Search

Nonsuicidal self-injury (NSSI) is widely considered to be a form of emotion regulation. Experiential approaches generally address the here and now rather than the past or the future, and they focus on clients processing emotions and behaviors in the current moment. There are a number of experiential techniques that may be helpful when counseling those who self-injure. Expressive arts activities (e.g., visual arts, music, dance, writing, and drama) may be helpful techniques to use in facilitating experiential awareness when counseling those who self-injure. Additionally, guided imagery is a system of visualization that may be used to promote relaxation and allow clients to imagine a future that does not include NSSI. Experiential therapies that focus on relationships are well suited for NSSI. Emotion-focused therapy addresses insecure attachment patterns and increasing emotional regulation. Accelerated experiential dynamic psychotherapy (AEDP) is helpful in addressing trauma and dissociation; clients mindfully reflect on the present moment and make healthier choices in real time. Enhancing self-compassion in those who use NSSI may also be helpful. Additionally, mindfulness techniques may facilitate emotion regulation and promote acceptance and change. The emotional freedom technique (EFT) blends cognitive therapy, behavioral exposure, and acupressure to help clients reprocess their thoughts and feelings. Eye movement desensitization and reprocessing (EMDR) is a therapeutic approach to help clients work toward changing maladaptive thoughts. Resource development and installation (RDI) is a method for clients to recognize adaptive coping mechanisms and put them into practice.

This chapter will explore best practices among school counselors for advocacy, prevention, and intervention related to addressing self-injury. In this chapter, the functions and purpose of Self-Injury (SI) will be explored, along with the relationship between SI and suicidality, and potential complications of SI. Ethical and legal issues associated with SI, including special considerations from the American School Counselor Association (ASCA), will also be addressed. Next, warning signs and risk factors for SI will be presented, and common myths will be discussed. Finally, the importance of collaborating with school personnel is highlighted, and best practices for school counselors working with students who engage in SI are provided.

Supervisors are responsible for protecting client welfare and for promoting counselor development. In order for counselor growth and development to occur, the supervisee must feel safe bein...

As the counseling profession evolves, educational standards for counselor licensure must be standardized from state to state. In this article, the authors discuss historical and current influences and present an advocacy model that has been used to standardize educational requirements in state counselor licensure laws.

Poverty has an impact on mental health and the counseling process in profound ways; however, counselors may fail to recognize the importance of poverty in clients' lives. The authors propose a model to help counselors navigate the complexities of counseling clients who are living in poverty. The I-CARE Model may help counselors develop insight about personal biases, acknowledge harsh realities of poverty, remove barriers to growth, and expand on the clients' own strengths. La pobreza tiene un profundo impacto sobre la salud mental y el proceso de consejeria; sin embargo, es posible que los consejeros no reconozcan la importancia de la pobreza en las vidas de sus clientes. Los autores proponen un modelo para ayudar a los consejeros a comprender las complejidades de los clientes que viven en la probreza. El Modelo I-CARE puede ayudar a los consejeros a desarrollar su percepcion de sesgos personales, reconocer las duras realidades de la probreza, eliminar barreras al crecimiento y ampliar las fortalezas de los clientes.

Many professional counselors will experience the loss of a client to suicide. The effects of this loss are explored in this article. The supervisor’s role in supporting a supervisee after a client’s suicide is presented. Additionally, creative interventions that can be used by supervisors to support supervisees after the loss of a client are provided. These creative techniques are theoretically grounded within the cognitive behavioral, solution-focused, and narrative paradigms.

Schools have a demonstrated need for student non-suicidal self-injury protocols and school counselors play an important role in the development and implementation of such procedures. This article presents an overview of school counselor considerations related to developing and implementing a self-injury protocol. It provides an example of a comprehensive school counseling protocol for addressing student self-injury, including a sample safety plan. The authors present a case study application and discuss implementation considerations.

The purpose of this investigation is to study the relationship between types of bullying and victimization and problematic behaviors, which include both internalizing and externalizing behaviors. S...

Hoarding disorder (HD) is a newly added mental disorder in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013). In this article, the symptoms, characteristics, and features of HD are described, along with diagnosis and assessment strategies. The most efficacious treatments for counseling clients diagnosed with HD are also discussed.

