Institute Inbrief - 01/12/2015
Welcome to Edition 238 of Institute Inbrief! You may have heard of the Eastern-influenced practice of mindfulness, with roots in Buddhist traditions extending back over 2500 years. You undoubtedly know about – and are probably at least somewhat familiar with – the (Western) psychotherapeutic approach of CBT, or cognitive behavioural therapy. MBCT is an adaptation of MBSR (mindfulness-based stress reduction) which brings mindfulness and CBT together. In this edition we provide a definition of MBCT, along with an overview of its historical background and development.
Also in this edition:
- Latest news and updates
- Articles and CPD information
- Wellness and counselling practice tips
- Social media review
Enjoy your reading!
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It’s time to start loving what you do!
We’ve been training qualified Counsellors for over 24 years. Overwhelmingly, the number one reason people cite as why they became a Counsellor – to start loving what they do. They were stuck in a rut doing something they had no passion for, and it was dragging them down.
If you want a deeper understanding of yourself, and to use that knowledge to assist others overcome their challenges and start enjoying life again – then counselling is likely for you.
Too often we get drawn into a career that offers little personal satisfaction. Counsellors are passionate about the important work they do. They’re often someone that friends and family naturally come to for assistance. And they get immense personal reward helping others.
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The root of happiness in your brain
Japanese neuroscientists have made a step forward in understanding the neurology of happiness. They have found that happier people have a larger ‘precuneus’: an area towards the back of the brain, hidden between the two cerebral hemispheres. The study is the first to link the area to happiness. Researchers asked people about the two major components of happiness. These are: their moment-by-moment experience of happiness, plus their feeling of satisfaction with life.
What is MBCT? Definition and Background
You may have heard of the Eastern-influenced practice of mindfulness, with roots in Buddhist traditions extending back over 2500 years (Sipe & Eisendrath, 2012). You undoubtedly know about – and are probably at least somewhat familiar with – the (Western) psychotherapeutic approach of CBT, or cognitive behavioural therapy, as proposed by Aaron Beck (2011). MBCT is an adaptation of MBSR (mindfulness-based stress reduction) developed at the University of Massachusetts Medical Center by Jon Kabat-Zinn and his colleagues (Kabat-Zinn, 1990) which brings mindfulness and CBT together. In this article we provide a definition of MBCT, along with an overview of its historical background and development.
Definitions
Mindfulness-based cognitive therapy (MBCT) is a psychological therapy designed to help prevent the relapse of depression, especially for those individuals who have Major Depressive Disorder (the principal type of depressive disorder defined by the DSM-5). It employs traditional CBT methods and adds in mindfulness and mindfulness meditation strategies.
Cognitive behaviour therapy (CBT) is a form of psychotherapy originally developed to treat depression, but which is now used for a number of mental illnesses. It works to solve current problems and change unhelpful thinking and behaviour (Beck, 2011).
Mindfulness has been defined, particularly for participants of MBCT, as “the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to things as they are” (Williams, Teasdale, Segal, et al, 2007).
Mindfulness-based stress reduction is a mindfulness-based program designed to assist people with pain and a range of conditions and life issues that were initially difficult to treat in a hospital setting. It uses a combination of mindfulness meditation, body awareness, and yoga to help people become more mindful and has been shown in clinically-controlled trials to have beneficial effects such as stress reduction, relaxation, and improvement to quality of life. Although it has roots in spiritual teaching, the program is secular (Greeson, Webber, Smoski, Brantley, Ekblad, Suarez, & Wolever, 2011).
Background and development of MBCT
Major depressive disorder (MDD) is one of the most prevalent psychiatric disorders, characterised by high relapse rates. In addition to the grim statistic that 80 percent of those who have an initial depressive episode will relapse, psychologists have also observed that each successive episode increases the risk of recurrence by 16 to 18 percent (Solomon et al, 2000; Kingston et al, 2007; Mueller et al, 1999). Given the high psychological as well as social and economic burden associated with MDD, relapse prevention must have high priority. The most commonly used strategy to prevent relapse is maintenance treatment with antidepressant medication, but even though it has an established effectiveness, its disadvantages have clinicians and clients alike searching for a different solution. For one thing, many clients are unwilling to take it for the recommended two years following r emission of depression. Even for those who sign up to do that, adherence is low. Many clients experience disturbing side effects and some people prefer a psychological solution to a pharmacological one (Cairns & Murray, 2015).
