Book Review—Career Development & Planning: A Comprehensive Approach (4th Edition)

The fourth edition of Career Development & Planning: A Comprehensive Approach explores career decision making and planning. The way in which the textbook is outlined is consistent with literature and research on career development. It is separated into three different sections: Career Concepts and Applications, Social Conditions Affecting Career Development, and Implementing a Strategic Career Plan. The first part of the book explores self-knowledge, allowing students to answer the question “Who am I?” in regards to career. The subsequent sections provide knowledge about the world of work and instructions for creating a career plan. Many career courses follow a similar outline, and this textbook can be useful in those courses.

This textbook provides many useful activities for students to complete on their own or in small groups during class. The activities allow the students to engage in dialogue about the content in the chapters. The practical elements of this textbook are useful as well. Facts regarding growth occupations, labor market trends and appropriate attire for interviews offer concrete information for students who are embarking on career journeys. The manual accompanying the textbook is also valuable, providing a plethora of material for the instructor, including helpful PowerPoint slides. This manual provides a convenient framework for an instructor who might be teaching this kind of class for the first time.

Although the textbook provides various activities for students to complete, many of them are located in the appendices. It might be useful to have more of the activities in the chapter for students to view.  In many instances, students often skip over the activities in a textbook even when they are easily accessible; with these activities in the appendices, students may be even less likely to consider or complete them. Students might also engage more with the text and understand it better if it were punctuated with case studies and other opportunities for discussion. In addition, the textbook could benefit from a greater emphasis on culture and environment, which play a significant role in career development. Examining cultural and environmental influences in depth might allow students to gain more insight into their reasons behind their decision making.

Career Development & Planning: A Comprehensive Approach gives counselor educators, clinicians and students extensive information about career-development processes through a theoretical lens. In addition, it provides activities and interventions to implement in counseling people of various ages and backgrounds. These activities can also be useful for training counselors and clinicians in career development and its practices. Career decision making proves challenging for many individuals, and this textbook’s focus on career development allows clinicians to understand how difficult it often is for people to make career decisions. Counselor educators and clinicians are trained in helping others gain self–knowledge, but not always from a career-development perspective. This textbook could potentially help clinicians offer counseling services from a career-development standpoint. Staying informed about the job market and various employment trends is also important for counselor educators and clinicians, who should maintain up-to-date knowledge for their clients. Professors, practicing counselors and students can all benefit from the information and activities presented in Career Development & Planning: A Comprehensive Approach.

 

Reviewed by: Diandra J. Prescod, NCC, Assistant Professor, University of Texas at Tyler, Tyler, Texas.

Reardon, R. C., Lenz, J. G., Peterson, G. W., & Sampson, J. P., Jr. (2012). Career development and planning: A comprehensive approach (4th ed.). Dubuque, IA: Kendall Hunt Publishing.

 

The Professional Counselor

http://tpcjournal.nbcc.org

Back to Basics: Using the DSM-5 to Benefit Clients

Matthew R. Buckley

It is a pleasure to introduce this special DSM-5 edition of The Professional Counselor, which provides a solid primer regarding changes in the DSM-5 diagnosis process and how these changes will likely impact mental health professionals. Changes within the DSM-5 have prompted counselors to revisit the basics of diagnosis and consider the cessation of certain conventions (e.g., the multiaxial system) and what these changes mean to counselors as they perform their vital work for the benefit of clients. The unprecedented inclusion of various mental health professionals in the development of the DSM-5 is an inherent recognition of how this tool is being used across a wide range of professional disciplines that focus on psychopathology. I hope these articles not only inform, but encourage further research into the practical use of the DSM-5, “stimulate new clinical perspectives” in mental illness (American Psychiatric Association [APA], 2013, p. 10), and inspire continued professional dialogue around DSM nosology and the diagnostic processes.

Keywords: DSM-5, diagnosis, psychopathology, mental illness, multiaxial system

The fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) is an update of a major diagnostic tool (APA, 2013). The manual was originally designed to help mental health professionals within a wide variety of disciplines assess and conceptualize cases in which people were suffering from mental distress. This conceptualization is important in that it facilitates an understanding in a common language toward the development of treatment planning to address complex and entrenched symptomology. The DSM has undergone numerous iterations and represents the current knowledge of mental health professionals about mental illness (APA, 2013). One of the primary aims of the DSM-5 workgroups was to align the manual with the current version of the International Classification of Diseases (ICD-9). In addition, political, social, legal and cultural dynamics influenced the development of the DSM-5—and not without controversy (Greenberg, 2013; Locke, 2011; Linde, 2010; Pomeroy & Anderson, 2013). As with any tool, concerns have emerged about the potential of misuse. It is the professional responsibility of skilled and ethical mental health counselors and other professionals to prevent misapplication of the manual (American Counseling Association [ACA], 2014, E.1.b, E.5.a–d). Walsh (2007) succinctly noted that “the primary goal of the DSM is to enhance the care of individuals with psychiatric disorders” (p. S3).

