Supervision

Supervisory Roles

Teacher

As an expert, the supervisor must provide the supervisee with answers and instruction for realistic and case-appropriate techniques, provide answers to his concerns, professional solutions for his confidence issues, and help him implement more effective case conceptualization techniques (Pearson, 2004; Young & Basham, 2008).

Counselor

In this role, we address issues related to the supervisee as a mental health counselor and determine which issues, if any, are provoking discomfort and a lack of self-esteem and confidence in the supervisee's ability to counsel (Young & Basham, 2010). In this counseling role, the supervisor facilitates self-growth and encourages an awareness of his personal abilities as a professional mental health counselor and the areas in which he needs to develop his effectiveness (Pearson, 2007).

Consultant

In the consulting supervisory role, we address intervention techniques and various therapeutic models that will strengthen counseling abilities. To increase confidence in counseling abilities and to augment the supervisee's range of experience, we will discuss the use of various counseling techniques. To improve the effectiveness of interventions we will review client outcomes. This supervisory role "provides options and alternatives rather than answers, and the interaction is more collegial" (Pearson, 2007, p. 363). Furthermore, we would discuss case conceptualization and treatment planning as they relate to current caseloads (Pearson, 2007).

Supervisory Skills Relevant to Roles

Teacher Supervisory Role and Educating

In the supervisory role as teacher, an ability to educate or instill knowledge is the most essential to the supervisee's success. Additionally, the ability to assess the supervisee's needs and augmenting his counseling knowledge is valuable. Where the supervisee lacks education and experience, the supervisor must provide appropriate teaching (Worthen & Lambert, 2007). This role embraces the supervisor's ability to provide constructive feedback, teach various intervention models and techniques, and provide explanations and reasoning behind these methods (Pearson, 2007).

Counselor Supervisory Role and Personalized Helping

In this supervisory role, the skill of identifying unresolved issues in the supervisee is valuable and necessary (Young & Basham, 2010). The supervisor must encourage self-growth as it applies to the supervisee's counseling abilities, and explore his or her personal strengths and weaknesses as they augment and constrain the supervisee's ability to counsel appropriately. The counselor/supervisor must have the ability to gain a personalized perspective of the supervisee and help him or her function effectively (Pearson, 2007).

Consultant Supervisory Role and Collaboration

Collaboration is the most valuable skill for the consultant/supervisor. This supervisor must have the ability to form an overall perspective of the relationship between the supervisee and his or her clients, and the models used for intervention (Pearson, 2007). Rather than teaching the supervisee new methods of intervention and providing answers for his or her questions, the supervisor, in a consulting role, engages in discussions and brainstorming alternative methods and perspectives (Pearson, 2007). The focus of this role type is more on the client, the treatment, and outcomes as the subject for exploring alternative methods and techniques.

The Importance of Supervision to Counselors and their Profession

Supervision is a valuable tool for monitoring clients as well as guiding the development of mental health counselors and other supervisees (Young & Basham, 2010). Typically, the supervisory process pairs a student or trainee with an experienced, more knowledgeable professional. This process is part of a gate-keeping system that maintains standards for the profession as well as new mental health counselors. A supervisor is responsible for determining the general quality of new counselors' professional knowledge and behavior, addressing challenges as well as strengths, and evaluating the individual as a future self-directed counselor.

The supervisor is responsible for protecting the profession as well as the individuals who seek help from mental health counselors. Worthen and Lambert (2007) determined "systematically and regularly monitoring client outcomes and providing outcome feedback to counselors and supervisors can enhance client outcomes, especially for clients not making expected treatment progress" (para. 22). Furthermore, one of the primary goals for clinical supervision is "the facilitation of competency as a counselor and professional" (Worthen & Lambert, 2007, para 1).

References

Pearson, Q. M. (2004). Getting the most out of clinical supervision: Strategies for mental health. Journal of Mental Health Counseling, 26(4), 361–373.

