Monthly Archives: December 2009

Counseling beyond U.S. borders

By Lynne Shallcross December 15, 2009

Deborah Pinkston moved to Venezuela in 1985 after her husband was stationed there with a church organization. She went as a missionary to work with orphanages and at-risk children but realized she needed additional training in counseling. So, during their furloughs back to the United States, Pinkston earned her master’s degree in psychology and counseling and, in 2001, began counseling in the South American nation. She founded a counseling center in 2002 and continued to work with two orphanages she had previously helped to establish until moving back to the United States earlier this year.

Whether it’s a spouse’s job, a personal desire to counsel abroad or any number of other circumstances that take U.S. counselors overseas, most find out quickly that counseling is practiced in different ways and means different things the world over. Counseling Today spoke with five American Counseling Association members who have firsthand experience counseling internationally. In sharing their stories, they suggest that many of the lessons they have learned while providing counseling in other countries can readily be applied to effective practice here in the United States.

Andrea Al-Adwani, Kuwait

Andrea Al-Adwani says the issues she deals with as a counselor in Kuwait would be familiar to most U.S. counselors — only the issues come with a unique twist. Take, for example, identity development. “Arab youth who have always attended private American or British school struggle with their developing identity versus the identity their parents want them to have,” says Al-Adwani, who has been a counselor at the American University of Kuwait in Safat for five years and has worked at a local clinic for two years.

In public schools in Kuwait, Al-Adwani says, children complete tasks by memorization. But many Kuwaitis send their children to private schools with a British or American curriculum, where they are exposed to Western influence, including an emphasis on critical thinking skills. This often leads to an unexpected consequence for the parents, who find that their children no longer believe something just because they are told it is so. For these kids, identity confusion looms large, Al-Adwani says. “If their English skills are stronger than their Arabic skills and they compare their religious teachings with historical context to interpret their faith on their own instead of following without questioning, then what does it mean to be Kuwaiti, to be Muslim? Can I still be Kuwaiti without thinking like my tribe? Can I still be a good Muslim if I talk to the opposite sex on the phone?”

Couples counseling also brings a mix of familiar and new issues to the table, she says. For example, in Kuwaiti and many Arab societies, it’s legally and socially acceptable to marry a first cousin. Some families insist on marrying within the family so the inherited wealth will be protected. And, Al-Adwani says, because a woman can only marry with the consent of her father, her choices are limited if her father expects her to marry within the family. “This is difficult if she does not like any of her cousins and even more difficult for the Kuwaiti lady who has attended Western schools and been exposed to other ways of life,” says Al-Adwani, who earned her degree from Regent University but moved to Kuwait so her half-American, half-Kuwaiti husband could manage the family business.

“Divorce is still seen as a scandalous tragedy (in Kuwait), even though the divorce rate among young people has risen substantially over the past decade,” Al-Adwani says. While a divorced man may find another wife, a divorced woman is seen as “damaged goods,” Al-Adwani continues, because she is no longer a virgin. The situation is compounded when the divorced couple is from the same family. “When cousins divorce, it can create an explosion within the tribe, with brothers and sisters blaming one another for their son’s or daughter’s poor behavior in the marriage and bringing shame on the family,” she says.

About 70 percent of the students at the American University of Kuwait are Kuwaiti, Al-Adwani says, with the rest being Egyptian, Jordanian, Syrian, Palestinian or a blend of Arab nationalities. In her work at the clinic, Al-Adwani sees clients 12 years and older from a variety of backgrounds — Arab nationalities, clients who are a blend of Eastern and Western ethnicities, women who are married to Kuwaiti men and “third-culture” Western families who move from country to country every few years. While Al-Adwani treats problems such as grief, depression and anxiety, she also handles a host of issues foreign to most U.S. counselors — including what to do when a husband or father takes a second wife, whether to wear a hijab (head scarf), the adjustment and challenges of wearing a hijab and the consequences of removing it. Lesbian-gay-bisexual-transgender issues also have a different slant in Kuwait, she says. “Members of the LGBT community face many challenges, but for many here, it is not an option for them to come out to their close friends or family members. This brings a new layer of challenges for this population as they pass through adolescence, face forced marriages and grow into adulthood.”

Second-generation trauma is another issue Al-Adwani sees quite frequently. Several Arab countries have experienced war in the past 20 years, she explains. “Kuwait’s landscape has been repaired since the Gulf War, but the people still carry the residual effects of witnessing death and destruction. Students who were small children and remember little or nothing about the war now wonder why their parents are short-tempered, judgmental, easily angered, irritable and unable to teach their children effective coping skills.” The kids take it personally, Al-Adwani says, so she tries to help them see that these responses are not about them but about the extreme situations their parents experienced. “After gaining a broader perspective, the students are often able to talk to parents calmly to work through disagreements, compromises, confrontations and boundaries and develop a much healthier self-esteem.”

When Al-Adwani arrived in Kuwait, she was amazed at the apparent lack of resources. It took her years of networking and using word of mouth to piece together a group of counselors, doctors, psychologists and a psychiatrist with whom she is comfortable working so she can give her clients the comprehensive care they need. In Kuwait, there are no mental health laws, and local laws are not always strong enough to protect victims, Al-Adwani says. “In fact, many sexual assault victims feel they cannot report the crime for fear they will not be able to get married or that the family will punish the victim for bringing shame to the household. Instead of a typical referral process used in the U.S., it is helpful for counselors in Kuwait to know when to facilitate an alliance with the strongest female family member to form an effective intervention for younger clients, especially in cases of domestic violence.”

Counselors in Kuwait need to be comfortable discussing religion, Al-Adwani says, because it is very closely tied with culture in Arab countries. In terms of techniques, Al-Adwani has made a couple of tweaks. “I have adapted my family systems framework to include drawing respectful connections between religions and using the clients’ own religious rituals as part of the process. I have increased my use of storytelling and analogies in this oral-based society, as well as helping clients reclaim their musical and dance heritage as methods of self-expression during a time when the conservative society bans public concerts and performance arts are often seen as a lower-class activity.”

Al-Adwani has also learned that it isn’t worth staking out positions she feels are “right” on certain issues if it offends the client or discredits the profession. “I may consider it perfectly fine to wear red nail polish, a sleeveless shirt or a knee-length skirt, but if I am working with a conservative Arab family, they will not even consider my help if I am dressed in a way they deem scandalous,” she says. And while Al-Adwani might otherwise feel comfortable going to work with little or no makeup, in Kuwaiti society, that signals a woman isn’t taking care of herself and, therefore, probably isn’t taking care of her family or her work. That woman would be seen as low class, Al-Adwani says. “In a classist society, people do not want to associate with someone who obviously appears to be from a lower class and will not consider them as a professional. ‘Dress for success’ means something very different in Kuwait.”

