CACREP and CORE entered into an historic affiliation agreement on July 12, 2013 whereby CORE will become a corporate affiliate of CACREP. The agreement includes a process whereby programs that wish to apply for accreditation under CACREP’s newly developed and adopted Clinical Rehabilitation Counseling program standards (to be implemented by CORE) will undergo a review process conducted jointly by CACREP and CORE. As part of this agreement, CORE and CACREP will also continue to accredit other programs within their respective scopes of practice.

CORE and CACREP are committed to working closely together to establish a framework for ensuring a smooth transition for currently accredited programs that wish to be reviewed under these new standards. Both organizations have also agreed to work towards recognition of programs accredited under the Clinical Rehabilitation Counseling standards with regard to state licensure and federal hiring eligibility. Until recognition of the Clinical Rehabilitation Counseling standards is achieved, programs accredited under these new standards will be permitted to hold dual accreditation status with CACREP’s Clinical Mental Health Counseling program standards.

CORE and CACREP have begun working on the details of the framework and will be releasing additional information in the early fall 2013. A process is being developed for rehabilitation counseling programs already training students for clinical counseling practice, as well as one for those programs interested in developing a more clinically‐focused program. Please visit the CORE or CACREP websites periodically at www.core‐rehab.org and www.cacrep.org to obtain the most updated information. Interested individuals are invited to attend sessions at the ACA, ACES, NCRE, AASCB, and other professional counseling conferences to learn more as the plan develops.

American Counseling Association member Karen Swanson Taheri is aiming to make the internship experience and the process afterward easier for counselors with the creation of the Counselor Intern Association of Louisiana (CIAL).

CIAL is a division within the Louisiana Counseling Association (LCA) dedicated to serving and connecting counselors-in-training who are working toward licensure, and it offers its members the following benefits:

• Networking opportunities with students, peers and other professionals
• Quarterly updates on employment availabilities across the state
• Regularly scheduled self-care opportunities
• Professional presentation opportunities

CIAL is also in the midst of initiating a mentorship program where counselor interns can mentor graduate students, and licensed professional counselors and supervisors can mentor counselor interns.

“In short, CIAL allows the voices of counselor interns to be heard and then advocates for their needs individually and collectively,” says Taheri, founder and president of CIAL.

CIAL also offers counselor interns a discounted rate for membership in LCA, as well as a discounted rate to attend LCA’s annual conference.

The idea to create CIAL came about during Taheri’s own experience as a counselor intern during the fall of 2010.

“I had recently relocated to Baton Rouge from Texas and was having a difficult time finding work that allowed me to continue adequately training for licensure while simultaneously getting paid,” recalls Taheri, now a licensed professional counselor and doctoral student at the University of New Orleans. “I also felt disconnected and isolated, as my first job did not have other counselor interns on staff.”

It was then that Taheri realized “that post-master’s counselors-in-training across the state may benefit from connecting with one another, as well as having access to knowledge of employment opportunities they qualify for.”

The idea continued to grow as she noticed other needs of counselor interns in the area.

“One of the issues in Louisiana is the registered counselor intern credential,” Taheri says. “I have heard firsthand accounts of employers passing over resumes because they saw the ‘counselor intern’ credential and thought the applicant was still a student and therefore not qualified for the position.”

One of Taheri’s goals for CIAL is to change the “counselor intern” credential to one that she believes “more adequately portrays post-master’s counselors’ capabilities.”

By 2012, Taheri’s plans to create CIAL and, thereby, a proactive, positive space for counselor interns in Louisiana were set in motion.

“I thought that it would be wonderful for counselor interns to be able to have an association to advocate for their needs and thought that it would be easiest to contact [interns or master’s students] through the statewide division of LCA,” Taheri explains. “I emailed Diane Austin, [executive director] of LCA, to find out what I needed to do in order to begin the process of creating such an association.”

Taheri was then put in contact with Paul “Buddy” Ceasar, a past president of LCA, who asked her to serve as chair of the first Counselor Intern Committee of LCA, which he created.

“I was ecstatic and, of course, accepted,” Taheri says. “At the first LCA Executive Board meeting that I attended, I had a petition ready and gained more than the required number of signers to create a provisional division within LCA. At the next board meeting, the motion to create CIAL was moved and seconded, and the rest is history, so to speak.”

As of June, CIAL had an executive board, official by-laws and approximately 180 members.

Taheri believes the more developed that CIAL becomes, “the more benefits counselor interns will have within the state of Louisiana. Since the initial development of CIAL, counselor interns are more easily able to connect with one another, have access to employment opportunities they are qualified for across the state and have a support system for voicing their concerns.” 

The need is certainly there for an organization like this, as Taheri says she notices many interns struggling to find jobs that offer continued training as well as a salary on which they can comfortably live.

