Monthly Archives: March 2017

Group counseling: Neglected modality in private practice

By Kevin Doyle March 7, 2017

After approximately 25 years of working in private agencies, I started a part-time private practice a few years ago focusing on my specialty area of working with clients with substance use disorders. Having worked largely with adolescents, I was looking forward to working more frequently with adults, especially after I had the realization that I was growing older and the adolescents were not.

One of my first efforts at outreach was to my state’s monitoring program for licensed health care providers (doctors, nurses, dentists, veterinarians and so on) because I was aware that these professionals are at high risk of substance use problems for a variety of reasons. Over the past eight-plus years, I have found this area of practice to be both stimulating and professionally rewarding.

As is the case in most states, my state mandates that health care professionals must, following an issue related to a substance use or mental health disorder, participate in its monitoring program for five years to ensure professional oversight during the transition back to practice. I quickly realized that the need for individual counseling throughout the full five years, although potentially appropriate in some cases, was likely not indicated in many instances. So, I approached several nurses in the monitoring program about starting a counseling group. They were open to the idea and even enthusiastic. Eventually, I asked them about including a physician. Their response to my question was memorable: “Don’t worry. We can handle him.”

Since that time, the group has grown to include several other health professions and has ranged in size from six to eight individuals. According to the participants’ report, it is helpful to be exposed to the input and perspective of others who have been through the process of addiction (sometimes diverting medications from patients and facing criminal prosecution) as they work to put their lives back together and obtain approval to return to professional practice.

Using this experience, I have subsequently established two more recovery support groups in my practice. Both groups are for men in early recovery from substance use disorders, which constitutes a large portion of my clientele these days. In talking with other counselors in private practice, however, I have learned that very few offer group counseling, preferring to stick to the traditional model of one-on-one counseling. Why don’t more counselors offer group counseling?

Potential advantages

The ACA Code of Ethics includes standards relating to group counseling, including A.9. (Group Work) and B.4. (Groups and Families). Although these standards identify responsibilities that counselors have when choosing to provide group counseling services, none of them includes any admonition for counselors to consider offering group work.

What, then, are the potential advantages? Let’s look at three that are most commonly identified.

1) Cost to the client/payer: A ballpark calculation, based on discussions I have had with other counselors, as well as rates posted on websites, is that the per person rate for group counseling is about one-third to one-fourth of the rate that counselors tend to charge for individual sessions. Using an example on the higher end, a counselor who charges $150 for a traditional therapeutic hour (a 45- to 50-minute session) would probably charge $40-$50 per person for group counseling. Many counselors also extend group sessions to 70-90 minutes to allow adequate time for each member to participate. In this day of tightly managed insurance benefits, the cost to the payer is much less in group counseling and tends to give clients the ability to participate for longer periods of time, which is often extremely beneficial.

2) Additional revenue for the practice: Not to be overlooked is the potential that group counseling offers for a practice to enhance revenues. There are only so many hours in the week and a limit to how many clients an individual practitioner can be effective in seeing. High-end estimates tend to run to seeing clients 25 to (at most) 30 hours per week, thus still leaving time for documentation, marketing, practice management, breaks, supervision, etc. Given overhead expenses such as liability insurance, rent, phone service, office supplies and equipment, internet/web access, licensing fees and more, it is challenging for counselors to make an adequate living without following sound business practices. One of these practices can be to offer group services.

3) Enhanced therapeutic value: Finally, as the ACA Code of Ethics stresses, we should ultimately make decisions with our clients in mind, keeping whatever is best for them paramount in our thinking. Both research and anecdotal evidence support the provision of group services as an important part of addressing many clients’ needs, with substance use disorder being a clear example. The experience of hearing from other people who are both struggling with the same issues and having success addressing those issues can be life-changing for clients. Likewise, establishing a support network that people can draw on outside of sessions can also be very therapeutic and is an important outgrowth of group work.

Potential disadvantages 

What, then, might be the disadvantages, and why do so few counselors in private practice offer group services?

1) Scheduling: One of the great benefits of owning a private practice for many counselors is the flexibility it affords them in both their personal and professional lives. In my experience, the days of the client who comes in every Wednesday at 10 a.m. are no longer; in most cases, they have been replaced with a more flexible, variable style. This also gives the counselor the ability to work around a full- or part-time job, family obligations, vacations and other scheduling issues.

