53:45.000 --> 00:53:48.000 the reality of their life 00:53:48.000 --> 00:53:51.000 right sometimes people will 00:53:56.000 --> 00:53:57.000 something that happened to 00:53:57.000 --> 00:53:60.000 them in their childhood right 00:54:00.000 --> 00:54:01.000 and they're -- 00:54:01.000 --> 00:54:03.000 portraying it as an adult 00:54:03.000 --> 00:54:08.000 mandatory report to happen 00:54:08.000 --> 00:54:10.000 right or it's something that's 00:54:10.000 --> 00:54:11.000 currently happening but it's 00:54:11.000 --> 00:54:12.000 happening with somebody else 00:54:12.000 --> 00:54:14.000 and they're really scared but 00:54:14.000 --> 00:54:15.000 they don't wanna directly tell 00:54:15.000 --> 00:54:16.000 you because you're gonna do 00:54:16.000 --> 00:54:19.000 something about it -- so those 00:54:19.000 --> 00:54:21.000 frameworks happen as well -- so 00:54:21.000 --> 00:54:22.000 it's important to look at that 00:54:22.000 --> 00:54:24.000 and your own value set and your 00:54:24.000 --> 00:54:25.000 beliefs when you think about 00:54:25.000 --> 00:54:27.000 termination and referrals if 00:54:27.000 --> 00:54:29.000 you're having empathy fatigue 00:54:29.000 --> 00:54:31.000 and you're having burnout 00:54:31.000 --> 00:54:32.000 that is about you and it's 00:54:32.000 --> 00:54:33.000 probably happening with all 00:54:33.000 --> 00:54:34.000 of your clients and not just 00:54:34.000 --> 00:54:35.000 that clients so that's you 00:54:35.000 --> 00:54:37.000 doing your work and you getting 00:54:37.000 --> 00:54:38.000 supervision consultation and 00:54:38.000 --> 00:54:41.000 probably taking a break right 00:54:41.000 --> 00:54:42.000 and it would probably be like 00:54:42.000 --> 00:54:44.000 a transfer or a referral or some 00:54:44.000 --> 00:54:45.000 dynamic of that that you would 00:54:45.000 --> 00:54:47.000 work towards doing so you're 00:54:47.000 --> 00:54:49.000 not negatively impacting the 00:54:49.000 --> 00:54:51.000 client but that becomes your 00:54:51.000 --> 00:54:54.000 work it's not client specific 00:54:56.000 --> 00:54:59.000 lot right a lot of community 00:54:59.000 --> 00:54:61.000 based work empathy fatigue 00:55:01.000 --> 00:55:02.000 happens because there's so much 00:55:02.000 --> 00:55:04.000 happening right this is where 00:55:04.000 --> 00:55:07.000 self care comes into the piece 00:55:08.000 --> 00:55:10.000 gonna ask you to do something 00:55:10.000 --> 00:55:11.000 if I'm not doing it myself I'm 00:55:11.000 --> 00:55:13.000 not going to be a hypocrite if I'm 00:55:13.000 --> 00:55:14.000 telling you that getting good 00:55:14.000 --> 00:55:16.000 sleep is important you better 00:55:16.000 --> 00:55:19.000 believe I'm doing it too right 00:55:21.000 --> 00:55:22.000 the other way they're like I'm 00:55:22.000 --> 00:55:24.000 here hundred and ten percent 00:55:24.000 --> 00:55:26.000 of the time I will like let go 00:55:26.000 --> 00:55:28.000 of my personal life and have 00:55:28.000 --> 00:55:29.000 no balance and no self care 00:55:29.000 --> 00:55:30.000 just because I want to make you 00:55:30.000 --> 00:55:35.000 better doesn't work that way 00:55:35.000 --> 00:55:36.000 right so yes that would be 00:55:36.000 --> 00:55:37.000 a reason for termination 00:55:37.000 --> 00:55:38.000 but it's not termination it 00:55:38.000 --> 00:55:40.000 would be transfer of care 00:55:40.000 --> 00:55:42.000 the other last piece that I 00:55:42.000 --> 00:55:44.000 want to cover about ethical 00:55:44.000 --> 00:55:45.000 dilemmas and