Barriers of counseling :

Establishing an agreement or pact is considered a barrier in the counseling. They feel that

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ERIC Identifier: ED279995
Publication Date: 1987-00-00
Home Author: Bolton-Brownlee, Ann
Source: ERIC Clearinghouse on Counseling and Personnel
Services Ann Arbor MI.
Issues in Multicultural Counseling.
Highlights: An ERIC/CAPS Digest.
Search for Traditionally, the United States has been defined
ERIC as a melting pot in which various cultures are
Digests
assimilated and blended as immigrants mold their
beliefs and behavior to the dominant white
culture. The melting pot image has given way to a
more pluralistic ideal in which immigrants
maintain their cultural identity while learning to
About
This Site function in the society. Not only are immigrants still
and flocking to America from Cuba, Haiti, Vietnam,
Copyright Guatemala, El Salvador, and other countries (LaFromboise,
1985), but minorities already living in the United States
have asserted their right to have equal access to counseling
(Arcinega and Newlou, 1981). This diversity creates
three major difficulties for multicultural
counseling: 1. the counselor's own culture,
Privacy
Policy
attitudes, and theoretical perspective; 2. the
client's culture; and 3. the multiplicity of
variables comprising an individual's identity
(Pedersen, 1986).
THE COUNSELOR'S CULTURE
A major assumption for culturally effective
Resources
for Library
counseling and psychotherapy is that we can
acknowledge our own basic tendencies, the ways
Instruction
we comprehend other cultures, and the limits our
culture places on our comprehension. It is
essential to understand our own cultural heritage
and world view before we set about
understanding and assisting other people
(Ibrahim, 1985; Lauver, 1986). This
Informatio understanding includes an awareness of one's
n Literacy own philosophies of life and capabilities, a
Blog recognition of different structures of reasoning,
and an understanding of their effects on one's
communication and helping style (Ibrahim,
1985). Lack of such understanding may hinder
effective intervention (McKenzie, 1986).
Part of this self-awareness is the acknowledge
ment that the "counselor culture" has at its core
a set of white cultural values and norms by which
clients are judged (Katz, 1985; Lauver, 1986).
This acculturation is simultaneously general,
professional, and personal (Lauver, 1986).
Underlying assumptions about a cultural group,
personal stereotypes or racism, and traditional
counseling approaches may all signal
acquiescence to white culture. Identification of
specific white cultural values and their influence
on counseling will help to counter the effects of
this framework (Katz, 1985).
Adherence to a specific counseling theory or
method may also limit the success of counseling.
Many cultural groups do not share the values
implied by the methods and thus do not share the
counselor's expectations for the conduct or
outcome of the counseling session. To counter
these differences, effective counselors must
investigate their clients' cultural background and
be open to flexible definitions of "appropriate" or
"correct" behavior (LaFromboise, 1985).
Another counseling barrier is language.
Language differences may be perhaps the most
important stumbling block to effective
multicultural counseling and assessment
(Romero, 1985). Language barriers impede the
counseling process when clients cannot express
the complexity of their thoughts and feelings or
resist discussing affectively charged issues.
Counselors, too, may become frustrated by their
lack of bilingual ability. At the worst, language
barriers may lead to misdiagnosis and
inappropriate placement (Romero, 1985).
THE CLIENT'S CULTURE
As counselors incorporate a greater awareness of
their clients' culture into their theory and
practice, they must realize that, historically,
cultural differences have been viewed as deficits
(Romero, 1985). Adherence to white cultural values has
brought about a naive imposition of narrowly defined
criteria for normality on culturally diverse people
(Pedersen, 1986). Multicultural counseling,
however, seeks to rectify this imbalance by
acknowledging cultural diversity, appreciating
the value of the culture and using it to aid the
client. Although the variety of cultures is vast, the
following examples indicate the types of cultural
issues and their effects on the counseling
situation.
In the cultural value system of Chinese
Americans, passivity rather than assertiveness is
revered, quiescence rather than verbal
articulation is a sign of wisdom, and self-
effacement rather than confrontation is a model
of refinement (Ching and Prosen, 1980). Since
humility and modesty are so valued, it is difficult
for counselors to draw out a response from a
Chinese American in a group setting. The
reticence which reinforces silence and
withdrawal as appropriate ways of dealing with
conflict may be interpreted as resistance by the
uneducated counselor. Democratic counselors
may also be uneasy with the role of the "all-
knowing father" that the Chinese respect for
authority bestows on them (Ching and Prosen,
1980).
Africans place great value on the family,
especially their children, who are seen as a gift
from God, and on social relationships, with a
great emphasis on the community and their place
in it. In this context social conflict resolution
becomes important, so that peace and equilibrium
may be restored to the community, while personal
conduct becomes secondary (McFadden and
Gbekobov, 1984).
Many African values also influence contemporary
American Black behavior, including the notion of unity, the
survival of the group, oral tradition, extended kinship
networks, self-concept, concept of time, and control of the
environment.
In his discussion of counseling the Northern Natives of
Canada, Darou (1987) notes that counseling is seen as
cultural racism when it does not fit native values. These
values are: cooperation, concreteness, lack of interference,
respect for elders, the tendency to organize by space rather
than time, and dealing with the land as an animate, not an
inanimate, object.
Bernal and Flores-Ortiz (1982) point out that
Latin cultures view the family as the primary
source of support for its members. Any
suggestion that the family is not fulfilling that
obligation can bring shame, added stress, and an
increased reluctance to seek professional
services. Involving the family in treatment will
most likely insure successful counseling
outcomes with Latinos.
INDIVIDUAL DIFFERENCES
There is always the danger of stereotyping clients and of
confusing other influences, especially race and
socioeconomic status, with cultural influences. The most
obvious danger in counseling is to oversimplify the
client's social system by emphasizing the most obvious
aspects of their background (Pedersen, 1986). While
universal categories are necessary to understand human
experience, losing sight of specific individual factors
would lead to ethical violations (Ibrahim, 1985).
Individual clients are influenced by race, ethnicity,
national origin, life stage, educational level, social class,
and sex roles (Ibrahim, 1985). Counselors must view
the identity and development of culturally diverse
people in terms of multiple, interactive factors,
rather than a strictly cultural framework
(Romero, 1985). A pluralistic counselor considers
all facets of the client's personal history, family
history, and social and cultural orientation
(Arcinega and Newlou, 1981).
One of the most important differences for
multicultural counseling is the difference
between race and culture. Differences exist
among racial groups as well as within each
group. Various ethnic identifications exist within
each of the five racial groups. Some examples
include: Asian/Island Pacific (Japanese, Korean,
and Vietnamese); Black (Cajun, Haitian, and
Tanzanian); Hispanic (Cuban, Mexican and
Puerto Rican); Native American (Kiowa, Hopi,
and Zuni); and White (British, Dutch, and
German). Even though these ethnic groups may
share the physical characteristics of race, they
may not necessarily share the value and belief
structures of a common culture (Katz, 1985).
Counselors must be cautious in assuming, for
instance, that all Blacks or all Asians have
similar cultural backgrounds. McKenzie (1986)
notes that West Indian American clients do not
have the same cultural experience of Afro-
American Blacks and are culturally different
from other Black subculture groups. Counselors
who can understand West Indian dialects and the
accompanying nonverbal language are more
likely to achieve positive outcomes with these
clients.
CONCLUSION
Although it is impossible to change backgrounds,
pluralistic counselors can avoid the problems of
stereotyping and false expectations by examining
their own values and norms, researching their
clients' backgrounds, and finding counseling
methods to suit the clients' needs. Counselors
cannot adopt their clients' ethnicity or cultural
heritage, but they can become more sensitive to
these things and to their own and their clients'
biases. Clinical sensitivity toward client
expectation, attributions, values, roles, beliefs,
and themes of coping and vulnerability is always
necessary for effective outcomes (LaFromboise,
1985). Three questions which counselors might
use in assessing their approach are as follows
(Jereb, 1982): (1) Within what framework or
context can I understand this client (assessment)?
(2) Within what context do client and counselor
determine what change in functioning is
desirable (goal)? (3) What techniques can be
used to effect the desired change (intervention)?
Examination of their own assumptions,
acceptance of the multiplicity of variables that
constitute an individual's identity, and
development of a client centered, balanced
counseling method will aid the multicultural
counselor in providing effective help.
FOR MORE INFORMATION
Arcinega, M., and B.J. Newlou. "A Theoretical Rationale
for Cross-Cultural Family Counseling." THE SCHOOL
COUNSELOR 28 (1981): 89-96.
Bernal, G., and Y. Flores-Ortiz. "Latino Families in
Therapy: Engagement and Evaluation." JOURNAL OF
MARITAL AND FAMILY THERAPY 8 (1982): 337-365.
Ching, W., and S.S. Prosen. "Asian-Americans in Group
Counseling: A Case of Cultural Dissonance." JOURNAL
FOR SPECIALISTS IN GROUP WORK 5 (1980): 228-
232.
Darou, W. G. "Counseling and the Northern Native."
CANADIAN JOURNAL OF COUNSELING 21 (1987):
33-41.
Ibrahim, F. A. "Effective Cross-Cultural Counseling and
Psychotherapy." THE COUNSELING PSYCHOLOGIST
13 (1985): 625-638.
Jereb, R. "Assessing the Adequacy of Counseling Theories
for Use with Black Clients." COUNSELING AND
VALUES 27 (1982): 17-26.
Katz, J. H. "The Sociopolitical Nature of Counseling." THE
COUSELING PSYCHOLOGIST" 13 (1985): 615-623.
LaFromboise, T. D. "The Role of Cultural Diversity in
Counseling Psychology." THE COUNSELING
PSYCHOLOGIST 13 (1985): 649-655.
Lauver, P. J. "Extending Counseling Cross-Cculturally:
Invisible Barriers." Paper presented at the annual meeting
of the California Association for Counseling and
Development, San Francisco, CA. ED 274 937.
McFadden, J., and K.N. Gbekobov. "Counseling African
Children in the United States." ELEMENTARY SCHOOL
GUIDANCE AND COUNSELING 18 (1984): 225-230.
McKenzie, V. M. "Ethnographic Findings on West Indian-
American Clients." JOURNAL OF COUNSELING AND
DEVELOPMENT 65 (1986): 40-44.
Pederson, P. "The Cultural Role of Conceptual and
Contextual Support Systems in Counseling." AMERICAN
MENTAL HEALTH COUNSELORS ASSOCIATION
JOURNAL 8 (1986): 35-42.
Romero, D. "Cross-Cultural Counseling: Brief Reactions
for the Practitioner." THE COUNSELING
PSYCHOLOGIST 13 (1985): 665-671.

