Monthly Archives: September 2018

Could toxic workplaces be killing your clients?

By Laurie Meyers September 27, 2018

Many American workers are overworked, exhausted and underpaid. Defying their biological clocks with shift work. Putting in 50-plus-hour workweeks and often juggling the work of two or more people — all under the eye of sometimes capricious management. Employees huddle together like Survivor contestants, hoping not to be voted off the island through layoffs, outsourcing or random termination. Employees also struggle to achieve work-life balance, hoping to leave work early enough to spend time with a spouse or partner, help their children with homework or take the dog for a walk. “Self-care” may consist of slumping on the couch, shades drawn, a six-pack or jumbo glass of wine at the ready, binging on Netflix. All while living paycheck to paycheck. And some experts say that it’s killing us.

The idea of work as a mortality risk may sound like an exaggeration, but research, particularly the work of Jeffrey Pfeffer, a professor of organizational behavior at Stanford University, suggests that the danger is all too real. His recently published book, Dying for a Paycheck, details his research on health effects often specific to work-related stressors such as unemployment and layoffs, the absence of health insurance, shift work, long working hours, job insecurity, work-family conflict, low job control, high job demands, low social support at work and low organizational fairness. Pfeffer’s conclusion: Stress caused by modern workplace conditions is sickening employees mentally and physically. Although the problem is global, Pfeffer’s research indicates that work is particularly toxic in the United States, where job stress costs employers more than $300 billion annually and may cause 120,000 deaths each year.

Pfeffer’s work is not the only research that reflects the unhealthiness of the American workplace. Mental Health America’s 2017 report “Mind the Workplace” detailed the results of the nonprofit’s Workplace Health Survey given to more than 17,000 employees across 19 industries in the United States. The survey showed that only 36 percent of employees felt that they could rely on supervisor support and only 34 percent felt supported by their colleagues. Respondents also felt underappreciated: 79 percent thought they were underpaid, and 44 percent reported that skilled employees were not given enough recognition. Survey participants cited this lack of support and appreciation for causing increased levels of employee disengagement and high rates of absenteeism (33 percent), work-family conflict (63 percent) and increased mental health and behavioral problems (63 percent).

The reality of the research is evident in the offices of many career and mental health counselors, where clients report struggling with heavy workloads, conflicts with managers and co-workers, poor work-life balance and general disengagement. Making the workplace less toxic will take systemic change, but in the meantime, counselors are helping their clients cope either by finding more compatible work environments or by better managing — or changing — their current positions. In addition, some counselors are helping employers build better, healthier workplaces.

Always working overtime

Over the course of her career, licensed professional counselor (LPC) Alicia Philipp, a former human resources professional who now specializes in career counseling, has seen a significant escalation in workplace stress. Overwork is one of the most common client complaints, she says. Not only are workplaces demanding more work from fewer staff, but many employees also are expected to respond to voicemail and email during off hours and on the weekend, says Philipp, whose practice is located in Atlanta.

“I think many consider the idea of using a time clock as confining, but sometimes I think we would all be better off if we could clock out from work daily and truly enjoy our free time,” she says.

In some workplaces, defining specific work hours — such as 9 to 6 — and not being available outside of those parameters is feasible, says Katie Playfair, an Oregon LPC who specializes in anxiety and career counseling. A set schedule works best if management and team members have similar schedules, she says. However, in an increasingly globalized marketplace, team members and contacts may be working on significantly different timelines.

Playfair, who also offers workplace consultations to employers, urges clients to set clear boundaries and to “talk process” with their employers. For example, an employee who was up until 1 a.m. working remotely with team members in Vietnam justifiably will not want to come into the office bright and early, but the employee cannot simply assume that it is OK to show up at noon without an explanation, she says.

“I would encourage them to email their boss at 1:15 a.m.: ‘The team in Hanoi was stuck on problem X until just now. I will be coming in around noon tomorrow. Also, I’ve asked them to communicate with me earlier on issues like this so that I’m not missing our 10 a.m. team meeting regularly,’” she says. “This message communicates: 1) I am not going to stay up until 1 a.m. working and come into the office at a regular time. 2) I understand I’m going to miss a meeting because of this decision. 3) I’ve attempted to prevent a situation like this from happening in the future.”

Playfair also encourages clients to set boundaries by letting their bosses and colleagues know how best to reach them after hours. For example, employees can let everyone know that after 6 p.m., they will be with their family and unavailable via email but will respond to a text or phone call in an emergency. A similar method can be used for weekends and vacations, she says. If employees intend to truly be unreachable, in addition to informing their colleagues, they should indicate their “away” status on voicemail and via email auto-respond messages.

In some cases, the pressure to overwork is indirect. Employees might overwork because that is how they achieved career advancement in the past, Philipp says. In other cases, bosses overwork, creating the perception (whether intentionally or unintentionally) that not staying late is a sign of slacking off or not doing a sufficient job, says American Counseling Association member Susan Grosoff-Feinblatt, an LPC who specializes in career counseling.

Overworking can also be a coping mechanism, she notes. By staying busy at work, clients can sufficiently distract themselves from job dissatisfaction or personal issues.

Restless and disengaged

Another common complaint from clients is a sense of disengagement. A variety of factors contribute to workplace dissatisfaction, but Philipp thinks that loss of control is the most significant cause. “Having a say in what and how things get done for the greater good of whatever purpose their work serves helps to make one’s work meaningful,” she says.

This lack of meaning and sense of powerlessness is happening in many professions, but over the past five years, a number of school teachers in particular have come to Philipp seeking help with feeling disengaged. “They want to teach, and many of them who have taught for years have seen huge changes in what is expected of them. It has taken them away from what they see as their role — engaging young minds in learning,” she says.

Some of the discouraged educators have left teaching altogether, whereas others found that changing schools allowed them to regain their sense of purpose. A few of the clients moved from teaching to administrative roles in hopes of making changes on a larger scale, Philipp says.

Grosoff-Feinblatt also works with clients whose jobs have undergone an uncomfortable change. For these employees, a promotion or shifting role responsibilities have left them feeling that they lack the skills and knowledge needed to perform their duties.

