Monthly Archives: March 2019

Inviting young people to talk about mental health

By Jonathan Rollins March 29, 2019

Lady Gaga is known for her candor and openness when it comes to speaking about her struggles with mental health. But as her mother, Cynthia Germanotta acknowledges that she didn’t initially understand why her famous daughter felt compelled to share so candidly — and without prompting — from the stage.

Over time, however, Germanotta’s perspective changed, especially as she began noticing that when Lady Gaga recounted her struggles, there was almost a visible sense of relief on the faces of many of her fans. “What I came to realize is that [in sharing these details], she was healing and her fans were healing. … I think the fans eventually came to hear her message of resilience and courage as much as the music.”

Speaking in front of approximately 4,000 attendees during her keynote talk Friday morning at the American Counseling Association 2019 Conference & Expo in New Orleans, Germanotta said that experience was the genesis of the Born This Way Foundation, a nonprofit that she and Lady Gaga co-founded in 2012 to empower youth and to eliminate the stigma around mental health.

Today, Germanotta said, she and the other Born This Way Foundation staff members “spend our days inviting conversations around mental health.” One of those staff members, Executive Director Maya Enista Smith, joined Germanotta on stage to facilitate the keynote presentation.

Germanotta shared some of her famous daughter’s backstory, telling the audience that when Lady Gaga (real name, Stefani) was in middle school, she faced a significant degree of taunting and humiliation. This caused her to question her self-worth and resulted in struggles with depression and trauma. These experiences “followed her to high school and college,” Germanotta said, and continued to plague her into her adult life.

As she found her voice, however, Lady Gaga decided to channel that hurt into helping others. She told her mother that she wished she had been better equipped to deal with life’s struggles as a young person and had a desire to give today’s youth the necessary tools to do what she couldn’t at the time.

According to Germanotta, in research conducted through the Born This Way Foundation, access to care (particularly access to affordable care) and simply not knowing where to turn for help are among the top issues impacting youth mental health. In one of the foundation’s studies, it was found that more than 90 percent of youth said they valued their mental health (even more than said they valued their physical health). However, less than 50 percent reported feeling that they had the tools to practice good mental health or knew where to turn for help.

“It’s important to treat mental health; it’s even more important to foster it,” Germanotta said.

Part of overcoming this barrier is simply inviting young people to have conversations around mental health and then giving or pointing them to the tools they need to help themselves and their peers. One of the Born This Way Foundation’s initiatives has been developing a Teen Mental Health First Aid program, developed in partnership with young people, that will be piloted in eight schools later this year.

One of the best things that parents can do — including parents who just so happen to be counselors — is to talk to their children about mental health, Germanotta said. She acknowledged that these discussions can sometimes be awkward, but “normalizing that conversation around mental health” can be a huge source of support for young people and provide them many of the tools they are missing. She also recommended that parents model this talk around the dinner table, “being very honest and open about your own issues and stressors.” One of the main reasons that teenagers don’t turn to their parents for help with mental health struggles is because they don’t hear their parents share about their own challenges openly, Germanotta said.

As for steps that counselors can take, Germanotta again stressed that “young people are struggling with not knowing where to go for that help. … Help them find you, what you do, and what resources are available to them.”

She also said that “one size does not fit all concerning what the answer or resource might be. You really can’t be prescriptive. … It comes back to meeting young people where they are and understanding their needs.”

Finally, Germanotta gave counselors a reminder: “Check your judgment at the door when talking to young people.” Feeling judged is one of the biggest reasons that young people choose not to open up and talk to adults about their struggles, she said.

Germanotta also invited counselors to partner and collaborate with the Born This Way Foundation in reaching young people. “It’s going to take us all,” she said. “We can’t do this alone. … The hope that I have is that this issue is being more recognized every day on a larger scale.”

When Lady Gaga was in college, some of her fellow students started a Facebook page called “Stefani Germanotta Will Never Be Famous.” Perhaps they didn’t realize how hurtful their words and actions might be to a young woman’s emotional and mental health. Regardless, they certainly missed the mark when it came to prognosticating the future Lady Gaga’s worldwide level of recognition and influence.

Fortunately, Lady Gaga is passionate about using her stage not just to boost her own fame, but to preach a message of resilience, kindness and courage — and to validate that it’s perfectly OK to live with, and seek help for, mental health issues.

Germanotta recounted to ACA Conference attendees what her daughter has told her: “Of course I want to be remembered for my music, but what I most want to be remembered for is helping young people change the world.”

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Find out more about the Born This Way Foundation at bornthisway.foundation

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In her own words

Read more about Germanotta’s perspective and experience through two articles she has written:

 

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Jonathan Rollins is the editor-in-chief of Counseling Today. Contact him at jrollins@counseling.org.

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

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

 

Bundle of joy?

By Bethany Bray March 28, 2019

What day of the week is it?” “Why can’t I get my baby to stop crying?” “Did I take a shower this morning, or was that yesterday … or the day before?” These are the types of questions that parents — and especially mothers — often find themselves asking in the foggy, exhausting and often-overwhelming months that follow the birth of a new baby.

“The first three months [of motherhood] are a twilight zone,” says Susannah Baldwin, a licensed professional counselor (LPC) who is the founder and director of a Greenville, South Carolina, counseling practice that specializes in maternal mental health. “Some people call it the fourth trimester, but I call it the twilight zone phase. … They go from working to, boom, they have a baby and don’t leave the house for two weeks.”

Regardless of whether the child is the woman’s first or fifth, the postpartum period can be characterized by the presence of unique mental health needs and challenges. In addition to learning (or reacclimating to) the ropes of parenting and bonding with a new baby, mothers must adjust to changes in their identity and to different pressures on their relationship with a partner and the family system as a whole. Navigating this major life change is made more difficult by sleep deprivation and by bodies that are undergoing the biological and hormonal shifts associated with not being pregnant anymore.

Counselors can play a vital role in preparing clients for this “twilight zone” and normalizing the often anxiety-provoking challenges that accompany the postpartum period. One of the most important things counselors can do for postpartum clients, Baldwin says, is to create a welcoming space and foster a therapeutic bond so that these mothers are comfortable talking through the good, the bad and the ugly of their experience. This includes bringing to light the irrational, fearful and sometimes shame-inducing thoughts that can be part of new motherhood.

These challenges are amplified for mothers who have a pre-existing mental illness, who don’t have a stable partner or strong family supports, or who are part of various at-risk populations, including those living in poverty. Clients who already struggle with self-doubt, negative thought patterns, unprocessed trauma or other issues related to mental illness may find it overwhelming to assume the role of caregiver for themselves and for an infant, says Baldwin, whose practice serves clients going through issues related to infertility, pregnancy, traumatic childbirth or postpartum distress.

