Monthly Archives: March 2020

Counseling clients into new territory: Five steps to redefine a foundation

By John Wheeler March 30, 2020

As professional counselors, we are often faced with challenging clients who express the desire for their life to be different yet continually make the same choices. We do not fill the role of advice givers as counselors, but if we’re not asking questions that encourage our clients to explore what’s true for them, then we are doing a disservice to them and to ourselves.

It is important for every counselor to have some pragmatic tools to assist in the counseling session. As clients explore “new territory,” it is not uncommon for them to face new challenges, feel like quitting or even decide to no longer seek counseling. With the steps below, I invite counselors to explore five easy ways to encourage “change” and facilitate clients toward redefining the foundations of their lives.

When we say “foundation,” we are talking about the fixed points of view that someone has either been taught or discovered from their own life experience and from which they create their basic belief system. Foundations give us a false sense of security while constantly providing us with information to make decisions. Although we must have a way to form our decisions and make choices, it is important to allow for a flexible foundation. When the foundation your client is using becomes too solid or too fixed, it does not allow them to make changes in the systems that govern their beliefs.

Step No. 1: Acknowledge what is no longer working. The first thing in redefining the foundation of clients’ lives is to get them to acknowledge what is no longer working. By simple definition, acknowledgment is the acceptance of truth or accepting that something exists. It is the ability to see that something is simply what it is — no more and no less. Acknowledging choices that have been made without placing a judgment on them (i.e., making them “right” or “wrong,” “good” or “bad”) creates a safe space for clients to explore their life stories.

Facilitating clients’ acknowledgment of everything that isn’t working also creates more flexibility in their understanding of different life events, such as having a parent leave or the ending of a marriage. Although this concept is existential, in its basic nature, this tool empowers clients to see the choices they have made, recognize the role they have played in every situation, and practice nonjudgment of themselves in a way that begins to unravel the barriers they have built.

What if acknowledgment of what is no longer working was the most freeing concept that your client had encountered?

Step No. 2: Determine the points of view in place. Once clients have acknowledged what is no longer working, it is time to determine the points of view they are using to create their lives. One of the fundamental beliefs in psychotherapy is that the way something or someone is perceived determines the likelihood of creating patterns, judgments and fundamental beliefs on which future choices are based. For example, if we perceive an individual as being rude, we may make every effort to avoid that person in the future.

By processing the points of view clients have taken around the events in their lives, we are inviting them to determine what is known to be true versus what they think to be true. Exploring a point of view about any area of their life can result in new insights, new awareness, new choice and new possibilities that clients may not have imagined previously.

How different would your life, business and practice look if you had no points of view on which you based your decisions?

Step No. 3: Explore the possibilities. Think of this step as a giant brainstorming activity in which clients and counselors welcome every possibility and do not label anything as impossible. Although it is important to be realistic and have measurable goals, counselors have to allow their clients to explore the new foundations being formed. At this level, counselors have challenged clients to be open-minded and flexible in their beliefs. To turn down ideas as dumb or to discount clients could create mistrust and new judgments.

What if you were willing to explore the infinite possibilities of the new foundation being formed?

Step No. 4: Make a new demand. Considering the possibilities that have been discovered, it is time to acknowledge what is reachable at the time of the session. Keep in mind that what is available now may be different in future sessions as clients get more comfortable. Making a demand is about clients accepting “what is” and then committing to doing, being or having something different in their life. This is the stage at which they get to choose whether to continue in the same pattern they have been repeating or begin to create something new. It is about taking responsibility and playing an active role in the creation of their life.

How different would things look if you made a different demand in your own life?

Step No. 5: Encourage clients to create for themselves. A risk of individual therapy is that relationships can change as clients change. It is important to discuss with clients that they can change only themselves and their own roles in their lives. Clients are the experts in their lives, so they must learn to choose what their lives will be like. Many factors play into the success of clients beginning a new chapter, but the most important thing they must learn is to do it without the counselor.

How can you encourage your clients in every session to explore something new for themselves?



In closing, please note that it is not a counselor’s place to push clients to change their foundations. As counselors, we do not have the right to push our agendas or beliefs on our clients. The pragmatic approach I have outlined will work best with clients who have a high motivation to change, express a strong desire for something different, and demonstrate a willingness to be more flexible with their views on life. This is a more directive approach to counseling, and counselors should always use their best judgment in determining whether this approach might best suit their clients’ needs.



John Wheeler is a licensed professional counselor in Dayton, Ohio, and a certified facilitator of Access Consciousness. His focus in therapy is on providing a space that allows clients to be the experts of their own lives and encouraging them to take a proactive approach to fostering lifestyles that work for them. Contact him at or visit


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.

