Solution Manual & Test Bank for Clinical Mental Health Counseling in Community and Agency Settings by TestbankMall

Manual and Test Bank for

Clinical Mental Health Counseling in Community and Agency Settings Fifth Edition i

TABLE OF CONTENTS CHAPTER 1: HISTORY OF AND PROFESSIONAL IDENTITY IN CLINICAL MENTAL HEALTH COUNSELING ..........................................................................................1 Key Terms ..................................................................................................................................1 Questions....................................................................................................................................2 Essay Questions ...................................................................................................................7 CHAPTER 2: ETHICAL AND LEGAL ASPECTS OF COUNSELING ................................8 Key Terms ..................................................................................................................................8 Questions....................................................................................................................................9 Essay Questions .................................................................................................................13 CHAPTER 3: CLINICAL MENTAL HEALTH COUNSELING IN A DIVERSE SOCIETY......................................................................................................................................13 Key Terms ................................................................................................................................13 Questions..................................................................................................................................15 Essay Questions .................................................................................................................19 CHAPTER 4: THE COUNSELING PROCESS .......................................................................20 Key Terms ................................................................................................................................20 Questions..................................................................................................................................21 Essay Questions .................................................................................................................24 CHAPTER 5: CLIENT ASSESSMENT AND DIAGNOSIS ...................................................24 Key Terms ................................................................................................................................24 Questions..................................................................................................................................25 Essay Questions .................................................................................................................28 CHAPTER 6: HOLISTIC APPROACHES TO CLINICAL MENTAL HEALTH COUNSELING.............................................................................................................................28 Key Terms ................................................................................................................................28 Questions..................................................................................................................................29 Essay Questions .................................................................................................................32 CHAPTER 7: CONSULTATION, ADVOCACY, AND EVALUATION ..............................32 Key Terms ................................................................................................................................32 Questions..................................................................................................................................33 Essay Questions .................................................................................................................36 CHAPTER 8: DEALING WITH CRISIS, DISASTERS, AND SUICIDE, WHILE MANAGING STRESS AND AVOIDING BURNOUT ............................................................36 Key Terms ................................................................................................................................36 Questions..................................................................................................................................38 Essay Questions .................................................................................................................41

CHAPTER 9: WORKING WITH GROUPS ............................................................................41 Key Terms ................................................................................................................................41 Questions..................................................................................................................................42 Essay Questions .................................................................................................................45 CHAPTER 10: COUPLES AND FAMILY COUNSELING ...................................................45 Key Terms ................................................................................................................................45 Questions..................................................................................................................................47 Essay Questions .................................................................................................................51 CHAPTER 11: COUNSELING CHILDREN AND ADOLESCENTS ...................................51 Key Terms ................................................................................................................................51 Questions..................................................................................................................................52 Essay Questions .................................................................................................................56 CHAPTER 12: COUNSELING ADULTS.................................................................................56 Key Terms ................................................................................................................................56 Questions..................................................................................................................................58 Essay Questions .................................................................................................................61 CHAPTER 13: COLLEGE AND CAREER COUNSELING .................................................61 Key Terms ................................................................................................................................61 Questions..................................................................................................................................62 Essay Questions .................................................................................................................66 CHAPTER 14: COMMUNITY AGENCIES, MEDICAL SETTINGS, AND OTHER SPECIALIZED CLINICAL SETTINGS ..................................................................................66 Key Terms ................................................................................................................................66 Questions..................................................................................................................................67 Essay Questions .................................................................................................................70 CHAPTER 15: EMPLOYEE ASSISTANCE PROGRAMS, PRIVATE PRACTICE, COACHING, AND MANAGED CARE ....................................................................................71 Key Terms ................................................................................................................................71 Questions..................................................................................................................................71 Essay Questions .................................................................................................................75 ANSWER KEY ............................................................................................................................75 GLOSSARY................................................................................................................................100 INSTRUCTIONAL ACTIVITIES ...........................................................................................142

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CHAPTER 1: HISTORY OF AND PROFESSIONAL IDENTITY IN CLINICAL MENTAL HEALTH COUNSELING KEY TERMS Clinical mental health counseling Community counseling Mental health counseling American Mental Health Counselors Association Frank Parsons Jesse B. Davis Clifford Beers Boston’s Vocational Bureau School guidance Council of Guidance and Personnel Association National Vocational Guidance Association American Personnel and Guidance Association American Association for Counseling and Development American Counseling Association Smith-Hughes Act of 1917 Army Alpha, Army Beta intelligence tests Strong Vocational Interest Inventory (SVII) Psychometrics Abraham and Hannah Stone E. G. Williamson Minnesota Point of View Trait-factor Counseling Edward Thorndike John Brewer George-Dean Act Dictionary of Occupational Titles (DOT) Carl Rogers National Mental Health Act U.S. Veterans Administration Society of Counseling Psychology (Division 17) of APA National Defense Education Act (NDEA) Counseling Psychology Gilbert Wren Community Mental Health Centers Act ERIC Clearinghouse on Counseling and Personnel Services (ERIC/CAPS) Association of Counselor Education and Supervision (ACES) Council for Accreditation of Counseling and Related Educational Programs (CACREP) National Board for Certified Counselors (NBCC) National Certified Counselor (NCC) National Academy of Certified Clinical Mental Health Counselors (NACCMHC) Chi Sigma Iota 1

Carol Gilligan Feminist theory Multicultural competencies and standards Managed care organizations Health maintenance organizations (HMOs) Contextualism Evidenced-based interventions 20/20 A Vision for the Future of Counseling Licensure portability Globalization of counseling Patient Protection and Affordable Care Act TRICARE Department of Veterans Affairs’ Choice Program Professional identity Nonprofessional helpers Generalist human services workers Professional helpers Professional counseling Bogust v. Iverson Weldon v. Virginia State Board of Psychologists Examiners Inspection Registration Certification Licensure Social work Psychiatry Biomedical model Biopsychosocial model Psychiatric mental health nurses Psychologists National Fair Access Coalition on Testing (FACT) Secondary service Primary service QUESTIONS Multiple Choice Questions 1. The story of a young man who rescued people from a river illustrates what key component of counseling? a. Counseling emphasizes intervention wherever possible. b. Counseling focuses on prevention wherever possible. c. Counseling avoids altering people’s environments. d. Counseling is a profession for altruists.

2. Which of the following terms was devised in the mid- to late-1970s to identify counseling activities that took place outside of educational settings? a. Clinical mental health counseling b. School guidance and counseling c. Mental health counseling d. Community counseling 3. Which of the following divisions of the American Personnel and Guidance Association was established for mental health counselors? a. American Community Counselors Association b. American Clinical Mental Health Counseling Association c. American Mental Health Counselors Association d. American Counseling Association 4. Counseling initially developed from a humanitarian concern to improve people’s lives in communities affected by a. World War I b. World War II c. Sputnik I d. The Industrial Revolution 5. Which of the following individuals founded Boston’s Vocational Bureau and is considered the “founder of guidance?” a. Frank Parsons b. Jesse B. Davis c. Clifford Beers d. Hannah Stone 6. Which of the following individuals was the first to establish a systematized guidance program in the public schools? a. Frank Parsons b. Jesse B. Davis c. Clifford Beers d. Hannah Stone 7. Who wrote the book, A Mind That Found Itself? a. Frank Parsons b. Jesse B. Davis c. Clifford Beers d. Hannah Stone 8. The first national professional organization in the counseling field was called the a. National Vocational Guidance Association b. American Personnel and Guidance Association c. American Counseling Association d. American Mental Health Association 3

9. The flagship journal of the American Counseling Association is the a. Counseling Psychologist b. Journal of Counseling and Development c. Journal of Professional Counseling d. Journal of Mental Health Counseling 10. Which of the following statements reflects the influence of World War I on the development of the profession of counseling? a. As a result of World War I, a greater emphasis in testing emerged, and psychometrics became a popular movement. b. Due to the war efforts, World War I halted the development of counseling for a season. c. World War I had little impact on the development of counseling. d. World War I hastened the need for counselors and psychologists to train and help select specialists for the military and other industry. 11. Which of the following statements reflects the influence of World War II on the development of the profession of counseling? a. As a result of World War II, a greater emphasis in testing emerged, and psychometrics became a popular movement. b. Due to the war efforts, World War II halted the development of counseling for a season. c. World War II had little impact on the development of counseling. d. World War II hastened the need for counselors and psychologists to train and help select specialists for the military and other industry. 12. Which of the following individuals formulated the first theory of counseling? a. Clifford Beers b. Frank Parsons c. Carl Rogers d. E. G. Williamson 13. The first theory of counseling stated that people had aptitudes, interests, and achievements called ______________ that could be combined in a variety of ways to form constellations of individual characteristics called ______________. a. Traits; Factors b. Factors; Traits c. Schemas; Cognitions d. Cognitions; Schemas 14. Which of the following individuals challenged the directive, counselor-centered approach and the major tenets of Freudian psychoanalysis with a non-directive, person-centered approach to counseling? a. Edward Thorndike b. John Brewer 4

c. Albert Ellis d. Carl Rogers 15. The National Defense Education Act (NDEA) was enacted in reaction to what event? a. World War I b. World War II c. The launching of Sputnik I by the Soviet Union d. The Great Depression 16. What did the 1963 Community Mental Health Centers Act authorize? a. The establishment of mental health centers in community colleges. b. The establishment of a nationwide system of community mental health centers. c. Funds for research and training to prevent and treat mental health disorders. d. Stipends and paid internships for students engaged in graduate counseling studies. 17. The first state to adopt a professional counselor licensure law was a. Arkansas b. Alabama c. California d. Virginia 18. Which of the following was formed in the 1980s to standardize counselor training and accredit counseling programs? a. APA b. APGA c. CACREP d. NBCC 19. What occurred as a result of the growth of managed care organizations in the 1990s? a. The number of independent counselors decreased. b. Many counselors became providers for health maintenance organizations (HMOs). c. The number of sessions a counselor could offer under managed health care plans decreased. d. All of the above. 20. Which of the following statements reflect(s) an impetus for forming the taskforce, 20/20: A Vision for the Future of Counseling? a. To address the issue of professional identity. b. To advance the future of counseling. c. To increase unity within the profession. d. All of the above. 21. Which of the following refers to the philosophy, training model, and scope of practice that characterize a particular profession? a. Professional credentialing b. Therapeutic professionalism 5

c. Professional identity d. Professional affiliation 22. _________________ represents a specialty area within the school of medicine? a. Psychiatry b. Social Work c. Clinical Psychology d. Professional Counseling 23. What is the purpose of the National Fair Access Coalition on Testing (FACT)? a. To ensure multicultural sensitivity in test construction and administration b. To advocate for equitable access to testing services for all appropriately trained professionals who have demonstrated competence in administering and interpreting assessment instruments. c. To ensure that all mental health professionals, regardless of training, have access to psychological tests. d. None of the above. 24. Which of the following mental health professions is represented by Division 17 of the APA? a. Professional Counseling b. Clinical Psychology c. Counseling Psychology d. Psychiatry 25. The definition of counseling reached by the task group, 20/20: A Vision for the Future of Counseling, includes all of the following except a. Counseling is a dynamic, lively, and engaging process b. Counselors promote wellness c. Counseling is diverse and multicultural d. All of the above are included in the definition 26. In which court case did a judge rule that a counselor with a doctoral degree could not be held liable for the suicide of one of his clients because counselors were “mere teachers” who received training in a department of education? a. Weldon v Virginia State Board of Psychologists Examiners b. Bogust v. Iverson c. Tarasoff v. University of California - Berkeley d. Iowa Law Review Note 27. All of the following are benefits of national counseling certification except? a. It ensures that counselors, rather than independent state legislators, set the national standards and minimum requirements for being a professional counselor. b. It provides referral sources and networking opportunities across state lines. c. It regulates professional practice. d. All of the above are benefits of national counseling certification. 6

28. _______________ is the international honor society for professional counselors, counselor educators, and students in counselor education programs. a. Psi Chi b. American Mental Health Counseling Student Organization c. Chi Sigma Iota d. Upsilon Psi Sigma 29. Which of the following counseling credentials is offered by NBCC? a. National Certified Counselor (NCC) b. Licensed Professional Counselor (LPC) c. Licensed Clinical Professional Counselor (LCPC) d. National Clinical Mental Health Counselor (NCMHC) 30. Which of the following legally recognized counselors as professionals who provided personal as well as vocational and educational counseling? a. Weldon v. Virginia State Board of Psychologists Examiners b. Iowa Law Review Note c. Bogust v. Iverson d. Tarasoff v. University of California – Berkeley 31. Which court judgment stated that counseling was a profession distinct from psychology? a. Weldon v. Virginia State Board of Psychologists Examiners b. Iowa Law Review Note c. Bogust v. Iverson d. Tarasoff v. University of California – Berkeley 32. _______________ certifies clinical mental health counselors who have met requirements in training, professional counseling experience, and performance on the NCE. a. The American Counseling Association (ACA) b. The National Board for Certified Counselors (NBCC) c. American Mental Health Counseling Association d. Council for Accreditation of Counseling and Related Educational Programs (CACREP) Essay Questions 1. Identify three noteworthy events in the 20th century and describe how each event has influenced the profession of counseling. 2. Identify three noteworthy events in the 21st century and describe how each event has influenced the profession of counseling. 3. In your own words, how has the profession of counseling changed since the early 1900s? What changes, based on future projections by leaders in the profession, do you foresee as most impactful, and why? 4. Give one example of each of the four service components in Lewis et al.’s (2003) clientenvironment interaction model. 7

5. What is the difference between licensure and national certification? 6. Discuss the benefits of national certification. 7. Discuss the importance of professional affiliation for clinical mental health counselors. CHAPTER 2: ETHICAL AND LEGAL ASPECTS OF COUNSELING KEY TERMS Ethics Morality Autonomy Nonmaleficence Beneficence Justice Fidelity Veracity Mandatory ethics Aspirational ethics Law Duty to warn Tarasoff v. Board of Regents of the University of California ACA Code of Ethics (2014)Confidentiality Marginalization Separation Assimilation Integration Guidelines for Acting in Ethically Responsible Ways Statutes Case law Civil law Administrative law Duty to care Privileged communications Practice act counseling statutes Tort Negligence Malpractice Administrative law Health Insurance Portability and Accountability Act (HIPAA) Expert witness Court order Due care Privacy Confidentiality Disclosure Informed consent Free consent 8

Professional competence Bracket Capacity Standards of care Synchronous counseling Asynchronous counseling Multicultural Competencies and Standards Health Information Technology for Economic and Clinical Health Act (HITECH) QUESTIONS Multiple Choice Questions 1. Which of the following, according to Van Hoose & Kottler (1985) is “a philosophical discipline that is concerned with human conduct and moral decision making” (p. 3). a. Morality b. Law c. Ethics d. Autonomy 2. Which of the following involves judgment and evaluation of actions and is associated with words such as good, bad, right, wrong, ought, and should? a. Morality b. Law c. Ethics d. Autonomy 3. All of the following are moral principles described by Kitchener (1984) except a. Nonmaleficence b. Beneficence c. Autonomy d. Capacity e. Fidelity f. Justice 4. A counselor struggles between protecting a client’s welfare and respecting a client’s freedom of choice and action. The counselor is struggling with which two moral principles? a. Fidelity and Autonomy b. Justice and Autonomy c. Capacity and Nonmaleficence d. Beneficence and Autonomy e. Nonmaleficence and Autonomy 5. A counselor who unintentionally harms a client would be breaking which moral principle? 9

a. b. c. d. e. f.

Beneficence Justice Capacity Nonmaleficence Fidelity Autonomy

6. Counselors who do not fulfill their obligations to clients are breaking which moral principle? a. Beneficence b. Justice c. Capacity d. Nonmaleficence e. Fidelity f. Autonomy 7. Which of the following ethical practices refers to truthfulness and integrity? a. Autonomy b. Capacity c. Veracity d. None of the above 8. Mandatory ethics are followed when clinical mental health counselors a. Make decisions based on internalized principles and ideals of the profession, not just external considerations. b. Comply with the required minimal standards of the profession. c. Judge or evaluate their professional actions through a spiritual or religious lens. d. All of the above. e. None of the above. 9. Aspirational ethics are followed when clinical mental health counselors a. Make decisions based on internalized principles and ideals of the profession, not just external considerations. b. Comply with the required minimal standards of the profession. c. Judge or evaluate their professional actions through a spiritual or religious lens. d. All of the above. e. None of the above. 10. Which of the following refers to a set of rules that governs particular activities in society? a. Ethics b. Morals c. Law d. Categorical imperative 11. Which of the following is true concerning the relationship between ethical codes and the law? 10

a. Ethical codes are not intended to supersede the law; they typically clarify existing law and policy. b. The law is not intended to supersede professional ethical codes; they typically clarify existing ethical codes and policies. c. Regardless of what the law states, ethical codes, which are defined by the profession and for the profession, should be followed. d. None of the above. 12. Which of the following, according to Welfel (2016) is the key reason for having ethical codes? a. To codify the nature of ethical responsibilities and to justify the mission of an organization b. To establish norms and expectations for practitioners, thereby minimizing the risk of harm to others c. To provide explicit answers to difficult questions d. All of the above 13. All of the following are true regarding ethical codes except a. Ethical codes are necessary and sufficient for promoting ethical behaviors. b. No ethical code can address every situation or potential dilemma. c. Some codes are ambiguous, making them open to interpretation d. Enforcing ethical codes is difficult e. There may be conflicts within the ethical codes as well as among different organizations’ codes. f. Sometimes conflicts arise between ethical and legal codes. 14. According to the 2014 ACA Code of Ethics counselors are restricted from engaging in romantic or sexual relationships with clients for at least how many years after the termination of the counseling relationship? a. 2 years b. 3 years c. 5 years d. Counselors are restricted, in all cases, by the 2014 ACA Code of Ethics from engaging in romantic or sexual relationships with clients. 15. At which step of Wheeler and Bertram’s (2015) Legal and Ethical Decision-Making Model would a counselor consult the 2014 ACA Code of Ethics? a. Step 1 b. Step 2 c. Step 3 d. Step 4 e. Step 5 16. Court cases based on rulings that interpret a law according to a specific case establish what is known as a. Case law 11

b. Civil law c. Criminal law d. Tort 17. Which of the following best represents the ruling in the 1993 Napa County, California case involving Gary Ramona? a. The case was decided on the duty to care legal concept—a legal obligation of health providers to not act negligently. b. The case was decided on the duty to warn legal concept—a legal obligation to protect potential victims from dangerous clients c. The case was decided based on the privileged communication concept—a legal obligation to protect communication between counselor and client. d. None of the above. 18. In which legal case did the court maintain that communications between licensed psychotherapists and their patients are privileged and do not have to be disclosed in cases held in federal court? a. 1993 Napa County, California case b. Jaffee v. Redmond c. Tarasoff v. Board of Regents of the University of California d. None of the above 19. Which of the following is a term that refers to a wrong that legal action is designed to set right? a. Criminal law b. Case law c. Tort d. Administrative law 20. Which of the following refers to situations in which a mental health professional does not carry out his or her responsibilities in accordance with the standards of care outlined by the profession? a. Conscription b. HIPAA c. Negligence d. All of the above. 21. All of the following represent areas of potential malpractice for counseling except a. Failing to take action when someone other than the client is in danger b. Improperly certifying a client in a commitment hearing c. Providing services for which competence has not been established d. Breaching confidentiality e. Promising a “cure” f. All of the above are potential examples of malpractice

22. Which of the following terms refers to a client’s legal right to determine what information about himself or herself will be shared with others? a. Beneficence b. Autonomy c. Privacy d. Confidentiality 23. A professional’s promise not to disclose information revealed during the privacy of the counselor-client relationship, except under specific mutually understood conditions, is called a. Privacy b. Privileged communication c. Confidentiality d. Justice 24. In which legal case did the court rule that counselors need to take reasonable action to help protect potential victims from dangerous client? a. 1993 Napa County, California case b. Jaffee v. Redmond c. Tarasoff v. Board of Regents of the University of California d. None of the above 25. Online counseling that occurs during the moment of connection is called a. Synchronous counseling b. Skype counseling c. Asynchronous counseling d. Voice over IP (VolP) Essay questions 1. Discuss the purpose of ethical codes, as well as potential limitations. 2. Describe five changes made to the 2014 ACA Code of Ethics. 3. List and describe the eight steps of Wheeler and Bertram’s (2015) Legal and Ethical Decision-Making Model. CHAPTER 3: CLINICAL MENTAL HEALTH COUNSELING IN A DIVERSE SOCIETY KEY TERMS ADDRESSING model Culture Ethnographic variables Demographic variables Status variables Multicultural 13

Multicultural counseling Etic approach Emic approach Cultural encapsulated Worldview Prejudice Racism Cultural racism Institutionalized racism Western values Acculturation Enculturation Cultural pluralism Triad role-play model Broaching Sexual preference Sexual orientation Affectional orientation Gay Lesbian Bisexual Queer Questioning Sexual attraction Sexual identity Homophobia Homoprejudice Heterosexism Homonegativity Bruff v. North Mississippi Health Services, Inc. (2001) Familism Coming out Internalized homophobia Work discrimination Transgender Genderqueer Transsexual Gender Dysphoria Transphobia Transprejudice Disability Physical disabilities Cognitive disabilities Psychiatric disabilities Ableism Prevention 14

Intervention Postvention or Rehabilitation Counseling Client-aimed interventions Environment-aimed interventions Crisis phase Chronic phase Terminal phase Socioeconomic Status (SES) Social class Classism Privilege Social class privilege Poverty threshold QUESTIONS Multiple Choice Questions 1. The “R” in Hays’ (2016) ADDRESSING model refers to which of the following: a. Race b. Religion (and/or spirituality) c. Race/ethnicity d. Risk factors 2. Which of the following terms describes any group of people who identify with one another on the basis of a common purpose, need, or similarity of background? a. Diversity b. Encapsulation c. Culture d. Ethnicity 3. As defined by Olatunji (2001), which of the following accurately describes multicultural counseling? a. Multicultural counseling refers to multiple perspectives or multiple cultural viewpoints within the counseling relationship in which none are dominant or considered more “normal” than others b. Multicultural counseling refers to binary perspectives or viewpoints within the counseling relationship in which certain viewpoints are healthier than others c. Multicultural counseling refers to multiple perspectives or multiple cultural viewpoints within the counseling relationship in which the viewpoint of the counselor is most accurate due to his or her training and self-awareness. d. None of the above. 4. As defined by CACREP, _______________ takes into account differences in areas such as language, social class, race, ethnicity, gender, sexual orientation, religion, and level of ability 15

a. b. c. d.

