Monthly Archives: May 2013

Counselor uses connection with Lakota tribe to expand cultural competencies

Heather Rudow May 24, 2013

The lives and worldviews of more than 100 Nebraskan youths and counseling students have been enriched thanks to Bruce Dickinson, who uses his passion for Native American culture to connect with members of the Lakota tribe.

Dickinson, a licensed professional counselor, has been taking high school students and graduate counseling students on cultural immersion trips to the Pine Ridge Reservation in South Dakota for more than a decade to help them understand what life is like on a reservation.

“I became interested in Native Americans as a history and English major in college,” explains Dickinson, a member of the American Counseling Association and the Nebraska Counseling Association. “I was also interested in archeology, so the indigenous populations in the Americas [were always] of high interest to me. Then I learned that my great-great-grandmother on my mother’s side was a full-blood Cherokee.”

Dickinson was able to dovetail this interest with his profession after meeting school counselor Dallas Chief Eagle, a member of the Lakota Nation. The two met in the early 1980s when ACA’s Midwest Region held its Fall Leadership Conference in Rapid City, S.D., and the South Dakota Counseling Association had its then-active division of Native American counselors host the conference.

The two became fast friends. Their relationship further fanned Dickinson’s interest in Native American culture and subsequently exerted an impact on his view of counseling.

“I have always attended multicultural workshops and attempted to look at things from a multicultural perspective,” he says. “This relationship with the Lakota has helped me realize that my counselor persona is constantly evolving, and that is essential if I am to remain a competent therapist. The Lakota have also reinforced my belief that counseling is all about relationships, listening for understanding, emitting a feeling of unconditional positive regard and conveying a belief that the client has the ability to help himself. I have also learned that counseling is about the relationship and not about the diagnosis.”

Dickinson and Chief Eagle have even participated in a Hunkapi, or “making of a relative” ceremony, so the two are now considered brothers in the eyes of the Lakota Nation.

While Dickinson’s life has been forever changed by his relationship with the Lakota and Chief Eagle, he wanted to build bridges between the community of Seward, Neb., where he has lived for more than 30 years, and the Lakota as well.

His first opportunity came in 1992, when Dickinson’s school district established a separate middle school and officials decided to begin the year with a program that would help incoming sixth-graders get to know each other. They decided to go with an outdoor education program with “Native American Awareness” as the theme.

“I was asked if I could try to get my friend, Dallas Chief Eagle, to come to the camp,” says Dickinson, who was a school counselor at the time. “The Nebraska Humanities Council awarded us a grant to pay his expenses that first year. It [has since become] so popular that a local bank annually pays for Dallas to attend the outdoor education camp.”

Dickinson was happy to give the students the opportunity to learn about Native American culture. But still, he wanted to do more.

Then, in 2004, he started to take high school-age youths from a local church on trips to Pine Ridge. The trips have taken place biennially ever since.

Participants go on a six-day “immersion program” through the nonprofit Re-Member. During their time on the reservation, they perform community service projects such as building bunk beds and skirt trailers, constructing and placing outhouses, performing roofing projects and building wheelchair ramps for the Lakota to use. In addition, they visit the mass gravesite for those lost in the Wounded Knee Massacre, Badlands National Park and other cultural sites important to the Lakota. Each morning, a Wisdom of the Elders presentation takes place, focusing on the history of the Lakota. At night, other presentations focus on Lakota culture.

Dickinson notices changes in many of the students’ mindsets upon returning home.

“They initially have difficulty with the poverty on the reservation, [such as the] living conditions and lack of good roads, and have trouble when they learn about the school dropout rate and unemployment [within the reservation],” Dickinson says. “But by the end of the week, most are determined to go home and make sure others understand the extent of the poverty and injustices. They have been touched by the relationships they have made and moved by the spirituality of the Lakota people.”

Several students have informed Dickinson that the trip was a life-changing experience and have returned a second time.

At the ACA Conference in Kansas City, Mo., in 2004, Dickinson introduced Chief Eagle to David Hof, a professor at the University of Nebraska Kearney (UNK).

