Monthly Archives: March 2017

Technology Tutor: Ethical and legal considerations of counseling tech

By Rob Reinhardt March 31, 2017

Last year, I interviewed a counselor who had been conducting text counseling via the Talkspace service (see ct.counseling.org/2016/06/technology-tutor/). Not long after this, two articles were published that brought some of the legalities and ethics of the Talkspace model into question (see bit.ly/ForbesTS and bit.ly/TSVerge). Given the continued growth of telehealth services, it seems a good time to provide an overview of ethics considerations when using technology in counseling.

Although those articles focused on alleged issues at one particular company, it is important that we apply our ethics decision-making lens to all applications of technology in our counseling work. This includes applications used for electronic health records (EHR), telemental health, internet faxing and so on.

Among the possible scenarios with ethical implications that have been raised for counselors using telemental health platforms are:

  • Concerns about potential violations of the Health Insurance Portability and Accountability Act (HIPAA).
  • Platforms removing the ability for clients to speak with their assigned clinicians.
  • Emails being sent to multiple clients in which the email addresses are visible to all recipients, resulting in possible confidentiality/HIPAA violations.
  • Platforms using the term “customer” instead of “client” in communications to those receiving services, suggesting that such platforms have only a business relationship with clients, not a professional one requiring the same level of privacy/confidentiality that is maintained by licensed clinicians.
  • Concerns that platforms do not have a quick and easy way for clinicians to access client contact information in cases of emergency.
  • Issues regarding mandated reporting and other ethical and legal responsibilities.

I am presenting these concerns here as an opportunity to explore potential real-life ethics situations in the digital age. Let’s examine how counselors can think about these issues and assess whether a particular telemental health or other software platform is right for them and their potential clients.

 

HIPAA

When interviewing any vendor that will come into contact with protected health information (PHI) for which you are responsible, a great starting point is to ask how the company complies with HIPAA. If you’re not satisfied with the vendor’s answer, this should be a nonstarter.

The vendor should be able to provide you with detailed information about how it complies with HIPAA and provide a copy of its business associate agreement (BAA). The BAA is the vendor’s contract with you acknowledging that it complies with HIPAA and detailing what its responsibilities are. If the vendor claims it doesn’t need to comply with HIPAA for some reason (a popular excuse is that the vendor “never has access to PHI”), you should proceed with extreme caution. This reason does apply in certain cases, but they are very rare.

Even if your vendor complies with HIPAA, it is very important not to assume that all of your bases are covered. There are still the ethics concerns noted earlier and the HIPAA compliance measures that you need to address yourself (see tameyourpractice.com/HIPAA).

 

Action point

Check your prospective vendors’ level of HIPAA compliance and confirm that they will enter into a BAA with you.

 

Client autonomy

“Autonomy, or fostering the right to control the direction of one’s life,” is the first guiding professional value listed in the 2014 ACA Code of Ethics (and is also an integral facet of HIPAA). Our ethics code says that clients have the right to choose their counselors. Therefore, counselors who are working as providers in these platforms have a duty to understand if this right will be given. It would be problematic if the platform could disconnect clients from their counselors without client consent or absent an ethical violation on the part of a counselor. If this is a possible scenario on a platform that a counselor is using, it should raise a red flag.

 

Action points

Relationship: When involving a third party such as a platform for telemental health in our counseling work, we must thoroughly investigate what the relationship between the third party and the client would be. Does the third party have “control” over that relationship and the associated records, or do the client and counselor maintain that control? It is important to consider what might happen in different situations. For example, if you decide to switch which vendor you partner with to provide a service, is there anything preventing you from working with the same clients through the new platform? If you need to refer out, how is that handled? Interestingly, these are the same sorts of questions to explore for those joining a group private practice.

Contact: As part of this confirmation of relationship dynamics, counselors should ensure that they have accurate contact information for clients or can gain access to that information in an emergency.

 

Handling of emergency situations

The handling of potential emergency situations is particularly relevant to any form of telehealth. As counselors, we are required by the 2014 ACA Code of Ethics to have a plan for handling contingencies, and when we involve a third party, it is important to explore whether that involvement might present new barriers to such a plan. For example, let’s say a counselor has an urgent need to contact a client or that client’s emergency contact. The counselor uses a cloud-based electronic health records (EHR) system to store client information. What happens if the EHR system or the internet connection is offline? Does the counselor or the EHR vendor have a contingency plan for accessing that information?

 

Action points

Vendor policies and procedures: Know how your vendors handle emergency situations. Is there a way to access data when you have lost your usual route of access? What are your vendors’ contingency plans? Do they have any documentation of past “up time” (percent of time they are up and running) or “outages”?

Contingency planning: Once you know your options with the vendor, what is your plan? Do you keep a secure backup of client contact information in case of emergency? Do you have a backup internet connection (perhaps you can access the EHR via your mobile device via the cellular network)?

If you need additional guidance regarding the creation of a contingency plan, see tameyourpractice.com/contingency.

 

Who is responsible for what?

One of the challenges described by clinicians who have worked with these platforms is identifying exactly who is responsible for what. Tied into both of the previous points, questions are raised about who is responsible for handling emergency situations, record-keeping, billing and even coordination of care with other providers.

Action points

Noting key responsibilities: It might help to make a checklist of your key ethical, legal and clinical responsibilities when it comes to clients (informed consent, HIPAA privacy and security compliance, etc.). Although many of these responsibilities are universal, others may differ depending on the environment in which you work and the clients with whom you work. Construct this checklist so that you are clear on who has ownership of each of these responsibilities and, if necessary, what the contingency plan is for each.

Vetting vendors (or “What are you agreeing to?”): What are the policies and procedures of the third-party vendor? What are the terms and conditions? What is the corporate climate and goals of the vendor? Is the vendor’s organization a for-profit venture run by venture capitalists with no experience in mental health care? Do they express an understanding, both verbally and in policy, of the ACA Code of Ethics? What limitations, if any, do they place on your provision of care? Are there additional limitations, such as clinicians being prohibited to talk with the news media about their experience using the software?

 

Terms and conditions

As tempting, and common, as it is to breeze through “terms and conditions” pages, this is definitely not the time to do so. Many of the action points I’ve mentioned will involve finding answers not just by asking vendor representatives, but by reading the terms and conditions or contract. What is written there is likely more binding than something that a customer service or sales representative told you. Furthermore, if what is written in the terms and conditions differs from what was verbally communicated to you, that should raise a red flag.

 

Action point

Go through the vendor’s terms and conditions with a fine-toothed comb. Weigh them against your ethics and legal responsibilities to ensure compatibility.

 

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Please note that this is not an exhaustive list. As we increasingly integrate technology into our counseling work, it also increases the number of risk management items on our plate. Thankfully, if handled well, the use of technology can also be of great benefit to our clients and our work with them.

Have questions about how your situation or the use of a specific service is affected by ethics and HIPAA? Send me an email. For a broader overview of telehealth considerations, read the article at bit.ly/TYPTH.

