Monthly Archives: May 2016

Nonprofit News: Finding work in nonprofits as a new counseling grad

By “Doc Warren” Corson III May 31, 2016

You have your sheepskin in hand, your name in large letters and the words “Master’s Degree” seemingly beaming out for the whole world to see. The high of the ceremony is still floating in your head when it suddenly hits you: I NEED A JOB!!!

You may start off confident enough, but then realize that you are competing with everyone else that just graduated and those who are already in the counseling field. You may find yourself feeling overwhelmed, possibly hyperventilating and contemplating curling up in a ball while waving your hands in front of your face. (What is it about that hand motion that helps folks find calm? That so could have been your research project …)

job searchI mean, you could do that or you could develop a cogent plan for success. The choice is yours.

I’m making a couple of assumptions here. The first is that you are looking to make a real and lasting impact in the counseling profession. The second is that you realize you need to get a start somewhere before you can make great strides.

The first real option is to take a job ANYWHERE that will hire you. This often means the HUGE nonprofits that seem to chew up and spit out clinicians with abandon. You know the type. They are often referred to as the Wal-Mart of mental health care in your state. They often pay 20-30 percent more than the smaller places and may offer as much as a $50,000 bonus if you stay two years past licensure. Yet few folks make it to that point. You have to wonder how bad the working conditions are if they pay so well and offer so many bonuses yet still have a turnover rate of 60 percent or more.

Still, they are a viable option that should be explored. God knows I worked in some hellish conditions while cutting my teeth in the profession, and you likely will too, so why not make a few extra bucks in the process? (I never did because I always chose to work at the underdogs.) If you have a degree, a warm smile, a pulse and a few references, you have a good chance of being able to enter the mill. If, however, you are striving for a bit more, read on.

Smaller counseling nonprofits often lack the pay or benefits of the Wal-Marts but often provide you with the chance to hone your craft alongside a dynamic group of folks who are not as caught up in red tape, position, power and hierarchy. These smaller nonprofits give you a chance to learn on your feet and work beyond the confines of a “normal” clinician to better prepare you for all phases of programming. Of course, you need to want to take on this kind of challenge or it won’t be a good fit.

Take my position, for instance. I direct two small programs, one that is a “regular” counseling setting and one that is a therapeutic farm. In the past week, I have done dozens and dozens of clinical sessions, consulted with a few programs, installed and reengineered drip and regular irrigation, worked with heavy antique equipment, done some electrical work, conducted interviews and dabbled a bit with music in therapy. Oh, I also worked with animals.

Not quite what they prepared me for in the seven educational programs from which I graduated, but totally what I love to do.

So, if you want to try to get a place in a smaller nonprofit — one that lets you experiment and leave the confines of a cubicle or office and one that does dynamic things — you should probably start by showing the nonprofit that you are a dynamic person.

As an interviewer, I often see folks who can be described as one-trick ponies. Sure, they know at least the basics of counseling, but their résumés or curriculum vita don’t typically show me other talents or interests. Your interests may not relate directly to your counseling job, but they may help you relate to clients.

Years ago, I was called to consult/debrief and perform crisis work with a welding crew that had just seen a co-worker die in the field. When the team leader learned that I had once been certified as a welder, he welcomed me into the crew quickly. Even the most resistant worker said they felt comfortable with me because I was “one of them.”

So let potential employers know about some of your nonclinical skills because it may help you get the job. Your work at a teen center or cleaning crew, your hiking adventures, your handyman skills and so on may just fill a void in a nonprofit’s current team dynamic. My wife once got a job in part because she was an avid quilter — and so was the person interviewing her. Sure, she had all the right qualifications and more, but so did others. Having something that the team needs and or that the interviewer personally cares about can make a real difference.

As a new grad, you likely lack a proven track record or reputation. This can hurt you; let’s not pretend otherwise. But what have you done besides take classes? Were you in the student government? Leadership skills totally impress most folks. Did you help organize a rally, benefit, public event or related activity? This shows eagerness, dedication and organizational skills. Maybe you took the summer off and hiked the Appalachian Trail. This demonstrates an ability to get things done and to perform self-care. That classic car that you rebuilt with a friend shows the ability to delegate and problem-solve and that you are unafraid to take risks or get dirty. Were you in ROTC, Police Explorers or a similar program? If so, that shows that you can follow directives. Military experience is always a plus too.

How is your eye contact in interviews? It’s important to maintain good eye contact without looking like you are challenging the interviewer to a stare down. Yes, that has actually happened to me and, no, that person did not get the job. Be friendly, be confident, be real.

What can you offer your potential new boss that the other applicants may not? I always tried to sell that I could work alone or in groups and that I could work well under good supervision, but that I could also excel if left alone to get the job done. I also sold that I was multifaceted and calm under fire.

When asked to give an example of how I handled stress, I shared a true work story. I was once trapped in an elevator because of a power outage. There was also a possible fire in the building, and the folks trying to get me out had no idea about how to open the elevator doors. They were starting to get really anxious. When they started to rev up, I calmed them down through the door and helped them regroup, refocus and prioritize. (“You know, as the guy trapped in the elevator, I would really like to know if there is a fire and how bad it is. Why don’t you go check on it and then come back. You know where I’ll be.”) In the end, power returned and I got right back on the elevator so that I wouldn’t have a lasting fear of them. I then went straight back to work.

OK, that was a bit dramatic, but you get the idea. Sell them on you. What can you do that few others can?

As a job interviewer, I will also Google you. What will I find? Those pics of you doing a keg stand will not help you get a job in this field. Overly angry posts about certain politicians, religions or individuals are not a help either. Seeing you dressed in a silly costume and playing around will likely be neutral at best (after all, we do realize that you have a life). Just think before you post.

One person who applied for a job with us years ago did not seem to realize how easily these web searches can be done. I was able to see the person’s posts clearly. I stopped reading after the third “Dude, last night I got so freaking wasted” post.

Of course, the best way to get a job at graduation is to start thinking about it on the first day of your first class. It’s never too early to start planning on building a solid foundation for employment.

Keep up the faith, send out the résumés and interview, interview, interview. You’re unlikely to find your dream job at first, but even a second or third choice can help build toward THE job. I’m rooting for ya.

