Monthly Archives: November 2019

Counselors, represent!

By Carol Z.A. McGinnis November 13, 2019

Tragic events tend to mobilize local and national news reports with questions and concerns that relate directly to the work that we do as professional counselors. Shootings, disasters, immigration issues, and political fallout are just a few examples that come to mind at the time of this writing.

What is particularly troubling to me is the lack of counseling expertise represented in the news in response to these events. Instead, we often endure ad hoc theories from professionals with no counseling experience who errantly connect tragic events to mental health issues. These individuals may mean well, but they make broad statements that connect video games with shootings, promote mental health policy that is rooted in subjective ambivalent “right” versus “wrong” societal thinking (rather than empirical research), and engage in ignorant blaming or scapegoating that leads to even more conflict and mental strife for the general population. What better time for licensed professional counselors to provide empirical context for these issues and offer hope for healing when it is needed most?

At the same time, I think we can largely blame ourselves as counselors for this gap in the national consciousness. We have fantastic representation in our state and national counseling associations and plenty of empirical research on topics of interest, yet we are not insistent on providing that content to our communities. As counselors, we have been trained to advocate through appropriate channels that include citizen-driven activities to challenge federal and state legislation, yet we have not learned how to promote our profession in the times we are most needed. Alfred Adler and Carl Rogers both held a global vision for our profession that included change and advocacy for the community at large. So, where do we start?

As a whole, the general public would find it useful to know a little more about what we do as professional counselors. People need to know that we are trained to probe more deeply about family dynamics, to inquire about the presence of guns and the use of prescription or illegal drugs, and to listen for evidence of strained relationships that may need immediate attention. We need to share that we have expertise in evaluating suicidal thoughts and potential homicidal intentions and that we often determine neglect or abuse for mandated reporting. People often worry about the ramifications of going to a counselor; our presence in the news media can go a long way toward easing those concerns.

After a tragic event occurs, these basic counselor skills can be invaluable for parents worried about their teenagers, spouses concerned about the safety of their mate, and adult children fretting about the welfare of their elderly parents. We can provide confidentiality that may be just the ticket when social concerns, political stressors, and environmental issues seem to be ever-present. As professional counselors, we are qualified to share insights on what symptoms to look for in a troubled family member, what signs might be particularly worrisome when a child withdraws, and how to find help when a particular mental health issue is occurring. It is information such as this that often seems to be lacking when the larger community is hurting.

 

Action steps

You may be asking: What can I do? Here are a few suggestions to get started.

First, take a moment to consider your particular skills and expertise. Do you work with people who struggle with depression? What information could you share publicly that might help others to cope, have hope, or seek help from a professional counselor? Alternatively, if your experience is with anxiety, what compassionate message might you share for people who are afraid to go to the mall or to the movies? If you work with people through illness or grief and loss, consider what messages you might be able to offer when the community at large is suffering with a particular loss. As a licensed professional counselor, you have knowledge, awareness and skills that would be tremendously useful in times of strife. It is just a matter of getting that content “out there” in the public.

Next, consider how you may want to advertise your availability to news outlets and the general public. One way to do this is to write an email or a letter to your local news station to identify yourself and the work that you do. Be brief in your communication, pointing to the specific issue or circumstance for which you may be most helpful. Include a business card or a link to a website if you have one. This is not the time to expound on your many research interests or on why you became a counselor. Be concise, clear and direct in describing what you specialize in so that news outlets can easily place you into a resource category.

It helps tremendously to have a professional Facebook, Twitter, Instagram or LinkedIn account that can connect your expertise to an active news media database or digital rolodex. Give some time and attention to this virtual representation to ensure that you are abiding by the ACA Code of Ethics. Consider locking down your settings to avoid inadvertent negligence on the part of potential clients who may try to direct message you. As stated in Standard H.6.a. in the ACA Code of Ethics, it is important to maintain a professional virtual presence that is separate from your personal presence online. It may be tempting to connect your professional site to your personal account, but resist this temptation.

Your professionally oriented social media sites should be designed to help local and national news media locate you should a specific need arise. Likewise, make it easy for the general public to find pertinent information on your credentials, expertise, and research interests. These details should clearly inform the general public about counseling and the specific work that you do, with special attention given to technology/social media competency (Standard H.1.a.) and your social media policy (Standard H.6.b.). Note how you may be of assistance to the community and the means for contacting you as a news source. Be sure to “friend” or “follow” all pertinent news outlets and local organizations that may need your help, and then take time to keep up with any interactions that occur with these entities.

