Monthly Archives: October 2009

A natural resource

Jonathan Rollins October 20, 2009

Early on in her career as a professional counselor, Sally Atkins was working with a client who was suicidal and experiencing severe depression. Progress was painfully slow, and after several sessions, Atkins feared she and the client had reached an impasse. “As a kind of last resort, I said out of my frustration, ‘Let’s just go hiking and talk in the woods.’ I simply had this instinct that she needed to move because she was so stuck in her life,” remembers Atkins, a member of the American Counseling Association.

Atkins had occasionally taken brief walks with other clients to help put them at ease, but this was not a typical stroll in the park. The two women embarked on a strenuous hike that lasted nearly six hours. And out on the trail, in the open air, they were finally able to capture the sense of forward movement that had eluded them in the confines of the counseling office. “I felt like something happened by virtue of us being out there,” Atkins says. “It was a marathon therapy and sharing session.”

After finishing the impromptu outdoor adventure, Atkins asked if there was anything the woman could take from the hike and apply to the difficulties she was facing in her life. “Just being outside gave her a sense of emotional comfort, and she said her problems felt small when compared with the immensity of the natural world,” Atkins says. “She was proud of the physical strength she had shown on the hike, and it made her think that perhaps she also had the emotional strength to keep going when things were rough in her life. The experience also made her realize she needed to take one step at a time rather than focus on the enormity of the whole problem. That was a major shift for her. After that experience, she was more willing to explore new possibilities and found new energy for dealing with her life.”

The experience also signaled a shift in Atkins’ approach to counseling. “It really was a turning point for me in becoming more interested in and aware of the connection between nature and mental health,” she says. Atkins went on to develop the first class in ecotherapy for graduate counseling students at Appalachian State University in Boone, N.C., where she is a professor of human development and psychological counseling and coordinator of expressive arts therapy. “In teaching and in counseling, we (Atkins and ACA member Keith Davis, her coinstructor for the ecotherapy class) use nature-based experiences to help clients and students find resources for personal growth and development and to enhance their experience of relatedness with each other and with the non-human world. We see the processes of change as observed and experienced in the natural world as a model for human change and growth. … It’s not for every client or every situation, but so many clients and students tell us that they take solace in nature.”

Outside the office walls

When Rick Carroll broke into the profession in 1993, many of his clients were juveniles receiving court-ordered counseling. “I noticed right away that they didn’t want to be there,” he says. “I also noticed that if I put down my pen and paper and walked outside with them, the whole stigma of counseling kind of flew out the window. Taking them outside the walls of the counseling office was beneficial.”

Today, Carroll is a licensed professional counselor with his own private practice, and he also provides counseling services for the Children’s Advocacy Center of Bristol/Washington County, Va. Rare is the day that he doesn’t get outside with clients, either providing walk-and-talk therapy sessions at a wetlands park near his office or leading an experiential counseling group for adolescent boys. Typical group activities include caving, golfing and navigating a high-ropes obstacle course.

Carroll is a believer in incorporating nature into the counseling process for a variety of reasons. On one hand, he says, being out in nature rather than inside a counseling office can make the therapeutic process feel less threatening to clients. Many of Carroll’s clients are children who have been abused, neglected or exposed to domestic violence situations. “Eye contact can be very intimidating for these kids – or for any client for that matter,” says Carroll, a member of ACA. “If they’re not having to look you in the eye, they have a greater chance of disclosing. They want to tell their stories, and walking in the park or engaging in some other activity outdoors as we talk makes it easier for them. Going outside is not a panacea for everyone’s problems, but it gets them into a place that’s neutral.”

On the other hand, Carroll has found that being outdoors typically enhances the rapport-building process with certain tough-to-reach clients, particularly those young men who don’t consider counseling to be “masculine.”

“Most adolescents don’t think they have any problems that they need help with,” he says. “But when you’re out in nature, that includes insects and reptiles and poisonous plants. Kids kind of think of it as a risky thing, and that appeals to them. Some of the best counseling sessions I’ve had were with kids who didn’t even realize they were in counseling because we were outdoors.”

In fact, Carroll says with a laugh, the outdoor activities that are central to his experiential approach have made counseling sound very appealing to certain adolescents. In the course of counseling, Carroll took a middle-schooler on an outing to a cave. The next time Carroll dropped by the school, one of the boy’s friends approached Carroll and said, “I need to come see you. I’ve got some problems.”

Carroll also incorporates nature into his work with clients of all ages because of its versatility and flexibility. “Reality therapy, choice theory, behavior modification – you can pull from any number of approaches and use them in conjunction with nature,” he says. “I’d like to see more counselors add nature to their toolboxes. I’d like to see it recognized as a legitimate intervention and acknowledged as a resource that can help a variety of issues.”

Reeling kids in

Barbara Flom, an associate professor in the University of Wisconsin-Stout School of Education, believes school counselors could and should make better use of nature in their work with students. “It’s a huge untapped resource. Nature is free, it’s available, and our kids really need it,” says Flom, an LPC who is a member of both ACA and the American School Counselor Association. “As a school counselor for 15 years and, before that, a teacher of children with emotional and behavioral disorders, I observed the powerful calming and focusing effects of nature with a wide variety of students. I didn’t know then about the research on nature’s therapeutic benefits, but I saw its impact firsthand with my students. Most of the research is targeted at reducing aggression and building social skills, particularly with kids who are struggling with behavioral issues or feelings of connectedness.”

As a school counselor, Flom helped to run a Hooked on Fishing program that brought students outdoors to fish at the town lake. The program proved successful on a number of levels, from modifying behavior and improving students’ academic performance to helping students develop social skills and a sense of connectedness to their peers. For instance, the school’s Anglers Club targeted a group of fifth-graders who were chronically behind academically. “Each week in spring, if these students managed to be on track with their homework, they went fishing off the lake bank behind our school during the Friday noon hour,” Flom says. “They made their goal every week. The outdoors can be a powerful motivator.” Some of the school’s most challenging students were assigned to maintaining the fishing equipment and came to Flom’s office to restring the fishing poles. “Students who had been on the margins academically, socially or behaviorally really shone as leaders and role models in the natural setting,” Flom says. “We can really empower those kids who are connected to the outdoors by showing them that their skills are valued.” In addition to acting as a behavior incentive, she says the program served as a resiliency and coping tool for many of the children.

In some instances, the outdoors can help level the playing field for students who don’t feel as though they measure up socially or academically. “The (Hooked on Fishing program) was a great equalizer,” Flom says. “You could have a Ph.D. or be nonverbal, but the fish didn’t know that.”

Another school counselor in Flom’s area currently runs an after-school fishing program and has noted that many of the students who participate are not involved in any other school activity. “He’s using the program as a bridge-building opportunity for these students,” she says. “It gives them a place to fit in and find connection and a reason to want to come to school in the morning. As school counselors, we’ve got to find ways to reel in these students who aren’t connected socially, who are struggling behaviorally or academically, and nature can often provide us that window.”

A habitat for healing and growth

Counselors and other helping professionals are missing out when they don’t recognize the valuable role the natural world can play in the healing process, says John Swanson, a longtime ACA member who is recognized as a pioneer in the field of ecopsychology. “Nature can be a wonderful sanctuary for the healing of grief and loss. It can also heal us emotionally, in part because nature is nonjudgmental,” he says. “It can accept and receive all of a client’s feelings and pent-up energies, no matter how raw.”

Swanson, the author of Communing With Nature: A Guidebook for Enhancing Your Relationship With the Living Earth, recalls one instance in which he was running a men’s group and seeing group members individually. One of the men had made his fortune in the fish industry in Alaska but had seen his marriage dissolve in the process. In addition, as a boy, an older sibling had sexually abused him while his parents turned a blind eye. Raised in a puritanical, immaculate and orderly home, he had never learned how to deal with his anger, so it continued to build and fester throughout his adult life. Now an imposing man standing 6 feet 4 inches tall and weighing in the neighborhood of 260 pounds, he had a problem with pent-up rage.

“I tried to figure out a way to help him get his rage out without him destroying my office,” Swanson says. “So we created a plan.” The next time the man came for counseling, he told Swanson, “The plan worked out great. I went to the beach and rearranged furniture.”

