Monthly Archives: August 2014

Do you have diagnosisitis?

By Thomas Winterman August 28, 2014

Diagnosisitis. Or, as it’s more commonly known, overpathologizing — an affliction that affects many counselors both seasoned and new.

People most often come to counselors because they have a problem and need help. As counselors, whenever someone comes to see us, we flip the switch and turn on the counselor hipster_applebrain. The counselor brain is a fascinating professional attachment that is installed in graduate school. It is great for a lot of things – problem-solving, empathizing, reflecting, critical thinking, etc.
There is one area, however, where the counselor brain works in overdrive, and this is not always a good thing. That area is pathologizing. Or in layman’s terms, diagnosing.
Counselors diagnose stuff; it’s what we do. And when you’re good at diagnosing things, it’s also kind of fun. When someone comes into the office and says, “I’ve been feeling sad …” the little mouse on the wheel inside my counselor brain starts sprinting, and I want to know about onset, frequency, intensity, duration and so forth. When someone says, “I have recurrent nightmares and panic attacks several times a week,” I immediately begin to think about the diagnostic criteria for posttraumatic stress disorder or acute stress disorder, formulating questions to get at specific symptoms and triggering events.
This comes naturally because it’s what I was taught and, frankly, it’s good practice. Because I work in managed care, I have to diagnose. That’s the only way the insurance company will pay my agency, which then pays me. There’s no way around it.
I am not anti-diagnosing; I am actually pro-diagnosing. Diagnosing is a good thing. If we can look at a symptom set and give it a label, we can treat it. The whole point of diagnosing is to provide clinical direction and give all members of the treatment team a clear picture of what the client’s underlying issue is and the goals for treatment. Sounds great! Ah, but there is one tiny problem: the fundamental attribution error.
The fundamental attribution error is not just a college-sounding phrase that impresses those around you. No, it’s much more than that. Diagnoses are made up of a symptom set, and the symptom set is attributed to the diagnosis (circular reasoning). Here is an example: Mr. X is sad. Why is Mr. X sad? Because Mr. X has depression. How do you know Mr. X has depression? Because Mr. X is sad. Huh? Mr. X has depression because he is sad and he is sad because he has depression.
This circular reasoning can insulate counselors from getting to true causes of disorders and helpful treatment solutions. This is why counselors are vulnerable to the fundamental attribution error, which is also known as attributing every symptom to a mental health disorder.
The first rule of diagnosing is to look at our symptom set and rule out medical conditions or substance abuse issues that could be causing the symptoms. If the client has a medical condition or is under the influence of a substance, he or she may present as having a mental disorder that is not truly there.
There is another critical area, however, that counselors (myself included) often miss: WELLNESS (it’s in all caps, so you know it’s important). What is wellness? Get out of the clinical mindset for a moment (Mr. X will identify three irrational thoughts that bring about distress and replace those thoughts with healthy and balanced ones … blah blah blah). I don’t mean to sound crass because the clinical stuff is great and it truly helps a lot of people, but we don’t need to start there. Start here, with 9-5-2-1-0, and find out if your clients are practicing proper wellness habits (this is great stuff for adults but solid gold for child clients).

9) Sleep: How many hours of sleep are you getting? Shoot for 8-9 hours. Have you been running on a lack of sleep? This one alone can look like a lot of mental health disorders (antisocial personality disorder is what it looks like for me before I have my coffee).
5) Eating: How is your diet? Aim for 5 servings of fruits and vegetables per day. Clean up your diet! For the brain to function properly, it has to be properly nourished.
2) Screen time: Aim for 2 hours or less per day. This goes for computers, television, cell phones, tablets, etc. I know this isn’t possible for a lot of people, mostly because their jobs may require them to look at a screen for 8 hours a day. The point with this one is to be mindful and cut down screen time whenever you can.
1) Exercise: Have you exercised lately? Go for at least 1 hour of exercise per day. This one is so important. Exercise acts as a natural antidepressant, releasing the “good feeling” chemicals into the brain.
0) No sugary drinks! These drinks are a diet and health killer. So drink 0 of them per day. This includes artificial sweeteners as well.

