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Sunday, March 02, 2008

Providing Counseling & Other Psychological Services

I'd like to articulate here my current practice of providing psychological services, and the procedural matters that may not be simply neglected lest conflicts ensue and ethics be infringed. I hope that Counseling and other fields' practitioners who read this blog may compare notes with me, or share their ideas as well. Only rocks don't change. I mean this is a way for me to keep improving wherever that is possible while there is still the chance. Email me at berngu721@gmail.com your ideas, opinions, and even criticisms. Thanks in advance.

Psychological Services & Credentials Necessary in Professional Practice
By psychological services is meant those activities wherein my training and expertise are required. Among them include: Counseling, Assessment, Consultation, Psychotherapy, including Group Process. In all of these, I have had sufficient course training from my classes in DLSU (De La Salle University). I might be accused of doing so without a Ph.D., which should hopefully come in due time. Nevertheless, I have had two years of supervised Psychological Assessment work in a respected Psychological Clinic along EDSA (Dayan's Psychological Clinic). I have done my Tests and Measurements as well as Individual, Personality, and Cognitive Assessment subjects in DLSU, the practicum requirements, as well as ongoing supervision while I was working in the said clinic. There I administered the psychological measures, did the interviews myself, scored and interpreted the tests and wrote the integration report. I have had the chance to have those reports given in feedback required of my training and practice. Most of all, the reports I wrote, while I may not have signed them myself, were presented before the courts of law here in the country, particularly when those reports were required in connection with marital annulment and even child custody cases. My current practice in Sarnelli Center for Street Children of providing psychological services similar to what I did in Dayan's Psychological Clinic attests to my continued updating of my practice. It is said that he who sings well prays twice, and that if you want to learn (better, my addition), teach. Hence, by continuing the practice I have continuing learning in the area. I even bought for my ongoing development needs the book Comprehensive Handbook of Psychological Assessment Vol. 2 Personality Assessment edited by Mark Hilsenroth & Daniel L. Segal, with Michael Hersen as Editor in Chief (2004), published in New Jersey by John Wiley & Sons, Inc. Since I finished my course work, I have bought books in other areas. Updating is really necessary to continue being relevant and better informed for a more confident practice. I make sure that I have read them at least once during the year. And I am thankful that I have been allowed to teach the Introduction to Psychology and Developmental Psychology subjects here in the seminary (Christ the King Seminary, Quezon City). These have afforded me the chance to promote to the students the idea that encountering psychological problems in oneself and seeking for help via Counseling may be better than not knowing about one's problems, and even not asking for help when one has discovered them oneself, an indicator of serious psychological disorder.

As to my other credentials, these are all extant in my Transcript of Records.

Practice of Psychological Services Provision
I also do Guidance and Counseling work, as well as individual and group consultation. Together with my assistant, Rex Kho, and with some student counselors (I've had two PhD students and one still taking her M.A. units, on supervision required in their course otherwise known as practicum) we have come up with a written program for the seminarians. The student-counselor who finalized the report still has to submit that to me.

Integrity of Psychological Measures
When I started the work way back 2001, among the things I ensured was the integrity of the psychological assessment measures. Before one can use psychological measures, academic and supervised training are required. Tests are never for the purpose other than they were meant to be. Hence, test providers stringently required me my transcript of records as well as certificate of recommendation by my assessment supervisors. For me to be accredited, I had to keep in mind the ethics and principles involved in the use of the materials. Contrary to most practices that I know, I only used the originals, earned the money for procuring them, and keeping a financial status of the office in order that when we needed to get the answer sheets or add more test booklets, I was sure of getting the needed amount, sans the bureaucratic obstacles of the institution, as well as infringing on the copyright laws of the land and of the authors/publishers.

Local Norming & Test Validation
For the past three years since I started, I took upon myself the task of ensuring we were following a local norm because some of the tests were of foreign norms. I had the findings reported in a faculty and formators forum so everyone gets to understand the why of the selection process. This year, I have conducted a validation work on one personality test in order to check whether its results can be used in lieu of some assessment measures which may have become bastardized by some groups. (I wrote about this in an earlier blog, about a certain congregation which practiced on one test using the xeroxed copy of a test given at a training for such types of personnel. The results showed unbelievable scores even the National Hero Jose Rizal wouldn't have managed, much less even the best person who's come and taken the test. It was good that I had another Form of the said test, and immediately was able to prove correct my hunch borne out of practice). The study is still ongoing and is about to undergo a statistical treatment in order to show the relationship between the two. In this way, we can be informed as to whether such a test can be reliable in lieu of the bastardized material. I shall have the results published here when we shall have finished. Yes, the participants have been informed about the conduct of the test, hence the feedback they can demand from the office for their purposes.

