Monthly Archives: October 2016

Why you should incorporate volunteering into your training: A student’s perspective

By Eleanor Rector October 17, 2016

You’re about to start a graduate counseling program. You’ve likely traveled to a new place, so you’re trying to adjust and find a new go-to burger joint. You have your priorities straight.

The last thing you want to do is research places to start volunteering. Besides, you’re already training for a career in which the focal point is helping people. Do you really need to go out of your way to do more? Sure, volunteering sounds good, and you would like to do it, but you’ve worked so hard to get here, and you don’t really have the drive to begin something that won’t further your career.

I have been there. You’re talking to a professional promise-maker here. I’ve organized groups to bring food and hygiene products to homeless individuals, but I’ve also made a thousand promises to myself or to other groups with good missions to volunteer, and when the time came, there was always a great excuse not to follow through. Maybe my cat was being extra cute, or my murder mystery suddenly took an interesting turn.

Whatever the excuse is, it seems important at the time. Besides, I tell myself, if I’m not there to help, someone else will take my place. And sometimes the amount of hurt in the world feels like too much for me to bear. And I wonder, even if I am there to help, will it really make any difference?

Fortunately, I attend a university that removes the hard part from the equation. At Adler University, volunteering in your first year is a mandatory part of every program. Students fill out a form about their experiences, strengths and interests. Then, in a process I have been promised is not random, they are assigned volunteer positions in underserved communities.

Some individuals are placed in nonprofit organizations they find interesting; others remain confused about their placement throughout the experience. I have watched one particular thing happen across the board, however. Those individuals who complete their volunteer hours with as little effort as possible don’t really gain much from the experience. On the other hand, those who complete their placements by really getting involved and being passionate about serving the underserved ultimately grow immensely.

This experience is so pedestrian that a saying developed around it: “You get out of it what you put into it.” However, clinicians, and especially those of us studying to become clinicians, may not understand how vital this volunteer experience is to our clinical practice. If we are to be guided by the ethical principle of beneficence, then we must do more than simply our jobs to help our communities and the individuals within them.

We must find ways to integrate our pledge to help the community into our everyday lives. Otherwise, we are following only the principle of nonmalfeasance. That is an essential principle, but simply doing no harm is not enough. Doing actual good reaches much further.

Yes, we are “doing good” when we are effective and ethical practitioners. But at the same time, we are simply doing our job well. To fulfill the principle of beneficence, we must go beyond the minimum of being effective clinicians and do good that effects change outside of our own personal spheres. Involving ourselves in our communities, in whatever way one chooses, will also benefit our practices immensely and allow us to be much more effective clinicians.

Acknowledging privilege

This, of course, requires a brief discussion on privilege. Luckily, the program at my university that organizes this volunteer placement to underserved populations also provides training sessions that help students understand the oppressive systems at work in the world, specifically inside the United States, and confront the privilege that we all possess.

This is incredibly helpful because acknowledging our own privilege is uncomfortable for many of us. All of us have faced struggles in one form or another throughout our lives. Some of us may not feel that we possess privilege in many respects. And this may be true, because privilege comes in multitudinous forms. But no matter the lack of Master Statuses we may possess, being able to afford (or even have the good standing to take out loans) to go to graduate school and become a counselor is a privilege in its own right.

Many people are afraid of acknowledging their privilege because they think that having privilege is a shameful thing. That’s a logical, although untrue, line of thought. There is often unnecessary guilt inherent in being born with privilege because we live in a world that works to keep the privileged on top while oppressing the underserved.

I am a Caucasian woman. So, even though I am a woman, I still carry the Master Status of “whiteness.” No matter what I’ve experienced or how difficult life may have been, I still carry that one Master Status. I can do my best to understand the experiences of other individuals and empathize with them. But there has to be a point at which each of us acknowledges that some individuals have had experiences we simply cannot understand.

This isn’t something to be ashamed of because no one can control the circumstances into which she or he was born. However, it is our responsibility to confront these circumstances and subsequent biases head-on if we are going to be socially conscious clinicians who are dedicated to following ethical principles. Furthermore, those of us with privilege have a responsibility to help those without privilege and without a voice.

I think the writer Toni Morrison expressed this sentiment particularly effectively: “I tell my students, when you get these jobs that you have been so brilliantly trained for, just remember that your real job is that if you are free, you need to free somebody else. If you have some power, then your job is to empower somebody else. This is not just a grab-bag candy game.”

Giving empathy another dimension

Acknowledging our privilege is important for many aspects of our work and a vital component of volunteerism. For starters, it helps us form empathy.

Although most (hopefully all) clinicians and clinicians-in-training possess some amount of empathy, acknowledging privilege gives our empathy another dimension. For instance, when working with homeless individuals as a teenager, I clearly had empathy for the population. Especially during the Great Recession, I understood that circumstances beyond these individuals’ control had led them to this place of desperation.

But this empathy needs to be multidimensional. Acknowledging one’s own privilege, and therefore the societal systems of oppression at play, allows one’s empathy to extend not only to the individual directly before you, but also to a whole group of individuals who have been affected by these systems. Now instead of feeling empathy only because of a particular individual’s immediate circumstances, I’m able to understand that clients’ lives have often been controlled by societal systems that existed long before these people came to be. These systems were created to oppress classes of individuals, leaving upward mobility out of the question for many and, too often, making simple survival an enormous feat.

Understanding community

In addition to growing our empathy, acknowledging our privilege is an essential part of understanding our own communities. Because we all experience privilege, we simply remain unaware of certain parts of our communities. These sections of our communities don’t concern us, so we often don’t bother to get involved in them.

This isn’t a lack of empathy. Rather, it is simply a lack of knowledge. Acknowledging our privilege means opening ourselves up to learning about the underserved of our communities and the problems that plague those with less privilege than us. Because we are clinicians, learning often sparks passion in us, and when we become passionate about changing an issue and providing voice to the voiceless, we can be unstoppable.

