Counseling Couples

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CounselingcouplesAlso inside: Treating youth depression Discussing CBT with Judith Beck Getting to know Don W. Locke

CounselingTodayCover Story24Finding a way forward togetherBy Lynne ShallcrossContentsJuly 2011When it comes to working with couples, counselors must take into account theindividual dynamics that affect people in their relationships, while also helpingthem examine their motivations for seeking change.Features32Young and depressedBy Jim PatersonStatistics suggest that the rate of depression among young people has steadily increasedover the past several decades, making it imperative that counselors play a primary roleboth in early detection and treatment.36Changing distorted thinkingInterview by David Kaplan2432Expert Judith S. Beck discusses why cognitive therapy actually focuses on more thancognitions, the application of the therapy in school settings and its relevance formulticultural populations and diversity.40Payback timeBy Lynne ShallcrossA desire to serve and the encouragement of an influential mentor led Don W. Locketo enter the counseling profession. As ACA president, his goals include further unitingthe profession he loves, while strengthening counselors’ sense of identity.43Reader ViewpointCross-cultural counseling of recent immigrantsBy Christina M. Rasmussen36New arrivals to the United States often undergo a considerable amount of psychosocialupheaval as they struggle to adapt to a new culture, language, social structure andfinancial reality.July 2011 Counseling Today 3

CounselingTodayJuly 201110111214162022Washington UpdateTwo-Minute AdvocateCounselor Career StoriesPrivate Practice StrategiesResource ReviewsThe Digital PsywayInside the DSM-5Need to Know5783945464748From the PresidentExecutive Director’s MessageLettersCT Learning ExamDivision, Region & Branch NewsNumbersNumbersby theColumnsPrimary care andmental illness in childrenA survey released in the spring by the National Alliance onMental Illness exposed a gap between primary care physicians’knowledge of mental illness and the needs of families whohave children living with mental illness. NAMI’s Child andAdolescent Action Center conducted the survey betweenJune 3 and July 1, 2009, and this marked the first time thatresults and analysis had been released. The 554 respondents tothe survey were parents whose children were diagnosed withmental illness before age 18.“Most Americans rely on family doctors and pediatriciansfor early detection of mental illness and, in many cases,treatment,” said NAMI Executive Director Michael Fitzpatrick.“Family dependence on primary care for mental health needsis especially great in smaller communities and rural regions.Primary care professionals need to be prepared to meet thechallenge.”The survey findings could suggest the value of counselorscollaborating with primary care physicians and other healthcare professionals in integrated care models. Among thefindings:n 63 percent of families participating in the survey reportedtheir child first exhibited behavioral or emotional problemsat age 7 or younger.nNews & NotesnBulletin BoardClassifieds59 percent of families said theirprimary care doctors werenot knowledgeable aboutmental health treatment.64 percent said theirprimary care doctorswere not knowledgeableabout local mental healthresources and supportfor families.The full report isavailable at Counseling Today July 2011Only 34 percent of families said their primary care doctorswere “knowledgeable” about mental illness, while 17 percentclassified their doctors as “somewhat” knowledgeable.

