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Counselors Audience

APA accepting feedback for DSM revision

By Bethany Bray February 6, 2017

The American Psychiatric Association has created an online portal for the public to submit suggested changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Launched this winter, the portal allows clinicians, scholars and members of the public to submit suggested additions, deletions or modifications to the DSM.

Often called the “psychiatric bible,” the DSM-5 is a go-to resource for many practitioners when it comes to the classification and diagnosis of mental disorders. APA released this most recent version of the DSM in May 2013, after more than a decade of planning, research and review.

The online portal creates a way to keep the DSM updated in a more timely manner and make changes incrementally, as new information and research is available, according to the APA website.

This new medium offers an important and much-needed chance to have counselors voices considered in what has traditionally been an arena dominated by psychiatrists, says Stephanie Dailey, who was involved with the American Counseling Association’s DSM-5 Task Force and co-author of the ACA-published book DSM-5 Learning Companion for Counselors.

However, Dailey, a licensed professional counselor and associate professor and director of counseling training programs at Argosy University, Washington, D.C., expresses some skepticism about which submissions might actually be considered for changes to the DSM. She contributed some thoughts, via email, to Counseling Today:

 

“The Diagnostic and Statistical Manual of Mental Disorders (DSM) has long been criticized, amongst other things, for poor utility; inadequate psychometric evidence for diagnostic categories and specifiers; comorbidity issues; overutilization of ‘catch all’ diagnoses (e.g., not otherwise specific [NOS] and generalized anxiety disorder [GAD]); and underutilization of emergent genetic, neuroscientific and behavioral research.

While APA’s DSM-5 Task Force attempted to rectify many of these issues, there are still considerable challenges in regard to validity, reliability and clinical utility within the DSM-5. Clarification of diagnostic descriptions, criteria, subtypes and specifiers is needed and there is a significant dearth of information regarding sociocultural, gender and familial patterns for diagnostic classifications. There is also a lack of rigorous psychometric validation for suggested dimensional and cross-cutting assessments (introduced in the DSM-5) and no consensus was made during the last revision to the DSM in terms of modifications needed for the personality disorders category. Thus, this diagnostic category has remained unchanged and clinicians (and clients) are facing the same challenges as they did 20 years ago when the DSM-IV was released.

In terms of the new portal, it is important for individuals to understand the revision process of previous iterations of the DSM to really appreciate the magnitude of an ‘open’ call for revisions. The revision process of the DSM-IV to DSM-5 was a 14-year process, beginning in 1999, which originated with a research agenda primarily developed by the American Psychiatric Association

Image via Flickr http://bit.ly/2lfWuka

(APA), the National Institute of Mental Health (NIMH) and the World Health Organization (WHO). In 2007, APA officially commissioned a DSM-5 Task Force which formed 13 work groups on specific disorders and/or diagnostic categories. While the scope was broad, the intent of the workgroups was to improve clinical utility, address comorbidity, eradicate the use of not otherwise specified (NOS), do away with functional impairments as necessary components of diagnostic criteria and use current research to further validate diagnostic classes and specifiers. Having released the draft proposed changes, three rounds of public comment and field trials were conducted between 2010 and 2012. During this time, numerous professional organizations, including ACA, voiced significant concerns (See ACA’s 2011 letter to APA: bit.ly/2kxJBVY).

Despite attempts to become involved, at no time has any professional counselor ever served on APA’s DSM Task Force. In regards to the new portal, our time to have a foothold in changes to current diagnostic classifications is now.

In looking at the portal which lists specific kinds of revisions sought, one can easily see that APA is looking to remedy the long-term critiques of the manual, specifically validity, reliability, utility and the need to capture emerging research.

However, what proposals (and by whom) that are selected for inclusion remains to be seen. While the portal allows anyone to submit a proposal, there is a long history of bias in the type of research which is deemed appropriate for consideration by APA. While there is no dispute in terms of the need for rigorous research designs and large scale studies to validate criterion, these studies are not likely going to be conducted by anyone outside of APA, NIMH, WHO and other large scale ‘think tanks.’

The problem, particularly for counselors, is both philosophical and practical. First, the psychiatric profession as a whole is trained in the medical model, while counselors tend to operate on a more humanistic, holistic perspective. Next, while Paul Appelbaum, chair of the DSM Steering Committee, stated that acceptance thresholds will be high, reports from Appelbaum and others have ensured scrutiny for submissions which don’t provide ‘clear evidence.’ This is not only vague, but likely slanted towards the psychiatric community.

No one is disputing the need for the best available scientific evidence or the ability of the counseling profession to produce substantive outcome research for the mental health community. The American Counseling Association has members who have significant, scientific-based expertise in areas relevant to the DSM and strong research agendas which can support evidence-based changes. However, our seat at the table in these discussions has been scant.

Thus, counselors are strongly urged to contribute to the revision process by submitting proposals and working towards serving as unique contributors to the next edition. This is particularly relevant to counselors whose focus is on marginalized populations and underserved groups. Outcome-based research is needed, specifically that which has been repeatedly shown to improve treatment outcomes.

