Monthly Archives: February 2013

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

Exploring the connection between mindfulness and differentiation of self

Heather Rudow February 11, 2013

AppelAttendees 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 that uniquely benefits 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 particularly beneficial. Next up are Dohee Kim-Appel and Jonathan Appel, a married couple who will be presenting on “The Relationship Between Bowen’s Concept of Differentiation of Self and Measurements of Mindfulness.” Dohee is an associate professor of art therapy and counseling at Ursuline College and Jonathan is an associate professor of psychology and criminal justice at Tiffin University.

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

The quality of our family relationships colors much of our mental and emotional development, our ability to balance reactive emotions with constructive thinking and our ability to be mindful of ourselves and others. Our hope is for attendees to view the connection between some mindfulness constructs and other therapeutic conceptual models; in this case, a construct well known in the family counseling literature — “Bowen’s Model of Differentiation of Self.” We hope one walks away with the knowledge of how central family relationships are to our mental health.

Why is it important for counselors to understand mindfulness and Bowen’s Concept of Differentiation of Self?

The skill of mindfulness suggests that one would be accurately aware of the present moment in the surrounding environment: one’s emotions, relationships [and] self-motivations. Educational and counseling techniques that induce mindfulness are increasingly being employed in psychotherapy and counseling and in self-help programs to understand and alleviate a variety of mental and even physical conditions. Our current research found mindfulness is very connected to the concept of “differentiation of self,” or the ability to relate with others without losing one’s healthy sense of self or becoming too emotionally overwhelmed by others. 

How did you first get interested in this topic?

It seemed to naturally develop from past and present interests. Dohee’s dissertation studied Bowen’s Differentiation of Self, [but as it relates to] the elderly. She also had an article on this topic published.

Then, on our last trip to Korea, we had a chance to spend time at a Buddhist monastery in the mountains, which sparked a newer research interest — mindfulness, a concept rooted in Buddhism. We were interested in how this Eastern concept had exceedingly been applied in the West — through psychotherapy and counseling. We ended up having a long conversation with a monk at the temple. A natural outgrowth was the development of a connection between past interests and ideas with new thoughts. It was a natural progression to join the two topics: differentiation of self and mindfulness.

What inspired you to present this session at the conference?

Experience has taught us that the real joy of learning comes as a result of expressing and dialoguing ideas with others. The ACA Conference is the ideal setting in which to do this. Ursuline College has been very supportive in this work and has encouraged involvement with ACA and the counseling profession.

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

Two things surprised us. There are different ways in which mindfulness is being defined and measured in the literature, and being able to work with each other on this — and other projects — is still truly a joy after 14 years of marriage. Our relationship brings the material alive for us. 

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

We hope everyone is able to get something out of it, from students to teachers to counselors to researchers. Those are all roles we have had. In many ways we are still students learning and thinking out loud when we present.

Is there anything else you would like to add?

The entire world is our classroom, in which we are constantly learning. We both feel it is a privilege we are able to do what we do.

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

The importance of career counseling with undocumented Latino students: A sneak peek into ACA’s Client-Focused Research Series

Heather Rudow February 8, 2013

casncacesAttendees 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 that ACA members are doing 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 will speak with presenters about their research and why they believe it is important to the enhancement of the profession. First up is Cassandra Storlie, who will be presenting the session “Career Counseling with Undocumented Latino Youth: A Qualitative Analysis of School Counselors.”

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

The cultural worldview of undocumented Latino youth often points to an environment of few career options. As counselors and social justice advocates, we are charged with the responsibility to cultivate the career development of all students. From this session, attendees will learn about the challenges school counselors encounter when working with the unique career development needs of undocumented Latino students. Attendees will be able to evaluate their own model of career counseling in the K-12 classroom and will be provided [with] suggestions on how they can improve their counseling approaches to meet the needs of undocumented Latino youth.

Why is it important for school counselors to learn about counseling undocumented Latino youth?

Of the 11.2 million undocumented immigrants, between 1.8 and 2 million are school-aged Latino students (Passel, 2006; Passel & Cohn, 2011). Many undocumented Latino youth entered this country as children, having no choice but to follow their parents’ direction in crossing the U.S. border. As these youth assimilate, they begin to recognize that their lack of citizenship affirms they do not have the same opportunities as their American counterparts (Gildersleeve, Rumman & Mondragon, 2010). Furthermore, undocumented Latino students experience an unconventional career development trajectory, which is often recognized first by school counselors and student affairs professionals (Ortiz & Hinojosa, 2010). There is a lack of counseling literature that addresses the unique issues of undocumented Latino youth in school settings, particularly on the issues of career development. School counseling approaches need modification to assist undocumented Latino youth in academic, social/emotional and career domains beyond the current multicultural framework to address the unique challenges faced by this population.

