Monthly Archives: June 2010

Counselors taking a stand

Lynne Shallcross June 15, 2010

When Manivong J. Ratts arrived in the United States in 1977 as a 6-year-old refugee from Laos, he quickly figured out that he and his family weren’t mirror images of the other families in town. Yakima, Wash., where his family settled down, was a predominantly agricultural community, and although Asian Americans lived there, they weren’t refugees, Ratts recalls.

“I remember going into the schools and the schools not understanding our experience and not being equipped with the skills and training to deal with people who were refugees,” says Ratts, assistant professor and director of the school counseling program at Seattle University. By the time he got to high school, Ratts was struggling. One day, the assistant principal called Ratts into his office and asked why he couldn’t be more like one of his friends, who happened to be Chinese American. “I can remember sitting in his office thinking, ‘But I’m not Chinese,'” Ratts says. “I also remember thinking, ‘He just doesn’t understand.’ And I shut down.”

Ratts’ life experiences led him to focus on social justice in his counseling work. “Growing up and being viewed as ‘the other’ allowed me to see how the environment can cause people to act in ways that society deems as irrational but I view as a normal and healthy reaction to circumstances that are unjust,” Ratts says. “In other words, it is normal that a family becomes upset or develops coping mechanisms to address the impact a war might have on their lives. To rationalize this as abnormal or to put a label on a person is unjust because it is placing blame on the person rather than on the larger social system.”

Ratts is one of a growing number of counselors who feel called to ensure that social justice principles are part of the bedrock of the counseling profession. Counseling Today asked Ratts and five other members of the American Counseling Association to share how social justice ideals guide them in their work and in changing the profession. Read on to hear their stories.

Carl Sheperis

You don’t need superpowers or mythic strength to stand for social justice, says Carl Sheperis, director of doctoral programs in the School of Counseling and Social Service at Walden University. Think smaller, he advises. “The biggest misconception is that the effort of working toward social justice has to be a Herculean effort,” says Sheperis, who was honored with ACA’s Counselor Educator Advocacy Award this year. “The reason many individual counselors enter the profession is because they love being in the service of others. Simply looking for opportunities to address inequities even on a smaller scale is a great act in the name of social justice.”

Sheperis, who began his advocacy efforts 20 years ago, remembers observing a preschool classroom and noticing a 3-year-old exhibiting symptoms characteristic of autism spectrum disorders. “I said to the teacher, ‘You have a child with autism. When did he arrive?’ The teacher said, ‘He doesn’t have autism. He is just quiet.’ At that point, because the child wasn’t a client, I could have walked away. However, the child didn’t have the ability to advocate for himself, so I asked the teacher if she would make a referral to me for pro bono services and allow me to speak with the parents.”

After a lengthy conversation with the child’s parents, Sheperis discovered the family had an older child with autism who was dealing with aggressive tendencies and health issues. “Because of the struggles with their older child, the parents didn’t recognize the issues their younger child was facing,” Sheperis says. “After a thorough assessment process, we were able to confirm a diagnosis of autism, work with the school district to develop an individualized educational plan and provide 20 hours of intervention services per week for the rest of the school year.”

Counselors operating from the “stereotypical 50-minute hours” can miss out on opportunities for change, Sheperis says. “Taking a few small steps toward living the philosophy of social change can go a long way. By recognizing an injustice and taking a step to address it, counselors begin to live the philosophy, and I think this can be quite simple.”

Although Sheperis originally got involved with advocacy efforts as a result of working with his clients, which often involved accompanying clients and parents to schools to help them advocate for themselves, the topic soon took a personal turn. “When my now 9-year-old son was diagnosed with autism seven years ago, I wound up having to advocate for him in the school system,” Sheperis says. “I think the blend of self-advocacy and helping others has broadened my understanding of advocacy and social justice.”

Striving for social justice is the responsibility of society as a whole, Sheperis says, but he believes counselors have a special role. “We shouldn’t be on the bandwagon; we should lead the charge,” says Sheperis, who began working with Head Start in 2000 and has donated more than $1 million of in-kind services to the program in the past decade through his private practice, Behavioral Services LLC. “We (counselors) have a dedication to social justice interwoven throughout all aspects of our work. Social justice is inherent in our ethical code, our standards for accreditation and throughout our work. Social justice is an overarching theme for what counselors do.”

At the same time, Sheperis is careful not to overhype current social justice efforts. “I don’t want to ever imply that the work we do today is any more important than the civil rights movement or the creation of suffrage for women,” he says. “But although social justice may not be more important today, I believe that it is more attainable today. Because of our ability to communicate globally without delays, the messages of social justice can be delivered in ways that were never possible before.”

Consider the response to the earthquake in Haiti, he says. The American Red Cross was able to raise many millions of dollars to support relief efforts in a short amount of time through a text-message campaign. “I think the counseling world has to take advantage of the resources we have to deliver messages and begin to think outside the box with regard to how we work in the service of others,” Sheperis comments.

For Sheperis, the concept of social justice in counseling boils down to a simple idea. “Pay attention to the world around you and see where there is an opportunity to take an action,” he says.

To illustrate this point, Sheperis reflects on a local fair he attended recently. While walking down the street, he saw a plastic cup on the ground. Instead of stepping on the cup and walking on like many others before him, Sheperis picked it up and tossed it in the garbage can. “I do that all the time,” he says. “When I see something, I try to point it out and then do something to address it. This goes back to the misconception that social justice requires a Herculean effort. If counselors pay attention to the world clients live in, they will see small places where they can take action.”

