Tuesday, December 9, 2008

Importance of Religion on Counseling by Tony Astro

Importance and Integration of Religion / Spirituality:

It is not just important to assess the religion and spirituality of an individual practicing the religion but it is important to incorporate the spiritual dimension on the counselor’s own personal lives to be truthful in communicating with the patient. Patient can sense if counselor is just being scholar or patronizing the patient. If counselor cannot deal with its own spirituality, how can the counselor honestly empathize with the patient?

Clinicians themselves are increasingly interested in incorporating the spiritual dimension in their own personal lives. Many are involved in their own spiritual development and utilize various spiritual exercises such as prayer and meditation. Those who are pioneers in this emerging field will experience more support and less resistance from colleagues when they share their experiences with clients, trainees and colleagues. Many will seek additional knowledge and training which will further increase their capacity to respond to the concerns of their clients. In other words, the prospects for incorporating the spiritual dimension in clinical practice are great (Sperry, 2001).


One major challenge a counselor can encounter is: Ignorance leading to Preconception (Bias). Spirituality is sometimes part of a person that tells, it is the ultimate truth and others are not the true religion. Too much familiarity of own religion can impose pressure to another. Some spiritual dimension requires that “God says you must share this truth to others” and imposes guilt. If counselor believes strongly on such conviction or principle, counselor may have to live a double life to accommodate the “other religion” who is also the ultimate truth.

Skills and Strategy:

It is not enough to know the what, where, when and how but why is that particular religion has an effect on person’s life. Let’s put that person’s shoes and develop true understanding / empathy of the person and ask: what if the spiritual dimension of that person happens to be my belief as well? It is not an option for the counselor to incorporate religion or spiritual dimension but it is a must to be more effective in knowing the patient whether he or she is spiritual or not.

Within hospice care it has always been clear that spiritual care is “not an optional extra”. Through the thirty years of the modern hospice movement a sense of the importance of the spiritual has been retained. Research published in 1995 compared hospice nurses and oncology nurses and demonstrated that the former group engage in spiritual care activities more often and felt more comfortable in so doing (Cobb and Robshaw, 1998).

Sperry, L. (2001). Spirituality in Clinical Practice: Incorporating the Spiritual Dimension in Psychotherapy and Counseling. Psychology Press, 2001. Page 194.

Cobb, M., Robshaw, V. (1998). The Spiritual Challenge of Health Care. Elsevier Health Sciences, 1998 Page 168

On Religion and Counseling: To be Addressed or not to be (Part 2) by Tony Astro


Religion and Counseling: To be Addressed or not to be - that is the question and here are my thoughts.
Must Be Addressed
Religion and spirituality must be tackled in counseling when clients begin to address his spirituality and belief and have an effect on member’s health and influence how both clients and counselor response to the issue of concern, psychologically and physically.
Religious, cultural differences about denomination (as well as the beliefs and practices associated with being in a denomination) between client and therapists are likely to exist, particularly for clinical and counseling psychologists (Walker, Gorsuch and Tan, 2004).
The counselor is responsible for researching client’s religion or spiritual belief just like analyzing the importance of his or her race, culture and ethnic orientation. Many if not all aspect of faith is challenging to quantify and as professionals, we look at the obvious and what is proven and not the “invisible” or spirit particularly to diverse minority or people of color and people with strong religious upbringing.
The amount of training that most clinicians undergo within their graduate and professional education is quite extensive. Yet, because much of the training is anchored within the context of a European American psychological perspective, the knowledge base is limited when applied to people of color. This is particularly evident when considering the notion of spirituality (Cervantes and Parham, 2005).
Must Not Be Addressed
In other circumstances when religion is not implied nor has no influence on the patient, religion or spirituality should not be addressed. But sometimes, patients do not have to bring up spirituality and if every avenue has been tried and the remaining aspect of culture that has strong “spiritual” side and has not been explored, it must be deliberated. Spirituality is multifaceted because it cannot be described physically. Exploring this area with the patient can be carefully investigated.
The whole issue of what ‘spirituality’ might be referring to is a complex one. While the word, itself, contains another word spirit, the term has been used more broadly than one to connote simply a belief in the inherent spirit of a person. It is, however, most frequently linked to religion and to religious beliefs. In discussing faith, religion, and spirituality, many community members believed that ministers should play a role in providing spiritual counsel and comfort to families when it comes to advance care planning. Community members believe it important to address faith and beliefs with one’s doctor ahead of time. Many believed in the importance of one’s relationship with God or with a higher power, and saw this higher spirit as playing a pivotal role in one’s health, working through healthcare professionals to sustain life, as well as determining when it is “your time to go” (Phipps, True and Murray, 2003).
Personal Challenges
A military career counselor has no authority to discuss religion on any occasion. Military chaplains are allowed to talk any subjects including medical and career counseling. Many of the military chaplains have counseling license and have a high level of privacy unlike any other counselor including physicians and psychiatrist. But as a counselor, I should consider the overall personality of a Sailor who needs help and some of them are shaped by religious belief such as:
1. A client is separating or transitioning from military to civilian and seeking career guidance because he does not believe in war – sacrificing life due to his Mormon upbringing.
2. An Islam client (Navy Sailor) does not want to be deployed to Afghanistan to fight those who have the same spiritual belief of supposed enemy of the Americans so he is seeking career guidance that does not involve in such conflict.
Clinical, career counselors and counseling psychologists who find it difficult to understand the cultural heritage of clients who practice their spirituality within the context of organized religion may wish to consult with explicitly religious therapists on such therapy cases (Walker, Gorsuch and Tan, 2004).
Proactive Plan
Being of the Christian faith, a professional counselor like myself is accountable to preserve the spirituality and religious belief of every client (or patient). To do this, even though the client is not vocally spiritual, must examine his/her overall culture including family’s background including religious convictions. The client may have long been agnostic but have previously believed in Judaism. His disorientation on his previous religion making him agnostic may have contributed to some of his mental uncertainty resulting to some psychological perplexity. Asking the questions will be reasonable: Do you have or had a religion? Why have you not practiced it? Do you want to talk about it?
After those questions, observe the client how he/she reacts. The counselor must then study and know Judaism and start incorporating (if needed) in issues strong to the patient. Some patients discuss matters that cannot be seen or quantified. Spirituality is one of them. If discussing religion gives comfort and liberation to counselee, the therapist must acknowledge it to shape him or her towards their stronger wellbeing.
Among the domains of multicultural attitudes and skills most pertinent to this study are (a) an awareness of one's own cultural heritage, (b) respect and comfort with other cultures and values that differ from one's own, and (c) an awareness of one's helping style and how this style could affect clients from other cultural backgrounds. Hence, knowledge of religion and spirituality is an important element of therapists' multicultural competency (Walker, Gorsuch and Tan, 2004).
Cervantes, J and Parham T. (2005). Toward a Meaningful Spirituality for People of Color: Lessons for the Counseling Practitioner. Cultural Diversity and Ethnic Minority Psychology by the Educational Publishing Foundation Vol. 11, No. 1, 69 – 81. University of California, Irvine.
Phipps, E., True, G., & Murray, G. (2003, December). Community perspectives on advance care planning: report from the community ethics program. Journal of Cultural Diversity, 10(4), 118-123. Retrieved December 2, 2008, from CINAHL with Full Text database.
Walker, D., Gorsuch, R., & Tan, S. (2004, October). Therapists' Integration of Religion and Spirituality in Counseling: A Meta-Analysis. Counseling & Values, 49(1), 69-80. Retrieved December 2, 2008, from Academic Search Premier database.

