Advertise on podcast: NCMHCE Exam Review

👋 Chat with me at https://t.me/docsnipesbot NOTE: ALL Podcasts are for educational purposes only and are NOT a replacement for medical advice or counseling from a licensed professional. Body dysmorphic disorder (BDD) is characterized by the belief that some aspects of one’s appearance are ugly, unacceptable, or otherwise deformed, while this is in fact not the case. Those with BDD overfocus on details of visual stimuli rather than global aspects BDD sufferers can become preoccupied with any aspect of appearance, but the most common concerns relate to facial features, including nose, eyes, skin and hair. The development of BDD is associated with past experiences of abuse, violence, and trauma A survey of patients with BDD found high rates of emotional neglect and abuse (68.0%), physical neglect and abuse (34.7%), and sexual abuse (28.0%) Patients are not only more likely to have a history of traumatic experiences but also to experience them as more painful and to be able to recall them clearly. Compared to other diagnoses, little is known about BDD The high rate of trauma/ACEs, frequent comorbidity with mood disorders, OCD and PTSD indicate involvement of the amygdala, the HPA-Axis and DMN Schema A strengths based, trauma informed approach is essential to lay the groundwork for developing safety and empowerment. Information about differences in cortical processing of visual stimulus as well as altered ability to accurately perceive facial expressions may also provide clues to future treatment strategies.

NCMHCE Adjustment Related to physical loss or chronic illness

NCMHCE Addiction Counselor Exam Review Biopsychosocial Assessment

NCMHCE Review Part 2 Screening Brought to you by AllCEUs.com Counselor Continuing Education Unlimited CEUs $59/month or $99/year Live Webinars as low as $4/hour Addiction Counselor Certificate Training $149 Screening Questions -- Anxiety ~ Do you worry about a lot of things most of the time? ~ Do you worry about specific things like germs or getting into a car accident a lot? ~ Do you get so worked up that you cannot eat or sleep? Screening --PTSD ~ Have you been in really bad situations in which you had no control? ~ Have you been in terrifying situations? ~ Do you ever have memories of those situations that disrupt your day? ~ Do you startle really easily? ~ Do you find yourself being irritable and pessimistic? Anger ~ Do you often get angry? ~ When you get angry, do you feel like you are ready to explode? ~ Do you think you are more irritable than other people? Screening Questions -- Depression ~ Do you feel pleasure or happiness on a regular basis? ~ Have your sleep patterns changed? ~ How is your appetite? ~ Do you often feel guilty? ~ How is your energy throughout the day? ADHD ~ Do you have difficulty finishing tasks? ~ Do you have difficulty getting organized? ~ Do you have difficulty if you have to sit still for a long time? ~ Do you have difficulty staying focused and filtering out distractions ~ Do you have difficulty waiting your turn or not interrupting? OCD ~ Do you sometimes have thoughts you cannot get out of your head? ~ How much time do these thoughts take up on average each day? ~ Do you ever feel like you have to do something over and over or something bad is going to happen? ~ How much time do you spend each day doing these things? Delusions and Hallucinations ~ Have you ever thought that people could read your mind or control your thoughts? ~ Have you ever felt like your mind was playing tricks on you? ~ Do you ever see or hear things that other people cannot see or hear? ~ Do you ever have difficulty knowing if you are awake or dreaming? Eating Disorders ~ How would you describe your eating habits? ~ Do you have any concerns about your weight? ~ How do you maintain your weight? Impulsivity ~ Do you ever find yourself doing things without really thinking about the consequences first? ~ Do you ever do things you know you shouldn’t but just cannot seem to stop yourself? ~ Do you buy things that you really don’t need just because they are there? Mania ~ Have you ever had so much energy that you couldn’t sit still ~ Have you ever found yourself not needing sleep or needing much less than usual? ~ Do you have times when you talk a lot more than usual and your brain seems to be going really quickly? Substance Misuse ~ Have you been bothered by “using medicines or drugs without a doctor’s prescription, or in greater amounts or longer than prescribed? ~ Have you used more than intended or spent more time engaging in an activity