Monthly Archives: May 2017

Aspiring to make suicide a relic of the past

By John McCarthy May 15, 2017

The story of yet another medical breakthrough related to some disease may not catch your attention. In fact, in an era of technological advances, such innovation is expected. After all, longer life spans and the defeat of diseases are seen as inevitable.

According to a story published last year in The New York Times, the rates of colon cancer, heart disease and dementia have all dropped in wealthier countries. Perhaps in the year 2117, people will wonder what those diseases even were.

My hope is that the same will be said for another primary cause of death, albeit one with a rate that is currently heading in the wrong direction. Suicide was the 10th-leading cause of death in the United States in 2014.

According to the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC), the age-adjusted rate for suicide increased 24 percent from 1999-2014. Rates were higher for both men and women in nearly all age groups over that period. The largest increases in suicide rates were found in girls ages 10-14 (a 200 percent increase) and in men ages 45-64 (a 43 percent increase). Firearms were responsible for the majority of male suicides, whereas the primary means among women involved poisoning.

Suicide accounted for nearly 43,000 deaths in the U.S. in 2014, according to the CDC. Put into perspective, the annual number of suicides equates to the entire population of many small U.S. cities, including places such as North Miami Beach, Florida; Wilkes-Barre, Pennsylvania; and Urbana, Illinois. Although violence is frequently and rightfully discussed in the media, the number of homicides in the U.S. in 2013 was approximately 16,000. In other words, for every death by homicide that we read about or hear about in the news, there are more than two completed suicides. These are lives lost that may go unnoticed by many.

Unlike with the medical diseases that I mentioned earlier, a similar story of progress for suicide prevention cannot yet be written. The NCHS found a current rate of 13 suicides per 100,000 population. A comparison with past decades yields similar findings. The rates per 100,000 population were 12.4, 12.6 and 10.6 in 1990, 1975 and 1959, respectively.

Furthermore, the economic cost is staggering. The American Foundation for Suicide Prevention estimates that suicide costs our nation $44 billion annually. A recent study on depression, a disorder frequently associated with suicides, estimated an annual cost of $210 billion, an increase of 22 percent since 2000.

A look at the global picture is slightly different, however. Suicides throughout the world decreased 9 percent between 2000-2012, according to World Health Organization (WHO) data. Various factors, including national strategies and new treatments available for depression, were cited as possible reasons for the decrease.

So, perhaps there is hope for decreasing instances of suicide, just as we are witnessing declines in other leading causes of death. WHO’s Mental Health Action Plan 2013-2020 calls for a 20 percent increase in coverage for individuals with severe mental disorders and, simultaneously, a 10 percent reduction in global suicides. The success of such aims is contingent on early identification of suicidal behaviors, community-oriented supports for people who have attempted suicide and restricting access to commonly used methods of suicide.

The leading causes of death in the United States in 1890 included typhoid fever, diphtheria and cholera, none of which are seen in the rankings today. Perhaps in the coming years, people will review a similar list, and maybe — just maybe — suicide will be a thing of the past.

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John McCarthy is a professor in the Department of Counseling at Indiana University of Pennsylvania. He is also a member of Ray of Hope: Westmoreland County Suicide Awareness and Prevention Task Force. Contact him at jmccarth@iup.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.

Counselors in the courtroom

By Margaret Taylor May 10, 2017

Counselor educators are responsible for ensuring that students are sufficiently prepared for entry into the counseling profession. It is challenging for counselor educators to include all areas of preparation because numerous content and curriculum standards must be met. One topic that often gets neglected is preparing counselors for testifying in court. In a paper presented at the 25th International Play Therapy Conference in 2008, Marilyn Snow and Ruth Ouzts Moore found that counselors were increasingly being called on to testify in court, especially in child custody cases. But most counselors are not well prepared to serve as competent witnesses or represent the counseling profession adequately.

Inadequate knowledge about the judicial system and process regarding court testimony may place counselors at risk for ethical violations. Therefore, I believe it is crucial that counselor educators prioritize educating students about testifying in court. The first time that I testified in court as a beginning counselor, I found that I had been poorly prepared by educators and attorneys. The experience nearly traumatized me. I was not ready for the questions that were asked of me or the grueling process of cross-examination. As a result, the client’s case suffered and the counseling profession was misrepresented.

After this initial experience of testifying in court, I vowed never to be caught unprepared again. I also determined to use my negative experience to better equip counselors for testifying in court.

Legal and ethical responsibility

Counselor educators are expected to be knowledgeable about ethical and legal issues in the counseling profession and recent changes in the field of counseling. Standard F.7.a. of the American Counseling Association’s 2014 Code of Ethics states, “Counselor educators who are responsible for developing, implementing and supervising educational programs are skilled as teachers and practitioners. They are knowledgeable regarding the ethical, legal and regulatory aspects of the profession; are skilled in applying that knowledge; and make students and supervisees aware of their responsibilities.” This section of the ethics code applies to the fact that counselors are frequently subpoenaed to testify on behalf of their clients. Accordingly, counselor educators are ethically obligated to educate students about their ethical and legal responsibilities when testifying in court.

