Monthly Archives: August 2015

VA expands policy to allow service dogs

By Bethany Bray August 31, 2015

The Department of Veterans Affairs (VA) has amended its policy to allow all types of trained service dogs in VA facilities, including canines that support people with mental health and emotional issues.

Previously, the only animals allowed in VA facilities were guide dogs, with few exceptions.

Keith Myers, an American Counseling Association member and licensed professional counselor (LPC) in Georgia who specializes in trauma and veteran’s issues, calls the change “a needed policy shift.”

“I witness firsthand the positive effects service dogs [have when] coming alongside a veteran,” he says. “Whether the dog is a calming influence for anxiety or a grounding presence for certain intrusive symptoms of posttraumatic stress disorder (PTSD), a service dog provides the veteran with a battle buddy, so to speak, that can help [in] many stressful environments. Unfortunately, these stressful environments can also include the local VA, such as a crowded waiting room or confusing parking deck. This policy change is long overdue at VA Medical Centers (VAMCs). I’m very happy with it, and I believe my clients with service dogs will also appreciate the change.”

The VA policy change takes effect this fall (September 2015). Now, any service dog, defined as “dogs that are individually trained to perform work or tasks on behalf of an individual with a disability,” will be allowed.

“Other animals will not be permitted in VA facilities, unless expressly allowed as an exception under the regulation for activities such as animal-assisted therapy or for other reasons such as law enforcement purposes,” the VA announced in a press release. “The regulation further confirms that service animals may access VA property subject to the same terms that govern the admission of the public to VA property, and may be restricted from certain areas on VA properties to ensure that patient care, patient safety and infection control standards are not compromised.”

Amy Stevens, an LPC who runs a Facebook group for female veterans in Georgia, thinks the policy change is good news, although its implementation remains to be seen.

“This is exciting news for many [service] women who have service dogs for emotional support as well as physical needs. The regulation is still not completely clear on how it will be implemented,” says Stevens, a service-disabled Navy veteran. “The question remains on how the service animal will be approved and what kind of documentation will be required to verify the training and roles in place. … Physical needs for injuries needing balance support or help with fetching and retrieving items can be readily apparent. The emotional needs of a veteran with PTSD are not so clear. The calming influence of a trained emotional support animal is very important, but it may not initially be clear what the ‘task’ might be. For example, when the veteran feels threatened or fearful, the task may be protective, such as the animal placing herself between the threat and the veteran. It does not mean barking or attacking the threat. The presence of the animal can also provide ‘grounding’ for a veteran who is mentally distressed by physical contact. Awareness of the animal … can help the veteran come back to herself and manage better. … We look forward to hearing more about this [policy change] in the near future as implementation begins.”

Stevens, a Cold War-era veteran, previously served as director of psychological health for the Georgia National Guard. She and Myers are both members of the American Counseling Association’s Veterans Interest Network.

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Related reading

See the VA’s original press release here: 1.usa.gov/1JyIivj

Coverage by Military Times: “VA amends access rules for service dogs at facilities”

For more information on a counselor’s role in certifying emotional support animals, see Counseling Today’s online exclusive: “Confirming the benefits of emotional support animals”

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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

Technology Tutor: What you need to know about credit cards

By Rob Reinhardt August 27, 2015

Credit cards are being used in more than 60 percent of all sales in the United States, and that number is expected to keep rising (see bit.ly/ccusage). That means it is increasingly challenging to run any sort of business without accepting credit cards. Counselors must also factor in the increasing number of clients who have a health savings account (HSA) or a flexible spending account (FSA) tied to a credit card.

The decision has become not so much whether to accept credit cards but how. With that in mind, this column will cover some things to be aware of, whether you have already been accepting credit cards or are just considering adding them to the payments you accept.

Lots of options

In the past, accepting credit cards meant purchasing equipment and paper and paying monthly minimum charges. But now, mobile options offered by Square, PayPal, Intuit and others let you swipe credit cards through a postage-stamp-size dongle attached to your smartphone or tablet. The dongle is typically free, and the merchant fee is usually a flat rate with no minimums.

