My Understanding Of Person-Centred Counselling Essay

My Understanding of Person-Centred Counselling Essay
Write an essay of your own choice, e.g. "My understanding of person–centred counselling". Relate
and refer to your own life experience and/or your work context.
I am on a life–long path as a Skilled Helper (Egan) with some training in Integrative Psychotherapy.
I am currently striving to integrate Carl Rogers' ideas and practices into my existing knowledge
framework whilst attempting to see previously identified phenomena through new eyes. My aim is
to use this knowledge to influence my practice as co–creator of therapeutic relationships. My
principal aims in this essay are to define some of the basic ideas of Rogers, to then describe how this
links and informs his notions of a joint therapeutic endeavour through his Core ... Show more
content on Helpwriting.net ...
Rogers seems therefore to be describing an emotional consequence resulting from what the
behaviourist BF Skinner called positive and negative conditioning. He conceptualised Conditions of
Worth as the limited ways in which a person could see him– or herself as being valued. The
formulation was also influenced by psychoanalyst Erik Erikson and his ideas of the early stages of
development. Rogers asserted that the child who learns trust and a sense of personal control are
more likely to have a sense of self agency and robustness in the face of later difficulties. This comes
about when conflicts find a successful resolution leaving both parties emotionally respected and
intact. Thus Rogers' more developed model of how a child is socially instructed can encompass
concepts such as shame (Psychoanalysis), Modelling (Albert Bandura) and ideas of Internalization,
amongst many others, and as such is more of a meta– model of growth of the personality.
In James' case he knew that if he worked hard at school he could gain his fathers approval. However
it seemed that he was in the shadow of his brother, who was also under the same pressure. He had
turned to cheating to get better marks to avoid his father's disapproval. James' own sense of right
and wrong were being clouded by his loyalty to– and competition with his brother, also his need for
approval from his father and his sense of duty to protect his frail mother by "not
... Get more on HelpWriting.net ...

The Therapeutic Relationship : Working Alliance, Respect...
The therapeutic relationship is consists of several factors such as working alliance, respect and
empathy, and multicultural competency. The relationship as working alliance is how the therapist
works diligently together with the client's for good results. In the helping process, respect is vital to
clients in a way that the client views the importance of the counseling. Empathy is another way of
allowing your client know you care about them. Multicultural competent is denoting the importance
of the therapist or helper advice that needs to be followed on being a successful counselor. Working
alliance is a part of the helping process that the therapist are encouraged to be aware in the helping
process. Greenson (1967) once stated that working alliance can join together relationship itself and
the relationship–as–means–to–achieving–desired outcomes. According to Bordin (1979), working
alliance was teamwork between the client and the helper committed to their goals and activities that
were discussed in sessions. Bedi (2006) has stated that the researcher has praised the therapist views
on being the helper versus no praises to the client views. Unlike, Bedi's study expressed how client
valued the helping setting, helper's self–presentation, helper's education, helper's appreciation of the
client, self–responsibility, and environment of the session. However, the debate between many
therapists' views is different on working alliance. Respect is an action that involves

Core Conditions Essay
Name of Student: Fiona Cruickshank Student ID: 51125153
Course Name: Counselling Skills 1. Course Tutor: Anne Smith
Counselling Skills Essay 1. Date Due: 17 Nov 2011
Counselling is a form of communication whereby one individual, from now on referred to as the
listener, forms a helping relationship with one or a group of individuals. (Hough 2010) A
counselling type relationship is used in a multitude of everyday home and work settings. These
individuals may not call themselves counsellors or indeed have any formal counselling skills
training. It is this training that sets apart therapeutic counselling from other forms of helping
communication. Sanders, (2007, p15) defines counselling skills as "interpersonal ... Show more
Why? Because as Sutton et al, (2008, p.36.) points out "counselling is essentially about facilitating
change" and sympathy and pity leaves the client stuck in the same place unable to move forward.
Instead the listener must show feeling for the client, effectively trying to mirror or share their
sensitivities. This also demonstrates a depth of self awareness by the listener showing that they
recognise the need for a clear distinction between themselves and their client. Burnard, (1992)
confirms that this also allows us to define clear boundaries within the professional counsellor–client
relationship. Empathy can be communicated non–verbally by facial expression, direct eye contact
and recognising the need to reduce the physical distance between counsellor and client.
This may be simply leaning forward which strengthens the conscious connection or "empathetic
resonance" between listener and client. (Freshwater, 2010, p30). I recall times during my
professional nursing career when I have felt frustrated, particularly when my medical colleagues
showed poor non verbal communication skills and did not fully engage with their patients: the
consultation with a bedridden patient from the end of the bed or the discussion held across a desk.
These physical barriers merely impede the counselling relationship. Sutton et al (2008, p39) believes
that the listener is required to "build a bridge of empathy".

The Therapeutic Process and the Therapeutic Relationship...
This essay will explore the nature of the therapeutic process; using my fifty minute long real play
session with one of my colleagues. Also, I will explore my experience of the therapeutic relationship
and how it influences therapeutic change and increase the affectivity of the therapy. In addition to
this, I will be attaining feedback from my client after discussing each stage of the therapeutic
process in detail to help me understand what worked well for the client and gain more insight into
what I need to improve in order for my future sessions to be more successful. Before the beginning
of the session, I made sure I place the chairs in an appropriate position to promote equality and
decrease the power dynamic between myself and the ... Show more content on Helpwriting.net ...
I made sure I used a welcoming tone as the way a counsellor greets their client will influence the
clients feeling towards the counsellor, and their confidence in the counsellor. It is equally important
to be friendly so that the client feels at ease and valued as a human being. However counsellors need
to refrain from putting on an act and remain congruent and true to themselves from the beginning,
while trying to meet them in a person to person encounter to avoid intimidation Geldard and
Geldard (2005). i asked her brief questions about her name and how she was to get acquainted with
her and build rapport. Asking questions helps facilitate a dialogue and encourages the client to talk
and tell their story Miller (2006). The client seemed tense and uneasy and spoke with a very high
tone of voice when she greeted me and introduced herself. When asked about the main reason for
turning to therapy, she started fidgeting and looked unsettled; this could be because of the unfamiliar
environment or she was not sure if she trusted me enough to tell me her story. Either way, I
remained silent whilst maintaining eye contact to give her the space, time she needed in order to
settle down and work out what she wanted to bring to the session. The client seemed very confused
as though she was not sure of what to say and looked up the ceiling taking pauses, blinking, sighing
as she spoke about the presenting issue. i nodded continuously to

Benefits of the Placebo Effect
What if there was a new drug that's making you high, but is just a sugar pill? What if you can get
drunk with non–alcoholic drinks? What if there was a pill that can cure all your physical and
emotional problems? This is known as the placebo effect. The placebo effect is a phenomenon in
which some people experience a type of benefit after the use of a placebo. A placebo is any
substance with no known medical effects; such as sterile water, saline solution, or a sugar pill.
(About.com Psychology) Although it doesn't have known effects, people exposed to the placebo
effect often gets the effect on what it's supposed to do.
A placebo is a substance or other kind of treatment that looks like a regular treatment or medicine,
but it is really not. It is actually a treatment or substance that is inactive; this means that it is not a
real medicine. The person who is getting a placebo does not know that the treatment is not real.
Sometimes the placebo is in the form of a "sugar pill," but a placebo can also be an injection, a
liquid, a procedure, or any other type of therapy that doesn't directly affect the illness being treated.
Even though placebos do not act directly on the disease, it affects about 30% of people who
experienced it.(Tulsa Brain Tumor Clinic.) People taking placebos have experienced reduced pain,
healed ulcers, eased nausea, and many other illnesses.(ScienceDaily.) As many people suggest, the
placebo is actually an expectancy effect; when people already know what

