|Course Syllabus: HMS 102 Introduction to Counseling (Rev. 8/10)
HMS 102 Introduction to Counseling (3 Credits)
This course is an introduction to the process of client assessment, therapeutic intervention, interviewing, and documentation of counseling interactions. Students will receive and orientation and overview of HIPAA regulations concerning patient/client confidentiality. This course is a prerequisite to HMS 106, Human Services Practicum I, and students must demonstrate understanding of basic HIPAA requirements in order to participate in the Human Services Practicum courses.
Mary Ray, PhD
Human Services Program Coordinator/Instructor
Great Basin College
1500 College Parkway
Elko, NV 89801
Office: MH 132 (library building)
Health Sciences and Human Services Support Staff: Dianna Byers: (775) 753-2301
Mary Ray Office Phone: 775-753-2005
Fax: (775) 753-2160
Hours by appointment. Please contact by phone or email.
Contact the instructor about course concerns by using the email from within the course. Call the instructor if you have lengthy questions or complex issues.
Required Text and Materials
Text: Orientation to the Counseling Profession: Advocacy, Ethics and Essential Professional Foundations by Bradley T. Erford (2010). Pearson. ISBN-13 #978-0-13-228351-9
Regular, reliable internet connection and access to a current word processing program
Students will complete assessments of hypothetical human services client situations, identify/apply appropriate therapeutic intervention techniques, and demonstrate knowledge of HIPAA/patient/client confidentiality regulation.
The objectives of this class include the following:
I. The primary objective of this class is to assist students with identifying therapeutic communication and intervention techniques, as well as developing client interviewing skills.
II. Secondary objectives include providing students with opportunities to explore a variety of problem-solving and client advocacy skills used in the counseling profession.
III. Thirdly, this course will provide students the opportunity to apply basic client confidentiality regulations and to become familiar with ethical and legal obligations for counselors and addictions professionals.
Expected Learner Outcomes and Methods of Measurement
Upon completion of this course, students will be able to:
1) Identify and provide services to support clients/patients with kindness, patience, caring, support and understanding of issues common to the human condition.
Measurement: Journals, class discussions, research essay
2) Demonstrate professional, therapeutic interactions between counselor and client, family members, and other health and human services providers.
Measurement: Journals, class discussions, research essay, HIPAA test, and final exam
3) Recognize approaches that demonstrate appreciation for human individuality for people of diverse cultural backgrounds, and acknowledge the rights and dignity for all while rendering professional services.
Measurement: Journals, class discussions, research essay, final exam
4) Develop a basic therapeutic intervention plan based on the problem-solving process and the assessment of client/patient needs, implement interventions, evaluate outcomes, and redirect and revise ineffective solutions, while maintaining appropriate levels of confidentiality.
Measurement: Journals, class discussions, HIPAA test, final exam
5) Demonstrate accurate, clear and precise verbal and written communications skills.
Measurement: Journals, research essay, and class discussions
6) Identify basic human functioning in terms of wellness, illness and addictive disease. Guide and instruct clients/patients to appropriate resources and interventions as appropriate.
Measurement: Journals, class discussions, research essay, final exam
7) Participate in personal and professional reflection in terms of self-evaluation, and effectiveness.
Measurement: Journals, class discussions
Methods of Instruction
Learning methods include the following activities:
The following grade point scale will be used:
A ≥ 93 B - 80-82 D+ 67-69
A- 90-92 C+ 77-79 D 63-66
B+ 87-89 C 73-76 D- 60-62
B 83-86 C- 70-72 F <60
Late Work Policy
It is the student’s responsibility to initiate the process of making up missed coursework/assignments, and/or obtaining missed instructional content. Incompletes may be requested and granted per GBC policy. Students are expected to participate and to complete all assignments on time. In order for late work to be considered for a grade, students must notify the instructor by course email EACH AND EVERY TIME that a late assignment or a late discussion post is submitted for a grade. Late submissions made without instructor notification will NOT be graded. No submission or discussion will be graded after the posted deadline for late/make-up work. No student work will be accepted for a grade after a student submits the final exam.