than intended? ~ Have you spend more time planning, engaging in or recovering from the use of the substance or activity? ~ Have you given up or had difficulty in significant areas of your life as a result of use of the substance or engaging in the activity. ~ CAGE ~ Cutting Down ~ Annoyed ~ Guilt ~ Eye Opener Summary ~ It is important to screen for a variety of issues ~ Know the diagnostic criteria for the most common mental illnesses ~ Many disorders have overlapping symptoms ~ Anxiety, PTSD, ADHD, Bipolar and Depression for example ~ Psychiatry.org has multiple free Cross Cutting Symptom Measures to be aware of ~ Screening just gives you a launch pad to help guide the in-depth biopsychosocial assessment Test Taking Tip ~ First Priority is identifying the diagnoses for everyone in the scenario. ~ Don’t try to be too broad. ~ If the scenario is about someone who recently underwent a traumatic event and the question asks for what to evaluate to support a provisional diagnosis, think about what you would a

011 -NCMHCE Review Treatment Planning Part 1 NCHMCE Review Treatment Planning Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs.com Podcast Host: Counselor Toolbox and NCMHCE Exam Review Objectives ~ Review goals and interventions to address anxiety, anger, grief, blended families and child issues. Anger and Aggression ~ Rule out danger to others and substance abuse. ~ Goals ~ Increased awareness of angry feelings, triggers and responses ~ Decreased frequency and intensity of angry feelings ~ Increased awareness of alternatives to aggressive responses ~ Increased ability to use assertiveness skills to address triggers for anger and aggression Anger Interventions ~ Daily journaling or logging to identify and track frequency, intensity and duration of angry feelings ~ Reflect upon and address anger triggers and aggressive behaviors ~ Use backward chaining to identify antecedents to anger and aggressive behavior ~ Construct a genogram to identify multigenerational triggers for and methods of dealing with anger ~ List prior experiences which have caused hurt and process those experiences to move toward forgiveness and release anger ~ Identify current triggers and targets for anger and address those. ~ Learn at least 5 alternatives to verbally or physically aggressive behavior. ~ Rehearse anger management skills ~ Refer for or teach effective communication skills ~ Bibliotherapy Anxiety ~ Rule out PTSD ~ Goals ~ Increased awareness of anxious feelings and responses ~ Increased awareness of triggers for anxiety ~ Decreased frequency and intensity of anxious feelings ~ Enhanced distress tolerance skills ~ Increased awareness of ways to cope with anxious behavior ~ Improved problem-solving skills ~ Enhanced self-efficacy Anxiety Interventions ~ Learn mindfulness to identify anxiety when it begins ~ Daily journaling or logging to identify and track frequency, intensity and duration of anxious feelings ~ Reflect upon and address triggers ~ Use backward chaining to identify antecedents to anxious behavior ~ Use cognitive interventions to address prior traumatic or fear-related experiences ~ Learn at least 5 coping skills to deal with anxiety ~ Learn at least 5 distress tolerance skills ~ Bibliotherapy Blended Families ~ Assess the expectations of each family member ~ Contact schools for information about children ~ Goals ~ Develop a new family identity ~ Help each person develop a new identity ~ Redefine roles within the family ~ Identify and resolve losses ~ Develop tolerance and flexibility ~ Create a parent coalition ~ Develop effective conflict resolution skills Blended families ~ Interventions ~ Normalize ~ Identify and process losses ~ Empower each person to create a new meaningful identity ~ Encourage verbal expression of all emotions including guilt, resentment, and feelings of failure or abandonment ~ Explore parental misperceptions about blending families and the children ~ Educate parents about varying developmental needs ~ Strengthen the identification of the new family unit ~ Identify and address conflicts within the blended family and with extended family members and ex-spouses ~ Ensure all members have personal space and can create a sense of “home.” Child Clients ~ Complete a comprehensive developmental history and refer for psychological testing as needed (i.e. for suspected neurological issues) ~ Interview parents and child. Use behavior rating scales ~ Get ancillary information from school and pediatrician ~ Set clear goals with the parents ~ Goals ~ Decrease maladaptive behaviors ~ Improved interpersonal skills ~ Increased ability to identify and appropriately express feelings ~ Increased use of distress tolerance and coping skills ~ Improved problem solving skills Child Clients ~ Interventions ~ Parent education of skills to model and behavior modification tools ~ Therapeutic play to assist with emotional proce

