Monthly Archives: March 2008

Untapped potential

Jonathan Rollins March 15, 2008

In a roll call of diseases, few provoke such deep feelings of dread and fear as Alzheimer’s, the fatal brain disorder that mercilessly assaults the mind as well as the body, eventually rendering persons incapable of remembering or connecting with others, and stealing their very identity in the process.

More than a century after the “discovery” of Alzheimer’s, scientists are still searching for a cure. Likewise, while they know the disease involves progressive brain cell failure, researchers have yet to pinpoint the single reason why that occurs. They have, however, identified several risk factors that increase the likelihood of individuals developing Alzheimer’s dementia. After taking a critical look at some of those risk factors — including depression and numerous lifestyle variables related to physical, mental and social activity — Kathryn Douthit believes counselors could potentially play a major role in delaying (if not preventing) the onset of Alzheimer’s dementia for literally millions of people.

“Although the study and treatment of (Alzheimer’s dementia) has largely been the purview of medicine, as information about this disorder has emerged, a clear role for counseling has taken shape,” Douthit wrote in an article for the Spring 2007 issue of ADULTSPAN Journal, published by the Association for Adult Development and Aging, a division of the American Counseling Association. “Interventions across the life span that address stress, depression management, social integration, spirituality and other targets of holistic wellness such as diet and exercise hold much promise for delaying or circumventing the cognitive disabilities associated with (Alzheimer’s dementia).”

Douthit, whose background before becoming a counselor was in the biomedical sciences, began investigating Alzheimer’s disease because of a longstanding interest in gerontology. “I started to look at these lifestyle correlates and environmental conditions — what was related to Alzheimer’s disease and what was related to high cognitive functioning late in life — things you can accumulate over the course of a lifetime that seem to delay or prevent the disease,” she says. “In the process, I found some amazing things that I thought were so relevant to counseling because of our emphasis on holistic health and our wellness orientation.”

Douthit, chair and associate professor of counseling and human development at the University of Rochester, uses a concept from sociology known as cumulative advantage to explain why counselors working across the life span might be able to help avert Alzheimer’s dementia. “As we age, our bodies and our minds are almost like a time capsule, a reflection of our whole lives,” she says. “If you are ‘advantaged’ at the beginning of your life, that advantage just accumulates over time. It’s basically imprinted in our physiology, which affects the way we act and feel. For me, the field of counseling is so germane to late-life psychological health because we address those lifelong accumulations and help prevent the cumulative disadvantages.”

While counseling interventions that address major risk factors such as depression and stress don’t necessarily stave off the disease process itself, Douthit says, evidence suggests those interventions may successfully delay the symptoms of Alzheimer’s dementia. She points out that because the disease most often manifests itself in the years that extend beyond average life expectancy, delayed onset would allow many individuals to reach the end of their lives before the symptoms become apparent. (Early onset Alzheimer’s, which afflicts those younger than age 65, seems to have a much stronger genetic link, and there is little evidence that counseling can play a role in preventing it, says Douthit, a member of ACA, AADA and the Gerontological Society of America.)

Despite the potential importance of the connections Douthit is making between counseling and Alzheimer’s prevention/delay, her work has not yet drawn widespread interest from others seeking to find a cure. “Thus far, I have had some folks in gerontology and sociology who are interested in this work, but I have not had any interaction with people from medicine,” says Douthit, president-elect of the North Atlantic Regional Association for Counselor Education and Supervision. “There are some people within medicine who are saying similar things about prevention, minus the counseling twist. Daniel Amen and William Shankle are two physicians of note who are talking about prevention/delay strategies. But no one I am aware of has made the link between prevention/delay and counseling wellness models in spite of the fact that it has the potential to be a powerful link. This, of course, speaks to the need for more counseling self-advocacy.”

Others in the counseling profession, including Jane Myers, a past president of ACA and one of the leading voices in the field of gerontological counseling, see the importance of the information Douthit and others are compiling. “What we are learning is that we can postpone the onset (of Alzheimer’s) for some people, some of the time, with appropriate preventive activities,” Myers says. “The emerging research is coming out of medicine and physiology, as well as psychology. As an applied profession, we need to build on that knowledge base and design interventions to help people make healthy lifestyle choices. The focus often is on getting the most life from your years rather than the other way around.”

Counseling interventions

Douthit says the identification of specific risk factors for Alzheimer’s dementia opens the door to many potentially helpful interventions that naturally fall under the purview of counseling.

