Tag Archives: Counselors Audience

Counselors Audience

Navigating life’s learning curve

Lynne Shallcross May 1, 2011

Picture this: You’re a college student cramming for finals in a campus lab late one Sunday night when you see a lanky, 6-foot-2-inch, long-haired man striding toward you wearing a red polka-dotted hat and carrying a tower of pizza boxes. You could be excused for thinking you’ve ingested one too many cups of coffee and that you’re finally hallucinating. But if you’re a student at the Savannah College of Art and Design (SCAD), you shriek with delight because the Pizza Fairy has arrived.

“We thought you were just an urban legend!” students tell Pat Mooney, who takes “flight” as the Pizza Fairy three times a year. Otherwise, Mooney can be found working as a counselor with SCAD’s Counseling and Student Support Services. Though slightly nontraditional, the Pizza Fairy is one of the counseling center’s most effective outreach initiatives.

Because SCAD is an art school, many of its students can’t sit in the comfort of their dorm rooms to study and complete projects, Mooney explains. This leaves them up late at night working in buildings spread across campus. So at 11:30 on the Sunday night before finals, Mooney hops in his van, picks up 73 large pizzas and distributes them to hundreds of lucky (and overworked) students. For every group of roughly 10 students that Mooney comes across, he delivers a pizza as well as a flier that reads, “You have been visited by the Pizza Fairy, whose motto is, ‘The road to good mental health is paved with pizza!'” The flier also contains information about how to access SCAD’s counseling services.

Mooney says the director of the counseling center first proposed the idea of taking pizza to studying students approximately seven years ago. When Mooney, a member of the American Counseling Association, volunteered for the job, he decided to make the outreach effort a little more fun, and soon it morphed into the Pizza Fairy concept. In retrospect, pizza turned out to be a wise choice, says Mooney, who notes that the “Arugula Fairy” probably wouldn’t possess the same cachet. “We [the counseling center] also sponsor Donut Divas, who do their thing in the morning,” he adds. “Some other departments, such as residence life, have picked up on the concept and take other kinds of snack foods around on nights when the Pizza Fairy is sleeping.”

But if the local Pizza Hut delivers, why does Mooney go to all that trouble? For one thing, Mooney says, it’s fun and uplifting, both for the students and for him personally. Delivered in this way, the pizza also seems to entice the students away from their computers, even if only for a few minutes, to talk with their peers and to feel a sense of connection. But the larger goal of the initiative, Mooney says, is to reach out to the campus community and remove the stigma of utilizing the counseling center.

“For years, various agencies and organizations have been making efforts to ‘destigmatize mental illness,'” says Mooney, who is also a member of the American College Counseling Association, a division of ACA. “We didn’t feel that quite hit the mark in terms of the message we wanted to get out. Though destigmatizing mental illness is certainly a good thing to work toward, we felt that there was a certain stigma to even coming to the counseling center or seeking therapy in the first place. That’s what we began to focus on in our discussions of how best to serve our students, and the nature of our outreach changed as a result.”

SCAD’s counselors still engage in many traditional outreach activities, such as depression, anxiety and eating disorder screenings, Mooney says, but they try to focus even more on fun activities. “We want to connect with students in such a way that if they run into problems that they’re having trouble solving utilizing their regular resources, they’ll think of us and not hesitate to contact us. We take great pains to not have a waiting list and to be a resource 24/7/365. Our sense is that in terms of service to the SCAD community, we’re able to do a better job because more students come to us before things get out of hand.”

When students get help early on, it might help them head off larger problems down the road, Mooney says. “People will try to solve their own problems, but when that begins not to work, we want folks to see us not as a place of last resort, but as a first stop. If they come to us initially, we might be able to prevent further deterioration.”

New low for mental wellness

Nationwide, more pizza fairies might be needed. A recent study by the Higher Education Research Institute at the University of California, Los Angeles puts the emotional health of college freshmen at its lowest level in 25 years. “The American Freshman: National Norms Fall 2010″ surveyed more than 200,000 full-time students at four-year colleges and universities and found that the number of students who reported their emotional health as above average had declined 3.4 percent since 2009 and 11.7 percent since the survey began tracking emotional health in 1985.

The survey’s results are on par with what many college counselors are seeing on their own campuses. Although Central Wyoming College’s once-rising enrollment leveled off for the first time in four years this year, Lance Goede, director of counseling and career services at the two-year community college, says his caseload has almost doubled. Meanwhile, at SCAD, Mooney and his colleagues have had conversations about how stressed the students seem in comparison with past years.

The economy is one likely factor, Mooney says. “Not only is the current situation with many students and their families stressful, [but] the prospects for new grads aren’t as rosy as they have been in the past. More students are having to work at jobs” — in addition to attending school — “and work longer hours to make ends meet, expenses are rising, family economic support is dwindling, competition for jobs is increasing and so on.”

“Consequently,” Mooney continues, “I think it’s more important than ever to help our students develop life skills that will serve them well when the chips are down. Deliberately paying attention to and acting in ways that promote good mental and physical health is important. Being able to think and solve problems creatively and with flexibility is useful, as is being able to collaborate, connect and network. Being able to tap into and maximize personal assets while compensating for deficits is helpful, too.”

ACCA President Brian Van Brunt agrees that the economy is a major factor in increased stress on campus. “Many college students are struggling with the idea of college being worth the investment on the other end,” says Van Brunt, who serves as director of counseling and testing at Western Kentucky University. “I think they often worry about having a job after college and if spending upward of $30,000 on a college education is something they will earn back over time. This can be particularly difficult for students who are watching their friends enter the workforce after high school and earning a paycheck while they are saving and working their way through college.”

But an alternative way of looking at the results of “The American Freshman” study, Van Brunt says, is that school counselors have grown more effective at supporting students in high school, enabling struggling students who wouldn’t have gone to college in the past to now achieve that goal. “We’ve supported more at-risk students to reach for college in ways they never have before,” he says. “Part of why they’re struggling [in college] is because they’re reaching higher than they have in the past.”

At Central Wyoming College, the student population is split equally between traditional students and those returning to school at a later age. Goede, a member of ACA and ACCA, has noticed an increase in students coming to campus with learning disabilities, particularly straight out of high school. He acknowledges there is a push in high schools to give students as many options as possible. Adding to that, Goede says, Wyoming has an open-door policy dictating that state community colleges must admit any Wyoming high school graduate who applies.

When students aren’t properly prepared to meet the demands of college classes, it leads to a buildup of stress and frustration, Goede says. To help alleviate that, Goede works in conjunction with disability services to assist struggling students. He also offers career counseling services so students are aware of their choices. For instance, if a particular student is focusing on a career that requires calculus but is struggling with basic math, Goede helps the student look at alternatives and set realistic goals.

