Monthly Archives: November 2015

Medicare bill gains critical co-sponsor

By Bethany Bray November 23, 2015

U.S. Sen. Michael Bennet has agreed to co-sponsor a bill that would allow professional counselors to be reimbursed for care of clients who have Medicare health insurance, an issue the American Counseling Association has long advocated for.

The Colorado Democrat’s endorsement of the bill carries significant weight because he sits on the U.S. Senate Committee on Finance.

Bennet’s decision to co-sponsor the bill came after months of advocacy by American Counseling Association members in the Denver area. He is now one of 11 bipartisan lawmakers who co-sponsor the bill.

[Editor’s note: Soon after this article was posted, the bill gained another co-sponsor: Sen. Sherrod Brown (D-Ohio). As of December 2015, the bill has 12 co-sponsors.]

Senate bill 1830, or the Seniors Mental Health Access Improvement Act of 2015, would establish reimbursement of licensed professional counselors (LPCs) and licensed marriage and family counselors (LMFTs) for the treatment of clients whose primary coverage is Medicare, the federal

ACA member and LPCC Denise Magoto (on left) and LPC and licensed addictions counselor Katherine Bujak-Phillips are pictured at an advocacy to Sen. Michael Bennet's office this spring. Bujak-Phillips leads the LPC peer supervision group at the Medical Health Center of Denver, where Magoto works.

LPCC Denise Magoto (on left) and LPC and licensed addictions counselor (LAC) Katherine Bujak-Phillips are pictured at an advocacy visit to Sen. Michael Bennet’s office this spring. Bujak-Phillips leads the LPC peer supervision group at the Medical Health Center of Denver, where Magoto works.

health insurance program for citizens who are age 65 or older. Medicare has covered psychologists and licensed clinical social workers (LCSWs) since 1989, but does not cover LPCs.

“For years now we’ve ben hearing about the baby boomer generation coming onto Medicare. They’re already predicting shortfalls in healthcare, and mental health is no exception,” says Denise Magoto, an ACA member who has advocated for Bennet’s support of S.1830. “There’s not enough licensed clinical social workers to go around. We’re already seeing that shortfall.”

Magoto, a licensed professional counselor candidate (LPCC) at the Mental Health Center of Denver, is all too familiar with the headaches that counselors face over the Medicare reimbursement issue.

Every time a new client comes to the Mental Health Center of Denver, the intake department works to match the client with a clinician based on what insurance they have and whether or not the center would be reimbursed for their care.

“It really complicates the process,” says Magoto, who handles a caseload of clients with serious or persistent mental illness, often coupled with substance abuse.

The crux of the problem is that it keeps professional counselors from helping an entire slice of the U.S. population — more than 40 million people. Senior citizens are far from immune to depression, suicide and other mental health issues, Magoto notes.

Magoto has worked with the ACA government affairs team through the spring and summer to draw Sen. Bennet’s attention to the need for counselor reimbursement through Medicare. She has met with Priscilla Resendiz, a constituent advocate in Bennet’s office, twice; last month, Magoto gave Resendiz a tour of the center where she works.

Resendiz was “incredibly receptive,” Magoto says. When they met for the first time in May, what Magoto expected to be a 10-minute session stretched to an hour and a half.

Dillon Harp, grassroots organizer in ACA’s Department of Government Affairs, says local advocacy, like Magoto’s efforts, is critical for S.1830 to gain momentum and support.

“(Resendiz’s) visit and the tour were a huge success and it was instrumental in Senator Bennet co-sponsoring this important piece of legislation. Denise was able to highlight the important work that LPCs do and show the staff member why this bill must be passed,” says Harp, who attended Magoto’s meeting with Resendiz in October. “Getting Senator Bennet’s co-sponsorship was a major milestone in ACA’s efforts to get this bill passed. Obtaining Senator Bennet’s support was a crucial because of his seniority in the Senate and because he is a senior member who sits on the all-important Senate Finance Committee, which has jurisdiction over the Medicare program. ACA could not have secured Senator Bennet’s support without all the advocacy work that ACA members in Colorado performed.”

Bill S.1830 was introduced into the Senate on July 22 by Sen. John Barrasso (R-Wyo.) and co-sponsored by Sen. Debbie Stabenow (D-Mich.). After its introduction, the bill was referred to the finance committee; It won’t go for a full Senate vote until more co-sponsors support the bill, says Harp.

One lesson Magoto says she’s learned through this process is to never think that your hands are tied, or that you can’t do advocacy work if you aren’t politically savvy. She admits she’s a novice when it comes to the intricacies of government. Magoto simply knew there was a problem that was affecting her daily work as a counselor and contacted ACA to see what could be done.

“Initially I had some fear … The biggest thing that I’ve learned is that it (advocacy) is a learning process and that’s OK. It doesn’t mean you shouldn’t (advocate or get involved),” she says. “Even though I had no idea what I was doing, I had a resource [ACA] to reach out to and walk me through it.”

(Left to right) Katherine Bujak-Phillips, Priscilla Resendiz (constituent advocate in Sen. Bennet's office) and Denise Magoto.

(Left to right) Katherine Bujak-Phillips, Priscilla Resendiz (constituent advocate in Sen. Bennet’s office) and Denise Magoto.

 

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To get involved in ACA’s advocacy for the Medicare bill, and other issues that affect professional counselors, email Dillon Harp at dharp@counseling.org or visit counseling.org/government-affairs

 

To receive ACA’s Government Affairs newsletter and action alerts, email dharp@counseling.org

 

 

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Seniors Mental Health Access Improvement Act of 2015

Follow the bill’s progress at congress.gov: 1.usa.gov/1QysDjy

 

S.1830 co-sponsors (As of December 2015; listed in the order in which they agreed to co-sponsor)

Sen. Debbie Stabenow, D-Mich. (original co-sponsor)

Sen. Al Franken, D-Minn.

Sen. Kelly Ayotte, R-N.H.

Sen. Jon Tester, D-Mont.

Sen. Thomas Carper, D-Del.

Sen. Kristen Gillibrand, D-N.Y.

Sen. Charles Schumer, D-N.Y.

Sen. Susan Collins, R-Maine

Sen. Angus King, Jr., I-Maine

Sen. Richard Blumenthal, D-Conn.

Sen. Michael Bennet, D-Colo.

Sen. Sherrod Brown, D-Ohio

 

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

 

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Ten intimate relationship research findings every counselor should know

By Sara Polanchek and Sidney Shaw

“Follow your heart but take your brain with you.” Relationship science has come a long way since Alfred Adler shared those words of wisdom, but they remain just as applicable today as when he Doveswrote them in the 1920s.

Modern scientific studies, ranging from smelling T-shirts (seriously) to connecting couples to skin and heart monitors while they discuss a topic of conflict, have changed our understanding of the scientific underpinnings of relationships. These studies have also informed improved approaches to bringing “your brain with you” as you follow your heart.

Our professional experience, both as relationship counselors and as instructors of undergraduate courses on intimate relationships, has cemented our belief in using the science of relationship to help both educators and individuals heed Adler’s words. In this article, we present 10 intimate relationship research findings that (we think) every counselor should know.

 

10) Health: Connection and intimacy improve health. Romantic relationships are correlated with overall well-being. More and more studies are showing that maintaining an intimate relationship provides protective factors in both emotional and physical health. Specifically, individuals who are engaged in a romantic relationship tend to report lower responses to pain, elevated immune responses, increased longevity and a greater ability to moderate their brain’s response to threat. A broader societal focus on enhancing the potential for individuals to form and maintain healthy connections with others could improve general health and life satisfaction for a significant portion of the adult population.

