This chapter discusses the major mental health disorders experienced by older adults, identifies the most effective counseling approaches and psychotropic medications used to address the mental health needs of older adults, and provides an overview of best practice counseling and treatment interventions used to address the mental health needs of older adults. In an overview of the literature regarding major depression and dysthymia, Zalaquett and Stens examined the effectiveness of four commonly used individual therapies for treating older adult depression: cognitive behavior therapy (CBT), interpersonal therapy (IPT), brief dynamic therapy (BDT), and reminiscence therapy (RT) and life review (LR) therapy. Counselors can develop brief checklists to assist clients in tracking their symptoms. Counselors should also educate themselves about the signs of excessive alcohol and substance abuse, noting that some medical conditions may have similar symptoms to drug or alcohol abuse.
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The practice of administering personality tests has become a significant role and function of many professional counselors. This chapter summarizes key information that can be found in many professional references and graduate texts. Personality assessments are best conducted as a part of an overall psychological assessment. Personality functioning cannot be validly assessed in isolation of cognitive, intellectual, or social functioning. Each domain contributes to the functioning of the individual as a whole and informs the others. The assessment process comprises multiple steps that include clarifying the nature of the referral question; selecting appropriate tests; test administration; test scoring and interpretation; integrating test findings; and compiling the psychological report. Personality inventories can be defined as psychological measures that comprise a number of items concerning personal characteristics, thoughts, feelings, and behaviors. The interpretation of personality test results is dependent on a variety of considerations.
This chapter serves as an introduction to prescribed psychiatric drugs for children and adolescents. It covers the most common disorders that require medication for children and adolescents as well as symptoms that are targeted and medication side effects. Anxiety disorders are the most common of all mental disorders and are often chronic, treatment resistant, and associated with considerable morbidity. The chapter explores the most common Diagnostic and Statistical Manual of Mental Disorders (DSM)-5-related psychiatric disorders children and adolescents experience as well as the most common medications used. Counselors of all disciplines can benefit from understanding not only the types of medications being prescribed but also the behaviors and cognitive thought processes believed to be treated. Counseling strategies were briefly addressed; however, counselors are encouraged to seek more in-depth information on each of these conditions and the best strategies in assisting this population.
Positive psychology is the scientific study of what goes right in life, from birth to death. It is the study of optimal experience, people being their best and doing their best. Positive psychology is a newly christened approach within psychology that takes seriously as a subject matter those things that make life most worth living. Positive psychology assumes that life entails more than avoiding or undoing problems and that explanations of the good life must do more than reverse accounts of problems. Positive psychology challenges the assumptions of the disease model. Psychologists interested in promoting human potential need to start with different assumptions and to pose different questions from their peers who assume only a disease model. Positive psychology can be criticized for being value laden, a charge that applies to all approaches to helping professions.
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The International Classification of Functioning, Disability, and Health: Applications for Professional Counseling
The International Classification of Functioning, Disability, and Health (ICF) is a classification system published by the World Health Organization (
WHO). The International Statistical Classification of Diseases and Related Health Problems (ICD) provides an etiological classification of health conditions related to mortality and morbidity, while the ICF provides a functional complement to the diagnosis-based ICD. The use of the ICF is important for a number of reasons, not the least of which is the prevalence of people with disabilities throughout the world. People with disabilities constitute one of the largest minority groups in the United States. The managed care industry has caused health professionals to be more outcome focused in their reports to third-party payers, rather than reporting only traditional diagnostic information. The medical model of disability guided early efforts to describe causes of mortality and morbidity, and has been relatively effective for detection and treatment of acute health problems.
The specialization of forensic expert testimony in mental health has traditionally been precluded for counselors and dominated primarily by psychologists and psychiatrists. This chapter focuses on the applicable laws related to providing expert testimony and their impact on how counselors must prepare and present their findings in court. It outlines legal definitions and differences in deposing or discovery testimony versus trial testimony. Knowing the order and relevant issues involved at each procedural step becomes important regarding testimony preparation. A practical look at the specific skills counselors should have in order to effectively work in the forensic field is discussed next as well as specific strategies in preparing for and testifying in a courtroom. The growing need for forensic mental health evaluators plays a significant role in scientifically and methodologically providing the court with valuable knowledge in helping to render more informed decisions.
