Tag Archives: Counselors Audience

Counselors Audience

Creating a common language

Jonathan Rollins July 1, 2012

During the long march to obtain licensure status for counselors in each of the 50 states plus the District of Columbia and major U.S. territories — beginning with Virginia in 1976 and ending with California in 2009 — the profession as a whole rightfully celebrated each individual victory.

“Unfortunately,” points out American Counseling Association President Bradley T. Erford, “the unintended consequence of this success is that we now have 50-plus different licensure laws, and if you want to move your practice from one state to another because you or your partner were transferred, you have to meet the qualifications for that new jurisdiction. Sometimes, the qualifications are very different. Sometimes, there are qualifications that came after the time when you received your education and training, so you do not qualify without meeting new standards. It is extremely frustrating to be deemed ‘qualified’ in one state and practice for a number of years and then move, only to be deemed ‘not qualified’ by another state. I am licensed in three states, and the hoops I had to jump through were somewhat different in each jurisdiction.”

The long-standing and knotty problem of license portability is precisely what delegates to 20/20: A Vision for the Future of Counseling are working to resolve. The delegates, representing 31 diverse counseling organizations, have been tasked with three objectives as part of the Building Blocks to Portability Project: to reach consensus on a common licensure title for counselors, to reach consensus on a licensure scope of practice for counselors and to reach consensus on licensure education requirements for counselors.

“The goal of the 20/20 Building Blocks [project] is to agree on a model for training, education and scope of practice so that jurisdictions can standardize their requirements and promote portability of licensure across states. If we had the foresight to construct this standardized process 30 years ago, perhaps we would not have thousands of frustrated counselors annually trying to reestablish a licensed practice in another state or territory,” says Erford, who was the Association for Assessment in Counseling and Education’s delegate to 20/20 before joining the 20/20 Oversight Committee, first in his role as ACA president-elect and now as ACA president.

At the ACA Annual Conference in San Francisco this past March, the 20/20 delegates reached consensus on “Licensed Professional Counselor” as the designated licensure title. They also endorsed the concept that having a single education accrediting body would be a clear benefit for the counseling profession. Finally, the delegates decided that the two 20/20 work groups focused on counselor education requirements and counselor scope of practice should develop their respective recommendations by mid-September so the 20/20 delegation as a whole can reach consensus on these two areas at the 2013 ACA Annual Conference in Cincinnati.

In March 2010, before turning its attention to the Building Blocks to Portability Project, the 20/20 delegates reached consensus on a unified definition of counseling as a professional relationship that empowers diverse individuals, families and groups to accomplish mental health, wellness, education and career goals.

Burt Bertram, who headed up the 20/20 work group that recommended LPC as the consensus licensure title for counselors, sees commonality in much of the work the 20/20 delegation has engaged in since its inception in 2006. “So much of what we’re doing throughout this whole process revolves around the issue of naming things so we can communicate and talk about them,” says Bertram, the Association for Specialists in Group Work’s delegate to 20/20. “In some ways, ‘things’ don’t really exist until they are named. … When the name of something is understood and accepted, the thing becomes more real, and there is less likelihood of confusing the named thing with other similar things.”

Perry C. Francis, who is leading the scope of practice work group, has a similar view concerning the work of 20/20. “We as a profession have struggled with defining counseling and what counselors can and cannot do for decades,” says Francis, the American College Counseling Association’s delegate to 20/20. “That is a reflection of the many different types of counseling specialties that make up the profession — school, clinical, college, etc. Each has a unique way of applying counseling to their population or setting. Creating a common language will help unite these specialties under the banner of ‘professional counselor.’”

Licensure title

Recommending LPC as the consensus licensure title to the overall 20/20 delegation wasn’t a difficult decision, according to Bertram. “There really wasn’t much debate [within the licensure title work group]. It seemed like the obvious choice,” he says.

In deciding which licensure title to recommend, the work group weighed several factors, including:

  • How easy the title would be for the public to grasp
  • Whether the title would offer a “pathway” for all counselors
  • Whether the title aligned with the previously established consensus definition of counseling
  • How consistent the title was with terms already in use in jurisdictions across the United States
  • How well the title distinguished “professional” counselors from other groups using counselor in their names (such as funeral counselors, financial counselors, camp counselors and so on)

Bertram says the title LPC is already in use in 32 states. “If our goal is to get all 50 states … to come around to one term, this made the most sense,” Bertram says.

