Monthly Archives: November 2014

Look before you leap

By Laurie Meyers November 25, 2014

For many counselor clinicians, opening a private practice is the epitome of “living the dream.” After all, you get to be your own boss, set your own hours and control how much you get paid. On the surface, it sounds wonderful.

But moving into private practice requires extensive planning as well as a set of new and, in some cases, unfamiliar skills that aren’t related to counseling. Counseling Today connected with several American Counseling Association members who are private practitioners to learn more about what it takes to succeed in private practice.

Risky business

One of the most important things — arguably the most important — to understand about going into private practice is that it’s a business, say experienced private practitioners.

“In addition to clinical skills, you need to have some background or get some training in being an entrepreneur, because it is a small business,” says Harrison Davis, a clinician who owned his own private practice for several years before joining a group practice. “I had to learn how to advertise, how to keep good accounting, how to submit claims.”

Counselors may not realize the many different hats they’ll need to wear in private practice, adds Ryan Thomas Neace, a private practitioner in St. Louis. Even counselors who are part of a small group practice rather than a solo practice will share in managing the business and figuring out such mundane tasks as who schedules the appointments, who writes the checks and even who cleans the bathrooms, he notes.

Davis agrees, pointing out that operating a private practice involves many day-to-day details that are easy to overlook until you are suddenly responsible for them.

For example: “One of my first clients … asked for a receipt for their copayment, and I didn’t have any way to do it. I had to put a note on some yellow paper. It’s funny now, but I can’t imagine going to a doctor’s office and no one being there to give you a receipt,” recounts Davis, who worked as a counselor in a college mental health clinic prior to entering private practice.

Counselors going into private practice also need to learn how to promote themselves. Having an online presence is especially important, says Neace, who currently blogs about counseling, spirituality and mental health for ACA’s website and the Huffington Post. “At first, I had much more time than money,” he says. “So on my first website, I spent a lot of time and figured out how to do things myself.”

It’s important for private practitioners to learn how to use their online presence effectively, adds Neace, whose practice emphasizes holistic healing that includes biological, psychological, social and spiritual aspects. “[Counselors] want to just have a website, but you have to realize, people aren’t looking for ‘Ryan Neace counseling’; they’re looking for ‘depression counseling St. Louis.’”

While Neace taught himself how to market online, private practitioners who aren’t as comfortable with their online skills might want to consider taking courses or hiring someone to help.

Rob Reinhardt, a practitioner and consultant in the Raleigh, North Carolina, area, transitioned into counseling from the information technology world. He applies the technical and business knowledge he gained in his previous career to his work as a counselor practitioner in private practice, where he accepts patients of all ages for individual, couple, relationship and family therapy. He also acts as a consultant to help fellow counselors with online marketing, technology and a variety of other practice essentials.

Reinhardt believes in empowering the counselors he works with, so he teaches them how to approach private practice essentials. For example, he says, “I coach people on how to reach out. When you’re reaching out to other professionals like doctors or lawyers, don’t do a marketing pitch.” Instead, he advises, counselors should focus on the collaborative nature of the relationship. “[Ask them] ‘What can I do for you? What kind of people are you seeing that you feel you might need to send for counseling? What are areas of mental health you haven’t been able to keep up with and need to know more about?’”

Although it might not be their second nature, Davis urges counselors going into private practice to promote themselves everywhere they can. “I’ve seen clinicians who are introverts, so they aren’t eager to go talk to people about their business,” he says. “I’m not uncomfortable with it. I will give my card to my barber, to my neighbor and say, ‘You may not need this, but if you know anyone who needs to talk …’”

But it’s not just marketing that private practitioners need to get comfortable with. They also need to possess or develop strict self-discipline, Reinhardt says.

“People think, ‘Hey, it would be great to go out on my own.’ But unless you can work really hard and do scheduling … You’ve also got to be good about returning calls from clients, keeping records, keeping on top of paperwork. You really have to form some good habits,” he says. “Even if you have software to produce things, if you don’t have a habit of pushing this button at this time, you’re not going to succeed.”

Davis agrees that operating a private practice requires a significant amount of discipline and effort. After nearly seven years as a solo private practitioner, he decided to join a group practice because so much of his time was being spent on paperwork. “My private practice was going well,” he says, “but the paperwork became overwhelming — keeping up with appointments, filling out insurance claims, printing out receipts, using PayPal to accept credit cards …”

No longer the boss, Davis says he gladly relinquished that role in exchange for someone else doing the administrative tasks associated with having a counseling practice. He says he is enjoying the chance to devote more time to clients and to true counseling rather than to running a business.

Despite his experience, Davis still thinks being a solo practitioner is an attainable and rewarding goal for many counselors. He cautions, however, that all counselors with an interest in transitioning into private practice need to have an accurate picture of what they are entering into. Then they need to be honest with themselves when determining how well suited they are to take on that role.

“You need to assess your own risk level,” Davis says. “You need to know how much of an entrepreneur you are. I think it has to be in your blood. You have to really want to own your own business. Ask yourself, how comfortable are you with not having a regular paycheck? How comfortable are you about promoting yourself and advocating for yourself? If you are comfortable with that, you will increase your chances of being successful.”

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Taking the plunge

The stories that follow are reflections and advice from ACA members who have made the leap into private practice, either as solo practitioners or as part of a small group practice.

Beth Ann Dague

Licensed professional counselor Wheeling, West Virginia

Name of practice: Ohio Valley Guidance Services

Year established: 2001

Practice overview: Dague is one of three partners who own the practice, and they also have two contract associates. Dague sees both children and adults. Her specialties include attention-deficit disorder, anxiety, depression, trauma, neonatal loss and abuse, but she treats most diagnoses.

