Monthly Archives: June 2015

From NFL linebacker to licensed professional counselor

By Bethany Bray June 22, 2015

Playing football in the National Football League (NFL) is not a career, it’s an experience, said Dwight Hollier, a former NFL linebacker who became a licensed professional counselor (LPC) after his playing days were over.

This lesson – one that took Hollier years to learn – is part of the message that he is working to spread throughout the NFL as part of the league’s new total wellness initiative.

The average player spends three and a half years in the NFL, according to Hollier. For players who

Dwight Hollier, a licensed professional counselor and the NFL's director of transition and clinical services, speaks at Mental Health America's annual conference this month in Alexandria, Virginia. Photo by B. Bray/Counseling Today

Dwight Hollier, a licensed professional counselor and the NFL’s director of transition and clinical services, speaks at Mental Health America’s annual conference this month in Alexandria, Virginia. (Photo by B. Bray/Counseling Today)

are drafted out of college, that average jumps to six years. Either way, it’s not a long time, said Hollier, who returned to the NFL in 2012 as director of transition and clinical services.

Hollier, speaking earlier this month at Mental Health America’s annual conference in Alexandria, Virginia, said he became depressed after retiring from playing in 2000. For a couple of years, he even stopped watching the sport he had loved since childhood.

“I didn’t know who I was without what I did,” said Hollier, who played eight years with the Miami Dolphins and one year with the Indianapolis Colts after starring in college at the University of North Carolina. “I would go cut the grass on Sundays [when NFL games were televised]. We had a very nice lawn at that time,” he said with a chuckle.

Today, Hollier is part of the NFL’s effort to support current and former players and their families off the field with everything from mental health issues and family relationships to adjusting to life after leaving the league.

“If you’ve been the best in the world at whatever you do, and then someone says you can’t do it anymore [because of injury, age or other reasons], that will affect you,” said Hollier, who previously worked as a licensed counselor in private practice before going to work for the NFL.

The NFL’s total wellness initiative includes everything from an employee assistance program that offers a series of free counseling sessions for current and former players and their families to financial literacy classes for young players who suddenly find themselves with money to spare. In 2012, the NFL established a 24/7 crisis line tailored to the needs of current and former players and their families.

Last year, Hollier was part of league-wide trainings on domestic violence, sexual assault and child abuse.

“‘No, we don’t talk about that’ – that’s they way a lot of us were raised,” said Hollier. “This [total wellness program] gives us a platform to have important discussions. … These guys are more likely to listen to someone who has worn the boots [played football professionally].”

Part of the challenge is changing the “play through the pain” mentality that can permeate football, from professional players all the way down through the youth leagues. As a child, Hollier says he remembers being told to “suck it up” to keep others from seeing weakness or pain.

“If you hear that all the time, it becomes your modus operandi,” he said. “You internalize it, and it makes it more difficult to reach out for help.”

Dwight Hollier (Photo courtesy of the National Football League)

Dwight Hollier (Photo courtesy of the National Football League)

Hollier is a graduate of the University of North Carolina at Chapel Hill with a dual degree in psychology and speech communication. He earned a master’s degree in mental health counseling from Nova Southeastern University in Davie, Florida, while playing linebacker for the Miami Dolphins. Prior to joining the NFL, Hollier worked with athletes and other individuals at Mind Over Body at Southeast Psych, a private practice in Charlotte, North Carolina.

 

 

 

 

 

Q+A with the NFL’s Dwight Hollier

 

Counseling Today: What made you decide to become a counselor?

Dwight Hollier: I think I was always a good listener growing up. I also know that my parents were giving people. We didn’t have a lot growing up, but we always had room for others. I have three siblings, but there were times where we had three or four other family members living with us. That spirit of giving and helping has stuck with me even to this day. I have to give my parents a lot of credit for the counseling spirit.

 

CT: You worked on your master’s degree in counseling while you played for the Miami Dolphins. Talk about how you decided on your post-playing vocation while still playing in the NFL.

DH: My undergraduate degree was speech communications and psychology. Psychology connected with me in a way speech communications did not, but I didn’t initially make the connection. When I was in my sixth year in the league, my teammates started calling me the “old dude” in the locker room, which really made me think that I probably needed to figure out what I was going to do next. I was only 27 or 28, but I had already beaten the odds, and I knew I should start exploring my life after football.

Fortunately, the Miami Dolphins training camp is located next to the Nova Southeastern University campus, and they had a fantastic counseling psychology program. I initially took a couple of classes to see if I could handle the workload. My coach at the time, Jimmy Johnson, and the rest of the coaching staff were really supportive, which allowed me to confidently pursue this degree. The program spoke to me right away, and I poured myself into being successful in both and was able to graduate in April of 2000, before playing my last season with the Indianapolis Colts.

 

CT: Could you talk about the counseling work you did before working for the NFL? Do you have a specialty?

DH: My initial practicum work was at a family violence center, where I worked with perpetrators and victims of abuse. The majority of my experience has been working with older adolescents and young adults around a variety of mental health issues. In my last couple of years of private practice, I did a lot of work with athletes around transition and adjustment challenges. I have worked as a foster care program manager, group home adviser, school social worker and football coach. All of these experiences helped shape the person I am today.

 

CT: Can you elaborate on what you do as director of transition and clinical services with the NFL?

DH: In my current role, I work with a great team of individuals in the Player Engagement Department to develop and implement psychoeducational programs for our NFL family to assist with success on and beyond the field. I also collaborate with our clinical partners to make sure we have the right wellness resources in place to assist players and their families.