NCMHCE Exam Review Group and Career Counseling Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs.com Podcast Host: Counselor Toolbox and NCMHCE Exam Review Objectives - Review - the indications and contraindications for group therapy - types of groups - stages of group formation - Group curative factors - Therapist’s role in group Indicators for Group - Indicators for Group - The primary problem involves affective, behavioral, cognitive or social issues - The client is verbally, cognitively and physically able to participate - The client is motivated to change - The client finds peer support and feedback beneficial - The client has a positive view of group therapy Contraindications for Group Therapy - People who refuse to participate - People who can’t honor group agreements including behavioral (impulsivity) and attendance - People who are unsuitable for group therapy - People in crisis, or who have a low tolerance for anxiety and frustration, or are markedly depressed - People whose defenses would clash with the dynamics of a group. - People who can’t tolerate strong emotions - People who experience severe internal discomfort in groups. Types of Groups - Gender based - Topic based (depression, PTSD, Addiction) - Skill Based (coping, problem solving, interpersonal) - Support - Psychoeducational - Therapy - Open - Closed: Short-term, task oriented Forming a Group - Stages - Forming - Storming - Norming - Performing - Adjourning Group Curative Factors - Social microcosm that allows for multiple transferences - Hope - Universality - Altruism - Self-understanding and insight Therapist’s Role - Explain the phases in the group process - Creating and maintaining cohesion and participation - Culture building - Focus on the here and now, illuminating the processes at work. - Use appropriate self-disclosure - Facilitate resolution of interpersonal conflict - Use linking and blocking - Model giving and receiving of feedback - Use structured activities - Identify and discuss group themes and patterns - Create interventions based on the stage of group development - Challenge harmful behaviors - Address interaction of group members outside of group Career Counseling– Models - Trait and factor model focuses on individual abilities, interests and personalities and work adjustment varies directly with the congruence between characteristics and demands - Client centered model emphasizes self-concept and the existence of choices based on what the client perceives is best in his/her life - Psychodynamic model stresses internal motivations and coping mechanisms and person's belief or knowledge about what he or she is able to do (Efficacy) - Developmental model focuses on career as a developmental, maturational process (Career Maturity Index) Career Counseling– Models - Behavioral career counseling focuses on making realistic career choices (behavior) and eliminating anxiety about making such choices - Values model helps clients choose careers in line with their values - Time: Future, Past, Present, Unconcerned with schedules - Social: Individual, collateral, hierarchical - Activity Value: Active vs. Passive responses - Life Values (Life Values Inventory) Career Choice – Holland/Trait-Factor - Personalities (RIASEC) - Realistic (hands on) - Investigative (problem solving) - Artistic - Social (Helping others) - Enterprising (Leading) - Conventional (Routine/systematic) Career Choice - Holland - Tests - Vocational Preference Inventory (General Holland’s 6-Types by rating 160 jobs) - Self-Directed Search (Identifies competencies, attitudes and self efficacy toward occupations. Hollands 6 types) - Vocational Exploration and Insight (increase occupations for consideration and understand what they want out of careers) - My Vocational Situation (identity and barriers) Other Career Tests - Ashland Interest Assessment for people who

