Monthly Archives: June 2011

Realizing a potential for leadership

Marcheta Evans June 1, 2011

Can you believe how the year has just flown by and that this is my last column to you?

As I contemplated what I would say, so many thoughts flooded my mind that I wondered how I could pull them all together and still stay within my limited word count. One of the first things I did was review my goals statement and my responses to the questions asked of all the ACA presidential candidates when I was seeking this office. I smiled when I realized how energetic, enthusiastic and lofty those goals were for someone serving in this role for only one year. Yes, when you run for this office, you understand that you are making a three-year commitment (inclusive of your year as president-elect and another year as immediate past president), but you are only president for a limited amount of time. Take my word for it, the clock goes by very fast! You have the opportunity to effect change, but not to the extent I had hoped.

Let me begin by saying what an honor it has been to serve as your president. This has been a phenomenal year, and I owe a debt of gratitude to so many people. When you make the decision to serve in this capacity, so many considerations must be evaluated, including the impact that service will have on your “real” job and your family. You also must determine whether you can exert a positive influence during your time of service.

As I delved into my true reasons for wanting to be the president of a 45,000-member organization, my thinking encompassed the leaders I had been exposed to in the past as well as the question of what I could possibly do differently. One of my primary goals was to inspire others to seek leadership opportunities. Whether this leadership manifested itself at the local, branch, region or division level, I wanted to encourage more diversity around the leadership table. I hoped through the simplicity of my story, others would be moved to realize their potential for leadership as well.

At the ACA Annual Conference in New Orleans, I received overwhelming confirmation of this goal being accomplished. This confirmation came from young and mature counselors alike who came up to me and thanked me for my example of leadership. It came in the form of the many hugs I received and the pictures I took with those who felt comfortable enough to approach me and ask. It came from the many individuals who talked about their struggles as minority counselors — whether because of their race/ethnicity, gender, sexual orientation or disability — and how they felt inspired to do more for the profession through advocacy and seeking leadership opportunities. These wonderful counselors simultaneously exuded a feeling of hope and the courage to risk having their voices heard.

I cried through some of the hugs, tears and stories that some of you chose to share with me, and I want to send a big Thank You to each of you and let you know how much that meant to me and to my personal growth this year. I might not have accomplished all of my lofty goals, but something happened along this journey that has impacted my heart, and that has been due to your personal stories. So, I am sending another big hug your way!

Mentioning goals, this has been a phenomenal year for your association. We have experienced a 6 percent increase in membership; the finances are in great shape; we held the most well-attended conference in more than a decade; plans were initiated for the establishment of a research and policy center; international collaborations are at a historically high level; disaster and crisis protocols are being developed; a task force is being appointed to work on a revision of our ACA Code of Ethics; ACA provided feedback concerning proposed revisions for the fifth edition of theDiagnostic and Statistical Manual of Mental Disorders; technology innovations are being incorporated into how we operate as an organization; graduate student initiatives are under way; and I could go on and on.

Needless to say, these things did not happen because of my leadership. I am sure you are familiar with the adage “It takes a village.” Well, that is an understatement for ACA. The people who were instrumental in all the successes of this past year include our awesome staff under the leadership of Richard Yep. Also, the Governing Council will continue to ensure that your needs are heard under the experienced leadership of Incoming President Don Locke. Your division, region and branch leaders continue to be phenomenal as well.

In the coming months, you will hear from the outstanding candidates who are running for the office of ACA president. I urge you to look for those who are enthusiastic about serving you in this profession. I know I am leaving you in capable hands, and I look forward to the upcoming leadership of Drs. Locke and Bradley Erford, your incoming president-elect.

Again, thank you for this honor, and I hope to see you next year at the ACA Conference in San Francisco!

With thanks for your incredible efforts this year

Richard Yep

Richard Yep

As someone who has worked for the American Counseling Association for more than 20 years, you might think that I have seen it all and heard it all. But truth be known, I have been in learning mode the entire time I have served the association, first in the area of public policy and then as your executive director. Sure, some ideas that may not be “new” per se seem to come up every few years, but because society and the profession continue to change, an idea that was discounted in the 1990s might be worth reconsidering today.

I learn from our staff, our members and our leadership. All of you constantly amaze me with your ideas, your creativity and your suggestions that enhance our role as the world’s largest organization serving professional counselors. I think maintaining an open mind to such ideas and suggestions is what has led ACA to its premier position among the helping professions. With what has been rolled out to members over the past few years, and what we have planned for you as we begin our seventh decade of service, I am confident we can maintain our momentum in supporting and advocating for the counseling profession.

In terms of learning from those with whom I work, I referenced this at the Opening Keynote session of the ACA Annual Conference & Expo in March. In introducing our president, Marcheta Evans, I mentioned the previous day’s Giving Back to the Community event, during which more than 100 counselors spread out to lend their hands, and their compassion, to the citizens of New Orleans. I then gave credit to the person on whose vision the event was based when I said, “This project was an idea that started with the woman I am about to introduce. She is part visionary, part educator, part counselor. But what I have come to know is that for all the various roles she takes on, Marcheta Evans is 100 percent committed to whatever she devotes herself to.”

I went on to say, “I have learned from Marcheta this year. I’ve learned more about diversity, about trying to listen to all sides of an issue and about taking the time for those who are in need of that time. Marcheta has this energy that she just shares with those around her. It isn’t the kind of energy that leaves those in her wake fatigued. Rather, it is an energy that makes you know that listening, being compassionate and moving together toward a common goal really does result in an even better outcome than what may have been envisioned.”

Most of you who know me are aware that I don’t make remarks like this unless I truly believe what I am saying. It was yet another example that despite my having worked for 23 different ACA presidents, I am still learning. Each ACA president has been unique, which means I have benefited from learning something new every single year.

I encourage all of you to take a moment and think about someone who has opened your eyes this past year. It might have been a colleague, a student, a child or even a furry four-legged friend. I would love for you to e-mail me your story about someone from whom you have learned. I can’t say it will appear in Counseling Today, but I do think that sharing the experience helps to make it even more special. In some ways, it is like acknowledging the impact that individual had on you this year.

Speaking of thanking people, as the program and fiscal year comes to a close for ACA at the end of June, we will bid farewell to an outstanding group of leaders who have served the association at the national level. We will also see the conclusion of terms for many leaders at the division, region, branch, committee and task force levels. To all of you, I am very appreciative of your efforts. The profession is grateful for your service.

Please know that many good things took place on your watch. Although you might have hoped that even more would be completed, remember that you have planted seeds of ideas and projects that will germinate and flourish in the years to come.

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 or by phone at 800.347.6647 ext. 231.

Thanks and be well.


Don’t turn away

Lynne Shallcross

Julie Bates offers a sobering thought to anyone who assumes that certain individuals choose a life of addiction. Bates, a doctoral candidate in counselor education at Penn State University, worked for three years at a methadone clinic in Massachusetts. One of her clients, a 23-year-old woman who exhibited track marks running from her shoulder down to her knuckles, had already been addicted to heroine and cocaine for a decade.

How had she gotten so far off track by the tender age of 13? Because her mother had injected her.

Bates, a member of the American Counseling Association, says that story stays with her wherever she goes, reminding her very clearly that clients with addictions need empathy and help, not judgment. While in treatment with Bates, the woman’s most difficult struggle involved rebuilding herself, redefining who she was after a decade of addiction and learning how to function as an adult without the addiction component.

In working with the woman for three years, Bates learned that addictions counseling is a long-term process. “Be patient,” she advises. “It’s not something that changes overnight or even over a couple months.” Although her client was able to stop using heroine after only about two months, it took closer to 10 months before there was any decrease in her cocaine use.

What helped the client finally make inroads in beating her addiction was writing letters to her mom, even though the letters were never mailed. In the beginning, the letters were positive, with the woman thanking her mom for her sacrifices and love. But as time went on, the letters became more “real,” Bates says, expressing such thoughts as, “Mom, you said you loved me, but you injected me when I was 13. What chance did I have?”

Through the process of writing the letters, the client realized she had been brought up to believe that when you love someone, you lessen their pain through drugs. Through counseling, she was able to tweak that worldview, learning that drugs do not equal love and that she was worthy of being loved on the basis of who she was, not what drugs she used or gave to others.

