Monthly Archives: March 2015

Addressing counseling’s portability crisis

By Bethany Bray March 26, 2015

Summer 2019 update: The American Counseling Association has created a state-by-state guide with updated information on licensure requirements across the country. Go to counseling.org/knowledge-center/licensure-requirements for information on licensure in your state or U.S. territory.

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It’s a frustrating scenario that happens all too often. A counselor moves to a new state and finds that although she has been practicing and licensed for years (or sometimes even decades), she doesn’t meet the requirements to become licensed in her new place of residence.

That’s because counselor licensure titles and requirements across the United States still vary from state to state. Even the most veteran counselor might need to secure additional supervision hours or meet other requirements to become licensed after moving across state lines.

However, this may not be the case for too many more years. The American Counseling Association and the American Association of State Counseling Boards (AASCB) are working on two separate initiatives aimed at solidifying professional counselor identity and turning licensure portability into a Branding-Box-airplanereality. State licensing boards will be receiving two letters in the coming months, each requesting changes that might make it easier for counselor licenses to transfer from state to state in the future.

“I see this [license portability] as the most important discussion point in the regulatory process for our profession,” says Bill Green, a past president of AASCB and chair of the Professional Counselor Examiners Committee, which regulates the practice of professional counseling and rehabilitation counseling in New Jersey. “My goal is to see portability in my lifetime. I’m 66, and I’m optimistic.”

The first of the two letters will ask state licensing boards across the United States to adopt a uniform professional title — licensed professional counselor (LPC) — and a uniform scope of practice, a five-paragraph job description that defines the work of professional counselors (see sidebar, below). This letter is the culmination of the Building Blocks to Portability Project that was part of 20/20: A Vision for the Future of Counseling, a yearslong strategic planning initiative that was co-sponsored by ACA and AASCB.

The second letter will introduce the AASCB Five-Year Portability Proposal. This idea, developed and endorsed at AASCB’s annual conference this past January, would encourage state licensing boards to grant licenses to counselors who move into their state with at least five years of professional experience and a license in good standing in their previous state.

The first letter will be a joint message from AASCB and ACA, co-signed by the presidents of both associations. The second letter will be from AASCB alone, says Susan Hammonds-White, AASCB president. The two letters will be sent to licensing boards in 52 jurisdictions, which includes all 50 states plus Puerto Rico and the District of Columbia. Both initiatives aim to make counselor licensure more portable and uniform across the country.

License requirements for counselors were set up state by state over a period of decades — beginning with Virginia in 1976 and ending with California in 2009 — as the profession matured and pushed to establish itself. But in the process, significant disparities arose between counselor licenses across the United States, from the number of supervision hours required to obtain a license to the license titles themselves.

More than 35 different license titles are currently in use by professional counselors across the country, points out David Kaplan, ACA’s chief professional officer. Kaplan, a past president of ACA who has worked as a counselor and counselor educator, says the profession is currently in the midst of a “portability crisis.”

In an age when people are more transient, the state-to-state license disparities routinely pose a hardship for counselors, says Hammonds-White, an ACA member and LPC in private practice in Nashville, Tennessee. She believes the counseling profession has reached a stage of development and maturity that will now allow it to address those disparities.

“We’ve been a profession long enough now to have enough longevity and enough people who have been in the field for a while to be able to look at ourselves in a more unified way,” she says.

In the counseling process, it is key for the counselor and the client to understand and trust each other. The same holds true for the factions within the counseling profession, Hammonds-White says. “Maybe we’re doing that [trusting] at a more national level. Maybe what we’re saying is, ‘I see you. I see you as legitimate. I accept what you have chosen to do in your state … [and] I’m OK with you becoming a counselor in my state.’ I see it as another step in the process of connecting across the country,” she says.

According to Kaplan and Hammonds-White, ACA and AASCB receive more calls and questions from counselors about licensure portability than any other issue. Kaplan says ACA headquarters receives at least 10 calls per week from members who are facing challenges related to licensure portability, including those who are moving because of a new job, a life change such as a marriage or divorce, or a spouse who is in the military.

“It’s the single biggest issue we get calls about,” Kaplan says.

A move toward uniformity

The joint letter from ACA and AASCB is expected to be sent this spring, according to Kaplan. A draft was being written as this article went to print.

Co-signed by Hammonds-White and ACA President Robert L. Smith, the letter will formally request that state licensing boards take necessary action to adopt licensed professional counselor as the professional title in their state, along with the five-paragraph scope of practice for counselors.

In certain states, making such changes will take time and may pose a challenge. “We’re asking states to do something that is hard for states to do, which is to open their statutes,” Hammonds-White says. “Depending on the political climate to a degree, opening the statute, you have to be a little watchful about doing that. [However], we hope that some states will be able to do this relatively easily.”

The procedure will vary from state to state, Kaplan explains. Some licensing boards have the ability to change regulations on their own, while others must first petition their state legislature. He is hopeful that some states will adopt the counselor license title and scope of practice within the next year, with a majority of state boards following suit within five years.

“It’s kind of like a wave,” Hammonds-White says. “If we get enough states to get a critical mass going, other states will look at what’s being done and [decide] to get on board. It’s kind of like the domino effect.”

Having a uniform license title and scope of practice rather than the hodgepodge of different titles and job descriptions that currently exist for counselors across the United States should help remove at least two of the obstacles to license portability for counselors, Kaplan says.

This past fall, there was widespread endorsement of both a single licensure title (LPC) and a scope of practice for professional counseling among the 31 major counseling organizations that participated in the 20/20 Building Blocks to Portability Project. Of the 29 organizations that ultimately voted, only the American Mental Health Counselors Association voted not to endorse the common licensure title, while the National Rehabilitation Counseling Association voted not to endorse the scope of practice.

[Editor’s note: The American Rehabilitation Counseling Association (ARCA) voted against accepting the scope of practice last fall. However, the organization changed position and voted to endorse the scope of practice at the 2015 ACA Conference and Expo in March.]

“Being able to say that the profession of counseling accepts this [licensure title and scope of practice] really gives it gravitas. … This shows we’re working on [portability] and making progress,” Kaplan says. “It won’t be immediate, but it’s progress.”

The five-year proposal

The counseling profession’s leaders are taking a multipronged approach to addressing licensure portability, Kaplan says. The scope of practice and licensure title constitute one prong, while AASCB’s five-year proposal represents another prong.

“We need multiple fronts on this,” he says. “There’s no one magic answer that will solve everything as it gets complicated.”

The AASCB five-year proposal will recommend allowing licensing boards to grant licenses to counselors who move into the state with five or more years of experience and a license in good standing from their previous state. Some states might also choose to require a jurisprudence exam, Hammonds-White says.

“This is AASCB’s response to the concerns that we hear, as board members, all the time regarding portability,” she says. “We hear from counselors who move with years, even decades, of experience, and in most circumstances they have to meet the requirements of their new state, which may mean more supervision hours. … We see the effects on people’s lives. We’re very committed to working on portability.”