9) Changing trends and times: Culture matters in relationship. Relationship-related norms have changed dramatically during the past five decades. No longer is marriage the presupposed path of a relationship, nor does marriage generally have the staying power of previous years. Increased rates of cohabitation before marriage (60 percent today compared with 5 percent in 1960) and advanced age at time of first marriage are two more signs that times have changed. Furthermore, 41 percent of babies are now born out of wedlock, compared with 5 percent in the 1960s. The fluidity of many of today’s relationships can create complex co-parenting landscapes that have consequences for the individuals involved and their children.

As counselors, our beliefs may be textured by demographic patterns of a prior generation. How might our beliefs and values influence our work? What are our attitudes toward the institution of marriage? Cohabitation? Divorce? What does the term traditional family currently mean?

Our awareness of changing relationship trends and the contemporary influences that have resulted in these changes provide an essential backdrop to our practice as counselors. Of the many influences that have led to the ongoing shift in modern norms concerning relationships, three stand out.

  • Economics: In industrialized societies, individuals are better able to support themselves without relying on a partner to fill in the gaps. Women in particular are less financially dependent than in previous generations and, therefore, less tied to marriage as a fundamental need.
  •  Individualism: Western cultures have a stronger focus on self. In part, this means that individuals want more out of their relationships — more excitement, more passion, more devotion — and feel justified in seeking new partners if these needs aren’t being met.
  • Technology: Technology has opened up the dating world, expanding potential partner choice from a very limited geographical proximity to a literally global “market.” Via social media and online dating sites, individuals can compare their partners’ perceived shortcomings with an infinite number of alternatives. In addition, a long-distance romance ignited through Skype is easily snuffed out when one partner returns to “single status” on Facebook or other media. In such instances, the ease of technology can deny individuals the growth opportunities that result from the discomfort of breaking up in a sensitive fashion.

8) Growth beliefs: The downside of a soul mate. The belief in a one-and-only soul mate is a very enticing notion. The prospect of finding that one person who is “perfect” for us or whom we were “meant” to be with seems embedded in our cultural lexicon. According to some scholars, the notion of the soul mate dates back to ancient Egypt some 5,000 years ago, but it is a belief that still largely persists in our culture today. A 2011 Marist poll found that 73 percent of Americans believed that destiny would lead them to their soul mate; the percentages of women (71 percent) and men (74 percent) who held this belief were roughly the same.

Belief in a soul mate is closely aligned with what modern researchers refer to as “destiny beliefs.” In contrast, people who hold “growth beliefs” adhere to the outlook that relationships naturally involve conflict and that challenges in the relationship can be overcome. It is easy to see how growth beliefs can translate into an approach that embraces conflict and struggle as inherent elements of relationships. People who are higher in their growth beliefs about relationships tend to deliberately engage in more relationship-maintaining behaviors and actively plan ways to resolve conflict in relationships than do those who are lower in their growth beliefs. Individuals with strong growth beliefs tend to view relationship conflict as normal and often interpret this conflict as an opportunity for growth and expansion.

Counselors who understand these differences are better poised to support their clients as they struggle to identify well-suited partners and to help ground their clients with a more realistic view of long-term relationships.

7) Perpetual problems: Not all problems should be fixed. Conflict makes frequent and unavoidable appearances in every relationship. Commonly, couples view the sources of conflict as problems to be fixed or solved. However, well-known relationship researchers Julie and John Gottman report that an astounding 69 percent of relationship problems are perpetual. These problems don’t have a solution and are therefore not going to get “fixed.”

Couples who approach all problems with a “solve it” mentality will find themselves in gridlock — terrain that is wrought with frustration and angst. It is critical that counselors reframe this gridlock and shift the focus away from resolution. In other words, help clients stop trying to fix every problem. Instead, focus on dialogue around the problem through a lens of compassion and understanding. Counselors can coach their couples as they develop the skills necessary to soften the edges of conflict and elicit the emotional security necessary for each partner to feel safe inside this process.

6) The magic ratio: Bad is stronger than good. Although negative interactions play an important role in relationships (for example, challenging an unfulfilling status quo or shining light on unproductive communication patterns), couples and families attending counseling are often there because they lack a healthy balance of positive and negative interactions. They are in a state that Robert Weiss referred to as “negative sentiment override.” For a healthy balance of positives and negatives, the “magic ratio” is 5 positives (minimum) for every 1 negative.

According to the Gottman Institute, the 5-to-1 ratio is typical of conflicted couples that are at relatively low risk for divorce. Among happy couples, however, that ratio is about 20-to-1. Thus, when working with couples and families, aim for positive sentiment override and assist clients with understanding their partners’ perception of negatives and positives. One partner may think that he or she is engaging in a positive interaction, but the other partner may not experience it as such. In a way, strength-based counseling is a modeling of this balance of negatives and positives. A helpful exercise for counselors is aiming to keep track of their own perceived positive-negative ratio in interactions with clients.

Acknowledging the need to increase positive interactions does not diminish the need to thoughtfully address the important role of negativity in relationships. As counselors know, all negative interactions are not created equal. A few guidelines for navigating negative interactions can provide clients with concrete tools.

First, when introducing a topic that may be perceived as negative, it helps to use a “softened startup.” Basics of this approach include beginning slowly and neutrally, using I statements, choosing an appropriate time to bring the topic up and placing emphasis on making a request as opposed to an accusation.

Even with these softened techniques in mind, negative feelings in the aftermath of conflict can still arise, but repair attempts can re-establish the healthy balance of negatives and positives. Repair attempts refer to acts that lower tension from a negative interaction. These may include suggesting a timeout, offering an apology, using a gentle demeanor or engaging in a kind act. Whatever the case, repair attempts, softened startups and a focus on increasing positive interactions are all aimed at nudging a couple into positive sentiment override and reaching that magic ratio.

5) Psychophysiology: A calm brain is more thoughtful and compassionate. In the context of love, an alarmed brain is a brain that is not at its best. Relationship researchers now have sophisticated tools to study the neurological and autonomic underpinnings of emotion. Diffuse physiological arousal occurs when emotional triggers elevate an individual’s heart rate approximately 20 beats per minute above typical. In this state, an individual’s ability to access compassion and empathy, laugh, listen or express affection is severely limited. Each of these actions is known to diffuse, or at least soften, hostile conflict.

Counselors can provide clients with important relationship tools by helping them understand their idiosyncratic triggers and teaching them how to moderate the impact of these triggers on their physiology. Individuals can learn myriad mind-body techniques that moderate physiological arousal and activate the body’s natural relaxation response.

4) Androgyny: Traditional gender roles can be detrimental to couples. Gender roles in society serve the function of defining roles based on sex. However, the simplistic, dichotomous view commonly reinforced by societal norms can be quite limiting and can negatively affect intimate relationships. Historically, the terms masculine traits and feminine traits have been used, but today’s researchers predominantly apply the terms instrumental and expressive to refer to different traits. Instrumental traits refer to task-oriented behaviors — for example, assertiveness, ambition, decisiveness, rationality and self-reliance. Expressive traits refer to traits involving emotional and social skills, including characteristics such as tenderness, compassion, empathy, warmth and sensitivity to others.

