Monthly Archives: July 2014

College disorientation

By Stacy Notaras Murphy July 24, 2014

Jane (name changed) came to the counseling center at Georgia Regents University (GRU) just one month after school started. A first-year student whose home was approximately a three-hour drive from the university, this was her first time being away from her parents. Her transition to college raised a number of different issues for Jane and resulted in her experiencing a high degree of anxiety, says Virginia Luke, an American Counseling Association member who serves as assistant director of the counseling center at GRU.

“She was living with three other students and was having a hard time communicating her needs to them. She was also having difficulty keeping up with her class assignments,” Luke recalls. “We developed a schedule for her to follow, as well as study skill training for college-level classes. For her relationship issues with her roommates, we worked on assertiveness training so that she could better express her opinions and needs. We worked on some relaxation training to help her with her anxiety issues.”

The true challenge of counseling today’s college students may be handling the sheer variety of issues that a single client can experience. Yes, college still stands as a time of great personal growth and joy for many of these students, but rates of anxiety and depression are also on the rise for this demographic. According to groundbreaking research by Penn State’s Center for Collegiate Mental Health (CCMH), 75 percent of all diagnosable mental health disorders become apparent by age 24. Given those numbers, it is reasonable to suspect that counselors both inside college counseling centers and outside of those facilities will be seeing more college students in their offices. In fact, counselors tuned in to the unique needs of this population may be on the front lines of preventing long-term mental health crises.

According to CCMH Executive Director Ben Locke, since CCMH began its innovative study of collegiate mental health in 2008, most student mental health concerns — including suicidality, self-injury and entertaining serious thoughts of hurting another person — have been climbing. “Part of the reason we started the project was that everyone was saying, ‘The sky is falling!’ But there was no data to back that up. This is data that really does back that up,” Locke asserts. “Now we’re able to talk about how these things are really happening, and, really, things are getting worse. We’re not just complaining.”

As an example, Locke points out that more students are entering college having experienced prior mental health treatment. This usually means they will respond to treatment in college more slowly than will students having their first experience with mental health issues, he says. Locke adds that students with prior mental health issues start off in more distress than their peers and often require more time in counseling, which puts new stresses on student mental health centers.

New life, new stressors

GRU’s Luke specializes in helping college students who are facing complicated transitions. “Many are away from their support system of family and friends. They may have issues adjusting to a new environment where they are not familiar with their surroundings such as where to shop, where to eat, where to get medical attention as well as [where to get] social support. In addition, they may find that at home they have their own space, and now they move into a residence hall where they may have to share their space with others,” she explains, adding that students may feel lonely, anxious and depressed as a result. “They are away from home and may find a new freedom for themselves and may make poor decisions about drinking, sex and drugs. They may experience stress about the amount of academic work required in college versus the amount of work required in high school.”

Wendy Killam is an ACA member and director of the clinical mental health counseling program at Stephen F. Austin State University in Nacogdoches, Texas. Her dissertation explored college student adjustment and wellness, and she knows firsthand the variety of transitions faced by these young adults. “For some, it’s the first time they have had to do their own finances, or just wake themselves to get out of bed or do their own laundry,” she says. For many students, she adds, college is also a time of significant exploration that might include drinking alcohol and having new sexual experiences.

“There are a lot of pressures, and one of the biggest things is that they often really are not ready for college in the first place,” Killam says, pointing to the number of remedial math and English courses offered at her university. “It’s hard to play catch up because your high school did not prepare you.”

Josh Gunn, the director of counseling and psychological services at Kennesaw State University in Georgia, agrees. He says both the academic and social pressures on students are starting earlier — even in elementary school — and that many students are not entering college with strong coping skills. “They show up a little less prepared to manage their personal selves, their stresses, their disappointments,” says Gunn, the immediate past president of the American College Counseling Association (ACCA), a division of ACA.

Noting the usefulness of the CCMH data, Gunn says research is showing that anxiety is the primary presenting problem for today’s college students. “For many years, [the main presenting problem] was depression. Now it’s anxiety,” he says. “I don’t think the economy has helped this at all. There was a time when you knew you would live a better life than your parents, but now kids come to college wondering if they will get through and even get a job or have health insurance at the end.”

Gunn points to outreach as a primary responsibility for counselors on college campuses. “You can’t just have a counseling center tucked away and hope they come,” he says. “We want to be as integrated as possible. We talk to anyone we can. We align with academic programs [and] we identify times in college student life when they may have more mental health issues.”

As an example, he mentions Kennesaw State’s nursing program, which is very competitive and rejects many students who apply. “When the students start applying, we [the counseling services staff] share the information, very softly, that ‘most of you won’t get into the program, and if you don’t, we are here to help you.’ It’s prevention work. We can support them and even help them find new careers.”

Killam says most schools are beginning to offer student orientation information regarding the transition to college. She adds that alcohol awareness is often a part of that education. Such programs offer prime opportunities for collegiate counseling centers to highlight mental health services, she says, but often, counseling centers don’t have the funding to support new initiatives or the necessary staff to take on all the new clients that those initiatives might generate.

“Like a lot of things, it has to do with campus culture,” Gunn adds. “The campus has a responsibility to develop a culture that pays as much attention to the students’ mental health and wellness as to their GPA.”

Max capacity

Most in the field agree that for treatment to genuinely be effective, clients need the gift of time to build a strong rapport with their counselors. But with tight budgets and a spike in the number of students seeking care, some counseling centers are feeling the pinch.

ACCA member Jonathan Kerr is director of counseling and career services at Toccoa Falls College in Georgia and also keeps a private practice on the side. He describes his center’s work as relational in nature, focusing on students’ transitions from home, changing intimate relationships, roommate issues and changes in friendship groups. “What seems to work best in therapy [with college students] is taking time to establish rapport, even though brief solution-focused therapy is the way things are moving,” Kerr says.

He describes working with one student who had suffered a breakup. She expressed feelings of depression and said her schoolwork had suffered, but it took her five sessions to feel safe enough to talk about the breakup. Both Kerr and the student noticed that the sessions that followed were more productive in moving her through the counseling process — helping her understand why she was struggling and getting her back on track with her schoolwork — but it first took time for them to build the therapeutic relationship.

After looking at Kennesaw State’s internal data, Gunn confirms that more students are using the university’s counseling services. “The number of appointments went up over the past five years, and, no, we didn’t hire more clinicians,” he jokes, adding that because college enrollment is on the rise, so is the need for counseling centers to serve those students.

