Monthly Archives: September 2016

Seeing people, not prisoners

By Kathleen Smith September 28, 2016

Upon being released from prison in the United States, the prospects for ex-offenders are grim. In some states, they might get $20 and a pair of clothes to wear out the door. If they’re lucky, they will receive a bus ticket back to the county where they were arrested. Almost immediately, they must secure or arrange for transportation, food and shelter in a world that might look very different from the one they were living in before their incarceration.

Rebuilding a life that is empowering and free of crime is anything but easy for ex-offenders. If your family lives in public housing, you can’t return home with them. If you have to check the box on employment applications saying that you’ve been charged with a felony, many people may hesitate to hire you. You might struggle to regain custody of your children, or you might be returning to a traumatic environment that is violent and unstable.

According to the National Institute of Justice, almost 80 percent of former offenders will be rearrested within five years of their release. Of these, an average of 30 percent will return to branding-images_prisonprison because of a parole violation. The Bureau of Justice Statistics reports that ex-offenders are also two to four times more likely than the general population to have a mental illness, which puts them at increased risk for substance use issues. The odds certainly aren’t in their favor.

When faced with the task of helping and empowering individuals who are exiting the criminal justice system, counselors confront a looming initial question: “Where do I begin?”

The answer to that question is as diverse as the counseling profession itself because many practitioners commit to tackling different facets of a client’s transition from incarceration to life on the outside. For instance, counselors facilitate career development. They connect ex-offenders with social supports and mentors who show that there is hope for a different life. Counselors provide invaluable trauma treatment to heal old and present wounds, and they train professionals within the penal system to empathize and start real conversations about change with those who are imprisoned or are preparing to transition out.

What these methods have in common is one of the unique qualities of the counseling profession: a person-centered approach that focuses on making space for a new narrative. Together, and from many angles, counselors are helping ex-offenders create new stories for themselves that don’t have to end with a clanging prison door.

Fostering career development

In 2012, a student in Mark Scholl’s career development class inspired him to consider a new kind of work. The student, a probation officer by day, created a career support group for ex-offenders and invited Scholl to co-facilitate. Scholl, a member of the American Counseling Association, used his expertise in career counseling to design skill-building activities for the group, and he found that he loved the work.

When Scholl moved two years later to join the Department of Counseling at Wake Forest University as an associate professor, he wanted to continue this work in the community of Winston-Salem, North Carolina. After consulting with friends, he found that the public library was the safest and most encouraging space to work with ex-offenders. “The library doesn’t have the politics of other settings, which distinguish between social workers and counselors and psychologists. It doesn’t have those turf issues because it’s just about serving people in the community,” he says.

The New Leaf Career Development Group has been running steadily ever since. Over a period of five weeks, Scholl guides a group of four to six ex-offenders through a series of workshops. Topics include job skills assessments, résumé writing, interviewing skills and job search strategies, all of which Scholl approaches with a postmodern slant. Activities also reflect many techniques found in solution-focused and narrative therapies.

“There’s a tendency on the part of the clients who’ve been released from prison to dwell on the past and to focus on their problem,” Scholl says. “Turning that around and focusing on positive alternative narratives is both therapeutic and empowering to the members.”

To engage these narratives, Scholl asks participants in the first session to create a metaphor for how they relate to their futures. He believes this technique provides therapeutic leverage because he and the other participants can encourage the individual group members to construct more adaptive metaphors throughout future sessions.

One group participant, whom Scholl calls “Sandy,” used the metaphor of being a runner in a baseball game. Sandy felt like she had been stranded at third base and frustrated that she couldn’t make it home. Scholl and the other group members helped Sandy open up her metaphor, suggesting that perhaps there was only a rain delay in the game or that she was “rehabbing” after an injury.

“We helped her emphasize her self-advocacy,” Scholl says. “She began to see her ability to choose her own direction and access resources.”

In their final graduation session, participants share their narratives about what they gained from the workshop and how they view the next chapter in their lives. Family members and friends are invited to respond with how hearing their loved ones’ stories has affected them.

Because many members of the group face additional challenges, such as homelessness or substance use, Scholl admits that success for group members is sometimes difficult to define. He and his colleagues at Wake Forest are currently conducting a qualitative study to evaluate the impact of the workshop on participants’ lives.

Individual successes do stand out, however. One member, whom Scholl refers to as “Carl,” completed the workshop series this past summer. Carl was an ex-offender who came to the workshop after looking for employment for an entire year without success. “He had difficulty remaining positive during mock interviews,” Scholl recalls. “We worked with him on emphasizing his strengths and how he could potentially contribute to a prospective work setting. During the last workshop, he announced that he had been hired as a forklift operator in a warehouse position. This, as you can imagine, was a very memorable success for the client and for our team.”

Reflecting on his experience with the career development group, Scholl says the possibility of empowerment motivates him to continue the work. “There’s a feeling of futility when you have to check a box on an application [saying you are an ex-offender]. It feels like a strike against you before the employer even meets you. So,” he says, “I really feel a strong inclination to do what I can to empower these folks.”

Mentoring ex-offenders

Before she began working with ex-offenders, ACA member Bethany Lanier’s inspiration came from television. “I loved Law and Order: SVU. I wanted to do that kind of work and figure out why people do what they do,” she says.

As a master’s student in clinical mental health counseling at Radford University in Virginia, Lanier worked with women who were up for release from prison, teaching them life skills and strategies for navigating their home environments. When she moved to Alabama to begin a doctoral program in counselor education at Auburn University, Lanier’s passion for that work didn’t end.

The numbers are daunting in the Alabama justice system. Facilities are operating at 190 percent of capacity, leaving little to no money (or energy) left to focus on combating recidivism. But rather than choosing to feel overwhelmed, Lanier, as a graduate assistant, began helping to develop a mentoring program for the local women’s prison and writing grants for funding. While doing research, which Lanier has since presented at an ACA Conference, she found evidence of the effectiveness of mentoring programs with the ex-offender population. She cites one program in particular, the Mentoring4Success initiative in Kansas, that effectively cut the state’s recidivism rate in half.

Inspired by other successes, Lanier continued working with her colleagues at Auburn to train mentors in Alabama. The mentors serve a number of functions for women exiting the correctional system, including teaching them how to navigate applications for the Supplemental Nutrition Assistance Program (also known as food stamps) or the Women Infants Children (WIC) program. Because many of the mentors are themselves ex-offenders, they also provide inspiring examples of success and needed social support.

“You have to have somebody that’s going to be supportive, somebody who’s going to answer all your questions and help you get where you need to go,” Lanier says. “It’s good for people to see somebody and say, ‘I don’t have to be like this, because she made it.’”

As a future counselor educator and a member of the International Association of Addictions and Offender Counselors (IAAOC), which is a division of ACA, Lanier has also given careful consideration to how to talk with students who are hesitant about working with ex-offenders. “Students say, ‘Oh, I don’t want to do that because it’s not safe’ or ‘It challenges my beliefs’ because we’re in the Deep South. But once people get out into the field, they realize you’re going to see these issues anywhere you go.”

For instance, Lanier explains, anyone working in a community mental health center or even in schools is likely to encounter the challenges and rewards of working with ex-offenders. For that reason, she believes counselor educators need to prepare students to think about the unique needs of this underserved population.

As for current counselors who would like to explore the power of mentorship in working with ex-offenders, Lanier encourages these helping professionals to consider the unique skills they can bring to the work, including active listening and empathetic understanding. “Don’t be afraid to take a risk,” she emphasizes.

Addressing trauma

In the literature, rates of posttraumatic stress disorder among incarcerated populations range anywhere from 4 percent to 21 percent, with women being disproportionately affected. Regardless, advocating for trauma work as a component in reentry preparation can be a tough sell. While focusing on basic needs such as housing and employment, ex-offenders may not have the money or the time to find effective therapy for trauma. Therefore, counselors have begun working with prisoners while they are still incarcerated to address their trauma and connect them to resources on the outside.

