Monthly Archives: June 2013

Behind the book: Mastering the Art of Solution-Focused Counseling

Heather Rudow June 7, 2013

78081Though he has written more than 125 publications, Florida-based counselor and educator Jeffrey T. Guterman says he is perhaps most looking forward to the debut of his newest book, the second edition of Mastering the Art of Solution-Focused Counseling, which was published by the American Counseling Association in June.

 So much has changed within the counseling profession and the world in general since the release of the first edition in 2006 that Guterman, a member of the ACA, notes it is almost as though he has written a completely new book. Click here to purchase Mastering the Art of Solution-Focused Counseling from the ACA website.

What inspired you to write the second edition of Mastering the Art of Solution-Focused Counseling? Why did you decide to write it?

It wasn’t long after the first edition of Mastering the Art of Solution-Focused Counseling was released in 2006 when students, counselors, colleagues and readers began to approach me and ask when I was going to write a second edition. So much has changed for solution-focused counseling, the field of counseling in general and the world that by 2011, I figured it was time. In those five short years, there was a sudden, rapid increase in the rate of change going on in the world. It’s not merely change, but it is change of change.

This accelerating, exponential change is occurring in various domains, including socially, culturally, politically and technologically, and it’s happening in our field, too. I discuss this in the final chapter of the book, “The Future of Solution-Focused Counseling.” I consider how the future might look specifically in relation to the solution-focused model. The final chapter also speculates about how rapid social and technological change may impact individuals and society, and the implications for counseling in general and solution-focused counseling in particular.

What are some of the differences between the first and second editions?

The second edition is basically a new book. It’s twice as many pages as the first edition, but the changes are also qualitative. The entire book is significantly updated. There are additional chapters and sections on new clinical applications, including anxiety, eating disorders, psychotic disorders, migraine headaches, spiritual and religious problems, self-injurious behavior and suicide. The most current developments in theory, research and practice are also provided. Additional features of the second edition include sample forms, supplementary materials and numerous excerpts from actual counseling sessions that illustrate the model.

How did you first get involved with solution-focused counseling?

After I received my master’s degree in counseling in 1985, I resonated with Albert Ellis’s rational emotive behavior therapy (REBT). As a master’s level counselor, I became proficient at REBT. I received personal counseling from Albert Ellis, who was my first mentor, and this was invaluable to me both on a personal level and in terms of helping me learn firsthand how to do REBT. Ellis also provided me supervision and training in my early days as a counselor. By the late 1980s, however, I sought new ways of conceptualizing problems and helping clients change.

When I started my doctoral studies in 1989, I was introduced to postmodernism along with its various factions, including constructivism, social constructionism and deconstructionism. It was around this time that I shifted from REBT to the solution-focused brief therapy (SFBT) model developed by Steve de Shazer, Insoo Kim Berg and their colleagues. Although I was now doing solution-focused clinical work, I found that I would still occasionally sneak in some REBT if I found that it fit with the client’s problem and worldview. I began to refer to myself — and still do — as a “recovering REBT therapist.”

This is when I developed a unique feature of solution-focused counseling, its strategic approach to eclecticism. This feature allows for the systematic, compatible and effective application of theories and techniques from other counseling models within solution-focused counseling and in a manner that enhances the solution-focused change process. So, if my client is a previous consumer of REBT or cognitive therapy or if his or her worldview seems to fit with this treatment, then it might be helpful to introduce and use, within solution-focused counseling, an REBT-like approach. The change process, however, would be in keeping with solution-focused counseling’s goal of identifying and amplifying exceptions, in this case, exceptions to the problem of “irrational beliefs.”

Solution-focused work is process-oriented and tends not to impose the content to be changed. Some clients, though, want some formal content, a counseling theory to make sense of their problem. The same goes for counselors, especially beginning counselors. It can be unsettling for some counselors to work from an almost purely process model that does not articulate the “what” to be changed beyond solution-focused counseling’s problem/exception ascription.

Getting back to my first mentor, by the mid-1990s, my relationship with Albert Ellis became collegial. Starting in 1996 and through 2000, I had the privilege to dialogue about postmodernism with Ellis and other leaders in counseling, such as Michael D’Andrea, Earl J. Ginter, Allen E. Ivey, Don C. Locke and Sandra A. Rigazio-DiGilio. These dialogues took place in print and at workshops held at some of ACA’s annual conferences. At that time, I had pretty much developed solution-focused counseling. It has now been 13 years since that dialogue ended and a lot has changed. I’ve written many articles, presented numerous workshops on solution-focused counseling and now the second edition of Mastering the Art of Solution-Focused Counseling has been released. 

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

The book sets forth a model that serves to crystallize counseling’s unique professional identity. Namely, an emphasis on the client-counselor relationship; multiculturalism and diversity; a strength-based, wellness and developmental perspective; and a strategic approach to eclecticism.

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

Counselors, counselor educators and counseling students of virtually all settings and specialties will benefit from Mastering the Art of Solution-Focused Counseling. The book is also well suited for mental health professionals in related disciplines, including psychologists, social workers, marriage and family therapists and psychiatrists. Helpers from other professions will also benefit from the book, including nurses, probation officers and life coaches.

Were there any surprises as you were writing this edition of Mastering the Art of Solution-Focused Counseling? 

There were a few. I was aware of the increasing research being done in various fields for solution-focused work. But when I took a closer look, I was surprised at the sheer number of studies. Also, there have been so many solution-focused, evidence-based research studies for specific clinical problems and populations.  I was also astonished by the amount of literature on various clinical applications. Solution-focused approaches have now been applied to almost every problem, population and setting you can think of.                 

Why should counselors feel compelled to read this book?

This book provides a comprehensive explication of solution-focused counseling, including the theory, clinical stages, assessment and intervention aspects of the model. A wide range of clinical applications are covered. In addition, the most current research developments for solution-focused counseling are described throughout the text, which serves to help readers connect those studies to both theory building and advances in practice.

Most important, solution-focused counseling is an effective and efficient counseling model aimed at helping clients experiencing a wide range of problems in various settings. I should note, however, that in contrast to the pioneering SFBT model developed by de Shazer and Berg, which includes the word brief in its name, solution-focused counseling does not. Solution-focused counseling is often brief, but not always. The omission of the word brief is intentional because I think calling a model brief is arbitrary. As I see it, sometimes solution-focused counseling is brief and sometimes it is longer term. When it is brief, I understand the brevity as a logical consequence of the model’s conceptualization rather than an end in itself. The brevity is a result of how problems and change are conceptualized. In solution-focused counseling, we are encouraged to view clients from a wellness perspective rather than in terms of pathology. I think it makes sense, then, that goals tend to be smaller in scope than traditional, problem-focused approaches.

What do you hope counselors take away from the book?

I hope counselors take away the ability to incorporate both the principles and techniques of the model in their everyday practices so they can give back to their clients a strength-based, solution-focused perspective. My goal for the book has always been to address the sometimes-complex, theoretical underpinnings that inform solution-focused counseling and its many practical strategies in a simple manner so it is accessible to all counselors who wish to incorporate this approach in their work.

Find Jeffrey T. Guterman online:

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

Transitions are what life is all about

Bradley T. Erford June 1, 2013

Bradley-TThe year has flown by very quickly and we have accomplished a great deal together, both as the American Counseling Association family and the larger counseling profession. There are many accomplishments I would like to share with you and many people to thank in the brief space available, but let me start by saying that ACA is on its strongest financial footing in many years. Our membership recently surpassed 52,700 individuals, reflecting a modern-day record of 25 straight months of membership increases. Denise Brown, Carol Neiman and the rest of the membership staff are magnificent examples of ACA’s “can do” attitude. We must do well as a business to do “good” as a profession, and our strong financial position means we have many years of promoting good works ahead of us. I am eternally grateful to ACA Treasurer Lynn Linde and ACA Chief Financial Officer Deb Barnes for their incredible fiscal stewardship.

I am exceedingly pleased with a half dozen new initiatives accomplished this year. First, the new and greatly improved ACA website, which officially went live in March, looks spectacular and is far easier to navigate than its predecessor. Second, ACA created the Center for Counseling Practice, Policy and Research under the capable leadership of David Kaplan and Will Stroble, two of the six counseling professionals on staff at ACA. One of the center’s first initiatives was the Practice Briefs Project. These practice briefs provide concise information on counseling topics that keep practitioners current with research-based practice. Each brief is packed with information and linked to additional web-based resources. The first dozen briefs, on topics ranging from posttraumatic stress disorder and suicide intervention to intimate partner violence and adult attention-deficit/hyperactivity disorder, already have been posted to the website; there are plans to add several dozen more throughout the next year. This series was edited by Victoria Kress, Catharina Chang, Rick Balkin, Joshua Watson and Skip Niles.

A third initiative involved giving a larger voice and role to our student members, and I am pleased to announce that Anna Flores Locke was elected the first voting student representative to the ACA Governing Council. The fourth initiative was wide-scale implementation of the ACA mentoring program, a project developed by the ACA Graduate Student Committee under the outstanding leadership of Nicole Adamson (the first ACA student member to chair an ACA standing committee) and Victoria Kress. To date, more than 200 mentor/mentee matches have been made, and the program is off to an exceptional start. If you would like to become a mentor to the next generation of professional counselors, see, send an email to and change the world!

The fifth initiative was the appointment of an ACA Task Force on Leadership Development under the leadership of Jane Goodman. This task force identified more than 40 emerging ACA leaders, and these individuals are being nurtured and encouraged to become more active in ACA leadership at every level.

A final initiative just now getting off the ground is related to this month’s cover story topic: What does counseling look like globally? ACA is deeply interested in helping to develop counseling around the globe and has several international counseling initiatives in the works. Key among these is developing the capacity to offer electronic international memberships to counseling professionals and students in developing countries within a cost structure that is sensitive to economic realities. Through the outstanding effort of Daya Singh Sandhu, we have established an International Counseling Interest Network that is poised to become an organizational affiliate and, eventually, an ACA division. Counseling has gone global, and ACA can play a key role in nurturing the counseling movement around the world. I was delighted to meet so many international students at the ACA Conference & Expo in Cincinnati, an event seamlessly implemented by ACA staff under the leadership of the incomparable Robin Hayes, Theresa Holmes and Trinh Le.

On the subject of new organizational entities, please join me in welcoming our 20th ACA division, the Association for Child and Adolescent Counseling. In addition, the Traumatology Interest Network is petitioning to become an organizational affiliate, also with hopes of becoming a division of ACA. The future of our profession is evolving, and ACA is growing and changing along with it.

Although a number of new initiatives were begun and accomplished, another very important initiative sponsored by ACA and the American Association of State Counseling Boards was brought to a successful conclusion. The 20/20: A Vision for the Future of Counseling initiative began in fall 2005 with a meeting of the Steering Committee, but it truly got under way in earnest when the 30 original delegates convened for the first time in Montréal in March 2006. The goal of 20/20 was simple: to work together as colleagues from diverse counseling constituencies and backgrounds to forge consensus on issues of importance to the future of our counseling profession. We have accomplished a great deal since that inception: a consensus definition of counseling; consensus principles for unifying the profession; a consensus licensure title; a consensus scope of practice; and a consensus endorsement of the concept of a single counseling accrediting organization. This year we celebrate the culmination of seven years of work to ensure that the future of our counseling profession is far better than the one we leave behind.

All of this progress, these changes and initiatives, would not be possible without the superb support and skills of ACA’s incredible 64 staff members and the best executive director in the world, Rich Yep. I have known and worked with Rich in leadership for more than a dozen years. I recently had the opportunity to observe him in his role as a volunteer leader in his own professional organization, the American Society of Association Executives. It will come as no surprise to anyone who has worked closely with Rich that he is as revered in ASAE as he is in ACA. We are truly fortunate to have an executive director with Rich’s skills and panache at the helm of ACA. Change is a natural part of life, and Rich is prepared to guide us through whatever transitions lie ahead. And there will be many.

My son runs track, the 400- and 800-meter distances, at his university. I never really considered track to be a “team sport” the way basketball and football are, but track clearly is a team effort when it comes to the relays. Every member of the relay team has the responsibility to move as fast as they can during their leg of the race and then to ensure a smooth handoff of the baton to the next runner. I have witnessed disastrous handoffs and marveled at others that seemed like poetry in motion. Once the handoff has been accomplished, all eyes focus on the next runner (as they should). Rarely do spectators notice the exhausted runner who just finished and is now gasping for air and coping with the aftereffects.

July 1 marks the 61st ACA baton handoff, as Cirecie West-Olatunji becomes the 62nd president of ACA. Cirecie and I have worked side by side over the past four years on Governing Council, and her stated goals of promoting mentoring, volunteerism, leadership development and the internationalization of counseling are fully supported by leadership and staff. We all look forward to another strong year of progress on these and other strategic initiatives under Cirecie’s very capable leadership.

On July 1, as Cirecie takes off full speed for the next leg, I will be that exhausted runner on the sideline. But rather than gasping and doubling over, I will feel immense gratitude for the accomplishments we achieved and the transparent, respectful and professional way in which these accomplishments came to fruition. I will also feel greatly relieved knowing that you — our ACA members, future leaders, current leaders and outstanding staff members — will continue to give it your all as we continue our journey to build and transform the counseling profession.