Groups, however, typically do meet at the same time every week, every other week or monthly. Rescheduling a group involves potentially inconveniencing eight to 10 participants, as well as the counselor, and is much more complex and problematic than rescheduling an individual client. Although I will occasionally reschedule a group in my practice, I usually hire another local practitioner to cover the group, obtaining a release of information from group members to facilitate client coordination with the other practitioner. Having a substitute counselor can supply a healthy change of pace for groups and can enhance the group process in future sessions too.

2) Lack of comfort with group modality: Group counseling classes are included in most counselor training programs, but it is possible for counselors to move quickly into a comfort zone of providing services on a one-to-one, individual basis and allow their group counseling skills to grow rusty. For many counselors, the transition to private practice begins as a part-time arrangement in combination with another full-time job. Thus, it may be many years before the counselor is fully engaged in private practice work as his or her primary activity. This may further contribute to the lengthy delay between when a counselor receives group skills training and finally implements those skills in a private practice setting. This is not the only scenario under which counselors move into working privately for themselves, but this pattern may partially explain why so few private practitioners offer groups.

3) Too much effort to establish: Finally, and related to the scheduling challenges noted earlier, there is the effort required to get a group off the ground. Persuading clients that group counseling is an option worth considering can sometimes be a formidable obstacle.

I recall one particular client of mine who was dead set against group work, indicating that he did not want to share his “personal business” with a group of strangers. After nearly two years of relatively successful individual counseling related to his problems with alcohol, he experienced a serious relapse, leading to inpatient treatment — where groups were a large part of the service delivery system. Upon returning to the community, he has engaged with his group and finds it to be an essential part of his overall recovery program.

On a more mundane level, simply finding a time that works for all potential members and the counselor can be a significant challenge. I have had some luck holding groups early in the morning, before many people start their workdays. Other options might include lunch-hour meetings, evening sessions or even weekend slots. Sometimes, however, the difficulty of establishing a regular meeting time can be so daunting that it prevents counselors in private practice from even attempting to start groups.

Conclusion

In summary, groups can provide a tremendous therapeutic opportunity for our clients to address their issues with the assistance of others who are confronting similar problems. Counselors should consider this modality more frequently as they look to simultaneously improve their work with clients and solidify their private practices from both a quality and financial standpoint.

Opportunities for retraining for those professionals who have not had group experience since graduate school are abundant. These opportunities include myriad continuing education options such as conferences, webinars and self-paced reading. Additionally, counselors can partner with other professionals in a co-facilitation arrangement. This may negate some of the financial upside of group work, but it can also assist in providing built-in coverage should a counselor need to miss a session.

Ultimately, as we ponder as counselors how best to meet the needs of our clients, group work should be something that we all consider as part of our ethical responsibility.

 

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Kevin Doyle, a licensed professional counselor and licensed substance abuse treatment practitioner, is chair of the Department of Education and Special Education and an assistant professor of counselor education at Longwood University in Virginia. Contact him at doyleks@longwood.edu.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for 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.
 

The healing language of appropriate touch

By Gregory K. Moffatt

I learned a lesson about the power of touch totally by accident. I didn’t learn this lesson in graduate school, from a book or journal article, or from any professional training. Instead, it happened in the front yard with my son.

He was 8 years old at the time and already displaying the burgeoning need for the independence of adolescence. We were wrestling in the grass, and I intended to tease him by holding him like a baby, thus challenging his independence. I expected him to immediately resist my grasp, but when I looked into his face and talked to him like a baby, he became surprisingly still. He stared straight into my eyes as one might expect an infant to do. I talked to him about when he was little and how I used to snuggle him in our rocking chair in the middle of the night.

“I can stop if you want,” I told him.

“No, that’s OK,” he answered calmly. Almost mesmerized, he stayed in my arms until I was too tired to hold him any longer.

This incident fascinated me so much that, in the tradition of theorists such as Jean Piaget, I used my child as a miniresearch subject, adding this type of snuggling to my son’s bedtime ritual. Several times over the next couple of weeks, just before sleep, I would snuggle him close, caress his hair or rub his back and talk to him about when he was a baby and what it was like bringing him home from the hospital. Each time I got the same response I had witnessed in the yard. It appeared that my son gained peace by letting me touch him tenderly as he lay in bed at the end of the day. If I didn’t snuggle him, he requested it.

After awhile, I decided to see if there was a use for this type of energy in therapy.

Why we touch

If you take a moment to observe people in the public square, you will be astonished at how often they touch — couples holding hands, a friendly back slap between friends, a couple sitting side by side on a park bench leaning into one another, a friend who touches another’s upper arm while listening intently.

Why do we do this? After all, most of the ways we touch are unnecessary for conveying the basic message. We could easily restrict ourselves only to words. Touch augments our conversations, adding garnish and accent to what we want to communicate, but it is also something much deeper.