Culture Diversity Multiculturalism Cultural encapsulation

5. Which counseling perspective emphasizes the universal qualities of counseling that are culturally generalizable? a. Cultural generalizability approach b. Hegemonic approach c. Etic approach d. Emic approach 6. Which counseling perspective focuses on the indigenous characteristics of each cultural group that influence the counseling process and consequently emphasize culturally specific counseling approaches? a. Indigenous approach b. Hegemonic approach c. Etic approach d. Emic approach 7. __________________ refers to the way people perceive their relationship to the world, including nature, other people, objects, and religious experiences. a. Worldview b. Multiculturalism c. Acculturation d. Ethnocentrism 8. ________________, according to Allport (1954) is a negative bias toward a particular group of people. a. Racism b. Transnegativity c. Prejudice d. None of the above 9. _______________ occurs when one cultural group considers another group inferior, and the first group has the power to impose its standards on the other group. a. Institutionalized racism b. Cultural racism c. Acculturation d. None of the above 10. The established use of policies, laws, customs, and norms to perpetuate discrimination and prejudice is called a. Institutionalized racism b. Cultural racism c. Acculturation 16

d. None of the above 11. The retention of one’s culture of identity is called a. Acculturation b. Cultural invariability c. Enculturation d. Cultural pluralism 12. Which of the following terms refers to individuals who are beginning to explore their sexual understanding and orientation? a. Gay b. Questioning c. Bisexual d. All of the above 13. _____________ includes both the affectional and sexual dimensions of self that are evidenced by thoughts, feeling, and behaviors. a. Sexual attraction b. Sexual behavior c. Sexual identity d. All of the above 14. Which of the following refers to an antigay bias, or a fear of individuals who are perceived as lesbian, gay, or bisexual? a. Homophobia b. Racism c. Sexism d. Heterosexism 15. In which court case did a federal appeals court uphold the job termination of a counselor who asked to be excused from counseling a lesbian client on relationship issues because of the client’s sexual orientation conflicted with the counselor’s religious beliefs? a. Jaffee v. Redmond b. Tarasoff v. Board of Regents of the University of California c. Bruff v. North Mississippi Health Services, Inc. d. None of the above 16. Which of the following refers to the primary importance of family in Latino communities? a. Personalism b. Respeto c. Familism d. Marianismo 17. All of the following are accurate regarding the coming out process except a. It’s a key component of minority sexual identity development. 17

b. It is an ongoing process, affected largely by an individual’s life circumstances. c. It is a one-time event, affected largely by an individual’s life circumstances. d. It is generally accepted that coming out is positively associated with mental health and relationship satisfaction. e. Coming out carries with it the risk of abandonment, ridicule, and disapproval and may be psychologically painful. 18. _____________________ is the practice of attempting to change a client’s sexual orientation from lesbian, gay, bisexual, queer, or questioning to that of a heterosexual. a. Cognitive-restructuring therapy b. Reparative therapy c. Exposure therapy d. None of the above 19. Which of the following refers to people whose gender identity and expression conflicts with their biological manifestation of sex? a. Transgender b. Gay c. Bisexual d. All of the above 20. _________________ is a term in the DSM-5 used to describe individuals who experience incongruence between their expressed/experienced gender and their assigned gender. a. Gender Dysphoria b. Sexual Identity Disorder c. Homosexuality d. Gender Identity Disorder 21. ________________ is an example of a cognitive disability. a. Sensory loss b. Learning disability c. Depression d. Congenital disability 22. Which of the following terms refers to a physical or mental impairment that substantially limits a major life activity? a. Heterosexism b. Ethnocentric monoculturalism c. Disability d. None of the above 23. Someone who fears having a group home for adults with mental retardation in his or her neighborhood may espouse which myth about individuals with disabilities? a. The Spread Phenomenon Myth b. The Dehumanization or Damaged Merchandise Myth c. The Feeling No Pain Myth 18

d. The Disabled Menace Myth 24. A client’s sense of coherence is determined by his or her perceptions of which of the following? a. Comprehensibility, manageability, and meaningfulness b. Wellness, cognitive harmony, sense of connection c. Meaningfulness, cognitive complexity, and sense of connection d. None of the above 25. Which phase of adaptation is a family in when members of the family are waiting for a diagnosis or have just received information about a family member’s disability? a. Crisis phase b. Chronic phase c. Terminal phase d. Apprehensive phase 26. _______________ refers to oppression, discrimination, or marginalization experienced by people who are negatively affected by socioeconomic disparity. a. Socioeconomic status b. Social class c. Classism d. Poverty 27. A counselor working with a client whose religion, ethnicity, and sexual orientation are different from his own, decides that he needs to process his thoughts and feelings about these contrastive cultural groups. This counselor is working on what facet of multicultural counseling competency development? a. Cultural skills b. Cultural responsiveness c. Cultural awareness d. Cultural knowledge 28. Jessica, a white female counselor, is working with Richard, a Chinese American male who is struggling with depression. Jessica has worked with many individuals with depression and, although she has not worked with a Chinese male with depression, she believes her existing knowledge base and skill set is sufficient. Which of the following statements, based on this information would be true of Jessica? a. Jessica’s thought process is culturally sensitive because she aims to give the same treatment to Richard that she has given to clients in the past. b. Jessica is exhibiting an etic perspective of counseling. c. Jessica is exhibiting an emic perspective on counseling. d. Jessica is actively contributing to institutionalized racism. Essay Questions

1. Discuss ways in which clinical mental health counselors can enhance their multicultural awareness, knowledge, and skills. 2. Describe five ways in which a counselor can convey cultural empathy. 3. Discuss ways in which clinical mental health counselors can establish an environment in which clients feel safe to explore issues related to sexual identity? CHAPTER 4: THE COUNSELING PROCESS KEY WORDS Safety Personalization Softness Role induction Informed consent content checklist Professional disclosure statement Initiative Reluctant clients Resistant clients Noncompliance Avoidance Ambivalence Motivational Interviewing Transtheoretical model of change Precontemplation Contemplation Preparation Action Maintenance Closed questions Open questions Door openers Door closers Culturally sensitive empathy Case conceptualization or case formulation Client records Subpoenas Treatment plan Support factors Learning factors Action factors Cognitive learning Affective experiencing Rehearsal Cognitive distortions Selective abstraction 20

Reframing Catharsis Overt rehearsal Covert rehearsal Duty to warn Termination Fading Referral Recycling QUESTIONS Multiple Choice Questions 1. All of the following are reasons to divide the process of counseling into three stages except a. Conceptually it can be helpful b. Counseling is a linear process c. Various tasks and responsibilities are associated with each stage d. Different client factors, such as motivation to change and responsiveness to treatment, are associated with each stage 2. __________________ refers to counselor-client understanding about the conditions, procedures, and nature of counseling a. Structure b. Role induction c. Fading d. Both “a” and “b” e. All of the above 3. Which of the following provides information to clients about the counselor and about the counseling process a. Action limits b. Professional disclosure statement c. Role induction d. Safety contract 4. ______________ refers to a motivation to change. a. Informed consent b. Rapport c. Initiative d. None of the above 5. Which of the following theoretical frameworks encourages counselors to roll with resistance rather than confront it? a. Cognitive-Behavioral Therapy 21

b. Developmental Counseling and Therapy c. Transtheoretical Counseling d. Motivational Interviewing 6. Maria, a client struggling with alcohol abuse, has taken small steps toward change. In which stage is Maria? a. Precontemplation b. Contemplation c. Preparation d. Action e. Maintenance 7. A counselor is providing continuing support, as well as using reinforcement management and follow-up contracts? In which stage of change might the counselor’s client be? a. Precontemplation b. Contemplation c. Preparation d. Action e. Maintenance 8. Which of the following counseling skills is effective in eliciting a large amount of information in a short time, but does not encourage elaboration? a. Open questions b. Closed questions c. Empathy d. Confrontation 9. All of the following are door openers except a. “What brings you to see me?” b. “What would you like to talk about?” c. “Tell me more.” d. “What if we move on to something different?” 10. ___________________ provides a way for counselors to link clients’ presenting problems to a treatment plan and serves to tailor interventions to specific client needs. a. Case conceptualization b. Rapport c. Empathy d. Clarifying probes 11. ______________ explains why the client is receiving services and what is going to take place in counseling a. Informed consent b. Professional disclosure statement c. Safety contract d. Treatment plan 22

12. Which of the following is an action factor? a. Cognitive learning b. Therapeutic alliance c. Reality testing d. Empathy 13. Which of the following is a term referring to negative, inaccurate biases that can result in unhealthy misperceptions of events? a. Cognitive distortions b. Resistance c. Delusions d. Abreaction 14. ________________ offers the client another probable and positive viewpoint of what a situation is or why an event might have happened. a. Selective abstraction b. Empathy c. Reframing d. Cognitive distortion 15. ________________ involves imagining and reflecting on a desired course of action. a. Overt rehearsal b. Covert rehearsal c. Corrective feedback d. None of the above 16. All of the following are important functions of ending the counseling relationship except a. Signals that something important has been completed b. Gives clients the opportunity to maintain changes already achieved and generalize problem-solving skills to new areas c. Serves as a reminder that the client has matured d. All of the above e. None of the above 17. Which of the following involves arranging other assistance for clients when the initial arrangements are not likely to be helpful? a. Termination b. Abandonment c. Referral d. Recycling 18. Which of the following involves the reexamination of all phases of the therapeutic process? a. Termination b. Abandonment 23

c. Referral d. Recycling 19. A client who is unaware that a problem exists is in which stage of change? a. Precontemplation b. Contemplation c. Preparation d. Action e. Maintenance 20. Which of the following techniques is recommended for use with clients who are in the contemplation stage of change? a. Gestalt techniques b. Behavioral strategies c. Relapse prevention d. Motivational interviewing Essay Questions 1. 2. 3. 4. 5.

List and describe the five stages of change of the transtheoretical model of change. List and describe six topics addressed during intake interviews. List and describe the four sections of the SOAP format. Discuss reasons why counselors should engage in careful record keeping. List and describe the five components of a treatment plan. CHAPTER 5: CLIENT ASSESSMENT AND DIAGNOSIS KEY TERMS

Assessment Diagnosis Appraisal Psychological testing Checklists Rating scales Minnesota Multiphasic Personality Inventory-2 NEO Personality Inventory-3 Myers-Briggs Type Indicator Structured clinical interview Semistructured interviews Unstructured interviews Mental Status Examination Mental disorder Substance use disorder Behavioral disorders Egosyntonic 24

Biopsychosocial (BPS) Model QUESTIONS Multiple Choice Questions 1. ______________ is an ongoing process in which counselors gather information about clients from several different sources and use the information to make decisions for treatment planning. a. Assessment b. Diagnosis c. Case conceptualization d. None of the above 2. ______________ is an objective, standardized measure of behavior and is usually used for evaluation. a. Assessment b. Appraisal c. Psychological testing d. Diagnosis 3. All of the following are methods of assessment except a. Formal or informal b. Standardized or nonstandardized c. Objective or subjective d. All of the above are methods of assessment. 4. Which of the following describes rating scales? a. Counselors simply mark words or phrases that apply to the client or the client’s situation. b. Counselors indicate the degree or severity of the characteristic being measured. c. Counselors ask questions in an ordered sequence. d. None of the above. 5. Which of the following is an example of a checklist? a. Brief Symptom Inventory b. Conners 3TM c. Myers-Briggs Type Indicator d. NEO Personality Inventory-3 6. Which of the following assessment instruments is based on the work of Carl Jung and Jungian theory, and is the most widely used personality inventory for normal functioning? a. Minnesota Multiphasic Personality Inventory-2 b. NEO Personality Inventory-3 c. Myers-Briggs Type Indicator d. Brief Symptom Inventory 25

7. ______________________ use prescribed items, but also give leeway if a specific issue needs to be addressed. a. Structured interviews b. Semistructured interviews c. Unstructured interviews d. None of the above 8. Which of the following is an example of a qualitative assessment procedure? a. Mental Status Examination b. NEO Personality Inventory-3 c. Card sorts d. None of the above 9. Test trustworthiness includes all of the following except? a. The test is valid b. The test is reliable c. The test is practical d. The test is fair cross-culturally e. All of the above relates to test trustworthiness 10. Approximately what percent, according to the NIMH (2014), of American adults (18years and older) are affected by mental health disorders in a given year? a. 5% b. 10% c. 18% d. 54% 11. ___________________ according to Hoheshil (1996) is “the process of comparing the symptoms exhibited by the client with the diagnostic criteria of some type of classification system” (p. 66). a. Assessment b. Appraisal c. Psychological testing d. Treatment planning e. Diagnosis 12. According to the DSM-5, which of the following are requirements that must be met for a syndrome to be considered a mental disorder? a. There must be sufficient evidence that the symptoms represent a dysfunction in the processes underlying mental functioning. b. The dysfunction must cause harm to the person in regard to psychological functioning that is clinically significant. c. The syndrome must be behavioral or psychological in nature and culturally sanctioned

d. All of the above are requirements that must be met for a syndrome to be considered a mental disorder e. a and c f. a and b 13. Which of the following statements is true regarding the DSM-5? a. It uses a multiaxial system to organize client diagnoses based on mental disorders, personality disorders, medical conditions, psychosocial factors, and global assessment of functioning. b. It uses a nonaxial system of diagnosis, in which mental health disorders, medical conditions, and psychosocial issues are listed on one axis. c. It avoids a dimensional approach to diagnosis to reduce the chance of variability and error in diagnosis. d. It is no longer aligned with the ICD-10, because the APA believed the ICD-10 was over-emphasizing biology in its mental health diagnostic criteria. 14. Which of the following is considered a depressive disorder? a. Substance Use Disorder b. Obsessive-Compulsive Disorder c. Tourette’s d. Disruptive Mood Dysregulation Disorder 15. People with which classification of disorders present with physical symptoms that initially appear to be medical in nature but cannot fully be explained as medical conditions? a. Feeding and Eating disorders b. Somatic Symptom and Related Disorders c. Anxiety disorders d. Depressive disorders 16. Which of the following is an example of a disorder in the category of disruptive, impulsecontrol, and conduct disorders? a. Anorexia Nervosa b. Adjustment Disorder c. Generalized Anxiety Disorder d. Kleptomania 17. Which of the following terms refers to a disorder being an integral part of the self? a. Egosyntonic b. Pica c. Schizotypal d. Histrionic 18. Which of the following is characteristic of someone with a Cluster B personality disorder? a. eccentricity 27

b. anxiety and fear c. emotional dysregulation d. all of the above are characteristics of someone with a Cluster B personality disorder 19. The “I” in the “DO A CLIENT MAP” model refers to a. Individual differences b. Individuation c. Interventions d. Interests 20. Which of the following questions is related to the psychological part of a biopsychosocial assessment? a. What genetic factors may be influencing the client’s wellbeing? b. What medications is the client taking? c. Does the client have a history of addiction or dependency? d. What cultural factors are relevant to the client’s presenting problem? e. Has the client experienced legal difficulties Essay Questions 1. Describe three ways in which assessment facilitates the counseling process. 2. Describe seven of the thirteen principles outlined by Hood and Johnson (2007) to help counselors conduct assessments skillfully. 3. Discuss the potential benefits and risks/limitations of diagnosis.

CHAPTER 6: HOLISTIC APPROACHES TO CLINICAL MENTAL HEALTH COUNSELING

KEY TERMS Biopsychosocial model Neurotransmitters Limbic system Messenger molecules BATHE Treatment plan Spirituality Religion Mindfulness Intention Attention Attitude 28

Wellness Salutogenic Wheel of Wellness Indivisible Self Prevention Primary prevention Secondary prevention Tertiary prevention Configural equation Incidence formula Stress Vulnerable populations QUESTIONS Multiple Choice Questions 1. Which of the following focuses on multiple, interrelated ways biology, psychology, and social/cultural factors are conducive or detrimental to health and well-being? a. Whole person approach b. Holistic mental health approach c. Biopsychosocial model d. None of the above. 2. Biological components of the BPS model include all of the following except a. Physical factors b. Biochemical factors c. Genetic factors d. Emotional intelligence 3. All of the following describe neurotransmitters except a. Chemicals in the brain that account for the transmission of signals from one neuron to the next across synapses. b. A complex set of structures that lies on both sides and underneath the thalamus, just under the cerebrum. c. Produced by the glands, such as the pituitary gland and adrenal glands d. Messenger molecules released from one neuron to another 4. A decrease in which neurotransmitter is linked to an increase in hyperactivity and irritability? a. Serotonin b. Dopamine c. Norepinephrine d. None of the above

5. _____________ is an inhibitory neurotransmitter that is closely associated with emotion and mood. a. Serotonin b. Dopamine c. Norepinephrine d. None of the above 6. Your client, Marcus, shares with you that he often reacts very passionately and aggressively to anyone he believes is taking advantage of him. From a biological perspective, what organ plays a key role in Marcus’s expression of emotions? a. Pituitary gland b. Frontal cortex c. Limbic system d. None of the above 7. According to Nauert (2008), decline in an individual’s immune system after facing chronic stress is due to which stress hormone? a. Cortisol b. Adrenalin c. Neurepinephrine d. GABA 8. In what way(s) do genetics play a key role in the biological component of the BPS model? a. Many psychiatric conditions have a genetic component that puts individuals at a higher risk for developing certain disorders b. They include support systems and work relationships that intersect one’s personal cultural identity. c. They independently determine the activation, severity and duration of mental disorders d. All of the above 9. Which of the following components of the BPS model include patterns of thinking, coping skills, judgment, perceptions, and emotional intelligence? a. Biological b. Psychological c. Social d. Sociocultural 10. You determine that your client is low in emotional intelligence. Which of the following would support this belief? a. Your client shares that he perceives and understands emotions in others really well but struggles to express them herself. b. Your client indicates that she is very logical and regulates her emotions very well.

c. Your client shares a history of relationship difficulties, and indicates that she struggles to share how she feels to her partners and rarely perceives or understands their emotions d. Your client shares that her pituitary gland isn’t working properly and she has been feeling really lethargic lately. 11. All of the following are areas of assessment in the BATHE technique except a. Background b. Empathy c. Trouble d. Handling e. Anatomy 12. _____________ has been referred to as the social or organized means by which a person expresses spirituality? a. Spirituality b. Religion c. Existentialism d. Theological counseling 13. _______________ is paying attention to the here and now in a purposeful, nonjudgmental manner. a. Spirituality b. Religion c. Mindfulness d. None of the above 14. All of the following are core building blocks of mindfulness except a. Intention b. Attention c. Attitude d. All of the above are core building blocks of mindfulness 15. All of the following are second-order factors of the IS-Wel except a. Creative self b. Social self c. Physical self d. Essential self e. Spiritual self 16. Which of the following IS-Wel contexts refers to lifespan over time? a. Local b. Institutional c. Global d. Chronometrical 17. Which of the following is a way to use the Indivisible Self Model in counseling? 31

a. b. c. d. e.

As an introduction of the Wellness model As an assessment of the wellness components To facilitate the development of a personal wellness plan For evaluation and follow-up All of the above

18. Which of the following is an example of secondary prevention? a. A counselor begins work with a person who is beginning to show signs of anxiety following a traumatic event. b. A counselor is working with a client who is dependent on alcohol. c. A counselor provides workshops to students on stress reduction. d. All of the following represent examples of a secondary prevention 19. Which of the following prevention models emphasizes the need to bolster people’s coping skills, self-esteem, and support systems? a. Configural equation b. Incidence formula c. Primary prevention calculation d. None of the above 20. All of the following are components that McNamara (2000) suggests a stress management program should include except a. General cognitive skills b. Physical ways of coping with stress c. Time management d. Skills for increasing self-control and self-esteem e. All of the above are components suggested by McNamara (2000) Essay Questions 1. Discuss the benefits of primary prevention efforts by counselors. 2. List the five components of the BATHE technique, and give two examples of how a clinical mental health counselor could address each area. 3. List and describe McNamara’s (2000) eight components of a stress management program. CHAPTER 7: CONSULTATION, ADVOCACY, AND EVALUATION KEY TERMS Consultation Client-Centered Case Consultation Consultee-Centered Case Consultation Program-Centered Administrative Consultation Consultee-Centered Administrative Consultation Consultee 32

Third party Advocacy Outreach Social justice Empowerment Social action Client outcome research Evidenced-based treatment (EBT) Evidenced-based practice (EBP) Moderators Treatment integrity Program evaluation Needs assessment Process evaluation or formative evaluation Program outcome evaluation or summative evaluation, or product evaluation Quality assurance Quality of care QUESTIONS Multiple Choice Questions 1. Who, according to Erchul (2009), is known as the father of the modern practice of mental health consultation? a. Frank Parsons b. Carl Rogers c. Viktor Frankl d. Gerald Caplan 2. Which of the following is a definition of mental health consultation? a. A problem solving, interpersonal relationship that develops through periodic faceto-face contacts between consultant and consultee. b. A systematic collection of information about the activities, qualities, and results of clinical mental health counseling programs c. A set of methods or approaches used to determine if there is a need for a certain program or intervention. d. None of the above 3. Which of the following would represent a “third party” in mental health consultation? a. A counselor receiving consultation for work with a client b. A consultant working with a counselor to help a client c. A client being served by a counselor who is receiving consultation d. None of the above 4. Which of the following is true regarding consultation? a. It represents a dyadic relationship between the consultant and consultee(s) 33

b. It is a direct relationship in that the consultant works directly with the client or client system. c. It is an indirect relationship in that the consultant works with the consultee, who works with the client or client system. d. None of the above 5. What is the purpose of consultation? a. To help the consultee with the challenges presented by the consultee’s client b. To increase the consultee’s skills for working independently with similar problems in the future. c. To directly help clients develop the skills necessary to cope with mental health challenges. d. Both a and b e. None of the above 6. In which of Caplan’s four types of mental health consultation is the primary goal to develop a plan to help a specific client? a. Client-centered case consultation b. Consultee-centered case consultation c. Program-centered administrative consultation d. Consultee-centered administrative consultation 7. In which of Caplan’s four types of mental health consultation is the primary goal to assess the consultee and administrative staff to develop more effective professional functioning of an individual, group, or entire organization? a. Client-centered case consultation b. Consultee-centered case consultation c. Program-centered administrative consultation d. Consultee-centered administrative consultation 8. The goal of consultee-centered case consultation is a. To develop a plan to help a specific client b. To improve the consultee’s ability to work effectively with a particular case as well as with similar cases c. To help an individual or group of consultees develop a new program or improve an existing one d. To assess the consultee and administrative staff to develop more effective professional functioning of an individual, group, or entire organization 9. A ______________ is an employee of an organization; whereas, a ________________ is not a regular employee of an organization or agency and is often brought into an organization for a specific purpose. a. supervisor; consultant b. consultant; supervisor c. internal consultant; external consultant d. external consultant; internal consultant 34

10. Which of the following expands the traditional role of individual counseling to a broader focus that addresses injustice, oppression, and environmental conditions that need to improve for the benefit of an individual or group? a. Process consultation b. Supervisory counseling c. Advocacy counseling d. Multicultural consultation 11. _______________ is a process through which clients gain the resources and skills needed to have more control over their environments and their lives. a. Outreach b. Empowerment c. Social Justice d. None of the above 12. ________________ includes contributing to the development of a strong professional identity, lobbying for professional recognition, and demonstrating professional pride and accountability. a. Advocacy counseling b. Social action c. Social justice d. Professional advocacy 13. _______________ are identified based on the outcomes of randomized controlled trials. a. Evidence-based practices b. Needs assessments c. Program evaluations d. Evidence-based treatments 14. _____________, according to Kazdin (2008), “refers to clinical practice that is informed by evidence about interventions, clinical expertise, and client needs, values, and preferences and their integration in decision making about individual care” a. Evidence-based practice b. Needs assessment c. Program evaluation d. Evidence-based treatment 15. Which of the following assessments is used to measure subjective well-being, presenting symptoms, overall life functioning, quality of life, and the therapeutic alliance? a. Outcome Questionnaire-45.2 b. Clinical Outcomes in Routine Evaluation c. Beck Depression Inventory II d. Client Evaluation of Counseling Inventory

16. Which of the following is a computerized system designed to measure clients’ subjective well-being, problems and symptoms, life functioning, and risk/harm? a. Outcome Questionnaire-45.2 b. Clinical Outcomes in Routine Evaluation c. Beck Depression Inventory II d. Client Evaluation of Counseling Inventory 17. Which of the following is a definition of a needs assessment? a. A problem solving, interpersonal relationship that develops through periodic faceto-face contacts between consultant and consultee. b. A systematic collection of information about the activities, qualities, and results of clinical mental health counseling programs c. A set of methods or approaches used to determine if there is a need for a certain program or intervention. d. None of the above 18. _________________ provides information about how well a program is being implemented a. Process evaluation, also called formative evaluation b. Program outcome evaluation, also called summative evaluation c. Process evaluation, also called summative evaluation d. Program evaluation, also called product evaluation 19. __________________ is an ongoing process by which an agency and outside groups monitor the quality of services offered a. Consultation b. Needs assessment c. Advocacy counseling d. Quality assurance 20. __________________ connects the costs of implementing a particular program with the benefits achieved by the participants. a. Efficiency evaluation b. Inefficiency evaluation c. Efficacy evaluation d. Sustainability assessment Essay Questions 1. 2. 3. 4.

Describe four qualities of a successful consultant. Describe five ways in which counselors might serve as advocates. Describe three issues or challenges of program evaluation. List and describe the 5C’s of empowerment developed by McWhirter (1994)

CHAPTER 8: DEALING WITH CRISES, DISASTERS, AND SUICIDE, WHIILE MANAGING STRESS AND AVOIDING BURNOUT KEY TERMS Crisis ABCX model of crisis Double ABCX model of crisis Developmental crises Situational crises Existential crises Nonevents Ecosystemic crises Posttraumatic Stress Disorder (PTSD) Crisis intervention Crisis management Equilibrium Disequilibrium Mobility Immobility Avoidance behaviors Triage Assessment Model Affective domain Behavioral domain Cognitive domain Six-Step Model of Crisis Intervention Compassion fatigue Secondary traumatization Crisis Incident Stress Management (CISM) or Mitchell Model Psychological First Aid Vicarious traumatization Suicide Suicide ideation Suicide attempt Suicide assessment SLAP Protective factors Safety plan Cognitive constriction Psychache Extreme risk High risk Moderate risk Low risk Burnout Event-related stressors 37

Client-induced stressors Self-induced stressors Overload syndrome Spirituality Self-awareness Sense of humor QUESTIONS

Multiple Choice Questions 1. According to Drapeau and McIntosh (2015), what is the rate of suicide for people between the ages of 15 and 24? a. 10 persons per 100,000 b. Less than 6.5 persons per 100,000 c. 25 persons per 100,000 d. None of the above 2. ___________ are 3.5 times more likely to die by suicide; whereas, ______________ attempt suicide more. a. Men; men b. Men; women c. Women; men d. Women; women 3. According to experts in the field, talking to clients about suicide can a. Increase clients risk for suicide b. Decrease clients’ overall stress and severity of suicidal thinking c. Put thoughts in adolescent clients’ minds that suicide is okay d. None of the above 4. When assessing for the presence of a suicide plan, all of the following are recommended except a. That the counselor be calm b. That the counselor be direct c. That the counselor be indirect by using euphemisms d. Ask open questions to invite discussion and gain information to help with risk assessment 5. The acronym SLAP refers to which of the following? a. Specificity, lethality, access to means, proximity of social support b. Suicidal ideation, loved ones, affect, plan c. Specificity, loved ones, aggressiveness, proximity of means d. None of the above

6. Which of the following is the strongest single predictor of future suicide? a. Substance use b. Age c. Military status d. Posttraumatic stress disorder e. Prior suicide attempt 7. All of the following are protective factors that reduce the likelihood of suicide except a. Interpersonal support b. Restricted access to highly lethal means of suicide c. Investment in effective clinical care d. Cultural/religious beliefs which encourage self-preservation e. Healthy problem-solving and coping skills f. All of the above are protective factors 8. ________________ have been replaced with a much more effective and ethical intervention called ___________________. a. No-Suicide Contracts; Involuntary Commitment b. Safety Plans; No-Suicide Contracts c. No-Suicide Contracts; Safety Plans d. Involuntary Commitments; Safety Plans 9. _______________ is an example of a developmental crisis. a. Retirement b. Death of a loved one c. Realizing one cannot have children d. War 10. _______________ is an example of a situational crisis. a. Retirement b. Death of a loved one c. Realizing one cannot have children d. War 11. _______________ is an example of an existential crisis. a. Retirement b. Death of a loved one c. Realizing one can never have children d. War 12. _______________ is an example of an ecosystemic crisis a. Retirement b. Death of a loved one c. Realizing one cannot have children d. War

13. Which of the following terms, according to Myer (2001) refers to a “time limited treatment directed at reactions to a specific event in order to help the client return to a pre-crisis level of functioning” (p. 5)? a. Advocacy b. Crisis intervention c. Suicide assessment d. None of the above 14. ___________________ is a lack of emotional stability or balance. a. Equilibrium b. Disequilibrium c. Mobility d. Immobility 15. Which of the following represents an affective reaction to a crisis situation? a. Intense emotional expressiveness, such as screaming and sobbing uncontrollably b. Perceptions of threat, loss, or transgression c. Denying or escaping the crisis event d. Immobility 16. Which of the following represents a future oriented response in the cognitive domain? a. Thoughts about what is happening during the crisis b. Recognition of something that is irrevocably lost or gone c. Perceptions of threat d. All of the above 17. In which step of the six-step model of crisis intervention does a counselor ensure client safety? a. Step 1 b. Step 2 c. Step 3 d. Step 4 18. In which step of the six-step model of crisis intervention does a counselor encourage the client to identify available support sources and coping mechanisms a. Step 3 – Providing Support b. Step 4 – Examining Alternatives c. Step 5 – Making Plans d. None of the above 19. ______________________ refers to changes that alter mental health professionals’ views of themselves, others, and the world and is associated with disruption in helpers’ views of safety, trust, esteem, intimacy, and control. a. Vicarious traumatization b. Crisis response c. Posttraumatic stress disorders 40

d. All of the above 20. ___________________ is an example of a self-induced stressor, according to Kottler and Schofield (2001). a. Perfectionism b. Resistant clients c. Excessive paperwork d. Getting married Essay Questions 1. Describe five ways in which clinical mental health counselors can manage stress and avoid burnout. 2. Discuss potential risk factors and protective factors related to suicide? 3. Using the six-step model of crisis intervention, describe, step-by-step how you would help individual who are currently in a crisis situation. 4. According to NOVA, what are the five goals of crisis interventions?