Kuwait is, in many ways, a shame-based society, Al-Adwani says. Individuals will give up autonomy rather than endure the possible shame of ruining the reputation of the family or causing younger siblings to be unable to find a good spouse, she says. “The good of the family is considered more important than the good of the individual because, in ancient times, it was the strength of the tribe that was able to protect the families and individuals. In modern times, people still do not want to be perceived as being weak or crazy, so many families choose to take their loved ones to Europe for treatment instead of risking someone in Kuwait finding out there is a problem and ‘ruining’ the family name.”

For other international counselors and even U.S. counselors with clients from an Arab culture, Al-Adwani offers a word of advice: Proceed with caution when your bias is very different from the client’s way of life. “If the client feels they are being judged by the counselor or that the counselor has a preference in the decision that the client makes, then the client may be influenced to make a decision that makes the counselor happy instead of the decision that works best for them in their culture. Clients will also terminate therapy if they make a decision that they believe will disappoint the counselor. Some clients would rather avoid contact than risk hearing or seeing shameful judgment from an authority figure, especially in a shame-based society.”

Reflecting on her five years of counseling practice in Kuwait, Al-Adwani says she’s learned not to compare cultures. “We are tempted to compare every new thing with the world we know. I have found that if I constantly compare life in Kuwait with life in the U.S., then I will always be frustrated, even angered.” The Arab mentality is quite different from Western thought, Al-Adwani says, but instead of picking one or the other, she has adopted both cultures separately. “I tell Americans who move to Kuwait that they must create a new ‘bubble’ in their head and put all the new culture in that new compartment because it simply will not fit into the same compartment as the information they bring with them from home. In my head there is both the Kuwaiti world and the U.S. world, and I can flow in and out of each of them while still maintaining the core beliefs that are important to me.”

That’s a difficult challenge and a tough mind-set to maintain, Al-Adwani admits, but she says it is crucial. “If I am tired, I can easily revert to my home culture and declare everything around me as ‘ridiculous,’ at which point I am very little help to my clients, my family or myself.”

Alemka Berliner, Uzbekistan

Wearing a backpack in the United States doesn’t usually signal that a person has a problem. But across oceans and lines of culture, perceptions can change. Being open to those different perspectives is crucial, says Alemka Berliner, a counselor and executive director of the Tashkent International Medical Clinic in Uzbekistan. Berliner remembers hearing sincere concerns from the sister of one of her Central Asian clients who had begun wearing a backpack. “(She) was concerned because there is ‘nothing he really needs in this bag’ and he is probably taking it everywhere he goes ‘just to be different,'” Berliner recalls. “She asked me if this is normal. I offered a very simplified response and shared that, in my culture, as long as the behavior does not cause harm to self or others or if the behavior doesn’t prevent the individual from functioning in society, it is not likely to be considered a disorder.” The client’s sister insisted she was still worried that her brother was not normal, even within Berliner’s definition. She told Berliner that wearing the backpack would hurt her brother because he would not be taken seriously and people would think he was strange. Because of the backpack, the sister said, her brother was not making friends, and she feared he would lose his job.

It might be hard to imagine that kind of concern in the United States, admits Berliner, who has also worked as a counselor in Croatia and Belgium. “I found that the origin, process and manifestation of many disorders are often similar across cultures, but at the same time, even the concept and understanding of what is to be considered a disorder or deviant behavior is not an agreed upon and accepted concept across cultures.” What Berliner does see as a commonality across all the cultures in which she has counseled is a search for meaning and purpose. “How we go about this search and how we see ourselves in this search clearly differ because our human experiences are different. Yet I found that the drive to make sense of one’s life, to take control of one’s life within the cultural boundaries, and a need to make reasonable explanations for one’s experiences are common to all my clients.”

Uzbekistan is a multiethnic country, with Uzbeks, Tajiks, Russians, Tatars and Koreans being just a sampling of the cultures represented among the Central Asian nation’s 28 million residents, according to Berliner. The Tashkent International Medical Clinic focuses on providing health care to foreign nationals, so Berliner’s clients hail from a multitude of cultural and ethnic backgrounds and vary in age, gender and religion. The topics Berliner addresses with clients include marital and relationship problems, work and stress-related concerns, substance abuse, grief, depression and anxiety. “Each and every presenting problem is related at least in some way or affected by the transitions or contact and experience with other cultures,” says Berliner, who earned her counseling degree from the University of Maryland University College Europe.

Counseling as a profession is not something many people are familiar with outside of the United States, Berliner says. Translating the word counselor is so difficult in some languages that psychologist is used instead. The trouble with that, Berliner says, is that the idea of psychiatry or psychology sometimes carries the stigma of a professional who works with the mentally ill or the “abnormal.”

In working abroad, Berliner has also noticed that the local law often doesn’t regulate counseling practice. “Guidance or requirements on issues involving minors and mandatory reporting may not be available,” she says. “Often there are no regulations, or they don’t apply to foreigners, and sometimes there are limited or no social services and support available for referral and consultation.”

Most of the courses on counseling culturally diverse clients as it relates to race, culture and ethnicity focus on counseling within the United States, says Berliner, who moves to a new international location every few years with her husband, a U.S. diplomat. But international counselors’ experiences with clients often involve the reverse — an individual’s cultural adjustment not to the United States but to a different country, such as Uzbekistan, after living for several years in America or elsewhere in the West, Berliner says. “I don’t speak all the native languages of the clients I see, nor can I claim full familiarity with their cultures. In the absence of that, the openness to accept and understand different realities, value systems, customs, spoken and unspoken expectations, social hierarchies (and) different ways of understanding self and others are the first steps in effective counseling in an international environment. The way of accessing this information also varies from client to client, so even assessment strategies may need to be reconsidered.”

Berliner has found that some treatment strategies, including cognitive behavioral, solution-focused and generally directive techniques, work better than others with culturally diverse and well-educated clients. But some of her Western clients seem to respond better and are more receptive to a person-centered approach, she says. “So again, no one approach fits all. In a multicultural environment such as Uzbekistan, all assumptions about human interactions are challenged, so counseling needs to take on a new dimension of sensitivity in all its aspects, from intake interview and treatment planning to counseling intervention.”

When Berliner thinks about what it means to counsel internationally, she looks at the ACA membership certificate hanging on a wall in her office. “There are words on the certificate that I believe best summarize my experience of counseling outside the U.S. — ‘uniqueness of each individual.’ I believe that working overseas requires a continuous search for and understanding of that uniqueness. I learned to guard my counseling from any attempts to fit my clients in any familiar, previously formed concept of who they may be based on their country of origin, their ethnic background, gender, age or presented life experience.”