Also, take a moment to consider what populations or groups in your area might especially appreciate a free workshop or presentation on the topic in which you specialize. Advocacy often begins in your local area, and people are more likely to ask questions about the counseling profession when they have the opportunity to get to know you better. Churches, synagogues and mosques tend to be places where disheartened and disenfranchised people go to get support. Offering to discuss your services in these places can open up new opportunities for the general public to understand what you do. Public clubs, parent groups, and schools may also grant you the opportunity to speak on a specific topic. Once these populations have the opportunity to learn about your work, they can also advocate for inclusion of a counseling perspective from their news sources.

If someone is searching for you in your area of practice, how will they find you? Psychology Today offers a “find a therapist” option that is helpful to the general public, but it incurs a monthly fee that some counselors may find distasteful. Another option to consider is starting a podcast, blog or streaming channel to bring your professional identity into the public eye. Although these options take time and energy, the results can include bringing your expertise to the consciousness of your immediate community. The creation of a website can also be useful as a less dynamic online platform where these other social media delivery systems can be “housed” in a central location. A unique domain for this purpose can be purchased and maintained with minimal cost and low effort. Community websites that provide free postings for mental health professionals at the county or city level can also be helpful. You may need to dig to find these, but they do exist.

Finally, don’t be shy about introducing yourself as a professional counselor when you are “off duty” and, if possible, take time to volunteer for an Advocacy Day sponsored by most state branches of the American Counseling Association. There are very helpful tips and tools located on the ACA website that provide direction on how to interact with local, state and national legislators, and steps for developing ethical social media sites. Another useful suggestion is to include a pertinent hashtag with your counselor postings (e.g., #CounselorsAdvocate) that can bring attention to that topic. Be creative in using hashtags that are specific to your knowledge, awareness and skills (e.g., #counselorforanger, #askacounselor, #counselinganxiety, #counselorgriefandloss). Connect with similarly named social media groups, and offer your availability in times of community tragedy.

In short, when tragic or troubling events occur, take a moment to think about your own skills, and then reach out to offer your perspective as a professional counselor to the news media. We often hear about the impact of public happenings in clients’ counseling sessions and may feel that we cannot act outside of that environment without sacrificing client trust. But there is a way to do this in an ethical manner. Remember, we don’t have to “take sides” on a controversial topic to provide much-needed positive messages to our communities. It may take courage for us to make this happen, but it is important for us to promote what we do as counselors when the people in our communities need it most.

 

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Carol Z.A. McGinnis is a licensed clinical professional counselor, national certified counselor and board certified telemental health provider. She is associate professor and clinical mental health track coordinator for Messiah College in Mechanicsburg, Pennsylvania. She is currently president-elect of the Maryland Counseling Association and specializes in research that focuses on anger processing (www.anger.works) and videogaming. Contact her at cmcginnis@messiah.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.

Counseling from an editor’s perspective

By Les Gura November 6, 2019

When I was a newspaper editor and reporters would tell me they had writer’s block, I sometimes used a technique championed by Pulitzer Prize–winning journalist Jon Franklin in his book Writing for Story. “Tell me your story in three words: subject, action verb, object,” I’d say.

After thinking about it, the reporter would deliver the initial three-word narrative, which would in turn ignite reporter-editor dialogue. Eventually, we would settle on the true narrative the writer was trying to tell, and off the writer would go to craft the full story.

When life brought me to graduate school for counseling, it was no coincidence that I found myself drawn to narrative therapy. To me, it made obvious sense to learn and understand client stories — a centerpiece of narrative therapy, according to its founders, Michael White and David Epston. Their book, Narrative Means to Therapeutic Ends, describes the power that story — and the maladaptive meaning often ascribed to it — has in people’s lives.

White and Epston explain how narrative therapy is about finding a client’s dominant narrative, externalizing the problem central to that dominant narrative, and identifying alternative narratives. But how does a professional counselor do that? Is what the client tells you the true dominant, or problem-saturated, narrative? Or might a presenting issue mask something deeper?

As I read more books, absorbed more information on narrative therapy, and began my internship in my final year of school, I recognized something. Clients don’t automatically understand the concept of a “dominant” narrative. Sometimes, they’re not even sure why they have come for counseling, other than a vague sense that something is not right.

It is the conversation between client and counselor that can elicit story. And that reminded me of my old editor’s trick — the three-word narrative.

Initial exploration

Thirty years as a journalist will garner you some skills, especially when your orientation is investigations and narrative writing. As I learned more about narrative therapy, I saw the parallels to my journalism past and went into the attic to fetch my old narrative writing materials, including Writing for Story and excerpts on writing techniques from the Poynter Institute. What I quickly realized was how easily and effectively the techniques of narrative writing could be adapted as part of the narrative orientation in counseling.