diversity and 00:55:45.000 --> 00:55:47.000 values is whenever we're 00:55:47.000 --> 00:55:48.000 communicating with our clients 00:55:48.000 --> 00:55:50.000 whether that's in writing 00:55:50.000 --> 00:55:52.000 or an actual session or our 00:55:52.000 --> 00:55:54.000 chart notes they have to be 00:55:54.000 --> 00:55:56.000 developmentally appropriate 00:55:56.000 --> 00:55:59.000 and culturally sensitive seems 00:55:59.000 --> 00:55:61.000 pretty obvious -- but it's a 00:56:01.000 --> 00:56:05.000 lot harder to do than it seems 00:56:05.000 --> 00:56:06.000 okay this could be anywhere 00:56:06.000 --> 00:56:10.000 from personal pronouns to -- 00:56:10.000 --> 00:56:11.000 what their cultural identity 00:56:11.000 --> 00:56:12.000 is and how you describe 00:56:12.000 --> 00:56:14.000 that in your note to how you 00:56:14.000 --> 00:56:16.000 do treatment recommendations 00:56:16.000 --> 00:56:19.000 right -- the most common 00:56:19.000 --> 00:56:21.000 treatment modalities have not 00:56:21.000 --> 00:56:22.000 been researched for all cultural 00:56:22.000 --> 00:56:24.000 backgrounds and they have not 00:56:24.000 --> 00:56:26.000 been normed right so you can't 00:56:26.000 --> 00:56:28.000 take one type of therapeutic 00:56:28.000 --> 00:56:29.000 method and apply it to all 00:56:29.000 --> 00:56:31.000 populations without making 00:56:31.000 --> 00:56:32.000 adjustments are without having 00:56:32.000 --> 00:56:34.000 consultation not appropriate 00:56:37.000 --> 00:56:39.000 you writing at a graduate level 00:56:39.000 --> 00:56:40.000 are your treatment plants at 00:56:40.000 --> 00:56:43.000 a graduate level or are they 00:56:43.000 --> 00:56:47.000 your clients understand it 00:56:47.000 --> 00:56:49.000 are you putting your personal 00:56:49.000 --> 00:56:50.000 thoughts and feelings and 00:56:50.000 --> 00:56:53.000 feedback into your summarizations 00:56:53.000 --> 00:56:54.000 or in your clients or 00:56:54.000 --> 00:56:56.000 are they actual fact based it's 00:56:56.000 --> 00:56:58.000 very hard to differentiate right 00:57:01.000 --> 00:57:04.000 release client information 00:57:04.000 --> 00:57:05.000 to the client unless there's 00:57:05.000 --> 00:57:06.000 a necessity and even that is 00:57:06.000 --> 00:57:09.000 limited -- the way that I was 00:57:09.000 --> 00:57:10.000 trained and this is the way that I 00:57:10.000 --> 00:57:11.000 encourage most people that do 00:57:11.000 --> 00:57:13.000 it is write your notes as if 00:57:13.000 --> 00:57:14.000 somebody's gonna be looking at 00:57:14.000 --> 00:57:17.000 it whether that's your subpoena 00:57:17.000 --> 00:57:18.000 to court whether that's your 00:57:18.000 --> 00:57:19.000 supervisor whether that's a 00:57:19.000 --> 00:57:22.000 client right so if you're going 00:57:22.000 --> 00:57:24.000 to have some apprehensions 00:57:24.000 --> 00:57:25.000 about why somebody's reading 00:57:25.000 --> 00:57:26.000 it you're probably not doing it 00:57:26.000 --> 00:57:30.000 right is my way of skewing that 00:57:30.000 --> 00:57:32.000 right the cultural competence 00:57:32.000 --> 00:57:34.000 piece of this that creates 00:57:34.000 --> 00:57:36.000 ethical dilemmas is when you 00:57:36.000 --> 00:57:38.000 incorporate language 00:57:38.000 --> 00:57:39.000 around treatment planning 00:57:39.000 --> 00:57:42.000 so an example would be I'm 00:57:42.000 --> 00:57:44.000 asking somebody to do self 00:57:44.000 --> 00:57:47.000 care at home and I'm doing it in 00:57:47.000 --> 00:57:49.000 