Tag Archives: advocate

Medicare bill gains critical co-sponsor

By Bethany Bray November 23, 2015

U.S. Sen. Michael Bennet has agreed to co-sponsor a bill that would allow professional counselors to be reimbursed for care of clients who have Medicare health insurance, an issue the American Counseling Association has long advocated for.

The Colorado Democrat’s endorsement of the bill carries significant weight because he sits on the U.S. Senate Committee on Finance.

Bennet’s decision to co-sponsor the bill came after months of advocacy by American Counseling Association members in the Denver area. He is now one of 11 bipartisan lawmakers who co-sponsor the bill.

Senate bill 1830, or the Seniors Mental Health Access Improvement Act of 2015, would establish reimbursement of licensed professional counselors (LPCs) and licensed marriage and family counselors (LMFTs) for the treatment of clients whose primary coverage is Medicare, the federal

ACA member and LPCC Denise Magoto (on left) and LPC and licensed addictions counselor Katherine Bujak-Phillips are pictured at an advocacy to Sen. Michael Bennet's office this spring. Bujak-Phillips leads the LPC peer supervision group at the Medical Health Center of Denver, where Magoto works.

LPCC Denise Magoto (on left) and LPC and licensed addictions counselor (LAC) Katherine Bujak-Phillips are pictured at an advocacy visit to Sen. Michael Bennet’s office this spring. Bujak-Phillips leads the LPC peer supervision group at the Medical Health Center of Denver, where Magoto works.

health insurance program for citizens who are age 65 or older. Medicare has covered psychologists and licensed clinical social workers (LCSWs) since 1989, but does not cover LPCs.

“For years now we’ve ben hearing about the baby boomer generation coming onto Medicare. They’re already predicting shortfalls in healthcare, and mental health is no exception,” says Denise Magoto, an ACA member who has advocated for Bennet’s support of S.1830. “There’s not enough licensed clinical social workers to go around. We’re already seeing that shortfall.”

Magoto, a licensed professional counselor candidate (LPCC) at the Mental Health Center of Denver, is all too familiar with the headaches that counselors face over the Medicare reimbursement issue.

Every time a new client comes to the Mental Health Center of Denver, the intake department works to match the client with a clinician based on what insurance they have and whether or not the center would be reimbursed for their care.

“It really complicates the process,” says Magoto, who handles a caseload of clients with serious or persistent mental illness, often coupled with substance abuse.

The crux of the problem is that it keeps professional counselors from helping an entire slice of the U.S. population — more than 40 million people. Senior citizens are far from immune to depression, suicide and other mental health issues, Magoto notes.

Magoto has worked with the ACA government affairs team through the spring and summer to draw Sen. Bennet’s attention to the need for counselor reimbursement through Medicare. She has met with Priscilla Resendiz, a constituent advocate in Bennet’s office, twice; last month, Magoto gave Resendiz a tour of the center where she works.

Resendiz was “incredibly receptive,” Magoto says. When they met for the first time in May, what Magoto expected to be a 10-minute session stretched to an hour and a half.

Dillon Harp, grassroots organizer in ACA’s Department of Government Affairs, says local advocacy, like Magoto’s efforts, is critical for S.1830 to gain momentum and support.

“(Resendiz’s) visit and the tour were a huge success and it was instrumental in Senator Bennet co-sponsoring this important piece of legislation. Denise was able to highlight the important work that LPCs do and show the staff member why this bill must be passed,” says Harp, who attended Magoto’s meeting with Resendiz in October. “Getting Senator Bennet’s co-sponsorship was a major milestone in ACA’s efforts to get this bill passed. Obtaining Senator Bennet’s support was a crucial because of his seniority in the Senate and because he is a senior member who sits on the all-important Senate Finance Committee, which has jurisdiction over the Medicare program. ACA could not have secured Senator Bennet’s support without all the advocacy work that ACA members in Colorado performed.”

Bill S.1830 was introduced into the Senate on July 22 by Sen. John Barrasso (R-Wyo.) and co-sponsored by Sen. Debbie Stabenow (D-Mich.). After its introduction, the bill was referred to the finance committee; It won’t go for a full Senate vote until more co-sponsors support the bill, says Harp.

One lesson Magoto says she’s learned through this process is to never think that your hands are tied, or that you can’t do advocacy work if you aren’t politically savvy. She admits she’s a novice when it comes to the intricacies of government. Magoto simply knew there was a problem that was affecting her daily work as a counselor and contacted ACA to see what could be done.

“Initially I had some fear … The biggest thing that I’ve learned is that it (advocacy) is a learning process and that’s OK. It doesn’t mean you shouldn’t (advocate or get involved),” she says. “Even though I had no idea what I was doing, I had a resource [ACA] to reach out to and walk me through it.”

(Left to right) Katherine Bujak-Phillips, Priscilla Resendiz (constituent advocate in Sen. Bennet's office) and Denise Magoto.

(Left to right) Katherine Bujak-Phillips, Priscilla Resendiz (constituent advocate in Sen. Bennet’s office) and Denise Magoto.




To get involved in ACA’s advocacy for the Medicare bill, and other issues that affect professional counselors, email Dillon Harp at dharp@counseling.org or visit counseling.org/government-affairs


To receive ACA’s Government Affairs newsletter and action alerts, email dharp@counseling.org





Seniors Mental Health Access Improvement Act of 2015

Follow the bill’s progress at congress.gov: 1.usa.gov/1QysDjy


S.1830 co-sponsors (As of mid-November 2015; listed in the order in which they agreed to co-sponsor)

Sen. Debbie Stabenow, D-Mich. (original co-sponsor)

Sen. Al Franken, D-Minn.

Sen. Kelly Ayotte, R-N.H.

Sen. Jon Tester, D-Mont.

Sen. Thomas Carper, D-Del.

Sen. Kristen Gillibrand, D-N.Y.

Sen. Charles Schumer, D-N.Y.

Sen. Susan Collins, R-Maine

Sen. Angus King, Jr., I-Maine

Sen. Richard Blumenthal, D-Conn.

Sen. Michael Bennet, D-Colo.




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: facebook.com/CounselingToday

Extending the reach of counseling

By Laurie Meyers

People in need of help don’t always show up automatically on counselors’ doorsteps and request services. Sometimes counselors have to be intentional about first forming connections with potential clients and inviting them to investigate the therapeutic process. In other instances, counselors may Mountain-Climber-Helpneed to get out of their offices and connect directly with people in their own environments to even make them conscious of counseling and let them know that help is available

The American Counseling Association members we spoke to for this article have engaged in different kinds of outreach and advocacy efforts so they can better assist communities in need. In the process, they have deepened their own understanding of different cultures and client populations.

Traffick stop

Human sex trafficking is not something that is limited to developing nations. The practice also goes on in the United States and is more common than most people would ever imagine, according to Stacey Litam.

A doctoral student in counselor education and supervision at Kent State University in Ohio, Litam also works as a licensed professional counselor (LPC) and clinical resident at Moore Counseling and Mediation Services in the Cleveland/Akron area. The practice, which specializes in mental health and substance abuse treatment and mediation, has developed a partnership with the Cleveland court system to identify and assist women who have been or are currently being trafficked for sex.

The practice’s CEO, Martina Moore, has a doctoral degree in counselor education and advocates for trafficking survivors, but it was the Cleveland Municipal Court that approached Moore with the idea of collaborating to create a human trafficking docket (a list of legal cases to be tried in court), says Litam, who became part of the collaborative team at the time of her hire in October 2014. Litam notes that fellow Ohio city Toledo has the fourth-highest rate of human sex trafficking cases in the United States, and she suspects that the success of that city’s human trafficking task force influenced Cleveland’s decision to find ways to identify and help trafficking survivors. Moore Counseling staff members had previous experience working with the Cleveland Municipal Court on other specialized dockets, such as those being heard in drug court.

The Cleveland Specialized Human Trafficking Court Docket identifies women who have been charged with solicitation of prostitution and assigns them to probation officers who work with Moore Counseling to set up an evaluation. Litam conducts the evaluations, looking for criteria indicating that a sex worker is being trafficked or has been trafficked in the past. Sexual trafficking is defined as the recruitment, harboring and transportation of a person for a sexual act using force, fraud or coercion, Litam explains.

For many Americans, the phrase sexual trafficking conjures up images of kidnapping and forced servitude, of someplace “other” or foreign. Litam acknowledges that she held those same perceptions before she began working with the trafficking docket.

