Tag Archives: Counselors Audience

Counselors Audience

National Action Alliance for Suicide Prevention aims to save 20,000 lives over next five years

Heather Rudow September 12, 2012

(Surgeon General Regina Benjamin speaks at the NSSP reveal. Photo:National Action Alliance for Suicide Prevention)

On Sept. 10, the National Action Alliance for Suicide Prevention (Action Alliance), along with Health and Human Services Secretary Kathleen Sebelius and Surgeon General Regina Benjamin, revealed the revised version of the National Strategy for Suicide Prevention (NSSP). The strategy,  revised after nearly a decade of research, aims to place more focus on the roles Americans can play in protecting friends, family members and colleagues from suicide. The NSSP also aims to help schools, businesses and health systems create guidelines of their own and lead the way in suicide prevention activities in the future.

“We are in a unique position to make significant progress in reducing the burden of suicide in our country,” said Jerry Reed, director of the Suicide Prevention Resource Center (SPRC) in a press release. “With the release of this revised strategy and the focus on its first four priorities, the Action Alliance is leading the suicide prevention agenda at the national level.”

Reed co-led the Action Alliance task force, along with Surgeon General Benjamin, that guided the revision process.

The revised NSSP features 13 goals and 60 objectives to advance suicide prevention. The Action Alliance has chosen four priorities to focus on first with the aim of saving 20,000 lives in the next five years.  The Action Alliance said that it chose these priorities because of their “potential to produce the systems-level change necessary to substantially lower the burden of suicide in our nation.”

The Action Alliance stated the following as its initial priorities:

 1. Integrate suicide prevention into health care reform and encourage the adoption of similar measures in the private sector.  The Action Alliance will work in partnership with the Centers for Medicare and Medicaid Services (CMS) to take advantage of the exceptional opportunities health care reform offers to make large-scale system changes that can prevent suicide and save lives. Successful integration into health care reform will naturally spill over into private health systems.

2. Transform health care systems to significantly reduce suicide. The Action Alliance will promote the adoption of “zero suicides” as an organizing goal for clinical systems by providing support for efforts to transform care through leadership, policies, practices and outcome measurement.  This priority will build on the momentum of the 2011 report released by the Action Alliance’s Clinical Care and Intervention Task Force, Suicide Care in Systems Framework. The Action Alliance will recruit pioneer health and behavioral health systems from across the country to implement this innovative framework within their respective organizations and will provide the support and tools needed to provide state-of-the art suicide care.

3. Change the public conversation around suicide and suicide prevention. The Action Alliance will leverage the media and national leaders to change the narratives around suicide and suicide prevention to ones that promote hope, connectedness, social support, resilience, treatment and recovery. Current media coverage and messaging around suicide can often do more harm than good by using language and ideas that make suicide seem more common than it actually is, especially when it is a response to difficult situations such as bullying, financial crisis and repeated exposure to military combat. This priority will instead be to promote stories about individuals who struggled with difficult situations, yet were resilient, found help or treatment, and established a stronger will to go on living. In reality, this is what happens the vast majority of the time. It will also promote the cultural norm of providing help and support to vulnerable members of our communities, and through that, change the course for those who are struggling with thoughts of suicide.

4. Increase the quality, timeliness and usefulness of surveillance data regarding suicidal behaviors. The Action Alliance will work with the Centers for Disease Control and Prevention and other public and private partners to markedly improve statistics on suicidal behaviors. Currently, there is a three-year lag time with national suicide data. Speeding up the release of these data will allow policy and program developers to better understand the problem of suicide, monitor real-time trends in suicidal behavior and assess the effectiveness of suicide prevention work .

Click here to read the latest version of the NSSP. For more information about the Action Alliance, visit actionallianceforsuicideprevention.org.

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

SAMHSA awards Minority Fellowship Program grant to NBCC to expand the behavioral health workforce, better address the needs of underserved populations

(Press Release from SAMHSA)

The Substance Abuse and Mental Health Services Administration’s (SAMHSA) Administrator Pamela S. Hyde announced the award of a minority fellowship grant of up to $1.6 million to expand the behavioral health workforce in order to reduce health disparities and improve health care outcomes for traditionally underserved populations. The grant will improve health care outcomes for these populations by increasing the number of culturally competent mental health and substance abuse counselors available in the public and private non-profit service sectors.

