Best Therapy Method for Couples

Running head: RESEARCH PROPOSAL ON COUPLES
COUNSELING
RESEARCH PROPOSAL ON COUPLES COUNSELING
5
Research Proposal on Couples Counseling
Social Work Practice Research I (SOCW - 6301 - 3)
Introduction
This research proposal is about undertaking research to find the
best therapy method for couples between individual, group, and
couples therapy. The proposal will detail the findings of past
researchers and will occasionally focus on the therapy methods
in the context of a couple that is experiencing conflict mainly
based on the rejection of their same-sex marriage by their
respective families. It will also detail the methodologies used
by other researchers in investigating the therapy methods. The
study will reveal the most recommended therapy method and the
variations of the method.
Research Problem and Question
Many couples quarrel because their respective families reject

their union or relationship or marriage. Most of the affected
couples are those whose respective families are deeply divided
on the basis of religion, race/ethnicity and socio-economic
status. However, some families just oppose relationships
because they threaten their traditions, which are mostly rooted
on religion. Some families oppose gay or lesbian relationships
or marriages. Even when a family member reveals that he or she
may attracted to a member of the opposite sex, the other family
members may rise up against that family member. It may make
teenagers and young adults hide about their sexual orientation.
The stigmatization may be too unbearable for the affected
individuals, who may choose to go into seclusion and engage in
suicidal actions. There are couples like Kathleen and Lisa who
courageously seek the help of therapists. Upon setting a stage
for positive development, couples can ease the tension in the
mind. They can open up to people and feel ready to solve
problems together. The question that comes in mind in light of
these facts is: What it the true impact of sexual orientation-
based rejection by family members on a relationship? How can a
social worker help couples overcome sexual orientation-based
rejection by family members on a relationship? The research
question of the study is: which between individual, group, and
couples therapy is the best therapy method for couples?
Literature Review on Individual, Group, and Couples Therapy
The therapeutic alliance concept is mainly associated
with individual psychotherapy, particularly in literature. Yet,
the concept is increasingly used together within the marital and
family therapy domains. According to Pinsof and Catherall
(1986), “a systemic perspective is brought to bear on the
concept within individual psychotherapy. A new, integrative
definition of the alliance is presented that conceptualizes
individual, couple and family therapy as occurring within the
same systemic framework”. The authors examined family,
couple and individual therapy and used some methodologies and
developed scales to determine their effectiveness. They found
out that a therapeutic alliance is the most effective therapy

method for couples. The authors knew that most people
traditionally relied on individual psychotherapy. Indeed, many
couples previously got counseled in different sections.
According to Anker, Duncan and Sparks (2009), the best type of
therapy is couple therapy, but it has to be based on feedback.
Thus, it is patient-focused research whereby continuous
progress feedback enhances outcomes and helps address various
problems. The authors knew that feedback had been found to
improve individual psychotherapy outcomes and wanted to find
out whether it could improve outcomes in couple therapy.
However, they knew that couple therapy is more effective than
individual therapy. Focusing on 410 subjects, they randomly
them into either one of the two groups. They found that couples
in the feedback condition showed significantly greater
improvement than those without feedback condition.
According to Synder, Castellani and Whitsman (2005), several
methodologies to couple treatment reveal clinically and
statistically substantial improvement for a significant amount of
couples in decreasing overall relationship distress. Findings
also indicate that the success of couple-based interventions for
all types of problems for one or both partners. However, some
studies show that couples do not obtain noteworthy gains from
couple’s therapy or experience substantial decline post therapy.
The authors conducted studies and compared women and men
participation rates and outcomes. They found that the
therapeutic alliance could be used to determine treatment
progress on individual and relationship variables in the
beginning and midway phases of couple’s treatment. Women’s
alliance in the mid-treatment phase uniquely predicted marital
distress improvement when compared to the early treatment
alliance. Male bonds with the therapists were very strong in
various areas. However, couples showed more improvement in
marital distress.
According to Heitler (2016), there are major differences
between individual, group, and couples therapy. Individual
therapy focuses on the development of a one-to-one relationship

with the therapist which can take on many facets based on the
therapist’s and mostly involves creation of an accepting
atmosphere where techniques are used to reduce symptoms and
for personal development. Couples therapy focuses on
improving the communication pattern within the couple. The
therapist knows more directly their way of life. He or she
determines their habits and routines during session. The
therapist analyzes and offers feedback about the interactions
and makes suggestions. The method is more intensive than
individual therapy. Group therapy involves the dynamic
interaction group members and the main aim is to have
individuals understand the projection they have toward other
members. They learn from the feedback the other people and the
therapist provide.
Heitler (2016) provides the advantages and the disadvantages of
various therapy methods. The advantages of individual therapy
include: the client can say anything to the therapist and he or
she won’t be judged. Assuming that the client involved is
embroidered in a conflict with the same-sex spouse, the client
can get many benefits in individual therapy. The attention of the
therapist is on one person and finding answers is quicker and
easier than in other approaches. The client gets an opportunity
to reflect on their life. The client gets support, feedback from
the therapist and these can help understand the situation. The
client can get some clarification about the situation. The client
can make suggestions on how to improve their own situation.
Couples therapy is more appropriate to situations where the
couples keep fighting many times and increasingly accuse each
other. The aim of the therapist is to improve the communication
of their needs by providing them with a list of things they
should do between sessions (Christensen, 2004). However,
couples may individually feel that they are being challenged by
the therapist in a similar way as with the spouse. Group therapy
is vital to families that find themselves in conflict because of
various issues. It may involve spouses and children, or spouses
and the extended family. In the case involving parents who are

