Monthly Archives: August 2017

Technology Tutor: Answering your questions: From protected health information to search engine optimization

By Rob Reinhardt August 31, 2017

I often receive questions during consultations that require fairly brief answers. Although I tend to focus on “big picture” topics in this column, I thought I’d take a break from that routine to answer some of the most popular questions I get asked related to technology in private practice.

Some of these questions touch on legal matters, but please note that my answers do not qualify as legal advice. You should always consult an attorney about legal questions.

 

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Can I use online accounting/billing services such as QuickBooks Online and remain compliant with the Health Insurance Portability and Accountability Act (HIPAA)?

The short answer: It depends. The answer centers around whether you are storing protected health information (PHI) in whatever online system you are using. According to the U.S. Department of Health and Human Services (HHS) summary of the HIPAA privacy rule, PHI is information, including demographic data, that relates to:

  • The individual’s past, present or future physical or mental health or condition
  • The provision of health care to the individual
  • The past, present or future payment for the provision of health care to the individual

This information must identify the individual, or a reasonable basis must exist to believe that it can be used to identify the individual.

If you are storing PHI with a third party, you must enter into a business associate agreement (BAA) with that party. The BAA is a contract that essentially states that the vendor will comply with HIPAA. It also lays out what the vendor’s responsibilities and your responsibilities are for protecting PHI, among other things.

To the question at hand, to use any online service that stores client information, you would need to choose a vendor that complies with HIPAA and that will enter into a BAA with you. At the time of this writing, QuickBooks Online does not meet those requirements. In fact, QuickBooks Online recommends that its users do not enter PHI into its system (see bit.ly/QBHIPAA).

So, why was my initial answer, “It depends”? Because if you are not entering any PHI into QuickBooks Online, then you can still use it while complying with HIPAA. The most common case for this is when client billing is handled through a separate application (see bit.ly/EHRReviews) and a counselor uses QuickBooks only for accounting (tracking of revenue and expenses not attached to any particular client).

 

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Can I remain HIPAA compliant if I use services such as an online calendar from a vendor that isn’t HIPAA compliant if I use only the client’s initials?

The short answer: No. HHS has clearly stated that “a data set that contained patient initials, or the last four digits of a Social Security number, would not meet the requirement of the Safe Harbor method for de-identification.”

HHS is referring to the de-identification of PHI. HIPAA does allow the storage and transfer of PHI if it has been properly de-identified. This means that someone would not be able to determine the individual with whom the PHI is associated because enough identifying information has been stripped away.

There are two methods to achieve this level of de-identification. One is the “expert method.” This means that you or someone you hire who has “appropriate knowledge of and experience with generally accepted statistical and scientific principles and methods for rendering information not individually identifiable” is able to declare and document that the PHI has been properly de-identified. This is a highly unlikely scenario for most counselors, so you will instead need to rely on the HHS guidance for obtaining Safe Harbor. That guidance is available at hhs.gov/hipaa/for-professionals/privacy/special-topics/de-identification/index.html.

 

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How can I get my website on the first page of search results?

The short answer is that there is no guaranteed way to get on the first page of search results. I encourage you to be wary of any “SEO optimization” vendor or service that promises that you’ll land on the top of the first page of Google search results, for example.

That being said, SEO (search engine optimization) is a real thing. It encompasses myriad tools and steps that you can take to improve the performance of your website in searches. Much of the process boils down to the content and keywords on your website, along with having external links pointing to your site, but it truly requires a focused, multipronged effort and time to achieve results. 

A great place to start is with the SEO tutorial at moz.com/beginners-guide-to-seo. After reading the tutorial, you should have a good idea of the things you might be able to do yourself. Even if you ultimately hire someone else to do it all for you, you’ll be better informed about what to realistically expect and better equipped to identify those who might be making false promises.

 

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If you’d like for me to address more questions like these in future Technology Tutor columns, send me an email. In the meantime, be sure to check out the new free TherapyTech with Rob and Roy podcast (I’m the Rob in there!) at therapytechrobroy.com.

 

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Rob Reinhardt, a licensed professional counselor supervisor, is a private practice and business consultant who helps counselors create and maintain efficient, successful private practices. Before becoming a professional counselor, he worked as a software developer and director of information technology. Contact him at rob@tameyourpractice.com.

