Monthly Archives: September 2010

Strength in numbers

Lynne Shallcross September 22, 2010

“Your father’s a jerk.”

In many elementary schools, such a comment might be rewarded with a swift trip to the principal’s office. But in Janice DeLucia-Waack’s group for children of divorced parents, the statement stood as nothing short of a breakthrough.

DeLucia-Waack, associate professor and program director of school counseling in the Department of Counseling, School and Educational Psychology at the University of Buffalo, SUNY, had played a song called “Is It My Fault?” for her group of second-graders. When the song was finished, she asked the kids whether any of them thought their parents’ divorce was their fault.

One hand shot up. “I know it’s my fault,” the little boy said. “My father tells me it is every Friday when he picks me up from school.” Before DeLucia-Waack could swallow the lump in her throat, one of the other group members spoke up with unabashed honesty. “Your father’s a jerk,” the boy’s peer told him. “When you get in the car on Friday, you tell him big people don’t get divorced because of little kids.”

Realizing he was the only one who had responded to his peer’s painful admission, the group member caught himself and said, “Well, that’s my opinion. Everyone else should give their advice, too.” After the other kids in the group added their own words of advice, the boy who felt at fault for his parents’ divorce practiced a few phrases out loud to say to his father.

The following week, the boy reported back to the group. No, he hadn’t told his dad he was a jerk, but he had conveyed the message loud and clear. “When you say that to me, it makes me feel really bad,” the boy told his father. “And I’d like you not to say that to me anymore.”

It was a poignant moment exemplifying the power of groups, says DeLucia-Waack, a member of the American Counseling Association and a past president of the Association for Specialists in Group Work, a division of ACA. “I could say to this kid 10 times, ‘It’s not your fault,’ but the other kids told him, and they told him clearly — ‘You need to say something to your dad.’”

Clear data exist that groups are more effective than individual therapy for children and adolescents, according to DeLucia-Waack, who consults for school districts across New York state on how to lead psychoeducational groups, among other things. In these psychoeducational groups, kids learn skills such as anger management, stress management, coping, communication, problem solving and conflict resolution. “We’re teaching a set of skills that they’re going to need for the rest of their lives,” DeLucia-Waack says.

Although the research differs on group effectiveness for adults depending on the type of group and intervention, many practitioners agree that group work is a valuable tool. ACA member Michael Kahn regularly runs personal growth groups that incorporate film out of his private practice in Charlotte, N.C. At the first meeting, he asks each group member to bring in and share with the other members a movie clip that resonates with the individual in some way. Throughout succeeding group meetings, Kahn assigns particular movies to watch, and group members discuss aspects of these films. Kahn says he looks for movies that have multiple story lines and an array of characters, such as Dead Poets Society or Fried Green Tomatoes, so there’s a good chance that some part of the story or characters will resonate with clients.

Kahn, who also uses film in workshops he offers for other therapists on ethics, grief and self-care, recalls one group member who watched a movie and returned to tell the group she hated it but couldn’t figure out why. After the group discussion, she realized the film spoke to an experience she’d had as a teenager that she’d never shared with anyone. Films often provide a certain level of safety that allows clients to share, Kahn says, because when clients talk about a movie, they are in some ways “removed” from themselves. But at the same time, he says, the right movie can effectively address issues in clients’ lives. “Film just has a way of winding its way past some of the defenses we have set up as individuals and can bring up other things [clients] were pushing away or things they didn’t know were there.”

In Medford, Ore., Jeff Borchers coleads groups through an employee assistance program (EAP) at Asante Health System. An ACA member who also maintains a private practice in Medford, Borchers says his groups are composed mainly of overworked nurses. “Nursing is the place where the rubber meets the road,” he says. “[Nurses are in] extremely stressful positions, and every year, they’re asked to do more with less.” Borchers’ groups, which average about 12 members, are heavily focused on psychoeducation and conflict management.

Many times, Borchers says, the groups are convened over a clash of new versus old — new nurses who are feeling overwhelmed reacting to more experienced nurses who have been on the job for many years and might be case-hardened and gruff in their personal skills. The nursing profession has changed quite a bit through the years, Borchers says, focusing more on quality patient care at the interpersonal level, which involves a more respectful way of communicating.

“There can be a lot of tears and heartache over that,” Borchers says. “Older nurses came up in a completely different environment. It’s a clash of cultures and a clash of generations. The way to resolve it ultimately comes down to empowering the younger nurses to be able to speak up and take a stand when they feel they need to and educating the older nurses on a different style of communicating.”

You are not alone

In addition to psychoeducational groups such as Borchers’ and DeLucia-Waack’s, ASGW identifies three other types of groups: task groups, counseling groups and psychotherapy groups. No matter the group’s purpose and nature, counselor practitioners agree the benefits can be wide ranging.

In addition to his film group, Kahn runs a group called Empty Arms at a local agency for parents who have experienced a miscarriage, a stillbirth or the death of an infant. Groups often focus on topics such as anger, relationships with friends, thoughts of having another child and spirituality. Kahn says the biggest benefit the group provides is a safe place where members will be understood. “They’re with a group of people who get it, who understand what this loss means, who understand that it is a loss,” he says. “They don’t have to explain themselves or defend themselves.”

The group can be especially helpful to those dealing with miscarriage, which parts of society don’t view as a legitimate loss, Kahn says. As an added benefit, group members can see what other mothers and fathers are going through, giving each individual a better perspective on what his or her own spouse might be experiencing. “To be around other folks who are experiencing the same thing gives them so much relief,” Kahn says.

Larry Tyson, associate professor and program coordinator of the University of Alabama at Birmingham Counselor Education Program, agrees that groups are effective in defraying feelings of isolation. “It allows clients to realize that they obviously are not alone in their situation or their dilemma. They are able to listen to people who have similar issues and struggles, as well as similar successes or possible successes.” Tyson, a member of ACA, says groups have the added advantage of offering multiple perspectives rather than the sole perspective of the counselor provided in individual counseling.

Another welcome by-product of group work is the confidence clients can gain from helping their fellow group members, Tyson adds. “It can allow people to serve as models for other folks who might not be at the same place that an individual is. They can share their experiences with other people. They can talk about the struggles or the successes they have had. So just as for the person who’s hearing this, for the person who’s talking about it and sharing, it allows them to acquire a sense of enhanced esteem. It gives them increased awareness of their own self and possibilities because they’ve been down that road.”