Worthen, V., & Lambert, M. (2007). Outcome oriented supervision: Advantages of adding systematic client tracking to supportive consultations. Counselling and Psychotherapy Research, 7(1), 48-53. doi: 10.1080/14733140601140873

Young, M. A. & Basham, A. (2010). Chapter eight: Consultation and Supervision. In Erford, B. (Ed.) Orientation to the Counseling Profession: Advocacy, Ethics, and Essential Professional Foundations (p. 193-212). Upper Saddle River, NJ. Pearson Education, Inc.

Accountability and Outcomes in the Counseling Profession

Treatment Outcomes and Accountability

Clients, Counselors, and Third-Party Payers

Clients, are perhaps, the most important stakeholder in treatment outcomes. The common goal in treatment is creating measureable change, without which, there has been little therapeutic value to the intervention. Accountability expects interventions have purpose, positive effect, and measureable outcome. In essence, the treatment must have worth to the client (Erford, 2010).

Knowing which interventions are the most effective is a significant benefit to mental health counselors (Bradley, Sexton, & Smith, 2005). Counselors are bound by moral code to function in the best interest of their clients and apply treatments effective in "promoting the welfare of clients" (Bradley, Sexton, & Smith, 2005, p. 488). In addition to their responsibility to stake holders, counselors must be accountable to third-party payers. Reimbursement may hinge on the payer's determination that "interventions used are research-based, empirically sound, and capable of producing desired outcomes (Erford, 2010, p. 393). These demands will continue to create competitive accountability among mental health counselors (Erford, 2010).

Counselors and the Impact of Counselor Effectiveness

Sexton (1999) claims although "the counselor is probably the most studied object in our research history," these studies may prove that no prototypic counselor exists. The most important factors in counselor effectiveness are "a level of skillfulness..., cognitive complexity..., and ability to relate and relationally match with the clients with whom they are working" (Sexton, 1999, p. 4). Additionally, the ability to properly identify and assess client needs in relation to developing an evidence-based treatment plan is essential.

Significance to Stakeholders and the Profession

Outcomes and Accountability

For the counseling profession to continue as a credible science, stake holders must see measureable change and improved outcomes. If the counseling profession cannot prove its effectiveness, there may be less need for its services. Counselors must be accountable in their provision of empirically proven therapeutic interventions so clients and other stake holders have confidence the service they purchase is valid, valuable, and effective (Erford, 2010). Accountability and acting in the client's best interest is usually synonymous with using interventions based on research and scientific evidence.

Needs Assessment and Program Evaluation

In counseling, needs assessment determines where the greatest needs are, and how to most effectively fill them. To make measureable change, one must first identify where change is needed. This identification is essential to treatment planning and effective intervention, which is ultimately important to stakeholders and for the reputation of the counseling profession (Erford, 2010). If counselors and the counseling profession cannot meet the needs of the populations they serve, they are ineffective and inconsequential. Programs must be held accountable and provide interventions with intended results (Erford, 2010). Without effective program evaluation, there is neither proven worth of the profession nor responsibility to provide effective interventions (Erford, 2010).

The Role and Significance of Research

In Outcomes

Sexton (1999) claims positive outcomes rely on "evidence-based counseling intervention protocols effective with the client problems they were developed to help" (Sexton, 1999). "Outcomes research is vital to the well being of the client, the ethical obligations of the counselor, and the advancement of the field" (Heaves & Erford, 2010, p. 391). It must show effectiveness. Outcomes are pivotal in the personal success of the client as well as all stakeholders, and research is foundational in proving the value of the process and outcome of intervention.

In Accountability

To strengthen their ability to implement therapeutic interventions, counselors must be aware of the proven effectiveness of their applications. Research provides the parameter for accountability and sets standards, without which no measure for comparison exists (Heaves & Erford, 2010). Research enables counselors to provide therapeutic interventions in the best interest of the client and serves as proof of the discipline's value (Erford, 2010).