As is always the case, I am sure I have missed some colleagues specifically deserving of thanks. After all, I am getting old and my memory is waning. ACA president years seem to me a lot like dog years; I feel like I have aged about a decade in the past dozen months. And as my grandma used to say, “There are two things you always remember about getting older. Memory is the second thing to go … and I can’t remember the first.” So I want to close this final column by saying, “Thank you!” for all that you do to keep elevating the counseling profession to greater and greater levels of respect, dignity and competent performance! All the best! — Brad

Global influence

Compiled by Lynne Shallcross

Global_InfluenceThe following article contains the complete responses from each individual interviewed for the June cover story of Counseling Today. This version is longer than what ran in the magazine.

To American Counseling Association President Bradley T. Erford, the globalization of counseling is not about creating a mirror image of the profession as it is practiced here at home. In fact, Erford thinks counseling’s global spread offers valuable opportunities for professional counselors in the United States to absorb new techniques and new ways of thinking about counseling from every corner of the earth.

“We have much to learn from how counseling is evolving in other cultures and nations,” says Erford, a professor in the school counseling program at Loyola University Maryland. “Regardless of where we live and practice, professional counselors share a core identity, and that identity is modified and molded by culture. Because all counseling is multicultural counseling, some of the ‘best practices’ we use in the United States may miss the mark when counseling clients and students from diverse cultures. We have much to learn from counseling professionals working all around the world who are using diverse and culturally sensitive approaches to build strong connections and create therapeutic changes that help promote mental health and wellness.”

Although counseling is comparatively new in the mental health arena, it is a fast-growing profession globally, says ACA President-Elect Cirecie West-Olatunji. “As international students acquire their training in U.S. programs, offered abroad and stateside, they are taking a message back to their home countries about the value of counseling in relation to the needs of their nations,” says West-Olatunji, associate professor and director of the counseling program and the Center for Traumatic Stress Research at the University of Cincinnati. “Many of these countries are developing counseling as a discipline and have integrated an understanding of social justice and advocacy as core values. Others have woven in culture-centered counseling concepts that honor religious and ethnic differences. Counselors in the U.S. can learn a lot by exchanging [ideas] with their counterparts in other regions of the world.”

Counseling is happening in some form in nearly every nation around the world, Erford says. In fact, counseling is even the primary mental health discipline in some nations, he says. As an example, he points out that counselors in Malaysia have licensure, while psychologists and social workers do not.

As counseling spreads across the globe, Erford notes the efforts of ACA and its colleagues to be involved in the growth process. For instance, ACA is exploring the idea of offering a low-cost electronic membership option to international counselors to make professional development and networking affordable to those in developing nations. In addition, Erford points out, the Council for Accreditation of Counseling and Related Educational Programs has developed the International Registry of Counsellor Education Programs, while NBCC (National Board for Certified Counselors) International is collaborating with a number of countries to develop licensing and certification mechanisms to meet diverse needs.

West-Olatunji knows from personal experience how beneficial it can be to interact with international colleagues and learn more about how counseling is practiced in other nations. “Having conducted several international outreach trips and provided consultation in multiple countries to help advance our profession, I have been greatly informed by the philosophical and procedural differences that exist in counseling programs outside of the U.S. In particular, I was amazed to see the use of dance and movement as part of the repertoire of interventions used in South Africa, Romania and India. Additionally, I was intrigued to learn about the infusion of religious and moral values in counseling from a counselor educator in Botswana. I have since incorporated a greater range of nonverbal counseling interventions within my training and research.”

Education, training and experience may vary widely among counselors from country to country, but Erford says the motivation and mission of counselors across the globe is the same: “to help people in intrapersonal and interpersonal anguish adjust to life in a healthier, happier way. Just as we know from outcome research in the United States that one’s license title or position title has little to do with therapeutic success rates, the same is true in other countries. For example, in some countries no college degree is needed to be a counselor; in others, a three-year undergraduate degree makes you license eligible. But what makes you successful is your ability to connect with people, motivate them to change and then facilitate that change using culturally sensitive and respectful strategies. Diverse people require diverse strategies. While counselors from the United States have much to offer, there is so much more we can learn from our international colleagues.”

In that spirit of sharing and learning, we hope the readers of Counseling Today will gain from the perspectives being offered here by 20 of ACA’s international members.


Yukio Fujikura runs a private practice in Yokosuka, Japan.

What is the role and function of a counselor in your country — why and when do clients go to see one?

Most medical doctors heavily depend on psychotropic medications with little time to listen to their clients. To make up for this, many mental health clinics and hospitals have a counseling room in which “rinsho shinrishi,” Japanese clinical psychologists who graduate from two-year programs, are working as a counselor. Without appropriate training as a school counselor, these rincho shinrishi also work for public schools as a school counselor. They typically work for some schools as a part-timer, four to eight hours a week for each school. On the other hand, we have many private practitioners in town who call themselves “counselor,” who haven’t got a formal training or credentials. Many Buddhist monks also play the role of the counselor in a counseling room in their temples. In short, it seems that most Japanese including politicians and government officials just see counselors as a quick and easy fix for increasing demand for mental health services in Japan.

What would you most want someone reading this article to know about counseling in your country?

For most Japanese, there are no differences between counselors and clinical psychologists. To be a “rinsho shinrishi” (clinical psychologist), however, you need to know how to use and interpret [a] Rorschach test. The problem is that more and more Japanese came to see that only rinsho shinrishi, with their credential partly and indirectly supported by the Ministry of Education, were legitimate counselors. On the contrary, clinical psychologists working as a part-timer without appropriate training should not be called a school counselor. In my view, we don’t need Rorschach test to help students suffering from bullying and school refusal or to help a couple overcome marital problems.

What obstacles does the profession of counseling face in your country?

The health insurance system in Japan covers no mental health services except those offered by medical doctors. What makes matters worse, it is almost impossible for many counselors to obtain the professional liability insurance. Only “rinsho shinrishi” (clinical psychologists) can obtain the professional liability insurance through their nationwide organization, which is partly supported by the Ministry of Education. Starting my business here in Japan, I thought I should obtain the professional liability insurance. I contacted several insurance companies only to get discouraging replies. Then I emailed HPSO [Healthcare Providers Service Organization], only to find that the insurance coverage they offered was only valid in the U.S. My last resort was to join a local chamber of commerce and industry so that I could obtain an insurance for personal information leakage as a member, which is just for my conscience sake. Another big issue is a lack of availability of supervision, especially for those who studied counseling in the U.S. and now live in Japan.


Klaus Lumma founded and is the senior adviser for the German Institute for Humanistic Psychology. In addition to working in private practice in Germany, Lumma is a part-time counselor with the Faber-Castell Academy, the Catholic University of Aachen and the Gestalt Institute of New Orleans, where he lives six weeks out of the year.

If you introduce yourself as a counselor to someone on the street, what does that mean to them? What is the concept of counseling in your country?

When I introduce myself as a counselor, I always say that counseling means more than psychotherapy and basically empowers the human capacity for biographical resources. People understand that I deal with the individual lifestyle of my clients and that I encourage them to enlarge the healthy parts of it, by paying solid attention to beloved early recollections and their different creative capacities.

What is the role and function of a counselor in your country — why and when do clients go to see one?

In Germany, the role of a counselor is multifunctional: some are working in the field of childcare and guidance; others are working with parents and couples; some work as school counselors for students; and many, who work in a private counseling studio, offer individual coaching for personal and professional development, mental health counseling and team support.

Where has counseling come from over the past decade in your country and where do you see it headed in the next decade?

Counseling has come from the ongoing need for personal guidance and professional support. For elderly people, it has come from the need for coping with guilt, [particularly] in relation to the history of Germany during the Nazi period of time. In the next decade [of] counseling in Germany, we see counseling heading towards the introduction of resilience work with art-therapeutic tools.

What would you most want someone reading this article to know about counseling in your country?

I would like the readers to know that counseling in Germany has two roots, both of which started in 1913: Alfred Adler’s “individual psychology” from Vienna and Frank Parson’s “personal guidance” concept starting off from Boston. The first has been used for different developments in the field of individual psychodynamic/biographical counseling, the latter for the strategic supervision and guidance in relation to professional issues.

What lesson or idea from your country would you share with counselors in the U.S. — in what way could counseling in the U.S. benefit from the way counseling is in your country?

Let’s share the idea of having biographical thinking and the fine arts being introduced into counseling concepts of the U.S.: including literature, painting, music and three-dimensional work (Gestaltung) in order to make more use of right-hemispheric, analogical learning.

And vice versa, what would you like to see counseling in your country absorb from the way counseling is done in the U.S.?

I have already introduced Frank Parsons’ ideas to German professionals in order to extend psychodynamic work with strategic and systemic interventions.

What obstacles does the profession of counseling face in your country?

Up to now, there is no law on counseling in Germany, only on psychotherapy.

How do you hope to see the counseling profession evolve in your country?

I’d like to hear the Germans use the international term “counseling” instead of the German term “psychosoziale berating,” which is misleading and also too narrow. The counseling profession in Germany would have more political support and power if the different schools of counseling would really unite within one counseling association, using the term counseling as [I] said before.


Buthaina Mohamed Baqir lives in Muscat, Sultanate of Oman, and works in the counseling center at a local university.

If you introduce yourself as a counselor to someone on the street, what does that mean to them? What is the concept of counseling in your country?

The immediate response is “ Oh, a social worker…so you solve problems?” The Arabic word for this profession is guide, therefore people consider it a profession where people would spill their problems out and [there is] no responsibility for the client to bear.

What is the role and function of a counselor in your country — why and when do clients go to see one?

The graduates of the counseling program in Oman, generally, abide by the American Counseling Association Code of Ethics. They have graduated from programs that follow the ACA Code of Ethics. We have graduates from the U.S., Jordan, Egypt, Oman and perhaps other countries that I am not aware of. The role of counselors and counseling varies according to the awareness level of the people. Some people are seeking counseling as the last resort when circumstances become more and more complicated. The role of counseling is marginalized in that people consider the service secondary to how they can improve their lives. People see counselors mainly for marital/family issues. At the educational institutions, the students seek counseling mainly for academic-related issues and adjustment issues.

What would you most want someone reading this article to know about counseling in your country?

Counseling is still in its infancy stages in the region and it requires a lot of collaborated effort to make it a recognized discipline. The family support is ample in this region, however due to the transitioning period and the generational gaps between the parents and children, counseling is needed at this stage. People still seek family and friends to discuss matters. They may be resolved in a good or otherwise manner, but they are resolved. Counseling as a discipline is still marginalized by many at the various levels of society.

What obstacles does the profession of counseling face in your country?

Awareness about what counseling can offer [and] the variety of counseling services and specialties. [Also], legal protection is not present — where if a client commits suicide, there is not law that would protect us [counselors].

How do you hope to see the counseling profession evolve in your country?

Awareness of the various services that can be offered [and] more involvement from the authorities.


Hildah Mokgolodi works as the principal education officer of guidance and counseling at the Ministry of Education and Skills Development headquarters in Botswana. Mokgolodi directs implementation of the guidance and counseling program in the nation’s primary through senior secondary schools, including some tertiary institutions. Mokgolodi also acts as a referral for teachers on difficult guidance and counseling cases and sees walk-in clients.

If you introduce yourself as a counselor to someone on the street, what does that mean to them? What is the concept of counseling in your country?

Counselling in Botswana is still a least understood concept. Many still believe anybody can offer counselling and they can counsel themselves, so what is the big deal? There was an influx of non-governmental organisations, which claimed to offer counselling through lay counsellors with the advent of [the] HIV and AIDS pandemic. The lay counsellors would have from a day’s training of HIV and AIDS counselling training to a few weeks. This support was not all that bad, but I think it went against all, if not most, ethical codes. It however highlighted the need for professional counselling in the country. Some who understand it somewhat still think counselling is for individuals who are insane. The biggest challenge is the issue of confidentiality; many individuals do not trust counsellors and it is reflected even more in schools where many learners are usually referred [to counselors] rather than self-referrals. Having said that, those who understand counselling for what it is make full use of it and keep coming back or making referrals where [they] see fit.

What is the role and function of a counselor in your country — why and when do clients go to see one?

The role of counsellors is to help clients adjust so as to function comfortably on a day-to-day [basis]. Most counsellors are in schools to help learners make learning meaningful. Counsellors are called to give support or intervene in crisis situations and some delicate cases.

Where has counseling come from over the past decade in your country and where do you see it headed in the next decade?

Botswana has improved in its training of professional counsellors, with the University of Botswana having its first graduates of master’s degrees a decade ago. The university has started an undergraduate programme. There was an association that was started and died a natural death; however, I am proud to say we now have a strong Couselling Association that, together with relevant stakeholders, is working on having a Counselling Act approved by parliament. The Ministry of Education and Skills Development has increased the number of teachers who have gone for long-term training in counselling or psychology and it is still the intention for the next few years.

What would you most want someone reading this article to know about counseling in your country?