Without touch, relationships are less than satisfying. Ask any married military couple when one partner is deployed, people who have loved ones in prison or couples whose relationships are dying. The absence of touch leaves us yearning and empty, even if we still hear statements such as “I love you.”

Conversely, watch the reunions of military families, loved ones outside of prison on the day of release or the power of gentle touches between couples who are trying to repair their broken marriages. These touches communicate that “You are safe” and “You are not alone.” These messages are at the very core of healthy human attachments.

There is great precision in touch, and social rules for touch are highly refined. We can touch only certain people in certain ways. At times touch must be invited, but there are other instances when it is expected; to ask for it would be uncomfortable. In my college classroom, it may be acceptable for me to briefly put my hand on a student’s shoulder as I lean over the desk and provide assistance on a test question, but I can’t leave it there very long. And if I move my hand in any direction at all from that shoulder, the touch immediately becomes awkward at the very least, but more likely unwelcome and inappropriate.

Appropriate touch depends on who is touching whom, the genders and ages of each person involved and the relationship between these individuals. Who we touch, what body part touches what body part, how long and with how much pressure — these are the unwritten rules of touch that, under normal conditions, we develop over time in our home cultures. Similar to the way that we manage personal space, we manage touch using unwritten rules that most of us know, yet we would have a very hard time articulating them.

The importance of touch  

We don’t have to look far to discover the importance of touch from the research. Studies going back to the 1800s demonstrated that babies who were not cuddled beyond their basic needs were more likely to die of fetal failure to thrive. They just didn’t grow.

Attachment theory is built on the importance of touch and has demonstrated that extensive face-to-face and skin-to-skin contact between caregiver and child is important for the bonding process. This is the foundation on which all relationships are built throughout life. Infant massage and the soothing effects of therapy animals are just two more recent areas of touch that are well-documented.

Interestingly, many mammals rely heavily on touch to communicate many things. For example, when an elephant mother delivers a calf, every adult female in the herd touches it. They bump up against it with their legs or trunk or in some other way make contact. This communicates acceptance into the herd. If they do not do this, the mother and calf are shunned. For the first several months of the calf’s life, it stays within touching range of its mother. Dogs, cats, lions, otters and chimps all touch with great frequency.

Early in the past century, John B. Watson advised parents to touch their children “as little as possible.” He couldn’t have been more wrong. Humans are social creatures. We have an innate need to interact with others, and touch is essential to our existence. The difference between good touch and bad touch is timing, place of touch, context and purpose. Touch that communicates giving is healthy. Hugging a crying child who has hurt his or her knee is a giving touch. Physical and sexual abuse are selfish, taking touches.

I saw the important role of touch in assessing relationships in the days when I did marriage therapy. Couples in my practice often didn’t touch at all. They sat on opposite ends of the couch or in different chairs. I could often spot the most troubled marriages by the way the couples touched or the way they completely avoided touching. Couples who were deeply committed to salvaging their marriages would touch one another gently, with compassion and healthy emotion, even in the midst of their hurts, resentments and anger. I remained on the lookout for things such as a pat on the arm, an empathetic hug or a natural snuggle against each other on the sofa.

John Gottman has noted that in healthy marriages, touching is one of the vital signs of positive interaction. According to Gottman, people in very troubled marriages may touch, but they grip, cling or touch with force or desperation. At home they withhold touch or touch too hard (abusively), both of which are deeply damaging.

The physiology of touch 

Touch affects us in the right side of our brains. We don’t think it through logically. In both positive and negative ways, we respond to touch instinctively.

In infancy, even before the cerebral hemispheres are fully developed enough to manage language, the brain stem, through the vagus nerve, connects the brain, the heart and the visceral organs of the abdomen. Interesting research known as polyvagal theory proposes that it is this 10th cranial nerve that gives us our “gut feeling” in some situations.

Touch stimulates this nerve, which is wired to the amygdala, the central switchboard of our emotions. When touch is “good,” it can stop the release of the hormones that cause stress. Good touch promotes the development of attachment. Bad touch does the opposite. In either direction, these routes are classically conditioned and become our default emotional responses; they can be changed only with counterconditioning. Consequently, right-brained emotional regulation may be part of the source of many dysfunctions. These dysfunctions serve as facsimiles for the things we really want.

Children touch freely and naturally. It isn’t until they are socially conditioned to do otherwise that they change. Unfortunately, that is when children join the ranks of even relatively healthy adults who desire to be touched but don’t know the most effective way to ask for it. In short, we don’t know how to say, “Hold me.”

