Counselor

This article is considered a canon article for Star Trek: Equilism.

Duties and Responsibilities

Providing mental health services to the crew

The counselor's primary responsibility is to maintain the mental health of the ship/station’s crew. This includes, but is not limited to: clinical assessment, psychological testing, crisis intervention, individual psychotherapy, group therapy, family therapy, marital/couples therapy, personal counseling, career counseling and preventative services such as education and screening. The counselor ensures that all crew are capable of performing their duties unhindered by psychological conflict or mental illness, and performs regular crew psychological fitness evaluations to this end.

In the performance of his/her duties, the counselor at all times remains sensitive to the normal emotional processes of the species and individual he/she is dealing with, and works to facilitate the individuals' natural healing processes.

Command Staff support

The Counselor supports and advises the command crew about issues that involve the mental health of the crew and Federation diplomacy.

Examples of this may include: assessment of a crisis situation and how it might impact the crew; theories and suggestions about how to approach a new species; measurement of potential dangers in a given situation; assessment of cultural contamination in cases where the Prime Directive might have been compromised; long-term effects of certain types of missions on crew members, including senior staff.

Diplomacy

As the Counselor has significant expertise in communications skills, they are often called upon to provide advice in diplomatic situations and/or to directly conduct diplomatic functions. It is the responsibility of the counselor to educate him or herself about the cultures with which the crew has interaction

Department Staffing

The Counseling department’s staffing level is at the discretion of the chief Counselor in consultation with command staff and at a level consistent with the needs of the ship/station. One counselor per 400 assigned crew is recommended, although this ratio can vary widely depending on the circumstances.

Qualifications

The qualifications for the counselor position require an advanced degree that specializes in both assessment and therapy. This includes, but is not limited to: Psychology Doctorate, Doctorate of Philosophy in Psychology or a similar mental health field, Medical Doctorate with additional training in Psychiatry, or a Masters in Psychology or an allied field.

Coursework in training must include basic abnormal psychology, social psychology, forensic psychology, psychopharmacology, principles of therapy, intellectual and personality assessment, and xenopsychology.

In addition to coursework, experience in counseling either as a counseling intern or as a psychiatric resident is required.

Ethical Principals

1. Confidentiality

1.1 Counselors will endeavor to protect the confidentiality of patients under their care and will share confidential information with others only with the informed consent of those involved, except as required by law, Starfleet policies, or in event of possible serious harm or death.

1.2 Counselors will inform patients of the limits of confidentiality prior to providing services.

1.3 The Counselor will collect, store, handle and transfer all private information in a way that attends to the needs for privacy and security. They will record only that private information necessary for the provision of continuous and coordinated service. Counselor’s offices will be kept free of recording technology (i.e.: internal sensors) except in exceptional circumstances. If recording equipment is in place, patients will be fully informed of the fact and the justification for it.

1.4 Patient confidentiality can and will be broken in cases where the patient presents a clear danger to themselves and/or others. In these cases, the counselor will disclose only that information relevant to the perceived risk and only to those in a position of needing to know.

2. Informed consent

2.1.1 Prior to providing services, the counselor will fully disclose the following: the purpose and nature of the proposed therapeutic activity; mutual responsibilities; confidentiality protections and limitations; likely benefits and risks; alternatives; the likely consequences of non-action, the option to refuse or withdraw at any time without prejudice, over what period of time the consent applies; and how to rescind consent if desired.

2.2 The counselor will ensure that the patient fully understands and that consent is not given under conditions of coercion, undue pressure or undue reward.

3. Respect

3.1 Counselors accept as fundamental the principle of respect for the dignity of sentient lifeforms; that is, the belief that each being should be treated primarily as a being in their own right, not as an object or means to an end. In so doing, Counselors acknowledge that all beings have a right to have their innate worth acknowledged.

3.2 Counselors will not engage publicly in degrading comments about others, including demeaning jokes based on such characteristics as culture, species, physical appearance, religion gender or sexual orientation. Counselors will refuse to participate in practices disrespectful of the legal, civil, or moral rights of others and will not practice, condone, facilitate, or collaborate with any form of unjust discrimination.