The purpose of this study was to identify factors that may protect or insulate people from engaging in nonsuicidal self-injury (NSSI). College students (N = 14,385) from 8 universities participated in a web-based survey. Results of bivariate correlations and multiple regression revealed that spirituality/religiosity, life satisfaction, and life meaning were predictive of NSSI. The authors provide practice suggestions for college counselors and other professionals charged with helping those at risk for NSSI. Keywords: nonsuicidal self-injury, spirituality, life satisfaction ********** Nonsuicidal self-injury (hereinafter referred to as NSSI or self-injury) is the deliberate act of physically damaging one's own body tissue without suicidal intent, usually by cutting, burning, or hitting oneself (International Society for the Study of Self-Injury, 2007). The most common method of NSSI is cutting, although most individuals tend to report engaging in at least two different forms of NSSI (Klonsky, 2011). It is estimated that 6% of adults, 15% of college students, and 21% of adolescents have engaged in NSSI at least once during their lifetime (Whitlock, Eckenrode, & Silverman, 2006; Whitlock et al., 2011), with the first episode of NSSI usually occurring during adolescence (Whitlock et al., 2006). Self-injury may lead to multiple complications and risks, with the behavior sometimes becoming more severe over time and possibly resulting in unintentional harm that requires medical attention (Hankin & Abela, 2011; Whitlock et al., 2006). People who self-injure may also be at an increased risk for suicide attempts (Whitlock & Knox, 2007; Whitlock et al., 2012). Anxiety, depression, eating disorders, substance abuse, and borderline personality disorder often co-occur with NSSI (Goldstein, Flett, Wekerle, & Wall, 2009; Gollust, Eisenberg, 8c Golberstein, 2008; MacLaren 8c Best, 2010; Whitlock et al., 2006). A history of childhood neglect, emotional abuse, or sexual abuse is also common among those who self-injure (Glassman, Weierich, Hooley, Deliberto, 8c Nock, 2007; Whitlock et al., 2006). The ostensible increasing prevalence of individuals who self-injure combined with the potential for serious physical harm and suicide (Whitlock 8c Knox, 2007) suggests that an understanding of factors that mitigate the risk of self-injury is important to college counselors who regularly engage in prevention and intervention efforts. Spirituality and religiosity are two constructs that have received attention in the literature as being potentially protective in buffering people from various mental health problems (Fallot, 2001). Spirituality is a general belief of an experience beyond human awareness or a belief in a specific higher power, whereas religiosity refers to formal belief systems and participation in religious institutions (Fallot, 2001). The constructs of spirituality and religiosity are difficult to differentiate (Fallot, 2001). Contributing to the difficulties in distinguishing religiosity from spirituality is the fact that spiritual beliefs are often shared by a group, whereas religion, by definition, includes a belief and a relationship with a higher power. Further overlapping the two constructs, spirituality and religiosity both include beliefs about the meaning and purpose of life (Fallot, 2001). In this study, because we are interested in the shared constructs of life meaning and life purpose, we use the terms spirituality and religiosity together. If there is a reference made to religion or spirituality per se in the literature review, the constructs studied in the said investigations were specifically referenced. Spirituality/religiosity can provide individuals with an adaptive means of understanding and experiencing life, as well as facilitating their ability to make meaningful connections with life experiences (Fallot, 2001). Research on the benefits that spirituality/religiosity provides in insulating people against mental health problems (e. …

Regulatory board-sanctioned supervision is intended to enhance the practice of disciplined counselor licensees and to protect the public. A qualitative research design was used to assess the perceptions of four supervisors who provided board-sanctioned supervision. The themes greater board-generated communication and ethics-related considerations were identified. Suggestions for state counseling regulatory boards are discussed.

In this article, a creative termination activity grounded in relational-cultural theory is presented. In addition to providing a means for summarizing the counseling experience, this activity promotes relational development in the midst of client termination. Following implementation of the activity, the client and counselor are provided tangible, co-constructed gifts that are symbolic of the therapeutic relationship and relational growth. The authors provide a rationale for how this intervention promotes self-awareness, outline directions for implementation, and provide a case illustration to demonstrate how counselors can help promote relational closure and solidify clients’ therapeutic gains.

The contributions of Thomas J. Sweeney to the counseling profession through professional leadership and advocacy, scholarship, teaching, and the development of Chi Sigma Iota are chronicled through a personal interview and comments from professional colleagues. Readers are provided with a sense of the depth and breadth of his more than 50 years of dedicated service.

This meta-analysis concluded that counseling and psychotherapy generally have a small to medium effect in treating anxiety in school-aged youth for termination (waitlist [k = 55;n = 2,959]d = .60[.52- .68]; placebo [k = 14;n = 867]d = .57[.42- .72]; treatment-as-usual [k = 10;n = 371]d = .32[.14- .50]; single group [k = 39;n = 889]d = .42[.37- .48]; and followup (waitlist [k = 22;n = 1,059]d = .51[.39-.63]; placebo [k = 2;n = 154]d = .73[.42-1.03]; treatment-as-usual [k = 9;n = 327] d=.21 [.02-.44]; single group [k = 36;n = 788]d = .58[.51- .65]). The findings of 80 clinical trials were synthesized using a random effects model for mean difference and mean gain effect size estimates. No effects of moderating variables were evident. Implications for counseling practice and future anxiety outcome research are addressed.