“Many racial and ethnic groups do not have access to quality behavioral health care delivered by practitioners who truly understand the language and culture of the people they serve,” said SAMHSA Administrator Pamela S. Hyde. “This grant will help ensure that we can effectively meet the behavioral health needs of all Americans, regardless of language or culture, reducing health disparities and improving the overall health and well-being of everyone who needs behavioral health services.”

The Minority Fellowship Program grant is being awarded to the National Board for Certified Counselors, Inc. and Affiliates based in Greensboro, N.C. in an amount of up to $825,000 each year for up to two years.  The actual amount of the funding is subject to the availability of funds.

Funding for this grant will support infrastructure development activities that include: providing stipends and other training related costs for professional counselors to improve their cultural and linguistic competency; workforce development activities aimed at increasing the pool of doctoral-level professional counselors who deliver culturally appropriate behavioral health services to diverse populations especially within the public and private non-profit sectors; collaborating with accredited, graduate schools for professional counselors to recruit more students,  including those in recovery, committed to serving minority populations with mental and substance use disorders.

Counseling Today will be featuring an article on this grant in an upcoming issue. 

Counselors: Support local police by sharing your skills

Diana Hulse & Peter J. McDermott September 1, 2012

Earlier this year, in an article for the FBI Law Enforcement Bulletin, we proposed that interpersonal skills training is fundamental to effective performance in all aspects of police work. We argued that although police officers receive expert training in tactical and legal skills, and that their mastery of these skills can be documented, it is unclear whether they are routinely taught interpersonal skills or how these skills are evaluated, if at all.

Actually, in preparing our article, we noticed that police officers rarely if ever receive basic interpersonal skills training, even though they are in dire need of developing these skills. Where can police officers find resources to assist them in the pursuit of these skills? One answer lies with counselor education programs and practicing counselors.

Counselor education programs provide curriculum and methods for teaching and evaluating foundational interpersonal skills. Counselor educators, practicing counselors and counseling interns can serve as coaches to teach, demonstrate, supervise and evaluate police recruits in the use of these skills. Counselors can also help veteran police officers to review, practice and upgrade performance in these skills.
There is no requirement for counselors to have specific knowledge of police work to help in this area. Rather, all that is needed is a willingness to share their skills. Police academy instructors are the ones who can then apply these skills to the training needs across the police academy curriculum.

Why police need to strengthen ‘talk’ skills

Police officers work with the public to create safe and crime-free communities. To be successful, they must display strong tactical and legal capabilities and also convey verbal and nonverbal interpersonal skills that communicate respect, diffuse conflicts, reduce violence, instill public partnership and demonstrate a professional demeanor.

The reality is that police engage on a daily basis in two activities: They talk to people and they touch people. The “touch” factor is represented by a concern for officer safety. Police are trained and evaluated in the handling of firearms, motor vehicle stops, self-defense, arrest and control, and responses to crimes in progress. “Talk” skills are essential to the execution of these tasks.
Talk skills are also necessary for police officers to create and maintain environments that encourage a tone of civility in their interactions with the public. It has been documented that the police and public have different expectations and attitudes that can raise tensions when the police and the public interact. These tensions can be further intensified today in an increasingly multicultural society in which a number of challenging issues and factors, including an uncertain economy, can lead to domestic or workplace violence, abuse, stealing, rage and bullying. Faced with these challenges, police officers must demonstrate a competence level with talk skills that is on par with their touch skills. Only by putting talk skills at the forefront of their training can police expect to contribute to their desire for a tone of civility, which is essential for maximizing a level of collaboration with the public that can lead to safe and crime-free communities.

Counselor educators, practicing counselors and counseling interns are an identifiable and critical resource to police in achieving a high level of training in interpersonal skills. Once basic interpersonal skills are in place, counselors can help police focus on other important skill sets, including how to give and receive feedback and how to succeed in leadership tasks.

Enhancing skills for giving and receiving feedback

Once police recruits complete classroom instruction, they enter what is called the officer field training program. This is where, under intensive supervision, police officers translate all learning experiences to date into acceptable performance in motor vehicle stops, criminal investigations, and domestic violence and conflict situations. In field training programs, officers receive mandatory feedback for a period of 10-14 weeks on their encounters with the public. This is analogous to the feedback process that counseling students engage in with site and university supervisors during their clinical training.

