Monthly Archives: August 2018

From the CEO: ACA: Still a home for professional school counselors

Richard Yep August 31, 2018

Richard Yep, ACA CEO

One of our longtime employees at the American Counseling Association recently reflected that we talk about team, but his perception was that ACA is really about family. He said that people can leave a team, or be asked to leave, but they are still part of the ACA family. That is our culture. I see it here on staff as well as in the relationships, networking and support that many of you provide to one another.

This brings me to an action that the ACA Governing Council took earlier this year when it mutually agreed with the American School Counselor Association (ASCA) that both groups should be recognized as two independent organizations (up until that time, ASCA had been a division of ACA). The board referred to this as a “new collaborative relationship,” and we continue to work with ASCA on issues of common concern. The decision was made after a number of years in which ASCA had been building its own set of resources, had its own staff and was no longer located in the ACA headquarters. The decision simply codified what had been happening for more than 15 years.

The decision by our board was a move based on efficiency and organizational structure. In no way did it have to do with a philosophical or professional “break” with school counselors. In fact, ACA continues to be a home for professional school counselors and school counselor educators. Among school counselors who identify as mental health professionals working in school settings, their home is clearly in ACA, just as it has been since the organization’s founding in 1952.

After the decision was made to recognize ASCA as an independent organization, Gerard Lawson, then the president of ACA, created a School Counselor Advisory Group composed mainly of practicing school counselors who work with K-12 students, but also a cadre of those who prepare graduate students to work in school settings. This advisory group, co-chaired by Kat Coy, a Tennessee school counselor, and Eli Zambrano, a counselor educator at the University of Texas at San Antonio, worked diligently to provide the Governing Council with a set of recommendations that was presented at the board meeting this past July.

The board was very clear that it wanted the ACA staff to begin working to ensure that school counselors who are current members of ACA know that their home is still with us. The board also wants us to look at the best ways to attract and recruit other school counselors who might realize that their best professional alignment is with ACA.

I am pleased to report that the ACA staff is working on a number of items that the advisory committee and the Governing Council discussed. We will continue to roll out resources and information throughout the coming year. We want to ensure that professional school counselors whose identities include being a mental health professional working in a school setting understand that ACA will continue to advocate on their behalf at the local, state and national levels.

We realize that professional school counselors have very different schedules than do our members who work as counselor educators or in private practice. Our goal is to ensure that what we develop for our school counselor members meets their professional needs and is done within the framework of their work and schedules.

Professional school counselors are not, and should not be considered as, ancillary to the life of a school. Rather, given what we have witnessed in this country over the past several years, I think it is safe to say that professional school counselors are key players in the lives of their students. From addressing social-emotional issues with students and helping them to achieve academic and career success to understanding the benefits of being able to work with diverse groups of people, school counselors make the communities in which they work better and safer places.

ACA continues to support professional school counselors. In addition, we reiterate our commitment to advocate on behalf of these important individuals in the social and public policy arenas. If you are a professional school counselor or school counselor educator, I hope you will share your thoughts and ideas with me concerning how ACA can do an even better job in these endeavors.

As always, I look forward to your comments, questions and thoughts. Feel free to call me at 800-347-6647 ext. 231 or to email me at ryep@counseling.org. You can also follow me on Twitter:
@Richyep.

Be well.

From the president: Play: A critical modality

Simone Lambert

Simone Lambert, ACA’s 67th president

The smell of a new box of crayons. The feel of a fresh can of Play-Doh. The sight of little miniatures neatly arranged in a sandbox. The sound of a puppet scene being acted out. These sensory experiences remind many of us of our childhood play with friends and family.

When play therapy, the topic of this month’s Counseling Today cover story, is described in the public, play is often the emphasized word and therapy the overlooked word. However, I remember from conducting play therapy that children frequently tasted the salty tears running down their cheeks as they diligently worked through life challenges in our counseling sessions.

We, as professional counselors in schools and communities, know that play is a critical modality in working with youth. Very young children do not have the vocabulary and command of language to accurately express their emotions through traditional “talk” therapy; thus, they rely on their natural language of play to express their thoughts and feelings. Many adolescents, adults and older adults also struggle to articulate themselves through the spoken word. Creativity in counseling can be used throughout the life span and across settings. In addition to play therapy, clients may engage in therapeutic work using mediums such as art, music and journaling.

With the start of the school year, professional counselors are reminded to advocate for youth and families in our communities who strive to maintain wellness in the midst of such challenges as physical and mental illness, trauma and addiction. Children may not be able to verbally describe their feelings of depression or anxiety. At a time when clients are going through their darkest days, they need access to mental health care, including play therapy in their schools and communities.

We need to advocate for children to have a voice through play therapy. Sometimes, children are told not to talk about the abuse they have endured or told to keep other secrets, purportedly to prevent harm to loved ones. They are instructed not to be disrespectful to adults, including school personnel, doctors, neighbors, family members and community leaders. Because of messages to be compliant and follow the directions of adults, children are vulnerable. Because of bullying, natural disasters, and mass violence in schools and communities, children are vulnerable. Because we are professional counselors, we must advocate for appropriate counseling services for these children.

We need to advocate for children and families to have affordable access to counseling services in the community. We know that early intervention makes a difference and that prevention can break the intergenerational cycle of abuse, mental illness and addiction. When clients arrive at our offices, we need to ensure that we are implementing evidence-based strategies in a culturally sensitive, developmentally appropriate manner. By becoming proficient in play therapy or knowing counselors in the community who are play therapy experts (and to whom we can refer clients), professional counselors can assist children who would benefit from this counseling modality. It can help them to address struggles in their daily functioning that have been brought on by a life transition, a traumatic event, a difficult relationship or a physiological issue.

