Category: Therapy

Introduction

Group therapy is a very effective avenue in the treatment of addiction and compulsive behaviors. Through group therapy, individuals receive specialized care and support about their prevailing conditions.

During group therapy, individuals relate their predicament to group members in reaching a viable solution. Group therapy involves the process of group development (Berg, 2006). This refers to various efforts towards the creation of a framework to offer support to clients.

Many therapists have difficulty in the creation of groups because of numerous complexities about the undertaking. Group development requires accuracy and precision to guarantee quality services to clients (Berg, 2006).

Various considerations suffice in the process of group development and formulation. The first involves the identification of the essence and rationale of the group. During this stage, the therapist must identify pertinent justifications that necessitate the formation of the group.

In most cases, the main aim of forming a group is assisting clients as they strive to overcome addiction and compulsive behavior (Berg, 2006).

Discussion

During the second stage, the therapist identifies the relevant resources that support the endeavors of the group. A group cannot function properly devoid of vital resources.

The therapist should identify such resources and possibly determine the source of the resources. Proper consolidation of resources creates an opportunity for the proper functioning of the group.

The third stage involves the creation of a specific organizational framework for the group. The proper organization complements group efforts and enhances efficiency in the delivery of services within the group (Berg, 2006). It also promotes the sharing of information among members.

Organizing a group is necessary for the establishment of guidelines for operation within a group.

During this stage of group development, the facilitator lays ground regarding issues such as time and venue of meeting as well as the duration of group meetings.

The final stage involves publicizing the group. This ensures that people with needs are aware of the group’s existence (Berg, 2006).

After the group commences activity, it is critical for the facilitator to ensure a high rate of retention and continuity about the participation and attendance of members. There are certain strategies that promote activity and achievement of group objectives.

One such strategy is role induction, which involves the use of relevant supporting material to sensitize members about their roles regarding group activities.

Vicarious pre-training uses similar materials to enhance understanding within the group. The above approaches enhance and promote rehabilitation and recovery within a group (Berg, 2006).

Conclusion

Group therapy is usually very effective in the treatment of addiction and compulsive behavior. The personal model offers the best approach to group therapy because it centers on a personal and effective relationship with individual members within a group (Carlbring, 2009).

The model emphasizes on understanding the dynamics of personal relationships about individual members within a group. By applying cognitive behavior therapy and motivational interviewing, the facilitator can seize the opportunity to offer quality service to clients within a group.

Cognitive behavior therapy and motivational interviewing accords an opportunity for the therapist to empathize and show concern to the predicament of individual group members (Berg, 2006).

It is important and critical for the facilitator to understand the dynamics of various models and determine their effects on group development and functioning. This promotes the desire for rehabilitation and recovery of all members within a group.

Indeed, group development is a complex undertaking. However, proper knowledge and understanding of its dynamics make it enjoyable and worthwhile (Carlbring, 2009).

References

Berg, R. (2006). Group Counselling: Concepts and Procedures. New York: Routledge.

Carlbring, D. (2009). Group Development: Contemporary Approaches. London: CENGAGE.

Introduction

Annually, around 50 thousand deaths are occurring in the United States of America due to suicide based on severe mental conditions. Mental disorders are the topic that concerns many people worldwide, since it affects the quality of one’s life in negative ways. There are several methods to cope with occurring disorders in life: get professional therapy, help oneself with medications, or engage in self-help. Furthermore, self-help can prove to be more beneficial for some less severe mental states.

Reasons that Support the Thesis

Reason 1

To find a good therapist, one has to invest hundreds of hours and dollars. At the same time, a decent self-help strategy can be found online for free within minutes, which can prove to be more convenient.

Reason 2

While a bad self-help book can waste one’s time, a bad therapy session can worsen one’s condition. Some therapists can appear well-trained and experienced, while the knowledge of others is almost non-existent.

Reason 3

Self-help strategies would make one feel stronger, wiser, and self-sufficient, which can make one a role model for others. Moreover, by increasing one’s self-awareness, one can recognize potential mental issues before they occur and cope with them with more ease.

Reason 4

Practicing self-help can increase one’s self-esteem, since an individual successfully copes with the surrounding issues and learns to be a better person. Furthermore, engaging in self-care can not only improve one’s mental state, but also advance one’s physical health.

Counter Arguments and Responses to them

Therapists claim that all mental issues have to be observed by them because humans are prone to self-diagnosing, which can lead to other significant complications. Moreover, they claim that by engaging in self-help, one can accidentally worsen their mental state if they are not strong-willed enough. Although, indeed, self-help is not suitable for everyone and some severe mental states are better cured at the therapist’s office, one should try it to know if this method is suitable for them.

Conclusion

To conclude, self-help can be useful in some situations and sometimes can benefit the person more than the therapy. However, it is essential to note that people with severe mental issues have to attend therapy, but they can use self-help to cope with their emotions as well, along with professional aid and medication.

References

Ebert, D., Donkin, L., Andersson, G., Andrews, G., Berger, T., Carlbring, P.,… Cuijpers, P. (2016). Does Internet-based guided-self-help for depression cause harm? An individual participant data meta-analysis on deterioration rates and its moderators in randomized controlled trials. Psychological Medicine, 46(13), 2679-2693. Web.

Fennell, M. (2016). Overcoming low self-esteem: A self-help guide using cognitive behavioural techniques. Robinson.

Hanson, K., Webb, T., Sheeran, P. & Turpin, G. (2016). Attitudes and preferences towards self-help treatments for depression in comparison to psychotherapy and antidepressant medication. Behavioral and Cognitive Psychotherapy, 44(2), 129-139. Web.

Smail, D. (2019). How to Survive Without Psychotherapy. Routledge.

Zwaan, M., Herpertz, S., Zipfel, S., Svaldi, J., Friederich, H., Schmidt, F., Mayr, A., Lam, T., Schade-Brittinger, C. & Hilbert, A. (2017). Effect of internet-based guided self-help vs individual face-to-face treatment on full or subsyndromal binge eating disorder in overweight or obese patients: the interbed randomized clinical trial. JAMA Psychiatry. 74(10),987–995. Web.

The widespread availability of MAT therapy is a severe challenge to the public health agenda, as it can provoke cases of opportunity misuse. More specifically, it refers to the fact that more clinicians have been given the freedom to use medication-assisted treatment for psychoactive patients, including as part of emergency care. Although such staff members had to be trained and competent, it cannot be guaranteed that each of them was fully aware of the new responsibility. The ethical dilemma from this perspective is that expanding the list of those performing MAT therapy improves the health care agenda and increases the likelihood of abusing their capacity for unauthorized work. This includes illegally prescribing medications to bypass the system, pressure from patients, using inappropriate medications due to haste or ignorance, and ignoring the benefits of MAT for emergency psychoactive poisoning therapy due to fear.

As mentioned earlier, the use of MAT to treat patients with psychoactive addictions has been expanded legislatively through The SUPPORT Act. In fact, most prescription medications are also regulated by the Controlled Substances Act, which classifies substances using five schedules. In addition, physicians and nurses who use MAT in their practice must be accredited and certified with the CFR authorizing the use of opioid substances for addiction treatment (SAMHSA, 2022). General rules describing the need for experience with a qualified clinical person, a description of MAT inclusions, and an overview of the specifics regarding maintenance therapy for juvenile adolescents are described in more detail in 42 CFR § 8 (LII, 2015). It is worth acknowledging that existing laws are constantly being updated and modified in the search for optimal regulation regarding psychoactive addictions among Americans.

References

LII. (2015). 42 CFR § 8.12 — Federal opioid treatment standards. Law Cornell. Web.

SAMHSA. (2022). Statutes, regulations, and guidelines. U.S. Department Health & Human Services. Web.