Note that the American Counseling Association does not endorse or condemn the use of any particular telemental health platform. Counselors should always consider the 2014 ACA Code of Ethics, local and national laws, and their own best judgment before using new technologies.

 

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

 

Letters to the editor: ct@counseling.org

 

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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.

Facing the fear of incompetence

By Kathleen Smith March 29, 2017

When Karena Heyward and Jessica Lloyd-Hazlett were enrolled in graduate school together at the College of William & Mary, they agreed to split the cost of a hotel room while attending the American Counseling Association’s annual conference. The two counselors didn’t know each other very well, but over the course of the weekend they found themselves engaging in long, authentic conversations about their lives. Returning home, they reflected on the topic of vulnerability, and the two began to build a friendship based on helping each other through difficult moments in the counseling profession and life in general.

Fast-forward five years, and that first step toward vulnerability has flourished into a series of presentations on the very same topic, including a session titled “Connecting to Our Vulnerability in Clinical Practice, Supervision and Self-Care” at the ACA 2016 Conference & Expo in Montréal. Heyward and Lloyd-Hazlett, now both counselor educators, initially worried about how people would respond to their insights and stories about their awkward moments as counselors. Instead they found a welcoming audience that craved conversations about self-doubt, discomfort and authentic connections in the counseling room.

Vulnerability has certainly become a buzzword in the helping professions in the past few years. Big names such as Brené Brown, a licensed master social worker, TED talker and research professor at the University of Houston, have taken theory about difficult emotions including shame and self-doubt and turned the content into best-sellers. But even though counselors’ clients are told that the very foundation of change is to embrace uncertainty and discomfort, there is a scarcity of research about the impact of self-doubt and the nature of vulnerability among counselors themselves.

Self-doubt among counselors, sometimes referred to in the literature as “fear of incompetence,” is associated with higher levels of stress, professional burnout, symptoms of depression, career changes and ethical misconduct. In a 2006 study of experienced therapists, Anne Thériault and Nicola Gazzola found that lack of knowledge was the most commonly acknowledged source of self-doubt. Other factors cited included a lack of strength in the counseling relationship, personal factors and a discrepancy between the counselor’s and client’s perceptions of outcome.

Intrigued by some of this research, Everett Painter, a counselor education doctoral candidate at the University of Tennessee, presented on the topic of self-doubt and similar “emotional gremlins” at the ACA Conference in Montréal. He guided the room in a discussion about the “oughts” and “shoulds” that often get in the way of good work for counselors.

“This kind of self-talk can be damaging and uncomfortable,” says Painter, a member of ACA. “For counselors, this sometimes sounds like, ‘What if I fail? What if this doesn’t work out the way I planned? What if my best isn’t good enough?’ So we talked about a lot of those expectations, where they come from, are they valid and how to manage them.”

Counselors of all experience levels frequently will face new or unexpected moments of self-doubt when working with clients. These moments are often set off by “triggering events” such as difficult content, a developmental plateau or something as simple as not knowing where to go or what to say next in a session. Counselors can respond to such moments either by pushing forward into the discomfort or turning away from the opportunity and detaching.

Lloyd-Hazlett, an ACA member and assistant professor of counseling at the University of Texas at San Antonio, views the ability to face this self-doubt as the definition of vulnerability. “It’s part of the process and, ultimately, it’s going to help us connect better with our clients,” she says. “We always want to have a certain level of uncertainty going into the counseling session. I don’t ever want to think that I know everything about this person’s life or that I know exactly what to do. Retaining uncertainty is essential to what we do. It’s going to feel uncomfortable, but I think counselors need to expect and embrace that, because that’s what we’re asking our clients to do.”

Though scarce, the research hints at the truth of embracing the presence of self-doubt. A 2011 study in Norway reported that extreme confidence isn’t a recipe for good counseling outcomes in part because counselors who are overly confident are less likely to be sensitive and attentive toward clients. Conversely, therapists with some degree of self-doubt who can admit to their shortcomings are more likely to reflect on their work and, in turn, do better and build stronger relationships with their clients.

In a 2009 descriptive study surveying new counselors, Thériault, Gazzola and Brian Richardson reported that the fear of incompetence also inspired counselors to read more, attend additional trainings and seek supervision. Novice counselors also reported that their fears were reduced when they shifted their focus from technique back to the counselor-client relationship. However, negative responses to self-doubt included feeling stuck or reactive, making technical errors and detaching from the therapeutic relationship.

A theory of vulnerability

Vulnerability can be thought about in multiple ways depending on the theoretical framework a counselor uses. The classic Rogerian principle of congruence, also known as genuineness, is a common foundation used by counselors to create and model vulnerability. Carl Rogers saw congruence as the most essential piece of the counseling relationship, suggesting that a professional facade or external presentation that does not represent the internal workings of the counselor would do little to facilitate change.

“We need to be our genuine selves in order to help our clients move toward change,” says Heyward, an ACA member and assistant professor of counseling education at Lynchburg College in Virginia. “Your genuine counselor self might look a little different than who you are in a friendship or who you are as a professor, but not necessarily. Obviously you have to abide by the ACA Code of Ethics and not make the session about you. So it’s a mixture of our professionalism and our ethical and legal obligations, but it’s also about bringing a piece of ourselves to the session.”

Lloyd-Hazlett admits that she was initially hesitant about the inherent messiness that comes with personal and professional growth. “For many years, I wanted to be vulnerable but without all the messiness — [rather] in a controlled way that still felt nice and neat,” she says. “But I have to be willing to stand in the messiness of not knowing exactly how something is going to go.”

Lloyd-Hazlett finds it useful to think about vulnerability from a cognitive developmental perspective. “As we go through life, hopefully we develop increasingly complex ways of understanding ourselves and others and the experiences around us. And that growth happens when we’re faced with experiences that don’t fit into our current schemas,” she explains. “Then we have a choice — do we lean into them, do we take that vulnerable step and try to grow, or do we avoid it?”

Heyward and Lloyd-Hazlett also regard relational-cultural theory (RCT) as a useful framework for viewing vulnerability as a strength within the counseling profession. Vulnerability can help foster an environment of mutual empathy and empowerment between counselor and client that in turn creates an atmosphere for growth and personal affirmation. Emerging from the feminist movement in psychology, RCT proponents teach that fear of rejection may cause individuals to hide personal flaws from others in a relationship, which can lead to disconnection, incongruence and feelings of isolation.

Lloyd-Hazlett and Heyward suggest that this tendency to avoid vulnerability can manifest for counselors as experiencing impostor syndrome, feeling stuck, assuming that a client doesn’t like them or experiencing countertransference. On the other hand, counselors who embrace discomfort, seek supervision and, to use a Brené Brown-ism, “rumble with their story” are more likely to create a counseling environment that successfully supports clients and also encourages growth.