Rhonda Bryant

Rhonda Bryant’s passion for social justice emerged thanks to her work in community and school settings, such as when she provided intensive outpatient counseling to women recovering from substance abuse. She recalls clients voicing their desires for full-time jobs that afforded a living wage, decent housing, access to medical care and quality schools for their children.

“However, their employment options were limited due to their criminal history and recovery status,” says Bryant, a member of Counselors for Social Justice who currently coedits the ACA division’s newsletter and previously served as the division’s community representative. “Some found that they were ineligible for federal student aid because they had a drug conviction. We spent many sessions exploring how to rebuild their lives given their perceptions of discrimination in the hiring process.” The counseling Bryant offered these women couldn’t be limited to “traditional” career counseling methods, she says. “I had to address their feelings and teach them how to navigate the system to obtain their goal of self-sufficiency.”

The connection between counseling and social justice runs deep, says Bryant, associate professor of school counseling at Albany State University. “Our profession was born from the efforts of people like Frank Parsons and Jesse B. Davis who were concerned about the total well-being of disenfranchised children and adults. Clifford Beers’ personal struggles with mental health and his activism to end the inhumane treatment of mental hospital patients also demonstrate the relationship between counseling and social justice. Counseling and social justice have gone hand in hand from the inception of the profession.”

A good way to begin delving into social justice as a counselor, Bryant says, is by carefully considering the sociopolitical history of society and how people benefit from societal institutions. “Next, the counselor must be willing to take a hard look at how these systems shape personal worldview and critically evaluate the confluence of social policy, procedures, law and the quality and types of counseling services we provide and to whom,” Bryant says. “Privilege is a theme that recurs in social justice counseling. I suggest that any counselor interested in social justice advocacy begin with the ACA Advocacy Competencies.”

Finding colleagues who share your interests is important, says Bryant. “Joining Counselors for Social Justice, which was explicitly chartered to address counseling and social justice, is a wonderful place to start. There are other [ACA] divisions committed to social justice as well.” Working with community organizers is another wise step, Bryant adds. “These are the folks at the grassroots level who know intimately the struggles in our communities.” She also suggests that counselors use the ACA Multicultural Competencies as part of their ongoing professional journey.

Bryant walks the talk at her university. Students in her program must demonstrate how they have influenced systemic change at their fieldwork placement sites. Bryant also conducts training in the ACA Advocacy Competencies with her students because she wants to promote introspection and consideration of the systems in which they live and work. She recalls one student who worked on an advocacy project aimed at improving teachers’ classroom interactions with students who had mental health diagnoses. “In her plan, she documented how students with mental health diagnoses like major depression and anxiety disorders were overrepresented in the in-school suspension program and out-of-school suspensions,” Bryant says. “Implementation of her in-service resulted in parents and teachers lobbying the local community service board for mental health treatment for teens in their county and continued discussion on how to create a learning environment that supported all students.”

One of the biggest misconceptions counselors have about social justice, Bryant says, is that it has no place in counseling. “I think this belief is rooted in the idea that counseling is apolitical and value-free,” she says. “We live in a world in which the lack of justice in educational, health, career and legal systems are realities that our clients face. To ignore these realities denies clients’ experiences and impedes clients’ ability to change their communities through advocacy.”

Manivong J. Ratts

Adhering to social justice principles in counseling requires that practitioners put together a few different pieces, says Ratts, who coedited ACA Advocacy Competencies: A Social Justice Framework for Counselors, published by ACA earlier this year. Social justice in counseling means ensuring that clients have access to resources, determining whether systemic barriers stand in the way of clients’ optimal psychological health and sometimes using advocacy to change those oppressive environmental barriers, he explains. “Moreover, operating from a social justice counseling framework may require that counselors alter how they conceptualize client problems, the types of counseling techniques employed and how they view the counselor role and identity. Unlike traditional counseling paradigms, which tend to conceptualize client problems as an internal phenomenon, social justice counseling encourages helping professionals to broaden their perspectives by viewing client problems from a bio-psycho-social perspective.”

Counselors are highly skilled at using biological and psychological reasoning to explain why clients are sometimes stuck, says Ratts, president-elect-elect of Counselors for Social Justice. “However, we often don’t consider how sociological factors such as oppression may contribute to client stress. Ignoring this important variable can actually do clients more harm than good because it may lead to interventions that require clients to change rather than their environment [to change], thus blaming clients for their plight.”

Exploring biological, psychological and sociological factors with clients opens the counselor up to options that include not only office-based techniques and interventions but also community-based work, Ratts says. “Encouraging counselors to step out from the comfort of their offices can be a daunting task for some because it requires the helping professional to utilize skills that are foreign or to conceptualize their clients in different ways,” he says.

Ratts offers a few questions that might help counselors in developing a social justice identity:

  • How might being a change agent and social justice advocate align with my values and beliefs?
  • How does social justice inform my theoretical counseling orientation?
  • How is my current practice as a counselor promoting a status quo of dominance and privilege for those in power?
  • How is my practice dismantling systems of power and privilege?

“I believe taking the time to reflect on and address [these] concerns can equip counseling professionals with the foundation they need to be successful social justice counselors,” he says.

Ratts believes pushing for social justice in counseling is important because it addresses the root of client problems and assists clients in living self-fulfilling lives. “More important, social justice is critical to the field because it aligns with our professional code of ethics, which states that counselors must engage in advocacy and address issues of equity at the individual, group, institutional and societal levels.”