Collaborative Drug Therapy Management (CDTM), involving a collaborative effort between physicians and pharmacists, address practical courses of cost effective health care management. The economic value of CDTM has been well-documented in many circles and this process has been established in many states of the U S as a means of reducing the high costs of health care delivery, particularly associated with Medicare. It is envisaged that the initiative of Massachusetts to bring CDTM legislation will help provide the best possible treatment, while simultaneously cutting increasing costs of health care delivery.

Pharmacists are the health professionals specifically trained to dispense prescription medication and provide a wealth of other pharmaceutical services. They have the crucial role in clinical care as they have the potential to decrease errors, costs and the demand on emergency and primary care physicians while improving patient outcomes. Collaborative drug therapy management (CDTM) with active involvement of pharmacist in prescription medication is a viable opportunity to capture new revenue streams within the health care industry, but the criticism includes the compromise of patient care at the expense of earnings.

Importance of an ideal cost effective health care delivery system

Main focus in health care management is continuity of care, equitable access, and quality and safety. It is criticized that the U S health care delivery system is fragmented, which fosters “frustrating and dangerous patient experience, especially for patients obtaining care from multiple providers in a variety of setting. It also leads to waste and duplication, hindering providers’ ability to deliver high-quality, efficient care.” (Shih, Davis and Schoenbaum).

Major factors contributing to fragmentation of health care delivery system in the U S are: absence of single national entity or set of policies guiding the health care system; states divide their responsibilities among multiple agencies; and primary care system is fragile. Poor performance of the U S health care system derived from fragmentation leads to dangerous patient experience, medical errors, high cost, waste, and duplication.

Introducing electronic health record systems for easy accessibility of patient information, coordinated patient care among multiple providers, accountability and collaboration among providers, easy access to appropriate care and information to patients, and continuous innovation of the system are important steps for an ideal high performance health care delivery system identified by the Commonwealth Fund Commission.

Inclusion of medication therapy management programs (MTM) in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) is considered as a big leap in recognition of pharmacist-provided appropriate drug therapy management for cost effective health care delivery. Pharmacists were the only health care professionals specifically named in MMA to provide medication management services. With the introduction of Medicare Reform Act of 2003 a new Medicare Part D prescription drug program was created in the U S and fresh fillip has been given to pharmacists and medication therapy management (MTM) in reducing other more costly health care services.

MTM, in part, may be defined as “a form of face-to-face assessment or intervention between pharmacist and a patient and a patient or caregiver that is provided to optimize and improve the response to medications and to help avoid potential treatment-related medication interactions or complications.” (External and Internal Assessment, 10). However, it is argued that there was no consensus definition of medication therapy management services in MTM provision, as prescribed in MMA Statute.

Importance of CDTM in Medicare management

The Part D Medicare program provides beneficiaries with the option to enroll into private health plans that have contracts with Medicare to provide drug coverage. It is perceived that Collaborative Drug Therapy Management (CDTM) would provide access to enhanced valuable pharmacy services that are calculated as part of the premium to all the Medicare recipients. Health care reform initiative enacted in Massachusetts in 2006 set goal to ensure affordability and adequacy of insurance coverage through health insurance plans that offer enough financial protection as well.

Massachusetts Health Insurance Connection, established to facilitate purchase of quality, affordable health insurance by small businesses and individuals who lack access to employer-sponsored health coverage is an integral part of state’s comprehensive health insurance reform. Reports state that health care reform plan implemented in Massachusetts in 2006 has yielded impressive results as the ‘state’s uninsured rate was cut nearly by half at the end of the plan’s first year, and residents saw a significant drop in their out-of-pocket expenses’.

The “minimum creditable coverage” standard established in Massachusetts is aimed to help protect residents from becoming underinsured. The standard mandates all insurance plans to provide a broad scope of key benefits, including preventive and primary care, prescription drugs, and maximums for annual deductibles and out-of-pocket spending.

Role of pharmacists in effective medical practice

It is experienced that pharmacists’ intervention in medication management and authorizing pharmacists to prescribe select medication and monitoring therapy has potential benefits for medical practice. Though physicians are responsible for managing patients’ care, including drug therapies, research evidence suggests that involving clinical pharmacists in managing drug treatment may reduce costs and improve the quality of care. (Report to the Congress: Medicare Coverage of Nonphysician Practitioners). Indian Health Service (IHS) model of protocol-based prescribing by pharmacists is acclaimed by the Institute of Health (IOH) to be “beneficial for patient satisfaction and pharmacist-physician relationships, reduction in physical referrals, and improvement in clinic efficiency.” (Emmerton, et al, 217-225).

It is envisaged that prescribing by protocol can lead to ‘containment of drug costs, reduction in medical practitioner visits, integration with medication reviews, and improving access to medicines’ (Quoted by Emmerton, Lynne et al, 2005). Studies conducted earlier and field evidence suggest that prescribing drugs and monitoring by hospital and community pharmacists are appropriate to improve patient health outcomes and possibly reduce health care costs. Research demonstrates that by having pharmacists involved directly in the medication process, there has been a reduction of 28 percent in morbidity and mortality for drug-related events during hospital visits, with a related cost savings of $76.6 billion (Malloy and DeBellis, 2006).

Literature review suggests that drug management has the potential to improve the quality of care for Medicare beneficiaries by reducing the incidence of adverse drug effects, improving patient outcome, and improving patient compliance with drug therapy. Drug management mainly focus on managing the drug therapy treatment of high-risk patients, those taking wide array of medications, or those with specific diseases, such as asthma, diabetes, heart attack, or hypertension.

The strategy to incorporate reimbursement codes that are specific to pharmacists performing medication therapy management (MTM) enables patients to obtain the type of care that is necessary to improve their health, and for healthcare providers to consider feasible cost-effective alternatives to healthcare delivery that might not have been present before (Texas State Board of Pharmacy, 2008). However, one of the most significant weaknesses related to CDTM services is that: “Many pharmacists, however, are not actively engaged in collaborative DTMSs, even in the states that have legislative approval, because of various obstacles including

1. difficulty in obtaining physician acceptance,
2. lack of support from directors and support personnel,
3. slow processes for getting credentialing status,
4. inadequate knowledge of billing and clinical skills,
5. indifferent attitude of pharmacy practitioners,
6. lack of a cohesive vision for practice models,
7. insufficient space to perform the services, and
8. outcomes failing to meet expectations” (Kuo et.al, 2004, p. 345).

Apprehensions about pharmacist role in medical care

Research has demonstrated that patients are often unaware of the services pharmacists are able to provide and are unlikely to appreciate the roles and responsibilities of pharmacists. In a competitive market, buyers and sellers of health care will naturally scrutinize the system to ensure that care and product are being provided in the most cost-effective manner. The role of pharmacists will be measured on the basis of care and services a patient receives. Every patient will seek optimum returns for which they are paying and expect fulfillment of their expectations. Since patients generally evaluate the services for value, convenience, and quality of care, extensive education about outcomes and cost-effectiveness of new services are paramount.

When all the stakeholders in health care compete with each other to extract optimal benefits they should be reminded that appropriate drug therapy is generally safer and more cost effective than other forms of treatment and that the personal and economic consequences of inappropriate drug use are enormous. Hence, it is recommended that: “Credentialing and privileging for pharmacists are important and complex issues intended to protect patients from incompetent providers, to safeguard organizations from malpractice allegations, and to meet regulatory agency and third-party payer requirements.” (Harris, et al., 19e).

Relevance of CDTM Act in Massachusetts

Collaborative prescribing, to some extent, was in operation throughout the past 25 years, and 27 American States had some form of legislation allowing this practice by 2001. Earlier prescribing collaboration includes aminoglycoside and pharmacokinetic dosing services, anticoagulant therapy adjustment and chemotherapy, and antiemetic management. Federal government recognized pharmacists as an integral part of health care team by involving them in medication therapy management as part of the Medicare Modernization Act of 2003, and the Collaborative Drug Therapy Management (CDTM) legislation is designed to create wider role for pharmacists among health care team.