CHAPTER 9: WORKING WITH GROUPS KEY TERMS Group Group psychotherapy Psychoeducational groups Task/work groups Psychotherapy groups Counseling groups Mixed groups Quality circle Self-help groups Support groups Group work Groupthink Forming stage Storming stage or Transition stage Norming stage or Working stage Performing stage Adjourning stage or Mourning/morning stage Screening Group process Open-ended groups Closed-ended groups Coleaders Self-disclosure 41

Feedback Follow-up Caring Meaning attribution Emotional stimulation Executive function QUESTIONS

Multiple Choice Questions 1. _____________, according to Gladding (2016), refers to a “collection of two or more individuals who meet in face-to-face interaction, interdependently, with the awareness that each belongs to the group and for the purpose of achieving individual and/or mutually agreed upon goals” (p. 4). a. Collective b. Group c. Congregation d. None of the above 2. ______________ is generally credited with starting the first psychologically oriented group? a. Carl Rogers b. Rollo May c. Kurt Lewin d. Joseph Hersey Pratt e. Jacob Moreno 3. All of the following types of groups have training standards developed by the Association for Specialists in Group Work (ASGW) except a. Psychoeducational b. Counseling c. Psychotherapy d. Task/work e. All of the above have training standards developed by ASGW 4. Which of the following describes the function of psychoeducational groups? a. The prevention of personal or societal disorder through conveying information and/or the examining of values. b. To help group participants resolve the usual, yet often difficult, situations connected with living in an ever changing world as well as to help participants develop their existing interpersonal problem-solving competencies to better handle future problems c. To help individual group members resolve their in-depth and sometimes serious psychological problems d. To improve work practices and to accomplish identified work goals 42

5. Which of the following describes the function of counseling groups? a. The prevention of personal or societal disorder through conveying information and/or the examining of values. b. To help group participants resolve the usual, yet often difficult, situations connected with living in an ever changing world as well as to help participants develop their existing interpersonal problem-solving competencies to better handle future problems c. To help individual group members resolve their in-depth and sometimes serious psychological problems d. To improve work practices and to accomplish identified work goals 6. Which of the following describes the function of task/work groups? a. The prevention of personal or societal disorder through conveying information and/or the examining of values. b. To help group participants resolve the usual, yet often difficult, situations connected with living in an ever changing world as well as to help participants develop their existing interpersonal problem-solving competencies to better handle future problems c. To help individual group members resolve their in-depth and sometimes serious psychological problems d. To improve work practices and to accomplish identified work goals 7. Which of the following describes the function of psychotherapy groups? a. The prevention of personal or societal disorder through conveying information and/or the examining of values. b. To help group participants resolve the usual, yet often difficult, situations connected with living in an ever changing world as well as to help participants develop their existing interpersonal problem-solving competencies to better handle future problems c. To help individual group members resolve their in-depth and sometimes serious psychological problems d. To improve work practices and to accomplish identified work goals 8. Which of the following is a prevalent myth about groups? a. They are second-rate structures for dealing with problems b. They force people to lose their identity by tearing down psychological defenses c. They require that people become emotional and spill their guts d. All of the above are prevalent myths about groups 9. All of the following are advantages of group work for group members except a. Recognizing that they are not alone, unique, or abnormal in their problems and concerns b. Learning more about themselves in social situations c. Trying out new behaviors and ways of interacting d. Creating a groupthink mentality 43

10. In which stage of group development are feelings of tension and testing of the group environment prevalent? a. Forming b. Storming c. Norming d. Performing e. Adjourning 11. In this stage of group development the group decides upon goals of working together. a. Forming b. Storming c. Norming d. Performing e. Adjourning 12. In which stage of group development is the foundation laid for what is to come and who will be considered in or out of group deliberations? a. Forming b. Storming c. Norming d. Performing e. Adjourning 13. This stage is also known as the mourning/morning stage. a. Forming b. Storming c. Norming d. Performing e. Adjourning 14. At this stage, group members become involved with each other and with their individual and collective goals. a. Forming b. Storming c. Norming d. Performing e. adjourning 15. In which stage of a group is a group leader likely to introduce structured experiences, rely more on spontaneity, and use increased self-disclosure? a. Forming b. Norming c. Working d. Terminating

16. All of the following are dynamics/characteristics of the working stage of a group except a. trust in self and others b. risk taking c. temporary increase in energy, anxiety, and anticipation d. Inclusiveness of others 17. Which of the following is a generally agreed-on number of group members? a. 4-6 b. 6-8 c. 8-10 d. 10-12 18. A group that has been running for the past six-weeks has recently lost a group member and added two new group members. This group would be considered a(n) a. closed group b. open group c. dysfunctional group d. Functional group 19. Which type of group is more likely to promote greater cohesiveness among group members and may be more productive in helping members achieve stated goals? a. closed group b. open group c. task/work group d. psychoeducational group 20. ___________________ is a multidimensional process that consists of group members responding to the verbal messages and nonverbal behaviors of one another. a. self-disclosure b. confidentiality c. feedback d. follow-up 21. All of the following are qualities of an effective group leader except a. caring b. meaning attribution c. emotional stimulation d. person-centered theoretical orientation e. executive function Essay Questions 1. List and describe the qualities of an effective group leader. 2. List and describe the four types of groups presented in the chapter. What is the focus of each? 3. Discuss the potential benefits and limitations of groups. 45

CHAPTER 10: COUPLES AND FAMILY COUNSELING KEY TERMS Family Family life cycle Family cohesion Family Adaptability Triangulation Enmeshment Dual-career families Single-parent families Childless couples Gay and lesbian families Empowerment counseling Aging family Multigenerational families Military families Vertical stressors Horizontal stressors Developmental stressors Situational stressors Unexpected life stressors Family development and environmental fit Couples counseling Theory of object relations Objects Transference Catharsis Differentiation Cutoff Fusion Triangulation Genogram Cognitive (intellectual or mental) processes Relabeling Paradoxing Prescribing the symptom Irrational thinking Double systems therapy Intrapsychic processes Interpersonal processes Identified patient Circular causality Nonsummativity 46

Equifinality Communication Family rules Morphogenesis Second-order change First-order change Homeostasis Negative feedback loops (morphostasis) Interlocking pathologies Emotional deadness Placater Blamer Responsible Analyzer Distractor Leveling Absurdity Reframing Ordeals Utilization principle Miracle question Logicoscientific reasoning Narrative reasoning Externalizing the problem Couple enrichment QUESTIONS

Multiple Choice Questions 1. _____________ concentrates on making changes in systems, whereas _______________ and __________________ primarily focus on intrapersonal and interpersonal changes a. group counseling; individual counseling; family counseling b. individual counseling; family counseling; group counseling c. family counseling; individual counseling; group counseling d. none of the above 2. Which term refers to those persons who are biologically and/or psychologically related through historical, emotional, or economic bonds and who perceive themselves to be a part of a household? a. Kinship bond b. Group c. Culture d. Family

3. __________________ is the name given to the stages a family goes through as it evolves over the years a. Individual life cycle b. Family Feedback Cycle c. Family life cycle d. All of the above 4. Which of the following is a critical task of an unattached adult, according to the family life cycle? a. Differentiation from family of origin b. Adjusting career demands c. Coping with energy drain and lack of privacy d. Dealing with increased activities and time demands 5. Which of the following is an emotional issue for families with a school-age child? a. Increasing flexibility of family boundaries to allow independence b. Allowing child to establish relationships outside the family c. Accepting exits from and entries into the family d. Letting go of children and facing each other again 6. All of the following are stage-critical tasks for retired adults, according to the family life cycle, except a. Maintaining individual and couple functioning b. Supporting middle generation c. Rebuilding the marriage d. Coping with death of parents 7. _______________ refers to family environments in which members are overly dependent on each other or are undifferentiated. a. Triangulation b. Close-knit c. Enmeshment d. Role-disjointed 8. An adolescent pulled in two directions because he is trying to please two parents who disagree with each other is experiencing a. enmeshment b. triangulation c. role confusion d. None of the above 9. What percentage of married couples in the United States are pursuing dual careers? a. under 15% b. under 25% c. over 50% d. over 78% 48

10. ______________ are more likely to experience conflict between their work and family roles than are _________________. a. Working men; working women b. Working women; working men c. Nonworking women; working women d. Nonworking men; working men 11. What percentage of single-parent families are headed by mothers? a. 25% b. 50% c. 85% d. 98% 12. All of the following are ways in which counselors can be effective when working with gay or lesbian couples and families except a. not assuming that the reason for therapy has to do with sexual orientation b. assuming that the underlying reason for therapy is sexual orientation c. being knowledgeable about political, social, and legal implications of being a lesbian or gay family d. Being able to refer clients to places of support in the community 13. Which of the following are the two dimensions of the Circumplex Model of Marital and Family Systems? a. family uniqueness and family togetherness b. family cohesion and family adaptability c. family homogeneity and family adaptability d. None of the above 14. Which of the following is a vertical stressor? a. current work or marital relationship problems b. accidents c. life cycle transitions d. dealing with family secrets 15. Which of the following is an accurate statement concerning couples counseling? a. Treating one spouse for one or two sessions before seeing the couple together is an appropriate practice that leads to greater rapport and commitment. b. Treating one spouse for one or two sessions initially doesn’t affect couples counseling. c. It is crucial, in almost all cases, that clinical mental health counselors see both members of the couple from the beginning d. None of the above is accurate. 16. Which of the following would be considered an object in the theory of object relations? a. past experiences 49

b. a significant other c. unresolved issues d. None of the above 17. ______________, the expression of pent-up emotion, is a must according to object relations theory. a. Catharsis b. Countertransference c. Transference d. Dream interpretation 18. Which of the following theories stresses learning through modeling and imitation? a. object relations theory b. social learning theory c. rational-emotive behavioral theory d. Bowen family systems theory 19. In Bowen family systems theory, _______________ is undifferentiated emotional togetherness. a. cutoff b. triangulation c. fusion d. sensorimotor fixation 20. Which of the following is an objective of the Bowen family systems approach? a. an attempt to create an individuated person with a healthy self-concept who can couple and not experience undue anxiety every time the relationship becomes stressful. b. to get couples to try new behaviors because their old behaviors are not working. c. to help couples challenge and change their belief systems about activating events. d. none of the above. 21. Which of the following therapies fosters the development of more secure attachment styles in couples by focusing on emotions? a. Rational-emotive behavior therapy b. Strategic-structural therapy c. Emotionally focused therapy d. None of the above 22. Which of the following describes nonsummativity? a. The family is greater than the sum of its parts. b. The same origin may lead to different outcomes, and the same outcomes may result from different origins. c. Family functioning is based on both explicit and implicit rules d. The ability of a family system to modify its functioning to meet the changing demands of external factors 50

23. Which of the following describes morphogenesis? a. The family is greater than the sum of its parts. b. The same origin may lead to different outcomes, and the same outcomes may result from different origins. c. Family functioning is based on both explicit and implicit rules d. The ability of a family system to modify its functioning to meet the changing demands of external factors 24. In which approach to family counseling do family counselors describe family members’ communication in terms of nonproductive roles such as placater or distractor? a. psychodynamic family counseling b. experiential family counseling c. behavioral family counseling d. structural family counseling 25. In which approach to family counseling do counselors join with the family in a position of leaders and attempt to formulate a structure in their minds of the family? a. psychodynamic family counseling b. experiential family counseling c. behavioral family counseling d. structural family counseling 26. A counselor working with a family believes that the second child in the family is largely responsible for the dysfunction occurring in the family system. Therefore, the counselor focuses much of his attention in family counseling on confronting the second child and trying to change his “maladaptive behaviors.” Based on this information, it appears the counselor is going against which concept? a. Nonsummativity b. Morphogenesis c. Homeostasis d. None of the above Essay Question 1. Discuss the main principles of two couples counseling theories. Specifically, describe how each theory conceptualizes problems within the relationship and how those problems can be addressed through counseling. 2. Discuss the main principles of two family counseling approaches. Specifically, describe how each theory conceptualizes problems with the family system and how those problems can be addressed through counseling. CHAPTER 11: COUNSELING CHILDREN AND ADOLESCENTS KEY TERMS 51

Early childhood stage Preoperational stage Initiative vs. guilt Middle childhood Concrete operational stage Industry vs. inferiority Adolescence Formal operational stage Egocentrism Identity vs. role confusion Bronfenbrenner’s Bioecological Model Macrosystem Mesosystem Exosystem Chronosystem Attributional bias Supportive behaviors Controlling behaviors Normative life events Nonnormative life events Genogram Kinetic Family Drawing Mental Measurements Yearbook Treatment of Adolescents with Depression Study (TADS) Anorexia nervosa Bulimia nervosa Lanugo Maudsley approach Body dysmorphia Muscle dysphoria QUESTIONS Multiple Choice Questions 1. Which one of the following individuals created a developmental theory related to moral development? a. Kohlberg b. Piaget c. Erikson d. Elkind 2. This person conceptualized cognitive development into four stages: sensorimotor, preoperational, concrete operations, and formal operations a. Kohlberg 52

b. Piaget c. Erikson d. Elkind 3. Which of the following is a key concept of sociocultural theory? a. zone of proximal development b. psychosocial stages c. maturational developmental processes d. attachment 4. Which of the following is a key emphasis of the theory presented by Ainsworth and Bowlby? a. Emphasis is on the role that emotions play in social and psychological functioning. b. Focus on the relationship between the emotional bond between a parent and child and the child’s psychosocial development over the lifespan. c. Focus in on adolescent psychopathology in the context of maturation and developmental processes d. Emphasis is on eight psychosocial stages and their associated developmental tasks 5. Which of the following represents Piaget’s preoperational stage of development? a. egocentrism b. symbolic play, drawing, and spoken language c. attributing lifelike qualities to inanimate objects d. All of the above 6. According to Erikson (1968), children in early childhood are in the process of resolving which developmental crisis? a. initiative versus guilt b. industry versus inferiority c. identity versus role confusion d. ego integrity versus despair 7. __________________ is an extremely important activity in early childhood, in which children find out about themselves and the world. a. cognitive-behavioral therapy b. psychodynamic counseling c. play d. elementary school 8. _________________ represents Piaget’s stage of cognitive development in which ability to reason logically about concrete, tangible information develops. a. preoperational stage b. concrete operational stage c. formal operational stage d. none of the above 53

9. Children in middle childhood are in the process of resolving which of Erikson’s (1968) developmental crises? a. initiative versus guilt b. industry versus inferiority c. identity versus role confusion d. ego integrity versus despair 10. A person who is able to deal with abstraction, form hypotheses, engage in mental manipulation, and predict consequences would likely be in which of Piaget’s stages? a. sensorimotor stage b. preoperational stage c. concrete operational stage d. formal operational stage 11. ________________ , which emerges during adolescence, is characterized by a belief in one’s uniqueness and invulnerability a. egocentrism b. ethnocentrism c. generativity d. ego integrity 12. Which of the following developmental tasks is associated with the identity versus role confusion conflict proposed by Erikson (1968)? a. finding contentment about one’s life—past, present, and future b. recognizing and finding peace with life successes c. forming one’s identity, including committing to goals, values, beliefs, and life purpose d. all of the above 13. The _______________ in Bronfenbrenner’s Bioecological Model refers to a specific environment in which an individual develops. This includes family, peer groups, school, and church. a. microsystem b. mesosytem c. exosystem d. macrosystem e. chronosystem 14. The _______________ in Bronfenbrenner’s Bioecological Model refers to an overarching belief system or culture that exerts its effects indirectly through cultural tools and institutions. a. microsystem b. mesosytem c. exosystem d. macrosystem 54

e. chronosystem 15. A youth who is depressed who believes that she is helpless to influence events in her life and that she is responsible for any failures or problems is likely exhibiting which faulty cognitive processing skill? a. positive attribution bias b. negative attributional style c. catastrophizing d. depressing 16. __________________ is an example of a nonnormative event. a. job loss b. school transitions c. changes in family and peer relationships d. poverty 17. The __________________ component of CBT helps individuals identify and change negative, pessimistic thinking, biases, and attributions. a. behavioral b. cognitive c. affective d. all of the above 18. Which of the following is a goal of interpersonal therapy for adolescents? a. to increase positive behavior patterns and improve social skills b. to help clients develop cognitive structures that will positively influence their future experiences c. to improve disturbed relationships that may contribute to depression d. both a and b 19. _________________ emphasizes that children, adolescents, and young adults (up through age 24) taking antidepressants should be closely monitored for adverse side effects of the medication, including suicidal ideation a. Treatment of Adolescents with Depression Study (TADS) b. Black box warning label on antidepressant medications c. SSRI d. None of the above 20. Individuals with _____________ weigh less than 85% of what is considered normal for their age. a. bulimia nervosa b. anorexia nervosa c. binge-eating disorder d. none of the above 21. Which of the following is a common characteristic of individuals with eating disorders? 55

a. They tend to be low achievers and sensitive to rejection. b. They tend to be high achievers and sensitive to rejection. c. They are usually buffered against other mental health disorders, because eating disorders, in general, are not comorbid with other mental disorders. d. None of the above 22. _______________ is a physical complication of eating disorders in which fine hair grows over the body. a. pica b. vibrissa c. lanugo d. bristle 23. ______________ refers to the excessive concern with becoming muscular. a. body euphoria b. muscle dysphoria c. well-being d. muscle euphoria 24. A counselor begins to work with an adolescent who strongly identifies with a particular clique but struggles to describe his own unique characteristics outside of that group. Based on this information, which of the following considerations would be appropriate? a. It’s important to recognize that this adolescent is experiencing role confusion and interventions should be initiated to help the client to become more individuated from his group. b. It is important to recognize that this is an example of an adolescent who has found his identity. c. It is important that the counselor keep in mind the influence of culture before determining whether this behavior is adaptive or maladaptive. d. None of the above. Essay Questions 1. What is cyberbullying? How it similar to and different from traditional forms of bullying? What can clinical mental health counselors do to confront cyberbullying? 2. Briefly describe the main tenets of Bronfenbrenner’s Bioecological Model? How might this model be helpful to clinical mental health counselors working with adolescents? 3. Describe how expressive arts may be used in counseling with children and adolescents. Give a specific example of an expressive art technique you could use with a particular age group (e.g., early childhood, adolescence). 4. What are the three treatment phases of anorexia recommended by the National Institute of Mental Health? 5. Discuss four ways in which clinical mental health counselors can help children whose parents are going through a divorce. CHAPTER 12: COUNSELING ADULTS 56

KEY TERMS Transition model Anticipated transitions Unanticipated transitions Nonevent transitions Nonevents Perspective Context Approaching Transitions Taking Stock of Coping Resources Taking Charge Emerging Adulthood Early adulthood Intimacy Autonomy Honeymoon stage Egalitarian marriages Middle adulthood Early middle life Late middle life Intimacy vs. isolation Cohabitation Midlife transition Role strain Menopause Perimenopause Generativity vs. stagnation Seasons of life Levinson’s Developmental Tasks of Middle Adulthood Boomerang generation Sandwich generation Hardiness Ageism Ego integrity vs. despair Young old Old Old Old Reminiscence Life review Gereotranscendence Selective Optimization with Compensation (SOC) Social convoy Adversity Resilience 57

Elderspeak Elder abuse Emotional autonomy Gender-aware counseling Feminist theory Gender role analysis Power analysis Culture analysis QUESTIONS Multiple Choice Questions 1. Which of the following is a term that refers to life events that are accelerated, delayed, or fail to materialize? a. anticipated transitions b. unanticipated transitions c. nonevents d. none of the above 2. All of the following gave rise to the emerging adulthood stage of development except a. The change from an industrial-based economy to an information-based economy b. Significant increase in educational and occupational opportunities available to women c. Greater tolerance of premarital sex d. The Vietnam war 3. All of the following, according to Arnett (2007), are common features of emerging adulthood except a. Age of identity explorations b. Age of feeling in-between c. Age of stability d. Self-focused age 4. The average life expectancy for an American born in 2015 is approximately a. 79 b. 88 c. 94 d. 99 5. Which of the following psychosocial crises, according to Erikson (1963), is faced by young adults? a. Identity vs. role confusion b. Intimacy vs. isolation c. Ego integrity vs. despair d. Generativity vs. stagnation

6. According to the 2015 U.S. Census Bureau, what percentage of Americans over the age of 18 are single? a. Over 25% b. Over 50% c. Over 60% d. Over 8% 7. ________________ is a visual representation of a person’s family tree depicted in geometric figures, lines, and words. a. family helix b. genogram c. family hierarchical processing model d. none of the above 8. ________________ refers to a transitional phase leading up to the time when women cease to have menstrual cycles and thus become infertile. a. premenopause b. perimenopause c. menopause d. transitional menopause 9. Which of the following is true about menopause? a. levels of estrogen decline dramatically b. levels of estrogen decline modestly c. levels of estrogen increase modestly d. levels of estrogen increase dramatically 10. According to Erikson, in middle adulthood, adults resolve the psychosocial crisis of a. Identity vs. role confusion b. Intimacy vs. isolation c. Ego integrity vs. despair d. Generativity vs. stagnation 11. Which of the following describes the term, generativity? a. finding ways to give to and guide the next generation b. finding ways to generate energy c. becoming detached from important relationships and self-centered d. finding ways to increase self-esteem 12. The term that refers to adult children who return home for an indefinite period of time during difficult economic times is called the a. boomerang generation b. sandwich generation c. baby boomer generation d. generation x

13. ______________ is a term used to describe individuals in midlife who are caring for children under the age of 18 as well as for aging parents. a. boomerang generation b. sandwich generation c. enmeshed generation d. none of the above 14. Which of the following, according to Maddi (1999), is a term that describes an individual’s stress resistance? a. supports b. stress management c. hardiness d. commitment 15. All of the following are included in Schlossberg’s (1984) 4 S transition model except a. situation b. sense of self c. supports d. strategies e. All of the above are included in the 4 S transition model 16. Which of the following, according to Erikson (1963), is a psychosocial task of older adulthood? a. Identity vs. role confusion b. Intimacy vs. isolation c. Ego integrity vs. despair d. Generativity vs. stagnation 17. All of the following are associated with reminiscence in older adulthood except a. It strengthens one’s sense of identity b. It is symptomatic of the initial stages of cognitive decline c. It increases engagement in problem solving d. It helps strengthen one’s preparation for the inevitability of death

18. _________________, a concept attributed to Joan Erikson (1997), is a period when older adults begin to withdraw from the material and focus on a world that is more spiritual in nature. a. gero-theo development b. gerotranscendence c. religio-spiritual myopathy d. depression 19. ______________ is the ability to bounce back. a. adversity b. vulnerability 60

c. sensitivity d. resilience 20. The majority of clients who seek counseling services are a. older adults b. men c. women d. children 21. Women who overvalue the approval of others may not have a well-developed a. internal locus of control b. external locus of control c. respect for self d. emotional autonomy 22. Your client, who is an older adults living with an adult child (caregiver), reports that she is not allowed to leave her bedroom more than once a day and does not receive meals more than once a day. As a counselor, what is your responsibility? a. You principle responsibility is to build up the ego strength of your client so she will advocate for herself in this situation. b. Because this is considered neglect and maltreatment, you have a responsibility to respond. However, because your client is an adult, you are obligated to keep this information confidentiality unless your client gives you written consent to talk to others. c. Because this is considered elder abuse, you are required to report this information to an appropriate local agency, such as adult protective services. d. Because mandatory reporting laws do not exist in some states in reference to elder abuse, your responsibility first and foremost is to learn what the requirements of your state are in terms of confidentiality and reporting. Essay Questions 1. Describe goals and actions associated with two developmental tasks in Levinson’s Developmental Tasks of Middle Adulthood model 2. List the components of the Schlossberg’s (1984) 4 S transition model. Describe how each could be used by counselors to help clients manage transitions. 3. What are the three primary factors of the theory of Selective Optimization with Compensation (SOC)? How might the SOC be used by counselors working with older adults? CHAPTER 13: COLLEGE AND CAREER COUNSELING KEY TERMS Emotion-focused strategies Problem-focused coping strategies 61