ACA member Tara Jungersen had already spent a significant portion of her career working with trauma and intimate partner violence before coming to Nova Southeastern University in 2009. But after arriving there, her colleague, Lenore Walker, introduced her to the Survivor Therapy Empowerment Program (STEP). A manualized treatment program, STEP uses principles of feminist therapy, survivor therapy and trauma theory to address common issues found in the incarcerated population. Its goal is to empower victims to become survivors.

“If somebody is stuck in a trauma cycle, if they are completely disconnected from experiencing emotion and safety in relationships, then they may lack the protective factors that can help them move forward in life,” Jungersen explains.

As the acronym suggests, the treatment program walks participants through 12 independent “steps” that help in dealing with trauma and its effects. Leaders teach relaxation skills, interpersonal skills and cognitive restructuring, and they also help participants examine their attachment patterns in relationships and grieve past relationships. The program is also focused on connecting women to resources on the outside to reduce recidivism.

“A person may be on a five-day hold, and they’ll be gone the next week. So we want to make sure that each step we teach can stand alone and that [participants] are able to find a qualified trauma therapist when they are released,” says Jungersen, who has led STEP groups herself and trained others to lead the groups. “We know that it’s challenging to find reduced-cost and pro bono services.”

Jungersen also notes that leaving prison can feel different for each person depending on the individual’s experience. For some women, jail provides structure and a departure from the chaos of their daily lives, which often can include drug addiction or physical and sexual abuse. But for others, the experience of incarceration itself is highly traumatic. For instance, a victim of sex trafficking may find herself in the same prison as her trafficker, or offenders may face abuse or neglect by correctional officers. Running a treatment program that promotes safety and stability can prove difficult if individuals are always on high alert and constantly feel exposed to danger, Jungersen says.

Despite the challenges, the STEP program has been employed successfully with both men and women in the United States and internationally. Jungersen acknowledges that when working with ex-offenders, measuring success requires different parameters than those used in traditional counseling settings. Qualitative data collected by Jungersen and her colleagues have indicated that STEP participants, who learn about their trauma symptoms and how these tie in with their substance abuse or other behaviors, are more open to seeking mental health treatment after their release as compared with their attitudes prior to participating in the program.

Regardless of whether counselors are doing trauma work specifically, Jungersen encourages them to consider the ways that trauma can affect ex-offenders and to avoid making generalizations about this population. “You’re going to have a wide distribution of cognitive functioning, a wide distribution of social skills and differences in individual trauma triggers,” she says. “Most ex-offender treatment is done in a group format. You’ve got to scan that entire group, recognize the nonverbals that indicate someone is getting triggered and adjust the conversation accordingly.”

Fostering motivation 

Melanie Iarussi was first introduced to motivational interviewing in her master’s program. She liked the method so much that she decided to become “trained as a trainer” so she could teach others how to elicit meaningful, change-oriented conversations. Now an assistant professor of counselor education at Auburn University, she has found an opportunity to provide training for probation and parole officers in the state of Alabama. By teaching the officers motivational interviewing techniques, Iarussi and others are introducing a different mindset to the people who work in corrections.

Motivational interviewing is an increasingly common technique encouraged by the National Institute of Corrections and other organizations. The technique’s focus on creating collaborative conversations and guiding people toward prosocial change is a drastic departure from many of the punitive, fear-based techniques the criminal justice system has traditionally employed. Because counselors have fairly limited interactions with ex-offenders, Iarussi and others see an opportunity to educate those who have the most access to this population — parole and probation officers.

“We know the prison system as it is does not work, and we know that taking a punitive approach is not effective in facilitating behavior change,” says Iarussi, a member of ACA and IAAOC. “By introducing MI [motivational interviewing], we’re trying to capitalize on what does work, and we’re bringing some counseling concepts to the conversation that can facilitate lasting change among people in the legal system.”

To teach and improve motivational interviewing skills, Iarussi asked her trainees among the probation and parole officers to record their conversations with their clients. In turn, she listened to the conversations and provided feedback. She says the officers who were able to make the shift to use the new skills noticed that they were having completely different conversations with their parolees.

“They were able to help their clients recognize that they do have choices over what they want to do. It’s not that they are trying to force them into something or back them into a corner, but they can present them with options,” she says. “You can have the conversation, but the choice is ultimately theirs.”

Iarussi acknowledges that empathy, a cornerstone of both counseling and motivational interviewing, is a challenging concept to teach. “Probation and parole officers have multiple roles. They’re not counselors,” she says. “Their primary job is to enforce the law. So … they have to make decisions about when it is appropriate to be empathetic and have these conversations, and when it is appropriate to enforce the law. And when it is maybe a combination of those two.”

One probation officer stands out in Iarussi’s mind because they both noticed a remarkable change in his work. In one training, Iarussi presented a video of a probation officer who wasn’t paying attention to the client. The officer was constantly interrupting and not giving the client the time he needed. Her trainee came to her later and said, “I was that person. I was that officer who treated people that way.”

Iarussi describes how the officer soon after began submitting tapes that featured longer, more in-depth conversations, whereas previously he had been meeting with his clients for only one or two minutes at a time. In the new tapes, he and his clients were discussing concerns and issues about parenting and work. The officer noticed the difference he was making. “He definitely felt the shift,” Iarussi says. “By changing his approach, he was making a significant impact in his clients’ lives.”

A unique perspective

Because each person who is incarcerated receives a range of services and interventions and faces a unique set of challenges, it is difficult to know what exactly keeps ex-offenders from returning to jail or prison. As research expands, however, professionals are gaining a clearer sense of what can decrease recidivism. Among the elements that have been identified as effective: assessing for risk, engaging individual motivators, using cognitive-behavioral strategies and providing ongoing support in the community. These are all strategies familiar to those in the counseling profession.

Whether it is using career counseling skills, trauma treatment or motivational techniques, counselors are taking their existing skills and intervening in the lives of people who are exiting the correctional system. They are also serving as advocates for systemic and legislative changes that give ex-offenders a better chance for success.

Above all, Iarussi and others believe counselors are in prime position to help their communities and the criminal justice system begin viewing ex-offenders as individuals rather than a series of daunting statistics. Counselors are trained to take off the lens of judgment and to empathize with experiences that might be far from their own. Both of these skills make the field uniquely suited to work with this population.

“What I experienced is that ex-offenders expect us to treat them like everyone else does,” Lanier says. “Sure, there is an extra layer of rapport building, because maybe they haven’t had anybody listen to them [before]. All they wanted was for me to hear them and understand they weren’t terrible people, but [rather] people who had made some bad decisions. As their counselors, we have to put our preconceived notions behind us and move forward.”

 

****

 

Kathleen Smith is a licensed professional counselor and a doctoral candidate at George Washington University. She also works as a mental health journalist and is the author of The Fangirl Life: A Guide to All the Feels and Learning How to Deal, published earlier this year. Contact her at ak_smith@gwmail.gwu.edu.

Letters to the editor: ct@counseling.org

 

****

 

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

 

A systemic perspective for working with same-sex parents

By Amanda C. DeDiego

According to census data, there were roughly 125,000 same-sex couples raising approximately 220,000 children in the United States in 2010. Since that time, increasing numbers of same-sex couples have declared committed partnerships, capturing the attention of policymakers and bringing the issue of legal recognition of same-sex partnerships to the forefront of politics.

In 2015, the U.S. Supreme Court heard the landmark case of Obergefell v. Hodges and ultimately declared it unconstitutional for any state to deny marriage licenses to same-sex couples. In doing so, the Supreme Court said that rights historically awarded to married partners, including adoption rights, must be extended to same-sex couples. Although state legislation traditionally branding-images_twodadsdetermines specific limitations to adoption rights awarded to married couples, under Obergefell v. Hodges, said spousal rights must apply to all couples equally.

This past summer, a federal court judge ruled adoption by same-sex couples legal in all 50 states. However, judges who make decisions to award parental rights can still create more stringent guidelines or additional hurdles for same-sex couples. So although this ruling is monumental in taking strides toward equality, it does not eliminate subtle discrimination experienced by same-sex couples seeking adoption rights.