This chapter specifically focuses on violence in the nation’s schools by providing: an overview of youth violence including risk and protective factors, assessment items for preventing violence, and suggestions of intervention/prevention strategies for reducing youth violence and its impact. The professionals involved with the aftermath of violence have specific roles related to severity assessment and determining clinical needs. Counselors should gather information from multiple sources on multiple issues as no one personality profile for a violent youth or target exists. Focusing on behaviors and placing those behaviors in a social-ecological context provides the clearest understanding of potential risk and directs treatment options and modalities. The success of violence prevention programs though can never be perfect. Violence will sometimes still occur, leaving students to deal with the physical, emotional, cognitive, behavioral, and spiritual consequences.
This chapter focuses on the specific skills and techniques required for working with individuals in a group setting. Our approach to group leading is an active, theory-driven, multisensory approach where the leader is actively involved in directing the personal work with an individual. One of the most difficult group leadership skills to master is the ability to work with an individual while keeping the other members engaged and involved. When leading any kind of growth, support, counseling, or therapy group, members will often bring up a concern that needs immediate and concentrated attention. Theory-driven group counseling is always more effective than when no theory is utilized. The process of including all group members takes great skill, much thought, and a lot of practice on the part of any group leader.
Family members often have different definitions of what is the problem or who has the problem. Thus, the counselor must first discover the underlying issue that has caused this family to seek treatment. Understanding a family’s presenting issue is paramount to accurate diagnosis and effective treatment. Counselors develop these case conceptualizations through informal and formal assessments of the family. Fortunately, there are numerous assessments of family functioning to be used for clinical purposes with an individual, entire family, or a subsystem of a family. Family techniques can serve as informal family assessments. Data can be collected through family play therapy, family sculpting, and genograms. Finally, counselors need to share the results in an appropriate and ethical manner with the family and any other third-party stakeholder as indicated by the family. For instance, some agencies may use family assessments to make critical decisions about family treatment and even child custody.
Family counseling offers a valuable alternative or addition to addressing individual client concerns. In the age of managed care, producing rapid results is both desired and necessitated by third-party reimbursement requirements, and family counseling fits well within this paradigm. Family counseling tends to be short term and solution focused, where specific, attainable treatment goals are set for a definite end point. Families may benefit more from intervals of brief problem-focused counseling, as opposed to long-term continuous counseling. Family counseling should then be tailored to resolve a particular issue in a limited time frame. Family systems describe communication as a regulatory process, whereby family members’ verbal and nonverbal communications bidirectionally influence the system. In order for this family counseling to be successful, counselors must build rapport with and engage all family members.
The aging population is likely to result in increasing numbers of people with disabilities in the workforce, who may have difficulty staying employed. Effective counseling practices must increasingly include attention to preparing both individuals and their workplaces for the impact of the aging process. Proactive education about ways to maximize the productivity of an aging workforce, effective case management, and workplace accommodations can significantly contribute to maximizing aging worker retention. A better understanding of aging is more closely aligned with the developmental model. Career development may be presented as a lifelong, dynamic process that requires individuals to engage throughout their lifetime in the ongoing assessment, analysis, and synthesis of information about the world of work and self. Counselor educators can prepare counselors-in-training for this task by including aging issues in the counselor education curriculum.
Assistive technologies or devices are tools for enhancing the independent functioning of people who have physical limitations or disabilities. An assistive technology device (ATD), as initially defined in the Technology-Related Assistance of Individuals With Disabilities Act of 1988, is any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified that is used to increase or improve functional capabilities of individuals with disabilities. ATDs range from low-tech aids such as built-up handles on eating utensils to high-tech, computerized systems to help persons with disabilities live independently and enter the workforce. The goal of rehabilitation and counseling professionals is to match an individual with an ATD that will enhance the person’s capabilities and quality of life. Persons with disabilities want as much emphasis placed on their community participation as on their physical capabilities, creating as much need to change and accommodate the environment as equip the person.
This chapter discusses some of unique differences as they relate to the assessment, diagnosis, and treatment in military counseling and related services. It addresses some of salient issues for professional counselors who must assess, diagnose, and treat active duty and veterans. Overall, understanding psychosocial adjustment issues related to chronic illness and disability as well as working with clients that have psychiatric, substance abuse, and mental health issues are essential in healing traumatic experiences. The chapter assists professionals in building a rapport with the intent of establishing a strong working alliance within the military culture. It provides an excellent and comprehensive resource for helping professional counselors understand the difficult challenges that military personnel must navigate during various stages of their deployment cycle. A great deal of counselor education and research has been developed that focuses on preparing professional counselors in understanding the unique cultural attributes of a diversity of cultural groups.
