- Maintaining mental health of crew
- Command Staff support
Categories of Mental Disorders
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
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
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.
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
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.
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
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.
3.1 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
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.
4.1 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
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
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
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
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.
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
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.
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
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
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.
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
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
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
Somatic anxiety symptoms include:
Palpitations, pounding heart or
accelerated heart rate
Trembling or shaking
Sensations of shortness of breath
Feeling of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady,
lightheaded or faint.
Paresthesias (numbness or
Chills or hot flushes
Cognitive anxiety symptoms
Fear of losing control or going
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
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
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
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.
Disorder is a pattern of distrust and suspiciousness
such that others’ motives are interpreted as
Disorder is a pattern of detachment from social
relationships and a restricted range of emotional
Disorder is a pattern of acute discomfort in close
relationships, cognitive or perceptual distortions,
and eccentricities of behaviour.
disorder is a pattern of disregard for, and violation
of, the rights of others.
Disorder is a pattern of instability in interpersonal
relationships, self-image and affects, and marked
Disorder is a pattern of excessive emotionality and
Disorder is a pattern of grandiosity, need for
admiration and lack of empathy.
disorder is a pattern of social inhibition, feelings
of inadequacy, and hypersensitivity to negative
Disorder is a pattern of submissive and clinging
behaviour related to an excessive need to be taken
Personality Disorder is a pattern of preoccupation
with orderliness, perfectionism, and control.
Federation Diagnostic and Statistical Manual (FDSM)
Basic diplomacy skills and principles:
Relevant Starfleet policies and procedures:
Species database: (Cultural customs and norms of known