As institutional and legal barriers to same-sex marriage and parenthood continue to diminish, counselors are increasingly called on to provide support for same-sex couples who are establishing legally recognized families. CACREP (Council for Accreditation of Counseling and Related Educational Programs) accreditation standards require programs to provide counseling students with training for supporting various issues in diverse relationships and families. However, more training and awareness are needed to properly prepare counselors to offer support specifically for same-sex couples and families.

For many years, same-sex couples could not find appropriately trained counselors to provide family and couples therapy. Now same-sex couples feel welcomed and have more referral options for counseling, but counselors still often lack specific training in best practices for supporting these couples and families headed by same-sex parents. Considering the systemic influences that affect same-sex couples, a counseling approach that also considers the systemic context is ideal.

Structural family therapy

Structural family therapy (SFT), developed by Salvador Minuchin, offers a means for counselors to address systemic issues in various contexts. The SFT approach is empirically validated and offers a map for counselors to conceptualize a family system on the basis of the roles the family members play. In addition to examining the family as a system, SFT takes into account the greater societal contexts that have an impact on the family.

Minuchin based his theory on the assumption that each family member plays a role within the family. Using Minuchin’s therapeutic approach, a counselor observes patterns in the family’s interactions to determine the hierarchy within the family system. Subsystems such as spousal, parental and sibling may also be present within the family. Any imbalance in the power, boundaries or roles within the family represents dysfunction in the system.

The goal of SFT is to adapt the structure of the family to the needs of its members to improve the function of the family system. This goal is accomplished in three phases:

1) Joining with the family

2) Enacting interactions within the therapy environment to observe family member roles

3) Creating unbalance to expand current roles, introduce boundaries and accommodate the needs of the family members in the system

As part of the SFT process, the counselor “joins” the family system to correct dysfunction. Minuchin described “joining” as the process of the counselor being accepted by the family to create a therapeutic bond. The trust gained in the joining process creates a therapeutic system that lasts the duration of the counseling relationship. The counselor works to help the family establish clear roles, while deconstructing power within the family system and subsystems. The goal is to create a functional hierarchy that meets the needs of family members.

One advantage to using SFT with same-sex parents is that this approach considers larger systemic influences on the family. Counselors working with same-sex couples may need to address unique systemic challenges. Thus, it is important to raise awareness in the counseling community about such issues so that we can address biases, practice awareness of issues facing the population and have a broad societal view of the family system and societal challenges impacting families with same-sex parents.

The road to parenthood

Traditional conception of children is not an option for same-sex couples. Thus, the road to parenthood for these couples is often emotional, complicated and challenging.

Some of these couples may already have children from previous relationships. SFT provides guidelines for work with blended families, but in many respects, same-sex couples have unique challenges in establishing family systems. In the past, many states would not recognize the adoption of children within same-sex partnerships. For same-sex partners with children from previous relationships, this meant that only the biological parent was able to serve as the legal guardian of these children. This created stress and conflict within relationships because the biological parent’s current partner was left without any legal rights as a parent. Not having legal guardianship of a child can cause same-sex partners to feel unclear about their parental identities. In turn, this may result in conflict within the partnership or struggles to establish a parenting relationship with children.

Egg donation and surrogacy: Not all couples have biological children from previous relationships, but the issue of legal co-guardianship is persistent regardless of how same-sex partners become parents. Same-sex couples may choose to pursue parenthood through surrogacy or through in vitro fertilization using a sperm or egg donor. In both cases, couples must choose which partner will be allowed to have the biological identity as the child’s parent. Because state laws have not always recognized the adoption rights of same-sex couples, the biological parent of the child often maintains all legal rights of guardianship.

Considering recent court rulings, the nonbiological parent may now seek status as a legal guardian. However, this parent may have experienced a lack of power in the family for some time because he or she was previously unable to identify as either a biological or legal parent.

Additionally, decisions must be made regarding the degree to which surrogates or sperm/egg donors will be included in and involved with the family. Thus, these family systems will potentially have multiple layers and subsystems, meaning that the same-sex partners may experience additional stress as they navigate choices concerning the level of connection to donors and surrogates.

Traditional adoption: The Supreme Court ruling in Obergefell v. Hodges acknowledged the possibility of same-sex couples facing continued institutional barriers, specifically naming instances of adoption agencies affiliated with religious organizations denying child placements for these couples. This past summer, a federal judge ruled a state ban on same-sex marriage to be unconstitutional, thus eliminating some systemic barriers to parenthood. Although overt discrimination in denying same-sex couples opportunities for adoption was eliminated, subtle discrimination that reinforces heterosexist standards of parenthood can still force same-sex couples to face stigma and additional stress during the adoption process. Same-sex couples have traditionally encountered legal obstacles, high standards for approval and long waiting periods to become adoptive parents. Historically, these institutional barriers have been substantial, causing many same-sex couples to turn to the foster care system in their pursuit of parenthood.

Foster to adopt: Foster care agencies often permitted same-sex couples to serve as foster parents, but there was always the question of whether the court system would subsequently deny these couples the option to legally adopt. This was often confusing and emotionally distressing for couples hoping to start families and gain the identity of parents. The Supreme Court has addressed these legal barriers, but it is unclear at this point what institutional and social barriers will remain for same-sex foster parents seeking legal adoption.

Additionally, same-sex couple foster parents may experience a lack of institutional support in preparing foster children for placement with a gay or lesbian couple. Thus, the adjustment to the placement can be more stressful for both the couple and the child. Couples may also experience subtle discrimination and a lack of sensitivity regarding pronoun use in record-keeping (for example, suggesting a father and mother caring for children, as opposed to two mothers or two fathers).

Systemic challenges

In addition to the typical stresses associated with blended families or adoptive parenting relationships, same-sex couples often feel that they must fight to gain recognition in their identities as parents, both legally and socially. This can create high levels of stress within these partnerships.

In 1979, Urie Bronfenbrenner discussed various social and political systems that influence individuals as members of society, including those individuals navigating marriage and parenthood. In addition to considering the legal and institutional challenges faced by same-sex couples in gaining identity as parents, counselors using SFT must consider the influences of the societal systems to which these clients belong. Unfortunately, discrimination and systemic challenges are still present after same-sex couples become parents, and counselors may need to help families navigate additional systemic challenges in raising children.

Institutional and legal challenges: Same-sex couples have long faced institutional barriers in gaining validation and recognition of their partnerships and marriages. Obergefell v. Hodges awarded the right to marry to same-sex couples and extended historically implied rights to same-sex couples who marry. However, states reserve the ultimate power to choose which rights to award (and to what degree) to married couples, including taxation, sharing of property and legal adoption. These discriminatory barriers exist beyond the courts. Among the institutional challenges that present struggles for same-sex couples attempting to establish family systems are division of work, parental leave and guardianship rights in caring for children.

Same-sex couples may experience challenges in deciding how to adapt their work schedules when raising children because of less employer flexibility, especially in the case of gay men. Thus, one partner may become the “breadwinner,” establishing greater financial power within the relationship. Given that legal adoption is not always permitted for nonbiological parents in a same-sex partnership, gaining access to a child’s medical or school records may also be a challenge.

In addition, same-sex couples often face challenges simply in finding a residence for their families. Research shows that landlords have traditionally assumed that same-sex couples will be troublesome tenants. Given limited choices for renting property, one partner may then become the legal owner of the couple’s purchased property. Particularly if this partner is already identified as the breadwinner of the family or the biological parent of the couple’s child, this situation can create a further imbalance of power within the parental subsystem.

Social challenges: Beyond institutional challenges, same-sex parents also experience subtle discrimination in social groups. Same-sex parents may not feel that they fit within traditional parenting roles and thus may not feel as accepted in social groups with heterosexual parents. Socially, same-sex parents can be the targets of hypercriticism for their parenting decisions by heterosexual parents.

Criticism and rejection are not isolated only to social groups. Families of origin may also express disapproval of same-sex couples becoming parents. Ultimately, same-sex couples may feel like outsiders in both social and familial groups, thus creating another source of conflict within the partnership.

Given that they are raising children in a heterosexual-centered society, same-sex parents may lack role models for navigating decisions as parents. When combined with social invalidation, this can leave same-sex parents feeling alone and lost.