3.3 Counselors will not contribute to nor engage in research or any other activity that contravenes intergalactic “humanitarian” law, such as the development of methods intended for use in the torture of sentient beings, the development of prohibited weapons, or destruction of environments.

3.4 If structures or policies seriously ignore or oppose the principles of respect for sentient life forms, Counselors involved have a responsibility to speak out in a manner consistent with the principles of this code and advocate for appropriate change to occur as quickly as possible.

4. Competence

4.1 Counselors will offer or carry out only those activities for which they have established their competence, and keep themselves up to date with a broad range of relevant knowledge, methods and techniques.

4.2 Counselors will evaluate how their own experiences, attitudes, culture, beliefs, values, social context, individual differences, specific training and stresses influence their interrelations with others, and integrate this awareness into all efforts to benefit and not harm others.

4.3 Counselors will engage in self-care activities that help to avoid conditions that could result in impaired judgment and interfere with their ability to benefit and not harm others.

4.4 Counselors shall not undertake or continue a professional relationship with a patient when they know or should know that their judgment is impaired due to mental, emotional or physiological conditions.

4.5 Counselors shall not undertake or continue a professional relationship when they are aware or should be aware that they face a potentially harmful conflict of interest as a result of a current or previous psychological, familial, social, sexual, emotional, economic, supervisory, political, administrative or legal relationship with the patient or a being associated with or related to the patient.

4.6 Counselors may continue a professional relationship, although a potentially harmful conflict of interest may exist, in exceptional circumstances such as emergencies where no other service provider is available providing that the patient is informed of the nature of the conflicting relationship, and consultation with other counselors is obtained as soon as is possible.

4.7 When interacting with a sentient being to whom the counselor has at any time within the previous 24 months rendered counseling services, the counselor shall not: engage in any behavior toward the person that is sexually seductive, engage in sexual intercourse or other sexual behavior with the person, or enter into any other relationship with the person that is potentially exploitive.

5. Use of Telepathy

5.1 The use of telepathy in assessment or treatment of any sentient being is prohibited without informed consent, except when imminent danger of harm exists. Telepathic probing is considered an extremely invasive act and a violation of section 3.1 of this code.

5.2 Conversely, empathic impressions are considered a normal method of gathering data in the formulation of hypotheses, similar to impressions gathered through other senses such as sight and hearing. All therapeutic hypotheses are considered as such until accepted or rejected by the patient.

The preceding principles are intended to guide the Starfleet Counselor in the provision of ethical and just services. Counselors are expected to uphold these principles to the best of their ability or risk disbarment from their profession.

In rare instances where Starfleet principles are at odds with the counselor’s ethical principles, the counselor is to weigh the risk of harm in all possible courses of action and decide based on their own conscience. Should a command officer directly order a counselor to engage in a course of action contravening these ethical principles, fail to provide justification for the order, and the officer otherwise seems of sound mind, the counselor should note their objections and the ethical principle they are based upon, and again use their conscience in deciding whether to comply. In such a situation a counselor is unlikely to face disciplinary action by their professional body.

General Categories of Mental Disorders

Cognitive Disorders Disturbances in cognition (thought or mental processes). Etiology (cause) is either a medical condition or a substance.

Delirium – characterized by a disturbance of consciousness and a change in cognition that develops over a short period of time. The disturbance in consciousness is manifested by a reduced clarity of awareness of the environment. The ability to focus, sustain or shift attention is impaired, and the individual is easily distracted by irrelevant stimuli.

Dementia – characterized by multiple cognitive deficits that include impairment in memory. Individuals become impaired in their ability to learn new material, or they forget previously learned material. They may lose valuables, forget tasks mid way through performing them, or become lost. In addition to serious deficits in memory, the following may also be present:

Aphasia – deterioration of language functioning. Examples: difficulty producing the names of familiar individuals and objects, vague or empty speech, muteness, echolalia (echoing what is heard) or palilalia (repeating sounds or words over and over).

Apraxia – impaired ability to execute motor activities despite intact motor abilities, sensory function, and comprehension of the required tasked. May contribute to deficits in cooking, dressing, etc.

Agnosia – failure to recognize or identify objects despite intact sensory function. Example: Unable to recognize common objects despite good visual acuity. In severe cases, the individual may be unable to recognize family members or their own reflection in the mirror.

