Question

What does it mean to be accountable in any profession? In education, one measure of effectiveness may be the number of students who graduate. For business, it may be the number of returning customers. But what does it mean for clinical mental health counseling? Simply, it is when clients meet their treatment outcomes. However, being accountable for those treatment outcomes can be challenging, and oftentimes new counselors are concerned about accountability, thereby making supervision and consultation essential for rising clinical mental health counseling.

For this Discussion, you consider potential challenges of accountability of treatment outcomes for clients.

Also, here is the posting that you will respond to differently in two paragraphs:

The subject of accountablity is kind of a hot button issue for me. Given my current line of work and experience with stakeholders (Erford, 2014) and third-party funding sources (Astramovich & Coker, 2007), I find that all too often the main focus is the allocation of resources and money rather than the client or population's wellbeing. In addition, certain members of these parties are not personally in touch with those they are making decisions for. Funding for people who can not fund their own care is a reality of this field, but the implications of that can be frustrating and sad.

I believe that, in the field of mental health and more specifically one-on-one counseling, outcomes can be very hard to measure. There are so many intricate dynamics to a person's life, especially when ongoing mental health challenges are present. A counselor is not always with their client, and are often only working with the information their client provides to them. We also know that it is ethically unsound to suggest to an adult client that he or she live in a certain way (Linde & Erford, 2014). Therefore, pinpointing a reason for improvement or lack of can prove very difficult. Due to this, I would say that maintenance is a more realistic goal for some. For example, I have a teenage client who is schizo-affective. Her condition is permanent and, although she is intelligent, her capacity for long-term improvement is limited. She is scheduled for weekly counseling and reports that she likes her counselor and enjoys going to counseling. Nonetheless, she often refuses to attend. She is emotionally limited, has violent outbursts, does not attend to hygiene (encopresis), and attempts elopement at least monthly. Usually she claims she does not remember or that voices told her to do whatever took place. To assign the responsibility for this to a counselor seems unfair, especially if it means that program resources or funding will be cut.

On the other hand, I can also see the "pros" to enforcing accountibility in certain settings. I have a few clients under the age of 18 who are in a variety of facility placements. These clients are all provided services that are appropriate for their specific needs. Staff and other providers who work with them regularly are able to monitor things in accordance with their treatment plans. For example, one of my clients has a goal of reduction in destructive behaviors toward peers. Staff keeps track of his behavior during school hours in a fashion similar to the single-case research design (Erford, 2014). Reports about these cases are then reviewed, usually on a monthly basis in a collaborative meeting involving all stakeholders. When things are going well, the treatment plans remain intact or can be revised to be less restrictive. When things are not going well, treatment plans are re-evaluated and other options for treatment are considered. This can be an effective way to make sure that clients are recieving care that helps them to meet goals that they agreed were attainable.

Personally, I think my own obstacle with accountability would depend on what type of setting or client population I end up working with. Based on my experiences to this point, I know that assessing service and treatment plans can be awkward. If there is good news to report, then meetings generally go well and clients leave feeling uplifted and motivated. However, if there is not much progress to note, it can cause a number of difficulties. Sometimes the client will not accept any culpability and will blame the providers. Sometimes clients will lie about certain items in order to feign progress, especially if a legal proceeding is in the near future. Other times, when clients are confronted about their lack of involvement or progress with a plan, they will withdraw and leave feeling criticized and angry. The relationship between provider and client can end up damaged. Again, it is generally unethical to force a client over 18 with the capacity to make decisions for themselves to participate in treatment (Linde & Erford, 2014). Thus, clients can walk away from counseling at any time. Inevitably, this would skew some assessment results, for reasons possibly unknown to the counselor or agency.

All in all, I think that accountability for counselors has both pros and cons. Perhaps when more methods for assessing treatment effectiveness are established, it will be easier to report on counselor efficacy in a fair and confident manner (Bradley, Sexton, & Smith, 2005)

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Accountability in Mental Health Counselling
One of the most challenging concerns in counselling is encountering difficult clients; those who are not ready to share with the counselor important information. The challenge of encountering a difficult client leads to the second challenge. As counselor, I have always asked myself whether the counselees deserve the blame for being challenging or should counselors assume full responsibility and be held accountable for not having the correct tools and approaches to help. Here is an illustration from one of the sessions with a teenage boy, “I am not telling you anything, and you cannot make me,” said the boy. Well, clients report to counselling sessions expecting to be talked to and criticized, but I was determined to prove the boy otherwise....

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