In Needs Assessment

Needs assessments provide counselors and the profession with real-life information regarding the needs of the populations in which they interact and intervene. Research determines how effectively counselor interventions meet these needs (Erford, 2010). Additionally, research explores needs in relation to interventions and outcomes to determine "the effectiveness of specific models paired with specific problems" (Heaves & Erford, 2010).

In Program Evaluation

Relevant and pertinent research has become increasingly reliable and the gold standard for treatment protocols and program efficiency. Empirically validated success and effectiveness have become the constructs by which programs are measured. Without success relative to the scientifically proven methods of intervention and treatment, programs cannot expect positive evaluation (Astramovich & Coker, 2007).

References

Astramovich, R. L., & Coker, K. J. (2007). Program Evaluation: The Accountability Bridge Model for Counselors. Journal of Counseling & Development, 85(2), 162-172.

Bradley, L. J., Sexton, T. L., & Smith, H. B. (2005). The American counseling association practice research network: A new research tool. Journal of Counseling & Development, 83(5), 488-491.

Erford, B. T. (2010). Chapter fifteen: accountability in counseling. In Erford, B. (Ed.) Orientation to the Counseling Profession: Advocacy, Ethics, and Essential Professional Foundations (p. 361-389). Upper Saddle River, NJ. Pearson Education, Inc.

Heaves, S.H. & Erford, B. T. (2010). Chapter sixteen: outcome research in counseling. In Erford, B. (Ed.) Orientation to the Counseling Profession: Advocacy, Ethics, and Essential Professional Foundations (p. 390-417). Upper Saddle River, NJ. Pearson Education, Inc.

Sexton, T. L. (1999). Evidence-Based Counseling: Implications for Counseling Practice, Preparation, and Professionalism. ERIC Digest. (pp. 1-6, Rep.). Greensboro, NC: ERIC Clearinghouse on Counseling and Student Services. (ERIC Document Reproduction Service No. ED435948)

The Effects of Trauma on Clients and Counselors

Examples and Descriptions

September 11, 2001

The most recent of crises engraved into American history, the terrorist attack on the World Trade Center took the lives of over 3,000 people and caused widespread terror that affected millions. Americans have indelible memories of that day, causing considerable stress for many. Direct and indirect exposure continues to cause sickness, depression, and post-traumatic stress syndrome (PTSD) as well as other mental health issues.

2011 Tohoku Earthquake and Tsunami

The March 11, 2011 earthquake and tsunami caused the death of over 19,000 people, ravaged large areas of the Japanese countryside, and continues to cause depression and post-traumatic stress syndrome in the Japanese population. The tsunami caused devastation in other locations, such as this author's state of Hawaii, which sustained millions of dollars of damage and spread fear and anxiety across the Hawaiian Islands.

Major Mental Health Effects of Disasters, Crises, and/or Trauma-Causing Events
Disasters, crises, and traumatic events cause depression, PTSD, generalized anxiety, nonspecific distress, fear, and an acute sense of one's own vulnerability (Satcher, Friel, & Bell, 2007). These same authors found 30% to 40% of disaster victims experienced PTSD in the year following a disaster. At least 10% to 20% of rescue workers and 5% to 15% of indirectly exposed individuals were affected as well. In Japan, a country with one of the highest suicide rates in the world, these rates are up over 30% since the tsunami (McCurry, 2011). General anxiety and depression continues among the Japanese people and children's depression and suicide is higher than normal (Shibahara, 2011). Satcher, Friel, and Bell (2007) found children highly susceptible to PTSD after similar disasters.

The World Trade Center attack plunged America into national crisis and war and altered the perception of personal vulnerability. Direct exposure caused more cases of acute stress, but first responders and caregivers experienced vicarious and/or secondary traumatic stress (Baird & Kracen, 2006; Harrison & Westwood, 2009). Sickness and disease continue to ravage responders and workers from the site. Furthermore, the disaster and the ensuing war's far-reaching effects caused depression, anxiety, and PTSD in military personnel, victims of the attacks, and in the general population (Satcher, Friel, & Bell, 2007). In both examples, the media created an exposure of global magnitude and widened the rippling effect of traumatization.