Here are some bonus wellness tips for you and your clients:
Connectivity: How connected are you to your community? Whether it’s attending church, participating is sports, volunteering or attending social functions, connectivity is a key to wellness.
Novelty: This one gets overlooked so many times. Learning a new skill (a musical instrument, a new sport, a hobby) takes a lot of brainpower — and that’s a good thing! Using your brain in this way creates new neural connections and (at the risk of getting too neuro-psychy) promoting integration among hemispheres in the brain is a key to wellness.
Humor: Don’t forget to laugh. After all, it is the best medicine.

These wellness principles should be the first goal of just about any treatment regimen, regardless of the client population with which the counselor is working (I believe it is most often overlooked when working with clients who have a low socioeconomic status). I work with children who have been abused and neglected, and it’s interesting to note that when their wellness is made a priority, many other symptoms seem to wash away. The clinical stuff is great, and it’s really, truly needed. Just don’t lose sight of the forest for the trees — or the person for the symptom cluster.




Thomas Winterman is a father, husband, therapist, author and blogger who lives in Panama City, Florida. He has worked in the mental health field for a number of years, mostly serving underprivileged children at a nonprofit agency as both a social worker and clinical counselor. You can find his blog at or email him at His first book, The Thrive Life, was published in April.



Also by Thomas Winterman, CT Online, April 2014: “On being a successful therapist”


Losing face: How Facebook disconnects us

By Jennifer L. Cline August 26, 2014

This past February, Facebook celebrated its 10th birthday. According to its website, Facebook now boasts more than 1.28 billion active users, and on any given day, more than 60 percent of those users access the site. Facebook’s stated mission is “to give people the power to share and make the world more open and connected.”

But has Facebook, in fact, increased our social connectivity? Facebook and other forms of Neck-plug-Smallsocial media have inarguably enhanced the dissemination of information and allowed for more frequent, albeit often superficial, exchanges between people. However, the reliance on Facebook for connectivity has raised considerable concerns about its impact on the authenticity of the human experience.

Ironically, in a technologically advanced world in which we are able to keep in touch at all times with all people, citizens of the United States are feeling more alone and disconnected. According to the General Social Survey in 1985, before the dawn of social media, Americans reported having on average three confidants — the people with whom they discussed vitally important personal matters. By 2004,the average number of reported confidants had dropped to two, and the most commonly offered response was “zero confidants.” In 2010, the Pew Research Center collected comparable data on “core discussion networks” and found the average number of reported confidants remained at two.It seems that despite the use of communicative technology to connect, people are actually feeling more socially isolated.

The frightening prospect of face-to-face interaction

At this 10-year mark for Facebook, I think it is fitting that we critically examine the impact of interpersonal technology on our real-life social connections. As a counselor and researcher, I decided to engage in dialogue with young adults, a particularly “plugged in” generation, about their use of social media. For the past year, I have been learning directly from young adults about what is working for them and what is not. I spoke with 55 college students, 30 in a focus group setting and 25 in individual interviews, and this article highlights some of the most interesting and relevant findings from those conversations.

Certainly, some individuals use social media in a way that enhances their connectivity, while others supplant their embodied interactions with technology. This made me wonder about the importance of preference. Therefore, I began by asking this group of young adults if they preferred social media or face-to-face communication for social interactions. Their responses were intriguing.

On the surface, almost everyone expressly stated that they preferred face-to-face interactions. However, their stories quickly revealed that this “preference” was not that simple. They knew, at least intellectually, that the best way to communicate was face to face. At the same time, they felt pressured by the spontaneity of embodied conversation and felt interpersonally vulnerable when engaging with someone face to face. Therefore, using social media was an easy and convenient way to bypass those challenges while still getting their interpersonal needs met. In fact, some of these young adults admitted to engaging with social media while in the presence of others so they would appear occupied and unavailable for conversation. They also confessed that they were particularly likely to use social media to address conflicts with others — even if that person was physically present in the same room with them.

Not surprisingly, these young adults acknowledged wishing they felt more competent when relating to others face to face. Unfortunately, being “out of practice” created a vicious cycle in which lack of social competence led to greater dependence on social media use, which led to even more interpersonal awkwardness.

Implications for counselors

What does this mean for counselors? At its most fundamental level, the counseling experience is based on the ability to build a therapeutic alliance between client and clinician. And by nature, most clinical experiences are intense, face-to-face, interpersonal interactions. Initiating counseling is a brave endeavor for anyone, but if young adults increasingly avoid face-to-face interactions, especially if those interactions might be emotionally charged, how much more difficult will it be for them to reach out for help?