Reflective Essay On Counselling
This reflective essay will try and develop an understanding of the experiences and theory that has
been applied to a counselling roleplay and applied content over the duration of the module.
Furthermore, identifying what has been covered and what has not been covered in the roleplay, its
strengths, weaknesses, what needs developing and how it can help as counsellors within the field.
The first topic will reflect on the skills and attributes that have been applied to the roleplay and how
it has been beneficial. The second topic will be a critical analysis on the roleplay conducted during
counselling focusing on what techniques have not been covered, what skills and attributes were not
demonstrated in the roleplay. Then identifying how ... Show more content on Helpwriting.net ...
395–396). Another strength was having open questions for the client to answer from what feedback
was received, in order to engage with the exploration skills of counselling (Kottler & Shepard, 2015,
p. 59). Open questions are very important to the exploration and overall process of working through
issues as well as building the relationship between client and counsellor, this approach links to the
use of OARS which stands for open ended questions, affirmation, reflective listening of content,
feelings, emotions and summarizing (Klonek & Kauffeld, 2015, p. 118). OARS as an open–ended
technique of questioning client issues is very important as one of the main techniques of counselling
is to make a quality of openness for the client, so they can express themselves without feeling
restricted (Lee & Prior, 2013, p. 101). The next positive point on the roleplay was the use of
empathic responses which were well conveyed by the counsellor on a median of good to very good.
Empathy is the process in which to try and understand issues from the client's perspective that could
identify underlying emotions, feelings or issues (Kottler & Shepard, 2015, p. 91). During the
roleplay, there was a good reflection on content and paraphrasing. By reflecting on

Using The Hydrate Rather Than The Anhydrous Form Of...
Theophylline is a bronchodilator used in the treatment of asthma, it has a low molecular weight of
180.2. It is slightly acidic, when in a saturated solution of water and has a pKa of 8.81.
2. What are the implications of using the hydrate rather than the anhydrous form of theophylline (i)
in formulation (manufacture of the tablet) and (ii) in biopharmaceutics (dissolution)? 20%
I. Manufacturing theophylline formulations come with challenges for both the anhydrous and
hydrate. For the anhydrous form, a study showed that the wet granulation of theophylline anhydrous
in conjunction with microcrystalline cellulose, led to the formation of the monohydrate form of the
drug. This is significant because the monohydrate has slower dissolution than the anhydrous form of
theophylline. Thus the method of manufacture is highly important as the study showed directly
compressed pellets had better dissolution profiles. Also it shows the importance of the choice of
excipients as pellets manufactured via wet granulation in the absence of microcrystalline cellulose
showed similar release to that of directly anhydrous theophylline.
Theophylline monohydrate has a tendency to dehydrate during the drying process, it can do so at
fairly cool temperatures of around 60⁰C. So this makes temperature an important factor in the
manufacture of monohydrate as phase transition can occur.
II. A study conducted in 1992 found

The Effects Of Induced Therapeutic Hypothermia On Cardiac...
"Medic respond, stoppage," chirped the intercom. The call went out for an adult male found down,
pulseless and apneic, by family at approximately 2200 hours. EMS personnel arrived on scene,
performed quality CPR and followed appropriate ACLS algorithms, and found an organized rhythm
with matching peripheral pulses at the third check. Per 2010 AHA guidelines, medics performed a
12 lead EKG, managed the patient 's hypotension with a fluid bolus, and managed the patient 's
airway by endotracheal intubation (American Heart Association, 2011). The patient displayed no
neurological response, the EKG revealed significant ST segment elevation in anterior and septal
leads, and intubation was performed successfully without induction or paralytic ... Show more
The American Heart Association (2011) states that, "Therapeutic hypothermia is the only
intervention demonstrated to improve neurologic recovery after cardiac arrest" (Pp 77).
Recommendations range between 32 and 36 degrees centigrade for 12 to 36 hours. Cooling may be
achieved through either introduction of cooled, isotonic, non–glucose–containing fluid, or surface
cooling interventions like ice packs or cold packs. The AHA states, however, that patient core
temperature must be monitored by an esophageal thermometer, a pulmonary artery catheter, or a
bladder catheter and that peripheral temperature measurements via axillary, aural, or oral
thermometers are inadequate for measuring core temperatures in targeted temperature management.
Therefore, while the AHA does recommend initiation of therapeutic hypothermia by EMS personnel
in certain situations, agencies must carry––and be trained in the use of––equipment to adequately
measure the patient 's core temperature. Further, the AHA states that therapeutic hypothermia results
in increased neurologic function post–cardiac–arrest but does not identify a timeframe for initiation
for these protocols, let alone explore whether or not initiation of post–cardiac–arrest targeted
temperature management by EMS influences patient outcomes. According to a study published in
the

Drug Study Assignment Essay
PHAR 1000 – Basic Pharmocotherapeutics
Eileen J. Arellano
Norquest College
Practical Nurse– Section D01
PHAR 1000 Written Assignment
Heather Zirk RN, BN
September 15, 2014 CASE STUDY:
Name of Client: Maggie Sears
Age: 66 years old
Primary Diagnosis: Cellulitis to left leg
Secondary Diagnosis: Depression Osteoporosis Type 2 Diabetes Mellitus
Past Surgical History: Tonsillectomy– as child Cholecystectomy– 15 years ago (51 years old)
Current Medications: "migraine pills" St. John's wort oil – for skin inflammation to left leg (for a
week)
Past History: Smokes ½ a pack of cigarettes per day (since she was a teenager)
Weight: 70 kg
Height: 150 cm
DOCTOR'S ORDER:
Medications:
Ancef 750 mg IV q12h
Elavil 50 mg po ... Show more content on Helpwriting.net ...
If headache recurs, doses may be repeated q 2 hr (not to exceed 200mg/day)
Doctor's Order: 75mg q4H max 2 doses daily
Is this Safe?: NO. The dose should be lesser. 25–50mg for lesser interval of q2H.
Metformin
Safe Dosages: 500mg twice daily. May increase by 500mg at weekly intervals up to
2000mg/day. If doses >2000mg/day are required, give in 3 divided doses (not to exceed
2500mg/day)
Doctor's Order: 750mg TID with meals
Is this Safe?: YES
Buffered Aspirin (Salicylates)
Safe Dosages: 2.4g/day initially; increased to maintenance dose of 3.6–5.4g/day in divided doses
(upto 7.8g/day for acute rheumatic fever)

Doctor's Order: 650mg (or .65g) q6H PRN
Is this Safe?: NO. The dose 650mg (or .65g) q 6H PRN that was ordered was lesser than what is a
safe dose according to the drug guide. And dose wouldn't be enough to help client's pain.
3. What would you do if the dosage ordered was not safe?
Clarify the order with the Physician involved. Refer to the drug guide or any reliable source if
necessary.
4. Indicate potential drug