Cognitive behavioural therapy has for some time been considered the “gold standard” among therapists for treating depression, and over the past three or four decades has enjoyed a position on centre stage as research studies to demonstrate its efficacy have proliferated. More than for any other therapeutic approach, an extensive literature base has documented how well CBT works, especially for depression (e.g., Butler, Chapman, Forman & Beck, 2006; DeRubeis, Gelfand, Tang, & Simons, 1999; Dobson, 1989; Gloaguen, Cottraux, Cucherat, & Blackburn, 1998; Hollon, Shelton, & Davis, 1993; Jakobsen, Hansen, Simonsen, Simonsen, & Gluud, 2012; U.S. Department of Health and Human Services (USDHHS), 1993; Wilson, Mottram, & Vassilas, 2008).
The frustrating reality about even approaches deemed to be effective, however, is that not all clients respond well to a given treatment. Meta-analyses have shown that generally only about half the patients treated with cognitive therapy demonstrate improvement clinically significant enough to meet strict U.S. Department of Health and Human Services standards (USDHHS, 1993). Moreover, even though clients receiving cognitive therapy have typically demonstrated lower relapse rates than those who receive medication (29.5 percent versus 60 percent, respectively), over one- to two-year follow-ups, some patients have still relapsed after cognitive therapy (Gloaguen et al, 1998).
Thus a crucial question has taunted clinicians and researchers alike, eventually motivating the development of MBCT. That question is this: if cognitive therapy is effective sometimes for some clients, how can we make this good thing even better, improving response rates and decreasing relapse rates?
Eastern meditative practice added to cognitive approach inspires MBCT development
An attempt to meet the above challenge was published in Segal, Williams, and Teasdales’s (2002) work proposing the use of mindfulness in cognitive therapy for the express purpose of preventing depressive relapse. The authors did not merely pluck the notion of adding mindfulness to cognitive therapy out of thin air, however.
Mindfulness-based stress reduction (MBSR) appears first
Eleven years prior to Segal and associates’ publication, the U.S.-based MacArthur Foundation asked Dr Segal to develop a maintenance version of cognitive therapy. Its goal would be to prevent relapse in patients who had already been treated for and recovered from depression. The journey to development would turn out to be a fairly lengthy one, with numerous twists and turns in the road. Early on Segal and his colleagues broke new ground by hypothesising that, when cognitive therapy worked against depression relapse, it did so not by modifying the content of a client’s cognitions as Beck (1976) had argued. Rather, it was now proposed that the relapse was avoided because individuals changed their relationship to their feelings: a process shift (Rohan, 2003).
Upon identifying negative thoughts, individuals could stand back and evaluate the thoughts, creating a shift in perspective in which thoughts could be viewed as passing events: possibly valid, but possibly not, and certainly separate from the individual thinking them. Such shifts are called “decentering” or “distancing” by Beck (1979) and “disidentifying” by Psychosynthesis practitioners (Assagioli, 1965). Using them suggested that mindfulness, particularly defined as we have above: “paying attention on purpose, in the present moment… to things as they are” (Williams, Teasdale, Segal, et al, 2007) would be a valid addition to cognitive therapy.
Beck’s cognitive model and response styles theory form foundation of new approach
Segal, Williams, and Teasdale based their maintenance therapy on a model of depression relapse which borrowed from both Beck’s work (1976) and also that of response styles theory (Nolen-Hoeksema, 1987). Individuals who had recovered from depression, said the model, would find that their sad moods reactivated a negative cognitive style, one associated with their previous dysphoric mood. This reactivation would occur, argued Segal and cohorts, because of a learned association between the two. Once re-activated, the negative cognitive style would run around well-worn “mental grooves” (much like those on old phonograph records), triggering a long-standing pattern of rumination, and reinforcing negative thoughts, feelings, and physical states. These vicious maintaining cycles were hypothesised to escalate a transient sad mood into full-blown depression if not checked (Rohan, 2003).