We also need to advocate for realistic student-to-school counselor ratios. In my previous role as a supervisor of school counselors, an intern said that she originally had thought that big kids had big problems and little kids had little problems. Once she completed her internship at an elementary school, however, she realized that little kids do indeed deal with big problems and that they often are disempowered to make changes in their lives at school or at home. Play therapy is a way to advocate for and assist youth with academic and psychosocial functioning.

To close this column, I’ll draw counselors’ attention to three resources that can help them in both their practice and advocacy efforts with children and adolescents:

The American Counseling Association’s Center for Policy, Practice and Research provides a variety of advocacy and practice resources for working with children and adolescents at the Your School Counselor Connection webpage: counseling.org/knowledge-center/school-counselor.
ACA divisions such as the Association for Child and Adolescent Counseling and the Association for Creativity in Counseling offer additional professional resources. Find out more about ACA divisions at counseling.org/about-us/divisions-regions-and-branches.
Counselors can engage in legislative advocacy on behalf of clients and communities by downloading the new and easy-to-use VoterVoice app, available in the Apple App Store or from Google Play. Alternatively, use the ACA Government Affairs Take Action page (counseling.org/government-affairs/actioncenter), which is also powered by VoterVoice.

Talking about #MeToo

By Laurie Meyers

In 2006, activist Tarana Burke founded the “me too” movement — a grassroots campaign to help survivors of sexual violence, particularly young women of color from low-wealth communities. Over time, the movement with a simple message — you are not alone — built a community of survivors from all walks of life.

In fall 2017, in the wake of allegations of sexual assault and harassment by film producer and entertainment mogul Harvey Weinstein and other powerful men, “me too” went viral — and global — with a single hashtag. Social media feeds were suddenly flooded with #MeToo, sometimes accompanied by personal stories or alternately issued as a statement in itself.

In the year that has followed this mass call for awareness, stories of sexual harassment and assault have continued to come to light. The discussions about how to achieve safety and equality show no signs of flagging. Some of these conversations are happening in counseling practices as counselors help clients process their own #MeToo stories.

For licensed professional counselor (LPC) Sarah Kate Valatka, a private practitioner in Blacksburg, Virginia, the most striking element of #MeToo has been the sense of community — albeit an unchosen one — the movement has created for survivors. That feeling of community not only helps clients feel less isolated but also engenders hope as they see other survivors navigating their own trauma, says Valatka, an American Counseling Association member whose practice specialties include addressing gender-based violence.

Other counselors say the movement is encouraging women who previously chose to remain silent about their experiences to seek help. “I absolutely believe this has empowered more women to come forward,” says Brooke Bagley, an LPC at the Sexual Assault Center of East Tennessee in Knoxville. “I have heard the narrative repeatedly — that many have been scared, isolated or unsure of the legitimacy of their own traumas, and this movement has given these individuals a voice.”

Indeed, Bagley says although the practice where she works has not seen a substantial increase in new clients, a number of people who had not previously thought of themselves as survivors have come in looking for help to process their experiences.

Charity Hagains, a licensed professional counselor supervisor who specializes in sexual trauma, says she and other counselors at the Noyau Wellness Center in Dallas have seen many new clients seeking help not for assault but for experiences they are just now realizing had crossed the line into sexual harassment. Hagains says she has commonly heard statements from clients such as, “It never occurred to me that this [behavior] wasn’t OK. Every boss I have ever had commented on my body.”

Hagains says the #MeToo movement has also caused many adult women to reconsider their younger experiences. Typical incidents these women have shared in session with Hagains include being pressured to show their bodies in a chatroom when they were preteens or being coerced into having sex as teenagers. At the time, they didn’t consider it coercion because they thought they were old enough to consent or had been drinking and thus excused the other person’s actions.

“It always made me feel awful,” clients have told Hagains. “I was ashamed, but I didn’t realize that it was something that other people would see as not my fault.”

Conversations such as these — both inside and outside of counselors’ offices — are long overdue, asserts Laura Morse, an LPC who specializes in relationship and sexual issues, including assault and trauma. Telling these stories has served to highlight how often sexual assault occurs, but clients are grappling with what comes next, she says.

“So much of the counseling journey with sexual assault survivors is figuring out the ‘and’ after identifying with #MeToo,” says Morse, a private practitioner in Lancaster, Pennsylvania. “Empowering individuals after assault to write their narrative, decide their legal choices and how or if they want to share their story, that’s the part of the conversation that #MeToo leaves us grappling with as a community.”

Moving on from #MeToo

The journey to healing from sexual trauma often begins with defining what has happened to the client, Bagley says. Using psychoeducation, she talks to clients about what constitutes sexual assault or harassment. She also explains common reactions and responses to sexual trauma. Once clients have a better understanding of what they have experienced, Bagley says she can delve into how their trauma is manifesting and work toward the management of symptoms.

Shame and guilt often accompany sexual assault and can be difficult to move past, says Trish McCoy Kessler, an LPC and owner of Empower Counseling, a practice in Lynchburg, Virginia, that focuses on the needs of women and girls. She starts by normalizing what clients are feeling and emphasizing that the sexual violence or harassment they have experienced is not their fault.

Kessler, a member of ACA, uses cognitive behavior therapy to help clients note when they experience a negative emotion and identify the thoughts that are evoking that feeling. She then challenges those thoughts, asking clients to consider whether any evidence exists to support their negative self-talk. Simply instilling hope in clients that their feelings of shame and guilt will lessen over time can help reduce their anxiety and stress, Kessler adds.