Loriann Oberlin, who works in private practice in North Potomac, Md., has experience running various types of groups, including groups for high school girls, women and elementary and middle school children, as well as separation and divorce groups for adults and children. “For children or teens trying to connect in a world where they may feel on the outside looking in, group therapy allows them that chance to feel accepted and understood and to make social mistakes but to also have thoughtful corrections and chances for a ‘redo,’” says Oberlin, an ACA member. “Adults, after working for a while with a therapist, may wish to move beyond one-on-one counseling and solicit peer feedback and connections. They usually feel good as well when they contribute to the group’s process and know they’ve helped a member in some particular way.”

Oberlin points to Irvin Yalom’s therapeutic factors of group therapy, which, she says, explain the benefits that group work can offer. Among these are improved social skills (group members hear feedback on how they come across to others) and instillation of hope (members find through group peers that there is hope for their situation). Another factor, Oberlin says, is universality, or the feeling that “we’re all in this together.” The information-giving aspect of groups helps clients learn from one another, while the altruism factor offers each person a chance to help their peers within the group.

Borchers, who has also been exposed to the positive power of groups during his three decades as a karate instructor, has witnessed powerful transformations at the group level that he doubts would have transpired in a one-on-one setting with a client and a counselor. For one thing, there’s safety in groups, he says, because clients can “lay low” if they feel it necessary. But groups also offer the added benefit of multiple perspectives and life experiences, allowing a client to share what he or she is going through and to hear varied feedback. “To have it come from a group, particularly someone who’s struggling with the same issues you are, that power can’t be duplicated in individual therapy,” Borchers says.

Shedding light on challenges

Oberlin has found group therapy to be particularly beneficial for children and teens with social skills deficits, learning challenges, slow processing speeds, attentional concerns, anxiety or mild to moderate mood disorders, as well as those going through situational stressors, such as their parents’ divorce.

“For adults,” she says, “[groups] can help through a situational stressor such as divorce or life transitions, as well as lack of connection, low self-esteem and for obtaining skill sets — dealing with difficult people, learning to be assertive, overcoming anxiety and sadness.”

Tyson agrees that group work has an array of benefits for diverse client populations, ranging from elementary school students to inpatient residential treatment clients. But it’s crucial, he emphasizes, that the therapist consider the emotional stability and cognitive ability of each potential member of the group. “Good group therapists know that evaluating and screening potential members is always helpful.”

Even group work proponents question the effectiveness of groups with clients in crisis. “If [clients] are needing the focus to be very much on them because they’re in a place of crisis or their needs are such that they would have a difficult time having the spotlight focused on other folks, then individual [therapy] would probably be the right way to go,” Kahn says. DeLucia-Waack, an ACA fellow, agrees. Anyone who is actively in crisis or suicidal is not a good candidate for group work, she says, adding that clients must have the capacity for introspection to be in a group.

For all its benefits, experts acknowledge that group work also poses some challenges. One of the toughest might come at the start — finding enough clients to put a group together. Sometimes, Kahn says, fellow therapists might overlook groups as a resource and refer their clients elsewhere, so it’s up to counselors who lead groups to keep their work in front of their peers. Social/professional networking sites such as LinkedIn are one possible way to let colleagues know about the groups you offer, he says.

Getting clients to show up is a challenge shared by individual and group therapists, Tyson says. Of course, a no-show in group work affects not just the individual client but fellow group members. If a client is habitually late or misses multiple sessions yet maintains he or she is committed to the group, Tyson suggests that confrontation at the group level can be helpful. Tyson says he would ask the group’s members whether they think the client is committed to the group in light of that individual’s actions. Let the group, rather than the therapist, confront the client, he advises.

“For me, one of the challenges — though I try to head it off with a good discussion and handout about groups beforehand — occurs when parents of group members, or even adult group members themselves, decide they will no longer be in group and they don’t wish to plan their last day in group,” Oberlin says. “Instead, they make the decision and sometimes inform the leader the same day as members.” That doesn’t allow for proper termination, she says.

Although many clients and parents of clients respect the rules Oberlin sets out at the beginning of the group, some don’t. “It can come across negatively to terminate abruptly,” she says. “These clients don’t recognize how such a quick decision impacts others. In one case, a girl came back to group the next week in tears because she really felt connected and understood by this person [who left the group suddenly]. It was all so quick and should have been planned better for all concerned.”

Clients’ individual issues can also pose challenges when putting people together in a group setting, Tyson says. That’s why it’s extremely important for the group leader to understand what each client is bringing to the table, he says. For instance, if a client is particularly manipulative in a one-on-one setting with a counselor, the counselor can confront the client about it and they can examine the issue together. But if that client enters a group setting, the manipulation can affect everyone. “Everything is multiplied by the number of people you have in the room,” Tyson says. Rather than the group leader intervening in a circumstance such as this, Tyson recommends letting group members talk about what’s impeding their progress and encouraging everyone to participate in overcoming the problem.

In school settings, time is of the essence and can therefore be a hurdle to effective group work, DeLucia-Waack says, adding that it is essential to have teachers, principals and other school personnel who are flexible. Educating people about the benefits of group work is another challenge, DeLucia-Waack says. “Sometimes people feel like it’s second-rate therapy,” she says. Clients themselves might question why they are being put into a group when a counselor could work with them one-on-one and give their issue undivided attention. “You have to do a lot of education for people as to why, sometimes, groups are even more effective,” she says.

Getting started

Tyson, who coedited Critical Incidents in Group Counseling, published by ACA in 2004, remembers having a strong interest in groups almost from the outset. “I noticed that about myself early in my career, that while I liked individual counseling, I was also fascinated with how people interacted in a group.” He believes that possessing a high level of interest is crucial to being an effective group leader. Although counselor educators can teach students group skills, he advises counselors-in-training and established practitioners to make sure their heart is in group counseling before following that path.

For counselors innately interested in group work, Tyson says the first step is educating themselves. He says running successful groups requires a specific skill set in terms of theoretical orientation, techniques used in a group setting, expected outcomes and the skills required to address the specific issues that clients bring with them to group. “Being a group therapist requires a whole different set of skills — some complementary to individual but [others] additional to individual. You just can’t go out and do group therapy.” The difference between individual and group counseling, Tyson says, is related to managing a set of individuals who might have a common issue but also possess different methods of processing information, sharing thoughts and feelings, and accepting feedback.

