A little discussion on sexual orientation

Sexual Orientation

            Over 1,500 animal species participate in homosexual behavior (http://www.news-medical.net/news/2006/10/23/20718.aspx), yet humans seem to be the only species who seems to have an issue with sexual practices that stray from the “norm” of heterosexuality. The idea of sex for purely procreation reasons is an outdated one, yet it still seems to infiltrate many social media outlets and even politicians debate the morality of same-sex relationships.

            The sexual continuum, as suggested by Kinsey, Pomeroy, and Martin (1948) suggests that sexuality is even more complex than many realize. The Heterosexual-Homosexual Rating Scale consists of a range from 0 (exclusively heterosexual), to 6 (exclusively homosexual), with a myriad of degrees of sexual preferences located along the scale. The scale portrays just how intricate individual sexuality can be, and just like humans, varies greatly.

            Another, and a bit more complicated way of measuring sexuality is the Klein Sexual Orientation Grid. While it does share the varying degrees of sexuality like in the Kinsey Scale, the Klein takes into account several different variables of interest. These include sexual attraction, sexual behavior, sexual fantasies, emotional preference, social preference, heterosexual/homosexual lifestyle, and self identification (Klein, 1993). Additionally, the Grid takes into consideration the past, present, and ideal sexual identity categories of the individual, thus indicating that in some, sexuality is fluid.

Legal and Ethical Considerations of Homosexual Clients

            In theory, mental health workers should treat every client like a human being, allowing full access to the quality care they deserve. However, this has not always been the case, which has led to legal implications for those who refuse to offer services to homosexual clients. A student in the counseling program at Eastern Michigan Universtiy was expelled from her program due to her refusal to counsel a gay client in 2009 (http://abovethelaw.com/tag/julea-ward/). However, a recently proposed bill in Tennessee (HB 1185) would prohibit universities from taking disciplinary actions against students in counseling programs who refuse to see LGBT clients, citing religious objections (http://openstates.org/tn/bills/108/HB1185/documents/TND00022457/). So, it appears that counselors can in some cases legally refuse to offer services to clients who identify as LGBT, but it still remains unethical, as the refusal to treat can in some cases, inflict more harm (Hermann & Herlihy, 2006).

Multicultural Competency and Sexual Orientation

            Multicultural competency addresses all aspects of who a person is, which encompasses their heritage, racial background, religious affiliation, and their sexuality. While there may be some counselors who object to same-sex relationships based on their own beliefs, there are steps that they can take to better prepare them to offer assistance to a wider variety of clients. Such steps include class activities, discussions, and continual learning in a safe environment (Charles, Thomas, & Thornton, 2005). Neglecting to include sexual orientation in multicultural training is a disgrace, especially within the marriage and family therapy (MFT), as not all couples that seek counseling are heterosexual.

References

1,500 animal species practice homosexuality. (2006, October 23). Retrieved from http://www.news-medical.net/news/2006/10/23/20718.aspx

Charlés, L. L., Thomas, D., & Thornton, M. L. (2005). Overcoming bias toward same-sex couples: A case study from inside an MFT ethics classroom. Journal of Marital and Family Therapy, 31(3), 239-249. doi:10.1111/j.1752-0606.2005.tb01566.x

Hermann, M. A., & Herlihy, B. R. (2006). Legal and ethical implications of refusing to counsel homosexual clients. Journal of Counseling and Development, 84(4), 414-418.

Kinsey, A. C., Pomeroy, W. B., & Martin, C. E. (1948). Sexual behavior in the human male. Philadelphia: W.B. Saunders Co.

Klein, F. (1993). The bisexual option. New York: Harrington Park Press.

Lat, D. (2012, February 6). Julea Ward « Above the law: A legal web site – News, commentary, and opinions on law firms, lawyers, law schools, law suits, judges and courts + career resources. Retrieved from http://abovethelaw.com/tag/julea-ward

Open States (n.d.). Bill Text - HB 1185 - Tennessee 108th Regular Session (2013-2014). Retrieved from http://openstates.org/tn/bills/108/HB1185/documents/TND00022457/

Sexual issues and multicultural implications: A personal reflection

Abstract

The realm of sexuality is quite vast, with many individuals having different concepts of what “normal” looks like with respect to human sexuality. Some are influenced by their own experiences, family beliefs passed down over generations, from religious definitions, and even by what culture deems as acceptable. Counselors often work with clients who have a different background, which includes sexuality. Multicultural competency spans more than where someone comes from, their ethnic makeup, and their socioeconomic status; sexuality also plays a key role in establishing who a person is, just as much as the aforementioned aspects. This paper will identify some key sexuality topics, as well as how counselors can help their clients when working with diverse clients. Additionally, legal considerations for counselors will be addressed in regards to sexuality issues.

