Monthly Archives: February 2014

The toughest kinds of groups

By Christine Schimmel and Ed Jacobs February 26, 2014

Group_chatIt’s 3 p.m. and you are anxious about going to the group you are leading because its members are being forced to attend by the court, the principal or some other authority figure. Being tasked with leading a group whose members don’t actually want to be there is an assignment that many counselors dread.

The purpose of this article is to help reduce the anxiety that often accompanies leading these kinds of groups. We also want to provide an array of ideas to help make a mandatory group a positive experience for most, if not all, of its members, as well as for you, the group leader.

Many times, leaders worry about the topic or content of the group and fail to pay attention to the elephant in the room — the members just don’t want to be there. Group leading is about the art of engagement, and this is especially true with involuntary members. When leading mandated groups, a primary consideration should be constant evaluation of the following question: How engaging is the group discussion or activity? You should frequently ask yourself whether what you are doing in group is interesting and appealing. The answer needs to be, “Yes, very appealing!”

Here is an example of how one counselor made the initial moments of the first session appealing when she was asked to go into a school and lead a group with students who had been caught smoking marijuana on school property. The students had been referred to the program as part of the “punishment” for getting caught. To make matters worse, the group met at 4 in the afternoon once a week. The counselor knew she needed to do something out of the ordinary to get the group off to a good start and to convince members to participate. This is what she did.

Counselor: “I know you are all very angry about having to be here, so let’s get this group started by just getting all that anger and frustration out on the table.” (Counselor pulls up a large trash can and opens the lid.) “You have five minutes to gripe, complain or do whatever you need to do. Take five minutes and get it all out here. Ready? Go!” (Allows five minutes for students to commiserate with one another.)

Counselor: “OK, now we are going to name this group. What do you all want to call this group? Do you want to call it the drug group, or do you want to give it some new name that sounds better than the drug group?”

The members spent a few minutes naming their group. Following that, the leader focused on the purpose of the group, which was to discuss the members’ use of marijuana at school.

Essential leadership skills with mandated group members

Our approach for leading nonvoluntary groups is one of active leadership. Those who subscribe to more of a facilitator model of group leading, where much of the responsibility for the flow of the session is given to the members, will likely find leading mandated groups to be frustrating, to say the least. We believe that “people don’t mind being led when they are led well.” We discuss this idea, as well as ways of working with reluctant members, in our book Group Counseling: Strategies and Skills, which we co-wrote with Robert Masson and Riley Harvill.

Leaders of nonvoluntary groups need more skills than those who lead voluntary groups. We think the following five skills are essential.

  • Be creative: Think outside the box. Many nonvoluntary members come to the group with the mindset that they will be bored and will not participate. Think of creative ways to engage these members.
  • Be energetic: Your energy may be the tipping point that gets members engaged. If you show little or no enthusiasm, members may well follow suit.
  • Be positive: Believe that the members can learn and change, and believe in the value of groups.
  • Be patient: Don’t get discouraged if it seems like members aren’t listening. Always realize that one or more members of the group are most likely benefiting from what you are doing.
  • Be thick-skinned: Know that some members are going to challenge you, ignore you and accuse you of a variety of injustices. Be prepared to deal with members who are resistant and defiant. Use a kind, confident voice, while always putting a positive spin on the value of the group you are leading.

Keys for dealing with negativity and hostility

Anytime you have mandated members, you must be prepared to deal with negativity and hostility. Here are some tips for doing just that.

  • Refuse to give in to the negativity: Instead, redirect it. The group process will be attacked. Stay positive and say that some members may find the group very helpful and even life changing.

Member: “This is all a bunch of b.s. How many times do I have to come?”

Leader (looking at everyone and talking with a firm, inviting voice): “I used to hate running this group because no one wanted to be here and no one talked, so I sought some help from people who had led these groups and from the members who were forced to be here. I asked them what would make this group better, and they gave me all kinds of suggestions. The best stuff came from former members who had hated it. They told me all kinds of good things that I should do, so that’s what I have planned for this group. And you know what? Every time I finish with the six-session series, there are at least three members who say they want to continue meeting because it helped them so much.”

  • Do not take attacks personally: Accept that you will be verbally attacked because mandated group members are frustrated or angry with the authorities who are making them attend.
  • Use inner circle-outer circle: This technique has worked for mandatory groups after the second or third meeting, but we recommend its use only if the negative energy is so bad that you don’t feel you can turn it around.

Leader (with a kind, caring voice): “Everyone has to be in the room, but I realize some of you are more invested than others. So, each week I’m going to give you an opportunity to indicate your desired level of participation. For those of you willing or wanting to participate fully and actively, pull your chairs to the center. The others can be on the outside, sitting quietly and just listening.”

The use of the inner circle-outer circle technique allows those who want to gain something to be able to do so without those on the outside being given the opportunity to sabotage the group. At the same time, those in the outer circle can still benefit from observing the other members’ work. We have found that members on the outside sometimes pay more attention when they aren’t allowed to speak. In some cases, they will even eventually ask to join the inner circle, which is certainly fine.

Do the unexpected

When leading groups with involuntary members, doing the unexpected eliminates some of the anticipated negativity that often occurs in these groups. One of the concepts we write about in our book Impact Therapy: The Courage to Counsel is the idea that the brain likes novelty. With the trash can example mentioned earlier in this article, the leader (a former student of ours) reported that the activity helped the members to release much of the negativity surrounding having to be in the group. She made sure she did not start the first session by immediately jumping into the group rules and providing some information about the “evils of marijuana.”

So often in involuntary groups, leaders focus on the rules and content and present “expected” information that turns off the members because they are still mad about having to be in the group. Doing unexpected, interesting things in an effort to “hook” the members’ interest is a much better way to approach the first session. Without an engaging opening, a leader will be battling lack of interest, negativity and disruptive behavior the whole way.

Think of times when you have attended a mandatory meeting and that meeting was somewhat boring. You probably got fidgety or sleepy, or even started talking or sending notes to the person next to you. Perhaps you simply retreated into your mind and started thinking about where to go on vacation, what to make for dinner or other things you could be accomplishing with your time.  Unexpected activities help to engage nonvoluntary members, especially during the first couple of sessions when they are still warming up to the experience of being in the group.

It is important not to rely on the members of any mandatory group to carry the group. Leaders who do often are met with dead silence because the members don’t come eager to talk, even if the previous session was a good one. Keep in mind that their attendance is due to being mandated, not because they look forward to attending. Leaders have told us, however, that members have reported to them that they do look forward to attending as a result of the first two sessions going well. Anytime you lead a mandated group, one of your main purposes is to get as many members as possible to recognize that the experience can be beneficial.

One mental health counselor who went into a school to lead an after-school suspension group told us that after his third session, the principal called him and said that some students were hearing such good things that they wanted to be suspended so they could be in the group as well. Good reports such as this are the result of counselors presenting unexpected, creative and engaging activities.

Use written exercises

One of the most engaging activities involves having members do various written exercises. Sentence completion, in which all members complete two to five sentences about something, works well for almost any population if the sentence stems are relevant and interesting. When reviewing the answers, most members are curious to find out if others have answers that are similar to theirs. The key is to develop thought-provoking sentences, but not too many of them.