 

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Dr. Warren Corson III

Dr. Warren Corson III

“Doc Warren” Corson III is a counselor, educator, writer and the founder, developer, and clinical and executive director of Community Counseling Centers of Central CT Inc. (www.docwarren.org) and Pillwillop Therapeutic Farm (www.pillwillop.org). Contact him at docwarren@docwarren.org.

Stepping across the poverty line

By Laurie Meyers May 26, 2016

According to a study by the U.S. Census Bureau, there were 46.7 million Americans living in poverty in 2014, or a poverty rate of 14.8 percent. The picture was even bleaker for many ethnic and racial minorities. The same study found that 26.2 percent of African Americans (10.8 million people) and 23.6 percent of Hispanic Americans (13.1 million people) lived in poverty. Children were also particularly vulnerable. The study reported that 21.1 percent of Americans under the age of 18 lived in poverty.

What qualifies as living in poverty? The answer is not simple. A number of factors are involved in calculating income, and the Census Bureau has created 48 possible poverty thresholds. Broadly, however, any single individual younger than 65 with an income of less than $12,316 or any single individual 65 or older with an income of less than $11,354 is considered to be living in Branding-Images_povertypoverty. The poverty threshold for two people under the age of 65 living together is $15,934, and the threshold for two people over the age of 65 living together is $14,326. For a family of three — one child and two adults — the threshold is $19,055. For a family of three with one adult and two children, the threshold is $18 higher at $19,073.

The thresholds are derived using the Orshansky Poverty Thresholds, a formula originally developed in the 1960s by Mollie Orshansky, an economist working for the Social Security Administration. The formula compares pretax cash income against a level set at three times the cost of a minimum food diet in 1963 in today’s prices (updated annually for inflation using the Consumer Price Index).

However, these numbers can’t truly capture the reality of daily life for those living under the strain of poverty, say counselors who regularly work with client populations that are economically disadvantaged. Imagine taking multiple buses and dedicating up to two hours of travel time to get someplace that someone who owns a car can reach in 20 minutes. Imagine having to choose between buying groceries or paying the electric bill. Imagine managing a chronic illness while living on the streets.

Counselors are trained in diversity and multiculturalism, but does this awareness of discrimination and alternative worldviews necessarily include those living poverty? Not often enough, asserts Pam Semmler, a licensed professional counselor (LPC) and private practitioner in Denver. “I’ve been to a lot of diversity trainings, and none of them covered socioeconomic barriers,” she says.

The average counselor doesn’t have adequate training or even a good frame of reference when it comes to clients living in poverty, says Semmler, who spent more than nine years counseling clients at the Colorado AIDS Project. The project is part of the Colorado Health Network, a statewide organization that provides health services, case management, substance abuse counseling, housing assistance, transportation, nutrition services and financial assistance to people with HIV and those at risk. Semmler has also provided training to staff at the Colorado Coalition for the Homeless on diversity issues specifically related to working with those in poverty.

Of course, people living in poverty are not one monolithic culture, Semmler stresses. However, they do share something deeply significant: a lack of money and limited access to the resources that money typically makes available.

“Poverty is actually a lack of multiple resources,” Semmler says. Financial resources are the most obvious, but those living in poverty also often lack health, housing, social, family, emotional and sometimes even spiritual resources, she continues.

To help clients living in poverty, counselors first need to understand the barriers that these individuals face in their everyday lives, say Semmler and other experts.

A different world

“We tend not to talk about a ‘culture of poverty’ as in years past,” says Louisa Foss-Kelly, a professor in the Counseling and School Psychology Department at Southern Connecticut State University whose research interests include counseling people who are economically disadvantaged. “However, people living in poverty often share perspectives and engage in similar survival-related activities. They do whatever it takes to meet their needs or those of the family’s.”

“For example,” she continues, “a client may sell belongings on the street to make some quick cash, barter services with neighbors and find other creative ways to pay bills that might not be understood by people in the middle or upper class.”

Because counselors often come from middle-class backgrounds, the practice of counseling often reflects those experiences and values, but practitioners should take care not to judge clients through this lens, says Foss-Kelly, an American Counseling Association member and LPC who has worked in community counseling settings with clients living in poverty.

“Unfortunately, many counselors have never been challenged to explore their own biases about poverty,” she says. “They may not understand the impact of their own socioeconomic history on the process of counseling.”

Counselors simply aren’t trained in the realities of living in poverty as part of their counseling education, says Victoria Kress, an ACA member and past president of the Ohio Counseling Association whose research interests include working with client populations that are economically disadvantaged. “For example, I was trained as a counselor in the early 1990s, and my training was based on middle-class values and assumptions,” she says. “It was assumed that my future clients would come in for counseling of their own volition; they would have food in their bellies; they’d be safe; they’d be verbal and forthcoming; they’d have transportation; they’d be invested in growing and living up to their optimal potential. As I began to see clients, it became increasingly clear that none of these assumptions was accurate.”

“People living in poverty engage in a constant financial battle,” Foss-Kelly adds. “They may have to work two or three jobs, find food banks and navigate the maze of social services organizations. They may struggle with children in emotional distress because of frequent moves or other family disruptions. These clients may arrive to counseling tired, hungry or late. A judgmental counselor might say that [these clients aren’t] serious about changing or that they’re too disorganized or lazy to take care of themselves.”

Chelsey Zoldan, an LPC, currently works as a counselor at the Medication Assisted Treatment Department at Meridian HealthCare in Youngstown, Ohio. But she has also counseled those in the rural Appalachian section of the state and says that time issues — mainly clients not having enough of it and being late to appointments — were among the most common obstacles.

Many clients living in poverty have unreliable transportation or no transportation at all, Zoldan points out. In some states, public agencies may provide transportation to community clinics and other services for those living at or below the poverty line, but there is no guarantee that transportation will be timely, she continues. Some clients rely on rides from friends and family, but the person doing the driving sets the schedule, which may not fit with the client’s needs. In other instances, friends and family members may not be reliable when it comes to promises to drive or offer other assistance, she says. Public transportation may not be readily available or may require multiple transfers on a sporadic schedule.

