The passage of the 1996 Health Insurance Portability and Accountability Act (HIPAA) was originally an effort by Congress to ensure portability of health insurance between jobs for American workers. This chapter provides a brief overview of HIPAA regarding mental health services, compliance issues for providers, filing and investigating complaints, violation penalties, a list of terminology, and resource links for more detailed information. Patients must be informed of their rights and are required to sign the appropriate forms authorizing the health care provider to obtain and/or provide information to other health care providers as relevant. All psychotherapy notes recorded on any medium by a mental health professional such as a licensed counselor or psychologist must be kept by the author and filed separately from the rest of the patient’s medical records to maintain a higher standard of protection.

Perceived prejudice events are recognized as stressors that are linked to lowered mental health for those who experience such events. Frequently misrepresented and even vilified in the press, Middle Eastern Americans are routinely negatively portrayed in the media and entertainment and are often the victims of stereotypes. Religion plays an integral role in the lives of many Middle Eastern Americans and may be a central component of their identity. The family is the central structure of Middle Eastern culture and plays a critical role in Middle Eastern social origination and in collective identity. Middle Eastern Americans may have a general skepticism of the authority of mental health professionals, in part due to the negative connotations of mental illness. The concept of mental disturbance may be difficult for them to accept as a diagnosis.

This chapter provides readers with an overview of the roles, functions, and knowledge base of counselors and addresses the professional issues that influence the identity and practice of counselors today. The primary role of a counselor is to assist clients in reaching their optimal level of psychosocial functioning through resolving negative patterns, prevention, rehabilitation, and improving quality of life. Rehabilitation counselors work with clients with disabilities and/or chronic illnesses, including those with psychiatric conditions, in settings such as state vocational rehabilitation agencies, hospitals, and so on. Addiction counseling, a recently acknowledged master’s-level counseling specialty, involves working in the substance abuse/addictions field and provides addiction prevention, treatment, recovery support, and education. The shared practice and knowledge domains of counselors and other helping professions coupled with the diversity within the counseling profession has, on the one hand, produced a rich, comprehensive, and inclusive field.

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.

The professional counselor often takes on the role of resource broker. A resource broker is a professional who helps the client to identify, access, and successfully use any vendor who can provide a service or material good necessary to operationalize the client’s service plan, that is, meet the client’s developmental needs or therapeutic goals. Success as a resource broker depends on the professional counselor having in-depth knowledge about community and professional resources. A resource broker is a professional who helps the client to identify, access, and use any vendor who can provide resources necessary to operationalize the client’s service plan. Resource brokers act in a liaison role among the client, the organization serving the client, and outside organizations from whom it is necessary to secure resources. The professional counselor, with whom the client is in a developmental or therapeutic relationship, is the ideal person to serve as resource broker.

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.

The history of counseling is a fascinating evolutionary process, particularly how the profession developed, and how quickly it has evolved through the professionalization process during the past half century. This chapter reviews and highlights the major events that led to the development of professional counseling, including the numerous professional specialty groups that make up the family of professional disciplines in counseling that provide services to clients in diverse practice settings. One of the critical issues that continues to challenge the counseling profession and related specialty areas are professional identity and professional unification. The unique divisions within the American Counseling Association (ACA) represent areas of specialized practice and special-interest areas that relate to a broad constituency of counselors regardless of their specialty areas of practice. Examination and certification standards for the certified rehabilitation counselor (CRC) credential have been established through empirical research throughout the Commission on Rehabilitation Counselor Certification’s (CRCC) history.

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.

Within rehabilitation counseling practice, clinical supervision is a process fundamental to one’s professional training and ostensibly to one’s ongoing professional development. This chapter addresses additional information relevant to current practice as it pertains to effective, ineffective, and harmful supervision as well as strategies to address the lack of training in clinical supervision, which seems to exist in the rehabilitation counseling field. This process involves individual, triadic, and group supervision formats through direct and indirect observation methods where supervisors function within acceptable ethical practices to promote counselor awareness, knowledge, and skills that result in successful rehabilitation outcomes. Although clinical supervision is an activity that, to varying degrees, each rehabilitation counselor participates in and may benefit from, we have limited understanding as to what constitutes evidence-based practice to inform the field. A long-term strategy would be to teach clinical supervision content as a separate course of clinical fieldwork for rehabilitation counselors-in-training.