AASCB will draft a letter asking states to adopt the five-year proposal in the coming months, after the joint letter regarding the uniform scope of practice and preferred licensure title has been sent, Hammonds-White says.

As is the case with the request concerning the scope of practice and licensure title, adoption of AASCB’s five-year proposal would require some states to modify their statues. In New Jersey, for instance, it could take a full year to make such a significant change, says Green, a longtime ACA member and retired professor of rehabilitation counseling at the University of Medicine and Dentistry of New Jersey, which has since merged with Rutgers University. “Counselors need to recognize that any changes we’re proposing require regulatory and statutory process, and that takes time,” he says. “If we can get this conversation, this dialogue, started now, we can make for a quicker passage of any kind of regulatory or statutory changes that need to be made.”

Here, too, Hammonds-White hopes to see a domino effect, with licensing boards adopting the idea as they see other states doing so.

The idea that eventually grew into the five-year proposal was first mentioned and discussed at AASCB’s annual conference in the winter of 2014, according to Hammonds-White. Members were receptive to the idea and returned to AASCB’s 2015 conference in January having spent the year giving it serious thought. “We discussed it more [in January] and really decided it was the way to go,” Hammonds-White says. “It became a proposal, something we feel will work. … As the conference closed, we introduced this proposal for [AASCB] state representatives to take back to their state counseling boards to take a look at.”

Hammonds-White, Kaplan and Green moderated a closing session on license portability at AASCB’s January conference, which was held in Savannah, Georgia. Green calls the proposal “a more creative way of looking ahead.”

“We want to make sure all voices are heard, but at the same time keep AASCB as an independent voice for the regulatory process for our profession,” he says. “We want to make sure we’re doing what’s in the best interest for [the licensing boards’] role, which is to protect the public.”

Keeping the momentum going

Once the two letters are sent, ACA and AASCB will follow up with state licensing boards to provide support and offer any assistance they may need to ensure the five-year proposal, scope of practice and licensure title are adopted, Kaplan says.

The best way for counselors to keep the momentum going is to contact their respective state counseling associations and licensing boards. It will be helpful if counselors let these entities know that the issue of portability is important and that counselors support the ACA and AASCB initiatives, agree Green and Hammonds-White.

“This is the time to step up to the plate,” Green says. “I hope counselors recognize that they have the right to address [portability] concerns with their state licensing boards. [Getting involved] will help move things along.”

Green, Kaplan and Hammonds-White get the sense that the counseling profession will be receptive to the portability proposals from AASCB and ACA — much more so than might have been the case even five years ago. Trust and cooperation between states has increased dramatically during that time, they agree. Hammonds-White points out that two states, Louisiana and Iowa, already accept out-of-state licenses from counselors with five or more years of experience, much as the AASCB five-year proposal hopes to achieve.

“We’ve seen so many significant changes in our profession in recent history,” Green says. “A couple of years ago, people would have said this [portability] could never happen. We’ve been able to have a very mature conversation with all the players. … I’m proud of the fact that ACA and AASCB are willing to take these creative steps as a way to address portability. There are challenges, but I’m confident and hopeful this could be a way to address national portability.”

New Jersey’s Professional Counselor Examiners Committee met in February. Green, its president and chair, says he explained the upcoming portability initiatives to members as well as the two letters that will be arriving in the coming months. “We’re ready to begin the process in New Jersey,” he says. “We’re starting to get our ducks in order.”

New Jersey already uses LPC as the professional title for counselors. However, if the board decides to adopt the scope of practice and five-year proposal, it will require a statutory change, Green says.

At the same time, New Jersey is ahead of the game when it comes to portability because the state licensing board has the ability to waive some of the statutory requirements for counselors who have three or more years of experience in another state, Green explains. This is considered on a case-by-case basis, he adds.

Looking ahead

Portability is a complicated issue, and these initiatives won’t be a total solution for the challenges counselors face in this area, Kaplan says. However, they do offer a step in the right direction and represent movement on a topic that may need to be untangled for years to come.

For example, AASCB discussed two portability ideas at its January conference that are still in the development phase. The first would involve licensure reciprocity between states that share a border, such as Tennessee and Kentucky. If the idea were to come to fruition, state licensing boards could set up an agreement to accept counselor licenses from a neighboring state, and vice versa, Hammonds-White says. This would make circumstances much easier for counselors who live near the border of two or more states.

The second idea is for regional agreements. In this scenario, multiple states within a region — for example, New England or the Southwest — would agree to accept licenses from practitioners who move state to state within the region. These types of interstate compacts “involve a whole lot of legalities,” Hammonds-White acknowledges. “We’re just starting to look at the idea.”

In addition to the five-year proposal, these ideas, though still in the development and discussion phase, show that AASCB is committed to working on portability, Hammonds-White says.

“State licensing boards have done an admirable job of complying to legislative statutes by establishing regulations to protect the public,” Green says. “That is the primary goal of all licensing boards, to protect the public. … We have certainly done that, and I’m very proud of our states. But I also recognize that it’s a very transient profession. Counselors are constantly moving from state to state. We see that in the emails and phone calls that ACA and AASCB receive. We take this as a very responsible challenge for us.”

 

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UPDATE:

Counseling licensure board representatives from Tennessee, Kentucky, Virginia and West Virginia met at the ACA 2015 Conference in Orlando to discuss an interstate compact for counselor licensure. On Friday, March 20, Kentucky and Tennessee signed the agreement and the other two states are moving forward to implement the compact. This is the first advancement of an interstate compact for reciprocity of counselor licensure within a region.

[Editor’s note: This news came to fruition after the above article went to print.]

 

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Background information on the 20/20 initiative, as well as contact information for state counseling associations and licensing boards, can be found on the ACA website at counseling.org. Once finalized, a copy of the joint letter from ACA and AASCB will be posted to the CT Online website at ct.counseling.org.

 

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Scope of practice for professional counseling as endorsed by 20/20 organizations

The independent practice of counseling encompasses the provision of professional counseling services to individuals, groups, families, couples and organizations through the application of accepted and established mental health counseling principles, methods, procedures and ethics.

Counseling promotes mental health wellness, which includes the achievement of social, career and emotional development across the life span, as well as preventing and treating mental disorders and providing crisis intervention.

Counseling includes, but is not limited to, psychotherapy, diagnosis, evaluation; administration of assessments, tests and appraisals; referral; and the establishment of counseling plans for the treatment of individuals, couples, groups and families with emotional, mental, addiction and physical disorders.

Counseling encompasses consultation and program evaluation, program administration within and to schools and organizations, and training and supervision of interns, trainees and prelicensed professional counselors through accepted and established principles, methods, procedures and ethics of counselor supervision.

The practice of counseling does not include functions or practices that are not within the professional’s training or education.