Counselors who don’t work in addiction clinics might not experience situations quite this extreme, but experts in the field warn that addictive behavior is often intertwined with many of the problems for which clients seek counseling. The realization that a client has addiction issues is daunting to many counselors who don’t specialize in that area. But Bates encourages those counselors not to turn away. “Don’t be afraid to talk to the client,” she says. “A big disservice would be ignoring [the addiction].”

Gerald Juhnke, professor and doctoral program director in the Department of Counseling at the University of Texas at San Antonio, says many clinical mental health counselors start their careers not wanting to work with anyone who has an addiction. In fact, Juhnke admits, when he set out in marriage and family counseling, he was one of those counselors who wanted to avoid addiction issues. But the reality is, when it comes to fairly common issues such as depression, anxiety or career and family problems, there is often an overlap with addictions, Juhnke says. Existing problems might compel a person to begin using drugs or alcohol or to engage in some other addictive behavior as a coping mechanism, or the problems the person presents with might be the result of a preexisting addiction. “Even though you don’t plan on seeing people with addictions, it will happen,” says Juhnke, a past president of the International Association of Addictions and Offender Counselors, a division of ACA, and former editor of theJournal of Addictions & Offender Counseling. “People rarely come in saying, ‘I have an addiction problem.’ They come in saying I lost my job, have problems in my family, etc.”

Sticking with an addicted client

Even when counselors don’t think they are skilled enough to work with addicted clients, Juhnke says automatically making a referral isn’t the best idea. Accredited master’s-level counseling programs include training in addictions work, so most counselors possess at least some knowledge in this area. Juhnke strongly recommends that counselors consult with a supervisor and then attempt to continue working with addicted clients. “The client might have a good relationship with you as the counselor,” he says. “If the counselor panics and says, ‘I can’t work with you anymore,’ then the client feels abandoned. They feel like, ‘I won’t tell anyone again that I have an addictions problem.’ If you’ve already got a good counseling relationship, don’t abandon the client. Get someone who can give you ideas and direction, and follow what they have to say,” advises Juhnke, who coauthored Counseling Addicted Families: An Integrated Assessment and Treatment Model with W. Bryce Hagedorn.

Kerrie Fineran, an assistant professor of counseling at the University of North Texas (UNT), offers similar advice to counselors who don’t specialize in addictions. She recommends that counselors seek supervision, educate themselves on the resources available in the community for addicted clients and refrain from automatically referring or including language in intake paperwork that indicates they won’t work with clients who are using. A referral may be necessary if a client needs help beyond what you’re able to provide, especially in cases in which outpatient therapy might not be enough, says Fineran, a member of ACA and IAAOC. “But the process of referral should be something that promotes hope and your belief in their ability to change and doesn’t destroy the trust they’ve built with you.”

If counselors are unsure about whether a client is exhibiting addictive behaviors, IAAOC President Juleen Buser says research often references the three C’s of addiction as a way to conceptualize some of the core characteristics. “Counselors can be on the lookout for these three C’s as they work with clients as a preliminary way to assess the presence of addiction: loss of control over addictive behaviors, despite the client’s aim to stop; compulsive use; and continued use regardless of negative consequences,” says Buser, assistant professor in the Department of Graduate Education, Leadership and Counseling at Rider University in Lawrenceville, N.J.

The addictions counseling field has made a significant transition over the past few decades, according to Juhnke. It used to be that most addictions counselors were former addicts in recovery, whereas now, Juhnke says, there is a movement of mental health professionals heading into the field with master’s-level degrees and a specialization in addictions work.

Juhnke notes the licensure situation regarding work with addicted clients can be complex. Requirements vary state to state, meaning that any licensed counselor might be permitted to practice addictions counseling in one state, while in another state, the counselor must also be licensed as a chemical dependency counselor to perform the same work. This can be frustrating and confusing, Juhnke acknowledges, especially for counselors with advanced degrees who are then informed they need yet another license to practice addictions counseling. On the positive side, he says, the effort to make the field more professional with licensed caregivers is laudable.

Although master’s counseling programs touch on addictions, Fineran says counselors who want to specialize in addictions work should seek additional training and continuing education opportunities such as conference presentations, workshops and specialty certification programs.

Addictions can come in the form of process or substance addictions, but regardless of form, addiction is still addiction, Juhnke says. “All addictions are very difficult. One isn’t more difficult than another. In general, substance disorders revolve around ingesting, inhaling, huffing, injecting or taking some type of substance. Process disorders generally revolve around ‘doing behaviors,’ such as gambling, shopping, eating, sex, pornography, running, weightlifting, etc. The No. 1 thing in treating addicted clients is respecting them and treating them as if they were your mother, father, sister or brother. Failure to treat persons with addictive disorders as a loved one first often results in misperceiving the client’s addictive behaviors as [being representative of] the person.”

Understanding the struggle

Students who enroll in Fineran’s drug and alcohol counseling class at UNT are going to feel deprived — and that’s just the way she wants it. Each semester, Fineran asks her students to commit to giving up a substance or a process for the duration of the course. The goal of the exercise is for the students to understand the process of addiction and develop empathy for the addicted clients with whom they’ll someday work.

“Many of them think that people with addictions should just stop, quit it and pull themselves up by the bootstraps,” says Fineran, who likewise commits to giving something up each semester. “It seems like a simple thing to stop something, but [with this exercise], they understand what the body goes through and what the mind goes through. They really struggle with it. They start to understand what individuals with these problems go through and gain an increased sense of empathy that they can tap into when working with individuals from this population.”

At the beginning of the course, about half of the students are excited to accept the challenge because they’ve been wanting to give something up but needed a nudge to follow through, Fineran says, while the other half are terrified and don’t see how the exercise will help them learn anything. By the end of the course, roughly 95 percent of the students say the exercise was an excellent tool that taught them about the process of addiction and about themselves.

Many of the students give up something that has a physical impact, such as cigarettes or caffeine, so it doesn’t take long for them to experience symptoms of withdrawal. Most of the students relapse at least once during the semester, so Fineran addresses that topic in class. Some of the students acknowledge that they simply no longer felt like abstaining, whereas others slip up without thinking, such as by ordering a Coke at a restaurant. Regardless of the reason, Fineran says, the students learn about the shame and guilt that accompany a relapse and, more important, learn about the process that led to their relapse. Fineran works with the students to create plans to recognize warning signs of a possible relapse and to head it off before it happens. The project is particularly worthwhile because these counselors-in-training may one day create similar plans with clients who have addictions, Fineran says.

The class also discusses how life presents continuing challenges in the recovery process. For instance, Fineran says, students who commit to giving up beer for the fall semester might not realize until later how this decision affects their football watching. Or perhaps they give up sweets only to realize what a challenge that will pose during the holidays. “They go home for Thanksgiving and find out what it’s like to live in a world where everyone else isn’t trying to give up what they’re trying to give up,” Fineran says.

In addition to giving up a substance or a process, Fineran asks her students to attend at least two recovery meetings in the community, followed by writing a personal reflection to share with their peers. The meetings are as impactful as the attempt to abstain from something, she says, because they show the students that real people — often those similar to themselves or even people they know — are struggling. In addition, students are often impressed and humbled by the sense of community and hope that they witness at the recovery meetings.

“People with addictions are often maligned,” says Juhnke, who requires students in his addictions classes to give up both a process and a substance for the semester in addition to attending multiple 12-step meetings. “We think they’re old drunks or old addicts and we shouldn’t pay attention to them. But if we think of them as moms, sisters, dads, etc., we see them as people, not as the behaviors.”

It can be easy to focus on the behaviors that often accompany an addiction — such as stealing, lying or cheating to secure another hit — without realizing that those behaviors take place as a result of a physical or psychological dependency, Juhnke says. “Take, for instance, an addict who steals his mom’s silverware or credit cards. We might say, ‘What a bad son.’ But those are the components of the addiction, not the person behind the addiction.” Putting his students in the shoes of an addicted person is an effective way of building empathy, Juhnke says.

Empathy is one of Carl Rogers’ core conditions of counseling, along with congruence and unconditional positive regard, but those conditions have a tendency of disappearing when the client has an addiction, Fineran says. “We often look at people and think, ‘Just quit! You lost your home, you lost your job, so just quit this.’ But empathy helps counselors see that clients with addictions aren’t really any different than other counseling clients.”