A number of factors go into deciding which product is a good fit for you, including number of locations, business structure and expected monthly volume of credit card charges. Mobile dongles tend to be the best fit for solo and small group practices, particularly those with more than one office. Large practices that do a significant volume of credit card business may be able to negotiate a better merchant rate with a local bank. Banks have begun to catch on that mobile solutions are desirable, and some may even offer a hybrid solution.

Transactions exempt from HIPAA

In providing consultations to private practice owners, I often get asked whether counselors need to have a business associate agreement with their credit card merchant service. Because the merchant does access protected health information, one might think that a business associate relationship is established. However, the Health Insurance Portability and Accountability Act (HIPAA) exempts these transactions, stating that a business associate agreement is not required “when a financial institution processes consumer-conducted financial transactions by debit, credit or other payment card, clears checks, initiates or processes electronic funds transfers, or conducts any other activity that directly facilitates or effects the transfer of funds for payment for health care or health plan premiums. When it conducts these activities, the financial institution is providing its normal banking or other financial transaction services to its customers; it is not performing a function or activity for, or on behalf of, the covered entity” (see bit.ly/HIPAABA). Note that this excludes only the transaction itself.

Special privacy and compliance concerns

Many financial services, especially those that provide mobile dongles, offer additional features beyond processing the transaction itself. Some provide the ability to email receipts to clients or prompt them for feedback on services. These features are not exempt from HIPAA regulations because they do not directly facilitate or effect the transfer of funds as noted above. In other words, a business associate agreement may be required if these features are turned on.

Counselors will need to perform a risk assessment (see bit.ly/TYPPCT) to determine how to address these features. This may involve turning the features off completely or documenting a client’s request to use them. For additional details, including the recommended actions to take, read the blog post I wrote at bit.ly/HIPAASquare.

PCI compliance

It’s important to be aware that the credit card industry has its own form of HIPAA called Payment Card Industry Security Standards (commonly referred to as PCI or PCI compliance). These standards detail the responsibilities of merchants to keep credit card and related data secure. For an overview of compliance requirements, see bit.ly/TYPPCI.

Smart credit cards

Credit cards are in the process of becoming more secure. New credit cards, often referred to as “smart” credit cards, are shifting to the EMV (Europay, MasterCard and Visa) standard. This means that they will have a computer chip integrated into the card. Legacy cards carry all of the card’s and card holder’s data on the familiar magnetic stripe and are easily counterfeited. Through the computer chip, EMV cards are able to generate transaction data at the moment of the transaction, making them much more difficult to counterfeit and steal information from.

[See more on smart chips at Rob’s blog: http://bit.ly/1VhYF3h]

Because of concerns about fraud and theft, much of Europe converted to the EMV standard several years ago. It took large breaches at places such as Target for banks in the United States to finally move forward with the upgrade. Still, banks are moving forward at a slow pace, first switching to cards that have both the chip and the magnetic stripe to give merchants an opportunity to catch up to the technology.

Those that accept credit cards will need new card readers to process the new cards. As of Oct. 1, the banks will be placing more responsibility for fraudulent charges on merchants if they haven’t adopted the new technology. That said, the banks are currently running behind on printing the new cards, so it may be difficult for them to enforce this, especially as it relates to small businesses. In any case, those who accept credit cards will need to migrate to this new card reader technology sometime in the not too distant future.

Should you pass on charges?

In online forums, I often see counselors asking if they should pass on the credit card merchant fees to their clients. Up until 2013, credit card contracts blocked merchants from passing these charges on, but as a result of a lawsuit against MasterCard and Visa, they were forced to allow “swipe fees” to be passed along. Some merchants (and counselors) view this as a way to recoup some of the costs associated with accepting credit cards.

Counselors should consider a number of factors before engaging in this practice, however. In most cases, I find that the cons of such a policy outweigh the pros. Furthermore, several states have passed legislation to make the passing on of swipe fees illegal. For a more in-depth examination of this topic, you can read my blog post at bit.ly/SwipeFees.