Human history suggests that humans have coped with hearing loss and Deafness for centuries, because it was addressed in some of the world’s most ancient texts, including the writings of Plato and Aristotle, the Torah, and the Talmud. A person who is Deaf or hard of hearing from birth or in the first days of life has a congenital hearing loss. Mixed hearing loss results from a combination of both conductive and sensorineural causes. The distinction between medical hearing loss and membership in the cultural group is made by capitalizing the term Deaf when referencing individuals in the Deaf cultural community. Cultural transmission is primarily a function of residential schools for the Deaf, and for this reason, the Deaf community strongly resists public school mainstreaming or inclusion. Treatment and management of hearing loss are very important and usually involve provision of assistive listening devices.

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.

Feminist therapy was born during the Feminist Movement of the 1960s and 1970s in protest over the oppression of women receiving treatment in counseling and psychotherapy. These practices start when children are born and they continue throughout their lifetime as gender-role socialization. To fully understand Feminist therapy, counselors need to first appreciate the issues involved in gender socialization and oppression. The oppression of women is evident when one considers that, regardless of occupation, there is a wage gap between men and women doing the same job; the glass ceiling that is reflected in the absence of women at the highest levels of business, industry, and education; sexual harassment of women; domestic violence in which women are most often the victim. Feminist counselors work to help clients understand the family history, internalized messages, and the effects of the socialization process on their presenting issue.

The definition of career encompasses one’s vocational behavior across the life span. Although the field of career counseling is developmental in both nature and definition, there are few theories that have specifically focused on this aspect of career counseling. This chapter focuses on highlighting a few of those career development interventions that have been shown to be effective and how they can be appropriately utilized across a person’s life span. It discusses aspects of diversity that offer their own unique challenges across the life span and are currently a priority topic in career development. Career guidance techniques in the elementary school setting might include curriculum infusion such as reading reference books and storytelling, group activities such as role-playing, and, finally, community involvement activities such as field trips and inviting local businesses to the school. Career counselors need to be cognizant of sexual identity models, regardless of a person’s developmental aspect.

This chapter covers two kinds of situations where the leader has to deal with involuntary members: all members not wanting to be in the group, and one or more members not wanting to be there. In groups where the entire group does not want to be there, the leader must recognize that he or she has two purposes: to try to cover the subject, such as anger, drinking, and driving, and to try to get the members to become voluntary. Many counselors find themselves leading involuntary groups groups with members who do not want to be there. These kinds of groups may include driving under the influence (DUI) groups, short-term inpatient groups where members have had psychotic breaks or tried to commit suicide, long-term inpatient groups such as drug and alcohol treatment centers or adolescent treatment centers, and school groups where students are in trouble for their behavior, truancy, or failing.

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.

Feminism is a social and political movement that focuses on improving the status of women and establishing equity among men and women. This chapter introduces the utility of multiracial feminism within clinical practice, particularly with women of color. It provides brief overviews regarding feminist theory, critiques of feminist theory, and feminist therapy. Lastly, although the term women of color is used within the chapter to reference ethnic minority women, it is used to recognize other social locations beyond race and gender, to include lesbian, poor, disabled, older, and non-American women. While gender inequality is a cornerstone of feminist theories, feminist theories of the past half-century can be grouped into three broad categories: gender reform feminisms, gender resistance feminisms, and gender rebellion feminisms. Various counseling and personality theories can also be integrated within feminist approaches. In addition, contemporary feminist therapy includes men, both as clients and therapists.

The individual psychology of Alfred Adler is based on a holistic and phenomenological understanding of human behavior. Adlerians believe that all behavior has a purpose and occurs in a social context, noting that one’s cognitive orientation and lifestyle is created in the first few years of life and molded within the initial social setting, the family constellation. The Adlerian theory purports that humans are all social beings and therefore all behavior is socially embedded and has social meaning. Adlerian psychotherapy is a psychoeducational, present/future-oriented, and time-limited approach. The Adlerian approach is a contemporary therapy as it is cognitive behavioral, culture-sensitive/ multicultural, and integrative. The four stages of Adlerian therapy are as follows: relationship, assessment, insight and interpretation and reorientation. This is believed to be a good strategy because the Adlerian theory gives counselors an overall framework from which to use a host of other methods that might appeal to them.