opposed to a same-sex marriage involving their child, group
therapy can help them understand their roles in the lives of their
children (Norcross & Lambert, 2011).
There are many factors to think about when selecting the kind
of therapy one should seek. For example, the costs for each are
different. Individual therapy is typically more expensive than
group therapy but more costly than couples therapy. The level
of willingness to involve other parties also plays a huge role.
Some people may feel the urge to do a “combined couples
therapy” which involves attending sessions as partners and also
having occasional individual therapy sessions for one or both
spouses (Liz & Strauss, 2005). The aim of having such a method
is to maximize the benefits of both individual therapy and
couples therapy. However, the method can be criticized for
encouraging one or both spouses to voice ideas, particularly
during individual therapy and encouraging them to listen more -
in couple’s therapy.
Current Research Methodology
The current research will be a survey where couples who have
been in individual therapy, couples therapy and group therapy
will be interviewed and asked to fill a questionnaire. A target of
about 21 couples would be adequate. It would be better to
ensure that the groups are equal in the number of couples.
However, the groups do not have to be equitably represented.
Statistical computations and comparisons of percentages can
help determine whether or not different study factors are
statistically significant (Yegidis, Weinbach, & Myers, 2012).
The aim is to find how couples responded to the three different
kinds of therapy methods. The study subjects will be asked to
rate different treatment methods used within their therapy
approach. According to Plummer, Makris and Brocksen (2014),
data collected when comparing treatment methods can help
suitability of those methods for general and specific
populations.
The current study addresses a gap in existing knowledge. While
the literature review largely reinstates the findings of various

researchers, the current study will help determine the most
effective therapy approach that also facilitates the effectiveness
of treatment methods. The study will help determine the
effectiveness of the variations of couple’s therapy such as the
combined couple’s therapy approach. It will help determine
whether or not some spouses could require individual therapy
while waiting to undergo couples or group therapy.
References
Anker, M. G., Duncan, B. L., & Sparks, J. A. (2009). Using
client feedback to improve couple therapy outcomes: A
randomized clinical trial in a naturalistic setting. Journal of
Consulting and Clinical Psychology, 77(4), 693-704.
Christensen, A. (2004). Traditional Versus Integrative
Behavioral Couple Therapy for Significantly and Chronically
Distressed Married Couples. Journal of Consulting and Clinical
Counselling, 72(2), 176-191.
Heitler, S. (2016). Prescriptions Without Pills: For Relief from
Depression, Anger, Anxiety, and More. New York: Morgan
James Publishing.
Liz, T. d., & Strauss, B. (2005). Differential efficacy of group
and individual/couple psychotherapy with infertile patients.
Human Reproduction, 20(5), 1324-1332.
Norcross, J. C., & Lambert, M. J. (2011). Psychotherapy
relationships that work II. Psychotherapy, 48(1), 4-8.
Pinsof, W. M., & Catherall, D. R. (1986). The Integrative

Psychotherapy Alliance: Family, Couple And Individual
Therapy Scale. Journal of Marital and Family Therapy, 12(2),
137–151.
Plummer, S. B., Makris, S., & Brocksen, S. M. (2014). Social
work case studies: Foundation year. Baltimore, MD: Laureate
International Universities Publishing.
Snyder, D. K., Castellani, A. M., & Whisman, M. A. (2005).
Current Status and Future Directions in Couple Therapy. Annual
Review of Psychology, 57, 317-344.
Yegidis, B. L., Weinbach, R. W., & Myers, L. L. (2012).
Research methods for social workers . Upper Saddle River, NJ:
Allyn & Bacon.
WAL_NURS6221_06_A_EN-DL.mp3
1926057.8