NCMHCE Review #9: Stages and Theories of Treatment CEUs are available at https://allceus.com/CE/course/view.php?id=1421 Dr. Dawn-Elise Snipes Executive Director, AllCEUs.com Podcast Host: NCMHCE Exam Review and Counselor Toolbox Objectives ~ Review the stages of treatment ~ Review theoretical approaches for individual counseling including ~ CBT ~ Behaviorism ~ Humanistic ~ Developmental Stages ~ Immediate Concerns ~ Evaluate risk factors ~ Establish rapport ~ Enhance motivation and hope ~ Address administrative and policy issues ~ Make a preliminary diagnosis or narrow to a couple Stages ~ Assessment and Goal Setting ~ Ask questions about ~ The perception of the problem ~ Duration ~ Mitigating and Exacerbating factors ~ Hoped for resolution ~ Impact on PSF in multiple dimensions ~ Physical symptoms ~ Make observations ~ Use collateral sources Stages ~ Treatment plan development (specific as possible—SMART) ~ Prioritize goals ~ Identify needs and services to meet those goals ~ Work with client to select interventions ~ Make appropriate referrals ~ Provide psychoeducation Stages ~ Middle stages ~ Consider a systems approach and involving family or at least addressing contributions of family to the problem and/or solution ~ Teach mindfulness, feelings identification, distress tolerance and coping skills to reduce core symptoms ~ Improve social support ~ Enhance self esteem and efficacy ~ Regularly monitor motivation, resistance and unanticipated barriers to change Stages ~ Late Stage ~ Solidifying gains ~ Generalize skills to other areas ~ Mindfulness and coping skills can be used not only for being aware of and addressing depression, but also anxiety, anger ~ Social support is helpful in recovering from depression, but can also be helpful for behavior change or coping with stress or grief. Stages ~ Termination Stage ~ Consolidate gains by reviewing progress and enhancing efficacy. ~ Ensure a support system is in place ~ Develop a relapse prevention plan ~ Identify and address issues related to termination Cognitive ~ Cognitive theories are active, directive and time limited ~ May include ~ REBT (Identify unhelpful thoughts, unhelpful emotions, UPR, anger management) ~ CBT (Identify unhelpful cognitions, and behaviors and choose more helpful ones and alter the cognitive triad—Self-World-Future) ~ DBT (Distress tolerance, emotion regulation, interpersonal, problem solving) ~ ACT (Radical acceptance, mindfulness, commitment to purposeful action, Unhooking/Defusion) ~ CPT (Challenging questions) Cognitive ~ Goals are to ~ Increase self monitoring and awareness ~ Identify unhelpful cognitions ~ Clarify and challenge underlying beliefs ~ Replace unhelpful triggers and behaviors with helpful ones ~ Increase adaptive problem solving ~ Counterindications: Psychotic disorders, dementia, FASD Behavioral Approaches ~ Emphasis on changing or replacing current behaviors by altering the antecedents and/or consequences through ~ Positive and negative reinforcement of alternate behaviors and punishment and lack of reinforcement of target behaviors ~ Social/observational learning ~ Focuses on observable, measurable behaviors not thoughts or emotions ~ Always gather baseline data and conduct a functional analysis ~ Interventions are conducted in the person’s natural setting and involve SOs Behavioral Approaches ~ Techniques in behavioral approaches ~ Systematic desensitization ~ Flooding ~ Assertiveness training ~ Aversion therapy ~ Extinction ~ Token Economy Humanistic Models ~ Seeks to understand people’s subjective experience ~ UPR for people’s uniqueness, wholeness ~ Belief in people’s natural tendency to move toward self actualization ~ View problems as stemming from incongruence between the self and perceived conditions of worth ~ Overall goal is to achieve congruence between the self and experience and an enhanced ability to cope wit

NCMHCE Review Human Diversity Dr. Dawn-Elise Snipes, LPC-MHSP, LMHC Executive Director, AllCEUs Counselor Education Host: Counselor Toolbox Podcast, NCMHCE Exam Review Podcast Objectives ~ Explore issues related to the counseling relationships with people who are culturally different ~ Identify approaches to use with culturally diverse clients Explore Cultural Diversity ~ Many of the problems experienced by minorities are related to prejudice and discrimination, cultural differences and other experiences associated with minority group status ~ Clients preferences for ethnically similar counselors depend on ~ Ethnic identity ~ Level of acculturation ~ Gender ~ Trust of therapist’s ethnicity Cultural Minorities ~ Lack role models ~ May be rejected or discriminated against Cultural Identify Development Model ~ Conformity: Preference for dominant culture and disavowing personal culture ~ Dissonance: Prefer a minority counselor and perceive their problems as stemming from their minority status ~ Resistance and Immersion: Reject the dominant culture. Prefer a racially similar