“The more I communicate with counselor interns across the state, the more passionate I become in hearing about their needs and advocating to have those needs met,” Taheri says. “It is my hope that other states will begin working toward developing divisions for their post-master’s counselors-in-training. The more unified and connected counselor interns are within each state, the more we can work toward creating a national advocating presence for post-master’s counselors-in-training. The more connected we all are as counselors, the more we can advocate for one another.”

If you are interested in learning more about CIAL, email Taheri at kswanson@uno.edu.

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

Letters to the editor: ct@counseling.org

President Obama recently called on Americans to start a “national conversation to increase understanding about mental health” and directed the secretaries of the Department of Health and Human Services and the Department of Education to launch the National Dialogue on Mental Health. The American Counseling Association is answering the president’s call by partnering with Creating Community Solutions, an integral part of the National Dialogue initiative. Creating Community Solutions aims to foster discussions on mental health issues by organizing community conversations in cities and towns across the nation, as well as through social media outreach. More than 53,000 counselors are part of ACA, and it is our hope that our members will lend their professional expertise by participating in these local conversations and engaging people through social media channels. Visit creatingcommunitysolutions.org to find a “Dialogue” near you, or get the tools you need to start your own.

The American Medical Association’s (AMA) recent classification of obesity as a disease will not only impact those who fall into that category, it will also affect the way counseling professionals treat obese clients. The question of whether this new classification is a wholly positive step forward remains to be seen, according to some counselors involved with the subject.

The AMA officially recognized obesity as a disease at its annual meeting in June, according to The New York Times.

“Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans,” said AMA Board Member Patrice Harris in a statement. Harris suggested that the move by AMA will help in the fight against Type 2 diabetes and heart disease, both of which have been linked to obesity.

The vote, however, was a contentious one. As The New York Times reports, the decision goes against conclusions made by the association’s Council on Science and Public Health, which had studied the issue over the past year:

The council said that obesity should not be considered a disease mainly because the measure usually used to define obesity, the body mass index (BMI), is simplistic and flawed. Some people with a BMI above the level that usually defines obesity are perfectly healthy while others below it can have dangerous levels of body fat and metabolic problems associated with obesity. “Given the existing limitations of BMI to diagnose obesity in clinical practice, it is unclear that recognizing obesity as a disease, as opposed to a ‘condition’ or ‘disorder,’ will result in improved health outcomes,” the council wrote.

Judith R. Warchal, a professor in the Department of Psychology and Counseling at Alvernia University in Reading, Pa., says she has “some concerns about what seems to be a trend by the medical community to overpathologize human behavior, blurring the boundary between typical and atypical. “

But in the case of obesity, “the evidence is clear that many physical disorders can be attributed to being obese and for some people with obesity, there are serious emotional effects that warrant treatment as well,” says Warchal, a member of the American Counseling Association.

Warchal hopes that the classification will lead to more research funded opportunities focusing on “the relationship of obesity to mental health issues, obesity discrimination and most importantly, on prevention.”

To date, Warchal notes, much of the focus of research efforts have been on the physical disorders associated with obesity and on recognizing that obesity discrimination exists. “We now need to identify specific interventions and comprehensive prevention programs that work,” she says.

Warchal and her colleague Paul West presented a session at the 2013 ACA Conference & Expo in Cincinnati on the topic “Obesity Is Not New — Addressing It in Counseling Is.”

West, an associate professor of psychology and counseling at Alvernia University and a private practice clinician, says he has mixed feelings on the decision.

“While I recognize obesity is a problem in our society, classifying it as a disease has some major repercussions,” says West, an ACA member. “According to news sources, the AMA, as an organization, overrode the recommendation of their own Council on Science and Public Health regarding this issue. Was this done simply to force the insurance companies to reimburse practitioners for the treatment services provided to obese individuals? Was it to raise awareness to the problem to stimulate government-sponsored research? The only criterion for diagnosis of obesity that I have been able to find is the BMI, which was developed a long time ago. I would like to see more criteria.”

On a positive note, Warchal predicts that “the recognition of obesity as a disease [could] lessen some of the social stigma and discrimination associated with obesity and provide new avenues for treatment. [R.M.] Puhl and [K.D.]Brownell (2001) have identified obesity as the last acceptable form of discrimination in society today.”

She also foresees that obese clients will notice the disease gaining more attention in the counseling process. “While not every client who has obesity will experience a mental health disorder, research indicates that about 25 percent of individuals who are overweight or obese have mental health issues that warrant treatment,” Warchal says.

She believes counselors can help combat obesity because they are in a unique position to collaborate with other professionals such as physicians, nutritionists and exercise specialists to develop comprehensive plans for the treatment of the whole person.

“Counselors can and should be an integral part of prevention and intervention programs,” Warchal says.

West notes different times in American history where certain conditions have been labeled a “disease,” which then raised public awareness and led to positive, significant changes in treatment.