Stereotyped gender roles have generally reinforced either instrumental traits or expressive traits based on a person’s sex identification. However, research continues to demonstrate the untoward effects of such narrow, stereotyped roles. For example, numerous studies have found that adherence to traditional stereotyped gender roles is significantly associated with relationship violence and justification of violence. Additionally, in a 2006 study, Heather Helms and colleagues found that spouses who follow stereotyped gender roles tend to have marriages that are less satisfying and happy than do couples that have more nontraditional gender roles.

There may be a tendency, because of socialization, to think of instrumental and expressive traits as opposite ends of a continuum. More accurately, these traits are essentially sets of skills, and a person can be low or high in these skills. The ability to utilize instrumental and expressive traits fluidly as dictated by the situation has been shown to be associated with more contented relationships. For numerous reasons, holding tightly to traditional gender roles can be detrimental for individuals and society. By teaching and cultivating awareness of the benefits of androgyny (embodying both instrumental and expressive traits), counselors can help couples build more satisfying relationships and become more well-adjusted individuals.

3) Passion paradox: Passion can have a downside. The novelty that accompanies young romantic love quickens our hearts and fills us with renewed vigor and passion. Some individuals report feeling superhuman and, indeed, many can tolerate pain at levels that would be quite unpleasant absent the vision of their new lover’s face to stimulate the release of pain-muting hormones.

However exciting and fun these passionate feelings may be though, they can also cloud our judgment and push our behaviors in directions that may not serve our best interests. For example, the flood of feel-good hormones that accompany a new relationship can mask the evidence of traits that are unhealthy for long-term relationships, such as reactive jealousy, possessiveness, dependency and so on. Similarly, in the early stages of a relationship, a couple may make choices (cohabiting, becoming pregnant, etc.) that the partners might avoid or delay if they were viewing each other with more clarity. In other words, commitment decisions might best be made after the novelty of a new relationship has waned and the realities of the partners’ true characteristics have had a chance to surface.

By addressing the common confusion between passion and intimacy, and discussing the normative processes of passion, counselors can help clients understand and respond thoughtfully to the developmental progression of most relationships.

2) Conflict and dialectics: Conflict and dialectics are ubiquitous. One of the most basic rules of conflict is that it is unavoidable. However, clients and counselors alike sometimes approach conflict as something to be snuffed out or avoided at all costs. Counselors can help improve intimate relationships by encouraging clients to approach conflict as an important thread woven into the fabric of relationships and teaching them to develop relationship skills to navigate conflict in a way that promotes personal and relational growth.

Research into relational dialectics — meaning the opposing tensions, motivations or philosophies that exist in intimate relationships — informs our approaches to dealing with conflict. Examples of these dialectics include autonomy/connection, openness/closedness, stability/change and integration/separation. According to dialectical theory, each of these domains contains a tension that can never fully be resolved. For example, working toward stability and predictability in a relationship can jeopardize the needs of one partner (or both partners) for change and unpredictability, which may result in a mundane relationship that lacks excitement. Providing psychoeducation about the inevitability of dialectics can soften its energy inside a relationship and open pathways for intimacy that may otherwise be thwarted.

1) Sexuality: “Good enough sex” is good enough. With few exceptions, cultures all over the world continue to accept a double standard inside the sexual relationship. Particular to Western culture, males are expected to want sex all the time, and success is determined primarily by the occurrence of orgasm. Females are expected to be sexually quiet and to fall in line with the whims of their husbands or boyfriends, and success is a secondary consideration reflecting male technique and his ability to “deliver” an orgasm to the female.

Ubiquitous messages from media serve to reinforce these roles. Although not a simple task, proponents of egalitarian sexuality encourage couples to avoid falling prey to the gender stereotypes that can inhibit sexual freedom. An expanded (and, sexual researchers might say, superior) version of sexuality emphasizes a focus on multiple facets beyond orgasm — nongenital touch, emotional intimacy, fun and stress release, to name a few — that can be cultivated in any relationship.

This “Good-Enough Sex” model, first introduced by Michael Metz and Barry McCarthy, challenges aforementioned stereotypes and instead emphasizes flexibility (with regard to expectation and prescribed roles), egalitarian desire and pleasure. A major premise of this model is a focus on realistic expectations. According to Metz and McCarthy, the couple that understands and accepts that up to 15 percent of sexual encounters will be dissatisfying is more likely to persevere and reconnect than is the couple that erroneously expects all sex to be “successful.”

Given that dysfunctional sexuality can erode couple intimacy, it is worthwhile to assess and explore this domain of the couple relationship with clients. Counselors can help clients untangle the embedded socialized behaviors that disrupt the pleasure processes and provide information regarding realistic sexual expectations.

Conclusion

As highlighted in this article, recent advances in relationship science provide counselors with new tools, techniques and insights to apply to their practice. As scientific study deepens our understanding of the mechanisms, motives and context of relationships, we are better equipped to help individuals and couples come to a better understanding of healthy relationships, their partners and themselves.

Relationships are inseparable from human history, yet the cultural context of relationships is ever changing — perhaps seldom more so than in recent decades. Cognizance of the drivers and impacts of these changing norms, as well as the cultural proclivities we inherit from the idiosyncratic nature of our own upbringing, can further empower our work. Staying abreast of the burgeoning field of relationship-related research is a daunting task, yet never have counselors been better equipped to help others take their brain with them as they follow their heart.

 

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

Polancheck

 

Sara Polanchek is the clinical director in the Department of Counselor Education and Supervision at the University of Montana in Missoula. Contact her at sara.polanchek@mso.umt.edu.

 

 

Shaw

 

Sidney Shaw is core faculty in the clinical mental health counseling program at Walden University and a certified trainer for the International Center for Clinical Excellence. Contact him at sidney.shaw@waldenu.edu

 

 

 

Letters to the editor: ct@counseling.org

 

 

Extending the reach of counseling

By Laurie Meyers

People in need of help don’t always show up automatically on counselors’ doorsteps and request services. Sometimes counselors have to be intentional about first forming connections with potential clients and inviting them to investigate the therapeutic process. In other instances, counselors may Mountain-Climber-Helpneed to get out of their offices and connect directly with people in their own environments to even make them conscious of counseling and let them know that help is available

The American Counseling Association members we spoke to for this article have engaged in different kinds of outreach and advocacy efforts so they can better assist communities in need. In the process, they have deepened their own understanding of different cultures and client populations.

Traffick stop

Human sex trafficking is not something that is limited to developing nations. The practice also goes on in the United States and is more common than most people would ever imagine, according to Stacey Litam.

A doctoral student in counselor education and supervision at Kent State University in Ohio, Litam also works as a licensed professional counselor (LPC) and clinical resident at Moore Counseling and Mediation Services in the Cleveland/Akron area. The practice, which specializes in mental health and substance abuse treatment and mediation, has developed a partnership with the Cleveland court system to identify and assist women who have been or are currently being trafficked for sex.

The practice’s CEO, Martina Moore, has a doctoral degree in counselor education and advocates for trafficking survivors, but it was the Cleveland Municipal Court that approached Moore with the idea of collaborating to create a human trafficking docket (a list of legal cases to be tried in court), says Litam, who became part of the collaborative team at the time of her hire in October 2014. Litam notes that fellow Ohio city Toledo has the fourth-highest rate of human sex trafficking cases in the United States, and she suspects that the success of that city’s human trafficking task force influenced Cleveland’s decision to find ways to identify and help trafficking survivors. Moore Counseling staff members had previous experience working with the Cleveland Municipal Court on other specialized dockets, such as those being heard in drug court.