Sources of sexual information

            A challenge faced by many of the current generation stems from the plethora of sources available in which they can gain information about society, sexuality, and culture. In the past, people were more apt to share the outlooks and beliefs of their family and those in their social circle. However, advances in technology have afforded individuals to expand their horizon when it comes to sexuality, thus broadening the definition of what is considered “normal” in society.

            Many still receive their guidance on appropriate sexual behavior from their religious affiliations. While turning to faith may comfort some, it also can make others feel excluded. According to the literature, a shift in acceptable sexual standards has swayed away from that of which is associated with Biblical tradition (Williams, 2013). Within the Christian faith, especially those who observe strict interpretation of the Bible, sexuality that strays from heterosexual or sex for procreation reasons is shunned. Sadly, such an outlook excludes many people, leading to an increase in depression, guilt, anxiety and suicidal risk (Subhi & Geelan, 2012).

            An additional influence into the definition of sexual identity is geographic location, which is also a part of one’s culture. One study found that sexual practices could be categorized by either “good/normal” or “bad/abnormal,” based on Western cultural standards (Morrison, Ryan, Fox, McDermott, & Morrison, 2008). The same study revealed that in addition to the acceptable practices, there were differences between what was deemed “normal” when it comes to gender, with male sexual practices that include homosexual fantasy and submission to fall under the category of “abnormal,” whereas the same was not found among female sexuality practices.

Geographic location comes into play when analyzing the level of acceptance of practices that are deemed “abnormal,” with the United States, Ireland, and Poland being associated with conservative sexual practices. Canada, Norway and the Czech Republic were reported as being more liberal when it comes to “abnormal” sexual practices (Morrison, Ryan, Fox, McDermott, & Morrison, 2008). The most sexual liberal, when compared to the United States, is Sweden, which reports a more accepting stance on nudity, masturbation, and expressing a desire for sex, including those that were deemed as “abnormal.”

Education and exposure: Combating biases

            Within the United States, many receive their sexual education from uncomfortable school presentations, which focus largely on either abstinence-only or abstinence-plus programs that stress abstinence as the primary choice, but also provide information on condoms and contraceptives (Haglund & Fehring, 2010). While the programs do provide some information about sexual health, they often come up short when it comes to the broad definition of sexuality. Many focus on safe sex, including condoms, contraceptives, pregnancy, and sexually transmitted diseases (Kirby, Laris, & Rolleri, 2007), leaving a large percentage of sexuality unaddressed.

            The educational shortcoming is not limited to those in the K-12 grades, as medical residents have also reported a lack of formal education when it comes to sexual health practices. A lack of education was found among the topics of non-Western cultures and homosexual relationships, with less than 50% of medical schools in the United States and Canada spending more than two hours on sexual health (Morreale, Arfken, & Balon, 2010).

            While many physicians and mental health care workers have come to the consensus that sexuality plays a large role in the lives of their patients (Morreale, Arfken, & Balon, 2010), the educational system does not appear to mirror their sentiments. Individuals who identify as gay often report feeling left out of the sexual education present in the educational system, and are more prone to being the target of harassment (Sherblom & Bahr, 2008).

            Just as sexual orientation seems to be missing from the curriculum, so do many other aspects of sexuality, including sexual dysfunctions. The lack of education regarding sexual dysfunction is not limited to the K-12 area of knowledge, but it is also present at the physician level. Formal education among physicians in the realm of sexual health is often just a bare bones version, which ignores an aspect of life that has the ability to affect the lives of their patients. Many physicians have reported being uncomfortable discussing the topic of sexual issues with their patients (Foley, Wittmann, & Balon, 2010). However, data suggest that physicians, who are involved in continuing education and possess effective communication skills, are more apt to speak to their patients about sexual health related topics (Foley, Wittmann, & Balon, 2010).

Ethical considerations and sexual issues

            Personal beliefs are an important part of one’s identity, but it is important for physicians and those in the mental health profession to separate their personal beliefs from that of their client. Counselors are bound to encounter clients who have a different cultural background, which makes multicultural education, including sexual identity, an important part of continuing education.

