Tag Archives: Counselors Audience

Counselors Audience

A family affair

Lynne Shallcross May 1, 2012

According to the Centers for Disease Control and Prevention, obesity now affects 17 percent of U.S. children and adolescents, which adds up to roughly 12.5 million kids. Since 1980, obesity prevalence among this group has almost tripled. Among children and adolescents ages 2 to 19, being overweight translates to a body-mass index (BMI) at or above the 85th percentile and lower than the 95th percentile for children of the same age and sex, while obesity signifies a BMI at or above the 95th percentile.

Mandy Perryman, coordinator of the counselor education program at Lynchburg College in Virginia, calls childhood obesity the No. 1 physical and mental health concern facing kids today. “We know about the physical damage, how kids are not expected to outlive their parents and other statistics, but these kids are suffering from more social isolation, more depression and more anxiety than other kids,” says Perryman, a member of the American Counseling Association who has been studying the topic for close to a decade.

In fact, the emotional side of childhood obesity can trap young people in a vicious circle. As Perryman explains, kids who are experiencing emotional vulnerabilities, including isolation and depression, sometimes end up eating more in an effort to cope. This can lead to them becoming even more isolated and sedentary and increase their risk of facing potential weight issues. “[And] when they become overweight,” Perryman says, “then those same issues become compounded.” Perryman became interested in the topic of childhood obesity while earning her doctorate at the University of New Mexico. She explored the relationship between parents’ weight-related perceptions and behaviors and their children’s body image and composition for her dissertation, and she has continued researching the topic of childhood obesity ever since.

Although physicians and nutritionists are perhaps more visible when it comes to addressing childhood obesity, Perryman contends that counselors can and should play a vital role as well. That’s because there is no better profession to understand and champion the family — especially from a wellness perspective — than counseling, Perryman says.

The original catalyst for a family appearing in a counselor’s office might be one child struggling with obesity, but helping the entire family achieve better health is often the main thrust of the counseling process, Perryman says. “The counselor can relate with the family and give a different perspective based on the wellness model,” she says. “We’re not looking at the deficits. We’re looking to enhance what the family can do.”

Ginny Gross, a counselor in private practice in Greenville, S.C., who specializes in weight-related disorders, says her young clients are often brought to her by concerned parents or referred to her by doctors or school counselors. Although an overweight or obese child might be her official client, she agrees with Perryman that the best counseling solution is to work with the entire family. In fact, Gross prefers to take a holistic approach that aims for lifestyle changes and includes working with others even beyond the parents. “I work with the children, their families, their doctors and a registered dietician,” says Gross, a member of ACA. “It is important to find a qualified registered dietician who is educated about eating disorders in order to help the child and parents learn about healthy lifestyle changes rather than ‘dieting’ techniques.” (Gross clarifies that she does not view obesity itself as an eating disorder. However, she says, many clients who are obese also struggle with eating disorders.) “Also, teachers can be incorporated into the mix if bullying or ADHD [attention deficit/hyperactivity disorder] are involved. It is important that the child’s pediatrician is involved in treatment to manage medications, to make sure labs and blood work are in a healthy range and to ensure they are not suggesting diet pills or a diet for the child.”

Working with parents of overweight or obese children sometimes focuses on highlighting the messages parents might be sending to their children, Gross says. For example, she says, negative messages about food or restrictive eating rules may only serve to fuel the child’s struggle with weight. Gross includes the parents in almost every session she has with an obese child. Sometimes, she also works alone with the parents.

Gross strongly advises parents against putting their children on diets. “This instills low self-confidence and decreases self-esteem to a lower point than it probably already is before the diet,” she says. “Also, teaching children dieting behaviors increases the chance of disordered eating, and research shows that diets and disordered eating often lead to diagnosable eating disorders. Even more so, it teaches children yo-yo dieting behavior from a young age. Research has found that yo-yo dieting leads to metabolic syndrome, diabetes, heart disease and even obesity.”

Perryman also contends that diets are the absolute wrong approach to take with overweight or obese children. Even for adults, she adds, diets don’t lead to lasting change. What will lead to lasting change, she says, is helping kids and families focus not just on doing something differently but thinking about it differently. Diets mean restricting yourself until you just can’t refrain anymore, Perryman says. And when you do give in, you feel guilt and shame, which might lead to more overeating. “You have to change [clients’] thinking and do some cognitive restructuring if you want the behavioral changes to last,” she says.

The work a counselor does with families might include talking about preparing and cooking meals together, eating together and exercising together, Perryman says. Gross adds that research has shown that eating together as a family decreases the chances of disordered eating and eating disorders. As explained by Perryman, disordered eating is when people use food for reasons other than nourishment, including attempts to numb themselves from pain or buffer themselves from interacting with others.

Also worth covering with the family of an obese child is how the family likes to celebrate, Perryman says. If celebrations usually focus on unhealthy food, talk with family members about how they can change some of those habits but still feel rewarded. “If a cupcake is special to me and then you substitute a carrot, it won’t work,” she says. “You have to come up with what will work with the family to feel like it’s a good exchange.” Perryman also suggests counselors explain to parents that labeling certain foods “off-limits” can actually backfire and how enforcing that mindset isn’t healthy.

Gross concurs. “I advise counselors to work with parents as much as possible on teaching children how to have a healthy relationship with food,” she says. “For example, foods should not be labeled as ‘good’ or ‘bad.’ All types of food should be allowed in the house and kept in the pantry, because when foods are restricted from anyone, the reward value increases in the brain for that food. So, when the child is exposed to that [restricted] food, they want it even more and it has more meaning.”

When meeting in session alone with parents, a counselor can also inform them that weight gain is a normal part of development, especially during puberty, Perryman says. She finds it surprising how many parents are unaware of that fact and how often weight gain during this period can lead parents to put their children on a diet. Perryman adds that the counselor might then also open up that conversation with the child and his or her parents in a session in an effort to help normalize what the child is experiencing.

Another point of discussion when meeting with parents alone is how these parents feel about themselves and talk about themselves in front of their children, Perryman says. For example, a child might begin nitpicking the way she looks if she absorbs and then mimics that behavior from her mother, Perryman explains. “We’re quick to focus on our appearance, but we need to reinforce for children that we’re proud of their values and their efforts and their accomplishments,” she says. “When we compliment them on the person they are, it takes the power away from everything being based on appearance.”

A positive approach

In addition to working with the family on healthy eating habits and increasing physical activity levels, Gross and Perryman say counselors can use cognitive behavior therapy to help a child struggling with weight issues. Weight loss often focuses on eating and exercising behaviors, Perryman says, but adding the cognitive piece helps to create lasting change for the child and family.

Gross views the counselor’s role as assisting the child to feel less isolated, develop stronger self-esteem, gain greater body acceptance and also learn to become aware of and cope with overeating triggers.

Perryman suggests having children carry a pocket-size mirror with them. If they start feeling low, Perryman says they can take it out, look into it and tell themselves something positive they’ve learned about themselves in counseling.

Taking a positive approach in working with overweight and obese children and their families is key, Perryman says. “We know that dieting children is the absolute worst thing we can do,” she says. “Restriction isn’t good for anyone, and fear is not a long-term motivator.” Counselors should take their approach from the wellness model, she says, with families encouraged to build on the strengths they already possess and to continue moving toward better health.