So far 43 other States in the U S have already passed similar legislations, and the practice has proven to improve quality of care, reduce errors, and save money in the state where it is currently allowed. However, it is viewed that authorizing pharmacists to prescribe drugs will exacerbate quality health care.

Main problems highlighted in authorizing pharmacists to prescribe drugs is that it may remove interaction with physicians undertaking diagnosis, create extra workload for the prescriber, complicate reimbursement for prescribing, require pharmacists to compromise other professional duties, and arguably lead to more room for error by involving more staff.’ (Emmerton, et al, 217-225).

All pharmacists may not be willing to shoulder the responsibility of diagnosis, prescribing, and follow-up, including an awareness of competence required to undertake ‘dependent’ prescribing. In addition, there may be implementation issues such as coordination of information and access, accreditation, education, accountability, and competency assessment, determination of scope of practice, and gaining of prescriptive authority (Shaw, J, 2002 and Aldouse, J, 2003).

Keeping prescribing and dispensing as separate entity is important for ensuring selection of appropriate treatment for the patient, and alienating physicians from prescribing is perceived to affect optimal patient outcome. This may prompt other professionals in health care to feel that prescribing pharmacists interfere on their area of professional responsibility, leading to professional grudge and breach in working relationships.

However, it is worth noting that pharmacists are not devoid of performance lapses. Holdford (2006) argues that “many pharmacists do not fulfill their professional roles because they do not know what to do or how to do it as a result of inadequate education, training, and supervision.” (Holdford, 02). In addition, their choice of prescription may be influenced by advertisements and some individual material benefits. It is experienced that sales people and drug manufacturers are likely to interfere in CDTM, because any personal preference by pharmacists may boost or deter the prospect of a particular manufacturer.

Institute of Medicine cites that drug manufacturing is a $122 billion industry and estimated $2.5 billion is spent on pharmaceutical advertising annually. The managed care industry reports that from 1999 to 2000, prescriptions written for the top 50 most heavily advertised drugs rose 245 percent, compared to 43 for all other drugs combined. (Moore). ‘Health care for all, report that in 2005, pharmaceutical companies spent $12 billion nationally in marketing to physicians (some $13,000 /physician), including provision of free samples’. (Goldfield, et al).

The data implies that a small increase in market share can reflect a multimillion-dollar boost for any particular company, and every manufacturer will vie to get the attention of prescribers to promote their product often. It is suggested that ‘reduced marketing to physicians will cut industry influence on prescribing decisions, leading to increased quality of prescribing, reduced complications from inappropriate medications, and reduced costs for both public and private payers.’ Similarly Holdford (2006) suggested that ‘good service scripts’ can improve efficacy of pharmacy students to provide the best care to patients, help enhance effectiveness, efficiency, confidence, and acceptability.

“A collaborative practice agreement is a voluntary, written agreement between a physician and a pharmacist outlining a plan of cooperative practice for drug therapy management. These agreements are limited to care within the scope of practice of the participating physician, or in some states nurse practitioners, and pharmacist.” (Collaborative Practice Agreements: What is Collaborative Practice Agreement).

Under CDTM, having entered a voluntary agreement with a physician, pharmacists may more effectively engage in monitoring and controlling pharmaceutical care, which will enhance safety and cost-effectiveness of medication therapy, as well as quality of life for patients. Bjornson et al. reported a benefit:cost ratio of 6:1 among health care teams, that included a pharmacist, compared with teams that did not have a pharmacist (Thomas et. al, 2006, p. 2490). Though CDTM offers financial advantages, there are still many questions to be answered regarding the long-term influence of CDTM on cost savings.

The A C C P has estimated that the annual cost of drug management under Part B of the Medicare program would be between $500 million and $1.7 billion, depending on the structure and use of the benefit. The lower figure assumes 2 outpatient visits per year for 8 million beneficiaries, and the higher number is based on 4 visits per year for 12 million patients.

These estimates assume an hourly payment rate for pharmacists of $60, with 65 percent of visits lasting 15 minutes, 25 percent lasting 30 minutes, and 10 percent lasting 60 minutes (Medicare Payment Advisory Commission, 2002, p. 24). As a result, it is evident that the long-term fiscal requirements of CDTM have yet to be fully determined, and therefore, it is important to consider that some states are not necessarily prepared to assume the fiscal responsibilities associated with this strategy, particularly since its long-term impact remains unknown.

With the emergence of CDTM the role of pharmacist has become well-defined and influential in healthcare delivery. It is projected that “If the profession of pharmacy does not move toward a cost effective, patient oriented practice, it can expect pharmacy technicians and/or technological advances to replace pharmacists who dedicate themselves solely to the dispensing and sale of medications and other products.” (External and Internal Assessment, 10).

Present Status of CDTM in Massachusetts

The Act establishing Collaborative Drug Therapy Management in Massachusetts has been signed by Governor Deval Patrick on January 15, 2009, and the Bill under Senate number 2706 is now referred to as Chapter 528 of the Acts of 2008. With the enactment of the Chapter 528, Massachusetts pharmacists shall become prescribers, under voluntary contractual relationships with doctors, in an effort to enhance patient outcomes. (Governor Signs Collaborative Drug Therapy Management). The CDTM Act of 2008 passed by the Commonwealth of Massachusetts has amended Section 7 and 9 of chapter 94C and section 24 of Chapter 112 enshrined in the General Law of 2006.

The Act authorizes duly registered pharmacists, to engage in collaborative drug therapy management and to issue written prescriptions in accordance with the provisions and guidelines of section 24 (subsection1 and 2) of chapter 112. Amendment to chapter 94C, section 9, permits a physician, dentist, podiatrist, optometrist, nurse practitioner and psychiatric nurse mental health clinical specialist, physician assistant, certified nurse-midwife, pharmacist, or veterinarian, as limited by various relevant new sections and subsections, when acting in accordance and consistent with federal law and in good faith and in the professional practice for the alleviation or treatment of pain, disease, and suffering can possess controlled substances and cause such controlled substances to be administered by a nurse under his or her direction.

Similarly the Act brought amendment to Chapter 112 of the General Laws by inserting two sections after section 24B. New section defines ‘Collaborative drug therapy management’ as the “initiating, monitoring, modifying and discontinuing of a patient’s drug therapy by a pharmacist in accordance with a collaborative practice agreement. For entering a pharmacist into a collaborative practice agreement, the pharmacist shall:

1. hold a current license to practice pharmacy in the commonwealth and currently be engaged in pharmacy practice in the commonwealth;
2. have at least $1,000,000 of professional liability insurance;
3. have earned a doctor of pharmacy degree or have completed 5 years of experience as a licensed pharmacist or the equivalent;
4. agree to devote a portion of his practice to the defined drug therapy area that the pharmacist shall co-manage; and
5. agree to complete, in each year of the agreement, at least 5 additional contact hours or 0.5 continuing education units of board-approved continuing education that addresses areas of practice generally related to collaborative practice agreements.

Though pharmacists introduced a bill granting much broader collaborative drug therapy, it was strongly opposed by several medical societies. The successful legislation is viewed as the result of consensus and collaboration between pharmacy organizations and the Massachusetts medical society. Passing of the bill was made possible by the concerted effort of pharmacists from all practice settings, students of the APhA chapter of the Massachusetts College of Pharmacy and Health Sciences and active involvement of individuals and MPhA executives.

Conclusion

Pharmacy practice is undergoing constant change with introduction of increasingly complex and expensive drugs, drug regimens, and diagnostic technologies emerging from biotechnology industry, and health care reform. Pharmacists must become participating members of the health care team and work collaboratively with physicians and other health care practitioners to provide total care to the patient.

By creating a collaborative environment the knowledge gained by pharmacists could be utilized to help patients achieve better outcomes from drug therapy, which can provide considerable cost savings to health care system. Incorporating continuous quality improvement program (CQI) that includes peer review for the identification and prevention of dispensing errors will ensure health care cost efficient and error free medication delivery by pharmacies.