This deeper understanding of my community took place for me at my volunteer site, where I took notes at a monthly meeting for the Harm Reduction Coalition, which aims to provide prophylactic availability in prisons to stop HIV transmissions both inside and outside of prison. By being in a meeting of this kind, I ended up learning far more about the correctional system than prophylactic availability. Simply by being involved, I was able to meet so many individuals whose lives had been touched by the general lack of health care within prisons. In the process, I was forced to let go of my preconceptions.

I logically had assumed that when individuals in prison became sick, they were provided with the health care to which they have a right. That is until I met a woman whose husband had been diagnosed with cancer in prison but was refused knowledge of his diagnosis and treatment. His family only learned that he had cancer when he died behind bars in the arms of his friends and an autopsy revealed the truth. I met another man who had been so deprived of sensory stimulation that he had to relearn how to talk, read, write and interact with individuals upon being released from prison. I heard horror stories of treatment being denied again and again and again so that the cost wouldn’t cut into the profits of privatized correctional health care corporations. When you are in prison, you are still supposed to have certain rights. But when those rights are violated, you are voiceless and powerless.

When I started volunteering, I thought I understood the population I was working with and the system by which they are controlled. But when you have the privilege to not automatically be aware of these systems, you find that they are far more intricate than you ever could have imagined. Often, simply learning about the populations who live within these systems and cannot escape makes it impossible to not want to be involved.

As clinicians, we need to understand that we have preconceived beliefs that are inaccurate about many parts of our society. And the reality is, we are going to have clients who are part of these populations or have been touched by these systems. To be truly responsible clinicians, we need to confront these preconceptions head-on by involving ourselves with populations with which we would not generally come into contact.

I still struggle with the idea that what I do doesn’t really make a difference — that the oppressive systems at work are so big and so concrete that anything I do can only make a dent. That’s true in a way. After all, I’m only one person. There’s only so much I can do. But I can help educate others so that they too can begin to make chinks in the armor around this system. And they can educate the people around them about the reality of the world in which we live. At the end of the day, no matter how small the things I’ve accomplished are, they’re still there. And they still make a difference.

Don’t be afraid to admit that your preconceptions are wrong. Instead be afraid of keeping those preconceptions rather than confronting them. Identify an area of society that sparks your interest and passion, and find ways to get involved. Only through accepting your privilege and confronting your biases and beliefs can you deepen your understanding of society and strengthen your abilities as a clinician.

So force yourself to get off the couch. Find a nonprofit that works in an area that interests you. Schedule a time to volunteer, and then follow through. You won’t regret it.

****

Eleanor Rector is a second year master’s counseling student specializing in forensic psychology at Adler University in Chicago. Originally from South Florida, she studied poetry and psychology at the University of Miami. She hopes to continue her education by pursuing a Ph.D. in applied neuropsychology. Contact her at erector@my.adler.edu.

****

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The Counseling Connoisseur: Nature-informed counseling for children

By Cheryl Fisher October 13, 2016

“Once there was a tree … and she loved a little boy” — from The Giving Tree by Shel Silverstein

*****

I recently returned from a wonderful week in Nova Scotia featuring painted clapboard cottages against blue skies and a seascape of majestic hills and swirling tides. With a history rich in forts, fur trades and complex propriety, Nova Scotia also affords miles of pristine trails for the avid (and not so avid) hiker.

On one such hike, I ventured up Cape Split, which offered a spectacular view of the Bay of Fundy following a two-hour uphill jaunt. The inland path was lush with evergreen and paved in centuries-old rocks. Snarled roots from ancient maples protruded from the narrow trail, and patches of mud provided slippery terrain. At times the trail seemed endless and unforgiving. However, just at that moment when body and morale were failing, the forest opened to a grassy knoll that blanketed the age-old rock formation overlooking the (now) returning six-foot tides of the Bay of Fundy.

Damp with perspiration from navigating the trail, we sat down and unloaded our backpacks, laying out a feast before us of lobster rolls and blueberry lemonade. The cool breeze from the bay mingled with the warmth from the sun. In that moment, I was sure there was nothing sweeter than communion with nature and the physical and emotional exertion and spiritual nourishment it afforded.

Camps and communion

For many children (and their excited parents), the end of summer signifies a return to school, studies and schedules. It is a time when we bid farewell to the lackadaisical whimsy of carefree days. Summer memories of camps, cookouts and canoes fade, making way for the cooler activities of autumn. However, for many children, summer camp did not include nature hikes, bonfires or kayaking; it involved indoor activities centered around a theme such as weight management, music acquisition or computer skills.

Research suggests that connecting to nature can result in reduced stress, increased energy, improved sleep, reduction of chronic pain, and accelerated healing from injuries and surgery. In particular, Peter Kahn and Stephen Kellert have argued that “a child’s experience of nature exerts a crucial and irreplaceable effect on physical, cognitive and emotional development.”

Yet modern living has insulated us from the positive ionic exchange between grass, trees, river and sky, resulting in a physical, psychological and often spiritual connection from the Earth and her creatures. According to researcher and therapist Martin Jordan in his book Nature and Therapy: Understanding Counselling and Psychotherapy in Outdoor Spaces, this detachment is associated with a variety of dis-ease, including epidemic rates of obesity and depression.

Richard Louv, author and founder of the Children & Nature Network, coined the term “nature deficit disorder” in his book Last Child in the Woods to refer to a generation of children who no longer spend time outdoors hiking, camping and otherwise interacting with the natural world. Direct contact with nature appears to benefit children physically, emotionally and spiritually.

Physical

Interacting with natural elements provides a varied and complex terrain and physical stimulation for children. Negotiating inclining hills or slippery declines, catching and releasing tadpoles or crickets, and chasing butterflies, for example, create opportunities for skill-building in a variety of areas, including large and fine motor skills, balance and hand-eye coordination. Most people can remember the challenge of a new skill … and the thrill of successful mastery.