Age-old issues

Looking beyond the economy and learning disabilities, counselors say the issues college students bring with them to the counseling center run the gamut. According to Van Brunt, some of the most prominent issues tend to be depression, anxiety, relationship problems and academic stress. “I think the age-old problems of school are still first and foremost on college students’ minds,” he says. “They worry about paying for college, about trying to [strike] a balance between finding enough time to study and to have fun, and there is that old fear of finding Mr. or Mrs. Right. While many of the ways college students experience stress have changed” — for instance, having to decide whether to invest in a life coach to choose a college, being bombarded with marketing from different schools and dealing with the added pressures of social media — “the underlying issues remain the same.”

In his experience at SCAD, Mooney has found that certain issues seem to ebb and flow throughout the year. For instance, in the fall, there’s a fair amount of homesickness and anxiety over time management and balancing the workload. In the second quarter, students aren’t generally as anxious about the adjustment, but the winter blues can set in. Mooney also points out that many mental disorders, such as bipolar disorder, schizophrenia and depression, often rear their heads during the college years and begin to interfere with daily functioning. There are various ideas about why this happens, Mooney says, but it’s one of the reasons they encourage students not to wait until things get dire before coming to the counseling center.

In Wyoming, Goede has noticed a consistent theme regardless of the students’ ages: relationship problems. “There’s a lack of communication between husbands and wives, boyfriends and girlfriends,” he says. “It seems like everything goes to an argument. Everything goes to an emotional response.”

Goede consistently hears from his student clients that they tend to react emotionally rather than analyzing the issue and considering how best to communicate. While the younger students sometimes have yet to develop more mature communication skills, the older students often need a refresher on those skills as well, he says. When Goede sits down with clients to help them analyze their situations, they often have “aha” moments in which they recognize that their significant others might have responded on the basis of something they said or didn’t say. “More than anything, it’s getting them to talk about what they are doing and giving them some insights about other ways to think about things or act,” Goede says.

College students experiencing relationship problems might not be aware there are options beyond yelling or making sarcastic remarks, Goede says, so he works with them to come up with other ways of reacting and then asks them to test drive these alternatives as homework. He says cognitive approaches can be effective in helping student clients analyze their thinking patterns, identify where they got off on the wrong track and see how they ended with an emotional rather than a rational reaction.

A fair number of Goede’s clients present with substance abuse issues. Many of these students are referred to him after violating rules in campus housing. Most of the issues stem from alcohol abuse, and Goede acknowledges it’s sometimes a matter of kids simply being away from home and pushing the boundaries. “But it’s definitely impacting their schooling,” he says. “There are definitely effects of substance abuse on their success.”

When students are referred to his office, Goede often uses one of two programs — eCheckup to Go (e-CHUG), an online program in which students answer a variety of questions and the program reports back on the physiological and mental health effects of alcohol on their lives, or Choices, a journaling program that helps students analyze how their behavior is affecting them personally. Both programs also include statistics that can help students realize they are in the minority as heavy drinkers, not the majority, Goede says.

A safe place

Heading off to college is a pivotal point in many people’s lives, and the nature of the transition can introduce or magnify issues of adjustment as young people reach independence and adulthood, Van Brunt says. The larger philosophical questions of “Who am I?” and “What am I living for?” often take center stage. “This transition phase from ages 18 to 22 is a significant one full of energy, questions, struggles and potential pitfalls — suicide, alcohol and drug problems, and balancing work and social needs,” Van Brunt says. “As with a young child, problems left untreated and needs left unmet can lead to lifelong difficulties in relationships and playing catch-up in certain developmental areas. College students are similar. Powerful relationship losses, abuse of alcohol and drugs and lack of hope and meaning during these developmental years can lead to cyclical broken ways of interacting with others and creating a happy life. College counselors are in a unique position to smooth over some of these rough spots, keep problems in perspective and, most important, inspire hope for a brighter tomorrow when things may look dark and without purpose.”

The counselor’s office should serve as a place where students can vent their frustrations and express their worries and fears about the future, Van Brunt says. “We help them place their concerns in a normative context, can often help reframe problems so they seem less overwhelming and assist students in obtaining a foothold to begin their climb out of the hole they find themselves in,” he says. “College counselors also offer direction and guidance in terms of managing stress, making decisions about medication and how to best manage symptoms of mental illness. Mostly though, we provide a caring, nonjudgmental place to work on their problems and worries. We listen, we care and we offer them support.”

At SCAD, Mooney works as a solution-focused therapist, which he says is particularly well suited to college students. Oftentimes, students actively want to solve their own problems, he explains, and solution-focused methods build on the assets they already possess. Mooney says he often can tell within the first five minutes of talking with student clients which of their skills will help them most in solving their problem.

In the case of one recent client, the solution was hidden in his athletic experience. The student came to Mooney expressing anxiety about the speech class he was required to take. He was very tall, a little self-conscious, and he would lose focus speaking in front of groups and end up talking in circles. Mooney asked the student a little more about himself and found out he was a swimmer.

Mooney told the student to imagine the moderate level of anxiety he might feel before a swim meet as opposed to the high level of anxiety he was experiencing before a speech. Mooney then encouraged him to try to plateau at that moderate state before a speech. Next, Mooney talked about how the student swam laps at meets and how he could use that concept to structure his speeches into a sequence rather than talking in circles. By working with Mooney and building on his existing skills, the student learned to manage his anxiety and went on to earn a good grade in the speech class.

Motivational interviewing (MI) and motivational enhancement therapy (MET) also tend to work well with college populations, Van Brunt says. “These approaches start with a therapist working with a student where they are and trying to help through harm reduction strategies. For example, if a student comes in and wants to cut back [his or her] drinking, an MI or MET therapist would start with where the student is currently drinking and help look at ways to cut back slowly. They would not frustrate or challenge the student but instead roll with any resistance and find ways to support the student’s successes and overcome any obstacles.”

Another of Van Brunt’s favorite tools is the humanistic existential approach to therapy. “Here, the therapist takes a stance related to the students’ humanity and essential ability to face obstacles and overcome challenges. The therapist engages students through rapport building, supports their choices and creates a safe place for them to explore and wrestle with dilemmas they may be struggling with.”

Van Brunt offers the example of one of his clients who has faced multiple suicide attempts, difficulties with her family and early childhood trauma. “Many think she doesn’t have what it takes to be successful on campus,” he says. “[But] home is worse for her, offering little support, and will likely lead to the worsening of her illness. The hospital holds no answers for her — she is in and out several times a semester. Her medications help stabilize her but don’t fix the underlying problem.”

As her counselor, Van Brunt focuses on giving her a place where she feels cared about and secure enough to talk. He advocates for her with different groups on campus, assists her with academic requests for accommodations on the basis of her illness and interacts with the conduct office on her behalf. “I help by giving her a stable, consistent place to come and talk when she needs to,” Van Brunt says. “This simple caring and understanding — and, dare I say, love — is what many college students are looking for. Therapy provides them a place to work through their problems in a nonjudgmental atmosphere with a therapist whose main goal is to help them feel more balance and peace in their lives.”