Marathon vs. sprint: Building a sustainable career as a professional counselor

Compiled by Bethany Bray March 27, 2020

Professional clinical counselors who sustain their careers over decades have literally thousands of clients come through their doors. There’s no denying that the job is rewarding, but the daily grind of helping people overcome trauma, loss, addiction and other “heavy” challenges can wear on even the most resilient of practitioners.

This begs a question: How do counseling professionals maintain their energy and motivation across the years? What does it take to stay fresh and inspired day in, day out, rather than growing stagnant over time?

Lynda Diane Noffsinger, a licensed clinical mental health counselor supervisor in Winston-Salem, North Carolina, has found that her answer to this question is to stay curious. Noffsinger has been a professional counselor for close to three decades but says she is still learning every day. Just last year, she earned her credential as a certified eating disorder specialist.

Noffsinger has worked as a counselor in a variety of settings — at a mental health hospital, at a residential substance abuse program, at a college counseling center and in a private practice that she owned for 20 years. She says each role taught her not just new counseling skills and techniques but also more about herself.

For instance, when she worked briefly as a clinical counselor at a residential and outpatient eating disorders program, “I learned that I do not like an administrative role. I missed direct counseling, and I missed the community I called home,” says Noffsinger, a member of the American Counseling Association since 1999.

Most recently, in her role as a counselor at a practice that specializes in helping adults and adolescents with mood disorders, she immersed herself in a 30-hour online training program in dialectical behavior therapy. “From this work experience, I’ve learned I’m a clinician, and that’s what I do best. I have spread myself too thin at times, experienced burnout at times and, some days, I’ve ended the day bone-tired,” Noffsinger says. “However, since 1993, I wake up every workday and, as Viktor Frankl would say, I know what my purpose is and [that] my life has meaning. Twenty-seven years later, I still love the counseling profession.”

What does it take to stay fresh, inspired and energized over the long haul of a counseling career? Counseling Today recently collected insights about career longevity from American Counseling Association members of varied backgrounds and practice settings. Read their thoughts below.

What has kept you energized across the years of your career? How have you avoided stagnation? Add your voice to the conversation by leaving a comment at the bottom of this article.



In my 33rd year of private practice, I am grateful for a profession where we can work as long as we choose and our clients often see working with an older counselor as a good thing.

Compared with the early years of my practice, my clients have become a more diverse group. Half my clients are under 40. They come from a variety of ethnicities, races, religions and sexual orientations. My days are both busy and varied — what one client brings to therapy looks very different from the previous client or the next one. Along with continuing to work on my professional skills, maintaining cultural competence and relevance helps keep my professional life from becoming too routine. My clients challenge me to see life from fresh perspectives.

For more than 15 years, I’ve been part of a small peer supervision group. The group has been an enormous gift. We support and challenge each other and provide different points of view. As someone in a solo private practice, relationships with peers have helped me avoid feeling isolated or stale.

In talking with newer counselors — and in reflecting on my own development — I’ve often thought that counselors prioritize caring for clients over self-care. That’s hazardous. I’ve learned not to be endlessly accommodating of clients’ need to reschedule if that would overload my schedule and leave me exhausted. And I’ve learned to become comfortable with the business side of my practice.

As a young counselor, I knew I wanted a practice where my clients and I would make decisions about our work without interference from insurance providers. Choosing not to sit on insurance panels meant that my practice grew more slowly. In the early days, I worked part time for nonprofit [organizations] to make ends meet. Having a vision of how I wanted to work has allowed me to build a practice where I can earn a comfortable living while also maintaining reduced-fee spaces for limited-income clients.

Someone told me early in my career that the world doesn’t need any more “burned out do-gooders.” I have taken that advice to heart, and I’m grateful to my younger self for the faith, patience and commitment needed to build a professional life that sustains me while allowing me to be useful to my clients.

— John Ballew, a licensed professional counselor (LPC) with a solo private practice in Atlanta



What an honor it is to have been providing counseling services for over 35 years. I may be simply lucky, but I’d like to think that the fact that I have never experienced burnout and am still in love with my profession has more to do with an intentional emphasis on taking care of my own mental health.

There are a number of intentional activities that have sustained my balance, hope and energy for the profession over three-and-a-half decades. The most potent of these might be to stay in my own lane. Regardless of the job I do, I recognize that others will do it differently and not comparatively. I’ve both supervised and provided counseling for other professionals who find their energy zapped, their attitudes hostile and their work disrupted due to a comparative evaluation of colleagues as either better or worse in some area of the job.

