Impairment: Implications for the Counseling Profession

The issue of impairment has not been adequately addressed in the professional counseling literature. The authors explore the issue of impairment in the counseling profession, drawing from the literatures of medicine and psychology in discussing the prevalence of impairment, several views of the topic, responses to the problem, and related ethical considerations. Recommendations for the analysis and resolution of impairment issues in counseling are presented.     

Models of Disability: Implications for the Counseling Profession

Because of the increasing number of people with disabilities, counselors of all specialties and theoretical orientations will be called on to provide services to clients with disabilities. The authors present a brief overview of 4 major models of disability to provide an introduction to the varying definitions and causal and responsibility attributions of disability. Viewing the client with a disability as an individual with multiple identities, roles, functions, and environments facilitates the counseling process.     

Suicidality in Schizophrenia: Implications for the Counseling Profession

Schizophrenia is a common mental disorder treated by many counseling professionals, and it is associated with a high rate of early mortality. The most common reason for early mortality in schizophrenia is suicide. To date, the most recent comprehensive study on correlates of suicidality among clients with schizophrenia is titled “Suicidal Behavior in Schizophrenia: Characteristics of Individuals Who Had and Had Not Attempted Suicide” (J. M. Harkavy‐Friedman et al., 1999). It is the purpose of this Trends article to review this study and discuss its implications for counselors.     

Photovoice: Fulfilling the Call for Advocacy in the Counseling Field

Counselors are bound by ethical code to advocate at individual, group, institutional, and societal levels to examine potential barriers and obstacles that inhibit the growth and development of clients. Photovoice is a participatory action research method that utilizes a specific photographic technique to capture an issue from the lens of those affected. The authors of this article propose that photovoice can be adapted to individual counseling with clients to fulfill our ethical call to advocate at the individual level to address barriers and promote growth. A case example is given to demonstrate how photovoice can be used in a counseling session to advocate for clients.     

Advocacy for Counseling and Counselors: A Professional Imperative

Although advocacy both for clients and for the profession is essential for the future of counseling and counselors, advocacy for the profession has received little systematic attention. A national plan for advocacy is needed, the effectiveness of which depends on achieving consensus concerning professional identity, promoting a positive public image, establishing effective intraprofessional and interprofessional collaboration, and obtaining the participation of each counselor in advocacy activities. Specific professional advocacy skills and techniques are described.     

Standards of Care: Potential Implications for the Counseling Profession

The potential implications for development of professionally defined “standards of care” treatment procedures for mental health counseling are presented. The role of xpert witnesses in malpractice cases is examined as one source from which the standards are currently derived. The influence of managed care on the current clinical practices is noted. Finally, the importance of using outcome research as the basis for developing a “best practices” concept of standards of care is discussed. The authors note difficulties and challenges involved in making a commitment to what could be the next major impetus to the mental health movement.     

Billing for Medical Genetics and Genetic Counseling Services: A National Survey

In January 2007 the American Medical Association added a new Current Procedural Terminology® (CPT) code, 96040, for “Medical Genetics and Genetic Counseling Services.” In order to identify the impact of having this new code and to identify issues with implementation of the code, the National Society of Genetic Counselors (NSGC) CPT® Working Group surveyed NSGC members using an internet-based survey tool. The majority of respondents (94%) reported being aware of the new code and over half of the respondents (69%) said they were billing for genetic counseling. Approximately 24% of those billing reported using 96040. Many facilities are not using this code and the reported success of billing using 96040 is highly varied. Continued education may be beneficial to encourage reimbursement for 96040 and follow up is needed to assess the ongoing implementation and impact of the new CPT® code.     