Zoldan, an ACA member, points out that it may take clients relying on area bus service two hours to get somewhere that it would take her 20 minutes to drive to in her car. She adds that the bus schedule is inscrutable to her and her colleagues, but that clients who are struggling to get by financially routinely navigate the inconsistent routes and take multiple buses to get where they need to go. Unfortunately, as a result, they are often late or even miss appointments altogether. “Some counselors might interpret this as meaning that they [the clients] don’t care or aren’t committed to the process,” Zoldan says, acknowledging that she had to shift her own perspective regarding timeliness when she first started working with clients who were economically disadvantaged.

Some health care and other service providers may not be willing to accommodate these scheduling challenges, and that is a problem, Zoldan says, because these clients still need to be seen. And if a provider turns them away after they are late in arriving, they may not come back at all, she points out.

Clients who are economically disadvantaged may also have limited work flexibility or lack child care, adds Kress, who is the community counseling clinic director, clinical mental health counseling program coordinator and addiction counseling program coordinator at Youngstown State University in Ohio. Counselors need to be sensitive to the logistical problems that these clients face, she says.

When possible, Kress says, practitioners should consider providing in-home counseling and flexible or drop-in scheduling. In addition, clinics or practices that have the resources might consider offering day care and transportation assistance, which could involve providing the actual transportation or giving out public transportation vouchers, Kress says.

Meeting basic needs

As Kress began her counseling career, she realized that many of her clients living near the poverty line were struggling simply to survive. This reality often required her to be more “active” in these clients’ lives than her training had prepared her for.

“One of my first clients — a teenage mother — came [to counseling] in crisis because her electricity had been turned off,” Kress remembers. “In that situation, what she needed from me was to help her figure out how to get it turned back on. Having never had my electricity turned off, I had no idea where to begin. And my counseling textbooks didn’t talk about how to get one’s electricity turned back on. I had to put aside my expectations, be flexible and roll with helping her problem-solve her electricity situation.”

Before counselors can begin to effectively address traditional counseling concerns, they must make sure that their clients’ basic survival needs — including food, shelter and clothing — are being met, say the professionals interviewed for this article.

In doing so, counselors working with clients in poverty may find themselves playing many different roles, says Zoldan, who is also a doctoral student in the counseling program at the University of Akron. “You might have to be care coordinator, do case management, perform vocational counseling,” she says. “You might also … help with county health funds, student loans, transportation.” Counselors might also serve as de facto mental health educators for their clients, their clients’ families and even the community at large, particularly in rural settings, Zoldan adds.

Some might think that many of these services are the purview of social workers, not counselors. But Kress has a message for those who protest this expanded vision of meeting the needs of clients.

“I’d say this: How can a person work on higher order counseling goals if they are worried about where their next meal is coming from or how they will get their electricity turned back on?” Kress says. “Effective counselors are flexible and meet their clients where they are at.”

Foss-Kelly agrees. “Counselors treat the whole person in context,” she emphasizes. “So we have to acknowledge and respond to the crises our clients face when they leave the counseling room, even if those crises are financial in nature. Counselors are well-trained to provide referrals and work alongside social workers. In addition, we have to integrate the client’s basic needs into case conceptualization, treatment and treatment planning.”

Kress adds that she believes it is “old-school thinking” to state that counselors shouldn’t also help clients with their basic needs. In fact, she says, in the area of community mental health, the days of clients being assigned to a case manager who was a social worker and then to a separate counselor are long gone. “Now what we see is clients being assigned one mental health professional who provides counseling and case management. The system has had to adapt to the needs of consumers.”

Although counselors in community clinics or facilities affiliated with local social services might more commonly work with individuals living in poverty, Kress and others interviewed for this article say that most practitioners will encounter clients who are economically disadvantaged at some point.

Zoldan urges counselors to be deliberate about ensuring that these clients feel empowered in their own treatment. Taking an authoritative approach as the counselor and neglecting or diminishing the client’s input is potentially detrimental, she points out. The counselor might very well be unaware of the individual’s basic needs that are going unmet, she says, and the client may not trust the practitioner at first because he or she is viewed as an outsider. “The goal is to collaborate with your client on everything,” Zoldan says. “People in poverty are used to feeling oppressed in different ways.”

“Many people who live in poverty perceive that existing institutions do not serve their interests and needs, and counselors need to recognize that they are part of the system, whether they like it or not,” Kress adds. “Counselors must be flexible and sensitive to clients’ needs.”

Because counselors are part of the system, they should work it to their clients’ advantage, say Zoldan and Kress. It can be important for counselors to align with agencies, clinics or charities that offer assistance with food, housing, health care and other needs, Zoldan points out. She urges counselors to build relationships with these organizations and to also make contacts with officials in local service agencies such as job and family services so that clients’ needs can be better met.

Seeking solutions

In addition to the challenges related to basic survival, those living in poverty face many other barriers, Kress says. Common issues among this population include substance abuse, chronic mental or physical illnesses, teenage pregnancy and unsafe living environments that might involve intimate partner violence, she explains.

“In my experience, clients need to have counselors acknowledge and validate their experiences,” she says. “Many times, clients may not even connect the dots that these experiences are having a significant impact on their lives. In many ways, these experiences have been such a part of the landscape of their lives that they don’t recognize the impacts they have on them.”

Semmler agrees, saying that many of her clients have never had anyone explain to them how poverty has affected the entire trajectory of their lives.

Those in poverty are often blamed for their circumstances and stereotyped as lazy or incapable of saving money, Zoldan says. The reality is that many of these individuals are working two or even three jobs just to scrape by and aren’t saving money because they don’t have any to spare, she says.

“Each day may start with managing different crises — trying to find food or a place to sleep or meeting other basic needs of the family,” Foss-Kelly observes. “This survival focus inevitably impacts both the content and process of any counseling session. A person-centered approach is a critical foundation for counseling, but it may move at a pace that’s too slow for addressing crises of survival.”

Adds Kress, “When working with these populations, counselors need to be active, involved and focused on concrete and present solutions.”

Several of the counselors we spoke to emphasized the need to help these clients recognize and build on the strengths they have already developed to survive under the strain of poverty. As with any client, counselors should take into account the worldview and individual context of a person living in poverty, says Zoldan, who likes to use strength-based counseling, particularly for those coming from generations of poverty.