How Would I Handle Donald: Counseling on Wellness and Someone Who Might be Depressive by Tony Astro

As a career counselor for two decades now, I have encountered a client who may need a clinical counselor, but there should be a way to handle it as the need arises primarily in the military where a clinical counselor is not as accessible. The chaplain is usually the next step which some of my clients would instead not go. Instead of waiting for the next appointment to pass the buck for advice, I think we can handle this by just lending a listening ear.

Here is a scenario that I have encountered as a counselor who confided to me, although I am not a clinical counselor, I had a dilemma and so here is my observation on how to handle, it seems like a depressive male and determine if it needs a further referral.

·         Donald (not his real name): Well… I am here in needing advice because I have been feeling incredibly discouraged recently. I… um… can't discover inspiration for the things that I know I have to do. I am not working now, so fundamentally I rest. Furthermore, I do not escape the house much. I am engaged with karate… other than that, there isn't much.

·         Counselor:  Can you reveal to me more?

·         Donald: Well… I just feel so down, so discouraged… like nobody truly comprehends me. Also, I would prefer genuinely not to associate with individuals much since they make me apprehensive at any rate… I do not recognize what to state [Sigh]. In this way, I merely abstain from getting things done. It is miserable.

·         Counselor: So, you have been feeling so unmotivated and sad recently that you have been not able to work, leave the house, or associate with individuals. Is that right?

·         Donald: Yeah… I have not worked in about a year. My folks still live in Japan, yet they help me fiscally when I am not working. I have been willing work recovery for as long as a half year, yet they revealed to me I was excessively wiped out, making it impossible to work. I might want to work once more. However, I simply don't know how I could do it… .since… I feel so overpowered often. What's more, I do not recognize what to do. I simply feel so discouraged.

·         Counselor: You said that your folks still live in Japan. To what extent you have lived in the U.S., and how is your emotionally supportive network here?

·         Donald: I have lived here for around 15 years. I have a couple of companions here. However, they do not comprehend me. They endeavor to help me. However individuals merely exploit me, I figure since I am excessively decent… I do not have limitations.

·         Counselor: What might you want to see changed in your life at this moment?

·         Donald: Hmmm… I would get a kick out of the chance to not feel so continuously discouraged and have the inspiration to do the things that I need to do… like discover a vocation, be more engaged with karate, and possibly observe a pleasant lady to be involved. I just would prefer not to feel continuously confused… moreover, feel so discouraged and, stop most of the contemplations that continue surging around in my mind. Drug encourages a few, yet insufficient. I attempt to meditate and be more motivated. However, it is tough. I simply keep considering. I'd additionally get a kick out of the chance to have more inspiration to escape my home since it was tough for me to try and come here today.

Here is my observation whether it may need to be referred to next level of counseling or continue the effort to counsel the member.

Donald admits to the counselor of having some psychological concern and intends an answer. The counselor has already started the first step which is narrative and eventually expands it into a life review.

Davis and Degges-White use the term life reviews as a naturally occurring process in which individuals share their stories through written or oral means. Individuals depend on language to make sense of mental images and on constructed symbols to communicate ideas and intents to others (Davis and Degges-White, 2008).

Donald’s ability to proclaim his problem of depression: “I just feel so down, so depressed…like no one understands me” is a good prelude towards going further and trace the roots of his depression. A narrative or life review counseling would be a very appropriate technique to know and bring out questions and answers like:
1. Have you felt this way before?
2. Are there any activities you have done in the past five years that helped you not to feel depressed?
3. When and how did you think that no one understands you?

The 2nd Application to be proposed is to have Donald try to write down his daily events either through a journal for his private readings. Have Donald review anything he writes and observes his self and gets back to the counselor for a follow-up.

Davis and Degges-White continue their studies: Comparing participants' earlier writings with their later books and asking participants whether they thought the life review activities improved their ability to view themselves gave a more comprehensive perception. Overall, the participants saw the event as one that provided personal analysis rather than a pure description of past events or relationships. They believed, they did deepen their understanding of themselves, and they felt that looking back did provide an opportunity to find connections (i.e., self-actualization). Their comments revealed that the experience encouraged them to undertake a personal search for meaning (Davis and Degges-White, 2008).

Another good indication that he is open to explore and cure his depression is admitting his weakness: “They try to help me, but people just take advantage of me, I guess because I am too nice…I do not have healthy boundaries.”

For some men, it is hard to admit any problems, even more, to acknowledge you have a depression which results to most men susceptible to other psychological illness (for not expressing weakness such as depression).

