Monthly Archives: May 2015

No laughing matter?

By Kathleen Smith May 27, 2015

A client comes in for his first counseling session. He has a carrot sticking up his nose and a banana in his left ear.

“Help!” the client cries. “Can you tell me what’s wrong with me?”

“Simple,” the counselor says calmly. “You’re not eating properly.”

Laughter is an essential part of the human experience, so it’s no coincidence that a profession that tries to make sense of the complexity and absurdity of human nature occasionally finds itself the butt Laugh_smallof a joke or the punch line of a comic strip. In its ongoing quest to be “taken seriously,” however, the counseling profession seemingly sometimes forgets that humor can be a key component of wellness and even the therapeutic relationship.

The profession’s squeamishness with jokes arguably can be traced back to the image problem that psychotherapy has in the media, with TV show counselors often portrayed as zany bohemian personalities in offices full of waterfalls and wind chimes. If Tracey Ullman as Ally McBeal’s karaoke-singing shrink and Lisa Kudrow on her Web Therapy comedy series have served as our ambassadors to the world, then no wonder we’re so nervous.

Despite what television portrays, it’s no secret that counseling is serious business. Clients wouldn’t come to counselors searching for solutions if their problems were just everyday troubles that could be fixed with a pat on the back or a funny movie. An equally sobering reality is counselors’ duty to avoid doing harm to clients, which is infused in the profession’s ethics code. Counselor educators spend so much time drilling the principle of nonmaleficence into the heads of graduate students that there hardly seems space left for a crash course in comedy.

But the reality is that we live in a world that sometimes borders on the absurd. And when things don’t work out exactly like they’re supposed to, we can either run for cover or we can laugh about it. “Or, as Taylor Swift might say, ‘Shake it off,’” jokes Samuel Gladding, professor of counseling at Wake Forest University and a past president of the American Counseling Association. “Humor helps us shake things off. Anxiety decreases when we realize that we’re not perfect and that we don’t have to be. Humor gives us that right to laugh. It helps us see more of our humanity and realize that the world isn’t always a somber, serious place.”

Despite sometimes being shunned, the therapeutic use of humor is not a new idea in counseling, and its lengthy history in psychology ranges from the wacky to the profound. Sigmund Freud saw humor as a means of expressing thoughts in the unconscious that had been suppressed in society. Viktor Frankl afforded the hope that humor was a means to lift the human experience above even the most horrible suffering.

Of course, no character in the annals of therapeutic humor is as unforgettable as Albert Ellis. A firm believer that taking oneself too seriously was a sign of psychopathology, Ellis took his in-your-face techniques to an unprecedented level. His infamous “rational humorous songs” were meant to illuminate the absurdities of irrational thinking, even though their bawdy lyrics might make most counseling professionals cringe today. We can no more imagine an addictions counselor leading a recovery group in a rousing chorus of “Drinking Is The Thing for Me!” (sung to the tune of “Yankee Doodle”) than we can picture anyone getting away with these tactics other than, well, Ellis himself.

By its very definition, humor is a lighthearted topic, but in the past few decades, science has taught us to consider its benefits a little more sincerely. “Humor is one of the handmaidens of wellness,” says Gladding, a frequent presenter on the subject. “The endorphins kick in, the heart rate is better and our breathing is deeper. There’s an old saying that those who laugh, last.”

Science also tells us there are health benefits to laughing or smiling even when we don’t feel like it. Take, for example, a 2012 study at the University of Kansas, where psychologists Tara Kraft and Sarah Pressman tested whether there is any truth to the phrase “grin and bear it.” Before completing short stress-inducing tasks, participants in the study were instructed to smile, to hold their face in a neutral expression or to hold chopsticks in their mouth to simulate a forced smile. Kraft and Pressman found that those who smiled or held chopsticks in their mouths experienced lower recovery heart rates compared with those who maintained neutral expressions. So, although it might sound odd, there seems to be some evidence that people who force themselves to smile in tough situations are healthier and probably happier.

“Before we even knew about the physical effects, Gordon Allport taught us that humor is a characteristic of healthy people,” Gladding says. “It helps with self-awareness, insight and tolerance, yet somehow we conceptualize counseling as serious and without those lighter moments.”

Although the potential benefits are obvious, using humor in counseling is often easier said than done. Sometimes it takes more than a TV show or a New Yorker cartoon for humor to jump-start these effects. Thus, counselors inherit the challenge of determining whether their own funny insights can flip the switch for clients and lighten their perspective.

Terry Bordan, a professor of counseling at Long Island University and a member of ACA, recalls how she once worked with a client who blamed herself for all of her family’s problems. In the client’s mind, she was at fault for everything. So, Bordan turned to her and said, “But what about the economy?” The client seemed bewildered by this response, so Bordan replied, “Everything is your fault, and the economy is tanking. Surely you must have something to do with that.”

The client immediately began laughing, realizing the absurdity of her thinking. “Laughter is a way of celebrating and therapeutically engaging the absurdities of life,” Bordan says.

This type of humor, known as a paradoxical response, is a commonly used technique in counseling. For it to be effective, however, clinicians must first ensure that they have established good rapport with the client. Bordan notes that if a client doesn’t laugh, the intervention will backfire, leaving the person confused or disheartened.

Gladding affirms this judiciousness, noting that respect for the client should be valued above all. “But sometimes,” he says, “I’ll use it with somebody who just refuses to speak, like a teenager. I might say, ‘Wow, this is really bad because now you’re going to have to always order pizza online. You can’t call in.’ Just something like that.”

Teaching humor 

If humor could play such a potent role in the therapeutic relationship, why don’t graduate counseling programs or organizations that offer continuing education dedicate more time to addressing the topic? To begin, educators are not quite sure whether humor is a skill that can actually be taught.

“I don’t know if you can teach somebody to have a sense of humor,” Bordan says. “A counselor has to be their authentic self, and if humor isn’t part of your DNA, then you’re not going to be able to use it successfully. If there’s a spark, you can get more of a flame. But zero times a million still equals zero.”