 

CT: What made you want to get involved in this way?

DH: Some would say that I did a lot of things right in preparing for my transition, and I would agree. But I also know how difficult my transition was, even though I [had] put a lot of pieces in place. I know that there are a lot of men and families who have had a much shorter NFL experience and some who haven’t finished their undergraduate degree. This role is an opportunity to serve those men and their families and assist in smoothing out their transition in and out of the NFL.

 

CT: How do you use your counselor training and skills in this role?

DH: One of the main tools any counseling professional needs is unconditional positive regard and listening skills. Part of my role is listening and working to identify the needs of our population and working collaboratively to find the right resources.

 

CT: Why do you think your position is needed in the NFL?

DH: I believe all industries could use a sharper focus on wellness and the potential clinical needs of their workforce. I am blessed to have this opportunity.

 

CT: As an NFL insider, what would you want counselors who work with clients for whom professional football plays a prominent part or influence in their lives — devotion to a team, spending many hours watching games, etc. — to know?

DH: I think it is important to leave their assumptions and biases at the door. Cultural competency will play a big role as well. Because of the high profile of the NFL, our men and their families are easily stereotyped. The reality is that our men and families come from a variety of backgrounds and experiences, and each should be treated as such. One bad experience with a counselor who doesn’t understand the culture could mean that this person never returns for the assistance he needs and potentially discourages others.

 

CT: Do you think there is more focus today on the mental health and wellness needs of professional athletes than when you were a player?

DH: In general, mental health awareness is much more prevalent than it was in the 1990s and early 2000s when I played. We have been much more intentional with addressing the stigma around mental health with our population. I also think that this generation is more aware and accepting of mental health issues and resources.

 

CT: What advice would you give to counselors who want to get involved with high-level athletes? Where or how could counselors be a help?

DH: I think it is important to learn as much as you can about athletes and the needs of athletes. There are great sports counseling and sports psychology programs out there that can help add a level of expertise to working with this population.

 

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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

 

Coming to terms with technology

By Laurie Meyers

In the early 19th century, during the Industrial Revolution, workers in the textile industry began protesting what they considered unfair labor practices. Many of them drove home their demands by destroying the factories’ machinery. It disrupted operations and hit management where it hurt — the pocketbook. These protesters weren’t anti-machinery; they just wanted to ensure that factories weren’t using the technology as an excuse to underpay workers while cheaply and quickly producing inferior goods. Regardless, the moniker the protesters acquired — Luddites — today stands as a synonym for the technophobic.

Few people could be called genuine Luddites these days. It’s almost impossible to avoid the march of technology in the modern age. Do you use the ATM or pay by credit card at the grocery store? You’re using a computer — often one with a touch screen, no less. Your car has a computer, which may or may not require that you learn how to navigate multiple menus just to listen to the radio. You can summon an instant map to your destination, go online to find an unadvertised coupon while at CT_Branding-Box-Techthe store, pay for your purchase without opening your wallet — all with your smartphone. There’s seemingly an app for everything, including your social life.

Texting instead of talking, catching up with friends via Facebook instead of a phone call, sharing your photos with the world — a lot has changed. Resistance to ever-expanding and ever-evolving technology options is, most likely, futile.

For some people, adapting to this vast array of new technology feels like sailing into uncharted waters, as though it were an unprecedented challenge. In reality, that’s not the case, notes Craig Windham, a member of the American Counseling Association who works with adolescents in private practice. “Every new wave of technology — telephones, radio, television, the Internet — has been met by initial apprehension,” he points out.

Part of that apprehension likely derives from a lack of knowledge. “I think everyone recognizes that technology is important, but they don’t necessarily understand it,” says Everett Painter, social media chair of ACA’s newly formed Counseling and Technology Interest Network (CTIN). “The speed with which it [technological advancement] develops sometimes outpaces our understanding.”

Is this cornucopia of technology good? Does it truly help us, or is it actually making life more difficult? Counseling Today asked several counselors to share their perspectives on the impact of technology, informed in part by what they’re seeing and hearing in connection with their clients. These questions seem particularly relevant now that many clients are experiencing so much of their lives online.

To begin with, the counselors with whom we spoke said that “good versus bad” is a false dichotomy when it comes to judging technology’s impact. “Technology doesn’t have any inherent goodness or badness,” exclaims Marlene Maheu, president of CTIN. “It’s just a tool … an instrument with which we can do harm or good.”

Finding love online

“The course of true love never did run smooth,” wrote William Shakespeare in A Midsummer Night’s Dream. In the age of social media, the rocky path to love may largely be charted online. This is particularly true for those in their teens or 20s, who not only vet potential partners on social media platforms but also gauge relationship status and develop further intimacy through site activity, says Renee Sherrell, an assistant professor of counseling and applied behavioral studies at the University of St. Joseph in West Hartford, Connecticut. Sherrell has conducted several studies on the interplay between Facebook and college students’ romantic relationships.

For these students who grew up with social media, initiating romance online is a natural process, Sherrell says. One benefit they cite is that it makes the initial “getting to know you stage” less awkward, and they also think it is a better way to determine compatibility.

“Young people can use social media as a way to get to know the person superficially and then decide if they’d like to invest more in the relationship,” Sherrell notes. The students she talked to during her research consistently said that they preferred becoming Facebook friends with someone they were potentially interested in before even giving that person their phone number. That way, they could look at their prospective date’s profile to see whether their likes and dislikes aligned.

