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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

Religion and Counseling by Tony Astro

For this discussion Three barriers that may be present between client and counselor if:

  • Religion and spirituality are addressed.
  • Religion and spirituality are not addressed.
  • Describe own personal challenges that could present within the domains of counseling and religion.
  • Develop a proactive plan to work through these challenges.


Subject: Discussion 9: Spiritual and Religious Belief - Challenges & Solution by Tony Astro Topic: u09d1 Barriers, Challenges, and Solutions
Author: Tony Astro Date: December 2, 2008 3:54 PM

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 with regard to 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).

Counselor is responsible to research 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 religion is very difficult 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 with 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 in any occasion. Military chaplains are allowed to discuss any subjects including medical and career counseling. Many of the military chaplains have counseling license and have high level of privacy unlike any other counselor including physicians and psychiatrist. But as 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. Member is separating because he does not believe in war – sacrificing life due to his Mormon upbringing.

2. An Islam sailor does not want to be deployed to Afghanistan to fight those who have the same spiritual belief of supposed enemy of the Americans.

Clinical and counseling psychologists who find it difficult to understand the cultural heritage of clients who practice their spirituality within the context of an organized religion may wish to consult with explicitly religious therapists on such therapy cases (Walker, Gorsuch and Tan, 2004) .

Proactive Plan

Being in a Christian faith, a professional counselor is accountable to preserve the spirituality and religious belief of every patient. To do this, even though the patient is not vocally spiritual, must examine his/her overall culture including family’s background including religious convictions. The patient 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. Counselor must then study and know Judaism and start incorporating (if needed) in issues strong to the patient. Some patients discuss issues that cannot be seen or quantified. Spirituality is one of them. If discussing religion gives comfort and liberation to counselee, 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.

Case Study: Internet Counseling with John by Tony Astro

The Case of John
Contemporary Issues in Counseling

John: Well… I'm here in counseling because I’ve been feeling really depressed lately. I… um…can't seem to find motivation for the things that I know I need to do. I'm not working now, so basically I sleep. And I don't really get out of the house much. I am involved in karate…but other than that, there isn't much.

Counselor: Can you tell me more?

John: Well…I just feel so down, so depressed…like no one really understands me. And I don't really want to be around people much because they make me nervous anyway…I don't know what to say [Sigh]. So, I just avoid doing things. It’s hopeless.

Counselor: So you’ve been feeling so unmotivated and hopeless lately that you’ve been unable to work, go out of the house, or be around people. Is that right?

John: Yeah…I haven't worked in about a year. My parents still live in Japan, but they help me financially when I'm not working. I’ve been going to work rehab for the past six months, but they told me I was too sick to work. I would like to work again, but I just don't know how I could do it…..because…I feel so overwhelmed most of the time. And I don't know what to do. I just feel so depressed.

Counselor: You said that your parents still live in Japan. How long you have lived in the U.S., and what is your support system like here?

John: I’ve lived here for about 17 years. I’ve got a few friends here, but they don’t really understand me. They try to help me, but people just take advantage of me, I guess because I’m too nice…I don’t have healthy boundaries.

Counselor: What would you like to see different in your life right now?

John: Hmmm…I’d like to not feel so depressed all the time and have the motivation to do the things that I want to do…like find a job, be more involved in karate, and maybe find a nice woman to be in a relationship with. I just don't want to feel confused all the time… and feel so depressed… and stop all of the thoughts that keep rushing around in my brain. Medication helps some, but not enough. I try to meditate, but it’s really hard. I just keep thinking. I’d also like to have more motivation to get out of my house, because it was really hard for me to even come here today.


John admits to the counselor of having some type of 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).

John’s ability to proclaim his problem of depression: “I just feel so down, so depressed…like no one really 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 feel this way before?
2. Is there any activities you have done in the past 5 years that helped you not to feel depressed?
3. When and how did you feel that no one understands you?

The 2nd Application to be proposed is to have John try to write down his daily events either through a journal for his own exclusive readings. Have John review anything he writes and observe his self and get back to the counselor for a follow-up.

Davis and Degges-White continues on their studies: Comparing participants' earlier writings with their later writings and asking participants whether they thought the life review activities improved their ability to view themselves gave a more comprehensive perception. Overall, the participants viewed the activity as one that provided personal analysis rather than pure description of past activities or relationships. They generally believed, they did deepen their understanding of themselves, and they felt that looking back did provide 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’m too nice…I don’t have healthy boundaries.”