Group Activities
We have also been able to conduct two group activities, courtesy of the student-counselor who needed to do so. For my part, I acknowledge that I still have to do so, but due to the load of work, I have yet to provide one. But it should by now be clear that the Guidance Office has done and can do even more. But I would like to ensure that the said activities have sound foundation, that is, based on expressed needs of the clientele and not as an a priori process. I mean by the latter as activities which only the Office sees fit. We may actually do so, but participation will be affected because these said activities may not be important, what a waste of badly needed resources and time! I can say this from having participated in a professional organization (PACERS) whose participation at Conventions and midyear workshops have seen increases because we seriously considered the particiapnts' needs. We reaped abundantly, and so did the participants. I would not like to be accused later of "imposing" the Counseling profession on the clients. This profession is one that advocates for a more free being. The more free an individual is, which can be had by becoming more informed, the more mature his behavior because there is agency borne out of freedom and informed choice rather than simple passivity.

Counseling Services & its Promotion, & Confidentiality
As regards Counseling, we make ourselves available for the seminarians. In fact, to promote Counseling, I have deviced a modicum for that. Seminarians, I have observed through the years, seem to have the "normal" male socialization of doing things on their own and seeking help only when the problem has become really unbearable or really problematic. Besides, there seems a negative opinion about going for Counseling or having gone through psychological assessment. Others think that doing so implies being problematic. But my training has taught me to counter this maladaptive thought, hence the steps we take to ensure client agency. I further believe that the clerics may become one of the best promoters of the Counseling profession especially when we shall have known its value because we have gone through it ourselves. Hence, after administering the test, we ready the results and announce that they can come and get it. In the feedback session, I make it clear to them that formators may need it, hence, they can submit a copy of the report to them but submit back to the office (for filing purposes) the copy which contains the seminarian's signature, the interpreter's signature, my signature and the formator's signature. In this way, I shall have kept the confidentiality clause required by the practice. We in the office have seen that there were seminarians who did not give their formators a copy of the report for reasons discussed in the Counseling session. Among these included the fear seminarians have about formators using the results of the test against them. I have always kept the philosophy that findings in the psychological tests may be best used for the development of the individual, and not against one's development. But if the formator does decide that the test results can be a good guide for the formation of the seminarian, he is basically free to do so. But at least, I shall have done my part of letting the seminarian know the results of the test(s) so that he himself may not have any difficulty deciphering the reason for expulsion as a formation strategy. I know of certain guys who have themselves opted to leave because they saw the wisdom of the test findings. The goal I want to see in the formation process is this: "Happy seminarians who know who they are, what they have, both strengths and weaknesses, so that they can have an informed decision about their choice to continue or not." In short, I would like to help them "own" their formation, rather than simply "float" or "coast along" the formation process, something which is so easy to do as has been observed in the past. In this way, we reduce unnecessary fear in the seminarian, as well as let the formators know how to respect their seminarians because of the information. Hence, only when the seminarian is sent for psychological assessment am I obliged to report (or send) directly a copy to the referring party. But even then, I make it clear to the seminarian that he too will have a copy of the report his formator gets. But for clients sent for Counseling, the only report I give to the referring party is a certification which says "such referred client has come on these dates for the said referred purposes." I cannot divulge the Counseling issues, much less volunteer them, and even the Counseling outcome. I leave it to the seminarian-client to inform the referring party the said data. This is my understanding of the confidentiality required in Counseling practice. This is the ethics that I keep in my professional practice, both for those inside the seminary, as well as outsiders who walk in or have been referred. This is the kind of Counseling I was trained in. Let it be understood as well that the Counselor always ensures the welfare of the client. Hence, only when clients are in the following cases - sexual aggression such as abuse and rape, and suicide - is the Counselor obliged to make the confidential circle wider, but always informing the client about the Counselor's commitment to the client's welfare evident in this obligation. By widening the circle of confidentiality is meant the Counselor's right or even obligation to do steps that may ensure that the client does not: get sexually offended again, or succeed in the suicide ideation or direction.

Counselor-Administration Conflict
I am right now being accused of not doing my job of assessing the seminarians the way I did before. Yes, I did not test them to see their current cognitive functioning. But I am using their previous data for the study I mentioned above. If ever psychological reports (like the ones ready for the seminarian to get) were not given to the formators, it was because the seminarians did not come for their feedback. But if the seminarians agree, and I need to first consult them since the contract is between them and the office, the ready reports are ready for release pending request. I know that this problem is not unique to my practice. It is a common experience for other counselors to have also had conflicts with school administrators because the latter may not really understand what counselors do. Hence this write-up.