This skill misalignment can sometimes be solved by seeking another position, but technology is increasingly changing how specific jobs are performed. Employees who want to remain competitive in the workplace have to seek additional training, which is a daunting prospect for many. Grosoff-Feinblatt says that clients sometimes see any new technology as part of some vast, unknowable, futuristic landscape. Helping clients let go of that notion and instead focus on what they actually need to learn for their position can greatly reduce their anxiety, she says.

Seeking new opportunities

Personal conflict is another frequent cause of work dissatisfaction. Negative workplaces abound and, sometimes, changing jobs is the only answer, but Philipp believes that counselors should also help clients identify what exactly went wrong. Not only does this examination help clients process how the experience affected them, but it also helps them consider their response to the situation — and hopefully avoid replicating it.

“In changing jobs, they may be getting away from a bad situation, but it could be something they see again at a new employer, and recognizing the earlier problems and getting a grasp on a solution earlier can be helpful,” Philipp says.

Philipp teaches clients to use the interview process to better determine whether a different prospective work environment might be a good fit. “So many people go into an interview anxious about how to answer the interviewer’s questions, but to be really prepared for the interview, a candidate should have some of their own questions to ask to help them assess if the company is a good fit,” she says.

For example, if a counseling client left a previous job because co-workers were uncooperative or even engaged in workplace bullying, the person should ask the prospective employer about the team and work environment there. Is the work done in a collaborative environment or more independently? What is the turnover rate for the department? What is the team’s biggest challenge?

As clients examine what they didn’t like about a former workplace, they may also find that they could have reacted to the conflict more effectively, Philipp says. Counselors can help these clients work on developing better resolution skills so that they can respond differently in the future.

Philipp also uses career assessments for clients who are fleeing negative workplaces. The assessments can help determine whether their interests, personalities, values and abilities are in line with the type of work they have been doing. In some cases, the client might want to consider a different career. Career assessments can also help determine what kind of work environment is best for the client. 

Whether her clients are searching for a new career or just a new position, Philipp encourages them to become more involved with other people working in the field by expanding their networks through professional associations and LinkedIn. This enables clients to learn more about what is going on within their industry, including the kinds of workplace environments that different employers offer.

Building a better workplace

Playfair says that creating a healthy workplace is complicated and involves multiple factors. However, she has some definite ideas about how employers should start the process.

“It includes paying people enough so that they can meet their basic needs and not have to worry about food or shelter, minimally,” she says. “Offering benefits is wonderful, but know the limitations of your benefits packages. Having an EAP [employee assistance program] doesn’t mean it’s usable. Having ‘good’ health insurance on the medical side doesn’t mean your employees have access to a good network of mental health providers.”

Human resource professionals have to fully understand the benefits that a company offers and be proactive about helping employees take full advantage of those benefits, she continues. Ideally, employers should also allow flexible work schedules so that employees can access services that are available only during business hours.

“Above all, organizations need to be less conflict averse,” Playfair emphasizes. “They need to address abusive behavior, implement good, evidence-based management practices, broadcast compelling and cohesive visions for employees to rally around, and have real dialogues with their employees about how to achieve those visions. This means making it safe for employees to communicate their needs and for them to receive honest feedback from the employer about the feasibility of implementing their ideas and where their idea ranks [among] company priorities.”

Philipp is less convinced that better benefits are the answer, but she agrees that enfranchising employees is critical. “Many employers have made some great improvements to provide benefits to employees to help deal with stress by way of health and wellness programs,” she says. “While there are known benefits to employees participating in those, the better approach, I think, is for employers to make sure their employees’ work environment is optimal to avoiding stress to begin with. Open and regular communication, allowing employees to have a voice and see that their efforts are helping in some fashion, is essential to a healthy workplace. Some employers talk of doing this but don’t really follow through with that idea. Being given lots of free benefits may be nice, but at the heart of why we work [is that] we want our efforts to matter.”

 

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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)

Books (counseling.org/publications/bookstore)

  • A Counselors Guide to Career Assessment Instruments, sixth edition, edited by Chris Wood and Danica G. Hays
  • Postmodern Career Counseling: A Handbook of Culture, Context and Cases, edited by Louis A. Busacca and Mark C. Rehfuss
  • Career Counseling: Holism, Diversity and Strengths, fourth edition, by Norman C. Gysbers, Mary J. Heppner and Joseph A. Johnston

Podcasts (aca.digitellinc.com/aca/store/5#cat14)

  • “Career Errors” presented by Frank Burtnett (ACA261)

ACA Divisions

  • National Career Development Association (ncda.org)

NCDA provides professional development, publications, standards and advocacy to practitioners and educators who inspire and empower individuals to achieve their career and life goals.

NECA was founded in 1966 to implement solid and practical interventions to enhance employability and long-term employment.

 

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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.

Infusing hope amid despair

By Laurie Meyers September 24, 2018

In 2015, two Princeton University economists, Anne Case and Angus Deaton, published a study in the Proceedings of the National Academy of Sciences of the United States of America that made a shocking claim: After decreasing for decades, the mortality rate for white non-Latinx middle-aged Americans was actually increasing. They ascribed this reversal of fortune in part to what they dubbed “deaths of despair” caused by an increase in alcohol abuse, opioid use and suicide. Their findings grabbed headlines and fueled furious debate in the public health and other research communities, particularly when they published a follow-up report in 2017 in the Brookings Papers on Economic Activity. Some researchers questioned the authors’ interpretation of mortality data. Other experts argued that the factors contributing to the rise in suicide rates and in opioid and alcohol abuse were too complex to be attributed to “despair.”

However, despite their narrow focus on a particular demographic slice, Case and Deaton were perhaps tapping into a greater sense of instability among the American populace. Since 2007, the American Psychological Association (APA) has conducted an annual nationwide survey — Stress in America — gauging both the overall level and leading sources of stress in the United States. The 2017 report revealed that two-thirds of the 3,440 adult Americans surveyed that August were significantly stressed about the future of the country. More than half of those surveyed — a group that spanned generations — said they considered the current time to be the lowest point in U.S. history that they could remember. Nearly 6 in 10 adults reported that the current climate of social divisiveness was a serious source of personal stress. Other significant sources of worry included money, work, health care, the economy, trust (or lack thereof) in government, hate crimes, conflicts with other countries, terrorist attacks, unemployment/low wages and climate change/environmental issues.