An early mentor of mine encouraged me to realize that what another [counselor] does — except in cases of gatekeeping — is none of my worry and that others might rise if they feel support and care. This has led me to celebrate my peers’ work, to be open to learning from them, and to generally feel positive about heading into the workplace in each of the venues [in which] I’ve been honored to work. The closest I’ve come to burnout involved colleagues who were unjustly negative. It’s truly an art to turn that around.

This leads me to the second most powerful agent of enthusiasm building: learning. I am a lifelong learner. I deeply value finding new theory, technique, strategy and skill and, even more, a deeper understanding and wisdom regarding the human condition. I just reread, along with one of my Gonzaga classes, [Viktor Frankl’s] Man’s Search for Meaning to jump-start our trek of discovery this semester.

This is related to a third factor: I mix up my work and the populations I serve. I teach, provide community prevention services, crisis intervention, group work, couples and family work, and individual counseling with as diverse a set of individuals as I can in my community. It’s never dull, I am never bored, and I am constantly learning more about each person and about humanity at large. I’m constantly reminded to advocate where needed but to not turn my attention to embitterment.

  Elisabeth Bennett, a professor at Gonzaga University who has had a counseling practice treating couples, families and individuals in Spokane, Washington, for 35 years



Sixty years ago, with new graduate degree in hand, I was hired as a school counselor. My counseling career had begun. Over the years, it has taken different shapes as jobs, settings, responsibilities and functions changed. Then, 21 years ago, I gave up tenure, license, income and position to retire. From the beginning to the official end of my active career, I have been energized, shaped, nurtured and sustained by an intense fascination with people.

My graduate education, combined with my fascination, shaped the way I interacted with people when I wore the hat of counselor or educator. Focusing on how people communicate and relate as casual friends continues to hold my attention. In both my professional and personal life, I have worked to be aware of that fuzzy line that separates intense conversation from therapeutic response, and I have worked hard to respect boundaries — both for myself and for the person or persons in the other half of the communication.

Early in my graduate education, I was given the maxim: “Counselor, know thyself.” It has been a guiding principle. Throughout my active career, regional and national conferences fed me with new ideas, refined techniques, and gave me rewarding interactions with professional colleagues and friends. I have always tried to have a group to whom I felt some accountability and who could assist me in that self-knowledge arena. In retirement, I have a regular group of friends to keep me grounded but without the professional expectation.

In retirement, I increased my volunteer activities in noncounseling situations that still required that I be a listening, caring individual. As example, for several years I facilitated a group of caregivers who met to share the pain and stress accompanying that role. I was facilitator, not group therapist. It worked for them and for me and was richly rewarding.

There came a day when I realized that my hearing loss and my inability to keep all the details of a conversation in my mind were affecting my facilitation skill. I knew myself. And I knew that my performance fell short of my expectations. Knowing myself means knowing what to do; it also means knowing when to quit.

I have had a good professional life. The fascination with people that moved me into my career remains high. It continues to sustain me in retirement. I hope it will continue to do so.

  Brooke B. Collison, an emeritus professor of counselor education at Oregon State University and a fellow and past president (1987-1988) of ACA



When I started my counseling training in 1990, I knew I wanted to pair expressive arts therapies with counseling. That has helped me build a long-term career. We artists recognize creation as a metaphoric marathon versus a sprint. The first draft of an art project does not have the rich depth of the final product.

Artists recognize that the path of producing a work of art — like an actual marathon in comparison to a sprint — travels a variety of landscapes such that the path often doubles back on itself. You revisit various aspects of each work of art and massage each aspect until each art piece feels completed.

Others, of course, have spoken of the art of counseling. I add to their words as I invite the dance of creation, which is different than a marathon or a sprint because creation involves movement that is more varied than running. When we are schooled, we are advised to do our own therapy, and that is key.

As we do the energetic dance of relationship with our clients, those dances will stir the dances we have shut down. Stephen Porges’ polyvagal theory and Peter Levine’s understanding of trauma patterning help us recognize the burst of intense feeling that awakens moves that have been mired in shutdown.

When we lose interest in expanding our movement repertoire because we sense an intense awakening, we may push ourselves to work robotically and eventually burn out. When we risk the drama, we awaken a presence that brightens our time with our grandchildren [and] helps us appreciate the journeys of our adult kids and those of our lovers. Finding presence allows us to pause to snuggle with our cats and walk our dogs around the block.

  Dee Wagner, an LPC and board-certified dance therapist at The Link Counseling Center in Atlanta for 26 years



What does it take to sustain a counselor over the long haul of a professional career?

