Chapter 2 - Summary

This chapter has presented an overview of the discipline of cross cultural counseling. Given the changing population demographics of the United States in the second decade of the twenty-first century, it is important that professional counselors develop the awareness, knowledge and skill to establish, maintain, and successfully conclude a counseling relationship with clients from diverse cultural backgrounds. At a fundamental level, any counselor who enters into a cross cultural counseling encounter must have self-awareness, an awareness of the world in which he or she lives, a foundational knowledge of traditional counseling theory, and aspire to high ethical standards. In addition, such a counselor must possess knowledge of culturally diverse perspectives of counseling and engage in cross cultural encounters as a way to enhance counseling skill development in a culturally competent manner. The sum total of this knowledge and experience should be cultural competency and the ability to effectively enter a cross cultural counseling encounter with culture in mind.

Chapter 3 - Summary

Unethical treatment causes harm to clients and leaves the counselor open to malpractice suits and loss of credibility. This may leave the counselor and client in vulnerable positions, which minimize or negate the benefits of counseling and damage the credibility of counselors and the counseling profession. A counselor’s best defense is to behave as ethically as possible while doing everything to promote the best interests of clients.

Most have entered this profession in order to help others while also earning a living and reaping the fruits of a rewarding career. For both to occur, counselors must: keep the ethical codes in mind at all times; strive to be as mentally, emotionally, spiritually, and physically healthy as possible; obtain a thorough graduate education that emphasizes both knowledge and practice; and seek continuing education, advanced training, and supervision when in the “real world.”

Chapter 4 - Summary

Counselors are faced with many exciting challenges as they traverse this unique professional helper’s journey. Personal growth and development require counselors to continually pursue a life of health and wellness in their personal and professional lives. There will be times when you find yourself on the spectrum of wellness toward wholeness and fulfillment in most areas of your life and other times that you encounter challenges to your wellness. Enjoy and be mindful of the simple things. Be good to yourself and to those you love. At other times, you will naturally find that the complexities of life have moved you toward the less desirable end of the wellness spectrum. You may have an unexpected illness, family concerns, changes in jobs, or any combination of these normal crises of life. You may find yourself in need of additional resources. Do not hesitate to seek the support you need! Personal counseling, supervision, and time spent in self-care practices may be needed to restore the equilibrium of life and help you achieve balance. Remember that, as a counselor, you are not exempt from the need for therapy to assist with the resolution of emotional wounds that interfere with your professional capacity. There is no shame in this need. It is important to monitor the impact these trying times may have on our work. Feedback from trusted colleagues, supervisors, and spiritual leaders can provide you with valuable insights and help you negotiate through the rough times. Remember, life has an ebb and flow, and these times, as we often tell our clients, are not permanent. Even during the worst of times, there is hope for rejuvenation and repair. We hope to have raised your awareness and offered knowledge and skills that can assist you in practicing good counselor self-care.

Chapter 5 - Summary

Counselors need to build their technological knowledge and skills in order to use these tools in their work (ACA, 2014). The Association for Counselor Education and Supervision (ACES) has composed 12 counselor education technological competencies that graduates should master upon leaving any program (Haley & Carrier, 2010). The ACA also offers the directive that counselors be knowledgeable about the technology they choose to utilize, and that counselors must be aware of the ethics and laws that surround its use (ACA, 2014).Technology is advancing so fast that by the time this chapter is in print parts of what is talked about here may already be obsolete. There may also be innovations that are not covered in this chapter.

Counselor education programs need to train future counselors to use the technology currently available, otherwise these counselors will fall behind other mental health service workers who are using this technology. There is no choice today as to whether a counselor will use technological advances in his or her practice. It is more a matter of which technology the counselor chooses. A new world has opened to counselors within the last few decades, a world that at times can be simultaneously frightening and exciting. There are so many choices from which to consider, as technology can be utilized in some form or another to aid in nearly every aspect of a counselor’s work. Counselors need to think about the benefits, the drawbacks, and the ethical considerations when implementing technology into their work.

Chapter 6 - Summary

This chapter began by having you envision the differences between professionals within the helping professions and those who provide help in different ways. As you can see, the work of a counselor is something that not only requires particular knowledge and skillsets but also something deeper—that personal desire and mission to help others get to that better place. Counseling is not one of those professions where you just go through the motions.