“When I first I got into this [work], I thought it was an issue that other countries dealt with,” says Litam, a board member of the Ohio branch of the Association for Humanistic Counseling, a division of ACA. However, she quickly learned that a substantial percentage of women and girls who engage in sex work are actually trafficked.

“I have probably completed about 45 assessments, and about three-quarters of those women met the criteria for trafficking,” says Litam, who adds that trafficking is “very insidious and pervasive.”

“A single woman might meet a man who helps her pay for food for her child or helps her with the rent,” Litam explains. “And then the guy says, ‘If you loved me, you would do this [have sex for money].’ He’s not using violence, but if the woman doesn’t do it, she may lose her housing or her child will go hungry.”

Another tactic that lures women into sex trafficking is a seduction of sorts, Litam says. A trafficker will pursue a romantic relationship with a woman, lavishing her with praise and gifts, until suddenly the woman “owes” him for the “gifts” of fine jewelry or nice clothing and has to pay off her debt, Litam continues.

In other instances, sex trafficking is all about survival, Litam notes, citing the experience of children living on the streets as an all-too-frequent example. “Children who are trafficked are usually runaways, ‘throwaways’ or [in many cases] LGBT [lesbian, gay, bisexual or transgender],” she explains. “Once they are on the street, they will be approached by a trafficker within 48 hours. Imagine that — you are an adolescent, and you are alone and need help. Traffickers are really good at finding them.”

Indeed, traffickers possess many of the skills associated with predators, such as the ability to sniff out the “wounded” and vulnerable, Litam continues. For many adult women who are trafficked, their journey to the streets began years earlier, because they were either trafficked or sexually abused as a child. In other cases, she says, women get caught up in trafficking to feed an addiction.

If Litam’s evaluation determines that a woman has been trafficked, she is eligible — after serving jail time for any solicitation charges — for the voluntary rehabilitation program that Moore Counseling has designed. The two-year program includes mental health counseling, intensive outpatient or residential treatment, substance abuse treatment and group counseling.

Trafficking survivors and women who are still being trafficked often live in unstable environments — typically with other women under the control of a trafficker, in housing they have a hard time paying for, with people who have substance abuse problems or in a home where they are being abused. In some instances, they may even be homeless. Living under such precarious circumstances makes it more difficult for these women to get off the street, let alone seek assistance for substance abuse or mental health issues, Litam points out.

“The two-year duration [of the rehabilitation program] was established in the hope that within this time period, our services would stabilize the client’s mental health, provide addiction treatment and aftercare, and help the client establish safe and stable housing,” Litam says. “Ultimately, I would like to see clients attend at least eight counseling sessions with me. Or, if the client is in need of substance use treatment, I would love for her to complete intensive outpatient treatment and aftercare while meeting with me once a week and perhaps continue to receive counseling afterward if needed.”

However, multiple factors keep many of the women from committing to the full program. “Women do not want to disclose,” Litam says. “I’ve never had a woman say outright, ‘Help me.’”

Some women aren’t ready to leave their traffickers, and those who stay, even if they are willing to come to counseling, are up against a fundamental problem. To the trafficker, time is money.

The women come to Moore Counseling and the rehabilitation program after spending time in jail, which can be as long as five days. By that time, the trafficker is already angry because he’s losing money, Litam explains. So the women are very vigilant and fearful of any time they spend away. Even an hour away will be noticed and questioned, Litam says.

“The benefit of counseling has to outweigh the cost of being away,” Litam says. Most of the women who are still being trafficked determine that isn’t the case, she concludes sadly. Many of the women who are eligible for the rehabilitation program will attend only a few sessions — or even just a single session. Litam says she treats each session as if it were the last one because, in many instances, it might be.

At a bare minimum, Litam makes sure that the women get a card that includes the phone number for the national human trafficking hotline. She also talks with them about having a safety plan, which involves figuring out where they can go, even if only temporarily, if they feel they are in danger. She encourages them to always have a “go” bag prepacked with any necessary personal items. Litam may also use motivational interviewing to help a client explore her ambivalence about her addiction or toward her relationship with her trafficker.

Women aren’t necessarily ready to engage in intensive counseling even if they are no longer being trafficked, Litam says. On average, trafficking survivors come in for four or five sessions before stopping, she says. But it’s not uncommon for these women to contact the program to begin counseling again a few weeks or months after their initial round, she adds.

“Some women may need to briefly touch on the trauma for a few sessions, take a few weeks off, then come back,” Litam explains. “I always welcome the women back when they do call. Trauma work is not on my time; it is on theirs.”

Litam uses a variety of techniques based on the client’s history and current circumstances. “Of course, every survivor will present with different needs depending on her individual resources and history. It’s whatever the client needs,” she emphasizes. “Sometimes they just want to sit and talk and not be judged. Sometimes it’s [the conversation] just about how worried they are about their child.”

One of Litam’s clients has made a significant amount of progress using creative-based interventions to express and release her trauma experiences. “We have also focused on addressing and reframing the cognitive distortions she developed while being trafficked,” Litam says.

Another of Litam’s clients has taken what she has learned through psychoeducation about how trauma affects the brain and applied it to her emotional regulation. “[She] finds peace in her ability to self-regulate her emotions outside of our sessions, has identified triggers and uses diaphragmatic breathing and progressive muscle relaxation as part of her daily self-care routine,” Litam says.

With other clients, Litam uses narrative exposure therapy to help them integrate complex trauma experiences into the context of their lives. “Establishing a timeline may look like placing a piece of rope on the ground with one end representing ‘birth’ and a balled up end representing ‘life that has yet to be lived.’ Clients place objects along the rope to represent positive and traumatic events along their timeline,” Litam explains. “Processing the trauma narrative in a safe place empowers clients to habituate to the trauma. Also, clients can feel empowered to see that much of [their] life has yet to unfold. It is a beautiful reminder and metaphor that things can get better.”

Litam also started a women’s resilience group at the practice where she works. She established it primarily to serve as an extra source of support for her female clients who have been trafficked, but she didn’t want the participants to feel labeled in that way, so she opened the group up to other female clients as well. She says the group represents a place where any woman can feel comfortable seeking peer support. Litam and several other counselors facilitate the group, which meets weekly.

Litam’s advocacy work doesn’t stop at her office door. She is also raising awareness within the law enforcement community about the prevalence of sex trafficking. Currently, she is working with a probation officer to set up a trafficking panel to better educate police officers.

Litam says police officers often lock up women for solicitation without looking for signs of coercion, even if the woman has visible bruises or other injuries. Her hope is that greater awareness by police officers about how common sex trafficking is might lead to earlier intervention and assistance for those being trafficked.

Litam is also an adjunct professor at Northeast Ohio Medical University, where she teaches students to use empathic communication in their patient interviews and examinations to look for signs that an individual is being trafficked or might be in danger. These indicators include constantly watching the door and being hypervigilant of her surroundings and the passage of time (time for which a trafficker will be wondering why she isn’t out making money).

Litam is also excited about research she is conducting with Jesse Bach, executive director of The Imagine Foundation, a nonprofit organization in Cleveland dedicated to ending human trafficking. Litam and Bach are studying human sex trafficker behavioral patterns, demographics and other characteristics in an attempt to establish a kind of trafficking “typology.” Their hope is that by identifying how different human sex traffickers operate, they can better understand how women (or men) are selected and kept under the trafficker’s control. Litam thinks that understanding these factors will also help identify intervention methods that might be more successful when counseling survivors and those currently being trafficked.

“Take, for example, a survivor who came from an unstable home and lacked a strong support system. Unfortunately, traffickers are predators and are excellent at identifying vulnerable women,” she says. “After months of ‘courting’ behaviors in which the trafficker convinces the woman he loves her and showers her with nice things, she may become conflicted in her ability to resist when he finally asks her to engage in commercial sex acts. This woman may need more intensive counseling on topics such as establishing appropriate boundaries, increasing self-efficacy, building strong support systems and CBT [cognitive behavior therapy] techniques.”

Litam says working with survivors and victims of human sex trafficking has become her passion. She believes that she can help these individuals not only by using her counseling skills with them but also by raising awareness of the prevalence of human sex trafficking.

“I would love for the average counselor to know that this is not a problem specific to Third World countries or inner cities, but that it is everywhere,” Litam says. She emphasizes that no neighborhood is exempt from human trafficking, regardless of whether that neighborhood is located in an upper-class suburb, a small town or even a rural area.

