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Counselors in the 21st century must not only respond to the pressures of managed care but also support the best interests of their clients. Criticism from consumers and professionals about the lack of empirical evidence of the efficacy of counseling as well as pressure from managed care companies have prompted a focus on evaluating treatment outcomes. This article provides a framework for developing standards of care by highlighting issues in outcome research in general and by reviewing treatment outcomes for obsessive-compulsive disorder., Counseling in the 21st century is increasingly influenced by the policies and regulations developed by managed care companies (Davis & Meier, 2001). Managed care has become a powerful influence because [...]

A personality-disordered individual who visits a mental-health clinician, seeking relief from his suffering is presented. The patient George had lived seven years on the street, drugging, knife fighting and stealing, though he remained dedicated to defensiveness in his actions and took over two months for the psychologist for a gradual transition of George through several counseling sessions.

Mallen, Vogel, and colleagues explore the developing field of online counseling from the unique perspective of counseling psychology. They examine the body of available research and relevant clinical, ethical, legal, and practical issues and make recommendations for counseling psychologists who desire to participate in online counseling. This article provides a critique of their contributions, finds support for much of what they present, offers additional suggestions for counseling psychologists, and makes recommendations for counseling psychology to resolve challenges that at present, limit online counseling's value, effectiveness, and impact. The author makes recommendations for practical research that studies the actual online-counseling process, establishing additional standards', more effectively disseminating information, enhancing training, expanding access through innovative programs, and increasing advocacy efforts.

The rejoinder responds to the four reactions by Jeffrey Barnett, Tai Chang, Delida Sanchez-Page, and Franz Caspar and Thomas Berger in the November 2005 issue of The Counseling Psychologist. In doing so, the authors emphasize the important need for further clarity regarding the effectiveness of online mental and behavioral health services in delivering a wide range of psychoeducation, self-help, and mutual-help facilities as well as direct counseling. The authors also highlight many of the reactants' important insights, including the comments on the appropriateness of online mental and behavioral health services for the underserved and whether online counseling should be used as a primary or secondary tool in counseling.

This article responds to some important issues that Mallen, Vogel, Rochlen, and Day raise in 'Online Counseling: Reviewing the Literature From a Counseling Psychology Framework.' This reaction reviews the appropriateness of online counseling for underserved populations. The author provides suggestions for better serving historically undeserved populations via the Internet. In addition, she describes the ways in which the Internet is currently useful for psychoeducational purposes.

Seventy-one suicide survivors were surveyed about their perceptions of the clinicians who were treating their loved one at the time of death. Survivors provided information regarding their perceptions and attitudes toward clinician behaviors before and after the suicide and their perceptions of helpful and troubling aspects of clinician behaviors. Results indicated that survivors share a number of common opinions regarding the mental health care providers treating their loved ones. Several differences existed between survivors who consider lawsuits against mental health care providers versus those who do not. The implications of these findings for clinical practice, legal issues, surviving suicide, and future research are discussed.

In a recent study by Ellason and Ross, patients with Dissociative Identity Disorder reported a decrease in symptoms on the Millon Clinical Multiaxial Inventory-II over a 2-yr. follow-up period. Patients judged to have achieved integration of their personalities rated themselves as more substantially improved on the Millon-II than did patients judged not to have achieved integration. Ellason and Ross suggested that this improvement reflected the influence of treatment; however, for several reasons, their findings are open to alternative interpretations. First, in the absence of proper control conditions, one cannot rule out the contribution of other factors to the over-all improvement of patients such as regression of symptoms toward the mean following the initial assessment. Second, patients' self-reported improvement was less substantial when data were reanalyzed using more appropriate statistical criteria. Third, the greater improvement observed among integrated patients relative to nonintegrated patients may reflect influences other than differential responsiveness to treatment, such as less severe pathology prior to treatment. More systematic research is needed to clarify the effect of treatment on Dissociative Identity Disorder.

The purpose of this study was to investigate major dimensions affecting the acceptability of loneliness counseling interventions from the potential client's perspective and to compare the results with dimensions posited by theoretical models of treatment acceptability Data were collected from 241 university students who were asked to sort loneliness counseling interventions on the basis of their similarities. Multidimensional scaling analyses revealed 4 dimensions underlying the acceptability of loneliness counseling interventions: the type of activity required by the intervention, the counselor-client relationship, the difficulty of the intervention, and the fit of the intervention to the problem.

Videotape analogues portrayed an intake interview with a client presenting issues related to sexual abuse. Two 30-min analogues were identical except for 19 s that portrayed the client as (a) apparently nondisabled or (b) using a wheelchair. Participants (36 therapists and 11 graduate students) viewed one of the conditions and completed a case conceptualization task. Therapists gave different priorities to treatment themes depending on whether the client had a disability and whether they, the therapists, had received any training in disability issues. Untrained therapists were more likely to focus on extraneous issues and less likely to focus on appropriate themes for a sexual abuse survivor with a disability.