Today, I have made my background as a writer and editor a centerpiece of my professional disclosure statement because I find it a great way to kick off a conversation with most clients. Talking about my past eases clients’ anxieties about coming to see a counselor and lays the groundwork for future narrative work.

When conversation turns to why clients have come to counseling, I usually give them a homework assignment to return to the next session with a three-word narrative that answers the question: Why are you here? The exercise itself invites conversation, just as it did with “blocked” writers.

In journalism, the writer and editor chat after the former returns from the three-word exercise with the headline “Council Approves Budget.” The editor might ask the reporter, “Is that all there is?” Was it simply a vote? Who are the winners and losers of this budget approval? During the ensuing discussion, the reporter reveals that the new budget will cut taxes for the first time in 10 years. The reporter now has a more accurate three-word narrative from which to frame the story: “Taxpayers Win Relief.”

Now let’s apply the three-word narrative to counseling with a fictional client named John, a 65-year-old who presents at his first counseling session with sadness at the death of his wife of 43 years, Sarah. His initial three-word narrative about why he has come to counseling is “Grief overwhelms John.”

The counselor explores the concept of “overwhelm” with John. What is that like? Does it have a physical effect? Is John able to sleep at night? This conversation allows John to explore the nature of his dominant narrative. It turns out that the “overwhelm” John feels may have its roots in grief, but he is actually worried about what comes next.

Passive vs. active

There is a specific intent in using the three-word narrative’s subject–action verb–object format that has to do with how we perceive the stories of our lives. It’s all about passive versus active.

Inevitably, when I use the three-word narrative with my clients, they initially place themselves in the “object” position of the three-word narrative, just as John did in the example (“Grief overwhelms John”). Clients perceive that something is happening to them beyond their control, and they don’t like it. Being the “object” puts them in the passive position.

In narrative therapy as described by White and Epston, a central goal is to externalize the problem, to help clients see a problem as outside of themselves. Clients are asked to name the dominant narrative, and that becomes how it is thereafter referenced. Often, the action verb or object point toward the name of the dominant narrative. In the fictional case, we might try to externalize John’s dominant narrative by calling it “overwhelm.”

That is not an easy concept to externalize, however, because it is outside of John’s control; he has put himself in the passive position of his narrative. Using another narrative therapeutic intervention called questioning, John and the counselor spend time better defining the dominant narrative. John eventually recognizes that what brought him to counseling isn’t so much being overwhelmed but rather fear of the future. Hence, through dialogue with his counselor, John reconstructs his dominant narrative to “John fears loneliness.”

In this new version, John is now in the active position of the three-word narrative; he is the “subject.” This allows him to better see his role in the dominant narrative and gives him the insight to externalize his dominant narrative, which for this example can be named “lonely.” On a subsequent visit, the counselor can simply inquire of John, “How are you handling ‘lonely’ this week?” John can respond in the context of how he has responded to that issue, his dominant narrative.

The side benefit of this approach is that by John viewing himself as the subject, he is better equipped to “act” in terms of moving away from his dominant narrative or simply seeing it for what it is — an immediate situation outside of himself that is causing him problems. Again, as White and Epston would say, John is not the problem; the problem is the problem.

Indeed, that insight will be the means by which John and the counselor collaborate on strategies to identify alternative narratives in John’s life. They will eventually move toward those alternatives and away from “lonely.”

Going deeper

In her textbook Theories of Counseling and Psychotherapy: A Case Approach, Nancy Murdock says that narrative therapy can be described as “where the client tells the therapist a story, the therapist listens, and the two make what they can out of it.” Indeed, narrative therapy is a social constructive theory and typically considered a shorter term approach to counseling.

Using the three-word narrative approach, however, allows counselors the flexibility to go deeper than identifying and working to change the dominant narrative. For example, I have found that the three-word narrative approach pairs well with the construction of a genogram, which is a diagram of family relationships and behavior patterns. Once clients have identified a dominant narrative in their lives, I will spend some time with them constructing a genogram to help us both see and begin to understand their more complete life story.

Genograms allow clients and counselors to gain insight into how clients perceive the strengths, issues and relationships in their lives. I often ask clients to devise three-word narratives that describe their lives at different ages and moments. This allows us to contextualize how stories change; more importantly, it helps clients see where personal strengths lie during periods in which their stories were not problem-saturated.

Seeing life as a progression of narratives also encourages clients to begin thinking about two things: 1) alternative narratives to the dominant one that has brought them to counseling, and 2) how to use their strengths to build a path to achieve the alternative, just as they see they have done in the past.

The approach can work for a variety of presentations. The fictional examples that follow show how a counselor might work with a client on the issues of grief, depression, trauma and anxiety. Each example includes the identification of the initial three-word narrative, the reconstructed dominant narrative after client-counselor discussions, the externalized name for the presenting issue and, ultimately, the alternative narrative identified by the client.

