This chapter focuses on consideration of two kinds of abuse: abuse that takes place within a church and abuse that takes the place of a church. In the first, the pastor is usually unaware of the abuser, and in the second, the pastor often is the abuser. The spiritual ramifications when trusted religious leaders use people for sexual gratification are enormous. Gartner described how children abused by spiritual leaders can develop a crisis of faith, believing that somehow they have betrayed God. There is also a problem of the heterosexual abuse of children and adults by clergy of all denominations. Psychotherapists can perform preventative and even ameliorative work in churches by meeting with church leadership to help train them in identifying and dealing appropriately with sex abuse in the church. With regard to spirituality and religion, it’s important that the abused person is treated psychologically and also spiritually.

In recent years, the rural hospital closure crisis has escalated with 2015 closure rates six times higher than in 2010. The National Rural Health Association (2020) reported that currently one in three rural hospitals may be at risk of closure. Much of the blame for closures has long been attributed to factors external to rural communities, such as reduced Medicare reimbursement, a declining rural economy, provider shortages, and being located in states that did not expand Medicaid under the Affordable Care Act. Improving equity in access to care has been an ongoing concern throughout most of the past half century, and rural access to care has been a particularly persistent problem. Improving equity in access to care has been an ongoing concern throughout most of the past half century, and rural access to care has been a particularly persistent problem. This chapter focuses on the Acceptability Scale.

Acceptance and commitment therapy (ACT) is a behavioral intervention designed to increase and improve psychological flexibility. Psychological flexibility, from the ACT perspective, is defined as contacting the present moment fully, as a conscious human being, experiencing what is there to be experienced and working to change behavior such that it is in the service of chosen values. The therapeutic work explored in ACT counters the problem solving approach. Clients are taught to be aware of their thoughts and emotional experiences. An important feature of the therapy is that the therapist approaches these issues with humility and compassion for the client’s experience. Many clients who have experienced military sexual trauma (MST) have limited their lives in a number of ways in an effort to control or prevent fear or fear-related experiences such as anxiety or difficult memories.

Evidence-based practice (EBP) is a seven-step problem-solving approach to the delivery of healthcare that integrates the best evidence from well-designed studies with a clinician’s expertise and the values/preferences of the patient/family. This chapter discusses the importance of EBP in achieving the quadruple aim in healthcare, describes the current state of EBP in healthcare, including EBP competencies, identifies the barriers and facilitators of EBP, and discusses the key leadership strategies to ignite and sustain EBP in healthcare. It briefly describes EBP competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings. Leaders must first understand that EBP is the direct pathway to achieve the quadruple aim in healthcare and be willing to invest in it knowing that healthcare quality and safety will be enhanced, population health outcomes will improve, healthcare costs will diminish, and clinician job satisfaction will increase as EBP diffuses throughout the organization.

This chapter explains the process of solution focused narrative therapy (SFNT) and offers suggestions for the therapist’s use of conversational questioning. SFNT therapy comprises six steps: best hopes, mapping the effects of the problem, constructing the preferred story, exception gathering, preparing the presentation of the preferred future and moving up the scale, and summarizing and inviting clients to watch for success. The most important step is beginning therapy. The therapist begins the session by introducing himself, learning the names of those attending, and asking the same question of all present. The chapter also presents an exercise, which may help to identify traits, values, and actions that help readers present their best self to their clients, particularly clients that are challenging.

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.

This chapter explores the unfolding of the phases of EMDR therapy as children go through developmental stages. Infants, toddlers, and preschoolers may express significant variation simply because of developmental processes and achievements. The chapter summarizes adaptations that may be helpful to consider through each phase of child development as the client and therapist simultaneously move through the phases of EMDR therapy. Mentalizing in parent-child relationships is a co-occurring theoretical and clinical intervention that is included through all the phases of EMDR therapy. With infants, toddlers, and preschoolers, the history taking, case conceptualization, and treatment planning are integrated with the goals of the preparation phase. Young children are often brought to therapy by parents who are concerned about clinical, emotional, behavioral, regulatory, and situational issues. Therapists and parents are active participants in the child’s therapy. Alternating bilateral stimulation can be taught in many ways using toys.

This chapter discusses the modifications of using Eye Movement Desensitization and Reprocessing (EMDR) therapy with preteens and adolescents while staying true to the eight phases. The difference between employing EMDR therapy with adults versus preteens and teens lies primarily in history taking, preparation, pacing of the phases, the therapist’s attunement to the client, and the therapeutic relationship. Many of the clinical decisions and procedural considerations for working with preteens and adolescents occur within the first two phases: the History Taking, Case Conceptualization, and Treatment Planning Phase and the Preparation Phase. In order to guide the EMDR therapy process, gathering a thorough history from both the client and caregiver is necessary. Exploring the client’s positive relationships, including favorite teachers, coaches, and beloved family members, can be used as resources and cognitive interweaves (CI) during EMDR therapy. Pacing refers to the timing of when to apply the various phases of EMDR therapy.

This chapter presents a review of adaptive behavior assessment from conceptual, technical, and practical perspectives. Although adaptive behavior is a construct with relevance across multiple disability populations served by rehabilitation professionals, its greatest relevance concerns persons with intellectual disabilities (ID). This chapter presents adaptive behavior assessment within an ID context. It begins by describing the population of persons with ID and how they are defined through federal legislation and professional associations. Specific focus is placed on the growing importance of adaptive behavior in the process of identifying persons with this disability. The chapter then presents a review of standardized and informal approaches to adaptive behavior assessment. To illustrate its professional importance and use of best-practice approaches, the chapter then addresses three practice areas where adaptive behavior assessment plays a key role in contemporary practice with persons with ID, including death penalty evaluations, community-based habilitation, and culturally responsive assessment.

This chapter considers addiction generally without reference to the specific chemical to which an addiction develops. It discusses the neuroscience of addiction. The chapter presents the story on how addictive chemicals change the brain. Research on brain changes with addiction does provide useful information on when recovering persons are more susceptible to relapse. The chapter discusses the understanding based on animal work, and considers the heterogeneity of addictive patterns in people. It explores some of the findings on genetic variations associated with the risk of addiction to drugs of abuse. The chapter then provides specific information on how to screen and initiate treatment. In the United States, opiate agonists like buprenorphine and methadone are legal and considered to be treatment. Mandated treatment is as effective as voluntary treatment, probably because alcoholics often get convinced of the wisdom of change in the course of treatment.

This chapter focuses on conceptualizing addiction in relationship to the experience of trauma. It briefly covers some of the major theoretical orientations used to understand how addiction develops in individuals with diagnosable substance use disorders and co-occurring trauma. The chapter highlights the importance of social neuroscience and identifies stigma-related obstacles to recovery. The chapter concludes with discussions of treatment approaches and strategies as well as the counseling implications of co-occurring substance use and trauma disorders.

The nature and specialty of addictions counseling is unique from general mental health counseling and as a result presents distinct ethical concerns for practitioners. This chapter reviews and discusses the unique ethical considerations in addictions counseling. It clarifies the distinction between addictions counseling as a counseling specialty and the field of substance abuse treatment and evaluation. The chapter provides a discussion of considerations for ethical addictions counseling practice. Prior literature has established common ethical issues experienced by practitioners providing addictions treatment. These include ethical issues related to: professional identity and certification; settings issues; privacy, confidentiality, and privileged communication; informed consent; mandatory clients; multiple roles and relationships; settings issues; counseling adolescents and minors; and issues of diversity multiculturalism. Addictions counselors must utilize self-care and consultation (among other behaviors) in order to resolve potential values conflicts that may arise in the provision of substance abuse counseling.