Clien Brown Reflection
I like the way Brown organized this book. She is gradually introducing some basic concepts prior to
introducing a particular model or a larger concept. For instance, she provides basic information
about different social classes prior to introducing theories of identity formation. Brown highlights
the important of having awareness of our own schemata and rules that we might impose on others.
She also emphasizes on the awareness of psychotherapist's personal relationships to each of the
social locations because these social locations can impact therapeutic relationship and potentially
become a source of trauma/threat for a client. I recall working with a client, who I shared many
overt social locations with. Even though I had no difficulty understanding her family upbringing, it
was apparent that client felt shameful and guilty, especially when comparing my achievement and
her substance use. After the initial session, the ... Show more content on Helpwriting.net ...
Additionally, she highlights the importance of continuing to assess trauma and use culture to inform
to inform treatment. It is extremely important to be a cultural competence psychotherapist as it will
help to avoid unintentionally inflicted secondary traumas. It will also help the healing process by
connecting trauma survivors to their own resources and honoring the inner and outer realities
informing trauma and its meanings. How a client translate his or her inner biological states of
posttraumatic disequilibrium into outward expressions of distress are strongly affected by culture
and context. I aim to be a psychotherapist who possesses the ability to understand how a trauma
survivor's multiple identities and social contexts lend meaning to his or her trauma experience and
promote recovery that includes their cultural

Therapeutic Value Of A Dog Essay
Responsibility. Therapeutic Values. Protection. There are many promises and reasons that children
tell their parents to allow them to have a dog in their family. They will say how they will take the
dog on walks every day and wake up with the new puppy early in the morning. Most of the time
their parents will fall for their unintentional trap. There are other reasons that will grab their parents
attention. Every child should have a dog in their life because the dog teaches responsibility, they
have therapeutic values, and they will protect the family of even the smallest things.
Owning a dog teaches children responsibilities. Parents can create tasks based on their children's
ages. Younger children can wash the doggie dishes, refill the water dish, help brush them, and most
of all give them love and attention. Older children can feed the dog, clean up after the dog, train and
exercise them, and love them as well. The way parents act towards the new dog is very important to
how to child acts towards the dog. If the parents are mean or become angry at the dog, then the child
has the possibility of doing the same. Children at a young age have a very impressionable mind. So,
if parents lose their temper and say that they will get rid of him/her. The children will feel as though
they can't be trusted. Children might also see ... Show more content on Helpwriting.net ...
Most dogs have a protective instinct built into them. There are specific dogs that are categorized as
guard dogs and were bred with certain protective characteristics, such as German Shepards and
Great Danes. Many claimed guard dogs are retired police dogs. Guard dogs are extremely
intelligent, quick on their feet and quick to think in pressure situations. They are said to have a
watchful eye (Best Guard Dogs for Families with Children). Protective dogs are highly devoted to
their family. They will put themselves into harm's way if it means protecting the children or

Client Centered Therapy
Jessica Jeffers
It is inevitable that in psychotherapy there are numerous theories. Theories arise out of scholarly
investigations of ideas on human behavior. Human behavior is an extraordinarily interesting subject
and therefore produces a plethora of ideas from a variety of theorists. These theorists are influenced
by their education, culture, and time period. One of the most influential, empathetically
understanding, theorists is Carl Rogers. His contributions to human behavior have changed many of
the theories that preceded him, and contributed his theory to many theories that followed him.
I want to explore Client/Person Centered Therapy. This is a type of therapy that was pioneered by
Carl Rogers. This therapy is different ... Show more content on Helpwriting.net ...
Rogers may not have worked with his clients to produce and obtain goals, but he did have a ultimate
goal in his therapeutic work. According to Rogers, "They [clients] are then able to accept themselves
as they are and to commit themselves to becoming more like they can and want to be" (as cited in
Truscott, 2010, p. 72). The client is in turn aided by the therapist in becoming as authentic as
possible. Thus this authenticity would provide the client with the ability to be true to themselves and
their feelings. I find this to be useful in allowing the client to process their internal feelings,
externally.
According to Truscott (2010), "Therapists must be willing and able to listen without prejudice,
judgment, or agenda if the client is to have any chance of feeling truly understood and accepted.
Positive feelings, negative feelings, and silence must be acceptable to the therapist" (p. 73). This is
interesting because it requires that the therapists become void of any judgments. To me this seems
like a difficult task to accomplish because of the nature of judgments. Understandably so, the
therapist would automatically make judgments of the client, as a natural inclination even with the
best intentions against judgments.
So, what kind of a therapist must one be to establish a patient centered therapy?

Reflection On Family Relationship
In this skills session my client brought her relationship with her mother and her feelings about that
relationship. She brought feelings of "sadness" "hurt" "upset" and "grief". She states early in the
session "I'm constantly searching for some sort of love" and "affection from her". She describes
feeling neglected and disregarded by her mother and the rest of her family. She admits that these
feelings have "stretched into the rest of her life" and have left her feeling "unworthy" "not good
enough" and like she "doesn't matter". She states that she feels "not worthy of affection" or "care" or
"regard". My client was questioning why her mother behaves the way she does towards her. She
finds her mother's behaviour "difficult to understand" and feels she doesn't "understand where it's
coming from". During the session my client describes her mother's behaviour in a particular scenario
when she felt her mother behaved differently when she had an audience to play to. My client
described feeling "ganged up on" by her mother, who was "backed up" by her visiting relatives. It is
clear my client wants a relationship with her mother and states this clearly when asked. She is
seeking answers "what is going on", "what is going on with this attitude?" My client states that she
has suffered with feelings of being "unworthy" for "most of her life" and suffered a nervous
breakdown two years ago after which she sought help from counselling and her GP. Considering
what I have outlined above it would appear that my client's feelings of being unworthy and of not
being good enough arise from feeling that she doesn't matter to, or is disregarded by her mother and
other family members. It would appear that my client's evaluation of her self worth or self–esteem
has been affected by her close family relationships. Carl Rogers (1959, p200 & p223) describes the
development of the self–concept (how an individual perceives themselves) and how this self–
concept is heavily influenced by the conditions of self worth set out by others. Conditions of worth
are constraints or preconditions, which an individual perceives are placed upon them by individuals
external to them. The individual believes that these preconditions must be satisfied or

Personal Counseling Characteristics
My Personal Counseling Characteristics Capuzzi, Stauffer, and Gross (2016) highlighted the
existence of "core conditions" identified throughout the counseling literature and research as an
essential piece of the therapeutic relationship (p. 8). Possessing and demonstrating these
characteristics and behaviors strengthen the helping alliance and aid in effectiveness as a counselor
when guiding the client to achieve optimal wellness (Capuzzi et al., 2016). The following narrative
outlines characteristics and behaviors emphasized as strengths necessary when developing a
therapeutic alliance with a client and those acknowledged as potential challenges or weaknesses
hindering the development of a therapeutic alliance. Additionally, explanations are discussed for
selected strengths and challenges as well as strategies to address challenges and weaknesses.
An Area of Strength Warmth as a core concept essential to the helping relationship is regarded as the
counselor's ability to convey "genuine caring and concern" to clients (Capuzzi et al., 2016, p. 11).
Without this ability to convey warmth as a counselor, the counseling process will not be effective,
especially as I believe warmth is essential to building rapport and promoting an environment in
which clients feel comfortable disclosing intimate details of their lives. After all, a client may be
more reluctant to disclose intimate aspects of their life if they believe that the individual to which
they are disclosing does not

