Monthly Archives: February 2017

Nonprofit News: Avoiding client disclosure on social media

By “Doc Warren” Corson III February 13, 2017

To many people, social media is the best thing since the abacus, transforming the way we live and do business. It offers us a world of knowledge with the stroke of a few keys and the briefest of pauses.

Of course, social media can be both a tool and a crutch that leads to sloppy habits. With the advent of clinician-centered discussion groups on Facebook and other online and social media sites that cater solely to clinical professionals, clinicians are posting an increasing amount of client-related information, sometimes going beyond what the ACA Code of Ethics and relevant laws allow. These clinicians are potentially leaving their clients vulnerable, while leaving themselves and their employers open to ethical complaints and legal suits.

The discussions that were once the domain of individual or group supervision now can be found on any number of social media platforms designed for counselors. Some of these posts come from clinicians from large programs, while others originate with those who are in private or small group practices. Perhaps this shows a lack of experience and knowledge combined with little to no supervision or oversight. I haven’t been able to find a comprehensive study that helps shed light on this topic.

Whatever the cause, accusations that a client’s privacy has been violated can lead to charges of malpractice (and other charges) being filed against the clinician and his or her employer. Comprehensive training followed by regular refreshers could do much to reduce this type of liability.

 

A problem since the early days of the internet

Since the advent of the internet and online bulletin boards (the precursors to Listservs, social media and online groups), there have been issues trying to balance new technology with privacy. About a decade ago, I briefly ran an online group for clinical professionals that was designed so that we could discuss general issues and concerns related to the counseling profession. Sometimes the discussion turned to challenging client cases. Several people, including David Kaplan, chief professional officer of the American Counseling Association, raised questions about this issue. A good-hearted, if sometimes heated, debate took place on these threads, and some very differing opinions were presented. It ultimately did little, however, to change the content of the postings. Within months, I was no longer affiliated with the online discussion group, in large part because of concerns I had about potential ethical violations.

I recently contacted David Kaplan again (he is still in the same role with ACA) to get his opinion on this topic. He agreed that it has been a long-standing issue and that, for both ethical and legal reasons, client information should never be posted on social media. To me, the most powerful thing he said was, “The key for me is the statement at the end [of the ACA Connect site rules and etiquette page]: ‘Please ensure that you phrase your post in a manner that does not describe an actual client.’”

Rather than listing several pages of links to ethical codes, state and federal laws, and the like, I will share the applicable rules and etiquette section from ACA Connect, ACA’s online communities that encourage discussion between counseling professionals.

“Do not present aspects of a case even if the client’s name is not given. Posts that give details about a specific client will be removed. Due to the potential violation of both the ACA Code of Ethics, state and/or federal law, case consultation is not allowed on ACA Connect. It is not permissible to present aspects of a case on a counseling listserv or online forum even if the client’s name is not given. Information shared by a client and clinical impressions must be afforded the same level of confidentiality as the name of the client. Describing a client’s presenting problem, diagnosis, or clinical treatment approach through listservs or online forums – even if the client’s name is not given – is a violation of confidentiality. It is perfectly fine to discuss issues (e.g., asking, ‘Does anyone have any resources on eating disorders in male wrestlers?’ or, ‘Does anyone have a referral to a specialist in PTSD in the Boston area?’), but please ensure that you phrase your post in a manner that does not describe an actual client.”

Owners, overseers, monitors and associated workers of online professional sites, Listserves, groups on social media and other platforms, be they volunteer or paid, could benefit greatly by posting rules that are similar to those above. The enforcement of those rules would prove invaluable.

 

Examples of violations

What follows are some examples of posts that, although they are well-meaning, could potentially lead to ethics or legal charges. (These examples are inspired by actual posts but are not being shared verbatim because I do want not to spread liability or bring possible embarrassment to the original posters; this article is about education, not shaming or embarrassing my fellow clinicians who work hard daily to assist those in their care).