Letters to the editorct@counseling.org

 

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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.

CEO’s Message: Professional counselors: Amazing healers

Richard Yep

Richard Yep, ACA CEO

First of all, my thanks to those of you who responded to last month’s column about pledging to help end the divisiveness in our society. Your words and commitment were inspiring, comforting and well-received. This column is about the next step we will need to take: healing.

Professional counselors do an amazing job of working with clients, students, families, institutions and communities to help heal so many different kinds of wounds. These wounds can be the result of discrimination, hate, bullying, hunger, homelessness or countless other types of oppression.

Many of you are called on each and every day to work with people in need of healing. I hope that you take pride in this important work that you do. I also hope that you constantly strive to learn more, experience more and do more regarding those who have such great needs. You need not email me (unless you want to!) about how you strive to help heal others; I know you are busy and want to stay focused on your clients and students.

I’ve written about this many times before, but it bears repeating: Here at the American Counseling Association, we want to help you in your quest to heal others. Now more than ever, your good work is critical in communities across the United States and around the world. We all know that the need for healing doesn’t take place only after a specific “hurt” has occurred. The feeling that you are about to be hurt (or could be hurt or have been threatened with being hurt) can also result in the need for professional counseling.

As a professional membership society, ACA is in a position to develop materials, resources and information designed to help you in your practice or on your educational path leading to your degree and license. I am fortunate to have an outstanding staff here at ACA that is ready, willing and able to assist you. All we need to know is what the biggest help would be to you.

If you do have time to communicate with me this month, let me know what you would like from your professional membership organization. I can’t promise delivery on every last request, but I can tell you that the staff and I will review your suggestions to see what is possible. If we can’t fulfill your request right now, we might be able to explore ways to do so moving forward.

One thing I often hear from professional counselors is what the ACA Conference & Expo means to them. This is the one time each year that you get to “be you” with thousands of other professionals who share your desire to be the best counselor possible. I know it’s only September, but the ACA Conference coming to Atlanta next April is already shaping up to be one of the best in terms of content. Our call for programs attracted so many responses that the various content tracks promise to be chock-full of interesting, timely and useful information for attendees. For more information about the ACA Conference & Expo, go to counseling.org/conference. Visit the site now, and then return each month to see what we have updated for you.

Finally, here is something else that I imagine you do not hear enough: Thank you. Your commitment, compassion, advocacy and work on behalf of clients and students does not go unnoticed. You are special human beings, and the impact you are making now will have a long-lasting effect on your clients and students and those with whom they will interact during their lifetimes.

As always, I look forward to your comments, questions and thoughts. Feel free to contact me at 800-347-6647 ext. 231 or via email at ryep@counseling.org. You can also follow me on Twitter: @Richyep.

Be well.

 

 

From the President: When a career path blazes a trail

Gerard Lawson

Gerard Lawson, ACA’s 66th president

Many counselors do not know Carol Bobby personally, but her work has influenced the work of almost every practicing counselor today. Carol began serving as the CEO of the Council for Accreditation of Counseling & Related Educational Programs (CACREP) in 1987 and has helped guide that organization, and the counseling profession, through times of incredible growth. Carol’s steady hand on the rudder has often helped the profession navigate difficult times too. After 30 years of leadership at CACREP, Carol has recently retired, and that is worth noting for a few reasons.

National standards for preparation are one of the hallmarks of a profession, along with a professional association (e.g., ACA and its divisions, Chi Sigma Iota), its own body of research and literature, credentialing (e.g., the national certified counselor credential and licensure) and a code of ethics. Each of these parts is required to make a profession more than simply an occupation.

The national standards for counselor preparation that CACREP has established are a central part of why counselors enjoy the recognition that we do today, regardless of whether you attended a CACREP-accredited program. Our ability to describe the high standards for counselor preparation allowed us to secure licensure in all 50 states. When Carol took the reins at CACREP, only 18 states had a license for counselors to practice independently. CACREP Standards have also allowed counselors to increase their work with TRICARE, the Department of Veterans Affairs and other federal programs. Perhaps most impressively, the professionalization of what it means to be a counselor has evolved because of groups such as ACA, the National Board for Certified Counselors, Chi Sigma Iota and CACREP, and Carol has always been a champion for working together to represent our profession.