Emotional and cognitive

According to Kahn and Kellert, a child’s experience of nature “encompasses a wide variety of emotions” and an “unfailing source of stimulation.” I remember the awe and wonder I experienced when my childhood naturalist neighbors taught me how to look for the tiny green caterpillars grazing on the cabbage leaves in the garden; then observing their transformation as they ate their way to chrysalises; and the unbearable waiting and waiting until these dormant creatures emerged into beautiful white butterflies.

More recently, I ventured into raising the threatened monarch butterfly. Still with the curiosity of a child, I planted my milkweed, purchased my microscopic caterpillars and watched in amazement as larvae transformed into J’s hanging from the top of my butterfly shelter. Sadly, a virus attacked my precious guests and killed each before they could take their first flight. I experienced genuine grief over this loss.

Moral

Nature provides endless teaching opportunities around issues of moral conscience. Kellert identified nine values of the natural world:

Aesthetic: Physically appealing
Dominionistic: Mastery or control over nature
Humanistic: Emotional bonding with nature
Moralistic: Ethical or spiritual connection to nature
Naturalistic: Exploration of nature
Negativistic: Fear and aversion of nature
Scientific: Knowledge and understanding of nature
Symbolic: Nature as a source of language and imagination
Utilitarian: Nature as a source of material and physical reward These values tend to emerge in a developmental manner, generally shifting from more self-centered, egotistical values to more social and other-centered values.

Nature-informed counseling

Nature-informed counseling refers to a vast array of scientifically based psychological therapies that use nature in clinical practice. Among the foundational assumptions of nature-informed counseling are that we are not machines; we are human beings who are sensual, curious and creative. We are interdependent with the full ecosystem in which we reside.

Furthermore, ecotherapy is an organic model of care that tends to the whole relationship between humans and the other-than-human. Here are several ways to incorporate nature-informed methods into your counseling practice:

1) Animal-assisted therapy: I am fortunate to be able to bring my goldendoodles to my office to be co-therapists. However, in addition to dogs, there are other smaller pets that may work more easily in your practice. For example, I had a betta fish (who was named Olive by a client) that I used with clients. Or place a bird feeder outside your window (if you are fortunate enough to have a window).

2) Horticulture therapy: There are numerous ways to integrate plants in a therapeutic manner. Have clients plant seeds and tend to their care. Or keep small pots of herbs in your office, providing an opportunity to explore aromatherapy. It is a wonderful release to pinch off a bit of rosemary, mint or thyme and inhale the calming, soothing or energizing fragrance.

3) Wilderness therapy: I have used “kayak therapy” with trauma survivors with great success. However, you may not work in a community with easy water access or even know how to kayak. Therefore, your wilderness approach might be more in line with taking clients on a walk on a trail or observing wildlife with them in a nearby lake or pond.

You can also co-create homework around nature walks. For example, I was working with a couple who seemed stuck, so I asked them to go for a walk together (without talking) and collect items along the way that reminded them of their marriage. When they returned to my office, they emptied their treasures, which included a rock (“that used to be how I saw our marriage”), a feather (“we are drifting away”) and a few twigs (“we have roots still”). After a discussion centered around the items gathered, I had the couple finish the session by using the items to create a sculpture that reflected the relationship they wanted to craft.

4) Other ideas:

Assess your clients’ relationship with nature. Where is their “happy place”? How often does they get to visit it? Where are their favorite memories housed?
Invite a family with which you are working to spend the night in a tent in the backyard and reflect on this experience in session.
Teach cloud spotting. Teaching clients mindfulness takes on a fun twist as you lie on your back and gaze at the ever-changing cloud formations.
Use transitional objects. I keep a box in my office filled with seashells, sea glass and rocks lovingly collected by my own mother when she walks the beach. I use these as transitional objects when clients might benefit from imprinting an image or experience to an object that they can carry in their pockets or purses throughout the day.

Ethical consideration

As with all forms of practice, ethical standards must be followed to avoid harm and litigation. So what are the ethical considerations when utilizing the wisdom of nature in psychotherapy? This depends on the extent and type of nature-informed therapy you are using. For example, the ethical guidelines for hiking a trail with a client may look a bit different than the guidelines for planting a sunflower seed and tending to it as metaphor for self-care and growth. However, in general the following issues must be addressed.

1) Do all parties feel physically and emotionally safe? Although you may thrive sitting in a field of poppies, your client may possess strong allergies to flower pollen that render therapy outdoors a physically uncomfortable experience. In addition to allergies, the client may exhibit phobias around the outdoors that need to be understood and appeased. Temperature and air quality may also be variables to consider.

2) Framing the relationship. For some therapists and clients, an office space with a designated chair arrangement signifies a professional relationship and the tasks that will ensue. A client may feel uncomfortable with the more lax and familiar atmosphere of sitting cross-legged on a hollow log while disclosing current therapeutic issues. Trading leather chair for log stump may alter the relationship in ways that prove unsettling for either the client or the therapist.

3) Is it confidentiality compliant? I have clients who love taking a walk during therapy. Some lament that it is the only time they have for physical activity. However, if we are walking in a heavily populated area, their confidentiality may be at risk. At the same time, an area that is too isolated may not be prudent should an emergency situation arise.

4) Get appropriate training. If you do not know how to kayak, taking clients on a wilderness kayak expedition probably isn’t wise. Always get training before using any modality in therapy.

5) Informed consent. It is always prudent to have clients sign an informed consent form that stipulates the possible risks and benefits of any therapy used in session. Therefore, a specific consent form that addresses the specific type of nature-informed therapy — including possible benefits and risks — needs to be explained and signed prior to taking that walk in the woods or a stroll in the garden during session.

Conclusion

Nature provides endless opportunities for metaphors, messages and meaning construction. Incorporating nature-informed approaches into our practices is not only creative but also clinically sound. It is as easy as taking the time to reflect on the sights, sounds, and smells just outside the door.

