Tag Archives: Counselor Educators Audience

Counselor Educators Audience

What’s on the radar of today’s counselor?

Stacy Notaras Murphy July 1, 2012

What’s the next big counseling theory or technique out there?

Earlier this year, Counseling Today posed that question informally to American Counseling Association members in an edition of ACAeNews. We wanted to get a sense of what is grabbing the attention of today’s counselors — what approaches are influencing the way they do their work, what new topics they are most curious to learn more about and how they are making room for these fresh ideas every day in the counseling room.

Not surprisingly, the responses revealed that ACA members are a diverse and creative group. You are mixing old theories with new techniques, while remaining flexible and attuned to the individual needs of your clients. You are building unique tool kits with extra training in the tried-and-true orientations you came to appreciate in graduate school, such as cognitive behavioral and existential approaches. Yet, you also are building on traditional skills with new approaches as varied as mindfulness, family systems and even equine-assisted psychotherapy.

Despite the wide range of responses to our question, a handful of subjects came up again and again on the knowledge wish lists of counselors, including a structured approach to couples therapy, ways to integrate mind-body techniques and guidance for getting a handle on “all that brain science stuff.” Regarding these topics as an admittedly partial snapshot of what is gaining momentum in today’s counseling circles, we asked counselors in the field to discuss how they made their training decisions and what others can expect by following their lead.

Body-centered psychotherapies

The increasing acceptance of a mind-body connection in mental health has yielded a number of new body-centered approaches to counseling in the past few decades. A wide variety of therapies are considered body-centered: sensorimotor psychotherapy, eye movement desensitization and reprocessing, somatic psychotherapy and even therapeutic massage and bodywork. As more clients seek assistance in connecting how their bodies feel with how they feel about their lives, some counselors are diversifying their skill sets by adding body-centered competencies found to enhance more traditional counseling techniques.

Evolved from the work of Wilhelm Reich, body psychotherapy helps people recognize their bodily sensations while considering emotions and behavior. Body psychotherapists operate from the belief that all experiences are reflected in the way clients move, in addition to how they think and feel. Techniques vary but may involve meditation, deep breathing, appropriate touch and observation that invites clients to notice how their bodies react to certain thoughts and feelings.

Jesse Virago is a licensed professional counselor in Verona, Pa., who discovered body-centered work while exploring her own “stuckness” in a previous career. “I found body psychotherapy to be the most fascinating thing I had ever experienced, and I soon realized I had found my own work too,” she says. To become a “somatic psychotherapist,” Virago completed her master’s degree in clinical mental health counseling while also engaging in somatic and psychodynamic training. Additionally, she studied massage, bodywork, hydrotherapy and other therapeutic arts, including yoga and tai chi.

“I don’t think of a focus on the body in counseling and psychotherapy as a ‘technique,’” Virago says. “It is more of an understanding that what we call ‘mind’ is, in fact, a function of the body — the whole body, not just the brain or the head. Thus, psychotherapeutic interventions can and do occur at what the transtheoretical researcher and theorist Wilma Bucci, Ph.D., calls the ‘subsymbolic level,’ as well as the symbolic — verbal and nonverbal — level. Given my experience, interests and training, it’s natural for me to integrate attention to the body in psychotherapy sessions. What can be difficult is finding relevant, accessible, high-quality training.”

Virago has discovered that a wide range of clients can benefit from counseling techniques that incorporate the body. “[It] can be a natural for very physical people — dancers, athletes, actors, artists, yoga and other somatic practitioners, etc. Conversely, it can be extremely helpful for those who are very out of touch with their bodies and want to address that in therapy,” she says.

“Diagnostically speaking, I have found that both the general public and mental health professionals tend to assume that somatic psychotherapy is most appropriate for conditions with a clearly identified physical component like somatoform, pain or eating disorders, hypochondria or body dysmorphia. But I find somatic psychotherapy extremely useful for clients with mood and anxiety disorders, and especially well suited for addressing the effects of developmental and situational trauma.”

“Developmentally speaking,” she continues, “somatic psychotherapy can be especially helpful with issues originating in the first three years of life, many of which are preverbal but can be very effectively engaged with somatic interventions. In terms of situational trauma, working with the body can be invaluable in helping clients integrate and recover from traumatic experience.”

Jan Beauregard, an LPC and American Counseling Association member in Fairfax, Va., founded the Integrative Psychotherapy Institute of Virginia, where she serves as clinical director. She had long surmised that body memories could be part of her work with trauma survivors, but she didn’t possess a solid framework for incorporating body memories until she took part in a workshop by Pat Ogden in 2004 and learned about sensorimotor psychotherapy. For the next two years, Beauregard traveled to Boston to participate in intensive training weekends through Ogden’s Sensorimotor Psychotherapy Institute (SPI). Sensorimotor psychotherapy unites traditional, verbal counseling with body-centered therapeutic techniques to help clients face trauma, attachment and developmental struggles.

“The training was both didactic and experiential,” Beauregard says. “We had peer partners and process groups and extensive practice of the sensorimotor techniques throughout the training. One of the hallmarks of an excellent training for me is when I learn new things about myself through application of a new model. I knew immediately that sensorimotor psychotherapy would deeply inform how clinicians do trauma treatment.

“What I like about sensorimotor psychotherapy is that it incorporates what we have learned about the brain, mindfulness and neurobiology. Pat Ogden’s work has given clinicians a systematic and engaging way to help a client release the negative energies held in the nervous system as a result of traumatic experiences.”

Initially, Beauregard found it challenging to introduce sensorimotor techniques to clients who had what she calls a “very cognitive, left-brain orientation.” So, she found herself focusing on the psychoeducational tools provided in her training. When presented with Beauregard’s own enthusiasm for this method, “even the most reluctant clients were eventually willing to step into some of the simple experiments,” she recalls. “Once a client experiences relief or feels a new sense of empowerment, they are eager to learn more.” Beauregard also discovered that moving to a more spacious office and purchasing chairs with rollers that allowed clients to navigate the space based on their own “body wisdom” helped them become more comfortable with the work.

Body psychotherapists, because they are counselors, must be more careful with the use of therapeutic touch than, say, body workers who apply sensorimotor techniques. “The way I solved this problem was to explain to clients that I would be using props like pillows, balls and other objects and that, sometimes, these objects were used in the trauma processing,” Beauregard says. “I demonstrated a variety of scenarios in how the objects would be used so that changing to the sensorimotor method would not be perceived as too invasive or different from other treatment techniques.”

Beauregard says sensorimotor psychotherapy helps clients release blocked energies and then decode and process the nonverbal experiences of trauma. She also has found it effective in working with addictions, anxiety and depression because, she explains, these diagnoses often result in somatic complaints due to unprocessed traumatic experiences.

Virago plans to continue training in somatic psychotherapies and to explore how to incorporate movement into her work. “I found that engaging in somatic psychotherapy myself — ‘learning through the body’ — was a great way to begin,” she says. “If this work speaks to you, read everything you can on the subject, train in a variety of approaches, seek out like-minded colleagues, join professional associations, consult with experienced practitioners, but most importantly, experience somatic psychotherapy for yourself.”

Numerous options are available for those wanting to incorporate body-centered therapies into their counseling practices. Boulder, Colo.-based SPI offers three levels of training, with prices based on location. In addition to her SPI training, Beauregard also has studied the Hakomi Method, LifeForce Yoga, Yoga Warriors and other body-based healing methods. She notes that maintaining her skill set requires ongoing peer supervision, and she plans to continue participating in telephone consultations and webinars with the SPI trainers. “I am continually searching for other body-based interventions that I can add to my tool kit,” she says, “[because] I have found incorporating Pat Ogden’s method to be transformative in terms of my effectiveness with trauma clients.”

EMDR for trauma treatment

It’s difficult to ignore the role that trauma plays in our interpretation of modern life events. From the trauma of losing a spouse through death or infidelity, to losing the opportunity to become a parent because of infertility, to the rise of traumatic brain injury, trauma is at the core of many counseling interactions. It makes sense that more counselors are seeking tools for helping clients understand trauma and release the pain around it. Increasingly, many counselors are turning to eye movement desensitization and reprocessing (EMDR).

