CCMHC cheat sheet

ACA Code of Ethics (2014) core principles: autonomy, nonmaleficence, beneficence, justice, fidelity, veracity; when principles conflict, document the reasoning used to prioritize.

Informed consent for minors requires both parental/guardian consent and developmentally appropriate assent from the client; confidentiality limits must be explained in language the minor understands.

Mandatory reporting duties are set by state statute, not by the ACA Code; the counselor must know the specific state definitions of abuse, neglect, and the reporting timeline (often immediately or within 24–48 hours).

Dual relationships are not automatically unethical; the ACA Code prohibits relationships that risk exploitation or harm, and requires the counselor to document safeguards when a nonprofessional role cannot be avoided.

The Tarasoff duty to protect/warn arises when a client poses a serious threat to an identifiable third party; the required action (warn the victim, notify police, or hospitalize) is determined by state law.

Record-keeping: ACA recommends retaining clinical records for at least 7 years after the last contact, or longer if state law or the age of a minor requires it; records must be kept securely and released only with a signed authorization.

Scope of practice: counselors practice within the boundaries of their education, training, supervised experience, and state licensure; referral is required when a client's needs exceed competence.

Ethical decision-making models (e.g., Forester-Miller & Davis) follow a sequence: identify the problem, apply the code, determine the nature and dimensions of the dilemma, generate potential courses of action, consider consequences, choose and evaluate, then implement.

Cultural identity development models (e.g., Sue & Sue's racial/cultural identity development) move from conformity to dissonance, resistance/immersion, introspection, and integrative awareness; a client's stage predicts how they respond to a counselor of a different background.

Acculturation strategies (Berry) are defined by two dimensions-maintenance of heritage culture and participation in the dominant culture-yielding integration, assimilation, separation, and marginalization.

Microaggressions are brief, commonplace verbal, behavioral, or environmental indignities (Sue et al., 2007) that communicate hostile or derogatory slights; they include microassaults, microinsults, and microinvalidations.

The Multicultural Counseling Competencies (Sue, Arredondo, & McDavis, 1992) specify three dimensions: counselor awareness of own assumptions/values/biases, understanding of the client's worldview, and culturally appropriate intervention strategies.

Cultural encapsulation (Wrenn, 1962) is the counselor's insulation from cultural differences, marked by rigid adherence to one set of assumptions and failure to recognize the client's cultural context.

When using interpreters, the counselor should use a trained interpreter rather than a family member, speak directly to the client, and avoid side conversations with the interpreter.

Worldview dimensions commonly assessed include individualism–collectivism, power distance, uncertainty avoidance, and time orientation (monochronic vs. polychronic).

Ethnic identity is a stronger predictor of counseling process variables (e.g., preference for counselor ethnicity, perceived counselor credibility) than are demographic variables alone.

Piaget's stages: sensorimotor (0–2, object permanence), preoperational (2–7, egocentrism, symbolic play), concrete operational (7–11, conservation, reversibility), formal operational (11+, abstract and hypothetical reasoning).

Erikson's psychosocial stages pair a crisis with a virtue: trust vs. mistrust (hope), autonomy vs. shame/doubt (will), initiative vs. guilt (purpose), industry vs. inferiority (competence), identity vs. role confusion (fidelity), intimacy vs. isolation (love), generativity vs. stagnation (care), integrity vs. despair (wisdom).

Kohlberg's moral development: preconventional (punishment/obedience, instrumental exchange), conventional (good boy/nice girl, law and order), postconventional (social contract, universal ethical principles). Gilligan critiqued the model as male-biased and proposed an ethic of care.

Attachment patterns (Ainsworth's Strange Situation): secure, insecure-avoidant, insecure-resistant/ambivalent, and disorganized/disoriented (added by Main & Solomon).

Bowlby's attachment theory holds that early caregiver interactions form internal working models that guide later relationships; separation and loss in early childhood are linked to later adjustment difficulties.

Vygotsky's zone of proximal development is the gap between what a learner can do alone and what they can do with guidance; scaffolding is the temporary support that is faded as competence grows.

Maturation vs. learning: developmental milestones are influenced by both biological maturation and environmental experience; delayed milestones warrant referral for developmental assessment.

Adolescent brain development: the prefrontal cortex matures later than the limbic system, contributing to heightened reward sensitivity and risk-taking in adolescence.