Counselors serve an important role in the lives of youth. They provide safe spaces for children to express their emotions, fears, thoughts, and worries. Supporting children and adolescents of special populations and marginalized statuses requires that counselors (a) recognize how personal bias may impact the counseling process; (b) utilize culturally competent, theory-based techniques in counseling; (c) understand how socioeconomic status, poverty, race, gender, and sexual orientation impact children and adolescents; and (d) utilize practical, strength-based approaches to counseling. Counselors remain committed to the work of building strength-based, culturally competent, and inclusive practices. The counselor’s efforts to provide culturally responsive strategies and interventions will greatly influence the success of counseling diverse populations of children and adolescents. With this in mind, clinicians must remain critically reflective of their worldviews and biases and commit to the life-long process of cultural competence.

For professional school counselors and clinical mental health counselors to serve students with disabilities and adequately advocate within the comprehensive school and community contexts, they must first understand the legislation that exists. Congress set these legislations in place to protect the rights of students with disabilities and assure them access, inclusion, and a free and appropriate public education. This chapter helps to identify the disability categories under the Individuals with Disabilities Education Act and the common characteristics of giftedness. It recognizes legislative mandates that apply to education of children and adolescents with disabilities and giftedness in grades Pre-K through 12. The chapter describes postsecondary transition issues for adolescents with disabilities entering postsecondary institutions. It expresses the connection between identity and disability. The chapter explains the role of the professional school counselor and clinical mental health counselors when working with students with disabilities and those classified as gifted.

Trauma work with children and adolescents remains challenging on all levels and becomes increasingly complex when violence permeates various domains of life. Counselors must also consider the reciprocal relationships between trauma and neurological, psychological, social, cultural, and systemic factors that alleviate or exacerbate the experience of trauma. Early identification, assessment, and intervention remain critical components of trauma recovery. The inclusion of trauma-informed interventions such as emotional awareness and regulation, as well as mindfulness skills can help children and adolescents diminish symptoms that overwhelm internal coping mechanisms. This chapter helps readers to distinguish the complexity and range of trauma experienced by children, identify the neurobiological, social, psychological, and academic impact of trauma causing events on children, and recognize various trauma-informed and creative interventions when working with children and adolescent clients, as well as important considerations for school counselors.

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.

The Individual Psychology of Alfred Adler provides a rich theoretical foundation for what has developed into Adlerian psychotherapy. This chapter defines the basic tenets of Adler’s theory of personality and therapy. Adler’s theory is grounded on the idea that childhood experiences are crucial to the psychological development, and that children, who are by nature in an inferior position to parents and other adults, strive to achieve some sense of superiority. Adler ’s work represents a psychological theory that acknowledges the influence of social factors on the personality. In efforts toward understanding the lifestyle, Adler viewed humans’ unique approaches to life through the lenses of the life tasks. These tasks included: the work task, the social task, and the sexual task. Adler believed that encouragement, the act of promoting courage within someone else, was the cornerstone of therapy and could inspire clients toward growth, healthy adaptation, and functioning in life.

This chapter explores the use of virtual simulation from an administrative perspective. Nursing education is moving from PowerPoint lectures and technical skills laboratories on static body parts to engaged learning with high-fidelity simulation, learner-centered experiential teaching, and simulated and standardized patients, all of which help students learn to think, act, and reflect like nurses. Virtual simulation is one way of teaching and learning professional skills, assisting with the integration of acquired scientific knowledge, theory, and practice to promote clinical reasoning and critical thinking. The chapter explores ways in which administrators can support faculty and students while enhancing the educational experience at their institutions. It is important that administrators manage faculty and student expectations and needs while assessing university support for a variety of options; they must address the challenges and opportunities, and explore ideas for leveraging support by developing partnerships.

Administrators must make a decisive, purposeful, realistic, and practical allocation of resources to lead and support the effort to adopt new, cost-effective, and learning enhancing instructional technologies. Nursing education administrators facilitate faculty development and active engagement in the area of virtual simulation and the use of technology in the teaching–learning process. The nurse administrator’s role is to ensure that technological systems are transformed effectively and that financial, ethical, and legal implications are considered. This chapter focuses on the positive aspects of the administrator’s roles as they relate to the integration of virtual simulation. The roles described provide a brief overview of the influence administrators can have on their institution’s technology plan, faculty’s willingness to engage in technology integration, and student learning. Visionary administrators are able to inspire, motivate, and support their faculty and students while paving the path to a smooth transition into virtual simulation integration.

Many developmental models view human growth from a space of lack or abundance, a perpetual fulcrum swinging from the word survive at one end to thrive at the other. This chapter discusses Urie Bronfenbrenner’s bioecological theory of human development to conceptualize female adolescent and young adult development. The contextual focus of this theory provides a global framework for counselors to view young women as individuals who both influence, and are influenced by, their surroundings. Customs, beliefs, and the government all play a role in the development of children and adolescents. When young females overcome the stigma associated with mental health services, they typically seek treatment in one of two primary settings: community mental health centers and schools. Relational-cultural theory (RCT) is an evolving feminist model of human development that views connection to others as essential to growth and disconnection as a major cause of disrupted functioning.

One important goal of Healthy People 2020 is to improve the healthy development, health, safety, and well-being of both adolescents and young adults. Patterns of behavior during adolescence and young adulthood determine adult health status and health risks. While youth are generally healthy, it is important to assess and screen for issues that begin or peak during this developmental phase. These issues include mental health concerns, substance and tobacco/nicotine use, nutrition and weight concerns, sexually transmitted infections (STIs) and HIV, unintended pregnancy, homelessness, academic issues, homicide and suicide, and accidents such as motor vehicle collisions.

To set the stage for what counselors need to know, this chapter introduces the reader to an overview of theories that lay a foundation for working with adult clients. It provides a discussion of theoretical perspectives that relate to both individual development and contextual factors. To capture this intersection of influence, the chapter highlights Erikson’s (1950, 1963) psychosocial stage model, along with contextual and life span perspectives of adult development. It introduces the transition perspective, delving into the transition process itself. Adults face times that are increasingly challenging. A central theme in our current social context is change, reflecting the dynamic impact of forces across demographic, social, cultural, technological, political, and historical domains. A theory is a set of abstract principles that can be used to predict facts and to organize them within a particular body of knowledge.

This chapter provides therapists with tools for teaching children advanced affect management skills. The goal for teaching children resourcing, coping skills, enhancing mastery experiences is to assist the child in creating his/her own toolbox of skills to be used in therapy and in daily life for more advanced coping. Therapists can begin by teaching the child about relaxation and then explore with the child current methods that the child already uses to relax. With guided imagery, the child is asked to choose a comfortable place to sit in the office and select a real or imaginary favorite place where the child feels most comfortable. In addition to breathing, guided imagery, progressive muscle relaxation, children can be taught other ways to help calm themselves. If the child becomes overwhelmed by affect, the child is likely to attribute the discomfort to the eye movement desensitization reprocessing (EMDR) therapy and the therapeutic process.

Nurses play a key role in the field of epidemiology and in population health. Population-focused nursing demands application of nursing theory and practice while integrating the tenets of public health to contribute to the improvement of community and population health. While advanced practice nurses may not all specialize in public health, it is essential that advanced practice nurses have a foundational knowledge of concepts on the health and illness continuum from a population perspective. This chapter articulates the meaning of advanced practice nursing. It describes the role of the advanced practice nurse in epidemiology and population health. Consistent themes emerge across all functional roles of advanced practice nursing. Advanced assessment and analytic skills to include use of epidemiologic data and concepts to better understand disease occurrence and distribution are crucial to optimal health outcomes.

