Monthly Archives: April 2011

What would you do?

Marcheta Evans April 1, 2011

The cover story for this issue focuses on ethics issues in counseling. Contemplating this topic and my development as a professional counselor, I must admit that my thoughts on ethical behavior have evolved over time. That is not to say that I was unethical before, but rather that I once viewed others in a certain way depending on how they handled situations in which I thought the “right” response was a black-and-white decision.

Yes, when I was younger, the answers seemed so obvious to me. But as I grew as a professional and truly started listening to the stories and experiences of my clients and students, I began to realize that life is not always black and white. There is so much color and context to life that we miss if we neglect to take the time to listen to what is going on with those we serve as professional counselors.

What Would You Do? is a TV program from ABC News. Its premise centers on placing people in various staged scenarios without their knowledge and monitoring their responses. As I initially watched some of the various scenes unfold, I said with such conviction, “Oh, I know what I would do. I would confront that injustice” or “I would say something to that person who was mistreating the other individual in the scene.” I truly wanted to believe I would react that way if I witnessed such a scene in real life. As I sat there, however, I began thinking about who I was and how my culture has changed since I was a child.

You may be wondering what this has to do with ethics. Give me just a second and let’s see if I can make it come together, because some of you may possess similar experiences. You see, ethics has several different meanings, including a system of moral principles; the rules of conduct recognized in respect to a particular class of human actions or a particular group, culture, etc.; a branch of philosophy that deals with values relating to human conduct with respect to the rightness and wrongness of certain actions and to the goodness and badness of the motives and ends of such actions.

Growing up back in the day in Alabama, I was a child of the neighborhood, so to speak. What I mean by that is that any adult had permission to correct my behavior if she or he saw me doing something I had no business doing. Not only would I get in trouble with that particular adult, but I knew there would be more to come when I got home. I would walk home from school in shame and in fear of how my grandmother would react to finding out I had misbehaved and that someone in the neighborhood had found it necessary to correct me. This was the culture of that time, and the adults’ response was considered proper.

Nowadays, how many of you would feel comfortable correcting someone else’s child or going up to someone and saying, “Baby, you should not be doing that”? I must admit, it’s not as easy to do now as it was back in the day. Today, we are afraid that we will be chastised in some form or fashion for butting in and not minding our own business. As a result, most people these days just sit on the sidelines, shake their heads and say, “What an awful situation that is” or “The child has no home training.”

Now I know some of you are saying that you definitely know what you would do in situations such as these, and I applaud your conviction. But many of you are unsure of how you would react. Perhaps you even remember a situation in which you wish you had said something but instead walked away.

As counselors, it is ingrained in us to advocate for those who cannot advocate for themselves. It is our responsibility to be actively engaged in our society. Granted, as I have matured, my formerly black-and-white mind-set has been altered, especially when it comes to claiming what I would definitely do. I have come away saying, “This is what I hope I would do if the situation ever presented itself.” I firmly believe we cannot know exactly how we would respond until we find ourselves in a given situation.

This, for me, is still a great positive. I review my past behaviors and responses and contemplate the definition of ethical or right behavior. I try daily to move beyond the mandatory ethics of my job and life and toward the aspirational ethics of being a social justice advocate.

What would you do? That is a question you must answer for yourself. My answer is, “I hope I would do the right thing for all involved.” That way, I can walk away with peace.

Forks on the left, knives on the right

Richard Yep

Richard Yep

When I was young and my mother was making dinner, at some point I would hear her say, “Dinner is almost ready. Would you please set the table?” Many of you reading this probably heard something similar in your homes when you were growing up.

Years later, when my son was playing baseball and he came up to bat, I would occasionally say, “OK, Dylan, table is set.” This of course referred to having runners on base and his being in a position to move those players forward.

Today, I want to share my thoughts about another table that has been set. In this case, the table is set for you, the members of the American Counseling Association. During the past few years, and under the guidance of the ACA Governing Council, your professional association has slowly but surely been reviewing, rebuilding and restructuring its products and services to make them more valuable and relevant to today’s counseling professionals and graduate students. We have done this in light of changing societal issues that you face as professionals. We also embarked on this multiyear change fully aware that if we didn’t make constant improvements designed with you in mind, ACA would no longer be able to help move the profession forward.

As the association begins celebrating its 60th anniversary, “resting on our laurels” doesn’t do anything to provide you with the products, networking and career services that today’s — and tomorrow’s — professionals will need. Some of you have communicated directly with me about what you want from ACA. Others of you have participated in our surveying and focus groups, imparting wisdom and offering suggestions concerning your ACA membership. Then there are those of you who have sent suggestions to ACA via the Web Idea Bank found on our website at Regardless of what form of communication you have used to share your thoughts, I appreciate your time in letting us know. We really do take your suggestions seriously, and we work as a leadership/staff team to determine what we can accomplish to meet your professional needs.

Your suggestions and our ability to tend to your needs can be measured by yet another milestone for the association. In January, ACA surpassed 45,000 members — something we have not seen in many, many years. In addition, voting in the recent ACA election resulted in our largest turnout in more than five years. And the ACA Annual Conference & Exposition in New Orleans, taking place March 23-27, will see us exceed $1 million in conference registrations and welcome more than 4,000 attendees, setting another modern-day record for our organization.

We continue to put more services and products online so you can take care of things from wherever you might live or work. Proof of professional liability insurance, continuing education certificates and many other resources are now available through To make sure we can handle all of this digital traffic, the ACA Governing Council approved a plan we put forward this past year to upgrade our technology infrastructure. We want to continue to deliver information to our most valuable asset — our members. Most of this transition will be completed by June of this year.

What’s next? Well, as I noted above, we have “set the table” with you in mind. But we now need you to come in, explore and then let us know what else we can do to help you meet the professional challenges that you face. We are your professional partner, and we are here to serve. So please contact me with any comments, questions or suggestions that you might have via e-mail at or by phone at 800.347.6647 ext. 231.

Thanks and be well.

Do the right thing

By Lynne Shallcross

Patrice Hinton Oswalt was flattered upon opening her e-mail and finding an Evite to a client’s long-awaited graduation. Choosing whether to accept or decline the invitation was no simple decision, however.

Oswalt was keenly aware that engaging in contact with a client outside of the counseling office could have ethical consequences. But she also knew the ethically “correct” answer could only be reached by weighing the best interests of her client. So, when the client came in for her next session, Oswalt, a career counselor with a private practice in Birmingham, Ala., opened the discussion by addressing the situation. She asked the woman to think about how it might feel to have her counselor present at the graduation.