  • “Hi all. I’m looking to make a referral for marriage counseling for a couple that has been married for 14 years. There have been multiple affairs by the stay-at-home husband while his wife was working in the insurance industry. She works till 6 p.m., so evening sessions are a must. They are in the Springfield area and have XYZ insurance.”
  • “I have a client who is 14 years old, has a history of cutting and has recently regressed after her parents told her and her twin brother that they are divorcing. She had also disclosed that she feels she may be bisexual. Any resources that may assist me in treating her would be greatly appreciated.”
  • “OK, so I have this client I’ll call ‘Will.’ I’ve worked with him for several years in my private practice in Newport News. He’s a retired steamfitter and the father of three young adults — two male and one female. Recently, the daughter called me to tell me that she noticed that some of her underwear is missing and suspects that he may have taken them and is possibly wearing them. She doesn’t want to talk to him about this but wants me to explore this in my next session with him. Any suggestions as to how I should approach this with him?”

 

Ways to avoid a violation

  • “Hi all. I’m looking to increase my referral list and am looking for clinicians in the Springfield area who have evening session times and take XYZ insurance. Experience with familial issues would be a plus.”
  • “I’m looking for resources for working with teens who cut and also for sexuality related issues. Thanks!”
  • In my opinion, the third example is beyond paraphrasing. It shows the need for good supervision even when in private practice. The information provided would make it easy to identify this family, even in a city that has a large shipyard.

 

Social media is not a replacement for supervision

In an increasingly connected world, it is important to remember that social media cannot replace the ethical requirement for supervision and it should not be treated as such. Joining these online/social media discussion sites for clinicians can make us feel more connected and less isolated professionally. They can help build a referral base and can help us to plan social events, but they are simply unsuitable for case consults.

Many of us employ a “we are all on the same team” mindset, and that can do much to help our profession. At the same time, we need to remember that seeking advice on these online/social media websites will never be the equal of calling the clinician in the office next to you and doing a case consult. Our clients are counting on us to keep their lives private; our ethics code and laws related to our profession are here to ensure that we do just that.

If you are in a small practice, be it group or individual, for-profit or nonprofit, be sure to have a solid source for clinical supervision and consultation that falls well within industry standards. This not only helps protect our clients, but also protects us against potential legal and ethical violations.

 

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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. Additional resources related to nonprofit design, documentation and related information can be found at docwarren.org/supervisionservices/resourcesforclinicians.html.

 

 

 

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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.

Digging into the numbers

By Scott Rasmus February 9, 2017

It has been relatively well-publicized in the media that mental illness typically affects 20 percent of the U.S. population, or about 1 in 5 people, yet the source of this statistic is rarely disclosed. Furthermore, media sources typically discuss mental illness in general terms and don’t address its susceptibility by age or present statistics on the prevalence of mental illness over time. For instance, a basic comparison of mental illness prevalence statistics between children and adults, or in any given year versus over a person’s lifetime, is rarely offered.

Therefore, I wanted to offer a web-based meta-analysis of prevalence statistics for mental illness by including as many reputable sources of mental health information as I could identify. These sources include the Centers for Disease Control and Prevention, the National Alliance on Mental Illness, the American Psychological Association, the American Psychiatric Association, the National Institute of Mental Health (NIMH), the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of the Surgeon General. The focus of my research was on the most current web research available, spanning the years 2011 to 2015.

Prevalence data

What are the generally accepted definitions of one-year prevalence and lifetime prevalence for mental illness? The NIMH defines one-year prevalence as the proportion of people who have experienced a mental illness in the past year, whereas lifetime prevalence reflects how many people have experienced an incidence of mental illness at any point in their lives up until the point of assessment. These numbers are typically reported as a percentage of the population. It is important to note that these statistics do not necessarily reflect new cases of mental illness, but rather those individuals who have experienced an instance of mental illness — new, ongoing or otherwise — in a given time period. With these definitions in mind, let’s look at the prevalence numbers.

In reviewing the prevalence statistics from various sources, my web research indicated that the average one-year prevalence for adults with mental illness was 22.2 percent (see Table 1), ranging from 14.5 to 26.2 percent over eight well-accepted sources. The average number trends higher than the general prevalence statistic that is often cited in the media, indicating that mental illness is somewhat more common than what is typically reported. With this in mind, one-year prevalence statistics should be revised and presented to the public to reflect that mental illness affects between 20 and 25 percent of adults in any given year.

