Monthly Archives: January 2010

A voyage of self-discovery

Lynne Shallcross January 15, 2010

It’s often said that when you love what you do, it doesn’t feel like a job. That sentiment might be a little idealistic, but all too often, career counselors say, people miss out by not following their hobbies and passions into a career.

Cyndi Doyle met one client in that exact situation. The man was working as a mechanic at an industrial plant but came to Doyle feeling unhappy and unfulfilled. “He would have these creative ideas of how to make things better, but they didn’t value that,” says Doyle, who went into private practice a year ago after working in career and crisis counseling in the nonprofit sector for more than 15 years.

The client revealed how he’d fallen into his career path. “His father told him, ‘You need to be doing something with your hands,'” Doyle recalls. “So that’s where he went. That’s where the money was. He always had this creative side, but he was never encouraged and never knew what to do with it.”

In addition to talking to Doyle about his job, the client shared how he spent his weekends in the air, flying a plane. Despite being unhappy at the industrial plant, the man hadn’t thought to turn his beloved hobby of flying into a career. In their sessions together, Doyle and the client discussed his love for planes and his creativity and came to the realization that returning to school for aerospace engineering might be a great move forward for the man. “Being in this business, I automatically think that way, but a lot of people don’t,” says Doyle, a member of the American Counseling Association.

The résumé and job search components are a very small part of career counseling, Doyle says. At its core, career counseling is about helping people find out who they really are. “It’s having a greater understanding of yourself — your interests, your personality, your values, the skills you have — and how that works into how you would like your working world, how you would like to contribute,” she says. “It’s getting a greater picture of the person and then helping them decide where they want to go with their career.”

Many people can relate to the experience of Doyle’s client, finding themselves in a job not because of a passion but because of a push from a parent, the draw of a lucrative paycheck or some other influence. Career counseling, Doyle says, empowers people to steer their own way forward. Considering most people spend a minimum of 40 hours a week at work, their sense of fulfillment is bound to greatly affect the rest of their lives, she says. The job itself, their coworkers and the work environment can all have a major impact.

More than a job

Many times, counselors who don’t specialize in career counseling aren’t comfortable broaching the subject of careers with their clients, says Mark Pope, professor and chair of the division of counseling and family therapy at the University of Missouri-St. Louis. Some counselors focus only on what they specialize in, as opposed to treating the whole individual. “It’s a lesson for the entire profession that there are many different facets of a person’s life,” says Pope, a past president of ACA and the National Career Development Association. “Like Freud said, love and work — those are the two critical components. If we’re not talking about that with our clients and asking those questions, we may never find out that there is a problem. That’s something I think all counselors need to think about.”

Career counselors emphasize that a career is much larger than just a job — it encompasses what people do in their leisure time, as well. Everything a person does in life can be broadly interpreted as career, Pope says. Clients don’t need to seek a career counselor only when looking for a job, he adds. Ideally, career counseling would be long term, Pope says, with counselors helping clients with whatever they encountered along the road of life — adjustment to a new job, the search for a different job or “career checkups.”

In many instances, career counseling needs and mental health counseling needs overlap. “Your career affects your total life,” says Sue Pressman, a career counselor who owns her own consulting firm and is serving as president of the National Employment Counseling Association, a division of ACA. “If you are calling yourself a counselor, you better have that training in mental health.” Having a strong background in mental health is one major advantage career counselors have over other providers such as career coaches, Pressman says. “That said,” she adds, “each one of us needs to know what our limitation is and when we need to refer.” And on the flip side, Pressman believes it should be a requirement for all counselors, including those who don’t specialize in career counseling, to have at least some training in career development.

Jill Schontag, a college counselor at the University of California, Santa Cruz, says career counselors’ mental health background is crucial to their everyday work. An ACA and NCDA member who also works in private practice, Schontag says she covers topics such as family of origin, self-worth, values and identity with career clients. “Your career is a huge aspect of your life, and it affects every other piece. I think a lot of people find their identity in their career because it’s where they are every day.”

Counselors working outside the career counseling specialty need to realize how important the concept of career is to a person’s mental health, Schontag says. “It’s the majority of where our time is spent. In our culture, the reality is that we actually do spend more time with our coworkers than with our family members.” To be fulfilled and challenged in our careers — or not — has a significant effect on our lives, she says.

A person’s values, skills and interests are integral to determining whether a particular career will be a good fit, Pressman says. “Having a career that is aligned with your values, your interests and your skills and that also takes your personality into account is going to add to your quality of life.” Conversely, she says, if there is misalignment, a person’s work and quality of life will be negatively affected.

Effective career counseling, Pressman says, keeps the following truths in mind: Clients’ values should never be compromised, clients’ interests can lead them to where they will feel most satisfied and clients’ skills are the easiest variable to change through training. She gives the example of someone working at a federal agency that requires employees to always put the agency first. “If you can’t do that because maybe your family comes first, you’re always going to struggle in your work,” she says. “You’re not going to be happy, and isn’t that what life is all about? You have to look at your values and what works for you and what doesn’t.”

In addition to values, Doyle says balance has a lot to do with happiness in a career. She cautions that balance isn’t about juggling, which is what many people aim for in an effort to do it all. “Balance doesn’t mean that everything’s equal. It means it is where you want it to be,” she says.

Doyle often asks her clients to divide their life into different categories, such as hobbies, friends, family, work, spiritual health and physical health. She then asks them to draw, in two separate circles, pie charts of what the breakdown looks like currently and how they might like it to be. “That can help people set boundaries,” she says. “To me, that’s balance. It’s not when everything’s on an equal playing field.”

Economic fallout

With unemployment numbers in the double digits and a recent economic downturn that many economists classified as the worst since the Great Depression, it’s no surprise that career counselors are seeing the effects on a daily basis. Pope calls the impact of the economy on career counseling “huge.”

“One thing we find is that in times of economic transition, and this is one of those times, career counselors come to the fore even more strongly,” he says. “They’re needed even more. … You really need to have somebody you can go talk to.” Not only have the numbers of layoffs been high, which naturally causes a lot of stress, but many other people are also staying in their jobs even if they are unhappy, just to remain employed.

“The greatest challenge right now is helping people who have been laid off through no fault of their own find new employment that is satisfying and meets their values, interests and skills because, frankly, there aren’t as many jobs out there as there are people who are looking for them,” Pressman says. A second challenge, she adds, is helping people who are unhappy in their current jobs to find new, more fulfilling employment when the opportunities have been significantly lessened. But she reminds her clients that the best time to look for a new job is when they already have a job. Even in a good economy, Pressman says, she would rarely recommend that anyone leave a current job without having something else lined up.