Could it be that simple?

The ethics of touch in therapy

We don’t have to look far to find a reason to avoid touch in therapy. Some people don’t like to be touched; touch can be self-serving for the therapist; touch can be misinterpreted and blur boundaries; touch is especially risky with some client populations such as sexually abused children.

But I believe there is a place for touch in therapy. About 10 years ago while I was attending an ethics seminar for child therapists, someone brought up the issue of touching one’s clients. “I never EVER touch any client,” one therapist adamantly averred. Nods and mumbling agreements from others followed.

After several similar comments, I couldn’t keep quiet any longer. I said, “If you choose never to touch your clients, you probably will be relatively safe from accusations of impropriety, but you may also cheat your clients of one of the most powerful tools you have at your disposal.”

I expected scowls and sneers from the 200 or so professionals in the room, but, strangely, my comment seemed to change the direction of the conversation. One after another, people noted how they had carefully used appropriate touch to bring healing and comfort to their clients. In the end, the general conclusion was that touch is a tool, like any therapeutic tool. To ignore it completely may be unnecessarily limiting to one’s practice. A proper touch in an appropriate way at the appropriate time can be comforting and healing.

The ACA Code of Ethics does not prohibit or, for that matter, even directly address touch. With the obvious exception of Standard A.5.a., which prohibits sexual or romantic relationships with clients, one must think through the various ethical implications of the ACA Code of Ethics regarding touch. Avoiding harm to the client (termed nonmaleficence and addressed in Standard A.4.a.) is probably as close as one can come to the issue at hand.

The question we must pose as counselors is whether touch would be helpful or harmful to the client in any given situation. A recent paper from the Association for Play Therapy proposes that touch should be used cautiously, but the key ethical issues are to avoid exploitation, to touch only in ways that are consistent with the therapeutic goals and needs of the client, and to take developmental considerations into account. The paper suggests that the likely interpretation of the touch by the child is also critical. This conceptual approach to touch is consistent with ethical codes from nearly all professional associations.

Therapeutic applications

I decided to work with children early in my career because, while I was an intern, I saw many people still carrying the pain of childhood abuse with them into their 50s and 60s. If bad touch can be so powerful that its effects can be felt for a lifetime, then maybe good touch can be so powerful that it can help heal these hurts.

At the time of the experiment with my son, I thought I was on to something new. Little did I know that this idea wasn’t novel. Donald Winnicott proposed this idea almost 70 years ago when he taught us that touch could be useful in psychotherapy. It is interesting that Winnicott’s research demonstrated that parents don’t actually have to be “great” parents. They simply have to be “just good enough,” to use his words, to meet the child’s needs. In other words, even marginal parents by social standards can be just good enough if they coo, snuggle and lovingly touch their children.

With a parent’s help, I’ve used touch as I did with my son with some of my clients. For example, one of my 5-year-old clients was exceedingly impulsive and hyperactive. I described what I wanted the mother to do and asked her if she would be interested in sitting in with her son during therapy and trying this behavior with him in session.

“He won’t let me hold him,” she said. “He is just too hyper.” But she agreed to try.

After asking his permission (I always respect a person’s right to not be touched — adult or child), we proceeded, and the results were fantastic. As I expected, his response was exactly like my son’s. He relaxed in his mother’s arms for almost 15 minutes without exhibiting a single hyperactive symptom. For this reason, I have given “touching homework” to parents for years. I am amazed at the number of issues that can be addressed with this simple behavior.

Another of my clients was a 15-year-old girl. She was defiant at home and at school, obstinate and bordered on incorrigible. The relationship between this teenager and her mother was tense to say the least. I suggested to the mother that her daughter really needed a physical connection with her. “Try just holding her and see what happens,” I suggested. Like the mother of the 5-year-old I just described, this mother told me that her daughter wouldn’t allow herself to be held, but she agreed to try.

The next week, the mother called to tell me about her experience. “My daughter came home from school and came in the kitchen. I asked her about her day and got the normal disinterested grunt from her. I said, ‘Come hug your mother.’ My daughter said she didn’t want to, but I said, ‘I’m not asking. Mother needs a hug.’”

She continued: “I stood there holding her for a minute or so, initially expecting her to pull away, but she didn’t. I felt her relax, and weakly she put her arms around me too. We stood there for 20 minutes. Neither of us said anything. You never told me how long to do it, so I just kept standing there!”