Holland's RIASEC typology: Realistic, Investigative, Artistic, Social, Enterprising, Conventional; congruence between personality type and work environment predicts job satisfaction and stability.

Super's life-span, life-space theory: career development unfolds across life stages (growth, exploration, establishment, maintenance, decline) and across life roles (child, student, worker, citizen, homemaker).

Super's concept of career maturity (later career adaptability) includes planning, exploration, decision-making, and self-efficacy in career tasks.

Trait-and-factor (Parsons) approach matches client traits (abilities, interests, values) to occupational requirements; it is the basis of most standardized career interest inventories.

Krumboltz's social learning theory of career decision-making emphasizes genetic endowment, environmental conditions, learning experiences, and task-approach skills; career indecision can result from faulty self-observations or ineffective problem-solving.

Gottfredson's theory of circumscription and compromise: individuals narrow occupational choices by sex type, prestige, and field of work, and compromise by giving up preferred fields first and prestige last.

Career assessment tools include the Strong Interest Inventory, Self-Directed Search, and O*NET; results should be integrated with the client's values and context rather than used as prescriptive answers.

Work adjustment theory (Dawis & Lofquist) predicts job tenure from the correspondence between the person's abilities and the job's requirements, and between the person's needs and the job's reinforcers.

Rogers' core conditions: unconditional positive regard, empathic understanding, congruence/genuineness; these are necessary and sufficient for therapeutic personality change in person-centered therapy.

Psychoanalytic constructs: id/ego/superego, defense mechanisms (repression, projection, displacement, rationalization, sublimation), transference, countertransference, and resistance.

Cognitive behavioral therapy (Beck) targets automatic thoughts, cognitive distortions (e.g., all-or-nothing thinking, catastrophizing, mind reading), and core beliefs; behavioral activation and homework are common components.

Solution-focused brief therapy (de Shazer, Berg) uses the miracle question, scaling questions, exception questions, and compliments to build on client strengths.

Motivational interviewing (Miller & Rollnick) is guided by four processes-engaging, focusing, evoking, planning-and uses OARS (open questions, affirmations, reflections, summaries) while avoiding the righting reflex.

Narrative therapy (White & Epston) externalizes the problem, separates the person from the problem, and develops alternative preferred stories through unique outcomes.

Group stages (Tuckman): forming, storming, norming, performing, adjourning; group leaders must manage conflict in the storming stage rather than suppress it.

Therapeutic alliance components (Bordin): agreement on goals, agreement on tasks, and the emotional bond; rupture-repair episodes are opportunities for therapeutic gain.

Group types differ in purpose and leadership: psychoeducational, counseling, psychotherapy, task/work, and support groups; scope of practice and screening criteria vary by type.

Screening and selection: leaders assess fit, readiness, and risk factors (e.g., acute crisis, inability to tolerate feedback) and provide informed consent about confidentiality limits, which cannot be guaranteed in groups.

Group stages and leader tasks: forming (orientation, safety), storming (conflict, power), norming (cohesion, norms), performing (productive work), adjourning (termination, transfer of learning).

Yalom's therapeutic factors include universality, altruism, instillation of hope, cohesiveness, catharsis, interpersonal learning, imitative behavior, and corrective recapitulation of the primary family group.

Co-leadership advantages: shared observation, modeling of healthy interaction, continuity during absences; disadvantages include cost and the need for co-leader coordination and supervision.

Confidentiality in groups is an ethical obligation of leaders and members, but leaders cannot enforce it; members should be asked to commit to confidentiality and limits should be reviewed at each session.

Termination in groups includes summarizing gains, addressing unfinished business, planning for maintenance, and providing referral options when needed.

Cultural considerations in groups: leaders monitor whether norms privilege dominant-culture communication styles and create space for members from marginalized groups to participate safely.

Reliability refers to consistency of scores over time or across items; internal consistency is often estimated with Cronbach's alpha, and scores ≥ .70 are generally acceptable for research, ≥ .90 for high-stakes decisions.

Validity is the extent to which evidence supports the intended interpretation of scores; types include content, construct, criterion-related (concurrent and predictive), and face validity.

Standard scores: z-score (mean 0, SD 1), T-score (mean 50, SD 10), IQ/standard score (mean 100, SD 15), stanine (mean 5, SD 2); percentile rank is not an equal-interval scale.

The normal curve: approximately 68% of scores fall within ±1 SD, 95% within ±2 SD, and 99.7% within ±3 SD.