            The American Counseling Association has set forth a code of ethics for those in the counseling field to abide by, which includes several references to cultural sensitivity. Specifically, Section A.4.b. addresses the idea that counselors are to be aware of their own values, and being cognizant of not imposing their own values onto their clients (ACA, 2005). Additionally, if counselors find that they are unable to treat clients, they are to cease treatment and offer referrals to other counselors that may be more adept within the scope of practice, as noted in section A.11.b. (ACA, 2005).

Conclusion

            The vast array of sexual issues that counselors may encounter during their practice makes personal reflection and continued education essential in providing quality services for clients. Cultural influence regarding what is deemed “normal” can vary due to religion, geographic region, and personal experiences, all of which contribute to an individual’s identity, including their sexual identity. Being aware that people vary within a culture is important for both those working in the mental health field, and society as a whole.

**References Available Upon Request**

I can’t, I won’t, and ethics

I consider myself an ethical person so perhaps that is what brought me to the decision I made this week. I had offered my skills as a writer to an individual I found through an online freelance site. I worked for them for about a week, writing a variety of papers for their clients. However, I continued to have this nagging pain, which seemed to be emanating from deep inside, from where I imagine my soul would reside. 

I attempted to push that worry aside, but it kept festering and infecting my thoughts, just like the heartbeat famous in Edgar Allan Poe’s The Tell-Tale Heart. I tried to rationalize my actions, focusing on the fact that I was being paid to do something that I loved…research and academic writing. However, no matter how much I focused on that aspect, I felt the guilt suffocating me, like a scarf that was cinching down upon my windpipe. 

To make matters worse, the works that I had put many hours into researching and writing, were being critiqued by the customers, who themselves had horrid grammar, spelling, and punctuation. How could some rich brat of a kid criticize my work? The work that they themselves wouldn't even attempt? When I saw the replies to my submissions, I became furious and decided that I could not continue.

Perhaps it is because I would never think of paying someone to write something that I would then attach my name on, passing it off as my own work. When it boils down to it, I was helping an anonymous individual commit the academic crime of plagiarism, which I do not condone. Education is something that should be praised and enjoyed, for it is a lifelong process, not something that you pay someone else to do for you. 

Some of the assignments were for introductory courses in a community college. If students are buying papers in the beginning of their post-high school education, perhaps they need to reexamine their plan. Some companies charge upwards of $20 per page, depending on level of expertise and time constraints, and the sad thing…they are able to remain in business, as students are still willing to pay. I even helped to edit a thesis on turbojet engines. Granted, that was a bit of an easier job, and a necessary one, but it was based on the actual work of the student, rather than just a figment of the farmed out writer’s imagination. 

As the new quarter is about to start, finishing up my first year of graduate school, I wonder how many of my fellow students, both past and present, use such services. I'd rather earn a failing grade, than buy my way through life. Fortunately, I am able to maintain a near perfect grade point average and take pride in my work. When people buy papers, they really are just cheating themselves. 

#DoWorkDontCheat

Counseling challenges: Cultural, ethical, and legal issues (Also known as the "Very nice effort" paper)

Abstract

Counselors often walk a delicate line between helping their clients, and the ethical and legal issues that come with working with individuals who are in distress. While there are set guidelines in place for counselors regarding such issues, it is often not a clear pathway to navigate smoothly. If a counselor does not make the right choice during practice, they risk repercussions, not just professionally, but on a personal level as well. Being entrusted with the lives of others, knowing that steps and decisions made during treatment can ultimately change the life of another human being, is a massive responsibility, and one that should not be taken lightly. Cultural competence plays a role in therapeutic pathways, and approaches should be tailored to suit the unique needs of clients, while still abiding by the legal and ethical implications that may arise. Working with a variety of professionals can also complicate the journey, making effective communication with clients and other treatment team member an essential key to mental health. 

Legal guides for counselors

            Counselors often wear many hats in the course of their position: confidant, guide, assistant, life coach, advocate, mentor, and occasionally work as a mediator between the legal system and their client. Working in such a diverse role, counselors are tasked with a great deal of responsibility, which also brings consequences for both the client and the counselor depending on the efficacy of treatment and the adherence to the ethical and legal standards in place. There are several guiding organizations, each contributing a different piece of the legal puzzle counselors are asked to navigate.