a very westernized model go 00:57:49.000 --> 00:57:50.000 meet your friends go out for 00:57:50.000 --> 00:57:54.000 coffee go watch a movie right 00:57:54.000 --> 00:57:56.000 culturally that's not appropriate 00:57:56.000 --> 00:57:57.000 for some individuals right 00:57:57.000 --> 00:57:59.000 that's not how that looks like 00:57:59.000 --> 00:57:60.000 so when I frame that in the 00:58:00.000 --> 00:58:02.000 treatment plan how can I be 00:58:02.000 --> 00:58:04.000 mindful of that so that the 00:58:04.000 --> 00:58:05.000 the client understands but 00:58:05.000 --> 00:58:07.000 I also understand why I did 00:58:07.000 --> 00:58:08.000 that so if I were to look back 00:58:08.000 --> 00:58:10.000 at it two years later because 00:58:10.000 --> 00:58:11.000 I got subpoenaed in court I 00:58:11.000 --> 00:58:13.000 know why I did that okay that's 00:58:13.000 --> 00:58:15.000 the cultural competence piece 00:58:15.000 --> 00:58:18.000 of it this right here you 00:58:18.000 --> 00:58:19.000 guys are gonna take a cultural 00:58:19.000 --> 00:58:20.000 competency course at some 00:58:20.000 --> 00:58:22.000 point I assume you'll see 00:58:22.000 --> 00:58:24.000 these frameworks this middle 00:58:24.000 --> 00:58:26.000 one on attitude I always 00:58:26.000 --> 00:58:27.000 like to talk about when we 00:58:27.000 --> 00:58:28.000 talk about ethical dilemmas 00:58:28.000 --> 00:58:30.000 ethical dilemmas in order for 00:58:30.000 --> 00:58:31.000 you to combat them and have 00:58:31.000 --> 00:58:33.000 appropriate consultation you 00:58:33.000 --> 00:58:35.000 need to have the ability to 00:58:35.000 --> 00:58:36.000 do cultural self reflection 00:58:36.000 --> 00:58:38.000 so what is my culture and how 00:58:38.000 --> 00:58:41.000 do I respond to other cultures 00:58:41.000 --> 00:58:45.000 right and -- the statement of I 00:58:45.000 --> 00:58:49.000 don't see color is not accurate 00:58:49.000 --> 00:58:50.000 okay I don't see color color 00:58:50.000 --> 00:58:52.000 does exist right if we talk 00:58:52.000 --> 00:58:54.000 about race if we talk about 00:58:54.000 --> 00:58:56.000 ability there's a spectrum 00:58:56.000 --> 00:58:57.000 there too it exists and it's in 00:58:57.000 --> 00:58:60.000 the room with your clients right 00:59:00.000 --> 00:59:02.000 so and I think the intention 00:59:02.000 --> 00:59:04.000 of that statement is to say 00:59:04.000 --> 00:59:06.000 I try my best not to be biased 00:59:06.000 --> 00:59:07.000 right that's the intention 00:59:07.000 --> 00:59:09.000 of that statement -- but as a 00:59:09.000 --> 00:59:12.000 client when most clients hear 00:59:12.000 --> 00:59:14.000 that they see it as you don't 00:59:14.000 --> 00:59:17.000 care about my diversity you're 00:59:17.000 --> 00:59:19.000 gonna treat me like any other 00:59:19.000 --> 00:59:20.000 person without looking at the 00:59:20.000 --> 00:59:23.000 nuances of my life right so we 00:59:23.000 --> 00:59:24.000 have to be very careful with 00:59:24.000 --> 00:59:26.000 that language okay that's what 00:59:26.000 --> 00:59:28.000 cultural reflection is about 00:59:28.000 --> 00:59:30.000 critical awareness of culture 00:59:30.000 --> 00:59:32.000 and how it creates inequality 00:59:32.000 --> 00:59:33.000 is very important because we're 00:59:33.000 --> 00:59:35.000 looking at if we're going to 00:59:35.000 --> 00:59:37.000 do a treatment recommendation 00:59:37.000 --> 00:59:39.000 or if we're asking somebody to 00:59:39.000 --> 00:59:41.000 come back and see us every