counseling-psychology git:20260728.80a7ab6A

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---
name: counseling-psychology
description: "Therapeutic frameworks, assessment, ethical practice, and client documentation for counselors and psychologists."
lastReviewed: 2026-04-30
---

# Counseling Psychology Skill


> Therapeutic frameworks, assessment, ethical practice, and client documentation for counselors and psychologists.

## Core Principle

Effective counseling creates a safe space where people can understand themselves more clearly and develop the capacity to change. The therapist's role is to facilitate growth, not direct it. Evidence-based practice grounded in the therapeutic relationship produces the best outcomes.

## Therapeutic Frameworks

### Cognitive Behavioral Therapy (CBT)

**Core model**: Thoughts → Feelings → Behaviors (bidirectional)

| Technique | Purpose | When to Use |
|-----------|---------|-------------|
| **Cognitive restructuring** | Identify and challenge distorted thoughts | Negative automatic thoughts, catastrophizing |
| **Behavioral activation** | Increase engagement in positive activities | Depression, withdrawal, avoidance |
| **Exposure** | Gradual confrontation of feared stimuli | Anxiety, phobias, OCD, PTSD |
| **Thought records** | Track situations, thoughts, emotions, alternatives | Ongoing self-monitoring |
| **Behavioral experiments** | Test beliefs through real-world experience | Entrenched cognitive distortions |

### Cognitive Distortions (Common Patterns)

| Distortion | Description |
|-----------|-------------|
| All-or-nothing thinking | Black/white, no middle ground |
| Catastrophizing | Worst-case thinking |
| Mind reading | Assuming others' thoughts |
| Fortune telling | Predicting negative outcomes |
| Emotional reasoning | "I feel it, so it must be true" |
| Should statements | Rigid expectations of self/others |
| Personalization | Taking excessive responsibility |
| Overgeneralization | One event = always/never |

### Dialectical Behavior Therapy (DBT)

**Four skill modules**:

| Module | Core Skills | Target |
|--------|-----------|--------|
| **Mindfulness** | Observe, describe, participate, non-judgmentally | Present-moment awareness |
| **Distress Tolerance** | TIPP, radical acceptance, pros/cons | Crisis survival without making things worse |
| **Emotion Regulation** | Opposite action, check the facts, PLEASE skills | Managing intense emotions |
| **Interpersonal Effectiveness** | DEAR MAN, GIVE, FAST | Assertiveness, relationships, self-respect |

### Motivational Interviewing (MI)

**Spirit**: Partnership, Acceptance, Compassion, Evocation (PACE)

| Principle | Technique |
|-----------|-----------|
| Express empathy | Reflective listening, affirmation |
| Develop discrepancy | Explore gap between values and behavior |
| Roll with resistance | Avoid argumentation, reframe |
| Support self-efficacy | Highlight past successes, autonomy |

### Session Documentation (SOAP Format)

```yaml
client_id: "CLT-2026-0042"
session_date: "2026-04-14"
session_number: 8
presenting_issue: "Generalized anxiety, work stress"

subjective: |
  Client reports increased anxiety this week following performance review.
  Sleep disrupted (4-5 hours vs. usual 7). Describes "constant worry" about job security.
  PHQ-9: 12 (moderate). GAD-7: 15 (moderate-severe).

objective: |
  Affect: anxious, tearful at times. Speech rate elevated.
  Engaged in session. Good insight. No SI/HI.

assessment: |
  Anxiety exacerbated by work stressor. Catastrophizing pattern evident.
  Treatment progressing; client applying breathing techniques but struggling
  with cognitive restructuring in high-stress moments.

plan:
  - Continue CBT, focus on cognitive restructuring
  - Introduce thought record homework for work situations
  - Review sleep hygiene strategies
  - Schedule next session in 1 week
```

**OARS skills**: Open questions, Affirmations, Reflections, Summaries

### Solution-Focused Brief Therapy (SFBT)

- **Miracle question**: "If you woke up tomorrow and the problem was solved, what would be different?"
- **Scaling questions**: "On a scale of 1–10, where are you now? What would one step up look like?"
- **Exception finding**: "When was the problem absent or less severe? What was different?"
- **Coping questions**: "How have you managed to cope despite these difficulties?"