My first counseling position was as an outpatient therapist in a mental health center that had just opened its doors. I also worked with the chronically mentally ill there before going to work at a treatment center for children, [where I did] both counseling and administration. I started supervising there. I then went to a private clinic and worked in the mental health department treating both children and adults. I knew I was ready [to go into private practice], as I had worked with a variety of diagnoses and felt ready to function more independently.

Private practice grows if you do good work. That is your best marketing tool. Learning about running the business is important. I have learned that as I went along. Hopefully this can be addressed in graduate schools. It certainly would be helpful. My ignorance probably caused me to lose some money.

Private practice is very rewarding. I wanted to work my own hours because of my children. My partners and I consult and do trainings and speaking engagements. It has been fun doing so many different things. However, increasing my income meant working sometimes six days a week and then two evenings. I know some practitioners who work every night. An advantage is having your own schedule, but a huge disadvantage is that there are no benefits such as insurance, liability insurance, CEUs, 401(k)s or any retirement funds. Any retirement fund you have will not be matched as it would in some other organizations. You also have to be disciplined to save for taxes.

I would never have guessed that I would have to see such a large number of clients to keep up with my expenses. I was caught off guard by the workload. [If you decide to join a group practice], it’s important to go into practice with like-minded people who can help with expenses. You do not want to go into business with unskilled or unethical counselors. It’s important that you like your partners. You are going to be making a lot of decisions and spending a lot of time with them.

People should start working on a solid referral base and be clinically sound before starting [a private practice]. I would not advise a beginning counselor to become a private practitioner.

My best advice is that you should really have a passion for individual counseling and be willing to form relationships with your referral sources. I have loved doing this.

Frank Fine
Licensed mental health counselor

Orlando, Florida

Name of practice: Orlando Counseling Center for Children, Families and Adults

Years in private practice: 14

Practice overview: A group practice for clients of all ages that Fine owns with his wife, who is a psychiatric nurse. They have four other employees. Fine specializes in trauma but counsels myriad issues with families, couples and individuals.

There was never a time that I was not going to be in private practice, even when I was told by my professors that it was difficult to make a living doing this. Understand that counseling is not a practice — it is a small business. Treat it as such. School yourself in everything from marketing and budgeting to planning and development.

No one teaches you what the job is. This area of study [private practice] is really about on-the-job training. No one tells you how to deal with clients once the door closes. No one tells you how to make a business out of this.

I think beginning counselors need a mentor in both business and counseling. It’s helpful to learn several initial things, including preparing a pro forma [financial statement], developing budgets, forecasting sales, preparing a marketing plan and learning what an employee assistance program (EAP) is and how to market for inclusion in the EAP network. Counselors should also understand insurance and how to market to insurance. It’s also helpful to understand trauma or a variety of specialties. Speaking Spanish is also a useful skill.

Counseling and business skills are equally important to private practice. If you are a good counselor but a lousy entrepreneur, your business will close. Likewise, if you are a good businessperson but a lousy counselor, your business will close.

Work hard. Be creative. Put 100 irons in the fire and look for two to get hot. There will also be at least two bumps in starting a business — count on it. The bumps can be big (IRS problems or general financial problems) or smaller (no clients), but if you make it through these two bumps, you will be successful.

Don’t cheat. Don’t skimp. Don’t do anything that you would be ashamed to tell your kids about.

Lori O’Leary
Licensed professional counselor
Barrington, New Jersey

Name of practice: O’Leary Counseling LLC

Year established: Her LLC was established in 2009, but O’Leary has been in private practice since 2000

Practice overview: O’Leary owns a group practice and has nine employees. The practice addresses all emotional and addictive issues. Accepts children older than 5, adolescents and adults as clients.

I began working in my father’s neuropsychiatric office when I was in college, assisting with group therapy and doing research for a book chapter for him on post-concussion syndrome. After college, I went to school for substance abuse counseling and got a state certification as a substance awareness coordinator. I worked in elementary schools and middle schools doing general counseling for students affected by substance abuse. Later, I took positions in an outpatient substance abuse counseling center for adolescent substance abusers and in a hospital detoxification program while I went to graduate school at night. When I got my master’s degree in psychology, the LPC license was adopted in my state, and I went back to school to fulfill the requirements while I took another position in a residential drug and alcohol rehab program.

My husband convinced me to venture out on my own, and since I had also acquired my certified alcohol and drug abuse counselor (CADC) credential and I had an M.A., I was able to hang a shingle and start substance abuse counseling while I was working on my LPC hours. That first year I used my father’s office when he left for the day, so there was no rent! Once I was making a sufficient amount of bank, I found my own office that was large enough to accommodate the three other therapists that I hoped to find [later on]. I joined the insurance panels and over the last 15 years have been able to build a group practice with eight other therapists and buy an office building, so I no longer have to rent.

I felt I was ready for private practice once I was legally able to do it. I had already worked as a counselor for 10 years, and I was confident in my abilities.

My motivation for private practice was because both my parents had private practices, although my mother was in law. I saw the freedom it gave them and the choices they could make, which was something I always knew I wanted. Of course, I am a control freak and I did not always like doing things the way employers wanted, so it was a logical direction. I [also] wanted to make more money.

The advantages are that on a Monday morning, I can lie in bed at 9 with a cup of tea and have a conversation with my husband when most other people are working for the man. I am the man, and it rocks!

Disadvantages are that on a Thursday evening at 9:30 after seeing 10 clients in a row, I am stuck trying to figure out what mistakes are going on and which insurance companies are not paying and how the practice software has serious flaws. Long days are inevitable, and I am often jealous of my employees who can go home and leave this place without worries. I do get occasional calls from clients with issues that need immediate attention, but that doesn’t really bother me. It is hard to have to constantly move forward and think of new ways to grow the practice. I never have enough time for anything at work. I do work very hard, but I also give myself the chance to play hard or sleep all day if that’s what I need.

