Tag Archives: Children & Adolescents

The anxiety behind selective mutism

By Donna Mac January 19, 2016

Selective mutism is an anxiety disorder and currently one of the most misunderstood, underdiagnosed and undertreated conditions in mental health. When children with selective mutism feel expected or pressured to speak in social situations, they become terrified, resulting in their level of anxiety increasing significantly. By remaining silent, they decrease this anxiety level slightly and obtain some relief for themselves.

For these children, remaining silent serves as a defense mechanism or a maladapted solution to create a sense of safety within themselves. Their instincts guide them to believe that their best chance to maintain themselves at a baseline level of homeostasis comes with no action at all. photo-1451471016731-e963a8588be8Hence, their voices freeze, and they are silent. This provides them with temporary relief but, longitudinally, these children suffer in silence if not treated effectively.

It can be challenging to really understand the anxiety behind selective mutism, especially for the parents, teachers and clinicians working with these children. In trying to conceptualize the experience of selective mutism, I have an analogy to help clarify. When I go to the eye doctor for the glaucoma screening with the “puff of air in the eye test,” my eyes actually freeze shut. It’s clear that I physically know how to open my eyes, and despite what the eye doctor thinks, I actually want to keep my eyes open. But my anxiety takes over, and my fear physically closes my eyes. In this heightened state of anxiety, I have an inability to open my eyes.

It is the same for people with selective mutism. They know how to speak (although the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders has documented that approximately 20-40 percent of these individuals have a form of a speech and language delay). It’s also important to understand that most of these children desperately want to be able to speak to others, but they are unable to do so because their fear creates an inability to speak in that moment. In other words, they are not trying to be manipulative or defiant.

Is my fear of the eye test that administers a puff of air in my eye a realistic fear? No, of course not! The air is not going to hurt me. I logically know that, so it is an irrational fear that is disproportionate to the event. Most people have some irrational fears throughout their lives. This doesn’t mean that they have a full-blown anxiety disorder. However, when an irrational fear such as the fear of speaking to other human beings gets in the way of functioning — whether that involves social, academic or occupational functioning — it is a serious issue that needs to be addressed therapeutically (and possibly with medication in addition to therapy.)


Brain science

To further grasp what is going on in the anxious brain of selective mutism, it is crucial to understand a key autonomic mechanism in the brain. In 1915, Walter Cannon coined the term “fight or flight” to describe the instinctual, physiological reaction to fear. Fight or flight consisted of only two fear responses. More recently, clinicians have added a third fear response — to freeze. In his book Nerve: Poise Under Pressure, Serenity Under Stress and the Brave New Science of Fear and Cool, Taylor Clark explains that when a person freezes from this autonomic nervous system response, the person becomes an alarmed-looking human statue.

This is how children with selective mutism can appear. When children with selective mutism take no action, this means their mouths freeze, but sometimes their whole bodies are paralyzed by fear too. In our ancestors’ days in the wild, the brain’s autonomic freeze reaction may have been a valuable tool to save lives, but in cases of selective mutism in today’s society, this response makes lives worse. Aaron T. Beck, the developer of cognitive behavior therapy (CBT), states that evolution has long favored our anxious genes. This is because way back in our ancestors’ time, it was obviously better to experience “false positives” (false alarms) than “false negatives” (which miss the danger). Evolution’s favoring of anxious genes may explain why so many anxiety disorders are rampant today.

The autonomic system that was so beneficial to protecting and saving people’s lives many years ago has its roots in the amygdala of the brain. Research has shown that a person with anxiety experiences a hypertrophy in the volume of neurons in the amygdala, heightening fear responses and causing an overactive amygdala. The amygdala receives information from the sensory modalities. With selective mutism, this translates to people with selective mutism coming into contact with others through seeing or hearing them, which in turn activates their fear response. This means that once a person with selective mutism comes into contact with someone else, his or her autonomic nervous system — specifically the sympathetic nervous system — is activated with the fight, flight or freeze response, signifying extreme danger.

Once sensory information activates the amygdala, it triggers a response in the hypothalamus, which results in secretion of the adrenocorticotropic hormone from the pituitary gland. At about the same time, the adrenal gland is activated and releases the neurotransmitter epinephrine (adrenaline). All of this produces the stress hormone cortisol, which creates an acute boost of energy. Catecholamine hormones such as adrenaline (epinephrine) or noradrenaline (norepinephrine) facilitate immediate physical reactions and prepare us for danger. In response, the body instinctively fights, flees or freezes.

The body cannot physically stay in such a heightened state of arousal for long periods of time, so the parasympathetic nervous system then activates the release of acetylcholine, the neurotransmitter that brings the body back to homeostasis after the fight, flight or freeze response. It is important to understand that the definition of “homeostasis” is different for a person with any anxiety disorder than it is for a person without an anxiety disorder. At a baseline level, research shows that people with an anxiety disorder will still be in a more-heightened state of anxiety than will a person without an anxiety disorder. This means that even at baseline level, children with selective mutism will most likely still not be able to speak to others outside of their immediate families without having been through treatment.


Treating selective mutism

How can children with selective mutism’s severe fear response be better managed so that they can more effectively function at school and in social situations in the community?