This is the time for counselors to become involved and make our experience known, and more importantly, our clients’ voices heard.”

 

 

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Find out more

 

Visit APA’s DSM portal at https://psychiatry.org/psychiatrists/practice/dsm/submit-proposals

 

See Counseling Today’s Q+A with Dailey: “Behind the Book: DSM-5 Learning Companion for Counselors

 

 

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

 

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

 

 

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

Hooah! Thoughts and musings on Operation Immersion

By Janet Fain Morgan January 3, 2017

Hooah: Military slang referring to or meaning “anything and everything except ‘no.’” Used predominantly by soldiers in the U.S. Army.

 

My father was in the U.S. Army for more than 30 years. I grew up as a military dependent, relocating every few years (and attending more than 20 schools) until I graduated high school. I joined the Army Reserve, later married my husband, a U.S. Navy submariner, and he eventually ended up retiring from the Army after 20 years. My eldest son joined the Army out of college and is currently on active duty.

I have been a licensed professional counselor in Augusta, Georgia; Bamberg, Germany; Lakewood, Washington; Fort Knox, Kentucky; Columbus, Georgia; and most recently, Somerset, Kentucky. As a member of the American Counseling Association and the Military and Government Counseling Association (a division of ACA), I am concerned about the rising number of suicides among our military veterans. On a related note, I am also concerned by the limited number of education and training opportunities available to counselors who are dedicated to the specific needs of military clients.

This past year, the Kentucky Counseling Association (KCA), a state branch of ACA, advertised a training program for counselors called Kentucky Operation Immersion. The program offered an immersion experience into military culture that aimed to help counselors become aware of the unique culture and specific needs of military clients. The training educated counselors on how better to help soldiers as they transition back from wartime environments overseas and reintegrate into a civilian society.

Only about 1 percent of the U.S. population actually serves in the military. Many people do not understand the difference between the military mindset and the civilian frame of mind. For that reason, I was impressed and excited to see that KCA was addressing a very important topic that can make a difference to our military members.

As a counseling professional and former soldier, I jumped at the opportunity to train with the Army National Guard at the Wendell H. Ford Regional Training Center. The Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID) and the Kentucky Army National Guard presented and sponsored the training, and many of their respective department members joined in the training. I had no idea what I had signed up for, but sometimes ignorance is bliss.

I arrived to join approximately 30 other participants from a variety of specialties, including drug and alcohol counselors, psychologists, school counselors and Kentucky Department of Veterans Affairs employees. The participants ranged in age from their 20s to their 70s.

Day One: Basic training

On the first day — basic training — we were introduced to the training leaders, department heads and Army National Guard soldiers who would mentor us throughout the training. We were issued our field equipment, including Kevlar helmets and flak jackets, which we would wear during our training for the next three days. Removing the metal plates that are normally part of the bulletproof garment decreased the flak jacket’s weight. Even so, the jacket was still heavy and served as a constant reminder of what soldiers wear to protect themselves during deployment.

Our first training exercise was an introduction to platoon formation and marching, but this version was much kinder than what I had experienced in my Army basic training days. Regardless, I found myself unable to maintain the pace of the platoon. This bruised my ego and provided a gentle indicator of the physical limitations I might encounter in the training exercises to come. And come they did …

The author, second from right in the back row, with fellow members of her Operation Immersion training squad.

The Field Leadership Reaction Course was a team-building exercise (obstacle course) that further introduced me to my counselor peers. We had fun coordinating our navigation of the ropes, walls and boards to achieve successful outcomes. Then Kentucky weather intervened, and we headed for shelter from tornadoes, storms and heavy rains. Chow took place in the mess hall with service members who invited us to ask them questions about the military and their military experience.

That evening we met Bobby Henline, an American hero, comedian and motivational speaker who served four tours of duty in Iraq. During his fourth tour, he was the sole survivor of a roadside bombing that left a third of his body burned. He shared his survival story and his outsize sense of humor with us. Bobby participated with us throughout the training and was an inspiration to us all. His humor helped lighten the serious moments, and his encouragement was invaluable. It was a true honor to meet him and a blessing to spend time with him.

Sleep was sweet after such a full first day.

Day One counseling takeaway: Military training is demanding physically and challenging mentally. Build relationships with military clients by asking about their training and work environments. Ask questions about any military-specific acronyms that they use. Many people know what an MRE (meal ready to eat) is, but fewer are familiar with what FOB (forward operations base) or TOC (tactical operations center) represent. Get to know these clients’ personal stories. This can shed light on what might be troubling them and why they are seeking counseling.

Day Two: Mobilization

Day Two arrived early — at 5 a.m. — and there we were, in formation, doing PT (physical training). Mobilization day started with breakfast in the chow hall, and then we had a class on sexual assault prevention. That morning we also heard personal stories of deployment from individual soldiers. Their stories spoke of bravery, tragedy, courage and, sometimes, boredom. All the stories touched our souls. In fact, when the program participants looked back over those days of classes, physical challenges and training, we decided the deployment stories were what we would remember most.