Counselor's Role in Responding to People

Trained counselors can ameliorate the psychological effects of trauma and disaster, provide crisis intervention, and monitor long-term damage in individuals and in communities (Dingman & Ginter, 1995). As an increasing number of natural and man-made disasters strike world-wide populations and media coverage exposes others indirectly, the effects of trauma spare few. Counseling must also be provided to rescue and other relief workers.

After the Japanese tsunami and the World Trade Center attacks, counselors taught coping skills to people affected with stress and anxiety. They helped normalize emotions under the circumstances, assisted in creating safe situations, and watched for warning signs of trauma-related stress (Baldwin, 2012; Dingman & Ginter, 1995). By offering strategies such as coping skills to the victims of trauma, counselors can decrease the effects of traumatization and help to restore the victim to mental health. Counselors may also be involved in designing proactive preparations as and general planning for disaster relief.

Vicarious Trauma and/or Secondary Traumatic Stress

Research (Arvay, 2001) suggests vicarious trauma (VT) and secondary traumatic stress (STS) are the same psychological constructs. Harrison and Westwood (2009) refer to McCann and Pearlman's (1990) definition of VT as "the cumulative transformative effects upon therapists resulting from empathic engagement with traumatized clients" (p. 203). Baird and Kracen (2006) discuss VT as the "result of exposure to graphic and/or traumatic material" (p. 182). Mental health counselors who engage with traumatized clients may experience the same trauma as their clients, only indirectly, or vicariously through the experience of their client (Baird & Kracen, 2006; Harrison & Westwood, 2009). STS can be a direct or indirect exposure to a traumatic event, and can produce the same symptoms as the more commonly recognized PTSD.

Strategies to Minimize Effects of Vicarious and Secondary Trauma

Internal reflection helps identify early symptoms of vicarious trauma and having an awareness of and acceptance that both VT and STS are normal and treatable (Trippany, White Cress, and Wilcoxon, 2004). Maintaining proactive peer support, actively maintaining a balanced lifestyle with regular self-care and self-awareness lessens the effects of vicarious traumatization "minimizing potential ethical and interpersonal difficulties" (Trippany, White Cress, and Wilcoxon, 2004, p. 36). Other proactive agendas include participating in counselor support groups, educating oneself on the signs and symptoms of vicarious traumatization in counselors, caring for a diverse group of clients, inspiring spiritual awareness in oneself and one's peers, and encouraging appropriate rest and relaxation for mental health counselors (Harrison & Westwood, 2009; Trippany, White Cress, and Wilcoxon, 2004).

References

Baird, K., & Kracen, A. C. (2006). Vicarious traumatization and secondary traumatic stress: A research synthesis. Counselling Psychology Quarterly, 19(2), 181-188. doi: 10.1080/09515070600811899

Baldwin, D. V. (2012). Disaster Mental Health. Trauma Information Pages. Retrieved January 25, 2012, from http://www.trauma-pages.com/disaster.php

Dingman, R. L., & Ginter, E. J. (1995). Disasters and crises: The role of mental health counseling. Journal of Mental Health Counseling, 17(3), 259-263.

Harrison, R. L., & Westwood, M. J. (2009). Preventing vicarious traumatization of mental health therapists: Identifying protective practices. Psychotherapy: Theory, Research, Practice, Training, 46(2), 203-219. doi: 10.1037/a0016081

McCann, I. L., & Pearlman, L. A. (1990). Vicarious traumatization: A contextual model for understanding the effects of trauma on helpers. Journal of Traumatic Stress, 3, 131–149.