Francine Shapiro developed EMDR psychotherapy and went on to found the EMDR Institute, which offers training to therapists and spearheads research on the technique’s effectiveness. The approach has been shown to help clients look at their distressing memories and develop better coping mechanisms. Practitioners guide clients through eight phases of treatment, including history taking, stabilization, identifying distressing memories, considering negative beliefs about self and naming a preferred positive belief. The client is then asked to focus on the targeted memory, considering both the negative thoughts associated with it and any related body sensations, while following the therapist’s fingers as he or she moves them back and forth across the client’s field of vision for approximately 30 seconds.

This process is repeated throughout the session, with the goal being to make the client’s experience of the memory less and less painful. Eventually, the client will attempt to replace the negative memory with a preferred positive belief, gaining confidence in this belief as the process is repeated. Clients are asked to pay attention to both positive and negative body sensations throughout the session.

Martina Glasscock-Barnes, an ACA member and LPC with offices in Arden and Asheville, N.C., learned about EMDR while working with hospice clients grieving losses due to violent ends. “I researched trauma recovery techniques and saw that the numerous clinical studies conducted on EMDR clearly yielded the highest trauma-recovery results,” she says.

She decided to start training in EMDR, which took place over the course of two intensive weekend seminars. Once comfortable with the techniques, Glasscock-Barnes began introducing EMDR to clients who had been exposed to the traumatic or sudden death of a loved one. “I found my clients to be quite open to the modality,” she says. “It is a simple eight-step model and easy to explain to a potential recipient.”

Learning to work with her clients’ distressing arousal was more challenging, Glasscock-Barnes acknowledges. “Simply talking about the traumatic memories [is] emotionally triggering,” she says, “so the clinician has the challenge of eliciting the pertinent information, while helping contain and calm the client’s distress. For me, it helped that I had considerable experience as a meditation instructor and teaching self-soothing skills such as [dialectical behavior therapy]. … The clinician cannot move forward until she can help the client develop a fair ability to self-soothe. Due to this, we might need to spend many sessions teaching these skills. Eventually, the template [will be] created for the event, and we can move forward to the EMDR application of bilateral stimulation to the brain.”

EMDR training fees may vary. Shapiro’s EMDR Institute charges a total of $1,530 for the two basic training weekend workshops required for certification. Students also must complete 10 hours of case consultation with an approved supervisor. Glasscock-Barnes encourages her fellow counselors to make the investment to train in EMDR. “Money and time spent on learning this excellent technique will more than pay for itself in the results you will yield helping your clientele. I find that more and more, clients come to my practice seeking an integrative approach using modalities beyond traditional talk therapy,” she says, adding that EMDR has significantly accelerated the healing process for her clients. “Not only will your clients experience relief; they [will] have the opportunity to experience resolution. The fact that a client suffering traumatic flashbacks and nightmares could have lasting resolution is life changing. My own clinical experience is consistent with the studies that show treatment results are maintained over time.”

Judy Vellucci is an ACA member who works in private practice in Northville, Mich. She uses EMDR with clients who have been sexually abused, those who are adult children of alcoholics and those who experience anxiety or depression. “People with everyday issues can be helped significantly [by EMDR] too,” she adds. Vellucci has observed that those clients who are initially most fearful of the EMDR experience typically yield the greatest benefit from the process. “Counselors can expect good results, especially for those clients whom they have been seeing long term,” she asserts.

“EMDR release[s] the sights, sounds, feelings and emotions that are locked in a part of the brain and allows [clients] to process these things adaptively,” she says. “It has freed clients who have been stuck in life to move forward in their recovery. Truly, the outcomes have been amazing for many, many clients.” Vellucci, who says she is moving toward retirement, completed the EMDR training four years ago and says it has added excitement to her working life. “I only wish I had made the choice to do the training earlier,” she says. “Anyone who seeks to enhance their self professionally and help their clients at the deepest level should seriously investigate the benefits of EMDR.”

Mel Gardner, an ACA member in Scottsdale, Ariz., began EMDR training in 2005 while working for a nonprofit organization serving populations with severe mental illness. “My DBT [dialectical behavior therapy] and CBT [cognitive behavior therapy] training applied to this difficult population was effective without question,” says Gardner, an LPC. “However, what I found was that the continuously high levels of emotional arousal that maladaptive coping styles were driven by could be significantly reduced by addressing the early life challenges that established them in the first place. Sometimes, disturbing memories like a rape or abandonment can be targeted. Sometimes, childlike ‘rules to live by’ or conclusions about self or the world drawn out of chaotic parenting are better targets. Whatever appears to be driving the present dysfunction … directs what needs to be targeted.”

Gardner firmly believes EMDR can benefit anyone who is open to the process. Today, she introduces EMDR as an option during the second session with a new client. She estimates that 80 percent of her clients opt to try the technique. “Whether the target is outright panic attacks, nightmares and overwhelming anxiety, or habitual behaviors of avoidance or dependence on sleep, substances, food or destructive relationships, once the target is clearly defined, the work can begin and the differences can begin to take hold,”
she says.

All three practitioners recommend ongoing supervision and continuing education in EMDR. Gardner also believes that counselors who take the time to experience EMDR with an individual therapist will cultivate a deeper understanding of its power. “The most important piece in building my own proficiency,” she says, “was to get my own EMDR work done by a local professional who — I knew from having the training myself — used the protocol as it is taught and had the specialization that I myself was looking to learn for my own population.”

Emotionally focused therapy for couples

With half of all first marriages ending in divorce (according to the Centers for Disease Control and Prevention), counselors are sitting across from more and more couples these days. Although most graduate counseling programs offer some insights into working with couples as part of broad courses on family therapy, few counselors leave school with a fully developed understanding of how to work with couples facing disconnection, infidelity, parenting struggles and, potentially, divorce. One research-based approach attracting counselors is emotionally focused therapy for couples, known as EFT.

Developed by Les Greenberg and Sue Johnson in the 1980s, EFT is an empirically based treatment approach rooted in attachment theory that guides the partners in a couple in identifying their emotional attachment and dependence on each other. Following a short-term schedule of structured sessions (usually between eight and 20 appointments), EFT counselors aim to help couples create a secure bond while developing new ways of interacting as loving adults.

The International Centre for Excellence in Emotionally Focused Therapy (ICEEFT) administers training and certification of EFT therapists. Those seeking certification must be licensed psychotherapists who have had graduate-level study in couples or family therapy. Potential EFT therapists can follow two tracks to certification, including a mix of externships, skills trainings, and group and individual supervision totaling more than 70 hours. Therapists also are required to present videotapes of their work for supervision. Training fees vary, but most two-day training workshops cost around $700, while individual supervision and tape review can be $75 or more per session.

EFT practitioner Jack Childers, an LPC in Leesburg, Va., and a member of ACA, notes that the training process was not an easy one. Childers provided a new tape of himself working with a couple for each of the eight required individual supervision sessions and then submitted an application, including two DVDs showing his work, for final approval. He says the individual supervision and tape evaluation proved to be the most helpful part of his training experience. Today, Childers estimates that he uses EFT about 95 percent of the time when working with couples.

“Once the EFT concepts sunk in for me, I found it pretty hard to [use other approaches with couples],” he says. “I also find myself thinking in EFT terms quite a bit in my work with individual clients. I think that in a way similar to intimate partner relationships, people often struggle with fear and pain when they try to connect with aspects of themselves.” Childers and a colleague currently are co-leading an EFT couples group that has been getting positive reviews. He says counselors learning to use EFT can expect to see their couples clients develop a safer and more secure emotional bond.

After visiting eight different couples therapists early in her marriage, Jenny Proudfoot longed to find an approach that would help her feel more connected to her partner rather than just resolve surface issues such as problem-solving and conflict management. She also left a job in the corporate world to study counseling but encountered EFT only after graduating from her program. Today, Proudfoot is an EFT therapist and ACA member practicing in Charlotte, N.C. “I would be lying if I said there is anything easy about learning EFT,” she says. “One needs to view it as a lifetime commitment to learning. It is such an experiential approach that it makes it far more challenging to master than some of the more cognitive approaches.”

