Monthly Archives: June 2007

Moving to the next level

Brian S. Canfield June 18, 2007

Counseling is a unique field and, by any objective standard, an established profession. We have a widely disseminated and growing body of scholarly knowledge as evidenced by high-quality journals and publications, professional conferences specific to the counseling field, our own national accrediting body and hundreds of accredited graduate training programs. The American Counseling Association plays a central and unique role in the vitality of the counseling profession by serving as the unifying organization for 38 active state branches and 19 national divisions representing various counseling specializations and areas of professional interest. 

Counseling has always been a diverse field. In 1952, four professional organizations banded together to form what is now ACA. From its inception, ACA has been a “partnership of associations,” created to provide a “common voice” for specialized groups of counseling professionals.

Rather than evolving into a homogeneous profession, clearly the trend over the past 50 years has been toward increased specialization. This notion of diverse groups united under a common “counselor” identity is a potential strength of our profession. It is also problematic and presents challenges with regard to counselor identity and the future of the counseling profession.

With the establishment of counseling licensure in 49 states, the question of who is a counselor has largely been decided. At present, there are approximately 100,000 licensed counselors throughout the United States, and these LPCs constitute the core of the counseling profession. However, the LPC license is not yet universal, nor is it an exclusive determinate of counselor identity. Notable exceptions to the “LPC standard” are counselors certified as “school counselors” and the thousands of qualified counselors who work in the state of California without access to licensure. 

Critical to the future of the counseling profession are appropriate accreditation and training standards. Both the Council for Accreditation of Counseling and Related Educational Programs and the National Board for Certified Counselors were founded as ACA initiatives. Although both organizations have evolved into independent and autonomous bodies, they continue to maintain a collaborative relationship with ACA. 

As we continue to grow and mature, our professional diversity and the question of counselor identity present challenges, as well as opportunities, for the future of our profession. Fortunately, we have some very bright people in a variety of ACA organizations and allied groups addressing this issue. To assist in this effort, I will emphasize six presidential goals and initiatives this year:

  • Affirm the ethos that holds membership in ACA, its branches and divisions as a professional responsibility of all counselors.
  • Formalize a structure within ACA that increases opportunities for involvement of all graduate student members in order to mentor and mainstream students into the counseling profession.
  • Affirm and, as appropriate, redefine the relationships between ACA, its divisions, branches and affiliate partners (e.g., NBCC, CACREP and the American Association of State Counseling Boards). Many of the previous relationship structures are no longer valid. We need to take a hard and honest look at the realities, particularly with regard to the American School Counselor Association and the American Mental Health Counselors Association, and redefine and improve these relationships.
  • Work to establish more collaborative and productive partnerships with other professional groups and associations, both domestically and internationally (e.g., the American Psychological Association, the American Association for Marriage and Family Therapy, the National Association of Social Workers, the British Association for Counselling and Psychotherapy, etc.).
  • Increase opportunities for member participation in the governance and leadership activities of ACA by ensuring equal opportunities for all ACA members. We are an association that has always taken the lead in advocating for equality and respect for human dignity. It is time we model true equality by rejecting paternalistic and discriminatory policies that have no place in our association. 
  • Embark upon the development of a formal “strategic plan” for ACA. We do not have a current strategic plan to guide us. Development of a strategic plan will allow us to be more proactive, rather than reactive, to the needs and challenges of the association. As president, I will call upon the Strategic Planning Committee to begin work on a comprehensive strategic planning process for our association.

If they are to be successful, these goals and initiatives must be a collective effort. To this end, I’m looking forward to working with both the continuing and new members of the ACA Governing Council and the leaders of ACA divisions and branches to address these important issues. I encourage you to become actively involved in this process by sharing your thoughts and ideas with your Governing Council representatives and the leaders of the branches and divisions with which you are affiliated.

Managed care companies now requesting to be considered by ACA

Robert J. Walsh and Norman C. Dasenbrook

It wasn’t very long ago that counselors were not considered eligible for any insurance or managed care reimbursements. The hard work by the American Counseling Association and state counseling organizations has changed that. Now managed care companies are coming to ACA and asking that its members consider becoming providers on their panels.

ACA Professional Projects Coordinator Martha McIntosh recently received the following inquiry:

“My name is Rachel Milazzo, and I am in charge of new provider relations at American Behavioral. We are a Managed Care and EAP company with nearly 1,000,000 covered lives. After reading an article in April’s edition (of Counseling Today), I am interested in the process of positioning my company or my contact information on the list of Provider Relations Contacts for the top 55 Managed Care companies.

Here is a little background about us.

  1. We currently manage Mental Health, Substance Abuse and EAP benefits for more than 800,000 members and are growing rapidly.
  2. Payment for Master’s-level therapists in both EAP and MH is $60/hour. That also holds true for the EAP program. Doctorate-level fees obviously depend on licensure.
  3. Our Website address is www.americanbehavioral.com. My personal e-mail is rmilazzo@americanbehavioral.com, which is a surefire way to get the information needed and ask questions.
  4. Our phone number is 1.800.925.5327 or 1.800.677.4544.