week 00:59:41.000 --> 00:59:42.000 because that's the clinical 00:59:42.000 --> 00:59:44.000 recommendation is it actually 00:59:44.000 --> 00:59:45.000 appropriate like does this 00:59:45.000 --> 00:59:47.000 individual have the means to 00:59:47.000 --> 00:59:49.000 do that is this person going 00:59:49.000 --> 00:59:50.000 to have consequences for 00:59:50.000 --> 00:59:53.000 seeing me right -- are they 00:59:53.000 --> 00:59:55.000 comfortable seeing me in the 00:59:55.000 --> 00:59:58.000 room -- perfect example -- 00:59:58.000 --> 00:59:60.000 my supervisor used to work 01:00:00.000 --> 01:00:03.000 in a school based setting -- 01:00:03.000 --> 01:00:06.000 and her colleagues had a a 01:00:06.000 --> 01:00:08.000 Muslim female who was required 01:00:08.000 --> 01:00:10.000 to be in sessions with him 01:00:10.000 --> 01:00:11.000 and she would no show all 01:00:11.000 --> 01:00:13.000 the time and he was like I 01:00:13.000 --> 01:00:15.000 don't understand I'm a nice 01:00:15.000 --> 01:00:18.000 guy here I am I want to help 01:00:18.000 --> 01:00:21.000 her we you know find a time 01:00:21.000 --> 01:00:22.000 out of her class so she can 01:00:22.000 --> 01:00:24.000 be there there's no reason why 01:00:24.000 --> 01:00:25.000 she can't be there when she's 01:00:25.000 --> 01:00:27.000 at school there's none reason 01:00:27.000 --> 01:00:29.000 and then when somebody asks 01:00:29.000 --> 01:00:30.000 her about it she's like oh 01:00:30.000 --> 01:00:34.000 yeah I really want to do it 01:00:34.000 --> 01:00:39.000 what happened why isn't she showing up 01:00:39.000 --> 01:00:41.000 he's a man and it's a 01:00:41.000 --> 01:00:43.000 violation of her family values 01:00:43.000 --> 01:00:44.000 to be in a room alone with 01:00:44.000 --> 01:00:47.000 a man right so they had to 01:00:47.000 --> 01:00:48.000 have a female sit in the 01:00:48.000 --> 01:00:49.000 room so that she could engage in 01:00:49.000 --> 01:00:50.000 session she had no problem 01:00:50.000 --> 01:00:51.000 with him but it was a violation 01:00:51.000 --> 01:00:53.000 of her family values and she's 01:00:53.000 --> 01:00:54.000 trying to uphold that and also 01:00:54.000 --> 01:00:58.000 her requirements in school 01:00:58.000 --> 01:00:60.000 right thinking outside the 01:01:00.000 --> 01:01:02.000 box a little bit that's 01:01:02.000 --> 01:01:03.000 the awareness piece of it if 01:01:03.000 --> 01:01:05.000 somebody's not showing up we 01:01:05.000 --> 01:01:07.000 not showing up just because we 01:01:07.000 --> 01:01:09.000 need to think about okay let's 01:01:09.000 --> 01:01:10.000 exhaust every reason that this 01:01:10.000 --> 01:01:11.000 person has for not showing 01:01:11.000 --> 01:01:13.000 up and address that the other 01:01:13.000 --> 01:01:15.000 one is respect for cultural 01:01:15.000 --> 01:01:17.000 difference you can never know 01:01:17.000 --> 01:01:19.000 about every single culture 01:01:19.000 --> 01:01:21.000 out there it's impossible 01:01:21.000 --> 01:01:22.000 cultural competency is not 01:01:22.000 --> 01:01:24.000 knowing about every culture 01:01:25.000 --> 01:01:28.000 you engage in self reflection 01:01:28.000 --> 01:01:30.000 can you engage in developing 01:01:30.000 --> 01:01:31.000 your own awareness and can you 01:01:31.000 --> 01:01:34.000 have critical thinking around 01:01:34.000 --> 01:01:36.000 what's in the room with you if 01:01:36.000 --> 01:01:38.000 you can do those three things 01:01:38.000 --> 01:01:40.000 you're able to combat ethical 