The Council for Accreditation of Counseling and Related Educational Programs (CACREP) Standards (2016) also address the ethical and legal responsibilities of counselor educators in preparing their students for practice. Two CACREP Standards apply to the issue of counselors testifying in court. Standard 2.F.1.b. states that programs must include, “the multiple professional roles and functions of counselors across specialty areas,” whereas Standard 2.F.1.i. specifies that training must be provided in “ethical standards of professional counseling organizations and credentialing bodies, and applications of ethical and legal considerations in professional counseling.”

Together, the ACA Code of Ethics and the CACREP Standards would appear to require that counselor education curricula incorporate training in the roles and responsibilities that come with testifying in court and otherwise acting in the best interests of clients.

Competence as a counselor educator

Counselor educators are not only responsible for providing students with material on courtroom testimony and other aspects of law pertaining to their clients; counselor educators are also to be knowledgeable about the topic themselves. Counselors and counselor educators should seek guidance from counseling professionals who have served as witnesses in court.

As reported in the Counseling Today article “Your witness” in 2011, George Cyphers, a counselor educator at Kent State University and owner of a consulting business, made this statement about testifying on behalf of clients: “I have learned over the years that this is a serious business because it involves a person’s life. You cannot afford to hold yourself out as an expert unless you are willing to invest time and effort to prepare thoroughly for the challenge of cross-examination.”

Experience from practicing counselors reiterates the importance of preparing students for courtroom testimony. Time and effort should be placed into designing a curriculum that includes education about testifying in court on behalf of counseling clients. Students who are well-educated and prepared in this area are able to represent themselves, their clients and the profession effectively.

If we agree that counselor education programs need to prepare students for court testimony, the question becomes what should counselor educators include in the curriculum, and how are these competencies best attained? Various expert witnesses, attorneys and counselors have provided suggestions on what is important to know prior to entering the courtroom. Writing for the Journal of Counseling & Development in 1990, Jan La Forge and Phyllis Henderson suggested four categories: the role of the counselor in the courtroom, pre-court preparation, courtroom etiquette and strategies for answering questions.

Role of the counselor in the courtroom

The role of the counselor while in the courtroom is that of a witness. Forge and Henderson asserted that the counselor serves as an educator to the jury and the judge, providing factual and neutral information. It is important that counselor educators distinguish between an “expert witness” and a “witness of fact.”

To testify as expert witnesses, counselors must first be qualified as such by the judge. Demonstration of knowledge and experience may include publications, presentations and specific training in the area of expertise. The prosecuting attorney will ask counselors questions about their qualifications. Counselors answer these questions by demonstrating their knowledge and expertise. After presenting their qualifications, it is possible that the opposing attorney will call those credentials into question. Counselors should be prepared for this possibility. If they are not challenged, it is likely that the judge will qualify them as expert witnesses, meaning these counselors can offer an opinion on the case.

Valuable witnesses are typically well-educated, intellectual individuals who are able to educate a jury about their expertise as it relates to the case. Expert witnesses should be skilled at teaching a jury, using short statements rather than long uninterrupted assertions.

Conversely, “fact witnesses” provide testimony about what has been observed, heard or known as true events during the course of counseling. Michael Puhl of Puhl Law Group explained (2014) that fact witnesses do not have a particular expertise; therefore, they are not permitted to offer opinions about the facts of the case. Counselors working with children are often called to testify as fact witnesses because of disclosure statements made by children during session. As fact witnesses, counselors may repeat statements made by the child but not offer an opinion about the truthfulness of the statement.

Various resources exist for counselor educators and counseling professionals when preparing to be called as expert witnesses. The following is a list of books and articles on testifying as an expert witness:

“The Ten Commandments of Testifying at Trial” by David Benjamin
“Expert Witnesses, Courts and the Law” by Elizabeth Butler-Sloss and Ananda Hall
“Working as an Expert — Tips for Expert Witnesses” by Aaron Larson
“May It Please the Court: Testifying Tips for Expert Witnesses” by Laurence Miller
“Courtroom Survival Guide” by Patrick J. Walsh
Feder’s Succeeding as an Expert Witness, fourth edition, by Harold A. Feder and Max M. Houk
The Portable Guide to Testifying in Court for Mental Health Professionals: An A-Z Guide to Being an Effective Witness by Barton E. Bernstein and Thomas L. Hartsell Jr.
Clinicians in Court: A Guide to Subpoenas, Depositions, Testifying and Everything Else You Need To Know by Allan E. Barsky and Jonathan W. Gould

This list is not exhaustive, but it serves as a good starting point for counselor educators to incorporate material into a course for counseling students. Material on courtroom testimony can be infused into different courses of a master’s counseling program for clinical mental health or school counseling. Orientation classes on the counseling profession or for clinical mental health counseling or school counseling would also be appropriate courses to include material on expert testimony. In a counselor education and supervision doctoral program, a course on contemporary issues in counseling would be a fitting place for information on counselors serving as expert witnesses.