First, there needs to be antecedent management to adjust the environment and the triggers to the child’s anxiety. Antecedent management can be accomplished using concepts from Sheila Eyberg’s parent-child interaction therapy (PCIT). This includes incorporating her concepts of child-directed interaction and PRIDE skills (praise, reflect, imitate, describe and enjoyment) both at school and in community settings.

PCIT can also be used in combination with a gradual exposure model in which B.F. Skinner’s operant conditioning is implemented. However, it is important to remember that operant conditioning is effective only when the environmental expectations of the child match the skills the child is capable of. How does a child become capable? This is when the psychoeducational skills from Beck’s CBT and mindfulness from Marsha Linehan’s dialectical behavior therapy can also be beneficial.

It is important to note that any and all of these techniques can be tried with many different anxiety disorders. As a clinician, I have tried all of these techniques in the therapeutic day school in which I work with students with generalized anxiety disorder, social anxiety disorder, school anxiety (school refusal), posttraumatic stress disorder and obsessive-compulsive disorder. Many of these techniques, originated by well-known clinicians, have been researched to show statistically significant results in managing anxiety in many anxiety disorders.

Once these children’s environments are controlled with antecedent management, their behaviors are shaped with successive approximations, working toward an incentive in which they are positively reinforced through operant conditioning and they have the psychoeducational skills to reduce their anxiety. When this happens, they will be more likely to be able to speak.

Many times, a foundation of intensive treatment for selective mutism is beneficial in getting a head start with this type of treatment because of the combination of interventions. Outpatient intensive treatment typically equates to 30 hours in one week with clinicians specializing in selective mutism. The skills practiced during the 30 hours of intensive treatment seem to hold their gains better than they do when acquired and practiced one hour per week in therapy. Imagine getting a 29-week head start and saving 29 weeks of a child’s life. Multiple intensive treatment centers exist across the country, many of which are based on a “day camp” model running roughly six hours per day for one week at a time. The child is typically placed with a group of children based on age level, and each child has a one-on-one clinician who rotates throughout the week.

Once the foundation of these skills has been built in an intensive program, the skills can be generalized into the child’s school environment and social situations within the community. Clinicians from the intensive treatment programs for selective mutism can then help train the parents, the child’s regular therapist and the child’s school staff members on how to best utilize antecedent management with the child, while also teaching them how to help the child manage anxiety so she or he can continue to be verbal with other people outside of the intensive programming setting.





Donna Mac is a licensed clinical processional counselor conducting psychotherapy in a therapeutic day school, treating children diagnosed with many mental health conditions. In addition, she is the mother of identical twin daughters, age 6, diagnosed with selective mutism, apraxia of speech, attention-deficit/hyperactivity disorder and a mood disorder. Her latest book is titled Suffering in Silence: Breaking Through Selective Mutism. Visit her website at www.breakingthroughselectivemutism.com for more information on selective mutism.


More from Donna Mac at Counseling Today:

Diagnosing ADHD in toddlers

The connection between ADHD, speech delays, motor skill delays, sensory processing disorders and sleep issues



Do preteens still play in counseling?

By Mark Loewen December 10, 2015

As a play therapist, I’m used to explaining the ins and outs of play therapy. Because play is a universal concept, most people understand that it is also a child’s “language” and can be used to address many issues in therapy. However, when it comes to preteens, play therapy takes a slight shift.

Whereas children don’t always have the ability to articulate their thoughts and feelings, preteens are becoming more able to hold conversations about important issues. They can still become very uncomfortable, however, if they have to sit across from an adult for a “serious” talk. Plus, by the time most preteens come to counseling, they’ve heard a lot of talking already.

Play is still very important to preteens, although it starts to look a little different. As children mature, activities move away from fantasy play to more structured games. Still, children of this age often feel trapped between childhood and the teen years. In play therapy, preteens often vacillate between play that is more common to younger children and activities that appeal more to teenagers.

At our counseling practice, we often use games and interactive activities to take the pressure off. Preteens enjoy both regular board and card games and also specialized therapeutic games. Games can be used to deal with anxiety, power and control issues, self-esteem, relationships and difficult behaviors. Specialized therapeutic games address topic areas such as depression, anger, anxiety, aggression, life changes, coping skills and much more. Skilled play therapists can use almost any game to address difficult issues with children and teenagers.

Preteens are also developing creative skills. They are moving into using abstract thought as life opens up to endless possibilities. Expressive arts are a great tool to address new thoughts and feelings. Using specific art materials, clients build, sculpt or draw to represent their struggles and find alternative solutions.

Preteens also enjoy using the sand tray and an array of miniatures to represent their “worlds.” Using miniatures provides a feel that is similar to setting up toys. At the same time, the child is using these

Image via Wikimedia Commons

Image via Wikimedia Commons

miniatures with a few guidelines that make the activity feel challenging. Sand tray therapy is a great way to allow kids in early adolescence to work through their issues without feeling pressured or judged.

Additionally, interactive activities can be used to teach mindfulness meditation skills. By learning to direct their breathing and use creative imagery, kids become more aware of their feelings and what’s behind them. By recognizing intense emotions, they are better able to control them and listen to what these feelings are trying to say to them.