Carol’s humility will cause her to recognize, correctly, that she has worked with incredibly talented staff members, board members, reviewers and visiting teams over the years to accomplish the things that CACREP has achieved. Someone had to blaze the trail that would move CACREP and the counseling profession forward, however, and Carol helped us find that path. She will also tell you that she never believed, as she was completing her dissertation, that she would get this job with CACREP. But as is the case with so many of us, when we find our career calling and allow opportunities to unfold in front of us, good things usually happen. So, as much as I am compelled to stop and recognize the career of one remarkable counselor, I am also intrigued by the career journeys that are being started by other individuals every day.

In 2016, CACREP-accredited programs graduated 12,824 new counselors (according to CACREP’s annual report). Every day, new counselors join the profession, filled with passion for the work they were called to do and new knowledge about the best practices for helping people. Most have absolutely no idea where their career will ultimately take them. Sometimes that first step on their career path leads to a school, where they will change kids’ lives every day. Or to a community mental health center, where they will advocate for clients in need. Or toward helping other people find the career paths that would be most rewarding for them. Those journeys start every day, and someday when we look back on those careers, we will see how each counselor helped to make the world a better place.

Whether just beginning your career or looking back with pride on a career well spent, we would all do well to reflect on the message that Carol Bobby has shared over the years. Be proud of the work that you do and your identity as a counselor, because no one else can do what you do, and you make a difference every day.

 

 

High anxiety

By Laurie Meyers August 29, 2017

Licensed professional counselor (LPC) Keri Riggs, an American Counseling Association member with a private practice in Richardson, Texas, started noticing the pattern about eight months to a year ago: clients reporting a sharp increase in anxiety. And it wasn’t only her existing clients who were expressing discomfort; new clients were seeking her out, surprised and distressed by the symptoms they were experiencing.

“I had [new] clients coming in who would say, ‘I went to the ER because I had chest pain, and they told me I was having a panic attack,’” she says.

Others told Riggs that although they had always had some anxiety, they had been able to handle it previously. Now they felt that they needed help and a place to talk about what they were feeling.

What is the impetus for this ongoing surge of stress and anxiety? Riggs believes that a confluence of terrorist events — ranging from multiple attacks in Paris to the Pulse nightclub shootings in Orlando, Florida, to the more recent bombing at an Ariana Grande concert in Manchester, England — have combined with the drama and divisiveness of the current political climate to leave many people feeling fearful and uneasy.

A substantial number of Riggs’ clients belong to groups — including immigrants, women and members of the LGBTQ community — that feel specifically singled out and threatened by the inflammatory rhetoric that has increasingly taken center stage over the past year-plus. Those who care particularly about the people in these groups or the issues affecting them also find themselves susceptible to a lingering sense of anxiety and dread.

Anxious atmosphere

Of course, it is not just people in “targeted” populations who are experiencing rising anxiety. In February, the American Psychological Association released a report, “Stress in America: Coping With Change,” that found two-thirds of Americans are stressed about the future of the nation.

Gerald Brown, an ACA member and LPC with a private practice in Statesville, North Carolina, didn’t need a survey to tell him that Americans are more stressed. “In both [my] new intakes and established clients — especially in the last four to six months — anxiety levels have increased tenfold,” he says.

Brown says that uncertainty about the future and the lack of cohesion in America’s political and social landscape have left many people living in a state of hypervigilance and suspicion, distrustful of those around them and prone to looking over their shoulders. He adds that this atmosphere of anxiety is affecting how people feel about themselves and making them question whether they can trust their own instincts about “outsiders.” Brown says he has witnessed an increased level of suspicion for anyone who might be considered “other,” which is serving to create a substantial societal divide.

ACA member Peter D. Ladd, a licensed mental health counselor who specializes in existential counseling and mediation, agrees, saying that what he calls a negative “emotional climate” is taking its toll on many people in the United States. He believes that this climate — filled with talk of revenge, resentment and hatred — is encouraging violence and harming people’s mental health.