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Despite this additional array of information to be aware of, I highly recommend that those in private practice consider accepting credit cards. Offering convenience to clients while receiving quick and efficient payment yourself makes this an all-around plus for anyone who wants to run a successful practice.

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

Letters to the editor: ct@counseling.org

Diagnosing ADHD in toddlers

By Donna M. MacDonald

In 2000, Dr. Steven Hyman, then director of the National Institute of Mental Health (NIMH), made a statement for the record and publicly recognized that preschoolers can have the mental health condition of attention-deficit/hyperactivity disorder (ADHD). He made this statement even though this belief was not widely accepted at the time. He further stated that preschoolers with ADHD were unable to interact happily and healthily with friends and family members, significantly impairing their self-esteem and the stress level of the family unit. Therefore, Hyman urged a push for more studies to be conducted on medication for children as young as age 3. (It’s important to note that Hyman is not “for” or “against” medication; he is for what is right for each individual case). He was hopeful that more studies and results would give parents of young children legitimately suffering from this disorder more treatment options.

In 2011, the American Academy of Pediatrics adjusted its guidelines for the diagnosis and treatment of ADHD to include younger children. Previously, it had “allowed” ADHD to be diagnosed in children only 6 and older, but since the push from NIMH in 2000, more research studies had in fact been conducted, and those results warranted the change to include the diagnosis and treatment of preschoolers.

Some public school preschools enroll their students at age 3 (even though most children start a bit later because of where their birthdays fall on the calendar). An ADHD diagnosis requires that the symptoms be consistently intense and frequent for a period of six months, which means that most preschoolers who legitimately have the disorder are receiving the diagnosis at the end of age 3 or the beginning of age 4. According to Dr. Demitri Papolos, a recipient of an NIMH Physician/Scientist Award whose research findings have been widely published, the latest research suggests that the age of onset for ADHD is usually prior to age 4 and can occur as early as infancy. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) reports that ADHD symptoms will have an onset prior to age 12 and that the observation of excessive motor activity during toddlerhood is likely. However, the DSM-5 states that these young cases of ADHD can be hard to distinguish from normative behaviors.

‘Within normal limits’

Given this information, what should counselors watch for in terms of identifying possible ADHD symptoms in these very young children? It can be challenging to discern between the typical hyperactivity, impulsivity, inattention, irritability and aggression that toddlers will inevitably display and the symptoms that are actually clinically significant and indicative of the neurodevelopmental disorder of ADHD in 1- to 5-year-olds. This is because in toddlers, as the DSM-5 states, behavior and emotional expression that is considered “within normal limits” spans a very wide range. Consider, for instance, the following scenarios:

What if a 1-year-old bites her sister?
What if a 2-year-old throws a tantrum in the store when he doesn’t get the toy he wants?
What if a 3-year-old runs around the minivan and won’t stay in her car seat?
What if a 4-year-old constantly says “NO!” and won’t follow directions?
What if a 5-year-old can’t sit still at the dinner table?

All of these scenarios can be associated with ADHD, but they are not necessarily indicative of the child actually having ADHD because each of the examples can fall within normal limits for the age range. This does not mean that these behaviors are always acceptable, however. Therefore, some of these behaviors will need modification.

On the other hand, in some instances, parents really do need to lower their expectations of what a toddler can and should be able to do. After all, toddlers are not meant to be mini-adults or even mini-children. Therefore, it is important to remember that it’s normal for a toddler to say “no” because it means he is trying to gain a sense of independence. It’s normal for a toddler to throw a tantrum when she doesn’t get her way because of the need for immediate gratification, which is associated with an immature frontal lobe of the brain. It’s normal for a toddler to want to run, jump and climb because movement actually helps the brain develop properly and helps the toddler to feel well emotionally. Toddlers don’t have long attention spans, so sitting still should be difficult for them.