What experience do you have with this group of students?

I have had a strong interest for this population because I have had family members who have struggled with their own career choices because of having an undocumented status. By witnessing their challenges in obtaining citizenship, I developed a passion in researching how the counseling profession can help ease the obstacles that face undocumented Latino students. I have also had the opportunity to work with undocumented Latino students at an elementary level during my doctoral internship.

What inspired you to host this session at the conference?

I think research on this topic is very much needed in the counseling profession. There are literally millions of Latino students that are undocumented, and school counselors need the support and resources on how to best work with this population. The ACA Conference is a fantastic place to be able to reach counseling professionals about this important topic.

How did you first get involved with the subject?

Throughout my doctoral program, I have focused my research on the developmental issues of marginalized populations in order to provide a voice to those who, so often, are not heard. For me, this topic is about social justice and advocacy for individuals that are oppressed. In observing the obstacles my family members have had in their own quest in gaining citizenship, I became interested in researching the emotional, social and multicultural challenges of undocumented Latino immigrants. Just recently, a colleague and I published an article on how school counselors and student affairs professionals can use a collaborative social justice model that can enhance the opportunities for undocumented Latino youth.

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

As I finished the data collection on this topic, it was surprising to me that the participants did not identify any multicultural career counseling theories that they used when working with this population. Most participants stated that they provide career counseling/guidance the same way to all students, documented or not. Yet they all identified the need to take a different approach with this population because of their unique needs. 

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

School counselors, school counselor site supervisors, career counselors, counselor educators and counselors-in-training.

Is there anything else you would like to add?

The laws on immigration are changing, and it is our duty to stay up to date on how that impacts the clients and/or students we work with!

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

Q&A with Brandon Ballantyne: From aspiring tornado chaser to counseling teens

Heather Rudow February 7, 2013

OLYMPUS DIGITAL CAMERABrandon Ballantyne, 28, a licensed professional counselor at Reading Hospital in Reading, Pa., has found a way to use his passion for the arts to help his teenage clients. Ballantyne, a member of the American Counseling Association and the Pennsylvania Counseling Association, has been a drummer for more than 15 years. He incorporates music, along with other creative interventions such as art and journaling, to help his adolescent clients express sometimes difficult thoughts, feelings and experiences. The teens with which Ballantyne works are typically admitted into the hospital’s inpatient psychiatric unit after episodes of self-injury, psychosis, suicidal ideation, suicide attempts, aggression or homicidal ideation. Still, Ballantyne believes that utilizing creative interventions is important for every counselor to practice, regardless of the client population. 

Why did you first decide to work with adolescent patients? 

Many people have asked me this question, and I have given most people the same interesting, honest response. Originally, I wanted to become a tornado chaser. However, I took a psychology class in high school and really enjoyed the material and concepts. I decided that the tornado-chasing idea was a little too risky, so I chose to pursue a career in working with teenagers.

Yes, these two career pursuits are very different, but maybe not as different as one would think. While working with adolescents as a counselor, you can encounter various challenges and obstacles to the therapeutic process. The therapeutic process itself is something that has always been very rewarding for me to be a part of. In therapy, we should not “chase” the challenges. And we should not fear the challenges. We should embrace them and be open to them. We should accept them as an important part of the therapeutic process.

If you know what I am talking about, then you can understand why I chose to work with adolescents. I believe that adolescents have an incredible ability to utilize their resilience and potential. As a counselor, I feel that you have the option of working with many aspects of a teen’s individuality, which includes but is not limited to their sense of humor, skills, hobbies, talents, aspirations, family and creativity.

Why did you think that creative interventions would be helpful for them?

Creative interventions are helpful for adolescents because it provides them with a safe, less intimidating outlet to express their thoughts, feelings and self-concept. From my personal experience, creative interventions allow adolescents to access their strengths more effectively in the therapy session. With the combination of art, music, journaling and talk therapy, the adolescent is able to experience various styles of self-expression. They also experience the autonomy of working with a counselor who allows them as an individual to choose which therapeutic outlet is most beneficial.

How long have you been using creative interventions with these patients? What results have you seen?

I have been using a combination of art, music, journaling and talk therapy with adolescents for approximately six years. Most of my work has been done on an acute inpatient psychiatric unit. I have noticed that when art is combined with journaling and cognitive therapy, the adolescents appear more comfortable disclosing thoughts and feelings. It seems as if they perceive support from both the counselor and the protective platform that their artwork creates.