After a class on combat-related trauma, we headed to the SIM (Simulation) Center, where we ate MREs and enjoyed the virtual combat simulators in the forms of EST (Engagement Skills Training with Night Vision), IED (Improvised Explosive Device training instruction), HEAT (Humvee Egress Awareness Training Simulator) and CSF2 (Comprehensive Soldier and Family Fitness).

That evening, we were briefed by the commander, Capt. Michael Moynahan, and heard another personal deployment story from Maj. Amy Sutter, a licensed clinical social worker. Her mental health perspective on deployment was invaluable, and we also gained insight on deployment from a female viewpoint.

Day Two counseling takeaway: Deployment is rough, both mentally and physically. The living arrangements are complex, and soldiers have many challenges related to isolation and loneliness. At the same time, privacy is often limited. Build the therapeutic relationship by asking your military clients about any and all deployments. Each deployment offers military members challenges and unique perspectives. These could be explored through open-ended questions about their personal experiences. Be aware that some of these clients have seen or done things that they do not want to disclose or remember.

Day Three: Deployment

Deployment day again came early, with PT that included a warmup and running track. Classwork began with a briefing on substance abuse, posttraumatic stress disorder and traumatic brain injury. After listening to a suicide prevention panel, we headed out on a bus to the Gwynn City MOUT (Military Operations on Urban Terrain) site for our deployment training.

The Army National Guard launched a few simulated IED attacks in the direction of our bus and also created a machine gun simulation to get us “in the mood” for our urban warfare exercises. Command Sgt. Maj. Matthew Roberge led the military demonstrations and the exercises to prepare us for clearing a building of enemy personnel. The smooth, precise and sharp Army National Guard soldiers modeled the intricate procedure for us, and in teams of four, we attempted to reproduce the action with our military-style paintball weapons.

Our attempt was a less than perfect assault, with paintballs flying everywhere and Kentucky counselors doing their best to come out of the training exercise unscathed. That said, there was much laughter and excitement throughout, and everyone emerged feeling abundant respect for our U.S. military, and especially the group of professionals who worked with us during our training experience.

Dinner that evening was a relaxing outdoor cookout, during which we said goodbye to many of the soldiers who were leaving for their drill weekend. Awards were given, speeches were made and the treasured “challenge coins” — engraved with a unit’s or organization’s insignia or motto and given as a sign of respect — were secretly passed from palm to palm.

Day Three counseling takeaway: Military members face death often and rely on their training and peers to stay safe. Their training is precise and has to be executed perfectly every time, or the soldiers and their companions run the risk of becoming casualties. A high level of stress accompanies each operation, and sometimes that stress may last for days, weeks or even months, with little or no downtime for the soldier. The residual effects from this intense training and the soldier’s subsequent experiences can last a lifetime. Counselors should understand the deleterious effects of combat. Even if operations are carried out perfectly, casualties can occur, accidents can happen and the effects can be devastating.

Day Four: Demobilization

Demobilization day was early to rise — 4:50 a.m. — so we could clean the barracks, pack our bags and return the gear. Breakfast was quick, but then our first speaker arrived to awaken our senses. Capt. Phil Majcher spoke about his role as battalion chaplain and the duties that were part of the military chaplaincy. He didn’t sugarcoat anything, giving many of us moral points to ponder.

Linda Ringleka, military and national liaison from Lincoln Trail Behavioral Health System, joined Capt. Majcher. Together, they led a workshop on suicide prevention and ACE (Ask, Care, Escort) training. The counselors participated in small group activities that included role-plays and real-time suicide scenarios.

Sgt. Brooks, a female soldier, offered to speak with the female trainees about her experiences as a woman in the military with two deployments under her belt. Gathering together as women, we heard her personal story of courage, determination, struggling as a single mom and the challenges of being female in the Army. Her story was incredible and touched each of us. I must also mention that watching Sgt. Brooks throughout the entire training was like witnessing a master of all trades. She did everything that her male counterparts did, and with effortless perfection.

As we wrapped up the training, pictures were taken and awards were announced. Heath Dolen, DBHDID program administrator, presented each of us with a certificate, and a coveted challenge coin was passed secretly in a handshake.

As I drove home, I reflected on the immense amount of information and knowledge we had all gained as mental health professionals. This training was invaluable in providing us with skills to help soldiers as they return from difficult and sometimes horrific experiences. Many of these potential clients need to know that the counselors assisting them do actually understand some of the hardships they have endured. Counselors must gain the trust of hurting service members before many of them will disclose the horrors that they witnessed or even participated in during a deployment to a war zone.

The rules that we typically live by in our society do not always correspond to the experiences that soldiers see and live through. The camaraderie of this very tightknit community is exceptional, and counselors must understand the underlying military culture and gain the trust of these soldiers to be as effective as possible. Of that, I am certain.