Kessler also focuses on coping skills with clients, she says, because many people who have experienced trauma use maladaptive coping skills such as substance abuse and emotional eating. Kessler teaches clients to instead use positive skills such as meditation, reaching out to friends (to avoid isolation), listening to music and writing or journaling. She has found it especially helpful to suggest that clients (and particularly teen clients) keep a list of effective coping skills on their phones to refer to when they are feeling overwhelmed. Kessler also emphasizes the importance of self-care, including getting adequate sleep, getting the proper nutrition and engaging in regular exercise.

Hagains notes that many of her clients lack compassion for themselves. She encourages them to identify as survivors rather than victims and attempts to teach self-compassion by holding a mirror up to the compassion that her clients show to others. For example, Hagains asks clients to consider what they would say to a friend going through the same experiences. “It’s usually not something like, ‘You’re awful,’” she notes wryly. “If you would give your friend a hug, give yourself a hug,” she urges.

Hagains also asks clients to identify the shame statements that they tell themselves. Then she helps them create positive, affirming messages to replace the negative self-talk.

Over time, Bagley has created a five-phase model that she uses for clients who have experienced sexual trauma. In the first phase, she assesses and identifies the client’s level of trauma through a symptom-based checklist. She then explores the emotional, cognitive, physiological and behavioral responses the client is experiencing.

Phase 2 focuses on building rapport and establishing the therapeutic relationship. Because clients who have experienced trauma are very vulnerable, it is imperative to provide a nurturing and safe environment, Bagley emphasizes. Once she has established a bond with the client and a sense of safety, Bagley focuses on the person’s present strengths and explores how the client can use those strengths to cope with the trauma.

Bagley begins cognitive-based interventions in Phase 3. Together, she and the client identify thought distortions attached to the trauma and start practicing ways of reframing negative beliefs.

In the fourth phase, Bagley focuses on identifying specific emotions. She teaches clients to practice mindfulness by noting where on their bodies they feel certain emotions and what is happening around them when they experience these feelings. Bagley says this helps clients identify triggers and also aids in bridging the mind-body disconnect that can occur with recent sexual trauma.

In the fifth and final phase, clients build a narrative surrounding their trauma. “At this stage in the therapeutic process, clients should be displaying more stability and management of symptoms,” Bagley says. “This is often apparent through changes in the language clients use to describe their trauma experience, as well as a shift in self-view.”

At this point, Bagley has clients retell their trauma to desensitize their trauma response and to empower them to feel more in control of their story.

It takes a village

Morse often works with other professionals, including law enforcement, to help survivors of sexual violence. She tells clients there are different paths they can take as part of their treatment and asks them what makes sense or seems helpful to them. Some clients are empowered by learning about their legal rights, and the possibility of pursuing justice gives them a sense of agency. For other survivors, gaining strategies to manage anxiety is critical to their daily functioning, Morse says.

When clients choose to seek justice through the legal system, Morse offers to go to the police station with them and sit in on a meeting with detectives. Beforehand, she prepares clients by explaining that they will be asked numerous questions about what happened to them. She also educates them about how lengthy the legal process can be and the emotional toll it may take.

Many of Morse’s clients have experienced harassment at work, and in these cases, they often choose to file a complaint through their employer’s human resources department. To prepare these clients, Morse goes through their employee handbook so they fully understand the company’s harassment policies.

Morse also strives to help survivors of sexual violence feel safe again, which often requires connecting them with outside resources. She frequently recommends self-defense classes, noting that in many cities, there are now free classes offered for survivors of assault. In some cases, reestablishing a client’s sense of safety may require a change in phone number or residence.

For those who struggle with overwhelming anxiety, Morse is a big proponent of eye movement desensitization and reprocessing (EMDR), and she refers these clients to a certified EMDR practitioner. If anxiety and depression are impeding her clients’ daily functioning, she has them meet with a psychiatrist to explore the need for short-term medication management of symptoms.

Morse says group therapy can also be a crucial therapeutic tool because it provides a way for survivors to share their stories with others who have experienced sexual trauma. Many community agencies and YWCAs offer free groups, she notes.

Morse also emphasizes the power of just being there for clients. “Many survivors of assault reflect that the most helpful part of the therapeutic process is simply having someone to listen and believe them on their journey,” she says. “Oftentimes, we’ll spend several sessions talking through the details and allowing a woman to rewrite her narrative as an assault survivor.”

When #MeToo is painful

Although counselors generally say that the #MeToo movement is socially necessary and can be personally empowering, they also note that for some survivors, the constant reminders of sexual trauma can have an unintended adverse effect.

“The movement can often feel like a double-edged sword in terms of awareness for survivors,” Bagley says. Although many survivors are grateful that the truth of the widespread nature of sexual violence is being made evident, the sheer volume of stories can be overwhelming. “It floods social media, news outlets [and] radio programs, leaving little escape for survivors,” Bagley explains. “Additionally, the backlash and negative media response to the movement has … a triggering and negative impact.”

Valatka agrees. “You [a survivor] may be on social media, and it’s just a normal day. Then someone shares, and it’s bringing it into your day — bringing it to survivors when they weren’t planning for it.”

Shaina Ali, an LPC and owner of Integrated Counseling Solutions in Orlando, Florida, says that when clients who are survivors of sexual assault or harassment bring up #MeToo, she uses an existential approach. “How does this affect your story? What does this mean for you?” Ali asks clients.

Her intent is to help clients focus on how hearing these stories affects their progress. In some cases, clients realize that they have handled potentially retraumatizing information better than they thought they might, says Ali, who specializes in trauma work. For others, their reactions are an indication that they have more trauma work to do. Ali notes that some of her clients who had come to her for issues unrelated to trauma realized that the #MeToo stories mirrored their own experiences — experiences they previously hadn’t recognized they needed to talk about.