Ladd, who sees primarily families and children in his private practice in Clayton, New York, says that many of his clients are displaying significant apathy. “I believe their sense of hopelessness comes from the climate of chaos presently dominating our government and society,” says Ladd, coordinator of the mental health counseling program at St. Lawrence University and the author of numerous books on conflict resolution and relationships. “In the same way that adolescents may feel apathetic from a chaotic family system, many adults, I believe, are feeling a sense of hopelessness from a chaotic government and society. Chaos wears people out, leaving in its wake a sense of hopelessness.”

Brown says more of his clients have been reporting relationship troubles, problems sleeping, unhealthy eating habits and a general sense of malaise. “A lot of new clients have been gaining weight, snacking a lot more, and it’s unconscious snacking. They didn’t even realize they were eating,” he says. “What I find is that people are watching the news too much and too often. … It impacts how they eat, how they sleep and their levels of anxiety.”

Balancing act

Riggs says that helping clients determine how much news to take in when they are feeling anxious is a delicate balance. “We walk that line [of], ‘How do I stay informed about what is happening in my world without becoming paralyzed?’” she says. “And that’s a very individual path, because what works for me might not work for someone else.”

Brown is a big advocate of turning off the news and getting off of social media, but he acknowledges that not everyone can or wants to turn away from reporting and opinions on current events. However, he does think that clients need to find a way to disconnect and wind down at the end of the day. He observes that many people arrive home from a day of work — which may have been anxiety-producing in and of itself — and put down their devices to have dinner, only to be drawn back in by a headline alert or a social media notification. Hours later, it’s time for bed, and they have spent zero waking hours being disconnected.

“I don’t think it’s healthy. You need to find a balance,” Brown emphasizes. He recommends that clients start the winding down process at least two hours before bedtime by dimming the lights, reading something light or listening to relaxing music. And although he isn’t anti-television, Brown recommends that clients not watch violent or intense shows at night. “Those images are hard to get out of our heads, and it impacts a lot of people’s sleep patterns,” he explains.

Riggs agrees that getting enough sleep is essential and one of the most important parts of self-care, particularly for those struggling with anxiety. At the same time, she says, self-care doesn’t come with a one-size-fits-all prescription. The key is cultivating pleasure and joy, she emphasizes. Some people seek solace in faith or work out their tensions through exercise. Others seek enjoyment — and perhaps seek meaning — through art, literature or music.

Riggs also helps clients build resilience by having them identify the sources of personal support in their lives and encouraging them to look back on the difficult times they have gone through in the past and survived.

Brown finds that spending dedicated time with each of his young daughters helps him maintain his personal equilibrium. “I think another thing that is missing [in modern society] is not getting one-on-one time with loved ones,” he says. “Everyone goes to their own corners at home and does their own thing.”

As restorative as spending time with loved ones may be for some, it can be a particular source of stress for others in these politically divisive times, Riggs observes. Some of her clients have mentioned that their friends and family members have minimized or dismissed their fears and anxiety. Others have struggled with loved ones who want to steamroll them into agreeing with a certain point of view. In those cases, Riggs says, “We talk a lot about assertive communications strategy. ‘What would you like to say [to this person]? What’s appropriate?’”

Sometimes those on opposite sides simply can agree to disagree by acknowledging that they will still love and respect one another despite their different viewpoints, Riggs says. However, it’s not uncommon for people to get pushback. “I’ve had clients who have had to hang up on people because [those people] refuse to respect the boundaries,” Riggs says.

Indeed, cutting off or limiting communication may be the only way for some clients to effectively deal with friends or family members who repeatedly cross boundaries and raise the clients’ stress levels. In certain instances, clients may have to unfriend people on Facebook or specify the terms under which they can meet or the topics that they can discuss.

Unfortunately, sometimes even that isn’t enough. “Really aggressive people can be toxic, and clients need to evaluate, ‘What value does this person bring to my life?’” Riggs says.

Seeking solace

Avoiding Facebook, scary movies and irate relatives is all well and good, but how do those who are feeling stressed and depressed get through the day?