Works Cited

Collaborative Practice Agreements: What is Collaborative Practice Agreement. GO2EC. 2008. Web.

Emmerton, Lynne., et al. Dependent Prescribing: Prescribing by Protocol. J Pharm Pharmaceut Sci. 8.2. 2005. Web.

External and Internal Assessment. Texas State Board of Pharmacy. 2006. Web.

Goldfield, Norbert., et al. A Consumer Driven Health Care Cost Control Agenda for Massachusetts: 17 Legislative Proposals. Health Care for All. 2007. Web.

Governor Signs Collaborative Drug Therapy Management. MPHA: Masacchussets Pharmacists Association. 2009. Web.

Harris, Ila M., et al. Developing a Business Practice Model for Pharmacy Services in Ambulatory Settings: Certification and Credentialing. ACCP White Paper. 2008. Web.

Holdford, David. Service Scripts A Tool for Teaching Pharmacy Students How to Handle Common Practice Situations: Introduction. American Journal of Pharmaceutical Education. 70.1. 2006. Web.

Moore, Richard T. Identifying and Preventing Medication Errors. Legislative Policy Association. 2009. Web.

Report to the Congress: Medicare Coverage of Nonphysician Practitioners. Medpac: Medicare Payment Advisory Commission. 2002. Web.

Shih, Antony., Davis, M P H Karen., and Schoenbaum, Stephen. Organizing the US Heath Care Delivery system for High Performance: Overview. The Common Wealth Fund. 2008. Web.

Occupational therapy is one of the most and, probably, the most significant from the social point of view branches of modern science. Helping people overcome the obstacles that hinder their social communication, occupational therapy offers the enabled sense for living. Understanding the principles of the modern occupational therapy and the ideas underlying it, one can realize what enhances the enabled people’s social life and encourages them to step into the big world.

There is no doubt that the given sphere of healthcare offers many promising and prospective ideas. Considering human occupation as one of the most efficient means of helping the enabled, one can come to the conclusion that the given sphere requires more consideration. Perhaps, with the development of occupational therapy, the enabled might feel better in the world that they are not used to living in.

Therefore, one of the crucial stages of learning the prospects of occupational therapy would be to find out about its development and the ideas underlying it. Understanding what makes the machine of the occupational therapy go round, one can suggest more efficient means of curing the enabled and providing them with a more successful therapy (Mallison 2009). Learning the role of the occupational therapy in the sphere of health promotion, one can figure out the new ways of enhancing the occupational therapy effect among the enabled and thus provide them with sufficient help. Therefore, the importance of the given subject cannot be doubted. As Skaffa (2011) said, “Occupational therapy practitioners have an opportunity to complement existing health promotion efforts by adding the contribution of occupation to programs developed by experts in health education, nutrition, exercise, and so forth” (607).

Observing the Ottawa Charter (Willcock 2003) from the viewpoint of a professional OT, I would reconsider the ideas offered in the Building Healthy Public Policy sector. It seems that in the given list of the spheres demanding most attention there is certain element lacking. On the one hand, each of the aspects of the social life touched upon in the given charter cover a man’s entire life, yet there is one element lacking. This is the knowledge that matters – the importance of being informed on the basic issues of the aspects mentioned. In addition, it seems that the sphere of healthcare has not been mentioned at all, which is a doubtless oversight. Speaking of the second charter, an OT would add, perhaps, certain elements connected with work or any other occupation. Considering the spheres that make the leisure of an individual is, no doubt, important, yet taking into account the sphere of the professional interest would make the basis of a successful therapy. Concerning the third charter, I would also add such point as “encourage” – for the elements mentioned in the table to interact, there must be another medium that could bring these elements into interaction. Speaking of the fifth charter, one must say that it could enclose the accessibility of the occupational opportunities and the equality in these opportunities into a single point.

Therefore, it is obvious that the problem of the occupational therapy development and the prospects that it offers for the enabled people are of great importance for the society, as well as the relationships within a family, or, as Cahill (2009) put it, “well-matched relationship between the child, the family system, and his or her surrounding environment”. Once helping the enabled people to feel that they are a part of the community, one will help to solve one of the greatest problems of the XXI century healthcare.

Reference List

Cahill, S. M., & Suarez-Balcazar, Y. (2009). The issue is – promoting children’s nutrition and fitness in the urban context. In American Journal of Occupational Therapy, 63, 112-116.

Mallinson, T., et al. (2009) Human occupation for public health promotion: new directions for occupational therapy practice with persons with arthritis. In American Journal of Occupational Therapy, 63, 220-226

Scaffa, M. E., Van Slyke, N., & Brownson, C. A. (2008) Occupational therapy services in the promotion of health and the prevention of disease and disability. In American Journal of Occupational Therapy, 62 (6), 694-703

Willcock, A., & Whiteford, G. (2003) Occupation, health promotion, and the environment. In Using Environments to Enable Occupational Performance. Eds. Lori Letts, Patty Rigby & Debra Stewart. Thorofare, NJ: SLACK, 56-67

Introduction

Today, people develop various attitudes toward conversion therapy and its impact on society. In Canada, much attention has already been paid to this pseudoscientific approach, which aims to help people change their sexual orientation or gender identity. At the end of 2021, the Canadian parliamentarians passed legislation to ban conversion therapy, which provoked multiple reactions and disagreements. Rachel Aiello and Brian Bird created articles to share their positions on the topic, addressing different perspectives and choosing specific approaches. The evaluation of the articles will be based on the framework developed by the Association of College & Research Libraries (ACRL, 2015) and focused on such elements as authority, creation, information value, research, scholarship, and searching worth. The ACRL framework proves that it is not enough to identify the authors’ purposes and intentions but to clarify if their words and arguments are strong and credible to succeed in delivering their messages. The articles by Aiello and Bird on conversion therapy’s ban in Canada have certain strengths and drawbacks, depending on authority levels, research methods, and standpoints to support their purposes.

Authors’ Points of View

Evaluating the structure and context of information plays an important role in understanding a topic and the level of facts’ credibility. The authors of the chosen articles address the government’s decision to ban conversion therapy in Canada. Aiello’s (2022) point of view is based on the fact that conversion therapy is not illegal in the country and the explanation that anyone who practices this approach should be imprisoned for five years. Bird’s (2022) standpoint is more subjective because he admits that the government puts Canada “on a worrisome path” due to the possibility of positive outcomes of conversion therapy. Each author is confident that eradicating this therapy would change society, and it is necessary to understand the context changes following a proper structure. The authority of the chosen articles lies in defining the social positions as citizens and proving that this special experience of conversion therapy banning remains ambiguous.

Research Process Evaluation

Each article usually presents the results of some research and ideas obtained from different sources. I am going to evaluate each resource for its research addressing the ACRL frame of research as inquiry and focusing on the chosen methods. Bird (2022) offers a strong background to explain why the current Canadian law is more than a ban for society. He mentions the example of a man who might need professional counselling to repress his non-heterosexual attraction and save his family (Bird, 2022). The author is curious about what could happen when cooperation with an expert becomes a crime. His research is not only a clear statement but an inquiry to define the essence. Aiello (2022), on the other hand, does neither pose additional questions nor raises concerns about the legislation. She introduces the facts about the comprehensive criminalization of conversion therapy in Canada and other countries (Aiello, 2022). In both cases, the governmental solution is the only reliable source on the basis of which additional perspectives and opinions are developed.

Authors’ Arguments

The strengths of the articles under analysis lie in the possibility of the authors stating their arguments in a clear and understandable way. For example, Bird (2022) believes that the effects of the law cannot be defined as purely positive or negative for Canadians and offers such arguments as parental involvement, religious controversies, and family values. Aiello (2022) creates the article within the frames of the offered law and uses the definition of conversion therapy, the imposed restrictions, and social expectations as the major arguments. These sources show how to match the product with the information needed to approve the legalization. Canada’s ban on conversion therapy cannot be ignored, but the ambiguity of its outcomes still bothers some individuals.