Commenting on postings and using Facebook messenger to talk, students increasingly rely on Facebook to communicate with potential partners, Sherrell says. “They like that online talking allows them the opportunity to perfect what they want to say,” she explains. Also, with a comment or text, they can choose to take as long as they want to reply rather than having to respond right away as they would on the phone or in person, Sherrell adds.

Once the students feel comfortable with each other, the interaction typically moves offline, and a relationship may develop. However, as the students in Sherrell’s study informed her, today’s romantic relationships are not “official” until a person’s status on Facebook reads “in a relationship.”

“Students explained that even though they could verbally tell their friends and family about a new partner, putting this news online for ‘everyone’ to see made the relationship more real to both partners,” she elaborates. “Furthermore, for some students, this relationship broadcasting also allows both partners’ friends to see that this is an exclusive relationship.”

Of course, there are also potential downsides to these virtual public displays of affection. By their nature, Facebook and other social media invite and encourage others to comment and offer their opinions, which may or may not be helpful, and, in some cases, can be actively negative, Sherrell says. This can have the effect of jaundicing not just the romance but also other friendships and relationships.

Another significant drawback to having a love life that plays out online is that it can be harder to detach when the relationship is over, Sherrell notes. “Many times young people decide not to unfriend or stop following an ex-partner in order to be able to still ‘see’ them [and] keep up with their life after their relationship,” she explains. “This can lead to increased heartache and sadness, which can lead to impairment in daily functioning. Some college students have reported skipping classes, calling off work and staying home from social gatherings.”

However, on balance, Sherrell believes that today’s connection between dating and social media is a positive. “I think that social media makes relationships easier for young people because it is their normal,” she says. “Although they report that at times it makes it confusing and complicated, in general, they enjoy it and feel happy to have another means of communication and connection.”

Sherrell notes that in the ever-changing landscape of social media, Facebook is already becoming passé for young people, including current college students. It is being replaced by platforms such as Snapchat (an application in which messages are more transient because texts self-destruct several seconds after being opened) and Instagram, a photo-sharing site. However, Sherrell thinks that students’ behavior on Facebook also applies to other prevalent social media platforms.

Wrestling with the ‘perfect’ image

Turning the camera on ourselves to snap a self-portrait is not a new phenomenon, but in the Internet age, the selfie has become ubiquitous. Selfies tell our stories: where we travel, what we celebrate, whom we love, what we feel and so on. Unfortunately, they can also drive an obsession with personal appearance.

The pursuit of others’ approval has expanded from websites such as Am I Hot or Not? to encompass entire social media platforms, such as the hugely popular site Instagram, which is somewhat like Facebook for photos. Users post pictures of all kinds to Instagram, from stark and barren winter landscapes to spectacular sunsets to the recent and widely shared images of rainbows over Ireland in the wake of the popular vote there that legalized gay marriage.

But the selfie is the lifeblood of Instagram. People who post pictures can use filters and tools to change a photo’s appearance, making it black and white, gauzy, sepia toned or adding other effects. They can also use programs such as Photoshop to significantly alter images, including thinning certain body parts, getting rid of a double chin or adjusting skin complexion. Once these images are posted, anyone can “like” or make comments about the photos. Users can also “follow” other users, be they friends, strangers or even celebrities.

Following can be fun, but for some people, it can also become obsessive and, in some cases, toxic. Michelle Bruno, a counseling professor at Indiana University of Pennsylvania, believes this widespread cultivation of the “perfect” image is exacerbating the struggle that many teenage girls already have with negative self-image.

“As adolescents, they are already engaging in social comparisons and fighting unrealistic media images at every turn,” notes Bruno, who studies trauma and resiliency in adolescent girls. Now they are also faced with the seemingly perfect images being portrayed on their friends’ social media accounts and on other websites. “[Adolescent girls] strive to maintain an online image and presence, to either take the ‘perfect’ picture or at least edit it in a way that makes it look perfect,” Bruno says.

According to Bruno, girls may obsess over several types of questions with their selfies. Among them: Is the lighting right? How about the pose? Are my friends editing their photos a lot, or do they just naturally look better than me?

Bruno asserts that women and girls are already socialized to value themselves on the basis of their appearance, and selfies create virtually endless opportunities to self-critique. And once their images become public via social media and the Internet, the likelihood that these girls will be demeaned, belittled or sexualized greatly increases, Bruno says.

“Additionally, girls can learn to garner their value from this external reinforcement,” she says. “They do not learn how to value themselves. They base their value on the reactions, ‘likes,’ responses and ideals of others.” Experiencing this at a time when self-esteem and cognitive development are still forming is particularly worrisome, Bruno says.

However, if social media and the Internet are often judged to be bad influences on the self-worth of female adolescents, so too can they help to counter the negative messages that girls are receiving, Bruno emphasizes. The widespread connectivity that the Internet allows can enable girls to find groups and individuals who want to emphasize positive messages about self-esteem and self-worth.

“There are currently many websites and Facebook pages full of many voices that advocate for body-positive, self-affirming and gender-equalizing stances,” says Bruno, citing examples such as A Mighty Girl, Girls Inc., Amy Poehler’s Smart Girls and To Write Love on Her Arms.

Just as the Internet can widely disseminate unrealistic (perfect) photos of celebrities, it can also be used to spread the message of celebrities who speak out about gender equality, diversity, positive body images and self-acceptance. In our celebrity-obsessed culture, these messages can have a profound effect on girls, Bruno emphasizes.

