Monthly Archives: April 2019

Counseling Connoisseur: The Gift of Community for Counselors — An Interview with Thelma Duffey

By Cheryl Fisher April 30, 2019

“Pull up a chair. Take a taste. Come join us. Life is so endlessly delicious ― Ruth Reichl

 

I sit down to write my last client note of the day and click away about the client’s presenting concerns. Smiling at the great progress she has made, I conclude with final comments and an action plan and then click save and submit where my therapy notes will be forever stored in a HIPAA-compliant digital safe. I slurp down my last sip of coffee–cold from the morning. Just a few more things to do then I can head home. I put away my files and lock the file cabinet. I pack up my bag and turn off the lights. I am the last to leave the office so I turn off the Keurig and store the teas and sweeteners. I look around at the empty suite. It is 8:30 p.m. I wonder if my colleagues were in today? I have seen clients back–to-back today with little time to socialize. I lock up the suite and head home.

I have found that while private practice affords many wonderful professional and personal benefits, it can be a very isolating experience. I see 20 to 25 clients a week, and I rarely schedule enough break time to visit with the other clinicians who practice in the suite. We each have our own schedule and do not rely on each other for our practices. Therefore, with the exception of my quarterly peer supervision breakfasts, weeks can go by without actually interacting with another therapist. This, I admit is not a good standard of practice, which becomes incredibly apparent when I leap toward my annual conferences with fervor. Conferences provide me with not only clinical, academic and business development, but professional community.

Professional community

As counselors we are held to a code of ethics that does not allow us to discuss the circumstances of our work day with others. Many years ago I was doing work with a prominent actress. While I would have never disclosed the circumstances of her therapy, I longed to tell my husband about meeting with her. Or the ex-girlfriend of a well-known musician. We work with celebrities, politicians and pillars of the community, in addition to marginalized individuals. The pain and suffering we hold for our clients is (at times) palpable. However, with the exception of supervision (and our personal journals which require de-identification), we don’t have a forum to process our work.

Community is essential. It is a place where others understand the magnitude of the work that we do and the weight it carries in our daily lives. It energizes, inspires and fortifies — allowing us to return to our work rejuvenated and renewed. Where do you find professional community? Do you participate in local counseling-affiliated organizations or make use of the extensive national opportunities that include the National Board of Certified Counselors (NBCC) and the American Counseling Association (ACA)?

Over the many years of my practice, I have affiliated with both local and national groups. However, I longed to find a forum that appreciates my research in nature therapy and my clinical interest in superhero narratives. I wanted to dialogue with others around the role of expressive arts and energy psychology in clinical practice. I wanted to collaborate with creative and innovative practitioners. I found my community in the Association for Creativity in Counseling (ACC), a division of the American Counseling Association (ACA).

I presented at ACC’s 2018 annual conference in beautiful Clearwater, Florida, where I was joined by dozens of others who genuinely uphold a creative lens to clinical practice. In addition to my nature-informed workshop and superhero presentation, topics included movement, art, expressive and animal-assisted therapies. Additionally, energy psychology was explored as a clinical modality. As I attached my Wonder Woman headpiece and armbands in preparation for my presentation I walked down the hallway of the conference and passed Snow White preparing for her session, I knew I had found my people.

 

Q+A

Thelma Duffey, ACA’s 64th president

Thelma Duffey, former ACA president and the founder of both the ACC and its accompanying Journal for Creativity in Counseling, participated in my nature therapy discussion and afterward allowed me to interview her about the conception and vision of ACC.

Cheryl:   What inspired you to found ACC?

Thelma: There were several factors that inspired my interest in creativity, and my hope to establish a division within ACA focusing on creativity in counseling. For one, I learned early on that as connected as we can be with our clients, and in spite of our sharing a trusting relationship, there are times in counseling when talk just isn’t enough. Most of us can identify with feeling stuck in a situation, thought, or feeling, and our clients are no different.  The good news is that people carry all sorts of resources within them, and there are all sorts of resources around us, which can serve as creative, innovative supports. When we tap into our clients’ creativity, and into our own, and share that creativity within a growth-fostering therapeutic relationship, we can create opportunities for change. This was particularly evident when I chaired a series of creativity conferences in the 1990-2000s in central Texas. The energy around them was incredible. These conferences became a place where practitioners, students, and counselor educators would come year after year with so much enthusiasm and shared energy.  It was that response, and my own experiences with clients, that generated the passion to establish ACC as a “home” for counselors with this interest.

 

Cheryl:  Over the past 14 years, what changes have you observed in ACC?

Thelma: One of the more exciting things I’ve seen over time is ACC’s growth into an international community of counselors who share a like-minded passion; counselors who are out there doing great things and making a difference. I’ve seen ACC evolve from a grass-roots effort into a well-established organization represented by members living across the country and throughout the world. That is amazing! I just returned from Clearwater, Florida where the ACC conference was held, and it was terrific being there with such great colleagues sharing such incredible ideas and interests.

 

Cheryl: What are your hopes/vision for ACC?

Thelma: My hope for ACC is that it will continue to thrive and that the membership will feel the comfort of “home” that we hoped it would. My vision for ACC is that as people connect with one another, they will discover new ways to support clients and communities, using creativity, connection, and the kind of compassion that can inspire change and promote healing.

 

Cheryl: What would you like counselors to know about ACC?

Thelma: ACC is a home base for students and counselors interested in exploring creative, diverse and relational counseling approaches. It was founded on the principles of relational-cultural theory and focuses on the interdependence of relationship and creativity. Creativity in Counseling as a new counseling approach has been included in a theories textbook, and it is exciting to see the many ways in which our creative thought processes, interventions, research, and resourcefulness can promote change. I feel so fortunate to be part of ACC!

 

 

Finding a community

I plan on attending and speaking at this year’s Association in Creativity’s annual conference, which will take place September 6-7 in Clearwater, Florida. I am ecstatic to have found a forum of like-minded clinicians who I can both share with and learn from in a professional forum.

The American Counseling Association has 18 divisions, four national regions, and 56 chartered branches in the United States, Europe and Latin America. Take the time to seek out a community that will ignite you and your clinical practice. It will not only inspire you– it will also benefit your clients.

 

Colleagues having fun at ACA’s 2019 Conference & Expo in New Orleans (Photo by by Paul Sakuma Photography).

 

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Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland. She is director and assistant professor for Alliant International University California School of Professional Psychology’s online MA in Clinical Counseling.  Her research interests include examining sexuality and spirituality in young women with advanced breast cancer; nature-informed therapy; and geek therapy. She may be contacted at cyfisherphd@gmail.com.

 

 

 

 

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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.

When yelling doesn’t work

By Lindsey Phillips April 29, 2019

Stop! Stop throwing that toy! Put it down. Put it down now! Don’t make me say it again. If you don’t stop that right now …” We all know how this story ends — with a frustrated parent and an upset child. But the story doesn’t have to end this way.

In Play Therapy: The Art of the Relationship, Garry Landreth asserts that to improve future adult populations, counselors must equip parents with counseling skills and help them become therapeutic agents in their children’s lives. This plan sounds simple, but how do counselors broach the topic of child discipline, especially when working with clients from cultural backgrounds that differ from their own?

Christa Phipps, a therapist and clinical supervisor at Hickory Grove Counseling Center in North Carolina, notes that parenting and discipline can be touchy subjects, and counselors often fear mentioning it. In fact, she says, the counselors she supervises are terrified to talk with parents about anything that may rupture the therapeutic relationship, so they often skirt around the issue of child discipline. Phipps has also noticed that the one African American counselor she supervises is apprehensive about discussing discipline with clients from other cultures, while her white supervisees are timid about approaching the issue with parents of all cultural groups, including their own.