Complex trauma National Career Development Association (NCDA) Career counseling Job Occupation Vocation Career Career Information Career Intervention Career Development Facilitator (CDF) Career Coaching Trait-and-Factor Theory Theory of Vocational Choice Congruence Consistency Differentiation Growth stage Exploration stage Establishment stage Maintenance stage Disengagement stage Life space Life span Life-Career Rainbow Career maturity Learning theory of career counseling (LTCC) Planned happenstance Social Cognitive Career Theory (SCCT) Self-efficacy Outcome expectations Occupational Information Network (O*Net) QUESTIONS Multiple Choice Questions 1. Which of the following is the primary accreditation body for college counseling centers? a. Association of College Counseling Center Directors b. American College Counseling Association c. International Association of Counseling Services d. CACREP 2. College men and women are more likely to use ____________ strategies than ____________ strategies. a. maladaptive emotion-focused; adaptive emotion-focused b. emotion-focused; problem-focused 62

c. problem-focused; emotion-focused d. adaptive emotion-focused; maladaptive emotion-focused 3. All of the following are risk factors for experiencing intense homesickness except a. being young in age b. perceiving the distance between school and home as great c. being independent of family d. Relying heavily on family members 4. Mark, a male college student, consumes 7 standard, alcoholic beverages in the span of 1 hour. Based on this information, which of the following is accurate regarding Mark’s drinking? a. Mark abuses alcohol frequently and, if he continues at this rate, he will need to attend Alcoholics Anonymous groups. b. Mark abuses alcohol and may be dependent on it. c. Mark is succumbing to peer pressure and a desire to fit in, which may be influenced by social anxiety. d. On this particular occasion, Mark’s drinking behavior met the definition for binge drinking. 5. A(n) ______________ is an activity undertaken for economic returns, whereas a(n) ___________ is a group of similar jobs found in different industries or organizations. a. vocation, occupation b. job, vocation c. job, occupation d. occupation, vocation 6. A _____________ implies a psychological commitment or calling to a particular field. a. job b. career c. vocation d. occupation 7. According to Super (1976) _____________ is the course of events that constitute a life. a. job b. career c. vocation d. occupation 8. Which of the following refers to a deliberate act designed to empower people to cope effectively with career development tasks? a. Career Information b. Career Intervention c. Career Education d. None of the above

9. Which of the following refers to a process that helps individuals and organizations improve their performances? a. Career Development Facilitation b. Career Counseling c. Career Psychotherapy d. Career Coaching 10. Which of the following statements is true of trait-and-factor theory? a. The theory stresses that the traits of clients should first be assessed and then systematically matched with factors inherent in various occupations b. The theory stresses the interpersonal nature of careers and associated lifestyles as well as the performance requirements of a work position c. The theory posits that career development is the lifelong process of implementing a self-concept. d. The theory suggests that four factors influence a person’s career decision-making: genetic endowment, environmental conditions and event, learning experiences, and task-approach skills. 11. Which of the following statements is true of Super’s life span, life space approach? a. The theory stresses that the traits of clients should first be assessed and then systematically matched with factors inherent in various occupations b. The theory stresses the interpersonal nature of careers and associated lifestyles as well as the performance requirements of a work position c. The theory posits that career development is the lifelong process of implementing a self-concept. d. The theory suggests that four factors influence a person’s career decision-making: genetic endowment, environmental conditions and event, learning experiences, and task-approach skills. 12. Which of the following statements is true of the Learning Theory of Career Counseling? a. The theory stresses that the traits of clients should first be assessed and then systematically matched with factors inherent in various occupations b. The theory stresses the interpersonal nature of careers and associated lifestyles as well as the performance requirements of a work position c. The theory posits that career development is the lifelong process of implementing a self-concept. d. The theory suggests that four factors influence a person’s career decision-making: genetic endowment, environmental conditions and event, learning experiences, and task-approach skills. 13. Which of the following statements is true of Holland’s Theory of Vocational Choice? a. The theory stresses that the traits of clients should first be assessed and then systematically matched with factors inherent in various occupations b. The theory identifies six categories that classify personality types and job environments: Realistic, Investigative, Artistic, Social, Enterprising, and Conventional. 64

c. The theory posits that career development is the lifelong process of implementing a self-concept. d. The theory suggests that four factors influence a person’s career decision-making: genetic endowment, environmental conditions and event, learning experiences, and task-approach skills. 14. ______________, according to SCCT, refers to an individual’s beliefs about his or her ability to perform successfully a particular task. a. outcome expectations b. self-efficacy c. cognition d. supports 15. _______________ is a technology-based career information system sponsored by the U.S. Department of Labor/Employment and Training Administration that provides the most up-to-date occupational information available a. LinkedIn b. Jobs of the Future c. O*Net d. Monster.com 16. ______________ is the oldest division within ACA. a. National Career Development Association b. American College Counseling Association c. American Coaching Association d. National Employment Counselors Association 17. Maria, a college counselors, does an intake interview with a client who expresses a lack of trust in others and uncertainty about whether Maria or anyone else could understand him. He also exhibits emotional dysregulation. Which of the following would be an appropriate consideration based on this information. a. The client is experiencing normal adjustment issues, such as homesickness, relative to his transition to college. b. The client may be experiencing symptoms of PTSD associated with complex trauma. c. The client’s is likely engaging in risky drinking behaviors that are causing him to experience emotional lability. d. The client may be experiencing difficulties focusing and completing tasks as a result of ADHD. 18. Abigail makes a very good living as a successful computer programmer. As her counselor, you’re surprised to hear Abigail share that she is dissatisfied with her job and wishes she could go back to school to become a marriage and family therapist. Based on this information, which of the following statements about Abigail would be accurate relative to Holland’s career theory?

a. Although Abigail is successful in her career as a programmer, it may be that her personality type is not congruent with her work environment and would be more congruent in a work environment that allows for greater social interaction. b. It may be that Abigail’s personality code on the Holland hexagon are adjacent, making it unlikely for her to find working environments that are consistent with her interests. c. It may be that Abigail has a clearly defined profile and, thus, has a harder time making career decisions. d. All of the above are accurate based on the given information and consistent with Holland’s theory. 19. Aubri is beginning to explore the world of work and beginning to have some preferences in regards to particular careers. Based on Super’s theory, in what age group would you place Aubri? a. Birth to age 14 b. Adolescence to early adulthood c. Middle adulthood d. Older adulthood 20. Myra was really worried about her ability to manage the work project that her supervisor gave to her. In particular, she thought she would fail to organize the project effectively and that it would turn out to be a big failure. Which of the following might an SCCT counselor say about Myra based on this information? a. Myra very likely is in a career that does not match her strengths. b. Myra very likely is in a career that does not match her personality type. c. Myra’s beliefs about her ability to perform successfully on a particular task is low and, in turn, her outcome expectations are low. d. Myra likely prematurely circumscribed possible careers based on external factors, such as gender, and compromised on a career that wasn’t best suited for her. Essay Questions 1. Briefly describe the seven element of The New Diversity Initiative. 2. Compare and contrast the following terms: job, occupation, vocation, and career. 3. List and briefly describe the six categories of Holland’s RIASEC model. CHAPTER 14: CLINICAL MENTAL HEALTH COUNSELING: SETTINGS AND SERVICES KEY TERMS Deinstitutionalization 66

Catchment areas Community-based mental health Substance Abuse and Mental health Services Administration (SAMHSA) Local management entities (LMEs) Productivity Partial hospital programs (PHPs) Intensive outpatient programs (IOPs) Assertive community treatment Certified clinical mental health counseling credential (CCMHC) 23-hour observation bed Hospice care Palliative care Substance abuse Substance dependence Dual diagnosis Polysubstance abuse Addiction Process addiction Addiction counseling Hazelden Model Detoxification Medical detoxification Social detoxification Self-detoxification Residential treatment Outpatient treatment Intensive outpatient program (IOPs) Denial Recovery Transtheoretical model of change Maintenance stage Precontemplation stage Intimate partner violence (IPV) Motivational interviewing Abuse Physical abuse Sexual abuse Psychological or emotional abuse Batterers Family preservation programs MST programs QUESTIONS Multiple Choice Questions

1. Prior to 1963, people with mental illness were a. treated in residential treatment facilities b. treated in community mental health centers c. primarily hospitalized in state institutions d. treated in group homes 2. What resulted in the deinstitutionalization of people with chronic and severe mental illness? a. World War II b. Development of CACREP c. Enactment of the Mental Health Deinstitutionalization Act d. Enactment of the Community Mental Health Centers Act 3. _____________ serve as administrative behavioral health authorities that outsource treatment to a network of providers a. SAMHSAs b. Local management entities c. Community mental health centers d. None of the above 4. Which of the following is an example of a direct client service? a. outreach program for persons dealing with life transitions and difficult situations b. advocacy for groups such as underserved populations dealing with chronic mental health problems c. promoting self-help programs d. none of the above 5. Which of the following is an example of an indirect community service? a. outreach program for persons dealing with life transitions and difficult situations b. advocacy for groups such as underserved populations dealing with chronic mental health problems c. Helping the local community organize to work for positive environmental change d. Educational programs on the nature of mental health 6. _______________ refers to the number of “billable hours” a clinician generates. a. Scale b. Productivity c. Yield d. None of the above 7. ____________________ is a specialty credential within the field of professional counseling. a. certified clinical mental health counseling credential (CCMHC) b. licensed certified mental health specialist (LCMHS) c. board certified clinical mental health counselor (BC- CMHC) d. all of the above 68

8. Which of the following provide(s) services to patients who continue to need intensive treatment but do not need 24-hour supervised care? a. intensive outpatient programs b. inpatient care c. partial hospital programs d. a and c e. all of the above 9. _________________ refers to care needed by an individual during the last months or weeks of his or her life. a. Grief and loss care b. Hospice c. MACCC d. None of the above 10. ________________ refers to a compassionate, comprehensive team approach to care that focuses on quality of life for anyone coping with a serious illness, including the patient and family members. a. Grief and loss care b. Chronic Rehabilitation Care c. Palliative care d. None of the above 11. ___________________ refers to the abuse of two or more substances simultaneously. a. dual diagnosis b. polysubstance abuse c. process addiction d. addiction 12. ___________________ is the coexistence of substance abuse and mental disorders a. dual diagnosis b. polysubstance abuse c. process addiction d. addiction 13. ___________________, according to L’Abate (1992), is “a persistent and intense involvement with and stress upon a single behavior pattern, with a minimization or even exclusion of other behaviors, both personal and interpersonal” (p. 2). a. polysubstance abuse b. dual diagnosis c. addiction d. none of the above

14. Mary is neglecting school and work responsibilities by spending much of the day on her smartphone checking email, responding to messages, updating her social media accounts, and playing games. It is possible that Mary has a a. substance addiction b. process addiction c. both a and b d. none of the above 15. ________________ is the dominant model for treating substance use disorders, and it is based on the disease concept of dependency. a. Minnesota Model of Addiction Treatment b. Missouri Medical Model of Addictions Model c. Motivational Interviewing Model of Addictions d. None of the above 16. _______________ is unmanaged, unsupervised detoxification that often is unsuccessful. a. Residential treatment b. medical detoxification c. social detoxification d. self-detoxification 17. Clients who successfully complete a chemical dependency program are considered to be in which stage of Prochaska, DiClemente, and Norcross’s (1992) transtheoretical model of change? a. action b. relapse c. preparation d. maintenance 18. Michael has been using and abusing cocaine for four years. He does not believe he has a problem and, thus, does not plan on changing his use of cocaine. In which stage of the transtheoretical model of change is Michael? a. precontemplation b. contemplation c. preparation d. relapse 19. ____________________ includes constant verbal abuse, harassment, extreme possessiveness, deprivation of resources, isolation, and the destruction of physical property. a. physical abuse b. sexual abuse c. psychological or emotional abuse d. none of the above 20. Which of the following is an example of a direct client service for child abuse? 70

a. sponsoring a parent support group that focuses on effective parenting skills b. working with DSS to provide supervision and structured intervention for visits between children and parents c. individual and family counseling for children and parents d. none of the above Essay Questions 1. Describe two settings in which clinical mental health counselors work that most appeal to you? Describe the population served at each setting, and the range of services offered. 2. List and briefly describe the phases of the Minnesota Model of Addiction Treatment. CHAPTER 15: EMPLOYEE ASSISTANCE PROGRAMS, PRIVATE PRACTICE, COACHING, AND MANAGED CARE KEY TERMS Employee assistance programs (EAPs) Private practice Coaching Managed care Fourth-party payments Positive wellness approaches Surveying community needs Consultation and Collaboration Supervision Community involvement Managed behavioral health care Fee-for-service Medicare Medicaid Health Maintenance Organization Act of 1973 Health maintenance organizations (HMOs) Utilization review (UR) Wickline v. State of California Muse v. Charter Hospital of Winston-Salem, Inc. Integrity Upcoding Downcoding Individual or Independent Practice Association (IPA) Preferred Provider Organization (PPO) Health Care Finance Agency (HCFA) Joint Commission on Accreditation of Health care Organization (JCAHO) National Committee for Quality Assurance (NCQA) QUESTIONS 71

Multiple Choice Questions 1. ____________________ provide mental health services to employees, recognizing that personal and professional issues can affect work performance, health, and general wellbeing. a. Private practices b. Managed care systems c. Employee assistance programs d. All of the above 2. ___________________ are reimbursements to EAP counselors provided by companies themselves. a. First-party payments b. Second-party payments c. Third-party payments d. Fourth-party payments 3. Which of the following is a service provided to an organization by an EAP that includes skill building for supervisors, managers, and executive on topics such as conflict management, communication skills, and performance management? a. workplace consultation b. policy consultation c. training d. critical incident management 4. Which of the following EAP services consists in EAPs responding to traumatic events that affect the workplace? a. Program implementation and management b. Training c. Critical incident management d. Workplace consultation 5. All of the following, according to Shallcross (2011) are tips for building a successful private practice except a. Meeting regularly with a cohort of professional peers b. Keeping in contact with current and former clients through Facebook and/or Twitter c. Returning phone calls within 24 hours d. Taking a marketing or business class 6. ________________ is a general term used to describe the systems of businesses and organizations that arrange for the financing and delivery of medical and mental health services. a. Private practice b. Executive coaching 72

c. Managed care d. Employee Assistance Program 7. Which of the following is described as “a way of providing care, a philosophy of care, a way to finance care, and a way to control costs” (Talbott, 2001, p. 279)? a. SAMHSA b. Psychiatric Mental Health Nursing c. Managed care d. None of the above 8. __________________ designated federal funding for the development of managed care programs and required employer to offer managed care options to employees. a. The Health Maintenance Organization Act of 1973 b. Wickline v. State of California c. Muse v. Charter Hospital of Winston-Salem, Inc. d. Joint Commission on Accreditation of Health care Organization 9. The process by which a managed care organization monitors the therapeutic process is called a. Capitation b. Utilization review c. carve-out d. gatekeeping 10. Miller (1996) referred to time-limited treatments imposed by MCOs that result in early termination as a. capitation b. rationing c. gatekeeping d. cost efficiency 11. In which of the following court cases was a service provider held liable for the HMO’s decision to limit hospitalization, even though the provider had recommended additional treatment? a. Wickline v. State of California b. Muse v. Charter Hospital of Winston-Salem, Inc. c. Tarasoff v. University of California - Berkeley d. Bogust v. Iverson 12. In which case did the court rule that it was the duty of the mental health facility to provide care to patients based on patients’ medical conditions, not on the needs of insurance companies? a. Wickline v. State of California b. Muse v. Charter Hospital of Winston-Salem, Inc. c. Tarasoff v. University of California - Berkeley d. Bogust v. Iverson 73

13. __________________ occurs when a practitioner assigns a more serious diagnosis than is warranted to obtain more authorized sessions. a. Downcoding b. Upcoding c. Treatment planning d. Integrity 14. A counselor whose client exhibits symptoms of borderline personality knows that she might struggle to receive reimbursement for this diagnosis due to its severity and persistence so she gives a mood disorder diagnosis instead. The behavior by the counselor would be considered a. Standard practice b. Rationing c. Capitation d. Downcoding 15. __________________ is a nonprofit organization whose goal is to improve the quality of healthcare services. a. National Committee for Quality Assurance b. Joint Commission on Accreditation of Health care Organizations c. Health Care Finance Agency d. None of the above. 16. Which of the following is a form of payment in which the provider is paid on a permember basis? a. carve-out b. case management c. capitation d. case rate 17. __________________ is a coordinated set of professional activities focused on treatment planning and assurance of treatment delivery that addresses the client’s needs while maintaining quality, cost-effective outcomes. a. capitation b. case management c. carve-out d. case rate 18. ______________, a relatively new discipline, is designed to help clients who are not in psychological distress and are able to use their strengths and resources to pursue goals, actions, and outcomes that enhance their lives, either personally or professionally. a. career counseling b. college/university counseling c. addictions counseling d. coaching 74

19. Which of the following is the name of the coaching credential offered by the Center for Credentialing in Education (CCE)? a. Human Services – Board Certified Practitioner b. Licensed Professional Coach c. Board Certified Coach d. National Certified Counselor 20. _________________ is designed for people who are in executive management and involves a one-on-one helping relationship between the coach and the client. a. life coaching b. executive coaching c. health and wellness coaching d. career coaching Essay Questions 1. What are some advantages and disadvantages of managed care for counseling? 2. How have managed care systems impacted the counseling process? 3. Let’s assume that you’re a counselor in private practice and you receive third-party reimbursements through an MCO. You have been seeing a client who is working on existential issues resulting from the unexpected death of her child. The client exhibits symptoms of sadness, grief, and loss, but does not meet the criteria for an Axis I diagnosis. You have met with the client six times (the allotted amount of sessions that the MCO will reimburse), but you believe she could benefit from additional sessions. You could justify additional counseling sessions and continue to receive reimbursement from the MCO if you diagnosed the client with an Axis I diagnosis. Using Haas and Malouf’s model of ethnical decision making, describe how you might handle this situation. 4. As a clinical mental health counselor, how might you go about securing a placement on a provider panel? ANSWER KEY Chapter 1 Answer Key Multiple Choice Questions 1. 2. 3. 4. 5. 6. 7.

b d c d a b c 75

8. a 9. b 10. a 11. d 12. d 13. a 14. d 15. c 16. b 17. d 18. c 19. d 20. d 21. c 22. a 23. b 24. c 25. d 26. b 27. c 28. c 29. a 30. b 31. a 32. b Essay Questions 1. Answers will vary depending on the events that students select. Here are some possible answers: a. The launch of Sputnik i. Precipitated the passage of the National Defense of Education Act (NDEA) ii. The NDEA provided funding for upgraded school counseling programs b. World War I i. interest in testing emerged ii. psychometrics (psychological testing) became a popular movement c. World War II i. Influenced the way vocations were looked at by men and women ii. Increased the influence of mental health professionals d. Civil Rights Movement i. Attentions became directed toward social issues ii. impact of the developmental model lessened e. Establishment of counseling theories i. Behaviorism ii. REBT 76

iii. Humanism 1. Rogers 2. Maslow iv. Etcetera f. Establishment and strengthening of what eventually became the ACA g. Establishment of CACREP h. Licensing and Credentialing 2. Answers will vary. Here are some possible answers: a. Prevalence of managed care i. The number of independent counselors decreased. ii. Many counselors became providers for health maintenance organizations (HMOs). iii. The number of sessions a counselor could offer under managed health care plans decreased. iv. Evidenced-based practices b. Online counseling i. ethical and legal issues surrounding it c. Increased emphasis on training counselors to respond to trauma and crises d. The merging of community counseling and mental health counseling to form a CACREP-accredited clinical mental health counseling track 3. Answer will vary. Here are a few possibilities: a. How the profession of counseling has changed: i. Counseling has become more diversified. 1. It has moved from a vocational and educational focus to include clinical mental health counseling, addictions counseling, college counseling, etc. 2. Diverse counseling theories and approaches 3. Clinical mental health counselors work in many different settings. ii. Counseling is becoming more unified 1. With the work of the 20/20 taskforce, the profession is becoming unified in its efforts to advance the future of counseling iii. It is more evidence-based. iv. It has grown in number and popularity 1. Membership of professional organizations 2. Credentialing, particularly licensure in all 50 states in the U.S. v. Standardized training with the creation of CACREP vi. Publishing of the ACA code of ethics b. Future projections i. Understanding and responding ethically to rapidly evolving technology 1. ACA code of ethics and credentialing will likely evolve to address issues specific to online or distance counseling, as well as to interactions with clients on social media ii. Understanding the complex connections between mental health and neurobiology and neuroplasticity 77

1. Could impact counselor training, our understanding and conceptualization of mental disorders, and our approaches to treating these disorders. 4. Answers will vary depending on the services that students select. See Figure 2-2 for details. A correct response would include the following: a. Direct Client Service: individual counseling b. Indirect Client Service: Referring clients to appropriate human service agencies c. Direct Systems Service: Stress management workshops d. Indirect Systems Service: Influencing public policy 5. Licensure and National Certification a. Licensure i. Arguably most important way of defining an occupation as a profession ii. Defines scope of practice iii. Determines who can and cannot offer certain services iv. A governmentally sanctioned form of credentialing based on the concept of the regulatory power of the state b. National Certification i. Ensures that counselors set national standards and minimum requirements for the practice of professional counseling. ii. Provides referral sources and networking across state lines. iii. National counseling certification is not a license to practice. iv. Counselors need to be aware of state licensure statutes before practicing. 6. Benefits of national certification: a. Ensures that counselors set national standards and minimum requirements for the practice of professional counseling. b. Provides referral sources and networking across state lines. c. National counseling certification is not a license to practice. d. Counselors need to be aware of state licensure statutes before practicing. 7. Importance of professional affiliation a. Issues facing the profession can be addressed collectively rather than individually b. Continuing Education c. Codes of ethics Chapter 2 Answer Key Multiple Choice Questions 1. c 78

2. a 3. d 4. d 5. d 6. e 7. c 8. b 9. a 10. c 11. a 12. b 13. a 14. c 15. c 16. a 17. a 18. b 19. c 20. c 21. f 22. c 23. c 24. c 25. a Essay Questions 1. Purpose and limitations of ethical codes a. Purpose i. Educate practitioners about sound ethical conduct ii. Provide a mechanism for accountability iii. Serve as a catalyst for improving practice iv. Clarify the nature of ethical responsibilities to clients and society v. Protect clients and members of the profession from unethical or incompetent practice vi. Helps protect a profession from outside regulation by providing a method for self-regulation b. Limitation i. Some issues cannot be resolved by a code of ethics ii. Some codes are ambiguous and, in turn, open to interpretation iii. Difficult to enforce iv. Conflicts may exist within ethical codes and among different organizations’ codes v. Some legal and ethical issues not covered in codes 79

vi. vii. viii. ix. x.

Conflicts may arise between ethical and legal codes Some may be adapted to specific cultures Cannot provide solutions to all situations Ethical codes are historical documents Knowledge of codes does not necessarily equate with ethical practice

2. Changes made to the 2014 ACA Code of Ethics a. Clarifies and highlights professional values b. Emphasizes use of technology c. Provides for use of social media d. Expands definition of relationship to prohibit counselors from having personal virtual relationships with clients e. Eliminates the end-of-life exception to the referral rule f. Clarifies counselors’ duty to inform. g. Expands the concept of pro bono services h. Clarifies counselors’ responsibilities with mandated clients i. Expands the role of confidentiality j. Provides updated requirements for counselor educators and researchers 3. Wheeler and Bertram’s (2015) Legal and Ethical Decision-Making Model: a. Define the problem, dilemma, and subissues i. What are the core concerns? 1. Legal? 2. Ethical? 3. Clinical? 4. Combination? b. Identify the relevant variables i. Who are the people and what is their involvement in the issue ii. What are the issues, dynamics and multicultural considerations? c. Review/consult the law, ethics codes, and institutional policy i. What laws (federal and state) pertain to this situation? ii. What codes of ethics relate to this issue? iii. Are there institutional policies to consider? d. Be alert to personal influences i. Personal values? ii. Bias/prejudice? iii. Countertranference? e. Obtain outside perspective i. Consultation ii. Supervision f. Enumerate options and consequences i. What are the options and potential consequences of those actions? ii. What might be some unintended consequences? g. Decide and take action i. Implement decision ii. Be prepared to reconsider options 80

h. Document decision making and follow-up actions i. Provide written evidence of clinical and ethical decision making ii. Provide written evidence of results of implementation Chapter 3 Answer Key Multiple Choice Questions 1. b 2. c 3. a 4. c 5. c 6. d 7. a 8. c 9. b 10. a 11. c 12. b 13. c 14. a 15. c 16. c 17. c 18. b 19. a 20. a 21. b 22. c 23. d 24. a 25. a 26. c 27. c 28. b Essay Questions 1. Enhancing multicultural competence a. Awareness i. Self-exploration: consider one’s own cultural heritage, values, and personal ethnic identity development 1. “How do I see myself as a member of my cultural group?” 2. “How do I see other people in my cultural group?” 81

3. “How do I perceive people who differ from me in regard to race, ethnicity, sexuality, and other areas? b. Knowledge i. understanding of economic, social, and political systems that affect psychosocial development ii. knowledge of histories, experiences, customs, and values of people from diverse groups iii. Read literature and use media to learn about lifestyles, customs, values, and traditions of ethnic groups iv. Interact with people in their cultural environments c. Skills i. recognize kinship influences, or roles played by immediate and extended family, and the community itself ii. Appreciate and be sensitive to clients’ language preference iii. Recognize and be sensitive to of gender-role socialization iv. Recognize the role of religion and spirituality within and between ethnic groups v. Consider the amount of privilege, or lack thereof, that a client experiences 2. Conveying Cultural empathy a. Chung and Bemak (2002) provide 8 suggestions (see section on conveying cultural empathy) 3. Establishing an environment in which clients feel safe to explore issues related to sexual identity. Answers will vary. See section on internalized homophobia and self-image for a list of suggestions. Chapter 4 Answer Key Multiple Choice Questions 1. b 2. d 3. b 4. c 5. d 6. c 7. e 8. b 9. d 10. a 11. d 12. c 13. a 14. c 15. b 82

16. d 17. c 18. d 19. a 20. d Essay Questions 1. Transtheoretical model of change a. Precontemplation: Unaware that problem exists. b. Contemplation: Aware of problem but denies seriousness of problem c. Preparation: Take small steps toward change. Potential commitment d. Action: Demonstrated commitment to change through overt actions e. Maintenance: Made positive changes and attempting to maintain them 2. Six topics addressed during intake interviews (Answers will vary) a. identifying information about a client b. presenting concerns and level of distress of client c. History of presenting concern d. Family background e. Personal history f. Previous counseling experiences g. Risk assessment h. Clinical impression and/or diagnosis i. Client’s goals for counseling 3. Sections of the SOAP format a. Subjective i. Info about problem from client’s perspective ii. Client’s feelings, thoughts, and goals iii. Intensity of the problem iv. Its effects on relationships b. Objective i. Factual observations made by counselors ii. Physical, interpersonal, or psychological findings c. Assessment i. Clinical thinking about client’s issues ii. synthesis of subjective and objective observations iii. Include Diagnosis (when appropriate) iv. Clinical impressions d. Plan i. Plans for future interventions and prognosis ii. Anticipated gains from treatment 4. Discuss reasons why counselors should engage in careful record keeping. a. Establish client treatment plans b. Help ensure continuity of care 83

c. d. e. f. g. h.

