Monthly Archives: February 2013

Exploring the connection between mindfulness and differentiation of self

Heather Rudow February 11, 2013

AppelAttendees of next month’s 2013 American Counseling Association Conference & Expo in Cincinnati will be treated to a new series of conference sessions aimed at shedding light on research that uniquely benefits clients. 

Called the Client-Focused Research Series, these 30-minute presentations aim to increase awareness of research that focuses on improving the services that professional counselors provide to clients.

In the weeks leading up to the conference, Counseling Today is speaking with some of the presenters about their research and why they believe it is particularly beneficial. Next up are Dohee Kim-Appel and Jonathan Appel, a married couple who will be presenting on “The Relationship Between Bowen’s Concept of Differentiation of Self and Measurements of Mindfulness.” Dohee is an associate professor of art therapy and counseling at Ursuline College and Jonathan is an associate professor of psychology and criminal justice at Tiffin University.

What would you like attendees to take away from your session?

The quality of our family relationships colors much of our mental and emotional development, our ability to balance reactive emotions with constructive thinking and our ability to be mindful of ourselves and others. Our hope is for attendees to view the connection between some mindfulness constructs and other therapeutic conceptual models; in this case, a construct well known in the family counseling literature — “Bowen’s Model of Differentiation of Self.” We hope one walks away with the knowledge of how central family relationships are to our mental health.

Why is it important for counselors to understand mindfulness and Bowen’s Concept of Differentiation of Self?

The skill of mindfulness suggests that one would be accurately aware of the present moment in the surrounding environment: one’s emotions, relationships [and] self-motivations. Educational and counseling techniques that induce mindfulness are increasingly being employed in psychotherapy and counseling and in self-help programs to understand and alleviate a variety of mental and even physical conditions. Our current research found mindfulness is very connected to the concept of “differentiation of self,” or the ability to relate with others without losing one’s healthy sense of self or becoming too emotionally overwhelmed by others. 

How did you first get interested in this topic?

It seemed to naturally develop from past and present interests. Dohee’s dissertation studied Bowen’s Differentiation of Self, [but as it relates to] the elderly. She also had an article on this topic published.

Then, on our last trip to Korea, we had a chance to spend time at a Buddhist monastery in the mountains, which sparked a newer research interest — mindfulness, a concept rooted in Buddhism. We were interested in how this Eastern concept had exceedingly been applied in the West — through psychotherapy and counseling. We ended up having a long conversation with a monk at the temple. A natural outgrowth was the development of a connection between past interests and ideas with new thoughts. It was a natural progression to join the two topics: differentiation of self and mindfulness.

What inspired you to present this session at the conference?

Experience has taught us that the real joy of learning comes as a result of expressing and dialoguing ideas with others. The ACA Conference is the ideal setting in which to do this. Ursuline College has been very supportive in this work and has encouraged involvement with ACA and the counseling profession.

Did anything surprise you as you were compiling information for your session?

Two things surprised us. There are different ways in which mindfulness is being defined and measured in the literature, and being able to work with each other on this — and other projects — is still truly a joy after 14 years of marriage. Our relationship brings the material alive for us. 

Who do you feel is the best audience for this session?

We hope everyone is able to get something out of it, from students to teachers to counselors to researchers. Those are all roles we have had. In many ways we are still students learning and thinking out loud when we present.

Is there anything else you would like to add?

The entire world is our classroom, in which we are constantly learning. We both feel it is a privilege we are able to do what we do.

 Heather Rudow is a staff writer for Counseling Today. Contact her at

The importance of career counseling with undocumented Latino students: A sneak peek into ACA’s Client-Focused Research Series

Heather Rudow February 8, 2013

casncacesAttendees of next month’s 2013 American Counseling Association Conference & Expo in Cincinnati will be treated to a new series of conference sessions aimed at shedding light on research that ACA members are doing on topics that uniquely benefit clients. 