The client had been coming to Oswalt for a year and a half. During that period, the client had been working full time while simultaneously earning a bachelor’s degree. She had sought out Oswalt mainly for career issues, but the two had also discussed issues surrounding the client’s relationship with her husband. If Oswalt attended the client’s graduation, the likelihood existed that she would meet the woman’s husband and family. Might that lead to questions about the client’s counseling work that the client wouldn’t want to deal with on her graduation day?

Branding-Box-Ethics“I wanted her to think through it in a 360-degree way, all the way around, not just get caught up in the moment of inviting everyone,” says Oswalt, a member of the American Counseling Association. After reconsidering the situation, the client decided it would be wiser not to have Oswalt attend the graduation.

Having a strong ethical compass is paramount to being a good counselor, says Oswalt, who in addition to running her private practice works two days a week as assistant director of career services at the University of Alabama at Birmingham. “I can’t be unethical and at the same time be an effective counselor,” she says. “The counseling relationship is built on trust — clients trusting that they can be vulnerable and that their counselor will not take advantage of that openness. To earn this trust as counselors, we must be trustworthy, to prove our worth and integrity. These are standards of behavior that tie directly into our professional ethics. Outside of the counseling relationship, our ethical code [the ACA Code of Ethics] provides us with a clearer professional identity, shapes how the public perceives us and offers guidelines for our professional behavior. We have to use our ethical code to increase our ability to analyze issues in ways that will facilitate our ability to move on to ethical action — to make it part of who we are as a professional [and] prepare us to deal with ethical dilemmas before they even arise. Most of us are trained to ‘do things right.’ Ethics help us to ‘do the right thing.'”

Oswalt’s graduation invitation is just one example of the ethical dilemmas that confront counselors on a daily basis. To help counselors anticipate common ethical challenges and learn how best to handle them, Counseling Today invited Oswalt and four other ACA members with expertise in counseling ethics to provide some insights.

Crossing the line

When the 2005 revision of the ACA Code of Ethics acknowledged that multiple relationships (referred to as “nonprofessional interactions or relationships” in the ethics code) are sometimes unavoidable and that they can be acceptable when carried out ethically, Oswalt applauded. “I like that the door opened up a little. It’s a more realistic way of approaching the counseling relationship,” says Oswalt, who presented on “Hot Topics in Counselor Ethics” at the ACA Annual Conference & Exposition in New Orleans in March. In the past, Oswalt says, even if you were the only counselor in town, you might have felt compelled to shut your office doors to someone you knew on a personal level in an effort to avoid any potential boundary issues. This challenge proved particularly formidable to counselors living and working in rural areas, for whom secluding themselves from community life wasn’t feasible.

Jeffrey Barnett, professor in the Loyola University Maryland Department of Psychology, says the belief used to be that counselors should never carry on multiple relationships because any contact with clients outside of the counseling office would automatically have negative consequences. “But the most recent thinking is that there is a big difference between crossing a boundary and violating a boundary,” says Barnett, who coauthored the Ethics Desk Reference for Counselors, published by ACA, with W. Brad Johnson.

Certain multiple relationships are now ethically acceptable, Barnett says, such as counseling your child’s teacher if no other counselors are available in the area. “Sometimes it’s us or nothing,” he explains. Instead of admonishing any and all multiple relationships, the focus of the 2005 ACA Code of Ethics shifted to determining whether any harm might come to the client if a multiple relationship existed.

Standard A.5.c. of the 2005 ACA Code of Ethics states that “Counselor-client nonprofessional relationships … should be avoided, except when the interaction is potentially beneficial to the client.” Standard A.5.d. goes on to say that “the counselor must document in case records, prior to the interaction (when feasible), the rationale for such an interaction, the potential benefit and anticipated consequences for the client or former client and other individuals significantly involved with the client or former client.” The standard also provides examples of potentially beneficial interactions outside the counseling office, which “include, but are not limited to, attending a formal ceremony (e.g., a wedding/commitment ceremony or graduation); purchasing a service or product provided by a client or former client (excepting unrestricted bartering); hospital visits to an ill family member; mutual membership in a professional association, organization or community.”

One important standard to keep in mind when considering crossing a boundary is the potential for impairment of objectivity, Barnett says. “If it’s a conflict-of-interest situation or if I can’t remain objective, it’s probably not a good idea,” he says. Returning to the example of counseling your child’s teacher, Barnett recommends compartmentalizing the roles — not asking about the teacher’s depression at the parent-teacher conference, and not asking about your child’s homework at a counseling session.

If a counselor ethically chooses to cross a boundary with a client, Barnett says having a good informed consent policy is crucial. “Informed consent clarifies up front the working agreement between the two parties,” he says. “Many clients may not know what their rights are, what appropriate professional behavior includes and what behaviors are not appropriate. Part of [the informed consent] is to educate the client. It is also to clarify our responsibilities and obligations.”

Oswalt adds that it is also wise to reread the ACA Code of Ethics or to use an ethical decision-making model, such as the one designed by Holly Forester-Miller and Thomas Davis, before proceeding.

Some multiple relationships, of course, remain clear ethical violations. Ted Remley, director of the counseling graduate program at Old Dominion University and a former executive director of ACA, served on four licensure boards over a 20-year period. During that time, he saw more than a few counselors stripped of their licenses to practice after having sexual relationships with clients. Although sexual relationships with clients are a clear violation of boundaries, they happen more than people might expect, Remley says.

Gary Goodnough, cochair of the ACA Ethics Committee and professor of counselor education at Plymouth State University, agrees that sexual boundary crossings, whether between a professor and a student or a counselor and a client, are always a hot-button issue in ethics. But he says these boundary violations are rarely the result of counselors being unfamiliar with the ethical guidelines. “I think it has to do with unmet needs that counselors have as human beings that cause them to behave in ways [in which they] meet their needs at the expense of others,” Goodnough says.

Like Goodnough, Remley thinks sexual missteps occur when counselors allow their own needs to invade the counseling space. Although inappropriate relationships can take many other forms, such as a counselor going on vacation with a client or hosting clients in the counselor’s home, Remley points to sexual impropriety as the ultimate problem. Part of the solution, he says, lies in counselor education programs addressing such ethical issues and preparing students to handle them. He adds that practicing counselors need to process their feelings when they are socially or sexually attracted to clients by consulting with peers.