The authors present the argument that professional counseling is philosophically grounded in humanism. As evidence, 5 major presuppositions of professional counseling--relationality, development, empowerment, wellness, and social justice--are situated as fundamental to the understanding of humanism. These tenets are presented as a foundation to ground professional counselor identity as humanistic, and thus position humanism as synonymic with professional counseling. Keywords: humanism, humanistic, professional counseling ********** Historically, scholars and theorists have positioned the humanistic philosophy as the third force of counseling, situated between behaviorism and multicultural counseling. However, humanism can arguably be best understood as a metaparadigmatic framework that guides the identity and the enactment of the professional values of counselors. The synonymic nature of professional counseling and humanism emerges from the emphasis counselors place on relationality, development, empowerment, wellness, and social justice. These five tenets of professional counseling ground our professional identity in humanism and provide the foundation for presuppositions that guide our work as counselors. Across this article, the aforementioned five presuppositions will be presented to elucidate how humanism is a metaparadigm that is synonymous with the values of professional counseling. Essential to a professional counseling identity is the value of relationships, a developmental perspective of growth and change, a holistic wellness paradigm, and a commitment to client empowerment through social justice (Carney, 2007; Chung & Bemak, 2012; Day-Vines & Holcomb-McCoy, 2007; Myers & Sweeney, 2005; Perepiczka & Scholl, 2012; Seccombe, 2002). Therefore, professional counselors can be seen as nurturers of relationships, wellness, development, and social justice, and as contributing to the foundational aspects of the existence that emerges through the enactment of humanism. Humanism has often been presented as a way of being (Rogers, 1961) and as a way of becoming--or evolving--into one's ideal self. At its core, professional counseling is grounded in a humanistic paradigm. While introducing us to the I and thou, Buber (1970) extrapolated the difference in personal attitude toward the individual versus an object. In doing so, he revealed a fundamental value of professional counseling: a foundational attitude toward individuals as a relation between, and to things as a connection with objects. According to Buber, these attitudes represent the basic twofold situation of human life, in which the relation to thou knows no bounds, whereas a relation to it or to object has bounds. From a professional counseling viewpoint, a comprehensive understanding of human behavior involves consideration of growth and developmental transitions. According to Vontress (1996), people, including professional counselors, are trying to make sense of life and in this quest develop a philosophy of existence. Within the philosophy of the professional counselor, the ideal is to assist the client in making meaning of existence in the context of growth and developmental transitions. The counseling profession's emphasis on human growth and development is demonstrated through action, education and training, and scholarship. In terms of action, professional counselors view growth and development as a normative process in which each individual engages via social, contextual, and ecological environments, which are grounded in culture, history, and experience; these aspects relate to, and provide the rationale for, social justice as an important aspect of both humanism and counseling. Professional counseling is grounded in two critical tenets of humanism: the individual is always in a fluid state of development, and the awareness that we as humans cannot be reduced to a series of parts (M. …

With the advent of the DSM-5 in 2013, the American Psychiatric Association eliminated the longstanding multiaxial system for mental disorders. The removal of the multiaxial system has implications for counselors’ diagnostic practices. In this article, the removal of the multiaxial system in the DSM-5 is discussed, and counselor practice suggestions related to each of the five Axes are provided. Additionally, ways in which counselors can sustain their current diagnostic skills while developing updated practices that align with the new streamlined system will be discussed.

In this article, the authors present guided imagery as a technique for use in teaching counselor trainees how to use the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) in a way that is sensitive to contextual issues and counselors’ personal biases. Specific guided imagery activities and scripts that can be used in teaching DSM-5-related concepts are provided. Guided imagery can facilitate the development of counseling students’ skills in the areas of case conceptualization, cultural empathy, self-awareness, and objective diagnostic decision making. Guided imagery scripts can enhance counselor trainees’ multicultural competencies as related to the diagnostic process. Practical considerations related to using the technique are provided.This column is designed to underscore relationally-based creative teaching practices used by counselor educators in the classroom. Our intention is to provide examples of novel, innovative ways for counselor educators and students to deepen their ...

In this article, the authors present a rationale and a means for utilizing creative rituals with traumatized adolescents. For adolescents who have experienced trauma, creative rituals can be utilized to help reorient their cognitive and emotional selves to the external world. Examples of two creative rituals that can be used in helping clients externalize trauma narratives are provided. Additionally, a discussion of the adaptations of these activities and the limitations of utilizing these interventions are provided.