Consulting the established guidelines is essential for counselors, their clients, and the entire mental health treatment community. Each branch of counseling has their own guide to standard of care, but most use the American Counseling Association’s Code of Ethics (2005) as a template from which they design their own guiding principles of care. There are currently 19 divisions of the American Counseling Association (Remley & Herlihy, 2010), allowing for a multitude of specialties, ranging from testing and gerontology, to art and sexual minority counseling. However, with the variety of areas available for counselors to practice, it is ultimately the responsibility of the counselor to seek out, learn, and abide by the regulations in place on the local, state, and governmental levels.

Decision-making models in counseling

            Due to the complexities involved in making ethical decisions for others, as well as remaining on the correct side of the legal system, counselors are often aided by the use of decision-making models. There are several to choose from, so finding one that best suits the situation, client, and specialty is possible with an examination of those available. Some specialties also have their own versions of decision-making models, including school, career, and addiction areas of focus. Some models are influenced by theoretical or philosophical sources, whereas others are founded in evidence-based practices (Cottone & Claus, 2000), further stressing the importance of finding the right one to fit the current need and dilemma.

            While the approaches may vary, one key aspect to any decision model remains constant: the legal standard of care counselor’s use when working with clients. The standard of care practiced by counselors, regardless of setting, must be consistent with what a reasonable, similarly trained and educated counselor would practice under the same set of circumstances (Remley & Herlihy, 2010). When consulting a decision-making model, it is imperative that counselors are able to separate their personal values from their professional role, as clients may possess a different value system, not shared by the counselor. Additionally, counselors need to realize that one decision-making model may not apply to all of their clients, thus making the need to be familiar with a multitude of approaches a necessity for an effective therapeutic outcome.

            One decision-making model for counselors working with a possible ethical dilemma, developed by Sileo and Kopala (1993), is a five-step model divided into an A-B-C-D-E method of approach that fits a variety of possible situations. The steps include assessment (A), benefit (B), consequences and consultation (C), duty (D), and education (E). Sielo and Kopala have even devised a worksheet to simplify the steps to what can be a complex process in finding a resolution to an ethical problem. While such a simplistic sounding approach may seem straight forward, it is essential for counselors to remember that despite the model used, that it cannot substitute for the combination of character, virtue, and counselor decision-making skills that come from experience and education (Jordan & Meara, 1990).

Even after employing the steps in a decision-making model, counselors may feel unsure about their actions and conclusion. In such instances, there are four self-tests one can take to evaluate the approach used and the outcome achieved (Remley & Herlihy, 2010). By analyzing the justice, universality, publicity, and moral traces that remain after a decision, a counselor can either feel more confident in their actions, or use their findings as an opportunity to learn and grow.

The A-B-C-D-E decision-making model in use

            In the case of Simone, an 18-year-old new mother who has a limited formal education, is receiving government assistance, and has no real motivation or future goals, it is essential for a counselor to approach the therapeutic relationship in a method that is helpful and does not come across as judgmental. Simone reports that she does not have a large support system in place, and lacks healthy and effective coping mechanisms, which are essential for individuals in similar positions. Teen pregnancy and motherhood is often associated with a negative impact in the realms of biological, social, and financial arenas of one’s life (Kramer & Lancaster, 2010).

Further complicating Simone’s situation is her familial history of mental health issues and her own possible learning disability, which some teachers had alluded to in the past. Possibly due to her stunted education and unhealthy family environment as a child, Simone is using marijuana to help her cope with the stress of being a new mother. All of these observations are associated with the first step in the decision-making model, assessment. Gathering information from clients allows the counselor to assess the strengths, weaknesses, depression, and resources, which can influence future steps. It is essential during the initial stage, and throughout the entire counseling relationship, that counselors put aside their own possible value conflicts and recognize that if such thing is not possible, they are ethically bound to make referral recommendations as per the 2005 ACA Code of Ethics (A.11.b.).

Upon assessing Simone’s presenting information, there are several areas that could benefit from further investigation. However, the physical and mental health of Simone and her child are the most pressing issues, and the ones that could benefit the most during the limited counseling sessions set forth by the grant that is providing payment for the services. Determining the key areas are essential in limited-duration counseling sessions, such as those arranged by Simone’s social worker.

