Grief is the process that occurs before people come to acceptance. It can be a painful experience involving many different feelings. Losses includes health issues, loss of a career, loss of relationships, an unborn child, and/orability or desire to have children. Experiencing loss and grieving may include physical, emotional, social, and spiritual responses. Grieving is essential for coming to terms with and processing the trauma and resultant losses. Trauma and its accompanying sense of loss may result in a terrible sense of disappointment and failure. Working with mental health professionals and other survivors can be extremely helpful in working through the grieving process. The grieving process involves acknowledgment and acceptance of loss. Psychotherapy is a process of “re-parenting” the inner child who may have had less than ideal caretaking. The neural connections in the brain can heal and change with new experiences.

In the therapeutic community (TC), the therapeutic and educational component that focuses specifically on the individual consists of the various forms of group process. The groups that are TC-oriented, such as encounters, probes, and marathons, retain distinctive self-help elements of the TC approach. This chapter provides an overview of general elements and forms of group process in the TC. Conventional psychotherapy and group therapy have not been particularly effective with substance abusers entering TCs for various reasons. Group tools are certain strategies of verbal and nonverbal interchange that are employed by participants to facilitate individual change in group process. There are two main classes of group process strategies: provocative tools and evocative tools. Provocative tools, hostility or anger, engrossment, and ridicule or humor, are most pointedly used to penetrate denial and break down deviant coping strategies such as lying.

The importance of the functioning of mind and the limitations of medication has encouraged some clinicians to advance the use of psychotherapy. In the present period this is mostly in the form of cognitive behavioral therapy (CBT) for schizophrenia and psychosis, and this is strongly promoted in the British Psychological Society (BPS) publication “Understanding Psychosis and Schizophrenia: Why People Sometimes Hear Voices, Believe Things That Others Find Strange, or Appear Out of Touch With Reality, and What Can Help”. Although this document has not been received without criticism, it makes some very interesting reading for us as eye movement desensitization and reprocessing (EMDR) therapists and students of the Indicating Cognitions of Negative Networks (ICoNN) model. The meta-analyses that showed the most encouraging effect sizes were looking at two groups: treatment-resistant schizophrenia, and forms of psychotherapy that were highly specific and tailored according to case formulation, targeting delusions and auditory hallucinations.

The eye movement desensitization and reprocessing (EMDR) method represents a significant advance in psychotherapy. While most of the empirical research on EMDR demonstrates its efficacy as a treatment for posttraumatic stress disorder (PTSD), including relational traumas. Dysfunctional patterns of relating in the family of origin can imprint themselves on the relational template of adults, only to be reenacted in the contemporary couples relationship. Because EMDR can be effective at transforming these earlier relational traumas, adults can become less reactive, enjoy greater distress tolerance, and have a more resilient ego boundary. Thus, EMDR is an invaluable tool in couples therapy. A 5-step protocol is proposed that can guide therapists to develop an EMDR treatment plan within the context of couples therapy. This protocol can and should be applied to both partners in most cases, but of necessity, the therapist must choose one partner to begin with.

This chapter outlines the basic practice of rational emotive behavior therapy (REBT) and considers aspects of the therapeutic relationship between clients and therapists in REBT. It provides the major treatment techniques that are employed during REBT. REBT is an active-directive form of psychotherapy in that therapists are active in directing their clients to identify the philosophical source of their psychological problems and in showing them they can challenge and change their irrational musturbatory evaluations. REBT therapists tend to be appropriately humorous with most of their clients because they think that much emotional disturbance stems from the fact that clients take themselves and their problems. REBT therapists not only offer them “affective” empathy but also offer them philosophic empathy. Effective practitioners of REBT are usually comfortable with behavioral instruction and teaching and with providing the active prompting that clients often require if they are to follow through on homework assignments.

This chapter discusses the type of group work using rational emotive behavior therapy (REBT) principles and practices. Several methods of psychotherapy, such as psychoanalysis, employ group therapy for expediency reasons. REBT distinctly uses an educational rather than a medical or psychodynamic model. REBT includes a number of role-playing and behavior modification methods that can be done during individual therapy sessions but that are more effective in group. Clients who are shy or who have interpersonal problems are particularly encouraged to join a group because it is often more therapeutic for them to work out their problems with their peers than to work on them only with an individual therapist. In cognitive-behavioral therapy in general and in group REBT in particular, the activity level of the therapist tends to be high. Group REBT and counseling especially have intrinsic disadvantages and limitations when compared to more individualized REBT proc.

