The authors provide a practical guide to teaching clients about the Parent-Adult-Child (P-A-C) diagrams, based on Berne’s transactional analysis (1964) and Bradshaw’s concept of an “Inner Child” (1991). The P-A-C diagrams serve as part of the psychoeducational foundation in the Attachment-Focused Trauma Therapy for Adults (AFTT-A) model for clients to learn about personality development and the impact of attachment trauma on the formation of the internal personality structure and functioning. The chapter provides a detailed, step-by-step guide for therapists to utilize with clients when explaining attachment trauma and the AFTT-A approach to healing inner aspects of the Self.

Adults with nonsecure, dismissive or preoccupied attachment patterns may show dismissive, negative, or anxious feelings in regard to a Child or Adolescent part of themselves. The Corrective Attachment Experiences protocol within Attachment-Focused Trauma Therapy for Adults (AFTT-A) helps create a new, positive attachment relationship between the differentiated Adult part of Self and Child/Adolescent parts of Self. The protocol develops and strengthens the nurturing and protective aspects of the adult (True Parent part of Self) and provides a healing experience of connection for Child/Adolescent parts of Self. The therapist and client collaborate in the creation of healing imagery and affirmations for the Child/Adolescent parts. Slow bilateral stimulation (BLS) is applied to deepen positive affective shifts. Furthermore, viewing and dialoguing with Child/Adolescent parts of Self through the present-day lens of the differentiated Adult part of Self moves the client toward healthy integration within the internal system. With repetition over time, the strengthened True Parent and Competent Adult parts of Self evolve into a confident and compassionate Authentic Self.

Clients with a history of attachment trauma tend to have Child/Adolescent parts of their internal personality system blended or enmeshed with their Adult part of Self. As a result, clients manage their present-day lives with their attention divided between their efforts to meet their adulthood needs for love, connection, respect, meaning, and belonging, and their Child/Adolescent parts’ attempts to get unmet childhood needs met through present-day relationships. Therapists teach clients how to identify when Child/Adolescent parts have “snuck out” of their Safe Places and have taken “charge” of therapy sessions or their present-day life. Attachment-Focused Trauma Therapy for Adults (AFTT-A) therapists employ the Tucking the Child/Adolescent Part of Self Into the Safe Place protocol to assist clients in orienting parts of Self to time, separating out Child/Adolescent parts from the Competent Adult part, tucking Child/Adolescent parts back into their sense of safety and nurturance, and reinstating the Competent Adult part as responsible for present-day situations and relationships.

Attachment patterns in adult life are typically a carry-over from patterns established in childhood. Viewed through the lens of the adaptive information processing (AIP) model, early attachment memories associated with positive emotions and perceptions are stored adaptively, bringing positive expectations and emotions into presentday relationships. When memory networks that hold unprocessed negative feelings and perceptions related to childhood relationships are triggered by reminders in current relationships, the associated emotions and perceptions negatively impact attachment patterns in present-day relationships. Through the lens of Attachment-Focused Trauma Therapy for Adults (AFTT-A) model, adult relationships can activate negative memory networks and a Child/Adolescent part of Self. This chapter explains the attachment patterns and introduces the concept of the emotionally corrective therapeutic experience.

A history of adverse childhood events within clients’ primary attachment relationships complicates posttraumatic symptomology and requires a multimodal approach to trauma therapy. Attachment-Focused Trauma Therapy for Adults (AFTT-A) expands and enhances Eye Movement Desensitization and Reprocessing (EMDR) therapy’s preparation phase (phase 2) to address the complexities of attachment trauma. The purposes of AFTT-A preparation phase are three-fold: (a) rebuild clients’ internal personality structure, (b) increase healthy interactions in significant attachment relationships, and (c) prepare clients for the subsequent EMDR therapy’s steps of reprocessing traumatic memories. Chapter 5 outlines the rationale, framework, goals, and steps of the AFTT-A preparation phase of EMDR therapy. Concepts included in the AFTT-A model are introduced.

Adverse events in childhood and adolescence in the context of relationships with attachment figures impact the development of a client’s personality or the internal structure of Self. Clients raised in invalidating environments have parts of their inner personality that are prevented from forming and maturing in healthy ways, thus creating an inner system whose parts are over- or underdeveloped and not capable of functioning together as a whole. Attachment-Focused Trauma Therapy for Adults (AFTT-A) therapists utilize the Negotiating New Roles for Parent and Adult Parts of Self protocol to help clients and their Resource Team negotiate changes in and new roles with the Parent (Critical Parent and True Parent) and the Adult (Emotion Controller-Regulator/little “a” and Competent Adult) parts of Self. The protocol assists clients’ parts to work together and to become healthy and effective Resource Team members.

The standard preparation phase of Eye Movement Desensitization and Reprocessing (EMDR) therapy includes the installation of Safe/Calm Places or States with clients preparing to reprocess adverse childhood events. Childhood trauma within the context of attachment relationships often necessitates an expanded and enhanced preparation phase that goes beyond what’s contained in EMDR therapy to ready clients for reprocessing traumatic memories. Thus, the Attachment-Focused Trauma Therapy for Adults (AFTT-A) model expands the concept of Calm/Safe Place or State to include a “Higher Power” as a perfected representation of a safe and nurturing figure, being, or caregiver. The idea of a safe and nurturing relationship is added as a corrective attachment experience within clients’ Safe Places. The step-by-step process of brainstorming and installing the Safe Place and Higher Power for the adult is presented.

A history of ongoing abuse and neglect within clients’ primary attachment relationships during childhood complicates posttraumatic symptomology and requires a multi-modal approach to trauma therapy. Attachment-Focused Trauma Therapy for Adults (AFTT-A) utilizes Eye Movement Desensitization and Reprocessing (EMDR) therapy’s preparation phase to address and resolve the complexities of attachment trauma in addition to providing the emotional groundwork essential for phases 3 to 8 of EMDR therapy. Once clients reconstruct parts of and attachments among parts in their inner personality system and begin to transform their self-cognitions and present-day relationships, they are ready to transition to the subsequent desensitization and trauma reprocessing phases of EMDR therapy. Therapists aim to apply and integrate the internal reconstruction and the attachment-focused protocols from the AFTT-A’s preparation phase to the subsequent EMDR therapy stages, thus maximizing positive EMDR therapy outcomes.

This chapter focuses on the integration of creativity within the counseling process. The chapter begins with a brief discussion of creativity. Then, the author discusses eight creative approaches to integrate within counseling, which include animals, dance and movement, drama, literature and writing, music, nature, play, and visual arts. The discussion of each approach includes (a) a description of the approach, (b) historical context, (c) use of the approach in counseling, (d) research supporting the approach, and (e) multicultural considerations. Finally, the author discusses ethical considerations for integrating creativity within counseling, including training, credentials, intentionality, self-awareness, experience, focus on the process, and efficacy of the approach.

This chapter introduces you to the counseling profession, paying particular attention to the following concepts: (a) the history of the counseling profession, (b) how counseling differs from psychology, psychiatry, and social work, (c) the role of advocacy in counseling practice, (d) the importance of embracing social justice, (e) intersectionality in client conceptualization, (f) trauma-informed care, (g) introduction to group work, (h) multicultural social justice competencies, and (i) emancipatory communitarianism as a lens for counseling pedagogy. You will learn about historical and current trends that have influenced and helped to shape the counseling profession. We will describe the importance of advocacy as a tenet of counseling practice and embracing social justice to guide your work. We will use an intersectionality lens to teach you about the importance of multiple identities on an individual’s lived experiences and trauma-informed care for individuals and groups increasingly affected by societal injustices and oppressions. We discuss group work as a therapeutic modality and discuss the importance of multicultural social justice competencies for effective counseling practice. Finally, we introduce you to the concept of emancipatory communitarianism as a lens to unpack theoretical frameworks that guide our work as counselors. Herein, we lay the foundation for the rest of your journey through practical skills that will help you learn counseling competencies and techniques in holistic and intentional ways. Finally, central to counselor development, we will continually invite you to look within and embrace personal growth as a necessary and accompanying process to your journey in becoming a counselor.