For some men, it is hard to admit any problems even more, to actually 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).

And so, coming from John’s own narrative, setting boundaries is important so that John will not be overwhelmed by the pressure of the people around him who does not understand his culture. Advise John 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 John to actually “find a nice woman to be in a relationship with” where he can talk to about the pressures from around him.

3. Encourage John to keep busy or continue his hobby of Karate and find a job just keep him focus on something else. This may just be all he needs: a job.

Counselor should continue to see John for another 6 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 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 5 weeks?

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

John’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 positive light to John’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

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

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:

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

Research and Counseling by Tony Astro

Coming out with good questions to client can come about with solid and extensive knowledge. The more information (facts or data) a counselor can get, the more 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 counseling. It is also worth thinking about what counseling can offer to research. Any research 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 change 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 process of a what a counselor can do in a day or in a year to each patients.

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 in order 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” in order 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:

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:

McLeod, John. Doing Counselling Research. London, , GBR: Sage Publications, Incorporated, 2003. p 187-188. Retrieved on 13 November 2008 at:

Personal Wellness Plan as Counselor by Tony Astro

With the strain of our job as counselors, health and fitness or wellness is very vital to success of psychotherapy. From previous postings, we are convinced that Vicarious traumatization or compassion fatigue could be a result if counselors does not have an appropriate Personal Wellness Plan.

Being in the military, exercise is mandatory because of the remarkable amount of trauma or pressure of deployments, combat and everyday duty at an average of 12 hours / day.

Research has shown that exercise serves to protect the immune system and 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 important including a healthy regimen diet. Being said is different than being done. With this hands-on practice of good daily habits, it needs a strong disciplined control to do it. Being in a team makes it easier because of 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 and so mental condition should also be kept in shape by meditation, journal, yoga, proper breathing or simply reading a great book. As a second proactive measure, counselor has tried most of them and prayer including journaling is the one that made a good effect on personal wellness.

Praying is a dialogue between you and an unseen counselor. The expression in voice or mind aids the counselor profess issues or anxiety including VT or compassion fatigue. This 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.

The bottom line is, physical and mental health is important for this counselor. Our goal is the same for the patient and practicing what we advocate during our counseling will be obvious to all patients.

Lastly, counselors cannot work single-handedly all the time. We all need reinforcement from those who has been through the practice of counseling. Their experience will help sustain both our physical and mental capacity.

Every year, the Navy Counselors Association is held in different parts of the country. Last year, over 700 Navy Counselors met in San Diego for a one week conference learning new methods, ideas, regulations about the profession of Navy 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 Navy standards posted online or publicized in instructions. Fortunately, this counselor has attended the last 7 years of this symposium and every time after a week, confidence and work attitude is improved.


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.

Last edited on: November 5, 2008 6:41 PM

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:

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

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
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

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

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’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

Mental Illness and Elderly Counseling: What I Have Learned @ Capella

I have learned so many things just reading everyone’s postings. Reading and making the point to the case not knowing if I answer it correctly was quite revealing and eventually learning from how and what I post on each discussion. It’s ok to critique one’s posting but I also learn from good feedback. Here are just 10 of what I have learned in the past 10 weeks:

1. Age matters and it varies how you do counseling but as counselors no matter how old or what group or type of a person is, needs EMPATHY. (Demographic)

2. Internet has heaps of RESOURCES and information and it may add challenge or confuse a counselor looking for an answer but creatively, counselors can get the answer timely. (Website critiques)

3. It’s a MYTH that all elderly are weak. (Interview)

4. Every single patient's CULTURE (Religion, Ethnic background, etc.) must be integrated in all our counsel. (The Case of Mrs. Falcone)

5. Every age goes into TRANSITION so does the way or type of counseling should be correlated to current situation of patient. (The Case of Joel & Joan)

6. GROUP counseling helps patient see their shortcoming and strength in others. (The Case of Joel & Joan)

7. Counselors cannot get a perfect solution. In order to correct an issue (e.g. Divorce vs. Family's Health), a patient (counselor's advice or family) may have to CONCEDE into something. (The Case on Margaret, Jonathan & Ellen)

8. MEDICATION is complex and should be monitored and take into consideration in every session. (Medication Factor)

9. Counselors must NETWORK (outsource), LEAD or mentor others & be open to LEARN (or get a mentor) from other counselors by proper planning and organization. Managing a patient is priority and taking care of yourself and your team is another. (Drop out Rate)