Furthermore, as clinicians, we see the value and merit in working through difficult experiences as simple as not knowing what to say in a given moment or asking someone out on a date and being rejected. Out of these events, we develop skills for dealing with difficult times, surviving painful disappointments, working through conflicts and directly facing the inevitable challenges of close relationships. However, if the current generation uses social media to bypass these less consequential growth experiences, how will they build these skills so that they have something to draw from when the difficulties and consequences are higher and more intense?

Finally, we know that meaningful interpersonal connections are important to our psychological health. Choosing more online interactions to meet the need for interpersonal connection allows users to avoid the difficulties of embodied relationships. Relationships in real life are often messy, frustrating and complex. Friends and loved ones are not always available to us, relating to others in the moment requires give-and-take, and our encounters sometimes leave us hurt and disappointed.

Online relationships, on the other hand, provide opportunities for less risky interactions that also require less giving of oneself. An online interaction does not require that we compromise our needs or delay gratification because friends are always available on Facebook, and when we’re finished with them, we simply click off. Choosing this one-dimensional interpersonal relationship potentially reduces online friends into self-objects that unidirectionally feed the user. Concern for the other is not required.

Social media motivations

My discussions with young adults about motivations for using social media resulted in answers that paralleled those about preference. Initially, they acknowledged their desire to keep in touch, to stay current and to take advantage of the ease and convenience of this technology — all answers that could be anticipated. However, upon further discussion, a tacit motivation for the use of social media emerged — the desire to psychologically protect themselves through enhanced control of social interactions and self-presentation. For example, I discovered that many college students use social media to covertly learn about others through passive observation and Facebook “stalking.” Then, using the information they have gathered, they approach these individuals in a manner that is likely to be well received, thus increasing the odds of interpersonal success.

Covertly learning the personal details of someone else’s life changes our experience of emotional intimacy. According to a 2010 article by Max van Manen, intimacy is created when there is a purposeful revelation of secret parts of oneself to another individual within the context of a trusted relationship. Facebook, however, reveals and makes public what was once personal, thus changing the meaning of privacy and intimacy. A continuous stream of social media updates allows a person to know what another is doing in a way that feels intimate or familiar, as if two people have spent all their time together. However, feeling emotionally intimate is not the same as being emotionally intimate, nor is feeling familiar the same as being familiar. Social media makes it easy to confuse the two.

facebookUsing Facebook is a bit like rummaging through a person’s medicine cabinet. You can look through either and learn a great deal about another person, some of which is quite private. However, it is fundamentally different to learn something about someone in this manner versus experiencing a purposeful revelation that requires vulnerability in the telling and empathy in the receiving. Counselors, of all people, know the value of being emotionally intimate, familiarly known and fully present with another human being. Fundamentally, reliance on social media sacrifices quality of interaction for quantity of interaction.

The college-age students I interviewed also described the heightened sense of control they felt over their self-presentation when engaging with others online. They explained their desire to present only their best selves online — their best pictures and their greatest moments — painting the picture of a happy, full and active life. These findings confirm recent research conducted by Catalina Toma and Jeffrey Hancock, who found that technology affords users the ability to select and edit their statements and take unlimited time to compose messages, allowing them to craft optimized versions of themselves online. Facebook, by definition, enables users to highlight treasured personal characteristics in an online profile and publicly display social connections with friends and family in an effort to be affirmed by other Facebook users.

These ideal self-presentations have multiple levels of impact on both the social media poster and the social media viewer. First, the ability to engage in self-promotion online, as well as the ability to maintain many shallow relationships, is a breeding ground for narcissistic traits. Furthermore, we have all suffered from the impostor syndrome, fearing that people would not really like or accept us if they really knew us, and social media can heighten this dynamic by promoting the creation of a reinvented self online. Posters may experience an increase in internal incongruence because they know that their real selves — the selves they actually know and experience — are different from the idealized selves they have presented online. Finally, even though Facebook consumers know that putting your “best face forward” is the rule online, they still look at others’ posts, compare themselves with those idealized self-presentations and begin to believe that others have better lives and a greater sense of well-being than they do.

