Tag Archives: Counselors Audience

Counselors Audience

The school counselor’s external office

Richard O’Connell March 25, 2012

Author’s note: Although this article is written mainly for school counselors, its basic concept and the strategies it contains are easily adaptable to other counseling fields.

When the paperwork begins to mount and the phone calls never seem to stop, school counselors often wonder, “When am I going to get the chance to see the kids? What about all those failing students I need to encourage? What about all those follow-up requests from parents?”

The next thought jumps to that initial dream that all school counselors have: “I love kids. I want to get to know them, and I really want to help them. But all I do is make endless schedule changes, fill out forms, keep logs and file. And when they finally get done, it’s time to begin scheduling for next year.”

As a school counselor, do you wish to:

  • Increase your contact with students?
  • Increase your faculty contacts?
  • Increase your efficiency, while decreasing your workload?
  • Increase your knowledge and awareness of students on the basis of their physical appearance?
  • Improve the guidance public relations effort in your school?
  • Strengthen your students’ realization that you really care about them?
  • Deliver more service to your students in a more efficient manner?

If so, try this simple practice. Stand in a central place such as the entrance to school, outside your office or in a main corridor each day for the half-hour before school begins and greet both students and staff.

Initially, it will take both courage and self-discipline to get to your self-appointed post each day. Yes, courage in putting yourself out front to be observed by the whole school community. It will be something new, and there will be those who see you as attention-seeking, self-promoting and possibly even as someone who does not know his or her place in the hierarchy of school beings. The courage part comes when you assume a piece of hallway turf even as staff question why you are there. It takes even more courage to reach out and begin to greet your students and fellow faculty members with a “Good morning.”

Over the years, I have come to value this practice, so I make the time in a very busy day to achieve this goal. After awhile, even those who criticized you will wonder why you are not at your post if you happen to be absent.

The hard part is simply to begin this practice. The rewards will be well worth the initial discomfort. The advantage of this practice is that, eventually, both faculty and students will know you are there to help answer questions, to give advice, to share small talk or just to say hello.

This practice also affords the counselor daily opportunities to assess student affect. This is valuable because the more we familiarize ourselves with our students, the easier it is to pick up on the subtle changes in behavior or appearance that can indicate a student is troubled.

A few examples from my experience will suffice.

  • When a normally upbeat youngster changes into a withdrawn or sad individual, you have an external warning.
  • When you see students arriving late, there is a problem.
  • When you see a student couple coming to school each day and forming a new relationship, this is valuable information.
  • When one member of the couple suddenly “disappears,” this can be equally significant information. There have been cases in which students were depressed or even suicidal after going through a breakup, and the counselor assessed the situation in the hallway.
  • When a student breaks a leg, you have immediate knowledge of the situation and can take action to assist the student, such as finding someone to carry the student’s books or notifying a teacher that it might be better for the student to come to class a little late to avoid overcrowded hallways.

All the visual clues you pick up firsthand can feed back into your interactions with parents and students during the normal course of the day. What’s more, this information is immediate; you won’t have to wait until someone comes to your office to fill you in.

A case in point: One morning a student approached me. I gently gave him a hello tap on the chest. He immediately flinched in pain. I inquired, “Are you all right?”

“I’m all right, but I just had my chest pierced for a ring.” I have since given that practice up, but his mother was astounded that I had such private information.

It is amazing how much of your work can be done in the hallway. By nature of our profession, we are constantly requesting students to follow up and fulfill their obligations. In the hallway, we can ask students the status of forms that need to be returned. We can remind them to live up to expectations. We can remind them that assignments are due. We can recognize and praise them for their achievements. We can ask them if they have delivered messages to their parents.

It is difficult to interview all of your students who might be doing poorly after a review of their report cards or progress reports. But standing in the hallway affords casual opportunities to see many of these students and to give them a bit of encouragement or advice. For most students, a friendly hello will suffice. For those who need a reminder (for example, to hand in an assignment, to speak to a teacher, to help another student, to be on time for class), just your presence may trigger a response.

By the way, a friendly hello from you in the morning might serve as a welcome postscript to a horrific family experience the night before. Above all, your very presence in the hallway and your effort to greet students with a kind hello is a statement to the students that you care about them. I am sure this message is conveyed in other ways throughout the day, but your presence in the hallway only increases the opportunities to reach more kids.

Regarding the faculty, they are on the run for the most part. Your presence in their path along the way to their classrooms gives them easy access to discuss a student, to request a conference or to fill you in on a particular problem. These exchanges are often made more difficult (and more time consuming) if a formal meeting has to be scheduled. Even substitute teachers appreciate having someone to turn to in trying to negotiate the intricacies of an unfamiliar school. This accessibility has tangential benefits, including helping to establish good rapport with staff. For counselors to function effectively in any school, we need the cooperation and support of our staff to assist our students.

Regarding the school administration, they appreciate the backup in the hallway. I have never been asked to function as a “monitor.” Rather, administrators appreciate the “reach out” efforts of counselors who are not closeted in their cubbyholes, “secreted away” from the main flow of the school. Your presence in the hallway will also reach “across the street” to central administration. The public relations aspect of the school counselor’s external office is obvious.

During the course of the year, many parents will also cross your path: PTA members, parents with staff appointments, new parents visiting the school and so on. On each occasion, your presence serves as a reminder that there are counselors in their child’s school who reach out, increasing the likelihood that the counseling department is spoken of favorably in their private conversations.

In summary, the school counselor’s external office delivers more service to students. It makes the counselor more accessible. It establishes a rapport with staff and conveys a sense of care and concern to students. It establishes an atmosphere of involvement and helps to break down barriers. It also maximizes the use of our time, so much so that I stand at my “post” whenever I can shake free during my busy day. And in addition to all these attributes, it has become for me a great deal of fun.

Richard O’Connell is a past recipient of the New York State Counselor of the Year Award. This article appears in slightly different form as an addendum to his book The Secrets to Being a Great School Counselor (available at thesecretstobeingagreatschoolcounselor.com). Contact him at docroc16@msn.com.

Letters to the editor: ct@counseling.org


What the future holds for the counseling profession

Compiled by Lynne Shallcross March 1, 2012

The future might be anyone’s guess, but David Pearce Snyder has spent his career making calculated predictions about what looms ahead. Snyder, a Bethesda, Md.-based consulting futurist who says he consults on the long-term future of anyone and anything, has a few ideas about what’s in store for the counseling profession throughout the next decade.

Snyder, who is also a contributing editor to The Futurist, the bimonthly magazine of the World Future Society, predicts that by 2020, everyone will be chatting with — not just through — their computers. The significance for counselors, he says, is that computers will be loaded with software enabling the machines to answer their owners’ questions — including questions that people today often go to see a counselor to discuss.

Instead of a live counselor being the first stop for someone with mental health, career, relationship or other issues, Snyder believes that person will initially ask the personal avatar “counselor” on his or her computer for feedback and advice. The personal avatar counselor will be stocked full of good health information, so it will offer constructive and helpful advice, according to Snyder. If the artificial counselor assesses that the person has a problem beyond the scope of assistance the computer can offer, it will recommend that the person see a real counselor. “The artificial counselor becomes the first line of defense,” Snyder says.

On the surface, that prediction sounds disturbing, as if advancing technology might threaten to make the counseling profession obsolete. But Snyder contends that artificial counselors will become crucial to the profession because there simply won’t be enough human counselors to meet the growing demand as the world becomes more complex and everyday life is filled with increasingly challenging problems and decisions. “More people will need help in making decisions about their lives,” he says. “Therefore, I believe the function of counseling will become increasingly important.”

As someone outside the profession, Snyder has an interesting perspective on the future of counseling. For an “inside” perspective, Counseling Today also approached a number of leaders in the field and asked them to share their thoughts (in their own words) on the next decade of counseling. As the American Counseling Association celebrates its 60th year as an organization, these counselors offer projections concerning the trends, issues, challenges and successes that might await the profession in the relatively near future.

Bradley T. Erford
is past president of the American Counseling Association and a professor at Loyola University Maryland. Contact him at berford@loyola.edu.

As I look into my clouded crystal ball to predict the direction of the counseling profession over the next decade, I realize that even though the profession of counseling is more than 100 years old and ACA is celebrating its 60th birthday, counseling as a profession is just coming into its own in terms of parity and respect among peer professions, legislators and the public. We have achieved licensure in every state, but there are over 40 different titles for professional counselor licensees and trainees. How can we expect the public to understand who counselors are and what counselors do when we do not even agree on what to call ourselves?

Developing a unified profession and helping promote a core identity as a counselor first and specialty area second is the preeminent professional challenge of the next decade. To address this challenge, accreditation of counselor education programs and credentialing/licensing of counselors will become even more important. Imagine how easy it would be to advocate for the counseling profession and protect the public if every counselor education program in the United States was accredited by the Council for Accreditation of Counseling and Related Educational Programs; imagine if every graduating counselor attained the credentials of National Certified Counselor and state licensure that was recognized and portable within all U.S. states and territories; imagine if every state licensure board required its licensees to graduate from a CACREP-accredited program and attain the same supervision, experience and examination requirements. Such goals of standardization would simplify immensely our task of protecting the public, advocating for the counseling profession and solidifying a unified professional identity.