Killam concurs: “If you contact just about anybody who works with college students, most of them will say they are just plumb overwhelmed by the demand [for their services]. … Most college campuses have a waitlist and will try to see people for emergencies, but more and more kids are coming in for mental health. And more and more, they are coming into campus already suffering with major mental illnesses.”

Research can be a strong tool when making the case for more collegiate mental health resources. Locke notes that some preliminary, unpublished CCMH data reaches the clear conclusion that the services provided by college counseling centers are highly effective. “We know the services are effective, so what’s the problem? The problem is the amount of services being provided,” says Locke, who explains that immediate treatment is rarely available for those who seek it via the overwhelmed college counseling centers. “The students who come [into the counseling center] a month into the semester probably are going to end up on a waiting list, or the clinician will say, ‘I can’t see you for three weeks.’ Within each campus, there is a relatively small group of people who get real treatment.”

Similar scenarios being played out on campuses across the country should provide the fuel for public policy discussions regarding the proper funding of college mental health services, Locke says. While limiting the number of sessions per client may help counseling centers manage costs, he says, those service limits can have a negative impact on treatment efficacy. “You need to provide treatment in a responsible way. You need to provide treatment until people respond,” he says.

The next step, Locke adds, is linking the effectiveness of mental health treatment to the university’s bottom line. “If we show that students who are treated effectively stay in college until graduation, that’s good for everybody,” he says. “In general, we’ve been seeing studies coming out that if you come to a counseling center, you are more likely than your general peers to remain enrolled.”

Despite the generally overburdened nature of college counseling and the low wages that may prevent people from considering it as a career path, Gunn says there are perks to working with this population that go beyond simply having summers off. “In the mental health field, we’re one of the best quality-of-life places you can work,” he says. “The fact that we are not dealing with insurance — because a majority of centers do not — we don’t have the hassles of private health care, and we’re not as bound to seeing a person only a few times due to a diagnosis. I get to do therapy with individuals and in groups, but I also talk to classes about how to sleep better, deal with stress better and have better relationships.” Gunn adds that more professional counselors are moving into college counseling at smaller community colleges, where their responsibilities may be more varied and interesting than what they were doing before.

Locke agrees, adding that compared with those working in community mental health environments, some might say collegiate mental health providers are “in the lap of luxury,” with their summers off and with clients who have more resources than the average client.

Yet he also points to the fact that, as estimated by the Institute for Health Metrics and Evaluation, mental health’s “global burden of disease” has reached 30 percent in the 15-24 age bracket in the United States. Meanwhile, the amount spent on mental health care, as compared with all dollars spent for health care in the United States, is around 6-7 percent, Locke says.

“The point is that sort of at a very bird’s-eye perspective, the burden of mental health problems is many times that at which the treatment is funded. And college counseling centers are struggling at the same place that community mental health and hospitals are struggling,” he says. “There’s a real imbalance there.”

Meeting needs

If college counseling centers are overburdened and resources are stretched thin, it stands to reason that some counselors in other settings will find college students on their caseloads. Recognizing the variety of stressors that accompany the transition to college and possessing an ability to work creatively are essential to having success with these clients. An effective treatment plan may include skills building, cognitive behavior techniques, mindfulness-based stress reduction and group work.

Luke notes that counselors working with college students should be open to dealing with a variety of problems. Counselors may see clients who come in because they feel they have deficits in time management and study skills or struggle with test anxiety, she says. “On the other end of the spectrum, we have seen more students coming in who have been previously diagnosed with psychological issues, are currently seeing a psychiatrist and are on medications,” she says. “These students typically require closer supervision and multiple sessions dealing with the transition to college.”

Counselors working with college students say healing often occurs when these students learn they are not alone in facing transition struggles. While Gunn argues that group work is often as good or even better than individual counseling for such cases, he acknowledges that many students imagine counseling being a dyadic process that doesn’t involve the input of others.

“The students who join our groups, for the most part, love them once they get in there and realize there’s a group of people who are ‘just like me.’ That’s so much more valuable,” he says. “There’s something very healing about working with peers working on common goals. It allows them to get help and to provide help to others.”

Killam agrees that groups can be highly effective but has noticed that college students are reluctant to join groups formed by college counseling centers due to the lack of anonymity. “Today’s college kids will post all kinds of things on Facebook, but they won’t go to [campus] groups because they might be embarrassed,” she says. Off-site group work can be a useful option for students afraid to show up for a group session on campus but who might thrive under the experience sharing and interpersonal learning delivered in group counseling.

Kerr has witnessed the same reluctance among students about joining therapy groups at the Toccoa Falls College counseling center. “Part of it is that we are a small campus, and it’s really hard to keep the perception of lack of confidentiality under control,” he says. However, he notes, the counseling center has had success with very small groups addressing targeted issues such as trauma and men’s issues.

Gunn encourages counselors to be creative when spreading the word about the mental health benefits of counseling, on campus and off. Citing the example of social skills training, he suggests that calling it a “psychoeducation workshop” as opposed to something that sounds more shaming might be the difference between a student getting help or trying to go it alone.




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:


It takes two (or more)

By Laurie Meyers July 23, 2014

gears_brandingDespite the American tradition of “rugged individualism,” working successfully is rarely a solitary activity. Although counselors are proud of their professional identity and strive to be experts in whatever their specific disciplines may be, there is still room for — even a need for — communication and the exchanging of ideas with individuals from other professions. The counselors in this article have found better ways to serve their clients, as well as significant professional satisfaction, by collaborating with others.

A team approach to teaching social skills

American Counseling Association member Chris Abildgaard has known for a long time that he wanted to help people with autism spectrum disorders.

“The first time I ever worked with a person with autism was in 1998 when I was a junior in college,” he recounts. “I just realized that for whatever reason, I clicked with and understood people with autism.”

That desire to help has taken Abildgaard, a licensed professional counselor (LPC) and national certified counselor (NCC) in Wallingford, Connecticut, from school psychology to private practice to a new multiprofessional collaborative practice that is built around the concept of “social thinking.”

Abildgaard, who specializes in autism spectrum disorders and social cognitive intervention and is certified in behavioral interventions for autism, started his career as a certified state school psychologist, which helped shape his view on collaboration.