Gladding suggests that counselor educators and supervisors can focus their energies on helping counselors become better at telling anecdotes or assembling a few jokes to use at appropriate times. But counselors should never feel pressured to be funny, he adds. “Just like some people are better athletes than others, some people are better at seeing the lighter, brighter side of life in a humorous way,” he says.

As for the graduate classroom, Bordan believes there is absolutely a place for humor. She says one of the nicest things a counseling student ever told her was that taking a class with her was like taking a class with Joan Rivers. “People take themselves too seriously, including researchers and educators. And humor is inherently not serious. So it’s almost a frivolous topic, and perhaps it’s shied away from in scholarship and in the classroom because of that,” Bordan says.

Eugene Goldin, a professor of counseling at Long Island University and co-author of an upcoming humor book with Bordan, advises that counselors must find a balance between using humor as a teaching tool and underscoring the seriousness of the work. “We don’t want to leave students with the impression that a client comes in and you start telling jokes right away,” Goldin says. “We downplay humor like we downplay self-disclosure as a counseling intervention when we’re teaching our students, because we don’t want the session to become all about them.”

As with any therapeutic technique, a host of multicultural concerns and considerations accompany the use of humor with clients. Humor is framed by culture and worldview, Goldin says, and it can do more harm than good if a client reacts with confusion or is deeply offended.

“Look at the climate right now,” Bordan adds. “What some people view as humor, others view as a call to war. You have to be so terribly careful and not become involved with something that might be viewed as irreverent.”

Research has found that when working with diverse populations, the counselor’s use of humor can help clients to perceive the counselor as their ally in the strange or potentially threatening environment of the consulting room. In a 2006 article in the Journal of Counseling & Development examining humor in counseling with African American college students, Linwood Vereen and his co-authors proposed that humor could help clients develop a sense of self-efficacy. They suggested that by allowing the counselor and client to process difficult subjects and challenges, humor could be a redemptive feature that promotes optimism and empowerment among diverse clients. They also warned, however, that a counselor’s use of humor could be insensitive and even harmful if it devalued a client’s concerns and experiences.

A double-edged sword 

Therapeutic work can also benefit when counselors choose to incorporate humor into their own lives. After all, it can be difficult to see the lighter side of life when you meet with multiple clients each day who struggle with depression or self-doubt.

“Counseling is toxic in so many ways,” Gladding says. “It’s not that we invite toxicity into our lives, but listening to clients can kind of wear you down.” He notes that he will sometimes attend a comedy act or see a funny movie just to laugh, because it helps him feel more resilient.

Gladding also acknowledges that humor can help prevent counselors from taking themselves too seriously when they make a mistake. He shares the story of how a misunderstanding turned from daunting to funny in his own practice. “Once I was working with a person of color, and she kept saying, ‘I really despise WASPs.’ I’m an Anglo-Saxon-looking guy, and I kept thinking, ‘Oh my goodness.’ What I didn’t realize was that behind the curtains, there were a number of wasps in the room. Then I [finally] realized she wasn’t talking about me at all. And I just had to laugh at myself and tell her I finally understood what she was saying.”

But there can also be a dark side to humor in the counseling room, particularly if clinicians make jokes when they feel uncomfortable or resort to sarcasm if they’re in a bad mood. Through

Former ACA President Samuel Gladding delivers a few jokes while standing on a desk during his session "Humor in Counseling: Maximizing a Therapeutic Tool" at the 2015 ACA Conference & Expo in Orlando. Photo by Bethany Bray/Counseling Today

Former ACA President Samuel Gladding delivers a few jokes while standing on a desk during his session “Humor in Counseling: Maximizing a Therapeutic Tool” at the 2015 ACA Conference & Expo in Orlando. Photo by Bethany Bray/Counseling Today

supervision and self-reflection, counselors should examine when and how they try to be funny. If they’re using sarcasm or dark or risqué humor, then it’s probably not for the betterment of their clients.

“Humor is a double-edge sword,” Gladding warns. “It can hurt or it can heal. If I’m taking inventory of the types of humor that I’m using and I’m finding that I’m putting people down or distracting from what we’re trying to accomplish, then I need to do something else. I need to ask myself whether it’s about [my] self-enhancement or the client’s self-enhancement.”

Incorporating a therapeutic use of humor into counseling practice is about taking small steps. Clinicians shouldn’t feel like they’re trying out for Saturday Night Live or altering their personalities to try to be funny. After all, the therapeutic use of self, including humor, is all about being authentic. The counselors interviewed for this article recommend the following strategies that clinicians and their clients can use to tap into humor as a wellness practice.

Assign humor homework. Gladding shares that he has assigned homework that involves laughter to his clients. “I ask them what they’d like to read or watch — maybe a favorite author or a comedian,” he says. If the client can’t think of anything, Gladding recommends funny but innocuous classic comedies featuring the Marx Brothers or the Keystone Cops.

Schedule time to be silly. Bordan says we should all — meaning counselors and clients — take time out of the day to laugh. “Just do something foolish and silly, whether it’s watching something funny on television or playing with a pet,” she says. “Or maybe just force yourself to laugh. Laughter is contagious, and we benefit when we dedicate part of our day to the practice.”

Use humor as a diagnostic tool. Assessing the role of humor in a client’s life can be an incredibly meaningful tool for counselors, Bordan advises. “Even if that client has no sense of humor, it is a diagnostic clue that can be used in assessing what is going on with [that person],” she says. If a client tends to use sarcasm or cynicism as a self-protective mechanism, then the counselor might be wise to avoid using humor as a tool with that particular client.

Use humor to change perspective. In a 2006 article co-authored with Goldin, Bordan and Gladding, Daniel Araoz recommended having clients see their life through the eyes of a cartoonist. This approach is meant not to devalue a client’s experiences but rather to increase awareness. “To uncover another level of reality in what happens around us is a special characteristic of a large part of what’s humorous and has a unique poetic quality,” Araoz wrote. “It may also be a demonstration of a very wise attitude: to see below the surface, to make the unconscious conscious.”