Counselor educators can also provide opportunities during practicum classes for students to meet with counselors who serve as expert witnesses. These expert counselors could answer students’ questions and concerns. Counselor educators can also arrange for an attorney or expert witness to attend class to demonstrate various court proceedings that counselors may encounter, including depositions, cross-examination, criminal trial and custody hearings. Role-plays of legal proceedings can also serve as an excellent method for educating counselors about what to expect in the courtroom.

Likewise, educators may arrange for students to observe a court hearing or attend a mock hearing or trial. A study conducted by Carol R. Colby and Lynn Landis Long in 1994 found mock trials to be a useful teaching method for graduate counseling students who are learning about ethics and legal proceedings. Legal and counseling ideas are integrated in a mock trial, providing students experiential learning and practical application. A mock trial helps students understand the functions of all people involved in the law, including judges, attorneys, mental heal professionals, jury members and court reporters. Educators can best prepare students for possible legal proceedings by pairing knowledge from lectures with experiential learning, such as roles-plays and mock trials.

Pre-court preparation: Documentation

Proper documentation is one of the many important tasks in preparing for court. Outside of the court setting, counselors are ethically obligated to maintain appropriate documentation of all clients. Therefore, preparing documentation for court should not pose a challenge.

Attorneys vary in what they request in a subpoena for records. Counselors should be prepared to provide all of the client’s records. However, counselors may be asked to present only records pertaining to a certain allegation or custody matter.

Many court cases do not occur until long after a counselor has terminated with the client. Being meticulous and cautious about documentation is crucial for counselors. It is generally recommended that counselors maintain detailed documentation of any action in a client case, including meetings with parents and client disclosures. Counselors should be aware that if an activity is not documented, then there is no hard evidence that it happened. This aspect is important to keep in mind when a client misses appointments.

Moore and Laura R. Simpson suggested in a 2012 VISTAS article that when writing case notes, counselors should be careful to use definitive descriptive language. For example, rather than stating, “It appears the child was neglected by family,” a counselor should state, “The child disclosed that the family withheld food for three consecutive days.” Careful language prevents the counselor from being trapped on the stand by a statement made in documentation. An attorney cannot challenge the counselor on a statement made by a client; however, an attorney can question a counselor about an opinion given in documentation.

Once records are subpoenaed by the courts, counselors should document the subpoena in their records and then should immediately contact clients to inform them of the breach of their confidentially. Clients have the right to know when their confidentiality is broken because of legal proceedings. This phone call or meeting to inform clients of the subpoena should be documented too. Thorough documentation of the limitations to confidentiality will help prove the counselor acted ethically should a client seek legal counsel.

Pre-court preparation: Conference with attorney

Counselor educators should inform students of the necessity of meeting with the attorney who issued the subpoena so that both the attorney and the counselor are well-prepared for possible testimony. Forge and Henderson explain that during this conference, counselors can be informed about particular documents that will be needed and what questions will be asked of them during testimony. Counselors can also inform the attorney of any concerning issues about the case to prevent the attorney from being surprised during the hearing.

Cross-examination will occur from the opposing attorney during the course of a court hearing. Meeting with an attorney in advance can provide opportunities to cover questions and strategies that may be used during cross-examination. Knowing ahead of time that attorneys are being compensated to discredit the witness prior to a court hearing can keep counselors from panicking or answering defensively while testifying.

Counselor educators are likely to have little experience with cross-examination. Inviting guest speakers such as community attorneys and counselors with expert testimony experience to counseling classes can provide students with concrete examples of the cross-examination process.

Courtroom etiquette

Etiquette in the courtroom may appear commonsense, but it is a topic that is often overlooked. Appropriate dress and behavior should not be disregarded when preparing counselors for court because these are signs that will indicate the professionalism of the counselor. Suits or work attire is recommended. Also limit accessories that may cause a distraction. Dressing properly is one of the simplest ways a counselor can establish credibility in the courtroom.

Body language is equally significant. Body language can communicate strength or weakness. It should communicate that the counselor is confident, knowledgeable and strong. Jamie Hamlet asserts (practicenotes.org/vol12_no4/testifying.htm) that language can establish counselors’ credibility with the jury and deters the deference attorney from antagonizing them. Body language is an important component in training to be a counselor. Therefore, counselors should already be familiar with the significance of communicating positive body language on the stand as a witness. By displaying the proper posture of sitting straight and leaning forward, counselors will express assertiveness and professionalism. Facial expressions should demonstrate genuine concern and thoughtfulness.

Furthermore, counselors should speak clearly and politely to those in the courtroom. Counselors should declare with authority and conviction if they are confident about a conclusion made regarding their case. Conversely, it is recommended that counselors refrain from being argumentative or defensive if challenged by an opposing attorney. Being argumentative may be perceived as disrespectful and unprofessional.

Frequently, witnesses are not permitted in the courtroom until it is time to give their testimony because attorneys do not want proceedings from the hearing to contaminate witnesses. Therefore, counselors should be careful who they speak with and limit their conversations. Forge and Henderson warn that speaking with a witness on the opposite side of the case could cause a mistrial.

Answering questions during testimony

Responding to questions asked by attorneys during testimony can be very challenging and intimidating. But with proper preparation, this process doesn’t have to be so daunting. Counselor educators should teach counseling students various strategies related to answering questions in the courtroom.