We are an international company and have just celebrated our 11th anniversary here in Birmingham, AL. We have URAC accreditation on top of the privilege to serve BCBS and their federal members as well as VIVA healthcare. I think that I mentioned we are having a credentialing meeting tomorrow, so I will get back with you if (there are) any extra questions about this new relationship.”

After ACA responded to the request, the following e-mail was received:

“I’m glad to hear that you have the information that you need to put us on your website. Our Board of Directors (was) very pleased and honored that the American Counseling Association took such a prompt interest in helping us. We are also in the process of linking your website to ours.”

ACA also received the following message from ACI:

“ACI (Employee Assistance Program) is open to new counseling providers. To inquire about being paneled, contact them at:

ACI, A Specialty Benefits Corporation
5414 Oberlin Dr. Suite 240
San Diego, CA 92121
P: (800) 932-0034
F: (858) 452-7819
www.acieap.com

A comprehensive list of 57 managed care and insurance companies that accept counselors can be reviewed and downloaded from a member’s-only section of the ACA website at http://www.counseling.org/Counselors/TP/PrivatePracticePointersMembers/CT2.aspx.

Q: I want to start a “limited” private counseling practice. Initially, I plan to only accept self-pay, fee-for-service clients. I may venture into insurance and managed care later as my practice grows, but not to start. Do I need a tax ID number (EIN) and an NPI number?

A: To begin your fee-for-service practice, you are not required to have either a tax ID or National Provider Identifier (NPI) number. But we highly recommend that you have both.

In lieu of a tax ID number, counselors in private practice can use their Social Security number to report annual profit or loss for tax purposes. For income of more than $600 in a tax year from a single payer (consulting, contract, fee for a speech, etc.), a 1099 miscellaneous income form is sent to the counselor and the IRS to report the income. This form will have to include your Social Security number.

Moreover, a client may want to deduct medical expenses and will need your Social Security number to do so. Now your Social Security number is being seen by your clients. For this reason, we think it is much better to use a tax ID number.

By having an NPI number, your clients can submit your charges to their insurance or medical flexible spending accounts themselves. This would add value to your fee-for-service practice. 

We will be presenting our workshop, “Starting, Maintaining and Expanding a Successful Private Practice,” on Sept. 21 in Charlotte, N.C., and on Sept. 22 in Durham. The North Carolina Counseling Association is sponsoring the workshop. For more information, contact NCCA by calling 888.308.NCCA (6222) or e-mailing www.nccounseling.org. Hope to see you there!

Robert J. Walsh and Norman C. Dasenbrook are coauthors of The Complete Guide to Private Practice for Licensed Mental Health Professionals (www.counseling-privatepractice.com). ACA members can e-mail their questions to walshgasp@aol.com and access a series of “Private Practice Pointers” on the ACA website at www.counseling.org.

Letters to the editor: ct@counseling.org

Trauma and the soul wound: A multicultural-social justice perspective

Judy Daniels and Michael D’Andrea

Compared to traditional Western views about counseling, the multicultural-social justice movement promotes very different ways of thinking about mental health, psychological development and the important roles counselors can play in fostering these concepts. The issue of trauma is an excellent example. Significant differences exist in the way many traditionally trained counselors think about trauma and the manner in which culturally competent counselors conceptualize the meaning of this term and the roles they can play in addressing the needs of traumatized clients.

One of the most respected multicultural experts in the mental health professions today is Eduardo Duran, and he presents a very different view of trauma. He describes trauma from an American Indian viewpoint in his book Healing the Soul Wound: Counseling With American Indians and Other Native Peoples (Teachers College Press, 2006). 

Some counselors are likely to dismiss the manner in which Duran describes trauma and the approaches that can be used to effectively deal with this experience. Nevertheless, we have written this month’s column to help expand the thinking of counselors who remain open to new ways of thinking about trauma and different approaches to addressing this experience from a multicultural-social justice perspective. 

Culturally different approaches

In discussing issues related to mental health in general and trauma in particular, Duran emphasizes the American Indian belief in holism. This perspective includes directing particular attention to the important interconnections that are thought to exist between a person’s mind, body and spirit, as well as one’s connections with the larger cultural community and environment to which she/he is a part. Although space restrictions limit our ability to address these issues in much detail, we want to illuminate several central points about the American Indian perspective of holistic interconnectedness and harmony as they relate to the problem of trauma.

As Duran points out, healthy human development is intimately linked to the holistic and harmonious mind-body-spirit connections that individuals can realize in their lives. Thus, unlike traditional Western counseling theories that focus on the manner in which traumatic events adversely impact a client’s mental and physical state of being, this American Indian perspective emphasizes the need to attend to the ways that traumatic events disrupt a person’s mental, physical and spiritual life forces. This perspective further suggests that traumatized clients commonly exhibit problems in their lives because some recent or historic event has fractured the harmonious interconnections believed to naturally exist between their mind, body and spirit. 

