09/03

Self-care is an ethical requirement in the ACA for counselor

Self-compassion
A BRIEF ORIENTATION TO COUNSELING. NEUKRUG
CHAPTER I: WHAT IS COUNSELING AND WHO IS THE COUNSELOR
Counseling might be associated with “facilitative, here-and-now, short-term, change,
problem-solving, being heard, and awareness”. Psychotherapy is associated with “deep,
dark, secretive, sexual, unconscious, pain, hidden, long-term, and reconstructive.” And
guidance can be associated with “advice-giving, direction, on-the-surface, advocacy, and
support.” There is some confusion between de three words related to their history.
Guidance was defined as “the process of guiding an individual.” Psychotherapy was
defined as “caring for the soul.” In an effort to unify the many counseling specialty areas, in
2010 a committee that included 30 counseling organizations came up with the definition of
counseling as “Counseling is a professional relationship that empowers diverse individuals,
families, and groups to accomplish mental health, wellness, education, and career goals.”
(ACA, 2010)
Counselors and Related Mental Health Professionals
Today, counselors ten to have has coursework in common areas defined by the professional
accreditation body the Council of Accreditation of Counseling and Related Educational
Programs (CACREP, 2009) Not all programs are CACREP accredited, but most follow
their guidelines. These include knowledge in the following eight content areas: 1.
Professional orientation and ethical practice, 2. Social and cultural diversity, 3. Human
growth and development, 4. Career development, 5. The helping relationship, [Link]
work, 7. Assessment, 8. Research and program evaluation. The professional association for
counselors, called the American Counselor Association (ACA), currently has 19 divisions
that focus on a variety of counseling concerns.
Table 1.1 summarizes the different degrees, accrediting bodies, and credentials that one can
obtain in the varying mental health professions (counselors and other related mental health
professions).
CHAPTER 2. PROFESSIONAL ASSOCIATION IN COUNSELING AND RELATED
FIELDS
Professional associations might come with a yearly conference, a journal publishes, and
networking. But there are many more benefits to belonging to an association: a sense of
belonging, workshops and conferences, mentoring and networking opportunities, job fairs,
lobbying efforts, scholarly publications, standards in the profession, ways to build your
professional portfolio, scholarships and grants, awards, needed service for members, a
place where we can become famous.
The American Counseling Association was founded in 1913, it is the world’s largest
counseling association and has the goal to “enhance the quality of life in society by
promoting the development of professional counselors, advancing the counseling
profession, and using the profession and practice counseling to promote respect for human
dignity and diversity” (ACA, 2012). Membership benefits of ACA include: professional
development programs, counseling resources, computer-assisted job search services,
professional liability insurance, consultation on ethical issues and ethical dilemmas,
assistance in lobbying efforts at the local, state, and national level; a counselor directory,
networking and mentoring opportunity, graduate student scholarship, subscription to the
Journal of Counseling and Development and Counseling Today, discounts and specialty
programs, links to ACA electronic mailing list, links to ACA divisions, legislative updates
and policy setting for counselor.
There are 19 divisions of the ACA, all of which maintain a newsletter and most of which
provide a wide variety of professional development activities, many publish journals. In
addition, ACA has 56 branches, which consist of state associations and associations in Latin
America and Europe.
Professional Associations in Related Mental Health Professions: The American art therapy
association, the American association of marriage and family therapy, the American
association of pastoral counselors, the American psychiatric association, the American
psychiatric nurse association, the American psychological association, the national
association of school psychologist, the national association of social workers, the national
organization for human services, and the national rehabilitation counseling association.
CHAPTER III. CHARACTERISTICS OF THE EFFECTIVE COUNSELOR.
What makes counseling effective? First and foremost, some clients factors such as
readiness for change, psychological resources, and social support may affect how well a
client does in counseling. However, these factors are intimately related to the counselor’s
ability to work with the client.
In recent years, the importance of evidence-based practice has been emphasized, this
approach has become commonplace in training clinics. However, it has also become clear
that specific counselor qualities, called common factors, seem to be even more important to
positive counseling outcomes than matching a treatment approach to a presenting problem.
Creating a working alliance with the client may be the most significant factor in creating
client change.
According to Neukrug, there are nine essential characteristics for effective counseling.
1. Empathy. It has been empirically proven to be related to positive client outcome and
is probably the most important ingredient to building a successful working alliance.
Car Roger’s definition of empathy is the following: “means that the therapist senses
accurately the feelings and personal meanings that the client is experiencing and
communicates this acceptant understanding to the client. When functioning best, the
therapist is so much inside the private world of the other that he or she can clarify
not only the meanings of which the client is aware but even those just below the
level of awareness. Listening, of this very special, active kind, is one of the most
potent forces of change that I know.”
2. Acceptance. Sometimes called positive regard, is another component likely related
to building a strong working alliance. Regardless of what the client says, it will be
accepted.
3. Genuineness. Refers to the counselor’s ability to be authentic, open, and in touch
with his or her feelings and thoughts within the context and parameter of the helping
relationship. Withing the counseling relationship, the counselor is real and seen by
the client as being in a state of congruence (feelings, thoughts, and behaviors are in
sync). It seems to be related to emotional intelligence (ability to monitor one’s
emotions).
4. Embracing a wellness perspective. Students in counseling, and counselors in
general, need to attend to their own wellness by embracing a wellness perspective if
they are to be effective counselor, avoiding empathic blunders, an inability to be
accepting, difficulty at building a real relationship, and countertransference. One
way to assess your wellness is to examine Myers and Sweeney’s Indivisible Self,
where wellness is viewed as a primary factor composed of five subfactors and takes
into consideration the individual’s context. Total Wellness is the sum of all items on
the 5F-wel composed of: Creative Self (thinking, emotions, control, work, and
positive humor), Coping Self (leisure, stress management, self-worth, and realistic
beliefs), Social Self (friendship, love), Essential Self (spirituality, gender identity,
cultural identity, self-care), Physical Self (exercise, nutrition), and Contexts (local
context, institutional context, global context, chronometrical).
Attending our own counseling helps to attend our own personal issues, decrease the
likelihood of countertransference, examine all aspects of ourselves, understand the
client’s perspective.
5. Cultural competence to cover any patient’s cultural background, by following the
RESPECTFUL Counseling Model from D’Andrea and Daniels (2005):
Religious/spiritual identity, Economic class background, Sexual identity,
psychological development, Ethnic/racial identity, Chronological disposition,
 Trauma and other threats to their personal well-being, Family history, Unique
physical characteristics, Language and location of residence.
6. The “It Factor” is the special way of working with and ultimately building alliances
with clients that every counselor has.
7. Compatibility with and belief in a theory. Helpers need to find a theory they are
attracted to that they find comfortable, interesting, and attractive.