What Makes A Successful Therapeutic Relationship?
Introduction Therapy is often said to be just as much of an art as it is a science. Namely because
there is so much that goes into it. To create a successful therapeutic relationship, there are some key
elements that need to be a part of the formula. Each therapist may end up having a different recipe,
but it is important that a therapist knows what ingredients he or she may need and what they can add
for it to be successful. Throughout this paper, this writer will discuss characteristics she hopes to
embody as a therapist, as well as the values and skills she wishes to bring with her into a therapeutic
relationship.
Values
There are many values this writer wishes to incorporate into a counseling relationship. The
fundamental values this writer wishes to incorporate are: flexibility, self–awareness, self–regulation,
and empathy. The ability to be flexible and alter what one does in order to fit the client's needs is
crucial to establishing and maintaining a therapeutic relationship. Flexibility can be demonstrated in
many different ways, such as the way the therapist interacts with the client, the tone of voice that is
utilized, down to the way the therapist provides material to the client. In being flexible, treatment is
able to remain focused on the client and his or her needs (Egan, 2014).
Possessing self–awareness is key to knowing and understanding the different attitudes, beliefs, and
values one has and understanding when differences could affect them. An example

It Is Critical For Self Disclosure Ethical And Clinical...
It is critical for self–disclosure precautions, frequency in practice, potential risks, and potential
advantages to be reconciled through a research–integrated framework considerate of paramount
ethical and clinical considerations. An attempt to do so will be made through first overviewing self–
disclosure ethical and clinical principles identified in the scholarly literature. These principles will
then be synthesized into a larger discussion in which there will be identification of which theoretical
and conceptual positions are most supported by admittedly limited empirical research and will
therefore be discussed in their implications/application to various practice scenarios. In so doing, the
discussion first addresses the more conservative subject of whether or not to disclose and then
progresses into discussing what can or should be disclosed to which clients under what clinical
circumstances and contexts (Audet, 2011). Moreover, because the possibility of a disclosing
therapist invites an uncharted level of intimacy into a professional relationship historically built
upon secrecy and subtlety (Bottrill et al., 2010). Methodology A comprehensive search of the
PsycINFO database was conducted utilizing key words searches germane to the larger subject
matter. Key words that yielded the most relevant articles became the key words for this paper. In
total, 50 papers were included. Excluded papers were not available in full text form or were clearly
not relevant. First, key

Substance Use Disorders: A Case Study
Establishing rapport with a client during the intake process is the foundation of a strong therapeutic
alliance that is crucial for ensuring client return and prevention of early termination of treatment
(Marini, 2015). Yet, counselors often find it challenging to find this rapport with clients who present
with substance–use disorder (SUD). They may be ambivalent for being compelled to seek treatment
by family or a judge. Denial and unwillingness to give up substance use behaviors can make the
client defensive and secretive. Even cultural, ethnic, and gender differences can foster client
suspicion if the counselor is perceived as biased or insensitive. Co–occurring mental disorders may
also create challenges; clients who have a high risk of ... Show more content on Helpwriting.net ...
The counselor should review disclosures and other policies with a relaxed manner and non–rushed
pace to allow comprehension and time for questions (Marini, 2015). This prevents the client from
feeling overwhelmed, powerless, or mistrustful. Sending the client home with a relevant homework
assignment or light motivational readings can sustain the client's sense of involvement and rapport
between sessions (Kelly, 2006). Also, follow–up letters of appreciation and well–wishes convey a
sense of caring when the client may otherwise lose motivation to change (Kelley,

Few Animal Studies Have Proved That Gabapentin Has A...
Few animal studies have proved that gabapentin has a potential to activate a serotonin receptor
(5HT3) at the spinal level and also attenuate the function of microglial cells[6]. In some parts of the
brain such as periaqueductal grey (PAG) and anterior cingulated cortex, gabapentin has been shown
to elevate the level of GABA, a major inhibitory neurotransmitter, which might serve as an
explanation of its' efficacy in partial management of seizure[14]. Although gabapentin is approved
to be used as an add–on treatment of focal epilepsies in 6 years and older patients and as
monotherapy in patients older than 12 years of age, it seems to show no efficacy when used in a
management of generalized tonic–clonic seizures, generalized absence ... Show more content on
Helpwriting.net ...
Due to an effect of gabapentin at the level of hypothalamus to regulate the temperature, it can also
be used as an effective non–hormonal therapy for hot flashes, a bothersome problem of menopause.
It is shown to be more efficacy if used in patients with hot flashes that associated with sleep
interference [17]. Study shows that a bioavailability of gabapentin is low and it is dose–dependent.
The bioavailability of 300 mg is around 60% and decreasing to less than 30% if the dosage is 1600
mg 3 times a day [4; 11]. It has low protein binding property and it is eliminated unchanged in the
urine, which means it will not change into toxic metabolite or intermediate that can be harmful to
the body. Gabapentin has a short half life of 5 to 9 hours, but with renal impairment, it will
increase[4]. A dose adjustment is required in patient who has creatinine clearance of 60 ml/min and
in the elderly because of reduced renal function that has been thought to be decreased around 1%
per year after the age of 40[4; 16]. A number needed to treat (NNT) of gabapentin is 6.3 and its
number needed to harm (NNH) is 25.6, therefore it is considered a safe drug [6]. The ceiling effect
has been reported to be 100 mg/kg in one study and 30–300 mg/kg in another study following oral
administration [13]. The pharmacokinetic of absorption of gabapentin is not linear unlike other
newer anti–seizure medications. The explanation for this event is because gabapentin absorption
depends on

Case Study Of Alkenylbenzenes
1 Introduction
1.1 Background China has a long history of safety use of many botanical or herb–based food items.
More than 6000 different kinds of Chinese herbs are identified and more than 600 of them are used
as raw material to produce medical products , plant food supplements (PFS) , herbal teas and food
flavours . There is a growing interest by consumers and industry for the development of botanical
products due to their "functional" properties or health benefits. Consumers equate "natural" with
"safe" when consider the ingredient used in these products . Moreover, the herbal teas can be
obtained easily in the supermarket or pharmacies with an relatively low costs. It is easy to find that
the market size of botanical preparations has increased significantly these years . However, the
growing use of botanical compounds as direct drinking ingredients is accompanied by an increasing
concern , the ... Show more content on Helpwriting.net ...
An important group of compounds of concern in botanical preparations and herbal teas are
alkenylbenzenes . The aim of this study is to assess the exposure to alkenylbenzenes as a result of
drinking the herbal teas obtained from Chinese market. The most known examples of
alkenylbenzenes are estragole (4–allyl–1–methoxybenzenes; CAS No.140–67–0), methyleugenol
(1–allyl–3,4–dimethoxybenzene; CAS No.93–15–2), elemicin (3,4,5–trimethoxyallylbenzene; CAS
No.487–11–6), safrole (1–allyl–3,4–methylene dioxy benzene; CAS No.94–59–7), myristicin (1–
allyl–4,5–methylenedioxy–3–methoxybenzene; CAS No.607–91–0) and apiol (1–allyl–
3,4methylene–dioxy–2,5–dimethoxybenzene; CAS No.523–80–8). Some studies have already
reported that these compounds may cause toxic effects on the liver by administration of high doses
in lifetime laboratory animal studies . The chemical structures of alkenylbenzenes are shown in