Test selection criteria: psychometric adequacy for the population, appropriateness of norms, reading level, cultural fairness, and alignment with the referral question.

Sensitivity is the proportion of true cases correctly identified; specificity is the proportion of non-cases correctly identified; positive predictive value depends on base rate.

Differential diagnosis requires ruling out medical conditions (e.g., thyroid disorders, substance use, medication effects) and using collateral information when possible.

Assessment of suicide risk includes direct inquiry, assessment of intent/plan/means, protective factors, and documentation of the risk formulation and safety plan.

Research designs: experimental (random assignment, manipulation, control) supports causal inference; quasi-experimental lacks random assignment; correlational designs cannot establish causation.

Internal validity threats include history, maturation, testing effects, instrumentation, regression to the mean, selection bias, and attrition; external validity concerns generalizability.

Sampling: random sampling improves external validity; random assignment improves internal validity; convenience samples limit generalizability.

Statistical significance (p < .05) indicates the probability of the observed result under the null hypothesis; effect size (e.g., Cohen's d) indicates practical magnitude-d = 0.2 small, 0.5 medium, 0.8 large.

Type I error is rejecting a true null hypothesis (false positive); Type II error is failing to reject a false null hypothesis (false negative); power is 1 − β.

Qualitative methods (ethnography, grounded theory, phenomenology, case study) generate hypotheses and explore meaning; trustworthiness is evaluated through credibility, transferability, dependability, and confirmability.

Program evaluation models include needs assessment, process/implementation evaluation, outcome evaluation, and cost analysis; logic models link inputs, activities, outputs, and outcomes.

Meta-analysis pools effect sizes across studies; heterogeneity (e.g., I²) indicates variability in effects beyond sampling error.

DSM-5-TR diagnostic criteria require clinically significant distress or impairment and the exclusion of substance/medical causes; diagnoses are not made from a single symptom.

Major depressive disorder requires ≥5 symptoms for ≥2 weeks, including depressed mood or anhedonia; specifiers include anxious distress, mixed features, melancholic features, and peripartum onset.

Generalized anxiety disorder requires excessive anxiety/worry for ≥6 months, difficult to control, with ≥3 of 6 symptoms (restlessness, fatigue, concentration problems, irritability, muscle tension, sleep disturbance).

Posttraumatic stress disorder (DSM-5-TR) requires exposure to actual or threatened death, serious injury, or sexual violence, plus intrusion, avoidance, negative cognitions/mood, and arousal/reactivity symptoms lasting >1 month.

Bipolar I disorder requires at least one manic episode (≥1 week or hospitalization); bipolar II requires hypomanic and major depressive episodes but no full mania.

Substance use disorder severity is based on the number of criteria met (2–3 mild, 4–5 moderate, ≥6 severe) in the past 12 months.

Treatment planning components: presenting problem, measurable goals, objectives, interventions, responsible parties, timeline, and evaluation criteria; plans should be developed collaboratively and updated as the client progresses.

Differential diagnosis of psychosis requires distinguishing primary psychotic disorders from substance/medication-induced psychosis and psychotic disorders due to another medical condition.

Crisis intervention is time-limited and focused on restoring equilibrium, ensuring safety, and connecting the client to ongoing care; it is not long-term therapy.

Suicide risk assessment: ask directly about suicidal ideation, plan, intent, means, and prior attempts; document the assessment and the rationale for the level of care chosen.

Safety planning (Stanley & Brown) includes warning signs, coping strategies, social contacts, professional contacts, and means restriction; it is distinct from a no-suicide contract, which has limited evidence.

Duty to protect: when a client poses a serious threat to an identifiable victim, the counselor must follow state law (warn, notify police, arrange hospitalization) and document actions taken.

Trauma-informed care principles (SAMHSA): safety, trustworthiness/transparency, peer support, collaboration/mutuality, empowerment/choice, and cultural/historical/gender issues.

Trauma responses include hyperarousal, intrusion, avoidance, and negative alterations in cognition/mood; grounding and stabilization precede trauma processing.

Acute stress disorder occurs 3 days to 1 month after trauma; PTSD requires symptoms lasting more than 1 month.

Mandatory reporting of child abuse/neglect, elder abuse, and dependent adult abuse is governed by state law; the counselor reports to the designated agency, not to the alleged perpetrator.