Perhaps the biggest threat to professional unity comes from within. Like many of you, I have worked with children, adolescents and their families in schools, provided mental health services to youths and families in private practice, and educated and trained the next generation of counselors in my current work in the university. While each of these positions was referred to by a different title (school counselor, licensed professional counselor, counselor educator), first and foremost I have always been a professional counselor! I happened to work in various settings performing various roles, but at my core, I have always been a professional counselor. Some divisive individuals currently stand opposed to the unity of the profession to which we have dedicated ourselves. These individuals place their political and personal agendas above the common interest of the counseling profession under the guise of counseling specializations. When we go to legislators to advocate for the counseling profession, we must speak with a single voice in order for that voice to be clearly heard and present a single vision for our goals to become realized. Other professionals, such as physicians, dentists, social workers and psychologists, realized this simple truth long ago and have become strong, respected advocates for their professions and the public.

Counseling has gone global. Governments around the world have recognized the importance of mental health and wellness. As a result, numerous counseling organizations have sprung up in nations around the globe looking for guidance related to accreditation, credentialing and organization-building. CACREP is helping to fill the accreditation need by introducing the International Registry of Counsellor Education Programs, which promotes high professional standards sensitive to the cultural and economic realities of international counseling. NBCC International is currently providing support to more than two dozen countries developing credentialing processes and in need of organizational support. At ACA, we are developing ways to encourage and make affordable international membership, and some international members have proposed development of an organizational affiliate or division focused on international counseling. We all share the goal of helping counselors in other countries build a strong, vibrant profession — and hopefully avoid some of the mistakes we have made in the United States.

Finally, as professional counselors, we need to firm up the scientific foundations of counseling effectiveness. There are over 400 published counseling theories, but the outcome literature only supports use of a small fraction of these helping approaches and only for limited developmental and clinical applications. Counseling researchers and journal editorial boards need to substantially increase efforts to validate counseling practices and assess counseling outcomes. It is far easier to advocate for the counseling profession with legislators and public policy administrators when armed with overwhelming evidence of the effectiveness of our services. ACA’s new Center for Research and Public Policy was created to focus our efforts on achieving this goal.

Barbara Herlihy is a university research professor in the counselor education program at the University of New Orleans, chair of ACA’s International Committee and chair of the ACA Foundation. Contact her at bherlihy@uno.edu.

Technology is changing our world at an astonishing pace. When I stepped into the 21st century just a few years ago, I wouldn’t have imagined that my phone would keep me connected to the world in thousands of ways, limited only by my number of “apps.” Next year, I’ll probably laugh that I thought a smartphone was innovative. That said, my predictions about the future start with the truth of a cliché — technology truly has transformed our planet into a global village. We cannot be unaware of the disparities in power and privilege that exist between and among peoples. Therefore, it seems likely that the social justice movement in the counseling profession will continue to gain strength and will become increasingly international in focus.

How will these changes impact counseling theory? In our upcoming book, Counseling as a Profession: Our Past, Present and Possible Future, Sam Gladding, Courtland Lee and I suggest that our profession will need to move away from existing theories that focus on individuals, couples and families and instead embrace systemic theories that address social ills and foster healing on a global level. Of existing theories, the multicultural and feminist approaches seem to hold the greatest potential for addressing these goals and may see increased acceptance and practice.

Most predictions about counseling theory have taken a narrower focus on the deep entrenchment in our society of the medical model and managed care, as well as our growing dependence on psychotropic medications. Thus, predictions are that brief-term, evidence-based, cognitive-behavioral approaches will dominate the future of mental health care. We believe that if counselors acquiesce to this status quo, we will contribute to the demise of our profession by rendering ourselves superfluous in a field already crowded with practitioners of the medical model. If, however, we can unite behind our identity as a profession that is uniquely strengths-based, holistic and grounded in the wellness model, we have the potential to turn the tide.

Another societal trend worth noting is that, due to advances in medical technology, people are living longer and our aging population is growing. In the future, we will need theories that respond to the needs of elders by addressing spiritual dimensions of living and existential issues such as isolation, meaning and death. But really, who knows what the future will bring for counseling theory? An unforeseen, entirely new paradigm may emerge that challenges all of our current assumptions.

Kurt L. Kraus is the facilitator of the “20/20: A Vision for the Future of Counseling” initiative and a professor in the Department of Counseling and College Student Personnel at Shippensburg University of Pennsylvania. Contact him at klkrau@ship.edu.

Likely, the next 10 years for the profession will surprise us. Predictions, especially about society in our tumultuous era, are probably best left to futurists who carefully analyze trends and foreseeable forces. Luckily though, actual change will come shaped by collective thinking, the complex evaluation of our profession’s purpose and efficacy, the goodness of fit between our achievements and the challenges the profession will find itself tasked to fulfill and, not least, the degree to which our current and emerging leaders and the visionaries of our profession nurture our own development, unity and growth.

I envision in a simile of identity development that our profession is reaching its early adulthood. The challenges encountered and overcome of our individuation — our adolescence perhaps — have given way to autonomy, recognition and professional fidelity, demonstrated in part by licensure across the nation, a burgeoning national and international counseling workforce, and our clearer and solidifying professional sense of self. Turf, semantic impasses and separatist ideologies of our adolescence wane. Our vision is emerging. We have authored a common definition of counseling and defined guiding principles [as part of the 20/20 initiative], and we begin these next years with ample room and welcome for a grand diversity of practitioners, specializations and missions.

Global politics and economies; technological advances and their consequences; the jeopardy of nationalism and other rampant isms; worry about the Earth’s finite resources and adapting to a warmer planet; the coming of age of generations with beautifully different goals and priorities than [were held by] their parents and grandparents — all will inevitably influence what we do this decade. We as a profession will be propelled in new directions by genomic discoveries and the neurosciences. An expanding embrace of world medicine and health practices coupled with redefinition of health care and service delivery in America will shape us. We, too, are a potent force as we adapt to local and world change. I believe that our profession will be vital in global efforts to raise the quality of life and in providing mental health care to serve our 7.5 billion neighbors by 2022 (U.N. projection). I think our profession will directly influence the emergence of new archetypes for what constitutes education, careers, families, societies, healthy human development across the life span, empathy, philanthropy and happiness.

What will tomorrow’s arrival offer and require of our profession? Our development as a unified profession has been courageous, motivated by compassion and fairness and guided by science and ethics. I am confident we are poised and ready to welcome the next 10 years and beyond. I’ve always been fond of surprises.

S. Kent Butler is an associate professor at the University of Central Florida and president of the Association for Multicultural Counseling and Development. Contact him at skbutler@ucf.edu.

Technology, technology, technology. Excuse me … did I remember to add technology? And we counselors, counselor educators and all concerned professionals involved in the counseling world had better get ready for the transition. I know that I went kicking and screaming into even owning a BlackBerry many years ago, and now I can’t seem to get away from my iPhone. As we journey more into the world of Skype, Facebook and other social media, we counselors have to learn to keep up with the Joneses as it were. Those of us who buck the system will be left behind. We have to meet our clients where they are, and it seems they want to be deeper into the 21st century. Think of the host of problems all of these new technologies will bring to the counseling office. We definitely need to be prepared!

How will these continually evolving trends affect us? How must counseling theories be adapted or even newly created to ensure that our clients’ needs are being met? With this new, innovative, oft-confusing technology comes new ethical concerns, new ways to reach out to our clients and definitely new issues that may need to have culturally sensitive and social justice-minded individuals ensuring that our clients are presented with the very best. Our personal best! Best “evidenced-based” practices have to be at the forefront of our discussions and research. Counselor education programs need to be able to ensure that their curriculums follow a pedagogy that embraces online counseling and supervision. These programs need to start really accepting online counseling programs, which are often seen as foes (come to think of it, I’m still kind of kicking and screaming even as I type this). Traditional programs need to acknowledge the next wave and find ways to attract students who are looking to the future.

We cannot allow ourselves to fall behind on this newfangled phenomenon. Seriously consider the challenges our profession is facing today. We are currently in a battle to define our profession (i.e., “20/20: A Vision for the Future of Counseling”). Technology will definitely be front and center within this fight. As we head to Washington and deal with the bureaucrats on the Hill, I am sure that how the world is evolving will be on their agenda. Definitions and portability issues aside, we need our two-minute elevator talking points for how we see ourselves technologically in this ever-changing society as well — and you surely don’t want to lose out in this battle to social workers, psychologists and coaches.

I’m game! Are you? Email me. Heck, FaceTime me … I will pull out my iPhone and chat with you for a minute.

Allen E. Ivey is a distinguished university professor (emeritus) at the University of Massachusetts Amherst. Contact him at allenivey@gmail.com.

There likely will be many new ideas to inform our research, theory and practice, but neuroscience will be at the forefront of what happens to us in the next 10 years.

Counseling changes the brain. The major conceptual, theoretical and practical breakthrough will be the recognition and incorporation of neuroscience into our counseling practice and research. Counseling colleagues are already applying neuroscience principles as they conduct both counseling and research using functional magnetic resonance imaging (fMRI). In interviewing practice, I constantly maintain awareness of the client’s attentional patterns and what likely is occurring in the brain. Relationship and empathic understanding have become even more important. Research demonstrates that high points of client/counselor empathy show in parallel movements on an fMRI.

Wellness and positive psychology will become more central. I’ve always taken a positive approach to the field, but I understand better [now] why and how a strength-based approach builds new neural networks and reinforces positive emotions (associated primarily with the frontal cortex). This even increases the size of the seat of memory, the hippocampus. The positive wellness approach combats and can overcome our protective but also negative emotions of sad, mad and fear.

It is fascinating to discover new scientific foundations for what we counselors have been doing since the beginning. But neuroscience adds to and clarifies what works and makes a difference for our clients. I behave much the same in my own interviewing, but now I am much better at knowing what I am doing and what is likely to happen with the client as a result of the relationship and my interventions.