Together, client and counselor will identify and form the path — using client strengths as well as other interventions — to move toward the alternative narrative.

Subject: Grief

Initial three-word narrative: Grief overcomes John

Reconstructed three-word narrative: John fears loneliness

Externalized name: “Lonely”

Alternative narrative: John conquers life

Subject: Depression

Initial three-word narrative: Hopelessness overwhelms John

Reconstructed three-word narrative: John destroys relationships

Externalized name: “Doubt”

Alternative narrative: John enjoys friends

Subject: Trauma

Initial three-word narrative: Abuse wounded John

Reconstructed three-word narrative: John trusts nobody

Externalized name: “Distrust”

Alternative narrative: John builds relationships

Subject: Anxiety

Initial three-word narrative: Indecision surrounds John

Reconstructed three-word narrative: John despises decisions

Externalized name: “Decision hater”

Alternative narrative: John relishes choices

Three-word narrative versatility

The beauty of the three-word narrative is both its simplicity and its ability to mesh with other interventions, in short, creating an integrated approach.

In addition to three-word narratives and genograms, I have used interventions such as reframing, motivational interviewing, mindfulness, wellness, and even harm reduction. All of these can help propel clients toward insights about themselves or the first baby steps to envisioning preferred narratives.

More simply, three-word narratives invite further exploration and conversation in an effort to go deeper. Understanding a client’s narrative — in the moment, in the context of the past, and to gain a sense of a preferred future — requires push and pull between client and counselor.

I have found my journalist experience to be most useful in asking questions. Not the rapid-fire style that is something of a cliché in journalism, but the more thoughtful, open-ended questions that show empathy. Not surprisingly, the most effective journalists are the ones who show their sources empathy and seek to fully understand a story. That’s even more true, obviously, for counselors using narrative techniques.

Narrative therapy as embodied in the three-word narrative technique has two other positive aspects worth noting. First, the three-word narrative is a transparent technique, which is typical of narrative therapy in general. It requires the counselor to openly explain the technique and its goals from the start, which has the benefit of also engaging the client in the work of therapy. By discussing my own background from the first meeting with a client, I am modeling the art of storytelling. This type of sharing promotes a two-way dialogue with clients.

Second, three-word narratives, as with many other aspects of narrative therapy, work well in a multicultural context. A counselor who seeks to understand life narratives is promoting the unconditional acceptance of a client’s family, culture, influences and environment in the shaping of those narratives. This promotes trust in the therapeutic relationship and the promise of collaboration.

As I move forward with my career in counseling, I anticipate finding other parallels with my former life and putting those ideas to work. The goal? To help clients recognize the narratives of their lives — past, present and future.

 

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Les Gura has been interested in narratives his entire life. After 35-plus years as an award-winning journalist, writer and editor, his own narrative took a turn in 2016 when he entered graduate school to become a clinical mental health counselor. He earned his master’s degree from Wake Forest University in the spring and joined CareNet Counseling in Winston-Salem, North Carolina, in September. He is a national certified counselor and a licensed professional counselor associate. Contact him at lgura@wakehealth.edu.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

 

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

One in three American kids affected by adverse childhood experiences

By Bethany Bray November 5, 2019

One-third of American children have gone through a negative experience that can have lasting implications for their physical and mental health, according to the U.S. Health Resources and Services Administration (HRSA).

Data from the agency’s most recent National Survey of Children’s Health indicates that 33% of children ages 17 and younger have gone through an adverse childhood experience (ACE) such as domestic violence or parental incarceration. Approximately 14% of children have gone through two or more ACEs, with a higher prevalence among black youths and those who live in households that are below the federal poverty level.

Among the children who took the 2018 survey, the most prevalent ACE was the divorce or separation of a parent/guardian (23.4%), followed by living in a household with someone with a drug or alcohol problem (8%), and the incarceration of a parent/guardian (7.4%).

“The new HRSA data is important because it helps us remember that all children are vulnerable to adverse experiences,” says Evette Horton, a licensed professional counselor supervisor and president of the Association for Child and Adolescent Counseling, a division of the American Counseling Association. “Our job as counselors is to assess for these adverse experiences and enhance the resilience factors that we know support children and adolescents. These include evidence-based mental health treatments, strengthening family support systems, and connecting to other resources in the community. Professional child and adolescent counselors are well-versed in promoting protective factors and stand ready to support children with any adverse experience.”

The U.S. Centers for Disease Control and Prevention defines ACEs as “all types of abuse, neglect and other potentially traumatic experiences that occur to people under the age of 18.” These experiences can range from the death of a parent to emotional or physical neglect and witnessing violence in a home or neighborhood.