“Performance Management”
Program Transcript
[MUSIC PLAYING]
MODERATOR: Let's talk about some of the structure to
managing people, a bit
about performance management, some of the dos and don'ts in
counseling and
in doing performance appraisals.
REBECCA F. CADY: Yes.
PAULET GREEN: You know, the thing that I find to be so
interesting about
performance appraisals is so many staff look at it as a negative
experience.
REBECCA F. CADY: Right.
PAULET GREEN: And I think that the tone that is set in the
performance
appraisal is the very first thing. A performance appraisal is not
supposed to be a
one-time--
MODERATOR: Absolutely.
PAULET GREEN: --thing. It is supposed to be an ongoing
process where staff

are consistently receiving feedback on a regular basis.
Documentation needs to
occur. Anecdotal note-taking is so very important so that as
situations occur, you
have an opportunity to document. As a manager, I know that
one of the things
that I do is as I document,
I try to categorize based on performance issues, so if an issue is
occurring, I
would label it under attendance or under whether or not they're
competently
fulfilling, so that when the time comes for an action to be taken,
if it's necessary
to get there, the number of anecdotal notes that you've taken
along the way
actually now make a comprehensive picture related to a
performance issue that
then can be addressed as we move forth.
MODERATOR: Absolutely. And one key tip about
documentation is I always
recommend that the manager review their notes with the
employee and everyone
sign them, at least that they were reviewed. Far too often do I
see some of those
notes coming forward in a case and the employee is shocked.
They've never
seen them. This evaluation was never done. They never knew
that the manager
was recording some of these things or that it was an important
aspect of their
performance.
REBECCA F. CADY: Right. And in terms of legal ramifications
of this process,

obviously you don't want someone to be surprised about what
you're telling them
© 2012 Laureate Education, Inc. 1
in a performance evaluation. And so I think your point about
this is an ongoing
process and it's not a once-a-year thing, that's so important.
Because if you have
someone who does feel surprised, well, then they're more likely
to take action if
they feel like they've been wronged.

MODERATOR: Unfair!
REBECCA F. CADY: Right. And many times a person who's
suing will get into
court or into a deposition situation and claim that they never
saw various
documents. And so I think that the suggestion to have the
employee cosign the
supervisor's notes, especially when counseling is taking place,
is very important,
because the person cannot then go back and say, well, I wasn't
aware of this, I
was blindsided, this wasn't fair, I wasn't given a chance to
correct these issues.
So I do think that's an important piece of the puzzle.
MODERATOR: One very good tool to use is a record of
conversation, just a one
page. Label it that way. Doesn't have to be disciplinary or
negative. And just to
take notes on it, and then both people just sign it and date it
when they complete.
What's your commitment to this issue? How are we going to
solve this behavior
or solve this problem?
PAULET GREEN: Another emphasis that I like to make with
performance
appraisals is, as we talked about before, that it doesn't have to
be a negative
process, because it really is growth oriented. It's supposed to be
focused on how
we can identify your strengths, but also the areas of needed
improvement and
how we can help you to strategize in order to be a better

performer. And one of
the ways that we've done that is that we do self-evaluations.
We have the employee, when they enter the performance
appraisal interview, so
to speak, they have a copy of the same document that we would
be using and
submitting, and they do a self-evaluation. It's really very
interesting, because
when we first started this process, we found that a lot of times
previous
managers just went through and did like fours and fives. Our
scales are one
through five, one needing the most improvement and five being
a very good
performance. Ofttimes, we found that the records we got weren't
necessarily
reflective of the employee's performance that we saw.
PAULET GREEN: And so in doing the self-evaluation with the
employee, plus
our evaluation, it did two things. The first is that it created a
discussion, because
the employee had one perspective, sometimes we had a different
perspective,
and you have to talk about where that came from and how you
justified the
scores that you gave. As a manager, one of the things that I
always made sure I
did was to give specific examples.

It was really important if I gave a four that I could justify why.
And as we had
those discussions, we oft found that employees, especially when
you gave them
specific examples, they were much more likely to say, OK, well,
maybe I'm not a
four, maybe I am a three. But then the other positive part of that
is that we
wouldn't just leave it there. We could move on to start
identifying what are some
of the strategies that we could use to help move you to being a
four or a five
performer.

MODERATOR: I think the key to fair performance appraisals is
to be consistent
in applying similar forms and similar standards to similar jobs,
and to be honest in
your feedback, and to be job related. Avoid those judgmental or
very general
terms-- she's a nice person.
MODERATOR: Or you're seen as rude. You have to give
examples, as you said,
as to what are the behaviors that are job related that are
problematic. Managers
who spend very little time in performance management may do
a very quick,
superficial performance appraisal, typically do it a little higher
than what's true,
and at the staff who don't know what to improve.
PAULET GREEN: That's the situation that we found. We had a
staff member who
there were some significant-- she was probably, I would say, an
average
employee, but there were also some areas where there were
some significant
performance issues. But because she had always been given
fives and fours,
she did not see them. And it wasn't until we did those self-
evaluations, with our
evaluations, had an opportunity to start having the discussion,
she said, how
come before I was getting my fours and fives and all of a
sudden--

REBECCA F. CADY: Right. I haven't changed what I'm doing
and now you're
telling me I'm not so great as I thought I was.
PAULET GREEN: That's right. But, again, I think the tone was
set that this really
isn't about punishing you. It's really not about being critical. It's
about trying to
move you to be the best person that you can be in your job. How
can we do this?
These are the specific examples that I can provide for you that I
have observed
with you functioning at levels that may not be reflective of a
four or five, but what
can we do? Like you said, have her give the suggestions what
can we do to get
you to that place. And it ended up being a very positive
experience because the
employee did improve over time.
MODERATOR: And many leaders don't know what to say or
how to say it. Or
they see behaviors, they're not sure how it ties to the job. They
just know they
don't like what they see. One of the things they can do is bring
that pattern or that
picture to their Human Resource partner and help them lay that
out. It is much
better to do that early than to do it when it's a full-blown
problem.