I had no college courses in business or business management and I feel that was a deficit, even though I was familiar with accounting and running a practice. I would have done better with more business education. I think I was just born with a lot of energy and tenacity, which was helpful, and I had confidence in myself and my ability to sell my practice. I also worked in intangible sales for a few years, which I think was extremely helpful.

My husband quit his job as a network administrator and now manages my group practice. Since my husband has a background in information technology (IT), I am really lucky. I honestly don’t know what I would have done without him working here. There are so many computer issues that come up from running a business that without an IT background, I would have been lost.

If I had to do it all over again, I would have gotten more business education. When a counselor is thinking about going into a private practice, I would say work for someone else or some other facility for starters. Get to know the business. Take business classes, learn how to write a business plan and do research. See who else does similar things and come up with your own niche. Talk to anyone in the business who will talk. Get as much info as you can before you start and educate yourself on the state you are working in and the parameters of your license. Talk with insurance networks to see if they are open in your area and what the requirements are.

I was not prepared for the insurance companies and their tactics. I think everyone should go through training on joining and participating with insurance. I have learned so much over the years, I could easily give a seminar on what to do and what not to do. What I was really caught off guard by was the games that insurance companies played. I will say it is better now in the electronic billing era, but I lost tens of thousands of dollars just by simple mistakes that I did not realize I made. The whole timely filing is a big deal too. I would sometimes not realize mistakes for a couple months and then get denied for appeals because I waited too long. Then they could legitimately not pay, and I had no recourse.

I cannot emphasize enough the importance of research. Talk with other private practitioners in your area; talk with anyone who will talk. Take a business course. Get an accountant and an IT person who works cheaply because you will need that more than you know. Mostly, make sure you have a cheering section behind you because if I didn’t have my husband, this would never have happened for me.

Beth Sikora
Licensed professional counselor and national certified counselor
Scottsdale, Arizona

Name of practice: The Wholeness Institute

Year established: 1996

Practice overview: Solo practice with focus primarily on mood and anxiety disorders, trauma, mild traumatic brain injury and midlife issues. Client base is mainly adults.

Most of my prior experience was actually in the business world. My prior career was in insurance, and in my positions I managed an agency, was responsible for marketing and underwriting a territory, and also developed and maintained relationships with agencies. In this position, I learned a lot about how businesses were run, how to write business and marketing plans, how to manage my time and meet the demands of competing forces, all while trying to maintain a financial profit for the territory for which I was responsible. All of this was invaluable experience in understanding what the business demands were and how to interact with attorneys, accountants and business owners of many different types of businesses; how to read and analyze financial statements; how to market a business; and how to present a professional image. This allowed me to also look at a counseling practice as a business, as well as a professional service that I was providing and needed to be ethical in and meet customer needs.

In addition, I did contract counseling work for a couple of counseling agencies in town and learned more about the professional setup of offices, ethical guidelines in practice, how to interact with medical insurance companies regarding claims, and other business practices. These experiences also allowed me to learn more about other agencies in town and what services were available, and to begin networking in the area in which I live.

I didn’t want to work full time or for a [counseling] agency in which I had no control over the type of client I saw and was required to see anyone, whether I was qualified to do so or not. I also come from a family of entrepreneurs, so [having my own business] was not a foreign concept and was something I felt comfortable with. I had a fairly good idea of how many extra hours it would take on a weekly basis.

The hardest thing for me is the inconsistency in income at times. If you’re working for someone, you get a salary whether it’s a good month or not, but in private practice you have to balance the budget. You may find you are short during the holidays because when you go on vacation, there is no income. So you’re being hit twice — once with no income and the second time with additional vacation expenses. Also, in difficult economic times your practice is hit harder. Still, as one therapist told me when I spoke with her about the feasibility of private practice, “I’ve never starved, but there have been times that I eat more peanut butter.” You have to be flexible, able to live with ambiguity and uncertainty, and you have to be very strongly self-motivated.

I believe private practice is about learning how to balance both business and counseling. If I’m making financial decisions or establishing fees, I still need to know about the ethics of practice and the American Counseling Association and National Board for Certified Counselors codes related to bartering, for example. If my records are subpoenaed, I must know the ethical responsibilities I have, but I must also be somewhat comfortable in dealing with attorneys, asking questions and getting help where I need it.

Many health providers are terrible business people in terms of finances in particular. All of us likely struggle with the business aspects as sole practitioners. But I either need to learn or I need to hire or contract with an ethical person who understands the nuances of mental health work so that I run a profitable business that also provides ethical service and is sustainable over the long run.

I would encourage anyone who goes into practice to first interview several individual practice providers and ask them what their nightmares are as well as what their sunshine days are like. Unless you talk with another entrepreneur in this field, you cannot understand what it will be like to be the owner, manager, therapist, bookkeeper, ethics specialist and janitor. Get the strongest understanding you can of these areas, and then get the education or mentoring you need to strengthen yourself in the business issues before you take this on — on top of the existing professional demands of being a therapist. And get some funding to support you for a couple of years.

Don’t try to go it alone. Have a consultant to discuss ethical issues with. Keep in contact with other professionals regularly. You’ll need a supportive family. And have your own therapist and coach that you go to when needed. It’s very stressful at times, but it’s also very enjoyable and fulfilling. And [remember to] always take care of your own self-care first.

Stacie Davis
Licensed professional counselor
Chesapeake, Virginia

Name of practice: Coastal Counseling Center

Years in private practice: 2

Practice overview: Part of a group practice with 15 practitioners, Davis specializes in trauma and dissociative disorders but also works with anxiety, depression, attachment issues, adjustment issues and grief and loss.

I worked for 12 years in community mental health, primarily with children and adolescents. During that time, I trained extensively in trauma-focused treatment, got my certified trauma specialist credentials and became certified in EMDR (eye movement desensitization and reprocessing).