In addition to the fear surrounding potential pink slips, Pope says he sees the economy affecting both extremes of the employment spectrum — students and retirees. After watching their savings take a hit, many older adults are delaying retirement, finding it necessary to stay in the workforce additional years to make up for what they lost. The trickle-down result is that fewer job openings are available, Pope says, and more students are delaying graduation. “It’s this big domino effect,” he says.

“I hear a lot of people delaying retirement, and I hear a lot of people coming out of retirement,” Doyle adds. “They’re scared, based on the tumble in the stock market.” She acknowledges the current scarcity in the job market is tough on graduating students but says it might be even more difficult for older workers, who may be dealing with biases related to their age from potential employers and competing with younger workers for less pay. In addition, older workers’ education may be out of date or they may not have the same level of education as their younger competitors.

Doyle says the depression and anxiety her clients are experiencing as the result of a bad economy are very real. Two of her clients are facing the possibility of losing their homes because of job loss. Doyle also reports seeing a rise in family and relationship problems in relation to career issues. In private practice, where Doyle treats children, adolescents and adults, she says some kids have come in with issues of anxiety and depression, but the problems boiled down to stress over a parent’s job. “A lot of what they were concerned about was whether or not they would have a roof over their head. It affects the system of the family and the system of individuals. It impacts everyone, not just the individual looking for the job.”

In times such as these, it’s easy for people to fall into a pattern of chasing a paycheck rather than building a career that aligns with their passions and values. When foreclosure might be around the corner, it’s not the best time to pursue a “dream job,” Doyle acknowledges. But even in a bad economy, she encourages her clients to seek opportunities that would result in a good fit rather than pursuing every stray job opening.

But finding any job at all can be hard when a person is feeling down about themselves and their abilities, Doyle says. “It feeds the cycle. If you don’t have the job, a lot of people can be depressed. And if you’re depressed, it’s hard to get the job.” Doyle works with her clients to help them identify their skills and better understand what they bring to the table so that in an interview, the optimism they feel about themselves will shine through. “Helping them to realize their strengths, helping them to build their self-esteem and self-confidence when thinking about themselves, is a huge part of (career counseling),” she says.

Oftentimes, Doyle says, a “transition job” can help — something temporary with a paycheck while the client looks for a more ideal job. Having a job — even if it isn’t the “perfect job” — begins to rebuild the person’s self-esteem, Doyle says. “In all actuality, it’s always easier to look for a job when you have a job. Perhaps they can’t be exactly where they want to be, but maybe they can step into the (target) industry somehow.”

Some of Doyle’s clients come into her office feeling dissatisfied with their jobs but are determined to “tough it out” because of the paycheck and benefits, she says. When landing another, better option isn’t immediately possible, Doyle helps clients determine where they might be able to find a sense of satisfaction outside of work so they can create a better balance for themselves. “When you think about it, we have different ways that our cup gets filled,” she says. “If you’re giving and giving and giving on the job but you’re not getting filled in any way, then you walk away empty.” Finding a job that offers fulfillment is ideal, but in the absence of that, Doyle’s goal is to help her clients “fill their cups” from other areas of life.

Trends and changing times

One of the more recent trends Pope has noticed is a transition from what used to be called placement centers at colleges and universities, which focused on finding students jobs, to career service centers. These career centers emphasize managing a career rather than locating one specific job, and alumni are returning to take advantage of the services. Pope says career service centers also hold great opportunity for career counselors, and many are moving into leadership positions within the centers. He also notes the changeover from what used to be called unemployment centers to workforce or one-stop career centers. While the majority of career counselors are in private practice, Pope says these and other services, such as government-run centers for people in the workforce, offer career counselors optional venues for putting their skills to use.

With the current pace of layoffs, another surge in career counseling has come in the form of outplacement consulting, Pope says. Sometimes, when employers announce layoffs, they offer outplacement services to their former employees. Those former employees can then seek career counseling for a certain period of time on the company’s dime, creating another job opportunity for career counselors, Pope says. There are also in-placement services, he says, which are normally offered when a large employer announces layoffs or restructures. In these cases, career counselors help employees find another job within the same company.

Another major shift has to do with contract employment, Pressman says. In a better economy, contracts were plentiful, especially for government work. But today, many of Pressman’s most highly skilled clients find it challenging to locate new contract work as the old contract expires. “There’s a lot of movement without security,” she says.

One thing Pressman tries to emphasize with her clients is the importance of adaptability and using skills in new and different ways. Pressman refers to this as “planting seeds for the changing workplace” and says even counselors can benefit from adopting this mind-set. For example, as a career counselor, Pressman says she does a lot more than just offer counseling, but it takes careful analysis to see how she might be able to transfer those skills. Graduate counseling students don’t normally take course work on conflict resolution, Pressman says, but “if that isn’t something that counselors live and breathe every day, then I don’t know what is.”

Realizing that was a skill set she could offer, Pressman taught a class on managing conflict at a federal agency through a local university’s office of continuing education. Just as she does with her own career, Pressman encourages her clients to look for new ways to practice what they already know.

There have been times in the past when people were very focused on getting a lucrative, powerful job and moving up the ladder, says Pat Schwallie-Giddis, president of NCDA and chair of the Department of Counseling/Human and Organizational Studies at George Washington University. But post-9/11, that mentality changed, she says, with more people searching for jobs that offer meaning. Schwallie-Giddis says people now routinely tell her, “None of us know what the future holds. I want to do something with my life that has meaning.”

Another way the workplace has changed is with the increasingly temporary view people take regarding jobs, Schontag adds. “Students are starting to realize that they’re not going to get a job and retire 50 years later with a gold watch,” she says. “It’s just not the reality anymore.” That’s good news for career counselors, she says, who now have potentially lifelong clients who will need career guidance as they move from one position to the next. Schontag sees continuing education and continuing self-exploration as the future. “I think that’s going to be more the norm,” she says. “Always moving forward and looking for the next step.”

In the past decade or so, Pope says, career counselors began paying more attention to culture and doing more work with a social justice mind-set. No longer does career counseling focus solely on college students and business professionals. “It’s focusing on the fringe and edges of society,” he says.

Take, for example, past offenders. In the past, felons would finish their terms in prison and then be sent back onto the streets with little help. Now, Pope says, the transition planning and follow-up are better, opening the door for career counselors to help past offenders plan for the future.

Regardless of the client, Pope says, a career counselor needs to understand the many cultures that make that person who they are, taking into account everything from gender and race, to sexual orientation and age, to urban or rural lifestyle. The danger of not taking the time to understand a person’s culture, he says, is that counselors might assume everyone thinks like them and possesses the same experiences.

Pope gives the example of a career counselor who has a Chinese client. The counselor needs to talk to the client about his life and career needs while also understanding that the client comes from a collectivist rather than an individualist culture. That means the client’s decision making will normally be conducted at the group level rather than reaching a decision independently in isolation.