culture. Perceive most problems as due to oppression ~ Introspection: Conflicts about loyalty and responsibility towards ones group and personal autonomy. More open to counselors of different backgrounds ~ Synergystic awareness: Developed a personalized cultural identity and can objectively evaluate and accept or reject the values of other cultures. Prefer counselors with similar worldviews Counseling Culturally Diverse Clients ~ Identify the client’s cultural identities and degrees of acculturation ~ Understand the client’s worldview ~ Consider the impact of social, economic and political discrimination and prejudice ~ Remember that clients from a low SES are more concerned with immediate survival than long-range goals ~ Explore their reactions to a culturally different clinician ~ Identify their perception of the problem and role of therapy ~ Explore issues related to cultural discrimination ~ Evaluate positive resources and strengths ~ Identify biopsychosocial issues related to the presenting problem ~ Use a time limited, problem solving approach African Americans ~ Humanitarian, people-oriented view ~ Family is extended past blood relatives ~ Family roles are flexible ~ Church is often important ~ Family therapy approaches are often the treatment of choice American Indians ~ Begin with small-talk not defending your competence or getting to business ~ Prefer a spiritual, holistic approach ~ Place greater emphasis on the family and tribe than the individual ~ Perceive most problems as a result of disharmony in one’s life ~ Views behaviors as motivated by interconnections with others ~ Treatment often involves helping to heal the community ~ Often prefer the involvement of tribal healers ~ May benefit from fables and lessons from tribal elders which cannot be written Asians ~ High context communication ~ Extended family often live together ~ Family may expect to participate in assessment and treatment ~ Interdependence ~ Mental illness can be seen as bringing shame on the family ~ Understate feelings and problems ~ Modesty and self-deprecation are often not signs of low S-E ~ Many mental health issues are somaticized ~ PTSD is not uncommon in refugee populations ~ Establish credibility Hispanics ~ Interdependence ~ Uncomfortable sharing very personal information ~ Concrete, tangible, present-focused approach to life ~ May have a relatively external locus of control ~ Often somaticize ~ Place importance on personal greetings and small talk ~ Family roles are relatively inflexible and patriarchal ~ Avoid insight oriented approaches and focus more on solution-focused approaches Sexual Orientation ~ Dealing with people to whom the client is not “out” ~ Understanding the lifestyles of people who are LGBTQ2IA ~ Help client access resources Coming Out ~ Stage 1 – Identity Conf

NCMHCE Exam Review Dangerousness and Abuse Dr. Dawn-Elise Snipes PhD, LPC-MHSP Executive Director, AllCEUs Counseling Education Host: Counselor Toolbox Podcast Objectives - Identify the characteristics of a dangerousness assessment - Identify factors associated with a high risk for violence - Identify steps in preventing danger to others - Review special cases - Domestic violence - Child Abuse - Elder Abuse - Substance Abuse - Eating Disorders - Emergency calls from nonclients Dangerousness Assessment - Identify the cause of the crisis - Determine the probability the client will hurt someone - Gather information using a mental status exam - Ask the client about a history of violence and current plans - Asses the client’s support system Factors Associated with a High Risk - Male - Alcohol use - History of violence or threats of violence - Antisocial behavior - History of child abuse - Recent provocation - Diagnoses: Substance use disorder, delirium, schizophrenia, mania, personality disorders, intermittent explosive disorder - Agitation - Loud or abusive speech - Poor impulse control - Emotional lability Duty to Warn - Must involve a reasonably identifiable victim and a credible threat of imminent danger - Contact law enforcement and the intended victim - Divulge only information necessary: You name, the client’s name and the threat (Diagnosis and other information is not necessary and still protected) - Inform the client ahead of time if appropriate Immediate Intervention - Provide a calm, controlled environment - Allow the client to vent feelings - Build self-esteem - Explore options for addressing the issue - Mobilize support - Help client understand the cause of the crisis* - Make a no violence contract - Ensure the client is calm prior to leaving - If client is unable to regain composure, encourage voluntary commitment - Use involuntary commitment as a last resort Domestic Violence - Indicators - Injuries at various stages of healing - Depression, anxiety, insomnia, nightmares, ASD - Vague somatic complaints - Complaints of relationship issues - Over-dependence on partner - History of substance abuse - Behavioral problems in children - If kids in the house, assess for child abuse DV Intervention - Use open ended questions - “How did you get that bruise” instead of “Did your spouse do this to you-” - If the perpetrator is present, assess for substance abuse - For victim - Get medical treatment as needed - Help victim protect herself—referral, escape plan - Challenge victim’s denial and self blame - Help client understand the situation (cycle of violence) and their options - Support group referral DV Intervention - For Perpetrator - Break through denial - Get commitment to a no-violence contract - Teach anger management skills - Support group referral Child Abuse Indicators - In Children - Sudden change in behavior - Excessive clinginess - Regression - Suicidal behavior - Antisocial behavior - Fear of adults - Overly sexualized behavior - Sleep disturbances - Childhood pregnancy or STD - School problems - In Adults - Unconcerned about child’s injuries - Provides false explanations - Conceals injuries - Uses harsh discipline - Has overly high expectations for the child - Was abused as a child - Extremely jealous or overprotective - Lacks social support outside the family Child Abuse Interventions - Mandatory reporting - Medical treatment - Ensure safety - Mobilize family support systems - Refer parents to support groups - Clarify events that caused the crisis - Build self esteem, reduce shame and self-blame - Support and validate positive behaviors in the parents - Teach parenting skills or refer - Increase parent’s understanding of the triggers and dynamics of abuse Elder Abuse - Mandatory Reporting - You see the abuse - The client tells you of abuse - You observe physical injuries that clearly indica

NCMHCE Exam Review Crisis Assessment Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director AllCEUs Host: Counselor Toolbox Podcast and NCMHCE Exam Review Podcast CEUs are available for this presentation at https://allceus.com/CE/course/view.php?id=1414 Objectives ~ Review crisis theory and the varying types of crises ~ Describe the stages of crisis ~ Identify the features of a general crisis assessment ~ Differentiate between a crisis and suicide assessment ~ Identify factors associated with a high risk of suicide ~ Review legal and ethical responsibilities (Tarasoff and Bellah vs. Greenson ~ Explore prevention and intervention strategies Crisis Definition ~ Crisis involves ~ A pivotal moment in which a decision must be made which involves facing both peril and promise (Echterling, 2005) ~ “People are in a state of crisis when they face an obstacle to important life goals—and obstacle that is, for a time, insurmountable by the use of customary methods of problem-solving.” (Caplan, 1961) ~ Symptoms of crisis: ~ Emotional distress ~ Physical distress/stress response ~ Cognitive disruption (concentration, problem solving, memory) ~ Behavioral changes Basic Human Needs (CHARGES) ~ When a basic human need has been impacted, it may prompt a crisis ~ Maslow: ~ Air, water, food, sleep, shelter, medical care, safety, love and belonging ~ Elliot (CHARGES) ~ Connection to something bigger than one’s self or a system of meaning to help us understand the world ~ Health and biological needs ~ Acceptance (love and belonging) ~ Relationships (intimate) ~ Goals and Purpose (Identity) ~ Efficacy/Control ~ Safety Types of Crisis ~ Situational crises are not anticipated and usually outside a person’s control ~ Physical (accident, illness, prematurity, birth defects) ~ Interpersonal (death of a person or pet, abuse, divorce) ~ Financial/Environmental/Material (Job loss, Foreclosure, House fire, hurricane, burglary, stock market crash, not getting accepted to …) Types of Crises ~ Cultural/Societal ~ Individuals have less control over these due to the fact that they are perpetuated by the action or inaction of others ~ Political unrest, discrimination and stigma related to gender, race, sexual orientation, violence Types of Crisis ~ Maturational ~ Normal developmental changes produce developmental crises (see Erikson), however, when these crises overwhelm a person’s ability to cope, they may prompt a mental health crisis. ~ To successfully resolve developmental crises, people