According to staff members who specialize in early intervention with children ages birth to 36 months at the U.S. Department of Health and Human Services, a child who is 12 to 15 months old should be able to hold attention to an activity for one minute. A child who is 16 to 19 months old should be able to hold attention for two to three minutes. Nearing age 2, a child should be able to attend for three to six minutes. By age 3, this attention span should increase to five to eight minutes, and by age 4, the child should be able to hold attention to one activity for eight to 10 minutes. This does not mean, however, that the child will necessarily be able to remain still while attending to the activity. It is important that clinicians and physicians have a thorough understanding of what is within normal range so that they do not misdiagnose ADHD.

As the child ages, the range of behaviors that is considered within normal limits diminishes significantly. For instance, if a 7-year-old engages in any of the scenarios listed above, such as biting another child or running around the minivan while the parent is driving, especially if this happens on a regular basis and the child is not responsive to consistent behavior modification techniques, it provides much more reason for concern for an actual mental health condition.

Indicators of ADHD in toddlers

So, what are the signs of actual ADHD in a toddler? For actual ADHD, the toddler’s behavior must showcase a pattern of chronicity, meaning demonstrating the behavior frequently and consistently for a period of at least six consecutive months and without responding to consistent behavior modification techniques. In addition, the behavior of a toddler with ADHD must be intense in nature — much more intense than a typical toddler who might showcase these symptoms occasionally.

There will also be a rule-out procedure for ADHD to ensure that the toddler’s behavior is not due to normal temperament, a medical issue or sleep disorder, the externalization of daily stressors or another mental health condition. If all these causes for the toddler’s behavior are ruled out, the following may serve as signs of ADHD in the toddler:

Putting self in danger on a regular basis. This action is due to the presence of novelty-seeking behaviors, sensory-seeking behaviors or impulsive behaviors. Examples include hanging over a second-story banister, jumping down an entire flight of stairs, climbing the bookcase or the drapes, or darting into the street.
Putting others in danger by impulsively becoming physically aggressive, such as ripping toys out of others’ hands or pushing another child off of a swing. These actions are the result of a strong need for immediate gratification.
Struggling to make friends and difficulty following social norms, such as taking turns while talking, sharing toys or waiting in line. Parents of young children with ADHD may notice that other parents routinely cancel play dates with them or are not heard from again after having one play date with their child.
Falling behind in preschool despite interventions in the classroom to help the child succeed.
Engaging in tantrums for extended periods of time (15-30 minutes) on a daily basis or, sometimes, several times per day. During these tantrums, the child loses all rational thought. These tantrums display cognitive, behavioral and emotional impulsivity. Many of these instances are triggered by events that are considered “minor.” Most typical toddlers would not react in this extreme manner to these events, so this type of reaction is considered “disproportionate to the event.”
Overreacting in a positive manner to minor events. An example is jumping from one piece of furniture to another out of excitement, yelling loudly and throwing his or her hands in the air because of getting to go to the park, even when visiting the park is an almost daily occurrence. This overreaction makes it especially difficult for the child to transition into actual participation in the desired activity because he or she struggles to calm down.

Behaviors must be measured not only in terms of developmental norms but also in proportion to the event. If an 18-month-old goes to the library for the first time, she may run, yell loudly and touch every book she can out of excitement. However, if the child is now 4 years old, has been to the library regularly and still struggles to use “quiet feet” or cannot maintain herself for the five minutes of story time, that is cause for concern. If a 3-year-old throws a tantrum for 20 minutes because the big trip to Legoland — a place the child has never been before — has been canceled, that’s more “normal” than if a 4-year-old engages in a tantrum for 20 minutes because it’s raining and he can’t go to the local pool that he visits almost every day. That reaction would be considered disproportionate to the event.

Children younger than 6 or 7 cannot process traditional talk therapy because of its abstract nature. Therefore, it is important to get the young child with ADHD involved in another form of interpersonal behavior therapy to work on self-awareness, self-management, social skills and decision-making skills. Play therapy, dance/movement therapy, art therapy, music therapy and animal-assisted therapy are examples of nontraditional therapy forms that may be especially appropriate for young children, as long as clinicians are incorporating all of the self-regulation skills necessary for a child to use age-appropriate behavior.