You know that developing the alliance consists of three relatively distinct phases: building the relationship, challenging the client to find ways to change, and facilitating positive action. Also important are the characteristics most effective counselors possess, including high levels of self-awareness, empathy, and genuineness, respect for others, and an ability to use themselves as vehicles of change.

You have learned that effective counselors use attending skills (eye contact, body language, and vocal tone) and basic listening skills (client observation, encouraging, paraphrasing, summarizing, reflection of feeling, and open/closed questions) throughout the alliance. Also vital is the use of self-attending skills, which emphasizes the importance of the person of the counselor in mediating the communications skills necessary in the therapeutic alliance.

You have been introduced to primary and advanced empathy skills as well as the challenging skills of confrontation, self-disclosure, and immediacy. These skills strengthen the alliance and move the client toward therapeutic change. Counselor action skills facilitate behavior change around the client’s stated goals for counseling. Further, it is important to consider the heavy influence of one’s spirituality dimension. Finally, termination skills are needed to bring closure to, and end, the therapeutic alliance.

Chapter 7 - Summary

This chapter has provided an overview of the major, traditional theories of counseling and psychotherapy and then moved into brief approaches, providing examples of how a counselor could use the previously described traditional approaches in a brief format. The examples provided in this chapter are meant to educate students with an appropriate conceptualization of the theories but are by no means all-inclusive of ways in which the counselor may approach the situation.

The chapter began with a discussion of psychoanalytic theory, which serves to either modify a maladaptive aspect of one's identity or integrate the learned and acquired skills missed during an earlier stage of emotional development. It then moved into a discussion of humanistic theories, which focus on the here-and-now while believing that individuals possess the basic inclination to become fully functioning. Of important note is that humanistic counselors are genuine, warm, and insightful. Existential theory focuses on finding meaning in one's life. By having meaning, people have a higher purpose, motivating them to take action. In exploring cognitive behavioral theories it was discussed how behavior theory focuses on maladaptive behaviors while cognitive theory focuses on maladaptive thoughts. Therefore, central to the concept of Beck’s (1967) cognitive theory is the belief that psychological dysfunction, or pathology, is a result of faulty logic in one's cognitions. Albert Ellis’ A-B-C-D-E approach to counseling, then, is a straightforward conceptualization toward addressing various psychopathology and life issues. The foundation of contemplative theories is mindfulness and here-and-now focus. By achieving this, clients may significantly reduce anxiety, depression, and other cognitive and somatic symptoms. Regardless of approach, however, the client must be motivated to change. Counselors considering the transtheoretical model may best meet clients where they are. A summary of the models including their main constructs and interventions is contained in Table 7.4.

Although Milton Erickson and Richard Bandler have been credited as the founding fathers of brief theory, it did not become a popular approach until 1973 when Jay Haley published the book Uncommon Therapy: The Psychiatric Techniques of Milton Erickson. Research supports the notion that many problems common to those seeking counseling may actually be resolved as well if not better using brief theory. Though limited in terms of sessions, brief interventions are more so focused on efficiency than time constraints. Brief interventions have proven efficacious toward working with individuals suffering from various substance use disorders.

Chapter 8 - Summary

The use of groups of all types is increasingly important to the role of the counselor in a variety of settings. As the decades have passed, emphasis has shifted from T-Groups to encounter groups to working with special populations. Self-help groups of all types are flourishing. The ASGW standards for the training of group counselors have received wide-spread acceptance. ASGW’s definitions of the four group work specialty types (task/work, guidance/psychoeducational, counseling, psychotherapy groups), information about stages of group life, and research on the characteristics of group facilitators have also enhanced the ability of the group work specialist to function in the best interests of clients in groups. In addition, the more group work specialists know about their responsibilities and the interventions they need to master, myths connected with group work, and issues and ethics and ethics associated with groups, the more competent they will be as facilitators of group experiences.