Write an Essay on Confidentiality and the Boundaries of a...
Boundaries not only reflect a need for physical space, but, our core values, self respect and our need
for safety and protection. They are invisible lines that differentiate people from each other. The
different forms or types of boundaries include physical, emotional, spiritual, financial, and
relational.
The formation of boundaries in Counselling, or a helping interaction, is very important. Helping
interactions provide people with an opportunity to help deal with their difficulties, whatever they
may be. It is a chance to be listened to and understood. As such, the helping relationship is an
intimate one. It is built around trust and support and offers the helpee (client), a place free from
judgment. Within a helping interaction ... Show more content on Helpwriting.net ...
Thus, boundaries allow the explorative process to continue. As the helpee may be not used to this
kind of framework and unaware of the importance of keeping the limits, it becomes helper's
responsibility to set up and manage the boundaries as well as to recognize the dilemmas that are
inherent within them.
The agreement on the boundaries concerning therapeutic relationship is beneficial for both the
helpee and helper. Boundaries preserve the therapeutic relationship by ensuring that a helper
understands the need to and can keep separate his personal and professional life. Counsellors, or
helpers who are able to maintain healthy boundaries do not carry the problems of their clients
around with them during leisure hours. They know how to say no, which allows them to keep a
balance in their lives. A helper that takes care of himself and knows where to draw the line is in a
position to provide a higher standard of service to his helpees, than a helper who blurs the
boundaries between personal and professional relationships and feels overwhelmed as a result.
Moreover, by making the distinction between a therapeutic relationship and social relationships, a
helper is able to retain a level of objectivity that a friend would struggle with if you went to him
with a problem. Your friend may have a stake in the outcome of your problems that a helper

Disruptive Behaviors Are A Challenge For Therapists
Disruptive behaviors are a challenge for therapists and require a different approach than those
implemented for adults. Establishing rapport is the foundation for the change process to begin.
Sommers–Flanagan and Sommers–Flanagan (2007) assert that traditional counseling techniques are
ineffective for working with children and adolescents, and a multicultural therapy approach
increases the likelihood of engaging them in therapeutic relationships. Adolescents are a subculture
and require a person–centered approach, whereas therapists believe that adolescents have the
resources and the ability to change. The therapeutic alliance formation involves the therapist's ability
to utilize the individual's strengths as a mode of change. Findings ... Show more content on
Helpwriting.net ...
Sommers–Flanagan and Sommers–Flanagan (2007) identified this approach as the–counselor–
knows–it–all approach, whereas the child or adolescent's opinions and beliefs are irrelevant.
Establishing rapport with adolescents depends on the ability of the clinician to engage them in the
therapeutic process. The goals for this counseling session involve establishing a worker–client
relationship and beginning the assessment process. Walborn (1996) reports that a vital early step in
the engagement process involves familiarizing the client with what to expect from therapy.
Sommers–Flanagan and Sommers–Flanagan (2007) upholds the position that counseling does not
work with teenagers, because it is often not offered to them. Counselors often attempt to mold them
into miniature adults and implement techniques that work well with adults and not children. The
techniques utilized in the initial session discouraged the development of a client–worker
relationship. Melissa became even more defensive as the session progressed. The clinician focus
was on the verbal message and not on the feelings underneath these statements. He continued to
challenge her position on the need for therapy, thereby upsetting the engagement process with this
client. Within multicultural counseling, responsibility, knowledge, and skills lie with the
practitioners rather than the client system. Within this context, the therapist had his agenda, and
instead

The Effects Of Aspartame Consumption On Children 's Own...
Title: Neurobehavioral Effects of Aspartame Consumption. This title did not give the readers any
clues as to whether the authors believe aspartame causes neurobehavioral side effects. However, it
does let the audience know the effects will be reviewed in this article.
Intended audience: The intended audience is professionals in the field of nutrition and dieting. Since
the army helped fund the research written about in this article it would not be a far stretch to believe
that they were looking into feeding solders a healthy diet and wanted to see the effects of aspartame
in their own controlled setting.
Writer background: Professor Glenda Lindseth teaches Nursing Science, Nutrition and Dietetics,
and Psychiatry at the University of North Dakota. Sonya Coolahan MD is a physician who practices
Internal Medicine at the Rapid City Regional Hospital in South Dakota. Dr. Thomas Petros is a
Psychologist who teaches at the University of North Dakota. Professor Paul Lindseth teaches
Odegard School of Aerospace Sciences, at the University of North Dakota.
Writer's angle: The writers are sharing their finding in a study of 28 students' consumption of
aspartame in a controlled setting to see if there are any neurologic effects.
Part 1: The one–sentence summary
The authors of this researched peer review highlight the effects of aspartame on the brain's cognitive
abilities, depression, and headaches.
Part 2: The one–paragraph summary
In the research article, Neurobehavioral

Essay about Philosophy and Therapeutic Recreation
As I make my way on this journey that is my life, I realize that I have always believed in the
fundamental worth of all humanity and my responsibility as a fellow human being to respect this
premise and also to support individuals, as much as I am able, to help unearth it should this basic
truth become hidden to them. This is a guiding principle for me and I believe that many of the
constructs of the field of Therapeutic Recreation (TR) are congruent with this philosophy. Making
the decision to obtain a Therapeutic Recreation Specialization (TRS) degree offered a theoretical
rationale in which to further explore the concept of leisure, define my professional philosophy and
an opportunity to reflect critically on the field which I have ... Show more content on
Helpwriting.net ...
When choosing to work with adults living with severe dementia, many people often ask me how or
why I do it. It's simple. Not only do I believe that all people have value, I likewise believe that all
people can contribute to society. The client who can no longer articulate their thoughts or needs or
desires is teaching me to listen and find alternative means of communication. In essence, they are
teaching me to be a better communicator. I think this is congruent with Sayers concept of
meaningful contribution. There are still so many things about the brain that we do not understand
that I would find it arrogant of me to assume that the person with dementia does not feel they are
still contributing to society in some way.
This improved communication skill, from my perspective, is an essential and necessary benchmark
for the establishment of an effective client/practitioner relationship. O'Keefe (2008) urges us to
listen to the narrative, there's a story to be heard, if only we adjust our philosophical positioning.
Eudaimonia, Leisure Ability Model, & A Strength Paradigm
Aristotle posits Eudaimonia, human flourishing and happiness, as the 'chief good' of humanity
achieved through 'reflective activity' over a lifetime (Aristotle, The Nicomachean Ethics, 2002).
From my perspective, the reflective activity to which he alludes is the pursuit of leisure.

Therapeutic Relationships And The Three Stages Associated...
Therapeutic relationships and the three stages associated with relationships
The whole reason for a therapeutic relationship is to facilitate a successful patient outcome. Each
person is unique and has different needs.
Stages of development of a therapeutic relationship:
Orientation Stage–involves nurses learning about patients and they initial concerns and needs.
Patents also learn about the role of the nurse. Patents are informed about the general purpose of
taking with the nurse. The initial purpose is plainly: identifying a problem on which you want to
work, helping you figure out what has been happening to you lately, or getting to know what has
been bothering you. This first stage is about building trust first before moving on to your initial
assessment. Afterwards the nurses job is to manage the patients emotions and providing support and
structure to the pt.
Working Stage–When patients are ready, the work toward changing their thoughts, feelings, and
behaviors can begin. However, drastic changes might not be the goal for some patients, particularly
the chronically ill. Stabilization with meds, reduction of symptoms, and development of supportive
relationships are valid goals. The parts of this working stage begin with in depth data collection.
This is where the nurse facilitates awareness, analysis, and interpretation through in–depth
exploration of issues and identification of priority issues. Reality testing is the next part, and is an
important strategy in the