CounselingTodayDon W. LockeFrom The PresidentLeading fromthe middleFor years, I have read thepresident’s message in CounselingToday. With each article, I feltI came to know about and understandmore clearly the direction of ourprofession and the individuals chosen tolead us for short periods of time. I hopethat with these monthly columns, I cancontinue that tradition.I must confess that when the call cameinforming me that I was the successfulpresidential contender, I felt much likethe dog who chases the car and thenlooks puzzled when the vehicle actuallystops. My service and leadership withinstate branches and several ACA divisions,as well as many years as part of theACA governing structure, had led me tobelieve that I might be able to providethe leadership needed by our professionalorganization. I first sought the office ofACA president as a young professionalmore than 25 years ago, then again 12years later as a more seasoned counseloreducator and department head. Uponseeking the office this time, many of mycolleagues asked me why, at this point inmy career, I was still interested in serving.My response was and is that I feel it is“payback” time for me — time to giveback to ACA. I believe my rationalefor seeking the presidential position onprevious occasions was valid, but lookingback, I am just as firmly convinced thatthose were not the proper times forme to take office. I needed additionalseasoning, maturity and experience.I needed to learn to be more patientand a more active listener. I needed todevelop a leadership style reached only byexperiencing both success and failure.Counseling Today StaffI hope I will be able to represent ourprofession and each of you in a mannerthat you can accept and respect overthe next 12 months. I am convincedof several facts about us. We are a verydiverse group of professionals. We havedifferent ideas. We have different personaland professional needs. We have differentbackgrounds. We work in a variety of jobsettings. We approach issues with passionand conviction. We discuss politics,religion and life in general with a widevariety of beliefs and with a certaintyof our opinions. It is that diversity thatwill either make us strong or cause us tobecome divisive.I have learned through the years thatmy passion often has interfered with myability to recognize that someone elsemight possess an equal level of passion. Ihave talked when I should have listened.At times, I have been unwilling toeven consider other points of view. It isbecause of those and other experiencesthat I hope to lead “from the middle”over the next 12 months.When I first heard that term applied toleadership, I was skeptical. I interpretedthe middle as a cop-out. My skepticismchanged when I began looking atthe difference between advocacy andleadership. The skill sets for advocacyand leadership differ when you are therepresentative of a group as diverse asACA. The president of ACA must speakfor and represent all members, andif advocacy becomes necessary, thoseefforts must reflect a strong majority ofmembers. Your leader needs to be madeaware of what you, as members, want andwhat actions you would prefer taken.I hope you will jot down this This is your direct contactto me at any time. For ACA leadershipto be successful over the next year, weneed to have input from you regardingwhat ACA is doing that you like andwhat else you would like to see done. Asprofessional counselors, we have manychallenges that can be resolved when wetruly work together within ACA. I lookforward to hearing from you and leadingyou from the middle. uPublisherRichard YepAssociate PublisherCarol NeimanEditor-in-ChiefJonathan Rollins800.347.6647 ext. 339jrollins@counseling.orgSenior WriterLynne Shallcross800.347.6647 ext. 320lshallcross@counseling.orgAdvertising RepresentativeKathy Maguire607.662.4451kmaguire@counseling.orgGraphic DesignerCarlos J. Soto II800.347.6647 ext. 377csoto@counseling.orgCT Column EditorsWashington UpdateScott Barstow800.347.6647 ext. 234sbarstow@counseling.orgCounselor Career StoriesRebecca Daniel-Burke800.347.6647 ext. 230RDanielBurke@counseling.orgResource ReviewsKelly DuncanKelly.Duncan@usd.eduPrivate Practice StrategiesAnthony Centoreanthony@thriveworks.comSpotlight on JournalsSheri Baumansherib@email.arizona.eduNew PerspectivesDonjanea L. Fletcherdfletche@westga.eduThe Digital PsywayMarty Jenciusmjencius@kent.eduInside the DSM-5K. Dayle Jonesdaylejones@ucf.eduLearning Curve: Notes From a NoviceSuze Hirshct@counseling.orgJuly 2011 Counseling Today 5