The introduction of the DSM-IV-TR states that the DSM has been used by numerous mental health practitioners (APA, 2000), with no mention of their investment as legitimate stakeholders in the process of DSM development. Well before the final revision of the DSM-5, various mental health professionals, organizations and other relevant collaborators helped formulate the manual in unprecedented capacities. In the introduction to the DSM-5 (APA, 2013) the authors intentionally state that numerous stakeholders were involved in DSM-5 development including counselors and “patients, families, lawyers, consumer organizations, and advocacy groups” (p. 6). Of particular note was the inclusion of national organizations such as the ACA in the form of a DSM-5 task force, which submitted position statements and recommendations to the APA. Various mental health professionals participated directly in the formulation of the DSM-5, primarily in field trials which “supplied valuable information about how proposed revisions performed in everyday clinical settings” (p. 8). Much of the data supports the use of more than 60 cross-cutting and severity symptom measures (see http://www.psychiatry.org/practice/dsm/dsm5/online-assessment-measures).

Clinical Utility

First (2010) reported that utilizing broad and diverse populations of mental health professionals provides rigor for clinical utility. Achieving clinical utility within the DSM diagnostic processes meets the following four objectives:

to help clinicians communicate clinical information to other practitioners, to patients and their families, and to health care systems administrators;

to help clinicians implement effective interventions in order to improve clinical outcomes;

to help clinicians predict the future in terms of clinical management needs and likely outcomes; and

to help clinicians differentiate disorder from non-disorder for the purpose of determining who might benefit from disorder-based treatments. (First, 2010, p. 466)

Any changes to the DSM were framed within the context of how they might be utilized by all mental health professionals, including revisions to definitions of diagnoses and symptoms, proposed diagnostic categories, dimensional assessment (including cross-cutting), and a renewed emphasis on severity specifiers. Ultimately, the consideration was whether the revised manual would be accepted and utilized by the practitioners it proposed to serve (APA, 2013; First, 2010). First (2010) noted that no mandate exists requiring the use of the DSM by any professional, and that other tools used to arrive at an ICD diagnosis exist or are in development (e.g., the NIMH Research Domain Criteria initiative; APA, 2013; Nussbaum, 2013). The DSM-5 workgroups were challenged to revise the manual in order to make it user-friendly and maintain its relevance among mental health professionals. Even though the manual is an imperfect resource, the goal was to enhance clinical utility.

Determining a Differential Diagnosis

In his primer on diagnostic assessment focused on the DSM-5, Nussbaum (2013) offers six considerations in determining a differential diagnosis that serve as an important basis for practice. These considerations or steps include the following:

to what extent signs and symptoms may be intentionally produced;

to what extent signs and symptoms are related to substances;

to what extent signs and symptoms are related to another medical condition;

to what extent signs and symptoms are related to a developmental conflict or stage;

to what extent signs and symptoms are related to a mental disorder; and

whether no mental disorder is present.

Each of these process steps serves as important reminders for getting back to the basics of rendering diagnoses that help inform treatment. When working with clients, these steps function as points of reference to rule out potential factors influencing misdiagnosis. Additionally, client cultural factors are essential at capturing comprehensive context for assessment and diagnosis.

Consider to what extent signs and symptoms may be intentionally produced. Signs and symptoms may be purposely feigned on the part of a client for secondary gain (e.g., financial benefits, drug seeking, disability status, attention from others, reinforcement of an identity of pathology, avoiding incarceration). Counselors must recognize the context in which signs and symptoms occur and pay attention when something does not “fit” with how a client presents for treatment. Assessing prior mental health treatment (including outcomes), cultural factors and potential motives to fake an illness can assist counselors in making an accurate differential diagnosis.

Consider to what extent signs and symptoms are related to substances. A wise and influential professor and mentor during my graduate training said, “Always assess for substance use!” Clients can present with a variety of conditions that are induced by prescription or over-the-counter drugs, illicit substance, or herbal supplements (Nussbaum, 2013). An important emphasis within the DSM-5 is substance-use and substance-induced disorders, which are included in many relevant diagnostic criteria (APA, 2013). Counselors are well-advised to make this determination in the initial assessment and continue to assess throughout the course of treatment.