“While working in the public schools, that’s really where I got my start in understanding the need to collaborate with other professionals and learn from other fields and disciplines,” he says. “In doing that, I think I have been able to explore different methodologies in terms of what works and what doesn’t work.”

Abildgaard bases his interventions in cognitive behavior therapy (CBT) and social thinking. Social thinking is a methodology developed by speech language pathologist Michelle Garcia Winner that focuses on how human interaction requires thinking about other people and what they might be thinking about us. According to Winner, our perception of what people think affects how we behave, which in turn affects other people’s perception of us. However, some people, such as those with high-functioning autism spectrum disorders, social communication disorder, Asperger’s syndrome, attention-deficit/hyperactivity disorder (ADHD) and nonverbal learning disability, don’t intuitively develop the nuances of social interaction.

Winner developed a curriculum and founded the main Social Thinking Center in San Jose, California, where she now teaches. Professionals in other fields who work with populations with social deficits can receive training in the social thinking method at conferences held at the various Social Thinking Centers nationwide.

“Social thinking incorporates a lot of the principles of CBT and gets to the essential questions like ‘why are we social?’ It really starts to define what social is,” Abildgaard says.

Abildgaard discovered social thinking six or seven years ago when the administration at the school where he was working assigned him to teach a group of four students who had varying presentations of autism and possessed different skill levels. “It was one of the most daunting things I’ve ever had to do because I had no idea what I was doing,” Abildgaard says.

In his search for additional methods to help the students with autism, he came across social thinking. He was so impressed with the treatment framework that it became an essential part of how he counseled, and when he went into private practice, he ended up founding the Social Learning Center, which uses the precepts of social thinking to improve clients’ social cognitive abilities. The center targets and teaches clients:

  • How their social minds work, including why they react and respond the way they do
  • The behaviors that make others feel good and bad
  • How these behaviors are affecting their emotions, responses to and relationships with others in different social contexts
  • The “why” behind the specific, isolated social skill and the reasons it would benefit them to use the skill
  • To consider the thoughts and feelings they create based on their behaviors, whether expected or unexpected

Abildgaard and his clinical staff of social workers, a therapeutic recreation specialist and a speech pathologist, plus interns and clinical associates in the fields of mental health counseling, psychology and related areas, teach those concepts using a variety of methods.

“It starts with learning from clients and their families and then asking, ‘How do we help our clients with social learning difficulties be independent and live in the world that they want to be in?’” Abildgaard says.

The Social Learning Center provides both individual and group therapy. In part, that is because functioning in a group is one of the areas the center’s young clients struggle with most, Abildgaard says.

“It’s very rare that you find people in schools who tackle what it means to be in a group,” he says. “You have to be in groups in class all day, and a lot of our clients don’t understand why they have to engage in these behaviors and why they should care about the kid next to them.”

Another area that typically proves challenging for many of the center’s clients is social interaction and feeling comfortable with others. The Social Learning Center’s team teaches its clients that it is OK for them to feel awkward and uncomfortable in social situations, even pointing out that everyone feels uncomfortable at times. However, the team emphasizes that part of life is learning what to do when we feel uncomfortable.

Many clients with social difficulties can become rigid because of their compelling need and ongoing search for comfort. For instance, Abildgaard says, a child or adolescent might wake up on the weekend and have every moment planned in his or her head. However, this plan may not fit with what mom and dad want to do, and this causes conflict. When this scenario gets repeated, it can lead to the young person being labeled as disruptive, in part because the child or adolescent does not understand, and thus is unable to explain, why he or she is reacting that way. For that reason, Abildgaard’s team works with clients on flexible thinking — understanding that not everything has to be planned out and that it is important to consider the thoughts and plans of others as well.

The center also likes to get its clients out into social settings rather than just having them learn about skills in an office. Abildgaard believes that the more socially oriented training that social workers receive is particularly beneficial for coaxing clients out. For instance, one of the social workers at the Social Learning Center is a proponent of adventure therapy, which aligns with Abildgaard’s mantra to all of his therapists: Get outside with your clients; don’t just sit at the desk and talk about being social.

Abildgaard also describes the involvement of the staff speech pathologist as critical. “I think sometimes we forget that behavior is communication,” he says. “When you are working with a client who has so-called behavioral deficits, some of that involves communication difficulties. Treating the behavioral problems is not just about extinguishing the behavior, but finding a way to communicate those thoughts and feelings in words.”

“I’m also continually reminded that sometimes we take for granted the difference between verbal and nonverbal communication,” he continues. “We don’t just communicate with our mouths, but with our faces and bodies.”

Body language typically clues people in to behaviors and unspoken thoughts, but this is something that people with social difficulties often have trouble interpreting. For instance, they might see a look on someone’s face and think it means the person isn’t interested in what they are saying when, in reality, the person is just thinking about what has been said and how to respond, Abildgaard says.

People with social difficulties also have trouble understanding what their body language is communicating to others. The speech pathologist at the Social Learning Center uses mirrors and videos so clients can see their own facial expressions and body language. This helps them start to learn how their nonverbal behavior affects other people.

“I’ve always thought [that we] need to integrate other disciplines in order to bring about the most effective change and treatment options for people,” concludes Abildgaard.

Helping the severely mentally ill to build better lives

During her more than 30-year career working as a counselor in the city jail system in Kansas City, Missouri, ACA member Nancy White has seen many people who were severely mentally ill cycle through the detention system. Oftentimes, these former inmates ended up in homeless shelters or in and out of psychiatric facilities. This was also the case with many other Kansas City residents who struggled with serious mental illness.

So, when management in the behavioral health department at Kansas City’s Truman Medical Center — where White worked counseling people who were homeless — asked her to help build and manage a new Assertive Community Treatment (ACT) team, she jumped at the chance. ACT is an outpatient treatment approach that provides personalized, comprehensive community-based care for those with serious, chronic and disabling mental illnesses.

Sometimes referred to as Program of Assertive Community Treatment, Mobile Treatment Teams or Community Support Programs, programs that use the ACT model are staffed with a multidisciplinary team of professionals such as counselors, psychologists, psychiatrists, social workers, medical doctors, nurses, substance abuse specialists and others. ACT programs can be run at the state, county or municipal level by mental health centers, private nonprofit or for-profit organizations, outpatient units of hospitals, managed care companies or other providers. The teams offer people with serious and chronic mental illness individualized assistance that includes mental and physical health services, substance abuse treatment, assistance with finding jobs or housing and a variety of other services.