Oppositional defiant disorder (ODD) involves patterns of negativistic, defiant, disobedient, and hostile behavior toward authority figures that last for at least 6 months (American Psychiatric Association [APA], 2013). ODD is among the most prevalent and resource-demanding mental health problems for children and adolescents (Loeber, Burke, Lahey, Winters, & Zera, 2000), with 5% to 10% of children ages 8 to 16 years having notable ODD behavior problems (Fraser & Wray, 2008). Characteristics of ODD include persistent stubbornness and refusal to comply with instructions, unwillingness to compromise with adults or peers, persistently and deliberately testing limits, failing to accept responsibility for one's own actions and blaming others for one's own mistakes, deliberately annoying others, and frequently losing one's temper (APA, 2013). ODD has also been associated with excessive arguing, cognitive and social deficits, and significantly problematic adult-child and child-peer interactions (Greene et al., 2002). According to Finger et al. (2011), youth with ODD demonstrate high rates of aggressive and antisocial behaviors, with a subset displaying callousness and psychopathic traits, including a lack of guilt, empathy, and remorse. It is sometimes difficult to determine whether a child truly meets the criteria for having an ODD diagnosis because many of the behavioral qualifications are commonly seen among youth in early childhood and adolescence (Fraser & Wray, 2008). If a child's behaviors consistently cause distress to the family system and have an effect on his or her social and educational functioning, further evaluation is warranted. ODD has been linked to many other comorbid disorders, such as anxiety; depression; and, most commonly, attention-deficit/ hyperactivity disorder (ADHD; Biederman, Newcorn, & Feldman, 2007). Jensen et al. (2001) found that ODD occurred in 30% to 60% of children diagnosed with ADHD. ODD has historically been considered a male problem (Loeberet al., 2000), and the developmental factors that accounted for symptoms in girls were only partly understood (Hipwell et al., 2002; Messer, Goodman, Rowe, Meltzer, & Maughan, 2006). One study (Munkvold, Lundervold, & Manger, 2011) found that the impact of symptoms and the prevalence of ODD were higher in boys than in girls. Fraser and Wray (2008) found that girls were more likely to demonstrate symptoms after the onset of puberty, during the adolescent years, whereas boys more frequently showed symptoms in early childhood. The manifestation of ODD in boys also differed from the manifestation of ODD in girls in that boys were more likely to demonstrate physical aggression or threaten others (overt aggression), whereas girls were more likely to harm or disrupt relationships with others (Crick & Grotpeter, 1995), better known today as relational aggression. Individuals diagnosed with early-onset ODD were more likely to have been abused by their parents, drop out of school, engage in serious crimes, and have greater long-term involvement with the mental health system. Because ODD is such a serious and common disorder and is comorbid with other disorders, it is important to determine whether counseling and psychotherapy reduce symptoms in individuals diagnosed with ODD. Primary counseling strategies discussed in the literature include family interventions and individual and group counseling approaches with children and adolescents. Family interventions, especially parent training programs, have been empirically supported as efficacious (Lonigan, Elbert, & Johnson, 1998). Brestan and Eyberg's (1998) research indicated that families completing a parent training program achieved both short- and long-term treatment goals. In addition to their known effect on child conduct problems, parenting group interventions promoted both child and family competencies (Borden, Schultz, Herman, & Brooks, 2010). Participants in a study of self-administered videotape parent training reported significantly fewer child behavior problems, reduced levels of stress, and less use of physical punishment (Webster-Stratton, 1990). …

Professional counselors experience a range of emotional and personal demands, which can easily impact their quality of life and clinical efficacy. Creative engagement and expression may be effective in managing the impact of a career in helping. In this article, the authors present an overview of counselor self-care, including its applicability to the American Counseling Association Code of Ethics (2005) and the 2009 Council for the Accreditation of Counseling and Related Educational Programs standards. Strength-based, creative approaches to counselor self-care are provided and discussed.

Visual arts mediums such as drawing, painting, making symbolic objects out of materials, and collage can be translated into useful creative interventions when counseling clients who self-injure. Theoretical support and guidelines for using visual arts when counseling clients who self-injure are presented. Specific examples of visual arts interventions that can be useful with this population are provided.

This article presents guided imagery as an intervention that can be used to address clients' nonsuicidal self-injurious behaviors. Guided imagery is a behavioral therapy technique that involves the use of positive thoughts or images to regulate negative emotional experiences, and it can be used to prevent and manage impulses to self-injure. Examples of guided imagery scripts that can be used with those who self-injure are provided, as are recommendations for counselor practice.

Informed consent and confidentiality are discussed in the context of counselors' use of the DSM diagnostic system. Considerations that can facilitate counselor diagnostic decision-making related to informed consent and confidentiality are identified in a case application. Suggestions that can enhance ethical diagnostic practices are provided.

The purpose of this article is to present creative ways that chain analysis techniques, an intervention used in dialectical behavior therapy, can be used to address clients' nonsuicidal self-injurious behaviors. A description and rationale for using chain analysis techniques with clients who self-injure is provided. An illustrative case example is used to demonstrate the concepts discussed in the article.