Counselling is a growing profession in Botswana that is picking up speed.

What lesson or idea from your country would you share with counselors in the U.S. — in what way could counseling in the U.S. benefit from the way counseling is in your country?

Couselling is not diagnostic and few labels are put on clients in Botswana, except when done by counselling psychologists. We believe lack of diagnosis reduces stigma, given just going for counselling on its own is stigmatised.

And vice versa, what would you like to see counseling in your country absorb from the way counseling is done in the U.S.?

I wish Botswana would not repeat the same developmental mistakes [the] U.S. made or encountered but learn from their best practices. I like the idea of counselling training starting off as general and, later in the study, one specializing based on their interest and a theory that one finds more appropriate for them. What I liked more was incorporating into the counselling room what works and not only sticking to a single theory but being aware of it.

What obstacles does the profession of counseling face in your country?

Counselling in Botswana has not been professionalized for a long time and it is not regulated by an act [of government]. Therefore, counsellors (professional, para or lay) cannot be held accountable for flouting ethical codes.


Nahla Eltantawy lives in Cairo, Egypt, and runs a private practice with a steady clientele of about 15 clients. Eltantawy received a master’s degree in social work from the University of Pennsylvania.

If you introduce yourself as a counselor to someone on the street, what does that mean to them? What is the concept of counseling in your country?

If I introduce myself to someone on the street, they probably wouldn’t know what counseling is. Most of them wouldn’t fully understand even after an explanation, while some will think I am either a psychiatrist or a life coach. The concept of counseling doesn’t exist in Egypt; the closest thing would be talking to a religion figure (sheikh) or “wise people.”

What is the role and function of a counselor in your country — why and when do clients go to see one?

There are very few qualified counselors in Egypt; most of them are wives of expats who live and work in their community. Other than that, when people have problems in Egypt they go to one of the following:

1) Psychiatrists: only educated upper middle-class people reach out to them when their problems go out of control, such as kids’ performance in school, depression, anxiety, grief, marital issues, etc. Most of the time psychiatrists prescribe medications.

2) Psychologists who hold a Ph.D.: same population with same issues. Most of the time, the clients don’t know that they are psychologists not psychiatrists because they have “Dr.” before their name. Clients don’t ask and psychologists don’t explain.

3) Life coach (no specific background or qualification): educated upper middle-class women have become addicted lately to “human developing centers” where they attend lectures about energy, how to control your brain, live a happy life, be positive and get one-on-one help for their personal issues.

4) Religion figures (sheikh): upper middle-class people reach [out to] them to discuss their family issues. Everybody else reaches [out to] them for every kind of issue, ranging from kids’ behavior to depression.

5) Relationship counselors (famous writers, actresses, radio/TV hosts, journalists): people call them to talk about their love and marriage troubles.

Where has counseling come from over the past decade in your country and where do you see it headed in the next decade?

Counseling in Egypt started out with wise men/women who give advice and has now turned into psychiatrists sending the message that medication is the answer. However, I believe that with more people getting exposed to the Western culture through education, traveling or even movies, people’s awareness of professional counseling will improve, especially after the American University in Cairo launched their master’s program in therapy.

What would you most want someone reading this article to know about counseling in your country?

The idea that I would like to share with counselors in the U.S. is that after working in both [the] U.S. and Egypt with individuals, couples and families, people are the same everywhere. They are humans. Yes, there are cultural differences the counselor should be aware of and sensitive toward, but they are not barriers. People everywhere share the same fears, insecurities and dreams.

What obstacles does the profession of counseling face in your country?

The obstacles that the profession of counseling is facing in Egypt are:

1) Lack of awareness of the profession.

2) The stigma: most people think that only crazy people or people who cannot deal with or tolerate life hardships go to counselors. Media actually plays a big role in this.

3) Men’s perception of therapy: most men in Egypt perceive counselors as someone who is invading their privacy, so they don’t allow their wives to seek their help. Plus, men think it is a shame to ask outsiders for help since “men know better and can fix their own issues, if they can admit they have any to start with.”

4) Lack of laws that determine certain qualifications or certificates needed to practice the profession.

5) Financial issues: Egypt is a developing country where 40 percent of the population live under [the] poverty line ($2 a day), so very few people can afford to see a counselor; plus we don’t have a health care system that can pay for this kind of service. To add to the mix, the NGOs won’t provide these services, since they have more essential priorities, such as providing the poor with some of the basic needs. Unfortunately, counseling in country like Egypt is considered a “luxury.”

How do you hope to see the counseling profession evolve in your country?

I hope one day counseling can be a structured, regulated, stigma-free, available and affordable service in Egypt.


Becky Aud-Jennison moved from Springfield, Ill., to New Zealand in 2011. She teaches counseling at the local tertiary education institute to second- and third-year students working on their bachelor’s degrees in social services.

If you introduce yourself as a counselor to someone on the street, what does that mean to them? What is the concept of counseling in your country?

I don’t have a sense that counseling has strong identity in New Zealand. It appears, and this is speaking from a naive newcomer’s position, that although New Zealand is very progressive when it comes to thinking of, and accepting, nontraditional treatments (i.e., energy modalities, acupuncture, various hands-off alternative approaches), counseling and therapy are looked at from a more “medical” or “traditional” perspective. There doesn’t appear to be a norm of going to counselling with issues. Self-referrals appear limited. Most referrals (and word is, those are relatively few) go through a [general practitioner] and are for an average of six sessions. New Zealand counsellors will tell you that they feel their services are not being utilised appropriately. Counselling doesn’t appear to be a service that people are as willing to seek privately in New Zealand as they do in the U.S. The counsellors I meet are very serious about their work and appear very knowledgeable. There seems to be a use gap, as if they are being phased out or were never welcomed in.

What lesson or idea from your country would you share with counselors in the U.S.?

My word to U.S. counselors would be to count your blessings that counseling has accrued the respect and professional regulation to legitimize and advance the practice that it has in America. Don’t assume other countries are more progressive. And don’t lose sight [of] the fact that this profession will not magically stay afloat: support the standards of best practices and regulation that help cement counseling as a permanent fixture in American society.

Is there anything else you’d like to add?

As a country whose mantra is “no worries,” New Zealand is very perplexed about their very high suicide rate. With the divisive nature of services here — mental health, AOD, psychotherapy, psychologists and counselling (and lack thereof) and the lack of a societal norm for getting help (which, in turn, increases stigma) — I find it mindboggling that the lack of places for people feeling depressed and desperate has not been addressed. Having worked closely with people who attempted suicide, [are] contemplating suicide and with families in the aftermath of suicide in the U.S. — I’m extremely concerned that intervention isn’t being systematically addressed and that I am speaking to counsellors who feel their field is evaporating.


Nathan Fischer lives in Austria. Not currently working as a counselor, he instead sees clients as a self-employed coach and took a full-time job teaching English to make ends meet. Fischer earned his master’s degree in counseling in the United States, and he and his wife will be returning stateside this summer, when he will work toward his counselor licensure and begin a doctoral program.

How did you land in Austria?

I moved to Austria in May of 2010, right after graduating with my master’s degree in counseling. I was born in St. Louis, but I moved to New Orleans as a child and grew up there. I also completed my studies there. I came to Austria to get married. My wife is originally from Austria, but she studied at the University of New Orleans and lived there for many years. We met in New Orleans in 2007, and shortly thereafter, she got her dream job offered to her back home in Austria. Since I was still in my graduate program at the time and didn’t really have a career as yet, I figured I wouldn’t be giving up a whole lot in the career field if I moved to Austria. I also didn’t want my then-girlfriend to have to choose between me and her dream job. So we decided to move. Plus, I thought I would be able to secure a school counseling job at the same school where my wife was employed as a Spanish teacher. After a series of interviews where I was promised the job, we thought it would all work out. The job fell through as soon as I moved over here though. As you can imagine, it was a rough time.

If you introduce yourself as a counselor to someone on the street, what does that mean to them? What is the concept of counseling in your country?

If I use the word “counselor,” I get a puzzled-looking face and people ask, “What’s that?” Most people I have come across in Austria are unfamiliar with the term “counseling.” There is also no exact translation of the word in the German language. The closest translation I have come across is the word “berater”— which means advisor or consultant — and German speakers in professional and academic circles simply use the English word. If I want people to understand what I do, I say that I am a “psychotherepeut,” or psychotherapist. While not exactly true, this isn’t such a bad compromise because the work of psychotherapists and counselors is not so far apart. However, there is a subtle distinction that is well-defined in the U.S. and is also understood by the majority of the public…not so here in Austria.

That being said, the concept of counseling is really the concept of psychotherapy and carries the same connotation here as it did several decades ago in the U.S. People I have talked to seem to think that only people with major psychological problems or people who are dangerous see these kinds of professionals. In my experience, the Austrian people are very friendly but also very private. Of course, I can only speak of my impressions, but I cannot imagine the typical Austrian seeking the help of a professional because of problems in a relationship or family… unless forced by the authorities. I believe this would be too embarrassing to most people, as well as an admission that they have failed in some way and cannot cope on their own.

This is a country located in the dead center of Europe, and as a result, they have been caught in the center of power struggles for centuries. More recently, the country has weathered two world wars and a holocaust, the latter being no small source of global shame. I truly believe that these world events have shaped the culture and mindset here into one not so open to exposing and looking at failures in general.

What is the role and function of a counselor in your country — why and when do clients go to see one?

I only know one Austrian who regularly sees a psychotherapist. This person has battled depression for the majority of their life and seeks help with that. Incidentally, I have heard about the work they have done together and, in my opinion, the therapist seems to be working from rather outdated perspectives of change and healing.

There is one fascinating anomaly I have come across here. The culture here places an extremely high value on productivity and hard work. As such, the phenomenon of “burnout” has become quite widespread and has drawn the attention of both the public and employers alike. There are actually public awareness campaigns (billboards and TV ads) and worker assistance programs in place to combat burnout. This is one area where I do see a lot of movement towards professional help. Although, the professionals dealing with this are more like life coaches/trainers than professional counselors/psychotherapists. Again, I would say that the distinctions are not readily recognized by the average person.

What would you most want someone reading this article to know about counseling in your country?

Establishing yourself as the same kind of professional as would be in the U.S. seems to be about establishing your authority. Austria has made a science out of bureaucracy and establishing your credentials is a tedious, lengthy and expensive process, one which I still have been unable to fully complete. If you plan to work here as a counselor, you will need to come with the correct paperwork and go through the proper channels. In short, do your research first!

Secondly, of course, is the language barrier. I came to Austria expecting to get a job in an English-speaking school as a school counselor. When that job fell through, I was left seeking other employment. Obviously, counseling is a speaking profession…we talk to our clients. Not only do we talk, we must have a real command of the language in which we counsel. My German has come a long way in the last three years, but I still do not feel confident enough to discuss a client’s inner world in German.

What obstacles does the profession of counseling face in your country?

I would say the biggest obstacle is cultural perception of how change happens and the meaning of asking for help. Counselors are in the business of helping people to change various aspects of their lives. In the past three years, it has been my experience that when the average Austrian seeks to change something in their life, they mostly struggle on their own. They are not inclined to seek the help of a professional. This is a proud, strong, resilient and hardworking culture with many wonderful qualities. I only wish I could do more to educate people here about the benefits of reaching out to a counselor and how much it really helps people to improve the quality of their lives and relationships.


Erik Mansager lives in Switzerland. He and his professional and life partner, Jane Pfefferlé, run a private practice with offices in Geneva and Morges. Mansager works exclusively with the expatriated English-speaking community, while his partner works with that population as well as the native French-speaking community.

If you introduce yourself as a counselor to someone on the street, what does that mean to them? What is the concept of counseling in your country?

In Switzerland, the word “counselor” (with two L’s) is a protected word. In its German (“berater”), French (“conseiller”) and Italian versions (“consigliere”) and in English (with one L), it is understood simply as “advisor.” This is used in many professional and non-professional settings so there is currently a strong effort to educate the public as to the professional understanding — as we have in the States.

What is the role and function of a counselor in your country — why and when do clients go to see one?

There has just been a major legal decision on behalf of counsellors who had petitioned the federal government to be granted the privilege of earning a federal diploma, which is necessary for federal recognition of the profession’s standing. This was granted over the objection of the Swiss psychological society. Because the counsellor-exam application addresses our focus on providing psycho-social psychotherapy — by which they mean adjustment to traumatic instances and stressful life situations.

The psychologists objected on several accounts: that counsellors would take away their business; that the name and objective of providing psychotherapy would be confusing to the public; and that counsellors were not trained in treating psychopathology. The court struck down the complaint, observing that the market would take care of the business angle; other new professions come and go without confusion to the public that education can’t address; and the counsellor application already noted that severe psychopathology would always be referred to appropriate helping professionals.

This was a major win for our profession here. Promoting its outcome, designing the exam and proffering it are the immediate tasks in front of us.

What lesson or idea from your country would you share with counselors in the U.S. — in what way could counseling in the U.S. benefit from the way counseling is in your country?