Here again, counselors can help supervising officers in field training programs learn effective ways of giving, receiving, clarifying and exchanging feedback, particularly if that feedback is corrective in nature. Many tools and approaches are available in the counseling literature, as well as in clinical supervision curricula, to help make the best use of supervision that leads to growth and competence as counselors. These same resources can be adapted for use in field officer training programs, allowing supervisors to enhance the professional development of police personnel, while helping officers to gain an appreciation of feedback and its link to their personal and professional development.

Enhancing skills for leadership tasks

Upon mastery of interpersonal skills and feedback skills, a natural progression is to focus on group facilitation skills. These skills are needed in a variety of situations common to police work, including debriefing meetings, block watch groups, and team or divisional commander tasks.

Here again, counselors possess the skills to provide training and supervision on a range of basic leadership competencies, including how to build interaction and gather information; how to draw members out, cut off extraneous conversation or shift the conversation to focus on the desired topic in a meeting; and how to use attention to the hereand now to address nonverbal behaviors that might negatively affect the work of the group.
Group work literature offers many models and ideas for counselors to use in helping police officers understand group dynamics and assemble a skill set that supports success in their leadership duties.

Sharing our skills: Who benefits?

With a solid grasp of basic interpersonal skills, police are in a better position to respond with competence and sensitivity to potentially volatile situations in their daily work. Additionally, as police gain mastery of interpersonal skills, feedback skills and skills for facilitating leadership tasks, they can model and transfer these skills to all members of the organization. A new generation of trained police personnel will emerge with proficiency both in human relations skills and tactical skills.

The timing is excellent for this type of collaboration between counselors and police. The medical profession is already addressing the need for physicians to learn how to communicate with patients and work as a team. Like doctors who listen carefully to their patients, police officers must listen to and understand the public to gather pertinent information, supplement their technical knowledge and build more civility and trust between themselves and the public they are sworn to serve.

By pursuing partnerships with police personnel, counselors will be fulfilling a call to share their skills with others in their communities. In addition, counselors will gain visibility for their expertise and contribute to the betterment of their communities.

Together, police officers and counselors will benefit through improved communication and increased understanding of what the other group does. In the end, communities will reap exponential benefits as a result of the collaboration between these two disciplines.

Contact your local police department today

You might believe that police organizations are insulated and difficult to reach as a counselor. We think such connections are possible, however. The key concepts to consider are creativity and opportunity.

Do you know a school resource officer in the local schools who might be willing to exchange ideas about training, or is there a training division within your local police department? You could take a copy of our 2012 FBI Law Enforcement Bulletin article, “Interpersonal Skills Training in Police Academy Curriculum,” and offer your assistance in providing skills training to young recruits or refresher sessions for veteran officers. We have written two other articles (one in print, the other in press) for the FBI Law Enforcement Bulletin that could serve as resources for your outreach efforts, and we are available to talk about our initiatives in the state of Connecticut.
The potential rewards for collaboration across the disciplines of counselor education and law enforcement are many. Such collaboration is a great way for counselors to share their important skills, helping police personnel to use improved interpersonal skills to achieve their mission of better communication with the public and safer, crime-free communities.

 Diana Hulse is professor and chair of the Counselor Education Department at Fairfield University in Fairfield, Conn. Contact her at dhulse@fairfield.edu.

Peter J. McDermott is a retired captain from the West Hartford and Windsor, Conn., police departments and a retired instructor from the Connecticut Police Academy. Contact him at pete06422@yahoo.com.

Letters to the editor: ct@counseling.org

ArtBreak: creative counseling for children

Katherine Ziff, Sue Johanson & Lori Pierce

The elementary school counseling model used in the Athens (Ohio) City Schools is one in which our counselors serve several schools, so I (Katherine Ziff) structure my work with priority to offering preventive and developmental services to groups of children. Three years ago, in consultation with our school psychologists and administrators, I began offering studio art-based group counseling sessions that we call ArtBreak to children. The program has evolved into an ongoing, choice-based studio art counseling intervention that allows children to relax and express their feelings, practice prosocial behavior and develop problem-solving skills and creativity. The program now serves 35-45 students each year. For the past two summers, supported by Integrating Professionals for Appalachian Children (IPAC) and Project LAUNCH, an initiative funded by the Substance Abuse and Mental Health Services Administration through the Ohio Department of Health, I have also been able to offer ArtBreak through public libraries in two communities. Project LAUNCH promotes the improvement of the health and wellness of children from birth to age 8, and the summer groups were composed of children in this age group.