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Donna M. MacDonald is a licensed clinical professional counselor who has worked professionally with ADHD for 15 years as a teacher, YMCA director and, currently, licensed clinical therapist in a therapeutic day school. She is also the mother of 6-year-old twins who were diagnosed with ADHD at age 3. She is the author of the book Toddlers & ADHD under the pen name Donna Mac. Contact her through her website at toddlersandadhd.com.

Letters to the editor: ct@counseling.org

Related reading: See MacDonald’s Counseling Today article from earlier this year: The connection between ADHD, speech delays, motor skill delays, sensory processing disorders and sleep issues

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Helping the helpers

By Jennifer M. Cook and Pamela C. Wells August 26, 2015

Tanisha is a master’s student in the middle of her internship. She has just left supervision with her site supervisor and says to herself, “Will I ever know enough?”

Chuck is a first-semester counseling student in a skills class. He hears a lot of feedback from his faculty member and tells himself, “I can’t do anything right.”

Dre and Janice are first-semester counselor educators who maintain the same crazy hours they did when they were doctoral students. They don’t really know where they stand or if they are accomplishing the goals they need to be accomplishing. They think to themselves, “Will I ever be enough?”

The process of becoming a counselor, supervisor or counselor educator can be exciting, exhilarating and, in some ways, exhausting. Counselor education programs encourage and expect personal growth and development, which can take many forms. Although growth can be exhilarating, it can also be challenging, both professionally and personally. We posit that a strength-based perspective can help fortify counseling students and new professionals through this growth process and bolster their personhood as they traverse identity shifts during graduate school and as they begin their careers.

In many conversations with master’s students, doctoral students and new professionals, we have heard the following sentiments:

“I don’t know who I am anymore.”
“I wonder who I will be when I graduate.”
“I’ve changed so much my friends and family say they don’t know me.”
“What if I discover I don’t like who I am becoming?”

During this time, counselors-in-training and new professionals are generally receiving constructive critical feedback from faculty members, supervisors and peers. Although this process is imperative for a counselor’s growth and development, taking in a great deal of critical feedback can cause people to feel unmoored and experience self-doubt. They find themselves thinking, “I can’t do anything right!”

Oftentimes, new counselors and new counselors-in-training focus their attention on all of the areas they need to “work on” — all of the skills they have yet to master, all of the insight they have yet to gain — instead of taking time to identify and concretize the ways they are growing and the areas in which they are already strong. A significant component of absorbing constructive critical feedback is the ability to discern between feedback that “fits us” (and is effective for our growth and development) and feedback that does not fit us. Along with that, it can be difficult, yet just as imperative, to hone our ability to notice our strengths and what we are doing well. We may very well develop a “criticism filter” rather than a “this is to help me grow” filter, ignoring our strengths in the process.

During this period of growth and development, counselors-in-training and new professionals may also struggle with a lack of support or a perceived lack of support. They might ask themselves, “Whom can I turn to?” or “Does anybody believe in me?” They may continue to struggle with their emerging sense of identity and identify with the “impostor syndrome”: “One of these days people will figure out I am not good enough/smart enough to do this, and they will remove me from my graduate program/new job.” All of these struggles can cause us to feel like impostors and feel inadequate. Possible mental health and somatic issues can even arise.

We believe that people have more strengths and are far more resilient than they often realize. Through identifying strengths, we believe counselors-in-training and new professionals are equipped to handle their identity struggles and areas for growth, while seeking support that nourishes who they are and who they are becoming.

Who we are

As two recent counselor education doctoral graduates, we empathize with the struggles related to feedback, have questioned our own developing identities and have dealt with negative thoughts about our abilities. We both moved across the country for our doctoral work (Jennifer from the West Coast to the East Coast, and Pamela from the East Coast to the West Coast), and then moved across the country again for our first jobs as counselor educators (Jennifer from the East Coast to the Midwest, and Pamela from the West Coast to the South). We recognize our ever-present shifting identities and the need to be open to constructive critical feedback.