For me, it has taken a lot of work on myself and paying attention to my needs outside of the counseling chair. If I have put my mask on first for oxygen, I am much more able to help others with theirs. When I haven’t done so, I struggle more, I stagnate more, and I find myself more frustrated. I also have truly come to believe that everything you ask a client to do, you better have done yourself. Whether that’s a sand tray therapy exercise, an expressive art technique, thought stopping, or getting to the gym, you have to do the work too.

What has kept you passionate?

There are two things that have really kept me passionate. First, every kid and family I have worked with and their willingness to show me their world and be vulnerable. This inspires me each day, and I try not to forget it. Second, supervising counselors-in-training, seeing them wade through this wonderful process, and being a part of their professional journey.

What are some lessons you’ve learned?

I think the biggest lesson I have learned so far is that I really feel like I know less and less each day. What I mean by that is I have learned to trust the process and pay attention to when I am trying too hard. When I first started practicing, I had no idea what this phrase “trust the process” meant. Now, I can feel it, see it, and have really come to appreciate it.

What does it take to stay fresh, day in, day out, and avoid stagnation?

Kids in the playroom always keep things exciting. Moreover, I try to remember that counseling is difficult for people, and I will never be doing them a service by merely making them feel good about themselves. Care is only shown in the tough stuff. Remembering that it is an honor and privilege to do this work always pulls me out of a jam in my own headspace.

  Quinn K. Smelser, an LPC, registered play therapist and doctoral candidate in counseling at George Washington University who has specialized in play therapy and trauma training. She is also a clinical instructor at Loyola University Maryland, where she teaches school counseling students and will soon offer play therapy courses.



When you’re at the beginning of your career is probably when you have the most stamina. You’re excited, you’re pumped, and you have great ideas. You’ve spent years and years learning and deciding on what you’ll do, and you’ve been dreaming about the day when you’re finally there. You get the career, and the hardest part in the beginning is [that] you still have to learn some more. You must master the specifics about your colleagues, your location and your administration. More importantly, you have to learn what you’re capable of. The first few years is more learning, and you need the patience to dedicate the time to observe. Whenever a race is started, we all fight the instinct to jump out of the gate, but you need patience and persistence if your goal is long term.

As you’re learning the career and carefully collecting knowledge, it’s important to build up your reputation, also known as your street credibility or “street cred.” You build up your reputation by showing up, being reliable and completing tasks. Be careful not to overcommit because if you miss deadlines or turn in inferior work, that becomes your reputation. The learning years help you figure out what that perfect balance will be — how much you can handle, what you can complete quickly, and what requires more effort and dedication on your part.

Once you have a good reputation and you’ve figured out the key players, you build up your crew, your squad, your allies, etc. Finding this group will help you brainstorm when you’re stuck, vent when you’re fed up and considering quitting, and inspire you to keep going. How do you meet these amazing people? Professional organizations. Attending conferences, meeting like-minded professionals and joining committees is where you’ll find these treasures. Stay in touch, and make the effort to stay involved with each other in between conferences. Having good people in your inner circle is worth their weight in gold.

Lastly, create healthy boundaries. We are not only our careers. We are family members, we are artists, we enjoy hobbies, and we’re involved in our communities in different capacities. Make sure you are getting fulfilled in all areas of your life, and dedicate time to all the things that matter. Practice makes perfect, and you will find out the equations and quantities that work best for you.

  Margarita Martinez, an academic success counselor and curriculum chair for student development at Northern Virginia Community College who also serves as vice president for Latinx concerns for the Association for Multicultural Counseling and Development (AMCD), as secretary of the Virginia Counselors Association, and as co-chair of the strategic plan committee for the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling



The person of the counselor is one of the most important elements in the counseling office. Participating in one’s own counseling, then, is crucially important. Creating a space to address one’s own past hurts and current relational self makes a counselor more able to see and to have compassion for themselves and for those sitting across from them.

When I participate in my own counseling, it helps me to remember what it is like to sit in the waiting room, in that awkward space of waiting, with ambivalence and yet longing to be seen. It helps me to remember the anxiety over what to say or how to answer a difficult question. But most importantly, tending to my own ongoing healing creates a generativity in me for this work. It produces more space within me to care for others in deep and authentic ways.

Also, we must continue to cultivate our own interests. This year I have been on a growth edge, learning how the feminine body holds stories in its fiber and its tissues. I have found a renewed sense of excitement as I learn. Learning can be fun, and it can also be restorative. Such learning, then, has a direct impact in the counseling room. When I am excited and growing, my work with others is much more fluid and energetic.