Proudfoot plans to continue participating in EFT training opportunities and supervision while also connecting with EFT professionals nationwide through a Web-based message board. “[Learning EFT] is definitely not for the faint of heart. It takes a huge time commitment and is very challenging, but when you see your couple’s [conflict] magically begin to de-escalate and are able to help them create a safe haven, it makes it all worthwhile,” she says.

ICEEFT notes research suggesting that 70-75 percent of EFT couples move from distress to recovery, but the organization says the approach is contraindicated for couples experiencing “ongoing violence in the relationship.”

Childers adds that significant addiction issues and emotional abuse also may impede EFT’s efficacy. “Other contraindications, I believe, include cases where one of the partners has already decided they want out of the marriage and is coming to couples counseling for reasons other than wanting to save the marriage, such as to appear to have done ‘everything possible.’ This is fairly common but, unfortunately, not very easy to assess,” he explains. “Clinically, once EFT has started, some partners are unable to focus on the pattern of interaction they have with their partner and stay with the narrative that the other partner is ‘the problem.’ These cases do not resolve successfully.”

Both Childers and Proudfoot recommend that anyone interested in EFT start with some of Sue Johnson’s publications, including the books Hold Me Tight and The Practice of Emotionally Focused Couple Therapy: Creating Connection.

Neuroscience: Banking on the brain

One topic creeping beyond the borders of counseling and into popular culture is neuroscience and its potential impact on happiness and well-being. Clients are walking into counseling armed with their own studies and expectations about neuroscience and its implications for their lives. According to ACA members Mary Bradford Ivey and Allen Ivey, both well-known professors and authors in the counseling field, this shift should be both exciting and motivating for counselors. Their recent live webinar describing neuroscience as the “cutting edge of counseling’s future” (see counseling.org/Resources/Webinars.aspx) was one of the most popular webinars ACA has produced thus far.

“The popular media is almost forcing neuroscience on counseling, psychology and medical practice,” Bradford Ivey says. “Almost every day we now read about exciting new research. And our clients are reading the same stories and watching it happen on television. Clearly, neuroscience represents a paradigm change and the cutting edge for the future. Neuroscience has vast implications for counseling practice. And, frankly, this is fascinating material. It draws our attention, and then we want more. The scientific literature is astounding, enriching and growth-producing, with many immediate, practical implications.”

Specifically, the Iveys point out that neuroscience has provided data-based evidence for what counselors have believed for decades: that the counseling process can change the human brain. “Millions of new connections — synapses — are gained and lost each day. Effective counseling strengthens positive connections, and new ideas produce new neural connections,” says Ivey, explaining the concept of neuroplasticity. “Neuroscience provides a new, broader and practical scientific base for counseling and validates what we have always done. We now have scientific evidence for empathy’s concrete existence.”

The counseling field’s tendency toward social justice is also supported by neuroscience, Ivey notes. “The best research that we’ve seen supporting the need for social justice comes from neuroscience. Poverty, child abuse, violence [and] bullying all impact our children and adolescents in negative ways, destroying neural connections and permanently shrinking brain size. But, fortunately, a wellness approach coupled with a positive, stimulating environment is able to build resilience for many of our clients,” he says.

As such, the Iveys now teach workshops on “brain-based counseling,” which emphasizes the counselor’s role in helping clients create “change goals” that can strengthen the power of the prefrontal cortex to override the negative feelings streaming from the separate amygdala and limbic system. “Our task is to shore up and strengthen the positive versus the negative,” Ivey says, noting that exercise and meditation have been shown to increase the brain’s gray matter.

The ultimate goal is not to ignore the negative emotions created in the limbic system and amygdala, however. “While we need to focus on positive emotions and strengths, we still need to support appropriate reactions to fear,” Ivey advises. “For example, some abused women ‘think’ [using the frontal cortex] that their abusive partner will straighten out. In this case, we need to use both natural fear plus cognitive reframing to help this woman move out on her own. And social support is needed. Neuroscience reminds us that we are social animals, and we cannot and should not leave clients alone to drift.”

The Iveys believe the blending of traditional counseling techniques with brain-oriented psychoeducation and interventions will become well established in the next 10-20 years. They point to the National Institute of Mental Health’s efforts to institute a brain-based approach to counseling that will create criteria for multidimensional diagnosis, integrating medicine, developmental psychology and multicultural issues with neuroscience.

“Neuroscience represents a paradigm shift for counseling and psychology,” Ivey notes. “Our teaching and research is already changing. Our curriculum and textbooks will as well. Very shortly, practitioners will be discussing with their clients how counseling and stress management have the potential to change the brain. This will become important in motivating clients to act on and take home discoveries made in the interview. With neuroscience, we will become more accountable and results oriented, but still aware that empathy, listening and our existing modes of practice remain central.”

Counselors in particular may be better suited to incorporating these changes into their work, according to Bradford Ivey. “The counseling profession is potentially ahead of other more pathology-oriented helping professionals such as psychologists and social workers due to our long history of a positive wellness approach,” she says. “However, recently we have partially succumbed to the allure of DSM [the Diagnostic and Statistical Manual of Mental Disorders], and we continue an emphasis on theories that focus on client ‘problems.’ It is time to discard that word and substitute ‘issue,’ ‘concern,’ ‘challenge’ and ‘opportunity for change.’ Neuroscience speaks so clearly to the importance of a wellness and positive approach. We need to adopt neuroscience findings and show the world that counseling and wellness is what is needed for the future.”

One way counselors already may be incorporating the benefits of neuroscience into their work is through efforts to help clients make what the Iveys call “therapeutic lifestyle changes” (TLCs). Examples may include establishing a healthy exercise routine, practicing meditation, getting more sleep, improving nutrition and seeking cognitive challenges. Other TLCs may require the subtraction of certain behaviors, such as being sedentary, consuming junk food, watching too much television, spending too much time in front of a computer or being too set in an unchallenging routine.

“The TLCs need to become central in counseling practice,” Ivey says. “These key elements of mental health are insufficiently stressed in our books and training systems. We can help both our clients’ brains and their bodies through this move to wellness.”

The Iveys recommend that anyone interested in learning more about neuroscience start by reading John Ratey’s book Spark: The Revolutionary New Science of Exercise and the Brain. They also suggest studying the work of Daniel Siegel, Jon Kabat-Zinn and Louis Colozino. They credit Robert Sapolsky’s lectures (available through The Teaching Company at thegreatcourses.com/greatcourses.aspx) with launching their own interest in neuroscience.

Integrative models: Finding your own perfect blend

With so many opportunities and avenues now available for learning new counseling theories and techniques, it’s growing increasingly rare for counselors to limit themselves to a single theoretical system. Many counseling graduate programs require students to explore and incorporate a variety of theories as they develop their own individual approaches. Gerald Corey, professor emeritus at California State University at Fullerton, is a psychologist, author and ACA fellow who has devoted his life and work to helping counselors and students develop their own blended orientations. His reasoning is simple: Individual clients come from a variety of backgrounds, and counselors need to possess the skills and experience to meet them right where
they are.

“One reason for the current trend toward an integrative approach to the counseling process is the recognition that no single theory is comprehensive enough to account for the complexities of human behavior when the full range of client types and their specific problems are taken into consideration,” Corey explains. “Most counselors now acknowledge the limitations of basing their practice on a single theoretical system and are open to the value of integrating various therapeutic approaches. Those clinicians who are open to an integrative perspective may find that several theories play crucial roles in their personal approach.”

In the process of uncovering their own integrative approaches, Corey suggests that counselors study all of the theories and accept that each theory has strengths and weaknesses, particularly when it comes to working with clients from different cultures and backgrounds. “Each theory represents a different vantage point from which to look at human behavior, but no one theory has the total truth,” he says. “Because there is no ‘correct’ theoretical approach, it is [best] for students to search for an approach that fits who they are and to think in terms of working toward an integrated approach that addresses thinking, feeling and behaving. To develop this kind of integration, students need to be thoroughly grounded in a number of theories, be open to the idea that these theories can be unified in some ways and be willing to continually test their hypotheses to determine how well they are working.”