Biological foundations and curriculum change: CACREP has set the foundation with their new standard that emphasizes bringing biological foundations into our training. At the moment, our field still operates from a “theory of choice” framework, which tends to focus on remediation and a problem-focused approach. Neuroscience leads us more to a positive, preventive approach. For social justice advocates, there is now substantial research that shows that poverty, abuse and oppression lead to less gray matter in the brain, less effectiveness in schools and a lifetime of continuing negative patterns.

On the positive side, wellness assessment and developmental life planning will become central. Less time is likely to be given to abstract theorizing. Stress management will become even more important [because] it provides us with ways to prevent damaging cortisol from entering the brain. It is clear that exercise, nutrition and meditation now are required areas of expertise for all counselors and therapists.

Casey A. Barrio Minton is an associate professor and counseling program coordinator at the University of North Texas and president of Chi Sigma Iota International. Contact her at casey.barrio@unt.edu.

I expect the counseling profession will continue its journey from adolescence to adulthood as we join together to respond to three major demands over the next decade.

  • Accountability: Our educational, governmental and human service institutions have entered the age of accountability. We know we have an ethical responsibility to provide our publics with the most effective and efficient services possible. Unfortunately, we sometimes remain silent as others define evidence-based services for professional counselors or limit us to externally defined types of services or numbers of sessions. In the next decade, I believe we will continue to realize the vital role of rigorous, socially valid research and intentional advocacy regarding professional counseling. As we do so, we will emerge with a stronger understanding of what works in professional counseling practice and education and, in turn, a more meaningful integration of evidence-based practices across counseling settings.
  • Understanding: We have long sought to identify indicators of mental health, and our profession is founded upon a well-developed understanding of holistic wellness. In the next decade, I expect we will develop a more sophisticated understanding of complex connections [between] mental health and a variety of factors such as neurobiology, spirituality, environment and culture. As we understand these influences, our approaches to counseling — including research regarding evidence-based practice and engagement in interdisciplinary cooperation — will need to evolve accordingly.
  • Identity: Demands for greater accountability and enhanced understanding will provide an opportunity for professional counselors to realize our potential as agents of optimal growth and wellness. To respond effectively, we will need to continue to cultivate a collective professional identity regarding who we are, what we do and where, when, why and how we serve. Such solidarity will help us to move forward in our efforts regarding licensure portability, expectation for accreditation, public awareness and advocacy, and interdisciplinary participation.

Manivong J. Ratts is an assistant professor in the Department of Counseling and School Psychology at Seattle University and president of Counselors for Social Justice. Contact him at vong@seattleu.edu.

The future of the counseling profession has the potential to be bright. As we consider the profession’s future, it is important that we continue to integrate the needs of the oppressed into emerging counseling theories, training paradigms and clinical practices. We need multiculturalism and social justice to become integral to everything that we do as helping professionals. Both multiculturalism and social justice need to become generic “forces” in the field if we are serious about addressing the issues of culturally diverse clients. To this end, we need to discard old ways of thinking and not become complacent by settling for the status quo of [what is comfortable].

Unfortunately, we have become too comfortable with the social order of things in counseling. We have developed what I refer to as an “additive approach” to helping that does not fully address the needs of culturally diverse clients. An additive approach to counseling is when we integrate multicultural and social justice into predominant counseling theories and ways of practicing without changing the core structure of an existing theory or practice. On the surface, it seems as if we have continued to evolve with the changing needs of society. However, the central tenets of the theory or practice remain the same. This is problematic because we continue to promote paradigms and practices that do not fully address the issues of culturally diverse clients.

A sense of urgency is needed because the consequences are dire. For instance, lesbian, gay, bisexual, transgender and questioning youth are struggling in America’s school system because school staff are ill equipped to respond to a culture of anti-gay sentiment on school campuses. Youth of color and the poor are receiving a K-12 education that our legislators would not want for their own children, yet they (youth of color and the poor) are expected to compete for the same resources (college admissions, jobs, health care, etc.) upon graduation. Predominant counseling theories and practices are not addressing these issues.

The viability of the profession is dependent on our ability to take risks and think differently. We need to stop recreating existing models and practices. For this to occur, we need to admit students into counselor training programs and hire faculty who are unafraid of standing up to the status quo. We need people who will “walk the talk” rather than people who “talk the walk.” We need people who will make us uncomfortable. We need people who identify as social change agents within the profession.

Don W. Locke is president of ACA and dean of the School of Education at Mississippi College. Contact him at locke@mc.edu.

Don W. LockeThe next decade will be exciting for the profession of counseling as we try to maintain the momentum of the past and face the unknown future. In my opinion, we have a variety of needs, challenges and opportunities. There is the two-pronged effort to secure professional unity (as counselors with areas of specialization continue to expand) and to meet the increasing pressure for portability of professional licensure between states. A new challenge is the increased use of technology, cybercounseling and virtual reality. An area of opportunity is the specialization and clinical training that will be provided at the doctoral level for practicing licensed counselors.

If we are to sustain the progress made with implementation of accreditation, licensure and credentialing, it will be necessary to ensure that professional counselors do not splinter by specialization into competitive groups and become adversaries for licensure, payment or clients. The next decade must be one of professional unity and a focus on license portability.

The possibilities presented to professional counselors by the use of technology are, to me, mind-staggering. I cannot envision where we will be in a year, much less a decade from now. There must be the development of ethical guidelines related to the use of technology, accelerated training for current students and annual professional development opportunities for practicing counselors. The prospect of using virtual reality during practicum and internships is already being explored. I have also been contacted by an ACA member who wants to form an interest group concerning the prospect of using virtual reality in therapeutic situations, especially as it pertains to the treatment of PTSD (posttraumatic stress disorder) and phobia. I am sure there are additional virtual applications being proposed for a variety of situations. The counseling profession must move quickly to be prepared for the technology-oriented future facing our clients and us.

More professionals will be pursuing the Doctorate of Professional Counseling (DPC). It is anticipated that the programs of study chosen by DPC candidates will provide them with opportunities to select areas of additional training so they can better serve specific client needs. I anticipate that this counselor training model, which recently became available and that prepares candidates for licensure at the master’s level and then specialization at the doctoral level, will expand significantly during the next decade.

Professional counseling has become respected as a viable mental health provider. The next decade will determine if that level of respect is maintained.

Thelma Duffey is president-elect of the American Counseling Association, a professor and chair of the Department of Counseling at the University of Texas at San Antonio and the founding president of the Association for Creativity in Counseling. She also works in private practice in San Antonio. Contact her at thelma.duffey@utsa.edu.

School bullying has long been a difficult experience for children. In fact, some of the more painful childhood memories reported by some adults involve being made fun of, left out or otherwise bullied by their peers. Bullies sneer, mock, intimidate and often involve others to normalize their actions. And today, children have an even greater burden to manage: Internet bullying. People no longer have to look their victim in the eye when bullying. They can simply post a hurtful message, mean-spirited blog or compromising photo. Unfortunately, we know the consequences of bullying. And we know that bullying doesn’t end in childhood.

The experiences of hurt and humiliation are very real societal concerns regardless of age. I can see counseling in the next decade increasing its focus on relational development: supporting realistic self-examination/care and finding innovative ways to promote genuine concern for one’s impact on others. The hope would be that an increased focus on relational competencies could have a productive ripple effect [over] time.

On a practical level, I believe the economy is a significant stressor for many people who find themselves in a Catch-22 situation. They experience stress, seek out services and then have a hard time paying for them — leading to more stress. Exploring creative ways to provide innovative, meaningful and cost-efficient counseling services is becoming increasingly important. A hybrid of face-to-face and online counseling could be one possibility.

As to where the profession heads in the coming decade, the brain will be an emerging area of interest. There is a plethora of information currently available on the neuroplasticity of the brain. I see this as exciting, cutting-edge work that could have a tremendous impact on our profession on so many levels. Still, this work is relatively new and ripe for investigation. I believe rigorous research that examines creative, innovative ways of regulating the brain to perform more optimally would be a wonderful next step in the profession of counseling. In the next decade, we may see important work related to addressing common counseling concerns such as depression, anxiety and addiction through brain regulation.

As far as emerging counseling theories, I see relational-cultural theory (RCT) as particularly relevant because it supports the counseling profession’s focus on wellness and mental health, particularly when conceptualizing people’s life experiences and their responses to these experiences. Using the language of connection, disconnection, development and context, I believe RCT has much to offer the counseling professional in the next decade.

Thomas Sweeney is a professor emeritus of counselor education at Ohio University and executive director of Chi Sigma Iota. He is also a past president of ACA. Contact him at tjsweeney@csi-net.org.

I believe our society is showing clear signs of embracing a more holistic, wellness perspective on well-being. This is being embraced not so much on a philosophical but [an] economic basis. It has always made more sense (no pun intended) to prevent illness, accidents and lifestyle disasters. Increasingly, government, business and industry are aware that life stress, physical inactivity and poor environmental conditions are creating huge repercussions in health care costs. Prevention is smart business, and happy, healthy workers and citizens even more so.

In addition, education is increasingly seen as an economic necessity. Some say that we are no longer world leaders in education. Our economy is suffering as a consequence. The global economy requires us to have competent, flexible workers who adapt to the changes driven by circumstances beyond our borders.

Professional counselors’ competencies in career, group and wellness counseling are unique to their core preparation. Integral to these skills are knowledge and competencies suited to a diverse and culturally rich global society. There will be even greater need for our interpersonal, group and multicultural competencies to help facilitate change in all work and social settings.

In addition, we are currently witnessing a revolution in how we can help those we serve. School counselors are now introducing children to biofeedback computer-based software programs. Such programs help children reduce their test anxiety, learn more effectively and experience self-efficacy with fun-based exercises that translate into classroom, social and learning benefits.