It’s important for college counselors to be broadly knowledgeable in varied techniques, Mooney says, because while cognitive behavior therapy might help with one student client, another might call for family systems or object relations work. “The thing that is key in my mind is that you tailor the approach to what the student needs,” he says. It’s important to skip a pathology-based focus, Mooney emphasizes, so that no matter what techniques counselors use, they look at the glass as being half full and focus on the client’s assets.

Van Brunt offers similar words of wisdom to counselors working with college students. “The main advice I would give is the importance of not overpathologizing problems that may be environmental and contextual in nature,” he says. “Many of the issues we see students for are related to struggles they are having with the normal, developmental adjustments to life away from home and moving toward independence.”

Van Brunt also acknowledges that college counselors will inevitably encounter more serious mental health problems that might require assessment, medication and ongoing treatment. In those cases, he says, it’s important to offer the same type of supportive and nurturing care and to understand that these students are often scared. Says Van Brunt, “Counselors and psychologists should always offer hope — the promise that tomorrow will be better.”

To see a video of the Pizza Fairy in action, visit http://vimeo.com/20717590.

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

Letters to the editor: ct@counseling.org

 

Do the right thing

By Lynne Shallcross April 1, 2011

Patrice Hinton Oswalt was flattered upon opening her e-mail and finding an Evite to a client’s long-awaited graduation. Choosing whether to accept or decline the invitation was no simple decision, however.

Oswalt was keenly aware that engaging in contact with a client outside of the counseling office could have ethical consequences. But she also knew the ethically “correct” answer could only be reached by weighing the best interests of her client. So, when the client came in for her next session, Oswalt, a career counselor with a private practice in Birmingham, Ala., opened the discussion by addressing the situation. She asked the woman to think about how it might feel to have her counselor present at the graduation.

The client had been coming to Oswalt for a year and a half. During that period, the client had been working full time while simultaneously earning a bachelor’s degree. She had sought out Oswalt mainly for career issues, but the two had also discussed issues surrounding the client’s relationship with her husband. If Oswalt attended the client’s graduation, the likelihood existed that she would meet the woman’s husband and family. Might that lead to questions about the client’s counseling work that the client wouldn’t want to deal with on her graduation day?

Branding-Box-Ethics“I wanted her to think through it in a 360-degree way, all the way around, not just get caught up in the moment of inviting everyone,” says Oswalt, a member of the American Counseling Association. After reconsidering the situation, the client decided it would be wiser not to have Oswalt attend the graduation.

Having a strong ethical compass is paramount to being a good counselor, says Oswalt, who in addition to running her private practice works two days a week as assistant director of career services at the University of Alabama at Birmingham. “I can’t be unethical and at the same time be an effective counselor,” she says. “The counseling relationship is built on trust — clients trusting that they can be vulnerable and that their counselor will not take advantage of that openness. To earn this trust as counselors, we must be trustworthy, to prove our worth and integrity. These are standards of behavior that tie directly into our professional ethics. Outside of the counseling relationship, our ethical code [the ACA Code of Ethics] provides us with a clearer professional identity, shapes how the public perceives us and offers guidelines for our professional behavior. We have to use our ethical code to increase our ability to analyze issues in ways that will facilitate our ability to move on to ethical action — to make it part of who we are as a professional [and] prepare us to deal with ethical dilemmas before they even arise. Most of us are trained to ‘do things right.’ Ethics help us to ‘do the right thing.'”

Oswalt’s graduation invitation is just one example of the ethical dilemmas that confront counselors on a daily basis. To help counselors anticipate common ethical challenges and learn how best to handle them, Counseling Today invited Oswalt and four other ACA members with expertise in counseling ethics to provide some insights.

Crossing the line

When the 2005 revision of the ACA Code of Ethics acknowledged that multiple relationships (referred to as “nonprofessional interactions or relationships” in the ethics code) are sometimes unavoidable and that they can be acceptable when carried out ethically, Oswalt applauded. “I like that the door opened up a little. It’s a more realistic way of approaching the counseling relationship,” says Oswalt, who presented on “Hot Topics in Counselor Ethics” at the ACA Annual Conference & Exposition in New Orleans in March. In the past, Oswalt says, even if you were the only counselor in town, you might have felt compelled to shut your office doors to someone you knew on a personal level in an effort to avoid any potential boundary issues. This challenge proved particularly formidable to counselors living and working in rural areas, for whom secluding themselves from community life wasn’t feasible.

Jeffrey Barnett, professor in the Loyola University Maryland Department of Psychology, says the belief used to be that counselors should never carry on multiple relationships because any contact with clients outside of the counseling office would automatically have negative consequences. “But the most recent thinking is that there is a big difference between crossing a boundary and violating a boundary,” says Barnett, who coauthored the Ethics Desk Reference for Counselors, published by ACA, with W. Brad Johnson.

Certain multiple relationships are now ethically acceptable, Barnett says, such as counseling your child’s teacher if no other counselors are available in the area. “Sometimes it’s us or nothing,” he explains. Instead of admonishing any and all multiple relationships, the focus of the 2005 ACA Code of Ethics shifted to determining whether any harm might come to the client if a multiple relationship existed.

Standard A.5.c. of the 2005 ACA Code of Ethics states that “Counselor-client nonprofessional relationships … should be avoided, except when the interaction is potentially beneficial to the client.” Standard A.5.d. goes on to say that “the counselor must document in case records, prior to the interaction (when feasible), the rationale for such an interaction, the potential benefit and anticipated consequences for the client or former client and other individuals significantly involved with the client or former client.” The standard also provides examples of potentially beneficial interactions outside the counseling office, which “include, but are not limited to, attending a formal ceremony (e.g., a wedding/commitment ceremony or graduation); purchasing a service or product provided by a client or former client (excepting unrestricted bartering); hospital visits to an ill family member; mutual membership in a professional association, organization or community.”

One important standard to keep in mind when considering crossing a boundary is the potential for impairment of objectivity, Barnett says. “If it’s a conflict-of-interest situation or if I can’t remain objective, it’s probably not a good idea,” he says. Returning to the example of counseling your child’s teacher, Barnett recommends compartmentalizing the roles — not asking about the teacher’s depression at the parent-teacher conference, and not asking about your child’s homework at a counseling session.

If a counselor ethically chooses to cross a boundary with a client, Barnett says having a good informed consent policy is crucial. “Informed consent clarifies up front the working agreement between the two parties,” he says. “Many clients may not know what their rights are, what appropriate professional behavior includes and what behaviors are not appropriate. Part of [the informed consent] is to educate the client. It is also to clarify our responsibilities and obligations.”

Oswalt adds that it is also wise to reread the ACA Code of Ethics or to use an ethical decision-making model, such as the one designed by Holly Forester-Miller and Thomas Davis, before proceeding.

Some multiple relationships, of course, remain clear ethical violations. Ted Remley, director of the counseling graduate program at Old Dominion University and a former executive director of ACA, served on four licensure boards over a 20-year period. During that time, he saw more than a few counselors stripped of their licenses to practice after having sexual relationships with clients. Although sexual relationships with clients are a clear violation of boundaries, they happen more than people might expect, Remley says.