I joined a group practice as an independent contractor. I knew I was ready to make the transition when I felt I had a really solid foundation as a clinician and when I got to a place where I wanted more independence. I also wanted to be able to focus more on clinical work and less on the red tape that often comes with agency work.

I wanted to have more control over my schedule and the opportunity to work with all ages, and I also really wanted to be able to specialize in treating trauma and dissociative disorders. The advantages are increased independence, the ability to create a balance in your caseload (and your life) that works for you, the ability to specialize, and less paperwork [than] is involved in agency work. I have the freedom to do things like cut back my hours at work if I take a class and then increase them again once the class is over.

The disadvantages are that it can be more isolating with less peer consultation and support, so it’s important to pursue consultation and peer supervision groups to maintain that support. Also, there are typically no benefits such as sick leave, insurance, etc., in private practice so it’s important to account for those extra expenses.

I think having gotten a lot of good consultation and supervision helps you to develop the clinical skills and confidence needed to go into private practice. It’s also helpful to have really good organizational skills.

To me, private practice is more about being a good counselor than a good businessperson. Particularly if you specialize in treating certain issues, the word gets out and you’ll stay busy.

I would recommend saving up as much [money] as possible. It takes a few months to build up to a full-time caseload, so you’ll want to have a financial cushion to support you until you’re more established. I also started working a few hours per week in private practice while I was still full time at my agency. That allowed me to start to establish a caseload, gradually get onto insurance panels and establish additional savings before making the big leap to full time. That big leap was then much less scary because the private practice world was already familiar from my part-time work.

I would strongly suggest trying it out part time with a group practice. That’s really a risk-free way to see if it’s suited to you while maintaining your full-time job. If it’s not for you, you haven’t lost anything by trying it out. And if it is for you, you’ve already begun to get established, which means it’ll take less time to get to a full caseload once you transition to full time. I have never regretted making the move.

Jennifer Locklear
Licensed professional counselor
Lewisville, North Carolina

Name of practice: Lewisville Family Counseling

Year established: 2012

Practice overview: A solo practice addressing mental health issues and substance abuse in children ages 6 and up and adults through the geriatric population. Locklear also counsels families and couples.

Before venturing into private practice, I had worked at mental health agencies for about nine years. I worked a lot with kids and families in community-based programs and with the severely and persistently mentally ill adult population on an Assertive Community Treatment Team. I had a lot of opportunities to work with kids, teens and adults, and with both the mental health and substance use population.

It is helpful to have both experience and training treating the population you want to treat in private practice. It doesn’t hurt to have a business background as well. For example, my undergraduate degree was in business administration.

Unless you have someone skilled who is going to run the business for you, it is equally important to be a good counselor and to be a good businessperson/entrepreneur. The competitive market makes it important to provide quality services, and being a good businessperson is important to being successful with the business end of the practice.

Private practice can be very rewarding. I was motivated by the autonomy of private practice. Some advantages of being in private practice include having autonomy and flexibility. Some disadvantages of being in private practice are the lack of benefits such as group health insurance and paid time off, and not having the support of other staff roles, including administrative staff.

When I started my private practice, I decided to first try private pay only in order to avoid the hassle associated with insurance companies. That didn’t go as well as I had hoped, and I ended up applying to be credentialed with insurance panels. This was a long and arduous process that I was not prepared for. I ended up hiring a credentialing company to help with the process.

Perhaps I wasn’t prepared to wear so many hats. Not only am I a counselor, I am also an accountant, secretary, janitor, medical records clerk, errand staff, checkout counter, manager, business owner, marketing professional, brochure writer, logo designer and bill collector.

Do your homework. Write a business plan. Move slowly and start with what you can afford. Consider subletting office space from another counselor a couple days per week until your caseload builds. Consider choosing an electronic health record (EHR) and using it from the beginning so that you do not have to transition your paper records to electronic later. Research EHRs and choose the one that will best fit your needs. If you will be accepting insurance, consider choosing an EHR that includes billing features.

One advantage of being a generalist is that you are not limiting yourself to a specific population. However, it can be difficult and expensive, in terms of both time and money, to try to be good at treating “everything.” As a private practitioner begins to develop effectiveness in a specialty, she or he can quickly become known in the community by referral sources such as doctors and other providers.

Deb Wilke
Licensed clinical professional counselor
Bolingbrook, Illinois

Name of practice: Compassionate Counseling

Years in private practice: 16

Practice overview: A solo practice focusing primarily on issues with clients who are lesbian, gay, bisexual or transgender

Previous to opening my practice, I was a case manager/therapist for the Department of Children and Family Services (DCFS) at an agency in Aurora, Illinois. My caseload consisted of young people who were actively suicidal or homicidal. The irony of that job was that the more stressful aspect of my work had to do with dealing with the agency and its hierarchy than the acting out of the youth.

I don’t believe anyone can ever truly be ready to handle the unknown. Private practice is such a different animal than working within a group, hospital or agency environment. I would strongly recommend to anyone considering going into private practice that they make sure to have an excellent consultant and a knowledgeable lawyer (of your work in particular) on retainer.

Probably the most beneficial learning experience for those seeking the chair of the counselor is to have spent sufficient time seated in the client chair. I have been amazed by the number of counselors, social workers and therapists of various kinds who have never sat in the client chair. I do not know how anyone can do this job adequately or sufficiently empathically without knowing what this experience is like for the client and having done one’s own work.

You won’t succeed in private practice if you aren’t skilled in both counseling and business. You may be the world’s best counselor, but if people don’t know who you are or where you are (the business side), no one will come to you. If you’re a terrific marketer and really good at selling yourself but you ultimately fall short of being who you need to be with your clients, no one will come to you.

I would seek out a place to practice where you feel you have adequate control over noise, interference, etc., and that you can see such a place being a long-term spot because the less you move around, the more likely people will find you without difficulty. Having as much control over your space as possible is truly a boon to your peace of mind and [provides] a sense of calm and protection for your clients.

