This article outlines research on a previous unstudied form of suffering specific to the Portugese immigrant community: problemas de nervos. Thirty-two Portuguese immigrant women (in Waterloo, ON and Boston, MA) were interviewed and each completed a questionnaire. Cluster analysis demonstrated that problemas de nervos has many meanings. The study profiled symptoms, causes and therapies associated with four variations of this culture-specific form of distress: "mal da cabeca" meaning problems with/in the head (e.g., lack of control, visions); " aflição" meaning affliction (e.g., nervous attacks, heart problems); immigration stress (causing sleep disturbances); and, conflicts with others (resulting in pressure within the body). None of the symptom clusters reported matched criteria for a DSM-IV-TR diagnosis, suggesting that problemas de nervos represents an idiomatic rather than universal expression of distress.

The authors offer an integral approach to counseling ethics using K. Wilber's (2000aWilber's ( , 2000b integral metatheory. The article examines traditional counseling ethics through the lens of K. Wilber's (2000aWilber's ( , 2000b) "all-quadrants, all-levels" model, consisting of quadrants, levels, lines, states, and types. The authors begin with the 4 quadrants and how they can inform understanding of traditional counseling ethics. Vertical development in relation to counseling ethics is addressed, followed by a case study of an ethical dilemma in counseling. The authors offer an integrally informed process of ethical decision making that can be seen to complement less comprehensive ethical decision-making models.T here are few areas in the practice of counseling that require more tolerance for ambiguity than ethical practice and decision making. Corey, Corey, and Callanan (2003) stated that, when it comes to ethics, one must avoid the trap of dispensing simple prescriptions for complex problems. Integral theory is an excellent map that can be applied to ethical practice in counseling to help counselors honor the complexity of ethical decisions and avoid oversimplification of complex issues. Integral theory helps counselors approach a more complete understanding of ethics by viewing multiple "truths" or perspectives as complementary. This in turn increases counselors' ability to make informed ethical decisions. The study and practice of ethical counseling contains a dichotomy in that clearly articulated ethical principles and codes of conduct exist alongside a marked lack of guidance on how to apply the principles and codes in many real-life counseling situations. In this article, we outline what the four quadrants or perspectives of integral theory imply for counselor ethics, we discuss the role of development and supervision, and we offer a brief case example.In some ways, the idea of integral ethics is somewhat of an oxymoron. Wilber (1998) has discussed ethics and morals in the context of the lower left (LL) quadrant or the "We" space of cultural understanding and intersubjectivity. However, in order for ethics to be more integral in nature, we must expand our conceptualization of ethical practice in counseling and attend to the remaining three quadrants of "I," "It," and "Its." We would like to suggest that, on the whole, current counseling ethics is less than integral and that an integral approach to counseling ethics must expand its scope of practice to include and incorporate the four quadrants in Wilber's (2000aWilber's ( , 2000b model.

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