 

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

Letters to the editor: ct@counseling.org

Embracing the ongoing push for progress

By Laurie Meyers March 25, 2015

Positive social change is possible. It is often slow and halting, but it does happen. In the past decade, people who identify as lesbian, gay, bisexual and transgender (LGBT) have experienced some positive change regarding their human rights and societal attitudes.

As of this writing, 37 states and the District of Columbia have legalized gay marriage. The Supreme Branding-Box-RockCourt is set to hear several marriage equality cases later this year, and its decisions may result in legalized marriage in all 50 states. There is greater public acceptance of LGBT people as well. In addition, more and more public figures have emerged from the closet, and a greater number of TV shows no longer shy away from featuring LGBT characters. In 2014, Laverne Cox, a transgender actress, appeared on the cover of Time magazine.

Although the LGBT community and its allies can increasingly celebrate many victories, this is tempered somewhat by the recognition that the LGBT population continues to face substantial challenges throughout society. Thirteen states still refuse to legalize gay marriage, and some judicial interference has reared its head in states where gay marriage has already been legalized. LGBT youth still face significant harassment and violence, particularly in school environments. Individuals who are transgender still confront a steady stream of misunderstanding, prejudice and violence.

Clearly, society still has a long way to go. And that is why counselors play such a crucial role in advocating for the LGBT population, demonstrating acceptance and helping these individuals navigate the changes and challenges facing them today.

Youth at risk

The adolescent and teen years are often marked by turbulence as young people grapple with issues such as grades, dating and friendships, self-esteem, emotional challenges, and college and career choices. LGBT youth face these same challenges in school environments that are often hostile and, in some cases, unsafe.

In a 2013 survey, “The National School Climate,” conducted by the Gay, Lesbian & Straight Education Network, 55.5 percent of LGBT student respondents said they felt unsafe at their school because of their sexual orientation and 37.8 percent because of their gender expression. Almost one-third of respondents reported losing at least one full day of school in the previous month because they felt unsafe, and 10 percent said they had missed four or more days in the previous month.

The survey indicates that LGBT students have good reason to be afraid. Almost 75 percent of respondents had been verbally harassed (threatened or called names) because of their sexual orientation; more than 55 percent had experienced verbal harassment because of their gender expression. Physical violence is also a significant concern for LGBT students. According to the survey, 36.2 percent of respondents had been physically harassed (pushed or shoved) in the past year because of their sexual orientation and 22.7 percent because of their gender expression. The violence extends beyond harassment — 16.5 percent of those surveyed had been physically assaulted in the past year because of their sexual orientation and 11.4 percent because of their gender expression. Given these numbers, it is perhaps not surprising that many respondents said they avoided gender-restricted spaces such as bathrooms and locker rooms because they felt unsafe or uncomfortable. The majority of surveyed LGBT students said they avoided school functions and extracurricular activities because they felt unsafe or unwelcome.

In addition to a hostile school environment, LGBT youth may face a lack of support or even open opposition from their friends, family members and communities. This rejection can result in high levels of stress, anxiety, depression and suicidal ideation, says Ken Jackson, a member of both the American Counseling Association and the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling (ALGBTIC), a division of ACA. Jackson gave a presentation on “Group Counseling Queer Youth in a High School Setting: Reflections and Lessons From a Six-Year Process” at the ACA 2015 Conference & Expo in Orlando, Florida, this past March.

For the past seven years, Jackson, head counselor at Decatur High School in Decatur, Georgia, has run a weekly peer support group for students who identify as lesbian, gay, bisexual, transgender, queer or questioning. Students are made aware of the group at the beginning of the school year when they are given “advisory” sheets to fill out. These sheets allow students to register their interests in a number of groups available at the school. All students are required to turn in an advisory sheet, so students don’t have to be afraid of sticking out or calling attention to themselves. The sheet also contains instructions for students who would rather disclose their interests directly to a counselor, Jackson says. In addition, LGBT students sometimes find out about the group from friends or teachers.

Students can belong to the group for as long as they need to, but initially Jackson asks them to commit to a semester. After that, it is not uncommon for students to come in and out of the group as they feel the need, he says.

Group discussions center on a mix of topics, some of which Jackson sets and others that students bring up. Many times, he notes, the discussions aren’t directly related to being LGBT. Instead, they often center on issues that are common to all students, such as coping with the death of a loved one, dealing with a parent who drinks too much or experiencing problems with a friend. The difference, Jackson says, is that group members can discuss these and other problems in an atmosphere in which they don’t feel the need to hide who they are.

“It [the atmosphere] lets them know, ‘This part of my [identity] is OK to talk about too if I want to and it comes up. I don’t have to make the mental effort of … putting up a shield so that I don’t mention something inadvertently,’” Jackson explains.

Of course, group participants do sometimes choose to talk about issues related to being LGBT. Frequent topics include when (or whether) to come out to friends, dating (including where to find people to date), feeling judged for being LGBT and problems with self-esteem.

Jackson thinks that group therapy is a particularly effective environment for LGBT youth to explore these issues. For one thing, he says, group work offers a practical approach because a counselor can reach more students. But even more important are the peer support and opportunities to learn from others in the group, he says. For example, in the LGBT group, students learn how to relate to others and what it feels like to be completely accepted. In turn, Jackson says, this helps group members navigate the challenges of the outside world.

Through the years, Jackson has collected quantitative and qualitative data both pregroup and postgroup. For the quantitative data, he looks at students’ grade-point averages (GPAs) at the beginning of the year and then at the 30-week mark. Usually, he says, the GPAs don’t change, but he views this as a success. Rather than the decline in grades and attendance that often accompany the challenges inherent in being an LGBT student, participants in his group are typically able to maintain their grades. The qualitative data come from the feedback that participants provide about the issues they have been facing, the things they have learned and the parts of the group sessions they think have worked best for them.

Group members have ascribed multiple benefits to the group experience, including increased self-acceptance, confidence, coping skills and self-awareness. Participants have also reported being more open to relationships, other people and their own feelings. Group members also expressed relief at having a place to talk about issues that aren’t generally seen as socially acceptable. They felt more clarity regarding their personal identities, and many reported developing close friendships with fellow group members, Jackson says.

A toxic combination

Although a substantial amount of research has been devoted to the challenges that LGBT youth face, little is available on what actually works, notes Catherine Griffith, an ACA and ALGBTIC member whose dissertation focused on reducing suicidality in this population. “There are a lot of suggestions for best practices [for treating suicidality in LGBT youth] but not much supporting evidence,” she notes.

Suicide is the third-leading cause of death among adolescents, and the rate among LGBT youth is even higher, says Griffith, who is also a researcher and assistant professor in the Department of Student Development at the University of Massachusetts Amherst. She says LGBT youth are more likely to be targets of verbal and physical harassment and assault than are their non-LGBT peers. LGBT youth also have higher rates of peer isolation and hopelessness and often lack positive coping skills, she explains.