10. Watching intelligently, counselors can learn a lot from a Hollywood MOVIE. (Film Analysis)

Tony Astro

Last edited on: December 5, 2008 2:14 PM

Learning Experience with Ellen (Conversation / Chat) in Mental Illness and Elderly Counseling @ Capella

Ellen: This course has been very educational. The three areas I gained the most knowledge or awareness in is in understanding the different psychiatric disorders, cognitive disorders and the importance of housing and the health care professional role in helping older adults live as independent as possible. As older adults are living longer and the number of people age 100 and older s also growing (Butler, Lewis, & Sunderland), I have learned that their needs and concerns are unique and special as they age. Some common psychiatric disorders older adults have to deal with is depressive disorder and Manic –Depressive Illness. Depressive Disorder occurs when the existence of depressed mood lasts longer than two weeks. Many older adults are dealing with depression it is the most common mental disorder afflicting up to 205 of people 65 years and older What I have learned is the devastating impact of depression. Depression can cause anxiety, alcoholism, drug abuse, schizophrenia, and personality disorders (Butler, Lewis, & Sunderland, 1998). Because depression can lead to so many other conditions it is important to understand its symptoms and take immediate action to help the older adult.

Tony: I have learned so much as well Ellen, but before I enumerate them, let me pick the topic that impact me most was through discussion and research on cultural diverse population because it is what matters I suppose as we all grow older: How (belief), Why (religion), Where (ethnic) and When (health & age) - that encompass how we age and now, the counselor has to unravel those to get deeper into the person's overall psycho-social wellness.

Ellen: Before this course I did not fully understand many of the cognitive diseases that are associated with older adults and how wide spread they are becoming as the number of people living longer increases. I now have a better understanding of mental disorders and changes in nomenclature. It is estimated that up to five million Americans suffer from some form of cognitive decline (Butler, Lewis, & Sunderland, 1998). There are three main cognitive impairments that explain organic brain disorder which are Delirium, Dementia, and Dementia of the Alzheimer Type. Delirium is a change in a person’s consciousness and it can be treated. Dementia effects short and long term memory and is irreversible. Alzheimer type Dementia or Alzheimer’s disease affects an estimated 4 million people in the United States. One fact I found interesting is that people do not die from the disease but from other natural causes or lack of self awareness which may cause lack of personal that causes infections form hygiene. In the United States there may be as many as seven to nine million victims of Alzheimer’s disease by the year 2025 (Butler, Lewis, & Sunderland, 1998).

Tony: Speaking of mental illness, I have learned from the discussion and readings on Mental Status Exam showed me how even the 75 and above can still be mentally active and so it is not about being old but having those type of illness you mentioned and the complications of medication (discussion on Medication Factors)

Ellen: That is true, with the increasing population of older adults and the increase in diseases associated with older adults, healthy aging is one main issue I became more aware of throughout this course. Old age can be emotionally healthy and satisfying time of life with little physical and mental impairment (Butler, Lewis, & Sunderland, 1998).

Tony: Another area that corrected me, gave me strength and wisdom is how we stereotyped our elderly: reverse childhood process, they are weak & smelly (someone commented that in the discussion and my son happen to said that too - that week to my 78 year old mom), setting their ways, economic burden, etc – are all precarious typecast for them. They are smart (portrayed in Driving Miss Daisy) and can be very useful for the society. Ellen, do you have any stereotype for those who are “further up the ladder” to heaven.

Ellen: I like how you described our elderly (touching a little about diversity and religion). Yes, there are many stereotypes that are associated with old age, but there are many older adults who are enjoying life and making healthy lifestyle choices. During this course I realized more that age is a number and you are as young as you feel. According to Butler, Lewis, & Sunderland, (1998), during middle age 40 – 65 there is an increase in awareness of aging and changes in life patterns like children grow up, parents grow old and new social and personal roles are assumed. Because I am in the early phase of middle age, taking this course has been an enlightening experience for me. I knew making positive life choices was important but I have a better understanding of those choices after taking this course. As older adults make healthy lifestyle choices many diseases can b prevented like stroke, diabetes, or heart disease. This course has improved my professional identity and has brought an awareness of older adults and their issues and challenges. Tony, do you have further things to discuss?

Tony: Yes Ellen, the discussion process is actually seeing the diverse experience of our class. What I have researched on enormous amount of information on the Internet is clarified further by some of the response (nice and critical) of the class. The Interview is actually more challenging for me because of my recent move from Connecticut to California last month but I managed to transfer and revise my new subject in my new small town here in Lemoore, CA. Also, how we manage our wellness as counselor is critical (Discussion on Intern Orientation and Drop out Rate) that I have learned to really pay attention to how I counsel and work with other counselors and not just focus on my client / patient / military personnel. Overall I enjoyed this class.