Authors’ Success and Failures

I think Bird was more successful in his arguments compared to similar attempts made by Aiello. According to the ACLR (2015), researchers and scholars should share new insights and introduce their perspectives and interpretations. Bird (2022) introduced conversion therapy’s ban and gave several examples of why this decision could have a far more impact than people thought. His approach was not only to mention the fact but developed new ideas to prove the possible failure of the law. Aiello (2022) did not promote a conversation but stated that conversion therapy was no longer legal in Canada. Bird’s success and Aiello’s failure could be explained through the prism of novelty and the intention to avoid or rely on dry facts only.

Resources’ Purposes and Results

The originality of ideas and the observed accomplishment should be proved through the offered goals and intentions of the authors. Information value is related to various aspects, including education, persuasion, negotiation, and understanding (ACLR, 2015). In both articles, the authors did not clearly indicate their purposes. Still, it is possible to use their titles as the major urge of their writings. The length and the content of Aiello’s article (2022) prove that her goal is to inform the reader and underline that conversion therapy is illegal in Canada. There are no other questions or concerns about the situation, which defines the purpose to inform was successfully met. Bird’s purpose (2022) is to persuade the reader that the therapy ban is not just another legal decision but an event that could cause a more serious impact. Addressing a number of examples and ambiguous situations, Bird (2022) concludes that more clarity on the conditions when citizens might be exposed to criminal prosecution is required. Thus, the resources’ purposes and outcomes are characterized by a strong information value.

Agreements and Disagreements

In fact, regarding the purposes and methods used by Aiello, it is hard to find enough reasons for disagreement. She introduced a clear statement and supported the discussion with several arguments to identify a serious milestone in LGBTQ2S+ rights. There are no right or wrong opinions because the article is based on facts and the outcomes of the eradication of conversion therapy. At the same time, Bird’s intention to add personal contradictions to the parliamentarian decision may be associated with some additional questions and strategic explorations. I think that Bird’s opposition to the biological predisposition of male and female identities is weak. For a long period, people have been living in a world divided between two basic genders – a man and a woman. The desire to create new gender differences might have some mental health or emotional arguments, but biology is a science with a long-lasting history. It is wrong and useless to question the worth of biology to support or oppose conversion therapy.

Conclusion

People need to believe in something and use their arguments and knowledge to support the chosen positions. Aiello’s and Bird’s perspectives are effective in their research, purposes, and arguments. However, the chosen articles have limitations due to an overall subjectivity (Bird’s case) and objectivity (Aiello’s case). Both authors agree that conversion therapy is now illegal in Canada, but Bird’s explanation made me disagree with the author because of multiple biased attitudes and provocations.

References

Aiello, R. (2022). Conversion therapy is now illegal in Canada.CTV News. Web.

Association of College & Research Libraries. (2015). Framework for information literary for higher education. Association of College & Research Libraries. Web.

Bird, B. (2022). Canada’s ban on conversion therapy could impact far more than that.Policy Options. Web.

Relapse Prevention Therapy (RPT) is one of the most effective theories of counseling helping people avoid the problem of alcohol or drug abuse. This theory was developed in the beginning of the 1970s, and first implemented in 1977. As identified by the developer, the theory has no adverse effects, unintended consequences or any other undesired outcomes. The main concept of RPT is in helping the patient with drug or alcohol abuse conditions avoid relapsing of their bad practices. This concept seems to work with one of the most complicated problems which the affected individuals face because it is well known that it is much easier to quit smoking or taking drugs for some short period, but it is easy to return to these unwanted behaviors under the influence of former set of behaviors.

First of all, speaking about the origin of RPT, it should be stated that it was developed in the beginning of 1970s, and first implemented in 1977 as a maintenance program after the other programs aimed for curing the patient with different types of addiction (Parks, 2000). According to Marlat and Witkiewit (2002, p. 2), the developer of this theory based it on the idea that “addictive behaviors are acquired, over-learned habits with biological, psychological, and social determinants and consequences”. During the researches, it became evident that people engage in harmful habits because they feel good doing so. With the acknowledge of the above mentioned fact, the team of specialists working on RPT theory developed methods aimed to destruct good feeling which people have during taking alcohol or drugs. This appeared to be an efficient method, and soon RPT theory acquired its due place among the other theories of counseling helping people avoid the problem of alcohol or drug abuse. Nowadays, this theory is actively applied in the United States, Canada and Scotland (Relapse Prevention Therapy, 2012). In the United States, the RPT based program is financed by the National Institute of Health. The school of thought from which it was originated is cognitive-behavioral therapy school.

The history of implementation of RPT theory in practice extends for more than forty-five years. During this long period, the specialists working with it developed effective practical strategy of its implementation. In the initial stage of treatment, they evaluate the inner potential of the patient. According to Marlat and Witkiewit (2002, p.2), “utilizing this Relapse Prevention Therapy begins with the assessment of a client’s potential interpersonal, intrapersonal, environmental, and physiological risks for relapse and the unique set of factors and situations that may directly precipitate a lapse”. Then, high-risk situation for this particular individual are identified. When the patient’s examination is ended, the period of medication begins. During this period, psychological cognitive-behavioral methods along with relevant medical support of medicaments and medical procedures are used. Simultaneously, the patient is subjected to the sports therapy with different exercises aimed for improving the patient’s physical condition and mood. The first period of treatment is very important. It is also connected with the biggest amount of difficulties. On this reason, the patients are isolated from the society during this period, Such strategy is aimed to help the patient avoid dangerous situations in which he or she may relapse one’s harmful behaviors. The main factor for the success in the implementation RPT is shown in the “identification of a client’s unique profile of high-risk situations for relapse and evaluating that client’s ability to cope with these high-risk situations without having a lapse” (Marlat & Witkiewit, 2002, p.5).

This counseling theory is of great interest for me because it is aimed for overcoming the syndrome of dependence during the treatment of abuse conditions. Everybody knows that it is easy to quit smoking, but very difficult to avoid this harmful habit in future. Many people gave up smoking multiple times, but they did not succeed in maintaining their new positive practices (Heather & Stockwell, 2004). RPT is aimed to help such people develop self-control and avoid unwanted behavioral patterns in order to cope with the problem’s relapse. According to Parks (2000, par.2), relapse can be identified as “a breakdown or failure in a person’s attempt maintain change in any set of behaviors”. Relapse is the most frequent problem for those who try to conquer their unwanted routines. RTP helps every individual analyze his or her life circumstances, and identify the areas where they are most probably subjected to the danger of relapsing their bad behaviors. Specialists working with patients using programs developed on the basis of this theory provide their patients with considerable measure of psychological support. In the form of friendly discussions, they offer the individual a chance to analyze one’s life circumstances and see those of them which should be changed. For example, in case the person is subjected to the unwanted behavior on the reason of bad influence by some people including the so-called “friends”, the specialists provide him or her with psychological help aimed to avoid such dangerous contacts. In the very beginning of the treatment course, the patient is isolated from the dangerous situations in the medical establishments. This minimizes the risks of the relapse problem. Later, the individual is assisted in avoiding unwanted behaviors until he or she develops new habits and strategies of behavior (Marlat, Park, & Witkiewit, 2002).

Evaluating the outcomes of RPT theory, hypothetical-deductive method can be implemented. The analysis of the most frequent problems for those individuals who try to avoid unwanted behaviors including alcohol or drug abuse shows that it is very difficult for them to maintain newly received positive practices which they acquired during the treatment program. The positive side of RPT is in addressing this common problem. Using hypothetical-deductive way of thinking in this case indicates relapses in bad behaviors as the most critical issue. Thus, because RPT addresses the above-mentioned problem, its effectiveness does not offer any grounds for distrust.