What the man had done was visit a deserted beach in winter along the Oregon coast, where he proceeded to spend the night tossing large pieces of driftwood back into the roaring surf. The driftwood, Swanson explains, represented the home furniture the man would have liked to have taken his anger out on because of what had happened to him. “He also tossed ‘mom’ and ‘dad’ into the surf – figuratively,” Swanson says. “Truly letting his rage out would have been unsafe and socially unacceptable in a lot of places, but this allowed him to finally begin releasing some of the anger from his life and move forward again.”

Carroll has occasionally employed a similar tactic with young clients who have experienced abuse or who have problems processing their anger. For instance, he and the client might walk through the woods pretending to be samurai warriors. The client can then use his “sword” (a large stick found during the walk) to strike at objects in his path, releasing some anger in the process.

Many individuals who were abused or bullied or felt alienated escaped to nature as a form of sanctuary when they were children, Swanson says. “And as adults, I prescribe that back to them – retreating to nature to find comfort, healing, answers.”

In other cases, nature provides the proper setting for clients to achieve a fresh perspective, embrace new possibilities and discover (or rediscover) long-hidden strengths and sources of joy. Swanson, who himself embarks on an annual vision quest to “reorient my life and review how I’m doing,” recalls leading a therapy group composed of adult children of dysfunctional families. After 10 weeks of group sessions, the group went on a weekend retreat along the Oregon coast, where they participated in outdoor activities together. One of the group members was a librarian in her 50s. “When we were out on the beach, she just took off running,” Swanson says. “She was like a gazelle, graceful and quick as she ran in and out of the waves. She had a delightful smile on her face, which was such a contrast to the woman we had known in group. As a child, she had escaped the oppression of her dysfunctional family by running wild and free in her outdoor activities and after-school sports. This romp on the beach became a turning point for her. She began to take more risks and pursue more opportunities to embrace again these kinds of embodied physical activities that allowed her to reclaim that sense of abandon and freedom she had lost as an adult.”

“The natural world is the most common environment for what (Abraham) Maslow described as peak experiences, as well as for growth experiences,” Swanson asserts. “Our sense of awe in nature is often so powerful that we can be transformed by it.”

Carroll possesses similar beliefs concerning nature’s ability to effect positive change in clients. Eight years ago, he started a group called Compass for adolescents who have been abused or neglected. The group mixes experiential, cognitive behavioral and narrative therapy approaches, and group members spend several sessions discussing family dynamics and setting goals. The group also places a heavy emphasis on outdoor team-building exercises. Activities include exploring a cave with a certified spelunker and navigating a high-ropes course 40 feet in the air.

“Many of these kids’ lives are saturated with chaos and stress,” Carroll says. “When I take them out of that environment and put them into nature where they can see wildlife or the wonder of a cave, those events create the peak experience moments that Maslow talked about and, for the moment at least, nothing else matters to them. I believe there are spiritual, psychological, social and biological components to being out in nature, so this approach to counseling is also holistic.”

Even proponents of incorporating nature into the counseling process admit that it is difficult to put an empirical measure on its effectiveness in treating common problems such as depression. However, based on pre- and post-testing, individuals in Carroll’s Compass group generally get along better in school, exhibit more mannerly and compliant attitudes at home and show increased self-confidence overall after completing the program. Thanks in part to those measures of effectiveness, Carroll has been successful in securing funding for Compass for eight years, with nearly 60 adolescents completing the program during that time.

Feeling disconnected

“It’s interesting to me that when I talk with people who are battling depression and ask them about the times when they feel least depressed, they talk about when they go on walks or on vacation,” says Keith Davis, as associate professor and coordinator of the clinical mental health counseling program at Appalachian State. “And you very rarely hear someone say they spent their vacation in a high-rise. It usually involves some sort of outdoor element or activity. To me, that suggests an innate pull to the outdoors.”

In addition to being a counselor educator, Davis provides counseling to clients experiencing anxiety or depression. He likes to conduct imagery work with these individuals, asking them to describe a special place where they feel best. “I swear, 100 percent of the time, that place is in the outdoors, sitting on a mountaintop or by a lake,” he says. “It’s always tied to nature. It’s never, ‘I’m sitting in my living room or in my car.’ Still, I don’t think we understand how deep nature’s impact really goes.”

A growing literature base is exploring not only nature’s potential for addressing certain behavioral, psychological and emotional problems but also the possibility that society’s growing disconnect with nature is a major contributor to – if not the direct cause of – many of those problems. In his influential book Last Child in the Woods published in 2005, journalist Richard Louv compiled a wide body of research and coined the term “nature-deficit disorder” in proposing that direct exposure to nature is essential for healthy childhood development as well as the overall physical and emotional health of individuals of all ages. “Nature-deficit disorder describes the human costs of alienation from nature, among them: diminished use of the senses, attention difficulties and higher rates of physical and emotional illnesses,” he wrote.

In addition to attention-deficit concerns, Carroll has noticed a rise in Asperger’s-type symptoms, including social isolation and an inability to judge social cues, among his adolescent clients. Like many professionals, he believes a link exists between these problems and adolescents’ increased exposure to cell phones, computers, iPods, video games and other technology.

In working with these clients, Carroll often takes them outdoors and has them sit down, close their eyes and describe what they hear. “These ADHD kids who supposedly can’t attend to anything suddenly stop and look around in awe,” he says. “It calms them down and grounds them. It soothes them. I think it’s more of a spiritual thing than an emotional thing.” Atkins believes individuals from every age group are at increased risk of having their senses numbed because of technological bombardment. “That’s why it’s important for counselors to tap resources that are inherent in the natural world to help people who are struggling,” she says. “We live in a time and a culture where we live separate from nature. But being in the natural world calls us to be present in a sensory way that enlivens us both emotionally and physically.”

Adds Swanson, “Counselors need to look for opportunities to extend (Martin Buber’s) I-Thou mode beyond our species and help clients reconnect with their surroundings. It’s prescribing them to get out of the rat race and smell the flowers, to bicycle to work rather than spending time in their car bubbles, to create beauty in the home by spending more time gardening.”

Swanson says modern culture has cut most people off from the natural rhythms of life, creating a sense of disharmony in the process. “We’re not going to be happy campers if we’re out of synch with nature,” he says. “We’d be much better off if we started the day watching the sunrise and ended the day watching the stars rather than watching TV, listening to the birds sing rather than listening to the radio. These natural cycles are much more soothing and organic than following digital clock time and chopping everything into minutes and seconds.”

Whether addressing graduate counseling students or working with clients, Atkins emphasizes the importance of learning not just about the natural world, but from it. “One of the fundamentals is observation,” she says. “Watching the natural world, the changing seasons, can teach us about change and the seasons of life. Sometimes, as a society, we think we need to have constant daytime to be productive. But it’s also beneficial for life to lay fallow sometimes.”

Davis raises the possibility that a renewed emphasis on “natural” education could result in fewer students being branded with an ADHD label. “I don’t think the traditional public school education and structure is consistent with the learning style of all kids, especially young boys,” says Davis, who started his counseling career as a school counselor. “I won’t go so far as to say that our growing disconnect with nature is the cause of depression and ADHD, but when I see boys out in nature, they’re not required to focus on any one thing. Instead, they can just focus on being outside in the elements. It’s active and action-oriented learning, and there’s no judgment placed on their level of interaction.” In fact, Davis is inclined to believe that society’s growing disconnect with nature has led to much of the dissatisfaction and disorientation that many people feel in their lives. “I go back to the idea that I think there is an innate instinct in people that calls them to nature, that is imbedded in our genetic code,” he says. “As we have gone from a tribal society to an agricultural society to an industrial society and now to a technological society, we’ve moved further and further away from our relationship with the natural world. But many people still yearn for that connection instinctually. However, they don’t necessarily relate that connection – or that lack of connection – to their overall wellness. We’re seeing some emerging literature on wellness in the counseling field, and part of wellness is living in harmony with your environment.”

A paradigm shift

That concept of living in harmony with the environment is especially important to Davis, Atkins, Swanson and other proponents of ecotherapy. As described by Atkins, ecotherapy takes the ideas inherent in ecopsychology – an integration of ecology and psychology – and applies them to therapeutic practice.