To be fair to students who turn work in on time, unexcused late work will receive an immediate 10% deduction, and additional deductions will be made in increasing amounts thereafter. Contact the instructor PRIOR to a due date to request an excused late submission. Generally, technical problems and/or difficulty with obtaining the textbook will not be considered for excused late work; allow yourself ample time to complete assignments in order to meet deadlines.
Note: A student who logs into the course, and then fails to participate, ceases to participate, and/or does not officially withdraw from the class, will receive a grade at the end of the course that reflects the total of actual points earned, even if that number is a zero. To be fair to students who turn work in on time, unexcused late work will receive a 10% deduction, and additional deductions will be made in proportion to the degree of late submission, determined by the instructor.
It is recommended that all assignments be completed, no matter how late due to the educational value of course work. Late work is accepted until the final exam due date/time. Extra credit may be offered at the instructor’s discretion, but ALL assignments much have been completed and submitted on time prior to requesting an extra credit assignment. Suspected violations of GBC academic honesty policy will be reported.
Per GBC catalog, “You must participate in classes regularly if you intend to obtain the full benefits of instruction.” It is important to keep up with written and discussion assignments. If you have difficulty participating due to technical problems (which cannot be resolved by calling the Help Desk at 775-753-2167), or in an emergency, please notify the instructor to make arrangements for making up missed class work/assignments to avoid grade deductions.
Accommodations for Students with Disabilities
Great Basin College is committed to providing equal educational opportunities to qualified students with disabilities in accordance with state and federal laws and regulations, including the Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973. A qualified student must furnish current verification of disability. The Director of Services for Students with Disabilities (Julie Byrnes) will assist qualified students with disabilities in securing the appropriate and reasonable accommodations, auxiliary aids and services. For more information or further assistance, please call (775) 753-2271.
Course Outline and Assignments
Topics: Welcome! Introductions/overview of counseling/case study
Class Goals: Identify course requirements, define counseling, and the role of the counselor
__Print out the syllabus. Read the entire syllabus and course announcements. Fill in due dates.
__Obtain textbook. Begin reading in textbook: Contents, Preface, and Chapter 1
__Introduce yourself to the class in the “Introduction” discussion area. This section is ungraded. Students may use this area for informal chat and for forming study groups during the course. Do not write information about which you are uncomfortable sharing, but do include some general comments about why you are taking the class, and/or want to become a counselor, and your personal qualities/experience/skills that you bring to the human services/counseling profession.
__Discussion #1: Post to the Discussion #1 area after reading the **MR. ZZZ Case Study** (found at the end of the syllabus). Discuss concepts of multiculturalism and diversity as related to counselor professionalism (based on information found in the readings in Chapter 1 or from professional websites), describe two issues that might challenge you if you were assigned as the counselor for Mr. ZZZ, and write five ways that you would address these challenges.
__Remember to include supporting documentation from the assigned readings in the textbook for all journals and all major posts, as described in the “Assignment Information” section of the syllabus below.
__Journal #1: List/describe 20 client strengths that you find for Mr. ZZZ in one complete sentence for each. You may have to look very closely; there are many…Also, write a 20-sentence definition/description of the meaning of the term “counseling” in complete sentences. You may use your textbook, or professional websites like the Counseling and Related Educational Programs (CACREP): www.cacrep.org for this first week only. After Week 1, supporting documentation (with page numbers and/or quotes with page numbers from the textbook within the narrative of your journal entry) will be required in all journals and major posts, even when you are asked to give your opinions, thoughts or ideas. Your opinions are important as well, and you may supplement your work with information from additional reliable, evidence-based sources.
__Note: You are encouraged to keep personal notes about insights about your thoughts and feelings as a part of your professional development process. You may refuse to share sensitive or private information at any time. Personal counseling is not a requirement of this course, but it is highly desirable, especially when you discover issues about which you experience significant emotional discomfort or distress. Help with finding a counselor can be obtained by calling Julie Byrnes at (775) 753-2271.