8. Competence is the counselor’s expertise and mastery. The ACA Code of Ethics
describes “Professional Competence” in eight areas, including: practicing within
one’s boundary of competence; practicing only in one’s specialty areas; accepting
employment only for positions for which one is qualified; monitoring one’s
effectiveness; knowing when to consult with others; keeping current by attending
continuing education activities; reframing from offering services when physically or
emotionally impaired; and assuring proper transfer for cases when one is
incapacitated or leaves a practice.
9. Cognitive Complexity consists of questioning even the things they believe. Seeing
things from different points of view.
CHAPTER IV. PREDECESSORS TO THE COUNSELING PROFESSION: FROM
ANTIQUITY TO EARLY SOCIAL WORK, PSYCHOLOGY, AND PSYCHIATRY.
Whether it’s the systems or advocacy emphasis of social works; the assessment, research
and theoretical underpinnings of psychology; or the diagnosis or psychopharmacology
focus of psychiatry; each has provided the counseling field with some important ways to
understand mental health and mental illness. Psychiatry started in the late 1700s.
Psychology traces as far back as the seventh century BCE, however modern psychology
began during the 19th century. Social work practice started in the 1500s, but it started
growing during the 1800s due to the growth of urban population.
SUMMARY OF IMPORTANT HISTORICAL EVENTS
3000 BCE Ancient Egypt. "Psychological" writings found on papyrus
400 BCE Hippocrates. Wrote the first "modern-day" reflections on the human condition
350 BCE Plato. Believed introspection and reflection to be the road to knowledge
350все Aristotle. Considered by many to be "first psychologist" — studied objectivity and
reason.
250 Plotinus. Believed in dualism-the concept that the soul is separate from the body
400 Augustine. Examined the meaning of consciousness, self-examination, and inquiry
1250 Thomas Aquinas. Examined the meaning of consciousness, self-examination, and
inquiry
1500s Elizabethan Poor Laws. Established legislation for the Church to help the destitute in
England
1650 Descartes. Believed that knowledge and truth come through deductive reasoning.
1700 John Locke. Believed the mind is a blank slate upon which ideas are generated
1800 James Mill. Believed the mind is a blank slate upon which ideas are generated
1800 Philippe Pinel. Founder of the field of psychiatry; viewed insanity from scientific
perspective; advocated for humane treatment of the mentally ill
1800 Benjamin Rush. Founder of American psychiatry, advocated for humane treatment of
the mentally ill.
1800 Anton Mesmer. Discovered the first uses of hypnosis
1800s Charity Organization Societies. Volunteers (friendly visitors) offered assistance to
the poor and destitute
1800s Settlement Houses. Individuals lived in communities to help the poor and destitute
1844 Origins of APA. Founding of the Association of Medical. Superintendents of
American Institutions for the Insane (precursor to the American Psychiatric Association)
1850 Jean Martin Charcot. Used hypnosis to understand disorders, saw the relationship
between psychological and organic sates.
1850 Dorothea Dix. Advocated for humane treatment for the mentally ill, helped establish
41 "modern" mental hospitals.
1875 Wilhelm Wundt. First experimental psychologist.
1875 Sir Francis Galton. Early experimental psychologist.
1890s Sigmund Freud. Developed the theory of psychoanalysis.
1890s G. Stanley Hall. Founded the APA; early American experimental psychologist
1890s James Cattell. Early American experimental psychologist
1890s William James. Philosophical Pragmatism: reality is continually constructed as a
function of its utility or practical purpose
1889 Jane Addams. Established Hull House in Chicago.
Around 1900 Emil Kraepelin developed one of the first classifications of mental diseases
Around 1900 Alfred Binet developed the first individual intelligence test for the French
Ministry of Public Education.
Around 1900 Pierre Janet saw a relationship between certain psychological states and
organic disorders.
Around 1900 Ivan Pavlov developed one of the first behavioral models of learning.
1940s Division 17 of APA formally became part of APA.
1950s Virginia Satir. One of first social workers to stress contextual or systems thinking.
1950s DSM. First diagnostic manual developed.
1955 NASW. National Association of Social Workers founded from a merger of seven
associations
1960. NASW establishes Association for Certified Social Workers.
1975 Donaldson v. O'Connor. Deinstitutionalization of hundreds of thousands of
hospitalized patients.
CHAPTER VII. ACCREDITATION IN COUNSELING AND RELATED FIELDS
The Council for Accreditation of Counseling and Related Education Programs gives
accreditation to the counseling profession. Accreditation has been one way of assuring that
programs are meeting minimum standards while promoting excellence in training
professionals. Counseling standards started to appear in the 1940s but it wasn’t until the 60s
that it started to take a more solid form. The Association for Counselor Education and
Supervision (ACES) began to examine the possibility of merginf these various standards
into one document entitled the Standards for the Preparation fo Counselor and Other
Personnel Service Specialists. But until 1979 the old ACA didn’t adopt them. And in 1981
the American Personnel and Guidance Association (APGA), the old ACA, created the
CACREP, a freestanding incorporated legal body that would oversee the accrediting
process. The most recent form of the CACREP standards went into effect in 2009. About
two thirds of the almost 450 counseling programs have been accredited.
CACREP offers many benefits of accreditation, like setting high standards and almost
always results in improves programs and a stronger sense of professional identity, attract
better students and faculty, students study from a common curriculum, are more
knowledgeable about counseling issues, and usually participate in more intensive and
longer fieldwork experiences; is often the standard used to determine who is eligible to
become certified or licensed; students can take the national counselor exam to become a
nationally certified counselor before; third-party payers are beginning to reimburse only
students who graduate from CACREP programs; easier to be accepted in doctoral program;
better job opportunities.
Today, CACREP (2009) offers standards for master’s degrees in clinical mental health
counseling (54 semester credits until 2013, thereafter 60 credits), school counseling (48
credits), students affair and college counseling (48 credits), career counseling (48 credits),
addictions counseling (60 credits). It also offers standards for doctoral degrees in counselor
education and supervision.
The master’s level standard for CACREP accreditation has a variety of requirements
withing three primary areas: the learning environment, professional identity, and
professional practice. Each specialty area has a wide range of additional requirements that
need to be covered.
The learning environment sets minimal standards for structure and evaluation of the
institution, the academic unit (the counseling program), faculty and staff, and evaluation.
Professional identity focuses on the foundation of the program and knowledge that should
be learned in the program.
Professional practice specifies a broad range of qualifications needed to supervise students
in their field placements (practicum and internship). It identifies the minimum number of
hours for practicum (minimum of 100 hours of field work with at least 40 of them being
direct service hours, one hours of individual or triadic supervision per week, and 1.5 hours
of group supervision per week) and internship (minimum of 600 hours of field work with at
least 240 of them being direct service hours, 1 hours per week of individual and/or triadic
supervision, and 1.5 hours per week of group supervision).