In conclusion, preteens are balancing child’s play and teen activities. Given enough freedom, children of this age group may allow themselves to delve into pretend play, dressing up or other activities that are more typical for younger children. On the other hand, they also like the challenge of activities that are considered to be more grown-up. Maintaining this balance requires their counselors to maintain a great level of flexibility and a nonjudgmental attitude. As a result, preteens will know that counseling is a place where they can use any of their internal resources at any time to address any issue at hand.



Mark Loewen is a licensed professional counselor, registered play therapist and parent coach in Richmond, Virginia. He is the owner of LaunchPad Counseling (launchpadcounseling.com), a practice that helps children, teens and parents cultivate their inner resources to overcome stressful circumstances. Contact him at mark@launchpadcounseling.com.


Parent-child relationship problems: Treatment tools for rectification counseling

By Monika Logan December 8, 2015

As counselors, we come in contact with clients who are angry or heartbroken and oftentimes feel defeated. This sense of pain and loss is frequently realized in the forensic setting in which I work with parents who are desperate to rebuild a parent-child relationship that is severely damaged or estranged. I also work with children who assert that they never want to see or speak with one of their parents again.

SadKidThese are not parents who have abused or neglected their children. They are parents who previously had what would be characterized as a good relationship with their children — until the time of a separation or divorce. I have worked with families in which the conflict has continued for longer than 10 years prior to therapy.

It should be noted that many people in the helping professions refer to this troubled parent-child relationship as “parental alienation.” Through the years, various nomenclatures have been applied in an attempt to give this pathological post-divorce phenomenon a name. But even as we settle on what to call it, we must help these children and the counselors who work with them.

Most counselors working with children or families have witnessed this dynamic to varying degrees. There are ample articles on child alienation, yet many counselors remain conflicted about how to effectively treat these troubled parent-child relationships.

I’ll provide a case example. “Sarah” contacted me and said she had been divorced for 15 years. She told me she had been happily remarried for five years, held a doctorate degree in mathematics and was employed as a full-time professor. But she indicated she had a damaged relationship with her 15-year-old daughter, “Julie.”

In chronicling her story in my office, Sarah vacillated between sobbing and seething with anger. She said that when Julie spent time with her biological father, “Michael,” that he undermined Sarah’s parenting boundaries, spoiled Julie and used every opportunity to denigrate Sarah. Sarah went on to say that she was worried because Julie was disregarding curfews and skipping classes, had been in trouble with the juvenile court system and had recently been caught smoking marijuana.

When I contacted Michael, he presented with a jovial disposition. He stated he was engaged to be married and was employed as a plumber. He initially appeared supportive of his daughter. Although he said he didn’t see any reason that Julie might need therapy, he indicated that he wasn’t opposed.

When Julie’s therapy sessions began, she insisted that she loathed her mother because Sarah was unreasonable. Julie stated that her mother grounded her for “trivial” reasons such as skipping school and smoking marijuana. When discussing her father’s approach to parenting, Julie described Michael as a superb parent because he did not stoop to “ruining” her life. In addition, Julie mentioned that her father was planning on buying her a car. She stated that her father would talk with her and not carry out “ridiculous, over-the-top consequences for trivial, normal teenage mishaps.”


Treatment tips

Step one: The first step is to ask yourself if you possess the skills and advanced training to work with families engaged in transition and ongoing conflict. If not, that is OK. This is a good time to seek referrals from colleagues who are comfortable with court-connected work.

Step two: When working with parents who are separated, divorced or are in the middle of a child-custody evaluation, counselors should request a copy of the court orders prior to starting treatment with their children. Counselors should be aware that some parents “therapist shop” and are actively looking for a counselor who will tell them what they want to hear, not necessarily what is helpful. Some potential clients are searching for a counselor to align with them and join in with them about how awful their ex-spouse is. Counselors should keep in mind that failure to contact the child’s other parent may introduce a host of issues (for example, board complaints), especially if the parent seeking treatment for the child does not have the right to do so per court order. Also make certain to obtain all necessary releases before conversing with any previous counselors who have worked with the family members.

Step three: Counselors working with parents who are irrationally rejected by their children need to be well-versed in the literature. Failing to recognize and treat alienated children and their parents prolongs emotional damage for the child and can harm the entire family system.

Step four: As a counselor, you must know who the client is. Are you working with the child, the child and the parent(s), or one/both of the parents? It is vital to understand how the client ended up in your office. Additionally, your role must be clear. Are you working as a court-appointed counselor or a court-involved counselor? Recognize that in cases of child alienation, other parties — such as other counselors, attorneys or parenting coordinators — are often involved.

Step five: Know your definitions, but do not diminish your clients by labeling them. When conversing with other professionals, it is acceptable to refer to the parent to whom the child aligns as the “favored” parent. The “rejected” parent (or “target” parent) is the parent whom the child rejects or refuses to spend time with. When working with the courts, and depending on their jurisdiction, counselors may want to use behavioral descriptions, not diagnostic labels.

Counselors should remember to focus on behaviors that can be described. Although it is acceptable to discuss the concept of triangulation, gatekeeping, pathological alignment or irrational alienation with your colleagues, it is not helpful to use these terms with clients.

Step six: Do not diagnose if you have not actually met the client or witnessed the parent-child interactions. For instance, if one parent seeks your services and reports that the other parent is alienating the child and is a narcissist and/or borderline, you cannot diagnose that other parent as borderline because you have not met with or witnessed that parent.