“One of the reasons we [the mental health community in Kansas City] started ACT is that many of our mentally ill citizens were spending time in emergency rooms, the hospital, psychiatric units and jail,” explains White, an LPC who manages the team. “We hoped that by providing intensive services, we could begin to reduce their hospital stays, jail stays and homeless issues.”

The program is able to provide such intensive and personalized treatment because of the low client-to-staff ratio — about one staff member for every 10 clients, White notes. In addition to a psychiatrist who provides about 12 hours of treatment a week, the staff is composed of a registered nurse, two LPCs (in addition to White), two vocational assessment professionals and three dedicated case workers (even though everyone pitches in with the case work).

In addition to the low client-to-staff ratio and the diversity of the staff, it is the focus placed on clients that makes the program work, White says. “When a patient first comes in, we meet with them to find out what their needs are and try to meet [those needs],” she says.

Building the clients’ trust level with the staff is also essential, White continues. “We need to show them what we can do for them before it [the relationship] will work,” she explains. “You have to find a way for this person to trust you so that they keep seeing you. If you say you’re going to do something, do it, or they won’t trust you. I tell my staff to never promise something they can’t deliver.”

Clients are referred from a variety of sources such as jails, psychiatric emergency rooms, drug courts, mental health courts and homeless shelters. Many are referred because of ACT’s contacts in the city.

White still sometimes works at the city jail, and the county jail is housed in the same building, so she has co-workers in both systems. “The ACT program can really be a reentry program for people coming out of jail,” she says.

White has encouraged the director and social work staff in the jail system to refer released prisoners with serious mental illness to ACT for evaluation. She also maintains contact with the physicians at the psychiatric emergency room and sometimes visits inpatients to tell them about ACT.

White and her team have also performed training sessions on crisis intervention at the Kansas City police department so that the officers will better understand people with mental illness when they encounter them on the streets or in jail. She also collaborates with the local mental health court. The staff there will sometimes call her after evaluating candidates for mental health court, and some of these individuals will end up at ACT.

White and the rest of the ACT staff deliver a range of services but start with the basics: food, clothing and shelter. After that, psychiatric care is delivered on the client’s terms. Wherever the client feels safe — whether that is at home, in a park or in another public place, is where the program’s psychiatrist will go. “We have the ability to say, ‘We know that you are frightened to go to a psychiatrist; can he come to you?’’ White explains.

White notes that the psychiatrist’s involvement in the program goes well beyond prescribing medications. In fact, this summer, he has been spearheading a program to get clients involved in gardening. Two of the program’s clients see him for therapy, but they also have regular sessions with the LPCs, as do the other clients.

“Counseling has been particularly important for many of our clients with chronic and persistent mental illness,” White says. “It has given them a chance to form a therapeutic relationship with a licensed mental health professional and has allowed them to talk about things that have happened in their lives — things that I suspect they have never discussed with anyone before.”

Reaching out to clients — getting them involved with and able to take advantage of community services — is a big part of ACT. Much of what White’s team does is possible because of the connections the staff makes in the community at large. For example, the ACT team regularly partners with church programs and food shelters to provide basics such as clothing and food.

“We collaborate with churches for food a lot,” White says. “We have enough of a relationship that if it’s after hours and a client needs food, we can call these places and say, ‘Hey, we know you’re not open right now, but we have someone who really needs food.’”

The team also helps clients find housing. Most clients do not come to the program homeless, but some are in group homes or living with their families and would like to start living independently. Over the years, the team has established relationships with apartment managers in the community.

“Once a client has found a place they want to live, we go with them to check it out,” White says. “If we like it, we may end up referring other clients.”

Team members visit clients regularly in their apartments to check on them. Sometimes while visiting with one client, White says, they run into others and have an additional opportunity to hear how they are doing. Residents and managers of the apartments get used to White and her team being around, so they become a kind of extended family. Clients look out for one another, and the apartment managers also reach out to the ACT team if they are concerned about the well-being of any of the residents.

Frequently, finding a place for the client to live is just the first step, White notes, because many individuals with severe mental illness need help with basic tasks of daily living. “Often they don’t know how to cook, how to clean or do laundry, so we teach them,” she says.

Sometimes the clients even want to go beyond the basics, like with money management. “A lot of clients have what’s called a professional payee. Someone has decided they aren’t able to manage their own money, so the bills are being paid by the professional,” White explains. “So we give them financial education so they can become their own payees.”

Although living on their own is a very important goal for clients, the ACT team also endeavors to get them involved in their communities. They can attend ACT-run substance abuse, therapy and vocational groups, and ACT team members will also take clients out to look for work. The team also finds drop-in centers where clients can be with other people, take classes, join groups for fun, go to a movie or participate in some other kind of outing.

“We’re trying to meet basic needs and help them have a better life, function socially and maybe even have a job,” White explains. “We want to increase their time spent in the community rather than in the hospital.”

“We’re also trying to make it better for their families,” she continues. “By the time a client has gotten so sick that he or she is in jail or in the hospital, the family often doesn’t know what to do anymore.”

To coordinate all of this activity and stay on top of clients’ welfare, the team meets every day to talk about which patients might be doing poorly or need extra help. The ACT team also maintains a 24-hour hotline that clients can call when they need help. “A staff member is always on call, so it’s not a stranger — it’s someone they know,” White says.

Making such a huge difference in people’s lives is rewarding, White says. “There are clients who are so debilitated when we begin to work with them — often still psychotic, very symptomatic — that any little progress is a great thing,” she says.

But the progress can also be dramatic. “I’ve seen some amazing things. To see these people get better instead of seeing them behind bars or strapped in bed is so unbelievable,” White says. “It shows that maybe if they had gotten the right services at the right time [earlier in life], maybe they wouldn’t have had to suffer so much.”

Schooling education administrators

School is an environment in which multiple professionals with varying educational and professional backgrounds — think teachers, administrators and school counselors — must work together. Sometimes, however, these professionals don’t truly understand the role that their colleagues actually play — or are qualified to play. These misunderstandings can negatively affect the relationship between colleagues and, worse, carry over to affect the relationship between staff and students.

That disconnect is something that Summer Reiner, an ACA member, witnessed firsthand during her five years as a school counselor.