Always tell the truth. This is the No. 1 concept to remember when testifying in court. Do not waver from this. Do not embellish your statements during testimony. Simply tell the truth and state the facts. If a question is asked that you do not know, merely state that you do not know the answer. Often witnesses think that they must have an explanation for each question asked of them and then feel pressured to speak. Counselors must understand that making an untruthful statement can ruin their credibility and harm the client’s case.

Community members who serve as jurors often place their trust in expert witnesses such as doctors, counselors, police officers, etc. Therefore, jurors will do their best to believe an expert’s testimony if credibility is established. If an expert witness betrays this trust by being dishonest or disrespectful on the stand, Laurence Miller states (in “May It Please the Court: Testifying Tips for Expert Witnesses”) that jurors are likely to disregard the witness testimony, harming the client’s case. Being honest and truthful increases the possibility that jurors will believe the testimony of the counselor.

Witnesses should take time to listen to the attorney’s questions and to formulate their responses. Simplicity is key. The more words that are spoken, the more questions that can be asked. If a yes-or-no question is asked, simply answer yes or no. Furthermore, the language that witnesses use should be simple. Laypeople will not typically understand the jargon used in the counseling field. Speak in a way that will be easily understood by someone outside of the profession.

Cross-examination is designed to be confrontational, causing one to feel pressured. Counselors should expect to be challenged on the witness stand. Learn not to take such challenges personally and to exhibit grace under pressure without becoming flustered or annoyed or losing your temper. Well-prepared counselors are ready to defend their opinions and remain firm on the conclusions made while testifying. This stance exhibits confidence, expertise and assurance to a judge and jurors.

Attorneys may attempt to fluster witnesses. This may involve asking numerous questions rapidly, speaking loudly and acting in an intimidating manner. When training to work with clients, counselors are expected to remain cool, calm and nonjudgmental during counseling sessions. These same skills should be applied during courtroom testimony. Educators should prepare counselors for this tactic and provide them with techniques to remain calm.

Conclusion

It has been established that counselor educators play a significant and vital role in educating and preparing counselors for testifying in court on behalf of their clients. Including material on court testimony in counselor education curricula protects both students and their future clients. Incorporating the topics discussed in this article into class syllabi and the overall curriculum is essential to preparing counselors to serve as competent witnesses and exceptional representatives of the counseling profession.

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Related reading, from Counseling Today: “Bringing counselor expertise to court”

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Margaret Taylor is a licensed professional counselor and supervisor in Alabama, having served as a counselor for more than 10 years. In addition, she is enrolled as a second-year doctoral student in the Auburn University counselor education and supervision program. Margaret has advocated for children and testified as an expert witness in numerous courts, including in criminal trials, custody cases and juvenile hearings. She has presented at state and regional conferences, providing counselors with the necessary tools to serve as effective witnesses in court for clients and the counseling profession. Contact her at barnema@auburn.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.

Preparing for the mental health impact of climate change

By Debbie C. Sturm and Lennis G. Echterling

Around the globe, coastlines are encroaching on communities, summer days are sweltering and reports of weather catastrophes often dominate the news media. These examples represent only a few of the monumental and pervasive environmental effects of our changing planet.

Climate change may be the most crucial issue confronting the inhabitants of our world today. The dramatic consequences that scientists have been predicting, such as rising sea levels, record-setting high temperatures and an increase in devastating natural disasters, are no longer theoretical. Although some still argue the point, climate change is now a grim reality, not a vague possibility in the distant future.

As devastating as these consequences are on our physical world, climate change also poses enormous threats to our psychological well-being. In a report released in 2012 by the National Wildlife Federation’s climate education program, with support from the Robert Wood Johnson Foundation, researchers predicted a sharp rise in mental health issues resulting from events related to climate change in the coming years. These issues include depression and anxiety, posttraumatic stress disorder, substance abuse, suicide and outbreaks of violence. The elderly, the poor, children and members of the military (and their families) were identified as being among those who will be most psychologically vulnerable.

We believe the counseling profession, which has its conceptual roots in the promotion of human growth and development, must play a more active role in addressing the mental health impact of climate change. For many decades, counselors have worked closely with countless individuals to help them achieve fulfilling careers, realize self-actualization, strengthen personal resilience and seek social justice. Recently, counselors have gained greater acceptance as valuable members of crisis and disaster response teams.

Our extensive training and experience in enhancing well-being enable us to serve as effective catalysts for positive change. Now more than ever, counselors are in a position to shape messaging and lead the way in effective prevention and intervention related to the psychological implications of climate change. This includes promoting climate resilience, strengthening disaster response programs and advocating for vulnerable populations.

Climate resilience and climate refugees

In January 2016, the Department of Housing and Urban Development announced a $48 million grant to move an entire indigenous community from Isle de Jean Charles, Louisiana, before the land disappears into the Gulf of Mexico. This marks the first allocation of federal dollars to permanently move an entire community impacted by climate change. These displaced people are now known as climate refugees. The main purpose of the grant is to work closely with the inhabitants of this community through a process that will honor their choices. By empowering the people and giving voice to their preferences, choice builds resilience.