Chapter 9 - Summary

Although counseling has traditionally been characterized by a verbal orientation, practitioners are now encouraged to explore other methods to help people cope with psychological problems. Duffey and colleagues (2016) noted that creative approaches are universally available and critical for counselors working in the mental health profession. They enhance the counseling process in many ways and are enjoyable and self-motivating for clients. Gladding (2016) noted that the creative arts foster “different ways of experiencing the world and are enriching, stimulating, and therapeutic in their own right” (preface). Gladding further noted that effective, culturally competent counselors choose a wide array of interventions when working with diverse populations and will find that using art, music, literature, or play as an adjunct or an alternative to traditional approaches may be the most meaningful way of engaging clients of all ages.

Creative arts approaches are not limited to the descriptions in this chapter. Movement, dance, drama, humor, and puppetry are other approaches that can meet client needs. No “universal” format exists for application; the creativity of the counselor and assessment of what would most effectively engage the client guide the implementation. The training needed to use these specialized approaches depends on whether they are used to supplement a verbal approach or constitute the major aspect of the counseling.

The diversity of creative counseling approaches can help effectively address a wide range of client needs, including clients from many different backgrounds. These methods move counseling beyond the mental arena, which relies on verbal techniques, to a more comprehensive orientation using a multitude of approaches.

Chapter 10 - Summary

Assessment is an integral and legitimate part of a counselor’s professional functioning. However, counselors have a choice about the attitudes they adopt toward assessment. They can view it as a “necessary evil” and employ minimal effort toward assessment functions, or they can do what they need to do to gain understanding of psychometric principles, tests, and assessment processes and therefore reap the benefits of effective assessment practices. Counselors who adopt this latter perspective will find that assessment is a valuable resource, and one that enhances their counseling practice.

Chapter 11 - Summary

The processes of diagnosis and treatment planning are integral to the overall practice of mental health counseling and are important elements of other areas of counseling practice. While there is much debate within counseling as well as among other mental health disciplines regarding the validity of diagnostic systems, most famously of the DSMs, at this point the centrality of diagnosis in the accessibility, affordability, and therefore the delivery of counseling services cannot be denied. It is incumbent upon professional counselors to become proficient in the process of diagnosis, as well as to be cognizant of the counseling profession’s traditions and values of wellness orientation, an emphasis on strengths, and the awareness and integration of cultural and social justice issues into the counseling process.

Chapter 12 - Summary

In this chapter, we reviewed historical natural disasters in the United States and provided an overview of counseling survivors of natural disasters and what the professional counselor must know before participating in relief efforts. Training in Psychological First Aid and/or Disaster Mental Health, as well as being a trauma-informed counselor provides the educational foundations for assisting in a natural disaster-caused crisis.

Chapter 13 - Summary

Professional counselors are in a prime position to provide leadership to advance the field of addictions counseling. This is true particularly for professional counselors from CACREP-accredited programs. For them, the master’s degree has been a requirement for licensure as a professional counselor. Their core curricular education has included research, assessment, group work, and social and cultural diversity. Graduates of CACREP-accredited Clinical Mental Health Counseling or Addiction Counseling programs also have training in diagnosis and treatment planning, as well as counseling persons with addiction and co-occurring disorders (for graduates of Addiction Counseling programs, training in this latter area is understandably more extensive).

By comparison, chemical dependency counselors are not necessarily required to have a graduate degree or to have had specialized clinical training (e.g., diagnosis). Many have practiced over the years with only a bachelor’s degree and the majority in the addictions counseling workforce still do not have a master’s degree (Rieckmann, Farentinos, Tillotson, Kocarnik, & McCarty, 2011). This will need to change in the next few years as more educated behavioral healthcare providers will be needed to address the influx of clients responding to the Medicaid expansion feature of the Affordable Care Act. Manderscheid (2014, p. 93) predicted that Medicaid expansion coverage “will favor persons with primary substance use conditions.”

Professional counselors who have specialized training in addictions and are eligible for dual licensure in their state (as mental health counselors and as chemical dependency counselors) may very well be the ones to advance more sophisticated change in addictions counseling. This entails translating emerging research into routine practice. The current emphasis on evidence-based practice has placed the spotlight not only on effective prevention and treatment approaches in the addictions (e.g., motivational interviewing), but also on ineffective and potentially harmful practices. These latter include the popular Drug Abuse Resistance Education (or DARE) conducted in many elementary and middle schools nationwide, planned interventions carried out by family members and friends (as is done on the television series “Intervention”), and confrontational counseling. All three of these have been rated by experts in the addictions field as discredited treatments (see Norcross et al., 2010). Professional counselors thus can assume a leadership role to correct misperceptions about appropriate services and highlight evidence-based practices, such as the ones described earlier in this chapter and recognized by NREPP.