In addition to already possessing “name recognition,” LPC owns an advantage because the terminology isn’t inherently limiting, Bertram says. “When you put something in front of the word counselor — for example, clinical mental health counselor — that narrows it,” he says.

The counseling profession has confronted a long-standing identity struggle in part because many counselors identify themselves by a specialty title rather than by a title that presents their core identity as a counselor, Bertram says. LPC should readily communicate that core identity. “The importance of the title is that it reduces confusion and increases understanding,” he says.

At the same time, the licensure title work group also recommended that an ability to recognize specialties be included for counselors, similar to physician licensing laws.

The 20/20 delegates voted 22-2 in favor of adopting LPC as the consensus licensure title.

Erford views this as a very important step. “Across the 50-plus jurisdictions, counselors have 40-plus titles. Think about it,” he says. “If we cannot even decide what to call ourselves, how can we expect U.S. citizens to know who we are and what we do? Calling ourselves licensed professional counselors and promoting a unified role and definition of counseling help protect the public from those unlicensed individuals who would harm the public and set our profession and professionals back in the process. When legislators in every state find out that every major counseling organization in the United States supports the title LPC, and then adopts that title, we are one step closer to a unified profession.”

Licensure education requirements

The 20/20 delegates did not vote on consensus licensure education requirements in San Francisco, but they did endorse their preference for having a single educational accrediting body (by a vote of 20-1, with three abstentions).

“Except for counseling, all mental health professions have a single accrediting body,” Erford points out. “They decided this issue long ago, and their professions are unified and powerful as a result. Having a single accrediting body sends a strong message to universities, and when governmental entities recognize an accrediting body, the profession becomes more unified and powerful. … It is crucial that we adopt standardized professional accreditation standards under a single accrediting body so that we can move forward as one profession with a single voice and huge influence.”

Currently, there are two accrediting bodies participating in the 20/20 initiative — the Council for Accreditation of Counseling and Related Educational Programs (CACREP) and the Council on Rehabilitation Education (CORE). Several people involved with the 20/20 initiative have indicated their hope that the two organizations, which explored the possibility of a merger several years ago, will unify in some fashion.

“To achieve licensure portability for the counseling profession, it is imperative that the criteria for licensure become comparable across the states. The profession does not currently have this,” says Carol Bobby, president and CEO of CACREP and chair of the licensure education requirements work group for 20/20. “What we have instead is 50 different states with 50 different sets of educational and supervised practice requirements. Some states require only a master’s degree, while others specify the number of graduate hours in the degree program. And these numbers can range from 42 to 60. Thus, students who graduate from 48-hours states will likely find themselves at a disadvantage, needing to go back to graduate school to gather more hours when they move to a state that requires a minimum of 60 graduate hours. … It gets more complicated than just hours, though, because some states list specific courses that must be included in the degree, and the lists of required courses can also vary from state to state.”

Bobby points out that when the Institute of Medicine (IOM) conducted research to determine whether counselors should be recommended to work as independent providers in the TRICARE health system, it raised concerns, saying there was “substantial variability among the states in training programs and requirements for licensure as a counselor.” IOM also noted that only some counselor education programs were accredited by CACREP and that in some states, a counseling license could be obtained with a postgraduate degree in a field other than counseling.

“One of the primary reasons that the IOM included graduation from a CACREP-accredited [mental health counseling] program in its final recommendations to Congress was to ensure consistency in the educational preparation of counselors hired within the TRICARE system,” Bobby says. “The IOM report indicated that they could not guarantee this level of consistency through acceptance of the use of the LPC status only.

“It is difficult for the counseling profession to gain the respect of our external publics with such variability in what it means to be a counselor, since the profession has offered so many pathways to becoming a counselor. Other professions, such as architecture, engineering and physical therapy, have one pathway to getting licensed, and that pathway is through graduation from an accredited program. This allows for the public to know what has been required in the licensee’s curriculum and supervised practice. This also allows for greater comparability of state licenses, and thus allows for greater mobility of professionals.”

