Volume 31, Number 3, July 2009
1. Chronic Pain: Biological Understanding and Treatment Suggestions for Mental Health Counselors (Pages 189-200)
David Farrugia; Holly Fetter
Biopsychosocial factors related to chronic pain are discussed as a necessary foundation for understanding
and helping clients who are in pain. Familiar evidence-based counseling approaches that have
proven useful for working with clients who are in pain are reviewed to identify how practitioners can use
their counseling skills to help these clients. Approaches reviewed are assessment considerations, use of
psychotropic medications, cognitive-behavioral strategies, hypnosis and imagery techniques, family
considerations, and positive psychology.
2. Suicidal or Manipulative? The Role of Mental Health Counselors in Overcoming a False Dichotomy in
Identifying and Treating Self-Harming Inmates (Pages 201-212)
Devon L. Cummings; Mindi N. Thompson
Suicide is a significant problem within jails and prisons. If self-harming inmates are labeled manipulative
and therefore not treated, this may lead to their death, because research demonstrates that these
“manipulative” individuals are at risk of suicide and need treatment. Attention to the role of mental
health counselors in jails and prisons is therefore necessary. This paper discusses that role and ways to
identify, assess, treat, and prevent suicides in jails and prisons. It provides suggestions for research on
suicide assessment with incarcerated individuals who are considered manipulative.
3. Psychological Differences in Shame vs. Guilt: Implications for Mental Health Counselors (Pages 213-224)
Stephen Parker; Rebecca Thomas
Recent work on the psychological distinctions between shame and guilt has important implications for
mental health counselors. In particular, the work of Lewis (1971) and Tangney (1990, 1995; Tangney &
Dearing, 2002) identifies psychological differences between shame and guilt and how they are phenomenologically
expressed that provides helpful insight to those working with clients experiencing these
emotions. This paper draws upon this work to establish criteria for distinguishing shame and guilt and
to offer guidelines for their treatment.
4. Using Puppets with Children in Narrative Therapy to Externalize the Problem (Pages 225-233)
Sue Butler; Jeffrey T. Guterman; James Rudes
A clinical application is presented for using puppets with children in narrative therapy to externalize the
problem. A case example illustrates the clinical application. Implications for the practice of narrative
therapy are considered.
5. Supervising Trainees who Counsel Clients with
Borderline Personality Characteristics:
Implications for Training and Practice (Pages 234-248)
Laura Fazio-Griffith; Jennifer R. Curry
This article presents findings from an exploration of clinical supervisors’ perspectives of the process of
supervising trainees who counsel clients with borderline personality characteristics. Six supervisors,
from private practice settings, nonprofit agencies, and counseling and training centers, participated in
three rounds of interviews. They explored the supervision process with trainees who counsel clients who
exhibit these characteristics and the influence these characteristics had on the supervision process.
Recommendations based on these findings are offered for supervision in clinical practice, counselor
education, and training.
6. Influence of the Supervisory Working Alliance on Supervisee Work Satisfaction and Work-Related Stress
William R. Sterner
This article presents an empirical study that identified agency supervisees’perceptions of clinical supervision
and its influence on work satisfaction and work-related stress in professional settings. Because
there is a paucity of literature addressing supervision of professional counselors, there is a need to better
understand what influence supervision has beyond academic settings. Participants were 71 members
of the American Mental Health Counseling Association who were selected using a criterion-based random
sample methodology. The methodology pulls together a unique combination of variables and instruments
for exploration with professional mental health counselors. Results revealed relationships
between work setting, supervisees’ perceptions of the supervisory working alliance, work satisfaction,
and work-related stress variables. Implications for practice, training, and research are discussed.
7. The Experiences of Transgendered Persons in Psychotherapy: Voices and Recommendations (Pages 264-282)
J. Alison Bess; Sally D. Stabb
This study explored the therapeutic alliance and satisfaction between transgender clients and their therapists.
The design was qualitative and heuristically based. Seven transgendered participants who had
lived full-time as their non-natal gender for at least three months and who had spent at least the majority
of a course of therapy discussing their current gender identity were recruited. Interviews were semistructured,
and each was transcribed verbatim. Three levels of coding were used for analysis: seven individual
depictions in narrative form, a single composite depiction bringing together similarities between
the experiences of the participants, and a single exemplary depiction of critical themes. Results suggest
that the participants did not experience many of the heterosexist, sexist, and pathologizing biases
described in previous studies. Rather, they described supportive and affirming relationships with their
therapists. Some participants had had negative experiences with previous therapists. Participants called
for further training and education for therapists and other helping professionals. Implications for theory,
research, practice, and policy are explored.