In an article in press for the Journal of Creativity in Mental Health on ecotherapy (“Ecotherapy: Tribalism in the Mountains and Forests”), Atkins and Davis write: “We hold the conviction that our connections with nature and the environment are vitally important for our personal well-being and for the well-being of the planet.” They later add that “The paradigm of ecotherapy posits that personal health is related to the health of the planet, not just physically but psychologically and spiritually as well.”

“The idea that personal mental health is not just the matter of an isolated individual but is related to the health of the planet is a crucial idea and challenges the assumptions of modern science,” Atkins tells Counseling Today. She adds that ecotherapy is in tune with indigenous cultural knowledge and healing practices, including those beliefs that preserve practices of environmental sustainability and connectedness to nature. Atkins and Davis point out that this emphasis makes ecotherapy a potentially attractive alternative for clients who struggle to find meaning or healing in traditional, Western-based counseling approaches that primarily focus on the individual as separate from the natural world.

Swanson, whose research led to the publication of “The Call for Gestalt’s Contribution to Ecopsychology” in 1995 in The Gestalt Journal, is of the same mind. “The navel-watching approach to counseling can be overly introspective,” he says. “We can build better therapy by helping clients to explore their extrospective relationships.”

“We sometimes get stuck with the concept that mental health exists between our ears,” he continues, “but in family systems theory, we look at how relationships can help our mental health. The next leap forward is to broaden this to include all of our relationships, including the human-nature relationship. It’s essentially moving to a living systems approach from a family systems approach. If our relationship with the natural world is healthy rather than abusive, then our human relationships are more likely to be healthy as well.”

Both Swanson and Atkins are adamant that ecotherapy not be viewed as simply another subspecialty of counseling. “It’s really a paradigm change – one that I’m hoping will become central to what we do,” Swanson emphasizes. “If we shrink this down to a subdiscipline of counseling or psychology, we’re doomed.”

The ecotherapy class that Atkins and Davis teach at Appalachian State explores how experiences in nature can lead to personal healing. Atkins says students have described the class to her as life changing, and many have gone on to incorporate nature and ecotherapy ideals into their own practice as counselors. “The class gives them a renewed appreciation of the power and beauty of the natural world and its application to their own self-care as well as to the care of clients,” she says.

In addition to participating in classroom discussions, students design personal medicine shields throughout the semester – an activity that reflects a tradition within the Eastern Band of Cherokee Indians, many of whom reside in a designated territory near Appalachian State. In making the shields, students collect items from nature and assemble them in whatever way they choose. “Traditionally, these shields were power objects that evoked a person’s strength, courage and vision,” Davis explains. “They always end up very unique to the student. They are something to remind us of who we are in the deepest sense and how we are connected to the natural world.”

The ecotherapy class also takes a field trip each year to engage in and design nature-based experiences and activities. Last year, students were challenged to build structures to survive in the woods. “Then we talked about how empowering that was,” Atkins says, “and discussed the symbolic applications to other areas of our lives.”

Speaking metaphorically

Many counselors, including those who rarely step foot outside the office, testify to the effectiveness of using symbol and metaphor to speak to clients on a deeper level. But perhaps nowhere is metaphor more powerfully presented than on nature’s stage, from the changing of the seasons to the caterpillar’s metamorphosis into a butterfly.

“The big lesson of nature is that everything is cyclical. That can be both comforting and scary,” says Atkins. “Regardless, nature has this way of putting our little individual, ego-centered stories into the bigger picture.” One of Davis’ favorite counseling techniques is to take groups to a stream or river, where he asks each individual to find a rock or stone proportionate in size to the challenge he or she is facing in life. Afterward, he asks group members to carry their rocks with them as he leads them on a hike. “It’s a metaphor to show them how their life challenges, the problems they hold on to, are weighing them down. It gets them thinking about ‘What choices do I want to make?’ If they come back with a pebble, I have them put it in their shoe,” Davis says, “because even the smallest little thing can be nagging at you and affecting every other area of your life. When they finally say, ‘I can’t go on any longer,’ I say, ‘OK, are you ready to let that rock go?’ or even ‘Can I carry that rock for you for a while?’ For some people, the lesson is that they need to be willing to let others help them with their burden.”

The exercise holds a different lesson for other individuals. On multiple occasions when leading families through this activity, Davis says, a mother or a father has volunteered to carry all the rocks as their family members get tired. “The question then becomes what’s the price you’re paying for carrying everyone else’s problems?” Davis says. “It provides them with a lesson about how that action affects their overall wellness.”

In his experience as a counselor and counselor educator, Davis says, both clients and graduate students have professed a fear of nature. “But I think a lot of getting people out into nature is helping them to get over their fears, expand their comforts zones and tap into some resiliency and strength they didn’t necessarily know they had. It’s exploring what their fear is really about. In many cases, their fear of some element of nature is very symbolic of fears and doubts that are paralyzing them in other aspects of their lives. It’s simply a window into something bigger.”

Atkins realizes that although many counselors may be interested in incorporating nature into therapy, they may also feel intimidated by the prospect of where or how to begin. “I don’t think you can take any client somewhere that you don’t go yourself, so I would first encourage counselors to get out there and experience the healing power of nature themselves,” she says. “I would also emphasize that the process of helping a person be more connected to nature can be really simple. It doesn’t have to involve a hike up a mountain. It can be simple and yet have layers of meaning. It can be symbolic and cleansing. There’s just no cookbook for this. Irving Yalom said to create a new therapy for every client, and nature offers us a world of opportunities to do just that.”

Jonathan Rollins is the editor-in-chief of Counseling Today. Contact him at
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More than meets the eye

Lynne Shallcross October 14, 2009

It’s a startling fact: Two out of every three adults in the United States are overweight or obese.

That statistic, among others, is revealed in “F as in Fat: How Obesity Policies Are Failing in America 2009,” a report released in July by the Trust for America’s Health and the Robert Wood Johnson Foundation. The report shows children aren’t faring much better, with the percentage of obese and overweight children ages 10 to 17 at or above 30 percent in 30 states.

While the cost of obesity weighs heavily on health care, the toll it’s taking on mental health cannot be ignored either. As the epidemic reaches sobering new heights (and weights), counselors believe their role is more important than ever. Weight issues often stem from issues more complicated than one too many Big Macs, experts say, and it’s the work to be done beneath the surface where counseling can help most.

In light of new statistics concerning the ever-expanding obesity epidemic, Counseling Today spoke with three counselors who specialize in body image and asked for their insights on how therapy can help.

Pennsylvania: 26.7 percent adult obesity

“We have become a nation of convenience, and certainly, packaged food products, fast food restaurants and portion sizes all play a role,” says Judith Warchal, a psychologist at the Reading Hospital and Medical Center in Reading, Pa. “But it’s not just about the food that we eat. It’s a far more complex issue. If it was just ‘Stop eating,’ it would be a far easier problem to solve. Alcoholics can stop drinking (and still survive), but we can’t stop eating. So it becomes a more complex issue in trying to manage the food that we eat.”

People who are overweight or obese often experience bias and discrimination, says Warchal, an American Counseling Association member and coordinator of the master’s program in community counseling at Alvernia University in Reading. “With children, we tend to say it’s the parents’ fault, but with adults, there’s a lot of bias that they’re lazy, that they have no willpower, that they can’t perform.” According to Warchal, research has shown that overweight and obese people face discrimination at work, and doctors spend less face-to-face time with obese patients.

“Managing portion sizes is a huge issue,” Warchal says, noting that portion sizes, as well as plate sizes, have grown dramatically over the years. “We fill up our plate without thinking that maybe 10 or 20 years ago, the plate would have been a little bit smaller.”

And while our intake of food is greater, we’re exercising less as a society. Warchal notes that when a person is overweight or obese – and possibly dealing with health complications – the likelihood of exercising decreases. “If you’re tired and fatigued and you have sore joints, it’s difficult to exercise,” she says. “Physically, it becomes a vicious cycle.”

The complexity of the issue shouldn’t steer counselors away, Warchal says, because their help is needed more than ever. “I think that (a person’s weight) becomes a hidden issue,” she says. “Oftentimes in the counseling office, clients will talk about depression, social isolation and feeling alienated, but they might not address directly that their weight could be contributing to those issues.”