****

For more information:

Ecotherapy: Healing With Nature in Mind by Linda Buzzell and Craig Chalquist (2009)
Nature and Therapy: Understanding Counselling and Psychotherapy in Outdoor Spaces by Martin Jordan (2014)
Children and Nature: Psychological, Sociocultural and Evolutionary Investigations by Peter H. Kahn and Stephen R. Kellert (2002)
Last Child in the Woods: Saving Our Children From Nature-Deficit Disorder by Richard Louv (2008)

****

Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland, and a visiting full-time faculty member in the Pastoral Counseling Department at Loyola University Maryland. Her current research examines sexuality and spirituality in young women with advanced breast cancer. She is currently working on a book titled Homegrown Psychotherapy: Scientifically-Based Organic Practices, of which this article is an excerpt. Contact her at cy.fisher@verizon.net.

****

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

****

Behind the Book: Partners in Play: An Adlerian Approach to Play Therapy

By Bethany Bray October 10, 2016

It’s often said that play therapy reaches young clients through their own natural “language” of play. When combined with tenets of the Adlerian method, play therapy becomes a tool for the therapist to build an egalitarian relationship with the client while focusing on the individual and his or her dynamics with others, according to Terry Kottman and Kristin Meany-Walen, co-authors of Partners in Play: An Adlerian Approach to Play Therapy.

“The Adlerian belief in the ability to make new choices and to reinterpret situations provides a vehicle for play therapists to work with children to get out of their boxes, change their lifestyle patterns, increase their social interest, make shifts in the goals of their behavior and a host of other forums for determining their paths,” write Meany-Walen and Kottman in the book’s second chapter. “One of your primary responsibilities as an Adlerian play therapist is to discover how each child expresses his or her special and wonderful self and to convey a sense of celebration in his or her uniqueness to the child, parents and other people who interact with him or her. Sometimes the child expresses uniqueness in a way that others do not appreciate.”

Meany-Walen, an assistant professor of counseling at the University of Northern Iowa, and Kottman, who runs a play therapy counseling, training and workshop center in Cedar Falls, Iowa, are both licensed mental health counselors and registered play therapists.

The third edition of Partners in Play was published earlier this year by the American Counseling Association.

Q+A: CT Online contacted Kottman and Meany-Walen recently to learn more about this unique approach. Their responses are co-written, except where noted.

Your book focuses on Adlerian play therapy, which combines play therapy techniques with the Adlerian method. Why do you think they are a good fit? Why does that combination work to help young clients?

Adlerian psychology has a clear and easy-to-follow way to conceptualize clients and figure out what is “underneath” the presenting problem. Before the development of Adlerian play therapy, there was no precedent for working with individual child clients, nor was there a precedent for using play as a treatment modality using Adlerian psychology. We believe that combining Adlerian psychology with play therapy was a logical way to capitalize on the Adlerian methodology for conceptualizing and developing a treatment plan [while] at the same time using play, the “natural” language of children, to communicate with them.

What are some key takeaways that you want counselors to know about this topic?

We want counselors to learn about the myriads of ways of using play, art techniques, sand tray, active games, movement and dance, bibliotherapy and therapeutic storytelling as a vehicle for helping children, adolescents, parents and family members to grow in positive directions. We believe that the four-phase model of Adlerian or Individual Psychology — building a relationship with the client, exploring the client’s lifestyle, helping the client gain insight into his or her lifestyle, and learning and practicing new skills — is an amazing vehicle for working with clients. We value the systematic way Adlerian counselors conceptualize clients — looking at assets and strengths, interpersonal dynamics, intrapersonal dynamics (like personality priorities, Crucial C’s*, goals of misbehavior, mastery of the life tasks), problem-solving skills, self-defeating thought patterns and so forth — as a way to determine the best way to decide on the direction and structure of the therapeutic process.

* The Crucial C’s are one method that Adlerians use to conceptualize clients. They were developed by Amy Lew and Betty Lou Bettner, who suggest that all people need to have courage (the willingness to try new things without a guarantee of success), connect (the desire and ability to build relationships with other people), be capable (the belief that they are able to master ideas and skills) and count (the belief that they are valuable and special without having to earn love or worthiness).

How does Adlerian play therapy fit with your personality and style as a counselor? What made you want to specialize in this area?

I (Terry) am a very encouraging and exuberant person. Adlerian play therapy reflects my personality by being positive and playful. I was drawn to Adlerian psychology because it is so focused on the strengths of the client, which is exactly what I wanted to do when I became a counselor. I love playing, have always loved playing and had spent my whole life working with children in some capacity. When I was in high school, I worked part time in a pediatrician’s office. When I was in college, I taught swimming lessons to young children and volunteered in an after-school program for children who came from low-income families. I got my first master’s degree in elementary teaching and my second master’s degree in special education. I loved working with children in schools. It was a natural transition for me to work as a school counselor and to become a play therapist.

Adlerian play therapy was also a natural fit for me (Kristin). I had often considered the experiences of my youth, and my perceptions of those experiences, as instrumental in shaping who I was as an adult. I explored many different counseling theories, and Adlerian psychology was most consistent with how I understand people and how I want to work with them. The systematic way of understanding people’s ways of belonging and operating in the world, from an Adlerian perspective, helps me to feel organized and productive, both of which are important parts of my lifestyle.

By happenstance, I took a class from (co-author) Terry Kottman where I began learning about the value and art of play therapy. I started to use some of the play therapy concepts with my own child, who was 8 years old at the time. I noticed drastic improvements in his mood, his behaviors and our relationship. I wanted to help other children and families in the same way.

One of the things that prompted you to write the first edition of this title (in 1995) was a rising interest in play therapy. Two decades later, is the field still growing?

Yes, it is. The field of play therapy continues to grow, with the Association for Play Therapy growing from 3,346 members in 1998 to 6,166 members in 2015, increasing at the rate of about 1.5 percent each year. There is a wider understanding of the importance of credentialing of play therapists (registered play therapists, or RPTs) among mental health professionals and with the public.