Depression prevention/intervention

Preventing or treating depression looks to be a particularly important element in the struggle against Alzheimer’s, Douthit says. Various studies have shown that prior experience with depression greatly increases the chances of developing Alzheimer’s dementia, she says, and one study has shown that the risk increases even more each time an individual goes through an additional cycle of depression. Depression also negatively impacts other areas of a person’s life and can lead to behaviors that likewise increase the likelihood of developing Alzheimer’s dementia later in life. For instance, Douthit says, persons who are depressed are less likely to engage in physical exercise or to take up activities that exercise their brains. Their relationships are also more likely to be negatively affected. Research suggests that people who experience social isolation or have a sedentary lifestyle are more likely to display symptoms of Alzheimer’s dementia, she says.

“In the area of depression prevention,” Douthit says, “we have to look at those things that are the bedrock of counseling practice: working with grief and loss issues, looking at interpersonal conflicts, adjustment issues, existential issues.”

She says it is critical for counselors to anticipate where clients might encounter these issues instead of waiting for the issues to hit individuals head-on. “For instance, what might women encounter in their 40s or 50s? Have them start talking about those things early,” she says. “When you’re working with a 17-year-old, what does it mean to be that age? Think about what is likely to throw us off balance and cause depression. Developmental counseling that addresses things likely to cause depression and stress are key.”

At the same time, Douthit says, counselors should also have a good handle on empirically supported treatments for depression. “It’s important to keep in mind the prevention techniques, the developmental crossroads, but to also have knowledge of how people can most efficiently quell the symptoms of depression over the short term to get them out of that damaging physiological state,” she says. She adds that counselors also need to know when medication might be helpful in treating a depressed client.

Stress management

Researchers have linked chronic stress to both depression and cardiovascular disease — two of the major factors that increase the likelihood of developing Alzheimer’s dementia. “Stress, particularly early in life, and even prenatally, appears to affect our ability to deal with and rebound from stress later in life,” Douthit says. “It causes our regulation of stress to be compromised. Ultimately, that can set you up for cognitive decline later in life.”

Once again, she says, counselors are naturally positioned to help people deal with stress across the life span. Among the interventions counselors can use:

  • Teaching relaxation techniques
  • Teaching mindfulness techniques
  • Helping individuals to prioritize (values clarification)
  • Encouraging individuals to build support networks
  • Helping clients improve self-esteem
  • Providing guidance to people who are going through career crises
  • Anticipating developmental issues
  • Attending to psychological problems that can exacerbate stress responses (recognizing underlying problems to help clients improve resiliency)
  • Helping clients deal with interpersonal problems

Social integration

Although the specifics remain elusive, researchers have found that social activity has a positive impact on brain health, Douthit says, and counselors can work with clients to overcome many factors that compromise healthy social functioning. “Really, this is lifestyle counseling in many ways,” she says. Among the helpful treatment techniques:

  • Helping people with social skills training
  • Examining family dynamics to help clients understand relationship patterns and how they interact with other people
  • Examining patterns of interpersonal communication
  • Working on self-esteem issues
  • Helping clients to carve out time for activities that foster social integration
  • Helping clients to establish more balanced lifestyles

Developing a comprehensive wellness plan

In examining the risk factors for Alzheimer’s dementia, Douthit has been amazed to see the counseling profession’s emphasis on holistic wellness assert itself again and again as a potentially crucial tool in preventing or delaying the disease. “Counselors haven’t articulated the science behind it (a holistic model of wellness),” she says, “but it’s apparent our good instincts have been right on.”

In particular, Douthit praises the Wheel of Wellness model developed by Myers, Thomas Sweeney and Melvin Witmer. “That’s almost like my bible,” Douthit says. “It’s a great prototype for developing a comprehensive wellness plan.”

Douthit described the Wheel of Wellness in her article for ADULTSPAN Journal: “This model, a centrally important resource in the counseling profession’s focus on prevention and wellness, fosters five so-called ‘life tasks’ as a basis for holistic wellness. These life tasks are (a) spirituality, defined as an awareness of that which exists beyond the realm of the material world; (b) self-direction, which includes sense of worth, sense of control, emotional awareness, coping with emotion, exercise, self-care, and cultural and gender identity; (c) optimization of work and leisure experiences; (d) friendship exclusive of family, marital or romantic ties; and (e) love relationships characterized as long term, mutually committed and intimate. Although these dimensions of wellness were not created specifically with (Alzheimer’s dementia) in mind, the degree to which they correspond to potential features of (Alzheimer’s dementia) prevention are quite remarkable.”