Because #MeToo and other news stories related to mental health — such as the recent suicides of Kate Spade and Anthony Bourdain — can potentially have an effect on any client, Ali always raises such topics in session. She says this serves two purposes: to check in and head off trouble before it starts and to give clients an opportunity to bring up experiences they haven’t previously been ready to share.

Sometimes the triggering comes from the casual conversation of people clients are close to, Hagains points out. As people talk about #MeToo, sexual assault and harassment survivors hear a lot of opinions being shared, some of which are full of blame. It is not uncommon to hear people say things such as, “Well, she went to his apartment, so she deserved it,” Hagains notes.

Hagains tells clients that in these cases, they need to set boundaries by telling friends or family members that they do not wish to discuss the topic and that they will have to agree to disagree. In certain cases, such as with casual Facebook friends, Hagains urges clients to decide how important it is for them to stay in contact. It may be in a client’s best interests to mute those who are making hurtful statements. Sometimes setting boundaries means limiting contact; other times it may become necessary to cease contact altogether.

What are men learning?

The larger goal of #MeToo is to change the way that men and society as a whole see — and treat — women. Is it working?

Hagains says the topic is definitely coming up in sessions with male clients. She says that about 90 percent of the men she counsels have asked her about behavior — as in what is OK and what isn’t.

“I think a lot of men are reexamining their roles,” she says. Many of them are realizing that what they thought was appropriate or complimentary to women can actually be offensive.

A familiar refrain that Hagains hears in session from male clients who are grappling with the implications of #MeToo: “I thought women liked to be complimented on their bodies.” She responds by telling them that it might be OK to say in a bar but definitely not at work.

Ali, an adjunct professor at both Central Florida University and the Chicago School of Psychology, has also heard increased discussion from men about the topic of sexual assault and harassment, both in her practice and in the classroom. Ali teaches clients and students about harassment, setting boundaries and establishing healthy relationships.

“The way I see it,” says Kessler, “is that #MeToo is not just for women. I want men to see, this is how you treat women.”

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Additional resources

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

Counseling Today (ct.counseling.org)

“Effective ways to approach sexual assault response” by Hasmik Chakaryan
“Counseling survivors of sexual assault” by Brooke Bagley and Joel Diambra
“After an assault” by Margaret Edwards and Charlotte Chapman
“Going beyond ‘no means no’” by Laurie Meyers
“Informed by trauma” by Laurie Meyers

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

“Adult Child Sexual Abuse Survivors” by Rachel M. Hoffman and Chelsey Zoldan
“Intimate Partner Violence — Treating Victims” by Christine E. Murray

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

Letters to the editor: ct@counseling.org

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

Left to their own devices

By Lindsey Phillips August 29, 2018

Want to hear a joke about a piece of paper? Never mind, it’s tearable. They may make you chuckle (or, alternatively, roll your eyes and groan), but there’s little denying that “dad jokes” such as this one help to perpetuate the stereotype of fathers as inept, ridiculous and out of touch.

Of course, fathers have heard it all: Is dad babysitting? Does he know which end the diaper goes on? Oh, he’s like the mom. He’s Mr. Mom!

That caricature might have been humorous in 1983, when Mr. Mom hit movie theaters, with Michael Keaton portraying a laid-off engineer who suddenly finds himself contending, cluelessly, with the demands of being a stay-at-home dad. But three decades later, the idea of men being present and involved fathers is no longer novel — or something to be ridiculed.

“Men hate being called Mr. Mom,” asserts Matt Englar-Carlson, a professor of counseling and director of the Center for Boys and Men at California State University, Fullerton. “[That role] is being put upon them by someone else, and they’re saying, ‘That is not my experience. I’m not a bumbling idiot.’”

According to the 2015 Pew Research Center report “Parenting in America,” mothers (58 percent) and fathers (57 percent) are equally likely to consider parenting to be important to their overall identity. Of course, the concept of fathering is constantly changing, especially considering the rise of women as financial providers, co-parenting, the diversity of fathers (e.g., gay fathers, older fathers) and changes in technology that allow more people to work from home rather than commuting to an office every day. Although people often focus on the negative effects of these changes, Englar-Carlson, an American Counseling Association member and co-editor of the 2014 ACA book A Counselor’s Guide to Working With Men, points out that they have also generated some favorable circumstances. “The changing of women’s roles [in the workplace] and the rise of co-parenting has created opportunities for men,” who now have the chance to be more present fathers, he explains.

And present fathers positively affect children in three key ways, notes Mark Kiselica, the acting provost and vice president for academic affairs and a professor of psychology at Cabrini University. First, by engaging in active play, such as throwing a ball, fathers promote their children’s physical development. Second, as role models, moral guides and disciplinarians, fathers help children become dependable, autonomous and friendly. Finally, fathers help their children’s cognitive stimulation, especially because current generations of fathers are more likely to be intimately involved in their children’s academic work and in promoting their achievement.

Despite the changing expectations and roles for fathers, men often struggle to update their own expectations around parenting, Englar-Carlson points out. Often, men are facing these challenges alone because resources on good fathering are scarce.

For that reason, counselors should be careful not to overlook the mental health of men who are struggling with one aspect or another of fatherhood. Instead, counselors can serve as a key asset in helping men learn to embrace and reframe their roles as fathers and helping them realize that they are not alone, says Englar-Carlson, one of the core authors of the forthcoming psychological practice guidelines for working with boys and men from the American Psychological Association.

Making fatherhood part of the conversation

Men often avoid seeking help, and even when they do go to counseling, they may mask the real reason they are there, says Eric Davis, an assistant professor in the Department of Leadership, Counseling, Adult, Career and Higher Education at the University of South Florida.