New Ideas, New Attitudesand Fresh Approaches for Working With Kids and TeensCyberbullying: What CounselorsNeed to KnowPlay Therapy: Basics and BeyondSecond EditionSheri BaumanWritten for counselors, teachers,school leaders, and others who workwith children and teens, Cyberbullyingaddresses the real-life dangers studentsface on the Internet. Includes a discussionof the different types of cyberbullyingand cyberbullying environments; anoverview of prominent theories ofaggressive behavior; practical tips toidentify and follow cyberfootprints;proactive responses to cyberbullying; effective, nonpunitivestrategies for responding to cyberbullying; useful informationon current technology and popular websites; and much more.2011 215 pgsOrder #72900 ISBN 978-1-55620-294-0List Price: 29.95 ACA Member Price: 24.95Terry KottmanWritten for use in play therapy and childcounseling courses, this extraordinarilypractical text provides a detailedexamination of basic and advanced playtherapy skills and guidance on when andhow to use them. After a discussion ofthe fundamental concepts and logisticalaspects of play therapy, Kottman illustratesboth commonly used and more advancedplay therapy skills. A new chapter on working with parents andteachers is designed to increase the effectiveness of play therapy.Practice exercises and “Questions to Ponder” facilitate the skillbuilding and self-examination process. 2011 375 pgsOrder #72905 ISBN 978-1-55620-305-3List Price: 54.95 ACA Member Price: 39.95Bullying in Schools: Six Methodsof InterventionCounseling Children: A CoreIssues ApproachRichard W. Halstead, Dale-Elizabeth Pehrsson, and Jodi MullenThis innovative book offers a means forpractitioners in community, mental health,and school settings to better assess, treat,and monitor children’s underlying issues.The diagnostic framework presentedhelps uncover the nature of children’s coreconcerns and provides guidance on howto address the issues they are strugglingwith. Includes numerous strategies suchas narrative approaches, play therapy,sand tray therapy, and expressive arts therapy. The bookgives suggestions for bringing parents, teachers, and otherprofessionals together as a collaborative team. 2011 192 pgsOrder #72901 ISBN 978-1-55620-283-4List Price: 29.95 ACA Member Price: 24.95presented by Ken RigbyThis DVD gives clear, practical guidanceon how to prevent and respond to bullyingin high schools. Using actors and roleplay, the DVD features a typical bullyingscenario and then demonstrates how thefollowing methods can be applied to thesituation: the Disciplinary Approach,Restorative Practice, Strengthening theVictim, Student Mediation, the SupportGroup Method, and the Method of SharedConcern. By showing the advantages and weaknesses of eachmethod, the counselor or teacher can see how each solutionmight work. Includes a PDF booklet with a summary ofimportant information and discussion guidelines.Produced by Loggerhead Films2009 35 minutes DVD Order #78239List Price and ACA Member Price: 129.00Please include 8.75 for shipping of the first bookand 1.00 for each additional book.Order by phone: 800-422-2648 x222Order online: Counseling Today July 2011

Richard YepExecutive Director's messageETransitions, volunteeringand looking aheadach July, ACA experiences the transition from one leadership group toanother. We have done it this wayfor many, many years. Although some volunteer leaders carry over into the new year, mosthave fulfilled their terms and have moved on.To all those serving this year, I say welcomeand thank you in advance for your service.As someone who has volunteered for manyother groups over the years, I know the typeof commitment and dedication it takes toshare your precious time with a professionyou love so dearly. I will thank you now, andI will thank you again when your service iscomplete. But please know that I appreciateall that you do throughout the entire year!The projects, services and issues all of youwill deal with during the next 12 monthswill help to move the counseling professionforward. Your expertise will be called upon,and we are lucky to have you in our cadre ofcommitted volunteer leaders.I know we all wish Don W. Locke, ournew ACA president, a productive year. I havethe privilege of working with the ACA presidents during their time as president-elect,and Don brings a great deal of experienceand enthusiasm to the leadership table. Heis very open to new ideas as we all work collectively for the good of the counseling profession. The ACA staff and I look forward toworking with President Locke.I would be remiss if I didn’t ask all of youto think about the profession’s next generation of leaders. We need more people to volunteer their time and energy to ACA. Ourtent is quite large, and we are inviting andwelcoming to those who want to get involvedin the association. Some ACA members havealready indicated their interest in participating on committees and task forces and inother projects, but I know many others ofyou are likely interested in sharing some ofyour valuable time. We definitely look forward to your involvement as well.Volunteers for ACA can be at any pointin their careers: graduate students, midcareerprofessionals, retirees and even those taking abreak from full-time work as counselors butstill maintaining their membership in ACA.You could have several hours per month tovolunteer, or you might have just a few hoursto dedicate to a project-specific activity. Ihope you will consider getting involved andshare this invitation with your colleagues andstudents as well. The phrase “the more, themerrier” really does apply in this case.ACA is on a roll. We completed our fiscal year on June 30 in very good shape. Ourmembership continues to grow comparedwith the previous 12 months, and our annualconference this past March was our highestattended event in more than a decade. Andon May 22, ACA even made the front pageof The New York Times in an article about thedwindling number of males in the mentalhealth professions.But, just