Concluding on all the above-discussed information, it should be stated that RPT is one of the very effective theories applied in the area of treatment of alcohol or drug dependences. The RPT theory of counseling is based on the concept of fighting with possible relapses of harmful practices by the patient. The effectiveness of this theory is proved since the 1970s. For about half a century, RPT is successfully applied in practice by the specialists from numerous hospitals in the United States. During such long history of its implementation, RPT became a basis for a number of successful practical methods applied during different stages of the patient’s treatment. The developers of this theory state that it has no adverse effects, unintended consequences or any other undesired outcomes. Nowadays, RPT theory of counseling is applied in a number of countries including the United States, Canada and Scotland.

References

Heather, N. & Stockwell, T. (Eds.). (2004). The Essential Handbook of Treatment and Prevention of Alcohol Problems. Chichester, England: John Wiley & Sons. Web.

Marlat, A, Park, G., & Witkiewit, K. (2002). Clinical Guidelines for Implementing Relapse Prevention Therapy. Web.

Parks, G. (2000). Relapse Prevention Therapy: A Cognitive-Behavioral Approach. Web.

Relapse Prevention Therapy (RPT). (2012). Web.

Introduction

The foremost issue of challenge testing, particularly within pandemic situations such as COVID-19, is the exposure of individuals to risks and unknowns. As such, in order to consider challenge testing to be ethically viable or not, researchers must first obtain control over the levels of risk. The ethical issue arises in case an infection leads to extreme examples of the condition or the presence of intolerable levels of hazard to the participants. The ethical concern within the selected setting depends on the ability of researchers to reduce exposure to risks and maximize the benefits of the study.

Discussion

The progress of accelerated testing and the introduction of COVID-19-related therapies have only become prevalent later in the pandemic. Similarly, the acceleration of therapy testing may not always be justified as therapies in particular often expose varying clinical value. Though they may not be inherently among testing participants or patients, their benefits may be insufficient in comparison to exposure to risk and prioritization over other treatment plans. However, through the perspective of the categorical imperative, it may be argued that therapies are essential for individuals that are most at risk. Therefore, the acceleration of therapy testing allows healthcare professionals to observe their moral obligation to provide treatment.

The acceleration of vaccination testing is the most debated in relation to treatments and preventative measures for Covid-19. This is likely due to the substantial issues that have arisen from lacking testing or the inefficiency of certain vaccines. Both the risk of an insufficient and absent vaccine suggests that cases of infection will increase which allows for the mutation of the virus. This could result in further exposure of individuals with preexisting conditions. As such, according to the maximum-minimum principle, there would be more ethical benefit from refraining from accelerated testing of vaccines.

In the case that drug testing reveals implications for the cardiovascular system, it is vital that testing addresses the relevant risks. Unethical conduct relates to cases in which contributing risks are not considered. As such, accelerated testing may not be considered as it provides patients and test subjects alike with greater risk and unchanged levels of benefits. Through the lens of utility, it can be identified that cases of cardiovascular issues as a result of exposure to tested drugs lead to decreased well-being. Thereby, it directly contributes to the suffering of the individuals involved and is unethical.

Based on the principle of maximum-minimum, the vaccine requires challenge testing. The principle promotes the improvement of social justice through universal systems, such as the meeting of basic needs through healthcare. As such, the challenge testing of a vaccine is vital to addressing the core issues of exposure to Covid-19. Often, social, economic, and racial backgrounds can impact a patient’s experience with the infection. The maximum-minimum perspective provides that the testing is done in order to make the vaccination more accessible.

Conclusion

Arthur Caplan’s position within bioethics is centered on the minimization of risks. It is applicable both in daily practice as well as within the medical field, particularly in testing for treatment and preventative measures (Whyte, 2022). Caplan summarizes that a lack or decrease of exposure provides benefits to individuals both ethically and medically. However, in incidents such as testing, which are not risk-free, tactics must be undertaken to have increased control over risk factors.

Reference

Whyte, J. (2022). COVID-19: Ethics and the unvaccinated. WebMD. Web.

Cognate Proposal

Mental health care has become an increasingly important intervention in modern society in the last few years, especially for the transgender and gender nonconforming communities. Because of the typical discrimination against members of this community, individuals are likely to develop mental problems and require psychological and clinical interventions (Tompkins, Kearns & Mitton-Kükner, 2017; Pinto, 2014). About 40% of adult members of the community have attempted suicide during their lifetime and about 75% of the youth in this group feel unsafe at school (DeBord, Fischer Bieschke, et al., 2017; ALGBTIC LGBQQIA et al., 2013). Therefore, the profession needs high standards of therapy and makes services readily available in a college setting where to care for those with needs (Grzanka & Miles, 2016). This proposal examines why an affirmative therapy cognate is beneficial to a college counseling program, how the cognate can make the program more marketable, and how it will better prepare future counselors for the counseling field.

Benefits of the Cognate

Individual members of the community tend to hesitate to seek counseling services, yet they are in need of help. Most individual members of the community often have difficulties finding affirmative counseling services or tend to be apprehensive about seeking counseling because of past experiences (White & Fontenot, 2019). Considering the high rates of mental issues among this specific population, it is clear that shying away from seeking help is harmful. Furthermore, counseling settings are not always free from discrimination, violence, and harassment, as incidents have been reported.

Mental health professionals ought to be highly competent when offering counseling services to members of the LGBTQ+ community. With skilled and knowledgeable counselors and agencies, it is possible to eliminate many of the apprehensions when members of the group are seeking professional services (White & Fontenot, 2019). Competent counselors will have the ability to make LGBTQ+ clients comfortable and safe and provide high-quality care.

Marketability

In most states, many counselors have not received adequate training to work with members of the often discriminated population. Counselors need to have knowledge about the population and its cultures as well as subcultures beyond the conventional concerns of clients (Patterson & Augelli, 2013). Many LGBTQ+ clients tend to have clues about the deficit in the field, which makes them prescreen therapists for competence and safety in issues of gender and affectional orientation.

The needs of LGBTQ+ clients are different from those of heterosexuals because of variant developmental and affectional experiences, stigma and oppression they are likely to face. In addition, members of the LGBTQ+ community have been lumped together as if their individual needs and concerns are uniform (Lelutiu-Weinberger & Pachankis, 2017). This is wrong because each subgroup has its needs and even individuals have specific demands. Once the program is established based on these proposals, it will be marketable because it will treat each client based on personal needs and not necessarily the needs of the group.

Counselor Preparation

The aim of the proposed program is to equip counselors with the knowledge and skills necessary to handle and work with individual LGBTQ+ clients. The proposed program will equip counselors with additional knowledge and understanding of the diverse needs of the different subgroups of the LGBTQ+ community (Borgogna & McDermott, 2020). Counselors will take additional courses and practical lessons beyond those of the conventional counseling course (Hunt, 2014). The idea is to give them awareness and knowledge about the population and its cultures as well as subcultures beyond the conventional concerns of clients..

Syllabi for 3 Sources

Course 1

Course Title: Transgender experiences: An introduction

Instructor Information

The instructor is a professor of psychology with 22 years of experience in practice and teaching. He has published 13 articles and authored 3 books to which he has contributed as a leading researcher and author.

Required Texts and Readings

• Hunt, J. (2014). An initial study of transgender people’s experiences of seeking and receiving counseling or psychotherapy in the UK.Counseling and Psychotherapy research, 14(4), 288-296.
• White, B. P., & Fontenot, H. B. (2019). Transgender and non-conforming persons’ mental healthcare experiences: An integrative review.Archives of Psychiatric Nursing, 33(2), 203-210.
• ALGBTIC LGBQQIA Competencies Taskforce, Harper, A., Finnerty, P., Martinez, M., Brace, A., Crethar, H. C.,… Hammer, T. R. (2013). Association for lesbian, gay, bisexual, and transgender issues in counseling competencies for counseling with lesbian, gay, bisexual, queer, questioning, intersex, and ally individuals: Approved by the ALGBTIC board on June 22, 2012. Journal of LGBT Issues in Counseling, 7(1), 2-43.
• Ginicola, M.M., Smith, C., & Fillmore, J.M. (2017). Affirmative Counseling with LGBTQI+ People. American Counseling Association.