In addition to the above, gathering a good community of people around oneself bodes well for long-term health. Health is found in belonging. Counseling is often isolating, and it can be an easy place to hide. Such hiding and isolation are the stuff of guilt and shame and not of health and healing. Because of such potential workplace hazards, I have a consult group of friends and colleagues whom I respect. They are people who push deep into my life and into my work. They are people who challenge me and know my inner world. I would not be able to do the work I do without having these people — and others like them — in my life, caring for and loving on me, in my goodness but also in my messiness. Honesty with my consult group turns into honesty in my counseling office, all the while keeping me grounded in remembrance of how hard it is to be vulnerable.

  Laura Wade Shirley, a wife, mother of three, licensed mental health counselor (LMHC) and teacher in Washington state. She worked with children and families in community mental health for three years, prior to opening a private practice in 2003. Since 2006, she has also taught and supervised students at the Seattle School of Theology & Psychology in practicum and case conference classes.



When I reflect on lessons learned to sustain my counseling career, two thoughts come to mind. The first is accepting who I am and who I am not. The second is the importance of a peer group whom I can be completely vulnerable with.

We often talk to our clients about being true to themselves. Previously, I was comparing myself to other counselors, which is not mentally healthy. I saw other counselors were receiving the most up-to-date training in their niche areas, and I wondered if I was doing enough. However, in checking in with myself, I was setting myself up for burnout. Comparing myself or going for training because I see others doing so, not because it is my area of specialization, is not what is going to sustain me for the long haul. However, I also know the importance of avoiding stagnation. It is then that I realized I need to attend my own training to keep my clinical skills sharp, while focusing on pursing additional training in my own area of focus. One cannot be an expert in everything. I had to be true to myself, just as we ask of our clients.

The second realization I had is how invaluable a group of peers is who will listen and not judge. In Irvin Yalom’s book Becoming Myself, he discusses a peer group he met with where they could talk about anything that might be impacting their practice while [still] respecting client privacy. This could range from personal problems to countertransference. While I am an advocate of counselors attending their own counseling as needed, I have also found my group of peers — whom I know I can have honest discussions with about myself, or them with me — to be the primary source of keeping me fresh and available, day in, day out, to my clients. Having peers who are available and nonjudgmental is fundamental.

Having a solid identity as a clinician and knowing who my people are, are major factors in not only sustaining my career but maintaining my inspiration and motivation.

  Deanna Johnston, an LPC who owns a private practice in College Station, Texas



When I think about [career] sustainability, I think about feeling appreciated and respected by my immediate supervisor and included by my colleagues with whom I have a trusting and supportive environment. And, of course, I need to feel compensated for my work and feel that I am valued by the institution in terms of my pay. With those things in place, I’ve always felt that I can tackle the tasks at hand and be creative. That being said, I have enjoyed collaborating with colleagues, early career professionals and students at all levels — undergraduate, master’s and doctoral.

This is how I would define workplace sustainability and job satisfaction. These are my most critical factors in remaining in a career for the long haul. This has been especially true for people of color and members of other marginalized groups. Research findings have suggested that we are far too often not supported by our peers nor by our supervisors and, as a result, we become targets of workplace bullying and implicit bias. This has led to the exodus of many talented counselors [and] counselor educators who are pushed out of promising careers.

What keeps me passionate about the work are, by far, my mentoring experiences. In every position that I’ve held, I have tried to pass on my knowledge about leadership, research, teaching and relationship-building. It has been a tremendous pleasure to see my former students acquire jobs and begin mentoring others. I feel content knowing that there is another generation of counselor educators and practitioners who have embraced the ideals that I have shared and wish to pass on these ways of being to others. I am thrilled to see how they have owned and advanced my research and teaching philosophy. And I am constantly challenged by new ideas and beliefs that they hold.

My most important lesson learned is that I am only a cog in a wheel. I have contributed to the profession to the best of my ability, but my ultimate goal is to be replaced by more energetic and passionate early career scholars and practitioners. I love to stay, but I’ll love to go even more. Generativity is a good thing.

  Cirecie A. West-Olatunji, a professor of counseling and director of the Center for Traumatic Stress Research at Xavier University of Louisiana. She is also editor of the Journal of Multicultural Counseling and Development and a past president of both ACA (2013-2014) and AMCD.



There are many things that I have worked on in order to prevent burning out. One of the main factors in preventing burnout has been maintaining strong boundaries when it comes to my family. It is necessary for me to put my family first and not allow my work to overshadow them. The first thing I did after establishing my LLC [limited liability company counseling practice] was to purchase a separate phone so that I could shut it off when necessary. I do not take on more clients or supervisees than my schedule can handle, and I have learned to say “no.” This can be challenging when, as counselors, we just want to be there for everyone.