This chapter presents several strategies, analogies, and metaphors to address dissociation from different angles and perspectives. Clinicians will have a wide range of methods of introducing and explaining dissociation to children. Analogies and stories that help children understand the multiplicity of the self may be presented during the preparation phase of eye movement desensitization and reprocessing (EMDR) therapy. A good way of introducing the concept of dissociation is by using the dissociation kit for kids. Stimulating interoceptive awareness is a fundamental aspect of the work needed during the preparation phase of EMDR therapy with dissociative children. Visceral, proprioceptive, as well as kinesthetic-muscle awareness should be stimulated. The installation of present resolution (IPR) was inspired by an exercise developed by Steele and Raider. In this exercise, the child is asked to draw a picture of the past traumatic event followed by a picture of the child in the present.

This chapter addresses the influence of the student role, especially in relation to students studying nursing informatics (NI). The NI student’s influence moves beyond the beginner roles and should be in the expert role. As students learn about NI, they also explore emerging technologies that provide opportunities for student-to-student collaboration. With the advent of virtual learning environments (VLEs) and virtual simulation, there is a greater need for faculty to develop informatics skills and competencies. The chapter provides a description of an educational process used to develop and deploy a program of simulation previously lacking in the graduate program and now used to improve NI skills and knowledge for both student and faculty. The foundations and framework for this project are based on needs and mandates identified by industry, healthcare, and professional organizations such as the American Nurses Association, Quality and Safety Education for Nurses Initiative, and National League for Nursing.

This chapter sheds light on how the managed care system works as well as the counselor's role in managed care and the importance of advocacy and issues related to payment and reimbursement. It offers a starting point to understand the system, and counselors must continue to seek more resources, join organizations and build networks with other counselors and change makers to become active members of the professional community. Managed care is an integral part of the healthcare system, and it is imperative for counselors to be able to understand the system in order to navigate it better. Counselors can anticipate the issues that are related to cost and payments and can provide more efficient service to the clients, if they understand how managed care system operates. The chapter demystifies the issues of payment for counseling services, specifically third-party billing, managed care, medical assistance programs, and other issues therein.

Emotional dysregulation is a key component of posttraumatic stress disorder (PTSD). It is important to understand the basic neurophysiology of stress and how it influences a survivor’s ability to cope. The mechanism involved in stress includes the connections among the hypothalamus, the pituitary gland, and the adrenal gland. Glucocorticoids influence metabolism and immune function, and send signals back to the brain about the stressor. Low cortisol levels immediately after a trauma may also be a risk factor for developing PTSD. The sympathetic nervous system (SNS) secretes catecholamines during stress, which help to consolidate memories. When military personnel have a history of childhood abuse and subsequent military sexual trauma (MST), they may be particularly vulnerable to developing PTSD. Anticipatory anxiety is also one of the greatest barriers in engaging clients in treatment. Mindfulness can be described as any practice that brings clients back to the present moment.

One reason mainstream providers shy away from treating sexual issues is that they want to avoid feeling possible discomfort if a client or couple reports that they engage in kink, or sexual practices outside of what is considered by many people to be “normal”; that is, penis-vagina intercourse between a heterosexual man and heterosexual woman, or what is sometimes referred to as “vanilla” sex. These fears are reflective of a centuries old, deeply held myth that sexual activity conducted without purpose of reproduction is “deviant” or “perverse.” Alternative sexual practices, or what the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition labels as paraphilias, may include BDSM (letters that can stand for bondage/domination, domination/submission, sadism, sado-masochism, or masochism), sexual acts involving articles of clothing or particular objects, fetishistic cross-dressing, and/or sexual role-play. Education regarding kinky sex and its devotees can help providers become more accepting and empathic when people who practice kink seek treatment.

Ideas and attitudes about gender and orientation have been rapidly transforming, challenging mainstream thinking about what it means to be male or female; gay, straight, bisexual, or asexual; or having a fluid identity, that is, having a gender identity or orientation that changes. Affirming therapy does not simply mean the provider is merely “LGBTQ+-friendly.”.The affirming provider must understand at a much deeper level the experience of being a member of a sexual minority group who may face social stigma, discrimination, homo-and/or transphobia, and fears related to coming or being out to family friends, and coworkers, and who have increased risk of anxiety, depression, substance abuse, and attempting or succeeding in suicide. This chapter focuses on a selection of the particular issues that providers must attend to in themselves as well as the LGBTQ+ client or couple. It describes sexual dysfunction and treatment in the sexual minority population.

Aiming for impact means that one not only thinks that one can transform clinical service, but wants to develop and provide patients and their families with the kind of positive moments that are remembered 20 years later. Leadership presupposes aiming for impact; that is, a determination to address the challenges inherent in the current healthcare system. Impact means always giving some thought to how something good can be parlayed into something better. If one is aiming for impact, developmental learning will inevitably move from focusing on mastery of what today is considered to be best practice to imagining and developing a new and improved version of future practice. Nurses have historically been socialized in the direction of convergent thinking, but leadership requires divergent thinking, experiences that promote creativity and innovation.

Allied and clinical mental health case management is a systems-of-care and strength-based model of care that transcends professional affiliations. Systems-of-care and strength-based approaches are framed by addressing the full scope of the health needs of the patient or client across areas of activity and participation and capitalizing on the patient or client's resources for health recovery while maintaining the efficient use of treatment care resources. The successful implementation of a systems-of-care and strength-based model of care by allied and clinical mental health case managers depends on the use of appropriate training, and skills as well as a case referral system that minimizes service discontinuities. This chapter presents a systems-of-care and a strength-based approach to allied health case management likely to result in superior mental health function and well-being for patients or clients, their families or significant others, and care providers.

In the United States (U.S.) there are 574 federally recognized tribes across 35 states. According to the 2010 U.S. census, about 5.2 million (1.6%) reported their race as American Indian/Alaska Native (AI/AN) and 2.9 million (0.9%) reported AI/AN as their only race. Fifty-four percent of AIs/ANs live in rural regions, with 68% residing in or close to their tribal reservation. Provision of healthcare services is a “federal promise” granted to federally recognized AI/AN tribes through treaties with the federal government. The Indian Health Service (IHS) is the federally designated healthcare provider for AIs/ANs from federally recognized tribes. This chapter briefly reviews healthcare services for AI/AN people. It defines hospice and palliative care, and describes their individual approaches to understanding end-of-life (EOL) and palliative care in two AI tribal communities. The chapter concludes with lessons learned and implications for rural nursing practice, research, and education.

This chapter focuses on anxiety disorders and deals with a discussion of the physiology of anxiety, including the major structures involved in the creation of a fear memory. It considers the mechanisms for extinction of conditioned anxiety. The chapter discusses the basic physiology of fear conditioning, specific anxiety disorders namely generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD), and explains treatments. It then reviews the literature about how clients can talk about their fears to minimize them and how relabeling or reappraising of past events can be helpful. There is evidence suggesting that the basal ganglia, structures associated with the control of movement, are involved in the expression of OCD behaviors in subsets of those with OCD. Cognitive behavioral therapy is effective in the treatment of generalized anxiety. Selective serotonin reuptake inhibitors are also used in the treatment of anxiety disorders.

Anxiety, depression, and delirium are common symptoms experienced by patients with serious illness. In palliative care, anxiety and depression commonly arise from fear of death, loss of independence, fear of being a burden to others, hopelessness, and loneliness, in addition to concern about symptom burden and disease progression. Anxiety manifests itself in four ways: physical symptoms, affective symptoms, behavioral responses, and cognitive responses. The patient and the family should be reassured that symptoms of depression and anxiety are effectively treated most of the time with pharmacological and nonpharmacological interventions. Effective treatment of anxiety, depression, and delirium necessitates a collaborative effort between the patient, family, and the health team. This chapter addresses the comprehensive patient-centered and family-focused care necessary for effective diagnosis, assessment, and treatment of anxiety, depression, and delirium in the palliative care patient.