What is a typical session like with your patients?

Initially, I start the session by inviting the patient to complete a drawing. I typically ask my patients to use colored pencils because I feel it gives them more opportunity to add more detail to their picture. For example, I may ask the patient to draw a picture of a volcano. Now, we all know that sometimes a volcano is just a volcano. However, each volcano is different. And each volcano has different characteristics.

Next, I would ask the patient to create a story about [his or her] picture. I would be sure to communicate that the plot of the story is completely up to them. However, it must include their volcano in some way. I also invite them to include a description of their volcano in the story as well.

After the story is complete, we are about 20 to 30 minutes into the session. Next, I invite them to share their picture and story with me. I have found that the stories that adolescents create to go along with their pictures are usually either really creative and intricate, or very brief and concrete. However, as a counselor, I pay most attention to the themes they include in their story as well as the description of their volcano. They might describe their volcano as explosive, or simmering, or quiet, or maybe even violent. The theme of their story might represent similar dynamics. The goal is to invite them to compare the characteristics of their drawing and creative story to themes in their actual life. Maybe their preference to express emotions is similar to the way they imagine their volcano erupting.

I think that if the patient is able to connect their own interpersonal preferences to the characteristics in their creative work, insight can be grown. I believe that once the adolescent discovers insight, they are able to experience more awareness of how situations and relationships in life influence them. I find that, sometimes, this type of insight is hard to grow in a classic talk therapy session.

Adolescents are unique individuals with unique ideas and perceptions. Using a creative intervention such as the one [I] described can provide them with an opportunity to discover new insight into their self-concept. By the end of group, a volcano will not just simply seem like a volcano anymore. I imagine you could facilitate the same intervention using tornadoes.

The specific object that they choose to draw is just as important as the themes and characteristics brought out in the story. This creative intervention is a less intimidating, safe platform that can be used to assess interpersonal themes, coping skills, relationships, self-esteem and more. I think it is important to end the [session] by making connections between their drawing and their real-life situations. This is the point in the session where insight can occur.

I believe that it is also important to offer a homework assignment as well. Inviting the patient to complete homework assignments reinforces a sense of responsibility to themselves and their treatment. For example, I might ask my patients to write a paragraph about what they feel they learned during the session and invite them to share it with me the next day. This also increases the flow of therapy and creates continuity from session to session, thus providing the patient with a fluid, consistent therapeutic experience.

Have you found any interventions to be more effective than others?

I have used art as a single intervention, journaling as a single intervention, talk therapy as a single intervention and music as a single intervention. All of these provide a unique platform for the patient to express thoughts and feelings, as well as build insight. However, it seems that the most progress has been made by using a combination of art, journaling and talk therapy [as part of] one creative activity. I feel that music is a good complementary item to utilize either at the beginning or at the end of the session. I tend to use soft rock/acoustic music to help the patients ground their mood both at the beginning and the end of the session. This is something that can be applied to both group and individual therapy.

What kinds of counselors do you feel would benefit from using these types of interventions?

I believe that all counselors can benefit from creative interventions. My priority as a counselor is to create a safe environment for my patients to express their thoughts and feelings. I feel that music, art, journaling and talk therapy can provide a client-centered environment that reinforces the patient’s autonomy to invest in treatment. I believe that the best progress is made when the patient is able to access their personal strengths, talents and creativity. 

Is there anything else you would like to add?

I believe that at the very root of all adolescents, there is a sense of resiliency that patients can access with the help of creative outlets. I encourage all counselors to consider the use of creative interventions when working with patients who seem to gravitate toward that kind of platform. Creative interventions may not be helpful for all adolescents. However, it is our professional and ethical duty as counselors to take a flexible approach with patients. We have to be willing to explore various styles of counseling and work with the patient to determine which styles are most beneficial. Allow your adolescent to have autonomy and control in your session, while at the same time providing assignments to reinforce accountability. As a counselor, you should not feel like a tornado chaser. Instead, maybe more like a tornado embracer.


Behind the book: Counseling Around the World

Heather Rudow February 5, 2013

HohenshilThis is the first in a series of articles in which Counseling Today interviews editors and authors of newly published or soon-to-be published books from the American Counseling Association.

First up is Thomas H. Hohenshil, professor emeritus of counselor education at Virginia Tech, associate editor of the Journal of Counseling & Development and member of the American Counseling Association and the Virginia Counselors Association.