Clinical trial of DBT and reluctant contact with Kabat-Zinn
When the authors saw a clinical trial of dialectical behaviour therapy (DBT) for borderline personality disorder which included mindfulness meditation (Linehan, Armstrong, Suarez, Allmon, & Heard, 1991), they became intrigued with the notion of mindfulness. It did not sit comfortably within their CBT-centric world view, however, so it was only with reluctance that they contacted Dr Jon Kabat-Zinn at the University of Massachusetts Medical School Centre for Mindfulness in Medicine, Health Care, and Society. Arranging a visit to the Stress Reduction Clinic there, they were able to observe chronic pain patients and others using mindfulness meditation to respond to stress over eight weekly group sessions of around 2.5 hours each.
The authors then developed their first course of maintenance cognitive therapy-attentional control training combining mindfulness with cognitive therapy techniques (Teasdale, Segal, & Williams, 1995, in Rohan, 2003). They believed that mindfulness could serve as an early-warning system for depressed mood, cut off rumination before it could escalate, and strengthen decentering from negative thoughts, whereby cognitive restructuring could be used. Unfortunately for the development of MBCT, however, the MacArthur Foundation reviewers did not approve the eight-week, group format attentional control training. It diluted the CBT program components, they said, in favour of mindfulness, which was as yet unproven (Rohan, 2003).
At this juncture, the authors revisited the Massachusetts Stress Reduction Clinic, this time observing sessions towards the middle of the program, which focused on difficult physical and emotional problems. The authors noted with curiosity that the problems were not fixed. Rather, the patients were bringing their problems to awareness and breathing into them. Instead of seeing them as “the enemy”, the mindfulness training helped the patients to disidentify, bringing a “kindly awareness” to the problems, which they viewed nonjudgmentally. This second set of observations inspired Segal, Williams, and Teasdale to change the structure of the attentional control training. Exiting “therapist mode” – helping clients to solve problems – the authors now moved toward “instructor mode”, a stance of empowering patients to be mind ful of their moment-to-moment experience. The treatment manual was re-drafted to embrace the eight-session group format used at the Stress Reduction Clinic and it retained some cognitive therapy elements. Mindfulness-based cognitive therapy was born (Rohan, 2003).
So, what is included in a course of MBCT?
Meditation and mindfulness. The original course of Segal et al (2002) consisted of eight consecutive weekly sessions of about two hours each. It contained both formal and informal meditation practices, including guided body scans, sitting and walking meditations, Hatha-yoga-based mindful movement, three-minute breathing spaces, and focused awareness on routine daily activities. There was a general progression from early attention to breathing or bodily sensations in guided meditations to later sessions which emphasised developing an independent practice and holding mindful awareness of mental events, such as emotions and thoughts which the client may have previously avoided.
Homework. From their inception, MBCT courses have featured homework as a central element. Clients are encouraged to spend 45 minutes daily practicing mindfulness activities; some of these would be led by guided meditation recordings.
Psychoeducation and cognitive therapy. The educational portion of the original MBCT courses included aspects of cognitive therapy. There was also psychoeducation, during which clients learned that feelings of distress might intensify and actually perpetuate their depressed mood rather than help resolve it if they attempted to resist or avoid unwanted thoughts. Clients were supported to include mindful activities toward well-being, such as taking a bath, going for a walk, or listening to nice music. Action plans typically completed the suite of assignments; these would identify early warning thoughts or feelings that signalled worsening symptoms, along with steps they had agreed to take in the face of imminent relapse (Sipe & Eisendrath, 2012).
This article was adapted from the upcoming Mental Health Academy’s CPD course “Mindfulness-Based Cognitive Therapy: An Overview”. For more information, visit www.mentalhealthacademy.com.au.
References
Assagioli, R. (1965). Psychosynthesis: A manual of principles and techniques. New York and Buenos Aires: Hobbs, Dorman & Company.
Beck, A.T. (1976). Cognitive therapy and the emotional disorders. International Universities Press.
Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17-31.
Cairns, V. & Murray, C. (2015. How do the features of mindfulness-based cognitive therapy contribute to positive therapeutic change? A meta-synthesis of qualitative studies. Behavioural and Cognitive psychotherapy, 2015, 43(3), 3420359.
DeRubeis, R.J., Gelfand, I.A., Tang, T.Z., & Simons, A.D. (1999). Medications versus cognitive behavior therapy for severely depressed outpatients: Mega-analysis of four randomized comparisons. American Journal of Psychiatry, 156: 1007-1013.
Dobson, K. S. (1989). A meta-analysis of the efficacy of cognitive therapy for depression. Journal of Consulting & Clinical Psychology, 57, 414–419.