Myers is excited by recent research indicating that wellness lifestyles may hold promise for postponing the symptoms of Alzheimer’s dementia. “Teaching wellness skills can have a lifetime positive effect on everyone,” she says, “and the sooner we help people understand the benefits of a wellness philosophy, the greater the number of years of healthy, happy living we can help people have. … Wellness is at the heart of who we are as a profession.”

Counselor advocacy and identity

Douthit is hopeful her investigation into counseling’s potential role in delaying or preventing Alzheimer’s dementia will become a major tool in advocating for the profession. “So much of what we’re talking about (in trying to head off dementia) really captures counselor identity,” she says. “It’s uncanny the way it aligns. This is fundamentally a part of who we are because we deal with these wellness issues long term. Plus, it pulls in the entire profession.”

Douthit firmly believes that her work concerning Alzheimer’s dementia also has a strong tie-in to counseling’s social justice focus. “Counselors have a firm grasp of social context and how it shapes who we are,” she says, “and so many of the (risk factors for dementia) can be related back to social disadvantage.”

According to Douthit, statistics support the notion that members of Latino and African American communities are at increased risk for developing dementia. Though researchers are not certain of the exact reasons, Douthit believes the higher risk likely has some link to the sociocultural challenges and economic hardships faced by many members of these communities. “If you look at some of the challenges of living in a poor urban or a poor rural area — poor housing, poor infrastructure, increased exposure to violence, exposure to other crime, inadequate schools and so on — there are so many factors present that cause huge stress in people’s lives,” she says. “And over a lifetime, that can be devastating.”

“As part of our social justice mission as counselors, we really need to start sorting through some of these things,” she adds. “We need to figure out how to integrate social justice into our practice.”

Douthit also challenges counselors to raise people’s awareness to the possibility that they can take steps to decrease the risk of developing Alzheimer’s dementia later in life. “If I talk about this with people who are 50, they’re riveted. For people in midlife, this is a selling point (for counseling),” she says. “But if we can get people in their 30s or 40s to start thinking about (holistic wellness), that’s a key time. If you don’t start taking steps before your 50s, it’s less effective.”

“We know that this is in part a ‘use-it-or-lose-it’ phenomenon,” says Myers about efforts to delay or prevent dementia. “Mental exercise is equally important as physical exercise, but we know that our brains are organs that function like all the rest — they need oxygen carried around by healthy blood to function effectively. Exercise, combined with proper nutrition, sets the stage for physical health. We know that health is a neutral state on a continuum that starts on one side with illness or unwellness and ends on the other side with high-level wellness. Our partners in the medical community are working overtime to get people to a state of health. Counselors have a unique role to fill in moving people toward the high end of the worseness-wellness continuum. We are well prepared for doing so, based on our philosophy of wellness, orientation to holism and skills in facilitating the processes of positive human change.”

Kathryn Douthit will present an Education Session on “Working Across the Life Span to Prevent Alzheimer’s Dementia: An Emerging Opportunity for Wellness Counseling” at the ACA Conference & Exposition in Honolulu on Sunday, March 30, from 11:45 a.m.-1:15 p.m.

Jonathan Rollins is the editor-in-chief of Counseling Today. Contact him at

Sobering statistics

  • In 2007, it was estimated that more than 5 million people were living with Alzheimer’s disease in the United States, including 4.9 million people over the age of 65 and between 200,000 and 500,000 people younger than 65 with early onset Alzheimer’s disease and other dementias.
  • One out of eight people age 65 and older has Alzheimer’s, and nearly one out of two over age 85 has the disease.
  • It is estimated that someone in the United States develops Alzheimer’s every 72 seconds; by mid-century, someone will develop Alzheimer’s every 33 seconds.
  • Seventy percent of people with Alzheimer’s and other dementias live at home, cared for by family and friends.
  • Survival time after diagnosis averages four to six years, but survival time can be as long as 20 years from the detection of the first symptoms.
  • In 2005, Medicare spent $91 billion on beneficiaries with Alzheimer’s and other dementias. That number is projected to more than double to $189 billion by 2015, more than the current gross national product of 86 percent of the world’s countries.
  • Almost 10 million Americans are caring for a person with Alzheimer’s or another dementia; approximately one out of three of these caregivers is 60 years or older.

— All statistics courtesy of the Alzheimer’s Association report 2007 Alzheimer’s Disease Facts and Figures

Proactive protection pointers

Angela Kennedy March 14, 2008

Attorney Anne Marie “Nancy” Wheeler and private practitioner Burt Bertram are collaborators in a mission to teach counselors how to steer clear of the profession’s common legal pitfalls.