Borchers agrees. “The skill set for group work includes, among other things, a subset of what I’d call leadership and team-building skills. That’s because I believe the therapeutic alliance, once made, is often best spent in motivating clients toward change. In individual counseling, it’s usually the therapist’s job alone to provide that kind of incentive. But in groups, there’s always the possibility that motivation comes from another elsewhere in the group. I believe Yalom suggests that we facilitators look for a natural leader to emerge — one who allies with the therapist. Whether this happens or not, our job is to prepare the seedbed for unexpected growth, however chaotic it may appear at first.”

ASGW President Bogusia Skudrzyk, associate professor in the Fairfield University Counselor Education Department, likens the skills needed to lead a group to those needed to lead an orchestra. “Perhaps as group leaders, we are somewhat like conductors who facilitate the rhythm and the beat, as it is up to each group member to give voice to their experiences,” she says. “So, just because someone knows how to play an instrument very well does not mean that he or she can immediately become a conductor. The ‘how’ of group work is equally important to what happens and what we need to know and do.”

At times, counselors might be thrown into the deep end with group work before they’re ready, Tyson says. “What I have found as a counselor educator and as a practitioner is that there are a lot of people who maybe only have one group class and are called upon in their work environment to lead groups. I’m not convinced that’s what you need. People who lead groups and want to do it well have to really work at becoming a good group facilitator. And that requires more than just one course in your master’s degree.”

Tyson remembers an instance in which one of his school counseling interns told him that another intern on the same project site from another university was running a group for children who were displaying self-injurious behavior. “The issue, to me, was how competent are you to run that kind of group?” he says. “Not just in group counseling techniques, but what do you know about that group? Do you feel trained to understand the psychology of that group of people? Being competent about your techniques and the population you’re serving is very important. If you’re not competent, try not to run the group until you become competent.”

Tyson and DeLucia-Waack agree that ASGW is a particularly helpful resource for counselors interested in or already doing group work. DeLucia-Waack points to three sets of standards — training standards, diversity-competency standards and best practices — available as free downloads on the ASGW website at asgw.org. ASGW has also worked with ACA to produce activity books, DVDs and other literature to help counselors, says DeLucia-Waack, who coedited the revised edition of Group Work Experts Share Their Favorite Activities: A Guide to Choosing, Planning, Conducting and Processing as well as School Counselors Share Their Favorite Group Activities: A Guide to Choosing, Planning, Conducting and Processing.

Counselors should also take continuing education classes and workshops and consistently reflect on their progress, Tyson says. In addition, many ACA members and other professionals in the field are highly acclaimed group therapists, Tyson says, so it would pay for counselors interested in group work to identify those experts and read their work. Then, he says, counselors should secure supervision. “Find someone you can talk to who is an experienced group leader and whom you can relate to,” he says. Another helpful tactic, DeLucia-Waack says, is for newer group counselors to colead groups with more experienced professionals.

Nothing can replace the value of practice and supervision when it comes to group work, Tyson says. “You have to get on the bike and do it. You’ve got to practice. You’re going to mess up, but you still have to get on the bike again.” Getting past the initial hesitancy to lead a group is a big step, he says, and that is exactly where supervision comes in, because the relationship allows a new group counselor to talk with an expert about what goes on in the group.

“Let the challenges be your teacher,” Skudrzyk says. “And find a mentor. Someone who is wise, honest and has an open heart, preferably through group work mentoring, too, so that we can keep learning about how we need to keep on changing without ever giving up who we are.”

Effective group leadership

The first piece of advice DeLucia-Waack gives to counselors who are ready to lead groups: Be yourself. “If you’re not genuine, particularly with adolescents, they won’t believe you and they won’t engage with you.” DeLucia-Waack remembers showing her true colors and singing along to some of the songs that were being played during a group session for fifth-graders. The verdict on her vocal skills? The kids laughed at her.

Instead of feeling embarrassed or choosing to suppress her singing, DeLucia-Waack remained open and genuine with the group members, telling them that she really enjoyed singing even though she was bad at it. What resulted was a great conversation about various things the kids didn’t think they could do well but wanted to do regardless. “Those are kind of teachable moments in that way,” she says.

Oberlin says counselors should understand up front that group work is time-intensive. It goes well beyond getting a group together, putting a board game in front of group members and seeing where it all leads, she cautions. “It’s not for someone who doesn’t wish to put planning into it. And, of course, there are progress notes for each individual and claims if you submit to insurance. There’s much time spent organizing, with phone calls to establish a group and extra work if you must cancel or call it off.”

Being even-keeled is another quality that helps in leading a group, Borchers says. “Staying centered and calm is a crucial ingredient to this work, particularly if you’re new to it.”

But there’s no substitute for being prepared, he says, both emotionally and for your clients in their environment. For example, when running EAP groups, Borchers says it’s imperative that he knows who the group members are and what they do in their jobs, the stressors present in their workplace and the specialized language they use in their jobs. “Groups have the ability to set their own pace, so you don’t want to be behind the eight ball on what’s going on,” he says. “If you can’t follow the thread of an argument, you can’t offer much in the way of a resolution.”

Although many counselors might have learned from counseling models not to provide too much structure for clients, DeLucia-Waack believes it’s important to have adequate structure in group work. This allows clients to feel safe and see how groups work while still giving them room to progress, she says.

All of DeLucia-Waack’s groups have an opening segment, a working session and a closing. Groups start at the same time each session so clients will learn quickly that if they’re late, they’ll miss something, she says. Having the closing is helpful because group members learn not to introduce new issues shortly before a group meeting is set to end. That’s part of providing a sense of safety for clients, DeLucia-Waack explains, because they know no one will say something provocative at the very end of the group and get out the door before it can be addressed.

Having an impact

Looking back, Tyson says, “I wish I had realized earlier in my career the power that comes from people being in groups — the power in terms of what they can learn.” After the initial nervousness wears off for clients in a group setting, they share more and risk more, he says. As they receive input from their fellow group members, they go out and try those new ways of thinking or acting in the world. Then they often come back and talk about that experience within the group. “That, to me, is growth, and as a therapist, that’s huge,” Tyson says. “That’s what I wish I had learned earlier on — the power that groups can give people and the impact a group can have.”