The Cleveland Specialized Human Trafficking Court Docket identifies women who have been charged with solicitation of prostitution and assigns them to probation officers who work with Moore Counseling to set up an evaluation. Litam conducts the evaluations, looking for criteria indicating that a sex worker is being trafficked or has been trafficked in the past. Sexual trafficking is defined as the recruitment, harboring and transportation of a person for a sexual act using force, fraud or coercion, Litam explains.

For many Americans, the phrase sexual trafficking conjures up images of kidnapping and forced servitude, of someplace “other” or foreign. Litam acknowledges that she held those same perceptions before she began working with the trafficking docket.

“When I first I got into this [work], I thought it was an issue that other countries dealt with,” says Litam, a board member of the Ohio branch of the Association for Humanistic Counseling, a division of ACA. However, she quickly learned that a substantial percentage of women and girls who engage in sex work are actually trafficked.

“I have probably completed about 45 assessments, and about three-quarters of those women met the criteria for trafficking,” says Litam, who adds that trafficking is “very insidious and pervasive.”

“A single woman might meet a man who helps her pay for food for her child or helps her with the rent,” Litam explains. “And then the guy says, ‘If you loved me, you would do this [have sex for money].’ He’s not using violence, but if the woman doesn’t do it, she may lose her housing or her child will go hungry.”

Another tactic that lures women into sex trafficking is a seduction of sorts, Litam says. A trafficker will pursue a romantic relationship with a woman, lavishing her with praise and gifts, until suddenly the woman “owes” him for the “gifts” of fine jewelry or nice clothing and has to pay off her debt, Litam continues.

In other instances, sex trafficking is all about survival, Litam notes, citing the experience of children living on the streets as an all-too-frequent example. “Children who are trafficked are usually runaways, ‘throwaways’ or [in many cases] LGBT [lesbian, gay, bisexual or transgender],” she explains. “Once they are on the street, they will be approached by a trafficker within 48 hours. Imagine that — you are an adolescent, and you are alone and need help. Traffickers are really good at finding them.”

Indeed, traffickers possess many of the skills associated with predators, such as the ability to sniff out the “wounded” and vulnerable, Litam continues. For many adult women who are trafficked, their journey to the streets began years earlier, because they were either trafficked or sexually abused as a child. In other cases, she says, women get caught up in trafficking to feed an addiction.

If Litam’s evaluation determines that a woman has been trafficked, she is eligible — after serving jail time for any solicitation charges — for the voluntary rehabilitation program that Moore Counseling has designed. The two-year program includes mental health counseling, intensive outpatient or residential treatment, substance abuse treatment and group counseling.

Trafficking survivors and women who are still being trafficked often live in unstable environments — typically with other women under the control of a trafficker, in housing they have a hard time paying for, with people who have substance abuse problems or in a home where they are being abused. In some instances, they may even be homeless. Living under such precarious circumstances makes it more difficult for these women to get off the street, let alone seek assistance for substance abuse or mental health issues, Litam points out.

“The two-year duration [of the rehabilitation program] was established in the hope that within this time period, our services would stabilize the client’s mental health, provide addiction treatment and aftercare, and help the client establish safe and stable housing,” Litam says. “Ultimately, I would like to see clients attend at least eight counseling sessions with me. Or, if the client is in need of substance use treatment, I would love for her to complete intensive outpatient treatment and aftercare while meeting with me once a week and perhaps continue to receive counseling afterward if needed.”

However, multiple factors keep many of the women from committing to the full program. “Women do not want to disclose,” Litam says. “I’ve never had a woman say outright, ‘Help me.’”

Some women aren’t ready to leave their traffickers, and those who stay, even if they are willing to come to counseling, are up against a fundamental problem. To the trafficker, time is money.

The women come to Moore Counseling and the rehabilitation program after spending time in jail, which can be as long as five days. By that time, the trafficker is already angry because he’s losing money, Litam explains. So the women are very vigilant and fearful of any time they spend away. Even an hour away will be noticed and questioned, Litam says.

“The benefit of counseling has to outweigh the cost of being away,” Litam says. Most of the women who are still being trafficked determine that isn’t the case, she concludes sadly. Many of the women who are eligible for the rehabilitation program will attend only a few sessions — or even just a single session. Litam says she treats each session as if it were the last one because, in many instances, it might be.

At a bare minimum, Litam makes sure that the women get a card that includes the phone number for the national human trafficking hotline. She also talks with them about having a safety plan, which involves figuring out where they can go, even if only temporarily, if they feel they are in danger. She encourages them to always have a “go” bag prepacked with any necessary personal items. Litam may also use motivational interviewing to help a client explore her ambivalence about her addiction or toward her relationship with her trafficker.

Women aren’t necessarily ready to engage in intensive counseling even if they are no longer being trafficked, Litam says. On average, trafficking survivors come in for four or five sessions before stopping, she says. But it’s not uncommon for these women to contact the program to begin counseling again a few weeks or months after their initial round, she adds.

“Some women may need to briefly touch on the trauma for a few sessions, take a few weeks off, then come back,” Litam explains. “I always welcome the women back when they do call. Trauma work is not on my time; it is on theirs.”

Litam uses a variety of techniques based on the client’s history and current circumstances. “Of course, every survivor will present with different needs depending on her individual resources and history. It’s whatever the client needs,” she emphasizes. “Sometimes they just want to sit and talk and not be judged. Sometimes it’s [the conversation] just about how worried they are about their child.”

One of Litam’s clients has made a significant amount of progress using creative-based interventions to express and release her trauma experiences. “We have also focused on addressing and reframing the cognitive distortions she developed while being trafficked,” Litam says.

Another of Litam’s clients has taken what she has learned through psychoeducation about how trauma affects the brain and applied it to her emotional regulation. “[She] finds peace in her ability to self-regulate her emotions outside of our sessions, has identified triggers and uses diaphragmatic breathing and progressive muscle relaxation as part of her daily self-care routine,” Litam says.

With other clients, Litam uses narrative exposure therapy to help them integrate complex trauma experiences into the context of their lives. “Establishing a timeline may look like placing a piece of rope on the ground with one end representing ‘birth’ and a balled up end representing ‘life that has yet to be lived.’ Clients place objects along the rope to represent positive and traumatic events along their timeline,” Litam explains. “Processing the trauma narrative in a safe place empowers clients to habituate to the trauma. Also, clients can feel empowered to see that much of [their] life has yet to unfold. It is a beautiful reminder and metaphor that things can get better.”

Litam also started a women’s resilience group at the practice where she works. She established it primarily to serve as an extra source of support for her female clients who have been trafficked, but she didn’t want the participants to feel labeled in that way, so she opened the group up to other female clients as well. She says the group represents a place where any woman can feel comfortable seeking peer support. Litam and several other counselors facilitate the group, which meets weekly.

Litam’s advocacy work doesn’t stop at her office door. She is also raising awareness within the law enforcement community about the prevalence of sex trafficking. Currently, she is working with a probation officer to set up a trafficking panel to better educate police officers.

Litam says police officers often lock up women for solicitation without looking for signs of coercion, even if the woman has visible bruises or other injuries. Her hope is that greater awareness by police officers about how common sex trafficking is might lead to earlier intervention and assistance for those being trafficked.

Litam is also an adjunct professor at Northeast Ohio Medical University, where she teaches students to use empathic communication in their patient interviews and examinations to look for signs that an individual is being trafficked or might be in danger. These indicators include constantly watching the door and being hypervigilant of her surroundings and the passage of time (time for which a trafficker will be wondering why she isn’t out making money).