“When you’re looking at career counseling, there’s not just one way to do it,” Pope says. “You have to look at the individual.”

Returning veterans

With wars in Iraq and Afghanistan, the number of returning veterans will continue to rise. That creates a need for counselors, Schwallie-Giddis says, not only in mental health counseling but in career counseling as well. She has met with returning veterans who are now students at George Washington. Some returned home to find that an old job wasn’t there as promised, while others said they felt like different people and wanted to do something new.

Pope says veterans are returning to campuses nationwide to take advantage of the GI Bill benefits. As a result, he says, programs have been created that focus on veterans as students and help them with this change. The challenge for veterans is not just returning to school and passing classes, Pope says, but dealing with the stress that can accompany the transition from military to civilian life. He believes career counselors are uniquely qualified to help in this situation because of their training and competency in dealing with the whole person.

“Veterans who are returning from the armed forces these days are especially vulnerable, so career counselors need all of their counseling skills in working with this population,” Pope says. “There are large number who are returning with a physical disability from wounds suffered during the two wars that are ongoing. This changes for many of them the way that they can work, and the adaptation to that also requires much grief counseling over the losses — of their dreams of what they thought life would be like, other losses of military comrades who were killed, of lost love relationships. These losses are dramatic. Returning vets are either very fragile or very resilient. It depends on the individual. These issues can have important effects on the process of career counseling, and career counselors have to be ready to address these issues as they help our veterans sort this all out. It adds layers of complexity to the career counseling, but it’s what we train our career counselors and all counselors to do.”

Schontag helped start a program for veterans at the University of California, Santa Cruz, about two years ago. Veterans Education Team Support (VETS) is a peer mentor program offering veterans the chance to get support from other veterans and assistance in the transition back to being a student. “It was something I helped spearhead because I felt like, here we were at war, but it seemed like college campuses hadn’t really caught up with the Department of Veterans Affairs in giving support to vets on campus,” Schontag says. The effort had a personal side for Schontag, whose father-in-law did three tours in Vietnam.

Research Schontag did for her dissertation, which focused on veterans returning to college campuses, showed that veterans trust other veterans more readily than civilians when it comes to getting referrals for resources or support. That’s why Schontag felt it was important for returning veterans-turned-students to have a place to go for support. In addition to peer support, a counselor is available to the veterans, Schontag says.

Although Schontag isn’t a counselor with the VETS program, she sees a complete range of students at the university, including some veterans. On top of the post-traumatic stress that many veterans experience after returning from war, Schontag says the transition back to student life can be difficult as well. “There’s the isolation of being back on a college campus where most of the students don’t have the experience they’ve had,” Schontag says. Ironically, it can also be jarring to go from the stressful environment of war to the more relaxed environment of a college campus, she adds. “Our students work hard and classes are difficult, but it’s not life or death. They’re just coming from such different worlds.” If nothing else, Schontag says, she wanted to raise awareness among her colleagues that this population exists and that its members have unique needs and struggles.

When it comes to working with veterans as a career counselor, Schontag says her job involves helping them reintegrate into the civilian work world. “A big part of this work is to help them identify, own and articulate all the skills that they gained in the military,” she says. “Most vets I’ve worked with have many valuable transferable skills to offer any employer. The challenge is to present these strengths in a way so that a recruiter can understand how these military skills match their needs.”

Careers over the life span

Counselors who don’t specialize in career counseling can take advantage of opportunities for professional development, Schwallie-Giddis says. Whether taking courses at a local university, watching online webinars or attending professional conferences, she says there’s no limit to the information available.

Many people will continue their careers their whole lives, Schwallie-Giddis says. That means counselors have the opportunity to take a holistic approach and look at the whole person over the entire life span. This includes helping clients to identify goals, find fulfilling jobs and, eventually, transition to retirement.

But even retirement isn’t the end, Schwallie-Giddis points out. The next step is helping clients figure out how they’d like to fill their post-retirement time. She cites research showing that people who remain active in retirement live longer. “What more of an incentive do you need than that?” she asks, adding that she encourages people to “reinvent” themselves rather than simply retire.

Schwallie-Giddis need go no farther than her Alexandria, Va., church to witness the payoff for someone who is passionate about her career. On a recent Sunday, Schwallie-Giddis and the rest of the congregation celebrated the 100th birthday of one of the church members. The woman was a nurse who stayed active and involved well past retirement age, even starting a program in which nurses visit the homes of new mothers. The woman could — and probably should — serve as a role model for all of us, Schwallie-Giddis says. “She’s very healthy and happy at the age of 100.”

Lynne Shallcross is a senior writer for Counseling Today. Contact her at lshallcross@counseling.org.

Letters to the editor: ct@counseling.org.

Career counseling and social justice

Rebecca Toporek, coordinator of the career counseling specialization in the Department of Counseling at San Francisco State University, calls on counselors to be aware of social justice issues related to career development that may arise because of the struggling economy. “When things aren’t going well and people feel like they don’t have control in their environment, there’s a wearing away of trust and there’s an increase of anxiety and fear and a lot of uncertainty,” says Toporek, a member of ACA, NECA and NCDA. “That uncertainty ends up affecting the way they see themselves. Within that context, I think social justice issues are more likely to come up.”

When jobs are scarce, people are more likely to let unfair employment practices skate by, Toporek says. These practices might range from discrimination to employees being asked to go well beyond the call of duty to retain their jobs. “People are feeling less likely to challenge situations that are not right,” she says.

Toporek’s first recommendation to career counselors is to acknowledge the experience for their clients. Many times, she says, people convince themselves they must only be imagining that discrimination is taking place or place the blame and responsibility on themselves. Toporek says it’s important for counselors to be knowledgeable of employment law and help educate clients about their rights. But it’s equally important, she says, to know when to refer a client to someone with more expertise, such as an employment attorney.

Outside of working with their own clients, Toporek says career counselors have a unique opportunity to advocate for social justice on a larger scale, and the ACA Advocacy Competencies can help. For example, counselors can advocate at the community level if they see a group of individuals facing the same employment barriers. Or, they can advocate at the legislative level, which Toporek admits is the broadest level and least likely to show short-term benefits. “But in the broader scope, it’s really important.”

Toporek also emphasizes the potential of “social entrepreneurship” in addressing extensive social issues, including poverty, homelessness and underemployment. “Social entrepreneurship is an approach that combines service, training and programs. (It) does not rely only on public funds or donations but looks at ways of accomplishing large-scale change through engagement of people who are in need,” Toporek says. “Some of this entails training budding career counselors to be creative in assessing community needs, rallying the community as active participants in designing and carrying out programs, and collaboratively creating ways to fund these endeavors, whether through grants or entrepreneurship.”