Here are some examples of various sentence stems:

  • The thing I fear most about being in this group is ________ (for any group)
  • If I give up drugs, it would mean _____________ (for mandated drug offenders)
  • I tend to hit those I love when _______________ (for mandated batterers)
  • The hardest thing about being on probation is ___________ (for those mandated due to probation)

Other written activities that can be engaging include making lists and answering questions (or even simply circling answers). Often group leaders are asked to use prepared material, but those who created the material did not necessarily consider that the members completing the material are doing so because they are mandated to participate in the program. We advise our students and workshop participants to carefully scrutinize prepared materials to determine how relevant and engaging these materials might be for mandated members.

Written exercises are extremely valuable for the leader because they make it easier to draw out members. The members now have something to say if called on; that is, they can read what they wrote. This helps immensely because mandated members are notorious for not volunteering to talk.

Use rounds  

A round is an activity in which all group members are asked to participate by sharing a word, number, comment or phrase. The value of rounds is that everyone speaks, even if only to give a number for a rating (such as “Rate how the week was on a scale of 1 to 10”).

One of the biggest obstacles with mandated members is their negative mindset and determination not to talk. By encouraging “controlled talking” through the use of a round, a leader can hear from everyone and also better manage any negativity by having the round be in the form of a word or phrase. For example, “In a word, or a phrase, or one sentence, describe your feeling about ___________ .” By using the round, when the negative member starts to go on about something, the leader can say, “Just a word or a phrase.” Yes/no rounds are also valuable in that they at least get members saying something. Here are some examples.

  • Leader: “I’m going to ask each of you to answer either yes or no regarding whether alcohol was involved in your arrest.” (The leader can ask follow-up questions to those who answer yes.)
  • Leader: “Yes or no. Was the discussion we just had helpful?” (The leader can ask follow-up questions regarding why the members said yes or no.)
  • Leader: “Yes or no. Do you have something you’d like to talk about in today’s group?” (Be prepared to hear only “no.” Even so, this question lets members know you are open to them bringing things up in group.)

The 1-10 rating round is also helpful for getting a sense of how the members feel about something.

  • Leader: “On a 1-10 scale, with 1 being very uncomfortable and 10 being very comfortable, how comfortable are you in this group?”
  • Leader: “On a 1-10 scale, how strong is your desire to change? One represents no desire to change, and 10 represents a strong desire to change.”
  • Leader: “Rate your week on a 1-10 scale, with 10 representing a very good week and 1 representing a very bad week.”

Most members are usually willing to share in the round, which gives the leader a way to draw out the resistant, quiet members, while controlling the negative members. During the warm-up phase of the first session, a round that often works is: “Given that you have to be here, in a phrase or a sentence, what can I or we do to make this a somewhat worthwhile experience for you?”

Even if the members say impossible things, the round at least allows and encourages everyone to say something. This is a big plus because silence is one of the hardest things to overcome with mandated members. Rounds get members talking, which helps with engagement.

Use creative props

Visual props help to engage group members because props are novel and engage both sides of the brain. With members who are mandated to group due to anger issues, a shaken Coke bottle or a bunch of long, medium and short “fuses” will work to grab their attention.

Leader (shaking a bottle filled with Coke): “Can I get a volunteer to point this at themselves and open it?”

Members usually laugh or say they’ll open it while pointing it at others. This leads to a discussion about their anger and the consequences of spewing it everywhere.

Leader: “How long is your anger fuse?” (Throws pieces of string, measuring various lengths and representing fuses, in the center of the group.)

Even reluctant members will usually at least pick a “fuse,” which indicates they are thinking about what is being said. The leader can then ask members to comment on their anger fuse and whether they think it can be lengthened.

Many mandated groups center on addressing members’ issues related to alcohol consumption. Members may have been caught drinking and driving or misusing alcohol at a school or university or in the community.

Leader: “I want all of you to stand and make a large circle. Now I want you to think about your personal goals. Think of them as being in the center of our circle.” (Leader puts a large piece of paper with the word “GOALS” in the center and allows members some time to stare at the sign and think about their goals.) “Each of you has an empty box on the floor in front of you that once contained a case of beer. Step into the box with both feet. Now try to move toward the goals you set for yourself in the middle of the circle.” (Members struggle to move, nearly fall, etc.)

This creative technique has a much greater chance of engaging the members regarding the consequences of their drinking in comparison with simply asking them about the consequences. The use of the box is a unique approach, and the brain likes novelty. Some members will get the point that drinking may interfere with successfully reaching their goals.

Use movement

Moving around instead of sitting often helps leaders to get and keep the attention of group members. A wonderful example of this is provided by the leader of a probation group who began each session with a “values continuum” (see below). The subsequent action created enough energy to allow the leader to spend the remainder of the group session simply processing the material that the continuum generated.

Leader: “Everyone stand up behind Carl.” (Carl is in the center of the room at the front; members line up behind him.) “This wall represents ‘I can change,’ and this wall represents ‘I can’t change — this is who I am.’ On the count of three, I’m going to have you move to where you see yourself. If you strongly believe that you can change, move way over there (points to one wall), and if you believe you can’t change, move over there (points to the other wall). Or put yourself somewhere in between that represents your belief about change.”

The value of this activity is that, unless members leave the room or refuse to move, they are participating. They are speaking with their feet as demonstrated by where they place themselves on the continuum. Additionally, moving around is more engaging for the members than just talking about how they feel about their ability to change.

In many mandated groups, one purpose is to get members to set new goals for themselves. This next activity may serve as an excellent movement exercise to focus on the idea of setting goals.

Leader: “Everyone stand and line up side by side.” (Leader moves about 8 feet in front of the members and draws an imaginary line.) “I want you to assume that this line is you reaching the goals we talked about in the first and second sessions. This is now the fifth session. I want you to move either forward or backward to indicate how close you feel you are to reaching the goals you set for yourself. On three I want everyone to move. One, two, three.”

Most members will move and talk about their progress or lack thereof. Even for those who don’t talk, the experience may have an impact because it helps them to visualize that they are not making progress.


One truth we have found in leading groups with involuntary members is that it is quite unpredictable what will engage them and get their interest flowing. Our overall message to anyone leading mandatory groups is:

  • Continue trying a variety of unique and unexpected activities.
  • Don’t give up.
  • Don’t give in to the negative members.
  • Believe in what you are doing and in the power of groups.
  • Use rounds.
  • Be creative — use props, written activities and movement exercises.
  • Commit yourself to making the group powerful for those members who, once engaged, want to make progress.

A commitment to this list of ideas will make leading mandated groups a more interesting, exciting prospect. Additionally, that same commitment should make the anxiety and stress associated with that 3 p.m. group subside.




For additional creative leadership ideas, check out the following resources written by the authors of this article:

Group Counseling: Strategies and Skills, seventh edition, by Ed Jacobs, Robert Masson, Riley Harvill and Christine Schimmel, 2012, Brooks/Cole

Impact Therapy: The Courage to Counsel by Ed Jacobs and Christine Schimmel, 2013, Impact Therapy Associates




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


Christine Schimmel is assistant professor in the Department of Counseling, Rehabilitation Counseling and Counseling Psychology at West Virginia University, where she coordinates the school counseling program. Contact her at


Ed Jacobs is associate professor in the Department of Counseling, Rehabilitation Counseling and Counseling Psychology at West Virginia University, where he coordinates the counseling master’s program. Contact him at


Letters to the editor:


Getting to know you

Stacy Notaras Murphy February 25, 2014

Two-faces_smallOne of the common reasons people start counseling is because they want to know themselves better. The time required to achieve this self-understanding varies, but some counselors make helping clients get a clearer picture of their personalities the first order of business. Many of these counselors find that certain personality assessment tools and techniques offer a fast train to this sort of insight.