It is critical that counselors not delay in getting involved, Ratts says. “The growing achievement gap that exists in K-12 schools, the rising cost of health care, the prevalence of hate crimes and the negative impact that poverty has on human development are just some examples of why all helping professionals need to develop a sense of urgency about operating from a social justice counseling framework. Clients and the communities in which they live are in dire need of strategies and interventions that will alleviate the social ills that obstruct healthy development. The social justice counseling movement attempts to address these issues by encouraging counseling professionals to reconsider their roles if they want to maintain their value as resources to society.”

Despite all the good he sees coming out of social justice in counseling, Ratts knows there will always be critics who question the validity of any emerging counseling movement. “On one hand, critics are important because they see things that others may not see and often ask difficult questions that proponents of a movement may not ask or see themselves,” he says. “On the other hand, critics can sometimes stifle a movement because of their unwillingness to be open to alternative perspectives or ways of helping.” The questions and criticisms vary, but some of them, such as the call for evidence-based social justice interventions, are valid, Ratts says.

However, Ratts would also remind critics that rather than being an “add-on,” social justice leads to a more holistic approach to counseling. “Operating from a social justice framework actually makes our jobs easier,” he says. “As a profession, we are very good at training counselors to view client problems as an internal phenomenon and helping clients alter their thoughts, feelings and behaviors. However, why look at client problems solely from this perspective? Using intrapsychic-based approaches may be helpful in the short term, but they often don’t lead to the type of long-term changes clients seek. What is the harm of also looking at whether social, political and/or economic conditions impede on human development?”

Ratts says the future of social-justice-infused counseling begins with counselor education programs, and he predicts that in the not-so-distant future, programs will offer courses focusing on community activism, incorporate social justice theories into all courses and conduct more research on social justice and its efficacy, among other changes. And as social justice becomes more mainstream in counseling, Ratts believes practitioners will begin identifying the natural connection between the two.

“Counselors will begin to realize that there is a seamless connection between working in the office setting and doing community-based work,” he says. “As this occurs, counselors will become more adept at knowing whether office-based interventions, social justice advocacy or a combination of both are necessary when working with clients and their families. They will begin to recognize that being outside the office setting can help inform what one does in the confines of an office environment and vice versa.”

Michael D’Andrea

Social justice counseling concepts aren’t new, says CSJ President Michael D’Andrea. In fact, he says, they’ve been an integral part of the profession since the early 1900s. “The pioneers of the counseling profession, including persons like Frank Parsons in Boston and Jesse Davis in Michigan, were concerned about the injustices occurring at that time and the adverse effect these injustices had on millions of people in our nation. These and other persons at that time developed various educational and vocational development projects to address these injustices to help foster healthy human development. These initial social justice advocacy efforts were expanded to address the needs of families in the 1920s, the rights of women and veterans in the 1930s and 1940s, the needs of school-age children in the 1950s, as well as counselors’ efforts to address issues of peace and justice that were illuminated by the civil rights and antiwar movements of the 1960s and 1970s and the multicultural counseling movement of the 1980s and 1990s.”

Although multiculturalism and social justice aren’t one and the same, the multicultural movement is rooted in social justice principles, D’Andrea says. “The genesis of the multicultural counseling movement can be traced to the late 1960s, when a group of Black counselors and psychologists articulated concerns about the various ways in which the fields of counseling and psychology perpetuate racism and White supremacy,” he explains. “The evolution of the multicultural counseling movement resulted in an expansion of this original focus to include research and clinical practices that reflected increased understanding of and respect for diverse cultural, racial and ethnic worldviews, values and beliefs. The social justice counseling movement formally emerged in ACA in the late 1990s in large part to illuminate and complement the original impetus for the multicultural counseling movement.”

An accurate understanding of the counseling profession’s history includes the myriad ways social justice has been part of counseling’s foundation for the past 100-plus years, D’Andrea says. The importance behind counselors addressing social justice issues in their work is twofold, he adds. “First, one of the primary goals of counseling is to promote healthy human development. Second, research findings are abundantly clear about the many ways that social injustices negatively impact the healthy development of millions of persons in our contemporary society. Consequently, if professional counselors are to effectively address the goal of promoting human development in their work settings, implementing social justice counseling and advocacy services in their professional endeavors is a professional imperative.”

Beyond fostering healthy human development, D’Andrea says professional counselors have a civic responsibility to ensure that fundamental rights are protected. “As citizens of the United States, all counselors are responsible for making sure that all of the people they work with are free to exercise their constitutional rights to life, liberty and the pursuit of happiness. Knowing how various forms of racism, classism, ableism, ageism, heterosexism, as well as injustices that are grounded in religious bigotry undermine the [ability] of millions of people in this nation to exercise these basic rights compels counselors who are committed to our democratic principles to address these issues in their work endeavors.”

“Counselors are well positioned in the places where they work and live to address a broad range of social justice topics,” D’Andrea says. For example, he suggests, counselors in elementary schools can work with administrators and teachers to develop policies and activities that address the injustices of bullying. Counselors in university settings can devote time and energy to ameliorating institutional racism and heterosexism, as well as confronting militarism. Counselors in community settings can address injustices stemming from sexism by offering empowerment counseling services to women who have experienced violence and advocating for women’s rights with elected officials and policy-makers. In addition, he adds, ACA members can lobby ACA leaders to expand the number of professional development opportunities focused on social justice at conferences.

Carrying out social justice counseling and advocacy boils down to three main components, D’Andrea says. “First, a social justice counselor strives to become aware of the ways that various forms of injustice and cultural oppression continue to be perpetuated institutionally in our contemporary society in ways that are harmful to healthy human development.”

Second, he says, social justice counselors should educate themselves on how counseling is historically grounded in social justice concepts but has also helped perpetuate injustices by encouraging clients to adjust to environmental conditions that are unfair and unjust.

