Monthly Archives: December 2012

NPR interviews ACA member about Sandy Hook

Heather Rudow December 19, 2012

(Photo: Wikimedia Commons)

ACA member Jane Webber was interviewed Tuesday on NPR‘s Morning Edition regarding the shooting at Sandy Hook Elementary in Newtown, Conn. Webber is an associate professor in the counseling program at New Jersey City University, former president of the New Jersey Counseling Association and current member of the ACA Crisis Response Planning Task Force. She also coedited the third edition of the book Terrorism, Trauma and Tragedies: A Counselor’s Guide to Preparing and Responding, which was published by the ACA Foundation in 2010.

Click here to listen to the interview

When the unthinkable happens: Counseling children following the Sandy Hook Elementary School shooting

Heather Rudow December 18, 2012

(Photo: Wikimedia Commons)

When the lives of six educators and 20 children between the ages of 6 and 7 were cut short in a mass shooting at a Newtown, Conn., school Dec. 14, the entire country found itself reeling.

The tragedy at Sandy Hook Elementary School is the second deadliest school shooting in U.S. history, following only the 2007 Virginia Tech massacre. It is, however, the most deadly shooting to take place at an elementary school.

Deb Del Vecchio-Scully, the executive director of the Connecticut Counseling Association and trauma expert, says the ages of the victims and the fact that the shooting took place at a school make the tragedy resonate with people in every corner of the country.

“School is supposed to be a safe place,” says Del Vecchio-Scully, a member of the American Counseling Association. “Not just [Sandy Hook Elementary] is going to be affected but also other schools in the area. There are going to be long-reaching effects on parents and children that we are going to see in the days, weeks, months and years to come.”

And as the community of Newtown grieves, Del Vecchio-Scully says the initial question is how the tragedy should be discussed with children.

“You want parents to be the source of information,” she says. “Not other kids, not the news. Be honest and direct, take your cues from your child and respond accordingly.”

Del Vecchio-Scully recommends keeping children away from news reports, as studies have shown they can increase the risk of posttraumatic stress disorder.

She says counselors, parents and teachers will need to be mindful of the way they help children cope with the tragedy because kids are still mentally and emotionally maturing.

“The younger child’s brain is not developed to understand the permanence of death, and that’s going to add a difficult layer to it,” Del Vecchio-Scully says. “[Children] are the ones who are going to ask ‘What happened? Why can’t I go back to school?’”

In addition, Del Vecchio-Scully says, it’s often hard for children to find the right words to describe how they feeling about what they’ve experienced.

Del Vecchio-Scully recommends giving children a creative outlet as a way to express their feelings. “Kids act out their worries and concerns through play and their artwork,” she says.

Because the event is still recent, Del Vecchio-Scully says most reactions a child may exhibit for the next week or two can still be considered normal. This may include regressive behaviors such as wanting to sleep in bed with parents, bed-wetting or acting out.

“Normalizing and fostering a sense of safety and routine is important right now, and that’s going to start at home,” she says.

It is also important for parents to foster open communication and to be open and honest about their feelings as well.

“Kids are very sensitive,” Del Vecchio-Scully says, “ and they’re going to get their cues from their parents.”

Similar to parents, teachers should also focus on maintaining a daily routine and should aim to answer questions from students to the best of their ability.

Del Vecchio-Scully says the impact of the trauma and the mental health needs of communities are layered like concentric circles.

“The inner circle includes the children, school staff and first responders who witnessed the event and/or the crime scene, as well as the officials who informed the families of the death of their loved ones,” she says. “Next are the parents of the surviving children and those whose children were killed. On the more outer rim of the circle is the rest of the greater Newtown community and the entire Connecticut community.”

The fourth layer includes the general public watching the tragedy unfold in the news media and through social media who are vicariously impacted, Del Vecchio-Scully says.

Crisis intervention is already occurring in Newtown, and for most counselors, Del Vecchio-Scully says, “our services will be needed once the crisis period passes and a void in caring for the community is evident.”

Although Del Vecchio-Scully says that now may not be the time for therapy, counselors, too, can take on the role of listener for those impacted by the shooting if the situation calls for it.

But in the months to follow, Del Vecchio-Scully says, “the crisis intervention teams will withdraw, creating a void of support, which will result in a shift of responsibility of the ongoing mental health needs of the community to local agencies and volunteer counselors.”

Counselors should be on the lookout for individuals who are at risk of re-traumatization.

“Newtown was one of the towns that was hit by Hurricane Sandy,” Del Vecchio-Scully explains. “They went without power for a week. As traumatic events get layered, the ability to cope gets less.”

This is also the time for counselors to focus on individuals in the outer concentric circles — those who may not have been directly impacted by the events in Newtown but are having trouble coping.