Phyllis Post, a professor of counseling and director of the Multicultural Play Therapy Center at the University of North Carolina at Charlotte (UNCC), advises counselors to address cultural differences outright rather than pretending that they don’t exist. Post, as an older white woman, acknowledges the cultural differences between her and her clients and asks clients directly how they feel about having her discuss child discipline and parenting with them.

Peggy Ceballos, an associate professor of counseling at the University of North Texas, says that parenting style and child discipline are both closely linked to one’s cultural background. “The main mistake I see is people avoiding those [cultural] conversations” in counseling, she says.

Carla Adkison-Johnson, a professor in the Department of Counselor Education and Counseling Psychology at Western Michigan University, agrees that counselors often avoid the topic of discipline because that is where the cultural aspects of raising a child come into play. Rather than neglecting the topic or making assumptions, counselors should ask clients about their child-rearing values and traditions, she advises. They can do this by asking questions about their parenting: What types of disciplinary methods are you using to prepare your child for adulthood? What behaviors warrant discipline? What are you struggling with right now? Do you feel comfortable with the boundaries between you and your child?

Adkison-Johnson, a licensed professional counselor (LPC) and a member of the American Counseling Association, also points out that how people were disciplined themselves often plays a role in how they parent their own children. Thus, she says, counselors might ask clients how they were disciplined when they were children, whether they are using any of these methods with their own children, and what disciplinary methods their parents used that the clients found ineffective.

In the 2015 article “Child Discipline and African American Parents With Adolescent Children: A Psychoeducational Approach to Clinical Mental Health Counseling,” Adkison-Johnson described an activity that helps identify how parents define discipline and what child behaviors they consider problematic. In the activity, a counselor shows parents a video clip or a written example of a child displaying inappropriate behavior. The counselor then asks the parents what an appropriate behavior would be and how they would handle the problem.

Ceballos advises counselors to introduce the topic of child discipline in ways that are nonjudgmental and accepting. Parents are typically more receptive to learning new skills — including skills related to appropriate discipline methods — when counselors establish a relationship in which clients feel accepted.

Post, an LPC supervisor and registered play therapist, agrees. “I never tell a parent that what they are doing is wrong,” she says. Instead, she introduces alternative parenting techniques.

Counselors should assure clients that their role isn’t to tell parents what to do, Ceballos says. Instead, they are there to offer additional parenting skills, to process those skills with clients, and to see whether clients might want to try the skills because they think that the techniques might work for their families.

When clients feel there is a parenting skill that they can’t incorporate, Ceballos, an ACA member, talks about it with them. She says she wants clients to feel safe and comfortable having these difficult conversations with her rather than telling her that they will try a new skill and then not following through.

Putting discipline in (cultural) context

Ceballos and Adkison-Johnson agree that before discussing child discipline with clients, counselors need to be aware of their own biases and beliefs around parenting. For example, how does a counselor define “good” parenting? How does the counselor’s cultural background influence this definition?

Adkison-Johnson, who co-edited Counseling African American Families in ACA’s Family Psychology and Counseling Series, argues that counselors also need to understand the current and historical context when broaching the topic of child discipline. For example, African American parents are often viewed in society in a pejorative way, as incompetent parents, she says. Thus, counselors must be intentional about dismissing this false perception and reminding themselves that African American clients are competent parents who have goals, ideals and values for their children. Discussing child discipline also means addressing assumptions, she says, including the fact that most counselors may still determine what is in a family’s best interest on the basis of a widely white, middle-class, mainstream perspective.

Rather than waiting for clients to bring up these cultural contexts, counselors should take on the responsibility of learning more about what their clients experience, Adkison-Johnson stresses. For example, counselors should know that African American parents often engage in racial socialization practices as a part of their parenting activities, she says. This involves communicating messages and behaviors to children to bolster their sense of identity, especially given that their life experiences may include racially hostile encounters.

Parents who are undocumented immigrants may instruct their children to behave well at school because they fear being called in for a meeting or having someone look into their family if their child misbehaves, Ceballos adds. For these families, establishing trust in the counseling relationship is crucial because it may be difficult for them to openly discuss how their undocumented status affects their parenting, she explains.

Ceballos advises counselors to use cultural humility when learning about clients’ belief systems regarding parenting and what parenting means within their cultural context. She also recommends that counselors get involved in the community to build trust with parents. For instance, she finds that partnering with schools helps make Latinx parents more comfortable with getting counseling services because it allows counselors to meet these parents in a place that is familiar to them and where they may have already established a level of trust. In addition, schools often have people who know clients’ cultural backgrounds and speak their native languages, she adds.

Yung-Wei Dennis Lin, an assistant professor in the Counselor Education Department at New Jersey City University, points out that some cultures may not be familiar with the counseling profession. A Taiwanese family who immigrates to the United States may not be aware of the role that school counselors play, for example. So, he explains, if a school counselor suddenly contacts the parents in reference to their children, the parents may wonder who this person is and what the person’s role is with their children.

Adkison-Johnson and Lin, an ACA member who specializes in play therapy and filial therapy, say that counselors — including those who have been out in the field for a while — would benefit from interacting with different cultural groups under supervision.

Multicultural development is a lifetime commitment, not just one workshop, class or book, Ceballos adds. She challenges counselors to continue working on recognizing and addressing their unconscious biases. “We learn best through experiences, so … expose [yourself] to different cultural groups, to different cultural experiences … within the community,” she says.

Spanking and the discipline continuum

“When we think of child discipline, we only think of spanking, and I think that’s where we’ve missed the mark,” Adkison-Johnson says. “In general, across all racial groups, child discipline is a broad program of parenting. … It’s [parents] teaching children basically how they want their children to be, how they want to socialize their children within their family structure.”

Spanking generates a lot of heated opinions and often overshadows other aspects of child discipline. Counselors can be prone to taking a position on spanking and focusing exclusively on that aspect of discipline while ignoring all the other parenting tools that people may use along with spanking, Adkison-Johnson says. However, research indicates that “children are more impacted by the whole program of discipline than just the isolation of spanking in and of itself,” she argues.

Spanking also evokes stereotypes of minority cultures relying heavily on physical discipline. In fact, Ceballos did focus interviews with Latinx mothers and found they were cognizant of a pervading stereotype of Latinx parents spanking and abusing their children. The mothers discussed the distress this stereotype causes them and how it made them feel unsafe to discuss child discipline openly with just anyone.

Similarly, Adkison-Johnson acknowledges the stereotype of African American parents primarily using physical discipline to address inappropriate child behavior.

However, Post says, research indicates that parents in all cultural groups spank. “It is not just that some cultural groups spank more,” she adds. In fact, as recently as 2013, two-thirds of parents in a Harris Poll reported that they had spanked their children.

When parents ask Phipps her thoughts on spanking, she tells them that what she thinks is not important and turns the conversation back to what is working for them. “Usually they say that spanking is not working for them. They feel bad about it, but they don’t know what else to do,” she says. “They feel powerless.”

Lin, the recipient of an ACA Best Practices Research Award in 2016 for his work on child play therapy, says that spanking often hurts parents emotionally. Plus, parents often realize that spanking requires double the work. He explains that parents spank to stop the behavior, but then they must wait until the child calms down from crying — as a result of the spanking — to communicate why they spanked them.

Adkison-Johnson finds that physical discipline is often used as a last resort with children. People opposed to spanking typically equate it with violence, she says, and because they consider it a violent act, they feel it is inappropriate. “A blanket injunction with spanking when we have not provided empirical research to support that blanket injunction is problematic because that’s more of an opinion,” she argues.