This toxic combination puts them at increased risk for suicide. Research has shown that LGBT youth are anywhere from two to seven times more likely than their non-LGBT peers to commit suicide.

In her dissertation, Griffith wanted to test an intervention that wouldn’t require a great deal of time or money to implement. Part of her inspiration came from watching videos from the It Gets Better Project. “I was struck by the idea of fostering hope as a solution to reducing suicidality,” she says.

Because of the barriers involved in working with minors, the subjects Griffith chose for her dissertation were 18–20 years old. She recruited participants by posting fliers in various locations and visiting local LGBT organizations.

Initially, Griffith thought that by virtue of being out of high school and perhaps living on their own, participants in this age group might not be experiencing as many problems as their younger LGBT counterparts. She quickly learned otherwise.

“I was surprised at the high levels of dysfunction,” she says. “People were really struggling. There were high clinical levels of suicidality and a lot of drug use and isolation — just a lot of deep dark things they were coping with.”

Griffith’s study involved an eight-week, randomized intervention. Although all of the recruited participants received help, to achieve randomization, half were put on a waiting list and the other half were placed in groups immediately. Participants were placed in groups of eight to 10 and met weekly for 45 to 60 minutes.

Griffith designed a structured curriculum, “It Gets Better: A Group Experience for LGBTQ,” that was divided into two parts — learning positive coping skills and building hope. “The first session was really focused on getting to know one another’s stories,” she says. This helped participants break the ice, while also allowing Griffith to take stock of what coping skills the participants were using and whether those coping skills were positive or negative. Sessions two through five focused on positive coping skills such as deep breathing and free writing.

Participants also learned about positive reframing, a technique that made Griffith nervous at first. “I wanted to tread carefully,” she says. “There is a lot of positive research [on positive reframing], but how could we approach positive reframing without undermining their experiences and without making participants feel that we’re saying their problems are not problems?” When participants were surveyed at the end of the study, Griffith was both surprised and relieved to find that reframing was perceived not as a negative but rather as one of the most helpful techniques.

Sessions six and seven focused on hope building. Activities included “flipping the coin,” which involved writing down something negative that, when looked at another way, could be perceived as positive.

Another activity was “letter from a future you,” in which participants were asked to write themselves a letter from an older, kinder self. Although this “self” could be from whatever point in the future the participants chose, it had to be a time when they could imagine that things had gotten much better in society and for them personally. Their future selves would be strong and confident and have the support of friends and family members. While envisioning this scenario, participants considered what advice their future selves might provide. After writing their letters, participants shared them with the group.

Griffith says the letters benefited the participants in several ways. First, the act of envisioning a better tomorrow was valuable because it helped to build hope. Sharing the letters was also very powerful because the participants could voice their hopes and hear the hopes of others. “It was very poignant and valuable to share and hear others’ stories,” Griffith says.

In addition, participants had created a valuable resource they could return to during times when they were feeling low or discouraged. By rereading their letters, they could remind themselves of the positive advice their future selves had provided to them.

All of the discussion and activities helped participants realize that because of the things they had been through, they were stronger — and more empathetic — than they previously realized, Griffith says.

In many cases, participants shared stories that they felt would help others, including one participant who had gone through a particularly difficult coming-out process with his family. He acknowledge that the process had been painful but said that after his family finally accepted him, he realized he had actually grown much closer to them through the experience. In struggling to come to terms with his identity, the family had engaged in numerous in-depth conversations, and he felt this had deepened his emotional connection to them. He had chosen to move past the hurt and hold on to the positives that had emerged from the experience, Griffith says.

Griffith’s groups also watched a short documentary, Always My Son, made by the Family Acceptance Project. It recounts the story of a son who, when he comes out, is initially rejected by his father. The film then focuses on how the family worked through the negativity and pain and eventually arrived at a place where not only is the father accepting of the son, but the family also hosts get-togethers for people who are going through the same types of challenges.

“I think focusing on the potential for the family environment to get better is huge,” Griffith emphasizes. “The difference between thinking there is a zero percent chance that my family will accept me as I am versus thinking there is a 10 percent chance is huge. It’s not even a huge increase in hope, but it makes suicidality go way down. For me, that is a huge finding.”

The eighth and final session was devoted to saying goodbye and reviewing progress. The group’s reflections yielded another significant finding — the overall impact that a relatively brief intervention such as this eight-week program could have on suicidality. Griffith had hoped that the program’s participants might gain some valuable skills from the project, but she was pleasantly surprised at how well it actually worked.

“What I found was that it was really effective in terms of increasing hope and coping skills and in decreasing negative coping skills,” she says. “It [the change] was not just statistically significant but also practically significant.”

Griffith hopes other counselors will consider using the program and its curriculum (interested counselors can email Griffith at cagriffith@umass.edu for more information).

“[I] wanted an intervention that school counselors would be comfortable taking up and implementing,” she says. She adds that although teaching coping skills is an important part of the intervention, the social support that the intervention provides is even more critical.

Intervening at institutional levels

One of the most effective ways of helping LGBT students is to work toward enacting change on an institutional level, says Colleen Logan, a past president of ACA and the program coordinator for the marriage, couple and family counseling program at Walden University.

Logan, who is also a past president of ALGBTIC, works with school administrators and counselors to help implement zero-tolerance bullying policies and establish affirmative environments. She starts with a simple concept: Each child gets to go to school in a nonhostile environment.

Logan is of course working with counselors, teachers and school administrators to enact more comprehensive changes, but that premise of ensuring a nonhostile environment is a starting point on which most everyone can agree, she says. “Even that [basic change] would make a difference,” she emphasizes.

A nonhostile environment is a place where violence isn’t tolerated, and neither is name-calling or the use of phrases such as “That’s so gay,” Logan notes. “Think about the sexual minority youth, about what his or her experience is every day at school,” she says. “[He or she is] trying to navigate friendships, develop positive self-regard and self-esteem, and trying to negotiate romantic relationships in the face of all this prejudice.”

Logan wants all school staff to become aware that sexual minority youth are watching everything they do. In the process, their actions — or lack thereof — send a message. That message can be negative and hostile, or it can be affirmative.

Logan also believes that counselors have a responsibility to lead the way in spreading an affirmative message and combating prejudice. “It’s our ethical, personal and moral obligation,” she asserts. “It’s part of who we are as counselors to educate for equality and social justice.”

This can include everything from educating others and modeling appropriate actions to providing a safe space for LGBT students, Logan says. For instance, counselors can indicate that their offices are a safe space for these students by taking simple actions such as displaying rainbow or “Safe Space, No Hate” stickers.

Jackson agrees that counselors need to lead the way. “It’s our job as counselors to go beyond what is in our offices, and it’s our job to affect the school environment,” he says.

Jackson says counselors should fight for three major objectives in schools:

1) Establishing a gay/straight alliance organization

2) Developing a harassment policy that specifically mentions sexual orientation and gender identity

3) Putting in place a network of “safe” adults or advocates within the school

Jackson also urges counselors to identify their own biases and preconceptions so they can set them aside and be empathetic and supportive of LGBT youth. Counselors should also make sure they are competent in LGBT issues, he says.