Counseling criminal justice clients can be both fascinating and clinically rewarding. The fascinating aspect of this work relates to the intriguing nature that crime plays in society. It is human nature to be curious about nonordinary events such as criminal behavior. This chapter presents a brief overview of central issues for counselors who may be interested in providing therapeutic service to criminal justice clients. It covers four main areas: an overview of clients served, a description of relevant “best practices” in working with criminal justice clients, a presentation of therapeutic targets, and suggestions for clinical practice. Given that criminal justice clients are more likely to have life management difficulties rather than psychiatric disturbance suggests that counselors can play a significant role in therapeutically modifying client characteristics. Counseling criminal justice clients who are incarcerated requires flexibility in both time and setting.
In this chapter, the latest regarding the science of couple therapy is combined with the art of therapy in a competency-based approach that considers individuals in the context of their family, culture, gender, values, and strengths. Competency-based therapy, which draws in part from the work of Milton H. Erickson, is one such approach known for its respect, optimism, hopefulness, collaboration, and strength-based focus. Sophisticated language patterns are utilized to create a change-friendly therapeutic environment that encourages hope and new possibilities while sustaining a strong working relationship. The therapist acts as a collaborator with the couple, and the therapy experience is a co-creation between the couple and the therapist. As the therapist learns the couple’s story, it is appropriate for the therapist to share back or paraphrase his or her understanding of their story in order to stay on track and accurately perceive the couple’s situation.
Substance abuse treatment programs and clinical counseling approaches are designed to treat a variety of substance use disorders (SUDs). Treatment approaches may include a combination of medical and psychosocial approaches. Therapeutic programs for individuals with SUDs include hospital-based inpatient programs and mutual-help groups; detoxification programs; partial hospitalization; intensive outpatient programs; therapeutic communities; halfway houses; pharmacotherapy-based interventions such as methadone programs for opioid addicts, naltrexone for alcoholics, and so on. The use of medications for treating physiological and psychological symptoms related to substance withdrawal and relapse can be beneficial additions to psychosocial treatments. In recent years, a driving force for integrating pharmacotherapeutic agents into treatment for substance dependence has been the increased understanding of the effects of psychoactive substances on the brain and body. In summary, some SUDs, especially those with severe SUDs, are best viewed as chronic, relapsing biopsychosocial-spiritual disorders that are treatable with successful outcomes.
This chapter serves as a brief introduction to psychiatric drugs. It addresses the more prevalent major drug classifications, including antipsychotic, antidepressant, antimanic, and antianxiety drugs. Subclasses are identified when appropriate, such as the selective serotonin reuptake inhibitor (SSRI) subclass of antidepressants. Some representative drugs for a specific subclass are also discussed; for example, the specific drug fluoxetine is addressed from the SSRI subclass. In addition, brand names are used in cases where a drug is commonly known by that name. A discussion of pharmacokinetics and pharmaco-dynamics is limited but is introduced in the review of antianxiety drugs to illustrate treatment strategies. Finally, a brief but meaningful review of the side effects of these medications is addressed. The goals of treatment of posttraumatic stress disorder (PTSD) are straightforward and include reducing primary symptoms, improving day-to-day functioning, treating comorbid symptoms, and preventing relapse.
Perhaps one of the most interesting skills one can learn in working with persons with disabilities is to assess what their mental and physical residual capabilities are in order to transfer these abilities into work skills. This chapter explores and discusses samples of a mental functional capacity evaluation (MFCE) and physical functional capacity evaluation (PFCE), then illustrates how each of these types of assessments may be used in establishing an appropriate work setting for clients with disabilities. MFCE and PFCE tend to be most often used in Social Security court hearings in an effort to determine whether an individual is capable of working at any job commensurate with his or her skills and abilities. The primary difference between both types of evaluations is that MFCEs assess an individual’s cognitive and emotional capacity, whereas a PFCE focuses exclusively on an individual’s physical capabilities.
The consequences of deployment on the family can present an array of difficulties for the family due to lengthy separation periods. When counseling family members of veterans, an initial consideration should be taken into account at the onset of therapy. Particular concerns involve the reevaluation of family roles and expectations, parental involvement, restoring intimacy, and sharing a common understanding of the challenges faced during deployment. In conjunction with identifying whether the spouse or family member meets the diagnostic criteria for posttraumatic stress disorder (PTSD), assessing for domestic abuse is a necessary concern for mental health practitioners. Aside from the aforementioned treatment implications, family systems theory has been recommended when working with veterans and their families. The theory focuses on the past, present, and anticipated future, lending it to work well with families of veterans as it runs parallel with the phases of deployment.