After identifying the areas that would benefit most from assistance and change, it is time to move to the evaluation of the consequences and consultation stage of decision-making. It would be important to be honest with Simone about what could happen if she were to continue on her current path, including the possible legal implications that may occur due to her using and selling of marijuana. Simone’s lack of interest in pursuing any career goals could also negatively influence the quality of her life and that of her child as well. It is important for the counselor to remember that the approach used during counseling sessions has a possibility of pushing the client away, resulting in a negative consequence for themselves, as well as for their client. Consultation with outside professionals, namely addictions counselors, supervisors, and colleagues, may be of benefit to gain additional insight into the situation and steps that could be of benefit to the client.

Upon presenting the possible consequences and paths available to Simone, it is time for the counselor to assess who they have a duty to in the situation. Complicating the case is the fact that Simone has a child who solely depends on her for physical and emotional support. There could be possible child abuse or neglect at risk, which would make the question of “To whom do I have a duty?” a challenging one for the counselor to answer. According to the ACA Code of Ethics, counselor’s primary responsibility is to promote the welfare of the client (A.1.a.), however, with the addition of a child into the equation, it would be recommended for a counselor to consult their colleagues to determine if further notification is warranted. Under B.2.a. of the ACA Code of Ethics, confidentiality can be breached in the case of possible harm or legal requirements. However, such actions should be evaluated prior to undertaking, as the therapeutic relationship may be damaged, so it is imperative for the counselor to evaluate the possible ramifications that could occur because of breaching the confidentiality of the client and notifying law enforcement.

The final step in the current decision-making model is education, which applies to both the counselor and Simone. Education should be a career-long goal, as techniques, intervention methods, and laws evolve over time. In addition to addressing the ethical and legal issues that are associated with Simone’s case, it would also be important for the counselor to be culturally competent, as there are unique needs associated with the needs of the client. Not much is known about Simone’s cultural background, so it may be useful to delve into that area of her life to learn a little more about how her counselor and social worker can effectively address her needs. There are specific challenges that arise when counseling women, including the societal pressures to be a caregiver and provider for her child, discrimination based on gender, and employment barriers, especially among single mothers (Sue & Sue, 2013).

Education about the local marijuana laws would be applicable in Simone’s case, as there are avenues she could take that would allow her to legally obtain medicinal marijuana to help her cope with the anxiety of becoming a new mother. Under Oregon’s Medicinal Marijuana Program (OMMP), Simone would qualify for a reduced application fee since she receives public assistance (http://public.health.oregon.gov/DiseasesConditions/ChronicDisease/MedicalMarijuanaProgram/Pages/top20.aspx) if she wanted to pursue that option. However, it may be a challenge finding a doctor that would recommend her to the OMMP to obtain medicinal marijuana due to her present condition of being the sole caretaker for her child. While medicinal marijuana is legal in the state of Oregon, it is still considered a felony according to the federal government. Due to the possible legal implications, as Simone’s counselor, it would be important to educate her on other healthier options for stress management.

Personal values of counselors

            Keeping one’s professional and personal boundaries separate is essential in the field of counseling and mental health; however, it is not always possible to keep aspects of one out of the other. Counselors are people, with beliefs and values of their own, which may influence their view on certain subjects that may arise during sessions with clients. In the case of Simone, her drug use while caring for her child may violate the belief system of her counselor. Society and the medical community has deemed marijuana as a therapeutic drug that can help to soothe a variety of ailments. However, under federal law it is illegal, thus presenting a possible issue in both the legal and ethical realms for the counselor. Seeking amplifying information, in conjunction with consultation with colleagues and supervisors, can contribute to finding an amicable outcome for both the counselor and client.

            Personal and professional goals are an important aspect to the lives of many individuals, and without such, many counselors would not have achieved their goals of licensure. Encountering someone such as Simone, who does not identify as having any aspirations or goals to work towards may be another area where the values and beliefs of the counselor would be challenged. While Simone’s possible learning disabilities may hinder her potential, with effective assistance, she may be able to become motivated to achieve more out of life than sitting at home caring for her child, passively watching television and listening to music. However, it would be important to remember that not all individuals are motivated by goals, so projecting the desires of the counselor onto Simone could end in disaster due to the incongruent outlooks.

            Just as Simone’s history and background have influenced who she is today, counselors often bring their beliefs and experiences with them into practice. It is essential that they do not allow their values to taint their practice, which is often easier said than done. During the educational process, the professional horizons are broadened and effective counselors are able to live in a state of essential cognitive dissonance, holding that two possible conflicting beliefs can occur at the same time. Becoming comfortable with the fact that the values of clients will often differ from those held by the counselor is a key trait for successful therapeutic practice.