Finding social support provides comfort for parents and children who are experiencing hyperawareness of the dominant heterosexual culture. Thus, same-sex parents often seek to create a new “family of choice” for social support. Same-sex parents often worry that their children will be subjected to heteronormative standards and social expectations in school. Children who have same-sex parents may experience discrimination or bias in social groups. Having the social support of other same-sex couples makes it easier for parents and their children to cope with discrimination and heterosexual norms.

Considerations for practice

Under SFT, the counselor joins with the family, becoming a part of the system instead of being a bystander to the process. Once this happens, the counselor will address issues of power, hierarchy, boundaries among family members and rules within the family system. The focus on family roles allows the counselor to adapt to the family system beyond traditional gender roles, which makes SFT ideal for work with same-sex couples and their families. Same-sex couples lack the traditional “mother” and “father” role within the family, so couples establish parenting identities based on their unique family system.

To determine the structure of the family system, a counselor must observe patterns of behavior among family members. In many cases, the lack of traditional gender roles among same-sex couples creates opportunities for greater balance in home and work responsibilities and egalitarian roles in parenting. Same-sex couples often experience greater fluidity and equality in parenting responsibilities than do heterosexual couples. Thus, decision-making in distribution of power within the partnership becomes more intentional.

The more gender-fluid roles of parents in same-sex families may challenge a counselor’s fundamental views of family. Thus, a counselor working with a same-sex couple must be aware of personal biases, or else the counselor may project gender labels onto family members. In addition, in recognizing one parent as more nurturing, it would be important not to automatically project onto the other parent the label of disciplinarian, especially considering the complementary function of parents under SFT. Instead, realize that gender fluidity in parenting roles means that same-sex parents may be sharing aspects of roles as both nurturer and disciplinarian.

In part because families with same-sex parents may not always receive support from biological family members, it is common for these parents to include neighbors or other social supports in their definition of the family system. The SFT approach allows for a more flexible definition of family. Thus, same-sex parents can invite social supports beyond the biological family to participate in family therapy. A large piece of SFT involves examining the authority exercised with children. This provides the counselor with insight regarding the hierarchy within the family system. Remembering that social supports may become an influential part of same-sex families, the counselor should remain open to considering the authority of nonparental figures within the family system.

Counselors must practice awareness of societal influences on families because these challenges often affect the balance of power within the family. Although societal issues may not be the presenting issue within the family, the influence of societal systems is always present. Additionally, counselors must practice ongoing reflection to be aware of biases in their work with this population. Working to eliminate subtle discrimination in the counseling environment — for instance, by creating gender-neutral intake forms — can create a welcoming environment for same-sex couples and their families.

Conclusion

SFT provides a framework to conduct counseling that considers systemic influences on families with same-sex parents. Recognizing the systemic and social barriers that same-sex parents face is a huge first step. Counselors must be aware of their own biases regarding their views of families when working with same-sex parents. In joining with the family system, counselors should be cautious not to assign gender roles to family members. Counselors also must be open to including social supports outside of the immediate family in the counseling relationship.

By practicing awareness of systemic barriers facing same-sex couples and being open to unique family systems, counselors can provide much-needed services to these now legally recognized partners who are navigating the road to parenthood and parenting in a heteronormative world.

 

****

 

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

Amanda C. DeDiego is an assistant professor of counseling at the University of Wyoming. She is a national certified counselor and has clinical experience in school, grant program, community and private practice settings with diverse client populations. Contact her at adediego@uwyo.edu.

Letters to the editor: ct@counseling.org

 

****

 

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Counseling interns get firsthand exposure to immigrant experience

By Bethany Bray September 26, 2016

An innovative partnership in North Carolina is pairing counseling graduate students from the University of North Carolina at Charlotte with clients of a free medical clinic nearby. Many of these clients are recent immigrants.

According to those involved with the effort, the partnership provides the student interns with a chance to hone their counseling skills while also offering them a firsthand lesson in advocacy and social justice issues.

The Bethesda Health Center (BHC) provides free primary care, diabetes and hypertension management, and health education for low-income and uninsured residents of Charlotte and the surrounding county. The UNC Charlotte counseling interns offer mental health care alongside these physical health services.

The partnership provides much-needed care to minority populations who are, statistically, the least likely to seek or access mental health services, says Daniel Gutierrez, an assistant professor of counseling at UNC Charlotte, as well as a licensed professional counselor, licensed mental health counselor and member of the American Counseling Association.

It has also provided counseling students with some valuable learning that transcends the typical textbook lessons, says Katherine Wilkin, an ACA member and clinical mental health counseling student at UNC Charlotte. Wilkin, who was born in Venezuela, is able to offer counseling to BHC clients in Spanish and English.

The experience has opened Wilkin’s eyes to the cultural factors that often increase risks for mental health struggles, including the stress of navigating a language barrier and acculturation to a new location.

“My experience at Bethesda Health Clinic has enriched my training and has strengthened my passion for providing mental health services to the Hispanic population in their native language of Spanish,” Wilkin says. “… This program exposes counselors and students to a diverse population with unique issues. The [U.S.’s] growing Hispanic population calls for mental health professionals to be sensitive and aware of the cultural considerations when working with this population.”

UNC Charlotte’s work at BHC was highlighted recently by National Public Radio (NPR). CT Online reached out to Gutierrez for a Q+A to find out more.

 

CT: In your own words, how does this program meet a need?

DG: Latinos are the fastest-growing and largest minority in the U.S., and they experience mental health disorders at the same rate — some argue at higher rates — as the majority culture. Yet, when compared to the majority culture, they are the least likely to access mental health treatment. They, on average, receive a lower quality of care and end up presenting with more severe symptoms.

There is no doubt that there is a great need for effective and accessible mental health care for this population. However, there are numerous barriers that keep Latinos from accessing mental health treatment, such as language difficulties, a lack of appropriately trained mental health workers, stigma and an overall difficulty trusting providers.

On the other hand, counselor educators everywhere preach the importance of teaching our students to work with underserved and vulnerable populations, but we don’t always have the opportunity to give our students quality learning experiences doing this work. This program meets two needs: a) it creates access to appropriate mental health services for an underserved population; and b) it creates a diverse and dynamic learning experience for our students.

 

What have you learned from this program?

I don’t think you have enough room [in this article] to describe what I’ve learned. I learned how complicated it is to set up a program like this. I learned the importance of doing work with the I_learnedcommunity and not just in the community. This program has also reaffirmed my belief that understanding people is more important than understanding illness.

 

 

Talk about the logistics of how this program came together. What did it take to get started?

First off, the real credit goes to people like Wendy Mateo, the executive director of the Bethesda Health Center. Before all the publicity from NPR, and with limited resources and under some very challenging circumstances, Wendy was wholeheartedly serving the Latino community by providing medical care and chronic health management to the low-income and uninsured immigrant families in Charlotte. She does an amazing job and is an inspiration to helpers everywhere.

When we met with Wendy, she expressed that although they were making considerable strides in improving the physical health of Latinos in Charlotte, there was a great need for mental health services for their patients. We quickly realized that serving at a clinic that helps the underserved in Charlotte would be an amazing opportunity for our counseling students, and that our counseling students could provide the services that Bethesda truly needed. So, we brought together a team of faculty from different departments and began conversations about building counseling capacity at this free clinic.

We began by first evaluating the mental health needs for the current patients. We conducted chart reviews, spoke with staff at Bethesda and began to develop an understanding of what kind of mental health needs they were facing. We then had a series of meetings evaluating space needs; developing the right type of forms; discussing issues related to supervision, ethics, confidentiality, HIPPA compliance, how to manage interpreters; and examining the whole process for providing services.

I think we were all very aware that starting this program had many moving parts and that it wasn’t going to be as easy as just putting two chairs in a corner and assigning clients to students. It was a long and complex process, if we were going to do this right. These clients are already underserved by the community and are statistically more likely to receive substandard quality of care. It was important that we gave them the best care we could and that our students were going to have a positive experience.