Linda Shaw, CORE’s delegate to the 20/20 initiative, says she understands the sentiment behind endorsing a single educational accrediting body. She is concerned, however, about rehabilitation counselors’ ability to get licensed if the 20/20 delegates ultimately recommend CACREP accreditation as the sole educational criterion accepted by licensure boards, particularly if CACREP and CORE do not end up merging in some fashion.

“Counseling has always been a critically important part of our identity,” Shaw says. “We label ourselves as ‘rehabilitation counselors,’ our accreditation and certification standards strongly emphasize counseling, and every roles and functions study ever conducted identifies counseling as being a central role of rehabilitation counselors. The American Rehabilitation Counseling Association has been a division of ACA since 1958. … We, too, seek to secure for the counseling profession a strong, unified identity and to advance the profession. While the specialization of rehabilitation counseling has different accreditation and certification organizations, the primary reason is that CORE and CRCC (Commission on Rehabilitation Counselor Certification) actually predate CACREP and NBCC (National Board for Certified Counselors), not because we see ourselves as being so different from other counselors that we must have different organizations. It was our very ‘sameness’ that led to the merger talks [with CACREP]. It would be a grave disservice to rehabilitation counselors and to individuals with disabilities who may need to access the services of rehabilitation counselors to exclude them from the credentialing process. As counselors, we value inclusion and we value the similarities that bind us together, as well as respecting the things that make us unique. I have confidence that these values will continue to guide us as we work together to create building blocks that will serve the best interests of the profession and of the individuals we serve.”

Licensure scope of practice

The scope of practice work group is reviewing a content analysis of all counselor scopes of practice across all 50 states. As is the case with licensure titles and licensure education requirements, scopes of practice vary from state to state.

“Simply put, licensure laws, which generally contain the scope of practice, are governed by each state, and each state has different politics and constituencies that seek to influence what those laws [include],” Francis says. “Some constituencies are supportive of our field, while others seek to restrict what counselors can do based on ignorance about our profession or hoping to limit competition for the ever-shrinking mental health dollar.”

The work group conducted a frequency analysis of the words used in the different scopes of practice to define the tasks that counselors are allowed to do, Francis says. “This gives us an understanding of the common tasks we are allowed to do and increases our awareness of the tasks we are not allowed to do but are trained to do, such as administer different types of assessments and inventories.”

“We will look at the tasks that are common across the board and seek to standardize the language and definitions used to create a scope of practice,” he continues. “Additionally, we will compare the laws to our education and abilities to identify those areas of practice that we may be denied, even though we have the skills and training to accomplish those tasks. Once we have that information, we can then create a scope of practice statement that will reinforce not only what we are already doing, but also expand into areas that we are capable of doing.”

“The scope of practice issue also signals insurance companies that professional counselors are equally competent as our cousins in the other mental health fields,” Francis adds.

Maturing of the profession

“The 20/20 Building Blocks initiative is all about developing a standardized process for title, educational requirements and scope of practice that will allow professional counselors to move across a state line and continue a professional practice and livelihood, just like medical doctors, psychologists and social workers do every day,” Erford says. “This process reflects the maturing of the profession of counseling. It also reflects the importance of vision and forethought as the counseling profession continues its forward momentum. We have to visualize where we want to end up, and then plan an efficient path to get there. Otherwise, we will be cast about by capricious winds and chaotic, tumultuous times. If we cannot explain to the public and our legislators who we are, how we were educated and trained, and what we can do — all in a unified voice — then how can we expect the public and our legislators to embrace the counseling profession?”

Jonathan Rollins is editor-in-chief of Counseling Today. Contact him at jrollins@counseling.org.