Kiselica, a licensed professional counselor and former president of American Psychological Association Division 51: Society for the Psychological Study of Men and Masculinities, agrees. Gendered thinking that men should be self-reliant, tough and not vulnerable may cause men not to pursue help, he adds.

Nathaniel Wagner, an assistant professor of counseling at Indiana State University, finds that men often seek counseling because of someone or something else such as their partner, their spouse or their employer. Counselors must help these clients understand that they have something to work on and get them motivated to want to make a change and improve their lives, he adds.

But how can counselors engage fathers who may be reluctant to seek help? First, counselors must clear their heads of the notion that all men don’t desire help, Englar-Carlson advises. Instead, counselors need to be proactive. When the client is a parent or an expectant father, counselors should start a conversation about fatherhood, mentioning resources and potential groups to see if the client is interested, Englar-Carlson says.

Counselors should also be aware of signs that fathers are struggling. Davis recommends listening for fathers or expectant fathers who mention feeling alone, isolated or disconnected. Counselors may also notice substance abuse issues or aggression, he adds.

Men often feel a strong cultural or societal expectation to provide for their families. As a result, counseling programs focused on helping fathers with jobs and their sense of duty as a provider may serve as a gateway to addressing other issues in their lives such as relationship problems or substance abuse, Kiselica says.

Assessment questions are a great way to discover what masculinity means to individual fathers, Englar-Carlson says, but he advises against asking blanket questions such as “What does it mean to be a man?” Instead, counselors might ask father-specific questions such as:

What does being a father and fathering mean to you?
How did you learn to be a father?
Who is the father you would like to be?
What do you do well as a father?
What special characteristics do you have that you can bring to your role as a father?

Men often think about these questions, but they don’t talk about them, Englar-Carlson observes. Asking such questions “puts fathering into the conversation. … It puts being a father as an identity in the room that we can explore,” he says.

Counselors should also be prepared to delve deeper if fathers provide stock answers. Englar-Carlson often finds that when he asks men about their parenting experiences, they respond with, “It’s great.” So, he pushes back and asks, “Is it all great?”

“Parents … [and] men are encouraged to be careful of what [they] say. Parenthood is presented as this amazing thing that’s so wonderful, but it isn’t always wonderful,” Englar-Carlson says. “And I think men have a difficult time talking about that because they don’t want to appear selfish [or] they don’t want to appear unsupportive.” By pushing back, counselors can encourage fathers to move beyond the general comments that they think they should give, providing them with a space to talk about their full range of parenting experiences, he says.

Wagner, a licensed mental health counselor in Indiana and Florida, says that he finds genograms and sociograms useful in uncovering fathers’ stories and overall family dynamics.

Using father-friendly language

When engaging fathers in these conversations, counselors need to be thoughtful and conscious of the language they are using.

Kiselica, an ACA member and editor of the Routledge book series on Counseling and Psychotherapy With Boys and Men, recommends appealing to men’s desire to work hard by using subtle phrases such as “let’s get to work on this” or even “let’s roll up our sleeves” (at which point he will literally roll up his sleeves).

He also suggests appealing to fathers’ sense of duty and responsibility by saying, “It takes a lot of guts to get help” or “You’re being brave in seeking counseling.” These statements symbolically send a message and ease fathers into a positive direction, he says.

Counselors can also use metaphors or examples from the client’s life as a way to connect with the client and find a common language, Wagner says. For example, if a client works in construction or talks about sports a lot, Wagner will use similar language in session. He also recommends using humor to engage fathers because men often find value in humor.

Because men are often goal-oriented when approaching problems, using a problem-solving mentality and step-oriented approach is helpful with some fathers, Davis says. Counselors can connect the client’s current situation to a personal example in which the client relied on his strengths to solve a problem, he suggests. For example, counselors might ask clients how building a swing set is similar to building a father’s support group, or they could ask how the client handled managing people at work and how those skills could apply to his current situation as a father.

Wagner agrees that being direct and open about the counseling process — which involves explaining what you’re doing as a counselor and why you’re doing it — is beneficial. If counselors discuss emotions, they need to explain to fathers why they are doing that and how it connects to a larger goal, he says. “Fathers and [men] typically focus more on fixing things, and they want to know that what we’re doing has a purpose and that we’re trying to find ways to fix and help them through this process. Having a goal and a plan and sharing that [information] can often be very helpful,” Wagner explains.

At the same time, emotional language can be difficult for some fathers. “When [counselors] do start talking to men about emotions, a self-disclosure can be really helpful,” Wagner suggests. For example, if the client had a negative experience with his father, then the counselor could say, “When I was a child, my dad was stoic and distant, so it was hard to know if I was loved by him.”

Using emotion words in a way that connects with clients may help them express their own emotions, Wagner explains. “You’re not asking them to talk about their emotions. You’re sharing it and showing that it’s OK to talk about [these emotions], and … that can be really helpful.”

Reconceptualizing fatherhood and masculinity

Englar-Carlson acknowledges that parents are typically defined in binary terms — mother or father. This causes people not only to compare the roles but also to overlook the unique and diverse experiences of fathers. “As counselors, we just have to constantly stretch how we think about this notion of parent and father,” he argues.

Reconceptualizing fatherhood raises some important questions: How can counselors help clients reframe their view of fatherhood in a positive light? What does healthy or positive masculinity look like? Englar-Carlson doesn’t think that people in the helping professions often sit around and contemplate questions such as these, but he believes that they should.

Wagner says counselors need to reflect on their own beliefs and biases about fatherhood to work effectively with clients. Counseling is more often geared toward women, so counselors have to reconceptualize how they think about fathers’ experiences and their roles, Wagner advises.