“Over the next couple of years, David and I began to discuss what I was experiencing on the Pine Ridge Reservation and the effect it was having on me and the high school students,” Dickinson says. “David had grown up in Custer, S.D., and was very interested in these experiences.”

They soon began examining the possibility of a multicultural immersion experience for graduate students attending UNK’s counseling program.

“We believed that this program could reinforce the need for counselors to identify the two to three major subcultures within their community of employment,” Dickinson says. “Once identified, they must acquire enough understanding of that culture to diminish the possibility of undermining the relationship before trust has been established. Once they are able to step out of their comfort zone, they develop a connectedness based on compassion and mutual growth.”

In 2007, Dickinson put together a rough outline of the course for Hof, which was then approved. Graduate students in the counselor training program have gone annually to Pine Ridge since the summer of 2008.

The purpose is to teach counseling students how to communicate in a culturally appropriate manner by stepping out of their comfort zones, Dickinson says.

“Once this occurs, shared experiences should bring about a connectedness based on compassion and mutual growth,” he continues. “This is a vital lesson when trying to connect with any client.”

The students must attend a class before the trip and discuss a list of handouts covering topics such as cultural differences, data about Pine Ridge, the Seven Sacred Ceremonies of the Lakota and the Wounded Knee Massacre. They then spend three to four days on Chief Eagle’s farm on the reservation.

Activities include:

Participating in an Inipi (sweat lodge) ceremony and observing a Wiwanyag Wachipi (sun dance) ceremony
Visiting the Wounded Knee mass gravesite, Red Cloud School, Oglala Lakota College and Black Elk’s grave
Hiking into the Badlands National Park and spending time in individual meditation
Participating in an evening discussion (observations and thoughts)
Nightly journaling

The students are not always prepared for what they experience.

“They are amazed by the Lakota people’s willingness to explain elements of their spirituality and invite them to participate in several family activities,” Dickinson says. “In our evening discussions, students indicated how this hands-on experience reinforced the importance of relationship building. Several indicated that they felt every counseling graduate student should have a similar experience. Several of the students have participated on more than one occasion.”

Some participants have even presented poster sessions about their experiences at ACA Conferences & Expos.

In general, Dickinson does not believe that many counselors receive the necessary training to be culturally competent.

“ACA and the Association for Multicultural Counseling and Development in 1992 jointly published in their journals a set of cross-cultural competencies,” he says. “However, I question whether graduate programs at the master’s-degree level are infusing these competencies throughout the curriculum. “

Until this happens, he believes it is important for state counseling branches and ACA to provide multicultural workshops to continue enhancing counselors’ skills in this area.

Dickinson also emphasizes the importance of counselors experiencing multiculturalism and diversity firsthand.

“In order to truly become culturally competent within another culture than your own,” he says, “you must go experience that culture.”

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

Think this, not that

Rita A. Schulte May 23, 2013

Imagine two women standing in front of a mirror. The first one has the following thoughts: “I can’t stand the way I look. I’m so fat.” She feels anxious, insecure and depressed.

The other woman says to herself, “I’ve gained a few pounds, but it’s not the end of the world. I can relax and start eating better next week.” She feels calm and accepting of herself.

The scenario is the same for both women, but their interpretation of it is significantly different because of one thing — their self-talk.

What we say to ourselves has a powerful impact on our emotional state. That’s why teaching clients to notice their self-talk is such an important part of therapy. Today more than ever, attachment- and mindfulness-based therapies are helping clients experience emotional healing. Drawing from mindfulness therapy, I coined the term “the art of noticing.”

Noticing helps clients pay attention to their internal monologues and understand how their negative inferences affect their emotional states. Noticing is particularly helpful when working with clients who experience anxiety, depression and eating disorders because these clients are especially prone to negative self-talk. Because self-talk is so automatic, it is easy to dismiss its effect on clients’ moods and belief systems, but noticing is a first step in helping clients to:

Recognize cognitive distortions
Slow down their thinking
Take note of negative internal monologues
Identify and pay attention to triggers
Practice a nonjudgmental stance
Use effective counterstatements

The voice

According to Edmund Bourne, a clinical psychologist who has written best-selling anxiety workbooks, each of us has a personality subtype that contributes to our mental health distress. This negative “voice” falls into the following four categories:

The worrier
The perfectionist
The critic
The victim

Each of these subtypes perpetuates negative self-talk. Our job as counselors is to help clients recognize and change those negative internal monologues by replacing them with positive counterstatements.