Therapeutic fallacies

Richard Warshak is a world-renowned expert on parental alienation. He has written countless peer-reviewed publications on custody disputes, divorce, alienated children and stepfamilies, and has developed educational materials. Warshak recently provided strategies that can guide counselors in working with this difficult parent-child dynamic. According to a study he published earlier this year (see http://psycnet.apa.org/psycinfo/2015-27699-001/), several fallacies can compromise the therapeutic process.

  • Children never unreasonably reject the parent with whom they spend the most time. The first fallacy counselors should recognize is that more time does not necessarily equal quality time. Using rapid clinical judgment, it is easy to conclude that a child identifies with the parent whom he or she sees the most. If counselors do not recognize this fallacy, they may determine that the parent must have done something that warranted poor treatment by the child. This line of thinking contributes to additional emotional distress. In turn, under this assumption, counselors can go on the lookout for flaws within the rejected parent to substantiate their beliefs. Counselors should be aware that when a child spends time with the nonresidential parent, that parent could be using that limited time to teach the child to disrespect and disobey the custodial parent. To offset this fallacy, counselors must stop thinking in unidimensional terms.
  • Children never unreasonably reject mothers. According to Warshak’s study, “Those who believe mothers cannot be the victims of their children’s irrational rejection are predisposed to believe that children who reject their mothers have good reason for doing so.” He advises that counselors should keep an open mind about both parents and consider that mothers may be rejected without good reason.
  • Each parent contributes equally to a child’s alienation. Counselors should not generalize that both parents are always equally at fault for a child’s alienation. Counselors would not place equal blame for intimate partner violence on the victim. Likewise, it is not helpful to equally blame both parents for a child’s unwarranted rejection when one parent may be instigating the child’s actions and attitudes.

One bias that comes into play is repetition bias. Those working in the field are permeated with the term “high conflict” and may deem that parental alienation is synonymous with that term. As described by Warshak, the term high conflict “implies joint responsibility for generating conflict.”

In my practice, I developed a nuanced view. There are times when both parents contribute to and could benefit from parenting education or family therapy. However, in the case of Sarah and Michael, Michael openly defied the court’s orders, ultimately refusing to let Sarah spend time with their daughter. He also denigrated Sarah in front of the child. I would not be practicing the concept of “non-maleficence” when working with Sarah if I were to suggest that she was at fault. Demanding more of Sarah and blaming her only adds insult to injury.

As Warshak points out, “When the rejected parent’s behavior is inaccurately assumed to be a major factor in the children’s alienation, therapy proceeds in unproductive directions.” At this point, counselors may wonder, “What am I to do?” A counselor should remain neutral and avoid making unwarranted assumptions.

  • Alienation is a child’s transient, short-lived response to the parents’ separation. This fallacy is damaging because child alienation may be deemed to be a normal byproduct of divorce that will resolve on its own. Prior to going into private practice, I co-led a support group for adults who had lost all contact with their children. These cases were not due to a background of abuse or neglect; instead, many involved a contentious divorce.

Unfortunately, some counselors espouse the notion that the child should decide when to see the rejected parent and suggest that over time, the child will come around. In some cases, the child may re-establish a relationship with the parent. However, not all children reconnect. And even if they do, parents cannot reclaim lost time.

Counselors understand that they should practice within the scope of their license. In many states, counselors are prohibited from making access or possession determinations. Counselors do not have the right to supersede a court order and tell an alienated child that he or she does not have to spend time with the rejected parent. Again, it is necessary to obtain a copy of the client’s current court orders prior to starting counseling.

Another practice tip is that counselors should encourage the parent who is the target of unwarranted rejection to remain in constant contact with his or her children. Counselors can also aid parents in knowing and understanding the stages of development and helping parents to formulate proper responses to a child’s verbal insults.

  • Rejecting a parent is a healthy short-term coping mechanism. Counselors can identify this fallacy by reflecting on common biases, many which are covered in counseling programs. Counselors must be cautious about the bias of wishful thinking because it provides a false hope to clients. As Warshak (2015) explains, “Counselors who believe that rejection of a parent is a healthy adaptation encourage parents to accept the children’s negativity until the children feel ready to discard it.” He goes on to say that “this is especially true when therapists assume that the alienation is destined to be short-lived.” Although we have specialized training as counselors, it is important to remember that we cannot predict future outcomes.

Another way to think about parental rejection is to consider whether the parents would ignore their child refusing to speak to one of the parents if the whole family still resided together. Understandably, most would find this unacceptable.

  • Alienated adolescents’ stated preferences should dominate decisions. This fallacy can be offset by using analytical thinking and a basic understanding of brain development. Many adolescents know more about adult matters than we would want them to know. Regardless, adolescents are not adults and should not make adult decisions. Adolescents are prone to peer pressure and are in the process of discovering their identity. Most adults cannot imagine asking if an adolescent would like to attend school. As Warshak writes, “Adolescents’ vulnerability to external influence is why parents are wise to worry about the company their teenagers keep.”

Counselors can help rejected parents to not personalize it when a teenager has a soccer game and prefers to forego parent-child time. Or when working with a favored parent who claims the child does not enjoy time with the target parent, counselors can point out that some adolescents do not enjoy their homework, but they are expected to do it anyway.