One solution, Warchal says, is intake screening. Just as counselors screen for things such as child abuse and suicidality, adding a question along the lines of “Has your weight ever been an area of concern for you?” could offer significant insight into the client. “There is a great opportunity for counselors to begin to assess the impact of weight and eating behaviors on their clients’ overall physical and emotional health,” Warchal says.

Many of Warchal’s clients deal with social isolation. “People who are overweight tend to avoid situations where their weight will become an issue for them,” she says. “What they report to me are feelings of embarrassment and fear.” Among the stories clients have shared: panic at the prospect of getting on an airplane because of a fear they won’t fit in their seats; a dislike of grocery shopping because they think others stare at the food in their carts; avoidance of family picnics because they worry there won’t be a chair big enough for them.

“One of the first things counselors can do is assess their own feelings about treating someone who is overweight or obese,” Warchal says. “Eliminate the self-bias – that is really important.” Overweight or obese individuals are often more attuned to other people’s reactions, she says, so creating a safe environment where clients feel unconditionally accepted is important.

Before launching into talk about weight control, Warchal cautions counselors to focus on the issue that’s most important to the client. If the client doesn’t perceive his or her weight to be an issue, the counselor should back off. “Assess readiness for change, because if the person isn’t ready, we’re not going to get anywhere,” Warchal says.

If the client is ready, Warchal says, self-monitoring activities such as keeping a food journal, exercise journal or journal of thoughts and behaviors can be useful. Clients can then write about and later talk in session about things such as their eating triggers, their feelings at a family gathering or their experience with exercise. “The perception about what others are thinking keeps a lot of people who are overweight and obese from going into a gym,” Warchal says. Beyond helping each client with his or her individual issues, Warchal challenges counselors to help change perceptions related to those who are overweight and obese. “Try to change the perception in general – our own perceptions, the client’s perceptions and the perceptions of other people in the client’s life’s – to a focus on health and not appearance.”

Illinois: 25.9 percent adult obesity

Let your client take the lead. That’s one of the most important lessons Dana Steiner ever learned.

Steiner remembers the 40-something married woman who came to her private practice in Gurnee, Ill. The client was morbidly obese, and although Steiner called her weight the “pink elephant” in the room, weight wasn’t what the woman wanted to address. Instead, she wanted to talk about her children, her husband and her career. So Steiner, an ACA member, followed her lead. Not until they’d gone through five months of weekly sessions did Steiner begin learning more about the woman’s past and present as they related to her weight.

After building trust with Steiner, the client shared that she had been raped as a teenager. In addition, her family held rigid ideas of sexuality being taboo, and she then married a man with very similar beliefs. The upshot, Steiner says, was that the client wanted to work on her image, lose weight and develop a healthier lifestyle, but her husband was opposed to those goals. He was worried that if she lost weight, her self-esteem would increase and she would assume greater power in the relationship.

Although the client stopped coming to counseling before the situation was resolved and Steiner doesn’t know how everything ultimately worked out, she keeps that lesson fresh in her mind when seeing clients. “I really learned to take my client’s pace, because if I had jumped the gun, she would have been out of there earlier,” Steiner says. “When you think it’s obvious what the client wants to talk about, don’t be so sure.”

Working with clients who struggle with their weight is familiar territory for Steiner, who estimates at least half of her clients are overweight or obese. She observes that our culture inundates people with confusing messages. “You see one ad for diet foods, one ad for McDonald’s and one ad with skinny models,” Steiner says. “Not only does it promote confusion, it promotes the sense of ‘I’m not good enough.’” And when people have a sense of self-loathing or low self-esteem, she says, it’s easy to turn to emotional eating to find some comfort. “You set up a vicious cycle,” she says.

Steiner also says our daily lives are more sedentary than they once were. Children sit in front of video games, and many adults now spend a large portion of their work life sitting in front of a computer. The trouble, Steiner says, is that we haven’t changed our eating accordingly. “We still think with the farmer mentality of three squares a day, but we don’t need that,” she says. “If you’re having three large meals a day, that’s probably way more calories than the average sedentary person needs.”

In Steiner’s experience, clients tend to minimize issues with weight not only because they feel shame in talking about them but because they believe if they only had more willpower or chose the right foods, the problem would be fixed. “It’s easy to take the client’s view that it’s not a big deal, but in fact, it is,” she says. It’s important for counselors to find out what kind of relationship the client has with his or her body, Steiner says, because people often use weight and eating as ways of distancing themselves from their physical self.

Steiner has seen clients mask issues related to self-worth, relationships and sexuality, among other things, with weight. “(The question is) what is the weight and eating doing for them, because it’s got to be doing something for them. Otherwise, they wouldn’t be doing it,” she says. Steiner first recommends that counselors aim to find out what purpose the eating serves for the client – is it to combat high stress, is the person uncomfortable with his or her sexuality, is the person eating out of boredom, is it a form of self-mutilation because the person is self-loathing? Then the counselor’s role is to help the client find an alternative solution, she says.

Many times, Steiner says, people who are overweight put their lives on hold, telling themselves they will wait to date or buy new clothes until they lose weight. What clients put on hold can be very revealing to counselors. “Maybe whatever they say they want to do, they have fears about, and the weight is the protective mechanism,” says Steiner, who often asks clients to do whatever they’ve been waiting to do – right now.

While working through the issues that may be behind their weight struggles, Steiner encourages clients not to weigh themselves. Instead of focusing on a number on the scale, she urges them to find activities and relationships that provide them with the sense of a “full” life.

“What are the activities that make you want to get out of bed in the morning?” Steiner asks. “It shouldn’t be your breakfast, unless maybe you’re a chef.” Removing the emotions from eating is important, she says, because quitting cold turkey isn’t an option. “They can’t stop eating. It has to be about food as a source of energy and providing nurture to your body.”

As a word of caution, Steiner reminds her fellow counselors that their best service to clients who are overweight or obese likely doesn’t involve providing nutritional education. “Don’t whip out your food pyramid,” she says. “We’re not talking about lack of education here. They’ve been there, they’ve read the books, they’ve tried everything. If all you present is education, then you’re missing the boat.”

Counseling this population can be challenging, Steiner concedes, because many times, weight loss happens slowly, if at all. Counselors should reframe their definition of success, she adds, because it’s not solely about getting the client down to a healthy weight. “Success is getting the client to do some cognitive restructuring about their weight and food.” Be aware of and celebrate any change, no matter how small, she says.

When working with this population, it’s also helpful for counselors to have some working knowledge of the biochemistry behind weight, Steiner says. She went back to her local community college and took a few introductory courses, including biology, anatomy and chemistry. While counselors shouldn’t be dispensing medical advice, Steiner says, being knowledgeable about the workings of the body can help them gain a better understanding of what’s going on with certain clients.

Above all else, Steiner says, “Don’t make assumptions about (clients’) readiness to address their weight or what their weight means.” She points out that a person who is 10 pounds overweight might be much more concerned with his weight than another client who is morbidly obese. Which goes back to Steiner’s original lesson – always let the client take the lead.

North Carolina: 28.3 percent adult obesity

Greensboro, N.C., counselor and dietician Julie Duffy Dillon estimates that about 50 percent of the clients she sees struggle with being overweight and are dissatisfied with their size. The reasons for the obesity epidemic are wide-ranging, but to Dillon, an ACA member, three factors stand out.

“It seems like more families are having to do things during dinnertime,” she says. When parents work late or spend much of the evening shuttling kids between sports and other activities, family mealtimes are often pushed aside, making parents more likely to forgo opportunities to set an example for their children, Dillon explains. In addition, on-the-go foods might be less healthy and lack variety. “I think it makes the kids really picky and not curious about new foods,” Dillon says. “They’re not seeing how adults eat.”

Exercise is another factor. “People are just not naturally moving as much,” says Dillon, who adds that years ago, people walked more, danced for fun and were more likely to engage in outdoor activities. What Dillon hears from her clients today is that they go to the gym, work out on a stationary machine and don’t derive much enjoyment from it. “Why would you keep doing it then?” she asks.