I highly recommend that all mental health care professionals who take care of our soldiers undergo the type of training offered in Operation Immersion. Our heroes deserve the best that mental health professionals can give them, and this training definitely moved us in that direction.

 

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Janet Fain Morgan is a military family life counselor licensed in Kentucky and Georgia. She is a faculty member of William Glasser International and a member of the Military and Government Counseling Association, a division of ACA. She is also a former soldier. Contact her at JMFainMorgan@gmail.com.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having your article accepted for publication, go to ct.counseling.org/feedback

 

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

Ask your doctor if nature is right for you

By Bethany Bray

Happy-looking people take a walk in the woods as small-print disclosures scroll across the bottom of the TV screen and a soothing voiceover explains possible side effects. As the scene closes, one of the actors looks squarely into the camera and says, “Ask your doctor if nature is right for you.”

The tongue-in-cheek NatureRx video campaign has the look and feel of the prescription drug commercials that inundate television in the U.S. The difference, however, is that they are “selling” something that is widely available and has proved to benefit mental health and overall well-being — without prescription drugs.

NatureRx is the brainchild of Justin Bogardus, a filmmaker and licensed professional counselor candidate in Boulder, Colorado. Everything seems to have a marketing campaign in this modern age, he says, so why not nature?

Rather than relying on a heavy-handed “you should” directive, the films use humor and a witty message to emphasize the benefits of getting outside, Bogardus explains.

“As a trained counselor myself [but primarily a filmmaker now],” he says, “I really wanted to create a message like NatureRx because I resonated with it so much personally. … I think people really resonate with the message and the humor because it’s fun, funny and inspiring to remember the little things that were always there, but sometimes we forgot about them, like nature and getting outdoors.”

NatureRx “commercials” have been screened at film festivals and shared widely online since the

Justin Bogardus, NatureRx filmmaker (Courtesy photo)

first video was released in the summer of 2015.

Bogardus has a film degree from Vassar College and has worked as an editor, writer and producer for several documentaries on wrongful conviction/incarceration. In 2013, he completed a master’s degree in Buddhist psychology and contemplative psychotherapy from Naropa University in Boulder. Although he primarily devotes his time to independent filmmaking and speaking engagements, he does occasionally see clients, lead group therapy and teach Buddhist psychology at Naropa.

 

 

Is NatureRx right for you? CT Online contacted Bogardus to learn more about the campaign and its connection to counseling and mental health.

 

The holiday season can be especially tough for people with anxiety and other mental health issues. At the same time, the weather is getting colder and the days are shorter and darker. Do you have suggestions on how to find “NatureRx” throughout the winter?

Research shows [that] as little as 10 minutes outdoors can reset the nervous system, especially if you can be mindful and present with nature for those 10 minutes. … Taking a walk and tasting the cold brisk air makes a big difference even in small doses.

I get asked about winter a lot in regards to NatureRx, and I love that question. I love winter. The outdoors seems particularly tranquil and quiet to me in the winter. There are no studies about this, but I actually think the positive impact of nature on our minds happens faster in winter. Something about a little temperature change and a change of scenery from the indoors in winter really resets my mind and body pretty quickly. Yes, it can be a little harder to motivate putting on jackets and boots when it’s cold and the sun sets so much earlier, but the colder air is more refreshing, I think. I also like to remember that our bodies were built for the outdoors, including the cold weather.

I also love this thing from Denmark called hygge (pronounced hoo-ga). Everyone knows how cold and dark winters in Denmark are, and the Danes have come up with a great word and lifestyle to make the most of it. It’s basically the idea of cultivating coziness, slowing down and taking in simple pleasures. It’s like NatureRx for the indoors.

I like that with the idea of hygge, you bring an overall sense of coziness to the winter and holiday season, which you bring with you both outdoors and inside. A 10-minute walk in the cold air, all bundled up in all the scarves, mittens, hats, puffy coats — whatever makes being outside a slowing down and cozy experience too. How great is a warm fire and hot cup of tea after a short dose of outdoors? How cozy and relaxing is that? So yes, back and forth with outdoors and the family, back and forth with getting warm and then getting refreshed outside with an overall sense of hygge. That’s a perfect recipe for the holiday season I think.

During holiday get-togethers, people and families can go stir crazy if no one is getting outside. Togetherness is great, but too much togetherness in an enclosed space is well … cue the commercial … “are you feeling tired, irritable [and] stressed out?” Who isn’t feeling tired, irritable and stressed out at some point during the holiday season? That’s the cue for a dose of nature, even a microdose. It really works and so does hygge.

NatureRx has been a lifesaver for me during the holidays. Now it’s fun because as I get outdoors for short breaks during each holiday season, the rest of my family has started doing it too. … Maybe they saw how happy and relaxed I was after a little time outside.

 

What do you want professional counselors to know about nature’s connection to wellness and mental health?