Contrary to the stereotype of lazy people just looking for a handout, living in poverty actually requires a significant amount of self-sufficiency, Zoldan points out. These clients typically must navigate public transportation and assistance systems and may juggle multiple jobs with child care and other family responsibilities, all of which requires a great deal of planning, she notes. Zoldan recalls a former client who had a backup plan for any major eventuality, including what to do if she couldn’t pay her rent, couldn’t afford food, lost her primary means of transportation and so on.

Kress notes that those affected by poverty may also acquire skills and strengths — including the ability to accept and handle difficult situations and live in the moment as needed — that aren’t readily apparent to most casual observers. “Identification and expansion of client and client-system strengths help to provide hope and support clients’ well-being,” she says.

In general, people who live in poverty also strongly value relationships, Zoldan says. This can oftentimes be very positive. For example, friends and family members can provide the person both emotional and practical support in the form of child care, meal sharing, housing and so on.

However, in some cases, it can also erect another barrier, Zoldan says. “Relationships are valued above all else,” she observes, meaning that counselors need to be aware that getting these clients to set boundaries or remove themselves from unhealthy living situations can be a complicated proposition.

Simply telling a client to cut off a relationship is not culturally appropriate, Zoldan says, so counselors may need to encourage other alternatives. For instance, if a client is struggling with substance abuse and her mother and sister are still using in their homes, a counselor might suggest that, rather than cutting off all contact, the client and her relatives talk only by phone or meet in public instead of in the relatives’ homes.

Ending or limiting these relationships with family and friends represents a significant loss of connection for clients. So Zoldan and her colleagues encourage these clients to get involved in 12-step programs in which they can get support and build a family of sorts within the recovery group. Zoldan’s agency also encourages group therapy, which can offer another source of connection and support for clients living in poverty.

Semmler is an attachment-focused therapist, so she always circles back to relationships. “When people attach in order to survive, the relationships are not always the most healthy,” she observes. Becoming psychologically healthy may require clients to break some of those ties, so Semmler, during her time with the AIDS project, would encourage clients to make healthy attachments to service providers and other participants in the program.

Helping the youngest living in poverty

Children living in poverty face many challenges that make it difficult for them to get an education, says Christi Jones, an ACA member who is an elementary school counselor in rural Alabama. The board of education for her school district is trying to remove one significant barrier by matching students who are in need of psychological assistance with mental health counselors. Part of Jones’ job is to help facilitate this process.

“At my school, mental health services are provided one day a week,” Jones says. “As a school counselor with approximately 600 students, collaboration with our local mental health agency assists in meeting student needs. At the beginning of each school year, I introduce the mental health counselor to teachers and staff members and assist in developing a schedule. When coming from the outside to work in a school, it is essential to have an understanding of the school culture.”

“I work with the mental health counselor to build relationships with key staff members who can assist in success in the school setting,” she continues. “The mental health counselor in turn ensures I understand what is required for students to qualify to receive services in the school setting. I can then share information about the program with both teachers and parents.”

Jones explains that students in the rural area where she works often need help beyond what she can give them as a school counselor. Transportation is an issue for many of the children’s families, so having an in-house mental health counselor at the school eliminates that barrier and also provides a source of long-term support for children and their families.

Jones sometimes continues to collaborate with the mental health counselor to address a student’s difficulties. In addition, because the mental health counselor is at the school only one day per week, Jones sometimes sees students who need additional support.

Another equally important part of her role as a school counselor is to advocate for students’ overall well-being, which sometimes means helping to meet basic needs such as food and clothing, Jones asserts. “My mentor counselor told me during my first year as a school counselor that basic needs must be met before you can work on issues,” she says. “I provide counseling to my students, but I also believe that social justice is an important part of my role as a school counselor. I work to connect my students and their families to resources.”

It is hard for children to focus on learning if they are hungry or worried about where the next meal is coming from, Jones says, so she worked with church and community leaders to create a weekend backpack program. “Local churches come each Friday and provide backpacks of food from our local food bank for students to take home,” she explains. During the winter and spring school breaks, families are also given enough food to last until school starts again.

Jones also maintains a clothing closet stocked with various seasonal clothes for students in need. She doesn’t wait for these students to approach her before offering assistance.

“If you take the time to get to know your students, it is not hard to find out who is in need,” Jones says. “If they see you on a regular basis and you talk to them, they will share their struggles and successes with you. Also, I see things just by observing students in the halls or in their classrooms. Students will sometimes come to school in flip-flops in cold weather, or you can tell their shoes or clothes are too small. Teachers also provide information about student needs.”

“As the school counselor, I have had the opportunity to help many of the families in my community,” Jones says. “Where I work, it is small enough that you get to watch your students grow up. You know all the families, and you care about your students long after they leave your building. Beyond data, I measure success in graduation invitations and students coming back to tell me they are going to college. [They are] often the first in their family to do so. There are many challenges to working with students living in a rural, high-poverty area, but there are opportunities to make a difference that make it the most rewarding profession.”

Embracing counseling’s core values

The counselors interviewed for this story emphasize that clients living in poverty want help and want to be heard. “The most important advice I can give [to counselors]: Be authentic and be understanding,” Zoldan says.

To build a therapeutic relationship with clients dealing with impoverishment — or any client, for that matter — practitioners must fall back on the core values of counseling, says Almeta McCannon, an ACA member who co-led a roundtable session at the 2016 ACA Conference & Expo in Montréal on counseling people affected by poverty. “I would advise clinicians to go back to the cornerstones of our profession: empathy, compassion, unconditional positive regard,” she says. “These are what allow us to relate to people who have experienced things we could never imagine and still be able to help them through a difficult time or situation. Assuming is the enemy here. I would encourage [counselors to ask] questions about the things that they do not understand and to really listen to the responses to those questions.”

Foss-Kelly believes counselors also need to take the next step and advocate for those living in poverty. “Counselors can play a key role in advocating for the marginalized, including those in poverty,” she says. “Of course, this advocacy begins with individual clients and communities, but it should also include spreading awareness in professional circles and among power brokers. People living in poverty come to counseling in a vulnerable state. We as counselors must fight to help other counselors understand their unique needs.”

 

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To contact the people interviewed for this article, email:

 

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Additional resources

To learn more about the topics addressed in this article, see the following resources offered by the American Counseling Association.

