Monthly Archives: December 2013

Sexual healing

By Wynn Dupkoski Mallicoat and Donna M. Gibson December 30, 2013

Mallicoat_Gibson_head-shots[1]Although many have posited sexuality counseling as a specialty, the universal nature of sexual experience makes it reasonable to expect counselors to have a basic knowledge of sexuality and sexuality counseling interventions. Because sexuality is a developmental process, the likelihood that a counselor will work with clients struggling with some aspect of their sexuality is high, regardless of the counselor’s concentration or setting. Although sexuality counseling does require specialized interventions, counselors need to increase their competency in meeting the needs of their clients.

Currently, standards from the Council for Accreditation of Counseling and Related Educational Programs only require that a sexuality counseling course be included as part of the marriage, couples and family counseling concentration. Although some programs offer sexuality counseling as an elective course, many counselors graduate from their programs without this specific training. As a result, counselors need to be proactive in seeking professional development opportunities beyond their graduate-level training. Specific goals to increase sexuality counseling competency include:

  • Exploring the various dimensions of sexuality
  • Increasing self-awareness regarding sexual biases, values and beliefs
  • Increasing comfort with addressing sexuality with clients 
  • Becoming more proficient in the assessment and diagnosis of sexual problems
  • Increasing knowledge of healthy sexual development

 Introduction to sexuality counseling

An introduction to sexuality counseling involves two components:

1) Becoming aware of sexuality-related constructs and myths to target the biases, values and beliefs of counselors and counselors-in-training

2) Defining sexuality counseling

Although sexuality counseling has often been viewed as a specialty within the counseling profession, there is increasing support to view it instead as an area in which all counselors need to demonstrate a basic degree of proficiency because it is relevant in all developmental stages across the life span. In their book Sexuality Counseling for Couples: An Integrative Approach (2006), Lynn L. Long, Judith A. Burnett and R. Valorie Thomas define sexuality counseling as “a process that addresses sex education, values clarification, exploration of sexual attitudes and beliefs, and exploration of self-image, sexual identity, gender role development and relationship issues.” Maintaining a broad definition of sexuality counseling expands the clientele with whom interventions may be implemented to assist in meeting their overall wellness goals. We also want to emphasize that the process of sexuality counseling often begins in individual counseling and expands to couples counseling.

As counselors enter the counseling relationship, they also bring their own subjective experiences of sexuality, much of which they may not be aware of until and unless sexuality becomes the focus of the counseling process. Lack of awareness can lead to counselors responding in a manner that is not therapeutic for clients, such as changing the subject, minimizing the client’s concern, or providing inaccurate or biased information. On the other hand, increased self-awareness regarding sexuality equips counselors to manage their own emotional responses and maintain objectivity. Counselors can increase their self-awareness and their comfort level addressing sexuality in various ways, including:

  • Writing down personal definitions of terms related to sexuality (for example, sexuality, sexual orientation, gender, gender roles and gender identity), discussing those definitions with colleagues and/or supervisors, and researching definitions of these constructs through the American Association of Sexuality Educators, Counselors and Therapists (AASECT), the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling (ALGBTIC) and other organizations.
  • Attending conference workshops focused on sexuality. Networking with other professionals can provide valuable opportunities to collaborate on cases, discuss personal reactions and increase knowledge and awareness of sexuality counseling.
  • Seeking information on sexuality from reputable websites such as siecus.org (the Sexuality Information and Education Council of the United States), scarleteen.com (Sex Ed for the Real World) or iasscs.org/program/archive-sexology (Archive for Sexology).
  • Exploring myths that self and/or others have expressed about sexuality. This includes considering stories, images and messages received from culture and family about gender, relationships and sexual behavior. Some examples may include:
  • Gender: “Boys don’t cry.” “Girls are sugar and spice.”
  • Relationships: Believing it is your partner’s job to make you happy. Believing that conflict in a relationship means the relationship is in trouble.
  • Sexual behavior: “Men think about sex all of the time.” “Women are less sexual than men.”
  • Joining professional organizations or networks that focus on sexuality. These include AASECT, ALGBTIC, the American Counseling Association’s Sexual Wellness in Counseling Interest Network and others.

Sexual dysfunction

Although counselors need to be aware of healthy aspects of the developmental experience of sexuality, they also need to be knowledgeable about sexual dysfunction. It is important to assess the limitations of one’s expertise and know when to refer a client to a certified sex therapist. Sex therapists specialize in the treatment of sexual dysfunctions. Prior to making a referral, it may be necessary to educate clients about the nature of sex therapy to dispel myths and increase their willingness to pursue more intensive interventions for sexual concerns because many clients worry about stigmatization.

Assessment is essential to determining if a referral is more appropriate than providing sexuality counseling interventions. The Diagnostic and Statistical Manual of Mental Disorders (DSM) outlines sexual dysfunctions recognized by the American Psychiatric Association. According to the DSM-5, sexual dysfunctions have been modified from previous editions to deviate from Kaplan’s sexual response cycle, noting that these phases may not be distinct. Sexual dysfunctions are gender specific, and there is a requirement that symptoms be present for at least six months and that the severity of the symptoms meet specific criteria.

Sexuality issues

Sexuality concerns go beyond dysfunction. Many clients experience distress over normal developmental sexual experiences, such as sexual orientation and gender identity, and over experiences that fall outside of normal sexual development, such as sexual trauma. For normal sexual development concerns, the counselor may implement interventions focused on assisting the client in resolving dilemmas between “self” and “other” concepts such as cultural and/or religious beliefs and sexual experiences, values and behaviors, or biological and psychological aspects. It is helpful for counselors to reach beyond the binary conceptualization of these social constructs (male/female, gay/straight, etc.). One model that may be beneficial in assisting counselors and clients to view sexuality as a fluid construct is Whalley’s Continua (2005), which asserts that sexuality has several components that may be viewed as continua, with clients falling somewhere between two extremes. This model identifies biological sex, sexual orientation, gender and gender expression as distinct aspects of sexuality that interact to create a total picture of a person’s sexual identity. The use of flexible models such as Whalley’s Continua allows counselors to have an open dialogue with clients during assessment and intervention stages about various aspects of their sexual experience and expression, rather than making assumptions.

For those experiences that fall outside of the norm, such as trauma, interventions would focus on minimizing the negative impact and symptoms associated with those experiences. Specific, evidence-based treatment approaches have been established to focus on traumatic responses. Numerous assessments are accessible to counselors to determine traumatic symptoms. In addition, trauma — particularly sexual trauma — has a significant impact on an individual’s sexual functioning.

Specific to childhood sexual trauma, a lack of knowledge might exist concerning what is a normal and not-so-normal sexual experience. One of the authors of this article had a former client who had experienced sexual abuse as a child and rape as an adult. It was difficult for this client to discern physical sensations that were healthy and pleasant. In her particular situation, the client first needed to become comfortable with her own body and learn about where specific genitalia were located. Once she became familiar with her body and the sensations created when her genitalia were touched, this demystified some of the previous trauma-related associations she had with sexual experiences.

Models of sexuality counseling

Several approaches have been established in sexuality counseling, each with distinct assumptions regarding sexuality that guide the techniques used to address the sexual concerns of clients.

Behavioral and cognitive-behavioral approaches assume that sexual behavior is learned and, therefore, can be unlearned. As such, a person’s sexual history is based on past behaviors and can be changed through behavioral rehearsal. From this perspective, interventions may include:

  • Psychoeducation: Providing education regarding sexual experiences that are normal, developmental and abnormal. 
  • Cognitive restructuring: Addressing thinking errors and myths regarding sexuality and sexual behavior.
  • Caring days: Each partner creates a list of detailed behaviors he or she would like his or her mate to perform, and both partners are assigned to engage in these behaviors on a consistent basis.
  • Behavioral techniques: Addressing specific sexual concerns through techniques such as systematic desensitization, assertion training and squeeze/start-stop techniques.

Murray Bowen’s intergenerational approach assumes that family patterns are repeated within a relationship, which can result in sexual problems. Specific emphasis is placed on the level of differentiation as essential in maintaining intimacy and sexual desire. Given this premise, interventions that counselors would use include:

  • Genograms: A pictorial means of gaining information regarding family patterns. It typically includes a minimum of three generations.
  • Detriangulation: Recognizing dysfunctional communication patterns and encouraging direct communication.

Problem-focused approaches assert that sexual problems exist to keep couples in balance and occur within a system, with changes to one part of the system affecting all other parts of the system. This mode of therapy is brief, usually taking place within 10 sessions. Interventions from this perspective include:

  • Joining: The process of connecting with each member in the client system.
  • Enactment: Developing enactments or scenes typical of the couple’s dynamics to diagnose the problem and create change.
  • Reframing: Communicating a person’s experience in a way that shifts his or her perspective.
  • Directives: Addressing client behaviors by giving specific instructions to illicit a new behavior.
  • Rituals: Events that provide meaning for clients.

Solution-focused approaches assume that change is inevitable and emphasize identifying solutions to problems rather than focusing on how the problem developed. In addition, strengths are highlighted, and only small changes are necessary. Interventions include use of:

  • The miracle question: “Suppose a miracle happens tonight and your sexual concern is gone. What would be different?”
  • Scaling: Framing likelihood for change on a scale of 1 to 10. “What makes that the number you chose?”
  • Highlighting previous successes: Looking for times when the client (or clients) solved the problem successfully in the past. 

Communication approaches assume that open communication fosters healthy sexual relationships. On the basis of this assumption, behavior serves to communicate in verbal and nonverbal ways, maintaining connection in a relationship. As such, techniques include:

  • The use of “I” statements 
  • Communication and problem-solving skills training 

The integrative model for sexuality counseling (emphasized by Lynne L. Long, Judith A. Burnett and R. Valorie Thomas) uses a systematic focus of understanding problems from both partners’ perspectives to reduce blame and increase collaboration. This model stresses cognitive, affective and behavioral changes in sexual patterns using resources and strengths. The model incorporates five stages: assessment, goals setting, interventions, maintenance and validation.

Assessment in sexuality counseling

Just as it is important to be aware of personal biases and to determine a model of sexuality counseling, assessment is essential to conceptualizing a client’s sexual concern. Prior to assessing, a counselor should contemplate several questions that will aid the process.