If people can change the critical things they tell themselves and focus on finding things they like about how they look, Bruno says, selfies can be used as a tool to allow girls and women to see and define their own unique beauty. “We must create platforms to discuss and combat the messaging and the factors that contribute to the way we see ourselves,” she urges.

From the playground to the computer: Cyberbullying 

The relative anonymity of the Internet is in many ways a good thing. People can seek information on topics that they’re too embarrassed to talk about, and those with social anxiety may find it easier to interact with others when they can remain unseen and unnamed. However, anonymity has also allowed one particularly toxic behavior to bloom: cyberbullying.

Anyone can become a victim of cyberbullying, whether it involves abusive comments being posted on a personal blog, malicious rumors being spread through postings on Facebook or even doxxing, which is the public release of personal information that has previously been kept private, such as a person’s real name or alias, home address, phone number, place of work or Social Security number.

However, children and teenagers are particularly at risk for cyberbullying, says ACA member Janet Froeschle Hicks, an associate professor of counselor education at Texas Tech University in Lubbock. “I think the anonymity of the Internet has opened an environment where kids who might not otherwise have bullied someone feel safe to do so,” she says. “Covert bullying has always been around, but the Internet offers a place to express this bullying behavior without a need for face-to-face interaction. This depersonalization and anonymity lead to the perception that there will be no consequences for hurtful actions.”

Whether cyberbullying represents an actual increase in bullying behavior is unclear, Hicks notes. However, she believes that the effects of cyberbullying can be even more devastating than traditional bullying because of cyberbullying’s 24/7 nature.

With traditional “offline” bullying, the abuse typically takes place on school grounds, and leaving school at the end of the day provides the victim with some type of respite, Hicks explains. In other words, going home might provide at least temporary sanctuary. When bullying takes place online, however, whatever is posted or said is there around the clock and always accessible for everyone to see.

“Years ago, when a kid was bullied, [he or she] might be taunted for a few weeks and eventually be able to forget about it because it became old news,” Hicks says. “Today, this same bullying incident is posted online, and the victim is forced to relive the incident every day for years.”

There are many ways to humiliate someone online, she notes. Examples include:

  • Creating websites that contain stories, cartoons, pictures, rumors and jokes about a person or group of people
  • Posting pictures of classmates online and asking students to rate them, with questions such as “Who is the biggest (derogatory term)?”
  • Hacking into someone’s email or social media account and sending vicious or embarrassing material to others
  • Engaging someone in an instant messaging conversation, tricking them into revealing sensitive personal information and then forwarding that information to others
  • Taking a picture of someone in the locker room and sending that picture to others
  • Posting malicious and cruel gossip about someone on social media or other public forums

The Internet also provides bullies with a much larger audience in front of whom they can demean others, Hicks notes. As a result, moving across town, to a new city or even to a new state doesn’t automatically stop the humiliation to which the victim is subjected. She believes that this might create more devastating and longer lasting emotional damage than offline bullying does.

Many parents think that the key to avoiding cyberbullying is to have their children stop going online, but that tactic is unrealistic, according to Hicks. Although it may be a good idea for adolescents to temporarily stay away from sites where they are being bullied, cutting the online cord entirely is facebookimpractical for this generation of children, she says. The Internet has become a “hangout” for today’s children and teenagers; it is where they socialize and interact with friends. And from a purely practical standpoint, many of today’s youth also require access to the Internet to complete homework, she notes. Rather than ban all online activity, Hicks advises parents to become familiar with social media sites and online safety strategies so they can help guide their children and provide them with emotional support when instances of cyberbullying do occur.

Despite the prevalence of cyberbullying, Hicks thinks that social media and the Internet offer many more positive effects than negative ones. For example, she says, social media platforms can be used to build supportive networks, and the global reach of the Internet brings opportunities to chat with people from all over the world.

“Never in history have we had the opportunities we now have to learn about culture,” she says, adding that learning about and building relationships with diverse groups of people can also help foster greater acceptance of others.

A way to stay connected 

It’s easy for people who grew up in the age before personal computers and smartphones to focus on the negative aspects of life online, notes Windham, a licensed clinical professional counselor in Washington, D.C., who is also a reporter and newscaster for NPR. But for younger people, it’s just one more way to interact, he notes.

“I think most young people see social media as an extension of their face-to-face friendships, another way to stay connected and communicate with them,” Windham says. “[But] they still much prefer hanging out in person with friends.”

However, today’s teenagers often have less freedom to wander out on their own, Windham points out, so texting and posting from their smartphones and other mobile devices enable them to “hang out” with their friends as previous generations used to do at the mall or other public spaces.

From Windham’s perspective, the online disinhibition that can motivate adolescents to post questionable pictures and intemperate interactions can also have significant positive benefits. For example, online interaction can encourage children and teenagers to move beyond surface pleasantries and into more substantive sharing, he explains.

“Teenagers will often share things about themselves online — say on a Facebook chat or on Tumblr — that they might be reluctant to reveal in person, and by doing so, open themselves up to getting help,” Windham says.

In fact, the teenagers in the church youth group with which Windham works helped prevent a possible suicide thanks to open sharing on social media. “One of these teens noticed on his Facebook newsfeed that a student at his high school had posted a message that indicated he might be suicidal,” Windham recounts. “Even though the teen barely knew this student — only his first name — he went out of his way to track down where he lived and call his parents to warn them.”

Fortunately, another student had already warned the boy’s parents, who confirmed that their son had indeed intended to take his life.

Windham points out that younger people are usually early adopters of any new technology, and he thinks the rest of us can learn something from their attitude about it — namely, not focusing so much on what’s negative or scary, but finding out how it can be useful to you.