“Third,” D’Andrea continues, “social justice counselors develop the counseling and advocacy skills necessary to address social injustices in the schools, agencies and communities where they live and work. This includes, but is not limited to, implementing the types of helping interventions that assist clients in becoming more knowledgeable of the ways that contextual factors affect their development and learning ways to increase their personal responsibility by addressing unjust dynamics that exist in their families, schools, universities, workplaces and communities.”

D’Andrea believes the future of social justice in counseling is bright. “The social justice counseling and advocacy movement is headed in a direction that will continue to transform the way counselors are trained and work so they are not only better able to promote the healthy development of larger numbers of persons from diverse groups and backgrounds in our society, but to do so in ways that strengthen the principles of democracy, peace and justice that continue to be imperiled in many ways in our nation at the present time.”

Anneliese Singh

Ask Anneliese Singh if social justice advocacy is a separate role for counselors, distinct from the rest of the profession, and her answer will be an emphatic no. “I see it as the reason underlying all of our work,” says Singh, an assistant professor at the University of Georgia as well as a safe schools activist in the Georgia Safe Schools Coalition. “Everything we do — from practice and research to supervision, training and outreach — includes opportunities for us to be social change agents.” Whether in work with clients or as students or supervisors, it’s important to explore privilege, power and oppression, she says. “What are the opportunities in all of our roles to identify injustices collaboratively with clients, to remove barriers to healthy development and to name individual and collective community resilience despite societal oppression? These are all important questions we should ask ourselves throughout all our work, no matter what counselor role we are engaging in at that moment.”

If counselors aren’t engaging in social justice-oriented counseling, they’re engaging in “status quo counseling,” Singh says. “In other words, without a social justice focus on the counseling relationship, we are merely helping clients adjust to oppressive circumstances rather than identifying root causes of stressors on clients’ lives — racism, sexism, heterosexism and other isms.”

For those who question the role of social justice in counseling, Singh offers the following perspective. “Many people like to critique the social justice movement within counseling, saying ‘Who are we as counselors to say what change should occur?’ and ‘What is oppressive?’ The problem with this type of critique is that it simply is unfair. If we are in fact practicing social-justice-oriented counseling, we are engaging clients in an exploration of societal barriers they face and the resilience they have to negotiate these barriers. Social-justice-oriented counseling is done with clients or on behalf of clients, as the ACA Advocacy Competencies assert. And if we are engaging in the highest integrity of social-justice-oriented counseling, we are constantly assessing our own experiences of privilege and oppression and identifying how these experiences influence how we work with clients.”

A combination of Singh’s faith and where she spent her childhood led her to focus on social justice. “As a Sikh, I follow our traditional values of seva, or service to community, and seeking truth and justice for all people,” she says. “I grew up with stories about our first guru, Guru Nanak, who sought to end the caste system in India. He recognized the value of all people no matter what their background was.” Singh also absorbed lessons from growing up in New Orleans, where she says racism, sexism and heterosexism were prevalent. “So I distinctly saw and felt the need for social justice. Amid so much oppression was also an amazing potential for social change because people from New Orleans tend to be very relational and care about being involved in their communities.”

When it comes to putting social justice principles into action, Singh believes the first step must take place in the classroom. “In counselor education, we need to emphasize the importance of social justice,” she says. “However, we cannot just say we value social justice and then ask counseling trainees to engage with systems of oppression without specific understandings of how power works and what specific advocacy skills are.” For counselors who have not received that kind of training, Singh says readings in outside fields, such as sociology, legal studies, queer theory and women’s studies, can help. Maintaining a circle of mentors, peers, friends and colleagues with whom to share stories, successes and “oops” moments is also helpful, she says. “And then you have to practice everything you have learned — not just in the counseling office, but also in the world. We want to ‘walk the talk’ of our beliefs and engage in building authentic relationships with others that can support community change and empowerment.”

The nation’s changing landscape should convince counselors to take another look at social justice, Singh says. “We have known for a while now that the demographics of the U.S. are changing, and we see that more than ever right now with people of color, queer people, people living with disabilities, etc., gaining more access to resources and services. At the same time, there are still many, many people without this access, and there are tremendous psychological consequences our clients face when they are not able to achieve their full potential.”

Singh points to Martin Luther King Jr.’s idea of “beloved community,” where all people would have access to the resources needed to engage in the world with their talents, skills, abilities, values and needs. “It is a vision we as counselors need to hold on to,” she says, “because we know the internalized oppression and negative self-worth that comes when people are not able to live their dreams — and when we are not able to live out our dreams as helping professionals.”

Some opponents label the push toward social justice in counseling as naïve or liberal, Singh says. “Let them do so. This is often the backlash that comes when you engage in social-justice-oriented work in any setting. The very next day, we need to keep doing what we as counselors know is the right thing to do. We need to recognize and honor clients’ pain as it connects to systems of oppression and develop a counseling relationship where their voice is supported, valued and validated.”

A rehabilitation counseling perspective

Social justice is a natural fit with rehabilitation counseling, says Patricia Nunez, because both stand for the fundamental dignity of all people. “Rehabilitation counselors are committed to a sense of equal justice based on the importance of persons with disability having equal access to that which is available to all persons. Rehabilitation counselors are also committed to supporting persons with disabilities to advocate for themselves, as well as to intervening as necessary to remove barriers, whether they be attitudinal, environmental or related to access to employment,” says Nunez, manager of case management with CNA Insurance and the American Rehabilitation Counseling Association’s representative to the American Counseling Association Governing Council.