Topics: Introduction to counseling
Class Goals: Identifying counseling history/methods/theories/trends/applications
__Read all of Chapter 1 and pages 395-400 in Chapter 16.
__Discussion #2: Post to the class discussion about “Think About It: 1.3" questions found on page 15.
__Journal #2: (2 parts) Part A. Write in 20 complete sentences (or more) about your response to Activity 1.2. Do this assignment alone. Part B. Re-read the section on “gate-keeping” on page 22. Write 20 complete sentences about what has been/is done by educators, members of the counseling profession, and/or state regulators about “gate-slippers.”
NOTE: In all journals (in both Parts A and B) the inclusion of supporting documentation/information from the readings in the textbook is required.
Topics: Professional preparation
Class Goals: Defining professional practice
__Read: Chapter 2
__Discussion #3: Post to the class discussion as related to “Think About It: 2.2” on page 51
__Journal #3: (2 parts) Part A: Write a list of 10 complete sentences or more about the considerations that any counselor should think about before accepting Mr.ZZZ as a client. Base your ideas on license/certification, training, experience, education, skills, and other client-centered factors. Part B: Respond to the first two questions in Activity 2.5 and list: (1) licensing requirements for substance abuse counselors and interns (CADC/LADC), (2) licensed professional counselors (LPC), and (3) requirements for certification for school counselors. Information should be about Nevada state requirements (or your state of residence).
Topic: The therapeutic encounter
Class Goals: Identifying ethical and legal issues
__Read Chapter 3
__Discussion #4: Post to the class discussion comments related to “Activity 3.8 and Activity 3.10”
__Journal #4: Complete activity 5.10 by writing 20 complete sentences. Note: read the information in Chapter 5 on page 136 and do internet research on this topic in order to fully develop in-depth, accurate responses.
__Choose one counseling method that is considered “alternative”/“holistic”/“complementary” for your research paper and email your topic to the instructor this week. The instructor must approve your topic, as duplications are not permitted. See instructions below for details regarding the research paper.
Topic: Insight-oriented approaches
Class Goals: Recognizing counseling strategies
__Read Chapter 4
__Discussion #5: Post to the class discussion about a hypothetical client issue from Mr. ZZZ’s case, and relate this to one of the theories from the 12 theories listed on pages 98-99. Choose one that has not been discussed by another student, if possible.
__Journal #5: (2 parts) A. Respond to the first three questions in Activity 4.1 in 10 complete sentences, or more. Part B: Complete the 7 matching questions in activity 4.4. Explain answers in two sentences or more for each response.
Topic: The “first five” minutes with a new client
Class Goals: Orienting the client to the counseling process, confidentiality and mandated reporting
__Read Chapter 5
__Discussion #6: Post to the class discussion about Activity 5.6.
__Journal #6: (2 parts) Part A: Write 10 statements in quotes that you would actually say to your new client Mr. ZZZ during the first visit during which you inform him about client rights and responsibilities, confidentiality, and other important information the client needs to know in order to be comfortable and to work effectively with you. Part B: Write 10 opening statements about what you would say during a first counseling visit with a 16 year old female who comes to see you about stopping smoking marijuana and then she suddenly tells you she might be pregnant--before you have even said anything at all to her! (For both these clients, write in the first person…Hint/example: “Hello, my name is ___. In order to work with you as your counselor, I need to tell you about some important legal and ethical requirements for our work together…”). Remember that supporting documentation is required for ALL journals…
__Review websites that contain information about client confidentiality and the Health Information Portability and Accountability Act (HIPAA). Here is a governmental site that will provide detailed information: http://www.hhs.gov/ocr/hipaa/
__Complete the HIPAA guided study materials and the “HIPAA” self-test that are located in the assignment section.
Topic: Therapeutic communication skills
Class Goals: Applying theories to counseling practice
__Read Chapter 6
__Discussion #7: Write a major post which contains a dialogue illustrating how you would do “feeling work” with Mr. ZZZ. Write all statements in quotation marks, in the present tense, to demonstrate the following counselor communications: 1. Inform Mr. ZZZ that his recovery in a [specific area] is not progressing, and you are concerned about him. 2. State that you understand his feelings of being upset with you for giving him feedback he does not like. 3. Respond with empathy as he is upset angry, hurt, defensive, etc. Process this with Mr. ZZZ using your best effort at showing compassion and understanding. As always, provide feedback response posts to your peers.