An effective way to begin this practice is to help clients identify which voice(s) fits them. Identifying the self-defeating statements of each voice helps clients to notice these statements and train themselves in the use of thought-stopping techniques and thought replacement.

Thought stopping requires teaching clients to ask key questions. For example:

How is what I’m telling myself contributing to my distress?
Will this thinking facilitate movement in the direction of my goals?
Do I want to choose to be upset?
What can I do differently?

Digging deeper into dysfunctional thoughts

Another tool therapists use to help clients with awareness is the Dysfunctional Thought Record, developed by Aaron Beck. The thought record requires clients to list negative self-talk (thoughts), then refute that self-talk by considering and listing rational counterstatements.

In my practice, I have incorporated several additional components to the thought record to help clients facilitate change. My goal is to help them focus not only on their thoughts but also the beliefs that are driving them. Linking their current beliefs to where the original hurt or attachment wound occurred is key to healing. I include the following topics in the thought record:

Situation causing distress: This is the presenting problem.

Feelings about the situation: Clients record their emotions and rate their intensity.

Beliefs: List clients’ beliefs about self, God and others.

Attachment wound: This is the original hurt from the past that helped strengthen the client’s present core belief. An example might be a client who was abandoned by her father.

The fear that became attached to the past hurt: Once the original hurt has been identified, I work to help clients explore the underlying fears they attached to the hurt. Examples include fear of rejection, fear of being abused, fear of being taken advantage of and fear of being abandoned.

Coping strategies the client developed: I explore with clients what defense strategies or coping skills they have used to deal with their pain. Examples include emotional withdrawal, people pleasing, performance, “try harder” strategies, avoiding conflict, codependency and anger.

Irrational beliefs: I ask clients to write down each of their irrational beliefs.

List of cognitive distortions for the current belief: After teaching clients about cognitive distortions, I integrate this into the thought record by having clients list all possible thinking errors that contribute to their negative attributions and false beliefs.

Positive counterstatements: I assist clients in constructing some positive counterstatements to refute or replace each dysfunctional thought or belief.

Putting it into practice: A case study

Debbie came to see me because her husband had an affair. She felt anger, hurt and anxiety. Her current belief, “I can’t trust others,” first took root in her past as a result of her father’s abandonment. Her husband’s infidelity further strengthened Debbie’s core belief that others can’t be trusted. Her father’s betrayal was the original hurt that established this belief.

This is where destructive vows come in. Vows are promises we make in our hearts to shield us from pain and rejection. Vows made early in life can live on in our actions, sometimes for decades, until something or someone comes along to prove them unnecessary. Debbie made a vow she would never allow someone to hurt her like her father had. When she met her husband, she took a risk and opened her heart, only to have it shattered again.

Debbie attached a fear (“Others will abandon me because of my flaws”) onto her belief (“I can’t trust others”). As we went through the steps on the dysfunctional thought record, she started to see the connection between the past hurt with her father, her fear and her current belief that she couldn’t trust others.

Finally, I wanted to help Debbie see what coping strategies she had developed to protect herself from the pain and rejection of the early attachment wound. These strategies, which developed out of her belief that she couldn’t trust others and her fear that others would abandon her because of her flaws, included people pleasing, trying harder, performing for acceptance, emotional withdrawal, avoidance and anger.

For the last part of the thought record, I had Debbie consider her cognitive distortions. I previously had spent a session teaching Debbie about cognitive distortions and showing her the connection between distorted thinking and mood states. She identified several cognitive distortions that she was prone to make consistently, and she immediately recognized the downward spiral her mood took when she engaged in this thinking.

Thought replacement and the use of positive counterstatements were the final pieces we implemented in Debbie’s thought record. Together, we developed a list of her beliefs and chose appropriate counterstatements for her to consider. Debbie now had some concrete tools to move forward.