Billing and Record-Keeping for Familial Cancer Risk Counseling: A National Survey

We surveyed 111 genetic counselors providing cancer risk counseling (CRC) in order to document their billing and record-keeping practices. Of the 75 respondents, billing was generally done under the supervising physician with a wide variation in charges. Follow-up telephone interviews with 28 counselors who charge patients revealed that billing was usually done using the CPT codes for consultations, and the ICD-9 diagnostic codes for cancer (if applicable), a medical complaint, or a family history of cancer code. Most counselors exclude some clinical information from the patient's medical record. In consultation notes, 81% of counselors document a discussion of genetic testing, but only 37% document the patient's actual testing decision, and only 19% document test results. In anticipation of increased referrals for CRC, data are needed on the components of a CRC visit, the amount of time required to provide CRC, patient outcomes measures, and charges and reimbursement. The feasibility and advisability of keeping results separate from the patient's medical record also needs to be addressed.     

Advocating for Atheist Clients in the Counseling Profession

Atheism is a controversial topic, with individuals who identify as atheist reporting high rates of discrimination. Despite increasing literature discussing religious/spiritual views and beliefs, few scholarly discussions of atheism in the counseling field can be found. Counselors need to be made aware of the issues facing atheist clients and educated on the best interventions to use in collaborative work with clients. Counselors should also be prepared to advocate for atheist clients in multiple domains. This article aims to explore the relevant literature around atheism, identify implications for counselors, and provide a path to advocacy for counselors in their work with atheist clients.     

Analyzing the Impact of the Medicare Coverage Gap on Counseling Professionals: Results of a National Study

The authors surveyed 6,550 members of the American Counseling Association regarding the current impact of Medicare policy on counseling professionals. More than half of respondents (54.8%) had been directly affected by Medicare reimbursement barriers, including 70.0% of practicing counselors. Statistical analyses indicated significant associations between years in the profession, direct experience with the Medicare coverage gap, and participation in professional advocacy related to Medicare. Implications for counselors, counselor educators, and counseling scholarship are discussed.     

The Ethics of Counseling: A National Survey of Certified Counselors

National survey data were collected from 579 counselors certified by the National Board for Certified Counselors (NBCC). Participants indicated their beliefs about whether each of 88 behaviors was ethical and also the degree to which they were confident of their judgment about the behavior. Systematic patterns in responding emerged in regard to age, sex, primary work setting, and degree. Participants also indicated their evaluation of 16 sources of ethical information or guidance. Highest ratings were given to American Association for Counseling and Development (AACD; now the American Counseling Association [ACA]) Ethical Standards, AACD ethics committee, the Journal of Counseling & Development, state licensing boards, and colleagues. The lowest ratings were given to local ethics committees, published clinical and theoretical work, court decisions, state and federal laws, and agencies for which participants had worked.     

Toward a Constructivist and Developmental Identity for the Counseling Profession: The Context-Phase-Stage-Style Model

The constructivist and developmental metatheories offer foundations for prevention- and health-oriented counseling approaches that target the whole population. In the assessment model proposed here, the counselor is directed toward 4 specific dimensions of human construction and development. They are the following: social context, life phase, constructive stage, and personality style. It is proposed that such assessment be infused into everyday counseling practice in schools, mental health settings, and colleges while also being a ground for the counselor education curriculum.     

Where Freud Took a Wrong Turn: A Rationale and Advocacy for Short-term Counseling

This article points to a fallacy in Freud's theory and treatment methods that have had disastrous effects for all helping professionals. It explores an alternative method that uses time limitation and confrontation as the basic counseling tools and techniques.     

Women of Spirit: Leaders in the Counseling Profession

This phenomenological study documents the voices and experiences of 10 female leaders in the counseling profession. Two protégés of each leader were interviewed to gain additional perspectives about these leaders. Leaders described experiences, contexts, processes, and outcomes that characterized their roles as positional and nonpositional leaders. Leaders highlighted themes of opportunity, challenge, unique and common ways of being, and empowerment. Protégés confirmed and enriched the leaders' accounts. Recommendations for personal and professional development are included.     

Counseling in Malaysia: An Emerging Profession

The emergence of counseling in Malaysia illustrates the importance of a strong professional association and counseling training programs at the university level.