Having a unified professional counseling identity is important for the counseling profession. This chapter focuses on multiple areas of professional identity. It begins with a discussion of models related to counselor identity development and developing counseling competencies. Next, the authors discusses professional and personal development and the importance of supervision and consultation. The chapter also includes a focus on the self of the counselor, counselor characteristics, burnout and related constructs, and wellness and self-care.

This chapter provides a survey of the main schools of thought that counseling theories fall under and the most prevalent counseling theories and frameworks that counselors use to help clients. We will center the concept of emancipatory communitarianism as a lens to evaluate and situate counseling theories and their orientations. We discuss the process of change and stages clients go through before and during therapy. Finally, we address the common factors of psychotherapy and the importance of each in promoting client healing.

This chapter provides a survey of current trends in the counseling profession and explores the future of counseling and anticipated impacts on client populations. More specifically, we discuss the emergence of neuro-informed counseling and telemental health services, the increase in aging populations and counseling services for them and their caregivers, the influence of social media and effects on the mental health of client populations, the effects of climate change on the physical, mental, emotional, and social well-being of communities around the world, the internationalization of the counseling profession, and novel psychopharmacological therapies.

This chapter focuses on certification, licensure, and accreditation standards, as well as ethical and legal issues in counseling. This includes a focus on (a) confidentiality, (b) privacy of information and records, (c) informed consent, (d) boundaries and relationships, (e) liability, and (f) ethical practice and religious beliefs. We also address ethical standards and ethical decision-making models and processes. Additionally, the chapter includes a discussion about counselor scope of practice, competency, and counselor impairment. We also integrate information regarding cultural considerations and social justice and advocacy.

This chapter focuses on trauma counseling, trauma-related symptoms, and trauma-informed counseling. The author discusses the prevalence, impact, and presentation of trauma symptoms across settings, as well as the operationalization of trauma-informed counseling. This chapter describes the importance of reestablishing safety and self-regulation in trauma counseling. The author notes the steps in treating trauma, including reestablishment of safety as an integral starting point. This chapter includes an exploration of the benefits of trauma-informed counseling across settings and client populations as well as the holistic impacts of trauma-informed care. This chapter also focuses on treatment, considerations for treating trauma symptoms across populations, and factors that contribute to resilience after adversity or trauma.

This chapter focuses on several types of counseling settings that serve clients across the lifespan with various presenting concerns. The settings include medical clinics and hospitals; correctional and forensic facilities; group homes, assisted living facilities, and nursing homes; community agencies; private practice; military and government; employee assistance programs (EAPs); religious institutions; rehabilitation facilities; colleges and universities; and preschools and elementary, middle, and high schools. The reviews of the settings include their history and a discussion of organizations that represent counselors and the promotion of counseling within each of the settings. Additionally, the chapter encompasses an exploration of the diverse aspects of counseling, as well as social justice and advocacy within the different work environments. The chapter also includes a section on counseling in rural settings.

This chapter focuses on substance-related disorders and behavioral concerns and addictions. It begins with a discussion of the history of drug use and the prevalence of problematic drug use and their consequences in the United States. Next, the author explores the etiology of addiction. Then, the chapter focuses on various classifications of drugs and includes descriptions of 10 different categories of drugs. Next, the chapter focuses on different types of behavioral addictions. The chapter also includes a discussion of the treatment process, treatment settings, and evidence-based practices for treating addictions. Finally, the author discusses stigma related to addictions and outlines strategies for addressing it.

This chapter highlights the topics of multiculturalism, intersectionality, and diversity. We anchor these themes on the Multicultural and Social Justice Counseling Competencies (MCSJCC; Ratts et al., 2015) and introduce the multicultural orientation framework with special emphasis on student assessment of their own intersectional identities. We provide an introduction to theories of human development, racial identity development, the generation name game, LGBTQ+ identity development, individuals with disabilities, counseling immigrants and refugees and their families, and other marginalized populations. We help students to integrate learning by focusing on otherness and critically evaluating their privileged and marginalized identities in the context of counseling individuals from advantaged and disadvantaged groups. We engage the student in examining all of these through a diversity, advocacy, and social justice lens.

This chapter focuses on research, assessment, and diagnosis in counseling. Within the research section, the authors discuss the importance of research for the counseling profession, being a consumer of research, and social justice and advocacy related to research. In the section on assessment, the authors discuss the assessment process, including the initial assessment and measuring treatment progress and outcomes. Finally, the diagnosis section includes the history of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and treating the diagnosis versus treating the symptoms. The chapter also focuses on selecting a treatment approach and the use of evidence-based practice.

This chapter focuses on counseling skill development, the counseling process, and modalities of counsel. The chapter begins with a brief discussion of the essence of counseling work. The chapter reviews the following topics: the counseling relationship, counseling skills, components of the counseling experience, learning suggestions.

This chapter focuses on the field and process of crisis counseling. The chapter begins with a brief discussion of crisis counseling and how it differs from traditional long-term therapy. After crisis is defined and operationalized, the chapter reviews the following topics: types of crisis, reactions to crisis, crisis counseling skills, crisis assessment, and crisis intervention.

This chapter provides an overview of complementary and alternative approaches in individual and group counseling. The following topics are addressed: spiritual counseling, Indigenous healing practices, drumming circles, Eastern traditions, yoga and mindfulness meditation, and transpersonal counseling.

The adult unresolved/disorganized attachment pattern is associated with mental disorganization and disorientation during the telling of a traumatic memory. Attachment-Focused Trauma Therapy for Adults (AFTT-A) includes the Therapeutic Story method developed by Lovett (2007) as an optional activity to move adults toward attachment organization through creation of an organized, coherent narrative related to a traumatic period of childhood. The format of the story, written in third person, parallels the phases of Eye Movement Desensitization and Reprocessing (EMDR). It begins by resource strengthening, provides a brief narrative of significant life events, includes cognitive interweaves that dispel confusion, and offers positive cognitions. The story provides organization and structure for unresolved/disorganized adults and provides a gentle way to transition to the EMDR standard reprocessing of individual traumatic events with complex clients. The story can elicit emotions/sensations related to stored preverbal trauma for effective EMDR reprocessing. Once the story is written, it is read along with application of bilateral stimulation (BLS). The chapter provides steps and an outline for writing a Therapeutic Story and a sample story written for an adult with preverbal trauma and childhood abuse.

The Attachment-Focused Trauma Therapy for Adults (AFTT-A) enhanced preparation phase for Eye Movement Desensitization and Reprocessing (EMDR) therapy starts the installation of a Safe Place and Higher Power for the Adult part of clients’ internal personality system. In this chapter, the authors adapt and apply the concepts of age-appropriate Safe Places and Higher Powers to provide a sense of safety and nurturing for clients’ Child/Adolescent parts of Self and to serve as the foundation of time orientation by assisting clients to discriminate between the past and the present moment. The step-by-step process of brainstorming and installing the Safe Place and Higher Power for Child/Adolescent parts of Self is presented.

The Attachment-Focused Trauma Therapy for Adults (AFTT-A) model recognizes that all therapists are human and experience their own emotional and physiological responses to interactions within the therapy office. The therapist’s own emotions can be a powerful force enhancing the client’s progress or impeding it. The AFTT-A model posits that by practicing mindful awareness, the therapist can stay conscious of their personal triggers and automatic responses in the therapy office. While mindful, the therapist can use their self-observations for personal growth and to gain information about the client’s relationship functioning. Finally, mindfulness allows the therapist to respond to the client with emotional attunement and a therapeutic perspective. This attuned connection calms the client’s nervous system and increases the client’s receptivity to the therapist’s interventions.