After their own struggles to give up a substance or a process, Fineran says most students realize that people with addictions are simply people with problems — just like everyone else. “It becomes less scary for them and less of a mystery about what addiction is about,” she says. “It’s really about people trying to make changes in their lives, which is the same as every other client who comes in who might not be addicted.”

“Without that empathy and understanding and care for our clients, I don’t understand how they could ever imagine that we believe in them,” Fineran says. “We need to believe in them. We need to believe that these people are worth the change.”

Motivation for change

Historically, treatment for clients with addictions has often been directive, confrontational and harsh, Fineran says, but the trend is moving toward a model that is more supportive and inclusive of Rogers’ core conditions. That’s good news, she says, because research shows people do better when they are encouraged and when someone helps them elicit their own motivation for change instead of simply “throwing the book at them.”

“One movement that has gained steam over the past two decades is a shift to treatment models such as motivational interviewing, which differ from earlier models that focused on more intensive confrontation of clients,” Buser says. “Motivational interviewing works from the premise that clients come to counseling at various levels of motivation. A counselor’s role is to meet the clients at their current level of motivation — not presuppose a client is ready for action when, in fact, [he or she] may only be contemplating the need for change.”

Buser says a counselor might first assess a client’s level of motivation and then work toward increasing that motivation. “Authors have discussed the use of scaling questions to assess readiness to change at the start of counseling. If a client is ambivalent about treatment, gentle questions and door openers can be used by the counselor to help the client explore this ambivalence. For example, a counselor might acknowledge the client’s tentativeness about change, while also pointing out the client’s dissatisfaction with at least certain elements of the addictive behavior.”

Empathy is a critical component of motivational interviewing, Buser says. “For example, clients who struggle with eating disorders, termed a process addiction, often hide their behaviors and experience a sense of embarrassment about … binge eating and purging behaviors. Empathy is critical in this sense, as clients will be more likely to open up and disclose their disordered eating practices if they feel accepted and understood by a counselor.”

Juhnke is also a proponent of motivational interviewing with addicted clients. Through the process of a counselor asking questions about which parts of a client’s life are going well and which parts are not, the client can reach a clearer understanding of what is going on in his or her life, he says. For instance, a client might present with marital problems, trouble holding a job or failing grades before the counselor figures out that an addiction is intertwined, Juhnke says. Although the client at first might deny that an addiction is part of the problem, as the counselor asks questions and the client continues to want a solution to the problem, he or she may begin thinking about the impact that addictive behaviors have on the situation. Motivational interviewing helps move clients from a precontemplative stage to a contemplative stage, Juhnke says, and often encourages them to “bite into the whole treatment process.”

If motivational interviewing doesn’t prove helpful, Juhnke next tries a solution-focused approach, which creates a target the client wishes to aim for. Instead of focusing on the problem and how bad it is, which can be overwhelming for the client, Juhnke says solution-focused techniques urge the client to think about what an improved life would look like and what changes need to take place to get there. “Clients can tell you what they need if you listen to them, and this allows them to have influence on the kind of treatment they need,” he says.

If a solution-focused technique isn’t the right fit for an addicted client, Juhnke recommends trying a cognitive behavioral approach in which the counselor helps the client gain insight into his or her addiction triggers and how to respond once those triggers hit. For example, with a client who comes home from work to an empty house, feels lonely and reaches for a beer, Juhnke might ask the individual for alternative ideas of how that void could be filled. Keep in mind, he cautions counselors, that the same solutions won’t work for every client.

Buser mentions additional therapies that are sometimes referred to as the “third wave” of addiction treatment, including narrative therapy. “Counseling strategies associated with this theory include externalizing the problem, which often involves naming the problem,” she says. “Counselors work to separate the addiction from the client, often by giving the addiction a name, such as ‘bulimia’ or ‘alcoholism.’ The idea is that, through this process of externalizing, clients will no longer internally connect with the addiction. Clients may come into counseling with the view that addiction is a part of them. In this narrative therapy technique, however, the addiction is cast as an external force, and the client takes on the role of actively working to fight against this addiction. Optimally, this reduces self-blame and inspires efforts to combat the addiction.”

A different kind of referral

Clients with addictions won’t always come through a counselor’s door by their own volition. Instead they arrive because they are mandated to counseling by the court system. Although that circumstance might appear to create an entirely different counseling situation, Rochelle Cade says much of the counseling process mirrors that used with other addicted clients. Another similarity is that empathy and unconditional positive regard remain crucial to the process, she says.

Cade, a visiting assistant professor at the University of Houston-Victoria who worked with court-mandated clients for five years, often allowed these clients to use the first or second session to “get things off their chest,” she says. Many clients are upset about why and how they were arrested, the court process, their punishment or their perceived treatment by a parole officer, among other things, Cade says. “In my experience, just listening with unconditional positive regard and empathy early in the counseling process is probably the single most effective intervention for establishing the counseling relationship with these clients. I have been told over and over again that no one else — not the arresting officer, attorney, judge, probation officer, family members, friends or bosses — just listens.”

Some people contend that clients who enter counseling of their own free will are more motivated or ready for the counseling process, says Cade, a member of ACA and IAAOC who serves on the editorial board for the Journal of Addictions & Offender Counseling. “Some would prefer that clients enter the counseling process with some insight into the problem or issue or at least have identified the issue for themselves. Court-mandated clients by title and referral do not usually meet these prerequisites for entering counseling.”

Although she uses the phrase “court-mandated,” Cade prefers to think of clients on a continuum of voluntarism rather than of dichotomies such as voluntary/involuntary or mandated/nonmandated. Many clients, not just those who are court-mandated, first come to counseling on the involuntary side of the continuum, she points out. For example, there is the client who goes to counseling because his wife threatens to divorce him or because his boss threatens to fire him if he doesn’t.

Although much of the counseling process is the same, Cade does acknowledge a few unique challenges in working with mandated clients. One is defining the identity of the counselor’s “client.” This most definitely includes the person in the room engaging in the counseling process but might also include the referral source, such as a judge, parole officer or case manager, or other elements of the community. Issues of confidentiality can also arise, she says. “Counselors, with a signed release of information from the client, complete progress reports and submit them to a probation officer, parole officer or case manager, report them to a drug or mental health court, or submit them to an attorney or judge,” Cade explains. “The counselor may abide by the ethical and/or legal parameters of confidentiality in providing these documents, but the recipient of the documents may not.”

Client autonomy can be another sticking point, Cade says, because when clients are referred through the legal system, typically, their “problem” has already been defined for them and the goals of their therapy have been predetermined. Many of Cade’s clients are ordered to participate in substance abuse counseling as a condition of probation for drug-related offenses. “The problem has been defined: marijuana use,” she says. “The goals have been established by the conditions of probation: Submit to urine analyses and have clean results, participate and complete counseling, and abstain from drug use.”

But if clients don’t agree that marijuana use is the problem or decide they’d simply like to decrease their use, that can be out of line with the court’s goals. “I have had several clients who smoked marijuana all day every day decide to cut their use to one joint at night before bed,” Cade says. “Is this reduction in marijuana use [considered] progress? According to the court, it is not. If the results of a urine analysis are positive for TCH, indicating the client is still using, [the court deems this a] lack of progress or failure to abstain from drug use.”

Termination often poses a final hurdle. Cade has had clients participate in counseling for several weeks or even months and then suddenly stop showing up, oftentimes because they’ve been sent to jail for probation violations, new offenses or other reasons. “When the client is incarcerated, the counselor does not have the opportunity to process the closure of counseling and ethically terminate the counseling process with the client,” she says.

Connecting the dots

Considering that people are complex, complicated beings, counselors say it’s not surprising that addictions often coexist with other issues. Certain personality disorders, including antisocial, borderline, narcissistic and dependent personality disorders, seem to have a “robust” connection with addictions, Juhnke says. Anxiety, depression and trauma also commonly accompany addictions, he says.

“Unresolved trauma can be common with many diagnostic subpopulations,” Juhnke says, “For example, I have often found my clients who fulfill Axis II borderline personality disorder have unresolved trauma resulting from sexual abuse or incest, or feelings — real or imagined — of abandonment by significant others. Drinking and drugging behaviors were common ways of attempting to cope with such unresolved or experienced trauma. Thus, asking clients about their history and paying close attention to potential traumatic unresolved issues is important.”