The experience of anonymity and ‘online muscles’

One final area of conversations with these young adults related to their decreased awareness of others while using social media — or experiencing a sense of deindividuation. According to psychologist Philip Zimbardo, who studies personal responsibility and group behavior, this phenomenon is strongly fostered in situations that provide some level of anonymity. It involves a diminished sense of individuality and, consequently, a reduction in the sense of personal responsibility, leading to behavior that is incongruent with one’s personal standards of conduct. In other words, deindividuation means we are more likely to engage in socially inappropriate or self-serving behaviors when we do not feel that our behaviors are closely associated with our identity.

It may seem odd that the phenomenon of deindividuation would apply to Facebook, given that one’s identity is known on the social media site. However, the young adults I interviewed observed repeatedly that users post things on Facebook that they would never say in real life, including inappropriate self-disclosures, aggressive comments, rude insults and extremist opinions. They revealed that behind the protection of a screen, users grow what one woman called “online muscles.” Although they said that knowing the identity of a Facebook user should make people feel accountable for their words, they acknowledged that the psychological distance created by the technology allows for the phenomenological experience of anonymity.

When students reflected on this phenomenon, they posited that not being able to see the other person allowed them to reduce the interaction to “just words.” As a result, they felt less accountability for how they might affect another person. Furthermore, they theorized that the phenomenological experience of anonymity was related to an altered sense of reality that many users experience while engaging with others on social media. Cognitively, these students were aware that Facebook is a venue for interacting with many people simultaneously, a way to “talk to everyone.” Yet time after time, they described losing track of their audience and feeling as though they were actually talking to no one. They characterized their experience as “talking to the computer, basically,” “talking to self” and “it’s just you and your words … you and the computer screen.”

Social media, a form of mediated communication, creates technological distance, which allows people to treat others in ways they would not consider if they were engaged in embodied interactions. In the process of becoming caught up in themselves, users forget their audience and say things they would not say in real life.

Final thoughts

Our adoption of social technology is happening at astronomical speed, and my conversations with college students, although certainly not conclusive, suggest that this is not a benign development. Instead, social technology is a bit like the Trojan horse — seducing us with its beauty and stated mission, but all the while secretly sabotaging our most human qualities.

The ability to make meaningful interpersonal connections is of profound importance to our psychological health. Rather than promoting social connections as Facebook posits, social media technology separates people from the relational and promotes the individualistic and narcissistic. Self-interest ultimately leads to a loss of self and a decreased awareness of others. Eventually, we are unable to see and fully experience the humanity of others, creating the psychological distance that allows us to treat others in inhumane ways. This represents a loss of our most essential human qualities — a loss that we cannot afford.


Jennifer L. Cline is a licensed professional counselor and approved clinical supervisor in Verona, Virginia. Contact her at

Letters to the editor:

Involving parents in child-centered play therapy

By Phyllis B. Post August 25, 2014

When young children, ages 2 to 9, are experiencing emotional and behavioral problems, the usefulness of talk therapy is limited because they often cannot communicate effectively using words. Play therapy continues to gain momentum as a viable approach to work therapeutically with young children because it is based on the premise that children communicate best through Dad&daughter_smalltheir usual way of relating — play. Using play in therapy is the most natural and effective way to help children.

Children are most often referred for play therapy when they demonstrate problems with friends, at home or at school. There are many different approaches to play therapy, but all are structured, theoretically based and developmentally appropriate, allowing young children to communicate and learn in the way that is most natural to them. Play therapy is different from “just” playing. It helps children express their feelings, assume responsibility for their behaviors and develop problem-solving skills. Play therapists are trained mental health practitioners who specialize in helping young children. An increasing number of master’s degree programs in counseling are including course work and training in play therapy. In addition, mental health practitioners can attend training provided by the Association for Play Therapy and the newest division of the American Counseling Association, the Association for Child and Adolescent Counseling.

As mentioned, a variety of approaches to play therapy exist, but I have found child-centered play therapy, as developed by Garry Landreth, to be particularly effective. Based on the work of Carl Rogers, a basic premise in child-centered play therapy is that children possess an innate force within themselves to grow and heal. Therefore, child-centered play therapists do not direct children on how to resolve their problems or use interpretation with children to promote their growth. Instead, child-centered play therapists relate to children in the playroom in ways that demonstrate a firm belief that children learn the most and heal most effectively when they themselves decide what to do in therapy sessions. Through a supportive and caring relationship with child clients, therapists help these children understand themselves, accept their feelings, assume responsibility for their behaviors in the playroom and learn to control their own behaviors.

Why work with parents?