‘Learning’ rather than ‘teaching’

Counseling must always start with an understanding of the client’s cultural values, says Rachael Goodman, an assistant professor in the counseling and development program at George Mason University (GMU) in Fairfax, Virginia. This is one of the underlying tenets of counseling and a thread woven through all that counseling students learn as they work toward their degrees. However, Goodman says, experiencing others’ cultural traditions firsthand can impart an understanding that is more powerful than anything learned in the classroom.

In 2013, Goodman, as part of an effort facilitated by Counselors Without Borders, helped lead a group of GMU graduate students on a trip to the Pine Ridge Reservation in South Dakota. There they spent time with the people of the Oglala Lakota Nation as they prepared for and performed their annual Sun Dance ritual. Counselors Without Borders, founded by ACA member Fred Bemak, a professor of counseling and development and director of the Diversity Research and Action Center at GMU, is an organization committed to providing culturally sensitive humanitarian counseling in post-disaster situations.

Goodman thought it was particularly important for the students, who were taking a cross-cultural counseling class, to be exposed to other traditions. “It’s important for us [counselors] not to simply impose what might be misaligned Western models,” she says. “With any community, understanding what their traditions are is important for social justice so that we are not exacerbating marginalization.”

Goodman, who is also a member of Counselors for Social Justice, a division of ACA, planned the trip to coincide with the Sun Dance ritual so the counseling students could see practices that have both spiritual significance and a healing purpose for the Lakota people. A girl’s coming-of-age ceremony was also taking place at the same time.

Goodman and the students arrived before the ceremonies began to help with the preparations. For Lakota traditional services, the ground must be prepared in a certain way — for instance, the students helped build a circular space and a traditional arbor. (Because the Sun Dance is so sacred to the Lakota, Goodman says she is not comfortable giving details about the ritual). The counseling group also helped the young women with their rituals such as quilting and quillwork, which involves dyeing porcupine quills for use in traditional art.

These ceremonies have many healing and spiritual elements, perhaps the most important of which is a reclaiming of the Lakota culture, Goodman says. “It’s very important because of the history of genocide,” she elaborates. “For a long time, the United States government outlawed a number of native practices. The idea that you [as a Lakota person] wouldn’t be able to practice these ceremonies is in itself a trauma, so being able to perform them again is healing in itself.”

The Lakota are reclaiming not just their traditional ceremonies but also their native language, which was also outlawed for a long time, Goodman says. The group she led spent time with school students who were taking a language immersion class intended to sustain and widen the use of the Lakota language.

“I wasn’t aware of the importance of language in spirituality,” Goodman says. “They [the ceremonies] are conducted in Lakota, and if you don’t know [the language], you would have trouble understanding spiritual traditions.”

Goodman and her group also learned about the Lakota method of equine assistance therapy, which she describes as an interesting mix of Western culture and native practices. She says that for the Lakota, the horse doesn’t serve simply as a “feedback” instrument but rather is part of a person’s healthy connection to nature and all beings.

Goodman says all of the activities the group participated in taught the counseling students not only about Native American cultural practices but also helped them realize that counseling and therapy don’t necessarily have to occur in a formal, 50-minute, one-on-one sit-down. Counselors can provide support to clients and communities simply by listening, understanding and witnessing, she says.

Something else that struck Goodman during the trip was how the historical trauma of the Lakota is still very much a part of their present challenges. The people she spoke with emphasized that while the media and even well-meaning helping professionals often focus on issues such as substance abuse and violence on Native American reservations, they are seeing only the surface issues and not recognizing the historical trauma that underlies it all.

The people of Pine Ridge also had a parting message for Goodman and her group: “Let people know. Go back and tell our stories.”

Creative college counseling

Sometimes the biggest need for outreach is in a counselor’s own backyard — or campus. College students remain one of the counseling profession’s most underserved populations, not because there aren’t counselors available to help students but because these students are unlikely to come to the college counseling center for help, even when they desperately need it.

Research indicates that many college and university students aren’t just stressed, but depressed and anxious as well. In fact, 42.4 percent of the almost 75,000 undergraduate students who completed the 2015 annual American College Health Association National College Health Assessment reported experiencing more than average stress within the past 12 months, and 10.3 percent reported feeling tremendous stress. When asked about depression and anxiety during the previous 12 months, 35.3 percent of survey respondents reported feeling so depressed that it was difficult for them to function; 57.7 percent indicated feeling overwhelming anxiety.

At the same time, only a fraction of students in distress appear to be seeking help. The 275 college and university counseling centers that participated in the 2014 National Survey of College Counseling, an annual report sponsored by the American College Counseling Association (ACCA), a division of ACA, reported that only 10.9 percent of college or university students had sought services at a campus counseling center in the past year.

Clearly, “build it and they will come” is not a fitting slogan for campus counseling centers. Tamara Knapp-Grosz, who was the director of the Savannah College of Art and Design (SCAD) counseling center for 15 years, wondered what might happen if the center was proactive about going to the students instead. She started the process by offering workshops on depression at the counseling center and at various other campus meeting facilities, but most students still chose to stay away.

“I started thinking, ‘What is the goal of outreach?’” says Knapp-Grosz, an ACA member who is leaving SCAD to become director of the counseling center at the University of North Texas. First and foremost, she believes college counseling outreach should build a connection not only between the counseling center and the students but also between the students themselves because they have the potential to serve as secondary sources of support for one another.

But Knapp-Grosz, who had become interested in positive psychology during the beginning of her tenure at SCAD, was also struck by the idea of creating “shifts in the energy and atmosphere” during stressful times such as final exams. As she and the counseling center staff brainstormed ways to bring some positivity and levity to the students, their first creative outreach endeavor was born.

When stress levels got high, the counseling center staff and interns would visit various classrooms and celebrate a famous artist’s birthday. Knapp-Grosz, the immediate past president of ACCA, wanted to truly personalize the events and target the students by their areas of study, so the birthday parties were specific to the students’ specialties. For instance, a class of painting students might celebrate Van Gogh’s birthday with a themed cake and trivia. A birthday party for Peanuts creator Charles M. Schulz, thrown for students in the sequential arts (narratives accompanied by illustration such as those found in comic strips, graphic novels and storyboards), produced laughing and dancing, she notes. Word would spread throughout the building about the birthday parties, attracting additional students to join the celebrations.

The birthday party tradition continues through the present day, and Knapp-Grosz believes the benefits extend beyond providing students a brief break from stress. “Students start to connect with each other,” she points out.

They also start to connect with the counseling center personnel. Fliers detailing the services that the counseling center offers are always available at the parties, but that is secondary to the influence of the interactions between the counseling staff and the students, Knapp-Grosz asserts. By being at these “parties,” counseling staff are introducing themselves in a nonthreatening way and helping students become familiar with mental health professionals, perhaps even demystifying their role in the process, she says.

Other in-classroom interventions include “brain breakers,” a brief interval during which a counseling center staff member arrives with a limbo stick and music and invites students to limbo.

Yet another outreach tool, the Pizza Fairy, has achieved almost cultlike status, Knapp-Grosz says with amusement. The Pizza Fairy is a counseling center staff member who shows up in the student residence halls with free pizzas (accompanied by counseling center fliers) that are donated by a local hospital. There is no set schedule, so it is always a surprise when the Pizza Fairy appears.

“He’s become almost an urban legend,” Knapp-Grosz says. “People will text each other about it — ‘Have you seen him? Is he coming?’” In fact, students have even shown up at the counseling center looking for the Pizza Fairy, she notes with satisfaction.

The creative outreach doesn’t stop there. The counseling center has also featured Doughnut Divas who dressed up in costumes and handed out doughnuts in front of classroom buildings in the morning. The Doughnut Divas were replaced by Granola Goddesses when the students requested healthier food.

Then there is a certain iconic character in a big red suit who makes appearances on campus. “Toward the end of the quarter, we do ‘psycho Santa,’” Knapp-Grosz explains. “[Staff members or interns] put on a typical Santa costume but with goofy socks or something, and we’ll have an article about [topics like the] holiday blues. They [the Santas] usually go to the dining halls and hand out candy canes. We’ll sometimes have elves and reindeer too.”

The creative outreach seems to have paid off. Knapp-Grosz notes that over time, use of the counseling center at SCAD has risen to include approximately 50 percent of the student population.

The unconventional approach to outreach also seems to benefit the counseling center staff, Knapp-Grosz observes. “You have less burnout and compassion fatigue,” she says. “It’s refreshing to be out and about, and we are interacting with a broader student population.”