I like to remind even the most self-described “I would rather do anything besides camping” indoor people that it’s all about discovering the dose of nature that works for you. [Moving] more plants inside or gardening, or having a great view of the outdoors from a window, whatever brings nature into your life in a way you like, I think, can support our well-being [and] slowing down, which is incredibly helpful, especially in [the] busy, screen-time, information-overload, never-stop-world so many of us are meeting these days.

I once met this great group counselor in New York City — a real expert and guru of counseling. I was telling him how I like to get outside and to meditate. He told me, “Getting outside and meditation are like rocket fuel for healing in therapy.” I think that’s the best way to put it. NatureRx helps on its own and in conjunction with all the others things we need for rich, healthy lives.

Yes, there’s a new big study from big-name institutions almost every week it seems about the positive impacts of the outdoors and nature on all kinds of well-being metrics, especially mental health for all kinds of symptoms and challenges [and] for healthy development of kids. But really I think NatureRx got millions of views and has made such a splash because on a deep intuitive level, we already know this. The healing impact of nature is a story as old as humanity itself.

Being outside in nature supports our well-being. Of course it’s not a panacea. It’s not a cure-all. But who knows? For some people it might be. I think it’s like good rest. It’s something we all know on some level is needed and super helpful for whatever life throws at us. And like good rest, you don’t want to overdo it or go outside with too much of an agenda, expecting nature to fix everything. Nature doesn’t work that way, but if you can hang back a little in nature, let its beneficial impact come to you more and more … it works! I could go on and on. The magic always happens eventually.

Since the dawn of human civilization, we [have] lived increasingly in busier spaces. Every culture and every civilization from every time period has countless stories about the need for nature — a respite and restorative space to not only heal, but find your truer and deeper voice in. NatureRx is that same story, updated for our times. I think nature is a timeless space, a great place to discover your authenticity and who we really are — outside the din and distraction of culture and civilization.

 

Do you have suggestions for how counselors can bring nature into their work with clients?

Well, first have clients watch the NatureRx commercial. Self-promotion? Maybe, but really it’s true. First-time viewers love the humor and then love sharing the videos with other folks — it just resonates with so many people. That was certainly part of the goal with NatureRx and the humor behind it. I didn’t want to prescribe nature and getting outside as a “should.” I wanted to playfully invite people to look at getting outside and nature from a fresh perspective, and of course spoofing a prescription commercial was the way to do that.

So for counselors of all kinds, I say … find ways to invite people into thinking about nature and getting outdoors as a fun, healing space rather than imposing the idea on them in subtle or not so subtle ways. I think [it’s] always good to start with some curiosity, asking people questions about nature, [such as] plants or places they may like. It seems almost everyone has some memory or some animal or plant or some outdoor smell or nature activity they already remember or enjoy. I think that’s a great starting point. Later on, it can also be good to offer some of the evidence-based information about getting outdoors, which some people like to know because it can increase their time outdoors and their perceived benefit from nature. But some folks don’t even need that didactic information.

I’m amazed how many folks already have some NatureRx practice in their life without even realizing they’re intuitively getting benefit from nature — even smokers I meet. Many smokers talk about enjoying the break outdoors as part of their smoking habit. It’s interesting how many, when they quit, still like to get outside, but this time just for a short walk or to sip a cup of tea or something. What they didn’t think about was how smoking was a tool to take a break outside, even in the cold. Without the cigarette, they still get to benefit from getting outside with a lot more enjoyment.

I met a woman I’ll never forget who liked to check the weather for the sunset time. She rarely ever watched the sunset. She just found herself always checking in on what time the sun would set. She didn’t care too much for camping or the outdoors; she would never describe herself as a nature person. I worked with her some, and we talked about what she liked about the sunset and knowing the rhythms of the sunrise and sunset from season to season. Before long, she told me she had started to actually take the time, even if it was just five minutes toward the end of the workday, to not only check the sunset time, but take some time outside to really enjoy watching the sunset. Simple. Relaxing. Restorative. I’m pretty sure she still does that today and loves it.

 

Who is your target audience for the NatureRx campaign?

When first creating the NatureRx commercials and the NatureRx movement online, I intended to target millennials with the humor and the particular disconnection millennials might feel around nature. It’s the first generation that may not have been exposed to the outdoors readily as kids and, consequently, that millennial generation — which I’m a part of, but on the older side — may feel that lack of nature more acutely.

I grew up in the city myself. I was lucky to have a father who took the time to take us to national parks and [go] hiking. That’s probably how I first fell in love with nature. But I had a lot of city friends who didn’t get those experiences growing up, and I always imagined those lifelong friends and what might appeal to them when crafting this message and writing NatureRx content. The millennial generation is so used to getting tons of information on their laptops and phones all the time, so certainly it was an important goal of mine in creating NatureRx to craft a fun-filled message that could connect with them in short form and on social media in a way that they could really enjoy and consider.

It’s food for thought for any age — even kids love our G rated versions of the commercials. It’s something we can all relate to.

 

Do you think medical and mental health professionals sometimes overlook nature and its therapeutic benefits?