This widespread inability among men to identify emotions and put them into words has enormous consequences. It blocks men who have it from using the most effective means known for dealing with life's stresses and traumas— namely, identifying, thinking about, and discussing one's emotional responses to a stressor or trauma with a friend, family member, or therapist (Brooks and Good, 2001).
Moreover, so, coming from Donald’s narrative, setting boundaries is essential so that Donald will not be overwhelmed by the pressure of the people around him who do not understand his culture. Advise Donald some ideas on how to set boundaries like:
1. Don’t accommodate friends or acquaintance that he thinks takes advantage of him for being Japanese.
2. Encourage Donald to actually “find a nice woman to be in a relationship with” where he can talk about the pressures from around him.
3. Encourage Donald to keep busy or continue his hobby of Karate and find a job just keep his focus on something else -  may just be all he needs: a job.
The counselor should continue to see Donald for another six sessions while making a follow-up questions such as:
1. Find other sources of motivation: Have you find resources online as well as in his community that would develop his ways of keeping busy, be employed, and maybe have a relationship.

2. Life Review or Narrative in writing: Did his writing ever help? Can he continue to do his journaling, be consistent and patient for another five weeks?

3. Wellness Plan: How is Donald’s health and what are diets and physical activities does Donald have been doing for the rest of the weeks/months.

Donald’s willingness to get advice from the counselor is already a sign of health. Continuing to be proactive with all these suggestions and communicate consistently with the counselor should bring a positive light to Donald’s issues.

Davis, N. and Degges-White, S. (2008, Fall2008). Catalysts for Developing Productive Life Reviews: A Multiple Case Study. Adultspan: Theory Research & Practice, 7(2), 69-79. Retrieved November 24, 2008, from Academic Search Premier database.

Brooks, G. R. and Good, G. E. (2001). The New Handbook of Psychotherapy and Counseling with Men. Vols. 1 and 2 : A Comprehensive Guide to Settings, Problems, and Treatment Approaches. San Francisco, Calif. Jossey Bass, 2001

Internet Counseling by Tony Astro

Many counseling are now done via the internet. Various agencies have used “chat lines” and discuss personal issues at the comfort of their home. An obvious advantage such as flexibility and accessibility due to location of both client and counselor comes to mind as well as extra confidentiality or privacy between counselor and counselee becomes an additional option if counselor prefers concealment.

Research has indicated that interacting from the comfort of home may offer client advantages of convenience and may encourage access to previously unavailable counseling services for those who live in rural areas or those limited by transportation barriers. Finally, online counseling may offer a degree of anonymity that encourages clients to be more forthright with their issues (Haberstroh, 2008).

With the current destitution of a client especially in lack of medical insurance coverage of patient, another advantage is the cost-effectiveness of having to cut the need of an additional space (in which cost is usually transferred over to client’s consultation fee).

Distance may be more economical than in-person counseling because counselors who do not need to rent commercial space have lower overhead costs, and neither client nor counselor has commuting expenses. Moreover, clients may be able to invest fewer hours in distance counseling because the dialog that ensues is often more goal-directed (Centore, 2008).

The obvious economic advantages brought about extensive options and choices to many clients. The more technologically adept our patient with the internet, the more they will use this means of counseling. But many should still consider the traditional, face-to-face counseling due to many disadvantages of internet counseling such as better-quality of communication – an integral part of counseling is listening, verbal and non-verbal communication.

In a research study by Paxton and her group has the following outcome: “From the participant’s perspective, internet delivery may also restrict communication. Not having personally met other group members and not having visual cues may reduce a participant’s sense of personal contact with other group members, thus impeding the development of relationships between group members and impacting on group cohesion. This may lower a participant’s capacity to motivate others and to give and receive support from the group.” (Paxton, 2007)

Furthermore, the absence of eye-contact, sudden change of emotion, the tone of voice, the fear of technology (especially when either counselor or counselee is unfamiliar with the internet, one may hesitate to “click” the button) from both side is a big consideration and disadvantageous to the client if online counseling is utilize.

In another research outcome: Internet counseling disposes with the process of building more intimate trust, a process that, in real life confrontation with a counselor, is slow, accompanies the exchange step by step, and is highly charged, especially in the beginning. This process is very much at the center of the client’s perceptions and self-persuasion at the time of the first contact in traditional counseling. It contributes to whether there will be any readiness to cooperate at all. In internet counseling, this psychological stage of relationship building is apparently skipped, because the client is able to reveal himself or herself directly in the online process, owing to one of the factors of psychological anonymity already mentioned (Schultze, 2006).

The main thing is internet is another option for a type of counseling that can be use in many simple cases like inquiry, follow-up from a face-to-face counseling, situational issues (i.e. relationship, job issues, etc.), additional counseling and referrals but this counselor deems that online counseling be use with limitation to be use only when it’s appropriate to the case. Internet counseling will not be ideal for intensive psychotherapy with major medical and mental complications (i.e. dementia, old age, depression, etc.). Counselors are ethically obligated to ensure not just the effectiveness of communication but ensuring that minimizing barriers of communication and accurate data.

ACA Code of Ethics under article A.12. Technology Applications on Benefits and Limitations states that counselors inform clients of the benefits and limitations of using information technology applications in the counseling process and in business/billing procedures. Such technologies include but are not limited to computer hardware and software, telephones, the World Wide Web, the Internet, online assessment instruments and other communication devices (American Counseling Association, 2005).

Counselors will continue to face challenges on counseling methods and must understand all the implications and usefulness of this medium of communication and be open to new ideas as well.

Furthermore, ACA states: When providing technology-assisted distance counseling services, counselors determine that clients are intellectually, emotionally, and physically capable of using the application and that the application is appropriate for the needs of clients (ACA, 2005).


American Counseling Association (2005). ACA Code of Ethics. Retrieved on November 17, 2008, from http://www.counseling.org/Resources/CodeOfEthics/TP/Home/CT2.aspx

Centore, A., & Milacci, F. (2008, July). A Study of Mental Health Counselors' Use of and Perspectives on Distance Counseling. Journal of Mental Health Counseling, 30(3), 267-282. Retrieved November 17, 2008, from Academic Search Premier database.

Haberstroh, S., Parr, G., Bradley, L., Morgan-Fleming, B., & Gee, R. (2008, Fall2008). Facilitating Online Counseling: Perspectives From Counselors in Training. Journal of Counseling & Development, 86(4), 460-470. Retrieved November 17, 2008, from Academic Search Premier database.