Mark teaching points with laughter. For counselor educators, humor can hammer down important points in the lesson. “Whenever we hear certain songs,” Gladding says, “we remember certain events that were happening in our lives at the time. When we punctuate a lesson with humor, the same process occurs. We make a mark where students can remember.”

Seek feedback. If a counselor wants to experiment with humor, it’s important to take baby steps. “Get feedback from clients and from supervisors about your own particular therapeutic use of self,” Goldin recommends. He emphasizes that counselors should never force techniques involving humor if they don’t come naturally. “The use of humor is about the client,” Bordan adds. “You’re not in a comedy club waiting for applause.”

When asked, Gladding admitted to feeling pressure to be funny when he presents on the topic of humor at professional counseling conferences. But he finds that starting off with a joke is great way to grab the attention of the audience. Here’s one he shared with me:

What did the math book say to the counseling book?

“Oh, man, I’ve got problems.”

So what did the counseling book say to the math book?

“It’s OK. I’m solution-focused.”

 

****

 

Kathleen Smith is a licensed professional counselor and writer in Washington, D.C. Contact her at ak_smith@gwmail.gwu.edu.

Letters to the editor: ct@counseling.org

Group effort

By Laurie Meyers May 25, 2015

When a client seeks help, often the focused, tailored nature of individual counseling is exactly what he or she needs. But sometimes there is a particular alchemy in a group.

Many clients benefit from group counseling, either in addition to or instead of individual treatment. Why is that? The counselors to whom we spoke pointed to one element in particular: peer power.

Jonathan J. Orr, president of the Association for Specialists in Group Work (ASGW), a division of the American Counseling Association, thinks that group counseling is always a better alternative than individual counseling. “If you think about it,” he says, “groups are the natural setting for us as Group_Brandinghumans. We are social beings by nature, interactive by nature, and group counseling most closely approximates how we live our lives.”

From Orr’s perspective, it is the intense individual counseling setting — in which clients share everything with a single person — that is more artificial, demanding a kind of forced intimacy. People are not naturally inclined to reveal all of themselves to just one person, he contends. But in a group, clients can choose what to reveal and can also listen and learn from what others share. It also tends to be easier to discuss problems with people who have experienced similar difficulties, Orr concludes.

The groups described in this article focus on specific client populations that counselors determined would benefit most from the group process. These group leaders emphasize that although proper facilitation skills are crucial to the success of the group, many of the most important contributions — and changes — are the result of the participants’ interactions.

Ex-offenders in need of job assistance

When people are released from prison in North Carolina, they are offered services such as substance abuse counseling, help finding affordable housing and money management courses. But one type of service is not offered to these individuals trying to reintegrate into society — a service that ACA member Mark B. Scholl believes is absolutely essential: career development.

Scholl began offering group counseling in career development to ex-offenders this past fall. At the time, he was a counselor educator at East Carolina University in Greenville, and the impetus for forming the groups came from a graduate student who was also a probation officer. The student explained that ex-offenders were not receiving any career guidance and asked Scholl if he could work with them on career development and related career entry skills.

“It just seemed like such a glaring omission when you think about becoming reintegrated into society,” says Scholl, who is also a member of the National Career Development Association, a division of ACA. “What individuals need to feel like they are reintegrated … is a purpose, and work fulfills that purpose for many of us. One of the most important indicators of desistance” — or not repeating the criminal behavior — “is having employment.”

Given those circumstances, Scholl and his student set up a career program for ex-offenders in Beaufort County. The program, designed by Scholl, is promoted by the North Carolina Department of Public Safety, which oversees the state’s probation and parole officers. Scholl also sends fliers to local mental health agencies. The program is open to both men and women, and the length of the participants’ criminal histories varies, he says. Typically, group members have been convicted of substance-related offenses, such as possessing or selling drugs, or other nonviolent offenses. But a few applicants have convictions for weapons charges or other violent offenses. Although this will limit their employment choices, it does not disqualify them from joining the group, Scholl says. However, the group does require that participants be clean and sober, take any mandated psychotropic medications, speak and write English fluently and be either unemployed or underemployed.

Scholl set up a second program in Forsyth County after moving from East Carolina to Wake Forest University. He and his co-facilitators, all of whom do the work pro bono, work with one group of ex-offenders at a time in each program. The groups are small, typically having four to six members apiece. Depending on the group members’ progress, there are six to eight sessions, each of which lasts for two hours. The group meets every three to four weeks and spends one to two sessions on each of the four topic areas: assessment, résumé writing, interviewing skills and job search strategies.

The program starts with a skills assessment. Facilitators and group members work together to identify experiences that can be translated into viable job skills. Scholl and the facilitators emphasize that skills are anything a group member is good at and may even include abilities that the person used in his or her criminal activities.

“You might be really good with numbers, or you might be really good at selling things,” he explains to participants. “You might have been selling things that were against the law, like drugs or stolen merchandise, but you still have those transferable skills and … those are valuable.”

Everyone in the group gets a transferable skills list, Scholl says. “[It] is very comprehensive. It includes different categories of skills like communicating, influencing and organizing, and under each of those categories, there are about 20 transferable skills,” he explains. “Because they’re transferable skills, [it doesn’t] require formal training or education to have them or to claim them.”

For instance, “communication” can include skills such as being a good listener, being good at explaining things or giving directions, being good at persuading and selling or even, in certain contexts, arguing or debating, Scholl says.

Everyone in the group picks three skills and then shares them with the facilitators and group members. These transferable skills will help the participants craft their résumés and also come into play as they learn about the interviewing process.

Scholl and the other facilitators give the group members sample résumés and a list of action verbs to use — for example, coordinate, sell, order, supervise, facilitate, interview — when writing their own résumé lines.

The group facilitators discourage ex-offenders from listing jobs that they held in prison on their résumés but stress that in addition to past paid work, participants can include volunteer work in churches and in the community. Skills that group members gained in prison or while engaged in criminal activity can be listed under the “professional skills” section of the résumé, Scholl says. The facilitators then edit and provide feedback on the group members’ résumés.

The next step in the group program is perhaps the most delicate and difficult: interviewing. Scholl describes the group’s counseling approach as postmodern, and that approach especially comes into play at this point.

