Monthly Archives: October 2017

The most wonderful time of the year?

By Bethany Bray October 23, 2017

Counselors can help clients prepare for the pressures that come during the holiday season, from a barrage of parties and social events to the temptation to compare themselves with the happy, near-perfect holiday scenes in movies, advertisements or friends’ social media posts.

For clients with seasonal depression, it can all be overwhelming — just at a time when people are expected to be happy and joyful, says John Ballew, a licensed professional counselor (LPC) with a private practice in Atlanta. Financial stresses, relationship concerns, grief over the loss of a loved one and other life challenges can feel more intense.

“This can be exactly the time that’s going to press on an old wound,” says Ballew, a member of the American Counseling Association.

Cindy Gullo, an ACA member and licensed clinical professional counselor in O’Fallon, Illinois, says she also notices an uptick in depression symptoms in her teen clients during the unstructured weeks of school break for the holidays, as well as anxiety over the return to school in the new year. She coaches clients to create and maintain structure over holiday breaks, including getting up at the same time in the morning and keeping up with the tasks they normally do while in school, such as completing reading assignments or practicing a musical instrument.

For Ballew’s adult clients, setting boundaries — from limiting their party RSVPs and holiday overeating to avoiding toxicity on social media — is often key to navigating the holidays. He also talks about the difference between self-care and self-indulgence with clients when preparing for the season.

“The adage that ‘No is a complete sentence’ is very applicable here,” Ballew says. “Especially if they have social anxiety, three hours at a party can feel totally overwhelming. Plan to go for 20 minutes, say hello to at least three people, then leave and admit you’ve done something difficult.”

On the flipside, clients who don’t receive any holiday invitations can sink into isolation or self-pity. Ballew says he works with clients to challenge themselves. Are they sitting at home waiting for the phone to ring? If so, they can be the one to call friends and initiate get-togethers. They can volunteer. They can choose to attend concerts and other local events on their own.

The holidays — from Thanksgiving to Valentine’s Day — can also be a struggle for clients who are single and unhappy about it. Again, Ballew says he challenges these thought patterns with clients. “For people who are alone, it’s learning to love being alone and make peace with it,” he says. “Reassess old patterns and beliefs and let go of things that aren’t working. What activities can you do alone? What beliefs do you have that keep you from enjoying things alone?”

Conversations with clients about setting boundaries can also be helpful in preparing for the family pressures and get-togethers that crop up during the holidays. For clients with particularly toxic or unhealthy family situations, this may mean limiting their involvement or staying away altogether, Ballew says. It may even be helpful to create their own new traditions during the holidays.

Sometimes, Ballew coaches clients to think of family visits as a trip to the zoo: What behavior might you see? What can you expect? What responses can you have ready for when family members make inappropriate or triggering comments?

When appropriate, he will create a “family bingo” board with clients, listing predictable patterns and negative behaviors that they can track in their minds. Although they wouldn’t bring the board to family gatherings, its creation is a way to prep for managing potentially challenging situations, Ballew explains.

“Approaching things with a sense that it doesn’t need to be that serious can be helpful,” he says. “With other folks, if the family is seriously dysfunctional, they just need to set boundaries. For example, if dad gets drunk, they don’t need to wait around to be berated. Have a [plan and] a place to go so you aren’t as vulnerable as when you were younger.”

Marcy Adams Sznewajs, an ACA member and LPC with a private practice in Beverly Hills, Michigan, specializes in working with teenagers and emerging adults. Like Ballew, she works with clients to prepare for family interactions over the holidays, with focus placed on empathy and listening skills.

“We do a lot of role-play in anticipation of family events,” she says. “What would happen if your uncle goes down this path and you respond in this way? How might that end? How would you like it to end? What are some different ways you can approach the situation? Teens don’t always have the ability to step back and say, ‘Just because someone doesn’t understand me doesn’t mean that I need to spout off my opinion at all times or respond.’”

“We also talk about understanding other people’s perspectives and life experiences,” she continues. “If they can look at a [family member’s] actions and behaviors from a place of empathy, sometimes it’s easier to sit through a conversation. Or, sometimes, it’s so horrible that all they can do is take a deep breath and get through it. Then we talk about management, mindfulness and ‘this too shall pass.’

“I tell them, ‘I can’t always help fix this, but I can help you cope, and you are strong enough to deal with this.’”

 

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READ MORE about supporting clients through seasonal depression in the article, “A light in the darkness” in Counseling Today‘s upcoming November magazine (page 50).