“ALGBTIC has some great competencies for counseling transgender students or clients, as well as lesbian, gay or bisexual students and clients,” Jackson says. (To access the ALGBTIC competencies, visit algbtic.org/competencies.html.)

For better or for worse

As more states legalize same-sex marriage, many LGBT couples are embracing an option that some thought they’d never have: the right to marry the person they love. Still, the ability to marry poses challenges — some that are familiar to all couples and others that are unique to same-sex couples. Counselors can play a vital role in helping clients navigate these issues.

It is not uncommon for two LGBT partners in a relationship to be at different stages of the coming-out process, and when considering marriage, that is a significant issue, says Joy Whitman, a past president of ALGBTIC and its current representative to the ACA Governing Council. “I’ve worked with a lot of couples in different stages, and it can pose multiple challenges,” she says.

Whitman, a licensed clinical professional counselor who has a practice in Chicago and is also a core faculty member in the counselor education and supervision program at Walden University, has helped couples determine what marriage — and the couple’s level of being “out” — will mean for them at work and as a family. In part, this involves giving deep consideration to several questions: How out do they want to be as a couple? How out are they currently as individuals? Are they already out to their respective family members? What will they tell their co-workers?

Whitman guides couples through the process of answering these questions and reconciling their different degrees of being out. To do this, she has to learn each person’s underlying reasoning. “The one [partner] who doesn’t come out may have some shame that we need to work through,” Whitman says, “or they might just be a more private person.”

Whitman then helps couples negotiate their differences. For instance, she might ask the partner who is most out to discuss specific situations in which he or she finds it particularly important, or most wishes, for the other partner to also be out. “You can’t always open up the closet all at once,” she says. “Sometimes, you have to work with the person who wants to go faster to slow down. It can take time, but the couple does get a deeper understanding of each other. It can really strengthen their relationship.”

What — or whether — to tell family members about the marriage is another area in which counselors can provide support and guidance to LGBT couples. Despite growing acceptance in society, the reality is that marriage brings with it a level of acknowledgment of “outness” that some family members may not be ready to handle.

Whitman had one client whose mother asked her not to invite their cousins to the wedding because the mother didn’t want them to know. In cases such as this, Whitman advises counselors to help their clients grieve and process any sense of loss before the wedding. That way, when the day arrives, they can focus not on who isn’t there to share this life event with them but who is.

In some cases, however, people anticipate the worst without truly needing to. “‘I can’t come out to my grandmother. It will kill her,’” Whitman cites as an example of something a client might say. “But equalitythat’s not necessarily true. Counselors can help [clients] decide what’s realistic. Is their fear going to be true? How can you be prepared for that reaction? How can you present this [the marriage] as a good thing?”

Practitioners may also need to counsel clients to practice patience with others’ reactions to their impending marriage. Sometimes families just need time to process the news, Whitman says. “If you’re coming out for the first time, it’s a lot [to take in],” she says. “You’re not just gay but getting married.”

After helping clients process their decision to get married, counselors can provide support in clients coping with the planning, Whitman says. For instance, clients might encounter vendors or members of the clergy who are not supportive of their marriage, and that can be uncomfortable. She advises counselors to talk with clients about their plans and prepare them to anticipate some possible pushback.

Finally, LGBT clients sometimes get overwhelmed as they prepare for the wedding and assume these feelings are connected to being gay. In reality, it is the type of emotion that all couples encounter, and counselors can help LGBT clients sort through that, Whitman says.

When identities intersect

When LGBT people are also people of color, the prejudice they experience is often amplified. They become potential targets of discrimination not only because of their ethnic or racial identities but also because of their sexual or gender identities.

Being a minority comes with feelings of marginalization that, when combined with regular threats of violence and harassment, create a “synergistic” outcome, says Richmond Wynn, an ACA member and licensed mental health counselor in Jacksonville, Florida.

“It’s more than just the result of being an ethnic minority or just being a sexual [or gender] minority,” he says. “It’s more than one plus one equals two. [It’s] more like one plus one equals three or four.”

This tricky addition is a result of discrimination being piled on discrimination and, in some cases, a feeling of rejection from one or more communities, says Wynn, an ALGBTIC member who is also an assistant professor at the University of North Florida.

For instance, LGBT persons of color may have grown up viewing their ethnic communities as a kind of sanctuary because everyone there knows what it is like to experience ethnic or racial prejudice. When those individuals then experience prejudice because they are LGBT, they may turn to their ethnic communities as a safety net. If those communities then reject them because of their LGBT status, their safe haven may be gone, Wynn explains. Conversely, because a person is LGBT and a person of color, he or she may not feel completely welcome or comfortable within an LGBT community, he says. Regardless, the intersection of a person’s multiple minority identities is many layered, says Wynn, adding that the amplified stress and daily challenges pose a significant risk to the person’s health and well-being.

“Research has shown an increased health disparity [in those with intersecting identities],” confirms Anneliese Singh, an ACA and ALGBTIC member who studies transgender resilience and LGBT mental health. “If you have another identity that protects against disparity, you don’t experience as many consequences. For instance, if you are a white gay man experiencing homophobia but you have a high income and access to more resources, there are less health disparities. But trans people of color have some of the highest health disparities — everything from low income, living in poverty, difficulty accessing mental health care and high rates of homelessness to hate crimes and other verbal violence.”

These disparities — a lack of resources and increased stressors — put LGBT people of color at high risk for physical and mental health problems. However, Singh and Wynn agree that despite the disparities and amplified marginalization, this conflict of intersecting identities can also be used to help build resilience.

Singh, who is also an associate professor at the University of Georgia, says some of her research has shown that transgender people may actually build resilience by the simultaneous development of a strong racial identification and a strong gender identification. By embracing both of their identities, transgender people are connected to both communities, which means additional sources of support, she explains.

“[Counselors] have to have a multifaceted approach to identity,” Singh says. “You have to look at what those intersections are. You can’t just assess gender, sexuality, race, religion. You need to try to understand what it is like [for example] to be an African American transgender person.”

By understanding clients’ identities and how they feel marginalized, counselors can better help clients find resilience factors that work for them, Wynn explains. “While it’s important to make sure that we understand how people are negatively impacted, it could also be used for the positive,” he says. “Counselors should look for [resilience] in the stories that clients tell us. We want to be aware so that we can highlight the areas of their stories that show resilience.”

“If they don’t occur organically in conversation,” he continues, “it’s reasonable to ask if there have been times when they have come out of an incident and felt stronger because of it — more energized or challenged.”

Wynn believes all clients can also build resilience in the face of truly horrible incidents. “Something simple I might ask is: How did you survive this? How are you sitting here today? How have you managed up until now? Because if they’re still here, they have been managing somehow,” he says.