Research has connected ACEs to health problems later in life such as mental illness, heart disease, addictive disorders, cancers and diabetes, and risky behaviors such as illegal drug use, unintended pregnancy and suicide attempts.

HRSA collects information on a range of children’s health-related topics from households across the U.S. for its annual survey; the most recent survey includes data from more than 30,500 children.

HRSA cannot directly compare the 2018 rate of ACEs to data from previous surveys because the language in a question asking about ACEs was changed last year. However, when excluding data for the question that was altered (regarding financial hardship), there was not a significant change in the number of ACEs between the 2016, 2017 and 2018 surveys.

 

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More from HRSA on the National Survey of Children’s Health: hrsa.gov/about/news/press-releases/hrsa-data-national-survey-children-health

 

Fact sheet on the 2018 survey: mchb.hrsa.gov/sites/default/files/mchb/Data/NSCH/NSCH-2018-factsheet.pdf

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Related reading, from Counseling Today:

Coming to grips with childhood adversity

The toll of childhood trauma

Informed by trauma

Counseling babies

Standing in the shadow of addiction

What’s left unsaid” (on child sexual abuse)

Interventions for attachment and traumatic stress issues in young children

Touched by trauma

 

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

 

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

 

Counseling survivors of sexual violence

By Amy E. Duffy November 4, 2019

After spending more than 14 years in the mental health field working with a variety of populations, including gang-affiliated youth, adults with chronic and persistent mental illnesses, combat veterans, and survivors of human trafficking, I am struck with an inescapable theme: Sexual violence plagues every facet of society. Sexual violence does not discriminate, regardless of demographics.

As a counselor, I entered this field to become a helper and to become a part of something bigger than myself. Fred Rogers could not have said it any better: “Look for the helpers. You will always find people who are helping.” This sentiment still rings true in my heart, but one thing the mental health field has shown me is that helping sometimes requires us to combat the systemic and institutionalized injustices that are prevalent in our society.

I recently found myself in a counseling session with a college-age cisgender female who was displaying feelings of hopelessness, crying profusely, and asking me “Why?” She was directly asking me why — after her sexual assault and after exercising every legal right available to her — the system was failing her. I was apologetic for her experience, but I found myself at a loss for words. She was correct; the system was failing her. Our society and our legal system have justice gaps that are expansive. I couldn’t think of an answer I could provide in that moment that would address her feelings of hopelessness.

In subsequent months, as I became aware of similar scenarios playing out with other clients, I began to feel both compassion fatigue and burnout begin to take root. As I’ve mentioned, my intention as a counselor is to help, and I felt that I was not helping enough. I know trauma and its associated treatment modalities like the back of my hand, but that didn’t mean I was doing my part to address the gaps in justice or systemic and institutionalized inequalities that were drastically affecting my clients and their shared experience with sexual violence.

Professional counselors cannot ignore the reality that 1 in 3 women and 1 in 6 men report some form of sexual violence over the course of their lifetimes (according to the National Intimate Partner and Sexual Violence Survey 2010-2012 state report). The Thomson Reuters Foundation conducted a survey in 2018 that concluded that the United States was the 10th most dangerous country for women among the 193 member states of the United Nations; it tied for third among nations where women were most at risk for sexual violence. The foundation defined sexual violence as “rape as a weapon of war; domestic rape; rape by a stranger; the lack of access to justice in rape cases; sexual harassment; and coercion into sex as a form of corruption.” Unfortunately, I have personally borne witness to each of these definitions of sexual violence while working in the mental health and counseling fields.

Given the epidemic of sexual violence, both domestically and globally, it is impossible for counselors to avoid contact with individuals who have survived such violence. To date, counselor education programs do not have a reputation for providing an adequate and thorough understanding of practices for working with this population in their curricula. In addition, progress in the field of sexual violence has been negligible, partially due to the significant gaps in research necessary to better inform prevention, policy and advocacy efforts. These absences of vital counseling resources triggered my desire to explore the Multicultural and Social Justice Counseling Competencies (MSJCC) in search of a plausible answer to this dilemma.

The MSJCC

The MSJCC, developed by Manivong Ratts, Anneliese Singh, Sylvia Nassar-McMillan, S. Kent Butler, and Julian Rafferty McCullough, recognize that individuals are part of a larger ecosystem in which privilege and marginalization coexist. The MSJCC provide a framework to best support survivors of sexual violence not simply on the intrapersonal level, as addressed within treatment models and counseling strategies, but on all socio-ecological levels, through advocacy and action. The MSJCC emphasize the importance of understanding individuals in the context of their social environment while advocating for social justice within that social environment.