Structure 

Our summer ArtBreak program offers sessions in the meeting spaces of community libraries. Participating public libraries enroll children in the program. These groups, each consisting of 10 children, meet six times during the summer for an hour each session. Sessions are held twice a week for three consecutive weeks for children up to
age 8.

The ArtBreak program in the elementary schools runs from October until the end of the school year. Each group meets weekly for 30 minutes. Groups are composed of seven to eight children from kindergarten through sixth grade. Students are referred by teachers, parents or a community mental health provider with a form that we developed based on the therapeutic goals supported by the Expressive Therapies Continuum. A parent or guardian gives each child written permission to participate in ArtBreak.

Guiding principles

ArtBreak has four guiding principles:

  • The Expressive Therapies Continuum
  • Choice-based studio art
  • The counselor as a facilitator
  • Multiage groupings and community

The Expressive Therapies Continuum is a foundational art therapy framework introduced by Vija Lusebrink and Sandra Kagin in 1978. A developmental hierarchy associated with how information is processed in relation to how images are created in a therapeutic context, the Expressive Therapies Continuum delineates three areas of therapeutic goals with associated media. Briefly stated, these are:

1) Use fluid media such as watercolor and finger paint to address kinesthetic/sensory goals such as relaxation and expression of feelings.

2) Use more resistive media such as colored pencil and crayons to address perceptual/affective goals such as improving cognition, increasing empathic understanding, identifying emotions and grasping cause and effect.

3) Use resistive media such as collage and sculpture to address cognitive/symbolic goals such as developing problem-solving skills, identifying and integrating strength, and supporting creative thinking.

In ArtBreak, we use the Expressive Therapies Continuum as a guide for stocking the studio with materials, reflecting on student work, setting goals for students, and completing documentation and evaluation. In a choice-based art studio such as ArtBreak, students are encouraged to make their own choices about media and materials. In stocking the studio, we avoid kits and preplanned projects and provide art-making materials that are high quality and safe for children. We have a few tools such as awls and mat knives for working with cardboard that are used only by the counselor or under close supervision, but everything else in the studio is for the children to use freely themselves.

The groups begin with a basic set of materials and media. Over time, we supplement these materials and media as children seem ready or ask for them. In this way, we have introduced multistep, complicated processes such as printmaking (when a student asked for a potato to carve and use to make prints), sewing (when a student asked to make a small pillow) and installations such as a whole-room, multimedia experience that the children dubbed “Winter Wonderland.”

The role of the counselor in ArtBreak is not to direct activities but rather to facilitate, model problem-solving, demonstrate the use and care of art-making materials, teach skills such as setup and cleanup, encourage and model supportive behavior and language, keep time, document student work products and process, and make decisions about new materials and processes to introduce to the children.

We find that multiage groupings of children are important to the process of building community within an ArtBreak group. This approach creates new patterns of behaviors and relationships by offering children social experiences that are different from those found in their regular classrooms. It also allows opportunities for new friendships across ages to develop. Older children sometimes are models and helpers for the younger ones, while younger children sometimes delight the older group members with their willingness to experiment and try out different materials.

Setting up the studio

We have conducted ArtBreak in a large room with a sink as well as a small room with no sink, simply outfitted with a bucket, cleanup cloths and a pitcher of water. A tile floor is much less worrisome than a carpeted one, but we have managed in a carpeted studio by reminding children about the floor when painting and cleaning up any drips quickly.

A good way to begin is to provide two or three materials from each of the three areas of the Expressive Therapies

Continuum and then to add to the supply according to what the children seem ready for. To start, include fluid media such as finger paint, chalk pastels and watercolors; more resistive media such as oil pastels, crayons, tempera paint and brushes, clay, watercolor markers and water-based oils; and resistive media such as collage materials, buttons and beads, graphite and sculpture materials.

A sculpture/construction area can be furnished at no cost by seeking donations of cardboard boxes of all shapes and sizes as well as other cardboard and plastic odds and ends. Provide construction tools and supplies such as scissors and hole punchers, pencil sharpeners, drawing pencils, glues, a variety of tapes (including duct tape), ribbons and strings, and brass fasteners of different lengths. You’ll need paper that is suitable for both wet and dry media, as well as glossy finger-paint paper.

Old cafeteria trays are helpful to contain individual work, and a large cutting mat is useful for cutting cardboard. Smocks can be made inexpensively from old shirts. A drying rack for paintings, at $120, has been our only single item of significant cost. The materials and supplies are permanently located in our school studios. In our summer library-based program, we use a portable system of bins that can easily be packed and stored in a corner of the room.