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Barriers to counseling patients with obesity: a study of Texas community

pharmacists.

O'Donnell DC, Brown CM, Dastani HB.

Roche Laboratories, USA. odonnell@mail.utexas.edu

Abstract

OBJECTIVE: To assess barriers to the counseling of obese patients and identify pharmacists' characteristics

associated with these barriers.

DESIGN: Cross-sectional mail survey.

SETTING: Texas.

PARTICIPANTS: 139 community pharmacists.

INTERVENTION: Self-administered questionnaire.

MAIN OUTCOME MEASURES: Respondents' perceived barriers to pharmacists' counseling of obese patients.

RESULTS: The top three barriers to counseling included lack of time (76.8%), lack of patient demand or expectations

(55.8%), and lack of reimbursement/compensation (49.3%). Pharmacists indicated that they rarely to sometimes

counseled obese patients and were somewhat comfortable with counseling about obesity management. They

perceived obesity management strategies to be somewhat effective in weight loss, but were neutral regarding their

confidence in achieving positive outcomes with counseling. Pharmacists who were more experienced were more
likely to indicate that obesity is controllable without medications. Those who considered obesity controllable without

medications were significantly more likely to view the various obesity management strategies as less effective,

compared with those who did not share this belief. Pharmacists who viewed lack of privacy as a barrier were

significantly less confident in achieving positive outcomes as a result of counseling. Creating awareness among

patients about pharmacists' ability to counsel was perceived as most important in overcoming barriers.

CONCLUSION: Pharmacists identified several barriers to counseling of obese patients. Pharmacists' demographics

and beliefs about obesity were significantly associated with their perceived barriers.

PMID: 16913390 [PubMed - indexed for MEDLINE]

How Counseling Works-From Alcoholism to

Anger Management to Zoophilia.
A Matter of Trust

I am going to guess that if you have arrived here, there is something going on in your life or the life of someone
close to you that is puzzling or troubling, and you are seeking information to clarify a choice.
That information may involve thinking, feeling, or behavioral components, and you may have thought about talking
to a professional counselor or are considering a career in counseling. (Yes!)
But before you make that decision, you want information about counseling tools, techniques, models, fields, etc.
I hope to provide you helpful tools, techniques, and recommendations based on my experience as a domestic
violence educator and training.
Counseling is an extraordinary experience. It works. My hope for you is that you find information here that will
guide your search to a clinician or tool (many good educational programs online now) which enhances your sense
of efficacy, brings more contentment,and allows you to live closer to your core values.
Counseling Defined
Counselors assist people with personal, family, educational, mental health, and career problems. Their duties vary
greatly depending on their occupational specialty, which is determined by the setting in which they work and the
population they serve.
Definition of Counseling from the American Counseling Association:
The application of mental health, psychological, or human development principles, through cognitive, affective,
behavioral or systematic intervention strategies that address wellness, personal growth, or career development, as
well as pathology.
First, The New Fields!
Neuroplasticity
Can the human brain change itself? Yes. Read here about neuroplasticity. The brain is a plastic, living organ that
can actually change its own structure and function, even into old age. This revolutionary and recent discovery
promises to overthrow the centuries old notion that the adult brain is fixed or unchanging. Yes, the brain can
function more effectively, which makes us more effective for longer periods of time.
Brain Fitness Programs

1. Brain Gyms :
Our brains resemble our muscles in one key respect: don’t exercise them, and they’re likely to lose
strength. Conversely, many experts now believe that brains stimulated in a healthy manner can better
resist debilitating mental conditions such as Alzheimer’s. In fact, there are brain gyms opening now which
utilize two of the programs found here, HeartMath and Luminosity, and the best of all, Mind Sparke.
2. Positive Psychology :
Positive Psychology is the scientific study of the strengths and virtues that enable individuals and
communities to thrive. The Positive Psychology Center promotes research, training, education, and the
dissemination of Positive Psychology.
– This field is founded on the belief that people want to lead meaningful and fulfilling lives, to cultivate
what is best within themselves, and to enhance their experiences of love, work, and play.
– Positive Psychology has three central concerns: positive emotions, positive individual traits, and
positive institutions.
– Understanding positive emotions entails the study of contentment with the past, happiness in the
present, and hope for the future.
– Understanding positive individual traits consists of the study of the strengths and virtues, such as the
capacity for love and work, courage, compassion, resilience, creativity, curiosity, integrity, self-
knowledge, moderation, self-control, and wisdom.
– Understanding positive institutions entails the study of the strengths that foster better communities,
such as justice, responsibility, civility, parenting, nurturance, work ethic, leadership, teamwork,
purpose, and tolerance.
Some of the goals of Positive Psychology are to build a science that supports:
 Families and schools that allow children to flourish
 Workplaces that foster satisfaction and high productivity
 Communities that encourage civic engagement
 Therapists who identify and nurture their patients' strengths
 The teaching of Positive Psychology