Perryman and Gross say although it is beneficial to have a basic knowledge of nutrition, counselors do not need to be specially trained in nutrition to work with obese children and their families. “However,” Gross says, “it is helpful to be knowledgeable about the non-diet approach to weight stabilization and what types of food children should be consuming and [to know about] not cutting out any of the food groups.”

“It is highly important for counselors to make sure children are eating all of their meals and never skipping meals, even if they do not feel hungry, and eating breakfast daily,” Gross continues. “Many children on stimulants for ADHD have suppressed appetites and do not want to eat or feel sick when they eat on their medications, but it is very important for parents and teachers to monitor these children’s eating patterns to make sure they eat an adequate amount of food. If a person doesn’t eat breakfast, their metabolism doesn’t get jump-started to where it needs to be for the day, and then they are more likely to overeat at lunch. Also, if a person skips meals or restricts food, not only does their metabolism decrease, their body goes into what we call ‘survival mode,’ which means our bodies are preserving energy and not burning energy because of a lack of intake of energy.”

Gross contends that although childhood obesity is a situation deserving of attention by counselors and society as a whole, we also need to be careful about the wording we use as a society. “We throw around the word epidemic lightly,” she says. “By talking about what a big problem [obesity] is, it can make kids feel bad. It can give them guilt and shame and make them feel there is something wrong with them.”

Although Gross says it’s worth working with children and families on changing thoughts and behaviors related to eating and exercise, and also acknowledges that environment can play a big part in a child’s struggles with obesity, she points to research showing that 50 to 70 percent of weight is genetically determined. That means certain children will have a larger uphill battle against weight gain than other children, and Gross wants counselors and society as a whole to be mindful of making a child feel at fault for being overweight.

Perryman agrees that nothing is wrong with the character of a child who is obese and says society needs to be careful not to make these children feel bad. In that same vein, when working with these children and their families, Perryman says, counselors should avoid applying labels and instead focus on empowering families and children to obtain better health.

However, Perryman acknowledges, on a societal level, childhood obesity is a problem — one she says shouldn’t be sugarcoated or downplayed because then it won’t get the attention it requires. Counselors should advocate to bring more attention to the topic, she says, because the more attention it receives, the more potential there is for change in what’s being served in school lunches, in keeping physical education classes intact even during budget cuts and in offering better nutritional options at lower prices nationwide. “If you can feed a family of four on a bucket of fried chicken but you can’t buy a healthy alternative for the same amount,” she says, “then you can’t sustain change.”

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

Letters to the editor:  ct@counseling.org

Specialist, generalist or niche provider?

Compiled by Lynne Shallcross

When budding counselors finish their graduate programs and head out into the world with degrees in hand, they face an often complex decision — whether to specialize in a certain area of counseling in hopes of working with a particular type of client or issue or whether to serve a broad swath of clients presenting with a wide range of issues.

In an effort to explore the thought processes behind individual counselors’ decisions regarding specializing or developing a more general practice, Counseling Today contacted six members of the American Counseling Association. Each opened a window into his or her chosen professional path and offered words of wisdom for other counselors concerning career direction.


Barbara Adams is a therapist in the children’s unit at a residential treatment program in Mobile, Ala. Adams’ career has included working both with diverse and specialized client bases, as well as a hiatus during which she retired her counseling license in her home state of Oregon after having a child with special needs. Adams has re-earned her counselor license in Oregon and is working on earning her license in her current state of Alabama as well. Contact her at badams@altapointe.org.


How did you decide whether to specialize or generalize as a counselor?

Part of it was my decision, but part of it had to do with the needs of the agencies for which I worked early in my career. Like good internships, the process of being assigned particular roles in various capacities over time allowed me to try on different clinical hats. It soon became obvious where my skills were more compatible with certain specialties. This led to years of specializing, although in a couple of different categories over the decades. I enjoy the comfort of intimately knowing the specialty, serving as a resource to others and engaging in cutting-edge practice. I don’t want to be out of touch with other areas, though. I want to keep myself open in case I go back to private practice or work in other settings, since my interests are so broad. Continuing education has helped keep me abreast of other areas, as well as being willing to be flexible within the company or seeking opportunities to familiarize myself with other “hats.”

What have been the pros and cons of your choice?

People who specialize must guard against burnout. It is very easy to fall asleep at the clinical wheel when you know the ins and outs so well that you occasionally find yourself cruising on autopilot. Specializing also made me less marketable when I returned to the field overall, although it was very helpful when I landed my current position working with children and adolescents. On the other hand, it is fulfilling to be so intimately acquainted with a particular niche.

With diversifying [generalizing], my high-energy personality enjoyed experiencing different aspects of the field, and it gave me fresh perspective. I also learned new things that I was able to apply to other areas, and it forced me to stretch myself. A positive aspect of generalizing is that it gave me an excellent core of experience on which to base future practice, whether specializing or diversifying. I have always been able to draw on my work as a generalist, even now in my specialty. An example is remembering some of the more challenging adult clients and now, working with children, being able to better visualize what interventions might be best at earlier ages in order to prevent them from ever getting to that point.

What lessons have you learned?

With specializing, I learned that it is important to follow your passion in practice. If you are drawn to and wind up doing what you enjoy, you are a more effective counselor, and those to whom you provide services are the real winners. You are never throwing anything away by changing specialties or crossing over into diversifying, since the very things that make you an expert in one role can often be applied in other ways in other areas.

In diversifying, I’ve learned so many wonderful tricks of the trade that I could have missed had I been focused on specializing. Working more generally is almost a specialty in and of itself. It demands flexibility, creativity and comfort with change. With both specializing and diversifying, solid clinical skills and ethics are a must. If these are well-established, one can do well in either capacity.

What advice would you offer to other counselors considering whether to specialize or generalize?

Counselor, know thyself! It is important to be able to assess your own skills and interests, to have a feel for what you might like — or not. Be acquainted with your personal beliefs and how your experiences have shaped you. These can help or hinder, and it’s important to be open to try new things. Counselors should list their goals for their career. For instance, if publishing a book or lecturing/teaching are goals, specializing would be important in order to be an authority on a subject. Those with a goal of private practice would do well to diversify. Read as much as you can about either path. Join a focus group online. Talk to other counselors in areas you might be interested in. Set up interviews or shadow them for a day. It will light your fire or send you packing, but either way, you’ll be a step closer to knowing what you want to do.

Lastly, fear no failure. Both specialization and diversification foster personal and professional growth through their respective experiences and will make you a better counselor either way. Both are critical to the success of the profession. You can never go wrong if you follow your passion because this is where you will put your best energy — a win-win. And passions can change. This makes us richer and provides us with more to offer the profession and those we serve.

Is generalizing or specializing more often a matter of choice or situation?

In my experience, it is usually dictated more by location and situation. Graduate internships in some areas may be limited to either more diverse or specialized settings; likewise for jobs in mental health. In today’s economy, it can also be dictated by a student’s or practitioner’s financial ability to pursue [his or her] preferred area. I have seen colleagues “settle” for an advanced degree in an area that wasn’t quite what they wanted to do or for a job they needed simply because of geographical or financial convenience. That being said, I believe there are always choices. If one is intent on pursuing [his or her] true passion, barriers tend to melt away, and we find those pathways.