Consider to what extent signs and symptoms are related to another medical condition. Clients present with signs and symptoms that may be caused by or coincident with another medical condition in a variety of ways. Nussbaum (2013) defined possible manifestations including (a) medical conditions that directly or indirectly alter signs and symptoms, (b) treatments for medical conditions that alter signs or symptoms, (c)  mental disorders and/or treatments that may cause or exacerbate medical conditions, or (d)  both a mental disorder and a medical condition that are not causally related. Counselors should gather medical information from the client and appropriately follow up with medical personnel as needed to ensure proper and accurate diagnosis, which will lead to more targeted and effective treatment.

Consider to what extent signs and symptoms are related to a developmental conflict or stage. A primary strength of counseling professional identity is the focus on human development as a key factor in client distress and resiliency. The counseling practice of “meeting clients where they are” includes where they are developmentally. Counselors must recognize where incongruence exists between what clients present and the expected behaviors or characteristics of their particular developmental stage. Nussbaum (2013) stresses the importance of gathering a comprehensive psychosocial history to determine expected developmental milestones. Being on the lookout for developmental delays,  regressive behaviors of an earlier developmental period, primal defense mechanisms, or signs of “a developmental conflict in a particular relationship” (p. 201) will help ensure that all essential contextual factors are addressed when making a diagnosis.

Consider to what extent signs and symptoms are related to a mental disorder. The definition of mental disorder has not changed significantly from previous versions of the DSM: a mental disorder is “a syndrome characterized by clinically significant disturbance in…cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes…[and] usually associated with significant distress or disability in social, occupational, or other important activities” (APA, 2013, p. 20). Identifying mental disorders, or the process of diagnosis, involves more than clear-cut observations and often includes the consideration of complex factors involving comorbidity, symptom clusters “that may be part of a more complex and unified syndrome that has been artificially split in the diagnostic system” (Nussbaum, 2013, p. 202), overlap between diagnostic criteria, genetic predisposition, and the mutual influence of two or more conditions. Counselors must be careful to consider the presence of these factors, consult when necessary, and take into account differential diagnosis to determine the most appropriate diagnosis given the verbal and observable data available.

Consider whether no mental disorder is present. Sometimes a client may present with symptoms that do not meet the full diagnostic criteria for a mental disorder, despite significant distress in social, occupational or other areas of functioning. In these cases, utilizing the not otherwise specified or unspecified diagnoses may be warranted in order to provide opportunities for deeper inquiry. For example, the symptoms of a disorder may be a secondary reaction to an identifiable social stressor that may justify a diagnosis of an adjustment disorder. The possibility exists that there may not be a diagnosis present (Nussbaum, 2013), and in these cases, counselors and other mental health professionals are challenged to make that decision in the face of pressures to diagnose.

Cultural Implications

It is imperative that counselors take their clients’ social and cultural influences into account when assessing and diagnosing. Culture impacts all aspects of diagnosis and treatment, including how and when treatment is sought; power differentials between clients and mental health professionals; the age, gender, ethnicity, race, religion, sexual orientation, and socioeconomic status of both clients and mental health professionals; how illness is defined by both; and how problems are conceptualized and addressed within the context of culture (Lewis-Fernández et al., 2014; Tomlinson-Clarke & Georges, 2014).

Two decades of experience using the Outline for Cultural Formulation (OCR), which was introduced in the DSM-IV (APA, 1994), evolved into the Cultural Formulation Interview (CFI) now contained in the DSM-5, comprised of 16 semi-structured questions designed to collect data in a more consistent and efficient manner. Like other dimensional, cross-cutting and severity measures developed specifically for the DSM-5, the CFI was field tested at 12 sites representing several countries to determine feasibility and usefulness (Lewis-Fernández et al., 2014). For the first time, culture in its varied manifestations has been intentionally incorporated into the DSM nosology through a specific assessment instrument. “The CFI follows a person-centered approach to cultural assessment…designed to avoid stereotyping, in that each individual’s cultural knowledge affects how he or she interprets illness experience and guides how he or she seeks help” (APA, 2013, p. 751). Counselors are encouraged to utilize the CFI as a way to understand their clients more meaningfully and to aid in clinical utility.

