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This paper examines the responsibilities of mental health professionals, particularly counselors, to those who identify or might be identifiable as “transgendered.” There are two main objectives. The first is to describe the critical reflection necessary to deal with gender-variant clients in an ethical and effective manner. The second is to discuss a psychotherapeutic model that is likely to be effective in integrating such reflection into the clinical process, and to make counseling recommendations on that basis.

Fascination with the twin bond has gripped cultures all over the world for millennia (Bryan, 1983). Although only approximately 3% of the total general population are twins, those who are twins have imbued twin relationships with expectations of extreme closeness, magical understanding, private languages, individual's fantasies of having another self(Bank & Kahn, 1982; Center for Disease Control [CDC], 2000). In 2000, the number of surviving individuals resulting from multiple births was 125 million worldwide. Equal fascination with the severing of this mystically strong bond seems like a foregone conclusion. Yet, strangely, a paucity of research has been conducted to investigate how twins cope with the death of a co-twin. Because the number of multiple births continues to increase, due to the use of fertility drugs and women waiting until later life to give birth, the likelihood of counselors encountering surviving members of a twin loss is growing. Women who wait until later life to conceive are at higher risk for conceiving multiple fetuses due to the irregularity of ovulation (i.e., as women age, the chances of both ovaries developing a follicle and both releasing these follicles during ovulation increases) as well as the increased need for fertility drugs to assist in conception. Counselors working with the bereaved surviving twin (or other surviving siblings in higher order births) need to understand the unique aspects of the twin relationship and resulting complicating factors for the grief process. Therefore, the focus of this article will be on the unique bereavement experience of the "twinless twin," the ways in which patterns of identity development affect the severity and nature of this grief, and implications for counseling the survivor. Overview Identical twins, more scientifically referred to as monozygotic (MZ) twins, are formed when one fertilized egg, or zygote, splits into two eggs, leading to the formation of two babies who share 100% of their genetic material (Bryan, 1983). Fraternal, or dizygotic (DZ) twins result when two separate eggs are released and fertilized by two separate sperm. This process results in two babies who share as much genetic material as singleton siblings, which is only about 50% of the genetic material (Segal & Ream, 1998). In the United States, 3% of all live births result in twins (CDC, 2000), making 6% of all babies who are born alive, twins. Throughout the world, rates of MZ twins are roughly the same (about 3 to 4 per 1,000 births), whereas rates of DZ twins are highest in Nigeria and lowest in Japan (Bryan, 1983). It is well known that MZ twins occur randomly, whereas DZ twins seem to run in families (Bryan, 1983; CDC, 2000), although some research suggests that these patterns may be more complicated than were initially thought (Segreti, Winter, & Nance, 1978). Stories, stereotypes, legends, and fantasies surround the mystery of twinship, but the general public's understanding of twins often ends with this fascination (Noble, 1983). Being a twin, and experiencing what Schave and Ciriello (1983) termed the twinning bond, carries both advantages and liabilities. For example, the intense closeness that comes to play a central role in the lives of twins (Wilson, 1995) can provide some protection against loneliness, easing the pains of adolescence (Pector, 2002) and, according to one study, serving as a deterrent to suicidal behaviors. A further example to illustrate the potential negative impact of the twin bond could be that research finds that the bond can also impair social relationships (Pector, 2002), increase the risk of academic delays due to circumstances such as "twin language" slowing development of appropriate communication skills (Pector, 2001, 2002), lead to difficulties with inequality (Woodward, 1988, 1998), and result in delayed individuation (Engel, 1975; Schave & Ciriello, 1983). Perhaps the most interesting consequence of the twin bond, and the most relevant to the issue of twin bereavement, is the fact that twins tend to form their identities along patterns distinct from those of singletons. …