Many Hispanics/Latinos have a high need for mental health services. Their emotional needs include issues around ethnic identity, immigration, acculturation, and discrimination. It has been suggested that H/Ls’ risk of mental illnesses is closely associated with the duration of stay in the United States, suggesting an inverse relationship to acculturation. Research suggests that compared to Anglo Americans, Hispanics have less access to and availability of mental health services, are less likely to receive needed mental health services, often receive a poorer quality of mental health care, and are under-represented in mental health research. The treatment of H/L men by psychotherapy remains one of the most challenging of all endeavors for the psychologist or therapist. Counselors must be culturally sensitive when treating H/Ls, keeping in mind traditional family patterns and gender norms, as well as other stresses that influence or can present as a mental health concern.

The purpose of this chapter is to acquaint therapists with the major concepts of disability-affirmative therapy (D-AT), focusing on five key concepts: special knowledge areas; using the models of disability clinically; making treatment accessible; case formulation; and being culturally affirmative. A basic tenet of D-AT is that incorporating information about disability will inform the case formulation such that it neither overinflates nor underestimates the role of disability. These are the effects of disability on developmental history, understanding models of disability, disability community and culture, and psychosocial issues. Adolescents with disabilities, particularly developmental or intellectual disabilities, may not be taught about sexuality. In the Medical model, disability has been stripped of the moral symbolism, and now is seen as representing abnormality contained within a person’s corporeal self. Such abnormality is the province of medicine, and intervention focuses on amelioration of the abnormality to the greatest extent possible.

To develop an appreciation for the electronic health record (EHR) it is important to understand the barriers to its adoption among mental health professionals. This includes the belief that it is easier and more convenient to document care using paper and pen. The chapter mentions a scenario, where even if the emergency room personnel were able to gain access to the patient’s paper medical record, they would have had a hard time understanding the record’s content. Another common problem with the paper record is the lack of organization especially under circumstances in which the patient has multiple mental health issues. After addressing a major concern with EHRs among mental health professionals and the inherent problems with paper records, the chapter focuses on the functionality that makes the EHR an appealing proposition. When health care data are stored electronically, the capability to share data among health care providers is heightened.

A brief description of the practice of Gestalt therapy is offered and presented here under its four primary theoretical constructs, but a more in-depth description following this same development can be found in The Handbook for Theory, Research, and Practice in Gestalt Therapy. The unity of Gestalt therapy theory does not refer to one grand design originated by one comprehensive theorist. To practice Gestalt therapy requires experiential training and supervision. Finally, the Gestalt theory is unified in Gestalt’s holistic approach. The therapeutic relationship is perhaps one of the best-attested factors with regard to outcomes in psychotherapy. The entire therapeutic relationship could be considered experimental, because at one level it is the provision of corrective, relational experience for many clients. Thus, there is a corollary between nondirective play therapy in working with children and the experimental approach of Gestalt therapists working with adults.

Clients have the freedom to choose whether to enter into or remain in a counseling relationship and need adequate information about the counseling process and the counselor. Professional disclosure statements disclose to clients the nature and boundaries of the counseling relationship they are about to enter. All states’ counselor licensure boards have their own requirements for topics to include in professional disclosure statements, and these may vary slightly from the standards in the ACA Code of Ethics. A major challenge in developing a written disclosure statement is balancing the need to include enough information to clearly communicate the nature and parameters of the counseling experience and the need to avoid providing so much information as to overwhelm and intimidate the client. For example, counselors employed in organized work settings, such as mental health, rehabilitation, or addiction programs, will provide different information in some areas, such as fees for services.

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.

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.

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.

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.

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.

The uniqueness of Native American Indian (NAI) people in the United States is founded on rich and diverse cultures that have enabled this population to survive severe political, economic, and environmental hardship. Counselors, psychologists, psychiatrists, and other mental health providers and therapists have an obligation to bear in mind the cultural differences of all clients in their vulnerable states. Respect for cultural beliefs and ways of living and thinking, regardless of how alien they may seem to the caregiver, will encourage the Native client to develop trust and more fully participate in his or her own healing process. It is important that therapists learn as much as they can about the NAI client because of the importance their identity and beliefs have for them as people with proud histories. In contrast, majority or White culture emphasizes saving, domination, competition, individualism, a future time orientation, and the nuclear family.

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.