Specialty area domains come second; all counselors have coursework in the common-core
curriculum areas of (1. Professional orientation and ethical practice; 2. Social and cultural
diversity; 3. Human Growth and Development; 4. Career Development; 5. Helping
Relationships; 6. Group Work; 7. Assessment; 8. Research and Program Evaluation). Once
that is covered the different specialty areas will cover different curriculum goals. Dor
example, CMHC requires students learning in the following knowledge, skills, and practice
areas: foundations; counseling; prevention, and intervention; diversity and advocacy;
assessment; research and evaluation; and diagnosis.
CACREP-accredited doctoral programs in counselor education and supervision must
conform to doctoral-level standards. First, they must show that students have addressed
master’s level of standards. In addition, it requires a minimum of 96 semester hours of
graduate level credits. Also, guidelines for learning environment, professional identity, and
professional practice are offered as well as specific learning outcomes for supervision,
teaching, research and scholarship, counseling, leadership, and advocacy.
In addition to CACREP, other accreditation or approval processes exists, including the
Council of Rehabilitation Education (CORE), the approval process of the American
Association of Pastoral Counselors (AAPC), the American Psychological Association’s
Commissions and Accreditation (CoA), the Council of Social Work Education (CSWE), the
American Association of Marriage and Family Therapists’ (AAMFT), Commission on
Accreditation for Marital and Family Therapy Education (COAMFTE), and the Council for
Standards in Human Service Education (CSHSE).
CHAPTER VIII. HISTORY OF COUNSELOR CREDENTIALING
First counselor traced back to the certification of school counselors in the 1940s. Other
credentialing did not begin until the 1970s. In 1974, rehabilitation counseling set the stage
by establishing the Certified Rehabilitation Counseling (CRC) through the Commission on
Rehabilitation Counselor Certification (CRCC).
In 1982 un the National Board of Certifies Counselor (NBCC) was founded to “establish
and monitor a national certification system, to identify those counselors who have
voluntarily sought and obtained certification, and to maintain a register of those
counselors”. Currently certifies 55000 counselors as National Certified Counselor (NCC)
when passing The National Counseling Exam (NCE). There are three specialty areas now:
National Certifies School Counselor (NCSC), Certified Clinical Mental Health Counselors
(CCMHC), Master Addictions Counselor (MAC).
The American Counseling Association (ACA) used to e the American Personal Guidance
Association (APGA) until 1974. In 1976, Virginia passed the first licensing law for
counselors. By 2010 all 50 states offered licensure. California was the last state in 2009.
There are different licensure names depending on the state.
Benefits of Credentialing: increased professional identity; increased sense of
professionalism; demonstrating expertise within a profession; gaining parity; and protecting
the public.
EMDR certified
The NCE is one of the acceptable exams for the LPC license in MN (there is another exam
you could take to get the LPC, but it’s not recommended). More internationally recognized
(Germany)
CHAPTER X. MUTICULTURAL COUNSELING AND SOCIAL JUSTICE WORK: THE
FOURTH AND FIFTH FORCES.
Multicultural counseling has been seen as the development of counselor competencies to
maximize counselor effectiveness in the counselor’s work with all clients. With its focus on
advocacy and taking action against oppressive forces, social justice work can be seen as a
subset of multicultural counseling. Whereas multicultural counseling is mostly focused
upon the development of counselor competencies in the counselor’s work with all clients,
social justice work focuses on (1) empowering clients so that they can take action against
oppression in their lives, (2) when needed, taking action for clients who are faced with
oppressive forces, and (3) taking steps to change society to assist those who are
marginalized.
Unfortunately, in working with diverse clients, we have not done well as counselors. In
fact, it is now assumed that when clients from nondominant groups enter counseling, there
is a possibility that the helper will (1) minimize the impact of social forces on the client, (2)
interpret cultural differences as psychopathology, and (3) misdiagnose the client. Why is
counseling not working for a large segment of our population? Often, it is the counselor
incompetence, because the helper holds one or more of the following viewpoints: a belief in
the melting-pot myth, incongruent expectations about counseling, de-emphasis of social
forces, an ethnocentric worldview, ignorance of one’s own racist attitudes and prejudices,
misunderstanding cultural differences in the expression of symptomatology, misjudging the
accuracy of assessment and research procedures, ignorance of institutional racism.
Conceptual Models Towards Understanding Cultural Identity helps us understand how
individuals come to make sense of the world relative to their cultural identities. The
Respectful Acronym asks clients about the following: religious/spiritual identity, economic
class background, sexual identity, psychological development, ethnic/racial identity,
chronological disposition, trauma and other threats to their personal well-being, family
history, unique physical characteristics, and the client’s language and location of residence.
The Tripartite Model of Personal Identity where client’s personal identities can be seen in
three spheres: the Individual level (client’s uniqueness), the Gorup Level (cultural and
ethnic groups), and the Universal Level (common experiences).
The Developmental Models of Cultural/Racial Identity examine how specific ethnic and
cultural groups pass through unique stages of development as they become increasingly
aware of their cultural selves.
The Racial Identity Development for People of Color offers a generic five-stage model of
racial/cultural identity that synthesized some of the more popular models for people of
color. Every individual is at a different stage depending on their values/lives. The stages are
Conformity, dissonance and beginning appreciation, resistance and immersion,
introspection and internalization, universal inclusion.
The White Identity Development suggests stage progression in that they propose specific
stages that Whites are likely to pass through as they become increasingly cross-culturally
aware (Table 10.2 shows the two models with the different stages, second model is for
white graduate counselors)
Multicultural Counseling and Social Justice Competencies. The Multicultural Counseling
Competencies delineate attitudes and beliefs, knowledge, and skills in three areas: the
counselor’s awareness of the client’s worldview, the counselor's awareness of his her own
cultural values and biases, and the counselor’s ability to use culturally appropriate
intervention strategies. The Advocacy Competencies encompass three areas (client/student,
school/community, and public arena), each of which is divided into two level: whether the
counselor is acting on behalf of the competency are or acting with the competency area.
The competencies run from the microlevel (focus on the client) to the macro level (focus on
the system).
Historically, psychodynamic approaches, behaviorism, and humanism were called the first,
second, and third forces in counseling. With the more recent focus on multicultural
counseling and on social justice, two new forces have emerged. These fourth and fifth
forces suggest that counseling theory alone cannot drive our work with clients.
INTENTIONAL INTERVIEWING AND COUNSELING. IVEY, BRADFORD, AND
ZALAQUETT.
CH1. INTENTIONAL INTERVIEWING, COUNSELING, AND PSYCHOTHERAPY.
These three terms are used interchangeably in this textbook.