This paper describes the development of a knowledge measure for the evaluation of a proactive training program for suicide postvention and analyses of its psychometric properties. The 25-item true-false knowledge test was administered before and after each of 12 training sessions; a total of 205 school personnel participated in the training and evaluation. Participants showed significant improvement in overall test scores and on several individual items following the training. Analyses suggested that the measure has construct validity, and that it taps a single underlying dimension. Strengths and weaknesses of the measure, and measurement issues in program evaluation are discussed.

This study examines outcome of treatment for psychoactive substance dependence in a clinic which made psychiatric care readily available. Veterans entering outpatient treatment for substance dependence (n = 222) received psychiatric evaluation for additional Axis I disorders using DSM-III-R criteria. Patients provided urine toxicology specimens at least weekly. Outcome (urinalysis results and treatment retention) was compared for patients with dual diagnosis (n = 103, 46.4%) and with substance only diagnosis (n = 119, 53.6%). Psychotropic medications were prescribed for 80.4% of the dual diagnosis subjects. In the first 6 months of treatment, dual diagnosis subjects compared to substance only diagnosis subjects gave a significantly greater percentage of urines positive for cocaine and opioids. In the second 6 months, dual diagnosis subjects who remained (n = 72, 70.0%) significantly reduced from the first 6 months their percentage of cocaine and opioid positives and did not differ in percent positives from substance only diagnosis subjects who continued past 6 months (n = 70, 58.8%). Treatment retention of dual diagnosis subjects (median months = 14.3) exceeded that of substance only diagnosis subjects (8.9; Lee-Desu Statistic = 9.02, p < .003). Dual diagnosis patients may initially perform more poorly than substance only diagnosis patients in substance dependence treatment. However, in the presence of psychiatric care, they eventually exhibit comparable success., INTRODUCTION Considerable recent attention has focused on individuals who simultaneously suffer from psychoactive substance dependence and additional DSM-III-R Axis I disorders (1)(2). Accurate diagnosis arises as a critical concern for [...]

A study of the process of individual counselor supervision and the relationship between supervisees' thinking style and the supervisors' behavior revealed that the supervisors were hostile dominant or structured and directive toward the beginning supervisee while they were friendly submissive or collegial and collaborative toward the advanced supervisee. Hostile dominant behavior encouraged deep-elaborative thinking in the beginning supervisee while friendly submissive behavior was more encouraging for the advanced supervisee. The beginning supervisee was also found to be more hostile submissive while the advanced supervisee was more friendly dominant.

The authors assessed the relationship of counseling students&apos; hypothesis formation skill levels to counseling effectiveness. Hypothesis rating scales were selected to assess skill in using a comprehensive range of client data, integrating multiple client dimensions, and forming questions for hypothesis testing. Results indicated that higher ratings of hypothesis formation skill were associated with higher client ratings of counselor effectiveness. A combination of four hypothesis skill ratings predicted more than 60% of the variance in total Counselor Rating Form-Short version (CRF-S) scores, and one or more hypothesis formation skills were predictive of each CRF-S subscale score.

In this article the author addresses the possibility of pretreatment change as a viable first intervention for solution-oriented counseling approaches. Using the interview questions and format of Weiner-Davis, de Shazer, and Gingerich (1987), 82 clients were surveyed to ascertain if a change in their problem context had occurred between the time an appointment was made for counseling and the time they come to the first session. The results indicate that most of the clients can identify desirable pretreatment change with the assistance of a counselor. Bateson&apos;s (1979) &apos;difference that makes a difference&apos; and client expectancy are posited as explanations for the client&apos;s perceiving pretreatment change as significant.

The primary objectives of this article are to summarize the current status of the vocational realm of counseling psychology and to present some ideas for a renewed agenda for vocational psychology. As reflected in various surveys and position papers, the professional interests and skills of counseling psychologists seem to be shifting away from career-related activities. The implications of this trend are detailed and a set of proposals for the reinvigoration of the vocational realm of counseling psychology is provided.

Student services professionals manage a number of mental health crises as part of their job responsibilities. This article examines some of the issues that arise from assisting foreign college students experiencing such crises, with special focus on psychiatric committal, withdrawal from school, and return to the home country.

A study conducted by Breton and his colleagues showing that children between the ages nine to 11 understood only 38% to 42% of the DISC questions may suggest that children within that age group simply do not possess the ability to answer complex questions attached to the DISC Version 2.25. Instead of rewriting questions for children of this age bracket, it may be best that psychiatrists refine strategies that seek to provide better structured interview questions that can yield more reliable and valid results.

Batterer counseling is established as a centerpiece for domestic violence intervention in the United States. The changes in the intervention systems are stated, which are useful to undertake batterer programs in the various regions and the dedicated, counseling is helpful for men who have high cultural identity.

An account of the rape crisis movement in the United Kingdom is given. It includes quotes from interviews with rape crisis counselors and trainee counselors, texts, poems, research and reflections.

SUMMARY Nurse Richard Harwin uses his experience as a mental health intervention police officer. Keywords Assessment * Criminal justice * Drop-in surgery * Education * Liaison * Mental health * [...]