Treatment goals and tips

When working with the child:

  • Promote a healthy relationship with both parents.
  • Help the child to correct cognitive distortions.
  • Work with the child to maintain a balanced view of both parents.
  • Improve the child’s critical thinking skills.
  • Recognize when a child’s behavior is incongruent from one setting to the next.
  • Augment the child’s coping skills.

When working with the rejected parent:

  • Recognize that the parent may feel misunderstood.
  • Work with the parent not to counter-reject the child.
  • Be aware of avoidance and passivity; the parent may want to escape the poor treatment of the ex-spouse and the child by avoiding the problem altogether.

When working with the favored parent:

  • Recognize there may be a role reversal. The child may be meeting the emotional needs of the parent. Help the parent recognize his or her role as a parent and encourage the parent to engage in adult relationships to find emotional support.
  • Keep an eye open for enmeshment. What might initially appear as a healthy parent-child relationship could be extremely unhealthy. For instance, there may be a lack of community or family support.
  • Recognize that children generally benefit from the involvement of parents, absence abuse or neglect. Realize that some rejected parents may have personality disorders and continue to instigate court hearings or defy court orders.


The do’s and don’ts

• Do not recommend a change in custody if one parent is behaving badly. Custody reversal may be necessary in some cases, but it is not the role of the counselor to make that determination.

• Do not align with one parent over the other.

• Do cooperate with parenting coordinators and the courts.

• Do recognize that parents in litigation are likely to be working toward an adult-oriented outcome — namely to prevail in court.

• Do consider a variety of explanations when working with a child or teenager who irrationally rejects a parent.

• Do not discard information that is inconsistent with the counselor’s viewpoint.



Monika Logan is a licensed professional counselor living in Dallas who specializes in troubled parent-child relationships and sexual behavior problems. In addition to maintaining a private practice and doing court-connected work, she recently developed a program to help youth in the criminal justice system maintain boundaries both offline and online and stay connected with their families. Contact her at mlogan@texaspcs.org.


Behind the Book: Solution-Focused Counseling in Schools

By Bethany Bray November 2, 2015

One of the many reasons solution-focused counseling is a good fit for school settings is because it’s a client-directed approach, says John Murphy, a longtime school psychologist and author of Solution-Focused Counseling in Schools.

School counselors often find the bulk of their time consumed with noncounseling tasks. When they Branding-Box-Solutionare able to meet with a student, using a solution-focused approach provides a customizable way to forge a therapeutic bond with the young person in a short amount of time.

“The simple and practical premise of solution-focused counseling – find what works and do more of it – is one of its most appealing features for school practitioners,” Murphy writes in the book’s conclusion. “This does not mean, however, that it is easy to do. Solution-focused work requires careful attention to language, client feedback, relationship building and other therapeutic nuances and skills. Mastery of these skills requires patience and practice. If your experience is anything like mine, however, it is well worth the effort.”

Solution-Focused Counseling in Schools was originally released in 1997; the American Counseling Association published a third edition of Murphy’s book earlier this year.


Q+A: John Murphy on Solution-Focused Counseling in Schools

In the book’s introduction, you write “schools are not set up to accommodate counseling.” Can you elaborate on what you mean by that?

This is not a criticism, merely an observation that the main purpose of schools is to teach reading, writing, math and other important academic skills. Unlike mental health centers and private practice settings where counseling is the main focus and the physical setting reflects that focus, school settings present some unique challenges for counselors.

These challenges include working around students’ and teachers’ busy class schedules, safeguarding client confidentiality and conducting “counseling sessions” whenever and wherever you can — in the lunchroom, on the playground, talking with a parent by phone or walking alongside a student or teacher in the hallway. This requires a lot of flexibility on the part of school practitioners.

But let’s not forget that there are advantages to school-based counseling as well. In addition to offering instant access to students and teachers, schools provide a natural and familiar setting for students and parents who might otherwise have to leave their community and travel long distances to receive services. For these reasons, and the fact that we know more than we ever have about helping people change, I ended the new edition of Solution-Focused Counseling in Schools by stating that there has never been a better time to be a school-based counselor.


From your perspective, what makes a solution-focused approach effective in helping elementary through high school students? How is it a “good fit”?

For starters, solution-focused counseling (SFC) is a clear and practical approach that makes sense to students, caregivers and counselors. Research tells us that people are more likely to benefit from counseling approaches that make sense to them, that respect their input and goals, and that customize counseling to them rather than requiring them to conform to the counselor’s preferred methods. SFC meets all of these criteria, which explains why it is effective with students of all ages.

Although solution-focused counselors validate problem-related experiences and struggles, they gently invite students to take action instead of spending a lot of time analyzing the problem. The “less talk, more action” nature of SFC seems to appeal to students as well as school counselors, who have very little time to do counseling in the first place.

Another reason SFC works with students is because it grabs their attention as “something different” rather than more of the same. Most students with school problems are well accustomed to problem-focused conversations with adults. These well-intentioned conversations emphasize what is wrong with students, with little or no attention to what they are doing well, which may include coping with a problem or preventing it from getting worse. In contrast, solution-focused conversations seek out students’ strengths and resources and explore how these assets could be applied toward solutions. In my experience, conversations that recognize and build on what is right and working with students engage their participation more effectively than “more of the same,” problem-saturated discussions.