Keep up on research related to the populations you serve. Don’t take seminars for the sake of required CEUs only. Try to line up your learning experiences to be helpful in the field.

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To contact the individuals interviewed for this article, email:

Harrison Davis at harrisond2@gmail.com
Ryan Thomas Neace at ryan@changeincorporated.org
Rob Reinhardt at rob@robreinhardtlpc.com
Beth Ann Dague at Bdague1@comcast.net
Frank Fine at frankfine@earthlink.net
Lori O’Leary at oleary@olearycounseling.com
Beth Sikora at wholenessinst@yahoo.com
Stacie Davis at counselor4kids@gmail.com
Jennifer Locklear at jennie.locklear@gmail.com
Deb Wilke at docwilke@gmail.com

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Continuing education

Counselors can earn seven CEs by listening to the ACA webinar “Profit is not a four-letter word,” which features eight entrepreneurial clinicians sharing their strategies for making a living and caring for clients.

Earn an additional credit by listening to the ACA podcast “Private practice preparedness,” featuring Rob Reinhardt and Anne Marie “Nancy” Wheeler.

For a full list of webinars and podcasts, visit the ACA website at counseling.org and click on the menu bar for continuing education.

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor: ct@counseling.org

Girls daring greatly

By Sabrina Marie Hadeed November 24, 2014

When discussing the idea of girls in the wilderness, the topic of vulnerability comes up often. Typically it is in the context of how girls are vulnerable in fragile ways that we should protect or shelter. However, having been a teenage girl myself, and now having worked as an adolescent mental health therapist for nine years, I can confidently say that vulnerability among girls in the wilderness has more to do with courage and resilience than anything else.

Brené Brown is one of the world’s leading researchers on the study of vulnerability and shame. In her most recent book, Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent and Lead, she highlights relevant themes such as learning to embrace imperfections, letting the people we love struggle and other elements of healing our shame. The book’s title was inspired by Theodore Roosevelt’s “Citizenship in a Republic” speech (1910), in which he said, “It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.”

I have witnessed countless examples of girls daring greatly in the arena of my adolescent therapeutic wilderness group in Bend, Oregon. As we drive out to our remote wilderness use area, my thoughts are filled with a review of the clinical conceptualization of each client. I systematically picture the face of each girl and review the presenting concerns, clinical assessment and other data relevant to the case. Anxiety, depression, history of self-harm and suicide attempts, defiance, drug and alcohol abuse, trauma, history of being bullied or bullying, and tumultuous family relationships are among the most common clinical features represented in my group at any given time. I also consider the strengths and innate potential that each girl possesses, wondering what has stood in the way of the maturity and expression of those strengths. My mind then wanders to the awe of watching nature (the wilderness) help each girl peel back the layers of unnatural overstimulation resulting from daily technology immersion and the false faces of social media relationships.

My teenage years took place before the era of Facebook and cell phones. I am astounded by the resilience that today’s adolescents must possess in order to survive the fast-paced, often cruel and technologically advanced world in which we now live. Many of the adolescent girls with whom I work have spent precious little time connecting with nature or disconnecting from their phones, televisions, computers and social media sites. Few have ever slept under the stars or stopped to listen to the wind whispering through the trees. In fact, most of the teenage girls I work with initially find it very uncomfortable to be in the remote wilderness. I commonly hear “I’m not good at being alone with my thoughts!” or “I can’t possibly be expected to sit and reflect; it’s too hard for me!” and “I need counseling, not sitting in the middle of nowhere!” These protests are understandable because these girls never learned how to sit by themselves and connect with nature. Instead they are used to being surrounded by any number of distractions that encourage disconnection from nature and the here and now.

One day, I arrived after my long reflective drive to the remote site where my group was camping. With my trusty, nature-loving golden retriever by my side, I exited our burly off-road vehicle, took a deep breath of the warm Cascades air and hiked up the barely visible dirt trail. Taking a final step over the gnarled volcanic rock, I could see the group of girls in the distance. Instantly, I was struck not by what I saw but by what I heard.

My ears and heart were suddenly being serenaded by six harmonizing girls. They were standing in a circle, all eyes focused on the group-appointed 17-year-old pseudo choir director. Their bodies stood like gracefully poised trees as they gently sang out. But they weren’t singing a song by any artist commonly attached to their generation, such as Lady Gaga or Miley Cyrus. Instead they were harmonizing so beautifully to “Rose Red,” a ballad from the Elizabethan era.

There was a disorienting two-second lapse of time where I had to remind myself where I was standing. For one lovely moment that day, we were no longer in the Oregon desert in a therapeutic wilderness program defined by mental health struggles and adolescent angst. Instead we were transported to a magical place where teenage girls put their pain aside to learn a song together, letting their voices sing out and dance along the juniper tree-spotted hills of the Cascades.

It was beyond any brilliant counseling technique I could have applied. The moment was made possible through the influence of a connection to nature, a disconnection from the distractions of cell phones and social media sites, a positive group culture, the ongoing collaborative support of the entire treatment team and, of course, the courage of six teenage girls. The girls had been able to develop emotional safety within the group and increase their self-confidence, which gave them the courage to “dare greatly.” I believe the power of vulnerability and daring greatly can be linked to reconnecting with one’s self through nature and disconnecting from the conveniences of our technologically smothered first-world lives.

In 2011, Brené Brown wrote, “I define connection as the energy that exists between people when they feel seen, heard and valued; when they can give and receive without judgment; and when they derive sustenance and strength from the relationship.”

Among the circle of singing girls there were no perfect vocalists, no dominating ego, no cyberbullies, no gestures of self-harm, no competing debutants. There was only honest harmonized courage and the presence of emerging self-acceptance and genuine connection. Moments like that remind me how the influence of nature can transform and why the power of vulnerability is born from the courage to dare greatly.