Later life anxiety is often found in conjunction with major depressive disorders, and can have foundations in dietary issues as well as drug associations. There has been a correlation between long-term presence of anxiety in older adults associated with female gender, lower level of educational achievement, being unmarried as well as having three or more co-morbid chronic conditions. The most common diagnosed anxiety disorder in the geriatric population is generalized anxiety disorder. Other anxiety disorders frequently encountered in practice include social phobia, agoraphobia, panic disorder, post-traumatic stress disorder and obsessive-compulsive disorder. This chapter briefly outlines and discusses each disorder. It helps the practitioners to: define anxiety; distinguish between anxiety disorders; discuss example tools that can be used to establish an anxiety disorder diagnosis; assess a geriatric patient for post-traumatic stress disorder using an appropriate clinical rating scale; and recommend general pharmacological (class) and non-pharmacological treatment options for anxiety disorders.

While the occasional experience of anxiety is a typical part of life, people with anxiety disorders often have intense and persistent worry and fear about everyday situations. This chapter contains three cases of anxiety disorders in two adult males and one adolescent female. Generalized anxiety disorder is highlighted in this chapter as well as the less common, selective mutism diagnosis. While the clients in these cases have symptoms that lead to a DSM-5 (Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition) diagnosis in the same category, these cases highlight how cultural factors and family of origins issues may exacerbate anxiety-related symptoms. Questions for consideration are also included.

Meeting academic demands, getting along with roommates, dealing with new social pressures, questioning career choices, managing finances, and other new responsibilities of the college experience can give rise to unexpected and undesired stress and anxiety. While event-related stress does not cause anxiety disorders on its own, it can worsen symptoms of a preexisting anxiety disorder or trigger an anxiety disorder in someone who may be predisposed. The symptoms of anxiety disorders generally involve disturbances in mood, thinking, and behavior. This chapter assesses the different classifications of anxiety disorders. Types of anxiety disorder includes generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD), social anxiety disorder, and specific phobias. The chapter evaluates effective treatment and intervention strategies for college student population. Among other psychotherapy approaches, cognitive-behavioral therapy (CBT), relaxation therapy (RT), and mindfulness-based stress reduction (MBSR) have received considerable empirical support in the treatment of anxiety disorders.

The process of technology integration is continually shifting. Successful integration of technology into the nursing curriculum is contingent on a myriad of contributing factors, not the least of which is that technology and curriculum continue to develop. The Faculty Administrators Students Technology Strategic Integration Model (FAST SIM) provides a framework for guiding the process of technology integration with the nursing curriculum. As stakeholders, faculty, administrators, or students may find relevance in applying the model from their individual perspective and particular needs. Paying particular attention to the influence and contribution from faculty, administrators, and students plays a significant role in the success of a technology integration plan or strategy. This chapter provides an overview of the key contributors to the technology integration process. It also offers suggestions as to how faculty, administrators, and students influence the process and identify opportunities to apply the FAST SIM.

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.

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.

As a health-care provider, one must be able to accurately and efficiently correlate subjective information with objective findings. This is especially important in electrocardiogram (EKG) interpretation. This chapter presents patient’s basic history and a corresponding EKG for clinical practice. Space is provided to document the pertinent findings. The exercises include heart rate calculation, rhythm evaluation, axis evaluation and heart block assessment including sinus block; first-, second-, or third-degree atrioventricular (AV) block; bundle branch block; and QT prolongation. It also includes evaluation for signs of ischemia and infarction and strain patterns such as those seen in ventricular hypertrophy and consider atrial enlargement. The chapter aims to improve EKG interpretation skills.

A family systems approach to understanding anxiety within a family or couple is complex. The Diagnostic and Statistical Manual of Mental Disorders (5th ed.) provides a framework for identifying and understanding anxiety disorders. This chapter reviews the DSM-5 Anxiety Disorders through a systemic perspective. Considering that a core concept of family systems theory is that individuals are embedded in larger systems, it is still important to understand the individual and internal factors that may influence anxiety disorders. The majority of research on the etiology and treatment of anxiety disorders focuses on individual variables or individual therapy. The research on family therapy for anxiety disorders is limited. The most well-researched family therapy model for anxious adults and children is family cognitive behavioral therapy. In order to further understand a systemic case conceptualization of a family impacted by anxiety disorders, a case example is provided.

There is no aspect of leadership as gratifying as helping others reach their potential. It is rewarding in a way that other things aren’t because any investment in people pays dividends forevermore. Appreciating others includes giving feedback that is customized to the person. There is growing evidence that indiscriminate praise doesn’t change behavior positively, particularly if the commendation is for something relatively immutable like being smart. Appreciating others includes a broad range of behaviors—valuing the contributions of different kinds of people; respecting what each generation contributes to the mix; developing a community of learning so all continue to grow and develop throughout their careers; understanding that investments in people have a ripple effect because those who have been helped tend to “pay it forward” and providing timely and effective feedback that encourages improvement or advancement. Appreciating others also means valuing what others have done to help your advancement.

International Society for the Study of Trauma and Dissociation (ISSTD)’s professional training institute offers comprehensive courses on childhood dissociation that are taught internationally and online. This chapter briefly cites some of the theories that have emerged in the dissociative field. One system, the apparently normal personality (ANP) enables an individual to perform necessary functions, such as work. The emotional personality (EP) is action system fixated at the time of the trauma to defend from threats. As with the Adaptive Information Processing Model (AIP) in eye movement desensitization and reprocessing (EMDR), each phase brings reassessment of the client’s ability to move forward to effectively process trauma. There are many overlapping symptoms with Attention Deficit Hyperactive Disorder (ADHD) and dissociation that often mask the dissociation. The rate of diagnosis of pediatric bipolar disorder has increased 40 times in the last ten years.

Assessing fidelity or adherence to the phases of Eye Movement Desensitization Reprocessing (EMDR) therapy is important for a variety of reasons, both for clinical purposes and for research purposes. Treating therapists need to assess fidelity in clinical practice in order to ensure that the therapist is using all eight phases of EMDR therapy without omitting important words, procedural steps, or phases of the treatment. By using a Fidelity Questionnaire, the therapist can monitor his or her own adherence to the phases in order to improve practice and prevent therapist drift. In spite of the positive treatment outcomes reported in the studies of EMDR therapy with adult clients, methodological concerns have contributed to a mixed response to the assessment of the efficacy of EMDR therapy. Therapists who make any changes to the protocol or omit any pieces of the protocol should document their clinical decision making for the modification or deletions.

Clients’ sexual complaints vary greatly, from those that arise from the need for sex education to those that require psychotherapy for 6 months to a year or more. As with all presenting problems, the provider needs to determine what, exactly, are the client's symptoms, when they appeared, and what has been tried to resolve them. The provider also needs a framework to guide inquiry and treatment planning. Most sex providers use a broad theoretical approach because of the need to sort out biological factors from psychological factors, the effect of the client's relationship and social environment on symptoms, and the intersection of culture and religion. This chapter features a sexological ecosystemic approach that is both developmental and biopsychosocial in its scope. It describes in detail the five subsystems—microsystem, mesosystem, exosystem, macrosystem, and chronosystem. The sexual history taking form at the end of this chapter is based on ecosystemic theory.