This chapter provides a theoretical background for Medical Family Therapy (MedFT) as the systemic approach to integrated care as well as unique considerations for supervision in the integrated care settings where MedFTs typically practice. It consists case example to offers a frame and illustration for the application of this important approach. MedFTs master the elements of a traditional mental health intake to assess any psychopathology, history of past treatments, use of medications, family and social history, and relational dynamics that influence the exacerbation or maintenance of individual, relational, and/or health problems. In integrated care settings, a course of treatment typically unfolds episodically because the patients and their family members will have onsite access to return to psychotherapy when the need arises again. For most MedFTs, clinical care and supervision occur in an integrated health care setting.

This chapter examines how to prepare patients for the reprocessing phases of the standard eye movement desensitization and reprocessing (EMDR) therapy procedure. The essential elements of the preparation phase covered in the chapter include providing patients the fundamental information needed for informed consent, and offering guidance and metaphors to orient patients to standard EMDR reprocessing procedures. The Preparation Phase in the EMDR approach to psychotherapy corresponds with the initial stabilization or ego-strengthening phase of treatment in the consensus model of treatment for trauma. An essential aspect of the preparation phase is patient education. Patients need to understand their diagnosis, symptoms, the impact of adverse and traumatic experiences, the stages of the treatment plan and what to expect during EMDR reprocessing. For those with histories of exposure to traumatic life experiences, normalizing the development of posttraumatic stress disorder (PTSD) is essential.

This chapter provides an overview of the medication issues and concerns mental health practitioners will encounter. The philosophy of the authors is simple: collaborative teamwork between physicians, prescribers, nurses, other health care providers, and mental health practitioners such as social workers is necessary for ethical and competent practice. Social workers make up the majority of mental health professionals in the United States. The chapter offers both historical and current perspectives on the importance of the knowledge of medications used in competent professional practice. From a social work perspective, it encourages an interdisciplinary team approach that takes into account the client's environment; thus, special attention is given to empowering clients to become active participants in the treatment process. The approach also recognizes the social worker as an important member of the health care delivery team. Psychopharmacology, medication as a primary treatment modality, and psychotherapeutic approaches are discussed.

Contemporary psychotherapy addresses behavioral issues of an older adult by focusing on the degree to which an older adult is able to cope positively with the environmental stressors converging on him or her. An environmental geropsychologist focuses on the environment component of Lewin’s equation and develops interventions to change older adults’ interpersonal and intrapersonal experiences with psychosocial stressors with interventions aimed at the environment. The theory of affordances states that the perceptions that older adults have of their physical environments have functional significance for older adults, and shape older adults’ behaviors. The tri-dimensional intervention model states that there is a comprehensive interaction among the cognitive, conative, and affective components in an older adult’s environment. All three components are the targets for intervention by an environmental geropsychologist. The conative component is the aspect of the brain that acts on one’s thoughts and feelings.

This chapter presents the conceptual framework for understanding eye movement desensitization and reprocessing (EMDR) therapy. It begins with a review of selected aspects of four models of psychotherapy that historically most directly support understanding the evolution of EMDR therapy. The early history and evolution of EMDR therapy in turn have been strongly associated with the search to understand and treat the relationship between trauma and dissociation. Classical behavior therapy views posttraumatic stress disorder (PTSD) through the lens of conditioning in which a powerful conditioned association is formed between specific cues were present at the time of adverse or traumatic experiences and the intense state of alarm evoked by the experience. In EMDR therapy, various strategies can be employed to support the goals of stabilization and symptom reduction. Some stabilization strategies commonly used in EMDR therapy were developed in other traditions such as progressive relaxation, self-hypnosis, biofeedback, and meditation.

This chapter examines sources of difficulty clinicians newly trained in eye movement desensitization and reprocessing (EMDR) therapy face in developing and following a treatment plan. It considers a series of essential elements of case conceptualization including degree of structural dissociation and attachment classification; standardized tools and clinical strategies for history taking including EMDR-specific forms and the use of bridge techniques; issues surrounding recovered memories and the plasticity of memory; and a brief introduction to the history of and concepts in attachment theory including the impact of attachment organization in phases of psychotherapy; tools and clinical strategies for assessing adult attachment classification. The chapter examines a research supported, symptom informed model for target sequencing in EMDR therapy and close with a sample treatment plan based on a prototype case of a rape survivor. It reviews three standardized tools to assist in gathering information about patients’ histories, presenting complaints, and treatment goals.