“Because attraction to clients is an uncomfortable topic in our profession, it often is not talked about in preparation programs,” Remley says. “In addition, counseling practitioners are often reluctant to admit being attracted to clients. Counselors have to create a professional environment where this topic is welcomed and honestly addressed so that future abuses of clients will not occur.”

Goodnough suggests counselor educators bear some responsibility in staying alert for red flags in student behavior. Students are enrolled in counseling programs for at least two years, which is long enough, Goodnough says, for professors to notice students with personality problems or unmet needs that might lead to significant ethical violations down the line. Faculty members should monitor students and assess their attention to ethical and legal issues, he adds. If problems occur, a remediation plan can be set up for the student. If the student is still unable to meet the goals, he or she may be dismissed from the program. “We need to pay attention to our gut as counselor educators, as well as to indicators that we set up for students to meet,” Goodnough says.

Ethical boundaries can be violated not only when dealing with multiple relationships outside the office, Barnett points out, but inside the counseling office as well. Again, it’s an issue of crossing versus violating a boundary. Crossing a boundary, Barnett explains, would be consistent with the client’s treatment plan, culturally welcomed by the client, motivated by the client’s best interests and an action considered professionally acceptable. For instance, with a grieving client, Barnett says he might put his hand on the client’s shoulder or give him a hug to show support. But carrying out that same gesture with a client who has a history of sexual abuse would be very wrong, Barnett says. Whereas a boundary crossing can be clinically acceptable and appropriate, a boundary violation is unwelcome by the client, motivated by the counselor’s personal needs and harmful to the client.

To friend or not to friend

Technology is designed to make things easier and more accessible. But counselors caution that technological advances can also usher in ethical unknowns. Laura Hahn, a private practitioner who offers counseling and consulting services in Atlanta, says the Internet can blur the boundary lines between counselors’ personal and professional lives. Many counselors have professional websites and social media pages while also maintaining a personal presence online. Hahn says it’s important to keep the two identities separate.

Hahn, an ACA member who presented on “Ethics and Technology” at this year’s ACA Annual Conference, points out that counselors have greater control over information they publish themselves, making it easier to keep boundaries intact. But they have less control — and might even be unaware of — information that others publish, such as photos posted by their friends. Hahn says it’s important for counselors to know what’s available about them on the Internet because their clients may be reading things posted not only by the counselor but about the counselor, including information ideally meant to be personal in nature. She advises that counselors regularly conduct a Google search on themselves to monitor what comes up in the results.

Counselors should also take steps to keep personal and professional information separate, Hahn says. “On a social network site like Facebook, use a ‘Page’ to display professional information and use a ‘Profile’ to display personal information. The page allows you to publish information for client use and does not have friends associated with it,” she explains.

The 2005 revision of the ACA Code of Ethics took place prior to social networking’s explosion in popularity and doesn’t address the topic directly, says ACA Manager of Ethics and Professional Standards Erin Martz. That means social networking can quickly become an ethical conundrum for counselors. Martz says sites such as Facebook should be treated as social interactions even though they’re virtual. The deciding factor then should be whether the interaction benefits or harms the client, she says. Martz points counselors toward Standard A.5.d. of the ethics code, which addresses Potentially Beneficial Interactions.

Goodnough agrees that Facebook represents uncharted territory for many counselors. “The ethical downside involves the blurring of personal and professional boundaries that can result when clients and counselors, as well as counselor educators and students, are ‘friends,'” he says. “While counselors typically refrain from [traditional] friendships with their clients, the threshold for online friendships differs in some people’s minds. Additionally, on Facebook, status updates can be reposted to another page, thus allowing friends of friends and, thus, potentially, clients or students, to see personal information and vice versa.”

Hahn simply suggests refraining from “friending” clients on Facebook. “Make it a policy by adding a statement to your informed consent documentation, and inform your clients up front,” she says. Counselors who find clients being overly interested in the counselor’s personal life and conducting intrusive online searches can explore that topic with the client in therapy, she says.

Counselors should be mindful of the content of everything they write, whether in an e-mail, a text message, a Facebook post or any other electronic communication, Hahn says, because the messages can be reposted or forwarded to those not originally intended to be recipients.

Goodnough agrees that counselors should proceed with caution when it comes to technology, especially as it relates to social networking. “There’s a whole new way that individuals and counselors interact with each other,” he says. “It’s not entirely clear what the best way [is to handle those interactions to] ensure that professional standards and ethical guidelines are enforced or that they live in those venues. We have to always recognize that we’re counselors. Even in our private role, people know us as counselors. Caution and being conservative is always called for.”

Hahn suggests that counselors looking to create a web presence for their professional practice should first read Standard A.12. (Technology Applications) of the ACA Code of Ethics to make sure they’ve done their homework before launching a website or networking page. For those counselors already online, Hahn recommends rereading the code to ensure that everything they have online is ethically sound.

Technology also expands accessibility to counseling, whether through videoconferencing services such as Skype, instant messaging, e-mail or another form of technology. Offering counseling services online connects people with therapy when they might not otherwise be able to head to a counselor’s office, Barnett says.

But if the benefit is that technology expands access to counseling for greater numbers of people, Barnett says the shortcomings can include a lack of visual cues when e-mailing or instant messaging and technological difficulties, especially with videoconferencing, such as when the video freezes or the connection is lost. “When you’re conducting a counseling session and that happens and the person is grieving or depressed, that’s not good,” Barnett says. “When you’re in the room with them, that can’t and won’t happen. Technology is a convenience, but it can also have drawbacks.”

Barnett suggests creating an electronic communication policy that details the plan for what will happen if the connection is lost. Standard A.12.g.8. of the ACA Code of Ethics supports his point, suggesting counselors should “discuss the possibility of technology failure and alternate methods of service delivery.”

Hahn says two additional ethical gray areas with online counseling include how the nature of the therapeutic relationship might be changed when the counselor and client aren’t sitting face-to-face in the same physical space and limits to confidentiality and privacy when counseling online. She recommends discussing those potential limits in advance with clients. Standard A.12.g.1. of the ACA Code of Ethics says counselors should “address issues related to the difficulty of maintaining the confidentiality of electronically transmitted communications.”

The crisis aspect of counseling is also a concern when a counselor is working with a client from a distance. If the client is in crisis and the counselor isn’t in the same room or even the same state, that can pose a problem, Barnett says. The solution, he says, is to research the area’s resources — crisis hotlines, local hospitals, emergency centers and the like — so the counselor can help the client find local assistance quickly if the need arises. That’s also a point covered under the Technology and Informed Consent standard (A.12.g.9.), which states counselors should “Inform clients of emergency procedures, such as calling 911 or a local crisis hotline, when the counselor is not available.”