Although Americans may not be drowning in despair, research such as APA’s report indicates that many people are feeling more insecure than ever. That sense of walking a tightrope without a safety net can cause significant psychological distress, which can in turn lead to health problems and mental illness. Many experts say the burden of general societal unease is often magnified for disenfranchised groups such as communities of color or those of low socioeconomic status. And trauma — whether caused by being a member of a disenfranchised group or by a history of abuse or violence — takes an even more significant toll on health and well-being. Any or all of these issues may be related to the rise in opioid addiction and suicide across the U.S.

A poverty of health and well-being

To some degree, most people in the so-called 98 percent — those not in the top 1-2 percent of individuals possessing the majority of the nation’s wealth — worry about money: affording a mortgage, sending the kids to college, saving for retirement. The Great Recession may be over, but recent research from the Federal Reserve Bank of San Francisco (FRBSF) indicates that the economy hasn’t fully recovered. In its Aug. 13 economic letter, the FRBSF states, “A decade after the last financial crisis and recession, the U.S. economy remains significantly smaller than it should be based on its pre-crisis growth trend.”

The letter goes on to speculate that this is due to substantial losses in the economy’s productive capacity post-crisis. These losses were so significant, FRBSF researchers assert, that they could result in a lifetime income loss of $70,000 for each American.

This is staggering news for most Americans, but for those who live in poverty — 40.6 million Americans according to a 2016 U.S. Census Bureau study — such an amount is catastrophic. The poverty threshold is broadly defined as any single individual younger than 65 earning less than $12,316 annually and any single individual 65 or older living on less than $11,354 annually. The poverty threshold for two people under the age of 65 living together is $15,934, and the threshold for two people over the age of 65 living together is $14,326. For a family of three — one child and two adults — the poverty threshold is $19,055. For a family of three with one adult and two children, the threshold is $19,073.

For people who have never been impoverished, it can be difficult to comprehend all the ways in which poverty can affect health and well-being. Forget vacations, higher education and saving for retirement. People living in poverty are often unable to access basic needs such as safe shelter, food and, in some cases, even running water, says Chelsey Zoldan, a licensed professional counselor (LPC) practicing in Youngstown, Ohio. She has also counseled clients in the rural, impoverished Appalachian region of Ohio.

“I’ve worked with many clients over the years who have had their utilities turned off and lived in homes without water, heat or electricity,” says Zoldan, an American Counseling Association member. Missing that foundation at the bottom of Abraham Maslow’s hierarchy of needs, these clients struggle to stabilize their mental health symptoms, she explains.

People living in poverty often have to reside in low socioeconomic status areas with higher levels of violence and crime. Zoldan says many of her clients have lived in supportive housing and regularly heard gunshots in their neighborhoods at night. Although some clients seemed to get used to it, others — particularly those with trauma histories — had trouble feeling safe in their own homes.

Those who live in poverty also often lack access to quality health care. “Not only are individuals limited in terms of health care coverage, but they may also struggle to obtain transportation to get to health-related appointments,” Zoldan says. “In my area, there was such a high demand for medical transportation to appointments that they stopped providing door-to-door transportation and only provided bus passes.”

Instead of a 15-minute ride to appointments, Zoldan’s clients now had to navigate public transportation, which could take up to two hours each way with a change of buses. Riding the bus also poses another significant challenge — having to walk numerous blocks to the stop, which during winter in northeast Ohio means navigating “tons of snow” and double-digit subzero windchills, Zoldan says. Even in more clement weather, many of Zoldan’s clients were unable to devote two to four hours a day to traveling to health-related appointments, so they stopped receiving services.

Self-care can also prove challenging for those living in poverty, and it doesn’t include vacations or nights out. Zoldan works with individual clients to identify free activities that they enjoy and can engage in at least weekly, such as taking a bath, attending a Bible study, going for a walk in the park, meditating, and reading books or magazines at the library. Unfortunately, some of these activities may not be available to all clients, either because they live in rural areas with few resources or because they are unable to arrange child care, Zoldan points out.

Zoldan advises counselors working with this client population to get outside the walls of their offices. It is critical that counselors make community connections, she says, so that they can help clients access resources such as shelters, housing authorities, food banks, clothing providers, programs that offer financial assistance for utilities, medical transportation and vocational services.

“In connecting our clients with these resources, we can work to build a safety net for our clients and create some more stability in their lives so that they can thrive,” she says.

The legacy of racism

Racism happens on both a micro and macro level, says Cirecie West-Olatunji, a past president of ACA. Microaggressions are more nuanced and under the radar and involve everyday interactions with individuals who exert privilege. It might be the shop clerk who ignores an African American person in favor of a white shopper or a student of color who is consistently not called on, despite raising her hand. Macroaggressions are overt and meant to intimidate members of a group, such as neo-Nazis marching in the nation’s capital and people openly using racial slurs. Together, the macro- and microaggressions create pervasive, chronic stress that is handed down through intergenerational trauma, explains West-Olatunji, an associate professor at Xavier University of Louisiana and director of the Center for Traumatic Stress Research.

Over the past 20 years, researchers have been studying a phenomenon they first witnessed in some of the grandchildren of Holocaust survivors. Despite not having experienced the Holocaust themselves, and instead having grown up in a middle-class environment in the U.S., these individuals displayed survivor-like trauma symptoms. The findings were startling but have proved not to be unique. After 9/11, researchers studied children who had not been born at the time that their parents served as first responders at one of the attack sites. Like the grandchildren of the Holocaust survivors, these children of 9/11 trauma survivors displayed corresponding symptoms despite not experiencing the trauma themselves, West-Olatunji says.

Chronic, pervasive stress and trauma can be seen in changes at the DNA level, she says. Some researchers believe that these DNA changes play a part in handing down the trauma from generation to generation.

For African Americans, the trauma is also handed down on a systemic level, West-Olatunji says. “It is evident in social structures, education, lack of power and aggressive acts that threaten the psyche of individuals who are culturally marginalized,” she says. Slavery still casts a long shadow, its legacy evident in the school-to-prison pipeline, the number of African American children who are in low-resource schools, their overrepresentation in special education and the disproportionate diagnosis of behavioral disorders. “Children are being tossed out of the American dream by a lack of resources,” she says.

The effects of openly expressed racism are also manifesting in society, West-Olatunji says. “We’re anxious and irritable and feeling less hopeful about the world,” she says. These “symptoms” match those displayed by culturally marginalized groups.