One client told Juhnke that drinking and using drugs were her way of dealing with feelings of abandonment after her ex-husband ran off with a younger woman. “She was able to clearly articulate why and how this unresolved trauma led to her addictive behaviors,” he says. “Removing her addictive behaviors without addressing the underlying trauma would have left her extremely vulnerable. Therefore, it is important to concurrently address any unresolved trauma and addictive behaviors.”

Grief and loss are also significantly interwoven with many addictions, Bates says, whether the losses occurred prior to the addiction beginning, were incurred as a direct result of the addiction or took place during the person’s recovery and set the client back. In circumstances in which clients were using when they experienced a loss, they may not have processed the loss properly and can come to counseling with built-up grief, Bates adds.

Common losses resulting from addictions are wide ranging, Bates says, and can include family, friendships, jobs/careers, freedom, health, finances and educational opportunities. Even in recovery, she says, addicted clients face the likelihood of loss, particularly as it relates to their friends and social identity because, in many cases, those things were tied to the person’s addiction. In losing the old support system, even if it was an unhealthy one, the person faces the daunting task of starting from scratch, Bates says.

“If you take the substance away, you have to reconstruct the identity,” Bates says. “When you have someone who hasn’t really had to form relationships without the presence of a substance, it can be hard to do. You have to relate to the new friends through personality, not through the substance. Sometimes it’s really difficult for people to do. They forget how to behave socially without the drug.”

Other losses that occur while the person is going through recovery, such as the death of a family member or a friend, can trigger a relapse, Bates cautions. Counselors should work with clients on the area of prevention, talking about how they can rebound from losses that might take place while they’re working through recovery.

Grief can also stem from giving up the addiction itself, Fineran says. “The addiction has been their best friend and their coping mechanism. When they give that up, there’s a process of grief they go through [in] reorienting to their lives without it.” Although counselors can focus on many positive aspects of recovery with clients, Fineran says it’s also imperative to recognize what clients might be giving up, such as the sense of comfort the addiction provided them when things weren’t going well and the people, places and things they fondly associate with the addiction.

Working through the grief

No matter what type of loss or when it occurs, Bates says the best thing counselors can do is to address it with addicted clients. Counselors don’t intentionally skip over grief work, she says, but sometimes more pressing concerns pop up in the context of addictions work, such as immediate health, safety and shelter concerns. But whenever possible, Bates suggests, counselors should remember to address losses the client has experienced along the way because those losses might be contributing to or sustaining the addiction. In many cases, she says, grief work enables the client to make better progress in recovery.

Bates says the focus of these interventions should be on recognizing both the positives and the negatives of the losses that addicted clients have experienced. One intervention Bates recommends is writing, whether it involves clients keeping a journal of their feelings and thoughts or writing letters. For instance, clients can write letters to the addictive substance, both ending the relationship and grieving the loss. Or they can write letters to their “using self,” such as “Dear using self, this is why I don’t want to be with you, this is what you took away from me, and this is what I’ll miss about you,” Bates says. A client in early recovery might write to his or her “recovering self,” explaining what he or she is looking forward to in the future.

“It’s really having them acknowledge what things they’re going to miss about the addiction, whether it’s numbing their feelings or feeling high when they need a pick-me-up,” Bates says. “It’s also remembering why we need to get rid of it and why it’s not useful.”

Whereas writing letters encourages clients to take the time to acknowledge both the positives and the negatives of their losses, journaling can help them create a log of their thought processes. Seeing their thoughts on paper aids addicted clients in identifying triggers and patterns they may have been unaware of previously, Bates says — for instance, how having a fight with a parent led to the client using afterward. The client’s journaling can also alert the counselor to grief and loss issues that had not come to light previously.

Another intervention Bates suggests is the creation of memory books, which can take either a positive or a negative focus. A client might make a positive memory book about a loved one who died, including what the client loved about that person, photos of the client and the loved one together and words or pictures cut out of magazines to describe the relationship. Creating the book can help the client process and acknowledge the loss, while memorializing the good things the person contributed to the client’s life.

On the other hand, Bates says, a negative memory book works well for addicted clients who are having a hard time ending their use. These clients might make a book about their addiction, including pictures of doctors or scars or any other bad memories associated with the addiction. “It’s a reminder of why I shouldn’t be using this, even if my body’s telling me I should,” Bates says.

Bates suggests additional techniques that can be helpful to clients dealing with addictions and grief, or addictions alone. Bibliotherapy is effective, she says, as is role-playing in groups, where clients can practice saying no to the addiction or work on new social interactions. Bates also recommends using music to help clients relax and having them draw or paint as a way of sketching out what their lives might look like with or without the addiction. Depending on the individual client’s coping skills, techniques such as guided imagery, meditation and progressive muscle relaxation can offer the client a tangible way of relaxing and regulating his or her body without a substance, Bates says.

Bates also points to Robert Helgoe’s book Hierarchy of Recovery: From Abstinence to Self-Actualization as a good resource for counselors working with addicted clients. Helgoe proposes two phases in recovery: the pull and the push. In the push phase, Bates says, addicts are pushed to remain sober to avoid the consequences of their addiction, such as jail time or liver failure. In the pull phase, the addict is pulled toward a new way of being and enjoying the rewards of recovery. Helgoe’s theory, Bates says, is that to move into the pull phase, a client must first fully grieve the addiction and all the losses associated with it.

Bates says counselors may find it worthwhile to talk with clients about the two phases and what will help them want to stay sober. “Consequences get you [the client] into treatment, but will they keep you here? We have to find something more valuable, and that’s [the client as a person],” she says. “If we can focus on the client as a thing of value, that’s worth working on.”

The spiritual side of addiction

Throughout history, spirituality and addictions have been linked, says Keith Morgen, assistant professor at Centenary College in Hackettstown, N.J., and a member of ACA. Using alcohol as an example, Morgen says that leading up to Prohibition, it was thought that alcoholics didn’t possess any morals, spirituality or godliness. “Addictions were considered as being immoral,” says Morgen, secretary-elect of IAAOC and chair of its Spirituality Committee. “[The thinking was], ‘Because they’re drinking or doing drugs, they’ve turned their backs on society or God.'”

But when Alcoholics Anonymous and the 12-step approach came into being in the 1930s, Morgen says spirituality became a source of strength and comfort for addicted individuals, a way to build themselves back up. “It’s a model for how [those with addictions] can spiritually exist in the world,” he says. The spirituality or higher power invoked in 12-step programs can be a traditional god or any other kind of spiritual, philosophical idea that guides one’s life, Morgen says. “When you do reach that last step, you’re said to have had a spiritual awakening. It’s at the end of the 12 steps, not the start. It helps you get to the point where you’re a spiritual, living member of the world around you.”

Reconnecting spiritually with family, friends, society and oneself is a key piece of the 12-step recovery, Morgen says. “The idea is that your addiction isolates you from the rest of the world. The 12 steps are a road map to get back to the world, the community, the people in your life and also yourself.”

Outside 12-step programs, spirituality can still be a crucial ingredient in the work that counselors do with addicted clients, Morgen says. Tackling spirituality is intimidating to many counselors, so Morgen recommends looking at it from the perspective of how clients see their place in the world — what they value and believe in, what gives them strength and what makes them feel full inside.

Counselors used to try to find out if clients had spirituality as a strength or coping mechanism and then wouldn’t delve any deeper, but they need to do more than simply “check the box” after asking the question, Morgen says. “If you conceptualize it as how [clients] have fulfillment, courage, strength, how they see the world — if all that stuff rolls into spirituality, you almost have to talk about that because that’s who the person is. To try to talk to [clients] about their issues, fears, addictions and trials without talking about values, beliefs, where it comes from, how it has meaning, how it shapes them, it’s almost impossible to do.”

Morgen’s advice to his fellow counselors is to understand that everyone has a different definition of spirituality, and each definition is right for that particular person. Even if clients don’t believe in a god or a higher power, just talking about their philosophical sense of what makes the world spin can be helpful to them, Morgen says.

What benefit can spirituality offer to addicted clients? For one thing, Morgen answers, it provides a point of reference. Many times, he says, in living with an addiction, what addicted individuals do, whom they hurt and what they lose become a blur to them. Spirituality provides these individuals a sense of foundation that they didn’t possess when they were in the throes of the addiction, Morgen says. “It gives you a way to look around and make sense of what’s gained, what’s lost, where you’ve come from, where you’re going and how you fit in to all of that. It gives you an ability to find some kind of meaning, direction and an anchor point.”