Counselling here in Switzerland has a long history — arising from the applied psychology traditions. This is the field in which pastors, nurses, midwives and others were trained — beyond their first profession — to provide for the mental health of their patients and clients. This tradition grew up beside the psychology profession, which was developing so vigorously at the Burghölzi in Zürich. This was not only the home of Jung’s analytic psychology but Karl Abraham’s interest in Freud’s psychoanalysis and, via Alexander Müller, Adler’s individual psychology. As a result of this tradition, counsellors more regularly have had in-depth training in a particular school of psychotherapy — and along with this, there is a tradition of receiving training-analysis in some fashion. My experience is that this lends simultaneously a cohesiveness and gravity to the profession that might not be as obvious in the States. Besides the big three just mentioned, the client-centered approach, transactional analysis and gestalt therapy are also utilized for this training and later as the methodology of counselling applied.

And vice versa, what would you like to see counseling in your country absorb from the way counseling is done in the US?

Although it was also a long struggle in the U.S., it would be nice if the helping professions could cooperate here as the U.S. professions do more and more nowadays. Here, social workers and psychologists seem quite protectionist and worse still, exclusive. It tends to be the case that if you don’t have a Swiss psychological education (or its strict equivalency), you are not welcomed to practice here.

What obstacles does the profession of counseling face in your country?

While we have been given professional recognition and have been granted diploma authorization, it will remain an uphill struggle for insurance coverage. This will take time, but is likely inevitably going to happen.

 How do you hope to see the counseling profession evolve in your country?

It will be most helpful if our small and growing organization continues to ally itself with the larger counselling groups here in Europe. Both the European Counselling Association and the ACA’s European Branch are available to us, and we have fledgling contact with them. Uniting is a strengthening factor and would be most welcomed. I hope that we will remain focused on our professional development and service delivery, without ourselves becoming protectionist as our portion of “the helping profession” continues to evolve to serve the needs of the community.


Tolga Nasuh Aran lives and works in Izmir, Turkey. He graduated from the Middle East Technical University Guidance and Counseling Program and has been working as a counselor since 1997. He works as a rehabilitation and family counselor with high-risk families, including those with children who are autistic. He is the president of the Turkish Counseling and Guidance Association of Izmir Regional Branch and the co-president of the Turkish Marriage and Family Counselors Association.

Where has counseling come from over the past decade in your country and where do you see it headed in the next decade?

There are many signs of progress visible in Turkish counseling today. In short, there are questions concerning the roles and functions of counselors, as well as the credentials required to be a counselor, that remain unanswered today. As a result, the counseling profession in Turkey, as in many countries, still seems to be in search of a professional identity of its own.

What would you most want someone reading this article to know about counseling in your country?

There is a lack of uniformity and consistency in counselor education programs among universities. In addition to the lack of consistency among curricula, there is no accreditation system for either undergraduate or graduate counseling programs.

How do you hope to see the counseling profession evolve in your country?

I hope to see my unique profession, counseling, developed likewise [as] U.S.A. in its own unique way. First of all, as practitioners, when we are studying counseling, our professors must be allowed to work in private or public counseling centers. And then, we need our professional organization to be more politically powerful. The Turkish Psychological Counseling and Guidance Association (TPCGA) should be expanded with its subdivisions and regional branches. [Similarly to] ACA, TPGCA should be like an umbrella: School Counselors Association, Marriage and Family Counselors Association, Rehabilitation Counselors Association, Mental Health Counselors Association, Carrier Counselors Association and Association for Counselor Education and Supervision could be established under TPGCA. In universities’ counseling programs will be undergraduate degrees, but subfields of counseling should have graduate programs (M.S., Ph.D.).

To develop our profession, we have to promote people, potential clients, solidarity with international counseling associations, use mass media very well, etc. Twenty years later, Turkish population will not have young population as it has now. People will be older, and rather than school counseling, people need counseling in different fields. We have to plan our profession according to future. The most important and necessary movement will be the approval of professional counseling. We have to make the laws for our profession. We have to build an organisation like NBCC and CACREP. A counselor should finish the supervision. After supervision, the council should approve the license. Thus a counselor can work with license. Graduate programs must be opened not only for researchers but also practitioners. There should be a core programme in counseling in all universities. This must be approved by the council.


Helena Ng lives in Macau. She works in private practice in both Macau and Hong Kong and also works as an assistant professor at a university in Macau. In addition to teaching, she manages the university’s counseling service and supervises counseling students in their clinical work.

If you introduce yourself as a counselor to someone on the street, what does that mean to them?

I have not conducted or read any study on this, however, from my encounter with and observations of people here, I imagine that some people would frown, not knowing what that (such an introduction) might mean. Others might smile and go away, probably would not want to be involved in anything related to counseling. Yet I believe that there some people may show genuine interest or curiosity about something I am going to tell them.

What is the concept of counseling in your country?

In Hong Kong, the concept of counseling is attached to a stigma — only crazy people would seek counseling. I heard many people describing counseling as “talking with someone.” It seems acceptable to them that they are “talking with someone” rather than receiving counseling. In my experience with clients coming from different backgrounds, I notice that people who have received more education seem to support the idea of counseling. There are some people who “appear” to be familiar with the concept of counseling. These people are eager to refer their relatives and friends to the counselor. Yet when they are asked to see a counselor, they would say that they are fine. Then there are some faith believers who seem to be confused about the concept of counseling and spiritual direction. For instance, many people talk about their emotional issues when they meet with their spiritual director.

On the whole, the concept of counseling is associated with something negative. Most people would not see a counselor merely because they want to gain clarity on something or hear some objective perspectives. Also, it occurs to me that a lot of people in Hong Kong do not consider counseling as a proactive means. For example, we often hear that people who have experienced trauma are asked to receive counseling. Perhaps pre-marital counseling service offered by many Christian church organizations is the only service that promotes counseling as a proactive means. This counseling service borrows a psychoeducational approach to prepare couples to live harmoniously as husband and wife.

In Macau, the situation is slightly similar, even though people here seem to be less familiar with the concept of counseling. People perceive social work as a major helping source and counseling is merely a component that supports social workers’ task. Generally speaking, people in Macau are less willing to pay a high fee for counseling service.

What is the role and function of a counselor in your country — why and when do clients go to see one?

In Hong Kong and Macau, counselors play the roles of a mentor, teacher, consultant and advisor. Quite commonly, people seek counseling because someone tells them to. I have a number of children, teenagers and adolescents as clients; all of them come to see me because their parent or parents asked them to. For couples, in general, it is the wife who “drags” the husband to come for couples counseling. For families, usually it is the wife or mother who came to see me first and brought their family members to discuss their issues in subsequent sessions.

In primary and secondary schools, students are asked by parents, teachers or principals to see the school counselor or educational psychologist. In most cases, these school children have emotional or behavioral issues and are asked to see a professional in the school premises.

In colleges and higher educational institutions, some students see the counselor for career guidance. There are very few students who would approach a counselor for their personal or emotional problems. Some educational institutions’ student affairs department may refer students to meet with the counselor on campus.

What would you most want someone reading this article to know about counseling in your country?

I hope that readers will get some information they rarely find in counseling textbooks. First, I would want readers to know that people in Hong Kong and Macau are not completely ignorant about or unfamiliar with the concept of counseling. There are people seeking counseling in Hong Kong and Macau for some years. Some of the users of counseling service may not know what exactly counseling is about, however, they somehow see that their life has been improved after they received therapy.

Second, the identity of counseling is very weak. How can it not be weak? There is no pure counseling program here that is offered by major higher educational institutions. I think it is important that people receive proper education about counseling, its potential benefits and the ways counseling can be offered.

Third, the credentials and standards of providers can be quite diverse as a result of the lack of requirement to obtain license or certificate to practice. It is crucial that the profession establishes an agreed set of ethical standards to guide ethical behaviors of professional counselors.

Finally, the demand for counseling is apparent, but it seems that such demand is still not being “heard.” The reasons behind this situation is possibly due to the weak identity of counseling; the stigma or negative connotation attached to counseling; the lack of empirical data to support the effectiveness of counseling; and the absence of pertinent publicity of counseling service.

How do you hope to see the counseling profession evolve in your country?

I would hope that the following scenarios could be realized eventually:

  • Formation of a pure counseling program at higher educational institutions
  • Founding of an Asian branch of the CACREP
  • Collaboration among individual counseling associations in Hong Kong, Macau and other Asian countries with the ACA
  • Publishing of more counseling-related research work
  • Instituting more counseling centers
  • Educating the public about the concept of counseling


Rachel Erhard is a senior faculty member in the School of Education at Tel Aviv University in Israel. She is a past chair of the master’s graduate program in counseling and past chair of development and research in the Psychological and Counseling Services in Israel. She is currently writing a book called School Counseling: A Profession in Search of Identity.

If you introduce yourself as a counselor to someone on the street, what does that mean to them? What is the concept of counseling in your country?

The evolution of school counseling in Israel grew out of ideological and social legislation. In a young country, which was absorbing many immigrants (in April we celebrated our 65th birthday), there were gaps in the social fabric between the more established citizens and its newcomers. There were differences of culture and approaches to modern society, as compared to some of the immigrants from Africa and Asia. As such, there was a desire to decrease the gaps and to provide equal opportunities to all students. Counseling began in the 1960s as a way to increase social mobility and desegregated learning environments to students from low social groups.

The evolution of school counseling in the U.S.A. and in Israel is actually quite similar. Both evolved from a vocational/educational model. Today in Israel, there is less focus on the vocational guidance and more emphasis on social-emotional development of the students.

What is the role and function of a counselor in your country — why and when do clients go to see one?

In Israel, school counselors must be certified teachers. The role of school counselor is a vital position in Israeli schools. As counselors are also educators, they are an integral part of the school faculty. Counselors are peers/colleagues of the classroom teachers and are seen as valuable resources for assistance in managing student challenges or difficult situations. Counselors provide training and professional development to teachers and other school personnel with respect to many subjects. Counselors are also valuable resources to parents and community members with respect to student achievement and performance in schools. As the academic and social/emotional supports, school counselors are seen as invaluable sources of guidance to students, parents and educators in schools. What seems to be a guiding principal is that the adult/educator closest to the student should be the one to provide the student with the needed support. As such, very often, the classroom teachers turn to school counselors for advice or suggestions as to how to handle situations in Israeli schools.

School counselors in Israel can be accessed in a variety of ways. Firstly, students can approach a counselor on their own. Counselors try to make themselves available as much as possible to students. Students who may not seek out a counselor on their own may be referred by a classroom teacher or administrator if there is a concern. Parents also approach often the counselor. Sometimes counselors, through their work as educators in the classrooms, will determine that a particular student is in need of support, or students may approach a teacher due to their exposure/familiarity with the counselor through their classroom experience.

What would you most want someone reading this article to know about counseling in your country?

One thing that stands out in school counseling in Israel is its constant growth and the spread of counseling across many facets of the education system. More and more — endless — issues are perceived as the counselor’s role. The good news is that school counseling is seen as an integral part of the Israeli education system. The difficulty is that school counselors have in addition to the traditional roles more and more professional responsibilities (sexual harassment, learning disabilities, crisis interventions, children of divorced families and more and more) without receiving additional time resources (hours) in their contract to complete all of the tasks at hand.

One of the biggest changes in school counseling in Israel is the shift from individual counseling to more of a systemic model. For example, two key areas of focus is the intensive involvement of the counselors in enhancing positive social-learning school climate and preventing school violence, bullying and harassment. Counselors are also trying to really focus on the wellbeing of students and prevention initiatives. There is a curriculum for K-12 called Life Skills, which counselors use in the training of prevention. That being said, very often, counselors find themselves in roles [that] are less preventative and more reactive, due to their ever-growing list of responsibilities. As such, counselors are moving from individual counseling to more of a consultative role with classroom teachers, parents, faculty/staff and administrators.

How do you hope to see the counseling profession evolve in your country?

In the next decade, I would hope that there would be more focus and emphasis on the unique identity of the role of school counselor. And on the other hand, being pragmatic and realistic, counselors will have to be able to be flexible and be relevant and adaptive, based on the rapid changes in policy and evolving nature of education. For example, the use of social media as a means for cyberbullying and harassment is truly horrific. On the other hand, how will counselors be able to effectively use and mediate the use of technology in school counseling?

I think the second thing to focus on in our two countries is the concept of social justice and school counseling. Poverty is on the increase and the gaps between students continue to grow. As school counselors, we will have to learn how to recognize and use our roles proactively to promote opportunities for underrepresented populations in education that might not be afforded in other social service arenas.

On one hand, we can learn from the U.S.A. on how to delineate and stay true to the more formal and theoretical approach to counseling. However, we should also keep our perspectives and approaches as inclusive and as broad as possible so as to include the larger social network and community.

Arleen Swan works as an “adjustment counsellor” at a secondary school in Bermuda, where she provides mental health counseling and support services to students in grades nine through 12. She has worked as a school counselor in Bermuda for 24 years.

If you introduce yourself as a counselor to someone on the street, what does that mean to them? What is the concept of counseling in your country?