Yes and no. I think the medical and mental health professions as a whole have some real ambivalence about nature and the outdoors. [But] I think a lot of that’s changing now as we see the alternative — being inside, disconnected and sequestered, and how that is having terrible health and well-being impacts on our bodies and minds. I think there’s a big shift in medical and mental health professionals around embracing the benefits of nature and getting outdoors because of this.

I think all this research coming out about the benefits of getting outdoors reveals this movement and paradigm shift. For the last few decades in medicine, culture and in parenting, the view was [that] getting outside and in nature is how you get sick or hurt. I think lots of folks are seeing now how wrong that view is.

 

In a nutshell, what inspired you to start the NatureRx campaign?

Nutshell? I love nutshells. That was a big inspiration. That and climate change. I wondered, how could I speak about the human relationship to nature in a way that connected with people personally, whether they believe in human-caused climate change or not? I don’t say anything about climate change in the commercials, but I think it’s in there nonetheless.

I was inspired by how nature is something I need in my personal life. It’s helped me in countless ways, and nature is something we all need as a valuable space for all earthly inhabitants. I hoped the message and humor would convey that — both the personal and universal value of nature. It was a way of giving back for me.

 

What do you want professional counselors to know about why your campaign is needed?

As a trained counselor myself, I like this phrase: “Of all the paths you take in life, make sure some of them are dirt.” For professional counselors, I think NatureRx is needed because there are many paths to healing and recovery for clients. I think it’s also true to make sure some of those paths are made of dirt. A dirt path in the woods is the real-life metaphor we can experience at anytime. It’s a great ready-at-hand place where we can see that natural healing isn’t like a manicured superhighway to health. There are twists and turns.

Getting outside reminds me of my most human qualities. It reminds me that I have a body that likes to be in nature, to look at nature and be healthy. It reminds me to take time to just be. I think that’s the energizing trail mix we all need on whatever path we’re taking in life. That’s the need I hope NatureRx fills. It’s an empowering message about how you can take back your life at any point by simply stepping outdoors. I think healing and counseling works well when people feel empowered with real solutions, and getting outdoors is most certainly one of those solutions.

 

 

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Find out more about NatureRx and watch Bogardus’ TED Talk at Nature-Rx.org

The NatureRx “commercials” are available there as well as on the YouTube channel: bit.ly/2h1MCZp

 

 

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

 

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

 

 

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

 

CT Online’s most-read articles of 2016

December 27, 2016

What were professional counselors reading at CT Online in 2016? The year’s most popular new posts ran the gamut, from articles on attention-deficit/hyperactivity disorder to technology to issues surrounding multiculturalism and social justice. More than 150 articles, both online-exclusive pieces and articles that also appeared in Counseling Today’s print magazine, were posted at ct.counseling.org in 2016.

 

Most-viewed articles posted in 2016 at ct.counseling.org

  1. Why failing the NCMHCE felt so good” (Online exclusive; posted in January)
  2. Coping with college” (Cover story; April magazine)
  3. Multicultural and Social Justice Counseling Competencies: Practical applications in counseling” (Feature article; February magazine)
  4. Reconsidering ADHD” (Cover story; August magazine)
  5. The anxiety behind selective mutism” (Online exclusive; posted in January)
  6. License to deny services” (Cover story; July magazine)
  7. Immigration’s growing impact on counseling” (Cover story; February magazine)
  8. The counselor’s role in ensuring school safety” (Cover story; September magazine)
  9. Gut health and healthy brain function in children with ADHD and ASD” (Online exclusive; posted in February)
  10. Using ‘Inside Out’ to discuss emotions with children in therapy” (Online exclusive; posted in March)
  11. Why can’t we be friends?” (Knowledge Share; February magazine)
  12. Technology Tutor: Thinking about discussing clients online? Think twice” (Column; September magazine)
  13. Raising counselors’ awareness of microaggressions” (Member Insights; June magazine)
  14. Stepping across the poverty line” (Cover story; June magazine)
  15. Counseling ‘unlikeable’ clients” (Feature article; September magazine)
  16. Counseling babies” (Knowledge Share; August magazine)
  17. Addressing ethical issues in treating client self-injury” (Knowledge Share; August magazine)
  18. Grief: Going beyond death and stages” (Cover story; November magazine)
  19. ACA endorses animal-assisted therapy competencies” (Online exclusive; posted in August)
  20. Controversies in the evolving diagnosis of PTSD” (Knowledge Share; March magazine)

 

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What was your favorite article of 2016? What would you like to see Counseling Today and CT Online cover in 2017? Leave a reply in the comment section below, or email us at CT@counseling.org

 

 

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Is it OK to have it all?

By Kathleen Smith December 21, 2016

As Lindsey Mitchell approached the end of her doctoral program in counseling at George Washington University, she wasn’t quite sure what was next. After a decade of intense focus on her education, she found her career options in the field both exciting and intimidating. When Mitchell began talking to other women in her program about career choices, she realized that questions about ambition, leadership and family were common among female counselors.