Paxton, S., McLean, S., Gollings, E., Faulkner, C., & Wertheim, E. (2007, December). Comparison of face-to-face and internet interventions for body image and eating problems in adult women: An RCT. International Journal of Eating Disorders, 40(8), 692-704. Retrieved November 17, 2008, doi:10.1002/eat.20446

Schultze, N. (2006, October). Success Factors in Internet-Based Psychological Counseling. CyberPsychology & Behavior, 9(5), 623-626. Retrieved November 17, 2008, doi:10.1089/cpb.2006.9.623

Counseling and Irritable Bowel Syndrome by Tony Astro

Irritable bowel syndrome is one of the most common chronic gastrointestinal disorders since almost half of the patients reporting to gastroenterologists with gastrointestinal symptoms. It is not a major life threatening disease.

IBS is defined by the presence of abdominal pain or discomfort in association with disordered defecation (that is, either constipation or diarrhea or both). The sensation of abdominal pain or discomfort is a key part of the definition of IBS. Other typical symptoms of IBS include: bloating, gassiness, abdominal distention, feelings of extreme urgency to use the bathroom, excessive straining while having a bowel movement, feelings of incomplete evacuation after having had a bowel movement, and the passage of mucus during evacuation (Lacy, 2006)

Client must be totally aware of the symptoms and how it can be pacify through medication in order that other psychological and social issues during counseling will not deviate. These pain and discomfort and inflate other issues psychologically to the patient and hence counseling cannot be effective.

The symptoms of IBS usually come and go, so that people can have long-lasting periods when they hardly notice they have it. In one study, fewer than a third of people were free of symptoms after 2 years, and in another, 1 in 20 people were free of symptoms after 5 years. IBS occurring after a bout of gastroenteritis (post-infectious IBS) may have a better prognosis – about 40% of
people with this appear to recover after 5– 6 years (Shmueli, 2007)

The social implications of IBS should also be considered during the counseling. When a client shows discomfort of IBS in public many issues arise: embarrassment, time wasted, prolong unplanned events, and even relationship with other people including friends and relatives may be affected. The main thing is IBS have social and psychological implications and must be treated with proper diet.

Time should be taken to explain carefully and sympathetically the possible mechanisms of symptom production and to reassure the patient of the lack of serious underlying disease (many patients being concerned that they may have cancer). Patients should be made aware that symptoms usually resolve (perhaps after months or years) and that, although there is no cure, symptoms can be relieved. Between 40 and 70% of patients respond to placebo (Anderson, 1998)

Here are some findings from Dr. Anderson on some treatment for IBS:
1. Dietary modification. Although no specific diet helps all patients, almost half of patients experience some relief with an exclusion diet consisting of one meat, one source of carbohydrate and one fruit. Such patients are able to identify several agents (most commonly sorbitol, caffeine or wheat products) which exacerbate the symptoms when reintroduced into the diet. A small subgroup of patients have a defined food sensitivity, usually lactose intolerance.
2. End-organ treatment Medical therapy can be useful for the short-term amelioration of symptoms, although many patients would prefer to manage without. It is often necessary to try several different preparations, as the response may be unpredictable and vary with time, possibly due to a high placebo response rate in patients with IBS.
3. Central treatment. An underlying affective disorder may or may not be the cause of IBS; however, it is often a reason why a patient seeks medical advice. Psychotherapy and hypnosis (and to a lesser extent, antidepressants) do benefit those with severe symptoms. Although antidepressants do not work in non-depressed patients, they do alter small-bowel motility (imipramine slows intestinal transit whereas paroxetine accelerates motility).


Anderson, Simon H. C. Key Topics in Gastroenterology. Oxford, GBR: BIOS Scientific Publishers Ltd, 1998. p 178. Retrieved on 13 November 2008 http://site.ebrary.com/lib/capella/Doc?id=5000295&ppg=188

Lacy, Brian E. Making Sense of IBS : A Physician Answers Your Questions about Irritable Bowel Syndrome. Baltimore, MD, USA: The Johns Hopkins University Press, 2006. p 29-30. Retrieved on 13 November 2008 at: http://site.ebrary.com/lib/capella/Doc?id=10188462&ppg=44

Shmueli, Udi. Irritable Bowel Syndrome : Answers at Your Fingertips.
London, , GBR: Class Publishing, 2007. p 28.

On Research and Counseling by Tony Astro

(Note: This past week my three-year research on “Counselors using Facebook.” was approved by the school board and it was a life journey, and lots of “lesson learned” not for the subject {counseling nor Facebook} but life in itself on time and patience. However, these are the two subjects I have been through in my academic journey on research and counseling as updated from my previous article in 2008)
Photo Credit:  Counseling Today - American Counseling Association

Coming out with right questions to the client can come about with solid and extensive knowledge. The more information (facts or data) a counselor can get, the more problems or questions are created. Research in the counseling field is compulsory and binding. It is vital to every client that near accurate information is the basis of alleviating the health of every patient. Research can bring about many questions and answers essential to all treatments.
The discussion on research methods in counseling and psychotherapy places great emphasis on what research can offer to advise. It is also worth thinking about what counseling can contribute to research. Any study that involves meaningful contact with people, for example carrying out interviews, running a focus or human inquiry group, explaining what will happen in an experiment, calls on many of the skills and competencies that are central to counselor training. Good researchers should be able to establish rapport, listen, respond non-defensively to questions, and engage in appropriate challenging. Counseling training offers a good grounding in these areas, upon which specific research skills can be built. However, going further than this, counseling theories also provide valuable tools for making sense of the relationship between researcher and informant (McLeod, 2003)
Counselors cannot always offer the best answer, but it can provide the better questions if research is done well. Up-to-the-minute information has changed many perspectives of every researcher and counselors. With the “website” movement accessible to many and modern day technology building up every day in the field of medicine, research has contributed to many processes of a what a counselor can do in a day or a year to each patient.
Research practices have been changing and developing as postmodern thinking has blurred the boundaries between the disciplines of philosophy, psychology, theology, humanities, anthropology, sociology and literature. Counseling practices have also changed and developed, and in the process, some fixed beliefs about psychological concepts of self and identity have been shaken (Ethengton, 2004).
The main thing is, counselors that complete a research can excavate more information to plan a broader perspective of the client and his/her issues without predisposition on few ideas including a personal opinion. When specifying an issue or classifying the client with a group, it helps to get many “arsenal” to prepare for whatever outcome of an interview from a group or an individual.
As you consult the literature, you can get ideas about how to set up and facilitate your group. In some cases, you may find readymade manuals for your particular group, complete with handouts and other media aids. With all the information out there, it is highly unlikely that you will find nothing related to your group idea. The completion of this step arms you with an arsenal of information about how to approach the group. It is your job to sift through the ideas and move to the next step in the planning (Berg, 2006).
Berg, Robert C. Group Counseling : Concepts and Procedures (4th Edition). Florence, KY, USA: Brunner-Routledge, 2006. p 131. Retrieved on 13 November 2008 at: http://site.ebrary.com/lib/capella/Doc?id=10172022&ppg=146
Etherington, Kim. Becoming a Reflexive Researcher : Using Our Selves in Research. London, , GBR: Jessica Kingsley Publishers, 2004. p 20. Retrieved on 13 November 2008 at: http://site.ebrary.com/lib/capella/Doc?id=10082346&ppg=20
McLeod, John. Doing Counselling Research. London, , GBR: Sage Publications, Incorporated, 2003. p 187-188. Retrieved on 13 November 2008 at: http://site.ebrary.com/lib/capella/Doc?id=10080851&ppg=194