Providing proof of quality care It’s an ethical standard Protects counselor if malpractice allegations are made Inadequate or incomplete record may be harmful to client and counselor Funding sources require documentation Essential to work in many clinical settings based on utilization review, peer review, and quality assurance review

5. List and describe the five components of a treatment plan. a. Problem statement i. presenting problem clearly described b. Goal statement and expected date of achievement i. specific, measureable goals related to presenting problem ii. expected dates that goals will be accomplished c. Treatment modality i. interventions that will be used to help in goal achievement d. Clinical impression or diagnosis i. Accurate reflection of client’s mental health as described in the assessment ii. Diagnostic terms, when used, should be listed according to DSM or ICD codes iii. Names and credentials 1. List names and credentials of people participating in development of the treatment plan 2. List name of assigned clinician 3. Sign and date by person writing treatment plan Chapter 5 Answer Key Multiple Choice Questions 1. a 2. c 3. d 4. b 5. a 6. c 7. b 8. c 9. e 10. c 11. e 12. f 13. b 14. d 15. b 84

16. d 17. a 18. d 19. c 20. c Essay Questions 1. How assessment facilitates the counseling process: a. gathering information to determine the nature of clients’ issues, prevalence of their problems, their strengths and skills, and whether counseling is likely to be beneficial b. Can help counselors and clients develop an understanding of the presenting problems and issues, conceptualize the issue, select and implement effective interventions, and evaluate the progress made in counseling 2. Describe seven of the thirteen principles outlined by Hood and Johnson (2007) to help counselors conduct assessments skillfully. a. Answers may include seven of the following thirteen principles: i. Determine purpose of assessment. ii. Involve the client in selecting areas to be assessed and in the interpretation of assessment results. iii. Be sure that the instruments demonstrate tests trustworthiness. iv. Never rely on a single assessment tool. v. Consider the possibility of multiple issues vi. Assess the client’s environment. vii. Evaluate client strengths, as well as concerns. viii. Consider alternative hypotheses. ix. Be aware of cultural and personal biases that may influence decisions. x. Consider the influence of individual factors (e.g., age, gender). xi. Consult with other professionals on a regular basis xii. Provide feedback about assessment results to clients 3. Discuss the potential benefits and risks/limitations of diagnosis. a. potential benefits i. provides a consistent framework and set of criteria for naming and describing mental disorders ii. Enable counselors to understand client symptoms and anticipate course of a disorder iii. Enables counselors to make use of growing body of research on treatment effectiveness iv. provides a common language for mental health professionals, which facilitates parity, credibility, communication, and collaboration. b. potential risk/limitations i. Can be stigmatizing and lead to misperceptions of the person

ii. Part of the medical-illness cure tradition and not consistent with a holistic, developmental approach iii. Historically contingent and socially constructed, not absolute reality iv. Can lead to pathologizing the client in that he or she is viewed as the disorder v. May have negative impact on people’s ability to obtain insurance and, in some cases, affect employment opportunities vi. Steeped in Western concept of mental health. May not be relevant to people of other cultures vii. Puts the focus of treatment on the individual rather than the family or social system Chapter 6 Answer Key Multiple Choice Questions 1. c 2. d 3. b 4. b 5. a 6. c 7. a 8. a 9. b 10. c 11. e 12. b 13. c 14. d 15. e 16. d 17. e 18. a 19. b 20. e Essay Questions 1. Benefits of primary prevention efforts by counselors. a. most efficient way of helping promote mental health among the largest number of people b. Cost effective c. Takes into account the importance of ecological systems

2. Five components of the BATHE technique, and two examples of how a clinical mental health counselor could address each area. Answers may very regarding examples. a. Background – building rapport and establishing collaborative relationship. i. What do you feel comfortable sharing with me today? ii. What can you tell me that would help me understand your circumstances? b. Affect – attempts to understand client’s current emotional state. i. What are some of the feelings you have right now? ii. What feelings have you experienced during the past week c. Trouble - client’s presenting problem i. What troubles you most today? ii. What disturbs you most about your current circumstances? d. Handling – assesses client’s coping style and support systems i. Who do you turn to for support? ii. How do you find relief? e. Empathy – conveyed by counselor to client i. You are dealing with some really challenging circumstances. ii. This situation must be quite difficult for you. 3. McNamara’s (2000) eight components of a stress management program. a. Education about causes and consequences of stress i. helping people recognize sources of stress ii. helping people realize their responses to stress b. Training in methods to reduce psychological and physical arousal i. deep breathing ii. relaxation exercises c. General problem-solving and decision-making skills i. problem-solving ii. decision-making d. General cognitive skills i. cognitive restructuring e. Physical ways of coping with stress i. nutrition ii. physical activity iii. sleep f. Time management i. balancing work and leisure ii. organizing tasks g. Skills for increasing self-control and self-esteem i. anger management skills ii. build resilience by identifying strengths h. Social skills i. conflict resolution ii. assertiveness training Chapter 7 Answer Key 87

Multiple Choice Questions 1. d 2. a 3. c 4. c 5. d 6. a 7. d 8. b 9. c 10. c 11. b 12. d 13. d 14. a 15. d 16. b 17. c 18. a 19. d 20. a Essay Questions 1. Four of these six qualities of a successful consultant: a. Positive caring approach b. Strong communication skills c. Responsible work ethic d. Thorough diagnostic skills e. Wealth of content knowledge f. System savvy 2. Any five of these seven ways in which counselors might serve as advocates. a. Client empowerment b. Client advocacy c. Community collaboration d. Systems advocacy e. Public information f. Social/political advocacy g. Professional advocacy 3. Describe three issues or challenges of program evaluation. a. Logistics of data collection 88

b. Gathering and interpretation of evaluation data c. Professional resistance to evaluation due to concerns about how the results would be used 4. 5C’s of empowerment a. Collaboration i. working collaboratively to define problem and plan for change ii. Taking steps to decrease inherent power differential between counselor and client b. Context i. acknowledging role of factors such as poverty, racism, sexism, classism, and other barriers c. Critical Consciousness i. raise clients’ awareness of social, economic, and other power dynamics affecting their well-being d. Competence i. focuses on clients’ strengths, resources, and skills, used to help them take action toward problem resolution e. Community i. include family, friends, ethnic affiliations, faith connections, etc. Chapter 8 Answer Key Multiple Choice Questions 1. a 2. b 3. b 4. c 5. a 6. e 7. f 8. c 9. a 10. b 11. c 12. d 13. b 14. b 15. a 16. c 17. b 18. b 19. a 89

20. a Essay Questions 1. Five ways in which clinical mental health counselors can manage stress and avoid burnout. Any five of these activities. a. Identify and rely on support group b. Carry an index card listing ways you can reduce your own stress before you become overwhelmed c. List the triggers that affect you so that you can plan ahead to reduce their impact d. Commit to regular physical exercise, even when working in disaster environments e. Be aware of somatic stressors f. Practice relaxation exercises g. Journal 2. Risk factors and protective factors a. Risk Factors: i. Sex (Males more likely) ii. Age (Elderly and late adolescence) iii. Marital status (Divorced or widowed) iv. Diagnosis (Presence of psychiatric or medical illness) v. Prior suicide attempt (This is the best predictor of a future suicide) vi. Family history vii. Unemployment viii. Access to firearms ix. Military veteran status x. Posttraumatic stress disorder b. Protective Factors: i. Interpersonal support (e.g., family, friends, care providers, faith-based groups) ii. Restricted access to highly lethal means of suicide iii. Investment in effective clinical care iv. Cultural/religious beliefs which encourage self-preservation v. Healthy problem-solving and coping skill 3. Using the six-step model of crisis intervention, describe, step-by-step how you would help individual who are currently in a crisis situation. a. Step 1: Defining the problem b. Step 2: Ensuring client safety c. Step 3: Providing support d. Step 4: Examining alternatives e. Step 5: Making plans 90

f. Step 6: Obtaining commitment 4. According to NOVA, what are the five goals of crisis interventions? a. Defuse emotions b. Rearrange cognitive processes c. Organize and interpret what has happened d. Integrate the traumatic event into his or her life story e. Interpret the traumatic event in a way that is meaningful Chapter 9 Answer Key 1. b 2. d 3. e 4. a 5. b 6. d 7. c 8. d 9. d 10. b 11. c 12. a 13. e 14. d 15. a 16. c 17. b 18. b 19. a 20. c 21. d Essay Questions 1. List and describe the qualities of an effective group leader. a. Caring i. more the better b. Meaning attribution i. clarifying, explaining, and providing a cognitive framework for change c. Emotional stimulation i. being active, challenging content, risk taking, and self-disclosure d. Executive functioning i. developing norms, structuring, and suggesting procedures 91

2. List four types of groups and describe when you would use each. a. Psychoeducational Group i. To convey information and examine values around a mental health topic ii. To facilitate prevention of personal or societal disorder iii. Example: psychoeducational group related to test anxiety or cyberbullying b. Counseling Group i. interpersonally problem- or concern-focused ii. Focus on helping group participants resolve the usual, yet often difficult situations connected with living in an ever-changing society iii. Increasing problem-solving or skill-development around a problem such as assertiveness, mild depression, anxiety, etc. iv. Processing group c. Psychotherapy i. Designed to help individual group members resolve in-depth and sometimes serious psychological problems ii. Example: CBT group for individuals with Bipolar Disorder d. Task/Work Groups i. Improve work practices and accomplish identified work goals ii. Accomplishment and efficiency in completing identified work goals 3. Potential benefits and limitations of groups. a. Benefits i. Group members realizing that they are not alone, unique, or abnormal in their problems and concerns ii. Group members learning more about themselves in social situations iii. Group members trying out new behaviors and ways of interacting in a safe environment and receive feedback iv. Group members observing how others resolve problems v. Group members seeking individual counseling or methods for attaining personal goals b. Limitations i. Many concerns and personalities not well suited for groups ii. Group pressure may force a client into action, such as self-disclosure, before he or she is ready iii. Group members’ problems may not be adequately dealt with iv. Potential for groups to lapse into groupthink mentality v. May be used as an escape or for selfish purposes and thereby disrupt the group process vi. Difficulty in accommodating different schedules vii. Groups may become regressive and engage in nonproductive and even destructive behaviors such as scapegoating, group narcissism, and projection (McClure, 1994) 92

Chapter 10 Answer Key Multiple Choice Questions 1. c 2. d 3. c 4. a 5. b 6. c 7. c 8. b 9. c 10. b 11. c 12. b 13. b 14. d 15. c 16. b 17. a 18. b 19. c 20. a 21. c 22. a 23. d 24. b 25. d 26. a Essay Questions 1. Main principles of two couples counseling theories. a. Answers will vary based on the theories chosen 2. Main principles of two family counseling approaches. a. Answer will vary based on the theories chosen Chapter 11 Answer Key Multiple Choice Questions 1. a 93

2. b 3. a 4. b 5. d 6. a 7. c 8. b 9. b 10. d 11. a 12. c 13. a 14. d 15. b 16. a 17. b 18. c 19. b 20. b 21. b 22. c 23. b 24. c Essay Questions 1. Cyberbullying, Similarities/differences with traditional forms of bullying, Counselors a. Cyberbullying: i. Using the Internet, cell phones, or other electronic devices to send or post text or images intended to hurt or embarrass another person b. Similarities/differences with traditional forms of bullying i. Cyberbullying attacks can take place anonymously and quickly involve hundreds of participants and onlookers ii. isolates and haunts victims relentlessly through the internet iii. Similarities; Creates similar effects: fear, reduced self-esteem and sense of safety, social isolation, embarrassment, increased suicidal risk c. What counselors can do: i. take the issue seriously ii. provide psychoeducation for parents iii. provide support groups iv. provide solution-focused counseling v. provide supportive individual therapy that includes skill training vi. work with perpetrators of cyberbullying vii. advocate laws and regulations that prohibit cyberbullying 2. Four ways to help children whose parents are going through a divorce. 94

a. Answers may include four of the following: i. Help children 1. acknowledge the reality of the marital breakup 2. disengage from parental conflict and distress and resume typical activities 3. resolve the loss of what used to be 4. resolve anger and self-blame 5. accept the permanence of the divorce 6. achieve realistic hope regarding relationships 7. work with parents of children involved in divorce Chapter 12 Answer Key Multiple Choice Questions 1. c 2. d 3. c 4. a 5. b 6. b 7. b 8. c 9. a 10. d 11. a 12. a 13. b 14. c 15. e 16. c 17. b 18. b 19. d 20. c 21. a 22. c Essay Questions 1. Goals and actions associated with two developmental tasks in Levinson’s Developmental Tasks of Middle Adulthood model a. Answers will vary based on tasks that students choose. b. See Table 12-1 for more information i. Levinson’s Developmental Tasks 95

1. 2. 3. 4.

Young-Old Destruction-Creation Masculinity-Femininity Engagement-Separateness

2. Components of the Schlossberg’s (1984) 4 S transition model. a. Assess Situation i. understanding triggers, timing, control, role changes, duration, and current stressors b. Assess Sense of Self i. List to clients tell their stories ii. Use narrative approaches to get a rich sense of the client’s experiences and perceptions iii. Creative arts, etc. iv. Assess hardiness v. Learning about a client’s spiritual beliefs c. Supports i. Finding out what external resources the client can depend on and which ones might be “toxic.” d. Strategies i. How clients navigate transitions ii. Building on strengths iii. Plans to manage transitions in ways that contribute to growth and wellbeing 3. Three primary factors of the theory of Selective Optimization with Compensation (SOC). a. Selection (choosing goals and activities that are meaningful and important) b. Optimization (enhancing positive changes to achieve a set of desired outcomes c. Compensation (counteracting certain losses in ways that make it possible to reach outcomes i. Clinical mental health counselors can help older clients explore ways to adapt work- or leisure-related pursuits so that they can continue to engage in activities that are meaningful Chapter 13 Answer Key Multiple Choice Questions 1. 2. 3. 4. 5.

a b c d c 96

6. c 7. b 8. b 9. d 10. a 11. c 12. d 13. b 14. b 15. c 16. a 17. b 18. a 19. b 20. c Essay Questions 1. The New Diversity Initiative a. Helping faculty and student affairs staff become comfortable discussing issues of mental illness and suicide b. Forming a counseling center research team c. Developing a video about the most common issues seen in college counseling centers and use it as a training tool d. Identifying students in psychological distress who might not otherwise be identified e. Investigating any type of disorderly conduct or disruption caused by a student on campus f. Designing a training module for presentations across campus aimed at continuing the program g. Using pretests and posttests to assess knowledge gained by faculty and staff who participated in the trainings 2. Job, occupation, vocation, and career. a. Job i. activity undertaken for economic returns b. Occupation i. group of similar jobs found in different industries or organizations c. Vocation i. implies a psychological commitment or calling to a particular field d. Career i. totality of work one does in a lifetime (Sears, 1982) ii. course of events that constitute a life (Super, 1976) iii. total constellation of roles played over the lifespan (Herr et al., 2004) 97

3. Six categories of Holland’s RIASEC model (See Figure 15-1 in the text for more detail) a. Realistic - doers b. Investigative - thinkers c. Artistic - creators d. Social - helpers e. Enterprising - persuaders f. Conventional – organizers Chapter 14 Answer Key Multiple Choice Questions 1. c 2. d 3. b 4. a 5. c 6. b 7. a 8. d 9. b 10. c 11. b 12. a 13. c 14. b 15. a 16. d 17. d 18. a 19. c 20. c Essay Questions 1. Two settings in which clinical mental health counselors work that most appeal to you? Describe the population served at each setting, and the range of services offered. a. Answers will vary. 2. Phases of the Minnesota Model of Addiction Treatment. a. Detoxification i. medical detoxification ii. social detoxification iii. self-detoxification b. Residential treatment 98

i. can occur in medical or nonmedical facilities ii. focus on attainment of short-term goals in treatment and development of longer term goals for posttreatment c. Outpatient treatment i. 3-5 days or evenings per week, ranging from 3 to 10 weeks of care ii. Group focused, intensive, and multidimensional iii. Family members often encouraged to participate iv. Clients asked to attend AA or NA meetings during treatment d. Aftercare i. Recovery considered lifelong process ii. Maintenance stage of change iii. AA and NA important in this process Chapter 15 Answer Key Multiple Choice Questions 1. c 2. d 3. c 4. c 5. b 6. c 7. c 8. a 9. b 10. b 11. a 12. b 13. b 14. d 15. b 16. c 17. b 18. d 19. c 20. b Essay Questions 1. Advantages and disadvantages of managed care for counseling a. Potential advantages i. Contain costs and maintain service ii. Time-limited treatment is research-supported practice that is effective iii. Greater access to mental health services 99

iv. Increased number of referrals for some practitioners v. Implementation of quality control and standards of practice b. Potential Disadvantages i. Standardized treatment guidelines fail to take into account the unique nature of clients’ needs and compromise counselors’ autonomy in determining specific interventions ii. Arbitrary time limits iii. Caps on the number of sessions approved iv. Increased paperwork v. Difficulties in being placed on provider lists vi. Increased job stress vii. Insufficient qualified personnel acting as gatekeepers viii. Based on the medical model ix. Ethical dilemmas 2. Impact of Managed Care on Counseling a. Brief therapy is mandated and characterized by immediate assessment of client’s presenting problem, clearly delineated goals, and active counseling b. Pragmatic therapeutic relationship to provide the most efficient and effective treatment c. Communication with the PCP often required, as well as increased interaction with other health care professionals d. Counseling process is monitored by the MCO (utilization review) i. Typically includes documentation of treatment necessity ii. Regular submission of treatment plans 3. Answers will vary. a. Haas & Malouf’s Model of Ethical Decision Making i. Gather information about the problem. ii. Consult with colleagues and look at relevant literature to consider pertinent legal and ethical principles iii. Create a list of appropriate responses iv. Conduct a cost-benefit analysis of each potential response v. Choose the option that best resolves the dilemma vi. Act on that option and evaluate its effectiveness Glossary 20/20 A Vision for the Future of Counseling: a group established by the ACA and 29 major counseling organizations to address the issue of professional identity and advancing the future of counseling.

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23-hour observation bed: an alternative to formal admission into an inpatient unit for clients who need intensive monitoring and evaluation. ABCX model of crisis: In this model of crisis, an event or situation (A) becomes a crisis depending on the resources (B) and perception (C) of an individual or family and the degree of stress (X) from low to high generated by the event or situation. Abraham and Hannah Stone: established the first marriage and family counseling center in New York City. Ableism: Discrimination against anyone with a disability. Absurdity: a technique used in experiential family therapy by Carl Whitaker. It is a statement that is half-truthful and even silly if followed out to its conclusion. Abuse: a pattern of behavior used to establish power and control over another person through the use of fear or intimidation. Academic Misconduct Research Group: included in the fifth step of the New Diversity Initiative, it a group directed to investigate any type of disorderly conduct or disruption caused by a student on campus. ACA Code of Ethics: a comprehensive document used to clarify the nature of ethical responsibilities, support the mission of the organization, establish principles that inform best practice, assist members in constructing a course of action, and serve as the basis of processing ethical complaints and inquiries. Acculturation: “cultural adaptation that occurs as a result of contact between multiple cultures” (Miller, 2007, p. 118). Action factors: a category of the common curative factors of effective counseling that includes factors such as reality testing, rehearsal, and mastery efforts. Addiction: “a persistent and intense involvement with a stress upon a single behavior pattern, with a minimization or even exclusion of other behaviors, both personal and interpersonal” (L’Abate, 1992, p. 2). Addiction Counseling: a CACREP specialty area. Adjourning stage: also referred to as the mourning/morning stage, it is the last stage of the group process wherein the group comes to an end, and members say good-bye to one another and to the group experience. Administrative law: created by government administrative agencies that develop regulations to help define the laws, or statutes, that are passed by a legislative body.

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ADDRESSING model: An acronymic guide developed by Hays (2016) that can help counselors systematically consider various cultural influences. Letters in model stand for age and generational influences, developmental disabilities, disabilities acquired later in life, religion (and/or spirituality), ethnicity (may include race), social status (or social class), sexual orientation, indigenous heritage, national origin, and gender (and gender socialization). Adolescence: the period when young people transition from childhood to adulthood. Adversity: refers to negative life events that impact people throughout the life span. Advocacy: an action taken by counseling professionals to help remove environmental barriers that hamper clients’ well-being (Toporek, 2000). Advocacy counseling: expands the traditional role of individual counseling, which focuses on intrapersonal concerns, to a broader focus that addresses injustice, oppression, and environmental conditions that need to improve for the benefit of an individual or group. Affectional orientation: refers to past, present, and ideal feelings about who is attractive and desirable in sexual and/or romantic ways. It also is called sexual orientation. Affective domain of the Triage Assessment Model: includes emotional responses such as anger/hostility, anxiety/fear, and sadness/melancholy. Affective experiencing: ways of feeling. Ageism: “an unreasonable prejudice against persons based on chronological age” (Myers & Shannonhouse, 2013, p. 151). Aging family: a family where both partners are age 65 or older. Ambivalence: term used to describe clients who exhibit mixed feelings about making changes, such as smoking cessation. American Association for Counseling and Development: the name of the national professional organization for counselors from 1983- 1992, formerly called the American Personnel Guidance Association. American Counseling Association: the current name, since 1992, of the national professional organization for counselors, formerly called the American Association for Counseling and Development. American Mental Health Counselors Association: professional organization founded in 1976 that defined the roles and goals of mental health counseling. American Personnel and Guidance Association: founded in 1952 with the purpose of formally organizing groups interested in guidance, counseling, and personnel matters. 102