Wendy is a 37-year-old mother of three who is attempting to complete her associate's degree at the local community college. She is seeking guidance from Vocational Rehabilitation Services because she is having difficulty arriving to class on time and finishing her homework assignments. She has relied on amphetamines and other narcotics in the past to help her concentrate and decrease her anxiety level; however, after an arrest for drug possession she was ordered by the court to enter into a substance abuse program. Wendy admits that she has been addicted to drugs for several years but "speed" helped her sustain attention and remain on task. She describes her elementary and high school years as "complete chaos." When she was able to concentrate, she would do well in class and successfully complete her assignments. However, she usually fidgeted in her seat, talked excessively during class, bothered other students, and frequently ended the day in the principal's office. Rather than provide her with strategies to help her retain information or develop healthy peer relationships, Wendy's teachers, elementary and high school counselors, and parents dismissed her as a hopeless "space cadet," "day dreamer," and "class clown." Despite Wendy's inability to sustain attention, she scored in the above-average range on an intelligence test and on a reading, math, and written expression achievement test. Nevertheless, her impulsivity, anxiety, and hyperactivity contributed to the development of a pattern of substance abuse. Wendy has not been able to sustain vocational employment or complete some college courses since she left high school. At present, she is hoping the rehabilitation counselor can provide her with the proper coping strategies to deal with the pressures of postsecondary education, the work environment, and life's daily challenges. The proceeding case example is just one of many that could be cited in which the individual was not identified early in her or his educational career as having attention-deficit/hyperactivity disorder (ADHD), and thus no interventions were developed to assist her or him in learning successful strategies to cope with the disorder. Counselors, particularly school counselors, have the skills and knowledge to assist in the identification of individuals like Wendy and to help them develop the skills necessary for success in high school and in the transition from high school to postsecondary education or entry into the workforce. The earlier an individual's ADHD is identified and comprehensive intervention plans are developed (which would include parents, teachers, counselors, and the child) the higher the probability that the individual will be successful in school and vocational pursuits. OVERVIEW OF ADOLESCENT AND ADULTHOOD ADHD Obviously, the previous case example illustrates an adult with undiagnosed ADHD who could have lived her life more successfully if she had been properly diagnosed and provided with necessary strategies to make healthy decisions. According to a commonly held perception of an individual with ADHD, people with hyperactivity are young children who are unable to remain seated in their desks. It is also commonly believed that these "restless" children are frequently referred by the parent or classroom teacher for a psychological evaluation, diagnosed with ADHD, and then treated "differently" by elementary school counselors, school psychologists, exceptional children's resource teachers, and parents to help the child "overcome the condition." More important, it is mistakenly believed that when these same children approach adolescence and young adulthood, they will grow out of the hyperactivity and perform well in high school, postsecondary education, social relationships, and the work environment. Recently, the image of the young child who is too hyperactive to sit still in the classroom has been recast. The following information has begun to circulate throughout the mental health profession: ADHD does not necessarily lessen or disappear upon completion of elementary school, ADHD afflicts girls as well as boys, and ADHD can linger throughout adulthood (Jaffe, 1995). …

Counselors working with older adults may encounter situations that are not directly addressed by the ethical standards of the American Counseling Association (1995). After an extensive review of the literature, the Standards Committee of the Association for Adult Development and Aging (1998) identified 3 areas of concern: older adults with cognitive impairments, older adults who are the victims of abuse, and older adults with a terminal illness. This article examines the unique needs of older adults with these concerns and proposes guidelines for counselors working with such clients.

The purpose of this study was to develop, implement, and evaluate a psychoeducational group intervention that addressed the needs of adult children caring for aging parents. The intervention consisted of four 2-hour sessions and included 70 care givers, 54 to 72 years of age, who were currently caring for a parent 60 years of age or older. A delayed-treatment, control-group design with follow-up after a 4-week interval was used to study three primary variables identified through an extensive literature review as essential for care givers. These included knowledge, care giver burden, and skill development. Skill development did not change following participation, nor did care giver burden variables measured. Significant increases were found at the .05 level for knowledge, overall coping resources, and self-disclosure following group participation.