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

Stacy Notaras Murphy

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

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

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

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

Body-centered psychotherapies

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

EMDR for trauma treatment

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

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

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

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

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

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

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

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

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

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

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

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

Emotionally focused therapy for couples

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

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

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

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

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

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

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

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

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

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

Neuroscience: Banking on the brain

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

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

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

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

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

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

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

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

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

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

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

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

Integrative models: Finding your own perfect blend

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

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

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

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

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

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

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

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

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

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

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

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

Letters to the editor: ct@counseling.org

Client, counselor, prescriber

Lynne Shallcross

Roughly one in 10 Americans over the age of 11 takes antidepressant medication, according to data released this past fall by the Centers for Disease Control and Prevention. Antidepressants are the third most common prescription taken by Americans of all ages and the most common among Americans ages 18-44. The rise in popularity of antidepressants has been meteoric in recent decades. Since 1988, the rate of antidepressant use nationwide among all ages increased almost 400 percent.

These data, collected as part of the National Health and Nutrition Examination Surveys between 2005 and 2008, don’t surprise Dixie Meyer. In fact, they further support the message she tries to share with counselors: You need to know about the antidepressants your clients are taking.

Antidepressants, which are prescribed not just for depression but also for anxiety disorders, pain disorders, learning disabilities and more, are the medication most requested by patients, says Meyer, an assistant professor in the Department of Counseling and Family Therapy at St. Louis University and a member of the American Counseling Association. She notes that primary care physicians prescribe the majority of antidepressants. “This suggests that a large portion of our clients on antidepressants sought out the medication without knowledge of why individuals need medications, and in most cases, an expert on psychotropic medications did not prescribe the medications,” says Meyer, who teaches psychopharmacology and has been researching the topic since 2007. “While counselors are not experts on antidepressants either, counselors need to understand when their clients may need to have the medication reassessed or when the counselor may need to meet with the medication prescriber.”

Elisabeth Bennett, chair of the Department of Counselor Education at Gonzaga University, says even though counselors are not prescribing the medications, they are in a prime position to assist clients who are taking antidepressants. “Medical professionals see their psychiatric patients an average of about eight minutes each … three to four meetings per year. This is not enough time to do all the tasks they must do, let alone to build a relationship [with the patient, which] is likely the most critical element contributing to successful compliance and treatment,” says Bennett, an ACA member who also works as a counselor in private practice and has researched, taught and presented on neuropsychology and psychopharmacology.

Counselors, on the other hand, see their clients two to four times per month for an average of 50 minutes per session, Bennett says. When counselors understand what an antidepressant is meant to do and what side effects it may cause, they can better prepare their clients to follow the regimen prescribed by the medical professional, she says. Counselors can also help prepare clients to note negative side effects that might need immediate attention, note when the medication is effective or when there are breakthrough symptoms, and to otherwise gain the most benefit while experiencing the least harm.

A second set of eyes

Meyer echoes Bennett, noting that the regular interaction counselors have with their clients positions them to help with management of antidepressant medications and, in some cases, to act as the liaison between clients and the prescribing doctor. To play that role effectively, however, Meyer emphasizes that counselors must educate themselves about antidepressants. “It is important for counselors to be knowledgeable about potential side effects of antidepressants, the empirical support for antidepressants and how antidepressants work, including how they alter neurochemistry,” she says. “Counselors also need to understand the neurochemical differences of depressive symptoms and how to monitor symptom improvement when clients are taking antidepressants. This is especially important when clients think their antidepressant is not working.”

Bennett points out that the liability and authority for all elements of a medical regimen remain with the prescribing physician but says counselors can be of great value to clients by educating them about the medications and the regimens that doctors prescribe. “Often, the time limitations of the doctor make such educational sessions rushed, and the counselor can supplement at a time when the client is better able to understand, thus increasing compliance,” she says. Among the topics Bennett suggests that counselors consider discussing with these clients:

  • How antidepressant medications work
  • Why complying with the regimen is critical
  • How long it takes to reach therapeutic windows (when enough medication is in the bloodstream to be effective)
  • Potential side effects that might arise
  • Which side effects to be concerned about and which to endure
  • How to talk with the prescribing doctor about symptoms

Meyer encourages counselors to stay alert to the side effects their clients are experiencing. If the side effects appear to be getting out of hand, Meyer suggests talking with the client and perhaps encouraging him or her to ask the prescribing physician to reassess the medication or dosage. Sometimes, too many side effects mean the dosage of the antidepressant is too high, Meyer says. “Other side effects may lead a physician to prescribe an additional medication to alleviate the unwanted effect,” she says. “For example, for individuals experiencing sexual side effects [such as] lack of desire, a physician may prescribe Wellbutrin, which has been shown to help with unwanted sexual side effects.”