A variety of personality assessment instruments are readily available to counselors, from interest inventories that help clients target particular career paths, to projective techniques that seek to uncover unconscious desires. In addition to giving clients a well-rounded sense of their own needs and expectations, these tools can provide counselors with concrete data that can help direct the course of treatment.

But for many counselors today, experience with personality testing and other assessments begins and ends with a few courses in graduate school. The Council for Accreditation of Counseling and Related Educational Programs maintains assessment as one of eight common core curricular areas required for accreditation, and many counseling degree programs include assessment instruction as part of courses on career counseling and research methods. Even so, while focusing on the more dialogical process of building an empathic therapeutic alliance with a new client, many counselors overlook the somewhat evaluative activity of assessment. Those who do make use of assessment instruments say they draw on the information gained through these tools to deepen their understanding of their clients’ needs — and to help clients do the same.

Providing a foundation

The tangibility of an assessment report always appealed to Suzanne Wall’s research-oriented personality. As such, the American Counseling Association member in Hartford, Conn., sought certification for administering both the Strong Interest Inventory and the Myers-Briggs Type Indicator (MBTI) assessments (see the sidebar posted below for more information on the assessments mentioned in this article). She has been using personality assessments for well over a decade, including during the 12 years she offered career development counseling on a private college campus.

“The assessment results were a starting point to a larger conversation about how [the clients’] natural gifts and talents could be applied to the world of work,” says Wall, who serves as president of the Connecticut Career Counseling and Development Association. “I am a numbers-oriented person and found the test information to ‘ground’ the counseling time — that is, to provide a foundation.”

Craig Lounsbrough thoroughly agrees that personality assessments can help root the early stages of treatment, while simultaneously offering a map for how to move forward. The licensed professional counselor and author maintains an outpatient counseling practice in Parker, Colo. During his 12 years as a private practitioner, Lounsbrough has found that personality assessments “provide a rapid, well-informed and rather comprehensive glimpse into the individual that gives therapy a strong and informed point of departure.” He notes that this helps him chart a more effective treatment course and often minimizes the length of treatment time required.

Lounsbrough uses personality assessments in all of his cases. Most clients are receptive to them, he says, because he doesn’t present them as stereotypical “personality tests,” but rather as tools for personal growth whose value extends beyond the counseling room. Although he makes most use of the MBTI, Lounsbrough also uses the Student Styles Questionnaire, the Minnesota Multiphasic Personality Inventory (MMPI), the Millon Clinical Multiaxial Inventory, the Taylor-Johnson Temperament Analysis (T-JTA), the Prepare/Enrich assessment and projective drawings. He says he has found that clients who resist using the instruments often have fears about the counseling process and may be less committed to it.

Tavye Morgan, an ACA member in Atlanta who offers counseling services and spiritual direction in her private practice, has been certified to use the Enneagram, an assessment that delineates nine personality types. She also describes personality assessments to clients as tools for personal growth, although she says clients may not fully comprehend them at first.

“At the very least, one of the things it does is help me understand where people are coming from when they come in for a counseling session,” she says. “While it is a self-typing tool [which depends on honest self-reporting], the Enneagram gives me a lot of insight into what is happening with my clients when they have no idea.” Morgan encourages clients to consider the assessment a tool for better self-understanding. “I am of the philosophy that if you understand why you behave the way you do, you are more able to change it,” she says.

Morgan was inspired to become certified to use the Enneagram with counseling clients after her own experience with the instrument. “It was the most powerful resource I had ever been exposed to, and it helped me understand parts of myself, behaviors and how I was motivated in certain ways. It truly helped me have clarity about the direction in which I was moving,” she says.

Morgan notes that the Enneagram combines the psychosocial with the spiritual. She says that angle spoke to her specifically because she has a master’s of divinity in parish ministry.

“In my pastoral role, I’ve performed a lot of weddings, and I use the Enneagram in my premarital counseling,” she says. “It really helps couples in their understanding of where each [person] is coming from. It really increases compassion when you are able to see the interior world of another human. We make the assumption that we all view the world in the same way, but we don’t. … We live in a world where people can’t see one another, but this really helps you see another person.”

Although Morgan is attracted to the spiritual context of the Enneagram, she emphasizes that it can be and often is used from a strictly secular perspective. “You can use it without any reference to the spiritual life, which is really good for people who don’t value that, like in the business world,” she says. “There were corporate execs in my training group [who were] interested in understanding personality and motivators and how to energize their teams to be more effective.”

She did part of her Enneagram training in England with participants from various countries. “We could see that it was not a culture-bound tool either,” Morgan says. “We all could relate to one another based on our personality type. We knew each other’s interior experience.”

Such assessments can help clients see that their struggles may be related to their personality type and the unique point of view it affords. Morgan offers the example of a 60-year-old female client with cancer who was struggling with deep anger. The Enneagram “showed her to be a ‘1,’ which is a personality type that can be so rigid that it often leads [those individuals] to become physically sick,” Morgan says.

With the help of the Enneagram, Morgan and the client were able to identify that the client’s rigid expectations of perfection were making her very angry with her daughter, driving a wedge between them, while exacerbating her own physical illness. As a result of this new level of self-understanding, the client began noticing when her expectations were unrealistic and started building a new relationship with her daughter.

“When she died, they were in such a good place,” Morgan says. “I really believe it was the Enneagram work she did that allowed her to look at what she was doing and how it impacted relationships with her loved ones.”

Deepening the therapeutic alliance

Arthur Clark, an ACA member and professor at St. Lawrence University in Canton, N.Y., thinks personality assessments are a natural fit for counselors. He wishes more professionals in the field would consider how easily the assessments can be integrated into the work counselors are already doing. Clark has been using projective techniques to help assess personality since the 1970s.

From the public’s perspective, the most well-known psychological projective technique is likely the Rorschach test, an assessment that asks clients to interpret a set of inkblots. But a variety of other projective techniques invite clients to explain their own perspectives on an ambiguous stimulus, such as an open-ended sentence or a blank sheet of paper on which they are asked to draw a picture. Clark became interested in projectives as a middle school counselor, while looking for an effective way to better understand students without sending them outside of the school for testing.

“I wanted to find something that I could blend into the counseling process, and I had some familiarity with the projectives, but it was minimal, as it is in most counseling programs,” he says. “So, I started using the sentence completion task, where you ask clients to complete a sentence stem with their true feelings. For example, you would say, ‘I wish that …’ and then they would say, ‘I could do better in school.’ I found that particularly helpful as a springboard for discussion. If a kid wrote, ‘I get angry … mostly at my parents,’ that was a lead-in.”

Eventually, Clark developed a protocol of three projective tests that took about 45 minutes to complete and interpret. The three tests involved human figure drawings, oral sentence completion tasks and asking about early recollections.

Clark posits that projectives have lost popularity due to the emphasis on empirical evaluations to determine a client’s progress. “It depends on how the projectives are seen. If they are viewed as standardized assessments, they don’t fare well because the reliability is not high,” Clark acknowledges. “I think a better way to look at projectives is to see them as counseling tools. They are informal devices that yield information much like you would find by talking to a client over an extended period of time, but they can be done in a single session. … There’s a way to use and look at projectives not in competition with the objective tests, but more as a set of hypotheses that can be confirmed or disconfirmed later.”