“We emphasize that [they] are active meaning-makers,” he says. “Part of the postmodern tradition is that we all have that capacity to construct meaning for ourselves. So, for example, one thing we practice is self-disclosing your criminal record in a way that’s as positive as possible. You make the part where you talk about your mistake and your bad choice brief and concise, and you own that you are fully responsible. But you quickly move on to emphasizing that you’re not letting it [the mistake] define you as a person.”

Group members can then delineate the steps they have taken to improve themselves. By presenting their pasts in this way, they become the authors of their past experiences, Scholl explains.

Group members also prepare for interviews by constructing narratives around their strengths and what they can contribute to a company. Facilitators teach participants to use the acronym STAR (situation, task, action, result) to build these narratives, Scholl says.

For example, if wanting to demonstrate a strength such as sales or planning skills, the group member might tell a story about a time in high school when he or she was asked to sell magazine subscriptions door to door (situation and task) and made a plan to go to 10 houses each day after school for a week (action). As a result, the group member sold 35 magazine subscriptions and raised X number of dollars toward the purchase of uniforms for the high school band (result).

Another application of STAR could be a story about when the group member worked in a laundry setting (without emphasizing that it was the prison laundry) with a co-worker who wasn’t pulling his or her weight. The group member reasoned with the co-worker and, as a result, the team member’s work improved, Scholl says.

Group members write their STAR narratives and break up into pairs to role-play, taking turns being the interviewer and the interviewee, Scholl explains. They then give each other feedback on how to make their stories more compelling or clearer, asking questions such as “Why was this a strength?” or “What was the outcome?” Participants then reassemble to get feedback from the facilitators and other members of the group.

Scholl and his facilitators emphasize the importance of the STAR narratives to the group members. “We talk about … when you are interviewing for a job, things like your GPA or how much money you made in your last position, that’s not the kind of thing that makes you a memorable applicant,” Scholl says. “It’s the stories you tell. If 150 people apply [for a job], the one or ones with the most compelling stories are going to be unforgettable.”

The last stage of the group program involves job search strategies, which includes information about the importance of the informational interview, how to conduct an informational interview and how to approach someone for such an interview, Scholl says. But the strongest emphasis during this portion of the group is on self-presentation, including grooming and hygiene, he says. The facilitators also stress to group members the importance of being polite and friendly to everyone they encounter, because they never know when they might re-encounter someone in the job search, Scholl says.

Scholl acknowledges that he doesn’t possess much hard data on the overall efficacy of the group. But he says he can point to tangible products such as résumés — many group participants now have one for the first time. He and his facilitators also have anecdotal evidence, such as hearing that “Doug” got a job last week or “Mike” is going back to get his two-year degree so he can acquire the training necessary to work in a field in which he has a strong interest. Former group members also come back to sessions to share what they got out of the program.

“We recently had a woman come back to say that she was going to get her four-year degree,” Scholl recounts. Although the woman had been sober for several years prior to participating in the career group, she also credited the group with helping her maintain her sobriety.

For Scholl, this demonstrates why the value of group counseling goes beyond its curriculum or resources. The true value is in group members experiencing mutual support. “I think there is so much power in the ability to role-play with a peer and to view the group as an alliance of peers that can bring information, ideas and support,” he says.

When the caregivers need care

Laura Kestemberg is the director and associate dean of the newly established clinical mental health counseling master’s program at Molloy College in Rockville Centre, New York. For the past few years, she has been researching stress in parents of children with autism. Along with fellow ACA member Laura DeGennaro, Kestemberg joined Molloy’s initiative to launch an interdisciplinary autism center.

As Kestemberg and DeGennaro, the clinical director and clinical coordinator, respectively, of the proposed autism center, worked with these children, they identified another group that needed help — the children’s parents. The social and behavioral impairments that accompany autism cause challenges that permeate almost every aspect of a family’s life, Kestemberg notes. “Parents [of children with autism] feel very isolated and ashamed and that it’s just them,” she explains. “Sometimes it’s been them [alone] battling with the school system or battling with providers.”

Parents of children with autism often experience a lack of social support, Kestemberg says. It’s not uncommon for friends and family members to pull away, and even if they don’t, it’s difficult for them to truly understand what the family is going through. But parents of other children with autism do understand, Kestemberg says, which makes a group counseling approach particularly helpful for them. In addition, group counseling has been shown to be very powerful for populations experiencing high levels of stress.

Both Kestemberg and DeGennaro had previously worked with parents of children with disabilities. “So we decided to put our heads together and try to have a clinical intervention for the parents,” Kestemberg says. They approached John Carpente, executive director of the proposed autism center and director of the Rebecca Center for Music Therapy at Molloy College, about providing this clinical resource for parents and collecting data on parenting stress.

As they were developing the group, Kestemberg and DeGennaro assumed they would run across other groups that focused on supporting the parents of children with autism, but that wasn’t the case. “We found that there were a lot of advocacy groups and a lot of parent training groups,” Kestemberg says. In training groups, counselors help parents learn to manage the child’s acting-out behaviors or show parents how to help the child manage in the school setting. “But it’s always about the child,” Kestemberg stresses. “We wanted … to do something where they could come to a group and [we could] say, ‘We’re going to talk about you — the parents, not your child. And we’re going to provide you with the strategies to help reduce your stressors.’”

Kestemberg and DeGennaro struggled with determining when to hold the group. They finally decided on the summer, when most children were still in summer camps, during the middle of the day. Evening groups were too difficult to coordinate because many of the parents didn’t have good child care options, and Kestemberg and DeGennaro didn’t yet possess the resources to offer child care while the group met.

Participants were recruited from the Rebecca Center and other local organizations that provide services to children with autism. Kestemberg and DeGennaro conducted a telephone intake interview with each parent. Although they wanted the group to include fathers, the mothers had greater availability. They ended up with a group of five women who met for 90-minute sessions 10 times throughout the summer of 2014.

Kestemberg and DeGennaro started each session by going around the circle and asking each woman to update the group on the most important things that had happened during the past week. At first, the women were more likely to bring up problems their children were having. “We tried to steer them toward what was going on with them or how what was going on with their child affected them,” Kestemberg says.