Prime & Safe: Counselors, Take care of Yourself First. A Personal Wellness Plan as a Counselor by Tony Astro

With the strain of our job as counselors, health and fitness or wellness is very vital to the success of our counseling. Vicarious traumatization (VT)  also known as compassion fatigue could be a result if counselors do not have an appropriate Personal Wellness Plan.  As counselors, we have to be empathetic, and this kindhearted engagement with disturbed clients and their reports of traumatic experiences sometimes drains us.  Here are acronyms I created to make it easier for you to remember:  Prime Safe: 
PRIME:  Physical, Religion, Intellectual, Mental and Emotional
As a prior military Navy career counselor, physical exercise is mandatory considering the remarkable amount of pressure of deployments, combat and everyday duty at an average of 12 hours/day.  Research has shown that regular physical training or exercise serves to protect the immune system.  Physical activities (workout, yoga, breathing) serves as an acceptable way to express anxiety, anger, frustration, feeling out of control, and helplessness (Culligan & Sedlacek, 1980; DeBenedette, 1988; Kirkcaldy & Shephard, 1990; Rosato, 1990; Sutherland & Cooper, 1990).
So for the first proactive measure, a physically strenuous workout twice or thrice a week is essential including a healthy regimen diet. Being said is different from being done. With this hands-on practice of good daily habits, it needs a robust and disciplined control to do it. Being on a team (being in the military is much more accessible, speaking from my 23-year experience) makes it more manageable compared to be an independent counselor because of groupthink accountability. Without accountability or a partner, wavering of this plan is imminent.

Effective counseling is not doable when our wellbeing is out of shape: physically or mentally.  Moreover, so mental condition should also be kept in a way by meditation, journal, yoga, proper breathing or merely reading a great book (I do all of them and journal seems to be the most effective for me second to prayer).  As a second proactive measure, I have tried most of them and prayer including journaling is the one that made a good effect on me for my wellness.
Praying is a dialogue between you and an unseen counselor. The expression in voice or mind aids the counselor to profess issues or anxiety including VT or compassion fatigue. It goes along with journaling, and the only difference is written scripts maybe read interchangeably as counselor or counselee while praying is unwritten yet speaking to an “imaginary” counselor depending on counselors’ religious conviction.

SAFE:  Social, Abilities, Financial & Environmental
Every year from 2005 to 2013, I attended the Navy Counselors Association held in different parts of the country with almost  700 Navy Counselors networking for a one week conference learning new methods, ideas, regulations about the profession in career counseling. The network of contacts adds or gives each counselor new perspective on how individual counselors do their particular job even though they have the career counseling standards posted online or publicized in instructions. This type of events, as well as local monthly gathering with like-minded people at least week, can build confidence, improve work attitude and personal wellness.

Proper use of social media groups can also help us get the right connection.  Clean your social media “environment” by filtering all negative clutter in your Facebook pages and try using LinkedIn connections to get you an online mentor. 
Counselors cannot work all the time single-handedly. We all need reinforcement from those who have been through the practice of counseling. Their experience will help sustain both our physical and mental capacity.  Joining a social media group and be active on its benefits as well as face to face networking.

Write a blog, share your experience and don’t be afraid to make a wrong grammar or wrong assumptions,  it takes practice, and soon you can build influence to your followers you never expected, I did.

If we have issues going on with our family and financial wellness, can we focus on giving the same advice to others? It is difficult unless we have been through it and our mind is clear or stress-free. When we moved from California to Connecticut then back to California in a span of 7 years, it took a significant financial toll in our family as we purchased houses in both places and we could not get a renter and housing market crash.  We were devastated and if affected how I did my counseling and eventually my promotion to higher rank as a counselor.  My wellness was unresolved, and it changed a big part of my job, not necessarily counseling my clients, but it was later fixed through proper budgeting, joining a group called Crown Ministry and having a financial advisor.

The bottom line is our overall personal wellness:  physical, financial, spiritual, social and mental health is vital for us as a counselor.  We have to take care of ourselves first before we can do it for others and that is not a cliche.  Our goal is the same for the client and practicing what we advocate during our counseling will be evident to all clients (or patients for clinical counselors).  Now that you have your personal wellness in place you are all set to talk to your client more efficiently and sincerely ask:  How are you doing and how is your personal well being?  What are your skills and passions?  

Culligan, M.J., & Sedlacek, K. (1980). How to avoid stress before it kills you. New York: Gramercy.
DeBenedette, V. (1988). Getting fit for life: Can exercise reduce stress? The Physician and Sportsmedicine, 16, 185-200.
Kirkcaldy, B.D., & Shephard, R.J. (1990). Therapeutic implications of exercise. International Journal of Sport Psychology, 21, 165-184.
Patrick, P. (2007). Contemporary issues in counseling. Boston, MA: Pearson

Managed Care by Tony Astro

Working with managed care organizations is a reality that every counselor experiences. For this discussion:
Describe the impact of managed care and its associated challenges from the counselor and client perspectives.
Discuss the ramifications of each of the following scenarios:
A counselor decides to discontinue services with a client whose managed care organization will not authorize more sessions.
A counselor continues providing services to a client without coverage by the managed care organization.
In terms of efficacy and efficiency, describe the proactive mechanisms, strategies, and techniques that can be implemented as part of the counseling process in an attempt to comply with the brief therapy model of a managed care company, while still complying with the ACA Code of Ethics.