We are also on the cusp of a revolution in delivery of services that never seemed possible before counselor credentialing. While in its infancy in counselor education, neurofeedback for use with children with attention-deficit/hyperactivity disorder and adults with anxiety and depression disorders has already begun. Licensed professional counselors are providing such services, sometimes even collaborating with physicians to help reduce and, in some cases, eliminate dependence upon drugs to regulate the body’s and brain’s imperfections.

The major trends in society will not be what drive the future of counseling practice, however. It will be determined more by how professional counselors educate others as to who we are and how we contribute to the realization of a healthy society by fostering wellness and human dignity. [To paraphrase what a U.S. government mental health director] told us in 1990, if you are a “group of groups,” I do not need to listen to you. If you are as one group, now that I have to hear!

Summer M. Reiner is an assistant professor of counselor education and the school counseling coordinator at the College at Brockport. She also chairs the ACA Ethics Appeal Panel. Contact her at sreiner@brockport.edu.

As a profession, I think we are beginning to thrive. Recently, we achieved licensure in all 50 states and gained recognition by the [Department of Veterans Affairs]. There are 598 CACREP-accredited counseling programs and over 48,000 counselors certified by the National Board for Certified Counselors. ACA has over 49,000 members and is still growing. I believe that society has begun to recognize the value of our approach with our emphasis on wellness, strengths and life span development and our rich clinical training. To support our momentum as a profession, we need to address the needs of our clients. Recently, our attention has shifted to disaster mental health and to working with the returning veterans. If I were to predict four additional issues that I believe we will need to be prepared to address, they would include:

  • Life balance: I think that technology is changing the way we live as well as our expectations about the world. The availability of the Internet and smartphones keep us plugged in at all hours. Many of us are multitasking — for example, texting one person, while visiting with another — and working around the clock. How many of us check our email before bed and upon waking?
  • Patience: Instant access to information and entertainment may fuel the need for instant gratification. I would predict that goal setting, career and life planning, and relationships will all be impacted.
  • Health-related decision-making: Given our technological abilities — for example, keeping people alive on machines, analyzing genetic information — I think clients may experience personal dilemmas. Making decisions about the life and death of a loved one, such as “pulling the plug,” can have a lasting emotional impact. A relatively new health option, genetic screening, may allow individuals to identify predispositions for health conditions, longevity and abilities. Individuals may then make life-altering decisions based on their “knowledge” of a predestined life experience. Given the permanency of the decisions, individuals may experience significant emotional distress.
  • Aging: We have known for some time that the baby boomers would eventually reach retirement age. Boomers are clearly a large group and have normalized the idea of seeking counseling for improving wellness. I believe they will expect to address their many age-related transitions through the counseling process. Ironically, ACA continues to pursue achieving Medicare recognition when few counselors are fully prepared to provide such services. NBCC and CACREP eliminated their emphases on geriatric counseling, and less than 2 percent of ACA members are members of the Association for Adult Development and Aging [a division of ACA].

Samuel T. Gladding is a professor and chair of the Department of Counseling at Wake Forest University and a past president of ACA. Contact him at stg@wfu.edu.

I think the profession of counseling will be more of a leader than a follower in the decade ahead. Counseling will lead in its emphasis on continuously refining itself as a profession and fulfilling its mission accordingly. The 20/20: A Vision for the Future of Counseling initiative, started in 2005, has transformed the profession from one where there was much internal squabbling and disagreement to one where there is more agreement, uniformity and pride in what counseling is and what counselors do.

Besides being a leading helping profession, counseling will be a leader in the next 10 years in its emphasis on wellness, creativity and career development theory and practice. These are all hot topics in society today. An emphasis on wellness is here to stay as Americans realize its importance. The counseling profession has some of the best minds in the country writing, researching and implementing practices in the wellness area. The wellness wheel created by Jane Myers, Tom Sweeney and Mel Witmer is one example of a concrete instrument being developed in counseling that has potential for a huge impact, both inside and outside the profession.

In the creativity realm, I continue to be impressed by the Association for Creativity in Counseling and the Journal of Creativity in Mental Health, edited by Thelma Duffey. ACC and those associated with it are into originality and transformation as related to counseling issues. The Journal of Counseling & Development, edited by Skip Niles, is also showcasing articles that deal with macro issues counselors need to be aware of and innovatively tackle.

Finally, because of the economy, career development and theory — one of the pillars on which counseling is based — will become stronger. Career issues are international, and solid career counseling is intentional wherever it is delivered. I think Mark Savickas’ narrative counseling approach is going to grow in popularity. Like existential and Gestalt theories, the narrative approach deals with meaning, mattering and the integration of persons.

Jill D. Duba is an associate professor and coordinator of the clinical mental health counseling and marriage and family therapy programs at Western Kentucky University. She also chairs the ACA Professional Standards Committee. Contact her at jillduba.sauerheber@wku.edu.

Counseling will be significantly impacted by the emerging relationship counselors have with the health care reimbursement system. Managed care promises several advantages. Clients will be assured that they get what they pay for, unnecessary long-term therapy will be eliminated and professional counselors will be paid for services rendered. But what are clients paying for? At what point does managed care begin to mandate what counselors do and how they are thus trained?

My family systems class recently asked me why professional counselors do not engage in co-therapy and why reflecting teams are not employing these techniques in practice, especially since they appear to be highly effective modalities. First, I explained that co-therapy and reflecting teams are not seen as cost-effective. Second, treatment plans must adhere to an outline provided by the managed care system. What professional counselors know and have studied to work is frequently usurped by what “Managed Care Knows Best.” Finally, professional counselors who depend on payment from managed care will have restricted opportunities to empower and help others if they simply document the use of preventative, holistic health and wellness approaches. Managed care may eventually determine counselor identity, the nature of the profession and certainly how counselors are trained and practice.

I believe the growth of the profession is dependent on the growth of the people it serves. Are people getting healthier? Are we getting closer to convincing people that seeking counseling for adjustment-related issues — before they are in crisis — is an illustration of “mental health”? Do the systems that our clients are a part of contribute to the individual health of their members? Are professional counselors seeking more knowledge and skills for helping people develop coping mechanisms, positive support systems and healthy mental lifestyles than [knowledge and skills] about identifying pathology, providing symptom relief and diagnosing? Do professional counselors know what clients need in order to maintain a healthy mental lifestyle within their cultural/family context? If these ideas are essential to counselor identity, we must focus on how to document effectiveness and maintain our core values.

In terms of theories, incorporating systemic, wellness-based theories in practice is crucial. We must conduct studies using wellness-based theories to document what works to help all populations maintain mental “health.” It is time to begin applying these theoretical models within a systemic context rather than using them as backdrops for long-winded and recycled conversations about where we are headed.

Mark Pope is professor and chair of the Division of Counseling and Family Therapy at the University of Missouri-St. Louis. He is also a past president of ACA. Contact him at pope@umsl.edu.

As the U.S. and other countries experience another capitalist cycle downturn, human services will continue to be the target for drastic budgetary cuts. The good news is this: It will get better (again), but more slowly because of the depth of the recession.

In the long term, counseling has great potential, greater than many of the other mental health professions. We are the youngest of all the mental health professions and, yet, we have overtaken them all. We continue to grow faster than other mental health professions (projections for the next decade include counselors: 18 percent [782,200], social workers: 16 percent [745,400] and psychologists: 12 percent [190,000]; see the Occupational Outlook Handbook, 2010-2011 edition). And because of our economic position — lower cost and yet high-quality services — we will continue to grow faster.

With the increasing move toward 60-hour master’s programs, I see a longer-term trend toward increasing professionalization of counselors. And with counselors achieving licensure now in all 50 states, we can and are moving strongly forward to inclusion in all nationwide programs (for example, TRICARE). We are truly ripening as a profession, with even greater potential for the future.

Finally, newer theories, interventions and models that address outcome quality in shorter-term interventions will increase, such as solution-focused therapy, eye-movement desensitization and reprocessing (EMDR) and other cognitive behavior theories.

J. Barry Mascari is an associate professor and chair of the Counselor Education Department at Kean University. He is also the American Association of State Counseling Boards’ delegate to the 20/20 initiative. Contact him at jmascari@kean.edu.

Four issues will continue emerging:

1) The profession must decide whether we succumb to what medicine did by moving to practice specialties or remain as broad generalists. People come with multiple problems, and counselors address multiple issues, so specialists would change our profession.

2) Trauma-informed counseling will require ruling out or treating trauma as the primary cause that keeps clients stuck despite many attempts at counseling. Counselors will be required to learn specific evidence-based treatments (EMDR), as well as other neurobiological treatments that will emerge (Brainspotting), to help people break the “recovery logjam” not resolved by talk therapy alone.

3) Addictions-informed treatment recognizes that many people have “use” issues and coexisting disorders that contribute to the self-medication cycle and will benefit from neurobiological techniques as well.

4) Finally, the struggle over using evidence-based techniques (difficult to replicate in noncontrolled client settings) or focusing on the therapeutic alliance and common factors will continue. Some mixture will evolve.

All counselors will need to develop a tool kit loaded with strategies and skills to be employed depending on the client’s needs. These will be less theory-based and more about effectively resolving client problems. Counselors will become a major force in the provision of mental health services.

As far as emerging counseling theories, I believe we are entering the posttheoretical era where older comprehensive “theories” will be presented for historical background in counselor training. My wife (Jane Webber) and I are writing about the posttheoretical era, where the current overemphasis on theories robs time from skill-building.