“The technology that puts constant connectivity in the palm of our hands has upsides and downsides,” he says. “It’s how we use that technology that matters most, and that is strongly influenced by the personal traits we bring to it.”

 

 

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The Counseling and Technology Interest Network

The Counseling and Technology Interest Network (CTIN) is a newly formed official interest network of the American Counseling Association that was approved by the ACA Governing Council in March. The mission of CTIN is to provide useful support to ACA members who are seeking to responsibly apply technology across the spectrum of counseling research, education, policy and practice. For more information, join the discussion at ACA Connect by going to community.counseling.org/home, choosing the “Communities” menu and then selecting “Interest Groups.” CTIN can also be found on Twitter: @counselingtech.

 

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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

 

 

Nonprofit News: A place for nonprofit counselors

By “Doc Warren” Corson III June 16, 2015

Counseling can be, and often is, a profitable business to be sure. There have been years when I’ve grossed in excess of $150k on my own. Make it a group, clinic or larger program, and profits can go through the ceiling.

Plenty of people write about how to make profitable practices, and that is great. But what about the folks who see counseling not as a money generator but as more of a calling? This new CT Online NonprofitNewscolumn will seek to give these counselors a voice and help them develop a nonprofit, or help them expand one, in the process. It will focus on the many issues found in the nonprofit world of mental health based on your feedback and questions.

You may already know me through the blog I have written for the American Counseling Association since 2011 under the heading “Doc Warren” (counseling.org/news/blog). Or you might know me from ACA Conference panels and presentations, or via the books I have contributed to, including one that focused on designing, building and running a successful practice.

Many may not know that I founded a nonprofit in 2005 through a $7,000 loan, seeking to serve people who were not privileged. At the onset, the charity only worked with folks on state insurance, but after a contract dispute with the company that managed the state program, it broke ties and opened its doors to private insurance holders, while always maintaining a great deal of pro bono and sliding scale services. The nonprofit has never focused on money. Instead, it has focused on service. This focus, in and of itself, helped it go from a nonentity to a sought after program that often overflows with clients, potential interns and eager volunteers who want to help make their world better than they found it. Practices from as far away as Australia have consulted with me in an effort to incorporate some of the nonprofit’s many facets into their own practices.

Starting a nonprofit is daunting. My company started out without such basics as a fax machine. But it has grown — without federal funding — to two thriving locations: the original 1,500-square-foot location and the 50-acre Pillwillop Therapeutic Farm that, though currently being remodeled, will offer almost 8,000 square feet of programming space over three floors.

Some see counseling as a business like any other. You have a service, set a price and provide that service to those who can afford it. Others see counseling not as a business in which to make money but as an opportunity to make a real difference in this world. The focus on making money is shifted to that of making a positive change.

I personally see it as answering a call from above. Years ago, bedridden and in very poor health, I found myself making many prayers. Some were for improved health, and some were for help to find meaning. After starting recovery from my surgery, I found I was receiving messages from everywhere that I should enter the field (more than one boss in my career has called me a preacher, a counselor or a shrink).

One of the final straws was being called into the factory office by a boss who was concerned that I was gaining a real following in the shipping and receiving area where I worked. It seemed to him that “everyone in the factory” was coming to me for guidance. At one point, he made it clear that I had not been hired “to be the company shrink” and informed me that I had another job to do. It dawned on me in that moment that he was right. I remember thanking him, telling him he was right and then telling him that I quit. It wasn’t until I got into my work van that I realized I didn’t have any idea about how to go to college. After all, no one in my family had ever done so.

My sister died at age 35. She was poor and lacked proper access to care. That was when I pledged to do what I could to prevent others from having to go through the same thing. I had no interest in becoming a medical doctor or specializing in what had taken my sister because I knew I was meant to be a doctor of counseling. So at that moment, I dedicated myself to finishing my education and founding a charity that would seek to level the playing field for all those in need.

To me, money is a necessary evil required to pay off mortgages and student loans. Otherwise, I do not care for it. I do, however, love serving others.

Your interest in nonprofits may differ greatly from mine, as might your idea for a preferred setting. Regardless of your desire, this column seeks to help you help others.

Let me know which of the following topics you’d be most interested in having me focus on in future columns.

  • Considerations for designing and opening a nonprofit
  • Credentials: Are you qualified to practice in your state?
  • Identifying the type of nonprofit you want to open
  • Selecting a space
  • Financing
  • Registering your nonprofit
  • Staffing issues
  • Advertising for nonprofits
  • Documentation requirements
  • Capital improvement campaigns
  • Grant writing
  • Personal safety/security in a growing nonprofit
  • Issues related to medication management in nonprofits
  • Billing services or in-house billing department?
  • Getting referrals/basic marketing
  • Website development and maintenance
  • Brochure writing and development
  • Opening a nonprofit on a shoestring budget
  • Supervision and other ethical responsibilities for clinical nonprofits

 

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Dr. Warren Corson III

Dr. Warren Corson III

 

“Doc Warren” Corson III is a counselor, educator, writer and the founder, developer, and clinical and executive director of Community Counseling of Central Connecticut Inc. (docwarren.org) and Pillwillop Therapeutic Farm (pillwillop.org). Contact him at docwarren@docwarren.org, particularly to let him know which topics you’d like future articles to cover.

 

 

 

 

 

 

 

Mental health a priority for new surgeon general

By Bethany Bray June 11, 2015

U.S. Surgeon General Vivek Murthy has pledged to work toward “culture change” to lessen the stigma that often surrounds mental illness.