The solution-focused approach fits with school counselors as well. In teaching classes and workshops throughout the U.S. and overseas, counselors often tell me that the solution-focused emphasis on “doing what works” as quickly as possible is more practical than cumbersome, time-consuming approaches that don’t fit well for schools and school problems. Building on students’ strengths also appeals to counselors’ desire to empower, energize and encourage people. The fact that solution-focused counseling accommodates a variety of cultural backgrounds and life experiences is another important feature in today’s increasingly diverse world. Most people, including myself, signed up for this business to lift people up, and SFC fits nicely with this goal.


What prompted you to do a third edition of this book? What’s new and different in this edition?

Though many of the basic ideas and techniques of SFC have been carried over from previous editions, several aspects of my approach to SFC have changed since the previously published second edition in 2008. Research continues to clarify specific elements of effective counseling, all of which are incorporated into the new edition of Solution-Focused Counseling in Schools. These elements include the importance of building a strong counselor-client alliance and of collecting ongoing client feedback.

The third edition has new chapters on topics such as the restrictive influence of problems and practical strategies for developing “goals that matter,” as well as additional practice exercises at the end of each chapter and a widely expanded chapter on innovative ways to use solution-focused strategies in group counseling, classroom teaching, peer helping programs, parent education, consultation with parents and teachers, systems-level change and referral forms. I also included new appendices with examples of solution-focused checklists and referral forms, therapeutic letters to students of all ages, scripts for introducing client feedback tools and handy crib sheets for conducting SFC sessions.


What is a main takeaway you want counselors of all types, including nonschool counselors, to know about the importance of solution-focused counseling in school settings?

The main takeaway is that the ideas and techniques in this book are “value added.” A value-added technique adds value and impact to whatever it is combined with, making everything else you do with clients more effective. Examples of value-added techniques include obtaining client feedback, giving compliments, validating students’ experiences and exploring exceptions to the problem.

The beauty of these techniques is that there are no risks or downsides to using them. The worst thing that can happen is that the person does not respond and nothing changes, at which point you simply move on to something else. Even then, value-added techniques can enhance the alliance by conveying respect for people’s input, wisdom and capability. The bottom line is this: You can use the techniques in this book regardless of your theoretical orientation and regardless of whether or not you consider yourself a solution-focused practitioner.


You were a public school teacher and school psychologist for many years. How have you seen the role of school counselor/psychologist change since then?

I haven’t seen much of a change in the roles of most school counselors or school psychologists, especially when it comes to the small amount of time they spend in intervention-related activities such as individual and group counseling, parent/teacher consultation and schoolwide prevention/intervention programs. I am not criticizing the professionals who fill these roles, many of whom would like to spend more time on such activities. School counselors and psychologists often tell me that they are pulled in so many different directions and saddled with certain responsibilities that leave little time for counseling and other intervention-related services. Unfortunately, the situation will not change in a big way if schools continue to rely exclusively on outside professionals and agencies to provide the bulk of school-based counseling and intervention services.


What advice would you give to a new professional who is starting a career as a school counselor?

Find ways to stay active, involved and hopeful about your profession and the people you serve. Effective practitioners are continually engaged in professional learning and development. They also find ways to sustain their hope in the midst of the ongoing problems and challenges they face on a daily basis. I would also advise them to make sure that their job description and role includes sufficient time for counseling and intervention activities.


Besides your book, what resources would you recommend for school counselors who would like to learn more about solution-focused counseling?

There are many more resources on solution-focused counseling with young people and schools than there were when I wrote the book’s first edition almost 25 years ago. An Internet search of “solution-focused counseling in schools” will yield various articles and chapters. The Solution-Focused Brief Therapy Association’s website (sfbta.org) contains general information about SFBT. I also maintain a website on solution-focused and strengths-based practices in schools that has a variety of links and additional information about solution-focused practice in schools, workshop offerings on the topic and other related topics (drjohnmurphy.com).





Solution-Focused Counseling in Schools is available from the American Counseling Association bookstore at counseling.org/publications/bookstore or by calling 800-422-2648 x 222


For more insights from Murphy, see these downloadable VISTAS articles from ACA:

Solution-Focused Counseling in Schools

Building School Solutions From Students Natural Resources

Student-Driven Interviewing Practical Strategies for Involving Students in School Solutions


Also, see ACA’s podcast with Murphy on solution-focused school counseling: bit.ly/1OSO26v





About the author

John J. Murphy is a licensed psychologist and professor of psychology and counseling at the University of Central Arkansas. Previously, he was a public school teacher and school psychologist.




Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org


Follow Counseling Today on Twitter @ACA_CTonline and on Facebook: facebook.com/CounselingToday



Stuck in the middle

By Ann M. Ordway and Ruth O. Moore October 21, 2015

Licensed professional counselors are increasingly becoming involved in court proceedings relative to their work with families involved in high-conflict divorce, separation and custody litigation. Counseling professionals can serve in a variety of roles when working with families embroiled in divorce litigation. For example, a counselor might develop a therapeutic relationship with an individual family member, a couple or the entire family unit. These roles are typically kept distinctly separate. However, when working with high-conflict families, such roles can become easily blurred. Thus, Child-Custody_brandingcounselors can be unexpectedly swept into litigation because of misinformation, hidden agendas, the expansion of what started as a fairly simple role or even a lack of knowledge about court terminology and procedures (such as not recognizing when counselors are required to release information to the court and when they are not).