Knapp-Grosz says that before she starts making similar outreach plans at her new job at the University of North Texas, she will need to meet the center staff and learn more about the needs of the student population. She does, however, have an idea involving therapy dogs, inspired by her own dog, a standard poodle. As a breed, poodles have a penchant for dancing.

“If it fits the culture, I would like to have poodle dancing [in the classroom or other campus locations],” Knapp-Grosz says with a laugh. “I just think that would be really cool.”

Connecting with communities

Advocacy and outreach are two of the values at the core of the counseling profession, says ACA President Thelma Duffey, who has made counselor advocacy and outreach one of her presidential initiatives.

“I think counseling outreach provides a way for us to connect with our communities and to participate in advocacy and services,” she says. “It’s an opportunity for counselors to contribute to their communities by offering their areas of knowledge and expertise — at times to people who feel, and sometimes are, unsupported or disconnected.”




To contact the individuals interviewed for this article, email:



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

Letters to the editor: ct@counseling.org

Taking steps toward dignity

By Bethany Bray August 24, 2015


What do we want? Dignity!

When do we want it? Now!

This chant echoed across the National Mall on Monday, Aug. 24, as a large group of people stepped off for the inaugural Destination Dignity march.

The event, organized by a coalition of mental health organizations, agencies and nonprofits, was planned to rally against the stigma and discrimination people with mental illness face, from trouble finding housing to increased rates of incarceration and homelessness.

Marchers, many wearing green T-shirts and ribbons and carrying signs, processed along the National Mall in Washington, D.C., finishing in front of the U.S. Capitol. Participants were from the local area, as well as Maryland, New York, New Jersey and other states.

The American Counseling Association was one of the event’s supporting partners; several ACA staffers and local members participated. ACA donated water bottles for the event that featured the ACA logo and the phrase “Step by step, day by day, stand up for mental health!”

Eduardo Vega, director of the Mental Health Association of San Francisco and one of the main organizers of the Destination Dignity march, was among the many people who said they hope the march will become an annual event.

Although Monday’s march was less than a mile, advocates still have many miles left to go before successfully destigmatizing mental illness, said Vega.



Destination Dignity marchers process along the National Mall towards the U.S. Capitol. (All photos by Bethany Bray/Counseling Today)





Destination Dignity: March for Dignity and Change in Mental Health

Aug. 24, Washington, D.C.


We call for:

  • An end to a society in which people with mental health conditions die up to 25 years younger than the rest of the population
  • An end to unconscionable levels of unemployment, incarceration, homelessness and suicide
  • An end to negative portrayals and scapegoating in the news and media
  • An end to underfunding of services, harsh practices and fragmented “fail-first” systems that require a person to be in crisis in order to access help
  • An end to the criminalization of mental illness and substance use conditions

Source: destinationdignity.org




For more information, see destinationdignity.org


Search for the hashtag #MHDignityMarch on social media for photos and posts from the day’s events





Eduardo Vega, director of the Mental Health Association of San Francisco, rallies the crowd. The back of Vega’s t-shirt reads “People recover. Stigma hurts. You can make a difference. Demand dignity now.”


A march participant is interviewed by the local media (Telesur).



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: facebook.com/CounselingToday


Taking counseling’s cause to Capitol Hill

By Bethany Bray July 30, 2015

ACA's Day on the Hill 2015 (Photo by Paul Sakuma).

(Photo by Paul Sakuma)

More than 100 professional counselors visited Capitol Hill on July 23 as part of the American Counseling Association’s Institute for Leadership Training (ILT) to advocate for the profession on a range of issues, from federal funding for school counselors to hiring more counselors at the Department of Veterans Affairs (VA).

Counselors from more than 30 states visited the offices of their respective U.S. senators or members of the House of Representatives, talking with aides and distributing fact sheets. In some cases, the

Dianne Baer, president of the Arkansas branch of the American Counseling Association, talks with Rep. Steve Womack (R-Ark. 3rd district).

Dianne Baer, president of the Arkansas branch of the American Counseling Association, talks with Rep. Steve Womack (R-Ark.). (Photo by Paul Sakuma)

counselors were able to meet with members of Congress in person, including Sen. Shelley Moore Capito (R-W.Va.), Rep. Raúl Labrador (R-Idaho) and Sen. John Thune (R-S.D.).

The counselor advocates were gathered in Washington, D.C., for ACA’s annual ILT event, a four-day conference of education sessions, trainings and business meetings for leaders in the counseling profession. ACA’s government affairs team organized the institute’s Day on the Hill.

“ACA leaders had another successful visit with members of Congress and their staffs about several issues facing the counseling profession,” reported Art Terrazas, ACA’s director of government affairs. “ACA leaders were able to advocate for more hiring opportunities for counselors and improved delivery of mental health services. We’re excited that our leaders had this opportunity to exercise their constitutional rights and empower members of the counseling community.”


ACA member-leaders from Florida talk with Eduardo Sacasa, a legislative correspondent in U.S. Sen. Marco Rubio’s office. Shon Smith (center, in bow tie), Southern Region chair-elect to the ACA Governing Council, advocated for the hiring of more professional counselors within the VA. Smith, a veteran himself, quoted data from a recent VA report estimating that 22 veterans commit suicide each day – a statistic that’s “completely preventable,” Smith said.

ACA member-leaders from Florida talk with Eduardo Sacasa, a legislative correspondent in U.S. Sen. Marco Rubio’s office. Shon Smith (center, in bow tie), Southern Region chair-elect to the ACA Governing Council, advocated for the hiring of more professional counselors within the VA. Smith, a veteran himself, quoted data from a recent VA report estimating that 22 veterans commit suicide each day – a statistic that’s “completely preventable,” Smith said. (Photo by Bethany Bray/Counseling Today)


Among the issues for which counselors advocated at the 2015 Day on the Hill:

  • Counselor inclusion as Medicare providers. Medicare does not currently reimburse licensed professional counselors (LPCs) for the much-needed treatment that they provide for older adults. During last week’s Day on the Hill, counselors asked for legislators’ support for a soon-to-be introduced bill, the Seniors Mental Health Access Improvement Act of 2015, which would establish Medicare coverage of LPCs. Sens. John Barrasso (R-Wyo.) and Debbie Stabenow (D-Mich.) are sponsoring the bill.
  • Funding for the Elementary and Secondary School Counseling Program (ESSCP), which provides grants to school districts that have a need for additional counseling services for students. ESSCP’s funding was recently cut in half. Day on the Hill counselor advocates pushed legislators to, at a minimum, keep the reduced funding ($23.3 million) in the bill.
  • Increased opportunities for employment of professional counselors within the VA. Currently, counselors make up less than 1 percent of the VA workforce, according to Terrazas. During the Day on the Hill event, counselors asked senators to co-sponsor bill S.1676, which would include LPCs in the VA’s health professional training program and allow LPCs with doctoral degrees to be hired by the VA.


ACA fact sheet on the VA (CLICK TO SEE FULL SIZE)

ACA fact sheet on the VA (CLICK TO SEE FULL SIZE)

ACA fact sheet on the ESSCP (CLICK TO SEE FULL SIZE)

ACA fact sheet on the ESSCP (CLICK TO SEE FULL SIZE)


ACA fact sheet on Medicare (CLICK TO SEE FULL SIZE)


Stephanie Dailey, president of the Maryland branch of the American Counseling Association and senior co-chair of ACA's Ethics Committee, talks with an aide in the office of Rep. Robert Wittman (R-Va.).

Stephanie Dailey, president of the Maryland branch of the American Counseling Association and senior co-chair of ACA’s Ethics Committee, talks with an aide in the office of Rep. Robert Wittman (R-Va.). (Photo by Bethany Bray/Counseling Today)

ACA member-leaders take the underground train that runs between the Senate and House buildings on Capitol Hill.

ACA member-leaders from Texas take the underground train that runs between the Senate and House buildings on Capitol Hill. (Photo by Paul Sakuma)




By the numbers: 2015 Day on the Hill

139 ACA members participated from 39 different states, the District of Columbia, Puerto Rico and the Virgin Islands

Offices visited:

78 Senators

109 members of the House of Representatives




Search for the hashtag #CounselorsEmpower for social media posts from ILT and the Day on the Hill


More photos are posted at the ACA flickr page: flickr.com/photos/23682700@N04/sets/72157656243041342




Advocacy tips

Some things to keep in mind when advocating for counseling with lawmakers at the local, state or national level:

  • Remember that you are the expert on this subject, not the politician. Be confident!
  • Keep in mind that a letter sent via U.S. mail can take two to four weeks to reach your legislators because it will have to be screened for security. Email, social media and in-person meetings are often more timely and effective.
  • Treat your meeting with a lawmaker as if it were a job interview: Dress nicely, be on time, be courteous and follow up with a thank you email.