Serving as the consultant for the American Counseling Association Insurance Trust Risk Management Help Line for the past two decades, Wheeler is very familiar with legal issues surrounding the therapeutic process. Additionally, she teaches a legal course in the counseling program at Loyola College in Maryland. Aside from maintaining his private practice, Bertram is a former member and chair of the ACA Insurance Trust and an adjunct professor at Rollins College, where he has taught counseling ethics for 15 years.

Together, these professionals have identified specific steps that counselors can take to reduce the risk of lawsuits and licensure board complaints. Following are their top 10 ways to comply with the legal system while still maintaining the integrity of the counselor-client relationship. To play it even safer, Wheeler says mental health professionals should seek services from local counsel for specific legal issues as they arise.

1. Adopt the decision-making model

The 2005 revision of the ACA Code of Ethics says, “When counselors are faced with ethical dilemmas that are difficult to resolve, they are expected to engage in a carefully considered ethical decision-making process.” In addition to this planned course of action to manage ethical issues, Wheeler and Bertram suggest counselors prepare a risk management tool kit, which should include:

  • Federal and state statutes, regulations and relevant case laws
  • Publications, articles and case studies on ethical issues
  • Employer-specific checklists and policies
  • Contact information for a local attorney and fellow mental health colleagues (for consultation purposes)

“Having an ethical decision-making model established allows a counselor to make a thoughtful and deliberate decision as opposed to a spontaneous or compulsive decision. In 99 percent of the cases, we want a thoughtful and deliberate decision. There’s time for it, and we owe our clients that,” says Bertram, who adds that the first step of the model should be to clearly define the problem. “That’s important so you know what ethical or legal issues, principles or points are at risk so you may develop appropriate solutions.”

To obtain an example of an ethical decision-making model, e-mail ACA Director of Ethics and Professional Standards Larry Freeman at

2. Two heads are better than one: Consult with colleagues

“This is one of the most important yet easiest strategies there is,” Bertram says. “Recognize that you aren’t in this alone. Peer consultation doesn’t have to be just for ethical dilemmas. It can be beneficial as we move along in our cases. Even if you are licensed, if you are a veteran professional, it doesn’t mean that another’s perspective isn’t helpful or valuable. But certainly, when there is an ethical situation, you will want to consult with at least one if not several other colleagues.”

Wheeler concurs, saying that when counselors encounter a sticky ethical issue, it is beneficial not only to seek peer consultation, but also to document that this action was taken. That way, if a lawsuit is filed, counselors have some proof that they sought advice and took reasonable action. “It shows that you took the time to help the client,” she says.

Wheeler adds there is occasionally confusion in the counseling profession concerning the difference between supervision and consultation. “If a counselor consults with a colleague, they are free to accept or reject what the consultant has to say,” she explains. “But if it’s supervision, there is a level of responsibility, and the counselor must follow what the supervisor advises.”

3. Develop appropriate informed consent

Both Wheeler and Bertram say it’s important for counselors to develop appropriate informed consent. This written document should be verbally reviewed by the client and the counselor before the client signs and treatment begins.

“Informed consent defines the parameters of practice,” Wheeler says. “It’s not just a piece of paper that you shove in front of the client and say ‘sign this.’ It’s an ongoing process rather than a onetime thing. It’s important for clients to know the limits of confidentiality.” State licensure regulations may specify the contents of an informed consent document, Wheeler says, but basic informed consent documents should include the following:

  • Confidentiality, privilege and privacy limitations or exceptions
  • Emergency procedures
  • Fees (if applicable)
  • Credentials, affiliation, supervision, consultation and so on

3.5 Responding to subpoenas

“The topic of subpoenas is an offshoot of confidentiality and privilege, and it’s the most frequently asked question posed through the ACA Insurance Trust Help Line,” Wheeler says. “Counselors get served with subpoenas a lot, and it causes a lot of anxiety.” Just because a counselor receives a subpoena doesn’t necessarily mean he or she will have to testify, she adds. According to Wheeler, counselors are most commonly served with subpoenas related to divorce or parental rights cases.

“There are steps that counselors need to know about if their client is involved in any type of legal proceeding,” she says. “The first step is to talk to your attorney or a risk management attorney through your professional liability insurance program (to find out if the subpoena has merit). … The bottom line is that with subpoenas, you want to get written consent from the client (authorizing the release of information) or a court order from a judge. There are state variations on that, but we don’t want counselors to automatically think that just because they get a subpoena, they have to send in the (client’s) records, because they could be violating their client’s confidentiality and then be at risk for a malpractice suit.”