In our conversations with master’s and doctoral students across the country, we heard many folks discuss their struggles with impostor syndrome, their feelings of not being good enough and their inability to recognize when they were doing a competent job. We, too, have grappled with the same things.

We realized that we needed to recognize our positive contributions and consider the strides we were already making, then apply those things to the ways we wanted to grow. In the process, we saw a change in ourselves and the work we do and, consequently, more readily saw changes in those whom we serve.

What a strength-based perspective is (and is not)

When people first hear about applying a strength-based perspective, they might say, “I am so not that optimistic” or “My life has been hard, not rainbows and unicorns.”

Our response is to agree with these comments. We, too, have had complicated lives and uncertain trajectories. We would not call ourselves “optimists” per se. Luckily, a strength-based approach does not require any of those things.

From our point of view, a strength-based perspective is about being realistic — but in a new way. This new way includes acknowledging your positive attributes and strengths rather than seeing only your faults and deficits. In this view of being realistic, one is required to reframe experiences. It does not require you to ignore what happened or pretend everything went exactly as planned. Instead, one reframes an experience to have a balanced perspective that includes both what went well and what can be adjusted. From a humanistic perspective, we believe this way of thinking and being affirms and cares for the whole person. It allows you to know you are a worthy, good person who is striving to do your best. Reframing adjusts your mindset and allows you the room to identify your strengths.

One of the hardest parts of adopting a strength-based perspective for many people, especially women and other individuals who have nondominant cultural identities, is their sense that it might be haughty, stuck-up or arrogant of them to identify their strengths. Many of us have been taught, whether culturally or through our families of origin, to ignore or downplay how we are competent because it might be perceived as bragging or being full of ourselves.

Again, fortunately, this is not what a strength-based perspective is about. A strength-based perspective does not ask people to get “too big for their britches.” It asks people to identify, realistically, how they are strong and to lead with their strengths.

We know that those of you reading this article are acutely aware of your shortcomings. We want to suggest that your shortcomings need some balance that can be provided only by your strengths. It is important for everyone to recognize that our individual strengths may be very different from your individual strengths — and that is a really great thing. So, remember the three keys to a strength-based perspective: be realistic, reframe and lead with your strengths.

How to identify strengths

We believe it is important to work from a strength-based paradigm. That means that if you want to tackle a challenge or work on an area of growth, it is imperative to know your strengths so you can use them to inform your process.

For example, let’s say a practicum student counselor wants to increase her use of open-ended questions during counseling sessions. As her supervisors, we ask her to identify her strengths. The student counselor, doubtful and frustrated, states, “I don’t have any. I just want to stop asking closed-ended questions.”

After talking about it with her further and explaining the importance of identifying one’s strengths, the student counselor shares that she uses silence well, cares deeply for her clients and truly wants to understand her clients’ perspectives. We encourage her to take it a step further: How can she use the strengths she identified to ask more open-ended questions? The student counselor shares, “Well, I know I learn more about the client when I ask open-ended questions. And because I care so much about my clients and want to understand my clients’ perspectives, it makes sense to show that through open-ended questions.”

New counseling professionals may experience something similar. For example, let’s say a new counseling professional is consulting with a colleague about a client who is challenging for her. In the conversation, her colleague hypothesizes aloud: “I wonder what it would be like if you were more authentic with your client?”

Immediately, the new counseling professional thinks, “I bet my colleague thinks I don’t know how to be authentic!” In an instant, the new professional who made an ethical choice to consult about a client who is challenging for her sees only possible judgment from her colleague. Yet it’s not too late for her to take a strength-based approach and change her inner dialogue. For instance, she might say, “I felt like I was being authentic, but I want to focus on how you said I could be more authentic. Can we brainstorm some ideas?”