Counselors in the United States would benefit from taking the same approach, Berliner says. “Counselors do well when they work on their awareness of their own cultural makeup and experiences, continuously work on expanding knowledge relevant to different cultural groups we work with — but making sure that we don’t try to fit our clients into what we learned about their particular culture — and strive to learn new skills and therapeutic techniques that could improve the effectiveness of our counseling intervention.”

Carly Henderson, Tanzania and Czech Republic

Knowing where you come from and taking the time to realize what that means to you and others was the most important lesson Carly Henderson learned during the six years she spent abroad working as a professional school counselor in international schools. Henderson counseled children age 3 years through fifth grade, as well as their families, in Dar es Salaam, Tanzania, from 2002 to 2005. From 2005 to 2007, she was a middle school counselor in Prague, Czech Republic. “The cultural piece is very, very important,” says Henderson, now working as a behavior consultant in a school district outside Portland, Ore. “And by this I mean my culture — all that I bring to the counseling setting. My assumptions and biases, my internalized view of others, my worldview toward politics and human rights, my racial identity development, my knowledge of and sense of self as an American overseas.” Henderson says being aware of your own culture and making the effort to understand its significance is likewise the most important thing in counseling relationships at home in the United States. “I need to know my own biases before I can ethically meet you at the table as my client.”

The majority of Henderson’s work overseas was with children of expatriates. Between the two posts, Henderson worked with children and families from Tanzania and the Czech Republic as well as Holland, South Africa, the United States, Great Britain, Romania, Russia and Japan, among others. Because few native English-speaking counselors or psychologists were present in either location, Henderson says she did more family counseling than school counselors typically do. “In some ways, my job mirrored that of a school counselor working in the U.S. However, there were several unique aspects to the job — namely, the transitory nature of the community and how that affects lifestyle and personal identity, cross-cultural factors and multiculturalism, third-culture kids, social and economic status in the home and guest countries, and access to resources and networking.”

The issue of third-culture kids, described by Henderson as children who have lived a significant part of their developmental years outside their parents’ culture, is one that she encountered quite frequently in the two international schools. “Third-culture kids build relationships to all of ‘their’ cultures, while not having full ownership in any. It’s different than an expatriate adult lifestyle in that it takes place during the developmental years, leading to a defined profile of strengths and challenges, which are shared among third-culture kids, even though their individual geographical histories vary.”

Henderson offers the example of a child who grows up in India but identifies herself as Canadian because either she was born in Canada or because one or both of her parents are Canadian. “When she lives in New Delhi as a 14-year-old, she is clearly not Indian. But when she returns to Canada for summer holidays after spending several years abroad, she is clearly not ‘Canadian’ either.”

In addition to the third-culture kids, Henderson did group and individual work with children who stayed put at the same international school from kindergarten through high school while friends and peers regularly came and went. “The effects are often overlooked. The concept of friendship and permanence of relationship changes in this setting. Children — and adults — either become quick to befriend, skipping the first few stages of bonding and getting right to the heart of it, or avoid it altogether, creating isolation and difficulty attaching to others.” International school settings often lack a full team of experts, Henderson says. In the absence of professionals who specialized in school psychology, special education, speech language pathology and occupational therapy, Henderson was called on to provide additional services, including counseling families. In addition, she made efforts to build relationships with the embassies and corporations that employed her students’ parents to ensure child safety. “For the expatriates in our school communities, there were less options or mandates for things like child protective services or wrap-around mental health services for families in need of intervention. Sometimes, the only recourse I had when faced with a situation of child abuse was to work with my school administrators and the family’s embassy or employer. The employer or embassy would put pressure on the family or return them to their home country.”

Looking back, Henderson, who found her first post through International School Services and her second through Search Associates and the European Council of International Schools, wishes she had known more about how other cultures view counseling before heading overseas. “With that said, the best way to learn this was to ask a lot of questions once I got there. There was a lot more initial work to be done in establishing the counseling relationship, including some ‘fishing’ to learn how I was viewed by my families and what they saw as my role.” Henderson even made an effort to get the word out to the teachers, who hailed from all parts of the world, about her role and what she could offer.

Henderson also reiterates the vital importance of culture. For the most part, she says, the books she read about other cultures before going abroad stereotyped groups, were overgeneralized and were written from a U.S. perspective. “African Americans, Asian Americans, Native Americans — I met few of these people overseas. However, I did work with many people from African and Asian countries. They are big and diverse places, and my bringing stereotypes to the table did me little good. I had to listen to teacher colleagues and parents and kids to understand where they were coming from and how to interpret situations from their perspectives.”

Henderson concedes she also had to learn what her own culture represented on a superficial level to those from other cultures. “(I discovered) that being an American meant things to others, and when I walked into the room as the counselor, I didn’t walk in tabula rasa.” While working in Tanzania, Henderson became a leader in the Seeking Educational Equity and Diversity program, housed at Wellesley College, but still she admits she had a lot to learn about being White. “Even in Tanzania, being White meant unearned power and knowledge. How I allowed space for others to tell their stories and assume leadership was something I needed to learn and reflect on constantly.” To counselors in the United States, Henderson says learning about themselves and reaching out to others can make a big difference. “It’s not enough not to make assumptions. As counselors, we need to actively investigate ourselves — all that we have learned and absorbed in our lives as ‘U.S.-ians.'” Also remember that the world is large and full of intelligent people, she says. “We can learn so much from others that will help us in our work and personal lives. Our national dialogue too often is about ‘What can we do for Africans?’ or insert another group who needs our money and our compassion. But forming relationships with people from other places can help us in so many ways.”

Christopher Kozlowski, Ireland

I found you when I needed you
At the end of a telephone
I had no one else to turn to
I was feeling so alone
And you listened
And you listened
And you listened
As my problems I poured out.

Those are the first lines of a poem written for Christopher Kozlowski by one of his first clients in Ireland. Kozlowski, who earned his degree in community counseling from Southern Illinois University, has been working as a counselor in Ireland’s National Counseling Service (NCS) for the past four years. NCS was founded to help people who experienced institutional abuse in Ireland’s government-funded industrial schools and orphanages (the country’s prime minister issued a formal apology for the systemic pattern of abuse in 1999). “Our service works from a counseling perspective, looking at the individual as an individual rather than a diagnosis,” says Kozlowski, who worked as an outpatient manager with the Union County Counseling Service in Anna, Ill., before moving to Ireland. Kozlowski’s clients are adults who experienced abuse, whether emotional, physical, sexual or neglect, before the age of 18. Kozlowski and his colleagues work exclusively with trauma; NCS clients either meet the criteria for post-traumatic stress disorder or exhibit significant symptoms. The duration of sessions varies widely. Kozlowski has seen clients for as few as six sessions and for as long as four years. “As a consequence of their early experiences, most if not all of my clients tend to be caretakers (but) find it extremely challenging to care for themselves or ask for help.”