Postpartum “is such a critical time,” says Baldwin, a practitioner certified in perinatal mental health. “If existing issues are left untreated, it will affect their attachment and entire [parenting] experience. Do not underestimate that this is a time of gravity in a new parent’s life. Really attend to that and keep it in mind.”

Baby blues

It is normal for new mothers to experience periods of worry or sadness in the days and weeks following the birth of a baby. If these feelings intensify or last longer than a few weeks, however, it may be a sign of postpartum depression.

The Centers for Disease Control and Prevention reports that 1 in 9 mothers nationwide experience depression either in postpartum or peripartum, which includes the period of pregnancy through and after the birth of a baby. Peripartum depression is the more accurate term to use because symptoms can begin during pregnancy itself, not just after the birth, notes Isabel A. Thompson, a licensed mental health counselor in Florida who is writing a book for mental health practitioners on strength-based approaches for working with clients with peripartum depression.

Counselors working with clients who are pregnant or are new mothers should listen carefully for potential indicators of peripartum depression. According to the organization Postpartum Support International, these red flags can include:

  • Crying and having persistent feelings of sadness
  • Feeling ambivalent toward the baby
  • Feeling numb, angry, irritable, guilty, restless or hopeless
  • Worrying about or having thoughts of harming the baby or oneself

Thompson, a member of the American Counseling Association, recommends that counselors conduct periodic wellness check-ins with all peripartum clients. This action helps screen for peripartum depression and mood disorders but can also identify other areas in which these clients are struggling. Check-in questions can include:

  • How is the client feeling in her relationship with a partner (if applicable)?
  • How much is the client socializing?
  • How is the client’s physical health? Is she eating regularly and sleeping when she is able?
  • Is the client feeling connected to her religion or spirituality (if applicable)?

“Also ask about her sense of meaning and purpose,” suggests Thompson, an assistant professor in the counseling department at Nova Southeastern University. “Sometimes in the day-to-day slog of caring for an infant, it’s easy to lose your sense of meaning. Bring her back to why she wanted to be a parent in the first place.”

Isolation can also come into play for new mothers. “Before,” Thompson says, “they were working and having social contact, and now they’re home alone. Help her find ways she can reintegrate with previous friendships and find support with other parents.”

Tools for the journey

The estimated prevalence of peripartum depression in the United States ranges from 8.9 percent of women during pregnancy to as much as 37 percent of mothers during the first year after birth of a baby. These statistics were included in a February 2019 JAMA article that recommended counseling — specifically cognitive behavior therapy (CBT) and interpersonal therapy — as an effective means of preventing perinatal depression.

The journal study, conducted by a government task force, compared the effectiveness of CBT and interpersonal therapy versus the effectiveness of physical activity, the use of antidepressants, omega-3 fatty acids, and other supportive and behavioral interventions such as infant sleep training and expressive writing. Researchers found the two therapy methods to be most effective in preventing perinatal depression, especially for mothers with a history of depression or “certain socioeconomic risk factors” such as poverty or single parenthood. Women who received either CBT or interpersonal therapy during the study were 39 percent less likely to develop perinatal depression than those who did not receive counseling.

The anxious and fearful thoughts that often come in pregnancy and postpartum can generate a barrage of new cognitive distortions, says Quinn K. Smelser, an ACA member and LPC in Washington, D.C., who is working on a doctoral dissertation about parent-child attachment and the Marschak Interaction Method. Teaching clients to challenge these distortions — such as through the help of CBT — can greatly enhance their ability to cope and persevere through the challenges of peripartum.

Smelser, who presented a session on attachment and maternal mental illness at the ACA 2018 Conference & Expo in Atlanta, says that person-centered approaches, mind-body interventions, breathing techniques and mindfulness can also be helpful with this population. Likewise, grounding techniques can be beneficial, but Smelser cautions counselors to remember that a woman’s body will process sensations differently as she progresses through pregnancy and postpartum. For example, Smelser had a client who found that pressing her feet into her shoes helped her to center herself — until she was about six months pregnant and the exercise just became painful.

Thompson notes that narrative therapy can also be helpful for new mothers. Each woman’s experience of conception, pregnancy, birth and postpartum will be different — and can range from easy to miserable. Having the client tell her story, whether it involved an unplanned cesarean section or was a long-awaited miracle after struggling with infertility, can help her process the experience, Thompson says.

Remember also that the childbirth experience itself can be traumatic and might require processing with a counselor. Thompson suggests having clients talk through or write (if they prefer) how the entire pregnancy, birth and postpartum period went for them and what they wished had been different.

A population at risk

When it comes to clients who are pregnant or new mothers, counselors’ first instinct may be to screen for signs of peripartum depression. That’s wise, given how common it is. But this population is also at risk for a number of other issues, from social isolation and burnout connected to exhaustion, to guilt and other emotions related to wanting — or not wanting — to return to work after maternity leave.

Baldwin, a co-author of the ACA Practice Brief on peripartum and postpartum anxiety, separates the issues that these clients are at risk for into three categories: perinatal distress, interpersonal distress and relationship distress.

Perinatal distress includes the classic symptoms associated with peripartum depression or anxiety, such as crying and sadness, but it extends to anything that is interfering with aspects of everyday life such as eating, sleeping, relationships or home life, Baldwin explains. For example, a mother with perinatal distress may be so worried that her baby is going to stop breathing that she stays up all night watching the child sleep. Or she stops checking the mail because there is a steep hill leading to her mailbox, and she’s afraid the baby might somehow fall out of the stroller.

Risk of isolation also falls under this category. An example is a mother who fears taking her baby out in public because it’s flu season, Baldwin says. “In American culture, we are driven to be independent and individualistic, and that drives parents to feel like they have to do everything alone. If they ask for help, it’s seen as a shortcoming,” Baldwin says. “The biggest threat [that can lead to isolation] is the cultural belief that you’re supposed to do this without anyone’s help.”

Interpersonal distress involves issues related to a woman’s changing identity and her transition to motherhood. Similar to what people experience during a midlife crisis, new mothers may feel generally unsettled in life. They may wrestle with difficult thoughts such as “I love my kid, but I don’t love this role” or “This isn’t what I thought it would be,” Baldwin says. This sense of unease can arrive with a first baby or a later birth.

“These crises come from subconscious places. [Mothers] don’t realize why they’re upset or unsettled,” Baldwin says. “They may find themselves making rash decisions. All the sudden, they have an awareness of a gap or hole that must be filled, and they don’t know what to do but try and fill it in.”

Relationship distress involves the new pressures that come when baby makes three (or four or five). Couples often assume that having a baby will make them stronger and create the family that they always wanted, Baldwin says. “But it can be the opposite if we’re not attentive to it. It’s so often underestimated, the huge impact that adding a child or dependent to a family will have,” she says.

Babies often provide lots of joy, but the simple reality is that they also exert a substantial drain on a couple’s finances, time and personal energy — all of which can affect the relationship dynamic. Clients may report feeling distant from their partner or struggling with a lack of intimacy after having a baby, Baldwin says. She adds that those struggles don’t revolve just around sex but also around finding time alone or experiencing a loving connection.