When it comes to using strength-based methods to work on your professional identity development, it may be helpful to start with what you know about yourself as an individual, and then move on to what you know about yourself as a professional. What aspects of your personality do you consider strengths? Which of your abilities do you naturally fall back on when the going gets rough? What types of situations, events and activities give you energy?

It can help significantly to write these qualities down so you can see them on paper. Reading true words about who you are, written in your own hand, can be powerful and moving for many of us. In fact, this process can bring up strong emotions. That’s OK. Stay with it. You might need to take a break, but commit to returning to the activity later that day or week. Connect with a trusted friend or counselor to help you process what you’re experiencing.

Next, write down one concrete aspect of yourself that you want to strengthen. Resist the temptation to make a long laundry list of faults. Recognize that this isn’t a time to berate or shame yourself. Rather, it’s an opportunity to look at yourself honestly, openly and with congruence concerning who you are and who you wish to become. Inevitably, any one area that you choose will strengthen your counselor, supervisor, researcher or educator identity.

This concrete aspect can be about a myriad of things. You might choose to strengthen a particular skill, like the counseling student did in the earlier example. You might choose to strengthen something that you identify as both a professional and personal concern. For example, a doctoral-level supervisor might notice that he gives constant advice to his supervisees rather than allowing them to explore possible solutions on their own. Similarly, he notices that he does this frequently with his partner and friends. He might decide to set the intention to strengthen his ability to listen more fully and to ask questions that allow his supervisees to explore their own options. Notice in this example that the supervisor did not set the goal to “give advice less often.” Instead, he focused on things he knows how to do and can improve upon: listening and exploration. With these objectives in mind, the supervisor is free to focus on strengthening what he knows how to do rather than trying to extinguish an unwanted behavior. When you focus on strengthening a part of yourself, unwanted behaviors tend to fall away on their own.

Finally, it’s important to reflect on your process. What do you notice? How do you feel mentally and physically? What’s working? Celebrate any incremental changes you observe, and be kind with yourself if things don’t change as quickly as you would like or even if things seem to get worse before they get better. Increase your self-care practices, and give yourself permission to not set perfection as a goal. “Perfection” is not a strength, and many of us understand how detrimental it can be to strive for that unattainable goal.

Realistically reframing negative thoughts

Through experience, we have learned that although a strength-based perspective makes sense conceptually, it can be difficult to understand how to put it into everyday practice. Consider the information on realistically reframing negative thoughts in the chart above.

What are your thoughts as you read these reframes? Can you imagine shifting some of your language in this way? It can be hard, but it is worth it. Remember, reframing your thoughts is a step toward allowing yourself to identify your strengths. And when you identify your strengths and apply them to bolster an area of growth, you will experience incremental progress toward the goal you want to accomplish.

Conclusion

Committing to a strength-based perspective can be scary because it encourages us to look at ourselves in an honest, authentic way. Yet applying a strength-based perspective can also be incredibly empowering because it helps us achieve a more balanced view of who we are and who we are becoming. By being realistic, reframing your experiences and leading with your strengths, you will begin to hone your strength-based abilities.

A strength-based perspective encourages you to keep moving forward and to keep growing, even when it seems “too hard” or “not worth it.” You possess strengths and gifts that are seen every day by the people you serve. Why not take the chance to see yourself through their eyes, and then use those qualities to bolster the ways you want to grow? You might be surprised by who you see emerge in the process.

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A strength-based perspective …