The Requirement for A Psychological Referral
Other than the purposes the Guidance Office sees fit in doing testing, a referral is usually required for such test administration. In the referral letter should contain the following - the reason for referral - as this usually directs the Office about which measure to administer. Psychological assessment can be consulted so that anyone who may not have sufficient data for a clearer understanding about a phenomenon in a client my find a more reliable opinion. I'd prefer to know when the report is expected. This saves the office from useless expenses incurred in cases when clients do not want to continue with their formation anyway and the feedback won't be that easy to provide as the person may not be accessible. The Guidance Office doesn't volunteer psychological information. Only upon referral are we to supply the information based on the required psychological opinion. The seminarian-client, even lay-clients should not be made "psychological guinea pigs," something which has been done some decades ago (in my case, we were tested without telling us the results, and some of my classmates were simply asked to leave, and the reason was that they failed the psychological exams). I know of some who left quite bitterly and would have wanted to be helped which the psychological test results could have provided, at least by way of a written report, a psychoeducational strategy which can befurther looked into. There is a prevailing impression that psychological assessment can be quite intrusive, i.ei, psychological assessment is viewed as knowing things even the person himself may be quite unaware of. Privacy is something so essential for every person, and it is important that psychological practitioners remember this. Informed consent is thus an essential component in the process.

When the formator sends in the seminarian for psychological assessment, he is actually consulting the psychological practitioner for its opinion on the referral issue. The formator has the task of ensuring as much information for a clear decision. But I would like to ensure that the psychological assessment process be also used in respect for the client's need to know the results, hence the provision of a copy of the feedback report to the client. Of course, it is also fine for the client being free not to get their report and only let their formator have it. However, it is for our interest in the Guidance Office that we know the client's position, hence the feedbacking, and this information given them even prior to the assessment.

On past practices
I remember that at the beginning of my practice here in the seminary, I have provided the results of the tests to formators, with a copy provided the seminarians as well. It was done because the formator requested it - verbally at least. In fact, before I made the psychological report for the Postulants, I inquired from Bro. Eugene Orog, SVD the reason for such a referral. And I have particularly informed the formators that if they have any difficulty in giving the feedback, they may always feel free to send the seminarian back to me so we can help. I also made it clear to the seminarians that if they want to have the feedback, or maybe a better one (in case of dissatisfaction with the written report), they may always come to the Office for such purpose. There were those who did, and there were those who came because there was no explanation done in the feedback, and still some who wanted to have their copy (because the formator did not give them). This is understandable because there are times when some formators may not know about psychological testing and its findings, and much more feel inadequate about sharing the report with the seminarian. Hence our willingness to assist in the formation process. It can even be possible that the psychological report becomes a file only for filing purposes. I would not want to do this type of work. There are other jobs to be done than this.

Intake and Exit Interviews
I opined in my report last year at the Formators' Meeting that Intake as well as Exit Interviews would be good occasions for data gathering about seminarian attrition. But with the work load I have, I admit not having done the former. The latter I may yet do, but that is if I have time. Other than the Guidance Office tasks and projects I already have, I also moderate students' theses, undergraduate as well as graduate theses and even serve in their defenses.

Institutional Requirement
Besides, I have yet to hear the go-signal of the institution for such activities to be integrated into the schedule. I have gathered materials so that we can systematize the information gathered, and maybe use them for future profiling. Other institutions that I know strongly require the Intake and Exit Interviews as written in their policy: No Exit Interview, no release of credentials (TOR). This institutional policy saves the Guidance Office from the impression of "lording over" the students the services it can provide if it does so on its own. Besides, no Counselor will do so without institutional sanctions. The practice of DLSU has shown that students have been helped through the Office for Counseling and Career Services. Hence the provision of competent Counselors for its students' Counseling needs.

Nurturing a Research Culture in Counseling Practice
Yes, in response to the PACERS 32nd Annual Convention theme, one's site for professional practice can provide opportunities for research so that new information can be provided. We need to keep the ethics while we do this as well as the time and chances for that. I hope by this blog, information can be disseminated, informing those who surround the Psychological practice, either as an active practitioner, client in need of its services. In this way, the Counselors' need to be given as well the space for their own ongoing education is afforded. I remember in Dr. Emmy Liwag's talk, most counselors have sources of information about research other than journals. Among them is the internet. I raised the idea about blogging. This may be the realization of that.

Thank you for reading this material. It was worth the time and effort to enunciate whatever I have been doing that has given me life and courage to continue in this field amidst the storms and misunderstanding that come with the human situation we're all in. God bless