When using counterstatements, it is important that clients have some measure of belief in their veracity. As a Christian counselor, I help clients develop a God-centered focus by rooting their counterstatements in their faith. This allows them the opportunity to connect with God on a personal level for healing. Debbie chose to memorize a Bible verse, “God will never leave you or forsake you,” to refute her negative belief that she would always be abandoned. This also helped to ease her anxiety.

Whatever treatment modality the counselor chooses, the goal is the same — to help clients become aware of their negative attributions and the beliefs that are driving them. Without addressing core belief systems, clients’ negative attributions will persist and continue to have a negative impact on their life’s trajectory.

Rita A. Schulte is a licensed professional counselor and host of the podcast Heartline. She has a private counseling practice where she specializes in the treatment of eating disorders, anxiety and depressive disorders, and grief and loss issues. Her book Shattered: Moving Beyond Broken Dreams will be released by Leafwood Publishers in September. Contact her at ritaundergrace@cox.net.

Letters to the editor: ct@counseling.org

Closing out the year with a huge thank you

Rich Yep May 20, 2013

Each June, ACA experiences several transitions, from our employees who find the weather outside nice enough to do their lunchtime health walks, to closing out “the books” as we finish our fiscal year. There are also personal transitions, such as staff members with children switching from getting their kids to school to figuring out their summer schedules. And some staff might possibly be thinking about taking a well-deserved vacation.

June is also the month when we prepare to transition from the current volunteer leadership team to a new cadre of enthusiastic, engaged and committed ACA members. For the past year, ACA President Brad Erford has led our team. Although I have known Brad for many years through his work as an ACA author, division leader and member of the Governing Council, these past 12 months have demonstrated to me how strongly he feels about the association, its members and everything that professional counselors do to help people face the challenges of life. Brad has been an articulate and extremely hardworking president. He has traveled extensively to represent the profession, given freely of his every waking moment and served as a communicator who speaks confidently, while still being an empathic listener.

Clearly, Brad is a president who doesn’t like to blow his own horn. That being the case, I will let you know that he faced several professional issues during his presidency. His ability to find solutions to situations was often based on his respect for those with divergent views. During a year in which several challenges arose concerning the practice, and future, of professional counselors, Brad did an admirable job of representing the association.

But as Brad would say, those challenges and issues required a response that was built on team effort. Always willing to dodge the spotlight (as noted), Brad made sure that ACA’s committees and task forces, and the other groups with which we partnered, felt that they were part of the team. Those team members included the members and chairs of our committees and task forces, as well as the leaders of our branches, regions and divisions. They also included our interest network participants and Brad’s colleagues on the ACA Governing Council.

From my perspective, the sad part of each June is when many of our volunteers complete their terms and rotate off of their current assignments. We are fortunate at ACA that some of these individuals will be retuning this year in new volunteer positions, while others will be back at the ACA table in the near future as authors, bloggers, presenters (either online or in person) or in other roles as volunteer leaders.

ACA has a broad and complex agenda, none of which could be addressed successfully without a talented group of volunteers. Some of these volunteers are still graduate students, while others are new professionals. We have both midcareer and retired folks as well. It really does “take a village,” but when we have a committed and dedicated community of volunteers, it shows that we are ready to face today’s business and lay the groundwork to address tomorrow’s challenges to the profession as well.

On behalf of the entire ACA staff, I want to thank all of you who have volunteered for the association in one way or another during the past 12 months. You don’t receive enough thanks for all of your efforts. Although this column does not come anywhere close to equaling your actions, please know how grateful we are for what you have accomplished. Put simply, job well done.

As always, I look forward to your comments, questions and thoughts. Feel free to call me at 800.347.6647 ext. 231 or email me at ryep@counseling.org. You can also follow me on Twitter: @RichYep.

Be well.

Cutting-edge curriculum: One N.C. professor prepares counselors to work with military clients

Heather Rudow May 9, 2013

Flickr_-_Official_U.S._Navy_Imagery_-_Sailor_carries_bags_for_U.S._military_family_members_arriving_in_Florida_after_evacuating_Japan.

(Photo: Wikimedia Commons)

Licensed professional counselor and college professor Angela McDonald is helping her students learn more about the mental health of military service members, veterans and their families, and what the best practices are for counseling them.