The counselor’s role in medication monitoring is to check in weekly with the client, Meyer says. “It is important for counselors to ask their clients if they are noticing anything unusual physically or mentally,” she says. “Counselors then need to be knowledgeable about what may be expected during the course of treatment. For example, some individuals report increased anxiety when they begin taking an antidepressant, but the anxiety subsides after a few weeks of treatment. It is important for counselors to know if certain side effects are transient.”

Sattaria Dilks, a licensed professional counselor who teaches at McNeese State University, says some antidepressants can have serious or even life-threatening side effects that counselors should be aware of and educate clients about. For instance, certain foods can have life-threatening interactions with monoamine oxidase inhibitors (MAOIs), a class of antidepressants, Dilks says. Other medications potentially can produce a life-threatening rash. Being knowledgeable of such side effects will alert counselors that a client needs to see a medical professional immediately, says Dilks, an ACA member who works in private practice as a psychiatric nurse practitioner in Lake Charles, La.

All medications have side effects, but there are two major concerns when it comes to antidepressants, Meyer says. One is increased risk for suicide among children and young adults, and the other is serotonin syndrome, in which a person’s serotonin level can increase to a potentially lethal level. Among the symptoms of serotonin syndrome are extreme anxiety, cognitive disturbances, cardiac disturbances, hyperthermia, seizures and coma, Meyer says.

Although not life-threatening, antidepressants can also have sexual side effects. As Dilks points out, clients might be more likely to disclose these side effects during regular sessions with a counselor than during a short visit with the prescribing physician.

Engaging in a conversation with clients about the relationship between physical wellness and mental wellness as it relates to antidepressants also can be worthwhile, Meyer says. “Many clients expect their antidepressant to be a ‘happy pill,’” she says. “They are disappointed, then, when they do not feel euphoric after taking the medication or assume the medication is not working because they don’t feel euphoric. Oftentimes, though, when working with these types of clients, it is important to ask about what changes they are noticing. In these situations, clients may report they are sleeping better or are not tired all the time. That is a great opportunity to discuss how those changes are positively affecting their lives. This helps clients see the big picture with how their medication may help them feel better, even if it is not an instant happy pill.”

Weighing the options

These experts also agree that counselors should know when to refer clients who aren’t taking antidepressants to a medical professional for additional help. If the client’s depression is mild to moderate and is of short duration, oftentimes, no drugs are needed, Dilks says. But if a client has a family history of depression, anxiety or bipolar disorder, has experienced multiple depressive episodes or has become suicidal, the counselor needs to refer the client for additional assistance, she says.

“Antidepressants are the most helpful for individuals suffering with the somatic symptoms of depression, anhedonia, worsened mood in the morning or concentration disturbances,” Meyer adds. “For many individuals experiencing grief, transient reactive depression or depression related to early life traumas, they may be better off processing the root of the depression with a counselor.”

With those clients who are considering antidepressant use, Meyer suggests that counselors review both the risks of taking an antidepressant and the risks of not taking an antidepressant so these individuals can make informed decisions. Counselors might also talk with clients about how diet, exercise, sleep and counseling may alter neurochemistry in a way that alleviates depressive symptoms without medication, she says.

Also worth discussing, Dilks says, is the fact that needing an antidepressant is not a failure on the part of the person taking it. “[Counselors can] help them work through that this is not a weakness [and] it’s not something they did or didn’t do,” she says. “It’s the genetic deck they got dealt.”

Meyer and Bennett point to multiple studies comparing the effectiveness of antidepressants only, counseling only and a combination of medication and counseling in treating depression. Meyer believes the results of these studies are worth discussing with clients so they will have the best information possible for reaching a decision concerning antidepressants. “Generally, the research suggests that medication only is the least helpful for treating depression,” Meyer says. “[Regarding] the best options for clients, some studies suggest counseling only is just as effective as a combination treatment. However, the majority of the research indicates the combination of counseling and medication as the best practice for depression. If the client chooses an antidepressant, it would be appropriate to address when he or she could expect to experience symptom relief, what type of symptom relief, how the medication works, the potential side effects and the expected length of treatment.”