 

From the Counseling Today archives: “Unhappy holidays: Helping clients through the ‘holiday blues’

 

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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.

 

 

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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.

 

U.S. student-to-school counselor ratio shows slight improvement

By Bethany Bray October 20, 2017

On average, there is one school counselor for every 482 K-12 public school students in the U.S. This number has decreased slightly from the previous year’s average of 491-to-1.

The American School Counselor Association (ASCA), a division of the American Counseling Association, compiles a report each year on student-to-school counselor ratios, based on data from the U.S. Department of Education’s National Center for Education Statistics. ASCA’s latest report, released this week, included data on public K-12 schools in the 2014-2015 school year, which is the most recent information available.

“The work that school counselors do to support students’ academic, career, emotional and social development is absolutely critical,” says ACA President Gerard Lawson, an associate professor of counselor education at Virginia Tech. “In today’s schools, counselors are also relied on for their expertise in working with broader mental health needs. It is encouraging to see some improvements in the ratio of students to counselors, and we know that counselors can serve their students, schools and communities more effectively, when the ratio of students to counselors is lower and sustainable.”  

The report highlights a disparity that exists across America. The highest ratio, with 924 students for every one school counselor, was Arizona, and the lowest, with a 202-to-1 ratio, was Vermont.

ASCA’s recommended student-to-school counselor ratio is 250-to-1.

“These counselor-to-student ratios are headed in the right direction, but they have a long, long way to go. More school counselors need to be hired, especially in states with the most egregious ratios,” says Nancy Carlson, a licensed clinical professional counselor and ACA’s on-staff counseling specialist.

 

Other highlights of the report:

 

  • States with the highest student-to-school counselor ratios were Arizona (924-to-1), California (760-to-1), Michigan (729-to-1), Minnesota (723-to-1), Utah (684-to-1), Illinois (664-to-1) and New York (635-to-1).

 

  • States with the lowest student-to-school counselor ratios were Vermont (202-to-1), Wyoming (219-to-1), Hawaii (293-to-1), North Dakota (307-to-1), Maine (315-to-1), Montana (319-to-1) and Tennessee (339-to-1).

 

  • California showed the most improvement over the previous year; the state’s ratio decreased 9 percent, from 822-to-1 (2013-2014) to 760-to-1 (2014-2015).

 

  • Alabama’s ratio also shifted 9 percent, but in the other direction. The state lost nearly 150 school counselors between 2013-2014 and 2014-2015, increasing its ratio from 417-to-1 to 453-to-1.

 

 

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ASCA’s full report, with a state-by-state breakdown, is available online: schoolcounselor.org/asca/media/asca/home/Ratios14-15.pdf

 

Read ASCA’s press release about this year’s numbers:  schoolcounselor.org/asca/media/asca/Press%20releases/ASCA-Student-to-SC-Ratios-Press-Release-10_2017-Final.pdf

 

The American Counseling Association’s School Counselor Connection page: counseling.org/knowledge-center/school-counselor-connection

 

 

 

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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.

 

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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.

 

 

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Behind the Book: The Secrets of Exceptional Counselors

By Bethany Bray October 17, 2017

Jeffrey Kottler has spent more than four decades as a counselor, educator and supervisor, and he has collected a lot of stories along the way.

He passes some of these stories on in his latest book, The Secrets of Exceptional Counselors, which is published by the American Counseling Association. With chapter titles that include “Admitting you’re lost,” “There are no difficult clients, only difficult counselors,” “Clients lie – a lot – and it might not matter” and “Who changes whom?” Kottler sprinkles his own insights among those learned from some of the most accomplished practitioners in the field.

The secret to being an exceptional practitioner? Unwavering passion and a spirit of constant reinvention, says Kottler.

“Ultimately, beyond a requisite level of intelligence and emotional functioning, the best among us are quite simply those who have worked hardest to develop themselves. They are intensely motivated and committed to becoming the best practitioners of their craft – and they are willing to make all kinds of personal sacrifices and devote time and energy in order to make that a reality,” Kottler writes in the book’s preface. “I am talking about passion and excitement for the work, for the people they are helping, the kind that doesn’t diminish over time.”

Kottler, a clinical professor of psychiatry at Baylor College of Medicine in Houston, dedicates the book to Jon Carlson, a close colleague who helped him gather much of the information in its pages. Carlson, a well-known counselor, professor and champion of Adlerian theory and practice, passed away earlier this year. The two had planned to write the book together.

Kottler, a keynote speaker at ACA’s 2015 Conference & Expo in Orlando, Florida, recently moved to Texas to start a new position at Baylor College of Medicine and to serve in a volunteer role (consultant and staff trainer) at the Alliance for Multicultural Services, a refugee resettlement agency. Previously, he was a professor at California State University, Fullerton.

 

 

Q+A: The Secrets of Exceptional Counselors

Counseling Today sent Kottler some questions, via email, to find out more about his latest book.

 

You and Jon Carlson spent years working with some of the most accomplished and influential practitioners in the field. What are some key insights you’d like to share? What were some of the reoccurring themes?

1) Truly extraordinary, exceptional counselors are not necessarily well-known. Most you’ve never heard of because they don’t care about attention and don’t have an interest in seeking fame or writing books.

2) Really great counselors are scrupulously honest and self-critical about their mistakes and failures. They own them fearlessly, forgive themselves for being less than perfect and then learn from them.

3) Exceptional professionals in any domain, flat out, work harder than others. But the idea of the so-called “10,000 hour” rule is wrong: It isn’t just experience and practice that makes anyone great; it’s practicing what you don’t do well. Extraordinary athletes, for instance, practice relentlessly those skills that are not yet within their comfort zone. Most people prefer to practice the things they have already mastered.

4) In spite of the obsession with the best theory or the newest technique or strategy, exceptional counseling (or parenting, or teaching) is about relational connections, those in which the client feels a connection. Great counselors recognize that their main job is to build mutual trust in the relationship, since when we trust our clients, we are more willing to experiment, become creative and try new things.

5) Exceptional counselors have discovered their own unique voice rather than simply imitate others. They have found ways to capitalize on their own signature strengths that are unique to them. That is why counselors can appear to operate in such different ways and yet still be effective.

6) They practice what they preach and live the values and lessons that they teach to others. They are models of what they hope their clients will become, yet are always searching for new and different ways to improve their own functioning, not only in sessions but in their personal lives.

7) Finally, my own favored interpretation is that exceptional counselors are consummate storytellers. They use metaphors, imagery, teaching tales, self-disclosures and other forms of narrative to help people become heroes/heroines of their lives rather than victims, or just survivors. In addition, they recognize that their main job, above all else, is to help clients to share and honor their own life stories. Almost every approach to counseling introduces a variation of that theme, whether called reframing, restorying, looking for exceptions, disputing beliefs, challenging discourse or others.

 

Please elaborate on what prompted and inspired you to write this book.

I noticed a disconnect between what we’ve learned from research and what counselors seem to pursue the most in their training. Everyone is hungry for the latest theory or the newest technique, even though they seem to matter relatively little compared to other factors. We talk a good game about the importance of the therapeutic alliance, but often we put more faith in the “doing” of counseling. When clients are asked what made the most difference to them in their counseling, they rarely mention any specific strategy or technique and instead say they felt understood. Of course, that doesn’t necessarily mean that some amazing intervention wasn’t critical, but just that it likely wouldn’t have [made] much impact if there wasn’t a solid relationship.

 

What do you hope counselors take away from this book?

In our previous books, Jon Carlson and I interviewed really prominent, well-known figures in the field. And many of them became writers and teachers because they had some very good ideas but were not necessarily very skilled as practitioners. Some of them didn’t even like doing counseling. So, I wanted to focus this time on counselors who just quietly go about their amazing work and what they can teach us.

I’ve always been intrigued by the phenomenon that there are so many great counselors and therapists who appear to operate in such different ways. How is it that some work in the past, others in the present or future? Some focus on feelings, others on thoughts or behavior. There has to be something in common, and I’ve learned that so much has to do with the counselor’s presence and charisma in all kinds of ways. Exceptional counselors are usually remarkable people. And it has always been so important to me that we apply in our own lives [that which] we say is so important for our clients.

 

In addition to your book and the insights it shares from others in the field, what resources do you recommend to help counselors stay inspired and passionate about their work?

I think counselors can learn more from our own clients as teachers, more from reading fiction, than the books that I, and many of my colleagues, write. It’s life experiences, especially those that are novel and challenging, that have taught me more than any text or resource. I constantly ask my clients to take risks, experiment with new behaviors [and] get outside their comfort zone – and I’m always pushing myself to learn and grow. I read a novel every week, accompanied by biographies and, lately, medical books. I retired from a counseling department and now teach in a medical school, and I’m so lost most of the time because our backgrounds are so different. And I love that at my advanced age, I’m still learning so much.

 

Learning from failures and mistakes plays a big part in professional growth and development. What do you want to stress about this to counselors – especially those who are starting out?

It’s often not safe for beginners to admit they are lost or that they don’t know what the heck they are doing (which, of course, is the way things really are). So, it’s really important to have a support system of like-minded people with whom it is safe to talk about fears, doubts and uncertainties.

The second thing that I don’t think gets nearly as much attention as it could is the parallel process that occurs in a counselor’s life – how our clients are constantly teaching us, triggering us [and] stimulating us in ways that can enrich our own daily lives. And also, that all of our own personal experiences, including trauma and failures, can be gifts that help us better understand and connect with others.

 

What secrets of your own would you add to this conversation? What are some highlights that your clients and students have taught you over the years?

This is more personal than you might expect, but I guess it’s how hungry I am to be valued, how I define myself, my worth, my value, in terms of the good I’ve done —every day. Even after all these years, I still don’t feel worthy or that I’m ever doing enough.

Especially during these insane political times, it seems even more important to do more, especially with those who are being left behind. Frankly I’ve been struggling with depression during the past year, feeling like I hardly recognize my country. Some of the decisions that are being made related to the environment, immigrants, refugees, LGBTQ rights and the poor are deplorable. I feel so helpless and sometimes feel like I’ve lost faith.

It is my students and clients who push me to be a better person and model for them what I think is most important. My time is almost over, and I can feel the clock ticking away, so I feel more urgency than ever to pass the baton to others.

My students and clients have challenged me to question what I think I know and understand. Their trust in me has been a vehicle for my own healing, in ways my experiences as a client couldn’t touch.

 

 

The Secrets of Exceptional Counselors is available both in print and as an e-book from the American Counseling Association bookstore at counseling.org/publications/bookstore or by calling 800-347-6647 x222

 

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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.

 

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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.

Spirituality in a church-based counseling program

By Jane S. Joyce October 11, 2017

As a counselor in a group supported by a church, I regularly encounter clients who want to discuss spirituality, or who even want spiritual guidance, assuming that because the counseling department is located within the church building, all the counselors are equipped to be spiritual leaders.

The situation can cause ethical concerns, especially considering Standard A.4.b. of the 2014 ACA Code of Ethics: “Counselors are aware of — and avoid imposing — their own values, attitudes, beliefs and behaviors.” The struggle emerges when clients want to discuss spirituality. Although I wish to stay clear of this topic, it can be misinterpreted as my being uninterested or avoiding the topic, which can lead the client to feel disrespected or unimportant. At the very least, the scenario is challenging.

The role of a counselor becomes blurred if too much emphasis is placed on spirituality; in the client’s eyes, the representation of the counselor’s job changes. For instance, the use of prayer can be risky, perhaps setting the counselor up as an “expert” in addressing God and conveying personal beliefs in the wording or delivery. There may be drastically differing belief systems between the counselor and the client, which could potentially damage the relationship. How can I address this situation so that the client’s beliefs and values are respected, while at the same time I follow my ethical code?

In his book Spiritual Practices in Psychotherapy: Thirteen Tools for Enhancing Spiritual Health (2009), Thomas Plante gives some very thoughtful suggestions on using spirituality in one’s practice. I have listed them here, followed by my personal experience of working with them in my practice.

 

1) Become aware of your cultural competencies.

I have learned not to be afraid to admit when I am unfamiliar with a client’s belief system. As with all clients, I strive to be respectful and sensitive to them and make notes to guide myself in learning more. Research, research, research: The internet is a treasure trove of information. Take advantage of programs offered by different faiths and different cultures. For instance, in a larger neighboring city, several annual festivals are held that highlight Native American, Hispanic, Asian and Greek cultures. Food, ritual, and crafts abound, and the experience lessens anxieties when working with other races.

In my graduate multicultural course, I was required to experience a different cultural setting. I attended the Hispanic mass at a Roman Catholic church. The mass was in English and Spanish, but the hymns were all Spanish. A little boy helped me sing by pointing to the words as they came up. It was a warm and uplifting evening, showing the importance of faith and family and giving me a new picture of that culture.

 

2) Take advantage of available resources and programs to increase your knowledge base.

Although I may be a church-based counselor, my job is not to promote my own belief system but rather to be available to hurting people. Learning about these clients’ cultures and beliefs assists me in becoming a better counselor. I mentioned some ways to connect in the previous paragraph, and looking for more opportunities around your area can be a fun way to expand your family’s knowledge too.

 

3) Consider religion to be like any other type of diversity.

Removing the emotion that can be attached to religion frees me to see it as just another facet of the client, just like race or sex. In fact, it can help me form a more objective view of the client’s total perspective. The ACA Code of Ethics emphasizes the need for counselors to honor diversity and adopt a multicultural approach to treating clients. Spirituality is a part of that diversity.

 

4) Consult colleagues.

I am fortunate to have three other counselors who are available for “brainstorming” sessions, and I receive differing viewpoints and possible approaches from them. Additionally, the American Counseling Association offers a wealth of resources on its website (counseling.org) that can guide counselors in learning more about multicultural counseling.

At times, the questions raised by clients are above my expertise. For example, one client questioned why she had not been given the desires of her heart when the Bible plainly states they will be granted. With her consent, I emailed the senior pastor and asked for his guidance. His answer was considerate and timely and gave her comfort in the situation.

Additionally, my mentor has a degree in theology, in addition to his counseling degree, and is always available for my queries. Clients appreciate that I will go the extra mile in exploring a matter that has so much importance for them and that I consult with reliable sources. It enhances the counseling relationship.

At times, the problem is deciding whether spirituality works in the treatment plan designed for a client. In his article, “A Qualitative Exploration Into How the Use of Prayer in Counseling and Psychotherapy Might be Ethically Problematic” (2009), Peter Madsen Gubi presented four words that can assist in deciding whether to include spirituality. He refers to it as EBQT, an easy way to remember his guide.

Evidence: Does enough quality evidence exist to support a spiritual adjunct to therapy? For me, this would be the amount of importance the client attaches to his or her spirituality and beliefs. Another decision-making took is determining whether the presenting problem includes a struggle with spirituality, which happens quite frequently in the church setting.

Belief: Is there congruence between the client’s beliefs, the counselor’s beliefs and the relevance of therapy? I see this as meaning do we both agree on the necessity of inclusion, and does respect exist for differing viewpoints? This is where knowledge and respect come into play. I must examine my own beliefs and biases to provide the best care for my client.

Quality: Will this improve the quality of care for the client? Does it enhance or detract? Will it derail what has been accomplished? Will it derail where counseling is supposed to take the client to accomplish his or her goals? I must be brutally honest on this point and be sensitive to where the client leads, not where I want to go.

Time: Can the component of spirituality be addressed in the time constraints of the session, with respect to the client? My sessions are 50 minutes in length. At times, addressing a spiritual problem can take the whole session, or a session might even have to be ended before crucial questions are addressed. I don’t have the luxury of allowing the session to run over because of other scheduled clients. This can be a real concern.

One last consideration does not apply to me but may to other people. Addressing components of spirituality can be tricky when dealing with third-party payers (insurance) because, generally, it is not reimbursable. We do not accept insurance at my church, but many other church-based counseling groups do. The treatment plan must be grounded in applicable theory, with goal-oriented, measurable results, to be reimbursed by insurance. Spirituality may be mentioned, but other treatment options must be included in filing claims. This is another time when consultation with peers is most helpful. Experience is the best teacher.

These recommendations have served me well for the past three years of practice. They have kept me on target and allowed me to provide the highest-quality attention to my clients’ needs without the input of my own beliefs. By following these shared techniques, it is my hope that your own practice will be strengthened and improved.

 

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Jane Joyce is a licensed professional counselor and doctoral candidate at Carson-Newman University in Tennessee. She is a counselor with LifeSource Counseling, First Baptist Church, Morristown, and an assistant to Dr. William Blevins at the Blevins Institute for Spiritual and Mental Health of Carson-Newman. She retired in 2014 from the Tennessee State Board of Probation and Parole after 25 years and began her second career. Contact her at jsjoyce@charter.net.

 

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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.

Counseling survivors of human trafficking

By Lamerial McRae and Letitia Browne-James October 9, 2017

Millions of human trafficking victims exist across the globe. In the United States, hundreds of thousands of victims experience trafficking. As society expands and evolves, human trafficking perpetrators find new ways to recruit and victimize others. The evolution of perpetration ensues because of increases in accessing technology, shifting state and federal laws, and changing criminal investigation methods within communities. Human trafficking continues to evolve into a new way of enslaving human beings, stripping individuals of basic rights and freedoms, while skirting the legal issues of slavery and ownership.

Human traffickers often recruit individuals by offering the fantasy of increased happiness, stability, relationship success and financial freedom. Human traffickers, often referred to as “pimps” or “playboys,” may recruit a female or male victim with promises of a better quality of life, including, but not limited to money, security and safe shelter. These perpetrators often present as charming and recruit their victims using lies and manipulation. They prey on victims from vulnerable populations, including those with low socioeconomic status (SES), biological females, children and adolescents, immigrants and LGBTQ+ youth. The fact that these vulnerable populations often remain dependent on others or experience institutionalized marginalization allows for perpetrators to paint the picture of a better life, both in terms of finance and social support. Thus, counselors must understand the cycle of perpetration and victimization to pinpoint potential victims among clients.

As a starting point, counselors must understand the nature of the phenomenon and seek ways to identify potential risk and protective factors. Counselors must learn to assess and address possible victimization with effective rapport building and intervention. For example, youth may display delinquent behavior (e.g., truancy, sexual misconduct, drug use) as a symptom of coercion and threats by a perpetrator. Perpetrators often experience greater ease when recruiting teenagers because of their tendency to be influenced by others. Sadly, when teenagers fall victim to a human trafficker, they are subjected to the victim-blaming phenomenon.

Thus, to build therapeutic rapport from a nonjudgmental framework, counselors need to understand the true source of teenagers’ behavior rather than labeling them as inappropriate or delinquent. As counselors increase their understanding of risk and protective factors, the profession may be able to conceptualize human trafficking as a systemic problem from a broad perspective.

 

Risk and protective factors

Several risk and protective factors exist for those falling victim to human trafficking. Risk factors include the following demographics and experiences. Risk factors, which are not limited to the list provided, may change over time with the help of counselors.

  • Low SES
  • Previous or current substance abuse
  • Social vulnerability (e.g., children, females, LGBTQ+ individuals)
  • Limited education.

Protective factors, referred to as strengths in counseling, include the following demographics and experiences. Counselors must foster protective factors and strengths in clients to reduce the risk of falling victim to trafficking.

  • Education
  • Family stability
  • Strong social support networks
  • Mental and emotional health

Counselors should understand these risk and protective factors to assess potential risks for human trafficking and to focus on increasing protective factors in counseling. For example, counselors may use a family counseling approach when working with survivors to increase their connections to loved ones and family. Throughout the process of recruiting and selling human trafficking victims, counselors may notice several risk and protective factors playing a role in the process.

 

Human trafficking business model and counseling implications

Human trafficking remains a mysterious and misunderstood phenomenon. Because of a lack of understanding about the effects of human trafficking on our society, counselors are charged with educating themselves to best address and assess individuals for victimization.

Counselors should recognize that survivors of sex trafficking require additional techniques (to those used with other clients) to build rapport with them and to reduce the mistrust that they commonly have about people. To best serve survivors, treatment approaches need to remain centered on survivors, empower them, provide safety and involve a multidisciplinary approach. In addition, professional counselors working extensively with sex trafficking survivors hold legal and ethical responsibilities to provide appropriate services and identify strategies to overcome barriers to their treatment, including specialized and intensive training.

To begin, counselors must understand the human trafficking business model to conceptualize the systemic issue and the moving parts that contribute to the continuing cycle. To highlight some of the societal and professional impacts, consider the parallel of the human trafficking business model to the process of manufacturing goods. The human trafficking business model includes the following stages of grooming and distribution:

1) The supplier recruits the victim.

2) The manufacturer grooms the victim.

3) The retailer determines price and then markets the victim.

4) The retailer sells and the consumer purchases the victim.

The human trafficking business model is a sophisticated process, not always linear in nature, and it functions as a well-established industry. Thus, the need exists to explore each of the model to better understand how to help victims and break the cycle.

Stage 1: Supplying victims. The supplier, also known as the initial human trafficking perpetrator, displays high levels of mental health concerns (e.g., antisocial personality traits) and shows little concern for the basic human rights of others. When victims enter this stage, counselors may find that these individuals report troubles at home, low SES, depression, anxiety and truant behavior. These factors contribute to their need to survive. Unfortunately, this may result in a perpetrator using charm or manipulation to attract the victims. Perpetrators remove victims’ identification, passports and other valuables to trap them in the world of human trafficking.

Clinical assessment is vital at this stage and remains an ongoing process. Counselors may want to ease survivors into telling their stories, paying special attention to the therapeutic relationship. Thus, the most valuable interventions at this stage include active listening and reflection. When administering specific assessment instruments, counselors will want to measure attitudes about victimization and perpetration and prevalence rates of violence. Counselors must use both open- and closed-ended questions to directly address potential victimization. Nonverbally, counselors will want to avoid direct eye contact and limit their use of touch because of victims’ trauma and abuse history.

Stage 2: Grooming victims. This stage involves moving human trafficking victims from the supplier to the manufacturer. Perpetrators continue to display high levels of antisocial behaviors and major mental health concerns; survivors present with mental health concerns such as depression, anxiety and addiction. Substance abuse concerns usually present when perpetrators force their victims to engage in substance use to coerce and control their behaviors, often resulting in addiction.

Counselors must use clinical assessment and maintain that ongoing process. In addition, because survivors have been manufactured as a human trafficking product, their levels of abuse and mistrust often appear high when they present to counseling. Therefore, counselors must focus on the therapeutic relationship as victims provide information about their experiences in trafficking. Counselors should pay special attention to reducing the stigma of substance use and mental health concerns, especially considering that victims develop these concerns because of coercion and violence.

Stage 3: Marketing victims. This stage involves moving survivors from the manufacturer to the retailer. At this stage, human trafficking perpetrators focus on the marketing and sales aspect of their exploitation. For example, based on the quality of their goods (i.e., victim age, appearance) and market demand, perpetrators determine the price for selling each of their victims. At this stage, survivors present with major depressive, dissociative and addiction disorders.

At this stage, counselors again use clinical assessment to understand the survivor’s story while maintaining a trustworthy therapeutic relationship. As previously stated, severe mental health concerns present because of the violence and abuse that victims experience. Thus, counselors need to use evidenced-based practices to treat depression and dissociative symptoms. Some of the most helpful interventions to treat these mental health concerns include grounding and relaxation techniques.

When focusing on grounding, counselors must engage the client’s physical world to assist the person in becoming present in the moment. For example, counselors may ask clients to locate an object in the room and provide an in-depth description. Relaxation techniques to practice include deep breathing and mindfulness meditation. Both types of techniques allow clients to practice coping skills during sessions that can translate to their everyday life experiences.

Stage 4: Selling victims. As retailers push survivors toward the consumers, the perpetrators continue to focus on marketing strategies and targeting potential consumers. Perpetrators often target large events (e.g., the Super Bowl, national political conventions) to take advantage of the crowds and high demand for paid sexual services. Those paying for the sex services, the consumers, exhibit low levels of depression and anxiety. These consumers often report avoiding relationship concerns or other mental health concerns, resulting in a desire to seek out sexual activity.

Because survivors have been a part of ongoing abuse and a cycle of victimization that they cannot break, counselors must use a systemic approach to providing services. For example, counselors need to provide information on shelters and building connections with family. Counselors may incorporate the use of technology and location services, safety words and discussing location with loved ones at all times.

 

Case example         

Toney, an 18-year-old multiracial, cisgender male, moved away from his caregivers’ home about one year ago and currently lives with a friend. He moved because of safety issues in his home and within the nearby neighborhood. When Toney was 16, his father died during a gang-related shootout at their home. Thus, Toney often felt afraid of engaging in a similar lifestyle and enduring similar consequences. Toney’s mother suffered from a severe substance use disorder that led to eviction from their rental home because she could not afford the rent. Toney and his mother became homeless.

While Toney was homeless, Kevin, a childhood friend, suggested that Toney come live with him temporarily as long as Toney obtained a job and contributed to the rent and utility bills. One day, Toney answered the front door, and a young adult male appearing to be about Toney’s age attempted to sell him a magazine subscription. Toney disclosed to the salesman that he was financially strapped. The young man told Toney about the large sums of money he made while selling magazine subscriptions and offered to put him in contact with the owner. Toney was intrigued by the idea of alleviating his financial troubles, and the young male immediately scheduled a meeting with the owner for later that night.

That evening, Toney met with the young salesman and the business owner in an abandoned parking lot, bought their sales pitch and decided to go to work. The business owner told Toney that he would need to move six hours away to another state because there was a high demand for work there and he would not have to pay any rent or utility bills. The business owner promised Toney the opportunity to travel and see many areas of the country while working in the job.

Thus, Toney left a day later to live in a weekly hotel in a new city with his new manager and several others. Upon arriving, the manager took them to a warehouse to pick up the product. They all began working the next day.

After a few weeks, Toney began grasping the reality of his situation. The job of trying to sell magazine subscriptions was strenuous and exhausting. He often worked 10- to 12-hour days while receiving limited rest and food. When Toney voiced concerns about the number of work hours he put in each day, his manager threatened him. The threats later escalated to physical assault when Toney again voiced his concern and when the manager perceived him to be underperforming at the job.

No matter how hard Toney tried, he could not meet the daily sales goal that the manager set for employees. When Toney failed to meet the daily sales quota, the manager either denied him his nightly meal or forced him to sleep outside of the hotel on the streets. As a result, Toney rarely ate and often did not receive the money he had earned while working. He was told that he would receive the money once the team had completed its sales goals for the area and had moved on to another city.

One day, while trying to sell magazines to a homeowner who declined to buy anything, Toney became agitated and started crying. He told the homeowner that he was in trouble and begged her to help him get home, across state lines. The homeowner had recently watched a documentary on human trafficking and invited Toney to use her phone to call the authorities.

The police arrived and took Toney’s statement about his work experiences. Fortunately, the responding officer had recently attended a departmental training on human trafficking, and she took Toney to the police station for further questioning and support. The officer connected Toney with a local nonprofit organization that provided multidisciplinary services, including professional counseling, to survivors of human trafficking. The organization offered shelter and provided Toney with career development services to help him obtain legitimate work. The shelter’s ultimate goal was to move Toney back to his hometown.

In counseling sessions with Toney, the counselor focused on direct questions to assess the nature of the human trafficking Toney had experienced. For example, “Did anyone threaten you or your loved ones?” and “Did you have difficulty leaving the work that you did selling door-to-door merchandise?” While initially reluctant, Toney eventually responded with answers that indicated his victimization. For example, he reported that his manager used threats and power and control tactics (such as denying Toney food, money and shelter) to force him to work.

Following assessment, Toney received counseling services focused on recovering from the abuse he had endured. Toney felt validated because he was not alone while accepting that he had fallen victim to human trafficking. The counselor and Toney focused on crisis intervention and stabilization in the beginning, which included discussions about adjunct services and basic needs assessments (e.g., food and clothing, job obtainment). Next, the counselor and Toney addressed the trauma, focusing on decreasing anxiety-provoking cues and scaffolding into addressing more severe cues and triggers. All the while, Toney and the counselor developed several grounding and relaxation techniques to use both in their sessions and in Toney’s real-world experiences.

One of the most valuable grounding techniques made use of a rock that Toney could hold whenever he felt distressed. The counselor taught Toney how to become present, while holding the rock, through discussions about the texture, shape and weight of the rock. Discussing these tactile experiences allowed Toney to focus on the here-and-now rather than attempting to escape feelings and thoughts.

Toney and the counselor also used a breathing method in which Toney would take a deep breath through his nostrils for at least three seconds and exhale through his mouth for three seconds. They determined that he needed to take at least three deep breaths during the exercise so that he could calm down.

In the final stages of counseling, Toney and the counselor developed an action plan to help him avoid falling victim to trafficking. That does not mean, however, that Toney took responsibility for the actions of others. Toney and the counselor reviewed the different needs he may have and how to meet those needs in a helpful manner.

While focusing on the trauma from human trafficking victimization, the counselor worked with Toney on obtaining a job at a local fast food restaurant. They chose this restaurant so that he could easily transfer to another store in his hometown once he felt comfortable with the transition. After three months, Toney finally returned home and moved back in with his friend, Kevin. He remained employed as a fast food line cook and began seeking education at a local culinary institute.

 

 

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Lamerial McRae is an assistant professor at Stetson University and a licensed mental health counselor in Florida. Her research and clinical interests include counselor identity development and gatekeeping; adult and child survivors of trauma, abuse and intimate partner violence; marriages, couples and families; LGBTQ issues in counseling and human trafficking. Contact her at ljacobso@stetson.edu.

Letitia Browne-James is a licensed mental health counselor, clinical supervisor and national certified counselor. She is a clinical manager at a large behavioral health agency in Central Florida and is in the final year of her doctoral program at Walden University, where she is pursuing a degree in counselor education and supervision with a specialization in counseling and social change. She has presented at professional counseling conferences nationally and internationally on various topics, including human trafficking.

 

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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.