Litam is also excited about research she is conducting with Jesse Bach, executive director of The Imagine Foundation, a nonprofit organization in Cleveland dedicated to ending human trafficking. Litam and Bach are studying human sex trafficker behavioral patterns, demographics and other characteristics in an attempt to establish a kind of trafficking “typology.” Their hope is that by identifying how different human sex traffickers operate, they can better understand how women (or men) are selected and kept under the trafficker’s control. Litam thinks that understanding these factors will also help identify intervention methods that might be more successful when counseling survivors and those currently being trafficked.

“Take, for example, a survivor who came from an unstable home and lacked a strong support system. Unfortunately, traffickers are predators and are excellent at identifying vulnerable women,” she says. “After months of ‘courting’ behaviors in which the trafficker convinces the woman he loves her and showers her with nice things, she may become conflicted in her ability to resist when he finally asks her to engage in commercial sex acts. This woman may need more intensive counseling on topics such as establishing appropriate boundaries, increasing self-efficacy, building strong support systems and CBT [cognitive behavior therapy] techniques.”

Litam says working with survivors and victims of human sex trafficking has become her passion. She believes that she can help these individuals not only by using her counseling skills with them but also by raising awareness of the prevalence of human sex trafficking.

“I would love for the average counselor to know that this is not a problem specific to Third World countries or inner cities, but that it is everywhere,” Litam says. She emphasizes that no neighborhood is exempt from human trafficking, regardless of whether that neighborhood is located in an upper-class suburb, a small town or even a rural area.

‘Learning’ rather than ‘teaching’

Counseling must always start with an understanding of the client’s cultural values, says Rachael Goodman, an assistant professor in the counseling and development program at George Mason University (GMU) in Fairfax, Virginia. This is one of the underlying tenets of counseling and a thread woven through all that counseling students learn as they work toward their degrees. However, Goodman says, experiencing others’ cultural traditions firsthand can impart an understanding that is more powerful than anything learned in the classroom.

In 2013, Goodman, as part of an effort facilitated by Counselors Without Borders, helped lead a group of GMU graduate students on a trip to the Pine Ridge Reservation in South Dakota. There they spent time with the people of the Oglala Lakota Nation as they prepared for and performed their annual Sun Dance ritual. Counselors Without Borders, founded by ACA member Fred Bemak, a professor of counseling and development and director of the Diversity Research and Action Center at GMU, is an organization committed to providing culturally sensitive humanitarian counseling in post-disaster situations.

Goodman thought it was particularly important for the students, who were taking a cross-cultural counseling class, to be exposed to other traditions. “It’s important for us [counselors] not to simply impose what might be misaligned Western models,” she says. “With any community, understanding what their traditions are is important for social justice so that we are not exacerbating marginalization.”

Goodman, who is also a member of Counselors for Social Justice, a division of ACA, planned the trip to coincide with the Sun Dance ritual so the counseling students could see practices that have both spiritual significance and a healing purpose for the Lakota people. A girl’s coming-of-age ceremony was also taking place at the same time.

Goodman and the students arrived before the ceremonies began to help with the preparations. For Lakota traditional services, the ground must be prepared in a certain way — for instance, the students helped build a circular space and a traditional arbor. (Because the Sun Dance is so sacred to the Lakota, Goodman says she is not comfortable giving details about the ritual). The counseling group also helped the young women with their rituals such as quilting and quillwork, which involves dyeing porcupine quills for use in traditional art.

These ceremonies have many healing and spiritual elements, perhaps the most important of which is a reclaiming of the Lakota culture, Goodman says. “It’s very important because of the history of genocide,” she elaborates. “For a long time, the United States government outlawed a number of native practices. The idea that you [as a Lakota person] wouldn’t be able to practice these ceremonies is in itself a trauma, so being able to perform them again is healing in itself.”

The Lakota are reclaiming not just their traditional ceremonies but also their native language, which was also outlawed for a long time, Goodman says. The group she led spent time with school students who were taking a language immersion class intended to sustain and widen the use of the Lakota language.

“I wasn’t aware of the importance of language in spirituality,” Goodman says. “They [the ceremonies] are conducted in Lakota, and if you don’t know [the language], you would have trouble understanding spiritual traditions.”

Goodman and her group also learned about the Lakota method of equine assistance therapy, which she describes as an interesting mix of Western culture and native practices. She says that for the Lakota, the horse doesn’t serve simply as a “feedback” instrument but rather is part of a person’s healthy connection to nature and all beings.

Goodman says all of the activities the group participated in taught the counseling students not only about Native American cultural practices but also helped them realize that counseling and therapy don’t necessarily have to occur in a formal, 50-minute, one-on-one sit-down. Counselors can provide support to clients and communities simply by listening, understanding and witnessing, she says.

Something else that struck Goodman during the trip was how the historical trauma of the Lakota is still very much a part of their present challenges. The people she spoke with emphasized that while the media and even well-meaning helping professionals often focus on issues such as substance abuse and violence on Native American reservations, they are seeing only the surface issues and not recognizing the historical trauma that underlies it all.

The people of Pine Ridge also had a parting message for Goodman and her group: “Let people know. Go back and tell our stories.”

Creative college counseling

Sometimes the biggest need for outreach is in a counselor’s own backyard — or campus. College students remain one of the counseling profession’s most underserved populations, not because there aren’t counselors available to help students but because these students are unlikely to come to the college counseling center for help, even when they desperately need it.

Research indicates that many college and university students aren’t just stressed, but depressed and anxious as well. In fact, 42.4 percent of the almost 75,000 undergraduate students who completed the 2015 annual American College Health Association National College Health Assessment reported experiencing more than average stress within the past 12 months, and 10.3 percent reported feeling tremendous stress. When asked about depression and anxiety during the previous 12 months, 35.3 percent of survey respondents reported feeling so depressed that it was difficult for them to function; 57.7 percent indicated feeling overwhelming anxiety.

At the same time, only a fraction of students in distress appear to be seeking help. The 275 college and university counseling centers that participated in the 2014 National Survey of College Counseling, an annual report sponsored by the American College Counseling Association (ACCA), a division of ACA, reported that only 10.9 percent of college or university students had sought services at a campus counseling center in the past year.

Clearly, “build it and they will come” is not a fitting slogan for campus counseling centers. Tamara Knapp-Grosz, who was the director of the Savannah College of Art and Design (SCAD) counseling center for 15 years, wondered what might happen if the center was proactive about going to the students instead. She started the process by offering workshops on depression at the counseling center and at various other campus meeting facilities, but most students still chose to stay away.

“I started thinking, ‘What is the goal of outreach?’” says Knapp-Grosz, an ACA member who is leaving SCAD to become director of the counseling center at the University of North Texas. First and foremost, she believes college counseling outreach should build a connection not only between the counseling center and the students but also between the students themselves because they have the potential to serve as secondary sources of support for one another.

But Knapp-Grosz, who had become interested in positive psychology during the beginning of her tenure at SCAD, was also struck by the idea of creating “shifts in the energy and atmosphere” during stressful times such as final exams. As she and the counseling center staff brainstormed ways to bring some positivity and levity to the students, their first creative outreach endeavor was born.