Corey stresses that creating an integrative approach is no easy task. It is a mistake, he contends, to “simply pick pieces from theories in an unsystematic manner or based upon personal whim.” Rather, developing a blended theoretical orientation requires significant thought about the compatibility of certain theories. Corey emphasizes that it is not a method for avoiding committing to one direction or another.

“Attempting to practice without having an explicit theoretical rationale is like flying a plane without a flight plan. If you operate in a theoretical vacuum and are unable to draw on theory to support your interventions, you may flounder in your attempts to help people change,” he says. “Ultimately, the most meaningful perspective is one that is an extension of your values and personality. Your theory needs to be appropriate for your client population, setting and the type of counseling you provide. A theory is not something divorced from you as a person. At best, a theory becomes an integral part of the person you are and an expression of your uniqueness.”

Corey, who says he personally has been influenced by the existential and person-centered counseling approaches, among most of the other contemporary approaches, recommends that counselors master a primary theory that can serve as their foundation and that exemplifies their own beliefs about human nature and the change process. “Take the key concepts of several theories that have personal relevance for you and apply these ideas to your own life,” he says. “What aspects of the different theories would most help you as a client in understanding yourself?”

“Personally, I do not subscribe to any single theory in its totality. Rather, I function within an integrative framework that I continue to develop and modify as I practice,” he explains. “I draw on concepts and techniques from most of the contemporary counseling models and adapt them to my own personality and therapeutic style. My conceptual framework takes into account the thinking, feeling and behaving dimensions of human experience.”

Continuing education and ongoing supervision are particularly beneficial in helping counselors to articulate the rationale for the techniques they choose, Corey says.

“Don’t adopt ideas without first putting them through your personal filter,” he says. “As you experiment with many different counseling techniques, avoid using techniques in a rigid or ‘cookbook’ method. Techniques are merely tools to assist you in effectively reaching your clients. Personalize your techniques so they fit your style, the needs of your clients, and be open to feedback from your clients about how well your techniques are working for them.”

Noting the importance of client/counselor attunement, Corey adds that experienced counselors are able to assess what is happening in the counseling room and then adjust their interventions to meet the client’s unique needs. “Perhaps the best way for a new professional to develop this ability is to be committed to listening to how clients perceive and react to their experience in counseling,” he says. “Counselors need to educate clients about the importance of their active participation in the process … and one way of being active is being a collaborator with the counselor and providing honest feedback on what they are getting from the counseling.”

By investing in continuing education and challenging one’s self through career-long supervision, a counselor’s active skill development truly can be a reflection of her or his own evolution as a human being, Corey says. “Continue reflecting on what fits for you and what set of blueprints will be most useful in creating an emerging model for practice,” he says. “Although you will have a solid foundation consisting of theoretical constructs, realize that the art of integrative counseling consists of personalizing your knowledge so that how you function as a counselor is an expression of your personality and life experiences. No prefabricated model will fit you perfectly. Instead, your task is to customize a counseling approach, tailoring it to fit your personality and the needs of your clients.”

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

Letters to the editor: ct@counseling.org

Judge throws out counseling student’s suit against Augusta State

By Heather Rudow June 28, 2012

(Photo: Flickr/Sir Mildred Pierce)

A federal district court in Georgia dismissed a case from a former Augusta State University counseling student, ruling that school officials did not violate the First Amendment when asking her to complete remedial training in response to her statements about counseling homosexual clients.

Jennifer Keeton sued the university in 2010 after being told by faculty that, unless she completed a remediation plan, which included attending diversity workshops and reading articles about counseling GLBTQ students, she would have to leave the program, Student Press Law Center reports.

Keeton was ordered to participate in remedial training based on comments she made about homosexuality in and out of the classroom, including suggesting that she would use reparation therapy when counseling.

Though originally agreeing to the plan Keeton withdrew her consent, citing her religious beliefs.

“I really want to stay in the program,” she wrote to faculty in an email, “but I don’t want to have to attend all the events about what I think is not moral behavior, and then write reflections on them that don’t meet your standards because I haven’t changed my views or beliefs… My biblical views won’t change.”

The American Counseling Association opposes the use of reparative therapy for homosexual clients.

“From the American Counseling Association’s perspective this is very much the right decision, says ACA Chief Professional Officer David Kaplan on the judge’s ruling. “It supports the ACA Code of Ethics as well as CACREP guidelines.”

The decision supported the role of the ACA Code of Ethics, cited by ASU, as the professional standard that governs how counselors should approach and work with clients and avoid using their personal beliefs in an influential manner.

The case echoes an earlier ruling in a case involving an Eastern Michigan University (EMU) counseling student, who claimed she was unfairly dismissed from the counseling program after refusing, on religious grounds, to counsel a homosexual client. The judge in the case rejected the lawsuit, holding that EMU was reasonable in its requirement that counseling students be able to serve homosexual clients and dismissing that her religious and speech rights were violated.

However, Kaplan says, lawmakers are retaliating by passing conscience clauses, legislation which seeks to ensure that professional therapists – including licensed professional counselors – won’t lose their licenses for denying services on religious grounds. The latest state to do so is Arizona, which recently enacted Senate Bill 1365.  ACA wrote to Arizona Governor Jan Brewer urging her to veto the legislation, but she signed the bill into law this last May.

“What Arizona lawmakers don’t seem to grasp is that counseling is about the client and their needs, not the counselors’,” says Scott Barstow, director of public policy and legislation for ACA. “There are lots of different religious beliefs out there, and yours or mine isn’t the only valid one.”


Universities of Malta, Maryland enhance students’ transcultural competencies through joint degree program

Heather Rudow June 1, 2012

The importance of developing culturally competent counselors has never been greater. As the world becomes increasingly interconnected because of technology, economic and business initiatives, pop culture and professional opportunities, cultures are less and less segregated. The likelihood of daily encounters with individuals from other countries or with different ethnic backgrounds is high, meaning counselors no longer can depend on having shared cultural experiences with their clients.

A joint Masters of Arts degree program in transcultural counseling between the University of Malta and the University of Maryland is aiming to prepare the next generation of counselors by teaching students how to work successfully in a variety of contexts, free from cultural biases.

The joint transcultural counseling program is the brainchild of Dione Mifsud, head of the psychology department at the University of Malta, a member of the American Counseling Association and current president of the International Association for Counselling (IAC), and Courtland Lee, a professor of counselor education and school counseling at the University of Maryland and a past president of both ACA and the IAC.

“I had … in mind for sometime that we would have a program with an international flavor,” Mifsud says. His idea took further shape after meeting Lee at an international counseling conference in Malta in 2008. Mifsud then proposed the idea to Lee at the ACA Annual Conference in Charlotte, N.C., in 2009.

The University of Malta had other international joint degree programs in place, Mifsud says, but nothing in the counseling field. Mifsud and Lee began working on a proposal for a joint master’s degree in transcultural counseling between the University of Maryland and the University of Malta, and the program was officially formalized in July 2011.

The first cohort of 14 students — hailing from Malta, Finland, Germany, China and the United States — began in the fall of 2011. When they graduate, they will receive degrees in counseling from both universities.

“What we told them we expect,” Lee says, “is that they will have the transcultural competencies to be world counselors, that they’ll be able to go to any country and adapt their worldview to the cultural context of that country and be good counselors.”

Generally speaking, Mifsud says, transcultural counseling focuses on the bridging of different ethnic cultures. That is not the only thing the program is trying to accomplish, however. “We’d like our counselors to be able to deal with not just ethnic realities, but daily [differences between cultures],” he says. “Each client brings a different culture with him.”

The 18-month joint master’s program is based out of the University of Malta in Valletta and is taught by professors from the United States, Malta and the United Kingdom. Mifsud believes the variety in the teachers’ cultural backgrounds enhances the transcultural element of the program.

