This chapter aims to help clinicians learn stabilization interventions for use in the Preparation Phase of eye movement desensitization and reprocessing (EMDR) treatment. Using these interventions will aid clients in developing readiness for processing trauma, learning how to manage symptoms of dissociation, dealing with affect regulation, and developing the necessary internal cohesion and resources to utilize the EMDR trauma-processing phase. Earlier negative experiences stored dysfunctionally increase vulnerability to anxiety disorders, depression, and other diagnoses. When assessing a client with a complex trauma history, clinicians need to view current symptoms of post-traumatic stress disorder (PTSD) or depression as reflections of the earlier traumas. The chapter outlines the strategies dealing with dissociative symptoms, ego state work, and internal stability that help clinicians to develop an individualized treatment plan to successfully guide the client through the EMDR phases of treatment.

The purpose of the constructive avoidance script is to assist clients in dealing with their anxiety or stress-provoking present day situations. Dissociative clients generally are phobic or avoidant of many activities such as medical procedures, going to the dentist, taking examinations, going for job interviews, and so forth due to the complex nature of their traumas, panic, anxiety, and other trauma-related problems. When the client is going to encounter a situation that has caused high stress or triggering in the past and has not completed eye movement desensitization and reprocessing (EMDR) target focusing on that issue, chances are that the ego states involved are not yet ready to deal with the situation. The client can practice with the parts before the upcoming event in sessions and as homework between sessions. This protocol assumes that clients have already established a Home Base and Workplace.

The purpose of the orienting to present reality (OPR) exercise is to help clients with a dissociative disorder, or help dissociative symptoms work with their ego state system to begin to experience present time and place. This generally enhances feelings of reality and security for the system as well as their sense of appropriate caring and protection by the adult client. The OPR Protocol is done in three steps: getting to know the ego state(s), using the workplace, and comparison between the present and the past. Generally, OPR will need to be repeated many times during treatment, since parts may appear who need orientation or reorientation during any phase in the therapy. This includes times during eye movement desensitization and reprocessing (EMDR) trauma processing when a disoriented part(s) may appear.

Clients who have experienced severe trauma often feel that there is a lack of safety in their lives. Therefore, it is helpful to have an uncontaminated place where it is possible for the client to meet and get acquainted with the ego states and a place where they can meet with each other and work together. The use of the Workplace for stabilization activities promotes awareness of the ego states or parts and also develops coconsciousness between the parts. Client and ego states’ reactions to these ideas that support communication and connection range across the affective spectrum from surprise to relief, feelings of normalcy, disapproval, disgust, revulsion, somatic reactions, or all of the above. Many types of workplaces or conference rooms are suggested in the literature in which the client sits at an oval table and invites ego states to sit in the empty chairs around the table.

This chapter offers practical utility to help expand rehabilitation counselors’ (RCs) and other mental health professionals’ thinking about the various considerations that underlie a culturally competent social justice approach to rehabilitation counseling practice. Rehabilitation counseling has demonstrated its commitment to the importance of cultural competency in improving the quality and availability of counseling and rehabilitation services to clients from traditionally under represented racial/ethnic groups. The chapter describes the multicultural and social justice counseling competencies (MSJCC), with particular attention directed to the social justice framework and how it may be used to assist in working toward equity in the context of changing demographics in American society. It then explains how individual and group racial, sexual identity, cultural, and identity development may impact the counseling process. The counseling literature recognizes LGBTQ individuals as inclusive under the umbrella of multicultural populations, as well as intersecting with other groups because of multiple identities.

The aging population is at a state of development that is not as focused on employment, and thus has difficulty finding its place in a society that defines people by their careers. Research is needed on the issues of aging workers, such as training needs, career transition issues, and retirement planning. Research is also needed on which accommodations, workplace modifications, and changes to policies and practices positively impact the retention and continued productivity of an aging workforce. Counselor practitioners are in a unique position to contribute to needed research design conceptualization, metrics, and analyses to test the multiplicity of interventions we will be exploring in the coming years to keep our aging workforce healthy and intellectually engaged in the employment environment. Counselors are experientially qualified to provide the needed services to keep this population productive and more fully engaged in their communities and continuing employment.

This chapter presents specific issues faced by older adults in response to adaptations to chronic illness and disability. Some individuals have congenital disabilities and others acquire a disability early in life and are able to adjust fairly easily, aging with their disability. On the other hand, some individuals acquire a disability later in life and may experience great difficulty making the adjustments to their condition. The chapter presents information on the age-related concerns of older adults, components and perceptions of aging, assessment issues associated with older adults, vocational interests, and death and dying perspectives. It also discusses the implications for service delivery in the context in which older adults are served along with laws and regulations that apply to the population. Aging and geriatric persons often utilize a variety of services from multiple entities (e.g., social, legal, medical, financial, and counseling).