Avoiding discomfort is not always evident as silence or a cold, detached demeanor on the part of the counselor, however. Fear of incompetence can also manifest as a kind of overfunctioning in the counseling room. Perhaps what is most interesting in Thériault and Gazzola’s interviews of both experienced and novice counselors is the consistent observation that self-doubt decreases when the designation of responsibility is clear.

In other words, counselors who assume too much responsibility for client outcomes are more likely to feel incompetent, whereas counselors who see clients as playing a significant role in creating change are more likely to experience reduced self-doubt and be more realistic about what can be accomplished with a client. But letting clients take responsibility and play a role in the therapeutic process often requires a certain level of discomfort, sometimes in the form of missteps, awkward silences and client resistance.

“It’s easy to stay stagnate and not address those issues of avoidance,” Heyward warns. “Sometimes we might not acknowledge the difficult parts of our job, or we compare ourselves to other counselors and find ourselves lacking. Growth is difficult, and we have to normalize that for ourselves and find a supportive community in our field [with which] to talk about these moments.”

Teaching vulnerability

Assuming the role of counselor for the very first time has its share of unavoidable discomforts. But in a classroom where students are graded and expected to perform to a certain level of competence, how do counselor educators think and talk about difficult emotions and awkward moments?

Painter acknowledges that scant space exists for such discussions in a curriculum that is already full for counseling students. Still, there are opportunities. “A good place is to look at counselor disposition,” he says. “It could be simple things like helping a student be able to tolerate ‘not knowing’ and turning that anxiety into curiosity. We have to help students understand that mistakes are going to happen, and it’s usually not the mistake that’s the problem. It’s how we handle those mistakes. If a mistake turns into fear or avoidance, then it becomes a problem.”

Painter also recognizes how high-risk clients are a potential source of self-doubt for student counselors that could be addressed in the classroom. He reflects on his own experiences working as a beginning counselor with clients who were suicidal and his tendency to second-guess himself.

“That’s a really heavy thing to work through, and when you first start, there’s lots of anxiety and worry, even outside the session,” Painter says. “You go back and think, ‘Did I do everything right? Did I assess everything I needed to?’ For me, early on, that was something I had to think a lot about, and it all came back to being a part of my development as a counselor.”

Heyward models vulnerability by being genuine and embracing awkward moments in the classroom, such as when she finds herself going off topic or those inevitable instances when technology goes awry. She also allows students to ask her questions about her experiences. “If they ever get into a situation with a client, hopefully they can go back to what was said in my class and give themselves permission not to feel guilty or shameful in those moments. Because it’s OK to feel stuck. It’s OK to feel like you don’t know what you’re doing. You can take time to breathe through it and figure out a positive way to recover from it,” Heyward says.

Lloyd-Hazlett uses the metaphor of a swimming pool when talking with her students about uncomfortable moments. “You can stand and look at the pool and talk about what the strokes are. You can imagine what it might be like to be in the pool, but at some point,” she says, “you just have to jump in. The water’s going to be cold, and you’re going to feel like you’re floundering. It’s going to feel unfamiliar until you can reestablish your bearings.”

The counseling arena

If discomfort, self-doubt and anxiety are actually signposts for potential growth, how might counselors know when they are moving toward vulnerability and the connections it can foster with clients?

Asked about her own experiences with self-doubt, Lloyd-Hazlett recalls working with a client referred to her by child protective services. The client, “Grace,” was at risk of losing custody of her child. During the counseling sessions, Grace described a history of personal trauma so severe that Lloyd-Hazlett felt tears well in her eyes on multiple occasions.

“I remember feeling completely overwhelmed by how I was supposed to help her given the severity of her concerns and the limited number of sessions we would have together,” Lloyd-Hazlett says. “As a counselor, I felt myself struggle to instill hope in a situation that just felt
so unfair.”

Grace didn’t show for the last few counseling sessions, but she later sent Lloyd-Hazlett a card. Receiving this card brought up a number of emotions, including guilt, for Lloyd-Hazlett. She talked this through with a colleague, who encouraged her to practice self-compassion and acknowledge the positive impact she had had on Grace’s life. “It didn’t fix everything, but during that time in [Grace’s] life, she had someone who cared for her and honored her story,” Lloyd-Hazlett says. “We forever impacted each other’s lives.”

Lloyd-Hazlett uses this story with her students to talk about self-compassion and the self-doubts that counselors may entertain when clients terminate. “I think it is important that we model our successes, failures and all of the stuff that comes in between,” she says.

Heyward says she knows she is moving toward vulnerability when she finds herself embracing moments of opportunity from which she easily could have retreated, such as the conference where she and Lloyd-Hazlett began to have genuine conversations.

“I know I’m living in the arena [of vulnerability] when it feels rough but I’m pushing myself through it. When I come out on the other side and say, ‘Yeah. That was pretty cool,’” Heyward observes. “It’s really that human connection, the connection with a supportive community in our field, or even that connection with myself that I feel when I push myself through those moments.”

 

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Kathleen Smith is a licensed professional counselor and writer in Washington, D.C. She is the author of The Fangirl Life: A Guide to All the Feels and Learning How to Deal. Contact her at kathleensmithwrites@gmail.com.

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.

Career counselors: On the front lines of battling student stress

By Neil O’Donnell March 27, 2017

It won’t be news to most readers that undergraduate students everywhere encounter an incredible amount of stress throughout their college years. Colleges and universities offer a considerable range of services and programming to address a variety of stressors, including test anxiety, financial hurdles and personal struggles.

Even with all that focus on helping students to mediate stress and anxiety, I think one source of stress often gets overlooked: career stress. After nearly 15 years serving as a career and academic counselor for undergraduates, I am disheartened that such an oversight remains prevalent, both nationally and internationally, among administrators in higher education.

In a recent survey of 131 undergraduate students, I found that only 12 percent remained undecided regarding what major they wanted to pursue. To assume that only 12 percent of these students remain stressed is misguided, however, especially when learning that 56 percent of respondents to the survey were still uncertain concerning the career path they wanted to pursue. From firsthand experience, I know that this uncertainty causes considerable stress and anxiety for undergraduates.

As for the survey? Of the students who participated, 49 percent indicated that they endured stress over deciding on a major or career path.

Why are so many students battling this stress? We certainly have incredible assets in place to provide undergraduates with career guidance. Most four-year colleges and universities have

career centers staffed with career counselors to help students research majors and career paths. In addition, career centers often offer enrolled students access to free career assessments, including the Strong Interest Inventory, FOCUS, Myers-Briggs Type Indicator or an array of other assessments based on the Holland Career Codes. But even with all these resources available, students rarely utilize career centers for much beyond getting help writing a résumé or cover letter during their senior years (admittedly, I was guilty of this too). Therein lies the problem.

Fellow career counselors and coaches know the following advice all too well, but for other counselors who are working with undergraduate students, I’d like to offer some insight into helping them navigate their career research and mitigate the stress that all too often accompanies that search.