Butler, R., Lewis, M., & Sunderland T. (1998). Aging and Mental Health. Austin, TX: Pro Ed Publishing.

Last edited on: December 9, 2008 10:34 AM

Movie Analysis: Driving Miss Daisy

Aging Process:

Ms. Daisy at 72 (Wealthy with strong Jewish religious background) started strong and imposing in her manners, aware of every details around her until she have that car accident that greatly affected her self-esteem.

She then created a friendship with Mr. Hoke (a black Christian, in a highly segregated and racist community) after being self-protective or suspicious about him. He in transition became a servant, a counselor and confidant. She develops her relationship out of her loneliness considering her son is very caring for her – she eventually became more affectionate of her driver, Mr. Hoke.

The third process is her eventual suffering of mental illness that landed her into a nursing home. The film did not depict the caused and it is assumed or stereotyped that it is part of the process of getting into old age.

Role of Counseling:

Mr. Hoke has some of the distinctiveness of being a good counselor: able to establish good affinity, benevolent, perceptive (considering the setting in the south of strong prejudice and segregation on Jew, Black, etc.). As counselor we should be aware of our patient’s culture, race and religion and be sensitive to their needs.
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 with regard to 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).

Counselor is responsible to explore not only her age but her culture including her religion. Many if not all aspect of religion is very difficult 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).

Strength and Struggles:

Ms. Daisy at 72 is capable of honestly communicating her feelings: cynicism and mistrust (towards Mr. Hoke ) and not accepting the fact that she may be in danger of driving her own car. The physicality of Miss. Daisy must be considered in all facet of her ability. She has to recognize the fact that she may not be healthy to drive but this is not to stereotype all elderly at 72 is not capable.

At retirement age (65 yr), there was a stabilizing, or even an improving, tendency in activity patterns, usually followed by further erosion through the final period of life. Strengthening behavior eroded dramatically with advancing age among adults, especially among men. Among adolescents, differences between female and male respondents were large for regular, vigorous activity (11.3 percentage points greater for male respondents). In comparison with female adolescents and adults, male respondents reported much higher rates of regular, sustained activity (5.5 and 5.9 percentage points, respectively), and strengthening (18.2 and 11.3 percentage points, respectively) (Casperen, et al, 2000).

When Mr. Hoke tries to befriend and encouraged rapport with Miss Daisy, she was defensive but in the long run, they develop a good healthy relationship. It is important that Miss Daisy continue to interact with someone to encourage and keep her social skills hale and hearty this in some ways will be nourishing for her.

Evaluation results of the elder wellness program suggest that blood pressure screenings provide community health nurses (CHNs) with unique opportunities to promote wellness in older adults when provided in an atmosphere that encourages nurse-client interactions (Shellman, 2000).

Caspersen, C., Pereira M. and Curran, M. (2000). Changes in physical activity patterns in the United States, by sex and cross-sectional age. Med. Sci. Sports Exerc., Vol. 32, No. 9, pp. 1601-1609, Retrieved on December 5, 2000 at:

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.

Shellman, J. (2000). Promoting Elder Wellness Through a Community-Based Blood Pressure Clinic SO: Public Health Nursing. Retrieved on December 5, 2008 at:

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.

Tony Astro
Two Thumbs Up for the movie Driving Miss Daisy.

Last edited on: December 6, 2008 12:12 AM

Counseling, Old Age and Medication

Summarize the following factors that are associated with the use of medication for the treatment of mental disorders in the elderly. Write two sentences for each summary:
Drug compliance.
Side effects.
Drug metabolism.
Drug costs.
Food-drug interactions.
Other factors that you view as important.

My Answer:
1. Polypharmacy or the use of multiply medication is critical for the Elderly patients. They use more medications than younger patients and the trend of increasing drug use continues through 80 years of age. Studies conducted in a variety of settings have shown that patients over 65 years of age use an average of 2 to 6 prescribed medications and 1 to 3.4 non-prescribed medications (Stewart and Cooper, 1994).

2. Drug compliance. The consequences of drug noncompliance or the correct following of medical advice may be serious in older patients. Estimates of the extent of noncompliance in the elderly vary, ranging from 40% to a high of 75%. Three common forms of drug treatment noncompliance are found in the elderly: overuse and abuse, forgetting, and alteration of schedules and doses (Salzman and Kupfer, 1995).