For youths, I found data only for those ages 8-18. My research indicated that the average one-year prevalence number for mental illness among youths supported the number that is typically reported in the media — 20 percent (see Table 1). However, whereas I identified eight reputable sources of statistics for prevalence of mental illness among adults, I could identify no more than two such sources for youths. This discrepancy in viable sources suggests that a need exists for better research to identify the prevalence of mental illness among our children and adolescents.

I next refined the study to look at the one-year prevalence statistics for severe mental illness (see Table 2). When investigating this special population that is rarely reported in the media, my research indicated that the one-year prevalence average of severe mental illness among adults was 5.7 percent, ranging from 4 to 9.5 percent over seven sources. For youths ages 8-18, the one-year prevalence for severe mental illness averaged about 14 percent over just two sources, with a wide range from 9 to 20 percent.

Putting these numbers in the context of general mental illness, it implies that among adults, severe mental illness constitutes about a quarter of all cases, whereas among youths, severe mental illness makes up more than two-thirds of cases in any given year. This highlights an interesting difference, but we may infer from these numbers that the prevalence of severe mental illness can differ widely based on the definitions applied to it.

My experience suggests that these definitions tend to be more ambiguous and often are termed “severe mental illness,” “severe mental disorder” or “severe emotional disturbance,” to name a few. In my work over the past several years, I have noticed that the interpretation of the definition for severe mental illness can vary so greatly that it may include as few as five mental illness diagnoses or more than 100. SAMHSA’s National Registry of Evidence-based Programs and Practices identifies 17 related terms for severe mental illness. These terms can vary by state and with the inclusion or exclusion of childhood mental disorders and functional impairment criteria. On top of this variance, mental health professionals understand that there is some subjectivity involved in the diagnosis of mental disorders to begin with, even before the classification of the mental illness is determined as severe or not.

Next, I looked at the lifetime prevalence of mental illness for both adults and youths (see Table 3). Interestingly, I found the number of credible sources for these statistics much more limited than those for one-year prevalence, with only two sources apiece for both adults and youths. For adults, the lifetime prevalence statistics averaged 48.2 percent, with a range from 46.4 to 50 percent. For youths, the lifetime prevalence of mental illness ranged from 13 percent (ages 8-15) to 46 percent (ages 13-18), averaging about 30 percent over the full 8-18 age range. Given that youths have had fewer years to experience mental illness, it makes sense that their lifetime prevalence rates are lower than the lifetime prevalence rates of adults.

Finally, when considering the lifetime prevalence of severe mental illness (see Table 4), I could find reliable statistics only for youths, with an average prevalence of approximately 21 percent over two sources. I didn’t find enough credible information about the lifetime prevalence of severe mental illness in adults to even report here. Given the scarcity of statistics for both youths and adults related to lifetime prevalence of severe mental illness, this appears to represent a large gap in the research.

Concerning numbers

After reviewing the prevalence data for mental illness, it makes sense to me to consider current research statistics related to how many individuals with mental illness actually receive treatment for their disorders in a given year. My research indicates that the statistics for both youths and adults seem very consistent with age, averaging about 45 percent overall, and ranging over four sources from 39 to 50 percent.

These numbers shocked me somewhat and were very concerning. Such statistics indicate that regardless of age, less than half of the people who experience an episode of mental illness receive the mental health treatment that they need. This statistic begs the question: Why is this the case?

I can only hypothesize about the answer, which likely has many facets, including a general lack of awareness about mental illness, the need for education around it and the powerful influence of stigma related to mental illness. The media associates mental illness with a number of negative outcomes, particularly highlighting its relationship to violence, which in reality is very rare. To better address this misperception, the board for which I serve as the executive director — the Mental Health and Addiction Recovery Services Board in Butler County, Ohio — has adopted a position statement based on multiple sources indicating that only 3 to 5 percent of those with mental illness are violent. Still, let me offer a practical example of how the prevalence numbers and treatment statistics can be applied to the county where I live and work.