Kahn says he loves to see the community created among group members as they learn from one another, reach out to one another and lean on one another. For counselors wondering what kind of impact their group is having on members, Kahn recommends scanning the parking lot after a meeting. It’s a great sign, he says, to look out his window after a session and to see clients chatting with one another in the parking lot instead of hopping in their cars immediately and speeding away. Kahn and one of his colleagues have coined the phrase “parking lot moments” to describe what happens if a group is really clicking.

“To me, it means that the support, the bonding and the community that you’re hoping is being created as a therapist has legs,” Kahn says. “Rather than them all leaving the group and getting in their cars and going off to their separate worlds, the fact that they’re continuing to connect outside the group [is evidence of] the strengthening of the community.”

Just because a community is being formed doesn’t mean that all the clients’ problems are being resolved, Kahn says. But simply feeling less isolated can be a big win for many clients, he says. “To know that they’re starting to reach out to folks who were strangers just a few weeks ago is really powerful and rewarding as a therapist.”

As Kahn and his colleague say to each other, when it comes to group therapy, “The more parking lot moments, the better.”

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

Letters to the editor: ct@counseling.org

Group work resources

All of the following books and DVDs can be ordered directly through the American Counseling Association’s online bookstore at counseling.org/publications or by calling 800.422.2648 ext. 222.

  • Group Microskills: Culture-Centered Group Process and Strategies (order #72872), by Allen E. Ivey, Paul B. Pedersen and Mary Bradford Ivey, provides a foundation for training culturally competent group leaders ($49).
  • Critical Incidents in Group Counseling (order #72812), edited by Lawrence E. Tyson, Rachelle Pérusse and Jim Whitledge, provides a means to explore the difficult decisions that group leaders face and the learning opportunities they create for further discussion ($29.95 for ACA members; $44.95 for nonmembers).

The following resources are produced by the Association for Specialists in Group Work, a division of ACA:

  • Group Work Experts Share Their Favorite Multicultural Activities: A Guide to Diversity-Competent Choosing, Planning, Conducting and Processing (order #72891), edited by Carmen F. Salazar, features contributions from experts in group work, multiculturalism and social justice ($35 for ACA members; $45 for nonmembers).
  • School Counselors Share Their Favorite Group Activities: A Guide to Choosing, Planning, Conducting and Processing (order #72885), edited by Louisa L. Foss, Judy Green, Kelly Wolfe-Stiltner and Janice L. DeLucia-Waack, offers 67 group activities for working with children and adolescents in schools ($35 for ACA members; $45 for nonmembers).
  • Group Work Experts Share Their Favorite Activities: A Guide to Choosing, Planning, Conducting and Processing, revised edition (order #78070), edited by Janice DeLucia-Waack, Karen H. Bridbord, Jennifer Sue Kleiner and Amy G. Nitza, presents more than 50 creative group activities ($35 for ACA members; $45 for nonmembers).
  • Celebrating Cultural Diversity: A Group for Fifth-Graders (order #78215), presented by Sheri Bauman and Sam Steen, is a DVD with a complete recording of a six-session counseling group with fifth-grade students ($199).
  • Leading Groups With Adolescents (order #78208), presented by Janice DeLucia-Waack, Allen Segrist and Arthur M. Horne, is a DVD showing nationally recognized group experts working with high school students ($199).
  • Group Work: Leading in the Here and Now (order #79816), presented by Peg Carroll, is a DVD demonstrating how group members learn to participate in the “here and now process” ($150).
  • Developmental Aspects of Group Counseling: Process, Leadership and Supervision (order #79817), presented by Rex Stockton, is a DVD presenting three easy-to-teach segments on the most critical areas in group counseling ($150).

In addition, membership in ASGW offers a wide range of other resources and benefits, including the Journal for Specialists in Group Work. For more information, visit asgw.org.

Livelihoods and cultures in crisis

Lynne Shallcross

The tragedy began April 20 when the Deepwater Horizon oilrig exploded about 40 miles southeast of the Louisiana coast, killing 11 crewmembers. Crude oil began flowing freely out of the deep-sea well, and BP, the oil company giant that leased the rig, was unsuccessful in its attempts to cap the well until mid-July. At press time, work continued on a relief well, which officials say is the only way to permanently stop the flow of oil from the ruptured well.

According to government estimates, this is now the largest accidental release of oil into water in history. The final toll the millions of barrels of leaked oil will have on the surrounding ecosystem is still unknown. Also unknown, counselors say, is the exact toll this crisis is taking on those who live in the region and rely on the Gulf Coast for their livelihood.

In July, Louisiana Department of Health and Hospitals Secretary Alan Levine wrote a letter asking BP America to provide $28.9 million to support mental health outreach activities through the Louisiana Spirit program, as well as services through local districts and nonprofit partners through October 2011. "Counselors on the ground have been reporting increased signs and symptoms of behavioral health instability that experience demonstrates will manifest into more clinically significant behaviors if left untreated," Levine wrote. "The net result could be a preventable tragedy if we do not work together to ensure we address it head-on."

In a prior letter to U.S. Health and Human Services Secretary Kathleen Sebelius, Levine also pointed out the urgent need for mental health services. "Our Louisiana Spirit crisis counseling teams have already engaged and counseled more than 2,000 individuals and are reporting increases in anxiety, depression, stress, grief, excessive and earlier drinking and suicide ideation," he wrote. "Community-based organizations report similar findings. We know that, left untreated, these symptoms can quickly develop into behavioral health problems that lead to the breakdown of the familial structures, domestic violence, abuse and neglect."

The residents of Houma, La., which bills itself as "The Heart of America’s Wetland" in its tourism materials, have been hit particularly hard by the disaster. Carol Benoit, a counselor in private practice in Houma, is already seeing the oil spill’s effects on her clients. Since May, Benoit, who works with children, families, couples and adults, has witnessed an increase in behavior problems in several children, including more frequent tantrums and more severe outbursts. "The anxiety level of some of the adults I see is markedly increased," adds Benoit, a member of the American Counseling Association. She has also noticed an increase in depression and suicidal ideations among clients, as well as an increase in drug use and domestic violence among clients with prior histories of those behaviors.

"For the adults, the oil spill represents another crisis in a string of crises including [Hurricanes] Katrina, Rita and Gustav, all of which had significant impacts here — flooding, threat to basic safety, etc.," Benoit says. "All of these crises occurred at the same time of year — summer." Summer is extremely hot, and residents constantly worry about the "next big storm," she says. Many people live under constant pressure, feeling an ever-present need to save money, have a backup plan ready and remain prepared to evacuate on short notice. "Many of the children I see are afraid of bad weather because of the destruction they have seen," Benoit says. "Also, they sense the anxiety of their parents and other adults. That is how it is in the ‘best of times.’ Now imagine all of that with [the oil spill] crisis on top."