  • Who is the conversation for?
  • What is the purpose of gathering information? What will be done with it?
  • What does the client need or want to tell? What will he or she find useful in this conversation?
  • Is there anything I know thus far that would indicate sexual issues?
  • Am I avoiding asking about sex, or is it really not relevant?
  • Will my client feel comfortable talking to me about sex? How will I know?
  • How will I know if I am being inappropriate or intrusive with my questions? 

After a counselor has pondered these questions, the next step is determining the most effective means of assessment. The counseling model may help in determining the specific assessment tool, but options should not be limited based solely on the model. It is also important to take into account a client’s needs, level of functioning and personality characteristics to determine the most effective means of assessment. Some examples of assessments of sexual concerns include:

  • Sexual genogram: Using a genogram, explore messages, gender roles, behaviors, communication, secrets and history related to sexuality. 
  • Sexual history: Usually used with preadolescents and older clients. Using a form, ask questions about details of the client’s sexual behavior. 
  • Formal tests: Select formal assessment tools after looking at psychometric properties, the nature of the problem and ease of administration. These tools should be used early in the counseling process. Ideally, a combination of measures is more helpful.
  • Observation: Includes what the counselor notices in session in the client’s verbal and nonverbal behaviors, the client’s self-observations and so on.

Treatment planning and maintenance

After assessment of sexuality and sexual behavior has been conducted, the next steps involve identifying goals, developing a treatment plan and implementing interventions. When setting goals with a client, it is important to first determine a common definition of the problem. Counselors should clarify terminology used by clients for sexual concepts to ensure that a mutual understanding is present. When a significant difference exists between the perspectives of the counselor and the client with regard to sexual language, an agreement should be reached concerning terminology to be used in the counseling process to minimize confusion.

Making goals realistic and behavioral in nature will increase the likelihood of success due to the ability to measure progress. It is also important to view sexual concerns as external to the client rather than being an aspect of the client’s personality to minimize blame and empower the client to make necessary changes. For example, a client who does not initiate sex with a partner may view the sexual concern as a “time problem” rather than an unwillingness to have sex or a lack of attraction to the partner. When working with a couple, it is important to assist the couple in developing a mutual definition of the problem and goals.

Once clear and measurable goals are established, the counselor is then able to determine the most appropriate intervention to address the sexual concern. Sexuality counseling interventions are viewed as active in nature, requiring the client to be the primary means of facilitating change and monitoring the effect of implemented changes. As the client moves forward in addressing sexual concerns, interventions move toward maintenance, which involves scaling back on sessions, educating the client about relapse and setbacks, and modifying the environment to support new behaviors. Preparing clients for setbacks includes discussing life events, stressors and resources.

Summary

The nature of sexuality counseling is being redefined as an essential skill for counselors, regardless of concentration. Although clients may enter into counseling with a specific sexuality concern, often they may feel uncomfortable discussing sexuality or may not be aware of the connection between sexual behavior and overall wellness. It may not be obvious that there is a sexual concern, making it essential to be direct when addressing sexuality with clients. There are numerous ways counselors can communicate an invitation for clients to discuss sexuality, including having books on the bookshelf that focus on sexuality and sexual behavior. Clients will notice this as they look around your office space, and that may offer reassurance that you are comfortable discussing sexuality concerns.

Another means of opening that door of discussion to clients is to include sexuality-specific questions in the assessment process, including specific questions on an intake form. For example, if a client presents with depression symptoms, you may ask, “How has your mood affected your sex life?” Or you may ask about the client’s sexual functioning regardless of whether symptoms are present (“How has your sex life been lately?”).

The case of a former client demonstrates the importance of the intake form in encouraging discussions around sexuality. In essence, the client knew he was being deployed in a few months and said he was concerned about the viability of his relationship with his girlfriend. This was discussed in the initial counseling session, but the presenting concern on the intake form mentioned he thought he could have a sexual addiction. In the next session, the intake form was used to introduce this. He revealed that he was masturbating extensively to online pornography but did not have a physical relationship with his girlfriend. Bringing the topic up through the intake form appeared to give the client permission to discuss his concerns openly.

Another way to introduce this topic in counseling is to highlight sexuality as part of overall wellness when discussing your philosophy of counseling.

Because counselors-in-training may not be required to take or even have access to a specific course in sexuality counseling, it is important that counselors seek opportunities to build their skills in addressing sexuality with all clients, regardless of age.

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Knowledge Share articles are adapted from sessions presented at American Counseling Association conferences.

 

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Wynn Dupkoski Mallicoat is a licensed professional counselor, licensed professional counselor supervisor, facilitator of ACA’s Sexual Wellness in Counseling Interest Network and contributing faculty member at Walden University. Her research emphasis has focused on enhancing sexuality counseling training through presentations, publications and leadership. Contact her at wenndy.mallicoat@waldenu.edu.

Donna M. Gibson is an associate professor of counselor education at Virginia Commonwealth University. She is a licensed professional counselor and a past president of the Association for Assessment and Research in Counseling, a division of ACA. Contact her at dgibson7@vcu.edu.

Processing the ‘whole’ with clients on the autism spectrum

By Chris Abildgaard December 23, 2013

Puzzle_smallFor clinicians working with individuals who have an autism spectrum disorder (ASD), a key component to any therapy (group or individual) is helping these clients see the “big picture” when it comes to social situations, academic assignments, the need to do daily chores at home, reacting to the size of a problem and so on. Piecemeal representations, or focusing only on certain parts, do not allow one to see or understand the global context of a situation.

Many of our clients on the autism spectrum get stuck on these “parts” due to deficits in their executive functioning and their inability to see the big picture (Gestalt processing deficit). From a cognitive behavioral perspective, one may associate this with rigid thinking, which leads to an emotion of frustration and sometimes anger as a “negative automatic thought.” These negative automatic thoughts eat away at these clients, and they become so inflexible that they cannot move past the thought and get to the point where they can process the whole event.

On tasks that require holistic processing, such as reading a social situation, individuals with an ASD or other social learning challenge often don’t fare very well. They are poor social observers who get stuck in their negative automatic thoughts. Many times, past negative results have an impact on their overall cognitive sets about being social (“I have failed at being social in the past. Why will this be different?”). Both social and academic successes are reliant on a person’s ability to integrate separate “social pieces” into a cohesive understanding of a larger
task or social situation (the big picture).
The person must be in a mental state to allow flexibility in his or her processing of the event.

Think of it as a jigsaw puzzle. Kids with an ASD can see only one or two puzzle pieces at a time and get frustrated because they can’t see how the pieces they have — and see as the most important — will fit into the larger puzzle. These core deficits affect the therapeutic process and the time it will take in therapy to process and restructure one’s thinking about a particular situation.

Have you faced the following situation as a clinician? A parent comes into the session and wants to talk about a specific incident in which “Ben” (the client) had a huge reaction to something that occurred over the course of the week. Now you are asked to process this situation with Ben several days later, but Ben will get stuck on parts or details of the situation that really have nothing to do with the bigger picture. To Ben, those parts he is stuck on are critical aspects that others (in this case, his mother) have failed to see. This is not an issue of reality versus fantasy. Rather, it goes to the heart of Ben’s social processing abilities and how he interprets the importance of events that are all relative to his core deficits in executive functioning, Gestalt processing and theory of mind (being able to take the perspective of another person).

So, how can we help? What follows is a simple yet effective strategy that counselors can use to improve social processing. The goal would be to help clients who have social learning challenges to make their own social plans and understand the social context they are in.

Investigating the big picture

What we know about individuals on the autism spectrum is that many (but not all) are visual learners. Using visuals is key to helping these clients understand the social expectations of situations. Initiate what we call a “social task analysis” on a piece of paper, white board or napkin (if nothing else) by drawing or writing out the following “parts” to the whole situation your client is processing with you. This process is not meant to be hard or upsetting for children or clients. It should be done when they are in a state of relative calmness and open to processing what they are thinking about or something that occurred in the recent past.

Remember, social problem-solving interventions should not be used only to process something negative. These strategies can be used to process something the person is thinking about, something that may be causing the person stress or even when something positive has happened. In fact, initiating a social task analysis following a positive event may help these clients to recall that positive outcome the next time they are faced with similar situations.

The social task analysis should include the following steps:

a) Identify the context. This includes not only the place and time of the situation but also sets the social and behavioral expectations for that situation.

b) Write down the names of the individuals involved. This brings meaning to the people in the situation.

c) Identify the “tipping point” in the situation. This might be a social roadblock, problem or glitch faced by the people or it can be a positive turn of events. It merely signals that something has happened to affect the thoughts, feelings and actions of people in a given space.

d) Identify the thoughts, verbal expressions and feelings of those involved.

e) Draw out a “plan” for the situation if there is a roadblock the person needs to overcome. The fact of the matter is that there may not always be a solution right then and there. It is more important that clients learn how to create a plan or a sequence of steps to attempt as a means of overcoming roadblocks rather than knowing there is always a “right” or “wrong” outcome. Counselors might find it beneficial to make a plan A and a plan B with clients as a means of teaching cognitive and behavioral flexibility. 

f) End by teaching clients to implement a reflection piece. Teaching clients (and their families) how to reflect back on a given situation is critical to developing positive episodic memories. This reflection time should be a learning opportunity that will help them the next time they face a similar roadblock.

When possible, and especially in school settings, leave some time for “behavioral rehearsal” of the possible scenarios that were discussed. I don’t think the students we are trying to teach social cognitive concepts to have enough opportunity to see themselves “be social,” so anytime a role-play can be performed, it will help them with their working memory of the situation as well as the motor planning aspect of all the social sequences. Research in this area of role-playing and video modeling certainly supports its use.

During your behavioral rehearsal, introduce some perspective-taking concepts by explaining the thoughts and feelings of people involved (and please start using the word “maybe”). For example, you may have the child or client verbally rehearse the following scenario: “Next time I see Joey, I will remember that he likes the Red Sox and maybe he will ask me about the Yankees. I will feel good because I asked him about something I know he likes. If he doesn’t ask me about the Yankees, that is OK too.”

This concept of “maybe” is important for our more rigid thinkers to understand. The use of the word “maybe” aims to create flexibility and is proactive because it does not allow these clients to create just one picture in their heads related to how things are “supposed to go.”