Conclusion

            Personal and professional value systems for counselors, while ideally exist in two different realms, may intertwine with one another, thus posing a risk of tainting the client and providing less than optimal therapeutic services. One key tool that counselors can when evaluating a possible ethical dilemma is known as decision-making models, one of which has been identified in the current paper. While the models do not guarantee an ethical and legal outcome of the situation, it does provide key questions to help the counselor to navigate and evaluate the challenges posed by their clients. Providing fair, factual, and helpful feedback to the clients regarding the possible ramifications associated with the choices they make can return a sense of personal power to the clients, knowing that ultimately the choice is theirs.

**References Available Upon Request**

Atheist in a foxhole: The role of religion in the US military

Abstract

The United States military is as diverse as the society in which its members are derived from, encompassing a variety of cultures. Within the spectrum of culture, several differences can exist, including gender, sexual orientation, worldviews, and religion, and often these differences can cause individual turmoil when trying to live within the military culture. Further complicating the assimilation are the unique needs of military members, who essentially leave their nuclear families behind, forging into a new life, complete with new rules and regulations, some of which do not mix easily with their personal cultural values. Counselors within the military are a vital tool in helping members cope with both the initial transitions and the inevitable stressors associated with life as a member of the US military. Additionally, counselors should be aware of the unique aspects of various religions, and how they can help their clients to work with clashes that may arise between what they believe spiritually, and the mission at hand.

Counseling goals

            The field of counseling is quite varied, from marriage and families counseling, to addictions and guidance counselors working in a high school environment, and learning about the particular area of focus is essential in creating a competent counselor. Each of the counseling specialties brings forth unique challenges, and it is the responsibility of the counselor to keep up with developing research and therapeutic intervention techniques that are both effective and culturally sensitive.

            Counseling a culture within a culture can be challenging, and that is exactly what becoming a counselor within the United States military entails. The culture of the individual is combined with the unique needs, rules, and regulations of the military environment, and often such a combination can result in a personal conflict. The diversity amongst military members mirrors the variety that is witnessed from which the members are derived. Recognizing and acknowledging that there are differences between the cultures of which the counselor identifies with, and that of which the client identifies with, is instrumental in establishing an effective therapeutic relationship. Such a difference can be found within the realm of religion, and just as in other cultural differences, it is imperative for the counselor to keep abreast of any possible personal belief clashes, as keeping one’s private life separate from professional persona is essential in providing the best counseling environment and services possible.

Cultural immersion

            Experiencing cultures and religions that one does not identify with can be a challenge, but it is a challenge that must be undertaken in order to assist clients during times of stress and/or personal turmoil. One such method is by attending a religious service that is outside of one’s regular and/or identified religion, if a religion is present. By broadening their personal horizon, counselors are better equipped to assist clients in matters pertaining to religious issues.

            As an anti-theist, it is important for my personal development to become familiar and aware of different religions, as it may additionally assist in professional development. While one does not have to ascribe to the beliefs and traditions that are practiced, it is an invaluable experience. Attending a church service can be daunting, especially when one is not affiliated with any established religion. However, by putting oneself in the shoes of another, greater understanding is achieved. The Immanuel Lutheran Church in Albany, Oregon is a neighborhood church, outfitted with traditional stained glass décor depicting the Lamb of God, Dove of Peace, and an assortment of patterns depicting a holy trinity. Inside there were candelabras, each with seven white candles that were lit, casting a welcoming glow on the chilly winter morning. Volunteers just inside the doors handed out bulletins in which several announcements were contained, including prayer needs for parishioners, an order of service hymns, and assorted readings that would be presented that morning during services. Prayers were requested for family members who were traveling, undergoing surgery, or for prayers of strength for family members who had lost a loved one.

            The congregation was small, perhaps totaling 20 parishioners in all, which lent a welcoming atmosphere to what could have been an uncomfortable experience. Conversely, with such a small gathering, blending in was not possible, and feelings of being an outsider arose, as the pastor made his way over to shake my hand and welcome me to his service. Aside from the difference in religion, the parishioners and myself shared some similar observable cultural aspects, primarily race and language.