“Couples often put themselves on the back burner” when a new baby arrives, Baldwin says. “They haven’t been on a date in six months. Or perhaps they’re not fighting but only talk about bottles and play dates and not about other things. … Resentment and bickering over tasks — that’s what often brings people to therapy.”

Smelser, a trauma and play therapist at the Gil Institute for Trauma Recovery and Education in Fairfax, Virginia, notes that peripartum clients and their partners are at risk for developing unhealthy patterns in their relationships. Examples include not making time for each other, having vastly different parenting styles, not dividing up responsibilities in an equitable manner, and getting so ingrained in certain roles and patterns that all flexibility is lost. If not addressed, these issues can create tension and grow into larger problems later in the relationship, Smelser says.

Counselors can broach the subject by asking questions about a client’s dynamic with her partner, Smelser says. Prior to having a baby, the client may never have seen her partner with a child or in a caregiving role. How she perceives her partner now may need some therapeutic attention, Smelser says. In cases of a pre-existing mental illness, counselors should stress the importance of these clients getting the support they need so that they can focus on themselves and engage in self-care.

“There’s so much opportunity to psychoeducate a pregnant client or new mom,” Smelser says. “They just need help adjusting. Really deep dive into that rather than glossing over how stressful new motherhood is. Don’t dismiss it [as a clinician]. Really talk about it and validate those feelings.”

How counselors can help

Do you know the difference between a doula and a midwife? How about what organizations offer postpartum support groups in your community? Are you comfortable conferring with a client’s OB-GYN if she has questions about taking antidepressants while breastfeeding?

Counselors don’t have to be parents themselves to offer empathy and a listening ear to peripartum clients. Becoming familiar with and sensitive to the unique needs of this population can make a major difference to mothers who are struggling.

> Make a plan: During pregnancy, help these clients create a safety plan to ensure that both they and their babies get the support they need in the months ahead. This is important for any mother, but it is vital for those with pre-existing mental illnesses, Smelser says. Counselors should discuss what steps the client would take to keep herself and her child safe were she to find herself in crisis and unable to manage. Identify the supports that she can rely on ahead of time. Also talk through what her therapy plan will look like with an infant at home. What might her needs be, and what should she focus on in counseling?

“Stopping therapy for a few months because of the demands of motherhood is the absolute last thing we want to happen,” Smelser says. “Plan on how and when she will give herself breathers. Will it be a neighbor taking the baby for 30 minutes while she goes for a walk? What does she do now to regulate [her mental health], and how can we ensure that it still happens? Make sure the mother has lots of support so she can take a break if she needs to, to help her better regulate to return to caring for the child. Even an hour a day for self-care, that can be vitally important.”

> Identify supports: Counselors should familiarize themselves with the parenting and maternal support groups — especially those geared for participants with a particular mental health diagnosis such as depression — in their local areas. If one doesn’t exist, Smelser suggests counselors consider starting a group themselves.

Thompson advises counselors to also be aware of lactation consultants, breastfeeding support groups, and pelvic floor and other women’s/maternal health specialists in their communities. In addition to birth doulas, there are also postpartum doulas who can support mothers in the weeks after a birth, she notes. Also, counselors can help connect clients who are struggling financially with programs that provide food and other assistance to new mothers, including the federal Special Supplemental Nutrition Program for Women, Infants and Children (WIC).

Some mothers may not feel comfortable sharing their struggles in a support group format, Baldwin notes. She suggests that play groups and other child-focused activities can offer an alternative that helps these mothers find social support and meet parents who are facing similar stressors. Counselors should also be aware of parenting classes, moms groups and exercise classes for mothers at local houses of worship, community centers or medical centers.

Baldwin also encourages counselors to become familiar with Postpartum Support International (postpartum.net), an organization that provides various resources and maintains local networks across the country.

> Focus on strengths: A new mother may experience feelings of inadequacy when a new baby arrives and she struggles with seemingly simple tasks such as figuring out her baby’s sleep schedule. First-time mothers especially may have thoughts such as “Why can’t I do this?” or “I have a Ph.D., but I don’t know how to help my baby stop crying,” Thompson says. These assumed inadequacies can spur feelings of guilt, shame or anxiety.

Counselors can help by normalizing clients’ experiences, Thompson says. Explain that it’s routine to struggle, and there are nuances to learning a baby’s needs and preferences. In addition, counselors can highlight clients’ strengths and focus on what they are doing well, she says.

“Help her identify her strengths, even if she’s not feeling them currently. How did she feel strong before she had the baby? How can she reconnect with that?” Thompson says. “Ask questions in a way that can help [her] identify the differences between caring for an infant and succeeding at work. Explain that it’s a totally new role, and validate that it will be hard: ‘You are used to being able to accomplish things easily, but now even taking a shower requires you to wait for your husband to get home from work.’ Normalize those challenges.”

Smelser tells clients that it’s normal for all parents — including those without pre-existing mental health issues — to feel like they’ve reached their wits’ end at times. “Recognize those moments as just thoughts. It’s just a moment and will pass,” Smelser says. “There are so many shoulds, such as ‘I should be able to handle this.’ Identify that as a cognitive distortion and equip the client with tools to handle it.”

> Ask the right questions: Baldwin suggests that counselors start by asking peripartum clients general, broad questions and then “follow the trail” to identify areas where they are struggling and need more therapeutic work or support outside of counseling. Have them discuss life “before” and “after” the baby: How are they sleeping? How often do they get time to themselves? How is their relationship with their partner?

“Depending on how open they are,” Baldwin says, “ask more specific questions, such as ‘When was the last time you talked [with your partner] about something other than the baby, chores or errands? Do you have a ritual in place for spending time together and connecting?’ Depending on their answer, go down the trail and ask more: ‘How often do you bicker? How often do you feel you’re parenting solo?’ One of the biggest challenges is that prioritization. The baby and the bills and the stuff gets prioritized.”

Follow up with more leading questions, Baldwin suggests, such as “Tell me how much of your energy goes into worry. Who in your life helps you out emotionally, practically and socially? Do you have people who can help you in all three areas?”

One of the most important questions counselors can ask, Baldwin adds, is whether a client has a family history of postpartum depression.

> Explore expectations versus reality: Exploratory questions can also help clients work through expectations they might be harboring (either consciously or unconsciously) about parenthood, Baldwin says. She suggests asking, “Where did you imagine you’d be at this point, and how does it compare to where you are?”

“Perhaps they always imagined loving staying home [with a baby], and it turns out they hate it. … Expectations can get people in trouble,” Baldwin says.

Control issues can stem from creating an expectation — such as planning to breastfeed or have a natural birth — that goes unmet due to factors outside of a client’s control, Baldwin says. Clients who have perfectionist or Type A tendencies may struggle in this area. Counselors may need to help these clients understand that having a baby is simply not a controllable experience, she says. It’s not as simple as making a plan and sticking to it.