The TPC Special Issue: Counseling and the DSM-5 

Because the DSM-5 is a tool for mental health professionals to utilize in their conceptualization of client distress, understanding how to use the DSM effectively is at the heart of this special issue published by The Professional Counselor (TPC). Readers will find a variety of articles that will assist mental health professionals by providing important context for most of the salient changes within the DSM-5 (APA, 2013) from the perspective of professional counseling. Inherent in each of these contributions is the theme of getting back to the basics in not only understanding the DSM-5 conceptually, but also providing ideas for putting concepts into practice.

An essential element in understanding and using the DSM-5 effectively is exploring the foundational and historical roots of this complex nosology. Dailey, Gill, Karl, and Barrio Minton (2014); Gintner (2014); and Kress, Barrio Minton, Adamson, Paylo and Pope (2014) offer excellent overviews of salient changes within the DSM-5 that impact clinical practice, including how the DSM has evolved over time. While there is necessary redundancy on key points (e.g., elimination of the multiaxial format, implementation of cross-cutting symptom measures, closer alignment with the ICD coding system), each article provides an important and unique perspective. Dailey et al. (2014) offer important perceptions on changes within the DSM-5 including how changes evolved historically and the philosophical foundations behind those changes, especially those that clash with the philosophical underpinnings of counseling. The authors review the implications of such changes for professional counselors. Gintner (2014) provides an excellent context regarding the harmonization of the DSM-5 with the ICD, the inclusion of cross-cutting symptom measures and dimensional assessment, and how the manual is organized. The article focuses on how counselors might respond to these changes. Kress et al. (2014) offer an important perspective on the removal of the multiaxial convention used by mental health professionals for over three decades and the implications for counselors in the practice of assessment and diagnosis. These authors provide an important context for the decision to terminate the multiaxial system including advantages and disadvantages of DSM-5 changes.

King (2014) describes the practical application of diagnostic criteria and the use of cross-cutting dimensional assessments. This perspective offers a backdrop on which to compare current practice and how it may alter with use of the DSM-5. This article focuses on clinical utility and ensuring that the DSM-5 remains a guide to assessment, diagnosis and treatment. Schmit and Balkin (2014) give a comprehensive review of the cross-cutting, dimensional and severity measures from the perspective of psychometric instrumentation, including the practical application of validity and reliability. These authors underscore DSM-5 assessments as soft measures and provide important cautions to counselors using these instruments in their work with clients, including the importance of developing multiple data points.

Understanding specific diagnostic categories is essential to good clinical practice. Welfare and Cook (2014); Kenny, Ward-Lichterman and Abdelmonem (2014); and Jones and Cureton (2014) provide solid descriptions of specific diagnostic criteria and emphasize areas essential to our understanding of developmental and demographic strata. Welfare and Cook (2014) tackle chronic and persistent mental illness manifested in diagnoses within the following categories: schizophrenia spectrum and other psychotic disorders, bipolar and related disorders, and depressive disorders.  Clinical examples help contextualize the process of assessing and diagnosing these disorders and provide a detailed example of effectively utilizing each step of the diagnostic process. Kenny et al. (2014) provide a cogent overview of the changes made to the “Feeding and Eating Disorders” chapter, including the addition of binge eating and avoidant/restrictive food intake disorders, severity criteria for anorexia nervosa based on body mass indexes, and how the diagnosis of eating disorder not otherwise specified (EDNOS) has changed as a result. Jones and Cureton (2014) offer important perspectives on significant changes to the “Trauma- and Stressor-Related Disorders” chapter and how these changes may impact clinical practice. The authors discuss how diagnostic criteria have been developed for both children and adults and how cross-cutting symptoms (e.g., panic and dissociation) manifest in a range of disorders. Another significant change to this category is the acknowledgement of sexual abuse as a traumatic event; this takes post-traumatic stress disorder (PTSD) out of the often associated realm of combat veterans and into more common and insidious manifestations of trauma.

Counselors should consider the aforementioned changes to the DSM-5 in the context of their counselor identity. Maintaining professional identity and promoting a wellness- and strength-based perspective continues to be an important concern for the counseling profession and the training of counselors. Tomlinson-Clarke and Georges (2014) provide an overview of maintaining professional identity in the process of assessment and diagnosis within a system representing the medical model. A particular strength is the inclusion of how multicultural competency is crucial in using the DSM-5 effectively, which is an essential basic foundation to sound practice. Implications for counselor preparation also are a focus. Finally, Frances (2014) provides a critical commentary of how the DSM has been used by pharmaceutical companies to leverage significant profits at the cost to consumers of mental health services and our economy. As the former chair of the DSM-IV task force, Frances reminds counselors and other mental health professionals of their essential place within treatment and cautions counselors to use the DSM in a balanced manner. His comments are consistent with advocacy inherent in our profession for treatments that promote client resilience, and address psychosocial and environmental factors that impact client functioning.