Interviewing is the basic process used for gathering data, providing information and
suggestions to clients, and offering workable alternatives for resolving concerns.
Closely related to interviewing, coaching is a short to medium term professional,
collaborative relationship between a client and coach, aimed at the “identification,
utilization, and development of personal/psychological strengths and resources in order to
enhance positive states, traits and behavior” (van Zyl et al., 2020).
Counseling is a more intensive and personal process. Counseling’s focus is on listening to
and understanding a client’s life challenges and then developing strategies for change and
growth. Counseling is most often associated with the professional fields of counseling,
human relations, clinical and counseling psychology, pastoral counseling, and social work
and is also part of the role of medical personnel and psychiatrists.
Psychotherapy focuses on more deep-seated difficulties, which often require more time for
resolution. Historically, psychotherapy was the province of psychiatrists, but they are
limited in number, and today they mostly offer short sessions and treat with medications.
For counseling and therapy to work, clients need to attend their sessions. Do they? Studies
indicate that the mean number of sessions attended per client of outpatient therapists is
about six sessions, a number very similar to the 5.65 observed for student therapists (Meier,
2021). Dropout rates are higher for certain populations like college students and minorities.
The Center for Collegiate Mental Health (CCMH, 2021) reported clients attend an average
of 4.35 individual sessions, including initial clinical evaluations and individual counseling.
Clients attending counseling improve on their issues and beyond. A survey of 562
counseling center directors reported anxiety (60.7%), depression (48.6%), stress (47.0%),
family concerns (29.0%), specific relationship problems (27.0%), and academic
performance difficulties as frequent client concerns.
Is therapy effective? Yes! Many psychotherapies have been found to be effective
interventions for a range of psychological concerns
If the culture of the client is different and the therapist has had insufficient training and
skill, or fails to follow ethical principles, errors may occur.
But an evidence-based approach by itself is not enough. Counseling is both a science
and an art.
There are different ways of listening to client stories. Counseling and therapy historically
have tended to focus on client problems. The word concern suggests something we all have
all the time. The word also suggests that we can deal with it—often from a more positive
standpoint. Defining concerns as problems or disorders leads to placing the blame and
responsibility for resolution almost solely on the individual. Issue is another term that can
be used instead of problem. This further removes the pathology from the person and tends
to put the person in a situa-tional context. It may be a more empowering word for some
clients. Carrying this idea further, challenge may be defined as a call to our strengths. All of
these terms represent an opportunity for change.
The culturally intentional counselor acts with a sense of purpose (intention), skill, and
respect for the diversity of clients. Cultural intentionality is a central goal of this text. We
ask you not only to be yourself but also to realize that to reach a wide variety of clients, you
need to be flexible, constantly changing behavior and learning new ways of being with the
uniqueness of each client. There are many ways to facilitate client development. Humility
is becoming a central part of multicultural competence and opens an intrapersonal and
interpersonal approach toward person-centered care. The word intentionality speaks to the
importance of being in the moment and responding flexibly to the ever-changing situations
and needs of clients.
Cultural intentionality is acting with a sense of capability and flexibly deciding from among
a range of alternative actions. The culturally intentional individual has more than one
action, thought, or behavior to choose from in responding to changing life situations and
diverse clients. The culturally intentional counselor or therapist remembers a basic rule of
helping: If a helping lead or skill doesn’t work—try another approach! Multiculturalism,
also referred to as diversity or cross-cultural issues, is now defined quite
broadly, it means jus that- many cultures.
Clients may feel stuck, overwhelmed, and unable to act. Frequently, they will be unable to
make a career or life decision. They are stressed. Often, they will have a negative self-
concept, or they may be depressed or full of anger. This focus on the negative is what we
want to help change as we emphasize positive psychology and enable development of client
intentionality, resilience, self-actualization, and transcendence. Resilience is a short-and
long-term goal of effective counseling and psychotherapy. Counseling’s ultimate goal is to
teach self-care and self-healing—the capacity to use what is learned in counseling to
resolve other issues in the future. This is the ultimate demonstration of achieved resiliency.
Self-actualization as a goal of counseling and therapy was central to the world of both
Carl Rogers and Abraham Maslow. It is the curative force in psychotherapy—humans’
tendency to actualize themselves, to become their potentialities . . . to express and activate
all the capacities of the organism (Rogers, 1961). Counseling and psychotherapy sessions
are indeed for the individual client, but both Rogers and Maslow also gave central
importance to being in relation to other and to give back to others and your society and
world—which includes advocacy.
Microskills identify the behavioral foundations of intentional counseling and
psychotherapy. They are the specific communication skills that provide ways for you to
reach many types of clients. The Microskills Hierarchy (see Figure 1.2) summarizes the
successive steps of intentional counseling and psychotherapy. The skills rest on a base of
ethics, multiculturalism, social justice and advocacy competencies, neuroscience, positive
psychology, and resilience. The five-stage structure provides a framework for integrating
the microskills into a complete counseling session. The empathic relationship–story and
strength–goals–restory–action framework provide an overall system for you to use and
serves as a checklist for all your meetings with clients.
Figure 1.2 The microskills hierarchy: A pyramid for building cultural intentionality.
Transcendence speaks about your capacity to go beyond yourself and successfully
apply your newly mastered skills to help others.
The micro skills teaching and learning framework is practice and feedback oriented, and
follows this step-by-step progression: 1. Introduction. Focus on a single skill or strategy
and identify it as a vital part of the helping process.
2. Awareness, Knowledge, and Skills. Read about the single skill or strategy and/or hear a
lecture on the main points of effective usage from your instructor. Cognitive understanding
is vital for skill development. However, understanding is not competence, nor does it show
that you can actually engage in an effective interview, counseling, or therapy.
3. Observation. View the skill in operation via a transcript and process analysis—or better
yet, watch a live demonstration or view a videotaped presentation. When necessary, do a
live demonstration.
4. Multiple Applications. Review different applications of the skills, variations according to
diversity and other cultural dimensions, and additional ways in which the skill or strategy
can be used.
5. Action: Key Points and Practice. Review the main topics of the chapter, summarized
under key points. Use video recording for skill practice (you can use your cell phone, tablet,
or laptop recording capabilities). Increase role-play practice’s effectiveness with observers
and feedback sheets. Seek immediate feedback from your practice session. How did those
who watched the session describe your interaction?
6. Portfolio of Competencies and Personal Reflection. Here you develop a summary of your
interviewing, counseling, and psychotherapy abilities. Questions will ask you to summarize
the meaning of the chapter for practice now and in the future.
No longer can we separate the body from the mind or the individual from his or her
environment and culture. Counseling and psychotherapy are moving closer to medicine,
neurology, and cognitive science.