In addition, the MSJCC framework acknowledges the need for understanding the complexities of diversity and multiculturalism within the counseling relationship, as well as recognizing the negative influence of oppression on mental health and overall well-being. This framework reinforces the need for counselors to recognize and uphold the reality of intersectionality, in which the various social constructs of race, ethnicity, gender, sexual orientation, economic status, religion, spirituality and disability contribute to a client’s unique worldview, experience and existence as a human being.

When counselors partner with survivors of sexual violence, both the counselor and the client need to recognize the roles that privilege and marginalization play in sexual violence and within the counseling relationship. Effective treatment and long-term healing cannot exist without this mutual understanding. The reality is that victim-blaming, rape myths and gender inequality are persistent elements in American culture and globally; these cultural characteristics constitute what is known as rape culture. Victim-blaming is the extent to which society holds victims of sexual violence responsible for their own victimization, whereas rape myths are stereotyped false beliefs regarding rape, survivors and perpetrators.

Within rape culture, the survivor is marginalized while the perpetrator is privileged, most commonly due to gender. The privilege of gender is then further extended and embedded into society within systems and institutions that protect the perpetrator. These systems and institutions are built upon the foundations of victim-blaming, rape myths, and gender inequality. For example, states such as North Carolina still have laws that blame the victim and support rape myths. These laws include the inability of a person to withdraw their consent to engage in sexual intercourse once consent has been provided. In addition, a person who voluntarily consumes alcohol and then is sexually assaulted is not protected under North Carolina criminal law because of the fact that they voluntarily incapacitated themselves.

Sexual violence is a gender-based violent act. Approximately 91% of sexual violence survivors are women, whereas roughly 9% are men (according to U.S. Department of Justice statistics on rape and sexual assault for 1992-2000). Each of these individuals has been violated in a perpetrator’s effort to oppress and exert power over the survivor. Within the counseling relationship, the counselor and client need to explore the perceived and actual characteristics of their respective marginalized and privileged statuses relative to the issue of sexual violence and in the full context of the intersectionalities described earlier.

Although toxic masculinity may be a newer term in our culture, the constructs associated with it have historically been interwoven into American culture and should be taken into account when applying the MSJCC framework with survivors of sexual violence. Toxic masculinity describes the rigid characteristics and attitudes that are often (falsely) associated with what it means to “be a man.” These characteristics include strength, violence, sex, power, and an absence of emotion and vulnerability. Toxic masculinity perpetuates sexual violence directed not only toward women but also toward men. Understanding the gender-based nature of sexual violence and social constructs such as toxic masculinity, it is vital for counselors to fully embrace the MSJCC framework and the ways in which it relates to survivors of sexual violence.

In my clinical opinion, a counselor should not enter the counseling relationship without fully understanding and accepting the reality that in American culture, 25% to 35% of people endorse rape myth acceptance and therefore engage in victim-blaming and the perpetuation of gender inequality. Counselors should also understand and accept that toxic masculinity is, in fact, a deficit for all genders. This understanding and acceptance is a component of counselor self-awareness within the MSJCC framework. Counselors must become aware of their own attitudes, beliefs and biases pertaining to sexual violence prior to engaging in a counseling relationship with survivors of sexual violence.

The MSJCC require ongoing self-awareness and personal reflection regarding the beliefs, values and biases possessed by the counselor. This is particularly important when working with survivors of sexual violence because of the socialized cultural beliefs to which all counselors have been exposed. If counselors have not adequately addressed their potential beliefs, values and biases, it can result in bolstering shame among survivors of sexual violence.

Expanding the role of the counselor

A primary concept of the MSJCC is the expansion of the counselor’s role. This expanded role is essential when working with survivors of sexual violence. Traditionally, the counseling process has occurred within the confines of an office setting and on the proverbial therapy couch. That scenario has never been adequate when addressing the needs of those who have experienced sexual violence and thus is long overdue for modification. With the inception of the MSJCC, counselors have a framework for expanding on their traditional role to provide best practices in the presence of a profound gap in justice for their clients. 

Social justice advocacy conducted within the MSJCC framework allows counselors to work at the intrapersonal, interpersonal, institutional, community, public policy, and international/global levels to address the systemic obstacles affecting survivors of sexual violence. In the remainder of this article, I will provide a hypothetical case conceptualization (representing a composite of numerous actual cases) to illustrate this multilayered application of the MSJCC framework by a counselor working with a survivor of sexual violence.