Vocational evaluation (VE) or assessment is an employment outcome service that can provide added value to the counseling process. A comprehensive process that systematically uses work, either real or simulated, as the focal point for assessment and vocational exploration, the purpose of which is to assist individuals with vocational development. Vocational evaluation incorporates medical, psychological, social, vocational, educational, cultural, and economic data into the process to attain the goals of evaluation. The consumer learns about personal strengths or areas for improvement, crystallizes interests, and makes plans as a result of the VE process. A VE is described as a “professional discipline that most people, including people with disabilities, will want to use to help identify and achieve career goals". To leverage the maximum benefit from a VE, the counselor must help prepare the consumer for the VE experience.
This chapter begins with a discussion of the importance of a clear understanding of psychiatric diagnoses for all allied health professionals. Given the historical prevalence of psychiatric diagnoses, it is a good use of our time to review the seminal diagnostic systems that inform diagnosis in clinical counseling. Clinical counselors and other mental health professionals may be the first health care providers to have established any type of therapeutic relationship with their client, revealing information that previously had never been a focus of any other professionals’ clinical attention. The accurate diagnosis of psychiatric conditions leads to appropriate referrals, selection of the most appropriate evidence-based treatments, and ultimately amelioration or elimination of problematic symptoms that negatively impact health and functioning. The most commonly used diagnostic system for psychiatric conditions worldwide is the International Classification of Diseases (ICD) system.
This chapter acquaints the professional counselor with the area of aptitude testing. It provides information regarding the purpose of aptitude tests, three primary types of aptitude tests, and the most commonly used aptitude tests. The chapter addresses criticisms of aptitude testing along with guidelines for appropriate use of aptitude tests. It closes with a discussion about the appropriate use of accommodations for clients with disabilities. Aptitude tests are norm-referenced, standardized tests that are designed to measure a person’s “ability to acquire a specific type of skill or knowledge". To understand the concept of aptitude, it is important to distinguish this concept from intelligence and achievement. The three primary types of aptitude tests are scholastic aptitude tests; vocational aptitude tests; and measures of special abilities. Any counselor involved in the selection, administration, scoring, or interpretation of aptitude tests should become familiar with professional standards related to the use of standardized tests.
This chapter provides practitioners with a basic outline of considerations and techniques for conducting family therapy. This modality is not individual therapy with a witness, wherein the therapist is central and interacting with one family member at a time. Instead, family therapy is an interactive, active, and provocative experience for both clinician and family members. The chapter outlines reasons for and against using a family modality, followed by basic principles underlying family therapy. It discusses how to get started in family therapy and highlights core intervention strategies that are common across most contemporary approaches. Family therapy is the appropriate choice of treatment for a number of presenting problems, including conflict among family members; difficulties associated with divorce; remarriage of parents; adjustment to illness or death of a family member; and psychological and behavioral problems of children and adolescents.
Substance abuse is the nation’s number one health problem, straining the health care system and contributing to the ill health and death of millions of Americans every year. According to the Schneider Institute for Health Policy report: There are more deaths, illnesses and disabilities from substance abuse than from any other preventable health condition. Psychoactive substance use disorders (SUDs) wreak havoc on American society. Chronic substance abuse often results in a decline in both physical and mental health status in users who then require care from medical and mental health professionals in hospitals, rehabilitation programs, and specialized substance abuse treatment facilities. Substance abuse affects the whole person, including the biological, psychological, social, and spiritual aspects of the individual. Substance abuse assessment and treatment occur concurrently with individuals with SUDs. Substance-induced disorders include intoxication, withdrawal, and other substance/medication-induced mental disorders.
Professional counselors, representing a variety of specialties, provide mental health services to individuals with psychiatric disabilities. Mental health disorders among young persons between the ages of 10 and 24 years now account for almost half of all youth disabilities worldwide. Although some gains have been made in service provision for persons with SMI, the increasing number of individuals with severe and lifelong psychiatric disabilities continues to challenge the counseling profession. Severe psychiatric illnesses are persistent mental or emotional disorders that significantly interfere with a person’s ability to carry out primary aspects of daily life such as self-care, household management, interpersonal relationships, and school or work. Psychosocial aspects of any disability are important factors in the treatment and rehabilitation of the individual. Persons with psychiatric disabilities are diagnosed with mental illnesses that limit their capacity to perform certain tasks and functions and their ability to perform certain roles.