Although this tribe is the first to be formally identified as climate refugees within the United States, climate refugee status is not a new phenomenon. The crisis in Syria, for example, has become so complex and tragic that it often eclipses the fact that a climate-related drought was the catalyst for mass migration to the cities, instigating intense cultural and economic conflicts.

Climate change threatens to become a tipping point in more and more areas of the world. Between 50 million and 200 million people could be displaced by 2050, according to the United Nations University Institute for Environment and Human Security. Populations that are economically and culturally vulnerable, such as those whose livelihoods depend on farming and fishing, will feel the impact most especially.

Climate resilience is the notion that we should not wait until there is no choice and people are traumatically displaced by the effects of climate change. Instead, we can help create resilience plans so that those who are impacted have both choice and voice in the matter. The International Red Cross has embraced the notion of climate resilience as a necessary element of preparation for what is to come, and as an opportunity to anticipate the physical, psychological and cultural needs ahead. Climate resilience, which is an integral component of disaster response within the International Red Cross, places significant emphasis on trauma and mental health response.

Place attachment

Consider again the people of Isle de Jean Charles. Although efforts are in place to help with the transition, residents still feel a deep attachment to their home. This isle holds their cultural and spiritual history. Their identity is deeply rooted to the story of this place.

Just as we are connected to our early attachment figures, we also share a deep and abiding attachment to our early places, both individually and culturally. In a 2016 article in The New York Times, Chief Albert Naquin of the Biloxi-Chitimacha-Choctaw tribe, the ancestral residents of Isle de Jean Charles, observed sadly, “We’re going to lose all our heritage, all our culture.”

Place attachment is the powerful bond that links a person to a place. It develops throughout one’s lifetime and even evolves over centuries throughout the history of a culture. This sense of connection to a specific place provides a profound source of meaning, belonging and sustenance. Simply put, this place is one’s home. Place attachment and sense of place are often interchangeable. Place identity considers attachment in terms of emotional or symbolic meanings, as internalized and integrated into a person’s identity.

Much like other aspects of attachment that we explore with clients struggling with any number of issues, place attachment is seated in a deep part of ourselves that connects to ancestry, early recollections, sensory experiences and story. It relates to the larger question of Who am I? — a question that can be partly answered through place identity.

In North Dakota, the Standing Rock Sioux Tribe recently engaged in a battle of culture and human rights against the Dakota Access pipeline, the construction of which threatens tribal land and clean water. Many have called Standing Rock a new civil rights moment encompassing a convergence of environmental rights, human rights and cultural rights. Tribal representatives from all over North America joined the Standing Rock Sioux in an empathic and familiar stand to protect culture and identity.

Journalist Rebecca Solnit, writing for The Guardian, spent time in Standing Rock to cover the movement. She gave eloquent voice to the tribe’s heartfelt commitment and place attachment: “Victors like to forget how they got their spoils, but the despoiled have long memories.” With a growing sense of awe, Solnit observed how the tribe relied on peace and prayer, valued humility and revered their ancestors.

Place matters as an integral piece of cultural, historical, existential and personal identity. The stories of people and their places, whether in Louisiana or the Dakotas, are as important as any other attachment issues or identity concerns that we consider when we counsel our clients.

Environmental justice as social justice

Issues that impact the planet also directly impact the people who live on the planet. At times, it seems as though conversations around environmental justice and social justice are happening with equal intensity and depth of passion but are taking place in two separate silos.

As the climate changes, families, communities and lives are affected. And as is true with so many other aspects of change, our most vulnerable neighbors — individuals with low incomes, communities of color, immigrants, indigenous peoples, children, pregnant women, older adults, people with disabilities and people with chronic medical conditions — are most subject to the impact. Understanding the issue and engaging in advocacy on behalf of the climate is also advocating on behalf of the people whose lives depend on a healthy planet. The global climate is interconnected — environmentally, psychologically, socially, culturally
and spiritually.

In 2010, the Council on Social Work Education declared sustainability and climate issues to be the social justice issues of the new century. In 2011, the American Psychological Association released a report highlighting the broad contributions that psychology could make, with continued research and advocacy, to understanding the power of the human-environment relationship. It included a call to action for scholars to bridge the gap between the science of environmental issues and the study and practice of psychology.

Our moral obligation

In a 2016 article on the ecoAffect website, psychiatrist Lise Van Susteren posed a challenge to those in the helping professions. She noted that we work with people who are faced with fears, traumas, unexpected changes and crises. We help our clients navigate this difficult terrain even as we view larger societal issues through a social justice and advocacy lens. She wonders, then, if we can ethically turn a blind eye to the approaching crises that our changing planet will bring. Do we have a duty to warn, to protect, or, at a minimum, to acknowledge that the changing climate is a significant variable in mental health?

The American Counseling Association has a long-established relationship with the American Red Cross as a model for and partner in disaster response. In 2002, the International Federation of Red Cross and Red Crescent Societies established the Red Cross/Red Crescent Climate Centre. This organization supports national Red Cross and Red Crescent Societies in their work to reduce loss of life and damage to livelihoods from climate change and extreme weather events. Goals include implementing information and education activities about climate change and extreme weather events; supporting the development of climate-adaptation activities and disaster-risk-reduction programs; and bringing concerns about the impacts of climate change on vulnerable people to the broader public. Considering the global movement toward acknowledging climate change in disaster response and preparedness, we believe it is vitally important for ACA to expand its vision for the future of disaster response.