Counselors should also be aware that antidepressants won’t work for every person or for every type of depression, Meyer says. “For example, one of the most common types of antidepressants, selective serotonin reuptake inhibitors (SSRIs), focuses on serotonin,” she says. “Yet, not all symptoms of depression are associated with serotonin.”

Effects can also vary among different populations of people, she adds. For instance, Meyer says, individuals of East Asian ethnicities typically respond better to lower dosages of antidepressants than do Caucasians. Age can also play a factor, she says. “While many children and adolescents take a variety of antidepressants, the only FDA (Food and Drug Administration)-approved antidepressant medication for use with youth is Prozac.”

If a counselor thinks a client might benefit from taking an antidepressant, it is acceptable to recommend that the client go to a doctor to be evaluated, Dilks says. However, she warns, a counselor should never tell the client to go to the doctor expecting or seeking a specific drug. It’s best to let the doctor make any recommendations, she says.

Teaming up for the client

Considering the amount of time typically spent with clients and the comparative strength of the relationship, counselors shouldn’t be shy about offering to collaborate with their clients’ prescribing doctors.

In her work as a psychiatric nurse practitioner, Dilks says she often communicates with her patients’ counselors to ensure more well-rounded care. “As a prescriber [myself], I think the counselor has a much closer relationship with the patient,” Dilks says. “They see them for a longer period of time — 50 minutes or more at a time — and generally see them more frequently. I find that if we touch base with each other periodically, we offer a more coordinated effort in providing the patient with continuity of care.”

Dilks says she collaborates with many counselors in her area, but to do so, clients must first sign a release allowing the counselor and prescriber to have ongoing contact as treatment providers. It’s not uncommon for Dilks to receive a text message or voice mail from a counselor to update her on a mutual client’s situation or to report side effects the client is experiencing related to antidepressant use.

Of course, the reality is that the counselor’s role in collaborating with the doctor, if at all, depends largely on the doctor and the client, Meyer says. “Some physicians or psychiatrists seek out the counselor’s opinion. I have been asked about client improvement and if I have suggestions for what may be best for the client. I have also discussed side effects. Some physicians may specially ask the counselor to monitor for certain side effects. Physicians may also want to know about compliance or complaints that the client has,” she says. “I find that often the role of the counselor is dependent upon the prescribing physician. This may include a meeting and then follow-up phone calls, or it may mean discussing with the client what he or she plans to share in his or her meeting with the prescribing physician.”

A counselor’s thoughts and observations can be especially helpful when the prescribing physician is a general practitioner, Bennett says. “Most general practitioners have not had many psych courses or extensive psych training. They tend to do very brief rotations through psychiatry during their third year of med school, during which time they are only briefly exposed to psychopathology and rarely exposed at all to what counselors can and do facilitate. They usually know that there is something ‘mental’ going on but not what to do with it. They medicate the symptoms as best they can and hope the patient will feel better and/or complain less. Counselors can be of great help to the medical professional but need to be sure to respect the professional and his or her role as the medical expert.”

Taking a collaborative approach can prove beneficial to both the counselor’s and the doctor’s practice, Meyer says. “Many physicians are looking for counselors for referrals. Oftentimes, a referral base can be created by counselors just through those physicians who are seeking out the counselor’s opinion. If asked to meet with a physician, this could be a great opportunity to leave some cards. The reverse is also true. Many counselors are looking for physicians for client referrals. From this, a mutually beneficial relationship could be created.”

But even more important, Dilks says, collaboration benefits clients. “All of us want our patients/clients to have the best care possible, and that is incredibly more efficient when we all work together — therapist, prescriber and patient.”

Antidepressants and bipolar disorder

When working with clients who are taking antidepressants, Dixie Meyer, an assistant professor in the Department of Counseling and Family Therapy at St. Louis University, is careful to assess for Bipolar Disorder I and II. Many people with bipolar disorder don’t seek counseling for manic or hypomanic episodes, Meyer explains, but they might seek counseling or medication for depression. For that reason, she advises counselors to be on the lookout for undiagnosed bipolar disorder.