She notes that parental use of physical discipline is a topic of much debate in the social science and legal literature. Several studies, including a meta-analysis by researchers Elizabeth Gershoff and Andrew Grogan-Kaylor (2016), associate physical punishment with negative childhood outcomes, which supports the premise that physical discipline is equated with violence. However, the most commonly cited studies on the consequences of spanking are correlational and do not show a direct causal link between physical punishment and long-term negative effects on children (see, for example, Robert Larzelere, Ronald Cox and Gail Smith, 2010).

“And from a culturally competent perspective, we’re actually still pushing our own [counseling or psychology profession] agenda because this is the way we want society to be regardless of whether it adequately addresses the child-rearing goals of parents,” she adds.

For this reason, Adkison-Johnson thinks that spanking, which is only one aspect of child discipline, has received too much attention. In fact, from her research with African American parents, she has found that child discipline happens on a continuum — one that is context and age specific. “That means … what the child does warrants the type of discipline that they will receive,” she says. “There’s no spanking randomly. There’s no discussion randomly. There’s no withdrawal of privilege [randomly]. Child discipline in African American homes is comprehensive and strategic and is dictated by the context [of the disciplinary situation] and age of the child.”

With the first behavioral offense, parents may explain what was wrong and tell the child not to do it again, she says. However, if the child has to be told repeatedly not to do something, then the parents may use a more severe form of discipline. As children age — roughly 6 to 11 years old — the discipline may become more restrictive (with physical discipline as a last resort) because the parents realize their children are interacting with the world, peers and the school system, and they want their children to behave a certain way regardless of what others do or say, Adkison-Johnson continues. When children become adolescents, parents typically use less physical discipline and more withdrawal of privilege unless the child commits a serious offense such as disrespecting the parent, she adds.

Several studies (such as one published in 2012 by Jennifer Lansford, Laura Wager, John Bates, Kenneth Dodge and Gregory Pettit) reveal that the negative effects of spanking often seen with white American children aren’t mirrored with African American children, probably because of how and when spanking is used, Adkison-Johnson says.

ACT, don’t react 

Post, Lin, Phipps and Ceballos all use child–parent relationship therapy (CPRT), a play-based treatment for children with behavioral, emotional, social or attachment disorders. The aim of CPRT is to teach parents how to use play therapeutically to strengthen the child–parent relationship and to reduce child behavioral problems and parent stress. CPRT skills include responsive listening, reflecting feelings and limit setting.

One CPRT rule of thumb is for adults to act as thermostats, not thermometers. This saying reminds adults that they control the situation (i.e., the “temperature” in the room) even when a child engages in negative behavior. If the adult is not in charge or not in control of his or her own emotions, then things can turn into a power struggle between the adult and child, further escalating the situation, Ceballos explains.

Because CPRT’s aim is to build a stronger relationship with one’s child, the approach is culturally congruent with Latinx culture and familismo (a Latinx cultural value of dedication, commitment and loyalty to the family), Ceballos says. Thus, when Latinx parents are exposed to CPRT, they are often receptive to learning the associated skills, she adds.

Once when Post was teaching child-centered play therapy skills, an African American student told her that he didn’t see how the child-centered approach would work for his culture, which preferred a more authoritarian or directive parenting style. By the end of the class, however, the student had a new appreciation for the approach. Because African American children grow up in environments that can be racially hostile to them, African American parents often see a need to engage in racial socialization practices — for example, teaching their children to be compliant for their own safety. However, the student eventually recognized the value of also providing these children with a safe space in the playroom where they could freely communicate who they were and what they were feeling. He reasoned that this would help them to grow more confident and competent.

Phipps, an LPC supervisor and a registered play therapist supervisor, recommends an IDEAL response for discipline — one that is:

  • Immediate (within three seconds)
  • Direct (be within 3 feet and make eye contact with the child)
  • Efficient (be measured and use the least amount of firmness possible)
  • Action-based (have the child model appropriate behavior to create motor memory for making future choices)
  • Leveled (aim the response at the behavior, not the child)

Phipps, a member of ACA, also teaches parents how to listen, acknowledge and accept children’s feelings even if they don’t agree with those feelings. For instance, she will often hear a child say, “I feel anxious,” and the parent’s response is, “There is nothing for you to feel anxious about.” That statement is not helpful, Phipps says.

Parents often need help discerning the difference between children’s behaviors and their feelings, she continues. She explains the distinction with the following example. It is OK for a child to feel angry at his or her parents, but it is not OK for the child to hit the parents. Many parents do not recognize the difference between the two, and they discipline the child if he or she gets angry, Phipps says.

Fussing at children because they are not behaving at home or school will not make them feel safe or secure, notes Post, a member of ACA. She advises adults to use the 30-second burst-of-attention technique. For example, when a parent is on the phone and a child is tugging on his or her shirt, the parent should stop for 30 seconds and attend to the child. After the parent gets on the child’s level and listens, then the parent can say, “I’m going back to my phone call now.”

Post, who currently trains teachers to use these skills, recently witnessed the power of listening to children rather than simply reacting to bad behavior. A young boy was being disruptive — throwing things and yelling — in a classroom. Instead of yelling for him to stop or threatening to call his parents, the teacher used CPRT skills. She got down on his level and in a calm voice said, “You feel sad.” The boy was silent for a time, and then he told her that the night before, someone had broken into his home while he was sleeping, and it was chaotic. After the teacher listened to his story, the boy calmed down and returned to the classroom.

Acknowledging feelings is the first step of the ACT model of limit setting. The subsequent steps are communicating the limit and targeting an alternative. Post and Phipps presented on this topic at the ACA 2018 Conference in Atlanta.

Post provides an example of using ACT to correct a child’s behavior. If a child is walking around when the family is eating dinner, the parent would say, “I know you want to get up from the table while we are having dinner, but now is the time to stay at the table and eat with the family. But you can walk around after dinner is over.” In this instance, the parent is providing the child with a way to meet his or her need at another time, Post explains.

Phipps, an adjunct professor at UNCC, practices the skills of the ACT model of limit setting with her counseling students, her counseling supervisees and her clients. With parents, she provides a scenario of a child misbehaving (e.g., throwing a toy), and then they discuss how to respond to the child using ACT. Sometimes, parents even write down the wording to practice later. Next, Phipps brings parents into the playroom so they can watch her execute these skills or even do them along with her. This helps parents feel more comfortable using the skills on their own later.

Although limit setting can be a difficult skill to learn, it is one of the most powerful tools that counselors have, according to Phipps, whose dissertation revealed its effectiveness. She worked with a child who was displaying aggressive behavior at preschool. After two sessions that involved limit setting, the child’s behavior improved at school. Phipps’ study also showed that as the child’s behaviors improved, so did the behaviors of his classmates.

Letting children take control

What happens when setting limits isn’t enough and the child continues to misbehave? Counselors and caregivers can turn toward choice giving. Landreth explains the skill of choice giving in his Choices, Cookies & Kids DVD, which Post says is a great resource for parents because it is humorous and contains relevant examples. When Post was in private practice, she would let parents watch the video while she worked with their child.

Phipps knows from personal experience that setting limits may not always be enough, and she says that choice giving is an easy skill for parents to use. She once had a young client who decided to throw sand in her office rather than play with it. First, Phipps tried setting limits: “I know you want to throw the sand, but the sand is not for … ” The boy threw sand in her face before she could finish her sentence. So, Phipps tried again, getting out the entire sentence this time before he threw sand in her hair. The third time that he picked the sand up, she set the limit again, and he decided to drop it. But when he picked the sand up for the fourth time, Phipps had had enough. She decided to use choice giving: “If you choose to throw the sand again, you are choosing to lose the sand.” The boy decided not to throw the sand.

“When you get to choice giving,” Post says, “do it once and be sure that you can follow through on your choices. [Also] be absolutely sure that you’re ready for this.”

Post advises using the word choose or choosing four times and leading with the positive choice first. She provides the following example: A child is walking around the classroom and won’t sit in a seat. First, the teacher sets a limit: “I know you want to walk around, but now is the time to sit in your seat. You can walk around at recess.” If that doesn’t work, the teacher gives the child a choice: “If you choose to sit in your seat right now, you are choosing to use the iPad for five minutes this afternoon. If you choose not to sit down in your seat, you are choosing not to have your iPad this afternoon.”

“Then that’s it,” Post says. “Then that child has to decide.” If the child is still walking around, the teacher says, “Oh, I see you’ve chosen not to have your iPad this afternoon.” The language should always emphasize that the child, not the adult, is the one choosing, Post explains. If the child gets upset, the teacher can say, “Oh, I am sorry you chose not to have your iPad. I would have chosen for you to have your iPad.”

The decisions the child is allowed to have control over will differ based on the developmental age of the child, Post continues. For example, a 3-year-old shouldn’t be allowed to decide if riding a bike alone around the block is a good idea, but the parents could let the child pick out his or her clothes for preschool.

With both limit setting and choice giving, children learn to control their behavior, begin to think of themselves as choice makers, and assume responsibility for their decisions, Post explains.

Phipps agrees. In her example of the boy throwing sand, the aim was not just to get him to stop throwing it and making a mess. It was for him to learn how to make decisions that would work for him in the real world.

Similarly, counselors can help parents view discipline from a completely different perspective — as a means to help children learn how to make decisions for themselves and control their own behavior, Post says. “It’s not to stop a child from doing something in the grocery store right this minute,” she explains. “It is to help a child learn that they make decisions for themselves and that their decisions count.”

Dealing with resistance

Parents who have been court ordered to attend counseling or whose children have been removed from the home because of the parents’ discipline practices are likely to be resistant to therapy, Adkison-Johnson notes. In such situations, counselors first need to confirm that the parents have a right to be angry, she advises. Counselors must also remember that their duty is to the client (the parent or parents), not the agency that made the referral, she says. (See sidebar, below, on the counselor’s role as a witness in court on physical discipline.)

When working with issues related to child discipline in such cases, counselors should prepare themselves to experience the full brunt of clients’ emotions, Adkison-Johnson says. Sometimes, white counselors feel uneasy with African Americans’ emotions, especially when those emotions involve anger, she adds.

“Be comfortable with the resistance. Be comfortable with the anger. Be comfortable with the fact that the client may not want to talk to you,” Adkison-Johnson advises. “They may have short responses at first. Sometimes they may not want to come back [to] the next session, but [they] come back anyway because they have to.”

Adkison-Johnson stresses the importance of counselors addressing these clients formally (unless they indicate otherwise), shaking the parents’ hands, and using their child’s name. These simple actions show respect for the family dynamic of authority, she explains.

The mental health field has a checkered past when it comes to its treatment of racial minorities, so African American families may also have a healthy paranoia that the clinician isn’t really operating in their favor. As a result, counselors must take baby steps to establish trust, Adkison-Johnson says. She advises doing this by acknowledging the parents’ fears and anger and by showing that the counselor is knowledgeable on the topic and understands the depths of the situation. Another important step toward establishing trust, she adds, is clearly explaining informed consent, limits to confidentiality, and clients’ right to remain silent.

Lin’s counseling students conduct free parenting training, and they post flyers to find parents who are interested. Although the parents are participating voluntarily, the training is sometimes recommended to them by their children’s teachers, and this can cause parents to have a bad attitude initially. Sometimes, parents also complain that they are too busy and don’t have time to complete the homework assignments, such as having uninterrupted playtime with their children for 30 minutes once per week. When parents come in with a negative attitude, Lin reminds his students that they must listen and avoid blaming the parents. One of the first skills counselors teach to parents is how to reflect children’s feelings, so counselors must model this behavior themselves, he stresses.

Sometimes, parents’ resistance to counseling stems from personal or cultural differences. When working with immigrant Taiwanese parents who identified as Christian, Lin’s counseling students voiced frustration that the parents were arguing with them about spanking, including quoting Bible verses on why it was appropriate to discipline their children this way. Lin’s advice in such situations is simple: “Never argue with parents. They have their own value system. They have their own beliefs.”

Instead, he advises counselors to focus on providing parents with additional parenting skills such as limit setting. “The more skills [parents] have, the better,” he says. “They don’t want to hold that stick in their hands all the time.”

Raising an adult 

While reading Michelle Obama’s book Becoming, Post found herself nodding in agreement with the parenting philosophy of the former first lady’s mother, who said she was raising adults, not children. According to the former first lady, “Every move she made, I realize now, was buttressed by the quiet confidence that she’d raised us to be adults. Our decisions were on us. It was our life, not hers, and always would be.”

Today, however, parents often assume their children’s responsibilities rather than viewing their role to be raising future adults. This is a tendency that crosses cultures. Lin recounts a saying in Taiwan: “If I give birth to a child and I don’t teach, then it’s my fault as a father.” This saying relies on the inaccurate belief that parents are responsible for their kids’ behavior, he says.

“When [parents] are so out of control in their own emotions when their kids are throwing a fit, usually it’s because they don’t have a clear boundary between themselves and their kids,” Lin says. With CPRT and filial therapy techniques, counselors can teach parents that children need to learn to be responsible for their own actions. This perspective will help parents remain calm and not become so upset if they misbehave, he adds.

Phipps’ belief is that parents are doing the best they can — whether she agrees with all of their parenting decisions or not. “We need to have a humbler approach to parents. … I have to walk humbly with a parent because I’m not walking in their shoes. I don’t experience that [child’s] behavior every single day,” she says. “I am the expert in the skills, but parents are the experts on their children.”

 

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Being a witness in court on physical discipline

According to a 2013 Harris Poll, nearly 8 in 10 Americans believe that spanking children is sometimes appropriate. The question is when does corporal punishment become abuse?

That answer is complicated because it varies by state. The most common approach, used in more than half of states, says that parents may use reasonable force if necessary to maintain discipline.

Counselors may be asked to inform the courts on this distinction. Being an expert witness on child discipline is a pressing issue right now, notes Carla Adkison-Johnson, a licensed professional counselor and a professor in the Department of Counselor Education and Counseling Psychology at Western Michigan University. In fact, much of her work has moved into expert testimony, which involves discussing her research to inform the court whether a parent should be brought up on criminal charges just for spanking their child. She works to inform court judges on how to distinguish between child discipline and child abuse when dealing with families.

As anti-spanking groups gain more political clout, they put pressure on child protective services to carry out their perspective, and this puts families of color at risk, Adkison-Johnson contends. She says that because of racial bias in our society, African American parents are disproportionately brought up on charges of physical abuse related to the child discipline practices they follow. The large majority of her cases as an expert witness have involved African American parents who have had their children removed from the home and who face potential jail time or a felony because they spanked their child.

Adkison-Johnson says that clinicians might also be called to serve in court as “witnesses of fact” (which differs from the role of an expert witness), particularly if they are working with families that have been mandated to attend counseling. In this role, counselors are working directly with the parents to help them but are also being asked to inform the court about the facts of the case. Thus, the questions that counselors ask these parents and the approach they take in counseling the parents are crucial, she stresses. Counselors must find out what parents have done, and they should ask specific questions about the goals and aspirations parents have for their children. This information will help address the “why” and “how” questions when evaluating parents’ disciplinary approach, she explains.

Adkison-Johnson points out that today’s parents often wrestle with establishing healthy boundaries and may have become more lenient in terms of discipline. The current parenting generation has been told not to spank or to use strict discipline with children and has been directed to instead negotiate with children on what the rules will be, she adds.

Counselors may also be asked to write letters on the progress they are making with clients. Adkison-Johnson advises counselors to let clients read these letters before sending them to the outside agency. “See if the client feels comfortable [that it is] an accurate portrayal of how they parent and what they believe took place in the counseling session, and be open to that discussion,” she says. She finds that clients will sometimes remember a detail that the counselor forgot or overlooked.

“Also, let them know that you are their counselor and not an agent for the court or child protective services and that you are committed to them and the success of their family,” she adds.

— Lindsey Phillips

 

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

Letters to the editor: ct@counseling.org

 

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

New maternal mental health certification available to counselors

By Bethany Bray April 25, 2019

It’s estimated that 1 in 9 American mothers experience peripartum depression.

Because maternal mental health issues are so prevalent, many counselors’ caseloads include clients who are struggling during the first weeks and months of motherhood. However, few practitioners are well-trained enough to fully understand the unique needs and risks this population presents, says Birdie Meyer, the director of certification for Postpartum Support International (PSI), a Portland, Oregon-based nonprofit established to raise awareness of and connect people to resources for maternal mental health issues.

“There are a lot of nuances to this stage of life,” says Meyer, a registered nurse with a master’s degree in counseling. “You can really do damage if you send someone to a therapist who doesn’t know perinatal mental health … [And] There aren’t enough providers out there.”

Worse yet, a practitioner who treats perinatal clients but hasn’t completed comprehensive coursework or trainings in this area can risk doing harm to mothers at a vulnerable time of life. In her decades working in perinatal mental health, Meyer says she’s witnessed horror stories of women being reported to their local department of social services by a practitioner who mis-read the symptoms of peripartum distress – which can include feeling ambivalent toward a new baby or, in severe cases, thoughts of harming the baby or themselves.

“The despair that comes with [peripartum depression] feels like life will never be better, never be the same again. Many times, women seek help but don’t get someone [a practitioner] who understood, or the woman didn’t know where to turn,” says Meyer, who recently retired as coordinator of the perinatal mood disorders program at Indiana University Health, a large hospital system based in Indianapolis.

For this very reason, PSI has begun to offer a certification for helping professionals in perinatal mental health. It’s a project that has been three years in coming, and Meyer was closely involved in the certification’s development and launch.

PSI’s new Certification in Perinatal Mental Health became available in August to counselors, social workers and other mental health practitioners, as well as prescribers (medical doctors, psychiatrists), doulas, midwifes, lactation consultants and other affiliated professions. So far, 130 practitioners have become certified but hundreds more have begun collecting the hours of coursework required to qualify to take the certification exam, Meyer says.

Before a practitioner can list PMH-C after their name, they must pass a rigorous exam and have at least two years of experience in their field. They must also show proof of completion for 14 hours of continuing education in a subject related to maternal mental health. Finally, applicants must participate in an intensive, six-hour training that PSI offers in locations across the U.S., or a pre-approved course equivalent.

PSI has partnered with Pearson VUE, a company with testing centers across the U.S., to proctor the certification exam. The cost to sit for the exam, a test of 125 multiple choice questions, is $500.

PSI developed and refined the certification exam with several teams of subject-matter experts, including professional counselors, Meyer says.

“The test is rigorous,” says Meyer, “but if you’ve had the training that is required you should be able to pass.”

In order to keep up the PMH-C certification, a practitioner will have to complete at least six hours of continuing education each year, she adds.

Meyer believes that the PMH certification will ensure that more and more practitioners are qualified and available to give parents get the help they need in a most critical and vulnerable time of life.

The certification came to fruition after the family of Robyn Cohen, a woman who passed away as a result of a maternal mental health issues, donated to PSI to fund the project in her memory.

 

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Find out more about PSI and the Certification in Perinatal Mental Health at postpartum.net

 

Email questions about the PMH-C to certification@postpartum.net

 

Listen to an extended interview with Birdie Meyer on the Mom & Mind podcast (episode 104): drkaeni.com/podcast/

 

 

 

Related reading: For more on the unique mental health needs of peripartum clients, see the feature article “Bundle of joy?” in the April issue of Counseling Today.

 

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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.

 

 

Grieving everyday losses

By Laurie Meyers April 24, 2019

As a society, we think we know what loss is: the death of a parent, partner or child; the destruction of a home through disaster; the shattering of finances through bankruptcy. These are tangible, recognized — sanctioned, if you will — losses. But counselors know that in reality, life brings myriad losses, many of which go unrecognized, unacknowledged and, most importantly, unmourned. The damage caused by these accumulated losses — sometimes referred to in the popular lexicon as “emotional baggage” — often brings clients to counselors’ doors wondering why they’re in so much pain.

In 1989, American Counseling Association member Kenneth Doka, who has written numerous books on grief and loss, established the phrase disenfranchised grief, which he defines as grief that is experienced by those who incur a loss that cannot be openly acknowledged, publicly mourned or socially supported. Disenfranchised grief may result from the loss of a relationship, the loss of identity or ability, pet loss, or even the loss of “giving up” an addiction.

“This unrecognized loss can be happening all around us but, because of the lack of acknowledgment and support, we wouldn’t know about it,” says ACA member Barbara Sheehan-Zeidler, a licensed professional counselor in Littleton, Colorado, whose practice specializes in grief and loss.

She gives the hypothetical example of a woman who is about to move to a thriving new town to start a higher paying job with great benefits. The woman has spent the past 20 years raising her family and creating a great life for her children, but now she is ready to move on. She is excited about entering this new phase in her life and meeting new people. At the same time, the woman is experiencing a lingering and persistent sense of sadness that she can’t explain.

What the woman is experiencing, Sheehan-Zeidler explains, is disenfranchised grief, which can affect clients in numerous ways:

  • Physically: Headaches, loss of appetite, insomnia, pain and other physical symptoms
  • Emotionally: Feelings of sadness, depression, anxiety or guilt
  • Cognitively: Obsessive thinking, inability to concentrate, distressing dreams
  • Behaviorally: Crying, avoiding others, withdrawing socially
  • Spiritually: Searching for meaning or pursuing changes in spiritual practice

In the example, the woman was not recognizing the losses of community, familiarity, social status and spiritual support from her local church that would come with moving, Sheehan-Zeidler explains. Once the woman actually identified and named those things as losses, the counselor was able to validate and explain her symptoms of insomnia, guilt, absent-mindedness, crying, indecisiveness, pervasive sadness and avoidance of social situations. This allowed the woman to grieve her losses and settle into her new life, Sheehan-Zeidler says.

“When we do not process unrecognized or disenfranchised losses, we run the risk of creating a narrative that is tainted with unprocessed feelings and unresolved grief,” she says. “Their Weltanschauung, a German word for worldview, is corrupted with an emotional burden that influences their beliefs and ability to connect. Consequently, they may be limited in projecting self-confidence needed to secure a new job or challenged to join a new social circle due to feelings of depression or unworthiness.” Unrecognized grief from the loss of a job, health or lifestyle can also cause secondary losses, such as damage to one’s self-esteem, a sense of shattered dreams, and lost community, she adds.

Sheehan-Zeidler helps clients process their grief through a variety of rituals. “I invite clients to create a special time, maybe 5 to 15 minutes daily, for the purpose of ‘being with’ their emotions and thoughts,” she says. “During this dedicated time, I suggest clients find a comfortable and private place to sit, journal their feelings and thoughts, light a candle, have soothing music, enjoy a cup of tea, and maybe have a special shawl or blanket to be used during these ‘time-to-mourn’ moments. Or maybe the client is more active, in which case I’d invite them to mindfully walk in a calming place where they can be with their thoughts and feelings as they reflect on their loss.

“The purpose of this time-to-mourn ritual is to create comfort around you and encourage the feelings to come forward in a planned way so we lead the dance with grief and mourning, and not the other way around. Additionally, as grief can come in unexpected waves, if we have a ritual in place, then we can put the ‘surprise’ grief aside, noting that we will visit with it the next time we are sitting or walking in our special place dedicated to honoring and processing the grief and mourning.”

Sheehan-Zeidler also recommends that clients drink plenty of water and get adequate sleep — taking naps if needed — as their minds and bodies process the loss. Finally, she reminds clients that their grieving process will include bad days, but also good ones.

Losing my addiction

“Put simply, disenfranchised grief is grief that is not acknowledged or valued by society,” says Julie Bates-Maves, an ACA member and a former addictions counselor. “Losses that are not seen as legitimate or worthy of our sadness or grief fit here.”

Addiction may be the king (or queen) of losses that are not typically viewed as legitimate or worthy. “Some people … don’t think that losing something ‘bad’ should hurt, but it does,” Bates-Maves says. “If we think about the functions of an addiction — that is, what they can provide for people — you start to see how hard they would be to give up.”

Bates-Maves notes all the ways in which addictions can fulfill people’s needs, albeit in unhealthy ways. “Addictive patterns often bring pain, but it’s a pain that’s familiar,” she notes. “They bring routine, even if it’s an unhealthy one. [It’s] the illusion of power and control over one’s body and mind: ‘I want to feel or think differently, and I know how to accomplish that.’”

Addiction can also provide companionship or escape from a sense of loneliness, whether through friends who also use, through distraction, through numbing (both physically and emotionally), or through the sense of energy and excitement that using substances can provide, Bates-Maves explains. “Losing any of that would be, at best, uncomfortable [and], at worst, unbearable,” she asserts.

“In my own clinical work and in speaking to other counseling professionals and clients, I have noted little discomfort or objection to exploring the negatives of an addiction with clients,” Bates-Maves says. “Notably, I have encountered hesitation or overt avoidance of the ‘positives’ of addiction, [such as] ‘don’t speak of the glory days’ or ‘don’t encourage clients to focus on what they miss; instead focus on what they have to look forward to in recovery.’ Consider this though — what if the ‘glory days’ are the only time the client felt powerful, or safe, or noticed, or admired, or skillful?”

When entering recovery, clients not only contend with the addition of a new set of behaviors, thoughts and feelings, but also an absence of “glory,” Bates-Maves continues. She believes that talking about the “positives” of addiction can help clients in recovery tackle challenges such as reestablishing a sense of their own identity, learning how to connect with others, and filling in any social skill deficits.

“Inviting reflection on the ‘glory’ of it all is a chance to observe a client reminisce about a time when they felt more worthy,” she explains. “If self-worth is centered on the addiction or a component of it, we need to know so we can help them redefine and reconstruct who they are, not just what they do. Losing an addiction is not simply losing a substance or behavior. It’s losing a way of surviving that our body and mind have become settled in. It can be a tremendous loss.”

As Bates-Maves points out, losses can occur anywhere along the addiction and recovery spectrum: prior to addiction; during addiction; during detoxification, treatment, initial, mid- or advanced recovery; prior to a lapse or relapse; and after a lapse or relapse. Some losses, such as a negative alteration in personal appearance or losing custody of children, may be the direct result of the person’s addiction. Other losses, such as the death of a parent, may happen separately from the person’s addiction but will still affect a client’s addiction or recovery, Bates-Maves emphasizes.

Other experiences common to people working to move from addiction to recovery include:

  • Loss of comfort: The person can no longer rely on his or her addictive pattern as a coping mechanism.
  • Loss of power: Choices are often restricted in recovery, and it’s not always OK to make a “bad” choice.
  • Loss of identity: The person may wrestle with the question, “If I’m not an addict, who am I?”
  • Loss of pain relief: The person may ask, “How am I supposed to manage my pain now? I don’t know any other ways that work as well as _________ does.”
  • Loss of perceived choice: Because substance use is no longer an option, the person has to find another way to live, cope and function.

“It can feel like the rug has been pulled out from under them, and some can flounder in the absence of the structure of an addiction,” Bates-Maves says.

“Also consider the more commonly talked about losses, like loss of lifestyle or [loss of] ‘using’ friends,” she adds. “While it may be healthy to move away from people who remain stuck in unhealthy patterns, it’s certainly not easy. As a counselor, I believe that people have a ton of worth, even in the presence of an addiction or negative behaviors. If I’m told to walk away from the positives of a relationship because there are also negative behaviors, I’d struggle. Clients deserve to struggle with that too. Health and happiness are not always the same thing. If I have the choice to be alone and healthy or to be in the company of others and unhealthy, I’d waiver — particularly if others forced me in one direction or another.

“I think it’s important that counselors really sit with what’s being asked of someone when they’re told they must now avoid people who are still using. Allow for the struggle and encourage clients to grieve the loss of good people who are still stuck. Don’t lose sight of the loss and grief there. Value what’s being lost or taken away instead of encouraging — or sometimes mandating — the death of a relationship. And talk about it. Balance is key. Talk about why some losses are needed, and validate that they’re painful. Allow the pain, allow the struggle, and help clients to cope with them as they move toward something different.”

Losses that are controllable — meaning that clients have some say over their occurrence — can actually foster hope in clients that there will be a chance for repair or course correction once they have adopted a new way of living, Bates-Maves says. Examples of losses that might be controllable include legal problems or convictions, family ruptures, loss of employment and financial problems.

However, even with new skills and hope, there is no guarantee that clients in recovery will be able to fix or recoup all that they have lost, she cautions. For that reason, counselors need to help these clients “sit with that and explore both options: How can I learn to be OK and heal if this is changed or fixed? And how can I learn to be OK and heal if this stays broken or less than I hope?”

“The key lesson there is that clients can reconstruct a meaningful life in recovery, even if some components never return to what they once were,” Bates-Maves says. “It’s about moving ahead and grieving what doesn’t move with you. Again, balance. Growth is often painful, and we want to value the pain and loss that come with growth. Knowing that some relationships have been damaged beyond repair might be very painful and a point of personal despair, but it can also be framed as a powerful motivator. We can mourn the past and work to repair the damage that’s done, and we can work to not repeat it. I think our main task as counselors is to help frame the pain as useful and informative. What people hurt about reveals what they value. It also reveals what they don’t want to repeat. Both elements are quite useful to a counselor in helping a client figure out where they want to go and how to start getting there.”

“I think the most important thing for counselors to remember is that change is really hard,” she emphasizes. “That may seem obvious, but consider how often we forget it. Sometimes clients are kicked out of treatment because they’ve lapsed or relapsed. Other times there are mandates about [whom] one can spend time with and [whom] one cannot, requirements for employment, etc.”

Continuing not to engage in addictive behavior, forging relationships with people who don’t use substances, and gaining and maintaining employment are all healthy goals. However, clients need to process many of their losses — particularly those connected to self-worth and self-efficacy — before it is possible for them to achieve those goals, Bates-Maves says.

“Give people credit for the pain that comes with change, and give them space to talk about it,” she urges. “Talk about how health and happiness aren’t the same thing [but] that the work of counseling is to make them closer. Talk about how in order to move forward, we often have to let go and how hard that is, even when we’re letting go of ‘bad’ things. Focus on where someone is and not only where we/they/you want them to be. If we want to help people move forward, we have to understand what’s keeping them where they are currently. But mostly, give people credit for the pain that comes with change, talk about it, and help them grieve.”

A question of identity

As a certified rehabilitation counselor and someone who sustained a spinal cord injury more than 30 years ago, ACA member Susan Stuntzner knows a lot about the losses and grief that come with disability. 

“At the time, I was paralyzed from the waist down, but within two months, I achieved some mobility and enough to walk with below-the-knee ankle-foot-orthotics [AFOs],” she recounts. “While learning to walk was a fantastic high point of the rehabilitation process, an equally important aspect was figuring out my new or different capabilities. More specifically, I learned I could not run, which is something I used to enjoy; lift more than 25-30 pounds; and that I had to push or pull things rather than lift as a means to move objects. I learned it was probably not a good idea to stand indefinitely and the importance of recognizing and honoring what my
body could do rather than expect me to do things in exactly the same way as I could before.”

Stuntzner also grappled with an issue that is particularly common among women with disabilities whose physical appearance is altered, either through injury or a disability present at birth: body image and attractiveness.

“Again, going back to my own experience, while muscles in my thighs worked, those below my knees did not. This meant my feet and ankles did not either,” she says. “Thus, there was a change in how I initially saw myself and my calves, as these did not have muscle return but they were an attached part of my body. Changing the way I viewed myself was difficult and a form of loss, as I was 19 years of age and highly conscious of fashion and, in particular, shoes. In short, I loved cool shoes and I still do. However, the partial paralysis below my knees meant I now had to wear AFOs and could no longer wear the stylish shoes I had so loved. While some of this may sound trivial, fashion and shoes — again, I was 19 years of age — was important to me, and this change represented a form of loss, along with the attention that my AFOs brought to the stranger passing by.”

“My own story is only one of many, as each person who lives with a disability — visible or invisible — has a story or set of experiences,” Stuntzner says. “For some, it may be cognitive changes [such as] memory, learning, recall, traumatic brain injury. For others, it may be health conditions [such as] irritable bowel syndrome, heart conditions [or] chronic obstructive pulmonary disease that disrupt daily activities and events. Other people live with sensory disabilities — loss of vision or hard of hearing. People who are hard of hearing but not deaf face challenges because people sometimes report not feeling as if they fit anywhere; they are not deaf, nor are they a part of the ‘hearing’ sector due to some of the limitations they experience.”

Regardless of a person’s specific set of circumstances, it is important that the person views themselves as a “whole” person, recognizes their assets and strengths, and builds upon those assets and strengths, Stuntzner says. Identifying one’s abilities, strengths and talents regardless of disability and functional limitations is a key part of what rehabilitation counselors help people do, she adds.

Counselors can help these clients grieve by listening and supporting them emotionally and psychologically as they work through the changes brought about by their disability, Stuntzner says. Counselors should understand that adjustment and grief are individualized processes and that two people with very similar conditions and functional changes may cope and adapt very differently, she notes. They also may require different therapeutic approaches to help them move forward. One size does not fit all based on disability type, Stuntzner emphasizes. It is important to view the person as a whole individual and to help people learn to see themselves as capable individuals comprising many different aspects and interests.

“Another key component of working through loss is helping people work through their negative thoughts and feelings, and experience successes, while living with a disability so they develop a strong internal locus of control and a sense that they can effect change in their life and create the life they seek,” Stuntzner says. “In short, it is about empowering people to discover who they are or who they can be in spite of the disability. As people become empowered, they learn to find their voice and own it and use it to help themselves and others. It is through this process that people oftentimes heal and learn to see the bright side of living with a disability.

“By bright side, I mean they learn to see the positive ways their life has changed or can change, and many find a higher purpose through the experience of living with a disability. However, this is a process, one that may begin with grief and loss, then morph into a personal and/or spiritual journey where people discover ways to grow and sometimes access their higher purpose or sense of self. It is on this journey that people find healing.”

Not just a pet

According to the American Veterinary Medical Association, at the end of 2016 (the latest year for which statistics were available), nearly 57 percent of American households had pets. Surveys have shown that the majority of people among that 57 percent also view their pets as part of the family. Yet many people do not regard the death of a pet as a “legitimate” loss. Indeed, those who have suffered the loss of a pet may not recognize their own grief, says licensed clinical professional counselor Cheryl Fisher, an ACA member whose counseling specialties include grief and loss.

In Fisher’s experience, it is not unusual for new clients to present with issues such as depression, anxiety or stress, and when talking about why they are seeking therapy, mention — almost as if it were a side note — “By the way, I just lost my cat.”

Fisher recalls a client who had come to her for grief counseling after the death of a relative. As Fisher listened, she realized that the client’s loss extended beyond that one death and that she was experiencing complicated grief.

The woman mentioned in passing that she rescued feral cats, two of which had died recently. These street felines were not easily domesticated, so the woman’s interactions with them had mainly been restricted to feeding them, Fisher notes. Yet the woman kept collecting them.

The client was very isolated. In fact, the recently deceased relative had been her only remaining family member. Except for the cats. As limited as her relationship was with them, the feral cats were her family, and she was grieving those losses as well.

“People are sheepish about sharing their grief, but our animals are the most vulnerable members of our families and also the most unconditional and accepting,” says Fisher, who shared the experience of losing her beloved dog Lily in her CT Online column, The Counseling Connoisseur (“Pet loss: Lessons in grief,” April 2017).

As she tells clients who are grieving (sheepishly or not), the relationships that people have with their pets — whether dogs, cats, fish or fowl — are strong not just emotionally but biochemically. In interacting with their pets, people feel a release of oxytocin, the hormone responsible for feelings of closeness and attachment.

Fisher also asks these clients to tell their “pet story.” She begins by asking how they met their pets. Fisher says the adoption or birthing story is very significant to the pet–human bond, and when clients start to recount it, they get very passionate as they open up to those memories.

“I always want to know the pet’s name, what kind [of animal it was], what the client liked to do with them and if they have pictures,” Fisher says. “It’s like traditional grief therapy — I’m helping them talk about their loved one.”

As clients talk, Fisher will say things that highlight the significance of their relationship with their pet. For example, she might say, “It sounds like Sadie stood right by you through the divorce.”

Fisher says she can almost see clients exhale: “You get it. I didn’t realize this was so important. She wasn’t just a cat!’”

Fisher also helps clients find ways to stay connected to their pet by giving examples of rituals that others have used. She urges clients to think about their relationship with their pet and the type of remembrance that would fit that bond.

For Fisher and her husband, it was taking Lily’s ashes to the beach where they and their goldendoodle had so often visited and played. “She loved the beach,” Fisher notes.

Some clients create scrapbooks with items such as their pet’s adoption papers and first pictures. Fisher included all the condolence cards she and her husband received in the wake of Lily’s death.

One of Fisher’s clients honored her cat, who loved to look out the window at birds, by constructing a special birdhouse that held pride of place next to the pet’s perch.

Fisher also mentions a video she saw at a conference on children and grief. It was called “Bridget’s Loss,” and in it, a little girl says goodbye to her fish in a “ritual flush.”

Fisher describes the scene: The mother, who filmed the video, asks her daughter if there is anything she wants to say before flushing the fish. The girl says, “Sammy, you were a good fish. You always did good fish things, and now you will be able to go with all the other fish, and I will see you in another time in heaven or wherever.”

The key to grieving pet loss is to have some kind of goodbye ritual, Fisher says, even if it is something completely private that involves only clients and their pet.

 

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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)

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

  • “An Overview of Military Service Members and Their Families: How Mental Health Professionals Can Best Serve This Population” with John P. Duggan and Odis McKinzie (WEB17002)

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

  • “When Grief Becomes Complicated” with Antoinetta Corvasce (ACA252)
  • “Love and Sex and Relationships” with Erica Goodstone (ACA231)
  • “Disability Awareness” with Robbin Miller (ACA196)
  • “Counseling Military Families” (ACA139)

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

 

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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.

Behind the Book: Critical Incidents in School Counseling

Compiled by Bethany Bray April 22, 2019

“There is no amount of preparation that fully prepares you for what happens in the classroom or on the job,” writes Heather J. Fye, co-editor of the third edition of Critical Incidents in School Counseling, in the opening chapter of the book.

A school counselor’s graduate degree and academic training serve only as a base for the continuous learning that happens on the job — in classrooms, via interactions with students, via collaboration with colleagues, and through professional development. Teachable moments, Fye writes, can happen both spontaneously and as planned elements of time spent with students.

As much as school counselors grow, learn and evolve on the job, the discipline itself continues to change. With this in mind, co-editors Tarrell Awe Agahe Portman, Chris Wood and Fye recently updated Critical Incidents in School Counseling to reflect an ever-changing landscape that now includes challenges such as cyberbullying. The American Counseling Association published a third edition of the book in December 2018.

Portman is dean of the College of Education at Winona State University; Wood is an associate professor in the counselor education program at the University of Nevada, Las Vegas; and Fye is an assistant professor at the University of Alabama.

CT Online sent the trio some questions, via email, to learn more.

 

Q+A: Critical Incidents in School Counseling

Note: Responses co-written by Portman, Wood and Fye.

 

In providing case studies, one of the goals of the book is to bridge the gap between the academic learning that school counselors receive in graduate school and in-the-moment practical experience. Besides using your book, what else do you suggest to help school counselors bring themselves up to speed?

School counselors need to be lifelong learners, continually reading professional literature and attending professional development [opportunities] such as workshops and conferences. One of the added features of the new edition of the book is that a list of resources is included by the authors [of each chapter] in response to the critical incidents. These resources include additional reading on the topic, websites with tools and information on the specific topics, and resources from professional organizations such as ACA and the American School Counselor Association.

Small steps are important. It is important for school counselors to find supports within the counseling community. If school counselors are unfamiliar with other school counseling professionals in their school district or surrounding areas, it may be helpful to reach out to them.

It may be helpful for school counselors to attend a local, regional or national conference or take part in volunteer activities, as time permits, from a counseling organization. If national involvement does not seem possible, start with the local or state chapters [of professional organizations]. State school counseling organizations or chapters often have excellent websites, newsletters and resources available.

Lastly, networking with school counselor educators at the university level may provide engaging and collaborative opportunities between counseling professionals.

 

Fill in the blank: I wish I had known ________ when I was in my first year as a school counselor. What would you want to share with new or soon-to-be school counselors who might be reading this?

Chris Wood: How much I still had to learn.

Much of this is not because of inadequate training. It is just due to the incredible demands on professional school counselors and that the unique and ever-changing needs of students and schools make any new school counselor face a challenging learning curve. So, I would want new school counselors to recognize the importance of constantly improving their knowledge, awareness and skills through professional development.

Heather Fye: How I fit in to making a difference in the lives of students.

Do not just accept the status quo. Change takes time. Remember why you became a school counselor and try to do something — even five minutes each day — that aligns with your passion. You know yourself best.

Tarrell Awe Agahe Portman: More about policies, procedures and standards which directly impacted student success.

I would want new school counselors to feel reassured of their purpose and influence on the lives of generations to come. This can be overwhelming but is really just a part of the circle of life.

 

School counselors might be the only counselor in their building, working with educators and helping professionals who have different licensure and training. What advice would you give to school counselors about remaining true to their counselor identity?

Professional school counselors should draw their identity from their training and certification/licensure, not from how others in the building may perceive them. Certainly, there are many threats to the identity of professional school counselors that could push them into tasks or actions that are inconsistent with their training or even their ethical standards. An obvious example is the fact that school principals may want school counselors to engage in activities that help fulfill some school need but ultimately inhibit the professional school counselor’s effective functioning.

Staying connected to the profession, reading the professional literature — including research — and regularly attending professional development that is specifically targeted toward school counselors can help buffer the negative effects of those who don’t understand a professional school counselor’s role.

Professional school counselors should remember to reflect upon why they wanted to become a school counselor, stay aware of positive changes in schools from their school counselor program, and stay true to their training and self as a professional.

School counselors gain many techniques throughout their graduate training that can help them build professional relationships. Finding supports, staying connected with others who want to make a positive impact in the school setting, and [engaging in] continuous learning through professional development can be integral to self-care as well as professional identity.

 

The last edition of this book was released in 2000. What prompted a new edition? Why is it relevant and needed now?

Societal changes and new demands on school counselors created the demand for the new third edition of the critical incidents text. It was 27 years between the first edition and almost 20 years between the second edition and this newer third edition. So, one of the reasons for a new edition is a need to provide incidents that are more contemporary, embedded in the current school climate, and [which] address incidents based on the current generation of students.

Just the advances in technology since the last book highlight the different world that students live in today. When the second edition of the text came out there, was no Facebook or Myspace — these came several years later — and the word cyberbullying wasn’t a common concept. By 2006, there was some research to suggest that cyberbullying was affecting almost half of all American teens. So, obviously, the rapidly changing world of students in schools warrants a book that can help school counselors respond to critical incidents.

The original rationale for the first two editions is still relevant: to assist school counselors and school counselors-in-training with knowledge, critical thinking and related resources in order to respond to the many critical incidents that they face in their career.

Importantly, in this newest edition, we focused on having school counselors author the incidents and used experts with actual school counseling experience to author the responses. We felt that this would help lend the book toward offering more pragmatic learning and direct application to professional practice.

 

What do you hope readers will take away from the book?

Hopefully, readers will be able to relate their own professional practice to many of the critical incidents in the book and leave with two takeaways.

1) We hope the readers will feel validated in what they are experiencing on the job and benefit from multiple perspectives in addressing professional challenges.

2) We hope the readers will feel greater confidence in relying on their own knowledge [and] awareness and put their skills into direct action that benefits students. Reading the incidents and responses is intended to help school counselors improve their ability to problem-solve situations, advocate for themselves and their profession, build a foundation in peer consultation, and engage in ongoing professional development.

 

The landscape of school counseling is ever-changing. Do you feel graduate programs across the U.S. are keeping up?

Yes, in the case of graduate programs that maintain the highest levels of accreditation, train their students in the most current models of evidence-based practice, and teach students to apply their learning in innovative ways. Such programs are equipping their students to face changes and challenges that we can’t even name yet.

In general, there is a progressive movement happening in graduate programs across the U.S. However, there continues to be a disconnect between schools and universities — counselor or educator. School counselors have many demands, and this is true for university faculty as well. So, there may always be a need to produce books and other resources that can help bridge the knowing-doing gap between what school counselors learn in graduate programs and the practical application of such learning in an ever-changing landscape.

 

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Critical Incidents in School Counseling 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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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.