Counselors must be proactive and engage in cautious practice when interacting with high-conflict families and with court professionals. We offer counselors 10 simple guidelines to follow.

1) Be aware of ulterior motives. There is no question that individuals going through separation or divorce appropriately turn to counselors for support and guidance to get through one of life’s most challenging psychosocial events. But the possibility also exists that attorneys will refer clients to counseling for other reasons. For example, if a couple is involved in custody litigation, an attorney might refer a client to a counselor to document the client’s version of events or to set the stage for later seeking an opinion from the counselor about the client’s mental health status or ability to function as a parent. There may also be times when attorneys direct clients to bring their children to counseling in hopes of later soliciting a supporting opinion from the counselor regarding the individual’s abilities as a parent.

A counselor needs to be clear at the onset of the therapeutic relationship about why the client is there, what the client expects, what the counselor can and cannot do and whether the referral is from the client’s attorney for a specific reason. It is critical for the counselor to also know who the identified client is.

Counselors can certainly work with clients to enhance their coping skills and to effect change. If a client has a history of substance abuse, for example, proactive and voluntary involvement in counseling can demonstrate that client’s interest in and willingness to tackle a problem before being ordered to do so by a judge. Participation in counseling can also indicate effort and bolster a court’s impression that the client’s problem is under control.

However, it is important that counselors not be used to perpetuate a false impression for court purposes. Counselors cannot control the sincerity of a client’s motive, but we do not want to be complacent in a ruse to gain an advantage in court.

2) Know your role and avoid dual relationships/multiple roles. A counselor in a therapeutic role provides support for clients and empowers them to build on their existing strengths and make positive changes. In contrast, an evaluator gathers information from multiple angles and sources for the express purpose of rendering a report and recommendations to the court.

Counselors can certainly opine about the condition and progress of the client. However, counselors should not opine about the condition, progress or functionality of individuals they have not met or for whom they have limited information.

Sometimes the client, or an attorney, will ask the treating counselor to offer an opinion about specific issues such as parental fitness, abuse or domestic violence. The counselor must offer recommendations and opinions that are consistent with the counselor’s role and competency. For example, it might be fine to say that the client presents with symptoms consistent with someone who has been a victim of domestic violence. But if the counselor’s information is limited only to what the client has told the counselor, it would not be prudent to comment on the propensity of the client’s partner toward violence. Similarly, it would not be prudent to repeat the client’s statements as fact if the counselor was not present for the described events.

3) Be familiar with ethical codes, legal statutes and best practices. The 2014 ACA Code of Ethics specifically addresses issues such as informed consent and confidentiality, dual relationships, multiple roles and identifying the client. When in doubt about a situation, counselors need to always consult the ACA Code of Ethics and avail themselves of the ethical consultations made available through the American Counseling Association (call 800.347.6647 ext. 314 or email ethics@counseling.org).

It is also in the best interest of counselors to be familiar with their state laws and regulations. Some state laws include nuances that more clearly define when confidentiality must be broken, such as in cases of child abuse and neglect.

Counselors must also refrain from offering legal advice to clients, while at the same time remaining aware of laws in their jurisdictions so they can avoid guiding clients down the wrong path. Counselors should refer clients to attorneys when legal advice is needed and in the client’s best interest. One counselor encountered serious legal problems and a licensing board complaint when she suggested that a client, whom the counselor believed to be a victim of domestic violence, take the children and relocate to another country where the client’s family lived. States have specific laws regarding the removal of children from the jurisdiction. Removal of children without the permission of the court or consent from the other parent can result in criminal charges against the removing parent and a loss of custody.

4) Obtain consent and document all contact. Counselors should obtain copies of any documentation regarding custody and visitation when a separation or divorce is involved. Counselors need to ask for the most current copy of the court order and document that the copy is represented to be the most current copy. A counselor’s informed consent document should outline the expectation that all modified and updated court orders will be provided as they occur.

When there is no official documentation, counselors must keep detailed records about what they were told and by whom. Counselors working with children in divorce situations should seek consent and input from both parents whenever possible. When this is not possible, the reasons should be documented. Sometimes a court order will grant one parent sole custody of the children or sole decision-making authority. Other times one parent may state that the other parent isn’t involved because of estrangement or death. Client records need to reflect what the presenting parent has told the counselor so that the counselor will have a reasonable basis for proceeding if another parent surfaces and objects.

5) Offer support, not re-entrenchment. From a humanistic perspective, the therapeutic alliance is built upon support and unconditional positive regard for the client. However, in cases of high-conflict separation or divorce, there can be a fine line between the position that the client is 100 percent right and the estranged spouse is 100 percent wrong.

It can be difficult for two people to settle the economic and custody-based differences in their legal case when one person is cemented into a faulty belief system of entitlement or stuck in a position rooted in principle. Settlements result from the art of compromise, and positions based on principles can be expensive. In other words, clients are sometimes so concerned with winning a point that they lose sight of the big picture and end up jeopardizing more important elements of the case. Counselors sometimes do their clients a disservice by being so supportive of the client’s position that the client cannot move forward realistically through a legal system that is often more concrete in the application of the law.