Amnesia – characterized by memory impairment in the absence of other significant accompanying cognitive impairments. Individuals with an amnestic disorder are impaired in their ability to learn new information or are unable to recall previously learned information or past events. Course of the illness is quite variable, depending on the primary pathological process causing the amnestic disorders. Traumatic brain injury, stroke or other cerebrovascular events or specific types of neurotoxic exposure may lead to an acute onset. Other conditions such as prolonged substance abuse, chronic neurotoxic exposure or sustained nutritional deficiency may lead to an insidious onset.

Substance Related Disorders – includes disorders related to the taking of a drug of abuse, to the side effects of a medication, and to toxin exposure.

Substance Use Disorders –

Substance Dependence: a cluster of cognitive, behavioural and physiological symptoms indicating that the individual continues use of a substance despite significant substance-related problems. There is a patter of repeated self-administration that can result in:

Tolerance – the need for greatly increased amounts of the substance to achieve intoxication (0r the desired effect) or a markedly diminished effect with continued use of the same amount of the substance.

Withdrawal – a maladaptive behaviour change, with physiological and cognitive concomitants, that occurs when blood or tissue concentrations of a substance decline in an individual who had maintained prolonged heavy use of the substance. After developing unpleasant withdrawal symptoms, the person is likely to take the substance to relieve or to avoid those symptoms.

Compulsive drug taking behaviour – The individual may take the substance in large amounts or over a longer period than was originally intended. The individual may express a persistent desire to cut down or regulate substance use. Often there have been many unsuccessful efforts to decrease or discontinue use. The individual may spend a great deal of time obtaining the substance, using the substance or recovering from its effects.

Substance Abuse: A maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances. There may be repeated failure to fulfill major role obligations, repeated use in situations in which it is physically hazardous, multiple legal problems, and recurrent social and interpersonal problems.

Substance Induced Disorders –

Substance Intoxication: the development of a reversible substance-specific syndrome due to the recent ingestion of (or exposure to) a substance. The clinically significant maladaptive behavioural or psychological changes associated with intoxication (i.e.: belligerence, mood lability, cognitive impairment, impaired judgment, impaired social or occupational functioning) are due to the direct physiological effects of the substance on the central nervous system and develop during or shortly after use of the substance.

Substance Withdrawal: the development of a substance-specific maladaptive behavioural change, with physiological and cognitive concomitants, that is due to the cessation of, or reduction in, heavy and prolonged substance use. The syndrome causes clinically significant distress or impairment. The signs and symptoms of withdrawal vary according to the substance used, with most symptoms being the opposite of those observed in intoxication with the same substance.

Psychotic Disorders: Delusions, hallucinations, disorganized speech or disorganized or catatonic behaviour.

Delusions – erroneous beliefs that usually involve a misinterpretation of perceptions or experiences. Their content may include a variety of themes:

Persecutory: the person believes he or she is being tormented, followed, tricked, spied on, or ridiculed.

Referential: the person believes that certain gestures, comments, passages from books, newspapers, song lyrics, or other environmental cues are specifically directed at him or her

Somatic: The person believes he or she is suffering from a serious illness, is disfigured, or smells badly, despite evidence to the contrary.

Religious: The person believes he or she has a special relationship with or is a deity.

Grandiose: The person believes he or she is omnipotent or possesses extraordinary worth, power or knowledge.

Hallucinations – may occur in any sensory modality (i.e.: auditory, visual, olfactory, gustatory, and tactile), but auditory hallucinations are by far the most common and are typically experienced as voices distinct from the person’s own thoughts.

Disorganized Speech – may slip off the track from one topic to another; answers to questions may be o9bliquely related or completely unrelated, or speech may be so severely disorganized that it is nearly incomprehensible and resembles aphasia in its linguistic disorganization

Disorganized behaviour – may manifest itself in a variety of ways, ranging from childlike silliness to unpredictable agitation. Problems may be noted in any form of goal-directed behaviour, leading to difficulties in performing activities of daily living such as preparing a meal or maintaining hygiene. The person may appear markedly disheveled, may dress in an unusual manner, or may display clearly inappropriate sexual behaviour.