“Certainly the public perception of alcoholism changed after the AMA declared alcoholism a disease in the 1950s,” he explains. “Before that time, it was considered a moral problem. The same occurred with cigarettes. Once declared a significant health risk, the cost of cigarettes rose dramatically as the number of smokers decreased. Lobbying efforts by the tobacco industry began to be less effective in the wake of public opinion to eliminate smoking.”

In terms of obesity, West says, “it will now be in the radar scope in physicians’ offices. Physicians will now be able to be reimbursed for the treatment of obesity, which will probably provide a better foundation [for] research into the problem.”

However, he adds, “Obese people will now be considered diseased based on their height and weight. You will have individuals who are carrying around extra weight who are otherwise healthy and have no other medical concerns. I don’t know if these people want to be labeled.”

Warchal warns that counselors may harbor unrecognized feelings and biases about obesity and toward obese clients because obesity has not been widely addressed as a counseling issue.

“While more research is needed, there is evidence to suggest that mental health professionals treat clients with obesity different than non-obese clients,” she says.

Warchal cites 2012 research by Brittani Pascal and Sharon E. Robinson Kurpius, which “identified more negative personal characteristics being attributed to obese clients than normal-weight clients. They found, consistent with other researchers who studied mental health professionals, that trainees rated clients with obesity as lacking in self-control, more unattractive and with lower self-esteem.”

Warchal recommends that counselors incorporate routine screenings for obesity-related mental health issues into their intake process.

“Counselors have the skills to address the behavioral changes that clients who have obesity need to incorporate into their daily routine when prevention or intervention is a focus of therapy,” she says. “Counselors are also trained to screen for depression, anxiety or other mental health concerns that clients who have obesity might experience as a result of discrimination, social stigma, rejection and bullying.”

Warchal and West have submitted a proposal for the 2014 ACA Conference & Expo in Hawaii, titled “Addressing Obesity Discrimination Through Counselor Training and Client Advocacy.”

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Angela Coker’s time conducting research in Botswana has not only taught her about counseling practices in the country, it has also reinforced the importance of increasing cultural competence among American counselors.

Coker, a licensed professional counselor and associate professor at the University of Missouri-St. Louis, is currently in the midst of an eight-month trip to Gaborone, Botswana to collect data for her research study, entitled “Counseling Across Cultures.” The study focuses on how culture impacts the practice of counseling in southern Africa. In addition, she had the opportunity to serve as a sabbaticant/visiting scholar at the University of Botswana (UB).

In July 2011, Coker, a member of the American Counseling Association, was selected as one of 15 scholars to travel across Brazil through the Fulbright-Hays Seminars Abroad Program. 

While in Gaborone this year, she co-taught two counseling courses at UB, conducted a program evaluation of the Counselling and Human Services program at UB and attended the U.S. Exploratory Mission to Botswana.

“I also presented at professional conferences, conducted professional development training for UNICEF workers in Gaborone, interacted with community organizers committed to ending gender-based violence, visited rural primary and secondary schools, attended conferences and workshops, and networked with a host of international scholars who were either working or conducting research in Botswana,” Coker says. “I also learned how to cook some traditional foods, became fairly well versed in [the] Setswana language and learned how to do African quilting from a talented Motswana woman. I took every opportunity to be a student of the culture.”

Coker says she has always had an interest in Africa. “Its people, culture and history. I was interested in travelling to Botswana because it is a nation of a population of just over 2 million people with rich cultural traditions.”

Botswana is also a country that has made great strides in developing its counseling services, according to Coker.

“Currently, the University of Botswana offers a bachelor’s degree, master’s degree and Ph.D. in counseling,” she says. “I thought travelling to Botswana would be a great opportunity for me to learn more about its culture, counseling needs and services, in addition to its overall higher education structure.”

There are three levels of practicing counselors in Botswana. The first level entails “paraprofessionals” or “guidance teachers,” who hold a bachelor’s degree or a diploma in counseling and serve as teachers, while also acting as guidance counselors. The next level of counseling professionals are those who hold a master’s degree and work in private practice, teach counseling courses or work in administrative positions in the Ministry of Education and Skills Development or at the university level. The last level consists of counselors who hold a Ph.D. in counseling, who primarily teach in higher education. Currently, there are no licensure requirements for counselors in Botswana.

At first, Coker says she had some difficulty getting locals to participate in her study.

“I have found that it is important to build relationships with individuals before they agree to answer any research questions,” she says. “This was especially true for me, since I was an American coming into the country. Most folks looked circumspect at me, wondering why was I there and what did I really want to do with their responses to my interview questions.”

However, Coker was able to get a number of diverse Botswana counselors to participate.

“I believe it is important for counselors to be respectful and understanding of the cultural nuances that may surround their data collection process and methodology,” Coker says. “Building rapport, respecting cultural concerns and honoring some degree of participant resistance is part of our work as cross-cultural researchers.”