Eating disorders are believed to be among the most lethal mental health diagnoses, with some estimates suggesting that 10% of people with anorexia nervosa will eventually die from complications associated with the disorder (Academy for Eating Disorders, 2010). The criteria for anorexia nervosa and bulimia nervosa are outlined in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association [APA], 2000). However, researchers have found that the symptoms experienced by most clients tend to fall under the eating disorders not otherwise specified diagnosis (Choate & Schwitzer, 2009; Schwitzer et al., 2008; Wilson, Grilo, & Vitousek, 2007). Some scholars have asserted that eating disorders have biological, sociological, and psychological origins, with the development and maintenance of eating disorders being linked to a variety of life experiences (Wilson et al., 2007). Some researchers have suggested that many people with eating disorders have suffered from various childhood traumas, including sexual abuse (Brewerton, 2007; Kong & Bernstein, 2009; Smolak & Murnen, 2002). Feminist interpretations of the origins of eating disorders focus on the contributions of gender roles; cultural variables; and issues of power, privilege, and marginalization in the development and maintenance of mental health concerns (Eriksen & Kress, 2008). As an outgrowth of feminist therapies, relational cultural theory (RCT) is a theoretical approach, which suggests that the need for connection and context, rather than individuation, is the foundation of development and is also central to understanding the disorders' etiology, maintenance, and treatment. RCT challenges traditional models of what growth looks like and has widespread implications for counselors' practice; its depathologizing perspective provides context to the many concerns that clients bring to counseling including issues of power, privilege, marginalization, stigmatization, belonging, and acceptance. Although relational approaches began by focusing on the unique psychological needs of women (Jordan, 2010), these approaches are now seen as increasingly relevant to male clients as well. RCT "hopes to better represent both women's and men's psychological experience as it seeks transformation of chronic disconnection into connection and empowerment of individuals of both genders and for society as a whole" (Jordan, 2010, p. 24). In this article, we provide an overview of eating disorders, followed by a brief discussion of the tenets of RCT. Finally, recommendations are presented for combining relationally focused counseling with evidence-based treatments for eating disorders via both prevention and individual counseling. * Prevalence of Eating Disorders A recent study on the prevalence of eating disorders reported that 0.9% of women and 0.3% of men reported having anorexia nervosa at some time in their lives, whereas 1.5% of women and 0.5% of men reported having bulimia nervosa (Hudsona, Hiripib, Pope, & Kessleb, 2007). Additionally, Hudsona et al. (2007) found that 0.5% of women and 2% of men reported having had binge eating disorder at some point in their lives. It is estimated that, at any given time, the number of girls and women reporting eating disorder symptoms may reach approximately 10% of the total population (APA, 2000). Although all individuals who have a complicated relationship with food may not meet the criteria for eating disorder diagnoses, their struggle with disordered eating is a real concern that may have an impact on their ability to function and may lead them to seek counseling (Academy for Eating Disorders, 2010). Historically, it was thought that rates of eating disorders were consistent among women in Western populations and that those in non-Western communities had far fewer incidences of these disorders. However, recent studies suggest that women of color are just as susceptible to eating disorders as their White counterparts are (Becker, Franko, Speck, & Herzog, 2003; Chamorro & Flores-Ortiz, 2000; Erickson & Gerstle, 2007). …

Counselors are regularly confronted with children and adolescents who reside in violent or potentially violent living environments. In this article, safety plans are presented as a tool that counselors can use to promote the safety of children living in unsafe family situations. Ethics-related counseling issues that should be considered when counseling children living in violent living homes are also discussed. A case example is provided to illuminate the presented concepts.

To describe basic nonsuicidal self-injury (NSSI) characteristics and to explore sex differences.A random sample from 8 universities were invited to participate in a Web-based survey in 2006-2007; 38.9% (n = 14,372) participated. Analysis assessed sex differences in NSSI prevalence, practices, severity, perceived dependency, and help-seeking; adjusted odds ratios for NSSI characteristics were calculated by sex status.Lifetime NSSI prevalence rates averaged 15.3%. Females were more likely than males to self-injure because they were upset (adjusted odds ratio [AOR] = 1.6; 95% confidence interval [CI] = 1.3-2.1) or in hopes that someone would notice them (AOR = 1.6, 95% CI = 1.1-2.7). Males were 1.6 times (95% CI = 1.2-2.2) more likely to report anger and 4.0 times (95% CI = 2.3-6.8) more likely to report intoxication as an initiating factor. Sexual orientation predicted NSSI, particularly for women (Wald F = 8.81, p ≤ .000). Only 8.9% of the NSSI sample reported disclosing NSSI to a mental health professional.NSSI is common in college populations but varies significantly by sex and sexual orientation. NSSI disclosure is low among both sexes.