Speaking at the opening session of Mental Health America’s annual conference last week just outside of Washington, D.C., Murthy said he plans to make mental health a priority during his tenure. Murthy, a physician, researcher and Harvard Medical School instructor, was sworn in for a four-year term as surgeon general in December.

People should be just as comfortable telling their boss they need time off for a therapy appointment to tend to their mental health as they are saying they are going to see the doctor for an injured ankle, Murthy said.

“[Mental health] is an area where we have a lot of progress to make,” Murthy said. “It will take a lot of effort, [but] I am looking forward to making progress together.”

Mental Health America President and CEO Paul Gionfriddo (far left) looks on as U.S. Surgeon General Vivek Murthy takes questions from the audience at the opening session of MHA's annual conference last week.

Mental Health America CEO Paul Gionfriddo (far left) looks on as U.S. Surgeon General Vivek Murthy takes questions from the audience at the opening session of MHA’s annual conference last week.

Mental Health America (MHA) is a nonprofit that provides mental health advocacy, education and support services through a network of more than 200 affiliates in 41 states. Last week, hundreds of health professionals, mental health advocates, researchers, educators, and business and government leaders attended the organization’s annual conference in Alexandria, Virginia.

Murthy’s focus on mental health has a personal connection. As a young man, Murthy happened to answer the phone call that brought his family the unhappy news that his uncle had taken his own life. Murthy later came to learn that his uncle suffered from untreated and undiagnosed depression.

“Piecing together the puzzle came too late for my uncle,” Murthy said. “There is no place for stigma when it comes to mental illness. … We need to make it more acceptable for [those who are mentally ill] to get the help they need.”

When it comes to mental illness, early intervention is key, he said. This can be improved, Murthy said, if medical professionals across the board, from oncologists to cardiologists, are better trained to identify the signs of mental illness and connect patients with appropriate care and support.

“Integration of mental health services and traditional medical care is definitely an area where we need to make progress,” he said. “Health care professionals need to be fully trained in mental health. … We need health care professionals who can recognize mental health needs, even if it’s not their traditional field.”

Murthy has been all over the country in his first six months as “America’s doctor.” He said his travels have shown him that although the nation’s mental health needs are substantial, there are also effective and innovative programs growing around throughout the United States.

Fighting stigma and improving mental health care “is something I believe we can do together. It will require resolve and commitment,” he said. “I’m confident we can create a better America for those with mental illness.”

 

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S G  MurthyRelated reading

U.S. Surgeon General Vivek Murthy wrote about his commitment to mental health in a recent post, titled “Raise Your Voice,” on the Substance Abuse and Mental Health Services Administration (SAMHSA) blog: 1.usa.gov/1dYqEVN

 

 

 

 

 

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B4Stage4

Mental Health America’s “B4Stage4” campaign aims to change the way Americans think about mental health. The Alexandria, Virginia-based nonprofit is working to remove stigma and improve access to care through advocacy – including at its annual conference held last week – and spreading awareness through social media and other mediums.

Care begins with prevention and early intervention — helping people before they reach crisis, or “stage 4,” explains MHA President and CEO Paul Gionfriddo.

“Mental health is more than an absence of ‘danger to self or others,’” he said at the MHA Conference opening session.

“We can build a different trajectory in the lives of people like Tim,” Gionfriddo said, referring to his son, who suffers from schizophrenia. “We need to change the message, change the reality, change the way the general public thinks about mental illness.”

 

Find out more about B4Stage4, download shareable infographics and fact sheets, and join in the social media campaign at mentalhealthamerica.net/b4stage4.

 

 

 

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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

Behind the Book: Harm to Others: The Assessment and Treatment of Dangerousness

By Bethany Bray June 9, 2015

The most effective solution to rampage violence, such as school or workplace shootings, is early, easy and frequent access to care for potential perpetrators, says Brian Van Brunt, author of Harm to Others: The Assessment and Treatment of Dangerousness.

Counselors play an integral part in this care, through identifying individuals who are at-risk and Depositphotos_31165405_sproviding treatment to move those individuals off the pathway of violence. These two skill sets – assessment and treatment of dangerousness – are essential, yet often lacking in counselor training and education programs, Van Brunt says.

In order to accurately identify individuals who pose a threat, counselors must work against the assumption that mental illness is often coupled with dangerousness or violence.

“Clinical staff typically are asked to assess individuals with mental health disorders who pose a potential for risk to others,” Van Brunt writes in the book introduction. “… ‘Harm to others,’ in other words, is focused more on mental health motivating causes that drive individuals to violence. However, the problem lately has been that many of the individuals being dropped off at the counselor’s office (particularly in K-12 and higher education settings) are making threats or posing a threat to others but have no indication of mental health problems … Although mental illness may be an important contributing factor in any of these [clients], the core of any assessment must be based on threat assessment principals, not clinical pathology.”

Van Brunt, the senior vice president of the National Center for Higher Education Risk Management Group, has a doctoral degree in counseling supervision and education. He is past president of the American College Counseling Association (ACCA), a division of the American Counseling Association.

 

Counseling Today caught up with Van Brunt to talk about his book, Harm to Others, and the importance of the assessment and treatment of dangerousness.

 

What do you hope counselors take away from the book about this topic?

I think there is a dearth of training in our field when looking at the assessment and treatment of those who represent a harm to others. Many graduate and doctoral programs teach suicide assessment and risk assessment, but few focus on the assessment of dangerousness in a way that is based on workplace violence literature. Simply stated, we are well prepared to assess a psychotic patient who is hallucinating and make a determination around commitment or hospitalization, but not prepared very well to assess the high school student who threatens to “go all Columbine” if they don’t have a grade on their final paper changed from a D to a C.