As professionals who believe that all individuals deserve basic human and civil rights, we need to challenge ourselves to see the climate crisis as an imminent threat. Counselors are positioned to bring a trauma-informed and resilience-based perspective to the front lines of crisis and disaster response. We must recognize that environmental injustices and environmental racism — such as what we have witnessed in Flint, Michigan; with Hurricane Katrina; with the 2016 Louisiana floods; and with the standoff in Standing Rock — are enormous social justice issues.

Given our knowledge and skills as counselors, we have both the responsibility and the potential to contribute to environmental advocacy, disaster response and preparedness for building resilient communities. It is our basic duty to promote and deepen human beings’ most fundamental attachment to our natural world.

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Debbie C. Sturm is an associate professor at James Madison University in Virginia and a licensed professional counselor with more than 10 years’ experience in counseling survivors of trauma and community violence. She engages in research related to nature connectedness and mental health, sense of place, the psychology of sustainability and environmental justice as social justice. Contact her at sturmdc@jmu.edu.

Lennis G. Echterling is a professor at James Madison University with more than 30 years’ experience in crisis and disaster response, supporting first responders, and international stabilization and recovery in war-torn regions. As a doting grandfather to two young boys, he believes it is important that we give greater consideration to the health of our planet and our children.

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.

Bringing the family counseling perspective into schools

By S. Kent Butler, Tony D. Crespi and Mackenzie McNamara May 8, 2017

Children in schools today come from increasingly diverse and complex families. As illustration, more than 1 million families are impacted annually by divorce. In fact, approximately 13.7 million single parents are raising 21.8 million children, and 1 in 3 Americans are stepparents, stepchildren, stepsiblings or part of a stepfamily. Furthermore, according to a 2009 article published in the journal Family Relations, it is estimated that only 31 percent of fathers who no longer live with their children maintain weekly contact with those children. It is easy to conclude that the issue of divorce alone has a profound impact on many millions of children in the U.S.

Now imagine that a young student and her mother walk into the professional school counselor’s office on a Monday morning. Mom explains that she and her husband are pursuing a divorce — he recently told her that he’s been having an affair and has decided to move in with his girlfriend. The daughter acknowledges feelings of depression and admits to having angry outbursts at home. Mom says she is concerned because her daughter’s grades have been dropping.

Considering the large number of children and adolescents coping with parental divorce, it’s not surprising that this fragmented family came to the school counselor’s office. In fact, it’s a good thing. Both daughter and mother need someone to talk to, and schools are a natural access point for services. However, many professional school counselors are not trained in family dynamics and are not familiar with key tenets that impact family counseling, so they may not know how to proceed.

A sample case

Susie is 15. A high school freshman, she knows only that her father left the house two months ago to move in with his girlfriend. Susie’s parents had been together for 16 years, getting married shortly after college.

Susie’s father hasn’t called since leaving. Susie is unaware that her father told her mother that although he loves Susie and her younger sister, who is in seventh grade, he hasn’t missed seeing them in the least. Mom decided not to share this comment with the children, but she does confide this secret to you, the professional school counselor.

Sitting in your office, Susie suddenly looks up and exclaims that she is scared she will have to move and change schools. She also says that she’s having a really tough time paying attention in class and explains that her grades are slipping. “I hate my dad for doing this!” she yells.

Suddenly, Susie starts shaking and breaks down in tears. After a few minutes, Susie tells you that she is spending a lot of time with her boyfriend, partly to stay out of her house. She acknowledges feeling depressed. After pausing for a moment, she looks at her mom and states, “I really hate Dad. His girlfriend is so young. She’s in her 20s. She’s not much older than me!”

Academically, Susie has been an A and B student, but her grades have fallen since her father left. Her mother acknowledges that things are tough at home and reveals that she didn’t learn about her husband’s affair until the day he moved out. “I really don’t know what’s going to happen,” she tells you. “I know we’re getting a divorce, but beyond that I just don’t know.”

Your school doesn’t have a social worker. However, you have a colleague who has been studying family counseling, so you knock on her door to ask for a consultation. After sitting down, you share a few thoughts.

You note that, fundamentally, Susie needs someone to talk to about these issues. Acknowledging that you are speculating, you openly wonder what type of impact the obviously poor communication in Susie’s family is having on her. After all, her father has not called in two months, her mother was completely unaware of the affair and her mother is keeping the father’s confession of not missing his kids a secret. These facets alone highlight poor family communication. In addition, Susie is scared that she might have to move and change schools. Clearly the issues are widespread.

Risk points

Here are some risk points to consider as you work with Susie:

Parenting after a divorce differs significantly from parenting prior to
a divorce.
Single-parent families in the United States are increasing.
Children of divorce have more mental health problems in comparison with their peers.
Suicide is the third-leading cause of death among U.S. youth.
Brain regions responsible for decision-making are not fully developed in youth.
Changes in family structure can have an affect on school grades.
Anxiety, depression and behavior problems are elevated after divorce.
Children of divorce often feel a sense of instability.