Conclusions

This special TPC issue on counseling and the DSM-5 provides a compilation of articles covering the history of the DSM, structural and categorical changes, the process of diagnosis, implications for practice, and cautions and criticisms. These articles validate the unique and important perspective counselors bring to their work, and challenge all mental health professionals to use the DSM-5 accurately. The DSM continues to evolve, and its advocates have made significant strides in reaching out to a variety of professionals; one manifestation of this outreach is the development of the DSM-5 website (see http://www.psychiatry.org/practice/dsm/dsm5). Counselors have the opportunity to use the DSM-5, provide feedback directly to the APA, and help shape and influence future editions of this diagnostic tool. This is an important way counselors can advocate for their clients as well as their profession, and shape how the DSM is used to help treat those suffering from mental and emotional distress.

 

Conflict of Interest and Funding Disclosure

The author reported no conflict of interest or funding contributions for the development of this manuscript.

 

References

American Counseling Association. (2014). 2014 code of ethics. Alexandria, VA: Author.

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Arlington, VA: Author.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

American Psychiatric Association. (2014). Online assessment measures. Retrieved from

http://www.psychiatry.org/practice/dsm/dsm5/online-assessment-measures

Dailey, S. F., Gill, C. S., Karl, S. L., & Barrio Minton, C. A. (2014). Historical underpinnings, structural alterations and philosophical changes: Counseling practice implications of the DSM-5. The Professional Counselor, 4, 166–178. doi:10.15241/sfd.4.3.166

First, M. B. (2010). Clinical utility in the revision of the diagnostic and statistical manual of mental disorders (DSM). Professional Psychology: Research and Practice, 41, 465–473.

Frances, A. (2014). DSM, psychotherapy, counseling and the medicalization of mental illness: A commentary from Allen Frances. The Professional Counselor, 4, 282–284. doi:10.15241/afm.4.3.282

Gintner, G. G. (2014). DSM-5 conceptual changes: Innovations, limitations and clinical implications. The Professional Counselor, 4, 179–190. doi:10.15241/ggg.4.3.179

Greenberg, G. (2013). The book of woe: The DSM and the unmaking of psychiatry. New York, NY: Blue Rider Press.

Jones, L. K., & Cureton, J. L. (2014). Trauma redefined in the DSM-5: Rationale and implications for counseling practice. The Professional Counselor, 4, 257–271. doi:10.15241/lkj.4.3.257

Kenny, M. C., Ward-Lichterman, M., & Abdelmonem, M. H. (2014). The expansion and clarification of feeding and eating disorders in the DSM-5. The Professional Counselor, 4, 246–256. doi:10.15241/mck.4.3.246

King, J. H. (2014). Clinical application of the DSM-5 in private counseling practice. The Professional Counselor, 4, 202–215. doi:10.15241/jhk.4.3.202

Kress, V. E., Barrio Minton, C. A., Adamson, N. A., Paylo, M. J., & Pope, V. (2014). The removal of the multiaxial system in the DSM-5: Implications and practice suggestions for counselors. The Professional Counselor, 4, 191–201. doi:10.15241/vek.4.3.191

Lewis-Fernández, R., Krishan Aggarwal, N., Bäärnhielm, S., Rohlof, H., Kirmayer, L. J., Weiss, M. G. . . Lu, F. (2014). Culture and psychiatric evaluation: Operationalizing cultural formulation for DSM-5. Psychiatry, 77, 130–154. doi:10.1521/psyc.2014.77.2.130

Linde, L. E. (2010). American Counseling Association DSM response to APA. Retrieved from http://www.counseling.org/counselors/ACA-DSM-response.pdf

Locke, D. (2011). American Counseling Association DSM-5 Letter to APA. Retrieved from http://www.counseling.org/resources/pdfs/aca_dsm-5_letter_11-11.pdf

Nussbaum, A. M. (2013). The pocket guide to the DSM-5 diagnostic exam. Arlington, VA: Author.