Counselor self-awareness: Beliefs, values, biases

The counselor identifies as Christian, is supportive of homosexuality and same-sex marriage, and opposes marital rape, recognizing that nonconsensual sex within a marriage is, in fact, rape. The counselor recognizes the value in people waiting until marriage to engage in sexual intercourse but believes that imposing this standard on others can inadvertently create significant pressure and shame, particularly if someone is then exposed to sexual violence. The counselor believes sexual intercourse should be between consenting persons who provide affirmative consent (with affirmative consent being defined as the presence of yes means yes rather than simply no means no).

The counselor also believes there is no place for aggression or violence within sexual intercourse. The counselor attributes this aggressive mindset in part to the prevalence of pornography, in which close to 90% of sexual acts include aggression against women (according to the 2010 article “Aggression and Sexual Behavior in Best-Selling Pornography Videos: A Content Analysis Update,” published in the journal Violence Against Women). The counselor believes that sexual violence is about power, control and dominance rather than a perpetrator’s elevated drive for sex or inability to control temptation, and that the latter beliefs reinforce rape myths and victim-blaming. The counselor also recognizes and opposes gender inequality in all spheres of life, including the sexual double standard that exists between men and women. The counselor has had consenting partners throughout her life span and has survived sexual violence twice.

The counselor has explored the antecedents to rape culture to identify her own experiences with these antecedents as well as with associated beliefs, values and biases. The counselor is opposed to traditional gender roles and finds them to be oppressive for all genders. The counselor believes that gender and gender roles should be fluid and not rigid and attributes this belief to being raised in a home where traditional gender roles were not always strictly enforced.

Regarding adversarial sexual beliefs and hostility toward women, the counselor recognizes her personal history of strained relationships with prominent female figures as a child, as well as significant “girl drama” during pre-adolescent and adolescent development. Historically, the counselor has interacted better with males and has had periods of doubting women. Regarding the acceptance of interpersonal violence, the counselor believes in standing up for one’s self, even if that means taking physical action. The counselor supports the Second Amendment but believes gun control is not adequate at this time. The counselor has historically enjoyed action movies but has recently begun exploring violence in the media.

To further understand how the counselor’s beliefs, values and biases could affect the counseling relationship when working with survivors of sexual violence, the counselor completed the Illinois Rape Myth Acceptance Scale (IRMA) and scored a 108 out of 110, indicating greater rejection of rape myths. The counselor also recognizes that this score is not reflective of the counselor’s lifelong involvement with rape myth acceptance and is aware of historically faulty thinking as an adolescent and young adult. The counselor acknowledges that self-reflection and development have contributed to her current IRMA score.

Privilege, marginalization and intersectionality

The counselor also examines the ways in which privilege and marginalization interact within the counseling relationship. The counselor is privileged due to being white, middle class, heterosexual and Christian, and having had the opportunity to obtain a higher level of education, whereas the counselor is marginalized for being a woman.

The client in this case conceptualization is privileged due to being heterosexual and Christian, whereas the client is marginalized for being a black woman of lower socioeconomic means who has not been afforded the opportunity to complete her education to date.

The counselor identifies the MSJCC quadrant of privileged counselor-marginalized client as the most appropriate to describe the counseling relationship. The counselor is also aware, however, that this is the counselor’s own perception of privilege and marginalization within the counseling relationship and that the client may have a different perception.

The socio-ecological model

The counselor begins at the intrapersonal level by sharing her worldview (as previously described) and bearing witness to the client’s worldview. The beliefs, values and biases of both parties are explored. Intersectionality is a main component within the intrapersonal level, with the social constructs of race, ethnicity, gender, sexual orientation, economic status, religion, spirituality and disability being explored by both the counselor and the client.

The counselor and the client also have an open discussion about privilege and marginalization, including the ways that they may enrich or create obstacles within the counseling relationship. For instance, both the counselor and the client have a shared experience and openly process their experiences of gender inequality and being discriminated against for being women. At the same time, the counselor openly recognizes the existence of white privilege and verbally acknowledges that her race has not made her life more difficult. The counselor also honors the specific incidences of racism that the client has experienced and is openly willing to share with the counselor.

At the intrapersonal level, the counselor and the client also discuss and process the client’s experiences with self-blame, victim-blaming, and rape myth acceptance. The client shares self-blaming beliefs such as, “I should not have gone out that night” and “I never should have had those drinks.” The client also shares victim-blaming attitudes that others have projected onto her, including how the client’s clothing was too revealing and how she could have been more assertive in her denial to engage in sexual intercourse.

Following the exploration at the intrapersonal level, the counselor begins to support the client at the interpersonal, institutional, community, public policy and international/global levels. At the interpersonal level, the counselor assists the client in exploring her various relationships and identifying a healthy social support network consisting of family, friends, neighbors and co-workers. During this time, the counselor also assists the client in implementing appropriate boundaries within those relationships that have been identified as being unhealthy or unsupportive. The client determines that several familial relationships are unsupportive due to significant victim-blaming attitudes and the demonstration of rape myth acceptance. The client then gives the counselor permission to provide psychoeducation regarding victim-blaming and rape myth acceptance to these family members and to challenge their beliefs that are further victimizing the client.