Person Centered Therapy
PCT Essay 1
Running head: AN ILLUSTRATION OF PERSON–CENTERED THERAPY
What do you consider to be the strengths and weaknesses of the person–centered approach? What
concepts and methods might build effective bonds with clients? Discuss any shortcomings in staying
with this orientation.
Word Count: 2214
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*
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/
PCT Essay 2
Abstract
This essay would attempt to explain the fundamental concepts and therapeutic methodologies that
might build effective bonds with clients.
It would also discuss the strengths and weaknesses within the person–centered approach. The key
concepts include self–actualization, conditions of worth, the fully functioning person, and the
phenomenological perspectives. The therapeutic ... Show more content on Helpwriting.net ...
Key Concepts & Methodologies
¦¦>' *
Rogers maintained that to create a growth–promoting climate in which therapeutic change * can
occur, and where clients can move forward and become what they are capable of becoming,
/
PCT Essay 5

/
/
some fundamental conditions must be present. The client must be anxious or incongruent and in
contact with the therapist. Therapists must be genuine, whereby their words, nonverbal mannerisms
and feelings are not to be contradicting. In addition, they must also accept the client and show
unconditional care towards them. The therapist must understand the client's thoughts, the ideas,
experiences, and feelings, when communicating back this empathic understanding
(Murdock, 2009).
Firstly, congruence (genuineness or realness) refers to the therapist's openness, genuineness and the
willingness to relate to clients without hiding behind a professional front.
Therapists who conduct sessions with this sincerity in mind have all their feelings available to them
in therapy sessions and may share significant emotional reactions with their clients.
However, congruence does not mean that therapists shift the focus of therapy to themselves in any
way or have a predetermined direction, or impose a professional agenda to their clients during
sessions. [Corey, 2005]
Second, a therapist should show

Social And Early Developmental Factors
Though not discussed explicitly stated, clearly there are cultural, social and early developmental
factors that should be considered as each influence or impact Jackie's symptoms or problems.
Culturally it can be argued that due to the lack of integration between his mother's heritage and his
fathers, there was a discourse within him. As described by Jackie his father was a traditional
Englishman, who did not allow his family to participate in his mothers cultural affairs. It can be
argued that due to the lack of convergence between his two cultural backgrounds, increased Jackie's
anxiety. Yoon et al., (2012), found that "both acculturation and enculturation positive contribute to
SWB (subjective well–being) when increase in one cultural orientation did not entail losing the
other culture" (p. 93). However, given the information provided about Jackie and his family
dynamic, it is clear that Jackie's father often dismissed his mother's cultural heritage, thus forcing
Jackie to acclimate to his English culture instead of his Indian heritage, potentially causing anxiety.
This anxiety also may be exacerbated by Jackie's migration to the United States, where he was
forced to accommodate another culture, after already having insufficient connectedness with his
heritage. Social factors such as Jackie's difficulty connecting to individuals and his impaired self
esteem, as evidenced by his continual negative language about his abilities, can attribute to his
inability to form

Placebo
The Placebo effect of medication
Do we really need industrial medicine?
In this essay I will begin by explaining the five major points of the placebo effect, such as the
understanding of placebo, the history, phenomenon, experiments and case studies. Placebos are used
in everyday life, from it being your doctor or even a commercial you've seen on the tv. Do we really
need prescribed medication or do we just think we do?
UNDERSTANDING PLACEBO
(Goldacre, n.d.)"The placebo effect is one of the most fascinating things in the whole of medicine.
It's not just about taking a pill, and your performance and your pain getting better. It's about our
beliefs and expectations. It's about the cultural meaning of a treatment". The placebo effect is one ...
Show more content on Helpwriting.net ...
In an experiment involving pain symptoms, a placebo is giving to control group A and the actual
pain pill is being giving to control group B. In every experiment involving placebo it uses either the
single–blinded method or double–blinded. In this experiment we are only using the single–blinded
method and this is where only the experimenter knows which patient or control group is receiving a
placebo. In some experiments they use the double–blinded method to make sure neither the patient
or the control group know that they are receiving a placebo. The reason they do the double–blind
method is because when the patient asks the experimenter if she or he is receiving the placebo
neither will actually

Identify the stages of a series of counselling sessions...
1 .1 Identify the stages of a series of counselling sessions The beginning The beginning of the
counselling process starts when the client first meets the counsellor, the saying "first impressions
count" is absolutely true for both the client and counsellor, the client will be very nervous and
unsure what is about to take place. The way the counsellor approaches the client in this infant stage
is vital for the client to gain trust and has the willingness to open up in later sessions. Some clients
may just rush into what is troubling them or say nothing, in both cases the counsellor will need to be
patient, observe and listen to what is being said as there will be vital information given and without
understanding this it could damage ... Show more content on Helpwriting.net ...
1.2 Evaluate the importance of an appropriate opening of a series of sessions In my opinion the
beginning of the counselling session is one of the most important stage of the process, the client will
be very nervous and will not fully trust the process they are about to embark on, their unknown
journey they will be nervous. The Client may hold back what they are feeling until they have gained
the trust of the counsellor, and know they are safe and in a confidential environment. Another
important factor in the opening stage is to draw up a contract and discuss the content with the client,
this will demonstrate it's a working relationship and both the client and counsellor will know their
barriers, it also gives structure and prevents any misunderstanding in the relationship. By having a
contract it demonstrates to the client they are safe and able to speak freely also it shows the client
that each session if totally confidential, there are exceptions to the rule and these will be included in
the contract and what the process will be if they disclose anything that is unlawful. Having
unconditional positive regard from the beginning will display to the client there is no hidden agenda
and that the counsellor is non–judgmental, this will support the client to develop the working
relationship and show the client they are valued and wanted, they will start to relax to open up freely
and loosen up their attitude towards the session. 1.3

Therapeutic Alliance And Therapeutic Relationship
Therapist–Patient Relationship Historically, the alliance construct refers to the effective relationship
between the therapist–patient and varying aspects of the alliance have been studied, for example, the
relationship and outcomes (Horvarth & Bedi, 2002, Lustig et al, 2002), the role of the alliance
(Horvarth & Luborsky, 1993) and the therapist's behaviours that predict the alliance (Duff and Bedi,
2010) and failures in the alliance (Duff & Bedi, 2010). Lambert & Barley (2001) argue that a
supportive alliance accounts on average for 30% of the variance in outcomes, whereas theory and
techniques only accounts for 15% of the variance in outcomes. In comparison to the coaching
relationship, the reverse is true as the same study (Grant, 2014) indicate theory and techniques
account for 18.49% of the variance in outcomes whereas a supportive ... Show more content on
Helpwriting.net ...
It is the depth and breadth of the research spanning over 3 decades that provides researchers in the
coaching domain a body of knowledge to build upon, compare and contrast (De Haan, XXX).
Throughout the literature, various terms are used to describe the relationship including, the
therapeutic alliance, ego alliance, working alliance and helping alliance and I will refer to the
generic term of alliance (Horvath & Luborsky, 1993) as meaning, "the client and counsellor's
subjective experience of working together towards psychotherapeutic goals in the counselling
context, including the experience of an interpersonal bond that develops while engaged in this
endeavour," (Duff and Bedi, 2010, p.91). The alliance is therefore viewed as partnership with both
parties actively contributing to the relationship with an emphasis on being

Carl Rogers's Theory : Person-Centered Therapy
Person–centered therapy otherwise known as client centered therapy is a non–directive approach to
counseling created by Carl Rogers. This theory is best described as based on the belief individuals,
rather than their environment or subconscious motivations, can control their choices and values and
accomplish their own unique potential for change. Rogers' theory stresses how it is the individual's
own responsibility for improving his or her life with the primary motivating force of humans is
reaching self–actualization which is the tendency to move in the direction of growth, adjustment,
socialization, independence, and self–realization (Erford, 2018). In terms of his theory, there are two
fundamental ideas at the center of it all, the first being about healthy development in terms of how
the individual views their own well–being. A healthy individual can see the relationship between
their sense of who they are and who they feel they should be. The second fundamental idea from
Rogers's concept of the conditions for healthy growth, and the role of a therapist in fostering healthy
growth. Throughout the process Rogers called person–centered therapy, the counselor seeks to
provide empathy, openness, and unconditional positive regard for the client. This research paper
examines the concept of person–centered therapy, the types of problems which can occur when
using this approach, strengths of this using this type of therapy along with examining the
weaknesses of using this type