 Dissemination of Positive Psychology interventions in organizations & communities

1. More Traditional Counseling Fields
Educational, vocational, and school counselors provide individuals and groups with career and educational
counseling.
School counselors assist students of all levels, from elementary school to postsecondary education. They advocate
for students and work with other individuals and organizations to promote the academic, career, personal, and
social development of children and youth. School counselors help students evaluate their abilities, interests,
talents, and personalities to develop realistic academic and career goals. Counselors use interviews, counseling
sessions, interest and aptitude assessment tests, and other methods to evaluate and advise students. They also
operate career information centers and career education programs. Often, counselors work with students who have
academic and social development problems or other special needs.
Elementary school counselors observe children during classroom and play activities and confer with their teachers
and parents to evaluate the children’s strengths, problems, or special needs. In conjunction with teachers and
administrators, they make sure that the curriculum addresses both the academic and the developmental needs of
students. Elementary school counselors do less vocational and academic counseling than high school counselors.
High school counselors advise students regarding college majors, admission requirements, entrance exams,
financial aid, trade or technical schools, and apprenticeship programs. They help students develop job search skills,
such as resume writing and interviewing techniques. College career planning and placement counselors assist
alumni or students with career development and job-hunting techniques.
School counselors at all levels help students to understand and deal with social, behavioral, and personal problems.
These counselors emphasize preventive and developmental counseling to provide students with the life skills
needed to deal with problems before they worsen and to enhance students’ personal, social, and academic growth.
Counselors provide special services, including alcohol and drug prevention programs and conflict resolution classes.
They also try to identify cases of domestic abuse and other family problems that can affect a student’s
development.
Counselors interact with students individually, in small groups, or as an entire class. They consult and collaborate
with parents, teachers, school administrators, school psychologists, medical professionals, and social workers to
develop and implement strategies to help students succeed.
Vocational Counselors
Vocational counselors, also called employment or career counselors, provide mainly career counseling outside the
school setting. Their chief focus is helping individuals with career decisions. Vocational counselors explore and
evaluate the client’s education, training, work history, interests, skills, and personality traits. They may arrange for
aptitude and achievement tests to help the client make career decisions. They also work with individuals to develop
their job-search skills and assist clients in locating and applying for jobs. In addition, career counselors provide
support to people experiencing job loss, job stress, or other career transition issues.
Rehabilitation Counselors
Rehabilitation counselors help people deal with the personal, social, and vocational effects of disabilities. They
counsel people with disabilities resulting from birth defects, illness or disease, accidents, or other causes. They
evaluate the strengths and limitations of individuals, provide personal and vocational counseling, and arrange for
medical care, vocational training, and job placement. Rehabilitation counselors interview both individuals with
disabilities and their families, evaluate school and medical reports, and confer with physicians, psychologists,
occupational therapists, and employers to determine the capabilities and skills of the individual. They develop
rehabilitation programs by conferring with clients; these programs often include training to help clients develop job
skills. Rehabilitation counselors also work toward increasing the client’s capacity to live independently.
Mental Health Counselors
Mental health counselors work with individuals, families, and groups to address and treat mental and emotional
disorders and to promote mental health.
They are trained in a variety of therapeutic techniques used to address issues, including depression, addiction and
substance abuse, suicidal impulses, stress, problems with self-esteem, and grief.
They also help with job and career concerns, educational decisions, issues related to mental and emotional health,
and family, parenting, marital, or other relationship problems.
Mental health counselors often work closely with other mental health specialists, such as psychiatrists,
psychologists, clinical social workers, psychiatric nurses, and school counselors. (Information on psychologists,
registered nurses, social workers and physicians and surgeons, which includes psychiatrists, appears elsewhere in
the Handbook.)
2. Substance Abuse Counselors
– Substance abuse and behavioral disorder counselors help people who have problems with alcohol, drugs,
gambling, and eating disorders.
– They counsel individuals who are addicted to drugs, helping them to identify behaviors and problems
related to their addiction.
– Counseling can be done on an individual basis, but is frequently done in a group setting. These counselors
will often also work with family members who are affected by the addictions of their loved ones.
Counselors also conduct programs aimed at preventing addictions.

1. Marriage and Family Counselors

Marriage and family therapists apply family systems theory, principals and techniques to individuals,
families, and couples to resolve emotional conflicts. In doing so, they modify people’s perceptions and
behaviors, enhance communication and understanding among family members, and help to prevent family
and individual crises. Marriage and family therapists also may engage in psychotherapy of a non-medical
nature, make appropriate referrals to psychiatric resources, perform research, and teach courses about
human development and interpersonal relationships.
2. Gerontological, Genetic, and Multicultural Counselors
Other counseling specialties include gerontological, multicultural, and genetic counseling. A gerontological
counselor provides services to elderly people and their families as they face changing lifestyles. Genetic counselors
provide information and support to families who have members with birth defects or genetic disorders and to
families who may be at risk for a variety of inherited conditions. These counselors identify families at risk, interpret
information about the disorder, analyze inheritance patterns and risks of recurrence, and review available options
with the family.
3. Other Counseling Fields
Counseling and counselors can work in nutritional, or pastoral settings, using special tools, such as a counselor in
an animal assisted setting, or use tools such as art, accupuncture, yoga, or are culturally based.
As this site grows, I will be providing information about counseling in all its myriad forms.
Please take advantage of the option on most pages to write me a note about your search. Your response will guide
my work. Thanks from a counselor and a counselee.
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Common Barriers to Seeking Counseling
For many, seeking the services of a professional counselor is a lot like going to the dentist—but
worse.
by Daniel L. Weiss

Most of us remember our reactions when, as kids, we found out it was time to visit
the dentist. If you were like me, you pretty much went kicking and screaming the
entire way. This resistance, although understandable (especially if you had the work
I had done), was based on a lot of misinformation. Going to the dentist hurt, it was
scary and never ended with a lollipop (as a visit to the doctor sometimes did). But
whatever pain we felt in the dentist chair was minor compared to the pain we would
have felt if our teeth had not been properly maintained by a trained professional.

For many, seeking the services of a professional counselor is a lot like going to the
dentist—but worse. Like the dentist, much of our resistance to going to a therapist
is based on misunderstandings. If these were cleared up, I’m convinced that a much
larger portion of our society would get some basic counseling help … and be
healthier for it.

Let’s examine some of the common barriers that keep people from seeking
counseling.

Denial
One of the most common barriers to counseling is the denial of the existence of a
problem, or at least a problem bad enough to seek professional help. There is
something stoic and resilient about humans; we want to prove ourselves, we want
to overcome. We can admire people for this hardy approach to life, but we must
also mourn for them at times. Refusing to come to terms with an obvious problem in
our life is not laudable, it is foolhardy.

Have you ever looked at your car manual? There are often two maintenance
schedules: One for normal conditions and one for harsh conditions. The schedule
designed for cars operating in harsh conditions involves more frequent tune-ups, oil
changes, and preventative diagnostic exams. Most people follow these schedules
for their autos faithfully; why do we refuse to maintain our personal health?

One of the most common misconceptions among all people regarding mental health
is that everybody else has it together. They all look fine, right? So we adopt the
same approach. We make sure our outside persona gives the appearance that we
are fine.