What is one thing you wish you knew about play therapy as a new counselor? What advice would you give to recent counseling graduates who are starting out and are interested in play therapy?

I (Terry) wish I had known that play therapy was not just for children — that teens, adults and members of families can also benefit from using play therapy skills and techniques (including art techniques, sand tray, active games, movement and dance, bibliotherapy and therapeutic storytelling) as a way to express themselves, explore their issues, gain insight, and learn and practice new ways of communicating, solving problems and interacting with others.

The advice I would give recent counseling grads who are starting a career in play therapy is to obtain really good training in play therapy. I believe it is essential to explore the different approaches to play therapy and find one that fits with your personality and what you believe about how personalities form and how people change. After that, find training that includes being observed with children and getting feedback about your skills and abilities.

What prompted you to create a third edition of this title? What new information will readers find?

The counseling field continues to evolve as we make discoveries and learn from our experiences. We wanted to provide updated information about play therapy, counseling and how the two merge. Since the last edition, we have seen an increase in the importance of evidence-based treatments and research. In the current edition, we include information about some of our ideas of researching Adlerian play therapy as well as published accounts of Adlerian play therapy. We also included various resources for readers such a list of activities to use with children and informal assessments to use with children, parents or teachers.

In addition to your book, what resources would you recommend for counselors who want to learn more about play therapy?

For beginning play therapists who want to know about play therapy skills, another book I (Terry) wrote that is published by ACA would be a good resource: Play Therapy: Basics and Beyond (second edition). Another excellent resource is the website of the Association for Play Therapy (www.a4pt.org).

****

Partners in Play: An Adlerian Approach to Play Therapy is available both in print and as an e-book from the American Counseling Association bookstore at counseling.org/publications/bookstore or by calling 800-422-2648 x 222

****

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.

****

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The value of contemporary psychoanalysis in conceptualizing clients

By Whitney Keefner, Hilary Burt and Nicholas Grudev October 5, 2016

As students in the University of Vermont’s graduate counseling program, our professors have stressed both the benefits and critiques of Sigmund Freud’s psychoanalytic theory. We grew curious about how Freud’s pioneering ideas have evolved over time and how they can be applied to clients today. We think that contemporary psychoanalytic theory provides a great foundation for understanding human development, and this article allowed us to explore its progression.

Freud’s psychoanalytic theory has received widespread criticism since its establishment in the late 19th century. However, Freud’s original theories have undergone numerous evolutions, resulting in the de-emphasis of antiquated ideas pertaining to psychosexual fixation and a modern emphasis on the influence of early life family dynamics on later life relational patterns. This shift from examining repressed libidinal urges to the intrapersonal/interpersonal etiology of relational patterns allows counselors to place problems into an addressable context — namely, the bolstering of intrapersonal resources (i.e., ego strength) and the formation and maintenance of quality attachment relationships. These two branches of psychoanalytic thought are known respectively as ego psychology and object relations.

Ego psychology

From a contemporary psychoanalytic perspective, an individual’s mental health is dependent on the regulatory abilities of the ego. The ego is the contemporary psychoanalytic term for the psychological mechanism that governs the processing of reality and the regulation of instinctual urges and moral rigidity. The ego has many significant roles, including perceiving and adapting to reality, maintaining behavioral control over the id and defending the individual from undue anxiety. The undeveloped (or overstressed) ego can lead to a wide span of threats to a person’s wellness.

Mental health issues arise when the ego has not developed properly and its regulatory functions are either immature or absent. The Psychodynamic Diagnostic Manual (a psychoanalytic “companion” to the Diagnostic and Statistical Manual of Mental Disorders that is used by many practitioners of contemporary psychoanalytic theory) outlines several functions of ego health. These functions (collectively referred to in the Psychodynamic Diagnostic Manual as the Personality Axis, or P Axis) include:

The maintenance of a realistic and stable view of self and others
The ability to maintain stable relationships
The ability to experience and regulate a full range of emotions
The ability to integrate a regulated sense of morality into day-to-day life

Counselors might use these functions collectively as a guide to conceptualize the health of a client’s ego, while simultaneously considering specific aspects of ego function as possible starting points for counseling interventions. It is also worth considering how clients may defend their sense of self through the use of defense mechanisms.

Considering ego and relationships: Object relations

Whereas ego psychology represents contemporary psychoanalytic views on the development and regulation of the self, a separate yet related branch of contemporary psychoanalysis focuses on the self in relationship with others. Many theorists within the psychoanalytic school of thought place significant emphasis on the association between intrapersonal and interpersonal wellness.

From an object relations perspective, counselors may view barriers to client wellness as stemming from the quality of early interactions between the client and his or her caregivers and how the client internalized these early relational experiences. When an infant is first born, it is undifferentiated from the mother. Thus, the self has not yet formed. The self is composed of the ego, the internal objects (i.e., structures formed due to early experiences with a caretaker) and the affect that binds the ego and internal objects together.

The development of internal objects and ego is crucial to one’s functioning in later life because impaired object relations may result in the development of abnormal behaviors, cognitions or emotions. To elaborate, when an individual experiences negative relational experiences in the caretaker-child dyad, healthy object relations fail to formulate. These relational blunders occur after ego-relatedness (i.e., the phase of absolute dependence on the mother). When the child is not provided with an ego-supportive environment, growth of the ego is inhibited.

Fragmented ego strength during childhood may contribute to later issues in adulthood. Object relations bears a strong theoretical resemblance to attachment theory in that the relational experience between a caretaker and an infant carries implications for functioning across the life span. For example, the relationships that individuals hold with others (caregivers, friends, romantic partners, etc.) shape the development and regulatory ability of the ego. Individuals with fragmented ego strength are therefore at a disadvantage because they developed a faulty foundation for both self-regulatory abilities and social interactions later in life.