Energized by these discussions with her colleagues, Mitchell decided to take the conversation to the American Counseling Association’s 2016 Conference & Expo in Montréal. Her idea took shape as a panel session called “To Lean In or Not to Lean In: The Diverse Experiences of Women in the Counseling Field.” The title alone was enough to catch the attention of many women at the conference and set the stage for an engaging talk between four ambitious and thoughtful counselors.

The phrase “lean in,” made famous by Facebook Chief Operating Officer Sheryl Sandberg’s 2013 book, Lean In: Women, Work and the Will to Lead, is rife with connotations and criticisms. Sandberg encouraged women to take risks, not make sacrifices based on hypotheticals, and to pursue leadership by taking a seat at the table. A former chief of staff for the U.S. Treasury secretary and a leader in the tech industry, Sandberg draws from her years of experience in male-dominated fields.

But when Mitchell and others considered this philosophy of leaning in, they faced an important question: What does “sitting at the table” mean in the counseling profession when the majority of counselors and ACA members are already female? Weren’t they already at the table?

A colleague of Mitchell’s recommended that she recruit Desa Daniel, a doctoral counseling student at Kansas State University, as a compelling voice for the ACA Conference panel discussion. Daniel thinks that numbers alone aren’t enough to change leadership dynamics. Although ACA and the counseling profession as a whole may be filled with women, she notes that leadership positions within the profession don’t always mirror those numbers. “We still have a long way to go until women hold positions in universities and governance that reflect their presence,” says Daniel, adding that she’d like to serve as president of ACA in the future. She currently serves as the student representative for Counselors for Social Justice, a division of ACA, and as student liaison for Division 45 (the Society for the Psychological Study of Culture, Ethnicity and Race) of the American Psychological Association.

Jessica Jackson, a licensed mental health counselor and a doctoral candidate in counseling psychology at New Mexico State University, also joined the discussion. She points to the male-dominated foundational and theoretical influence in the field as a real challenge. “When you look in the texts, our foundational knowledge is coming from men of European descent, and the structure of the training is based on that,” she says. “No one deviates from the blueprint, so to me, that doesn’t feel like a field dominated by women.”

Jackson also points out that texts such as Sandberg’s, as well as feminist psychology and various waves of the feminist movement, typically failed to include black women in the conversation. Part of her role on the panel, she says, was to help remind counselors that women of color can still be forgotten or excluded in a space that is predominantly female.

Having it all

Comedian Tina Fey wrote that the rudest question someone can ask a woman is, “How do you juggle it all?” Fey suggested the question operates on the assumption that, for women at least, success in one arena of life (e.g., the workplace) implies failure in another (e.g., family life). The question is rarely posed to men. Members of the conference panel set out to consider what “having it all” looks like in the counseling profession and whether balance between multiple arenas of life is possible.

“Can women have it all? I think yes, but we may have to package what that looks like in a different and creative way,” Mitchell says. Currently serving as an Americans with Disabilities Act counselor at Houston Community College, Mitchell points to the male-dominated workplace models that create impediments to women who desire balance between work and family life. For instance, she observes, when their children are ill, some mothers in the workforce will hide that fact and instead claim a sick day for themselves because they don’t want their parenting responsibilities to hurt how they are perceived at work.

“You would think that in a female-dominated field like counseling, it would be better,” Mitchell says. “But we’re still using these male business models instead of thinking about how we can be greater leaders to women that maybe we didn’t have. Sometimes we don’t have a model for what that looks like, so we have to start creating our own.”

These sentiments reflect a common critique of Sandberg’s idea — namely that Lean In ignores systemic obstacles that are present and remain unchanged in the workplace, regardless of whether women make it to the top playing by the current rules. So what rules do counselors need to change to make the workplace and the classroom more flexible and empowering places for women?

Mitchell asked Megan Doughty Shaine, an assistant professor of psychology and counseling at Hood College in Maryland, to bring her voice to the panel as a professor and parent. Shaine shared how her desire to have a multifaceted career and also be a mother affected her path. “It does change the way you move through your education, from the internships you accept, to the jobs you consider, to how you prioritize things,” she says. For example, Shaine limited her search for doctoral programs to the East Coast because she wanted to be close to her family when she started one of her own.

Shaine recommends that women in counseling leadership model how conversations about “having it all” are OK and even encouraged at work. “You’re more likely to have a female supervisor than a male supervisor, at least in the clinical world,” she says. “We have to really evaluate how open we are with these issues of work-life balance.”

Jackson agrees, pointing out that real pressure still exists to choose between focusing primarily on career or family in academia. “People don’t feel comfortable choosing a middle ground because that looks like you don’t know what you want,” she says. “But I don’t think it’s impossible to integrate and have both. My idea of success is being able to acknowledge and appreciate the many roles that I have as a black professional woman without having to sacrifice what means the most to me.”

Finding balance

Members of the panel also considered how to model what good mental health looks like for women trying to balance multiple roles in life. “So many of the conversations that we have about self-care feel fake,” acknowledges Daniel, who does CrossFit every day as a self-care measure. “We have to show tangible examples of what it looks like and how people manage it over the course of their careers. We need to lead by example but also help people set objectives and deadlines for self-care.”