Gloaguen, V., Cottraux, J., Cucherat, M., & Blackburn, I.M. (1998). A meta-analysis of the effects of cognitive therapy in depressed patients. Journal of Affective Disorders, 49, 59–72.
Greeson, J. M., Webber, D. M., Smoski, M. J., Brantley, J. G., Ekblad, A. G., Suarez, E. C., & Wolever, R. Q. (2011). Changes in spirituality partly explain health-related quality of life outcomes after Mindfulness-Based Stress Reduction”. Journal of Behavioral Medicine, 34 (6): 508–18. doi:10.1007/s10865-011-9332-x. PMC 3151546. PMID 21360283.
Hollon, S.D., Shelton, R.C., & Davis, D.D. (1993). Cognitive therapy for depression: Conceptual issues and clinical efficacy. Journal of Consulting and Clinical Psychology, 61: 270-275.
Jakobsen, J.C., Hansen, J.L., Simonsen, S. Simonsen, E., & Gluud, C. (2012). Effects of Cognitive Behavioral Therapy versus Interpersonal Therapy in patients with major depressive disorder: A systematic review of randomized clinical trials with meta-analyses and trial sequential analyses. Psychological Medicine, 42(7), 1343-1357. Doi: hyperlink.
Kabat-Zinn, J. (1990). Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York (NY): Dell Publishing.
Linehan, M., M., Armstrong, H.E., Suarez, A., Allmond, D., & Heard, H. (1991). CBT of chronically parasuicidal borderline patients. Archives of General Psychiatry, 48: 1060-1064.
Mueller, T.I., Leon, A.C., & Keller, M.B. (1999). Recurrence after recovery from major depressive disorder during 15 years of observational follow-up. American Journal of Psychiatry, 156, 1000-1006.
Rohan, K.J. (2003). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. Psychiatry, 66 (3), ProQuest Psychology Journals, 272.
Segal, Z.V., Williams, J.M.G., & Teasdale, J.D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York (NY): Guilford Press.
Sipe, W. E.B., & Eisendrath, S.J. (2012). Mindfulness-based cognitive therapy: Theory and practice. Canadian Journal of Psychiatry, 57 (2): 63-69. Retrieved on 6 October, 2015, from ProQuest Psychology Journals.
Solomon, D.A., Keller, M.B., Leon, A.C., Mueller, T.I., Lavori, P.W., Shea, M.T., Coryell, W., Warshaw, M., Turvey, C., Maser, J.D. et al. (2000). Multiple recurrences of major depressive disorder. American Journal of Psychiatry, 2000, 157(2), 229-233.
U.S. Department of Health and Human Services (USDHHS). (1993). Depression in Primary Care: Treatment of Major Depression. AHCPR Publications.
Williams, J.M.G., Teasdale, J.D., Segal, Z.V., et al. (2007). The mindful way through depression: Freeing yourself from chronic unhappiness. New York (NY): Guilford Press.
Wilson, K. C. M., Mottram, P. G., & Vassilas, C. A. (2008). Psychotherapeutic treatments for older depressed people. Cochrane Database of Systematic Reviews, 1. Art. No.: CD004853. DOI: 0.1002/14651858.CD004853.pub2.
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The Benefits of Kindness
The Dalai Lama remarked that kindness “is my simple religion. No need for temples. No need for complicated philosophy.” I like the profound, well, simplicity of that. Most of us are no stranger to kindness. Even if our family didn’t emphasise it because of religious principles, we were probably told to be kind so that we could be a good friend/citizen/community member. We tried to follow the Golden Rule just because we should. Many of us, though, saw doing kind acts for others as a “should do” – something that stood in opposition to the powerful “want to do” of meeting our own needs.
Science: We’re not totally selfish
Economists and philosophers have traditionally thrown their weight behind the thought that humans are selfish beings: selfishness is a survival mechanism after all. But recent scientific advances have radically changed the kindness landscape. Functional medical resonance imaging and neuroscience have demonstrated that we are hard-wired to help each other. In one of an exploding number of kindness studies, neuroscientists recently found – by observing brains firing in real time – that the act of helping another person triggers activity in the caudate nucleus and anterior cingulate cortex regions of the brain. These are the parts of the brain involved in pleasure and reward, and there is now evidence which shows that serving others induces the same sort of pleasure as gratifying a personal desire. We are, concluded the researchers, born to cooperate with each other.