“It became obvious to me that most people in the school didn’t really understand what counselors do,” says Reiner, who went on to write her dissertation on teachers’ perceptions of counselors. She found most teachers assumed that all school counselors were mirror images of the counselors they had worked with early in their careers. They had little idea of the specialized training school counselors receive or the breadth of skills and knowledge they possess. And because many school administrators are former teachers, this meant the people who had the most control over how school counselors were deployed to do their jobs often didn’t understand what these counselors could or should do.

When Reiner joined the counselor education faculty at the State University of New York at Brockport as an associate professor and school counseling program coordinator, she decided to take a look at the education administrators’ program to see if she could bring about a meeting of the minds.

“I looked at the administrators’ course work, and I saw that they had no training on any of the other school professionals’ roles,” Reiner says.

They did, however, have a course on program evaluation, and in one of Reiner’s courses, school counseling students develop a comprehensive school counseling program. So Reiner proposed that the two classes hold a mock school board meeting in which the counseling students would present their school counseling program. Because the education administration students were trained in program evaluation, they would evaluate the counselors’ program.

In anticipation of the mock board meeting, Reiner gave a presentation to the education administration class about what school counselors are trained to do and what they are not trained to do so that the administration students would have a frame of reference when they evaluated the school counseling program.

“It became a truly collaborative experience because my students got to have the experience of presenting in a board of education setting, and we had the opportunity to educate the administrators on what school counselors are trained to do and what they should be expected to do,” Reiner says. “And the administrators benefited from being able to put their skill set to the test in terms of evaluating a program and learning how to give feedback.”

At the end of the experience, the counselors-in-training also gave feedback to the future school administrators about how they came across when providing the evaluation.

“They [the counseling students] might give an example like, ‘You know, when you looked over your glasses at me and spoke to me, that was intimidating,’” Reiner recounts. “So it raised awareness among the administrators around how people might be receiving their messages.”

After the mock school board meeting, both sets of students reported feeling that the experience had been very educational for them. In fact, they wanted more. “So, as the years went on, we began to add more and more collaborative pieces to this experience,” Reiner says.

Another major collaborative project is an assignment in which both groups choose a school district and go online to download data about the surrounding community, including school report cards, housing information, prevalence of crime (both inside the schools and in the larger community) and other information. The school counseling students evaluate the data and develop recommendations on what they can do to help address problems in the community, while the future administrators detail how they would want their subordinates to approach the issues.

For example, the school counselors might find that the district has a drug problem and propose starting a drug counseling initiative. The school administrators might want to set up brief educational sessions in small groups that all students would eventually attend. In the process, both groups learn how the other would handle a similar situation. Afterward, they evaluate the ideas and provide feedback to one another concerning why the proposed solutions might or might not be possible to implement, Reiner explains.

Another part of Reiner’s administrator-school counselor collaboration is lesson plan evaluation. School counselors are charged with helping students grow emotionally, socially, academically and developmentally. One of the ways they do that is by coming into classrooms to teach. Although typically a small part of their jobs, it is often the piece weighed most heavily by others, Reiner explains. But given all that school counselors have to learn as part of their training, lesson planning often takes a back seat, so Reiner thinks it is useful for the students to get help from the student administrators, many of whom are former teachers and are adept at lesson planning. The counselors-in-training not only develop lesson plans for the future administrators to read and evaluate, they also “teach” their lesson plans in classroom presentations. The administrators-in-training can then provide tips regarding content and engaging students. On the other side, the counselors-in-training can help the future administrators understand why certain lessons that might be controversial, such as open discussions about sex, are developmentally appropriate and important.

Reiner hopes her collaborative program will be a step toward greater understanding and communication between school counselors and education administrators. She eventually wants to conduct a study of the real-world outcomes of the program to determine whether the lessons stick in the long term or simply raise awareness in the moment.

However, Reiner is pretty confident of the effect the collaborative program is having on her school counseling students. “I think they come out of it feeling much more secure that they know what they are doing and that they are good at it,” she says.

The parent coach

Counselors are no strangers to addressing problematic parent-child interactions, whether as part of family therapy or as an element of counseling interventions with individual child clients. But Meghan Walter, an ACA member and NCC from the Orlando, Florida, area, has found it helpful to take a more hands-on, training-oriented approach by incorporating “parent coaching” into her services.

“Parent coaching is closely related to counseling but is a very distinct, specialized kind of consulting,” says Walter, who now operates a private practice as a parent coach. “Instead of focusing on someone’s background or specific personal issues, we help clients identify their parenting goals and give them tools to reach those goals.”

Unlike counseling, parent coaching is a relatively brief intervention that usually takes three to four sessions, Walter says. She meets with the parents, helps them assess and articulate their parent goals, and then gives them the tools they need to reach those goals.

Parent coaching is a nascent field, and at this time, there is no official license or training requirements to qualify as a parent coach, Walter says. However, there are training programs available. Walter received her online training through a program at Concordia University, which uses the Parent Coaching Institute’s model (see “Before you send a client to parent coaching, find out what that coach’s background is,” she advises counselors.

Walter’s interest in parent coaching was ignited during her days as a school counselor. Working with students made her realize that counseling interventions would be most effective if they could be reinforced not only at school but also in the home. However, many school counselors weren’t used to including parents in their counseling programs and interventions.

“School counselors need to learn how to work with parents,” Walter says, “and I realized that we could really benefit from learning some parenting consulting skills.”

Walter started her own parent coach studies and then went on, as an associate professor of counselor education at Stetson University in Florida, to teach future school counselors some of the concepts of parent coaching. She also encouraged them to get further training in parent coaching as a valuable adjunct to their school counselor training.

Eventually, Walter went from just teaching the principles of parent coaching to actually coaching parents herself. Some of her clients come to her directly, but frequently she receives referrals from other counselors who feel she offers complementary services to the counseling they are providing. She is currently working with a couple expecting a baby.

“This couple has a child already, and with that first child their marriage experienced serious stresses,” Walter says. “Now that they are expecting again, they want to [preemptively address] some of the problems through couples therapy.”

Because marriage health affects the health and development of children, the couple is also receiving parent coaching from Walter. “I’m helping them build some skills and to see how couples skills play into establishing good parenting practices,” she notes.

In this case, Walter, who is trained to teach certain Gottman Institute programs, is using the institute’s Bringing Baby Home curriculum. The Gottman Institute is a well-known organization dedicated to researching and teaching methods to strengthen couple and family relationships.