Anorexia nervosa: an eating disorder in which individuals weigh less than 85% of what is considered normal for their age and height. Some individuals with anorexia nervosa restrict eating (restricting type) while others engage in compulsive exercise or purge by means of vomiting or use of laxatives (binge-eating/purging type). Anticipated transitions: considered normative, that is, they are expected to occur in a somewhat predictable sequence across the lifespan. Appraisal: used interchangeably with assessment and refers the use of formal and informal techniques of gathering information. Approaching transitions: one of the three major parts of the transition model that refers to identifying types of transitions and the transition process itself. Army Alpha, Army Beta: intelligence tests commissioned by the U.S. Army to screen its personnel. Association of Counselor Education and Supervision (ACES): a division of the American Counseling Association focused on counselor education and supervision. Aspirational ethics: followed when counselors make decisions based on internalized principles and ideals of the profession, not just external considerations. Assessment: “any systematic method of obtaining information from tests and other sources, used to draw inferences about characteristics of people, objects, or programs” (AERA, 1999, p. 172) Assertive community treatment (ACT): a case management model that is designed to assist clients in accessing, cording, and integrating mental health services. Assimilation: part of a 4-step process to separate one’s personal values from professional values consisting of an adoption of new professional ethics and abandonment of former cultural values. Asynchronous counseling: a form of online counseling in which there is a time lapse between client-counselor communications. Attention: a core building block of mindfulness that refers to paying attention to what is going on at the moment; focusing. Attitude: a core building block of mindfulness that refers to observing what is going on in a nonjudgmental manner. Attributional bias: a faulty cognitive processing skill in which an individual erroneously attributes qualities such as hostility to others in situations that actually are neutral. Autonomy: a moral principle proposed by Kitchener (1984) pertaining to respect for and 103

protection of clients’ individual freedom of choice and action. Autonomy: increasing one’s independence from parents, becoming financially stable, and being able to make decisions. Avoidance: term used to describe clients who display behaviors such as displaying in-session extremes expressed as outbursts against the counselor; debating, attempting to derail or detour conversation with such terms as “I don’t know” or by changing the subject, or manipulating the session by waiting until the end of the session to bring up important information.” Avoidance behaviors: crisis reactions in which clients try to ignore, deny or escape the crisis event. BATHE technique: A BPS assessment that enables counselors to assess the major domains of the BPS model, which includes the following areas: background, affect, trouble, handling, and empathy. Batterers: those who inflict physical abuse. Beck Depression Inventory II (BDI II): Outcome measure used to monitor client depression. Behavioral disorders: process disorders such as gambling disorders. Behavioral domain of the Triage Assessment Model: responses to crisis including approach behaviors, avoidance behaviors, and immobility Beneficence: a moral principle proposed by Kitchener (1984) that refers to counselors’ obligation to contribute to the welfare of their clients. Blamer: term used by Satir to describe a nonproductive communication style in which a family member, under stress, tends to dominate and find fault. Biological components of the BPS model: include physical, biochemical, and genetic factors that influence mental health. Biomedical model: a paradigm in which a professional solely emphasize and treat physiological symptoms of a disorder, and do not take into account other factors, such as behavioral, psychological, and social factors. Biopsychosocial (BPS) model: an approach to medicine and mental health that recognizes the interrelated, integrated roles played by biology, psychology, and social/cultural factors in the maintenance of wellness and the understanding of illness. Body dysmorphia: a distorted body image. Bogust v. Iverson: a 1960 court case in which a judge ruled that a counselor with a doctoral 104

degree could not be held liable for the suicide of one of his clients because counselors were “mere teachers” who received training in a department of education. Boomerang generation: a term referring to adult children who return to live at home for an indefinite period of time during difficult economic times. Boston Vocational Bureau: Founded in 1908 by Frank Parsons, it represented a major step in the development of vocational guidance. At the bureau, Frank Parsons worked with young people who were in the process of making career decisions. Bracket: the act of intentionally separating counselors’ personal values from his or her professional values “to provide ethical and appropriate counseling to all clients” (Kocet & Herlihy, 2014, p. 182). Broaching: Using the cultural meaning that clients attach to phenomena to facilitate client empowerment, strengthen the therapeutic alliance, and enhance counseling outcomes. Bronfenbrenner’s biological model: consists of five interactive systems, including the microsystem, mesosystem, exosystem, macrosystem, and chronosystem. Bruff v. North Mississippi Health Services, Inc. (2001): a court case in which a federal appeals court upheld the job termination of a counselor who asked to be excused from counseling a lesbian client on relationship issues because the client’s sexual orientation conflicted with the counselor’s religious beliefs (Hermmann & Herlihy, 2006). Bulimia nervosa: an eating disorder characterized by recurrent episodes of binge eating, typically twice a week or more, followed by attempts at compensating by purging or exercising. Burnout: “a state of physical, mental, and emotional exhaustion caused by long-term involvement in emotionally demanding situations” (James, 2008, p. 521). Capacity: ability to make rational decisions. Career: the course of events that constitute a life (Super, 1976). Career coaching: an interactive process that helps individuals and organizations improve their performances. Career counseling: several definitions exist: “a formal relationship in which a professional counselor assists a client or group of clients to cope more effectively with career concerns” (Niles & Harris-Bowlsbey, 2013, p. 16). Career development facilitator: an occupational title that designates individuals working in a variety of career development settings. Career education: a systematic attempt to influence the career development of students and 105

adults through various educational strategies, including providing occupational information, infusing career-related concepts into the academic curriculum, and offering career planning activities (Brown, 2012). Career information: Information about the labor market, including job trends, industries, and comprehensive information systems. Career intervention: a deliberate act designed to empower people to cope effectively with care development tasks. Career maturity: the readiness of a client to make sound career choices. Carl Rogers: Espoused a nondirective approach to counseling that focused on giving clients the responsibility for their growth. Carol Gilligan: facilitated the introduction of feminist theory through her landmark study on the development of moral values in females. Case conceptualization: also known as case formulation, it includes many definitions. It provides a way for a counselor to link a client’s problems to a treatment plan, as well as a way to tailor interventions to specific client needs. Case management: links clients to essential services and supports, such as financial benefits, health care, and psychiatric treatment. Catchment areas: geographic areas of 75,000 to 200,000 people. Catharsis: releasing or expression of pent up emotions. Certification: a professional, statutory, or nonstatutory process “by which an agency or association grants recognition to an individual for having met certain predetermined professional qualifications” (Fretz & Mills, 1980, p. 7). Certified clinical mental health counseling credential (CCMH): a specialty credential within the field of professional counseling, which is now administered by NBCC. Checklists: a type of assessment tool designed to allow clients or observers to simply mark words or phrases that apply to them or their situation. Chi Sigma Iota: an international academic and professional honor society for counselors. Childless couples: couples who do not have a child or children. Child maltreatment: child abuse (i.e., physical, sexual, psychological or emotional) and neglect. Chronosystem: One of the five interactive systems of Bronfenbrenner’s Bioecological Model. It 106

refers to the evolution of the four other systems over time. Circular causality: the idea that family members affect each other for better or worse, and the family as a whole, through their multiple interactions. Civil Law: applies to acts committed that affect the civil rights of individuals or other bodies. Classism: refers to oppression, discrimination, or marginalization experienced by people who are negatively affected by socioeconomic disparity. Client-aimed interventions: include personal adjustment counseling, vocational counseling, behavioral modification, and skill development in performance of the activities of daily living (ADLs). Client-centered case consultation: the most commonly used form of mental health consultation wherein the consultee presents a case about a particular client who is experiencing a problem for which the consultee needs treatment recommendations. Client-induced stressors: include difficult or resistant clients, clients experiencing trauma or crisis, and clients who terminate prematurely. Client outcome research: designed to evaluate the effectiveness of specific interventions. Client records: refers to all client information that is needed for effective service delivery. Clifford Beers: former Yale student hospitalized for mental illness several times during his lifetime. Exposed the deplorable conditions in mental institutions with his book, A Mind That Found Itself. Clinical mental health counseling: Represents the merging of community counseling with mental health counseling. Emphasizes wellness, prevention, personal growth, psychoeducation, treatment, and empowerment. Clinical Outcomes in Routine Evaluation CORE-OM: A computerized system designed to measure clients’ subjective well-being, problems and symptoms, life functioning, and risk/harm. Client Evaluation of Counseling Inventory (CEC): client outcome measure used to measure subjective well-being, presenting symptoms, overall life functioning, quality of life, and the therapeutic alliance. Closed-ended groups: groups that do not admit members after the groups have begun. Closed questions: used to elicit a large amount of information in a short time, but do not encourage elaboration. Coaching: “partnering with clients in a thought-provoking and creative process that inspires 107

them to maximize their personal and professional potential (ICF, 2016). Cognitive constriction: a severe reduction in a person’s ability to develop options for managing stress. Cognitive disability: a category of disability which includes the following developmental disabilities: Alzheimer’s disease, learning disabilities, and other cognitive impairments. Cognitive distortions: negative, inaccurate biases that can result in unhealthy misperceptions of events. Cognitive domain of the Triage Assessment Model: responses that include client perceptions of transgression, threat, and loss. Cognitive (intellectual or mental) processes: technique in Bowenian therapy in which a counselor asks the family content-based questions. Cognitive learning: ways of thinking. Cohabitation: refers to the lifestyle of unmarried couples living together in an intimate, sexual relationship. Coleaders: two leaders facilitating a group. Coming out: refers to the ongoing process of letting other people know that one is lesbian, gay, or bisexual. Communication: a family counseling term that refers to the idea that all behavior is communicative and, thus, it is important to attend to both the content (i.e., factual information) and relationship (i.e., how the message is to be understood) of a message. Community-based mental health: also called community behavioral health, aims to provide a comprehensive system of care designed in partnership with the community, service providers, and payors. Community counseling: term identifying counseling activities that take place outside other established domains. Community Mental Health Centers Act of 1963: authorized the establishment of a nationwide system of community mental health centers (CMHCs) that would serve the needs of America’s newly deinstitutionalized mentally ill population by focusing on outpatient, community-based services. Compassion fatigue: a response to helping or being involved with people who experience trauma or extreme predicaments and exhibit symptoms that resemble posttraumatic stress disorder.

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Complex trauma: exposure to traumatic events repeatedly over time. Concrete operational stage: Piaget’s third stage, during which children are capable of reasoning logically about concrete, tangible information and are able to mentally reverse actions, although they can only generalize from concrete experiences. Confidentiality: professional promise not to disclose information revealed during the privacy of the counselor-client relationship, except under specific, mutually understood conditions. Configural equation: prevention equation developed by Bloom (1996) which focuses on three dimensions: increasing individual strengths and decreasing individual limitations; increasing social supports and decreasing social stresses; and enhancing environmental resources and minimizing environmental pressures. Congruence: a central construct of the Theory of Vocational Choice, it refers to a match between personality type and work environment type. Consistency: a central construct of the Theory of Vocational Choice, it refers to the relative proximity, regarding the arrangement of the letters on the Holland hexagon, of a person’s threeletter personality code. Consultant: the professional helper providing consultation Consultation: “a problem-solving, interpersonal relationship that develops through periodic faceto-face contacts between consultant and consultee” (Erchul, 2003, p. 105). Consultee: the professional working directly with the client who requests help from the consultant. Consultee-centered administrative consultation: emphasis of the consultation is “to assess the consultee and administrative staff to develop more effective professional functioning of an individual, group, or entire organization” (Sears et al., 2006, p. 405). Consultee-centered case conceptualization: consultation focused on improving the consultee’s ability to work effectively with a particular case as well as with similar cases. Emphasis is placed on possible shortcomings in the consultee or in the support system of his or her organization (Erchul, 2003). Context: a term associated with transitions that refers to factors such as environment, gender, culture, socioeconomic status, and other variables that influence the effects transitions have on people. Contextualism: organism-context interaction (Thomas, 1996). Controlling behaviors: parental interactions with children that include rule-setting, negotiating, and consistent discipline that help establish guidance and flexibility within the power hierarchy of the family. 109

Counselor burnout: a form of compassion fatigue characterized by a state of emotional , mental, and physical exhaustion brought on by prolonged stress. Covert rehearsal: involves imagining and reflecting on the desired course of action. Council for Accreditation of Counseling and Related Educational Programs (CACREP): accrediting body of the counseling profession. Council of Guidance and Personnel Association: a loose confederation of organizations focused on educational and vocational guidance, and personnel related activities. Counseling: “a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals” (20/20: A Vision for the Future of Counseling). Counseling groups: groups that are interpersonally problem or concern focused, the main goal of which is to help group participants resolve the usual, yet often difficult, situations connected with living in an ever changing society. They also emphasize helping participants develop their existing interpersonal problem-solving competencies to better handle future problems. Counseling psychology: a specialization area in psychology that is represented by Division 17 of the APA. Counseling psychologists have doctoral degrees and are employed in universities as well as a range of human services settings. Couple enrichment: based on the concept that couples, and consequently their families, stay health or get healthier by actively participating in certain activities with other couples (Mace & Mace, 1977). Couples counseling: working with two partners on their relationship. Court order: a subpoena to appear in court at a certain time in regard to a specific case. Criminal law: applies to acts that are considered crimes against society and are prosecuted by the government, not the individuals. Crisis: a perception or experiencing of an event or situation as an intolerable difficulty that exceeds the person’s current resources and coping mechanisms (James, 2008, p. 3). Crisis Incident Stress Management (CISM): a comprehensive, integrated, systematic, and multicomponent crisis intervention model, also known as the Mitchell Model, based on crisis intervention, group psychotherapy, community psychology, and peer support. Crisis intervention: a “time-limited treatment directed at reactions to a specific event in order to help the client return to a pre-crisis level of functioning” (Myers, 2001, p. 5).

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Culturally encapsulated: of or relating to counselors who disregard cultural differences and operate under the assumption that all counseling theories and techniques are equally applicable to all clients. Cultural pluralism: term used to describe minority groups who participate fully in the dominant society, yet maintain their distinct cultural differences. Cultural racism: occurs when one cultural group considers another group inferior, and the first group has the power to impose its standards on the other group. Culturally sensitive empathy: the ability to perceive the cultural frame of reference from which a client operates and which guides the client’s perceptions. Culture: refers to any group of people who identify with one another on the basis of a common purpose, need, or similarity of background. Culture analysis: entails enabling clients to examine the multiple identities that have shaped their lives and examine ways cultural beliefs have impacted their lives, both positively and negatively. Cutoff: a concept in Bowen family systems marital theory to describe physical or psychological avoidance. Day Programs: provide intensive treatment (e.g., individual therapy, group therapy, psychoeducation) to clients who do not need 24-hour care but have significant impairment due to psychiatric, emotional, behavioral, and/or addictive disorders. Deinstitutionalization: the removal of people with severe mental health issues from state institutions and public hospitals. Demographic variable: include variables such as age, gender, and place of residence (Pedersen, 1990, p. 550). Denial: a common defense mechanism that involves minimizing the effects of substance abuse on oneself or others. Department of Veterans Affairs’ Choice Program: a program that allows veterans to obtain a wide variety of health care, including mental health, from non-VA providers. Detoxification: the process of removing toxic substances or qualities. Developmental crises: crises that occur during the normal flow of human growth and maturation. Developmental stressors: stressors that families experience which are associated with age and life stages. Diagnosis: “The process of comparing the symptoms exhibited by the client with the diagnostic 111

criteria of some type of classification system” (Hohenshil, 1996, p. 66). Dictionary of Occupational Titles (DOI): first published in 1939, it is a major source of career information for vocational counselors that describes known occupations in the United States and codes them according to job titles. Differentiation: a key focus of Bowen family systems marital theory, it refers the ability to distinguish one’s thoughts from one’s emotions and one’s self from others. Differentiation: a central construct in the Theory of Vocational Choice, it indicates the degree to which an individual’s interests are defined. Disability: a physical or mental impairment that substantially limits a major life activity. Disclosure: refers to counselors providing clients with the information they need to make informed decisions about entering into counseling, remaining in counseling, and sharing personal information. Disengagement stage: the final stage of Super’s developmental theory (65 and above), in which individuals detach from work and align with other sources of life satisfaction. Disequilibrium: a crisis intervention assessment term referring to a lack of emotional stability or balance. Distractor: term used by Satir to describe a nonproductive communication style in which a family member, under stress, tends interrupt and constantly chatters about irrelevant topics. Door openers: noncoercive invitations to talk. Door closers: judgmental or evaluative responses. Dopamine: a neurotransmitter, the reduction of which is linked to an increase in hyperactivity and irritability. Double ABCX model of crisis: in this model of crisis there are double A, double B, and double C factors that represent accumulated or multiple aspects of the elements that go into making a situation a crisis, such as stressors, resources, and coping strategies. Double systems therapy: an REBT perspective in which emphasis is placed on personal and family systems change. Downcoding: the act of a counselor assigning a less serious diagnosis to a client than is warranted so that a client can receive treatment. Dual-career families: families in which both marital partners are engaged in developing careers to which they have a high commitment (Hertz & Marshall, 2001). 112

Dual diagnosis: the coexistence of substance abuse and mental disorders. Due care: refers to the legal obligation that counselors have to act in the best interest of the client. Duty to Care: a legal obligation of health provider to not act negligently. Duty to Warn: refers to counselors’ duty to take reasonable action to help protect potential victims from dangerous clients. Early adulthood (~25 to 40 years): traditionally identified by several indicators: finishing education, entering full-time work, marriage or partnership, and parenting. Early childhood stage (ages 2 to 6): sometimes called the play years. During this period, motor skills are refined, children begin to build ties with peers, and thought and language skills expand rapidly. Early middle life: the period during middle adulthood from ages 40-54. Ecosystemic crises: natural or human-caused disasters that overtake a person or group of people who “find themselves, through no fault or action of their own, inundated in the aftermath of an event that may adversely affect virtually every member of the environment in which they live” (James, 2008, p. 14). Efficiency evaluation: connects the costs of implementing a particular program with the benefits achieved by the participants. Egalitarian marriages: marriages in which spouses relate as equals, share household tasks, and engage in conflict resolution. E. G. Williamson and Associates: developed the first theory of counseling called trait-factor counselor or the Minnesota Point of View. Egocentrism (in adolescence): characterized by a belief in one’s uniqueness and invulnerability and may be reflected in reckless behavior and grandiose ideas. Ego Integrity vs. Despair: In Erikson’s theory, the psychosocial crisis of older adulthood that is resolved when individuals believe that they have accomplished what they set out to do. Egosyntonic: a common perception of personality disorders whereby clients view their disorder as an integral part of the self. Elder abuse: refers to maltreatment, neglect, and exploitation of older adults. Elderspeak: a condescending way of speaking to older adults that often resembles “baby talk” as 113

evidenced by simple, short sentences, exaggerated emphasis, a slower rate, and a higher pitch. Emerging adulthood: a new, distinct stage of development that represents a time of transition between adolescence and young adulthood. Emic perspective: focuses on the indigenous characteristics of each cultural group that influence the counseling process. Emphasizes counseling approaches that are culturally specific. Emotional autonomy: the freedom from persistent needs for external approval and reassurance. Emotional intelligence: the ability to perceive, understand, and express emotions. Emotion-focused strategies: affective coping mechanisms that individuals employ to deal with life stressors, such as self-help and self-punishment. Employee assistance programs: work-based programs that address the personal problems of employees and their family members to improve the productivity of the workforce. Empowerment: the process through which clients gain the resources and skills needed to have more control over their environments and their lives. Empowerment counseling: counseling focused on increasing clients’ self-advocacy and helping clients overcome inequities that may undermine the development of health relationships (Savage et al., 2005). Enculturation: involves the retention of one’s culture of identity. Enmeshment: a term that describes family environments in which members are overly dependent on each other or are undifferentiated. Environment-aimed interventions: interventions that are targeted toward barriers in the external environment that may need modification to meet the client’s goals, such as helping a client use assistive aids. Epinephrine: a hormone that is secreted by the adrenal glands, also known as adrenaline. Equifinality: a term in family counseling that refers to the concept that the same origin may lead to different outcomes, and the same outcome may result from different origins. Equilibrium: a crisis intervention assessment term that refers to a state of emotional stability or balance. ERIC Clearinghouse on Counseling and Personnel Services (ERIC/CAPS): provides multiple sources of information about counseling activities and trends in the United States and throughout the world.

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Establishment stage: the third stage of Super’s developmental model (ages 25-44), in which adults choose and implement a career and become established in that career. Ethics: “a philosophical discipline that is concerned with human conduct and moral decision making” (VanHoose & Kottler, 1985, p. 3). Ethnographic variables: include variables such as ethnicity, nationality, religion, and language (Pedersen, 1990, p. 550). Etic perspective: emphasizes the universal qualities of counseling that are culturally generalizable. Event-related stressors: stem from individuals’ personal lives and may include developmental transitions, health-related issues, and financial concerns. Evidence-based practice (EBP): “a broader term and refers to clinical practice that is informed by evidence about interventions, clinical expertise, and [client] needs, values, and preferences and their integration in decision making about individual care” (Kazdin, 2008, p. 147). Evidence-based treatment (EBT): treatments identified based on the outcomes of randomized controlled trials. Executive coaching: involves a one-on-one helping relationship between the coach and the client aimed at helping the executive perform his or her duties more effectively. Existential crises: equated with intense, pervasive inner conflict and anxiety associated with the existential issues of purpose, meaning, responsibility, freedom, and commitment. Exosystem: One of the five interactive systems of Bronfenbrenner’s Bioecological Model. It refers to a context that exerts an indirect influence on the child’s development. Expert witness: “an objective and unbiased person with specialized knowledge, skills, or information, who can assist a judge or jury in reaching an appropriate legal decision” (Remley, 1992, p. 33). Exploration stage: the second stage of Super’s developmental theory, it takes place during later adolescence and early adulthood and the major tasks of this stage include a general exploration of the world of work and the initial specification of a career preference. External consultant: someone who is not already employed by the organization. Externalizing the problem: a narrative technique in which family members are asked to identify and name a problem so that all family members can objectively address unproductive behaviors (White, 1995). Extreme risk: in reference to suicide assessment, this evaluation is given when a client is unable to agree to a safety plan and has a specific and lethal plan for suicide. 115

Fading: refers to a process in which counseling appointments are spaced over increasing lengths of time. Family: those persons who are biologically and/or psychologically related through historical, emotional, or economic bonds and who perceive themselves to be a part of a household. Family adaptability: the ability for a family system to be flexible and to change. Family cohesion: emotional bonding between members of a family. Family development and environmental fit: a crucial variable in unexpected stress, as the environment in which families reside influence the way they respond to unexpected crises. Family life cycle: name given to the stages a family goes through as it evolves over the years. Family preservation programs: provide family-based services designed to keep dysfunctional families together. Family rules: provide expectations about roles and actions that govern family life. Fee-for-service system: insurance companies pay for services rendered by practitioners after consumers meet specified deductible amounts. Feedback: a multidimensional process that consists of group members’ responding to the verbal messages and nonverbal behaviors of one another. Feminist theory: focuses on the influence of gender, the oppression of women, and the influence of politics. Feminist therapy: informed by feminist theory, its primary goal is to empower clients, both female and male and includes three basic tenets: the personal is political, the relationship between counselor and client is egalitarian, and concerns of women and oppressed persons are primary not an afterthought. Fidelity: a moral principle proposed by Kitchener (1984) which refers to the need for counselors to be loyal to their clients, to honor their commitments, and to fulfill their obligations. First-order change: continuing to do more of the same things that have been done previously. Five Factor Wellness Inventory: assessment instrument designed to assist individuals in making healthier lifestyle choices and examine areas of their life that may be out of balance. Follow-up: used to keep in touch with group members after a group has terminated, to determine how well individuals are progressing on personal or group goals.

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Formal operational stage: Piaget’s fourth stage, in which individuals are able to deal with abstractions, form hypotheses, engage in mental manipulation, and predict consequences. Forming stage: the first stage of a group in which a foundation is usually laid for what is to come and who will be considered in and out of group deliberations. Fourth-party payments: reimbursement for services paid by the companies themselves. Frank Parsons: known as the founder of guidance. Focused his counseling work on prevention and growth. Founded Boston’s Vocational Bureau. Free consent: ability to engage in an activity, such as counseling, without undue pressure or coercion. Fusion: a concept in Bowen family systems marital theory to describe undifferentiated emotional togetherness. Gay: refers to men who are sexually oriented to other men. Gay and lesbian families: families made up of a parent who is gay or lesbian or two partners who are gay or lesbian. Gender Dysphoria: term used to describe individuals who experience incongruence between their expressed/experienced gender and their assigned gender. Gender role analysis: entails examining the gender socialization that has shaped clients’ lives. Genderqueer: individuals who do not identify with the traditional labels of male and female. Generalist human services worker: considered second-level helpers, these individuals usually are human services personnel who have received some formal training in human relations skills but work as part of a team rather than individually. Generativity vs. stagnation: In Erikson’s theory, the psychosocial crisis of adulthood that is resolved through finding ways to give to and guide the next generation. Genogram: a visual representation of a person’s family tree depicted in geometric figures, lines, and words. George-Dean Act: Passed by Congress in 1938. Created the Vocational Education Division of the U.S. Office of Education as well as an Occupational Information and Guidance Service. Gerald Caplan: known as the father of the modern practice of mental health consultation. He developed and refined many conceptual models and methods for practicing consultation in clinical mental health and other settings. Gender-aware counseling: involves (a) recognizing the ways gender roles are socially and 117

culturally constructed (Belsky, 2016); (b) recognizing that gender development is influenced by a multitude of factors, including biology, cognition, culture, and socialization by caregivers (Root & Denham, 2010); and (c) recognizing that gender refers to socially constructed roles, whereas biological sex refers to the possession of an XY chromosome pair for genetically healthy males and an XX chromosome pair for genetically healthy females (Robinson-Wood, 2017). Gerotranscendence: a period when an older adult begins to withdraw from the material and focus on a world that is more spiritual in nature. Gilbert Wren: wrote a widely influential book, The Counselor in a Changing World. He emphasized working with others to resolve developmental needs. Globalization of counseling: recognizing global changes (e.g., financial instability, climate changes, population aging, advances in technology). Glucocorticoids: a hormone secreted by the adrenal glands, also known as cortisol or hydrocortisone. Group: “a collection of two or more individuals who meet in face-to-face interaction, interdependently, with the awareness that each belongs to the group and for the purpose of achieving individual and/or mutually agreed upon goals” (Gladding, 2016, p. 4). Group process: the interaction of group members based on intrapersonal and interpersonal dynamics. Group psychotherapy: often occurs in inpatient facilities and are set up to help individual group members resolve their in-depth and sometimes serious psychological problems. Groupthink: mentality in which stereotypical, defensive, and stale thought processes become the norm while creativity and problem solving are squelched. Group work: “a broad professional practice involving the application of knowledge and skills in group facilitation to assist an interdependent collection of people to reach their mutual goals, which may be intrapersonal, interpersonal, or work related. The goals of the group may include the accomplishment of tasks related to work, education, personal development, personal and interpersonal problem solving, or remediation of mental and emotional disorders” (ASGW, 2000, p.3). Growth stage: the first stage of Super’s developmental theory (from birth to age 14), in which children form a mental picture of themselves in relation to others. Guidelines for acting in ethically responsible ways: developed by C. D. Swanson (1983) which can be used to help counselors assess their thoughts and actions. The guidelines include the following steps: 1. Personal and professional honest; 2. Acting in the best interest of clients; 3. Acting without malice or personal gain; and 4. Justifying an action. 118

Hardiness: term that describes an individual’s stress resistance. Hazelden Model: also known as the Minnesota Model of Addiction Treatment, it is a multidisciplinary model based on the disease concept of dependency, which asserts that chemical addiction is a treatable disease with specific origins, symptoms, progression, and outcomes. Ascertains that recovery is only possible through abstinence accompanied by major emotional and spiritual changes. Health and Wellness Coach: work with clients who are interested in developing healthier lifestyles and/or examining their levels of wellness in various areas of life, including physical, social, emotional, spiritual, intellectual, and other domains. Health Information Technology for Economic and Clinical Health Act (HITECH): enacted to provide additional privacy and security requirements regarding electronic health records. Health Insurance Portability and Accountability Act (HIPAA): a federal regulation that has many standards and rules that address client and patient privacy and security. Health Maintenance Organization Act of 1973: designated federal funding for the development of managed care programs and required employers to offer managed care options to employees. Health maintenance organizations (HMOs): one of several forms of managed care systems designed to reduce total health care costs by shifting care to less expensive forms of treatment. Heterosexism: refers to the viewpoint that heterosexuality is the only acceptable sexual orientation. High risk: in reference to suicide assessment, this evaluation is given when a client has a suicide plan but easily engages in safety planning. Homeostasis: a state of equilibrium in which a family tends to remain unless forced to change. Homonegativity: a term that encompasses the concepts of both homophobia and heterosexism. Homophobia: refers to an antigay bias, or a fear of individuals who are perceived as lesbian, gay, or bisexual. Homoprejudice: also called homophobia, refers to an antigay bias, or a fear of individuals who are perceived as lesbian, gay, or bisexual. Honeymoon stage: approximately the first six months of marriage in which couples experience excitement about starting a new life together and a propensity to idealize each other. Horizontal stressors: those related to the present, such as current work or marital relationships and life cycle transitions.