Based on the 2010 census numbers, Butler County has a population of about 370,000 residents. Applying the one-year prevalence statistics for mental illness of 20 to 25 percent, this implies that between 74,000 and 93,000 residents in our county experience an incidence of mental illness in a given year. Of those residents, upward of half don’t receive the mental health treatment services that they need. Potentially, that’s more than 46,000 county residents who may not be living their lives in as fulfilling and productive a manner as they otherwise could, especially when we know that mental health treatment largely works. People recover through modalities such as talk therapy, medications, lifestyle changes and other treatment approaches, which often are incorporated in an integrated way. What a challenge we face in addressing the mental health needs not only in my county but in our entire country and beyond. There are so many lives affected and so much productivity lost to what are very treatable illnesses.

Compiling the information I have shared in this article on the prevalence of mental illness related to time, age and treatment has really impressed on me how much work remains to be done to obtain better estimates of the general incidence of mental illness in our country and the world. We especially need more detailed statistics related to the cultural and demographic aspects of mental illness. The bible of mental illness, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, contains some valuable information related to prevalence and cultural data for specific diagnoses. There remains, however, a need for better research via large random studies that look at mental illness in general, including developmental disabilities and substance use disorders. I often wonder if the published mental health statistics that I review include these categories of mental illness.

Furthermore, as better statistics are researched and reported, mental health prevalence numbers need to be compared with those of well-known physical illnesses such as cancer, heart disease, diabetes, obesity and hypertension. In this way, I believe we can better demonstrate and publicize how common mental illness truly is in our society. Taking these actions will go a long way toward educating the public about its incidence, thus normalizing mental illness and, I hope, reducing the stigma with which it is often associated.

 

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

Scott Rasmus is the executive director of the Butler County (Ohio) Mental Health and Addiction Recovery Services Board. He received his doctorate in counselor education from the University of Central Florida. He is dually licensed in Ohio as a licensed professional clinical counselor-supervisor and as an independent marriage and family therapist. He has presented internationally on mental health topics. Contact him at RasmusSD@bcmhars.org.

Letters to the editor: ct@counseling.org

 

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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 Social Adventures and Experiments of  Tommy Joe Peterson

By Brandon S. Ballantyne February 7, 2017

The idea of this therapeutic short story is to creatively illustrate the various dilemmas that occur from the perspective of a socially awkward young man, Tommy Joe Peterson. Through the story, the reader is able to gain perspective on the thought process and problem-solving skills of this uniquely talented 11-year-old boy.

Whether this fictional story is read by a child or read to a child by a teacher or counselor, the discussion questions included at the end are aimed at facilitating reflection and interpersonal growth. I believe that discussing the responses to the discussion questions will allow for improved awareness and insight into real-life dilemmas and help children to improve their problem-solving skills in a creative, narrative manner.

The target population for my therapeutic short story consists of teachers, parents, therapists and children of elementary through middle school age, particularly those with a mental health diagnosis similar to or consistent with autism spectrum disorder or social anxiety.

Friendship

Hello, my name is Tommy Joe. I am 11 years old. And in my mind, I am not just a boy. I am the world’s most coolest teenage superhero in my school. Well, at least I pretend to be.

Let me tell you about the time I almost saved my friend William from a flying plate of steaming hot lasagna in the cafeteria. Oh, and just so you know, William is only a few months younger than me. This is what happened …

The day started out just like any other day. I woke up at 6:37 a.m. I always wake up at that time to ensure that I get as many cartoons in as I can before I leave for school at exactly 8:02 a.m. I like the superhero cartoons. Batman is obviously the best, and I think I am like him in some ways. Although most adults say I am socially awkward, whatever that means. Clearly, they do not understand my abilities.

Anyway, after my cartoon time, my mother prompted me to participate in what she calls “activities of daily living.” She is a nurse, and I hear those types of phrases all the time. I have gotten used to it. This is the part of my morning routine during which I brush my teeth and comb through my brown wavy hair. I usually place some deodorant under each armpit, but not a lot. I typically do not like the texture, but I tolerate it enough to get at least a little bit of scent on me. Every good superhero needs a scent — at least that is what my mother tells me.

It was almost time to leave for school, so I slipped on my Velcro shoes and placed my bright red turtleneck on so it fit nice and snug, just the way I like it. I refuse to wear anything else but that red turtleneck. I feel most like a superhero in that shirt. Some people tease me for this. They clearly do not understand my abilities.