Problematic substance use is not an isolated concern confined to certain groups of people. It is a public health issue that affects all Americans. This means that no counselor can opt out of addressing the issue of addiction with clients or their families. It thus seems imperative that professional counselors obtain further and specialized training in: (a) theories of addiction beyond the disease model, (b) screening and assessment methods, (c) diagnosis of substance use disorders, and (d) evidence-based prevention and treatment practices for persons with addictions, including those with co-occurring disorders. Translating this training into routine practice will advance the field, thereby improving access to services for the more than 20 million persons age 12 and older in the United States who needed treatment for a substance use problem in 2013 but did not receive it (SAMHSA, 2014b). This number represents the vast majority (88 percent) of persons with a substance use problem and indicates significant changes are needed in the delivery of services. Professional counselors are in a prime position to develop and implement a truly integrative approach to addictions counseling, one that, according to W. R. Miller et al. (2011), is comprehensive, holistic, evidence-based, multidisciplinary, and collaborative. The organizations and their corresponding websites listed in the Useful Websites section can assist professional counselors in their efforts to integrate addictions counseling into their work.

Chapter 14 - Summary

We have introduced career counseling as an integral part of any counseling work. You are now equipped with the basic principles of career counseling, and prepared to delve deeper. You have learned that career counseling developed, and continues to evolve, in response to economic and political trends, and that it is almost impossible to separate it from personal issues. We reviewed theories, assessments, and special issues related to the provision of career counseling.

Chapter 15 - Summary

The counseling profession is at a crossroads. Graduate training assures a solid preparation for entry into the field, increased credentialing options define for the public what they can expect from mental health counseling, and professional counselors have gained recognition and status as professionals in mental health care. With a bright future, it is important to not lose touch with the rich history of the profession. First and foremost, counselors care about those they serve, respecting the dignity of each human being.

In a new age, those roots will serve the profession well. The nature of advocacy is descriptive of the challenges faced by counselors in a new century. The pluralistic nature of America makes it imperative that the profession be mindful of its own biases, increases the knowledge and understanding of differing systems (especially families), and broadens counseling approaches to be more useful to more of the community. Along the same lines, the counseling profession itself would be well served to increase the diversity within its own ranks.

The concept of advocacy expands to include the responsibility of speaking on behalf of the clients we serve and those we don’t, seeking services and resources for those who may otherwise fall through the cracks. As economic diversity continues to create greater disparity between the “haves and the have-nots,” professionals must lend their clout to improving the conditions of their communities.

Maintaining clinical competence and practicing cultural humility is a professional, ethical, and, in the case of the private practice, essential responsibility in order to be successful. Conditions may sometimes conspire to make those previously listed responsibilities difficult to meet. Professional mental health counselors must take responsibility for self-care and must take measures to remedy such a situation in order to provide competent counseling for their clients.

Mental health counselors have a specific role in the larger profession of counseling. The role has evolved out of a rich history and is supported by specific academic and clinical training. Mental health counselors collaborate with other mental health care professionals and have opportunities to practice counseling in many diverse settings. Some of these settings include community agencies (public and private), hospitals and health care facilities, government sponsored programs and services, and private practice. Some counselors have private practices. Professional counselors have available to them many different professional credentials, which helps to define for the public what counselors do and increases their professional recognition in the mental health care community. Fifty states offer some form of professional counseling license and all counselors who qualify can seek certification as a National Certified Counselor (NCC). Some professional counselors hold credentials in counseling specialties. Mental health counselors have made many advances during the relatively brief history of the counseling profession. That history reflects ongoing efforts to make sure the definition of counseling accurately reflects the competencies of counseling practitioners, as well as the roles fulfilled in the mental health profession.