Hohenshil, along with Norman E. Amundson and Spencer G. Niles, edited Counseling Around the World, which was published in October. He spoke with Counseling Today about the experience.


How did you first get involved with this subject?

I have been interested in international affairs since attending graduate school. Several years later, I had the opportunity to take a sabbatical from Virginia Tech and taught with the Boston University overseas program for a year in Germany and England. This provided the opportunity for extensive travel in Europe and interaction with people from a variety of countries and cultures. Later on, this interest was translated into a special section on international/global counseling for the Journal of Counseling & Development (JCD) and finally [in] serving as co-associate editor of the international section of JCD with [fellow editor] Norman Amundson.

What inspired you to edit Counseling Around the World?

Counselors from dozens of countries expressed interest in writing articles for the international section of JCD. However, due to space limitations, it was not possible to publish many of them. As Norman Amundson, Spencer Niles and I talked about this, we decided there was more than enough interest and need to develop a book on the general topic of global/international counseling. Since [ACA] had not previously published a book on this topic, Carolyn Baker, director of publications, was approached with the idea. She suggested we develop a proposal and submit it to ACA, which we did and it was approved. 

What surprised you as you were editing Counseling Around the World?

To generate the main content for the book, a method was developed to systematically study the counseling profession from a global perspective by having experts from 40 countries write chapters describing the status of counseling using a standard reporting format. One of the most surprising things to me was that virtually all of the invited chapter authors enthusiastically agreed to participate and that we met all of the submission timelines, which is quite unusual with this type of book. Being able to use of the Internet to facilitate the editing and communication process with authors from the 40 different countries significantly reduced the amount of time required to complete the book.

What are some main issues or topics in the counseling profession that relate to this book?

There are dozens of counseling related topics [that] are covered in this book. However, due to limited space, six of the major ones will be briefly described here:

1. One of the first themes we noticed was that how counseling develops in a country depends on how it began. For some, the initial focus was on education, and in those countries, school counseling took the lead. In other countries, industrial development was an initial focus, and in those, vocational counseling played a primary role. In others, counseling was first developed with the assistance of organized religion. In those countries, churches took a leading role in developing community counseling centers and church-affiliated counseling services.

2. The topic of diversity is a major theme threaded throughout the book. We found that how counselors deal with different types of diversity is often significantly different from country to country.

3. What counseling theories and techniques work best in a particular culture is a third major topic. For example, collectivist-oriented cultures tend to use different counseling theories and techniques than individually oriented cultural settings.

4.Credentialing is a fourth major issue. How counselors are approved for practice differs widely from country to country and involves everything from licensure for private practice by governmental agencies to certification programs by professional associations to no credentialing at all. Quality-control issues are especially important in countries in the process of developing counselor credentialing. Governmental agencies and the public are concerned about how counseling quality is assessed.

5. Counselor education varies significantly from country to country. Some follow CACREP-type standards, while others have their counselors trained in other countries or are in the initial stages of developing their own counselor education programs. The differences are sometimes dramatic.

6. It is important and difficult to establish a separate identity for professional counseling in all countries. It is clear that basic counseling functions are practiced in every culture in the world, sometimes by professional counselors, sometimes by others. The identity problem is complicated by the fact that even with trained mental health professionals, counseling services may be provided by psychologists, social workers, art therapists, music therapists, play therapists and various [other] medical personnel, in addition to professional counselors.

What do you hope counselors take away from the book?

I hope readers will take away an increased sense of global literacy. Although it is important for all counselors to deal with issues of diversity, there is a new goal evolving [that] also calls for us to be globally literate. Global literacy is the basic information needed to maneuver through life in the highly interconnected and complex world of the 21st century. Due to today’s sophisticated technology, the world is fast becoming a place in which people from diverse cultural backgrounds are interacting in ways that would have been unimaginable even a few decades ago. Although dealing with diversity is important for all helping professionals, acquiring global literacy must become a new goal for counselors who wish to practice in a culturally competent manner in the future.

Who do you feel is the best audience for the book?

Counseling Around the World is a good text for courses dealing with international/global counseling. It would also be a valuable text for use with courses focusing on multicultural counseling/diversity issues. In addition, it could also be used as part of introductory courses to show beginning students how counseling is practiced in other countries and the fact that there are developing job possibilities in different regions of the world. The book can also be a valuable reference tool for practicing counselors who may be working with clients from other countries. Finally, as has been indicated by a number of professional leaders, all counselors must become globally literate in the future if they are to provide effective services for their clients.

Click here to order Counseling Around the World.

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