Looking back, would you recommend that others follow your path?

Starting with generalization exposes us to a broad array of experiences in the counseling field. This helps us as professionals to gain insight into our clinical preferences — a valuable tool to carry into the future of one’s career. I believe there are risks associated with starting with specialization. Namely, possibly limiting oneself in the field. Even if you know where your passion to serve lies, you will ultimately be better in your area of expertise if you can fall back on experiences, both positive and negative, in generalizing. There is something to be said for well-roundedness and what it can contribute to specializing.


Tamara Suttle is a counselor in private practice in Castle Rock, Colo. In private practice since 1991, she now splits her time between clinical counseling work and consulting with mental health professionals who are seeking to build their own practices. Contact her at tamara@tamarasuttle.com.


How did you go about making the decision to branch out from your own counseling work to help other counselors grow their practices?

When I relocated to Colorado from Texas and started over at 40-something, I realized that I knew an awful lot more than I did the first time around, and my clinical practice grew quickly and easily. As I met colleagues in the area, I repeatedly heard narratives of struggle and hopelessness. I started looking around and realized there wasn’t anyone out there helping counselors to build strong and vibrant practices by emphasizing their strengths. Although there are a few others who can be found online now that focus on building practices, at the time I couldn’t find anyone doing this work for our field.

What lessons have you learned along the way worth sharing with other counselors?

  • That old adage about “find your passion and the money will follow” is true.
  • Counselors with the strongest practices diversify their incomes.
  • Out-of-the-box thinking always trumps the “tried and true” when it comes to marketing.
  • The F-word is fear, and it can leave you cold and hungry.
  • Finding your courage is imperative in building a practice.
  • There are many right ways, not one right way, to build a private practice.

What have been the pros and cons in this niche you created working with other mental health professionals?

I think the cons are the pros. One con is that there wasn’t a ready-made niche for this work. No one was doing it. The benefit, of course, is that no one was doing it. Another con is that there wasn’t a road map for how this piece of my practice should look. The benefit? I get to make it look exactly like I want it to.

Another con is that I had to create a new image and brand from scratch — one that was clearly separate from my image and brand as a professional counselor. The benefit is that it is an opportunity to highlight and play with an overlapping but different set of skills. It’s a refreshing balance to the bulk of trauma-focused work that I do as a counselor.

Another con is that the phone rings more and the online community I’ve built requires continual attention. Next to word of mouth, social media is what fuels this piece of my business. LinkedIn, Twitter, my online community for “Private Practice from the Inside Out,” Google+ and Facebook require focus and commitment. The benefit is that I have built tons of relationships both inside and outside of the United States. Some are professional, others have become personal.

Do you anticipate continuing down this path in the future?

I will continue working with counselors and allied health professionals in this niche. It feeds my spirit and balances out my clinical work. It’s about giving back to the field and mentoring new professionals. There are lots of counselor educators and institutions contributing to the clinical end of our field, but there are very few that are speaking to the business needs of clinicians. To continue feeding the clinical needs but neglecting the business needs is not serving our field in the long run. We absolutely need strong clinicians, but we also need business-savvy clinicians who can build and sustain their businesses as CEOs of solo practices, nonprofit agencies and for-profit institutions.

What do you see as the difference between specializing and having a niche?

Niching is a marketing tactic, and specializing can be both a marketing and clinical tactic. Neither restricts the variety of clients you work with. Nevertheless, most counselors do, I think, resist niching and specializing. I think we’re back to the “F-word.” For new counselors, they are often fearful of missing a potential client, so they think they need to tell folks that they “do it all.” More seasoned therapists often find it difficult to change their marketing strategies — how they describe their work, where they focus their work, etc. And that, too, often boils down to fear.

By choosing to specialize in an area, a counselor has learned about a specific subject matter in depth and has become competent in working with that particular issue or population. It’s possible to specialize in more than one area. And, in fact, I believe that this is exactly what seasoned therapists do. We develop bodies of knowledge, experience and competence — not just interests — in specific areas. One of the benefits of developing specializations is that counselors are then able to make fewer mistakes because they have that depth of knowledge. Specializing supports risk management. And, of course, another benefit to specializing is that you have more options for niching your practice, which is related to how and where you market your practice rather than to whom and where you choose to focus your actual daily work.

Can generalizing as a counselor  be effective as well?

Absolutely! And, how I practice is a generalized practice with a wide variety of clients. However, it’s important to remember that generalizing is not an effective marketing strategy. Generalizing is what most of us practice. It’s not how most of us get to be remarkable or memorable [though], and these two things are key to building a practice today.

Marketing research shows that we are a “boutique” society. We purchase our products and services for their uniqueness — think niche. Those of us on the providing end of services know that we do many things rather than one thing. However, our clients — think consumer — want to believe our services are special and unique to their needs. Thus the need to niche your practice [marketing-wise].

How do you market the clinical side of your work?

Among other things, I carve out time on my calendar every week to address marketing. I set goals. I meet new potential referrals sources every week. I follow up with current/old referral sources every week. I check in with my clients to make sure I’m doing a good job and to learn how I can improve my services. I create new “projects” that will use my skills in different ways. I look for opportunities to do public speaking and training. I look for opportunities to collaborate with colleagues on projects. I never go anywhere without business cards, and I pass them out liberally. And I am active on social media and actively network online around the country, always building relationships. Bottom line, I look for opportunities to meet people, be helpful, become a resource and build relationships with people. No one refers to a stranger. This is what counselors are trained to do, and most of us do it well. Unfortunately, most of us do not realize that it’s also necessary to run a business, especially one as personal and intimate as ours is.

What advice would you offer a counselor wanting to specialize?

When I work with therapists-in-training on how to build a private practice, I talk a lot about the importance of specializing. I take them through an exercise to help them brainstorm the stepping-stones and turning points in their lives, their interests and passions, and their mentors and teachers. By doing this, I help them “float up” some of the areas [in which] they may already be gathering special bodies of knowledge. If you are a counselor who is also a child of an alcoholic or a transgender woman who has experienced the journey of transitioning, you have lived experiences that can contribute to specializations in those areas.

Of course, that lived experience alone is not sufficient to declare a specialization in those areas. Formal training and consultation is also necessary to specializing. I tell my consulting clients that it’s never too early to begin that training if you know you want to specialize in an area. Even in graduate school, you have the opportunity to take electives and choose particular tracks of training. If you know you want to specialize in play therapy, take those classes as early and often as you can.


Daniel J. Weigel is an associate professor of counseling at Southeastern Oklahoma State University. Weigel has worked in very rural areas where he served a wide range of clients. Both as a graduate student and as a counselor educator, he also researched the topic of general versus specialty counseling. Contact him at dweigel@se.edu.

What led you to work as a generalist counselor?

