Monthly Archives: December 2014

Going wild

By Bethany Bray December 23, 2014

In a matter of months, 16-year-old “David” had gone from being a successful student to spending 12 or more hours per day playing video games. He lost his scholarship to a private school, then dropped Branding-Box-Utah-streamout of school altogether, refusing to leave the couch, even to bathe.

He also stopped communicating with his family. His parents, with whom David had previously been affectionate and close, were afraid he was shutting down.

Diagnosed with depression, David saw four different mental health professionals without making much progress. What finally reached David was wilderness therapy, a unique treatment model that brings clients to natural settings for intensive therapy with a counselor (or other mental health professional) and peer group.

David spent 12 weeks in a program in the high desert plateaus of southern Utah. Although initially resistant to the program, the wilderness setting and peer group eventually prompted him to become social again and work through his struggles. David and his parents exchanged letters while he was away, helping to repair the relationship.

Now back at home, David is again close with his family and flourishing at school. In fact, he was recently elected student body president, says Steven DeMille, an American Counseling Association member who was David’s counselor at Redcliff Ascent, a wilderness therapy program in Utah.

In a post-therapy case study, DeMille, a licensed clinical mental health counselor who is a clinician and director of research at Redcliff Ascent, wrote, “The wilderness provided David with a challenging, straightforward and neutral environment to reflect on old behaviors and try out new options. … David realized that he no longer needed to defeat the structure through disengagement to meet his personal needs. He could meet his needs through following rules and meeting social and family expectations.”

Redcliff Ascent is one of a growing number of programs across the United States that specialize in wilderness therapy. Although models vary from program to program, the majority involve taking groups of clients — most commonly youth or young adults — out into the wilderness for an extended period of time. Participants, including program staff, typically sleep outside, pitch tents, hike and cook food over an open fire.

Therapy occurs in both group and one-on-one sessions. But it also takes place “in the moment,” such as when a client’s anxiety flares when struggling to start a fire or self-doubt kicks in when tasked with leading a hike by compass, says Sean Roberts, a clinical mental health counselor who has worked in wilderness therapy for almost a decade.

“The wilderness is such a powerful intervention because it’s unpredictable,” adds Sabrina Marie Hadeed, an ACA member and licensed professional counselor at Second Nature Cascades, a wilderness therapy program in Oregon.

In one case, a client of Hadeed’s was struggling to set up the tarp for her sleep shelter during an unexpected rainstorm. Frustrated to the point of tears, she gave up and sat down in the rain. The situation served as a chance for Hadeed to talk with the client about coping when circumstances were out of her control and how to ask others for help, both of which were hard for the young woman.

“There’s equal balance in the wilderness of challenge and nurturing, structure and safety, and really learning what’s inside and outside of your control,” says Hadeed, who is finishing her doctorate in counselor education and supervision at Oregon State University. “It’s challenging [for clients] to lean into the discomfort of their difficult feelings rather than turn from them. As long as it’s safe, we’ll encourage them to do that [and they] will increase tolerance for those feelings. In a traditional setting, you meet with a therapist for an hour, even if it’s twice a week. You leave that space and you don’t have to practice what you’ve practiced in the session. In the wilderness, you have to practice all the time — how to give feedback, express frustration, interact with peers.”

Simply put, wilderness therapy is evidence-based therapy — including traditional methods such as Adlerian therapy, cognitive behavior therapy and others — that is done outdoors, say Roberts and DeMille, who presented together on the topic at the 2014 ACA Conference & Expo in Honolulu.

The wilderness therapy model is intensive in many ways, from the group dynamics and 24/7 interaction with program staff to the often breathtaking scenery and natural challenges confronting the clients. Practitioners in the field say wilderness therapy has been proved to have positive outcomes for clients, from better management of behavioral disorders, anxiety, addictions and other struggles to boosts in self-confidence and overall health, including nutrition and sleep patterns.

“The therapy is much more challenging than anything physical,” says Roberts, an ACA member who just began a position as clinical director at Cascade Crest Transitions, a residential program for young adults in Bend, Oregon. “It creates a very powerful milieu. … It’s an incredibly rich and fertile environment for therapy [and] a strengths-based approach to healing.”