3. Side effects or problems that occur when treatment goes beyond the desired effect especially antipsychotic medications are particularly problematic in elderly patients, who experience many age-related changes that may exacerbate medication side effects. Side effects of particular concern in the elderly include anticholinergic reactions, parkinsonian events, tardive dyskinesia, orthostatic hypotension, cardiac conduction disturbances, reduced bone mineral density, sedation, and cognitive slowing (Masand, 2000).

4. Drug metabolism or the set of chemical reactions of drugs is significant with the elderly. Aging is accompanied by marked changes in the physiology of many organs, as well as in their constituent cells. These nonpathological alterations in structure and/or function may affect normal physiological processes in the elderly (individuals >65 years) (Schmucker, 2001).

5. Drug costs particularly to elderly have not only had economic impact but health is affected. The increased cost-sharing for prescription drugs in elderly persons and welfare recipients was followed by reductions in use of essential drugs and a higher rate of serious adverse events and ED visits associated with these reductions (Tamblyn, 2001).

6. Food-drug interactions. Interactions between food and drugs may inadvertently reduce or increase the drug effect. The majority of clinically relevant food-drug interactions are caused by food-induced changes in the bioavailability of the drug (Schmidt, Lars and Dalhoff, 2002).

7. Many elderly needs further assistance in monitoring their taking of medication. As age progress so does the number of prescription drugs is taken. The difficulty is not just in keeping track of the right medication and the side effects due to polypharmacy but the elderly has lesser capacity to scrutinize and avoid jeopardizing their health due to all the above cases as they keep themselves healthy and live longer.


Masand PS (2000).Side effects of antipsychotics in the elderly. Department of Psychiatry, State University of New York, Syracuse 13210, USA. Retrieved on December 2, 2008 at:

Salzman C, Kupfer D, Frank E. Medication compliance in the elderly. The Journal of clinical psychiatry. Wallingford CNS Academy, New York NY 1995, vol. 56. Physicians Postgraduate Press, Memphis, TN. Retrieved on December 2, 2008 at:

Schmidt, Lars E.; Dalhoff, Kim (2002). Food-Drug Interactions. Review Article on Drugs. 62(10):1481-1502, 2002. Retrieved on December 2, 2008 at:

Schmucker, Douglas (2001). Liver Function and Phase I Drug Metabolism in the Elderly: A Paradox. Review Article on Drugs & Aging. Retrieved on December 2, 2008 at:

Stewart RB, Cooper JW (1994).Polypharmacy in the aged. Practical solutions.
Department of Pharmacy Practice, College of Pharmacy, University of Florida. Retrieved on December 2, 2008 at:

Tamblyn, R. (2001). Adverse events associated with prescription drug cost-sharing among poor and elderly persons. Journal of the American Medical Association Volume: 285 Issue: 4 Pages: 421-429 Published: Jan 24 2001. Retrieved on December 2, 2008 at:

Last edited on: December 2, 2008 11:43 AM

Retirement Counseling: Case Study

Joel is a 65-year-old man who recently retired from an executive position in a large corporation. Although he says he looked forward to retirement, he never developed any interests or relationships outside of work. He complains of feeling "tired" and "bored." His wife, Joan, has always been a homemaker. Now that Joel is home during the day, he tries to show her ways to be more efficient in doing the household chores. Joan describes frustration with his "supervision," and the difficulty of finding time for herself or her friends when Joel is underfoot all day.
Follow these steps to participate in this discussion:
Describe two benefits of providing individual psychotherapy to Joel and to his wife.
Identify the themes with which you hypothesize Joel is struggling.
What would be the benefits of Joel attending group therapy for retired men?
How would intergenerational couple's therapy benefit Joel and Joan?

My Answer:
Subject: Week 8: Counseling Retired 65-Year-Old Joel and his wife Joan by Tony Astro Topic: u08d1 Case Analysis
Author: Tony Astro Date: November 30, 2008 8:17 AM

Joel is suffering from a mild depression brought about by a change of pace from previous 9-5 drudgery of being an executive “supervising” his employees in a large corporation into a slow and less pressure lifestyle. Not all and sundry reacts the same way to retirement, some will be looking forward to see a chance to relax or relief from the stress of working in a large corporation, particularly those who don’t have many perks and excitement of an executive.