I ended up working as a generalist counselor due primarily to my upbringing in a rural city in South Dakota. My entire life, I have been educated, lived and worked in rural parts of the country. This is part of my personality. I have always been a rural person, despite my willingness to travel and work in many different states. And since so many rural parts of the country have such a shortage of mental health professionals, I did not have the option of specializing in a particular area. Rural areas are predominantly served by community mental health centers rather than specialty clinics. Fortunately for me, I found generalist counseling to be quite rewarding and a natural fit for my personality and professional counseling career aspirations.

What lessons have you learned from your work and your research?

I have learned several lessons in my work as a generalist counselor and supervisor. The first lesson has to do with ambiguity tolerance. Specifically, those who work as generalists face many ambiguities in their work [because] client populations and issues differ dramatically from one day to the next. If a counselor’s personality type is not one that allows for tolerance of these daily uncertainties, he or she will struggle.

Hand in hand with this ambiguity is an increased demand for counselor independence and responsibility. This is especially true when it comes to the unique demands of crisis management due to a lack of providers and referral sources to address around-the-clock mental health emergencies in rural shortage areas. Generalist counselors must know their limits and set their own boundaries. Issues of counselor competency are forefront in this regard.

In one research study I conducted, I examined the differences between rural and urban counseling. A surprising discovery was made. Specifically, when asked questions regarding a counselor’s willingness to provide counseling despite feeling “unqualified” or “not fully competent,” rural generalist counselors were significantly more likely to provide counseling services anyway due to a limited referral base. The struggle between client abandonment and stretching one’s definition of personal competence is a very difficult path to traverse for many counselors. Managing dual or multiple relationships amid the isolation of rural generalist practice also showed stunningly significant differences between rural and urban counselors. Such challenges related to managing unavoidable dual relationships due to lack of referral options, seeing clients in the community outside of work and client privacy amid community gossip.

Based on these findings, it is clear that generalist counselors have to be astute in following ethical and legal guidelines, seek supervision and consultation regularly throughout their careers and take special care to prevent burnout. Self-care for counselors in any setting is highly important. However, generalist counselors appear to need a carefully planned program of self-care due to the unique challenges of their work, such as isolation, crisis work, fewer colleagues with whom to consult, etc.

What are the pros and cons you see attached to generalist practice as a counselor?

The pro of diversifying is that your job is always changing, which provides opportunities for more flexibility, freedom and responsibility than specialization. Some counselors thrive in this work environment; others dread it. The cons of generalist counseling involve freedom and responsibility — also mentioned as pros — which require personality traits that accommodate increased levels of independence and ambiguity tolerance.

How should other counselors go about choosing between generalizing and specializing?

As a counselor educator, I encourage my students to complete their practicum and internship experiences in a variety of settings. I also encourage my students to complete a portion of their internships in a rural community mental health center. These recommendations help counselors-in-training find the client populations and/or issues with which they feel most comfortable providing treatment.

Looking back, is there anything you would do differently?

Yes and no. Fortunately, I recognized my personality style prior to completing my internship and post-master’s hours. I found generalist counseling to be a good fit for me. I also saw great turnover in my colleagues who worked in the same setting. I knew I wanted to eventually become a counselor educator at a rural university. Fortuitously, things seemed to fall into place for me in both job settings — as a counselor and as an educator.

One thing, however, I would do differently in my work as a rural generalist counselor is to set up a better self-care system and network. I would spell out self-care strategies and follow them religiously. I would set up a network of peers also working as generalists for regular consultation meetings even if it would require miles of travel.

Lastly, I also learned to take time off for mental health days when needed. I know it sounds cliché, but I’ll say it here: Counselors cannot help others if they are not taking care of themselves. Burnout leads to impairment, and impairment leads to client harm.

Is there always a choice in generalizing versus specializing?

Most often it is a choice, as long as a person has geographic mobility. Counselors often end up working at the sites in which they have completed their internships. However, counselors who live in rural areas often have limited opportunities to specialize. In my case, I worked in a part of Colorado that was considered so rural that the U.S. Census considered it “frontier.” By accepting this job, I had no choice but to serve a very diverse client population. Specializing was out of the question. It was, however, my choice to take this job — a decision that was based on my recognized personality preferences.


Andi Edelman is a vocational rehabilitation counselor and licensed professional counselor who transitioned from a specialty working with individuals with disabilities to working in private practice with all manner of clients interested in career development. Contact her at aedelmancc@comcast.net.

What figured into your decision to move from working with a specific client population to working with a wider variety of clients?

Early in my career, I liked the idea of assisting individuals with disabilities with identifying and achieving successful life outcomes. I ended up working primarily with adolescents and young adults with disabilities, helping them come to terms with their disabilities and learn how to identify and capitalize on their strengths. Focusing on transition to secondary education and to the world of work, much time was spent on helping them develop their employability skills, learn about work, [assess their] expectations, explore occupations, etc. As my career progressed, the age of the individuals with whom I worked became more diverse, but it was still focused on individuals with disabilities.

I realized that my counseling was applicable to anyone, with or without a disability. The steps one takes to identify abilities, interests, strengths, limitations, learning style, preferences [and so on] are basically the same. For people with disabilities, there was the additional consideration of the disability and how it impacted them, necessitating additional discussion, helping them understand rights and laws that protect them, and learning about accommodations that could be put in place to enable success. When I decided to go into private practice, I made the decision to offer services to everyone — all ages, with or without disabilities — because my skills were applicable to all. I was hoping for a greater variety in individuals and the type of assistance sought.

What were the pros and cons of your switch?

I don’t think there were any cons for my diversifying. There is a need for people to specialize and really become experts in what they do, to know it intimately, because there are many folks who require specialized guidance. Diversifying does not take away your specialty. It just adds to the breadth of whom you serve and attracts a greater pool of individuals. I have found that many individuals with whom I work — those who aren’t seeking disability-related expertise — actually do have different learning styles [and] exhibit signs of attention deficit disorder, have chronic illnesses, depression, mental health issues, etc., but don’t consider themselves “disabled.” For those people, my knowledge about disability, disability resources and accommodations is an added benefit. The biggest pro for me is it has increased my network and engaged me on a broader level.

Moving from diversifying to specializing or vice versa moves you out of your comfort zone and stretches you in many ways. To me, that’s a pro. For others, it could be a big con. Also, depending on what you do, you may need different certifications, and different education and training might be required. Your professional support networks may change and can become more restricted, which could be a pro or a con, or may widen — again, this could be a pro or a con, depending on the person.

What lessons have you learned along this path?

When I was just providing disability-related services, the pool of individuals with whom I worked was smaller — both the individuals I counseled, as well as the professionals with whom I interacted. To me, in retrospect, being specialized was limiting. To meet the needs of the population I worked with, I spent most of my time pursuing continuing education and training focused on disability, keeping up with resources, technology, services and programs that could benefit my clients and my ability to provide them with the best service I could. If and when I had time, I kept up with the larger piece of counseling, theories, programs [and so on], but my focus was more narrow than broad.

When I made the decision to diversify, I made the conscious decision to increase my scope of reading, resources and course offerings, and I also expanded my professional network beyond those focusing on disability issues. As I broadened my reach, I found that I was excited by the variety of people, techniques and resources I was accessing. I met terrific people whose thoughts and ideas were a valuable addition to my thinking and my work, and I found greater satisfaction in my work. I think broadening my scope makes me a better, more well-rounded counselor.