Barnett recommends that counselors offering online counseling of any kind provide thorough informed consent so clients will understand the pros and cons, risks and benefits of the process. Also set out a clear fee structure, he says, including whether e-mail is charged based on the time the counselor spends in responding or by the number of lines.

In addition to having the clinical competence to address a wide variety of topics with online clients, it’s also important to be technologically competent, Barnett says. Before proceeding, he adds, counselors should be sure they have the right technology and know how to use it effectively.

Also important, Barnett says, is that counselors are both licensed and competent to provide the services they are offering online, just as they would be if offering those services in person. Even if counselors are licensed in the state where they are giving the advice, it can be problematic if they aren’t licensed in the state where the client is receiving the services, he says.

That’s true, Martz says. Although regulations can vary from state to state, most states do not allow counselors to provide counseling services — virtual or in person — unless the counselor is licensed in the state where the client is located. Because ethics are tied directly into following the law, Martz says that ethically, counselors offering services to a client in another state need to find out what the laws are and follow them.

Being prepared

Beyond boundaries and technology, a range of other topics can prove to be ethical sticking points for counselors. For example, Oswalt says, diversity and multiculturalism. “It’s hard to be an expert in all areas of multicultural awareness,” she says. But she adds that it’s the counselor’s responsibility to step outside his or her own worldview when helping clients.

Oswalt says her goal is to be able to sit across from her clients and have a grasp of some of the external issues that might be affecting them. To do that, Oswalt says she takes advantage of training opportunities at state and national conferences where she can expose herself to different cultural competencies. If counselors find themselves lacking the cultural context to understand what might be going on with a client, Oswalt recommends referring.

“Counselors who are ignorant of the social and cultural context of a client risk misdiagnosing and pathologizing something that is very much the norm in the culture of that client,” Oswalt says. “This could cause great harm to a client, [which goes] against the principles of holding the client’s best interests above all else and avoiding harm. Multicultural awareness also includes communicating in developmentally and culturally sensitive ways and understanding various cultural concepts of confidentiality. Counselors must strive to not only understand the client’s cultural point of view but also to understand how [the counselor’s] own culture has shaped their perceptions of the world.”

To broaden their multicultural competence, Oswalt suggests that counselors participate in individual or group counseling, do volunteer work with populations with which they are unfamiliar, participate in workshops that highlight specific cultural groups or discuss issues in a supervision group. “The insights and information they gain will better prepare them to understand diverse clients, avoid discrimination and select culturally sensitive and appropriate interventions,” she says.

Barnett suggests another aspect of ethics that counselors should consider: the role of ethical decision making and prevention versus merely cleaning up the mess after a problem occurs. So many situations that counselors face fall in a gray, middle area where the answer to the ethical question isn’t clear, he says. He points to an ethical decision-making model in his book that guides counselors through things to consider and questions to ask when making a decision. “Frequently, people think of ethics as good and bad, right and wrong,” Barnett says. “That’s only relevant when it’s clearly appropriate or inappropriate. In the middle, the answer is usually, ‘It depends.'”

In addition to finding a decision-making model, Barnett says it’s important for counselors to be aware of the major areas where ethical dilemmas might occur, such as confidentiality, competence and multiple relationships, and then take action to prevent difficulties. Counselors should be cognizant of their own motivations for decision making, use self-awareness to notice when difficulties are first beginning and then respond appropriately, he says.

“Prevention also includes practicing ongoing self-care to ensure our ongoing psychological wellness, maintaining a balance between our personal and professional lives, and regularly practicing what are termed positive career-sustaining behaviors such as regular exercise, getting adequate rest, having a healthy diet, managing stress on an ongoing basis and the like,” Barnett says. “Prevention may also include personal counseling or psychotherapy, the use of consultation when faced with ethical dilemmas and being sure to practice within our areas of competence.”

Yet another important perspective is the idea that ethics are meant to guide you, not your neighbor, Remley says. “In my opinion, the ethical standards are meant to be applied to ourselves. Counselors should be using them to guide their individual behavior, and one of the problems is a lot of people want to impose the ethical standards on others. In a way, that is inappropriate,” he says.

Remley says some counselors get in the habit of using ethical standards to judge other people’s behaviors or professional decisions rather than simply saying, “I don’t agree with you.” He offers a hypothetical situation: A counselor is working in a community mental health center, and after talking to a client, the counselor chooses not to have that client admitted to a hospital against his will. One of the counselor’s colleagues might think that it is the wrong decision to make, but instead of saying “I don’t agree with you,” the colleague labels the counselor unethical.

There are times when it might be appropriate to deem someone’s decision unethical, Remley says, but those times are few and far between, because very seldom is a case that clear-cut. People cut others down by calling them unethical because it’s more powerful than just disagreeing, Remley says, but he warns that the approach can have a grave effect on an individual’s reputation.

“Each individual counselor should refrain from labeling the behavior or decision of other people as unethical,” Remley says. “They should be judging their own behavior by this code of ethics and the ethical standards but not constantly applying them to other people. I’ve seen it too often in my career, and we need to talk about it as a profession.”

Do no harm

Striving to be ethical is at the heart of being a good counselor, Goodnough says. “Professional ethics are an extension of our own integrity,” he says. Among Goodnough’s list of recommendations for practicing ethically as a counselor: Be mindful of your actions, be knowledgeable of ethical codes, consult widely on ethical dilemmas, engage in continuing education, be affiliated with a professional association and always be in a supervisory relationship.

Goodnough says the way counselors act can protect clients and support the ideals of the profession — or not. “If we don’t get [ethics] right, we’re not doing our clients or our society any good,” he says. “In fact, we’re causing harm. It deserves the attention of all practicing counselors.”

Among Oswalt’s tips for ethical practice are understanding ethical codes, consulting with colleagues for advice when ethical difficulties arise, keeping up with current literature in the field, knowing how your state laws apply to the profession and taking full advantage of member benefits through ACA, including free ethical consultation.

Oswalt adds that it’s important for counselors-in-training to begin focusing on ethics while still in the classroom. Reflecting on her master’s program at Georgia State University, Oswalt says the topic of ethics was on the table for discussion in many of her classes. Even though she was in “decent shape” in her knowledge of ethics when she graduated, Oswalt says she continued to run into tricky issues. In those instances, she consulted with colleagues. “It’s not if a counselor will face an ethical dilemma, it’s when, so try to get yourself prepared,” she says. “A good foundation doesn’t do it perfectly, but it’s a great springboard.”