The oil spill represents a severe financial threat to residents, Benoit says, because the community is losing two industries that serve as main sources of employment: seafood and oil production. Benoit notes that the flag of Terrebonne Parish, where Houma is located, features an image of a shrimp boat and an oil well. "How bad it will get as far as the economy is an unknown factor," she says. "Unknowns are very anxiety-producing because people cannot prepare for what they do not know. What they do know is that people are losing their jobs."

Margaret Songe, an ACA member who worked as a counselor intern for Terrebonne Mental Health Center in Houma until this past spring, says when livelihoods are affected, it sets off a chain reaction. "Maslow’s hierarchy of needs starts with survival, and if those needs aren’t met, the other higher needs are not likely to be met either, making for diminished lives in several ways," she says. "Without adequate support from professional counselors, affected people — those seeking/wanting/choosing to get help, of course — may have difficulty responding well to the environment, meaning others around them and themselves."

Asking for help, Songe continues, isn’t an easy task. "Our people are self-reliant to a fault, in a way. Pride and shame issues arise when they must get financial assistance or have to fight to get BP and/or the government to pay claims, especially because they often meet with resistance and/or red tape from either or both. Not ‘being heard,’ especially when in a desperate situation, creates depressive symptoms, as well as anger and resentment and, at its worst, ‘learned helplessness,’ when the person or group just gives up [and] stops believing that they can affect their situation at all."

The spill is also a threat to basic safety, Benoit says, because people are afraid of eating seafood due to the possibility of toxicity from the dispersants and oil. "How long will it take to clean up? No one knows. Can it be cleaned up? No one knows. What would happen if or when a hurricane hits now? How much worse would it get? How long will our food supply be contaminated? What kinds of cancers do the toxins cause? Will fertility be affected? These are the questions people are asking," she says.

Much at risk

The oil spill has put the area’s entire way of life at risk, Songe says. "Grand Isle, our beach in the Gulf, has been closed. Seafood is a staple of our diet. Plus, the sports and recreation — swimming, [water-]skiing, fishing — opportunities have been curtailed. This is how we live. Our region’s way of life, including our recreation, culture, diet, entertainment, livelihood and tourism, is threatened, and it has a traumatic affect. We are all directly affected."

Benoit notes that in the Gulf region, eating and catching seafood is an integral part of the distinct Cajun culture. Because part of the cultural heritage involves harvesting seafood and wild game from the surrounding area, there is a deep psychological connection to the wetlands, which are now polluted, she says. "On that level, it is a psychological blow to the cultural identity of the people of the region. We have watched the wetlands wash away despite years of efforts by people here to save the wetlands, and now this. It is as if we are watching the disappearance of our culture."

Another impact less often discussed in the media, Benoit says, is the stress caused in the community by political and social division related to the crisis. "There are various opinions about who is at fault, what needs to be done, what can be done," she says. "So, when people seek support from each other, they often do not find it."

In the aftermath of events such as 9/11, Benoit points out, there was a common enemy. Therefore, most people agreed about who did what and how to respond. "But in cases such as this, it is all very debatable," she says. "This causes conflicts in families and support systems. It is difficult for people to find the kind of emotional support they need while tiptoeing around political hotspots."

Tammy Cheramie, who worked as a school counselor for Vandebilt Catholic High School in Houma this past year, says the trauma doesn’t end with the oil spill and cleanup. The possibility of a moratorium on oil drilling is yet another effect confronting local residents. "The moratorium threat is causing businesses in the oil industry to rethink hiring, drilling and services," says Cheramie, a member of ACA who admits she’s slightly biased because her parents worked in oil-related industries and "big oil" has been good to her family. "It is a trickle-down effect the Obama administration apparently is oblivious to right now. It is affecting an industry already impacted by a bad economy."

Valerie Cooper, a part-time counselor for the Terrebonne Parish Drug Court who also works in private practice, has heard similar worries from her clients. "The clients I see now are anxious due to the uncertainty of job situations," says Cooper, an ACA member who also teaches at-risk high school students who are earning their GEDs. "The oil spill has made a dramatic impact on the fishing/tourist/restaurant business, but the bigger concern now is the moratorium imposed and oil companies looking elsewhere to drill. Clients understand not to expect things from government but are now becoming angry and discouraged and don’t see a future." Cooper says she is expecting to see an increase in drug and alcohol abuse, domestic violence, anxiety, depression and even suicide in the near future.

Jessica Fournier, a school counselor at Houma Junior High School who also runs a private practice in Houma, says the spill has sent shock waves through the community because of the uncertainty surrounding the long-term effects. "The clients in my private practice whom I treated throughout this disaster were not directly affected by the spill but did express concerns about the effects," says Fournier, a member of ACA. "It was and is a topic that everyone discusses. Concerns range from frustration that the spill continued as long as it did [to] the loss of their livelihood and concern over how our environment will be affected in the long term."

Children aren’t spared from the stress surrounding the situation, Fournier says. "I would suspect that our children will be more affected as they are forced to relocate to different schools in order that their parents may earn a living," she says. "Parents may also be more argumentative over the stress this incident has placed on our community."

Fournier predicts the effects on her students will be similar to the post-traumatic stress they experience after the threat or impact of a hurricane. "It is equivalent to an environmental incident beyond our control," she says. "It increases individuals’ feelings of helplessness and hopelessness at the lack of control [we] have on the environment."

Benoit agrees that children are absorbing a lot of the impact from the spill. "They feel, see and hear everything that is going on," she says. "They try to make sense of it. They know something tragic has happened. They know that the adults are worried. They see the adults cry, express anger and have symptoms. And they [the children] worry, they act out, they have trouble sleeping, etc."

Erin Dugan, an assistant professor in the Department of Rehabilitation Counseling at Louisiana State University Health Sciences Center-New Orleans and clinical director at the center’s Play Therapy Clinic, is anticipating an uptick in referrals after schools are back in session. "Due to past history, we saw children emotionally, behaviorally and cognitively process the effects of such an environmental disaster some time after the initial onset," says Dugan, a member of ACA. "After 9/11 and Hurricane Katrina, we saw much emotional, behavioral and cognitive turmoil — depression, anxiety, fear, aggression, anger, frustration, etc. — in the months [following those events]. Schools are currently out and … unfortunately, more children are referred while they are in session due to the emotions, behaviors and cognitions that cannot be allowed to continue in the school setting."