For men, retirement is a concern that can affect the very essence of their lives. A large number of men derive an almost singleminded identity from their work. Many develop no diversified interests outside their employment and are caught up in a narrow definition of who they are and what they are worth as people. Work and life become so interconnected that the loss of a job can eliminate the reason for living (Butler, Lewis, & Sunderland, 1998).

Now what Joel needs is to refocus out of his previous lifestyle to his new life and to “seize the day” of being at home enjoying other activities other than “supervising” as the executive boss of Joan so Joan can find more time for herself. Counselors need to help Joel reevaluate his transition through individual psychotherapy. Joel and Joan must first admit to the counselor of having some type of psychological concern and intends an answer. The counselor will conduct an individual therapy for the first session through narrative or 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).

A narrative or life review counseling would be a very appropriate technique to know and bring out questions and answers individually like:
1. What are the things you miss being an executive? (Question for Joel)
2. Is there any activities you have done in the past 5 years that helped you not to feel depressed? (Joel)
3. When and how did you feel that Joel don’t understand you or you feel like he supervises you like one of his employees? (Joan)
4. Have you tried doing something fun together since you (Joel) retired? (Both)

Counselor would also propose to have Joel and Joan try to write down their daily events either through a journal for their own exclusive readings. Have them individually review anything they write and observe themselves and get back to the counselor for a follow-up.

Davis and Degges-White continues on their studies: Comparing participants' earlier writings with their later writings and asking participants whether they thought the life review activities improved their ability to view themselves gave a more comprehensive perception.

Davis and Degges continues in their research: Overall, the participants viewed the activity as one that provided personal analysis rather than pure description of past activities or relationships. They generally believed, they did deepen their understanding of themselves, and they felt that looking back did provide 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).

Joel and Joan is going through a transition and together, they should be counseled as a couple and also within a group of an adult who is going through similar circumstances as they are who has an impact in their individuality.

Adults continuously experience transitions. Adults’ reactions to transitions depend on the type of transition, the context in which it occurs, and its impact on their lives. A transition has no end point; rather, a transition is a process over time that includes phases of assimilation and continuous appraisal as people move in, through, and out of it (Goodman 2006).

Transition counseling through individual and group is a process that they both must go through formal counseling. Also would advise Joel and Joan to have activities together and join a group like the Association of Retired Americans and other local community group of seniors or couple. This will keep Joel’s mind out of his previous lifestyle and transitioning both of them towards being a normal couple and they may see this through other people in a group including inter-generational.

In groups, clients have opportunities to hear about a variety of sources of support and coping strategies used by others. When we ask adults what has helped them survive, we most often hear about a sense of humor, support from special people, and faith (Goodman 2006).

Butler, R. N., Lewis, M. I., & Sunderland, T. (1998). Aging and mental health: Positive psychosocial and biomedical approaches (5th ed.). Austin: Pro-Ed, Inc.

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.

Goodman, Jane. Counseling Adults in Transition : Linking Practice with Theory (3rd Edition). New York, NY, USA: Springer Publishing Company, Incorporated, 2006. p 53 and p 250

Last edited on: November 30, 2008 8:24 AM

Marriage Counseling Case

Margaret and Jonathan have been seeing you in couples counseling for 5 months. One of the issues that they have been in sharp disagreement about is Jonathan's mother, Ellen, who has lived with them for 2 years. Margaret has assumed more of the care over the past year, because Jonathan's job requires that he travel each week. There are two teenage children in the home—one is a senior in high school and the other is in the tenth grade.
Margaret and her mother-in-law get along well enough, but the original agreement when Ellen moved in was that she would only stay for 1 month until she found a place of her own. Since that time, Ellen fell, broke her hip, and became very depressed. In the last session with Margaret and Jonathan, Margaret informed her husband that unless Ellen moved out, she would file for divorce. This was stated in the last 5 minutes of the session, right before she stormed out of the room. As you review your notes, you begin to plan how to conduct the next counseling session, which both agree to attend.
Answer the following questions:
What are the key issues you will address?
What strategies will you use to acknowledge each partner's struggle with Ellen?
What do you hypothesize is Ellen's role in this couple's dilemma?
What is the effect of this family's struggle on each adult and the children?

My Answer:
First of all before this counselor take the responsibility of becoming a marriage counselor must seek advice on someone who has a level of expertise on marriage and divorce.

Mental health counselors who offer couple and family counseling are obliged to deliver only those services they can provide competently. The American Counseling Association (ACA), one of its divisions, the International Association of Marriage and Family Counseling (IAMFC), and the Council for Accreditation of Counseling and Related Education Programs (CACREP) view couple and family counseling as a specialty area within the profession of counseling. Counselors providing couple and family services are expected to have professional counseling competence as a foundation for couple and family counseling competence (Welfel, 2001).