Weight issues also stem from a lack of self-care, Dillon says, explaining that people don’t generally take the time to listen to their bodies or refuel them properly. Many of Dillon’s clients tell her they try to work through their hunger pangs or don’t feel hungry until the end of the day. She compares that to holding your breath for a long period of time – when you finally breathe again, you gasp in a lot of air. It’s the same with food, Dillon says. When people ignore their hunger and wait to eat, they need more to feel full, portion sizes increase and they might gravitate toward instant-energy foods such as candy or cereal.

Individuals who are already overweight are just as susceptible to falling into this cycle, Dillon says, because when they feel hunger signals, they know they have overeaten in the past and don’t believe they should actually be hungry again. “People end up not trusting themselves,” she says. That mind-set often leads people who are overweight to delay eating, only to then overeat again later.

Adding to that lack of self-trust are all the stereotypes applied to larger people, from laziness to lack of intelligence to weak willpower. “Many clients start to internalize those stereotypes,” Dillon says. “If they’re not going to believe they can do it or if the message they’re getting is that it’s their fault, then they’re not going to have much motivation to change.”

Dillon uses a non-diet approach called intuitive eating with her clients. The underlying idea is to give clients unconditional permission to eat what their bodies need, she says. The approach considers clients to be their own experts, encourages them to trust their hunger and fullness signals and accepts them exactly as they are. “It allows the person to feel more accepted, more OK with themselves, more OK with their body,” Dillon says. “When a person feels that, there’s less enjoyment or craving to eat outside of hunger cues.”

Intuitive eating helps a person eat for fuel, not emotional reasons, which is an ability we’re born with, Dillon says. She gives the example of toddlers who eat until they’re full and then go off to play. “That’s before we mess around with it and tell them to clean their plate,” she says. “(The intuitive eating approach) helps a person come back to that.”

The common phrase “war on obesity” communicates a sense of urgency to people, Dillon says. While some urgency is necessary – given that poor health is never good – it can also have a downside. “What it makes people end up thinking is that they need a quick fix,” Dillon says. But all too often, quick fixes don’t stick. “Learning to trust in the body again takes time. This is more of a solution for the long term.”

One of Dillon’s clients was a woman in her 20s whose weight had reached 400 pounds. Because she was suffering medical problems due to her obesity, the woman’s doctor had referred her to Dillon. Dillon learned that the woman’s parents had put her on various diets at a very young age. She started sneaking and hoarding food, and when her parents found out, they made her feel ashamed.

Initially, rather than talking about the woman’s weight, Dillon worked to help the client accept herself just as she was. As they continued through therapy, Dillon introduced the woman to intuitive eating so she could relearn her hunger and fullness signals. The weight came off slowly at first, but after two years, the woman had lost 200 pounds. “She needed to be heard and she needed to heal her relationship with food,” Dillon says. “Giving her unconditional permission to eat is something that healed her.”

If a counselor is seeing a client who struggles with depression, it’s OK to ask how that individual feels about his or her body, Dillon says. If eating or weight has become problematic for the client, Dillon suggests that counselors team up for treatment with a doctor or a dietician because of their in-depth knowledge of physiology.

Counseling can be especially useful in helping clients explore their history with food and how they were raised, Dillon says. Being taught to clean their plate as children, being brought up in a home where money was tight or having parents who put them on a diet can all figure into people’s relationships with food later on. Dillon recommends that counselors help clients determine the factors that push them to eat beyond their hunger cues. Many times, eating is an emotional reaction – eating out of boredom, loneliness or frustration, she says. And although emotional eating can be a normal reaction according to Dillon, when it gets out of control, counselors can help clients find an alternative way of dealing with those emotions.

Dillon also cautions counselors to be aware of their own body image and food issues. For instance, a counselor might think that sugar is bad and that eating less of it is a surefire way to lose weight, but that’s not always true, Dillon says. “I wish counselors wouldn’t pass on their own food beliefs,” she says. “That’s something that really affects clients because they trust their counselor and they’re going to honor their request.”

Dillon hears from many of her clients how hard it is to bring up weight issues in counseling because of the shame they feel. It’s incredibly important for counselors to make it OK for clients to talk about weight, she says, and for that reason, Dillon believes acceptance is key above all else. “Tell clients either in actions or words that I accept you as you are,” she says. “That acceptance is what I see most clients needing, and that’s what ends up helping them lose weight in the end.”


Keeping tabs on the kids

Peter Warchal, who has been a high school counselor for 34 years in Reading, Pa., says that to attack obesity effectively at the adolescent level, schools need to implement a systemwide approach. At Warchal’s school, multiple parties are invested in trying to stem obesity among students.

  1. Teachers: Tasked with imbedding good health practices and educating students about the effects of obesity through the health and physical education curriculum.
  2. School nurse: Monitors student weights and communicates with the parents.
  3. Administration: Warchal’s school district has taken a larger role in deciding what foods and drinks are available to students in vending machines.
  4. School counselors: Warchal says he, like other school counselors, can tackle weight and obesity issues on an individual basis.

“The obesity issue needs to be done with a systemwide perspective. If you have that going for you, you have a shot at making an impact in a youngster’s life,” says Warchal, husband of fellow ACA member Judith Warchal, who also counsels overweight and obese clients in her work at the Reading Hospital and Medical Center.

– Lynne Shallcross

Lynne Shallcross is a staff writer for Counseling Today. Contact her at
Letters to the editor:

Pittsburgh pride

Lynne Shallcross October 1, 2009

When attendees of the American Counseling Association Annual Conference & Exposition head to Pittsburgh next March, they’ll be in for a treat. Whether in town just for the conference or an extended stay, they’ll find themselves in the middle of the most livable city in the United States, an honor bestowed on Pittsburgh by The Economist earlier this year. The ACA Conference, to be held March 18-22 and cosponsored by the Pennsylvania Counseling Association, will offer attendees the perfect chance to see just how much the Steel City has changed.

Speak with almost any ACA member who hails from Pittsburgh, and they’ll easily rattle off a list of things that make the city great. Chelsea Howe, an ACA member who’s called the city home all her life, says the old steel town image is long gone. “It is a vibrant city with culture, nightlife and beauty,” says Howe, who works at the Children’s Hospital of Pittsburgh in addition to running a private practice. “Pittsburgh offers many things that you find in a bigger city, but people are very friendly at the same time. It is like a big city with a small-town feel.”

Counseling Today checked in with a few other hometown members to get their lists of recommendations. So grab a highlighter and let these ACA-member tour guides show you the best of what Pittsburgh has to offer.

Megan Carbaugh

Carbaugh is a student member of ACA who grew up in Pittsburgh. She’s earning her master’s degree in counseling psychology from Chatham University as well as working full time as a program supervisor for Best Buddies Pennsylvania.

Must-see list

  • PNC Park and Heinz Field
  • Andy Warhol Museum
  • Heinz History Center
  • Kennywood amusement park
  • Pittsburgh Zoo & PPG Aquarium
  • Carnegie Science Center
  • Benedum Center or Heinz Hall (try to purchase tickets for shows in advance)
  • View from Mount Washington (for photographers – professional or not!)

Eat, drink and be merry

  • Dozen Bakeshop, a bakery and cafe with vegan options and gourmet cupcakes (
  • Primanti Bros. for their one-of-a-kind sandwiches (
  • Hofbrauhaus, a German restaurant and brewery (
  • Church Brew Works, a one-time church converted into a brewery (
  • South Side (aka East Carson Street) and Station Square have tons of places to eat and drink.
  • Fat Head’s Saloon for good food and beer, but be warned it’s often crowded (
  • The Wine Loft for good wine and relaxing with friends (

First-time visitors will be surprised to learn _

  • Pittsburgh is nicknamed the City of Bridges.
  • Pittsburgh is NOT a steel town anymore.
  • Pittsburgh has a lot of culture and beautiful sites.
  • French fries and shredded cheese are common salad toppings.

What makes Pittsburgh unique?

  • Sports teams (Steelers, Pens, Pirates)!
  • Pittsburgh was once a historically blue-collar steel town that has transformed into a modern corporate headquarters for many businesses. It hosted the 2009 G20 Summit in September.
  • The people (mostly friendly and approachable)!

What is Pittsburgh’s most overlooked treasure?

Its beauty – winding hills, rivers and bridges. Also, the Pittsburgh Zoo and Kennywood.