Outdoor behavioral health care

DeMille prefers to use the term outdoor behavioral health care rather than wilderness therapy because he says the latter is a nebulous, unregulated term that many nonprofessionals use. He recommends that counselors looking to refer clients search for programs that adhere to the outdoor behavioral health care model, which is a regulated industry with set standards (see sidebar on the Outdoor Behavioral Healthcare Council below).

“There are going to be programs out there that say they’re wilderness therapy, but that’s not necessarily outdoor behavioral health care,” DeMille says.

Outdoor behavioral health care is light years away from the “boot camp” image that many people still associate with wilderness therapy programs, where participants are “broken down” in order to build them back up, Roberts and DeMille say. In fact, outdoor behavioral health care is the opposite, says DeMille.

Regulated programs, including all of the programs for which the counselors interviewed for this article work, have field guides with small groups of clients around the clock. Although the guides are not counselors or mental health professionals, they are given extensive training in wilderness living and serve as adult mentors to clients. Client groups range in size from a few individuals to a dozen people.

Clients meet regularly with a counselor or other licensed mental health professional from the program’s support staff. These counselors work closely with the field guides to get feedback and check in on the client’s progress concerning the treatment plan or goals.

Counselors lead group and individual therapy sessions, work on outreach to families and provide case management. As a clinical director, Roberts says he will also join a group at least once per session for an overnight trip outdoors. He remains on call whenever he isn’t with the group.

“There’s so much more to work with than when I’ve done outpatient work and so many more ways to gather [client] data,” Roberts says.

Clients enter outdoor behavioral health care programs for a number of reasons, including treatment for a variety of mental health diagnoses, behavioral problems, substance abuse issues, problems with school or relationships and trauma recovery. Client stays are usually open-ended; they leave the program only when they are ready, Roberts says. An average stay at DeMille’s program is 70 days, whereas the average at Hadeed’s program is eight to 10 weeks. Programs have rolling admissions, with clients joining and leaving the group intermittently.

Parents of youth clients stay involved with the program and visit their sons or daughters in the wilderness, even sleeping overnight. Hadeed’s program maintains a website for clients’ families where they can post photos and updates and exchange messages while their teenager is out in the wilderness.

Prior to discharge, counselors spend a significant amount of time preparing clients for re-entry into home settings or social situations that previously caused them distress or with which they had difficulties. This process includes working to hone the client’s decision-making and communication skills, relapse-prevention strategies and other coping methods, DeMille says.

In addition, outdoor behavioral health care therapists often work with school staff, counselors and other helping professionals in the client’s hometown to ease the transition. “We do put a lot of energy into figuring out what will set them up for success as they leave,” Roberts says.

The right fit

Outdoor behavioral health care is often effective for clients who are “stuck or deteriorating in treatment” or not responding to traditional therapy methods, according to DeMille. It can also be a good fit for those who drop out of traditional talk therapy or end up hospitalized after a suicide attempt or overdose.

The approach is also effective, says Roberts, with clients who are struggling with a “failure to launch”: young adults who are underperforming in life or career, including failing or being kicked out of school or college.

Roberts, who is finishing his doctorate in counselor education and supervision at Oregon State University, previously worked at Second Nature Entrada, an outdoor behavioral health care program in southern Utah, near Zion National Park. He notes that many of his clients have “been through tons of talk therapy” but struggled to put what they learned into practice. Many have legal records, family systems issues, depression, a history of suicide attempts or struggles with self-medication via substance abuse. These clients are often wrestling with dysfunctional relationships, destructive life patterns or an internalized sense of hopelessness, he says.

“They need an opportunity to unplug from that [life] and course correct — shift the trajectory of where they’re heading … stabilize and gain some tools to increase their confidence,” Roberts says.