“If we go into a session and we try to focus immediately on emotions and feelings and these things that men often find very scary, then we’re likely to get very early termination and fathers and men shutting down and leaving,” Wagner explains. “So, it’s us really being very patient, being very slow [and] building that relationship where fathers and men experience safety.”

Counselors can also use strength-based approaches, which will help counselors to develop empathy, establish rapport and use fathers’ strengths more effectively. “There are great strengths that men bring to the way they approach things, and if we search and build upon those strengths, we’re likely to be successful,” explains Kiselica, who served as a consulting scholar for the federal fatherhood initiatives of the Bill Clinton, George W. Bush and Barack Obama administrations.

“I focus on the aspects of positive masculinity that I see in the man, which helps me build rapport with [him],” Kiselica says. For example, he will notice and affirm positive aspects of traits such as perseverance, hard word and caring for one’s family. By taking this approach, counselors will often gain fathers’ trust with other issues such as violence and aggression, he adds.

Kiselica also stresses the importance of using culturally salient language and promoting the more desirable form of masculinity. For example, counselors working with Latino fathers might emphasize the cultural term caballerismo (a positive image of a nurturing and caring man) rather than the term machismo (a strong sense of masculine pride) to help clients focus on the positive strengths of being a man who cares and respects his family.

Englar-Carlson agrees with using a strength-based approach. “A lot of the research that exists on the psychology of men is really looking at the places where men go wrong, or what I might call the dark side of masculinity,” he explains. Masculinity has been defined “in terms of conflicts or contradictions or things that men are not supposed to do — don’t feel, don’t ask for help, don’t do this — and we have a harder time looking at what men are supposed to do.”

Fathers come in to counseling already fully aware of what is not going right, Englar-Carlson argues. In fact, because men frequently internalize their experiences, their core emotion is often shame, he says. Because of this, male clients will typically feel shame for not being good enough or even for being in counseling. As a result, Englar-Carlson advises counselors not to start sessions by asking fathers about all the things that have gone wrong in their lives. He says this will result only in sad or resistant clients.

“Men are more interested in initially talking about where they would like to be. This is a term often known as possible masculinity,” Englar-Carlson explains. Counselors working with these clients might consider asking questions such as “Who is the father you’d like to be, and what does that look like?” Then, counselors can help fathers figure out how to achieve that goal.

Working with stay-at-home dads

According to the Pew Research Center, the number of fathers who stayed at home with their children nearly doubled from 1.1 million in 1989 to 2 million in 2012. In addition, 21 percent reported caring for their home or family as the reason for staying home, a fourfold increase from 1989 when only 5 percent cited this as the reason.

Although the number of stay-at-home dads has risen, the negative stereotypes and bias surrounding the choice have not gone away. In a 2013 Pew Research Center survey, 51 percent of respondents thought children were better off with mothers who stayed at home and didn’t hold a job, whereas only 8 percent felt the same way about fathers.

Davis, who has presented on stay-at-home dads at the ACA Conference, finds the pervasive bias against these fathers to be problematic. He conducted a research study with 14 stay-at-home dads, and almost everyone mentioned having a negative experience, such as being the recipient of a nasty look or comment in public. One participant in the study mentioned that his father-in-law had expressed disappointment in his decision to stay at home because he was letting his wife provide for the family.

In addition, people often assume that stay-at-home dads are unemployable or lazy or that they have a disability, Davis continues. Such negative experiences can lead these men toward isolation, depression or even substance abuse, he warns.

Despite these challenges, many stay-at-home dads are happy being the primary caregiver. In Davis’ study, participants described the positive aspects of being at home, such as building a stronger relationship with their children and watching their children’s cognitive, physical and emotional growth.

Having a father at home is also beneficial and positive for the children, Davis asserts. “It’s almost unanimous that dads [and children] are having wonderful experiences. … We’re seeing stronger academics for these kids with [stay-at-home dads]. We’re seeing stronger social development. We’re seeing stronger personal development. We’re seeing stronger family bonds,” he says.

Davis argues that it is not poor quality of life, but rather negative stereotypes, the lack of communication between fathers and other outlets, and the relative lack of support that these fathers receive that cause problems for stay-at-home dads.

Davis suggests that counselors connect these clients with resources such as the National At-Home Dad Network to help them build support and community. In particular, he thinks school counselors are well-positioned to help identify and provide community resources for stay-at-home dads.

Counselors should also ask why men became stay-at-home dads. Making the decision consciously is more empowering than making the choice out of necessity because of unemployment, the cost of day care or other similar reasons that are more shame based, Englar-Carlson points out. The good news, he argues, is that there is no reason why men can’t move toward a more empowering mindset and embrace their position as stay-at-home dads.

Counselors can use a strength-based perspective to help clients find the positives of being a stay-at-home dad and restructure their thinking about it, Davis says. If a stay-at-home dad experiences a snarky comment at the park or a sense of isolation because other parents at school won’t talk to him, counselors need to ask what his desired outcome would be, Davis suggests. How does the client want to address or change this negative experience? Does he want to ignore it and walk away or challenge people’s biases? To help clients discover this answer, counselors can engage in conflict-resolution or role-playing exercises with these fathers, which will assist them in adjusting their perceptions and reactions to these situations, he says.

When fathers are resistant to staying at home and are doing it only out of necessity, counselors may see these clients struggling with anger, aggression and animosity toward their children and partners, Davis says. In such cases, counselors should be on the lookout for any potential issues of abuse. Counselors can also help these fathers identify and process their emotions of guilt, remorse or anger and adjust their perspective to see staying at home with their children not as a negative experience but as a growth-fostering opportunity, he says.