REBECCA F. CADY: Right. And I would also hope that built
into the facility's
evaluation program is that the managers need to be evaluated on
how they're
doing in providing feedback to the employees.
PAULET GREEN: Right. Absolutely.
REBECCA F. CADY: Because otherwise they'd miss
opportunities for their own
growth.
PAULET GREEN: Yes.

MODERATOR: Well, if we're working with employees and
we're working on
improving that behavior, there are some that just don't make
that step. And then
we have to deal with discipline. Let's talk about some of the
possible pitfalls in
doing disciplinary actions, and actually even leading up to
termination. But let's
deal with discipline for corrective purposes first.
PAULET GREEN: I think the tone we set is very important.
And the term that I
like to use is "corrective action," because the term speaks for
itself, that this is a
process where it allows us an opportunity to correct something.
And so I think
that once the employee knows that, again, it takes away some of
the resistance
or the fear that ofttimes is related to that disciplinary process.
MODERATOR: In the discipline process, I think most
employers look at providing
some due process to the individual when there is an incident
that occurs or when
there is poor performance. Can you give us some insight into
that due process
that we may want to do?
REBECCA F. CADY: Just as a matter of good business practice,
and in terms of
staff development and retention, you want to obviously have a
process whereby
if an employee has a real legitimate disagreement with the way
they've been
evaluated or things that they're being expected to correct-- I
mean, there may be

a disconnect between the manager and the employee. The
manager may not be
great at giving feedback. There may be some kind of personality
issues going on.
The employee has to have some kind of recourse.
And it's just a matter of good business practice and good staff
retention. The
employee should be able to address that. And the hospital
policies should allow
for some sort of oversight of the line manager's decisions and
counseling by
either the manager of the department or the director of nursing,
usually in a step-
wise fashion. And that will be one of the things that will be
looked at if an
employee has grievances and they end up going to court over it,
is what was the
hospital's policies and procedures for dealing with this
internally?
MODERATOR: And was it followed?

PAULET GREEN: Yes.
REBECCA F. CADY: And was it fair? And obviously if you
have union nurses
involved, that's sort of a whole different ball of wax. The
disciplinary measures
and the way that process is laid out is all part of the agreement
with the union.
And that's something that definitely you want to make sure that
Human
Resources is involved in, because those rules are very specific,
and if you run
afoul of them, it can be a big headache for everyone involved.
So those were the
two things that I would want people to be aware of.
MODERATOR: You know, if you have a public employer, due
process can even
be broader. It could be that the employees have a right to know
how they're
doing.

MODERATOR: And have a right to state their side of the story
before any action
is taken.
PAULET GREEN: Yes.
REBECCA F. CADY: Absolutely. And that's why there's
feedback and the give
and take. I don't think evaluations should ever be a one-sided
process.
PAULET GREEN: No. No.
REBECCA F. CADY: And ideally they're not. I think the self-
evaluations are very,
very effective for getting people to buy it. And I think
sometimes employees are
surprised, that they may rate themselves lower in an area than
perhaps their
managers.
MODERATOR: That's right.
REBECCA F. CADY: Perceptions are very different.
Everything's relative. And so
I think it's very, very helpful in fostering a good environment of
communication,
which really spills over into so much other things with health
care nowadays--
patient quality care, the way health care providers interact. And
I think it's
important to set the tone in terms of the employment
environment, that we're

going to treat you fairly and with respect, and these are the
things we expect of
you in return.
PAULET GREEN: And having that appeal offers that check and
that balance
that's needed in the system.
REBECCA F. CADY: That's true.

PAULET GREEN: Absolutely. And even as the manager, it also
helps you to
understand that you need to have all your T's crossed and your
I's dotted,
because if not, you could actually have a legitimate evaluation,
but because you
don't have the documentation to support it, you're not able to
support it under
appeal conditions.
REBECCA F. CADY: Exactly.
MODERATOR: Some key things that managers should consider
before taking
some form of discipline? I'd put the first one out there, to be
timely.
REBECCA F. CADY: Right. Very important.
MODERATOR: Factual.
PAULET GREEN: Yup.
REBECCA F. CADY: And I would also say if the potential
disciplinary action is
related to something that might be impacted by the Americans
with Disabilities
Act or one of these other laws that we've discussed already, that
that red flag
would need to go up and Human Resources would really need to
be contacted in
terms of, I have a situation developing here, and it involves--
maybe it's an
absenteeism issue. Or maybe it's a questioning whether the
person is still