McDonald, an assistant professor and program director of the clinical mental health counseling programs at the University of North Carolina at Pembroke, aims to introduce her students to the unique challenges that this group of clients faces through “Counseling Members of the Military and Their Families,” a three-credit elective course she is teaching for the first time this semester.

“My main impetus for offering this course is to help our program produce highly trained counselors with expertise in this population,” explains McDonald, a member of the American Counseling Association and the North Carolina Counseling Association (NCCA), a branch of ACA. “The demand for jobs [serving the] mental health [needs of] the military community is high yet still cumbersome for counselors who compete with social workers for counseling positions. I want our students to be able to offer the best counseling services they can provide to these individuals and their families. I want our students to be able to tell future employers that they have the best, most up-to-date, empirically supported skills to address the needs of service members and their families.“

Course topics include learning about the history of trends within the military that impact the counseling profession; how to advocate for counselor recognition within both the Department of Defense (DoD) and the Department of Veterans Affairs; posttraumatic stress disorder and trauma; suicide risk and prevention; women’s roles in combat; sexual assault and harassment; adjusting to deployment; and family violence. There will also be student-to-student sharing of relevant experiences and guest speakers from the region with expertise on relevant subjects.

McDonald has been planning the course for the past two years, but she says she was able to really put things in motion beginning this past January when UNC-Pembroke received accreditation from the Council for Accreditation of Counseling & Related Educational Programs (CACREP).

“Then, I was able to put in the time to pull the latest research articles and evidence-based practices together for the course reading materials and develop collaborative relationships with community partners to get guest speakers together,” McDonald says. “The first contact I made was to Sen. Kay Hagan [D-N.C.], and from there, I worked with her [on] military issues and [on finding] veterans liaisons to network within the state. The liaisons were a huge source of contacts and information and very supportive of LPCs and mental health issues. There was a lot of networking that had to take place since I am not a member of the military community myself, but I’ve been very excited about getting connected.”

The topic is of critical importance to counselors across the country, but McDonald finds it especially important in this particular area of North Carolina, where there is a high concentration of active duty service members.

“Our campus is within an hour’s drive of Fort Bragg, a large Army military installation,” she says. “We are also only a few hours from Marine Corps base Camp Lejeune. We have many students who are spouses and partners of active duty service members and also many students who are veterans themselves or who grew up in military families.”

McDonald is not a veteran herself, but she says that having grown up in an area of Virginia with a high concentration of service members, she has a “great deal of respect and admiration for this population. As a family counselor and college counselor, I witnessed the impact of associated stress and trauma that these individuals and their families experience. I wish I had had more access to specialized training in the skills needed to sit with clients who had experienced pain that was far beyond what I had or would experience. There are many wonderful professional development opportunities available now at conferences to help prepare counselors in the field, but our course will provide more intensive instruction suitable for beginning counselors.”

During the interview process for the school’s counseling program, McDonald says she frequently hears that applicants’ ultimate career goals are to provide mental health counseling to members of the military.

“This class is being offered in response to an enormous amount of interest from our clinical mental health counseling students, as well as our professional school counseling students,” McDonald says. “Our students see the need to develop specialty skills to meet the unique needs of active duty service members, veterans and their families. The administration on our campus is very supportive and encouraging of our efforts to focus on this population.”

McDonald says she hopes students come to understand the “seriousness of some of the grim statistics [concerning] suicide, sexual assault and relationship violence that are present among the military community after taking the class, but I also want them to understand how to apply the resiliency framework to build on strengths and resources to move forward.”

In addition, McDonald is aiming to cultivate a new crop of counselors who actively advocate for their profession. She has been working with ACA’s Public Policy Department to help with NCCA’s grassroots efforts to gain recognition from the Pentagon of North Carolina’s licensed professional counselor accreditation, something she is incorporating into the class.

“Currently, the DoD does not list N.C. as a state with an approved LPC,” she says. “Counselors who are licensed in North Carolina as LPCs and want to apply for a counseling position at Camp Lejeune, for example, are being told to apply for licensure in another state and seek reciprocity to work as counselors in N.C. The DoD list of approved state LPCs doesn’t reflect major changes in N.C.’s LPC requirements enacted in 2009.”