When visiting Pittsburgh, always remember to _

  • Check the weather forecast in the spring – prepare for rain, snow and sunshine.
  • Wear your black and gold!
  • Go to Primanti Bros. and eat a sandwich!

Gina Acquavita

Acquavita, who works at Western Psychiatric Institute & Clinic in addition to counseling in private practice, says among Pittsburgh’s chief attributes are that it’s safe, it’s affordable, there’s always something to do and its people are friendly.

Must-see list

  • Mount Washington. Take in the best views of the city on Grandview Avenue and ride one of the two inclines – some of the only working inclines left in the country.
  • Drive over the Fort Duquesne Bridge for another great view of the city.
  • Phipps Conservatory in Oakland

Eat, drink and be merry

Primanti Bros. They put coleslaw and french fries on sandwiches, and we love it!

First-time visitors will be surprised to learn …

  • Pittsburgh has 446 bridges, the most of any city in the world – three more than Venice!
  • We also have our own language: “Pittsburghese.” We who live here are known as yinzers, and people will say yinz instead of “you guys” or “y’all.” Other words include slippy (slippery), redd up (clean up) and dawntawn (downtown).

What makes Pittsburgh unique?

The bridges and accent, obviously, but otherwise, the sports fans … and all the arts! There is a cultural district downtown, tons of awesome museums and all of the music clubs for local artists, and cafes.

What is Pittsburgh’s most overlooked treasure?

Lawrenceville. It’s a neighborhood most visitors wouldn’t go to. It’s small and has been run-down for years, but in the past couple of years, huge changes have been made, and there are tons of amazing shops, museums and unique things to do.

When visiting Pittsburgh, always remember to …

Go to the Strip District! There are tons of Pittsburgh-themed restaurants and shops and stands with cheap, fresh foods – especially if you go on Saturday morning.

James Matta

Matta, a longtime Pittsburgh resident, works at California University of Pennsylvania’s Counseling Center. In addition, he works part time at Western Psychiatric Institute & Clinic and runs a small private practice.

Must-see list

A must-see for any first-time visitor is coming down what is known as the parkway west from the airport and then entering the Fort Pitt tunnel. After passing through the tunnel, you burst through the side of a large hill, and the city explodes into view. I also highly recommend taking a nighttime ride on one of the two inclines to Mount Washington to view the city. The view allows visitors to see one of the few confluences – three rivers merging into one – in the country.

Eat, drink and be merry

People from all over the world came here during the years of the steel mills to find employment and the promise of a better life. With them came their heritage, with food at the heart of it. The north side of town is known as Deutschtown or Dutchtown because of its German ancestry. Max’s Allegheny Tavern ( serves “wunderbar” German dishes. The restaurant offers an authentic beer garden, as well as my personal favorites: Viener Schnitzel, potato pancakes, sweet and sour cabbage and kasespaetzle, with apple strudel to top it off.

Another great restaurant gaining a fan following on the north side is Bistro to Go ( It has a mix of what it calls “comfort foods,” but it often has a strong New Orleans flavor thanks to one of the chefs who worked there for many years. Also worth checking out is Pamela’s ( in the heart of the Strip District for breakfast. During the 2008 presidential primary race, President Obama stopped in. He liked the flapjacks so much, he brought the owners to the White House in May to make them again.

First time visitors will be surprised to learn …

The city has been listed as the most livable city by five different independent surveys. And it’s one of the few places in the United States that was only marginally affected by the economic turndown. It’s being used as a role model for other cities.

What makes Pittsburgh unique?

The people. This might sound a bit like a cliché, but it’s true. I believe their family, work and education values are at the heart of their being. For example, I have never heard one Pittsburgher ever deny that this was a blue-collar town, even after a major overhaul in the work sector. They not only believe in themselves, but they also believe in their neighbor. It is not uncommon to hear a visitor say that when they asked someone for directions, the person stopped what they were doing and led the traveler to their destination.

What is Pittsburgh’s most overlooked treasure?

Many individuals are unaware of the rich cultural amenities. The Pittsburgh Symphony, Carnegie Museum, Phipps Conservatory, Carnegie Library of Pittsburgh, Pittsburgh Zoo and the National Aviary are just a few.

Gina Fitzmartin

Fitzmartin, who has a private practice in the Squirrel Hill neighborhood, specializes in working with eating disorders, addictions and trauma.

Must-see list

  • Head to Station Square, near where the three rivers merge, to find riverboat tours both during the day and night.
  • Go downtown to Point State Park. Enjoy the fountain, bring a picnic lunch and watch the river activity.
  • Go to the top of the Cathedral of Learning at the University of Pittsburgh for a spectacular view of the city.
  • Schenley Park (
  • Phipps Conservatory (

Eat, drink and be merry

  • Nakama Japanese Steakhouse and Sushi Bar (
  • Kiku for sushi (
  • Abruzzi’s Restaurant for Italian (
  • Paparazzi Restaurant for Italian
  • Monterey Bay Fish Grotto (
  • Zen Social Club (
  • Diesel Night Club (
  • Hard Rock Café (

What makes Pittsburgh unique?

We are very proud of our sports teams. The Steelers have won six Super Bowls, and Heinz Field is right across the river from Station Square. The Penguins hockey team won the Stanley Cup in 2009. And the Pittsburgh Pirates play in a beautiful park right next to the football stadium.

What is Pittsburgh’s most overlooked treasure?

The Oakland neighborhood.

Bea Guillen

Guillen, who attended the University of Pittsburgh as an undergrad, is finishing up her master’s in counseling psychology at Chatham University. She gives the city a thumbs-up for its affordability, friendly people and many entertainment options.

Eat, drink and be merry

My favorite restaurants in the city are Abay Ethiopian Cuisine ( in East Liberty, Udipi Café for Indian food in Penn Hills, Green Forest ( for Brazilian in Penn Hills, Fat Head’s Saloon for American in the South Side, Fuel & Fuddle ( for American and Redbeard’s Mountain Resort for American. For nightspots, my favorite bars are Redbeard’s, Hemingway’s Café ( and Fat Head’s.

What makes Pittsburgh unique?

Pittsburgh is unique in its “feel.” It is a small city that has everything one can think of, but it is convenient and affordable, with a personality of its own. The dialect is interesting, and the passion for the Steelers and the Penguins is definitely something worth experiencing.

What is Pittsburgh’s most overlooked treasure?

Our skyline.

When visiting Pittsburgh, always remember to …

Stop at Primanti Bros. for one of their super sandwiches!

Sara Gales

Gales grew up in the area and is earning a master’s in rehabilitation counseling at the University of Pittsburgh. She’s also a predoctoral fellow in the Cognitive Skills Enhancement Program at the Hiram G. Andrews Center in Johnstown.

Eat, drink and be merry

  • Fat Head’s Saloon for sandwiches, burgers and wings
  • The Church Brew Works and Restaurant
  • Italian restaurants in the Bloomfield neighborhood – the Pleasure Bar, Alexander’s, Tessaro’s
  • Toast! Kitchen & Wine Bar ( has a relaxed, laid-back atmosphere. Share a bottle of wine and talk the night away.
  • The Funny Bone ( Enjoy a night of laughter at this comedy club.

What makes Pittsburgh unique?

Pittsburgh is made up of many little neighborhoods, each with its own sense of style and cuisine. Check out Bloomfield, Shadyside, Squirrel Hill and South Side.

What is Pittsburgh’s most overlooked treasure?

The Nationality Rooms in the University of Pittsburgh’s Cathedral of Learning.

A piece of advice for first-time visitors

The Carnegie Science Center is a place for families with children to visit rather than for adults alone.

When visiting Pittsburgh, always remember to …

Get out and explore, but be patient. Construction, tunnels and bridges can sometimes make traffic difficult to handle.

Taunya Tinsley

Tinsley, an assistant professor in the California University of Pennsylvania Department of Counselor Education, says she loves Pittsburgh because of its affordability, sports teams and professional opportunities. She is also the facilitator for the ACA Sports Counseling Interest Network.

Must-see list

The North Shore (PNC Park, Heinz Field, Rivers Casino, Pittsburgh Police Fallen Officer Memorial), the downtown Cultural District, Mount Washington, Station Square, the Strip District, the South Side and the waterfront.