capable of actually performing the essential job functions. And
those things can
arise as disease processes develop in an individual. Things may
change. Their
accommodations that they require may change. And so I would
be very careful if
that was the scenario to make sure to consult Human Resources
before anything
was done.
MODERATOR: Our managers typically call and talk about a
situation, and then
say, I'm thinking of doing a corrective action or a suspension or
even a
termination. Do you think that's the right step? And then we get
into a discussion
about are they prepared to go to the step that they're getting to.
REBECCA F. CADY: Right. And the other thing to keep in
mind is that all of this
process really is confidential. It's for the use of people within
the hospital for
conducting the business of caring for patients in a safe and legal
manner. And
this is obviously not stuff that managers should be discussing
with one another in
the elevator. It's important to keep that in mind, because if that
confidentiality is
breached, the employee may, in fact, have a cause of action
against the hospital.
MODERATOR: I'd take that even a step further. We ask that all
the original
documents come to Human Resources. Managers can keep
copies in their file,
but I prefer to have the original. And the reason for that is I

have been in far too
many situations where the manager says, oh, I'm ready to
terminate, we have
done warnings, we have done suspensions, we've done
everything right. There is
nothing in their file. And so I say to them, well, produce what
you've done, and let
me look at it before we make a decision. Well, I get a call the
next day, my file is
missing. I don't know what happened. It was in my office.

MODERATOR: Did you have it locked? Well, maybe not. And
so things
mysteriously disappear at times. And all the reason to have your
originals in safe
keeping.
PAULET GREEN: Yes.
REBECCA F. CADY: Definitely a good point.
MODERATOR: We were talking about performance
management, and handling
difficult performance issues, and the forms of taking discipline
of different types--
written warnings, suspensions, or even terminations. But there
are times where
an acute situation occurs. It's a crisis because there's a theft, or
an alleged
abuse, or a complaint of sexual harassment, or a drug diversion-
- a number of
things that are one-time events, hopefully. Let's talk about how
we may want to
handle that and some advice to our managers.
PAULET GREEN: I think it's really important for managers,
again, to be very
aware of what's going on on their units with their staff. And that
when these
things are identified, that they're addressed early with HR. And
that there's a
system set up that if these crises occur and the manager is not
on the unit, that
there's a system set up where the manager is notified in a very

timely manner so
that she can start the ball rolling and whatever needs to be done
in order to be
able to adjust the situation.
MODERATOR: My advice is to not take any of those situations
lightly.
REBECCA F. CADY: Absolutely.
MODERATOR: Immediately, those kinds of issues need to
bubble to the top of
the priority list and an investigation needs to begin.
REBECCA F. CADY: Absolutely. And from a legal standpoint,
obviously the first
priority in that situation is to make sure that the patient is safe
and taken care of
and that the appropriate people are notified in terms of the risk
manager. If we're
talking about patient abuse, or even if someone's discovered
using narcotics on
the job, that can obviously have potential huge legal
ramifications for the facility.
And so in that situation, patient safety has to be one of the top
considerations.

MODERATOR: Title VII of the Civil Rights Act gives the
employees the right to
work in an environment free of harassment, ridicule, insults.
Let's talk about the
difference between hostile work environment and sexual
harassment.
REBECCA F. CADY: Okay. There are two things that are
covered here. Hostile
environment is things such as bullying, either racial or cultural
putdowns,
basically what we would call as bad playground behavior and
not playing well
with other children, anything that would be offensive to
somebody based on their
race, or their national origin, their skin color, their gender, that
type of thing.
And sexual harassment can also fall into a hostile work
environment. The classic

example of that is the girlie magazines in the locker room or the
posters, the
revealing-poster s-in-the-locker-room type of thing. And that's
prohibited, as well
as frank, outright-- what's called quid pro quo harassment,
which is basically you
will allow me to touch you or do things to you or you will lose
your job or you will
get poor evaluations.
MODERATOR: Or not a promotion?
REBECCA F. CADY: Right, or not a promotion. And so those
are the two sort of
flavors that that comes in. And the hospital's obviously liable
for any of those
activities that occur under its roof. If the harasser is a
supervisor, potentially the
supervisor could be held personally liable for those actions.
But, generally
speaking, when the harasser is a co-worker, while the facility
would be on the
hook for that or liable, the individual co-worker would not
necessarily be subject
to a civil suit regarding that behavior.
So it's something to keep in mind. And obviously all facilities
have policies that
prohibit this kind of behavior. And it's very important that
facilities consider having
specific, very clear protocols laid out for disciplining
employees when the issues
involved are implicated by Title VII.
PAULET GREEN: And the other issue, as you're discussing
again, is coming

back to knowledge-- educating the staff, having those in-
services where you
have individuals coming in and letting them know exactly what
is appropriate and
what may not be appropriate and about the different parameters
of their
behavior.
REBECCA F. CADY: Exactly. And in terms of the bullying and
harassing kind of
behavior that doesn't really have to do with sexual issues, again
it comes back to
that manager. Is the manager supporting his or her staff if a
doctor is being
nasty? That's very important. And that also spills over into
patient safety issues.
It's a big thing we're seeing lately. So these issues are multi-
faceted and they're
complicated. And, again, the manager doesn't need to feel like
it's all on his or
her shoulders. Human Resources--