“Counselors can also look at [working with these clients] through a lens of grief counseling,” Davis suggests, “because you’re talking about a loss for some of these dads. This is a loss of a breadwinning role. This is a loss of a socially accepted role. … How do [counselors] help them process that loss and move on?”

Grieving miscarriage

People sometimes think that men don’t grieve over miscarriage because they are physically removed from the experience of pregnancy. This bias may result in men not receiving the help or support they need to process a miscarriage.

“Men experience emotions at the same level as women, in general, but often have difficulty expressing it,” points out Wagner, an ACA member who presented on men grieving miscarriage at both the 2017 and 2018 ACA conferences. With miscarriage, men may hold in their grief or try to find other outlets, he continues. For example, they may stay busy with work to hide or avoid their feelings, or they may lash out at others.

After counselors learn that a male client has experienced a miscarriage, they can normalize the client’s feelings by introducing the topic, Wagner suggests. Counselors can mention how many men who have experienced miscarriage question their masculinity because it is connected to the idea of being a father and then ask if this feeling resonates with the client, he says.

Once again, counselors can use clients’ strengths, such as a desire to be strong for their partners, as a means of getting them to express emotion. In a 2010 article for Psychotherapy: Theory, Research, Practice, Training, Kiselica and Martha Rinehart, a staff therapist for Council for Relationships in Oxford Valley, Pennsylvania, described the successful use of positive psychology with a Latino client who experienced a miscarriage during the 16th week of his girlfriend’s pregnancy while he was incarcerated in a state prison. Because the client held traditional beliefs about masculinity and was in an environment that further reinforced those beliefs, he hid all emotions expect for anger and grieved alone in his cell at night. As with other men grieving a miscarriage, his focus was not on himself but on staying strong and supporting his partner. Initially, Kiselica praised the client for sparing his girlfriend from worrying about his pain, but, eventually, Kiselica used this strength of wanting to support his girlfriend to convince the client to share his own grief and experience with her. This also allowed him to process and manage his feelings about the miscarriage.

Englar-Carlson, who has personally experienced the grief of miscarriage, realized that if he didn’t start talking about it, no one would ever know, so he reached out to his male friends who were supportive. From counseling strategies with women grieving miscarriage, counselors know the importance of talking about it, he says. “If not, it becomes an unacknowledged loss. And for men, it’s a similar kind of thing. There can be this unacknowledged loss that happens. Men are taught to pack that in, just stuff it inside, and just move on.”

With miscarriage, men “are grieving loss potential rather than a person,” Wagner observes. “It’s what this person could have been.” He recommends helping male clients find ways to connect and express what they wanted — this potential self — to what they do and how they express their grief. For example, if a man dreamed of throwing a ball around with his child, then the counselor might encourage him to coach a T-ball team, Wagner says.

Clients may also benefit from memorializing the child in some way, Wagner adds. He recounts a father who bought a cuff link and tie clip to use on the day of the birth. Instead, the father chose to wear them on the day the miscarriage happened. Afterward, he wore them on a monthly basis in remembrance.

Building supportive relationships

Regardless of whether men are stay-at-home dads, grieving a miscarriage or simply dealing with the everyday challenges of parenting, they often want to know that they are not alone. So, building relationships and finding support are key.

Kiselica argues that counseling services need to have an approach that is consistent with the way men form friendships. “One of the big mistakes counselors [make] is that they expect a guy … [to] come into [their] office at a set time, sit down face-to-face and spill [his] guts,” he says.

Men often form friendships by doing things together, such as playing sports, working on projects or playing video games, Kiselica says. Through the process of being active, they talk and discover what is happening in each other’s lives, he explains.

For that reason, Kiselica advises counselors to consider engaging in activities with clients who are fathers. This could involve shooting basketball, going for a walk, grabbing a bite to eat or helping a client work on his car. For example, counselors working with young fathers might start off with a quick meeting, do some type of recreational activity with the client, get something to eat and then sit down to talk more formally. Through this process, counselors stand a better chance of creating a relaxed, nurturing atmosphere that encourages fathers to open up and talk, Kiselica says.

“It is remarkable how … [struggling fathers are] bolstered by the support of other good men,” Kiselica says. Counselors can help connect these clients with other fathers, or at times they can even fulfill this supportive role themselves. Kiselica had a client who had a negative relationship with his own father, and when Kiselica made affirming messages about the client being a good father, he saw the man’s eyes turn red. The client was trying to keep from crying because he had never had another man compliment him in that way before.

It’s not surprising then that group work is one of the most effective treatment options for men, Englar-Carlson says. In groups, fathers are able to share their experiences and learn from the experiences of other fathers, he explains.

Davis has found that fathers often request some type of group work, whether it is a support group or participation in group activities. In groups, fathers can commonly share problems, gain insights, identify personal strengths and arrive at the realization that they aren’t alone, he says. School counselors could also consider providing after-school groups or other groups that allow fathers to connect with each other, he suggests.

Although many fathers find group work useful, others are hesitant to get involved because it feels like a place where they might be required to share their feelings, Wagner warns. For these men, group activities (such as a fishing trip) with others who have had similar experiences are often helpful because there is no built-in talking component, he notes.

Englar-Carlson also thinks that finding ways to build relationships with other men is critical. “Part of the antidote [to the ‘dark side’ of masculinity] is relational connection in some capacity, so it’s about helping men … develop a relationship with each other,” he says.

Fathering matters

For Englar-Carlson, the take-home message is simple: Fathering matters. People are not taught a lot about what it means to be a father, yet being a father is a wonderful experience that dramatically changes a man’s life, he notes.

The National At-Home Dad Network advocates to ensure that the message that fathers matter is heard. In 2013, the organization declared, “Mr. Mom is Dead,” and campaigned to banish the term. Shortly thereafter, Mr. Mom made Lake Superior State University’s list of banished words for 2014. So, change is coming slowly.

