Monthly Archives: February 2013

Who are you? Who, who, who, who?

Bradley T. Erford February 28, 2013

Bradley-TThe Who, performing “Who Are You?,” was playing in my head this morning. The song was released in 1978 but easily could have been inspired by the events of 1964, when the band transformed its identity and went through four name changes in a single year: from The Detours to The Who to The High Numbers before finally returning to and etching the identity of The Who in history.

We are all familiar with Erik Erikson’s fifth stage: identity vs. role confusion. Normally in adolescence, people develop a personal identity and cogent sense of self, usually after much experimentation with different roles, behaviors and activities, and no small amount of soul searching. We all strive to gain direction in life and fit somehow into society, even if we find that “fit” by acting against society. We are told that if we receive encouragement and reinforcement throughout our exploration, we are likely to emerge with a strong identity; confusion and insecurity await those unsure of their beliefs and mission. What is sometimes lost in the discussion is that identity — knowing who you are — is a critical precursor to the future tasks of intimacy, generativity and integrity. Thus, a strong identity is critical to a meaningful and productive life and career.

This month’s Counseling Today cover story focuses on professional identity — a topic I believe is perhaps THE critical professional issue of our time. Who we are as professional counselors today is very different than who we were 35 years ago (before licensure), 65 years ago (before ACA) and 100 years ago (when the counseling profession was born).

We all come from diverse cultural and experiential backgrounds, and we draw strength from this diversity, both singly as individual counselors and collectively as a profession. How each of us got here is like a confluence of small streams flowing into what is now a major river of the counseling profession. Our past shapes our future and how we make sense of the present.

I majored in biology as an undergraduate. Yes, my mother got a deathbed promise that I would become a doctor (she just didn’t say what kind of doctor). I still remember the class discussions concerning how biological systems are defined and operate. A viable system must establish and maintain a clear boundary to protect itself from harm. But the system’s boundary must also remain permeable to outside influences so that it can exchange substances needed for growth and survival. If the system becomes rigid and impermeable, it will atrophy and eventually die. The counseling profession is a system, and we need to remain permeable to outside influences to thrive, even while protecting ourselves from harm.

At the core of our professional identity are specialized educational standards, knowledge and training in a number of essential areas. Our core principles are focused on wellness and strengths so that our clients and students not only become “not sick,” but also actually become healthy and thrive. These core principles, among others, form our identity as professional counselors.

Growing pains inevitably will occur, but there is a reason why they are called growing pains — we are growing and developing, becoming different and better than we were. In just the past few years, we have wrestled with and are still in the process of overcoming a number of developmental challenges, including requiring all core faculty in CACREP-accredited counseling programs to have degrees in counselor education, standardizing counseling degree programs by moving to 60 credits for all CACREP-accredited master’s degree programs, viewing school counselors as counselors who practice in educational settings rather than educators who have specialized counselor training, and requiring supervision of counselors-in-training by professional counselors (credentialed supervisors). Years from now, these practices will have become so woven into the fabric of our professional identity that we will question what took us so long to adopt them. And 35 years from now, after facing many more challenges and growing pains, we will be in a very different place and share a more unified identity and advocacy voice.

Given our professional focus on human development, I have recently wondered why we do not have an overriding stage theory or task model of professional counselor identity — a theory or model to help us explain how to promote and attain a unified identity, and perhaps stave off “multiple professional identity disorder.” Certainly such a theory would espouse a common core of educational and training standards, attainment of appropriate licensure and certification, and participation in professional counseling associations. Although these components all exist today and are paving the road to a more unified profession in the future, a great number of challenges still exist, and some backsliding is sure to occur.

For example, I recently wrote a letter to the 2016 CACREP Standards Revision Committee. Among other issues, I asked the committee to reinsert what seems like a minor clause, but one with vast implications for professional identity. The revised standard requires that “faculty must identify with the counseling profession through sustained memberships in professional counseling organizations.” The previous standard inserted the parenthetical phrase “… through memberships in professional organizations (i.e., ACA and/or its divisions).” Removal of that phrase would certainly lead back to “multiple professional identity disorder.”