Community-based rehabilitation (CBR) originated in 1978 as a strategy for improving rehabilitation services and outcomes for people with disabilities living in low-and middle-income countries who were not well served by traditional medical-model rehabilitation. CBR enlists and empowers the person’s social network from family to community to provide and sustain a network of care and support, create opportunities for participation, and remove physical and attitudinal barriers to inclusion. Guidelines for CBR practice are ensconced in the five key components of the CBR matrix: health, education, livelihood, social, and empowerment. Poverty and its consequences are a particularly central concern to CBR planning as a prerequisite to robust community health and health care. Empowerment is the starting point for CBR planning, acting as an organizing feature of the plan, and the source of its motivation for success.

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.

Experts in the fields of special education and rehabilitation recognize that the transition process must include the provision of quality services for all youth with disabilities as they prepare to leave school. Transition for any student with a disability involves several key components, including an appropriate school program; formalized plans involving parents and the entire array of community agencies; and multiple, quality options for gainful employment and meaningful postschool education and community living. Facilitating a student’s transition from a school program to the workplace requires movement through school instruction, planning for the transition process, and placement into meaningful community-integrated employment. Traditionally, rehabilitation counselors working with a public agency have spent most of their time in case management rather than counseling responsibilities. As a member of a transition planning team, the counselor may also assume a role of ensuring dissemination of accurate information to parents and educators.

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.

This chapter provides a contextual discussion in which to understand sexual minority people of color. The term sexual minority people of color represents a diverse group of people; in many ways, it is an imprecise construct to describe the many unique specific characteristics and concerns of individuals generally included under this umbrella term. This term is used in the chapter in an effort to reflect the diverse racial identity and sexual identity expressions among individuals often labeled as “people of color” and “LGBTQ” (lesbian, gay, bisexual, transgender, and questioning). It discusses some of the psychological, sociopolitical, and sociocultural concerns of the group. The chapter also discusses some of the unique experiences of this group broadly to provide an overview of the issues that many people of color may experience that mental health practitioners need to know when working with members of this group.

Of the eight core areas that the Council for Accreditation of Counseling and Related Educational Programs requires in all counselor education programs, two are concerned with development: human growth and development, and career development. One may ask why career development merits its own distinct category and is not just subsumed under human development. The roots of our concern with human development extend back to the Enlightenment of the 18th century, with its emphases on rational thinking, scientific method, and the rights of the individual. Although trying to stay within the new paradigm by casting his theory as a personality theory because it describes different types of persons, Holland was primarily concerned with the match between these types and occupations that call for people of that type. In the 1970s, a heightened interest in cognitive processing and in strategic decision making emerged across a range of academic disciplines.

This chapter addresses work in the context of disability and provides a choose-get-keep framework for examining vocational development and work issues in counseling. It also discusses implications for counseling. Many helping professionals focus on the medical condition or diagnosis as defining disability. The presence of a health condition or symptoms is not the sole cause of disability but may contribute to limitations in functioning, and not all health conditions lead to disability. The legislative environment also affects work and disability. Counselors must be prepared to discuss the functional limitations that the individual experiences that may be attributed to a physical or mental impairment related to the first part of the definition of disability. Vocational development may be affected by disability in a number of ways. Disability that occurs from birth, or in childhood or adolescence, may delay development of vocational identity.

This chapter offers a practical approach for facilitating disaster mental health and stress debriefing groups using a combination of crisis response models; specific guidelines for structuring such interventions and responding to individuals and groups; and resources to assist in personal and professional growth in the specialty area of disaster mental health response. Additionally, three case scenarios are provided at the end of the chapter for the purpose of practicing the skills of disaster mental health and stress debriefing interventions. Initially, the preintervention and planning stage is critical in assessing, coordinating, and communicating with others on the disaster team concerning the trauma survivors’ psychological, spiritual, and medical/physical level of functioning. The ethical and competent disaster mental health practitioner knows that he or she should never force emotions or shame individuals for not disclosing, especially early on in the grieving and healing process.

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.

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".

Rational emotive behavior therapy (REBT) is a founding cognitive behavioral approach to treating psychological problems and is the basis for most of the cognitive behavioral approaches as studied and practiced today. REBT is a modern interpretation and outgrowth of the Stoic and rationalist schools of philosophy. The REBTer distinguishes between appropriate negative emotions and inappropriate negative emotions. REBT demonstrates the applicability and practical usage of its psychotherapeutic message. The main demands in REBT that constitute a wide variety of disturbances can be categorized as Three Main Musts, and their corollaries. All of these beliefs interact and affect each other in nuanced ways, and the experienced practitioner would explore how that occurs. Most of these salient beliefs contain demands, in the form of Musts: musts on self, musts on others and musts on the world, and conditions.