__Journal #7: (2 parts) Part A. Write responses to Activity 6.4. in 10 complete sentences or more about Part A. Part B. Complete Activity 6.1 and Activity 6.2 with someone outside of class. Write 10 complete sentences about Part B. Then write 10 complete sentences about the following questions: What did you learn from these activities? Why are these skills important for counselors to develop? Don’t forget to include supporting documentation from the readings.
Topic: Multicultural counseling skills
Class Goals: Applying cultural/diversity awareness and sensitivity
__Read Chapter 7
__Discussion #8: Post to the discussion comments related to Activity 7.4
__Journal #8 (2 Parts): Part A: Complete the “three dimensions” in Activity 7.5 based on the sample client case, Mr. ZZZ. Quote the client’s words verbatim at least once. Invent/add details to enrich your presentation. Be as objective as possible, as if you were holding a video camera and microphone. Your reader should be able to “see” or picture the client’s identity OBJECTIVELY from your description. (Remember: client records are legal documents, and may be summoned by a court/judge). Your work should be done in 20 complete sentences or more. Part B: Define the terms in activity 7.1 in your own words (but provide supporting documentation for ideas taken from the readings) in two complete sentences or more for each term. Specifically note the client’s race, gender, ethnicity, religion and language.
Topics: Consultation and supervision
Class Goals: Recognizing professional growth issues
__Read Chapter 8
__Discussion #9: Post to the discussion comments related to Reflection 8.1
__Journal #9: (2 parts) Part A: Complete Activity 8.3 in 10 complete sentences or more. Part B: Read Activity 8.9. Discuss in ten complete sentences or more at least five professional issues you would consider if you were asked to supervise a counselor intern. Discuss in ten complete sentences five professional factors that you would consider regarding choosing a supervisor for yourself if you were a counselor intern.
Topic: Principles of career counseling
Class Goals: Building vocational counseling skills
__Read Chapter 9
__Discussion #10: Post to the discussion your comments related to Activity 9.2
__Journal #10: (2 parts) Part A. Write one client-centered goal related to Mr. ZZZ’s vocational needs. Then write 10 client-centered objectives for this goal in complete sentences. The focus should be strength-based, as well as a reflection of this client’s needs. Write goals and objectives from the point of view of the client’s actions…”The client will…” Part B. Define in at least 2 complete sentences each the meaning of each of the 5 letters in “GLBTQ”.
Topics: Violence prevention and assessing mental status
Class Goals: Completing assessments and designing interventions for suicidal and violent clients
__Read Chapter 11 (The material in Chapter 10 is covered in other courses. Feel free to read it on your own.)
__Discussion #11 Post to the concepts of client and public safety, and a “duty-to-warn” as related to counseling considerations when encountering each of the following situations: (1) a violent, threatening or homicidal client and (2) a suicidal client (3) a client who comes to a counseling session under the obvious influence of drugs or alcohol.
__Journal #11: (2 parts) Part A: Mr. ZZZ tells you that last week he had “a rare, fleeting thought about cutting on myself” when he was alone in the evening, but says he has no thoughts of suicide, no plan, and no intention at the present time…Write a 10 sentence, detailed client-centered “contract for safety” (a plan for action in case of thoughts of serious self-harm) which gives this client specific information/options about suicide prevention. Part B: Complete a 20-sentence description of Mr. ZZZ’s mental status which contains information about each of the items from the list on page 280. Remember that this is a legal document, and to be as factual and as objective as possible. Do not make assumptions or write judgmental statements. You may invent additional information about Mr.ZZZ. Refer to counseling/mental health websites as needed. Pretend you are using a video camera and a microphone. What would an observer see and hear from this client? How would an observer know he has mental/behavioral health problems?