The bus ride to school is short. I live only four blocks from the school. And as a fifth-grader, riding the bus is the cool thing to do. On that day, the older kids were making fun of the way I was dressed. They always do. They also make fun of the way I only spray certain sections of my hair. You see, only some sections of my hair get messy, so there is no need to hairspray it all down. Only certain sections need a touch-up.

I do not think that the other kids understand my perspective. I don’t mind though. Life can be hard for a superhero like me. Clearly the other kids on the bus do not understand my abilities. And anything is better than riding to school with your parents, although my mother does listen to good music. But that is beside the point, and I do not want to ramble on, so let’s get back to the story of how I almost saved my friend William from an extremely steaming hot plate of lasagna.

I meet my friend William at the same spot every day before going into school. Every superhero needs a sidekick, and William is mine. William is shorter than me, and he refuses to be called Billy. He thinks that William is more formal, and he likes that. He has red curly hair and orange glasses. I do not really know where he got those glasses, but I like them. His glasses usually slip down to the end of his nose, and he has to spend most of the day adjusting and readjusting them. We have every class together. Every superhero needs a sidekick, and at least William understands my abilities.

The day was pretty boring until art class. It is like that every day. William and I count down the minutes leading up to our fourth-period art class. For us, it is more than just art class. It is a time for us to create new supercool superhero ideas. And on this day, the topic of class was “favorite transportation.” This was a perfect topic for superheroes like us.

William and I decided to create a spaceship. This was no ordinary spaceship. This was a supercool spaceship that William and I had imagined ourselves using to explore the outermost limits of our galaxy — beyond the black holes, red dwarfs, supernovas and solar flares.

By the way, space is my other supercool area of interest. William is mostly indifferent to the idea of space travel, but every superhero needs a sidekick, and because of that, I think he would come with me anyway. I guess the only problem would be if William gets motion sickness. I wonder if he gets sick in the car? To tell you the truth, I do not really know how William gets to school each day. I have never been in a car with him. Quite frankly, I only see him at school. Oh well, I do not want to ramble. Let’s get back to the story of how I almost saved William from an extremely overwhelming, steaming hot plate of lasagna in the school cafeteria.

Before describing the scene that would be about to take place in the cafeteria, it is important for me to be able to tell you how our art project turned out. William and I made a spaceship using cardboard, paint and a whole lot of glue. The spaceship was red, just like my turtleneck.

William is exceptionally good at folding cardboard, so I gave him the job of working on the wings. William attached long, narrow wings that seemed as if they would touch the ceiling. We carefully added glue to all the areas that needed to be held together, and then we added more glue, and then more glue, and then one last coating of glue to ensure that this spaceship could tolerate the astronomical elements that space travel would bring to the table. Every good astronaut needs a sidekick.

Our hands were sticky from the glue. It was hard for us to pull our fingers apart. But our spaceship was complete. William and I carefully placed the spaceship in our art closet to dry.

The bell rang for lunch. We hurried out of the classroom without cleaning up the rest of our materials. This was necessary because we need to get to lunch early so that we can sit at the table in the left corner — the one by the ice cream cooler. I like ice cream sandwiches, and it is important to be next to the cooler so that I can get two of them before they sell out. Every superhero needs his energy, and I just happen to get mine from ice cream sandwiches.

William prefers pizza, but they do not always have that. I once had the idea of putting my ice cream sandwiches on my pizza, but I have not been able to convince William to try it with me. And as a superhero, you need your sidekick to be on board before trying anything new. But that is for another story. Let’s get back to this one. I don’t want to ramble.

William and I entered the cafeteria and at a casual but fast pace assumed positions at our table by the ice cream cooler. The cafeteria was loud and chaotic as various students attempted to jockey for position in the lunch line. The teacher on duty was obviously struggling to keep order. I could tell by the look on her face. I did not have this teacher for class, but any good superhero can tell when another person is in obvious distress. I wish I could have helped her, but I needed to remain in position at my table.