Recovery communities

Although popular among many people recovering from addiction, 12-step programs aren’t a perfect fit for everyone, says Gerald Juhnke, professor and doctoral program director in the Department of Counseling at the University of Texas at San Antonio. For clients who don’t connect with the spiritual emphasis of 12-step programs, Juhnke says a number of alternatives exist, including Rational Recovery and Secular Organizations for Sobriety.

Some clients might not be comfortable with the personal interactions that 12-step programs require throughout the various stages of recovery. “If that is the situation, the counselor needs to understand how to get the client the necessary environmental supports without 12-step programs,” says Juhnke, a past president of the International Association of Addictions and Offender Counselors, a division of ACA. “I must say, however, that it is exceptionally difficult to try to recover without changing one’s interactions with current ‘using’ friends. Twelve-step programing immediately provides a group of interpersonal supporters and a social environment where all are in recovery and most, if not all, are very supportive of the client’s personal recovery.”

Although the 12-step approach won’t work for every addicted client, Juhnke says one significant benefit of these programs is that they offer a good mix of people just beginning the recovery process with those who are further down the road. For those just starting out, he says, it can be vital to gain support from more experienced peers, while also being able to look to others for advice and wisdom when relapses occur.

— Lynne Shallcross

ACA addiction resources

The following books can be ordered directly through the ACA online bookstore at or by calling 800.422.2648 ext. 222.

  • Developing Clinical Skills for Substance Abuse Counseling (order #72895) by Daniel Yalisove provides a framework for understanding substance abuse and teaches the basic concepts and skills necessary for effective counseling ($29.95 for ACA members; $44.95 for nonmembers).
  • A Contemporary Approach to Substance Abuse and Addiction Counseling: A Counselor’s Guide to Application and Understanding (order #72888) by Ford Brooks and Bill McHenry offers a basic understanding of the nature of substance abuse and addiction, its progression and clinical interventions for college/university, school, and community/mental health agency settings ($35.95 for ACA members; $49.95 for nonmembers).
  • Critical Incidents in Addictions Counseling (order #78058) edited by Virginia A. Kelly and Gerald A. Juhnke explores the opportunities and challenges of working with clients struggling with addiction ($19.95 for ACA members; $24.95 for nonmembers).

Lynne Shallcross is a senior writer for Counseling Today. Contact her at
Letters to the editor:

Spotlight on eating disorders

As an assistant professor in the Department of Graduate Education, Leadership & Counseling at Rider University, Juleen Buser’s work focuses on process addictions and, more specifically, eating disorders. Counseling Today asked Buser, president of the International Association of Addictions and Offender Counselors, a division of the American Counseling Association, for her thoughts on the circumstances surrounding eating disorders and possible effective treatments.

Tell us a little about clients with eating disorders. What are they struggling with?

Clients who struggle with eating disorder symptomatology may be struggling with either clinical or subclinical levels of eating disorders. Two major clinical eating disorders include anorexia nervosa and bulimia nervosa.

Anorexia nervosa involves self-starvation behavior, and diagnostic criteria include weight below normal standards and a flawed view of one’s body as overweight. Bulimia nervosa involves binge eating, which is characterized by consuming a large amount of calories in a relatively short time period, a sense of loss of control regarding this food consumption and subsequent compensatory behaviors, such as self-induced vomiting or laxative use. In the new DSM-5 revision, binge eating disorder is planned to be included as a clinical diagnosis. This disorder involves the binge eating behavior of bulimia nervosa but does not include the subsequent compensatory behaviors.

Prevalence rates for clinical eating disorders have been documented to range from approximately 1 percent to 3.5 percent and, overall, are more common among females than males. However, researchers have documented that many more women struggle with subclinical levels of eating disorders — that is, behaviors and attitudes that would not necessarily conform to the criteria for a clinical diagnosis but are nonetheless concerning. Clients struggling with subclinical forms of eatingdisorders may diet frequently, vomit after meals twice a month and engage in a range of other problematic behaviors. Evidence also suggests that subclinical eating disorders can progress to clinical eating disorders. Thus, early intervention efforts on the part of counselors are vital.

Clients who struggle with eating disorder symptoms may engage in their behaviors as a coping strategy. They may utilize, for example, binge eating and purging as a way to manage a range of stressors in their lives — including their distress about their bodies. Interestingly, some research has noted that binge eating and purging behaviors are, in some ways, effective coping strategies, as certain negative emotions have been found to decrease after a binge-purge episode. Yet, other negative emotions, such as shame, have been found to increase after binging and purging. This could be a point of intervention for counselors, who perhaps work from a motivational interviewing perspective and seek to help clients explore ambivalence about treatment.

What techniques are especially helpful?

The field has recommended a multidisciplinary treatment model when working withclients who struggle with eating disorder symptoms. For example, medical professionals are often necessary to assess and monitor the physical health of clients, and working with nutritionists can also be incredibly valuable forclients.

In terms of counseling techniques, therapies such as cognitive behavioral therapy have strong empirical support in the literature. Moreover, authors have also discussed the import of experiential strategies. For example, given that clients who struggle with eating disorders frequently have challenges verbalizing their emotions, art-based techniques can be instrumental in theprocess of accessing and expressing emotional experiences.

Prevention efforts are also crucial. Researchers have documented a range of risk factors for eating disorder development, including dissatisfaction with one’s body and thin-ideal internalization, which refers to an individual’s belief that the thin body shape, often lauded by the media, signifies beauty and is an ideal toward which to strive. Counselors can target these risk factors in prevention programs. For example, some prevention programs introduce the construct of thin-ideal internalization and help clients evaluate this thin ideal and become critical consumers of media messages.

— Lynne Shallcross

Life in transition

Lynne Shallcross

David Fenell has been on both sides of the fence. As a retired colonel and behavioral sciences officer with the U.S. Army and Army Reserve, he has counseled many soldiers returning from deployments on how to fit back in with their families at home. He would advise them to take it slow and to prepare themselves to find that their spouses had changed in some way. “Recognize and value the things he or she has done to keep the home fires burning while you’ve been gone,” he would tell soldiers.

Fenell, who retired in 2009 after 26 years of service, including tours in Afghanistan and Iraq, found it necessary to heed that advice himself when, following a deployment of his own, the transition back home ended up feeling a little less than seamless. While Fenell was deployed, his wife had enrolled in graduate school for counseling. He returned to find that she had turned their house into a quasi-library, with each room serving as a study zone for a particular area of counseling. “I came back home, and the house was completely changed,” says Fenell, interim dean and professor of counselor education in the College of Education at the University of Colorado at Colorado Springs.

Fenell, a member of the American Counseling Association, made a conscious decision to take it slow, respecting what his wife had accomplished while he was gone. But roughly three weeks after his return, nothing had changed, so he broached the subject with his wife. “I don’t feel like there’s really anyplace for me in the house right now,” he told her. “Every room is dedicated to a counseling subject, and it doesn’t feel like home anymore.” His wife quickly moved things around and, before long, Fenell felt like he had a place in the home again.

Fenell’s bumpy transition isn’t unique among those serving in the military, but he was lucky enough to have a counseling background that enabled him to remedy the situation. Those aren’t skills that the average returning soldier possesses. With increased deployments during the past decade, more soldiers are in need of counseling support, Fenell says, and because there aren’t enough military providers to handle the need, referrals to civilian counselors are on the rise.

Lynn Hall, dean of the College of Social Sciences at the University of Phoenix, echoes Fenell, saying that because of today’s extended conflicts, military members are often experiencing multiple deployments. The stress on the family and the couple is greatly enhanced each time a service member is deployed, says Hall, an ACA member who worked for about 10 years as a school counselor in Department of Defense schools in Germany.

The makeup of the military has changed through the years, Hall notes, with more of its members married now than in the past, meaning multiple lives are affected by frequent military moves and deployments. After the change to an all-volunteer military in the 1970s, the military began promising to support military families, Hall says, making it easier for service members to choose the military as a career while still maintaining a family.

In general, according to Hall, military couples marry and have children earlier than civilian couples. Although service members receive the housing, salary and benefits to support a family, the military life often necessitates that these young families move away from extended family, leaving them with less familial support, Hall says. With more military members deploying and leaving their families behind, the need for counseling, including couples and family counseling, is on the rise, says Hall, who wrote Counseling Military Families: What Mental Health Professionals Need to Know, published by Routledge in 2008.