Although attempts to create a transtheoretical approach met with limited success, it seems that most new ideas look like a slimmed-down [version of Arnold] Lazarus’ multimodal approach. Clients bring multiple issues requiring multiple strategies, which means taking evidence-informed or other effective techniques and applying them to specific client problems. Brief solution-focused and motivational interviewing [approaches] moved in that direction, combining the therapeutic alliance and common factors (taken from Carl Rogers’ work) with strategies framed into a logical treatment model. In light of these changes, counselor educators will be challenged to create teachable models in a way that students understand.

Also, the pendulum of religious fundamentalism swings back as people discover that faith cannot always explain everything and seek to create their own meaning and understanding. A revival of existential thought (Western Buddhism) may re-emerge in counseling.

Deborah Stokes is the director and owner of the Better Brain Center in Alexandria, Va. She is a licensed professional counselor and board certified in neurofeedback. Contact her at dstokes@TheBetterBrainCenter.com.

I believe that over the next decade we will see counselors expand their skill set to keep abreast of the emerging science on the brain and how brain disorders affect behavior, mood, academic performance and interpersonal relationships. We will see, for instance, counselors acquiring training on how to interpret objective measures of brain function such as SPECT and quantitative EEG. These measures will be used to provide input during, for example, marriage counseling, academic counseling and career counseling.

We will see more counselors learning innovative methods of changing brain function, including the neuromodulation methods such as neurofeedback. I also believe that, while psychodynamic approaches will always be important to explore genetic or family-of-origin factors (the loaded gun), there will be a shift toward looking more at environmental factors (the trigger finger) such as nutrition and lifestyle factors that affect the brain and, ultimately, the behavior.

I also see a growing trend with young adults and teens presenting with poor social skills and the inability to interact one-on-one or in groups. There is a growing isolation that I believe is fueled by the explosion of technology and the overreliance on electronic gadgetry to socially connect. So, there is a growing need for social skill-building groups for these young people.

Courtland C. Lee is a professor of counselor education at the University of Maryland and a past president of ACA. Contact him at clee5@umd.edu.

As I consider the evolution of counseling over the next decade, it will be important for the profession to be aware of a number of important global trends. Issues such as worldwide financial instability, climate changes (global warming), unprecedented population aging, ongoing political instability and ideological conflicts, increasingly diverse communities, and rapidly evolving and ever-pervasive technologies all have the potential to significantly impact human development and well-being.

It will be important, therefore, for the counseling profession as it is known in the United States to develop more of an international perspective on counseling and human development, given the sense of global interconnectedness that is emerging among mental health professionals. In many parts of the world, both individually and organizationally, counseling professionals are moving beyond provincial conceptions of theory, research and practice to join in collaborative efforts to foster notions of mental health and human development that stretch across geopolitical boundaries. It will be important for ACA and counselors in this country to be part of these collaborative efforts. Counseling theory and practice over the next decade should focus on understanding human nature in a broad global context. In addition, counselor training must stress the notion that what happens in one community in any part of the United States must be understood within this larger global context. More than ever, it will be crucial for counselors to be able to “think globally and act locally.”

Given this, I believe that counseling practice over the next decade must be predicated on counselors becoming globally literate human beings. Global literacy is the breadth of information that extends over the major domains of human diversity. It consists of the basic information that a person needs to possess in order to successfully navigate life in the technologically sophisticated, globally interconnected world of the 21st century — a world in which people from diverse cultural backgrounds interact in ways that were previously inconceivable.

Global literacy implies an understanding of the contemporary world and how it has evolved over time. It encompasses important knowledge of cultural variations in areas such as geography, history, literature, politics, economics and principles of government. Global literacy is the core body of knowledge that an individual gains over a lifetime about the world in which he or she lives. The driving force behind the development of global literacy is the commitment one makes to ensure that openness to cultural diversity is the cornerstone of his or her life. While the development of multicultural competency should continue to be an important goal for professional counseling training and practice, global literacy must be the goal for a life lived in a culturally competent manner. It logically follows, therefore, that one cannot be a culturally competent counselor if he or she is not a globally literate person, and a wider understanding of the world will be crucial for counselors in the decades to come.

Blair Sumner Mynatt is a doctoral student in counselor education at the University of Tennessee and the student representative to the ACA Governing Council. Contact her at bmynatt@utk.edu.

In my opinion, a future focus of the counseling profession should center on the counseling needs of older adults. In the United States, baby boomers represent a growing percentage of the overall population. As they retire, the counseling profession must be ready to meet the unique developmental needs of this age group. Research suggests that the mental health needs of older adults are growing at an exponential rate, and counselors must be prepared to serve the needs of this underserved population.

The process of aging is a universal phenomenon that needs more attention in counselor preparation programs. There is a general lack of evidence-based practices for older adults. Counseling programs should place a specific emphasis on understanding and meeting the developmental needs of older adults. Counselors should be prepared to work with older adults’ issues such as grief and loss, disability related to physiological functioning, career needs and lack of access to services.

Counselors need training in counseling-based interventions specific to older adults and the awareness of services available in the community. Counseling programs should prepare students to work in more client-focused settings, such as older adults’ homes. If counselors do not reach out to this population, chances are high that older adults will not receive services due to transportation and mobility limitations.

Counselors can play a vital role in the successful aging of today’s older adults. The mental health needs of older adults are often overlooked and can only be expected to grow in the immediate future. The training of future counselors, flexibility of service delivery and development of evidence-based practices are vital for people experiencing this inevitable part of human development.

Cirecie West-Olatunji is past president of the American Counseling Association and associate professor and director of the Center for Traumatic Stress Research at the University of Cincinnati. Contact her at westolce@UCMAIL.UC.EDU.

There are three major trends that are emerging in the discipline of counseling: the internationalization of counseling, more nuanced understanding of traumatic stress and the role it plays in psychological distress, and counseling children.

As more countries explore the value and benefit of having counseling professionals in their society, counseling will become increasingly visible outside the United States. A major benefit of this expansion is that it has the potential to create a global synergy that advances our knowledge and application within the discipline. In particular, globalization of counseling can augment our cultural competence and understanding of sociopolitical context in service delivery.

Another trend is in the area of traumatic stress. There are several human challenges that fuel this trend, such as a) the impending return of U.S. troops from areas of conflict, b) the evolution of the term traumatic stress to include more pervasive triggers (for example, systemic oppression and historical bias/discrimination) and c) the increase in natural and human-made disasters worldwide. More recent catastrophic disasters have [had a greater impact on] individuals, families and communities due to their size, intensity and duration. These changes in the characteristics of disasters have offered new challenges to disaster mental health professionals. Additionally, the prevalence of technology has delivered disasters and subsequent secondary stress to a worldwide audience. Thus, counselors need to create innovative interventions that respond to contemporary challenges.

Finally, the third trend in counseling is attention paid to counseling young children. As the discipline matures, counselors are increasingly defining new areas of application for service delivery. Working with infants, toddlers and preschool children is an emerging area for counselors that allows them to traverse down the developmental pipeline to apply the core principles of counseling to young children. Such an area is appealing to professional counselors because counseling young children requires a focus on prevention and use of a developmental perspective.

Given these three emerging trends, we are likely to see several new theories develop. One would be the creation of new culture-centered counseling theories that come from Eastern Europe, southern Africa, the Pacific Rim or South America. Another area where theory is likely to be developed is in providing more definition to the area of traumatic stress in relation to pervasive intergenerational issues. In working with young children, we are likely to see a flurry of theories related to counseling young children ages 0 to 5. The next decade in counseling will be a very exciting time in which counselors will need to be more responsive than ever.



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A closer look at developing counselor identity

Timothy E. Coppock

Professional identity has emerged as one of the hot topics in the counseling profession. A quick look at the 2011 ACA Conference schedule and a preview of the sessions for the 2012 conference in San Francisco reveals that, as counselors, we are interested in discussions that investigate the topic and equally interested in adding the topic to our research agendas. This article is a personal reflection on the importance of professional identity from my vantage point both as a professional counselor and a counselor educator. An aspect I am most interested in is how we can strengthen and enhance the process of developing identity as professional counselors.

As is the case with most counselors, the first thing I need to do when meeting a new client is to introduce myself and talk about my identity as a professional counselor, what my client can expect from the counseling process and the expectations that he or she might have. I most often find that I have to define my professional identity by describing what I am not: I cannot prescribe medications, and I am not a psychologist. I go on to say that professional counselors are licensed to help resolve mental and emotional problems. A few clients ask for even more clarification concerning specific competencies, but most individuals are satisfied that their needs can be met so long as I assure them that their insurance will cover my charges.

I find that I have almost the same conversation with applicants to our master’s program in community counseling. If this conversation doesn’t take place at their admissions interview, then most assuredly I will need to provide some further explanation and clarification at several points during their first two or three semesters until the notion of professional identity begins to sink in. By the time master’s students reach their fourth or fifth semester and begin practicum and internship, maybe they will have some level of confidence in the professional identity for which they have trained. At least that’s our hope, isn’t it?

A personal journey

I believe my understanding of professional identity was formed in much the same way. I remember asking dumb questions of my professors at Bowling Green State University as I explored the shared concepts of analysts such as Freud, Jung, Adler and Rogers. Like many of the students entering into the community counseling program where I now teach, I did not have a background or degree in psychology or an applied science such as social work. And, to be honest, the lines between disciplines were quite blurry as I acquired the skills for counseling. What distinguished my identity as a professional counselor from the other professions was not so much based in what I was taught but rather in who was doing the teaching and in the application of these concepts. My professors were counselors who had put the theories and techniques into practice, who exemplified the best of the skills needed to help others bring about desired changes, and who understood the importance of what works and what doesn’t in the development of plans to reach goals.