The emphasis placed on ensuring that individuals’ spiritual energy is in harmony with their mental and physical life forces is an important consideration that distinguishes American Indian psychology from most traditional Western counseling theories. Duran’s writing directs particular attention to the ways in which traumatic events inflict “a wounding on the soul.” This phenomenon is referred to as the “soul wound.”

A second important concept asserted in the theory of the soul wound relates to what Duran calls “historical and intergenerational trauma.” This trauma involves the recognition that horrifically violent experiences inflicted on individuals in the past result in unhealthy outcomes that are passed on to one’s offspring and manifested in future generations.

Duran notes that the past genocide of American Indians represents the sort of historical violence that results in intergenerational trauma. Briefly stated, this means that the horrific physical suffering, death, psychological harm and soul wounding that occurred during the genocide continues to be experienced today by many persons of American Indian descent. Multicultural-social justice counseling theorists and researchers suggest that the disproportionately high levels of substance abuse, domestic violence and suicide among American Indians today is partially due to a failure to heal the soul wound that was transmitted intergenerationally as a result of the historic trauma that their ancestors experienced.      

Duran encourages mental health practitioners to address three levels of interventions when working with people who are suffering from trauma:

  • Working with individual clients who are experiencing problems due to trauma
  • Providing outreach, advocacy and healing services to the larger community of which the client is a part
  • Engaging in efforts that are aimed at what he calls “healing the land”

New professional roles and services

Unlike traditionally trained counselors, who are encouraged primarily to address the psychological and physical manifestations of trauma, culturally competent counselors are sensitive to the importance of addressing traumatized clients’ spiritual needs as well. The concept of the soul wound and the helping strategies that Duran outlines provide counselors with a broad range of practical interventions that can be used to promote more harmonious mind-body-spirit connections with traumatized clients in individual counseling settings.

Duran also describes working with the broader cultural community as a vital component of trauma counseling. This requires counselors to be willing to implement advocacy, consultation and social change services aimed at fostering a greater level of justice among those individuals who continue to be subjected to the sort of historic trauma that American Indians have experienced in this country.

Finally, Duran discusses the importance of counselors working to “heal the land.” He emphasizes the American Indian belief in the vital interconnections that exist among all animate beings and inanimate entities, as well as the spiritual energetic connections that exist between all people and Mother Earth. He further notes that the current trauma being inflicted on the Earth by our collective polluting and poisoning of the global environment has a significantly negative and traumatizing impact on our own mental health and sense of psychological well-being. From this perspective, counselors are encouraged to consider how the role of environmental activist is linked to the work that counselors can do to address the various forms of trauma experienced by millions of people in contemporary society.

Clearly, the ideas presented in this cultural perspective of trauma counseling are very different from those used in many counselor education training programs and professional development workshops. Space limitations restrict the presentation of these concepts to a very rudimentary discussion. For this reason, we encourage readers interested in obtaining more detailed information about an American Indian view of trauma and the types of culturally sensitive counseling strategies being used to address this problem to check out Duran’s book, Healing the Soul Wound: Counseling With American Indians and Other Native Peoples.

Trauma along the Thai border

Angela Kennedy

On the basis of their presentations at the Asia-Pacific Childhoods Conference in Singapore last year, Fred Bemak and Rita Chi-Ying Chung, both counselor educators at George Mason University in Virginia, were invited to take part in a mental health exploratory mission to Myanmar recently.

The United Kingdom division of Save the Children (www.savethechildren.org), a child-focused international nongovernmental organization, has established programs to work in the communities of Myanmar to improve the quality of life among the nation’s children and families. The organization’s programs address child protection, economic opportunities, education, nutrition, HIV/AIDS and health.

In Myanmar, it has become relatively common practice for young Burmese women and girls to be lured to Thailand with promises of employment as waitresses, factory workers or domestic servants, Bemak says. Because of extreme poverty, many families in Myanmar encourage their children to accept the jobs so they can send money back home. Children as young as 8 leave their families and villages, sometimes all alone, to make the illegal journey across the border into Thailand.

Once there, the girls are often forced into prostitution or held captive, working and living in the squalor of sweatshops. Their “employers” use threats, abuse, debt and bondage to control the children and force them to work in deplorable conditions. Many times factory owners push children to work 12 to 16 hours a day. In some circumstances, the children are drugged with amphetamines and forced to work even longer hours without sleep.

Officials with Save the Children asked Bemak and Chung to go to Myanmar and interview village elders, families and children in hopes of determining answers to the following questions.

  • Why are so many Burmese children leaving home and migrating across the border into Thailand?
  • What are the issues within the families prior to migration?
  • What does the migration process entail and what challenges do these children face en route?
  • What measures can be taken to ensure the safety of the children after they are in Thailand?
  • How can those who return to Myanmar be helped to integrate back into their communities in a healthier way?

The couple, both members of the American Counseling Association, agreed to take a three-week expedition to Myanmar and report back with their findings, including suggestions and recommendations pertaining to the mental health and well-being of the migrating children. What the counselors found was a society where many young women have been traumatized.