01:01:40.000 --> 01:01:41.000 dilemmas that arise around 01:01:41.000 --> 01:01:44.000 diversity and values right 01:01:44.000 --> 01:01:45.000 you guys are gonna delve into I can't delve 01:01:45.000 --> 01:01:47.000 into that in ninety minutes 01:01:47.000 --> 01:01:49.000 but you guys will do that -- 01:01:49.000 --> 01:01:51.000 so that's all I have for you 01:01:51.000 --> 01:01:52.000 today but I want to know if 01:01:52.000 --> 01:01:53.000 you guys have questions for 01:01:53.000 --> 01:01:54.000 me about anything we talked 01:01:54.000 --> 01:01:56.000 about or any other cases or 01:01:56.000 --> 01:01:58.000 career paths or anything like 01:01:58.000 --> 01:01:60.000 that my favorite thing that's 01:02:00.000 --> 01:02:02.000 really hard -- I really like 01:02:02.000 --> 01:02:03.000 diversity of like being able to 01:02:03.000 --> 01:02:04.000 do a bunch of different things 01:02:07.000 --> 01:02:10.000 what I like to do -- the thing 01:02:10.000 --> 01:02:12.000 that I enjoy most in clinical 01:02:12.000 --> 01:02:14.000 practice -- is I really like 01:02:14.000 --> 01:02:17.000 family work -- so whether 01:02:17.000 --> 01:02:18.000 that's doing family sessions 01:02:18.000 --> 01:02:20.000 or integration of families -- 01:02:20.000 --> 01:02:22.000 into a client's individual 01:02:22.000 --> 01:02:24.000 sessions that's really where my 01:02:24.000 --> 01:02:26.000 passion is something that I've 01:02:26.000 --> 01:02:28.000 experienced that I don't want 01:02:28.000 --> 01:02:34.000 to happen but has changed -- 01:02:34.000 --> 01:02:36.000 oh I'll tell you one -- I 01:02:36.000 --> 01:02:41.000 had a -- -- individual who 01:02:41.000 --> 01:02:46.000 came in to see me two times -- 01:02:46.000 --> 01:02:50.000 was transgender -- pronouns 01:02:50.000 --> 01:02:55.000 were he and him and -- I had 01:02:55.000 --> 01:02:59.000 no context of the case and I 01:02:59.000 --> 01:02:61.000 looked at the chart and looked 01:03:01.000 --> 01:03:03.000 at the preferred name and the 01:03:03.000 --> 01:03:08.000 pronoun and it was flipped it was 01:03:08.000 --> 01:03:10.000 done the wrong way so I went 01:03:10.000 --> 01:03:14.000 out and -- used this individual's 01:03:14.000 --> 01:03:19.000 legal name -- which was very 01:03:21.000 --> 01:03:23.000 and on the spot in the waiting 01:03:23.000 --> 01:03:26.000 room he was like no that is not 01:03:26.000 --> 01:03:28.000 my name and I was like oh I'm 01:03:28.000 --> 01:03:31.000 sorry completely oblivious I 01:03:31.000 --> 01:03:32.000 turn around walk back because I 01:03:32.000 --> 01:03:34.000 thought I had the wrong person 01:03:34.000 --> 01:03:36.000 and then halfway back I was 01:03:36.000 --> 01:03:37.000 like wait a minute that was 01:03:37.000 --> 01:03:39.000 the person what did I do and I went 01:03:39.000 --> 01:03:42.000 back made the mistake again 01:03:42.000 --> 01:03:44.000 because instead of saying I'm 01:03:44.000 --> 01:03:47.000 sorry I did that -- I said 01:03:47.000 --> 01:03:49.000 so my file said that your legal 01:03:49.000 --> 01:03:51.000 name is blah blah blah so didn't 01:03:51.000 --> 01:03:53.000 present myself well at all 01:03:53.000 --> 01:03:55.000 in that moment right so I'm 01:03:55.000 --> 01:03:56.000 utterly embarrassed and then 01:03:56.000 --> 01:03:58.000 we finally got into the session 01:03:58.000 --> 01:03:60.000 and the whole time I'm so self 01:04:00.000 --> 01:04:03.000 conscious that I interchange 01:04:03.000 --> 01:04:05.000 the pronouns the entire