 

1) Get students to visit their campus career center during their first semester at college. I understand students have a lot to contend with as they enter their first semester of college. Between getting comfortable with the layout of the campus, the location of their classes, college-level course work and the campus food, the first two weeks of the semester are not an easy time for students who are seeking to begin their exploration into majors and career paths. By the third week, however, I find that students are ready to invest time into career research, and a visit to the career center is a good first step. Before sending my students to the career center on campus, I provide them with an overview of the center’s resources and the services the staff provides to undergraduates. Additionally, I discuss career assessments with my students and the information they can glean from assessment results.

Counselors familiar with the career assessment used by a student’s campus career center can provide students with background on the assessment, including information on the assessment’s format and how to access the assessment online if that is an option. Additionally, it is a good idea to stress the importance of seeking a full interpretation of the assessment results by one of the career specialists at the campus career center. In some instances, students can receive assessment results without having to speak with a career counselor or career coach whose expertise includes interpreting these assessments. As I tell my students, they will undoubtedly be able to gain insight from the assessment themselves, but I also stress that there are a multitude of intricacies they will likely overlook. These are bits of information that a career specialist would be able to identify and interpret for the student — information that could be crucial in helping a student identify an appropriate major or career path to pursue.

To avoid a lot of the hesitation and accompanying stress that students have with visiting a career office, I find it helpful to provide students with a few questions to ask the career center staff. In particular, I advise students to ask about the center’s career assessment and how to set up an appointment to go over the results. For those students with majors already in mind, advise them to ask if a particular career center counselor has experience helping students in that major.

A final step is to make certain students know where to find the career center. Yes, it is relatively easy in most cases for students to determine where on campus the career center is located. However, I find that providing the contact information to the students increases the likelihood that they will follow through and visit the career center. Take the extra minute or two to show students the career center’s website, and then email students the center’s contact information, including room location, email and phone number.

2) Seek a follow-up with the student. Before I end my initial meeting with students, I ask them to meet me after their meeting(s) with career center staff. I find that doing so encourages students to follow through on the guidance and their career research. These follow-up meetings offer the opportunity to mediate any stress that arises from visiting the career center. Specifically, students are often stressed that one visit to the career center did not help them immediately decide on or discover the best major and career path for them.

During these follow-up meetings, I help students develop (or adjust) their career research plans. Those counselors who are certified and proficient in the career assessments their students have taken can use these meetings to address student misunderstandings about their assessment results and expand on any feedback the students received from career center staff.

3) Seek additional follow-up after the student completes the assessment. In the event the student took an assessment but did not review the results with a career specialist at the college career center, advise the student to return for a review from the career center staff. It is critically important that students receive that feedback from those who are trained to interpret the results. I have found that the majority of students who meet with career center staff for guidance report that these meetings help reduce their stress and anxiety related to career concerns. In my current survey, 78 percent of respondents indicated that their meetings with a career counselor helped them decide on a major or career path. Furthermore, 69 percent of respondents indicated that meetings with a career counselor helped reduce their stress surrounding career and educational planning.

4) Advise students to communicate with professors on campus whose specializations match the students’ career interests. Even the most experienced career counselor has limited knowledge of the diverse job opportunities afforded by every major and degree. For example, from my personal experience, none of the career counselors on my college campus knew the array of specialties within anthropology, a field that leads to careers beyond professorships, museum curators and forensic specialists.

This is where campus professors are so vital to a student’s career research. The professors in each department likely possess a wealth of knowledge regarding job opportunities and career specializations that a given major affords students. Unfortunately, students often fail to seek career guidance from department professors earlier on (i.e., freshman or sophomore year).

As career counselors, it is incumbent upon us to direct our students to department professionals. Again, drawing from my own experience, speaking with department professors helped me to identify and focus on short-term and long-term careers, which ultimately reduced my stress (especially when many individuals asked me what in the world I was going to do with an anthropology degree).

5) Advise students to communicate with professionals in the communities surrounding the college campus. Connecting with campus professors/professional staff is often not enough to provide college students with a full understanding of the potential (career-wise) that each major offers. To that end, it is important to encourage students to reach out to community professionals to gain an extensive understanding of the possibilities that exist. Another benefit to reaching out to community professionals is that students may learn of unadvertised job opportunities during these discussions, all while expanding their professional networks. What’s more, engaging with professionals who have already put the student’s major into practice often helps to put the student’s mind at ease.

6) Encourage students to seek field experience during summer breaks. Summer vacation is a time for college students to reenergize. That said, there is no reason why students can’t use the summer months to further investigate their major and the career opportunities the major offers. Finding part-time, full-time or volunteer employment opportunities is a great way to gain firsthand experience in the field. Encourage students to speak with their professors and the community professionals with whom they connected to determine what jobs or volunteer opportunities exist that would provide related experience and help students gauge the appropriateness of the major they are currently pursuing.

Such summer experiences are more prevalent than most students and counselors might realize. It comes down to asking the right people what opportunities exist. In addition to giving students related experiences to include on their résumés, such jobs could provide money for college and help students expand their professional networks. Based on my own undergraduate experience, such opportunities reduced student stress by helping them gain a better understanding of the course material from the major, while also revealing hidden career paths not often attributed to the major.

7) Remind students that it’s OK to change their minds regarding their career goals. So what happens when students follow the above advice and determine that they are pursuing a major or career path that is unsuited to their interests, strengths and long-term career goals? Changing a major can be extremely stressful for students because they often feel it is a sign of failure. I remind students that changing a major is a common occurrence. At the same time, I also remind them that it is better to change directions with their newfound knowledge of their major and themselves now than to wait; it is a decision that could save them considerable time and money later on. It is also important in such moments to congratulate students for their efforts. This is encouragement that will help them tackle the stress and worry that often follow a change in major.

 

Collectively, these strategies have aided me in reducing my students’ stress, while simultaneously helping them determine a worthwhile career and gain valuable field experience prior to graduating. It is especially rewarding when one of my advisees follows through on this advice and has a full-time job lined up before graduation because of connections that he or she has made with community professionals. It is even more rewarding when graduates from years past return to say they still love the major and career paths they pursued after completing the aforementioned research. I believe other career counselors might find similar results as they assist students in managing stress related to choosing majors and career fields.

 

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Neil O’Donnell is a senior counselor for SUNY Buffalo State’s Educational Opportunity Program, where he provides personal, academic and career counseling to undergraduates. O’Donnell is also the author of The Career-Minded Student, a book that provides a plan of action that helps undergraduates succeed in class while preparing to compete for jobs immediately after graduation. Contact him at odonnenp@buffalostate.edu.

 

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Related reading

From the Counseling Today archives: “Unprepared, undecided and unfulfilled

Anxiety, confusion and questions of identity greet many college seniors as they consider their impending graduation and the necessity of determining their next steps in the ‘real world.’ wp.me/p2BxKN-3PD

 

 

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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.