What should other counselors consider when deciding between serving a specialized client base or a general client base?

I would recommend that they consider where their comfort level is and how they want to utilize their skills and abilities. Sometimes people want to excel in one area only, and that’s fine. Sometimes people want to excel in a broader context. Any and all of it is fine and productive. It boils down to personal preference.

If they specialize and want to diversify, it is important to objectively consider the skills that transcend any population and what you can offer. It’s important to identify any education and training needs that might be unmet to meet the needs of a more diversified client base. Marketing is another consideration, as is strategically broadening their professional/peer network. Also, I think it’s important to consider the population for whom you want to provide services, where you will find the target population and if there is a need for your services.

Do you think you possess a counseling niche?

When I specialized in working with individuals with disabilities, I would say that could have been considered my niche. That is what I wanted people to know, and that is what I marketed. Now that I am broader, I don’t believe I have a niche other than providing career counseling to individuals in need of assistance. But on my website, I do mention my specialization of being a certified rehabilitation counselor and a licensed professional counselor and my having experience in working with people with disabilities. I no longer market that, however. My reach is broader, my networks are broader, my referral sources are broader. I have done extensive outreach to social workers, psychologists, psychiatrists, counselors and other professionals, as well as to broad organizations, to identify referral sources for my clients as well as market myself to them. That said, I did include people, services and organizations that specifically provide assistance to individuals with disabilities, but that was because I wanted to be inclusive and capture the broadest group possible, not because of my specialization.

Grace Bell is a counselor in private practice in Seattle. Her work with clients focuses primarily on the Work of Byron Katie. Contact her at gracebell@comcast.net.

Give a brief description of the Work of Byron Katie.

The Work of Byron Katie is a modality of self-inquiry somewhat like the Socratic method of inquiry. People use it in the therapeutic process as a tool for change. It is simple in that there are actually only four questions, and then the final piece is finding what is called the “turnarounds.” The very first step is identifying painful or stressful concepts, in writing. Examples of painful beliefs that people have when they come to counseling include the following:

  • He shouldn’t have left me.
  • I had a terrible childhood.
  • I will never get over the trauma I experienced.
  • I need more money.
  • She is too critical.

These concepts are basically judgments, beliefs or sayings that we’re telling ourselves that produce grief, rage, fear, sadness or any kind of stress whatsoever. This questioning process known as The Work stops this first painful experience going through our minds and investigates it very carefully.

The four questions, which Byron Katie organized in about 1986, are Is it true?; Can you absolutely know that it’s true?; How do you react, what happens, when you believe this thought?; and Who would you be without the thought?

Then you turn your painful concept around. So, “He shouldn’t have left me” becomes the opposite: “He should have left me.” The client thinks about this and finds some examples of how this is true also. Then there is another turnaround where the client trades places with the person they are feeling badly about — “I shouldn’t have left him” — and finally, there is a third turnaround all to the self — “I shouldn’t have left myself.”

How did you find this work and come to specialize in it?

Byron Katie is an odd name, but she’s actually a woman who is nearly 70 who lives in Ojai, Calif., and teaches her work to thousands of people each year. I became interested in her work when I attended her nine-day School for The Work in Los Angeles seven years ago. I found it to be one of the most profound workshops I had ever done in my life, absolutely life-changing, and I am not easily swayed by teachers, gurus or inspirational speakers. I decided that as a practicing general part-time counselor at the time in private practice who often worked with clients with eating disorders, I wanted very much to bring this model to them.

How do you attract clients to this specialty?

I find clients by building an email list, spreading the word through Facebook groups and my professional and personal Facebook pages, tweeting, being on LinkedIn and sending out a daily post/blog called Grace Notes about living with these questions. I also teach a lot of local workshops and print fliers for those, and I get clients and participants through word of mouth.

Have there been pros and cons to your choice?

The pros are that I get paid well by people worldwide who already have read Katie’s book or know The Work and have had success using it. The method really cuts to the chase for personal issues with others and in a greater, spiritual sense. Another pro is that I can offer groups and classes and workshops in this method, and people sign up from all over the place, traveling from fairly far distances to attend. They may not know who I am or have only a referral for me, but they know they want to do The Work. The cons are that people usually need to read Katie’s book Loving What Is or have some kind of contact with The Work in order to get it and want it.


Emelyn Kim is a counselor who specializes in gerontological counseling. She provides counseling to family caregivers of older adults in Hawaii, in addition to working in the continuing education department at her local community college. Contact her at eme@eccehawaii.com.

How did you end up specializing in this area of counseling?

I had worked as a case manager for older adults at the Hawaii State Department of Health, as a senior program specialist developing wellness education for Blue Cross insurance members 55 years and older and as a coordinator of a new case management program for family caregivers of elders at a large nonprofit agency. In my work with family caregivers, I found that they needed help relating to and communicating with their older relatives. This nonprofit agency wanted untrained case managers to offer counseling to their clients, but I did not feel qualified as their supervisor to provide counseling. After two years of developing and implementing this program, I felt it was time to learn more about the counseling field. Getting my master’s in gerontological counseling in 2006 meant progress because I would improve on the counseling I was doing intuitively. It felt like a natural step to take in my career.

What lessons have you learned along the way?

I learned that I had to believe in myself and trust that I would be able to handle going back to school at age 55. Making this decision at any age is a commitment and requires you to be passionate about your specialty area. If you are uncertain or ambivalent about going into a counseling specialty, you may not find it rewarding or even interesting. I already had a variety of work experience with older adults as well as being a family caregiver to my parents and other relatives. I consider counseling as a skill learned in order to be better able to help others care for older adults. The lesson is finding your passion, whether in a specialty area or just counseling in general.

What have the pros and cons been of following this path?

The pros are being at the cutting edge of a specialty that will soon be in demand as our baby boomers age and need more family and professional caregivers. The cons are that many caregivers and elders are unable to pay for counseling services because they are on a limited income and health insurance does not reimburse for this specialty. Usually, the adult children who care for their parents do not understand or value having a counselor assist them in overcoming the many obstacles that occur when providing 24/7 care. They are so focused on the physical and medical needs of their frail elders that they tend to neglect their own physical and mental health.

Looking back, is there anything you would do differently?

In hindsight, I should have talked to counselors already in private practice. I could have gotten more practical tips on what to do or not do in establishing a private practice. Marketing my counseling business has been difficult, as I was not comfortable promoting myself.

Where do you see the future taking you?

I anticipate doing more education of both family and professional caregivers and hope to expand to the neighbor islands. I would like to offer both individual counseling and educational seminars to informal and paid caregivers of older adults. There is a need to increase public awareness of caregiver stress and the potential for elder abuse. I think that creating partnerships with other businesses and nonprofit agencies can help to spread this message.

Is there always a choice concerning whether to specialize or generalize, or is the decision often dictated by a person’s situation?

I believe that counselors always have a choice to specialize or diversify. By not choosing, the counselor allows the situation to dictate the choice. If you don’t like the situation, you should look at what you can control to make a change in the situation, or perhaps it just takes a shift in your perception of it. Either way, counselors should feel they have a choice and not allow anyone or the situation to say that they have none. The key is to know what you want, believe in it, and then you will see your path. Believing is seeing — not the other way around.