Like Fenell, Hall says more civilian counselors are needed to help military families. The military is stretched too thin to meet the current demand, she says, in part because the military is deploying more mental health workers overseas to be with the troops. In addition, more members of the National Guard and Reserves are deploying. When those individuals return to their civilian lives, they will be more likely to need civilian counselors, Hall says, especially if they don’t have the ongoing support of military resources.

Hall recommends that counselors who want to get connected with military clients contact the family support centers or military mental health providers on local military installations and ask to be added to their referral lists. Counselors can also check with local National Guard or Reserve offices to inquire whether they have referral systems in place. Another option Hall mentions is Give an Hour (, a program for which counselors can sign up to volunteer their time to work with military families. The program “would be a great way to get in the door,” Hall says.

Fenell also offers ideas for counselors who want to work with military personnel and their families, including reaching out to military chaplains and requesting consideration as a referral source, placing ads in military installation newspapers and informing local Veterans Affairs hospitals and service facilities about their qualifications as counselors.

The significance of couples counseling with military couples shouldn’t be lost on counselors, Fenell says. “It is always a plus for the warrior when he or she is in a stable, loving marriage. It enhances performance in combat or any other military situation. On the other hand, a highly stressful marriage can take the warrior’s focus away from the mission and can lead to problems for the military unit in life-threatening combat situations.”

Culture shock

“There’s a much greater demand for civilian providers, and it’s especially important that they have familiarity with military culture and the things that military couples go through,” Fenell says. Understanding the culture of your client is integral to being an effective multicultural counselor, and the military is most definitely a distinct culture, he emphasizes. Counselors need to connect with clients in ways that validate their culture, their ethnicity and their perspective. In counseling service members and their families, that means letting the clients inform you about their lifestyle, Fenell says.

There seems to be a mentality among service members that civilians don’t understand the military, Hall says. “It could be something as simple as [the counselor] calling an officer by his first name,” she says. “And then the officer says, ‘The counselor doesn’t get it. I don’t want to be here.'” Not understanding the differences between being an officer and being enlisted, not being familiar with military acronyms or not being aware that service members don’t have the power to decide when they’re going to move are common examples of mistakes counselors can make that will turn military clients off from the start, Hall says.

It’s also crucial for counselors to understand and respect the authoritarian structure of the military, Hall says. “As counselors, we’re trained in an egalitarian mentality that everybody in a family should have their rights and everyone should be open to listening and being respectful,” she says. “In a military authoritarian structure, civilian counselors have to put their own values on the shelf and realize that the military has to be the way it is in order to survive, and the couples need to realize that is the culture they live in. They don’t get to make decisions about when they’re going to move or where they’ll live. Their life is regimented.” Within the individual household, a couple can respect each other and care about feelings, Hall says, but it’s important for counselors to understand that the couple’s larger community might not share those same values.

If the nonmilitary spouse is feeling stress from the regimented structure, the counselor can help that spouse express how difficult it is to his or her partner, help the couple respect each other’s feelings and help the struggling spouse to meet his or her own needs within the existing military structure, Hall says.

Fenell concurs that counselors must understand that service members have many of their decisions made for them. Certain decisions are ultimately beyond their control. “There’s a strict protocol in terms of following orders and doing your duty,” he says, “and counselors are more inclined to want to help people find their own solutions and seek the best course of action for themselves. Sometimes, those two dimensions can come into conflict.” Although military values and strict obedience to orders might clash with the values counselors normally support and encourage in their clients, Fenell says it’s necessary for counselors to understand the context of a military couple’s problems in terms of the values they work under.

A certain set of “givens” exists in the military culture, Fenell says, including anything having to do with following direct orders, such as when and where to deploy. “You don’t really have a choice to say, ‘I don’t want to go this time and I think I’ll leave the military now,'” Fenell says. “The goal for the counselor is to help the military member make the best of those givens, finding areas that are not amenable to change and those that are.”

Ever-changing family dynamics

As Fenell experienced firsthand, one of the biggest hurdles for military couples is the change that occurs when a spouse deploys. “I always tell my couples change is ubiquitous,” Fenell says. When spouses deploy, they tend to think their family will remain exactly as it was before they left, he says. “When [the service member] returns, he or she has freeze-framed what it was like prior to the separation, expecting to step into a family dynamic that is unchanged. But it has changed.” If the couple has children, they have grown. The spouse who remained behind has shouldered additional responsibilities and has likely grown into a more autonomous and independent person as well, Fenell says.

He recommends that counselors encourage the couple to identify the changes that have taken place. It’s often the case that both spouses have changed, Fenell points outs, even though each partner is more likely to notice only the changes in the other person. It helps to have the couple discuss how things played out during the deployment, how responsibilities shifted and how they can renegotiate the division of labor, he says. One area in which problems can arise is when one spouse has grown more autonomous and the other feels threatened by that development. When this happens, Fenell says the counselor should help the threatened spouse recognize that the relationship is evolving, becoming more healthy and less dependent. Having a service member return and automatically expect the spouse to give up all the duties he or she was shouldering, essentially relegating the person to a subservient role in the relationship, is not ideal, Fenell says. “Giving up autonomy is not a recipe for a good marriage.”

The transitioning of one spouse out of and then back into the household can be extremely stressful, Hall says. When one spouse leaves, the remaining spouse and their children learn to function as a single-parent household. But when the soldier returns, all roles and responsibilities must be shifted again. In some cases, the returning spouse expects to take over right away. “Family members think, ‘Hey, wait a minute. I did this job for nine months. Why are you now telling me what to do?'” Hall says. In other cases, service members are unable to help pick up the slack at home because they are still overwhelmed by what they experienced during their deployment. This can also heighten tension in the home.

Part of the solution is for counselors to help each person understand the other person’s perspective, Hall says. The spouse who remained behind might think he or she has done a great job running certain aspects of the household and could be reluctant to surrender those duties now that the service member is home. On the other hand, Hall says, the service member needs to feel that he or she can contribute to the household again. “Get both people to hear the other person’s side,” she says, “and then start making some reasonable accommodations to get the service member back involved in the household without the spouse feeling like she’s giving up everything.”

There are also instances in which the spouse who stayed behind makes it known that she or he can’t take another deployment, Fenell says. If the service member doesn’t want to consider giving up a military career, the circumstances can turn into a major roadblock for the couple. “One of the things you try to discover in working with the couple is whether it’s more than ‘I just can’t do it anymore,'” Fenell says. For example, he says, the spouse might feel overwhelmed by the prospect of handling the kids again solo while the military member is deployed. In that case, he says, helping the spouse determine ways to secure more support in caring for the children during the next deployment might offer a possible solution. “But if it’s pure ‘I can’t do it again, and I won’t,’ and the warrior won’t leave the military, then you can help them disengage in ways that are least damaging to themselves and to the kids. Make [the split] as amicable as possible.”

In many cases, Fenell points out, when the nondeployed spouse is doing well during the deployment, the kids are also managing well. But when the spouse is feeling stressed out and overwhelmed, the kids pick up on that and might start struggling, too. The family’s anxiety can transfer to the deployed service member as well, Fenell says, creating extra difficulty in the combat situation. He believes the best-case scenario is to encourage the nondeployed spouse and children to seek counseling during the service member’s deployment. This offers them a sense of stability, an outlet where their concerns can be heard and a place to receive concrete suggestions for overcoming life’s challenges as well as assistance in finding additional support systems.

On a different front, combat stress is something that can and often does return home with soldiers, Fenell says. But in his opinion, post-traumatic stress disorder is being overdiagnosed among returning military members. “Many returning veterans do have some symptoms. However, most are having normal reactions to very abnormal circumstances,” he says.

If everyone, from society at large down to the service members’ military units and families, treats them as if they are “damaged goods,” then the service members are going to have a more difficult time recovering, Fenell says. But if the culture, the military and the service members’ families come to perceive these symptoms as a normal reaction to the stressors of combat, “they’re creating a context for healing rather than a culture that pathologizes,” he explains. Counselors with expertise in trauma therapy might be especially well equipped to help military couples navigate this healing process, he says.

Beyond deployments, Hall says the repeated transitions military families must face in getting reassigned and moving every few years can place a strain on them and make them feel as though they don’t fit in with the way the rest of the world works. When people don’t possess a feeling of belonging, Hall says, they often end up feeling ” less than.” Her recommendation to counselors is to assist these families in acknowledging some of the positive aspects of being involved in the military as well as ways the experience has made them stronger.