Documentation

Written and photographic documentation is a daily task for the facilitating counselor. We keep notes describing group and individual process as well as reflections about new materials and supplies needed, changes in process and ideas to support children in their art making. Part of the documentation includes communicating with teachers and with families about what their children are making in ArtBreak and their process.

We also learn by asking children questions about ArtBreak: Tell me about ArtBreak. What do you do here? What do you learn?

Children tell us they learn about emotional regulation and sensory expression: “I learn I have to work calmly in here”; “Finger painting feels good. It is awesome and smooth. Regular paint is not so fun as finger paint.”

They describe using their cognitive skills: “We learn about tools, what you can make with them, being careful with them”; “You use your thinking. You think about what you make”; “I learned how to make a robot, how to sew.”

They tell about community and group process: “We have fun. We help each other, and that’s fun.”

And they delight in the opportunity for creativity: “We aren’t directed. Your mind is not in a can”; “We don’t get told what to do, what to make. We have ideas”; “ArtBreak is when you can express your ‘magination!”

ArtBreak has evolved to a point where we are beginning to conduct outcome research and offer school counseling interns opportunities to learn to structure and facilitate ArtBreak groups. I (Katherine) am also working with Margaret King of Ohio University to prepare a workbook detailing complete ArtBreak “how-tos” for practitioners.

“Knowledge Share” articles are based on sessions presented at past ACA Conferences.

Katherine Ziff is a school counselor in the Athens City Schools in southeastern Ohio as well as an exhibiting artist. Contact her at katherineziff@aol.com.

Sue Johanson is a school psychologist in the Athens City Schools and vice chair of IPAC. Contact her at sjohanson@athenscity.k12.oh.us.

Lori Pierce is a school psychologist in the Athens City Schools. Contact her at loripierce@athenscity.k12.oh.us.

Letters to the editor: ct@counseling.org

Resources 

  • Engaging Learners Through Artmaking: Choice-Based Art Education in the Classroom by  Katherine M. Douglas and Diane B. Jaquith
  • Studio Thinking: The Real Benefits of Visual Arts Education by Lois Hetland, Ellen Winner, Shirley Veenema and Kimberly M. Sheridan
  • Expressive Therapies Continuum: A Framework for Using Art in Therapy by Lisa D. Hinz
  • Katherine’s ArtBreak blog: briarwoodstudios.wordpress.com

 

Home is where the client is

Dawn Friedman

For some counselors, meeting clients where they’re at is more than a figure of speech. Counselors who specialize in home-based therapy work with clients in their living rooms and at their kitchen tables, giving much-needed assistance to families and individuals who otherwise might not be able to access mental health services. Home-based counseling eliminates barriers for families who don’t have good child care options or who have trouble securing rides to the clinic.

An ecological framework focused on family preservation shapes most home-based counseling programs, with counselors considering their identified clients in the context of the complete family and community systems. Parents at risk of losing custody of their children to social services are usually targeted for home-based services, which often involve other wrap-around help such as case management and psychoeducational support. Home-based work also makes sense for foster families who could use help navigating the intensity of the needs of the children in their care.

Theresa Robinson is an American Counseling Association member who works for a community mental health agency in Tucson, Ariz. She says her clients face multiple challenges — poverty, dual diagnosis and insecure housing are common concerns — so her agency uses a team approach that allows the counselors to focus exclusively on therapy, while ensuring that clients get the extra assistance they need. Monthly team meetings focused on the child and family keep everyone on course and ensure stability of services.

“We have care coordinators who do case management and family support specialists who help with parenting skills and psychoeducation,” she explains. “For example, in a family where the children are removed and are now in foster placement, the family support specialist will be going in to help the foster parent deal with parenting issues, and I’ll help the kids deal with the emotions and feelings around missing mom and dad.”

Robinson says being able to read her clients’ environments — to see how they use their space together and how that shapes their experiences — allows her to build rapport more quickly. “I do a lot of work with teens, and they show me their rooms, what they’re doing and drawing, and the music they’re listening to,” she says. “I think it makes them feel less defensive and less likely to shut down because I’m coming to their turf as opposed to asking them to come to an unfamiliar place and talk about their feelings. I think I’ve gotten a lot further a lot quicker [with home-based counseling].”