The learning landscape continues to evolve as new technological tools enable teachers to deliver robust learning experiences. It is important to help teachers, administrators, and students know where to begin so that the transition to virtual learning is smooth, without educational loss. This chapter consists of two sections: current trends and issues in technology integration and technological pedagogical content knowledge. The first section briefly reviews the trends in instructional or educational technologies that are causing administrators, teachers, and students to reflect on and modify their thinking about learning and educational content delivery. The second section explores constructivism, the scientific underpinnings of nursing informatics, and ethics. Nurse educators must also address the ethical challenges brought about by this evolving learning landscape. After reading this chapter, one can understand current trends and issues, as well as the influence of nursing informatics and ways to approach new ethical dilemmas.

The Council on the Accreditation of Counseling and Related Education Programs (CACREP) standards are composed of both common core standards and counseling specialty standards. Assessment and Research are two of the common core areas required in the training of master’s level counselors. Due to the emphasis on assessment, this chapter focuses primarily on assessment via distance counseling (DC) and telemental health (TMH), yet also addresses common concerns and guidelines in conducting distance research. The Association of Assessment and Research in Counseling is the professional counseling organization devoted to research and assessment. Neither TMH nor DC is specifically mentioned in the Assessment and Research CACREP standards, yet both standards require students to be trained in “ethical and culturally relevant strategies” for assessment and research. TMH has been found to be effective with diverse and hard-to-reach populations, including rural populations, persons with disabilities, veterans, and individuals who don’t readily access counseling.

This chapter focuses on practical assessment issues related to the effective implementation of problem-solving therapy (PST). When comparing an individual’s Social Problem-Solving Inventory-Revised (SPSI-R) scores with the normative data provided in the manual, raw scores are converted to standard scores such that the total SPSI-R score as well as each of the five major scale and four subscale scores have a mean of 100 with a standard deviation of 15. If the referral problem is specific, or if PST is being provided to a group that was constituted around a common diagnosis, other checklists may exist or can be developed that include common problems related to that diagnosis or group theme. Group treatment can be preferable in those situations where multiple clients are able to serve as sources of feedback to each other regarding both problem-solving skill acquisition and implementation.

This chapter reviews the types of assessment tools that cover all phases of development, including emotional, social, developmental, educational, and psychological. In developmentally grounded psychotherapy, a multimodal approach to assessment is necessary. A multimodal approach covers direct interviews of parents and children, interviews of parents and other caregivers, observations in the office and in the child’s natural environment, and the implementation of standardized measures. Child and adolescent personality assessment tools are more likely than adult tools to look at emotional, social, and behavioral functioning because personality disorders are not diagnosed until at least age 18, when children reach adulthood. Ultimately, assessment tools are used to verify the therapist’s clinical impressions to guide diagnosis and treatment planning. The diagnosis only benefits the clinical process because it guides treatment planning and clinical interventions.

The out of control sexual behavior (OCSB) assessment plan provides an opportunity to deliberately and comprehensively examine the worries and fears surrounding a client’s sexual world. An OCSB assessment offers a unique situation for therapist and client to have a sexual health conversation. Most therapists have experienced their own psychotherapy or completed a range of psychological or personality tests in their personal mental health care or throughout their professional training and career. The Hypersexual Behavior Consequences Scale (HBCS) is the more detailed review of the explicit linkages between sexual behavior and the many potential negative consequences the behavior causes. Clinicians treating sexual dysregulation assume that attention deficit hyperactivity disorder (ADHD) prevalence among men concerned with controlling sexual behavior derives from their predisposition toward the hyperactive and impulsive behavior associated with ADHD. Recent studies confirm a high prevalence of mood disorders and anxiety disorders among patients seeking help for hypersexual behavior.

There are essentially three sectors of private rehabilitation counseling: the public sector, the private nonprofit sector, and the private-for-profit sector. This chapter helps the reader to learn the differences between nonforensic versus forensic private-sector vocational assessment and to learn about forensic life care planning and types of assessment used in the development of such reports. It differentiates the nuances of private vocational rehabilitation, forensic vocational consulting, and forensic life care planning are differentiated. The chapter also describes about the types of vocational assessment measures in non—private-sector versus private-sector vocational rehabilitation. It then discusses the various assessment measures and resources used in private-sector rehabilitation, including transferable skills analysis, labor market analysis, and functional capacity evaluations. The chapter finally describes the various life care planning assessments, including activities of daily living, day-in-the-life videos, comprehensive intake interviews, and multidisciplinary expert consultant assessment.

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.

Assessment interviewing often takes place during the early stages of helping, which includes obtaining information about the client related to the client’s problem or area of change desired. During this stage of helping, the counselor is involved in “conceptualization or formulation” of the problem within counseling sessions or specifically within the assessment interview. Interviewing to assess entails a focus on all aspects of clinical concern, including physiology, cognition, behavior, duration, severity, relationships, and context. A detailed and thorough assessment interview that clarifies the problem holistically leads not only to accurate assessment but also, in later stages of helping, to amelioration. Assessment interviewing is viewed as the foundation of the therapeutic, counseling, and/or rehabilitation process. This chapter is on the assessment interview. It covers types and formats of assessment interviews. This overview is intended to orient the reader to the importance of depth, detail, and thoroughness within the assessment interview.

This chapter explains the importance of age-appropriate transition assessments and recent amendments to federal legislation that support the use of transition assessments. It then describes various formal and informal academic assessments and appropriate uses of alternative assessments with students with significant disabilities. The chapter describes essential assessment tools used in transition-to-work via supported and customized employment processes, including how to use situational assessments. It also describes the various community assessment domains along with methods for mapping available community resources and assessing skills needed to use identified resources. When used effectively, transition assessments for academics, employment, and community living inform transition planning. The selection of assessment measures should be dependent on the individual’s goals and plans for the future. The ultimate goal should be to identify appropriate assessments that help youth with disabilities better understand their strengths, skills, and needs in order to achieve their own personal life goals.

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.

In conducting psychological assessments to identify psychopathology, it is essential that clinicians continue to engage in activities that help them remain current on the state of the science. The models to conceptualize psychopathology, the diagnostic criteria, and the instruments used to inform clinicians in arriving at diagnoses and treatment plans continue to evolve. The assessment of psychopathology is rooted in knowledge of the empirical evidence of the diagnostic criteria, and a lack of current information of the empirical evidence can lead to faulty application of assessments or incorrect conclusions regarding diagnoses. Interviews, behavioral observations, self-report inventories, psychological testing, historical/medical record review, functional assessment, and clinical judgment are all necessary in the formation of a diagnostic picture that provides an accurate depiction of clients’ current issues and the selection of interventions that are likely to be the most effective.

Substance use disorders (SUDs) are complex health conditions, which are frequently remitting and relapsing disorders. They can impact many domains of life and require comprehensive knowledge in order to assess in a meaningful way. This chapter conceptualizes people living with SUDs from a holistic, ecological, and trauma-informed perspective and discusses the diagnostic criteria for SUD, including assessment for severity of disorder. It first outlines ways to broadly assess clients at risk for SUD or currently struggling with SUD using an ecological model. Because SUDs are complex and impact many life domains, the chapter includes discussion of health and disability, risk factors, protective factors, and assessments for commonly co-occurring life features, such as trauma, as part of comprehensive SUD assessment practice. This approach aligns with the International Classification of Health, Disability and Functioning model of inclusion of personal and environmental factors known to impact functioning, health, and rehabilitation and recovery efforts.