What has kept me passionate? Clients. Listening to, processing and being a part of clients’ stories gives me life. There have been times in my career when I was not seeing clients due to school or pregnancy. When I stepped back into the counseling space, I was renewed and reminded of what I love about being a counselor. I have also found that working with students and young professionals has been rejuvenating. I can recall being in their shoes. Assisting them on their journey to become a counselor is immensely rewarding.

A valuable lesson that I have learned is to live each moment of your process rather than completing things simply to check boxes. I did that, to a degree, early on in my training and career. I have since learned the importance of growing with each experience and not for a moment thinking that I have it all figured out. Continuing to learn from my peers, my clients and my mentors is a process I will never outgrow.

Education and learning have always been central in my life. Staying interested in what is new or on the horizon helps me to avoid stagnation as a clinician and supervisor. I can always try something new — or even something old in a new way. Working with populations that I love and feeling that I am helping others in some small way allow me to continue without feeling my work is mundane.

Clients and supervisees will never cease to amaze me with their stories, their strength and their resilience. I feel honored to be able to be a small part of their story.

  Christina McGrath Fair, an LMHC at GentleWave Counseling, Consultation and Clinical Supervision in Stuart, Florida



The challenge to remain fresh depends greatly on my ability to effectively manage my time. Revelations surrounding my career — sex therapy — are an everyday occurrence, with issues ranging from sex education [and] advocacy [to] societal influences and legislation. My task is to discern how much time and energy are placed on the given subject. One day, a legislative bill threatens the rights of sexual minorities; the next day, multicultural interventions for the trans community are explored.

Human sexuality is so fluid, any staleness on my part would deem me an ineffective counselor. I often choose topics [to explore] that I am unfamiliar with or that are highly controversial. The opportunities to stay fresh on things relevant to sexuality are ubiquitous. It is just a matter of allocating the appropriate time to the appropriate issue.

I truly believe that I embarked on my counseling career decades ago, although I have been seeing clients for [only] two years. A long-term counseling career is synonymous with a long-term parenting career or long-term partner career. Counseling, similar to parenting and partnering, is innately what I do and have done for years. The particulars — CEUs, licensure, certifications, etc. — are the extenuating factors, but I have been educating, advocating, learning and counseling for years.

For me, building a long-term counseling career comes as natural as breathing. The less organic aspect is establishing a business based on my counseling career. Fortunately, my awesome support system and deep respect for entrepreneurship allow me to feel optimistic and excited about building a business around my career as a sex therapist.

Sustaining my motivation or passion for sex therapy is relatively easy. I don’t have to plan for it or think about it. When I awake in the morning, I’m reminded of the importance of intimacy and communication with my partner. As I interact with my daughters every morning, I’m reminded of the importance of sex-positive messages that occur throughout their formative years, particularly as they develop their sexual identities. When I talk or listen to people about their insecurities or their level of dissonance, I’m reminded of how misinformation, society, trauma and self-perceptions can adversely alter the trajectory of a beautiful soul.

There is no plan or preemptive thought of how to stay motivated. Life is gracious enough to constantly remind me that people deserve to exist without the harsh barriers that impede sexual wellness.

  Cheryl D. Walker, a sex therapist and associate professional counselor in private practice in Atlanta



The climb to a successful career as a licensed mental health counselor has been both challenging and satisfying.

As a middle-aged woman returning to higher education, this was my first challenge as I struggled just with that decision. Did I really want to dive in, and would I be ready for the rigor of learning? Would I do well with the time and expense commitment? Would my children and husband be supportive … and was it truly OK to be self-full? I knew it was now or never as the clock ticked on.

I know now it was the right timing and decision. I know appreciating the classroom learning, possibly for the first time in my life, was a huge benefit because I could fully direct my focus without the distractions of starting and caring for a young family.

No sugarcoating here: Working in agencies was truly brutal from a systems perspective. I took some solid lumps by inadvertently stepping on management toes. The challenge of working with clients, while most important, became second to fulfilling the job requirement of productivity. I remain very grateful to have survived the mill-type atmosphere of clients in and out. I gained such amazing clinical experience and somehow managed to be regarded as a good counselor professionally. I would encourage people going through this portion of the climb to connect with counselors, co-workers and physicians with whom they feel commonality because they will be your future collaborators and colleagues in private practice or agency [work].

What sustained me was keeping my focus on my professional goal to be a licensed counselor and eventually to own my private practice. I look back and realize I was strong even when I felt inadequate or resource-less. I’ve learned these feelings are transient and never fixed, so I trust the journey.