Through her research, Coker says she “found that counseling in Botswana is a growing area, full of progress and opportunities.”

In terms of counseling, Coker discovered that, traditionally, “Batswana,” or the citizens of Botswana, may initially consult with traditional healers as a means of addressing their mental health and emotional needs before they ever venture into a counselor’s office.

“They have also accessed the wisdom [of the] elders in their families and communities whenever they have a life challenge that must be addressed,” Coker continues. “Formalized counseling is still a relatively new phenomenon in Botswana. Most people find it as a bit strange to talk to a total stranger about intimate private or family issues. They tend to consult with spiritual leaders in their churches, they also partake in community activities as a way of reinforcing their collective existence and connection to each other.”

She cites a tradition called a “letsema,” which means harvesting, as an example.

“A ‘letsema’ usually happens early in the morning before the sun gets too hot,” Coker explains. “It is a time when a farmer elicits the help of his or her extended family and community to come and assist with the harvesting of their crops. This activity would be a whole day, if not an entire weekend, depending on the size of the farm. While harvesting the crops, neighbors and family come together, as they are working they sing, share the events of their week and consult with each other. After the work is done, they share food and have a big feast. Such activities reduce an individual’s sense of isolation, increases their support network and adds to their overall mental and psychological wellness. It also serves as a venue for informal counseling.”

But Coker says she has seen areas where formalized counseling has gained acceptance.

“Primarily, we [are seeing] an increased need for counseling in the schools where young people are facing issues such as academic stress, peer pressure, orphan-hood, sexual abuse and parental neglect,” Coker says. “Counselors who work in private practice report seeing issues of relationship issues, anxiety disorders, grief and loss concerns and marital conflict. Most of the clients who frequent private practice counselors are professionals who are highly educated, have traveled abroad, have the economic means to pay for counseling or who have employers that have implemented the equivalent of what we might call an Employee Assistance Program, designed to assist their employees with any counseling needs.”

She has also noted an increase in college counseling in Botswana, “where issues such as career development, academic difficulties, relationship issues and grief and loss have been the focus. Also, another big area is in HIV/AIDS counseling and health education.”

Coker believes that most American counselors are striving to be culturally competent in some way.

“After all,” she says, “it is a journey that requires us to unpack our previous ways of thinking and develop new levels of consciousness. It is fundamental to who we are as counselors, regardless of our specialization.”

She believes counselors can enhance their cultural competence through their daily lives.

“We must be intentional about seeking out new experiences that stretch our existing thinking about human diversity,” Coker says. “Too often we allow human differences [such as] race, gender, age [and] ethnicity to be barriers to us getting to know each other. Other ways of enhancing our cultural competency is through our own research/scholarship production, organizational involvement, community outreach, clinical work and supervision.”

She believes multiculturalism is an important focus for counselors because it “acknowledges and makes way for a better contextual understanding of our clients, which encompasses both their cultural history and contemporary daily living. It takes into account, race, gender, social class, age, sexual orientation, ethnicity, immigration status, language, physical abilities, etc. Cultural competence is one of many useful tools to help us in the assessment of our client’s lives. Also, because of the emergence of social justice as a action-oriented framework, multicultural counseling allows us to also address institutional barriers that are harmful to our clients.”

Coker’s experiences in Botswana have added to her own cultural understanding of the world.

“It makes me feel more connected to a global community,” she says. “I believe it has increased my global consciousness and identity as a counselor educator. It has definitely enhanced my research and reaffirmed my interest in the internationalization of counseling and trying to understand how we as Western counselors can learn from our colleagues and clients across the globe. Further, being in Botswana for the last six months has also made me understand more clearly my privilege as an American and what benefits come along with that, [for example], access to good education, health care and overall general options in life.”

In terms of her racial identity, Coker says she “felt very comfortable in Botswana. As an African American woman, I was validated in terms of having the privilege of seeing so many people who look like me! The women were of different body sizes, but mostly they were full-figured women who didn’t have hang-ups about the size of their hips, thighs, etc. I really appreciated this — as it was very reaffirming to my personhood. “

Coker has also found that, through her experiences, she is more sensitive to issues relating to acculturation.

“I now know what it is like to be new in a country without family and have to learn how to manage on your own,” Coker explains. “I also learned that in order to really benefit from any cultural immersion experience, you cannot be shy or be an introvert! You must be willing to take advantage of every new opportunity or experience that comes your way. If you don’t, you may miss out on something important. I guess this is part of being intentional in terms of developing a new conceptual lens and understanding new cultures. I definitely recommend that every counselor take advantage of international opportunities as a means of enhancing their research, teaching, supervisory skills, and multicultural awareness and competency development.”

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

Letters to the editor: ct@counseling.org