This chapter addresses application of Eye Movement Desensitization and Reprocessing (EMDR) therapy within the three prongs of past, present, and future for bringing memories of attachment trauma to an adaptive resolution. Therapists are provided methods that help ensure safety and efficiency during desensitization and reprocessing of traumatic memories and triggers. For example, therapists can narrow the focus and restrict the associations to additional traumatic memories as needed to ensure safe reprocessing. Therapists may alter the sequence of past, present, and future prongs if it’s clinically necessary to ease clients into addressing the past. Attachment-Focused Trauma Therapy for Adults (AFTT-A) therapists apply cognitive interweaves that assist clients with accessing aspects of the healthy internal system developed through AFTT-A to assist clients with bringing painful memories to an adaptive resolution.

Adults with secure, healthy attachment patterns desire closeness, assume positive intentions in the behaviors of others, and express emotions appropriately. They hold a wealth of positive beliefs that support healthy relationships, such as “I’m good as I am,” “I deserve to be loved and cared for,” and “Most others are trustworthy and mean well.” Secure, healthy attachment patterns in adulthood develop through childhood experiences with trustworthy, sensitive attachment figures. However, adults who lacked nurturing, sensitive care as children can move toward secure attachment patterns in adulthood through experiences of connection with other adults who are secure. Being on the receiving end of sensitive, attuned responses from a secure other can provide an emotionally corrective relationship experience for the nonsecure adult. Thus, a relationship with the Attachment-Focused Trauma Therapy for Adults (AFTT-A) therapist who interacts from a place of security can be a powerful ingredient of change. The Eye Movement Desensitization and Reprocessing (EMDR) reprocessing phases of AFTT-A can deepen new, positive emotions and beliefs about self and others by bringing disturbing attachment memories to adaptive resolution.

The adaptive information processing (AIP) model explains that clients who experienced attachment trauma when young have unprocessed disturbing memories stored in neural networks along with associated emotions, perceptions, and sensations. Through the lens of Attachment-Focused Trauma Therapy for Adults (AFTT-A), the internal personality system of adults with a history of attachment trauma may hold Child/Adolescent parts of Self that carry unprocessed disturbing affects from childhood into adulthood. The younger parts are hypervigilant and easily activated along with an associated negative affect while the Adult part of Self is simultaneously attempting to carry out present-day adult tasks. The activation often leads to a “blend” of “Adult Brain” and “Kid Brain,” decreasing the capacity of the Adult part to effectively communicate, problem-solve, self-regulate, and develop healthy attachment relationships. Through the Strengthening the Competent Adult Part of Self protocol during the Eye Movement Desensitization and Reprocessing (EMDR) preparation phase, the AFTT-A therapist can assist the client in developing a strengthened and differentiated Competent Adult part of Self with capacity to “step into” adult life.

The Attachment-Focused Trauma Therapy for Adults (AFTT-A) model of the Eye Movement Desensitization and Reprocessing (EMDR) preparation phase provides clients with an internal foundation of safety and nurturing for Adult and Child parts of Self; a reconstruction of inner parts and relationships among parts; development of Competent Adult and True Parent parts; connection to an inner team of strengths and resources; time orientation; and skills needed for present-day life and relationships. Therapists assess their clients for readiness to move into EMDR therapy phases 3 to 8. Therapists learn the signs clients show when they don’t have permission or consent from inner parts to move forward through the preparation phase protocols as well as into desensitization and reprocessing present-day triggers and memories of traumatic events. Clients utilize their Resource Team to brainstorm both potential difficulties with and the solutions to overcome problems with subsequent steps in therapy.

Infants are born with an innate awareness that they need to keep their parents nearby to survive. Infants and young children begin learning how to adapt to their parents’ attachment patterns to keep them close and get their needs met the best they can. Child behaviors that keep parents close eventually generalize to other relationships, even into adulthood. Attempts by the Adult part of Self to change these self-protective behaviors can trigger anxiety in Child parts of Self, creating internal resistance to the changes. This chapter describes a protocol for assisting clients with identifying the “old rules” in their “Early Bonding Contract” for keeping parents close and the healthy “new rules” they might consider adopting for present-day relationships. The next steps involve dialoguing with the Child part of Self and deepening positive shifts with slow bilateral stimulation (BLS) followed by a modification of the Eye Movement Desensitization and Reprocessing (EMDR) Resource Development and Installation (RDI) Future Rehearsal for adopting the new rules.

Clients who have a diagnosis of dissociative identity disorder (DID) are on the severe end of the dissociative continuum. The internal system of the client with DID is usually complex and may include more than one Adult part as well as multiple Child/Adolescent parts. At least some parts may operate autonomously with dissociative barriers between themselves and other parts, resulting in lack of co-consciousness and creating significant complications in adult life. Clients who live with severe dissociation experience fragmentation of both time and sense of Self. Attachment-Focused Trauma Therapy for Adults (AFTT-A) is not designed to be a comprehensive treatment for the DID client; however, with adaptations and consideration for the increased complexity of the internal personality system, the protocols of the AFTT-A model can create stabilization through work with the internal personality system and the emotionally corrective therapeutic relationship during the preparation phase of Eye Movement Desensitization and Reprocessing (EMDR) therapy.

The authors introduce the basic concepts, foundational theories, and framework for their therapeutic approach to working with adults with a history of childhood attachment trauma. Based on decades of clinical experience, Attachment-Focused Trauma Therapy for Adults (AFTT-A) expands and enhances the standard components and protocols of the preparation phase of Eye Movement Desensitization and Reprocessing (EMDR) therapy to assist clients in rebuilding their internal personality structure, increase healthy interactions in significant attachment relationships, and prepare for the subsequent EMDR therapy’s steps of reprocessing traumatic memories. Essential to working with adults with attachment trauma is the development of a strong therapeutic bond that offers clients a corrective emotional experience. The authors give a brief synopsis of the importance of therapists’ self-awareness and attunement to clients on the therapy relationship and process.

A detailed and comprehensive initial assessment in Eye Movement Desensitization and Reprocessing (EMDR) therapy phase 1 is essential to therapists’ ability to establish clients’ readiness for EMDR therapy. The initial assessment includes evaluating clients in multiple areas in addition to the EMDR readiness criteria. Such an assessment provides therapists with an overall estimation of clients’ past and current physical and mental health status, level of functioning, social support, family, and experiences of abuse and/or neglect and offers the context in which clients will be participating in EMDR therapy. Three main barriers to clients starting phases 3 to 8 of EMDR therapy are lack of social support, emotion over- or under-control, and other issues that may interfere with clients’ ability to regulate affect or emotions such as significant mental illness, drug or alcohol problems, and safety issues. Clients with a history of attachment trauma tend to need an extended period of time in the preparation phase of EMDR therapy prior to reprocessing traumatic memories. Phase-based trauma treatment utilizing a team approach is an example of an intervention that prepares clients to move into phases 3 to 8.

The preparation phase of Eye Movement Desensitization and Reprocessing (EMDR) therapy includes Andrew Leeds’s Resource Development and Installation (RDI) protocol to assist clients in connecting to and strengthening their own inner resources. Attachment-Focused Trauma Therapy for Adults (AFTT-A) is an enhanced version of internal resourcing and introduces the idea of a resource “team” extending Leeds’s resources to include figures or team members who represent clients’ inner resources. The authors utilize team meetings between clients and their Resource Team members not only to connect to and strengthen links to inner resources but also to provide corrective internal attachment experiences. The protocols for brainstorming and installing the internalized Resource Team are presented.