Although there is consensus among play therapists that effective consultation with parents can maximize beneficial outcomes for children, parental involvement in the process often does not extend beyond the intake session and brief periodic check-ins when parents bring their children to therapy. But effective parent consultation can help parents better understand why play therapy is beneficial for their children, how play therapy interventions are purposeful and that the effectiveness of the interventions can be assessed. In addition, these consultations can provide parents support and hope, both of which help prevent early termination by the parents.

Although play therapists may be aware of the importance of parent consultation in helping children, many therapists are not confident about how to approach consultation with parents. In a national survey in 2008, Tim VanderGast found that play therapists identified consulting with parents as one of their greatest needs in clinical supervision. Because child-centered play therapists focus on the relationship with the child rather than on the presenting problem, they face unique challenges when helping parents understand how this popular theoretical approach helps children with specific goals that are established to assess progress.

The goal of this article is to provide some practical guidelines for therapists as they consult with parents when conducting child-centered play therapy. In addition to describing child-centered play therapy to the parents, these guidelines include:

  • Learning about the child and developing a trusting relationship with parents
  • Addressing objectives and goals
  • Relating established goals to the child-centered approach in the playroom
  • Providing ongoing parent consultations

Learn about the child and develop a trusting relationship with the parents

Parenting is often difficult and stressful. When issues create the need to involve a young child in therapy, the counselor’s ability to convey to parents the core conditions (as described by Rogers) of empathy, acceptance and genuineness cannot be overemphasized. It is through these conditions that a strong therapist-parent alliance starts to form. Additionally, consultation meetings provide an opportunity to model the person-centered approach with parents, showing them the power of the basic principles that will be used with their child in child-centered play therapy. To begin building this trusting relationship, I recommend that therapists meet parents for the initial session without any children present.

The first step is listening to the parents’ description of the child. This process results in a better understanding of the parents’ perception of the problem, as well as their worldview and the child’s cultural context. For example, when a mother who had not completed high school described her reasons for bringing her child to play therapy, the therapist sensed the mother felt uncomfortable in the elementary school environment and felt intimidated by her child’s teacher. In this situation, the therapist could demonstrate sensitivity to the mother’s perspective by responding to her feelings of uncertainty and discomfort in that environment. However, I would caution that even as therapists attend to the parents’ concerns, the focus should remain on the child’s issues rather than on the parents’ issues.

Address objectives and goals

Communicating the objectives and establishing specific goals for therapy are important for several reasons. First, the process demonstrates to parents that play therapy interventions are purposeful, which might not be as obvious in child-centered play therapy as it is in talk therapy with older children or adults. In addition, the objectives and goals are useful in evaluating the effectiveness of the play therapy. They become the benchmarks to assess progress during ongoing consultations with parents. Finally, we cannot ignore the fact that outcome goals are required in the managed care environments in which many counselors work.

As described by Landreth in the third edition of his book Play Therapy: The Art of the Relationship, child-centered play therapy adheres to the objectives of helping children become:

  • More self-reliant
  • More accepting of themselves
  • Better problem solvers
  • Better able to assume responsibility for their own behaviors

The idea of setting specific goals in addition to those four broad objectives can feel uncomfortable to child-centered play therapists. They may fear that they unconsciously possess some expectations and biases that could inadvertently cause them to direct the child in play therapy or to view the child’s behaviors in the playroom through the lens of the established goals. Awareness of this possibility is important and should be monitored through clinical supervision. However, a combination of broad objectives and specific behavioral goals is optimal for monitoring the effectiveness of therapy.

Focusing on the overarching objectives that can be observed in the playroom and in the child’s life outside of the playroom helps us to recognize broad-based changes. Focusing on more specific goals related to the issues presented by parents ensures that attention is also directed to changes in those behaviors that might not be observed in the playroom. Therefore, using both broad objectives and specific behavioral goals is useful in monitoring the effectiveness of play therapy interventions.

In the initial meeting with the parents, the play therapist strives to establish goals that reflect the family’s cultural context, given that each family has its own expectations and experiences with the meaning of help seeking, mental health and play. During this process, play therapists must be sensitive to the parents’ cultural backgrounds because the parents’ values will influence the types of goals established for their child. For example, in some cultures, compliance with authority, both at school and at home, is highly valued. Thus, the goals that evolve for the child through the therapist-parent interaction could focus on compliance and responsiveness to limits. In other cultures in which children experience more permissive relationships with their parents, the goals for play therapy might include enhancing the child’s self-confidence and ability to make decisions. This collaborative process between parents and therapists will result in a consensus on the goals for play therapy.