This chapter describes the third of the eight phases, the Assessment Phase of Eye Movement Desensitization and Reprocessing (EMDR) therapy that is related to the developmental stages of children from infant to adolescent. It explains the procedural steps with detailed explanations of the techniques and skills necessary for successfully steering a child or teenager. It is essential for the therapist to recognize that eliciting the procedural steps for the phase is impacted by the child/teen’s level of development, and scripts for the procedural steps need to be adjusted into child/teen language. The chapter provides instructions to the therapist with scripts for each of the procedural steps. The assessment phase starts with Target Identification and Organization, which is a continuation of Phase 1 and the therapist continues with image, Negative Cognition (NC) and Positive Cognition (PC), Validity of Cognition (VoC), emotion, Subjective Units of Disturbance (SUD), and body sensation.

This chapter highlights the out of control sexual behavior (OCSB) assessment treatment elements for enhancing client motivation. Transtheoretical model (TTM) identified and organized principles and processes from every school of psychotherapy into a system that recommends the application based on the individual’s stage of readiness for change. The potential for internalized sociocultural sex negativity or unresolved psychosexual injuries that lead to countertransference is much greater among therapists who have avoided looking closely at their sexual development, sexual attitudes, and sexual health. OCSB treatment offers a self-discrepant model for behavior change. For some partners, OCSB treatment’s lack of a disease model is a significant source of distress. The chapter focuses on synthesizing the assessment information to construct the client’s OCSB Unique Clinical Picture, which is the basis for treatment recommendations.

Assistive technologies or devices are tools for enhancing the independent functioning of people who have physical limitations or disabilities. An assistive technology device (ATD), as initially defined in the Technology-Related Assistance of Individuals With Disabilities Act of 1988, is any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified that is used to increase or improve functional capabilities of individuals with disabilities. ATDs range from low-tech aids such as built-up handles on eating utensils to high-tech, computerized systems to help persons with disabilities live independently and enter the workforce. The goal of rehabilitation and counseling professionals is to match an individual with an ATD that will enhance the person’s capabilities and quality of life. Persons with disabilities want as much emphasis placed on their community participation as on their physical capabilities, creating as much need to change and accommodate the environment as equip the person.

This chapter explores the contributions of attachment theory and the related development of mentalizing as concepts that provide the theoretical cornerstones for clinical interventions with children of substance-abusing parents (COSAPs) of all ages as well as for substance-abusing parents of infants. It describes attachment and mentalization-based treatment programs that have been developed to help people who have difficulty with affect regulation, resulting from insecure attachment with their substance-abusing parents. Attachment patterns developed early in life provide a template through which people approach their interpersonal relationships and regulate their feelings of pleasure and distress. Being unable to regulate feelings is a primary difficulty of people who develop substance-abuse disorders for which COSAPs are at high risk. Mentalization-based treatment holds the promise of providing a way to prevent and ameliorate emotional disturbance in children and adolescents from substance-abusing families and to teach new ways to regulate emotional distress in adult COSAPs.

The neurobiology of posttraumatic stress disorder (PTSD) and the effects of lifetime trauma on an individual have been covered extensively in the literature over the past two decades. This chapter reviews some of the relevant trauma-related neurobiology literature as it applies to military sexual trauma (MST), both in men and in women. The presentation of premilitary factors is structured around three major areas in the neurobiology of traumatic stress: early life trauma and the emergence of the emotional response; lifetime cumulative effect of trauma and the hypothalamic pituitary axis (HPA); and additional factors contributing to long-term vulnerability or resiliency. The brain and behavioral patterns are molded in parallel with early life experience. When a child develops the ability to recall events, he or she experiences the beginning of autobiographical memory. Primary affective states originate in the reticular activating system (RAS) of the brain.

This chapter describes the cardiac axis. Axis refers to the general direction of electrical conduction through the heart. The QRS complex represents ventricular depolarization. Each lead represents a different angle or vector of depolarization through the ventricular myocardium. All of these added together represent one average QRS vector, referred to as the axis. The four axis categories are: normal, left, right, or indeterminate. This is determined based on the four quadrants that are created by the intersection of leads I and aVF. These two leads are the most important in determining axis. They intersect at the center of the heart and form four right angles. The normal vector points down and to the patient’s left side. Axis is described in degrees.

Definitions of aging continue to evolve. This chapter considers aging a part of normal life processes which consists of the acquisition of knowledge and skills over time, the honing and maximizing of these traits and eventually the time period in which all body systems decline from maximal functioning capacity. It reviews normal aging processes in addition to factors which can affect life longevity such as genetic and environmental factors and the human response to environmental stressors. The chapter also presents a brief review of healthy aging and holistic measures. After reviewing the chapter, practitioners will be able to: define aging, longevity and life expectancy; recognize factors that may impact longevity; summarize major normal age-related physiological and psychosocial changes in humans; explain domains that may promote healthy aging; and discuss the importance of the Annual Wellness Visit in supporting healthy aging.

Program evaluation is systematic collection, analysis, interpretation, and presentation of findings to facilitate stakeholder decision-making regarding the efficacy and efficiency of programs, including, but not limited to, the needs of the organization, the impact of program on outcomes, the cost-effectiveness, and overall utility of a program. This chapter helps the reader to; Identify approaches to the development and use of scores from tests for health-care quality improvement; summarize concepts of test score bias and validity and relationship between health behavior and other observed behaviors; identify approaches to minimize test score bias and interpretation invalidity; and to summarize characteristics of tests that can influence the reliability and validity of scores. Identifying fitting evaluation questions across multiple stakeholder groups, determining the most suitable means with which to gather data, and actively analyzing and using the data to inform continuous program improvement are essential. Ideally, this interactive process will lead to improved outcomes.

Psychometric theory conceptualizes measurement quality in terms of two related properties of scores: reliability and validity. Reliability and validity are properties of scores and not tests (measures), and relevant findings from previous studies may be specific to populations examined in those studies. Thus, one consideration in selecting and justifying measures for a research project is whether evidence is available to support this use of scores in one’s population of interest. Researchers developing and promulgating the use of new measures should give careful attention to what types of reliability are relevant and to nuanced construct definition and theoretical elaboration to allow for accumulation and evaluation of validity evidence. This chapter discusses basic concepts related to reliability and validity of measurement and provides examples derived from the growing literature on core self-evaluations, including empirical data derived from the most popular measure of this construct: the Core Self-Evaluation Scale.

Child psychotherapy is different than any other type of adult-child relationship. A trained mental health professional is using clinical skills to help a child find the answers to the problems he or she has encountered. This chapter outlines the most common symptoms in child psychotherapy. Anxiety is one of the most common symptoms of childhood, but the etiology and manifestation of anxiety varies. Anxiety is a symptom of many other disorders, including generalized anxiety disorder (GAD), separation anxiety, obsessive-compulsive disorder, panic disorder, social phobia and other specific phobias, selective mutism, mood disorders, and post-traumatic stress disorder. Gifted children tend to have higher levels of anxiety because they can think about things they are not yet emotionally prepared to manage. The chapter discusses clinical interventions for common issues of childhood, along with resources for children, directions for parents, and references for parents, caregivers, educators, and therapists alike.

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.

Women are very familiar with the experience of being evaluated by their physical attractiveness. This socialization intersects across all stages of a woman’s development beginning in early childhood. Too often, college women’s beliefs about their own attractiveness influence their self-worth. This chapter provides an overview of the “beauty pageant effect”, a phenomenon in which college women compete against one another based on their physical appearance. In addition, exploration of the beauty pageant effect suggests that social comparison theory, evolutionary psychology, and realistic comparison theory play a significant role in the interactions of college women. The chapter presents negative impacts of this type of competition and discusses a brief overview of clinical implications. Prevention work needs to target all women on campus and especially any at-risk populations, such as women with a history of mood disorder, socially isolated students, and those with a personal or family history of eating disorders.