Otherwise, playing the role of a marriage counselor, both must agree during the initial session to get the counseling and accept the fact that two individuals are in crises, solution must take place and Divorce is not the only solution. The issue is how both Margaret and Jonathan can come out with a solution without compromising their marriage and their relationship with Ellen both as mother, mother-in-law and grandmother to their children.

Ellen’s unexpected health condition became a burden to the family and it is expected that now that both have to suddenly have to take care of three people. It is unexpected that this sudden responsibility will create conflict to the marriage of Margaret and Jonathan including their children. Divorce is not the solution.

Another major issue that should be address is Ellen’s depression. Both have to accept the fact that depression is not normal and must be look upon by family members. Being the mother of Jonathan, they will be both responsible for her well-being.

According to the Epidemiologic Catchment Area Study (ECAS) sponsored by the National Institute of Mental Health (U.S.) in the 1980s, depressive symptoms occur in approximately 15 percent of people over sixty-five years of age. At least 3 percent of elderly people suffer serious depression, especially those who reside in nursing homes, where the rate of depression approaches 15 to 25 percent (Ainstworth, 2000)

Although Ellen is the responsibility of Jonathan (assuming he have no other siblings and father), his next alternative is to find a nursing or adult-care residence that will accommodate Ellen for the time being. During this process, Ellen must know that this is a “trial” basis while her son and daughter-in-law mend their issues and possibility of divorce. Like most changes, this may be unacceptable at first to Ellen and may even aggravate her depression.

Late-life depressions may involve withdrawal from previous social, hobby-related, and recreational pursuits because the elder has lost interest or does not have the energy. Self-neglect may result in the depressed older person putting less emphasis on personal appearance and hygiene, as well as loss of interest in cooking and eating, with subsequent weight loss (Ainsworth, 2000).
If Ellen is eligible for Medicare, she may draw the additional expense there for accommodation of her new home and maybe for 1 or 2 years, she may return to move back to Jonathan / Margaret

This solution is not perfect but it will save a much vital issue: Divorce - which may possibly cause depression for Jonathan, Margaret and the 2 children. The couple and Ellen has to make a hard choice: another environment and additional expense for Ellen versus the damage of Divorce.


Ainsworth, P. 2000. Understanding Depression: Understanding Health and Sickness Series, Publication: Jackson, Miss. University Press of Mississippi.

Welfel, E. R. and Ingersoll, R. E., 2001. The Mental Health Desk. New York John Wiley & Sons, Inc. (US)

Last edited on: November 18, 2008 11:31 PM

Treatment Center Drop Out Rate

At the Center, you have recently conducted an audit of treatment outcomes as part of the continuing quality improvement effort implemented 18 months ago. You note that the treatment drop out rate has gone up significantly since last December. You decide to investigate.
Identify factors that you would hypothesize are responsible for the increased drop out rate. Describe factors that relate to patient characteristics, counselor characteristics, reimbursement system characteristics, and any other potential reasons that would explain this change. Limit the total number of

1. Overall mediocre quality care. Patients will notice in the short or long run how the Center is being run from treatment by counselors to facilities. Quality improvement should be a priority, and principles and methods of improving quality should be adopted.

2. Cultural Incompetence. Diversity and ethnic education should be part counselors agenda when handling patient on a daily basis.

Racial and ethnic minorities frequently lack access to culturally appropriate care. In the effort to create smaller and more efficient provider networks, there is a risk of eliminating providers and groups who have special expertise with different cultures and different healing practices (e.g., Afrocentric counseling and Spanish-speaking services, sweat lodges for Native Americans, and American Sign Language services for individuals who are deaf). Often, the reason given for exclusion of cultural practices is that accepted evidence of effectiveness does not exist. The committee observes, however, that controlled trials or other outcomes assessments have not been done for many, if not most, medical treatments (Institute of Medicine Staff, 1997).

3. Underestimating the scope of the issues. When client or patient approaches a counselors, it should not be taken lightly nor ignore other possibilities of the problem.

Although the stigma associated with seeking treatment for mental or addictive disorders is a significant factor in masking the scope of these problems by keeping them “in the closet,” the unusual fragmentation of these sectors of care is also part of the problem. A first factor is that, unlike most other health conditions, separate publicly managed health care systems are maintained for mental illness and substance abuse treatment (Institute of Medicine Staff, 1997).