### Person-Centered Therapy (Rogerian)

Three core conditions:

1. **Unconditional Positive Regard** — Non-judgmental acceptance
2. **Empathy** — Understanding the client's internal frame of reference
3. **Congruence** — Therapist authenticity and transparency

## Assessment

### Clinical Interview Structure

1. **Presenting problem** — Chief complaint in client's words
2. **History of present illness** — Onset, duration, severity, triggers, coping
3. **Mental status exam** — Appearance, behavior, speech, mood, affect, thought process/content, cognition, insight, judgment
4. **Risk assessment** — Suicidal ideation (plan, means, intent), homicidal ideation, self-harm
5. **Psychosocial history** — Relationships, work, education, housing, substances, trauma
6. **Treatment history** — Prior therapy, medications, hospitalizations
7. **Strengths and resources** — Protective factors, support systems, coping skills

### Standardized Measures

| Instrument | Measures | Items | Scoring |
|-----------|----------|-------|---------|
| PHQ-9 | Depression severity | 9 | 0–27 (≥10 = moderate) |
| GAD-7 | Anxiety severity | 7 | 0–21 (≥10 = moderate) |
| PCL-5 | PTSD symptoms | 20 | 0–80 (≥33 = probable) |
| AUDIT | Alcohol use risk | 10 | 0–40 (≥8 = hazardous) |
| Columbia Protocol | Suicide risk | 6 | Triage classification |
| PHQ-A | Adolescent depression | 9 | Modified PHQ-9 |

### Risk Assessment Framework

| Level | Indicators | Response |
|-------|-----------|----------|
| **Low** | Passive ideation, no plan, strong protective factors | Safety planning, increased monitoring |
| **Moderate** | Ideation with vague plan, some risk factors | Safety plan, restrict means, increase frequency |
| **High** | Specific plan, access to means, intent | Immediate safety intervention, possible hospitalization |
| **Imminent** | Active attempt or imminent threat | Emergency services, involuntary hold if needed |

## Treatment Planning

### SMART Goals for Therapy

| Element | Clinical Example |
|---------|-----------------|
| **Specific** | "Reduce panic attacks" not "feel better" |
| **Measurable** | "From 4 per week to ≤1 per week" |
| **Achievable** | Realistic given client's resources and timeline |
| **Relevant** | Aligned with client's stated priorities |
| **Time-bound** | "Within 12 sessions" or "by 90-day review" |

### Treatment Plan Template

1. **Problem statement** — Specific, behavioral description
2. **Long-term goal** — Desired end state
3. **Short-term objectives** — Measurable stepping stones
4. **Interventions** — Specific techniques and modalities
5. **Timeline** — Session frequency, review dates
6. **Discharge criteria** — What "done" looks like

## Ethical Practice

### APA Ethics Code — Key Principles

| Principle | Application |
|-----------|------------|
| **Beneficence & Nonmaleficence** | Do good, avoid harm |
| **Fidelity & Responsibility** | Honor commitments, manage conflicts |
| **Integrity** | Honesty, accuracy in professional work |
| **Justice** | Fair access, equitable treatment |
| **Respect for Rights & Dignity** | Privacy, confidentiality, informed consent |

### Confidentiality Exceptions

| Exception | Threshold |
|-----------|-----------|
| Duty to warn/protect | Immediate, credible threat to identifiable person |
| Mandated reporting | Suspected child/elder/dependent adult abuse |
| Court order | Valid judicial order (not subpoena alone) |
| Client consent | Written, informed, specific |
| Medical emergency | Risk to client's life |

### Boundaries

- No dual relationships (therapist + friend, employer, romantic partner)
- Social media: no friending/following clients
- Gifts: generally decline; consider cultural context
- Self-disclosure: therapeutic purpose only, brief, redirects to client
- Termination: planned, with referral if needed, not abandonment

## Documentation

### Progress Note Formats

**DAP Format**:

- **D** — Data: What happened in session (observations, client statements)
- **A** — Assessment: Clinical interpretation, progress toward goals
- **P** — Plan: Next steps, interventions, homework

**SOAP Format**:

- **S** — Subjective: Client's report
- **O** — Objective: Clinician observations, test results
- **A** — Assessment: Diagnosis, clinical formulation
- **P** — Plan: Treatment next steps

### Documentation Standards

- Document within 24 hours of session
- Factual, behavioral descriptions (not judgments)
- Record interventions used and client response
- Avoid jargon clients wouldn't understand in their records
- Include risk assessment at every contact when risk is present

## AI in Mental Health — Guardrails

**Critical**: AI must never provide therapy, diagnose mental health conditions, or replace clinical judgment.

- AI can assist with: psychoeducation materials, symptom tracking tools, scheduling, documentation templates
- AI must not: interpret assessment scores, make diagnostic impressions, recommend specific interventions
- Always include: "This is informational. If you're in crisis, contact 988 Suicide & Crisis Lifeline or go to your nearest emergency room."
- Client data is PHI — all HIPAA protections apply
- AI suggestions are decision support, never decision replacement