Defense mechanisms

In her book Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process (2011), Nancy McWilliams conceptualizes a person’s capacity to acknowledge reality — even when that reality is unpleasant — in terms of ego strength. Ego strength, like other aspects of wellness, is constantly in flux and can be eroded temporarily by the stresses of day-to-day life. When ego strength is compromised by anxiety-provoking circumstances, or even by mental fatigue (we note, for example, that our egos begin to feel considerably less sturdy by the end of the semester), ego defense mechanisms serve as a kind of respite from perceived threats. When sensitive topics are broached in the context of counseling, client defense mechanisms may present themselves. Because these same defenses likely arise in other contexts that are interpersonally challenging for clients, acknowledging and discussing these defensive processes may prove to be a generative pathway to change.

According to McWilliams, when clients use a defense mechanism, they are generally trying unconsciously to avoid the management of some powerful, threatening feeling (e.g., anxiety, grief, shame, envy). In the same way that fabled knights used shields to deflect the fiery breath of a dragon, clients may use defense mechanisms to ward off potential threats while attempting to maintain safety and stability in their stances.

It is important to note that the use of defense mechanisms is a common, if not daily, occurrence in the lives of most people. Indeed, the use of defense mechanisms is considered by most mental health professionals to be adaptive and necessary for sound mental health. George Vaillant (1994) described how defense mechanisms help people to regulate internal and external reality, and decrease conflict and cognitive dissonance. However, it is also important to note that defense mechanisms can be used in ways that are more adaptive or less adaptive. The degree to which an architecture of defenses might be considered adaptive pertains to the frequency and rigidity with which the defenses are used and the types of defenses employed.

In broad terms, defense mechanisms might be defined as primary or secondary defensive processes. McWilliams considers primary defenses to be less adaptive because they contain a greater degree of distortion in the boundary between the self and the outer world relative to secondary defenses. Primary defense mechanisms are characterized by the avoidance or radical distortion of disturbing facts of life.

For example, McWilliams explains how the primary defense mechanism of introjection involves substituting the perceived qualities, values, behaviors or beliefs of another person for one’s own identity. In effect, these individuals are uncritically adopting the attitudes, values or feelings that they perceive a valued other wants them to have. McWilliams suggests that such global distortions of self and reality likely have their origins in early developmental stress and the lack of developmental opportunities to cultivate a coherent and stable ego or a differentiated sense of self.

McWilliams considers secondary defenses to be “more mature” because they allow an uncompromised sense of self to remain relatively intact, even as an uncomfortable reality is held at bay. Secondary defenses allow for greater accommodation of reality and a stable sense of self. For example, counseling students may occasionally employ “gallows humor” (humor is one of numerous secondary defenses that McWilliams describes) before taking tests such as the National Counselor Examination. Humor in such cases helps to ease the tension by distracting from the reality of the situation without engaging in significant denial or distortion of the situation itself.

The degree to which developmental opportunities have allowed for the establishment of the aforementioned ego domains and the type of defensive architecture generally used (i.e., primary vs. secondary) contribute significantly to how clients perceive difficulties in their lives.

Ego dystonic vs. ego syntonic

An essential aspect of understanding an individual’s mental health is the presence or absence of an observing ego. According to McWilliams, an observing ego enables clients to see their problems as inconsistent with the other parts of their personalities. Such problems are termed ego dystonic. In terms of counseling individuals with ego dystonic problems, the client’s and the therapist’s understanding of the problems are likely to align because both parties recognize the problems to be undesirable. Thus, the observing ego allows for identification of unwanted problems and helps the client bring his or her personality back to a desirable level of functioning.

Problems that are unrecognizable by an individual are termed ego syntonic. According to McWilliams, such problems are likely to be rooted deep in the individual’s personality and often develop during early childhood. Because ego syntonic problems are intertwined in the person’s character, addressing these problems can be perceived to be a direct assault on the individual’s personality.

Taking away an adult representation of an adaptation from childhood could compromise an individual’s entire way of being. It is therefore important for counselors to handle ego syntonic problems slowly and delicately. For example, counselors could validate and empathize with a client’s ego syntonic experience while subsequently offering an alternative perspective. Establishing rapport and trust in the counseling relationship is perhaps the strongest tool when working with individuals whose maladaptive behaviors are intertwined in their personalities.

Substantial time is required for ego syntonic problems to become ego dystonic, and treatment is not possible until an individual can recognize his or her problems as such. The presence or absence of an observing ego determines whether an individual’s problems are neurotic or entwined in his or her character. Ego syntonic problems are telling of a dysregulated ego because the ego lacks the ability to acknowledge, understand and accept reality. Individuals who are capable of recognizing their problems likely have a better sense of self and a more developed ego.

Summary

Contemporary psychoanalytic thought emphasizes the impact of the ego on an individual’s well-being. Whether development is viewed from an object relations lens or an ego psychological lens, the ego is at the core of healthy development. The ego’s ability to balance the id and the superego, and process reality and emotions, can be learned only if an individual’s social relationships throughout his or her lifetime foster healthy ego development. Unhealthy development or underdevelopment of the ego can cause psychopathological problems because an individual’s abilities to process reality and emotions are likely to be impaired.

According to McWilliams, all of us have powerful childhood fears and yearnings. We handle them with the best defense strategies available to us at the time and maintain these methods of coping as other demands replace the early scenarios of our lives. Thus, defense mechanisms are useful in protecting the ego, but when used in excess, they may cause psychopathological problems. In this way, ego defense mechanisms are like sugar. When needed, sugar provides valuable energy that prevents the body’s systems from malfunctioning. But when consumed in excess, sugar can cause disease and negatively affect an individual’s well-being.