time 01:04:05.000 --> 01:04:07.000 the entire time right so messed 01:04:07.000 --> 01:04:09.000 up my first session I apologize 01:04:09.000 --> 01:04:12.000 at the end right -- because 01:04:12.000 --> 01:04:15.000 now I'm completely flustered 01:04:15.000 --> 01:04:17.000 person comes in a second time 01:04:17.000 --> 01:04:18.000 right and this time I was like 01:04:18.000 --> 01:04:19.000 I'm prepared Sharon I'm 01:04:19.000 --> 01:04:21.000 not messing up this time 01:04:21.000 --> 01:04:22.000 right this is a big deal I can't 01:04:22.000 --> 01:04:24.000 mess up I don't mess up the 01:04:24.000 --> 01:04:27.000 pronouns but the way that I did 01:04:27.000 --> 01:04:29.000 the clinical recommendations 01:04:29.000 --> 01:04:31.000 were not appropriate for that 01:04:31.000 --> 01:04:35.000 individual at all right -- the 01:04:35.000 --> 01:04:37.000 person was not -- seeing me for 01:04:37.000 --> 01:04:38.000 those purposes he was seeing me 01:04:38.000 --> 01:04:40.000 for legal obligation actually 01:04:40.000 --> 01:04:43.000 right -- totally messed that 01:04:43.000 --> 01:04:45.000 up that was -- something that 01:04:45.000 --> 01:04:49.000 I hope never happens again -- 01:04:49.000 --> 01:04:51.000 and I learned a lot from that 01:04:51.000 --> 01:04:54.000 about myself right -- because 01:04:54.000 --> 01:04:56.000 that was very early in my career 01:04:56.000 --> 01:04:57.000 and I was like I -- I'm not 01:04:57.000 --> 01:04:58.000 gonna mess up I'm not gonna mess up 01:04:58.000 --> 01:04:59.000 right completely doing that 01:04:59.000 --> 01:04:60.000 and I put a lot of pressure on 01:05:00.000 --> 01:05:03.000 myself and afterwards I did a 01:05:03.000 --> 01:05:04.000 bunch of trainings and did a 01:05:04.000 --> 01:05:06.000 bunch of consultation to really 01:05:06.000 --> 01:05:10.000 learn how to navigate that -- 01:05:10.000 --> 01:05:11.000 because I -- I work with that 01:05:11.000 --> 01:05:13.000 population so I'm confident in 01:05:13.000 --> 01:05:14.000 it but it's when you're in 01:05:14.000 --> 01:05:16.000 that pressured you've already 01:05:16.000 --> 01:05:17.000 messed up moment how to kind 01:05:17.000 --> 01:05:20.000 of step back is really hard 01:05:20.000 --> 01:05:22.000 and took a lot of practice 01:05:22.000 --> 01:05:24.000 like a lot of practice and I still 01:05:24.000 --> 01:05:26.000 practice it even now -- so 01:05:26.000 --> 01:05:28.000 I tell you guys all when you 01:05:28.000 --> 01:05:29.000 go into internship you will 01:05:29.000 --> 01:05:30.000 mess up and there's a lot of 01:05:30.000 --> 01:05:33.000 pressure it's okay just it will 01:05:33.000 --> 01:05:35.000 be okay all right you're all 01:05:35.000 --> 01:05:36.000 gonna mess up -- but get some 01:05:36.000 --> 01:05:38.000 training and competency around 01:05:38.000 --> 01:05:39.000 that there's actual trainings 01:05:39.000 --> 01:05:41.000 around when you're in that high 01:05:41.000 --> 01:05:42.000 stress situation how can you 01:05:42.000 --> 01:05:43.000 do self care for yourself in 01:05:43.000 --> 01:05:45.000 the room even though you're 01:05:45.000 --> 01:05:46.000 working with a client and 01:05:46.000 --> 01:05:48.000 there's stuff going on -- I 01:05:48.000 --> 01:05:50.000 really encourage people to do 01:05:50.000 --> 01:05:51.000 trainings like that before they 01:05:51.000 --> 01:05:53.000 really get into clinical work 01:05:53.000 --> 01:05:54.000 thank you 01:05:54.000 --> 01:05:58.000 music 01:05:58.000 --> 01:05:62.000 music