One of the most powerful parts of the clients’ experience at NCS, Kozlowski says, is the respect paid to their needs. The simplest example of that, he says, is how clients are given tea or coffee and biscuits while they wait for their appointments. “This simple act has often been mentioned to me by clients and how they are made to feel at home, safe and cared for when attending services.”

One of the biggest differences Kozlowski has noticed between counseling in the United States and Ireland is the degree to which health care administration and financial reimbursement steer the course of counseling. “My experience in the U.S. was that managed care often dictated the most ‘appropriate’ service or means of engagement. Whereas here, I find counselors practicing as psychoanalytical therapists, with Gestalt, cognitive behavioral therapy and person-centered techniques, and client needs take a front seat to financial concerns.” Although Kozlowski says concise documentation is a key part of his work in Ireland, the paperwork is limited to notes about progress. His experience in the United States was that insurance companies had a great deal of influence on the number of counseling sessions and relied heavily on the diagnosis. In Ireland, however, the number of sessions is dependent on the client’s needs, and a diagnosis isn’t necessary to proceed with counseling work. “The emphasis in Ireland would be more about the well-being of the client and the client’s specific needs as opposed to the external restraints placed on counselors in the U.S. by third-party payers,” he says.

Counseling is a young profession in Ireland. Most work is done by clinical psychologists who are part of teams led by psychiatrists within a medical model, Kozlowski says. Although that means counseling opportunities are limited, he feels optimistic about the future. “Irish counseling organizations are working to establish professional standards and qualifications of practitioners while simultaneously lobbying policy makers to recognize the counselors and expand their (area of practice).”

Initially, Kozlowski was a little nervous about connecting with his clients because the Irish tend to be “fiercely nationalistic and proud of their heritage,” he says. Being a foreigner to the country and culture, Kozlowski worried that his clients wouldn’t trust him fully and would fail to benefit from the therapeutic process. “Fortunately, what I have found is that we all struggle with the same basic challenges of humanity. These common challenges link us as humans regardless of where we come from and make mutual understanding possible.”

Beyond the commonalities, Kozlowski finds being genuine of the utmost importance. “I find clients want me to be who I am. That means that I do not try and be Irish or (act like) someone with the answers to all their concerns. Instead, (it’s about) being an American who practices in Ireland and who, although a trained professional, is human, makes mistakes and sometimes needs clarification on things which may seem obvious to a client.”

While he says his clients are the ones to be congratulated for their successes or improvements, it’s clear Kozlowski’s clients think he plays a role in their healing, too. His client’s poem concludes:

It could have all been so different
I may not have made it through
But thanks to you and all your helpful staff
My mind is now renewed

Deborah Pinkston, Venezuela

During her eight years of counseling in Venezuela, Deborah Pinkston learned that, sometimes, the best thing a counselor can do is listen. One client in particular stands out in Pinkston’s mind. A young woman who was born in China but whose family immigrated to Venezuela when she was an adolescent came to Pinkston because she was struggling with the pull between Chinese tradition and her new life in another country. The client had quickly adapted to the Latin culture and fallen in love with a Venezuelan man. The client’s parents, however, had picked out a Chinese man for her to marry, leaving her feeling torn between her family’s wishes and the life she wanted to lead.

“There are no easy answers in situations such as these,” says Pinkston, who lived in Venezuela for 24 years before moving back to Arkansas in June, where she is now interning at Northwest Counseling Inc. while working to obtain counselor licensure from the state. “I sat with her as she struggled with this issue, as she poured out her pain and anguish. Joining the client and walking beside (him or her) through the process is sometimes the most valuable thing the counselor can do. It would have been easy for me as an American to say, ‘Just do what your heart tells you.’ But she was from another culture, another family, another world, and that line of reasoning wouldn’t have been of any value to her.”

During her time in Venezuela, Pinkston provided counseling services through a church, for two local orphanages and for a private hospital in the city of Valencia. She counseled people of all ages, socioeconomic levels and cultural backgrounds. Valencia is an international city, Pinkston says, so her client base included a range of different nationalities.

Many of the young adults Pinkston counseled struggled with issues of family and self. “They felt that they had a duty to their family but also had ideas about what they wanted to do with their lives that was in opposition to what their family expected or needed. Again, for a North American, the answer is easy: ‘Do what you want to do! They’ll get over it!’ In counseling language, ‘What is it that you want to do?’ It’s not that easy for a young person who is born into a collective culture.”

In Venezuela, the “client” is often the entire family, sometimes spanning three generations, Pinkston says. “With clients from ethnic backgrounds different from our own, we must be prepared to find that the client approaches the counseling session with a completely different expectation or mental picture of what counseling is all about.”

For example, she explains, Hispanic culture is a collective rather than an individual-based culture, so the well-being of the group is given priority. “It seems that Hispanic families are a perfect example of systems theory — what affects one affects everyone else, and all the relationships and dynamics are interrelated,” says Pinkston, who had as many as eight family members in a single counseling session. “The actual counseling session with a complete family can be very interesting and challenging as Grandma goes to sleep, the teen pouts and the toddlers run around the room while Dad is trying to talk.”

Although challenging, counseling the entire family at once is a fun version of group therapy, Pinkston says, and there’s never a dull moment. “It gives the counselor a unique opportunity to observe how the family interacts and all the issues that are affecting the well-being of the family and its individual members. Communication exercises can be practiced in the counseling session, and no one is left out or in the dark about what is happening in counseling.” She says it was actually refreshing to work with entire families — something that isn’t always easy to arrange with Caucasian families. “So much can be done with several individuals at once when they are all present in the counseling session. Although it may feel overwhelming at the beginning — I certainly felt overwhelmed the first time I counseled a family of three generations together — it can also be very effective in bringing about positive changes in family dynamics and relationships.”

Looking back, Pinkston wishes she had grasped from the start just how much she could learn from her clients. “I’m ashamed to say it, but at the beginning, I went in thinking I had the answers. I found out that much of what I thought I knew didn’t work for some clients because of their ethnic background.” Pinkston says counselors must put aside their biases and open their minds in order to learn. “We must be students of the individuals we are serving and students of their culture if we are to guide them through a healing process that is effective for them. Even when we feel that we are familiar with a particular culture, we must not assume that all individuals from that particular ethnic group are the same and share the same culture. There are subcultures within each culture, so the learning process never ends.”