But if we really want to have an impact on future generations of professional counselors and build a unified profession, accrediting bodies and universities must require counselors-in-training to participate in professional counseling associations. In a recent “round” at an ACA Governing Council meeting, a question was posed: How did you become involved with ACA? No less than 90 percent of us responded that we were “told” to join ACA by our graduate faculty. We had a firm professional counselor identity because our faculty and mentors had firm professional counselor identities. So, I also requested that CACREP establish a standard requiring graduate counseling students to identify with the counseling profession through sustained memberships in professional counseling organizations (i.e., ACA and/or its divisions). Exposing all of our counselors-in-training to the world of the professional counselor would be a giant step toward a unified professional counselor identity. The current reality is that most counselors-in-training do not belong to a professional counseling association. That is troubling.

A larger question is how we develop and maintain an appropriate professional identity (boundary) while still benefiting from the input and strengths of our interprofessional colleagues (permeability). After all, we share the same literature, have similar training standards and often receive similar supervision. But will we, as a counseling profession, mirror the mistakes of other mental health professions that seek to create impermeable barriers between professional groups? That seek to restrict counselor practice through legislation and regulations?

No one knows for sure what the future holds, but just as our appreciation for classic rock has matured, so will the counseling profession mature … over the next 35, 65 and even 100 years. But for now, enjoy reading this month’s feature articles and answer this question: Who are you?

The counseling profession really wants to know!

Counselors, we want to hear from you on HIPAA

February 27, 2013

HipaaMost counselors are well-acquainted with the Health Insurance Portability and Accountability Act (HIPAA) regulations regarding privacy. Many professionals, however, have only a basic knowledge of the security facets of HIPAA. With the recent release of the HIPAA Final Rule, it has become even more important that counselors are aware of their responsibilities when it comes to security electronic PHI (protected health information). In an upcoming article for his new Counseling Today column, Rob Reinhardt will be exploring where counselors are now, where they need to be and how they can get there. Please help him tackle the first part of his article by completing a brief survey about mental health professionals and HIPAA at

Using neurofeedback to treat ADHD

By Heather Rudow February 21, 2013


Lori A. Russell-Chapin

Attendees of next month’s 2013 American Counseling Association Conference & Expo in Cincinnati will be treated to a new series of conference sessions aimed at shedding light on research by ACA members on topics that uniquely benefit clients. 

Called the Client-Focused Research Series, these 30-minute presentations aim to increase awareness of research that focuses on improving the services that professional counselors provide to clients.

In the weeks leading up to the conference, Counseling Today is speaking with some of the presenters about their research and why they believe it is important to the enhancement of the profession. Next up is Lori A. Russell-Chapin, professor of counselor education and associate dean of the College of Education and Health Sciences at Bradley University. Russell-Chapin, who is also co-director of the Center for Collaborative Brain Research and a member of the Association for Creativity in Counseling and the Association for Counselor Education and Supervision, will be presenting with Theodore J. Chapin on “A Pilot Study of Neurofeedback, fMRI and the Default Mode Network: Implications for the Treatment of ADHD.”

What would you like attendees to take away from your session?

Counselors need to better understand that there is another noninvasive method for the treatment of psychological and behavioral symptoms. Neurofeedback (NFB) is that other option, in addition to counseling and medication. Neurofeedback, a type of neuromodulation, helps to regulate the brain and helps it to perform in a more efficient and effective manner. NFB works with computerized software, an electroencephalograph (EEG) instrument and the principles of operant and classical conditioning to help normalize and strengthen dysregulated brainwaves.

Counselors also need to better understand the importance and role that neuroscience must play in our everyday counseling lives. What we now know about the brain enhances and changes how we conduct counseling. I have been telling our graduate students for years that understanding the brain will change how we do counseling. That knowledge has arrived, and we counselors must understand and utilize those fascinating results. It only makes us more competent in our trade.

How did you first get involved with studying attention-deficit/hyperactivity disorder (ADHD)?

Whenever I would go into the school system to help our student counselors, there always seemed to be so many young children who had symptoms of ADHD. In our private practice it is also a prevalent concern. ADHD is the most common childhood psychiatric disorder, with a cumulative incidence reaching 7.5 percent by age 19 (Barbaresi, Katusic, Colligan, Weaver, Pankratz & Mrazek, 2004). 