Pomeroy, E. C., & Anderson, K. (2013). The DSM-5 has arrived. Social Work, 58, 197–200. doi:10.1093/sw/swt028

Schmit, E. L., & Balkin, R. S. (2014). Evaluating emerging measures in the DSM-5 for counseling practice. The Professional Counselor, 4, 216–231. doi:10.15241/els.4.3.216

Tomlinson-Clarke, S. M., & Georges, C. M. (2014). DSM-5: A commentary on integrating multicultural and strength-based considerations into counseling training and practice. The Professional Counselor, 4, 272–281. doi:10.15241/stc.4.3.272

Walsh, B. T. (2007). DSM-V from the perspective of the DSM-IV experience. International Journal of Eating Disorders, 40, S3–S7. doi:10.1002/eat.20397

Welfare, L. E., & Cook, R. M. (2014). Revising diagnoses for clients with chronic mental health issues: Implications of the DSM-5. The Professional Counselor, 4, 232–245. doi:10.15241/lew.4.3.232

 

Matthew R. Buckley, NCC, is a faculty member in the Mental Health Counseling program at Walden University, Minneapolis, MN. Correspondence can be addressed to Matthew R. Buckley, Walden University, 100 Washington Avenue South, Suite 900, Minneapolis, MN 55401-2511, matthew.buckley@waldenu.edu.

 

Book Review—What Every Mental Health Professional Needs to Know about Sex

The role of sexuality in the mental health profession can be somewhat blurry for both the novice and the trained counselor. Stephanie Buehler, MPW, PsyD, and certified sex therapist skillfully tackles this issue in her book, What Every Mental Health Professional Needs to Know about Sex. She demystifies the role of sex in therapy by expanding mental health professionals’ knowledge of common sexual issues through outlining stereotypes, appropriate language, sexual anatomy, sexual health and sexual problems, as well as assessment and treatment.

In Chapter 2, Buehler challenges counselors to dispute their present belief system, modifying any current rules they have about topics of sexuality within therapy. Buehler cites Ford and Hendrick’s (2003) report that counselors tend to view promiscuous clients as having more pathology, highlighting the prevalence of this conservative sexual worldview found among counselors. After bringing awareness to this issue, Buehler quickly changes gears and focuses on sexual anatomy (Chapter 3), providing scholarly terms and definitions for both sexual anatomy and the stages of psychosexual development. Next, Chapter 4 references the World Health Organization when defining sexual health as the absence of disease, dysfunction, or infertility and the presence of positive sexuality.

Buehler also identifies sexual health problems unique to both women (Chapter 6) and men (Chapter 7), since addressing potential health issues is imperative in order to further tailor treatment goals for each sex. For instance, the author provides multiple tips for helping men reduce sexual dysfunction and increase sexual health.  Transitioning towards couples, she offers several sexual exploration activities to help increase intimacy and sex. Buehler’s ecosystemic approach guides professionals in assessing couples’ sexual problems (Chapter 8) in accordance with their personal development and interaction with others. Additionally, the author provides a comprehensive list of questions to help counselors assess for numerous influences on each partner’s sexuality and/or sexual-related issues. When bringing to light the emotional distance of couples, the author emphasizes, “When sex goes, love withers.”

Throughout the remainder of the book, Buehler offers insight into various populations particularly affected by sexual issues. The overarching goal of  the author is to provide knowledge, increase awareness, and highlight counseling implications for these groups. Chapter 9 addresses parents’ questions about sex, providing a framework for helping parents learn to appropriately share sexual information with their children. Chapter 10 covers therapy with sexual minorities, addressing gaps in practitioners’ knowledge of special issues for LGBTQ individuals. The author believes it is necessary for clinicians to expand their knowledge of the LGBTQ community and other sexual-minority populations, because a counselor’s acceptance of his or her client is crucial for therapeutic success. Furthermore, flexibility from the counselor will also facilitate counseling sessions regarding topics like gender, age, and lifestyle preference (e.g., swinging, polyamory, etc.). In the remaining chapters, Buehler discusses other sexuality issues including sexual abuse, pain disorders, reproduction, medical problems, aging, problematic pornography viewing, and alternate sexual practices.

What Every Mental Health Professional Needs to Know about Sex provides a framework to expand upon the reader’s current knowledge of sexual issues with diverse populations. Moreover, it serves as a guide containing techniques for mental health professionals to utilize in their future work with clients.

 

Reviewed by: Kelley Holladay, NCC, doctoral student, University of Central Florida, Orlando, Florida.

Buehler, S. (2014). What every mental health professional needs to know about sex. New York, NY: Springer.