The kindness drugs: You can get them legally
And there is more good news if you are a “do-gooder”. You might be sincerely engaging in a kind act because it feels like that is who you are; if so, good on you! But we also now know that, on a biochemical level, kindness makes us happier. It does this by flooding our brain with endogenous opioids – the brain’s natural versions of morphine and heroin, which cause elevated levels of dopamine, a “feel-good” chemical responsible for what has been called the “Helper’s High”, or if you prefer, “The Giver’s Glow”.
Dopamine is not the only kindness-induced drug we get when we perform a good deed. It has also been shown that acts of caring and kindness, especially when accompanied by emotional warmth, produce high levels of the cuddle hormone, oxytocin. This, in turn, releases nitric oxide into our blood vessels, lowering our blood pressure and relaxing us. Thus, kindness is cardio-protective, helping us to have a healthier heart. The oxytocin also reduces levels of free radicals and inflammation, which slows ageing at its source: in the cardiovascular system.
So all those smiling people involved in community service are probably telling the truth when they talk about how happy volunteering makes them – they should be; they are high on kindness! In fact, the effect is so powerful that social scientists now recommend that those going through mourning or wanting to beat an addiction should begin volunteer work. It is shown to promote a healthy lifestyle, reduce cholesterol and combat stress. In one study of Alcoholics Anonymous participants, those who began volunteering during their first year of not drinking doubled their chances of recovery.
Benefits of Kindness
To re-cap, when you engage in kindness, you become happier, have a healthier heart, and decelerate your ageing process. There are more benefits as well. With kindness you also enjoy better relationships and “become infected”: kindness is contagious!
Let’s consider these last two together. When you do something nice for someone, for that moment at least, you feel emotionally connected to that person in a bond that recognises your mutual membership in Club Human. That sense of bonding may extend to forge a deeper, stronger, or more lasting relationship with the person. It’s no secret that kindness is “the secret ingredient” in long-lasting friendships and marriages. But even if it’s just helping a fellow passenger on the plane lift their carry-on luggage into the overhead rack, the act is contagious.
When one person behaves generously, it inspires observers to repeat that generosity later, toward different people. Each person in a social network influences hundreds of people, many of whom the generosity “originator” may not have even met.
What kindness can you do?
I recently checked out the Australian Kindness Movement website. One of my favourite tabs was the “kind things to do” page: https://www.kindness.com.au/kind-things-to-do.html. From taking a nap on Sunday afternoon (kindness to yourself) to writing letters of appreciation to groups performing services for the community (kindness to helpers such as the Fire Brigade and the Op Shop volunteers), this page is the longest – and probably most creative – compilation of kindness possibilities I’ve ever seen. I challenge you to click on the link and try a few. As Ralph Waldo Emerson observed, “You cannot do a kindness too soon, for you never know how soon it will be too late.”
Written by Dr Meg Carbonatto B.S., M.A., and Ph.D.
This article was originally published in Asteron Life’s Balance Blog. AIPC regularly contributes to Balance’s wellbeing blog category.
References:
Australian Kindness Movement. (2011). Australian Kindness Movement: Making a difference in the world through the power of kindness Australian Kindness Movement. Retrieved on 5 November, 2015, from: hyperlink.
Big Think. (2014). The health benefits of being kind. Big Think. Retrieved on 5 November, 2015, from: hyperlink.
Goodreads. (2015) Quotes about kindness. Goodreads, Inc. Retrieved on 5 November, 2015, from: hyperlink.
Hamilton, D. (2011). 5 beneficial side effects of kindness. Huffington Post. Retrieved on 5 November, 2015, from: hyperlink.
A Case Using Brief Psychodynamic Therapy
Wendy is a 54 year old woman who has two adult children and has been married for twenty-nine years. Her husband, Steve, has recently and unexpectedly informed her that he no longer loves her and that he wants a divorce. Wendy was shocked to hear this, and she now reports that she is constantly crying and feels extremely anxious. Wendy has not told anyone about this situation, although she and Steve have agreed to explain his decision to their children within the week.