Personal Strengths In Counseling Relationships
1. What personal & professional strengths do you have that you can use and build on to create
helping relationships with your clients? My personal strengths include a dedication to social justice,
I am compassionate, I am open–minded and able to evaluate issues from various aspects and points
of view. Professionally, my strengths are experiences working with individuals from various ages,
cultures, ethnicities, beliefs, and socioeconomic statuses. I have worked with individuals with
various mental health concerns, people with past and current substance use, and those experiencing
domestic violence. These strengths will assist me in creating helping relationships with my clients
because I think it will foster a trusting and safe environment which will encourage the clients to
confide in me as well as work together to effect positive change in their lives.
2. What knowledge, skills, and values do you already have that help you form an effective helping
relationship? I have learned how to ask open ended questions to obtain as much information as
possible. I am also learning how to validate and use reflexive listening. These skills will help the
clients know that I care about them and want to help. I believe that every person possesses strengths
and the capacity to change. I also believe that everyone has the right to have a life worth living, and
has the right to live however they want as long as it doesn't harm others.
3. Describe how you currently view your overall

Case Study Of Cellulitis
outcome measured the proportion of patients that had a repeat of cellulitis during the drug phase and
follow–up phase (Thomas et al., 2013).
The results of this experiment showed some interesting information. In the end 136 patients were
put into the penicillin group and 138 patients were put into the placebo group. From these patients
15 (5%) took back consent or couldn't be found, 11 died (4%) and 206 (75%) were put into a
secondary care (Thomas et al., 2013). In total 247 (90%) of the patients did the minimum of 18
months of follow–ups and 214 (78%) said that they took at least 75% of the tablets between the two
groups (Thomas et al., 2013). During the trial, the primary outcome saw that it took a median of
about 626 days in the ... Show more content on Helpwriting.net ...
Antoher group was given clarithromycin and hydroxychloroquine mix 500 mg and 200 mg
respectively twice daily (Berende et al., 2016). And the other patients got placebos twice daily
(Berende et al., 2016). Everyone was blindly assigned.
At the end of the study 205 patients (73.2%) reported a minimum of one adverse effect, like diarrhea
or nausea (Table 2) (Berende et al., 2016). Nine people had a serious adverse effect and 19 had a bad
enough side effect that they discontinued with the study (Table 2) (Berende et al., 2016). In the end
though most of the patients made it throughout the whole study.
To measure results the researchers used a 36–question questionnaire at the beginning at the end of
the treatment of the 14 weeks, at 26 weeks, at 40 weeks, and finally 52 weeks after treatment
(Berende et al., 2016). From the results 252(90%) of the patients completed the study. 76 out of 86
for the doxycycline, 64 out of 96 for the clarithromycin–hydroxychloroquine and 92 out of 98
patients finished from the placebo group (Berende et al., 2016).
At the end of the study the results showed some interesting results. By looking at the questionnaire
mean all the patients quality of life increased from the original of 31.8 to 36.4 at the end of the
treatment. Even though the scores were higher at the end of the treatment there was no significant
difference in any of the groups that were studied

Assessment of Therapeutic Effects of Subcutaneous...
Background and Objective: Neurologic literatrure about therapeutic effect of subcutaneous
corticosteroids in patients with migrainous chronic daily headache is scare. Aim of this research is
assessment of therapeutic effects of this management in the patients.
Methods: Consecutive patients with migrainous chronic daily headache in our headache clinic
enrolled a prospective before and after therapeutic study during 2010–2013. Fourty mg
Metylprednisolone was divided in four subcutaneous injection doses. Two injections were done in
right and left suboccipital area exactly at retromastoid cervicocranial junction and two injections
were performed in lower medial frontal area exactly at medial right and left eye brow limit. A
headache daily was filled out by the patient before and one month after intervention. The severity of
pain was classified based on the Pain Intensity Instrument, using a 0–to–10 point numeric rating
scale. Paired t test and Chi–square served for statistical analysis.
Results: 504 patients (378 females, 126 males) with migrainous chronic daily headache underwent
the study. Dramatic, significant, moderate and mild or no improvement constituted 28.6%, 33.3%,
23.8%, and 14.3% of the post treatment courses respectively. Therapeutic effect of intervention on
mean pain scores was significant; t=7.38, df=20, p=.000. Two cases developed subcutaneous fat
atrophy in frontal injection site and 3 cases experienced syncope during injection.
Conclusion: Subcutaneous

Assignment Questions On Mastering Competencies
Engagement Paper 3
MFT 645
Armig Yepremian
Chapter 13 in Mastering Competencies in Family Therapy by Gehart was about case
conceptualization. This is an important chapter because as growing clinicians we are going to have
to conceptualize and present cases. This chapter addresses ways of gathering background
information about the family structure, and the boundaries of the families; such as, understanding
closeness and distance, triangles in the family, and their hierarchy. This chapter reminds clinicians
how we must be culturally competent, because some communication stances, patterns, and the
hierarchy structure in the family can be culturally normal to our client. The chapter helps the
clinician identify these patterns, ... Show more content on Helpwriting.net ...
Once that information is collected, the chapter addresses how to write the information gathered as a
clinical assessment. In the article, Addressing Cultural Impasses with Rupture Resolution Strategies:
A Proposal and Recommendations by Daniel J. Gaztambide, as cited in Safran et al., (2011), rupture
is defined "as a tension or breakdown in the collaborative relationship between patient and
therapist," ranging from minor transactions that over time may impact the relationship to more
dramatic negative processes such as overt hostility (P 185). Safran and Muran (2000) call this
"rupture markers." As the name suggests, rupture markers are signals that a strain or incongruence
between client and clinician is taking place. P185. The therapist addressing ruptures requires
knowledge to be able to draw attention to the here–and–now transaction between patient and
therapist, emphasizing an intensive exploration and negotiation of each participant's contribution to
the interaction. Being mindful of the power imbalance inherent in the therapeutic relationship, the
therapist grounds their intervention in an awareness of their feelings in the moment, addressing his
or her contribution to the impasse and accepting responsibility. Such recognition of the therapist's
ability to make mistakes empowers the patient by validating the reality of their experience.cP.185.
Rupture resolution strategies promote treatment by placing a focus on addressing ruptures as