Topic: Client interventions
Class Goals: Creating effective intervention/treatment plans
__Review Chapter 11
__Discussion #12 Post to the discussion about counseling considerations for assessing and helping clients with a COD (co-occurring disorder, aka, “dual diagnosis”). Choose one common mental health condition from the DSM (Diagnostic and Statistical Manual, text, page 287) and describe the signs and symptoms. Include some basic counseling interventions for clients with this issue. Try not to duplicate the content of the posts of other students.
__Journal #12: (2 parts) Part A: Use the “Table 11.3: Client Map” format on page 295 to map Mr. ZZZ’s case in at least 20 complete sentences. Part B Identify one mental health issue for Mr. ZZZ and write it as a goal. Then write three client-centered objectives for Mr. ZZZ’s goal. Finally, describe, in 10 complete sentences or more, your approaches to this client. Some considerations: How would you help this client to problem-solve? How would you help him to improve his self esteem? How would you help him to better cope with his “stress”/PTSD issues?
Topic: Physical disabilities and charting client progress
Class Goals: Identifying levels of care
__Read Chapter 12
__Discussion #13: Post to the discussion about Activity 12.12. Include evidence-based information related to the challenges of working with clients with physical disabilities, injuries and/or chronic pain.
__Journal #13 (2 parts) A. Respond to the questions in Case Study 12.3 in ten complete sentences. B. Write a 20 sentence “progress note” about Mr. ZZZ. Be factual. Quote the client. Write only what you have actually heard the client tell you, and record only what you know to be true and factual in his case. Do not make assumptions. Do not make judgmental remarks. Remember that charting and progress notes are legal documents. Points will be deducted for spelling, writing and usage errors. Label, sign and date your note. (Hint: Many agencies use client notes known as the “SOAP” note format and you can do an internet search to learn about these.) to clearly show which information was gathered directly from the client and which is the counselor’s opinion, impression, or plan.
__Complete your research essay--due at the end of next week
Topic: Referral development and support groups
Class Goals: Identifying support systems on community, state, national and international levels
__Read Chapter 13
__Discussion #14 Post your research paper in the discussion area as a Word document/attachment. Also post only ONE “major” post which contains the location of each level of care in mental health settings in your community/Nevada, based on the list on page 309. Peer response posts are not required this week.
__Journal #14: One of a counselor’s roles is to refer clients to support groups. This is done to help clients find a social network for recovery, in addition to professional counseling. Write a 20 sentence description of a specific support group referral that you might make within your own community for Mr. ZZZ, as a narrative written in the first person (“I”—would be you, the counselor). Explain this referral to your client, Mr. ZZZ. How would you tell him the purpose--and to prepare him--for a new peer support group experience (AA, Al-Anon, RR, CODA, etc.). Locate an actual group in your community; include a local phone number, contact person’s name, location, meeting times, etc.
__Research essay is due by the end of Week 14. Post your research essay as an attachment to the Week 14 discussion so that your classmates can read it. Label your paper as a separate post “Research Essay”. DO NOT email papers to the instructor.
Topic: Discharge planning and continuing care
Class Goals: Preparing a client for discharge
__Discussion #15 Read each of the research essays posted in the Week 14 discussion area. Choose only ONE of your classmate’s papers to write about. Write a discussion in 20 complete sentences or more about the strengths and weaknesses of this intervention. Would you recommend this type of therapy to your clients? Why and why not? How would you respond to a client who wanted to try this form of therapy? (Do not critique your peer’s writing style or APA formatting. Include documentation from the readings to support your opinions.)