Setting goals with parents is hard work, and it takes practice. Goals must be concrete, measurable and observable to ensure that progress can be tracked. In addition, goals that are strength-based and that focus on solutions provide hope for parents.

As parents talk about the reasons they sought play therapy for their child, the work of the play therapist is to help them “translate” their concerns into specific behaviors that can be assessed and to set benchmarks to determine how they will know when their child has changed. For example, a mother brought her 5-year-old son to play therapy because he was “out of control” at home and at school. The therapist asked, “What does ‘out of control’ look like?” With that helpful nudge, the mother was able to elaborate, saying, “When it is time for him to get dressed in the morning, he screams for about 15 minutes and hits himself. He says ‘no’ to every request I make of him. And the teacher sends home a note almost every day about him yelling and hitting other children at school.” Based on this specific description of the boy’s behaviors, it became possible to establish realistic goals.

One question therapists can ask parents is, “How will you know when your child has changed and no longer has this problem?” This information provides the basis for benchmarks for change. In the example above, goals were created that specified how many days each week the child would comply with his mother’s requests, not have a tantrum at home, not hit himself and not receive a report from the teacher about problem behaviors in the classroom. Such clearly stated goals are helpful not only in assessing change but also in managed care environments that require the monitoring of behavioral outcomes for insurance reimbursements.

It cannot be overstated, however, that establishing such goals with parents prior to the start of child-centered therapy does not change the way that play therapists relate to the child in the playroom. There are no predetermined interventions during the counseling sessions that seek to change the child’s behavior. Instead, therapists consistently offer a safe relationship and an environment in which the child is free to be self-directive. In fact, in a chapter for the 1997 book Play Therapy Theory and Practice: A Comparative Presentation, Landreth and Daniel Sweeney recommended that child-centered play therapists continually reflect upon their way of being in clinical supervision to address the issue of inadvertently directing the child’s behavior.

Relate established goals to the child-centered approach the playroom

Perhaps the most challenging part of the initial consultation with parents is explaining how the behaviors of the counselor in the playroom help children achieve both the broad objectives and the established goals of play therapy. Play therapists can help parents by describing how each of the established goals could be addressed in the playroom. Using the earlier example, if a young child is “out of control” at home and school, the play therapist might explain to the parents that through the safe relationship with the therapist, the child will learn to assume responsibility for his decisions in the playroom and will have opportunities to demonstrate self-control if setting limits is necessary in the play therapy session. In this way, parents can recognize that what occurs in the nondirective playroom can be helpful in addressing issues occurring at home and at school.

Provide ongoing consultations

Every four or five sessions, therapists should meet with the parents without the child being present. The purpose of the ongoing consultations is to maintain and foster a strong therapist-parent alliance, allow the parents and play therapist to collaboratively assess the progress toward goals, and further educate parents about child development, parenting skills and community resources.

It is important for child-centered play therapists to maintain case notes to document significant events, attitudes and play themes in the play sessions. In addition, reviewing case notes can be useful when assessing progress toward goals. For example, if a child is experiencing anxiety outside of the playroom, case notes can help identify changes in behavior that indicate anxiety in the playroom as well, such as when making decisions about what to do in the playroom, facing the therapist or interacting with the therapist. For a child presenting with goals related to aggressive behavior outside of the playroom, documentation of play sessions could note changes in the child’s response to limits setting. Case notes can be reviewed to identify play session themes (for example, themes of power, mastery or nurturance) to share with the parents. When meeting with parents, play therapists should remain sensitive to maintaining the child’s confidentiality by not disclosing specific play behaviors or the child’s verbalizations during play sessions.

Maintaining and fostering a strong therapist-parent alliance: A primary goal for these meetings is to foster a warm relationship with the parents. The counselor can do this by acknowledging the parents’ experiences, struggles and feelings and responding with empathy and care. Through listening to the parents, the play therapist is better able to support and educate when it is appropriate.

Assessing progress: If parents share more general concerns about themselves at the beginning of the session, the counselor can focus the session on the child by asking an open-ended question such as “How have things been going with ___?” Using active listening skills at this time ensures shared understanding of what the parents are saying. Play therapists should listen for information related to the stated goals for therapy. If the parents do not address each of the goals identified in the first intake session, the therapist can systematically address the goals not mentioned. It is not uncommon for a review of the original goals to surprise parents. Some parents will have no memory of certain goals because the issues will have resolved themselves.  