This was partly due to the fact that the ice cream cooler is positioned just outside the kitchen, and as kids pass through the lunch line, they typically select their favorite ice cream product to complete their tray. William and I do it backward — we wait for a break in the line, and then we purchase our desserts first. Most kids do not think of going to the ice cream cooler first because it is positioned at the end of the line. Being the most supercool superhero that I am, I had developed this approach early last year. William agreed with me, although he typically does. William is a great sidekick.

The time was right. William and I stood up to go make our selection. I always purchase two ice cream sandwiches. William typically purchases the Italian ice. At least I think he does. Anyway, it was at that moment when we stood up that I began to notice an increase in chaos in the far right-hand side of the cafeteria. I quickly glanced over, and before picking out my ice cream, I noticed a food fight taking place. It was on the other side of the cafeteria, but it appeared as though it was escalating rapidly.

I needed to get my ice cream. I reached down and realized that I could not pull my fingers apart to grab it. Oh no, it was my worst nightmare. My fingers had been glued together from working on our spaceship in art class. It seemed that the harder I tried to pull them apart, the more they seemed to be glued together.

I had one dilemma with not being able to literally pick up my ice cream sandwich, and another dilemma with the rapidly growing food fight that was moving across the cafeteria like a tidal wave. I had to make a decision. I either needed to take cover and sacrifice my ice cream sandwich, or I needed to take the chance of being hit by food and attempt to grab my ice cream with my glued-together fingers. I had to think quickly.

At that moment, I noticed a red substance flying through the air toward William. I saw it out of the corner of my eye, so it was hard for me to tell what it was. But as it flew through the air, I realized that it was a piece of lasagna. It was hot. I could see the steam coming off of it as it whizzed past the heads of various students.

At this point, even the teachers were taking cover. Mr. Jones was under the table, and Ms. Sprockett was hiding behind the soda machine. The flying lasagna was coming our way, and based on my superhero calculations, it was heading directly toward William.

Everything was moving in slow motion. William was frozen in fear. He needed me. I quickly lunged in his direction and raised my hands in an attempt to take most of the blow from the flying lasagna. Every good superhero occasionally makes sacrifices for his sidekick — at least Batman did.

The only problem was that my fingers were still glued together. The lasagna not only hit my arms, covering me in sauce, but it also smothered William. He had sauce and cheese all over him. And the worst part of it was, I didn’t even get my ice cream sandwiches. The last thing I remember was William tasting the lasagna that was dripping off of his cheeks. William is always good at embracing chaos.

I guess even the best superheroes sometimes have trouble rescuing others. But William and I are still friends. He has forgiven me, and there are no hard feelings between us. I guess what I have learned from this situation is that every superhero needs a sidekick. I do not know what I would do without William. He is my best friend. But maybe next time, I won’t use so much glue.

 

Therapeutic discussion questions 

  • According to Tommy Joe, every superhero needs a sidekick. Who is the sidekick in your life? Who do you feel supported by? Who listens to you when you talk?
  • What makes someone a friend? What makes you a friend? What types of things do friends do for one another?
  • Discuss a difficult situation that a friend helped you with. What did they do to support you?
  • Discuss a difficult situation that you helped a friend with. What did you do to support them?
  • The glue on Tommy Joe’s fingers makes it difficult for him to rescue William and pick up his ice cream sandwiches. What should Tommy Joe have done prior to going into the cafeteria that would have made it easier for him to help William?
  • What is a goal you have in your life? What is an obstacle you face in your life? How can you plan ahead to make accomplishing your goal easier?
  • What can your sidekick do to help you reach your goal?
  • If you were Tommy Joe, what would you have done differently in the story? How would making different decisions have affected the outcome of the story?
  • Is there another way the story could have ended? If so, I would love to hear your version.

 

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Brandon S. Ballantyne, a licensed professional counselor and national certified counselor, has been practicing clinical counseling since 2007. He currently practices at Reading Health System in Reading, Pennsylvania, and Advanced Counseling and Research Services in Lancaster. He has experience working with both adolescent and adult clients struggling with moderate to severe depression and anxiety. He has facilitated many unique interventions and group modalities in the area of addressing relationship conflict and negative thought patterns. Contact him at ballantynebrandon@yahoo.com.

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 having your article accepted for publication, go to ct.counseling.org/feedback.

 

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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.