__Journal #15: Write in 20 complete sentences, a description of the factors that a counselor should consider when beginning and implementing the discharge planning process for Mr. ZZZ. Note when and how this process should begin. Include an explanation of the purpose for continuing/after care, and identify two specific methods for relapse prevention as related to the case of Mr. ZZZ. Include supporting documentation from the readings.
__Review for final exam
Class Goals: Final exam and course evaluations
__All late work is due prior to submitting the final exam
__Final exam due
__Course evaluations due
Journals: Journal assignments are designed to facilitate your processing of the course content, and for expressing ideas based on both personal/professional opinion and on academic research. They must be typed in 12-point font and contain documentation in the form of page-numbered references from the readings in the textbook within the narrative of your journal work—in addition to personal opinion, reflection or ideas. Other reliable sources may used, but the source of the additional information must be clearly identified within the narrative. “Wikipedia” and other dictionary-type, non-evidence-based references are not acceptable. Use only reliable, evidence-based counseling, psychology, and social services resources and websites. Journal assignments are original, research-based compositions, and college level writing is required in terms of grammar, punctuation, complete sentences, spelling, and documentation. Points will be deducted for writing errors due to the importance of accurate, clear documentation in the counseling profession. Specific due dates for journals are listed in the course announcements.
Research Essay: Ancillary Counseling Method: Choose one “alternative”, “complimentary” or “holistic” therapy or counseling method* by the end of week 4. Your topic must be approved by the instructor. THREE reliable, evidence-based, mental health professionally-related resources must be used and documented by citations and references in your paper. APA style/format is required (including an abstract, introduction, conclusion, cover page, citations, running headers, reference page, etc. Contact the library or the academic success center staff for help if needed. The “OWL at Purdue” website contains examples of APA papers/formatting.) Include a discussion of three reasons why you would. Describe two or more benefits and two or more challenges for clients and counselors when clients decide to use this of this type of service while seeking “traditional” counseling.*Some examples of these methods include: acupuncture, acupressure, art therapy, hypnotherapy, biofeedback, play therapy, pet therapy, equine therapy, faith-based/religious counseling, nonviolent communications (NVC), music therapy, occupational therapy, neuro-linguistic programming, massage, reflexology, “touch-for-health”, reiki, sweat lodges, medicine wheel, chakra/energy balancing, aroma therapy, etc. You may not duplicate another student’s choice, so clear your topic with the instructor before you begin your research. Due date is listed in the course announcements.
HIPAA self study/test: The HIPAA self-study, test instructions, and self-test materials are posted in the assignment section under “HIPAA.” The test must be written in your own words. Complete sentences are required. The due date is listed in the course announcements.
Class Discussions: The discussions are where students can process and integrate course concepts and ideas from the readings with the instructor and with other students. One “major” contribution of at least 10 complete sentences which contains supporting documentation (page numbers and information from the textbook readings) is required for each discussion. Also, two peer responses of at least five complete sentences each which advance the discussion and deepen academic inquiry are required, for a TOTAL OF THREE DISCUSSION POSTS per discussion, unless otherwise specified. Personal problems, disrespectful, judgmental remarks, or complaints about course material and/or assignments are not appropriate for the class discussions. Contact the instructor for assistance with these types of issues. “Major” posts are worth 60% of the participation score, and each “peer post” is worth 20%. Due dates are posted in the course announcements.
Final Examination: Due on Tuesday of final exam week (see course announcement for due date/time). The final examination will be posted in the course announcements by the beginning of finals week. It is a closed-book test, to be completed without assistance or reference material of any kind, and is to be written in your own words. The use of complete sentences and college level writing is required. Due to the importance of documentation by counseling professionals, points will be deducted for writing and spelling errors. The final exam is the last assignment of the course. No coursework will be accepted after the final exam has been submitted. The final exam may be submitted late, but a 10% deduction will be made for exams received after the due date/time. The due date is posted in the course announcements.