During these ongoing consultation sessions, the therapist can share themes observed in the play therapy sessions, especially if they relate to the established goals of therapy, such as the child’s ability to control behaviors when limits are set or an increasing ability to assume responsibility for decisions. After reviewing the goals, the therapist and parents collaboratively determine whether the original goals were met, whether they need to be modified or if it is time to terminate the relationship.

Providing education on parenting skills and community resources: If the decision is made to continue play therapy, the therapist and parents set a time for their next meeting. Once it is established that the parents will be returning, the play therapist can also share appropriate parenting skills based on the needs of the parents and child. Most parents are eager to learn new approaches to discipline and highly value the skills of limits setting and choice giving. In addition, teaching the skills of responding to the child’s feelings and returning responsibility to the child has been found to reduce parental stress and create a more positive environment in the home. That outcome can influence the entire family system.

Ongoing meetings with parents also provide opportunities to address other needs the child may have that are not currently being met. The therapist can then provide or recommend appropriate resources. For example, if a child appears to have a learning disability, the play therapist should make an appropriate referral for the child to be assessed for needed services.


Child-centered play therapists focus on the relationship with the child rather than the presenting problem. Thus, therapists face unique challenges in helping parents understand how this theoretical approach supports children in progressing toward specific goals. To demonstrate the effectiveness of their work with children and to respond to the demands of managed care in agency settings, play therapists must skillfully share the objectives of child-centered play therapy, establish behavioral outcome goals and then assess progress toward achieving those goals. The guidelines proposed in this article are specifically designed so that child-centered play therapists can collaborate with parents to more effectively help young children.


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

Phyllis B. Post is a professor in the Department of Counseling at the University of North Carolina at Charlotte and the founder of the Multicultural Play Therapy Center at the university. She is a licensed professional counselor supervisor and registered play therapist. Contact her at

Letters to the editor:

CEO’s message: Caring, concerned or mad as hell?

By Richard Yep August 22, 2014


Richard Yep, ACA CEO

The maturation of any profession takes various twists and turns as it comes into its own and becomes an acknowledged group, both publicly and by those it serves. Professional counseling is alive and well, but it does face challenges, obstacles and a need to “figure out” who and what it will be as it relates to the millions of children, adolescents, adults, couples and families that it can positively impact.

A number of discussions on Listservs, on the ACA Connect site, in the trade press and even in the offices of public policy decision-makers might make one question whether the counseling profession really does agree on its identity or what defines its members as “counselors.” As someone who has worked with the profession for nearly three decades, I find the dialogue and discussion to be healthy. Why? Because these conversations and, yes, sometimes verbal assaults, help all who are involved to refine their thoughts about the profession. More important, it means that all of you really do care about what it means to be a professional counselor.

Some of you are entrusted with preparing those who will serve as professional counselors, while others are conducting important research. And there are many of you who are directly engaged with clients. The conversations about the definition of professional counseling, who is appropriately trained to serve certain clients and what should be included in accreditation and licensure laws are critical discussions that will strengthen this incredible profession in the long term. Just as you might ask clients to explore issues about themselves to foster and support positive life outcomes, many of you are going through that same process of discovery for the profession.

While it may seem as if the profession is still grappling with issues of identity at times, I typically view it as healthy interaction. Discussions revolving around who has power and authority; whether we should hold protests, sign petitions or form new organizations; why some individuals always post on Listservs while most do not; and blaming “them” (whoever the “them” might be) for what is ailing the profession are all indicators that the counseling profession has matured. Divergent viewpoints are actually a good thing, even though I know some will say that too many divergent viewpoints make it appear that we are fractured and being taken over by “others” who do not have the best interest of the profession at hand.

Let’s face it. Society is changing rapidly, and professional counseling is being directly affected. Just look at the number of states now recognizing same-sex marriage, the huge wave of veterans returning from war in need of mental health support, the data linking neuroscience to mental health, the rise of “cyber” everything and the societal chasm that is increasing even as the economy recovers. These are mega issues that will need to be dealt with by the counseling profession. I don’t want to diminish the importance of the discussions taking place on ACA Connect, CESNET or any other forum, but please find a way to ensure that we don’t become so focused on the internal issues that we all lose ground on what is needed to serve clients and students.