as is the case with many of you,our success does not allow us to rest on ourlaurels. Over the next 12 months, we will becelebrating ACA’s 60th anniversary. Duringthis time, we will continue to roll out newproducts, services and resources designedwith our members in mind. Our success istied to your input, and I appreciate those ofyou who have contacted me with suggestions.I also want to express a special debt of gratitude to the ACA staff, which comes up withterrific ideas for enhancing your membershipand advancing the counseling profession.I know it seems early, but I do hope youwill look at your calendar and mark March21-25, 2012, as a great time to be in SanFrancisco. Why? Because we will be convening the 60th ACA Annual Conference &Exposition. With hundreds of sessions fromwhich to select and the chance to interactwith thousands of your colleagues, visit exciting exhibits and experience the City by theBay, how can you go wrong? Visit for more information and toobtain the best rates on registration. This isone conference you will not want to miss!As always, I hope you will contact me withany comments, questions or suggestionsthat you might have. Please contact me viae-mail at or by phone at800.347.6647 ext. 231.Thanks and be well. uCounselingTodayAmerican CounselingAssociationPresidentDon W. Locke800.347.6647 ext. 232locke@mc.eduPresident-ElectBradley T. Erford800.347.6647berford@loyola.eduExecutive DirectorRichard Yep800.347.6647 ext. 231ryep@counseling.orgCounseling Today (ISSN 1078-8719) is themonthly magazine of the American CounselingAssociation, 5999 Stevenson Ave., Alexandria,VA 22304-3300; Telephone: 703.823.9800;Internet: Opinions expressedin this magazine do not necessarily representopinions of the editors or policies of theAmerican Counseling Association.Subscriptions are available for 150 for 12 issuesby calling PP&F at 800.633.4931. Single copiesare available for 12.50 each by calling ACA inhouse fulfillment at 800.422.2648 ext. 222.Periodicals postage paid at Alexandria, Va., andadditional mailing offices. Postmaster: Sendaddress changes to ACA Member Services,5999 Stevenson Ave., Alexandria, VA 22304.All rights reserved, 2011 by the AmericanCounseling Association.Editorial PoliciesCounseling Today reviews unsolicited articlesand guest editorials for possible publication.Not all articles will be accepted for publication.Send articles or request a copy of the writingguidelines by e-mailing PolicyThere shall be no discrimination against anyindividual on the basis of ethnic group, race,religion, gender, sexual orientation, age and/ordisability.Mission StatementThe mission of the American CounselingAssociation is to enhance the quality of lifein society by promoting the developmentof professional counselors, advancing thecounseling profession and using the professionand practice of counseling to promote respectfor human dignity and diversity.July 2011 Counseling Today 7

LettersMore information neededI just read the article “No more sittingon the sidelines” (May) by MichaelChaney, Joel Filmore and KristopherGoodrich and want to thank you for it.In the early seventies through the mideighties, I worked in a clinic specificallyfocused on gay and lesbian clients inBoston. In the very beginning, people meton a park bench in the Boston Common.Eventually, we were able to rent officespace. Sometimes we actually got paid,but there was a lot of donated time, andmaintaining office space was of paramountconcern.During this time, I also taught a religionclass in a local Catholic school anddedicated time to the topic of sexuality,specifically focused on gay issues, labels,sexual orientation and so on. I helped startthe Boston chapter of PFLAG (Parents,Families and Friends of Lesbians andGays) and led the sessions for the first yearuntil the group came out publicly. Someof the parents didn’t show up for that firstpublic meeting, and a few others camewith paper bags to hide their faces.I have never worked with a transgenderperson, though I have, on occasion,noticed someone who is transgender. Iwas torn by the reticence, anger and fearthat I noticed in some cases, but I was notin a position to respond beyond a simplerecognition of that person — if thatindividual would even allow eye contact.In particular, I remember a young womanI saw at a roller-skating rink. She stayedby herself, didn’t speak with anyone anddidn’t make eye contact. Her felt need forisolation saddened me.I’m also writing to suggest that thiswould be a timely issue for the AmericanCounseling Association to present in oneof its “Free CE of the Month” offerings.I don’t suppose many therapists have hadmuch training in this area, and this wouldbe a golden opportunity to help them startthe process of no longer sitting on thesidelines.Ronald E. Wozniak, S.J., LMHC,CCMHC, NCCWeston, Mass.8 Counseling Today July 2011Thank you for your rathercomprehensive articles on counseling withclients whose sexual orientation is otherthan heterosexual only (“‘Come and bewho you are’” and “No more sitting on thesidelines,” May). Your suggestions wereexcellent and very helpful. My experienceand training has focused on clients withdevelopmental disabilities, and because“people first” language (e.g., people withdisabilities) is the