After establishing a format and structure for the services, we recruited two doctoral-level counseling students who were licensed professional counselors to begin seeing clients. We called this our pilot study. We evaluated the progress of these initial students and used this data to inform the placement of master’s students. That following semester, we began placing master’s counseling students in their internships and practicums at the site. Thus far, the clients and the students both consider this program a great success.

 

Based on your experience, what advice would you give to counselors who might want to get involved in something similar in their local area?

One of the key members of our team, Mark DeHaven, is known for saying, “Collaboration is good, but partnership is better.” Too often we try to collaborate with community sites because they are great places to get data or place students, and that has merit. However, when you partner with a community agency, you begin to share responsibility and work together toward common goals, and that’s a whole other wonderfully beautiful thing.

I invite those who want to start these kinds of programs to begin by building strong community partnerships. It is complicated and sometimes cumbersome to partner with community agencies, but it has to be less about you and your agenda, and more about the needs of the people you are serving.

It’s also important that you develop a strong team of like-minded people [who are] willing to not just talk the talk but also walk the walk. I am lucky to work along some great and passionate people from different departments. Our team consists of Edward Wierzalis, a fellow Department of Counseling faculty member and the UNCC counseling program clinical coordinator; Mark DeHaven, a distinguished professor in public health science; Roger Suclupe, a lecturer from social work; Amy Peterman, an associate professor and director of clinical training in the Health Psychology Department; and a counseling Ph.D. student, Carolina Benitez.

This team made this project come together. So, my second piece of advice for future counselors is to build a good team.

 

The NPR piece says this came about because you were “looking to get more involved in the community.” Can you elaborate? Why is that important to you?

Well, I think this is probably a pretty personal question. I think everyone on our team serves in the community for different reasons. For me, I am driven by the spiritual ideas of welcoming the stranger, reaching out to those deemed the least and doing justice. I was also mentored by people who continually stated that in a world with so many health disparities, economic disparities and so much need, counselor educators should strive to go beyond mere talk and do impactful work.

After the NPR story went national, the first words from my mentor’s mouth were, “Some people got help — and that is the important thing.” I hang that email by my desk at work because it keeps me focused. Those of us with counseling training are equipped to do good in this world. Doing nothing seems like a mistake to me.

 

What type of nontextbook lessons have you seen your students learning?

Probably what I’ve enjoyed the most about this process is the surprising reactions I’ve seen from students. Our program has an emphasis on multiculturalism and diversity, so the students are well-versed in textbook knowledge. However, the internship experience [at BHC] offeredtears_in_eyes them a real quality experience working with a population that was culturally different from their own.

I have had students come to me during their experience and sit in my office with tears in their eyes, and say things like “I just didn’t know” and “I love working with these people.” I think it raised student awareness to some of the struggles Latino immigrants face, such as having to cope with the traumas they experienced before entering the U.S., the stress and anxiety of leaving loved ones behind, and trying to care for family with limited resources. They also expressed new levels of multicultural awareness and realized that there was much they had taken for granted, such as the ability to speak the same language as their clients.

At the end of the most recent semester, we had students describe their experiences, and most stated that what [they had] learned most form the program was “working with people who are culturally different from you,” “understanding that most Latinos are very different and come from different countries, even though they are all labeled as Latino” and “learning the challenges of working with translators and the importance of tuning into body language.” Students also stated that this site [BHC] provided them with experiences that many of the other sites could not.

 

What do you want counselors to know about this program and your experience with it?

I would want my colleagues across the country to know one thing: This is worth doing. Latinos and other racial ethnic minorities are not receiving services at the same rates as the majority population. There is a need for helping professionals willing to reach out to our communities.

This kind of work might be complicated to set up and require more energy than you want to expend, but it’s good work and it is worth doing. It’s a great experience for the students and the community. It’s not simple work; you will most likely make a lot of mistakes getting this kind of a program off the ground – I know we did – but it is so much better to dance and miss a few steps than to never dance at all.

 

****

 

From NPR: “Students Fill a Gap in Mental Health Care for Immigrants

Find out more about the Bethesda Health Center at caminocommunitycenter.org

 

Contact Daniel Gutierrez at DGutierrez@uncc.edu

 

****

 

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

 

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

 

****

 

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The relationship as client

By Laurie Meyers September 22, 2016

Among the most common difficulties that bring couples to counseling are infidelity, financial problems, sex and intimacy issues, parenting challenges and ongoing tensions with the in-laws. Each of these problems has its own unique characteristics, but according to couples counselors, they tend to share a similar root cause — namely, lack of communication. The challenge for couples counselors (and their clients) is to identify how communication went awry — or if it ever truly existed in the first place — and then work to reestablish it.

Couples counseling is fundamentally different from individual counseling, says Paul Peluso, past president of the International Association of Marriage and Family Counselors, a division of the American Counseling Association.

“Too often, counselors think that couples counseling is ‘individual counseling times two,’ and they conduct individual counseling with each person, while the other partner observes,” Peluso says. “That really isn’t couples counseling. Instead, with couples counseling, you have not just branding-images_inkhearttwo perspectives in the room that you have to balance, but you have the … relationship that you are working with. In fact, it is the couple’s relationship that technically is your client, not the individuals in the couple.”

Having a relationship as the client instead of an individual makes it much more challenging to build a therapeutic alliance, says Barbara Mahaffey, a licensed professional clinical counselor and ACA member who practices in Chillicothe, Ohio. The relationship is not just an entity, but rather two separate people who have different thresholds for opening up and trusting, she explains. Couples also come in with different goals and expectations. Mahaffey, who specializes in counseling couples and families, says her task as a counselor is not just to address these goals and expectations, but to help the couple discover how they can reconcile their personal expectations and establish new goals that will allow them to move forward as partners.

“Couples will come in and want to fight over who is right and who is wrong in the relationship,” Peluso says. “It is the couples therapist who has to sell the idea that no one is wholly ‘right’ or wholly ‘wrong.’ Paradoxically, neither is to blame and both are to blame — in the technical sense — for the state of the relationship at the same time. Both have played a role in setting up the conditions for the relationship. So the focus is on how each person’s behavior and reactions to [the] other affect the couple’s relationship. If each person wants to be in the relationship, then they have to take responsibility for how their behavior impacts the health of the relationship. And this is very different than individual counseling.”

Confronting infidelity

Unfortunately, the catalyst that most often pushes couples into a counselor’s office is also one of the most difficult issues to move past.

“The single most common issue that brings couples into therapy is infidelity,” says Peluso, a licensed marriage and family therapist (LMFT) who has written several books about both infidelity and couples counseling. “Over the last 20 years, researchers have demonstrated that this is the most common presenting concern, and if it is not revealed initially, it is often disclosed in the course of couples therapy. Infidelity can take many forms, from sexual to nonphysical intimacy, and it now includes relationships online.”

“In terms of who cheats, researchers have found that women are just as likely as men to participate in infidelity,” Peluso continues. “As a result, practitioners have to know how to deal with the complex and often devastating issues that accompany infidelity. Unfortunately, when couples counselors are asked about it, they overwhelmingly say that it is the topic they feel least prepared to treat.”

Amber Lange, a licensed professional counselor who owns and practices at Bedford Health, a group practice in Lambertville, Michigan, can attest to the high demand for infidelity counseling. Her practice has become known for specializing in issues surrounding infidelity and betrayal. Initially, the sheer need for counselors knowledgeable about and willing to tackle this particular relationship threat astounded her. “I’ll never be out of a job [as an infidelity specialist],” she says ruefully.

Among couples for whom the act of infidelity is fresh, the nonoffending partner is typically experiencing acute stress and may even have symptoms that resemble posttraumatic stress disorder, Lange says. The offending partner, on the other hand, is typically feeling beaten down because he or she has repeatedly been asked blunt questions that shine a direct light on his or her indiscretions: What did you do? Where? How much money did you spend?

In cases in which the infidelity is years in the past, the core counseling issue more often involves a lingering lack of trust, Lange says. “The nonoffending partner [may have] forgiven the offending partner, but they have never rebuilt trust,” she explains. “So the nonoffending partner is hypervigilant about trust and the [possibility of the] offending partner reoffending.”