The family members resist the psychoeducation and continue to engage in victim-blaming and rape myth acceptance. Therefore, the client decides to implement boundaries to appropriately distance herself from these relationships. The client then makes an intentional effort to widen her social network by connecting with other friends and family members. After visiting a shared interest group with the counselor, the client decides to join the group in hopes of also making new friends.

At the institutional level, the counselor and the client begin to explore the social institutions with which the client is associated. During a session, the client shares that she has observed sexual harassment in her workplace and expresses concern that she will continue to be exposed to these interactions. With the client’s permission, the counselor reaches out to the employer and offers to provide an organizational training to the entire staff on sexual harassment and gender inequality in the workplace.

The client also shares that she has been a member of her church for more than a decade. She is finding it increasingly difficult to attend regularly, however, because of the feelings of shame associated with the church’s message regarding purity. The client also shares her perception that the church displays rape myth acceptance frequently during its teachings. With the client’s permission, the counselor reaches out to explore the possibility of meeting with church leaders about their own rape myth acceptance tendencies and to develop a plan with church leaders to provide a more supportive environment for survivors of sexual violence. Furthermore, the counselor uses this experience to develop a program to help all community churches create safe places for survivors of sexual violence.

The counselor’s work does not stop here. As an active member of the community, the counselor has various opportunities to address norms at the community level. For instance, when processing at the intrapersonal level, the client shared her experience with racism, disclosing that she often felt unheard during her school years and was frequently passed over when her hand was raised to contribute to class discussions. Instead, she received discipline referrals for speaking out of turn and being disruptive. The counselor validates the client’s experience with microaggressions and acknowledges this display of racism. The counselor then assists the client in connecting with a community volunteer opportunity in which the client will be tutoring school-age minority females. This gives the client an opportunity to empower not only herself but minority female youth as well.

The counselor also notices that the community has limited events to raise awareness about sexual violence, suggesting that the topic is unimportant, taboo, or not considered to be an issue within the community. With that in mind, the counselor decides to organize a committee of other counselors to coordinate an annual Take Back the Night event. The hope is to engage the community more on the topic and to create a new community norm of open discussion regarding sexual violence.

The public policy level is most closely associated with the gap in justice witnessed by survivors of sexual violence. For that reason, the counselor is intentional about making action at this level a priority. The counselor becomes knowledgeable about state and federal laws that affect survivors of sexual violence and openly shares this information with the client. The counselor attends public forums on the topic and provides expert testimony regarding the need for improved laws that protect survivors. The counselor also meets with state legislators to discuss how laws that reinforce victim-blaming and rape myth acceptance affect survivors of sexual violence and the communities in which they live.

At times, the counselor challenges the language used in sexual violence legal cases, including questions such as “What actions did you take to prevent the alleged sexual assault?” and statements such as “The victim chose to stay.” The counselor does this by reframing these retraumatizing questions and statements to be trauma-informed. In these instances, the counselor reinforces the truth that survivors cannot prevent their sexual assault from happening, nor does one’s decision to be in a specific environment suggest that survivors are responsible for being assaulted.

Similar to the public policy level, the international/global level requires the counselor to take action outside of the office and, at times, behind the scenes. The counselor educates herself on gender inequality on a global level, including human trafficking, farming disparities between men and women, unequal labor wages, lack of education for females, immigration, and child marriage. The counselor joins organizations that address these various topics, which have both direct and indirect associations with sexual violence. The counselor then disperses information on these topics on a blog linked to her website. Finally, the counselor participates in specialized training to complete immigration assessments for those seeking asylum in the United States and those hoping to gain access to their afforded protections under the Violence Against Women Act.

Conclusion

Sexual violence is epidemic in contemporary society. This epidemic is largely fostered by the prevailing rape culture in the United States and worldwide. Thus, it is highly likely that counselors will encounter survivors throughout their careers across a wide range of clientele. This article provides relevant background information on sexual violence and victimization, along with an application of the MSJCC, to promote a deeper understanding of sexual violence and to detail a promising framework for counseling and advocating for these survivors.

 

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Amy E. Duffy is a licensed professional counselor supervisor specializing in trauma and working in private practice in Raleigh, North Carolina. She is currently pursuing her doctoral degree at North Carolina State University, where she is studying gender inequality and sexual violence in her dissertation research. Contact her at amyeduffylpc@gmail.com or HarborBehavioralHealth.com.

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Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

 

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