Executive function is a set of mental skills that include working memory, flexible thinking,
and self-control (Zelazo, 2014–2021). We use these skills every day to learn, work, and
manage daily life. Emotional regulation and self-regulation refers to the ability to control
troublesome emotions and impulses.
Whether in interviewing, counseling, or psychotherapy, the conversation changes the brain
through the development of new neural networks. This is an example of brain plasticity and
neurogenesis.

Some 80% of medical issues involve the brain and stress. The evidence is clear that stress
management and therapeutic lifestyle changes (see Chapter 2) are effective routes toward
both mental and physical health and are necessary regardless of your counseling style or
chosen theoretical approach.
First let’s recognize that interviewing and counseling occur in many places other than a
formal office. The office is really a metaphor for your physical bearing and dress—smiling,
culturally appropriate eye contact, a relaxed and friendly nonverbal style. In spite of raised
concerns, studies conducted on telemental health show that counseling and psychotherapy
delivered via online services is similar to traditional in-person therapy for treating diverse
populations and a variety of client concerns.
Sample Practice Contract/ Client Feedback Form (make sure to save both for future use)
CHAPTER II. ETHICS AND MULTICULTURAL COMPETENCE

Particularly vital for counseling and therapy are the following:

1. Maintain Confidentiality
2. Recognize your limitations
3. Seek consultation
4. Beware of individual and cultural differences
5. Remember both the Golden Rule and the Platinum Rule. In counseling and psy-
chotherapy: Treat the client as you would like to be treated. Treat clients the way
they want to be treated.
6. Give special attention to ethical treatment of children and their rights
The early history of interviewing, counseling, and psychotherapy is populated primarily by
famous White male European and American figures, such as Sigmund Freud, Carl Jung,
Carl Rogers, Viktor Frankl, Albert Ellis, and Aaron Beck. While their contributions are
legion, the focus of their writing has been primarily on the individual with only minor
attention to cultural difference to women, or to BIPOC people (Black, Indigenous, and
People of Color).
The RESPECTFUL model (D’Andrea & Daniels, 2001, 2015) (see Figure 2.1) listed mul-
tiple groups and communities which impact our lives and represent some of the multiple
voices that clients bring to us. In addition, it provides a way for you to identify the past and
present voices and communities1 that affect your own thoughts, feelings, and behaviors.
This framework is a basic awareness and knowledge opportunity.
Individualism is defined in the Merriam-Weber dictionary as: Doctrine that the interests of
the individual are or ought to be ethically para-mount. Also: conduct guided by such a
doctrine. (2) The conception that all values, rights, and duties originate in individuals.
Community is defined in the Merriam-Weber dictionary (search “What is community?”).
A group of people living in the same place or having a particular characteristic in common.
A feeling of fellowship with others, as a result of sharing common attitudes, interests, and
goals. Community-based research seeks to empower communities and effect policy
changes. It seeks to democratize knowledge by recognizing and valuing the unique
strengths and perspectives of all members involved in the research process.
Martin’s Global Cultural Therapy.
There is also the possibility of cultural and historical trauma in each of the RESPECTFUL
dimensions. You can add the RESPECTFUL model to your skills and action by helping
clients extend their understanding of themselves as cultural beings and building resilience
and cultural health. At times, you may want to provide them with a handout on the
RESPECTFUL framework and discuss with them the meanings they take out of looking at
themselves as people of many cultures.
Privilege is power given to people through cultural assumptions and stereotypes, as well as
unawareness and disinterest in past oppression. Recall that the meaning of privilege will
vary with social context and communities.
A national mental health crisis has been identified by the American Psychological
Association (2020, 2021) and stress has become a major and defining issue in virtually all
counseling and therapy. Research reveals that mental and physical health are declining due
to an inability to cope in healthy ways with stressors recently experienced.
Krupnik (2020) conceptualizes the stress response on a continuum. Early in this continuum
are the normative stress responses to everyday stressors, where the individual recuperates
very quickly. Next are the pathological stress responses to sustained or stronger stressors,
where recuperation is only partial. Last, are the traumatic stress responses, where intense,
abrupt, or chronic stressors disrupt mental and physical functioning. Events that elicit a
traumatic stress response may be relational, occurring among individuals or within family
or other groups; environmental, such as accidents or natural disasters; or cultural, such as
discrimination, displacement, or war. The effects of these stressors are many, such as
neurobiological changes in the brain; weakening of immune defenses; and interpersonal
and intrapersonal difficulties, parenting issues, and mental disorders. Infant and childhood
trauma are not considered in most counseling and therapy books and courses. Yet it is these
traumas that are carried through life, often resulting in illness and mental health problems.
Hawes et al. (2021) have developed a scale for identifying childhood traumas. Adverse
Childhood Experiences (ACEs) includes many issues your clients may have experienced
and may carry in their minds at an unconscious level. The impact of trauma is actually
carried in the body as well as the mind, and can lead to physical illness. Real traumas from
the past all too often remain undiscovered in the counseling interview. Why? Talking about
them may be hurtful or the client may be unaware of their relevance. Nonetheless, the
research now suggests that clients’ experience remains—and is carried on in the body with
possible significant changes in the brain and mental functioning. Specialized trauma care,
trauma informed care, TF-CBT (trauma-focused CBT).
The Soul Wound that occurs with and from historical trauma has been most clearly defined
by Duran (2019) as he outlines the experiences of Indigenous Americans over the
generations. Between 1870 and 1900, at least 80% were killed and their lands lost as they
were moved to reservations. The result has been poverty, racism, poor medical attention, a
shorter life span, and loss of awareness of cultural heritage and spirituality over the
centuries. In addition, Indigenous people are often invisible to the White people who have
taken/stolen their land. The traumatic wound does not disappear: it remains “in the soul”
and appears in the body. Psychological liberation from historical trauma occurs when
clients discover that what they saw as a personal issue is not just “their problem.”
The intergenerational and epigenetic transmission of trauma was first identified by Israeli
researchers examining the lives of second-and third-generation survivors of the Nazi
Holocaust. Furthermore, there is now clear neurobiological evidence that changes in the
genome can be transferred from one generation to the next (epigenetics)—and onward from
that point to future generations.
Awareness of yourself as a cultural being is a vital beginning to authenticity. Unless you see
yourself as a cultural being, you will have difficulty developing awareness of others. Many
people still deny the power of the harassment and bullying of microaggressions. It
is best that you be prepared to watch for instances of microaggressions, help clients name
them for what they are, and provide counseling for emotional support, cognitive
understanding, and deciding when and how to respond to these painful event. Racial battle
fatigue is a concept developed by William Smith, which was initially used in reference to
the experiences of African American men, but is used today to describe the neg-ative and
racially charged experiences of all People of Color in America. Racial battle fatigue
describes the physical, mental, and emotional stress of coping with the constant stream of
microaggressions and overt racism for People of Color. Reflective coping style, active
problem-solving, cognitive restructuring, expression of emotion, and social support seeking
approaches serve to buffer the effects or racial battle fatigue.