Bringing Baby Home prepares couples for the arrival of a baby by focusing on three major goals: strengthening the couple’s relationship, encouraging mothers and fathers to prepare for the transition to parenthood, and giving expectant parents basic information about infant psychological development and related parenting tips.

“When you have a firm relationship, you are really providing a foundation from which a child can grow and thrive,” Walter says. “You are teaching them relationship building and communication skills and to foster emotional intelligence. This helps children to be able to identify, accept and manage emotions in a socially appropriate way.”

Walter also has clients who come in for parent coaching who need additional help to work on their marriage or receive family counseling. In such cases, Walter maintains a list of counselors she can refer these clients to while she focuses on coaching them in parenting skills. When given permission by these clients, she also discusses certain aspects of treatment with the outside counselor.

Recently, a couple came to Walter for parent coaching to help them manage their relationship with their daughter who has attention-deficit/hyperactivity disorder. The daughter was having problems with her schoolwork, including losing assignments and turning in incomplete work, and the parents wanted help with setting expectations and providing the household more structure.

“As we worked on it, I realized the parents needed couples therapy,” Walter says. “There was a pattern going on between the parents in which the dad would be dictatorial and lay down the rules, but he let the mother be responsible for actually implementing them. This allowed the dad to stay out of it and remain passive and judgmental. This was a long-standing issue between them as a couple.”

In addition, the parents were struggling with another daughter who refused to consistently follow the house rules, such as doing chores and sticking to a curfew. “The mom had a hard time putting rules in place, so part of my work with them was to empower mom and to get the dad involved,” Walter says. “The mom was doing too much for her children and sacrificing a lot of herself.”

One of the things Walter coached the parents on was maintaining curfew. She explained that no matter how reasonable sounding the daughter’s excuses were for being late, they needed to adhere to the time they had agreed to. If the daughter missed curfew, they needed to follow through and revoke her privileges for a week or two. The key for these parents was to learn to set appropriate rules and maintain them, Walter concludes.

In addition, through the combination of parent coaching and couples therapy, the mother eventually realized that she wanted to do some work, even in a volunteer capacity, that would take her outside of the home on occasion.




To contact the individuals interviewed for this article, email:




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

Letters to the editor:

Group Process From a Diversity Lens: ‘This workshop is police bashing!’

By Lee Mun Wah

The following vignette describes an actual situation that occurred in one of my diversity workshops. In addition to the vignette, I am including my thoughts/rationale and the intervention I used, as well as questions for other group facilitators to consider, group/dyad exercises and a summary that helps to place the event in a larger societal context.

This vignette is adapted from my diversity training manual, The Art of Mindful Facilitation, although the manual is not necessarily meant to be a faithful adaptation of the accompanying film clip. This month’s article looks at the issues of shame and blame.

This is meant to be an interactive process, so I ask that readers follow the steps below in their suggested order.

1) Watch this short video clip:



2) Return to this article and read the vignette.

3) Answer the “practice process questions” following the vignette.

4) Before reading further, write your own intervention.

5) After writing your intervention, read the remainder of the article, which includes my thoughts, the intervention I used and a summary.

For an introduction to this series, read “Group process from a diversity lens” in the April issue of Counseling Today.


In this particular diversity workshop, I showed the film Last Chance for Eden. In one of the scenes, an African American woman talks about being stopped by the police. This started a conversation among the workshop participants.

I asked the participants to stand or raise their hands if they felt they had ever been pulled over by the police because of the color of their skin. A black woman shared that she was driving home late one night when she was pulled over for no apparent reason and forced to get out of her car while the police questioned her.

pulledoverShe described the scene like this: “The police officer starts saying, ‘Well, what do we have here? Where did the girlfriend get the car?’ And I’m not saying anything. He tells me to step out of the car. And he says, ‘Where are you going?’”

I asked the audience members to raise their hands if this story was familiar to them. Most of the people of color raised their hands. Suddenly, a Caucasian woman, Susan, jumped up and yelled, “This workshop is police bashing!”

Practice process questions for group facilitators

1) What came up for you when watching the video and reading this vignette?

2) What key words would you focus in on?

3) What are the issues sitting in the middle of the room?

4) What do you think are Susan’s issues with the workshop? Why?

5) What is familiar about this situation?

6) What do you think Susan wants? Why?

7) Why do you think she is so angry?

8) Who would you work with first?

9) How would you include the group?

My thoughts

I wasn’t surprised by Susan’s remark but rather by her intensity and passion. I had a feeling there was something very personal connected to her reaction. She wasn’t simply someone who didn’t believe the stories being shared in the workshop; she was someone who had a deeper stake in these stories.

I suspected there was yet another story behind Susan’s statement. It was what she wasn’t saying that needed to be shared. From there, a deeper dialogue could be pursued between the victims, their perpetrators and the larger community. Those who had told their stories had created an opening for everyone else.

What was also important here was not to forget the trauma of the victims who had shared their stories of racism and police harassment. They too needed to be acknowledged and supported, as well as for some action to be taken. In the process, we also needed to discover how many others in the audience didn’t believe the victims or felt that the diversity workshop was police bashing.

My intervention

I told Susan I had a hunch that I wanted to check out. “Do you have a partner or a relative in law enforcement?” I asked. She said, “Yes,” and then started to cry out loud.

I asked her what that was like. She poured her heart out about how hard it was to see her husband go out at night, not knowing for certain he would return. She apologized for being so outspoken but said she wanted people to know that her husband really cared about people too.

Group/dyad debrief

1) What came up for you during this experience?

2) Who did you identify with? Why?

3) What was good about this and what was hard? Why?

4) What do the black woman and Susan have in common?

5) What came up for you when most of the people of color raised their hands?

6) What would be a good question to ask them?

Workshop issues


The definition of blame is assigning responsibility for a fault or wrong. Those who are heavily into blaming often feel powerless and/or overwhelmed by some perceived wrong. As a consequence, something in their lives remains unfinished and continues to wound and stimulate them.

Inquire whether they are blaming an individual, a group or an institution. The perpetrator or institution may be unavailable for dialogue, which therefore brings about feelings of depression and hopelessness.

Those who are blaming are often unable to be direct with their own feelings. Hence, they are often left with unfinished feelings that foster resentment and anguish.

What kinds of “rewards” do they get from being victimized? On the other side, what is lost from their lives when they are unable to feel relaxed and safe?


Suggested interventions

1) Through the use of role-play, have the participant confront his or her perpetrator(s) by choosing audience members who most closely represent the perpetrator(s).