need support, energy and safety. ~ Examples: Child to adult, empty nest, retirement, child birth, marriage… Types of Crisis ~ Normal developmental reaction or mental health issue? ~ *Determine which symptoms are expected reactions to a normal developmental transition vs. a sign of an emotional or mental health issue ~ Adjustment disorder with depressed mood, anxiety, both or behavior disturbances is conditional upon a particular situation, a life change or a stressor of some sort that precipitates the event ~ Carefully differentially diagnose between adjustment disorder, anxiety, depression, PTSD and personality disorders. ~ Normalize expected reactions to developmental transitions Types of Crisis ~ Normal developmental reaction or mental health issue? ~ The symptoms of adjustment disorder with disturbance of conduct can include: ~ Behaviors that are outside the norms of society ~ Actions that violate the rights of others ~ Outbursts of anger ~ Attempts at revenge ~ Substance use or abuse ~ Emotionality/mood swings that are acted upon Factors Affecting the Response ~ Demographics (DARES) ~ Age ~ Religion ~ Ethnicity ~ Situational and social supports ~ Perception of the event– How does it impact (BASIC) ~ Biological necessities ~ Acceptance and belonging ~ Similarity to prior traumas or crises ~ Interpretation/world view ~ Control (sense of) ~ Available coping (CRAP) ~ Crises in the past

NCMHCE Assessment Review Part 3 Brought to you by AllCEUs.com Counselor Continuing Education Unlimited CEUs $59/month or $99/year Live Webinars as low as $4/hour Addiction Counselor Certificate Training $149 Assessment - Categories of information - Presenting issue - Mental Status Exam - Emotional - Behavioral - Physical - Personality - Coping Skills - Family of Origin - Culture - Social Supports and interpersonal relationships - Environment live and work - Developmental stage - Activities of daily living and ability for independence - Motivation Assessment - Categories of Information - Emotional Signs and symptoms - Degree of emotional control - Ability to feel and express a range of emotions - Emotional appropriateness - Emotional issues which may be a focus of clinical attention - Anger - Anxiety - Depression - Grief - Guilt Assessment - Categories of information - Psychiatric signs - Looking for diagnostic criteria for disorders - Affective, behavioral/physical, cognitive, social indicators of mood disorders - Changes in thinking behavior associated with cognitive impairments - Signs of a substance use disorder - Discussing with client - Exacerbating factors and triggers - Mitigating factors and effective interventions Assessment - Categories of information - Medical and Physical Symptoms and Issues - Consider the possibility that symptoms are caused by a medical condition and refer for an evaluation - Evaluate current medications and consider medication side effects - Is the client intoxicated or in withdrawal from a substance - Vegetative symptoms: Persistent problems with appetite, weight control, sleep, energy, sexual desire and function Assessment - Categories of information - Medical and Physical Symptoms and Issues - Somatoform Disorders: Physical symptoms with no detectable physiological cause - Includes pain disorder and body dysmorphic disorder - When tests and physical exams do not support the patient’s symptoms consider malingering of factitious disorders Assessment - Categories of information - Personality Traits - Patterns of behavior, thinking and perception that are pervasive can indicate a personality style such as aggressive, addictive, Type A or co-dependent or a personality disorder such as antisocial, histrionic, or borderline - Ego functioning - Self regulation/impulse control/frustration tolerance - Defense mechanisms - Healthy use limits dysphoric emotions without significantly disrupting a persons life Assessment - Categories of information - Coping skills - Coping abilities, resources and deficits - Current coping strategies that are and are not effective - Ways the client has responded to similar problems in the past (adaptive and maladaptive) - Specific individual characteristics that impact coping ability such as developmental level, cognitive functioning, locus of control and sense of self-efficacy - Family of Origin - Cultural background - Socioeconomic background Assessment - Categories of information - Interpersonal Relationships and Social Supports - Type, quality and effectiveness of current relationships - If isolated, evaluate for voluntary withdrawal, poor social skills, alienation, shyness/social