Counselors interviewed for this article agreed that outdoor behavioral health care can be a good fit for clients who struggle with:

  • Self-harm
  • Low self-esteem
  • Poor body image
  • Depression
  • Emotional, mood or anxiety disorders
  • Developmental disorders, including attention-deficit/hyperactivity disorder
  • Trauma
  • Behavioral disorders
  • Substance abuse
  • Poor school performance
  • Being disruptive, uncooperative or withdrawn
  • Having poor boundary issues with peers (such as crush obsessions or sexting)

Conversely, outdoor behavioral health care is not recommended for clients with:

  • Severe eating disorders
  • Severe forms of autism
  • Learning disabilities that cause them to become oversensitized easily
  • Psychotic disorders such as schizophrenia
  • Medical conditions that necessitate being near a hospital (for example, diabetes)

Being comfortable with the outdoors is not a client prerequisite, Hadeed emphasizes. In fact, taking clients out of their comfort zones — and away from their cell phones, friends and favorite TV shows — is often a factor in their healing and progress.

Hadeed says counselors considering whether to refer a client to an outdoor behavioral health care program should first speak with program staff to determine if the client might be a good fit. Conversely, if a counselor is working with a client who has already gone through an outdoor behavioral health care program, the counselor shouldn’t hesitate to reach out to program staff to collaborate, she says.

“Whether it has been one year or five years, the experience will still be with [the wilderness therapist], and they can talk through what works [for that client],” Hadeed says. “That collaborative piece is really important.”

A journey of self-discovery

Gil Hallows, executive director of Legacy Outdoor Adventures in Utah and chair of the Outdoor Behavioral Healthcare Council, calls the outdoor behavioral health care model a “modern-day rite of passage.” He draws comparisons with the Australian aboriginal “walkabout” and similar rites in other traditional cultures in which adolescents spend time in the wilderness to learn, grow and discover their strengths, returning to society as adults.

Similarly, outdoor behavioral health care is an “individualized journey of self-discovery,” says Hallows, who has worked in the field for two decades.

Hallows and the counselors interviewed for this article agree that numerous factors contribute to the modality’s success with clients, including:

Time away: Outdoor behavioral health care clients spend weeks away from home. In doing so, they are removed from the people, circumstances and other factors that may be contributing to their destructive behaviors and struggles with mental health, including friends, addictive substances and technology.

Hallows refers to this as “the great slowing” because clients have time to think more clearly and reflect on their life away from distractions. “It takes a young person away from everything they’re accustomed to manipulating,” from their own families to video games, he says.

In addition to long hikes, journaling time and other opportunities for self-reflection, some outdoor behavioral health care programs include a “solo” experience, in which clients spend time alone for introspection.

The time away from school cliques, name-brand clothes, cell phones and other familiarities often leads to breakthroughs in self-identity for clients, Hadeed says. In one case, a client discovered that her sense of humor and knack for performing could be a strength and a way to process and communicate her feelings rather than a means of getting her in trouble, as it had in the past.

Time away challenges clients to ask those important questions of identity, Hadeed says. “[It] highlights the strengths, gifts and natural positive qualities they have that they weren’t aware of because of the distractions of daily life, including technology,” she says.

Learning by doing: Part of the outdoor behavioral health care experience for clients is learning to take care of their own equipment, cook meals together and share in other chores such as gathering wood and building fires.

In most cases, clients are learning to do things they’ve never done before. Moments when clients struggle or get frustrated turn into opportunities for in-the-moment encouragement and guidance from program staff.

Roberts says this process leads to empowerment and taps into a host of skills that will carry over into everyday life, including dealing with frustration, sticking with a task, learning to ask for help and engaging in long-term planning.

“It’s almost unavoidable — clients will learn skills, [including] self-confidence, problem-solving, self-care and task accomplishment,” Hallows says. “It’s extremely fulfilling and rewarding to observe the transformation that takes place in a young person when they discover who they are and what they are capable of doing while on a wilderness journey.”

Roberts says he will suggest tasks for clients based on issues they are dealing with in their therapy sessions. He works with the field guides to set up interventions, such as the job of leading a hike by compass, to see how clients respond to specific challenges.

Roberts says he might also suggest that a client who is weighed down by emotional baggage (such as anger or a destructive behavior) take a walk while carrying a rock, a stick or some other object. Afterward, he will talk with the client about the metaphor of carrying something around with us constantly, why that is a challenge and how it can be overcome.