McCurry, J. (2011). Japan's slow recovery. The Lancet, 378(9785), 15-16. doi: 10.1016/S0140- 6736(11)61002-7
Saleh, M.A. (1996). Disasters and crises: Challenges to mental health counseling in the twenty- first century. Education, 116(4), 519–528.
Satcher, D., Friel, S., & Bell, R. (2007). Natural and manmade disasters and mental health. JAMA: Journal of the American Medical Association, 298(21), 2540-2542.

Shibahara, S. (2011). The 2011 Tohoku Earthquake and Devastating Tsunami. The Tohoku Journal of Experimental Medicine, 223, 305-307. doi: 10.1620/tjem.223.305

Trippany, R. L., White Cress, V. E., & Wilcoxon, S. A. (2004). Preventing vicarious trauma: What counselors should know when working with trauma survivors. Journal of Counseling & Development, 82, 31-37.

Psychopharmacology and the Mental Health Counselor

Kaut and Dickinson (2007) claim "a growing challenge for mental health counselors is to understand the potential benefits and limitations of many different types of drugs" (p. 204-205). Regarding pharmacology and human behavior, understanding the relationship between the two has become an essential education. Effective, collaborative professional relationships provide the client with comprehensive treatment planning that may include pharmacological intervention for which referral must be made to prescribing professionals (King & Anderson, 2004).

Boundaries for Recommending and Prescribing Medication

In the contemporary milieu of pharmacology's role in mental healthcare, it is essential for mental health counselors to understand their role as well as the boundaries within which they must ethically and legally function. Having an awareness of pharmacological interventions benefits the client, the counselor, and the prescribing professional (King & Anderson, 2004). Advancing knowledge of the neural mediation of behavior through pharmacological treatment does not antiquate psychotherapy and its beneficial methods (Kaut & Dickinson, 2007). On the contrary, both aspects of supporting mental health are elemental.

Mental health counselors practicing at the master's degree level do not usually have essential knowledge and training to recommend medications. Certainly, they have no legal right to prescribe them. Prescribing medications must be left to a trained professional with drug- prescribing licensure, although with training, the counselor may assist the prescriber by making recommendations. Because of the counselor's comprehensive understanding of the client's circumstances, the prescribing professional may benefit from the counselor's assistance (King & Anderson, 2004). Referring the client to the appropriate medical professional is in the client's best interest, especially when the counselor suspects a biological basis for presenting behavior. Specifically, the trained counselor may well recognize the client's need for prescription medication but making recommendations to the client for such treatment is the exclusive responsibility of the prescribing professional.

Mental Health Counselors' Role in Client Medication Education

As suggested by Kaut and Dickinson (2007), without specialized training in pharmacology, the mental health counselor must self-educate, sometimes on a case-by-case basis. Considering the significant role of pharmacology in contemporary mental health care, maintaining a balance of understanding its significance as well as using caution in its application is essential (King & Anderson, 2004). Ingersoll and Brennan (2001, as cited by Kaut & Dickinson, 2007) emphasize the counselor's role as the one who "understand(s) prescription medication (or other psychoactive drugs/substances) in order to capably address client concerns or therapeutic issues" (p. 216). The mental health counselor provides the client with necessary information as well as maintaining an open discussion about the drugs specific to the client's treatment as well as monitoring side effects and drug interactions. In many cases, the prescribing medical professional may fall short in explanations to the client, leaving the client's medication education to the counselor (Kaut & Dickinson, 2007). For example, if a client is experiencing troubling side effects, likely he or she will contact the counselor with questions and concerns.

Referring Clients for Prescription Medication

Identifying Medical Health Professionals for Client Referral

Depending on the particular client need, the appropriate referral for prescription medication may be directed to a psychiatrist, a psychologist with prescribing rights, the client's primary care physician, or other medical professional. It is not unusual to include specialists, depending on the health concerns. For example, a neurologist might be the appropriate referral when the client has seizures or frequent migraines. Determining the most appropriate collaborative partner depends on the client's significant issues (Ruddy, Borresen, & Gunn, 2008).