As for counseling within U.S. borders, the advice Pinkston brings back from Venezuela is to embrace multicultural counseling. “The more relationships the counselor can build with individuals from diverse cultures and the more the counselor can travel, read and inform himself about various cultures that he may be called upon to counsel, the more prepared the counselor will be to understand the issues that may affect the counseling process and outcomes.”

When seeing clients from other cultures here in the United States, Pinkston says it’s important for counselors to keep in mind that many of the issues will be related to loss — loss of home, family, jobs or a familiar way of life — when individuals leave their home country. “We often assume that everyone who comes to the U.S. is gaining everything — a ‘step up’ for immigrants — but sometimes the opposite is true. Many individuals have left nice homes, successful careers, and they have left many of their family members behind when they come from countries that are torn by war and conflict. Others are leaving a dictatorship where the country they once loved has become a living hell.”

Parents might also be grieving the fact that their children will not fully experience the customs and traditions of their home culture, assimilating into American culture to a certain degree instead. “I raised my children in Venezuela and, at times, I grieved that they weren’t in the U.S. for Thanksgiving, Christmas, Easter and the Fourth of July,” Pinkston says. “We tried to celebrate these holidays and traditions the best we could, but it wasn’t the same as being in our home country at those special times.”

The most important thing a counselor can do is simply be there for clients and try to understand what they are going through, Pinkston says. “So much loss has occurred for many individuals, and they are dealing with these losses while at the same time trying to survive in a new culture. Adjustment issues are huge, and a caring counselor can go a long way in showing the support and guidance that our clients need.”

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Letters to the editor: ct@counseling.org

Counseling profession reaches the big 5-0

Lynne Shallcross December 5, 2009

On Oct. 11, California Gov. Arnold Schwarzenegger signed Senate Bill 788 into law, making California the 50th and final state to license professional counselors.

“This is a momentous occasion,” said American Counseling Association President Lynn Linde. “Now all 50 states and the District of Columbia and Puerto Rico have licensure. What this means is that professional counseling is now recognized in all areas of the country and, more important, that protections for the consumers will now exist everywhere. Licensure for counselors significantly expands the availability of mental health services, which is crucial to helping meet the need for services.”

California began regulating the marriage and family therapy (MFT) field in the 1960s as a consumer protection, says A. Dean Porter, president of the California Coalition for Counselor Licensure (CCCL), which led the counselor licensure effort in the Golden State. “Since then, those who wanted to do mental health counseling have pursued the MFT license. Those who wanted to do school counseling earned the Pupil Personnel Services credential. Those who wanted to do career or rehab counseling could practice without a license,” explains Porter, an ACA member who worked as a career counselor in private practice for many years.

As executive director of the California Registry for Professional Counselors, Porter received calls and e-mails from licensed counselors across the country asking how they could get licensed in California. “I had to respond that the only licenses available in California at the master’s level were the LCSW (licensed clinical social worker) and the MFT licenses,” she says. “The MFT license requires that the graduate degree focus on marriage and family, so many LPCs were unable to qualify.”

Approximately 10 years ago, Porter began educating herself on counselor licensure and presenting workshops at conferences in California about counselor licensure in other states. Then, in 2002, she convened a meeting of representatives of existing professional counseling associations in California. “Twelve of these organizations — three have since dropped out — formed the California Coalition for Counselor Licensure with the purpose of initiating state regulation of professional counselors through licensure,” Porter says. “Although there were separate attempts over the years by career counselors and rehabilitation counselors to be licensed, the recent effort by the CCCL is the first serious, well-orchestrated, persistent attempt to license counselors in California.”

CCCL’s first bill was introduced in 2005, the second in 2007. The third — and, ultimately, successful — bill was introduced in January by Republican Sen. Mark Wyland and Democratic Sen. Darrell Steinberg and received bipartisan support. Porter says the bill had the support of the Board of Behavioral Sciences, which will regulate the license, and the California Psychiatric Association. CCCL also had the cooperation and neutrality of the California Association of Marriage and Family Therapists, the California Society for Clinical Social Work and the California Chapter of the National Association of Social Workers. “After five years, we were able to work things out with the California Psychological Association and the California Chapter of the American Association of Marriage and Family Therapy so that SB 788 was not opposed when it went for the final votes,” Porter says.

“CCCL could not have accomplished this goal if it were not for the support of ACA and the National Board for Certified Counselors,” she adds. “Both organizations were generous with financial and technical support.” Like many other states, California is facing a shortage of mental health providers. Adding well-qualified LPCCs into the workforce will help address that need, Porter says. California’s new pool of professional counselors will also be able to provide more access to the underserved and enable the state to participate in federally funded programs, such as providing for veterans through the Department of Veterans Affairs.

Scott Barstow, ACA’s director of public policy and legislation, says California becoming the 50th state to license counselors will help increase the profession’s visibility. “One of the hurdles the counseling profession has always faced is that the word counselor is so generic,” he says. “Now we’re at a point where every state in the country has established pretty comparable minimum standards for being licensed as a counselor, so that word really starts meaning something.”

The bill will go into effect Jan. 1, after which time California’s Board of Behavioral Sciences will work on implementing it. There will be a six-month grandfathering period from Jan. 1, 2011, through June 30, 2011, and applications for the license will be available Jan. 1, 2012. Interested counselors can read a summary of requirements and keep abreast of updates by visiting the CCCL website at caccl.org. Now that licensure is finally established in California, the next step will be ensuring an organization is in place to protect and maintain the license, Porter says. CCCL is exploring what that organization might be.

“Today is a victory for so many counselors who have been advocating for licensure in California,” said ACA Executive Director Richard Yep upon the bill being signed into law. “This legislation will serve to regulate the profession of counseling, and that is good for the profession and for consumers of mental health services. Gov. Schwarzenegger’s signing of this bill caps an effort that began more than 30 years ago when no state licensure existed. We express our appreciation to all who were so critical in this important effort.”

The road to 50

Bob Pate vividly remembers when Virginia became the first state to license professional counselors. The year was 1976, and Carl Swanson — whom Pate refers to as the “father of counselor licensure” — was leading the charge. Pate, professor emeritus of the University of Virginia Counselor Education Program, was then a young assistant professor who helped Swanson and a group of others push for licensure. The effort began after a court case in Virginia opened the door for counseling to be recognized as a separate profession from psychology. Swanson, a counselor educator at James Madison University who was also an attorney, enlisted others to help, Pate says.