The shooting at Sandy Hook Elementary will have an especially far-reaching impact because a school setting is something that all children share and experience, Del Vecchio-Scully says.

Del Vecchio-Scully says the events mirror the attacks on 9/11. “The world watched in real-time, and individuals will be impacted in some way that we can’t really know right now,” she warns counselors.

Del Vecchio-Scully stresses the importance of the role of counselors in helping children and communities cope and move forward in the months following a tragedy such as this.

“Kids are extraordinarily resilient,” she says, “and we have to give them the chance to be.”

The Connecticut Counseling Association is creating a list of licensed professional counselors in Connecticut who would like to provide their services to the Newtown community. Interested therapists should contact cca_exec_dir@msn.com with their name, address, email and telephone number, along with their license number. In addition, the state of Connecticut is recruiting mental health clinicians as well. Counselors can register at surveymonkey.com/s/YLGXFBJ

Heather Rudow is a staff writer for Counseling Today. Contact her at hrudow@counseling.org.

Dropping Asperger’s from the DSM divides counselors

Heather Rudow December 17, 2012

(Photo:Wikimedia Commons)

One of the most contentious changes in the soon-to-be released fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is the American Psychiatric Association’s decision to drop Asperger’s syndrome from the manual and place it under the category for autism spectrum disorders (ASD).

In a statement, the American Psychiatric Association said, “The [new] criteria will incorporate several diagnoses from [the] DSM-IV, including autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder (not otherwise specified) into the diagnosis of autism spectrum disorder for [the] DSM-5 to help more accurately and consistently diagnose children with autism.”

Counselors and others are split on the impact this decision will have, both on mental health professionals and individuals with Asperger’s.

Melinda Gibbons, an associate professor of counselor education in the educational psychology and counseling department at the University of Tennessee, says autism has become more recognized and understood by the general public.

“There is more publicity about autism in the media, and there has been a significant increase in the numbers of children diagnosed with autism,” says Gibbons, a member of the American Counseling Association. “I think the public still has only a vague understanding of the specifics of autism, but many people can now describe the disorder in generalities and/or point to someone they know with the disorder.”

Gibbons has also witnessed improved understanding among mental health professionals. “The amount of research on autism and autism spectrum disorders has increased dramatically,” she says. “Clinicians and teachers working with the K-12 population see the need to understand ASD in their students and help them be successful in school and beyond.”

Jamie Schutte, a professor at the University of Pittsburgh in the Department of Rehabilitation Science and Technology, believes this has to do with the increase of the disorder itself among youths in recent years.

“In 2000, the Centers for Disease Control (CDC) estimated autism spectrum disorder prevalence at 6.7 per 1,000, or 1 in 150 children [who are] 8 years old,” says Schutte, an ACA member. “In 2008, the prevalence was 11.3 per 1,000, or 1 in 88 children aged 8 years. No one knows the cause of this increase in prevalence, but it is definitely happening.”

Schutte adds that the representation of ASD has also become more prevalent in popular culture, including in novels such as The Curious Incident of the Dog in the Night-Time by Mark Haddon and on TV with characters such as Dr. Dixon on Grey’s Anatomy and Max Braverman on Parenthood, “which,” she says, “has increased awareness on the part of the pubic and media.”

That same level of broad understanding doesn’t necessarily extend to Asperger’s, however, according to Gibbons. “There is much less media attention on [Asperger’s] and, many times, people combine it with autism,” she says, “not understanding the differences between the two diagnoses.”

“Asperger’s is a relatively new diagnosis, only showing up in the DSM-IV for the first time as an actual diagnosis,” Gibbons says. “As a result, the number of students diagnosed with Asperger’s has increased tremendously, and we are now starting to see college students and young adults with this diagnosis. Adding Asperger’s as a diagnosis gave clinicians clarity in diagnosing a disorder for clients who showed some signs of autism-like symptoms but demonstrated average to above average intelligence and normal language development.”

Gibbons thinks dropping Asperger’s from the DSM will make it harder to advocate for clients because they will not have a specific Asperger’s diagnosis.

“In particular, school counselors might experience more difficulties placing students in appropriately difficult classes once ASD is used instead of Asperger’s,” Gibbons says. “Students with Asperger’s typically demonstrate average to above average intelligence and usually are fully integrated into mainstream classes. They receive supports such as physical therapy, social skills instruction and special rooms for times when they feel overstimulated, but they also tend to do very well in classes and often enter into honors classes. This pathway might be more difficult to maneuver with the ASD diagnosis.”

Additionally, she believes the new “lumped” diagnosis will make it difficult to distinguish between children whom previously were given the Asperger’s diagnosis – now to be called mild ASD – and those with mild autism symptoms – what used to be called high-functioning autism.