When stress levels got high, the counseling center staff and interns would visit various classrooms and celebrate a famous artist’s birthday. Knapp-Grosz, the immediate past president of ACCA, wanted to truly personalize the events and target the students by their areas of study, so the birthday parties were specific to the students’ specialties. For instance, a class of painting students might celebrate Van Gogh’s birthday with a themed cake and trivia. A birthday party for Peanuts creator Charles M. Schulz, thrown for students in the sequential arts (narratives accompanied by illustration such as those found in comic strips, graphic novels and storyboards), produced laughing and dancing, she notes. Word would spread throughout the building about the birthday parties, attracting additional students to join the celebrations.

The birthday party tradition continues through the present day, and Knapp-Grosz believes the benefits extend beyond providing students a brief break from stress. “Students start to connect with each other,” she points out.

They also start to connect with the counseling center personnel. Fliers detailing the services that the counseling center offers are always available at the parties, but that is secondary to the influence of the interactions between the counseling staff and the students, Knapp-Grosz asserts. By being at these “parties,” counseling staff are introducing themselves in a nonthreatening way and helping students become familiar with mental health professionals, perhaps even demystifying their role in the process, she says.

Other in-classroom interventions include “brain breakers,” a brief interval during which a counseling center staff member arrives with a limbo stick and music and invites students to limbo.

Yet another outreach tool, the Pizza Fairy, has achieved almost cultlike status, Knapp-Grosz says with amusement. The Pizza Fairy is a counseling center staff member who shows up in the student residence halls with free pizzas (accompanied by counseling center fliers) that are donated by a local hospital. There is no set schedule, so it is always a surprise when the Pizza Fairy appears.

“He’s become almost an urban legend,” Knapp-Grosz says. “People will text each other about it — ‘Have you seen him? Is he coming?’” In fact, students have even shown up at the counseling center looking for the Pizza Fairy, she notes with satisfaction.

The creative outreach doesn’t stop there. The counseling center has also featured Doughnut Divas who dressed up in costumes and handed out doughnuts in front of classroom buildings in the morning. The Doughnut Divas were replaced by Granola Goddesses when the students requested healthier food.

Then there is a certain iconic character in a big red suit who makes appearances on campus. “Toward the end of the quarter, we do ‘psycho Santa,’” Knapp-Grosz explains. “[Staff members or interns] put on a typical Santa costume but with goofy socks or something, and we’ll have an article about [topics like the] holiday blues. They [the Santas] usually go to the dining halls and hand out candy canes. We’ll sometimes have elves and reindeer too.”

The creative outreach seems to have paid off. Knapp-Grosz notes that over time, use of the counseling center at SCAD has risen to include approximately 50 percent of the student population.

The unconventional approach to outreach also seems to benefit the counseling center staff, Knapp-Grosz observes. “You have less burnout and compassion fatigue,” she says. “It’s refreshing to be out and about, and we are interacting with a broader student population.”

Knapp-Grosz says that before she starts making similar outreach plans at her new job at the University of North Texas, she will need to meet the center staff and learn more about the needs of the student population. She does, however, have an idea involving therapy dogs, inspired by her own dog, a standard poodle. As a breed, poodles have a penchant for dancing.

“If it fits the culture, I would like to have poodle dancing [in the classroom or other campus locations],” Knapp-Grosz says with a laugh. “I just think that would be really cool.”

Connecting with communities

Advocacy and outreach are two of the values at the core of the counseling profession, says ACA President Thelma Duffey, who has made counselor advocacy and outreach one of her presidential initiatives.

“I think counseling outreach provides a way for us to connect with our communities and to participate in advocacy and services,” she says. “It’s an opportunity for counselors to contribute to their communities by offering their areas of knowledge and expertise — at times to people who feel, and sometimes are, unsupported or disconnected.”

 

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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

Revisiting Ferguson

By Holly Wagner, Christina Thaier and Brian Hutchison November 17, 2015

[Editor’s note: Roughly one year ago, CT Online wrote an article about the initiatives the counseling department at the University of Missouri – St. Louis (UMSL) was engaging in as protests and turmoil rocked the city of Ferguson after Michael Brown, an unarmed black teenager, was fatally shot by a white Ferguson police officer, Darren Wilson.

This fall, we’ve asked some of those counselors to reflect on what they have experienced and learned since serving as witnesses to history and trying to help others find their voices as “storytellers.”

Brian Hutchison is a licensed professional counselor (LPC) and associate professor at UMSL; Holly Wagner is an LPC and assistant professors at UMSL; and Christina Thaier is a provisional licensed professional counselor (PLPC) working on a doctorate in counselor education and supervision at UMSL. They are all American Counseling Association members.]

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As a St. Louisan, I [Christina] have started to mark time — or perhaps how I recognize myself or my city — as before, during and after Ferguson. Post-Ferguson, one of the things I’ve come to understand is the power of the storyteller. I’d heard many times in history classrooms (which were not my favorite) that history is determined by the one who is telling the story. I believed it then, I’m sure, but I’ve come to understand it differently post-Ferguson, in a know-it-in-your-bones sort of way.

And so, as the three of us do our best to honor this opportunity to serve as storytellers about our experience of Ferguson, we do so recognizing the weight of such a privilege, knowing there are voices more worthy than ours to do so, and hoping to honor the young man (Michael Brown), our fellow St. Louisans and the city the story truly belongs to.

From Holly Wagner: A time to respond, a place to be heard and a space where crisis and growth convened

Timing can mean a lot in life. When someone is asked why a certain decision was made or a sequence of events occurred, the response is often about timing. For example, we often hear folks say, “It’s time for a change” or “It’s about time” or “It just wasn’t the right time.”

As I reflect on the events that led up to the crisis in Ferguson in August 2014, as well as the community responses following Michael Brown’s death, the concept of timing and time seem significant. For the people of Ferguson and the surrounding North City of Saint Louis, it was “past time for a change.” The time had come for their voices to be heard. In our own small, unique way, the faculty and students at UMSL showed up to listen.

August 2014 was my first semester as a faculty member in the UMSL Department of Counseling and Family Therapy. I had literally just arrived on the UMSL scene when it was time to respond. It was time to act, to do something helpful, and there was no time to be hesitant about it. I remember feeling overwhelmed by the energy and intention that surrounded me as my new colleagues and students leapt into action, driven by a desire to be helpful, yet unobtrusive. We talked about how to show up in ways that would truly benefit the people who were hurting. The idea of the sand tray naturally emerged as a potential medium for expressions to come forth during the crisis.

Through previous experiences with sand tray work with both children and adults, I felt innately that it could be the conduit needed for peoples’ voices to be heard. We were intentional in framing our work as an expressive technique to facilitate storytelling rather than sand tray therapy. We approached the events simply with sand and figurines, as well as open ears and hearts. What transpired made it evident that this simple approach was truly all that was needed at that time.

I have often heard that the Chinese symbol for “crisis” also contains aspects of the word “opportunity.” At the time of the Ferguson crisis, it seemed difficult to hold those two words or truths together. It was hard to imagine something good coming from the pain and struggle that was so palpable at the time. As counselors, however, we understand that healing is a process that takes time and space during which meaning can be made. Over time, if we are given the space to create insight and meaning, we can adapt and grow in response to the trauma or crisis we experienced. Thus, this was our intention as we showed up to the various events surrounding the Ferguson crisis. We witnessed the immediate effects of freely expressed emotions, meaning making and insight, and relief and validation related to a story being told.

While it is more difficult to ascertain any long-term effects that our engagement may have had on our community members, it has truly been amazing to hear the accounts of the impact this participation has had on our own students’ growth, awareness and counselor development. For many students involved, working with a sand tray or responding to a community crisis had been solely discussed theoretically up until that time. Responding to our community’s needs allowed students an opportunity to experientially engage in ways that they found meaningful to their development as persons and [as] counselors, while igniting a passion for social justice work. It was a time we will never forget.