Studies reveal that healthy and functional families exist in virtually all cultures. Health and well-being in these families are an interactive process associated with positive relationships and outcomes. In families, being healthy and well involves ethical accountability, such as promoting good relationships and balancing the give-and-take among members. In regard to health and wellness, one cannot assume that healthy individuals necessarily come from continuously healthy and well-functioning families. Communication is concerned with the delivery and reception of verbal and nonverbal information between family members. It includes skills in exchanging patterns of information within the family system. In fact, highly resilient individuals, who successfully overcome adversities, do well in life. A healthy marriage is complex and multidimensional. Roles in healthy and well-functioning families are clear, appropriate, suitably allocated, mutually agreed on, integrated, and enacted.
Over the course of the past 10 years there has been a paradigm shift in the way that society views individuals from the lesbian, gay, bisexual, transgender, and questioning (LGBTQ) community. As this shift in acceptance takes place, those within the counseling professions find themselves needing to meet the needs of a growing population of people, namely sexual minority couples. Counseling professionals need to consider issues related to overt or covert microaggressions when working with same-sex couples. In surveying the characteristics of same-sex couples as well as the apparent similarities and differences compared to opposite-sex couples, it is fitting to note the onset of important caveats. The experience of homophobia and internalized homophobia is one common theme that counselors will encounter in addressing problems in same-sex relationships. The lack of support systems for homosexual couples is systemic throughout multiple societal domains, rooted by the view of sexual minorities as illegitimate.
One of the fastest growing industries over the past decade is that of home health care, with record numbers of aging baby boomers retiring, and some of them requiring a caregiver to assist them to remain independent in their home for physical and/or supervisory personal assistance. Functional support can be informational, emotional, or instrumental. Depending on the type of disability a loved one presents, a caregiver may be providing any combination of all three types of support. Disabilities requiring some degree of caregiving for younger persons include the need for instrumental support for those with severe cerebral palsy and muscular dystrophy from birth. As family caregivers are on the front line for providing care, they are also by default often required to provide monitoring of medical health status, identifying and in certain cases treating secondary complications, and coordinating with relevant medical professionals when needed about their loved one’s health status.
The social justice counselor (SJC) is essentially a new breed of contemporary counselor who no longer works with blinders on regarding a narrowed vision of counseling that focuses on treating a client’s symptoms while ignoring any external contributing factors of client distress. This chapter describes social justice counseling, its emphasis, why it is needed, and why all counseling disciplines should stay abreast of the topic, its counseling strategies, and the premise as to why social justice needs to be considered in counseling. Social psychologists and sociologists have long studied the psychological ramifications of inequality regarding the reciprocal effect of individuals’ interactions with their environment. The chapter explores the economic, health, and psychosocial ramifications of inequality and oppression to provide counselors with insights regarding the worldview and daily lives of the poor and oppressed in American society.
Pain is an “unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage". Pain can be acute or chronic in nature. The majority of clients seeking counseling services tend to have benign chronic pain. Chronic pain is pain that persists beyond the time one would expect normal healing to occur. Psychogenic pain is pain that has been diagnosed as being psychological in nature. It should be noted that psychological factors can influence the experience of pain in all clients who have chronic pain. Clients who have chronic pain are often involved in concurrent pain treatments in addition to counseling services. The cognitive behavioral approach to counseling has a positive effect when combined with active treatments such as medications, physical therapy, and medical treatments for chronic pain clients in treating pain, thoughts about pain, and pain behavior problems.
College is a time of great excitement, growth, and change for all students. The vast majority make it through their college years having lived up to the emotional and intellectual challenges that college presents and have fond memories of their experiences. The professional counselor who works with the college population is faced with unique diagnostic issues when conceptualizing the client. The traditional-age college student traverses many transitions and developmental stages that bring about stresses and strains that can affect the general mental health of the student. The professional counselor is aware of and uses both a developmental understanding as well as a clinical understanding of the student who presents himself or herself for counseling services. There is a growing perception among college counseling center directors that more students come to college with more severe psychological problems.
This chapter offers a description of the empathy fatigue construct as it relates to other professional fatigue syndromes, a recently developed tool that may be useful for screening and identifying professionals who may be experiencing empathy fatigue, and resources for self-care of empathy fatigue and building resiliency. Many counselors spend a tremendous amount of time and energy acting in compassionate and empathic ways searching for the meaning of their clients’ mind, body, and spirit that has been lost to trauma, incest, addictions, and other stressors that prompt questions concerning the meaning of their lives. As the professional counselor engages in therapeutic interactions, this may predispose the counselor to experience an empathy fatigue reaction that ranges on a continuum of low, moderate, and high. However, there are multiple risk factors that should be considered as identified in the Global Assessment of Empathy Fatigue (GAEF).