Books (counseling.org/bookstore)

  • ACA Advocacy Competencies: A Social Justice Framework for Counselors edited by Manivong J. Ratts, Rebecca L. Toporek & Judith A. Lewis
  • Counseling for Multiculturalism and Social Justice: Integration, Theory and Application, fourth edition, by Manivong J. Ratts & Paul B. Pedersen
  • Multicultural Issues in Counseling: New Approaches to Diversity, fourth edition, by Courtland C. Lee

Webinars (counseling.org/continuing-education/webinars)

  • “Why Does Culture Matter? Isn’t Counseling Just Counseling Regardless?” with Courtland C. Lee

Podcasts (counseling.org/continuing-education/podcasts)

  • “Hunger, Hope and Healing” with Sarahjoy Marsh
  • “Multiculturalism and Diversity. What Is the Difference? Is Not Counseling … Counseling? Why Does It Matter?” With Courtland C. Lee

VISTAS Online articles (counseling.org/knowledge-center/vistas)

  • “Counselor Training and Poverty-Related Competencies: Implications and Recommendations for Counselor Training Programs” by Courtney East, Dixie Powers, Tristen Hyatt, Steven Wright & Viola May
  • “Preparing Counseling Students to Use Community Resources for a Diverse Client Population: Factors for Counselor Educators to Consider” by Sarah Kit-Yee Lam
  • “Professional Counseling in Rural Settings: Raising Awareness Through Discussion and Self-Study With Implications for Training and Support” by Dorothy Breen & Deborah L. Drew

In addition, counselors who would like to get involved in issues of diversity and social justice may be interested in joining Counselors for Social Justice, a division of ACA. Founded in 2000, CSJ’s mission is to work to promote social justice in society through confronting oppressive systems of power and privilege that affect professional counselors and their clients and to assist in the positive change in society through the professional development of counselors. Visit CSJ’s website at counseling-csj.org.

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editorct@counseling.org

Accepting failure as part of professional advocacy

By Whitney N. White May 25, 2016

In recent months and years, I’ve seen counseling and mental health move up the list of “hot topics.” Influential actors, leaders and even government officials have spoken up and drawn these areas into the light in a new and brilliant way. As a culture, we are talking about mental health now and reaching out for help more than ever. I find this inspiring and believe that all of this bold new conversation and outreach is changing lives for the better.

First lady Michelle Obama has spoken publicly about the importance of mental health and the need to end associated stigma. Kate Middleton, the Duchess of Cambridge, recorded a video message this year in support of Children’s Mental Health Week. Actor Jared Padalecki, of Supernatural fame, talked publicly about his own mental health struggles and launched the Always Keep Fighting charity T-shirt campaign (I regularly see clients sporting the clothing that is sold to support the cause). MTV has run news segments on celebrities working to shut down stigma related to mental health. Leonardo DiCaprio talked about his struggle with obsessive-social justicecompulsive symptoms after filming The Aviator. While filming the movie, he stopped trying to control his tendencies toward obsessive-compulsive disorder and ended up developing stronger symptoms that lasted long after filming had ended.

For these reasons, I thought at least a tiny bit of the battle was over. What battle? The battle for counseling to be taken seriously as a profession, the battle to get people to understand that mental health is as important as all other aspects of health and the battle to get help to those who need it. I believed these changes and new discussions meant that the control tower had cleared the runway and all we needed to do as a profession was fly in and land.

 

A bubble burst

I didn’t want to be like many of the mental health professionals — counselors, caseworkers and others — I met during my school-related practicum. I’d hear them speaking about red tape, see the cynicism in their expressions and sometimes even sense their disdain for my fresh-out-of-the-box, new counselor, can-do attitude. But they knew what I’m beginning to understand.

The battle isn’t over. It won’t ever be over. We can’t rest from this as a profession. We have to keep going, keep working and keep educating. When a chiropractor points out that his church shut down its free counseling program because “counseling is just talking and doesn’t really work,” we have to smile and use that as an opportunity to educate. When a woman in line at Starbucks sees the American Counseling Association gym bag we’re holding and assumes that we just help kids get into college, we can speak up about what we really do.

My bubble was burst a few months into my first real counseling position at a nonprofit agency serving children in Texas. Texas is a large and, for the most part, very rural state. Many of its small cities don’t have any licensed mental health professionals. In addition, there are many people without the money or insurance to pay for services despite the Affordable Care Act, and many others lacking the resources to travel half an hour or more to access counseling services. Most families have parents and caregivers who work. Taking a block of time out of their workday for counseling has a price attached, both in terms of money and stress.

In an effort to provide services to populations in these circumstances, the agency where I work allows counselors to set up satellite offices in neighboring communities. This helps when families can’t make the trip to the main office or can’t afford to take off work to make that trip. To take this a step further, we often gain permission from schools in these outlying areas to see children in the schools where they attend (with proper consent and releases). Because of other tasks that require their time and expertise, school counselors don’t typically have the time to provide in-depth mental health counseling to students in need.

I received a few calls from residents of a nearby town who wanted a counselor to come provide services to children in the community. Each of the referral calls came from families with children in the local school district, so I was surprised when I reached out to the school to offer counseling services and got a “no” in response. The school’s lead administrator informed me that I could use space on the campus one day per week, but students would be permitted to miss only music class.

This was bad news on a couple of levels. First, because the school is small, each grade level goes to music class together. In other words, I wouldn’t be able to have two clients in the same grade because my sessions are 45 minutes long and music class is 50 minutes. Second, it would be impossible to protect the privacy of my clients under those circumstances. It wouldn’t be long before every kid in the school knew that if a student left music class, he or she was going to counseling. Never mind the underlying message that music (the arts) is frivolous — just like counseling.

I responded to the stipulated offer by explaining the privacy concerns I had about the situation. I also reiterated that multiple families with students in the school had sought services and that I wouldn’t be able to see everyone during music classes. I mentioned that I always talk with parents and children about what time of day will work best for them based on the child’s performance in each class and when that class occurs. I reminded the school administrator that Texas permits children to miss school to attend counseling appointments, just like they are permitted to miss class to see a medical doctor.