The mother finally told her daughter that she could go if she wanted, but — as my son did with me — the daughter declined and continued standing there soaking up the human-to-human contact. Her real need was for contact — especially from her mother — but she didn’t know how to ask for it. This teenager had substituted promiscuity, chemicals and other facsimiles because she didn’t know how to say “touch me” in a healthy way. After this interaction, her dysfunctional behaviors began to abate.

I believe that counselors can also garner great benefits by carefully using therapist-client touch. For instance, I have used hand massage with children who have been physically abused. Their body memory has taught them that touch is a painful thing. At first, some of them have trouble interpreting touch. Others, sadly, but consistent with the research, feel very little at all. This is their bodies’ subconscious defense against repeated painful touch.

My goal is to use hand massage as counterconditioning to retrain the body memory of these children to recognize good touch, pleasant connection with another human being and how touch can be a giving behavior rather than a taking behavior.

During these sessions, the child stands in front of me while a parent watches from a nearby chair. I gently massage the child’s hands with lotion as I talk about his or her value as a human being and what a great gift it is to feel another person in a nonthreatening way. The first time or two that I do this, these children often stare at me and remain motionless, having absolutely no idea how to process a touch that feels so pleasant. Over time, they begin to long for it and, as parents practice this technique at home, the children need me less and less.

Conclusion

The number of reported cases of abuse today is far beyond what it was 20 years ago, in part because people know what to look for. People who routinely work with children are trained to look for signs of abuse in children and also in behaviors that they observe between adults and children. Even laypeople have become acutely aware of various forms of abuse.

For the most part, this has been a very good change. However, it has been accompanied by an increased possibility of being sued for abuse or, even worse, charged with a crime and jailed because of abuse allegations. This has led many professionals who work with children (teachers, counselors, psychologists and others) to completely back away and, like some of my colleagues in the seminar, never to touch children in any way. This is a tragic shift. Children long to be touched — as do most of the rest of us.

A friend recently told me that he and his wife had gone to couples therapy. At the conclusion, the therapist asked if she could hug them both. It offended my friend greatly, and he told me he would never go back to counseling. I suspect this therapist either significantly misread cues or, more likely, was seeking to fulfill her own needs. As we all learn very early in our training, it isn’t about us.

But as is the case with any tool in therapy, appropriate touch can be a powerful tool for healing. Just as we have learned over the decades about the use of personal space, we can find differences in the meaning of touch based on who is touching whom, in what way, with what frequency and in what context. So, I propose that counselors consider using touch as one of the many tools in their therapeutic toolboxes.

By the way, my son is an adult now. Recently he came home for a visit. One of his boyhood friends was with him when he came through the backdoor. Even though his friend was watching, my son hugged me long and hard. It was a deep and meaningful hug and, just as when he was little, I was surprised that he held on so long. But I didn’t mind at all.

 

 

For some good reading in this area, I recommend Touch: The Science of Hand, Heart and Mind by David J. Linden, and Touch in Psychotherapy: Theory, Research and Practice, edited by Edward W. L. Smith, Pauline Rose Clance and Suzanne Imes.

 

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Gregory K. Moffatt is a licensed professional counselor, a certified professional counselor supervisor and a professor of counseling and human services at Point University in Georgia. He has been in private clinical practice for nearly 30 years. For the past 18 years, he has specialized with children ages 3-10, and he has worked with infants and babies, providing developmental analyses and consultation with parents and organizations that deal with children. Contact him at greg.moffatt@point.edu.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for 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.

Technology Tutor: Starting the year off on the right technological foot

By Rob Reinhardt March 6, 2017

Many of us are aware of the ebb and flow of people seeking counseling services. Around the holidays and the beginning of the school year, more calls come in for help. During the summer, things slow down a bit.

Having provided technology consultation to mental health clinicians for seven years now, I’ve noticed some patterns myself. One that stands out is that many counselors in private practice seem to take stock in the business and technology side of their practices as we transition into the new year. I’ve reached this conclusion by looking at the significant rise in the number of emails and phone calls I receive each year at the beginning of January.

With that in mind, I present some of the top business and technology challenges and questions that counselors have been addressing lately. Some of these may not apply to every counselor, whereas others are items we should all be taking care of.

HIPAA compliance

Now is a great time to revisit your compliance with the Health Insurance Portability and Accountability Act (HIPAA). HIPAA is not a one-and-done kind of thing. It requires that you periodically review your risk analysis and management plans, as well as your policies and procedures. Assuming that you already have completed at least an initial risk analysis, a review can be done fairly quickly. The following are some primary tasks to cover.