2) Have the participant share what he or she needs to heal.

3) Ask the participant what effect this experience has had on his or her life. What has the participant “lost”?

4) Ask what part of the perpetrator(s) is also a part of the participant.

5) Does the participant want a solution?

6) Explore the kinds of feelings the participant is withholding.

7) What is the participant’s individual, group or family history regarding this issue?



The definition of shame is a painful emotion caused by a strong sense of embarrassment, guilt, disgrace or unworthiness.

The difference between shame and guilt is that people who feel shame think they are inherently shameful, whereas people who feel guilty typically associate that feeling with a specific act or situation.

People who feel shame often look down or avert their eyes when talking about their experiences. Have them look up, not only to face those around them, but also to be seen, accepted and possibly forgiven.

Shame often “freezes” people to the past and makes them feel powerless. The work is to have them relate what happened and how it affects them today. This gives their shame a face and present-tense reality.


Suggested interventions

1) When she or he is finished sharing, have the group notice the impact of what happened to that person.

2) Have the group repeat back what it heard.

3) Ask group members if they have ever felt ashamed and didn’t want anyone to know about it. If they are willing, have them share their personal stories.

4) Have the group members share how they feel about this person. In the cycle of shame, a main cause is the feeling of unworthiness. By having group members share how they feel about this person in a positive way, they offer acceptance and healing.

We all have something of which we are ashamed. To go on with our lives, we need to take responsibility, forgive ourselves and others, and then try again.

Group summary

As the facilitator, I presented the following summary to the entire group:

“If I hadn’t asked what was underneath Susan’s remark, we would never have known the deeper story behind her words. Everyone has a story, and if we don’t jump too quickly into being defensive or adversarial, we can learn about their lives and what they have gone through to get to this room today.

“There are good law enforcement officers everywhere, and their jobs are important and perilous at the same time. But as in all professions, there are also those who use their positions to harm others and who act out racism and sexism. It is imperative to bring them to justice because they not only rob individuals of their dignity and well-being, but they also tarnish a community’s reputation and the sense of safety for all its citizens.

“Susan, I heard you say that your husband cares for justice. In that case, I have a hunch that he would not stand for the things that happened to these folks. When he and members of this community stand together and say ‘no more,’ then it will exemplify the very best in a community — ensuring happiness and equal protection for all its citizens. Would your husband be willing to meet these folks and see what he can do to help?”

Susan was certain that he would be willing to do that. The audience applauded.




Lee Mun Wah is a Chinese American documentary filmmaker, author, educator, community therapist and diversity trainer. For more information, including a link to his services and trainings, visit the StirFry Seminars & Consulting website at


Letters to the

Behind the book: Career Counseling: Holism, Diversity and Strengths

By Bethany Bray July 22, 2014

Within a generation, cultural shifts have transformed the American workforce – and so too the field of career counseling.

Today’s young adults are attending college in greater numbers than their parents, and if they get married at all, they’re much more likely to tie the knot later in life than previous generations have. At the same time, the baby boomers are reaching their 60s and 70s and facing the adjustments of retirement or semi-retirement.

“Far from being a standard or rote procedure, career counseling, in response to these social and economic changes, has become a dynamic, creative and highly individualized process,” write the authors of Career Counseling: Holism, Diversity and Strengths in the book’s introduction.

Career_Counseling_brandingThe first edition of Norman Gysbers, Mary Heppner and Joseph Johnston’s book Career Counseling was published in 1998. The American Counseling Association released a fourth edition this year.

Although each edition has featured updates addressing the field’s changing landscape – for instance, a chapter on using social media was added to the most recent edition – the authors and counselor educators have always retained their focus on taking a holistic approach to career counseling.

The issues that career counseling clients present with are complex and “interwoven with personal, emotional, family and work issues,” the authors write. “… Many client problems addressed in career counseling originate in the work world and then spill over into other arenas of life.”

Counseling Today caught up with Norman Gysbers to talk about the fourth edition of Career Counseling, as well as the importance of taking a holistic approach – a “wide angle lens,” he explains – to career counseling.


Q+A: Career Counseling: Holism, Diversity and Strengths

Responses from co-author Norman Gysbers


What do you and your co-authors hope counselors will take away from the book?

We would like counselors to take away that, contrary to the classic stereotype, career counseling belongs in the general class of counseling because it has the same basic characteristics and qualities that all forms of counseling [have].

The interaction in career counseling is psychological in nature, and the working alliance is critical. At the same time, it differs from the rest of [counseling] in that presenting problems often focus on work and career issues — although personal, social and emotional problems often emerge as the counseling relationship continues to evolve. In addition, quantitative and qualitative assessments and career information are used more often in career counseling.


What prompted you to create a fourth edition of this book? What updates or changes will readers see in the new edition?

Since the third edition was published in 2009, new information, new ideas and new techniques have emerged to help counselors work with individuals’ career issues and goals. Also, while the basic themes of holism, diversity and strengths were embedded in the third edition, we wanted to highlight and emphasize them in the fourth edition. In addition, continued career development theory building focusing on postmodern theories also prompted a fourth edition. Finally, social media has become a fixture in the way we relate with others, so we added a chapter on using social media in career counseling.


The book advocates for taking a holistic approach to clients’ career development. From your perspective, why is this important?

We believe that we need a wide-angle lens to first view our clientele so we can see them both individually and contextually. Unfortunately, there has been a tendency among some counselors to first view their clientele within the silos of the career, academic and personal/social/emotional domains.

The holistic approach offers us a way to see and understand that these domains are really interrelated, not separate. While it may be appropriate to work with specific problems/concerns/goals in each of these domains, the holistic approach tells us that we also need to continue to see and understand them holistically in the context of clients’ overall lives. Sometimes we need to focus on the figure (the individual), sometimes on the ground (contexts) and sometimes on both the figure and the ground.


Who is your target audience for this book?

The book is designed for practicing counselors in many different work settings. It is also designed for counselors-in-training in counselor education, counseling psychology and other helping relationship programs because it provides them with the prerequisite knowledge and skill they need to do career counseling.


A chapter of the book focuses on dealing with resistant clients. Is this common in literature on career counseling?

The answer is no, but it should be! Anytime client change is part of the counseling process, client resistance is possible. Since career counseling often deals with clients making transitions, it is important for counselors to understand what resistance may look like in clients’ behavior. In the chapter in our book on resistance, we describe various forms of client resistance and some possible ways to deal with it. We believe it is important for counselors to know what resistance may look like so that when it takes place during counseling, it will be recognized and can be dealt with.