Helping clients on the autism spectrum to see the bigger picture will take time, patience and a variety of tools in the clinician’s toolbox. Setting small goals that enable improvements to be seen in this area is important because it will allow the counselor, the client and, in the case of children, the client’s parents to know that things are progressing in the right direction.

 

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Chris Abildgaard is the director of the Social Learning Center in Wallingford, Conn. He is a nationally certified counselor, a nationally certified school psychologist and a licensed professional counselor with a specialization in autism spectrum disorders and social cognitive interventions. Through his clinical practice and professional interests, he has been exploring methods for integrating cognitive behavior therapy with other tools to improve executive functioning. Contact him at chris@sociallearningcenter.org.

Almost 20 percent of U.S. adults experienced mental illness in 2012

By Bethany Bray

Nearly one in five adult Americans experienced a diagnosable mental illness last year, according to statistics released recently by the federal government.

Less than half (41 percent) of these 43.7 million adults received any mental health services in 2012. While jarring, these numbers are consistent with statistics gathered for 2011, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).

SAMHSA’s annual National Survey on Drug Use and Health surveys the civilian, noninstitutionalized population of the United States ages 12 and older.

The most prevalent reasons 2012 responders gave for not receiving professional help, according to SAMHSA, were because they could not afford it, thought they could handle the problem without treatment or did not know where to go for services.

Additional highlights of the survey’s findings for 2012:

  • 9 million Americans, or 3.9 percent of adults ages 18 and older, had serious thoughts of suicide in the past year; 2.7 million, or 1.1 percent, made suicide plans, and 1.3 million (0.6 percent) attempted suicide.
  •  2.2 million youths, or 9.1 percent of individuals ages 12 to 17, experienced a major depressive episode in 2012. These youths were more than three times as likely to have a substance abuse disorder than peers their age who did not experience a major depressive episode.
  • Adults who experienced mental illness in 2012 were three times more likely to have met the criteria for substance abuse disorder than those who did not have a mental illness (19.2 percent versus 6.4 percent). Those who had a serious mental illness in 2012 were even more likely to have had substance dependence or abuse (27.3 percent).

With these statistics in mind, the government recently launched MentalHealth.gov, a website with information about the basic signs of mental health problems, news, information and discussions of mental health issues and how to locate help. Users can enter their ZIP code to find mental health services in their local area.

SAMHSA also launched two grant programs that will provide millions of dollars in funding to agencies providing mental health care and outreach to children and youth.

 

Find SAMHSA’s complete survey data here: http://1.usa.gov/18Y5IEK.

 

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org.

Angry words

By Stacy Notaras Murphy December 20, 2013

Angry-words“Anger is a signal, and one worth listening to,” wrote Harriet Lerner in The Dance of Anger, her seminal book about anger and intimate relationships first published in 1985. Lerner told millions of readers — in the counseling field and beyond — that our anger is a tool alerting us that something is not working in our lives. But anger can also inspire fear in others, whether at home, in our workplaces or in our communities. This leads many people who are angry to isolate themselves from loved ones or others who are afraid of such powerful emotions. In some instances, it prompts them to seek help from licensed professionals.

Though anger may be what brings these individuals through the office or agency door initially, it is unlikely to remain the singular focus of the client’s counseling path. Eventually, with the benefits of psychoeducation and personal insight, clients often realize that their anger is simply a more acceptable, “go-to” surface emotion that covers up deeper fears and sadness. Counselors with anger management training and expertise often face the delicate challenge of helping these clients view anger as a helpful symptom and tool rather than something to be avoided whenever possible.

Anger management programs typically invoke the same cognitive-behavioral and insight-oriented therapeutic techniques that most counselors practice on a daily basis. Clients often are asked to pay attention to what happens in their bodies when they start to feel anger, to practice mindfulness and self-calming techniques, and to explore more adaptive ways of expressing their feelings. Although referring clients to anger management classes or groups is effective in many cases, counselors wishing to explore these issues in their own offices might find themselves invigorated by helping clients finally succeed at something many never thought possible.

Francesca G. Giordano, director of the Master of Arts in counseling program at Northwestern University’s Family Institute in Evanston, Ill., traces her interest in working with clients who are angry to the energy they bring into their treatment. “It was when I began to work with couples with relational conflicts that I started to be really interested in the transformational characteristics of anger,” reflects the longtime American Counseling Association member. “In 2004, I began to conduct qualitative research interviewing individuals who have been able to use their anger to transform their lives. During this time, I also did a lot of reading about social justice leaders who were able to use their angry feelings in a positive, world-changing way. This had a powerful effect on increasing my awareness that, sometimes, encouraging clients to become more angry was as important — sometimes more important — than helping them manage their anger.”

Giordano emphasizes the importance of separating the emotion of anger from its potential behavioral outcomes such as aggression or conflict. “What I think many clinicians miss are the positive characteristics of anger,” she says. “Often we are so concerned with managing the negative behaviors associated with angry outbursts, we forget that feelings [of anger] do have a positive potential to bring people together and to motivate self-care.”

Giordano further points out that a deeper understanding of a client’s anger can reveal it to be a reasonable reaction to unfair and unjust treatment. Here, she recommends that counselors help clients use the energy of their angry feelings to create action plans to move toward a more empowered existence.

Working out the anger

Jim Messina, an ACA member and counselor educator in Tampa, Fla., has written extensively about anger management and has launched a 12-step-style program to help people struggling with anger and self-esteem issues. He also asserts that counselors must be careful not to focus solely on the symptom of anger when clients present for anger management assistance.

“Too often, we are in a hurry due to agency policies and procedures or our own lack of patience to dig deep into the causation of the issues for which clients come in to see us,” he says. “We must slow ourselves down and be good FBI agents to sort out … the real causation for the behaviors which we are witnessing in the client.”

To this end, Messina helps his clients recognize the many ways that anger presents itself, ranging from holding resentments against loved ones to acting out aggressively toward others. After a journey to better understand his own anger and self-esteem issues many years ago, Messina developed a program to help others cope with intense anger and resentments. The program includes activities that he has named “Tools for Anger Work-out.” These exercises help clients notice and respond to their feelings, which they often release through a nonthreatening physical action such as beating on pillows or yelling in a parked car with the windows closed. Clients in the program learn to relax when their anger is ignited, apply rational thought to determine the source of their anger and then clarify their feelings and connect them to unresolved issues from the past.

The combination of individual counseling and workout exercises has proved effective at helping clients find healthy ways to express their anger, Messina says. For example, when he was in private practice, he maintained an “anger workout room” for clients that featured a 40-pound karate kick bag. Clients could punch and kick the bag to release the angry energy that was causing them distress. “My clients could go in and beat on it until they felt like they had released some of the pent-up energy” that had been keeping them emotionally immobilized, he says.

One of Messina’s clients during this time had a successful business career and a connected relationship at home. Despite those factors, he was experiencing horrible outbursts of anger that he felt unable to control. Using an inner child assessment that Messina had developed, the man identified childhood wounds of feeling ignored by his family, leaving home at age 18 and never having contact with them again.

“This severe emotional and physical neglect left him scarred and unable to regulate his emotional response to events, people or conditions in his life,” Messina says. “All of his friends and co-workers were getting the brunt of his displaced anger.” The treatment plan involved group therapy, daily anger workout exercises and journaling that revealed his deep sense of abandonment, resentment and guilt.

“He was able to do this work so well that he has become known in the workplace as the ‘go-to guy’ whenever you have a personal hurt or concern. He is an effective communicator now who no longer strives to be invisible,” Messina says. The counseling process helped the client understand his family members without requiring him to re-engage with them, which could have been emotionally detrimental and was clinically unnecessary, according to Messina.

Power in numbers

Hollywood has offered many cliché images of so-called anger management classes. Messina urges counselors to know what is being offered in such classes in their communities before making referrals. “Without a healthy, well-managed and well-monitored model of release of the pent-up emotions which erupt in domestic violence, child abuse, physical assault and aggression on others, it is hard to believe the folks who are so eruptive are that much better after attending five to 10 [anger management] classes,” he says.

Appreciating the difference between self-selecting and court-mandated group therapy is key. L. Kay Howard is an ACA member and licensed professional counselor (LPC) in private practice in Houston, where she conducts both individual anger management work and court-mandated anger management groups. She says her court-mandated clients often are more reluctant than her self-selecting individual therapy clients to look at their anger issues. She traces this denial to feelings of legal injustice, noting that many mandated clients initially work hard in the group setting to try to justify and explain their legal troubles. In turn, she says, they often feel even more victimized when they learn about the fees and amount of time involved in attending mandated anger management groups. Conversely, Howard has found that clients who voluntarily come to treatment for anger issues often do so at the behest of a spouse or employer and are generally more willing to admit they are struggling with anger.

Howard, like Messina, has created her own curriculum for working with clients and has become certified in the anger resolution therapy approach developed by Newton Hightower. “I prefer doing anger management in groups, even though I do both [group and individual work],” Howard says. “I personally feel they learn more about their anger [in groups]. … When listening to others in the group, they sometimes see themselves in others’ stories.”

Jennifer McClendon is an ACA member and senior counselor/co-occurring specialist at the John Brooks Recovery Center in Atlantic City, N.J., where she provides group counseling to clients dealing with mental health and substance abuse disorders. She makes the case for encouraging those with anger issues to partake in both individual sessions and group work. “The group experience provides clients the experience needed to communicate they are not alone in dealing with their issues and offers a healing atmosphere, if the group can achieve this level of intimacy. The individual counseling experience allows clients to verbalize thoughts, feelings and experiences they may not be ready or need to prepare to address in a group process,” she says.

Illustrating this complementary approach, McClendon tells the story of Tommy (not his real name), a client mandated to a residential treatment center for substance abuse. Having already served 15 years in prison for another offense, and reporting a history of verbal abuse and no knowledge of his biological father, Tommy was included in a therapy group led by McClendon that met three days per week. She recalls that Tommy was guarded and directed much of his anger toward other group members, sabotaging their work by calling them insincere and refusing to open up about his own feelings. His anger about the process prevented him from experiencing the power of the group. All McClendon could do was be patient and work to build a therapeutic alliance with him through their companion individual counseling sessions.

During his time in treatment, Tommy’s sister, whom he referred to as his “real mother,” passed away. He didn’t discuss his grief in group, but a few weeks later, one of the other group members shared about his own use of drugs to numb himself against experiencing painful anger and sadness. The group member then directly invited Tommy to share the story of his sister’s death.