“I find in terms of assessment, the objective evaluations — the Beck and MMPI and Millon battery — are all important. But the projectives can supplement and give a more well-rounded view of a person,” he says. “With the many issues and challenges facing clients today, I don’t think we want to leave anything behind.”

Clark also thinks the testing process can help build rapport between the client and counselor. “Rather than simply asking a person questions, [with the use of projectives, clients] are emitting information. They are involved in the projectives inherently. So, if you are drawing or completing sentences, there is direct involvement and participation,” he says. Projectives “also allow freedom of expression, and during that time the counselor can observe the client and be encouraging. That is enhancing the counseling relationship.”

Clark adds that many clients are wary at the start of counseling, coming into session with their defenses up. He has witnessed how projective exercises encourage clients to lower their guard, in part because the client and counselor are participating in something together.

Clark says projective techniques and other personality assessments are an obvious match for counselors because the field emphasizes relationship building. “[Counselors] know empathic understanding is important and that it’s essential to involve the client in the counseling process,” he says. “It wouldn’t take too long before counselors, on their own, could find a way of using the projectives and building them into their own styles.”

When and where?

Some counselors ask clients to complete a particular assessment prior to their first intake session. Others take some time to determine whether such work would be useful or even welcomed by the client. Though Morgan thinks most of her clients would benefit from the stronger sense of self-understanding that the Enneagram potentially offers them, she doesn’t automatically introduce it in every case. “Some people are really trying just to keep their heads above water, so it’s not always my first suggestion,” she says. “Then there are other people who are really interested in learning about their full potential.” In most instances, she adds, the decision to use the Enneagram with clients boils down to a judgment call.

Counselors engaged in career development work may be the most comfortable and familiar with personality assessments. Wall describes the process of interpreting the results with the client as “the sweet spot where data science meets career development” and says the assessment experience can put into words the truth about a client’s life experience.

“The results confirm both positive and negative experiences from a client’s work and personal life,” says Wall, adding that this provides an essential guide for career planning. “As a counselor, I find deep satisfaction in translating assessment data to concrete, practical action steps. Witnessing the ‘aha!’ moment in a client’s new understanding of their life is when I know I have empowered the client with a valuable tool to help them in their personal career development process.”

Wall has discovered particular success working with clients who are facing job transitions, often due to company downsizing in a postindustrial economy. She mentions one client who lost her job during a restructuring. The client’s assessment results showed that she placed a high value on the social bonds formed at work, which made losing the job all the more painful. Armed with this knowledge and a stronger sense of which work settings would maximize her natural talents, the client was motivated and able to find a new position.

Wall asserts that the value of the career counselor is in being able to craft a strategy and work through it with a client who may be stuck due to exhaustion, frustration or fear. “The antidote is client-centered, customized information curated by a career development expert,” she says. “The assessment process is an important piece.”

For those counselors who see more general client populations, an assortment of assessments may be useful. Lounsbrough has discovered particular success using personality assessments as part of the treatment for attention-deficit and attention-deficit/hyperactivity disorders. “What I have found is that, sometimes, the symptoms associated with these diagnoses can in part be a product of the patient’s personality versus being entirely related to these particular diagnoses,” he says. He adds that this realization often provides clients with a greater sense of hope and an enhanced sense of control over their symptoms.

Lounsbrough also finds assessments especially useful in helping clients understand communication issues. “Personality profiles shed light on various communication styles and how differing individuals may be clashing or not connecting. This information is particularly helpful in family and couples counseling,” he says. “Not only does it explain many of the difficulties relative to communication, [but] it allows individuals to understand those differences and make sense of them. I have found many individuals obtaining a tremendous amount of relief in simply understanding the barriers to their communication.”

Lounsbrough would like more counselors to consider using assessments with their clients. “It seems that few therapists actually take advantage of these assessment tools. In my work, assessment tools significantly improve outcomes and move therapy along at a quicker pace,” he says. “Additionally, given the added information that these resources provide [clients], the therapist can have a bigger impact on the [client’s] overall life.”



Personality assessments

This is a partial list of some of the most commonly used personality assessments available to counselors. Many of these assessments require certification to administer, while others offer online scoring and reporting.

  • Enneagram of Personality Types: A typology that identifies nine separate, yet interconnected, personality types. It has been used widely in business and spiritual contexts. See
  • Millon Clinical Multiaxial Inventory: A tool to assess psychopathology that considers personality characteristics and their impact on clinical diagnoses. See
  • Minnesota Multiphasic Personality Inventory: A psychometric test that measures adult personality and psychopathology. See
  • Myers-Briggs Type Indicator (MBTI): Based on Carl Jung’s theory of psychological types, the MBTI helps people identify themselves within 16 distinct personality types and provides information about how those types can influence life and work decisions. See
  • NEO Personality Inventory-Revised: A 240-question assessment of the “Big Five” personality domains. See
  • Prepare/Enrich Relationship Inventory: Aimed at couples, this inventory helps clients learn about their relationship expectations and communications styles. See
  • Strong Interest Inventory: A vocational interest inventory that can help people learn more about what their true interests are before selecting a career path. See
  • Student Styles Questionnaire: A tool for assessing students in grades 3-12 for personal learning preferences that are rooted in the Jungian theory of personality types, much like the MBTI. See
  • Taylor-Johnson Temperament Analysis: Often used in family and couples counseling, this assessment aims to help clients understand their individual personality traits and thereby reduce conflict with loved ones. See
  • Thematic Apperception Test: A projective psychological test that invites clients to tell stories about pictures provided by the administrator. See


Contributing writer Stacy Notaras Murphy is a licensed professional counselor and certified Imago relationship therapist practicing in Washington, D.C. To contact her, visit


Letters to the editor:

In search of wellness

By Laurie Meyers February 24, 2014

Water-drop-leafJacqueline Swank, an assistant professor of counselor education and researcher at the University of Florida, believes in the power of nature. “I grew up on a farm,” she says. “Every aspect of my life involved nature.”

The barnyard and surrounding woods were her playground, but living close to nature offered her more than amusement. “Nature was also a place I turned to in order to cope with things,” says Swank, a member of the American Counseling Association. Those experiences have informed her career in both research and practice, where she studies the effects of nature on child and adolescent wellness.

Wellness is something of a buzzword these days, touted and tossed about in pop culture and by various professions. But in counseling, wellness is much more than the latest passing fad — it is entwined in the roots of the profession.

“Counseling has embraced wellness from the beginning,” says ACA Chief Professional Officer David Kaplan. “Expanding on the profession’s initial focus on vocation, we have embraced a comprehensive, holistic approach to wellness that includes not only work, but also a sense of self-worth, spirituality, emotional awareness, coping skills and problem-solving, an emphasis on relationships and other elements that are essential to living a balanced life.”

“Helping clients become as healthy as possible is, and always has been, a central tenet of professional counseling,” he adds.

So much so that when delegates to the 20/20: A Vision for the Future of Counseling initiative developed and agreed on a unified definition of counseling in 2010, wellness was one of the components explicitly highlighted: Counseling is a professional relationship that empowers diverse individuals, families and groups to accomplish mental health, wellness, education and career goals.

But given that wellness is a core component of the definition of counseling, how does the profession define wellness itself?

Jane Myers, along with frequent co-author and spouse, Thomas Sweeney, has studied wellness for years. Their research led them to develop the Wheel of Wellness, a complex model of individual and societal factors that influence well-being, and later the Indivisible Self, an evidence-based model of wellness that is grouped according to the five factors of the self: the Creative Self, the Coping Self, the Social Self, the Essential Self and the Physical Self.