Adults who were raised in an emotionally neglectful, rejecting, or abusive environment frequently develop nonsecure attachment patterns that continue into adulthood. Adults with dismissive patterns tend to be avoidant of emotional closeness and negative emotions. Adults with preoccupied patterns tend to be assertive about getting their emotional needs met through close relationships, and they experience emotions strongly. Adults with unresolved/disorganized attachment with respect to a history of unresolved childhood abuse or loss experience mental disorganization when memories are triggered. However, some adults with a difficult childhood have experienced at least one emotionally corrective relationship that led them to a new perspective and an emotional shift so profound that their attachment pattern shifted from nonsecure to “earned” secure. Attachment-Focused Trauma Therapy for Adults (AFTT-A) therapists provide attuned, secure-based responses to nonsecure client behaviors and words. The therapeutic relationship is a powerful component of AFTT-A for improving clients’ attachment patterns.

This chapter provides an overview of important elements of conducting group supervision, as well as conducting supervision of group workers. Because most clinicians eventually become supervisors, and because the Council for Accreditation of Counseling and Related Educational Programs (CACREP, 2016) does not currently require coursework in supervision, this information is critical for current trainees to provide a framework from which to begin supervising once they are independent practitioners. Included in this discussion of supervision is an emphasis on prioritizing supervising with a social justice lens and focus on attending to diversity topics, both in supervisees’ individual and group work, but also within the supervision group. Finally, trends in group work, including trauma-informed group work, conducting groups online, using groups beyond the traditional task, psychoeducation, counseling, and therapy groups will be discussed.

This chapter focuses on providing an overview and critique of individual theories that have historically been applied within group counseling. In addition, a summary of the strengths and challenges associated with doing tso is espoused. We then move to examine group developmental theory from multiple perspectives. Similarities and differences among these group developmental theories are discussed, and readers are encouraged to practice conceptualizing current or previous groups they have been a part of through an integrated, inclusive, developmental lens.

In this chapter, the authors discuss theoretical and conceptual knowledge that explore specific aspects of group counseling that must be considered to ensure ethical group counseling practice. The chapter examines a case illustration using an ethical and cultural lens in order to see the impact these dimensions can have on a group. The focus will be to discover strategies to overcome anticipated challenges. These challenges include the breaking of confidentiality, the difficulties managing racially and culturally diverse groups when language is a barrier, and dealing with suicidality that might emerge in the midst of group sessions. Accountability is included in this discussion both in terms of the group’s outcomes and the individual members’ goals, as well as the group leader’s competency.

In this chapter, we review the current landscape of the group counseling literature, as well as how you as a group leader can use assessment strategies in your groups to evaluate their effectiveness. Assessment is considered from both an individual member perspective, as well as the perspective of the group as a whole. Particular attention is paid to the importance of considering race and ethnicity throughout your assessment practices. Sample assessment ideas are included that span a range of developmental levels and treatment settings. In addition, challenges to conducting research in group work are identified, as well as gaps in the existing literature.

The group process is defined by stages of development. This chapter introduces those phases by identifying characteristics associated with each stage, and explores feelings experienced by members and group leaders in each stage. Also discussed in this chapter is the facilitation skills utilized to move groups through each stage, while attending to ethical and cultural implications.

While this book presents the fundamentals of group counseling, this chapter explores ways to push the boundaries of traditional group counseling. This chapter lays out the emerging trends in group counseling across specializations, while providing the context for healing engagement and asset-based group counseling. Additionally, this chapter examines the ways in which group counseling can be used for personal growth and social action. Furthermore, reflecting on one’s own group facilitation skills, this chapter explores how the same skill sets can extend beyond group counseling interventions and be utilized to build capacity within communities.

Groups are everywhere in our lives—we participate in family groups, task groups related to work and school, and friendship groups. Often, counselor trainees show up to the first day of group counseling class with little understanding of the multitude of ways groups impact our lives, and as a result, have little enthusiasm for the class. The purpose of this chapter is to expand students’ conceptualization of groups and group work, and to increase their enthusiasm and commitment toward learning to be effective leaders.

This chapter explores the history of the training group experience, the purpose of having students participate in exploring their own and others’ identities within the activity, and the ethical concerns that are inherent in the process. Students will gain knowledge about the training group experience, as well as increase their hopes and expectations for what they may be able to get out of the activity. The training group experience, an important CACREP requirement, is a part of all CACREP-accredited counseling programs

There are a number of considerations to keep in mind when planning a culturally sustaining group experience. Culturally sustaining practices are a term used in P12, that allow, invite, and encourage members to not only use their cultural practices from home in school (or in this case, group), but to maintain them. Leaders need to decide the type of group they plan to facilitate, and then they will need to begin planning the group even before they recruit and prepare members for their group experience. This plan will spur how to go about the screening process and determine whether an open or closed group would be more appropriate. Other determinations such as group demographics, size, length, and meeting platform (in person or virtually) must also be decided. These planning strategies are discussed in the chapter. We include examples of school and community agencies. Our examples are not exhaustive, but provide a flavor for what could be possible when planning for this important counseling modality.

In the current chapter, there are a number of case illustrations that will be used to highlight various topics discussed throughout the preceding chapters of this text. All of these cases provide opportunities to examine group leadership; however, the reader will be asked to consider reflecting on these cases from either a practitioner, a counselor educator, or a clinical supervisor perspective. First, we discuss timely issues facing our society and counseling profession. These topics help to situate the case illustrations that are dispersed throughout this chapter. Next we draw upon guiding documents within the counseling profession to highlight areas that aspiring culturally sustained group leaders should become deeply knowledgeable about. We conclude this chapter with implications for future group counseling research, training, and practice. We are unable to determine exactly what will emerge in the future, but we use the current trends, recommendations from professional organizations (e.g., Association for Specialists in Group Work [ASGW]) and our own personal and professional experiences, and clinical haunches as guideposts for what might unfold.

This chapter lays the foundation for basic group counseling skills that all group leaders need to possess to run groups effectively. Examples include active listening, reflecting content and feeling, summarizing, linking members, drawing members out, cutting members off, and attending to the here and now. The authors use the case illustration to demonstrate how the different skills used may impact the trajectory of the conversation and group development. Additionally, this chapter provides examples of effective advanced processing skills that assume a culturally diverse group membership. Further, the authors explore the dynamics inherent in co-leader relationships, identify the pros and cons of using a co-leadership model, and highlight the best practices for engaging in a co-leadership model effectively.

This chapter is an overview of a number of important concepts. We begin by helping the reader understand the basics for group development and group dynamics. The reader also begins to understand one’s group leadership style and the impact on one’s identity on this development. Exploring one’s group leadership style (e.g., skills, dispositions, experiences) helps set the stage for what to look for when setting up a group, how to evaluate a group, and understand the overall benefits that can be derived from evaluating the group. This chapter also advocates that facilitating culturally responsive groups is an ethical mandate and that one’s growing multicultural awareness, ethical compass, and general leadership competence can impact group development.

This book introduces a new, successful, research-based, and proven approach to treat depressive disorders. In this introduction, we give an overview of the successes and limitations of current guideline-based treatment of depressive disorders as well as a first overview of our 12 years of research in this field. We found that an approach that considers depression as a stress- and trauma-based disorder is critical for treating depressive patients, especially patients who do not respond well to current guideline-based treatment. Eye movement desensitization and reprocessing (EMDR) therapy is the centerpiece of this new treatment and has already shown its effectiveness in treating depression successfully in a number of controlled studies. This book contains many case studies and information to inform the practice of EMDR-trained clinicians.