“Social justice in career counseling is critical in this climate of economic crisis,” Toporek continues, “where those who had few resources before become even more exposed to cuts and disparities in areas such as public education and job training, health, housing and basic services. Career counselors must be able to recognize the larger system within which these problems exist and intervene beyond the individual. Because career counselors work directly with people in need, they can convey the human stories, the vision of the strength and potential of clients and communities that are persuasive in policy-level decisions that affect the most vulnerable.”

— Lynne Shallcross

Putting a human face on homelessness

By Lynne Shallcross January 14, 2010

Sandy Sheller understands that, sometimes, the best counseling session might take place just waiting for the bus.

Sheller, the coordinator of mental health training for the Salvation Army of Greater Philadelphia, vividly remembers a client who was having trouble making it to a drug rehabilitation program. A caseworker informed Sheller that the woman, who was in her late 30s, was being “noncompliant” by refusing to go to the rehab program, which was a requirement for her to stay in the shelter.

Instead of lecturing the woman, demanding an explanation or jumping to conclusions, Sheller asked the client to talk about her situation. The key, Sheller says, was asking in an empathetic, nonjudgmental way. “I wasn’t trying to make her do anything, and she knew that,” says Sheller, who worked as an art and family therapist in an inner-city Salvation Army family shelter for about five years before becoming a coordinator a year ago.

The client explained that the rehabilitation program had changed locations, meaning she now had to take multiple buses to get there. Waiting for the first bus, the client had experienced panic attacks that prevented her from making it to the rehab program. Eventually, Sheller says, she and the client worked on the triggers and history that fed into the woman’s panic attacks, but first they took it slow and brainstormed more immediate solutions.

Sheller asked if going to the program was something the woman wanted to do and thought she could do, and the woman confirmed that it was. Together, they decided it would help if Sheller stood outside the shelter with the client as she waited for the bus. “She said, ’I think I just need somebody to be there, to remind me it’s just waiting for a bus and I’ll be OK,’” Sheller remembers. After about a week of waiting for the bus together, the client felt she was ready to handle the wait on her own. From then on, she came back to Sheller each day and reported how things had gone.

Much of the work Sheller does with clients facing the challenges of homelessness is simply about recognizing them as fellow human beings, she says. Given different situations or circumstances, any of us could find ourselves in the same position. “If I had gone through your life experiences,” Sheller tells her clients, “there’s no telling if I wouldn’t be where you are.”

Waiting at that bus stop was one of many experiences that taught Sheller the importance of simply being there for clients who are confronting homelessness. “To work effectively in the shelter means you have to really be where they are and go where they need to go,” says Sheller, a member of the American Counseling Association and assistant clinical professor in Drexel University’s Hahnemann Creative Arts in Therapy Program. “It requires you to be open and nonjudgmental, to be there for what’s needed. Get rid of the preconceived ideas that counseling is sitting in an office — be there in a very humanizing way.”

Nowhere to turn

Homelessness leaves people feeling they have no one to turn to and nowhere to go, Sheller says. “It’s the sense of feeling very isolated, very helpless, very alone and, at the same time, very stigmatized by society. You feel like a failure. The sense of feeling helpless is one of the hardest things that we, as human beings, endure. No one who’s homeless wants to be homeless.” There are complex situations underlying why each person becomes homeless, says Sheller, adding that she’s never met anyone who wants to be in that situation.

Michael Brubaker, an assistant professor at the University of Cincinnati’s School of Human Services and academic coordinator in the addiction studies program, says the stigma surrounding homelessness stems in part from the Protestant work ethic on which the United States was built. Not only are people thought to be responsible for pulling themselves up by their bootstraps and getting themselves out of homelessness, he says, but there also exists a general bias that these individuals are solely responsible for their becoming homeless in the first place.

Brubaker has worked with homelessness for the past 12 years and conducted a study that involved taking counseling students to a shelter to learn from the residents. “We realized that we, as counselors, are not immune to influences from society,” he says. “(The shelter residents) can probably teach us better than we can teach them what their circumstances are about.” Brubaker, a member of ACA, emphasizes that homelessness is more of a situation and less of a population. Approximately 80 percent of those who become homeless in a given year are transitionally, not chronically, homeless, he says.

A large percentage of people in shelters have trauma in their history, Sheller says. Many of the shelter residents she sees grew up in foster care, aged out of the system, had children and are now homeless. They’ve had little or no consistent support for the long haul, she says.

The experience of being homeless can be traumatic in itself. “That experience of losing support — of realizing that family is not there to support, that friends are not there to support, to realize that society is not there to support — can be a very disheartening and even traumatic experience,” Brubaker says. The physical aspect of being on the streets is also traumatic, he says, in part because people experiencing homelessness are vulnerable to attacks by youth and predators, as well as harassment from authorities.

Sonya Lorelle, a doctoral candidate in the Old Dominion University Department of Educational Leadership and Counseling, says systemic barriers can provide significant hurdles for people attempting to overcome homelessness. Lorelle, an ACA member who spent time as a counselor in a shelter system in Norfolk, Va., recalls instances in which parents secured a job on the late shift in hopes of providing their family some financial stability. But, Lorelle says, barriers popped up from every angle — the bus route back home would stop running at a certain hour or child care wouldn’t be available after 6 p.m. “During a holiday when child care and school were closed or when the child became ill or had a doctor’s appointment, the balance would be thrown off,” she says. “More than once, I saw a parent lose a job for having to take a day off to take care of their children, putting them back at square one. Everything had to be perfectly balanced.”

Telling the story

Because of the struggling economy and the shortage of housing, Sheller estimates the current average length of stay for residents in many of the Salvation Army shelters is approximately a year. “It’s a really long time that you can get to work with them and create healing environments for them,” she says. Many shelters must refer clients out to other agencies for mental health care, but Sheller and other counselors who work with homelessness say having in-house mental health services, whenever possible, is helpful.

Although none of the shelter residents were required to see Sheller for counseling, she tried to build relationships with them and improve their experience within the “system.” Many shelter residents had encountered authority figures elsewhere who were supposed to help them but instead made them feel powerless and at fault for their circumstances, which only added to their sense of shame. “We (as counselors) are changing the paradigm,” she says. “We tell them in words and in actions, ’You’re not sick. You’re not bad. It’s what has happened to you. Let’s tell the story, and let’s help you out of it.’ It’s a trauma-informed perspective counselors should adopt when working with the homeless and one I have found extremely useful.”

Society’s biases against the homeless are often internalized by the people who experience homelessness, Brubaker says. “We offer something unique as counselors in our ability to help expand the perspective and encourage change,” he says. That means helping people take the blame and burden off themselves, while simultaneously empowering them to take the lead in changing their circumstances.