  • Review your current risk analysis and remove technology that is no longer used to store or transmit protected health information (PHI).
  • Of the items remaining, ensure that the level of risk presented by those technologies hasn’t changed and that your current methods for managing risk are still effective and appropriate.
  • Now be sure to add any new technologies that might be missing. It’s always best to add new items to your risk management plan as they are implemented in your practice. Making sure that you cover all bases to catch anything that slipped through the cracks is a prudent measure.

If you’re not sure what all of this risk management and analysis means, check out my blog article on the Tame Your Practice site for additional information (bit.ly/HIPAArisk).

Encrypted communications

Both HIPAA and the ACA Code of Ethics (see Standard H.2.d) require counselors to use encryption to secure PHI, including communications with clients, whenever it is reasonable. The truth is that, these days, it’s almost always reasonable to use encryption.

Encrypted email is inexpensive to implement, and although it isn’t always quite as user friendly as unencrypted options, sometimes the cost of privacy is a bit of inconvenience. It’s like those extra seconds you take to turn on the sound machine outside your office — it can really make a measurable difference.

Both the ACA Code of Ethics and HIPAA also provide for client autonomy, which means clients can choose for PHI to be transmitted through unsecured means. It is important to note, however, that this requires that clients have been informed of and understand the risks. It is also important to evaluate whether we should really consider risking confidentiality, either out of convenience or for the sake of saving a few dollars a month. Roy Huggins of Person-Centered Tech makes a great case for why it makes sense to follow through with encrypting email and text (bit.ly/encryptornot).

Want to see how easy it is to use encrypted email? I included a demonstration video in the following blog post: bit.ly/emailencrypt.

Social media policy

Now is also a great time to make sure that you’re satisfying the requirements of Standard H.6. of the ACA Code of Ethics pertaining to social media presence and use. If you are utilizing social media (Facebook, Instagram, LinkedIn, Twitter, etc.), the ethics code requires that you:

  • Maintain a separate personal and professional presence. This relates to our responsibility to avoid engaging in dual relationships. This means taking actions such as creating a professional Facebook page.
  • Incorporate social media into your informed consent. We have a responsibility to inform our clients of the “benefits, limitations and boundaries of the use of social media” (Standard H.6.b.). Depending on how you engage in social media use and marketing, this may vary according to the platform you are using. It is important for clients to understand, for example, the potential benefits and ramifications of them “liking” your professional Facebook page, such as their friends seeing that they liked your page and the kinds of online advertisements that will be displayed to them as a result of liking your page.
  • Maintain client confidentiality by not disclosing information about them online. Also respect their online privacy unless they provide consent to view that information. I strongly encourage you to read my September Technology Tutor column on the dangers of online disclosure (ct.counseling.org/2016/08/thinking-discussing-clients-online-think-twice/). It’s not as simple as making sure that you don’t use identifying information.

An excellent way to address this is to develop a social media policy that you can then incorporate as part of the client orientation/informed consent process. Keely Kolmes offers a wonderful template as a starting point (drkkolmes.com/social-media-policy/).

Business and technology evaluation

Even if you have all of the above buttoned up nicely, it’s always a good idea to evaluate your business operations at least once per year. Is what you are doing working? Could it be improved? Can you implement technology, streamline processes or align your efforts to better move toward your goals? This is also a great opportunity to examine the return on investment (bit.ly/ROITYP) on things you’ve already implemented. Are you getting the expected results?

You’ll find plenty of freely available articles at the Tame Your Practice website (tameyourpractice.com) on these topics and more if you need additional details.

 

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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.

Behind the Book: Group Work With Persons With Disabilities

By Bethany Bray

Group counseling can serve as a powerful antidote to the isolation clients often feel, whether they’re going through infertility, addiction or a range of other issues. This can be especially true for clients with disabilities, say Sheri Bauman and Linda Shaw, co-authors of the American Counseling Association-published book Group Work With Persons With Disabilities.

“For persons with disabilities, being in a group with others who have the same challenges can reduce the sense of isolation that often accompanies such circumstances,” they write in the book’s introduction. “… When members encounter others at different stages of dealing with an issue, they may develop a sense of hope that they, too, can make progress and feel more satisfied and fulfilled. For those whose disability may limit their opportunities to join with others, the feeling of cohesiveness that develops in groups can provide that sense of belonging that is so essential for optional human functioning.”

Bauman and Shaw are both professors in the University of Arizona’s Department of Disability and Psychoeducational Studies. They collaborated to write Group Work With Persons With Disabilities to use in a course they co-teach on group work.

 

Counseling Today sent them some questions, via email, to learn more:

 

The group dynamic in and of itself can be a powerful counseling tool. Please talk about how this can be the case, particularly, for clients with disabilities.