One ethical responsibility that counselors must take very seriously is tied directly to the position of power they hold in the counseling relationship, Remley says. “When clients seek counseling services, they are vulnerable. There is very little oversight of the interactions between counselors and clients, and clients could easily be abused in counseling relationships because of the power counselors have. Therefore, it is very important for counselors to practice in an ethical manner that results in their clients being helped and never being harmed or taken advantage of.”

Barnett emphasizes that point as well. “Clients come to counselors in need, seeking assistance for important issues and difficulties. They come to counselors needy, dependent on us and trusting us to only act in ways that are in their best interests. A failure to act ethically in our professional roles can lead to direct harm to clients and can undermine the public’s trust in counselors in particular and in mental health professionals in general. This could result in people who are in need of help not accessing the help they need. The public is trusting us to help them, not to harm them.”



Letters to the editor:




Don’t Touch Me

By Stacy Notaras Murphy

Susan* can’t remember not being sensitive to tactile stimuli. Ever since she was a child, she has had aversions to many things, including light touch, the feeling of rain on her skin, being breathed on, tight clothing, and jewelry or hair brushing the back of her neck. “I was never a warm, cuddly person because of my difficulties with touch, and my family gave me endless grief about my short, stiff hugs,” she says. “But in general, on my own, I had coping strategies and just avoided situations that made me uncomfortable.”

It wasn’t until Susan’s young son was diagnosed with a sensory processing disorder (SPD) that she pieced together these bits of her history and began viewing them as parts of a nameable condition. With her son now in occupational therapy and developing a treatment plan, Susan’s knowledge of the SPD spectrum has expanded greatly. Asked what she has learned through personal experience that others cannot discover just by reading a book, she replies, “The Handshake. Hand drawn sketchproblems that are often touted in children don’t go away with adults, and they can have a serious impact on interpersonal relationships and, therefore, happiness.”

By way of definition, individuals with an SPD might have trouble understanding, processing and reacting to information received from their senses. These individuals often feel their senses are unreliable or inconsistent, making basic tasks such as dressing and walking difficult. SPDs can make daily organization challenging, and they can lead to low self-esteem, anxiety and depression. Recent emphasis on diagnosis in childhood has raised the profile of sensory integration issues within parenting communities. SPDs often are recognized in tandem with other diagnoses, particularly attention-deficit/hyperactivity disorder and autism, but some people experience the disorder without a comorbid condition. Although the American Psychological Association does not plan to recognize SPDs as part of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the organization has requested further study on the topic.

It stands to reason that children with SPDs grow into adults with SPDs. But when children are not diagnosed, and do not follow protocols that include occupational therapy, they often reach adulthood without a definition for their struggles. Lacking effective coping strategies, they may find themselves in a counselor’s office facing depression, anxiety, addiction or other complicating conditions. Experts agree that SPDs can present more as a mental health issue, leading to misdiagnoses ranging from generalized anxiety and phobias to obsessive-compulsive disorder and bipolar disorder. Armed with an understanding of how SPDs present in adult populations, counselors can help these clients find more comfortable ways of living.

“I think that most people with SPD will assume their problems psychological and therefore seek either psychotherapy, medication or both,” says Sharon Heller, a developmental psychologist and author. “Few will know that SPD drives their behavior because it is generally considered a dysfunction of special needs children when, in truth, probably as much as 30 percent of functioning adults suffer from it to some degree. The more you learn about SPD, the more you see it all around you, manifested as disorganization, clumsiness, messiness, spaciness, irresponsibility, low motivation, underachievement, distractibility, social awkwardness, inappropriate behavior — the list goes on.”

What it looks like

Heller herself struggles with “sensory defensiveness,” which falls under the SPD umbrella. “I knew my over-reactivity to the world couldn’t be from just stress and anxiety because I had little to no control over it, and I hadn’t always been like that. It came on gradually, following head trauma. But I didn’t know why it was happening or what to do about it, so I built a cave and crawled in. What a sigh of relief when I found out it was an actual syndrome called sensory defensiveness.”

Heller began a “sensory diet” that included the deep skin brushing technique, proprioceptive input into her joints, exercises for her balance system and therapeutic listening, used in combination with cranial-sacral therapy. Her symptoms abated. “Today it’s mild and presents relatively little interference in my life,” she says. “As a writer, I knew that I had to spread the word to other adults with this relatively unknown syndrome who too were in the dark.” Her book Too Loud, Too Bright, Too Fast, Too Tight details the sensory defensiveness experience.

She explains how an adult client with an SPD might present in therapy: “If you have a client who is uptight but also ‘off-center,’ sensorimotor issues may be fueling their anxiety and depression. … Sensorimotor problems — [such as] low muscle tone, clumsiness, spaciness, over/under-reactivity to sensation, hyperactivity, attention deficits, learning problems — make ordinary activities effortful and interactions harder than they are for others. Succeeding in learning, relationships, careers, sports and life skills is a constant challenge.”

“Constant failure and difficulty in coping with day-to-day life causes stress and anxiety, and [in] not knowing why you fail to meet up to standard, you feel weird, stupid and inept,” Heller says. “Further, constant failure results in learned helplessness — ‘Why bother? It won’t work’ — and you get depressed.”

Heller gives an example of how this can play out. “Some people with SPD have great difficulty losing weight because they have low muscle tone and, uncoordinated and clumsy, find moving an effort,” she says, adding that exercise is not pleasurable for these individuals and physical activity has likely caused them much embarrassment in the past. “When they do lose weight, they feel less connection to their bodies. You need muscles for body awareness — to feel your body’s ‘edges’ — and, lacking them, you need extra weight to feel grounded.”

“[Overweight] and lacking control over your life, you feel depressed and go to therapy or take antidepressants,” she continues. “While this may help take off the edge and help you to cope better with life’s slings and arrows, it doesn’t cut off the head of the snake, and the central sensorimotor problems remain. If, on the other hand, you knew you had SPD and got therapy to increase body awareness and coordination, you would more willingly engage in exercise. This would give you greater control over your body, and the whole negative feedback cycle may be interrupted.”

Christopher Auer, a special education administrator in Denver and an affiliate faculty member at Regis University, didn’t recognize that his sensory sensitivities might be part of something larger until he got involved in the SPD community because of his young son’s diagnosis. “I was at a conference with [noted SPD researcher] Lucy Jane Miller, and I was presenting. I apparently appeared overwhelmed, and she asked, ‘You know SPD is genetic, don’t you?'”