• Is: Realistic

• Is: Person affirmative

• Is: Reframing

• Is: Self-care

• Is not: Rainbows, sunshine and unicorns

• Is not: Constant optimism

• Is not: Ignoring one’s shortcomings

• Is not: Haughty, stuck up or arrogant

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If you are thinking …

How you might apply a strength-based, realistic reframe

“I’m a mess. How can I ever help other people?”	“I have navigated a lot of change in a short amount of time. I know my experiences will allow me to be present for my clients.”
“I can’t possibly finish all of this work in such a short amount of time. Everyone else is succeeding, but I think I’m failing.”	“I’ve been a hard worker in the past. There is no reason why this will be any different.”
“I laugh every time someone mentions self-care. Who are these people? I don’t have time for that!”	“I know that self-care is imperative to my own wellness, as well as to my personal and professional development. Self-care has been a cornerstone for me in the past, and because I care about myself and my clients, I know I can make it a priority again.”
“I am completely overwhelmed and confused by my new workplace. I didn’t learn any of this in graduate school.”	“I have been overwhelmed and confused before. I found a way through it then, and I can find a way through it now.”
“I feel pressured to be good at everything — counseling, supervision, research, teaching, service. I can’t do it all!”	“I’m correct. I can’t do everything all at one time. I can take things step by step, one thing at a time.”
“Who am I to be trusted with educating future counselors?”	“I can be trusted to educate future counselors. I can remember why I chose this path and how I got here.”

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Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Jennifer M. Cook is an assistant professor in the Department of Counselor Education and Counseling Psychology at Marquette University in Milwaukee. Contact her at jennifer.cook@marquette.edu.

Pamela C. Wells is an assistant professor in the Department of Leadership, Technology and Human Development at Georgia Southern University in Statesboro.

Letters to the editor: ct@counseling.org

CEO’s message: It’s about that vision thing

By Richard Yep August 25, 2015

Looking ahead to both challenges and opportunities helps prepare us for what the future may bring. It is an activity that can be done either formally or informally, but what we know is that if we don’t look

Richard Yep, ACA CEO

ahead, we can lose control of our destiny or, in this case, that of the counseling profession. Here are some past activities that attempted to “look ahead.”

Nearly 10 years ago, ACA and the American Association of State Counseling Boards entered into a partnership to co-sponsor a project called 20/20: A Vision for the Future of Counseling. This initiative would grow to encompass 31 organizations representing the counseling profession. The group came together to engage in a long-term, strategic view of the profession. Out of this effort grew a current project focused on the building blocks to licensure portability.

This past summer, the ACA Governing Council embarked on its latest strategic planning process that will help shape the association and its offerings to members over the next several years.

Last month, the ACA staff began a “heavy lift” of integrating a number of program goals that will align strategically with what the volunteer leadership and our members have indicated they need from us.

It wasn’t so long ago that when we talked about the year 2020, it still seemed so far away — almost like we were thinking about life with the Jetsons. (Did I just date myself by using that reference? Millennials — you can Google that word to find out what I meant).

The year 2020 is now less than five years away. Given that we need to look beyond five years to prepare ourselves for the rapid changes taking place in society, I want to ask each of you a favor. An eye doctor would say that 20/20 qualifies as very good vision, 20/30 offers a little less clarity, 20/40 even less so and 20/50 certainly needs some type of corrective lens. So, if I asked you what the counseling profession will “look like” in 2050, you would need to rely on some educated guesses, especially in comparison with your projected picture of counseling in 2020.

In 2050, a majority of the graduate students currently in counselor education will be in their late 50s and early 60s. Those who are currently midcareer will be collecting Social Security or some type of pension. And those who are currently retired might be part of one of our fastest-growing population segments — those who are 100 or older. By 2050, the United States is projected to have at least 6 million centenarians.

So, I am interested in what you think both society and the counseling profession will be like in 2050. Just jot down your thoughts and send them my way via Twitter (@Richyep), email (ryep@counseling.org) or the “old-fashioned” way (a letter to 6101 Stevenson Ave., Suite 600, Alexandria, VA 22304). You can also call me at 800.347.6647 ext. 231. I will read (or listen to) whatever you send and hope to summarize things in a future column.

With all that you do for clients, students and your communities, I know you don’t always have time to think about what might be happening next week, much less 35 years from now. But I also think it is important to look forward (way forward in this case). Not so much to predict the specifics of the future, but to realize that with so much change, we need to be adaptable and nimble so that the counseling profession can remain viable, and even thrive, by meeting the needs of clients and students in 2050.

As always, I look forward to your comments, questions and thoughts.

Be well.

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