4. Lack of Knowledge. Many counselors may stop learning when they reach their level of "in"competence. Counselor should be open to learning and accept the fact that not all information can be limited.

One major consequence of this limitation is the lack of the more enduring, intensive relationship of treatment personnel and patients, which can be an important source of data about the older person as well as a check on one’s evaluation of him or her (Butler, 1998)

Butler, R., Lewis, M., & Sunderland, T. (1998). Aging and Mental Health: Positive Psychosocial and Biomedical Approaches. Austin, TX: Pro-Ed.

Institute of Medicine Staff (1997). Managing Managed Care: Quality Improvement in Behavioral Health. Washington, DC, USA: National Academies Press, 1997. Retrieved on 14 November 2008 at:

Top Ten Advise for an Intern Counselor

Communication is the underlying key to becoming a good counselor. It is talking and listening about the issues to and from the patient and finding the solution.

Chapman notes the following qualities or personal traits of a successful counselor: patient, perceptive and sensitive, likes people, non-threatening demeanor, sense-of-humor, desire to help, positive attitude, good listener, warm personality and a problem solver (Chapman, 1993)

Most counselors have different views about the ideal counselor based on our experience or maybe image of each person. When counseling interns, they must be mentored (not only tell them how to counsel because personality is a big factor in counseling) and be given the goal of doing the best to help and improve the wellness of every individuals, couples and families in the Senior Center as follows:

1. All counselors must show Empathy. Clearly empathy and facilitation skills are critical for the successful leadership of nearly any enterprise. Employees at every level want to be respected, heard, and treated with dignity, and that is the very essence of the counseling relationship. These highly developed counseling skills are tremendous assets to the leader/manager of any enterprise, but especially a counseling organization (Herr, 2005).

2. Counsel on the right time and on the right place. To have a successful counseling session, both parties need to be relaxed and comfortable so that communication is free and easy. It is most difficult to select a time that is ideal and pressure-free for both parties. When the chips are down, the counselor should make the major adjustment. In other words, select the best time for the person being counseled because nothing will go right when the person who has the problem is on edge because the timing is wrong (Chapman, 1993, p 31).

3. Although most of the patients in this particular case are seniors, they are still diverse and have differences and so choose the right technique or be flexible in your manner of counseling. When it comes to counseling, techniques are useful but simple ways of helping others reach elegant solutions to their problems or opportunities. Techniques are tools to facilitate communication. Dozens of techniques make up the counseling process. Some will fit into your personal comfort zone. Others will not. When you have discovered and woven certain techniques into your behavior, you will have created your counseling style. It is the purpose of this book to assist you in doing this. Your counseling style will include everything from the tone of your voice to the process you follow— how you start, how you end, and how you lead the counselee to his or her solution. Whether your style becomes effective may not be measurable because a counselor can seldom get long-term feedback on the final results of the communication that took place. (Chapman, 1993, p 34).

4. Don’t over work or take some time off and ensure that personal wellness is taking care of.

5. Seek advice from another counselor if it’s needed especially if client is starting to become unmanageable.

6. Maintain trust and integrity - always.

7. Have sincere desire to help at all time.

8. Have a sense of humor.

9. Constantly have a positive attitude.

10. Less talk and more ears. Always be a good listener.

Raabe, in Issues in Philosophical Counseling asserts that (Counselor) has a duty to take time off from counseling practice for the purpose of both professional development and personal well-being, she has the duty to seek counseling for herself if the need arises, and she has the duty to refuse to work with a client who is hostile, abusive, controlling, or manipulative, or who purposely sabotages the counseling process. The necessary element of trust in a counseling relationship means not only that the client must be able to trust that the counselor has the sincere desire to help, but also that the counselor must be able to trust that the client has the sincere desire to be helped (Raabe, 2002).


Chapman, E. N. Personal Counseling: A Practical Guide That Teaches Basic Counseling Skills. Boston, MA. USA: Course Technology Crisp, 1993. p 18 and p 31. Retrieved on 14 November 2008 at:

Herr, E. L. Professional Counselor as Administrator: Perspectives on Leadership and Management of Counseling Services across Settings. Mahwah, NJ, USA: Lawrence Erlbaum Associates, Incorporated, 2005. p 325.

Raabe, P. B. Issues in Philosophical Counseling.Westport, CT, USA: Greenwood Publishing Group, Incorporated, 2002. p 218.

Last edited on: November 15, 2008 9:38 PM

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