Many depressive patients come into psychotherapy treatment with little focus, decreased energy, and a loss of confidence in themselves. In the psychoeducation section of this chapter, the authors focus on helping patients learn about their emotions, accept their protective emotions, and reconnect with their enriching emotions. They teach many different resources such as the container, paying attention to the five senses, breathing, and learning how to regulate their vegetative systems. Also, they teach patients to stay within their window of tolerance and how to manage themselves when they are outside of it. In the stabilization section, the authors teach therapists to use many techniques in the service of self-regulation and self-care: the Self-Contact Technique, diaphragmatic breathing, grounding, aligning, glimpsing the Hidden Heart: The Magic Query, Hakomi’s 3-Step Procedure, and the Triple Thanksgiving.

In this chapter some practical consequences of the paradigm shift to understand depression as a stress- and trauma-based disorder are discussed. As successful eye movement desensitization and reprocessing (EMDR) therapy helps to resolve these memories, the authors show how EMDR therapy works with depressive patients. Randomized controlled trial (RCT) studies demonstrate that not only is EMDR therapy for depressive disorders at least equal to other treatments, but there are more complete remissions. The EMDR DeprEnd Protocol is a significant step forward in the treatment of depressive patients and in the reduction of depressive relapses. This is important as the effect of treatment-resistant depression leaves patients at risk for suicide and families to bear the loss of their family member. Improved treatment possibilities would also occasion economic savings. With more knowledge about the importance of childhood memories in the development of depression, we can also do much more for primary prevention of depression.

Relapse prevention is an essential part of the DeprEnd Protocol. Although it is a significant step forward when the current depressive episode is resolved and patients are completely in remission for their depressive symptoms, in most cases, especially in cases of recurrent depression, one additional step is very important—relapse prevention. This is most important to consider even with patients who achieved complete remission. We have observed that most of the risk factors for depressive relapse are residual pathogenic memories, persisting triggers, and potential future psychosocial situations; these are the types of memories and situations that are likely to trigger a depressive relapse and benefit from the use of the 3-Pronged Protocol of eye movement desensitization and reprocessing (EMDR) therapy. It is also helpful to install positive resources that support healthy functioning in patients’ daily lives. This chapter identifies different starting points that can be used in a relapse prevention strategy to inoculate patients against depressive relapse.

In this chapter an outline of the eye movement desensitization and reprocessing (EMDR) DeprEnd Protocol, as well as the rationale for its interventions, are given. Also, an important instrument to identify some of the pathogenic memories behind the depressive episodes, the Symptom Event Map, is introduced. In EMDR therapy, treatment plans that adhere to formal guidelines are frequently called protocols. In our book, we use both terms synonymously. The DeprEnd Manual EMDR is the current treatment plan for depression, and it can largely be seen as evidence based. In addition to the steps for treatment and preparation for reprocessing, the protocol contains a sequence for targeting pathogenic memory networks.

In this brief chapter, all the current randomized controlled trial (RCT) studies that treat depressive patients with eye movement desensitization and reprocessing (EMDR) are listed in more detail.

For the treatment of patients with complex depressive disorders with comorbidities and often significant psychosomatic symptoms, additional treatment tools are often very helpful. Drawing is a useful way to represent trauma, supporting the differentiation between the adaptive and traumatized selves as a way to limit avoidance and dissociative reactions. It was first used to assist patients who were blocked in their ability to access traumatic material and who move between shut down and emotional arousal. Drawing was a less threatening way to first establish a sense of safety through body-based resources and then to enter the uncomfortable world of their traumatic experience. With the drawing as the image for the eye movement desensitization and reprocessing (EMDR) Assessment Phase, the rest of the assessment is accessed in the usual manner. Whenever a drawing is used, the Standard EMDR Protocol should be used later to be sure the material is fully reprocessed. This chapter describes the EMDR-Drawing Integration (EMDR-DI) Protocol and includes case studies and patients’ drawings.

Major depressive disorder (MDD) is a disabling psychiatric condition and, although drug treatment is most widely used to treat MDD, it is often ineffective and can lead to treatment-resistant depression when it does not work. Childhood and adolescent trauma, as well as early adverse life experiences, especially interpersonal traumas/attachment adversity, are risk factors for depression. The biological bases of MDD are explored, including the effect of traumatic and stressful events on gene expression. For example, there is evidence for traumas that occur during early childhood inducing alterations in the stress response system that continue into adulthood, as well as early life adversity affecting molecular pathways relevant to the development of MDD. This suggests that interpersonal traumas like emotional abuse and neglect strongly impact these patients. The expert authors report on studies that show that eye movement desensitization and reprocessing (EMDR) is very effective in improving depressive symptomatology in treatment-resistant MDD patients with a history of trauma.

The Symptom Event Map is one of the most helpful tools for treatment planning in the DeprEnd Protocol for the treatment of depression as it charts depressive episodes and their intensity, Episode Triggers, and Compensation Zones. The Symptom Event Map is made of two unrelated maps: the symptom map charts the intensity of the depressive episode(s), and the trauma map plots the stressful life events, including or not including Criterion A incidents with their appropriate Subjective Units of Distress (SUD) levels. The Symptom Event Map is an effective tool to chart the course of depressive episodes and identify the Episode Triggers. Viewing the image of the course of the depressive events, including Compensation Zones of full recovery, help clinicians with their treatment planning and case conceptualization. It also points out the targets that will be helpful in relapse prevention. This chapter introduces the Symptom Event Map and provides a case example.

Finding a certified eye movement desensitization and reprocessing (EMDR) therapist is an important step in receiving effective treatment. For organic causes of depression, it is helpful to consult with a primary care physician or psychiatric specialist. EMDR therapy is important to consider when there are depressive relapses. There are nine randomized controlled studies that show that EMDR therapy is successful or equivalent to other therapies and more studies are in process. There is a clear connection between the effectiveness of EMDR treatment and the qualification of therapists. Professional qualifications, as well as quality training, are important in EMDR. Please consult regional EMDR associations for information on qualified therapists. Positive chemistry is important for a good treatment outcome as well.

Treating belief systems with eye movement desensitization and reprocessing (EMDR) therapy is an important part of the DeprEnd Protocol. A second group of pathogenic memories that often need to be reprocessed in depressive patients are memories that create negative belief systems and self-concepts. Even though many depressive patients lose their depression after processing their Episode Triggers with EMDR, many still suffer from residual depressive symptoms caused by negative belief systems. In this chapter, we introduce how to identify negative belief systems and two ways to identify specific memories that result in negative belief systems that need to be processed with EMDR.

About 60% of all depressive patients suffer from mental health comorbidities. In many cases, the comorbidity of these depressive patients is posttraumatic stress disorders (PTSDs), complex PTSD (C-PTSD), and/or moderate to severe dissociative disorders. While structured research in this patient group is still in its infancy, in this chapter we cover what we have learned by treating many of these complex patients. It is clear that the greater the complexity with which patients present, the more psychoeducation, resourcing, and eye movement desensitization and reprocessing (EMDR) memory reprocessing sessions are needed. Often, complex patients have faced years of treatment and are not diagnosed accurately. Those considered treatment resistant are often patients with a history of trauma/PTSD or a dissociative disorder. The first step for these patients is to help them understand their disorder and to stabilize them before any EMDR processing. We have observed that when these steps are taken, complex and dissociative patients make real progress with their trauma and then their depressive disorder.

When it is time to begin memory processing when treating depressive patients, it is usually best to focus on Episode Triggers first. The Episode Trigger is defined as the stressful and sometimes traumatic event/s that occur/s for most patients 1 or 2 months before the depressive episode starts. Most of these events are not classical traumatic events that that include danger for one’s life, but events that come from stressful interpersonal relationship events like losses, separations, and humiliations. This chapter describes some of the most common patterns of depressive reactions to such events. The use of the Symptom Event Map is encouraged to chart patients’ negative events and their depressive episode(s), according to a timeline. This helps the patient to understand and the therapist to build a treatment strategy. The chapter also describes some of the different types of depression that can be identified on the Symptom Event Map.