Why did you decide to perform this study?

According to Konrad and Eickhoff (2010), there has been a shift of focus from regional brain pathology in children with ADHD to dysfunction in distributed network organization. Because of that belief, I took the opportunity to write a proposal for monies through our Center for Collaborative Brain Research. Our team of researchers did pre- and post-tests with fMRIs to test the ADHD hypothesis of the dysfunctional distributed network. Neuroimaging provides researchers much more advanced methods of understanding the brain and its functions and structures.

What surprised you most as you compiled your results?

Our research team certainly wanted to validate and replicate the efficacy of NFB in the treatment of ADHD, which we were able to state. However, in our pilot study, finding that the Default Mode Network (DMN) was consolidated and, even more importantly, normalized to some extent after 40 sessions of NFB was exciting and remarkable. Many researchers believe that the DMN is essential to our everyday functioning especially in the world of subjective, internal functioning of the environment around us. Often children with ADHD have great difficulty activating the DMN during a resting state or quiet time. The post-fMRIs showed that activation during the resting state after 40 NFB sessions.

Why do you feel this kind of ADHD research is important?

Further advancing knowledge is always an important reason to conduct research. Taking that knowledge and being able to offer those results to children and parents as another type of treatment for ADHD that is intrinsic, noninvasive and long-lasting is a “breath of fresh air” compared to the many side effects of stimulant medications.

Who do you feel is the best audience for this session?

Our workshop would be appropriate for any counselor who wants to know more about additional treatments for children with ADHD. It is just fascinating to see the brain results that the advancements in neuroscience offer. 

Is there anything else you would like to add?

I have been providing individual counseling for several decades. I know counseling works and helps people change their lives. My neurotherapy and neurofeedback training has changed how I conduct counseling and my view of the counseling world. It has strengthened my skills and helped me have better outcomes for my clients.



Managing stress for the millennial generation

Heather Rudow February 20, 2013



Authors William Strauss and Neil Howe are widely credited with coining the term “millennial,” a name they give to those born from 1982 to 2004. The idea of the millennial has been picking up steam as of late — in the past year, it has become part of modern nomenclature and the subject of myriad media critiques and television shows.

And, fittingly, this generation is the focus of a newly released study by the American Psychological Association (APA) that revealed that millennials are more stressed than ever before and more stressed than their older counterparts.

An online survey of 2,020 U.S. adults 18 and older found that 39 percent of millennials reported that they were more stressed this year than the previous year. That’s compared with 36 percent of those in Generation X, ages 34 to 47; 33 percent of baby boomers, ages 48 to 66; and 29 percent of matures, 67 and older.

On a 10-point scale, where 1 means “little or no stress” and 10 means “a great deal of stress,” the 2012 average between all generations is 4.9. Millennials reported a 5.4 on the scale.

Managing stress is also harder for millennials compared with other generations. Sixty-two percent of millennials reported making efforts to reduce stress, yet 25 percent say they are not doing enough to manage it, compared with 15 percent of boomers and 7 percent of matures.

In addition, only 29 percent of millennials say they are doing an excellent or very good job of managing their stress, compared with 50 percent of matures, 35 percent of Generation Xers and 38 percent of boomers. In fact, since 2010, the percentage of millennials who reported doing a good job managing stress has decreased: in 2010, the APA reported the number at 33 percent, and in 2011, it was 32 percent.

However, Brian Van Brunt, a past president of the American College Counseling Association, a division of the American Counseling Association, and senior vice president of professional program development for the National Center for Higher Education Risk Management Group, says he is not too concerned by the findings.

“These kinds of studies tend to attract national attention because we like to see the newest generation struggling with their adjustment to the world,” Van Brunt explains. “This isn’t all that different from my generation, Generation X, being labeled as ‘slackers’ and ‘adrift.’”

To Van Brunt, the statistics actually portray a generation with fairly average stress levels.