Katie Gurwell, a Seattle-based licensed mental health counselor whose specialties include grief and life transitions, tells clients to build a “first-aid kit” with 3-by-5-inch cards that have helpful suggestions written on them such as “go eat something right now” or “put this song on.” She also urges them to start noticing when something makes them feel good — including small events such as seeing a beautiful flower, spotting a bird or hearing a specific song — and taking 10 to 20 seconds to savor and absorb the moment rather than just moving on.

When clients are overcome by stress, Riggs recommends using cognitive behavior techniques such as naming five things that they see or thinking of five countries that start with the letter “S.” She says these simple exercises can draw people away from their anxious sensations and into the cognitive, which is calming. One grounding technique that Riggs recommends to clients is to stop and observe what they hear in their environment, such as voices in the next office, birds outside the window or a clock ticking.

Brown likes to employ a simple breathing technique that he also recommends to clients: Inhale for four seconds through the nose, hold the breath for seven seconds and slowly breathe out for eight. He is also a devotee of the song “Weightless,” which the British group Marconi Union and sound technicians created to be the “most relaxing sound ever” (available on YouTube). A British neuromarketing research firm, Mindlab International, conducted a study and found that listening to the song produced a greater state of relaxation than any other music tested to this point.

Re-establishing control

We may not be able to change the world — or other people — but it’s still possible to regain a sense of personal control. That’s one message that counselors can communicate to clients who are anxiety-ridden over the current state of the world.

Brown helps clients envision a new future by creating a “vision board.” He asks them to fill a blank white poster board with images, words or phrases related to personal growth, such as self-improvement ideas, relationship goals or career prospects. Examples might include a desired job title or position or even a place that the client wants to visit. Brown believes that looking at and reflecting on these words and images every day can help people envision the steps that they need to take to achieve their goals.

Another way to re-establish personal control is for clients to understand the elements that trigger their anxiety, Riggs says. “What’s the story [clients are telling themselves] about what is going to happen? So many clients are saying, ‘What if? What is this going to mean for my children?’”

Clients often fear that if something bad happens, they won’t be able to handle it, Riggs says. So she asks, “What is your worst fear? What’s important to you, and what are you afraid of, and what do you want to do about it?”

She notes that part of anxiety is being effectively frozen, meaning that the antidote often involves taking action. Riggs first helps her clients identify what is within their control and what is not. She then helps them learn to let go of what is outside their control but to take action on the things that are.

“Taking action” can mean anything from getting involved in local politics to making a symbolic gesture (such as boycotting particular businesses or brands) to finding a community of
like-minded individuals so the client doesn’t feel alone in his or her struggles, Riggs explains.

One of Riggs’ clients decided that she wanted to become more active in helping refugees, so they spent a session talking about steps the client could take to do that. The discussion involved questions that helped the client define the level of involvement that would be personally meaningful. “What’s my next step? Am I a person who can just write a check, or do I need to be grass-roots and have refugees come live in my home?” Riggs says.

At the same time, clients don’t necessarily need a “cause” to make a difference or take action, Brown says. He says that bringing meaning and purpose to others through volunteering — such as by visiting a retirement home and playing games with the residents as he and his family do — can give clients a sense of control. “Despite what is happening politically,” he says, “you can begin to effect change in positive ways.”

 

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

Letters to the editorct@counseling.org

 

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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.

Nonprofit News: Writing a mission statement

By “Doc Warren” Corson III August 28, 2017

Many counselor clinicians contact me in a panic over writing a mission statement (which includes a purpose section) as part of applying for federal recognition as a 501(c)(3) not-for-profit corporation (tax-exempt). Although this can indeed be scary, it needn’t be overly confusing.

The IRS page at the time of this writing gives the basic parameters for this status. Please note that you do NOT have to meet all of these requirements.

“The exempt purposes set forth in section 501(c)(3) are charitable, religious, educational, scientific, literary, testing for public safety, fostering national or international amateur sports competition, and preventing cruelty to children or animals. The term charitable is used in its generally accepted legal sense and includes relief of the poor, the distressed, or the underprivileged; advancement of religion; advancement of education or science; erecting or maintaining public buildings, monuments, or works; lessening the burdens of government; lessening neighborhood tensions; eliminating prejudice and discrimination; defending human and civil rights secured by law; and combating community deterioration and juvenile delinquency.”