Religious applications to the military culture

            While the experience of one religion during the aforementioned exercise does not encompass the breadth of the religions found within the military, being exposed to a belief system that differs from one’s own is insightful. Within the military, religious chaplains are available to servicemembers, and offer a touch of familiarity, even in a warzone, as some are deployed along with active duty members. Such an inclusion is useful, especially when servicemembers are confronted with two differing sets of rules; orders handed down by superior officers, and by a belief that “Thou shalt not kill” (Earl, 2012). The moral and cultural contradictions that one may face in the military culture has the potential to hinder military recruitment, as some believe that the break from one’s religious identity, in favor of a different choice that may bring with it a requirement to kill or harm another, is considered a sin (Perabo, 2010).

             As stated previously, culture within the military is varied, including religions. In addition to the different branches of Christian religions of which the military is primarily comprised of (Perabo, 2010), Muslim culture is also present within the armed forces, which is not always received favorably, especially in a post-9/11 military culture. It is essential for a counselor to be aware of the possible cultural incongruities that may exist when serving in the military and being a practicing Muslim. One such challenge can be seen in the current conflicts in traditional Muslim countries such as Afghanistan. Some Muslim Army personnel have reported conflicted feelings, as part of the Prophetic tradition states, “when two Muslims face each other in fighting and one kills the other, then both the killer and killed are in hellfire” (Stark, 2011). Awareness of cultural clashes is essential for the counselor to effectively assist the client to address the situation. Combining two vastly different views and approaches have the possibility of causing great emotional turmoil, which can be lessened by consulting a culturally competent counselor.

            Another growing concern within the US armed forces is the growing number of military sexual trauma (MST) incidents, and the emotional turmoil increases when the trauma results in a pregnancy. Some religions, including Roman Catholic and Christian, forbid their members from obtaining abortions. Additionally, the services are not available on military instillations, and becoming pregnant in a warzone leaves few options for female combat soldiers, who have been known to perform abortions on themselves (Jacobson & Jensen, 2011). The psychological toll that results from experiencing both the physical trauma and the conflict between religious beliefs makes cultural sensitivity essential for a counselor working within the military, for the client is most likely going through one of the most stressful periods in her life.

            However, MST does not just affect female military members, as the rates for male victims of MST are estimated to be roughly equal to that of female victims, with an average of 30,000 cases of each (male and female victims) in 2003, with many more victims scared to come forward and report the incident (Burgess, Slattery & Herlihy, 2013). Male survivors of MST who identify as highly religious have another stressor to battle with, namely their sexuality. If another man sexually assaults them, some have a conflict of faith. However, recent research indicates that attitudes toward gays in the military are changing, reflecting a more accepting stance, but the views are not shared by men who identify as “highly religious” (Besen & Zicklin, 2007). As a counselor, it is imperative for a counselor to put aside their own personal beliefs about sexuality, in order to fully assist their client. By being cognizant of religious traditions, as well as the unique aspects of military culture, the therapeutic relationship can be a tremendous opportunity for growth, for both the client and the counselor.

Communication styles

            The combination of religion and military culture can pose a difficult task for a counselor, especially when one is not familiar with one of those aspects. Exposure to a variety of religious aspects can help a counselor better address that particular aspect. Facilitation through conscious effort to seek out religious experiences that differ from those one is affiliated with can assist in expanding their personal horizon and in turn, help the counselor to become better equipped with tools to assist their clients who come from a different culture.

            It is essential to keep in mind that one style or therapeutic approach will not work for every client a counselor may interact with during practice. Communication styles vary depending on culture, gender, affiliation, and in the military, rank. Awareness, fluency, and openness are three character attributes that will help a counselor to work towards cultural competency. Continual learning, including the ability to shift therapeutic approaches to match the needs of the client are essential when working with a variety of individuals, who come with their own sets of thoughts, ethics, values, and behaviors (Sue & Sue, 2013).

Conclusion

            As a religious minority, and a gender minority within the military population, it is important to separate personal from professional as it pertains to culture. While there is a possibility of overflow, from one aspect to another, keeping an open mind when working with clients who have a different set of beliefs is essential to building an effective therapeutic relationship with clients. Seeking out novel experiences can help to enrich the life of a counselor, which in turn, may help the lives of their clients.

**References available upon request**

Working together towards a common goal: How referrals can benefit clients and counselors

Abstract

Mental health professionals offer a great service; however, there are some instances in which a referral to a different counselor is required to most effectively assist the client. Referral services are a wonderful tool to utilize, as long as the appropriate measures are taken to protect both the client and current counselor. The primary goal in mental health counseling should be the mental well-being of the client, which may include admitting that the counselor does not have the needed skills and specialization to address issues that may come up during sessions. There are several considerations to keep in mind when referring a client to another provider, including specialization, scheduling, and ethical concerns. 