preferred nomenclature,I will use the single word nontraditionalin this letter when referring to the sexualorientation of persons who are lesbian, gay,transgender, queer and/or questioning.I found your discussion of religiousand spiritual issues especially refreshingin that you avoid referencing religiousdenominations by name when notingthe sense of rejection experienced bymany individuals with a nontraditionalorientation. As thorough as you were,it seems to me there is one importantfacet of the religious element that wasmissing which is vital to this discussion.That is the widely misunderstood andoften misrepresented stance of the RomanCatholic Church (the Church) in thishighly sensitive area.It is common knowledge that theChurch considers homosexual behaviorto be a serious sin, and this has been thecause of the above-referenced experienceof rejection by many Catholics andformer Catholics with a nontraditionalorientation. What is much less commonlyknown and far less publicized is that theChurch does, in fact, welcome personswith a nontraditional orientation, justas it welcomes all of us, recognizing thatall are sinners. The Church’s role as thebody of Christ on Earth is to call all ofus to repentance for our sins as well as toencourage and support us in our efforts torefrain from sinful behavior(s). Many, ifnot most, Catholic dioceses in this countryprovide such support for their memberswith nontraditional orientations in manyways, including groups such as the onestarted in New York City called Courage.These groups are composed primarily ofpersons with nontraditional orientationsand others who wish to support groupmembers in their efforts toward sexualpurity (chastity).Editorial policyCounseling Today welcomesletters to the editor from ACAmembers; submissions fromnonmembers will be publishedonly on rare occasions.Only one letter per person pertopic in each 365-day periodwill be printed. Letters will bepublished as space permits and aresubject to editing for both lengthand clarity. Submissions can besent via e-mail or regular mail andmust include the individual’s fullname, mailing address or e-mailaddress and telephone number.ACA has the sole right todetermine if a letter will beaccepted for publication.Counseling Today will notpublish any letter that containsunprofessional, defamatory,incendiary, libelous or illegalstatements or content deemedas intended to offend a personor group of people based ontheir race, gender, age, ethnicity,religion, sexual orientation,gender identity, disability,language, ideology, social class,occupation, appearance, mentalcapacity or any other distinctionthat might be considered by someas a liability. ACA will not printletters that include advertisingor represent a copy of a letterto a third party. The editorof Counseling Today will haveresponsibility for determiningif any factors are present thatwarrant not publishing a letter.E-mail your letters to or write toCounseling Today, Letters to theEditor, 5999 Stevenson Ave.,Alexandria, VA 22304.

Both Counseling Today articles onthis subject suggest that therapy focuson encouraging clients to “be who theyare.” If we, as therapists, are ethicallybound to support our clients in this way,ought we not to include discussion of thesupport available to Catholic clients of anontraditional orientation who expressa desire to continue living within theCatholic Church? Our role, it seems tome, is to ensure they understand all thechoices available.Arthur C. Lowitzer, Ph.D.Allentown, Pa.A world of differenceI truly appreciated Gregory K. Moffatt’sarticle (“Counseling across borders:Limitations and realities of cross-culturaltherapy”) published in the ReaderViewpoint section of the May edition. Ihope Counseling Today might encouragemore submissions that are theoreticallygrounded as well as practical andappropriate for today’s diverse world.I was very impressed and touched byDr. Moffatt’s experiences, which in factcorrespond to my own. I am a counseloreducator and practicing psychologist witha specialty in work with diverse clients. Iwill use his article with my students andto remind myself that “I am not crazy”when putting what I was taught in a morerealistic and congruent perspective.I applaud Dr. Moffatt’s article and hopeto see more like it.Marcel Soriano, Ph.D.California State University, Los AngeleswDr. Paul Pedersen, a member of ACA,asked that I share an experience I hadrecently with readers of Counseling Today.Apparently, he feels it has merit for encouraging others who counsel in everydaylife, especially in developing countries. I’mhonored that he has mentored me andsupports the work I do in Africa.After 36 years in an elementary classroom, I have had the privilege of travelingin French-speaking Africa with a nonprofitfoundation whose mission is to train grassroots pastors and church leaders, manyof whom have little or no training. WhenI accompany a team as a member of theU.S. board of directors, I often have theopportunity to teach practical life skills.Although I am not a licensed counselor,I have done my share of listening andproblem solving with children and knewI could transfer those skills in Africa, soI was particularly interested in GregoryMoffatt’s experience with cross-culturaltherapy in the May issue.On a recent trip to Mauritius, I described how important it is to relive atrauma that may make one a victim ratherthan a victor. As I encouraged this groupto gently prod their counselees to remember even the smallest details at the timeof their trauma, one pastor interruptedand announced that he now knew why hebecame almost physically ill and unable towork productively during a storm. He vividly recounted a time as a small child whenhe was forced to walk a significant distancebut found himself lost and unable to reachhome. Only at this meeting did he remember that it had been raining, thunder hadbeen rumbling, and he had been afraidhe would never be found. Immediately, itall made sense to him, and he understoodthat his fear was hindering his work as ashepherd to his congregation. We prayedas a group and rejoiced that he had brokenthrough a trauma that had held him captive most of his adult life.This story indicates that even simplecounseling practices we learn as educatorshere in the United States can be used to setpeople free from the haunts of trauma. Although I’ve had mentors who have taughtme basic counseling skills, I have relied onMuriel Cook’s book Kitchen Table Counseling to help me understand. Whether Iam listening to others’ stories or teachingconflict-resolution skills, positive ways toreact to pain and trauma, goal setting orother topics we so easily learn in our educational system, many in today’s world donot have access to such information, andsharing those skills with them can be lifechanging for people.Thank you, Mr. Moffatt, for teachingme that “counseling” in remote tribal areasdoesn’t always work like we think it’s supposed to here in America.Rita Wigfield1992 Minnesota Teacher of the YearCorrectionIn a caption in the News & Notes section of the June issue, ACA President DonW. Locke was mistakenly listed as Don C.Locke. We regret the error. uworldwide medical & dental careersVast OpportunitiesExceptional BenefitsRewarding» FIND JOBS » POST RESUMES » START TODAYPractice your specialty with one of the largest health carenetworks in the world. Army Medicine Civilian Corps – providingworld-class health care to military personnel and their familiesat more than 70 facilities throughout the United States, Europeand the Pacific.THE DEPARTMENT OF DEFENSE IS AN EQUAL OPPORTUNITY EMPLOYER. Applicants will receiveappropriate consideration without regard to non-merit factors such as race, color, religion, sex, national origin,marital status, sexual orientation except where specifically authorized by law, age, politics or disability whichdo not relate to successful performance of job duties.July 2011 Counseling Today 9

Washington Update -By Scott BarstowMedicaid at risk in budget talksFundamental changes are beingconsidered to Medicaid, whichis the key component of thenation’s health care safety net. Membersof Congress and President Obama havebegun working toward an agreementto raise the nation’s debt limit, buttime is running out before the limit isreached and the federal governmentbegins defaulting on its financialobligations. Republicans in the House ofRepresentatives are demanding deep longterm spending cuts as a precondition forapproving a debt limit increase.The budget proposal the Houseapproved for Fiscal Year 2012 (H.Con.Res. 34) would end Medicare as it isknown today. When individuals reacheligibility, they would be given a voucherwith which to buy their own insurancein the private health care market. Thesize of the voucher would not keeppace with health care cost inflation, andbeneficiaries’ out-of-pocket costs wouldalmost double. This fundamental changein the Medicare program has becomeone of the more well-known — andunpopular — aspects of the Housepassed budget proposal, but similarchanges are being discussed for theMedicaid program.Medicaid was established at the sametime as Medicare, in 1965. WhileMedicare covers 39 million people age 65and older, plus another 8 million adultswith permanent disabilities, Medicaidcovers roughly 30 million children, 14million low-income parents and adults,and another 14 million older adults andindividuals with disabilities who needassistance covering their Medicare out-ofpocket costs.The House budget resolution (aka the“Ryan Budget,” named for its author andHouse Budget Committee Chair PaulRyan of Wisconsin) would cut Medicaidspending by 750 billion over 10 yearsand turn it into a block grant program.Beginning in 2013, states would receivea fixed contribution from the federalgovernment, based on population growth10 Counseling Today July 2011and the consumer price index, to operatetheir Medicaid programs. Accordingto the Congressional Budget Office,Medicaid would be cut in half by 2030under this proposal.In part because of its drastic effect onthe viability of the Medicaid program, theSenate rejected the House-passed budgetby a 57-40 vote on May 25. Nevertheless,policymakers are still attempting to makedeep cuts in spending, and if defenseand Medicare spending Counseling Today (ISSN 1078-8719) is the monthly magazine of the American Counseling Association, 5999 Stevenson Ave., Alexandria, VA 22304-3300; Telephone: 703.823.9800; Internet: Opinions expressed counseling.

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