The greater probability is that almost everyone you see is undergoing some sort of
internal or external struggle. Some are weighed down by physical illness, others
struggle with circumstances they cannot control, such as joblessness or the death of
a close friend; many walk around filled with shame, fear, doubt, guilt, anger,
hopelessness, or a host of other emotional and mental issues. As Christian educator
Christopher West said, it’s like we are all driving around town with flat tires. Since
everyone else is also driving around on flat tires, we think it is normal.

What we fail to realize is that we were not intended to be driving around on our
rims, sparks flying and rubber shredding. If we got a flat tire on our car, few of us
would continue driving on it. We would immediately stop and change the tire before
continuing on our way.

When it comes to our emotional and mental health, many of us have been driving
on our rims for a long time. We are convinced that because our vehicle is still
moving forward, we are just fine. But, this is not how we were designed to operate.

Some of the healthiest people I have ever met are recovering addicts. These folks
have no pretensions and no illusions. They know they have been wounded through
their own actions and the actions of others. They differ from others in that they took
that knowledge of their woundedness and used it to transform their lives. It wasn’t
easy, but they are now the people more likely to be devoted to helping and serving
others.

The real first step in getting healthy, whether from physical, mental, or emotional
wounds, is to admit that something isn’t right. A visit to a professional therapist is
like a diagnostic exam. They are trained to help you discover what has gone wrong;
together you decide what kind of treatment you may or may not need.
Social stigma
Although this is decreasing, a stigma is still attached to seeing a counselor. There is
an impression—especially among those who have never tried counseling—that only
people who are really sick or mentally ill would need to see a therapist.

The good news is that our society is beginning to see the value of professional
counseling. More and more people are using the services of licensed therapists for a
variety of reasons, many of them involving life experiences common to all of us. A
counselor can help a college student learn to manage stress, or to determine if the
stress is being caused by something deeper than a heavy course load. Some benefit
from counseling as they work through the grieving process due to divorce or the
death of a loved one. Others seek counseling for depression and are able to
alleviate it before chemical imbalances occur in the brain.

For others, however, counseling may be the very thing that pulls them away from
serious mental illness or addiction. The first step in most 12-step programs is to
admit that one is powerless over the addiction. This means that on their own power,
they are unable to stop their errant behavior. One of the primary assistants in the
addict’s community of caregivers is a trained professional who can help unlock the
deeper reasons why the individual is seeking solace in his addiction.

Getting healthy is the most important goal for a person, whether the problem is
major or minor. We cannot be concerned about the unhealthy viewpoint of
individuals in society who still maintain that counseling is only for a certain category
of people. As one counselor said, “Get over it and get help.”

Religious stigma
Just as common as social stigma, there is a strain of thought among Christians that
counseling is somehow contrary to God’s Word, and therefore should be avoided.
They hold the Bible up and insist that everything we need for life is contained
within. Although this is a proper spiritual approach, it can definitely be misapplied.

God designed us as embodied persons. He endowed us with a body, mind, and

spirit. The Bible doesn’t contain up-to-date medical manuals, but few Christians
would refuse a doctor’s treatment because they couldn’t locate the proper chapter
and verse authorizing them to do so. As psychologist Dr. James Dobson has said,
the task of a Christian psychologist is not fundamentally different than that of any
Christian. He needs to exercise discernment by filtering everything through the
screen of God’s Word. In this way, a Christian approach to psychotherapy would
reject methods and theories that contradicted God’s revealed truth.

Mental and physical health are similar in this regard. As our medical knowledge
progresses, we understand more clearly just how intricate and wondrous God’s
design is. Unlocking the mysteries of the mind does not replace our faith in Christ, it
illuminates it.

Secular counseling can miss the vital spiritual link to our mental and emotional
health, but trained Christian counselors can offer an integrated approach that
includes body (behaviors), mind (thoughts and emotions), and spirit (our
relationship with God).

Fear
Of all the reasons to avoid counseling, this is the most understandable. Many of the
problems that lead to counseling are caused by painful experiences that a person
often has no interest in reliving. Some of these include:

• Death
• Divorce
• Sexual abuse (childhood, rape, etc.)
• Physical abuse
• Addiction (for the addict or spouse)
• Major trauma or calamity
Just the thought of diving into those painful memories is enough to keep many
people from seeking help throughout their lives. Even as we acknowledge the
reality of this pain, we can also offer encouragement to move forward.

Consider a gunshot wound. The bullet hits its target without warning, completely
upending a person’s world. The initial reaction is shock, pain, and fear. All efforts
are centered on survival. Although the bullet did not kill its target, it caused major
damage. Perhaps the bleeding was stopped and the entrance wound managed to
heal over. Is this person healed at this point? No. The internal damage has never
been properly treated and the bullet still moves around inside, causing further
damage and bleeding. If left untreated forever, the internal wound could eventually
kill the person.

Emotional wounds operate in much the same way. Many of them occur instantly,
such as with the death of a loved one or the discovery of marital infidelity. Pain,
shock, and fear immediately set in and our efforts are bent on simply surviving
another day. Yet, deep within us, the internal wound is still open, bleeding, and
dangerous.

Our fear is based on the pain of reopening the entrance wound, but this focus keeps
us from seeing how destructive and dangerous the internal wound is. Reopening the
wound will be painful for some as they begin counseling, as will finding and
extracting the bullet that caused the wound. Yet, without getting to the source of
our pain, we will never fully heal. We will always carry the weight of our original
wound with us, and we will notice the bleeding from time to time as the wound tells
us that it still isn’t healed, that it is still harming our lives.

Cost
Cost is a common barrier for the practically minded. For those with limited incomes,
it is not unreasonable to consider the price tag for something that seems less
important than rent, food, or clothing. Yet, for those who can afford counseling,
there is an all-too-common practice of bargain hunting for professional therapy.
Would we bargain hunt for heart surgeons or parachute manufacturers? Why, then,
would we cut corners when it comes to our mental and emotional well-being?

I believe some of this attitude comes from our ability to cope with problems in our
lives. To use our earlier analogy, we have become accustomed to driving on flat
tires. If we can just fix one tire, we’ll still be better off, right?

Unfortunately, with professional counseling, as with many aspects of life, you often
only get what you pay for. Choosing the right counselor is as important in many
ways as choosing the right mate. The choice can positively or negatively affect the
rest of your life. This is not the time to pinch pennies.

If you are going to bargain hunt, consider first the total cost of your decision, not
just the cost of professional counseling. How much extra each week do you spend
on food, cigarettes, or alcohol to help calm your nerves, reduce stress, or medicate
your internal pain? Have your problems led you to drop out of school, lose a job, or,
worse yet, your family? How much will your problem cost or hurt you over the
course of your life?

If we only look at the economic arguments, it still makes better financial sense to
find the best counselor regardless of cost. Many company health plans will pay a
portion of the counseling fees, even if the therapist is out of the network. For those
who need counseling but do not have health plans, many good Christian counselors
are willing to write off a portion of their fee or to lower it for poorer individuals.

Another option is to contact a local evangelical church, some of which offer pastoral
counseling or support group counseling at low or no cost. There are usually
solutions to every potential problem. Remember, too, that God is the Great
Physician and desires you to be well. Lift up your concerns in prayer and ask Him to
lead you to the right person and to provide the means.

Bad experiences
While less common than the other barriers, having a previous bad experience with a
therapist can be one of the hardest to overcome. A person with a prior experience
that has not helped, not been focused, or has led to counseling abuse (a rare, but
real occurrence), is unlikely to ever return. This negative experience compounds the
initial trauma or situation that led the person to seek help, and may actually serve
as a prison door locking the individual into his internal pain for the rest of his life.

If you find yourself in this situation, I encourage you to try again. Whatever past
experience you may have had, there are steps you can take to ensure it doesn’t
happen again.