“The essence of wellness is the integration of mind, body and spirit. It is not static but constantly changing day to day,” says Myers, a past president of ACA and executive director of Chi Sigma Iota, an international honor society that values academic and professional excellence in counseling.

Although counseling has always been committed to helping each client become as “whole” a person as possible, for much of the profession’s history, counselors didn’t feel it was appropriate to ask clients about their spirituality or to become involved with physical health issues, Myers notes.

“I think we’ve moved to a very holistic view as a profession, understanding that all parts of the human experience are related, and we can’t leave anything out if we are going to be effective for our clients,” Myers says. “Everything affects everything else.”

“Emotions are so physically and biologically based in the body that, as counselors, we can’t afford not to look at the whole person,” she adds.

Myers thinks counselors across the profession have become more aware of the importance of wellness in practice, thanks in part to ongoing professional development and to graduate counseling programs’ current focus on wellness in their curricula. The profession is also realizing that this holistic model of wellness is a crucial part of what sets counseling apart from other mental health disciplines, she says.

Sweeney, executive director emeritus of Chi Sigma Iota and also a past president of ACA, sees wellness as an extension of counseling’s original roots in guidance and thinks the profession needs to reclaim this territory.

“Counselors are agents of change — there to help people step by step,” says Sweeney, who is also professor emeritus of counselor education at the Ohio University College of Education.

Myers and Sweeney also believe that tools such as biofeedback and neurobiofeedback and areas of research such as neuroscience and cardioneurology will continue to expand the profession’s understanding of wellness in years to come.

The power of nature

Swank sees nature as a vital component of wellness. As a practitioner, she worked primarily with troubled children and adolescents, including two years at a therapeutic wilderness program for troubled boys. The camp offered many outdoor activities, but one project that grew to be particularly successful had humble roots. “I started a garden with just a few boys who were interested in it,” Swank says, “but as plants started to grow, others developed an interest.”

The little garden blossomed into a kind of life skills school. Swank watched as the boys began developing socials skills while working together in the garden. When deer invaded the garden, the boys also had to cultivate problem-solving skills quickly.

The garden became a source of pride. “The boys were proud to show their parents the produce they had grown,” Swank recounts. “They said that this gave them an opportunity to show their parents and others that they could be successful in doing something positive instead of negative, and this made them feel good about themselves.”

Many of the boys in the wilderness program had been in detention facilities. Most of them were from urban environments and had limited experience with nature, Swank says. Unhooked from electronic devices and without many of their normal conveniences at the wilderness school, the boys had to learn new ways to react and cope.

“They learned that they could not only survive but thrive in a natural environment by learning to rely on nature and each other,” Swank says. “Relying on each other and having to learn to live in a group setting also altered the way the boys viewed their own behavior. They began to understand that their behavior affected those around them, and not just themselves.”

Swank also witnessed the calming, comforting effect that nature had on children in another therapeutic environment. “When I worked in day treatment and inpatient, we created a butterfly garden, and the children and adolescents often requested the opportunity to go sit in the garden to relax and calm down,” she says. “They also considered this a safe, comforting environment to talk with the counselor.”

Swank is now involved with wellness research. Last year, she conducted a study involving gardening and elementary school children.

“We found that children’s self-esteem improved following participation in the gardening groups,” she says. “Many of the children struggled academically, and they were able to experience success in the garden.” She adds that the children also said they felt happier in the garden and liked working together.

The program was so successful that the school counselor contacted Swank to talk about continuing the program. The children had been asking the counselor when they could go to the garden again.

Exploring ‘EcoWellness’

Ryan Reese, an instructor of teacher and counselor education at Oregon State University-Cascades, co-developed with Myers the concept of EcoWellness, which explores the power of nature when integrated into the counseling process. He contends that experiencing nature in whatever manner — in a garden, on a mountaintop or even through an image on the computer screen — holds the potential to increase a person’s sense of well-being.

“I think nature is really at the core of who we are and that the connection runs deep,” says Reese, an ACA member who offers individual and family counseling services in natural settings. “In the last several centuries — because of the Industrial Revolution and the age of technology — we’ve really removed ourselves from it. Before that, we were really reliant on nature for survival.”

Although most of us are no longer quite so dependent on nature in our day-to-day lives, Reese believes that the mind and body still need and crave that connection. He notes research showing that even if people are sitting inside, a view of the natural environment — even in a mural or on a computer screen — reduces their heart rate and can reduce symptoms of depression and anxiety.

In fact, a research study described in a 2010 issue of the Journal of Environmental Psychology found in a series of studies that nature has an energizing effect on people. Many of the studies took place outdoors, but one study was conducted inside, with participants viewing photographs of either buildings or natural scenes. Those viewing the nature scenes received the same kind of energizing effects; those viewing the images of buildings did not.

In addition to an evolutionary need for nature, Reese cites the attention restoration theory developed by psychologists Rachel and Stephen Kaplan in the 1980s. The theory posits that activities such as reading, watching television or being on the computer require “hard attention” — a kind of attention that makes the brain work hard and which can leave people feeling tired and grumpy. In contrast, experiencing nature doesn’t require such hard focus or thought, and can thus provide a break for the brain and give people a sense of “being away from it all.”

Reese uses nature as a wellness tool in his private practice with clients who are interested. “I’m pretty careful not to promote my own agenda. All counselors should be aware of this, especially those [who] want to integrate nature,” he says.

Some clients like to have outdoor counseling sessions in which they walk with Reese on local trails while talking about their concerns. “It is often more comfortable for the clients to talk as we are walking,” he says. “For some — especially adolescents and men — it helps remove the stigma attached to sitting down face to face and talking about their emotions.”

One of Reese’s clients insists on all counseling sessions being outside. But for another client, being outdoors made it easier for her to dodge her issues, so Reese moved the sessions back inside.

Sometimes clients mention visiting an outdoor space in the past that gave them a sense of relaxation or freedom. When that happens, Reese requests that they do some homework — namely, revisiting that place and practicing being mindful or just “being.”

In other instances, Reese uses nature as a metaphor with clients because they don’t know how to describe what they are feeling or don’t want to confront it directly. For example, he worked with one young boy who had been acting out in school, including yelling at and hitting his classmates. During their first session together, Reese talked to the boy about nature and being outside. He discovered the boy liked to go to a local park and would be excited about meeting Reese there. With the mother’s permission, they met at the park and eased into the therapeutic environment by walking and throwing a ball. One day, Reese asked the boy to show him something in nature that he felt best described him.

“He pointed to this shriveled up, leafless, dying tree that was isolated, with no other plants around,” Reese recalls. The boy identified with the tree because it didn’t have any “friends” around it.

Reese then asked the boy to point to something that represented what he wanted to be. The boy pointed to a big, tall tree surrounded by many plants. In the boy’s eyes, this meant the tree had many friends and “shared” its shade with others.

The two trees gave Reese the opening he needed to assess the boy’s problems and goals. Going back to the trees helped the boy talk about his difficulties — and his progress — in a nonthreatening way, and his behavior gradually began to improve.

Reese thinks the natural environment is the missing piece in wellness models. In fact, the EcoWellness concept he co-developed (first described in the October 2012 issue of ACA’s Journal of Counseling & Development) posits that a person’s wellness is affected by the extent to which he or she is connected with nature. Reese has gone on to create the EcoWellness Inventory, which is a way of measuring the effect of nature on an individual’s overall wellness. Currently under peer review, the inventory is based on seven major factors: physical access to nature, sensory access, connection, protection, preservation, spirituality and community connectedness.