Do you feel you have developed a niche that you tailor your marketing to?

I agree that specializing in a certain area of counseling is a little different than niching. In the beginning, I didn’t realize that and promoted my counseling services to those organizations I already knew in my aging network. I found some resistance among older adults to accepting counseling because they consider it as psychotherapy for mental illness and say they are not crazy. I tend to agree that the medical model of looking for disease does not fit with caring for older adults. I narrowed my target market to the adult children of older adults and found my niche there.

Because I work mostly at the community college, my practice is limited to part-time hours. I offer flexibility to accommodate caregivers. Usually, I meet clients at their homes in the evenings and on weekends. I can rent a meeting room for those occasions when a formal group meeting of family members of the elder person is needed.

Now I’m actively marketing or promoting my counseling services to those agencies that deal with caregivers of older adults. At the nonprofit agency where I had developed the case management program, I offer to do family counseling at a discounted rate, and their case managers apply to a funding source, a third-party grant, to pay for my fee. I also advise and mentor their case managers on a pro bono basis to help them deal with difficult cases

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

Letters to the editor:  ct@counseling.org


Seven tips for working effectively with parents

John Sommers-Flanagan

Working directly with parents can be either terribly frustrating or exceptionally gratifying. Many counselors initially feel both fear and frustration at the prospect of counseling parents. That was certainly the case for me. I not only felt intimidated, but I also held several negative beliefs about parents that adversely affected my ability to work with them effectively.

Fortunately, experience helps. I was able to develop more positive attitudes and expectations about parents. I hope the following tips will help you experience more gratification and less frustration as you provide professional counseling services to parents.

Tip 1: As is also true with multicultural counseling, developing self-awareness helps. Two self-awareness issues are crucial. First, self-reflection and collegial discussion can assist you in identifying negative, stereotypical or unhelpful attitudes or expectations that you might hold concerning parents. Second, it’s especially important to know your personal and professional parenting buttons … because parents will inadvertently or intentionally push them.

To borrow and twist the title of an old Art Linkletter and Bill Cosby TV show, sometimes parents say the darndest things. For example, parents have told me:

  • “I got spanked as a kid and I turned out OK.”
  • “I’ve taught my 6-month-old to speak in complete sentences and to defend himself using martial arts.”
  • “You’re just a stupid-ass counselor who doesn’t know anything about living in the real world.”

Self-awareness can give you a better chance at managing potentially unhelpful reactions to these darn things parents say. Often the best response is to listen closely and respond with empathy to deeper meaning or feelings. Examples of how to respond to the preceding statements from parents include:

  • You really want your child to turn out OK too.
  • It’s important to you to prepare your child for the world.
  • You’re not sure I’ll be able to relate to you and your situation.

Underneath their defensiveness and hostility, parents usually feel scrutinized and vulnerable. This is why empathic and active listening is essential.

Tip 2: Knowing the popular parenting literature can help establish your credibility. Most of us studied textbooks on child development, psychopathology and brain science as part of our professional training, but parents are more likely to ask about parenting books than textbooks on developmental theory. Parents will appreciate it if you know what terms like tiger parenting and the Ferber method mean. They’ll also notice and value your knowledge of popular or classic parenting books. For example, when sibling rivalry issues arise, if you can tell the opening story from Adele Faber and Elaine Mazlish’s Siblings Without Rivalry, you’ll simultaneously be engaging with, showing empathy for, teaching and establishing credibility with parents.

Tip 3: Remember that empathy and acceptance should precede education. This is a big challenge because as counselors, we can be especially eager and excited about sharing positive parenting information with clients. To address this, you should try to practice — as much as possible — Marsha Linehan’s concept of radical acceptance. A radical acceptance mantra sounds something like this: “I accept you as you are and am committed to helping you change for the better.” Practicing radical acceptance can help because it emphasizes acceptance as a precursor to change. And if you don’t hold your tongue and demonstrate empathy and respect, parents are likely to tune out all the excellent information you have to share with them.

Tip 4: Be direct, honest and collaborative. If a parent asks whether you have children or whether you’ve worked with parents like them, always answer the question directly and honestly. There’s no need to rationalize, justify or equivocate to prove yourself. After you’ve answered the question directly and honestly, gently paraphrase the parent’s underlying concern. You might say something like: “No, I don’t have children. And I can totally see why you’d ask. Underneath your question I hear concern about whether I can really understand your situation and whether I can be of help. All I can say is that I hope you’ll give me a chance. Of course, you’ll be the best judge of whether I’m helpful or not.”

Handling parent questions directly and honestly will nearly always allay parent concerns about your competence — at least temporarily. If not, your best strategy is to offer a referral.

Similarly, if you don’t know the answer to a specific question posed by a parent, admit it. More often than not, children’s problems are at least partly mystery. Share your respect for this mystery with parents. Admit that what you have to offer is experimental. As a counselor, you need to be collaborative with parents because they’re the ones who will be trying out whatever ideas you share. In the end, they’ll determine what works and what doesn’t.

Tip 5: Ask parents for their best explanation for their child’s misbehavior. Parents are a treasure trove of important ideas. Often, they’ll have a secret or unstated fear or hypothesis about why their child is having a particular difficulty. This secret fear is often wrapped in guilt. Unfortunately, if the counselor doesn’t directly ask “What do you think is causing your child’s misbehavior?” the parent may never share his or her personal theory of what’s really wrong.

Tip 6: Focus on parent strengths using compliments and validation. Many parents are naturally insecure about their parenting, so the best counseling approach is one that is explicitly and repeatedly strength-based and affirming. However, as you might already know, it can be difficult to sort through a particular parent’s frustrations and pessimism to identify parent strengths.

From a constructive or solution-focused perspective, positive and affirming comments from practitioners should stimulate parent motivation toward self-improvement. Consequently, when working with parents, counselors should avoid criticism, focus on the positive and trust parents to lead them to where the work needs to be done.

Tip 7: Offer clear and prescriptive advice, then step back … and listen. When working with parents, I’ve made it a practice to say at the beginning of the session that at first I’ll be listening more, and then later I’ll be offering suggestions and advice. I then tell them it’s their “hour,” so if they want me to shut up and do more listening, they should say so; if they want more advice, they should tell me that as well. In response to this collaborative sharing of power, nearly every parent I’ve ever seen responds with something like, “Oh, I want advice!” This is a good thing because when parents give counselors permission to offer advice, they’re more likely to listen.

After giving advice, it’s very important for counselors to intentionally and systematically listen for the client’s reaction. Usually it works best if you ask directly for the parent’s response. For example: “What do you think of the idea of using an emotional time-out with your child?” or “How do you feel about trying out a mutual problem-solving approach to start a discussion with your child?”

This short list of tips focuses primarily on the process of working with parents. That’s because most parenting resources available to counselors focus much more on the content counselors should be teaching parents. However, if you focus on using the process presented in this brief article as a means of delivering high-quality parent education content, you’ll be more likely to have pleasant, positive and gratifying experiences as you work with parents — which is a very nice outcome.