1. Call Focus on the Family’s Counseling Department at (719) 531-3400 x7700 to

get a referral to a local Christian therapist. All professionals on our referral list have
gone through an extensive screening process. Our counselors can give you the
name of someone in your area, but, more importantly, they can provide support and
encouragement for you to overcome your prior experience. (This service comes at
no cost to you.)

2. If your past experience involved unethical conduct by the therapist, you may
consider bringing ethics charges against him or her. Ethical misconduct can include
inappropriate sexual behavior, breech of confidentiality, unless required by law, or
fraudulent billing practices. If you were harmed, there is a chance others were as
well. Speaking out can prevent future abuse from occurring. If you suspect a
therapist of ethics violations, call Focus on the Family and ask to speak with a
counselor who can help you through the process.

A better tomorrow
There are real barriers to seeking professional help, but none of them are so large
or insurmountable that you should be denied a healthier, happier future. If one or
more of these barriers has kept you from getting counseling, please consider calling
the Counseling Department at Focus on the Family at (719) 531-3400 x7700
weekdays 9:00 a.m. to 4:30 p.m. (MST) to help you move forward with your life.

Copyright © 2004 Focus on the Family. All rights reserved. International copyright
secured.

About the author

Daniel L. Weiss is the Media and Sexuality Analyst for Focus on the Family. He also
serves as project manager for Pure Intimacy.

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Psychologist, Social Worker, Counselor, & MFT!!

Section 12
Client Cultural Mistrust & Willingness to Self-Disclose
Question 12 found at the bottom of this page
Answer Booklet | Table of Contents
Get PRINTABLE format of this page
Self-disclosure is literally the sine qua non of most approaches to counseling and
psychotherapy. Due to a history of oppression, however, African Americans in the
United States have been socialized to hide their true feelings, particularly when
relating to Caucasians (Grier & Cobbs, 1968: Ridley, 1984). This can be problematic
for African Americans who seek counseling because they are underrepresented
(compared with their representation in the general population) as professional
counselors and psychologists. Thus, if many African American clients are to receive
counseling they will have to see Caucasian counselors. To the extent that self-
disclosure is essential to successful counseling, it is important that Caucasian
counselors attempt to overcome the barriers to self-disclosure that may exist between
them and their African American clients (Vontress, 1971).
One reason that African American clients may be unwilling to self-disclose
Caucasian counselors is that they simply do not trust Caucasians (Ridley, 1984).
Terrell and Terrell (1981) have identified four areas in which African Americans are
mistrustful of Caucasians: (a) educational and training settings, (b) political and legal
systems, (c) work and business interactions, and (d) interpersonal and social contexts.
They developed the Cultural Mistrust Inventory, which assesses African Americans'
mistrust of Caucasians across these four areas. Terrell and Terrell (1984) found that
premature termination rates for African American clients were significantly related to
the counselors' race and client's trust level. Clients who scored high on cultural
mistrust and who saw Caucasian counselors were most likely to terminate counseling
prematurely. In a more recent study, Watkins and Terrell (1988) found that highly
mistrustful African Americans rated a Caucasian counselor less favorably on measures
of counselor genuineness, self-disclosure, acceptance, trustworthiness, outcome, and
expertness than did African Americans low on mistrust. (They also found that highly
mistrustful African Americans expected less from the counselor, regardless of
ethnicity, than did African Americans low on mistrust.)

A number of authors have suggested that Caucasian counselors need to confront

openly the racial difference between them and their African American clients rather
than to project an image of "color blindness" (Jones & Seagull, 1977). The term color
blindness has been used euphemistically to describe the counselor who is either too
insecure or too arrogant to acknowledge that racial differences may affect the course of
counseling. Evidence that color blindness is viewed negatively by African Americans
was documented in a study by Pomales, Claiborn, and LaFromboise (1986) African
American undergraduate men and women were exposed to one of two videotapes of a
Caucasian female counselor working with a African American male client The scripts
for the two videotapes were identical except for three points at which the counselor's
responses were varied to reflect cultural sensitivity or cultural blindness. Participants
gave more positive ratings to the counselor under the culture-sensitive condition than
under the culture-blind condition.
Although the Pomales et al. (1986) study did compare the effects of counselor cultural
sensitivity with counselor cultural blindness, it did not address the issue of
dissimilarity confrontation. By openly acknowledging ethnic and cultural differences
and the barriers they may produce, the counselor is demonstrating a sensitivity to the
history and socialization of African Americans and his or her own willingness to deal
with these issues before proceeding with counseling. The purpose of this study wad to
expand on the Watkins and Terrell (1988) and Pomales et al. (1986) studies by
employing dissimilarity confrontation as an independent variable, a measure of self-
disclosure as a dependent variable, and a nonstudent population as participants.
The current findings indicate that among African American adults, there is a
direct relationship between mistrust of Caucasians in general and perceptions of a
Caucasian counselor as a credible source of help.
Although the relationships between dissimilarity confrontation and willingness to self-
disclose and perceived counselor credibility were not found to be statistically
significant, they were found to be directly correlated as hypothesized, and further
research on dissimilarity confrontation seems justified. The current findings, however,
suggest that Caucasian counselors will need to do more than simply confront racial and
ethnic differences in an initial counseling session to build their credibility with adult
African American clients. In the case of the fictitious counselor in this study, being
Caucasian may have negatively affected his or her ascribed status, at least among
mistrustful African American adults. An expressed philosophy of dissimilarity
confrontation alone apparently did little to enhance the counselor's achieved status. Sue
and Zane (1987) have identified three cultural issues that Caucasian counselors may
need to focus on when attempting to build credibility with culturally different clients.
First, client problems must be conceptualized in a manner that is consistent with the
client's belief system. Second, the methods of resolving the problem must be
compatible with the client's culture. And third, the goals of counseling held by the
counselor must be consistent with those held by the client. Sue and Zane's (1987)
analysis of achieved credibility suggests that it is a multifaceted phenomenon
involving a number of counselor skills. Dissimilarity confrontation may be an
important component of these skills but in isolation may have little or no impact.
Some evidence was found that willingness to self-disclose to a Caucasian counselor
increases with more income and decreases with more education. It can be hypothesized
that African Americans, in order to achieve higher levels of income in a Caucasian-
dominated world of work, may have to establish rapport with and learn to trust at least
some Caucasians. On the other hand, more education may include increased
knowledge about the history of African American oppression by Caucasians and may
lead to less willingness to disclose to a Caucasian counselor. This is purely speculative,
however, and the current findings may be unique to African Americans participating in
the cooperating Afro-American Community Center. More research is needed on the
relationships between African American income and education and willingness to self-
disclose to a counselor.
- Poston, Carlos, Craine, Micael, & Donald Atkinson; Counselor dissimilarity
confrontation, client cultural mistrust, and willingness to self-disclose; Journal of
Multicultural Counseling & Development; Apr 1991, Vol. 19, Issue 2.
Personal Reflection Exercise #6
The preceding section contained information about client cultural mistrust and
willingness to self-disclose. Write three case study examples regarding how you might
use the content of this section in your practice.
QUESTION 12
What are the four areas in which African Americans are mistrustful of Caucasians? Record the
letter of the correct answer the Answer Booklet.
 Answer Booklet for this course
Forward to Section 13
Back to Section 11
Table of Contents
Top