Clients are increasingly bringing their beliefs, values, and faith systems into the consultation room. Taken together, religion and spirituality have been a part of our world since time began, defining cultural boundaries, influencing the arts, affecting the direction of health care, causing and ending wars, and generally impacting the development of humanity. Religious and/or spiritual clients bring their beliefs and values into the consultation room as a part of their identity and culture. The mental health profession has recognized this shift as evidenced by a call for and an increase in published research; professional books targeted to the subject of spirituality and religion within counseling and psychology. As the counselor begins to develop the therapeutic relationship with the client, it is important to create a safe environment so that the client feels comfortable in bringing to the session those important issues that are in need of exploration and remediation.
Professional counselors working with children face many challenges that pose significant difficulties in behavioral and mental health treatment. Challenging behaviors in children include those behaviors that cause injury to self and others, cause property damage, interfere with the acquisition of skills, or result in isolation. There are ethical concerns that some parents may possibly reveal information to the counselor about parenting practices that may lead the counselor to suspect child abuse. Counselors can provide statements to parents about suspected child abuse-reporting laws and discuss those laws before beginning parent interviews. It is also required by counselor licensure laws that counselors disclose their philosophy of working with parents and children. The professional counselor should provide parents the opportunity to express their thoughts, feelings, and concerns regarding the reason they brought their child in for therapy. Clinicians can also assist parents in improving their children’s behaviors and performance at school.
Private practice for most counselors has been a goal. Currently, with licensure in all states, parity with other mental health professionals, and the ability to bill third-party payers, the goal has become more realistic. Being a well-trained and ethical counselor is the foundation for starting a private practice, but while being competent is essential, the challenge is to think outside of traditional training. Successful counselors in private practice are able to incorporate business principles into a counseling practice. As a counselor in private practice, one needs to see oneself as the chief executive officer (CEO) of a corporation, not only needing to make good clinical decisions, but also needing to make good business decisions. As a counselor in private practice, one needs to see oneself as an entrepreneur. An entrepreneur, as defined by Webster’s dictionary, is someone who “organizes, manages, and assumes the risks of a business or enterprise".
This chapter discusses the nuts and bolts of treatment planning and related issues. Treatment planning is an essential part of the counseling process. An effective treatment plan addresses clients’ presenting concerns and takes into account motivation, available resources, social context, preferred coping styles, and impediments to treatment. Clients’ social context is an important consideration in treatment planning. Culturally competent counselors understand that symptoms of emotional distress and the meaning that clients make of these symptoms are culturally bound. A counselor operating within the context of a particular theory will conceptualize the client’s presenting concerns and helpful interventions through the counselor’s theoretical lens. Interventions that reflect behavior change may be drawn from behavioral models, interventions that target exploration of feeling and meaning in the client’s life may be drawn from humanistic-existential and cognitive models, and interventions that target social networks might be drawn from systems models.
Burnout is a biopsychosocial concept defined as comprising a number of distinct work-related symptoms: emotional and mental exhaustion, physical depletion, decreased sense of professional efficacy, negative self-evaluation, depersonalization, cynicism, apathy, and indifference. Virtually all burnout studies find the same relevant factors as causal, varying only by occupation, current societal factors, and type of organizational structure and processes. The complexity of work, particularly the repetitiveness and difficulty with discrete job tasks, is related to the self-directed nature of the counselor’s work ethic. Training professional personnel is a constant activity in most human service settings. It is possible to prevent, reduce, or even cure burnout through training activities. The relationship between burnout and job expectations has specific origins. Burnout appears to be a significant personnel problem most neglected by human service administrators.
The therapeutic approach described in Reality Therapy achieved remarkable success, and the principles and practices were adopted by numerous counselors, especially those working with “hard to reach populations” such as disaffected youth and prisoners. Dr. Glasser, however, continued to update and revise not only the theory, but also aspects of recommended counselor practice. Reality therapy falls within the general category of cognitive behavioral approaches and provides a framework that gives focus and structure to the process of working with clients. Clients’ willingness to share their preferences and wants and consider the effectiveness of their own behavior is a crucial component of this approach. Client motivation is fostered by several factors, one of which is the attitude and perspective of the reality therapy counselor. A positive, trusting relationship is crucial to success, and the reality therapy counselor maintains an attitude of interest in and respect for the client.