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Sabrina Marie Hadeed is a licensed professional counselor, national certified counselor and approved clinical supervisor. She is a primary therapist at Second Nature Cascades and a doctoral candidate at Oregon State University. Contact her at sabrinamariecounseling@gmail.com.

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Wilderness therapy: A closer look

See the January issue of Counseling Today for an in-depth feature article on wilderness therapy (to which Hadeed contributed).

NCC will require graduation from a CACREP accredited program beginning in 2022

November 20, 2014

The National Board for Certified Counselors (NBCC) has announced that after January 1, 2022, individuals applying for the National Certified Counselor (NCC) credential must hold their degree from a counselor education program accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP).

NBCC is an independent credentialing organization based in Greensboro, North Carolina, and the NCC is a voluntary, private certification. Counselors who did not graduate from a CACREP accredited institution who have, or will, receive their NCC before 2022 will continue to be recognized by NBCC after this change occurs.

This decision was made by the NBCC board and formally announced on November 17 to those holding the NCC and to other organizations such as ACA.

Learn more about the NBCC announcement here.

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Storytelling and hope in Ferguson

By Bethany Bray November 17, 2014

It was a striking scene: Protesters, many of whom had been on the front lines of the unrest and turmoil in Ferguson, Missouri, for more than 10 weeks, pausing to talk with a counselor and create a scene in a sand tray.

At times, there were “heavy tears” as grief, frustration, hurt, exhaustion and anger – as well as hope and empowerment – bubbled over as people told their stories, says Brian Hutchison, a licensed professional counselor (LPC) and assistant professor at the University of Missouri – St. Louis

A person creates a scene in a sand tray in the UMSL counseling tent in October. Photo courtesy of Brian Hutchinson.

A person creates a scene in a sand tray in the UMSL counseling tent in October. Photo courtesy of Brian Hutchison.

(UMSL). Some of the protesters talked of being hit with rubber bullets, seeing friends arrested or being arrested themselves.

Hutchison is part of a group of roughly 40 UMSL counseling department staff and students who have been involved in numerous initiatives in the Ferguson area this fall. Those initiatives have ranged from leading trauma response training with Ferguson public school teachers to organizing “pop-up” counseling tents near the ongoing protests and marches.

Tensions in Ferguson and the surrounding area boiled over this fall after unarmed black teenager Michael Brown was fatally shot by a white police officer, Darren Wilson, in August. Accounts of what transpired leading up to the shooting have varied widely.

Protesters and community activists have been demonstrating ever since the incident, some camping out in the city and sleeping in tents, Hutchison says.

Brown’s shooting was a flashpoint that opened long-simmering wounds surrounding racial inequality in the community.

“A Band-Aid has been ripped off a wound that had not healed,” says Holly Wagner, an LPC and assistant professor in the department of counseling and family therapy at UMSL. “People have been hurting for a long time, and they’re at the point where they’ve had enough — enough pain, enough misrepresentation — and they’re ready for change. That’s what this movement is about.”

Hutchison’s office at UMSL is a little more than one mile from the apartment complex where Michael Brown was shot; UMSL is located in the district where Brown went to high school.

The UMSL counseling department has long-standing relationships with many community leaders in the Ferguson area, Hutchison says, and the university was involved in the community long before it made headlines and became synonymous with racial tensions.

In the midst of all the turmoil, UMSL’s counseling department has set up counseling tents for protesters and onlookers and organized community meals with table discussions on race relations. It has also organized or participated in community workshops and a panel talk between local counselors, residents and community activists. On the day of Michael Brown’s funeral, Hutchison and his colleagues led trauma response training for teachers in the Ferguson-Florissant School District, after the schools had been closed for more than a week because of protests and ongoing tensions.

“There is violence [connected to the protests]. I’ve seen it,” Hutchison says. “But for every three people throwing bricks into a window, I’ve seen 60 people stand in between [the people throwing bricks] and the window. … I am so thankful and humble because I am witnessing a cohort of people activate as citizens. Not only have they camped out for 60-plus nights, but some of these people were in rival street gangs and reconciled when they heard about Michael Brown being shot. … That’s the best we can hope for in a generation of young people.”

Wagner, who is in her first semester teaching at UMSL, had put together sand tray kits for a unit on play therapy prior to the fall semester. When tensions began to boil over in Ferguson, Wagner thought the kits seemed like a natural tool to use in the community.

“Play is the way kids talk, but it’s also our language,” she says. “If we allow ourselves to engage in something that creates meaning in an immediate way, it helps us tell our story.”

The UMSL team in a pop up counseling tent at a recent protest. Photo courtesy of Brian Hutchison.

The team of UMSL counseling professors and students have been setting up a tent with tables, chairs and sand trays near organized marches and protests. Passersby are invited to stop in, pause to reflect and simply “tell their story” to a listening ear, Wagner says. Participants create a scene in a sand tray as they talk.

“It’s a space for them to come in and take a break — a small moment to say, ‘I’m not sure, I’m scared and I’m in pain,’” Hutchison says. “It’s some of the most amazing work I’ve done in my career. It’s really powerful.”

Participants are also given a handout that entitles them to five free counseling sessions at several clinics on the USML campus, as well as information about other local counseling offices that offer therapy on a sliding scale, Hutchison says.

The initiative has been so well received that people have to wait for a seat to open up sometimes.

“If they were a little dubious about [play therapy], as soon as they sit down and start doing it, that quickly fades away,” Wagner says.

The tent creates a quiet space and an opportunity to be heard — a welcome change from protesting and the struggle to get a message across, she says. People are not just willing but also needing to talk.

“People are so exhausted from yelling and wishing people would hear them. When they come to the tent, all they have to do is talk,” Wagner says. “… They’re so passionate about this. They’re giving everything of themselves to try and be heard and have some action take place.”