Swanson was wise enough to understand that the licensure effort needed to be cohesive and involve everyone in the counseling profession, not just the subset of people who wanted to be in private practice, Pate says. Some advocates also wanted the license to be at the doctoral level, he remembers, but Swanson knew setting the bar at the master’s level would get more people behind the effort. “His genius was seeing that this was never getting started unless it was a movement of the united counseling profession,” says Pate, a member of ACA. Putting things in perspective, before Virginia made history, counseling wasn’t recognized as a legitimate licensed profession, Pate says. But the 1976 passage of the counselor licensure bill in Virginia spread hope around the country. “It energized people to think, ’Gee, this is really possible,’” Pate says. “Virginia was all but held up as an example.”

By the dawning of the new millennium, 44 other states and the District of Columbia had followed suit with Virginia and passed counselor licensure legislation, but counselors in California, Hawaii, Minnesota, Nevada, New York and Puerto Rico were still struggling to achieve recognition. Judith Ritterman, executive director of the New York Mental Health Counselors Association, worked for 11 years on the effort in New York before a bill passed through the state Legislature in 2002. Before the passage of counselor licensure legislation, New York had almost 40 graduate school programs offering counseling, Ritterman remembers, but options for employment for those graduates were few and far between without licensing. “There was really only one thing to do, and that was to work on getting licensed,” she says.

Ritterman credits on-the-ground efforts for the bill’s eventual success. “We established a massive grassroots effort, and when you have a large-scale grassroots effort, it’s unlikely to fail,” she says. But licensure is only the beginning, Ritterman emphasizes, adding that subsequent steps include revising language in the bill, getting insurance reimbursement and educating government agencies and the public about who counselors are. Sandra Joy Eastlack, a program specialist in Hawaii’s Department of Human Services, served as president of the Hawaii Counselors Association from 2006 to 2007. She estimates that she and her colleagues spent approximately 20,000 hours working to get counselor licensure passed in Hawaii. HCA and the Hawaii Rehabilitation Counselors Association joined together to form the Alliance for Professional Counselor Licensure in an effort to push through legislation. After years of hard work, a bill passed in 2004, and after the sunset date, the governor signed it into permanent law in 2008.

Eastlack says the licensure goal was finally attained only because of constant effort. Previously, she says, Hawaii counselors had tied all their hopes to a single bill or to a single year’s effort and didn’t regroup and try again once the initial attempt failed. But one-shot thinking doesn’t work with legislation, Eastlack says, so she committed herself to seeing counselor licensure through in Hawaii, no matter how long it took.

Looking ahead

Even though all 50 states have finally secured counselor licensure, ACA’s Barstow says there’s no reason for counselors to stop their advocacy efforts now. Many lofty goals still remain for the profession. One is having counselors included in Medicare, and another is getting counselors recognized under defense health care programs. It’s Barstow’s hope that the profession’s long and concerted effort to earn licensure in every state will pave the way for even more advances. “Being licensed in all 50 states will make it easier to convince federal policy makers that now is the time to get those (other) things done,” he says.

License reciprocity is another major goal for the counseling profession — one the American Association of State Counseling Boards is fully behind. “Reciprocity is a commendable goal for AASCB to help states achieve,” says Chris Greene, AASCB president and chair of the North Carolina Board for Licensed Professional Counselors. “The National Credential Registry is the logical vehicle to move these efforts along. Each state’s board will have to decide exactly how reciprocity fits in with its state’s statutes regarding licensure. Now that all states have counselor licensure, it seems to me that our next efforts might be cooperative work for reciprocity insofar as our individual statutes will permit.”

Thomas Sweeney, professor emeritus at Ohio University and executive director of Chi Sigma Iota Counseling Academic & Professional Honor Society International, echoes the need for licensure to translate from state to state. “Because of all the changes made by legislators responding to pressures from other providers, there is a lack of portability of credentials among the states,” says Sweeney, a past president of ACA. “Establishing compatibility among the laws or at least some means of states accepting another state’s credential must be a high priority for professional counseling.”

Not only would a move toward reciprocity help individual counselors, it would also help the profession, says Sam Gladding, professor and chair of the Department of Counseling at Wake Forest University and a past president of ACA. “Portability of licensure and a unification of standards in the various states is the next step forward,” Gladding says. “If we can achieve these two goals, we will be better yet as a profession, and the public we serve will be better off because they will be assured of who we are as professionals and as a profession.”

Thirty-three years after Virginia passed the first national counselor licensure bill, Pate is still looking ahead. “I have great pride in seeing what Virginia started (in the counseling profession) nearing completion,” he says. “We still need to work on equal employment and reimbursement opportunities. But 50 is a great milestone.”

Lynne Shallcross is a staff writer for Counseling Today. Contact her at lshallcross@counseling.org. Letters to the editor:ct@counseling.org

Counseling and neuroscience: The cutting edge of the coming decade

Allen Ivey, Mary Bradford Ivey, Carlos Zalaquett and Kathryn Quirk December 3, 2009

“Experiences, thoughts, actions and emotions actually change the structure of our brains. … Indeed, once we understand how the brain develops, we can train our brains for health, vibrancy and longevity.” — John J. Ratey, A

User’s Guide to the Brain

Counseling builds new brain networks. Research in neuroscience and cognitive science is highly supportive of our emphasis on listening, empathic understanding and building strengths and wellness. Somewhat surprisingly, neuroscience’s findings on the brain result in a more complete awareness of how environment and culture shape the individual. The bridge between biological and psychological processes is erasing the old distinction between mind and body, between mind and brain — the mind is the brain.

How and why are neuroscience and cognitive science relevant to counseling practice? First, neuroscience provides comforting research that suggests most of counseling theory and practice is on target. But it also gives us a clearer understanding of why what we do actually works. Moreover, it imparts ideas for improving our work with clients. We also learn that our wellness and environmentally based orientation is correct. Unless we have a meaningful and effective environment, we cannot grow and change. In counseling, this means that our key word relationship is all that more important and that we need to honor and respect what we have done and what we can do in the future.

You likely have noticed frequent stories on television and in the popular media on brain research and its implications for the future. This research has reached a state of precision where it now has immediate meaning for counseling process and outcome. Neuroscience and neuroimaging have found that measurable structural changes occur in client brains as a result of cognitive and interpersonal therapy. Advances in positron-emission tomography scans and functional magnetic resonance imaging have made it possible to measure areas of the brain that “light up” or “fire” under various stimulus conditions. And it is not just the client who develops new neurons and neural nets in the process of counseling; the counselor’s brain is changing as well.