Gary Goodnough, cochair of the ACA Ethics Committee and professor of counselor education at Plymouth State University, agrees that sexual boundary crossings, whether between a professor and a student or a counselor and a client, are always a hot-button issue in ethics. But he says these boundary violations are rarely the result of counselors being unfamiliar with the ethical guidelines. “I think it has to do with unmet needs that counselors have as human beings that cause them to behave in ways [in which they] meet their needs at the expense of others,” Goodnough says.

Like Goodnough, Remley thinks sexual missteps occur when counselors allow their own needs to invade the counseling space. Although inappropriate relationships can take many other forms, such as a counselor going on vacation with a client or hosting clients in the counselor’s home, Remley points to sexual impropriety as the ultimate problem. Part of the solution, he says, lies in counselor education programs addressing such ethical issues and preparing students to handle them. He adds that practicing counselors need to process their feelings when they are socially or sexually attracted to clients by consulting with peers.

“Because attraction to clients is an uncomfortable topic in our profession, it often is not talked about in preparation programs,” Remley says. “In addition, counseling practitioners are often reluctant to admit being attracted to clients. Counselors have to create a professional environment where this topic is welcomed and honestly addressed so that future abuses of clients will not occur.”

Goodnough suggests counselor educators bear some responsibility in staying alert for red flags in student behavior. Students are enrolled in counseling programs for at least two years, which is long enough, Goodnough says, for professors to notice students with personality problems or unmet needs that might lead to significant ethical violations down the line. Faculty members should monitor students and assess their attention to ethical and legal issues, he adds. If problems occur, a remediation plan can be set up for the student. If the student is still unable to meet the goals, he or she may be dismissed from the program. “We need to pay attention to our gut as counselor educators, as well as to indicators that we set up for students to meet,” Goodnough says.

Ethical boundaries can be violated not only when dealing with multiple relationships outside the office, Barnett points out, but inside the counseling office as well. Again, it’s an issue of crossing versus violating a boundary. Crossing a boundary, Barnett explains, would be consistent with the client’s treatment plan, culturally welcomed by the client, motivated by the client’s best interests and an action considered professionally acceptable. For instance, with a grieving client, Barnett says he might put his hand on the client’s shoulder or give him a hug to show support. But carrying out that same gesture with a client who has a history of sexual abuse would be very wrong, Barnett says. Whereas a boundary crossing can be clinically acceptable and appropriate, a boundary violation is unwelcome by the client, motivated by the counselor’s personal needs and harmful to the client.

To friend or not to friend

Technology is designed to make things easier and more accessible. But counselors caution that technological advances can also usher in ethical unknowns. Laura Hahn, a private practitioner who offers counseling and consulting services in Atlanta, says the Internet can blur the boundary lines between counselors’ personal and professional lives. Many counselors have professional websites and social media pages while also maintaining a personal presence online. Hahn says it’s important to keep the two identities separate.

Hahn, an ACA member who presented on “Ethics and Technology” at this year’s ACA Annual Conference, points out that counselors have greater control over information they publish themselves, making it easier to keep boundaries intact. But they have less control — and might even be unaware of — information that others publish, such as photos posted by their friends. Hahn says it’s important for counselors to know what’s available about them on the Internet because their clients may be reading things posted not only by the counselor but about the counselor, including information ideally meant to be personal in nature. She advises that counselors regularly conduct a Google search on themselves to monitor what comes up in the results.

Counselors should also take steps to keep personal and professional information separate, Hahn says. “On a social network site like Facebook, use a ‘Page’ to display professional information and use a ‘Profile’ to display personal information. The page allows you to publish information for client use and does not have friends associated with it,” she explains.

The 2005 revision of the ACA Code of Ethics took place prior to social networking’s explosion in popularity and doesn’t address the topic directly, says ACA Manager of Ethics and Professional Standards Erin Martz. That means social networking can quickly become an ethical conundrum for counselors. Martz says sites such as Facebook should be treated as social interactions even though they’re virtual. The deciding factor then should be whether the interaction benefits or harms the client, she says. Martz points counselors toward Standard A.5.d. of the ethics code, which addresses Potentially Beneficial Interactions.

Goodnough agrees that Facebook represents uncharted territory for many counselors. “The ethical downside involves the blurring of personal and professional boundaries that can result when clients and counselors, as well as counselor educators and students, are ‘friends,'” he says. “While counselors typically refrain from [traditional] friendships with their clients, the threshold for online friendships differs in some people’s minds. Additionally, on Facebook, status updates can be reposted to another page, thus allowing friends of friends and, thus, potentially, clients or students, to see personal information and vice versa.”

Hahn simply suggests refraining from “friending” clients on Facebook. “Make it a policy by adding a statement to your informed consent documentation, and inform your clients up front,” she says. Counselors who find clients being overly interested in the counselor’s personal life and conducting intrusive online searches can explore that topic with the client in therapy, she says.

Counselors should be mindful of the content of everything they write, whether in an e-mail, a text message, a Facebook post or any other electronic communication, Hahn says, because the messages can be reposted or forwarded to those not originally intended to be recipients.

Goodnough agrees that counselors should proceed with caution when it comes to technology, especially as it relates to social networking. “There’s a whole new way that individuals and counselors interact with each other,” he says. “It’s not entirely clear what the best way [is to handle those interactions to] ensure that professional standards and ethical guidelines are enforced or that they live in those venues. We have to always recognize that we’re counselors. Even in our private role, people know us as counselors. Caution and being conservative is always called for.”

Hahn suggests that counselors looking to create a web presence for their professional practice should first read Standard A.12. (Technology Applications) of the ACA Code of Ethics to make sure they’ve done their homework before launching a website or networking page. For those counselors already online, Hahn recommends rereading the code to ensure that everything they have online is ethically sound.

Technology also expands accessibility to counseling, whether through videoconferencing services such as Skype, instant messaging, e-mail or another form of technology. Offering counseling services online connects people with therapy when they might not otherwise be able to head to a counselor’s office, Barnett says.

But if the benefit is that technology expands access to counseling for greater numbers of people, Barnett says the shortcomings can include a lack of visual cues when e-mailing or instant messaging and technological difficulties, especially with videoconferencing, such as when the video freezes or the connection is lost. “When you’re conducting a counseling session and that happens and the person is grieving or depressed, that’s not good,” Barnett says. “When you’re in the room with them, that can’t and won’t happen. Technology is a convenience, but it can also have drawbacks.”

Barnett suggests creating an electronic communication policy that details the plan for what will happen if the connection is lost. Standard A.12.g.8. of the ACA Code of Ethics supports his point, suggesting counselors should “discuss the possibility of technology failure and alternate methods of service delivery.”

Hahn says two additional ethical gray areas with online counseling include how the nature of the therapeutic relationship might be changed when the counselor and client aren’t sitting face-to-face in the same physical space and limits to confidentiality and privacy when counseling online. She recommends discussing those potential limits in advance with clients. Standard A.12.g.1. of the ACA Code of Ethics says counselors should “address issues related to the difficulty of maintaining the confidentiality of electronically transmitted communications.”