Driven by family loyalty

“We were sent to help (Save the Children) understand the issues around this migration and what is going on psychologically and sociologically with the families, communities and the children themselves,” says Bemak, noting that they also met with state health officials. Save the Children staff led Bemak and Chung, along with translators and a government monitor, through the Mon and Kayin states of Myanmar. Several of the villagers had never previously seen a foreigner.

“Most of the children didn’t have any education, they weren’t in school and many had been working from the age of 3,” Bemak says. “For example, they would help building roads. The children would carry rocks down from the mountains. The whole family would be involved in this and earn a few cents every day, but that money was critical for the family to eat. The 20 cents the 3-year-old earned contributed greatly to the family having enough rice to maintain and survive.” The poverty level and need is so profound in Myanmar, he says, that communities have romanticized the idea of migration.

“There is tremendous loyalty to the family,” he continues. “Children say, ‘My family is hungry, and I can go (work in Thailand) and help feed them.’ So they migrate and tolerate some of the abuse and some of the exploitation to help their family.”

No accurate statistics are available on how many Burmese children have left for Thailand, but Chung and Bemak learned informally through their meetings that roughly one child out of every two will migrate for work. Because the migration is so widespread, the United Nations, Save the Children and other child advocacy agencies have determined that it cannot be effectively stopped. The allure of earning up to 10 times the typical Burmese salary is too great. The villagers believe (and in some cases it’s true) that their children will be able to support the entire family with the money they earn in Thailand. In turn, the families become dependent on the child and actually encourage children to migrate.

“What’s happening is entire villages are sanctioning the migrations over the border,” Bemak explains. “There is an acceptance of the migration, so we are looking at how can we create a safe migration for the children.” He adds that agencies are working with the Burmese to ensure the children’s safe passage across the border, help them find legitimate employment while there and also provide them with support networks if they find themselves in a dangerous situation. Additionally, Bemak and Chung want to address the needs of returnees, whether they escaped forced labor in Thailand, were deported back to their villages or came back of their own free will.

‘Don’t ask, don’t tell’

“For generations, everyone has been accepting this migration, and nobody talks about what really happens because it’s too painful,” Bemak says. “Thailand has an actively rampant sex trade, so there is tremendous opportunity to earn money in commercial sex work. What we found in the villages with elders and parents was interesting. There was a mentality of don’t ask, don’t tell. Nobody is talking about the commercial sex work, the exploitation of the children, the sexual and physical abuse of the children or the pain and trauma that the children went through.”

Initially, he says, the villagers would deny that anything bad had happened to the children and insist that there was no need for concern. Eventually, however, they would admit that sexual abuse and exploitation were problems. Some villages estimated that up to 80 percent of the children had suffered some form of abuse.

“We talked with some of the returnees, and they are extremely traumatized,” Bemak says. “They sit in their room, won’t come out or socialize. The returnees just aren’t functional. I think they have PTSD (post-traumatic stress disorder) and they are highly depressed, but nobody knows how to handle them or talk to them. In fact, Rita and I were the first people many of them ever spoke with about some of the awful things that had happened to them.”

While visiting one village, Bemak and Chung were invited to sit with some of the elders at a banquet. They dined in an open-air hut, sitting on the ground and eating fresh fish, rice and vegetables. Several young girls — returnees from Thailand — stood around the tables, fanning the adults to keep insects away and to provide a breeze. Bemak felt awkward about the situation, so he began speaking to the girls with the help of the translator. After the meal, he asked if he could stay and talk in more depth with three of the girls in particular.

“I pulled them to the side, and they were shocked that anyone had noticed them, but they just looked like and sounded like they were quite depressed and upset,” he says. “They had all three returned in the past year from Thailand. I told them they didn’t have to describe the details of what happened, but it seemed like all three of them were very pained by it and hurting. Tears started coming and they nodded their heads. We started a whole impromptu counseling intervention session. They were hungry for that, almost desperate to have someone to talk to.”

Personal stories

This experience was repeated several times during the course of the two counselors’ journey. “You could see immediately that these girls were traumatized by the experience,” Chung shares. “We heard the same stories over and over again. They went to Thailand with the assumption that they would be working in a factory or as a housekeeper, and more times than not they were subjected to some sort of abuse — physical, emotional or sexual, or all three.”

For example, Chung says, one of the girls spoke about working in a five-story factory in Thailand. The girls slept on the top floor, and a barbed wire fence surrounded the facility. They were not allowed to leave, and many were too frightened to attempt an escape. Their captors told the girls that if they did escape, they would be arrested and thrown in prison because they were in Thailand illegally. The young girl who shared her story with Chung was eventually able to escape during a police raid.

“I spoke with some other girls who were around 12 years old when they first migrated. They talked about their boss abusing them. They said that physical abuse was OK — you just get hit or slapped. The sexual abuse really impacted them the most,” Chung says. “Another girl was a housekeeper, and she was drugged. She was abused by the father and sons living in the home, as well as friends of the father.” She adds that many times, girls working as maids or nannies are forced to sleep in closet-size rooms and live off the food scraps left by the family.