Seeking your professional “peeps” in regular monthly meetings that you commit to in your schedule is golden and leads to the gifts of shared respect, as well as referral pools for your — and their — clients.

I’ve learned to value what I still need to learn, [including] aspects of private practice not covered in my education or practical work and the business end of owning a business. [I recommend that counselors] hire out what you don’t know or aren’t great at until you learn it yourself. Also, keep up with learning new theories because the freshness of exploring interesting trainings [will] always complement what you know so well already. My practice is eclectic because I enjoy variety, and it has been truly exciting.

The best advice I can give now that I’ve been self-employed for a while is to allow yourself regular self-care with vacations or staycations filled with calm, fun and levity. The balance is needed, not at all a luxury.

  Lena Kieliszak, an LMHC in private practice in Rochester, New York



We all sing the songs we need to hear. By trade, I am a counselor educator and a counselor whose practice is made up largely of clients who are serving in helping, healing or ministry positions. Really, in many ways, my clients are people just like me.

So, what’s your song? Kindness? Self-compassion? Tending to empty thought patterns? Engaging in better self-care? It is our humanity that frees and guides us in our work with others. It is our humanity that breeds care and compassion, the hallmarks of neural/psychological/interpersonal integration, per Dan Siegel. Because I am human, I have needs and wants, not all of which get met. I know what it means to suffer. I know what it means to experience pain and to wish for ways to relieve it or deny it. I know what it’s like to find myself returning to unhelpful patterns of thinking and acting, time and time again. Because I am human, I have a song to sing.

I hope it can be said that I am far more human than I was when I first started this work 20 years ago. If we are all on a journey of becoming who we already are, then engaging with the work of others has offered me tender moments of being mirrored in my own humanity. The reality is that I need connection just as much as my clients do. Our profession has nomenclature — countertransference, getting triggered or activated, projection, collusion, etc. — that can tend to pathologize the humanness of the encounters we may experience with those who sit across from us. But part of the rich delight in doing this work — and part of what has allowed me to log 20 years at it and to be ready for another 20 more — is that I get to hear myself say things that I need to hear as much as my clients [need to hear them]. The frame of counseling and the counseling relationship holds not just my clients, but me too.

For me, what’s most sustaining is what inevitably comes when I am full and receptive: [being] open to hearing, in whatever form and from whatever voice possible, the song I need to hear. My humanity, my work and my longevity in the field all depend on it.

  Doug Shirley, an LMHC with a private practice in the Seattle area and assistant professor of counseling at the Seattle School of Theology & Psychology



Early in my career as a professional counselor, I began to see that stepping into the world of [my] clients on a regular basis with my full attention and whole heart could leave me depleted and carrying concern for these clients long after the sessions were over. In response, I took care of myself by journaling, drawing and painting to allow space for my mind to simply be and to process my experiences. I began to set boundaries to remind myself when I could just be “Adele,” take care of my own needs, and engage in living life to the fullest.

There were times I took a break from the counseling field and worked in other similar people-oriented fields, but I missed that deep personal meaning from the counseling experience. So, I sought variety in the positions or environments in which I could engage in this role rather than stepping out of it completely. Through time, I also found a wider range of ways to express myself and release tension, stress or worry, such as running, taking drawing classes and enjoying acupuncture or massage.

Later, I invigorated my therapeutic approach by becoming trained in using sand tray therapy to bring clients’ experiences to life in ways they could not simply tell me. Seeing the power of clients exploring their experiences in the sand and seeing their issues in a new way was so exciting. Most recently, I became certified in yoga to apply the powerful healing effects of mindfulness, meditation and release of tension. Invigorating my counseling practice by attending more specialized workshops allowed me to draw upon new methods and delivery of a range of treatment strategies that are impactful, effective and, at times, even fun.

Compassion fatigue from the demands of this role can take its toll on counselors. During my doctoral studies on this topic, I uncovered that counselors continually engage in empathy but may not find ways to close the deep concern needed to draw upon empathy. This was a real “aha!” moment for me. No supervisor had ever quite framed it for me this way. So, I developed ways to extend client empathy with purpose but then to step back out of it with clear intention.

Focusing on growing, being curious, and engaging in self-care has helped me to stay buoyant while navigating these powerful and deeply fulfilling experiences over the past 25 years.

  Adele Logan O’Keefe, an LPC and owner/director of Sage Counseling & Wellness in Lexington, Virginia



I have managed my own private practice since 2006, and maintaining meaning and engagement has been a purposeful and intentional goal. I enjoy the marketing aspect of being a business owner, and I have made it a priority to stay current with technology and move into areas that do not come naturally to me, such as blogging and social media.