Supplemental Readings

• Nadal, K. L. (2013). That’s so gay! Microaggressions and the lesbian, gay, bisexual, and transgender community. Washington, DC: American Psychological Association.
• Patterson, C. J., Augelli, A. R. (Eds.). (2013). Handbook of psychology and sexual orientation. New York, NY: Oxford.

Course Description

The purpose of this course is to give the students an opportunity to develop a comprehensive awareness of the identities related to gender, sex, gender identity, and gender expression. Using theory and research, the course will focus on bio-social-cultural-psychological factors and aspects that shape gender experiences and influence individuals’ self-understanding throughout lifespan (Nadal, 2013; Richards, Bouman, Seal, et al., 2016; Moe, Johnson, Park et al., 2019). Finally, the course will create awareness among the learners about the experiences of LGBTQ+ clients in the hands of counselors.

Course Requirements

Taking the course will require the students to be in a master’s or doctoral-level counseling program. They should have at least a bachelor’s degree in counseling, psychology, psychiatry or related fields from recognized institutions.

Grading

Table 1: Detailed outline of the grading criteria for the course

Assessments

The course will have tests seeking to assess the absorption of content and skills by the learners. However, the main area where the assessment will be conducted is the main exam, continuous assessment tests, and assignments, homework, and term papers. A grading rubric has been developed and will be used for assessment.

Table 2: Grading rubric for class participation and group work assessment

Table 3: Rubric for research reports, written assignments, and term papers.

Course Outline

• Week 1: Introduction to transgender.
• Week 2: whither the category “transgender”.
• Week 3: History of transgender.
• Week 4: Transsexual empire- origins and history of the discipline.
• Week 5: Lived experiences of different subgroups in LGBTQ+ community.
• Week 6: Health and wellbeing of the LGBTQ+ community.
• Week 7: Psychology and mental issues of LGBTQ+ community.
• Week 8: Psychological and clinical interventions: Relationship between providers and LGBTQ+ patients/clients.
• Week 9: Affirmative therapy for LGBTQ+ clients.
• Week 10: Student presentations and exam.

Additional Standard University Requirements for All Syllabi

Students are expected to behave according to the university student behavior code. It is the duty of all students to ensure that they are available for all tasks in the course.

Course 2

Course Title: Trans-affirmative clinical practice.

Instructor Information

The instructor is a professor of clinical psychology and psychiatry and has been working at the university for the last 4 years. She is a specialist in both practice and teaching and is involved in research work.

Required Texts and Readings

• ALGBTIC LGBQQIA Competencies Taskforce, Harper, A., Finnerty, P., Martinez, M., Brace, A., Crethar, H. C.,… Hammer, T. R. (2013). Association for lesbian, gay, bisexual, and transgender issues in counseling competencies for counseling with lesbian, gay, bisexual, queer, questioning, intersex, and ally individuals: Approved by the ALGBTIC board on June 22, 2012. Journal of LGBT Issues in Counseling, 7(1), 2-43.
• DeBord, K., Fischer, A., Bieschke, K., & Perez, R. (2017). Handbook of sexual orientation and gender diversity in counseling and psychotherapy. In Handbook of sexual orientation and gender diversity in counseling and psychotherapy. American Psychological Association.
• Ginicola, M.M., Smith, C., & Fillmore, J.M. (2017). Affirmative Counseling with LGBTQI+ People. American Counseling Association
• Moe, J., Johnson, K. Park, K., & Finnerty, P. (2019). Integrated behavioral health and counseling gender and sexual minority populations.Journal of LGBT Issues in Counseling, 12(4), 215-229.
• Grzanka, P. R., & Miles, J. R. (2016). The problem with the phrase “intersecting identities”: LGBT affirmative therapy, intersectionality, and neoliberalism.Sexuality Research & Social Policy: A Journal of the NSRC, 13(4), 371–389.

Supplementary Readings

• Patterson, C. J., Augelli, A. R. (Eds.). (2013). Handbook of psychology and sexual orientation. New York, NY: Oxford.
• Pinto, S. A. (2014). ASEXUally: On Being an Ally to the Asexual Community.Journal of LGBT Issues in Counseling, 8(4), 331–343.
• Tompkins, J., Kearns, L.-L., & Mitton-Kükner, J. (2017). Teacher Candidates as LGBTQ and Social Justice Advocates through Curricular Action. McGill Journal of Education, 52(3), 677–697.
• American Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed.). American Psychological Association.

Course Description

This course utilizes trans-affirmative models of clinical practice to help students learn about the foundational practices as well as principles for providing therapy to transgender clients and their families. Students will critically examine the cultural context, which includes the systems of power and privilege, within which the practices are constructed (Hasan, Alviany, Clarissa et al., 2017). The focus point for the course is the self-of-the-therapist client advocacy, and ethical practice.

Course Requirements

Students who will take this course must be registered for Master or Doctoral degrees in psychology, clinical psychology, psychiatry, and related areas.

Grading

Table 4: Detailed outline of the grading criteria for the course.

Assessments

This course will have five tasks as it is common in the department- classwork, assignments, homework, and term papers, continuous assessment tests, main exam, and practical work.

Table 5: Grading rubric for class participation and group work assessment.

Table 6: Rubric for research reports, written assignments, and term papers.

Course Outline

• Week 1: Introduction to trans-affirmative clinical practice.
• Week 2: Gender as a non-binary construct and gender identities.
• Week 3: Gender identity and sexual orientation.
• Week 4: Intersection between gender identity and other cultural identities.
• Week 5: Interactions of practitioner’s attitudes and knowledge with gender expression.
• Week 6: Stigma, prejudice, discrimination, and violence.
• Week 7: Influence of institutional barriers on TGNC people.
• Week 8: Promoting social change.
• Week 9: Lifespan development.
• Week 10: Assessment, therapy, and intervention.

Additional standard university requirements for all syllabi

Students are expected to behave according to the university student behavior code. It is the duty of every student to ensure that he or she is available for all tasks in the course.

Course 3

Course Title: Gender in therapy context: An intersectional approach.

Instructor Information

The instructor responsible for teaching course 2 will also take this course. She is a professor of clinical psychology and psychiatry and has been working at the university for the last 4 years.

Required Texts and Readings

• Golden, R. L., & Oransky, M. (2019). An intersectional approach to therapy with transgender adolescents and their families. Archives of sexual behavior, 48(7), 2011-2025. DOI: 10.1007/s10508-018-1354-9
• Adames, H. Y., Chavez-Dueñas, N. Y., Sharma, S., & La Roche, M. J. (2018). Intersectionality in psychotherapy: The experiences of an AfroLatinx queer immigrant. Psychotherapy, 55(1), 73. DOI: 10.1037/pst0000152
• Grzanka, P. R., & Miles, J. R. (2016). The problem with the phrase “intersecting identities”: LGBT affirmative therapy, intersectionality, and neoliberalism. Sexuality Research and Social Policy, 13(4), 371-389.

Supplementary Readings

• Moe, J., Johnson, K. Park, K., & Finnerty, P. (2019). Integrated behavioral health and counseling gender and sexual minority populations.Journal of LGBT Issues in Counseling, 12(4), 215-229.
• Nadal, K. L. (2013). That’s so gay! Microaggressions and the lesbian, gay, bisexual, and transgender community. Washington, DC: American Psychological Association.
• Patterson, C. J., Augelli, A. R. (Eds.). (2013). Handbook of psychology and sexual orientation. New York, NY: Oxford.