The course provides students with training in counseling while also allowing them to “assimilate a broader view of the sociocultural context surrounding counseling,” according to the University of Maryland’s website describing the program.

Students must complete course work, a practicum (done in the country of the student’s choosing) and a final paper. The aim of the program, as described by the University of Maryland website, is to provide the students with “a wider exchange of cultural viewpoints and experiences surrounding contemporary counseling theory and practice.”

There is also something of a political aspect to the program, Mifsud acknowledges. Upon completing the program, he hopes graduates will be able to think transculturally and potentially influence political organizations such as the United Nations and organizations with social justice missions to operate in ways that will positively enhance all cultures.

Mifsud has an idea why more students are choosing to focus on transcultural counseling. “It has to do with counseling becoming a global phenomenon, and also an increased focus on international issues [in society in general], not just in counseling,” he says.

Lee agrees, adding that social justice and transculturalism have become hot topics in modern society and are increasingly relevant for counseling students.

The program dovetails the prevalence of internationalism in the world and in counseling by having the students complete their internships in unique, transcultural settings, from schools to organizations that house immigrants to jails.

Anabel Mifsud (no relation to Dione), research officer and administrator for counseling programs at the University of Malta, explains that it is important for counseling students to intern in settings such as jails because “[prisoners] are marginalized and quite different from the general population, and there are many foreigners there as well.”

Anabel believes transcultural counseling will continue to become more relevant over time. “I think increasingly we are living in a transcultural environment,” she says. “People are moving from one place to another, and we’re seeing a large influx of immigrants, especially in Malta.”

The diverse student cohort in the program in Malta further enhances the ideals being taught in the classroom, Anabel says. “The transcultural element is manifested through these students coming from different countries,” she says.

Student Anders Granberg, a member of ACA, is but one example of the culturally diverse backgrounds found within the program. He is from Finland but has also lived extensively in Hong Kong.

He says studying with students from other countries has helped him learn in ways he would not have otherwise. “They bring their own flavor from wherever they’re from,” Granberg says, “[which affects] how they react to counseling and different aspects of counseling.”

Granberg’s own transcultural background, as well as the growing multiculturalism he has witnessed throughout the world, inspired him to study transcultural counseling. “It interests me a lot and was one of the reasons I got into counseling in general,” Granberg says. “People cross into different cultures all the time and don’t always understand what’s going on. That’s something I understand [in relation to] my own life, and I want to help others with that as a counselor.”

So far, his favorite course has been “Multicultural Counseling,” which was taught by Lee. “It allowed us to reflect on our own cultural elements, and not just our ethnicities, but our genders and other abstract things,” Granberg says.

As Lee explains, “It is basically a modified course that I’ve been teaching in the U.S. for the last 30 years. When you teach a multicultural course in the United States, there is always a focus on race and ethnicity, but that is not the case when teaching the course internationally. [For example], there is a focus on religion [in the class here] because that is a big issue here in Malta. We talked about culture in a much broader, more global sense.”

Student Suelle Micallef Marmara, who is from Malta, says Lee’s class and the other courses she has taken have already altered her worldview. “I’m becoming more transculturally aware, and I’m noticing more conflicts between other cultures and when people don’t integrate with other cultures,” she says.

Marmara believes the transcultural counseling program will prepare her to stay much more open-minded with her clients as she becomes a licensed professional counselor. “It will help me be more aware, be less prejudiced and put less space between [myself] and a [client], which ultimately helps [me] become a better counselor,” she says.

Wenjiao Zhang, a student from China, agrees. “This program changed my views in many ways, [including] how I see perspectives in general,” she says. “For example, I didn’t see how local healing practices could be used as part of counseling practices … but now my eyes are open.”

Victoria Garcia, a student from the United States, says one of the most effective aspects of the program for her is that she is studying abroad for it. “I don’t think it would be as beneficial if it was in the United States,” she says. “And now I’ve made friends from all over the world that I’ll keep in touch with as I continue on this journey to become a counselor.”

Garcia says the program has encouraged her to further develop her views, both transculturally and introspectively. For example, she has come to understand that she struggles to identify with her own ethnic culture, but her courses are helping her to reconcile this aspect of her life. Getting to know one’s self better will only serve to enhance one’s competencies as a counselor, Garcia says.

Garcia is grateful to be experiencing the program, not only because she will graduate with two degrees, but because the program is offering knowledge that she believes will be key to the evolution of the counseling profession.

“I think it’s important to be culturally competent and globally literate,” Garcia says. “I’m not saying you have to be an expert in every culture, but if you don’t understand a little bit where somebody’s coming from, it’s hard to connect.”

 Heather Rudow is a staff writer for Counseling Today. Email her at hrudow@counseling.org.

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A loss like no other

Lynne Shallcross

Imagine this scenario: You are a counselor, and you have two clients. They are the same age and same gender, and both experienced the death of a partner at roughly the same period in life. So, you can reasonably expect that both will have similar reactions to that parallel loss and both will benefit from similar counseling techniques to deal with the residual grief, right? Not likely.

In fact, says Vincent Viglione, an adjunct professor of counseling at Kean University and Montclair State University in New Jersey, one of the most important things for counselors to understand about grief and loss is that although the experience of loss is universal, every individual’s grief process is unique. “We as counselors recognize that certain client responses are not necessarily pathological,” says Viglione, who is doing his doctoral dissertation on adult sibling grief and continuing bonds at Montclair State. “As such, we attempt to normalize our client’s feelings. In doing so, however, we must preserve the idea that their circumstance is unique to them. Normalizing, then, is never saying, ‘You’re just like everyone else.’”

Keren Humphrey, a retired professor of counseling at Texas A&M University-Commerce, agrees about the unique nature of each person’s grief experience, not only because of her work with clients but also because of her own experience with grief and loss. “In the last two years, I have experienced a number of significant losses, including breast cancer with a double mastectomy, my husband’s extended illness and death, [and] my mother’s decline from Alzheimer’s and her death only a month after my husband’s death,” says Humphrey, whose book, Counseling Strategies for Loss and Grief, was published by the American Counseling Association in 2009. “These experiences have certainly reiterated my view that each person’s experience of loss and grief is unique. The meanings I attach to my losses and my ways of grieving are specific to me.”

Understanding that notion of uniqueness and applying it in session as a counselor means there is no one “right” approach to grief-related counseling work, Humphrey asserts. Rather, to work effectively with these clients, practitioners must be capable of drawing from a variety of counseling skills and techniques and tailoring a therapeutic approach that is custom fit to the client’s specific personality, situation and needs.

A good starting point for counselors is to take the role of “witness” and realize that the client is the expert, Humphrey says. “It’s a time for you to shut up and facilitate the client in telling [his or her] story. We too often in counseling jump too quickly into reflecting feelings and attending and worrying about the next thing we’re going to say to the client. That interferes with [clients] telling their story. Back off of those automatic responses and just allow clients to tell their story of loss.”

A loss is the absence of something we deem meaningful, Humphrey explains, while grief is our response to that sense of loss. People normally associate loss with the death of a family member or close friend, but it can also be inclusive of the loss of a house, a relationship, a job or any number of other things. Sometimes, says Anne Ober, an assistant professor in the Department of Counseling and Human Development at Walsh University, it can even be the loss of a particular feeling. For instance, Ober points out that after 9/11, even people who weren’t directly affected by the terrorist attacks might have felt a loss of the sense of security they had presumed previously.

Elizabeth Doughty Horn, an assistant professor in the Department of Counseling at Idaho State University, says grief can also stem from the loss of expectations that weren’t met. From the outside, to those observers who aren’t experiencing the loss personally, the loss might not appear particularly significant — for example, a high school student failing to make the cheerleading squad. Many of the losses people experience are disenfranchised, Horn says, meaning they aren’t recognized or appreciated as losses by society. Hallmark doesn’t make cards for disenfranchised losses, she notes.