In taking this approach, Wynn says that he is not asking clients to discount the incidents they have experienced. Rather, he is encouraging them not to become saturated with them but to instead draw strength from their experiences.

Wynn and Singh both emphasize that counselors working with LGBT people of color — or any LGBT client for that matter — must have a firm grasp of multicultural and LGBT competencies. Counselors should also self-evaluate to identify their own biases and the ways in which they feel marginalized, Wynn says. Taking that step will help sensitize counselors to what their clients are experiencing, he concludes.

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Additional guidance

The Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling, a division of ACA, was founded in 1975 under the name Caucus of Gay Counselors. Members of ALGBTIC advocate for greater awareness and understanding of lesbian, gay, bisexual and transgender (LGBT) issues among members of the counseling profession and related helping occupations. For more information, visit algbtic.org.

For further reading:

  • Casebook for Counseling Lesbian, Gay, Bisexual and Transgender Persons and Their Families, edited by Sari H. Dworkin and Mark Pope, published by ACA, 2012
  • Group Counseling With LGBTQI Persons, by Kristopher M. Goodrich and Melissa Luke, published by ACA, 2015

 

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To contact the individuals interviewed for this article, email:

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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

 

What would Yalom do? Ten nuggets of wisdom for counselors old and new

By Cheryl Fisher March 23, 2015

In the winter of 2014, I bedded down for a long-deserved rest. As a counselor educator, I basked in the idea that after posting final grades, the university would be closed for the holiday season. With a full private practice, often seeing 25 clients a week, I had made the executive decision to close my office between Christmas and New Year’s to make full use of my respite. Twelve days of rest, relaxation and reading! Lots and lots of reading.

I had ordered and methodically piled up in my home office every textbook or novel promoted by my clients or my students. The pile was just waiting for me to slow down long enough to open the crisp pages of wisdom and intrigue. With the holiday break, I would finally have the time to enjoy these sage words from great thinkers and authors. There, vying for my attention, were the works of Rollo WWYD_2May, Friedrich Nietzsche and Irvin Yalom, each enticing me in their own seductive way to join in the intimacies of the human experience.

I made myself a cup of jasmine tea, lit a fire in the fireplace and pulled my new Christmas throw over my tired shoulders. Inhaling the scent of jasmine mixed with the musty pages of the selected paperback, I caressed the book’s smooth binding and held it close to my chest. I gently set the book in my lap and turned the first page. This would be the beginning of my relationship with Irvin Yalom.

I had required my students to entertain Yalom’s philosophies surrounding the counselor-client relationship in his book The Gift of Therapy. No other has so genuinely approached the experience of being authentic and authentically human in the therapeutic relationship. Yet, I had only flirted and danced through those pages of disclosure and boundaries.

It was when I immersed myself in the titillating experience of Yalom’s literary masterpiece, When Nietzsche Wept, however, that I swore my allegiance to his wisdom. Within this teaching novel, Yalom brilliantly intertwines the lives of the successful Josef Breuer, the neophyte Sigmund Freud, the despairing Friedrich Nietzsche and the seductive Lou Salomé. The encounter that ensues captures the essence of the sacred-yet-murky therapeutic relationship and the courtship that occurs between healer and healing.

I reflected on my role as a counselor educator, a midwife to second-year clinicians-in-training who (as they experience the final stage of their birthing) make one final attempt to remain safe in the womb of graduate school. “There must be more to this therapy thing. Surely I do not know what I am doing! Teach me your tricks. Offer me your magic wand!” they implored as they faced their launch into the professional community.

I assured them they would remain in the shelter of supervision and community as they continued their journeys as helpers. I commented on the vast amount of continued work they would do, both professionally and personally. I reminded them that the most important element of the therapeutic relationship is … the relationship.

Yet, I wanted to be supportive. I wanted to offer an elixir to relieve their discomfort. I pondered the unrest of the neophyte counselors and inquired, “What would Yalom do?” To this question, I provide my learners with final lessons as interpreted by me and borrowed from When Nietzsche Wept.

 

1) Symptoms are messengers. Yalom’s Nietzsche suggests, “Perhaps symptoms are messengers of a meaning and will vanish only when their message is comprehended.” The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders has provided us with a new manual for categorizing and labeling sets of symptoms. For many counselors — in particular new counselors — the responsibility of diagnosis can be daunting. Many of my students chide me as I refer to the “patterns of behavior” a client manifests versus a specific diagnosis. For example, “Jody” may be experiencing depressive symptoms. However, Jody is not referred to as “being depressed” because this may imply that Jody’s identity is to “be depressed.” Yalom further challenges that all behavior is purposive and serves the host. Therefore, discovering how these patterns or symptoms serve the client may provide insight into deeper meaning.

2) Cultivate meaning. Viktor Frankl, psychiatrist and author of the groundbreaking book Man’s Search for Meaning, describes meaning construction as paramount to the human condition. He notes, “You can take everything from a man, except his attitude about his circumstance.” Yalom concurs that the cultivation of understanding is key for a client’s wellness. Therefore, I am inclined to assess what meaning the client ascribes to a particular symptom or patterns of symptoms.

For example, I had a client who presented with concerns over discovering that her husband had a fetish for wearing women’s lingerie. Initially, I thought her discomfort was related to possible concerns about his sexuality. However, upon further exploration, this client’s real discomfort was related to her own body image. She found her husband to be more comfortable wearing his pink nightie than she was wearing hers, and this resulted in her envy and resentment.

3) Model honesty. To truly be honest, one necessarily experiences risk — risk of rejection, risk of betrayal. Yet vulnerability can offer great rewards in relationship. As clinicians, we ask our clients to be truthful, and we often negatively refer to those who withhold information as “resistant.” Do we ask the same of ourselves, however? Do we allow ourselves, as Yalom suggests, to model this behavior so that our clients can “learn there is no horror in openness and honesty between people?” Brené Brown, author of the 2012 bestseller Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent and Lead, writes, “Vulnerability sounds like truth and feels like courage. Truth and courage aren’t always comfortable, but they’re never weakness.”

4) Healer and healed are in courtship. Yalom poignantly reminds us that the secret to the therapeutic alliance is the unconscious dance that occurs between the healer and the healed. This intricate pattern between transference and countertransference may resemble a perfectly executed waltz or a more random quickstep. Rarely understood outside the counseling community, it is within this complex relationship that healing occurs.

Furthermore, the healer is often equally touched by the experience of being in relationship with the client. This is best portrayed in Hermann Hesse’s novel Magister Ludi, in which two great healers discover one another. In desperation, the young student seeks the help of the great teacher and remains in service to him until his dying days. It is during the final scene as the sage healer is dying that he confesses that he too had sought out the care of the younger healer and that both were served by the relationship.