LGBTQ issues across the life span

By Laurie Meyers March 24, 2017

The specific biological mechanisms that underpin how people develop as lesbian, gay, bisexual, transgender, questioning or queer (LGBTQ) are still undiscovered, but what many researchers have determined is that neither sexual/affectional orientation nor gender identity is a choice. Rather, they are innate, unchangeable parts of who a person is, much like skin color.

And like people of color, LGBTQ individuals regularly encounter significant prejudice throughout their lives. This stigma can make life’s typical slings and arrows all the more painful. Although tremendous progress has been made in LGBTQ rights in the past few decades, counselors must still work to understand the barriers that these clients face across all stages of the life span.

“Growing up in any marginalized group can cause issues surrounding identity,” says Misty Ginicola, the lead editor of the new book Affirmative Counseling With LGBTQI+ People, published by the American Counseling Association. “For LGBTQI+ persons” — referring to individuals who identify as lesbian, gay, bisexual, transgender, queer, questioning, intersex, asexual, ally, pansexual/polysexual or two-spirited — “the unique identity surrounds not only who they bond with and are attracted to, but very often also their own gender identity and expression. Rather than having their differences be celebrated, unfortunately, LGBTQI+ people commonly grow up in an environment where they internalize very early on that their differences are taboo or undesirable, particularly if they grow up in a disaffirming religious context. Being marginalized also puts a person at greater risk of experiences of trauma and bias incidents, which impacts how safe a person is in any given context.”

Growing up LGBTQ

In general, experts are finding that children and adolescents are growing more comfortable with coming out at an early age, according to Ginicola, a professor of counseling and school psychology and coordinator of the clinical mental health counselor program at Southern Connecticut State University. If this coming-out process transpires in a supportive and affirmative environment, it can help LGBTQ students to form a strong sense of self and establish healthy relationships, she notes. However, in many cases, these individuals face significant stigma from an early age.

“Being LGBTQ in school requires continuous negotiations between authenticity, connection, safety and health,” explains Colton Brown, a member of the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling (ALGBTIC), a division of ACA. “Students may find themselves in unsupportive or even hostile environments.”

ALGBTIC President Tonya Hammer notes that physical, emotional and verbal bullying of LGBTQ students begins as early as elementary school or even prekindergarten. “While physical bullying, particularly that which results in injury and at times death, is prevalent and probably the most talked about since it makes the news sometimes, the cyberbullying and the emotional and mental bullying that take place can often be just as harmful … if at times not more so,” she says.

LGBTQ individuals may be subject to bullying across the life span, but the experience of being bullied can be particularly devastating when it occurs early in a person’s life, says Hammer, an assistant professor of counseling and coordinator of the counseling program at Oklahoma State University. “The power of language and words to inflict damage — especially on children — is often dismissed,” she says.

Insults and taunts — long a staple of playgrounds and classrooms — have found an additional and often particularly vicious arena in cyberspace, warns Hammer, whose research focus includes both bullying and the intersection of gender and sexual/affectional orientation. “Cyberbullying — from Instagram to Snapchat — is only growing and, unfortunately, much harder to address and remedy,” she says. “If physical bullying takes place on school grounds, counselors, teachers and administrators have the capability to take action. However, much of cyberbullying takes place outside of their purview, as well as that of parents, and often goes unnoticed by adults.”

Transgender students are particularly at risk for bullying, stigma and rejection, says Brown, a counselor in the college clinic at the University of Central Oklahoma and a doctoral student in counseling psychology at Oklahoma State University. “Transgender students often face difficulty with coming out because their authentic selves are typically much more visible than [that of] LGBQ students,” he notes. “These students face bathroom and locker room barriers that may come from peers, teachers, administrators and even state policies.” Transgender students also may be excluded from participating in many extracurricular activities such as sports teams because of their gendered nature, he says.

Brown points out that these painful exclusions are happening during a crucial developmental period when adolescents are typically learning how to form various emotional bonds. Transgender and other LGBQ adolescents “may be looking for friendship or romance but can be met with rejection [instead],” he says.

Further complicating matters for many transgender adolescents is that they may not be able to fully establish their personal identities. Those who wish to transition medically need parental support until they are 18, Brown explains.

But transgender students are not the only members of the LGBTQ community who face unique barriers in coming out and finding community, Brown says. Bisexual youth also often find themselves struggling for acceptance and a sense of belonging, not just among heterosexual, cisgender students, but also within the greater LGBTQ community, he says.

“Bisexual people are generally defined by who they are dating at a given time,” Brown explains. “For example, if a male student is dating a female student, then [he is] assumed to be heterosexual. If that same male student is dating a male student, the script flips, and he is now considered gay. Students do not often consider that this student may actually be bisexual. These perceptions can result in these students not feeling ‘straight enough’ for the heterosexual kids or ‘gay enough’ for the gay kids.”

“Bisexual students are in this middle ground in which they may be left without a close-knit group unless they find other bisexual students,” Brown continues. “These students may also struggle more with coming out due to the continued pressure to define themselves outside of who they are or are not dating. Other students also internalize monosexist messages from adults, media and culture and may harass or discriminate against bisexual students. These factors can result in bisexual students feeling shame and may result in internalized biphobia.”

The potential rejection and lack of support may lead LGBTQ children and youth as a whole to be wary of being their authentic selves with friends, teachers, parents and counselors, Ginicola says. “They may also attempt to hide this identity from romantic partners before they have accepted their affectional orientation or come out to others,” she continues. “In this context, identity development in adolescence is disturbed, particularly if they experience rejection.”

A safe space

The good news is that counselors can help bridge the acceptance gap for LGBTQ youth.

“Counselors can create a safe space by a variety of means,” Hammer says. “It can be as simple as displaying an HRC [Human Rights Campaign] ‘equal’ sign in their office or a small rainbow flag somewhere. I know that sounds minor, but small symbols can signify something to students.”

“It is also a matter of having resources available,” she says. “GLSEN [formerly the Gay, Lesbian and Straight Education Network] has a resource called Safe Space Kit that provides curriculum, activities and also stickers that can be displayed which indicate that your office is a safe space. Additionally, counselors can provide programming that is LGBT inclusive or sponsor organizations like a Gay-Straight Alliance. There are activities or weeks that counselors can help organize, such as No Name-Calling Week, Ally Week and Day of Silence.”

When meeting with students, school counselors can create supportive environments by using language that does not assume a student is attracted to any particular sex, Brown says. “This can let students know that you are open to them sharing that information when they are ready,” he says. “School counselors can also be sure to have pamphlets and information sources that include LGBTQ issues and use these examples if they present to classes. Counselors can also include LGBTQ sensitivity training in any presentation they may give to faculty and staff so that the supportive environment may be spread.”

GLSEN has been tracking the school experience of LGBTQ students since 1999 through its National School Climate Survey. Although the survey has shown an improvement in awareness and acceptance of LGBTQ students in schools, significant harassment and discrimination still exist, particularly in relation to transgender students. The 2015 survey found that 85.7 percent of LGBTQ students heard negative remarks from their peers specifically about transgender people, whereas 65.3 percent heard negative remarks from teachers and other school staff members. The survey also found that 22.2 percent of transgender students had been prevented from wearing clothing considered inappropriate based on their legal sex, while 60 percent of transgender students had been required to use a bathroom or locker room of their legal sex.