If the act of infidelity is recent, Lange helps the couple work through their “why, who, where, how” stage. “I talk about the idea of how you can’t ‘unknow’ something once you know it,” says Lange, a professor of counseling at Capella University. “There’s a lot of knowledge that you can gain that may further traumatize you, such as the sexual positions that your partner was in with someone else.”

Clients may also wonder if their partner did things with another person that the nonoffending partner refused to do. If this information is disclosed, Lange explains, it can lead the nonoffending partner to do things he or she is uncomfortable with in an attempt to please the offending partner.

Instead of attempting to get answers to questions that can further damage the relationship, Lange encourages the nonoffending partner to ask structured questions such as: When did you start having sex? When did you stop? Did you have unprotected sex? These types of questions provide information that the nonoffending partner needs to know, Lange says.

The next phase of Lange’s therapeutic approach involves narrative therapy. As part of this stage, Lange might ask couples who delayed getting therapy after the infidelity to briefly touch on information about the affair as a way to see if there are lingering questions. This process also helps Lange to assess the strength of the couple’s bond.

The story of ‘us’

Regardless of whether the couple is confronting a recent infidelity or the infidelity happened years in the past, constructing the story of their relationship represents the core of the healing process, according to Lange. Couples build the narrative to gain a clearer understanding of how and when the cracks in their relationship developed, she explains. They talk about the beginning of their relationship and explore how they interacted. Were they friends and true partners? What happened that started pulling them apart?

“Life” — deaths, births, work, money and so on — is usually the answer to that second question, Lange says. In addition, people typically change over time, which further alters the nature of the relationship, she notes. All of these factors in combination can make a relationship vulnerable to disruption. Add in misperceptions and unmet expectations, and once tiny relationship fissures can turn into large cracks that cause couples to drift apart.

Among the most common life events that can start to pull some relationships apart is the birth of a child, Lange says. “Before the birth, couples were able to spend all their time and energy and money on each other. After the birth of a child, ideally, you love that child and invest all of that [time, energy and money] in parenting and child rearing — which is not bad, but [couples] come into my office, and they haven’t been on a date in three years.”

In addition to not making time for the romantic relationship, the couple may be trapped in patterns that are actively pulling them apart, Lange says. “You’ve been great parents, but the mother is staying home or working and raising kids at the same time, the father is working and overworking to pay for the mortgage and save for retirement — those kinds of things can hurt a relationship,” she says.

When a couple stops talking to each other, it creates a gap, and it is tempting to fill that gap with other people or activities, Lange notes. Partners may begin to betray each other in different ways, whether it is spending time on social media instead of with each other, watching pornography or working long hours, she says. “In the process, we’ve let the relationship go awry,” Lange observes.

But this risk of unraveling is not exclusive to couples with children. Those who get married or enter into domestic partnerships too quickly upon meeting or when they are very young are also particularly vulnerable, Lange says. For example, those who form romantic relationships in their teens or early 20s are in the midst of experiencing significant personal development. This may not happen at the same rate for both partners, eventually leaving them feeling as if they don’t know each other, Lange explains. Likewise, people who get married or form a domestic partnership in the matter of a few weeks have not typically had enough time to establish a strong base of friendship. Over time, it’s not uncommon for them to realize that they don’t even like each other, Lange says.

Lange asks clients not to make a decision about whether to stay together until after they have gone through the process of identifying what went wrong. Then, if they choose to stay together, Lange helps them start to discuss how to protect the relationship going forward. This typically includes setting aside time to talk with each other more frequently, being intentional about making time for dates and even going on vacations without the kids. But it also involves each partner identifying the behaviors in which he or she engages that play a role in pulling the relationship apart.

For example, Lange recounts something that a client recently shared. “One of the things that I have recognized about myself over the past six months is that I tend to withdraw,” the client told her. “When my partner and I got into an argument, I went away, slept in the kids’ room and wouldn’t talk. I would work 85 hours a week. Even when I wasn’t in the office, I was checking my email.”

In essence, Lange says, the client just wasn’t “there” in the relationship. Other people do the same thing by burying themselves in hobbies such as sports or scrapbooking. As a result, they end up spending more time with friends or with hobbies than they do with their partner and family, Lange says.

The process of building the couple’s story in counseling and finding the cracks and vulnerabilities is a long one. For the first four to six weeks, when a couple is still going through the initial trauma phase of the infidelity, Lange has them come to counseling every week. Once a couple moves on to the storytelling stage, she has them come to counseling only about once per month, in part because she feels that much of the processing and healing needs to take place between sessions as the couple slowly rebuilds the relationship.

“They have to have time to figure out things … how to be in relationship, how to recreate their friendship and how to build [new] good memories,” Lange says. During the process of rebuilding the relationship, trust is also being reestablished and forgiveness is being granted. Then the couple can move forward, she explains.

Ideally, the couple will also identify potential problem areas and reach compromises on how to address those issues. For example: “You say I can’t work 90 hours a week, but we need money, so how are we going to figure that out? … This is [our] story. Here’s the way we go forward. Here’s what we need to do.”

Symptom vs. problem

Brian Canfield, a past president of ACA, also says that infidelity is the event that most commonly brings couples into his office. But he believes infidelity is always indicative of other underlying problems in the marriage or relationship.

“I view an affair not as the problem but as a symptom,” he says. “An affair is like malarial fever. It’s uncomfortable, but it’s not the fever itself that’s going to kill you — it’s the disease.”

Canfield believes that if a counselor addresses the underlying issue first, it will help to stabilize the couple, which will then allow them to deal with the ramifications of the infidelity. “You [the counselor] have to assess if there is a commitment and desire to save the relationship,” says Canfield, an LMFT whose practice has offices in Louisiana, Arkansas and Florida. “Trust and betrayal, that’s not where you put the spotlight. The trust will return once you stabilize the relationship.”

Canfield starts by asking the couple what they want out of the counseling process and their relationship as a whole. “What would you like to see happen? If it is possible to salvage the marriage, would you be willing?” Canfield asks. “A lot of people want to know why [the affair happened], but here is where we are. Where do you want to be? If you were going to redesign marriage, how would it look?”

Canfield says financial difficulties are the most common underlying issue that couples bring into his office. In his experience, there is so much shame surrounding finances that most couples would rather talk about the details of their sex lives than money. He frequently encounters situations with couples in which one partner has been maintaining a hidden bank account or run up the balance on their credit cards without the other partner knowing. He tells couples that part of the counseling process involves full disclosure.

“A lot of couples are in tremendous denial,” Canfield says. “They don’t know how much debt they are in, what their bills are or have a good picture of how much income they are bringing in.”

Sometimes people feel entitled or convince themselves that it’s OK to buy what they want regardless of how it affects their spouse or partner. They tell themselves that they work hard and that they deserve it. Canfield sees part of his role as helping to bring clarity to these situations to encourage better choices.

“The other spouse may say that if this doesn’t change, I will exit the marriage for my own survival. Which circumstances are more important? Keeping the marriage or continuing to spend?” he asks.

Canfield doesn’t try to play the part of financial adviser to couples (although he does recommend that couples seek professional financial advice elsewhere if needed). Instead, he helps couples recognize their need to possess a clear picture of their financial situation and to develop a reasonable budget.

“It’s a matter of priorities and trade-offs,” he says. “The key as a couples counselor is to have the couple work together as a team. Most couples, when they work as a team, can find common ground.”

Canfield emphasizes that as a couples counselor, it’s not up to him to dictate how much a couple will spend on their priorities. Instead, his focus is simply on making sure that they have agreed on a plan going forward.

Once the underlying issues have been addressed, Canfield helps the couple deal with what he calls the “moral disparity” in a relationship in which infidelity has occurred. The nonoffending partner may feel like he or she has the higher moral ground, but to move forward, the couple must try to reach a “mutual amnesty,” Canfield says.

This involves a delicate balance. Canfield tries to make the couple aware that the infidelity occurred because of the underlying problems — to which they both contributed — that were straining the relationship. However, he always makes it clear that it is not the fault of the nonoffending partner that the other partner cheated. Yes, they both contributed to the relationship’s problems, but the offending partner chose to act out by having an affair.