Called the Client-Focused Research Series, these 30-minute presentations aim to increase awareness of research that focuses on improving the services that professional counselors provide to clients.

In the weeks leading up to the conference, Counseling Today will speak with presenters about their research and why they believe it is important to the enhancement of the profession. First up is Cassandra Storlie, who will be presenting the session “Career Counseling with Undocumented Latino Youth: A Qualitative Analysis of School Counselors.”

What would you like attendees to take away from your session?

The cultural worldview of undocumented Latino youth often points to an environment of few career options. As counselors and social justice advocates, we are charged with the responsibility to cultivate the career development of all students. From this session, attendees will learn about the challenges school counselors encounter when working with the unique career development needs of undocumented Latino students. Attendees will be able to evaluate their own model of career counseling in the K-12 classroom and will be provided [with] suggestions on how they can improve their counseling approaches to meet the needs of undocumented Latino youth.

Why is it important for school counselors to learn about counseling undocumented Latino youth?

Of the 11.2 million undocumented immigrants, between 1.8 and 2 million are school-aged Latino students (Passel, 2006; Passel & Cohn, 2011). Many undocumented Latino youth entered this country as children, having no choice but to follow their parents’ direction in crossing the U.S. border. As these youth assimilate, they begin to recognize that their lack of citizenship affirms they do not have the same opportunities as their American counterparts (Gildersleeve, Rumman & Mondragon, 2010). Furthermore, undocumented Latino students experience an unconventional career development trajectory, which is often recognized first by school counselors and student affairs professionals (Ortiz & Hinojosa, 2010). There is a lack of counseling literature that addresses the unique issues of undocumented Latino youth in school settings, particularly on the issues of career development. School counseling approaches need modification to assist undocumented Latino youth in academic, social/emotional and career domains beyond the current multicultural framework to address the unique challenges faced by this population.

What experience do you have with this group of students?

I have had a strong interest for this population because I have had family members who have struggled with their own career choices because of having an undocumented status. By witnessing their challenges in obtaining citizenship, I developed a passion in researching how the counseling profession can help ease the obstacles that face undocumented Latino students. I have also had the opportunity to work with undocumented Latino students at an elementary level during my doctoral internship.

What inspired you to host this session at the conference?

I think research on this topic is very much needed in the counseling profession. There are literally millions of Latino students that are undocumented, and school counselors need the support and resources on how to best work with this population. The ACA Conference is a fantastic place to be able to reach counseling professionals about this important topic.

How did you first get involved with the subject?

Throughout my doctoral program, I have focused my research on the developmental issues of marginalized populations in order to provide a voice to those who, so often, are not heard. For me, this topic is about social justice and advocacy for individuals that are oppressed. In observing the obstacles my family members have had in their own quest in gaining citizenship, I became interested in researching the emotional, social and multicultural challenges of undocumented Latino immigrants. Just recently, a colleague and I published an article on how school counselors and student affairs professionals can use a collaborative social justice model that can enhance the opportunities for undocumented Latino youth.

Did anything surprise you as you were compiling information for your session?

As I finished the data collection on this topic, it was surprising to me that the participants did not identify any multicultural career counseling theories that they used when working with this population. Most participants stated that they provide career counseling/guidance the same way to all students, documented or not. Yet they all identified the need to take a different approach with this population because of their unique needs. 

Who do you feel is the best audience for this session?

School counselors, school counselor site supervisors, career counselors, counselor educators and counselors-in-training.

Is there anything else you would like to add?

The laws on immigration are changing, and it is our duty to stay up to date on how that impacts the clients and/or students we work with!