4. Know ‘duty to warn and protect’

“This is a big issue that first got a lot of attention back in the 1970s with the Tarasoff decision in California, a case that said mental health professionals had the duty to warn or protect the victim when a client poses a serious risk of violence against another person,” Wheeler says.

According to Bertram and Wheeler, Tatiana Tarasoff was attending the University of California-Berkeley in the late 1960s when a fellow student, Prosenjit Poddar, murdered her. Poddar was upset by his unrequited affection for Tarasoff and sought help for depression at the campus hospital. While in session, he told the psychologist that he wanted to kill Tarasoff. Acting in good faith, the mental health professional contacted the authorities. Poddar was detained briefly but then released. A few months later, Poddar killed Tarasoff by stabbing her. He then called the police. He was charged and found guilty, but Tarasoff’s parents filed a wrongful death suit against the university and the psychologist. The case went to the state Supreme Court and eventually defined mental health professionals’ responsibility to warn and protect clients’ potential victims. Although the case was heard in California, it paved the way for similar laws nationwide.

Wheeler says it’s imperative for counselors to familiarize themselves with their state’s laws pertaining to a counselor’s duty to warn and protect, and then to take appropriate action if a client makes a threat. Furthermore, counselors who work in school or university settings should be cognizant of recent changes in policy regarding students threatening violence on campus. Wheeler notes that 50 school shootings have taken place worldwide since 1996, and many universities have reexamined their emergency procedures and policies since the massacre last spring at Virginia Tech.

Since the Virginia Tech tragedy, Bertram says, counselors and other mental health professionals have felt greater tension as they try to walk the sometimes fine line between protecting a client’s confidentiality and taking appropriate action to safeguard the public. He has noticed a pendulum swing, with counselors taking action sooner and being more proactive in preventing harmful acts. “We are nowhere near figuring this all out. There will be court cases, and it will trickle down into statutes and ethics codes,” says Bertram, who believes the process will slowly unfold over the next decade.

Adds Wheeler, “A lot of times the Family Educational Rights and Privacy Act (a federal law that protects the privacy of student records) has been seen as a roadblock against counselors speaking to school administration or parents, but FERPA has exceptions that will allow counselors to release information. That’s one thing counselors really need to know is that FERPA is not this absolute roadblock.”

According to the National Association of College and University Attorneys, FERPA allows information from student education records to be shared with appropriate parties if knowledge of the information is necessary to protect the health or safety of students or other individuals. The situation must be considered an emergency, however; information should not be disseminated based on a “knee-jerk” reaction, according to FERPA.

5. Documentation

“Documentation allows for a thoughtful view of the case every time you finish a session. Clinically, that’s a huge reason to do so,” Bertram says. “From a liability point of view, it provides evidence of careful clinical decision making. In the event that something does go wrong or your judgment is questioned, you have proof in your case notes that you weren’t just checking boxes; you were actually thinking about that client and responding to what you saw.”

State requirements might determine what must be documented in a client’s records, but at a minimum, Wheeler says counselors should document the presenting problem, diagnosis, treatment plan, progress of treatment, end result and follow-up plan. Furthermore, both experts agree that when working with a potentially dangerous client or difficult situation, it’s in a counselor’s best interest to document all details related to abuse and threats to self or others. This should include not only notes about the course of treatment but also the actions (reporting to authorities, consultations and so on) taken by the counselor.

Guidelines for documentation can be skewed for school counselors, Wheeler says, because school districts vary on whether counselors should keep detailed records.

6. Managing boundary issues and “co-occurring” relationships

The ACA Code of Ethics states that “co-occurring” or nonprofessional relationships with clients, former clients, their romantic partners or their family members should be avoided, except when the interaction is potentially beneficial to the client (see Standard A.5.c., “Nonprofessional Interactions or Relationships” and Standard A.5.d., “Potentially Beneficial Interactions”).

Potentially beneficial interactions may include:

  • Attending a formal ceremony (for example, a wedding/commitment ceremony or graduation)
  • Purchasing a service or product provided by a client or former client (excepting unrestricted bartering)
  • Hospital visits to an ill family member
  • Mutual membership in a professional association, organization or community
  • However, counselors must handle nonprofessional relationships with care and within clearly defined boundaries, Wheeler says. Among the possible issues that can arise with co-occurring relationships:
  • Loss of objectivity
  • The potential for misunderstanding
  • Conflict of interest
  • Increased risk for breach of confidentiality
  • Client exploitation
  • Lawsuits and licensure board complaints

“Even though the most recent ACA Code of Ethics opens up the door to the idea that not all nonprofessional relationships are bad, according to the regulations of some states, they are still prohibited,” Wheeler points out. “So counselors need to not only look at the ACA ethics but also see what their state licensure laws and regulations tell them.” Additionally, she says, when presented with the issue of a co-occurring relationship, it’s smart for counselors to document the details of the relationship and to speak to the client about boundaries and the appropriate course of action for the situation.