 

From Christina Thaier: Showing up

On a sleepy, snowy afternoon when I was 18 years old, I was complaining to a friend’s mom about how I didn’t want to get dressed up for a family member’s wedding that evening. She looked at me gravely, in that “I’m about to say something really important” sort of way, and offered some unrequested advice. As if it were an absolute truth, she declared, “You honor the people you care about by showing up” — she was talking about weddings, funerals, birthday parties, dinner parties and probably even church — “and you should take the time to look nice. It tells them that their celebration matters to you.”

In other words, go put on a dress and a smile, and act like you know better than to think you are the center of the universe.

Though I’m stubborn, and it took me longer than it should have to understand the wisdom of her words, they eventually became part of who I am and what I do. In August of 2014, when our city was in a state of crisis, when we had no idea what was going to happen next, what was the right thing to do or how to go about it, her words offered a familiar solace — you show up, where you are invited, if someone matters to you.

As school was opening, many of us were asking the same questions: As counselors-in-training, what is our role? What do we do? How can we be helpful? Dr. Brian Hutchison and Dr. Holly Wagner offered us an answer. They asked our chapter of Chi Sigma Iota, of which I was currently serving as president, to consider showing up with them.

They taught us how to build a mobile outreach unit made up of sand trays, story stones, paint and symbolic figurines. They told us there was no manual, no evidence-based protocol, no textbook or peer-reviewed article with the answers we needed. They were willing to let us see that they didn’t really know what healing tents at a protest might look like — but they went anyway.

I remember being afraid as I drove to the first protest with a car full of sand and figurines. Were we crazy? Was it safe? Did I have anything to offer? Would I say the wrong thing? Did I know what I was getting myself in to?

Viktor Frankl said that despair is suffering without meaning. We had hoped to offer others, in our own small way, an opportunity to discover something meaningful for themselves during this crisis. The truth is, we might have been the ones most moved by the experience.

It turned out that the few hours I spent with my colleagues, holding a space for strangers to tell their stories, was one of the most meaningful experiences of my life. We laughed and cried and mourned and hoped and, most of all, we witnessed human beings seeing and hearing each other as we truly were during Ferguson. To say it was beautiful is not enough.

 

From Brian Hutchison: Who am I?

I remember the last time I was called a racist. It was approximately 11 years ago. I believe at the time that this fact was no longer true, but it shook me deeply because I knew that at one time, early in my life and into my late teens, it was. At that time, I had never known a person of color, nor had I read the works of Baldwin or Biko or Douglas or Coates or any of the myriad authors who have shaped my worldview over the past 25 years.

Having been asked to reflect on my personal experience while working with residents and protestors in Ferguson, Missouri, following Michael Brown Jr’s death, my thoughts go back to that moment when I was last called a racist. I had already decided that much of my work would focus on issues of social class, urban poverty and black people, yet that wound — inflicted by the social experience of my youth and not the person who called me a racist — throbs with raw pain still today. And I am a person who is able to set that acute pain aside, who can deflect by focusing on the power of choice and mastery I feel in my life. In essence, I am a person who is male and white and straight and educated living in the United States in the early 21st century.

Who am I to be asked to be helpful to the mostly black community of Ferguson? Who am I to be asked to be helpful to the mostly black community of protestors? Who am I to be asked to help the mostly young, black community of organizers? More than anything else, being asked to reflect on my personal experience of being asked to help in Ferguson makes me think, “Who am I?”

My answer does not feel elegant enough to put to the page, yet I am compelled. I am a person who did not ask to be male, white, straight, able-bodied, and to have an opportunity to be this educated. The choices I have been given were not mine to decide when the seeds of their possibility were first planted. These choices are my privilege, but the choices for most whom I have met in the schools, community centers, tents and streets of the St. Louis community do not look like mine. They are not made with an ingrained sense of mastery and power. They are choices made despite the circumstances of their lived experience.

What I did choose was to say yes. I did choose to ask if I could be helpful versus demanding to help (from my privileged worldview in my privileged way). I did choose to show up as often as I could when asked but never to ask if I could show up. I did choose to do what was asked instead of what I wanted to do. These choices were simple, yet did not come to me easily because of my 44 years of accrued habits lived within my bubble of privilege.

The gifts I received were the knowledge that I can step outside of myself and be led by others, do have the capacity to work through my own history of guilt to be helpful and that there is something to be gained by counselors — all types of people who are counselors — if we simply say yes, be humble and show up when asked.

 

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(Clockwise, left to right) UMSL students Jeremy Kane, Korey Lowery, Emily Muertz, Christina Thaier, UMSL assistant professor Holly Wagner and Gabrielle Fowler create story stones during a protest in downtown St. Louis in October 2014. The group used story stones, sand trays and other therapeutic tools with protesters.

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As you can probably tell, the three of us can be taken back to during Ferguson quite easily. We look back at that time of crisis in our city and shudder at images we can’t unsee — violence and grief and so many raw emotions on every television, computer screen and headline. We see breaking news and front pages that paint a portrait of St. Louis as divided and conquered. All of that was part of the story, yes. But somewhere in the wreckage and loss, the black and white, the debate and the protest, mourners came together and explored what it meant to be a St. Louisan during, and then after, Ferguson.

In the last year, in post-Ferguson St. Louis, what have we learned? We know that history-making happens in the present. We know that art and connection have the potential to be transcendent. We know that words like “race” and “privilege” are easier to say with practice but not nearly as important as words like “value,” “worth” and “dignity.” We know that holding a space for someone else is a gift for both parties. We know that people will surprise us — for the good and the bad. We know that our city needs more change and that we love her despite her imperfections. We know that we want to continue being part of that change. We know we don’t really know what that looks like, and we can’t find the answers in our textbooks or journals or empirical truths. But we think it might start by showing up. And listening.

 

The UMSL sand tray team (left to right), Brian Hutchison, Katy Leigh, Brianne Overton, Jennifer Culver, Susan Kashubeck-West and Holly Wagner, pictured at a wellness night event organized soon after the 2014 protests began. Leigh, Overton and Culver are UMSL doctoral students; Hutchison, Kashubeck-West and Wagner are UMSL faculty. The wellness night was sponsored by the Organization for Black Struggle and the Hands Up Coalition to provide those who had been sleeping out at night for days a place to rest, eat, get a massage and do some sand tray storytelling, says Hutchison.

The UMSL sand tray team (left to right), Brian Hutchison, Katy Leigh, Brianne Overton, Jennifer Culver, Susan Kashubeck-West and Holly Wagner, pictured at a wellness night event organized soon after the 2014 protests began. Leigh, Overton and Culver are UMSL doctoral students; Hutchison, Kashubeck-West and Wagner are UMSL faculty. The wellness night was sponsored by the Organization for Black Struggle and the Hands Up Coalition to provide those who had been sleeping out at night for days a place to rest, eat, get a massage and do some sand tray storytelling, says Hutchison.

 

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See Counseling Today’s article from one year ago, “Storytelling and hope in Ferguson” at wp.me/p2BxKN-3L6

 

 

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A woodworker’s perspective on the journey of counseling

By Peter Allen November 13, 2015

These days, when I’m not working with clients, I find myself spending more time in my home woodshop, a place where I feel free, creative, expansive and courageous. In spite of this, it is also a place where I have made plenty of half-hearted attempts and experienced numerous failures.