Courtland Lee, also a past president of ACA, believes the effects of racism extend beyond the targeted group. In fact, he contends that racism can be considered a mental illness.

Lee began thinking of the concept of racism as mental illness after reading Stamped From the Beginning: The Definitive History of Racist Ideas in America, a book by Ibram X. Kendi that examines the intellectual roots of racism. Although many people may consider racism the purview of poor, white, rural Southerners, it has historically been handed down from the best and brightest minds in science, medicine, philosophy, religion and psychology, Lee explains. Racism is woven into our intellectual and social fiber and is used to manipulate people through fear of the other, he continues.

Lee says that targets of racist behavior are ground down by the constant micro- and macroaggressions, leading to “cultural dysthymia,” or collective low-grade depression. This collective depression is manifestly not conducive to mental health, and he argues that its effects aren’t felt solely by those who are targets of racism.

Lee believes that the fear and hatred of those who perpetrate racist acts is also mentally traumatizing — not just to those who are targeted but to the perpetrators themselves — and that the trauma must be addressed to treat the mental illness of racism. Counselors can do this on a systemic level through advocacy and on an individual level by helping people who are racist see that the agitation, irritability, hostility and hypervigilance they experience is caused by their beliefs. The challenge is getting perpetrators of racism to see that the defensiveness and fear inherent in racist thought can also bring those fears to life, Lee says.

For instance, one commonly cited reason to block immigration from Mexico is that these immigrants are stealing American jobs and damaging the economy. However, a lack of visas and fear of anti-immigrant violence have kept Mexican seasonal workers away from sectors such as the Maryland crab industry. In their absence, merchants who sell crab meat to restaurants and stores cannot recruit enough employees to clean and process their haul, even at high wages. That means the crabs cannot be sold, which is a major economic blow to the industry.

As a country, the United States needs to discuss racial issues, Lee says. Counselors, who are trained to encourage conversation, can and should facilitate these dialogues in their communities, through churches or community centers, he suggests. “We really do live in a sick society,” Lee says. “We can help people get well, but the only way to get well is to cure the society.”

As individuals, counselors can also play an important role in validating the experiences of people of color and speaking out when they witness micro- or macroaggressions, West-Olatunji says. She also urges counselors to explore non-Eurocentric methods, such as using the tradition of storytelling in the Latinx community or testifying in the African American community. Non-Western traditions can be applied effectively across cultures, making them a useful addition to any counselor’s toolbox, West-Olatunji says. 

Touched by trauma

“Life is a traumatizing experience,” says Cynthia Miller, an LPC in Charlottesville, Virginia, whose practice specializes in trauma. “It’s full of challenges, unexpected and uncontrollable events, and losses. I don’t think any of us gets through it unscathed.”

Miller, an ACA member, says trauma is on a spectrum that begins with ordinary stress and gradually progresses to completely overwhelm a person’s ability to cope. Eventually, it can even put them at risk of death.

A seminal study that the Centers for Disease Control and Prevention and Kaiser Permanente began in 1995 established a link between adult health problems and adverse childhood experiences such as emotional and physical neglect, sexual and physical abuse, exposure to violence in the household, and household members who had substance abuse problems or had been in prison.

These experiences fall on the more extreme end of the spectrum — often referred to as “big T” traumas. However, Miller cautions against discounting the “little t’s” as sources of distress. Where a trauma falls on the spectrum is individual and variable. “Some people might experience the loss of a job as stressful but wouldn’t be completely overwhelmed by it,” she explains. “Others might experience it as very overwhelming and become immobilized. So one person’s stressful event is another person’s traumatic event, and one person’s traumatic event is another person’s ordinary stressful event.”

Miller notes that mental health professionals recognize events such as the loss of a job, economic insecurity, divorce and family problems as sources of stress but often don’t accord them the same level of treatment as “real” mental illness. “It’s really a false distinction,” she says.

Someone who has lost a job or is going through a divorce is experiencing significant stress and is likely flooded with cortisol in the same way that a person who has experienced violence is, Miller asserts. “It’s really the chronic stress from either a ‘little t’ trauma or a ‘big T’ trauma that eats away at us and sets us up for depression, anxiety, anger problems, health problems and substance use,” she explains.

“There are a lot of things going on in society that could be experienced as traumatic,” Miller continues. “Globalization and automation are rapidly changing communities and workplaces, eliminating some industries and leaving workers scrambling for jobs that pay less and offer less job security. Economic inequality is growing, and housing costs keep rising. People feel increasingly insecure and like their futures are being threatened. That’s leading some people to feel helpless or hopeless. Others are angry and lashing out.”

Trauma-informed counseling is critical to recovery from both “big” and “little” traumas, Miller says, as well as for building ongoing resilience.

“I think that the biggest thing that trauma-informed counselors bring to the treatment process that less-informed counselors may not is an alternative explanation for behaviors that are often seen as purely manipulative, obstinate, oppositional, attention seeking or antisocial,” Miller says. “Trauma-informed counselors may be more likely to view a client’s reactions and behaviors as attempts to cope or protect themselves rather than chalking them up to resistance, treatment noncompliance or poor motivation. They also bring an awareness of the importance of creating a sense of safety and control for a client, and they work to create environments in which clients have as much autonomy and input into their treatment as possible.”

Miller also decries the traditional “split” between substance abuse and mental health treatment. Although she doesn’t believe that all substance abuse is caused by mental illness or trauma, she says these are often underlying factors that go untreated, which puts clients at risk of relapse.

Regardless of the cause, substance abuse is an illness that needs to be treated, she asserts. “For far too long, substance abuse has been treated as a problem of weak moral character rather than an effort to soothe emotional pain that someone doesn’t feel able to cope with,” she observes.

Miller also points to the contrasting public reactions to the crack and opioid epidemics. Whereas the crack crisis of the 1980s and early 1990s was considered a criminal problem, the current opioid epidemic is recognized as a public health problem, she notes. Miller ascribes this difference not only to the traditional judgment of substance abuse as a moral failing but also to the reality that crack was seen largely as affecting African Americans, while opioids are generally viewed as affecting white Americans. (Some researchers and commentators have also begun noting that the growing number of opioid-related overdoses and deaths among African Americans has largely been left out of the national narrative.)