The therapeutic or curative factors in groups are well known. It’s not unusual for people with disabilities, particularly newly acquired disabilities, to feel that their experience is unique and that their disability can be socially isolating. Consequently, the following curative factors may be of particular relevance for persons with disabilities: universality (realizing one is not alone in their struggles); instillation of hope (seeing other members who are living full and productive lives, despite myths and misconceptions about disability); cohesiveness (the feeling of belonging that develops within a group); interpersonal learning (discovering, through group feedback, how others see them; having the opportunity to practice new skills in a safe environment); and the imparting of information (learning practical medical management skills and information about negotiating social and physical barriers in their environments). There are others but these are particularly relevant.

 

What would you want counselors to know about this topic — Especially counselors who may not have encountered it in graduate school?

Regardless of a counselor’s specialty area of practice, it is highly likely that sooner or later people with disabilities — who are about 20 percent of the population — will seek services from them and just like any other clients, many will be potential group members. People with disabilities have all the same kinds of issues any other person may have, so it is likely that they will appear in groups with a variety of themes. Often when people with disabilities seek assistance from a counselor, there is a tendency on the part of the counselor to assume that the disability itself is the source of the problem. Counselors should guard against the tendency to do this, as the issue may or may not be related to the disability. Just as they would approach any other client, the counselor must see and address the needs of the whole person. Including questions that invite discussion about disabilities (some are invisible) in screening interviews will alert the counselor that some accommodations may be needed, and give the counselor the opportunity to seek out additional information if unfamiliar with the needs of individuals with this particular disability as it applies to group participation. Although people’s disabilities are an important aspect of their identity, they are more than their disability. In our book, we provide counselors with background information and specific skills that will allow them to conduct groups with this clientele successfully.

 

In your opinion, what makes counselors a “good fit” for leading groups with clients with disabilities?

A counselor who is sensitive to diverse groups will be able to bring that sensibility to include persons with disabilities. Counselors who are able to reflect on their own potential biases and fears will bring honesty to the experience and serve as important role models to other group members. Counselors also need to be open to learning additional information that would increase their comfort level and competency in working with diverse group members, including those with disabilities.

People with disabilities are not different from other group members. Just as in working with any diverse group, having an understanding of the particular needs of these members is an important area of cultural competence.

 

Do you feel that, in general, counselors might have misconceptions or gaps in knowledge about group work with clients with disabilities?

Just as in the general population, persons with disabilities are often overlooked and misconceptions are common. Generally, people without disabilities tend to believe that disabilities have a much more negative impact on quality of life than do people with disabilities themselves, and they may see “successful” people with disabilities as heroic or especially admirable. Additionally, many people assume that the most important life task of a person with a disability is to “overcome” their disability. In point of fact, many people with disabilities see their disability as part of the natural diversity of people, and that the problem is not so much the disability itself, but rather the barriers to full participation in life created by physical and attitudinal barriers. Adjustment to disability is seen as a social, rather than a personal problem.

Many counseling training programs touch on disabilities only tangentially, and thus indirectly convey the message that this is not a group that counselors will encounter in their practices, unless they specialize in disabilities. The reality is that persons with disabilities may have relationship problems, financial problems, stresses, depression and all of the same kinds of concerns that bring nondisabled people to groups.

 

What advice would you give to a counselor who might want to refer a client to a group? What should they keep in mind? How can they find an appropriate group in their area?

Groups provide many opportunities for growth for persons with and without disabilities, as well as for the counselor. Groups offer many advantages over individual therapy, such as the chance to learn and practice new skills in a safe environment, to receive feedback from others, to learn from others’ experience, to develop relationships, etc.

Counselors referring a person with disabilities to a group should prepare the client just as they would any client when making a referral. In our book, we discuss a number of screening considerations, such the advantages of homogeneous vs. heterogeneous groups, which may be important in finding a good match for the client’s present needs. Logistical issues may also be important to consider, such as access, availability of public transportation, etc. These issues are discussed in detail in our book.

Be careful to avoid making assumptions about what a client can and cannot do; counselors sometimes underestimate the potential of clients to benefit from the group experience. The best expert on the client’s abilities and needs is the client him or herself.

 

What inspired you to collaborate and write this book?

[At University of Arizona,] we have graduate counseling programs in both school and mental health and rehabilitation specializations, and we both teach sections of a group counseling course that is required of students in both programs. When planning for this course, we were unable to locate a suitable supplementary text to address this important topic – so we wrote one! Additionally, we wanted to provide a resource to practicing group counselors who may feel that they would benefit from increasing their knowledge about disability and wish to expand their capacity for cultural competency and inclusiveness.