Discovering the sacred 

For some people, a connection to nature may be sacred. Others may find what they are seeking in a church, a temple or a mosque. Still others may reach a higher plane through meditation. Spirituality can come from organized religion or from a quiet place within oneself, but wherever one finds it, it can be an important part of wellness, says Craig Cashwell, a professor in the University of North Carolina at Greensboro Department of Counseling and Educational Development.

Participating in religious communities or spiritual practices can enhance wellness by cultivating a sense of peace and hope, which Cashwell considers antidotes to depression and anxiety. That’s why he believes that counselors should not be afraid to incorporate spirituality into the counseling process when appropriate.

“I think a lot of counselors really struggle with that because there’s a fear of imposing values on clients. That’s a wise fear to have, but I don’t think it should be a crippling fear that keeps us from exploring these issues with clients and making informed decisions about how and where and if to integrate spirituality into our counseling,” says Cashwell, who is also a private practitioner and the co-author of Integrating Spirituality and Religion Into Counseling: A Guide to Competent Practice, published by ACA.

“We start by distinguishing between religion and spirituality. For many people, those two are very tightly connected, but they’re not the same things,” Cashwell says. “Spirituality is a very personal set of beliefs and practices that are used to cultivate a spiritual life. For some people, this calls for a connection to a higher power, while for others, it’s more a kind of connection with their higher selves. I like to think of it as a personal process of transcending our own ego and sort of connecting to something bigger than ourselves.”

As for how to integrate spirituality into counseling, Cashwell says that depends on whether it is appropriate to the process and whether the client is open to it. “It can take lots of different forms,” he says. “[For example], we often use bibliotherapy in lots of different ways, encouraging clients to read particular books. In some cases we do consultations and referrals with members of the religious community when it’s beyond our scope as counselors, encouraging [clients] to talk to an imam, rabbi, priest or pastor, or whatever term they use, about particular issues when it’s appropriate.”

Counselors can also encourage clients to participate in spiritual activities if those activities tie into the clients’ belief systems, he adds.

But Cashwell cautions that spirituality is not always beneficial to wellness. “I think spirituality and religion can both be very vital aspects of wellness for people, but they can also be processes though which people are less well. It really depends upon how healthy the religion or the spirituality is,” he explains. “There are lots of examples of very toxic beliefs and practices out there that can actually decrease wellness.”

“When someone sort of self-identifies with a religious label or a spiritual label, as a counselor that tells me virtually nothing at all about that person,” he says. To determine whether a client’s spirituality is enhancing his or her wellness, the counselor needs to move beyond labels and ask about the person’s practices and beliefs, he emphasizes.

As an example, Cashwell recounts one client’s case, leaving out many of the details to protect the person’s privacy.

“I had a client who was recovering from an addiction. Two of the many questions on my intake form involve spirituality: ‘How important is spirituality or religion to you?’” — measured on a five-point scale — “and the follow-up question, ‘Is this something you would be interested in talking about in counseling?’ On this client’s intake form, he circled a very high number for spiritual importance, but when responding to the question about talking about it, he circled ‘No,’ which is always an interesting combination.”

When Cashwell gets that kind of response, he respects the client’s wishes. But as Cashwell and the client developed a stronger relationship through the first few sessions, he returned to the topic to ensure he had understood the client properly.

“What it came down to was he had a long history of being very religious, and it had created a lot of shame for him around his addiction,” Cashwell explains. “I asked him if he engaged in any spiritual practices, and he said, ‘Well, I used to pray all the time. I used to pray every day, multiple times throughout the day, and always at the beginning of the day.’ Obviously this was an important spiritual practice for him, so I asked, ‘Used to?’ And he quoted Scripture for me from the Book of Psalms, which is part of the Christian Bible, and this text basically said that God doesn’t hear the prayers of the unjust.”

In addition to being in recovery from addiction, Cashwell’s client had been medicated for obsessive-compulsive disorder. “He basically began to ruminate on that particular piece of Scripture and this belief that he was beyond forgiveness, beyond redemption and beyond mercy,” Cashwell says. “Psychologically, that was obviously not a good place for him, because he was basically saying, ‘I’ve done so many bad things, I’m such a horrible person, that I’m lost to any higher power in the universe. They don’t care about me.’”

“This was an attachment issue — a connection issue with his higher power,” Cashwell continues. “I knew better than to go at that directly because that could just create resistance on his part. But we began to talk about that, and I began to ask more about it, and I ended up asking for written permission to talk to his pastor. The pastor was astonished and said that this was not what the religion teaches us.”

The pastor met with the client and assured him there was nothing he had done that could not be undone or forgiven. Cashwell says that trying to advise the client of that himself would have blurred his role as a counselor. Reaching out and inviting in someone who was a significant spiritual influence in the client’s life was more effective,
he notes.

“He still struggled with it, but it really was an epiphany for him,” Cashwell says. “He began to entertain the notion that maybe — in his language — he could be redeemed, he could be forgiven for what he had done and that God did still care for him.”

“That’s an example of how, as counselors, we have to be careful of how we work with spirituality,” Cashwell says, “but it’s also an example of a time when it was powerfully evident that spirituality needed to be part of the treatment. I wasn’t the spiritual expert — his pastor was — but he could go talk to him and come back and discuss things with me. I didn’t blur the roles there. I could just use my counseling skills to help talk him through the process. If we hadn’t touched on that, hadn’t worked with that, I’m not sure he would have been able to stay sober because that was just a deeply rooted sense of shame for him.”

Whether they attach spirituality to it or not, Cashwell thinks most clients could benefit from engaging in some sort of contemplative practice.

“The beauty of that is it can take lots of different forms,” he says. “If the client is a practicing Buddhist or open to other spiritual traditions, you can talk about it as mindfulness, but for other clients who are indifferent to or opposed to religion, you can use Jon Kabat-Zinn’s work, which gives a more psychological and scientific slant to it. Of course, the largest religious group in the country is Christian, and within Christianity there are also some contemplative practices such as centering prayer and contemplative prayer.”

Cashwell points out that a small percentage of clients, such as those with schizophrenia or those with obsessive-compulsive disorder who ruminate, will not benefit from contemplative practice. But it can provide a wellness boost for most other clients. “It’s up to us to figure out what form that might take given the client’s spiritual views,” he says.

Art as an avenue to wellness

Andrea Berry believes art offers a therapeutic way to express difficult emotions. She also views art as a kind of creative mindfulness practice that can enhance wellness by helping people to feel grounded, calmer and more “centered.”

Berry is a private practice counselor and certified art therapist in Laramie, Wyo., who specializes in art therapy and counseling clients with medical conditions. Some of her clients come for her wellness program, which she describes as part counseling/part coaching.

Her practice is informed by her past as a clay potter. The clay wheel is used for centering the potter’s work, and it stands as Berry’s metaphor for wellness. “When you work with clay, you learn about centering the clay on the wheel, which actually makes it stronger and more flexible. You can make it bend and stretch without cracking,” explains Berry, a member of ACA. “You can build pressure [when manipulating the clay], move through the pressure and go through the fire and remain strong. The potter opens up the clay and stretches it — that is the job of the counselor — guiding, allowing the clay to remain strong.”

The art projects Berry uses vary from client to client. She says she doesn’t follow a “process” when choosing art projects; rather, it is intuitive and collaborative. “I might do some mandala work or some altar building. Or, I might teach people knitting or crocheting,” she says.