I communicated this all very professionally and from a place of love and advocacy for my would-be clients, my profession and my agency. In response, I got another “no” that included an explanation of how and why academics are the focus of this particular school. This school’s administration either doesn’t understand the way that mental and emotional health (which counseling supports and develops) affect academic performance, or they do and choose to ignore it. I’ll never know. I did my best to provide a basis for conversation and education about counseling. It didn’t work, and I was frustrated. A school — the place where so many issues are first identified — was refusing to help its students.

Months prior to this disappointing outreach, I had volunteered to present at a local high school career day. After the rejection of my services by the other school, I was hesitant to follow through on this career presentation. How would I possibly line up next to police officers, doctors and teachers as a career option? Had anyone even signed up for my presentation on mental health counseling as a career? Would the cynicism building up inside of me because of others’ rejection and resistance to mental health progress dull my eyes, spirit and voice as I talked to potential future counselors?

When the day arrived, more than 120 students had signed up to hear my presentation on mental health counseling. They asked great questions. For instance, a freshman asked, “How does working with others and their problems affect you as a counselor?” A ninth-grader asking about vicarious traumatization! They were listening! And interested! I opened up about what it is like for me to be a counselor.

 

Getting to ‘yes’

In a nonprofit agency, we often wear many hats. Sometimes we are counselor, case manager, outreach coordinator, guest speaker, educator and secretary. Sometimes we are all those things and more within a single hour of the day. We are advocates for our clients and would-be clients. I advocated for potential clients with the area school in hopes of making services available and easily accessible and to require less time out of class. I failed, but I tried. Sometimes we’re disappointed that others — professionals affected by our work — don’t understand its importance or take it seriously. But on some days, we get through. Some days we get a “yes.” That “yes” means the world to the people we work to serve.

It is vitally important that as a profession, we continue to advocate and communicate with professions that touch ours. Medical professionals, teachers and many others have contact with our clients. Their perspective on counseling can have an effect on how our clients view counseling — on whether or not they seek and receive the services they need. In the face of frustration, it is important to remember to talk openly and to stay educated about the research that supports our field and the interventions we use. The next time you’re brave enough to speak up, you may get a “yes” that changes minds and outcomes for better down the road.

The disconnect I’ve experienced across professions is often a result of my desire to avoid perceived conflict by not speaking up and telling someone how fantastic my research-supported profession is. Talk about our profession. Talk about it anytime you’re given a chance like I was at my chiropractor’s office. When you’re in line at Starbucks, talk about it with the woman who comments on your ACA bag. Talk about it on social media. Speak up about what we do and the research that supports it, and be ready to power through the possible frustrations of a “no” or disagreement.

We don’t just expect children to learn algebra “naturally.” We educate them from their first day of school until their last, which prepares them to do algebra in real-world settings. Yet the attitude of public educators is at best “refer for counseling”; at worst, “kids can do that away from ‘education’ time.”

The “yes” I hope to witness someday is a big one. In my head, every school in my state — in the United States — will welcome vetted agencies to enter schools and provide in-depth services on campus when they’re needed and with appropriate consent from guardians. I envision a time when I’ll call or visit a school campus that welcomes me and my bag of counseling goodies every time (it does happen!). I close my eyes and see schools with life skills courses — entire courses devoted to bettering the whole person in which kids can learn about emotions, coping skills, communication and healthy relationships.

My vision of counseling science as a cornerstone of health and education is a big one. Imagine! Sending kids into a classroom to learn how to communicate effectively with one another. Producing high school graduates with all the tools to truly live life to their fullest, most successful potential. This vision may seem very far away, but there was a time when children weren’t educated about math beyond what they might learn at home. In my moments of frustration, I close my eyes and see these things and remember to speak up for my profession, my colleagues and my clients.

Recently, Prince Harry, who has long been outspoken on mental health issues related to veterans of war, spoke with Good Morning America. He stated, “Psychological illnesses can be fixed if sorted out early. … We’ve got to keep the issue at the forefront of people’s minds. … Just talking about it makes all the difference.” The counseling profession must continue that battle, talking not just about mental health but about what we are able to do to help.

 

 

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Whitney N. White holds a master’s degree in clinical mental health counseling. She is a national certified counselor and a licensed professional counselor intern in Texas, where she is employed in the nonprofit sector working with youth. Some of her passions are working with youth struggling with self-injury; using yoga to connect body, breath and mind; and spending time with her family. Contact her at whitneywhite82@gmail.com.

‘We must do more’: Counselors have part to play in stemming U.S. suicide increase

By Bethany Bray May 19, 2016

After more than a decade of almost constant decline, the rate of suicide deaths in the United States has increased 24 percent over the past 15 years. In fact, the country’s rate of suicide is at its highest point since 1986, according to data released recently by the U.S. Centers for Disease Control and Prevention (CDC).

Between 1999 and 2014, rates of suicide death increased for both males and females for all ages between 10 and 74. The highest rates of increase occurred between 2006 and 2014, according to the CDC.

In 2014, the age-adjusted suicide rate for males (20.7 for every 100,000 population) was more than three times that for females (5.8).

In the male population, suicide rates are most prevalent among those 75 and older. For females, suicide rates are highest for those in the 45-64 age range, which was also the case in 1999. But the greatest rate of increase for suicides took place among females ages 10-14. Although the total number of suicides among that population was comparatively small (150 in 2014), it represented a threefold increase between 1999 and 2014.

 

Counseling Today contacted Doreen Marshall of the American Foundation for Suicide Prevention (AFSP) to discuss these statistics and what professional counselors can do to help bring an end to this concerning trend.

Marshall, vice president of programs for AFSP, holds a doctorate in counseling psychology. Prior to joining AFSP, Marshall served as associate dean of counseling at Argosy University.

 

Doreen Marshall, vice president of programs for the American Foundation for Suicide Prevention

Doreen Marshall, vice president of programs for the American Foundation for Suicide Prevention

As someone who has worked in suicide prevention for many years, what is your reaction to these statistics?

We have known that the numbers have been on the rise, although it is sobering to see this increase over time, particularly in light of our ongoing efforts to prevent suicide. It is important to recognize that while other causes of death — such as those from HIV/AIDS, heart disease and breast cancer — have decreased over this time period, the suicide rate continues to rise. The data presented in this report is just one cross section of what we need to get a full picture of the suicide rates across America. We know that suicide prevention efforts that are concentrated and strategic can be successful. We have seen that targeted efforts can reduce suicide rates, and many of these can be expanded for wider impact and more lives saved. As a nation, we need to invest our time and resources in such prevention efforts, as well as in research to better understand the problem of suicide.