Conceptualizing clients through a contemporary psychoanalytic lens can provide counselors with a deep understanding of the past and present factors that are shaping clients’ lives. This approach illuminates how adaptations formed during childhood can present as maladaptive behaviors or cognitions in adulthood. Unlike classic psychoanalysis, contemporary psychoanalytic theory considers the social factors that contribute to ego health, therefore giving counselors a more comprehensive and applicable understanding of the client.

****

The authors would like to extend a special thank you to Aaron Kindsvatter for his contributions and supervision.

****

Whitney Keefner is a second-year student pursuing a dual master’s degree in clinical mental health counseling and school counseling at the University of Vermont. She is currently interning at Spectrum Youth and Family Services in Burlington, providing integrated co-occurring treatment for mental health and substance abuse issues. Upon completing her degree, she hopes to continue working with individuals struggling with substance abuse in a community mental health setting. Contact her at wkeefner@uvm.edu.

Hilary Burt is a second-year graduate student in clinical mental health counseling at the University of Vermont. She is interning at UVM Counseling and Psychiatry Services. After she completes her degree, she hopes to work with children and adolescents in a community mental health setting. Contact her at hburt@uvm.edu.

Nicholas Grudev is a second-year graduate student interning at the MindBody Clinic at the University of Vermont Medical Center. Upon completing his master’s degree, he plans to enroll in a doctoral program to study counseling psychology. Contact him at ngrudev@uvm.edu.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for getting published in Counseling Today, go to ct.counseling.org/feedback.

****

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

****

Establishing a professional international counseling identity

By Karena J. Heyward and Eleni Maria Honderich October 4, 2016

The counseling profession continues to grow and develop at both the national and international levels. Yet compared with psychology and other health professions, counseling might be considered to be in its adolescent years of development.

The psychology profession is well-established, enjoying worldwide recognition. At the same time, many people outside of our profession of counseling still question who we are. As Erik Erikson might say, counseling is in its identity formalization stage. In this stage, we are grounding and conveying our professional identity for others to understand. This time can be powerful and transformative. However, it can also be scary to reflect on questions related to identity because we are speaking not only to our known Westernized conceptualizations of what it means to be a counselor, but also to global perspectives.

In the United States, contingent on one’s social circle or environment, the word counselor can mean a plethora of things, from a camp counselor to a financial counselor to a counselor at law. How many times has our profession been faced with questions such as “What is a counselor?” and “What does it mean to be a counselor?”

As we answer those questions, we must acknowledge the larger picture at hand. Namely, counseling identity spans the globe and transcends a Westernized view of conceived professional identity. How a counselor is defined will vary depending on culture. Although communal philosophies bond us (e.g., wellness-based models), differences still exist in terms of application (e.g., theoretical preferences). Cultural differences don’t make one way of doing things the “right” way or the “better” way. Instead, they speak to individualization of the treatment process with respect to cultural needs and norms, and continued professional growth and evolvement.

Another question arises: Why even consider internalization? If some counselors are still in the process of formalizing their own identity on a national level, why consider a holistic identity? In conversations with peers around the globe, some opponents of efforts to internationalize counseling have noted that:

An international counseling identity is nearly impossible to define because counseling looks fundamentally different through a global lens.
Individual countries may lose their voice within an international identity if a Western perspective to counseling dominates the field.

On the other hand, proponents have reflected that unification has the potential to:

Make the profession stronger and increase its credibility
Reach and help more clients
Help counselors continue growing and learning from one another

As the authors of this article, we are vested in this very topic. We are influenced both by our own cultural backgrounds (German and Greek descent, respectively) and by cultural immersion experiences abroad that opened our eyes to the world of counseling within different cultures. These experiences shaped us, leaving us thirsty for more. In conducting literature reviews, we found a variety of scholarly articles examining what counseling means through specific cultural lenses from around the globe (e.g., Italy, South Korea). Our appetite was not satiated, however. We wanted to learn what an integrated counseling identity might look like. We believe such an identity is quintessential to the counseling profession continuing to establish credibility and distinction as a unique and valuable mental health profession.

Although the literature spoke on cultural perspectives of counseling in different countries, we found that this research tended to use a monocultural lens (“Counseling in [insert country]”). Monocultural lenses can be integral to breeding understandings of culture-specific conceptualizations. Such analyses leave the resolution of multicultural differences and similarities untouched, however.

Hence, our next step toward possible internalization of a counseling identity involved ongoing cross-cultural conversations with peers around the world. These conversations focused specifically on concepts of counseling identity and the idea of global identity integration. The remainder of this article summarizes some of our findings related to these cross-cultural conversations. We conducted interviews with 18 counselors from around the globe to help begin this dialogue about an international counseling identity.

Acknowledging the good and the bad

The cross-cultural conversations about the formation of an international counseling identity revealed both potential challenges and benefits. Noted challenges included cultural differences related to the practice of counseling that might be undermined through a unified definition, difficulty capturing multiple voices or perspectives in one identity and fear of monocultural domination (e.g., Westernization).

The primary argument and challenge raised against unification was the fear of multicultural denunciation. As one colleague noted, “Each country — and even each jurisdiction in a given country — has differing histories, approaches and orientations that would make it very difficult to create one all-encompassing identity.” Another counselor elaborated further, saying that “even if it were possible, [I’m] not sure if we would want this. [It] could be too reductionist.”

While acknowledging these challenges, participants stated that the benefits of a unified international identity might include increased credibility and a stronger professional identity for counselors; subsequent results from the incorporation of a multi-international cultural lens into professional practices and standards; and more standardized practices geared toward best serving clients across countries (some counselors also considered this to be a drawback). In general, these benefits were grounded in advancing client practices and professional credibility.

One counselor remarked that the counseling profession could continue to move forward if “standards are equal all over the world, taking out the illegal, underqualified people who could seriously damage people’s lives.”

Similarly, another colleague noted, “While I think some things will always have to be accounted for as different between cultures, some basic ethical and educational principles can and should be maintained universally.”

One participant asserted that “the counseling field lacks a certain level of organization, therefore losing some respect.” We believe these claims can be ameliorated through a universal counseling identity.