7. Know reporting duties

Counselors are aware that they need to report child abuse, but a case can become problematic when counselors must determine exactly what qualifies as abuse. When in doubt, Wheeler and Bertram recommend that counselors call their area child protective agency and ask, hypothetically (without providing names), whether the action in question is a form of abuse and should be reported. Other reportable issues include elder/venerable adult abuse, unprofessional conduct of a peer and malicious actions risking the infection of disease (such as HIV/AIDS). However, many reporting decisions depend on the unique circumstances of the case and state health laws.

“In some states, the duty of confidentiality trumps the reporting duty, and in other states, the reporting duty trumps confidentiality,” Wheeler says, “so this can be a very tricky issue because you want to do what’s in the best interest of the client.”

Bertram says he reminds counselors that they only need a suspicion of abuse to report it; it’s not their responsibility to investigate or substantiate the suspicion.

8. Learn and follow school/institutional policies

Eisel v. Board of Education of Montgomery County (Md.) was the first suicide case brought against school counselors. A state court found that school counselors were partially responsible for the student’s suicide because they neglected to take further measures to prevent it, according to Wheeler. In 1991, the court ruled that school counselors had a duty to notify the parents of a 13-year-old student about the suicidal statements she had made to peers. Nicole Eisel mentioned to a classmate that she wanted to kill herself. The student notified the counselor, and Eisel was called in and questioned. After Eisel adamantly denied having suicidal thoughts to two counselors, they determined she was safe and that her statements were a nonissue. The counselors didn’t notify either school officials or Eisel’s parents. Days later, Eisel and another student committed suicide.

After that case, Wheeler says, many school districts put policies in place allowing school officials and parents to be notified when a student expresses suicidal ideation. “The point that we are trying to make here is that counselors must know what their school or institution’s policy is and follow it,” Wheeler says. “Policy not followed is worse than no policy at all.” Furthermore, she says, if counselors are in the position to make or revise policy, it’s important to make the policy workable, within state laws and in accordance with their licensing board regulations. “If you develop policy that people can’t implement in real life, then that’s worse than having no policy at all,” she says.

9. Follow rules of supervision

“Hardly any guidelines existed for supervision 10 to 20 years ago,” Wheeler says, “but a lot of the state counseling boards are now really defining what supervision is and what it entails, and they are specific on what has to be done when supervising. We strongly suggest a written contract between the supervisor and supervisee so that the agreement is clear.”

Among the elements Wheeler and Bertram suggest the contract include:

  • Meeting times and frequency
  • Expectations of both supervisor and supervisee
  • Fees (if applicable)
  • Specifics of how the supervision will occur (reviewing notes, watching sessions through a two-way mirror, tape recordings, etc.)
  • Specific circumstances to immediately notify the supervisor (a client reporting abuse, suicidal thoughts and so forth)
  • How to contact the supervisor in case of emergency

Considering that the supervisor is responsible for the actions of supervisees, Bertram says it’s good practice to keep notes on the supervising sessions, especially if ethical or legal issues are presented. “One of the most important jobs of the supervisor is to help the supervisee learn the red flags — when things are going poorly with a case and you need to take action,” he says. “(Supervisors) are there to help develop the supervisee into an independently practicing professional, so legal, ethical and clinical considerations, as well as professional behavior, should always be topics of discussion. You are there to help them become a true professional counselor rather than just someone who does counseling.”

10. Obtain appropriate professional liability insurance

Both experts strongly encourage counselors — whether in private practice or institution-based — to maintain some kind of professional liability insurance. “Make sure you get a policy that covers some amount of attorney fees and licensure board matters,” Wheeler advises. “Those are more frequent than civil suits against counselors. Counselors need to ask about the financial status of the underwriter and if the provider offers some kind of risk management help.”

Wheeler and Bertram will present three Education Sessions at the ACA Conference & Exposition in Honolulu: “Top 10 Steps to Reduce Risk of Lawsuits and Counselor Licensure Board Complaints” on Friday, March 28, at 11 a.m. and again on Saturday, March 29, at 2 p.m., as well as “Lessons Learned by Virginia Tech: How to Prevent Harm and Safeguard Privacy and Freedom” on Friday, March 28, at 7:30 a.m.