> Discuss returning to work: Counselors can play a key supportive role as clients navigate emotions surrounding the decision of whether to return to work. Remind clients that there is no right or wrong decision and that nothing is permanent: If they return to work and find themselves overwhelmed, they have the power to make changes, Baldwin says.

“The whole point of questions on this subject is to empower them to realize that they choose their job, their lifestyle,” Baldwin says. “Ask them, ‘What are your plans for returning to a job?’ I don’t even say your job. If they express hesitation or distress, then I’ll focus on it and ask more questions: ‘How did you imagine it would be? How did you imagine it would feel to drop your child off at day care?’”

Counselors can help clients who have made the decision to return to work prepare both mentally and practically. Baldwin suggests that clients do a “dry run” long before their first day back. This includes waking up early and getting themselves and their child ready as if they needed to leave by a certain time to make the drop-off at child care. “Going back to work doesn’t have to be this big ominous day,” Baldwin notes.

> Work on your vocabulary: Do you know what a nipple shield is? When was the last time you walked down the baby aisle at Target? Unless a counselor is familiar with a new mother’s world, that mother isn’t going to feel comfortable disclosing feelings that are intense, personal and sometimes scary in therapy sessions, Baldwin says. Counselors who don’t specialize in maternal mental health should bring themselves up to speed on current birth and parenting practices to connect with peripartum clients. Postpartum Support International has a page of resources for practitioners on its website and offers a certification in perinatal mental health.

Counselors should also be aware of the different options for childbirth, adds Thompson, who presented a session on breastfeeding and peripartum depression at the ACA 2017 Conference in San Francisco. Babies are born today in hospitals, at home or at birth centers with a range of support professionals, from midwives to nurses, all of which have different philosophies.

> Focus on attachment: Counselors who are working with postpartum clients should be mindful of the importance of the mother-infant bond and provide support for mothers who are struggling in this area. Research suggests that the bond formed through breastfeeding can be protective for mothers and reduce symptoms of peripartum depression, Thompson notes. However, many mothers are unable to breastfeed for various reasons, so counselors should frame questions on this topic carefully to avoid inducing guilty feelings. In addition to breastfeeding, mothers and infants can bond through skin-to-skin contact, by making eye contact while bottle feeding and in other ways, Thompson says.

Maternal mental illness — and untreated mental illness in particular — has the potential to affect the attachment bond, which can have negative implications for a child’s cognitive development and relationship patterns later in life, Smelser says. Counselors can ask questions to get indications of how well mothers are connecting with their babies. “How does she react when her child cries? Are there moments in the day when it’s harder?” Smelser says. “If she has a baby with colic, she may need a space where she can simply be honest and say, ‘It’s awful.’ Can she soothe her baby? What’s working and not working? Is she figuring [her child] out?”

Counselors can also normalize these struggles and stress to these clients that it is OK to ask for help whenever they need it, Smelser adds.

> Talk about medication: Many psychiatric medications have different risks and side effects when taken during pregnancy, breastfeeding and postpartum. Counselors must make sure that their clients are communicating with their prescribers, Smelser emphasizes. Counselors should also check in regularly during counseling sessions about clients’ medication management and how medications are affecting their mood. If granted permission by the client, counselors can also check in with the client’s OB-GYN and other medical professionals.

“Make sure everyone is talking to one another and that the mother is getting all the information she needs from her prescriber. Help and empower her to advocate and ask questions,” Smelser says. “Connections between practitioners — a client’s OB-GYN, prescriber and counselor — are not always that great. Medical professionals don’t always ask [patients] about mood or mental wellness. In an ideal world, all these people would be housed in the same space, but we are not there.”

Thompson also stresses the need for regular check-ins with clients about medication usage. Clients should discuss any changes in dosage with their prescribers, weighing the possible risks of taking the medication during pregnancy or breastfeeding against the risks to their own wellness if medication is reduced or not taken, she adds.

> Be baby friendly: Allowing and even inviting mothers to bring their newborns into counseling sessions can go a long way toward helping them feel supported and understood, Thompson notes. Finding child care can often be a barrier to treatment. When it comes to referrals, counselors should look for inpatient programs that allow new mothers to attend with their child, she adds.

> View mother and baby as one unit: In the United States, medical professionals often place greater focus on an infant’s health in the first few months of life. In reality, Thompson asserts, the mother’s and baby’s health are intertwined, and counselors should keep this in mind.

“During pregnancy, they were literally one unit, and only recently have become two. Emotionally, they’re still so bonded. That connection needs to be honored,” she says. “Addressing any mental health needs the mother has will automatically help her connect with her baby. If she is struggling with mental health, she will be less responsive to her baby’s facial cues and expressions. Healthier moms mean healthier babies.”

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Contact the counselors interviewed in this article:

 

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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:

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

Use your ACA member login to access practice briefs on postpartum posttraumatic stress disorder, peripartum and postpartum anxiety, and peripartum and postpartum depression.

Counseling Today (ct.counseling.org)

ACA Interest Networks (counseling.org/aca-community/aca-groups/interest-networks)

  • Women’s Interest Network

 

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Bethany Bray is a staff writer and social media coordinator for Counseling Today. Contact her at bbray@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.

Establishing a private practice

By Laurie Meyers March 22, 2019

“If you build it, they will come.” Most of us are familiar with this popular misquote from the movie Field of Dreams (the actual quote is “he will come”), in which a ghostly voice urges Kevin Costner’s Iowa farmer to build a baseball diamond in his cornfield. Following through on this vision despite the risk of bankruptcy, Costner’s faith is eventually rewarded when he gets the chance to reconcile with his deceased father and multitudes of fans start flocking to his “field of dreams” to watch baseball games.

It’s an attractive and enchanting thought: Give the people what they want (or need), pursue your dreams, and the rest will follow. However …

Remember the dream part? In real life, establishing a small business such as a private counseling practice requires a lot of preparation, planning and ongoing maintenance. Being a good clinician is not enough. Counselors who have established their own practices say that the other major requirement for success is business skill — and more of it than many of them expected they would need.

How will you market your practice? Who will do the scheduling and billing? File the paperwork? Balance the books? These are just a few of the questions counselors need to consider as they contemplate establishing a private practice.

Counseling Today asked four American Counseling Association members with experience in private practice to share their stories, their lessons learned and tips for others in the profession who might be looking to strike out on their own.

 

Tapping into the power of the internet

Ryan Thomas Neace, a licensed professional counselor (LPC) and founder of Change Inc., a private practice located in St. Louis, first discovered his entrepreneurial spirit when he established himself as a local DJ at age 15. Neace started working in entry-level mental health positions during his first year of graduate school, and over the course of eight years gained experience in residential, agency, school, in-home, college and community counseling. Along the way, he discovered something crucial: He was an excellent clinician but a terrible employee.