Counselors frequently counsel clients who live in poverty. The authors describe the new CARE model that addresses the influence of multiple systems on poor clients' experiences. A social justice, humanistic intervention, the CARE model emphasizes cultivating a positive counseling relationship with poor clients, empathizing with their unique realities, and working to remove barriers to future success and well-being by building on their strengths. ********** A large proportion of the clients served by community mental health centers are individuals classified as working poor and those living in poverty (Gilens, 1999). Indeed, people living in poverty tend to be among the most marginalized and stigmatized people in the United States (Gilens, 1999). Despite the need this population has for counseling services, the values, expectations, and requirements for participating in counseling may be at odds with the needs of many poor people. This is often the case because most traditional counseling models are more consistent with middle-class values than with values exhibited by poor people in U.S. society (Gonzalez, 2005; Javier & Herron, 2002). People struggling to have their personal and psychological needs met may find that the services provided by community mental health centers in general and professional counselors in particular do not meet these unique needs, nor do they honor the myriad strengths that are commonly manifested by many poor persons in society. In this article, we introduce a model that is useful in conceptualizing effective counseling strategies for people living in poverty. The model is titled the CARE model, which highlights the need to cultivate relationships, acknowledge realities, remove barriers, and expand the strengths of poor clients. A unique aspect of this model is that it addresses the impact that multiple systems have on poor clients' lived experiences. This model emerges from a humanistic perspective that encourages the growth and the development of clients as outlined by the American Counseling Association's (ACA) Code of Ethics (ACA, 2005; Preamble and Section A, Introduction). Because the CARE model is developmental in its focus, it is grounded in the belief that people (a) are dynamic rather than static and (b) have an innate propensity to healthy growth and purposeful living (Sperry, 2002). Developmental perspectives are inherently humanistic in that they offer hope that a client's problems are not permanent and that positive change is always possible. Central to the humanistic and developmental perspective is the belief that people have the capacity to move forward, to change, to become empowered, and to ultimately attain wellness (Fitzsimons & Fuller, 2002). The ACA Code of Ethics (2005) mandates that counselors provide culturally and contextually sensitive and competent services when working with clients. Multicultural competence includes the recognition that it is important to understand and address broader societal influences when counseling clients in marginalized and devalued groups (Sue, Arredondo, & McDavis, 1992). Multiculturally competent counselors are also aware that persons with less power in society commonly experience a greater level of stress from multiple sources. These heightened stressors greatly increase poor people's biological predisposition and psychological vulnerability to various health problems as compared with individuals in more privileged and empowered groups (Belle & Doucet, 2003). Culturally sensitive, developmental, humanistic, and social-justice-minded counselors do not separate clients' difficulties from their sociocultural group experiences. Instead, these practitioners search for culturally competent and responsive ways to foster the health, well-being, and empowerment of persons living in poverty. MENTAL HEALTH AND THE CULTURE OF POVERTY The Diathesis-Stress Model predicts that life stressors may interact with genetic or physiological variables to cause various mental health problems (Barlow & Durand, 2005). …

The use of reused or recycled materials in counseling interventions provides counselors with an opportunity to use unique counseling mediums while simultaneously being socially and fiscally responsible. In this article, ways that reused or recycled items can be used in counseling are discussed. Practical suggestions for using reused or recycled items in counseling and specific creative interventions in which recycled materials can be used are provided.

This article presents a school counselling intervention that utilises letters written from the future. Few peer-reviewed articles have addressed the use of letter writing in a school counselling context, and none have focused on the use of letters from the future as a means of school counsellor intervention. The authors present a theoretical framework and specific guidelines for using letters written from the future in school settings. Case examples of letters written from the future are provided.

In this article, the authors present risk management considerations of which mental health counselors should be aware when counseling adolescents who engage in nonsuicidal self-injury. They address considerations related to self-injury and suicide, assessment and evaluation, countertransference, social contagion, and body privacy and make recommendations to minimize client and counselor risk while enhancing client care. Rachel M. Hoffman is affiliated with Meridian Community Care.

There are numerous ethical considerations inherent within the process of assigning a Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000) diagnosis. In this article, general ethics considerations such as informed consent and confidentiality, accuracy of diagnosis, and multiple relationships are examined as they relate to clinical mental health counselors' use of the DSM-IV-TR. The article concludes with the authors' suggestions for ethically sensitive diagnostic practices.

This article presents a review of creative interventions that can be helpful in facilitating the resolution of traumatic grief in children and adolescents. Traumatic grief is conceptualized as a condition in which a person loses a close loved one (e.g., a parent or a sibling) in a traumatic manner, and ensuing trauma-related symptoms disrupt the normal grieving process. The presented creative interventions will be conceptually linked to an evidence-based, cognitive behavioral treatment model that can be used in addressing traumatic grief. The creative interventions presented will include the use of writing, storytelling, drawing, commemorating, and ritualizing in relation to traumatic grief.