At the same time, Hall says, it’s equally important to address the grief that accompanies a life of constant transition, which includes saying goodbye to friends, family members and even pets. “The military mentality is that you move on and you don’t worry about it,” Hall says. “You’re not allowed to grieve.” But working with military families means allowing them — giving them — that space to acknowledge what they are leaving behind and what they will miss. That is an important piece in helping these families make healthy transitions, Hall says.

The right approach

When working with military couples, Fenell says basic counseling techniques such as establishing a healthy relationship based on trust and reflecting each person’s perspective can go a long way. “A skillful therapist can connect with both partners in each person’s own way without feeling more of an inclination [that] one person is right and one is wrong,” he says. “Once they see you’re going to be objective, they’ll trust you more.”

Family therapy can be helpful in letting the counselor experience firsthand how the family interacts and attempts to solve its own issues, Fenell says. This approach also allows the counselor an opportunity to normalize the reconnecting process in situations in which a spouse is returning from a deployment and trying to bond with the children.

In terms of specific counseling techniques, both Hall and Fenell agree that going straight for the couple’s feelings isn’t the best approach. “Military men are trained right from the beginning that they’re not supposed to acknowledge their feelings,” Hall says. “If we go there first, we’re basically going to lose them.”

“We want to get in touch with thinking in the realms of ‘What do you believe about this? What do you believe that relationships should look like? Where did you learn that? What do you think you could change that might make a difference?’ If we’re lucky,” Hall continues, “we’ll be with them long enough that we’ll get to the emotional piece. But first, focus on what the military focuses on: ‘What are the goals? What do I have to change about my thinking or attitude? And how do I change my behavior in order to reach my goals?'”

A cognitive behavioral approach works well with military clients, Hall says, as does solution-focused therapy and Adlerian techniques. With this particular population, Hall is a proponent of reducing the chaos and finding ways to get problems resolved in a timely manner. “We need to get in and help them make a change quickly. If we do, then they’ll probably come back,” she says. Hall adds that because of the ongoing cycle of relocations and deployments, the “next session” is never a guarantee with military clients. For that reason, counselors should focus on being goal oriented in each session, she says.

Fenell agrees that a cognitive behavioral approach is a good starting point with military families. As the counseling relationship grows and the couple learns to trust the counselor more, he says the counselor might move into more affective approaches. When appropriate, Fenell recommends emotionally focused couples therapy because it is grounded in a systemic viewpoint, recognizes healthy dependence as a strength and helps couples affectively tap into feelings present in the relationship. Structural family therapy is another technique to which a military mind-set might more readily relate, Fenell says.

Guiding a struggling military couple to retrace why they selected each other as mates can also prove fruitful, Fenell says. The counselor can help the couple review what attracted them to each other, what values they had in common and why they bonded, with the goal of enabling them to build on that foundation moving forward.

Hall says that when she worked in the overseas schools, military families often came to her looking for concrete answers and solutions to their problems. Befitting the authoritarian structure of the military, these families pledged that if she simply would tell them what to do, they would do it. “If we as counselors buy into that and it doesn’t work, then we’re the bad guys,” she warns. Instead, Hall recommends turning the situation around and helping these clients explore for themselves what solutions might work within the military structure in which they operate as well as within their own families. “We can give them some things to consider or help them look for the consequences of each one of their actions,” she says, “but we’re probably not doing anyone a favor by saying, ‘Here’s the answer.'”

Beyond the counseling sessions, Hall advises that counselors stay on top of other resources in the community and promote their availability to military clients. Many military installations have family support centers, support mechanisms for families going through a deployment and even career counselors, but military members aren’t always aware of these tools, she says.

Civilian counselors should understand ahead of time that military couples are unlikely to look like or interact like civilian couples, Hall says, regardless of the specific problem that has brought them to counseling. “We’re not trying to take them to a place where they can sit down and make decisions about whether they’re going to move to a new community or not,” she says. “Hopefully we can get them to make decisions as to how they raise their kids or spend their money, but you always have to help them understand that it’s within the military structure.”

Lynne Shallcross is a senior writer for Counseling Today. Contact her at

Letters to the editor:


Bullies with byte

Jim Paterson

There are those who think cyberbullying is an overpublicized issue, a passing fad that counselors and school authorities should be able to handle in the same way as they would schoolyard bullying.

But bullying experts have grown to realize that these online attacks are both different from and more insidious than traditional bullying. For one thing, perpetrators of cyberbullying may not be the type of students one would normally expect to find involved in traditional bullying. For another, the attacks can take place anonymously and quickly involve hundreds of other participants and onlookers. Cyberbullying effectively isolates its intended targets and haunts its victims relentlessly because the attacks reside and proliferate throughout a primary social network for today’s youth — the Internet.

Some experts worry that despite the growing frequency and severity of such incidents, counselors either don’t believe that cyberbullying is a critical concern or don’t know how to address this modern-day problem effectively.

“I don’t see the topic much discussed in counseling circles,” says Sheri Bauman, associate professor and director of the school counseling program at the University of Arizona. “That really concerns me. It is an important issue, and it’s here to stay.”

That perceived knowledge gap led Bauman, an American Counseling Association member of 25 years, to write Cyberbullying: What Counselors Need to Know. The new book, published by ACA, describes the problem of cyberbullying, the reasons why it occurs and recommendations for prevention and treatment.

Bauman and others in the field suggest it is imperative that counselors quickly get up to speed on the complexities of the problem and possible counseling approaches to address the problem, including the need to educate young people and their parents.

A pervasive issue

Cyberbullying is not only a different problem than traditional harassment, experts say, but also a growing one. Most estimates suggest that 20 to 30 percent of young people are involved in cyberbullying incidents, either as perpetrators or as targets. Cyberbullying can involve sending e-mails or text messages, posting on social networking sites or participating in “trash-polling” sites, where visitors are invited to post unflattering comments about someone, often on the basis of the individual’s photo.

Unfortunately, plenty of examples speak to the impact these tactics can have:

  • Ryan Halligan, a middle school student with a learning disorder, was the focus of bullying and suggestions that he was gay. He hanged himself after a girl who claimed to be his friend (a relationship he sought out to dispel conjecture about his sexual preference) told him publicly that he was a “loser” and that she had been pretending to like him just so she could post their conversations online and humiliate him.
  • Ghyslain Raza, a slightly overweight Canadian youngster, was famously dubbed the “Star Wars Kid” for a video he made in private pretending to fight with a lightsaber. Another student made it public by posting it to a website and, eventually, it was viewed more than 900 million times, with music and other features added on. Raza dropped out of school after being taunted repeatedly and sought psychiatric help.
  • Megan Meier, 13, hanged herself after a boy she developed a relationship with online dismissed her by telling her, “The world would be better off without you.” The boy, however, was fictitious, created by the mother of one of Meier’s former friends and rivals.
  • Jesse Logan sent nude pictures of herself to her boyfriend, who then circulated them online after they broke up. She was ridiculed and began skipping school. The school was notified, but didn’t act, according to her mother. Logan went public with her story in a TV interview but shortly thereafter hanged herself.

Increasingly, instances of cyberbullying are being reported in school counseling offices nationwide, often starting early in middle school. Even elementary school children can harass each other online through seemingly friendly chat rooms.

A different animal

How is cyberbullying any different from other types of bullying that take place during adolescence? “The nature of technology magnifies the potential for harm [with cyberbullying],” Bauman says. “The size of the audience who could potentially witness the humiliation of a target is enormous. The bullying takes place without restrictions of time and place, so the target has difficulty finding a safe haven.”

Jesica Lingo, a school counselor at Lake Chelan Middle School in Washington state, conducted her thesis on cyberbullying and has been close to cases at nearby schools. “Because the bullying is done with technology, it can spread much faster, is more permanent and invades spaces that were previously safe,” says Lingo, a member of ACA. “At the very least with traditional bullying, a victim could get a reprieve at home. Now, there is the possibility of 24-hour victimization.” With time, she adds, past verbal assaults and past incidents of traditional bullying can be partially forgotten and can begin to lose their power, but with online bullying, the taunts and insults remain in cyberspace to be read over and over again, causing the target to relive the bullying each time.