Through storytelling, people who come through the tent have been expressing grief and loss, trauma, disappointment, frustration, isolation and a sense of being misunderstood, report Hutchison, Wagner and Christina Thaier, a UMSL student who will graduate this spring with a degree in clinical mental health counseling.

On the other hand, a great sense of hope is also evident, according to the UMSL team.

The young African-American man who created this sand tray scene said he was a crab figure he had placed under the shell to “hide,” and the snake represented the danger he was feeling. Photo courtesy of Brian Hutchison.

Often, participants will place figures such as trees, animals and shells upside down in the sand tray as they talk. According to Hutchison, this is an indication of feelings of chaos, turmoil and danger.

“The No. 1 thing I heard was the question of value,” says Thaier, an American Counseling Association member and president of UMSL’s Chi Sigma Iota chapter. “Am I valuable as a human being? What does what happened with Michael Brown say about my value as a person and his value as a person? What do I do about that, and how does it impact my life?”

The UMSL tents are not meant to be a place for intensive therapy, Wagner explains. Rather, they present an opportunity to provide a listening ear and offer referrals to a counseling office.

The UMSL team plans to keep offering what Wagner describes as their “mobile play therapy response unit” indefinitely. She believes they are filling a need that is likely to increase as the case surrounding Brown’s death makes its way through the courts.

“We’re still at the first chapter of this story, I’m certain,” concurs Hutchison. “We want to be a consistent presence, a consistent safe space.”

“This is not a sprint but a marathon. We are in it to be called upon repeatedly,” Wagner says. “… If people know we want to listen, they’ll talk and share their stories. My sense is that their real stories aren’t being listened to. What’s really on their hearts is yet to be told.”

UMSL’s Chi Sigma Iota chapter has covered the costs for the sand trays and other materials for the counseling tents, Thaier says. The chapter, which has roughly 40 active members on campus, is also discussing the possibility of continuing the initiative in local schools or senior centers.

The entire experience has been an opportunity to learn by doing, side by side with peers and professors, says Thaier, who is doing an internship at a private practice and applying to doctoral programs.

“We feel humbled and honored to be involved,” she says. “It’s taking our learning to such a deeper level. We’re all finding our voices of who we are professionally and what social justice is.”

“… It’s amazing to watch all of my peers have this experience with me and see that experiential learning on a whole new level,” she continues. “It’s been a bonding moment for us as students, working together and being able to talk and process our experiences. To see the emotion in everyone’s face, that’s a memory I’ll have forever.”

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Social justice in action: A counselor’s role

Hutchison, Thaier and Wagner agree that when social justice issues arise, a counselor’s role is to get involved.

“I feel Ferguson could be anywhere, I really do,” says Wagner.

The tensions and anger being expressed by protesters are not isolated to Ferguson, agrees Thaier.

“This is already in everyone’s backyard,” Thaier says. “You don’t have to be at a protest or be at a gathering to go back and have these conversations with your clients and ask ‘what support can I give?’”

The first step, Hutchison says, should be to listen and thoughtfully consider the situation before jumping in. For the UMSL group, this meant attending a rally in downtown St. Louis and visiting Ferguson to witness the police response this fall.

Most important, Hutchison adds, is a large dose of humility.

“No one knows what counseling on a city street during social upheaval looks like. We don’t have textbooks for that,” he says. “Be respectful and mindful of your own privilege. … Be humble. Be willing to be helpful and resist the urge to interject [your own opinions].”

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Brian Hutchison is tweeting photos and updates about his department’s work in the Ferguson area. Follow him @DrBHutchison and look for the hashtag #UMSLCounseling

To contact Hutchison, email hutchisonbr@umsl.edu

For updates and more information on the situation in Ferguson, Hutchison recommends these websites:

fergusonoctober.com

obs-onthemove.org

handsupunited.org

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ACA podcast: “Understanding Ferguson”

Rebecca Daniel-Burke, a counselor and ACA’s director of professional development, interviews Ken Oliver, a licensed professional counselor in Missouri. As a native of St. Louis, Oliver has a personal connection to Ferguson and the surrounding community. He currently serves as the graduate program director and associate professor of counseling at Quincy University in Illinois.

Click here for a link to the podcast.

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook: facebook.com/CounselingToday

The Hope Chest: Finding calm within the storm

By Kim Johancen-Walt November 13, 2014

We have all taken seminars, classes and workshops focused on the importance of self-care. These forums generally highlight the importance of taking care of ourselves outside of work. We talk about the importance of finding balance, taking spin classes, kickboxing or engaging in hobbies such as drumming or knitting. But despite our best efforts to make self-care a priority, there are times when many of us still find ourselves feeling fatigued, increasingly irritable and disconnected from our personal relationships.

When we are merely burned out, all of those pickle ball classes we participate in or blankets we crochet can work to rejuvenate our spirits so we can continue engaging with our clients and within our own lives. Sometimes, however, we find ourselves unable to bounce back, stretched beyond our natural elasticity and resilience. Through our daily exposure to trauma, we are at risk of developing tilted vision without even recognizing that it is happening. At these times, our self-care may not be enough to prevent us from doubting our ability to effect real change for the people we are trying to help. Activated and overwhelmed, we can lose our way, maybe even seeing our clients as problems rather than people.

Vicarious trauma is like a slow-moving virus that weakens our muscles and compromises our immune system. The reality is that we are all at risk. As a therapist in the field for many years, I understand the weight of trauma both personally and professionally. I engage routinely in self-care, take mental health days as needed, strive to find balance and do my best to resist the urge to isolate when I feel particularly stretched. But it is important to remember that distraction alone is not enough to help us heal from the impact of trauma, whether that trauma is direct or vicarious. Sometimes, no matter what we do outside of work to protect ourselves, we still can’t stop the disease from spreading; we merely slow it down. We have to find a way to stop the poison from permanently impairing our system.