The counselors interviewed for this article agree that the first step in helping is simple and straightforward: Simply listen. “Having someone just listen to your story is really important. They haven’t been heard, they haven’t been validated. They would tell me, ’I feel like a number. No one cares about me,’” says Lorelle, reflecting on her work in the shelter system.

The real key is listening with an open mind, Sheller adds. “Homelessness doesn’t fit into a neat, stereotyped box. It’s an experience that anyone could have. Therefore, we shouldn’t have any preconceived ideas about what a homeless person is and what he needs — it has to come from the person.” Someone might arrive at a shelter with the attitude that all people in authority roles are evil, she says. Rather than telling the individual that isn’t true, it’s important to be respectful, listen and try to understand how that perception has been formed by the person’s past experiences, Sheller says. Many of the systems the homeless go through want these individuals to change themselves, she says. “But they just want someone to understand them first.”

Given their immediate needs and their sometimes-negative experiences within systems theoretically set up to “help” them, it may seem a daunting task to convince shelter residents that counselors have much to offer. “Much of our convincing will not be in words, but rather in our deeds,” Brubaker says. “Are we physically available to those in need? Are we willing to step out of our offices and meet with individuals on a park bench or over a meal at a shelter? Are we quick to judge a person who lives without a home? A caring presence can make a huge difference.”

A place to belong

The specific approach counselors use with these individuals isn’t the most important thing, Sheller says. “Whatever (technique) you use, the basic ability to relate to people and to build those relationships are really the most important,” she says. Homelessness can feel isolating and disconnecting, she explains, so forming relationships can build connection and empowerment. “From that, people can rise up. You’re fostering an experience where they feel like they’re OK and it’s going to be OK.”

Building relationships with homeless clients begins with simply getting to know them, Sheller says. Counselors can strengthen the relationship by being open, joining them where they are and focusing on being with them instead of imposing requirements or restrictions, she says. Counselors should strive to reach a level in the relationship where they can readily recognize when the person is struggling. If Sheller noticed that a resident didn’t seem quite right, she might ask that person to take a walk with her to Dunkin’ Donuts. Counseling in shelters doesn’t adhere to hourly appointments in an office, Sheller says. “You have to build relationships and build community, not just be in an office waiting. You’re just there and available and real.”

One part of getting to know clients is understanding why they act in certain ways, Sheller says. She recalls a particular shelter resident who seemed to be having unnecessary trouble getting food stamps and setting up her gas and electric accounts so she could move to available housing. Instead of jumping to conclusions, Sheller sat down with the client and asked what the problem was.

“What I really needed to understand was that it wasn’t her being noncompliant or resistant, but something else was going on that was preventing her from doing that,” Sheller says. The woman revealed she was frightened that if she followed through on those tasks and moved into new housing, a perpetrator from her past would be able to find her at her new address. Avoiding the move and remaining at the shelter felt safer, she told Sheller. Sheller helped the woman find ways to make herself safer, including getting a restraining order, and also helped her work through some of the trauma she had experienced. After that process, the woman was able to fulfill the requirements to move out of the shelter. “Don’t always assume the behaviors that seem to be uncooperative or unmotivated are really that,” Sheller says. “They may be behaviors people have adapted to help them survive.”

Many people who have experienced homelessness have also experienced trauma, which often makes them hypervigilant and hyperalert, Sheller says. Creating a safe environment — an environment that isn’t further disempowering or demoralizing — will encourage these clients to seek out the counselor. “If people can’t feel safe, it’s really going to be hard for them to move forward in their lives,” she says. Safety encompasses feeling safe within yourself and learning how to handle your own emotions, Sheller says.

Loss is also inherent in homelessness, Sheller adds. Many people find themselves in shelters after a loved one becomes ill or dies, someone loses a job or a home burns down. Helping people deal with their losses is critical, Sheller says, and one way of doing that is through building a sense of community because when people break through their isolation, they realize they aren’t alone in their problems. In addition to community meetings and therapeutic groups, Sheller has organized rituals to help shelter residents deal with loss. For example, she led a “balloon memorial” during which individuals wrote down a loss they wanted to let go of and then attached the paper to the string of a balloon. “It could be a tangible loss or a loss such as loss of missed years while I was using, loss of childhood innocence because of abuse, etc.,” Sheller says. “The balloons were simultaneously released as a group on the grounds of the shelter. We held hands and had a few minutes of silence together. It was very powerful.”

The most important component to building trust with homeless clients is following through and doing whatever you say you’re going to do. “If I said I was going to make a call for them, I needed to make that call. Otherwise, the trust was broken,” Lorelle says.

Contrary to what most traditional counseling teaches, Sheller says it can be helpful for counselors to be vulnerable and share their feelings when working with homeless clients. Let these clients know that you’re sad or hurt or angry about what has happened to them, Sheller tells counselors.

Changing the path

Looking back, Brubaker says the most important thing he learned about helping people who have experienced homelessness is to focus on their strengths — what they are doing well and what has enabled them to survive on the streets. “The mere use of the word homeless is a deficit-based identifier,” he says. “The biggest change for me was seeing the strengths of individuals and being mindful of that. I wish I had been trained from the beginning to really look for that. That’s made a huge difference in my approach and how effective I can be.”

Considering the high incidence of trauma among people who experience homelessness, Brubaker says training in trauma would serve counselors well. “This will hopefully wake up many counselors to their need to obtain training in the area of crisis and trauma work,” he says. “Counselors should also know their limitations, consult with others who know this population and advocate for the best services possible. No counselor should feel alone in their pursuits, so networking with competent professionals, indigenous healers and other service providers is essential.”

Counselors agree that working with homelessness is very demanding. It’s challenging emotionally, Lorelle admits, and if a counselor feels hopeless for too long, burnout might be waiting around the corner. “The lesson I learned is that you have to find that hope and find the value in what you’re doing. It may not (come in) huge leaps and bounds, but appreciating the small things along the way and celebrating their successes, that’s an important piece, and that’s what kept me going.”

No counselor can fix everything, Sheller says, and it’s important for counselors to accept that truth while maintaining the proper perspective. “You might not ever see the change; you might just be planting the seed,” she says. “You have to go in there and believe that if you can create an experience that is different, that you’re setting the course. You’re changing the path for that person, and that’s all you ever have control of.”

 

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Lynne Shallcross is a senior writer for Counseling Today. Contact her at lshallcross@counseling.org.

Letters to the editor: ct@counseling.org.

 

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Effects on education

Sonya Lorelle, currently earning her doctorate from the Department of Educational Leadership and Counseling at Old Dominion University, worked for two years as a children’s counselor with an agency providing emergency and transitional shelters in Norfolk, Va. School was a common area of struggle for the children, Lorelle says. “It was not uncommon to have children who were at least one grade behind, which often seemed to stem from the history of residential instability and resulted in switching schools often.”