6) Maintain neutrality where appropriate. This guideline pertains mostly to counselors working with children. It is easy to become invested in the parent whom the counselor sees or talks to most frequently. Hearing only one side of the story can absolutely affect the counselor’s view of the child’s experience, especially when the child has limited verbal or cognitive abilities, is not emotionally insightful or is not detail oriented.

Counselors should start with the understanding that children generally fare much better in divorce situations when they are not caught in the middle. Counselors serve the child well by supporting his or her relationship with both parents, unless there is a clear risk of harm to the child. Counselors can refer family members in need of support to other professionals to avoid conflicts of interest.

7) Do not offer an opinion of someone you have never met. It isn’t uncommon for a lawyer to ask a child’s counselor to render an opinion and recommendations regarding custody of the child or for a client’s counselor to opine regarding parental fitness and ability. However, the counselor should stick exclusively to what the counselor knows.

It is OK to speak about the counselor’s own client — with the client’s permission — to include what that client has reported, the consistency of words and affect, and impressions regarding that client. It is not wise, however, to offer comment on a parent whom the counselor has never met. Such comments would be based exclusively on what the parent who is a client has reported to the counselor. It is acceptable to state, “The client reported that her husband hit her,” but it is not advisable for the counselor to state, “Mr. Jones is an abusive man who is violent in his relationships. He should not be trusted to have custody of his son.”

8) Do not assume you can avoid court involvement. Some counselors think they can avoid court involvement by adding one or two phrases to their informed consent documents stating that they refuse to participate in court proceedings. Although there might be an argument that the client agreed to waive any right to call the counselor as a witness, a subpoena can trump that agreement. In other words, if an attorney subpoenas a counselor, the counselor will likely have to appear for a deposition or for a hearing.

The counselor can seek to have the subpoena quashed and should not release any clinical information until it is determined that the subpoena is valid and will be upheld. Best practices suggest that the counselor obtain consent from the counselor’s own client or an authorization to release information. However, even without that consent or waiver, the counselor may have to provide records or even testify.

Avoiding court begins the moment the client walks in the door. Informed consent and documentation are essential. Counselors should be trained in courtroom dynamics, testimony and legal and ethical issues even when it is the counselor’s preference to not go to court. Such measures, including ongoing communication with the client, can decrease the likelihood of having to participate in court proceedings.

9) Consult with your state licensing board, malpractice insurance carrier or attorney when necessary. If subpoenaed, consulting with an attorney before releasing records or providing testimony is wise. It is helpful for any counselor whose practice involves working with high-conflict families to have an attorney available for prompt consultation if necessary.

An attorney can review documents and guide the counselor regarding the process for balancing ethical responsibility and court involvement. Sometimes subpoenas can be quashed or suppressed. Some counselors make the mistake of responding to a threatening letter from legal counsel suggesting that the counselor must immediately make all records available. An attorney will know if the request or demand is valid in the counselor’s jurisdiction and can guide the counselor away from any ethical pitfalls associated with an incorrect response or the premature release of confidential records. Under no circumstance, however, should a subpoena simply be ignored.

10) Choose your words carefully. Wording can be everything. When asked for a report or an opinion, the counselor should confine his or her response to that which the counselor knows. Counselors should avoid supposition and assumption. It is acceptable to say, “My client stated …,” but it is not acceptable to respond as if the counselor was present or witnessed the event unless that is the case.

Simple wording can make a difference in how the counselor’s opinions or recommendations are received. When asked a question by an attorney, the counselor should listen to the question, think about it and then offer an answer that is responsive without providing more information than was requested.

Credibility is critical, and it is the counselor’s reputation (as well as the best interests of the client) on the line when the counselor renders an opinion or makes recommendations. The counselor must be able to support recommendations and opinions with facts, best practices and empirical evidence.


Counseling high-conflict families going through separation or divorce can present a slippery slope. The work is extremely important for the family unit and its individual members because they are dealing with an extremely challenging life event. However, cases involving the courts are stressful in even the simplest of cases. Many counselors prefer to maintain a supportive role and do not wish to do forensic (court-related) work. However, they can easily be maneuvered into the role of witness regardless of their efforts to avoid that position.

The guidelines provided in this article do not represent an exhaustive list of the professional and ethical responsibilities of counselors involved with high-conflict divorce cases. However, following these guidelines can help counselors maintain credibility, be more mindful of potential legal and ethical obligations and provide the client or family with needed emotional support. The guidelines should also remind counselors of the importance of receiving training for work with this population.




Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Ann M. Ordway has been an attorney for 25 years and practiced in family court for many years before entering the counseling profession. She is completing her doctorate in counselor education and supervision through Walden University. She is a distance clinical professor in the Department of Counseling and Special Populations at Lamar University in Beaumont, Texas. Contact her at aordway@lamar.edu.

Ruth O. Moore is a licensed professional counselor and national certified counselor who is a distance clinical professor at Lamar University. She has extensive experience in expert witness testimony and has published and presented widely on court process in child abuse and child custody cases. Contact her at rmoore@lamar.edu.

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