You are way too important to not be serving those who need you most. As noted, I am not negating the importance of the internal professional issues that are being discussed and debated. But I do want to send a reminder that there are millions of noncounselors (clients, students, the public) who don’t give a fig about who gets to vote on the ACA Governing Council, whether a sit-in takes place at the next conference, whether certain perspectives about the profession should be censored or (God forbid) that parliamentary procedure was or was not followed during a meeting of some counseling group.

Now before those of you who actually read this column go to your keyboards to let me know the importance of Robert’s Rules of Order or about anything else that may have insulted you, please understand that I have the utmost respect for the rules, as well as for the opportunity for members and others to discuss the important issues of the day. As leaders and engaged members of the profession, it is your right and your responsibility to ensure that your viewpoints are heard and that discussion, debate and dialogue occur.

What I would hope is that with each argument being made, each opinion being shared and each action being contemplated, we will not lose sight of the most important aspect of why the counseling profession exists. Before the next posting, the next letter to the editor, the next petition or even the next time someone is about to comment, I would just like to know that the following questions were asked: Is this something that will benefit our clients and students? If so, what supports that perspective?

I am impressed by the passion and dedication that so many of you have for the profession. I see very positive outcomes from the discussions that have been carried on both in ACA and non-ACA forums. Thank you for your service and your leadership.

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

Be well.

From the president: A note of appreciation

By Robert L. Smith


Robert L. Smith, ACA President 2014-2015

Former presidents of the American Counseling Association informed me that the time in this office would fly by faster than one could imagine. I now know this to be true, considering that I am writing my third column, which indicates that nearly a quarter of the 2014-2015 presidency has been completed. Yet I feel good about what has transpired to this point during my brief tenure. Some very significant task forces are already working on the most salient ACA concerns. My directive to each group is to present options to the Governing Council and ACA membership that will continue to move the association and the counseling profession forward. My expectation is to see concrete action at our Governing Council meeting held during the 2015 conference in Orlando, Florida. In the meantime, I will share updates of these activities in this column and other ACA outlets.

This month, however, I would like to share some thoughts about ACA members that have been reinforced for me while serving as your president. Four fundamental and significant characteristics are evident.

  • First, ACA members are a caring group of professionals with a positive orientation. You care deeply about those you serve, your colleagues and the counseling profession.
  • Second, ACA members are high-energy, articulate individuals. It therefore behooves all those in leadership positions to listen to you and tap into your energy.
  • Third, ACA members recognize the significance of diversity and adaptability, along with unity and cohesiveness. We are a diverse group with a wide range of ideas. At the end of the day, however, we recognize the importance of unity and cohesiveness when responding to external challenges.
  • Fourth, ACA is blessed with a significant number of outstanding leaders. Leaders range from the very seasoned to those who are emerging. Our leadership styles are diverse, and this diversity is demonstrated at every level. Our future as an organization is bright, as is the future of the counseling profession because of our volunteer leaders and ACA’s emphasis on preparing these leaders.

This last point was evident during the Institute for Leadership Training (ILT) held in Washington, D.C., in July. This year, ILT participants met jointly with the ACA Governing Council. For those unfamiliar with the ILT, ACA founded the institute to bring together leaders from the regions, branches and divisions to enhance their leadership skills, promote the counseling profession and meet with legislators to advocate on behalf of counselors. This year’s advocacy efforts included calling on Congress to demand that more licensed professional counselors (LPCs) are hired by the Department of Veterans Affairs, rallying support for the Elementary and Secondary School Counseling Program and building support for legislation that would provide reimbursement of LPCs as providers covered by Medicare.

I look forward to continually addressing these and other challenges while serving as your president. The ILT is just one example of ACA and its members working on behalf of professional counselors. Likewise, I know many of you are working in support of the counseling profession, perhaps quietly in your local setting or with students and fellow counselors, with your state legislators, or on special committees or commissions that influence decisions that affect our clients and professional counselors. Please share what you are doing through the various ACA outlets, demonstrating examples of working to create a better life for those in need, as well as advocating for professional counselors so they have the opportunity to use their skills and training to assist others.


Robert L. Smith, Ph.D.

Counseling is a professional relationship that empowers diverse individuals, families and groups to accomplish mental health, wellness, education and career goals.