In late February, President Trump rescinded a 2016 directive issued by President Obama that ordered schools to allow transgender students the use of bathrooms that match their gender identity. The battle reached the Supreme Court with G.G. v. Gloucester County School Board, in which Gavin Grimm, a transgender boy, filed suit against the Virginia school board alleging that it violated Title IX of the Education Amendments of 1972 by denying him the use of the boys’ restroom. On March 2, in a development indicative of growing support for transgender individuals, 53 major businesses signed on to a “friend of the court” brief in support of Grimm. However, the case ultimately was sent back to a lower court.

School counselors can play a critical role in supporting the rights of transgender students, Brown says. “School counselors can help advocate for and with transgender students through engaging in school policy discussions and promoting fair bathroom, locker room and athletic policies,” he urges. “They can also be outspoken against bullying of transgender students and assist other school professionals with stopping bullying. Importantly, school counselors can also support transgender students simply by using [these students’] identified names and gender pronouns. Although this seems small, many students are not supported in this way, and acknowledging [their] true selves can help foster their development.”

Brown also encourages school counselors to educate themselves about the multiple identities that fall under the transgender umbrella, such as gender-queer (individuals who do not identify with conventional gender distinctions, such as solely male or female, but instead identify with both or neither) and gender-fluid (individuals whose gender identification fluctuates over time).

Hammer adds that the Southern Poverty Law Center and its Teaching Tolerance program provides materials for schools that focus not only on LGBTQ identity issues but also ethnicity and racism. “It is important to remember that our cultural identity, no matter what our affectional/sexual orientation, is made up of so much more,” she says. “The intersection of our ethnicity, age, religious and/or spiritual orientation, gender, affectional/sexual orientation, where we live, etc., are all important factors to consider when working with a client. As a counselor, you should not ignore any aspect of a client’s culture. For example, the intersection of affectional/sexual orientation with a person’s religious and/or spiritual identity can either be a source of support and comfort for someone, or possibly a source of rejection and trauma.”

As always, Hammer says, the most important thing to focus on when working with LGBTQ students is the counselor-client relationship. “Listen to them with respect and treat them with dignity and not as if they are abnormal,” she says. “Let them know that they matter — to you, to their families and to the world.”

Working for a living

One of the hallmarks of adulthood is the ability to support oneself, which typically means going to work, notes ACA member Larry Burlew, whose research specialties include issues around adult development, gay men and career development. However, work can be an uncertain and sometimes hostile place for LGBTQ individuals, Burlew says.

For instance, those who are LGBTQ often have no legal protections against discrimination in the workplace, says Burlew, a counselor educator who is retired from full-time teaching and is currently an affiliate professor at the Chicago School of Professional Psychology in Washington, D.C. There is no federal anti-discrimination protection for LGBTQ individuals, and only 20 states and the District of Columbia prohibit discrimination on the basis of sexual orientation or gender identity.

“It’s easy for them to be dismissed from work without necessarily a good reason,” says Burlew, who was also a licensed professional counselor with a small private practice for almost 30 years.

Even if a workplace is not actively hostile, there may be what Burlew calls a “lavender ceiling” — an environment of subtle but pervasive anti-LGBTQ discrimination. So when LGBTQ individuals first enter the workplace or start a new job elsewhere, they are often dealing with a lot of unknowns, he says. As a result, some LGBTQ individuals decide not to come out or be out at work, choosing instead to keep that part of their identities very private, Burlew says. For LGBTQ individuals, this can require a delicate balancing act between developing and keeping social workplace connections and not fully revealing who they are, he continues.

Even those individuals who are fully out at work often still find themselves managing perceptions, Burlew says. “I think that LGBTQ workers get very creative about how to be successful. When you get to an organization, you get creative about how to present who you are in a way that is acceptable to fellow workers,” he says. “[The question becomes], how do you introduce it in conversation?”

LGBTQ workers also have to determine how they will handle microaggressions, Burlew says. He adds that he has been in situations in which he had to decide whether it was safe to address certain comments and jokes that disparaged the LGBTQ community.

Concerns about how they might be perceived can even influence professional choice for LGBTQ individuals. “I’ve had [clients] throughout the years such as gay men who wanted to go into, say, construction and had fears about that,” Burlew says. He would have these clients visualize going to work in the environment that they feared and imagine how they would be received. Then he would talk with these clients about their fears and explore possible scenarios to help them build skills for dealing with problematic situations.

Burlew uses the example of a gay man working in project management at a construction site who hears that some of the workers have been making fun of him when he isn’t around. What are this man’s options? He has to decide whether he feels safe trying to change the environment (a process called an active adjustment) or if he will choose to change himself instead (a reactive adjustment).

In the case of an active adjustment, Burlew and the client would discuss the potential consequences of trying to change the workplace. They would then work on how to use assertive communication to address the problem. This might include having a conversation with the men making the jokes and saying something such as, “I’ve heard that you don’t want to work with me, and I was just wondering if it has anything to do with me being gay?” Burlew would help the client develop assertive communication skills through role-play and practicing what he wanted to say. Burlew and the client would repeat these techniques until the client felt comfortable addressing the problem on his own.

In the case of a reactive adjustment, Burlew would help the client reduce his stress level through systematic desensitization. He would do this by having the client talk about the incident in which he experienced the most stress. They would continue to “practice” the incident until the client could imagine the situation without feeling an undue level of stress.

Burlew and the client would also talk about avoiding work scenarios, if possible, that caused the client the most stress. If avoiding these situations was not possible, Burlew would help the client evaluate how to move forward by asking questions. Did the client need to stay in the position for his career? If so, for how long? Were other alternatives possible, such as pursuing additional education or staying with the company but taking another position?

Relationships and family

Life isn’t just about work, of course, but also about personal connections and family.

Young adults can sometimes struggle to establish intimacy, and Burlew says this can be even more of a challenge for LGBTQ individuals because they are often still trying to sort out who they are. They may not be fully out, even to themselves, he explains, which can delay establishing relationships. Then, as these young adults begin making connections in the LGBTQ community and start dating as LGBTQ individuals, additional challenges can arise.

“In addition to the bountiful issues that face heterosexual, cisgender couples, LGBTQI+ couples face [other] stressors from being marginalized,” Ginicola says. “Experiencing bias incidents, trauma and rejection from loved ones can add incredible stress to a relationship. It can be particularly traumatic to have people who are supposed to unconditionally love you — parents, family and your closest friends — disapprove of or reject your partnership while celebrating heterosexual relationships with showers, weddings and family pride.”

Problems can also arise if partners have different degrees of “outness.” As Ginicola explains, “If one person in the relationship is fully out to others, and one partner is not, this can cause additional struggles within the relationship, where one person may feel invalidated.”