Eat, drink and be merry

  • Monterey Bay Fish Grotto
  • Sonoma Grille in the Cultural District for international cuisine (
  • Kaya in the Strip District for Caribbean, South American and Pacific cuisine (
  • Tusca for Mediterranean tapas (
  • Jerome Bettis’ Grille 36 in the North Shore (
  • Nakama Japanese Steakhouse and Sushi Bar for happy hour
  • The Wine Loft
  • Bossa Nova (

First-time visitors will be surprised to learn …

While Pittsburgh is historically known for its steel industry and bridges, the city is now largely based in health care, education, financial services and robotics.

What is Pittsburgh’s most overlooked treasure?

Phipps Conservatory

When visiting Pittsburgh, always remember to …

Speak Pittsburghese (!

To learn more about the 2010 ACA Conference & Exposition in Pittsburgh (March 18-22), or to register to attend, visit call 800.347.6647 ext. 222. Register early to ensure the best rates.

Online exclusive!

Here are even more insider tips from Pittsburgh pros.

Tour guide Diana Hardy

Hardy, a native of Pittsburgh, is the program manager at the Good Grief Center, a bereavement resource and referral center that offers services free of charge to the public.

Must-see list:

  • John Heinz History Center
  • Carnegie Museum and Music Hall
  • Andy Warhol Museum
  • Phipps Conservatory
  • PNC Park (baseball field)
  • Heinz Field (football)
  • The Pittsburgh Symphony
  • University of Pittsburgh
  • Duquesne University

Eat, drink and be merry:

  • Ruth’s Chris Steak House or Morton’s the Steakhouse
  • LeMont for American and French
  • Monterey Bay Fish Grotto for seafood and the best crab cakes in Pittsburgh
  • Tin Angel for American and Greek

What makes Pittsburgh unique?

Its friendly natives, landscape and notorious one-way streets.

What is Pittsburgh’s most overlooked treasure?

The items at the John Heinz History Center

Tour guide Martha Iskyan

Iskyan is a retired counselor who has owned a house in Pittsburgh for almost five years.

Must-see list:

  • Steelers or Penguins game (to feel the true Pittsburgh spirit)
  • Duquesne Incline
  • Mount Washington at night
  • Andy Warhol Museum
  • Ride on Gateway Clipper or Just Ducky tours (travel on all three rivers and get a history lesson)

Eat, drink and be merry:

  • Pho Minh (quiet Vietnamese)
  • Thai Cuisine
  • Monterey Bay Fish Grotto (mainly seafood with an incredible view)
  • Fat Head’s Saloon (great beer, good American food)

A night out

  • South Side for bars and people-watching
  • Fire House Lounge

First-time visitors will be surprised to learn…

How much Pittsburghers love Pittsburgh.

What makes Pittsburgh unique?

Friendly people and each neighborhood is unique.

What is Pittsburgh’s most overlooked treasure?

Not overlooked, but well worth the trip is Mt. Washington, especially at night.

Is there a tourist trap that first-time visitors are better off avoiding?

Primanti Bros. (unless you really like your entire meal between bread).

When visiting Pittsburgh, always remember to…

Come prepared for any weather-it is unpredictable, but cloudy a lot.

Tour guide Michael Connelly

Connelly, who has lived in Pittsburgh his entire life, is president of Positive Pathways.

Must-see list:

  • Mt. Washington and the Inclines
  • Senator John Heinz Pittsburgh Regional History Center
  • The National Aviary
  • The Strip
  • Andy Warhol Museum
  • Carnegie Museums of Art & Natural History
  • Phipps Conservatory & Botanical Gardens
  • Carnegie Science Center & UPMC Sportsworks
  • The Mattress Factory
  • Nationality Classrooms at the Cathedral of Learning

Eat, drink and be merry:

  • Mineo’s Pizza House
  • Monterey Bay Fish Grotto
  • Station Square
  • F. Tambellini Ristorante

A night out

  • Banana Joe’s Lava Lounge
  • The Town Tavern
  • Tiki Lounge

What is Pittsburgh’s most overlooked treasure?

The skyline!

When visiting Pittsburgh, always remember to…

Never wear any other football jersey except a Steeler jersey!

Tour guide Dennis Nigra

Nigra is an LPC and a school counselor in Pittsburgh.

Must-see list:

  • Andy Warhol Museum
  • Mattress Factory
  • Carnegie Science Center
  • Heinz History Museum
  • Strip District
  • National Aviary
  • Rivers Casino

Eat, drink and be merry:

  • Legends of the North Shore for Italian cuisine
  • Primanti Bros.
  • Monterey Pub on the North Side

First-time visitors will be surprised to learn…

What an attractive city Pittsburgh is.

What makes Pittsburgh unique?

History and legacy of industrial leadership and current research in medical and robotic technology.

When visiting Pittsburgh, always remember to…

Pay close attention to local dialect known as Pittsburghese.

Tour guide Dave Wheitner

Wheitner, who earned his master’s in counseling, runs a life-coaching practice.

If individuals enjoy nature, they should look on the activities calendar for Venture Outdoors at and on the site for Bike Pittsburgh ( Related to Venture Outdoors, check out the Kayak Pittsburgh rental site across from the Convention Center ( The Phipps Conservatory is also worth seeing, and wonderful hiking trails run throughout Frick Park on the east end of town. We have some great riverfront trails, and many people don’t know that you can now bicycle from Pittsburgh to Washington, DC using bicycle trails.

Also, because it’s often portrayed as a big “meat and beer” city, I’ll note a few vegetarian and vegan-friendly restaurants worth checking out. This is something that’s often neglected in write-ups, and may be helpful to some of your readers:

Zenith is a funky antique/knick-knack shop and restaurant combination on the South Side and is well-known for its Sunday brunches featuring an all-you-can-eat vegan buffet including vegan bundt cakes. It gets pretty crowded on Sundays but isn’t that busy on other nights. If you’re alone, or in a party of two or three, you may have the opportunity to sit at a table with others you don’t know and meet some cool people.

A few blocks from Zenith is the Double-Wide grill, still featuring elements of the former repair garage it occupies (including lights made from gasoline pumps), with a menu that includes options for omnivores, vegetarians and vegans.

The Quiet Storm Coffeehouse and Restaurant on Penn Avenue has a very modest atmosphere but tasty food and drinks, including a range of vegetarian and vegan options-even several vegan milkshakes. It can be very busy on Sunday mornings but quieter during the rest of week.

Oh Yeah! ice cream shop on Highland Avenue usually has five or six flavors of vegan ice cream among its options, along with a ton of toppings and “mix-ins” that many people would never consider putting in ice cream. I love fresh ginger and Chai spice mixed in with vegan coffee ice cream. Be aware that lines can be long on hot days.

Finally, if you travel to the intersection of Murray and Forbes in Squirrel Hill (one of Pittsburgh’s most walkable neighborhoods on the east end of town), you’ll be within a short walk of a few dozen restaurants (including Mediterranean and Asian options), cafes, dessert shops, small specialty shops/boutiques, a book store, convenience stores, a supermarket and a movie theater. A large number of buses including the 61A, 61B and 61C go past this intersection, and the ride from downtown will take you through the University of Pittsburgh and Carnegie Mellon campuses.

Tour guide Tawna Loutsenhizer

Loutsenhizer, who has lived in the Pittsburgh area for 45 years, is a therapist at Gateway Rehab and works in private practice.

Must-see list:

  • Mt Washington (take incline from Station Square)Strip District
  • Andy Warhol Museum

Eat, drink and be merry:Primanti Bros.

  • Aladdin’s Restaurant (Middle Eastern restaurant with several locations)
  • Abay Ethiopian Cuisine
  • Mineo’s Pizza
  • Buca Di Bepo (Italian)
  • Legends of North Shore (Italian)

A night out

  • Jerome Bettis Grille 36
  • D’s SixPax & Dogz
  • Church Brew Works

First-time visitors will be surprised to learn…

That Pittsburgh has great parks located in city limits-Frick Park and Schenley Park. The are great for walking, running and being in nature.

When visiting Pittsburgh, always remember to…

Ask about the Steelers, drop the y’all for “yinz” and remember that the city is built on a triangle, not a square, so navigating can be confusing.