“When you look more closely, you discover that [the study is] on a 10-point scale, where 1 means ‘little or no stress’ and 10 means ‘a great deal of stress’ [and] the 2012 average is 4.9,” Van Brunt says. “The article goes onto to state that millennials are stressed at a 5.4. I’m not convinced that this is cause for alarm. While these students certainly have a host of problems in front of them, keep in mind what it would be like to rate your stress one a 10-point scale. This study is saying that the average amount of stress millennials are putting down on the keyboard is just slightly over the halfway point. To me, that seems right on par for college students struggling with today’s challenges of increased tuition, [balancing] work, life and academic pursuits, and working in a country that appears to be struggling a bit as we come out of a recession.”

Jane Rheineck, an associate professor in the Department of Counseling, Adult and Higher Education at Northern Illinois University and a member of ACA, says developmentally speaking, millennials are often at a crossroads in their lives, which contributes to heightened feelings of stress.

“They are at the beginning of their careers, which inherently creates stress, and the unpredictability of the job market adds another level of stress,” says Rheineck, who is president elect-elect of the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling, a division of ACA.

Rising costs in education has lead to an increased burden on students, “[making them] wonder, ‘How am I going to pay for my education?’ or, ‘How will I be able to afford to pay back student loans?’”

Through his work with students in this age group, Van Brunt has found the main causes of stress to be the same as when he was a college student 20 years ago.

“I would agree with the survey’s findings that things like work, worrying about student load debt, academic demands [are causing stress],” says Van Brunt, who was previously director of counseling at Western Kentucky University. “During my time in college counseling working with stressed, anxious and depressed millennials, I would often hear them trying to figure out their place in the world ­— looking for a job or sense of purpose — upset about friendships or relationships that didn’t work out, overwhelmed by balancing their academic coursework and trying to have enough money to live on while at school.”

Rheineck, who is also a past president of the Association for Adult Development and Aging, a division of ACA, offers the perspective of millennials as graduate students.

As an educator, she has seen the stress of going to graduate school, working and family obligations, as well as the increased cost of going to school increase stress levels for students.

“In most cases, I think the image of being a ‘care-free’ graduate student is long gone,” Rheineck says.  She has found that those competing obligations can certainly contribute to stress.

The study found the top stressors of millennials are money, work and the economy: “All are direct ties to finances,” Rheineck says.

Van Brunt believes that if there is aspect in which millennials worry more than previous generations, it is in “the struggle of trying to find their place in the world, given the changes going on in the college and workplace.”

Thinking back to his time in college, Van Brunt says, “the old saying went, ‘It used to take a high school diploma to get a good job, but now you need a bachelor’s.’ Now, I hear students saying they need a master’s to be successful, and even then, there are no guarantees that the effort they put in will pay off in the end.”

“I think millennials worry about the investment in college and wonder how this investment matches up with their dreams,” Van Brunt continues. “Entering college is kind of like getting on a train that goes faster and faster as the years pass. It’s very hard for an 18-year-old to have a sense of their career and life goals when they get on the train. It becomes almost impossible to get off once they have invested so much money and time into their college years. I’ve seen that create panic and anxiety in the students I counsel.”

In terms of the significance for counselors, Van Brunt says they need to “remain on those front lines to help out students who might feel lost or pressured by their college choices. I’m reminded of the film Dead Poet’s Society, where the main character commits suicide over the pressure to become something he ultimately was not. Counselors help these students better manage their stress, expectations and help them develop conflict-resolution skills to bring these discussions around [so they can talk about] where their life is ultimately heading.”

Rheineck thinks counselors need to be aware of the unique, cultural changes facing each generation.

“Being 18 in 2013 is very different than being 18 in 1983, or even 2003,” she says. “That being said, every generation has had unique historical, sociological challenges that have impacted adult development and, as a result, stress.”

As a way to help the millennials he counsels, Van Brunt finds he is “leaning more heavily on Irvin Yalom’s existential therapy work as well as some of Michael White’s narrative therapy to help clients better understand their sense of story and place within the world. These approaches help them wrestle more directly with the problems that are causing the anxiety and worry in their lives. While there are no easy solutions here, the broadening of perspective can be helpful to relieve some of the stress.”

Additionally, he recommends counselors utilize cognitive behavior therapy, which he says “offers some tried and true technical approaches to help students better organize their lives and look more closely at where their goals fall out of step with their actions. I also find James Prochaska and Carlo DiCliemente’s work in this area extremely helpful to assist students build a more realistic frustration tolerance when they don’t perform perfectly right out of the gate.”