 

There is a lot of data packed into this report. What are some of the main takeaways you would want to point out to professional counselors?

We must do more to prevent suicide in our local communities, and this is where counselors can have a key role, both in terms of providing treatment to those who need it [and in] educating the public about suicide risk. All counselors need to be knowledgeable about the factors that contribute to suicide risk.

Suicide is a complex phenomenon, and assessment also needs to consider risk factors in the context of the individual who is being assessed. Suicide risk increases when several life stressors and health factors converge at the same time. For example, 85 to 90 percent of those who die by suicide had a mental health condition, whether diagnosed or not, at the time of their death, so we know that the detection and proper treatment of mental health conditions can plan an important role in suicide prevention. Other factors that should be assessed include a person’s past history of suicide attempts or behaviors, access to lethal means, past history of child abuse or trauma, present substance use and current life stressors.

 

What do you want professional counselors to know about this situation? What should they keep in mind and be aware of?

In short, suicide is on the rise in the U.S. In terms of trying to explain the increase, suicide experts consider a few possible contributions. One thing we know for sure is that a large contributing factor is untreated mental health conditions. Another factor is the economic downturn and job losses that occurred during that same period of time, resulting in increasing stress. There may also be a cohort

effect for the baby-boomer generation, in which suicide rates and other problems like substance use problems and other health conditions, and higher rates of life problems like divorce, have unfortunately followed this demographic population from their earlier stages of life. Despite these considerations, it is hard to know all of the factors that may have contributed to the increase. But we do know that the suicide rate is higher now than in the past.

 

From your perspective, is there anything counselors could or should be doing differently in their work with clients in light of this data?

Many of us may not have had extensive training in suicide prevention as part of our graduate work, so it is important to seek more information and training on how to effectively counsel someone who is experiencing suicidal thoughts or has engaged in a suicide attempt. Given the numbers, it is very likely that we will encounter someone who is suicidal or who has been affected by a suicide death in the course of our counseling work, so all counselors need to improve their knowledge and skills in this area.

 

What advice would you give to counselors who work with populations that showed a sharp increase in suicide deaths — for example, girls ages 10-14, Native Americans, middle-aged adults?

It is important to keep this report, and the increases noted, in context. While suicide does happen in young girls, it is fairly rare compared to the suicide rates in middle-aged and older adults. While the rise is of concern, it was based on an exceedingly low base rate in 1999 of 0.5 per 100,000. It was a total of 50 girls in 1999 and 150 in 2014 across the United States. The overall numbers of suicide deaths in girls ages 10-14 remain low.

In the U.S., most of the persons who die by suicide are middle-aged and older adults, and terms of race/ethnicity are Native Americans, Alaskan Natives and Caucasians.

That said, I think counselors should be aware that there is no one age, race or ethnicity that is immune from suicide, and risk should be assessed across all demographics and ages. In children and adolescents in particular, early detection and adequate treatment of mental health conditions such as depression, bipolar disorder and anxiety can go a long way in helping to reduce their lifetime suicide risk.

 

What would you want school counselors, in particular, to know and keep in mind?

School counselors should encourage their schools to have a policy for responding to suicide in students. They should also encourage regular training of school personnel to know the risk factors and warning signs of suicide as well as how to refer a student for further assessment if they encounter a student who is suicidal. School counselors often play an important role when a student is suicidal, so it is important that they expand their knowledge in this area as well.

 

From your perspective, how can counselors play a part in combating these statistics and preventing suicides?

First, I would encourage counselors to familiarize themselves with risk factors and warning signs for suicide, as well as seek additional professional training in evidence-based interventions for those at risk for suicide, such as cognitive behavior therapy for suicide prevention (CBT-SP), dialectical behavior therapy (DBT) and collaborative assessment and management of suicide (CAMS), among others.0001-245393381

At the minimum, all counselors should build their skills in assessing for suicide and assess their clients regularly. They should also learn about ways to effectively help their clients to manage their suicidal feelings between sessions, such as by using safety planning as a brief intervention. Counselors and other clinicians have an obligation to familiarize themselves with how to best work with those who are suicidal in a way that is compassionate, responsive and effective.

I think one of the biggest barriers to prevention is that people, including counselors, are sometimes afraid to ask their clients directly about suicide. Asking about suicide does not increase an individual’s risk for suicide. More likely, asking them conveys that you are paying attention to the difficulties they are experiencing and are willing to take steps to help them. It is important that we, as counselors, use our knowledge of suicide risk and of mental health conditions to work to educate the general public about suicide prevention.

I would also encourage counselors to get involved with local and national advocacy efforts that support suicide prevention efforts. More information about advocacy and how to get involved in suicide prevention can be found at our website at afsp.org.

 

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Graphic via the U.S. Centers for Disease Control and Prevention

Graphic via the U.S. Centers for Disease Control and Prevention

 

 

Read more

 

Find out more and view and the CDC’s breakdown of data at http://1.usa.gov/1qG5IZf

 

Via NPR, “Suicide rates climb in U.S., especially among adolescent girls” http://n.pr/1Vqxlm9

 

For more insights on this topic, see Counseling Today’s cover story, “Facing the specter of client suicide

 

Did you know the Substance Abuse and Mental Health Services Administration (SAMHSA) has created a smartphone app with suicide prevention tools and resources for practitioners? Find out more here.

 

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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 at facebook.com/CounselingToday.

Addressing children’s curiosity of private parts

By Ashley Wroton May 16, 2016

Damion’s (*) grandmother walked into the office, eyes reluctant to connect. Sitting on the sofa, she slowly began to explain her reason for coming in.

“I made this appointment for my grandson. He’s 3. The day care has threatened to suspend him. He pulled his pants down while in line to go outside, and last week wasn’t the first time.”

Chloe’s (*) dad, with mixed emotions of anger and worry, stated, “She’s only 5. She has all brothers. I’m afraid that someone has hurt her. She’s pulling her dress up at the bus stop and laughing about it, even after we tell her to stop.”