Although it might not spring to mind for those who don’t work with people with disabilities, rehabilitation counselors naturally think of disability issues fitting under the social justice umbrella, Nunez says. “When you think about it, the empowerment of the individual, combined with the active confrontation of inequality in society as it impacts the persons with whom we work, is a core part of what we do.”

Rehabilitation counseling places high value on facilitating client independence and helping people with disabilities integrate into employment and their communities, Nunez says. “But our advocacy is in partnership with the individual with the disability, not for them or about them. In fact, in our newly updated Code of Professional Ethics for Rehabilitation Counselors, we clearly address advocacy.” For example, Nunez says, Standard C.1.b. states, “Rehabilitation counselors provide clients with appropriate information to facilitate their self-advocacy actions whenever possible. They work with clients to help them understand their rights and responsibilities, speak for themselves, make decisions and contribute to society. When appropriate and with the consent of clients, rehabilitation counselors act as advocates on behalf of clients at the local, regional and/or national levels.”

Some counselors might hold a misconception that rehabilitation counselors must advocate for the client, Nunez says, but the updated code of ethics clarifies that rehabilitation counselors are bound to assist clients with self-advocacy. “Only when appropriate and only with the consent of our client are we to act as advocates for our clients,” she says. “Now, that does not stop me from taking any opportunity to educate those around me as to the rights, capabilities and access issues of persons with disabilities. But I should not take it upon myself to advocate for a particular client if it is not within that person’s wishes for me to do so. We must be clear about the difference between client advocacy and where our ethical boundaries lie, and general advocacy for equality in society.”

— Lynne Shallcross

ACA resources

The second edition of Counseling for Social Justice (order #72841), edited by Courtland Lee, offers 13 chapters written by a variety of experts in the field. The cost is $32.95 for ACA members and $47.95 for nonmembers.

ACA Advocacy Competencies: A Social Justice Framework for Counselors (order #72896), edited by Manivong Ratts, Rebecca Toporek and Judith Lewis, includes chapters written by Anneliese Singh and many other authors. The cost is $46.95 for ACA members and $64.95 for nonmembers. Both of these resources can be ordered directly through the ACA online bookstore at counseling.org/publications or by calling 800.422.2648 ext. 222.

Included in the ACA Podcast Series is Podcast HT 013: “Multiculturalism and Diversity: What’s the Difference?” The 52-minute podcast features Courtland Lee, professor and director of the Counselor Education Department at the University of Maryland at College Park, addressing topics such as the importance of emphasizing cultural differences in counseling and the importance of cultural competency. To access the podcast, visit the ACA website at counseling.org and click on the “ACA Podcast Series” button on the right-hand side of the page.

Lynne Shallcross is a senior writer for Counseling Today. Contact her at lshallcross@counseling.org.

Letters to the editor: ct@counseling.org

ACA offers feedback for DSM revision

June 2, 2010

In mid-April, American Counseling Association President Lynn Linde sent a letter to the American Psychiatric Association regarding the proposed draft revisions to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). On behalf of the 43,000 members of ACA, Linde detailed feedback on five areas of particular importance to professional counselors: applicability across all mental health professions, gender and culture, organization of the DSM-5 multiaxial system, lowering of diagnostic thresholds and combining diagnoses, and dimensional assessments.

After the American Psychiatric Association released proposed draft revisions in February, ACA solicited member feedback both online and through a town hall meeting at the ACA Annual Conference & Exposition in Pittsburgh. After this comment period ended, an ACA task force convened to boil down the ideas and suggestions.

"Professional counselors have a master’s or doctoral degree in counseling and utilize the DSM as an integral part of our work," Linde wrote in the introduction of the letter to David J. Kupfer, chair of the American Psychiatric Association’s DSM-5 Task Force. "As such, ACA appreciates the opportunity to provide feedback on the proposed draft revisions to DSM disorders and criteria."

Linde then detailed six recommendations from ACA.

1) The DSM-5 should focus on clinical utility across mental health disciplines.

Although ACA welcomed the openness of the DSM revision process and the opportunity to comment, Linde expressed concern about the minimal attention given to clinical utility for clinicians who are not psychiatrists. According to literature, components of clinical utility include appropriateness, accessibility, practicability and acceptability, as well as reliability, predictive value and specific clinical implications. Although some empirical work had been done on these components, the ACA letter noted that "users" were limited to psychiatrists and medical interns, leaving studies with non-medical mental health professionals undone. "It is assumed that when diagnostic criteria are user-friendly, the likelihood and accuracy of usage are increased, clinical decision making is improved and clients are better served," ACA’s letter stated. "Therefore, the American Counseling Association strongly suggests that the task force examine usage patterns of clinicians across educational levels and across disciplines."

2) The DSM-5 should integrate gender and cultural issues across disorders and criteria.

Although culture and gender play important roles in mental health, the mention of those topics, from ACA’s perspective, is too insignificant in the proposed draft DSM revisions. ACA members expressed concern that the mental health issues of African, Latin, Asian and Indigenous Americans, as well as recent immigrants, LGBT individuals, the aging population, individuals with disabilities and other marginalized populations would continue to be misdiagnosed, underdiagnosed or ignored through the proposed classification system. The ACA letter offered the example of a female client who had experienced repeated sexual harassment at work and then presents with symptoms of depression, anxiety or other disorders. "The etiology of the symptoms is sociopolitical/cultural and/or historical, yet the client will be diagnosed with pathology," Linde wrote.

3) The DSM-5 Task Force should provide specific information about the multiaxial system reorganization and allow for further comment after this information is provided.