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.

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.

This chapter provides a review of key evidence-based practice (EBP) concepts and discusses how this approach can be effectively implemented to improve the professional practice of rehabilitation counseling. EBP is particularly relevant to the rehabilitation counseling profession in this era of accountability, best practices, and quality outcomes. Rehabilitation counselors have been incorporating empirically supported interventions used by counseling professionals and vocational rehabilitation (VR) professionals that are validated by disability and rehabilitation researchers. However, there are still not enough rehabilitation counseling interventions that are developed and validated specifically for people with disabilities. Dunn and Elliott argued for the supremacy of theory and its place in rehabilitation research. With greater efforts to conduct meaningful theory-driven and intervention research, it will enable rehabilitation counselors to truly engage in EBP to improve employment and quality of life outcomes for people with disabilities.

This chapter briefly highlights existing literature and research concerning identity development formation and the coming-out process for lesbian, gay, and bisexual (LGB) individuals. It then focuses more specifically on cultural issues that exist within the LGB community and more closely focuses on counseling considerations that will assist mental health professionals to work more effectively with LGB clients of color. Sexual identity development models were constructed to better understand the coming-out process for LGB individuals. Specifically, LGB identity models provided a conceptual framework to describe the psychological and sociocultural identification as a LGB group member. Social supports relative to racial or ethnic identity may not be the same social supports relative to the LGB community. Counseling professionals may find that LGB people of color often struggle to reconcile their feelings of homonegative beliefs and their desire to practice their form of religion or spirituality.

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.

This chapter focuses primarily on one of the core qualities of the professional counselor: a commitment to wellness. Interrelated with development, personal growth, and prevention, wellness informs the way counselor assess client needs, develop and implement wellness plans, and evaluate client outcomes. The wellness paradigm, in contrast to the medical, “illness-oriented” model of client care, shifts the focus to facilitating optimal growth and development in clients. Remediation of many disorders may be reconceptualized as helping clients overcome developmental challenges through positive lifestyle choices; growth itself can become the target of counseling. While discussing wellness components, self-assessment is needed to personalize the meaning of each factor for clients. Using a psychoeducational model to teach wellness components allows clients to see how change in one area contributes to changes in others, and helps them review the components of holistic wellness.

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.

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 discusses career development theories in four different categories: personenvironment fit, developmental, social learning, and postmodern career development theories. The leading developmental career theory is Donald Super’s life span, life space theory. Super’s theory drew on a variety of disciplines, such as psychology and sociology, and developed what he called a “differential-developmental-social-phenomenological career theory". Postmodern career development theories emphasize a person’s subjective career development experience or his or her understanding of his or her career development journey as it takes place. The contextual theory views career development as dynamic, allowing for individuals to achieve meaning through their own actions within their social environment. Integrating theoretical orientations related to individual difference and individual development provides the fullest explanation for those seeking to understand the career development process. Such integration also links career development to human development, which represents an important next step in the evolution of career development theories.

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.

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.

This chapter explores some of the possible underpinnings behind Sue and Sue’s citation that in counseling situations with minorities, more than 50% of clients do not return for a second visit with a counselor. This potential elephant in the room may lie deep within the past history of cultural distrust that many persons have toward the White race in America through stories that are passed down by their parents and grandparents. The chapter discusses a brief history behind some of the transgressions by White Americans toward racial and ethnic minorities to provide counselors with some perspective on the possible reasoning behind each minority group’s lack of trust. It explores those characteristics of culture that transcend time, acts of legislation, and cursory attempts at equality. Ethnic and racial minorities in the United States are still connected to yet vivid histories of segregation, oppression, marginalization, and discrimination.

This chapter provides a primer of knowledge with the aim of increasing skills for professional counselors working with LGBTQ individuals, couples, and families. People today can see television shows with lesbian, gay, bisexual, transgender, or questioning (LGBTQ) characters, same-sex couples, married same-sex couples raising children, as well as art depictions of diverse, modern families. Despite the numerous civil rights advancements made by the LGBTQ community, many state legislators and attorney generals have argued that allowing gay men and lesbians to marry will harm the institution of heterosexual marriage. In addition, traditional family organizations have worked to impede or overturn the civil rights progress made by the LGBTQ community. Same-sex individuals and couples form families tantamount to heterosexual individuals and couples. Heterosexual marriage remains one of the most common ways that LGBTQ parents acquire children.

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.

This chapter reviews dimensions of effective intake interviewing, including preparation, skills, cultural competency, informed consent, and format. Preparation is important for the effectiveness of an intake interview. This includes attention to space in which the interview will be conducted, a review of available client information, and consideration of the purpose of the interview. An intake interview relying primarily on questions may leave clients feeling disconnected from the counselor and discouraged about the potential benefits of the counseling process. The structure and the breadth of the intake interview is determined by many factors, including where the counseling is taking place, accreditation and insurance requirements, and the intensity of clients’ distress or level of functional impairment. An effective interview allows the counselor to accurately understand clients’ presenting concerns, collaboratively consider outcome goals, develop a supportive relationship, and promote hope about the benefits of the counseling process.

The relatively high rates of marriage and low rates of divorce, along with a greater tendency to live in extended family households, indicate a strong orientation toward family among Asian Americans, for whom it serves as an important source of strength and resiliency. Asian Americans’ self-worth and self-identity are strongly tied to their collective identity as members of a family. Characterized as faithfulness to parents, this value is very significant and is exemplified by children offering respect, honor, loyalty, dutifulness, and sacrifice to their parents. Asian Americans may be accommodating, appeasing, and amenable, refraining from openly confronting others in order to maintain interpersonal harmony. The valuing of interpersonal harmony can result in the client striving to build a strong working alliance with the counselor. Asian Americans are distinguished by the extremely low levels at which outside treatment is sought for mental health problems.

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.

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.

This chapter clarifies differences between two aspects of supervision and reviews the need to evaluate training interventions to improve clinical supervision competence. It examines evidence-based practice as it relates to qualities and competencies needed to work as an effective clinical supervisor. The chapter addresses the benefits of using group supervision and its potential for developing multicultural competence; examines possibilities through distance supervision; and concludes with a brief discussion of the importance of ethical standards in clinical supervision. It provides foundational material that is expounded elsewhere in this desk reference as applied to rehabilitation counselor supervision practice. Using the available information from various clinical and research sources to inform the professional field is commonly referred to as evidence-based practice. In general, supervisors who are knowledgeable about counseling theory and practice and help supervisees to develop a deeper understanding of clinical issues through constructive feedback, demonstrate respect and concern for their supervisees.

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.

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.

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 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).

This chapter presents an overview of the principles and skills of the counseling style. Motivational interviewing (MI) is a clinical style, a form of psychotherapy, which is “a person-centered goal-oriented approach for facilitating change through exploring and resolving ambivalence". Applications of MI in health and mental health are increasing. Mental health studies have encompassed dual disorder management; mental health treatment; problem gambling counseling; sexual behavior change. The microskills can be used in any counseling context. Ambivalence is central to the philosophy and practice of MI. It is a discrepancy between a counsel-ee’s behaviors and how he or she wants to be that is elicited and reinforced in the direction of change. MI has good evidence for effectiveness, and training in the style can potentially improve outcomes in a range of treatment contexts.

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.

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.

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.

The terms sexual abuse and sexual assault are frequently used interchangeably in the literature to indicate sexual acts with a person who does not give consent. When these acts are also accompanied by physical force, death threats, incapacitating substances, or kidnapping, the term aggravated sexual abuse is applied. Sexual abuse is commonplace, but the actual prevalence of sexual abuse is difficult to determine because there is no central agency responsible for the gathering and assimilation of these data. Abuse can be reported to a number of agencies that do not share information, such as government and legal entities, medical facilities, mental health services. Unresolved sexual abuse may result in somatic reactions, negative thoughts and beliefs about the self, negative emotions, destructive behaviors, and interpersonal problems. A number of additional issues may require therapeutic interventions if the sexual abuse was intrafamilial, including addressing the mother-victim relationship and the perpetrator-victim relationship.

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.

A national expert on managed care was invited to help explain what counselors were up against as they tried to be recognized as providers on insurance plans. Managed health care plans negotiate lower prices with therapists so that employers can give their employees discounted services. There are three types of managed health care plans: health maintenance organization (HMO), preferred provider organization (PPO) and point of service plan (POS). All licensed counselors who work with insurance and managed care plans must use the national provider identifier (NPI) number when filing an insurance claim. The specter of managed care has caused anxiety and frustration for counselors, but many times the issues can be tackled with an old-fashioned problem-solving approach. A medical billing software system allows the counselor to keep patient information on the computer and send claims directly to a clearinghouse that will format and send the claim to the insurance carriers.