These cultural/ environmental/contextual data are integrated together to produce what we
call cognition and emotion, the way we know the world—our worldview. New
environmental stimuli combine with memories of past experience in the hippocampus. To
maintain any sense of balance in the face of these hurts, a person needs to have devel-oped
a base of resilience and faith, trust, and pride in their family’s cultural background. This is
cultural health. What is called the attentional network is key to how we attend to the world
and then integrate internal and external perceptions. . Out of this comes a “brain map” in
memory, which guides us in the future. Solid memories of strength enable coping with
these situations, though the microaggressions still hurt. Counseling seeks to strengthen
these positive connections. If you encounter many good things in life, the brain map will
take a positive turn. Good input generally results in good output. On the other hand, less
effective and more damaging output comes from being raised in a family, community, and
region about which you are provided only prejudiced information (including by the media).
Negative beliefs about the self or others easily become embodied and hard to change.
When trauma occurs, the following typically occurs in the brain (Sweeton, 2017). 1. The
thinking center is underactivated (pre-frontal cortex, PFC). 2. Emotion regulation is
underactivated (anterior cingulate cortex, ACC). 3. The fear center is overactivated
(amygdala). This leads to difficulty in concentration, making decisions, and also may lead
to lack of control emotional outbursts. The result of severe trauma may be Post Traumatic
Stress Disorder. Trauma-focused cognitive behavioral therapy (TFCBT) is recognized as a
form of CBT for individuals and families. It often integrates other theories and strategies.
Microcounseling’s listening skills are essential in CBT and virtually all methods (e.g.,
motivational interviewing, interpersonal therapy). Drawing out of stories and enabling the
family system to communicate more effectively is essential. Another type of practice might
encompass psychoeducation, exercise, mindfulness meditation, yoga, and the Therapeutic
Lifestyle Changes. Actions that may provide help in situations of child maltreatment are:
referral to community resources, parent education, and cognitive behavioral therapy. Home
visitation programs are another commonly used approach. Family counseling needs to be
made available.
Resilience is the ability to bounce back from normal daily setbacks, temporary failure, and
early or late trauma of many types. Search for positive stories of strength; help the client
remember the resources they have in family and friends; identify what the client has done
right. Searching for the positive psychology/wellness story does not deny client concerns
and serious challenges. But our aim is constantly to watch and listen for strengths that will
eventually be part of the solution. Positive psychology’s central aim is to encourage and
develop optimism and resilience.
Optimism is defined in various dictionaries with many affirmative words—among them,
hope, confidence, and cheerfulness. It also includes a trust that things will work out and get
better, a sense of personal power, and a belief in the future. Optimism is a key dimension of
resilience and the ability to recover and learn from one’s difficulties and challenges. the
field of counseling has developed an extensive body of knowledge and research supporting
the importance of positive psychology, a strength-based approach. Psychology has
overemphasized the disease model and all too often places a self-defeating and almost total
focus on difficulties, ignoring the client’s own strengths in the resolution of issues.
Nonetheless, the positive psychology movement is well aware that happiness is not possible
in the midst of excessive stress.
Advocacy-oriented professionals, educators, and students recognize the influence of social,
political, economic, and cultural factors on human development. They look at themselves
as
persons living in context. They also help their students understand their lives in context.
The ACA Advocacy Competencies include two dimensions (i.e., extent of client
involvement and level of advocacy intervention) across six domains of advocacy: (a)
client/student empowerment, (b) client/student advocacy, (c) community collaboration, (d)
systems advocacy, (e) collective action (formerly public information), and (f)
social/political advocacy. Therapeutic lifestyle changes (TLCs), discussed in the following
section, are a key route to identifying and encouraging an engaged lifestyle. Examples of
lifestyle changes include increased exercise, better nutrition, meditation, and helping others,
which in turn helps us feel better about ourselves.

TLCs for stress management, building mental and physical health, brain reserve, and
resilience. 1)Physical exercise: Key to stress management and behavioral health is getting
blood flowing to the brain and body. Exercise increases brain volume. 2)Nutrition, weight,
and supplements. Relatively new to our field is the importance of helping clients deal with
the central health and brain issue of nutrition. Avoid the whites (pasta, sugar, salt) and snack
only on healthy food. Vegan, vege-tarian, and Mediterranean diets have proven to be
effective. 3)Social relations: Being with people in a positive way makes a significant
difference in wellness. Interpersonal rela-tionships, of course, are often the central issue in
interviewing and counseling. We want our clients to engage socially as fully as possible, as
this not only builds mental health but also builds the brain and body. Love and close
relationships build health. 4)Cognitive challenge: Take a course, learn a language, learn to
play an instrument—basically do something different for growth and the creation of new
neural networks. Uncertainty can be growth producing, challenging the assumptions that
we have worked so hard to accumulate while young. Find balance. 5) Sleep: A full rest is
critical for brain functioning and development of new neural networks. Lack of sleep is one
of the indications for depression or anxiety. 6) Meditation and relaxation: meditation makes
a positive difference in your well-being and brain, even increasing gray matter. 7)
Multicultural pride and cultural identity: Our personal identities as multicultural beings
affect both our mental and physical health. The harassment that comes with racism, ethnic
prejudice, and lack of opportunity deeply affects People of Color. Regardless of our race or
ethnicity, we still face issues of religious discrimination and favoritism, economic injustice,
ableism, sexism, heterosexism, and other forms of oppression. In addition to these 7 factors,
there are more TCLs factors that might fit some clients best (drugs and alcohol, medication
and supplements, positive thinking, beliefs, art, relaxing, more education, nature break, no
smoking, money and privilege, helping others, control screen time, and joy/humor. We
often make things too complex with fancy theo-rizing. TLCs are a shortcut to health that
will change our practice. Learned optimism heals and can change a life. Focus on strengths
and what clients can do rather than on what they can’t. The positive approach builds
cognitive reserves that will enable them to meet challenges more effectively. Keep it
simple, use humor and laughter, and increase zest for life.
CHAPTER III. LISTENING, ATTENDING, AND EMPATHY
Attending focuses on the counselor’s verbal and nonverbal behavior, whereas observation
skills focus on the specifics of clients’ nonverbal and verbal behaviors. Attending behavior,
essential to an empathic relationship, is defined as supporting your client with individually
and culturally appropriate verbal following, visuals, vocal quality, and body language/facial
expression. Listening is the core skill of attending behavior and is central to developing a
relationship and making real contact with our clients. It is the observable behaviors that
affect the client immediately—culturally appropriate eye contact, supportive body language
and facial expression, verbal following without topic jumps, and showing you understand
underlying emotions via the tone of your voice. To communicate that you are indeed
listening or attending to the client, you need the following “3 V’s 1 B”:*

Take multicultural differences into consideration.