It is especially important to be cognizant of undiagnosed bipolar disorder because the use of antidepressants may precipitate a manic episode, says Meyer, who teaches psychopharmacology at St. Louis University and has been researching the subject for five years. “Caution should also be utilized when working with individuals who have a family history because they may be at risk for bipolar disorder,” Meyer says. “When counseling clients who are on antidepressants, we address how they are feeling after using the antidepressants. If clients report irritability, racing thoughts or distraction, I also look for other indicators of mania or hypomania such as increased motor behavior or rapid speech. If symptoms of mania or hypomania are observed, I recommend the client meet with a psychiatrist about treatment with a mood stabilizer.”

To contact Dixie Meyer, email dmeyer40@slu.edu.

To contact Sattaria Dilks, email tdilks@mcneese.edu.

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

Letters to the editor:  ct@counseling.org

Judge throws out counseling student’s suit against Augusta State

By Heather Rudow June 28, 2012

(Photo: Flickr/Sir Mildred Pierce)

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

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

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

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

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

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

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

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

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

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

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


“Who am I?” Changing Jobs and Questioning Your Professional Identity

Paul Battle June 22, 2012

A few years ago, I applied for the position as director of a student services department at the university where I am employed. I had worked in the department for several years and felt qualified for the position.  I prepared for the interview; I had several ideas to enhance student services, stay connected with students, impact retention, and improve processes. I had worked well with students, and really honed my skills as a counselor. I was very disappointed when I was turned down for the promotion.  The hiring committee selected an outside person who had more “management experience,” but did not have a counseling background.  They wanted someone that was good with numbers, data and documenting results.   Although I had a wealth of academic counseling experience, I did not have any management experience on my resume.

Shortly after this setback an assistant registrar position became available on campus. The person in this role would be working behind the scenes on things like the university course schedule, the academic calendar and registration. If I was selected for this position, I would find myself working in-depth with the student information system, but having little interaction with students. However, I would also be managing personnel.

It took me several days to turn in my application, as I was torn.  I adored the interaction and work I did with the registrar’s office. They were a great team, and they were wonderful people. It was a great office in which to get that entry-level management experience. Yet I would leave the work I loved, working one-on-one with students, helping them with their career and academic decisions, something I truly loved. On top of that, I was pursuing a doctorate in counselor education.  I have hopes of obtaining a faculty position and teaching counseling.  If I took this job, I was afraid I would be perceived as not being a counselor or as not using my counseling skills.  How would I answer the question, “What can you tell me about your counseling experience?”  Would I be able to move back into counseling in a few years and work with people again?  I feared this question at future job interviews.  On the other hand, I would gain hiring, disciplining, scheduling, budget, and project management experience and be able to document it. These were all the skills I had not been able to offer for the previous position.  Therefore, I hemmed and hawed, back and forth, back and forth. In the end, I sat down and reviewed the pros and cons.  I discussed my decision with my family.  After deliberating at length, I applied for the position, interviewed, and was hired.  I transferred to my new post with the potential fear that I would lose my counselor identity.

Over the past three years, I have had many wonderful opportunities in my role as assistant registrar. I’ve been able to act as a change agent.  My staff and I have reviewed policies and practices, updated procedures, and have restructured the office to improve work flow and productivity.  We have launched new projects and have successfully enhanced the student services we provide. I work with some of the best people in the registrar business.  I have gained some very valuable experience as a manager.  I have been on committees and subcommittees that have really reshaped the face of the university.  I have been involved in some new, exciting projects that moved the school forward.  I have gained a greater understanding of how the university works from a different perspective.  All this and I have been mentored by some great leaders and supervisors.