Psychologists work with micro-level and macro-level orientations. Clinical psychologists with a micro-level orientation focus on individuals, families, and small groups when performing psychotherapy. Community psychologists have a macro-level orientation. The aging population presents many opportunities for psychologists, both those engaged in scholarship and those working clinically with older adults, and for community psychologists addressing issues relating to social structures and organized communities of older adults, economic issues such as poverty and access to medical services, and issues relating to senior housing. Contemporary theory indicates that it is equally important for psychologists working with older adults to focus on the positive aspects of aging when addressing the psychopathological problems older adults are experiencing. Erikson’s stage theory originally had seven stages: basic trust versus basic mistrust; autonomy versus shame and doubt; initiative versus guilt; industry versus inferiority; identity versus role confusion; intimacy versus isolation; and generativity versus stagnation.

This chapter presents the author’s view that for multicultural counseling approaches to be successful; there must be a strong consideration for race, ethnicity, and biracial/ethnic identity; attributes of age, gender, gender fluidity, disability, social, economic, educational, rural, urban, and geographic identity and other ethnographic variables that define individuals and groups by nationality, ethnicity, languages, and spiritual and religious identity. In addition, there has to be awareness that many cultures do not endorse counseling and psychotherapy approaches. The chapter talks about core constructs in multicultural counseling and offers guidelines on how to apply such approaches with indigenous cultural groups that reach beyond the U.S. borders. This is necessary because professional counseling associations have organized volunteers and provided disaster mental health relief opportunities for counselors who want to serve on disaster sites internationally. The chapter also discusses mental health practitioners culturally competent skills that help translate theoretical models into multicultural counseling.

The value of efficiency is quite important in practically all psychotherapy, but is often neglected. Feeling better has a great advantage, but it is limited in many respects. In Rational Emotive Behavior Therapy (REBT), an existential view of depth-centeredness in psychotherapy has various advantages over less depth-centered views. Pervasiveness in psychotherapy may be defined as a therapist helping his or her clients to deal with many of their problems, and in a sense their whole lives, rather than with a few presenting symptoms. Extensiveness in psychotherapy means that clients can be helped not only to minimize their disturbing negative feelings for example, anxietizing, depressing, and raging but also to maximize their potential for happy living that is, to be more productive, creative, and enjoying. Efficiency in therapy, particularly with resisting clients, therefore consists of convincing them thoroughly that they’d better go for a more elegant, rather than a less elegant, change.

This chapter explores many kinds of resistance to psychotherapy and to self-help therapy and describes how one, as a therapist, can effectively deal with them. Obviously, however, it will favor Rational Emotive Behavior Therapy (REBT) that started in 1955 and that has developed into Cognitive Behavior Therapy (CBT) in the 1960s and 1970s. Therefore, for REBT and CBT to be effective, one had better convince clients of the importance of their beliefs and show them that it is quite possible to change them and thereby improve their disturbing Consequences (C’s). The chapter emphases on a number of cognitive, emotive, and behavioral techniques, and is therefore similar to what Arnold Lazarus calls multimodal therapy. REBT, more than the other Cognitive Behavior Therapies, particularly differentiates healthy negative feelings, such as concern, sorrow, regret, frustration, and annoyance from unhealthy or destructive feelings, such as panic, depression, and rage.

This chapter considers more methods of contradicting and actively working against Irrational Beliefs that people can use with some of their most difficult clients. Resistant clients frequently view self-change as too arduous and painful because it requires so much persistent effort and practice. Rational Emotive Behavior Therapy (REBT) and Cognitive Behavior Therapy (CBT) therefore try to help them to reframe the process of self-change as more of an adventure and challenge than a hardship. Many resistant clients lose their sense of humor when they neuroticize themselves. A major goal of REBT and CBT, therefore, is to have clients solidly achieve a basic philosophy of effort. Its practitioners assume that resistors often indulge in low frustration tolerance (LFT). Quick and active disputing of clients’ Irrational Beliefs may save people’s considerable time and effort, and demonstrate to clients that helpful techniques of psychotherapy can be done in a short period of time.