“I think there are a lot of adults who don’t have a diagnosis but who have developed ways of being,” Auer says. He has learned to “disappear” into his smartphone when he feels overwhelmed so he can get grounded and check out for a while. “A better way would be for me to name the feeling and ask for space to tune out, then I can come back and interact with someone. It’s developing that communication piece so it’s clear for everyone. That’s the same for kids as well. You want them to recognize what their coping skills are, but you also want them to be able to come back and interact in a social way, to develop the inner resources or inner pool of energy so they can function more readily.” Auer and his wife Michelle, an occupational therapist, have written a workbook for kids with SPD, Making Sense of Your Senses.

Kristina Taylor is a developmental disability specialist and American Counseling Association member in Chicago. She became familiar with SPDs through her work with individuals with developmental disabilities while she was pursuing her master’s degree. “The longer I worked with people who had sensory integration or processing issues, the more I came to understand aspects of the disorder and how making small accommodations can really help,” she says. “I now work in the developmental disability field and see these issues in most of my clients.”

She notes that these issues present in many different ways. “For instance, if the therapy room or their work environment is too light or dark, too hot or cold, if things are not arranged in certain ways, or even if I am wearing my hair a different way that day, it can throw off their ability to engage in what we need to do because it takes more effort to process this input.”

As a result, Taylor says many of her clients have unconsciously developed their own coping strategies for dealing with their individual symptoms. “Many individuals I work with wear headphones or other things over or in their ears while working, riding the bus or being out in public. It helps to decrease the noise input they have to process. I have also seen individuals carry some small item they can squeeze to get needed sensory input when they are having difficulty processing their environment. Wearing certain types of clothing is another coping mechanism. Shutting their eyes when they are overwhelmed with input is common also, or just disengaging from their surroundings until they do not feel as overloaded.”

Cindy is a mental health clinician in California. She struggles with sensory processing issues, such as a sensitivity to artificial light and turbulence and consistently feeling that her body temperature is too warm, but she had not heard of the disorder until two years ago. “I thought I just had strong likes and aversions and adapted my life [and] surroundings to accommodate these things,” she reflects. “It was quite by accident that I stumbled across this disorder through a child I worked with whom had been diagnosed in the early 2000s. I looked it up on the Internet, and suddenly I found myself relating a little too much to some of the things that were mentioned.”

“I believe that unless I was speaking to a mental health professional, I would have no chance of relaying how I experience my world,” Cindy continues. “A general practitioner would probably send me directly to a neurologist for an MRI or make sure I got medicated.”

Today, Cindy never uses the overhead fluorescent lights in her office and often wears noise-canceling headphones when her officemate becomes distracting. She keeps a cooling fan near her desk or tries to sit near air-conditioning vents. At home, she avoids television, sleeps with a fan on, wears earplugs at night and often has ambient music playing.

On the positive side, Cindy believes her sensitivity has made her a more intuitive counselor for small children. “As my knowledge of SPD has grown, I have been able to make more and more sense of the behaviors I see in the classroom,” she says. “I think it’s probably easier for me to walk into a classroom and notice when the environment is too stimulating, loud, cluttered, boring, etc.”

“We had a child in our program who wouldn’t use the bathroom and would completely melt down every time the class had potty breaks,” she says. “I walked into the bathroom when the class was in there, and the sound was completely overwhelming. Imagine a completely tiled, six-stall bathroom filled with 15 3- to 5-year-olds! No wonder she didn’t want to go in. Sure enough, the teachers found that when they took her on her own, there was no issue. Sometimes, it helps to speak the language.”

In the counseling room

In addition to being diagnosed with Asperger’s syndrome, Karen has central auditory processing disorder, which is part of the SPD spectrum and impairs her ability to respond in conversations. She also has difficulties with tactile stimuli, such as cold temperatures and food textures, as well as strong odors. She describes the experience of walking through a department store perfume aisle as “all the keys of a piano being played at the same time.”

Karen’s journey toward understanding herself has included trips to her primary care physician, a speech therapist and an occupational therapist. “I’ve worked with counselors and other providers in psychiatry because from my teens, I’ve been treated for depression, anxiety, etc. I spent a lot of years in therapy and seeing doctors. The therapist was great and helped me think about some of my sensory issues.”

“Counselors need to work with any of their clients to try and address root causes of their suffering,” Karen advises. “It’s not always because of a simple chemical imbalance or because of negative thinking patterns. It’s not the case that the person can articulate what is really going on.”

“SPD is challenging to uncover in a case where someone comes in because they’re ‘feeling bad’ or clinically ‘depressed’ or ‘anxious’ and it’s not clear where the stress is coming from,” she says. “SPD can create other kinds of stress — social, executive functioning, which can lead to job stress, financial difficulties, alienation. It’s not enough to say, ‘Make friends’ when the person is overwhelmed by the sights, smells or sounds of other people in places where people normally spend time with others.”

Karen recommends that counselors “spend time with the person trying to understand their visceral experience of the world. If the setting permits, go out into the world with the person and explore what that is like. It may not just be the depression keeping a person from the grocery store.”

SPD treatment plans often include collaboration with occupational therapists, physical therapists and speech therapists, and Taylor says her experience working with these professionals has been highly positive. “I am not sure if this is typical or if I have just been very lucky, but many times these specialists have been very willing to work together to implement goals and sensory plans. Many work to increase independent living skills and vocational skills and help the clients work on making plans in advance for when they need sensory breaks.

“I have worked with these specialists to develop sensory rooms in homes, schools and workplaces, and to develop sensory diets, including meeting needs for deep pressure, wearing weighted vests, using weighted blankets, taking movement breaks, etc. I have found them all to be a very useful and integral part of a holistic therapy approach and full of great ideas and resources.”

Taylor notes that counselors can play an important role by advocating for SPD clients outside the therapy room as well. “I have written letters to employers to ask for sensory accommodations or to just explain certain behaviors that they often think are odd. I have written letters to state representatives to advocate for increased social services for these individuals, and I have protested at rallies. I also feel that just listening to [these clients’] needs and trying to understand as much as I can is a daily way in which I advocate.”

Taking time to understand

Roxanne Nichols is an ACA member and senior staff clinician at Boise State University. Despite her training, she admits she was only “minimally familiar” with SPDs as a whole until this past summer. That’s when her daughter, after years of struggle and being diagnosed with bipolar disorder, was referred for neuropsychological testing.