“After what seemed like an hour of silence, Tommy tried to speak but instead cried,” McClendon says. “He also talked about his feelings of abandonment and anger toward his mother and apologized to his group members. … This loss seemed to help Tommy, probably for the first time, experience his true feelings without any substances. The story from his peer appeared to have been beneficial in helping him release what seemed like a time bomb of emotions in a healthy way.” Tommy later went on to complete a separate eight-week class in anger management.

Anger education in action

Lauren Ostrowski is an ACA member and LPC at a community counseling agency in Pottstown, Pa. She developed a strong interest in anger management during her neophyte days as a counselor because she noticed how deeply some of her clients experienced anger and how strongly connected the emotion was to the other issues they were facing. She says she always aims to teach her clients that everyone is entitled to be angry if they truly feel that way. “What matters is what we do when we are angry or intensely emotional and whether certain reactions are safe and healthy for all involved,”
she says.

In her experience, Ostrowski has found that listening is the most important step in understanding the roots of a client’s presentation of anger. “While clients will often state that they have no idea what makes them angry, a few sentences later, they are unknowingly talking about their triggers,” she says.

Treatment plans usually start with safety and symptom reduction, which includes teaching clients coping skills to help them experience their anger in a safe manner, Ostrowski says. She helps clients learn to communicate with “I statements” and recognize when it might be necessary to step aside and calm down before pursuing a topic with another person. She also has had success advising clients to set time limits on discussions involving hot-button topics. “Sometimes, dreaded conversations can feel more surmountable if there are time limits,” she explains.

Ostrowski reminds counselors of the need to create a safe environment for themselves and for their clients when facing anger issues. “Remember, anyone has the potential to get angry, whether or not anger is a main focus of treatment,” she says. “A client who reports that they typically throw glass or other breakable objects may be willing to squeeze a soft stress ball or hold an ice cube when angry.

“It’s also important for counselors to remember that we are often discussing issues that lead to anger outbursts, so we may see them in session. I empower clients to tell me what they are going to do if they get angry in session — before it happens. Sometimes a subject change is in order, even if this is temporary. If a subject is important enough to make a client angry in session, they are usually willing to go back to the topic after they have calmed down.”

Giordano says most counselors are well equipped with cognitive-behavioral techniques that can easily be applied to anger management intervention, but she hopes they will also employ their developmental skills and strength-based clinical tools to assist clients struggling with anger issues. “I would encourage counselors not to limit themselves to training that focuses on CBT [cognitive behavior therapy] treatment techniques alone,” she says. “Anger is very connected to experiences with injustice, so training in multicultural counseling techniques is very helpful. Anger has a powerful gender component to it, so training in feminist treatment techniques is also helpful. … I think angry feelings need to be associated much more clearly with the need for positive healthy change and emotional connection.”

McClendon says her work in substance abuse counseling lends itself to anger management because her clients who have been mandated to treatment often exhibit behaviors that appear threatening to others. She teaches these clients that anger often is a conditioned response, not their primary emotion. Her aim is to provide a corrective experience through the therapeutic alliance that helps to normalize their experiences, educate them about the function of emotions and develop healthier ways to identify and express their feelings.

When facing resistance from clients dealing with anger at the substance abuse treatment facility, McClendon has found that motivational interviewing techniques help to establish the therapeutic alliance. “Like most clients, the clients I work with seem to want to know that it’s OK for them to be angry, afraid, reluctant, etc., without being judged. I have found that most clients will lower their defenses and talk about their beliefs, problems, etc., if I, or a group, can genuinely communicate empathy,” she says.

McClendon’s advice to counselors is never to tell a client that he or she doesn’t have the right to be angry. “Allow the client to have these experiences, but [also] help them understand themselves better, encourage them to identify how they want to change and facilitate this change process through ongoing support and education.”

 

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Contributing writer Stacy Notaras Murphy is a licensed professional counselor and certified Imago relationship therapist practicing in Washington, D.C. To contact her, visit stacymurphyLPC.com.

 

Turning points

Compiled by Jonathan Rollins December 19, 2013

signA counselor’s path forward is rarely linear. Agreed? Somewhere over the course of a career, something is almost guaranteed to happen that will change the counselor’s perception of, approach to or relationship with counseling.

In fact, if you practice or teach long enough, you are likely to encounter several “somethings” that will shift your professional worldview in surprising and enlightening ways. These professional turning points may be the result of working with a specific client or being introduced to a particular client population, unwrapping a new counseling intervention or therapy model, overcoming personally challenging circumstances or simply encountering a serendipitously timed bit of wisdom.

Counseling Today recently invited several American Counseling Association members to reflect on their turning points and share the lessons, whether subtle or dramatic, that still guide them today.

 

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There were two experiences, closely associated in time, which changed my view of counseling and my work as a counselor. The first was being asked by Juliette Lester, director of the National Occupational Information Coordinating Committee (NOICC), to deliver a talk on adult career development at their annual conference. This was at a time when NOICC, and many career development specialists, focused on K-12 and saw career decision-making as something done once. In trying to come up with a metaphor for what I saw at my career center and the adults that I worked with, I decided that dentists had, in the last few generations, changed their practice from one that was crisis oriented to one that focused on prevention, education and periodic checkups — thus, the dental model for career counseling.

In thinking about this model, I realized I was still clinging to the belief that clients came to career counseling to make decisions, plan actions, perhaps learn the skills of self-directed decision-making, but that ultimately we would be wrapping up their issues in shiny paper, tying a pretty ribbon and that they would leave in some way “done.” Although this was rarely the reality, I still acted as though this was the desired outcome of our relationship. The dental model freed me — and them — from this unrealistic expectation and allowed for their coming back to me or others as new circumstances arose or as internal change signaled a need for new action.

The second experience happened around the same time and involved a client whose issues were largely intrapersonal and whom I had considered a major failure. She had seen me for several months, then one day canceled an appointment and never returned. No shiny paper, no pretty ribbon!

A few months later, I happened to run into an acquaintance who was a friend of this client. This acquaintance proceeded to tell me how happy “Zoe” was with our interactions and how much I had helped her. Huh? Perhaps the client did not need me to wrap her up and tie her ribbon. Perhaps she had gotten what she needed and the need for closure was mine, not hers.

This is not to say that organized and planned termination is not a valuable part of counseling, whether the presenting issues are intrapersonal, interpersonal or career related — and usually all three are part of the picture. But what changed for me was the belief that closure was necessary, that I was in charge of making that happen and that people’s lives could be tidily wrapped up and they could henceforth ride into the sunset. I discarded the metaphorical shiny paper and pretty ribbon and allowed clients to have fuzzy, untidy, incomplete endings.

What a relief.

— Jane Goodman, past president of the American Counseling Association and National Career Development Association, and professor emerita of counseling at Oakland University in Michigan

 

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While working toward my master’s degree in mental health counseling in the 1980s, I resonated with Albert Ellis’ rational emotive behavior therapy (REBT). Upon graduating in 1985, I practiced REBT at a psychiatric hospital and in a small private practice, and I became rather proficient. This was helped during a vacation I took to New York City in 1986. I scheduled three personal psychotherapy sessions with Albert Ellis. Meeting with the pioneer of REBT allowed me to experience Ellis doing REBT firsthand and work on some of my personal issues as well.

After practicing REBT for almost a decade, it seemed that everywhere I looked, I saw irrational beliefs. But I wanted to try something different and sought alternative methods of helping clients change. This is when I entered a doctoral program at Nova Southeastern University in Fort Lauderdale, Fla., in 1989.

Significant changes occurred for me during the doctoral program. In particular, a shift transpired when I read the book In Search of Solutions: A New Direction in Psychotherapy by Bill O’Hanlon and Michele Weiner-Davis. This book describes the principles and techniques of solution-focused therapy. For me, it was a change from focusing primarily on problems and what was not working for my clients to focusing on solutions and what was going right. The following case, which occurred in my practice at about this time, coincided with my shift from REBT to solution-focused work.

For the past two months, I had been using REBT with a client named Jon for various problems, including anxiety, depression and conflicts with co-workers. Jon came to the next session and reported, “It was a good week.” Instead of using REBT and inquiring about the client’s irrational beliefs, I followed up on Jon’s statement and asked, “What was good about this past week?” He described various positive events. There was no mention of irrational beliefs during the session, only what was better in his life. I was doing solution-focused therapy.

My shift from REBT to solution-focused counseling was only possible because I was willing to challenge some of my taken-for-granted assumptions about problems and change and what it means to be human. As counselors, we often see our function as helping clients to bring about change. I now view myself as part of the system to be changed, rather than separate from my client. The former view helps create collaboration, whereas the latter view tends to engender resistance.

This is not to say I no longer find utility in REBT. I still use its techniques if it fits with the client. And I foresee a day when I might experience another paradigm shift, as I did when I moved from REBT to solution-focused therapy. One of the most important lessons I have learned as a counselor is to always be willing and prepared to change.

— Jeffrey T. Guterman, licensed mental health counselor, Fort Lauderdale, Fla.

 

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The small orange rectangular flags on the car antennas waved west, flapping against the backdrop of a bleak, gray Midwest morning. A motorcycle escort guided the procession of mourners following the hearse. Even in a heated car, I could feel the bone-chilling cold of a January morning as I sat and watched. It crossed my mind that the ground would be frozen — too cold to dig 6 feet down. People would probably not want to linger at the gravesite. Would they eat afterward at a nearby church or restaurant? I considered a menu of ham sandwiches and potato salad, coffee and homemade pies. I caught myself short and drew a deep breath. No, this was not the funeral I had to plan. This was not my grief, thank God, but it was a piercing reminder of my personal horror.

Just 14 days earlier, a beloved family member had overdosed on opiates, resulting in a complete collapse of the lungs. A respirator kept him alive as we desperately waited and prayed. When hope was vanishing, we took a gamble and had him Life Flighted to a larger hospital. It was a “Hail Mary” gesture, a last-ditch effort to see if a more powerful ventilator could jump-start his breathing. I remembered that surreal feeling when every minute was filled with an unbearable intensity. One moment I would see an eyelid flutter and my heart would soar. In another moment, I would be considering what funeral home to use.