Dugan reports having seen an overall sadness and depression in both parents and children since the spill happened. "However," she says, "it is uncertain whether this environmental disaster has brought about the sadness, depression and anxiety or whether it’s a double-impact/resurfaced trauma from the past natural disaster, Hurricane Katrina or even the economic decline that this country has been affected by over the past several years."

The road ahead

Recent cutbacks in social services further complicate an already tragic situation, Songe says. "There have been articles in The (Houma) Courier, our daily newspaper, asking nonprofessional people to volunteer to counsel and receive an afternoon’s worth of training to assist with the mental health crises caused to our residents by the oil spill. These kinds of actions tend to devalue counseling because they give the impression that anyone can do it — no training necessary." The short-term solution, Songe says, is to help those affected get services from qualified, trained professionals.

Cheramie agrees, adding that the expense of private counselors in a time when families might be slashing their budgets, combined with cutbacks in funding for public mental health services, create a double-whammy for those going through this crisis. "I think counselors and social workers need to go to these people most affected and reach out to them in their communities," she says. "They are going to be too prideful to seek it out. We will have to reach out in churches, schools and community events. Even if we’re doing it pro bono, we are going to have to do what we have to do to get our state through this time and place."

As a result of this disaster, Benoit finds she’s putting in longer hours, fielding more calls and seeing more crisis cases. In an effort to help her clients cope, she tells them to get involved. "There are events at various churches that specifically avoid divisive, political bias and focus on bringing people together to pray for all of the people, animals, wildlife, etc.," she says. She also discourages clients from watching too much media coverage of the spill.

As it concerns children, Dugan recommends that caregivers and schools respect the feelings of their students and are prepared to look at their own mental state before providing support. "Adults should care for themselves in order for the role of the caregiver to be accurately perceived by the child," she says. "The caregiver who appears out of control to the child may allow the child to take on roles, duties and responsibilities that are not appropriate, ultimately causing undue stress, pressure, anxiety, frustration, anger and resentment."

Cooper has attended local, state and parish planning meetings with the Department of Health and Hospitals to create strategies for getting mental health information to the affected areas. "People from these areas are self-reliant, humble and proud and find asking or seeking help of any kind difficult," Cooper says. "Counselors and mental health professionals are being proactive, going into the communities hardest hit [and] bringing information and services to community fairs, concerts and organized events to encourage continued participation in the communities."

In the near term, Benoit believes there is a need for outside help. "I think there needs to be a program such as the [American] Red Cross program that was in place after Katrina. This allowed people to receive counseling services funded by money donated to the Red Cross. Mental health workers here are psychologically tired and need support from counselors who are not living in a crisis zone."

Over the long term, Songe would like to see counselors performing outreach in affected communities, researching mental health needs and fostering cohesiveness among citizens. "But this is a key point," Songe says. "Whatever is done should be done by a professional in the field who knows what to ask and how to help intervene on these folks’ behalf — individually and for families. Especially since this may be a population not accustomed to asking for mental health assistance, it is essential that trained counselors be used — people who know not just how to do interventions, but how to elicit responses from and give support to someone at the same time. Not just someone who pats their hand and says, ‘Everything’s gonna be OK.’ They will certainly see through that and feel dismissed once again."

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

Letters to the editor: ct@counseling.org

Lending a helping hand

Erin Martz, ACA manager of ethics and professional standards, researched the question of licensed professional counselors relocating temporarily to the Gulf region to work with individuals affected by the BP oil spill. She shared the following information:

  • Alabama, Louisiana and Mississippi all have clauses in their rules and regulations that allow counselors licensed in other states to provide services for 30 days without having to notify the state board.
  • Florida has an exemption that allows counselors licensed in other states to practice for 15 days without having to notify the state board.
  • Texas has no such exemption, and counselors cannot provide services unless they are licensed in the state of Texas.

Breaking the cycle of addiction and crime

Chris Morkides September 21, 2010

Bob Houston, 52, has a job in the mental health field.

He has four children, a marriage of five years, an active role in his church, a GED — obtained more than 30 years after dropping out of high school — and plans to become a minister.

Houston had something completely different a decade ago: a drug addiction that caused him to spend most of his adult life in jail, stopped him from getting an education and led to prostitution.

“Heroine, PCP, cocaine, pills. Every drug they made, I think I did,” Houston says. “The longest clean time I had was a month or two. I just couldn’t stay clean. I tried though.”

After an arrest in 2002, Houston was admitted to the drug court program in Prince George County, Va. The program, like many other drug court programs throughout the country, utilizes a special court docket to deal with nonviolent criminal offenses committed by drug-addicted offenders.

A year after entering a program that combines substance abuse treatment, job counseling, the development of social skills and the possibility of jail if the offender relapses, Houston graduated. He has been clean ever since.

“Before, when things came up that I couldn’t handle, I’d pick up a drug or a drink,” Houston says. “Drug court gave me a chance to take a hard look at myself. I got spiritual help. I got professional help. I got a different mind-set.”

Melding of two models

Drug courts have been functioning since 1989 when, in response to a rampant crack-cocaine problem, Miami-Dade County, Fla., started this country’s first drug court to deal with the drugs, the offenders, the social costs and the very, very heavy monetary weight of simply prosecuting drug offenders and throwing them in jail.

Now, some two decades later, more than 2,000 drug courts are in operation nationwide. Measured by reduced rates of recidivism, monetary savings and effective recovery from substance abuse, proponents proclaim drug courts a success story. President Barack Obama’s drug czar, Gil Kerlikowske, views drug courts as a way to “break the cycle of addiction and crime.” The president’s proposed 2010 budget reflects this thinking, earmarking $50 million more for drug courts than was allocated in 2009.

Drug courts essentially meld two different approaches for dealing with substance abuse: the traditional criminal justice model, in which drug addiction is an antisocial behavior best handled by the legal system, and the medical model, in which substance abuse is viewed as a disease to be treated therapeutically so that those afflicted can eliminate drug use and change their lives for the better.