Mitchell suggests that establishing and maintaining boundaries is an important piece of achieving balance. “I feel the pressure to be everything to everyone, and I know that is not a realistic expectation,” she says. “There will be stages in my life where my professional career has to take priority and other times when it will take a step down in importance. I know I entered this profession because I care about people and want to help, so there can be a conflict when I have to put myself first and inadvertently disappoint somebody in another area of my life. So it is a bit of a Catch-22. But this conflict will have to be resolved by continuing to reevaluate my values, my stage of life and what my goals are at the time. It’s an ever-changing process.”

Rather than a detour from success, Jackson sees the pursuit of balance as integral to achieving her goals. “I’m a happier and better person when I can feed the many different parts of who I am,” she says. “By engaging in prayer, checking in and being honest with myself, and being present in the moment, I am better prepared to achieve my idea of success. Potential conflicts may arise due to this expectation that to be successful in your career, you must dedicate your entire life to your career. But I don’t believe in that. I don’t believe that I have to achieve burnout in order to be successful.”

An intersectional approach 

Another critique of the philosophy behind the “lean in” movement and second-wave feminism is the relative lack of examination of women’s intersecting identities. At the ACA Conference, panel members wanted a significant amount of the conversation to focus on the diverse roles and identities of women in the counseling field and the impact this reality has on what it means to lean in.

Jackson points out how traditional advice given in books such as Sandberg’s, including the call to be assertive, may not work for every woman. “As a black woman, being assertive comes across as being the angry black woman. So how do I navigate the need to be assertive without also coming across as angry, even when I’m not angry? Because as soon as I’m assertive, that’s what everyone assumes,” Jackson explains. “When people give you advice, it’s coming from their social identity: their privilege, their background, etc. So you have to figure out what you can take from that and what you can leave.”

Jackson also recommends that female counselors gather both mentors who share their identities and those who do not to help them better navigate the field. When her interest in pursuing a research career led her to apply to the National Research Mentoring Network, she decided to choose a white male as one of her mentors to give her a different perspective. “He gave some insight on how to approach challenges rather than simply focusing on why people don’t understand things the way I do,” Jackson says.

For Jackson, who aspires to improve pipelines for people of color into academia and the mental health field, leaning in also includes starting conversations about the changing landscape of counseling and the reality that counselors don’t provide services to just one population. “We have to expand our ability to provide therapy to people with multiple identities and make room for them at the table as well,” she says. “If the path to leadership was really so linear, there would be a more diverse group of people stepping into those roles.”

Shaine asserts that counseling programs also have to address intersecting identities for their students, particularly those who are considered nontraditional. She points to the young women in her classroom who also work full time and the middle-aged mothers who are returning to school after a long hiatus or a career change. “We have to support them and try to be creative in helping students navigate a program,” she says. “Otherwise, we’re going to lose their voice and we’re going to end up with this monolithic student body, which I don’t think any of us want. That feels very antithetical to the counseling profession, where we want a diversity of perspectives.”

Counseling education programs could also use creativity and a focus on intersectionality to prepare women for a variety of roles in the field. Daniel points out that these programs rarely focus on issues such as licensure, starting a business or management roles. “Counselor ed programs need to step up their game and talk to people about what’s possible on the ground,” she says. “It’s socially unjust to send women out into the field without the full resources of what it really means to have a clinical practice.”

Advice from the panel

When asked what advice they would give to women entering a counseling education program or their first job as a counselor, panel members provided a variety of suggestions.

Mitchell, who aspires to a major leadership role in university student services, says that surrounding herself with the type of women who prompted these conversations in the first place was her best resource. “Sometimes we’re afraid to do that because we don’t want to feel like the least intelligent person in the room,” she says. “But you have to put your insecurities aside and see what you can learn from these women because, someday, you’ll be the person in the room somebody else is looking up to.”

Jackson says that advocating for your interests can go a long way. “If other people have that interest, then maybe you have enough people to request a class on that subject,” she says. “To me, that’s how change starts — being vocal and advocating for yourself.”

Shaine says women in the counseling profession shouldn’t lose sight of the flexibility they possess. “You can make a choice and change your mind later. We have an incredibly flexible field that gives us many different options. Be gentle with yourself,” she advises, “and know that the choices you make now can always be adjusted if they don’t suit you in the future.”

Daniel, who aspires to be a faculty member in a counselor education program, says that supporting other women can be empowering in itself. “We need to be better about supporting all women in their journeys, even if it doesn’t look like [our] own,” she counsels. “At the end of the day, we are creating pipelines for little girls to be what they want to be.”

 

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Kathleen Smith is a licensed professional counselor and writer in Washington, D.C. Her book, The Fangirl Life: A Guide to All the Feels and Learning How to Deal, was published earlier this year. Contact her at ak_smith@gwmail.gwu.edu.

Letters to the editor: ct@counseling.org.

 

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