This chapter presents cognitive behavioral therapy (CBT)-based techniques specifically for practicum and internship students and other trainee clinicians. The author explains how he introduces behavioral activation to a kid. It is harder for a kid to be depressed if he is doing fun things, and easy for kids to understand having fun. The brain releases higher doses of mood-lifting neurotransmitters when we socialize, are physically active, and are doing novel, fun things. Behavioral activation is a tried-and-true stable of CBT. A common presenting complaint among depressed or stressed kids is poor sleep. In the author’s practice, kids most complain about a difficulty falling asleep, followed by a difficulty staying asleep. A good starting point is to consider what a good sleep schedule looks like. This chapter shows some of the strategies for combating insomnia. Collectively, the recommendations try to create a comfortable context, a relaxed body, and an unfettered mind.

The practice of behavior therapy has many features in common with that of other forms of psychotherapy, for example, the development of a collaborative working relationship between client and therapist. Behavior therapy is distinguished by its use of particular techniques to address specified problems, by its allegiance to psychological experimentation, and by its commitment to empirical validation. In application to the treatment of anxiety and related disorders, behavior therapy drew inspiration from studies of classical conditioning and experimental neurosis. Systematic programs of gradually confronting feared situations therapeutically, in the imagination or in real life, are familiar features of contemporary behavioral practice with anxious clients. Behavioral assessment is designed to provide detailed information that focuses and directs behavioral treatment. Treatment techniques involving self-control and self-management are viable because clients can alter the contingencies affecting their own behavior.

This chapter introduces a behavioral therapy as a psychological approach to treatment that assumes that mental health problems derive from external forces that impinge the individual. It focuses on the empirical works of two major researchers, Ivan P. Pavlov and Burrhus F. Skinner, who developed learning theories that have serious implications for the treatment of emotional concerns. The chapter addresses the cognitive behavioral therapy movement, both historically and practically. Cognitive behavioral therapy, or CBT, has taken the behavioral therapy movement the internal versus external locus of influence boundary. It addresses how cognition, which is an internal psychological process involving language and perception, can be associated with behavioral techniques to improve case conceptualization and to affect treatment outcomes positively. The Cognitive Behavioral Therapist will first and foremost address the cognition and will try to change the thoughts that are associated with problem behaviors.

It has been said that working in interdisciplinary teams is a core competency all health professionals will need in the 21st century; they need to be able to collaborate, coordinate, and, most of all, communicate with one another in order to optimize care and maximize operational excellence. Nurses need to be active in interdisciplinary organizations from the start of their careers, and present/publish their work in interprofessional forums. Nurses have many advantages in interdisciplinary collaboration—sound basic education in humanities, social sciences, and basic sciences; many community connections; and experience in facilitating care across different providers. Interdisciplinary opportunities provide more prospects for effecting large-scale change than discipline-specific opportunities do. Moving beyond the discipline specific doesn’t mean that nurses leave nursing; it means they assume positions in which they can now advance the perspective of nursing in ways that others can appreciate, while attracting additional public support.

This chapter reports the findings of a literature review designed to examine the level of support for the Symptom–Action–Timeline process and O’Lynn’s Symptom Action Process (SAP) model. It addresses the recommendations proposed by O’Lynn to: (a) expand the definition of symptom to include psychological symptoms; (b) expand the definition of symptom to be more reflective of a health need so that self-care measures to prevent illness or promote health are included; (c) recognize that intentional disregard of a health need is a type of self-care action, especially when mental health needs are involved; (d) embed the model within an environmental context external to the decision tree to account for demographic variables, access to resources, and so on; and (e) design the model to be more circular in nature, allowing for sequential or concurrent health-related actions.

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.

Statistics is all about recognizing and addressing sources of variability, either through study design or statistical analysis. Variability is both essential for understanding associations and a nuisance that encumbers our efforts at measuring them. This chapter provides a description of the properties of variables. Variables are measurable characteristics or traits that vary from object to object. It is useful to classify variables by their scale of measurement. Two goals of research are to characterize attributes or features of a population and assess associations of interest. These activities necessitate the need for observing characteristics of members of a population. Sensitivity can be expressed as the conditional probability that a diagnostic test produces a positive test result given an individual has the disease. Specificity is the conditional probability that a diagnostic test produces a negative test result given an individual is disease free.

Bipolar disorder is a mental disorder that causes unusual shifts in mood, energy, concentration, and the ability to perform daily tasks. This chapter contains three cases of bipolar disorder in adults. These cases illuminate how the same disorder manifests in different people with different backgrounds, including an African American woman, a Caucasian man, and a young Caucasian woman. Discussions of intersectionality, substance use/abuse, and questions for consideration are also included.

Bipolar disorders affect 2.5 million adults in the Unites States annually and approximately 6 million Americans have a bipolar spectrum disorder and 1 million are age 60 or older. Bipolar mood disorders are the sixth leading cause of disability worldwide. This chapter introduces practitioners to bipolar spectrum mood disorders, etiology, prevalence and comorbidities. In addition, it discusses the differences in bipolar 1, bipolar 2, cyclothymic disorders, and bipolar mixed episodes. The chapter presents a case study with differential diagnoses and risk factors for comorbidities. It discusses mood disorder assessment tools including evidence based treatment options. After reviewing this chapter, practitioners will be able to: identify diagnostic criterion for bipolar spectrum disorders; analyze unique differences in bipolar spectrum disorders; apply assessment tools and differential diagnosis to support bipolar diagnosis; evaluate risks and comorbidities of geropsychiatric populations with bipolar disorders; and understand treatment options for geropsychiatric populations with bipolar disorder.

This chapter examines a history of bipolar disorders so that the dramatic differences in the prevalence of this disorder over time will make some sense. It provides the rationale for the addition of the bipolar II category in 1994 to the Diagnostic and Statistical Manual of Mental Disorders (DSM). The chapter discusses the history of the bipolar category, and reviews its neuroscience and genetics. It then reviews current pharmacological treatments and their outcomes. It then provides the case for kindling, because part of the rationale for early treatment of bipolar disorder derives from the kindling hypothesis. The chapter covers alternative, nontraditional treatments. Lithium, anticonvulsant and atypical antipsychotics are used in the treatment of bipolar disorders. Keeping a regular schedule for eating and sleeping improves outcome for both those with bipolar I and II. All of the drugs used to treat bipolar I induce depressive symptoms.

Blocking beliefs questionnaire can be used by therapist to discern the Blocking Beliefs of children and adolescents. It is adapted from questions in Thought Field Therapy and the Blocking Belief Questionnaire. Frequently, therapists are not aware when children and teens are saying things that are actual Blocking Beliefs and are slowing down, looping or preventing processing. The adult statements/Blocking Beliefs are listed first in the questionnaire followed by examples of words that a child/teen might use to express his or her Blocking Beliefs. Children and teenagers often state their issues in more concrete and specific ways than adults. It is the therapist’s job to identify the child/teen’s Blocking Belief and translate it into more generalizable terms. Once therapists have identified possible Blocking Beliefs, the beliefs can be targeted directly with the Assessment Phase and then reprocessed to enable continued processing on previous targets.

The goal of the Body Scan Phase is to guide the child/teen through the steps to achieve a clear body scan. The therapist asks the child/teen to scan his or her body using the script. A set of bilateral stimulations (BLS) is done, if any sensation is reported. The discomfort is reprocessed fully until it subsides, if a discomfort is reported. Then the body scan is done again to see if there are still any negative sensations. BLS is done to strengthen the positive feeling, if a positive or comfortable sensation is reported. The Body Scan Phase often occurs during the session immediately following the Installation Phase, when the client has achieved a Validity of Cognition (VoC) of 7. Typically a session would not begin with Body Scan Phase unless the previous session ended at the conclusion of the Installation Phase.