The crisis aspect of counseling is also a concern when a counselor is working with a client from a distance. If the client is in crisis and the counselor isn’t in the same room or even the same state, that can pose a problem, Barnett says. The solution, he says, is to research the area’s resources — crisis hotlines, local hospitals, emergency centers and the like — so the counselor can help the client find local assistance quickly if the need arises. That’s also a point covered under the Technology and Informed Consent standard (A.12.g.9.), which states counselors should “Inform clients of emergency procedures, such as calling 911 or a local crisis hotline, when the counselor is not available.”

Barnett recommends that counselors offering online counseling of any kind provide thorough informed consent so clients will understand the pros and cons, risks and benefits of the process. Also set out a clear fee structure, he says, including whether e-mail is charged based on the time the counselor spends in responding or by the number of lines.

In addition to having the clinical competence to address a wide variety of topics with online clients, it’s also important to be technologically competent, Barnett says. Before proceeding, he adds, counselors should be sure they have the right technology and know how to use it effectively.

Also important, Barnett says, is that counselors are both licensed and competent to provide the services they are offering online, just as they would be if offering those services in person. Even if counselors are licensed in the state where they are giving the advice, it can be problematic if they aren’t licensed in the state where the client is receiving the services, he says.

That’s true, Martz says. Although regulations can vary from state to state, most states do not allow counselors to provide counseling services — virtual or in person — unless the counselor is licensed in the state where the client is located. Because ethics are tied directly into following the law, Martz says that ethically, counselors offering services to a client in another state need to find out what the laws are and follow them.

Being prepared

Beyond boundaries and technology, a range of other topics can prove to be ethical sticking points for counselors. For example, Oswalt says, diversity and multiculturalism. “It’s hard to be an expert in all areas of multicultural awareness,” she says. But she adds that it’s the counselor’s responsibility to step outside his or her own worldview when helping clients.

Oswalt says her goal is to be able to sit across from her clients and have a grasp of some of the external issues that might be affecting them. To do that, Oswalt says she takes advantage of training opportunities at state and national conferences where she can expose herself to different cultural competencies. If counselors find themselves lacking the cultural context to understand what might be going on with a client, Oswalt recommends referring.

“Counselors who are ignorant of the social and cultural context of a client risk misdiagnosing and pathologizing something that is very much the norm in the culture of that client,” Oswalt says. “This could cause great harm to a client, [which goes] against the principles of holding the client’s best interests above all else and avoiding harm. Multicultural awareness also includes communicating in developmentally and culturally sensitive ways and understanding various cultural concepts of confidentiality. Counselors must strive to not only understand the client’s cultural point of view but also to understand how [the counselor's] own culture has shaped their perceptions of the world.”

To broaden their multicultural competence, Oswalt suggests that counselors participate in individual or group counseling, do volunteer work with populations with which they are unfamiliar, participate in workshops that highlight specific cultural groups or discuss issues in a supervision group. “The insights and information they gain will better prepare them to understand diverse clients, avoid discrimination and select culturally sensitive and appropriate interventions,” she says.

Barnett suggests another aspect of ethics that counselors should consider: the role of ethical decision making and prevention versus merely cleaning up the mess after a problem occurs. So many situations that counselors face fall in a gray, middle area where the answer to the ethical question isn’t clear, he says. He points to an ethical decision-making model in his book that guides counselors through things to consider and questions to ask when making a decision. “Frequently, people think of ethics as good and bad, right and wrong,” Barnett says. “That’s only relevant when it’s clearly appropriate or inappropriate. In the middle, the answer is usually, ‘It depends.'”

In addition to finding a decision-making model, Barnett says it’s important for counselors to be aware of the major areas where ethical dilemmas might occur, such as confidentiality, competence and multiple relationships, and then take action to prevent difficulties. Counselors should be cognizant of their own motivations for decision making, use self-awareness to notice when difficulties are first beginning and then respond appropriately, he says.

“Prevention also includes practicing ongoing self-care to ensure our ongoing psychological wellness, maintaining a balance between our personal and professional lives, and regularly practicing what are termed positive career-sustaining behaviors such as regular exercise, getting adequate rest, having a healthy diet, managing stress on an ongoing basis and the like,” Barnett says. “Prevention may also include personal counseling or psychotherapy, the use of consultation when faced with ethical dilemmas and being sure to practice within our areas of competence.”

Yet another important perspective is the idea that ethics are meant to guide you, not your neighbor, Remley says. “In my opinion, the ethical standards are meant to be applied to ourselves. Counselors should be using them to guide their individual behavior, and one of the problems is a lot of people want to impose the ethical standards on others. In a way, that is inappropriate,” he says.

Remley says some counselors get in the habit of using ethical standards to judge other people’s behaviors or professional decisions rather than simply saying, “I don’t agree with you.” He offers a hypothetical situation: A counselor is working in a community mental health center, and after talking to a client, the counselor chooses not to have that client admitted to a hospital against his will. One of the counselor’s colleagues might think that it is the wrong decision to make, but instead of saying “I don’t agree with you,” the colleague labels the counselor unethical.

There are times when it might be appropriate to deem someone’s decision unethical, Remley says, but those times are few and far between, because very seldom is a case that clear-cut. People cut others down by calling them unethical because it’s more powerful than just disagreeing, Remley says, but he warns that the approach can have a grave effect on an individual’s reputation.

“Each individual counselor should refrain from labeling the behavior or decision of other people as unethical,” Remley says. “They should be judging their own behavior by this code of ethics and the ethical standards but not constantly applying them to other people. I’ve seen it too often in my career, and we need to talk about it as a profession.”

Do no harm

Striving to be ethical is at the heart of being a good counselor, Goodnough says. “Professional ethics are an extension of our own integrity,” he says. Among Goodnough’s list of recommendations for practicing ethically as a counselor: Be mindful of your actions, be knowledgeable of ethical codes, consult widely on ethical dilemmas, engage in continuing education, be affiliated with a professional association and always be in a supervisory relationship.

Goodnough says the way counselors act can protect clients and support the ideals of the profession — or not. “If we don’t get [ethics] right, we’re not doing our clients or our society any good,” he says. “In fact, we’re causing harm. It deserves the attention of all practicing counselors.”

Among Oswalt’s tips for ethical practice are understanding ethical codes, consulting with colleagues for advice when ethical difficulties arise, keeping up with current literature in the field, knowing how your state laws apply to the profession and taking full advantage of member benefits through ACA, including free ethical consultation.

Oswalt adds that it’s important for counselors-in-training to begin focusing on ethics while still in the classroom. Reflecting on her master’s program at Georgia State University, Oswalt says the topic of ethics was on the table for discussion in many of her classes. Even though she was in “decent shape” in her knowledge of ethics when she graduated, Oswalt says she continued to run into tricky issues. In those instances, she consulted with colleagues. “It’s not if a counselor will face an ethical dilemma, it’s when, so try to get yourself prepared,” she says. “A good foundation doesn’t do it perfectly, but it’s a great springboard.”