Days later, the healing turning point occurred. Heroic medical efforts and fervent prayer resulted in what I will always consider a miraculous recovery. He started to breathe and got well.

Was this my turning point, the watershed moment when significant change occurs? Of course it impacted me. My understanding of addiction as a horrific brain disease was no longer academic but personal. My empathy for those who try to help a loved one recover from a malady of chronic relapse was heartfelt. My compassion for those clients who have prematurely lost a treasured person had no limits. My social justice awareness increased as I gratefully acknowledged that I had insurance and resources that are just a pipe dream for the poor. This was not the experiential education that I desired to make me a better counselor. Yet it did indeed do that. Sit with someone who has suffered; it is a different kind of presence.

For me, there is not the turning point that has changed my life. My turning points are a series of emotional landmarks. I have experienced those wonderful serendipitous landmarks as well as the terrible, unjust ones. Like our clients, we try to hold together that uneasy pairing of darkness and restoration, pain and beauty, trouble and wonder. Theologian Richard Rohr describes this as a collision of seeming opposites. I think the message is to abide in the ambiguity and tension, stay steadfast on the path and choose to make every turning point a transformative experience in our personal and professional lives.

— Sanda Gibson, doctoral candidate at Ohio University and supervising professional clinical counselor currently counseling students at Denison University in Granville, Ohio

 

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In my early years as a counselor, I was dually focused on the external behavioral skills of being a counselor and the counseling-related knowledge that I was continuing to accrue. In retrospect, I think I was knowledgeable of theory and research and had at least a modicum of skills. What I did not have early in my career was a moment-to-moment awareness of the counseling process as it unfolded. That is, I had the behavioral microskills and knowledge of theory but was generally missing the process dimension of counseling.

Then, as a doctoral student, I received supervision training. Learning the Discrimination Model and developmental models of supervision gave me a framework to think about not only the content of what the client was saying, but also the process dimensions of counseling and the centrality of the therapeutic relationship. As I worked with supervisees to help them develop as a counselor, I was learning with them. More than at any point in my development, I was starting to think like a counselor.

Although I had completed my doctoral counseling internships, I used the third year of my doctoral program to continue to refine these skills. Although I was ABD (all but dissertation) and employed as a graduate assistant in my doctoral program at the University of North Carolina at Greensboro (UNCG), where I was teaching and doing supervision, I knew that I needed to build on this new knowledge, awareness and skills, so I began doing contract work as a counselor with a local agency. It was as if a new light had come on. I was no longer content to conceptualize the client from a theoretical perspective and use the behavioral skills of counseling to influence change. Suddenly, I needed to be in the world of the client in a way I had never imagined possible. I only thought I understood the concept of empathy, but clients began to teach me so much more. The sum of these experiences taught me how to become immersed in the world of the client. As I moved deeper into their world, I found myself experiencing far more compassion and empathy for clients.

As I became more open to the suffering of others, I became less resistant to my own personal struggles and suffering. Though I suspect there is more work to be done on me than I can do in this lifetime, I started to look more honestly at who I was becoming not only as a counseling professional, but also as a person, a partner and a parent. As I reflect back, it is hard to imagine quite how much of my own development sprang from the turning point of having “super vision” by observing counseling sessions from my once-removed perspective as a supervisor.

— Craig S. Cashwell, professor in the UNCG Department of Counseling and Educational Development, licensed professional counselor and approved clinical supervisor

 

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I’ve had several turning points during the course of my career. I believe it is important for counselors to be open to new training — and experiences — to help them become better professional counselors. I realize that to list all of my turning points and influences would be too lengthy. Therefore, I will narrow it down to my two most influencing turning points.

The first occurred in 2002 after I attended training in rational emotive behavior therapy (REBT) by the Albert Ellis Institute. After attending the training, I had a good framework for how to utilize REBT with my clients. Before attending the training, I found myself haphazardly grasping for techniques and concepts to use with my clients. After the training, I had a good solid framework to work from, which helped me to better conceptualize how I could help my clients.

The first lesson I would pass along would be the importance of diving deeply into one to three compatible theories to build a solid theoretical foundation. After building a solid theoretical framework, the counselor can then use concepts and techniques from other theories and become what Arnold Lazarus called “technically eclectic,” while still having a good theoretical foundation.

My second most influential turning point was in 2012 when I was introduced to feedback-informed therapy as devised by Scott Miller and Barry Duncan. By utilizing the Outcome Rating Scale and Session Rating Scale during each session, I was able to get feedback from clients on their progress and how I could tailor my approach to better help them. It has completely revolutionized the way I do counseling, and I cannot imagine how I was able to do counseling before I discovered these instruments.

The lesson I would like to pass on to others is to use a feedback instrument so that you know how your client is responding to treatment and, second, to be willing to adjust your approach to each particular client rather than trying to fit your clients into your approach.

— Micah Perkins, private practice, Edmond, Okla.

 

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I knew in 2004-2005 when rendering post-tsunami caregiving in southern India and psychological response in Mississippi and New Orleans after Hurricane Katrina that I’d be doing this for the rest of my working life. I felt, “Oh, thank God, I have finally found my life’s work” and also “Oh, no! Is this my life’s work?” There was both relief and worry because I knew disaster counseling would be difficult at times.

Since then, I have been ascending deye mon gen mon, tackling problems of health equity. The Haitian saying deye mon gen mon, translated “beyond mountains there are mountains,” refers to a cycle where, once you solve one problem, another problem appears, and so you go on and try to solve that problem too. In the idea of deye mon gen mon, it is important to attempt the ascent, despite a problem’s appearance as being insurmountable.

Let us use our talent for imagining the futures of the people we serve: healthy, resilient people despite challenges — or because of challenges. The imagination is a guide, a prop, a companion. It enabled me to imagine how in Haiti, I could organize a disaster mental health practicum for students in my doctoral program and find through the Internet an NGO (nongovernmental organization) with which to collaborate on this training in their medical clinic in Haiti. I got permission from my university’s institutional review board to do research on the resilience of Haitian children and their parents’ child-rearing skills to help them face crises. I am in the latter part of my academic career, and my research program has undergone a dramatic change. From studying the mental health of immigrants in the United States and multicultural counseling competencies, I am now studying disaster mental health services to the poorest of the poor.

I encourage counselors to be altruistic, a word not commonly used in psychology. But to help eliminate health disparities, we have to be altruistic. Altruism is a key aspect of building a client-therapist relationship in a disaster setting. Altruism is not an abstraction; it benefits clients. Altruism is not just moral; it has repercussions socially and politically. Let counseling challenge the individualistic

perspective in favor of altruism. When poverty is in front of me in Haiti, it has a reality for me. It is our clients’ sociocultural reality. I believe in the importance of the bond between mental health and human rights and between mental illness and disabling social realities masking the political nature of clients’ troubles.

Disaster counseling goes like this. First, you perform the proximal intervention to help a family deal with the impact of trauma on partner and child-parent relations. The word gets around that you’re a good “doctor of the mind.” The family’s neighbors come to see you and benefit from you. Once you gain trust within a community, you start changing the societal micro- and macroconditions that made the family vulnerable to trauma in the first place. We are ascending mountains beyond mountains.

— Gargi Roysircar, professor of clinical psychology and director of the Multicultural Center for Research and Practice at Antioch University New England

 

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“Mom talked a lot about how helpful you were. In fact, the day she died, she asked me to tell you ‘thank you’ for all that you did. My brother and I want to tell you how grateful we are for how you helped our mom.”

Those comments were part of a letter I received in 1985 from the children of a woman named Emma who was a member of the church where I was an associate pastor and music director. I was a young minister without any counselor training or experience and was completing my seminary training when this life-changing letter arrived in the mail.

Emma was 63 years old and had struggled with cancer, on and off, for 10 years. Two months prior to her death, her cancer returned with a vengeance and was no longer treatable. At least twice a week, I would visit Emma in the hospital. Initially, the visits were brief because I did not know what to say to her. After she was moved to her daughter’s house, the visits would last for an hour or so because I stopped focusing on what I should say and started focusing on hearing Emma. For over a month, I was privileged to be with this precious person as she told me the story of her life. I talked very little and, consequently, learned a great deal about Emma — and about life.

When I received the aforementioned letter from her children, I was confused. From my perspective, I had done very little. I was simply present with Emma and listened. But that was not Emma’s perspective. I learned Emma’s perspective in talking with her children. In hearing what my visits meant to her, I learned the power of genuine presence and the power of hearing the heart of another. My visits with Emma, and learning what those visits had meant to her, radically and positively changed my view of being with others and prepared me for the next phase of my life.

Prior to my experience with Emma, I seldom had parishioners come to me to talk about problems and struggles. When they did, I was focused on the right thing to say instead of being present with and truly hearing them. After Emma, parishioners started coming to see me on a regular basis. To better help them, I started reading books on counseling. The books emphasized what my experiences with Emma had taught me.

Upon graduation from seminary in 1987, I started master’s-level training in counseling and then began pursuing a Ph.D. in counselor education. Midway through my doctoral program, I accepted a teaching fellowship. Teaching counseling courses, along with working with clients in private practice, helped me realize that my future was in counselor education.

But it all started with Emma. Everything I’ve learned over the years as a counselor and counselor educator, and all the research on successful outcomes in counseling, harken back to what I learned in my experiences with Emma: the crucial importance and power of encouragement-focused relationships — ones in which we are genuinely present with others and truly hear them.

Thank God for Emma.

— Richard E. Watts, university distinguished professor and director, Center for Research and Doctoral Studies in Counselor Education, Sam Houston State University

 

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Early in my counseling career, I worked with young women in high school. I was consistently impressed with their intellectual abilities, talents and unique personalities. Yet I was also quite surprised by the types of challenges these young women experienced. Life seemed more complicated than it had been for my generation that experienced adolescence against the backdrop of the 1970s. Opportunities for girls and women had expanded by the 1990s, and somehow young women seemed to believe they were supposed to participate in every activity that was available. Not only that, they were supposed to “do it all” perfectly while meeting a very narrow definition of beauty.

Mary Pipher’s book Reviving Ophelia captured much of what I was observing. Reading this book was a turning point in my career. I learned that many challenges facing young women were challenges created by our culture. The way I worked with young women changed as I realized the importance of teaching them to carefully consider cultural messages. For example, I started teaching media literacy and encouraged my students to advocate for a culture in which women were not judged mainly on appearance and a standard of beauty that changed from decade to decade. I encouraged them to focus their time on developing their talents and pursuing their interests. Instead of starving themselves to try to meet an unrealistic standard of beauty, I helped the students see the benefits of eating to have energy so they could follow their dreams.