Heather Rudow is a staff writer for Counseling Today. Contact her at

Q&A with Brandon Ballantyne: From aspiring tornado chaser to counseling teens

Heather Rudow February 7, 2013

OLYMPUS DIGITAL CAMERABrandon Ballantyne, 28, a licensed professional counselor at Reading Hospital in Reading, Pa., has found a way to use his passion for the arts to help his teenage clients. Ballantyne, a member of the American Counseling Association and the Pennsylvania Counseling Association, has been a drummer for more than 15 years. He incorporates music, along with other creative interventions such as art and journaling, to help his adolescent clients express sometimes difficult thoughts, feelings and experiences. The teens with which Ballantyne works are typically admitted into the hospital’s inpatient psychiatric unit after episodes of self-injury, psychosis, suicidal ideation, suicide attempts, aggression or homicidal ideation. Still, Ballantyne believes that utilizing creative interventions is important for every counselor to practice, regardless of the client population. 

Why did you first decide to work with adolescent patients? 

Many people have asked me this question, and I have given most people the same interesting, honest response. Originally, I wanted to become a tornado chaser. However, I took a psychology class in high school and really enjoyed the material and concepts. I decided that the tornado-chasing idea was a little too risky, so I chose to pursue a career in working with teenagers.

Yes, these two career pursuits are very different, but maybe not as different as one would think. While working with adolescents as a counselor, you can encounter various challenges and obstacles to the therapeutic process. The therapeutic process itself is something that has always been very rewarding for me to be a part of. In therapy, we should not “chase” the challenges. And we should not fear the challenges. We should embrace them and be open to them. We should accept them as an important part of the therapeutic process.

If you know what I am talking about, then you can understand why I chose to work with adolescents. I believe that adolescents have an incredible ability to utilize their resilience and potential. As a counselor, I feel that you have the option of working with many aspects of a teen’s individuality, which includes but is not limited to their sense of humor, skills, hobbies, talents, aspirations, family and creativity.

Why did you think that creative interventions would be helpful for them?

Creative interventions are helpful for adolescents because it provides them with a safe, less intimidating outlet to express their thoughts, feelings and self-concept. From my personal experience, creative interventions allow adolescents to access their strengths more effectively in the therapy session. With the combination of art, music, journaling and talk therapy, the adolescent is able to experience various styles of self-expression. They also experience the autonomy of working with a counselor who allows them as an individual to choose which therapeutic outlet is most beneficial.

How long have you been using creative interventions with these patients? What results have you seen?

I have been using a combination of art, music, journaling and talk therapy with adolescents for approximately six years. Most of my work has been done on an acute inpatient psychiatric unit. I have noticed that when art is combined with journaling and cognitive therapy, the adolescents appear more comfortable disclosing thoughts and feelings. It seems as if they perceive support from both the counselor and the protective platform that their artwork creates.

What is a typical session like with your patients?

Initially, I start the session by inviting the patient to complete a drawing. I typically ask my patients to use colored pencils because I feel it gives them more opportunity to add more detail to their picture. For example, I may ask the patient to draw a picture of a volcano. Now, we all know that sometimes a volcano is just a volcano. However, each volcano is different. And each volcano has different characteristics.

Next, I would ask the patient to create a story about [his or her] picture. I would be sure to communicate that the plot of the story is completely up to them. However, it must include their volcano in some way. I also invite them to include a description of their volcano in the story as well.

After the story is complete, we are about 20 to 30 minutes into the session. Next, I invite them to share their picture and story with me. I have found that the stories that adolescents create to go along with their pictures are usually either really creative and intricate, or very brief and concrete. However, as a counselor, I pay most attention to the themes they include in their story as well as the description of their volcano. They might describe their volcano as explosive, or simmering, or quiet, or maybe even violent. The theme of their story might represent similar dynamics. The goal is to invite them to compare the characteristics of their drawing and creative story to themes in their actual life. Maybe their preference to express emotions is similar to the way they imagine their volcano erupting.

I think that if the patient is able to connect their own interpersonal preferences to the characteristics in their creative work, insight can be grown. I believe that once the adolescent discovers insight, they are able to experience more awareness of how situations and relationships in life influence them. I find that, sometimes, this type of insight is hard to grow in a classic talk therapy session.