Professional development plans (PDPs) are contracts used to address problematic student behaviors in counselor education. The PDP can be used to systematically document and address (a) faculty expectations of the student, (b) specific behaviors required of the student, (c) tasks in which the student and faculty will engage to facilitate student success, and (d) consequences if the student does not successfully address the expected tasks and engage in the required behaviors. A sample PDP is provided, and practice suggestions are discussed.

The definition and measurement of counsellor trainee competency is an issue that has received increased attention yet lacks quantitative study. This research evaluates item responses, scale reliability and intercorrelations, interrater agreement, and criterion-related validity of the Professional Performance Fitness Evaluation/Professional Counseling Performance Evaluation, a measure used by counsellor educators to evaluate professional fitness. The results identified several scale items that were insensitive to substandard skill levels and indicated that university and site supervisors' trainee ratings did not agree. Both site and university supervisors did identify a majority of students demonstrating substandard skills, and when the site and university supervisors' ratings were combined, the supervisors identified 79% of the noncompetent trainees.

The authors advance motivational interviewing and the transtheoretical model of change as a conceptual framework for counseling clients who engage in nonsuicidal self-injurious behaviors. The major principles of motivational interviewing are applied in a case study of a client who self-injures. Recommendations are made for mental health counseling practice. Non-suicidal self-injury (NSSI), or self-injury (SI), is often defined as “a volitional act to harm one’s own body without intention to cause death” (YaryuraTobtas, Nezirogula, & Kaplan, 1995, p. 33). Although the relationship between suicide and SI is complex, the behavior is by definition discrete from suicide; it is an act intended to injure the body without causing death (Simeon & Favazza, 2001; Yaryura-Tobias, Neziroglu, & Kaplan). Examples of SI are selfcutting, self-burning, and deliberate self-hitting—behaviors generally considered intermittent, discrete acts of self-directed self-harm (Simeon & Favazza). It is estimated that 1%–4% of the general population and 21%–66% of clinical samples engage in SI (Darche, 1990; DiClemente, Ponton, & Hartley, 1991); there is evidence that prevalence rates are equally distributed among men and women in community samples (Briere & Gil, 1998). An average of 13% of high school students report having engaged in SI at least once (Ross & Heath, 2002), and one recent study of college students found the lifetime prevalence rate of college students having at least one SI incident was 17% (Whitlock, Eckenrode, & Silverman, 2006), suggesting that a significant number of adolescents and young adults self-injure. SI has attracted considerable attention in recent years, not only in clinical environments but also in a number of recent television episodes, movies, and

The purpose of this article is to present an intervention, the externalization of client problems, which can be used to address non-suicidal-self-injurious behavior. Specific externalization techniques are discussed, including naming the problem, letter writing, and drawing. A case application and implications for practice are presented. ********** Non-suicidal-self-injury (NSSI) is most concisely described as a volitional act of self-harm with the intent of causing physical tissue damage (Favazza, 1996). Yates (2004) elaborated on the definition of NSSI by describing this act as the direct and socially unacceptable destruction of body tissue, which occurs without conscious, intentional suicidal intent. Counselors who work with clients engaging in NSSI may struggle to determine the presenting problem, treatment goals, or appropriate level of care for current behaviors. Moreover, treatment paradigms may rely on the assumption that in order to effectively help clients with NSSI, the counselor must help the client to completely ameliorate the self-injurious behaviors. Another common assumption of most theoretical paradigms is the idea that the client must be taught (by the counselor) to apply cognitive and behavioral skills that will, theoretically, preclude further self-injury (Muehlenkamp, 2006). This prescriptive approach may fail to consider the unique strengths and contributions of the client and may serve to alienate the client by providing little opportunity for her or his perceived goals to be expressed and integrated into the counseling process. Given the ostensible value of a collaborative approach in facilitating therapeutic success (Eron & Lund, 1996), we present in this article a strength-based intervention (i.e., the use of externalizing techniques) that can be applied when counseling clients who engage in NSSI. OVERVIEW OF NSSI Research estimates have indicated that 21% to 66% of clinical samples and 1% to 4% of the general population engage in NSSI (Darche, 1990; DiClemente, Ponton, & Hartley, 1991). Prevalence rates appear to be equally distributed among men and women in community samples (Briere & Gil, 1998). In one study, 13% of high school students reported that they had engaged in NSSI at least once (Ross & Heath, 2002). One recent study of college students found that the lifetime prevalence rate of college students having at least one NSSI incident was 17% (Whitlock, Eckenrode, & Silverman, 2006), suggesting that a significant number of adolescents and young adults engage in NSSI. Osuch, Noll, and Putman (1999) suggested that the following six motivational factors underlie NSSI: (a) affect modulation, (b) desolation, (c) punitive duality, (d) influencing others, (e) magical control, and (f) self-stimulation. Affect modulation encompasses the use of NSSI to control (i.e., increase or decease) feelings and emotions. The concept of desolation describes using NSSI to alleviate feelings of emptiness and anhedonia. Punitive duality relates to the concept of self-punishment, or situations in which a person engages in self-inflicted violence because of the need to punish her- or himself. Individuals who use NSSI as a method for influencing others often engage in the behavior with the intention of communicating anger, hurt, or rebellion in a manner that does not involve verbally speaking of these emotions. Magical control involves the client believing that her or his self-injury will prevent something from happening or will control some unacceptable impulse or desire (i.e., preventing the client from hurting someone else). The last motivational category identified by Osuch et al., self-stimulation, involves the client engaging in NSSI with the intention of increasing emotional arousal (e.g., increasing a pleasurable, euphoric sensation). NSSI is a complex behavior. People who self-injure have a variety of mental health diagnoses (e. …