Seeking solace

Just as crack enveloped areas that were economically devastated — at the time, predominantly African American urban neighborhoods — opioids are most common in rural areas that can no longer depend on the industries that once sustained them. West Virginia is one of the epicenters of the opioid crisis, and Carol Smith, an ACA member and past president of the West Virginia Counseling Association, believes that isolation and the lack of opportunity in much of the state are helping to fuel opioid abuse.

A frequently spun narrative of the crisis is that of unsuspecting people who get addicted after being prescribed opioids for pain after injury or surgery, but those cases make up a small percentage of those who are addicted to opioids, according to Smith. Indeed, people have been using opioids for pain relief for decades without becoming addicted on a large scale, notes Smith, a counseling professor and coordinator of the violence, loss and trauma certificate of studies at Marshall University. The people who do get addicted after being prescribed opioids usually already have substance abuse problems, she says.

However they first encounter opioids, the people most at risk for addiction are those who lack good coping skills and social support, Smith says. They typically also have a certain degree of existential despair, which is only reinforced by the long-term abuse of opioids.

Smith explains that West Virginia is particularly vulnerable to this sense of despair because its topography of mountains and waterways makes building roads and installing cables prohibitively expensive. This isolates the state not just physically but virtually because of the lack of high-speed internet access, she says. This lack of connectivity discourages new economic development, further reinforcing the cycle of poverty. As a result, many of the state’s inhabitants don’t feel that they have a lot to lose or much to strive for, Smith says, leaving them vulnerable to anything that might make the day go by faster or easier.

With its emphasis on treating the whole person, counseling is integral to the effort to stem the tide of addiction, Smith says. Counselors can help clients fight despair by guiding them to regain a sense of purpose through goal setting and identifying reasons for living. In addition, counselors can aid clients in dispelling their sense of isolation by teaching them relationship skills and helping them build support networks. Smith also stresses the importance of combining counseling with medication-assisted treatment, which addresses the physiological aspects of addiction.

Dying of despair?

According to the Centers for Disease Control and Prevention (CDC), 45,000 Americans 10 years and older died by suicide in 2016, the most recent year for which statistics are available. In the June CDC Vital Signs report, the agency said that from 1999-2016, the suicide rate rose by more than 30 percent in 25 states. While acknowledging that those suicide statistics are the most accurate figures available, the American Foundation for Suicide Prevention has stated that it believes actual rates are much higher.

Case and Deaton’s study connected the rise in the suicide rate in part to despair caused by a dearth of employment and lack of opportunity, but some experts say that causation is far from clear.

“It is hard to pinpoint a specific cause,” says ACA member Darcy Granello, a professor and director of the Ohio State University suicide prevention program. “Frankly, the numbers are increasing at such an alarming rate and across so many different demographic groups that we have to be careful not to paint broad brushstrokes and assume that specific factors apply to all of these different groups.”

Granello, whose research focuses on suicide prevention, does believe that Americans are feeling more isolated and disconnected, however. “That pervasive sense of loneliness is especially dangerous for those who already struggle with depression,” she says. “We know that social connectedness, feeling supported and having a sense of belonging all are protective factors that help minimize the risk for suicide. When those are taken away, suicide risk increases.”

Granello says myriad factors may be contributing to the rise in suicide, but recent research has caused experts to question their understanding of suicide. For example, historically, 90 percent of those who kill themselves have some kind of mental illness — often undiagnosed or untreated. However, more and more people who die by suicide do not have a diagnosable mental illness at the time of their death, Granello says.

“This is challenging to everyone in the field, and it causes us to rethink much of what we know,” she says. “It means that suicide is more and more the result of people who simply do not have the resources to cope with life’s problems, whether this inability to cope is because they are living with a mental illness or simply because they are overwhelmed by life and have never developed healthy coping strategies.”

Granello urges counselors to focus on helping clients develop those strategies. Those at risk for suicide are often ill-equipped to face life’s challenges, make long-term plans and envision a future, she says. For many people, the key to survival is getting through the crisis period — that window when they are most tempted to end their lives, she continues.

Counselors can teach clients to move out of their isolation, reach out to others and develop healthy coping strategies, Granello says. But to do that, counselors need to be adequately trained in suicide prevention, assessment and intervention — something that Granello doesn’t think is happening often enough. She stresses the need to push for comprehensive, empirically supported suicide prevention training in counselor education programs and through continuing education.

“We have to do this,” Granello says. “We are, quite literally, fighting for our lives.”

 

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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)

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

  • A Contemporary Approach to Substance Use Disorders, second edition, by Ford Brooks and Bill McHenry
  • Counseling for Social Justice, third edition, edited by Courtland C. Lee
  • Multicultural Issues in Counseling: New Approaches to Diversity, fifth edition, edited by Courtland C. Lee
  • Suicide Assessment and Prevention, DVD, presented by John S. Westefeld

ACA Mental Health Resources (counseling.org/knowledge-center/mental-health-resources)

  • Trauma and Disaster
  • Suicide Prevention
  • Substance Use Disorders and Addiction

Podcasts (aca.digitellinc.com/aca/store/5#cat14)

  • “Counseling African-American Males: Post Ferguson” presented by Rufus Tony Spann (ACA285)

Webinars (aca.digitellinc.com/aca/pages/events)

  • “Traumatic Stress and Marginalized Groups” with Cirecie A. West-Olatunji (CPA24341)
  • “Dissociation and Trauma Spectrum” with Mike Dubi (CPA24333)
  • “ABCs of Trauma” with A. Stephen Lenz (CPA24329)

Competencies (counseling.org/knowledge-center/competencies)

  • Multicultural and Social Justice Counseling Competencies

 

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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.

Voice of Experience: One quiet hour

By Gregory K. Moffatt

Seven-year-old “Adam” (not his real name) concentrates on the project in front of him. He is coloring on a piece of paper on the floor in my therapy room, and I am sitting close beside him. Crayons litter the floor, and I can see him thinking carefully as he selects each color. He leans back against my arm like a baby bird snuggling beneath its mother’s wing. This simple behavior says, “I trust you,” and it is a very good sign.

As he bends forward to color, he exposes his neck beneath the curls of his hair. I can see the fading remnants of bruises in the shape of fingers. Similar bruises are visible on the exposed skin of his arms. I know there are still more bruises in places I can’t see. I also know that he would never lean back against his stepfather like he is doing with me. It wouldn’t be safe for him. The touches he has received at home have not been gentle ones.