Catatonic motor behaviours – include a marked decrease in reactivity to the environment, sometimes reaching an extreme degree of complete unawareness, maintaining a rigid posture and resisting efforts to be moved, active resistance to instructions or attempts to be moved, the assumption of inappropriate or bizarre postures, or purposeless and unstimulated excessive motor activity.

Mood Disorders – disorders that have a disturbance in mood as the predominant feature.

Depressed mood – Depressed, sad, hopeless, discouraged mood or the loss of interest or pleasure in nearly all activities. In some species the mood may be irritable rather than said. Related symptoms may include reduced appetite, sleep disturbance, agitation, decreased energy, tiredness and fatigue, a sense of worthlessness or guilt, impaired ability to think, concentrate or make decisions, thoughts of death, suicidal ideation or suicide attempts. It must cause distress or interfere in social, occupational, or other important areas of functioning.

Manic Episode – a distinct period during which there is an abnormally and persistently elevated, expansive, or irritable mood. Often includes inflated self-esteem or grandiosity, decreased need for sleep, pressure of speech, flight of ideas, distractibility, increased involvement in goal directed activities or psychomotor agitation, and excessive involvement in pleasurable activities with a high potential for painful consequences. The disturbance must be severe to caused impairment in social or occupation functioning.

Mixed Episode – alternating moods accompanied by symptoms of mania and depression.

Anxiety Disorders – Disorders where the primary symptoms are of anxiety, either somatic or cognitive. Anxiety may be triggered by specific situations or things (phobias), or it may occur with no obvious precipitating factor.

Somatic anxiety symptoms include:

Palpitations, pounding heart or accelerated heart rate

Sweating

Trembling or shaking

Sensations of shortness of breath of smothering

Feeling of choking

Chest pain or discomfort

Nausea or abdominal distress

Feeling dizzy, unsteady, lightheaded or faint.

Paresthesias (numbness or tingling sensations)

Chills or hot flushes

Cognitive anxiety symptoms include:

Fear of losing control or going crazy

Fear of dying

Obsessions: persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress. The most common are repeated thoughts about contamination, repeated doubts, a need to have things in a particular order, aggressive or horrific impulses and sexual imagery.

Compulsions: repetitive behaviours or mental acts the goal of which is to prevent or reduce anxiety or distress, not to provide pleasure of gratification. In most cases, the individual feels driven to perform the compulsion to reduce the distress that accompanies an obsession or to prevent some dreaded event of situation.

Post Traumatic Stress Disorder :the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death of serious injury, or other threat to one’s physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate.

The individual’s response to the event involves intense fear, helplessness, or horror. The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event, persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness, and persistent symptoms of increased arousal.

Adjustment Disorders – a psychological response to an identifiable stressor or stressors that results in the development of clinically significant emotional or behavioural symptoms. The clinical significance of the reaction is indicated either by marked distress that is in excess of what would be expected given the nature of the stressor or by significant impairment in social or occupational functioning. Does not apply when the symptoms represent bereavement. The stressor may be a single event or there may be multiple stressors.

Personality Disorders - an enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.

Paranoid Personality Disorder is a pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent

Schizoid personality Disorder is a pattern of detachment from social relationships and a restricted range of emotional expression.

Schizotypal Personality Disorder is a pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behaviour.

Antisocial Personality disorder is a pattern of disregard for, and violation of, the rights of others.

Borderline Personality Disorder is a pattern of instability in interpersonal relationships, self-image and affects, and marked impulsivity.

Histrionic Personality Disorder is a pattern of excessive emotionality and attention seeking.

Narcissistic Personality Disorder is a pattern of grandiosity, need for admiration and lack of empathy.

Avoidant personality disorder is a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.

Dependent Personality Disorder is a pattern of submissive and clinging behaviour related to an excessive need to be taken care of.

Obsessive-Compulsive Personality Disorder is a pattern of preoccupation with orderliness, perfectionism, and control.

Tools

• Federation Diagnostic and Statistical Manual (FDSM)
• Counseling practices
• Basic diplomacy skills and principles
• Relevant Starfleet policies and procedures
• Species Database (Cultural customs and norms of known species)