An understanding of these risk points is essential for moving forward with children and families because the risk points can provide direction for the work that needs to be done. For example, knowing that mental health symptoms are elevated following divorce and impulsive decision-making is greater among youth, you should assess Susie’s level of safety. In this case, Susie also makes many “red flag” statements.

These are things that counselors know how to address but might not always consider without an awareness of the data. In addition, parents can become defensive, or they might blame themselves for their children’s difficulties. For this reason, it is imperative to educate parents on these risk points. It is also important to realize that family issues may require clinical supervision.

Supervision around work with families

Susie is not alone. As your colleague notes, Susie is one of many children and adolescents who are coping with family stressors. With the prevalence of so many family issues, a growing number of states have enabled licensed marriage and family therapists (LMFTs) to work in the schools. Connecticut, New Mexico, Maine, Texas and Illinois have passed specific laws to allow LMFTs to work in schools, whereas Massachusetts allows LMFTs to work under a general mental health designation.

Schools clearly represent an important access point for mental health professionals. But with only six states utilizing LMFTs in schools, it is extremely important for professional school counselors and their supervisors to know how to manage these situations with families.

As you ponder your next meeting with Susie, you need information. Direct supervisors are often part of the structure of many agencies, but professional school counselors might need to seek support from a colleague with training in family counseling. Such supervision might come from a guidance director, a school psychologist, a consulting psychologist, a marriage and family counselor, or a local family agency.

Two popular family therapy models that might help Susie are presented below.

Symbolic-experiential family therapy

This model, derived from the work of Carl Whitaker, addresses both individual and relational patterns. It is focused on both personal growth and family relations.

Fundamentally, the therapist helps dislodge rigid patterns and stimulates flexibility using a family’s natural pull toward growth. Focusing on the present, the therapist helps people recognize their real feelings, express those feelings and move forward, individually and as a family. Key points follow.

The “battle for structure” involves clients (a family) “sizing up” a therapist. There is no “identified patient”; rather, the family is the therapy unit. In this model, the therapist must win the battle and control therapy. For instance, if the therapist invites the entire family and one member does not show up to the session, the therapist may refuse to meet until everyone attends. In the case with Susie, you might note that you, Susie, her mother and Susie’s sister must all attend.
The family must win the “battle for initiative”; this involves their decision to take charge of their lives and decisions. Is Susie committed to resolving her feelings? Will she commit to six counseling sessions? Is she willing to confront her father about calling his children? Is she motivated to initiate change?

Therapy progresses through stages:

1) Engagement: This is the “meet and greet” phase. You have already started this stage with Susie and her mom.

2) Middle phase: Families are encouraged to change through confrontations, encouragement and interventions. Can Susie’s family meet to start this process?

3) Late phase: Increased flexibility is a focus for the family. Can Susie’s family talk through how the divorce will change their life?

4) Separation: As the therapist separates, the family takes responsibility.

Symbolic-experiential family therapy often advocates the use of co-therapy, making it a great model to use with a more “senior” therapist. In this fashion, supervision can be active and ongoing as you acquire firsthand skills in family counseling.

Structural family therapy

The structural approach, typically associated with Salvador Minuchin, views problems as being rooted in family interactions. Fundamentally, if we can help change the family’s organization (structure), its members typically find that they feel better and their symptoms are often relieved. Key points follow.

Enmeshment or disengagement: Family members may range from those who are overly connected to those who are disengaged. Enmeshment tends to prevent growing maturity, whereas disengagement may lead a child to feel abandoned. Most families are not one or the other but have subsystems that reflect their tendencies. For example, a disengaged father who is overly involved at work may neglect the family. In response, the mother may compensate by becoming overly involved. Is Dad really connected? What is the structure
Boundaries: Are parental boundaries rigid or flexible? Are grandparents a resource? Can a child visit Dad at work, or does the family maintain a rigid rule against it? Can Susie ask Dad questions? What are the boundaries? What is spoken? What is unspoken?
Alignments: Who joins together? Are children aligned against the parents? Did a parent resent and refuse to attend a child’s sporting activities? Did a parent require everyone to attend? What are the alignments?
Triangulation: The permutations of triangulation in families can be abundant. A child and parent may triangulate against another parent. A parent having an affair can create a triangle with the other spouse. Will Susie triangulate with Mom against Dad? What triangles exit?

The structural model also features several stages:

1) Joining and accommodating

2) Assessing family interactions

3) Monitoring dysfunction

4) Restructuring patterns

Summary and considerations

When a student walks into a professional school counselor’s office, we are presented with a rare opportunity. When a student and parent walk in together, we are handed an even rarer opportunity.

Family counseling offers unique and engaging ways of reframing problems. Rather than blaming an individual for a particular problem, family counselors look at the family system. Perhaps a child’s acting-out behaviors allow parents to avoid looking at their relational problems. Perhaps a child’s failing grades reflect more on family anxiety and stress than on individual issues. Fundamentally, family counseling takes a larger, more systemic perspective of presenting issues.