Patient counseling-Barriers

Submitted by Vijaya Ratna on Tue, 08/24/2010 - 10:56

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Patient Counseling-Barriers
Dear Pharmainfo.net friends
I appear again to talk once more on patient counseling . In this blog I want to focus on the
barriers that may present themselves to the process of patient counseling. I can tell you, because I
gave lectures on this topic in a number of places, that people have a nature of resisting change
and we must have the patience to talk with them and discuss with them slowly and clearly so that
they can think through all the changes that we are suggesting. The most common pat reply that I
get from many pharmacists, when I tell them that they must do patient counseling is this
“Madam, long queues of patients, stand impatiently before us, waiting for their medicines. To
give them medicines without any dispensing error is in itself a great task. How can you expect us
to do any counseling here?”
So there are barriers for every action and there are barriers here too. These barriers may be
present in the system or in the provider (pharmacist) or in the recipient (patient)(1). Let us
discuss each of these in detail.
System based barriers: as I said in my opening paragraph, there may be resistance from the
people around us, who may say things like:
• Where is the time/space/personnel/material for patient counseling?
• If you give some patient counseling and some adverse things happen, who is going to be
responsible for it?
• Nobody is doing patient counseling, why should we do it?
• Doctors may not like this activity, let us not do it.
• Patients may not like to hear anything.
For all these doubts and problems we must be able to give answers like the following:
• We must create the time and space and personnel and material required for patient counseling.
We must do this because patient counseling is going to bring better results in pharmaceutical
care and thus in healthcare.
• No adverse thing will happen, because we are not telling anything “off the cuff”. We are
keeping in our possession, well researched, prepared documents and we are telling only from
these documents. They are prepared from books such as Drug Information for the patient,
published by USP.
• If we start patient counseling, our institution will get benefit and get good name.
• Doctors will not oppose this activity. In fact they are appreciating it. This is because doctors
usually do not have the time to sit and discuss with each patient, his/her treatment. Whereas a
pharmacist has the time and the necessary information inputs to plug this hole.
• Some patients may not like to take counseling. In such cases we need not do any counseling.
We can give our advice to only those patients who need it.
Provider based Barriers:
• Pharmacist may not have the necessary knowledge/communication skills/interpersonal
behavioral skills/ aptitude/ time to do patient counseling
• Pharmacist may face other problems like; he/she may not know the language of the patient/
may have some speech or hearing problem and so on.
These barriers must be overcome in the following manner:
• Pharmacist must acquire all the necessary inputs like knowledge/ communication skills/ soft
skills including proper body language and aptitude.
• The language problem and any other problem must be suitably addressed by taking help from
some hospital employee.
There may be some barriers from the side of the patient like:
• Patient may not have time/attitude to listen/ capacity to understand.
• Patient may not know any language that the pharmacist knows.
• Patient may be feeling some hesitation due to some cultural type of issues, like girls may be
unwilling to take counseling from boys and boys may be unwilling to take counseling from girls.
• Highly educated people may not like to take counseling.
• Patient may suffer from some defect with respect to hearing or speech.
• Patient may be suffering from some misconceptions or fears due to which nothing will
penetrate his mind.
These barriers may be overcome in the following manner:
• Patient must be convinced with amicable words that counseling is good for him/her.
• Pharmacist must take the help of some employee who knows the language of the patient.
• Here we must deal with the situation as it demands and preferably girls must talk to women and
boys to men.
• We may leave alone those who do not want counseling.
• For the sake of hearing and speech impaired people, we must have models or charts to help us
in giving counseling.
 • We must talk to the patients and draw their fears out and dispel them. This is not a one hour
matter, but it will take a few sittings for the pharmacist to gain the confidence of the patient.
Thus, overall, patient counseling is a business, where we overcome the barriers of all types and
the fears of all types, and carry out the process. This is important because it is going to make the
patient’ s life and healthcare much better.
Reference:
1. Proceedings of the National Seminar on Clinical and Hospital Pharmacy, 17th and 18th
October, 1999, pages 36 to 38.
This blog does not contain any plagiarized material.
• vijayaratna's blog
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• 391 reads

Dear mam
Submitted by Indira on Sun, 08/29/2010 - 11:37.

really great blog. Patient counseling is as important as formulation.A pharmacists responsibility

doesn't end at the lab. But one has to really take a great move by conducting campaigns on
patient counseling of some most commonly used drugs and some common precautions and try to
indulge the interest in patients. I hope being professionals when the patients take a step forward
to know about their medication, pharmacists or doctors may not take a back step to help them.
Indira.

Counseling Tools and Strategies

Clinicians who are able to communicate effectively with their patients can facilitate lifetime contraceptive success. A
challenge for clinicians is to package effective counseling into the time allotted for office visits. A poll conducted by ARHP in
1996 found that almost 70 percent of women spend fewer than 15 minutes with a clinician during visits for contraception.1
In a subsequent poll conducted in 1998-99, 40 percent of obstetrician/gynecologists who responded said that they did not
have adequate time with their patients.2

Factors Affecting Contraceptive Continuation

 TABLE 14. Aspects of High-Quality Care6
Studies have documented that the Aspect of Care (score range)
quality of care a patient receives at the
Needs assessed (0-3)
time she adopts a contraceptive method
affects her subsequent contraceptive • Asked whether she wanted to conceive a child
use. A retrospective study of • Asked how long she wanted to wait before the next birth
contraceptive discontinuation among
• Asked about previous family planning experiences
1,945 Indonesian women found that
Information received (0-7)
those who reported being given the
method of their choice were significantly • Shown or told how adopted method works
more likely to be using contraception • Told how to use the method adopted
one year later.3 Discontinuation rates
• Warned of potential side effects
were 72 percent among those not given
• Instructed on how to handle problems
their method of choice, compared with 9
percent among those who received their • Informed of warning signs
method of choice. Other studies in West • Told of option to switch methods
Africa, China, and India suggest that
• Informed of methods that protect against STIs
women who receive more counseling or
information at the initiation of use have Method choice (0-4)
lower rates of discontinuation than those • Asked which method she preferred
who receive little counseling.4,5 Pre- • Told about at least one additional method besides the method
treatment and ongoing counseling about adopted
hormonal effects and possible side • Received information without any single method being promoted
effects appears to be especially by provider
important.4,5 • Given her method of choice
A recent assessment in the Philippines Interpersonal relations (0-7)
found that the overall quality of care has
• Permitted to ask questions
a substantial impact on contraceptive
• Given adequate answers to all questions
continuation.6 A number of aspects of
care were identified and given score • Treated in a friendly manner
ranges at baseline to assess the quality • Shown respect for privacy
of family planning services received
• Received care in a clean environment
when a contraceptive method was
• Received satisfactory care
adopted (Table 14). The variable
combining the five aspects of care • Given information, education, and communication material
proxies total quality and was scored as Continuity of care (0-3)
low, medium, or high to differentiate
• Scheduled for a follow-up visit
among levels of overall care. The
• Informed of alternative sources of care
medium level was defined as quality
within one-half of a standard deviation of • Given an appointment card showing the date of follow-up visit
the mean; values falling outside the
range of medium quality were considered the low and high levels of total quality. At follow-up 16 to 24 months after
initiating use of a method, the percentage of women continuing use of a modern method of contraception increased as the
level of quality of care increased from low (53 percent) to medium (59 percent) to high (65 percent) (Figure 3). After
accounting for the effects of fertility intentions and
background variables, the odds of use of a modern
method of contraception among women who had
received medium- or high-quality care were 31
percent and 64 percent higher than among those
who received low-quality care.

How can busy clinicians provide high-quality care

and effectively communicate with the patient in the
limited amount of time provided for contraceptive
counseling?

Motivational Interviewing
Health care providers can deploy a variety of approaches to facilitate successful contraceptive use. Many young women feel
that they are ineffective and unable to master anything—life seems out of control. When a young patient says that she
won't be able to remember to take the pill every day, the clinician should try to build on her past successes. For example,
she's doing well in high school, and she has learned to drive a car, therefore, how easy it will be for her to master using
the pill. If the health care provider expects success in people, then they will be successful. The word "try" should not be
used, because it may suggest attempts and failure. Respect the patient's present view and be empathetic, letting her know
that her clinician cares about her. Avoid arguing with the patient; this only creates resistance to change.