Providing Client Information to Prescribing Professional

To support collaboration with other medical professionals adequately, the mental health counselor needs to provide an overall case conceptualization, assessments, and "past history or contextual circumstances" (Kaut & Dickinson, 2007, p. 218). Additionally, the counselor may convey any ethically allowable and reasonable information necessary to create a comprehensive perspective of the client's need for pharmacological intervention. The primary responsibility for such therapy ends with the prescribing physician and in the client's best interest, any appropriate information pertinent to this decision should be shared.

The Relationship between the Mental Health Counselor and Prescribing Professional

According to Ruddy, Borresen, and Gunn (2008), "health care professionals must receive training in how to work together productively" and "must work toward developing interdisciplinary relationships" (p. 123). The mental health counselor plays a bidirectional role, communicating information between the client and the prescribing professional, a role that "maximizes client outcomes where integrative therapies are involved" (Kaut & Dickinson, 2007, p. 218). The counselor is in regular contact with the client, and in collaboration with medical professionals, functions as the foremost representative for the client as well as the eyes and ears of the prescribing professional. Throughout pharmacological intervention, the mental health counselor must continually re-assess the effects and success of the overall treatment. Always the client advocate, the mental health counselor collaborates with other healthcare professionals, consistently in the client's best interest (King & Anderson, 2004).

References

Ruddy, N. B., Borresen, D. A., & Gunn, W. B. (2008). Colocating with medical professionals: A new model of integrated care. In The collaborative psychotherapist: Creating reciprocal relationships with medical professionals (pp. 115-133). Washington, DC: American Psychological Association. doi: 10.1037/11754-006

King, J. H., & Anderson, S. M. (2004). Therapeutic implications of pharmacotherapy: Current trends and ethical issues. Journal of Counseling & Development, 82(3), 329-336.

Kaut, K. P., & Dickinson, J. A. (2007). The mental health practitioner and psychopharmacology. Journal of Mental Health Counseling, 29(3), 204-225.

Assessment, Diagnosis, and Research

Assessment, Diagnosis, and Research

"A good case conceptualization should effectively link a client’s presenting problem to a treatment plan as well as provide the basis for tailoring treatment to client need and expectations" (Sperry, 2005, p. 1). Additionally, case conceptualization embraces a holistic perspective of the client that includes understanding the client's issues as well as "the how and why the problems have developed" (Mears, 2010, p. 269). Without this comprehensive approach to mental health counseling, it is unlikely the client will be treated effectively.

Importance of Assessment and Diagnosis

In Case Conceptualization

Assessment and diagnosis are pivotal in case conceptualization. Accurate assessment and diagnosis help to form an overview of the client and contributing circumstances. Without a thorough assessment, it would be difficult to develop an overall perspective and comprehensive treatment plan. Assessing the client's general thinking and reasoning skills, behavioral issues, interests, and personality provide the perspective necessary for comprehensive case conceptualization.

To gain information significant to the client's personal circumstances, care must be taken to implement the most appropriate assessment, and one that is valuable and in the best interest of the client (Mears, 2010). Ultimately, integrating "the information gathered during the assessment with counseling and developmental theory, as well as diversity and social justice issues...leads to (a) diagnosis and effective treatment planning" (Mears, 2010, p. 283). As part of the case conceptualization, the diagnosis is essential to determining the treatment as well as the goals of any intervention. Without a definitive diagnosis, it is difficult to have a holistic grasp of the client, her circumstances, and the plan for intervention and recovery.

When a client is treated by multiple health care professionals, the assessment and diagnosis create a common language by which medical professionals care for the client. For example, in the case of an individual with bipolar disorder taken to a hospital because of severe mania, without understanding the pre-existing diagnosis of mental illness, the doctor may not fully understand how to treat the patient appropriately. Furthermore, most insurance companies require a definitive diagnosis for reimbursement for mental health services rendered to the client.