One ethical responsibility that counselors must take very seriously is tied directly to the position of power they hold in the counseling relationship, Remley says. “When clients seek counseling services, they are vulnerable. There is very little oversight of the interactions between counselors and clients, and clients could easily be abused in counseling relationships because of the power counselors have. Therefore, it is very important for counselors to practice in an ethical manner that results in their clients being helped and never being harmed or taken advantage of.”

Barnett emphasizes that point as well. “Clients come to counselors in need, seeking assistance for important issues and difficulties. They come to counselors needy, dependent on us and trusting us to only act in ways that are in their best interests. A failure to act ethically in our professional roles can lead to direct harm to clients and can undermine the public’s trust in counselors in particular and in mental health professionals in general. This could result in people who are in need of help not accessing the help they need. The public is trusting us to help them, not to harm them.”

 

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Letters to the editor: ct@counseling.org

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ACAC becomes newest organizational affiliate of ACA

Lynne Shallcross

It was a question Randy Astramovich heard over and over: Why doesn’t the American Counseling Association have a division for counselors working with children and adolescents in a multitude of settings? This past spring, Astramovich decided it was time to take action so these counselors could have a true organizational “home.”

Astramovich, along with a few other individuals interested in seeing the idea come to fruition, collected 450 supporting signatures. With approval from the Governing Council, the Association for Child and Adolescent Counseling became ACA’s newest organizational affiliate this past fall. Once ACAC gains 500 ACA members, it can qualify to become an ACA division.

ACA Executive Director Richard Yep says the timing couldn’t be better. “I appreciate all of the work that the founding officers of ACAC did to move the process forward to the Governing Council. The issues that confront professional counselors who work with children and adolescents are at an all-time high, and the work of ACAC could be instrumental to the success of those providers.”

“The movement toward the establishment of ACAC originally grew out of conversations between ACA members who provide counseling services to children and adolescents across a wide variety of settings and who sought venues within ACA for networking, collaboration, research, preparation and training in child and adolescent counseling,” Astramovich wrote in a letter petitioning for ACAC to become an organizational affiliate. He further noted that although ACA’s Annual Conference & Exposition regularly features a grouping of conference presentations on child and adolescent counseling, no place existed within the ACA family for those counselors to collaborate and network outside the conference. Astramovich, now founding president of ACAC and an associate professor of counseling at the University of Nevada, Las Vegas, also pointed out that other organizations for helping professionals, such as the American Psychological Association and the National Association of Social Workers, already offered special divisions for child and adolescent work.

“Many of the child and adolescent counselors and counselor educators found ourselves without a specific network of support in ACA,” echoes Dee Ray, ACAC secretary and associate professor of counseling and director of the Child and Family Resource Clinic at the University of North Texas. “Over the years at conferences and through e-mails, we’ve wondered why there wasn’t a division solely dedicated to working with children and adolescents. We provided informal support for each other, but we wanted to have an organization that provided a formal network and support system for this population.”

Now that ACAC is up and running, Ray says expectations are high. “We hope that ACAC will focus on the training needs of counselors who work with children and adolescents and additionally provide professional support in terms of ideas, resources and encouragement to keep counselors motivated and energized to work with children,” she says.

ACAC will offer a variety of benefits to members, says Astramovich, who also serves as editor of the Journal for International Counselor Education. The organization will promote best practices, as well as research and networking opportunities for professional counselors who work with children and adolescents. ACAC will also strive to highlight the unique developmental and cultural needs of these clients, advocate for expanded child and adolescent counseling services, promote interdisciplinary collaboration among specialties whose members work with children and adolescents, and offer ACA members a collective voice in this specialty. “Although other [ACA] divisions address children, we felt like there was a need for some unity in the provision of counseling services to children across multiple settings,” Astramovich says.

ACAC’s primary focus will be to promote research and effective counseling services for children and adolescents, Astramovich says. In working with adults, he adds, most counselor practitioners come to understand that many of the issues their clients struggle with are rooted in their childhoods. Professional counseling is based on the idea of optimal human development, Astramovich says, and maximizing counselors’ effectiveness with children and adolescents could prevent or lessen problems for those individuals when they reach adulthood.

ACAC will also work to ensure that counselors in the field have the education and qualifications necessary to be effective, Ray says. “For so long, our field has focused mostly on working with adults and just applying those same skills to children and adolescents. Working with children and adolescents requires a specific skill set, and we will advocate for counselors to become formally trained in those skills. In addition, we will seek to differentiate skill sets needed for children and skill sets needed for adolescents. We will provide a developmental focus to work effectively with children and adolescents.”

Bridging the disconnect

ACAC isn’t geared specifically toward school counselors, but because they work closely with children and adolescents, the hope is to get school counselors actively involved in ACAC, Ray says. “However, ACAC will focus on the needs of all counselors who are counseling children and adolescents,” she emphasizes. “Private practitioners, mental health counselors in the schools, agency counselors, counselors in hospitals and school counselors are all part of the network that works with children and adolescents. The counseling part is the most important aspect of our concentration.”

Michael Moyer, ACAC trustee and assistant professor at the University of Texas at San Antonio, says when it comes to school counselors and professional counselors working with children and adolescents, partnering is key. “I believe ACAC will emphasize the need for collaboration between school and community counselors,” he says. “School counselors provide valuable services within the school system and the school setting, and community counselors also provide valuable services outside the school walls. Sometimes there is a disconnect between the two, and I feel very strongly that there should be collaboration and support from both sides to best support children and adolescents.”

It’s possible, Astramovich says, that ACAC could also promote a new paradigm in the way services are provided to children and adolescents in schools. Astramovich previously worked in Dallas as a school counselor and found that the ratio of students to school counselors left counselors juggling too many tasks. “What was clear was that the demands placed on school counselors are enormous,” he says. “There are so many duties school counselors are expected to fulfill that it’s simply impossible for all those duties to be met effectively by one individual.” (ACA recommends a maximum average student-to-counselor ratio of 250:1, but the most recent data released by the U.S. Department of Education’s National Center for Education Statistics show the average ratio in U.S. elementary and secondary schools stands at 457:1; see the March 2011 issue ofCounseling Today for more information.)

Astramovich says the future could include creating school-based counseling centers, which might look much like university counseling centers, with a variety of helping professionals, including professional counselors, available to students. If the dynamics trend that way, Astramovich says, school counselors wouldn’t disappear, but their roles would likely change. For example, the roles might be split between an academic counselor who helps students with courses and academic concerns and a mental health counselor who is based in a school counseling center. “Asking one individual to provide all the services that our children need isn’t realistic,” Astramovich says.

A tailored approach

The issues today’s children and adolescents face are wide ranging, Ray says, but perhaps the most common trouble point is society’s lack of understanding of what is developmentally appropriate in terms of mental health, growth and education. “This developmental mismatch between what is expected of children and what is naturally healthy for them is at the root of many children’s behavioral and emotional health problems,” she says.