It’s tough to say exactly when my identity as a professional counselor first emerged because it is indeed a process. It takes time for professional identity to develop, and it requires strong mentors who are willing to invest their time and energy not only in teaching but also in leadership and advocacy. I was simultaneously flattered and challenged when my master’s program adviser, Susan Huss, invited me to co-present at a regional counseling conference. Similarly to most of my fellow students, my life consisted of working a full-time job, attending night classes, finding time to study and balancing multiple roles as a father, student and, now, counselor-in-training. How would I work a two-day event into my already full schedule? How could I stretch my meager budget to include a conference registration and professional membership?

To be sure, professional identity is much more than attending and presenting at conferences. But the process of building identity does include strong relationships with mentors and colleagues who aspire to teach and learn from one another at conferences and continuing education events. And, most formidably, professional identity is built during the two to four years devoted to acquiring the master’s degree required for licensure as a professional counselor in all 50 states. Indeed, there would be no licensure for professional counselors and, hence, we would not be able to provide vital services to clients if it weren’t for the dedication and advocacy of professional counselors and counselor educators. Professional identity depends in part on the critical decisions and crucial sacrifices made by leading counselors and counselor educators. They forged the relationships and coalitions necessary to enact laws that ensure credentialing and accreditation by organizations such as the National Board for Certified Counselors and the Council for Accreditation of Counseling and Related Educational Programs. They also provide us with the ACA Code of Ethics and other professional guidelines that protect both the public and our obligation to provide services that meet standards of care. Ultimately, if not for the perseverance and continued dedication of these leaders, counselor licensure laws would not have been enacted in all 50 states.

What distinguishes counselors?

Ever since my years as a doctoral student at the University of Toledo, I have clung to the tenets of a profession that has worked hard to define itself within the complex context of other related professions. Ideally, these related professions would work together as a team, with an integrated approach, to provide mental health services. However, these professions often perceive one another as competitors, fighting for community contracts, insurance endorsements and licensure rights.

Martin Ritchie is another mentor/adviser, and now colleague, who has made a profound impression on my life and career. Indeed Martin Ritchie and Susan Huss represent a league of counselor educators who have invested their entire careers in the building of counseling as a profession. On one unforgettable occasion, Martin challenged my doctoral cohort with a concise history of professional counseling, giving specific emphasis to the identity conflicts professional counselors experienced regarding the related professions of psychology and social work. Embedded in his lecture were the primary issues of a fledgling profession — a profession oftentimes viewed as a stepchild in the course of lobbying and legislative efforts to secure licensure, a profession scrutinized by managed care and representatives of federal funding to determine if its members are legitimate providers of mental health services, a profession frequently lumped together with other social service providers variously as “mental health therapists,” “psychotherapists” and “clinicians.” Dr. Ritchie’s questions still reverberate in my memory: What gives us distinction? What sets counselors apart? Have we indeed earned our identity as a separate profession?

There are no simple answers to any of these questions. The reality is that professional counselors share a heritage of theories, techniques and, to some extent, training with several other types of mental health professionals, most notably marriage and family therapists, social workers and counseling psychologists. In Pennsylvania, where I currently am a counselor educator and also have a limited practice, professional counselors can be licensed with educational backgrounds in no less than 10 related fields. Indeed, the multiple tracks available to licensure in some states have in my opinion contributed to a blurring of professional identity, for counselors and consumers. From the point of view of the consumer, it doesn’t matter which license I use to practice, so long as my profession is regulated to protect the consumer. Psychologists, social workers, marriage and family therapists, and professional counselors all use the Diagnostic and Statistical Manual of Mental Disorders and bill the same insurance companies. Some attempt to make the distinction that professional counselors subscribe to a wellness model as opposed to a medical model. But quite frankly, other related professions would claim the same.

So what does make the difference? I believe the difference lies primarily in two areas: in our education and in our supervision as counselors. Professional counselors are trained in counselor education programs by faculty who identify as professional counselors, and we are supervised by licensed professional counselors (LPCs). Counselors educated and supervised by professionals other than counselors are unlikely to have a clear professional identity. CACREP’s work has provided a foundation to ensure that students develop both professional identity and standards for knowledge and skills specific to the profession of counseling.

Supervision is equally influential with regard to our identity as professional counselors. For a number of years, before there were enough LPCs to provide supervision, professional counselors were supervised by other professionals. However, as a profession, we have reached the point at which all 50 states have licensure laws that regulate not only the title of “professional counselor” but, in many states, the practice of counseling as well. Related to the achievement of that objective, most states currently require either that a professional counselor provide supervision or that a minimum number of supervision hours be provided by an LPC.

The task of instilling and developing identity as a professional counselor includes some serious challenges, not the least of which is the limited time available for the identity-building process. The program I am privileged to teach in at Gannon University is a three-year master’s degree program. Other master’s programs can be completed in as little as two years, however. Students entering master’s counseling programs come from a variety of backgrounds and with corresponding bachelor’s degrees: social work, psychology, art therapy, criminal justice and even from humanities or business. Entering students often possess almost no understanding of how counseling is different from other social service professions. In comparing my experience with that of other counselor educators, I have found this is commonplace among three-year master’s programs and even in larger programs featuring multiple tracks or offering a doctoral degree in counselor education.

The challenge is that counseling, unlike other related social service professions, has no corresponding undergraduate major and, hence, no undergraduate professional identity. Undergraduates typically may choose to major in psychology or social work in their freshman or sophomore years, which provides those professions as many as six to eight years to create and develop strong professional identity. Indeed, for a number of students the expectation is that a master’s degree in counseling will be a stepping-stone to a Psy.D. or a Ph.D. in psychology. It has become a challenge for counselor educators to develop curricula that offer the essential components to train counselors, while simultaneously including experiences that will instill and enhance strong identity as a professional counselor. A number of master’s programs are three-year programs in which the third year is spent in clinical practice and internship. Many full-time programs are only two years, however. At best, this leaves only one or possibly two years of classroom contact and exposure to professors and other students in the cohort during which identity-building experiences can be planned.

Suggested solutions

I view myself as a solution-focused, strengths-based counselor. In the best of that tradition, it is time to consider ways to reach beyond the next two to three years. One option for addressing this deficit of time is to expand beyond the bounds of graduate education and training by developing an undergraduate minor in counseling. At a minimum, this would provide undergraduate students — particularly those with related majors in psychology, social work or criminal justice — an opportunity to explore professional counseling. In turn, an undergraduate counseling minor would provide three to four courses in content areas such as basic helping skills, human development and professional orientation. This potentially would expand the amount of time students could develop their identity as professional counselors to as many as four or five years. An important component of this solution is that these undergraduate courses would have to be taught by instructors who strongly identify as professional counselors. One option would be for counselor education doctoral interns to teach the courses. This would represent a secondary benefit for larger counselor education programs that support doctoral degree programs. Another advantage of this approach is that undergraduate students who minored in counseling would be much better prepared for master’s programs. Universities might benefit from this increased awareness in the form of higher enrollment.

A strong predictor of professional identity is membership in professional organizations such as the American Counseling Association, attendance at professional conferences and pursuing leadership opportunities in professional organizations. One of the hats I wear is as faculty adviser for our local chapter of Chi Sigma Iota, the professional honor society that has distinguished itself as being clearly and singularly identified with professional counseling. Students are not eligible for membership in CSI until their second semester. Although the work of CSI is commendable in building professional identity, for students in master’s-only programs, this leaves precious little time for active involvement: about 18 months. I participated in a roundtable discussion in March 2011 with other chapter faculty advisers from master’s-only programs, and it was quickly noted that my experience is not unique. Again, as one who looks for solutions, what if CSI chapters placed even more emphasis on non-membership participation in events for first-year master’s students? And in the interest of expansion of opportunities for identity development, what if CSI supported programs that could be implemented at the undergraduate level to promote the profession of counseling?

Gannon University’s master’s program, like many other CACREP-accredited programs, is in the process of preparing for reaccreditation under the 2009 CACREP Standards. Much adieu has been made over the requirement that 50 percent of master’s course work be taught by core faculty. At issue has been an additional standard related to the professional identities of core faculty members. From a very practical, strengths-based approach, it would seem that the counseling profession could only gain from strengthening the identity of those who are primary to the formation of professional identity in the counseling profession.

In summary, I believe an expansion of the time allotted for development of professional identity can serve to strengthen and enhance our work as professional counselors. The bottom line, of course, is the public we serve. Clients will benefit if they are treated by professional counselors who are not only competent in their counseling skills but also confident in the specific role professional counselors play in providing services.

“Knowledge Share” articles are adapted from sessions presented at past ACA Annual Conferences.

Timothy E. Coppock is assistant professor an clinical experiences coordinator in the community counseling program in Gannon University’s Department of Psychology and Counseling. Contact him at coppock001@gannon.edu.

Letters to the editor: ct@counseling.org

Fitting together as a family

By Lynne Shallcross

Kara Carnes-Holt’s daughter had one wish on her fifth birthday. “I wish that this mommy and daddy keep me forever,” the little girl said as she blew out the candles on her cake.

Hearing her wish, Carnes-Holt and her husband assured their daughter they were going to keep her forever. They became foster parents to their daughter when she was 4, and the adoption was finalized when she was 5.

Their daughter is now 11, but reflecting on that wish still breaks Carnes-Holt’s heart. “A child who is not adopted doesn’t have that fear,” says Carnes-Holt, an assistant professor in the counseling program at the University of Wyoming who works with adopted children and families through the university-based clinic. “I wish that my child didn’t have that fear. A child at 5 should never have to worry that they’re not going to have a mommy and daddy forever. No child should have to worry about that.”