Adolescents are unique individuals with unique ideas and perceptions. Using a creative intervention such as the one [I] described can provide them with an opportunity to discover new insight into their self-concept. By the end of group, a volcano will not just simply seem like a volcano anymore. I imagine you could facilitate the same intervention using tornadoes.

The specific object that they choose to draw is just as important as the themes and characteristics brought out in the story. This creative intervention is a less intimidating, safe platform that can be used to assess interpersonal themes, coping skills, relationships, self-esteem and more. I think it is important to end the [session] by making connections between their drawing and their real-life situations. This is the point in the session where insight can occur.

I believe that it is also important to offer a homework assignment as well. Inviting the patient to complete homework assignments reinforces a sense of responsibility to themselves and their treatment. For example, I might ask my patients to write a paragraph about what they feel they learned during the session and invite them to share it with me the next day. This also increases the flow of therapy and creates continuity from session to session, thus providing the patient with a fluid, consistent therapeutic experience.

Have you found any interventions to be more effective than others?

I have used art as a single intervention, journaling as a single intervention, talk therapy as a single intervention and music as a single intervention. All of these provide a unique platform for the patient to express thoughts and feelings, as well as build insight. However, it seems that the most progress has been made by using a combination of art, journaling and talk therapy [as part of] one creative activity. I feel that music is a good complementary item to utilize either at the beginning or at the end of the session. I tend to use soft rock/acoustic music to help the patients ground their mood both at the beginning and the end of the session. This is something that can be applied to both group and individual therapy.

What kinds of counselors do you feel would benefit from using these types of interventions?

I believe that all counselors can benefit from creative interventions. My priority as a counselor is to create a safe environment for my patients to express their thoughts and feelings. I feel that music, art, journaling and talk therapy can provide a client-centered environment that reinforces the patient’s autonomy to invest in treatment. I believe that the best progress is made when the patient is able to access their personal strengths, talents and creativity. 

Is there anything else you would like to add?

I believe that at the very root of all adolescents, there is a sense of resiliency that patients can access with the help of creative outlets. I encourage all counselors to consider the use of creative interventions when working with patients who seem to gravitate toward that kind of platform. Creative interventions may not be helpful for all adolescents. However, it is our professional and ethical duty as counselors to take a flexible approach with patients. We have to be willing to explore various styles of counseling and work with the patient to determine which styles are most beneficial. Allow your adolescent to have autonomy and control in your session, while at the same time providing assignments to reinforce accountability. As a counselor, you should not feel like a tornado chaser. Instead, maybe more like a tornado embracer.


Behind the book: Counseling Around the World

Heather Rudow February 5, 2013

HohenshilThis is the first in a series of articles in which Counseling Today interviews editors and authors of newly published or soon-to-be published books from the American Counseling Association.

First up is Thomas H. Hohenshil, professor emeritus of counselor education at Virginia Tech, associate editor of the Journal of Counseling & Development and member of the American Counseling Association and the Virginia Counselors Association.

Hohenshil, along with Norman E. Amundson and Spencer G. Niles, edited Counseling Around the World, which was published in October. He spoke with Counseling Today about the experience.


How did you first get involved with this subject?

I have been interested in international affairs since attending graduate school. Several years later, I had the opportunity to take a sabbatical from Virginia Tech and taught with the Boston University overseas program for a year in Germany and England. This provided the opportunity for extensive travel in Europe and interaction with people from a variety of countries and cultures. Later on, this interest was translated into a special section on international/global counseling for the Journal of Counseling & Development (JCD) and finally [in] serving as co-associate editor of the international section of JCD with [fellow editor] Norman Amundson.

What inspired you to edit Counseling Around the World?