We can find openings with our clients to build our own resiliencies along with theirs. By reflecting on these sacred conversations, we can learn valuable lessons that allow us opportunities to heal within the storm. Longevity as a therapist comes from using (rather than avoiding) our exposure as a way to build immunity and ultimately to become even better healers. On-the-job resiliency training involves deepening our understanding of the value of human connection for ourselves, remembering that pain and discomfort are an essential part of living fully and that helping others is a direct pathway to helping ourselves.

Powerful connection

“Patricia,” 36, lived alone and had come to therapy for issues related to the loss of relationships in her life, including a long-term boyfriend and the unexpected death of her mother several years earlier. Patricia was motivated to heal and live a fuller life. Her motivation was evident not only in her regular visits to my office but also in her diligence to practice various techniques and strategies in between sessions. She was also dedicated to other healing practices, including her work as an artist, seeing an acupuncturist and attending yoga on a regular basis. But despite all of these efforts, Patricia continued to talk about feeling stuck in the abyss and unable to find her way out.

She started coming to therapy frustrated, telling me over and over again that she was doing everything she was supposed to do to take care of herself, yet nothing seemed to be working to stop the pain. After acknowledging her incredible efforts along with her frustration, I reminded her that although she was engaging in several meaningful practices, she was doing all of these things by herself. We discussed how as human beings we absolutely cannot heal in isolation. We need each other. Rumi’s teachings remind us that it is the relationship that hurts, but it is also the relationship that heals. After exploring this concept, we discussed how Patricia could begin cultivating more meaningful relationships in her life moving forward despite a fear of further rejection and abandonment.

When the constant exposure to trauma begins to cloud our vision, our connections to peers, friends and family members are threatened as we begin to show the same symptoms of numbing and constriction that our clients exhibit. Whether we see our own therapists or choose to spread it around to our existing support network, others remind us that we are good, that we have experienced success in many areas of our lives and that we make a difference. In other words, we are reminded that it is not all bad. In graduate school, we are taught that the relationship with our clients is paramount to any therapies, skills or strategies we offer. Connection (or reconnection) is the most powerful medicine available to heal the isolation that comes from trauma.

Painful experience

As Patricia began to accept that building relationship outside of therapy was essential to her healing, we began to work with the rawness of her past through a broader lens of human experience. As she discussed moments when the emotional pain was so intense it threatened to split her open, I encouraged her to remember that her pain was not uniquely hers. Although experiences of loss may differ greatly from person to person, it is something we all have in common. Embracing the painful experience is an essential part of what it means to live fully. Through this practice, Patricia began to connect to others more deeply, growing in awareness that there were people everywhere who knew the pain of loss, the feeling of heart-crushing grief and the ache of abandonment.

As therapists, we remind ourselves — as we remind our clients — that the inevitability of change ensures us that pain, just like joy, will not last indefinitely. It is with this knowledge that we remind others to keep moving, to keep breathing and to not give up. It is the not giving up that is most essential. Remembering (or experiencing) the universality of pain can be incredibly humbling for us as healers. No one is immune, and life does not pick and choose who gets clobbered. It is through this knowing that we find humility and the sweetness of shared experience. We find our way and the courage needed to withstand the violent storm raging around us.

Tasting our words

Patricia eventually decided to take her painting to the next level by becoming an art instructor at a local studio. She discussed how it brought her happiness to know she could help others through creative expression and also by helping her students build confidence in their abilities to create beautiful paintings. We discussed her decision to help others as part of her healing because it allowed her an opportunity to reap the benefits of receiving what she gave away. Patricia’s choice to become a teacher helped her cultivate purpose, connection and success.

Therapists with potentially compromised systems are at risk of abandoning ship by closing their offices temporarily or, in some cases, leaving the field altogether. And although there is value in taking a self-appointed sabbatical, a radically different choice would be to continue showing up in the chair. The fact is, we cannot do the work we do as counselors without compassion, however difficult it may be to find at times. By keeping our hearts open so that we can be there for others, we effectively resist the urge to disconnect from ourselves and from the people that matter most in our lives. We are either open or we are not. By tasting our words, we offer comfort and reassurance to ourselves as we offer comfort and reassurance to others.

No one is immune to the impact of trauma, the devastation of loss and the activation that reminds us that although we are therapists, we are also carriers of the virus. Through our connections to the

caring others in our lives, we are able to integrate our own trauma stories while keeping a larger perspective. By helping our clients work through painful feelings, we are humbled, remembering that the experience of loss is an essential part of what it means to live fully. Furthermore, by helping others we can remain open, resisting the urge to close ourselves off from relationships and from our own lives. It is the work itself that helps us heal.

Perhaps over time we can treat ourselves with greater compassion and gentleness, not waiting to seek support but rather asking for it when we need it most. Perhaps by remembering our shared experience, we can hold steady in the storm. Maya Angelou spoke about how the universe continues to present us with opportunities to learn valuable lessons over and over again until we finally “get it.” Whether trauma comes in the form of personal experience or from the ongoing exposure to the trauma of others, this is an important concept for the wounded healer.

What is the universe trying to teach you?

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Kim Johancen-Walt writes “The Hope Chest” column exclusively for CT Online. She is a licensed professional counselor with almost 20 years of experience. Her clinical experience includes working as a therapist for La Plata County Human Services, where she helped develop a treatment model for adolescents in Durango, Colorado. She has presented her clinical work at mental health conferences nationally, including at the annual conference for the International Society for the Study of Self-Injury. Additional clinical experience includes a position as assistant training director and senior counselor in the Counseling Department at Fort Lewis College. She currently operates a full-time private practice in Durango. Contact her at johancenwaltks@gmail.com.

Previous columns:

The Hope Chest: The GIFT of therapy

The Hope Chest: Unpacking the hurt

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