Prevalence, Incidence, and Risk Factors for ASD and PTSD
In a previous article, we explored the definition of trauma, and reviewed the DSM-V diagnostic criteria for two trauma-related mental health disorders: acute stress disorder (ASD) and posttraumatic stress disorder (PTSD). The answer to how many people in a given population have AST or PTSD is not straightforward, as it should be considered in the context of how many potentially traumatic events (PTEs) people are exposed to in the general community. Countries in prolonged conflict or who are prone to natural disasters (flooding or hurricanes, for example) may have higher exposure rates to potentially traumatic events and thus a higher per-capita ratio of PTSD in the general population than countries with fewer PTEs occurring. The ratio of PTSD-to-PTE may not be higher, however, than countries with a lower incidence of PTSD per capita, but who have a correspondingly lower exposure to PTEs.
Q&A with Toula Gordillo (Clinical Psychologist)
Q. Can I use stories to have young people deal with domestic violence?
A. Report cases of domestic violence occur every two minutes (Blumer, 2015). These stats are hard to believe, and it's not just female women and children who are the victims. Research suggests that two in five people (39%) under the age of 15 (that's almost half of our youth) experiencing physical and/or sexual abuse are male (https://www.oneinthree.com.au).
Domestic and family violence (FDV) affects everyone – men, women and children, and the stats suggest that Indigenous and multicultural children and youth are most at risk. The financial burden and emotional damage that this act of violence places upon individuals and our society cannot be underestimated.
The story of The Frog and The Scorpion can be used to help a young person recognise that individuals’ patterns of behaviour, or the behaviour of others, are partially due to their level of caring. A person’s level of caring in some or all situations may be allocated as a percentage by the young person. Caring ranges from 0-100% (with 0% demonstrating little or no level of caring and up to -20% for malicious AWOL behaviour) to 100% (demonstrating a great deal of over caring).
The story prompts the discussion and reflection by the individual or group. The story may be used by teachers to deliver to a whole group of students (as a Story Image Tool - SIT), for parents to discuss with their child/children, or by counsellors with individuals and families (as part of Story Image Therapy – SIT-2).
Steps in using Story Image Therapy & Tools (SITT)
The story as an educational delivery tool – (for teachers, youth workers etc in a non-therapeutic role):
1. Introduce young person to the story with a simple statement such as “I have a little story I think you might find interesting”. Keep the mood light and positive and introduce it at a time when the young person is relaxed and can engage.
2. Talk to the young person/s through the story, as opposed to using the story (“through the story” means stopping, reflecting, identifying with the characters − rather than simply using the story to explain a concept).
3. Ask the young person/s to imagine the story as they are reading it (they might read it by themselves if they are a teen, or with a parent/teacher/counsellor if they are a preteen). Encourage them to read slowly, pausing at each section to think about what they have read.
4. Ask the child/youth questions about the story: a) who were the main characters, b) what were their behaviours, c) what motivated them to act in a certain way, d) why do they think the story has two endings, e) could they identify with any of the characters in the story i.e., could they see any patterns of thinking/behaviour exhibited by the protagonists that are displayed by people in their everyday life. Ask the young person whether they liked the first (original) ending or the second ending and why.
The story as a counselling tool – (for therapists, school counsellors etc. in a counselling role):
1. The parent/teacher or counsellor encourages the young person to visualise the story as much as possible. Use colourful images, graphics, music, artistic mediums to deliver the story and evoke emotion within the young person. The more they visualise the characters, internalise their actions and attach emotions to the characters, the more the victims and perpetrators are likely to learn key concepts, such as ineffective patterns of thinking associated with DFV.
2. As a counselling tool, the story and subsequent images may be used according to the parameters of the context within which it is delivered e.g. Psychologists may use the story and image during therapy, school counsellors may use the story to determine whether the young person may require therapy.
In summary: Use stories and images, delivered through short stories and music, to help explain what domestic violence is and provide strategies to help deal with its consequences.
Toula Gordillo is a Clinical Psychologist, AIPC private assessor/tutor and regular contributor for Institute Inbrief. Toula has an extensive work history as a Clinical Psychologist, Teacher, and Guidance Officer. For more information, visit www.talktoteens.com.au.
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Consider this before “Friending” a client
The same questions counsellors use to make wise decisions about dual or multiple relationships in the real world may be employed when considering the ethical consequences of engaging in an online dual relationship with a client. Specific to the question of social media, Zur (2014) recommends a comprehensive review of the situation through a set of questions that many digital immigrants would need to get consultation in order to answer accurately.
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