At first, it was difficult for some of the group members to open up. “The mindset was, ‘If I let a little bit out, I just won’t stop crying,’ or … ‘I’ll have so much anger that I’ll blow people away,’” Kestemberg recalls.

Little by little, as Kestemberg and DeGennaro reassured the members that the group represented a safe place with others who were going through the same challenges, the women began to share. They talked about very painful topics, such as deciding whether to have another child, feeling alone in their marriages or yelling at their offspring and how ashamed they felt about doing that in the face of the child’s disability. “And other women in the group would say, ‘You know, I’ve done that too,’ or ‘I also think my marriage isn’t going so well,’” Kestemberg says.

As the women shared, an important concept became evident to each group member: “You are not alone.” In turn, this helped the group work toward the goals that Kestemberg and DeGennaro had set for the parents, which included:

  • Feeling more empowered
  • Decreasing their feelings of guilt
  • Decreasing their stress levels
  • Becoming more aware of their own needs
  • Learning to use more positive coping strategies

The experiences the women shared weren’t just helpful emotionally but practically as well, Kestemberg says. For example, one mother expressed concern about going in front of a school district special education committee to talk about her child. These meetings involve educators, service providers and parents getting together to decide how best to meet the needs of the child. However, the gatherings can be emotionally charged because these parents often feel like it is a struggle to obtain the proper services for their children. Going in front of the committees, they feel the burden of having their facts straight and presenting a compelling case concerning why their requests for their children are valid.

In the case of this mother, the other group members suggested role-playing to help her prepare. Several of the other mothers had already gone through similar hearings, Kestemberg explains.

Another common experience the women reported was feeling like they had to gird themselves before entering the house upon returning home. “A lot of our moms … said, ‘I’m so stressed that I can’t go right into my house. I sit in my car, have a cup of coffee, listen to the radio or do what I have to do before I have to face the chaos of what’s going on in the house,’” Kestemberg reports.

To help them cope with these overwhelming moments, DeGennaro and Kestemberg taught the mothers mindfulness techniques such as meditation, deep breathing, observing thoughts, mindful eating and walking, body scans and guided imagery. They also closed each session with a GROUP THERAPYmeditation or relaxation exercise and asked group members to practice the mindfulness techniques themselves as homework. Kestemberg and DeGennaro also informed the mothers about mobile apps for relaxation such as Stress Tracker, Breathe2Relax, MindShift and Take a Break! Guided Meditations for Stress Relief.

But so much of the benefit from the group came from what its members gave to each other, like offering to role-play, Kestemberg says. “[The group] was much more powerful than meeting with a therapist or mental health care provider one-on-one because they were with other moms who had gone through it,” she emphasizes.

The group ended up being a mix of mothers with children who were very young and newly diagnosed with autism and mothers whose children were as old as 18. Kestemberg and DeGennaro initially thought it would be best to separate participants by age or level of severity of diagnosis, but because the total number of recruits ended up being so small, there was a need to combine them. This was a serendipitous necessity because it allowed the mothers with children who were newly diagnosed to see that there were other mothers who had “survived” and flourished throughout the school years.

These shared experiences resulted in a strong bond forming among the group members. The mothers would email each other between sessions to trade resources or just to offer support.

Kestemberg and DeGennaro conducted both pre-group and post-group parental stress assessments but did not find a significant decrease. However, they think that the mothers’ experience of opening up and actually acknowledging what they were going through may partly account for the results. Acknowledging the strain may have changed the way they reported their stress levels, DeGennaro explains.

This was only a pilot study, but DeGennaro and Kestemberg already have a waiting list for this summer’s groups. They intend to increase the number of sessions and plan to measure participants’ coping styles and levels of loneliness, anxiety, depression, subjective well-being and hope.

Helping kids at risk of dropping out

How can schools help students who are struggling academically and at risk of falling behind or even dropping out? When ACA and ASGW member Jonathan Ohrt was an assistant professor in the counseling and higher education department at the University of North Texas (UNT) in the Dallas-Fort Worth area, he worked with groups of students to teach them skills that could help them succeed. UNT had an agreement with two area middle schools to work with students the schools deemed to be at risk for dropping out. Students qualified as at risk using a combination of teacher recommendations and items from the Texas Education Agency’s at-risk factors, which include not maintaining an average of 70 in two or more subjects in the previous or current school year and having multiple suspensions.

Ohrt and his team had researched which elements were most predictive of students’ academic success or failure. Although GPAs and test scores typically receive the lion’s share of attention, Ohrt found that social and emotional factors played larger roles. Armed with these findings, Ohrt decided to use the Student Success Skills (SSS) curriculum (designed by counselor educators, researchers and ACA members Greg Brigman and Linda Webb) because it has shown success with factors such as goal setting, self-regulation, academic self-efficacy and engagement. The curriculum also focuses on factors such as social skills, overall health and well-being, and physical activity. Although the curriculum features elements of psychoeducation, Ohrt believes the practical elements of goal setting and peer support are most crucial to group members’ success.

Ohrt and his co-facilitators led three different groups, each containing six to eight students, at the two middle schools. The groups ran for eight weeks with one 40-minute session per week.

The first session was spent on introductions, with the students getting to know one another and the facilitators. The second session was psychoeducational in nature, with the leaders talking about the life skills that are related to being successful, such as goal setting, progress monitoring, memory skills, managing attention and managing anger. The SSS curriculum includes worksheets that explain the life skills areas, and the facilitators went over these with the students to help them identify areas they needed to work on.

After that, the students set goals and worked on maintaining them, which provided the focus for sessions three through seven. The group leaders helped the students visualize setting and achieving goals. “Talk to the students about what their goal might look like and what the concrete steps are,” Ohrt advises. “As a group leader, you need to be able to visualize what would help them succeed [and] what is going on that is causing them not to succeed.”

Ohrt likes to use solution-focused counseling during this process, prompting group members with questions such as, “Did you have a time when you were doing well in school? What was going well? What changed?” He adds, however, that implementing solution-focused counseling isn’t a requirement for leading such a group. Counselors can use their preferred theoretical orientation to help group members visualize their goals.