MODERATOR: Or embarrassed to bring it up.
REBECCA F. CADY: Right. Because it's really the right thing
to do. You can't
stand by and let this happen on your unit, because you will be
held responsible,
both by the facility, and the nursing board will probably be
taking a look at it as
well if you're not taking care of these issues. You're still
practicing nursing even
though you are acting as a unit manager. And so the board of
nursing is going to
want to look at that, if something really blows up.
MODERATOR: Today, with the internet, I'm seeing staff, like
on nights, slow
times, surfing porn sites at work. That has not been an
uncommon situation. And
in the example I'm thinking of, the staff knew that that was
happening, and
probably a few of them had said something to a charge nurse, or
a charger nurse
had observed it. So then leadership had knowledge.

MODERATOR: And at the point leadership has knowledge, they
have a
responsibility to do an action--
MODERATOR: --to remedy the situation, not to ignore it and
hope that it will go
way.
PAULET GREEN: Absolutely. And, again, you go down to that
being a
performance issue, because is that what a staff member is being
paid to do? And
so, again, it's dealing with the situation based on the
performance issues and
documenting accordingly.
REBECCA F. CADY: Very true.
MODERATOR: When a complaint comes up, my
recommendation is, number
one, call Human Resources immediately, because most
managers don't know
what to do-- someone called someone a name, someone said a
bad joke, they're
dealing with pornography, whatever the situation is. Human
Resource has
trained professionals to do the investigation. We usually do not
turn it back to the
manager to investigate the facts. Human Resources will
interview the accuser--
interview the complainant first and then the accuser and the
witnesses, to try to
determine whether the situation even occurred--

PAULET GREEN: Ah-hum.
MODERATOR: --whether it occurred but there was nothing
wrong, whether it
occurred and it was very inappropriate, or many times whether
we can even tell if
anything came up. So many investigations turn out to be--
REBECCA F. CADY: He said, she said.

REBECCA F. CADY: But it's also important that this process
be, again,
confidential, and that people who are interviewed understand
that they're not to
be going around talking about the process or what happened, or
the fact that
they gave an interview and what they said. If the matter gets
into litigation, all of
that is potentially discoverable. And it's often better just to keep
one's own
counsel in these matters, because the more you say, the greater
potential there
is that you're saying something that's--
MODERATOR: Inappropriate.
REBECCA F. CADY: --either inappropriate or that's going to
reflect poorly on
you. And it's probably better just to let the process proceed
within the parameters
that are set up by the facility. It really should not be a subject
of lunchroom
conversation at all.
MODERATOR: How about dealing with how the EEOC looks at
some of these
types of comments? How many times, how pervasive do
comments need to be,
before the Equal Employment Opportunity Commission looks at
it as really an
offense?
REBECCA F. CADY: Well, the difficult thing with this is it
kind of depends on

each situation. There's no real cookie-cutter approach to it
because each
individual is different. Some people become upset very easily
and some people
don't. Certain things-- obviously, the quid pro quo, sexual
harassment issue is
very across the board.
MODERATOR: Very obvious.
REBECCA F. CADY: And the other thing it's important to bring
up, if for whatever
reason the employee initially went along with it.
MODERATOR: Or dated, they were dating?
REBECCA F. CADY: Right. Or they were dating, or there was
some kind of real
personal relationship. It's very important for the protections of
the Act to be
triggered, the employee has to say, I want this to stop, it needs
to stop, and if it
doesn't, then I'm going to consider this to be a harassing
environment. And so
that really has to occur, and people need to be aware of that,
because

sometimes those situations happen, if a doctor and a nurse are
dating or
whatever.
Once it turns from good to bad, the employee has to make a
statement. If they've
participated in it voluntarily or consensually up in to a certain
point, then they
have to basically run the flag up the pole to say, OK, this isn't
all right anymore. I
wanted the relationship to end, this person is not letting go of it,
and that gets into
a sort of a whole other Human Resources issue of people dating.
But it's
important for the Act to be triggered, that if there was a
previous relationship, that
the employee has to say, OK, I need it to stop now.

MODERATOR: Now. What we see most often is employees who
are unwilling,
unable to have that conversation. And in those circumstances,
we will facilitate
that discussion or be a witness in the room--
MODERATOR: --when that type of a discussion is occurring.
REBECCA F. CADY: It can be very uncomfortable. And
oftentimes there's
obviously a disparity in power between the two parties
involved, and if the party
who wants the behavior to stop is afraid, which is often the
case--
REBECCA F. CADY: They are embarrassed. They feel like
they've done
something to bring it upon themselves. And it's very important
that, A, the
manager knows about it, and B, that the people in Human
Resources become
involved, again because this is what they do for a living.
They're the experts at
sort of helping people get along, and they can provide that
support and backup
for the person. Really, the hospital has to do that.
MODERATOR: Has to do that.
PAULET GREEN: And I know we've talked about it again, but
this is just another
point that I'd like to emphasize it, where it is so important,