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Hospice care: the care needed by an individual during the last months or weeks of his or her life. Identified patient: an individual in family counseling who is seen as the cause of trouble within the family structure (the family scapegoat). Identity vs. role confusion: Erikson’s psychosocial crisis of young adulthood in which adolescents are challenged to form an identity. This psychosocial crisis is positively resolved through opportunities to explore options, try on various roles and responsibilities, and speculate about possibilities. Immobility: a crisis intervention assessment term referring to a state of being incapable of changing or coping in response to different moods, feelings, emotions, needs, and influences. Being unable to adapt to the immediate physical and social world. Incidence formula: a model of prevention that emphasizes the need to bolster people’s coping skills, self-esteem, and support systems. Indivisible Self: a model of wellness that consists of a primary factor of global wellness, five second-order factors, and 17 third-order factors, as well as four contextual scores. Industry vs. inferiority: Erikson’s psychosocial crisis of middle childhood that is resolved positively through children receiving opportunities to develop a sense of competence and capability. Informed consent: a client’s right to know what he or she is getting into when he or she engages in counseling, which allows him or her to make informed decisions about his or her treatment and the release of confidential information. Informed consent content checklist: a checklist used to guide the informed consent process that includes the following: counselor’s background and professional affiliations, therapeutic process issues, risks, benefits, and alternatives, fees, confidentiality and privileged communication, structure of the counseling relationship, diagnostic labels, emergency situations and interruptions in counseling, and information for involuntary clients. Initiative: motivation to change. Initiative vs. guilt: In Erikson’s theory, the psychosocial crisis of early childhood that is resolved positively when children are given opportunities to explore, experiment, and ask questions. Inspection: a credentialing procedures in which “a state agency periodically examines the activities of a profession’s practitioners to ascertain whether they are practicing the profession in a fashion consistent with the public safety, health, and welfare” (Swanson, 1983, p. 28). Integration: part of a 4-step process of separating one’s personal values from professional values in which counselors adopt the new profession’s values while retaining important aspects of his or her own personal values. 120

Internalized homophobia: occurs when a lesbian, gay, or bisexual individual internalizes negative societal attitudes about sexual minorities (Robinson-Wood, 2017). Intervention: direct, time-limited strategies that often are implemented in crisis-like situations, such as spinal cord injury, myocardial infarction, or severe psychological distress. Institutionalized racism: refers to the established use of policies, laws, customs, and norms to perpetuate discrimination and prejudice. Integrity: honesty and fairness in diagnosis and treatment, as well as being accurate and unbiased when reporting to other parties, including managed care organizations (Cooper & Gottlieb, 2000). Intensive outpatient program (IOP): serve more stable individuals than those served by PHPs who still need structured treatment programs but on a more flexible basis. Intention: a core building block of mindfulness which refers to practicing mindfulness purposefully. Internal consultant: an employee of the organization or agency. International Association of Counseling Services (IACS): the primary accreditation body for college counseling centers. Interpersonal processes: An emotionally focused therapy term that describes how partners organize their interactions into patterns and cycles. Intimacy: making a long-term commitment to another person, or the ability to form meaningful relationships with others, even if those relationships do not result in marriage or partnership. Intimacy vs. isolation: In Erikson’s theory, the psychosocial crisis of young adulthood that is resolved through a long term commitment to another person or through the forming of meaningful relationship with others, even if those relationships do not result in marriage or partnership. Intimate partner violence (IPV): form of domestic violence that occurs between two people in a close relationship and can include physical abuse, emotional abuse, sexual abuse, and/or threats of physical or sexual violence (Centers for Disease Control [CDC], 2016). Intrapsychic processes: An emotionally focused therapy term that describes how partners process their emotional experiences. Irrational thinking: a “highly exaggerated, inappropriately rigid, illogical, and especially absolutist” way of thinking that leads to neurosis and relationship disturbance (Ellis et al., 1989, p. 17). 121

Job: an activity undertaken for economic returns. Jesse B. Davis: first person to set up a systematized guidance program in the public schools. John Brewer: Wrote the book, Education as Guidance, in which he proposed that every teacher be a counselor and that guidance be incorporated in the school curriculum. Justice: a moral principle proposed by Kitchener (1984) that refers to treating all people fairly. Kinetic Family Drawing: a qualitative assessment method in which the counselor asks the child to draw a picture of everyone in the family doing something. Kinship influences: refer to the roles played by immediate and extended family, friends, and the community itself. Lanugo: fine hair that grows on the body as a result of malnutrition and starvation. Late middle life: Period during middle adulthood from ages 55 to 65. Law: set of rules that govern particular activities in society. Learning factors: a category of the common curative factors of effective counseling that includes factors such as cognitive learning, affective experiencing, and feedback.

Learning theory of career counseling (LTCC): a career development theory that suggests that four factors influence a person’s career decision making: genetic endowment (innate traits and abilities), environmental conditions and events (planned or unplanned), learning experiences (instrumental and associative learning), and task-approach skills (work habits, expectations of performance, cognitive processes, and emotional response patterns). Leveling: a technique used in experiential family therapy in which the counselor teaches family members to own personal feelings and express them clearly. Lesbian: refers to women who are sexually oriented to other women. Licensure: “the statutory process by which an agency of government, usually a state, grants permission to a person meeting predetermined qualifications to engage in a given occupation and/or use a particular title and to perform specified functions” (Fretz & Mills, 1980, p. 7). Licensure portability: the ability to transfer a professional license from one state to another state. Life-Career Rainbow: a model developed by Super to illustrate how six life roles can be depicted within a person’s life space.

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Life coaches: help people with a range of life issues that may be challenging, such as balancing multiple roles, dealing with stress or lack of motivation, or questioning life’s meaning or purpose. Life review: an intervention that counselors can use with older adults to build on the therapeutic potential of reminiscence. Life space: the combination of life roles in which people participate (Super, 1980). Life span: the five stages of Super’s developmental theory. Limbic system: a complex set of structures that lies on both sides and underneath the thalamus, just under the cerebrum, which plays a key role in the way clients feel and express emotions such as rage, fear, aggression, and sexuality. Local management entities (LMEs): serve as administrative behavioral health authorities that outsource treatment to a network of providers in the area. Logicoscientific reasoning: characterized by empiricism and logic. Low risk: in reference to suicide assessment, this evaluation is given when a client has no thoughts of suicide but some risk factors). Macrosystem: one of the five interactive systems of Bronfenbrenner’s Bioecological Model. It is an overarching belief system or culture that exerts its effects indirectly through cultural tools and institutions. Maintenance stage: the fourth stage of Super’s developmental theory (ages 45-64), which includes the major task of preserving what one has already achieved. Malpractice: most common cause of legal liability for mental health counselors, in which a counselor has been negligent in carrying out professional responsibilities or duties. Managed behavioral health care: a growing segment of the managed care industry that specializes in mental health and substance abuse treatment. Managed care: a general term used to describe the systems of businesses and organizations that arrange for the financing and delivery of medical and mental health services. Mandatory ethics: followed when counselors comply with the required minimal standards of the profession. Marginalization: part of a 4-step process associated with separating one’s personal values from one’s professional values in which a counselor is basically unaware of his or her personal, let alone professional, values.

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Maudsley approach: a somewhat controversial, family-based treatment model for eating disorders that requires parents to assume responsibility for feeding their child or adolescent, especially in nonchronic cases. Medical detoxification: removal of the substance (e.g., alcohol, illegal drugs) from the body under the direction of medical professionals. This occurs when withdrawal can be life threatening. Menopause: the time in life when levels of estrogen in women decline dramatically. During menopause, women cease to have menstrual cycles and thus become infertile. Mental disorder: According to the DSM-IV-TR (2000), it is “a clinically significant behavior or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significant increased risk of suffering death, pain, disability, or an important loss of freedom” (p. xxxi). Mental health counseling: CACREP specialty area. Mental Measurements Yearbook: published by the Buros Institute, it provides descriptions and reviews of a wide range of published instruments. Mental Status Examination: provides information about a client’s level of functioning and selfpresentation. It provides a format for organizing objective and subjective data gather during the interview and can be used for initial diagnostic impressions. Messenger molecules: neurotransmitters released from one neuron to another neuron. Mesosystem: One of the five interactive systems of Bronfenbrenner’s Bioecological Model. It is defined by interrelations among two or more microsystems. Microsystem: One of the five interactive systems of Bronfenbrenner’s Bioecological Model. It is a specific environment in which an individual develops, such as family peer group, or school. Middle Childhood (ages 7 to 11): children develop literacy skills and logical thinking. Middle Adulthood (ages 40 to 60-65): also known as midlife transition, it is a time of multiple transitions, including physical changes, psychosocial challenges, relationship adjustments, and caring for aging parents. Military families: families that have at least one family member enlisted in the armed services. Millennial generation: people born in the early 1980s through the early 2000s. Mindfulness: paying attention to the here and now, in a purposeful, nonjudgmental manner.

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Minnesota Multiphasic Personality Inventory-2: a widely used assessment instrument used to identify individuals who may be experiencing a psychiatric problems, as well as to discern important characteristics such as anger, alienation, depression, and social insecurity. Minnesota Point of View: Also known as trait-factor counseling, it was developed by E. G. Williamson, and emphasized a directive, counselor-centered counseling approach. Miracle question: a solution focused intervention in which clients are asked to imagine that their problem is suddenly solved. Mixed groups: groups that do not fit well into any of the four categories of groups. These groups encompass multiple ways of working with members and may change emphasis frequently. Mobility: a crisis intervention assessment term referring to a state of being able to autonomously change or cope in response to different moods, feelings, emotions, needs, and influences. Being flexible or adaptable to the surround environment. Moderate risk: in reference to suicide assessment, this evaluation is given when a client has thoughts of suicide without a clear plan. Moderators: characteristics that influence the intervention outcome (Kazdin, 2008). Morality: a philosophical discipline interested in judgment or evaluation of actions. Morphogenesis: the ability of the family to modify its functioning to meet the changing demands of internal and external factors. Motivational interviewing: a theoretical framework which encourages counselors to roll with client resistance rather than confront it directly (Miller & Rollnick, 2011). MST programs: intensive, short-term, home- and family-focused treatment services for youth with behavioral and emotional disturbances. Multicultural Competencies and Standards: provide guidelines for practicing culturally sensitive counseling with diverse populations. Multicultural Counseling: refers to “multiple perspectives or multiple cultural viewpoints within the counseling relationship in which none are dominant or considered more ‘normal’ than others” (West-Olantunji, 2001, p. 418). Multiculturalism: takes into account differences in areas such as language, social class, race, ethnicity, gender, sexual orientation, religion, and level of ability. Multigenerational family: households that include a child, a parent, and a grandparent. Myers-Briggs Type Indicator: based on the work of Carl Jung and Jungian theory. Helps clients 125

examine differences and similarities of personality types based on four dimensions. Muscle dysphoria: an excessive concern with becoming more muscular. Narrative reasoning: characterized by stories, substories, meaningfulness, and liveliness. National Academy of Certified Clinical Mental Health Counselors (NACCMHC): an affiliate of AMHCA, which defines training standards and certifies counselors in mental health counseling, as well as train supervisors of mental health counselors. National Board for Certified Counselors (NBCC): formed in 1982 and certifies counselors at the national level. National Career Development Association: the oldest division within ACA, its mission is to inspire and empower the achievement of career and life goals by providing professional development, resources, standards, research, and advocacy. National Certified Counselor: a counseling professional who has passed a standardized test called the National Counselor Exam administered by NBCC and has met experiential and character reference qualifications. National Defense Education Act (NDEA): enacted following the Soviet Union’s launching of Sputnik I, the primary purpose of which was to identify scientifically and academically talented students and promote their development. National Employment Counseling Association: offers professional leadership to people who counsel in employment services or career development settings and to people employed in related areas of counselor education, research, administration, or supervision. National Fair Access Coalition on Testing (FACT): a nonprofit organization that advocates for equitable access to testing services for all appropriately trained professionals who have demonstrated competence in administering and interpreting assessment instruments. National Mental Health Act: passed in 1946, it authorized funds for research and training to prevent and treat mental health disorders. National Vocational Guidance Association: First national professional organization in counseling field. Needs assessment: a set of methods or approaches used to determine if there is a need for a certain program or intervention. Negative feedback loops: morphostasis, or the process by which family members attempt to rectify unbalanced situations caused by other family members’ actions and return to homeostasis. Negligence: refers to situations in which a mental health professional does not carry out his or 126

her responsibilities in accordance with the standards of care outlined by the profession. NEO Personality Inventory-3: assesses the Big Five personality factors: extroversion, agreeableness, conscientiousness, emotional stability (neuroticism), and openness. Neurotransmitters: chemicals in the brain that account for the transmission of signals from one neuron to the next across synapses. Noncompliance: a term used to describe a client who does not follow through with assignments in counseling, such as not completing homework, or showing up late for appointments or missing appointments. New Diversity Initiative: a model that comprises seven elements and addresses mental illness on college campuses in an inclusive manner by involving faculty, staff, and students throughout the college campus. Nonevents: life events that are accelerated, delayed, or fail to materialize. Nonevent transitions: events people expect to happen but then do not occur. Nonmaleficence: a moral principle proposed by Kitchener (1984) that refers to not harming other people. Nonnormative life events: those unexpected, acute demands that may alter the course of development, either directly or transactionally. Nonprofessional helpers: considered the first level of helping, helpers at this level are usually untrained and good-hearted volunteers who try to assist those in need in whatever ways they can. Norepinephrine: a neurotransmitter that modulates other transmitters and shares some similarities with dopamine. Nonsummativity: a term in family counseling that refers to the concept that the family is greater than the sum of its parts. Normative life events: anticipated generic challenges that everyone encounters. Norming stage or working stage: the third stage of a group which consists of group members working together and deciding upon goals for the group. Objects: in the theory of object relations, these are significant others in one’s environment, such as a mother, with whom children form an interactive emotional bond. Occupation: a group of similar jobs found in different industries or organizations. Occupational Information Network (O*NET): a technology-based career information system that provides the most up-to-date occupational information available. 127

Old: category of older adulthood that spans the ages of 75-84. Old old: category of older adulthood that spans the ages of 85 and beyond. Open-ended groups: groups that admit new members after the group has begun. Open questions: typically begin with words such as what, how, or could and allow the client more latitude to respond. Ordeals: a technique in strategic family therapy in which one does something a he or she does not want to do (e.g., buying a gift for somebody who is disliked). Outcome expectations: the consequences a person expects to occur following a particular course of action. Outcome Questionnaire-45.2 (OQ-45.2): Used to measure symptom distress, interpersonal relationships, social roles, and risk assessment. Outpatient Counseling Services: provide individual, group, and/or family counseling and, at times, medication management with the goal of helping clients improve personal and social functioning. These services often address both acute and chronic mental health needs. Outreach: refers to initiating behaviors toward people in need for the purpose of making a helpful difference. Overload syndrome: the tendency to take on too much and continually push personal limits. Overt rehearsal: verbalizing or acting out new behaviors. Palliative care: a compassionate, comprehensive team approach to care that focuses on quality of life for anyone coping with a serious illness, including the patient and the family members. Paradoxing: a structural-strategic approach in which a counselor helps a family or couple to insist on just the opposite of what they want. Partial hospitalization program (PHP): a type of day program that provides brief, intensive structured treatment for clients who need a high level of care. Patient Protection and Affordable Care Act: act passed in 2010 by the Obama administration, commonly referred to as Obamacare or the Affordable Care Act. Perimenopause: a transitional phase leading up to menopause in which levels of estrogen decline dramatically. Personalization: an office that includes mementos, personal items such as photographs, and diplomas or certificates (Nasar & Devlin, 2011). 128

Perspective: a term associated with transitions that refers to an individual’s appraisal of the transition. Persuasiveness: also called social influence, is “the process of encouraging clients to take reasonable and growth-producing risks, to make thoughtful decisions and health choices, to disclose and process feelings and experiences, and to move forward toward their goals” (Seligman, 2006, p. 23). Physical abuse: ranges from bruising to murder and often begins with trivial injuries that escalate over time. Physical disability: a category of disability that includes the following: sensory loss, orthopedic impairments, amputations, congenital disabilities, and chronic illness. Placater: term used by Satir to describe a nonproductive communication style in which a family member, under stress, tends to agree and tries to please. Planned happenstance: the “creating and transforming of unplanned events into opportunities for learning” (Mitchel et al., 1999, p. 117). Polysubstance abuse: refers to the abuse of two or more substances simultaneously. Positive wellness approaches: health-related activities that are preventative, holistic, and benefit individuals who practice them consistently. Posttraumatic Stress Disorder (PTSD): a trauma that lasts in a person’s mind long after the event itself has passed. People with PTSD may exhibit a number of symptoms, including reexperiencing the trauma through flashbacks, avoidance of trauma-related activities, intense fear or helplessness, emotional numbing, and a range of coexisting disorders such as substance abuse, obsessive-compulsive disorder, and panic disorder (American Psychiatric Association, 2013). Postvention: also called rehabilitation counseling, focuses on helping people with permanent or chronic physical, cognitive, and psychiatric disabilities cope successfully and adjust to life with those disabilities. Poverty threshold: the amount of cash income minimally required to support families of various sizes. Power analysis: entails helping clients learn about how they use power and how power is used against them. Practice act counseling statutes: delineate, from a legal perspective, what professional counselors can and cannot do (Wheeler & Bertram, 2015). Prejudice: a negative bias toward a particular group of people (Allport, 1954).

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Preoperational stage: Piaget’s second stage that includes children ages 2 to 7 in which children are developing the ability to represent objects and events through imitation, symbolic play, drawing, and spoken language. Children at this stage may attribute lifelike qualities to inanimate objects and have difficulty with abstract nouns and concepts. Prescribing the symptom: a structural-strategic approach in which a counselor has the couple display voluntarily what they have previously manifested involuntarily, such as fighting. Prevention: an approach focused on stopping something from happening, such as cancer, depression, or suicide. Primary prevention: occurs “before the fact” and refers to prevention efforts that attempt to reduce the number of new occurrences of a disorder. Primary service: a main service. In counseling, this includes individual, group, couples, and family counseling (Remley & Herlihy, 2016). Privacy: the client’s legal right to determine what information about himself or herself will be shared with others. Privileged communication: legal term describing the protection of confidentiality between two parties. Problem-focused coping strategies: coping mechanisms that individuals employ which use problem-focused techniques, such as action, planning, and acceptance. Process addiction: addictions such as gambling, workaholism, and sexual addictions, which are not the result of a chemical or substance that is ingested. Process evaluation: also called formative evaluation, it provides information about how well a program is being implemented. Productivity: number of “billable hours” a clinician generates. Professional advocacy: contributing to the development of a strong professional identity, lobbying for professional recognition, and demonstrating professional pride and accountability. Professional competence: According to the ACA Code of Ethics (2014), professional competence indicates the following: “Counselors practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience. Whereas multicultural counseling competence is required across all counseling specialties, counselors gain knowledge, personal awareness, sensitivity, and skills pertinent to being a culturally competent counselor in working with a diverse client population (Section C.2.a) Professional counseling: “a professional relationship that empowers diverse individuals, 130

families, and groups to accomplish mental health, wellness, education, and career goals” (ACA, 2010). Professional Disclosure Statement: a document that provides information to clients about the counselor and about the counseling process. Professional helpers: Individuals who are educated to provide assistance on a preventive, developmental, and remedial level. These individuals hold advanced degrees in one of the main helping professions, including social workers, psychologists, psychiatrists, psychiatric nurses, and clinical mental health counselors, among others. Program-centered administrative consultation: Emphasis of consultation is placed on helping an individual or group of consultees develop a new program or improve an existing one. Professional identity: the philosophy, training model, and scope of practice that characterize a particular profession. Program evaluation: a systematic collection of information about the activities, qualities, and results of clinical mental health counseling programs so that judgments can be made about overall program effectiveness (Patton, 2008). Program outcome evaluation: Also called summative evaluation, it provides information about whether, and to what degree, the goals and objectives of the program have been achieved. Protective factors: the presence of factors that reduce the likelihood of suicide, such as interpersonal support, restricted access to highly lethal means of suicide, investment in effective clinical care, cultural/religious beliefs that encourage self-preservation, and healthy problemsolving and coping skills. Psychache: pain and anxiety resulting from stressors that can make it difficult for a client to hear or retain a lot of new information. Psychiatric disability: a category of disability related to mental health, such as schizophrenia, chronic recurrent affective disorders, and severe personality disorders. Psychiatric-mental health nursing: mental health field accredited by the American Nurses Credentialing Center. Psychiatric mental health nurses assess, diagnosis, and treat individuals or families with psychiatric disorders. Psychiatry: a specialty area in the school of medicine. Psychoeducational groups: a group that stresses growth through knowledge and emphasizes the prevention of personal or societal disorders through the conveying of information and/or the examining of values.

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Psychological components of the BPS model: include patterns of thinking, coping skills, judgment, perceptions, and emotional intelligence. Psychological or Emotional Abuse: includes constant verbal abuse, harassment, extreme possessiveness, deprivation of resources, isolation, and the destruction of physical property. Psychological First Aid (PFA): a disaster response program with the goals of protecting, directing, connecting, detecting, selecting, and validating (Levers & Buck, 2012). Psychological testing: an objective, standardized measure of behavior used primarily for evaluation. Psychology: a helping profession accredited by the American Psychological Association. Areas of specialization include clinical, social, cognitive, developmental, counseling, and school psychology. Since the 1940s, psychologists have been viewed as experts in psychological assessment. Psychometrics: psychological testing. Psychotherapy groups: set up to help individual group members resolve their in-depth and sometimes serious psychological problems. Quality assurance: an ongoing process by which the agency and outside groups monitor the quality of services offered. Quality circle: the prototype of a task/work group in which members of a work unit discuss the processes under which they operate and try to make continuous improvements. Queer: a term that refers to individuals who identify outside of the heteronormative or gender binary community. Questioning: those who are beginning to explore their sexual understanding and orientation. Racism: based on prejudicial beliefs, which maintain that racial groups other than one’s own are inferior (Casas, 2005). Rating scales: assessments used to indicate the degree of severity of a characteristic being measured. Recovery: “a process, a new way to live one’s life beyond mere abstinence from alcohol and other drugs. Recovery defines how one lives life today, implying hope, healing, and restoration” (Adams & Grieder, 2005, p. 17). Recycling: Involves the reexamination of all phases of the therapeutic process and gives both counselor and client a second chance to achieve positive change. Redundancy principle: operating on a small set of predictable rules. 132

Referral: involves arranging other assistance for clients when the initial arrangements are not likely to be helpful. Reflective structures: provide time away from work and responsibilities for the purpose of being alone with one’s thoughts. Reframing: a counseling response used to offer clients another probable and positive viewpoint of what a situation is or why an event might have happened. Relabeling: a structural-strategic approach in which a counselor helps a family give a new perspective to a behavior. Registration: a credentialing procedure that requires practitioners to submit information to the state concerning the nature of their practice. Rehearsal: ways of behaving. Religion: although defined in many ways, it is often referred to as the social or organized means by which a person expresses spirituality. Reluctant client: someone who has been referred by a third party and is usually unmotivated to seek help. Reminiscence: the process of recalling memories and reflecting on their significance. Residential programs: include transitional facilities where individuals recently discharged from hospitals learn to function in the community. Resilience: the ability to “bounce back.” Resistant clients: clients who exhibit behaviors that could be categorized as noncompliant, avoidant, or ambivalent. Responsible analyzer: term used by Satir to describe a nonproductive communication style in which a family member, under stress, tends remain emotionally detached and intellectual. Role induction: also called structure, refers to counselor-client understanding about the conditions, procedures, and nature of counseling. Role strain: stress that families, particularly dual-career families, may experience as a result of attempting to juggle work, school, extracurricular activities, and social relationships. Safety: an important variable to consider when working toward creating a healing counseling environment, such as ensuring that the room is soundproof.