Rheineck stresses the need to for counselors to pay attention to any minorities or subgroups within the millennial generation.

“For example,” she says, “LGBT persons face a tremendous amount of stress from being oppressed. This population, for example, is two to three times more likely to attempt suicide and face addiction issues; couple that with the universal stressors that effect all millennials, the recipe for disaster can be enormous.”

Heather Rudow is a staff writer for Counseling Today. Contact her at













The impact of community on postnatal depression

Heather Rudow February 13, 2013

CCU_MeAttendees of next month’s 2013 American Counseling Association Conference & Expo in Cincinnati will be treated to a new series of conference sessions aimed at shedding light on research gathered by ACA members on topics that uniquely benefit clients. 

Called the Client-Focused Research Series, these 30-minute presentations aim to increase awareness of research that focuses on improving the services that professional counselors provide to clients. 

In the weeks leading up to the conference, Counseling Today is speaking with some of the presenters about their research and why they believe it enhances the work of the profession. Next up is counseling student and public health advocate David Jones, who will be presenting on “Advocacy Outside the Box: A Multilevel Spatial Analysis of First-Time Mothers With Postpartum Depression.”

What would you like attendees to take away from your session? 

A greater knowledge of individual and community risk factors associated with postnatal depression (PND). Additionally, they will have an expanded conceptualization and tools for working with their clients and community.

Why is it important for counselors to learn the difference between community and individual risk factors associated with postpartum depression?

From an ecological perspective or other social models, there is a conjugal dance between individual and community risk factors. To effect lasting change, the counselor needs to see within but also beyond the individual risk factors toward the context: community. This context is a powerful influence on the individual’s affect, mood, cognition and behavior. Further, the individual’s choices have collateral. This collateral affects the family, which impacts neighborhood, which influences the community and vice versa.

How did you get involved with this subject?

My career is in public health, but I am also a counseling student. Through my work at Cincinnati Children’s Hospital and Medical Center and my studies emerged a passion around improving the outcomes of children.

Further, counseling and public health have a natural marriage: prevention. Therefore, through the lens of life course theory, the best approach is to intervene before the birth of the child to change the trajectory of lifelong outcomes for the child. Hence, a counselor seeks interventions before womb, secondarily when the child is in the womb and, tertiary, postpartum.

What inspired you to present this session at the conference?

It is a desire to bring about awareness and advancing the field of counseling. I believe that research is imperative for improving the health of our clients and their communities. Furthermore, there is a call for the counseling profession to get more serious about research. By doing so, it will advance our identity as counselors. 

Did anything surprise you as you were compiling information for your session?

The sample was drawn from a home visiting program for first-time mothers. The program contracts with seven agencies within Hamilton County, Ohio, to conduct their services. Each agency provides services in a specific catchment based on ZIP code. What was of particular interest was the severity of these rates and that the majority had rates higher than the national averages [of] 10 to 15 percent. Yet, conversely, the Hamilton County rate was high as well.

When looking at the individual risk factors, several became salient. For example, race and ethnicity were significantly different between those at risk for PND  (EPDS score < 10) than those not at risk. Another risk factor associated with the risk of PND was years of education.

Besides these finding above, what was remarkable was the many risk factors that were not found to be significant. This study linked the home visitation client record data with hospital discharge data, Ohio birth certificate data and 2010 Census tract data. After the linkage, there were over 300 variables associated with each case. Through analysis, no significant association was found for preterm birth and infant loss among others.

When examining the area level (Census tract) variables, it was a surprise that median home value was not significant. Yet, other area level variables did have an association such as percent of vacant housing units, percent on SNAP and GINI Index score.

This is the initial step in our investigation. Our study group plans on digging deeper into the data and looks forward to seeing what we will find.

Who do you feel is the best audience for this session?

This is important for a variety of audiences. One is the counselor who works with this specific population. Others that become prominent are counselors who take prevention and community outreach to heart, such as those who are passionate about social justice. It is relevant for counselors-in-training to expand their conceptualization of their profession. Finally, based on ACA’s call, it is imperative for all counselors [to take part] in a concerted effort to advance the counseling profession’s presence in research.

Heather Rudow is a staff writer for Counseling Today. Contact her at