The cornerstone of our new concept of treating depressive disorders is eye movement desensitization and reprocessing (EMDR) therapy. EMDR therapy is a psychotherapy approach that was developed by Francine Shapiro, PhD, in 1987 and it has proven its efficacy in treating posttraumatic stress disorder (PTSD). EMDR is recognized worldwide as one of the most effective treatments for PTSD. Different from the usual forms of talking therapy, EMDR is based on a completely different neurobiological mechanism that was discovered and documented by a Korean research group (Baek et al., 2019). To understand the processes that occurred during EMDR treatment and to improve treatment planning, the Adaptive Information Processing Model was hypothesized and the concept of biologically active, pathogenic memories that can be traumatic and nontraumatic was developed. In this chapter, EMDR therapy and its basic concepts, as well as the first pioneering publication in the field of depression, are discussed.

There are certain types of memories, such as those of being depressed or suicidal, that patients experienced earlier in their lives; however, when these memories come up in the present, it feels as if they are true in the present, but they really are not. It is confusing for both patients and therapists alike. Often these memories are accompanied by intense feelings in the body but are not accompanied by images or thoughts. Often, they are overlooked even though they are, in our observation, a risk factor for depressive relapse. Even though many of the patients treated with eye movement desensitization and reprocessing (EMDR) DeprEnd improve during the previously mentioned parts of the DeprEnd Protocol, they may take another major step forward after their Depressive and Suicidal States/memories are reprocessed. In this chapter, we explain how to identify these Depressive and Suicidal States and how to process them with EMDR therapy.

In this chapter on treating bipolar disorder with eye movement desensitization and reprocessing (EMDR) therapy, expert Benedikt L. Amann discusses the affective spectrum and bipolar disorder specifically. Bipolar disorder is a strongly genetically influenced illness that overlaps with other psychiatric illnesses such as schizoaffective disorders, depression, or psychosis. The etiology of this disorder frequently includes—beyond a polygenetic basis—dysfunctional family background and childhood trauma. There is a high risk for suicide, especially in the depressive and mixed phases of the illness, but, next to medication as the basis for treatment, psychoeducation and psychosocial interventions are helpful. For psychotherapy with these patients Benedikt L. Amann developed—with his research group—five EMDR subprotocols to be used in EMDR’s Phase 2, including a psychotherapeutic mood stabilizer protocol with indications, in a pilot trial, that mood gets better in these patients without causing affective relapses during the processing of trauma and adverse life experiences.

In the previous chapter we took our first look at the period of development from middle childhood through adolescence and evaluated some of the cultural and contextual factors that can shape those developmental years. The focus of this chapter is to provide you with specific theoretical lenses through which to view development from ages 6 through 17 (though they apply to other developmental periods as well). The theories outlined in this chapter are foundational developmental theories commonly taught and frequently used in the helping professions. Keeping a keen focus on the years of middle childhood and adolescence, we begin with an exploration of Piaget’s Cognitive Development theory then move on to Erikson’s Psychosocial Stages of Development. We will explore the significant contributions of each theorist to these stages of development while also viewing them with a critical eye, bearing in mind the contextual and cultural elements we discussed in the previous chapter. In addition, we further explore updated research and theoretical models that expand on these theories or offer alternative perspectives, and we use our case study client from Chapter 6, Dev, to help us unpack and understand all of this along the way.

Humanity’s evolutionary history has imbued us with specific capacities and limitations that require specific needs be met, in a specific order, so that we might survive and grow. As social mammals with the largest brains relative to body size, our in utero gestational period and process builds the foundation for the subsequent architecture of our lived experience, which is informed by the relational, cultural, and contextual factors to which we are exposed throughout conception, gestation, birth, early bonding, and initial moves toward functional interdependence in early childhood (Evertz et al., 2021).

In this chapter, you meet Xquenda, who goes by “Miguel” at school. We will explore some of the relational, cultural, and contextual factors of his conception, gestation, birth, early bonding, and transition to school age. We will also begin thinking about how culturally responsive, trauma-informed clinical support could help him and his family resolve the toxic stress and overwhelm they carry from loss, migration, ongoing acculturation, financial strain, and environmental exposures.

We also introduce a non-exhaustive set of specific challenges commonly resulting in toxic stress that impedes optimal development, increases risk for young children and families, and merits ongoing training for mental health professionals to stay current, compassionate, and effective in their prevention and intervention services. We will attempt to counter this toxic stress by introducing research that highlights what mental health professionals may do to help create buffering advocacy relationships that are attuned, sensitive, empowering, anti-racist, de-colonizing, and working toward more social justice.

Age is relative, as the saying goes, so how do we know when we are “old”? Some of us may turn 40 and start to proclaim, “I feel so old! I’m falling apart.” Others may celebrate their 80th birthday and ask, “I wonder what is next? I’m so excited about what I am still learning and experiencing.” As we have discussed in this textbook, the age ranges that represent different stages of development have shifted over time. Since as recently as 100 years ago in the United States, the average lifespan was 47 years old and so today our perceptions of “old age” have certainly changed. Today, people in Western societies are living longer and longer. Within gerontological research, it is typical to distinguish among the “young-old“ (50–64 years), the “old“ (65–74 years) and the, and the “old-old“ (75+ years; Cronin & King, 2010). Our previous chapters discussed middle adulthood reaching into the lower to mid 60s; we now focus our discussions on this phase of life to include the ”old” and the ”old-old.” In this chapter, we explore the cultural and contextual factors that impact this final stage of lifespan development. As individuals move into their later phases of life, how do they experience the developmental process? How do beliefs around old age, physical and mental health, death and dying, and the role of “elder” in families and cultures impact the experiences of the old and very old? We will focus on the case of Rose, a recent widow of a partner of 40 years who is beginning to experience dementia.

In the previous chapter, we explored a subset of relational, cultural and contextual factors of conception through early childhood, and introduced a few ways varying cultural and contextual experiences may influence early development that might otherwise be relatively generalized across the single species of Homo sapiens. In this chapter, we will apply relevant theories, models, and research that inform our understanding of developmental experiences of conception through early childhood, following the chronology of theory development to show how theory and practice have deconstructed and refined over the last century. Western theories of ego development (Freud, Reich, Bowlby, and Ainsworth) are discussed in the context of infancy and early childhood, updated with relational–cultural considerations and emerging research. In addition, we explore factors including physical health, emotional health, resilience, and self-concept as applied to this stage of life as we continue to examine the experiences of Xquenda, our fictional client from Chapter 4. We will also look a bit more at Xquenda’s family, and how they may also be experiencing the developmental challenges of early parenthood.

In the previous chapter, we examined some of the cultural and contextual factors impacting development in late adulthood. This stage of life is typically characterized as starting in the mid 60s and continuing into the 80s, 90s, or until the end of the natural lifespan. In this chapter, we look at developmental theories, models, and research about older adults, and strive to understand how to apply these theories to work with adults in late adulthood. As it is important to always view developmental theories with a critical eye, we include both critiques of the theories presented, and recent and relevant research and writings about how these theories inform our understanding of older adults. Using the case of Rose, our fictional client introduced in the previous chapter, we will present psychosocial development theory (Erikson), human potential stages (Cohen), bioecological theory (Bronfenbrenner), and the ecological theory of aging (Lawton). We include additional cultural and contextual factors of aging impacting development, and conclude with thoughts from two experts from the field, Dr. William Barkley and Dr. Nina Nabors.

Lifespan development is a complex process centered on how humans learn, grow, and advance from infancy through the end of life. This chapter is designed to orient you to the primary components of human growth and development as well as the additional considerations of socio-political factors that ultimately impact the development process. As you review this chapter you will explore the origins of lifespan development theory in the helping professions and gain an initial understanding of how developmental theories and models are used to help frame the lived experiences of our clients. You will also be provided with an orientation that explains how we have laid out the larger text and what you can expect as a reader of this book. Finally, in preparation for your movement into future chapters and exploration of post-birth development, you will spend some time evaluating the process of gestational development, as it sets the stage for all development to follow.

In this chapter, we introduce you to some of the seminal developmental theories and their basic tenets of lifespan development. These theories reflect the earliest conceptualizations of the human development process, including the foundational understanding of ego, cognitive, moral, attachment, and adult development. Many of these theories are dated and reflect flawed research methodology, overgeneralization, individualistic perspectives, and cultural bias. However, they also represent the origins of developmental psychology and are the initial building blocks from which updated theories and current research have evolved. This text is designed to have you think expansively about the lifespan development process, and just like any big-picture perspective you must first explore what is at the center. It will be foundational to your understanding of the remaining chapters in this text, as well as to the ways in which you move forward and use developmental theory to frame your understanding of those you work with as a mental health professional. To this end, we invite you to explore the theories in this chapter with a curiosity and appreciation for what they bring to your understanding of the human experience and as a way to meaningfully critique and update that knowledge with the theories, perspectives, and content that follows in subsequent chapters.

In this chapter, we introduce you to knowledge and intervention models related to multiculturalism, intersectionality, and diversity. Moving away from more traditional and overgeneralizing models of development to those that evaluate specific cultures, contexts, and intersecting identities, this chapter exposes you to developmental models that emphasize the uniqueness and value of culture and context in the lifespan development experience. We begin this chapter with an invitation to a deeper exploration of issues central to mental health professional identity development by integrating a focus on “otherness” and the challenge of privileged identities in the context of serving individuals and family systems from disadvantaged groups. This will lay the groundwork for the models and theories that come after and facilitate your understanding of the ways in which these advocacy models inform social justice efforts within the context of competent mental health practice. Later in the chapter we explore important facets of identity development including models of racial and ethnic identity development, female identity development, and sexual orientation identity development. We also introduce the systemic and contextual theoretical frameworks of Vygotsky, Bronfenbrenner, and McGoldrick and wrap things up with a discussion of recent and relevant research associated with the models and theories in this chapter.

If you are reading this chapter it very likely means that you have moved through one of the most influential developmental stages of your life, that of middle childhood and adolescence. This period of significant growth and change spans the ages of 6 through 17 and offers both a shared existence with others as well as a distinct experience that is all our own—shaped by the cultures and contexts in which we live. Using the case study of Dev, a transgender boy assigned female at birth, in this chapter we will explore the significance of culture and context on the pivotal years of his middle childhood and adolescence experience. We will further evaluate how the individual elements of culture and context, as well as the intersectionality among them, influence development for older children and teens and why this is so crucial to your future work in the helping profession. We will round out this chapter with a podcast and reflections from Dr. Stacee Reicherzer, an expert in the field of trans identity development and otherness.

Middle Childhood Development, Adolescent Development, Cultural Factors in Middle Childhood, Cultural Factors in Adolescence, Contextual Factors in Middle Childhood, Contextual factors in adolescence.

What is “middle adulthood”? As recently as 100 years ago in the United States, the average lifespan was 47 years old. As baby boomers continue to be the largest demographic in the country, people are living longer and as a result, creating a new stage of life—middle adulthood. This stage ranges from anywhere between 40 and 65 years old and is marked by significant changes and milestones. From launching children, to caring for aging parents who are also living longer, to experiencing the beginnings of physical, psychological, and cognitive changes that come with aging, middle adults are as much in transition as their teenagers. In this chapter, we explore some of the contextual and cultural considerations of moving through the years of middle adulthood. We will anchor our discussion in the case of Ellen, a recently separated mother of one caring for her mother who finds herself in the existential crisis of “Who am I now? and “Who can I become?”

This chapter provides the introduction to emerging adulthood and early adulthood—the first stages of adulthood—through the cultural and contextual lens of an African American man, Bi’lal. Throughout this chapter, racial identity development theory, ethnic identity development theory, and Black Male Identity development theory are used to understand Bi’lal’s identity as a cultural being. Contextual constructs like minority status stress, race-related stress, and post-traumatic slave syndrome are explored to examine their impact on Bi’lal’s development. This chapter also includes elements designed to support practice. There are excerpts of how one helper, Therapist James, supports Bi’lal post-critical incident, toward his goals as a person approaching early adulthood. Additionally, there is expert advice and reflection from a social worker experienced in working with African American males in the development stages of emerging adulthood and early adulthood.

In the previous chapter, we explored cultural and contextual factors of moving through the developmental phase of middle adulthood. As a reminder, this stage of life can range between 40 and 65 years old but, as evidenced by the ever-extending lifespan, can even represent people who are in their 70s (Overstreet, n.d.). In this chapter, we look specifically at relevant theories, models, and research that inform our understanding of experiences of people in midlife. Theories of psychosocial development (Erikson), ego development (Loevinger), and moral development (Gilligan and Kohlberg) are discussed in the context of middle adult development. Relevant and emerging research specific to the theories presented will also be a part of our discussion, as it is important to be able to critically analyze theories and models based on new information. In addition, we consider factors including physical health, sexual health, and resilience and self-concept as applied to this stage of life as we continue to explore the experiences of Ellen, our fictional client from Chapter 10. We will also look a bit more at Ellen’s husband, Clark, and how he may also be experiencing the developmental challenges of middle adulthood.

In the previous chapter, you were introduced to Bi’lal and we reviewed his emerging and early adult development from the perspectives of culture and context. The conversation addressed racial identity development, ethnic identity development, Black male identity development, and emerging and early adulthood theory. In this chapter, we explore adult development theory through the lens of Bi’lal’s partner and companion Mystic. You should develop a depth of understanding of the various development theorists’ ideas about the first stages of adulthood and start to consider the relevance to the areas of practice you expect to participate. This chapter will include summaries of theories of personality and psychosocial identity development. You will also have opportunities to hear from experts in the field about how they use development theory in their work with their clients.

This chapter examines the construct of evil from the perspective of moral psychology. The chapter first discusses contemporary theories of evil and common misconceptions about evil. The chapter then draws on examples from social psychology in order to examine the psychological and situational causes of evil actions. The relation between trauma and evil is then explored with an emphasis on Primo Levi’s account of Auschwitz and the concept of the “gray zone.” Finally, the chapter discusses the nature and possibility of healing and reconciliation (“moral repair”) after evil has been done.

This chapter focuses on the ethical implications of trauma work. The chapter begins with a discussion of the five ethical principles and connects ethics to practice in trauma work. Next, the chapter defines and describes several key terms and concepts related to ethical practice, including wounded healers, compassion fatigue, ethical and moral behaviors, moral suffering, and self-care. The ethical implications of supervising counselors engaged in trauma work are described next, including the importance of addressing multicultural issues and intersectionality in practice. The crucial process of transforming from victim to survivor is described, as well as counselors’ ethical obligations in that process. Finally, a number of resources, related to ethical practice in trauma work, is provided online.

This chapter focuses on the intolerance experienced by marginalized groups of people, based on race, ethnicity, and immigration status. It reviews current knowledge about violence-based trauma among minority groups and offers discussions that highlight historical patterns of and risk factors for PTSD. The chapter briefly summarizes interventions and treatments that relate to race-based, ethnicity-based, historical, and intergenerational trauma.

This chapter describes a range of techniques and strategies to facilitate trauma recovery. Included are examples from emotional, somatic, neurobiological, relational, and cognitive approaches to trauma-informed treatment. The chapter discusses techniques that are based on Herman’s (1992/2015) three-phase model of safety/stabilization, working through, and reconnection, as well as integrative techniques based on a holistic approach to trauma recovery. These tools both empower survivors to self-regulate and to avoid retraumatization, with or without processing the trauma story through talk- or narrative therapy. Finally, individualized tools for addressing client and counselor self-care and self-regulation, shared trauma, and traumatic grief are discussed, with a special focus on trauma treatment during the global pandemic of COVID-19.

This chapter focuses on issues related to mass violence and the effects of mass violence on the populace, both in terms of proximal and distal locations of those affected. The increase of mass violence has caused global concern. The effects of mass violence events continue to traumatize those who are affected. This chapter offers insight to help understand the impacts of mass violence on survivors, families, communities, and society.

This final chapter focuses on synthesizing the information about trauma, stress, crisis, and disaster presented in the previous 32 chapters of this textbook. As an extension of analyzing the counseling implications presented across all of the chapters of this book, Chapter 33 presents the details of an integrative systemic approach to trauma (ISAT) model, with the hope that it can expand upon and continue to construct the trauma scaffold described in the first four chapters of this textbook.

The distress of populations affected by genocide, war, and the specific phenomenon often referred to as “ethnic cleansing” and political violence is typically viewed through the lens of trauma and posttraumatic stress disorder (PTSD) (the word “war” is used in the rest of this chapter to refer specifically to “ethnic cleansing”). However, there have been increasing critiques of the assumed universal applicability of the trauma paradigm, from psychologists and psychiatrists, as well as anthropologists and sociologists, engaged with individuals and societies affected by mass violence. This chapter reviews how the specific characteristics of genocide, war, and political violence pose challenges to biomedical and Western psychological framings of trauma. It argues the need for greater attention to cultural context, intersecting structural oppressions, and social justice and considers how narrative- and arts-based tools, underpinned by principles drawn from multicultural and decolonial approaches, may assist in this endeavor.

This chapter focuses on the effects of criminal victimization and ways that counselors can respond effectively. This chapter discusses specific counseling responses, including symptom management, short-term mental health stabilization, and longer-term counseling and psychotherapeutic strategies. The counseling implications for working with crime victims are elaborated.

Posttraumatic stress disorder (PTSD) is a condition that is characterized by profound neurochemical and neuroendocrine changes in the central nervous system (CNS). The physical response to trauma, in those susceptible to its development, can induce physical and behavioral changes. Understanding the impact of these neural changes is the basis for developing a rational medication therapy regimen for a client diagnosed with PTSD. The use of these medications is vital for symptom management so that the benefits of counseling can be realized. This chapter will discuss the neuronal and pathophysiological impact of trauma on the brain while subsequently describing how medications can impact symptom improvement. Medications that are discussed in this chapter include the use of antidepressants, antipsychotics, and other novel agents used in the pharmacotherapy of PTSD. Both U.S. Food and Drug Administration (FDA)-approved medications and “off-label” medications are explored.

This chapter focuses on introducing the reader to theories about stress and crisis and on promoting basic stress management and crisis intervention skills. Stress and crisis often intersect with trauma and disaster events and are foundational aspects of the scaffold being created, in the first four chapters of this book, for grasping the profound effects that stress, crisis, disaster, and trauma can have at individual and systemic levels.

This chapter focuses on aging as a natural process that affects every one of us. It provides an interdisciplinary overview on how older adults’ health needs and the relationships for them change with the aging process, conspiring their biopsychosocial vulnerabilities and assets during the later life years. Most importantly, it discusses the developmental aspects of aging, the meaning of age, issues affecting older adult people, and the significance of relationship support to successful aging. In doing so, the chapter surveys the demographics of aging and the evidence from aging-related research important to the health resourcing of older adults. Finally, the chapter considers a case illustration on the implications of aging to healthcare resourcing from family, cultural, and social policy perspectives.

This chapter focuses on issues associated with intimate partner violence (IPV). It examines the impact on survivors of IPV as well as on families, communities, and societies. The chapter presents theories for contextualizing and understanding IPV as well as offering strategies for counseling survivors of IPV.

This chapter focuses on understanding issues of loss and grief as well as their intersections with trauma experiences. It examines the classical theories associated with loss and grief, describing the transition to a postmodern perspective of how grief is experienced. The chapter describes interventions that can be used with clients experiencing loss and grief, along with the counseling implications. Practice-based resources are available online.

This chapter examines the history and evolution of violence in schools and presents the various mental health and violence prevention theories and interventions that have developed and continue to emerge in the ever-changing landscape of the spillover of societal violence into spaces historically considered safe, such as American schools. This chapter delves into the discrepancies in response time and method, funding, and maintenance of follow-up in districts and communities that have fewer resources. Statistics regarding the occurrence of violence in public and private schools are presented, and strategies aimed at increasing safety are discussed. Brief and long-term counseling approaches are explored, and resources are offered online at Springer Connect.

This chapter focuses on the counseling speciality of disaster mental health. Topics include a discussion of the science behind various natural disasters and the psychological effects experienced by the survivors. Also discussed are the stages of disaster recovery and counselor actions within each phase. Additionally, this chapter describes the unique lived experiences of first responders and ways that professional counselors can intervene to support the unique. behavioral health needs of rescue workers. Finally, the counselor’s role in the COVID-19 pandemic is discussed.

In addition to traumas that heterosexual and cisgender people experience, queer and transgender people face a heterosexist and cissexist culture, in which marginalization and trauma against them is normalized or minimized. In this chapter, the experience of hate crimes and violence, relational and interpersonal trauma, religious based-trauma, and sociocultural and political-based trauma are covered in relation to how it impacts Lesbian, Gay, Bisexual, Trans, and Queer (LGBTQ) people. Clinical and counseling implications are discussed. The increase in mental health challenges is explained via the minority stress model. Implications for diagnosis and trauma-informed practices for queer and transgender people are discussed. Additionally, the role of the mental health professional as a social justice advocate is explored, including how social justice frameworks can be incorporated in the counseling environment.

Psychological trauma is complex and sometimes difficult to understand, and its various manifestations can be challenging for the treating counselor. Psychological assessment and testing can provide the counselor with tools to hone clinical judgment and understanding of clients’ trauma experiences beyond what is available in the counseling interview. After providing an overview of psychological assessment in general, we discuss the types of assessment methods available and provide specific instruments that can be of use in the assessment of psychological trauma. These methods include structured interviews, trauma-specific tests, and broad-based personality assessment tests, including self-report and performance-based methods. The chapter ends with a discussion of best practices in the psychological assessment of trauma along with recommendations for integrating assessment into counseling practice.

Counselors and other therapists providing counseling to clients diagnosed with posttraumatic stress disorder (PTSD) may be at greater risk for developing secondary trauma, also called vicarious trauma. While PTSD had been the focus of much research in the counseling field, less emphasis has been placed on counselor self-care. This chapter focuses on the rationale for counselor self-care.

This chapter introduces foundational knowledge necessary for understanding the effects of psychosocial trauma, stress, crisis, and disaster. It offers brief discussions about the historical implications of how psychosocial trauma has come to be defined as well as how the related diagnostic categories have developed. Finally, the importance of recognizing the human capacity for resilience and growth, in the face of trauma, is emphasized.

This chapter focuses on integrative approaches to trauma therapy, crisis intervention, and disaster response. The purpose of the chapter is to identify and explain best practices for integrative mental health responses aimed at supporting survivors of trauma, crises, and disasters. While each unique situation requires a tailored response, this chapter describes the basic principles that apply to nearly all emergent, mass casualty, and traumatizing events.