    Advocacy tips from the ACA (CLICK TO SEE FULL SIZE)

    Advocacy tips from the ACA (CLICK TO SEE FULL SIZE)

  • Before you go, make sure that you thoroughly understand the issue you plan to speak about. Also be familiar with the lawmaker – his or her interests, background and platforms.
  • If you’re seeking support of a particular bill, be sure to mention it by name and number.
  • Most of all, tell your story. Oftentimes, personal anecdotes and examples are more memorable and get your point across better than facts and figures.
  • Social media can be a powerful tool to draw attention to a cause. All but two or three U.S. legislators have a Twitter feed or Facebook page. Keep in mind that legislators – or at least office staffers – monitor these social media accounts and look at every mention and tag that involves them.
  • If you don’t know the answer to a question, simply explain that you don’t know the answer but are willing to find it and get back to the legislator – then do so!

Source: Dillon Harp, grassroots organizer, ACA Government Affairs


ACA member-leaders from Florida stand with Eduardo Sacasa (center, in necktie), a legislative correspondent in Sen. Marco Rubio's office.

ACA member-leaders from Florida stand with Eduardo Sacasa (center, in necktie), a legislative correspondent in Sen. Marco Rubio’s office. Pictured are (left to right) Jacqueline Swank, president of the Association for Creativity in Counseling (ACC); Seneka Arrington, president of National Employment Counseling Association (NECA); Katheryn Williams, secretary of ACA’s Southern region; Sacasa; Kristie Knight, secretary of the Florida Counseling Association (FCA); Shon D. Smith, Southern region chair-elect to the ACA Governing Council; Anne Flenner, FCA president-elect; and Michelle Bradham-Cousar, FCA president. (Photo by Bethany Bray/Counseling Today)



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: facebook.com/CounselingToday

Advocacy in action

By Laurie Meyers April 23, 2014

ProtestAdvocacy is a concept that can evoke visions of protesters and picket lines, phone banks and information booths, and maybe even knocking on doors and accosting strangers on the street.

But at its most basic level, advocacy means to help or assist, and isn’t that the essence of counseling?

“I feel that the basic principles of advocacy — helping people to be their best — have always been a part of the profession in some ways,” says Courtland Lee, a past president of the American Counseling Association and a pioneer in multiculturalism and social justice work. “But it’s evolved over time. People really started to use the word advocate in the real sense [in the] 1960s as the major social justice movements — the struggle for civil rights, the anti-Vietnam War movement and the call for women’s equality — began to transform society.”

Counselors, like the rest of society, were affected by these movements, Lee says. “It started as more of a philosophy that counselors need to be agents of social change. As it evolved, advocacy became part of the multicultural and social justice movements,” says Lee, a professor of counselling at the University of Malta and editor of the ACA books Multicultural Issues in Counseling and Counseling for Social Justice.

Counselors began realizing that working with the client one on one wasn’t always enough, Lee says. Making lasting differences in clients’ lives often required challenging the prevailing environment and working to change it.

Rita Chi-Ying Chung, an international expert on multicultural and cross-cultural counseling, discovered that truth at the beginning of her career when she began working with refugees, a population forced to navigate many cultural barriers when arriving in a new county.

“I felt that we were creating kind of a revolving door where we would see clients, they would feel better, and then leave and go back in their world and get exposed to whatever issues or injustices that were happening to them, and their pain and difficulties would just come back,” says Chung, an ACA member and professor in the counseling and development program at George Mason University (GMU) in Fairfax, Va. “As counselors, I just think a critical part of our counseling is advocacy — not just on an individual level but on a community as well as a systemic level.”

The need for advocacy isn’t limited to large societal movements or even large groups of people, however. The need is present in every counselor’s office, school or classroom.

“Advocacy is not an adjunct piece; it’s a core, fundamental piece of any counseling we do with anybody,” says Fred Bemak, Chung’s research partner, frequent collaborator and spouse.

Lee offers the example of a famous case in Maryland in which a mother struggling to make it paycheck to paycheck and who couldn’t afford health insurance was unable to take her son to the dentist when he got a toothache. Tragically, the tooth became infected, the infection spread to the boy’s brain and he died.

“So, imagine this mom coming in for grief counseling,” Lee says. “It’s one thing to help her process grief, but at the same time, she is stuck in a dead-end job [and] another son has never been to the dentist, so the same thing could happen to him. Grief counseling on its own is not sufficient.”

But how would a counselor advocate for the client? By addressing the circumstances that led to the tragedy, Lee says. For instance, he suggests, the mother needs a better job, so perhaps the counselor could find a program that would help her upgrade her skills. The counselor could make a simple phone call to the state’s social services department to see what assistance the client might be eligible for, such as help with energy bills, emergency cash that could go toward paying rent or food stamps. The counselor could assist in securing dental care for the other child by checking with the dental community to find a dentist or clinic willing to provide low-cost or pro bono work.

Many of today’s counselors are actively advocating for clients, causes, social change and even the profession itself. In this article, we share a few of their stories.

Stopping traffic

Since 2012, Rita Chi-Ying Chung has received both the Gilbert and Kathleen Wrenn Award for a Humanitarian and Caring Person and the Kitty Cole Human Rights Award from ACA. Much of her work focuses on social justice and human rights. But Chung, who is also a consultant, researcher and faculty member at GMU’s Diversity Research and Action Center, didn’t start her career looking to become an advocate. Instead, advocacy found her.

“I was trained in a more traditional way of counseling, and advocacy wasn’t a real part of it,” says Chung, who was born, raised and educated in New Zealand, where she received her master’s and doctoral degrees in psychology at Victoria University of Wellington. But then the so-called “boat people” — Southeast Asian refugees who fled by sea on makeshift rafts and boats — started arriving in New Zealand in the 1980s. These were the “second wave” of Southeast Asian refugees from Vietnam, Cambodia and Laos who were fleeing the postwar chaos that still lingered nearly a decade after the fall of Saigon and the end of the Vietnam War.

Chung was working in community mental health centers as the refugees poured in. Her superiors thought she was uniquely qualified to work with this emerging client population because she was the only Asian counselor in Queensland and perhaps in all of New Zealand at that time.

“I was bilingual in Chinese — not any other Asian languages, just Chinese — but many of the refugees were Chinese-speaking Vietnamese, so we were able to communicate,” Chung recalls. “Because of that, I think some of the social services staff thought, ‘OK, she’s Asian. She’s talking to some of them, so therefore, she must be able to speak to all of them.’’’

The hugely uninformed assumption that one Asian person could somehow communicate with all other Asian people made Chung consider that the mental health community was likely oblivious to other cultures and their specific psychosocial needs as well. After all, if professionals didn’t even know what language the refugees spoke, how could they begin to understand and help them cope with their trauma?

Chung has published numerous articles and books on advocacy, multiculturalism and social justice. Today, she continues to advocate for and work with refugees, immigrants, minorities and other at-risk groups. An international conference on at-risk children led Chung to her current primary focus: child sex trafficking, particularly of Asian girls. She spent approximately three years traveling to Burma (Myanmar) with the nongovernmental organization (NGO) Save the Children UK to work with trafficked children and study possible ways to stop child trafficking.

The issues surrounding child trafficking are complex, Chung says. Girls are often sold to traffickers by their parents, which most counselors (and most other people in the Western World, for that matter) find extremely difficult to understand. But these are areas that are extremely impoverished, Chung explains, and sometimes the choice boils down to taking money from the traffickers for one child or watching one or more of your children starve to death.

“If it’s a difference between someone in your family’s going to die if you don’t put food on the table or you may be trafficked to another country, what are you going to do?” asks Chung. “You also need to understand Asian culture. In general, there is this concept of filial piety. The obligation for any child is to take care of their parents, which includes not only taking care financially, but to obey and respect and sacrifice anything for the greater good of the family.”

Even when the police raid a brothel and the trafficked girls are “freed,” they may choose not to go home, Chung says. “It’s not because they love what they’re doing. In all my years studying the trafficking industry, I’ve never met anyone who said, ‘Yeah, I volunteered.’ The Asian girls don’t leave because they feel that leaving is letting their family down,” she says.