In such cases, it is important for counselors to explore the reasons that one partner prefers to remain in the closet or less out, she says, paying particular attention to how each partner’s coming-out experience may have differed. The partner who fears being fully out may have come from a culture in which being LGBTQ was not just taboo but also put the individual at high risk for violence. Or the person may have grown up in a religious background that stridently disapproved of LGBTQ individuals, Ginicola explains. Counselors should also encourage the out partner to talk about how it feels for the relationship to be “hidden,” Ginicola says. By improving communication, counselors can often help these couples resolve their conflict in a way that works for each partner, she says.

Another area in which LGBTQ individuals and couples face significant barriers is family planning. “In some states and in most international adoptions, same-sex couples cannot adopt,” Ginicola points out. “Therefore, they may have to utilize expensive alternatives, such as artificial insemination or IVF [in vitro fertilization] or surrogacy.”

“Again, counselors should employ affirmative counseling techniques to support these individuals and partnerships,” she says. “Acknowledging the realities and struggles of being an LGBTQI+ couple or relationship is important, as is providing nonjudgmental support and connecting clients to resources that can help them with family planning that is specific to LGBTQI+ couples.”

Taking a toll

As individuals face the various struggles that are unique to being LGBTQ throughout childhood and into adulthood, it can take a significant toll on the body.

“The LGBTQI+ person is under much greater stress than is typical for a heterosexual, cisgender person,” Ginicola says. “If the person has intersectional identities that are also marginalized — ethnic minority, immigrant, differently abled — this stress will be exponentially increased. Although anxiety, depression and suicidal ideation are common as a result of this increased stress across the LGBTQI+ spectrum, the research indicates that each subpopulation experiences different physical and mental health problems.”

“For example,” she continues, “lesbian and bisexual women are more likely to be obese and are more likely to smoke. Gay men are more likely to experience eating disorders, including anorexia, drink excessively and use substances to cope, which impact their physical health.”

In addition to all of this, medical doctors aren’t always cognizant of how LGBTQ health needs might be different from the needs of their other patients, says ACA member Jane Rheineck, a past president of ALGBTIC. For example, she notes, gynecologists often offer lesbians — even out lesbians — birth control.

In addition, LGBTQ individuals often feel uncomfortable or unsafe disclosing in doctors’ offices, Rheineck says, which means that they may delay or even altogether avoid seeking health care. Counselors can help by educating LGBTQ clients about some of the unique risks that they face, but also by providing them with validation, support and empathy for these difficulties, she says.

“Psychoeducation surrounding minority stress, understanding why these negative coping factors are there, [and] recognizing and validating the stress that they experience is crucially important,” Ginicola says. “Cognitive behavior therapy can be helpful in this regard. [It involves looking] at how their inner self-talk and coping skills are moving them more toward their goals or further away.”

Ginicola says counselors can also help clients find LGBTQ-friendly health care through resources such as the Gay and Lesbian Medical Association’s website (glma.org), which has a provider finder.

Being older in a youth-obsessed society is not always easy, but being older and LGBTQ can be even more difficult, Ginicola asserts. Older LGBTQ adults are not only discriminated against in general society but can often find themselves marginalized within the LGBTQ community, she explains. “Therefore, they may experience bias incidents both inside and outside of their community,” she says.

Older LGBTQ adults were more likely to have come out in a hostile societal environment, says Christian Chan, a former family counselor and current doctoral candidate in counseling at George Washington University in Washington, D.C. This history of intense stigma and marginalization puts older LGBTQ adults at even greater risk for mental health issues such as depression and substance abuse, he notes. In addition, at a stage in life when health care issues may necessitate the need for long-term care, older LGBTQ adults are more likely to have a difficult time securing it because retirement communities and nursing homes often discriminate against those who are LGBTQ, Chan and Ginicola say.

Counselors can help this client population, but only if they are aware of the issues, says Chan, who serves as the student trustee for ALGBTIC and the member at large for outreach and advocacy for the Association for Adult Development and Aging, a division of ACA. He emphasizes the need for further training in counselor educator programs and beyond.

“[We should] focus on extending training on how to discuss sexuality, affectional [orientation] and gender identity in conversations and meaning-making around self-disclosure and coming out,” says Chan, who is also president of the Maryland Counseling Association. “It appears to me that many counselors are unsure about how to navigate these questions at large in counseling, which makes the counseling less culturally responsive to older LGBTQ adults.”

Chan urges individual counselors to help their LGBTQ clients build social support networks. “This is especially important in the sphere of redefining family for older LGBTQ adults,” notes Chan, who adds that the concept of family may need to be extended beyond the traditional definition for these clients.

Chan also points counselors toward organizations such as Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders (sageusa.org) and the National Resource Center on LGBT Aging (lgbtagingcenter.org) that specialize in helping older LGBTQ adults. AARP’s website (aarp.org) also contains a significant amount of information on LGBTQ issues.

Transgender individuals walk a particularly difficult and dangerous road throughout the life span, confronting widespread misunderstanding and discrimination and an extremely high likelihood of becoming victims of violence, Ginicola says.

“Trans persons, particularly trans women of color, face incredible bias both inside and outside of the LGBTQI+ community,” she says. “When a person transitions, their family and partner must transition with them, which may not always be possible. For example, a trans male, designated as female at birth, may have been in a relationship with a lesbian. When he transitions to male, his partner may experience identity issues and  difficulty in accepting a male as her partner. Transitioning can bring a transgender person such relief in terms of finally being able to be their authentic self, but at the same time, they are likely to experience rejection, bias incidents and discrimination within their personal and professional lives. This is why trans persons are also at the highest risk for suicide.”

Ginicola says that affirmative counseling is crucial to transgender — and, indeed, all LGBTQ — clients. “Affirmative counseling is truly about validating an identity,” she says, “while understanding the realities of being marginalized, building coping skills, connecting clients to affirming communities and making cultural accommodations.”

 

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ACA Illuminate

The American Counseling Association will be holding Illuminate, an innovative counseling symposium focused on serving the needs of the LGBTQ community and those who work with members of this community, from June 8 to 10 in Washington, D.C.

Illuminate is a passion project for ACA President Catherine B. Roland, who has made LGBTQ issues one of her presidential initiatives. “The inspiration [for Illuminate] occurred many years ago and became real right after I was elected ACA president,” Roland says. “I knew that the marginalized population of the LGBTQ community, and the diversity and multiple identities within it, should be a focus of mental health treatment.”

Roland’s goal for Illuminate is to help more counselors and counselor educators gain a greater awareness of the needs of the LGBTQ community and learn how to offer the best care. She also hopes that the symposium will generate additional specific strategies for working with the population, families and career aspirations of LGBTQ adults across the life span.

For more information, visit counseling.org/illuminate. The deadline for early bird registration is April 7.

 

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association.