“My daughter has a sensory processing disorder called nonverbal learning disorder,” Nichols says. “As I began to read about it, I recognized almost all of the symptoms in her, whereas [the bipolar diagnosis] kind of fit, but never fully grasped all that she had going on. And bipolar is supposed to be treatable with medication, but that didn’t seem to alter her much, except for the sedation.

“Since her most recent and I believe accurate diagnosis, she has been off medication completely and with great success. We have educated ourselves on how to more effectively communicate with her. I would suggest [to counselors] that if a client presents with symptoms that have you shrugging or the symptoms seem to have atypical patterns, think outside the box and outside the DSM.”

Noting the paradigm shift that comes when a family member is diagnosed with an SPD, Nichols says counselors ought to ask clients questions that might point to the disorder. For example: When did you learn to ride a bike? How do you organize your room? How well do you handle transitions?

Taylor says counselor education programs could do more to educate students on sensory processing issues but adds that many related fields are also lacking knowledge. “I have several counselors and psychologists who are close friends, and since they do not usually work with clients with sensory processing issues, they don’t understand the needs or aspects of the disorder,” she says. “I have discussed aspects of cases, ensuring confidentiality, with them for consultation purposes [and found] out they do not understand why someone would flap their hands, bang their head or need deep pressure to help regulate themselves. I do not think most counseling programs offer enough training on these issues either. I know I never learned about a sensory diet in my [master’s] program.”

Taylor suggests that all individuals can be classified somewhere on the sensory spectrum, which might be a helpful mind-set for counselors to adopt. “Some of us can regulate our sensory processing systems well and do not need many coping mechanisms, while others need more help and support. However,” she says, “we have all had experiences when we were overwhelmed with sensory input. We can take how we felt in these situations and use that to better understand what daily life is like for those with sensory processing disorders. I think counselors can apply many of the tools and resources used with [the SPD] population to any client.”

Heller laments the lack of SPD information available beyond that which targets children with special needs, so she is writing a new book specifically for adults with SPDs that will be published next year. She notes that many online communities provide support and information on the topic and encourages counselors to spend time educating themselves. “I believe the role of the counselor is to help the client cope with the psychological sequelae that accompany this dysfunction and to give the person guidance and hope, especially because many, if not most, have been crippled by learned helplessness and feel too defeated to take steps to improve their condition,” Heller says.

On the whole, Cindy is optimistic about the counseling profession’s ability to help those with SPDs. “I believe that counseling is moving toward a more holistic view of the person, and not just in the social work way. The systems that support a person are critical, but just as critical is the way a person perceives their experiences and environment — and that is through the senses. Your clients may not even know they have SPD, but as mental health clinicians, we can help them explore the differences between how their senses bring information to them and how that can help or hinder them.”

“Become familiar with SPD and the work that occupational therapists do to assist those who are struggling with SPD,” Cindy advises counselors. “Support your client in becoming their own advocate and in finding coping skills to help them become more successful in their lives.”

At the same time, Cindy says, counselors should not assume that these clients automatically need, or necessarily want, to function just like everybody else. “Those of us who have SPD and don’t know it don’t even think we’re perceiving things differently than other people. But if we do notice, we just think we’re ‘quirky’ that way, or lazy, or whatever we were called growing up because of the sensory differences we had. Every single person out there has some sort of sensory issue. That’s normal. It’s when the processing of sensory input becomes interruptive to quality of life or success in school or employment that it should become a focus of treatment. Don’t diagnose everyone. And don’t make everyone go to an occupational therapist for treatment. Some of us are very attached to our quirks. … They are part of what others love about us as well.”

Note: *Some names in this article were changed by request.




Stacy Notaras Murphy is a licensed professional counselor practicing in Washington, D.C. To contact her, visit

Letters to the



ACAC becomes newest organizational affiliate of ACA

Lynne Shallcross

It was a question Randy Astramovich heard over and over: Why doesn’t the American Counseling Association have a division for counselors working with children and adolescents in a multitude of settings? This past spring, Astramovich decided it was time to take action so these counselors could have a true organizational “home.”

Astramovich, along with a few other individuals interested in seeing the idea come to fruition, collected 450 supporting signatures. With approval from the Governing Council, the Association for Child and Adolescent Counseling became ACA’s newest organizational affiliate this past fall. Once ACAC gains 500 ACA members, it can qualify to become an ACA division.

ACA Executive Director Richard Yep says the timing couldn’t be better. “I appreciate all of the work that the founding officers of ACAC did to move the process forward to the Governing Council. The issues that confront professional counselors who work with children and adolescents are at an all-time high, and the work of ACAC could be instrumental to the success of those providers.”

“The movement toward the establishment of ACAC originally grew out of conversations between ACA members who provide counseling services to children and adolescents across a wide variety of settings and who sought venues within ACA for networking, collaboration, research, preparation and training in child and adolescent counseling,” Astramovich wrote in a letter petitioning for ACAC to become an organizational affiliate. He further noted that although ACA’s Annual Conference & Exposition regularly features a grouping of conference presentations on child and adolescent counseling, no place existed within the ACA family for those counselors to collaborate and network outside the conference. Astramovich, now founding president of ACAC and an associate professor of counseling at the University of Nevada, Las Vegas, also pointed out that other organizations for helping professionals, such as the American Psychological Association and the National Association of Social Workers, already offered special divisions for child and adolescent work.

“Many of the child and adolescent counselors and counselor educators found ourselves without a specific network of support in ACA,” echoes Dee Ray, ACAC secretary and associate professor of counseling and director of the Child and Family Resource Clinic at the University of North Texas. “Over the years at conferences and through e-mails, we’ve wondered why there wasn’t a division solely dedicated to working with children and adolescents. We provided informal support for each other, but we wanted to have an organization that provided a formal network and support system for this population.”

Now that ACAC is up and running, Ray says expectations are high. “We hope that ACAC will focus on the training needs of counselors who work with children and adolescents and additionally provide professional support in terms of ideas, resources and encouragement to keep counselors motivated and energized to work with children,” she says.

ACAC will offer a variety of benefits to members, says Astramovich, who also serves as editor of the Journal for International Counselor Education. The organization will promote best practices, as well as research and networking opportunities for professional counselors who work with children and adolescents. ACAC will also strive to highlight the unique developmental and cultural needs of these clients, advocate for expanded child and adolescent counseling services, promote interdisciplinary collaboration among specialties whose members work with children and adolescents, and offer ACA members a collective voice in this specialty. “Although other [ACA] divisions address children, we felt like there was a need for some unity in the provision of counseling services to children across multiple settings,” Astramovich says.