5) Isolation exists only in isolation. Nietzsche’s emotional release results in a profound understanding by Breuer: “Isolation exists only in isolation. Once shared, it evaporates.” The importance of social supports is well documented in the research, and the therapeutic relationship provides an intimate and significant relationship for many of our clients. For some, it may be the first time that they have told their stories. This is powerful. Up until that moment of disclosure, it has remained a secret that has anchored the client to the experience and the emotional turmoil that is attached to the experience.

6) Choose your fate, love your fate. Yalom’s Nietzsche confronts Breuer about agency in one’s life, offering that we make choices in our life that contribute to our experiences. He further contends, “The spirit of a man is constructed out of his choices!”

Our clients often present to counseling feeling stuck in a life that they feel has happened to them. WWYD_1They do not feel that they have agency in their life. It can be powerful to simply offer that they possess the ability to choose many of their experiences in life, and they always have the ability to choose how they respond to their circumstances.

7) Take time to chimney sweep. “Chimney sweep” is a term in the text that is synonymous with brainstorming and relative to the technique of free association. It refers to the free flow of thoughts around a topic or idea as a method to access meaning. This, however, requires us to unplug and put aside all other activities that may distract us from this “housekeeping” of sorts. Additionally, chimney sweeping requires adequate time to empty our cluttered thoughts, turn our attention and eventually meditate on the topic of interest. This results in a purging of thoughts, ideas and meanings tangled within the threads of the subject matter. It adds to clarity of mind and peace of body.

8) Be more generous to your own humanity. Yalom’s Nietzsche declares a “granite sentence” of the human experience to be to “become who you are.” He continued, “That means not only to perfect yourself but also not to fall prey to another’s designs for you.”

Kristin Neff, associate professor of human development and culture in the Educational Psychology Department at the University of Texas at Austin and author of the book Self-Compassion wrote in her blog (dated June 25, 2011), “Instead of endlessly chasing self-esteem as if it were the pot of gold at the end of the rainbow, therefore, I would argue that we should encourage the development of self-compassion. That way, whether we’re on top of the world or at the bottom of the heap, we can embrace ourselves with a sense a kindness, connectedness and emotional balance. We can provide the emotional safety needed to see ourselves clearly and make whatever changes are necessary to address our suffering. We can learn to feel good about ourselves not because we’re special and above average, but because we’re human beings intrinsically worthy of respect.”

9) Die at the right time. Yalom’s Nietzsche and Breuer agonized over mortality and Nietzsche proposed, “Die at the right time. Live when you live! Death loses its terror if one dies when one has consummated one’s life. If one does not live in the right time, then one can never die at the right time.”

Consummating one’s life necessarily requires the shunning of distractions of the past and concerns for the future. It requires us to be fully present in the moment. It commands courage to take risks in life and love. This results in vulnerability (there it is, again!). However, to live fully means to embrace all aspects of the human experience. Pain, suffering, joy and ecstasy are all shared experiences of humanity. Would I give up one aspect for another?

For example, I recall the day my daughters moved from our home. They had graduated college the same week and were launching into their exciting new lives. We procrastinated in saying our goodbyes, and when the time came, we collapsed in each other’s arms in hysterical fits of tears and laughter. I remember smoothing the hair of my grown daughters, kissing their foreheads and reminding them that the reason we were experiencing grief over this milestone is because we had chosen to love deeply. I, for one, will always choose love.

Now armed with several, though certainly not all, of the nuggets of wisdom provided by the brilliant Irvin Yalom, I leave you with one final thought from my humble experience as a counselor.

10) We are people, not pathologies. We are human beings seeking relationship and wanting to belong in community. We want to love and be loved. As counselors, we have the greatest privilege in being asked to enter into the most vulnerable spaces with others and to be in relationship. That is a sacred gift and the secret to therapy.

 

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Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland. In addition to her practice, she is a visiting full-time faculty in the pastoral counseling program for Loyola University Maryland. Contact her at cy.fisher@verizon.net.

The Hope Chest: The writing on the wall

By Kim Johancen-Walt March 16, 2015

Through our traumas, we are often at risk of ingesting our perpetrators, continuing to perpetuate the same cycles of abuse and abandonment on ourselves and on others, and believing the messages of unworthiness communicated through the injuries that were inflicted. Left unchecked, these messages can be fully absorbed like toxins through our skin, and we may not even know we are WritingOnWallinfected.

It is not enough to help our clients identify the source of their ongoing patterns and propensity to both abuse and abandon. We must also help them reveal how these beliefs continue to affect their relationships with themselves and limit their ability to truly heal.

 

Powerless to change

“Devin,” 45, had started therapy because of complicated grief associated with having his fiancée leave him several months before our first meeting. Devin was severely depressed and was becoming increasingly suicidal. Early sessions included taking a close look at Devin’s relationships, which revealed a pattern of abuse set in motion by growing up with a mother who had been both physically and sexually abusive to Devin at a young age.

Because of early trauma, Devin had grown up believing he would continue to be victimized. At first, treatment involved uncovering this belief and how it had defined his relationships with others. We unpacked his various traumas and co-created a space in which he could process these events and integrate them differently along the way. Motivated, Devin worked hard to change how he had narrowly defined himself and began broadening his personal identity. Knowing he was making progress, I was not expecting the reemergence of earlier symptoms, dying embers of self-abuse growing once again into a raging fire.

One day, coming in for a session looking simultaneously exhausted and agitated, Devin discussed feeling increasingly hopeless. We revisited the progress he had made up to that point, how he had fostered compassion for himself and his perpetrators, and how he had taken steps toward a bright and meaningful future. But despite these efforts to shine light on his growth, Devin continued to feel both stuck and helpless to move any further. It became obvious that he still believed he was powerless to change his life.

Feeling his frustration, I asked Devin how he could continue his healing while also holding on to a belief that he could not change. Although abrasive, his victim identity had become a comfortable blanket he wrapped tightly around himself throughout his life. We discussed how it was hard to let go and identified the various ways he continued to stay in the shadows. For example, precious time in counseling was still spent focusing on many of the people who had hurt him. It was at these moments of misguided focus that he continued to disappear, abandoning himself in the process of trying to understand and predict the actions of others.

Open to the idea that he had been binding himself, we discussed the true nature of acceptance. Acceptance is not about needing to embrace the events that have happened; it is about embracing the impact of these events. This involves being completely present to our experience (while simultaneously limiting the overwhelm), feeling the fullness of our grief and loss, and acknowledging what we need along the way.

Early on in counseling, time spent dissecting the actions of others may have been valuable in regard to deepening Devin’s understanding that his abuse was not his fault. But at some point, more time needed to be spent acknowledging his personal experience and his needs moving forward. Extinguishing the flames of abandonment involves catching those moments when we abandon ourselves. By focusing only on those who abandoned us, we can slip back into the abyss, feeling powerless with no obvious way out.

As Devin became more proficient at recognizing his own patterns of abandonment, he also became more adept at focusing on his feelings, his passions, his desires and, ultimately, his true identity. Changing how he related to himself and the belief that he had to abandon allowed him the opportunity to let go more fully and ultimately get back on the journey to focusing on what was truly in his control.