A few years later, when I taught my first theories class, I learned about feminist theory. The lessons I learned from Reviving Ophelia and working with young women finally came together in one theory. The feminist theory principle that many of the problems clients bring to counseling are a result of our culture reflected my experiences. I found my theoretical home in this theory that not only encouraged individual growth but also stressed cultural change. Feminist theory became a major component of my research and my work as a counselor educator. Through course work I developed with a feminist theory lens, I have watched both the women and men in my counseling courses become less constrained by gender-role norms and more committed to advocating for a society in which men and women are not limited by gender-role stereotypes.

— Mary A. Hermann, associate professor and chair, Virginia Commonwealth University Departments of Counselor Education & Foundations of Education, and chair of the ACA Foundation

 

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I don’t have a specific moment that I identify as my turning point. However, my chosen turning point is one that I encounter every day. So, every day, I need to figure out how to use my turning point to help me continue to become a strong counselor and strong professor.

I stutter.

Yup, how’s that for career planning? Stutterer picks two of the most verbal professions for a career.

Some days, fluency comes easy. Some days, fluency is a struggle but it works. Some days, it doesn’t work that great.

That’s my turning point. When it goes well, to remember how much work I put into the process. When it is a struggle, to not let the struggle overwhelm or consume my thoughts. I refocus on what I have accomplished.

I have adjusted to that position over the past several years. It also comes as no surprise — after the fact — that during that transition, I have also shifted from cognitive behavioral back to my original counseling orientation of existentialism. I was extensively trained in both existentialism and cognitive behavioral, but I gravitated to cognitive behavioral as my primary orientation earlier in my career for a host of reasons. However, as I began to conceptualize my own daily struggles with fluency, I began to see a parallel with how some of my clients struggled with their own issues.

As an existentialist, I truly believe you can never know anyone else. You’re not in their head or soul. However, I use my own struggles for a mechanism to create what I call an esoteric flexibility to pick up on the nuanced experiences of frustrations, pains, worries, anxieties and self-doubts.

Many concepts of existentialism are hard to learn and even harder to experience. Issues of surrender, humility and responsibility are a challenge. I think considering these issues in my own life helps me to see how to better apply them to counseling. As philosophical and theological as those concepts may be, those issues also are a call to action to create a specific and concrete plan for change. But … this stuff is sometimes hard. You learn that quickly after a day of disfluency in front of clients or a classroom.

Being a stutterer and a counselor and professor is hard. But it also has benefits. It has forced me to work on my own self-doubt stuff as it comes; to not focus too much on the negative; to find pride in accomplishments (tenure, professor of the year award) I never would have imagined being possible when I was younger and stuttered.

While never discussing my own stuff in session, I use existentialism to pass along the realization of benefits that come out of struggle. I don’t think I would be able to do that as well if I never stuttered. So, figuring out my fluency in the context of counseling and academia has granted me the ability to better do my jobs.

I am a professor. I am a counselor. I also happen to stutter. Wouldn’t change it if I could.

— Keith Morgen, assistant professor of counseling and psychology, Centenary College, and president of the International Association of Addictions and Offender Counselors

 

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I have been a school counselor for almost 12 years. In the beginning of my career, I used the 20th-century guidance counseling approach to schedule and advise my high school students. However, in 2010, I transferred to elementary school and was required to conduct classroom guidance sessions. That is when I realized how important it is to incorporate innovative strategies to keep the students engaged while addressing their personal, social, academic and career goals.

For that reason, I decided to incorporate technology into every aspect of my school counseling curriculum. I have accomplished this goal by utilizing various techniques, including using PowerPoints to guide my classroom sessions, utilizing Remind101, establishing email groups to communicate with students in the same graduation cohort and utilizing Excel spreadsheets to monitor student data.

Now that I have returned to the high school level, this change has been a major benefit enabling me to use effective approaches to keep the lines of communication open with my students. Additionally, I can ensure that all of my students have the college and career readiness skills required to successfully transition to the postsecondary environment.

— Tamika Hibbert, school counselor, Carver School of the Arts, Atlanta

 

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One of the things I’ve always adored about our field is the opportunity — if not the mandate — to frequently reinvent ourselves every few years as a direct (or indirect) result of our interactions with clients. I’ve also found it amusing when clients return after a period of time, fully expecting that I operate in the same way that I did the last time they visited. In fact, we are all works in progress.

I could write a whole book (and probably will now that we are exploring this issue) about turning points in my career, but since I am pressed to just pick one, I’ll stick with the latest one that occurred during the past few weeks. I’ve long been a fan of experiential learning, whether in sessions or the classroom, and have been skeptical of the real potential of any “talking cure” that doesn’t translate conversation into action. With that said, I’ve lately been experimenting with immersion experiences related to sending clients or students on sojourns or adventures that will stretch them in new ways or help them to expand their repertoire of skills and options. I’ve dabbled with this in lots of different ways over the years, harnessing the power of transformative travel experiences or even leading groups to far-flung places around the globe to work on service projects. There’s considerable research to support the impact of such efforts, including how altruistic behavior leads to greater life satisfaction as well as better health and even longevity.

Just a few weeks ago, I decided to take things a little further, and that represents a major turning point for me. I invited a group of students to join me in spending a weekend working on Skid Row, serving meals, talking to residents who live on the streets, interviewing staff and police officers, and even spending the night sleeping on the roof of a homeless shelter. I like to think that I’m worldly and experienced in these sorts of expeditions, but I was completely unprepared for the depth and power of what happened to me and to the others in the group. It was the heartbreaking stories of the homeless that were so impactful, but more than that, it was watching the changes that the group volunteers were going through as they operated way out of their comfort zones.

These are lessons that I already knew but didn’t practice as diligently and committedly as I have resolved to do in the future. I’m now convinced, more than ever, that as a counselor, supervisor and instructor, what I should be doing a lot more deliberately is structuring experiences for others that invite them to go out into the world and make a difference, to get outside themselves, to disengage from their own issues and troubles in order to connect with others — especially those who need help the most.

— Jeffrey Kottler, professor of counseling at California State University, Fullerton, and president of Empower Nepali Girls

 

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The turning point for me as a counselor came a year ago, when my husband of 21 years, Roger, was diagnosed with cancer and died seven weeks later. I had to stop counseling before his death to take care of him and to deal with the aftermath of his death. I took eight months off from both teaching and counseling. When I returned to practice, I made some key decisions.

I had previously had a lot of children on my caseload. I loved the children, but I had to recognize that working with children required a lot of energy, plus coordination with parents and, often, attorneys, child protective services workers, adoption/foster agencies and social services. I had to admit that I was still dealing with grief, which takes energy in and of itself, and that I no longer had the energy to do justice to what the children needed from me. Yes, I do miss them, but I had to approach the situation in an ethical manner.

I now work with adults, both individually and as couples. I do not feel rushed because of pending reports due to those affiliated with child cases. I am giving my clients my full attention without having other items on my mind. I can focus on the needs of each person as they require, and I have sufficient energy to work as I should.

— Rosemarie Scotti Hughes, dean emerita at Regent University School of Psychology and Counseling, practitioner at Eden Counseling and Consulting in Virginia Beach, Va., and adjunct online faculty at Liberty University

 

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There have been several turning points in my career as a counselor; times when my work progressed to a new level and I sensed I was able to assist clients in a way that before was unavailable to me. My entrance to the field was by working as a client with a wonderful therapist who was an adherent to Bowenian family systems theory. From her I learned to understand my family’s dynamics and how these dynamics exist both within and between persons.

After some years of studying and practicing from this perspective, I began to sense that my comfort was with heady, complex theory that relied on thinking and that I needed to move in the direction of affectively oriented work. I attended Gestalt groups and other experiential trainings. I grew tremendously as a person and as a counselor. My work deepened because I had deepened.

Over time, I began to perceive that I needed to work on issues that were deeper than what could be easily verbalized, which led me to seek out training in spiritually oriented breathwork and related trance states. Although this likely isn’t the path for every counselor, it allowed me to work on issues that were beyond direct consciousness, deeply rooted in the body and resistant to transformation by only talking about them. This work propelled my counseling skill to levels that previously were beyond my awareness. I was able to trust clients’ internal healing impulses and join them more deeply in intensely painful yet transformative work.

My journey convinces me that we only help clients in ways that we have been helped ourselves. We are able to heal what has, in some way, been healed in us. It is certainly a bit of a cliché, yet an apt one, that to be a great counselor one must also be a great client. We learn from books, lectures and experiences. However, in our line of work, we learn most from our own efforts to be transformed personally.

— Scott Young, professor and chair, Department of Counseling and Educational Development, University
of North Carolina at Greensboro

 

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Because there is an acute shortage of trained mental health professionals in India, caseloads are very high. In community settings, teams of counselors and psychiatrists usually work with 150-200 clients every day. The school I served had around 5,000 students. So, after working only three years, I had signs of burnout. Burnout issues were so severe that I even wanted to be away from human civilization. With a choice to move to Florida or Wyoming, I chose the latter because of its population density of four persons per square mile. I enrolled in a doctoral program with a plan to not work with clients and only focus on research and supervision. My professors at the University of Wyoming, particularly Michael Smith and his use of chaos theory in supervision and teaching, helped me to get in touch with my inner subjective experiences.

In my work, I try to create parallels between the process of counseling and counselor training, particularly by facilitating exploration of the inner subjective experiences by my students. That is, students have established personal meaning systems into which the information from the course is assimilated. I try to carefully attend to the unique meanings that my students assign to the course material so that I can tailor the learning experience to their personal experiences.

In particular, students are often comfortable with certainty and predictability. However, counseling is inherently ambiguous and uncertain. Therefore, I use the concepts from chaos theory to take students on a nonlinear journey in the zone of unpredictability.

In this age, cutting-edge research and a focus on deterministic paradigms have led to an undervaluation of inner subjective experiences and nonlinearity. John Dewey shared his concerns regarding the dangers of this pursuit of certainty. James T. Hansen has shared similar concerns in his articles.