Adam’s world is very small. He lives in a small trailer and attends a small elementary school. He doesn’t play sports, take piano lessons or engage in any other activities outside of his home. He has never had a party or been to a sleepover at a friend’s house. Chances are good that he never will.

Adam’s world is small, but it is also very crowded. Siblings, stepsiblings, mother, father, stepparents, teachers, social workers, counselors, doctors, lawyers, judges — these are the people who inhabit Adam’s world.

Adam looks forward to coming to see me each week. When his world and mine overlap, it is just the two of us. We play in the sandbox, draw pictures or play with puppets. I learn a lot about his world from the way he plays, his choices of toys and the emotion he puts into the activities of our sessions together. Sometimes he talks of yelling and hitting. Other times he tells stories of policemen and social services workers. Still other times, he just plays quietly.

There is little I can do to make Adam’s home life easier. The law has done little to protect him and, as well-intentioned as they have been, social agencies have in many ways made his life harder. He is a powerless child at the mercy of a world of adults who like to think they care. But in reality, they care more about their own interests and personal agendas than they do about children like Adam.

To most of the people in his life, Adam is just the troubled kid whom nobody would miss if he disappeared. He is a child who makes teaching harder. He is the disruptive child whom parents don’t want their kids playing with. They can’t understand him, and many of them don’t even try. Even his caseworker is too busy and too jaded to connect emotionally with Adam. I can only help him develop skills to cope in his crowded and noisy world. It breaks my heart, but I’ve seen it many times.

In some ways, Adam is an enigma to me. He giggles as he tells me about something funny his sister did at home. How does he find happiness in this life he lives?

It always surprises me how the things of the world that otherwise would be important to me seem to fade in their significance when I am working with a child such as Adam. No matter what is happening in my life, when I close my office door and I have this quiet hour with a client, I don’t think about politics, war, terrorism, money or even my family. I concentrate fully on Adam. I am his for one hour. He knows he is safe with me and that I will always honor and respect him, his thoughts and his dreams. He knows I will not betray his secrets or laugh at his fears.

When our time is up, Adam rises to leave. He doesn’t look back as he exits my office. One way he copes is by living from moment to moment, investing only in that moment — no future and no past.

People often wonder how I work with children such as Adam. “How can you sleep at night?” they ask, shaking their heads.

I can sleep because I know that even if it is only for one hour, I can make a child’s world a little more tolerable. I know I am helping create a better world for children like Adam because for one hour, they can know they are safe and secure and that I really do care about them. I have no hidden agenda.

I can sleep because working with children like Adam helps me to put life in perspective. It makes me a better father and a better human being. This is my calling, and I wouldn’t have it any other way. This is why I became a counselor.

 

 

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Gregory K. Moffatt is a veteran counselor of more than 30 years. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at Greg.Moffatt@point.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.

Behind the Book: Gatekeeping in the Mental Health Professions

By Bethany Bray September 17, 2018

The academic evaluation of graduate students in counseling education programs is straightforward: Their ability to master the material becomes apparent in grades assigned and credits earned.

“However, evaluating trainee competency in the domains of interpersonal behavior, intrapersonal functioning and professional conduct to determine readiness to practice is much more subjective,” write Alicia M. Homrich and Kathryn L. Henderson in the preface to their book Gatekeeping in the Mental Health Professions, published by the American Counseling Association.

Gatekeeping’s “ethical mandate speaks not only to protecting the clinical professions and the public from harm but also to providing trainees with transparent feedback regarding their competence and their likelihood of success as professional clinicians. During their time of struggle and challenge, effective feedback and remedial support from gatekeepers can offer trainees an opportunity, should they choose to accept it, to achieve success and develop into competent, ethical and professionally effective clinicians.”

An important issue that is sometimes avoided, gatekeeping is of growing interest in the counseling profession and an often-discussed topic at professional conferences, Homrich notes.

Homrich, a professor in the graduate studies in counseling program at Rollins College in Winter Park, Florida, and Henderson, an assistant professor in the Department of Counseling and Applied Behavioral Studies at the University of Saint Joseph in West Hartford, Connecticut, became friends through their mutual interest in the topic. Counseling Today sent the duo some questions to find out more.

 

Q+A: Gatekeeping in the Mental Health Professions

 

You are both counselor educators. How did you become confident and comfortable with the gatekeeping aspect of the job?

Alicia M. Homrich: I don’t think gatekeeping is ever easy or comfortable. Every step of working with a student who is struggling with intrapersonal issues, interpersonal behavior and/or professional conduct concerns needs to be handled delicately and respectfully.

There are criteria that have made the difference in the graduate program where I work: All faculty are in agreement about our ethical and legal obligation to gatekeep to protect future clients and the reputation of our profession. The second is the intentional formulation of strategies that include very clear standards for student behavior and published policies and procedures [which] students are informed of when they enter the program and throughout their enrollment. This ensures that remediation efforts are not a surprise, if they occur, and are intended to help get the student on the right track.

Other than these two important tactics, we work as a team to make decisions on how to go forward. Group consensus and support for each other increase our comfort level so no one faculty member or supervisor is acting alone. We do the same by educating our site supervisors.

Kathryn L. Henderson: Yes, never easy or comfortable. I find it so important and vital that it is a duty and not a choice. That’s what draws me to this topic. Especially when harm to a client is possible or there’s the concern a student might not be successful in the field after graduation. To me, that’s tantamount to lying by omission or false representation if we ignore serious concerns. It also does a great disservice to our students.

Consulting with colleagues and mentors has been central to the development of my gatekeeping abilities. I find not being alone and having support to be essential.

 

Do you believe that the counseling profession, as a whole, does a good job with gatekeeping?

AMH: I believe the counseling profession does more than our allied professions to educate and inform gatekeepers of their roles, remediation strategies, and ethical and legal mandates. However, in terms of actual implementation of gatekeeping strategies, a lot of variation exists across counseling education programs nationwide.

Some programs are diligent about their obligation to gatekeep — implementing policies, engaging in procedures and remediating or dismissing students or supervisees with personal or professional conduct [that is] inconsistent with profession standards. Other programs avoid the gatekeeping process altogether in order to retain students, avoid potential legal action or sidestep the uncomfortable emotional and time-consuming nature of the gatekeeping process.