My book provides counselors clear and practical guidance on the fundamentals of how to conduct a violence risk assessment. Harm to Others closes the knowledge gap for new and seasoned clinicians being asked to conduct these kinds of assessments and work with challenging, hostile and difficult patients.

 

In your opinion, what makes professional counselors a “good fit” for violence assessment and training? What unique skills do they bring to the table?

I’d suggest a willingness to learn about how to do this important work in a research-supported manner. In my experience, an enthusiasm to learn more about violence and risk assessments is much more critical than an advanced academic degree. Many in the threat assessment community come from law enforcement or counseling backgrounds and have learned how to complete risk and threat assessments through on-the-job training, individual scholarship through workplace violence books and articles, and training through organizations such as the Association of Threat Assessment Professionals (ATAP) and the National Behavioral Intervention Team Association (NaBITA). But the underlying connection for a “good fit” tends to be a willingness to devote the time and energy to this scholarship.

This can create a bit of a challenge since there is no current licensure or certification standard when it comes to violence risk or threat assessment, so there is no objective standard of what makes a good threat assessment that exists in the law enforcement or psychology field at this time. As with clinical licensure and certification, a focus on research-informed practice, adherence to ethical standards found in both psychology and law enforcement, individual supervision and hands-on experience would be the four pillars I would suggest when preparing to do this kind of work.

I would also suggest the ability to build rapport and lower an individual’s defenses is critical in this work. Forming an attachment with the person who is being assessed is key to obtaining accurate data in order to build a valid risk or threat assessment. Crisis and emergency clinicians, those who work with personality disorders in their client caseload, family therapist and those who assess and treat teenagers often have skills in developing rapport and connection in difficult and adverse conditions.

 

 

What are some misconceptions you feel counselors have about dangerousness in clients?

I think one of the biggest problems that leads to misconceptions is an over-reliance on mental health diagnosis when it comes to assessing or treating dangerousness. There is an assumption that mental health problems such as depression, autism spectrum disorders (ASDs), post-traumatic stress disorder (PTSD) or anxiety leads to dangerousness or violence. This is one of the reasons I stress a solid overview and study in the field of threat and violence risk assessment. This is a problem beyond mental health concerns. And this distinction is often a difficult one for the public or untrained clinician to always appreciate. For example, the diagnosis of depression isn’t a central risk factor for targeted violence; instead we look at hopelessness and desperation. The diagnosis of ASD isn’t the concern; it’s the potential accompanying social isolation that prevents the assessment of the escalating threat.

There is also the distinction between ‘being a threat’ and ‘making a threat.’ This is often a source of difficulty for those new to this work. While direct threats are always cause for concern, the follow up assessment of the lethality of this threat becomes paramount. While all of us understand we would be concerned with someone at work who tells his supervisor “I’m going to come into work tomorrow with a katana sword and go all Kill Bill (the Quentin Tarantino films about an assassin) on you,” the real assessment here comes in understanding issues of weapons access, action and time imperative, fixation and focus on target and similar risk factors. I reference many of these factors in Harm to Others and refer frequently to the giants in the field such as Reid Meloy; Stephen Hart; Mary Ellen O’Toole; Michael Gelles and James Turner; and Frederick Calhoun and Stephen Weston to help counselors develop a deeper understanding of the questions they should be asking when assessing or treating a potentially violent client.

 

 

Do you feel today’s counselors are coming out of graduate school with adequate training/knowledge of violence assessment and treatment?

Unfortunately, the answer is no.

There are a number of excellent programs out there such as George Mason University’s forensic program chaired by Mary Ellen O’Toole and Alliant International University’s program under Eric Hickey in California, but assessing and treating potential dangerousness in clients is an issue that hasn’t yet been included in most psychology graduate programs. There certainly is a focus on crisis counseling, assessing suicidality, conducting mental health assessments and assessing and treating violence in higher risk clients with bi-polar, substance abuse, or psychotic disorders, but none of this really gets to the underlying core of work on violence and risk assessment that exists in the professional literature on workplace violence.

 

What would you want all counselor practitioners — marriage counselors, addictions counselors, mental health counselors, etc. — to know about violence assessment and treatment?

Well, first, I would suggest an understanding that these are two different skill sets. Assessing a potential threat is different than on-going therapy and treatment with a potentially violent or dangerous client.

Second, I would want all licensed clinicians to at least have a basic understanding of the risk factors related to targeted or rampage violence. If I was in a room of counselors and I asked what the risk factors were for suicide, I would quickly get a response. They would tell me being a male, age 18 to 22 years old. They would talk about lethality, access to means, prior attempts, situational stressors and having a plan. Suicide risk factors are well taught and well understood not only by clinicians; even the lay public has a foundational knowledge of what to look for if they were concerned about a potential friend or colleague who might be suicidal.

When it comes to risk factors that indicate a potential for harm to others, I think most clinicians draw a blank. They may guess at social isolation or wearing all black. They may suggest an anti-social tendency or disenfranchisement. They may talk about being on medication or playing violent video games. But few clinicians have a good understanding of what risk factors are supported by literature to better understand the risk of rampage or targeted violence. In Harm to Others, I provide several lists of these risk factors with practical examples of how to assess and mitigate these items to help prevent future violence.