In addition, ACA recently released a revised and expanded edition of their book The Counselor and the Law: A Guide to Legal and Ethical Practice. The new edition is in accordance with the 2005 ACA Code of Ethics and contains information on current federal and state laws to guide counselors in making crucial legal and ethical decisions.

The book is available to ACA members for $33.95 and to nonmembers for $44.95. Orders (Order #72857) may be placed through the ACA online bookstore at or by calling the ACA order line at 800.422.2648 ext. 222.

For additional information or questions regarding risk management, ACA members can contact Wheeler through the ACA Insurance Trust Help Line at 800.347.6647 ext. 284. To learn more about the ACA Insurance Trust, visit

Angela Kennedy is a past senior writer at Counseling Today.

Letters to the editor:

The vital role of school counselors in the counseling profession

Brian S. Canfield March 1, 2008

Throughout my career as a practicing counselor and counselor educator, I have admired and appreciated the contributions of school counselors and the central role they have played in the development of our profession. In many states, school counselors were the driving force behind successful counselor licensing efforts.

As one of 19 national divisions chartered by the American Counseling Association, the American School Counselor Association was created by ACA members to serve the professional interests of school counselors. Over the years, ASCA has done an outstanding job promoting the interests of school counselors. As a counselor educator who has played a central role in training school counselors for almost three decades, I have always encouraged my students to become members of both ACA and ASCA. I believe that division membership, concurrent with ACA membership and state branch membership, is a responsibility of all members of the counseling professional.

For most of its history as a national organization, all ASCA members were also members of ACA. However, about 10 years ago, ACA policy was changed so that joint divisional and ACA membership were no longer required. Many recognize that this policy change resulted in some unintended and unfortunate consequences for the counseling profession. At present, ASCA has approximately 23,000 members, but only about 3,500 ASCA members currently hold joint membership in ACA.

The affiliation between ACA and its member divisions has always been and remains a voluntary association. Contrary to a common misconception, ASCA never “disaffiliated” from ACA. ASCA remains an important part of the “ACA family” — with all the rights and responsibilities of a fully chartered national division, including full voting rights on the ACA Governing Council.

The professional diversity of our 19 national divisions is a strength of ACA. However, it is not always easy to strike a balance between our collective association and the autonomy of our national divisions. At times, it has seemed like a “Federalist” versus “states’ rights” issue (something which, in the mid-19th century, led to the secession of the Southern states and the subsequent “War of Northern Aggression,” or the “War Between the States,” depending upon one’s regional perspective).

An emerging professional identity model in the field of counseling is that “counselors” are, first and foremost, members of an identifiable “profession of counseling,” even though most specialize in a particular practice area or work setting (marriage and family counseling, college counseling, school counseling and so on). This model is similar to that of the medical profession, in which all members are “medical doctors,” although they typically specialize in a particular area of practice or work setting (for example, emergency room physician, internist, psychiatrist, etc.). This model presents a common professional identity and a unified voice while concurrently respecting areas of specialization. For the field of counseling, this “single profession” model reflects the national accreditation standards of the Council for Accreditation of Counseling and Related Educational Programs. It has been the professional identity model behind successful counseling licensure in 49 states.

At present, ASCA leadership holds a different notion of professional identity — one that advocates for “multiple professions” of counseling rather than a single profession with multiple specializations. It is important to acknowledge that the ASCA professional identity model is not “wrong” — it is merely different — but it conflicts with the single profession model championed by ACA and most other professional counseling groups.

I have great respect and admiration for ASCA leaders, who are all members of ACA as well. I believe they have brought innovative leadership to ASCA. Reasonable people sometimes disagree on important issues. As such, it is important that we avoid a “them and us” position as we work toward a solution to the present impasse over professional counselor identity.

While I am a strong advocate of ASCA and the important work it does, on the issue of professional identity, I find myself in strong disagreement with my ASCA colleagues. If we are to advance as a profession and better serve the needs of society, I believe a single profession of counseling, with areas of specialization, provides a unified voice and the best model.

One area in which this professional identity issue is being played out is at the state branch level. In many states, school counselors remain seamlessly integrated into the larger ACA-chartered state branch. However, in some states, school counselors have seceded from their state branch, choosing a separate professional identity within that state. In some states, there are now two school counselor associations, with one group holding the traditional single profession/specialization model and the other embracing a school counselor identity more aligned with the teaching profession — separate and distinct from “professional counseling.”

Confounding this issue, one of ASCA’s initiatives is to draft a “unified dues” program in some states. This is an attractive membership plan — one in which a school counselor writes a single check covering annual membership dues to both ASCA and the ASCA state branch. Unfortunately, the plan excludes state branch membership, exacerbating the problem of professional unity.