This chapter provides some ways to classify jokes into categories, discusses some theories about what makes something funny, and get into the caveats about why this work can be so difficult. This information can lay the groundwork for humor’s role in communication, personality, health, thought, and the like. Comedy alters mood, thought, stress, and pain. Jokes and laughter may play an important role in health, mental illness, marital bliss, education, and psychotherapy. Although a comprehensive model that explains every funny thing in the world would be quite complicated, humor definitely lends itself to study. Cynicism aside, experiments on comedy and mirth have generated amazing insights in the arts and sciences, leading to new ways to recognize, generate, and use funny material. As ubiquitous and intuitive as comedy seems to be, the grand theory and explanation of all humor remain elusive.

This chapter assists the clinician in understanding the various techniques, beyond clinical case examples, that have helped advance neuroscience research. It provides a discussion of how some of the original research methods are now used for clinical purposes. Advances in imaging techniques have been extremely useful in understanding brain-based functioning, studies utilizing animals are numerous, and they cannot merely be replaced with advanced technology. An electroencephalogram (EEG) records electrical activity of the brain in a noninvasive manner by placing electrodes, small flat metal discs, on the scalp in order to record extracellular current flow of neurons. EEGs can be used to examine whether a patient has epilepsy, sleep disorders, mental disorder, or delirium. Clinicians need to maintain awareness and general understanding of these advances in order to better serve their patients as well as to assist in advancing the practice of psychotherapy.

This chapter explores the relationship between personality disorders (PDs) and risk of suicidality. It gives special attention to the borderline PDs (BPD). Although significantly fewer, a small number of protective factors have been identified among individuals with BPD that serve to reduce the risk of suicide. These include: (1) Lower levels of impulsivity; (2) Greater emotional stability; and (3) Reward-dependent attachment style. Psychotherapy has been found to be effective for addressing the elevated risk of suicide within the context of BPD. Dialectical behavior therapy (DBT) is one of the main empirically supported treatments for reducing suicide attempts and nonsuicidal self-injury among individuals with BPD. To engage, develop a therapeutic alliance, and effectively treat individuals with BPD at risk of suicide, it is essential for clinicians to become informed of not only the risk and protective factors but also their own personal and professional beliefs regarding the disorder.

This chapter briefly mentions some of the significant changes that have taken place in psychotherapy. It shows how psychotherapists can endorse a good deal of postmodernism, can still stick largely to the scientific method, and can do effective therapy. Narrative techniques have always been used in psychotherapy, including Rational Emotive Behavior Therapy (REBT). REBT and Cognitive Behavior Therapy (CBT) aim to be more efficient and more effective than other therapies that are primarily oriented toward changing people’s dysfunctional thoughts, emotions, or actions. The chapter also shows how these can be added to and integrated with other therapeutic practices, such as person-centered, Gestalt, and psychoanalytic therapy. Recent findings in experimental psychology are important to development in psychotherapy and seem to at least partially confirm some of the main theories and practices of REBT.

Microskills are the basic foundational skills involved in effective counseling that facilitate the process of counseling and alliance formation. The success of counseling interventions depends largely on these skills, which help to create the necessary conditions from which positive change can take place. Children and adolescents are in the process of developing emotional competency. Often, due to their own challenges, parents and other adults in their lives have modeled avoidance of uncomfortable feelings. Many expressive techniques have been used to compliment a wide range of psychotherapy and counseling theories, including psychoanalytic, object relations, cognitive-behavioral, humanistic, transpersonal, and others. Without formal training in play or art therapy, counselors can simply utilize play and drawing to help children relax, to be creative, to be active in their treatment, to use their imagination in corrective ways, and to develop the therapeutic environment and relationship.

Feminist family therapy is a meta-philosophy: a group of feminist perspectives that can focus and expand psychotherapy models. This chapter reviews several feminist perspectives and how each can inform a feminist family therapy lens. It discusses the role of feminist clinicians, the process of change, specific feminist-informed conceptual and executive techniques, and the role of feminists as supervisors and trainers. Radical feminists paid most of their attention to gender but also acknowledged that racism, classism, and heterosexism also affected people in couples and families differently, and argued that overt attention to the origins and outcomes of power dynamics should be incorporated into the therapist’s work. Cultural feminism arose concurrently with the radical feminist critique and quickly brought into discussion the construction of social power as it intersected with class, ethnic identity, gender, age, physical ability, and soon thereafter sexual orientation.