APA accepting feedback for DSM revision

By Bethany Bray February 6, 2017

The American Psychiatric Association has created an online portal for the public to submit suggested changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Launched this winter, the portal allows clinicians, scholars and members of the public to submit suggested additions, deletions or modifications to the DSM.

Often called the “psychiatric bible,” the DSM-5 is a go-to resource for many practitioners when it comes to the classification and diagnosis of mental disorders. APA released this most recent version of the DSM in May 2013, after more than a decade of planning, research and review.

The online portal creates a way to keep the DSM updated in a more timely manner and make changes incrementally, as new information and research is available, according to the APA website.

This new medium offers an important and much-needed chance to have counselors voices considered in what has traditionally been an arena dominated by psychiatrists, says Stephanie Dailey, who was involved with the American Counseling Association’s DSM-5 Task Force and co-author of the ACA-published book DSM-5 Learning Companion for Counselors.

However, Dailey, a licensed professional counselor and associate professor and director of counseling training programs at Argosy University, Washington, D.C., expresses some skepticism about which submissions might actually be considered for changes to the DSM. She contributed some thoughts, via email, to Counseling Today:

 

“The Diagnostic and Statistical Manual of Mental Disorders (DSM) has long been criticized, amongst other things, for poor utility; inadequate psychometric evidence for diagnostic categories and specifiers; comorbidity issues; overutilization of ‘catch all’ diagnoses (e.g., not otherwise specific [NOS] and generalized anxiety disorder [GAD]); and underutilization of emergent genetic, neuroscientific and behavioral research.

While APA’s DSM-5 Task Force attempted to rectify many of these issues, there are still considerable challenges in regard to validity, reliability and clinical utility within the DSM-5. Clarification of diagnostic descriptions, criteria, subtypes and specifiers is needed and there is a significant dearth of information regarding sociocultural, gender and familial patterns for diagnostic classifications. There is also a lack of rigorous psychometric validation for suggested dimensional and cross-cutting assessments (introduced in the DSM-5) and no consensus was made during the last revision to the DSM in terms of modifications needed for the personality disorders category. Thus, this diagnostic category has remained unchanged and clinicians (and clients) are facing the same challenges as they did 20 years ago when the DSM-IV was released.

In terms of the new portal, it is important for individuals to understand the revision process of previous iterations of the DSM to really appreciate the magnitude of an ‘open’ call for revisions. The revision process of the DSM-IV to DSM-5 was a 14-year process, beginning in 1999, which originated with a research agenda primarily developed by the American Psychiatric Association

Image via Flickr http://bit.ly/2lfWuka

(APA), the National Institute of Mental Health (NIMH) and the World Health Organization (WHO). In 2007, APA officially commissioned a DSM-5 Task Force which formed 13 work groups on specific disorders and/or diagnostic categories. While the scope was broad, the intent of the workgroups was to improve clinical utility, address comorbidity, eradicate the use of not otherwise specified (NOS), do away with functional impairments as necessary components of diagnostic criteria and use current research to further validate diagnostic classes and specifiers. Having released the draft proposed changes, three rounds of public comment and field trials were conducted between 2010 and 2012. During this time, numerous professional organizations, including ACA, voiced significant concerns (See ACA’s 2011 letter to APA: bit.ly/2kxJBVY).

Despite attempts to become involved, at no time has any professional counselor ever served on APA’s DSM Task Force. In regards to the new portal, our time to have a foothold in changes to current diagnostic classifications is now.

In looking at the portal which lists specific kinds of revisions sought, one can easily see that APA is looking to remedy the long-term critiques of the manual, specifically validity, reliability, utility and the need to capture emerging research.

However, what proposals (and by whom) that are selected for inclusion remains to be seen. While the portal allows anyone to submit a proposal, there is a long history of bias in the type of research which is deemed appropriate for consideration by APA. While there is no dispute in terms of the need for rigorous research designs and large scale studies to validate criterion, these studies are not likely going to be conducted by anyone outside of APA, NIMH, WHO and other large scale ‘think tanks.’