Research has shown that children who experience homelessness are at increased risk for developmental delays, Lorelle says, so she often requested a full psychological assessment to check for learning problems or delays. The assessments sometimes helped secure the children extra assistance at school in areas in which they were falling behind.

In addition to providing counseling services to the children, Lorelle says the case managers helped inform parents of their rights under the McKinney-Vento Homeless Assistance Act, which allows children to remain at their home school for the remainder of the academic year if there is residential instability. Schools are supposed to provide transportation for these children, and Lorelle says case managers and counselors can help parents work with a school liaison to ensure that happens.

— Lynne Shallcross

Reconnecting the head with the body

Jonathan Rollins

What can athlete’s foot teach health professionals about the effective and efficient provision of counseling services? Plenty, according to Russ Curtis.

Most people who contract athlete’s foot don’t hesitate to pick up a topical medication from their local grocery store or at Walmart, tossing the spray or cream into their shopping cart along with a gallon of milk, cans of soup, some snacks, greeting cards, a package of batteries, the latest best seller, detergent and various items for the home.

But imagine, says Curtis, if those same sprays and creams were sold only in stand-alone stores that specialized exclusively in treatment of the skin fungus. Suddenly, the stigma level for seeking treatment would rise greatly. Individuals would duck in and out of the store, hoping not to be noticed by passersby or, even worse, identified by their neighbors. Others, too embarrassed to run this risk, would forgo treatment altogether and pin their hopes on the condition clearing up on its own. Many whose problems could successfully be addressed with minimal treatment early on wouldn’t seek help until their condition grew much worse, leading to the necessity of more radical, lengthy and extensive treatment.

Unfortunately, it’s probably all too easy to see that if you substitute “minor mental health problem” for “athlete’s foot” in the scenario Curtis describes, you get a relatively accurate picture of why many people avoid counseling. That’s why Curtis and a number of other counseling professionals are advocating for integrated care, a model of treatment that allows clients to sidestep much of the stigma attached to mental health, normalizes access to behavioral health services and treats people before their problems grow too large.

“Integrated care is essentially the colocation of physicians with mental health care providers, working dynamically and consulting together throughout the day to best help clients,” says Curtis, an associate professor in the counseling program at Western Carolina University (WCU).

“’One-stop shopping’ is something we’re seeing just about everywhere, and that’s where health care is going too,” continues Curtis, an American Counseling Association member who infuses integrated care into the counseling curriculum at WCU. “People prefer the one-stop setup. It decreases the stigma of receiving counseling when it’s wrapped up as part of a visit to your primary care physician.”

The degree to which physical and mental health services are integrated within individual medical practices varies depending on the collaborative model being used, as does the exact role of the counselor (often referred to as the “behavioral health provider” in the parlance of integrated care). Some of the more common duties include providing assessment services, psychoeducation, brief therapy and case management, consulting with physicians and nurses, and acting as a liaison to the consulting psychiatrist and outside mental health community. A counselor in an integrated care setting essentially serves as the on-site mental health specialist.

Integrated care does have its detractors and skeptics within the counseling profession. “Some mental health professionals get offended and think we’re trying to replace their services by promoting integrated care,” concedes Eric Christian, a licensed professional counselor who helps agencies develop integrated care sites as the integrated care coordinator for the Mountain Area Health Education Center (MAHEC) in Asheville, N.C. “But integrated care is a more population-based approach to mental health. We’re meeting clients where they tend to go for help — their primary care physicians. It does not replace specialty mental health care or substance abuse care requiring extensive therapy, but rather fills a service gap along a continuum of health care services. Integrated care offers an opportunity to deal with people’s mental and behavioral health issues when they’re mild or moderate rather than waiting for people to qualify for community mental health services only as things get much worse.”

The rationale for integrated care

Researchers have found that up to 60 percent of patients’ visits to their primary care providers have no biological basis, Christian says. According to one study conducted in 1991, 80 percent of patients with psychological distress present to primary care with unexplained physical symptoms.

“When doctors perform tests and everything comes out normal, that’s a good time to have the counselor talk to the patient and find out what else might be going on. How are things at home? At work? Have they been laid off? Clearly, those stressors can play a role in headache or chest pain or other physical conditions the person is experiencing,” says Curtis, who worked in mental health before becoming a counselor educator and completed his final internship at a medical center that provided integrated care.

A 2001 study by Yeates Conwell of the University of Rochester Medical Center Department of Psychiatry found that primary care physicians identified only 40 percent of those patients who needed mental health services; of those patients who were identified, only 10 percent sought mental health treatment. Various other studies have revealed that between 50 percent and 90 percent of referrals to behavioral health practitioners outside of the medical clinic do not result in therapy.

Says Christian, “Part of the stigma, especially for someone new to having a mental health issue, is that if you’re given an outside referral by your physician, the implicit message is, ’Your mental health issues are not even dealt with here. You need specialty care.’”

By having a behavioral health professional working closely with doctors on site, Christian says, integrated care models not only help prevent many people with mental health needs from falling through the cracks but also wipe away much of the stigma that might otherwise prevent these clients from accepting or following through with treatment.

Another argument for integrated care, Christian says, is that while more than 70 percent of medications for treating anxiety, depression and attention-deficit/hyperactivity disorder are prescribed in primary care physician settings, in most cases, patients aren’t receiving the recommended behavioral health treatment to complement these medicines. In integrated care settings, however, counselors can address behavioral health concerns with these clients and check in with them about medication adherence and side 
effects between physician appointments. “Integrated care offers an opportunity for the whole person to be treated in one location,” Christian says.

Even so, Curtis admits integrated care might be a foreign realm for many counselors. Some balk at the thought that their interactions with clients in integrated care will mainly involve brief interventions and quick assessments rather than traditional counseling sessions. Christian and Curtis, who have presented together on the topic of integrated care, say some counselors regard it as “therapy light.”

“Mental health professionals sometimes roll their eyes when we talk about brief sessions,” Curtis says, “but there’s evidence suggesting that the approach is effective, and I’m still not sure who created the 50-minute session. If you’re a counselor and you’re partial to the wood-paneled office, fish tank, fern and the 50-minute session, you’re going to have trouble with this model.”

That would be a shame, Curtis continues, because he believes counselors can excel in integrated care settings, thus demonstrating to doctors and patients/clients the valuable contributions counselors can make to an individual’s overall health and well-being.

“That would be good for our profession,” he says. “Counselors have a great opportunity to make an impact in this setting. There are lots of private physician offices out there, and that’s where folks go to get their mental health needs met because it’s whom they trust. In these settings, we can work with folks briefly before their problems get severe. It’s a little bit of that wellness model we talk about in the counseling profession. That’s some of the value of integrated care.”