 

 

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Group Work With Persons With Disabilities is available both in print and as an e-book from the American Counseling Association bookstore at counseling.org/publications/bookstore or by calling 800-422-2648 x 222

 

Sheri Bauman and Linda Shaw will be signing books at ACA’s 2017 Conference & Expo in San Francisco on Friday, March 17 from 1 to 2 p.m. Find out more at counseling.org/conference/sanfrancisco2017

 

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About the authors

Sheri Bauman is professor and director of the counseling graduate program in the Department of Disability and Psychoeducational Studies in the College of Education at the University of Arizona. She has a background in public school counseling.

Linda Shaw is professor and department head in the Department of Disability and Psychoeducational Studies at the University of Arizona. Her background is in rehabilitation counseling; she is a licensed mental health counselor and a certified rehabilitation counselor and was a member of ACA’s Code of Ethics Revision Task Force in 2014.

 

 

 

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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.

 

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To be a counselor is to be inclusive

By Catherine B. Roland March 1, 2017

Catherine Roland, ACA’s 65th president

Dear Counseling Colleagues,

This is the month I will meet and talk with thousands of our members at the ACA 2017 Conference & Expo in marvelous San Francisco. We will join together to create new networks and continue friendships, generate interest in any number of issues that have emerged and, finally, engage in powerful interactions with one another to effect positive change and celebrate difference. This last element may be the most challenging of all.

On Jan. 21, I participated in the Women’s March on Washington with over half a million others, including three close friends and colleagues. We conveniently connected so that we would be “in the front,” but as the media accurately recorded, there was no front, back or side — only a middle. The day was marvelous and without incident. The participants were diverse in culture, ethnicity, gender, age and geography, and they represented every part of this country and, indeed, the world. The positivity I felt there, the tremendous hope expressed, the outpouring of support for women’s rights and human rights, was overwhelming at times. I left feeling close to euphoric.

The week following the Women’s March provided a deep challenge to many social justice advocates, counselors and counselor educators, advisers, supervisors and students. Airports in cities large and small were filled with protesters speaking out against what appeared to be a refugee “ban” on people from seven Muslim-majority countries. Regardless of political affiliation, this policy has struck a frightening chord. The Muslim community, and anyone who supports freedom, was immediately facing fear and uncertainty, confusion and anger. Those overriding feelings have impacted our work as counselors in schools, colleges, agencies and private practice — in fact, our work as humans living in America. It has nothing to do with politics; it has everything to do with humanness. That’s the bailiwick of professional counselors.

That sense of purpose I felt from the Women’s March weekend plummeted to a low I hadn’t experienced since 1968, when we witnessed two beloved leaders, heroes and icons — Martin Luther King Jr. and Robert F. Kennedy — gunned down mercilessly because of their civil rights/human rights agenda. Five years earlier, President John F. Kennedy had been murdered because of a similar agenda.

A confluence of feelings of anger, misery, disbelief and helplessness descended on me. To deny safe passage into America for those fleeing impending death or abuse, because of where they come from or what they believe, puts everything we do as counselors and helpers at risk. The burden to offer excellent and empathic counseling service is a heavy one in general, and in the days and months ahead, we will be asked to generate new kinds of skills for offering help, hope and further training about diverse groups. When counselors’ constituents are hurting and struggling, regardless of why, we serve and impart hope without judgment. And we will continue to do just that!

In San Francisco, we will gain much strength from our time together. For those unable to attend in person, the best path to take is the sessions that will be made available online. This is a vital time in our profession. We must display our identity proudly and with purpose.

With Dr. Irvin Yalom and Jessica Pettitt starting us off with respective keynotes on Friday and Saturday, our hope and resolve as advocates of social justice and inclusive diversity will be supported and engaged. We will be encouraged to do our best, most ethical work.

For future consideration, learn about Illuminate, a unique and intensive ACA training symposium being held June 8-10 in Washington, D.C. The focus for this event is counseling and advising the marginalized population of LGBTQ adults, with emphasis on the intersectionality within group. Our two keynote speakers are Colleen Logan, a lifelong LGBTQ advocate and a past president of ACA, and Cheryl Holcomb-McCoy, human rights advocate and dean of the School of Education at American University. Look for more to come on Illuminate.

I will end with my consistent message that you have heard all year: Positivity, Hope and Courage. That hasn’t changed. It will just cost each of us a little more passion and effort. We know who we are as counselors.

See you in San Francisco in a couple of weeks!