To see change on the societal level, Ray believes the most important thing counselors can do is be active members of ACA and ACAC and advocate for best practices with children and adolescents. “Clinically, a counselor needs to be educated in working with children and adolescents from a theoretically sound framework,” she says. “Formal education will help counselors develop a belief system from which techniques and skills will emerge. The current trend to just grab any book or article on a technique to use with young people is ethically suspect and fairly ineffective.”

Counselors generally rely on talking in their work with clients, but Ray points out that children and adolescents often communicate in nonverbal ways, making it imperative that counselors cultivate their own nonverbal communication skills. “Because of cognitive differences or emotional issues, children and adolescents typically prefer nonverbal methods of communication to build relationships,” she says. “For example, young children communicate through their play, so we have found play therapy to be the most effective means of developing counseling relationships. Adolescents might prefer a physical activity or expressive arts activity to build their counseling relationships. Counselors need to be trained and supported in these methods to be effective in their counseling.”

Astramovich echoes that sentiment, saying that the use of developmentally appropriate techniques with children and adolescents is key to helping them. For instance, he says, counselors should gain experience using play techniques because substantial research exists showing the effectiveness of these techniques with kids.

Moyer adds that counselors must keep things exciting and moving when working with kids. “I find myself integrating different activities and types of play and not using as much traditional talk therapy,” he says. “Children and adolescents have so many options and activities that involve fast-paced technology that counselors working with that population have to be able to adapt their counseling skills to keep [these clients'] attention and make it meaningful to them.”

Another unique aspect of working with children and adolescents is the potential interaction with their parents or guardians, Moyer says. “Unlike working with adults who can provide their own informed consent, children and adolescents cannot. A legal guardian must provide that consent for them. In addition, parents and guardians have a legal right to know what a counselor is talking to their child about and, I believe, should be involved in the counseling process. On the other hand, as a counselor, I have to balance that sharing of information with the parent or guardian because the child or adolescent is my client, and I have to be able to build a trusting relationship with them. In short, there is a balancing act in building a trusting relationship in which the child or adolescent feels comfortable and confident in talking openly [even as the counselor keeps] the parents informed to an appropriate extent.”

As ACAC gets off the ground, Ray and Moyer offer some general words of wisdom about working with children and adolescents. Quality formal education is absolutely essential, Ray says, as is quality supervision of a counselor’s work by an experienced child counselor supervisor. “Working with children and adolescents is qualitatively different from working with adults,” she says. “Further, working with children is qualitatively different from working with adolescents. One cannot just apply those adult counseling skills to children and expect them to work. Counselors need a new language to be effective.”

Moyer offers the same advice he gives to his counseling students: “Be genuine. Children and adolescents can see right through you when you are being fake, and you will lose them pretty quickly. Be present and listen to their concerns. And [be] nonjudgmental. Children and adolescents — like all populations, I’m sure — are judged constantly on their thoughts and actions. Counselors can do wonderful things just by listening and not judging.”

Interested in getting involved in ACAC? Contact Randy Astramovich at randy.astramovich@unlv.edu for more information.

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

Letters to the editor: ct@counseling.org

 

Breaking away from the pack

Lynne Shallcross March 15, 2011

Breaking away from the packFor Margie Williams, the goal was always to be her own boss. “In grad school, I knew that I’d have to learn to be a therapist by actually doing it, and that meant putting in the time at the best training site I could talk my way into. The years I spent working at a residential treatment center gave me a solid foundation in every aspect of this field, until there came a point when I was ready to call my own shots.”

…continue reading

Forging family bonds

Lynne Shallcross March 1, 2011

A simple e-mail makes all the hard work worthwhile for Susan Branco Alvarado. “I may not show it all the time,” an adopted teenage client wrote to Alvarado, “but I really appreciate everything you have done for me. Thanks to you, my relationship with my mom has gotten a thousand times better and my life has also changed for the better. So thank you!”

Alvarado, who runs a private practice in Falls Church, Va., that specializes in adoption issues, had begun working with the client and her mother after individual therapy for the daughter failed to yield improvements in her mood or her connection with her adoptive mother. “Initially, the sessions were not smooth with the family because years of disconnectedness and resentment had built a wall between them,” says Alvarado, a member of the American Counseling Association. “This wall was especially evident in session when the teen would pile several pillows between her and her frustrated mom.”

The teen displayed a high level of anxiety, anxious attachment to her mom and an increasing level of withdrawal and irritability, while the mother felt rejected by her daughter and helpless. After Alvarado tried a combination of narrative and expressive therapies in addition to Theraplay, a form of directive parent-child play therapy, the mother-daughter duo reported progress. “Both excitedly shared that they had a successful disagreement with a healthy repair to reconnect them,” Alvarado says. Helping adopted children and their families has personal meaning for Alvarado, who was adopted herself from Bogotá, Colombia.

The work is equally personal for Suzanne Clark, who runs a private practice specializing in adoption issues in Roswell, Ga. Born in Kentucky and raised by adoptive parents in Florida, Clark says she didn’t have much interest in or understanding of adoption until she went to college and began working as a Big Sister to pregnant teenagers.

“At the time, I didn’t realize why I was so fascinated with this population. I just thought it was a fun community service activity,” says Clark, a member of ACA. “After I graduated from college, I began working within the foster care system, then transitioned to a job at a maternity home. I completely immersed myself in my work with these girls, some of whom were parenting, some of whom were making adoption plans for their children. It was around this time I began to realize that this was the one way I was able to connect with my own birth mother and give back to her. The only thing I had ever known about her was that she was 15 when she had me. I never thought much about it past that.”

Both Alvarado and Clark offer counseling to individuals who have been adopted, birth parents who have chosen to make a plan of adoption for their children and families who have adopted a child. Clark also offers consultations to adoptive families and birth parents who are considering adoptions, as well as group counseling and lectures on adoption issues throughout the Atlanta area. Alvarado, whose clients range from infancy to middle adulthood, also provides workshops to local adoption and child welfare agencies, as well as presentations at adoption conferences.

According to Alvarado, counseling on adoption-related issues relies heavily on family work. It includes normalizing typical adoption-related developmental milestones, such as when children begin wondering why they were adopted or express a desire to meet their birth parents, and involves helping family members learn to trust one another.

“Additionally,” she says, “adoption therapists should be knowledgeable in identifying and treating trauma-related disorders. This can be a factor in situations where a child has been removed from his or her first family because of abuse or neglect or has experienced trauma in institutionalized settings. This type of counseling also includes birth family searching and preparation for birth family reunions and post-reunion relationships.”

Counseling that’s focused around adoption issues requires practitioners to pick up on subtle nuances in complex situations, Alvarado adds. “Therapists must be skilled in identifying the layers of adjustment issues that can stem from prenatal conditions, heredity, parental bonding and child attachment concerns, identity issues, trauma, and grief and loss experienced by both children and adoptive parents within adoptive families.”