Counsellors, in Bermuda, have become an integral body of professionals providing a variety of services and resources. The largest setting of employment for counsellors is in the school setting. Since approximately 1995, we have seen counsellors placed in every level of the Bermuda government educational system: pre-school, primary, middle and senior school.

In general, the Bermuda community does have a basic knowledge and understanding of a counsellor’s role, function and services rendered. As I speak specifically to the role of school counselors, most people view them as assisting with specific academic, social/emotional, mental health, behavioral and parenting challenges. There are mixed reviews about how the other educational professionals and parents/guardians view counsellors. The thought is that we “fix problems” and have untold powers unbeknown to ourselves to do miraculous (quick-fix) work.

Having said [that], for the most part, counsellors’ work is valued as they have become essential professions on [the] island.

What is the role and function of a counselor in your country — why and when do clients go to see one?

Counsellors work in a variety of settings in Bermuda. As previously mentioned, the Bermuda education system is one of the largest employers. However, there are counsellors in mental health settings in Bermuda, along with private practitioners and in the employee assistance programs.

Clients can seek counselling services for a variety of reasons similar [to] that of persons accessing counselling services in the U.S.A.

Where has counseling come from over the past decade in your country and where do you see it headed in the next decade?

Professional counsellors working in Bermuda, in general, have received their master’s education and designation from an accredited institution in the U.S.A., Canada or the United Kingdom. There are some who are members of the ACA and/or local BCA (Bermuda Counsellors Association with affiliation with APCO & ACA).

The Bermuda Health Council, under the auspices of the Ministry of Health and supported by the Bermuda Counsellors Association, [is] looking to establish legislation on the registration and regulations of counsellors and other mental health professionals working in Bermuda.


Gilberto Salinas is an assistant professor of psychology and clinical director of the Department of Student Counseling and Disability Services at Texas A&M International University in Laredo, Texas, just across the border from Nuevo Laredo, Mexico. Salinas, who also has a small private practice, has done counseling work in Nuevo Laredo, but not since 2007 due to violence associated with the drug cartels. He works with many people from Mexico who have been displaced or have come across the border and sought counseling help.

If you introduce yourself as a counselor to someone on the street, what does that mean to them? What is the concept of counseling in your country?

Sadly, the general Mexican populace believes that a counselor is a “loquero,” someone who works with “crazy people.” Those who do seek services generally have the expectation that the counselor will give them advice and answer their questions. However, once the concept of psychotherapy is understood, they embrace it and tend to be faithful.

Where has counseling come from over the past decade in your country and where do you see it headed in the next decade?

People still hold on to “familismo” and tend to keep things in the family. Nevertheless, the stigma of seeking professional services outside of the family unit or the church appears to be slowly decreasing, especially among the college-age individuals. Theoretically, counseling in Mexico historically has been very Freudian; nevertheless, more theories have been gaining favor, such as Gestalt and person-centered lately. I believe there will be a proliferation of diverse theoretical practices in the future decades. Because of the years of drug cartel violence, I see Mexico as a crucible for development and consumption of trauma-focused approaches to therapy.

What would you most want someone reading this article to know about counseling in your country?

In Mexico, there is a wide field for research and service in this country for serving the severely traumatized population because of the cartel violence. In the U.S., there is urgent need for counselors who speak Spanish and are well-versed in the Mexican culture to serve the displaced affluent Mexicans who are legally migrating to the U.S.


Amandi Mboya works as a community counselor with the Ruben Centre, a faith-based organization in Nairobi, Kenya. Mboya, who graduated from Fordham University’s Graduate School of Religion and Religious Education, works with preadolescent boys and girls, offering crisis intervention, ongoing support and life-skills activities.

If you introduce yourself as a counselor to someone on the street, what does that mean to them? What is the concept of counseling in your country?

The concept of counseling in Kenya is widely understood to both young and old generation in the city where I am based. I have no statistics on how widely counseling is understood [across the country]. Professional counseling is well known in the city areas where majority of the elite lives. Most of my clients are poor people who can not avoid to pay a trained counselor. Some have never attended counseling before, others never heard or not sure what is the role of a counselor.

What is the role and function of a counselor in your country — why and when do clients go to see one?

The role and function of a counselor in my experience is that of a teacher, someone who knows and understand another person’s struggles, whether intrinsic or extrinsic issues. His or her role is to guide the one seeking help toward some kind of healing or better coping with the situation.

Where has counseling come from over the past decade in your country and where do you see it headed in the next decade?

Traditional counseling has been in existence for years; on the other hand, professional counseling is a new concept that is gaining ground with most people. Probably, the emerging of HIV/AIDS pandemic has speed up the professional counseling concept. Professional counseling is here to stay.

What would you most want someone reading this article to know about counseling in your country?

I would like the readers to delete a concept that counseling is a Western concept. It is a universal need, only in Western [cultures], things are more structured, documented and strong ethical and legal.

I worked in America as an intern, before coming back to Africa. Most people are paid for their service. My experiences in Keya so far, counselors are volunteers who are willing to support others in their daily struggles.


Grazia Di Giorgio is a counselor in private practice in Bari, Italy. She also sees some counseling clients and provides some clinical supervision via Skype.

If you introduce yourself as a counselor to someone on the street, what does that mean to them? What is the concept of counseling in your country?

I came back to live in the South of Italy only a little over a year ago after having trained and worked as a counselor in the U.S. from 2000 to 2011. Since coming back, I have had a lot of practice in explaining what I do and what counseling is in this country, so this is a particularly interesting question for me…

I will begin with the second part of the question and say that in general, so far, I have met only a few people in Italy who seem to already know something about counseling. On the other hand, for the most part, people seem quite curious about it, and I have received many excellent client referrals from friends and acquaintances just on the basis of casual conversations about my counseling and “somatic experiencing” work.

Aside from reflecting a still very strong cultural stigma against mental illness and the predominance of classic psychoanalytic tradition and of the “medical mode” over the entire field of psychology in Italy (a situation that seems comparable to the one in the U.S. not too long ago), this ignorance about counseling can be partly explained by the fact that although there are several counselor training programs active in Italy at this point, the profession was still entirely unregulated until a controversial law was passed only a couple of months ago. In fact, the concept of counseling here seems to be profoundly marked by a very conflictual relationship between the psychologists and the counselors, with psychologists revindicating the exclusive right to a professional status and exclusive access to the title of psychotherapists, while at the same time pushing for a very restrictive definition of the activities and the areas of competence and intervention allowed to a counselor.

In spite, or perhaps precisely as a result of this state of things, I have found that people’s interest and hopes for engaging in this work seem almost always enlivened by my explanation that a counselor — unlike a psychologist — works on a more egalitarian basis with her clients, that s/he is trained to use specific techniques in order to work on specific issues or problems defined and agreed upon collaboratively with the clients, and that we are limited to a rather small number of sessions, usually also agreed upon at the beginning.

Many people seem quite excited to hear this and to understand that counseling does not work with what for them is the “classical” medical model based on the idea of pathology and operating within the hierarchical structure of a doctor-to-patient relationship. Instead, I explain that my job consists mainly of supporting self-awareness, offering some relevant information, providing containment and ultimately fostering the person’s own resources and sense of agency.

The current Italian law requires me to tell any prospective client that as a counselor I am prohibited from working long term with anyone or with people with more serious and/or chronic mental health issues. I will confess, especially given the extensive and excellent clinical experience and training that I have accumulated in the U.S., that I see this rule as an unfair limitation of my scope of practice, but at the same time, this statement often has turned into a point of interest for my interlocutors when I treated it as an opportunity to emphasize by contrast the profoundly creative and empowering perspective that counseling offers to anyone who, rather than seeing themselves as a mentally ill patient in need of a diagnosis and medical treatment, might choose of their own accord to explore new ways and possibilities to live her or his life in a fuller or more satisfying way.

What is the role and function of a counselor in your country — why and when do clients go to see one?

I think that I already partly answered this question in my response to the previous one. As I have mentioned, the role of a counselor in Italy is starkly separated from that of the psychologist or the psychotherapist. As such, we are required to clarify for each prospective client that we do not provide medical or psychological cures and that counseling sessions don’t have a diagnostic or a therapeutic function, which is instead reserved for the psychologist, the psychotherapist, the doctor or the psychiatrist. Except then for those of us who are also comprised in one of these latter categories, counselors here have only a very marginal role — if one at all — as consultants or service providers within public and/or private organizations, but for the most part, we seem to operate out of a private office or within a counseling training program.

Because of this limiting definition of our area of expertise (which of course ends up having a detrimental impact on the training standards and the competence levels of the counselors who train and practice here), I would say that people who come to see a counselor in Italy must generally be at a rather high level of functioning. Often, I would say that people are motivated to begin this work by an interest in the specific technique or model that the counselor is trained in (for example whether the counselor works with family constellations, neuro-linguistic programming, art, movement, etc.) So far, almost all of my clients in Italy have come to see me because they were interested in trying somatic experiencing work, which is an approach to traumawork and neuro-rehabilitation originally developed in the U.S. by Peter Levine. This powerful work is still pretty much completely unknown here, and, in spite of its overtly therapeutic agenda, it can be legally practiced in Italy with the title of counselor.

What obstacles does the profession of counseling face in your country?

In short, I would say that the obstacles for Italian counselors mostly seem to revolve around the cultural stigma and the lack of information and awareness around mental health-related issues, as well as the heavy credentialing/scope-of-practice limitations currently imposed on our professional category.


Raymond Cheong lives and works in Singapore and is a third-generation Singaporean. He is a clinical child/youth counselor and operates a learning/counseling clinic that handles academic, social and emotional learning issues among children.

 If you introduce yourself as a counselor to someone on the street, what does that mean to them? What is the concept of counseling in your country?

Counselling in Asia is a taboo word, hence we combine learning and counselling to create a holistic place for the children and parents to come for learning counselling. Children and youth learning difficulties, apart from physiological deficiencies, social and emotional deficiencies, can cause them to do badly in learning academically and with learning about people, things and matters. Inevitably, anti-social behavioural issues surface. Combining counselling and learning is our mode of operation here in Singapore.

In Asia, it is not common that an adult go for counselling, although they know the importance of it. It has to do with the misunderstanding that if you were to visit a counselor you have an issue and hence you are not normal. Asians live in a very judgmental society basically.

They will usually respect me as a counsellor and will associate me with children and youth more than adults. Usually when a child is in trouble, it is not common to see parents admitting they are at fault to a certain or large extent. It is always the child’s issue and no one else…hence only the child needs counselling.

Where has counseling come from over the past decade in your country and where do you see it headed in the next decade?

Over the past decade, I have observed counselling practise moving up the professional ladder here in Singapore with more awareness from the public about the importance of counselling. I trust with more regulatory control, we can make counselling a profession that is more respected by the mainstream as a holistic way to seek human mental, learning and perspective help without the use of medication and reckless classification of people into disadvantage learning spectrums out of convenience by other professionals.

How do you hope to see the counseling profession evolve in your country?

I hope to see more mid-life career change individuals step into the profession to help others. However, they should learn from the basic rather than leveraging on previous higher qualification to study a master degree in counselling psychology … They should learn from a diploma onwards to understand more about the micro skills in counselling instead of just plucking themselves into a master degree program. Counselling knowledge from academic [pursuit] cannot be directly applied with a qualification certification.


Huguette Ostiguy is from Canada but has been working in Malawi since 1979. Ostiguy works for the St. John of God Community Services, teaching at St. John of God the College of Health Sciences, which offers a two-year counseling training.

If you introduce yourself as a counselor to someone on the street, what does that mean to them? What is the concept of counseling in your country?

Here in Malawi, the work [of] “counselling” came with the recognition of the reality of HIV and AIDS in the early 1980s when the Ministry of Health introduced the HIV Testing and Counselling (HTC). So the work [of] counselling has been and still is strongly connected to that, as there are HTC sites all over the country. So for people, [counselling] mainly means to be tested for HIV and to be explained about risky behaviour or to avoid getting infected, etc. It is now offered to clinics of pregnant mothers so to know their HIV status and so to take measures to avoid transmission to the baby. With the development of a more professional training in psychosocial counselling — to underline the difference with HTC — slowly the word counselling in taking a new meaning.

What is the role and function of a counselor in your country — why and when do clients go to see one?

Beside the Psychosocial Counselling Services offered at St. John of God Community Services, Mzuzu, where people come spontaneously for assistance, there is no other such service yet. Slowly, other people are now getting trained mainly in Kenya or Uganda, and that also is starting to contribute to the counselling services reaching to people mainly in faith-based organisations and churches.

Where has counseling come from over the past decade in your country and where do you see it headed in the next decade?

See the description above for the past. For the future, professional, therapeutic, psychosocial counselling is moving ahead. Training will continue at St. John of God College of Health Sciences, and other theoretical courses, as well as short programmes, are given and will continue to be offered by different stakeholders.

What would you most want someone reading this article to know about counseling in your country?

Professional trained counsellors are much needed to offer assistance to people and to support the training. Nothing resembles more a human being [than] another human being. We all have the same psycho-emotional needs, the same pain and the same desire for freedom. Up to now, counselling is not yet recognized as a profession in Malawi, and so it not yet included in the establishment of services, even in the Ministry of Health, neither in Ministry of Education, etc. This is a challenge for us to move this forward and to get one day the official recognition by the government of Malawi of counselling as a profession and for the counsellors their rightful place among the professionals offering services for the well-being of the people of Malawi.