because these things
are very uncomfortable to talk about. They're very
uncomfortable to deal with.
And so, again, it's really important that the manager is aware of
her own fears or
anxieties or level of discomfort in relation to these areas,
because ofttimes she is
the front, the individual that has the ability to be able to take it
to Human
Resource and intervene on behalf of the employee.
REBECCA F. CADY: Very important.
MODERATOR: Let's talk-- wind this up a little bit-- about that
unsatisfactory
employee that we have to terminate, whether it's performance
that we've been

counseling all along that hasn't turned around or one of these
situations that's
very serious and the manager makes a decision to terminate for
theft or
harassment or whatever. Some tips that you've learned over the
years about
terminating employees?
PAULET GREEN: I think, again, consistency in documentation,
consistency in
the feedback that you have given, so that if it's not a crisis
situation, that there's
been some egregious behavior that in and of itself is grounds for
termination, if it
has been an ongoing performance-based issue, that that
feedback has been
given to the employee on an ongoing basis so that it's not a
surprise.
I do have to say, though, that I can't remember ever sitting in a-
- no matter how
positive you try to make those situations, that it's ever a good
feeling. And we've
oftentimes had situations where employees have refused to sign
the document
because, again, it's just one way, I think, oftentimes employees
feel that if they
don't sign it, that it doesn't make it valid or legal.

REBECCA F. CADY: It doesn't exist.
MODERATOR: That's right.
PAULET GREEN: But it is knowing that, again, in a situation
like that, what we've
done is to document that the employee has refused to sign it.
And in cases
where we know that it's going to be an uncomfortable situation,
we've sometimes
had HR sit in, or as an observer, to witness the process. So,
again, we have
another objective person to be able to speak to the process that
occurred in the
room.
MODERATOR: We sit in a lot of those meetings, sometimes to
facilitate it,
because the manager is too shook up or doesn't have the
confidence. Maybe
they're brand new and it's their very first termination. That can
be pretty
unnerving. Other times we sit in as a witness so that there is a
second objective
perspective as to what occurred in that meeting.
PAULET GREEN: That's right.
MODERATOR: Managers come to Human Resources when
they're ready to
terminate. They actually have to get our permission to go to that
step. And there's
a series of questions we ask them. Number one, did the person
know what
performance behaviors they needed to do? How do you know
they know? Is it

documented? Is it in the file? Did they have training? Is the
training documented?
Did they have an opportunity to improve their behavior?
It's truly unfair to have had attendance problems for six months
and the manager
suddenly says, that's it, I've had enough, I'm ready to terminate,
and the
employee doesn't even know that it's a problem, a difficult
situation. So those are

some of the very key things. Then to look-- and this is a tough
one-- is that
consistency of application. If one person has been late five
times and you're
ready to discipline, what are the rest of your employees doing?
PAULET GREEN: Right. Right.
MODERATOR: What if you have someone who's been late for
work ten times?
What have you done there?
REBECCA F. CADY: Exactly.
MODERATOR: You want to talk about the implications of
consistency?
REBECCA F. CADY: Well, it's important because you don't
want to create the
suggestion of favoritism or discrimination, especially if any of
the hot-button
issues are applicable. I mean, it may just be a matter that the
manager gets
along better with somebody than she does somebody else, but
it's still not a good
way to do business, and it's not a fair way to treat employees.
And it can lead to
problems.
It's a violation of the employee's due process to have decisions
made based on
something other than their actual performance. And if they're
not treating similarly
situated employees in the same way, then that certainly provides
a very heavy
suggestion that it's been made on some basis other than actual

performance.
MODERATOR: And in that list that I'm talking about that I
usually ask managers,
I always include also has the person had the opportunity to
explain their side of
events? Sometimes there are very good mitigating
circumstances for why they
did what they did. So that's always a piece before you move to
termination, as
well as looking at are they in a protected class, like an ADA
situation or some of
those things, before you make that decision.
MODERATOR: I'd like to thank you, Rebecca, for adding your
legal insight into
these tough issues. And, Paulet, for giving us the practical
application of
managing a workforce. I think we've spoken about the
importance of our nurse
managers using Human Resource professionals and dealing with
some of these
employment issues, everything from hiring and performance
management and
taking discipline in order to build a more positive work
environment and retaining
our valuable staff.
MSN Discussion Rubric
Criteria
Levels of Achievement

Outstanding Performance
Excellent Performance
Competent Performance
Room for Improvement
Poor Performance
Content-Main Posting
30 to 30 points
-Main posting addresses all criteria with 75% of post
exceptional depth and breadth supported by credible references.
27 to 29 points
-Main posting addresses all criteria with 75% of post
exceptional depth and breadth supported by credible references.
24 to 26 points
Main posting meets expectations. All criteria are addressed with
50% containing good breadth and depth.
21 to 23 points
Main posting addresses most of the criteria. One to two
criterion are not addressed or superficially addressed.
0 to 20 points
Main posting does not address all of criteria, superficially
addresses criteria. Two or more criteria are not addressed.
Course Requirements and Attendance
20 to 20 points
-Responds to two colleagues’ with posts that are reflective, are
justified with credible sources, and ask questions that extend
the Discussion.
18 to 19 points
-Responds to two colleagues’ with posts that are reflective, are
justified with credible sources, and ask questions that extend
the Discussion.
16 to 17 points
Responds to a minimum of two colleagues’ posts, are reflective,
and ask questions that extend the Discussion. One post is
justified by a credible source.
14 to 15 points