Tour guide Cheryl Siniakin

Siniakin, who was born in Pittsburgh, works in therapy and counseling.

Must-see list:

Phipps Conservatory The view from Mt. Washington and the Duquesne Incline University of Pittsburgh Nationality Rooms National AviaryStrip District

Eat, drink and be merry:

Frick Café ElevenCapital Grille (steak) Café Sam (American)

First-time visitors will be surprised to learn…

That Pittsburgh rocks!

What makes Pittsburgh unique?

Pittsburgh pride and our sports teams. What is Pittsburgh’s most overlooked treasure?The Chatham University campus

When visiting Pittsburgh, always remember to…

Stop by the Original Hot Dog Shoppe for some amazing French fries!

Tour Guide Charles Esposito

Esposito, a Roman Catholic priest who provides spiritual counseling, loves Pittsburgh for all its cultural events and historically significant sites.

Must-see list:

  • The Nationality Rooms at the University of Pittsburgh and the building in which they are housed, the Cathedral of Learning, still the tallest university campus building in the world
  • The Andy Warhol museum on Pittsburgh’s North Side
  • The restored P&LE Railroad Station lobby on the South Side, now a restaurant called the Grand Concourse and just adjacent to it, an inclined plane funicular to lift to you up to Mt. Washington’s Grandview Avenue
  • The industrialist Henry Clay Frick’s Victorian mansion in Pittsburgh’s East End called “Clayton.” It has a “gasolier” over the dining room table where President Roosevelt once ate. It has an art museum and great café in the garden where you can have traditional English afternoon tea.
  • The world-famous “Falling Water” home by Frank Lloyd Wright (about an hour or so East of Pittsburgh)

First-time visitors will be surprised to learn…

How our steep hills create areas where the sidewalks need to become stairways and that because we have two rivers converging to create a third, Pittsburgh has more bridges than any other city in the world.


Pittsburgh tours

ACA members and their families can take advantage of several great tours while in town for the conference. Here are four fun excursions to complement your stay.

Pittsburgh City Tour

Let the story of Pittsburgh come alive as a knowledgeable tour guide leads you around the city. The tour begins in the downtown Golden Triangle, continues to Oakland – the cultural and educational center of Pittsburgh – and wraps up with a trip up the Duquesne Incline for a breathtaking view of the city.

Pittsburgh’s Treasure Tour

See many of the hidden treasures Pittsburgh has to offer on a trip through the Carnegie Museum of Art, the Carnegie Museum of Natural History, the Nationality Rooms in the Cathedral of Learning at the University of Pittsburgh and the Heinz Memorial Chapel.

Art Tour

The first stop on this tour is the Andy Warhol Museum, another of the four Carnegie Museums of Pittsburgh and also the most comprehensive single-artist museum in the world. Art fans will then continue on to the Mattress Factory, a museum of contemporary art.

Science Center Tour

Curious minds, old and young, will enjoy this trip to the Carnegie Science Center, the fourth of the Carnegie Museums of Pittsburgh. Take in four floors of exhibits, the Rangos Omnimax Theater with its larger-than-life films and a tour of the USS Requin, docked outside the museum.

For more information or to purchase tickets for these tours, visit


PCA cosponsors ACA Conference

When the American Counseling Association comes to Pittsburgh in March for its Annual Conference & Exposition, the Pennsylvania Counseling Association will be serving as a proud cosponsor. Counseling Today asked PCA President Holly Branthoover to share some information about her state branch of ACA.

Introduce yourself to our readers.

I assumed the presidency July 1 but have been involved with PCA for five years, serving for four years as chairperson of the Membership Committee and one year as president-elect. I am an associate professor in the counseling department at Indiana University of Pennsylvania and a licensed professional counselor working in private practice. I also volunteer with the Disaster Action Team of the Southwestern Pennsylvania Chapter of the American Red Cross and volunteered during Hurricane Katrina, providing mental health services.

Tell our readers a little bit about the makeup of PCA.

PCA, a state branch of ACA and a member of the North Atlantic Region of ACA, is committed to serving and representing Pennsylvania’s professional counselors by providing leadership and professional development. The purpose of the association is to enhance human development throughout the life span and to promote professional counseling.

What significant challenges and/or accomplishments has PCA experienced in the past year or several years?

One major focus for counselors in Pennsylvania was the securing of professional licensure. PCA was highly involved in lobbying efforts to secure licensing for LPCs and LMFTs (licensed marriage and family therapists). The law was finally passed in March 2002, and we continue to be active in legislative issues affecting counselors in our state. Each October, we hold a very successful state conference where we bring in national speakers and provide free CEUs to our members. One challenge has been keeping the organization viable in this current economic climate, considering that the association is staffed by volunteers. However, we have been successful and creative in our efforts!

What are some of the issues PCA is focusing its efforts on at this time?

Right now, we are undertaking an alliance with ACA to provide management services for PCA. We are hoping to increase consistency in providing services for our members by joining with ACA. We are also trying to help address the issue of LPC supervision in Pennsylvania. Because our licensure law is so new, students often struggle to find the LPC supervisors required to become licensed.

What does holding the ACA Conference in Pittsburgh mean to PCA and to counselors throughout Pennsylvania?

I cannot say how excited we are to have ACA in Pennsylvania in 2010! We are hoping to draw attention to our organization and how we can be of service to counseling professionals who are not already involved with our organization. We hope to boost membership and involvement, while also providing services to our current members. We will have a PCA-sponsored reception, PCA-sponsored workshops and registration benefits for our current members.

Lynne Shallcross is a staff writer for Counseling Today. Contact her at Letters to the editor:

Don’t read this column

Richard Yep

Richard Yep

I hope that title caught your attention and, now, for some reason, here you are, reading this column. Well, I figured you might start reading. Why? Because as professional counselors and counselor educators, you are inquisitive, you like to know what is going on and, as good advocates, you are problem solvers. I appreciate all of those qualities about the members of this outstanding association.

And since you have continued to this second paragraph, I will now ask you to both engage and respond. At ACA, we are blessed to have a growing number of student members. In the long run, this bodes well for the profession in many ways. While those of us on the “grayer” side of our careers begin to think of life’s activities after full-time employment, it is good to know that others are beginning to fill the proverbial pipeline and preparing to take the place of those who are retiring. In terms of the counseling profession, I like the idea that student membership in ACA continues to grow. Of course, the organization subsidizes each of those student memberships. We do so in hopes that these student members will remember the support being provided to them today even after they graduate. We need to ensure we are doing everything we can to see that student members move first into the “new professional” membership category and then ultimately continue on as professional members. Quite frankly, that doesn’t always happen.

Not moving from student membership to new professional membership and then on to professional membership in ACA means that a disconnect occurs after a student graduates. The obvious answer is that this happens due to five simple letters: M-O-N-E-Y. Even allowing first-year professionals the same dues they paid as students is not enough to get them to stay.

While many students eventually return to ACA as professional members, the lag time between those periods is something of great concern to us. We need students to see the value in maintaining their membership on a continuous basis, both during and after the matriculation process. This is where you come in (hopefully, you aren’t sorry that you kept reading!).

If you are currently a student member, were previously a student member or even if you were never a student member, I want your ideas, thoughts and input as to what ACA needs to do to ensure that individuals retain their membership as they move from graduate school to full-time careers in the profession. My phone number and e-mail address are listed at the end of this column. Let’s find out what students like about being members of ACA and what it would take for them to maintain that membership continuously throughout their careers as professionals.

I am turning to all of you because of your interest, your creativity and your desire to keep growing the counseling profession. You do such a great job of advocating for your clients and students that I figured engaging in some advocacy for your professional association would be a natural fit. You can also rest assured that your ACA leadership and staff are looking at how best to address the need to have student members maintain a continuous relationship with ACA as they emerge into the profession.

Let me thank you in advance for any input or suggestions you make.

I also want to express my appreciation for your patience as ACA made some important “back end” improvements to our website and membership database over the past few months. We did our best to keep our “downtime” to a minimum, but we also realized the changes were necessary if we were going to continue meeting the needs of those who access resources and make transactions over our website.

I hope you will contact me with any comments, questions or suggestions that you might have. Please contact me via e-mail at or by phone at 800.347.6647 ext. 231.
Thanks and be well.