“We’re (counselors and physicians) clearly trained very differently, but we need to work collaboratively to make sure our clients have the best care, because emotions and behaviors play a huge role in our physical health,” Curtis says. “Clients and physicians both like the integrated care setup, and I think counselors could do well in this setting. The biggest obstacle is our mind-set — breaking out of that traditional counseling box that we’ve created for ourselves and our clients.”

Offering a more complete picture

An LPC and private practitioner in Bristol, Va., Rick Carroll doesn’t shy away from outside-the-box thinking when it comes to counseling. So when three doctors who wanted their medical practice to provide holistic care approached Carroll roughly two years ago and asked if he could help them with patients experiencing unexplained medical symptoms, he signed on.

Carroll began screening the patients for a range of factors, including family dynamics, social issues, substance abuse, exercise, diet and spiritual well-being. “As a result, C-Health (the medical practice) started getting a more complete picture of their patients,” says Carroll, a member of ACA. “People often come to the doctor thinking that if they can just get that stomach pain or back pain taken care of … They don’t understand that the physical, the mental and the spiritual are often connected.”

While still maintaining his private practice, Carroll consults closely with C-Health in a partly integrated system. Carroll has a separate office across the street from the medical practice, but their Instant Messaging and e-mail systems are linked. C-Health and Carroll share a networked computer system, and Carroll has the ability to put in electronic progress notes, select and document diagnoses, choose billing codes and so forth. The two days a week Carroll is at his office (he also provides counseling services for a Children’s Advocacy Center), he stops by C-Health to speak with the medical staff directly. Carroll also has access to notes on the patients, including any medications they are taking.

“The doctors and nurses defer to me when it comes to treating that person psychologically,” he says. “It’s been a very humbling experience to have medical professionals grab me and say, ’Hey, I need some help here.’ At the same time, I’ve learned an awful lot from them. It’s been a good match.”

While C-Health’s five doctors and seven nurses have some basic training in psychology, Carroll regularly queries them about the issues they could use some insight on and offers in-services as needed. Among the topics he has covered: dealing with ADHD, identifying possible signs of domestic violence, recognizing stress brought on by the economy, looking for instances of cutting or self-harm and recognizing signs and symptoms of sexual abuse. “Now they’re (the medical staff) looking for signals, cues and signs that there’s something going on beyond the person not sleeping well,” Carroll says.

This type of collaboration has been a win-win-win for the medical staff, the patients/clients and Carroll. “People trust their doctors, and if the doctors are able to pick up on something that’s not medically oriented — ’Is there any stress in your life?’ — they’re able to introduce me to the situation,” Carroll says. “They’ll tell the patient, ’This person is part of our team. He provides another avenue to get you better.’ One of the biggest benefits for the medical practice is that it doesn’t have to see people for situational-specific depression and anxiety as much. That frees the doctors up to see other patients.”

In the region where Carroll and 
C-Health are located, coal mining is still a big industry, and the strenuous work often results in a high level of pain for the miners. The miners who receive pain medications through C-Health must attend a pain management support group led by Bill Haynes, an LPC and ACA member who is a colleague of Carroll’s. Held at the medical practice, the group explores topics such as identifying support systems and recognizing how stress can exacerbate pain. Carroll does individual work with these types of clients.

Carroll also leads patient groups and provides psychoeducation for C-Health. For example, C-Health is starting a special program for diabetics and wants these patients to learn about stress management, so Carroll will present monthly workshops.

According to Carroll, approximately 90 percent of his client base originates from his collaborative relationship with C-Health.

Finding an ’in’

According to a study published online in Health Affairs in April 2009, two-thirds of the primary care physicians surveyed didn’t have access to mental health specialists because of barriers such as insurance restrictions or a lack of such professionals in the area. In referencing the survey, Rodger Kessler, director of the American Academy of Family Physicians’ Collaborative Care Research Network (CCRN), stated that mental health is the most difficult specialty for family physicians to access. On top of that, he said, when physicians refer patients to outside mental health providers, it results in care being initiated in only 20 to 40 percent of cases. Driven in part by those numbers, CCRN is currently pursuing practice-based evidence to support the theory that a treatment model combining mental health, substance abuse and physical health services will produce better outcomes than the traditional referral system.

The integrated care model isn’t widespread at this point, so formal avenues for funneling counselors directly into these settings aren’t abundant. Fortunately, say Christian and Curtis, medical health professionals are increasingly recognizing the value of collaborating closely with behavioral and mental health professionals. This means many primary care physicians, pediatricians and other medical health professionals are open to counselors approaching them about implementing a system of integrated care.

“There are lots of grassroots ways to do this,” Christian says. “Counselors might approach their own doctor or their child’s pediatrician with the idea. What’s most important is that you show them how you can function in their format, in their environment. Initially, suggest the opportunity to shadow doctors for a while and let them know how you could interact with their patients. See where you might be able to plug in as a counselor and how that would free the physician up to move on to other patients.”

Christian also recommends that counselors look for medical practices launching new programs for a particular segment of patients. For example, he says, some medical practices have special programming and/or dedicated clinic time for patients with diabetes, and 11 to 15 percent of these patients are diagnosed with major depression, while many others have depressive symptoms. “A counselor could approach a medical practice and say, ’Instead of just referring these clients to me, it would be nice to be able to say that you have someone on staff who can talk with them about their depression or speak with newly diagnosed patients about lifestyle and behavior changes to help address their illness,’” Christian says.

In addition, specialty environments are tailor-made for integrated care, he says. For instance, counselors might work in a cancer patient support program to help with psychosocial issues and depression, to meet with family members and to provide grief work.

During his internship, Curtis roamed throughout the hospital, providing support wherever it was needed, from the cardiovascular unit to the emergency room. “A lot of times, patients’ mental health needs would be met in the emergency room,” he says, “and the ER doctors really seemed to like having us there.”

Another natural fit? “Integrated care is really nice for pediatric settings,” Christian says, “because most kids can benefit from some level of behavioral health intervention during the course of their development, and with this model, it can be dealt with at the point of care.”

Curtis believes the timing is right for more counselors to make inroads in integrated care. “Doctors are hearing a lot more about the connection between mind-body wellness,” he says. “Counselors have been talking about wellness for a good while, and now there’s a lot of discussion about positive psychotherapy. Evidence is showing that if we can elevate people’s moods, that can play a part in improving their health.”

Confronting challenges

Although the market may be ripe for counselors to enter integrated care, they should be aware of some of the inherent challenges. High on that list is reimbursement issues.

“Reimbursement criteria vary so much from state to state and from one insurer to another,” Christian says. “Patients may not have a behavioral health benefit or realize it is being used during the visit, so disclosure and consent for services is very important. In addition, the primary care facility may be overwhelmed with having to negotiate billing for behavioral health services, so a lot of planning has to be done, and the practice manager has to be on board.”