A comfortable “prosodic” tone tends to make clients feel more relaxed with you. becomes a
way that all of us can improve emotional regulation. Verbal underlining is another useful
concept. As you consider the way you tell a story, you may find yourself giving louder
volume and increased vocal emphasis to certain words and short phrases.
What determines a comfortable interpersonal distance is influenced by multiple factors.
Hargie, Dickson, and Tourish (2004, p. 45) point out the following: gender, personality,
age, topic of conversation, personal relationship, ability.
Selective attention is central to interviewing, counseling, and psychotherapy. The thalamus
is seen as the “switching station” that sends and exchanges specific messages with various
brain regions, the brain stem, and the spinal cord, enhancing body response to stimuli.
Silence is sometimes the best answer. It turns out that the auditory cortex remains active
when you are attending or listening to silence. Clients can’t talk while you do. Review your
sessions for talk time. Who talks more, you or your client? Watch clients while they tell
their stories. Many types of clients can benefit from learning and practicing these skills.
Gearhart and Bodie (2011) have shown that teaching active listening and empathic skills
builds closer relationships in a variety of populations.
Putting yourself in the client’s shoes and viewing the world through their eyes and ears are
ways to describe empathy. A common current practice is to describe three types of empathic
understanding. This is the convention that we will use in this book. Chapter interview
transcripts will be evaluated on the following scale.
Subtractive empathy: Counselor responses give back to the client less than what the client
stated, and perhaps even distort what has been said. In this case, the listening or influencing
skills are used inappropriately. Basic empathy: Counselor responses are roughly
interchangeable with those of the client. The counselor can say back accurately what the
client has said. Skilled intentional competence with the basic listening sequence (see
Chapter 8) demonstrates basic empathy. You will find this the most common counselor
comment level in interviews. Rogers pointed out that listening in itself is necessary and
sufficient to produce client change. Additive empathy: Counselor responses that add
something beyond what the client has said often are additive. This may be adding a link to
something the client has said earlier, or it may be a congruent idea or frame of reference
that helps the client see a new perspective.
Key to this process are the mirror neurons, which fire when humans or animals act and
when they observe actions by another. Many believe that mirror neurons are one of the
most significant discoveries in recent science. Note that research consistently shows that
the mirror neurons of children and adolescents diagnosed with conduct disorder and adults
diagnosed with antisocial personality disorder do not activate. In fact, there is evidence that
many with these diagnoses show pleasure when observing others in pain. In short, your
empathic being and ability to listen and be with clients are a vital part of helping your
clients grow and change. Listening and empathy are not just abstract concepts—they are
clearly measureable and make a difference in other people’s lives.
Telebehavioral health has affected the practice of counseling and psychotherapy and the
relationship between counselor and client. Telehealth has been proven to be effective, and
with training and supervision attending skills can also be implemented.
Social skills training involves psychoeducational methods to teach individuals an array of
interpersonal skills. These skills include listening, assertiveness, dating, drug refusal,
mediation, and job interviewing. Virtually all interpersonal actions can be taught through
social skills training. Training as treatment is a term that summarizes the goals of social
skills training. The microtraining format of selecting specific skill dimensions for education
has become basic to most psychoeducational social skills programs.
Skills you may show competence with in the classroom or in practice sessions may
gradually be lost unless you maintain awareness and constantly use the skills. The type of
practice required to develop expertise, according to Ericsson (2021), is not simply doing
work. It is a cognitively effortful activity in which one is thinking about what one is doing.
It involves a reflective component, plus the opportunity to obtain feedback on the quality of
one’s performance through an expert trainer.
Communication skills training improves professionals’ communication, self-efficacy,
confidence, and satisfaction. Furthermore, communication skills training has a positive
effect on patient outcomes, such as satisfaction and perception that the provider understood
their issue.
Teaching listening skills can be helpful to many clients. Consider the following steps: (1)
negotiate a skill area for learning with the client; (2) discuss the specific and concrete
behaviors involved in the skill, sometimes presenting them in written form as well; (3)
practice the skill with the client in a role-play in the session or group counseling session;
and (4) plan for generalization of the skill to daily life.
CHAPTER IV. OBSERVATION SKILLS
Authorities vary, but many say that 85% or more of communication is nonverbal. Thomson
(2011) reviewed the literature and found that 55% of communication is body language.
Observation is the act of watching carefully and intentionally with the purpose of under-
standing behavior and, when appropriate and timely, this leads us to change our behavior.
Awareness, knowledge, and skills: principles of observation.
Nonverbal-behavior. There is also the “recognition response”: You will find that many
clients look down as they realize that what you just said is true and makes a difference.
They also may look down when something hurts inside, or when they are embarrassed or
want to avoid what is happening in the session. Your ability to observe will help you
anticipate and understand what is occurring with your client, but be careful to watch for
individual and cultural differences. A small point, sometimes amusing, is when the client or
you bring fingers to nose when they are uncomfortable or “want to wipe something away.”
Some call it the Pinocchio Effect. Do not overinterpret this behavior, but it can be a route
toward better understanding the immediate emotions of a client. However, sometimes a
nose wipe is just that—a nose wipe-
Facial expressions. Grawe (2007, p. 78) reviews key literature and points out that the
amygdala, critical center of emotional experience, appears to be highly sensitive to “fearful,
irritated, and angry faces . . . even when the faces have not been perceived consciously. . . .
We can be certain that in psychotherapy the patient’s amygdala will respond to even the
tiniest sign of anger in the facial expressions of therapists.” Self-awareness of your own
being is obviously as important as awareness of client behavior.
Body language. Hand and arm gestures may give you an indication of how you and the
client are organizing things. Random, discrepant gestures may indicate confusion, whereas
a person seeking to control or organize things may move hands and arms in straight lines
and point with fingers authoritatively. Smooth, flowing gestures, particularly those in
harmony with the gestures of others, such as family members, friends, or even you as
counselor, may suggest openness. Often people who are communicating well mirror each
other’s body language. Mirror neurons in the brain enable counselors to become empathic
with their clients. When empathy is at its height, client and counselor may unconsciously sit
in identical positions and make complex hand movements together as if in a ballet. This is
termed movement synchrony. Movement complementarity is paired movements that may
not be identical, but still harmonious.
Acculturation issues in nonverbal behavior: avoid stereotyping. Acculturation is the degree
to which an individual has adopted the norms or standard way of behaving in each culture.