This chapter explores various issues concerning providing counseling services to clients with terminal illness and their families, providing guidelines for counseling clients with terminal illness, working with terminally ill children, bereavement counseling strategies, and caregiver support. Counseling people facing death, and their families as they observe the decline of their loved one, requires compassion, empathy, and a conscious understanding of living and dying. In our death-denying culture, it is often extremely difficult to hear that one has an illness. The crucial component for counseling the dying is honest communication. Facilitating honest communication between the terminally ill person and the family is important to help ensure that the person is not isolated from them, which can occur when families are overly protective. After the death of the terminally ill person, family members may continue to need emotional support and counseling.
Existential-humanistic (E-H) psychotherapy is a coalescence of American humanistic psychology, which emphasized optimism, potential, and relatively rapid transformation, with European existential philosophy and psychology, which underscored challenge, uncertainty, and relatively gradual transformation. E-H therapy is characterized by the cultivation of freedom, experiential reflection, and responsibility. EI therapy, or the apprehension of diverse practice modalities within an overarching existential context, is one of the latest trends within E-H practice. This therapy has the advantage of addressing a broad array of clients, diagnostic issues, and therapeutic settings. The aim of EI therapy is to facilitate client freedom. E-I therapy proceeds on the basis of clients’ desires and capacities for change, and the liberation conditions available to impact those desires and capacities. In short, the E-H therapeutic orientation provides a deep and broad alternative to mainstream emphases on physiological, behavioral, or cognitive change.
The practice of behavior therapy has many features in common with that of other forms of psychotherapy, for example, the development of a collaborative working relationship between client and therapist. Behavior therapy is distinguished by its use of particular techniques to address specified problems, by its allegiance to psychological experimentation, and by its commitment to empirical validation. In application to the treatment of anxiety and related disorders, behavior therapy drew inspiration from studies of classical conditioning and experimental neurosis. Systematic programs of gradually confronting feared situations therapeutically, in the imagination or in real life, are familiar features of contemporary behavioral practice with anxious clients. Behavioral assessment is designed to provide detailed information that focuses and directs behavioral treatment. Treatment techniques involving self-control and self-management are viable because clients can alter the contingencies affecting their own behavior.
This chapter reviews the evolution of psychoanalysis and the psychodynamic therapies from Freud’s time through the present, emphasizing the implications of the major psychoanalytic theories for psychotherapy and counseling. Foundational theoretical and technical concepts in this tradition are italicized. Space limitations prevent covering analytic ways of helping children, couples, families, groups, and organizations; instead, concentration is put on psychoanalytic approaches developed for individual adults. Although contemporary psychoanalytic therapies have diverged considerably from their Freudian base, the core ingredients of all psychodynamic approaches are present in Freud’s early work. These factors include an appreciation of unconscious processes, a valence to all mental life, a developmental viewpoint, the inevitability of conflict and defense, and the ubiquity of transferential processes. Alternative therapy paradigms, including those that have reacted against psychoanalysis, have incorporated many concepts from the psychodynamic clinical tradition.
African Americans constitute approximately 14% of the American population. They have been an integral part of this society since its conception, yet they face a myriad of issues. These issues include health issues, employment issues, health insurance issues, racism, and discrimination. In the area of employment, the unemployment rate for Blacks is more than twice as high as the White population, and the poverty rate is approximately three times as high. Racism and poverty are manifested in African American incarceration rates. The term African American as a descriptor includes many segments of the American population, including populations brought to America from West Africa during the slave trade. Many African American children have self-respect and positive self-esteem despite the specter of racism and discrimination. Religion and spirituality are an important part of American culture and this is no less so for the African American community.
We are in the midst of a paradigm shift in the helping professions as a result of new extraordinary stressful and traumatic events that have accelerated globally. While medical professionals, police, and other first responders prepare for the medical-physical rescue in a host of disaster scenarios, professional counselors are also called on to provide the mental health rescue. The disaster scenarios that take place on the global media stage add another dimension of reality that negatively fuels our experience of empathy fatigue. Overall, the epidemiological significance of global disaster rehabilitation means that we must be in a constant state of “mission readiness” for service to assist others that may be affected locally, regionally, or nationally. Counselor empathy and insight in acknowledging that oppressed minorities’ daily lives may include food insufficiency and the need to deal with these basic survival necessities must take precedence before any mental health counseling can occur.