Melding the two models has worked. A National Drug Court Institute study has shown that judge-supervised drug programs lower prison costs and prison overcrowding. A study conducted by the Urban Institute estimated that an expenditure of nearly a half-billion dollars by the United States on more than 50,000 nonviolent drug offenders who went to drug court in 2005 resulted in more than $1 billion in reduced law-enforcement and prison costs.

From a therapeutic standpoint, drug courts help recovering addicts stay clean.

“It’s hard as a counselor to get alcoholics and addicts to stay in treatment long enough to effect change,” says Ellyn Joan Essic, past president of the International Association of Addictions and Offender Counselors, a division of the American Counseling Association. “People might not want to be in drug court, but they’d rather be there than in jail. It gives you time. And once you break that barrier, you see change.”

Change is effected by bringing members of the legal and mental health communities — judges, attorneys, probation officers, case managers and mental health counselors — together. Judges preside, and the efficacy of the process, according to a Department of Justice report published in 2006, depends greatly on the judge’s informal, flexible and hands-on style, the “nonadversarial nature of the proceedings, the frequency of required hearings and the opportunity for direct communication between defendants and the bench.”

A model outlined by the National Association of Drug Court Professionals and the Justice Department in a 1997 report lists the following as key components in the success of drug courts: a coordinated strategy between legal and mental health workers, the integration of substance abuse treatment with justice system processing, use of a nonadversarial approach, early identification and placement of eligible participants, access to continued treatment and rehabilitative services, frequent testing for alcohol and drugs, a coordinated strategy between legal and mental health workers, ongoing judicial action with participants, monitoring of program goals, continued education and partnerships with public and community-based organizations.

“Folks in drug court get a lot of assistance nobody else gets,” Essic says. “You get a full court assessment. You get treatment. You can get housing if you need it and assistance with employment.”

What mental health therapists get is additional time to work with recovering addicts, a luxury not often enjoyed when the incentive to stay out of jail does not exist.

“I know I have longer to work with this person,” says Essic, who advocates the use of cognitive behavioral and reality-based therapy in substance abuse treatment. “I know I can go deeper. I know I can push harder and use more confrontation if needed. They can’t get away from me.”

The bigger picture

Malinda Lamb, the clinical services director for the 6th Judicial District of Correctional Services in Iowa, and ACA member Nicole Pizzini presented on drug courts at the 2008 ACA Annual Conference in Honolulu. Lamb figures that the average client in her district’s drug court program stays 12 to 18 months. She emphasizes rewards, such as birthday cards, 30-day cards for staying clean and certificates for completing various phases of the program, as incentives in her program.

Of course, there is also another major source of motivation. “All of our clients either face prison or do drug court,” Lamb says. “This is the last resort for some people who are longtime users. Under supervision, they get clean time, they do well, they transition. Then we make sure their recovery continues.”

Lamb’s program includes six months of supervised aftercare. “We look at the bigger picture,” she says. “We look at mental health, housing, giving back to the community.”

“It certainly beats the alternative, which is jail,” says Carolyn Hardin, director of the National Drug Court Institute. “You can do jail sitting on your hands. But it’s different going into treatment and addressing issues that led to drug and alcohol abuse. I don’t believe kids, when they grow up, want to be on crack. But something happened along the way. This is something that drug court addresses: what happened along the way.”

Mental health professionals play a vital role in drug court programs, often stepping into settings that address co-occurring mental health and substance abuse disorders. The treatment, a part of clients’ probation, focuses on substance abuse, recovery from substance abuse, issues underlying substance abuse and the intertwined relationship between substance abuse and mental health issues.

Drug court gives substance abusers the incentive or, depending on the speaker’s semantic preference, the disincentive of jail. It gives the therapist additional support. “The therapist knows he has a team,” Hardin emphasizes.

Joe Madonia is the director of the Brooklyn Treatment Court, one of the first drug courts in the state of New York. Madonia’s style? Accentuate the positive.

“Counselors need to focus on a client’s strengths,” says Madonia, a licensed clinical social worker and teacher at New York University who maintains a private practice in Manhattan. “They need to look at the positive aspects of their lives.”

Brooklyn’s drug court emphasizes education, skill building and vocational services. “Some of our graduates have become counselors,” Madonia says.

Madonia says his court follows a “carefully designed list of sanctions and incentives, the last sanction being jail.” He prefers to deemphasize the possibility of jail with clients, but he is fully aware that it provides a hammer that helps him pound home other aspects of his program.

Drug court professionals take incentive where they can find it. “The old saying is, ‘You can lead a horse to water, but you can’t make him drink.’ We try to get them thirsty,” Madonia says.

Bob Houston doesn’t reach for alcohol when he is thirsty these days. Instead, he reaches for his 3-year-old son, Joshua. He reaches for his Bible. He reaches out to others who are battling addiction the way he once battled addiction.

“I’m accountable today,” Houston says. “I take responsibility as a husband and a father. I have steady work. I’m active in the church and in a lot of community projects. My life has changed dramatically. People trust me now.”

Houston gives much of the credit for his solid footing to his experience in drug court. “I wouldn’t be like this [without it],” he says. “I’d probably have the same mind-set that I had then: that I could use drugs and live. But I can’t get high and live. It’s impossible.”

Chris Morkides is a mental health therapist in Wilmington, Del., specializing in co-occurring disorders and anger management. Contact him at cmorkides@aol.com.

Letters to the editor: ct@counseling.org

Learning more

How can counselors get involved in drug courts? Locate drug courts and contacts by accessing nadcp.org/learn/find-drug-court or nadcp.org/learn/state-leaders/state-drug-court-coordinators/current-state-drug-court-coordinators. The National Drug Court Institute offers training to drug court teams, including training for the roles played by treatment providers and counselors. Training offered specifically to treatment providers can be found at nadcp.camp8.org/TreatmentProviders.

Beauty, sadness, laughter, learning

Marcheta Evans September 5, 2010

Have you ever had an experience that was overwhelmingly beautiful and sad at the same time? I just returned from such an experience. I had the wonderful opportunity to spend three weeks on the continent of Africa in the country of Malawi.

Malawi is one of the poorest nations in Africa, and life expectancy is only about 50 years (less than a decade ago, it was barely over 40). The country’s slogan is “the warm heart of Africa,” and I couldn’t agree more with this description. As a counselor, I have worked in some of the poorest areas in the deep South, but I have never in my life encountered such poverty as I saw on my visit to Malawi. At the same time, I have never witnessed such caring and such giving of the little they do have. I experienced this firsthand by the way they gave to me, a complete stranger from the United States.