anxiety, substance misuse or compulsive behaviors, low self-esteem, PTSD - Capacity for healthy interpersonal relationships (boundaries) Assessment - Categories of information - Social Roles and Role Functioning - Each role holds a set of role expectations - What roles does the person fulfill (child, parent, spouse, employee, friend…) - Is there role ambiguity or role conflict (parent/friend; parent/employee) - Has there been a loss of an important role (empty nest, divorce) - Is the client overwhelmed or ambivalent about the responsibilities associated with a role (parenting, employee, spouse) - Are client’s normal dependency/affiliation needs being met in an appropriate way (boundaries) - Is the

NCMHCE Exam Review Podcast Assessment Part 2 Brought to you by Counselor Toolbox Podcast and AllCEUs.com Counselor Continuing Education where you can get Unlimited on demand CEUs for $59 or unlimited live webinars for $40 Objectives ~ Define assessment ~ Review acronyms to help you remember what to look for when assessing for a problem. What is Assessment ~ Assessment is the process of gathering, analyzing and integrating information into a comprehensive picture that describes ~ The nature, frequency, intensity and duration of the client’s problems ~ The roles the client, significant others and the environment/community play in the current issues ~ The functioning of the client and significant others ~ Client motivation to address presenting issues ~ Resources needed to resolve problems and effectively participate in treatment. Presenting Issue ~ Represents the problems that are foremost in the client’s mind ~ Denial of any problems may also provide information into client insight, judgement and motivation Evaluating the presenting issue ~ When did it begin? ~ What makes it worse? Better? ~ How often does it occur and to what intensity? ~ If the client is reporting multiple symptoms, assess the above for each and identify which symptom presented first. ~ What are the antecedents of (triggers/precipitants) the problem? ~ How do you feel when the problem occurs? What are you thinking? ~ Describe what happens right after the problem (reinforcers), habitual responses. Stressors ~ What stressors are occurring and what is their frequency, intensity and duration? ~ How does the client deal with the stressors? ~ Are the stressors impacting the course of the presenting problem? Emotional Range ~ Emotional control (dysregulation or flattening) can impact the client’s health, relationships and functioning at work or school. ~ People who avoid dealing with emotions may develop depression, anger or anxiety ~ People who experience dysregulation may also develop depression, anger or anxiety ~ Trauma-induced changes in emotional range may also impact the client’s ability to function ~ Remember that affect is the current, transient state. Always assess affect. Mood Disorders ~ When the client presents with mood symptoms, inquire about ~ Previous episodes of the same symptoms ~ How he or she has dealt with them before ~ If there was a previous episode, was there full remission? Depression ~ What to look for ~ Anhedonia ~ Dysphoria ~ Sleep changes ~ Appetite changes ~ Changes in psychomotor behavior ~ Reduction in libido ~ Reduced energy ~ Nonverbals indicating any of the above ~ Highly self-critical ~ Cognitive distortions ~ Hopelessness/pessimism ~ Irritability ~ Guilt/shame ~ Difficulty concentrating ~ Withdrawal from relationships Depression Mnemonic A SAD FACES ~ A = Appetite (Weight Change) ~ S = Sleep (Insomnia / Hypersomnia) ~ A = Anhedonia ~ D = Dysphoria ~ F = Fatigue ~ A = Agitation / Retardation ~ C = Concentration Diminished ~ E = Esteem (Low) / Guilt ~ S = Suicide / Thoughts of Death Mania ~ What to look for ~ Elevated mood ~ Grandiosity ~ Irritability/aggression ~ Pressured speech ~ Flight of ideas ~ Restlessness ~ Hypersexuality ~ Impulsivity ~ Limited insight ~ Poor concentration ~ Impatience ~ Gregariousness ~ Provocativeness Mania Mnemonic DIG FAST ~ Distractibility ~ Indiscretion ~ Grandiosity ~ Flight of ideas ~ Activity increase ~ Sleep deficit ~ Talkativeness Anxiety ~ What to look for ~ Irritability/edginess ~ Uneasiness/worry ~ Panic ~ Hypervigilance ~ Psychomotor agitation/Nervous habits ~ Nonverbals indicative of worry ~ Ruminating ~ Persistent worrying about a variety of things ~ Difficulty concentrating ~ Withdrawal from relationships ~ Highly critical of self ~ Sleep problems ~ Clinginess/dependency Anxiety Mnemonic: Worry WARTS ~ Worry ~ Worn out ~ Absentminded ~ Restless ~ Touchy ~ Sleep