Codes of ethics must undergo periodic revision to ensure that the contents of the code reflect current trends and issues in counseling practice. This chapter provides a brief overview of some of the more common ethical and legal terms counselors may encounter in ethical complaints. Often one of the most confusing concepts for counselors is credentialing. A credential simply indicates that a counselor’s education and experience have been reviewed by a professional or legal body, and he or she can legitimately hold himself or herself out as a professional possessing specific knowledge and skills that meet the minimum standards of the profession. The chapter discusses professional ethics committees and state licensure boards. It also explains the court system briefly as it applies to ethical complaints in counseling. There are four legal entities that regulate the practice of counseling: professional ethics committees; state licensure boards; criminal courts; and civil courts.
The 2014 edition of the ACA Code of Ethics raises the bar for the ethical practice of professional counselors and is the first edition of the code that delineates the core values of the counseling profession. This chapter provides an overview of new concepts and professional responsibilities in such areas as professional values, ethical decision making, avoidance of the imposition of counselors’ personal values, counselor education, social media, and distance counseling. It concludes with a list of resources for learning more about the ethics code for the counseling profession. The Ethics Revision Task Force (ERTF) spent time researching and discussing counseling codes of ethics from around the world. The counselor-in-training cited personal religious beliefs as the basis for their decision. In order to protect a client’s privacy when conducting distance counseling, the revised ethics code requires counselors to verify a client’s identity at the beginning of each electronic session.
This chapter addresses what counselors need to know about professional credentialing, including trends and considerations that counselors may need to monitor. It concludes with basic tips for counselors interested in licensure and certification. Professional credentialing is critical to defining and regulating the practice of counseling. Licensure, certification, and accreditation are distinct forms of professional credentialing. Although each serves the common purpose of protecting public safety by establishing the minimum standards of knowledge and skill for professional counselors. Credentialing is likely to evolve rapidly as the U.S. health care system becomes more politicized. With such progress in professional credentialing, professional counselors need to look ahead for opportunities and challenges in licensure laws and national certification standards. The variety of counselor licensure laws nationally presents a serious problem for professional counselors in their ability to move from state to state without disruption and the ability to practice counseling.
The priorities of community mental health services exerted further pressures toward brief interventions that could reach more clients. Many health care systems in the United States have been developing practices such as managed care to reduce the number of psychotherapy sessions. This chapter defines brief psychotherapy, provides an overview of the types of brief psychotherapy, and outlines some of the major theoretical concepts and techniques associated with each of these therapeutic approaches. Brief therapy is dependent on the type of mental health condition, onset of the disorder, degree of client motivation, and the therapist’s ability to establish an effective therapeutic alliance and assist clients in attaining therapeutic goals. The values of brief therapists tend to be different from those of traditional, long-term therapists. Brief therapists also take the client’s presenting problem seriously and believe that understanding why a problem has arisen is often secondary or irrelevant to producing client change.
- Go to chapter: Integrative Approaches in Counseling and Psychotherapy: Foundations of Mind, Body, and Spirit
This chapter offers guidelines and resources that will assist therapists to integrate traditional talk therapies with indigenous health and healing practices. Additionally, it offers foundational principles, thoughts, beliefs, ancient wisdom, and philosophies on mind, body, and spiritual wellness. The comprehensive foundational resources at the end of the chapter explore the literature in counseling, psychology, theology, spirituality, and complementary and integrated medicine. Each of these resources honors the tradition of various culturally relevant indigenous practices that integrate the mind, body, and spirit. In many ways, person-centered counseling and psychotherapy are ritualistic in their form, structure, and practice. Likewise, indigenous healing practices also maintain a form, structure, and ritualistic system for health and healing. The author makes an attempt to objectively state 30 specific foundational cultural beliefs through an extensive literature base in psychology; theology; spirituality; and complementary, alternative, and integrated medicine.
This chapter defines job satisfaction, examines the literature linking occupational choice to job satisfaction and describes the relationship between work satisfaction and well-being. The relationships among occupational choice, job satisfaction, and life satisfaction are important issues for counselors to consider no matter what specialty or setting they are in, as the problems or stress clients experience in one of these domains may affect the other and may overall decrease their sense of well-being. Job satisfaction has been studied from different perspectives, including organizational or sociological perspectives and psychological or career perspectives. Career theories and theorists have often approached the issue of job satisfaction and the meaning of work from a person-environment interaction framework. Research indicates that satisfaction in work potentially spills over into satisfaction in life; therefore, counselors’ awareness of the way the occupational choice contributes to the meaning and importance of work is a critical component of counseling interventions.