This chapter focuses on ways to effectively engage clients starting with initial contacts which extend throughout the course of therapy. Essential to the chapter is examination of specific collaborative processes that help to form and strengthen the therapeutic alliance. The best process predictor of outcome is the quality of the client’s participation in therapy (Orlinsky, Rønnestad, & Willutzki, 2004). A responsibility of the therapist is to continuously monitor the client-therapist alliance, checking in regularly, and being responsive to client feedback. There are numerous ways to establish and strengthen the alliance between the therapist and the client. The chapter describes five collaboration keys that collectively provide research-based means for building and strengthening the client-therapist alliance from the outset of services. They also help to build expectancy and hope, tap into client strengths, align with clients’ cultures, and orient therapy toward future change.

This chapter reviews the adaptive information processing (AIP) model, which is the theoretical foundation of the eye movement desensitization and reprocessing (EMDR) approach to psychotherapy. It examines how the concept of memory networks has evolved from its roots to the way it is used in EMDR therapy. The concept of dual attention can be viewed as a state in which consciousness is in balance and where attention can fluidly shift between current sensory perceptions and relevant memory networks. The chapter also reviews research on the specific effects of trauma and early developmental deficits on information processing. The chapter considers what theory and outcome data suggest regarding the effects of different modes of bilateral sensory stimulation during EMDR reprocessing. For clinicians and patients with significant training and experience in models of verbal psychotherapy, initial experiences of optimal responses to EMDR therapy can seem dramatically rapid and comprehensive.

If one purpose of psychotherapy is to treat all mental disorders including sexual problems, then the provider needs a definition of sexual health. Besides being a vague concept, sexual health is also complex, as it is more than the idea that sex is a fun activity that should be enjoyed by all. What sexual health entails, but is so little spoken openly about, are attitudes, behaviors, and beliefs that foster increased feelings of self-esteem, the ability to explore erotic dimensions of human experience, and facilitation of adult attachment. It also includes that the individual has the physical means for sexual enjoyment, though what that means may vary by person and across the life span. Though sexual health may be portrayed as a basic human right, it is not necessarily an innate human state. This chapter examines some common factors that undermine sexual health.

Aside from the study of theories of counseling and psychotherapy, there is probably no other area of study that is more related to the everyday practice of counseling that than the area of professional ethics. This chapter defines terms related to the ethical practice of counseling and psychotherapy such as an “ethics”, “morality”, and an “ethical dilemma”. It differentiates professional versus philosophical ethics. The chapter outlines mandatory versus inspirational standards of practice. It also addresses professional credentialing issues, along with the need for ethical sensitivity in decision making. The chapter explains the system of ethics governance in counseling and defines skills necessary to become a professional decision maker. Decision making is a cornerstone of professionalism. Counselors must be viewed, and must view themselves, as intellectuals. They must also invest in their profession and be actively engaged in professional activities that better the profession and those served by the profession.

Clinical mental health counseling is a specialization within the broader profession of counseling focused on psychological wellness, and the diagnosis and treatment of emotional and psychological disorders. Ethical issues encountered by mental health counselors are similar to other counseling specialty areas, yet there are unique issues related to topics such as diagnosis and third-party reimbursement. Counselors who specialize in mental health counseling are introduced to information that will assist them in managing an array of legal, ethical, and professional issues. The chapter helps the reader identify trends in professional credentialing and licensure. It compares and contrasts the roles and functions of practitioners of mental health counseling from those of practitioners of other counseling specialties. The chapter discusses the ethical issues specific to the practice of mental health counseling and reviews the ethical issues related to diagnosis and assessment.

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.

Sex therapy is often distinguished from other types of psychotherapy as being specialized strictly in the treatment of sexual dysfunction, ensuring that cisgender, heterosexual people’s genitals work so that they can experience penis-vagina intercourse. This is unfortunate, because sex therapy covers a broad spectrum of human experiences, both in and out of the bedroom. Our sexuality can touch almost any aspect of life across the life span, with minor or profound effects. Our self-esteem, our relationships with others, our perception of life as being joyful or bleak can all depend on how we feel about our sexuality and our attitude about sexual pleasure. Providers who include treatment of sexual problems must also be adept at many different theoretical approaches. Bronfenbrenner’s ecosystemic approach and its application to sexuality is also being used more frequently in conceptualizing sexual development and interactions between and among systems in varied populations.