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Safety plan: a safety plan involves collaborating with the client to develop a written list of healthy coping responses for the client to engage in when noticing the early signs of suicide ideation. Salutogenic: health enhancing. Sandwich generation: term used to describe people in midlife who are caring for children under age 18 as well as for aging parents. School guidance: a preventative educational means of teaching students how to deal effectively with life events. Screening: process by which group leaders determine who is appropriate for a group. This process also entails prospective group members determining whether they are appropriate for a group. Seasons of Life theory: a theory developed by Levinson that was based on interviews with middle-aged men. It suggests that midlife begins with a transition (ages 40 to 45) followed by a life structure (ages 45-50). The structure is re-evaluated between ages of 50 to 55 and ends in a culminating life structure (ages 55-60). Secondary prevention: targeted toward people at risk of developing a mental health problem or who are exhibiting early symptoms of a disorder. Secondary service: a peripheral or less important service. Secondary traumatic stress: a response to helping or being involved with people who experience trauma or extreme predicaments and exhibit symptoms that resemble posttraumatic stress disorder. Second-order change: ability to make an entirely new response. Selective abstraction: taking a detail out of context and using it to negate an entire experience. Selective Optimization with Compensation (theory of): suggests that successful aging involves three primary factors: selection (choosing goals and activities that are meaningful and important) optimization (enhancing positive changes to achieve a set of desirable outcomes), and compensation (counteracting certain losses in ways that make it possible to reach those outcomes). Self-awareness: an in-depth knowledge of one’s attitudes, values, and feelings, as well as the ability to recognize ways situations and events affect oneself. Self-detoxification: removal of the substance (e.g., alcohol, illegal drugs) from the body in an unmanaged, unsupervised manner. It is often unsuccessful. Self-disclosure: “here and now feelings, attitudes, and beliefs” (Sherzer & Stone, 1981, p. 206). 134

Self-efficacy: refers to an individual’s beliefs about his or her ability to perform successfully a particular task. Self-help groups: take two forms: those that are organized by an established professional helping organization or individual (i.e., support groups) and those that originate spontaneously and stress their autonomy and internal group resources (Riordan & Beggs, 1987). Self-induced stressors: include perfectionism, unrealistic expectations, an unhealthy lifestyle, exhaustion, and fear of failure on the part of the clinician. Semistructured interviews: address the same issues as structured interviews but they are more flexible in sequence, wording, and interpretation. Sense of humor: being able to laugh at oneself and absurd life events. Separation: Part of a 4-step process a counselor goes through to separate his or her personal values from professional values in which counselors have developed personal morals and values but are not aware of professional ethics. Serotonin: an inhibitory neurotransmitter that is closely associated with emotion and mood. Too little can lead to depression, problems with anger control, obsessive-compulsive disorder, other emotion disorders, and suicide. Sexual abuse: any forced sexual activity. Sexual attraction: erotic attraction to someone. Sexual identity: includes both the affectional and sexual dimensions of self that are evidenced by thoughts, feelings, and behaviors. Sexual orientation: also called affectional orientation, refers to past, present, and ideal feelings about who is attractive and desirable in sexual and/or romantic ways. Sexual preference: a term that implies choice and needs to be avoided. Single-parent families: families headed by either a mother or a father as the sole parent responsible for taking care of her- or himself and a child(ren) (Gladding, 2015). Situational crises: occurs when an unexpected, extraordinary event occurs that the person had no way of anticipating or controlling. Situational stressors: stressors that families experience which are associated with interpersonal interactions (Figley, 1989).

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Six-Step Model of Crisis Intervention: a crisis intervention model that describes a six-step process by which listening and acting are enacted by the counselor. The six steps include defining the problem, ensuring client safety, providing support, examining alternatives, making plans, and obtaining outcomes. SLAP: an acronym developed by Sommers-Flannagan & Sommers-Flannagan, 1995) to assist a counselor in assessing for suicide plans. The acronym stands for specificity, lethality, access to means, and proximity of social support. Smith-Hughes Act of 1917: legislation that provided funding for public school to support vocational education. Social action: refers to behaviors designed to promote social justice. Social Cognitive Career Theory: a theory of career development that focuses on the “(a) formation and elaboration of career-relevant interests, (b) the selection of academic and career choice options, and (c) performance and persistence in educational and occupational pursuits” (Lent et al., 1994, p. 79). Social convoy: the people who accompany us through life’s journey. Social detoxification: removal of the substance (e.g., alcohol, illegal drugs) from the body that occurs in a residential, nonmedical setting. Social justice: “involves promoting access and equity to ensure full participation in the life of a society,” particularly for those members who have been marginalized (Lee, 2013, p. 16). Social class: typically based on components of SES and is hierarchical in nature. Social class privilege: benefit or advantage given to a person by reason of social position. Social components of the BPS model: also conceptualized as sociocultural components, include family relationships, support systems, work relationships, and the broader cultural environment as it intersects one’s personal cultural identity. Social Learning Theory: a form of behaviorism that stresses learning through modeling and imitation. Social work: a helping profession that often emphasizes a systems and contextual approach to helping. Social workers may have bachelor’s, master’s, and/or doctoral degrees, can be licensed to practice in all 50 states, and may work in many different settings, such as schools, medical and public health environments, mental health and substance abuse settings, etc. Society of Counseling Psychology (Division 17) of APA: a division of the American Psychological Association established in 1946 to facilitate personal, vocational, educational, and interpersonal adjustment (Society of Counseling Psychology, 2007). 136

Socioeconomic status (SES): term that classifies people according to social and economic dimensions, which include the following indicators: income, occupation, education level, use of public assistance, and access to health care. Softness: refers to the soft surfaces and textures, including such things as sofas, comfortable chairs, movable furniture, and lamps to create a healing counseling environment. Spirituality: According to the ASERVIC Summit Results (1995), it is a “capacity and tendency that is innate and unique to all persons. The spiritual tendency moves the individual toward knowledge, love, meaning, peace, hope, transcendence, connectedness, compassion, wellness, and wholeness. Spirituality includes one’s capacity for creativity, growth, and the development of a value system” (p. 30). Standards of care: “the professional conduct as practiced by reasonable and prudent practitioners who have special knowledge and ability for the diagnosis and treatment of clinical conditions” (Granello & Witmer, 1998, pp. 371-372). State Licensure: governmentally sanctioned form credentialing that defines scope of practice and determines who can and cannot offer certain services. Status variables: include variables such as social, economic, and educational background, as well as a wide range of formal or informal memberships and affiliations (Pedersen, 1990, p. 550). Statute: a law that is written and passed by a legislative body. Storming stage: the second stage of a group, sometimes called the transition stage, which is often characterized by “increased tension and testing of the group environment (Greason, 2011, p. 104). Strong Vocational Interest Inventory (SVII): Published by Edward Strong in 1927, the publication of this psychological instrument set the stage for future directions for assessment in counseling (Strong, 1943). Structured clinical interview: “a list of relevant behaviors, symptoms, and events to be addressed during an interview, guidelines for conducting the interview, and procedures for recording and analyzing data” (Vacc & Juhnke, 1997, p. 471). Subpoena: a summons that requires court attendance. Substance abuse: characterized by continued use of a substance in the presence of significant adverse consequences. Substance Abuse and Mental Health Services Administration (SAMHSA): a division of the Department of Health and Human Services.

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Substance dependence: refers to the repeated, nonmedical use of a substance that harms the user or precipitates behavior in the user that harms others. Substance use disorder: a category of the DSM-5 that includes substance abuse and substance dependence. Suicide assessment: an evaluation that can include a clinical interview as well as the administration of objective measures. The goal of the assessment is to evaluate known risk factors and warning signs, understand each client’s unique situation, and subsequently develop appropriate and responsive interventions to reduce a client’s overall risk of suicide. Suicide attempt: a self-inflicted, potentially injurious behavior with a nonfatal outcome for which there is evidence (either explicit or implicit) of intent to die. Suicide: a self-inflicted death with evidence (either explicit or implicit) of intent to die. Suicide ideation: Thoughts, wishes, desires, or intent to die. Super’s Life Span, Life Space Approach: posits that career development is the lifelong process of implementing a self-concept. Support factors: a category of the common curative factors of effective counseling that includes factors such as the therapeutic alliance, trust, empathy, and catharsis. Support groups: groups that are organized by an established professional helping organization or individual. Supportive behaviors: parental interactions with children that facilitate socialization through warmth, nurturance, responsiveness, and open communication. Synchronous counseling: a form of online counseling in which the counseling occurs during the moment of connection between counselor and client. Taking Charge: One of the three major parts of the transition model that refers to strengthening resources to facilitate coping and moving through the transition toward a positive outcome. Taking Stock of Coping Resources: One of the three major parts of the transition model that refers to identifying potential assets and liabilities as they apply to the situation, support systems, self, and strategies for coping. Tarasoff v. Board of Regents of the University of California: a court case in which the California Supreme Court ruled that a therapist has a duty to protect the public that overrides any obligation to maintain client confidentiality. Task/work groups: assist members in applying group dynamics principles and process to improve work practices and to accomplish identified work goals.

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Temperament: a child’s emotional style, or the specific traits with which each child is born and which influences the way the child reacts to the surrounding environment. Terminal phase: the time in which the primary caretakers frequently are under a tremendous amount of stress and family strain due to the anticipated loss of their loved ones. Tertiary prevention: refers to efforts aimed at reducing the debilitating effects of an existing disorder. Test trustworthiness: includes validity, reliability, cross-cultural fairness, and practicality. Terminal program outcomes: outcomes that are most immediately recognizable. Termination: closing the counseling relationship. Theory of Object Relations: a theory that addresses how relationships are developed across the generations. Theory of Vocational Choice: developed by John Holland (1997), it stresses the interpersonal nature of careers and associated lifestyles as well as the performance requirements of a work position. Therapeutic confrontation: involves pointing out discrepancies in clients’ beliefs, actions, words, or nonverbal behaviors. Third party: the client or client system served directly by the consultee. Transition model: model proposed by Schlossberg that emphasizes the importance of life transitions that affect adults of all ages. Tort: refers to a wrong that legal action is designed to set right. Transsexual: refers to individuals who pursue hormonal treatment and/or sex reassignment surgery so that their externalized gender identification will match their internal gender identification. Treatment plan: a document that explains why a client is receiving services and what is going to take place in counseling. It lists measurable and desired outcomes of treatment. Trait-factor theory: first theory of counseling, the main premise of which was that persons had traits (e.g., aptitudes, interests, personalities, achievements) that could be integrated in a variety of ways to form factors (constellations of individual characteristics). Transference: In the theory of object relations, a counselor uses this process, which is the way through which each partner restructures internally based perceptions of, expectations of, and reactions to self and others and projects them onto the counselor.

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Transgender: transgender or transgendered individuals are persons whose gender identity differs from their biological sex. Transference: a technique used in the theory of object relations wherein a counselor facilitates the process of each partner restructuring internally based perceptions of, expectations, of, and reactions to self and others, and projecting them onto the counselor. Transphobia: also called transprejudice, refers to a lack of knowledge, understanding, and acceptance of transgender people which results in societal stigma, marginalization, and discrimination for transgender people (Singh et al., 2010). Transprejudice: also called transphobia, refers to a lack of knowledge, understanding, and acceptance of transgender people which results in societal stigma, marginalization, and discrimination for transgender people (Singh et al., 2010). Transtheoretical Model of Change: developed by Prochaska and associates that describes five different levels of readiness for change: precontemplation, contemplation, preparation, action, and maintenance. Treatment of Adolescents with Depression Study (TADS): a study that found that combination of psychotherapy and antidepressant medication appeared to be the most effective treatment for adolescents with major depressive disorder. Treatment integrity: The extent to which interventions are delivered in a comprehensive manner by a trained interventionist (Hagermoser et al., 2009. Triad role-play model: A role play developed by Pederson (2002) in which participants take the role of counselor, client, and problem, and they simulate a counseling session with the goal of articulating the problem from the client’s cultural perspective, anticipating resistance from a culturally diverse client, diminishing defensiveness by studying the counselor’s personal defense responses, and learning and practicing recovery skills when culturally related problems occur. Triage Assessment Model: provides a framework for assessing client’s reactions to crisis in three domains: affective, behavior, and cognitive (ABC). Triangulation: refers to family fusion situations in which one person is pulled in two different directions by the other members of the triangle. TRICARE: program for which counselors graduating from a CACREP or regionally accredited institution will qualify until January 2021 when only CACREP accredited institutions will qualify. Ultimate program outcomes: outcomes that are most enduring. Unanticipated transitions: also called unscheduled events, they are not predictable or expected and may be positive or negative. 140

Unexpected life stressors: life events that take family members by surprise or are beyond the control of the family. Upcoding: the act of a counselor assigning a more serious diagnosis to a client than is warranted in order to obtain more authorized sessions from a managed care system. U.S. Department of Labor: a premier source of occupational information that publishes numerous career-related resources. U.S. Veterans Administration: funded the training of counselors and psychologists by granting stipends and paid internships to students engaged in graduate money. Utilization principle: a technique in brief solution-focused family counseling in which a counselor uses whatever clients present in counseling “as a basis and means for client solutions and change” (Lawson, 1994, p. 244). Utilization review (UR): the process by which managed care systems monitor the therapeutic process. It may occur before, during, and after treatment. Veracity: a moral principle that refers to a counselor being truthful and having integrity. Vertical stressors: those dealing with family patterns, myths, secrets, and legacies. They are historical and inherited from previous generations. Vicarious traumatization: changes that alter mental health professionals’ views of themselves, others, and the world, and is associated with disruptions in helpers’ views of safety, trust, esteem, intimacy, and control. Vocation: implies a psychological commitment or calling to a particular field. Weldon v. Virginia State Board of Psychologists Examiners: a 1974 court case in which a judge ruled that counseling was a profession distinct from psychology. Vulnerable populations: individuals who collectively experience stress associated with economics, social class variables, and exploitations for an extended period of time (Lewis et al., 2003). Wellness: “a way of life oriented toward optimal health and well-being in which body, mind, and spirit are integrated by the individual to live life more fully within the human and natural community. Ideally, it is the optimum state of health and well-being that each individual is capable of achieving (Myers, Sweeney, & Witmer, 2000, p. 252). Western values: include individualism, autonomy, action-oriented approaches to problem solving, strong work ethics, and an emphasis on rigid time schedules (Sue & Sue, 2016). Wheel of Wellness: a holistic theoretical model of wellness that was designed to illustrate 141

characteristics associated with healthy people. Work discrimination: unfair and negative treatment based on personal attributes that are unrelated to job performance (Chung & Bemak, 2002). Worldview: refer to the way people perceive their relationship to the world, including nature, other people, objects, and religious experiences. Young old: one of the three categories of older adulthood that includes ages 65-75. Zone of proximal development: emphasizes a range of tasks too difficult for a child to complete alone but possible with the help of others. INSTRUCTIONAL ACTIVITIES CHAPTER 1 1. Have students get into groups of three or four to discuss their reasons for wanting to become a clinical mental health counselor. In particular, prompt students to share the following: (a) their thoughts about where and with what population they would like to work; (b) what settings and populations they would like to learn more about; and (c) what settings and/or populations they are less interested in working with or ones they would like to avoid. 2. Divide the class into two groups. Have group one reviews the 2016 CACREP standards related to Clinical Mental Health Counseling, and have group two read the 2001 CACREP standards related to Community Counseling and Mental Health counseling. Provide the following questions: What are the similarities? Differences? What would you change and why? What do you think is most important? How does this help your understanding of clinical mental health counseling? 3. Generate a discussion with the class about how the profession of counseling has evolved through the 20th century and into the 21st century. After that discussion, divide the class into small groups to discuss their beliefs about how counseling will have changed in ten years, when they are about to retire, and in the next 75 to 100 years. Have groups present their ideas. Consider tying whatever changes they foresee to the importance of continuing education and professional advocacy. 4. Divide the class into seven groups, a group for each mental health profession discussed in chapter 1. Assign each group a different mental health profession to research, and have each prepare a 5 to 10 minute presentation about the mental health profession that they were assigned. In particular, have students research and discuss the following about each profession: (a) training requirements, (b) scope of practice, (c) common settings in which they work, and (d) preferred model of treatment (e.g., medical model). 5. Have the class generate a list of all the entities that they can think of in a community 142

(e.g., police stations, banks, schools, hospitals, factories, power stations, phone companies, tax office, non-profit agencies, recreation facilities, post office). Then have students debate which entities, if any, do or do not have counseling components. 6. Take a number of field trips as a class to diverse community settings, such a medical settings, community mental health centers, and other counseling settings. If, logistically, a field trip is not an option, Internet/phone ‘visits’ could be used. Arrange to have students take a tour and gather as much information as possible. Have students reflect on their experiences using a journal. Have students write a paper describing (a) the benefits and challenges they discovered by visiting the various sites, (b) how they anticipate applying insights gained in these experiences to their counseling work in the future, and (c) describing how pertinent each site is in relation to expanding their knowledge about clinical mental health counseling. 7. Assign outside reading of a particular journal article related to clinical mental health counseling. On the day the assigned reading is due, divide the class into small teams of four to five players each. Conduct board races, in which a member from each team goes to the board, taking reading assignment with him or her. While at the board, ask a question from the reading. Assign points or a reward to the group that gets the answer correct. Every member should be given at least two turns, and use a timer if necessary. CHAPTER 2 1. Watch a televised episode in whole or in part of Dr. Phil together as a class. What do students notice about his counseling skills? What theoretical approach might he utilize? What does his show say about the way counseling is perceived in today’s world? What can students advocate to encourage or discourage today’s view of counseling? Discuss the ethical challenges observed in the program. Is it ethical to encourage vulnerable people to disclose personal issues in a televised show? How ethical is it for Dr. Phil to make money from this type of show? Discuss the legal challenges in the program, if any, (e.g., confidentiality, privacy issues). Are children featured in the program and is this legal? What informed consent process might be followed? 2. Divide the class into four or five groups. Share a different case study with each group that depicts a potential ethical, legal, or professional dilemma. Have students read their assigned case study as a group and discuss the potential ethical/legal/professional issue(s) that the case scenario poses. Have students consult the ACA Code of Ethics as well as ethical decision-making models to determine appropriate responses. Have students present their responses to the class.

CHAPTER 3 1. Invite speakers to the class from diverse backgrounds who work in clinical mental health counseling settings (this could be set up as a panel OR arrange for speakers to visit at separate intervals). Ask speakers to share particular recommendations for beginning 143

counselors about working with clients from diverse backgrounds/cultures/ethnic groups. Facilitate a question-and-answer session to allow students opportunities to ask pertinent questions related to multicultural counseling. 2. Divide students into small groups. Ask them to share with their group the following (a) what their given and/or last name means to them; why they were given the name they were given; (c) what nicknames they have had and how they have felt about their nicknames; and (d) how their name influences their identity. In a larger group format, discuss how self/cultural awareness is an important part of multicultural counseling competence. 3. Read Plato’s Allegory of the Cave to the class. Have students discuss in small groups how the allegory relates to culture in general and multicultural counseling specifically.

CHAPTER 4 1. Show clips of counseling videos that depict the three stages of the counseling process, including the initial phase, working phase, and closing phase. Show clips of each video to the class and ask students to determine what phase of the counseling process the clip is depicting. Have students justify their responses based on the counseling skills and techniques being used by the counselor, the responses given by the client, and the perceived rapport between the counselor and client. 2. Show a video clip of a mock counseling session. Give the students background information about the client as needed. Upon completion of the video clip, have students create a SOAP or STIPS note of the session. 3. Have students divide into small groups (3-4 students) to discuss events in their lives that have ended. How did they end? What did you like/dislike about the ending? What feelings did/do you have about the event? How might this experience be similar to termination sessions in counseling? CHAPTER 5 1. Divide the class into groups containing 4-6 members. Each group of students will present a case with a specific diagnosis. a. First, the group role plays a case to the class (the class will NOT know in advance the disorder being portrayed, but it is recommended that the instructor know all diagnoses being presented to ensure more variability). One group member portrays the counselor, one the client, one the observer who is the timekeeper & provides feedback at the end of the role play to the counselor on their demonstrated intake skills, other group members may be family members or significant others related to the client, the counselor may also have a coach. b. Second, divide the class into groups and the students presenting the case. Lead each class group in composing an intake summary, diagnoses, and plan of care 144

(written). (The presenting students do not share the actual diagnosis portrayed during this planning stage, but function as time keepers, task minders, scribes, etc. for the written plans. c. Third, reassemble the class, share group findings, present actual diagnosis portrayed and pertinent written treatment interventions, including medications if relevant (presenters may want to utilize a demonstration sample from a software recordkeeping system). d. Fourth, the presenting group provides pertinent facts about the actual diagnosis and effective treatment interventions to the class (Handouts required). (Optional: Recommend a book that could be suggested for a client to read who might be diagnosed with this particular disorder. Provide a written summary of the book and how it could be useful for counseling). Discuss with the class. e. Fifth, provide a written reference list about treatment interventions or effective approaches with at least four journal references cited with at least two informative websites. 2. Have students keep a running list of interview questions they feel would be helpful in their own work as counselors. At the end of the course, have students compile the questions in a way that will make it easy for them to use (e.g., by type of information the question elicits). CHAPTER 6 1. Present a counseling case, either through a counseling video or written case study, and have students conceptualize the case based on the biopsychosocial model. Consider asking the following: What additional information would you like to know? How might you gather that information (e.g., what questions would you ask? what assessment tools might you use?).

CHAPTER 7 1. Create a brochure that could be used to advocate for clinical mental health counseling. Brainstorm pertinent information to include in the brochure. Discuss effective ways to present important points. 2. Take a trip to meet your state legislators in the state capitol or at their local office. Distribute advocacy brochures created by the class and introduce yourselves to the legislators. Discuss as a class why this is important and what was learned from this experience? (Consult the ACA website for up-to-date information pertaining to advocacy). 3. Have students come up with an idea for a presentation at the ACA conference. Prepare and plan as if students will present during a poster session at the annual conference (and do present, if possible). Ideas include advocacy, social justice, healthcare reform, clinical mental health consultation, outcome studies, etc. 145

CHAPTER 8 1. After discussing key elements of a suicide assessment, assign students to triad groups to practice doing a suicide assessment. Instruct students to rotate through the following roles: counselor, performing the suicide assessment; mock client, playing the role of an individual at risk of committing suicide; and observer, providing written feedback to the counselor. 2. Bring a package of balloons to class. Ask students to help you inflate the balloons (some may choose not to inflate balloons for various reasons, and that is fine). After you have ten to fifteen balloons inflated, ask for five or six volunteers to help with a demonstration. Assign one of the volunteers to be a counselor. Ask the student if he or she has any of his or her own challenges/issues/stressors in his or her life. If the student says yes, then give him or her a balloon or two to hold that represent(s) his or her problems. Ask the counselor if holding these balloons is manageable. Next, assign the remaining participants to be individual clients of the counselor. Give each of them one or two balloons that represent their presenting concerns in counseling. Have the “clients” hand their balloons (problems) to the counselor to hold. As the “counselor” struggles to hold onto these balloons (problems) without dropping them, process the experience with him or her. Ask how he or she is currently feeling. After the “counselor” struggles for a few minutes to hold the balloons, thank the participants and excuse them to return to their seats. Discuss with the class the concept of compassion fatigue, vicarious traumatization, and burnout. Ask the “counselor” and class member what the “counselor” could have done to feel less overwhelmed by the balloons (problems). Answers will vary but will likely include the following: seek supervision or consultation, pursue counseling for personal concerns, and find opportunities to set the problems aside for a time and engage in self-care activities. CHAPTER 9 1. Have each student develop and present a psychoeducational group session to the class. The topics can range from a current clinical mental health counseling issue OR how to conduct the other groups described in this chapter. CHAPTER 10 1. Have students role-play couples sculpting. Discuss what they like about this method, and what they dislike. 2. Divide the class into groups, and assign each a group a family systems theory. Have each group present the main concepts of each theory, as outlined in the text, to the class. CHAPTER 11 1. Instruct students to select two agencies from the community that specialize in child and 146

adolescent counseling. Have the students obtain contact information for both agencies (two separate agencies), visit one of them (they must schedule an appointment), and collect information about the site. Brainstorm in class what information is vital to collect (e.g., what is information is important for referrals? what do the students want to know? what would your client want to know?). Information about the agency that students may want to gather includes, populations served, credentials and specializations of therapist, specific services offered, and approaches used). Ask that students take a tour of the facility, to find a brochure or written information about the agency, and to ask about outcome studies, referral procedures, costs, etc. Next, have students contact their second agency by phone, collecting the same information. Discuss the differences between the two contacts. (What is the difference between a phone and personal visit? How would you compare your rapport with the person by phone, in person? How might a client feel being referred to either agency? How would a counselor best prepare the client for the referral?) Students should write up their experiences addressing ALL questions for review in class. The class should compile all of the information to share with each other – this is the start of a community resource file. 2. Have students brainstorm a list of the various counseling specialties in community settings, for example, substance abuse counseling. The class can then be divided into groups or each student can research 1 specialty and provide information on specific credentials that are needed and what additional training and preparation is required for the specialties, for example, the requirements to become a Licensed or Certified Substance Abuse Counselor might be researched and shared with the class by one group/student. CHAPTER 12 1. Assign students to watch the movie, Les Miserables, and have them write a paper describing how Erikson’s adult stages of psychosocial development are depicted in the movie. It is important that students support ideas with specific examples. In class, divide students into groups of three or four to discuss their insights. 2. Ask students to select a favorite middle-aged adult fictional character from a novel (Note: it might be helpful to give them a week or two to brainstorm a character). Have the students describe the character using Levinson’s Developmental Tasks of Middle Adulthood. CHAPTER 13 1. Set up a SIGI-Plus demonstration with the class. Often the campus career center or campus counseling center has a computer-assisted career guidance system available. Try to use the case example of Jeremy from the text to create a client for the demonstration. 2. Invite the directors of your university career center and counseling center to present in class. If possible, as a class, visit the university career center and counseling center.

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CHAPTER 14 1. Have students depict through drawing different clinical mental health counseling settings. Where does counseling occur? In what types of settings does clinical mental health counseling take place? Provide each student with a piece of newsprint and crayons or markers in order to complete their pictures, and then share as a large group or in smaller groups. What kinds of places were missed? Was there a central theme to the places students picked? 2. Invite a panel of counselors who work in different community settings to come to class. Allow each panelist an opportunity to discuss what a typical workday looks like at their respective sites. Allow ample time for questions and answers. CHAPTER 15 1. Invite an EAP counselor to your classroom. Ask each student to prepare at least one question for your EAP speaker pertaining to counseling in the workplace. Highlight the unique considerations that EAP counselors face, for example, supervisory-mandated counseling referrals. 2. Divide class into small groups. Ask each group to respond to the following prompts: What are some of the issues managed care has introduced into the field of clinical mental health counseling? What are the advantages of managed care? Disadvantages? 3. Have students role play a counselor calling for authorization for six additional counseling sessions from a managed care utilization reviewer (several role plays can occur with a helpful reviewer and a reluctant reviewer). Discuss the challenges and benefits of communication for counselors with a managed care company. What are the considerations for the client? Confidentiality issues? Quality of care issues?

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