Typically, counselors in integrated care settings might apply traditional therapy billing codes and use their National Provider Identifier (NPI) number. But some counselors may be able to take advantage of “incident to” billing, meaning the behavioral health provider’s services are rendered as a physician extender for certain patient conditions. In these cases, the physician’s NPI is used for billing, and master’s-level counselors receive a higher reimbursement level for their services.

In North Carolina, Health and Behavior Assessment/Intervention codes have been developed as part of newer Current Procedural Terminology codes for use with Medicaid patients. The behavioral health codes allow counselors to address behavioral health issues associated with the management of chronic medical conditions such as diabetes and fibromyalgia, smoking and tobacco use and so forth. The codes are used “incident to” the physician and do not require that the patient be diagnosed with a mental health problem.

Certain cost increases are also associated with integrated care, which scares off some primary care providers, but Curtis says research shows that integrated care models actually result in overall health care savings of 20 to 40 percent. He points out that by catching patients’ behavioral and mental health problems earlier in the process, integrated care reduces the number of hospital admissions and emergency room visits.

The thought of working in integrated care appeals to many counselors because of the variety, the opportunity to work with other types of health care providers and the fact that not every client is presenting with high-end mental health issues, Christian says. As appealing as these attributes may sound in theory, however, some counselors struggle with the transition to a less structured, less formal, less traditional counseling environment. “Again,” Christian says, “this model doesn’t work for counselors who are rigid about having 50-minute sessions. It also requires someone who has some business sense and is willing to address administrative issues. And you have to be comfortable with interruptions by other clinicians who may need your assistance.” Because integrated care is still relatively new, he says, counselors must also be willing to embrace a trailblazing role at most medical offices rather than expecting to walk into a fully functioning system that is free of any kinks.

“You have to be able to roll with ambiguity,” Curtis adds, “and you have to be flexible. You need to be someone who can be present and calm with clients, yet quick and to the point when talking with a physician.”

Working in a truly collaborative environment might be a major adjustment for many counselors, Carroll says. “In this setting, you have to understand that you can’t do it all yourself. You have to be able to surrender that mind-set and ask for help.”

At the same time, he says, counselors should be ready to justify why they are offering a different diagnosis than the doctor. “I have rarely encountered any power struggles,” Carroll says, “but to assert yourself without ticking others off, to traverse that slippery slope, is more an art than a skill.”

In the face of any challenges, Carroll says, it is most important to buy into the effectiveness of the integrated care model and remember that everyone on the team is working toward a common goal. “Integrated care is something that really benefits the clients. And, ultimately, the clients’ needs trump our needs.”

Jonathan Rollins is editor-in-chief of Counseling Today. Contact him at jrollins@counseling.org.

Implications for counselors

Although Russ Curtis already infuses integrated care into the counseling curriculum at Western Carolina University (WCU), the associate professor and ACA member hopes to one day establish an integrated care elective or track for counseling students. Curtis currently has three students doing internships with integrated care facilities thanks to Eric Christian, a graduate of the WCU counseling program and the integrated care coordinator for the Mountain Area Health Education Center in Asheville, N.C.

Curtis and Christian, who copresented on the topic of integrated care at the 2009 ACA Annual Conference in Charlotte, N.C., have identified several implications for counselors who would like to practice in an integrated care environment:

  • Network with physicians.
  • Set up practices in medical office parks.
  • Obtain licensure and advocate for LPCs to receive Medicare reimbursement.
  • Become familiar with brief assessment tools to identify substance abuse, depression and anxiety disorders (including postpartum problems).
  • Develop proficiency in providing brief therapy.
  • Become familiar with pharmacology, including common side-effects of different medications.
  • Take classes/workshops in physiology and health psychology, such as smoking cessation, fibromyalgia, chronic pain and irritable bowel syndrome, because all have behavioral health components.
  • Become a generalist — a counseling professional who is able to enter any situation and provide some input.

Implications for counselor educators:

  • Introduce integrated care to students in the first clinical mental health counseling class.
  • Develop a specialty for students in integrated care.
  • Talk to physicians and hospitals about internships for counseling students.

A new decade begins: Rededicating and recommitting

Richard Yep January 1, 2010

Richard Yep

It seems like we were just wondering what Y2K would mean for our computers, digital instruments and other data systems. Now here we are at the beginning of a new decade of the 21st century. On behalf of the American Counseling Association staff, I want to wish you all a Happy New Year full of good health, prosperity, peace and compassion for one another.

Rather than a resolution, which we might stick on the refrigerator door and then promptly forget about, I’d like you to consider something else — namely, a “professional rededication” — that begins with my asking you a favor.

For nearly 58 years, ACA (formerly the American Personnel and Guidance Association and then the American Association for Counseling and Development) has dedicated itself to the improvement of the counseling profession in order to better help those whom our members serve. Your being a member has allowed us to develop resources, information and positions that have led ACA to becoming the “largest organized body of professional counselors in the world” (a phrase I often use as a reminder of the important role and professional responsibility such a description carries).

But here is something you may not know. It is estimated that upward of 600,000 people in the United States alone identify as being a counselor. Despite steady increases in ACA membership every month since July 2009, a surge in student membership during the past year and the recent achievement of California becoming the 50th state to enact a counselor licensure law, our 42,000 members represent only about 7 percent of the profession’s estimated total. This is not OK.

ACA sets professional standards, enforces a strong code of ethics and provides tens of thousands of continuing education credits to counselors every year, making us the organization to which many more counselors must belong. So here is the favor I want you to consider.

During 2012, ACA will celebrate its 60th anniversary. I am asking you to join me in committing to a “60/60” campaign that will bring ACA to 60,000 members by the time we complete our 60th anniversary year. This borders on being an audacious goal given the economy and other societal factors. It will not be an easy task, but as trained professional counselors, you know that many things worth committing to are not easy.

What I am asking each of you to do is to bring one person to our ACA community. Invite them to join us at our table, follow our Code of Ethics, participate in our programs, contribute their ideas about the profession and take part in the leadership of the world’s largest organized body of professional counselors.

We can meet the challenge proposed by the “60/60” campaign. But be advised that it will take all of us — members, leaders and staff — if we are to be successful. For this phase of the challenge, no T-shirts, no coupons, no ACA baseball caps and no BMW convertibles will be given away if you are successful in recruiting your one new member. We need to do this because we believe an ACA that is inclusive, diverse and serving as a laboratory of new ideas for the counseling profession is better than resting on our laurels and being satisfied with what we have accomplished during the previous six decades of service.

I do not know which leaders, staff or members will be at our table 36 months from now on Dec. 31, 2012, but I can tell you that I will be the first to rededicate myself to finding more professional counselors and students in counselor education who are willing to be members of ACA. I hope you will do the same.

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

Thanks and be well.