Mindfulness is a contemplative practice involving focused attention, attentiveness to the present moment, and nonjudgmental awareness. It is a way of experiencing the world that can facilitate powerful life changes and open the door to greater well-being. Clinical interventions that use mindfulness offer a unique perspective that can help people improve clients’ lives. Mindful hypnotherapy (MH) is an intervention that intentionally uses hypnosis (hypnotic induction and suggestion) to integrate mindfulness for personal or therapeutic benefit. This chapter begins with a quote from Dr. Milton Erickson, one of the most important figures in contemporary psychotherapy and hypnosis: “Until you are willing to be confused about what you already know, what you know will never grow bigger, better, or more useful“. There is great potential for the integration of hypnosis and mindfulness; however, to achieve this, clinicians and individuals must be open and flexible in their understanding of both concepts.

This chapter presents advances in the understanding of adolescent brain development that can inform and improve social work practice with youth leaving foster care. Foster care populations have a high rate of mental health disorders, and the association of types of child maltreatment with elevated risk for such disorders is well known; discussion of specific mental health problems and their treatment can be found elsewhere. Conventional mental health approaches have often targeted the innervated cortical or limbic neural systems, rather than the innervating source of the dysregulation. Psychotherapy, whether psychodynamic or cognitive, acts on and has measurable effects on the brain, its functions, and metabolism in specific brain areas. The ethical response is a sharing of the dilemma, and of information about the neurobiology of the client’s struggle, to enable the client to make as informed a decision as possible. In addition, neuroimaging techniques themselves lead to other ethical dilemmas.

This chapter addresses a variety of general clinical and therapy issues regarding the effective implementation of problem-solving therapy (PST). It discusses the ideal problem-solving therapist and emphasizes the importance of the therapist-client relationship. The chapter describes a variety of adjunctive therapy strategies and instructional guidelines that can be used by the clinician to enhance a client’s overall problem-solving learning and skill acquisition. It provides a list of ‘do’s and don’ts’ specifically related to the effective implementation of PST. It is important for the PST therapist to be well-versed in the areas of social problem solving, stress, emotional regulation, brain-behavior relationships, and the various details of a variety of health and mental health problems. Similar to many other directive forms of psychotherapy or counseling, particularly those under a cognitive-behavioral umbrella, the success of PST to a large degree depends on the effectiveness of the manner in which it is actually implemented.

Several psychotherapy principles are especially important in dealing with medication withdrawal, including healing presence, empathy, and the importance of working with couples or families. Patients in turn are extremely sensitive to the moods and attitudes of anyone who prescribes them psychiatric medication. Modern psychotherapists need to develop expertise concerning psychiatric medication effects, especially adverse drug effects. Increasing knowledge about the limits and adverse effects of psychiatric drugs makes it advantageous for every member of the collaboration to do his or her part to stay abreast of the latest scientific developments. Insight-oriented or psychodynamic therapy encourages the individual to remain in touch with feelings while taking full responsibility for personal conduct. The Non-Emergency Principle of psychotherapy is an important aspect of healing presence. Empathy is the ability to understand the individual’s feelings and attitudes while viewing them from a caring perspective.

Prescribers and therapists who embrace a person-centered collaborative approach to therapy and to medication withdrawal will find it professionally gratifying and will help many patients and their families. Any time a prescriber determines that a patient is suffering from sufficient emotional distress to benefit from medication, that same patient should be encouraged to try counseling or psychotherapy. Prescribers can no longer assume the role of medical doctors or nurse practitioners working in isolation prescribing for patients who then depart the office to dutifully take their drugs. All psychiatric drugs have serious long-term adverse effects and tend to produce chronic brain impairment (CBI). The modern prescriber will best serve patients by working together with therapists, patients, and their significant others or families, especially during difficult drug withdrawals. Many patients and families feel wounded by their experience with prescribers and therapists. They feel they have been pushed into taking psychiatric drugs.

This chapter explains three illustrative cases of psychiatric medication withdrawal in adults such as Angie: Medicated through her divorce and the death of her father, Sam: Withdrawing a patient who didn’t want psychotherapy, and George: Withdrawing a suicidal and delusional patient from medication. The person-centered collaborative approach starts with “the person”-the individual who seeks help. Because human beings are unique and enormously varied in their infinite qualities, every therapy and every withdrawal process will be unique and varied. The three cases involve circumstances hazardous enough to need a collaborative approach. Many patients in private practice, especially emotionally stable patients who have taken one drug for only a few months, will be much easier to withdraw from medication. Some will be much more difficult and even impossible on an outpatient basis, especially patients taking multiple drugs for many years while becoming increasingly impaired and dependent on others.