While we do not excel at predicting violence; this remains a holy grail for the violence risk and threat assessment field. While we will never develop an accurate model of violence predication, we can certainly identify risk factors and prevent violence. Think of the risk factors of a heart attack. We understand these well: lack of exercise, being obese, hereditary factors, poor diet, and smoking. Each of these risk factors are targeted by public health prevention and education programs to reduce the risk of a heart attack. Yet, we can’t predict a heart attack. This is how we should think about identifying the risk factors for rampage or targeted violence. Our goal becomes prevention and intervention, rather than predication.

 

In the book introduction, you write, “The most effective solution to rampage violence is early, easy and frequent access to care for potential perpetrators.” In your opinion, how can counselors play a role in this access to care?

Quite frankly, we need to become that care. The reality is those who most need to be in counseling to change the path to violence they are on are the least likely to show up and remain connected to care.

It reminds me of the streetlight effect — the old story about the drunk man looking for his keys. It goes like this: A policeman sees a drunk man searching for something under a streetlight and asks what the drunk has lost. He says he lost his keys and they both look under the streetlight together. After a few minutes the policeman asks if he is sure he lost them here, and the drunk replies, no, and that he lost them in the park. The policeman asks why he is searching here, and the drunk replies, “this is where the light is.”

Most of us spend our time providing therapy with those clients who voluntarily come in for treatment, but those in real need, those who have lost hope and find their only solace by sitting alone andSecurity business man avoid danger risk planning these kind of horrific attacks, are not connected to care. Our mental health system fails them under the guise of individual rights. We do not have an adequate step between voluntary outpatient care and involuntary inpatient commitments.

We need a mental health system in the United States that functions more like our child protective service system. When a child is found at risk, an investigation occurs and a caseworker is assigned. The case remains open until the risk is mitigated. We don’t have a system like that for violence risk to others. Too many times we end up shaking our heads saying things like “Well, we all are concerned, but there is nothing we can do until the person breaks the law or threatens someone.” We say, “They need to be in counseling, but they aren’t an acute danger to themselves or others, so we can’t mandate or force the issues.” We need to address this gap. Without the ability to require care once the risk factors are identified, there is little hope to reduce targeted violence.

And of course, this raises the specter of Big Brother. The recent National Security Agency (NSA) scandal doesn’t help matters much either. Yet, we are willing to take away individual rights of parents when a child is at risk. I struggle with why we don’t have a similar mechanism in place when there is an individual who has many of the risk factors, yet hasn’t broken any laws or doesn’t meet commitment criteria. We need to address this Goldilocks problem when the porridge is neither too hot nor too cold. How do we attend to the student everyone is concerned about, but hasn’t yet broken the law or school conduct code?

 

 

What advice would you give to a counselor who wants to work on/improve their violence assessment and treatment skills? What resources would you point them toward?

There are three trainings that I would recommend for a counselor looking to improve their skills in violence risk assessment.

  • The Association of Threat Assessment Professionals was the place I started my journey in the area of threat assessment. They offer an amazing conference each August in Anaheim, California.
  • My organization, NaBITA also offers detailed training in violence risk and threat assessment and we hold our conference annually; this fall it is in San Antonio.
  • Stephen Hart also offers a wonderful set of trainings and workshops on the topic of Structured Professional Judgment (SPJ) through the company Proactive Resolutions.

If attending a conference or training is outside of your budget, I would suggest the following three books that have been very useful in my personal training and experience in violence risk and threat assessment.

  • The first is Reid Meloy and Jens Hoffmann’s International Handbook of Threat Assessment (2013). This collection of articles provides the reader with a sound overview of the current state of the field.
  • The second book is by Michael Gelles and James Turner: Threat Assessment: A Risk Management Approach (2003). This book is a very accessible starting place for those interested in the process of threat assessment.
  • The final book would be Mary Ellen O’Toole’s book Dangerous Instincts (2012). This text offers uncanny insight into the world of identifying and assessing threat.

 

What inspired you to write this book?

I’ve written several other books that circled this topic. Ending Campus Violence: Prevention Strategies and New Approaches to Prevention (2012) was written to a college and university administration and student affairs audience. A Faculty Guide to Disruptive and Dangerous Behavior in the Classroom (2013) was written to faculty who wanted better guidance on managing classroom behavior and identifying dangerous students.

This book, Harm to Others came from frequent requests (I’ve received) at trainings from counselors and psychologists around the country who are being asked to conduct violence risk assessments on their clients. This book provides them with a practical guide full of examples and additional resources to better assess and work with dangerous individuals.

 

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About the author

 

Brian Van Brunt is president of the National Behavioral Intervention Team Association and senior vice president of the Pennsylvania-based National Center for Higher Education Risk Management (NCHERM) Group, a law and consulting firm that addresses risk management issues in educational settings. An author of several books, he is a frequent speaker and trainer on issues of threat assessment, mental health and crisis management across the globe.

Van Brunt has a doctoral degree in counseling supervision and education from the University of Sarasota/Argosy and a master’s degree in counseling and psychological services from Salem State University in Massachusetts.

 

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Branding-Box_Van-BruntHarm to Others: The Assessment of Treatment of Dangerousness is available from the American Counseling Association bookstore at counseling.org/publications/bookstore or by calling 800-422-2648 x 222

 

 

 

 

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For more information

Brian Van Brunt was also interviewed for a recent American Counseling Association podcast, titled “Harm to others.” Listen to the hour-long podcast here: counseling.org/knowledge-center/podcasts/docs/default-source/aca-podcasts/ht052—harm-to-others

 

 

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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