In the years since their daughter joined their family, Carnes-Holt says they’ve concentrated on creating new family traditions, taking lots of family pictures and celebrating the anniversary of the day their daughter was adopted.

Although her daughter no longer fears that her parents might leave her, Carnes-Holt says it takes time for foster children and adopted children to heal. “You can tell a child [that you’ll keep them forever], but they also have to live it for a while,” says Carnes-Holt, a member of the American Counseling Association. “It’s just going to take some time for them to believe it. They have to feel that they can be part of the family and that they’re loved. Actions are stronger than words.”

Carnes-Holt says her daughter suffered emotional abuse and was frequently neglected by her birth family. She was in a therapeutic foster home prior to coming to live with the Carnes-Holts and struggled upon joining their family. Carnes-Holt believes rebounding from past trauma and loss of caregivers is a long-term healing process for foster children and adopted children, and she contends that the primary healing comes via new relationships. “In counseling, we focus on interventions and techniques, but the most healing component is a long-standing, unconditional relationship with someone,” she says. “That provides the most healing dynamic of anything we can do [as counselors].”

There are three different “tracks” for children through the foster care and adoption system, Carnes-Holt explains. First is foster care only, in which a child is removed from the home and placed temporarily with a foster family by the child services system. In this scenario, the goal remains to reunite the child with his or her birth family. If that doesn’t work, it becomes a foster-to-adopt situation, Carnes-Holt says. In this scenario, the parental rights of the birth parents are terminated, and the foster family is often given the first chance to adopt the child. With the third track, adoption only, parental rights have already been terminated. The child lives for a period of time with a family in a foster situation until the adoption can be finalized.

Michelle Zeilman works as a counselor with foster children through a nonprofit organization in St. Louis. A few decades ago, permanent foster care was more of the norm, she says. But after the Adoption and Safe Families Act was passed in 1997, the foster care system was tasked with either working toward reunification of children and their birth families or finding adoptive placements, says Zeilman, who is also an adjunct professor at the University of Missouri-St. Louis.

Counselors might encounter or seek out foster children, adopted children and their families as clients in a variety of ways. For instance, Carnes-Holt says, counselors might work with foster children through a community mental health agency, a private practice that accepts Medicaid or a children’s home.

Laura Hoskins, an ACA member who runs a private practice in Brattleboro, Vt., and specializes in working with adopted children and their families, says counselors can first seek out work with agencies that support those families. After gaining the necessary expertise, counselors can consider setting up a private practice and specializing, she says.

Although closely related, working with foster children and their families can be a different experience for counselors than working with adopted children and their families, according to Carnes-Holt. “[With] foster families, you are working more with external systems such as Child Protective Services,” she says. “Oftentimes, the outcome and future for the child may not be determined, so treatment planning and preparing the child for the future can be difficult. You also do not have control over many decisions that are being made for that child, such as visitation, reunification, termination of parental rights, etc. You can make recommendations, but those are not always followed, although you can always try to be the advocate.”

“For adoptive families,” Carnes-Holt continues, “you are working more on developing a strong sense of connection and attachment in the family system, working to create a sense of permanency for the child and integration within [his or her] new setting. You are working to help the parent and child create an attuned relationship that lays the foundation for increased chances of long-term success for the family.”

Wounds from the past

These counselors say both foster children and adopted children often deal with issues of attachment and trauma. As a result of their traumatic histories, Zeilman says, these children sometimes exhibit acting-out behaviors, aggression, withdrawal or hypervigilance. And although focus is often placed on the trauma and abuse history of the child, Zeilman says another important aspect often gets overlooked: the trauma the child experiences being removed from one home and trying to assimilate into a new family system.

Fitting in with a new family can be challenging for many foster children, Zeilman says. For instance, children from abusive backgrounds might have different ideas about how family relationships are defined and look, and they sometimes have developed certain behaviors that helped them survive in the past. Those behaviors can become problematic in their new foster home, Zeilman says. “As a therapist, the view I take is that I should be able to work wherever the needs are at that time,” she says. “I might sit down with the foster family and child and talk about what the expectations are in this new system and how we can help the child understand that things work differently here.”

Likewise, hypervigilance among foster children is also often rooted in their traumatic experiences, Carnes-Holt says, and it can appear similar to attention-deficit/hyperactivity disorder. Peer interaction can also be difficult for foster kids, she says, and they might exhibit oppositional behaviors and an extreme need for control because of the loss of control they otherwise feel in their lives.

It can be difficult for foster parents to see the child struggling, but Carnes-Holt says they shouldn’t take it personally. She explains that the child is simply working to process all of his or her previous experiences. “It’s hard when you try day in and day out to connect [with the child] and you still get opposition and struggles at school and at home,” she says. “[Foster parents] have to learn to make it through the long haul and create the relationship and separate out those behaviors as symptoms of what [the child has] been through. It’s not about them hating you.”

As for the birth parents in a foster situation, Carnes-Holt says they need to take some ownership of what has happened and work to reestablish the child’s trust because that link has been damaged. It takes a lot to say, “I messed up, and I can do better,” she notes, but just because parents apologize doesn’t mean that the level of trust will be rebuilt immediately. A counselor might work with the birth parents to deal with their own issues, to avoid placing blame on external systems and to prove themselves trustworthy to their child again, Carnes-Holt says.

When working with foster children, understanding child development is critically important, Zeilman says. “As these children reach new developmental phases, they tend to reprocess their situation — the abuse/neglect, removal from the birth family, placements, identity, etc. This may bring new issues and problems that these children will need to work through. Therapy may need to be revisited at different times as the child develops.”

In Carnes-Holt’s view, the primary role of the counselor when working with a foster child is to be the advocate for the child, working with the child services system to secure whatever he or she needs to live a safe and happy life. Depending on the plan the system dictates for the child, a counselor might conduct individual counseling with the child or conduct family counseling with the birth family and child, the foster family and child, or the potential adoptive family and child.

Settling into a new home

It’s commonly thought that children adopted as infants are more likely to have an easier time adapting and attaching to an adoptive family, Carnes-Holt says. But even for those children adopted almost immediately after birth, an attachment had been formed while the biological mother carried the baby, Carnes-Holt points out, meaning there was also a break in the attachment between the child and the primary caregiver.

Although older children who are adopted are often considered more at risk for issues such as learning disabilities, attention issues and attachment struggles, Carnes-Holt says it’s not necessarily their age but more so their experiences that dictate how they will manage in a new family. A 5-year-old who lived in a stable family with the same mom and dad but gets adopted after her parents die in a car accident might fare better than a 2-year-old who has been in multiple foster homes, Carnes-Holt says. She acknowledges, however, that the older children are, the more chances they have had to experience traumas.

Echoing Zeilman’s thoughts concerning foster children, Hoskins says that during typical developmental stages of growth, the prospect of adoption can add a wrinkle to what is already a challenging time. “The easiest example to illustrate this is the task of teenage adolescents to individuate and determine who they are and where they fit in — in their family, the world, anywhere,” says Hoskins, who has two adopted children. “For a child who may have had no contact with birth parents while growing up, this can be a particularly challenging time period.”

Another hurdle for children who have been adopted, particularly internationally, is the potential stigma or challenge of being the only person in their family, school or even town with a particular skin color, Hoskins says. “While this is not usually a difficult issue for preschool-age children, it can become a more significant issue as the child matures and he or she begins to notice the difference and becomes confused about whether this is their family. And peers may use [the difference] to taunt.”

Carnes-Holt says adopted children can struggle with the idea of the difference between adopted and biological children. Counselors can support the family by helping the parents understand how best to explain the difference, she says. For example, the parents might tell the child that there are many ways to make a family and that they are connected by their hearts. She says it’s important not to tell a child, “We couldn’t have a baby, so we decided to adopt,” because this can imply adoption was the less-favorable option.

One welcome difference Hoskins notices now in comparison with years past is that the stigma of adoption has decreased and more parents are being open with their children about their histories. “A generation ago, it was not uncommon for parents to keep from their child the fact of their adoption,” she says. “The child may not have learned about it until an extended relative said something unknowingly, the child discovered their adoptive state when needing to produce their birth certificate for legal purposes of some kind or even [found] documents revealing the truth of their adoption after their adoptive parents had died. Being adopted was considered a much greater stigma in generations past than it is now. Much of the adoption literature encourages parents to begin telling their child their adoption story at a developmentally appropriate level as soon as the child joins the family. Creating an adoption book or a life story book is another way families today are encouraged to celebrate the fact of their child’s adoption.”

The issues faced by adoptive parents can vary based on the circumstances surrounding the adoption of their child, Hoskins says. If the adoption is classified as “open,” meaning the potential exists for a continuing relationship with the birth parent or parents, determining how close that relationship will be is a challenge for everyone involved, Hoskins says. If the adoptive parents were unable to have children biologically, they may also be struggling with feelings of shame or unworthiness, even after an adopted child has joined their family, she says.

When the child is acting out, it can be isolating and scary for foster or adoptive parents, Carnes-Holt says. These parents have a tendency to feel ashamed, to question whether they are providing a good enough home and to believe that they are the only family struggling, she says. On top of that, they often don’t know where to go for help, Carnes-Holt adds. If counselors are working with prospective adoptive or foster parents, it is important to validate that it is a wonderful thing that they are considering doing, Carnes-Holt says, but at the same time, to prepare them to potentially encounter some negative behaviors on the part of the child.

“Adoptive parents may be dealing with the challenging behavior of a child with reactive attachment disorder (RAD) or posttraumatic stress disorder (PTSD) due to their early life experiences,” Hoskins says. “To attempt managing these challenging behaviors on their own would likely only lead to frustration and an unhappy family. Counselors can best help these families by, at most, obtaining training regarding adoptive parenting, RAD and PTSD in adopted children and, at least, reading recommended books on these issues. Encouraging families to become involved in or actually offering a support group for adoptive parents can be extremely helpful.”