The Powerful Placebo: From Ancient Priest To Modern Physician
The history of the placebo
The placebo, though unknown at the time, has been a fundamental part of medicine since antiquity.
Simply put by Shapiro and Shapiro (who are considered influential writers in placebo research), "the
history of the placebo is the history of medical practice itself, until modern times". (Shapiro &
Shapiro, 1997) In their book, 'The Powerful Placebo: From Ancient Priest to Modern Physician',
there is an extensive list of ancient medicine medicaments and procedures all of which would now
be deemed bizarre and inexplicable. For example, medicines included parts of frogs and scorpions,
the flesh of vipers and grated skull. It must be remembered that the eccentricity of these treatments
is accounted for by the lack of ... Show more content on Helpwriting.net ...
This is the phenomenon known as the placebo effect. (Benedetti, 2009)
However, it has only been in the last century, due to the rise of evidence–based medicine, that we
have identified the placebo.
What is the placebo and the placebo effect?
The definition of the placebo and placebo effect is disputed but according to Shapiro and Morris,
who wrote an extensive dissertation on the placebo:
"A placebo is defined as any therapy or component of therapy used for its nonspecific,
psychological, or psychophysiological effect, or that it is used for its presumed specific effect, but is
without specific activity for the condition being treated." (Shapiro & Morris, 1978) "A placebo
effect is defined as the psychological or psychophysiological effect produced by placebos." (Shapiro
& Morris, 1978)
Shapiro and Morris' definition is widely accepted and quoted, to words of similar effect, in other
journals and books (for example 'Placebo interventions, placebo effects and clinical practice').
Shapiro & Morris then differentiate pure placebos which they describe as 'treatments that are devoid
of active, specific components' from impure placebos, which 'contain non–placebo components'. A
profound definition would be as follows, "Impure placebos are substances, interventions or
'therapeutic' methods which have known pharmacological, clinical or physical value for some
ailments but lack specific therapeutic effects or value for the condition for which they have been

Ontological And Epistemological Debate About The Nature Of...
Ontological and Epistemological debates about the nature of the therapeutic relationship.
'Existence' and 'Relationship'. Can these two concepts exist independently of each other without the
presence of the one to be necessary for the presence of the other? Is it possible for anything to exist
without being related to anything else nor being perceptible by touch? Is it possible for something to
exist if it cannot be described nor being visually present, even though it brings out strong feelings
and a sense of connection?
Epistemologically, everything we see (people, objects, etc.) exists only in relationship to something
else.
As Cottone (1988,363) mentions, relationship is what we are born from, nurtured by and getting
educated from. Our existence is defined within the domain of the society, and it is within society
where we interact with others, socialise and satisfy our biological needs. ... Show more content on
Helpwriting.net ...
From the ancient years, the relationship between two people has healing properties and is the main
influence for changes in people's lives.
Especially, in counselling and psychotherapy, the relationship between client and counsellor is the
most significant part of the therapeutic procedure. Many studies (Buborsky et al. 1983, O' Maley et
al. 1983, Hill 1989) illustrate that it is the therapeutic relationship more that any other factor, which
determines the effectiveness of counselling therapy. Moreover, literature which reviews the way, in
which clients experience the therapeutic process, indicates that the many of the client's thoughts and
feelings remain unspoken during the counselling sessions. (Dinnage, 1988, Mearns and Dryden,

Analysis Of A Counselling Session Using A Case...
Analysis of a Counselling Session using a Case Conceptualisation and Drop–out Risk.
Counselling has one aim: to help the client. This is a simple aim however it is often difficult to put
into effect, this was experienced first–hand in the practice therapy session. Counselling encourages
individuals to develop a self–awareness and enables them to make changes in their lives (Cross,
2010). The use of micro–skills is essential in any counselling session as it ensures that the client
feels heard and understood and the use of the skills impacts the strength of the therapeutic
relationship (Geldard and Geldard, 2005; Lambert & Barley, 2001). The following will outline a
summary of the session as well as the clients presenting problems and my aims when approaching
this particular session. The video will then be analysed in relation to the micro–skills that were
displayed or were attempted, the essay will then outline a case conceptualisation in regards to this
particular client and the factors that may influence them to prematurely discontinue with the therapy
sessions.
Elham, The client, was a 21 year old Lebanese–Australian female who was feeling stressed and
anxious about university, she had an upcoming surgery and was worried about how this would
impact her university work. She was also trying to maintain her work and home life. She discussed
the importance of her family and how they gave her support and strength to carry on, she also
discusses her coping strategies as

Therapeutic Hypothermia: Preventing Damage After Cardiac...
Introduction Hypothermia protocol for the post cardiac arrest patient has been an evidence based
practice of this therapy for about a decade now. This intervention, often used in the critical care
setting, is now expanding to primary emergency responders as well. This paper will present some of
the notable research that has been done on therapeutic hypothermia, and current use of this
intervention. Control studies, animal studies, and case studies have been published related to these
medical interventions. Unfortunately, there are still many healthcare providers not using this
intervention. Dainty, Scales, Brooks, Needham, Dorian, Ferguson et al. (2011) study states,
"observational research shows that therapeutic hypothermia is ... Show more content on
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Reperfusion injury is the harmful adverse effects attributed to reestablished circulation (Writing
Group et al., 2003). Hypothermia inhibits or reduces normal body functions such as apoptosis and
inflammation, and these can often cause additional damage (Torgersen, Bjelland, Klepstad, Kvale,
Soreide et al., 2010). Also, by cooling the body to the designated range the metabolic rate slows
down and decreases oxygen demand. This allows tissue to avoid ischemia, in particular the brain
and heart. The brain is protected in many ways including preserving the blood brain barrier and
decreasing harmful free radicals (Wall, 2011). More recent studies done on animals have been
performed in order to manipulate the variables associated with the hypothermia protocol in attempt
to solidify the most effective treatment. Although animal studies allow for a more precise scientific
method and yield important information, they are not guaranteed to be identical in a human patient.
One study involved pigs that underwent a mechanically induced 100% occlusion of the LAD. The
results suggested that only early–induced hypothermia, prior to reperfusion, yield a decreased infarct
size. Also hypothermia, regardless of onset time related to reperfusion decreased microvascular
obstruction. In addition, the study utilized IV cold saline to achieve a more rapid cooling. The pigs,
about 50kg, reached less than 35 degrees Celsius in 5 minutes. The usual time for humans to cool
using

Pharmacological Intervention Assignment : Patient X
The situation that was chosen for this pharmacological intervention assignment is the case of Patient
X, a 35 year–old male with a history of recurrent sigmoid diverticulitis who has opted for elective
laparoscopic sigmoid hemicolectomy. In conjunction with his surgery, he will be starting a regimen
of alvimopan (Entereg) to prevent the development of postoperative ileus. His situation fits into the
perioperative clinical focus of nursing practice because the dosing recommendations for alvimopan
include beginning the first dose preoperatively, 30 minutes to 5 hours prior to surgery (Erwele,
2008). This assignment will include an assessment of the patient, the establishment of a broad
behavioral outcome and specific behavioral objectives ... Show more content on Helpwriting.net ...
Because of the significant interference these recurrent episodes are having on his life, and with
understanding of the risks, benefits and alternatives of the procedure, he has consented to proceed
with laparoscopic sigmoid colectomy, including a pharmacological regimen of alvimopan. Common
adverse effects of alvimopan include nausea, vomiting and abdominal distention (Erowele, 2008).
Preoperatively, he denies nausea and vomiting, and his abdomen is soft and mildly tender in the left
lower quadrant. Per his laboratory studies, Patient X has normal hepatic and renal function. He is
not obstructed and is not taking opioids for analgesia. Though he is able to perform his activities of
daily life independently, the fact that alvimopan is only available to patients who are hospitalized
dictates that, per Orem's Theory of Self–Care, he has a self–care deficit that can be met by the
supportive–educative nursing system (Necor, 2014). Broad Outcomes
By the end of a 20–minute teaching session, Patient X will be able to describe why he is being
prescribed alvimopan, the potential side effects, and what he can do to minimize the impact of
potential adverse effects.
Specific Objectives
Objective One: By the end of a 20–minute teaching session, Patient X will be able to express the
outcome he hopes for from his

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