 

Attempting to solve the problem with the problem

“Reece,” 53, was an accomplished career woman. Always impeccably dressed and looking as if she had just stepped out of a salon, Reece maintained a successful business. At the same time, she was also struggling with an alcohol problem and unresolved grief surrounding the recent loss of another meaningful relationship in her life.

Reece had grown up with parents who focused solely on achievement and withheld love from her when she failed to perform at high levels. She discussed, for example, how her father had encouraged her to start dieting at age 12, limiting treats when she didn’t lose weight, and how both parents rarely acknowledged her perfect report cards, stating that her academic achievements were expected and nothing to celebrate. As perfectionism took root at a young age, Reece constantly chased approval from others, believing she was never good enough despite her numerous achievements.

Through early stages of counseling, Reece became more aware of her drive for perfection and why it had evolved. We discussed how her need to perform continued to run her life and affect her relationships with others. She routinely chose partners who affirmed the belief that she had to perform or else be punished. Although it was useful information for Reece to realize how perfectionism was part of how she had survived as a child, it became apparent that her growing awareness was not enough to effect change. She became increasingly impatient (both with herself and with me) and progress slowed. She would have occasional bursts of confidence and clarity, but inevitably she would slip back into her depression and grief over the loss of her relationship with her boyfriend. It was during these “slips” that her self-abuse would also become amplified. In addition to other forms of self-injury, she began coming to therapy with scratches on her neck and the backs of her hands.

During one particularly difficult session in which Reece arrived with fresh cuts, I told her that she may be “stuck” because she was attempting to solve the problem with the problem. She had tried to approach healing and recovery the same way she had approached everything else in her life — with perfection, unrealistically high expectations and punishment in various forms when she failed to deliver.

In her push to move quickly through recovery, she routinely minimized her feelings, berating herself for not moving forward and effectively tightening the chokehold of both abuse and abandonment. Acknowledgement is the No. 1 prescription for healing and recovery because it is the exact opposite of what has been done. With traumatic events, our needs have been completely disregarded. Reece’s refusal to acknowledge her grief and despair had simply created more of the same. Her substance abuse and self-injury were two more perpetrators serving to mute and minimize her feelings and needs.

Beginning to recognize that sitting in the mess was also a way to move through it, Reece started to practice patience for her own natural healing process. She began working toward the idea that she was inherently lovable because of who she was, not because of what she did. She began seeking acknowledgment from caring others and received additional messages of worthiness in the process. Increasing her exposure to lovingkindness was the antidote.

 

Letting go

Letting go is a challenging and difficult practice. It requires commitment, recommitment and tremendous patience. When therapy seems to stagnate and our clients feel as though they are hitting an unmovable wall, it may simply mean that they are getting ready to push through to the other side. Sometimes letting go of our old identities, even the ones born out of abuse and abandonment, can activate both new and old feelings of loss. We might actually hold on more tightly as we feel the old relationships with ourselves slipping through our fingers. The desperation comes because we cannot bare the thought of additional loss. For many of our clients, these relationships with themselves and others, although abusive, are what they have always known, making it difficult to let them go.

Without understanding the pervasiveness of these messages and the terror of potential additional loss, we are at risk of joining our clients in their frustration over a lack of progress. Our frustration and failure to accept our clients unconditionally can tighten the vice grip of self-abuse rather than help free them from it.

We do not want to reinforce messages of abandonment through our work. We simply have to read the writing on the wall that our clients are bumping up against. If we do that, we may be able to helpWritingOnWall2 them discover that seemingly slow moments in therapy are actually a necessary part of healing and recovery. It is a signal that they are in the final steps of letting go and it is always darkest before the dawn.

It is not enough to change our patterns with others. We have to first start by changing the patterns with ourselves. What keeps us pushing is the faithful knowing that there is beauty on the other side.

 

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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

The Hope Chest: Finding calm within the storm

Saturday keynote: Counselors are the magic pill

By Bethany Bray March 14, 2015

Counselors Jeffrey Kottler and Richard Balkin delivered a fast-paced, information-packed keynote talk peppered with humor, visual clips and abundant insight this morning at the ACA 2015 Conference & Expo in Orlando, Florida.

The duo kicked off the conference’s second day with an address about the importance of

(Left to right) Jeffrey Kottler and Richard Balkin deliver the Saturday keynote at the 2015 ACA Conference & Expo.

(Left to right) Jeffrey Kottler and Richard Balkin deliver the Saturday keynote at the 2015 ACA Conference & Expo.

relationships – both in and outside the counseling office.

Clients look more for a connection, relationship and support than a diagnosis or other trackable data, Balkin said to the standing-room-only crowd.

There is no “magic pill” intervention, theory or technique that counselors can offer clients to automatically make them feel better. Instead, counselors themselves are the magic pill, Balkin said.

Balkin and Kottler have very different background and styles, but their keynote’s engaging back-and-forth made it clear they are both very dedicated and passionate about what they do.

Balkin is a researcher and professor at the University of Louisville and the editor of the Journal of Counseling & Development. Kottler, a prolific author, splits his time between California State University in Fullerton and Nepal, where he founded a nonprofit that supports young women who are at risk of becoming forced into early marriage or sex slavery.

ACA President Robert Smith asked Balkin and Kottler to co-present the Saturday keynote at this year’s conference, a pairing the duo jokingly referred to as a “shotgun marriage.”

“I believe in data, but I believe in the data of stories,” said Kottler, who did a book signing after the keynote. The telling and trading of stories is what creates and retains relationships, said Kottler. It’s also what makes us human. That’s why it is so important that counselors facilitate clients telling their own stories.

Counselors don’t always have to fully understand their clients, Kottler said, but the client must feel they are understood by the counselor.

The duo touched on several points that make a difference in counseling, from keeping clients engaged and being “fully present” as counselors to assessing outcomes and working towards goal with a client. A counselor should make adjustments to the relationship to meet the client’s needs as therapy progresses, said Balkin.

But sometimes, a counselor’s role is simply to hold the client’s sadness, Kottler said. Often, that

includes loving a client in a way they’ve never been loved before – with respect and without manipulation.

“So much of what we do is love people,” said Kottler. “We call it compassion, we call is caring, we call it empathy.”

 

ACA President-elect Thelma Duffey (at far right) greets the standing-room-only crowd prior to the Saturday keynote.

ACA President-elect Thelma Duffey (at far right) addresses a standing-room-only crowd prior to the Saturday keynote. (Photos by Bethany Bray/Counseling Today)

 

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See images from the 2015 ACA Conference & Expo, including the Saturday keynote, at flickr.com/photos/23682700@N04/

 

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Related reading:

See Counseling Today’s Q+A with Balkin and Kottler: ct.counseling.org/2015/01/its-all-about-the-relationship-qa-with-richard-balkin-and-jeffrey-kottler/

 

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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