Usha Nair is from Singapore and worked there as a counselor until 2007, when her husband was posted to Mumbai, India. Nair obtained a job as a counselor with a local airline in Mumbai in 2010. She works with airline staff members who, stationed away from their homes, cope with work-related stress and being away from their families.

If you introduce yourself as a counselor to someone on the street, what does that mean to them? What is the concept of counseling in your country?

Most people respect the profession, aware that it requires a college degree and practical training. They do not differentiate between counselors and psychologists. Many think it is an interesting job, especially since counselors are privy to others’ personal issues/struggles. However, most Indians also believe that only the “mentally ill” or those “unable to handle issues on their own” seek counseling. Hence, there is a stigma attached to seeking professional help.

What is the role and function of a counselor in your country — why and when do clients go to see one?

These would depend on the setting in which the counselor operates — in schools, hospitals, organizations or when mandated by the courts, etc. Being a society that values family and community cohesion, most Indians prefer to resolve their issues within these groups and only seek professional help as a final resort. However, younger Indians are more receptive to counseling because many had counselors in school or college. Hence, they pay less heed to the stigma.

Where has counseling come from over the past decade in your country and where do you see it headed in the next decade?

Having been here for only about three years, I am unable to comment accurately on how counseling has evolved in India. However, the younger generation of Indians is more receptive to counseling services due to awareness and exposure at school, college and in some workplaces. With a rising middle class that is exposed to foreign cultures and practices (through travel, television and the Internet), I believe seeking professional counseling will carry less stigma and be more accepted in the future.

What would you most want someone reading this article to know about counseling in your country?

It is important to be aware of, and sensitive to, the client’s history and background, especially in the areas of culture and traditions. India has a huge population and diverse religions, traditions, cultures and beliefs. There is also a wide gap between the have and have-nots.

What lesson or idea from your country would you share with counselors in the U.S. — in what way could counseling in the U.S. benefit from the way counseling is in your country?

Most people in India have a strong belief in destiny/fate. While this sometimes leads to apathy in resolving personal issues, it also increases their patience and tolerance for frustrations/suffering. Rather than rely heavily on “textbook” counseling techniques or focus on which theory/approach to adopt for clients, it sometimes helps to explore and reinforce the client’s spirit — through active listening, encouragement, positive thinking and where appropriate, humor. Also, I feel U.S. counselors may be somewhat generous in dispensing “positive regard” to one and all; I think it is alright occasionally to have a client “earn” it.

And vice versa, what would you like to see counseling in your country absorb from the way counseling is done in the U.S.?

From my experience, many clients here, upon seeking professional help, expect the counselor to solve their issues for them or offer solutions and answers within one or two sessions. They are somewhat reluctant (or lazy) to do “homework” or explore options before taking a decision to improve their situation. Counseling here would benefit from the practice of encouraging clients to be proactive in their own healing and empowerment, rather than focus on solutions [solely from the counselor].

What obstacles does the profession of counseling face in your country?

I believe only a few universities in India offer psychology courses with counseling as a major. Hence, counselors may be adept in the science of psychology but not as competent in the art of counseling. Attending foreign universities is a very costly undertaking for the average Indian. Also, counselors (especially in private practice) may not get many clients, given the stigma attached to seeking professional help. This may turn young people away from the profession, which in turn reinforces fewer universities offering the course.

How do you hope to see the counseling profession evolve in your country?

Counselors can help their clients (and the public) to view their service as yet another avenue to achieve wellness. Stakeholders (government, healthcare institutions, schools, NGOs, etc.) need to work together to improve infrastructure and increase funds so that this service is available to all who need it or can benefit from it. They can also dispel the negative image of mental illness through education and outreach programs.


Gudbjörg Vilhjálmsdóttir is a professor in a two-year master’s program in career guidance and counseling at the University of Iceland. She has been teaching there since the counselor education program began in 1990.

If you introduce yourself as a counselor to someone on the street, what does that mean to them? What is the concept of counseling in your country?

I discussed this question with my first-year students and they said that often people do not know what they are talking about when they say they are studying to become counselors. Ten to 20 years ago, that was certainly often the answer I got, but today my experience is that counselors have a positive image because everyone has career problems, [and] this was something many of my students also related to. They said that the profession of counselor is considered respectful “because all the counselors I know are ambitious and genuine people,” to quote an email from one of my students. My experience also tells me that the image of counselors is positive since all my students who have graduated from our program get counselor positions, at least those who want to pursue that career path. About 300 students have received a one-year diploma, and thereof, about 80 have pursued their studies to a master’s degree. The master’s degree was optional from 2004 to 2010 but is now the only educational program available.

What is the role and function of a counselor in your country? Why and when do clients go to see one?

Here I can cite a study that tells us that nearly 60 percent of school counselors’ time is devoted to personal counseling. Another study on adult guidance tells us that by far the most used counseling method is face-to-face counseling. The counselor/student ratio can vary from 1/200 to 1/2000, so accordingly, the roles vary. I would therefore say that their role is rather traditional, at least in schools.

Where has counseling come from over the past decade in your country and where do you see it headed in the next decade?

Counseling is changing fast. In 2008, we had a legislation that said that all students should have a right to counseling. The counseling profession was licensured in 2009. [Since] the 2008 [economic] crisis, adult counselors have been very active in creating innovative and very successful interventions to the unemployed. I see counseling in Iceland heading towards a more organized and comprehensive program that has less emphasis on personal counseling and more emphasis on career counseling and career education. For the moment, I would like us to have a more common vision, and fortunately, there is a growing emphasis on policy-making at the ministry of education.

What would you most want someone reading this article to know about counseling in your country?

I would like you to know that counselors that work at all school levels, in adult education centers and employment offices are all trained in the same program. Of course, the reason is that the population of the country is small, but it means that counselors speak the same professional language, they shift positions from working with children and then adults and vice versa. I would also like you folks out there to know that if it wasn’t for international associations like American Counseling Association or the International Association for Educational and Vocational Guidance, as well as the Nordic associations of counselors, we here in Iceland would not have progressed as real professionals. International cooperation is vital for us.

What lesson or idea from your country would you share with counselors in the U.S.? In what way could counseling in the U.S. benefit from the way counseling is in your country?

I am aware of the fact that Iceland is a tiny country compared to the U.S. But the successful programs that were implemented in the wake of the 2008 crisis for young unemployed, for adults that lost their work in the financial sector, for older unemployed and, now recently, a big intervention targeting those people who have been unemployed for more than three years. These interventions have included the state, municipalities, unions, employers associations, unemployment offices and adult education centers. I think that the underlying idea is that work is highly valued in our culture and somehow it is intolerable that a person has “idle hands” as we say.

And vice versa, what would you like to see counseling in your country absorb from the way counseling is done in the U.S.?

So many things, I cannot but mention a few. Supervision of students, counseling methods, counseling theories, counseling research, strong professional identity, multicultural awareness, a big professional body (ACA), inspiring leaders in your counseling field and more.

What obstacles does the profession of counseling face in your country?

In fact there are only opportunities, the only obstacle is when people in leading positions within the profession don’t see them or do not realize that they have been given opportunities. One of my students said that she would like to see counselors more prominent in our society, that their work was better known. She also said that they need better salaries. I often tell my students that a crisis in a person’s life is made of the

building blocks we use when construing a new vision with our counselees. The key is often that people can see what the crisis is made of and how to redesign a new path in life. I think the obstacle for counseling here in Iceland is when we think that counseling should not change and methods stay the same. Then we are in trouble. Renovation is essential to what we do.

How do you hope to see the counseling profession evolve in your country?

I am now working on creating an integrated web system for the country, which means that I think it is essential to use technology to reach out to everyone in the community. I would like the counseling profession to evolve hand-in-hand with the users of [technology] towards a situation where every citizen can have an easy access to counseling where she and he will learn how to manage her or his career and that the assistance given is well-organized and really helpful. One of my students said that she would like to see this profession more acknowledged in schools, especially from children aged 6 to 16. She also thinks it is absolutely necessary that career education should start at an early age. She would like to see at least one counselor in every school and the counselors’ association start an advertisement campaign that informs people about the professional work of counselors. I agree with her. Counselors need to show their power and make use of it as advocates of their counselees.


Gerardo Alfonso Steele Zúñiga is from Costa Rica, where he runs a private counseling practice in the capital city of San José.

If you introduce yourself as a counselor to someone on the street, what does that mean to them? What is the concept of counseling in your country?

If I introduce myself as a counselor, people immediately ask about its meaning. This is like that because there is not enough knowledge about counseling. It happens that around here counselors work in educational settings: primary, high school or university.

Usually the translation to Spanish of the [word] counseling or counselor concepts is “orientación” or “orientador,” and what people in need of mental [and] emotional help tend to look for is the psychology professional. Thus, counseling, in the people’s mind, has to do with [a] school setting.

What obstacles does the profession of counseling face in your country?

The obstacles for the counseling development in Costa Rica is one of the cultural type, in the sense that what is well established is the psychological thought. I hope it should be a strong evolution in the real sense of counseling.

Looking for more?

The following resources can help counselors get involved in and learn more about international counseling issues.

  • ACA International Counseling Interest Network (contact Holly Clubb at to join)
  • ACA’s Journal of Counseling & Development features a special international counseling section in each issue.
  • Counseling Around the World: An International Handbook, edited by Thomas H. Hohenshil, Norman E. Amundson and Spencer G. Niles, and published by ACA. Native counselors and leading experts from 40 countries discuss the opportunities for growth in their countries and the challenges they face (visit the ACA Online Bookstore at
  • International Association for Counselling 
  • The International Journal for the Advancement of Counselling is published under the auspices of the International Association for Counselling and promotes the exchange of information about counseling activities throughout the world
  • NBCC International
  • Counselors Without Borders 
  • The Journal for International Counselor Education, published by the University of Nevada, Las Vegas, is a peer-reviewed scholarly journal that promotes counselor education and supervision internationally 

Lynne Shallcross is the associate editor and senior writer for Counseling Today. Contact her at

 Letters to the editor:

Avoiding the parent trap

Lynne Shallcross

Parent_Trap_June-2013Parenting is often referred to as the hardest job in the world. Just how hard is it, then, to counsel someone who is struggling in that role?

Hard enough that John Sommers-Flanagan and Sara Polanchek teamed up to present a session titled “How to Listen So Parents Will Talk and Talk So Parents Will Listen” at the American Counseling Association 2013 Conference & Expo in Cincinnati in March. The session was based on the book of the same title that Sommers-Flanagan co-wrote with his wife, Rita Sommers-Flanagan, and which was published by Wiley in 2011.

“Parenting is a very challenging endeavor,” says Polanchek, who worked for 12 years as a parent educator and counselor at a nonprofit organization that provides education and support to parents in Missoula, Mont. Parents are hard on themselves, often evaluating themselves — and feeling judged by others — on the basis of their children’s behavior, says Polanchek, who is now a doctoral candidate in the Department of Counselor Education at the University of Montana but continues to supervise some of the nonprofit’s counselors and parent educators. In addition, she says, the United States has a kind of pull-yourself-up-by-the-bootstraps mentality that suggests parents should be able to figure everything out on their own; if they seek any help, society seems to suggest they are failures as parents.

And although the Internet offers a plethora of information on the topic of parenting, that information can be as confusing as it is helpful. For any given problem, Polanchek says, parents can find a proposed “solution” online, but if they spend a few minutes digging deeper, they are likely to uncover an opposite solution being offered for the same problem. Parents who come to see a counselor for help have likely already exhausted the tips from their neighbors, their child’s school counselor and their co-workers, Polanchek says. In addition, they have probably read more than a few books on parenting.

“When I last checked, there were 107,000 parenting books available on Amazon,” Polanchek says. “That number is daunting, and when we consider that many of these resources are in conflict with each other, it is no wonder parents feel overwhelmed. By the time parents come to us [counselors], they’ve likely tried lots of techniques and believe they’ve failed.”

Regardless of whether parents decide on their own to seek advice from a counselor or are ordered to do so by a court, when they arrive at a counseling session, they are feeling vulnerable, Polanchek says. As a result, they are also often defensive and leery of the counselor.

Not surprisingly, approaching those vulnerable and sometimes defensive parents can be daunting for counselors. Sommers-Flanagan and Polanchek, both members of ACA, say it isn’t uncommon for counselors to feel afraid of or even angry at parent-clients. But those emotions interfere with a counselor’s effectiveness, they warn.

“Everyone I know needs some parental guidance, but there is so much out there that it’s overwhelming, so parents put up walls,” says Sommers-Flanagan, professor and acting chair of the Department of Counselor Education at the University of Montana. The first and best thing counselors can do to encourage parents to lower those walls, Sommers-Flanagan and Polanchek say, is to provide an accepting space, free of judgment and criticism, where the counselor’s job is to listen and be supportive rather than to offer well-meaning advice straight off the bat.