One of the proposed draft revisions for the DSM-5 is to combine Axes I, II and III. That action, which would essentially commingle physical and mental conditions, could potentially result in dilution of the focus of each type of disorder and confusion over comorbid conditions. The ACA letter advised that treatment focus could be diminished with an undisciplined compilation of disorders, and knowledge gained from state (Axis I) and trait (Axis II) characteristics would be lost. Combining the Axes risks medicalizing mental health rather than underscoring the uniqueness of each mental health problem.

4) The DSM-5 Task Force should clarify the boundaries between specific mental disorders and normal psychological functioning, and efforts to combine diagnoses should not result in increased difficulty in determining specialized accommodations.

The proposed draft revisions lean toward lowering diagnostic thresholds and combining diagnoses, Linde wrote in the letter. "Although ACA is encouraged that this may add some clarity and an ability to categorize some symptoms that have otherwise fallen under the NOS (Not Otherwise Specified) category or caused clinicians to use adult diagnoses in identification of symptoms in children, we recommend more clarity of the boundaries between specific mental disorders and normal psychological functioning. We are concerned that without this clarification, the lowering of diagnostic thresholds may increase false positives or provide questionable indicators of future diagnoses." Among the examples ACA used to support this point: Diagnosis of substance use disorders would require only two symptoms to meet the criteria, major depressive disorder would no longer exclude bereavement, and the autism spectrum disorder would include pervasive developmental disorder and Asperger’s disorder.

6) Dimensional assessments should have utility across mental health disciplines, integrate with existing categorical diagnoses and provide strong psychometric properties.

Part of the proposed draft DSM revisions address dimensional assessments, which are slated for inclusion within the existing categorical system. The purpose is to provide clinicians with additional help in assessment, treatment planning and treatment monitoring. But ACA points out that professional counselors have long known about the limitations of a purely categorical approach. The letter from ACA emphasized support for efforts to improve the quality of diagnosis through dimensional assessments but also suggested that dimensional assessments have clinical utility to all mental health practitioners, that the system integrate existing categorical diagnoses and that dimensional measures be "thoroughly tested and show strong psychometric properties."

In closing, Linde reflected on the American Psychiatric Association’s stated goal of an open and inclusive process in revising the DSM. She noted the process has been less inclusive of mental health disciplines outside of the psychiatric community. "The American Counseling Association has expressed a willingness to participate in the development of the DSM-5," Linde wrote. "However, we have been excluded from this process repeatedly without explanation. It is essential to involve us in this process because we provide a unique perspective. Because of the frequency and duration of counseling appointments, clients/patients may share information with a counselor that is essential to diagnosis and assessment that they do not share with their psychiatrist. As such, ACA requests that we be included in both the field-testing process and the dissemination of information to be adequately prepared for the final feedback opportunity in 2011."

To read the letter in full, go to counseling.org/counselors/ACA-DSM-response.pdf.

ACA Chief Professional Officer David Kaplan said special credit should be given to the ACA DSM Task Force appointed by Linde to review the proposed draft revisions, solicit feedback from ACA members and incorporate those comments into the recommendations that ACA ultimately submitted to the American Psychiatric Association.

The following members served on the ACA DSM Task Force:

  • Charles Pemberton (chair)
  • Camille Clay
  • Rebecca Daniel-Burke
  • Karyn Dayle Jones
  • Monica Kintigh
  • Jacqueline Swank

Letters to the editor: ct@counseling.org.

Making definitive progress

Jonathan Rollins

Since 2005, delegates representing 30 major, diverse counseling organizations have been meeting to determine what steps need to be taken to ensure a healthy and strong future for the counseling profession. The initiative, "20/20: A Vision for the Future of Counseling," first succeeded in identifying seven principles considered critical to moving the profession forward. Most recently, at the American Counseling Association’s 2010 Annual Conference & Exposition in Pittsburgh, the 20/20 delegates reached consensus on a common definition of counseling, capping off a nearly yearlong process.

Counseling Today contacted a few of the individuals participating in the ongoing 20/20 initiative, asking them to share their thoughts on this latest accomplishment and why it was such an important undertaking.

How difficult was it to arrive at the following consensus definition? Counseling is a professional relationship that empowers diverse individuals, families and groups to accomplish mental health, wellness, education and career goals.

Sam Gladding, 20/20 facilitator: Different individuals and associations emphasize various aspects of counseling. What 20/20 did that was unique was to conduct a Delphi study of what features of counseling stood out most among a host of diverse groups inside and outside the American Counseling Association. Each of the delegates in the seven teams that 20/20 is divided into gave input into the process of what features unite counseling as a profession, and the teams, in turn, brought these definitions forth. The process lasted almost a year, with individual delegates reacting to each definition that teams suggested. A factor analysis of the words most often used in the suggested definitions of counseling was done also. The goal was to reach an apolitical, objective and brief definition of counseling.

When the 20/20 delegates came together in a face-to-face meeting in Pittsburgh, the Delphi study results were tweaked to a 21-word definition. In the meeting, everyone who wished to make suggestions or comments about the definition was listened to. It was agreed that different associations might want to preface this definition with emphases that they embrace. The whole process was long, arduous and research-based. Many voices, visions and passions were heard and considered. It was not easy, but I think the result is the product of a process that worked. I think the final definition captured the essence of counseling —#8212; not all the nuances, but the essentials that make counseling counseling.