“I tended to do first and ask forgiveness later, whether or not it coincided with what I thought management might want, because I typically thought my ideas were better and less bound to inside-the-box thinking,” Neace says. “I was right, I think, but it wasn’t a very good way to
stay employed.”

Fortunately, Neace’s entrepreneurial spirit and good connections put him on the path to self-employment. “In the course of all of that action [working in numerous counseling environments], I had latched on to a mentor who saw a lot of promise in me and recognized I was gifted in some ways he was not — business acumen, administration, etc. — and he asked me whether I’d consider starting a private practice with him in Virginia. We started brainstorming, and that was that. He put up about $10,000 for office furniture and technology, and we found the space we liked.”

Neace and his mentor co-owned and ran the practice together for several years, but, eventually, both wanted to move to different areas of the country. “I moved back to St. Louis in 2013 and started my first sole ownership practice there,” Neace says. “Five years later, it has two locations, 12 therapists, several support staff, and we’re conducting approximately 700 client sessions per month.”

Although Neace’s move was obviously a success, he acknowledges that it took a substantial amount of hard work and planning to achieve. “About 18 months before I moved back to St. Louis, I started looking online at where all of the counseling practices were,” he says. “I noticed that there tended to be a large accumulation of practices in the western county parts of the metropolitan area but not a ton in the up-and-coming urban areas that for several years were being revitalized and developed. While the county regions were clearly where a majority of the local wealth was, I decided that if I priced our services effectively, there was a decided advantage to being more local to the city itself. We could pick up [gain] residents who were tired of driving to the county for mental health services, and we could even get county residents who were dissatisfied with the kinds of therapists who dominated the landscape in their neck of the woods or [those residents] who worked in the city and might find the idea of getting therapy in the city attractive from a convenience standpoint — [for example] on their lunch hour — or from the perspective of having a bit of geographic distance between themselves and their therapist’s location.”

During this period of research, Neace was also building a website for his practice on WordPress. He already had some experience working with websites, and anything that he didn’t know, he found through online tutorials or support forums. Recognizing that the most essential part of having an online presence is showing up in search results, Neace sought help from a friend who was an expert in search engine optimization (SEO).

The friend taught Neace how to ensure that Change Inc. would show up whenever someone searched online for terms such as “St. Louis____ (anxiety, depression, LGBTQ, etc.) counseling.” Three to six months before Neace was even scheduled to make the move to St. Louis, he was already getting one to two phone calls per week from prospective clients. One month before Neace opened the doors to his new practice, he already had his first few clients scheduled.

Today, Neace’s practice continues to focus on SEO even as it has developed a stream of referrals from previous clients and area clinicians with whom Neace has built relationships. Change Inc. has also taken a nontraditional approach to marketing.

“Instead of spending money on traditional print or other marketing efforts, we partner with other small businesses — typically nonprofits — that have a mission we feel is supportive of our own and that reach a target demographic similar to our own,” Neace says. “We offer these organizations financial support in exchange for direct marketing opportunities to their target audiences and brand association, [such as] event or web advertising where our brand and their brand is featured together in a prominent way.”

Neace acknowledges that owning his own practice can be demanding, but for him, it produces less anxiety than trying to work within someone else’s confines. “Certainly, owning a practice increases the stress, though I think it’s a qualitatively different kind of stress,” he says. “Perhaps the most prominent difficulty in ownership for me is the heightening of my personal sense of loneliness, in that no one sees how much I’ve risked or how hard it can be, simply by virtue of the fact that they aren’t owners. But if you’re an entrepreneur of my kind, it is a labor of love where the rewards far outweigh the additional stress.

“Again, I’m highly motivated by the autonomy and independent decision-making, as well as the notion that each decision I make stands to increase my interests financially and otherwise. And I love getting to create an environment that prioritizes the elements of counseling that I believe are most important to transformational clinical work.”

When asked what advice he would give to counselors interested in setting up their own practices, Neace emphasized the following:

  • “Learn and implement SEO like your life depends on it. People should be able to search ‘Your city, Your industry, _____’ and you come up in the top five every time.”
  • “Find someone you trust who has a business that is thriving and ask them every question [you have]. Trust that if you are annoying them or if they don’t want to answer, they will tell you. Otherwise, be totally relentless about learning from them.”
  • “Remember that most people selling business how-tos are actually in the business of selling business how-tos, not in the business of having a successful, meaningful business. Most of the good information is free [from] mentors/friends … or next to free [from] books.” (Neace particularly recommends The E-Myth Revisited: Why Most Small Businesses Don’t Work and What to Do About It, by Michael Gerber, and Built to Sell: Building a Business That Can Thrive Without You, by John Warrillow.)
  • “Don’t be bogged down by convention. Do it the way you want to unless it absolutely makes no [financial] sense. Expect that people will tell you you’re breaking the rules and to generally be appalled that you have the audacity to think outside the box.”
  • “When you get scared and want to quit, run the numbers. Calculate the amount of money you need to keep the business afloat each month, and let that be your true north.”
  • “It helped that I had a side hustle [adjunct teaching online]. On the other hand, eventually it will eat into your ability to do the business. There’s definitely something to being all-in. If you keep a side hustle, keep one that doesn’t give you enough to live on. Let the hunger you feel drive you.”
  • “Don’t try to have everything at once. For the first two years, I worked in a space with old carpet and paint, three empty offices and a waiting room with the couch from my basement and some chairs I bought off Craigslist. Rome wasn’t built in a day.”

 

Knowing your strengths and maintaining flexibility

“In my 25 years as a therapist, I’ve been in and out of private practice depending on the needs of myself and my family,” explains Keri Riggs, an LPC currently practicing full time in the Dallas area. “So, I’ve worked full time as executive director of a nonprofit and full time as an intensive outpatient coordinator at a hospital. I always wanted to keep my hand in counseling, so I often contracted through agencies or under other therapists or had a solo practice while still being employed.”

“I believe when counselors are just starting out, the decision about solo practice depends a great deal on their economic or marital status,” Riggs says. “If you have a stable family income with benefits, your options are different than if you are a single parent or sole income provider for your household.”

Riggs cautions others to think carefully about giving up additional sources of income while building a practice. “I … regretted quitting my part-time agency work while building my practice. I only made $17,000 that year, and it was the toughest year ever,” she says.

Riggs has used a variety of methods to attract clients. “I see many resources on Facebook or online promising people can have a flourishing full-pay, noninsurance practice within a year, but that hasn’t been my experience,” she says. “I believe it depends on demand in the geographical area [and whether] a counselor elects to accept insurance or employee assistance program work.”

In Riggs’ experience, it usually takes two to three years to build a full practice. “I do believe it’s valuable to network and to have a niche but also not to over-focus on that,” she says.