This chapter discusses breast conditions such as breast cancer screening guidelines, abnormal breast discharge, breast mass, and mastalgia/breast pain. Evidence-based guidelines for breast cancer screening continue to evolve with research findings. National organizations publish their own guidelines that can vary slightly. Practicing clinicians must decide which organizational recommendation they will adhere to and stay updated on any published changes and the rationale for the change. The chapter discusses etiology, history, physical examination, laboratory/radiologic testing, differential diagnosis, treatment, complications, consultation/referral, and follow-up for abnormal breast discharge, breast mass, and mastalgia/breast pain.

Primary care providers have become the main providers of mental health services for their patients. Building on long standing relationships with children and their families along with an emphasis on development, early intervention and prevention, pediatric practices are the ideal setting for the integration of mental health into primary care. One model for working with families that is being used successfully in many health care settings is SBIRT, which stands for screening, brief intervention, referral and treatment. This chapter presents brief interventions that are evidence-based interventions and can be provided by primary care providers in the context of brief office visits or several standard office visits. Brief interventions can be used as a stand-alone treatment for those at-risk as well as a vehicle for engaging those in need of more intensive specialized care.

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.

Helping professions tend toward an ethic of self-sacrifice. Coming to terms with budgeting and financial management can be at best an afterthought and, at worst, anathema to the professional counselor. In the absence of independent wealth, failure to develop sound budgeting and financial management skills leads to stress, uncertainty, and, in the worst-case scenario, insolvency. From the perspective of fiscal management, distinguishing one’s work and becoming known among other professionals as a skilled and committed clinician is a key aspect of competition and collaboration. The degree to which clinicians are influenced by fiscal management in the orientation of their clinical practice varies, but can be an important consideration for beginning counselors as they establish a practice. Counselors often pursue therapeutic work because they find it intrinsically meaningful and personally and intellectually challenging. They do not consciously pursue the necessary skills to operate a financially sound psychotherapy practice while in training.

The importance of mentoring to nurses gathered steam in the 1980s with the growth of graduate education and specialty practice, the development of nursing research, and awareness of the paucity of role models as more nurses took on leadership positions. Building a mentoring network is the means by which one keeps up-to-date, surmounts limitations, discovers opportunities, and continue to evolve as a leader. The feminist critique of mentoring pointed out that not only had gender been ignored in who got mentored, but race and social class were also disregarded. The best way to grow our mentoring network is through professional organizations. Understanding the reciprocal nature of collegiality can be especially useful to top performers because their triumphs can engender envy and retaliatory behaviors; to counteract such competition, they should make sure that anyone who works with them profits from the relationship.

Regardless of the setting and the structure of our pitch, we first to understand how to develop a pitch that compels our target audience to help provide us with the resources we need. This chapter explores eight essential components that will help us find success when pitching our idea/product/service. The eight essential components include: evoking emotion through story; knowing your audience; grabbing attention; painting your unique value proposition; providing enticing solutions; showing results (or evidence); keeping it conversational; and asking for what you need. These components should serve as the foundation for all pitches. Also covered are the three main structures of commonly used pitches: the elevator pitch, the sales pitch, and the venture pitch.

This chapter focuses on helping children to further develop their skills in self-reflection, mindfulness, and somatic awareness, along with managing triggers and learning calming techniques. It discusses contracting with self-states for new responses or roles that enhance mastery of daily skills. Empowerment and learning calming techniques will improve the child’s overall functioning-an integral step toward stabilizing the child for trauma processing. Building somatic literacy is needed with dissociative children so they can begin to understand and express what they are feeling. Incorporating physical exercise to build affect regulation, increase mind-fullness, and also expand window of tolerance is essential for calming down the overactive stress-response system. The chapter examines how to help dissociative children to increase their capacity to manage traumatic triggers. The key to healing dissociative children is seeing beyond the triggers and acting-out behavior and discovering the true source of the child’s impairment-the fractured mind that drives the behavior.

This chapter illustrates three important elements such as individual and institutional betrayal trauma, and reparative individual and institutional experiences. Military sexual trauma (MST) survivors receive psychological care from a wide swath of mental health professionals, within the context of both veteran and civilian institutions. The therapeutic orientations draws a combination of cognitive, dialectical behavioral, and relational-cultural theories, will influence the way we conceive of MST. A caregiver having cognitive, emotional, and physiological reactions of love, protectiveness, affiliation, and nurturing toward an infant buffers against the huge responsibility and effort it takes to provide sufficient care. Therapists may be able to gain clinical traction with MST survivors by understanding that MST almost always includes experiences of both individual and institutional betrayal. A therapeutic environment where mutual empathy and empowerment are present can provide an antidote to the patient’s previous environments, lacking in empathy and rife with disempowerment.

Cancer is a devastating diagnosis that many individuals still associate with death. Upon initial diagnosis, individuals embark on a treatment journey that is overwhelming with medical jargon, new healthcare providers, unknown outcomes, and fluctuations of hope amid the distressing effects of the disease and its treatment. The most frequently diagnosed adult cancer types are female breast, prostate, lung, and colorectal cancer. These four most commonly occurring cancers will be the focus of this chapter. The overall incidence and prevalence of cancer has increased with individuals living with cancer as a chronic illness. Treatment options have improved survival rates, decreased toxicity, and provided palliation. Symptoms associated with the disease and the toxicities of treatment require a commitment to an interprofessional model of care across healthcare settings. Palliative care focuses on the physical, psychosocial, and spiritual needs of the cancer patient and family as well as bereavement needs of families.

It is estimated that approximately 5" to 10" of cancers are inherited as a result of germline mutations. Inherited cancer syndromes result in an increased risk of a specific type of cancer as well as other cancers or conditions. This chapter focuses on hereditary cancer syndromes associated with breast and colon cancers. Like that of other genetic conditions, the importance of risk assessment is key to early recognition of the syndromes so that appropriate management of risk can be implemented, which includes enhanced surveillance, chemoprevention, or risk-reduction surgery, if applicable. It discusses the RISK assessment process when evaluating individuals for inherited breast cancer syndromes, discusses the RISK assessment process when evaluating individuals for inherited colon cancer syndromes and Identifies resources for risk communication and risk management when suspecting individuals for inherited cancer syndromes. The chapter provides additional educational resources for the advanced practice registered nurses (APRNs) pertaining to cancer genetics.

One of the primary focuses of rehabilitation counseling is the career development, employment, and vocational behavior of individuals with disabilities. Career assessment plays a very large role in the conceptualization of career-related issues and the delivery of appropriate career and employment services to people with disabilities. This chapter provides rehabilitation counselors with the necessary information and understanding of concepts and career assessments that impact the career development and employment of people with disabilities. It begins with an overview of the importance of work and the benefits derived from engaging in productive work—related activities. The chapter briefly discusses the factors that impact the career development and employment of people with disabilities and introduces the Illinois Work and Well-Being Model as a conceptual framework that can be used to guide career assessment. The chapter concludes with a description and overview of commonly used career measures used in rehabilitation counseling setting.

The focus of career counseling has been on helping individuals successfully enter the world of work. This chapter provides a description of the career counseling specialty, defining the roles and functions, employment settings, and clients of career counselors. It provides a brief history of the professional specialty, with information on historic and current credentialing. The chapter outlines professional credentialing and licensure matters for career counselors. It describes ethical and legal issues specific to the practice of career counseling and explains diversity issues and ethical decision making. It differentiates the roles and functions of practitioners of career counseling from those of practitioners of other counseling specialties. The chapter reviews the assessment issues of career counseling. Career counselors practice in a variety of settings and render services to diverse individuals, corporations, and organizations. They must have sufficient knowledge and training to assess clients and administer tests.

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.