Matters of miscommunication

Mahaffey, an associate professor of human services technology at Ohio University–Chillicothe, finds that relationship difficulties usually involve a significant degree of miscommunication, which is exacerbated by a number of factors. She helps couples understand how communication can get mixed up by explaining the pieces of a “miscommunication model” that she has devised.

Mahaffey starts by asking both partners to list all of the traits they possess that are different from their partner’s traits. She then takes these lists and draws two people facing each other. This represents two people talking, whereas the lists represent their different — and sometimes conflicting — points of view. Mahaffey often also draws a “family rule book” between the two figures. This represents how a person’s family of origin can affect the way he or she interprets interactions with a partner. Mahaffey often asks couples about their family backgrounds and experiences to illustrate the influence of the family of origin.

Mahaffey will then ask both partners to think about all the times they asked for something and didn’t receive what they wanted from their partner. As they voice these details, it’s not unusual for one partner to exclaim, “You never said that!” Typically, the case is not that either partner is lying, Mahaffey says. Rather, it’s that one of the partners has not been phrasing the requests in a way that effectively communicates what he or she needs, Mahaffey explains. She also informs the couple that humans think at about 500 words per minute but cannot speak more than 125 words per minute, meaning there is ample opportunity for the intended message to get lost.

Other complicating factors in communication include different coping styles (such as one member of the couple shutting down verbally or retreating physically or emotionally during times of stress), the fact that women often process information differently than men and the daily anxieties of life, Mahaffey says. For example, it’s hard for a couple to communicate effectively when one or both partners are stressed about finances, work or the car breaking down.

The last part of Mahaffey’s model entails explaining how words themselves — or how people define them — can get in the way. For example, Mahaffey might ask a couple, “What’s the definition of love? Is it that supper is on the table when I come home? Or liking to snuggle? Or texting 60 times a day?”

At this point, Mahaffey has the couple use “I” statements and talk about what needs they feel are being unmet. One partner might say, “I like to have help with housework.” The other partner might note that the request usually comes during a football game or while engaged in something else that he or she enjoys doing. At this point, Mahaffey might ask if the partner would be willing to provide help either before or after the game. This exercise highlights just one example of an area of possible compromise. The larger point is that the couple needs to sit down and talk about what they need from each other and how those needs can be met, Mahaffey says.

Intimate partner violence 

All counselors, but couples counselors in particular, should be looking for signs of intimate partner violence (IPV) among their clients, asserts Ryan Carlson, an ACA member and couples counselor who has done research on screening methods for IPV.

Because IPV is such a prevalent societal problem, all counselors — knowingly or unknowingly — will encounter clients who have experienced or are currently experiencing violence at the hands of their partners, Carlson says. According to data gathered in 2011 and published in 2014 by the Centers for Disease Control and Prevention, more than 1 in 4 women and more than 1 in 10 men in the United States have in their lifetime experienced sexual violence, physical violence or stalking by an intimate partner.

Providing counseling in the presence of such interpersonal violence can be dangerous, not just to the victim but also to the counselor, says Carlson, a licensed mental health counselor practicing in Columbia, South Carolina. That is a primary reason it is important for counselors to be alert to the signs of IPV and to have a protocol to follow should a client be a victim.

Perhaps the most beneficial thing counselors can do is to get connected to the people Carlson calls the “real experts” on this issue — those who work at local domestic violence shelters. “Most of what I have learned [about IPV] has come from domestic violence advocates,” he acknowledges.

Not only can these advocates help counselors assess whether it is safe to work with a couple in which IPV is a reality, but they also stand ready to assist clients who are looking for help, says Carlson, an assistant professor of counselor education at the University of South Carolina.

Carlson says he uses the term IPV because it is more inclusive than domestic violence. There is an IPV continuum, and domestic violence is on the extreme end of the spectrum, representing the most severe cases that involve, as Carlson puts it, “power and control,” as opposed to nonlethal violence or verbal abuse. From Carlson’s perspective, it is not safe to try to conduct counseling in those cases involving power and control.

Carlson advises counselors to use a formal screening tool for IPV at intake but says there are other red flags to look for, including a client’s unwillingness to take responsibility for actions. “Control over finances or transportation is [also a] red flag,” he continues. “Is one partner restricting access to cell phones, finances, the car, who the other partner can interact with? … Look for body language. Does one partner consistently look to the other when they answer questions? Is it permission seeking? Is there inconsistency in their answers? For example, as part of a meeting to determine whether or not a couple would want to participate in a research study I was doing, I asked about income. The husband gave me an answer, but when I met with the wife separately, she said the husband wasn’t really working and that she wasn’t allowed to talk about that.”

This one disparity turned out to be an indication of severe domestic violence. Carlson followed his protocol and was able to get help for the victim.

What does a protocol look like? Carlson says he has a formal memorandum of understanding with the local domestic violence shelter saying he can call at certain hours when he has a need for consultation. The memorandum also states that he will not provide identifying information about the client, only basic relevant information. This includes the presenting problem and any context he feels is important. The consultant can then advise him on whether the couple’s case might be a power-and-control situation. In those instances, Carlson must find a way to offer help to the victim without tipping off the partner who is engaging in the abuse.

With all of the couples Carlson counsels, his regular practice is to meet briefly with each individual separately at the beginning of each session. This is primarily so that he can get each partner’s point of view independently on the difficulties the couple is experiencing, but it also provides him with a chance to provide contact information for the domestic violence shelter if circumstances warrant. Carlson and the partner who is the target of the abuse may even call the shelter together.

In some cases, however, the victim of the abuse is not ready to leave the relationship. Carlson say many counselors may have a hard time relating to that. “We think we need to get the person out of the relationship immediately, but [we] need to do it safely,” he cautions

The victim has typically been living under abusive circumstances for years and may not yet have reached a crisis point, Carlson explains. Again, he uses consultation with his domestic violence resources to help him navigate this terrain. Regardless of whether the victim is ready to leave, Carlson says the average counselor should not try to continue providing services in these power-and-control cases. Telling the couple that he feels this particular modality will not work for them has proved to be a successful way of terminating treatment without escalating the problem of abuse, he says.

Lynn Linde, senior director of the ACA Center for Counseling Practice, Policy and Research, adds the caveat that counselors should make sure their states do not require them to report suspected cases of IPV under mandated reporting laws.

There are IPV cases for which Carlson thinks couples counselors are qualified to help. These involve lower lethality or “situational couple violence” (as opposed to one partner begin generally aggressive outside of the relationship as well). In such instances, a couple’s arguments may get out of hand and they may engage in behaviors such as pushing or throwing things at each other. “This can be dangerous, but it’s not as dangerous as choking or using a weapon,” Carlson says. However, he says, it is important for the couple to acknowledge that this behavior is unhealthy and to show a willingness to learn more appropriate ways to interact. It’s also essential that neither partner is afraid of the other, Carlson stresses.

In contrast, partners who engage in power-and-control tactics usually show little or no remorse and may exhibit antisocial-type behavior, Carlson explains. In fact, he says, studies have shown that when engaging in the abuse, these types of offenders typically experience a drop in heart rate rather than an escalating heart rate that is typically associated with anxiety over one’s situation or actions. Carlson also notes that whereas research indicates that men are almost always the perpetrators of power-and-control types of IPV, situational IPV is gender neutral.

None of this information constitutes a foolproof method for deciding whether it is safe for a counselor to work with a couple with a history of IPV. That’s why Carlson continues to do research on screening methods that are better at identifying the presence of violence among couples and where on the spectrum of severity that violence falls.

“Getting it wrong can be very dangerous,” Carlson concludes.

Counseling LGBTQ couples

Although the issues that bring lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ) couples into counseling are generally the same as those that affect heterosexual couples, the legalization of same-sex marriage has raised some issues unique to LGBTQ relationships, say counselors who work with this population.

“There is a tremendous validation both from the legal system and from society upon their relationships,” says John T. Super, an LMFT who is also a clinical assistant professor of counselor education at the University of Florida. “This validation can provide an emotional confidence or boost surrounding a same-sex relationship that lessens the perceived stigmatization that has occurred. Additionally, since the Supreme Court decision [legalizing same-sex marriage], we have seen a large number of those in long-term relationships choosing to marry and report feeling equality to traditional marriages.”