Some of the returnees come back to Myanmar completely traumatized, unable to readapt and reintegrate into the community. While in Myanmar, Bemak and Chung began training and advising Save the Children staff on how to work with the children and how to build in avenues for returnees to express their feelings.

“There is a tremendous need for strong supportive aftercare programs for returnees,” Bemak says. “When they come back, the village is the same, the family is the same, nothing has changed, but they are significantly different and they can’t talk to anyone about it. The international organizations need to have some intensive aftercare support for the kids that come back. There needs to be a lot more training going on to help them deal with PTSD, depression, trauma, and those kinds of interventions have to happen within the context of the community and be culturally sensitive.”

Offering recommendations to turn the tide of trauma

In addition to strongly recommending trauma counseling for returnees, Bemak and Chung made several suggestions for dealing with the entire migration continuum, including preventative interventions, improving the life skills of those who are migrating and helping returnees to reintegrate successfully. Among their recommendations:

Illustrate the myths of migration. Returnees often glamorize their experience in Thailand and never speak of the abuse or dangers. “They come back and tell all these wonderful stories about how great it was,” Bemak says. “The history has been that the children don’t talk about the painful parts or difficult parts, so (other) kids start to think it’s a wonderful possibility.”

Bemak and Chung recommended that Save the Children collect real stories from returnees and create story books to explain some of the harder aspects of migration and show the reality of the experience.

Provide additional vocational training. Save the Children currently offers vocational training to teach children a skill so they can make enough money to stay in Myanmar. The organization also requires all returnees who are involved in its programs to take part in the training. Unfortunately, Bemak says, the vocational training is limited only to sewing and small engine repair, leading to an overabundance of workers looking for employment in those two markets. Children often finish the training only to find that there is low demand for their new skills, so they end up returning to menial, low-income jobs or returning to Thailand.

“It doesn’t pay to be back (in Myanmar),” Bemak says. “So we suggested that there might be training in electronics, like for radios and TVs, carpentry, welding or basic business skills, so there are lots of different opportunities. If they have jobs, they are more likely to stay.”

Involve the family in prevention and reintegration. In some instances, Bemak says, children go to work in Thailand and send their earnings back home only to have their parents drink or gamble it away. The children return home several months later to find there is little or nothing to show for their efforts and sacrifice.

Bemak and Chung recommended that Save the Children teach money management skills to families in Myanmar. Additionally, they advised of the need for strong role modes in the community to speak up against migration and support those children remaining at home.

Form partnerships with indigenous groups. In an effort to protect and save children from abuse, Buddhist monks from both Myanmar and Thailand literally capture children and return them to their villages. Many of the monks have established educational programs, interventions and orphanages to persuade children not to return to Thailand. They do this without funding or assistance, seeing “good karma” as the reward for their deeds.

The monks and international organizations in this part of the world have informal relationships, Bemak says, but have not established any real partnership combining efforts to help children. “It’s important for counselors and these programs to link with indigenous healers and spiritual leaders because that will make their chances to help these children stronger,” he says.

Bemak says Save the Children officials are very pleased with the counselors’ recommendations, so much so that Chung and Bemak have been invited back to Myanmar in December to visit the villages bordering China and then again next year to investigate internal migration issues. “We are really establishing a long-term relationship to look at these issues and help some of the international organizations understand what is going on,” Bemak says. “We are hoping this will help set up national prototype programs in Myanmar and establish international protocol because this issue has implications globally.”

The couple encourages counselors to become more proactive in championing social justice and human rights issues. “We as a profession are far larger than our borders,” Bemak says. “The profession needs to look at the internationalization of counseling. We can’t just be limited to the child down the street. We need to start thinking about how do people fit into this international context and how do we work and understand international issues. One out of 10 people in the U.S. is foreign-born, so we are dealing with many multicultural issues. This kind of work that we do in other countries allows us to bring lessons learned on how to work cross-culturally back home.”

Because of their dedication and commitment to these issues, Deputy Secretary of State John D. Negroponte has also invited Bemak and Chung to participate on a government task force on refugee and immigrant youth.

A trauma education

Stacy Notaras Murphy

As the news of mass shootings at Virginia Tech unfolded on April 16, few were better equipped to appreciate the tragedy’s impact than American Counseling Association member Nancy Miller. A former licensed school counselor who is now in private practice, Miller understood the mental anguish created by such an event. With disaster mental health training from the American Red Cross, she also possessed knowledge of what would occur on the campus in the aftermath of the violence. But perhaps what most drew Miller to the tragedy was her role as a Hokie parent.

“My daughter graduated from Virginia Tech the year before,” Miller says. “So here I am with this specialty (training), and there was this immediate need. I was at my office in Northern Virginia when the crisis occurred, and I found myself thinking, ‘I’ve got an expertise. I don’t just want to sit here. I’ve got to help.’”