What originally inspired you and your co-authors to collaborate and write this book 16 years ago?

The first edition of the book that the three of us wrote was based on an earlier book that I had written with Earl J. Moore in 1987 titled Career Counseling: Skills and Techniques for Practitioners. A number of years after the publication of this book, the three of us talked about the need to take the basic ideas in the 1987 book and expand and extend them, given the continued and expanding interest in career development and career counseling in the 1990s. As a result, the first edition of our book was published in 1998.


What would you want all counselor practitioners — marriage and family, school, addictions counselors, etc. — to know about the book’s subject matter?

We would like counselor practitioners to know that the book presents a theory-based, practice-focused approach to career counseling. It presents career counseling from a holistic perspective using the concept of life career development as a way to understand overall human development in general and career development specifically. It is a strengths-based conception of career development and career counseling, and it focuses on working with diverse clientele of all ages and circumstances.

Specific attention is given to the ever-changing work world. It emphasizes the importance of the working alliance in career counseling. It describes selected modern and postmodern career theories, and it presents a number of qualitative and quantitative assessments. Client resistance is discussed, and the use of information in career counseling is described. How to use social media in career counseling is also featured, as is information on how to close career counseling relationships.





Career Counseling: Holism, Diversity and Strengths is available from the American Counseling Association bookstore at or by calling 800-422-2648 x 222




About the authors

Norman Gysbers is a professor in the Department of Educational, School and Counseling Psychology at the University of Missouri in Columbia, Missouri.

Mary Heppner is a professor of counseling psychology at the University of Missouri.

Joseph Johnston is a professor in the Department of Educational, School and Counseling Psychology at the University of Missouri as well as director of the university’s career center.




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


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I want what I’m worth

By Kathleen Smith July 17, 2014

This past May, I stumbled out of my university’s basement counseling clinic and into the sunlight. The unremitting winter had spanned my work as a doctoral intern as I supervised master’s students, counseled clients and conducted administrative work. For the sum total of zero dollars and zero cents.

Ready to embark on the last and longest leg of my graduate school journey — my dissertation — Money2I groaned at the fork in the road. At one end, a low-paying counselor job at a nonprofit awaited me. Or, newly licensed, I could take on a caseload at a group practice that would take a giant bite out of my paycheck.

With either option, would I have energy left to do research? A future of scuttling around mountains of paperwork or becoming absorbed in the emotional field of the consulting room seemed like a sure way to leave my degree on hold until the end of the decade.

“Sometimes you just have to pay your dues,” more than one colleague advised me. This was a phrase I knew well. I had recited it myself to graduating master’s students who worried about how they would find employment and pay the rent until they earned the 3,300 hours they needed for licensure, as well as to fellow doctoral students paying money out of pocket to do free labor for course credit.

Experience is precious in the counseling profession. Internships, supervision and apprenticeships are fundamental to serving our clients and promoting knowledge in the field. But money is valuable too, and all too often we forget to remind each other of this simple truth. During my quest to earn my Ph.D. — all those hours spent researching and supervising — I slowly became numbed to the assumption that the experience alone was worth the work.

In the counseling field, we ask our students to be advocates for clients who don’t have the power or ability to speak up. But somehow we have lost sight of how to campaign for ourselves. Negotiating a salary or the nuts and bolts of entrepreneurship are unheard of subjects in the counseling classroom. The emphasis on experience alone teaches us that when we graduate, if someone is willing to pay us to do what we love, any amount of money will suffice.

Not being valued is more than just a professional issue. It’s a women’s issue as well. We may bemoan the lack of men in the mental health professions, but there is a long-standing connection with low-paying salaries among professions traditionally taken up by women. We attribute lopsided gender representation to the “feminization” of mental health rather than consider that men more often seek professions that value their worth in dollar signs.

In the age of Sheryl Sandberg and glass ceiling metaphors, we assume that because a counseling classroom is full of women that they won’t face the same challenges as women in male-dominated fields. We tell young women that getting married is the smartest way to support themselves through graduate school. And we teach our counseling students to joke about not being in the field for the money.

Over the winter break, in an effort to detox from the first half of my internship year, a therapeutic TV binge resulted in my consumption of four and a half seasons of CBS’s The Good Wife. Captivated by the show’s clever insights on office politics and self-confidence, I sat up straight and began taking notes. When one of the female characters was negotiating for more money, she uttered five words that I will never forget: “I want what I’m worth.”

Over the next few months, I took a few shaky steps toward starting a career as a mental health writer built on more than just experiences. I turned down writing opportunities that weren’t compensated. When strangers emailed me for feedback, I kindly but firmly explained to them that I offered rates for editing. I said no to jobs that wouldn’t value me, and I asked editors to start paying me for my work.

Rather than take either fork in the road, I mapped out a niche for myself as a mental health writer. I learned that when you value yourself, other people will start to believe your work is really what you say it’s worth, and that you shouldn’t be ashamed to remind people that you can’t pay the bills with gratitude.

I learned more about my worth from two weeks of fiction than five years of graduate school. But no university is at fault in this story, as negotiating worth is an issue that counselor education in its entirety has neglected to address. We may advocate for our inclusion on a legislative level, or discuss it at conferences, but we need to start the conversation from the ground up, and it starts in the classroom.

As a journalist, I’ve had the privilege of interviewing many entrepreneurs in the field, and their advice all boils down to the same message — graduate programs have to start teaching money1business sense and marketing skills or the future will be financially grim for the thousands of graduates pouring out of programs.

There are always financial realities to the helping professions. We may never have a majority of our students receiving paid internships or reaching their ideal salaries. Most of us will never live like we work on Wall Street or at a big, scary law firm because that life simply isn’t for us. But we can educate our students that they are of worth and that they should not be ashamed to want more than the warm feelings they get from helping others.

I believe that sitting across the room from someone and being accepted and heard unconditionally is of value. And I believe that studying about how people change and asking hard questions about the human experience is of value as well. Because I know the worth of these pursuits, I’m no longer afraid to tell others that I value my time and my talents. I want what I’m worth, and there’s no shame in that.



Kathleen Smith is a licensed professional counselor in Washington, D.C., a mental health writer and a frequent contributor to CT Online. Read more of her writing at


Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.