However, Riggs does recommends that counselors focus their marketing efforts. “Don’t just send flyers to doctors’ offices. They end up in the trash before a doctor ever sees them,” she says. Instead, she advises that private practitioners find ways to speak directly to their target client populations, such as by holding workshops or giving presentations at service organizations.

Riggs enjoys running her own practice but grants that being a CEO and a counselor is a tough balancing act. “There’s a saying: You can’t work on the business when you’re working in the business. So, if I’m seeing clients, I can’t be working on marketing, billing/accounting, networking, blogging.”

In addition to seeing clients and running the business side of things, it’s essential that self-employed counselors continue to devote time to self-care, Riggs says. “I’ve discovered my magic number of clients I can see in a row and in a day,” she says. “I’ve blocked time in my calendar as I’ve gotten busier to eat, return phone calls and do administrative tasks. Occasionally, I block a mental health day for myself and spend time with non-therapist friends.” Peer consultation is also essential, Riggs adds.

Riggs doesn’t have office support staff but does outsource certain tasks. She employs an accountant and someone to manage her website and consults with a social media expert. She does her own scheduling, billing and filing of health insurance claims with a little technological assistance. Riggs uses practice management software that allows clients to schedule online, sends clients appointment reminders, bills insurance, posts payments and even provides a central place for Riggs to take progress notes and write treatment plans. “I couldn’t manage without it,” she says.

Not having the luxury of sick time or paid leave as a private practitioner can be difficult, but Riggs thinks the trade-off is worth it. “I love the freedom and I love being my own boss,” she says. “I can arrange to go to the kids’ school or doctors’ appointments or even take a recharge nap on my office couch in between clients if I need to.”

When asked what advice she would give to counselors interested in setting up their own practices, Riggs says the following:

  • “Work with your own personality strengths and weaknesses. If you procrastinate on accounting and hate it but have a talent for writing, spend your time writing and hire someone to help with the financial aspects.”
  • “If you don’t want to deal with the administrative aspects of your practice, don’t. Get with a group [that] provides that for you and willingly pay the costs involved.”
  • “Don’t feel like you have to do everything all at once. Serve the clients you have and serve them well.”
  • “Find a supportive accountability partner if needed, and engage in regular peer consultation with other counselors.”
  • “Be kind to yourself. Keep learning and growing.”
  • “Make sure you have a life outside of work.”

 

Identifying a need and growing into a group practice

Michael Stokes, an LPC and founder of Stokes Counseling Services LLC, in Naugatuck, Connecticut, set up his own practice because he wanted to develop a niche devoted to treating LGBTQ individuals and their families. “There were not agencies focused on LGBTQ services in my area, and this was a significant unmet need in my community,” he explains.

To get up and running, Stokes networked with other counselors in private practice, but he says he owes the most to a former supervisor. “Her guidance around logistics helped me develop a step-by-step process for opening my practice. The first step was finding an office location [and] community I wanted to practice in. This was not difficult since I knew exactly the town where I wanted to set up my practice. From there, I needed to find office space I could afford. Living paycheck to paycheck, I needed something extremely cheap. I cashed in my saving bonds from when I was a baby and used that $500 to secure my lease on the office space. After the office space, I finalized my paperwork [and] insurance paneling and started to let others know I [would] be open for business Oct. 1.”

Like other first-time small-business owners of all stripes, Stokes was unaware of how much business knowledge he would need to run his own practice. “I had no formal training,” he says, “so I dove straight into reading, researching and seeking out experts in the field of private practice.”

Initially, Stokes’ practice was part time, but as he grew more confident with the business side, he decided to go full time. Suddenly, his practice mushroomed.

“When I took the leap into private practice full time in April 2012, I was eager to build my caseload to a place that was comfortable,” he says. “What I found instead was that I was seeing way too many clients, and the referrals were not stopping anytime soon. I was seeing about 40 clients a week and knew I could not sustain that level of practice.” Stokes realized that without additional help, he would have to start turning clients away, which he was loath to do.

“Simultaneously, colleagues from other agencies were reaching out to understand my experiences in private practice and asked if they could start to see a few clients in my office when I was not there. Little did I know, this was my starting point of group practice development. Being able to serve more clients was an amazing experience. As I began to cultivate my group [practice], I knew it was important for me to bring clinicians on who had different styles, theoretical orientations, different niche areas and populations. This allowed us to build a cohesive practice of clinical services. We now have over 50 licensed clinicians who serve thousands of clients in our state.”

Stokes started with a mission of providing help to the underserved LGBTQ community, but he didn’t anticipate just how much private practice would reignite his passion for clinical work. “I was working in clinics and nonprofits throughout my career. Feeling very overwhelmed, overworked [and] underpaid, I was on the path for early burnout,” he says. “Having my own space was empowering because I was able to design a safe place for myself and my clients. To this day, I am a huge advocate for private practice and helping clinicians find success in this arena.”

When asked what guidance he would give counselors who are thinking of setting up their own practices, Stokes says, “My best advice … would be explore all of your opportunities. Have a good handle on who your ideal client is, where you want to serve and what supports you need [to have] in place as you go down the path of private practice work.”

 

Keeping clinical skills sharp as a counselor educator

Misty Ginicola, a professor in the counseling and school psychology department at Southern Connecticut State University, is primarily a counselor educator. She began her career teaching, but decided that she wanted to keep her clinical skills sharp.

“I wanted to be a more effective professor,” she says. “It definitely helps students to have plenty of narratives on how something might work with a client.”

Ginicola, now an LPC with a private practice in West Haven, Connecticut, decided to focus on two specific populations — LGBTQ individuals and highly sensitive people. She purchased a website and started the process of completing the business application process for her town, registering for tax purposes, applying for a National Provider Identifier number, and getting on insurance boards, all of which took longer and proved to be more complicated than she had anticipated. Ginicola says she fervently wishes she had known enough beforehand to find someone with insurance board experience to guide her through the process.

Striking a balance between teaching, consulting on and conducting research projects, doing clinical work and all of her other commitments requires a bit of juggling and a lot of self-care on Ginicola’s part.

“I put limits on the number of clients I take. I only take a maximum of five clients at a time. I also only see clients during times when it will not interfere with family time,” says Ginicola, the mother of two small children and the president-elect of the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling, a division of ACA. “My self-care is vast and it really has to be. I practice pranayama — breathing practices — throughout my day and coherent breathing every night. I practice yoga every day and am a yoga teacher. I teach three times a week, and it really keeps me working on my own wellness, as I have to practice through the week and stay true to my own physical wellness. I make sure to be honest with myself and to communicate clearly with others what I need. I have learned to say no to lots of things that do not bring me happiness or speak to what I feel is my life purpose, or dharma. By really focusing in on those things, I do not feel overwhelmed. Everything I do truly feeds my soul.”

When asked what advice she would give to counselors who want to set up their own practices, Ginicola says, “Really understand that it involves being a business owner, not just a counselor. Therefore, if it is going to be your primary source of income, it takes a lot of work in setting up and retaining a thriving practice. As a part-time practice owner, the demand is not as much to make a good income at it. I can put a limit on my number of clients, I can choose what insurance boards I truly want to work with, and I can specialize in specific issues. I think establishing a specialization is an excellent way to attract clients and gain referrals.”

 

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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:

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

  • “Private Practice: The Ethics and HIPAA of Technology” with Rob Reinhardt and John P. Duggan (WEBA18007)
  • “Private Practice: Building Your Brand” with Deb Legge and John P. Duggan (WEBA17007)
  • “Private Practice: Managing Your Business” with John P. Duggan and Deb Legge (WEBA18002)
  • “Private Practice: Getting Off to a Strong Start” with Deb Legge and John P. Duggan (WEBA17005)
  • “Counselor Risk Management: Counselors and Technology — A Two-Edged Sword” with Anne Marie “Nancy” Wheeler and John P. Duggan (WEBL18005)
  • “Private Practice: Choosing a Best Fit” with Rob Reinhardt and John P. Duggan (WEBA18004)
  • “Ethics and Values in Real-Life Counseling Practice” with Stephanie F. Dailey and John P. Duggan (WEBA17006)
  • “Counselor Risk Management: What You Didn’t Learn in Grad School That Could Lead to a Lawsuit or Licensure Board Complaint” with Anne Marie “Nancy” Wheeler and John P. Duggan (WEBA18001)
  • “Does One Size Fit All? How to Successfully Get and Keep Your Clients” with Janis Manalang (CPA20695)

Counseling Today (ct.counseling.org)

Books (counseling.org/publications/bookstore)

  • The Counselor and the Law: A Guide to Legal and Ethical Practice, eighth edition, by Anne Marie “Nancy” Wheeler & Burt Bertram
  • ACA Ethical Standards Casebook, seventh edition, by Barbara Herlihy and Gerald Corey
  • Ethics Desk Reference for Counselors, second edition, by Jeffrey E. Barnett and W. Brad Johnson
  • The Secrets of Exceptional Counselors by Jeffrey A. Kottler
  • Counselor Self-Care by Gerald Corey, Michelle Muratoni, Jude T. Austin II and Julius A. Austin
  • Cognitive Behavior Therapies: A Guidebook for Practitioners edited by Ann Vernon and Kristene A. Doyle
  • Creating Your Professional Path: Lessons From My Journey by Gerald Corey

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

  • Self-Care

 

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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: Invisible people, Part 1: Native Americans

By Gregory K. Moffatt March 18, 2019

The little girl sitting next to me was no more than 5. Her bony little body was draped in clothes that appeared to have been worn for several days. Unmistakably Apache, she looked up at me and smiled from her seat on the school bus in which we were riding. As is sadly common among children on the sprawling Apache reservation in Arizona, her teeth were rotted off at the gum line.

“Does your daddy hurt you?” she asked me matter-of-factly. After four years of working with these children, I was still shocked at how rampant the ills of society were among these populations. Child abuse, suicide, domestic violence, addiction, unemployment, substandard education, truancy/dropout and, yes, poor dental hygiene are just a few of the problems that are so disproportionately part of the experience of Native Americans who live on reservations.

In traveling the world, I have encountered cultures so vastly different from my own that it is hard to describe them to my friends and family members. You don’t have to leave the United States to have that experience, however. My heart breaks for the lovely people I have met — Apache, Hopi, Navajo — on reservations located within our borders.

Native Americans on reservations are among three groups that I will be addressing in a series of monthly columns on “invisible people.” One or more of these groups may be within walking distance of our counseling offices without our even knowing it.

I live in Georgia, the home of the Cherokee Nation, but many in our state have no idea that the Cherokee people are here. They know the Cherokee only from movies or perhaps because they have seen someone on the roadside in the north Georgia mountains dressed in traditional clothing and offering to pose for a photograph with tourists who are willing to pay a few dollars.

Sadly, the mention of “Cherokee Nation” likely causes many people to think of a sports mascot and not the literal nation of the Cherokee. I sometimes wonder if the average person realizes how many of our states, roads, rivers, cities and towns are named after one tribe or another or are otherwise derived from Native American words. Yet the heritage of these people gets lost in the blur of movie stereotypes, school mascots and advertising caricatures. It’s heartbreaking.

Because Native Americans are often “invisible,” so are their struggles. I suspect the typical American knows more about Middle Eastern culture than about the rich and beautiful cultural heritage of their Native American neighbors who may live only doors away. Native Americans who live on reservations are often inaccessible to those who might try to understand them, and those who live off the reservations possess a heritage that is largely misunderstood by nearly everyone.

Do you know the difference between a Seminole and a Blackfoot, an Apache and a Hopi, or a Cheyenne and a Tonkawa? Did you even know that the Karuk, Wichita, Koi and Kaw are tribes? Seeing all Native Americans as the same is as insulting as assuming that all Spanish speakers are from Mexico.

Misunderstandings abound. For example, for some tribes, feathers are indeed a part of the honor of a headdress. What you probably don’t know is that many tribes would never use a feather as decoration because it is part of what is dead, and that is sacred — not to be worn as jewelry or adornment.

It is next to impossible for tribes to perpetuate their traditions, religions, languages and cultural values as a subset of mainstream American culture. So, they are relegated either to abandoning these things or to moving onto a reservation, where life options for themselves and their children are significantly limited. What a bitter choice to make.

But even in 2019, in a culture in which we have removed cartoons such as the “Frito Bandito” from advertising, some Native Americans are still forced to look at caricatures of themselves in sports team mascots and advertising. If you think that I’m being overly dramatic, watch the documentary In Whose Honor. Only a cold-hearted viewer would not be moved.

I worked for years with Apache and Navajo parents, teens and children on a reservation, but in general, most of them never grew to trust me. I was a white man, so there was no reasonable cause for them to trust me. As we have all been taught in other arenas, distrust is to be expected when you represent the population in power. I have found that it is sometimes easier these days to practice with other minority groups, but not so much with Native Americans.

Unless you have gone out of your way to learn about Native Americans, my guess is that this article has opened some eyes. We pride ourselves on cultural diversity as counselors, but I’m not confident that the blinders we wear allow us to really see how much we don’t see — at least when it comes to the three groups of “invisible people” I am addressing in this series. I hope this first column on invisible people will open counselors’ eyes to what we might be missing.

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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: Wellness Counseling: A Holistic Approach to Prevention and Intervention

Compiled by Bethany Bray

“Each area of an individual’s life inevitably affects other areas,” write Jonathan H. Ohrt, Philip B. Clarke and Abigail H. Conley in the preface to their new book Wellness Counseling: A Holistic Approach to Prevention and Intervention. Mental health practitioners who target a treatment plan to only one aspect of a client’s life “neglect to recognize the interplay/interconnectedness of the different components that compose the well-being of our clients.”

“When I am counseling a client and reflect on the wellness model during an intake session or goal setting, I am prompted to ask not only about the presenting concern but also about factors such as the client’s religion/spirituality; gender; and physical, emotional, social and mental well-being,” Clarke explains in the books first chapter.

With that in mind, the authors write, it is imperative that counselors are able to articulate the profession’s connection to wellness, both to their clients and to other professionals. After all, the term “wellness” is in the very definition of counseling and is “an inextricable part of our professional identity,” write Ohrt, Clarke and Conley.

 

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Ohrt is an associate professor and counselor education program coordinator at the University of South Carolina. Clarke is a licensed professional counselor and faculty member in the Department of Counseling at Wake Forest University. Conley is an assistant professor in the Department of Counseling and Special Education at Virginia Commonwealth University and an affiliate faculty member in the university’s Institute for Women’s Health.

Wellness Counseling: A Holistic Approach to Prevention and Intervention was published by the American Counseling Association in December 2018. CT Online sent the co-authors some questions via email to learn more about this resource.

 

 

Q+A: Wellness Counseling

Responses written by co-authors Jonathan H. Ohrt, Philip B. Clarke and Abigail H. Conley

 

“Wellness” is often thrown around as a buzzword in our culture. How would you define wellness as it relates to counseling?

In our book, we utilize Jane Myers, Thomas Sweeney and Melvin Witmer’s definition of wellness [from their Journal of Counseling & Development article “The Wheel of Wellness Counseling for Wellness: A Holistic Model for Treatment Planning”] to guide our approach, which is that wellness is “a way of life oriented toward optimal health and well-being, in which body, mind and spirit are integrated by the individual to live life more fully within the human and natural community.”

Building off of this definition, we conceptualize a five-domain model of wellness that connects mind, body, spirit, connection and emotion [and] that highlights the interconnectedness of these domains within the whole self. Because of this holistic approach, one small change in one area can lead to positive changes in others. Thus, a client’s strengths are just as important, if not more so, than their struggles.

Finally, a key part of a wellness counseling approach is helping a client work toward their own optimal level of harmony both within and among each domain rather than [pursue] the often elusive idea of balance.

 

In the book, you all mention that wellness goes hand in hand with prevention. What do you want counselors to know about this intersection?

Prevention models in health care (e.g., primary, secondary and tertiary prevention) and education (multitiered systems of support) start with a focus on providing preventive interventions and education to avoid problems from occurring. These models emphasize healthy behaviors, decision-making, coping strategies, and strength and resiliency building.

From a wellness perspective, counselors can focus on prevention by assessing their clients holistically and collaboratively developing goals for clients to work toward optimal physical and mental health prior to the onset of problems. Goals can include physical health goals, mental health goals and goals related to the clients’ social functioning and spirituality. Counselors who focus on wellness can also advocate for policies that help promote wellness for individuals within various systems.

 

What tips would you share to help practitioners remember to step back and take a look at the client’s whole picture and not just the presenting problem?

Wellness models are one of the most useful tools to ensure that counselors consider the whole client. Utilize wellness models for client conceptualization and during sessions with clients. This will remind you to examine the client’s presenting problem from multiple perspectives.

For example, what (if any) spiritual, physical or cognitive components factor into the presenting concern? Inviting the client to reflect in this way communicates to them the importance of viewing themselves holistically. You can then discuss client strengths across wellness areas.

Counselors can also share with clients that they utilize a wellness-based approach during the informed consent process. As a self-awareness activity to solidify the relevance of wellness, you may want to write and periodically update your own wellness plan that consists of areas for improvement, strengths and goals.

Another fun and helpful exercise for counselors is to view television shows and reflect on the multifaceted nature of the stressors and lives of the characters on the show.

 

What is a main takeaway that you would like readers to know about wellness counseling?

Readers should know that wellness counseling is an approach that can be of value to and incorporated with most any client. It is useful regardless of the type or severity of the client’s presenting concern. It can be helpful when working with children or older adults.

The challenge is to not fall into the trap of a singular view of the client. It takes effort for the counselor to delve into the various aspects of the client’s well-being. Clients might initially balk at the idea of these different components of self. But this discomfort can result in benefit to the client.

Wellness counseling is versatile because the counselor can incorporate counseling theories that are most helpful to the client while remaining within the wellness framework. Wellness counseling is client-centered [because] you are offering the client new ways of understanding and experiencing themselves and new avenues for goal achievement.

 

Would you say that wellness is a new concept in the counseling profession? How long has it been something that counselors have adopted?

Wellness has been at the core of the counseling profession throughout its history. Most counselors tend to view their clients holistically and from a developmental perspective. Melvin Witmer, Thomas Sweeney and Jane Myers developed more defined theoretical and empirical wellness models for counselors in the early 1990s and 2000s. Their models are still widely used for client assessment, conceptualization and treatment planning.

A newer trend related to wellness is the integration of behavioral health with primary care. Counselors are becoming more aware of the strong relationship between physical health and mental health. Counselors are now more likely to be part of an interdisciplinary treatment team through which physical health and mental health services are integrated and coordinated together more strategically. This model fits well with a wellness perspective because counselors can engage in interdisciplinary collaboration with other professionals to provide interventions that address the client’s holistic functioning.

 

Are there any misconceptions or misunderstandings about wellness counseling that you’d like to clear up?

The exciting thing, in our experience, is that wellness appears to be critical to the identity of most counselors we have encountered. However, we have noticed that some counselors use aspects of wellness counseling without full intentionality or struggle to describe wellness counseling.

Thankfully, counselor educators such as Jane Myers and Thomas Sweeney have developed this information. We hope to highlight and add to their work, providing counselors with skills specific to this intervention and guidelines for determining whether or not they are working within a wellness counseling approach.

 

What inspired you to collaborate and create this book? Why is it relevant and needed now?

This book came together because the three of us have had many conversations about the ways that we teach wellness counseling (both as stand-alone courses and as a component of other core counseling courses) and the need for a text that delves deeply into what a wellness-based counseling approach is conceptually and also what it looks like in practice.

We wanted to write a book that is grounded in theoretical and empirical support and also provides techniques for client assessment, case conceptualization, treatment planning and intervention.

We wholeheartedly believe that wellness is an inextricable part of our professional identities as counselors and [that it] should serve as a framework for a holistic, prevention-focused approach to clients across the life span.

 

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Wellness Counseling: A Holistic Approach to Prevention and Intervention 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.

 

Hear more on this topic in a session with the co-authors at the ACA Conference & Expo in New Orleans later this month. Ohrt, Clarke and Conley will present a session on wellness counseling Friday, March 29 at 4 p.m. Find out more at counseling.org/conference

 

 

 

 

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Bethany Bray is a staff writer and social media coordinator for Counseling Today. Contact her at bbray@counseling.org.

 

 

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.