Resolving differences

When we speak about a unified and integrated counseling identity, we do not assume this means that we will all be one and the same. Instead, it means we will stand together. Unification does not equate to a strict identity of the “right way.” Rather, it builds on phenomenological similarities of the counseling profession across cultures while respecting cultural diversity. We must have mutual respect for one another and be willing to listen to and learn from each other even as we acknowledge cultural differences.

These are points and themes that emerged from our cross-cultural conversations with counselors. They also serve as philosophical pillars to current international initiatives taking place through the International Registry of Counsellor Education Programs (IRCEP) and NBCC (National Board for Certified Counselors) International (NBCC-I). These initiatives are vested in professional internationalization and feature a strong emphasis on cultural respect and understanding. These programs don’t project a counseling identity but rather listen to the voices and needs of the associated country in terms of accreditation (IRCEP) and personal credentials (NBCC-I).

We believe that for counseling to grow as a profession, there needs to be a willingness to engage in continued conversations related to an international counseling identity even as we remain open-minded and respectful. The field does look different in other countries, and the conversation is not about right versus wrong; it is about how we all can stand together while respecting one another.

As one participant commented, “I believe some more open communication would be great for establishing a better level of trust and understanding between countries.” Similarly, another participant of this study noted that “multicultural barriers need to be observed.”

Through such respectful communications and open dialogue, we can begin to develop an international counseling identity that is grounded in mutual respect and understanding and that benefits all cultures while furthering our professional identity. As this happens, counselors should face fewer questions from outsiders linking us to psychologists and social workers.

Implications for counselors

Although we, the authors, are vested in the concept of integration, we recognize that cross-cultural conversations must first occur so that counselors around the globe can respectfully united. Regardless of whether the profession ultimately integrates on an international level, cross-cultural conversations related to multiculturalism, client welfare and professional identity should take place.

Multiculturalism and client welfare: Engaging in conversations related to integration may be equated to gaining a multicultural perspective and pursuing cultural competence. Thinking about and potentially developing a unified counselor identity should lead counselors from various countries to consider the perspectives of professionals from different parts of the world. These perspectives might vary depending on the dominant religions of the country in which the counselor practices, the races or ethnicities prevalent in the country, the socioeconomic norms of the area, the country’s infrastructure and the systems that govern the country.

These conversations can help counselors from any background to broaden conceptualizations of the self, others and one’s general worldview. In addition, a counselor’s role might be broadened beyond the individual counseling setting to include reflection on the benefits of the counseling field as a whole. Among the other counseling experiences that can help lead to these realizations are working with military personnel or government agencies overseas, working in international schools around the globe or being involved with counseling programs that expose their students to cultural immersion experiences in various countries. Unfortunately, these experiences may not be available for counselors in all countries.

Professional identity: Imagine if people emigrating from one country to another automatically understood what a person identifying himself or herself as a counselor meant and knew what to expect from the counseling process. The potential exists for reaching more clients worldwide if we can establish a clear identity across the globe for the counseling profession.

One of our field’s vulnerabilities in the United States is that counselors have not carved out the reputation and cohesiveness that other health professions have attained. When you hear that a person is a medical doctor, you are immediately aware that this person practices medicine. Although a medical doctor’s approach to fighting illness and healing the body may differ depending on his or her location in the world, it is a universal “known” that when one does not feel well physically, a doctor is needed. Likewise, most people throughout the world understand that their mental health concerns can be addressed by seeking help from a psychologist or psychiatrist.

Unfortunately, the same scenario tends not to hold true with professional counselors, in part because of our relative “newness” in the world. Let’s move past this stage and toward concepts of unity by becoming grounded in cross-cultural conversations and respect. As Abraham Lincoln noted, “A house divided against itself cannot stand.” Developing a unified counseling profession in countries where mental health counselors practice has the potential to strengthen our professional identity and reputation around the globe.

Self-reflective processes

Cross-cultural conversations are first grounded in self-reflective practices and understanding of self. As noted, these conversations have a multitude of benefits, including the potential for increasing cultural competency and professional identity.

The following macro-level reflections might prove helpful in the self-reflective process. These prompts are similar to the questions we asked research study participants in our cross-cultural conversations.

How would you describe the counseling profession in the country in which you practice?
What challenges do counselors face in the country in which you practice related to the establishment of the profession of counseling or the professional identity of counselors?
How is the counseling profession in the country in which you practice similar to and different from the counseling profession in other countries?
What do you think about a unified and international counseling professional identity (e.g., do you believe it can or should exist)?
What would the benefits and challenges of a unified identity be?
How could counseling organizations, certification/license-granting bodies, professors of counseling and practitioners facilitate the development of an international counseling identity?

Reflect on these questions, thinking about where your beliefs fall. As with any multicultural consideration, note potential positives and negatives (challenges) while also reflecting on your own ideas related to respectful integration. In addition, converse with colleagues and expand such conversations to the macro-level sphere if possible.

We, the authors, would also love to hear your thoughts. Please contact us to continue this needed conversation. Together, as a profession, let’s step forward together.

****

International Association for Counselling

IAC, established in 1966, is an international association concerned with the interdisciplinary study of counseling. Its vision: “A world where counselling is available to all.” Its mission: “To serve as an international leader and catalyst for counsellors and counselling associations by advancing culturally relevant counselling practice, research and policy to promote well-being, respect, social justice and peace worldwide.” For more, visit iac-irtac.org.

****

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

Karena J. Heyward, an assistant professor at Lynchburg College, is a licensed professional counselor in Virginia and an approved clinical supervisor. She serves as an IRCEP ambassador. Contact her at karena.heyward@gmail.com.

Eleni Maria Honderich is a contributing faculty member at Walden University. She is an ambassador for IRCEP and is vested in international studies and professional development in the counseling profession. Contact her at emhond@gmail.com.

Letters to the editor: ct@counseling.org

****

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.