Miller volunteered three days of service through the New River Valley Community Services Board, beginning the day after the shootings. She was stationed at the hotel that served many of the victims’ families who were arriving to collect their children’s belongings. Partnering with the Virginia State Police as they helped the families make positive identifications of the victims’ bodies, Miller provided immediate grief counseling and facilitated student support groups.

Before the tragedy at Virginia Tech, colleges and universities mainly were familiar with traumas relating to the loss of individual students, such as death from a car accident, an illness or even suicide. The school’s staff would focus on recognizing the student’s contributions, peers would participate in a memorial and those closest to the student might seek counseling support on or off campus.

In retrospect, shootings at the middle and high school levels might have made the tragic migration of this type of violence toward colleges inevitable. As a result of the Virginia Tech massacre, universities nationwide have started an intensive review of their disaster planning, with counseling support playing a significant role in that preparation. While there are many transferable lessons from the ways that middle and high schools have dealt with mass shootings in recent years, important nuances also exist that separate those adolescent groups from their college-aged counterparts.

A foot in each camp

Responsible for their day-to-day activities, if not completely financing them, many college students enjoy a quasi-independence that eases the transition from adolescence to adulthood. Sam Gladding, a past president of ACA and counseling department chair at Wake Forest University in Winston-Salem, N.C., notes that those involved in caregiving after a tragedy must be willing to see college students as occupying a unique developmental space and tailor support to that distinctive position.

“There is more of a responsibility for college students to take initiative along with the officials in terms of healing and doing things that are constructive in regard to the trauma, whereas in high school and middle school, initiative is much more from the top down, from the administration down,” Gladding explains. He twice traveled to Blacksburg to provide support for students, first as they returned to classes the week after the shootings and again for their graduation in May.

“There’s just more freedom to respond to a tragedy in different ways at a college,” Gladding says. “At Virginia Tech, while the administration did an incredibly good job of bringing the community together to heal, the students themselves would be out giving ‘free hugs’ to one another. You probably wouldn’t find that at a middle school. There’s more initiative and responsibility at the college level. The memorials, whether makeshift or otherwise, tend to be more spontaneous at that level.”

Perry Francis, an ACA member and associate professor of counseling at Eastern Michigan University in Ypsilanti, agrees, adding that college students’ routines are very different and necessitate different approaches to trauma treatment. “In high school, you’ve got kids who are still living at home for the most part, and they have a very structured environment with regular daily routines,” he says. “It might be easier for a school counselor to make a specific, post-trauma presentation to all the freshman English classes, explaining what they might be going through and where to get help. Comparing that to a college campus, you see there is very little structure beyond when you go to class. (After a tragedy) they might offer a room where kids can drop in or out and counselors might set aside certain hours for group sessions, but the onus to find help is more on the student at the college level. If you’re in a residence hall, you can isolate yourself more readily than in a K-12 environment. At a high school setting, the teacher may interact with you and say, ‘Go talk to a counselor.’ Can that happen in a college setting? Yes, but the students certainly have more freedom to turn that down.”

Jane Webber, director of the mental health/school counseling campus programs at Seton Hall University in South Orange, N.J., experienced the aftermath of the disastrous dormitory fire that took three students’ lives there in 2000. She notes the importance of realizing that college students occupy a limbo-type space, with one foot in adolescence and another in adulthood.

“College students are on their own,” says Webber, an ACA member. “They do their own laundry, they date who they want to, they get up when they want to. But when there’s a real tragedy like a shooting, part of them wants to snuggle back underneath their blankets at home because parents really are their safety zone. They really step back, as we all do in a tragedy. We go to our comfort zones — our parents, our peers, our spiritual resources. There’s a dance between individuation and going back to where it’s safe. College students go back to the safety zone for a shorter period of time than high school students. We want to provide support while still making sure that we’re affirming the fact that they’re young adults. Home is the retreat, a hassle-free zone where they’re safe for a few days. But you want to get them right back to college, because they have more of a foot in the college than at home.”

Webber, who served as the lead editor for the second edition of ACA’s Terrorism, Trauma and Tragedies: A Counselor’s Guide to Preparing and Responding, advises emphasizing college students’ more adultlike, resilient qualities to help them reestablish their normal routines. “How many kids went home after Virginia Tech and lasted a day or two, then said, ‘I have to be back; that’s    where I belong’? That is where they belong. They really do return to normal, as much as possible. Trauma is a very normal response to a very abnormal situation. But you get right back in and you go to a memorial, you go back to class and you talk about it. You do it much faster than you would in high school.

“High school students, in contrast, often become very dependent in a crisis. We have to affirm college students’ adulthood and individuation, but we also know we absolutely have to bring in their support community, which is peers, parents, etc. As far as counseling and support, we have to validate that college students are really young adults, and we affirm the best in their adulthood. That is, connecting with them and providing a variety   of situations in which they can receive help, but not dragging them to it.”