Because online social connections have taken on such importance for today’s students, having that environment contaminated by a personal attack can serve to dramatically isolate any young person who becomes a target, Bauman says. “Also, the anonymity of the Internet, and sometimes text messages, increases the boldness of the perpetrator and the fear of the victim,” she adds. “If the source of the behavior is unknown, it could be anyone, including an assumed friend. So, the victim’s basic trust is undermined.”

By its very nature, cyberbullying often draws in young people who wouldn’t normally be bullies, Lingo says. “There aren’t consequences because of the anonymous nature of the Internet and because they don’t see firsthand the negative effects of the bullying,” she says. “There is a lack of empathy.” According to Lingo and others familiar with the issue of cyberbullying, that divide between victim and perpetrator can have an even more serious effect on the emotional health of a young person who feels powerless and vulnerable.

Sexting, the practice of sending sexually suggestive or explicit messages or pictures via a mobile phone (as in the Jesse Logan case), adds another problematic layer to the issue of cyberbullying, says Christine Bhat, assistant professor of counselor education at Ohio University and a member of ACA. “The sexual component in sexting or ‘outing’ someone who isn’t ready to be outed can silence the victim because it is hard for a betrayed or embarrassed teen to seek help from a parent or other adult knowing that the adult might be offended or angered by the information or photos,” explains Bhat, who has studied cyberbullying and spoken broadly on the topic, including at the 2011 ACA Annual Conference in New Orleans this past March.

In addition, she says, although adults normally have a general grasp of traditional bullying, they are not always familiar with new communication technology, making it harder for them to detect a problem or to intervene to help resolve it.

“Several things make cyberbullying potentially more harmful,” Bhat says. “A large number of people are privy to the humiliation of the victim, not just those on the bus or in the cafeteria. It could be online for the world to see, laugh at or comment on. Victims become overwhelmed with the idea that everyone is tuned in [to their humiliation].”

Supportive therapy

Those most familiar with cyberbullying say the issue oftentimes isn’t taken seriously, which is a mistake. “The consequences of any type of bullying are not trivial,” Bauman says. “They are long-lasting and, in many cases, very serious, resulting in depression, anxiety and social withdrawal.” The emotional concerns of young people often cascade, she says, meaning that the anxiety and fear brought about by cyberbullying can cause social withdrawal and a lack of attention to schoolwork, then lower grades and, eventually, more unhappiness at home. Bauman says the resulting state is comparable to that of someone experiencing post-traumatic stress disorder.

“When someone writes a nasty comment on their wall in Facebook, it can be devastating for teens,” Lingo says. “Not only can all of their 352 [Facebook] friends read what was said, but all of the 576 friends of the person who wrote it can read it. For many adolescents, their Internet world is as real and as important to their social lives as their daily lives and school.”

As is the case with traditional bullying, counselors have three responsibilities when it comes to the phenomena of cyberbullying: assisting targets of the bullying, assisting the bullies themselves and educating young people, parents and other adults.

Marilyn Campbell, associate professor of psychology at Queensland University of Technology in Brisbane, Australia, specializes in the study of bullying and offered four principles she believed counselors should follow in a 2007 report on the topic.

First, she said, counselors should ask targets of bullying how they want to be helped. “As with any client, one needs to individualize the solution,” Campbell wrote.

Second, counselors should reinforce with young people being bullied that they are not at fault. “Avoid saying, ‘You need to be assertive. You need to stand up to the bullies. Just tell them to stop or ignore them.’ [The person being bullied] may feel blamed for the event and may retaliate,” Campbell wrote. While being careful not to blame the individual being targeted, other experts note that it is important to educate young clients about why they might be a target for bullies and discuss when and how these clients can be more assertive.

Third, Campbell wrote, counselors should find out if the person being bullied has other serious emotional issues, assess whether the other issues are related to the bullying and explore those issues along with the more practical aspects of the bullying incident to ensure that the client is fully treated.

Fourth, counselors should attempt to provide the client with some “positive peer relations and social cohesion, where peers and friends can support and protect him or her,” Campbell said.

“Victims need supportive therapy that does not blame them and skills training to help them behave differently in the future,” Campbell emphasized.

Treating both sides

Bauman mentions six topics Australian psychologist Evelyn Field developed to help targets of bullying: regulating feelings, understanding their role in the incident, building self-esteem, communicating confidentially, creating personal power and developing a network of support.

Bauman also recommends four types of therapy she believes to be helpful in cases of cyberbullying — in some instances, both for the target and the perpetrator.

Brief solution-focused counseling. This approach is “most appropriate for responding to incidents of low-level severity,” says Bauman. She notes that a 2000 study showed brief solution-focused counseling was very successful in helping both bullies and their victims. The approach encourages clients to focus on exceptions to the problem, build on their self-identified strengths, consider life without the issue and develop strategies for similar situations in the future.

Support groups. This approach can take on a number of different forms, Bauman says, including groups composed of various individuals who have been targets of bullying or groups made up of a single victim’s supporters and friends, plus individuals involved in the incident and the primary perpetrator, all of whom work together to come up with supports for the victim. In school settings, administrators can establish rules requiring that perpetrators participate in such groups. Oftentimes, the perpetrators are repentant and willing to help in an effort to rectify the situation.

Shared concern. Counselors hold meetings with cyberbullies and supporters of the person who was bullied to determine what happened and what might be done to improve the bullied individual’s circumstance, especially in cases in which a group was involved. The perpetrators of the bullying are encouraged to help the person they targeted and are supported in their efforts. Bullied individuals are also interviewed for their perspective on the problem, including what might have made them targets.

Restorative justice. Reserved for the most serious cases, this more formal technique is designed to rebuild relationships, while also allowing bullies and other perpetrators to make amends. The process allows targets of bullying to express themselves in a session in which the goal is to reach a formal agreement on how the victim can be aided. This approach has prescribed steps and a tight structure that might require additional training on the part of counselors, according to Bauman.

When it comes to perpetrators of bullying, Bauman points out that traditional punitive responses rarely change the person’s behavior. “Punishment teaches the offender what not to do, not how to behave appropriately,” she says. “And it may be that what he or she learns is just not to get caught.”

ACA member Scott Schaefle, assistant professor for counselor education at the University of Colorado Denver, emphasizes that bullies need counseling, too. “Old-fashioned empathy is important for victims and bullies,” he says. “Many cyberbullies are also victims of cyber- or traditional bullying, and empathy will help with rapport. Also, a harsh approach can just drive online activities further underground and make them more harsh, compounding the problem.”

Bhat adds that cognitive interventions may be effective in correcting bullies’ thinking errors, including disengagement and hostile attribution bias, in which bullies assume that others are always acting against them.

It is also critical to educate bystanders about how they are contributing to the problem of bullying when they choose not to intervene and to recognize them when they step forward with information, Bhat says.

Schaefle supports that notion, including in instances of cyberbullying. “If a slanderous web page gets hundreds of visits, it reinforces the bullying behavior,” he says. “If it is reported to adults who follow through and do something, that sends a very different message.”

Educating parents and other adults so they understand the technology, how it is being used inappropriately and how they can help cyberbullying targets is key, Bhat says. “People have realized that intervention in cyberbullying cases has to be systemwide. Having clear, widely known policies with descriptions of unacceptable behaviors and clear consequences evenly applied is necessary,” she says. “There are some schools that have policies that no one knows about.”

Counselors can also help their schools develop acceptable use policies (AUPs) and then make certain these policies are understood and adhered to by students (samples of AUPs are available online and in the book Cyberbullying and Cyberthreats by Nancy Willard). Some schools have students sign pledges and display the AUP prominently in the school building and online.

Bhat also believes parents can be reminded that because they pay for electronic media, they should take responsibility for its proper use by their children. She suggests that counselors pass on the following tips to parents:

  • Set ground rules for the amount of time children can spend online. “Parents need to be aware that online addiction is becoming a mental health issue of concern, with a pattern similar to other types of addictions,” Bhat says.
  • Establish rules about whom children can interact with and where, as well as what information will be shared with parents.
  • Discuss appropriate versus inappropriate content and public versus private conversations.
  • Discuss clear consequences for not abiding by the agreed-upon rules for using technology.

“Educating students, parents and teachers is a must,” Lingo says. “It’s not just a school issue or a home issue anymore. It needs to be dealt with as a community.”

Jim Paterson is a writer and editor and the head of counseling at Argyle Middle School in Silver Spring, Md. Contact him at

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