“I am also into gratitude and giving,” she continues, “so we talk about how wellness doesn’t have to be about you.” Her clients sometimes make things for other people, and Berry asserts this action often ends up boosting the clients’ mood and wellness.

Berry also takes a holistic approach, paying attention not just to mind and soul, but to body as well. “I refer people to nutritionists, physiologists, trainers … I even have clients who go to the gym with me,” she says. “I become the guide and share in their triumphs and struggles. I talk about my journey, and we work together to maintain wellness.”

Berry also uses art with clients who are trying to return to a state of wellness. “I work using a lot of nonverbal expressive therapies with people who are dealing with medical conditions themselves, people who have caregiver issues or [people] coping with bereavement,” she says. “There is a lot of evidence-based research in psycho-oncology on the use of expressive modalities — particularly art — for posttraumatic work.”

In fact, a 2006 study published in the Journal of Pain and Symptom Management found that art therapy helped reduce many cancer symptoms.

The medical process is traumatizing both physically and emotionally, and it can be hard for people to express that trauma verbally, Berry says. “It isn’t prefrontal cortex stuff — it’s gut stuff, it’s heart stuff,” she says. “So art therapy is a good nonverbal way for people to connect the head and the heart.”

Berry believes it is not only easier but also more effective to express trauma nonverbally. “We can talk our way through something, but we are not actually changing our internal response,” she says.

Berry says she creates a safe space for people to express themselves through art. “It’s about empowering the client — the client is the artist,” she says. Berry then helps her clients process the experience by talking about what they have produced.

“The specific projects vary from client to client,” she says. “For instance, I worked with a woman with dementia, and we made ‘scribble drawings’ together. We just sat there and scribbled. Part of her treatment plan was to have her engage with another person and have as much interaction as possible.”

At its most basic, the process involved Berry and the woman picking colors, scribbling and watching to see what emerged. “One day we came up with clouds and made a story,” Berry says. “This pushed her to go back and forth in conversation.” That experience represented genuinely hard work for the woman, Berry says, but strengthening that aspect of her functioning was a crucial part of her treatment plan.

In another case, Berry worked with the family of a teenager who had cancer. “We did collage work, and they all made collages of their experience of how cancer had changed their family — both good and bad — and then we talked about that.”

Helping the mind by helping the body

Kathleen Douthit, associate professor and chair of the counseling and human development program at the University of Rochester’s Warner School of Education, believes adopting a wellness perspective requires acknowledging the literal link between mind and body. She studies psychoimmunology (PNI), a discipline that explores how the mental process is linked to the nervous, endocrine and immune systems. By peering through the lens of PNI, she says, one can see a clear path from what we consider to be “just thoughts” to actual physical manifestation.

A crucial part of wellness is a healthy connection and collaboration between mind and body, says Douthit, a member of ACA. When stress becomes chronic, the mind and body “collide” rather than “connect.” This starts a chain reaction in the body that damages the nervous, endocrine and immune systems, she explains.

A healthy immune system is in constant communication with the nervous and endocrine systems. But chronic stress causes an information overload that derails this communication and causes immune system chaos, she says. A damaged immune system can’t perform all the functions that help keep us well. Inflammation then starts and damages multiple mind and body systems, Douthit explains.

“Inflammatory disease can cause conditions such as cardiovascular disease, fibromyalgia and chronic fatigue. Inflammation can also cause dementia later in life,” she says. “Once you start getting into something like cardiovascular disease, then you have inevitable problems with depression. If you don’t have enough blood getting to brain cells, you start running the risk of psychological problems.”

In addition to the effect of reduced blood flow, there are more direct assaults on mental health. For example, inflammation causes problems with neurotransmitters, Douthit says.

“There is some thought that this alteration is the key to some serious psychological disorders,” she says. “So, not only do you get a breakdown of the neurotransmitter process, you also have all these inflammatory cells floating around. You end up getting suppression of neuroplasticity, and that becomes really key in being able to lay down some of the pathways that we try to lay down in counseling.”

The good news, Douthit says, is that counselors are in a prime position to help by assisting clients in establishing a wellness regimen that combats stress and interrupts or mitigates this sinister chain reaction. Counselors can also help clients find support and assistance with areas such as nutrition and fitness, she says.

“There are all sorts of reasons that people aren’t willing to face their lack of wellness,” Douthit says. “Counselors can be really key to helping people work through that resistance — and that’s lifesaving. If you can really get someone to understand highly self-destructive patterns, you can help them understand the importance of intervening on their own behalf.

“Acknowledging the mind-body process — to me that is the key to human development,” concludes Douthit.



The following individuals welcome comments or questions from readers:

Kathryn Douthit at

Ryan Reese at

Jacqueline Swank at



References in this article


Integrating Spirituality and Religion Into Counseling: A Guide to Competent Practice, second edition, by Craig S. Cashwell and J. Scott Young, 2011

Journal articles

“Vitalizing effects of being outdoors and in nature,” Journal of Environmental Psychology, June 2010

“EcoWellness: The Missing Factor in Holistic Wellness Models,” Journal of Counseling & Development, October 2012

“Relieving Symptoms in Cancer: Innovative Use of Art Therapy,” Journal of Pain and Symptom Management, February 2006



Laurie Meyers is the senior writer for Counseling Today. Contact her at

Gatekeepers for the profession

By Kathleen Smith February 20, 2014

gateImagine you are a counselor educator sitting down to read the morning paper and find a mug shot of one of your counseling students on the front page. Or perhaps while attempting to complete an assignment for a substance abuse course, one of your students attends an Alcoholics Anonymous meeting and steals the spotlight by impersonating someone struggling with alcoholism. Or maybe in your family counseling course, a particular student insists on regaling the class with endless stories about his parents’ harrowing divorce.

These are just a few of the many (and more obvious) red flags alerting educators that not every student admitted into a counseling program is ultimately fit to enter the profession. But with school administrators and admissions departments often eager to expand the number of students enrolling in programs, counselor educators can find themselves quite alone in carving out and directing the process of remediation and dismissal of students. Counselor educators hold the unique position of being gatekeepers for their profession, attempting to evaluate what harm a student might do to future clients if he or she has a deficit of skill or a lack of insight into his or her own behaviors, values, biases and abilities.

With programs committed to having high graduation rates, faculty members have begun placing more focus on preadmission practices that can help them screen out students who are not ideal for the counseling profession. In addition to the standard one-on-one interview and admissions essays, these tactics often include group discussions or even planned social functions with other graduate students who remain on alert for any strange behaviors.

“We have a vignette blatantly related to social justice issues,” says Janee Both Gragg, an assistant professor and chair of the clinical mental health counseling program at the University of Redlands and a member of the American Counseling Association. “We ask them [prospective students] to talk through the vignette, and we just observe when the red flags appear. And definitely some of those biases will come out; you can feel the hairs on the back of your neck raise. You think, ‘This is not a good fit for my program, and not a good fit for the profession possibly.’ But you are also trying to figure out how much of that is ingrained and how open are they to learning and growing.”

Even after being accepted into a program, however, students often find that counseling course work elicits a desire to explore and share personal experiences. This often leaves counselor educators with the task of distinguishing between students attempting to integrate material into personal practice and those using classroom time as a version of personal therapy.