Participants in outdoor behavioral health care often gain new perspective, DeMille says. “Things that you have taken for granted [meals, for example], all of a sudden you have to work for,” he says. “It develops a sense of mastery, competency. They grow in confidence and competencies.”

The model also lends itself to learning what is and isn’t in your control, Hadeed says. “You can’t control the rain, the wind or the weather, but you have control over whether you’re going to put on a jacket or build a fire, and that can be translated to a family setting,” she says. “You can’t control what mood your dad is in when he comes home, but you can control your response to that mood.”

Group dynamic: In most cases, clients in outdoor behavioral health care programs join a group of people they’ve never met before. Over time, the client bonds with group members and staff leaders, Hallows says.

“Sharing a common experience with a group of peers and staff, it lends itself to establishing a tight peer group that holds each other accountable,” he says. “They learn to identify and express emotion, become honest with themselves. And if they’re not, they’ll be called out by their peers.”

Clients work through anxieties and other issues alongside one another, learning as they go. The shared experience with people who are trying to overcome similar struggles is the opposite of the isolation of one-on-one therapy in an office, DeMille points out.

“The group dynamic allows [clients] to work on problems in conjunction with peers in their group,” he says.

The around-the-clock guidance from field staff is also a factor, agree DeMille and Hallows. Clients benefit from seeing adult mentor figures working alongside them, completing hikes, setting up camp

Clinical mental health counselor Sean Roberts provided this photo of his previous “office” in the wilderness northwest of Enterprise, Utah.

Clinical mental health counselor Sean Roberts provided this photo
of his “office” in the wilderness northwest of Enterprise, Utah.

and sharing meals, chores and other tasks. These field staff work closely with the program counselors to make sure that clients are on the right track and meeting treatment goals.

Hadeed notes that many of her clients come into the program with a misconception of what therapy is or should be. She explains to them that there’s more to therapy than feeling good; therapy presents both challenges and rewards.

“[Therapy] is not always about helping you to feel happy but rather learning to tolerate very normal feelings — worry, fear, anxiety,” she says. “It’s helping you to learn how to tolerate and better express those feelings, ask for help and if you feel like crying, crying. We help them learn that these emotions they are feeling are totally normal, and the more you try and contain them, the more they’re going to come out in other ways.”

The natural setting: Lastly, the natural environment lends itself to lessons of growth and healing. Many outdoor behavioral health care programs take groups into national parks and other breathtaking locales.

“There’s something healing about being outside,” Hallows says. “A good counselor … finds the wilderness setting a huge ally. [For example], counseling a person who has survived a rainy night, kept himself dry and started a fire. Compare [those skills and victories] to his or her life before. … Imagine how impactful one can be as a counselor if you have that experience and setting as an ally. The experience of living outdoors and living in a group of peers, those are the change agents, and if you add counseling to that, you’re leveraging the experience.”

Bringing the outdoors in

The counselors interviewed for this article agree that some of the elements that make outdoor behavioral health care successful can be introduced in more traditional office settings as well. For example, group therapy and hands-on experiential exercises will be more effective at reaching certain clients, Roberts says.

In addition, instead of talking with clients about what happened yesterday, consider working through challenges “in the here and now,” he says. “Give [the client] a task to do. Put together a puzzle [or do] something that is going to create some anxiety, a chance for failure — whatever fits for the client.”

As in outdoor behavioral health care, traditional counselors can also include discussions about overall health, including exercise, nutrition and sleep habits, Roberts says. In addition, both DeMille and Roberts recommend getting outside with clients during counseling sessions when appropriate, such as by taking walks. Furthermore, they say, counselors can prescribe clients to take walks or get outside more on their own.

Parents sometimes turn to outdoor behavioral health care as a last resort, an 11th-hour option after going through multiple therapists or programs, Hadeed says. She’d love to see the opposite: wilderness therapy as a family’s first option.

When most people think of counseling, they picture an office and the iconic leather couch. Instead, what if they pictured a mountainside group therapy session or a counselor chatting with a client as they hiked or went fishing?