When patients avail themselves of managed care, they give up the liberty to shop around between doctors, therapist or counselors and coverage is normally limited depending on the capacity of the patient to pay. It is distressing that many stories about Americans not getting the right treatment or at the right time on their condition because of this. The counselor has the ethical obligation to do the service to a patient in need even to those who are not covered by managed care.
The ACA guidelines mandates that professional counselor will treat clients with respect and dignity, especially in regard to age, color, culture, disability, ethnic group, gender, race, religion, sexual orientation, marital status, or socioeconomic status (APA website).

Find the client an alternative care that will be suitable to the patient economically or cover the service if counselor cannot be compensated. APA continues as advised to all counselee: “Your professional counselor will, when necessary, assist in making appropriate alternative service arrangements. Such arrangements may be necessary following termination, at follow-up, and for referral.” Counselors must also inform clients of all financial arrangements related to service prior to entering the counseling relationship. Clients may request this information in writing.
Pro-bono work has faulty implications to ethics standard of managed care. Everyone’s goal should be the health of the client and not the takings of health maintenance organizations (HMOs). Unfortunately the current system is convoluted with rules and regulations at the expense of both the counselor (medical profession) and the counselee or patients.

In the motion picture Sicko (Moore, 2007), the universal health care plan versus American Health system was investigated and portrayed the US System or HMO’s as profit oriented as most patients interviewed in the movie were displeased. If this system happens in the middle of counseling a suicidal or alcoholic in the brink of death, counselors will be in a dilemma and the alternatives are few. A counselor who continues providing services to a client without coverage by the managed care organization may not only exigent to a counselor but penalized by the managed care system due to required standard procedures or technical rationality.

Amidst this seemingly ever present source of angst, the counselor professional must remain engaged in advocacy efforts at the community and professional organization levels to ensure that the voices of disenfranchised mental health populations are heard and their needs are addressed. At the same time, counselor professionals typically also continue to be engaged in devising other community-based options as stop gap measures for consumers in need of mental health care (Patrick, 2007).

Moore, M (Producer and Director). (2007). Sicko [Motion picture]. United States: Weinstein Company.

Patrick, P.K.S. (2007). Contemporary Issues in Counseling. Boston: Allyn & Bacon.
APA Website, 2008, The Layperson's Guide to Counselor Ethics, Retrieved on November 2, 2008 at: http://www.counseling.org/Files/FD.ashx?guid=606b5973-315c-4118-8b2c-2fbfd8194f82

Case Study: Trauma & Counselors Wellness by Tony Astro

Jennifer is an investigator for the child protection team. Her primary responsibility is to investigate reports of child abuse and neglect. She has been working in this position for about two years. Prior to this position, she was a case manager for the child protection team for about six months.

Jennifer is seeking counseling because, for the past two months, she has been experiencing extreme irritability and bouts of anger towards her husband. She is also having difficulty sleeping and reports very disturbing dreams. Jennifer describes several episodes in which she watches television and an hour passes by without her realizing anything that actually happened during that time period. She states that she just knows that she is “staring into space” and zones out. Jennifer also reports having some episodes of tearfulness and crying that occurs for no apparent reason.

When asked about the stress level at her job, she reports at that it is very high. She discusses a particular incident that occurred about 3 months ago in which a family was being investigated for child abuse. Before the case could be fully investigated, in a matter of a few days, the child died of sudden infant death syndrome (SIDS). Although this was not one of her cases, she says that it brings back thoughts of a previous case in which the child died of SIDS after he was reunited with his family. This occurred a year after her investigation, when the child was removed from the home. Jennifer states that she often feels overly responsible for the welfare of these children, yet has limited support and resources within the agency to completely protect them. She states that she receives no support from her employer or supervisor in debriefing from difficult cases.

Jennifer reports having no difficulty with her husband, finances, family, or any other area of her life. She states that her irritable behavior is completely out of character. She describes herself as a very positive, happy person.


Jennifer’s compassion fatigue shows the symptoms of a vicarious traumatization due to her previous related experience of child abuse, directly or indirectly. The a gradual lessening of compassion over time is common among victims of trauma and individuals that work directly with victims of trauma. It was first diagnosed in nurses in the 1950's (Barnes, 1997). Sufferers can exhibit several symptoms including hopelessness, a decrease in experiences of pleasure, constant stress and anxiety, and a pervasive negative attitude. This can have detrimental effects on individuals, both professionally and personally, including a decrease in productivity, the inability to focus, and the development of new feelings of incompetency and self doubt (Beaton, 1995).

Jennifer specific fatigue is reflected by her intrusive thoughts and self-doubt. Other empirical investigations have found vicarious traumatization to be associated with avoidance reactions (Weiss, Marmar, Metzler & Ronfeldt, 1995); increased social isolation, anger, anxiety, and sadness (Sexton, 1999); and intrusive thoughts and self-doubt (Pearlman & MacIan, 1995). (Meyer, 2006)

Jennifer being a female is more compassionate and more susceptible to compassion fatigue or vicarious traumatization. A recent University of Iowa study reveals a biological link between pain and fatigue and may help explain why more women than men are diagnosed with chronic pain and fatigue conditions like fibromyalgia and chronic fatigue syndrome (Newswise). Besides advising Jennifer to engage in healthy and healing activities, this learning will adapt Megan Bayliss, Director of Imaginif suggestions as follows (Imaginif website)
1. Understanding and responding to Jennifer’s own needs is the essence of an effective self-care strategy. Learning to balance work and play is an important place to begin. Those who work in stressful helping environments often find it difficult to leave work at the office when it is time to go home. This may include replaying situations or conversations over in their head or continuing to mentally work through issues even when the paperwork is left behind. Clearly setting boundaries of “their time” and “my time” is an important step to regaining control over your life. Creating time for rest and leisure is part of this. Finding activities that focus your mind and body elsewhere, such as reading, bush walking, sports, gardening, or playing with children, aid in clearly separating work time from leisure.
2. Maintain a positive view of the world: When working with clients who have experienced trauma, it may become easy to believe that the world is falling apart or that people are going mad. The world is not falling apart everywhere and not everyone is mad. Remember that, although bad things happen and people are affected, there is a lot of good that goes on as well. Work to look for the good in people and situations. Remember the good you are doing.
3. Use workplace supervision (or friend/peer debriefing) in a way that suits you. Talking about what you are feeling and how your work is affecting you not only provides an outlet for your feelings but may also allow your supervisor to understand your needs and likely your fellow caseworkers needs as well. Your supervisor/friend may be able to help you find ways of handling work related stress.