 

The Professional Counselor

http://tpcjournal.nbcc.org

Video Review — Three Approaches to Personality Disorders: Dialectical Behavioral Therapy with Marsha Linehan, PhD

Dr. Marsha Linehan, creator of Dialectical Behavioral Therapy (DBT), has developed a valuable DVD that illustrates how impactful the DBT approach can be when working with clients who present with challenging issues (e.g., suicidality, borderline personality disorder). Dr. Linehan explains the basics of DBT while demonstrating and describing this unique approach in a clear and concise way. This DVD is designed to help the viewer understand the key components of this efficacious treatment modality.

DBT is a comprehensive multidiagnostic treatment. To help viewers understand the foundational components of the DBT approach, Dr. Linehan discusses the four basic stages: (1) helping clients struggling with behaviors that may be life-threatening (e.g., suicidality) or that may interfere with their quality of life (e.g., loss of relationships), in order to gain control of such behaviors; (2) focusing on emotional experiencing to reduce traumatic stress; (3) helping clients take ownership of their behaviors and establish trust in themselves; and (4) achieving mindfulness/spirituality with focus on transcendence and building a capacity for joy. Dr. Linehan further enhances this valuable information with an illustration of a behavioral assessment with a challenging client. While observing Dr. Linehan’s interactions with the client in this video, the viewer can see how a thorough behavioral assessment contributes to each of the basic stages of DBT. Dr. Linehan pauses intermittently throughout the video to describe the process of her work, which allows the viewer to comprehend ways to apply DBT to their practice.

The dialectical piece of DBT refers to the balance of opposites: the need for one to change, but also to accept the way he or she is. Dr. Linehan believes that everything in the universe is connected, even both sides of opposites. In this video, she helps the client identify where the truth lies in both ends of opposition. While she hones in on the client’s perception of reality and validates his experience, she also helps him identify alternative perceptions of reality. Mismatches in perceptions are identified and linked to the client’s life challenges, which helps him gain a better understanding of the world around him and the need for behavior modification. Utilizing an assertive yet empathic approach, Dr. Linehan validates the client’s desire not to change, while also challenging this perspective in order to help increase his insight and desire to change. By observing the demonstration in this video, counselors can learn valuable ways to approach clients presenting with challenging issues and diagnoses, and gain a basic understanding of the DBT approach.

In addition to this informative DVD, the viewer receives an instructor’s manual by Katie Read, MFT, filled with useful content (e.g., tips for making the best of the DVD, summary of the DBT approach, discussion questions, related websites, suggestions for additional videos and further reading, etc.). Overall, this DVD is informative, helping the viewer form a clear understanding of the DBT approach. This DVD is ideal for both novice and seasoned counselors working with clients who present with challenging issues and diagnoses and who need to establish and maintain healthy behavior modification.

 

Reviewed by: Kristina Nelson, doctoral student, University of Central Florida, Orlando, Florida.

Psychotherapy.net (Producer), & Yalom, V. (Director). (2013). Three Approaches to Personality Disorders: Dialectical Behavioral Therapy with Marsha Linehan, PhD [DVD and video streaming]. Available from http://www.psychotherapy.net/video/dialectical-behavior-therapy-linehan

Available in DVD and streaming format as part of video subscription at Psychotherapy.net/subscriptions.

 

The Professional Counselor

http://tpcjournal.nbcc.org

Video Review — Psychotherapy for Chronic PTSD: A Vietnam Vet’s Journey

Psychotherapy for Chronic PTSD: A Vietnam Vet’s Journey is a 2-hour and 47-minute training DVD appropriate for a classroom and/or training seminar. The DVD features three individuals: Dr. Victor Yalom (serving as the interviewer), Dr. Frank Ochberg (the clinician with expertise in post-traumatic stress disorder [PTSD]), and Terry (Dr. Ochberg’s client who has struggled with PTSD following his experiences in the Vietnam War). One unique aspect of this DVD is that Dr. Yalom candidly interviews both the clinician and the client about the work that occurs between them; their comments demonstrate the tremendous impact of both the therapeutic relationship and the specific techniques that the DVD highlights.