John Sommers-Flanagan is a professor of counselor education at the University of Montana. Additional material for working with parents is available in his books Tough Kids, Cool Counseling (2007, American Counseling Association) and How to Listen so Parents Will Talk and Talk so Parents Will Listen” (2011, John Wiley & Sons). Free information and parenting tip sheets are also available on his blog at johnsommersflanagan.com.

Letters to the editor: ct@counseling.org

Using a wider lens to conceptualize client problems

Heather Rudow April 18, 2012

(Photo: Wikimedia Commons)

One of the pillars of the counseling is empowering clients to achieve the goals they have set themselves. But over time, counselors have also placed greater focus on international issues and social justice counseling.

Manivong J. Ratts, president of Counselors for Social Justice, a division of the American Counseling Association, calls social justice the “fifth force” in counseling. According to Ratts, social justice recognizes that client problems cannot be understood solely through an intrapsychic lens.

“Social justice counseling calls on counselors to use a wider lens to conceptualize client problems by viewing clients in [the] context of their environment,” says Ratts. “When counselors are able to see clients in [the] context of their environment, they begin to see how larger social, political and economic forces influence client development. Moreover, counselors begin to see how oppressive conditions such as poverty, racism and homophobia negatively contribute to human development issues.”

One way that counselors can broaden their lenses, he says, is by getting involved with organizations that have social justice goals or missions. CARE (Cooperative for Assistance and Relief Everywhere Inc.) is one such nonprofit organization.

Founded in 1945 with the aim of fighting global poverty and focusing on poor women across the world, CARE often helps people who have gone through traumatic events that have seriously impacted their mental health. Richard Perera, CARE’s communications coordinator, says it is important for organizations such as CARE to provide psychosocial support systems for people who have experienced natural disasters, famine, violence, sexual assaults or poverty or have been displaced from their homes by war. He explains this “can mean direct counseling, but can also mean working through the community.”

For example, says Perera, in emergency camps for Somali refugees in Dadaab, Kenya, CARE provides training to the adult members of the camps so they can provide others with healthy ways of coping with traumatic experiences. Additionally, the knowledge they acquire helps them understand why some of the child refugees might misbehave.

“They don’t [think], ‘Oh, this kid is acting out because they’ve been through a traumatic experience.’ They [typically] just think they’re being bad,” Perera says. “Kids can be resilient, but they need a routine, and they need an environment where they can play and learn.”

Perera says CARE’s top priority is providing the people they help with a place where they feel safe and emotionally supported. He believes this is why the organization resonates with counseling professionals and the reason counselors might consider getting involved with the nonprofit’s endeavors.

“If there comes a time when the U.S. takes a stand [for or against an international issue],” he says, “counselors can be advocates for an enlightened foreign policy.”

One of CARE’s latest aims is supporting President Obama’s Fiscal Year 2013 request for the International Affairs Budget, which helps alleviate poverty, global hunger and famine, HIV/AIDS and maternal mortality. It also enables the United States to respond to humanitarian crises.

“I think of it as an investment,” Perera says of the International Affairs Budget. It doesn’t cost much in comparison to the rest of the budget, he says, and keeping children mentally, physically and emotionally stable in unstable countries helps the entire world to stay safe in the long run.

Ratts says it is important for counselors to take action and support organizations such as CARE as well as the president’s request for the International Affairs Budget because events that occur overseas also have an impact on the United States.

“Poverty is a global phenomenon that permeates all parts of the world,” he says. “More importantly, counselors need to understand that poverty is a global issue that affects us all. We cannot focus solely on local-level initiatives because we don’t live in a vacuum. The growth of technology has helped society to understand that we live in an increasingly global society where international politics can affect us at the local level. For this reason, counselor involvement in such initiatives as CARE to address global poverty is critical because it leads to quality schools, health care and employment. … Social justice-oriented organizations are important in helping to address equity issues that impact our world. These organizations help promote awareness of social injustices and serve as a way to systematically address the social ills of society. I think it is important that counselors be involved with at least one organization that addresses a social issue they are passionate about. Imagine how much better this world would be if all 50,000 members of ACA joined one organization similar to CARE. … As a collective, we would make this world more just and humane.”

In his view, Ratts doesn’t believe that counselor education programs have adequately equipped counselors with necessary social advocacy skills in part because counselor educators are not adequately equipped themselves.

“For the most part, counselor educators are not trained in community engagement and systems-level work,” he says. “Most have been trained under a paradigm that promotes the medical model and intrapsychic ways of helping. This problem is akin to the early days of the multicultural counseling movement when counselor educators were attempting to train graduate counseling students on becoming multiculturally competent but not having the training themselves. Unfortunately, the lack of social justice competence among counselor educators is setting a stage for future students to fail and for clients to leave counseling believing they are the problem when, in fact, their problems may be a result of larger oppressive conditions. “

Developing international and social justice competence would not only enhance the counseling profession, Ratts says, but also help make the world a better place for all citizens.

“Social justice must begin with us,” Ratts says. “Counselors need to develop competence as social justice advocates before they engage in advocacy interventions at the local, state, national and international levels. Counselors, even well-intentioned ones, can do more harm than good when they seek to help others but are not equipped to deal with the complexities of the world. Counselors need to first be multiculturally competent if they seek to address social justice issues. Cultural competence allows counselors to address sociopolitical issues in a culturally appropriate manner. Counselors also need to be cognizant of domestic and global politics. Understanding domestic and global politics can help counselors develop a better sense of whether individual counseling or environmental-level advocacy is needed. Counselors need to allow a community, whether it be domestic or international, to teach them what is needed. Oftentimes, we see counselors coming into a community thinking they know what is best for the community. We see this in higher education settings where well-intentioned faculty develop service-learning opportunities for their students but fail to take the diligence and time needed to truly understand the community. When this occurs, student learning occurs at the expense of the community.”

For more information about CARE’s mission and latest endeavors, visit its website.

For more information about Counselors for Social Justice, visit its website.

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

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Why aren’t they screaming? A counselor’s reflection on aging

Judith Gusky April 1, 2012

When I was younger, I often wondered how it was possible that elderly people weren’t consumed with fear of the inevitable. But Erik Erikson seemed to have a “good enough” theory to settle my inner turmoil. As an undergraduate back in the early 1970s, I surmised from Erikson’s theory that as we successfully move through each stage of development, our “reward” is our inauguration into the next stage. Each success in turn opens the next opportunity to successfully negotiate life’s challenges and conflicts until we reach the penultimate — an old age of peaceful integrity, not one of despair or fear of death.

Failure to meet challenges at any stage along the way can always be addressed by going back under the safe tutelage of the therapeutic relationship. If necessary, we might even go back to the beginning, to find that “good enough” mother and a sense of trust, autonomy, initiative, identity, intimacy or generativity — whichever it might be. The key, I found, is in our resiliency.

But I wonder, even still, does old age give us the time we need to renegotiate life’s failed challenges? And what about “late old age” (80-something or 90-something)? What are the challenges of a developmental stage that people rarely attained until recent times?

The ‘ninth stage’

The Eriksons made it. Erik was 91 at the time of his death in 1994, and his wife and collaborator, Joan, died in 1997 at the age of 95. What might they have had to say about old age as they were living it?