Generally, Ohrt says, each group member chooses just one goal on which to focus because making small, specific adjustments over time tends to be the most sustainable path to success. Typical goals include:

  • I’m going to complete my homework on time more often
  • I’m going to spend X number of hours preparing for my math tests
  • I’m going to focus on paying more attention in class
  • I’m going to work on controlling my anger

The students paired off at the beginning of each session and talked about the progress they had made with their goals. Then the entire group convened again, with each student again sharing his or her progress. If certain group members were having difficulties with their particular goals, the other students often shared what had worked — or what hadn’t worked — for them. If no one offered a possible solution, Ohrt or the other facilitators spurred discussion by asking questions such as “Has anyone struggled with that?” or “Have any of you heard something else that another student did that you might want to try?”

Session eight, the final session, served as a general wrapup of the group, with students talking about what they had learned and how they had progressed.

Ohrt and his team tested for three elements both before and after the groups: self-regulation, perceived academic efficacy and self-esteem. The results showed that although the students’ self-esteem had not improved, they had made strides in both their self-efficacy and self-regulation. When the team repeated the testing two months after the groups concluded, however, it found that the students had gone backward a bit on their improvements. Ohrt thinks that holding brief booster sessions every few months after a group ends might help to maintain the students’ gains.

Ohrt is now working as an assistant professor of educational studies at the University of South Carolina, where he is supervising graduate students leading similar groups in several area schools.

 

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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

Dispatches from Nepal: Sharing stories, normalizing fears

By Bethany Bray May 21, 2015

In the aftermath of the recent earthquakes that have devastated Nepal, Jeffrey Kottler has found that some of the most effective counseling tools available are empathy and a listening ear.

Kottler, a professor of counseling at California State University Fullerton, is in Nepal to join the earthquake relief efforts of Empower Nepali Girls (ENG), the nonprofit he founded 15 years ago.

Empathy comes easily, Kottler says, because he’s just as afraid and stressed by the constant

Jeffery Kottler pictured at an ENG medical camp.

Jeffery Kottler pictured at an ENG medical camp.

aftershocks that shake the South Asian country as its native residents are. A 7.8-magnitude quake left much of Nepal in ruins on April 25; the destruction was made worse by a 7.3-magnitude quake on May 12.

Kottler has set up a “counseling corner” in the medical tents organized by ENG. People have been standing in line for hours to be treated, he says.

 

Counseling Today is posting a series of online articles about the conditions in Nepal as Kottler sends in his travel journals from the field. More photos and information is in our first article here.

 

Jeffrey Kottler’s travel journal: May 14

Kathmandu area

I used to think seeing 10 clients a day was a busy day, but we treated 158 medical and 41 counseling cases at the medical/trauma clinic we set up in two school classrooms. This was the first of five that we plan for the hardest hit areas. People from all around the area lined up patiently outside our “offices.” While Matt, our medic, Monet, our triage specialist, and two of our ENG scholarship girls who are now nurses worked furiously in room to treat broken bones, abrasions, infections, wounds and all kinds of trauma-related symptoms, I worked with various families, children, adults and couples. At one point, there were so many people lined up at the door toward the end of the day I just invited them all in for a group session.

With 17-year-old Chhusang Sherpa acting as my interpreter and assistant, I talked to people about their nightmares, insomnia, hypervigilance and struggles losing their homes. The few in the region who were willing to talk about their fears felt isolated and alone, as if they were the ones who were weak. One woman told me her husband and children accused her of being “cowardly” because she startled so easily and refused to enter their house, preferring to sleep outside.

I saw two 70-year-old friends together presenting various chronic medical complaints for which our medic and nurses had no treatments. They were both extremely hard of hearing, so I kept yelling (through Chhusang) that their symptoms became worse because of the stress they were under.

I saw a family concerned about their 5-year-old son who had been trapped in a building during the first earthquake and was now mute.

I saw two young mothers, with their children, who wanted to talk about their fears because they said nobody else would listen. They reported that most of their neighbors and family were acting as if things were normal, making it difficult to tell their stories.

I saw a political leader who, because of his position, was not able to admit to anyone that he was terrified all the time. He couldn’t sleep. He could barely function. I told him that because he was a leader, it was his responsibility to help others talk about their fears and concerns.

I saw an older woman who couldn’t get in to see our doctor, so instead she came into my office to hold my hands and look into my eyes. We sat like that for several minutes until she smiled, thanked me and walked out. I turned to Chhusang to ask her what that was about, and she just shrugged.

I saw a 96-year-old man who was in remarkably good health but felt he was going to die soon. It seemed important to him that he tell me about his life. He must have enjoyed our time because he returned later in the afternoon for another session.

Then there were cases when I was so far out of my usual standards of care that I could only shake my head. One man complained of vertigo, which made perfect sense to me, because I have also been dizzy since the earthquake, feeling as if the ground is constantly moving (which it is!). I reassured him the symptoms would go away, but he insisted on some medication to make him feel better. So I “prescribed” some little orange pills, one in the morning before breakfast and one in the evening before dinner, and he’d feel better. They were aspirin.

I saw a 6-year-old boy and his family because of their concern that he wasn’t “normal” since the earthquake. I tried to engage the fellow, but he just kept hugging his mother. Once I offered him a chocolate mint energy bar as a bribe, he started talking about his fears to me and his family, reassuring them that his reactions were absolutely and perfectly normal, given the circumstances.

I saw a mother who broke her arm saving her child from a collapsed building during yesterday’s earthquake (a 7.3-magnitude quake May 12), and she had refused to go to the hospital to get it X-rayed and fixed. Matt (the medic) sent her to me to persuade her to go or she might lose the function of her arm. I tried to be gentle, but during the translation, Chhusang scolded her and told her she owed it to her child to take care of herself.

I looked at Chhusang with awe and admiration. In the time we’d spent together, this high school girl was becoming quite the counselor herself.