“That would be my dream,” Hadeed says.

Wilderness-authors

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The freedom and light heart I deserve

The following prayer was written by 19-year-old Skye Angelo Rossman, a former client at Second Nature wilderness therapy.

“In my life, I have experienced much love and much hate. I did not enjoy the severity of the extremity. From this day forth, I ask to eliminate the one that doesn’t allow me the freedom and light heart I deserve. I have been through much and will go through much more. It is my hope that I am given the respect I give you in my life. It is with eternal gratitude I pray, amen.”

— Reprinted with permission from Sean Roberts and Skye Angelo Rossman 

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The Outdoor Behavioral Healthcare Council: Collecting data, carving out a niche

In the early 1990s, what little knowledge most Americans had of wilderness therapy came via news headlines when something went wrong at a program, including, tragically, a handful of fatalities.

The decade had witnessed a marked increase in the number of programs launched, says Gil Hallows, chair of the Outdoor Behavioral Healthcare Council. However, he says, wilderness therapy programs were operating independently, without a distinct sense of mission or best practices.

With this in mind, representatives from five wilderness therapy programs came together in spring 1996 with the aim of solidifying the field of wilderness therapy. They called themselves the Outdoor Behavioral Healthcare Council. In addition to establishing best practices, the group began collecting data to document, verify and maximize the effectiveness of the wilderness therapy treatment model, Hallows says.

“It became clear that organizing would allow us to set some standards [and] allow us to better work together in educating the public on what we do and how we do it. … We wanted to focus on doing this the right way,” says Hallows, who also serves as executive director of Legacy Outdoor Adventures, a wilderness therapy program in Utah.

Most recently, the council partnered with the Association for Experiential Education to develop a set of accreditation standards specific to wilderness therapy programs. The council adopted the accreditation model in early 2014. Member programs must now become accredited within two years of joining the Outdoor Behavioral Healthcare Council.

Close to 20 years after its founding, the Outdoor Behavioral Healthcare Council has 17 member programs, plus two others currently going through the application process. The council hosts an annual symposium, held this past year in Park City, Utah, with education sessions and networking opportunities for professionals in the field.

More than 15 years’ worth of the group’s research — from statistics on program safety to client substance abuse pre- and post-participation — is available to the public through the council’s website (see OBHcouncil.com).

To become a member of the council, a program must collect data regularly for the council’s research mission. Members typically record data points about clients’ mental and overall health at intake, discharge and six months after being discharged from a program, Hallows says.

Statistics on the effectiveness of wilderness therapy, especially its cost effectiveness, are fueling the council’s campaign to improve insurance coverage of outdoor behavioral health care. Historically, insurance companies have been reluctant to reimburse clients for costs incurred for participation in wilderness therapy programs, Hallows says.

The Outdoor Behavioral Healthcare Council is reaching out to insurance companies and providing data on wilderness therapy’s effectiveness in hopes of changing that scenario. The group also provides resources to help guide clients’ families through the appeal of a claim denial, Hallows says.

“Part of this campaign is to make outdoor behavioral health care more available to average families,” he says.

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Related reading

  • Sabrina Marie Hadeed’s piece “Girls daring greatly,” a first-person perspective of how wilderness therapy can reach and help adolescent girls
  • Wilderness therapy: The question of affordability,” a look at the cost of wilderness therapy programs and the steps the Outdoor Behavioral Healthcare Council is taking to make them more affordable for average families

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

Letters to the editorct@counseling.org

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Wilderness therapy: The question of affordability

By Bethany Bray

Wilderness therapy is an intensive, out-of-the-box treatment modality. One of the elements that makes it so effective – multiple staff who devote focused, substantial time to clients, both individually and in group settings — drives up the price tag.

“[Wilderness therapy] is an investment, and I explain it to families as such, including the time and effort they put into it,” says Sabrina Marie Hadeed, a licensed professional counselor at Second Nature Cascades, a wilderness therapy program in Oregon.

Although models vary from program to program, wilderness therapy involves taking groups of clients WildernessHike— most commonly youth or young adults — out into the wilderness for an extended period of time. Participants, including some program staff, typically sleep outdoors, pitch tents, hike and cook food over an open fire.