“If fathers are viewed on the periphery around the birth experience … their own wonderment and experience also remain on the periphery, and yet it’s often a time … in which they’re undergoing rapid psychological changes in terms of how they view themselves, how they view their role, [and] how they view the person they want to be [and] the father they want to become. Yet, sadly for so many men, this happens in isolation,” Englar-Carlson says. “As society changes and expectations change, then counseling and support services should also change to match those needs.”

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist living in Northern Virginia. Contact her at consulting@lindseynphillips.com or through her website at lindseynphillips.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.

Putting PTSD treatment on a faster track

By Bethany Bray August 27, 2018

An exposure-based therapy method has shown to reduce the symptoms of posttraumatic stress disorder (PTSD) in just five sessions, according to researchers.

Written exposure therapy (WET) consists of one 60-minute and four 40-minute sessions, during which clients are guided to write about a traumatic event they have experienced and the thoughts and feelings they associate with it. Researchers recently tested the method’s effectiveness alongside cognitive processing therapy (CPT), a more traditional talk therapy method that typically involves more than five sessions. Clinical trials were conducted at a U.S. Department of Veterans Affairs (VA) medical facility with adults who had a primary diagnosis of PTSD.

The researchers’ findings, published in JAMA Psychiatry this past spring, suggested that WET was just as effective as CPT in reducing PTSD symptoms.

“WET provides an alternative [treatment] that a trauma survivor might be more likely to consent to, especially if verbalizing the trauma narrative causes a sense of shame or guilt,” says Melinda Paige, an American Counseling Association member and assistant professor at Argosy University in Atlanta whose specialty area is trauma counseling. “The more evidence-based options the trauma counselor has to consider, the more options can be offered to the client. WET provides an option for written expression rather than verbal and a shorter length of treatment, which may be preferable to survivors, including [military] service members.”

“Effective trauma treatment is the antithesis of the traumatic event itself in that survivors experience person-centered core conditions such as congruence/genuineness, nonjudgement and empathic understanding, as well as a sense of control over their recovery experience,” adds Paige, a member of the Military and Government Counseling Association (MGCA), a division of ACA.

MGCA President Thomas Watson agrees that the addition of another method to a trauma counselor’s toolbox will only benefit clients. “Those involved with service delivery to service members and others diagnosed with PTSD are always enthusiastic about how applied, evidence-supported treatment approaches have the potential for effective and ethical positive change,” says Watson, an ACA member and assistant professor at Argosy University in Atlanta. “An obvious goal of the WET approach is to implement effective treatment options that are efficient for both client and clinician.”

The research study involved 126 male and female participants, some of whom were military veterans and others who were nonveterans. The participants were randomly sorted into two groups: those who received five sessions of WET and those who received 12 sessions of CPT.

“Although WET involves fewer sessions, it was noninferior to CPT in reducing symptoms of PTSD,” wrote the researchers. “The findings suggest that WET is an efficacious and efficient PTSD treatment that may reduce attrition and transcend previously observed barriers to PTSD treatment for both patients and providers.”

The researchers reported that the WET group had “significantly fewer” dropouts (four) than did the CPT group (25).

This factor is another reason for counselors to consider using WET, Paige notes. “Maintaining a survivor’s physical and emotional safety and doing no harm by utilizing evidence-based and minimally abreactive trauma reprocessing interventions is essential to trauma competency. Therefore, WET may be a less invasive and more tolerable exposure-based PTSD treatment option,” she explains.

At the same time, Benjamin V. Noah, an ACA member and past president of MGCA, was discouraged to see that the study excluded PTSD clients who were considered high risk. Individuals had to be stabilized by medication to be included in the clinical trials.

“Many of the veterans I have worked with dropped their medications [because] they do not like the side effects. Therefore, I believe the study overlooked veterans that may be higher risk,” Noah says. “Additionally, a high risk of suicide was an exclusion for being in the study. Again, this leaves out those veterans who need help the most and could benefit from a short-term approach.”

Noah, a licensed professional counselor in the Dallas area whose area of research is veteran mental health, has used written therapy methods in his own work with veteran clients and has found the methods helpful. A therapy session provides a safe and supportive environment for clients to write about traumatic experiences – particularly clients who may be trigged by the exercise when alone, he explains.

“I have had veterans triggered doing [writing] as homework; keeping the writing in session acts as a safety measure for the [client]. Helping veterans resolve their event or events — which I call the ‘nightmare’ — that led to PTSD has been a focus of my work since I was able to put my own nightmare to bed,” says Noah, a U.S. Air Force veteran and a part-time faculty member in the School of Counseling and Human Services at Capella University.

WET is one of many methods that should be considered by clinicians working with clients who have PTSD, Noah adds.

“I would like to see more research within the VA and National Institute of Mental Health on the use of Viktor Frankl’s logotherapy, solution-focused brief therapy, sand tray therapy and other approaches that counselors are using in their work with veterans,” Noah says. “There are articles focusing on other approaches, but these tend to be the experiences of a few counselors and do not have the research rigor used by [the WET study researchers]. I do applaud the authors for showing the efficacy of a brief therapy approach for use with veterans, and I do plan to look deeper into written exposure therapy and perhaps use it in my future work with veterans.”

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Find out more:

Read the research in full in JAMA Psychiatry: jamanetwork.com/journals/jamapsychiatry/article-abstract/2669771

From the National Institute of Mental Health: “A shorter – but effective – treatment for PTSD”

Related reading from Counseling Today:

“Controversies in the evolving diagnosis of PTSD”

“Informed by trauma”

“Exploring the impact of war”

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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.