Team approach

The mental health care system is often comprised of several key players, each with their own brand of specialty they bring to the table. Some of these include social workers, psychologists, child and adolescent therapists, and counselors, each providing a key role in the mental health care of their clients. Team-based care, considered one of the best ways to ensure access and integration of services (Drake & Latimer, 2012), involves the bringing together of information garnered through interactions with each of the mental health care providers, and can be a bit daunting, but it is possible. However, there are certain ethical idiosyncrasies involved when working with a group of treatment providers, which must be addressed in order to prevent possible harm to both the client and provider.



Guidance for treatment team members can be found in the American Counseling Association’s (ACA) Code of Ethics, Standard D, which addresses the ethical considerations regarding the relationships between treatment team members. When working with a variety of specialties, it is imperative to abide by the rules set forth, in order to provide the best treatment, while still adhering to the confidentiality and ethical clauses to protect the client. One key in providing such services can be found within the informed consent that is provided to the client at the beginning of services, which states the limits of confidentiality and when a breach is required (ACA, 2005, Standard D.2.d.). However, it is imperative that all members of the treatment team are aware of the importance of maintaining confidentiality, as the actions of adhering to the legal and ethical obligations can been perceived as alienation and an inability to cooperate by other healthcare providers (Birky, Sharkin, Martin, & Scappaticci, 1998).

Collaboration case study

The case of a 31-year-old single mother of three children includes a variety of team members, including a child therapist, fellow counselor, a psychologist, and a social worker, who all play a key role in the mental health care of the family. The children rage in ages from three to nine, and some of their behavior has indicated a concern to the child therapist involved in the case. Since the therapist has met with the children a limited number of visits (three), there is not much to compare the recent actions with, other than the behavior exhibited during the previous sessions. 

        Comparing the behavior to that of “typical” adolescents would not be effective, or ethical, as the children are individuals. However, some of the behavior may indicate a need for further investigation regarding their home life, interactions with their mother, and their behavior in school. Two of the children are currently enrolled in school, and the mother has inquired via the assigned social worker, about day care for the youngest. A letter sent by the children’s therapist to the school counselor requesting any documentations regarding possible abuse or incidents experienced by the children may be useful. By collaborating with the school counselor, the treatment team is working to discover how to serve the clients, which is covered under the ACA Code of Ethics (ACA, 2005, Standard D.1.c.).  

Several of the treatment members have disclosed that the mother is often impaired, possibly by alcohol, and her actions were somewhat erratic. The offer of psychological assessments was extended to the mother; however, she has not followed through with the exams. The reluctance to complete the assessments provided by the psychologist is not uncommon, as an estimated 70% of all dropouts from mental health treatment occur after the first couple of visits. However, if the mother can agree to meet with a psychiatrist, her risk of dropout reduces dramatically (Olfson et al., 2009). The stigma of obtaining mental health treatment may play a role in the mother’s hesitation, which is detrimental to the wellbeing of herself as well as her children. The barrier imposed by the stigma can also diminish self-esteem and prevents the client from participation in treatment (Corrigan, 2004).  


Sharing of information within the treatment team is an exemption to the confidentiality clause and does not violate privileged communication guidelines. However, it is still wise to obtain written permission from clients prior to collaboration (Remley & Herlihy, 2010). In cases where there is a risk of possible abuse or neglect, the counselor has an obligation to notify the appropriate agencies and the confidentiality agreement is considered void (Remley & Herlihy, 2010). 

        When considering a referral, it is important to include the client in the decision, as in the aforementioned case study. Having the mother play an active role in her mental health treatment can lead to a higher rate of attrition and program adherence (Olfson et al., 2009). Having a working relationship with the treatment team and familiarity with the psychiatrist employed at the community mental health center would make the referral process smoother for the client and the treatment team involved. Sharing of relevant information would also assist the psychiatrist in an evaluation, however, it is important to provide case notes and documentation that is objective, as to not sway the possible diagnosis. 

Conclusion

Effective communication within and between treatment team members is essential to obtaining the best treatment possible for the client. Referrals to a professional who has received specialized training in a certain area of expertise may be necessary at times, and should be made with input from the client involved. A letter addressing such a request can be found in the Appendix. Guidelines for the appropriate ethical and legal steps to take during referrals are available for counselors and should be consulted when making such decisions.

**References available upon request