In short, what public good are you going to provide? Let’s face it. If the NFL was able to go so long as a tax-exempt organization (it announced it was voluntarily going to give its status up after an outcry on social media), your therapeutic program has a great chance of qualifying, provided that you do more than simply offer the occasional sliding fee for a client. A solid mission statement and purpose can mean so much in terms of a successful application. Give it some thought, explore examples and write multiple drafts before submitting.

 

What is your mission?

Think of your mission statement as the rudder of the ship you will be traveling on. It helps maintain control and direction and limit the scope of the trip you are taking. The mission statement is your chance to give a clear definition of what you are seeking to accomplish as a nonprofit.

Although the mission statement can be adjusted as needed, much like the rudder, it is typically adjusted slowly so as not to upend what you have been doing. Maintaining balance is key, especially in a rough sea. For instance, when my charity was founded, our main stated mission was to give equal and open access to behaviorally based therapeutic counseling services regardless of ability to pay. As we progressed and expanded not only our physical size but also our staffing, we incorporated additional services and periodically made adjustments to our mission statement.

It is vital to craft a mission statement that clearly states what you aim to do while also keeping in mind that you need to meet certain criteria to become a 501(c)(3). More information is available at https://www.irs.gov/charities-non-profits/charitable-organizations/exemption-requirements-section-501-c-3-organizations.

 

What is your purpose?

Don’t worry if your mission statement fails to capture everything you are going to do as a charity. You will also be required to clearly state the purpose of the corporation (nonprofits are corporations in the eyes of the law and, as such, are owned by no one person or group; in effect, they own themselves).

There is no need to be overly wordy or excessive in this section. Simply state the main goals of your organization. For clinical programs, you might state the type of clinical programming you will offer and identify the population(s) served, the general services that will benefit the community, associated educational opportunities and related programming. It is wise to include a “catch-all” purpose as well (see No. 5 below).

 

Example of a mission statement and purpose

The mission of Community Counseling Center of Central Connecticut Inc. is to provide a holistic program that addresses the therapeutic, cultural, occupational and cultural needs of those we serve in a nature-based setting.

 

Purpose of the Corporation

The purposes, for which the Corporation is formed, as set forth in its Certificate of Incorporation, are:

To conduct the following activities, which are exclusively charitable, educational and scientific within the meaning of Section 501(c)(3) of the Internal Revenue Code of 1986, as amended, including:

  1. To provide the highest quality behaviorally based therapuetic outpatient services to individuals, couples, children and adolescents in the most caring environment possible.
  2. To provide means for clients to share experiences, support one another, and improve their care.
  3. To provide outreach services to raise awareness to the needs of the community, the benefits of mental health treatment as well as to aid in the decrease in the stigmatization that those who receive mental health services sometimes endure.
  4. To provide presentations, workshops, lecture series and trainings in areas that relate to the work, goals and needs of the clients served and professionals who work in the mental health.
  5. To engage in any other activity which will further the interests of individuals served and or targeted by the corporation, their families, or professionals treating individuals with mental health issues and related disorders or engaging in research about mental health and related disorders.
  6. To acquire, maintain and preserve open space, woodlands and related properties in order to provide a means for holistic programming and educational activities as well as passive recreation*. (Added 1-1-2015)

* For land use, passive recreation connotes activities that have little to no impact on the land.

 

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The mission statement and purpose of the corporation are among the hardest items to be included in the formation of your bylaws, which are the very heart of any nonprofit. As we’ve just explored, however, it is far less difficult to write these elements than you may have imagined.

 

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This article should not be viewed as all-inclusive or as a substitute for working with trained professionals.

 

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Dr. Warren Corson III

“Doc Warren” Corson III is a counselor, educator, writer and the founder, developer, and clinical and executive director of Community Counseling Centers of Central CT Inc. (www.docwarren.org) and Pillwillop Therapeutic Farm (www.pillwillop.org). Contact him at docwarren@docwarren.org. Additional resources related to nonprofit design, documentation and related information can be found at docwarren.org/supervisionservices/resourcesforclinicians.html.

 

 

 

 

 

 

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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.