“The reason these issues come up more in a counseling world is because we are all trained as counselors,” says Julie Strentzch, an assistant professor at St. Mary’s University and an ACA member. “We’re good listeners, and we’re good at paying attention to the nonverbals. These particular individuals who are there to seek help rather than to learn how to give help are drawn to that ability. And because it is a part of our commitment as clinicians to do no harm, sometimes we get drawn into helping them before we realize that we’re almost enabling them. We have to keep good boundaries between what we’re doing as educators and what we’re doing as clinicians, but those lines tend to blur. I don’t think that people aren’t responsible and won’t deal with it in other [academic] departments. They just may not have the insight to catch it early.”

As documented faux pas in the classroom and the clinic begin to accumulate, counselor educators must consider whether to pursue remediation or academic dismissal. With counseling programs often housed in schools of education, counseling faculty may not find any other model in neighboring departments to pursue this type of combined clinical and academic scrutinization and correction. They must consider which traits and behaviors are correctable, and which continue to remain entrenched in the student’s character.

“A lack of awareness of how others perceive is No. 1,” says Scott Tracy, director of the graduate programs in counseling at Waynesburg University. “A very concrete example would be when a student in a class conversation is not aware that every other student in the class is rolling their eyes. The next one that is very important is an inability to self-correct. Everyone makes mistakes, but a counselor has to continue to learn and adjust.”

Other counselor educators agree that a deficit in skills is not as concerning as a counselor-in-training’s resistance to receive feedback. “Students are going to keep moving forward as long as they are able to sit with the discomfort and hear how they need to shift,” Strentzch says. “Because that’s also what we ask our clients to do. It’s when we meet the resistance and we can’t break through it that we have to do the remediation plan.”

Historically, in many academic programs, students with behavioral issues have been passed through by reluctant administrators with the rationale that those students will not be able to find a job in the profession, regardless of their diploma. Counseling faculty, however, must dedicate energy to examining the potential for future harm to clients that each student poses, while also managing the frustrations of the present. This position can put them at odds with admissions staff, who may encourage programs to admit up to three cohorts a year or expand course offerings.

“There is a pull between really high monitoring and quality of a cohort coming in, and the demand and pressures that faculty members have in working collaboratively with marketing and admission,” Gragg says. “I draw hard lines on certain things, but anywhere else I can be flexible, I go above and beyond because I have to sustain the relationship. When I started this program, I wanted to absolutely understand the process of having the pieces in place for remediation. And I’m not going to ever graduate, if I have a say in it, someone who’s not appropriate for the profession.”




Kathleen Smith is a family systems counselor and postgraduate trainee at the Bowen Center for the Study of the Family. She is also a doctoral counseling student at George Washington University. Contact her at

A passion to serve: veterans and counseling Q+A

Compiled by Bethany Bray February 18, 2014

SoldiersSuicide rates. Chain of command. Posttraumatic stress disorder (PTSD). Military jargon and slang.

For counselors, working with military veterans brings its own challenges and need for baseline knowledge.

“Just as with any other culture that is different from your own, it is not enough to simply want to help members of the military. There is a need for true cultural knowledge and competency,” says Natosha Monroe, co-leader of the American Counseling Association’s Veterans Interest Network.

The network, composed of roughly 85 counselors, serves as a sounding board for discussion and insights on counseling military service members, both active and retired.

From how better to advocate for nonmedicated therapies to strategies for navigating the Department of Veterans Affairs (VA), members of the interest network strive to learn from each other and stay current on issues that affect the military population, says Monroe.

Monroe, a practicing counselor in the Dallas area, is one of seven people who moderate the Veterans Interest Network. She served 13 years as a behavioral health specialist in the U.S. Army and is a sergeant first class in the Army Reserves. Monroe has provided mental health care, both in humanitarian efforts and support services for U.S. troops, in Haiti, the Dominican Republic, Afghanistan and Guantanamo Bay, Cuba.

“I am not an officer in the Army,” Monroe explains, “because currently no military branch recognizes our profession [of counseling]. All behavioral health care officers/providers are social workers, counseling/clinical psychologists or psychiatrists only.”


Q+A with ACA’s Veterans Interest Network

Responses written by Monroe, with input from network co-leaders Patrick Gallegos, Todd Burd, Xiomara Sosa, Keith Myers, Linda Sheridan and Tony Williams.


Why should counselors be aware of/interested in veterans issues?

Our group offers ACA members three primary things:

1) A place within ACA for veterans to come together to share and discuss similar interests, support veteran members who are deployed and to interact in a way that will hopefully resemble the camaraderie many of us have experienced in our military service.

2) An opportunity for counselors interested in working with the military population to share ideas and to learn more about the military population through conversation and observation.

3) A place to network with others who have like-minded ideas and issues specific to military counseling-related topics.


What challenges do counselors face in this area?

1) Veterans often have decisions made about their best interests but not so often are asked their opinions on what they’d like to see happen. This often leads to gaps in real needs being fulfilled.

2) Oftentimes counselors have never had any military experience and they see military clients without being culturally competent first.


What are some trends you’re seeing?

Service members are experiencing an almost exclusively medical model of treatment when they seek mental health help. Most are never given the option for nonpharmaceutical care and in some cases are reporting being given more medication when they report that the medication is “making them feel like a zombie.” It is very difficult for them to see LPCs (licensed professional counselors).


What would a new counselor need to know about working with veterans?

1) Just as with any other culture that is different from your own, it is not enough to simply want to help members of the military, there is a need for true cultural knowledge and competency.

2) Don’t jump the gun and take therapy or diagnosis down the wrong track. For instance, truly look at symptoms rather than seeing a person who’s been to war, has nightmares and then “bam,” label it PTSD.

3) Thoroughly examine your client’s previous diagnoses and don’t just go with it. Same with medications.


What would a more experienced counselor need to know?

Same response as above.


What are some tips or insights you’d give regarding veterans that could be useful to all counselor practitioners?

Out of respect and professionalism, take the time to learn things such as military rank and structure, military language/slang/terms and what current military operations are going on in the world. If you know none of this, what does that say to your client? Ignorance of military culture interrupts the therapeutic experience every time a counselor looks confused or has to stop a train of thought for a definition or clarification.


What are some current issues or hot topics that the interest network has been discussing?

We are passionately advocating for members of the military to have equal access to what our profession can bring to the table — nonmedication therapy for their mental health care needs.

1) Right now, the VA system blatantly discriminates and, in most cases, completely excludes [licensed professional counselors] from counseling positions.

2. Currently, there is a complete exclusion of licensed professional counselors in positions of behavioral health care officers in all military branches, making ours the only mental health care profession, along with marriage and family therapists, that is not recognized or allowed to serve in uniform.

3) Grandfathering in of non-CACREP counselors into the VA system and also for various health insurance policies.

4) Increase awareness and respect to the fact that service members fall within a unique micro-culture within the society as a whole and must be given multicultural consideration in therapy sessions by all counselors — meaning too that counselors must be culturally competent prior to beginning work with the military client.

5. Increasing awareness of specific mental health care concerns such as suicide rates.

6. LGBT integration into health and wellness benefits and rights.


What makes you personally interested in this area?

I (Monroe) am a veteran, and it’s frustrating not to be allowed to do my job in the Army. Also watching my fellow soldiers constantly being heavily medicated without being offered the option of seeing someone in our profession.



The Veterans Interest Network is one of 17 interest networks open to ACA members. In the coming months, CT Online plans to highlight each network – from sports counseling to traumatology – with an online Q+A article.

For more information on ACA’s interest networks or to get involved, see




Bethany Bray is a staff writer at Counseling Today. Contact her at

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