Overall, Jennifer needs to detach herself by using alternatives around her (peers, time, supervisors, meditation) and minimize the activities of direct involvement with the case.

Barnes, M. F (1997). "Understanding the secondary traumatic stress of parents". In C. R. Figley (Ed). Burnout in Families: The Systemic Costs of Caring, pp., 75-90. Boca Raton: CRC Press.

Imaginif website cited on 30 October, 2008 at http://www.imaginif.com.au/

Meyer, D., & Ponton, R. (2006). The healthy tree: A metaphorical perspective of counselor well-being. Journal of Mental Health Counseling, 28(3), 189–201.

Neswise website cited on 30 October, 2008 at http://www.newswise.com/articles/view/539520?sc=rsmn
Beaton, R. D. and Murphy, S. A. (1995). "Working with people in crisis: Research implications". In C. R. Figley (Ed.), Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized, 51-81. NY: Brunner/Mazel.

Fatigue and Vicarious Trauma by Tony Astro

For this discussion:
Describe the phenomena of vicarious traumatization and compassion fatigue by identifying the signs and symptoms of these stress-induced challenges and what can lead to their development.
Answer this question: On a macro level, what proactive mechanisms could be implemented at worksites to assist counselors with these stress-induced challenges?
Use the Dunkley and Whelan article, “Vicarious Traumatisation: Current Status and Future Directions,” and the course text to support your discussion.


One of the many qualities of a good counselor is empathy . Without knowing the issue either through personal experience or learning from previous patients, not setting up boundaries or proper counseling process on how much counselors gets involve in client’s traumatic experience such as rape, depression, alcoholism, economic, and other social disorder may result to Vicarious Traumatization (VT) or Compassion Fatigue (CT), secondary traumatic stress disorder (STSD) or a simple burnout.

The psychological, physical, emotional, and spiritual toll that burnout, CT, VT can have on individuals and their families and friends can be short lived or long lasting (Patrick, 2007). For definition, most of the studies on VT are referred through McCann and Pearlman (1990) who conceptualized the risks of working with trauma clients as vicarious traumatisation. (Spelling of traumatisation vs. traumatization is kept from original reference of transcripts) This refers to the transformation that is thought to take place within the counselor as a result of empathic engagement with the trauma client (Thomson, 2003). For McCann and Pearlman, vicarious traumatisation is a normal reaction to trauma work and so it does not pertain to any particular therapeutic approach (Dunkley and Whelan, 2006).

This counselor has limited experience in the military of such type of counseling except burnout comes closer to mind. Any events including alcoholism, post deployments, suicidal tendencies or financial difficulties can sometimes affect the emotional capacity of the counselors when clients suffers from such events. When referring to previous experience of this counselor, it brings back a memory that triggers hurtful recollections affecting objective counseling. Biased personal solutions are sometimes given to the client because that was the strongest moment of relief helpful personally to this counselor.

Vicarious traumatisation appears to be a natural by-product of relieving trauma clients’ emotional suffering and so is a crucial issue for helping professionals. Researchers need to investigate vicarious traumatisation amongst a variety of professionals who work with a range of clients who have experienced trauma. One group that requires particular research attention is telephone counselors. (Dunkley and Whelan, 2006)

Many social workers are also telephone counselors. The 9/11 events within the New York area may be composed of clients and counselors who have experience such devastating experience of deaths and grotesque killings of many people including co-workers or family of counselor and counselee.

Pearlman and Mac Ian (1995) reported that therapists who work with trauma victims and who have a personal trauma history show more negative effects from their work than those therapists without a personal trauma history. McCann and Pearlman (1990) suggested that vicarious traumatization among professionals working with victims result from the inability of the therapists to process the traumatic clinical material in which they hear. (Farrar, website)

There should be boundaries when dealing with a client whose trauma is similar to the counselors. Outsourcing help from a non-biased counselor should help facilitate some of the counseling. Not necessarily taking over the responsibility but getting second opinions just like in any medical profession must be sought after by the counselors. Part of being an effective counselor is interacting with other group or set of contacts that will help both the counselor and counselee.

Trauma work should not be done in isolation. Regardless of a social worker’s practice setting or agency, having supportive colleagues can reduce isolation and create lighter moments. Work in the trauma field may whittle away at social workers’ natural abilities to trust. It is important for workers to learn to share positive connections with others. This can occur through formal supervision or peer groups, or informally through social gatherings. Positive connections are instrumental in reminding workers of the meaningful and rewarding elements of life at home and work. Seeking and nurturing supportive relationships with peers, actively engaging in supervision, and talking to friends are other avenues of connection. (Clemans, 2004)

Clemans, S. E. , Understanding Vicarious Traumatization – Strategies for Social Workers, Journal: Social Work Today, Vol. 4 No. 2 p. 13

Dunkley, J. and Whelan, T., British Journal of Guidance & Counseling; Feb2006, Vol. 34 Issue 1, p 107-116, 10p

Farrar, A. E., Vicarious Traumatization of the Mental Health Professional, Retrieved on October 22, 2008 from http://www.apa.org/apags/profdev/victrauma.html

Patrick, P. , Contemporary issues in counseling, Pearson Education, 2007, p. 211

Counseling and World Events

Numerous environmental, political, economic, and societal events have occurred worldwide over the past several years that have had an impact on the functioning of society as a whole and as a result, on the counseling profession. Use the articles you located in the Studies activity to:
Identify two of these events.
Analyze the effect of these events on the counseling profession.
Identify the contemporary counseling issues that have evolved as a result.