In some instances, only certain aspects of loss get recognized, while other often more complicated aspects go overlooked. Consider a person recently diagnosed with cancer. “Once someone has been diagnosed with cancer, his or her identity is often linked with the disease,” says Horn, a member of ACA who has researched, published articles, taught classes and presented at conferences on the topic of grief and loss. “The bulk of their day-to-day life is spent focused on cancer — scheduling, getting to and from doctor appointments, reassuring well-wishers, letting people know about their illness, processing their own emotions as well as their family’s. Obviously, people acknowledge grief and loss associated with getting cancer, but they may not view it in terms of the loss of self.”

Many times in cases of disenfranchised loss, clients themselves don’t recognize the issue as one deserving of feelings of grief. They come to a counselor saying, “I shouldn’t be so upset about this,” Horn says. One of the most helpful things counselors can do is to acknowledge the extent of the losses clients have experienced and assist them in connecting the way they are feeling with those losses.

Even in situations in which loss is generally recognized by society at large, counselors say it is common for clients to come into counseling feeling unsure about why they are struggling. “It happens so often,” Horn says. “People come in and recognize there has been a major change, but they’re not seeing it in terms of grief. They might say, ‘I know I lost my job, but I have a new job, so why am I still focused on the job I lost a year ago?’”

Society often emphasizes getting over things and moving on, Horn says, but in many situations of loss, the process of “getting over it” doesn’t happen quickly, if ever. One of the newer trends in grief and loss counseling is the rejection of the idea of “closure” as a completed process, Horn says, especially as it relates to death. But many times, she says, clients either think they should be “over” something already or they don’t even recognize that their pain stems from an issue of grief and loss.

“I believe that once counselors begin to view transitions in terms of grief and loss,” Horn says, “they really won’t have to look for these issues in their clients. Rather, they will see an aspect of them in almost every client issue. I’m not suggesting that everything in life is grief and loss — how depressing — but there can be an element of these in much of day-to-day life in varying extremes.”

Viglione, an ACA member who runs a private practice in Denville, N.J., agrees. “For every client that I see, I find an element of loss in what they’re presenting if I look closely enough.”

Stepping away from the stages

Counselors say one of the more significant changes in the area of grief and loss counseling in recent years has been the move away from using Elisabeth Kübler-Ross’ stages of grief model. Ober, a member of ACA who has researched, counseled and taught on the topic of grief, points out that Kübler-Ross herself said her stages were misapplied and that she originally designed them to be used with individuals coming to terms with their own death. Although Kübler-Ross’ work was very beneficial and started a larger societal conversation about death and dying, Ober says applying the stages to clients going through grief and loss isn’t very helpful and in some cases can even be harmful.

The problem is that the stages model doesn’t fit everyone’s experience, Horn says, especially in light of how each person’s reaction to loss is unique. Humphrey agrees, saying the model suggests that everyone experiences grief the same way. “That just simply is not true,” Humphrey says. “It does not respect the differences among people in terms of personality, social-cultural influences and that kind of thing. We need models that allow us to focus on uniqueness of people. It also ignores process. Instead, we need to understand that clients are in a process of adapting, renewing and reviewing. They’re in a process, not in a stage.”

Horn says research conducted on how the stages were used in therapy has shown that counselors were doing harm to some clients by trying to shoehorn them into stages. For example, if a client wasn’t having the particular experience the counselor thought he should be having according to the stage model, the client may have tried specifically to have that experience, she explains. “And that’s when people get into trouble — when they’re not following their own natural process, when they try to do something that doesn’t fit into who they are,” Horn says.

The stages also gave the impression that if clients went all the way through each of the stages — denial, anger, bargaining, depression and acceptance — they would encounter an end point to their grief, Horn says. “But grief is an ongoing process of adaptation,” she says. “The idea of closure is no longer seen as being possible for most people. Rather, it’s ‘How do I adapt or integrate this loss into who I am and into everyday life?’”

Humphrey again emphasizes that the trend in grief and loss counseling in the past decade or two has been toward realizing there is no one-size-fits-all model or therapeutic approach to helping clients. “Instead, the counselor helps clients focus on useful material and implements therapeutic strategies appropriate to the uniqueness of a given client,” she says. “For example, I would use nondirective methods with a client who is uncomfortable with more directive approaches. I might use narrative therapy strategies to help a client explore cultural influences and later use solution-focused or behavior-based strategies for specific problems or to increase awareness of personal strengths for the same client. I might use cinematherapy to highlight multiple issues, but not with people who hate movies. It is important that counseling professionals remember that effective grief counseling is not about the counselor’s specialty. … Rather, it is about selecting and adapting various therapeutic approaches to the particular needs, preferences, personal history, grieving style and multiple contexts of a given client. Using only one approach with every client is ineffective and, worse, very disrespectful.”

Go with what’s natural

The main goal in working with clients who have experienced a loss is to help them experience and express their grief in the style that is most natural to them, Horn says. That might mean encouraging clients to disregard outside influences or the internal “shoulds,” she says. For instance, a person who has just experienced the death of a loved one might get the message from his church that the death was “meant to be” and that it is time to let the person go. “Maybe that ends up making the client feel they should be happier this has happened or that they shouldn’t be feeling so sad,” Horn says. When clients refer to what family members, their religious community or some other outside influence thinks, Horn suggests counselors raise clients’ awareness of this and ask what they are experiencing.

Helping clients find their natural grieving style starts with listening to them and supporting what they say they’re thinking or feeling. “A client might say, ‘I’m really sad, but I haven’t cried and I feel guilty for not crying. I’m more focused on the logistical details of what led up to the person’s death,’” Horn says. “So we try to help foster that rather than putting pressure on them to cry or telling them that they’re in denial.”

In fact, Horn says, one of the newer models some counselors are using in loss and grief work, the adaptive grieving styles model from Terry Martin and Kenneth Doka, recognizes that certain clients will be more affective in their grieving style, some will be more cognitive and others will find themselves along the continuum in between. Understanding that different grieving styles exist and encouraging clients to grieve in the way that’s most natural to them is key, Horn says. For instance, grief groups are often helpful to affective grievers, who might want to share and cry with others, she says. On the other hand, cognitive grievers might want to focus on problem-solving associated with the loss and could find talking about the loss repeatedly with a group to be overwhelming.

“Counselors use this model to help better conceptualize and work with clients,” Horn says. “They educate clients about the uniqueness of grief and help them to identify their personal style, [which is] usually blended, with one more prominent than the other [affective versus cognitive]. This helps to normalize their natural style and helps to remove some of the perceived pressures to grieve in a particular way. Counselors can then use techniques that complement a client’s predominant style, allowing them to experience and express [their grief] more naturally.”

Horn also mentions Margaret Stroebe and Henk Schut’s dual-process model as potentially beneficial because it focuses on different aspects of the loss. It looks at both loss-oriented stressors, which deal with thoughts and feelings related directly to the loss, and restoration-oriented stressors, which refer in part to the life roles that have been changed after the loss. The model suggests that people experiencing a loss will oscillate between the two, Horn says.

Ober’s take on the dual-process model is that people need to move between the emotional impact of the loss and the day-to-day logistical impact of the loss. For example, a recent widower might have an intense emotional response in which he cries and talks about his deceased wife, but he may also have to figure out how to cook because she previously prepared all of their meals. “What this theory suggests is that it’s healthy for the person to move between those two [responses] and have a balance,” Ober says. “People who are able to do both fare better in the long run than people who focus on one or the other research shows.”

Meaning-making, which Robert Neimeyer, Thomas Attig and Michael White have researched, is another potentially helpful concept, Ober says. It provides a way of helping clients determine what the loss means to them in their life and their life story, she says, and has similarities to narrative therapy. However, Ober says, counselors need to let clients guide them before using this technique. Clients need to indicate on their own in some way that they are trying to make sense of why the loss happened and what it means to them. “That won’t be the case for everyone,” Ober says. “You shouldn’t apply it unless your client is really at that place.”

Ober also points to continuing bonds theory as potentially helpful. The theory is in contrast to Sigmund Freud’s idea that a person needs to cut ties with whomever has died and focus instead on the here and now. The continuing bonds theory suggests that a person who has lost a loved one can still have a nonphysical relationship and some sort of communication with the deceased person. Letter writing, putting up photos at home, returning to a special place that was important to the deceased person and celebrating the deceased person’s birthday or death anniversary are a few examples of ways to continue the bond, Ober says.