Course Description

This course explores the intersectionality of trans-identity within the community systems. Students will learn about systems of oppression and privilege that resulted in cissexism and transphobia (Ginicola, Smith & Filmore, 2017). Family law and family policy, working with groups of families and individuals, and coloration with multiple systems in clinical work will be the areas of focus in the course.

Course Requirements

Enrolling in the course will require students to have registered for Master or Doctoral degrees in psychology, clinical psychology, psychiatry, and related areas.

Grading

Table 7: Outline of the grading criteria for the course.

Assessments

For assessments, each of these areas will have tests seeking to assess the absorption of content and skills by the learners. A grading rubric has been developed and will be used for assessment.

Table 8: Grading rubric for class participation and group work assessment.

Table 9: Rubric for research reports, written assignments, and term papers.

Course Outline

• Week 1: Introduction intersectional approach.
• Week 2: LGBT-Affirmative therapy models.
• Week 3: self-altering strategies and gendered socialization.
• Week 4: Breaking down structural barriers.
• Week 5: multiple marginalized statuses and mental well being of LGBTIQ+.
• Week 6: Affirmative intersectional counseling.
• Week 7: Intersection of sexual orientation and traumatic stress.
• Week 8: development and evaluation of training workshops.

Additional Standard University Requirements for All Syllabi

Students are expected to behave according to the university student behavior code. It is the duty of every student to ensure that he or she is available for all tasks in the course. Students should address the instructor in the right manner and using the right channels when there is a need to fail to appear in class, participate in tasks, or take exams or submit assignments and reports.

Example Lesson Plans

Syllabus 1 Lesson Plan

Class: Week 5 Lived experiences of different subgroups in LGBTQ+ community.

Syllabus 2 Lesson Plan

Class: Gender identity and sexual orientation.

Syllabus 3 Lesson Plan

Class: Week 1- Introduction intersectional approach.

References

Adames, H. Y., Chavez-Dueñas, N. Y., Sharma, S., & La Roche, M. J. (2018). Intersectionality in psychotherapy: The experiences of an AfroLatinx queer immigrant. Psychotherapy, 55(1), 73. DOI: 10.1037/pst0000152

ALGBTIC LGBQQIA Competencies Taskforce, Harper, A., Finnerty, P., Martinez, M., Brace, A., Crethar, H. C.,… Hammer, T. R. (2013). Association for lesbian, gay, bisexual, and transgender issues in counseling competencies for counseling with lesbian, gay, bisexual, queer, questioning, intersex, and ally individuals: Approved by the ALGBTIC board on June 22, 2012. Journal of LGBT Issues in Counseling, 7(1), 2-43.

American Counseling Association. (2018). ACA code of ethics. Author.

American Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed.). American Psychological Association.

Borgogna, N. C., & McDermott, R. C. (2020). Perceived discrimination is disproportionately associated with sexual minority mental health: Implications for non-monosexual sexual minorities.Journal of Gay & Lesbian Mental Health, 24(1), 20-39.

DeBord, K., Fischer, A., Bieschke, K., & Perez, R. (2017).Handbook of sexual orientation and gender diversity in counseling and psychotherapy. In Handbook of sexual orientation and gender diversity in counseling and psychotherapy. American Psychological Association.

Ginicola, M.M., Smith, C., & Fillmore, J.M. (2017). Affirmative Counseling with LGBTQI+ People. American Counseling Association

Golden, R. L., & Oransky, M. (2019). An intersectional approach to therapy with transgender adolescents and their families. Archives of sexual behavior, 48(7), 2011-2025. DOI: 10.1007/s10508-018-1354-9

Grzanka, P. R., & Miles, J. R. (2016). The problem with the phrase “intersecting identities”: LGBT affirmative therapy, intersectionality, and neoliberalism.Sexuality Research and Social Policy, 13(4), 371-389.

Hasan, S., Alviany, Y., Clarissa, C., & Sudana, S. (2017). High perceived discrimination and no family support increase risk of poor quality of life in gender dysphoria. Universa Medicina, 36(3), 187-196.

Hunt, J. (2014). An initial study of transgender people’s experiences of seeking and receiving counseling or psychotherapy in the UK. Counseling and Psychotherapy research, 14(4), 288-296.

Lelutiu-Weinberger, C., & Pachankis, J. E. (2017). Acceptability and preliminary efficacy of a lesbian, gay, bisexual, and transgender-affirmative mental health practice training in a highly stigmatizing national context. LGBT health, 4(5), 360-370.

Moe, J., Johnson, K. Park, K., & Finnerty, P. (2019). Integrated behavioral health and counseling gender and sexual minority populations.Journal of LGBT Issues in Counseling, 12(4), 215-229.

Nadal, K. L. (2013). That’s so gay! Microaggressions and the lesbian, gay, bisexual, and transgender community. Washington, DC: American Psychological Association

Patterson, C. J., & Augelli, A. R. (Eds.). (2013). Handbook of psychology and sexual orientation. Oxford University Press.

Pinto, S. A. (2014). ASEXUally: On Being an Ally to the Asexual Community. Journal of LGBT Issues in Counseling, 8(4), 331–343.

Richards, C., Bouman, W. P., Seal, L., Barker, M. J., Nieder, T. O., & T’Sjoen, G. (2016). Non-binary or genderqueer genders. International Review of Psychiatry (Abingdon, England), 28(1), 95–102.

Svinicki & McKeachie (2014). McKeachie’s Teaching Tips (14th ed.). Cengage/Wadsworth Publishing. (this is a paperback edition)

Tompkins, J., Kearns, L.-L., & Mitton-Kükner, J. (2017). Teacher candidates as LGBTQ and social justice advocates through curricular action. McGill Journal of Education, 52(3), 677–697.

White, B. P., & Fontenot, H. B. (2019). Transgender and non-conforming persons’ mental healthcare experiences: An integrative review.Archives of Psychiatric Nursing, 33(2), 203-210.

Addiction is adversity that has the power to destroy a person’s life. Unfortunately, the rates of addiction among women are increasing continuously due to a variety of cultural, social, and biological factors. Since minority women face a greater risk of negative consequences for health and are more likely to relapse, it is essential to develop practices that would help throughout their recovery (Ait-Daoud et al., 2019). Adolescence is the future of society, and their health and general well-being ensure that the future of the world is stable. Exposure therapy is a means of treatment that allows patients to overcome their issues through confrontation with the troubling subject.

Adolescent minority women with addiction would benefit from exposure therapy. It has been established that adolescence could be treated for addiction through exposure therapy. Exposure in sensu requires the patients to imagine the situations that trigger them to partake in the addiction. This kind of therapy could be taken to the next level, for example, by simulating the state of drunkenness with special goggles or VR (Geisel et al., 2021). This method has an effective availability since there are plenty of therapists who are experienced with exposure therapy, and health insurance covers it. Generally, exposure therapy takes five to twenty sessions, depending on the patient. There are certain strengths and weaknesses of this method of treatment. For example, exposure therapy could take place at home through VR sets for those who are impaired or unable to travel to the therapist’s office. However, exposure therapy is known to have high patient dropout rates, which would be detrimental to the patient’s safety and health.

In conclusion, it is essential that adolescent minority women face adequate treatment for addiction, as they are the future of society. One such method is exposure therapy, which allows one to confront triggering situations. It could be undergone in both the therapist’s office and at home with the help of VR, which makes it highly efficient. However, exposure therapy can lead to patient dropouts, making this treatment possibly dangerous.

References

Ait-Daoud, N., Blevins, D., Khanna, S., Sharma, S., Holstege, C. P., & Amin, P. (2019). Women and addiction: An update. Medical Clinics, 103(4), 699–711.

Geisel, O., Lipinski, A., & Kaess, M. (2021). Non-substance addiction in childhood and adolescence–The internet, computer games and social media. Deutsches Arzteblatt international, 118(1-2), 14–22.