The DVD begins with a detailed review of PTSD, in which Dr. Yalom interviews Dr. Ochberg. Following this review, Dr. Ochberg begins to describe his treatment regimen, starting with a thorough assessment of the client’s holistic health. Specific areas covered include physical health, nutrition, sense of humor, spiritual beliefs/practices and social relationships. Dr. Ochberg’s unique approach includes elements such as (a) not being the one who opens the door to clients sharing their traumatic experience, (b) connecting current clients with former clients to serve as support networks (with clients’ permission), (c) using creative techniques (e.g., poetry) and (d) involving the family in the treatment process. Dr. Ochberg notes the important fact that there is a crucial need for competent clinicians who are interested in working with clients struggling with PTSD; unfortunately, there are many more clients who need services than there are such clinicians.

Dr. Yalom next interviews Terry about his experience of living with PTSD following the Vietnam War (before starting therapy with Dr. Ochberg). Terry waited 40 years to seek counseling. His motivation to seek treatment, like that of many veterans, was spurred by the recognition of how miserable his life had become. His first attempt at therapy was with a clinician who was unskilled in treating PTSD; luckily, this clinician kept a good referral list of others with the necessary expertise. This is how Terry came to meet with Dr. Ochberg. Next, Terry recounts what he found to be most helpful in working with Dr. Ochberg, including both the relationship and the techniques they used.

Following the interviews of Dr. Ochberg and Terry, the DVD spends the remaining time on various session segments in which Dr. Ochberg and Terry demonstrate the discussed techniques. Drs. Yalom and Ochberg provide commentary to accompany the segments. Among these segments, the value of using the client’s religion/spirituality as a source of meaning-making receives specific focus. During the session, Dr. Ochberg readily admits to having routinely avoided his clients’ religion/spirituality during the early part of his career. He notes that he felt that he was missing a significant source of strength for clients as they created meaning about their traumatic experiences. Terry shares how impactful it was for Dr. Ochberg to explore his belief system, as it helped him to release much of his survivor’s guilt.

The DVD next demonstrates Dr. Ochberg using several therapeutic techniques during the treatment process. Dr. Ochberg first shares a poem he had written about his work with Terry (and other PTSD sufferers). He reads the poem to Terry and experiences his reaction, which seems to constitute a cathartic moment for Terry. Another unique strategy that Dr. Ochberg uses when working with PTSD is Ochberg’s Color Wheel, a pie chart with six colored segments. Each color corresponds to various feelings (and associated thoughts): yellow represents jumping for joy, blue signifies serenity, red reflects love (of others), green signifies self-love/self-respect, orange represents sensual pleasure, and purple reflects spiritual connections. Terry learns to use the wheel as a means of identifying feelings that have been numbed by traumatic experiences, and/or refocusing himself when in the midst of extreme anxiety, anger/rage, depression, etc. In the midst of the session segment, Dr. Ochberg invites Terry to mindfully consider each of the representative colors as a means of soothing an episode of anxiety. Next, Terry explores his anxious thoughts through the filter of the colors.

The final technique that Dr. Ochberg demonstrates is the Counting Method. Clients learn this PTSD-alleviating technique prior to use in the session, and they employ it when their flashbacks and/or intrusive memories are significantly impacting their lives. The clinician provides instructions to properly prepare clients for this technique, which involves clients silently allowing themselves to relive the events as they occurred (with all the associated thoughts and feelings). The clinician counts aloud from 1 to 100, and upon completion of the counting, the client shares what he or she experienced during the counting. The counselor writes down what the client shares and then processes the events in detail. Dr. Ochberg demonstrates this technique with Terry and discusses its purpose and utility.

Accompanying the DVD is an Instructor’s Manual, which serves as a useful adjunct to showing the video in a classroom or training seminar. The manual includes discussion questions that can be used for small groups, reflective writing exercises and the like. Additionally, the manual contains detailed descriptions of the techniques that the DVD demonstrates, including a guided role-play for students/practitioners who desire to practice these techniques. The manual concludes with suggested websites, videos and readings for those who want to pursue additional information on the treatment of PTSD.

The DVD package would be appropriate to use with graduate students in such courses as diagnosis and treatment, trauma counseling and/or a course that focuses on counseling veterans. For practicing clinicians intent on working with trauma survivors and/or combat veterans, this DVD would be a great aid to building their professional competence.

 

Reviewed by: W. Bryce Hagedorn, NCC, University of Central Florida, Orlando, Florida.

Psychotherapy.net (Producer), & Yalom, V. (Director). (2012). Psychotherapy for Chronic PTSD with Frank Ochberg, MD [DVD and video streaming]. Available from http://www.psychotherapy.net/video/ptsd

Available in DVD and streaming format as part of video subscription at Psychotherapy.net/subscriptions.

 

The Professional Counselor

http://tpcjournal.nbcc.org