In a videotaped interview in 1993, while Erik was in a nursing home, Joan Erikson said she felt a responsibility to rethink their eighth and final stage of human development — integrity vs. despair. She thought they owed an apology to people for theorizing that wisdom and integrity were so great.

In retrospect, she found that other people might see wisdom and integrity in an old person, but that’s not what that old person was feeling. “We shouldn’t have made it up,” she admitted. “We hadn’t been there yet. Maybe we should have talked to a lot of old people.”

The Eriksonian “ninth stage” emerged from her reflections. In a second interview in 1995, a year after Erik’s death, Joan conceptualized the newer, final stage of development by way of a metaphor — that of a woven fabric. She called it the Woven Cycle of Life. Erikson saw the warp, the lengthwise threads attached to a loom before weaving, as a person’s “indomitable core.” Throughout life, everything that was in utero is there — all our potential.

The weft, the thread that is woven back and forth to complete the fabric, represents life’s experiences and the challenges and conflicts along the way. When our strength wanes, the fabric’s color becomes grayer, colorless. But our strength keeps coming back, and when it does, our fabric’s colors are bright.

Erikson believed that the strength, the warp, is always there. Nothing is ever completely cut off. “You can always go back,” she said. You can make up for it anywhere along the line. This is the resiliency of human beings.

Providing a little more meat to the metaphor, Erikson theorized that the ninth stage is where we begin to see things from the other point of view. The eight stages of development are always presented in a syntonic-dystonic order (trust vs. mistrust, autonomy vs. doubt and shame, integrity vs. despair and so on). In old age, the order is reversed. The dystonic takes precedence. For example:

Mistrust vs. trust: When you get older, you realize there are certain things you cannot do. You may become mistrustful. But you have to draw on the trust, forgive the weakness (the failing memory, the slowing gait) and trust the rest.

Guilt vs. initiative: You may become insistent about taking on a particular project or challenge. You make people do things your way. You overestimate your physical competence. Your decision turns out to be wrong. The guilt comes not only because you didn’t have the physical capacity but also because you shouldn’t have made the choice in the first place.

Role confusion vs. identity: When you become dependent, when others are taking care of you, you question who and what you are.

Isolation vs. intimacy: In old age, isolation comes first. If you are isolated, you may yearn for intimacy.

Stagnation vs. generativity: How far do you go along with the stereotype of yourself as an old lady or an old man? To what extent will you choose to go on being a productive, contributing human being? To what extent will you withdraw?

In short, all of life’s conflicts and challenges are reexperienced in old age. From Erikson’s point of view, success in the ninth stage of life allows the older person to assert the Self by saying, “Don’t take away from me what I have. Let me choose.” It is all about maintaining our indomitable core.

Is it gerotranscendence?

Joan Erikson remained productive even in the last few years of her life. Among other things, she devoted the last chapter of her 1997 revision of Erik’s book The Life Cycle Completed to the concept of gerotranscendence.

Swedish sociologist Lars Tornstam coined the term gerotranscendence in 1989 in part to revive an interest in the “disengagement theory” of aging. This psychospiritual theoretical concept posits an alteration of consciousness in old age, a redefinition of the Self in relationship to others and a new understanding of fundamental existential questions, including:

  • Increased feelings of a cosmic communion with the Spirit of the Universe
  • Redefinition of the perception of time, space and object
  • Redefinition of the perception of life and death and a decrease in the fear of death
  • Decreased interest in superfluous social interaction
  • Decreased interest in material things

I’m not sure this is exactly what Joan Erikson was thinking about when she wrote about the ninth stage of human development. It would be nice to believe that, provided we can hold on long enough to our physical and cognitive health, we might have this tidy little process to look forward to. I think life is perhaps a bit too messy. But some may be so blessed to experience good aging and a “good death.”

What good can counseling do?

I love Ann Orbach’s 1996 book Not Too Late: Psychotherapy and Ageing. Orbach is a British psychotherapist, now retired. I relate closely to her account of herself as a 50-something therapist working with aging adults. The difference, of course, is that I am just at the beginning of this career, while she was already a well-seasoned psychoanalyst when she saw her first elderly client.

Each chapter in the book is like a literary adventure, and it offers a challenge to the ageism inherent within Western society and the counseling profession. For example, we laud the “wellness” model of mental health as counselors but tend to return to the medical model and pathology when working with aging adults.

Orbach’s perspective is personal and humane, inspirational and refreshing. She has helped me look at myself as an aging counselor and the aging clients I counsel in a different way.

One of her chapters, titled “Why Aren’t They Screaming?” begins: “For someone who is young and healthy enough to expect long years ahead, it is almost impossible to grasp what it would be like to have to accept a shrinking future in which there will be little further change or achievement or drama.”

As counselors, we want to help each client to live more fully and to pursue the same life-enhancing goals we desire for ourselves. But inevitably, Orbach tells us, the aging adult’s life is diminishing, and the ultimate goal will be that of facing death.

Facing such a reality is not easy, regardless of whether our clients enthusiastically embrace the existential challenge. As counselors, we might be as uncomfortable (or even more uncomfortable) as our clients are with the topic of death and dying. And so we resist, offer moral support and encouragement, and turn a blind eye to pharmacological dependency when challenge and rigor may be what is called for. Orbach is mindful that what we resist looking at in our clients is likely what we resist examining in ourselves.

Most counselors are not trained in long-term psychoanalysis. Brief, solution-focused therapy predominates in the field. Yet, why should the elderly regularly be singled out for short-term therapy? Is it the element of time, the stereotypical belief that perhaps it is simply too late to expect significant change?

Most elderly clients today probably are seen by mental health professionals for depression and anxiety, which is usually diagnosed by a primary health care provider after the older adult has lost a spouse, battled an illness or struggled with physical or cognitive incapacity. The medical model seems the only reasonable model to follow. So, we leave much of the work of counseling the elderly to those in the social work profession who dominate mental health care in the arena of nursing homes, hospitals and hospices.

Yet, if we entertain the notion, as did Joan Erikson, that personality and identity continue to evolve and develop even in the very advanced stages of life, then we owe the elderly much more.

Old age is an important stage of development. The strengths a person has achieved and demonstrated throughout the life cycle will be challenged as that person encounters a decline in physical and mental abilities in old age. But in this stage of life, whether we label it a ninth stage or gerotranscendence or something else, whether our clients look backward or forward, a successful outcome is possible. This outcome is one in which the final years can be lived to the fullest, in harmony with one’s past life and without fear of death, or at least with the acceptance of life’s existential limitations.

In one of her final interviews, Joan Erikson said she was uncertain of how to advise people concerning what to do as they reached old age. If nothing else, she said, the thought that came to her was that they should go on “becoming.”

It was a very existential response for a developmental psychologist. It reminded me of Viktor Frankl’s admonition that there is meaning in life, available to everyone, and that life retains its meaning under any condition and until its final moment. We owe this much to each elderly client who crosses our path.


Judith Gusky is a licensed professional counselor in Pennsylvania who came to counseling as a midlife career changer. Contact her at judithgusky@gmail.com.

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