Getting our field to accept and learn this new area will be challenging, however. We aren’t aware of any curriculum that includes a serious discussion of how we can use neuroscience and cognitive science in counseling and therapy practice. Fortunately, our major accrediting association, the Council for Accreditation of Counseling and Related Educational Programs, anticipated this future in its 2009 standards. In relation to one of CACREP’s “eight common core curricular areas,” we found the following statement incorporating these new ideas:

“Human Growth and Development — studies that provide an understanding of the nature and needs of persons at all developmental levels and in multicultural contexts, including all of the following:

a. theories of individual and family development and transitions across the life span;

b. theories of learning and personality development, including current understandings about neurobiological behavior …”

This CACREP Standards statement provides a rationale and direction for our new future. We are now at a point where neuroscience and its related areas can and will provide a powerful impetus for adding new content to our counseling curriculum and practice. Unless we become aware of this new paradigm and change, we are in danger of falling behind in our daily practice, teaching and research. John Cacioppo and Jean Decety have written that “psychological science in the 21st century can and should become not only the science of overt behavior, not only the science of the mind, but the science of brain function.” Not only does neuroscience clearly indicate that we are on the right track, but it also demonstrates the need for updating our field if we are to remain current and relevant.

Many counseling professionals worry about the “medical model” and a possible focus on pathology. However, you will find that neuroscientists have a strong environmental orientation — client development over the life span clearly impacts the brain. Evidence suggests that effective counseling and therapy can change the brain in positive ways. In truth, neuroscience reinforces counseling’s wellness model.

Five basic concepts

Five basic concepts illustrate the usefulness of neuroscience to counseling.

1) Neuroplasticity: Simply put, the brain can change — it is not fixed. Instead, it responds to external environmental events and/or actions initiated by the individual. The old idea that the brain does not change is simply wrong. Neuroplasticity means that even in old age, new connections and neural networks are born and can continue development. Regardless of age, genetic background or life experience, change can happen. As Jeffrey Schwartz and Sharon Begley have noted, “Neuroplasticity can result in the wholesale remodeling of neural networks … a brain can rewire itself.” Effective counseling not only changes minds but changes brains as well. As helpers, we find that our brains also grow and change.

2) Neurogenesis: Counseling can support the building of new neurons! One of the most startling findings is that completely new neurons can be generated in the learning process, even in older people. The idea that we only go “downhill” in later life has been proved wrong. Neurogenesis occurs in many areas of the brain. We develop new neural networks throughout the life span in response to new situations or experiences in the environment. Exercise is particularly important as a lifetime process to ensure brain and physical health. Exercise increases blood flow and the release of positive neurotransmitters such as serotonin. Many of you reading this article have experienced the serotonin “high” of running or other physical activity. This positive high through exercise needs to be part of your treatment regime for clients. Serotonin release is particularly helpful in mitigating depression. If clients are sad, encourage them to walk or run. Not only will they feel better, but their brains will be expanding as well.

3) The importance of attention and focus: Our basic concepts of attending behavior and attention — required for the learning process that is counseling — are measurable through brain imaging. When client and counselor attend to the story, the brain of both interviewer and client become involved. Factors in attention include arousal and focus. Arousal involves the reticular activating system, at the brain’s core, which transmits stimuli to the cortex and activates neurons firing throughout many areas. Although the brain is holistic, the executive frontal cortex can determine the direction of attention. If you attend with energy and interest, and this is communicated effectively, expect your client to see you as a positive resource. The microskill of attending behavior becomes ever more important. Meditation is an excellent treatment to facilitate client focus and attention. As with exercise, evidence is clear that meditation is an important treatment and wellness alternative.

4) Clarifying our understanding of emotions: We think of the basic emotions as sad, mad, glad and fear. Disgust and surprise have been added through Paul Ekman’s research. Brain imaging now reveals that each of the emotions fires different parts of the brain. Again, we see that our basic counseling concepts are verified. The amygdala is the major seat of the negative emotions of sad, mad and fear, but it is also an energizer for learning and absorbing new input and memories. Many areas of the brain are activated by positive emotions. The prefrontal cortex and the hippocampus are obviously important, but the nucleus accumbens sends out signals to the dorsal cingulate cortex and prefrontal cortex, making it possible to focus on the positive. Thinking and feeling positively are heavily influenced by executive cognition functions.

5) Focusing on wellness and the positives: When counselors focus on negative issues and problems, this builds a self-reinforcing circularity between the “demons” of the amygdala and the frontal cortex. The result? Negative thinking, accompanied by negative feeling, which is characteristic of depression. Pessimism feeds on itself. Research is clear, however, that an effective executive frontal cortex focusing on positives and strengths can overcome the negative. Appropriate medication (for example, Lexapro and Wellbutrin) can enhance positive thinking by increasing the supply of serotonin. Albert Ellis’ and Aaron Beck’s cognitive behavior counseling does the same thing. As the old popular song goes, “You’ve got to accentuate the positive, eliminate the negative.”

Keep in mind that wellness activities such as exercise, positive reframing of old stories, interpersonal relationships, meditation and leisure all facilitate our ability to control the demons of negative thinking and feeling.

Empathy and mirror neurons

Empathy is not just an abstract idea; it is identifiable and measurable in the physical brain. Fascinating research on brain activity validates what the helping field has been saying for years. As Decety comments, “The basic building blocks (of empathy) are hardwired into the brain and await development through interaction with others. … Empathy (is) an intentional capacity.”

Let us “unpack” the meaning of that complex sentence and its implications. Mirror neurons are neurons that fire when we behave, think or feel, and they also fire when we see others behave, think or feel. Mirror neurons enable you to sense and understand what the client is saying and feeling. These neurons even impact your internal bodily responses when you are empathically experiencing the world of the client. This is a natural talent you can encourage and develop by increasing your awareness of the client and noting what happens inside your own body.

At the same time, you are awakening the mirror neurons in the client and facilitating his or her development of new connections in thoughts, feelings and action. This awakening shows in the verbal behavior of clients and the action they take as a result of the interview. And as clients restory their issues, new neural connections are born. Your empathic behavior and the relationship are central to change, further emphasizing the importance of a positive approach to change. If we listen and selectively attend only to problems as counselors, this will reinforce negative patterns in the brain and make the change process slow and clumsy.

What we learn here is that the empathic person’s brain responds to another person’s experience, even though he or she does not actually experience that person’s world. Many studies over the years back up this central point. For example, around their second year, children indicate concern for others cognitively, emotionally and behaviorally by comprehending others’ difficulties and trying to help. Perhaps you have seen two young children playing together. One falls and starts crying. Even though the second child has not been hurt, he or she also cries. This ability to observe the feelings of others could be considered the developmental roots of empathic understanding.

Decety points out that the antisocial, criminal personality has a reduced ability to appreciate the emotions of others. There is less firing of mirror neurons in the prefrontal cortex, and this deficit also appears to be a dysfunction of the energizing amygdala and hippocampus (long-term memory). Decety’s breakthrough work with children diagnosed with conduct disorder again reveals less activity in mirror neuron areas of the brain.