Viglione recommends William Worden’s tasks of grief approach as another potential tool for helping grieving clients. The tasks take clients through accepting the reality of the loss, working through the pain of the grief, adjusting to the new environment and reinvesting in life.

A life story that continues

Humphrey says helping clients to explore and tell their story of loss is important, as is helping them create a new story of who they are today. “Sometimes people can be stuck with their old story, looking at the past as if time stops,” Humphrey says. “They’re living physically in the present and the world is moving on, but they’re stuck. That brings them into counseling. What you’re trying to do as a counselor is help them create a narrative that builds onto their old story by taking into account their losses.”

“Creating a post-loss story of one’s life involves making sense of the losses; dealing with disrupted beliefs, assumptions and expectations; and developing revised but enduring bonds with the loss object,” she continues. “Many clients respond positively to simply introducing the notion of building or creating a post-loss story, so it becomes an ongoing theme in treatment. Thematic genograms, therapeutic writing, objections of connection, loss timelines, decisional balance, client-generated metaphors and wisdom letters are particularly useful strategies here.”

The difference between primary and secondary losses is an important distinction for counselors to make, Humphrey says, and one that can help guide the course of treatment. For example, in a scenario in which a client’s spouse has died, the primary loss is the spouse. The secondary losses might include companionship, a sexual partner and expectation of a future together. “The secondary losses are really the guts of the loss, and that’s where the focus of counseling should always be,” Humphrey says. “When you focus on the secondary losses, it helps you understand what the client sees as meaningful and what should be addressed in counseling.”

“Counseling professionals focus on secondary losses because this reveals the unique meanings, influences, individualized adaptive processes, client strengths and potential problematic issues that constitute client grieving,” Humphrey continues. “I ask a lot of open-ended questions that invite exploration and that recognize the client as the expert on their grief. ‘What does that mean to you? Tell me what works and doesn’t work for you. What feelings/thoughts/behaviors go with this or that? What should I know about you that will help us understand your experience? Tell me the story.’ Their responses provide clues to potential issues and direction for therapy.”

Jane Newman, an ACA member who runs a private practice in Portland, Ore., says one of the first steps she takes with grieving clients is to validate their loss and express empathy for the difficulties they are experiencing. Counselors have to be sure never to minimize or diminish a client’s loss in any way, she cautions.

After validating their loss and pain, Newman says she asks clients, “Now what?” In her current caseload, Newman has a male client recently diagnosed with terminal cancer. He is a respected scientist who has been forced to sideline his career because of the cancer. “He’s mad and unhappy because within weeks, his whole identity changed,” says Newman, who previously worked as a hospice counselor and in a cancer center as a bereavement counselor. “As a scientist, he doesn’t operate much on a feeling level. He’s mad because he’s not productive right now. I need to honor that and talk to him about how that must feel and not try to take any of those feelings away. And then the [conversation] is, ‘So, now this is part of your life too. This is a new phase of your life. Let’s talk about what you think you might want from this part of your life.’ I want to help him identify those things so that he can get closer to making this part of his life productive, even if that means having some wonderful conversations with his family. I wouldn’t say, ‘How do you make the most of it?’ I would say, ‘Let’s talk about what you might want from this part of your life.’”

Newman says part of a counselor’s role in working with clients who are experiencing loss and grief is to illuminate the strengths and support systems they might be overlooking. Ask how they have coped with stressors in the past and what has helped them get through hard times before, she says.

When grief and loss hit close to home

Of course, counselors aren’t immune to experiencing loss and grief in their own lives. Dealing with that reality goes hand-in-hand with all types of counselor self-care, Horn says. “We need to be acknowledging our own grief and loss and allow ourselves to have that unique experience and expression,” she says. “We tend to feel that we’re above it all or should be immune to losses. We also tend to believe that as counselors, we’re supposed to be so together and that with all of our coping skills, we’re not supposed to hurt.” These misguided beliefs can lead counselors to discount their own grief and loss, Horn says, even as they carefully guide clients to do otherwise.

One of the best things counselors can do is to raise awareness of their own loss histories and their thoughts surrounding grief and loss, Ober says. Ober uses an exercise from Humphrey’s book, Counseling Strategies for Loss and Grief, to help her counseling students become more mindful of their personal experiences of loss and grief, which in turn will lead them to better assist future clients. The exercise involves the counselors-in-training making a timeline of grief and loss through their lives by detailing specific losses. Ober then asks the students to write about what it was like to complete the exercise, including if anything bothered them while exploring past losses or whether they identified something that provided them with encouragement and hope during tough times.

The exercise is one that these counselors-in-training might choose to repeat with future clients. But the main objective, Ober says, is to get the students to build their personal awareness of grief and loss, which can help them avoid countertransference with future clients and become knowledgeable of their own cultural backgrounds and biases related to grief and loss. For instance, she says, students might learn that their families had specific rules related to grief and loss, such as not talking about the deceased person or not crying about the loss. “We can’t impose those [rules] on clients,” Ober says.

Ober suggests that practicing counselors seek supervision or consultation with other professionals so they can talk through what’s going on with their clients and in their own lives. This process can help counselors become aware of how losses might be affecting them and their work, Ober says.

Most people deal with loss in an effective way, Humphrey says. However, if counselors are feeling “stuck,” Humphrey says they should consider seeking counseling for themselves, just as they would recommend that clients do.

Getting prepared to address grief

Because there are no CACREP standards that deal specifically with grief and loss, Horn says it’s rare that graduate counseling programs require a course on the topic. “It’s really criminal to a certain extent that we do not require students to learn about grief and loss when every client we see will likely present with some element of grief and loss,” she says. “More likely than not, counselors are graduating without having taken formal training on grief and loss. There is preliminary research showing that having some type of formal education on death and dying or grief and loss does reduce anxiety around working with these issues.” For the very reason that it might not have been part of their training, Horn urges counselors to educate themselves on the topic by going to workshops, reading current literature and taking continuing education classes on the topic.

Counselors need to educate themselves not only on how to work with clients experiencing grief and loss but also how to identify it in the first place, Horn says. “Almost every client we see is going to have an element of grief and loss within their story. [When counselors] don’t have the lenses of being able to identify aspects of their story as being grief and loss, I think we miss a larger picture with that client.”

Humphrey recommends that counselors who are just starting out stay theoretically grounded so they will be ready and able to integrate any number of theories into grief work depending on the client’s particular needs. Meanwhile, Humphrey urges more experienced counselors to keep current with work in the field because the thinking concerning how best to address grief and loss has changed through the years.

The advice Newman offers to counselors, regardless of experience level, is to remember that work with grief and loss issues remains tied to the fundamentals of counseling. “It’s not about what I have to say to them, it’s about what they have to say to me. It’s really listening, being as present as you can be with that person, not judging, not thinking I’m the expert,” she says. “It’s giving that respect that [clients] have the expertise for what they’re going through.”

In combination with that expertise, it’s trusting that clients also possess the strength and resilience to carry on, Newman says. “Doing this work gave me so much faith in the human spirit,” she says. “I was face-to-face with people who had to find the strength to get themselves through probably the hardest times of their lives, and I don’t think I’ve met the person yet who curled up in a ball and didn’t do that. There’s sadness attached to it, but it’s inspiring the way that people find their way through. It’s about the resilience of the human spirit. People find strength that they didn’t know they had, and that is inspiring. We’re survivors and we are resilient. And at times, when it looks like it’s the worst time ever, it is the worst time ever — but when you feel that pain, then you begin to find your way through it.”

To contact the individuals interviewed in this article, email:

Interesting in reading more? Click here to read our online exclusive, “Helping military children navigate through grief,” which highlights an organization cofounded by an ACA member that offers camps for kids who have lost a loved one in military service, among other programs.

Lynne Shallcross is a senior writer for Counseling Today. Contact her at lshallcross@counseling.org.