As a registered play therapist and licensed professional counselor who works with children as young as 3, these scenarios represent common conversations that I have with worried and confused parents. When children display behaviors that adults consider sexualized, it is a natural reaction to begin fearing that abuse has taken place. However, for preschool-aged children, it is a common and developmentally appropriate exploratory behavior.

In fact, research studies support that many children who engage in sexualized play or behaviors have not experienced sexual abuse. In a 2009 article published in Clinical Psychology Review (see digitalcommons.unl.edu/psychfacpub/403/), Natasha Elkovitch of the University of Nebraska-Lincoln and her co-authors also outlined that typical, “high-frequency” behaviors reported by parents of preschoolers include:

  • Touching private parts at home or in public
  • Exposing private parts to others
  • Trying to look at others’ private parts
  • Standing too close to others
  • Touching female breasts

While knowing that this curiosity and naïve exploration of their bodies and the bodies of others is a normal, developmentally appropriate stage, however, it does not lessen the often awkward feelings and uncertainty of how to handle it.

This feeling is only compounded by the dreaded anticipation of the teen years. As children grow, their knowledge and awareness of sex also grows through exposure to caregiver relationships, peer interactions and the media (i.e., TV, Internet, social media).

The statistics related to sexualized behaviors and the adolescent stage of development add to many caregivers’ fears. According to a 2008 adolescent survey report conducted by the Centers for Disease Control and Prevention, 50 percent of U.S. adolescents (grades 9-12) were sexually active, 7.1 percent had their first sexual experience before age 13, nearly 15 percent had already had “four or more partners,” and 38.5 percent did not utilize contraception.

When caregivers observe or learn about their child’s play involving private parts and respond with alarm, sternness, isolation of the child or avoidance of the topic, the caregiver may inadvertently be shaming the child. This makes the mental connection for the child that private parts are bad and that their caregiver is not someone to talk to about their curiosity.

Research conducted by William Pithers and colleagues in 1998 indicated that children exhibiting sexualized behavior problems were more likely to have parents who viewed their children as attention seeking, considered time with them as unrewarding, were emotionally distant and engaged in more conflict-dominated interactions. Children who grow up under this parenting style tend not to view their caregivers as reliable role models of interpersonal relationships, confidants or valuable resources on awkward topics. These children are more likely to seek answers, nurturing and a semblance of love from others, taking their cues from online information and peer pressure.

Damion’s grandmother was part of the generation that did not talk about such behaviors. Such behaviors were not just kept private; they were left a mystery. Damion’s grandmother was also really overwhelmed. She had a job, teenagers of her own she was still raising, a husband, friends and a very busy 3-year-old grandson who was missing his mother. She was exhausted and admitted to often thinking that Damion was a burden and too needy. She just wanted his problem behaviors to stop.

Chloe’s dad was raising four children on his own, with Chloe being the only girl. He was at a loss and thought that he had failed as a father. He admitted that conflict was a major part of daily life in their home. He was stretched thin for time, money, patience and ways to relate to his daughter.

So, what can caregivers do to help their children bridge the expanse from developmentally appropriate curiosity of the world around them in preschool to healthy decision-making and boundaries?

Thankfully, many researchers have been asking versions of this question for decades. The answer consistently comes that the relationship that children have with their caregivers is the key to positive outcomes — specifically, the authoritative parenting style of balancing warmth and support with Underwater photo of happy family swimming in the blue poolmonitoring and control. This is supported across socioeconomic and ethnic groups.

Beginning in the first year of life, children are learning how and whether to trust their caregivers. Erik Erikson’s stages of psychosocial development also states that during the preschool years, children are attempting to gain a sense of autonomy. They want and need to feel emotionally safe enough both to explore the world around them (including their bodies and others’ bodies) and to seek out caregivers when confusion or “storms of life” arise. This time of a preschooler seeking refuge in a caregiver is the most valuable and opportune time to start the lessons of interpersonal boundaries, social etiquette, family morals and values, and decision-making skills.

With preschoolers, it is best to engage in these conversations and lessons through play. When children are engrossed in their toys and own imaginations, they are much more likely to talk. Garry Landreth, a pioneer in the world of play therapy, has said, “Play is a child’s language, and toys are their words.”

Entering a child’s world through play is the best way to speak his or her language about tricky topics. Watching children’s play and keeping track of the themes in their play can provide great insight into what they are trying to gain mastery over or what is troubling their hearts and minds. Playful lessons may seem counterintuitive. However, they make the most lasting memories and connections for children. Entering a child’s world through play also builds bonds that help the child feel the emotional security to seek caregivers out when troubles come.

In working with Damion and Chloe, it was vital to include their caregivers. With both families, we decided to set aside certain times at home during the week for a special, uninterrupted time with each child and caregiver. It started out as 15 minutes of imaginative play of the child’s choosing. All behavior concerns started to decrease.

We also used our therapy session to begin talking about private parts and why they are private. This conversation was transitioned into the home as the caregivers became more confident in their preferred way of talking about the subject with the child. The caregivers and I also worked to increase the balance of warmth and support with monitoring and control. Through therapy, we confirmed that no abuse had occurred; the children’s behaviors were a combination of developmentally appropriate curiosity and negative attention-seeking behavior.

Through my work, I have found that many caregivers, when trying to teach their children about private parts, are uncomfortable with many of the books that describe reproduction or sexual abuse. A colleague and I decided to write a book that approaches this topic from a normal, developmentally appropriate perspective in a way that helps caregivers start the conversation and normalizes talking to caregivers. It’s … Just Private will be available at booksellers in the upcoming months.

 

 

*All identifying details of these stories have been altered to protect the identities of the individuals referred to in this article.

 

 

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Ashley Wroton is a licensed professional ItsPrivatecounselor and registered play therapist in Hampton, Virginia. She received her master’s degree in education and her education specialist degree in mental health and school counseling from Old Dominion University. She is the co-author, with Shelby Debause, a licensed marriage and family therapist, of It’s … Just Private, a children’s book that helps young children understand the need for setting boundaries with their bodies and gives caregivers strategies for communicating those boundaries. Ashley and Shelby can be reached through Facebook at Ashby Consulting LLC or through the genesiscounselingcenter.com website.