Field guides are with clients around the clock; clients also see a staff therapist regularly and interact with a support crew – everyone from a wellness coordinator or other medical professional to administrators who plan and drop off water, food and supplies to groups.

“The ratio of staff and employees to clients is very large [in wilderness therapy], which means the cost per day – most of which goes to paying salaries and wages – is significant for many families,” says Gil Hallows, chair of the Outdoor Behavioral Healthcare Council.

The expense, compounded by the fact that it’s not often covered by insurance, makes wilderness therapy cost-prohibitive for some families, admits Hallows.

However, many in the field are working to change this fact.

The Outdoor Behavioral Healthcare Council, an organization formed to advocate, research and identify best practices in wilderness therapy, is spearheading a campaign to improve insurance coverage.

(Many in the field prefer the term “outdoor behavioral healthcare” to “wilderness therapy.” The former refers to a regulated industry, while wilderness therapy can be a more nebulous term.)

Historically, insurance companies have been reluctant to reimburse clients for costs incurred for participation in outdoor behavioral healthcare, says Hallows, the executive director of Legacy Outdoor Adventures, an OBH program in Utah.

The OBH Council is reaching out to insurance companies and providing data on wilderness therapy’s effectiveness in hopes of changing that scenario. The group also provides resources to help guide clients’ families through the appeal of insurance claim denials, Hallows says.

“Part of this campaign is to make outdoor behavioral health care more available to average families,” he says.

At the same time, Hallows asserts that the OBH model is cost-effective, especially when compared with nonwilderness programs with similar staffing levels.

“A brick-and-mortar type of residential program, in order for them to be priced lower than a wilderness therapy program, they have to lower the staff-to-participant ratio,” he says.

 

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

 

 

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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

 

CEO’s message: The year of recommitting

By Richard Yep

Richard Yep, ACA CEO

Richard Yep, ACA CEO

During its 63-year history, ACA has been physically located at just four addresses. The most recent building at 5999 Stevenson Ave. in Alexandria, Virginia, was home to the association for more than 30 years. So, you can imagine what moving to our new location might have been like. Sixty-two employees and six decades of books, photos, files and other memorabilia were part of what I have called “the great migration.” Though the move was just a half block away (6101 Stevenson Ave.), this undertaking could not have happened on time and on budget without the amazing group of people that make up your national headquarters staff. I want to publicly acknowledge the efforts of all those who truly went that extra mile, pitched in where needed and worked many long hours.

In addition to the fact that our former building was scheduled to be demolished at some point in the near future, the physical move was necessitated by other factors, including our need to have staff in an open work environment that allows them to collaborate in teams and to have the space to create the products and services that our members require. In essence, our move is symbolic of doing business and providing services in a new way.

As the counseling profession evolves, it finds itself in a pivotal role given the challenges, issues and obstacles that prevent individuals from reaching their full potential. We welcome increased recognition of the counseling profession thanks to our collective advocacy to communities and public policy officials and our work with organizations with which we share common concerns.

Your national headquarters staff and I are recommitting to what we will do for you. As we begin the new year, I also encourage you to recommit to the profession and to those for whom you advocate each and every day. Your work in communities throughout the nation and the world makes our society more understanding, more compassionate and, hopefully, more tolerant.

With all that is going on in society, I see recommitting as a way to generate even more energy, ideas, support and collaboration among the helping professions. A few months ago, I asked “What do you find most meaningful as a professional counselor or counselor educator?” The response was overwhelming, touching, poignant and real.

This month, I ask you to recommit to the counseling profession. Think of the power and positive goodwill it would generate if each of our 55,000-plus members did something to demonstrate that recommitment in 2015. How to recommit? Here are a few examples:

  • Contact an elected official at the local, state or federal level and let that person know about the good work being done by you and your colleagues in the counseling profession.
  • Let your local media know that you are available to talk about how counseling can benefit the community.
  • Volunteer one hour per month to a local nonprofit organization.
  • Participate in a community dialogue to help bring together diverse groups.
  • Become more active in ACA by letting me know you are available for a volunteer role (we will be respectful of your valuable time, so please indicate how much time you want to give per month).