“These two groups often differ on intellectual disability status and language development,” Gibbons says, “but might eventually be classified with the same disorder status using the new ASD diagnosis.”

Schutte, on the other hand, believes the change in Asperger’s classification will actually reduce diagnostic confusion.

“I think this is a good idea,” she says. “The DSM-IV [categorizes] autism, Asperger’s, pervasive developmental disorder not otherwise specified and childhood disintegrative disorder, [which] caused confusion because they were not well defined. Even experienced clinicians could disagree on the ‘correct’ diagnosis. In addition, there were other diagnostic terms floating around, including autism spectrum disorder, atypical autism and high-functioning autism, that were not defined in the DSM but seemed to be clinically relevant. So, there was little consistency, which is confusing for everyone, including counselors, clients, families and researchers.”

Gibbons says she does see some positives to the reclassification — namely that it simplifies the diagnosis and may help with third-party reimbursement and distribution of services.

“On the other hand,” she says. “I think people with Asperger’s differ substantially from people with autism, and combining the two diagnoses may lead to overlooking these differences in favor of the similarities between the two. Also, in terms of identity for the students, I think this is a major change with possible negative consequences.”

Schutte believes development of the new all-inclusive category of ASD “and providing recommendations for severity based on the amount of support needed makes sense. It also makes sense to combine the ‘social’ and ‘language’ diagnostic criteria because language is largely a social behavior. Also, I’ve worked with many adults with Asperger’s diagnoses who didn’t experience delays in the development of language but still had some language abnormalities, including idiosyncratic speech and unusual prosody.”

However, she adds, “I think some clients, especially those who identify as having Asperger’s, will be disappointed with the change or resistant to let go of the diagnosis, because they have developed a positive identity around it. The diagnosis of Asperger’s may carry less stigma than autism, so parents and clients may have preferred it. There has also been some advocacy work done around Asperger’s, for example, the website Aspies for Freedom.”

Gibbons echoes this statement, worrying that misconceptions may arise as a result of lumping children with Asperger’s in with children who have autism.

“Kids with Asperger’s are often seen as college-going, high-achieving students,” she says. “Kids with autism, on the other hand, often have less positive outlooks. I am generalizing here, but losing the Asperger’s diagnosis and combining it with ASD may create changes in others’ perspectives of these students. Also, I think there will be a change of identity for older clients with Asperger’s. Knowing your diagnosis can be a helpful piece of self-understanding, and changing the diagnosis label can be potentially damaging for these clients.”

Gibbons thinks it will be important for counselors to talk to clients with Asperger’s and their families about the impending change. This is especially true with older clients, she says, “who already have some understanding of the Asperger’s diagnosis. In addition, I think counselors need to advocate for their students with Asperger’s so that schools and others understand their strengths – normal language development and average to above average intelligence – and their differences from others on the autism spectrum.”

Although the change might affect the way things are processed through insurance, Schutte does not believe dropping a specific diagnosis for Asperger’s from the DSM should alter much in terms of everyday life. “Treatment plans are based on the individual and not the diagnosis,” she says, “so despite the change in diagnosis, services should continue on as planned. Individuals and families who have concerns about the change in the diagnosis should talk to their counselors, who can, hopefully, address specific concerns and assuage fears about the change.”

“Diagnosis is important for a variety of reasons,” she continues, “including implications for treatment, public policy, planning for needs and development of services, granting access to resources to qualified recipients, and individual attitudes toward and adjustment to disability. However, at the end of the day, a diagnosis is only a word. Everyone with ASD is different, and so regardless of diagnosis, an individualized approach to therapy that incorporates the individual’s goals, environment, strengths and weaknesses is going to be the best approach.”

For more information, read Counseling Today’s October Knowledge Share, “Addressing challenging behaviors for individuals with autism spectrum disorders.”

Heather Rudow is a staff writer for Counseling Today. Contact her at hrudow@counseling.org.

A peek at the interview process for doctoral students seeking counseling faculty positions

Kathleen Smith December 14, 2012

(Photo:Flickr/bpsusf)

From the moment he stepped off the plane, Tyler Wilkinson knew he had to be ready. Ready to have a meaningful conversation in the car on the way to campus, ready to engage at a faculty dinner meeting and ready to field questions from potential future colleagues during a marathon interview day commencing at 7 the next morning.

Ask any candidate for a counseling faculty position to describe the job interview process, and you are likely to get the same response: exhausting. “It was exhausting in the sense that you always have to be ‘on,’ and you’re always trying to stay focused on interacting with the person in front of you,” says Wilkinson, a member of the American Counseling Association. “Yet at the same time, you’re anticipating what is coming up next.” A faculty member at Indiana University of Pennsylvania’s Department of Counseling, Wilkinson ran the gauntlet of interviews this past spring as he was completing his Ph.D. at Auburn University.