Counselors from dozens of countries expressed interest in writing articles for the international section of JCD. However, due to space limitations, it was not possible to publish many of them. As Norman Amundson, Spencer Niles and I talked about this, we decided there was more than enough interest and need to develop a book on the general topic of global/international counseling. Since [ACA] had not previously published a book on this topic, Carolyn Baker, director of publications, was approached with the idea. She suggested we develop a proposal and submit it to ACA, which we did and it was approved. 

What surprised you as you were editing Counseling Around the World?

To generate the main content for the book, a method was developed to systematically study the counseling profession from a global perspective by having experts from 40 countries write chapters describing the status of counseling using a standard reporting format. One of the most surprising things to me was that virtually all of the invited chapter authors enthusiastically agreed to participate and that we met all of the submission timelines, which is quite unusual with this type of book. Being able to use of the Internet to facilitate the editing and communication process with authors from the 40 different countries significantly reduced the amount of time required to complete the book.

What are some main issues or topics in the counseling profession that relate to this book?

There are dozens of counseling related topics [that] are covered in this book. However, due to limited space, six of the major ones will be briefly described here:

1. One of the first themes we noticed was that how counseling develops in a country depends on how it began. For some, the initial focus was on education, and in those countries, school counseling took the lead. In other countries, industrial development was an initial focus, and in those, vocational counseling played a primary role. In others, counseling was first developed with the assistance of organized religion. In those countries, churches took a leading role in developing community counseling centers and church-affiliated counseling services.

2. The topic of diversity is a major theme threaded throughout the book. We found that how counselors deal with different types of diversity is often significantly different from country to country.

3. What counseling theories and techniques work best in a particular culture is a third major topic. For example, collectivist-oriented cultures tend to use different counseling theories and techniques than individually oriented cultural settings.

4.Credentialing is a fourth major issue. How counselors are approved for practice differs widely from country to country and involves everything from licensure for private practice by governmental agencies to certification programs by professional associations to no credentialing at all. Quality-control issues are especially important in countries in the process of developing counselor credentialing. Governmental agencies and the public are concerned about how counseling quality is assessed.

5. Counselor education varies significantly from country to country. Some follow CACREP-type standards, while others have their counselors trained in other countries or are in the initial stages of developing their own counselor education programs. The differences are sometimes dramatic.

6. It is important and difficult to establish a separate identity for professional counseling in all countries. It is clear that basic counseling functions are practiced in every culture in the world, sometimes by professional counselors, sometimes by others. The identity problem is complicated by the fact that even with trained mental health professionals, counseling services may be provided by psychologists, social workers, art therapists, music therapists, play therapists and various [other] medical personnel, in addition to professional counselors.

What do you hope counselors take away from the book?

I hope readers will take away an increased sense of global literacy. Although it is important for all counselors to deal with issues of diversity, there is a new goal evolving [that] also calls for us to be globally literate. Global literacy is the basic information needed to maneuver through life in the highly interconnected and complex world of the 21st century. Due to today’s sophisticated technology, the world is fast becoming a place in which people from diverse cultural backgrounds are interacting in ways that would have been unimaginable even a few decades ago. Although dealing with diversity is important for all helping professionals, acquiring global literacy must become a new goal for counselors who wish to practice in a culturally competent manner in the future.

Who do you feel is the best audience for the book?

Counseling Around the World is a good text for courses dealing with international/global counseling. It would also be a valuable text for use with courses focusing on multicultural counseling/diversity issues. In addition, it could also be used as part of introductory courses to show beginning students how counseling is practiced in other countries and the fact that there are developing job possibilities in different regions of the world. The book can also be a valuable reference tool for practicing counselors who may be working with clients from other countries. Finally, as has been indicated by a number of professional leaders, all counselors must become globally literate in the future if they are to provide effective services for their clients.

Click here to order Counseling Around the World.

 Heather Rudow is a staff writer for Counseling Today. Contact her at






Record number of military suicides begs questions about the path forward

Heather Rudow February 1, 2013

8410502197_b2223c9814_zDespite recent efforts from the Department of Defense to stem the rise in military suicides, the number of service members who took their own lives last year appears to have topped the number of troops killed in combat.

Despite the Pentagon’s recent efforts to hire more mental health workers, begin a long-term study of mental health for military personnel and expand the reach of mental health services for service members and their families, there were 349 active-duty suicides in 2012 — a record high.

Art Terrazas, grassroots advocacy coordinator for the American Counseling Association, believes if it were easier for licensed professional counselors to join in the Pentagon’s efforts, then the rising military suicide numbers would have a better chance of decreasing.

“The news is deeply saddening and, at the same time, troubling,” Terrazas says. “Any loss of life is tragic, and that tragedy is compounded when someone falls victim to suicide. What is also troubling is that despite the fact that mental health in the military has gained more attention in the past year and more efforts have been made to address mental health care, we continue to fall short of meeting the goal, which is reducing or eliminating suicides among our service members.”

Last year, ACA conducted an aggressive outreach campaign to various media markets to highlight the fact that the Department of Veterans Affairs fell behind in its efforts to recruit and obtain all available mental health clinicians, specifically licensed professional counselors.

ACA’s Public Policy Department believes the DOD has still not done enough to get military personnel the mental health services they need.

“From our point of view, if you are going to do all that you can to meet the mental health care demands of the troops, then that means you are going to utilize all the tools at your disposal,” Terrazas says. “[The DOD] is not doing that. They are sidelining thousands of counselors from working with our military members because of rules that they have created. The DOD is putting up its own barriers when it comes to recruiting every mental health clinician to combat this very serious problem.”

Terrazas says he hears from counselors across the United States almost every day who are being denied work at VA facilities.

“Many of these counselors are veterans themselves,” he continues. “Counselors have not been given the chance to help combat this problem simply because the government hasn’t allowed them to be part of the solution.”

ACA member David Fenell is one of those counselors who has been on both sides of the fence. As a colonel and behavioral sciences officer with the U.S. Army and Army Reserve, he retired in 2009 after 26 years of service, which included tours in Afghanistan and Iraq. Since then, he has counseled soldiers returning from deployments on how to fit back in with their families at home.

When Fenell first heard the news of the suicide numbers, he says he “felt sad that so many of our warriors were so desperate and in such pain. I was sad that they found no options, other than suicide, to relieve that pain and desperation. We try to prepare our soldiers to be resilient and provide them with tools to face adversity, but that training does not seem to have helped those who took their lives.”

Fenell believes the DOD has a lot of helpful programs for military personal in need. “Unfortunately, these programs were either not accessed by the struggling warriors or were not effective if used,” he says. “I know the DOD is currently reassessing its suicide-prevention strategies.”

Fenell points to a Dec. 24 issue of Army Times, which, he says, “reported that about half the 301 service members who committed suicide in 2011 had accessed a mental health provider or received inpatient care before committing suicide. About a third of these had received services within 90 days of their deaths. Over 50 percent of the service members who committed suicide had no known mental health diagnosis. Over 70 percent were drug- and alcohol-free at the time of their death.”

Part of the problem continues to be stigma, Fenell says.

“Service members may seek help but may not fully disclose the depth of their pain because they don’t want to appear weak,” he says. “Also, military mental health care, because of the intense demand for services, can be sporadic. So a client whose depression deepens may not have an appointment scheduled and may be unwilling to call emergency services.”

Lynn Hall, dean of the College of Social Sciences at the University of Phoenix and author of the book Counseling Military Families: What Mental Health Professionals Need to Know, agrees.

“My thoughts go to what are we not doing for these service members and how can life seem so hopeless [for them],” she says. “We talk about moving beyond the concept of the stigma of seeking help, but doesn’t this indeed suggest that we haven’t done enough to decrease this stigma?”

Hall, a member of ACA, says she has found through her research that three conditions are typically present when a suicide occurs:

  • A weapon is available and the individual has been trained to use it.
  • The individual has experience or some level of comfort with death.
  • The individual has a fear of being a burden on others.

With members of the military, Hall says, the first two conditions are present. “Military are trained to use weapons and have weapons available and, at least for those in combat, have experienced death. Therefore, it is only the third condition that perhaps we have not focused on enough in the mental health world.”

The most common characteristics of military life are change and transition, Hall says, and with any change or transition comes grief and loss. The power of accumulated grief over time to lead to high levels of distress is often not recognized, Hall says. “Every person in a military environment must learn how to make healthy transitions, and perhaps everyone going into the military needs to be assessed for prior loss and unfinished grief.”

The relevant questions then become, Hall says, “Does something in the military experience trigger this fear of being a burden on others? Is this what pushes service members over the edge? Being a burden on their families and/or their communities because of their emotional state or even their physical injuries?” If so, Hall says, “might we not focus on this aspect of ‘healing’ for all in the military, or possibly focus more on preventative measures in military training?”

Terrazas believes utilizing counselors is one of the only ways to reduce the number of suicides in the armed forces.

“Federal agencies have made the decision to place barriers that keep counselors from treating service members, military families and veterans,” Terrazas says. “Even though past congresses and presidents have clearly stated that counselors should be part of the effort to treat invisible wounds of war, there seems to be an effort in several agencies to promulgate rules that keep counselors from working [with] the VA and the DOD. Those rules need to be changed so that we can start getting as many mental health clinicians as we can into this fight. It wouldn’t require an act of Congress, it wouldn’t require a lot of hoops to jump through. All it would take is for the administration to [make] some common sense changes so we can get people the help they need. [Counselors] have not been given a chance to help solve the problem.”

Fenell, too, thinks counselors could play a much greater role in the effort to reduce military suicides.

“Licensed professional counselors are trained to establish effective and continuing therapeutic relationships with their military clients,” he says, “and many suicidal service members need a stable, ongoing, supportive relationship to help get through the darkest periods of their depression. Counselors can effectively provide that type of intervention.”

Additionally, Fenell points again to the Army Times issue which states that the most noted causes of military suicide were broken relationships, workplace problems and financial problems. “Licensed professional counselors can be effective in helping in each of these problem areas,” he says.

Hall says she believes that on a local level, “Every single counselor, social worker, psychologist, even physician, who sees a service member must be screening for suicide ideology. This is not something that should happen only when there is a crisis or major loss, but with everyone. We in the mental health world are perhaps not paying close enough attention to the accumulation of grief/loss issues and assume that if someone ‘looks’ healthy because they are capable of functioning, that they are indeed healthy.”

She also questions whether society has the responsibility of raising boys in a less stereotypical way, teaching them that “being a warrior with all its ingrained messages about being dependable, not needing help, being strong, not being weak or invincible is not the ultimate demonstration of being male. The military is, for some young men, the exaggeration of this stereotype, and we may not have enough up-front assessment of our young people to determine the reasons why someone joins.”

It is ACA’s hope that the suicide rate will go down to zero next year. But unfortunately, Terrazas says, there is no indication that will happen.

“The RAND Corporation told us that in 2009, we lost more service members to suicide than we lost in combat in either Iraq or Afghanistan, and 2012’s numbers are higher than they were in 2009,” Terrazas says. “While there has been a lot of work and a lot of resources have been dedicated towards ending this terrible problem, we as a country are still failing and we as a country need to do more. We just hope that both the Department of Defense and the VA will finally listen to recommendations that ACA has made over the past year so that we can get more counselors where they’re needed. And we hope that we all remember this and remind ourselves that this is part of the true cost of war. This is part of the price that we pay when we activate the members of our armed services, and it’s a cost that we should never forget.”

Heather Rudow is a staff writer for Counseling Today. Contact her at