Letters to the editor: ct@counseling.org


Countering Fear and Inertia in the Job Search: A Call to Action for Counseling Students, Counselors, and Counselor Educators

Elaine J. Casquarelli May 30, 2012

(Photo:Flickr/US Department of Labor)

The economic crisis of 2008 is still with us. Jobs for mental health and school counselors have been – and continue to be – cut. We hear about the possibility of more terminations to come in the media. Among the rumors of downsizing are some that indicate the trend will soon reverse, but graduating students need jobs now. It is indeed a scary time for professional counselors to be looking for work in their chosen profession. There is hope, however. It is the perfect time for students, counseling professionals, and counselor educators to be working together to strengthen our professional community and create opportunities to do what we do best – provide a forum or our students and clients to heal their pain and suffering.

I have a particular lens through which I enter this conversation. I am a doctoral student in Counseling and Counselor Education who also has the privilege of working with counseling students as a career advisor and coach. In my work, I am confronted with students’ fear every day. Their fear and anxiety are pervasive. Students are afraid there won’t be jobs. They are anxious about competing with their friends and colleagues for the few positions that do exist. They fear they don’t have enough experience. They worry they won’t do well in an interview. If they live in New York, they fear that they will not be able to get a job in which they will be able to earn licensure, or even worse, that they will not be able to find work at all. Some have responded by giving into their fears, and inertia has set in. The fear and anxiety, coupled with the rigor of the last semester of studies, also keeps students from seeking services that will help them find post-graduate counseling positions. Often, the situation feels hopeless.

I contend the situation is not hopeless, but it does necessitate a communal response within the counseling profession. Fostering hope and realization of vocational opportunities requires a clear vision, a willingness to confront our own fears and anxieties, and an unwavering commitment to work together as students, counselors, and counselor educators to promote the wellness of our profession – and ultimately of our students and clients. After all, we have defined our work as, “a professional relationship that empowers diverse individuals, families and groups to accomplish mental health, wellness, education, and career goals” (American Counseling Association, 2010). Further, as counselors, we are often tasked with being the holders of hope when our students and clients cannot find hope in their own lives. So, let us commit to the task at hand.

Counseling Students

As a counseling student, you are being initiated into a vocation that includes great responsibilities, difficult challenges, awe-inspiring transformations, and the privilege of walking with others through their struggles and successes. Continually, I am inspired by the compassion, caring, and determination of counseling students in my program. Many come to this profession with a natural desire to help others experience growth, success, meaning, and healing in their lives. I do not think our program is unique in this regard. We spend a lot of time learning to help others move through their struggles and, many times, connect with and feel their pain and suffering. The obstacles our clients face are many, including violence, neglect, and personal and systemic discrimination. Our task is to promote wellness as we invite them to face their concerns, doubts, and insecurities. Regardless of our theoretical perspectives, most of us do this by some combination of (1) promoting insight, (2) eliciting alterations in thoughts, behaviors, and/or emotions, (3) providing access to resources, (4) nurturing connections to supportive communities, and (5) advocating for our students/clients. As counselors in development, we must do what we ask of our clients/students.

In seeking a professional position, we are in essence asking an agency, school, or organization to pay us for the privilege of helping students and clients face their fears and overcome the obstacles life has placed before them. If we are to be bold and courageous enough to walk this walk with students and clients, we must also be courageous enough to do so ourselves. That means, we need to become aware of our own fears and the way they are impacting our lives; challenge and move through the thoughts and emotions that keep us stuck in inertia; seek out the resources available to us through our departments, colleges, universities and communities; nurture supportive connections to the local, regional and/or national counseling communities as well as our personal communities of support; and engage in advocacy on behalf of ourselves and our profession.

Professional Counselors

Most counselors I have been privileged enough to meet enjoy the opportunity to connect with students and promote mentoring relationships. In the past, building such relationships may have felt like a meaningful activity; however, the current economy has rendered mentorship absolutely necessary to the success of students and new professionals, and to the continued vibrancy of the counseling vocation. As professional elders, we have a responsibility take the initiative to cultivate relationships with those who are new to the field and help them navigate their own developing occupational identity, skills, and endeavors.

Mentorship can occur in a variety of venues. We can connect with students through our participation in local, regional, or national counseling organizations. It is often suggested that students attend organizational meetings to connect with counselors. Some students excel at meeting and interacting with others in social and professional settings; however, some students can feel intimidated or anxious about doing so. Therefore, when students do attend organizational meetings it is incumbent upon us to take the initiative to reach out to them, inquire about their interests, foster a professional relationship, and introduce them to other professionals with similar interests. We are often quick to recommend that students take on leadership positions and it is a wonderful treat when they do. Yet, it is important to cultivate relationships with students even when they don’t take on such positions. We have a plethora of professional gifts to offer students, so let us share enthusiastically and unabashedly.

We can also assist students by actively creating job opportunities for them. That is quite a bold statement to make in our current economic state of affairs, isn’t it?  Yet it is possible, particularly for those of us who are mental health counselors in private/group practice.  Let me explain. I’ll begin by recognizing that private practice is not the best setting for some graduating students. Therefore, it will be important for students to consult with their faculty, supervisors, and site hosts to determine the best setting for their own development. However, private practice is a very viable option for some graduating students provided that there is appropriate support for them as they develop their counseling skills. This is where we come in. I encourage those of us in private practice settings to provide invitations and opportunities for new graduates to join the practice and then offer the appropriate supervision and clinical support for their work to continue to flourish. In some states, that means that we need to earn a supervision credential. In other states, it means that we have to incorporate our practice as an LLC with the central mission and activity of providing mental health counseling. It can be helpful to engage in conversations with private practice counselors across state lines to determine the most effective ways to support the growth of new counselors in private practice while simultaneously supporting the wellness of their clients.

Counselor Educators

Again and always, mentorship and advocacy are the primary tasks. Just as counselors are being called to mentor students through attendance and participation in professional organizations, so must we. Counselor educators can require that students attend meetings of local counseling organizations. We can then teach students how to connect with other professionals by attending the meetings ourselves and introducing them to members who have similar interests. It is also essential to teach students about the importance of nurturing community connections within the counseling profession during their first semester of academic training. That will give master’s students the most time to meet other counselors in the field, learn about the mental health needs and services in their communities, and gain a better grasp of the professional requirements of their work. In the end of this process, graduating students will be better informed about the needs of their students and clients and more knowledgeable about the upcoming clinical, administrative, and systemic demands of their work.

We must continue to engage in both legislative and educational advocacy initiatives that result in the creation of more jobs for graduating students. We can do this by engaging in organized efforts to meet with our legislators and by selecting research topics that provide implications for policy development. For example, we might design a research project that investigates the impact of employing fewer school counselors in our K-12 schools. Participation in the development and nurturance of collaborative relationships among students, counselors, and counselor educators can constitute a ripe topic for research. We can only help students and strengthen our professional community by gaining a better understanding of the ways in which collaboration and mentorship impact occupational wellness and competence. We can investigate, articulate, and integrate into training the best practices or competencies for keeping our own occupational fears at bay so that we can indeed be the holders of hope for our clients.

Working Together

We all – students, counselors, and counselor educators alike – need to get out of our comfort zones, walk with or through our fears, connect with one another, and promote wellness in our profession. A commitment to doing so can serve to transform fear into a strong community of learning, practice, research, and advocacy. So let us take a collective deep, centering breath and move forward together in hope and courage.

The wise words of poet Audre Lorde can guide us during this critical time in our professional growth. She wrote the poem in the singular and I have changed her words to the plural, but the message remains the same:

When we dare to be powerful,
To use our strength in service of our vision,
Then it becomes less and less important whether we are afraid.

Elaine Casquarelli is a counselor specializing in career development, LGB concerns and spiritual issues in counseling.  She is currently a doctoral student in Counseling and Counselor Education at the Warner School of Eduction, University of Rochester, and works as a career advisor for graduate students enrolled in counseling and education programs at her institution.  She can be contacted at Elaine.Casquarelli@Warner.Rochester.edu.

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