Safety first

Al Sylvia Procter, an ACA member in private practice in Valley, Ala., spends most of her time on the road traveling to her clients’ homes, many of which are in isolated rural areas. Procter was introduced to home-based work as a student, when she worked as an intern at a family services agency. Although the agency offered both office-based and home-based counseling, she found that home-based counseling generally served her clients better. When it came time for Procter to build her private practice, going into her clients’ homes seemed like the obvious choice.

Procter acknowledges that the 20 years she spent as a military police officer make her feel comfortable going into environments that other practitioners might avoid. Mindful of safety, Procter keeps her cell phone charged and always makes sure that someone else knows where she should be at any given time. She also schedules intakes at neutral, public locations such as libraries or even laundromats so she is able to explain her expectations, secure the client’s buy-in and gauge her own comfort level with going to that particular client’s home.

“I’m old school,” Procter says. “I’m just straightforward, and I let my clients know up front what I need to work with them. If they can’t do that, then maybe they need a different therapist. I’ve gone to houses with loose dogs, and I tell [the clients] to put them up, or else we can meet someplace else. If all else fails, we can terminate the relationship.”

For counselors accustomed to controlling the therapeutic environment, home-based work can be challenging. Houses may be dirty, and there isn’t always a clear place to do counseling. The client might not have a kitchen table or a couch to sit on in the living room.

Procter says home-based counselors should be prepared to confront conditions that are less than ideal, while still remaining flexible. “I don’t want them to have to clean for me,” she says. “I want their house to look the way it normally works.” She adds, however, that if health and hygiene issues are present, such as roaches crawling on the floor with the baby, she will address those issues in session.

Counselors interested in home-based work also need to be adaptable, Proctor says, because the number of interruptions is greater than when doing office-based work. For instance, clients might need to suspend a session to attend to a crying baby or to answer a knock on the door, or they may need to get up to start dinner. Rather than regarding these circumstances as distractions, many home-based counselors view them as opportunities to witness how the family is managing and to offer interventions where appropriate.

To save on gas and to lessen the wear and tear on her car, Procter schedules her clients by county, arranging appointments around the several multidisciplinary team and committee meetings that she participates in regularly. Because she maintains a home office, she saves on rent, and a portion of her living expenses and her other business-related expenditures such as mileage, Internet and cell phone are tax deductible.

Understanding services

Christine Woods is an ACA member in Rolla, Mo., whose private practice consists entirely of home-based clients. She says home-based work has been more effective for her than meeting with clients in an office. “My colleagues think I’m completely insane, but I do not like in-office therapy,” Woods says. “I get better results because [my clients] are more relaxed and more calm.” Woods also believes she is able to build the therapeutic relationship more quickly during home visits.

She offers an example of why home-based counseling has the potential to be so effective. “There was a situation where I was doing family therapy for a kid and her mom, and they were constantly fighting about chores,” Woods says. “One day, one of the assignments I had for them was to have mom show her daughter how to actually do those chores. The daughter says, ‘Oh my gosh! I get it.’ She needed her mother to show her, and from then on, they didn’t fight about chores. If I hadn’t been right there helping them work through the exercise, I wouldn’t have had that opportunity.”

Most of Woods’ clients come to her through referrals from other agencies and have more experience with case managers than with counselors, so part of her work involves explaining what counseling is and what she can and cannot do for clients. Because Woods is in private practice, she does not work with a team. Instead, she stays updated on community resources and helps clients get referrals to additional programs when their needs go beyond her scope of practice.

Woods echoes Procter’s advice concerning the need for home-based counselors to be clear and up front about their expectations. “I’m pretty blunt. I say, this is what my role is, and if you need case management, if you need parenting skills, we can hook you up with services to address that, but what I do is strictly therapy.”

Possessing the proper attitude is pivotal to the success of home-based counseling. “When people invite me into their homes, the most private place they have and the place they feel most secure, I recognize that it’s a privilege,” Woods says. In fact, she adds, demonstrating her respect for and acceptance of her clients is even more powerful in that context. “You cannot be judgmental. If the furniture is stained or the house is run-down, for them to be able to feel like they’re treated with respect when I walk in, that’s key to helping them feel OK and trust me.”

Mandate for the profession

Greg Czyszczon is an ACA member and doctoral candidate in counseling and supervision at James Madison University who is researching home-based counseling. He says discussions about home-based work can get muddied, both for clinicians and for clients, because paraprofessionals — college graduates with little to no clinical training — are sometimes hired to do home-based work with clients, and these services are often confused with actual counseling.