I tried all kinds of things during the sessions: normalizing their fears, explaining about trauma and its symptoms, inviting them to share their stories, teaching deep breathing and relaxation strategies, introducing a little self-talk, encouraging them to talk to others and literally holding them.

But I found what often worked best, especially with the children, was sharing with them that I felt much the same way they did: out of control, scared and overreacting to any sound or movement. We mostly laughed about that together.

 

 

 

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For more information on Empower Nepali Girls, see empowernepaligirls.org

See recent photos and updates from Nepal at ENG’s facebook page

 

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

 

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

The misrepresentation of black girls with brown skin

By Mashone Parker May 19, 2015

I grew up in a low-income housing project on the South Side of Chicago. I faced many challenges as a young girl in this homogenous and sometimes destructive community. Of the many things I experienced while growing up poor, I’d like to raise some awareness of how black girls continue to suffer within culture because of a low acceptance of their dark skin tone. This article focuses on “dark-skinned” African American girls.

Black girls have had a difficult time in our society for quite some time. Dating back to the days of Parker1slavery, black women were stripped away from their families and taken away from their homes. This is history that may never be undone, and the lingering damage is compelling.

During these times, slave owners created the “paper bag” theory, which separated the black race further. Blacks who were lighter than the brown paper bag were able to work in the house and received “better” treatment than the other slaves. House slaves were seen as “better than.” I believe this initial separation of our race led to the detrimental impact that skin tone has on black girls with dark skin even today. Some black girls still describe their dark skin as being “less attractive” and even “ugly” in comparison with African American girls who have fairer, lighter skin.

The brown paper bag phenomenon created a hierarchy within the African American race. It led to many blacks being treated unjustly and unfairly not only by whites but also by people of their own race. Slavery was abolished in the United States in 1865. But 150 years post-slavery, young black women continue to carry the weight of feeling unloved and not beautiful simply because of the variance in their brown skin.

 

‘You’re cute to be dark’

I remember the first time I heard someone say this to me. I was 15. A light-skinned young man told me and one of my close friends who also has brown skin that we were “lucky” because we were “cute to be dark.”

My mouth dropped open when I heard those words. I guess I had never really thought about the fact that I was a dark-skinned girl. Was it because I did not have the darkest skin? My skin is a solid brown, and there are many tones darker than my own. Perhaps I was just color blind. Or, most likely, maybe it was because I had never looked at my dark skin as being something that was “less than” or not attractive.

When I was a little girl, I always felt pretty. My parents and other people always told me how beautiful I was — and they left out the whole “to be dark” thing. But I believe that I became more socially aware of my dark skin after this experience.

I began to wonder if other people saw me that way — “lucky” to be cute despite having dark skin. I wondered if my dark-skinned friends felt that they weren’t cute, or felt lucky if they were. I became very aware of my dark skin, but I never doubted that it was beautiful.

Maybe I was privileged. I lived in a home where there was a range of skin complexions, from light to very dark. My mom has a light complexion, while my dad has a solid dark mahogany complexion. People often referred to him as “black” or “dark.” My sister and I scored somewhere in the middle of the two, so I suppose my mother was the oddball in our house.

 

‘Aha’ moment

After that day with my friends, something else happened to me. I started to pay attention to other people’s thought processes and actions in relation to skin complexion. I started to notice that people to whom I was really close had those same feelings. I felt cheated that, all of this time, I had been left in the dark on this thing that apparently I was a part of and did not realize.

My dark-skinned friends make references such as “she’s only pretty because she’s light-skinned” or even favor their children with lighter skin. Other dark-skinned friends say that they will only date light-skinned men. Finally, my friends, who are both light-skinned and dark-skinned, say, “She’s cute to be dark.”

Because of the preferential treatment that African Americans with light skin received from both blacks and whites, it conveyed the message that the more blacks conformed to white attributes, the better their lives would be. How can we expect our children to go out in the world and be confident of their worth when we secretly or, in some cases, not so secretly hold such a negative view of black beauty? From straightening our hair and bleaching our skin to wearing hair weaves and colored contact lenses, many of us are guilty of rejecting our natural black selves in an attempt to conform to mainstream society. My fear is that this has a very harmful impact on the mental health of young black girls.

 

Misrepresentation: Stereotypes

The media plays a critical role in representing society’s view of beauty. As a young girl, I do not remember many famous black women who were on television AND represented in a respectful way. And to go one step further, a black woman on television with dark skin was rare (if she even existed).

I loved playing with my dolls, but I did notice one thing: My dolls did not look like me. My Barbie was white, as were most of my baby dolls. At the time, I did not understand that this could have an effect on me someday. Kenneth and Mamie Clark’s 1947 study found that black children preferred white dolls over black dolls. This study conveyed the message that blacks had a poor acceptance of the black dolls.

When I watch movies, television and music videos, I see black women represented in an undesirable way. I see dark girls represented in an even worse way. I notice that the dark-toned girl is the prostitute, the mistress, the whore, the hypersexual friend, and she’s single. The light-skinned girl is the wife, the main girlfriend, the most wanted and desirable by men. This sends very mixed messages to young black girls.

Black girls struggle within their own communities, their own schools and even their own homes. I once sat with my younger brother and his friends, all of who were between the ages of 10-14. I asked these boys their views on beauty and skin complexion. The darkest boys in the crowd stated that a pretty girl has light skin and long hair. The boys with lighter skin said that her complexion didn’t matter. Does that experience represent how boys and girls in our society as a whole view dark skin?

What I believe is interesting is that the experiences that occur within black culture are a complete replica of white privilege. Some light-skinned African Americans are very aware of their privilege but feel guilty about it because it was not something that they chose. Others use their privilege to their advantage. I have met very bold individuals who will say that, yes, they are more attractive because their skin is light.

FLOTUS4

First Lady Michelle Obama

I realize now that, as an adult with dark brown skin, mainstream society still questions my beauty. I realize there are many girls who suffer and feel unattractive, especially in comparison with someone who has lighter skin. I realize the variation of skin tone for these young girls does not matter — lighter is better. I realize that some young girl watches television every day waiting to see a beautiful and famous girl with dark skin like herself. I realize that it is women such as Michelle Obama, Tika Sumpter, Gabrielle Union and Kelly Rowland, to name a few, who give dark girls hope of being viewed as beautiful. I realize that although I did not struggle with my dark skin, many girls do. I realize that this is something that needs to be addressed, especially in our own black communities.