This article describes a solution-focused and Ericksonian group counseling model that can be used with adolescent girls who have been sexually abused. An overview of the components of this approach is provided. A postintervention focus group provided additional results and ideas for the future development of the group counseling model. ********** Current prevalence studies report that between 15% and 38% of females are sexually abused as children (Corey & Leslie, 1997; Finkelhor, Moore, Hamby, & Straus, 1997; Green, 1993). Furthermore, Kumar, Steer, and Deblinger (1996) indicated a 67% prevalence rate of sexual abuse among female adolescent inpatients receiving psychological/psychiatric care. Despite the prevalence and recognition that sexual abuse has serious psychological consequences, the treatment literature has offered minimal guidance in determining what treatment interventions are effective in supporting this population. The need for continued treatment efficacy research is clear (Saywitz, Mannarino, & Berliner, 2000). Many survivors of sexual abuse believe they are defective, damaged, or otherwise flawed (Courtois, 1988). After sexual abuse, survivors often blame themselves for the occurrence of sexual abuse, and they may struggle to build or rebuild a positive self-identity (Courtois, 1988). In the aftermath of sexual abuse, it is common for the survivors to struggle with a positive self-esteem and a sense of self-efficacy in managing and coping with life's struggles. An important treatment goal from any theoretical perspective is to help survivors of sexual abuse integrate the abuse experience while preserving their self-esteem (Courtois, 1988). Moving beyond a focus on the maintenance of self-esteem, in this article, we provide a model that is intended to actively highlight and help clients connect with their personal strengths and resources and facilitate their growth and development (Calhoun & Tedeschi, 2006). In the following section of this article, a brief review is provided of the research related to counseling sexually abused adolescents. A description of the tenets of a literature-based, group counseling model that focuses on client empowerment is discussed. To provide readers with information that may help them apply the model, the interventions associated with the presented group model are detailed. Finally, the results of a focus group used to assess the adolescent group members' perceptions of the group and its personal impacts are presented. COUNSELING ADOLESCENT SURVIVORS OF SEXUAL ABUSE: LITERATURE REVIEW Group counseling may best meet adolescents' developmental and therapeutic needs, and it is sometimes considered the intervention modality of choice when counseling adolescents (Corder, 2000; Gerrity & Mathews, 2006; Kruczek & Vitanza, 1999). According to Erikson (1959), adolescence is a time when one's primary tasks are to develop a sense of independence and autonomy from one's family while establishing a stable self-concept and identity. Groups provide a safe place for the adolescent to practice implementing his or her emerging identity while also facilitating the separation-individuation process and a subsequent increase in autonomy (Glodich & Allen, 1998). Consistent with the idea that adolescents need to separate from their families and develop into autonomous individuals, adolescents are more likely to accept feedback from peers than they are from adults, as is the case in an individual or family counseling context (Chaffin, Bonner, Worley, & Lawson, 1996). As it is true with other counseling groups, adolescents' feelings of isolation and being different from others can be decreased through interactions with same-age peers in a group setting (Glodich & Allen, 1998). Because adolescents identify with their peers, groups provide an outlet for participants not only to identify with others' problems but also to identify with their solutions. …

In the context of counseling sexual abuse survivors, the creative counseling technique of having clients write letters—to themselves or others—from a future context is described. A theoretical framework for writing letters to oneself from the future is presented. Specific types of letters from the future are explained, and case examples and applications are provided.

Mental health counselors regularly counsel clients who are in intimate relationships with partners who are violent. There is a dearth of literature addressing safety-related considerations when counseling clients in relationships that involve intimate partner violence (IPV). The authors draw on the literature to address safety-related counseling considerations that can be applied when counseling these clients. This article provides information about how to accurately assess IPV, explores safety-related ethical issues that arise when counseling clients in IPV relationships, and explains the use of safety plans as a tool for promoting the safety of clients in IPV relationships.