“Don’t start with, ‘Well, Julia, I have a few ideas I can share with you about how you can be a better mom,’” Sommers-Flanagan says. “If you offer advice too soon, you raise their defenses.” He suggests that counselors not offer any advice until parents confirm it is OK or ask for guidance themselves.

“I think the first few moments, sometimes before we’ve even sat down, are crucial because this is when parents are deciding whether or not they can trust me,” Polanchek says. “There is an attitude of acceptance that I hope to communicate when I greet parents and initiate the session.”

“Like many people, I have very protective feelings for children,” she continues, “and it is tricky to discuss parenting behaviors that might be perfectly acceptable but don’t necessarily line up with what I might consider ideal. This is where a lot of self-reflection about my values and triggers is necessary so that my wish to be accepting is authentic.”

Empathize, accept, collaborate

Sommers-Flanagan recalls leading a divorce education class in which one father made it blatantly obvious how much he did not want to be there. A judge had set attending the class as a condition the man had to meet so he could have unsupervised visits with his daughter.

One of the first things the man announced to Sommers-Flanagan and the rest of the group was that he didn’t “need a stupid-ass parenting class.” Sommers-Flanagan says that as a counselor, it was important for him to ignore a natural reaction to bristle at the comment and to find instead empathy for the man and understand how difficult it was for him to be going through a divorce. “Thank you for sharing that,” Sommers-Flanagan told the father. “You must really love your daughter to be here.”

At the end of the class, Sommers-Flanagan gave the man his certificate of completion and tried to joke with him, saying he probably would really want to put the certificate up on a wall at home. The man gave Sommers-Flanagan a funny look, took the certificate and left.

But about a week later, the same client called Sommers-Flanagan to apologize for his behavior in class. He told Sommers-Flanagan he had indeed hung the certificate on the wall of his trailer, and when his daughter had come for a visit, she saw the certificate, hugged him and told him she was proud of him.

The story illustrates two of the main principles Sommers-Flanagan recommends when working with parents: empathic understanding and radical acceptance.

Offering empathic understanding means seeing through any negativity the client presents and understanding that, underneath it all, parents really just want to love their children, says Sommers-Flanagan, who has an independent practice that includes parenting consultations in collaboration with a local nonprofit agency. The idea behind radical acceptance, he says, is that counselors should receive and accept anything and everything a parent says in session without judgment. “Obviously, that’s basically impossible, because being judgmental is a natural human tendency,” he says. “Nevertheless, we make an effort to be nonjudgmental [as counselors].”

Sommers-Flanagan offers an example he used in the book How to Listen So Parents Will Talk and Talk So Parents Will Listen. A parent might say, “I believe in limiting my children’s exposure to gay people. Parents need to keep children away from evil influences.” The counselor might respond with, “Thanks for sharing your perspective with me. I’m glad you brought up your worries about this. Many parents have similar beliefs but won’t say them in here. So I especially appreciate you being honest with me about your beliefs.”

A key point about radical acceptance is that it doesn’t involve agreeing with the client, Sommers-Flanagan says. At the same time, he says, radical acceptance is especially helpful in situations when parents say something extreme that might push a counselor’s emotional buttons.Polanchek says collaboration, the third important principle when working with parents, means striking a balance between respecting parents as the best experts of their child, taking the necessary time to truly understand the situation and offering enough of what parents are looking for in terms of “answers” to make the counseling session worthwhile for them.

Polanchek acknowledges that when she first started working with parents, she was nervous and often overcompensated by letting her clients know up front how much knowledge she possessed and how many tips she could offer. In a well-meaning effort to help parents, Polanchek says, she rushed too quickly to provide solutions. “Sometimes the first instinct is wrong,” she says. “But even if the counselor’s first instinct is right, the counselor will then have denied parents the process and ability to get to the solution on their own.”

One of Polanchek’s favorite couples came to her office via court order. “They were clearly not happy about being forced into a parenting session, and when they came into my office, they said something like, ‘Don’t even tell us not to spank. We know our rights, and we know we can legally spank our kids,’” Polanchek remembers. “I acknowledged that I understood their concerns, and I made an agreement with them on the spot that I would not tell them what to do. It was rewarding to see how they made a shift from feeling angry about being with me to feeling relief in being able to tell their story.”

Ironically, Polanchek says, one of the couple’s biggest concerns was that their children were getting into trouble for hitting others at school. “I’m afraid that in my neo-counselor days, I may have drawn the connection for them between being spanked at home and then hitting at school. Luckily, I resisted this impulse. Two sessions later, they came to me and proudly announced, ‘We are no longer a hitting family.’ In the process of sharing their struggles, they came to their own conclusions about the message their spankings were sending to their children.”

Letting the client lead 

Parents come to counseling with a variety of concerns and issues. Among the most common, Sommers-Flanagan says, are strong-willed children; children who are angry, irritable or distressed; children who are impulsive; and teenagers who are engaging in potentially destructive behaviors. Parents may also seek a counselor because of how angry or upset they are feeling about their child or their own behavior toward the child, says Sommers-Flanagan, who with his wife Rita co-authored the bookTough Kids, Cool Counseling: User-Friendly Approaches With Challenging Youth, published by ACA.

Also common are parents who are concerned about managing their child’s emotions, Polanchek says. “I think this comes up a lot because, as adults, we are often surprised by how demonstrative our children can be when they have big feelings,” she says.

When he begins working with parents, Sommers-Flanagan says he communicates openly about his counseling approach. For instance, he says, he might tell them, “I want to listen as much as possible to you and ask you a few questions because you’re the best expert on your child. And halfway through the session, I might begin sharing some ideas with you about what might be helpful. And yet, I want you to know that this is your hour. If I am listening too much and not offering enough ideas, just ask me. Please tell me if you want more suggestions and ideas, but also please tell me if you want me to be quiet and listen.”

After sharing that with parents, Sommers-Flanagan says they almost always say to him, “Oh, I want advice.” And that means they’re inviting him — and his advice — in. “Then when I do offer something, it’s not a surprise,” he says. “We’ve already agreed on it.”

If a counselor listens well, validates, summarizes and shows empathy, parents will typically ask for advice eventually, Sommers-Flanagan says. “If not, then after listening well, validating, summarizing and showing empathy, the counselor can ask for permission to offer up parenting ideas or solutions, and usually the parent will be receptive,” he says. “If not, then it’s generally advisable to keep on listening.”

The model that John and Rita Sommers-Flanagan emphasize in their book on listening and talking to parents is a combination of person-centered principles and solution-focused approaches. “This is a challenging integration,” John Sommers-Flanagan says, “but I think it’s helpful because parents want and need empathy, but they also want quick solutions.”

Counselors must gently pursue as many details as possible, Sommers-Flanagan says. If a parent comes in and says her children are playing video games in the morning and don’t listen to her when it is time to get ready for school, Sommers-Flanagan will dig for more details. For instance, when do they start playing the games? What does she do when the kids don’t pay attention to her? Was there a time when this problem didn’t exist?

During the process of talking with the mother, Sommers-Flanagan might tell her it sounds like she knows her kids very well and that it is obvious how much she loves them. He also might listen for things she would like to see happen and then ask her if he can write those items down as goals.

Backward behavior modification is one common issue among parent-clients, Sommers-Flanagan says. He explains that parents tend to reinforce negative behaviors by paying too much attention to them, while essentially ignoring positive behaviors. “This is the opposite of what we should all be doing,” he says. “When working with parents, we often emphasize they should switch to using boring punishment/consequences and exciting rewards. In one case, after only one session, the parents returned and said their household had completely turned around and become more pleasant just by using boring consequences and exciting rewards.”

Polanchek likens the idea of backward behavior modification to growing plants in a garden. “What we pay attention to will grow,” she says. “We want to be watering the flowers instead of the weeds.”

Although the counselor may transition into problem-solving at some point during the session, Polanchek says the key components of empathy, radical acceptance and collaboration should continue throughout. “For example, I have a lot of empathy for parents who are trying something new, and as a parent myself, I’m able to be very genuine in my appreciation for how hard it can be,” she says. “Also, I always ask permission before moving into problem-solving strategies. Communicating respect to parents in this way goes a long way in helping parents feel like the process is collaborative and that they aren’t being told what to do.”

Polanchek says she tries to use the same language the parents use when talking with them about their child. “I also do a lot of checking in to see if what I’m saying feels right to them,” she says. “In this, I’m trying to let them know that I understand their child is not just a cookie-cutter version of every other child — their child is unique and only they, the parents, know what might work for their child.”

Do’s and don’ts

Working with parents can be a challenge, but Sommers-Flanagan and Polanchek offer some basic do’s and don’ts that counselors can follow to strengthen the working relationship and achieve better outcomes.

  • Do trust the process of collaboration, empathy and radical acceptance.
  • Do notice and appreciate the strengths that parents possess, even when those strengths aren’t readily apparent at first.
  • Do be respectful because parents, much like teenagers, can sense disrespect a mile away.
  • Don’t offer information or advice before you have listened.
  • Don’t give too much advice.
  • Do comment on some of the strengths you hear in parents’ descriptions of their children. Too often, parents hear very little that is positive about their kids.

Sommers-Flanagan also says counselors need to let parent-clients know the limits of confidentiality up front as part of the profession’s ethical mandate. “I like to say something like, ‘What you say here stays here. It’s private. However, in cases where there may be danger or abuse, I will need to make a report to the police or Child Protective Services. Not that I suspect this is the case with you — I’m just required to tell you up front about the limits to your privacy or confidentiality in here.”

Counselors also would be smart to stay abreast of the currently popular parenting literature so they will be familiar with what their clients might be reading, Sommers-Flanagan says. And, he says, prepare to respond to questions about your credentials. “Clients might ask, ‘Do you have children?’ Don’t say, ‘I don’t have kids, but I do have a dog.’ Instead, capture the essence of the message: Can you help me? Reflect back to [the client], ‘I don’t have children, and what I understand from what you’re saying is that maybe you’re concerned about whether I can understand your situation and if I can help,’” Sommers-Flanagan says.

Oftentimes, the parent will speak up at that point, Sommers-Flanagan says. If not, he says, the counselor might continue on to say, “If by chance you’re worried about that, I hope you’ll let me know, but I also hope you’ll give me a chance to help you. But in the end, you’ll be the one to decide that.” It is critical that the counselor not be defensive about this questioning, Sommers-Flanagan says.

Sommers-Flanagan suggests that counselors just starting out spend some spare time outside of the office with children and parents. This will help fledgling counselors to become more comfortable with children and child development, with parents, and with the ways that children and parents tend to interact. “Work on understanding the types of interactions that happen between parents and children that are problematic and those that are helpful,” he says. Close supervision is also recommended. Sommers-Flanagan suggests sitting in on parent counseling sessions to get a feel for them in person.

Polanchek says she would talk to new counselors about this topic in much the same way she works with parents. “I would empathize with their anxieties, and I would probably throw in a bit of self-disclosure regarding my own anxieties from when I first started,” she says. “After asking permission to offer some tips, I’d tell them to trust the process. It can be very powerful for parents to hear their struggles reflected back to them in a safe environment. It is easy to feel nervous about not having the right solutions, but the real magic is in the process.”

Sommers-Flanagan advises more experienced counselors to “use their basic listening and validation skills and avoid providing education or advice even though their advice might be excellent. We need to exercise our patience and use good timing even when we immediately think we know what’s best for parents.”

Recently, Polanchek met with two counselors whom she characterizes as “outstanding.” Even so, they were feeling frustrated and down because some of their sessions with parents and their children seemed overwhelming and ineffective. “I told them — after they asked for advice, of course — that sometimes we need to simply focus on the very micro ways in which we are helpful,” Polanchek says. “Maybe because we were empathic, a parent was able to use a softer voice with his or her child that day. Maybe because we noticed a strength, the parent was able to notice a new strength in a child. It can be daunting to work with some parents whose values are so different from our own, but I think keeping focused on the small ways we are effective is helpful.”

To contact John Sommers-Flanagan, email To contact Sara Polanchek, email For a variety of tip sheets for parents, visit For parenting education resources and an electronic mailing list, Sommers-Flanagan recommends visiting the National Parenting Education Network at

Lynne Shallcross is the associate editor and senior writer for Counseling Today. Contact her at

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Dispelling the myths of aging

SeriaShia Chatters & Carlos Zalaquett

KnowledgeShare_June2013Our experience working with students and professionals in training and research suggests the necessity of re-examining the issues affecting older adults. This population, defined for the purposes of this article as individuals age 65 and older, is quickly increasing in number and will need our services in multiple ways, including assisting them in adapting to the natural changes associated with the aging process, encouraging them to embrace activities that increase wellness and vibrancy, and reducing the myths associated with this developmental stage.

This is underscored by the misconception that sadness must accompany aging. Our research revealed insights quite contrary to commonly held beliefs. Recent epidemiological studies have found that adults ages 40-59 exhibit higher rates of depression than do older adults. Subsequently, older adults develop a sense of integrity and achieve a level of happiness and life satisfaction that in some cases surpasses the happiness of their younger counterparts.