Chapter 16 - Summary

Clinical rehabilitation counseling is the newest counseling specialty in the field of rehabilitation counseling. Clinical Rehabilitation Counseling Programs are dually accredited by CACREP and CORE insuring that clinical rehabilitation counselors receive the same training as vocational rehabilitation counselors and clinical mental health counselors. This exciting field is based on advocacy for people with disabilities who have the basic human right to equal access and self-determination in our communities, schools, and workplaces. Clinical rehabilitation counselor serve an important role in assisting people with chronic illness or disabilities, and their families, to adapt to their impairments and maintain a satisfying quality of life. Clinical rehabilitation counselors work in settings where people with disabilities need services including: state agencies, independent living centers, Veteran’s Affairs, private rehabilitation counseling forensic firms, medical and mental health settings, private practice, and higher education settings.

The field of rehabilitation counseling has made many advances to improve the lives of people with disabilities through intervention research and outcome studies of benefit programs. With the advent of clinical rehabilitation counseling, more people with disabilities receive important counseling services that improve lives. The future of rehabilitation counseling promises exciting challenges as the profession changes to meet the needs of our society.

Chapter 17 - Summary

This chapter has attempted to introduce the reader to the systems thinking that is the essence of couple and family counseling. In addition, I have tried to detail some important cultural and professional contexts that influence this work and have illustrated this perspective through descriptions of couple and family counseling diagnosis, interviewing, and treatment. Couple and family counseling treatment is rich in powerful techniques. It is my hope that this brief introduction to the concepts and techniques of couple and family counseling will whet the reader's appetite for further exploration. If that should prove to be the case, the references marked with an asterisk (*) are good starting points.

Chapter 18 - Summary

The world of school counseling is one of great opportunity and challenge. Unlike other specialty areas in counseling, school counseling has, as an ultimate goal, the academic success of students. The role of school counselors is multifaceted and includes many activities related to providing services for students, parents, school personnel, and the community. The school counseling profession continues to respond to the needs of a diverse and ever-changing society. Issues related to diverse student populations, equitable access to education, technology, and role definition of the school counselor will continue to permeate the profession (Jones & Granello, 2002). Outcome-based program evaluation and finding time for counseling in an age of testing and accountability is also a challenge for school counselors.

So, how would a school counselor work with Paul, the struggling student in Sidebar 18.1? First, the school counselor might consult with Paul’s teachers to try to understand what specific behaviors Paul has been demonstrating in class and what changes they have observed in his school performance. Second, the school counselor would conduct individual counseling with Paul to assess his perspective on what is going on in his life. Using effective counseling skills, the school counselor would try to get Paul to be open about his life situation and the effect his home and social life might be having on his school performance. The school counselor would encourage Paul to express his feelings about things, perhaps confront the drug behavior, and then ask what Paul would like to have happen. In this session, the school counselor is also going to address Paul’s decline in academic performance and help generate strategies to provide support for him at school. If necessary, the school counselor will help Paul identify resources that he can use to improve his academic performance as well as resources to address his substance use. Finally, the school counselor would seek Paul’s consent to speak with his parents so that everyone can be informed about the impact of the family situation on his academic progress. If Paul gives consent, the school counselor would arrange a meeting with the parents (with Paul present if he wishes) and perhaps include teachers as well so that everyone is collaborating about helping Paul experience success inside and outside of school. A comprehensive school counseling plan, involving the roles of counseling, consultation, and coordination of services as well as monitoring and assessing the effectiveness of interventions, will increase Paul’s likelihood of success in his school career as well as in life.

Chapter 19 - Summary

College counseling or college student affairs are career options for those who hold master’s degrees in counseling and college student development. Jobs in colleges and universities are varied and range from positions as counselors in traditional college counseling centers where clients are seen in individual sessions to positions in financial aid or admissions where little activity takes place that might be considered counseling. The setting of the college or university has a significant impact on the jobs master’s level counselors might find. Working in a small residential liberal arts college that has 100 undergraduate students is much different from having a professional position in a multi-campus urban community college that has 100,000 freshman and sophomore students, or being a counselor in a large state university with 80,000 students who are both undergraduates and graduate students.

Graduate students who plan to be counselors or student affairs professionals in colleges or universities should join and be active members of the American Counseling Association (ACA) and its division, the American College Counseling Association (ACCA). They should also consider being members of the American College Personnel Association (ACPA). If they are oriented toward administration, they should also join the NASPA: Student Affairs Administrators in Higher Education. Once they become professionals, to ensure they have current information in the field, college counselors and student affairs professionals should maintain active memberships in appropriate professional associations.