If you are recommitting to the profession in 2015, please send me an email or give me a call to let me know what action you are taking. Or you can go to the ACA Facebook page and post what you are doing to recommit. As we begin a new year, please know how grateful I am for your work and your dedication.    

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

Be well.

From the president: Six-month update

By Robert Smith

Robert L. Smith, Ph.D., ACA 63rd President

Robert L. Smith, Ph.D., ACA 63rd President

The tenure for the president of the American Counseling Association is one year. In addition, there is a year as president-elect and a year as past president. The presidential year moves at a rapid pace, being filled with numerous responsibilities, opportunities and challenges. This has been true for me, already at the halfway mark of my tenure. Opportunities to meet with ACA members and emerging leaders have been rewarding and memorable. Opportunities to speak at state, national and international conferences have been energizing and enjoyable. Even problem-solving meetings to address our challenges have been stimulating at times.

Throughout these first six months, intentional collaboration, a concept that works well and pays dividends, has been emphasized. Branch, division and region leaders, along with committee chairs, have also embraced this theme. Continuing on this path will lead to positive outcomes.

Several projects and plans are in place, including:

  • Investment projects that fund divisions, branches and regions to build membership and collaborate with ACA
  • Task forces examining efficient ACA governance models that would allow opportunities for entry of new interest groups and organizations
  • An ACA international/global conference planned for 2015
  • Establishment of collaborative behavioral counseling networks
  • Groundwork for an ACA international research and dissemination center

I am confident these projects will see completion in the next six months. However, while addressing current challenges and completing innovative projects, we also need to look toward the more distant future. Embedded in keynote presentations, I have been sharing a vision for counseling and the counseling profession as it might one day be described in various media accounts. Enjoy this look at potential future “news coverage” of the counseling profession.

Newsweek: “Counselors are playing a major role not only in increasing the confidence and competence of students at the elementary and secondary school levels in the areas of math and science; they are also seeing their innovative programs increase the number of young people selecting careers in the in-demand areas of science, technology, engineering and math.”

USA Today: “The research center at the American Counseling Association has identified a set of evidence-based practices that interrupt the pathways to clinical depression. In other words, stopping depression before it starts.”

Military news reports: “The U.S. military reported its finding from the Veterans Affairs office today. The report cites the effectiveness of licensed professional counselors (LPCs) who have been working with military personnel. LPCs with specialized training have been able to effectively diagnose legitimate cases of PTSD and mitigate symptoms of those experiencing trauma by using brief therapeutic interventions.”

The Chronicle of Higher Education: “Several mental health professional groups are working feverishly to keep up with the changes made by the American Counseling Association’s revised Code of Ethics. ACA brings a fresh look at ethical issues by focusing on the use of technology, and particularly the infusion of social media. The ACA Code of Ethics is a model for other mental health groups.”

The New England Journal of Medicine: “The medical society recently adopted several practices from the research center of the American Counseling Association on methods to empower patients experiencing serious medical problems. A number of medical schools are now infusing the ACA recommendations into their training programs.”

USA Today: “Job satisfaction has taken on a new twist, as the research center at the American Counseling Association and the National Career Development Association have discovered by identifying the six most salient factors indicating moderate to high levels of job satisfaction by today’s workers, and three mega factors that determine whether a high level of job satisfaction will be retained.”

We have the potential to turn all of the examples above into reality because the counseling profession and counselors ROCK.

Be well,

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. 

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Technology tutor: What can counselors learn from Edward Snowden?

By Rob Reinhardt December 22, 2014

Branding-Box-T_TutorPrologue: Your feedback needed! The Technology Tutor column has returned and will be published more often (bimonthly instead of quarterly). With more opportunities to bring you information about technology use in counseling, I want to know what you want to read about. In the past we’ve covered practice management systems, websites, HIPAA/HITECH, telehealth, the 2014 ACA Code of Ethics and more. With more frequent columns, we can get into more detail and even answer some direct questions. Please write to me and let me know what technology topics you’re interested in. Thanks to all of you who have already written in with your comments and ideas.