Hypnotic relaxation therapy (HRT) is a particular system or approach to hypnotherapy. It involves a careful case formulation and treatment planning that capitalizes on the evolving body of empirical evidence for hypnotic relaxation interventions and psychotherapy. It is both structured and individualized and considers that all information is processed at both the conscious and unconscious levels of awareness. It is a highly integrative therapy that may be directed toward the development of coping skills, symptom relief/ alteration, facilitating insight, or relapse prevention. The Elkins Hypnotizability Scale (EHS) was developed for ease of administration by the clinician, time efficiency, and relevance to clinical practice. From the perspective of HRT, the conscious and unconscious minds are conceptualized from a social-psychological perspective, specifically Cognitive-Experiential Theory. Rapport and a positive therapeutic relationship are essential to achieve an optimal response to HRT in the context of psychotherapy or medical procedures.

This chapter aims to bring together the postmodern psychoanalytic perspective for both contemporary models of psychodynamic thought and hypnosis and the relational variables as they relate to hypnosis from this perspective. The relationship between hypnosis and psychoanalytic/psychodynamic thought dates back to Freud and Breuer’s book, Studies on Hysteria. Their collaboration involved the use of hypnosis in treating hysterical symptomology. The chapter reviews the relational variables that the psychodynamically and hypnotically trained practitioners use for assessment and treatment as they arise in the interaction field for both. The relational variables are the therapeutic alliance, transference, counter-transference, projective identification, and the use of transitional experience. Projective identification is an important relational variable for the psychodynamically trained therapist who is also trained in the uses of hypnosis. The chapter presents a brief case example of how the relational variables contributed to initially working with the patient and ultimately deciding the appropriate hypnotic suggestions.

This chapter reviews clinical presentations of ego-state problems and the diagnosis of ego-state pathology, methods for clinical activation of ego states, how ego-state therapy is conducted, and the goals and principles of ego-state therapy. Ego-state therapy has a very sparse evidence base and has research problems similar to psychodynamically oriented psychotherapies and hypnotically facilitated therapies in general. The chapter describes the nature of ego states and of their configurations in health and distress. It shows how ego-state pathology manifests itself, how it is diagnosed, and how it is treated safely within a phase-oriented strategy by using a series of clinical vignettes. The chapter also reviews ego-state therapy from its beginnings as a hypnoanalytic therapy to its expansion into a widely practiced therapeutic modality, with standards for training and competence. Ego-state issues affect many behaviors and phenomena in health care patients that might be otherwise inexplicable.

Establishing rapport, building therapeutic alliance, and establishing and maintaining healthy boundaries are all important therapeutic skills especially when working with victims of military sexual trauma (MST). Along with being caring psychotherapists, clinicians may be called upon to play a key part in third-party issues, such as legal issues including custody battles or in reporting on clients for MST Department of Veterans Affairs (VA) service-connected disability benefits. This chapter reviews psychotherapeutic issues that arise when treating those with MST, specifically, barriers to treatment, establishing trust and rapport, boundaries, third-party issues, and documentation. The issues that prevent MST survivors from seeking mental health treatment mirror problems that service members may have had in reporting it, including fear of blame and stigma. To protect clients and therapists alike, it is also important to be mindful of other common boundary testing by trauma clients.

Supervision in family therapy is an inherently complex enterprise. In any supervision of psychotherapy work, the supervisor must navigate the hierarchy of supervisor, therapist, and client; in family therapy, the client unit may include its own complex hierarchy as well. There are very different approaches to the supervision relationship. Ethical decision making in such a complex environment is understandably challenging for therapist and supervisor alike. Some evidence from other mental health professions suggests that supervisors may be hesitant to discuss issues of supervisees’ sexual attraction to clients in supervision, for fear of being accused of harassment or otherwise breaching ethical boundaries. Some supervisors are surprised to learn that confidentiality in supervision is very similar to confidentiality in therapy. There are a number of ways that ethical problems can arise in supervision, each requiring careful attention to be resolved in the best interests of all involved: client, therapist, supervisor, and setting.

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.

This chapter examines both the history and benefits of teaching specific models in Marriage and Family Therapy (MFT) supervision and then focuses on an integrative, moderate common-factors approach. MFT as a profession originated in the late 1950s and 1960s with a series of rebellious pioneers who rejected the dominant individual-based behavior and psychoanalytic models of the time in favor of something new. Supervisors who intend to integrate common factors into the supervisory experience and education have several tasks, possibly the most important of which is to provide education to supervisees about the factors that truly are common to all psychotherapy modalities. The chapter describes the seven common factors: client factors, therapist factors, the therapeutic alliance, hope and expectancy, allegiance of the therapist, feedback, and interventions, such as behavioral, cognitive, affective that cut across all models.

Somatic experiencing (SE) has emerged from a long tradition of somatic education and body-oriented psychotherapy. When the body successfully implements the planned action sequence and adequately releases the remaining unused survival energy, the person regains equilibrium and does not encounter the physiological sequelae associated with trauma. The person then moves from acute arousal into a state of chronic arousal and generalized dysfunction in the central nervous system. SE draws upon the neurobiological study of the multidirectional interconnection between the body, brain, and mind. Posttraumatic stress disorder (PTSD) and the symptom clusters associated with the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders illustrate the body’s “stuck energy”. Treating survivors of military sexual trauma (MST) introduces a unique set of circumstances. In the military, unit cohesion is synonymous with safety and survival.

This chapter focuses on the common themes of meaning and the sacred that emerge in pastoral counseling practice. It elucidates explicit and implicit spiritual content that is commonly presented by clients. The chapter explores the explicit spiritual content commonly raised by clients within the Abrahamic traditions. It also explores implicit spiritual content, which is seemingly inherent to the human condition and often occupies the subtext of a client’s presentation. Grounding the exploration of explicit and implicit spiritual content in pastoral counseling is the belief that competent practice requires counselors to be spiritually and theologically flexible. Pastoral counselors employ a diversity of treatment modalities and are not limited to one model or school of psychotherapy. Responding to explicit and implicit spiritual content within mental health practice is a hallmark of pastoral counseling. Whether spiritual content is explicit or implicit, one primary goal of pastoral counseling is to facilitate spiritual growth.

The study of ethics is like a journey. This chapter provides a synopsis of responses to allegations of unethical or illegal practice. It defines prevention measures and ways to avoid breaches of ethics. The chapter describes ethical practice in counseling and psychotherapy. It outlines the consequences for victims of unethical conduct. The chapter defines the ethical professional counselor and describes the counselor’s response to an ethical challenge in the context of potential legal and professional scrutiny. It discusses what a counselor should do when confronted with an allegation of ethical misconduct. No professional is immune to ethical dilemmas—no matter how ethically sensitive counselors may be circumstances will always arise that place them in a quandary. It is important, however, that counselors recognize when they are facing a serious ethical challenge. With such recognition, wise counselors protect themselves from a naive decision and a possible breach of ethical standards.

This chapter discusses problematic interactive media use (PIMU) among children and adolescents. It describes the PIMU as a syndrome. There are four prominent presentations: gaming, social media, pornography, and information seeking. A comprehensive assessment of PIMU requires systematic history taking and thorough examination. There are validated research and/ or clinical measures designed to assess the presence and severity of PIMU symptoms such as Young’s Internet Addiction Test, Chen Internet Addiction Scale and Compulsive Internet Use Scale. Because of the medical problems associated with PIMU, a comprehensive assessment should include a routine physical examination. The most commonly used treatment modalities are counseling and cognitive behavioral therapy. Behavior modification is central to treatment of PIMU. Psychopharmacology can be helpful as an adjunctive intervention to support psychotherapy.

Counselors must deal with a variety of ethical issues and dilemmas. Specific ethical standards, relevant laws, and legal decisions are the guides for ethical and legal practice. This chapter defines the ethical and legal standards applied to the practice of counseling and psychotherapy. The standards are: confidentiality, privacy, privileged communication, roles and relationship boundary issues, informed consent, responsibility, and competence. The chapter describes the relationship between professional ethics and the law. It outlines important legal decisions and legal case law related to ethical practice. Counselor competence means that the counselor or therapist is capable of performing a minimum quality of service and the service is clearly within the limits of the counselor’s training, experience, and practice as defined in professional standards or regulatory statutes. Counselors without specialized training in a particular area should refer clients to appropriately trained professionals. These are the rules that mental health professionals should know well.