Despite this range of engagement, the counseling profession is one of two clinical training tracts that consistently takes gatekeeping seriously. Psychologists have paid the most attention to the responsibility of gatekeeping, as evidenced by task force work and literature. Social work comes third in the lineup, and marriage and family therapy appears to be the least attentive of the clinical professions in examining this issue and providing strategies as measured by their professional literature.

Despite this variation, each profession acknowledges the need for a gatekeeping process in their ethics and standards. A continuum exists across professions that includes very conscientious educators and supervisors versus programs that don’t prioritize or are avoidant of the gatekeeping mandate described by their ethical codes.

 

What resources would you recommend for counselor educators or supervisors who aren’t comfortable with gatekeeping and having tough conversations with counselors-in-training?

AMH: Work with your colleagues to design and implement policies and procedures, and don’t go it alone, especially for serious conversations with trainees. Obtain support for decision-making and action-taking from your professional colleagues, including department chairs, deans and administrators, as well as human resources, some of whom you may have to educate about our ethics and licensure obligations. I have also increased my comfort level by going to workshops hosted by ACA and the Association for Counselor Education and Supervision (ACES), as well as reading every professional article I can find on the topic.

The goal of this book [Gatekeeping in the Mental Health Professions] has been to bring all of the knowledge and wisdom generated by the four allied mental health professions, along with strategies that work, together in one resource.

KLH: One thing that helps me when I’m struggling with gatekeeping is to reflect on my own personal process and try to hunt for the source of the discomfort. Is it fear of hurting the student or supervisee? Second-guessing myself? Fear of confrontation or conflict? I find that dealing with my own discomfort head-on helps me to process through it more effectively.

As for those tough conversations, I find empathy goes a long way. It does not mean agreeing with a trainee’s choices or actions, but it helps create a connection at times.

 

Are there any misconceptions on this topic — particularly, ones held by counselors — that you want to clear up?

KLH: One misconception, or perhaps a common fear, is that gatekeeping is always a negative experience — and it can be. However, I’ve had many constructive and positive outcomes from gatekeeping. Students sometimes will express gratitude in that no one has ever been that honest with them or they have not felt as if they mattered in the program but do now.

AMH: I agree with Kathryn. The assumption that engaging in gatekeeping is overwhelming and conflictual is inconsistent with my experience. There are plenty of supervisees and students, whether they are the individuals engaged in remediation or not, who are appreciative that there are standards that protect future clients and the reputation of the profession. They also witness experienced members of the profession engaging in the process of protecting current students and supervisees, vulnerable clients and the reputation of the profession for which they are training. They appreciate the action of supervisors and faculty in gatekeeping efforts and go on to value and fulfill this ethical mandate after graduation.

 

In the book’s preface, you write that evaluating a counselor trainee’s personal and professional conduct is subjective, not clearly defined, and “lacks common agreement within and across the mental health professions.” How can this be remedied, in your opinion? Or is it a concept that can’t be standardized?

AMH: I believe it is a concept that can be standardized, at least in the counseling profession. I would love to see ACES initiate a task force that identifies standards for interpersonal, intrapersonal and professional qualities critical for professional counselors and [then] publish a set of best practice standards or a procedural list for the gatekeeping process that is supported by the division and ACA. This would provide a steppingstone or source of support for counselor educators and supervisors.

I have conducted and published a few research projects on this topic in an effort to get the ball rolling. These studies and resulting lists of suggested standards and procedures are covered in the book.

KLH: Yes, I agree totally. The field of psychology has done much more work through the American Psychological Association and its official task forces than [has] the counseling field, which we discuss in the book. Research is emerging that is promising and could inform any potential professional association task forces.

I would love to see ACES or ACA initiate an effort as well to create best practice norms. A set of official best practice standards could also be a tool to advocate to university or agency administrators who may be wary of provoking unhappy students, similar to how the American School Counselor Association (ASCA) standards serve an important advocacy tool for school counselors.

 

What inspired you to collaborate and create this book?

KLH: Our main goal was to create a sort of one-stop shop for tools and resources on gatekeeping and remediation, which Alicia mentioned earlier. Instead of needing to do extensive research on the many aspects of gatekeeping, which can be overwhelming, the book serves as a thorough resource on how to implement gatekeeping.

We hope, in particular, that it serves as a catalyst for new supervisors and doctoral students to undertake this important ethical task. The opportunity for us to collaborate happened at first by chance: We only know each other through meeting at professional conferences. We both would present on the topic and then attend other presentations on the topic, so we got to know one another over the years. And then we became friends.

AMH: The development of our professional collaboration and resulting friendship has been based on our shared passion to improve our profession, demystify the gatekeeping process and encourage counselor educators and supervisors to engage in this vital professional responsibility. We wanted to provide information, strategies and skills that support the implementation of gatekeeping in training. Our friendship developed as we worked together to achieve these goals and came to know each other better.

 

Why do you feel the book is relevant and needed now?

KLH: The literature in the field has developed to a level where compiling the findings in the form of a book to encourage application of the information was logical. This is something that clinical educators and supervisors are actively trying to understand and implement.

For instance, the topic of gatekeeping is growing in popularity. It was scarcely on the map about a decade ago, and then it exploded and continues to be a common topic at conferences. Because of the many ethical and legal issues attached to gatekeeping, it is important that counselor educators and supervisors practice in an informed and progressive way, for the protection of the field and to strive in the best interests of our students and supervisees.

 

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Gatekeeping in the Mental Health Professions is available both in print and as an e-book from the American Counseling Association bookstore at counseling.org/publications/bookstore or by calling 800-347-6647 ext. 222.

 

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Related reading from Counseling Today

 

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Follow Counseling Today on Twitter @ACA_CTonline and Facebook at facebook.com/CounselingToday.

 

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

 

 

Bringing CBT into the doctor’s office

By Bethany Bray September 12, 2018

When you get your annual physical, does your primary care physician ask if you’ve been feeling atypically sad or anxious lately?

Primary care doctors are often the first professional a person will tell about symptoms related to depression or other mental health issues. With this in mind, two Pennsylvania counselors have created a presentation on coping skills and takeaways from cognitive behavior therapy (CBT) that medical doctors can use with their patients.