For her part, Carnes-Holt believes RAD is a rare diagnosis that at times can be overused by mental health professionals. Being pulled away from a primary caregiver disrupts an attachment and is traumatic, but having a normal reaction to those events doesn’t necessarily indicate a disorder, she says.

Helping children heal

According to these counselors, many of the same counseling techniques work with foster children and adopted children. Zeilman points to cognitive behavioral therapy (CBT) techniques as being supported by research. Once the child is in a more stable situation, trauma-focused CBT can also be helpful, she says. Many counselors also use solution-focused techniques, Zeilman adds, because the counselor and child can pick a problem and figure out a solution for it, which helps to stabilize the child’s environment.

Carnes-Holt, a child-centered play therapist, says the model of child-parent relationship therapy is helpful in teaching parents the basic skills and philosophy of child-centered play therapy so they can use it with their children. Parents learn reflection of feelings, therapeutic limit setting, esteem-building statements, choice giving and more, she says. Child-centered play therapy offers an unconditional relationship with the child, Carnes-Holt explains, and the goal of child-parent relationship therapy is to encourage parents to offer that kind of relationship as well.

The reason child-centered play therapy is so effective both with foster children and adopted children is because these children have lost a substantial amount of control in their lives, Carnes-Holt says. This mode of therapy allows the child to be in control and allows for therapy to happen at the child’s pace. “Children have it within themselves to heal,” she says. “They’ll take the counselor where they need to go.” Theraplay, parent-child interaction therapy and dyadic developmental psychotherapy are three other commonly used techniques with this population, according to Carnes-Holt. All three, however, are more directive than child-centered play therapy, she says.

Hoskins points to a handful of clinicians who have written books, conducted research or offer trainings relevant to working with adopted and foster children. Dan Hughes has authored several books on working with attachment-disordered children and families and also leads workshops and trainings for parents and clinicians. Hoskins also recommends Nancy L. Thomas’ book When Love Is Not Enough: A Guide to Parenting Children With RAD-Reactive Attachment Disorder. Bruce Perry is another well-known expert who has done research on the effects of trauma on early brain development. He founded the ChildTrauma Academy in Houston.

Carnes-Holt says more and more research is being done to understand what trauma and attachment do to the brain. As answers continue to surface, she believes counselors and parents will come to recognize that these children are not intentionally trying to be difficult, but that their brains have been shaped differently because of past experiences. Many of these children’s behaviors are fear-based, she says, not based in willful defiance or manipulation. And although it takes time to heal the brain, Carnes-Holt says stable, ongoing relationships can go a long way in doing just that.

It’s crucial that any counselor working with this population also learns to work systemically, Carnes-Holt says. Counselor education programs often prepare counselors to focus on individual and family therapy, she says, but counselors working with foster and adopted children and their families must know how to collaborate effectively with agencies, schools, doctors and many other variables in the equation.

It can be challenging for counselors when they feel pressure to produce results in a certain period of time, Carnes-Holt adds. For instance, the foster care system might decide a child should begin having visits with his or her mother again even though the counselor doesn’t think the child is ready for that step yet. “Somehow, you have to collaborate to move forward,” she says.

Training is a must for any counselor working with foster and adopted children and their families, Hoskins says. “Please have focused training or supervision in this field, because it is not simply counseling with the added flavor of adoption,” she emphasizes. In addition to reading recommended books, it is even more helpful to take workshops and earn continuing education from trainings provided by clinicians who are respected in the field, Hoskins says. “Knowing adopted families personally can make a huge difference, and actually being an adopted parent gives one experience you can’t gather even from all these other sources,” she adds.

Zeilman agrees that training is critical. “This population has traditionally been provided service by social workers, so LPCs (licensed professional counselors) seem to be newer to this population,” she says. “My formal educational training as an LPC provided an excellent foundation, but it was absolutely necessary to seek professional training outside of my formal educational training to increase my competence.”

Working with foster children and adopted children offers counselors unique opportunities to witness and learn from the resilience that these children demonstrate, Zeilman says. She recalls working with one child who had been physically and emotionally abused by family members before being placed in a wonderful foster family. After seven months of therapy, the girl no longer needed any psychotropic medications.

“Her birth father had filed an appeal to the Termination of Parental Rights ruling,” Zeilman says. “This client had moved forward so much by the time court arrived that she asked to address her birth father, expressing that she loved him, that he would always be her father, but that she wouldn’t accept his behavior. She asked him to let her go — all unscripted and unprompted. This was a child who was still in elementary school. As much as we work to help our clients, we often forget how much we can also learn from them. I learned much from her strength, her courage and her ability to remain hopeful.”



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See Counseling Today‘s online exclusive: Reading up on adopted and foster children




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National report puts focus on managing stress to decrease chronic disease

Heather Rudow February 13, 2012


A nationwide report about stress in day-to-day life conducted by the American Psychological Association (APA) reveals that, although average stress levels have decreased slightly over the past year, a substantial number of Americans say their individual stress has actually increased through the years. Not surprisingly, the report also reveals that stress has a domino effect on our health, and experts contend that the only way to properly address these effects is through a change in America’s health care and political system.

The report, “Stress in America: Our Health at Risk,” covers a survey conducted online among 1,226 U.S. residents between August and September of 2011.

“What we found this year is really a good news, bad news story,” said Norman Anderson, CEO and executive vice president of the APA, at an APA-sponsored town hall to discuss the report.

The survey revealed that 22 percent of Americans reported “extreme stress,” which was marked as an 8, 9 or 10 on a 10-point scale, with 1 being “little or no stress” and 10 indicating a “great deal of stress.” The relative good news is that the reported average stress levels decreased slightly from a 5.4 in 2010 to a 5.2 in 2011.

However, Anderson noted, individual levels of stress have increased for some Americans. According to the report, 39 percent of participants said their stress had increased over the past year, while 44 percent said their stress had increased over the past five years.

The report found those at greatest risk for high amounts of stress are individuals with a chronic illness such as depression or obesity (which APA identifies as a chronic illness), and those who take on the role of caregiver for a loved one.

On the stress intensity scale used for the survey, caregivers reported an average stress level of 6.5, whereas the general public reported an average stress level of 5.2. Fifty-five percent of caregivers also reported feeling overwhelmed by the amount of care required by the family member for which they are responsible. The survey revealed that caregivers are more likely than the general public to say they’re doing a poor/fair job of “practicing healthy behaviors, including managing stress (45 percent vs. 39 percent) and getting enough sleep (42 percent vs. 32 percent).” They also appear to manage their stress in ways that are more destructive to their health. The study found that caregivers are twice as likely as other respondents to report smoking as a way to ease their stress (20 percent compared with 10 percent). Caregivers are also more likely than the general population to have a chronic illness — 82 percent compared with 61 percent.

As a press release from APA notes, findings from “Stress in America” revealed that “on a scale of 1 to 10, people living with depression (6.3) or obesity (6.0) report significantly higher average stress levels than the rest of the population (5.2). Those with depression (33 percent) or who are obese (28 percent) are significantly more likely than the general public (21 percent) to say they do not think they are doing enough to manage their stress. As compared to the general public (11 percent), more people who are obese (34 percent) or depressed (22 percent) report that their disabilities or health issues prevent them from making healthy lifestyle changes.”

APA President Suzanne Bennett Johnson said at the town hall meeting that it will be difficult to significantly decrease stress levels in the United States unless the nation’s health care model also changes. In her view, care systems have not addressed behavioral aspects of getting or living with a chronic illness. “I think our health care system needs to focus more on people and less on disease,” she said.

Katherine Nordal, executive director of APA’s Practice Directorate, said it is important to consider a person’s family dynamics and environment when looking at what stresses that person. “We don’t live in a vacuum,” she reminded the town hall audience.

Anderson, Johnson and Nordal agreed that health care providers should not only ask about patients’ health and behavior, but also about what is happening in their families and personal lives as well.

The three also support a holistic, team-based approach to therapy, in which patients see a primary physician as well as a mental health specialist such as a counselor or psychologist. In addition, they championed community-based programs such as those found at the YMCA as one avenue for helping Americans cope with stress.

“It’s different than going into a hospital and thinking, ‘I’m back in treatment again,’” said Jonathan Lever, vice president of health strategy and innovation for YMCA of the USA. “Many of these programs are group-based, and there is magic among these group programs because people are there to support them.”

Along with trying to change the health care system to become more person-centered, another hurdle mental health professionals face is convincing Americans that high-stress lifestyles are linked to poor health down the road.

As “Stress in America” reports, even though nine in 10 adults think a link exists between stress and the development of a major illnesses such as heart disease, depression or obesity, there is a disconnect when it comes to applying this rationale to themselves: 31 percent believe stress has a “slight or no” impact on their own physical health; 36 percent of Americans also hold the same belief regarding the impact of stress on their mental health.

“America has a choice. We can continue down a well-worn path where stress significantly impacts our physical and mental health, causes undue suffering and drives up health care costs. Or we can get serious about this major public health issue and provide better access to behavioral health care services to help people more effectively manage their stress and prevent and manage chronic disease,” Anderson said in a press release. “Various studies have shown that chronic stress is a major driver of chronic illness, which in turn is a major driver of escalating health care costs in this country. It is critical that the entire health community and policymakers recognize the role of stress and unhealthy behaviors in causing and exacerbating chronic health conditions, and support models of care that help people make positive changes.”

Read the entire report here.

Source: American Psychological Association

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

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