Handling loss

Clark points to research showing that even if a child has been adopted at a very early age, grief can still emerge as a by-product later in life. “That grief, even though it’s preverbal, is still imprinted in them and definitely affects how they interact with people and form relationships,” Clark says. Grief can also weigh on adoptive parents, she adds, who might still mourn the biological child they couldn’t have on their own.

Clark often starts by telling these families that she understands their desire to be considered a “normal” family, while also encouraging them not to overlook the fact that their family was created on the basis of some type of loss. The parents might have struggled with infertility and not dealt with the grief, she explains, while the adopted child must deal with the loss of his or her original family. “When those two things are overlooked and the family tries to come together and pretend like everything’s OK, everyone’s feelings of loss and grief are still there,” Clark says. “And it comes out in the relationships.”

An important first step, Clark says, is acknowledging that everyone might be experiencing grief. She often recommends allowing parents to admit and deal with their grief alone with the counselor rather than in front of the adopted child. Clark then helps the parents or child pay tribute to the lost relationships.

With parents, she says, the process can begin by having them describe the initial hopes they had for their family or what they think their biological child would have been like. “Depending on what the parents identify as their choice of expression, I have them draw a picture, write a poem, tell a story [or] act out a scenario that depicts these feelings,” Clark says. “Based on this, we decide how they would like to pay tribute to this child. Some people make a memory box, some plant a tree. It’s really about giving them permission and then a voice to express these things.”

The process is similar with the children, although geared toward their age and how they feel most comfortable expressing themselves, Clark says. “Based on this, we decide how they would like to pay tribute to their birth family. If the adopted child is younger or adolescent and still living with the adoptive family, the adoptive family is included in what the child wants to do. We also discuss that the grieving process is a continuum of feelings that will change as the child reaches certain milestones throughout life.”

Clark says building a bridge between the adoptive family and the birth family — even if the adoptive family doesn’t know anything about the birth family — is important so the child will feel connected to everyone. There are ways for adoptive parents to acknowledge the child’s grief and honor his or her relationship to the birth family through talking, Clark says. For example, an adoptive parent might tell the child his ability to play soccer so well must come from his birth parents. Talking openly takes away some of the unspoken shame the child might feel, Clark says.

In session, the counselor can also help children understand why they were “given away,” which is how Clark says many children phrase their adoption. Even if children have a wonderful adoptive family and are functioning well, they still long to know where they came from and why they didn’t remain there, Clark says. She suggests that counselors offer these children space to acknowledge those feelings. Journaling, writing “letters” (not to be mailed) to the birth family and drawing pictures are among the useful techniques that can help adopted children heal and gain insight, she says.

In addition to grief, Alvarado says common issues that adopted children face include feelings of being “different” from their peers, potential discrimination, particularly with transracial or transcultural adoptions, and curiosity about their heritage and birth families. “Counselors can be very helpful to children experiencing these typical concerns by normalizing them, facilitating exploration of their identities within a safe environment and facilitating discussions of these topics within the context of the family system,” she says.

Telling the story

Alvarado points to family therapy as the most effective tool in working with adoptive families. “Regardless of the age of the child, it is very important that the counselor is facilitating increased connections between the child and the parent or parents,” she says, adding that Theraplay is one method that enhances the quality of the attachment. In addition, she says, narrative and expressive therapies such as drawing, sand tray and bibliotherapy are helpful in creating and retelling the story of a child’s adoption journey within the family context. Alvarado also uses cognitive behavioral techniques, relaxation and mindfulness training to reduce anxiety and some trauma symptoms among clients.

Andrea Miller, a registered play therapist in Charlotte, N.C., who has worked with a number of adopted kids during her three years in private practice, says communication between adoptive parents and the children is often a challenge. She sometimes asks the parents and child to take part in an activity, such as drawing individual pictures of the day the child was born. Even though the child can’t remember the event and the adoptive parents most likely were not present, Miller says discussing how each person views that day can serve as a good jumping-off point.

Miller, a member of ACA, also points to “adoptive stories” as a helpful tool, with the child drawing a time line from when he or she was born up through the present. The child can use the time line as a way to identify, verbalize and open up about feelings related to his or her biological parents. “Showing [adoptive] parents that time line and having them involved helps them understand some of the questions that the child might have but may not have asked or didn’t know how to ask,” she says.

Among adoptive parents, a feeling of competition with the birth parents can sometimes surface, Clark says. It’s important for counselors to let the adoptive parents admit that and then give them a comfortable place to talk about it or cry about it. “Not all adoptive parents feel competitive, and there may be varying degrees of these feelings,” Clark says. “It’s offering a space to voice these feelings, acknowledge them, discuss them and maybe even use the topic as a discussion point with their adopted child, depending on the age and maturity of that child.” Group counseling can be helpful, she says, because it allows adoptive parents to see others at different stages of the process who have made it through difficult times.

Adoptive parents can also bear the burden of feeling that they’re expected to meet a higher standard of parenting, both before and after an adoption. “For lack of a better term, adoptive parents have many hoops to jump through before they are able to adopt,” Clark says. “In addition, they typically have to endure long periods of time while they are approved and matched with a child. These experiences alone set them apart from families who are able to conceive biologically. You add to this having to navigate an open or semi-open adoption gracefully without any signs that they maybe feel tired and frustrated by the process, and you have a family who is already having to meet a higher standard than non-adoptive families. Simply acknowledging or suggesting that this might be the case and offering a place for the family to voice their frustration, or just exhaustion, can be very healing.”

In extreme cases, Alvarado says, some parents can experience post-adoption depression (PAD), which can be similar to postpartum depression. “In these situations, parents can experience extreme levels of depression and anxiety, may report a desire to disrupt or dissolve the adoption and even harm their child,” says Alvarado, who recommends screening clients for symptoms of PAD. She believes counselors can be most helpful to parents by educating them about normative adoptive family milestones, normalizing grief and helping them find coping mechanisms and community resources.

In recent years, Clark says, the trend has been toward doing more open adoptions, in which the adoptive and birth families stay in contact. This can present a host of challenges, such as determining when to include the birth family in events and how much freedom to give the child when it comes to contacting the birth family. Talk is often the answer, Clark says, and counselors can help adoptive parents and children (if they are old enough to be part of the conversation) identify the issues by encouraging them to share their fears, wants and expectations with one another. In many instances, this serves to decrease each family member’s anxiety level.

Even when counselors help adoptive families open the lines of communication, the prospect of search and reunion can present a major hurdle. The issue is more prevalent now that e-mail, the Internet and social networking sites are making it easier for birth families and those who have been adopted to find each other, Clark says.

“Adoptive families have varying degrees of comfort with the topic,” Clark says. “Some are totally open to it and are just waiting for the day that their child decides to make contact or to offer the information to their child without hesitation. Others feel that their child should have all of [his or her] needs met by the adoptive family, and there is no need to discuss it. Regardless of where the family is on the continuum, it’s really key to open up the topic for discussion and acknowledge that it is something to consider when everyone feels comfortable.”