Although the Supreme Court’s decision is a huge advancement for the LGBTQ community and has given many couples the opportunity for which they have long waited, actually getting married has not been absent of negative consequences for some couples, says Super, a member of ACA. “Clients have explained [that] when they announced their marriage … it was in many ways similar to the coming-out process in that those who are choosing to marry and are in same-sex relationships may face resistance from friends and family as they legalize the relationship,” he explains. “I have heard clients say that their friends and family accepted their relationship, but when they choose to marry, the thought of the same-sex couple entering into a legal marriage is a line the friends or family are not comfortable crossing.”

Counselors have an important role in helping same-sex couples navigate the resistance they may face when they decide to get married, agrees Joy Whitman, a past president of the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling, a division of ACA. Amidst the joy of getting married, there may be feelings of hurt and loss from being rejected all over again by certain individuals or segments of society, she says. Counselors can help couples grieve and process this loss.

According to Whitman, who previously worked as a couples counselor, marriage can also exacerbate a common problem in same-sex relationships: unequal comfort levels with being “out.” Marriage can make the partner who is less “out” feel especially vulnerable, she explains.

Counselors should also be aware that for the first time, LGBTQ couples are facing divorce, Whitman says. Not only is this a new experience, but the need in many cases to stand up in court and disclose intimate relationship details can be particularly disconcerting for clients in same-sex relationships, she says.

Super and Whitman also note that counselors need to be aware of the generation gap among different LGBTQ couples. “Couples who are in their 20s experienced a very different level of social acceptance than couples in their 50s or older,” Super points out. “This generational difference can be important to understand when determining the levels of internalized oppression the individual or couple has experienced.”

Despite these issues and other issues that are specific to the LGBTQ community, Super and Whitman emphasize that couples counseling is couples counseling. Peluso, an associate professor of counselor education at Florida Atlantic University, agrees.

“In many respects, the practice of couples counseling shouldn’t change that much,” he says. “Focusing on the relationship means taking the relationship as it is created by the partners involved. The only judgment that the couples counselor is making is, ‘Is this healthy for you right now?’ and then seeing how the couple can change that. That is fairly universal.”

 

****

Additional resources

To learn more about the topics addressed in this article, see the following select resources offered by the American Counseling Association.

 

Books (counseling.org/bookstore)

Podcasts (counseling.org/continuing-education/podcasts)

  • “Love and Sex and Relationships” with Erica Goodstone

Webinars (counseling.org/continuing-education/webinars)

  • “Crazy Love: Dealing With Your Partner’s Problem Personality” with W. Brad Johnson
  • “The Secrets to Surviving Infidelity” with Scott Halzman

VISTAS Online articles (counseling.org/continuing-education/vistas)

  • “Five Counseling Techniques for Increasing Attachment, Intimacy and Sexual Functioning in Couples” by Elisabeth D. Bennett, Jaleh Davari, Jeanette Perales, Annette Perales, Brock Sumner, Gurpreet Gill & Tin Weng Mak
  • “Helping Couples Reconnect: Developing Relational Competencies and Expanding Worldviews Using the Enneagram Personality Typology” by Thelma Duffey & Shane Haberstroh
  • “Loving Kindness Meditation and Couples Therapy: Healing After an Infidelity” by Laura Cunningham & Yuleisy Cardoso
  • “Supporting Same-Sex Couples in the Decision to Start a Family” by Debbie C. Sturm, Erika Metzler Sawin & Anne L. Metz
  • “Working With Intercultural Couples and Families: Exploring Cultural Dissonance to Identify Transformative Opportunities” by Cheryl L. Crippen
  • “Working With Sexual Addictions in Couples Therapy” by Sara L. Wood

Practice Briefs (counseling.org/knowledge-center/practice-briefs)

  • “Counseling Couples With a Trauma History” by Catherine J. Brack & Greg Brack

ACA Divisions

  • The International Association of Marriage and Family Counselors helps develop healthy family systems through prevention, education and therapy (see iamfconline.org).
  • The Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling seeks to promote greater awareness and understanding of LGBT issues and improve standards and delivery of counseling services provided to LGBT clients and communities (see algbtic.org).

 

****

 

Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editorct@counseling.org

 

****

 

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

From the president: Strategic planning for counselors equals action

By Catherine B. Roland

Catherine Roland, ACA's 65th president

Catherine Roland, ACA’s 65th president

Dear Counseling Colleagues,

I’d like to share some thoughts on how counselors, counselor educators and counseling students can plan and act in a strategic manner to accomplish many goals. I see the process of planning as strategic because it leads to the future along a path of accomplishment that is based on a combination of need, desire, logic and commitment.

As I write this, difficult challenges continue to occur — challenges that have affected all members of our society and the counseling profession. Some of these challenges have involved natural disasters, such as the tragic flooding in West Virginia and Louisiana. Other challenges are the result of killings and shootings in various parts of our nation and the world, including in Dallas and in Baton Rouge, Louisiana.

It is important to note that all of the examples I mentioned occurred over a brief period this past summer. That short time span can create a kind of pile-on effect for people. There are only so many negative or horrific events that individuals can accept without their levels of self-confidence, trust and happiness being affected.

That is where we find ourselves as counselors: working with K-12 students, college students, graduate students, children, adults, older adults and other diverse populations across the life span. We must also remember to practice self-care as counselors. We often get double and triple doses of sadness and horror as we learn about an incident ourselves and then reexperience it multiple times through our clients and students.

It may be worth exploring the strategic planning process as a way to begin establishing and accomplishing goals for yourself and for your clients and students, especially around issues that are sad or distasteful or that cause negative feelings. We sometimes think of strategic planning as an exercise conducted in university or organizational meetings. However, we can also use these skills to make plans concerning how we, as counselors, can help in the most effective way possible in whatever specific area we are involved.

If we create a treatment plan in a clinical setting for a client whose brother was shot, design a post-divorce family group for middle school students who had to relocate to a different city because of flooding, or plan the agenda for a semesterlong safe-sex/risk behavior series on a college campus in a state where the incidence of HIV/AIDS is alarming, we are being strategic. Each of these examples would have lasting effects, could be continued with broader objectives and would have measurable outcomes that would expand through the three- to five-year scope of the planning.

If those exercises featured a continuum of activities each year, short- and long-term goals, and a set of outcomes to be accomplished over the course of the three- to five-year scope, I wonder if the overall plan would be more influential. A more developmental view of planning might ensure that the plan and the activities surrounding it would evolve.

For situations similar to the examples here, time is relative. For instance, take the college student who just learned that two of his best friends have been diagnosed with HIV. In many ways, those diagnoses may run his life. But working with him on a set of strategies that he can accomplish and feel good about may be exactly what allows him to come out of a scared level of depression, maintain his friendships and excel in school. Farther-reaching strategies that use logical planning tools for clients and students may offer the most effective results because the clients and students will feel more in charge. And after all, clients are in charge of their behavior, perceptions and attitudes.

As you work this fall to serve your clients or students, I invite you to email me regarding any planning projects you have designed that entail the kind of strategic thinking discussed in this column. Hearing from you will allow for greater connection and sharing. We need to offer our colleagues all kinds of examples of success so that we can continue to provide counseling that is effective and state of the art.

Fall is typically a prime time for conferences sponsored by American Counseling Association regions, divisions and branches. Perhaps you have already attended one or more yourself. These gatherings provide opportunities to reflect, connect and make the most out of a specific period of time by learning from the best and offering our best in return. Gatherings of colleagues are opportunities. The sage collective advice of colleagues can lead counselors to create multifaceted plans and enjoy feelings of accomplishment and wonder as these plans begin to evolve and play out strategically.

I have adopted a phrase from a physical therapist I know: “Motion is lotion.” My interpretation is that lotion facilitates action, allowing for deeper movement and flexibility toward accomplishment. Let me know if you decide to put these words into practice to become a more empathic and strategic counselor. I’d love to hear about it.

Very best,

Catherine

croland@thechicagoschool.edu