 

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Mashone Parker is an assistant professor at Purdue University-Calumet. She teaches in the counseling and development program within the College of Education. Contact her at mashone.parker@purduecal.edu.

 

 

Dispatches from Nepal: Aftershocks heighten trauma, grief

By Bethany Bray May 14, 2015

The people of Nepal are focusing on basic needs right now – finding shelter, food and water; staying safe; and caring for family. Anything else, including processing the trauma that comes from

One of the girls in the Empower Nepali Girls program, standing with her family in front of what used to be her home. They are now living in a tent.

One of the girls in the Empower Nepali Girls program, standing with her family in front of what used to be their home. They are now living in a tent.

experiencing a 7.8-magnitude earthquake, will come later, says Jeffrey Kottler.

Kottler, an American Counseling Association member and professor of counseling at California State University Fullerton, traveled to Nepal this week to join in the work of Empower Nepali Girls, the nonprofit organization he founded 15 years ago.

“We [have] provided tents for people living outside, treated 20 patients for a variety of medical problems and tried to soothe the children, many of whom are a wreck,” he wrote in his travel journal May 12. “I feel so helpless, trying to hold them, reassure them and ease their fears, when what they really need is a safe place to live and a place to go to school.”

Empower Nepali Girls develops mentoring and supportive relationships with children at greatest risk of being forced into early marriage or sex slavery. Since the April 25 earthquake that devastated Nepal, however, ENG staff and volunteers have been helping with sanitation efforts, distributing supplies such as tents, food and water, and providing medical care to the injured.

Jeffrey Kottler, top center, plays a game to soothe and distract children in the Empower Nepali Girls program.

Jeffrey Kottler (top center) with children in one of the tents Empower Nepali Girls has set up since the earthquake. The children were drawing pictures and talking about where they were and what they were doing when the first earthquake hit, he says.

One of the ways Kottler’s team has tried to soothe the children in their program – and distract them from the ongoing aftershocks – is by encouraging them to draw and then hanging their artwork on the tent walls. The ENG team is also using and distributing an ACA fact sheet on trauma, Kottler says.

The initial 7.8-magnitude quake left much of Nepal in ruins, without electricity, safe drinking water, food and other basic supplies. On the day of the earthquake, an Empower Nepali Girls team member, Sara, was in the middle of her quest to climb Mount Everest to plant an Empower Nepali Girls flag on top of the world’s highest peak. She was trapped by an avalanche and stranded for three days, but she was eventually rescued, Kottler reports.

Aftershocks have rattled Kathmandu and the surrounding area since April 25, including another 7.3-magnitude earthquake this week. More than 8,000 people have died, while countless more have been injured.

Kottler experienced the 7.3-magnitude quake shortly after he arrived in Nepal.

“We were playing games with the children — ‘duck, duck, goose’ — when a huge earthquake hit, knocking many people to the ground, collapsing buildings and terrorizing the children who are already so fragile from the constant turmoil beneath the earth,” Kottler writes. “… The aftershocks continue to literally rock our world. I don’t feel haunted as much by the terrible shaking as I do by the sounds of the children crying and screaming and the glazed looks in their eyes. I couldn’t sleep last night very well because the aftershocks kept rocking the bed. I slept with my clothes on and flashlight nearby in case I had to bolt quickly.”

Many Nepalese have been sleeping outside out of fear of more aftershocks.

“Although it is early for major trauma symptoms to take hold, many of the children are having nightmares and many people refuse to go into their homes at all,” Kottler says. “I kept trying to reassure them that we would do all we could to help them rebuild their lives — and their homes and schools. It feels to them as if so many of their dreams are now gone.”

ENG families huddle in a tent to wait out an aftershock.

ENG families huddle together in a tent during an aftershock.

During his two-week trip to Nepal, Kottler will travel with an Empower Nepali Girls team to Namche, near Mount Everest, where the epicenter of this week’s earthquake was. Landslides and avalanches have washed away entire villages, he says.

“We are setting up medical camps in various regions to provide basic health care, distribute antibiotics to those with respiratory infections and distribute medical supplies to clinics in the areas. We’ve prepared simple treatment manuals for responding to the most acute trauma symptoms and the more severe cases that will start appearing in a few months when we return with another team,” Kottler writes in his travel journal.

“… Our team consists of a special forces medic, a hospital administrator and a friend acting as a ‘mule’ to help get all our medical supplies through customs at the airport. I saw so many supplies piled up at the airport, so little getting to the people who need them. We have to operate very quietly, under the radar, because the government has been making it very difficult for relief agencies to function. Riots have broken out with people trying to escape the capital or they are protesting the government inaction. Politicians are afraid to show their faces for fear they will be killed by everyone who is so furious at the chaos and incompetence of the government.”

This map, courtesy of Empower Nepali Girls, shows the areas where the nonprofit operates.

This map, courtesy of Empower Nepali Girls, shows the areas where the nonprofit operates. (Click to enlarge)

Empower Nepali Girls operates in 15 different locales throughout Nepal, including remote regions where children are the most at risk.

Kottler has traveled to Nepal more than 20 times since founding Empower Nepali Girls and working as the organization’s CEO. Numerous counselors and counseling students have traveled with Kottler to Nepal during the past decade, helping organization provide mentoring and mental health training, conduct home visits and teach in local schools.

Kottler spoke briefly about his work in Nepal when he co-presented a keynote address in March at the 2015 ACA Conference & Expo in Orlando.

 

Jeffery Kottler pictured at an ENG medical camp this week.

Jeffery Kottler pictured at an ENG medical camp on May 13.

 

 

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CT Online will post more articles in the coming weeks as Kottler continues to send in his travel journals from the field.

 

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For more information on Empower Nepali Girls, see empowernepaligirls.org

See recent photos and updates from Nepal at ENG’s facebook page

 

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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