In contrast to approaches at the high school level, where students tend to stick to their cliques in times of crisis as well as in times of normalcy, Webber recommends decentralizing support groups at the college level. Allowing college students to move in and out of peer support groups mirrors the way those students move in and out of peer groups under normal circumstances, she explains. “College students are always creating new programs. You have to be ready to have counselors or personnel available to consult with them but not to take over,” she advises. “There’s a very fine line between consulting and taking over the process. They don’t want that.”

Brooke Collison, a past president of ACA and professor emeritus at Oregon State University in Corvallis, agrees that the scattered nature of a college campus requires special consideration when formulating post-traumatic support responses. “In a school that is K-12, you have encapsulated groups. Everybody reports to the one building, it’s easy to see who is present and who is not present, and it’s easier to organize group responses,” he explains. “At a university, other than students living in a dormitory, they are loosely connected. You may have classrooms in the university where instructors don’t particularly know students or where students may not know each other because (there is) no other bond or connection. So a difference is getting to know the university’s unique landscape and trying to find those specific groupings where students can develop mutual support.” This may include sports teams, student clubs or Greek organizations, he says.

Collison has been on the front lines as a counselor after a number of tragedies impacting either high school or college students, such as the plane crash that killed 31 people, including members of the Wichita State University football team, in 1970 and the 1998 shootings at Thurston High School in Springfield, Ore. He suggests that college-level caregivers take a post-trauma approach that is both supportive and educational in nature.

“One of the important counselor functions is to normalize the feelings and experiences that come from being close to or involved in a shooting,” he says. “It’s OK to be frightened, OK to feel less secure. It’s not strange or weird that you don’t want to go into certain buildings. That’s a part of the process.”

Trauma true to type

Still, counselors need not create a brand new trauma counseling script just because college-level students exist in an unstructured space between adolescence and adulthood. According to Gladding, who worked with 9/11 victims prior to volunteering his services at Virginia Tech, unexpected adversity often elicits predictable reactions across all age groups.

“An act like this always shakes people up because it’s so abnormal, out of the norm of what one would expect or think about,” he says. “It doesn’t matter where you are that that occurs. It’s also common to realize you’re not in control of what’s happening or how it’s happened. Some of the stages of grief and recovery are very much similar. They may manifest themselves differently at the college level, but going through recovery is just something that people of all ages and stages of life have in common.”

Karin Jordan, head of ACA’s Traumatology Interest Network and chair of the graduate department of counseling at George Fox University in Portland, Ore., recommends several guidelines regardless of the population affected by the tragedy. These guidelines include discouraging individuals from making major changes, such as moving, and encouraging them to maintain pre-disaster daily routines. She also encourages psychoeducation to normalize the counselee’s experiences, consultation with a psychiatrist if post-traumatic stress disorder is suspected and assessment of self-destructive behaviors. Jordan suggests working with the counselee to name supports and coping techniques.

Sue Pressman had to put such trauma counseling skills to intimate use with her daughter, Lianna Dosik, a Virginia Tech freshman who was asleep on the same floor of the dorm where the first shootings took place on April 16. After having Dosik home in Arlington, Va., for the week after the shootings, Pressman, an ACA member and career management counselor, helped her daughter move back into the residence hall.

“She had given us restrictions before we got there, like she didn’t want to use the elevator, because the shootings took place right near the elevator,” Pressman says. “As a counselor, I decided that I’m going to take my ‘mother hat’ off right now and put on all those skills that I went to school to learn. I said, ‘I do not want my kid to be living in fear about walking in and out of this dorm.’ So as we walked in I said, ‘Why don’t we use the elevator? Let’s do it together.’ We got on the elevator, and it was fine.

“Then she decided that she wasn’t going to look down the hall where the shootings took place. So later I said I would go look and just see what they had done to the area. I was trying to make it so that it was not the end of the world for her. I walked to that side and she started tiptoeing behind me, and then we saw the wall they had built.” Pressman explains that the university had built a wall isolating the rooms of the two slain students. Other students had written messages to them on the wall. “She saw that and then was able to feel safe coming and going from her room,” Pressman says.

Campus as community

Pressman notes that the most difficult part for her daughter was the presence of so many strangers on campus — most there for support and safety — during those first days back at school. “Normally, if you were on the drill field, you were on your way to classes or playing games or having some kind of event, but never a memorial,” Pressman says. “But that day, they had all these church groups that were singing ‘Amazing Grace.’ They were just everywhere with candles. It was just so much. She didn’t want to see all those people there anymore. They were all there to try and do good, to help and offer services, but it was really hard, because that’s not the purpose of a college campus.”

Miller adds that those working with a college-level tragedy must take care when placing counselors in supportive roles. Whereas high schools are often more established within a larger community and school system, universities tend to be more isolated communities within themselves and may attract a larger number of “drop-in” responders following a tragedy. “This was so complicated,” she says. “I spoke to one student who was angry with the intrusion on campus of all the outside people, and I could completely understand that point of view.”