The problem, particularly for counselors, is both philosophical and practical. First, the psychiatric profession as a whole is trained in the medical model, while counselors tend to operate on a more humanistic, holistic perspective. Next, while Paul Appelbaum, chair of the DSM Steering Committee, stated that acceptance thresholds will be high, reports from Appelbaum and others have ensured scrutiny for submissions which don’t provide ‘clear evidence.’ This is not only vague, but likely slanted towards the psychiatric community.

No one is disputing the need for the best available scientific evidence or the ability of the counseling profession to produce substantive outcome research for the mental health community. The American Counseling Association has members who have significant, scientific-based expertise in areas relevant to the DSM and strong research agendas which can support evidence-based changes. However, our seat at the table in these discussions has been scant.

Thus, counselors are strongly urged to contribute to the revision process by submitting proposals and working towards serving as unique contributors to the next edition. This is particularly relevant to counselors whose focus is on marginalized populations and underserved groups. Outcome-based research is needed, specifically that which has been repeatedly shown to improve treatment outcomes.

This is the time for counselors to become involved and make our experience known, and more importantly, our clients’ voices heard.”

 

 

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Find out more

 

Visit APA’s DSM portal at https://psychiatry.org/psychiatrists/practice/dsm/submit-proposals

 

See Counseling Today’s Q+A with Dailey: “Behind the Book: DSM-5 Learning Companion for Counselors

 

 

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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.

 

 

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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.

CEO’s message: Reflections on ACA’s 20th president

By Richard Yep February 3, 2017

Richard Yep, ACA CEO

As the CEO of the American Counseling Association, I have many opportunities to meet leaders, members and those who are entering the counseling profession. Those who are newer to the profession or who are just starting along the leadership path bring energy, enthusiasm and new perspectives to the table. Just as I have great interest in and wish to support this cadre of professionals who will carry ACA and the profession into the middle of this century, I am continuously in awe of those who have already reached the pinnacle of the profession. Why? Because so many of them continue to want to give back.

Garry R. Walz, ACA’s 20th president and someone for whom I possessed great respect, was a prime example of this exceptional group of individuals. When I heard the news that Garry had passed away in December, it represented to me the extinguishing of one of counseling’s bright lights. It is uplifting to know, however, that the impact he had on so many current counselors and counselor educators will continue to keep his spirit alive (see ACA’s “In Memoriam”).

At Garry’s memorial service, I referenced a coffee mug that I use almost every day. On one side of the mug is a Chinese character, and on the other side is its English translation. The word is friends. Garry gave me that mug during one of his many trips to ACA headquarters over the past 20 years. I keep it pretty clean, and I never leave it in the ACA kitchen! It is something special from someone special.

That is how I will remember my friend, Garry Walz — as someone very special. Although I am nearly 30 years younger than Garry was, he never talked down or “pulled rank” on me (although given his many accomplishments, he certainly could have). Rather, Garry had a way of “talking up” and making those with whom he worked feel special. I knew him long enough to understand that this wasn’t an act. Garry was the real deal. He was a genuine person who cared about those he taught, mentored and worked beside.

Even into his 80s, Garry still had a twinkle in his eye whenever he was talking about his latest idea. And for those who knew him, Garry always had a new idea. Unlike others who might harbor lots of ideas, however, Garry had a way of making things happen and bringing his ideas to reality. He delivered on many fronts — as the longtime director of ERIC/CASS (the Educational Research and Information Clearinghouse on Counseling and Student Services), as the founding editor of VISTAS, as ACA’s 20th president and, I’d say perhaps even more important, as a friend, partner, father and grandpa.

When I arrive at the ACA Conference in San Francisco next month, I will miss seeing Garry. He didn’t attend just to visit with his friends of many years. He went to make new friends! And I am thinking he might have been there to bounce even more new ideas around. Plus, as an avid photographer, he always wanted to gather together as many VISTAS authors as possible so we could take a “class picture.” He was the consummate networker.

So, when the ACA past presidents gather, I will make sure to be with them to reminisce about Garry as we all toast what I think was a wonderful professional life. And when I get back to the office, I will be sure to clean my coffee mug and put it right back on my desk.

As always, I look forward to your comments, questions and thoughts. Feel free to contact me at 800.347.6647 ext. 231 or via email at ryep@counseling.org. You can also follow me on Twitter:
@RichYep.

Be well.