Journal articles (counseling.org/publications/counseling-journals)

  • “Long-Term Outcomes of Lesbian, Gay, Bisexual and Transgender Recalled School Victimization” by Darrell C. Green, Paula J. Britton and Brian Fitts, Journal of Counseling & Development, December 2014
  • “I Am My Own Gender: Resilience Strategies of Trans Youth” by Anneliese A. Singh, Sarah E. Meng and Anthony W. Hansen, Journal of Counseling & Development, April 2014

Counseling Today (ct.counseling.org)

Practice briefs (counseling.org/knowledge-center/practice-briefs)

  • “Counseling People Living with HIV/AIDS” by Brandon Hunt
  • “LGBTQQ-Affirmative Counseling” by Anneliese Singh and Maru Gonzalez

Books & DVDs (counseling.org/publications/bookstore)

  • Affirmative Counseling With LGBTQI+ People edited by Misty M. Ginicola, Cheri Smith and Joel M. Filmore
  • Group Counseling With LGBTQI Persons by Kristopher M. Goodrich and Melissa Luke

Podcasts (counseling.org/knowledge-center/podcasts)

  • “Queer People of Color” with Adrienne N. Erby and Christian D. Chan
  • “Group Counseling With LGBTQI Persons” with Kristopher M. Goodrich and Melissa Luke
  • “Living Straight: Coming Out After 40” with Loren Olsen
  • “Counseling Queer* (LGBT) Youth” with Anneliese Singh

ACA divisions 

  • Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling (algbtic.org)

 

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

Letters to the editor: ct@counseling.org

 

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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.

What gets in the way? Examining the breakdown between research and practice in counseling

By Samantha McMorrow March 22, 2017

It is frequently noted that counselor practitioners in the field do not contribute nearly enough to research and publications, despite calls for them to do so. It is believed that research should inform counseling practice and practice should inform counseling research, yet there appears to be a breakdown between the two.

The counseling literature has presented several common hypotheses regarding why counselors in practice typically choose not to participate in research and publication efforts. These reasons include a lack of time, a lack of reinforcement, a lack of interest and a lack of experience in research.

Lack of time certainly seems like a valid hypothesis. It is undoubtedly a factor with considerable influence, especially for those counselors who are working in agencies where they must secure a large number of billable hours each week. Still, it is not necessarily the prohibitive factor.

Arguments can definitely be made that there is also a lack of reinforcement or a lack of interest for counselor practitioners to conduct research or to publish. For instance, employers at agencies and schools do not have their systems set up to reinforce this work in the way that universities do. However, this in itself is not inhibitive either.

Inexperience in the area of conducting research also seems like a reasonable factor that could impede practitioners’ contributions to research and publications. However, as a practitioner myself, I contend that a looming factor exists that has not been brought to the forefront. Namely, it is just not very easy to be out in the field and have access to channels to conduct publishable research. There are systems in place that are meant to protect our subjects (and rightfully so), but these systems do not lend themselves well to counselors in the field conducting research.

Furthermore, the path for practitioners to follow to get started in research is not always clear. A counselor in the field has access to clients but not necessarily access to university faculty, and without that, the counselor is stopped before he or she even gets started. The counselor could certainly conduct action research in efforts to inform his or her own practice. However, peer-reviewed, scholarly publications will not accept traditional research for publication without Institutional Review Board (IRB) approval, which comes from universities. Furthermore, universities will not grant IRB approval to research proposals without having a principal investigator (PI), and this PI must be a full-time faculty member of the university.

This is the first and most difficult hurdle to get over in practitioners conducting research. The counselor must find a full-time faculty member at a university that is willing to be the PI on the counselor’s research, which is no small commitment. Then the counselor must hope that the faculty member remains at that particular university throughout the course of the counselor conducting and writing up the research. Otherwise the counselor goes back to the beginning again to locate a new PI and submit an amendment to the IRB board to get approval for this change. The whole process can be confusing and intimidating for counselors in the field to navigate.

Subsequently, the process of getting IRB approval once the counselor practitioner has formed a partnership with a PI is detailed and somewhat lengthy, but not overly complex. Both researchers in this partnership will need to complete certain trainings to ensure that they understand issues surrounding protecting their subjects. They will also complete documents displaying the informed consent process that will be used in their research and submit the detailed and complete plan for the research, which may require cultivating further relationships with other departments if advanced statistical analysis is part of the research plan. This relationship can be the lifeline that keeps practitioners involved in the research effort once the analysis of the data becomes advanced and possibly intimidating for the average counselor in practice.

Furthermore, the university should have comprehensive instructions for how the counselor will submit the research proposal for IRB approval. This will be done once the counselor has a PI and a complete plan for how the research will be conducted. In addition, if counselors plan to conduct their research at their agencies or in their school districts, they will need to secure additional approvals from those specific sites.

This is the less understood and more complicated side of research for many practitioners, but it can be sorted through. Cultivating relationships with faculty members in counseling and other needed departments at universities can ease this process.

In a 2005 article, “Collaborative Action Research and School Counselors,” Lonnie Rowell looked at these collaborative relationships, noting that research-oriented facilities were being developed to bridge this gap between university faculty and practicing counselors. In addition, they serve as a model to link counselors-in-training with counselor practitioners for action-based research.

But despite attempts to build stronger connections between researchers and clinicians, another important factor often impedes counselors from engaging in research. A 2010 study by Darcy Haag Granello published in the Journal of Counseling & Development looked at cognitive complexity among practicing counselors over the course of their careers. The study found that counselors do grow and develop over their careers, especially with 10 or more years of experience. However, seasoned counselors may “forget” that they did not always know a particular technique or approach or did not possess their current conceptual understanding of issues or relationships when starting out in practice. This lack of reflection on their own growth could lead them to erroneously believe that they have nothing to research or write about that other counselors do not already know.

Taking some of our own advice as counselors in this situation could prove to be the solution. If counselors are mindful about their practices and really reflect on what they are doing, how they are doing it and why they are doing it, plenty of ideas will follow. Alyson Pompeo and Dana Heller Levitt proposed in their 2014 article, “A Path of Counselor Self-Awareness,” that practicing counselors have an ethical responsibility to self-reflect on their practices. Being a curious observer of your own work as a counselor can lead not only to professional growth but also inspiration regarding needed research and possible publications.

The literature has identified several factors to explain the existing disconnect between counselor practitioners and research efforts. If we are to truly use research to guide practice and use practice to inform research, then a bridge needs to be built that will bring counselor practitioners into the world of research. If we acknowledge the need for developing connections between university faculty and counselor practitioners, plus the need for increased self-reflection in the field, perhaps the gap that must be bridged will end up being not quite so large.

 

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Samantha McMorrow is a practicing school counselor with K-12 endorsement and a licensed professional counselor. She is also a national certified counselor and is certified as a chemical dependency counselor in Alaska. McMorrow currently serves as an adjunct instructor for the University of Alaska Fairbanks in its Counseling Department. Contact her at sgmcmorrow@alaska.edu.

 

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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.