However, at times I questioned myself: Am I still a counselor?  Often, my position requires me to be frank and directive, not empathic, which is the direct opposite of the core values taught to me in my counseling coursework.  In order to maintain my counseling connection, I began to supervise new counseling professionals.  I would help out in the student services areas to discuss schooling, career choices, and goals with students in passing and give them words of encouragement. When confronted by others who said that I am not a counselor, I would reply that I use my counseling skills on a daily basis.  I listen to faculty express their dismay about room constraints and their unhappiness with structural issues. I help brainstorm solutions with higher administration and offer assistance.  I help students that are in a rough situation connect to the resources on campus.  I work with departmental administrative assistants to trouble shoot miscommunication between students and university personnel.  On any given day I listen, I confront, I gently nudge, I troubleshoot, and I reflect on issues with a variety of people.  Although I tell myself, “I am a counselor,” at times I feel like a fake and that everyone else was right.  I use the skills, but I’m not counseling.  I’m not helping students.  I continued to fear that I would not be hired into a faculty position because I didn’t have the right experience.

Recently, the chair of the counseling department asked if I would like to teach a brand new course.  The class is an undergraduate counseling course that lets students survey the field. I had helped formulate the course, and would be the first instructor.  Again, I found myself in a hemming and hawing situation. This experience would add to my C.V., but I had finally begun to make movement on my dissertation.  All through the doctoral program, faculty advised us to eliminate distractions and focus on our dissertation.  They stated a completed dissertation is the best dissertation.  For me, writing and research were finally coming together.   Again, I discussed the decision with family.  After a long deliberation, I weighed the pros and cons.  I felt this teaching assignment would help me feel like a counselor again.  I would also have recent experience when applying for faculty positions.  I figured I could lose a little sleep this semester, work my 40 hour per week job, teach a course and work on my dissertation. I agreed to teach the course.

One of my first tasks was to select a textbook.  I am not sure I have ever been trained on selecting a textbook.  I went to the various publishers’ websites and ordered several textbook samples.  I happened to discover Granello and Young’s Counseling Today: Foundations in Professional Identity.  The book appeared to be a great fit.  The course I was teaching was titled “Foundations of Counseling.” Granello and Young do an exceptional job of showcasing the diversity of the counseling field by providing interviews from professionals in a wide variety of roles. The students would get an inside look as they began to explore what counselors really do for a living.

Before the semester started I began reading the text and preparing lectures and class activities.  The initial class went well and I was looking forward to the next. For the second week of class, we studied Chapter 2: What do Counselors Do?  Granello and Young provide a list of 20 tasks that counselors do.  They start with the typical tasks that students think of when they think of a counselor: therapist, group leader, and diagnostician. They go on from there to list other responsibilities such as consultant, administrator, and record keeper.  As we transitioned from the helping roles into the administrative roles, the students interested waned.  Yet, my interest peaked as I started to realize, “I am a counselor!  I am still a counselor!”  Although my title doesn’t reflect counselor, I am still a professional counselor, where I transitioned into an administrative role.  It was an overwhelming excitement to see in writing how I still fit within a profession I am passionate about.

On a daily basis I act as a consultant on a variety of topics to a variety of people on campus.  I assist in solving student and faculty concerns to help provide a better educational experience.  I serve as administrator to the backbone of the institution: the academic schedule. I am also a record keeper.  I maintain the records for the university, document proper retention, and ensure all guidelines are followed.  Granello and Young state that counselors act as mediators and advocates of social change.  I often get called into meetings between departments and serve as a mediator to ensure all parties are provided with the resources they need, particularly when there is a dramatic need for a late room change.  I also advocate for students and ensure that those with accessibility concerns can get into the classroom and are provided with the space they need to learn.  After reviewing the list with the class, the students stated they did not want to do many of the tasks I enjoy doing every day.   As a future counselor educator, I will be able to give a broader insight to this non-typical role that counselors can do.

For the last three years, I have questioned my professional counseling identity.  My job title seemed to reflect a very different occupation.  It took an introduction to counseling course to remind me of who I am.  I am a counselor.

Paul Battle is the assistant registrar of registration and student services, a lecturer in the Department of Counseling and a doctoral candidate at Oakland University in Rochester, Michigan. He is a licensed professional counselor in Michigan. He can be contacted at  battle@oakland.edu.

Follow Counseling Today on Twitter.

Letters to the editor: ct@counseling.org