Many within ACA question whether a professional identity model that holds school counseling as a separate and distinct profession, and not as a specialization of a larger profession of counseling, appropriately meets the needs of the majority of school counselors. This is of particular concern for those school counselors who did not emerge from the ranks of teachers and do not identify with the teaching profession. It is also problematic for school counselors who, in addition to certification, have obtained independent professional status as licensed professional counselors or the equivalent and wish to have professional options beyond the school setting.

While I cannot predict with any certainty what the future may hold for the counseling profession in general or the specialization of school counseling in particular, I do know that ACA will continue to support the needs and interests of our members who are school counselors. I believe this can best be accomplished in collaboration with ASCA leadership. It is my hope that we will continue to work collaboratively as we address these and other important issues that affect the future of professional counseling and school counseling.

Contact me with your thoughts via e-mail at

An ounce of prevention

Richard Yep

Richard Yep

The adage “an ounce of prevention is worth a pound of cure” resonates for me when I think about the work of professional counselors. This is also true in terms of the preparation and continuing professional development that counselors undertake, first as graduate students, and then as they move into full-time service.

As you read through this issue of Counseling Today, you will again be reminded of the benefits of taking action prior to the onset of crisis — for example, engaging in holistic counseling to decrease the risk of encountering devastating diseases such as Alzheimer’s (see “Untapped potential” on page 1). You will also see an article on page 1 (“Proactive protection pointers”) about how counselors can best avoid legal challenges to the good work that you do.

You will read about many other ways to improve your professional (and perhaps personal) life as a counselor in the various columns, articles and, yes, even advertisements that appear in our newspaper. While we sometimes also report on past events so we can learn about “what went wrong,” it is clear to me the articles that help prepare professional counselors the most are those that provide resources, information, tips and advice on how to maximize the important services that you provide to so many people each and every day.

Later this month, nearly 3,000 professional counselors, counselor educators, graduate students, researchers and related human service providers will gather for the American Counseling Association’s Annual Conference in Honolulu. We have already received registrations from several Asian nations, and the list of those coming from other countries outside of the Pacific Rim ensures that this will be an event that provides a practical, hands-on experience as well as numerous opportunities to network with colleagues from around the world. If you are attending the Annual Conference, I look forward to seeing you there. If you had not planned on going, we hope you might change your mind and join us for this major gathering that features more than 450 Education Sessions and events. For more information, including what the conference has to offer, go to

“Prevention” is a word used often in the helping professions, and it seems to me that professional counselors are the perfect service providers in how that action is put into practice. There are countless examples of how professional counselors advocate for both their clients and the profession.

One specific example of prevention is seen through the action of advocacy. Last month, more than 50 counselors, counselor educators and graduate students met during ACA’s Legislative Institute in Washington, D.C. During the three-plus days of training and education, the group learned about public policy issues impacting the counseling profession. As the culmination of the Institute, the entire delegation went to Capitol Hill to meet with U.S. senators, U.S. representatives and their policy staffs to advocate for programs that impact the clients and students served by professional counselors. In other words, by helping public policy officials to better understand the needs of their constituents, serious problems can be prevented (there’s that word again) in the future.

Over the next few years, ACA will undoubtedly look at itself in terms of how best to provide services, benefits and resources to its members. This has been a 55-year evolutionary process, and I cannot see it stopping anytime soon. When we look at change, it is in the hope that we are providing what members and other helping professionals need so they can best advocate for and help their clients and students. We want to practice “prevention” in terms of providing what you need now rather than looking back at what we should have done only after a crisis hits.

I hope that last sentence makes sense to you. I hope you also know that it means we need to hear from you about what you think the most important resources are that ACA can provide. I encourage you to let me know your thoughts.

One “sneak peek” I can share has to do with the publication you are currently reading. Counseling Today is circulated to more than 45,000 members, subscribers and institutions every month. When we look at change to meet the needs of the counseling profession, it is not done lightly. And over the next few months, we will be working on the biggest change in the history of our publication. In July, you will see a drastically revamped Counseling Today. The modifications you will see and touch have been born out of the need to “change with the times” and to respond proactively to the evolution of the counseling profession. So stay tuned!

I want you to know how much your work is valued — this is something that I want you to hear. And I also want you to know that ACA will continue to do what it can to provide resources, information and services, not only to help you as you deal with various crises, but also with ways in which prevention can be part and parcel of the wonderful services you provide.

As always, please feel free to contact me with any questions, comments or suggestions by e-mailing or calling 800.347.6647 ext. 231.

Thanks and be well.