The activities students participate in while exploring inner subjective experiences most times lead to tension, anxiety and nervousness. I then work with them to process those emotions to continue our journey toward self-awareness.

For example, experiential family therapy interventions create turmoil and intensify what is going on here and now in the family. While teaching that approach, I assign students a topic to prepare in one minute and present to the class. I instruct them that they cannot talk to anyone during that minute and can just prepare their notes. Then I share that the topic is “sex.” After the minute is over, I tell them that no one is going to present (everyone takes a sigh of relief), but we will process what was going on physiologically and psychologically.

Student responses vary from numbness in the legs to a sudden rush in the stomach, heart or face. The conversations don’t go smoothly every time. I have had students who have responded negatively: “I am very frustrated and angry with you during that minute.” I follow up: “It is OK to have those emotions. Where were you feeling those strong emotions in your body?” After processing the students’ responses, I check with them about the reason for the origination of those emotions. What are/were the other situations in their life where they have experienced similar reactions? How did they process those?

One of the goals of this activity is to create awareness about their inner subjective experiences and the physiological precursors of stress/anxiety so they can better manage that before the “emotional brain” takes over the “rational brain.”

— Sachin Jain, co-chair of the American Counseling Association’s International Committee and president of the Indian Association of Mental Health Counselors

 

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I remember feeling stunned as she talked about the murder of her 5-year-old son more than 30 years earlier. I encouraged June, age 65, to trust the process while simultaneously braking, not wanting her to be overwhelmed by grief. Although I had been working with her for several weeks on issues related to depression, she had not revealed the tragic loss of her child until that moment.

Recent events in June’s life had familiar threads and older pain was dislodged — feelings associated with the death of her child, shot and killed by a stranger. Although I felt tremendous empathy for June, I remember also feeling somewhat muted, something I had begun experiencing more of in my work. I felt like the therapy I offered lacked both flavor and creativity. At the time I attributed my lack of inspiration to the ebb and flow of a challenging career as a mental health counselor, but upon more thoughtful examination, as well as consultation, I realized I was battling an extreme case of burnout.

I was unable to shed the stories of suffering and loss I was hired to “treat.” I felt powerless in the presence of the intense emotional pain many of my clients were experiencing. Speeding up when I should have been slowing down, I grasped for the latest strategies, trying to fill the hole. Other parts of my life also became infected.

As June surrendered to the process, talking about the pain of losing a child, she eventually started to also talk about the beauty in the sunrise she witnessed every morning, the bright swirls of color in a painting she saw in a store, the deep gratitude she had for her five dearest friends, one for each year of her son’s life. The lessons I learned from June were vast and remain essential to my work. These lessons include knowing that deeper healing happens when it happens, whether immediately after the storm or 30 years later. Even trees, over time and left to their own natural process, can work out infection and grow thicker skin around the lightning strike.

Other lessons I carry include being very aware that I cannot have compassion for others if I do not have it for myself. Without my own watchful eye, my need to feel in control can melt into the space I cocreate with my clients. I can find myself at risk of getting in the way, not allowing my client’s inherent wisdom to direct the path. I can begin to condemn resistance instead of remembering to honor it. At these times, I strive to remember what I know instead of what I don’t.

Several years ago, my daughters and I were meeting my husband for lunch. I remember standing outside in the warm wind with the girls as we waited for Steve. I watched the trees with tall trunks twisting back and forth. Thinking about their thick roots, I was unaware that my oldest, Bella, then 7, was also watching the trees in quiet reflection. She reached for my hand and said, “Look Mommy, the trees are dancing.” I held her close and joined in on her enthusiasm. Together we watched the trees bow, dance and bend with the breeze.

— Kim Johancen-Walt, licensed professional counselor, Durango, Colo.

 

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Before the Flood of ’85 here in the Shenandoah Valley, my private practice work in counseling was a traditional one — 50-minute sessions, appointed times and a professional office setting. I was surrounded by the familiar trappings — diplomas, certificates and books — that spoke to my legitimacy. But in the midst of the chaos and devastation that the flood left in its wake, I decided to organize a disaster response team. Suddenly, my encounters with survivors took place in shattered neighborhoods and primitive shelters. Without appointments, I had to intervene on the fly. Without diplomas on the walls, I had to rely on my actions to demonstrate how I could be of help in this ground zero environment.

At this turning point in my career, I also learned a fundamental lesson. When I reached out to survivors, I discovered that virtually everyone welcomed me into their homes and temporary shelters. As my hosts, they often offered me coffee, invited me to sit on one of their salvaged chairs, showed me photographs of their disaster experiences and, most important, shared their survival stories. I was on their turf — not in my safe and secure office — and I learned that my initial intervention was to be a grateful guest who bore witness to their resilience.

Although I am now a full-time professor of counselor education, I continue to be involved in crises, traumas and disasters as a volunteer, trainer, consultant and intervener. The work has been gut wrenching, painful and even heartbreaking at times, but I have never found as much professional fulfillment and personal inspiration as I have in my encounters with fellow human beings whose courage, compassion and hope continue to amaze me.

That lesson also has continued to serve me well in my more traditional counseling work. I became more comfortable with encountering my clients not as the expert on their lived experience, but as a guest who was being invited into their inner worlds. I found myself thanking my clients for their gracious and welcoming hospitality as they allowed me into their lives.

In an emergency, something new emerges. When I responded to the distress calls of the Flood of ’85, I discovered my own professional calling.

— Lennis G. Echterling, professor and director of counseling programs, James Madison University

 

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There are many fascinating experiences that have influenced my thinking about serving others. However, a turning point of significance was teaching and counseling in Latin America, particularly Venezuela. After every visit, I would return to the States with a renewed sense of spirituality and humanness. The experiences of teaching, counseling, praying, singing, eating and enjoying each other’s presence will always be with me.

On another level, it was the demonstration of the use, or nonuse, of title or position that had an indelible effect on me as a young, inexperienced counselor. This occurred while working with several seasoned professionals. I remember a client entering our office to meet his scheduled counselor. The client anxiously approached his counselor and reverently said, “Oh, Dr. _____, I am so glad to meet with you.”

The seasoned counselor respectfully said, using the client’s first name, “I am also glad to meet with you, but please call me (gives his first name), as I was (uses his first name) long before Dr. _____.”

This experience has stayed with me, stressing the importance of meeting others, including clients, on equal ground and using core conditions of empathy, genuineness, respect and congruence that are emphasized in counselor preparation programs.

For over 40 years, I have studied, practiced, demonstrated, researched and supervised counselors using a wide range of approaches. I have emphasized and found myself using one or more of the following: person-centered (called Rogerian during my training), behavioral, systemic (referred to as planned change or social engineering during my time), rational emotive behavior therapy, transactional analysis (used successfully as a counselor, particularly with couples), cognitive behavior therapy, hypnotherapy (trained, but not utilized), solution-focused therapy, integrative counseling (my mainstay for years, but it takes time and experience to evolve), eye movement desensitization and reprocessing, and motivational interviewing. With couples and families, I have been influenced by structural family therapy, behavioral therapy and solution-focused therapy. I find that when couples are stuck, family-of-origin work is most helpful. The conglomerate of professional training and the experiences with the above approaches have influenced who I am as a person and counselor.

However, I believe the relationship I have with clients trumps the above approaches. The importance of the relationship was taught during my formative training years and has been emphasized by lifelong mentors and supported by evidence-based research findings. I have realized that the relationship and focusing on one’s cognition, affect and behavior are essential for lasting change by clients. As an academician, it is easy to focus on the client’s cognition and behavior, while spending less time on affect. So, as a final caveat to counselors, be human, emphasize the relationship and remember to work with each of the above modalities.

— Robert L. Smith, American Counseling Association president-elect and professor, department chair and doctoral program coordinator, Texas A&M University-Corpus Christi Department of Counseling and Educational Psychology

 

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Anxiety has been a defining, harrowing aspect of my inner world for as long as I can remember. When I started graduate school, I imagined that the anxiety would magically lift at some point in my counseling work — that, somehow, the inner churning would cease. Of course, this turned out not to be completely true because the anxiety was a part of who I was, not something specific to my counseling work. I realized that my counseling work just brought it out in spades because it evoked my childhood experience of feeling overly responsible for others, especially my mother.

So, I worked on my anxiety. I talked about it in personal therapy and supervision. I began meditating daily. I envisioned the anxious part of me as the little girl who grew up feeling like she had to take care of everything, and I gave her soothing, compassion and love. In short, I began gradually turning toward my anxiety instead of running away from it. (It has been a great lesson in how easy it is to say clients should do this, yet how hard it can be to actually do it!)

One might think, Aha! So here is the turning point. Well, yes and no. The intense work on my anxiety absolutely helps in and of itself, but I have also experienced a significant shift in my counseling work. Before, while sitting with some clients, I struggled to get past my anxiety to access what might be going on for them. My anxiety was like constant static on a phone line, preventing me from connecting with them. Now, feeling quieter inside, I have a more nuanced sense of what I am feeling (sometimes it is indeed anxiety), and I can consider sharing it with my clients in a tentative way to see if I am picking up on something they are experiencing.

I know very well that therapists experience their clients’ feelings, but in inquiring with them, I am still slightly amazed when I discover that the feeling isn’t just mine. That has been the biggest revelation regarding my anxiety: realizing not just academically, but viscerally, that my feeling of anxiety in a session is sometimes my client’s anxiety lighting up my own. Therefore, it is not my feeling to carry all alone. I can then put it in the room between us and talk with them about it. I feel empathic and connected to them instead of panicked and disconnected.

After a lifetime of anxiety, this realization has rippled through my entire inner world. I have finally understood in my bones not only that the anxiety I feel in session is possibly, partially, my client’s as well, but also that the anxiety I felt as a child wasn’t all mine to carry either. Each time I realize this anew, whether it be with clients or outside my consulting room, the anxious little girl in me feels a huge weight lifted.

— Amanda Norcross, licensed professional counselor intern,
Austin, Texas

 

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Like most people, I was going through life working, enjoying my family, engaging in a hobby that I loved and living with the day-to-day challenges of life. My counseling career has always been at the core of my foundation, so it was important that I lived my life in a manner similar to what I was teaching my clients. Then I got the news, and everything changed.