Being on-site as a short-term counselor, Miller notes that it was important for her to be matched with a population that would not form an attachment, only to have that attachment broken when her volunteer commitment was over. “I think it was wise for them to station me at the hotel with the families as they came, as opposed to stationing me at the hospital with the injured, because that’s more long term,” she explains. “I was very impressed that they had lined up so quickly so many resources. We had fliers and information to hand out about where they could go for counseling at Virginia Tech and back home in their hometowns.” (The Virginia Tech counselor education program also contacted ACA about coordinating free counseling for students who were going to be away from campus for the summer; for more on this initiative, see “ACA members rally to provide free counseling to VT students” on p. 3.)

Collison points out that advanced crisis planning ought to include volunteer screening if at all possible. “At the time of a crisis or catastrophe, many well-meaning people come out of the woodwork to ‘help.’ That is not the time to be screening who you have working in the school as a volunteer crisis counselor,” he says, noting that within the flood of volunteers  there are often people who may do more harm than good in a crisis. “For example, some clergy may respond to crisis with evangelizing speeches or belief statements about death that do not set well with the people grieving. If community volunteers are to be included in crisis response groups, then the first time they come into the school should not be the day of the crisis. They need to be recruited, trained and should spend time in the school.”

Tracking the troubled

Not surprisingly, student gunman Seung-Hui Cho’s violent rampage at Virginia Tech has heated up the debate over privacy rights and public safety on college campuses. In particular, difficult questions have been raised about the ability of universities to track the mental health histories of their students in an effort to better protect their communities. Again, there are nuanced differences between using such information at the high school and college levels.

“High schools tend to notify the parents quicker (about mental health issues) than we would at the college level,” explains Sylvia Shortt, past president of the American College Counseling Association, a division of ACA, and assistant director of student development at the University of West Georgia in Carrollton. “Many times, notifying certain students’ parents would be absolutely the worst possible thing for the students because of their relationships with the parents.”

Shortt also notes that some students have come to link the counseling process with loose confidentiality. “Many have had negative experiences with counseling in middle school or high school, with counselors notifying parents of everything they were doing,” she says. “So when we get them into counseling in college, they don’t trust the process because their confidentiality has been compromised in the past. Building that trust back can be difficult at times. We certainly wouldn’t hesitate to break confidentiality for danger to self or others, but you have to be very careful because of trust issues to not take confidentiality lightly.”

Tracking a troubled student at the college level is also challenging compared with the high school level. “They are captive audiences in public (high) schools, but in college they’re not — they’re legal adults,” Shortt says. “Certainly if a professor notifies us about a troubled student, we most definitely follow up on it, but the difference is that we still can’t force somebody to have counseling unless they have behavioral problems on campus. If they have discipline problems and have been through the process, we can. If their behavior is affecting their roommate or other people in the residence halls, then certainly you have more of a legal right to tell them they have to come in. But if their behavior is just a little bit strange, but they’re not affecting anyone or they’re not breaking any laws or rules on campus, you can’t force anyone to come into counseling.”

Pointing to the Family Educational Rights and Privacy Act, which governs most private and public universities and colleges, Jordan notes that privacy rights provisions are challenging in situations where students present with negative emotions. “Universities are challenged in maintaining the privacy and rights of students, but at the same time have a responsibility to respond proactively to the student’s needs, especially in light of the existing research that has shown that preventive mental health services work,” she says. “Administrations might also be challenged regarding possible legal obligations to individual students and those potentially at risk for harm. In this litigious time, the threat and potential for lawsuits might be part of the decision-making process.”

Collison sees counselors playing an important role in protecting students’ rights at both the high school and the college level. “Anytime there is a shooting like this, there is a tendency to start doing profiling of potential shooters,” he says. “We run the risk of interfering with people’s rights. If we start looking at every person who is isolated, noncommunicative and a student, and begin to get jumpy, maybe even invading their privacy, then there’s a real risk. I think counselors ought to be on the line to help protect the rights of students, while at the same time being on the watch for people who are isolated, disconnected. It’s kind of a double line for the counselor, whether at the high school or university level.”

The road ahead

In the aftermath of any tragedy, people find some comfort in taking stock of what happened and thinking about ways to prevent similar situations in the future. Counselors are in a unique position to assist universities as they inevitably ask, “What if this happens here?” Jordan says all university/college disaster preparedness plans ought to consider a variety of issues when updating their crisis protocols, including:

  • Ease of use
  • Training of the crisis team
  • Partnerships with community service agencies
  • Regular crisis drills
  • Strengthening relationships with local law enforcement
  • Developing specific plans for a variety of scenarios, such as bomb scares, intruder threats and stalking situations

“It might be helpful to involve counselors, especially those with trauma or disaster training, in the intervention and postvention designing and/or updating of the disaster/trauma preparedness plan, as they can provide valuable feedback regarding the mental health services that can/should be provided,” Jordan notes.

Francis also suggests that counselor education programs consider whether they are providing their students with the proper skills for dealing with such a violent crisis. “The question is how much training can we provide to students within the model of counselor education that’s currently in place,” he says. “I can make the case for having a two-credit course on suicide assessment, while others can make a case for how to do trauma counseling. The question is how much can we pack into a program that first has to teach them how to do counseling at a very basic level.”