One of McDonald’s projects for the class is to write an advocacy letter to a state official regarding the matter.

“I want students to know that their advocacy efforts to bring greater recognition of counselors as mental health professionals are effective,” she says. “I want them to know how to advocate for themselves and our profession.”

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

NIMH announces project to replace DSM

Heather Rudow May 6, 2013

The National Institute for Mental Health has launched a plan replace the DSM-5 with a new “Research Domain Criteria (RDoC)” project. Stating that the DSM is little more than a dictionary, that the DSM criteria are unreliable, and that those diagnosed with mental disorders “deserve better,” NIMH Director Thomas Insel made the announcement this past week. With its 1.5 billion dollar budget, NIMH is the major source of mental health research in the United States.

“The National Institute of Mental Health is to be applauded for taking on the monolith that the DSM has become,” says American Counseling Association Chief Professional Officer David Kaplan, “as we have needed a more developmental, systemic and ecological alternative for a long time. However, we need to have a healthy skepticism as NIMH has traditionally focused on the biological causes of mental health issues and so the Research Domain Criteria project may just be replacing one problem for another. ACA will monitor this and provide input to NIMH as the project develops.”

Click here to see the complete NIMH announcement. For more information on the Research Domain Criteria (RDoC) project, click here.

Updated: ACA DSM-5 Task Force chair analyzes NIMH’s decision

Paul Peluso, associate professor of counselor education at Florida Atlantic University and chair of ACA’s DSM-5 Proposed Revision Task Force believes that, in order to fully understand NIMH’s controversial decision and Director Thomas Insel’s comments, one must look at three things: the “context, history and timing.”

“What is surprising about this is that these comments come from the director of the NIMH,” Peluso continues. “From the beginning, the APA and NIMH were collaborating on the creation of DSM-5. In 1999, some of the leaders of APA met with the director of NIMH to discuss a new version of the DSM. … Thirteen conferences were held between 2004 and 2008 [regarding the DSM]. This begs the question, if NIMH was so involved in this planning stage, and sponsoring conferences with the expressed purpose of finding ‘scientific evidence,’ then the current director’s statements seem to indicate that this goal was not successfully met. Again, further evidence of dissatisfaction — at best — of the current DSM.”

Lastly, Peluso says, it is important to note the timing of Insel’s announcement.

“The DSM-5 is scheduled to be released on May 22 at the annual conference of the American Psychiatric Association. According to the NIMH website, the RDoC has been in its current draft form since 2011. In addition, APA voted to approve DSM-5 in December of 2012. Despite this, Dr. Insel posted his comments on April 29, 2013, just ahead of the DSM-5’s publication. Given that this plan has been in preparation for two years, one has to conclude that the timing of this critique and declaration of a new research direction has to be suspicious.”

Putting together the context of Insel’s statements, the history behind NIMH and APA’s relationship and the timing of the release of the decision, Peluso thinks the “NIMH is issuing a serious vote of ‘no confidence’ in DSM 5.”

Updated: ACA President-Elect finds announcement has positives and negatives for counselors

ACA President-Elect Cirecie West-Olatunji has mixed reactions to news of NIMH’s proposed RDoC and what it could mean for the counseling profession.

“The new statement by NIMH regarding use of the DSM is promising and laudable while also posing challenges for clinicians,” she says. “The positive side of their position is that a major entity in mental health is providing a critical analysis of the usefulness of the DSM, particularly within a contemporary context. Further, NIMH is offering a viable alternative. And, while other scholars and organizations have previously offered alternative nosologies for diagnosing clients, having a major organization such as NIMH take a critical stance is significant and encouraging.”

However, West-Olatunji has her reservations regarding the RDoC.

“The danger lies in focusing exclusively or primarily on biological factors,” she continues. “Other concerns, those that are humanistic and environmental in nature, can also provide valuable information about clients’ presenting problems. Moreover, there is just as much danger of over-pathologizing clients, particularly those who are marginalized, within the approach offered by the NIMH.”