Note: There is a risk of losing data if responses are typed in the assignment area. Upload your work after saving it on your computer or jump drive as a Word document or rtf (rich text format) file. You may upload multiple files for one assignment--until you click “submit.” Once you have submitted an assignment, you will no longer be able to add pages or files to that assignment, so do not “submit” your work until you have completely finished uploading documents. Emailed submissions will not be accepted without prior permission from the instructor. Obtain permission from the instructor before emailing any assignment. If the instructor is unable to open a file, then it cannot be graded. Generally, technical problems are not reasons for excusing late work, so allow enough time to complete your work.
Summary of Assignments/Point Values
Assignment Points possible Due Date
Discussion 15 discussions @ 20 points each 300
Journal 15 journals @ 20 points 300
Research Paper: Counseling Method 100
HIPAA Test 100
Final Examination 200
Total points possible 1000
Rubric for Written Assignments and Presentations
Addresses all elements of assignment with high degree of accuracy and clarity
Demonstrates high levels of critical thinking and practical application
Documentation of resource information is complete
Meets most expectations
Addresses most elements of assignment with accuracy and clarity
Applies theoretical material in several areas or in most applications
Supporting documentation is included
Meets some expectations
Demonstrates understanding of material, but with minimal insight
Some required information/elements not addressed/some inaccuracies
Supporting documentation is incomplete or sources are not academically strong
Meets few expectations
Most required information is missing/is inaccurate and/or many concepts unaddressed
Inadequate/incomplete/incorrect documentation of sources/references
Opinions are not documented
Meets very few or no expectations
No supporting documentation where required
Unable to open file, no resubmission
Undocumented use of another's work/violation of academic honesty policy
Assignment submitted after the final examination/final due date
Effort will be made to adhere to these guidelines, but in order to facilitate student learning, the instructor reserves the right to change any part of this syllabus at any time. This syllabus is not a contract.
**Hypothetical Client Case: Mr. ZZZ **
You are working in as a substance abuse counselor intern at an outpatient counseling office in rural Nevada. Mr. ZZZ, an obese 55 year old, self-reported gay man walks into your office. He is wearing worn cowboy boots, wrinkled jeans, and a torn sweat shirt. It is 20 degrees and snowing outside.
He tells you that he moved to Nevada last year from Los Angeles—where his family of origin resides: “My relatives are all drunks—and nuts—just like me!” he laughs. He reports he had a couple of “drinking-buddy friends” in Reno, but knows no one here, as he just arrived just yesterday. He has been living in a half-way house in Reno for two months. Last night he slept in his car at a rest stop on the highway…And all his belongings are in his car.
He reports that he has been abstinent from alcohol for three months since he was discharged from detoxification from alcohol at the Veterans Administration (VA) Hospital in Reno. He is now taking blood pressure medication, which he was given to him by his VA doctor at the Reno VA clinic. He says, “I feel great. Nothing is wrong with me except my drinking gets out of control…and they say I have this stress problem…” He admits he has difficulty sleeping at night, and has vivid dreams of combat when he was in View Nam.
He states he is unemployed, and he receives a “couple hundred dollars a month” from VA disability benefits. He says, “I used to work as a car salesman—but I can sell anything,” and he says wants look for work here because “I’ve always wanted to live in the real west. I liked to read stories about horses and cowboys when I was a kid.”
He reaches for a cigarette in his pocket, but stops himself. “Oh, yeah, and I want to quit smoking…” tapping his foot nervously, “Can you help me with that, too?”
He denies depression or suicidal ideation, but he tells you that he doesn’t want to discuss his years in the military, or to talk about any childhood problems. He says he has a history of getting into fights while drinking, and that this caused him problems during his Army days.
He tells you he has gone to a few AA meetings in Reno, but has never had a sponsor in AA. He states that he does like AA meetings “OK”, but he shrugs and confides to you that AA members in Reno can be “real mean” to gay people.
He adds that he is Jewish, and he says he misses attending religious services. He asks you, “Where is the nearest synagogue?” Then he adds quietly, “You know, I really want to stay off the booze and stop smoking. Will you be my counselor?”60>