Verbal behavior. . Three useful concepts for session analysis are presented here: key words,
concreteness versus abstractions, and “I” statements versus
“other” statements. If you listen carefully to clients, you will find that certain words appear
again and again in their descriptions of situations. Noting their key words and helping them
explore the facts, feelings, and meanings underlying those words may be useful. Verbal
underlining through vocal emphasis is another helpful clue in determining what is most
important to a client. Through intonation and volume, clients tend to stress the single words
or phrases that are most closely related to central issues for discussion. Clients who talk
with a concrete/situational style are skilled at providing specifics and examples of their
concerns and problems. The language of these clients forms the foundation or “bottom” of
the abstraction ladder. These clients may have difficulty reflecting on themselves and their
situations and seeing patterns in their lives. Clients who are more abstract and formal
operational, on the other hand, have strengths
in self-analysis and are often skilled at reflecting on their issues. They are at the “top” of
the ladder, but you will find that getting specific concrete details from them as to what is
actually going on may be difficult.
Clients’ ownership and responsibility for issues will often be shown in their “I” and “other”
statements.
Once the client is relatively comfortable and some beginning steps have been taken
toward rapport and understanding, a major task of the counselor or therapist is to identify
basic discrepancies, mixed messages, conflicts, or incongruities in the client’s behavior and
life. A common goal in most sessions is to assist clients in working through discrepancies
and conflict, but first these must be identified clearly. In any of these situations, it is helpful
to aid clients in understanding their ambivalences
by summarizing the conflict—the client’s own thoughts, emotions, and behaviors and/or
conflicting issues posed by someone else or life’s situation. The summary of the conflict
can then be followed by a variation of the basic challenge, such as “I hear you saying one
side of the issue is (insert appropriate comment representing part of the conflict or
discrepancy). But I also hear the other side as (insert the opposing side of the conflict).”
Then, through further listening and observation, the client may come up with their own
unique solution.
CHAPTER XIII. HOW TO INTEGRATE MICROSKILLS WITH MULTIPLE
APPROACHES
Microskills, five stages, and theory. We have chosen crisis/trauma counseling and cognitive
behavioral therapy to illustrate
how the five stages and microskills can be applied to theories other than those described
earlier in this book. We begin with crisis/trauma counseling.
Crisis/trauma counseling. Crisis/Trauma counseling is the most pragmatic and action-
oriented form of helping. The word pragmatism comes from the Greek word for deed, act,
to practice, and to achieve pragma (pragma). Even more than decisional counseling, crisis
counseling is concerned with action and useful, pragmatic results for the client. However,
pragmatism is embedded in a caring attitude that is fully aware that most responses to a
crisis can be considered completely normal. What is crisis/trauma? Crises are critical life
events that frequently lead to negative consequences. Crises are closely related to traumas
and can be seen as belonging to a continuum. Trauma is a pervasive reaction that impacts
virtually all parts of a person’s life. Trauma means stress, stress hormones, and a rise in
cortisol to the brain. It has been pointed out that virtually all the world’s population
experiences one or more crises/traumas in their lifetimes. In that sense, crises are an
expected part of life, and “normalizing” the crisis is one foundational idea to keep in mind.
The Five Principles of Trauma-Informed Care

Crisis/trauma counseling involves two major phases: (1) working through the initial trauma
and (2) appropriate follow-up and further counseling.
Seven stages for helping clients build resilience.
The Psychological First Aid (PFA) is another initial model of response to assist disaster
survivors (APA, 2021). The PFA goals are to assess risk, promote safety, and stabilize
survivors of disasters and connect them with help and resources. The Red Cross and the
American Psychological Association provide PFA courses and extensive resources in their
websites.
Suicide Watch: Awareness and Knowledge. A review of research literature lists eleven key
factors to consider as indicating the possibility of a suicide attempt: severe anxiety, panic
attacks, depression and the inability to experience pleasure, alcohol, difficulty in
concentration, sleeplessness, hopelessness, employment problems, relationship loss, a
history of physical/sexual abuse, and especially a history of past suicide attempts or
deliberate self-harm. To this list we would add the dangers of drug abuse, serious health
issues, and serious interpersonal conflict such as bullying or harassment. Bad economic
times, such as the recent long depression with difficulty in finding work to match talents (or
any work), can also be a suicide cause.
the Suicide Risk Assessment Guide suggests looking for strengths and resources to build
on, both for the here and now of the interview and for long-term safety of the client. The
guide points out the following, which will be familiar to you from our emphasis on positive
psychology and strength-based approaches. Use all of these as you seek to support your
client while you plan for appropriate referral. • Positive social support • Spirituality • Sense
of responsibility to family • Children in the home, pregnancy • Life satisfaction • Reality
testing ability • Positive coping skills • Positive problem-solving skills • Positive
therapeutic relationship. The three key warning signs are (1) actual threat to hurt or kill
oneself; (2) seeking access to pills, guns, or other routes; (3) talking or writing about death,
dying, or suicide (including giving away valued objects or pets to friends or family). In
these cases, take immediate action. The Suicide Risk Assessment Guide reminds us to
remove anything lethal and keep the client safe and with some caring person available.
Depending on the level of risk, if necessary, get immediate help and facilitate moving to a
hospital.
Awareness, knowledge, and skills of CBT. CBT is an information processing system in
which thoughts influence our feelings and actions. The purpose of CBT is to explore
thought patterns, help the client see that they are ineffective or irrational, and enable the
client to “think differently.” However, we believe that attention to relationship, feelings,
and meanings is more essential than CBT typically suggests.

APPENDIX III. THE FAMILY GENOGRAM

Much important information can be collected in a family genogram. Many of us have
family stories that are passed down through the generations. These can be sources of
strength (such as a favorite grandparent or ancestor who endured hardship successfully).
These family stories are real sources of pride and can be central in the positive asset search.
There is a tendency to look for negative issues and challenges in the family history, and of
course this is appropriate. But use this important strategy positively whenever possible. Be
sure to search for positive family stories as well as negative stories. How can family
strengths help your client?

We have found family genograms helpful and use them frequently; however, there are
situations in which some clients find them less satisfying than the community genogram.
There is a Western, linear perspective to the family genogram that does not fit all
individuals and cultural backgrounds. It is important to adapt the family genogram to meet
individual and cultural differences. You will find Ethnicity and Family Therapy. The family
genogram is most effective with a client who has a nuclear family and can actually trace the
family over time. We developed the community genogram because some of our clients
were uncomfortable with the family genogram. The Transgenerational Trauma and
Resilience Genogram (TTRG; Goodman, 2013) can help in comprehensive trauma
assessment and intervention from a transgenerational trauma and resilience framework. The
TTRG emphasizes an ecosys-temic view of trauma and focuses on culturally relevant,
social justice–oriented, and strength-based interventions. Also attend to sociopolitical
concerns that may affect trauma and recovery