In Treatment Planning

According to Mears (2010), "a good treatment plan requires an assessment appropriate to the client's presenting concerns and a case conceptualization that includes an understanding of what the problem is, how it developed, and how to deal with it" (p. 291-292). Diagnosis and assessment provide guidance and direction toward evidence-based intervention and treatment. For example, if an individual presents with a nebulous set of symptoms and without substantiated diagnosis, choosing an empirically-derived treatment is difficult. Furthermore, the assessment and diagnosis give the client and counselor a focus in the scope of treatment planning and helps establish goals and strategies for the counseling intervention. Additionally, the diagnosis helps the client to more accurately understand his needs as well as how the treatment plan will work toward his recovery.

For insurance purposes and in managed care settings, a formal diagnosis, usually defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition - Text Revision (DSM-IV-TR) (American Psychiatric Association, 2001) as well as an evidence-based treatment plan is required for reimbursement for continued mental health counseling (Mears, 2010). In cases in which collaboration is necessary for treatment planning, case conceptualization creates a common language to describe the client's overall circumstances, treatment goals, interventions, and outcomes, as well as a holistic description of the client (Bufford, 2008). For example, when a mental health counselor refers a client to a psychiatrist or other mental health care professional, the case conceptualization will provide sufficient information on every aspect of the client.

Repercussions of Misdiagnosis

Intentional misdiagnosis or misdiagnosing to obtain necessary coverage for a client is unethical and illegal. Such action is a flagrant violation and a breach in the commitment to ethical behavior as described in the American Counseling Association (1995) and the American Mental Health Counselors Association (2000). Mental health counselors can have criminal charges brought against them and lose their reputations as well as their licenses (Braun & Cox, 2005). Aside from the legal and ethical ramifications, negative effects for the client include stereotyping by others (including health care professionals) because of the labels used in diagnosis (Mead, Hohenshil, & Singh, 1997).

For example, in the case of children diagnosed with attention deficit disorder, teachers associated with the child may develop preconceived ideas and anticipate behavior, leading to a cycle of self-fulfilling prophecy of negative behavior by the children in response to the teacher's expectations. Furthermore, a mental health diagnosis or misdiagnosis on an individual's medical record is a permanent entry and one that can affect one's employment, promote stereotyping by others, and represents a preexisting condition for future health insurance claims.

Conclusion

When taking any first step, it is necessary to identify one's footing, how one arrived at their current destination and intended direction, and how they will proceed. Assessment and diagnosis are central to case conceptualization and treatment planning, and in essence, pivotal in client intervention and healing.

References

American Counseling Association. (1995). ACA code of ethics and standards of practice (6th ed.). Alexandria, VA: Author.

American Mental Health Counselors Association. (2000). Code of ethics of the American Mental Health Counselors Association. Journal of Mental Health Counseling, 23, 2–22.

American Psychiatric Association (2001). Diagnostic and statistical manual of mental disorder (4th ed., text revised). Washing, DC: American Psychiatric Association.

Braun, S. A., & Cox, J. A. (2005). Managed mental health care: intentional misdiagnosis of mental disorders. Journal of Counseling & Development, 83(4), 425-433.

Bufford, R. K. (2008). Escape from Alcatraz: Finding safety and peace. Journal of Psychology and Christianity, 27(1), 66-72.

Mead, M. A., Hohenshil, T. H., & Singh, K. (1997). How the DSM system is used by clinical counselors: a national study. Journal of Mental Health Counseling, 19(4), 383-402.

Mears, G (2010). Chapter eleven: Assessment, Case Conceptualization, Diagnosis, and Treatment Planning. In Erford, B. (Ed.) Orientation to the Counseling Profession: Advocacy, Ethics, and Essential Professional Foundations (p. 269-297). Upper Saddle River, NJ. Pearson Education, Inc.

Sperry, L. (2005). Case Conceptualizations: The Missing Link Between Theory and Practice. The Family Journal, 13(1), 71-76. doi: 10.1177/1066480704270104