ACAC’s primary focus will be to promote research and effective counseling services for children and adolescents, Astramovich says. In working with adults, he adds, most counselor practitioners come to understand that many of the issues their clients struggle with are rooted in their childhoods. Professional counseling is based on the idea of optimal human development, Astramovich says, and maximizing counselors’ effectiveness with children and adolescents could prevent or lessen problems for those individuals when they reach adulthood.

ACAC will also work to ensure that counselors in the field have the education and qualifications necessary to be effective, Ray says. “For so long, our field has focused mostly on working with adults and just applying those same skills to children and adolescents. Working with children and adolescents requires a specific skill set, and we will advocate for counselors to become formally trained in those skills. In addition, we will seek to differentiate skill sets needed for children and skill sets needed for adolescents. We will provide a developmental focus to work effectively with children and adolescents.”

Bridging the disconnect

ACAC isn’t geared specifically toward school counselors, but because they work closely with children and adolescents, the hope is to get school counselors actively involved in ACAC, Ray says. “However, ACAC will focus on the needs of all counselors who are counseling children and adolescents,” she emphasizes. “Private practitioners, mental health counselors in the schools, agency counselors, counselors in hospitals and school counselors are all part of the network that works with children and adolescents. The counseling part is the most important aspect of our concentration.”

Michael Moyer, ACAC trustee and assistant professor at the University of Texas at San Antonio, says when it comes to school counselors and professional counselors working with children and adolescents, partnering is key. “I believe ACAC will emphasize the need for collaboration between school and community counselors,” he says. “School counselors provide valuable services within the school system and the school setting, and community counselors also provide valuable services outside the school walls. Sometimes there is a disconnect between the two, and I feel very strongly that there should be collaboration and support from both sides to best support children and adolescents.”

It’s possible, Astramovich says, that ACAC could also promote a new paradigm in the way services are provided to children and adolescents in schools. Astramovich previously worked in Dallas as a school counselor and found that the ratio of students to school counselors left counselors juggling too many tasks. “What was clear was that the demands placed on school counselors are enormous,” he says. “There are so many duties school counselors are expected to fulfill that it’s simply impossible for all those duties to be met effectively by one individual.” (ACA recommends a maximum average student-to-counselor ratio of 250:1, but the most recent data released by the U.S. Department of Education’s National Center for Education Statistics show the average ratio in U.S. elementary and secondary schools stands at 457:1; see the March 2011 issue ofCounseling Today for more information.)

Astramovich says the future could include creating school-based counseling centers, which might look much like university counseling centers, with a variety of helping professionals, including professional counselors, available to students. If the dynamics trend that way, Astramovich says, school counselors wouldn’t disappear, but their roles would likely change. For example, the roles might be split between an academic counselor who helps students with courses and academic concerns and a mental health counselor who is based in a school counseling center. “Asking one individual to provide all the services that our children need isn’t realistic,” Astramovich says.

A tailored approach

The issues today’s children and adolescents face are wide ranging, Ray says, but perhaps the most common trouble point is society’s lack of understanding of what is developmentally appropriate in terms of mental health, growth and education. “This developmental mismatch between what is expected of children and what is naturally healthy for them is at the root of many children’s behavioral and emotional health problems,” she says.

To see change on the societal level, Ray believes the most important thing counselors can do is be active members of ACA and ACAC and advocate for best practices with children and adolescents. “Clinically, a counselor needs to be educated in working with children and adolescents from a theoretically sound framework,” she says. “Formal education will help counselors develop a belief system from which techniques and skills will emerge. The current trend to just grab any book or article on a technique to use with young people is ethically suspect and fairly ineffective.”

Counselors generally rely on talking in their work with clients, but Ray points out that children and adolescents often communicate in nonverbal ways, making it imperative that counselors cultivate their own nonverbal communication skills. “Because of cognitive differences or emotional issues, children and adolescents typically prefer nonverbal methods of communication to build relationships,” she says. “For example, young children communicate through their play, so we have found play therapy to be the most effective means of developing counseling relationships. Adolescents might prefer a physical activity or expressive arts activity to build their counseling relationships. Counselors need to be trained and supported in these methods to be effective in their counseling.”

Astramovich echoes that sentiment, saying that the use of developmentally appropriate techniques with children and adolescents is key to helping them. For instance, he says, counselors should gain experience using play techniques because substantial research exists showing the effectiveness of these techniques with kids.

Moyer adds that counselors must keep things exciting and moving when working with kids. “I find myself integrating different activities and types of play and not using as much traditional talk therapy,” he says. “Children and adolescents have so many options and activities that involve fast-paced technology that counselors working with that population have to be able to adapt their counseling skills to keep [these clients’] attention and make it meaningful to them.”

Another unique aspect of working with children and adolescents is the potential interaction with their parents or guardians, Moyer says. “Unlike working with adults who can provide their own informed consent, children and adolescents cannot. A legal guardian must provide that consent for them. In addition, parents and guardians have a legal right to know what a counselor is talking to their child about and, I believe, should be involved in the counseling process. On the other hand, as a counselor, I have to balance that sharing of information with the parent or guardian because the child or adolescent is my client, and I have to be able to build a trusting relationship with them. In short, there is a balancing act in building a trusting relationship in which the child or adolescent feels comfortable and confident in talking openly [even as the counselor keeps] the parents informed to an appropriate extent.”

As ACAC gets off the ground, Ray and Moyer offer some general words of wisdom about working with children and adolescents. Quality formal education is absolutely essential, Ray says, as is quality supervision of a counselor’s work by an experienced child counselor supervisor. “Working with children and adolescents is qualitatively different from working with adults,” she says. “Further, working with children is qualitatively different from working with adolescents. One cannot just apply those adult counseling skills to children and expect them to work. Counselors need a new language to be effective.”

Moyer offers the same advice he gives to his counseling students: “Be genuine. Children and adolescents can see right through you when you are being fake, and you will lose them pretty quickly. Be present and listen to their concerns. And [be] nonjudgmental. Children and adolescents — like all populations, I’m sure — are judged constantly on their thoughts and actions. Counselors can do wonderful things just by listening and not judging.”

Interested in getting involved in ACAC? Contact Randy Astramovich at for more information.

Lynne Shallcross is a senior writer for Counseling Today. Contact her at

Letters to the editor: