It is not uncommon for children, adolescents, and families to seek counselors’ services when they are in crisis. Despite a growing literature base in school crisis prevention, intervention, and preparedness, there is a relatively scant literature base addressing mental health crisis intervention for professional counselors. This chapter addresses elements pertinent to crisis intervention, including mandated reporting, and associated trauma or grief. Children understand and process grief and trauma differently based on developmental and cognitive ability levels. Unfortunately, it is not uncommon for children to experience traumatic events before reaching adulthood. As an example, international studies document that child sexual abuse, physical abuse, or domestic violence affects approximately 25% of children. War, natural disasters, motor vehicle accidents, violence, terrorist acts, and refugee experiences can all contribute to trauma reactions. Regrettably, if left untreated, complications associated with unresolved trauma or grief can last well into adulthood.

Consciousness is something that every child understands, yet scientists and philosophers struggle to explain it. Consciousness provides an essential human quality to life experience, as one depends on it to organize and prioritize their memories, emotions, and actions. Unraveling the enigma of consciousness, and its impairment, has been a thorny road to travel, often littered with confusion and denial. This has been particularly true regarding understanding of the effects of psychological neglect and trauma on ones biopsychosocial systems. Consciousness is alterable by several influences: alcohol, drugs, anesthesia, childhood neglect and abuse, traumatic experiences, neural injury, and disease. This chapter begins by briefly exploring global alterations of consciousness, such as anesthesia, coma, and vegetative states. This allows us to examine the impact of these pervasive states of impaired consciousness on the neural systems, noted earlier. It then examines in detail disorders of consciousness induced by psychic neglect and trauma.

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 provides an overview of how clinical mental health counselors work with crisis, disaster, and trauma issues. A focus is placed on the pragmatic, neurobiological, and existential natures of crisis, disaster, and trauma along with the ways that these dynamics are implicated in numerous counseling scenarios. The chapter presents the basic crisis intervention skills, discusses disaster response, and emphasizes the importance of understanding trauma. It anticipates that students will have an advanced course that covers these important topics more fully. The chapter provides an adaptation-resilience building framework for conceptualizing disaster response. It then discusses the issue of psychosocial trauma from a multidimensional perspective, and elaborates some of the key aspects of trauma. The chapter explores the most salient issues involving crisis, disaster, and trauma, with a focus on their implications for the clinical mental health counseling (CMHC) profession.

This chapter provided an overview of the possible effects that the work of counseling may have upon counselors themselves. It has long been recognized that exposure to the distressing experiences and feelings of others can cause similar distress in those who listen and provide intervention. We also recognize that counselors can derive benefit and grow from the work that they do with their clients. Finding approaches to the work of counseling that enhance the potential for growth while minimizing distress is significant part of maintaining successful counseling practice. The chapter addresses issues related to counselor self-care and maintaining a healthy ability to continue with the work of counseling. The issues that are addressed include vicarious responses to trauma (both positive and negative), a biopsychosocial systemic approach to counselor wellness, strategies for engaging in wellness-focused self-evaluation, techniques and tools for stress management, and approaches for maintaining a healthy work/life balance.