It is natural for people to be curious when they meet someone different from themselves. In this case, I think it was more of a shock for them to see me than to see the “white” people from the United States. Upon seeing me, they expected me to be Malawian and to speak the native language of Chichewa. When I opened my mouth to speak, they were taken aback, and for a second, they were confused about who I was and what language I was speaking.

I’ll share a funny story that happened when I visited one of the orphan care centers in a very rural village about 15 kilometers from any road. The village chiefs who were there to greet us wanted a private audience with me to verify that I was not Malawian and that I could not speak the language. Once again, when I opened my mouth, it removed all doubt that I might be from their country. As represents the true spirit of the Malawian people, I was immediately invited to return to the village to spend at least five years so they could teach me the language. I laughed, thinking to myself that they must consider me a really slow learner! But in that exchange, they also asked me not to forget about them. As I looked into their eyes, I was moved to tears. There is no way I will forget this experience as long as I have breath in my body.

To see the resiliency of people and to witness how children learned, even in classes of 200 or more, was truly amazing. The students were sitting bunched together on concrete floors, with little or no learning supplies. How could learning possibly occur in such conditions? Yet, somehow, it did. The purpose of my visit was to work with the native educators to develop textbooks and guided supplementary materials for literacy development through a USAID grant, but I walked away forever changed in regard to how I view learning and material wealth.

This month’s Counseling Today cover story focuses on group work. When I first heard the topic, it reminded me of a book I read many years ago called “Why Are All the Black Kids Sitting Together in the Cafeteria?” by Beverly Tatum. Just the title alone reminds me of how we can gravitate toward the familiar and have a tendency to separate ourselves from one another. How often do we take the time to explore outside of our comfort areas? As counselors, we ask our clients and students to expand beyond their comfort groups, but do we actively engage in this type of practice ourselves? Even within our own organizational structure, we could be at risk of perpetuating this separateness if we were to practice “divisiveness” among our divisions and regions.

Thankfully, this couldn’t be further from our goal. In fact, the 2010 American Counseling Association Institute for Leadership Training, which took place in July, embodied collaboration at its best. This is fitting because of the ACA leadership’s emphasis on the importance of working together. In another example, while in Africa, I was able to connect with some of our counseling colleagues in Malawi to discuss ways we might be able to facilitate their growth organizationally. This connection was made possible because of a great collaboration with the National Board for Certified Counselors.

I know how comfortable it can be to connect with “like” people or organizations. That is how we all became a part of this great organization. But we cannot stop there. Professionally, it is our responsibility to explore and expand our worldviews through our active participation with “differentness.”

Your professional association, getting better all the time

Richard Yep September 2, 2010

Richard Yep

When September rolls around, many of us think of it as another “new beginning,” given that it is the start of the school year for many folks. For a number of us who followed a traditional education model, September was when we went “back to school,” which we associated with new clothes, interacting with new teachers and meeting up with friends we hadn’t seen all summer long.

Because I seem to be in this mind-set, I wanted to share what the American Counseling Association has been doing as we “begin” a new year with all of you. Not to sound like an infomercial, but some very positive things are happening at ACA, and I want you to be aware of what your leadership, your staff and your association are involved in.

For instance, toward the end of July, more than 110 leaders from ACA branches, regions and national divisions gathered in the Washington, D.C., area for the second annual ACA Institute for Leadership Training. The event spanned five days and featured networking, professional development, leadership training and resource gathering.

One of the highlights for me was seeing so many professional counselors and counselor educators head to Capitol Hill to talk with senators, representatives and their staffs about the importance of counseling and the need for policy that allows consumers access to the services provided by our members. This was a very powerful experience, and despite a few pre-meeting jitters, your leadership was phenomenal in accomplishing what they did. Kudos to all who attended and participated in the institute. If you ever get a chance to participate in this event, I hope you will do so. The next one is scheduled for July 27-31, 2011, also in the Washington area.

We also realize that extended periods of travel away from your students and clients are not always feasible. We have listened to those of you who want more continuing education opportunities, and I am glad to report that during the current fiscal year (July 1, 2010, through June 30, 2011), you will have an even greater number of chances to obtain CE credit through ACA. In fact, as the year progresses, you will see that our podcasts will be eligible for CEs, so check our website and take the time to download something from our ever-growing podcast library.

During 2010-2011, ACA will publish a number of new books. Included in those releases will be:

  • Play Therapy: Basics and Beyond, second edition, by Terry Kottman
  • Counseling as an Art, fourth edition, by Sam Gladding
  • Integrating Spirituality and Religion Into Counseling, second edition, edited by Craig Cashwell and Scott Young
  • Experiential Activities for Teaching Multicultural Competence in Counseling edited by Mark Pope, Joe Pangelan and Angela Coker
  • Counseling Children: A Core Issues Approach by Richard Halstead, Dale Pehrsson and Jodi Mullen
  • Group Work and Outreach Guide for College Counselors edited by Trey Fitch and Jennifer Marshall
  • Developing and Managing Your School Guidance and Counseling Program by Norm Gysbers and Patricia Henderson

I encourage you to check the ACA website so you can be the first to know when a book is released. The new and improved ACA Publications Catalog was packaged with the issue of Counseling Today you are now reading.

We are also very excited to return to New Orleans for the ACA Annual Conference & Exposition (March 23-27, 2011). Recently, we were able to confirm that our opening keynote speaker will be CNN reporter Soledad O’Brien, and our second keynote presenter will be Dr. Judith Beck of the Beck Institute for Cognitive Therapy and Research (for more on these speakers, turn to page 50). Add to that more than 400 education sessions, along with a very special community project that you will be hearing more about, and I think we can all agree this will be one ACA Annual Conference that should not be missed. Next month, look for the ACA Annual Conference Advance Registration Brochure (packaged with Counseling Today) for more details!

With all that we work on, I realize we don’t always take enough time to celebrate the “good times.” So, if I may brag on ACA a bit, our membership at fiscal year end (June 30, 2010) was the highest it has been in five years, and your official ACA magazine, Counseling Today, recently won four awards for writing and design excellence!

So, for those of you beginning a new school year, the best of luck in your academic endeavors (whether you are learning or whether you are teaching!). I believe the information in this column provides just a few examples of what your staff and your leaders are doing on your behalf.

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

Thanks and be well.