Economic turmoil is real, and it feeds fear among us says the Philadelphia Inquirer headline and so is the entire country / citizens are apprehensive. This will definitely increase anxiety among clients and hence need for more creative counseling. The demand for therapist may increase but their ability to recompense the insurance requiring premium may also increase. The ability of counselors to accommodate and effectively counsel the demanding nature of counseling may negatively affect both clients and counselors.

The current election campaign and eventually who will be winning this election affects the counseling world in terms of accommodation of our clients through Medicare and Social Security issues of both candidates platform.
Legislative changes must take place on health plans that deals with our licensed professional counselors. The American Counselors Association seeks help in contacting our Congressman and vote for the right candidate in the upcoming election.

Despite being widely recognized by private sector health plans, licensed professional counselors have yet to be recognized under Medicare. When a client turns 65, counselors lose both their business and their income, and too many counselors are denied hospital jobs because they cannot bill Medicare. This issue affects the recognition of and respect for the counseling professions throughout the country--from rehabilitation and school counseling to professional counseling. (American Counselors Association)

American Counselors Association website. Retrieve on October 19, 2008 at http://capwiz.com/counseling/issues/alert/?alertid=11789001

Case Study: Tyrone - Gay

Contemporary Issues in Counseling
The Case of Tyrone


Tyrone: Hmmm…so…what brought me here today. I don't even know where to start. Things have just been so rough lately. It’s like everything has been coming down on me, from work, to family…to everything. Like, I've never done this before, you know, come to counseling. And I don't even know how it’s going to help.

Counselor: Can you tell me more about what’s going on in your life right now that makes you feel like everything’s coming down on you?

Tyrone: Well, work is probably my most significant problem. I mean I’ve been working at Main Hospital for about just over a year as a lead in the quality control department. And my actual job is fine. I do a good job. It’s more the people, especially my subordinates. Basically, they have to work on a project before I get it. I complete the project it, then I pass it to my supervisor for approval.

[Sounding frustrated] And it’s just that...it’s just that they're not working to my expectations, and I get so frustrated. I mean, when it’s all said and done, if it’s not done right, I get blamed for it. So, I'm the fall guy for the entire office. And I’m just so sick of it…even on the last project. It was awful by the time it got to me. I tried to fix it and even went back to one guy who worked on it before me. And he just looked at me and said, “Well I’m done with that. I did my part. It’s your baby now.” And that just really ticked me off you know! Like I didn't yell at him, but he definitely knew I was mad.

So, of course I was in a bad mood and took out on my partner when I got home that day, and he got mad at me. We argued for almost 2 hours! Things have not been going well there lately. Work, of course, is so stressful, and I just feel like I’m on edge all of the time. I can't sleep. I can’t concentrate. I’m just frustrated all of the time. I don't know what do.

Counselor: Tell me a little bit more about what’s going on at home.

Tyrone: Well like I said, on the days I come home from a bad day at work, he says that I just get mad at him…I either blow up or don’t talk at all. And then he gets mad, and of course I get mad. Honestly, it seems like we’ve been fighting more lately, even on top of the whole work thing. I just really don’t know what’s going on.

I mean, we’ve been together for a couple years, and been pretty serious…between us of course…[insinuating that nobody knows about his gay relationship]. For the past couple months we've been fighting a lot more lately. Maybe if I could figure out how to make my workdays better, things would go better at home…you know?


Even though I am not designated as a clinical / psychologist / labor / social counselor, I must direct my client towards the right expertise but still be well rounded. As a Navy Counselor, I am directed to focus on Career and Transitional counseling. I am surrounded by other counselors that I network and occasionally pick their brains from: chaplains, family, legal, and other counselors. With regards to homosexuality, I am bound not to give advice (not that someone has approach me about their situation and knowing the stance of military against homosexuality) but rather referral mostly to chaplains as their “safest” route versus the psychiatrist (medical) whose counselings must be disclosed to the client / personnel's Commanding Officer (only Chaplains has the right not to disclose sessions / counselings)

Military has very structured ways of dealing with counseling. There is couselor for each issues (medical: psychological, career: myself, social: chaplain) yet it is very limited and most of the time, officially be recorded on their service record therefore it affects the career in many cases such as the "Don't ask, don't tell" policy.

Under Don’t Ask, Don’t Tell (DADT), overt homosexual behavior is grounds for dismissal, but the military is discouraged from actively investigating suspicions of homosexuality. Nevertheless, more than 12,000 service personnel have been discharged under the policy, according to the Servicemembers Legal Defense Network, a Washington, D.C.-based nonprofit organization dedicated to ending discrimination against military personnel affected by the policy (Persky, 2008)

In Tyrone’s case, I wanted to give it a different perspective where he will be discriminated and therefore affecting his work. If Tyrone was working in the military, will he have the same inefficiency or relatively the same issue that he is encountering now? I would say worst because now he has to deal with legal, career and benefits ramifications for being gay by being discharged and out of work.

In a Newsweek article, APA complained once more: homosexuality has now been grouped with other "conditions, circumstances and defects" like bed-wetting, repeated venereal-disease infections and obesity. The reclassification is "even worse," says Aaron Belkin, who studies gays in the military at the University of California, Santa Barbara. "Now [homosexuality] is explicitly deemed to be a defect." Pentagon spokeswoman Cynthia Smith says the Defense Department does "not think homosexuality is a mental illness" and says the classification could be re-examined (Rosenberg, 2006)

Complications will continue to arise if ever I will be counseling Tyrone (as a military or even as a regular civilian) for his homosexuality and so I stand on my first objective and that is to focus on what Tyrone has came and approach the counselor: his issue on supervisor efficiency or work management and domestic issue and not to focus on his homosexuality or lifestyle because "work" is his core issue, to quote Tyrone: "Maybe if I could figure out how to make my workdays better, things would go better at home…"

Persky, A. S. (2008), Don't Ask, Don't Tell: Don't Work?, ABA Journal. Chicago: Oct 2008. Vol. 94, Iss. 10; pg. 18, 2 pgs
Rosenberg, D. (2006), The Military: A Renewed War Over 'Don't Ask, Don't Tell'; Newsweek. New York: Nov 27, 2006. Vol. 148, Iss. 20; pg. 8

Last edited on: October 19, 2008 4:05 AM

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