On July 1, 2012, I was informed that I had a tumor on my kidney and was being referred to an oncologist and a surgeon. It was cancer, they said, but it was operable and there would be no further treatment needed after the kidney was removed. I would have to learn to live with one kidney, but all would be OK. Talk about turning points in your life.

Thanks to God, the tumor turned out to be noncancerous, and the problem around my kidney that was really causing my medical issues was taken care of. Today, God’s healing has continued and the tumor is gone. I am healthier than I have been in years, but I am no longer the same person I was, and I see counseling from a different perspective.

Before this experience, I saw counseling from the lens of an existential counselor who believed it was the idea that we lived inauthentic lives that led us to neurosis or the lack of well-being. I believed that if I could help a client find his or her authentic self, then healing could be accomplished and my clients would be able to find their meaning and purpose in life. The process would be challenging but within everyone’s range of ability. Peace in our lives could be had by connecting with the spiritual or transcendental part of ourselves.

Emmy van Deurzen called the spiritual dimension of our lives the Überwelt. I had always believed that we create a philosophical outlook that is focused on our spiritual lives or on that view we each have of an ideal world. It is about discovering or attributing meaning to our lives in a manner that finally allows us to fit the pieces of our life puzzles together. This way of seeing the world was important, but it was not the central focus of my counseling.

Today I see the world much differently. The Überwelt is the core of my personal existence. I now believe true healing in counseling comes when individuals can elevate their Überwelt to the center and core of their being. I realized I had something to live for that I could not see earlier. It is for the world around me, the people in it and, most important, for myself. The goal of counseling is focused on the creation of a fulfilled life, and what better way than to live with your Überwelt at the center of living.

— Richard C. Henriksen Jr., associate professor, Sam Houston State University Department of Educational Leadership and Counseling

 

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A turning point for me occurred with my first position as a community college counselor in Chicago. To give context, I was hired at a time when the multicultural affairs program merged with the counseling program to better address the unique needs and challenges of students of color.

I graduated with my master’s in counseling thinking that I was equipped to work with clients. However, I quickly realized that I was ill equipped to address the unique challenges experienced by clients who experienced external barriers. I was not prepared to work with the honor role student who was homeless, the transgender student who wanted to go on an overnight retreat with other student leaders or the Muslim student whose professor made anti-Muslim remarks in class shortly after 9/11. These clients were not accessing clinical services through the counseling department in large part because they felt counselors did not fully understand how to address oppressive external barriers that contributed to their problems. Instead, they sought “counseling” from multicultural affairs staff.

This observation led to the realization that my approach to counseling needed to change. Helping clients gain insight into their problems was not enough. I needed to address the external barriers contributing to their problems. I couldn’t just sit in my office hoping and waiting for clients to make an appointment with me. I needed to reach out and develop relationships with them in nontraditional ways. I began attending student clubs such as the LGBTQ (lesbian, gay, bisexual, transgender and questioning) and Asian/Pacific Islander organizations. I reached out to instructors to present in their classrooms on various diversity and social-justice-oriented topics impacting college students. In addition, I made it a point to say “hello” to clients in the hallways. It also was not uncommon for me to talk with clients’ families. In other words, I was doing things that were counter to what I was taught in graduate school. I kept doing them though because I realized the results of my actions had long-term positive impacts on clients.

This turning point made me realize that some situations may call for traditional approaches. Other situations may call for counselors to intervene in the social milieu. As a counselor, it is my ethical responsibility to determine in collaboration with clients whether individual or systems-level work is needed. I recognize this is a challenge for many counselors who operate in a system that only supports individual-level, office-based work. However, we need to consider how to balance individual counseling with systems-level work if we are to remain a viable resource in society.

— Manivong J. Ratts, associate professor, Seattle University Department of Counseling and School Psychology, and past president of Counselors for Social Justice

 

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During my master’s training, a situation occurred between me and the faculty coordinator of our program, the man who later became my dissertation chair and mentor. There seemed to be some tension in our relationship. For the life of me, I cannot remember the exact cause of our rift, but I believe it revolved around the fact that he was always one to challenge me. It was his mission to break me of bad habits and get me out of my own head when counseling — a theme I have come to learn plagues most budding counselors. I, knowing better and more than he, of course, rebelled. I think that is where the drama set in. I challenged his feedback with indifference and at times in front of my entire cohort. I don’t think he took too kindly to my rebuffs. A couple of weeks went by, and he and I barely communicated. Our relationship was like ice.

It all came to a head in an A&P supermarket near campus. I was shopping, and in came he and his wife. She was cordial, and we carried on a conversation. He was not. He never even acknowledged my presence. This ticked me off even more, but I had no clue as to what to do. I spoke with one of my cohort members, and she told me that I should just go to him and get to the bottom of our issue. That had never even crossed my mind. It was easier being mad and ranting to her!

I manned up and went to his office. He sat there and listened as I tried to get to the point. I was already hurt, and his store snub had rubbed me the wrong way. As I brought this to his attention, his reply was, “Yes, I know.” He basically had done it on purpose to teach me a lesson … to “break me” as it were. I looked at him in major disbelief because, again, I was “in my head.” I was like, “Yeah, right. You were just being a jerk, and now you tell me it was a planned intervention.”

However, in that moment, I needed something from him. I am not sure what. Perhaps his approval. I got very emotional and cried, hurt by his treatment of me, his so-called “lesson.” We worked it out together though, eventually talking about my counseling skills and what I was doing wrong in practicum with my clients. I finally heard him. It became an aha moment for me. The best supervision session ever!

We continued our conversation, and I learned a lot from him, both on that day and beyond. Bottom line: When you have an issue with someone, especially someone who is challenging and pushing your growth, don’t hold it in. Go to the source. Work it out. That turbulent time became one of my fondest memories in counseling. He broke me, so to speak, and helped me develop my inner counselor by getting out of my head and more into my clients. It is modeling I continue today with my students.

— S. Kent Butler, associate professor of counselor education, University of Central Florida, and a past president of the Association for Multicultural Counseling and Development

 

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I was in my fifth year as a school counselor. I felt I was doing really well. I was feeling comfortable counseling students, collaborating with school staff and even providing advice to parents. You might say I was feeling on top of the world.

Then, one day, a parent approached me. Her daughter Lori had become very sick and was hospitalized for a few weeks. During her hospital stay, she stopped talking. A doctor diagnosed Lori with selective mutism. Mom tried to find a therapist but could not find anyone who worked with children with selective mutism. She didn’t know what to do, so she wanted my help. I said, “Sure!” with a big smile.

She left my office. I had no idea what to do. So, I didn’t do anything. I didn’t see the student. I didn’t speak to the student’s teacher. I did nothing. A few weeks later, I ran into Lori’s mom. I was so nervous, but I gave her a big smile and said, “Hi!” She asked me when I was going to see Lori. I said, “Oh, yes, I will definitely start seeing her.”

So, I went back to my office and I didn’t do anything … again. I didn’t see the student … again. I didn’t speak to the student’s teacher … again. I did nothing … again. But this time, I couldn’t stop thinking about Lori and her mom. I didn’t understand what I was doing. I felt confident in my counseling with students, so what was going on with me now?

It finally hit me. I didn’t know selective mutism. I didn’t know what it was or how to handle it. I had to change this. I had my turning point. I went online and looked up selective mutism. I ordered books on selective mutism. I signed up for workshops on selective mutism. I read and learned everything about selective mutism. I contacted Lori’s mom and told her that I was educating myself and would start to see Lori. I felt my confidence returning.

I started working with Lori. Well, that was a big challenge for me. During my years in college, I was taught how to speak to a client, but this was something so different. I couldn’t concentrate too much on talking because my client wouldn’t talk to me. I don’t want to get into the whole process with Lori, but at the end of the year, and after a lot of work, Lori was talking. We reached success!

Since my turning point, I face all challenges differently. When I have that uncomfortable feeling (like the one I had with Lori’s mom), that is my cue to educate myself. It is looking at myself, admitting that I do not know everything and telling myself that is OK. But my job is to figure things out so I can try to reach success with clients. So, if you ever have that uncomfortable feeling, ask yourself what you do know and what you do not know. Then Google!

— Dara Weiss, school counselor, Closter, N.J.

 

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Counseling is often a solitary profession. We see clients, but we seldom talk about them — at least to others. This implicit code of concealment, which I initially mistook for confidentiality, was at the center of a significant turning point in my early career. I was counseling in a rural mental health center and seeing a lot of problematic and complicated cases. Equipped with a new master’s degree and a sincere desire to help, I believed I could and should handle all the people and circumstances that arrived at my door by myself.

It did not take me long to realize my silence was taking me down a dead end street, however. Carl Rogers was never filmed seeing the “craziness” that came alive in my office, yet he always appeared confident. I, on the other hand, was baffled, stumped, chagrined, frightened, bewildered and definitely not Rogers. What my education had failed to teach me was the uniqueness of counseling icons and what to share, with whom, when and how.

As happenstance would have it, at the end of my first week when I was particularly discouraged, I left the building with another older staff member named Frank. He read me like a book but was respectful and inquired about my downcast look. I explained my situation, my voice breaking up at times. He then said something simple and straightforward. “Sam, we’re a team. There are four of us serving a county of 70,000. If we don’t bounce ideas off of each other and assist one another, none of us is going to make it past next week.”

I knew in an instant after our conversation that I would see many more Mondays. Frank had opened a door for me, metaphorically and literally. I had found help beyond myself. My formal education had taught me much, but it had not mentioned the power of allies — fellow professionals. The rest of the staff was more experienced and sophisticated than I was. They had already wrestled with difficulties and clients like I had experienced — and with some others I had yet to encounter. They were willing to give me ideas and strategies. I could, in turn, help them with an infusion of fresh knowledge that I brought with me from my recent academic experience.

Forty years hence, I still marvel at the reality of what we, as counselors, can do for one another. The mental intangibles and case particulars of staff meetings and conferences go far in enriching and enlivening our lives. Colleagues make workloads lighter. They are helpful in numerous, sometimes inexplicable, ways and make outcomes brighter. We do not live by bread alone, or unto ourselves, regardless of how smart or skilled we may be. It is foolish and disastrous to try to work with clients depending on just our own knowledge and limited experiences. Interacting with other professionals is crucial and makes life immensely better.

— Samuel T. Gladding, professor and chair, Department of Counseling, Wake Forest University, and past president of the American Counseling Association

 

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