Bradley Erford, 20/20 delegate representing the Association for Assessment in Counseling and Education: Anytime you gather 30 leaders with diverse backgrounds and passionate beliefs in a room for a limited amount of time, you are virtually certain to run out of time before you run out of excellent ideas and perspectives. It took about a year to agree on a one-sentence definition, beginning in Charlotte in March 2009 [at the ACA Conference in North Carolina] and ending in Pittsburgh in March 2010.

This definition was actually a synthesis of several definitions and represented the core of what we all do as professional counselors, regardless of our specialty area or discipline. It represents what we all share in common and captures the essence of the counseling relationship. Counseling specialties are encouraged to add to the one-sentence definition to accurately convey how each focuses or expands upon this global essence.

S. Kent Butler, 20/20 delegate representing the Association for Multicultural Counseling and Development: It was very difficult to reach consensus, as each individual, representing a participating organization, had their own unique way of formulating the definition. Some of my colleagues looked at the definition as a concise explanation of the nature of counseling —#8212; a brief elevator definition for legislators —#8212; while others found it important to embrace cultural aspects of the definition that would be inclusive of all of our constituencies. It was, for me, the start of very important conversations surrounding multiculturalism and social justice that I believe often get overlooked because they revolve around subjects unfortunately still taboo in America. While the conversations were difficult, I believe that in our last meeting, there was a breakthrough. So perhaps now we can give ourselves permission to engage in enriching conversations that will further unify our counseling community.

We all had to compromise and see things from all angles [in reaching this definition]. There were some very compelling arguments that led to this final version.

Carol Bobby, 20/20 delegate representing the Council for Accreditation of Counseling and Related Educational Programs: Arriving at consensus can be difficult when there are just a handful of people working together, but when you consider that 20/20 involved 30 organizations bringing different perspectives and emphases to the table, you should expect difficulties in reaching consensus. I actually think the process went more smoothly than any of us should have expected.

Of course, the Delphi process that the 20/20 delegates completed prior to the meeting in Pittsburgh informed us of the necessary components that, at a minimum, had to be included in the definition.

We also knew going into the Pittsburgh meeting that we needed a definition that could be understood by our constituents outside of the profession, meaning that we had to keep the language clear and the definition unencumbered by "counselor speak." By counselor speak, I mean those words or phrases that are meaningful within the profession but may be misunderstood by outsiders.

Rhonda Bryant, 20/20 delegate representing Counselors for Social Justice: Difficult is not the word I would choose to describe the process. Rather, the process was intensive in that it required depth of thought, understanding and respect for others who may not share my professional worldview.

Thomas Clawson, 20/20 delegate representing the National Board for Certified Counselors: Because most of the organizations involved in this process represent differing missions, the consensus approach was tedious but elegantly handled by the Delphi voting procedure. Organizations that represent a specific type of counseling or philosophy of practice were challenged to help create a definition that didn’t need to mention some part of each group’s passions.

Is it the last of such definitions? I assume that the profession will make changes in our definitions over time.

Lynn Linde, ACA president and member of the 20/20 Oversight Committee: The delegates had to put to the side aspects of counseling that are specific to their practice/area of expertise or interest to get to the shared or common core. That was a bit harder for the delegates to do, but they did it.

Why is it important to have a common definition of counseling?

Bradley Erford: This definition of counseling was developed to communicate what we do to external publics: clients, politicians, citizens, businesses and organizations. I think one representative said it best: "We need a clear, concise statement of what we do that I can communicate to a legislator in the elevator between the first and second floors." I think we accomplished that.

Carol Bobby: If the counseling profession wants to be understood by the public, we have to find ways to communicate who we are and what we do in a consistent and unified fashion. I have been to numerous meetings over the past 20 years where legislators, in particular, have told us that we need to speak with a unified voice. If we are seen as a fractionalized group of professionals that compete against each other, we will be treated as such. We are stronger when we work together for recognition.

S. Kent Butler: The common definition allows our various disciplines to embrace a common vision and meaning for the work that we all do. The definition does not limit our ability to advocate for our own personal niches, but it empowers counselors as a whole and helps us challenge opponents who question or don’t find value in the service that we, as helping professionals, provide to our constituents.

Lynn Linde: It is important for counselors to be able to speak with a unified voice and to be able to share a common vision for what we do. Otherwise, our stakeholders, the public and others become very confused about the different words that are used. We confuse the public and our supporters when we use different words to describe what we do, and from a public policy and legislation perspective, it makes it very hard to advocate.

Sam Gladding: The word counseling is "sexy," and people from many different walks of life are tempted to use —#8212; and, often, abuse —#8212; the word. A common definition of counseling gives associations inside and outside of ACA a tool they can employ to clarify what counselors in various settings do. Such a definition is important for moving the profession forward. Counseling too often has been fragmented and unfocused in helping others understand what the profession does. This definition should help all of us advocate for clients and for what we do as a profession to make the culturally diverse society we live in better.

In what ways does this definition help counselors stand apart from their colleagues in other helping professions?

Carol Bobby: This definition has many important elements that acknowledge who we are apart from other professions. First, it includes the mental health and wellness components that we have emphasized. Just saying these words out loud differentiates us from professions that focus on illness and disease. Second, it acknowledges our history, because we continue to believe in the importance of examining the educational and career goal components of those who come into counseling. Third, the word empower that is used in this definition is a key element, because it implies the belief that through the counseling relationship, clients will learn to be self-advocates.

Lynn Linde: This definition emphasizes wellness and the developmental nature of counseling, as well as personal, educational and career foci. Other mental health professions have more of a remediation of illness focus. The definition also encompasses the focus on empowering our clients and diversity, which is more specific to counseling than other mental health professions.