“In many areas of the country, people are allowed to offer services in-home that they could not offer in an office,” Czyszczon says. “An agency might send a 23-year-old with a bachelor’s degree in sociology [who maybe] worked for a year in an after-school program, and [he or she] would be the one working with kids who have trauma history and abuse history living in homes where there is substance abuse and domestic violence. For some reason, when it’s in-home, it’s acceptable to have people in there who don’t have training.”

That scenario is bad not only for clients, Czyszczon says, but also for counselors who are offering home-based services because the resultant confusion diminishes the therapeutic work that many appropriately trained clinical counselors are doing. In a 2011 presentation at the ACA Conference in New Orleans, Czyszczon and fellow ACA member Cherée Hammond advocated for the counseling profession to recognize home-based counseling as a specialized area of practice, much like play therapy or couples counseling. Czyszczon and Hammond believe counselors should have specific training on family systems, crisis counseling, resiliency, attachment, trauma-informed care, multicultural intervention, child development, substance abuse and serious mental illness before they begin doing home-based work. They would also like for ACA and the Council for Accreditation of Counseling and Related Educational Programs to join in the discussion. “We want to say, if you’re going to be a [home-based] counselor, then these are the recommended competencies in this in-home scenario, and we need to be specific about those as a profession,” Czyszczon says.

Gerard Lawson, an ACA member and associate professor in the Virginia Tech School of Education, has conducted research on home-based counseling and supervision and asserts that it is some of the most challenging work that counselors can take on. Offering home-based services aligns with the counseling profession’s social justice mandate, he says, but too often, those tasked with doing this work are ill prepared for its many challenges. These practitioners can also be confronted by a professional stigma that says home-based work is case management rather than true counseling, Lawson adds.

“These families [clients of home-based counseling] are multichallenged, often on the verge of homelessness, often with involvement with the court system, with addiction issues and poverty,” he says. “You’re working bad hours and going out to people’s homes. Maybe your caseload isn’t as full as someone doing office-based work, and that could create the perception that this is less than counseling. But, actually, it’s counseling-plus. It was the hardest work, bar none, that I’ve ever done in my life.”

“When I talk to supervisors about home-based work, what I try to tell them is that the system is upside-down,” Lawson continues. “There is no good reason that we should be sending people out who are working on their master’s degree or who are newly graduated to attend to cases that would be challenging for a more-seasoned professional. The best and the brightest [of our profession] should be doing this work.”

Lawson says isolation and burnout are issues for home-based counselors because they spend most of their time in the field and may not get the peer support that office-based colleagues receive simply by checking in with another clinician on staff. “Counselors [who do this work] are prime for compassion fatigue and vicarious traumatization. This kind of work places them at greater risk,” he warns. “That’s a recipe for burnout, or they’re just going to become numb to it, and they’ll invest less and less of themselves. The antidote to that is good supervision, but a lot of the supervisors have never done home-based work.”

Lawson would like to see greater numbers of experienced counselors take on one home-based case to augment their in-office work. Spreading around this workload would create a larger peer group of counselors experienced in home-based work who could offer one another support, he says. It would also allow counselors who currently do mostly home-based work to see some clients in the office, supplying these counselors with the attendant peer support that comes with working on-site.

“Maybe it doesn’t become an exclusive sort of service anymore,” Lawson says. “For everybody that’s doing outpatient work, perhaps they flex their time and have one home-based client that they work with one day a week. That would decrease the stigma [of home-based counseling], and it would also mean that this would be less segregated. If everyone is doing it, then it becomes more of ‘This is what we do as a profession.’ We could say, ‘If these families haven’t been successful here [in the office], they need a more intensive level of treatment, and that should continue with the same counselor.’”

Like Czyszczon, Lawson sees home-based counseling as a matter of social justice and thus part of the counseling mandate. “The reality is that this population needs better service, but they’re given less and less attention,” he says. “As a professional, I find that troubling. And as a member of the community, I find that shameful.”

Although the work is difficult and stressful, Woods says she has no plans to go back to counseling out of an office. “Some people are made for office therapy, but I get better results when I work with people in their homes,” she says. “There’s a gift that I’m to learn from them just like there’s a gift that they’re to learn from me.”

Dawn Friedman is a writer and counselor-in-training in the community counseling program at the University of Dayton. Contact her through her website at DawnFriedman.com.

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