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.

This chapter presents an overview of a guiding model for clinical practice for the use of homework with a broad spectrum of clients and presenting problems. As with many aspects of clinical practice, these guidelines will be most effective if tailored to meet the individual client’s goals for therapy. The chapter provides suggestions for increasing counselors’ skills in incorporating homework assignments into the therapy process. This material is primarily based on the work of Aaron T. Beck’s cognitive theory and system of psychotherapy. Certainly, behaviors and cognitions are commonly addressed by homework, but better accessing of emotions, or addressing interpersonal relationships, are examples of other directions that homework can take. A theoretical framework to explain the mechanisms behind how clients engage in homework assignments, and how such successful engagement can augment psychotherapy 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.

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.

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.

This chapter provides a general overview of the cognitive behavioral history, model, and techniques and their application to counseling practice. Cognitive behavior therapy (CBT) originally evolved out of two traditions, the behavior therapy tradition and the psychodynamic tradition. Behavior therapy was one of the first major departures from the more traditional, psychodynamically oriented approaches to therapy. Through the use of Socratic questioning, CBT involves an ongoing assessment of the person and the problems throughout the therapy experience and is very sensitive to the idiosyncratic nature of an individual’s problems. Once cognitive, behavioral, and emotive patterns are identified for change, the CBT therapist begins to introduce a variety of focused techniques to facilitate this process. Behavioral interventions can be especially helpful in promoting change in individuals who have a harder time making elegant core belief changes through cognitive methods.

Counselors seek to understand their clients; based on that understanding, they establish a therapeutic alliance and, in cooperation with the client, develop treatment goals. Greater numbers of persons with physical, cognitive, emotional, and psychiatric disabilities seek counseling services due to the following factors: the growing number of people with all types of disabilities; more complete integration of people with disabilities (PWDs) into the broader culture; growing awareness that anyone can acquire a disability; and a rising Disability Rights movement, which is advocating for civil rights and a higher standard of living for PWDs. Counselors may avoid dealing with disability issues, or they have restrictive ideas about the roles of PWDs, and counselors may not expand the range of roles and behaviors available to their clients with disabilities. Individual counselors and the counseling profession are faced with the task of questioning our assumptions about disability and the individuals who experience them.

This chapter explores two separate occurrences in the counseling process: clients who do not return after the first session, and effectively dealing with early termination of counseling. Most practitioners are all too familiar with one or both of these phenomena in counseling and are often left wondering what happened during the process for it to end prematurely or to never begin. The chapter addresses probable reasons why clients do not return following the first session and offers practical strategies regarding how to minimize this occurrence. Professional disclosure provides clients with answers to many questions they might otherwise have about the process, policies, and procedures. Treatment goals and length of treatment will vary depending on counselor theoretical orientation. Cognitive behavior therapy, is usually short term, focusing primarily on symptom reduction through the development of client coping skills and self-efficacy, and less emphasis on the client-counselor relationship.

This chapter discusses the challenges counselors typically encounter when working in rural communities as well as suggestions for maximizing the opportunities that rural practice provides. Because of stressors characteristic of rural areas, such as poverty, single parenting, less formal education, unemployment, lack of health insurance, stigma surrounding mental illness, and inaccessible or inconsistent community resources, few opportunities may exist for receiving mental health care. In terms of mental health service delivery, Human and Wasem suggest that availability, accessibility, and acceptability are important aspects to consider in rural communities. The use of communications technology in the educational, clinical, training, administrative, and technological aspects of health care is known as telehealth. Telehealth can vary from e-mail communication to videoconferencing to more advanced computerized therapy programs. One of the most salient ethical issues in providing therapy in rural areas is that of dual relationships.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Counseling techniques that focus on communication training and family therapy may have developed as remedies for such problematic interpersonal coping strategies. The implication for counseling is that models for interpersonal negotiation and gender role flexibility may be lacking in some southern European American homes. Many treatments for European Americans are already part of the traditional counseling practice. Sometimes issues that arise in counseling a White American client may be related to a lack of understanding of the impact of privilege on the client and ignorance related to race. Some scholars have noted the lack of emphasis on encouraging White people to explore what it means to be White or have called for White people to explore their own cultural identities. When counseling White Americans, the ethnic variety within one specific religion or denomi-reference nation creates further diversity in religious and spiritual expression.

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.