As counselors, we must dispel myths associated with aging, advocate for the needs of older adults and help this population adapt, thrive and maintain a sense of life satisfaction and achievement as they go through the multiple changes associated with reaching the last stages of adulthood.

Myth 1: Various mental disorders are inherent to the process of aging. The potential of experiencing a reduction in physical and mental abilities as we grow older leads many people to believe that feeling sad and depressed is an inherent part of the aging process. Depression and anxiety are not mandatory to aging, however. In fact, in many cases, aging is associated with resilience and happiness. An example of this resilience was illustrated during the recent economic crisis when this age group weathered the storm better than others. In 2011, a Pew Research Center survey found that 54 percent of older adults gave their personal financial situations a “high” rating, compared with roughly one-third of younger and middle-aged adults. This was a noticeable increase from the 50 percent of older adults who applied that rating in 2004.

Of course, aging does bring on well-documented changes such as decline in physical, perceptual and mental functions, with subsequent slower reaction times and limited or impaired memory. But many older adults deal successfully with these challenges. They learn to cope, modify their activities, change roles and wisely apply their resources and capabilities to newer goals and objectives that are age appropriate. Role modification may be demonstrated in the shift from parent to grandparent or by modifying lifestyle.

Highlighting successful older adults may aid in dispelling this myth, while simultaneously encouraging other older adults to increase social interaction, expand their social networks and continue to contribute to society. Furthermore, social interaction may serve as a promoter of mental and physical health.

Braulio Alonso exemplifies the ability of older persons to continue leading a full, meaningful life after age 65. The city of Tampa, Fla., named Alonso “best Tampanian” because he embodied the morals and values held most dear by its residents. At age 70, Alonso had a high school named after him, provided math tutoring once a week to high school students, served as a driver and delivery person for Meals on Wheels and participated on many community boards. Additionally, Alonso continued to be a contributing member of society and earned many accomplishments later in life.

Myth 2: Older adults should feel down and blue as they age. Two important issues are worth mentioning here. First, the belief that aging inevitably brings sadness should be questioned. In 2012, the Centers for Disease Control and Prevention reported rates of depression to be lower among adults ages 60 and older than among adults in all other age groups. Second, negative stereotypical views can have detrimental effects on our understanding of and service to older adult clients. The commonly held belief that older adults should feel “blue” because of aging can mask symptoms of clinical depression.

We have previously reported on the “invisibility” of depression among older adults due to misdiagnosis by mental health professionals. Symptoms of clinical depression were often overlooked because these symptoms were assumed to be part of aging, indicating that feeling blue is inevitable and chronic. It is true that disorders such as depression tend to acquire chronicity, especially if left untreated. However, the issue of treatment leads to our discussion of Myth 3.

Myth 3: There are no treatments for what older adults are experiencing. This myth, which complements the first two myths, suggests we lack effective treatments to help older adults with the problems they are experiencing, such as symptoms of depression. Contrary to this belief, a number of treatments are currently available to serve this age group. Some treatments, such as cognitive therapy (a la Beck) and interpersonal therapy, have enough research evidence to describe them as efficacious. These psychosocial models of counseling interventions have been shown to be as successful as medication in the treatment of depression and work better than medication in the prevention of recidivism among older adults. Modifications of these therapeutic approaches, by integrating spirituality and religion, have demonstrated significant effectiveness in the treatment of older adults. Additionally, counselors should consider using strength-based approaches to counseling such as developmental counseling and therapy and interventions such as Therapeutic Lifestyle Changes. These psychosocial interventions may aid in highlighting the positive aspects of aging and decrease the “problem” focus of traditional psychotherapy.

Myth 4: There is only one age bracket of “older adults.” Ordinarily, we define 65 as the beginning of the older adult stage and assume this stage spans from 65-75, a calculation based on life expectancy. However, the number of individuals joining the 75-100 age group is rising. Today, more than 53,300 individuals have reached 100 years of age or older in the United States alone. This group is known as the centenarians or the “very old,” but a sizable number could be described as the “very old in good spirits” group. Many of the characterizing issues, tasks and challenges facing this group are largely unknown, which presents a key opportunity for further research. We will benefit from gaining a better understanding of the very old and investigating what helps this group continue to grow and thrive.

Myth 5: A significant number of agencies, support networks, events and activities are available for older populations. The assumption is that a sufficient number of shelters, nursing homes and facilities exist for older adults. However, restrictions in Medicaid and Medicare, threats to Supplemental Security Income, and issues with insurance and coverage have reduced the number of outlets available. Some of the current resources deny admission to older adults with psychological, social or mental disorders. There is also a shortage of long-term hospitalization beds, leading some older adults with mental disorders to become homeless or incarcerated. This is a major issue, as illustrated by the fact that many nursing homes and assisted living facilities are not equipped to handle older adults in the mid to late stages of Alzheimer’s disease if they are ambulatory.

Myth 6: Older adults are gender homogeneous. The number of older adults by gender is not similar. The male-to-female ratio falls rapidly as individuals move into the older and very old age brackets, with women outnumbering men. According to statistics provided by the U.S. Census Bureau, by the time individuals reach the age group 80 and older, the male-to-female ratio reaches 38.1 to 61.9; by 90 and older, the male-to-female ratio reaches 27.8 to 72.2; and by 100 and older, the male-to-female ratio reaches 17.2 to 82.8. This predominance of women should lead to increased focus on issues such as poverty, health care, social security and housing from a woman’s perspective.

Dispelling the myths of counseling older adults may help to reduce ageism and improve the effectiveness of services. On the other hand, identifying the real issues that affect older adults will aid in providing services. This is important because failing to recognize their issues is a helping opportunity lost. In the absence of adequate services and care, older adults’ quality of life may be significantly affected and can deteriorate quickly. In turn, the ensuing conditions can further debilitate the bodies, abilities and cognitive functioning of older adults, reducing their quality of life and accelerating the aging process.

Meet Grandmother Tita

The following example provides an illustration of the challenges involved in transitional situations for older adults and provides some evidence of the preventative nature of intervening during the transitional period. This example also demonstrates how a cognitive behavior therapy (CBT) approach can be applied in a modified form to counsel an older adult in her transition to a nursing home, which is often characterized by significant anxiety and sadness. Embracing a more accurate perspective and strengths-based approach should lead practitioners to include evidence-based practices (see examples under Myth 3) to help older adults improve their physical and mental health and wellness. A comprehensive counseling and therapeutic approach should work with older adult clients to make life changes known to positively affect the aging process, such as appropriate diet, exercise, cognitive training and social engagements, to name a few.

In this section, we discuss the use of CBT with an older adult suffering from generalized anxiety disorder due to her impending transition into an assisted living facility. This transition has the capacity to produce a mood disorder or anxiety due to the issues she may face as her ability to live independently becomes severely challenged or limited.

Grandmother Tita is a 74-year-old Bahamian woman. Her daughter, Natalie, has brought her to therapy at the urging of Grandmother Tita’s pastor. Grandmother Tita immigrated to the United States approximately 30 years ago. She recently broke her hip and found out from her primary care physician that she will have to be transitioned into long-term care. Grandmother Tita would like to live with one of her children (she has two sons and one daughter). However, none of her children are able to provide the care she needs. 

Grandmother Tita reports feeling worried about leaving her home permanently. She is afraid of long-term care because of what she has heard about the associated conditions from some of her friends. She has experienced problems sleeping due to nightmares about living in the assisted living facility. In addition, she complains about neck and back pain and shortness of breath. She says that when she thinks about moving, her heart beats fast, she breaks into a cold sweat and she experiences dizzy spells.

When asked if she has received previous treatment, Grandmother Tita reports seeing her pastor on a weekly basis. In fact, she has spent many hours with her pastor as she tried to make a decision concerning her transition. When Grandmother Tita started complaining about issues related to anxiety, her pastor recommended that she see a counselor. She is skeptical of the therapeutic process. However, she has come to therapy after her children encouraged her to attend.

Developing rapport and incorporating a strengths-based approach

Developing rapport with Grandmother Tita is central during the initial session because multicultural clients may be less likely to return to therapy if they do not feel a connection or common understanding with the therapist. Establishing rapport may be difficult if you do not understand some of the issues common to older people that may require some modifications to the CBT process. Integrating effective modifications can increase positive therapeutic outcomes by ensuring homework completion and adherence to treatment. Consider the following tips in the early stages of the case conceptualization process:

  • Consider the belief systems, values and healing practices of the older adult client.
  • Ensure you are knowledgeable of the services available within the client’s community.
  • Be knowledgeable of indigenous healing practices.
  • Understand that immigrants face multiple stressors, some of which may include the incongruence of belief systems between first-generation and second-generation immigrants.
  • Consider environmental factors during assessment and diagnosis.
  • Acclimate your client to the process of receiving mental health services.

During the case conceptualization process, it is important to consider integrating various techniques while you are developing your problem list and treatment plan. Consider focusing on the client’s strengths and integrating language that highlights the possibility of overcoming issues. An example would be changing the word problem to challenge (as suggested by Allen Ivey). To strengthen your working hypothesis, it is important to discuss the working hypothesis with the client.

Guidelines and summary 

Although CBT has been found to be effective in treating generalized anxiety disorder in older adults, it is important to consider the way this disorder may present. In some cases, older adults’ symptoms of anxiety and/or depression may not meet criteria from the Diagnostic and Statistical Manual of Mental Disorders. This does not mean, however, that these clients’ symptoms should be ignored. In the case study of Grandmother Tita, she might have declined into depression or suffered from significant symptoms of anxiety if her family and community had not intervened.

Furthermore, it has been suggested that in the absence of treatment, generalized anxiety disorder can develop into major depressive disorder. Preventative measures such as helping older adults manage daily tasks, including doctors’ appointments and medication regimens, can be effectively integrated into problem-solving-based counseling techniques. These techniques can help older adults organize daily activities that were seen as trivial in their younger years. Failing to master these simple tasks can exacerbate the older client’s symptoms of anxiety, depression and anger.

Practical tips

The practical tips that follow can help counselors provide evidence-based interventions for older adults.

Tip 1: Tackle cognitive changes: Mild to moderate cognitive changes are common in older adult populations. To improve therapeutic outcomes, a counselor should present information in the session in multiple modalities. Additionally, a counselor should repeat and summarize as often as necessary and use folders and notebooks to aid in organization. Finally, consider offering memory training or additional activities to improve cognitive functioning.

Tip 2: Tackle sensory impairment: Older adults may experience sensory impairment that can hinder the counseling process. A culturally sensitive office environment should include informational material, pamphlets and handouts in bold print. Encourage clients to use tape recorders and assistive devices. Maintain a list of community resources, including optometrists and audiologists, that specialize in older adult populations.

Tip 3: Tackle issues of physical health: Many older adults experience a decline in physical health. This decline can adversely affect an individual’s mental health and ability to access social services. Ensure that your client has had a recent physical, especially if increased physical activity may be considered as part of the treatment plan. Develop a treatment plan that includes realistic goals, challenges dysfunctional thinking that may hinder physical activity and includes input from other health care professionals, if needed.

Tip 4: Develop a culturally sensitive therapeutic environment: Although a percentage of older adult populations reside in assisted living facilities, the majority of older adults reside in their own homes, in senior living communities or in partial assisted living facilities. A counselor may consider offering outreach services such as providing in-home therapeutic services. Your office environment should provide materials in multiple modalities as well as multiple entrances or office areas that are accessible to individuals who may have mobility issues. You might ask your office assistant to go into the lobby to help older clients with the sign-in or intake process. Also ensure that you are aware of your client’s perception of the aging process. There are varying perceptions of aging from culture to culture. Counselors should not assume all mental health issues are related to the aging process.

Tip 5: Consider successfully aging older adults a great resource for younger generations: In The Longevity Project, a 2011 book by Howard S. Friedman and Leslie R. Martin, it was reported that individuals who were sociable, helped others, stayed physically active and associated with other healthy individuals were more likely to lead long, healthy lives. Many individuals in this research study who exhibited these traits lived to be 100 or older. As Braulio Alonso demonstrated, older adults can be significant resources, provide assistance and become positive role models for younger generations. Encouraging your older adult clients to develop a social circle and connect with their communities can be mutually beneficial.

In summary, we need to be more optimistic about aging and develop a more accurate picture of this population if we are to provide effective help. As counselors, we can be advocates and aid in the process to change common myths and widely held assumptions regarding older adults and the aging process.

As the baby boomer generation approaches retirement age, the need for augmented mental health services will continue to rise. It will become essential for mental health professionals to be aware of and have working knowledge of best practices when providing services for the older adult population.

“Knowledge Share” articles are adapted from sessions presented at American Counseling Association conferences.

SeriaShia Chatters is an assistant professor in the psychology and human services program in the Department of Natural Sciences and Public Health at Zayed University in Dubai, United Arab Emirates. Her research interests include preparing mental health professionals and mental health counseling programs in schools. Contact her at

Carlos Zalaquett is a professor in the Department of Psychological and Social Foundations at the University of South Florida, where he is the coordinator of the clinical mental health counseling specialization and the graduate certificate in mental health counseling. He is an internationally recognized expert on mental health, diversity and education.

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