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In June 2013, Edward Snowden, a former employee of the CIA and contractor with the National Security Agency (NSA), leaked classified documents that shed light on certain NSA practices that blurred the lines between the nation’s security and the privacy of its people. The practices included secretly accessing the email and phone records of American citizens. Some of these practices extended beyond our borders, creating tensions between the United States and some of its allies.

Regardless of whether you see Edward Snowden as a patriotic whistleblower or a traitor to his country, he has some valuable insights into technology and privacy — insights to which counselors would be wise to pay heed. The Guardian recently interviewed Snowden and released a teaser video (theguardian.com/world/video/2014/jul/17/edward-snowden-video-interview) that includes information all health care professionals should consider. His ideas are congruent with the changes we have seen in the ACA Code of Ethics, as well as the most recent updates of HIPAA/HITECH (Health Insurance Portability and Accountability Act/Health Information Technology for Economic and Clinical Health Act).

Early in the interview, Snowden is asked which professionals, besides journalists, should be changing their behaviors based on what we now know. His reply: “Anyone who has an obligation to protect the privacy interests of their clients is facing a new and challenging world, and we need new professional training and new professional standards to make sure that we have mechanisms to ensure that the average member of our society can have a reasonable measure of faith in the skills of all the members of these professions.”

Later, he re-emphasized this policy when queried about the potential for the average person to even know what questions to ask about technology. He stated, “We need to think of it in terms of literacy, because technology is a new system of communication, it’s a new set of symbols that people have to intuitively understand. It’s like something that you learn, just like how you learn to write letters at school, you know, you learn to use computers — how they interact, how they communicate. And technical literacy in our society is a rare and precious resource.”

Snowden also said “there shouldn’t be a distinction between digital information and printed information.” He noted that this is integral to maintaining privacy and that a free state should have the same privacy rights associated with digital information as with other forms of data.

The important takeaway here is that our clients will be trusting us to use technology in a responsible manner. They will expect us not only to be technologically literate but also to know what we need to do to keep their protected health information (PHI) secure.

It’s almost impossible to avoid technology use in counseling these days. Even if some counselors are still dedicated to keeping their charts and calendars on paper, their clients are likely increasingly using email, smartphones and other forms of technology to communicate with them. Therefore, it’s important that we all become literate in this new “language.”

Of course, it’s important not only for our clients but also for our profession. We are all on the same team in a seemingly endless struggle to obtain parity. We know that we are as qualified and effective as other mental health professionals. Convincing some others, however, has been an ongoing challenge. One of the many ways we can help ourselves in this effort is to consistently demonstrate our knowledge about technology use in the provision of mental health care. The 2014 revision to the ACA Code of Ethics shows that our profession is giving technology the attention that it deserves. Now it is our responsibility as counselors to follow suit.

With all of the privacy issues revealed by the Snowden leaks, we might ask whether it is safe to use technology in our work. Despite all the concerns raised about the NSA and privacy by Snowden, he is still an advocate for technology. When asked if technology is compatible with privacy, he responded, “Absolutely! Technology can actually increase privacy, but not if we sleepwalk into new applications of it without considering the implications of the new technology.”

This speaks directly to HIPAA’s requirement for a risk assessment and analysis — the process of identifying, documenting and addressing security risks in storing and transmitting electronic PHI (see tameyourpractice.com/blog/think-youre-too-small-hipaa-fine).

In short, counselors have an opportunity to improve the protection of their clients’ privacy through the use of technology. To do so, however, we must become literate in the language of technology so that we can adequately assess risks, provide informed consent and advocate for client privacy. The added bonus is that in doing so, we can further bolster our arguments for parity with other mental health professionals.

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In addition to my free blog at tameyourpractice.com, you can also find some great opportunities for technology education at personcenteredtech.com.

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Rob Reinhardt, a licensed professional counselor supervisor, is a private practice and business consultant who helps counselors create and maintain efficient, successful private practices. Before becoming a professional counselor, he worked as a software developer and director of information technology. Contact him at rob@tameyourpractice.com.

Letters to the editor:  ct@counseling.org