The nucleus accumbens is related to sexual functioning and the “high” from certain recreational drugs. It is particularly responsive to marijuana, alcohol and related chemicals and thus is key in addiction. When we seek to help an addicted client, we are working against some very powerful parts of the brain. One of our great challenges is helping these clients examine and rewrite their stories and find new actions through healthy alternative highs to replace the strengths of addiction. When you find these clients developing new life satisfactions and interests (wellness), you are influencing them toward behavior that can result in new positive responses in the nucleus accumbens and other parts of their brain. William Glasser, the founder of reality therapy, long ago stated the importance of building positive addictions to combat drugs, antisocial behavior and alcohol.

Neuroscience, stress and social justice

Stress management becomes a central strategy as we develop an increased understanding of neuroscience. Toxic and long-term stress is damaging. Paul Krugman summarizes: “Poverty in early childhood poisons the brain. …

Neuroscientists have found that many children growing up in very poor families with low social status experience

unhealthy levels of stress hormones, which impair their neural development. The effect is to impair language development and memory — and hence the ability to escape poverty — for the rest of the child’s life.” Racism, sexism and other forms of oppression send damaging cortisol into the brain.

Clients need to be informed about how social systems affect personal growth. As counselors, we can help clients understand that the issue does not lie in them, but in oppressive systems. They should avoid self-blame and self-pity. We can build strengths through a wellness approach and a focus on positive gender and cultural identity. Neuroscientists have found that the brain fires most when seeing faces that resemble one’s own. This is an important component of antiracism training. We all need to work against our personal and cultural conditioning. We can do this by studying, but more effective is moving into culturally different communities and meeting and working with people different from ourselves.

Finally, there is social action. What are you doing in your community and society to work against social forces that bring about poverty, war and oppression? Are you teaching your clients how to work toward social justice themselves? A social justice approach includes helping clients find outlets to prevent oppression and work with schools, community action groups and others for change.

Looking to the future

Neuroscience research provides an important biological foundation for understanding the impact of our work as counselors. The very act of interviewing and counseling produces changes in client memory (as well as your own). Always be aware that learning and new ideas are being constructed in the session. We suggest that counselors continue to study and learn about brain structures and functions because new findings may provide further support for our work and suggest specific guidelines for practice.

Space does not permit exploration of how specific microskills, theories and therapeutic strategies are likely to affect neurotransmitters at the deepest levels. But data are beginning to suggest that effective counseling can be more long lasting than medication in many cases. Why? We are clearly impacting neurotransmitters in the process of developing new neural networks, which contain our thoughts and feelings, which lead to behaviors. And we are simultaneously teaching skills that will last long after medication has ceased.

Brain research is not in opposition to the cognitive, emotional, behavioral and meaning emphasis of interviewing and counseling. Rather, it can help us pinpoint types of interventions that are most helpful to the client. In fact, one of the clearest findings is that the brain needs environmental stimulation to grow and develop. We can offer a healthy atmosphere for client growth and development. We advocate the integration of counseling, psychotherapy, neuroscience, molecular biology and neuroimaging, and the infusion of knowledge from such integrated fields of study, into practice, training and research.

Note: This article is adapted from Intentional Interviewing and Counseling: Facilitating Client Development in a Multicultural Society, seventh edition, by Allen Ivey, Mary Bradford Ivey and Carlos Zalaquett (Brooks/Cole/Cengage).

Allen Ivey (allenivey@gmail.com) is a 2009 ACA fellow and distinguished university professor (emeritus), University of Massachusetts, Amherst.

Mary Bradford Ivey was one of the first individuals named an ACA fellow and is vice president of Microtraining Associates.

Carlos Zalaquett is an associate professor at the University of South Florida and coordinator of the mental health counseling specialization.

Kathryn Quirk is a college counselor with Chyten Educational Services.

Letters to the editor:ct@counseling.org

A vote for the profession’s future

Richard Yep December 1, 2009

Richard Yep

When I first started my career at ACA, I was in what was then called “Government Relations.” I mainly worked on issues at the federal level and then provided grassroots training for those who wanted to interact with their elected officials.

In the mid-80s, a handful of states had enacted counselor licensure, but I knew it would be awhile before we would be able to say that all 50 states and the District of Columbia had licensed professional counselors. Admittedly, I probably didn’t know it would take quite this long or that it would take this much money, staff time and such an incredibly dedicated group of volunteers to make this goal a reality.

Good things do come to those who wait, however, and our long, arduous, 30-plus-year wait is now over. All 50 states, the District of Columbia and Puerto Rico officially license professional counselors. With passage of the counselor licensure bill in California, along with the governor’s signing of the bill, we now have a law in the Golden State! I want to personally express my congratulations to our members in California and those who constitute the California Coalition for Counselor Licensure for their hard work and determination, their ability to navigate the political system and their knowledge of how to work with our sister professions.

The effort in California was led admirably for the past 12 years by Dean Porter. She made this a labor of love and persevered when others questioned the value of such an effort. You can read more about the California counselor licensure law in this issue, but I just wanted to make sure that everyone knew how excited and appreciative I am for such Herculean efforts!

And speaking of voting, in case you miss the excitement of last year’s U.S. presidential election, you can still “go to the polls” this month as an ACA member. All individuals who were members of ACA as of Oct. 31, are eligible to cast a ballot. In addition to ACA president-elect, there are a number of regional and division slots that have competitive races. I hope you will exercise your right to vote for the candidates you think will do the best job. In this issue of Counseling Today, you can read the ACA president-elect candidates’ responses to questions posed by the ACA Nominations and Elections Committee. The candidates’ responses are thoughtful and show a deep interest in the profession. Read them, and you will obtain a sense of each candidate’s vision.

This may not be a race for the White House, but the role of ACA leadership really does have an impact on the profession and those whom our members serve. ACA has been making very positive moves in regard to meeting the needs of counseling professionals. We pride ourselves on continuing to work toward a solid financial base and delivering products, services and information to members via various communication formats. Those whom you elect will be key to our ongoing success, so please take the time to read about the candidates and then cast your ballot for the person you think will move us forward.

Last, but not least, I also want to give a “shout out” to those already serving in leadership roles at ACA. Your president, Lynn Linde, and the rest of the Governing Council met in November and tackled an incredible agenda that included the association’s new strategic plan. This will serve as a map that the staff and I use as we determine products and services and build our budget. It is an exciting time for our association, and I appreciate your support and your commitment to being a member.

I hope you will contact me with any comments, questions or suggestions that you might have. Please contact me via e-mail at ryep@counseling.org or by phone at 800.347.6647 ext. 231.

Thanks and be well.