Recently, I have noticed several meaningful connections between the art of therapy and the art of woodwork. I have a profound love and admiration for both of these pursuits. They have both challenged me in manifold ways and exposed me to growth experiences.

Allow me to further explain. I love working with reclaimed wood — that is, wood that has been used before in another capacity. Reclaimed wood tends to be old and scarred. It is often discolored from weathering and the simple fact that it has existed in the world for years. For this reason alone, much of it ends up in the landfill. Some people might describe reclaimed wood as “unworkable” or “not worth it” or “no good.”

I have seen that people can be like this reclaimed wood. Their years in the world and their experiences often leave them marked, hardened or scarred in certain ways. They can even come to think of themselves in the same terms that get applied to reclaimed wood: “I’m no good.”

My primary task as a counselor is to see past this patina, weathering and scar tissue left by old traumas. Often with clients, I can clearly see their potential, but they cannot … at first. Sometimes I need to hold their potential in my mind until they can see it. This is often as vital as establishing rapport — maintaining a solid belief in the client’s intrinsic value, beauty and purpose in life, even when the client can’t.

The first thing you need to know about any wood is that as long as it’s not rotten, then it has beauty and purpose left to offer the world. Because my belief is that no person is ever truly rotten, I operate from the assumption that all people have this beauty and purpose just waiting to be discovered and expressed in their lives. This assumption is not born of unrealistic naïveté but rather of my actual experience of working with clients in the counseling profession. A big part of my task is simply to help my clients rediscover their beauty and purpose.

The second thing you need to know about wood, especially battered and bruised wood, is that sanding it can make a world of difference. Another way of saying this is that helping to smooth out the rough edges can work miracles. But let me tell you bluntly, if you don’t like sanding, then you won’t like woodworking.

So it is with my profession. If one doesn’t like working to help people smooth out their rough edges, then one won’t like being a counselor. From my perspective, the first way we go about removing a rough edge is to learn better communication skills. This skill can transform yelling, cursing and sullen withdrawal into “I feel” statements and assertive feedback. We help clients learn how to express themselves so that others can and will hear them, and that opens the door to greater mutual understanding. Just as sanding the wood makes it more pleasing to touch, better communication makes whatever a person has to say more accessible and easier to receive for the listener. When we remove harsh angles or tones, the overall experience becomes smoother.

Counseling and woodwork require a remarkably similar approach. Over the years, I have discovered that I do my best work in the woodshop when I approach the art with humility, patience and few if any judgments about what I “should” be doing. Conversely, when I approach my woodwork or my clients with frustration, impatience or hidden agendas, the work gets tends to stall and get bogged down. Thus, the hidden truth of success as a woodworker or counselor lies less in specific technique and more in how one shows up to each encounter. So, I strive to live my life in such a way that I can show up for my clients and practice my craft with skill.

Patience did not come naturally to me. I had to practice … a lot. And I have gotten better at it. In both counseling and woodwork, an old saying holds value: One can either do it quickly or well … but not both. So, it holds true again that specific techniques are less important in both disciplines than having patience and awareness of my own emotional state as I engage in the process.

This leads us to another noble truth about these pursuits: There is no substitute for the process of trial and error. There is no 60-minute class that will lead to mastery of woodwork once the hour has concluded. Likewise, there is no miracle intervention I can offer to clients to make them get well. Practice makes the master, and this is the case in counseling. Developing skillful means in woodworking, counseling or one’s life requires the same elements: desire, courage, the proper tools and a tolerance for discomfort, diligence and flexibility.

Our culture places a high value on giving advice. Although I do provide skills training and psychoeducation as a counselor, I rarely provide advice to clients. I have found that advice is often given to manage the speaker’s anxiety rather than to assist the listener. This is no different in the counselor-client relationship. Counselors can fall into the trap of needing to “fix,” or being the expert. woodworking toolsThen we may dole out advice and thereby attend to our need to be competent rather than attending to our clients. Even a master woodworker’s instruction alone cannot turn another person into a master woodworker. Only many hours in the shop can produce a master.

Rather than giving advice, I try to offer clients an experience in which they can experiment with new modes of thinking, feeling and being. I provide a safe place to conduct these experiments and inquiries into the nature of self. This is what my woodshop offers to me: a safe place to try and to fail, to learn and to grow.

After such experimentation, trial and error, frustration and retooling, the client decides what works well and what doesn’t for his or her particular context and values. Whether working with humans or old wood, what works well and what doesn’t becomes clear in time. So, ideally, we will begin to apply the lessons of any given experience to the next experience coming up. That is called growth and change.

Sometimes in session or in the woodshop, I find myself going back to old habits. I get impatient; I have an agenda. Each time I have this experience and become dissatisfied with the results, I am less likely to duplicate it in the future.

To revisit a theme I mentioned earlier, my discipline becomes less about figuring out what is “wrong” with clients or how to “fix” them and becomes more about caring for myself so that I may be present with people when the time comes. I do my best woodwork when I am curious, patient and attentive to conditions in real time. I always start with a vision and some idea of direction, but I remain flexible enough to take in new information and change course if that is indicated. Working with clients is exactly the same. I never know what may come up, so I remain fluid in my approach.

In woodworking, people often mistake hard work for talent. In my case, I started off with very little talent for the art itself, but my diligence and practice paid off. The first time I tried to make dados with a router, it was a miserable failure (forgive the shop talk). The 10th time I tried it, it went pretty well. I am proud to be a novice woodworker because it means I have so much wonderful learning ahead of me.

Likewise, in counseling, talent has little to do with success and results; hard work has everything to do with success and results. If we are developing, for example, the skill of holding boundaries with other people, it is likely that we will have great difficulty doing so initially. However, it is highly unlikely that this will be difficult to do the 100th time we attempt it. By the 1,000th time, we no longer try to hold boundaries; we hold boundaries. After trying to route dados dozens of times, I longer attempt it; I simply do it. It’s become a skill instead of a challenge.

Clients do this same thing over and over in counseling. They turn challenges into skill sets that they become confident in using. Whether I’m in the woodshop or the client is in my office, as our skills sets increase, the possibilities of what we can achieve also increase.

I like to build simple furniture such as coffee tables and farmhouse benches. I also like to help my clients assemble new selves from all the various pieces they have been working on. A bench is assembled one piece and one step at a time. Each piece requires a certain skill set to complete. And so must a client work on communication first, and then emotional awareness and literacy, and then distress tolerance or emotional regulation, and then boundaries, and so on and so forth (or this order could be completely different).

Whatever path the client takes, once these pieces have been developed, they can be assembled and integrated into something — or someone — that is greater than the sum of its parts … just as the bench is greater than the old, landfill-bound individual pieces of wood that compose it. Having done this hard work, in no way has the fundamental character of the wood or the client been altered. We have simply cleared away the obstacles blocking a full realization of the inherent potential contained within.

To paraphrase what Michelangelo famously said about his statue David, the sculpture was inside the marble all along; he just had to clear away whatever was incongruous to David. A person’s beauty and purpose have been there all along. As counselors, we simply work to clear away what prevents that beauty and purpose from being realized and expressed.

 

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Peter Allen is the program director for College Excel (collegeexcel.com) in Bend, Oregon. The company helps college-bound young adults who have attention-deficit/hyperactivity disorder, depression, anxiety and executive functioning deficits to succeed academically. Contact him at petercallen@gmail.com.