Doctoral students looking for counseling faculty positions are often advised to consider how the timing of their arrival will affect their preparation. Interviewees might be rushed or exhausted from an early morning flight, but those arriving a day ahead of time might face an anxious night of tossing and turning. “I flew in the day before, which is good in one sense because it allows you to prepare,” says Joel Filmore, a doctoral candidate at Northern Illinois University and a member of ACA. “But for someone like me, it just created 24 hours of anxiety building up to the daylong interview. I tried to use that time to relax and reflect and work on my presentation, to make it more polished.”

With interviews often reduced to a single day, candidates face a gauntlet of meetings with several deans, department chairs, faculty members, administrators and students. And beyond the numerous rounds of questioning, they are expected to present and defend their own unique research, teach a course to unfamiliar students and socialize with future colleagues at several meals. “The day physically and mentally drains you because you don’t really know what anyone is thinking the whole time,” Wilkinson says. “You’re trying to get a sense of their thoughts, but everybody’s trying to make a good impression.”

Recently having faced an entire day of half-hour interviews, Filmore recalls a challenge he hadn’t been anticipating — hearing the same questions again and again. “They have to ask all the candidates the same questions so they’re not showing favoritism, and I wasn’t prepared for that. But it made it much easier by the second or third group of people I was meeting with, because I already had a framed answer for them. The challenge, I think, is to make it sound fresh, as opposed to being a canned response.”

More so than other faculty interviewees, counselor education candidates are also called to reflect on nonacademic experiences and their potential contribution to a career in academia. Wilkinson advises candidates to reflect on the interaction between teaching and clinical experiences — a question these candidates may very well be asked by an interviewer. “They’re not only interested in your teaching and scholarship,” he says. “There’s a piece of being able to speak to your clinical experiences, so consider questions about approaches to counseling in addition to teaching approaches. How does your teaching influence your counseling, and vice versa?”

Perhaps the most underutilized audience during the interview process, however, is the students themselves. Most counseling faculty candidates are given the opportunity to interact with students through teaching a class or during a scheduled meeting time. Filmore emphasizes that this opportunity should not be overlooked. “You want to have that experience to see how the students interact with faculty, but also, how do they experience somebody new? These are counseling students, so are they able to adapt to new situations?”

Another recommendation is to take full advantage of any brief moments of respite. “Anytime you’re offered a bathroom break, take it,” Wilkinson advises. “Even if you don’t have to use the bathroom, it’s your own little space saved for a moment to recollect your thoughts and take a deep breath.”

“I literally went out to the parking lot, got in the rental car, turned on the car, put on the air conditioning and just sat there for that whole half hour decompressing,” says Filmore, reflecting on one lengthy interview day.

Although no amount of practice can completely prepare a candidate for the interview process, doctoral counseling students are advised to take advantage of programs offered by their universities. Wilkinson attributes much of his own readiness to the Preparing Future Faculty Program at Auburn, which taught him about “the other side” of being a faculty member — “not just teaching and research, but faculty governance, the job search process, how to write a competitive vita and what to know about the interview process,” he says.

Doctoral counseling students also have exposure to the interview process through their own departments, which may be interviewing new faculty members. Seeing the process at work and bouncing observations off of faculty members can be an invaluable step in learning the interview game.

But for those who are in the thick of the interview process, the most pressing and perhaps the most challenging bit of advice is to stay composed and not to stress, despite the exhaustion they will likely experience. “There is a clear delineation between those programs that ‘fit’ you and those that do not,” Filmore says. “For the programs that fit, [the process] is almost effortless, so all the worry will be for nothing.”

Kathleen Smith is a certified rehabilitation counselor and a doctoral counseling student at George Washington University. She is also a regular contributor to the Counseling Today website. Contact her at ak_smith@gwmail.gwu.edu.

SAMHSA asks for input on definition of trauma

Heather Rudow December 13, 2012

From now through Dec. 21, the Substance Abuse and Mental Health Services Administration (SAMHSA) is seeking public input on its concept paper, SAMHSA’s Working Definition of Trauma and Principles and Guidance for a Trauma-Informed Approach.

SAMHSA has developed the following working definition of individual trauma: Individual trauma results from an event, series of events or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual’s functioning and physical, emotional or spiritual well-being.

The SAMHSA concept paper is divided into three sections. Each section has its own unique forum in which individuals can provide comments and vote on comments offered by others:

The feedback forum began Dec. 10.

“Feedback on the forum is an important part of the public dialogue on this issue,” wrote SAMHSA in a press release. “Your feedback will be carefully considered in the shaping of the definitions of trauma and trauma-informed approach, and the principles and guidelines of a trauma-informed approach.”

Fore more information, visit blog.samhsa.gov/2012/12/10/defining-trauma-give-us-your-feedback