“At the same time, they can’t leave because there is nowhere to go,” she continues. “In this culture, there is such stigma about rape and abuse. There’s such shame and loss of face, which doesn’t just apply to the girl but to the whole family.”

“It’s difficult,” Chung says. “I suddenly realized that in such an economically depressed situation, we’re not going to stop trafficking. It took me awhile to just accept the fact because I came into it thinking I was going to help prevent it.”

What Chung does do is ease community reentry for girls who have the option of coming back, in part by helping communities develop realistic alternatives for making money.

Easing reentry also involves education, Chung says. Part of that is sitting down as a community and collectively talking about how the group can heal, she says. Sometimes the healing involves listening to the girls’ stories.

“Sometime we’ll do role-play where the girls play out what it is like to be trafficked, telling their stories in an indirect way,” explains Chung. “Survivors will take on different trafficking roles. One person will be a trafficked individual, one person will be the madam in the house, etc. During this kind of simplistic playing out of roles, you can look around the community, and people are just crying. They’ve never truly thought about what the girls’ experiences were like. Once we get those tears out, the healing begins.”

Even so, the process is never simple. In some cases, Chung says, the family won’t take the girl back, especially if she is pregnant. However, others in the community may step forward and offer her a place to stay. Sometimes girls who were trafficked will band together and find a facility where they can live as a group.

Regardless, it remains essential to provide the girls with ways other than sex work to make money. Sometimes, however, the suggestions aren’t practical.

“We’ve got to give girls education and skills, but there are these programs out there that want to teach girls to be hairdressers and then send [them] back to their villages. What’s the point?” Chung exclaims. “Because, quite frankly, if I’m poor and I’m having trouble putting food on the table, I’m not going to pay someone to wash my hair.”

“I say [instead], what are the local resources? In one area, they have all these grasses they can weave with, and people use natural products to make dyes,” she explains. “So we thought, why not make lots of baskets and dye them different colors? Maybe we can find someone to take them once or twice a week to local markets and sell them, and that’s a way of sustainable living.”

For those who are still being trafficked, Chung and others have tried to provide a few safeguards. “We set up toll-free numbers in countries so that if there’s been some coercion, fraud, some threat, there’s someplace they can call,” she says. “Sometimes girls don’t even realize they are being trafficked into the sex industry. They have been told that they are going to be a maid or waitress or nanny somewhere, earning a lot of money, and before [they] know it, they are in a situation where their passports have been taken and they’ve been told that they owe a lot of money.”

Any attempt to stop or reduce trafficking must also address the demand side, emphasizes Chung, who was invited in 2008 to give a presentation on the cultural issues surrounding child trafficking at the United Nations. “White European men will go to different countries in Europe or Asia to have sex with children, but they don’t classify themselves as pedophiles. In the trafficking world, we call them ‘casual pedophiles,’” she says.

Most people are also unaware of how much sex trafficking goes on in the United States, Chung says. People would be shocked to discover that sex trafficking can take place anywhere, in anybody’s neighborhood, she says. The victims are not only women and children brought in from other countries but, in some cases, underage American girls. According to an FBI report from 2011, more than 290,000 U.S. youth were considered to be at risk for becoming trafficking victims. Although most victims of trafficking come from impoverished backgrounds, traffickers also target girls from more affluent families who are vulnerable for a variety of reasons, such as a history of sexual abuse, drug addiction, extreme low-self esteem, a desire to fit in or even promises of a glamorous lifestyle. Chung points out that in Northern Virginia, where she lives, there have been recent cases of high school girls being pulled into the sex industry.

“Human trafficking goes way back in civilization — back to the days of the Roman Empire — and it’s big business,” concludes Chung.

Counseling and advocacy: Two parts of a whole

For Fred Bemak, the academic program coordinator for counseling and development at GMU, advocacy and counseling are fundamentally intertwined. He was an advocate even before he became a counselor, and that experience shaped how he viewed his training and the counseling profession.

While in college, Bemak served as a summer counselor in the Upward Bound program, which works with youth from diverse backgrounds, including those who are economically disadvantaged, to give them a jump start toward college. Bemak continued working with Upward Bound throughout his counseling training, and the juxtaposition created significant cognitive dissonance for him.

“I realized pretty quickly that helping people accommodate to those social conditions was not a good way to do counseling,” explains Bemak, the founder and director of GMU’s Diversity Research and Action Center. “The traditional counseling field said, ‘Let me help somebody feel better about themselves even though they’re poor and they’re hungry and they don’t have a job and people are discriminating against them, and let me help them adapt to all that so that they can manage their lives.’ … From my Upward Bound experiences, I learned that’s not quite enough. Because we’re helping people to adapt to oppressive situations and the conditions of their lives don’t change, we’re just trying to change their mental status to say [in essence], ‘I’m poor and I’m happy,’ and that’s ridiculous.”

Bemak trained in what was considered to be one of the more progressive programs of its time, but as he describes it, it was still based on European-American concepts that didn’t fit the circumstances he was seeing at all.

“In the morning, I’d have been in the African American community with parents who were frustrated and angry and upset about life, trying to figure out how to manage without food. And then,” he says, “I’d go to these counseling classes, and it would be like two different planets.

“There was my training, and then there was working with vulnerable people in difficult circumstances. I had to craft together … how do I take this training and capitalize on it for the purpose of meeting the needs of people who are in marginalized circumstances?”

Those dual, clashing experiences spurred Bemak to get his doctorate so he could qualify for positions through which he could influence policy and bring social justice, multiculturalism and advocacy to organizations across the United States and then abroad.

His international work began when one of Bemak’s friends, a Yale University psychiatrist, received a general call for assistance from community service providers to assist with the needs of incoming Southeast Asian refugees. “He said, ‘Call Fred. He knows about working with children,’” Bemak recounts. “I said, ‘But I haven’t even been to Vietnam or Cambodia!’ They said, ‘You’ve been to Asia, and that’s as close as we can get.’”

Bemak learned by doing. “I didn’t know much about that population and what was going on,” he says. “But very quickly, because there were very few people in the United States doing this work, I became an ‘expert.’ I didn’t know enough to deserve the title, but there was basically no one else, so I was getting calls from all over the country to do training and consulting, and everywhere I went, I learned more.”

Bemak’s work has since expanded to include refugee populations from around the world. He has helped provide services in 55 different countries. He says his experiences continually remind him of the importance of advocacy and how much more he still needs to learn and do.

“One of the things I’ve been doing recently that has been very, very intense is working with postwar/conflict youth. Working with child soldiers, working with abductees, working with orphans, working with people infected with HIV/AIDS as a result of war. I’ve been doing that in Uganda most recently and looking at some other projects in Liberia,” says Bemak, who consults for the NGO Invisible Children.

“It’s incredibly intense and painful work,” he continues. “Many times in these counseling sessions, I’ll have been the first person to hear these stories because people have not been able to tell them because they have not found the conditions in which they feel they can.”

All of Bemak’s advocacy counseling work revolves around helping diverse people and communities in need, but after Hurricane Katrina, he felt compelled to create a kind of urgent care counseling unit that would respond in the wake of disasters. Bemak was at a national counselor educators’ meeting when, roughly six weeks after the devastating storm, someone asked who among the attendees had been to the Gulf Coast and seen the horrible devastation. Only a few hands went up. Worse yet, in Bemak’s opinion, the counselors who had visited the region had assisted primarily by helping to clean up, not by putting their desperately needed counseling skills to good use with the affected population. Worst of all, he says, when he looked into relief efforts, he found that small, diverse communities in Mississippi were not getting the services they needed. He notes that most of the focus was on New Orleans, but even there, the need was so great that there weren’t enough mental health providers to go around. Bemak was afraid that smaller affected communities in Mississippi were getting lost in the shuffle.

“So, I created Counselors Without Borders in my head, right there,” he says. In addition to its work in Mississippi after Hurricane Katrina, Counselors Without Borders has also provided culturally sensitive services to migrant communities and on American Indian reservations when wildfires scorched Southern California in 2007, as well as in Haiti in the wake of the 2010 earthquake.

The organization only deploys where it is needed. “I only want to go to places where needs are not being already met,” Bemak says. “Counselors Without Borders is a backup organization to come in and do culturally responsive work where it’s not being done.”

The thread that runs throughout all of Bemak’s work is social justice — how to address human rights and help achieve equity in counseling. The answer, for him, is advocacy.

“In the work we’re doing [as counselors], I think we’re really contributing to problems by not addressing advocacy and by not incorporating that as a core part of our jobs,” he asserts. “I think we’re contributing to the social problems and the inequities and the social conditions that oppress and hurt people.”

The battle for mental health

Keith Myers, a licensed professional counselor in Atlanta, has always been interested in the military. It’s a bit of a family tradition. His father was in the Navy during World War II, and both of his brothers have also served.

Myers chose to take a different route. The ACA member has been a practicing counselor for approximately 11 years and has worked in a variety of clinical settings. One of those settings turned his interest in the military into a focus for advocacy.

Myers has been a private practitioner for almost a year now, but before that he spent about two and a half years working with and advocating for veterans and active-duty service members at the Shepherd Center in Atlanta, a private rehabilitation center that specializes in brain and spinal cord injuries. As he would learn, working with this population required an approach based on an understanding of the military’s unique culture.

Specifically, Myers worked in the SHARE (Shaping Hope and Recovery Excellence) Military Initiative, an intensive outpatient program for veterans and active-duty members who had sustained a traumatic brain injury (TBI). Although SHARE received referrals from the military, it was a privately funded initiative that provided something military services did not offer — a chance to receive physical rehabilitation and mental health treatment simultaneously, Myers says.

“Patients could receive treatment for both their TBI and PTSD [posttraumatic stress disorder], which is a great advantage because it can sometimes be difficult to tease out what is [caused by] TBI and what is PTSD since their symptoms often overlap,” says Myers, a member of both the ACA Veterans Interest Network and the ACA Traumatology Interest Network.

The treatment was comprehensive. Patients had access to physical therapists, occupational therapists, speech therapists, physiatrists and mental health treatment, including individual, group and, in some cases, family therapy, Myers explains.

To even begin the process, however, Myers had to earn the clients’ trust — to advocate through understanding. “Military clients can be a difficult population to establish trust with just because they have a general mistrust of anyone outside the military. … There are exceptions, but they are pretty distrustful of civilians in general,” he says.

That distrust extends particularly to mental health practitioners of any kind. In the military, a strong stigma is attached to mental health problems and treatment, Myers explains. And if a service member does get help within the military system, there is virtually no confidentiality, unlike in the private or public mental health sectors. Military mental health practitioners report to higher-ranking officers and must disclose any potential problems that come up in sessions, he says.

“In fact, among military personnel, the mental health professionals are known as ‘wizards’ because they can make you disappear from your unit,” Myers says ruefully.

So, with each of his clients, Myers began by explaining that confidentiality worked differently at the Shepherd Center. He would not be revealing their conversations to anyone. Although he was required to give general reports on progress, the details of what was said in the therapy room would stay in the therapy room.

Myers also used his background to start to connect. “I was a little looser with my professional and personal disclosures. I could see there was clinical value in disclosing that I came from a military family and sharing some of my experience,” he says.

Just having knowledge of military culture and knowing the differences between branches was a big help. “Always know your branches,” he advises. “Never call a Marine a soldier — that’s an Army designation. Don’t call someone a sailor unless they are in the Navy.”

It may sound like a small thing, he says, but the military and its branches have their own unique culture, and taking a multicultural approach and getting to know and understand this population’s customs is essential to establishing trust and counseling effectively.

“It’s a slow process in the beginning,” Myers says, “but once rapport is established, the sense of trust becomes an almost unbreakable bond.”

Now back in private practice while earning his doctoral degree, Myers’ desire to help military members has led to significant advocacy work, both at the individual and community levels. Myers currently sees several military clients and advocates for them by helping them fill out disability paperwork with the Department of Veterans Affairs. He also accompanies certain clients on visits to their physicians. The visits started when several clients confided to Myers that they didn’t really know what they wanted or needed from their doctors.

“We would sit down before the physician’s appointment, and the client and I would talk about the visit and what their needs were,” Myers explains. “Then we would kind of do a role-play of what I [as the client] might say to the physician, and sometimes the client would say, ‘What you said is better than how I would say it, so would you mind coming to my appointment?’”

The clients felt better having someone to help articulate all of their needs, and Myers liked being there to make sure his clients felt their needs were being addressed.

Myers is also advocating by educating other mental health and health professionals about the unique needs of the military population. He has presented at multiple health facilities in the Atlanta area, including an audience of 80 at an area psychiatric center. Myers also presents on the topic to faculty and students at Mercer University, where he is earning his doctorate.

Myers’ presentations educate audiences about the extreme physical and mental stressors that military clients experience. “The heat is extreme — often well over 100 degrees — and military members have to endure it, often while dressed in body armor,” he points out. “Missions require a high degree of vigilance and are sometimes ambiguous. They may be peacekeeping or diplomatic [missions], but there is always the threat of IEDs [improvised explosive devices] and the possibility of ambush or military fire.”

Those in combat also have to face things such as conflict within the unit, the loss of fellow unit members, general fear and horror, and the possibility of death or being maimed. And even when they return home, Myers says, they still must deal with the memories and the myriad emotions those memories engender.

Myers has been pleased with the feedback he receives, particularly from audience members who come up after his presentations to tell him they have always been interested in treating military members but haven’t known how or where to begin. He helps interested counselors and other mental health professionals to get started, whether it is through professional connections or simply working with nonprofit advocacy organizations such as the Wounded Warrior Project.

Myers says he will continue to present, and once he has finished his doctorate, he hopes to teach counselor trainees not just about military culture, but also combat and trauma.

“One of the most rewarding aspects of working with this population is being able to serve those who served,” he says.

The accidental advocate

When ACA member Kevin Feisthamel began his job at the Cleveland Clinic Foundation’s Melon Center for multiple sclerosis (MS), he knew little about the disease. He had just finished a counseling internship that focused on health psychology and had developed a strong interest in neuropsychology. So when a neuropsychological technician position opened up in the MS clinic, he jumped at the chance, despite not knowing anything about the symptoms, prognosis or treatment options for MS. At first, he simply focused on administering the personality and intelligence tests. After all, he reasoned, that was what he was there for.

But it didn’t take long for Feisthamel to recognize the devastation that MS can cause and to realize that the clinic patients needed more than just test administration — they needed empathy and knowledge.

After their initial baseline tests, patients would return about three months later to be retested. Feisthamel would score the tests, and the clinic neurologist and psychiatrist would evaluate the results, looking for decline or changes in cognition.

“Suddenly,” Feisthamel says, “I was seeing these highly intelligent people whose mental function was markedly decreasing over time. I would also see people — kids, really — who were 18 or 19 and in wheelchairs, and I was amazed at how debilitating this disease could be. I just couldn’t imagine what they were going through, and I tried to put myself in their shoes but realized that I didn’t even know enough to do that. That’s what got me started. I felt educating myself was crucial not only for myself but for the clients I was seeing.”

Although Feisthamel wasn’t addressing the decline and associated symptoms directly with the patients, he felt he needed to know more to better understand the bad news he sometimes had to deliver. He also wanted to help on a systemic level by participating in research that could uncover more about the effects of MS — in particular depression and fatigue, which were symptoms he witnessed so often.

Eventually, Feisthamel began sitting in with the neurologist and taking part in the discussions with patients. He also was invited to start taking part in presentations on the research the Cleveland Clinic was doing related to MS. He was involved in several studies, including one that focused on depression in MS patients. For that study, Feisthamel looked at the personality assessment data the clinic had collected and tried to identify specific personality characteristics that might help individuals cope with their depression.

Feisthamel eventually left the Cleveland Clinic to pursue his doctorate, but he retained his passion for research and advocacy. He no longer devoted so much time to MS, although he did write a meta-analysis of research on pharmacological and counseling interventions for MS patients with depression for his psychopharmacology class. The article was later published in a peer-reviewed journal in 2009.

Today, Feisthamel teaches at Walden University and is also director of the health center at Hiram College. He is still an enthusiastic advocate, but his current focus is on the science of happiness and positive psychology. He established a Hiram chapter of Active Minds, an organization that empowers students to speak openly about mental health to encourage help-seeking behaviors, and recently completed a week of education on suicide prevention. Feisthamel sees clients daily but says about 80 percent of his job at Hiram revolves around getting out and educating people about where and how to get help and what kinds of things they can do for themselves.

“I don’t worry a lot about the people I do see,” he says. “I worry about the ones I don’t. That’s why I have to get out of my office to talk about counseling services and to give presentations on campus to students and faculty.”

Feisthamel is also encouraging advocacy among future counselors. Walden’s counseling program is focused on social change, he says, and he regularly asks his students to think about what social change is and how they can use it to advocate for their clients.

“We can have a huge impact, not just at the national level, but at the community level,” he emphasizes.

Defending counselors everywhere

John Yasenchak, an ACA member from the Bangor, Maine, area, never really considered himself much of an advocate. He’d participated in a few things to help raise awareness around counselor identity, but mostly he was focused on his practice and the classes he taught at Husson University.

Then came the fight around MaineCare, the state’s Medicaid program. The state Legislature has been trying to cut the program’s funding for years, according to Yasenchak, and in 2013, lawmakers decided MaineCare should stop reimbursing licensed clinical professional counselors (LCPCs) for patients who had “dual eligibility,” meaning they were eligible for both MaineCare and Medicare.

“The justification was based on Medicare’s refusal to include counselors as legitimate mental health providers who deserve to be reimbursed,” he explains. “The state pointed to this regulation and asked why it should reimburse counselors if the national Medicare system wasn’t.”

The prospect of being locked out of MaineCare sent shock waves through the state’s counseling community, Yasenchak says, because it would put counselors’ income or positions in jeopardy and many clients wouldn’t be able to continue receiving care from their chosen LCPC providers. “I had students coming in asking me if they should continue in the counselor education program. Was there an actual future in counseling? Would they even be able to find jobs, or should they switch to another helping profession?” Yasenchak recounts.

The situation served as a real wake-up call about the need for Maine counselors to start lobbying for recognition as legitimate mental health providers, not just at the state level but at the national level too, Yasenchak says. They did lobby the state Legislature, but the Maine Counseling Association (MeCA), a branch of ACA, and the Maine Mental Health Counselors Association realized that counselors could never be secure professionally until the Medicare problem was addressed.

Yasenchak, then serving as president of MeCA, and others started reaching out to contacts who had connections to Susan Collins, one of Maine’s U.S. senators. In the meantime, the state lobbying effort was gathering support from consumers and the CEOs of federally backed medical centers and furiously raising awareness. This activity and the many written testimonials it garnered were part of the background information presented to Collins. Her office responded positively but wanted more information, even asking Yasenchak and others to do research in the Federal Register.

The legwork paid off. By the time Yasenchak and several of his colleagues met with Collins, she had agreed to help sponsor the Seniors Mental Health Access Improvement Act of 2013 in the U.S. Senate. The bill is currently being reviewed by the Senate Finance Committee. A companion bill that includes Medicare reimbursement for LPCs has also been introduced in the House of Representatives.

Yasenchak and colleagues Deb Drew and Jeri Stevens are sticking with the process. Despite the dedicated lobbying at the state level, the Maine Legislature passed legislation denying reimbursement to LCPCs for dually eligibl clients. This is a targeted exclusion that does not apply to any other mental health professionals, Yasenchak points outs. Clients who had previously seen an LCPC had to transfer care to other providers unless they pursued a special waver.

Yasenchak knows that counselors’ livelihoods and clients’ treatment will continue to be threatened — and, in some cases, eliminated — until the fight for Medicare reimbursement is won.

Looking back, moving forward

As the counseling profession moves forward, all counselors need to learn how to advocate for their clients, Lee says. Advocating for all clients means that counselors will help not just by talking about their clients’ presenting issues, but by ensuring that they have access to the resources necessary to meet their needs, he explains. This shift toward advocacy is reflected in the increasing number of counseling programs that train students in working for social change.

As calls for counselor advocacy grow, so does the need for strategies to carry out advocacy work. Rebecca Toporek helped provide counselors with practical steps for implementing advocacy efforts when she, Judy Lewis, Mary Smith Arnold and Reese House developed the ACA Advocacy Competencies as part of a task force. The ACA Governing Council endorsed the Advocacy Competencies in 2003.

“The Advocacy Competencies were created to provide counselors with definitions, strategies and guidance to facilitate the process of working with clients and client communities to identify the most appropriate action and strategize appropriate actions,” Toporek says.

The competencies define six domains of appropriate advocacy for counselors:

  • Client/student empowerment
  • Client/student advocacy
  • Community collaboration
  • Systems advocacy
  • Public information
  • Social/political advocacy

For more information on the Advocacy Competencies, go to counseling.org/docs/competencies/advocacy_competencies.pdf?sfvrsn=3.

For Bemak, the issue is fairly simple. “If we’re not advocating for our clients,” he says, “we’re not doing our jobs.”




KCA advocates for its next generation

At the Kentucky Counseling Association (KCA), advocacy has taken the form of nurturing and supporting the next generation of counselors.

KCAOver the past few years, KCA, a branch of the American Counseling Association, has launched a series of initiatives focused on counselors entering the profession. Those initiatives range from creating a special tab with graduate student resources on its website to increasing its educational offerings for entry-level counselors at its annual conference.

The effort has been “a win-win,” says KCA Associate Director Bill Braden. The entry-level counselors have brought fresh ideas and a new voice to KCA, while the association’s more experienced counselors have been able to mentor and network with the profession’s next generation.

Attendance at KCA’s annual conference has doubled, which KCA Executive Director Karen Cook attributes to the association’s recent focus on graduate students. KCA has expanded conference offerings for graduate students and new professionals, such as Q&A sessions on licensure, mock job interviews and the creation of a special lounge at the conference venue where graduate students can meet up and network.

The new programs and initiatives were created to focus on a challenging and critical time that can exist postgraduation for new counselors. Upon finishing graduate school, many budding counselors confront the pressures of finding a job and establishing themselves in the profession, all while burdened with student loan debt, Braden points out.

Cook and Braden say that KCA’s leadership team came to the realization that the association needed some type of outreach or mentorship initiative to connect new graduates with the state’s experienced counselors. A small task force, formed in 2012, developed a survey to identify graduate student needs and how KCA could help meet those needs. The survey was circulated at the annual conference and throughout the state. The task force then evolved into a student leadership team that includes representatives from universities throughout Kentucky.

“When we talked with our peers, [we] felt like students were missing out on how they fit into the bigger picture,” says Shana Goggins, a member of the original KCA task force who graduated from the master’s program at Eastern Kentucky University (EKU) in May 2013. “We felt like [we could do] more … to show students how much easier it is to get involved with a professional organization as a student, rather than waiting until you’ve graduated, you’re in the field and you’re trying to navigate work and just getting yourself oriented. We wanted to do something to show students that they were a viable part of the association.”

Goggins and her colleagues helped create a graduate student academy at KCA’s 2013 conference with a lineup of offerings tailored to new counselors, including the Q&A on licensure and sessions on self-care, public speaking, professional networking and other helpful topics.

“We want [new counselors] to understand how important it is to be proud of their profession and the importance of what we do,” Cook says. “We want to continue to listen to their voice and connect them with counselors in the field. We don’t want them to feel like they have to go it alone. … We love to see the interaction that goes on now between the grad students and the [experienced] counselors.”

KCA has also expanded its long-standing graduate school scholarship program. Each university in Kentucky now receives one scholarship for a counseling student to attend a summer class. The scholarship recipient, in turn, is invited to be involved with KCA’s annual conference in the fall, Cook says.

Panagiotis “Panos” Markopoulos, a classmate of Goggins’ at EKU who is now a doctoral student at the University of New Orleans, said KCA supports its members like a family. “It’s not just a one-way street, most definitely,” he says.

Markopoulos and Goggins were both involved in the 2012 task force and were instrumental in launching KCA’s focus on entry-level counselors, Braden says.

“As much as we’ve helped KCA, KCA has helped us,” says Goggins, a prelicensed counselor who is still involved with KCA. “I like to think that they’ve definitely helped us a lot more than we’ve helped them. But they would probably say the opposite. It’s a win-win, on everybody’s end.”


— Bethany Bray




To contact individuals interviewed for this article, email:

Courtland Lee at courtland.c.lee@um.edu.mt

Rita Chi-Ying Chung at rchung@gmu.edu

Keith Myers at doc355@yahoo.com

Kevin Feisthamel at FeisthamelKP@hiram.edu

John Yasenchak at yasenchakj@husson.edu

Rebecca Toporek at rtoporek@sfsu.edu




Social justice advocate and visionary Judy Lewis passed away as this article on counselor advocacy was being written. See page 48 of Counseling Today‘s May issue for an “In Memoriam” article on her life and legacy.



Laurie Meyers is a staff writer for Counseling Today. Contact her at LMeyers@counseling.org

Letters to the editor: ct@counseling.org