Responds to less than two colleagues’ posts. Posts are on topic,
may have some depth, or questions. May extend the Discussion.
No credible sources are cited.
0 to 13 points
Responds to less than two colleagues’ posts. Posts may not be
on topic, lack depth, do not pose questions that extend the
Discussion.
Scholarly Writing Quality
30 to 30 points
-The main posting clearly addresses the Discussion criteria and
is written concisely. The main posting is cited with more than
two credible references that adhere to the correct format per the
APA Manual 6th Edition. No spelling or grammatical errors.
***The use of scholarly sources or real life experiences needs
to be included to deepen the Discussion and earn points in reply
to fellow students.
27 to 29 points

is written concisely. The main posting is cited with more than
two credible references that adhere to the correct format per the
APA Manual 6th Edition. No spelling or grammatical errors.
24 to 26 points
is written concisely. The main posting is cited with a minimum
of two current credible references that adhere to the correct
format per the APA Manual 6th Edition. Contains one to two
spelling or grammatical errors.
21 to 23 points
-The main posting is not clearly addressing the Discussion
criteria and is not written concisely. The main posting is cited
with less than two credible references that may lack credibility
and/or do not adhere to the correct format per the APA Manual
6th Edition. Contains more than two spelling or grammatical
errors.
0 to 20 points
-The main posting is disorganized and has one reference that
may lack credibility and does not adhere to the correct format
per the APA Manual 6th Edition or has zero credible references.
Contains more than two spelling or grammatical errors.
Professional
Communication
Effectiveness
20 to 20 points
-Communication is professional and respectful to colleagues
and response to faculty questions are answered if posed. -
Provides clear, concise opinions and ideas effectively written in
Standard Edited English.
-Responses posted in the Discussion demonstrate effective
professional communication through deep reflective discussion
which leads to an exchange of ideas and focus on the weekly
Discussion topic.
18 to 19 points
-Communication is professional and respectful to colleagues.

-Provides clear, concise opinions and ideas effectively written
in Standard Edited English.
Discussion topic.
-Responses are cited with at least one credible reference per
post and a probing question that extends the Discussion.
Adheres to the correct format per the APA Manual 6th Edition.
No spelling or grammatical errors.
16 to 17 points
-Communication is professional and respectful to colleagues. -
Provides clear, concise opinions and ideas effectively written in
Standard Edited English.
Discussion topic.
-Responses are cited with at least one credible and/or contain
probing questions that extends the Discussion. Adheres to the
correct format per the APA Manual 6th Edition. May have one
to two spelling or grammatical errors.
14 to 15 points
-Communication is professional and respectful to colleagues.
-Provides opinions that may not be concise or ideas not
effectively written in Standard Edited English.
-Responses posted in the Discussion may lack effective
professional communication that does not extend the
Discussion, leads to an exchange of ideas and/or not focused on
the weekly Discussion topic.
-Responses are not cited and/or do not contain a probing
question. May not adhere to the correct format per the APA
Manual 6th Edition. May have more than two spelling or
grammatical errors.
0 to 13 points

-Communication may lack professional tone or be disrespectful
to colleagues.
-Provides opinions that may not be concise or ideas not
effectively written in Standard Edited English
-Responses posted in the Discussion lack effective professional
communication through discussion that does not extend the
Discussion, do not lead to an exchange of ideas and/or not
focused on the weekly Discussion topic.
-Responses are not cited and do not contain a probing question.
May not adhere to the correct format per the APA Manual 6th
Edition. May have multiple spelling or grammatical errors.
Timely Submission
0 to 0 points
All criteria met: Initial post submitted on time. Response to two
peer initial posts. Response on 3 separate days.
-5 to 0 points
5 points deducted for responding to less than two peers or 5
points deducted for responding less than three days.
-10 to -5 points
5 points deducted for responding to less than two peers and 5
points deducted for responding less than three days.
-10 to -10 points
10 points deducted for Initial post submitted late.
-20 to -15 points
Initial post submitted late and 5 points deducted for responding
to less than two peers and/ or 5 points deducted for responding
less than three days.
© 2016 Laureate Education, Inc.
Page 4 of 4

Best Therapy Method for Couples

Best Therapy Method for Couples

Recommended

Recommended

More Related Content

Similar to Best Therapy Method for Couples

Similar to Best Therapy Method for Couples (9)

More from toltonkendal

More from toltonkendal (20)

Recently uploaded

Recently uploaded (20)

Best Therapy Method for Couples