When Brandon Ballantyne and Kevin Ulsh spoke to the primary care physicians and other medical personnel at Tower Health in Reading, Pennsylvania, recently, they found an interested and engaged audience. The medical practitioners were particularly interested in learning more about how to help patients who present with anxiety and related problems during medical appointments.

Ulsh and Ballantyne are mental health therapists in the inpatient and partial hospitalization programs, respectively, at Reading Hospital, which is part of the Tower Health system. Ballantyne is also a licensed professional counselor and American Counseling Association member.

How can aspects of CBT be translated for use in the medical professions? CT Online asked Ulsh and Ballantyne some questions to find out more.

 

How did this come together? Did you reach out to the doctors, or did they invite you to come?

We have always been interested in the concept of extending coping skills practice and implementation into primary care settings. We believe that the primary care setting is where most individuals first report problems associated with anxiety, stress, depression and so on. In many situations, the primary care physician is the first provider to address such issues.

Recently, we have observed a growing trend to integrate primary care and behavioral health services. We decided to take these observations and build a coping skills lecture that can assist providers in the primary care setting with addressing stress and anxiety, along with other mood-related problems with the patients they serve. We developed an outline for a presentation and broadcast the idea to the primary care Tower Health continuing education team, who then gave us an invitation to present it as a part of their lecture series.

 

How did it go? Were the doctors open to your message? What were some of the things they asked or commented about?

The lecture went well. The doctors in attendance were attentive and interested. They asked several questions about how to address behaviors particularly associated with adolescent anxiety such as school avoidance and oppositional defiance. We addressed these questions by referring back to the cognitive model, which we highlighted as a foundation of our lecture.

We think it was important to have a discussion with the doctors about the clinical indicators of avoidance versus defiance. Utilizing a cognitive philosophy, we emphasized that avoidance typically shows itself as a behavior which prevents an individual from doing something that they would like to be able to do or would want to be able to do if not affected by anxiety. The anxiety that drives avoidance is typically a product of some anticipated fear. … The individual has cognitively come to the conclusion that the fear itself is an already established fact or guarantee.

Defiance, on the other hand, is a behavior that is driven by the desire to maintain control by resisting demands and expectations to comply with things that are simply undesirable. In other words, in the cognitive process that drives defiance, an individual may think, “If I don’t like it or don’t want to do it, then I don’t have to, and it doesn’t matter what anyone says.”

Therefore, primary care physicians may be able to get a better handle on what it going on with the patient, clinically, simply by asking about their thinking.

 

From your perspective, how could CBT be helpful in a medical setting? Please talk about why you chose to focus on CBT when you spoke to the doctors.

We chose to focus on cognitive behavior therapy when providing this lecture because CBT is an evidence-based approach that has been shown to be an effective form of treatment for multiple psychological problems across various populations. We believe that in the primary care settings, patients will benefit most from socialization to the cognitive model, so that they can gain a clear understanding of the difference between a thought and an emotion.

Once an individual understands the relationship between a thought, an emotion and a behavior, they acquire control over regulating their mood and reactions in a positive way. CBT-based skills are goal-oriented, problem-focused and able to be introduced and taught to individuals dealing with a wide range of psychological problems.

In the fast-paced primary care setting, brief psychological education and skills practice can be a piece of the treatment puzzle that not only addresses the emotional problems of the patient, but also offers skills that they can continue to utilize and benefit from outside of the office (such as deep breathing, sleep hygiene, behavioral activation, disputing cognitive distortions, thought journals, activity scheduling, etc.).

 

From your perspective, what are the benefits to this kind of collaboration? In other words, benefits not only for the professionals involved, but for the patients/clients too.

There are multiple benefits to this kind of collaboration. We believe that in most cases, the first call that patients make when they are not feeling well is to their family doctor. On some occasions, they are being seen by their family doctor for a physical health issue. However, in the midst of assessment, they may reveal an emotional problem or talk about a significant stressor that is causing psychological distress.

This is because for the most part, individuals attend treatment with a primary care doctor whom they trust. Maybe they have been seeing this doctor for most of their life. They have learned to confide in this doctor quite often. Therefore, they may be more open to acknowledging emotional problems within that office setting.

The type of collaboration that we facilitated reinforces the importance of integrating psychological education and coping skills practice into a primary care setting. For professionals, it improves the continuum of care and reduces the stigma of mental health problems. Ongoing behavioral health collaboration, and having a behavioral health component to primary care treatment, implies that psychological distress is a natural area of assessment which patients might otherwise be hesitant to acknowledge or discuss. In this way, patients can become more open to behavioral health support and more accepting of their need to seek outpatient therapy to further resolve symptoms.

 

What advice or tips would you give to counselors who might want to collaborate with medical professionals, like you did, in their local area?

We would suggest that mental health professionals in all parts of the country consider developing a presentation on one particular area of therapy and/or psychological education that you feel passionate about [and] which you also utilize with the clients you serve. The goal is to develop a component of that theoretical orientation that is applicable to a primary care setting. It has to be something that primary care physicians can utilize within the short amount of time that they have with their patients.

We found that in our lecture, doctors were most interested in the practical applications of CBT as it pertains to the acute management of anxiety. We assume that other helpful topics may be closely related to dialectical behavior therapy [and] concepts such as mindfulness, distress tolerance and opposite action.

 

Is this something you think that counselors could or should do more of? What did you learn through this process?

As a result of providing this lecture, we learned that primary care doctors are very much interested in behavioral health support and assistance. It seems as though there has been an increase of patients presenting to family physicians with emotional problems. The doctors that we spoke with were very thankful for the background on CBT and the skills practice that we provided. In fact, they practiced some of the skills with us.

It reminded us that regardless of the [health] profession, we all will be most effective [with] our patients if we are also taking good care of ourselves. Integrating behavioral health support, psychological education and coping skills practice into a primary care setting reinforces the importance of seamless multidimensional treatment, ultimately helping patients to receive effective care that addresses their physical and emotional needs, and offers the safety to accept the behavioral health treatment that they may otherwise be hesitant to pursue.

 

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Ballantyne and Ulsh can be contacted via email:

Brandon.Ballantyne@towerhealth.org

Kevin.Ulsh@towerhealth.org

 

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Related reading, from Counseling Today:

Integrated interventions

The counselor’s role in assessing and treating medical symptoms and diagnoses

When brain meets body

 

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Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

 

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