Professional school counselors possess wonderful skill sets. They understand rapport building. They understand relational dynamics. They understand problem assessment and the utility of interventions. The connection between families and school adjustment is undeniable. At the same time, school counselors will likely find continuing education and supervision indispensable in helping families.

In our experience, students and families can often benefit from a family counseling perspective. With so many students in the schools coping with changing family structures, it is vital that we expand our skill sets. Fortunately, there are multiple platforms through which we can provide help. Some of these options include:

Individual counseling from a family perspective
Co-therapy with single families
School-based divorce groups with multiple children
Single-parent support groups

This article is intended to stimulate thinking and provide a preliminary glimpse into two prominent family counseling theories. Our advice? Be available. Be sensitive. Consider finding a supervisor who is capable of expanding your knowledge and skills in this invaluable area. Truly, children, families and the community stand only to benefit.

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S. Kent Butler is an associate professor at the University of Central Florida. He is a licensed professional counselor, national certified counselor and national certified school counselor. He is particularly interested in mentoring, supervision and multicultural issues in counseling. Contact him at skbutler@ucf.edu.

Tony D. Crespi is a professor at the University of Hartford. He is a certified school counselor, licensed marriage and family therapist, and licensed psychologist. He is particularly interested in family counseling and legal issues that affect supervision.

Mackenzie McNamara is a doctoral student in the counseling psychology program at the University at Albany, State University of New York. She most recently worked for New London Public Schools in Connecticut.

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.

Pain to purpose

By Kelly D. Farley May 5, 2017

Burying a child is not something that most people think about — until they must do it. I’ve done it twice, and I must say, I really do not know how I survived it. It has been more than 10 years, and I still do not truly comprehend the impact these events have had on my life.

It took me a while after the death of my children to realize that I needed help and that asking for help was not a sign of weakness. I reached a point where if I had any hope of surviving these losses, I needed to learn how to surrender. That meant I had to allow myself to be transparent and vulnerable — two words I was not comfortable with and did not truly understand.

Because of my lack of familiarity with transparency and vulnerability, the first step for me was acknowledging that I couldn’t do it by myself. I needed help. I had always prided myself on “handing things” on my own.

I will never know the damage I caused myself by not surrendering and asking for help soon after the deaths of my children. I still remember the pep talks I would give myself: “Keep pushing. You’ll get through this.”

But I didn’t, not by myself or by “handling things” my way. The tried-and-true approach to life that I had been taught and was convinced worked “if you only fought hard enough” no longer worked for me.

After 18 months of fighting, I finally threw in the towel and decided to seek help. It was the first time in my life I had considered going to a counselor, and it was only after a friend recommended it to me. I had no idea how a counselor could even help me, but I was finally willing to give it a try. I was desperate for the pain to subside, so I decided to stop fighting and surrender to the process of healing.

I learned many things through the process of working with a counselor. For one thing, I learned that I was dealing with more than just grief and depression. I was also dealing with posttraumatic stress disorder. I also learned that life is about more than just me and my needs. I started to see things from a different perspective and through a new lens. As I started to heal, I realized I had the ability to help others who had lost a child and were following in my footsteps.

I decided to make helping others through the death of a child one of my life missions. It gave me a purpose to pull others along in the aftermath of burying a child. I felt like I knew the way out, and it was my responsibility to go back and help other men find their way out as well.

I decided to do this by writing a book called Grieving Dads: To the Brink and Back. I also decided I would be an advocate and fight for other grieving families when I could. One of the first opportunities I had to do this was in 2011 when I met fellow grieving dad Barry Kluger. After several conversations, we realized there was something wrong with the three to five days of bereavement leave granted to most employees after losing a child. We both agreed that parents who bury a child need more time to comprehend what has happened to them and to their child. These parents’ lives are forever changed, and they need adequate time to start the very difficult path of surviving the loss of a child.

From these conversations, the idea for the Sarah Grace-Farley-Kluger Act (also known as the Parental Bereavement Act of 2017) was conceived. This legislation proposes a change to the Family Medical Leave Act of 1993 and would allow bereaved parents to take up to 12 weeks of unpaid time off after the death of their child without fear of losing their job.

Those of us who have lost a child understand that 12 weeks will not erase the pain that accompanies this loss. But we do believe that it allows bereaved parents the time to start the grieving process and seek the help they need to survive this nightmare.

Our mission is driven by our desire to provide compassion to others in their most vulnerable moments. We understand that we cannot do this on our own. We need help to get this commonsense legislation passed. We invite you to join us in our mission by contacting your representatives and senators and encouraging them to support this legislation. Together as one voice, we will get this done.

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To support the need for a Parental Bereavement Leave Act as a way of extending coverage and existing benefits allowed by the Family Medical Leave Act, visit FarleyKluger.com.

See the full text of the bill:

House bill: H.R.1560: congress.gov/bill/115th-congress/house-bill/1560/related-bills

Senate bill S.528: congress.gov/bill/115th-congress/senate-bill/528

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Kelly D. Farley is the author of Grieving Dads: To the Brink and Back. Visit grievingdads.com to learn more.

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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.