Bradley Erford: It covers all of the major influences on the professional counselor’s identity: empowerment, diversity, wellness, mental health, educational and career planning. These are the cornerstones of any counselor’s professional training. Other disciplines may claim some of these areas, but all professional counselors embody each of these facets.

Thomas Clawson: The definition says that we are a mental health, not a mental illness, profession. The developmental approach sets us apart from other mental health professions.

Rhonda Bryant: We actually discussed this as the definition was developed. Our definition does not explicitly address multiculturalism or the role of social justice. Unfortunately, we stand apart from other colleagues in this omission. Other helping professions address social justice and multiculturalism as inherent to the helping process.

Other thoughts

Rhonda Bryant: Getting to know the representatives of the multiple organizations participating on the 20/20 committee provided insight as to how our profession is shaped by collaboration and partnership. I hope that as we move forward, the definition will continue to engender discussions and strategies about how professional counselors can assist our clients in meeting life goals and dreams.

S. Kent Butler: Trust the process!

Thomas Clawson: The definition of counseling is a statement that allows the group of 30 organizations to proceed on to the more action-oriented part of the 20/20 process —#8212; the seven areas of action that the group has established. The signature of 20/20 will be the larger body of work, not the final definition.

Lynn Linde: I think the delegates should be very proud of the work they did. The entities represented have made this a priority and given their support over the past five years. It is truly remarkable that we were finally able to get to this point.

Sam Gladding: We will poll the delegates to see where they want to go next. We have based our work on seven agreed-upon principles that give us direction. They are as follows:

I. Sharing a common professional identity is critical for counselors.

II. Presenting ourselves as a unified profession has multiple benefits.

III. Working together to improve the public perception of counseling and to advocate for professional issues will strengthen the profession.

IV. Creating a portability system for licensure will benefit counselors and strengthen the counseling profession.

V. Expanding and promoting our research base is essential to the efficacy of professional counselors and to the public perception of the profession.

VI. Focusing on students and prospective students is necessary to ensure the ongoing health of the counseling profession.

VII. Promoting client welfare and advocating for the populations we serve is a primary focus of the counseling profession.

Whatever we do in the future will be based on these principles.

I have loved working with the 20/20 group. There is a lot of energy and constructive thinking within the group. The work of this initiative is important —#8212; indeed, essential —#8212; to the future of the profession of counseling.

At press time, a letter had been sent asking all organizations participating in the 20/20 initiative to endorse the consensus definition of counseling arrived at by the delegates. For more information on 20/20, including participating organizations and delegates, background on the initiative, the complete Statement of Principles and concepts for future exploration, click on the "20/20: A Vision for the Future of Counseling" button on the ACA home page at counseling.org.

Jonathan Rollins is editor-in-chief of Counseling Today. Contact him at jrollins@counseling.org.

Leadership and volunteer appreciation

Richard Yep June 1, 2010

Richard Yep

Each June, the American Counseling Association comes to the close of its fiscal year, but more important, we begin the transition from one leadership group to another. For the past 12 months, the ACA staff and I have worked with a group of highly dedicated volunteers who truly have the best interests of the profession in mind. These leaders have chosen to commit their time, energy, ideas and hard work to advance the mission of our association and to enhance the counseling profession.

Although a new group of leaders is standing at the door ready to take on the challenge of a new year of service, we would be remiss if we failed to acknowledge those who served with such distinction this past year. To the thousands of volunteer leaders at the state, regional, division and national levels, I want to personally thank you for making this a successful year in so many ways.

ACA’s membership numbers are at their highest point in several years, we had an outstanding turnout at our Annual Conference in Pittsburgh, and participation in our blog, podcast series and online education offerings grew to new levels. Last summer, we launched the ACA Institute for Leadership Training, which brought together counseling leaders from all over the United States for training, networking and conversations with public policy officials on Capitol Hill. And, of course, we finally saw the fruits of our labors when California became the final state to enact a counselor licensure law. As we look ahead, this year’s leadership has been instrumental in laying the groundwork for future success on behalf of the profession, as well as on behalf of those whom our members serve.

We are certainly thankful for all ACA members’ support for the good things we have accomplished throughout the past year. We also appreciate the work performed by the ACA staff. However, I want to reiterate my thanks to the leadership teams at all levels for the efforts they have made to move the agenda forward. To those of you who served this year as volunteers and leaders, thank you.

As the executive director of ACA, I have the good fortune of working closely with our volunteer leadership team. One of the closest working relationships is the one I have with the ACA president. This year, our association benefited greatly from having Lynn Linde serve as our chief elected officer. Lynn brought to the table decades of experience as a competent, dedicated and compassionate leader. Regardless of the situation, challenge or crisis, she was there to support staff and leaders. At this point in our history, Lynn was the right person at the right time to lead ACA. She has been, in a word, unflappable. She never lost her cool and was always the first to show her support and appreciation for those around her.

Few members realize how much work the ACA president does during her or his term of office. However, as the organization’s executive director, I am keenly aware of the sacrifices made by and the energy required of our top elected officer. I personally have come to depend on Lynn for many things. Her advice has always been right on target and very much appreciated.

Next month, we welcome a new crew to the leadership team. This column, however, is dedicated to those of you who voluntarily agreed to serve this past year — another year in which ACA grew and thrived. You did much more than simply serve as caretakers of a 58-year-old organization. Rather, you have left the association in better shape than when you started. The profession is better and stronger because of your efforts.

Take ownership, take pride and, now, take a rest!

Please contact me with any comments, questions or suggestions that you might have via e-mail at ryep@counseling.org or by phone at 800.347.6647 ext. 231.

Thanks and be well.