If the health care provider

expects success in people, then
they will be successful.

There are five stages of change (Table 15). First, the health care provider needs to determine whether or not the patient
sees a need to change her behavior. For example, you may have seen the patient in her car smoking a cigarette or have
detected the odor of cigarettes on her
TABLE 15. The Five Stages of Change
clothing. You can say that you know
she's smoking and wonder if she has  First, we see no need to change our behavior.
been thinking about quitting. She may  Then, we begin to see a need for change.
 We act and begin to change.
reply that she has important tests
 We integrate the change.
coming up and she's not sure that it  We may relapse; learn new skills, and start again
would be a good time. You can advise
her that when she's ready to stop smoking, you'll be there to help her.

References

1. Association of Reproductive
Health Professionals. Women's SIDEBAR G. Approaching the Male About Contraception
attitudes and perceptions about
Although the focus of this Clinical Proceedings is the periodic well-woman
their healthcare providers and
visit, men who see the primary care provider should be informed about
non-contraceptive health contraceptive options including:
benefits of oral contraception.
○ Condoms
(Survey
conducted by ○ Emergency contraception for their partner
○ Vasectomy

2. Robert A. Becker for the
Association of Reproductive
Health Professionals). January,
1996.
3. Kravitz RL, Leigh JP, Samuels
SJ, et al. Tracking career
satisfaction and perceptions of
quality among US obstetricians and gynecologists. Obstet Gynecol 2003;102:463-70.
In addition, young single, sexually active men should be made aware of
paternity and statutory rape laws in the state in which they reside.
Sensitivity regarding sexually active men not engaged with women should
be maintained. STI issues should be discussed as well with all men.
Clinicians might consider providing men with a printed handout that briefly
discusses the methods of contraception available to women. The handout
should include a phone number for appointments.

4. Pariani S, Heer DM, Van Arsdo MD Jr. Does choice make a difference to contraceptive use? Evidence from East
Java. Stud Fam Plann 1991;22:384-90.

5. Cotten N, Stanback J, Maidouka H, et al. Early discontinuation of contraceptive use in Nigeria and the Gambia.
Int Fam Plan Perspect 1992;18:145-9.

6. Lei Z-W, Wu SC, Garceau RJ, et al. Effect of pretreatment counseling on discontinuation rates in Chinese women
given depo-medroxyprogesterone acetate for contraception. Contraception 1996;53:357-61.

7. RamaRao S, Lacuesta M, Costello M, et al. The link between quality of care and contraceptive use. Int Fam Plan
Perspect 2003;29:76-83.
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One of the newest and hottest things in psychotherapy is phone counseling,

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Those who risk nothing gain nothing. If you do nothing about the problem, chances are the
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kentroybrand@aol.com
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BREAKING BARRIERS TO COUNSELING

Roger Bannister broke the barrier of the 4 minute mile. The Wright brothers broke the barrier of
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Don't settle for "good enough." It will take work, but there are few things in life more satisfying
than a good marriage or a strong family. Take your marriage or child to the next level. Call 256-
766-5707 to aggressively seek solutions that work. Determine to take your marriage or child
higher and higher.
NEED A PEACEMAKER?
Do you long for peace and harmony in your marriage and family? Feel like you have tried
everything. Does avoiding your family seem easier and easier? Have you considered a
peacemaker? Peacemakers are skilled at not blaming and not taking sides. Competent
peacemakers help each person become the best they can be while also working on the family
interaction. If you would love to go to sleep tonight with some hope of peace, please be
aggressive. Challenge the disharmony by finding a positive solution. Try marriage or family
telephone/phone/skype counseling/relationship advising. Call 256-766-5707 to find out the first
step to peace.
ADVANTAGES OF TELEPHONE/PHONE/SKYPE
COUNSELING/RELATIONSHIP ADVISING

1. Fast and simple to set up

2. Confidential
3. Broadens choices of counselors
4. Saves time and money
5. Relieves some of the intimidation of seeking counsel
6. Is effective and produces results
7. Flexibilty in scheduling
A FAMILY MATTER provides skype marriage counseling and skype child therapy for any
English speaking family in the United States of America.

Skype counseling is available for the following states: Alaska, Hawaii, Washington, Oregon,
California,
Arizona, Nevada, Idaho, Montana, Wyoming, Utah, New Mexico, Colorado, North Dakota,
South Dakota, Nebraska, Kansas, Oklahoma, Texas, Louisiana, Arkansas, Missouri, Iowa,
Minnesota, Wisconsin, Illinois, Kentucky, Tennessee, Mississippi, Alabama, Georgia, South
Carolina, North Carolina, Virginia, West Virginia, Maryland, Delaware, Pennsylvania, New
Jersey, New York, Conneticut, Massachusetts, Vermont, New Hampshire, Rhode Island, Maine,
and Florida.

Skype marriage counseling, skype therapy for children or skype individual psychotherapy is
available for and from the following cities and surrounding areas:

Honolulu, Hawaii, Hilo, Hawaii, Anchorage, Alaska, Juneau, Alaska, Seattle, Washington,
Everett, Washington, Bellingham, Washington, Tacoma, Washington, Spokane, Washington,
Longview, Washington, Portland, Oregon, Eugene, Oregon, Medford, Oregon, Sacramento,
California, San Jose, California, San Francisco, California, Monterey, California, Los Angeles,
California, Pasadena, California, San Diego, California, Tuscon, Arizona, Phoenix, Arizona,
Flagstaff, Arizona, Las Vegas, Nevada, Reno, Nevada, Boise, Idaho, Idaho Falls, Idaho,
Pocatello, Idaho, Helena, Montana, Billings, Montana, Butte, Montana, Missoula,
Montana,Cheyenne, Wyoming, Jackson Hole, Wyoming, Denver, Colorado, Colorado Springs,
Colorado, Glenwood Springs, Colorado, Aurora, Colorado, Fort Collins, Colorado, Boulder,
Colorado, Albuquerque, New Mexico, Santa Fe, New Mexico, Dallas, Texas, Fort Worth, Texas,
Austin, Texas, San Antonio, Texas, Houston, Texas, El Paso, Texas, Amarillo, Texas, Oklahoma
City, Oklahoma, Tulsa, Oklahoma, Wichita, Kansas, Kansas City, Kansas, Topeka, Kansas,
Lincoln, Nebraska, Omaha, Nebraska, Grand Island, Nebraska, Sioux Falls, South Dakota, Rapid
City, South Dakota, Aberdeen, South Dakota, Fargo, North Dakota, Minot, North Dakota, St.
Paul, Minnesota, Minneapolis, Minnesota, Cedar Rapids, Iowa, Des Moines, Iowa, Council
Bluffs, Iowa, Dubuque, Iowa, Ottumwa, Iowa, Sioux City, Iowa, St. Louis, Missouri, Kansas
City, Missouri, Jefferson City, Missouri, Poplar Bluff, Missouri, St. Joseph, Missouri,
Carbondale, Illinois, East St. Louis, Illinois, Springfield, Illinois, Alton, Illinois, Bloomington,
Illinois, Peoria, Illinois, Joliet, Illinois, Aurora, Illinois, Evanston, Illinois, Rockford, Illinois,
Decatur, Illinois, Chicago, Illinois, Waukegan, Illinois, Madison, Wisconsin, Kenosha,
Wisconsin, Racine, Wisconsin, Milwaukee, Wisconsin, Oshkosh, Wisconsin, Eau Claire,
Wisconsin, Appleton, Wisconsin, Superior, Wisconsin, La Crosse, Sheboygan, Wisconsin,
Detroit, Michigan, Ann Arbor, Michigan, Grand Rapids, Michigan, Pontiac, Michigan, Bay City,
Michigan, Saginaw, Michigan, Kalamazoo, Michigan, Muskegon, Michigan, Flint, Michigan,
Lansing, Michigan, Marquette, Michigan, Gary, Indiana, South Bend, Indiana, Elkhart, Indiana,
Fort Wayne, Indiana, Muncie, Indiana, Indianapolis, Indiana, Kokomo, Indiana, New Albany,
Indiana, Evansville, Indiana, Terre Haute, Indiana, W. Layfayette, Indiana, Cleveland, Ohio,
Toledo, Ohio, Cincinnati, Ohio, Columbus, Ohio, Dayton, Ohio, Portsmouth, Ohio, Springfield,
Ohio, Lima, Ohio, Marion, Ohio, Sandusky, Ohio, Canton, Ohio, Frankfort, Kentucky,
Louisville, Kentucky, Lexington, Kentucky, Paducah, Kentucky, Owensboro, Kentucky,
Bowling Green, Kentucky, Lexington, Kentucky, Hazard, Kentucky, Ashland, Kentucky,
Madisonville, Kentucky, Memphis, Tennessee, Jackson, Tennessee, Dyersburg, Tennessee,
Columbia, Tennessee, Clarksville, Tennessee, Nashville, Tennessee, Murfreesboro, Tennessee,
Chattanooga, Tennessee, Knoxville, Tennessee, Kingsport, Tennessee, Oak Ridge, Tennessee,
Huntsville, Alabama, Gadsden, Alabama, Decatur, Alabama, Birmingham, Alabama, Bessemer,
Alabama, Tuscaloosa, Alabama, Selma, Alabama, Montgomery, Alabama, Phenix City,
Alabama, Pritchard, Alabama, Mobile, Alabama, Gulf Shores, Alabama, Jackson, Mississippi,
Biloxi, Mississippi, Natchez, Mississippi, Hattiesburg, Mississippi, Laurel, Mississippi,
Greenville, Mississippi, Tupelo, Mississippi, Clarksdale, Mississippi, Monroe, Louisiana,
Lafayette, Louisiana, Baton Rouge Louisiana, New Orleans, Louisiana, Shreveport, Louisiana,
Alexandria, Louisiana, New Iberia, Louisiana, Houma, Louisiana, Little Rock Arkansas, El
Dorado, Arkansas, Pine Bluff, Arkansas, W. Memphis, Arkansas, Hot Springs, Arkansas, Fort
Smith, Arkansas, Fayetteville, Arkansas, Jonesboro, Arkansas, Searcy, Arkansas, Atlanta,
Georgia, Marietta, Georgia, Roswell, Georgia, Alpharetta, Georgia, Rome, Georgia, Athens,
Georgia, Macon, Georgia, Valdosta, Georgia, Savannah, Georgia, Brunswick, Georgia, Albany,
Georgia, Columbus, Georgia, Pine Mountain, Georgia, Augusta, Georgia, Columbia, South
Carolina, Charleston, South Carolina, Greenville, South Carolina, Spartanburg, South Carolina,
Myrtle Beach, South Carolina, Raleigh, North Carolina, Chapel Hill, North Carolina, Durham,
North Carolina, Charlotte, North Carolina, Asheville, North Carolina, Fayetteville, North
Carolina, Wilmington, North Carolina, Gastonia, North Carolina, Winston-Salem, North
Carolina, Greensboro, North Carolina, Kitty Hawk, North Carolina, Richmond, Virginia,
Lynchburg, Virginia, Virginia Beach, Virginia, Norfolk, Virginia, New Port News, Virginia,
Roanoke, Virginia, Charlottesville, Virginia, Martinsville, Virginia, Petersburg, Virginia,
Alexandria, Virginia, Staunton, Virginia, Washington, D.C., Silver Springs, Maryland,
Baltimore, Maryland, Annapolis, Maryland, Hagerstown, Maryland, Cumberland, Maryland,
Charleston, West Virginia, Clarksburg, West Virginia, Dover, Delaware, Newark, New Jersey,
Atlantic City, New Jersey, Trenton, New Jersey, Jersey City, New Jersey, Philadelphia,
Pennsylvania, Pittsburgh, Pennsylvania, Harrisburg, Pennsylvania, Altoona, Pennsylvania,
Johnstown, Pennsylvania, Williamsport, Pennsylvania, Reading, Pennsylvania, Scranton,
Pennsylvania, New York City, New York, Long Island, New York, Albany, New York, Buffalo,
New York, Rochester, New York, Syracuse, New York, Newburgh, New York, Binghamton,
New York, Schenactady, New York, Niagara
Falls, New York, Bridgeport, Conneticut, Hartford, Conneticut, New Haven, Conneticut,
Providence, Rhode Island, Boston, Massachusetts, Belmont, Massachusetts, Arlington,
Massachusetts, Worcester, Massachusetts, Springfield, Massachusetts, Cape Cod, Massachusetts,
Lowell, Massachusetts, New Bedford, Massachusetts, Nashua, New Hampshire, Concord, New
Hampshire, Manchester, New Hampshire, Montpelier, Vermont, Burlington, Vermont, Portland,
Maine, Augusta, Maine, Bangor, Maine, Jacksonville, Florida, Gainesville, Florida, Orlando,
Florida, Pensacola, Florida, Panama City, Florida, Tallahassee, Florida, Ocala, Florida, Tampa,
Florida, St. Petersburg, Florida, Sarasota, Florida, Naples, Florida, Miami, Florida, Fort
Lauderdale, Florida, Hollywood, Florida, Fort Myers, Florida, Homestead, Florida, Key West,
Florida, Miami Beach, Florida, West Palm Beach, Florida, Fort Pierce, Florida, Lakeland,
Florida, Melbourne, Florida, Merritt Island, Florida, Daytona Beach Florida, Brandenton,
Florida, Clearwater, Florida, and Coral Gables, Florida. Contact A FAMILY MATTER at 256-
766-5707 for an appointment.
A Family Matter provides marriage counseling, marriage therapy for couples, counseling for
children, anger management, psychotherapy for depression or anxiety, counseling for alcohol or
drug problems, divorce counseling, Christian family counseling, and phone or skype
counseling/advising/consultation.

Our clinic serves the online community, as well as communities in North West and North Central
Alabama, North East Mississippi, and South Central Tennessee including:

Florence, Muscle Shoals, Tuscumbia, Sheffield, Lexington, Rogersville, Cherokee, Russellville,

Athens, Madison, Decatur, Huntsville, Red Bay, Killen, Hamilton, Leighton, Moulton, Phil
Campbell, Haleyville, Iuka, Corinth, Belmont, Booneville, Tupelo, Lawrenceburg, Savannah,
Collinwood, Loretto, St. Joseph, and Waynesboro:

35630, 35633, 35634, 35677, 35661, 35674, 35660, 35648, 35610, 35653, 35585, 35654, 35581,
35582, 35593, 38847, 35645, 35646, 35616, 35653, 35652, 35648, 35611, 35612, 35758, 35601,
35602, 35603, 35813, 35801, 35804, 35814, 35815, 35810, 35804, 35824, 35807, 35808, 35812,
35807, 38464, 38372, 38450, 38469, 38485, 38852, 38834, 38835, 38827, 38829, 38801,
38802.

We provide marriage counseling, marriage therapy, psychotherapy for individuals and therapy
for children.

For an appointment with a marriage counselor or family therapist contact us at 256-766-5707.

Call us today, and let us help your Marriage and your Family!!

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