Thanks to Twitter, I follow meaningful cultural shifts worldwide. I listen to radio stations and podcasts with differing political views, as well as trending corporate leadership. Our mental health care reach is limitless, with DIY videos on YouTube, numerous virtual specialty groups on Facebook, and compelling personal disclosure at the hands of terrific authors with diverse backgrounds. I enjoy reading the Stoics as well as firsthand accounts of military culture from Navy SEALs [and of] high-achieving athletes — true psychological warriors reminding me to be the best version of myself.

It is healthy and appropriate to recognize my own areas of expertise and competence (therapists can be ambitious and confident too). As I learn my strengths and feel confident in that footing, I am more comfortable admitting to areas that need more growth and insight.

I so appreciate colleagues who have become friends. We chat often, consult, meet for walks and coffee. This is integral to my well-being and mental health. Private practice is a lonely proposition, and no one should go it alone.

I recently organized an open house for my office building. It was a true hodgepodge of small business owners with the primary goal to provide public awareness. The secondary gain was cross-referred business and a budding community.

An annual live continuing education training is always beneficial, and preferably not in my own backyard. Most recently, I drove an hour away, checked into a hotel and ordered room service (an act of self-care). The next day brought new friends and colleagues.

I encourage fresh ideas and the continued advancement of our field, such as Silicon Valley’s tech money currently being invested in psychedelic research.

My daily unwind is a meditative, 1,000-piece puzzle in the evenings. If my family feels like chatting, they can find me there. A completed puzzle gives me a sense of accomplishment. Every piece found its niche and is perfect in the end.

  Christina Neumeyer, a licensed marriage and family therapist in Carlsbad, California



My identity as a professional counselor has grown in importance to me over the years as I’ve come to witness and experience the extraordinary need for our work and the positive impact we can make for individuals, families and communities. Witnessing growth, change and increased well-being with clients has been a sustaining factor in my ability to stay fresh, passionate and engaged during my career. Also, the ability to shift my focus from being a school-based counselor to becoming a health educator/coach while using my skill set and strong commitment to wellness has fed my ability to sustain. Becoming more involved in cross-cultural trainings as a trainee and then facilitator has been integral these past few years to actively address injustices and inequitable situations that clients suffer from. I feel strongly compelled to do this work as our world becomes more challenging to live within for so many people.

Keeping myself well so that I may do this work includes intentionally eating healthfully, physically moving my body in ways I joyfully anticipate regularly, drinking lots of water, getting adequate sleep and rest, receiving supportive supervision and personal counseling, and pursuing my pleasures as often as possible (time with family and friends, reading, traveling, and playing with my kitten, Daisy).

I never want to leave the profession because it is a part of me. I think I will always want to do this work in some capacity for at least a bit of time as I age.

Knowing what I know now, I could give this advice to myself at the beginning of my career: “Relax! You’ve got this. You are well-suited to share love and support with those you encounter. Take care of yourself as well as you encourage others to do for themselves.”

  Julie Bloomfield, an LPC and health educator and coach at Henry Ford Allegiance Health in Jackson, Michigan




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


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.

Spotlight on: The ACA Graduate Student Ethics Awards for Master’s Degree Students winner

March 26, 2020

This award recognizes exceptional, demonstrable understanding of the ACA Code of Ethics, the foundation of ethical professional counseling practice.

Winners: Samantha Burton, Ingrid R. Pipes, Ben Stoviak and Katie Voorman of Carlow University


The essay addresses the ethical dilemmas that counselor Keith faces after deciding to offer distance video counseling to his client, Tina. Before Tina moved to another state, the face-to-face therapeutic relationship between Keith and Tina was trusting and effective. After a few video counseling sessions over FaceTime, Keith experiences poor video connection and some feelings of awkwardness during sessions. Tina has also followed Keith on his private social media pages and contacted Keith on his personal phone number. To review the ethical considerations of this particular issue, this dilemma will be examined through the lens of the American Counseling Association’s foundational principles. Specific ACA (2014) codes are considered and applied in relation to Keith’s dilemma. Relevant court cases, as well as the National Board for Certified Counselors Policy Regarding the Provision of Distance Counseling Services (2016) are introduced to give insight for ethical rational. Using the Forest-Miller and Davis Ethical Decision Making Model (2016), Keith will work through steps to determine a course of action.


Essay: Application of the Forester-Miller and Davis Decision Making Model: A Case Study

This case study seeks to evaluate historical activities between a professional counselor, Keith, and individual client, Tina, who has been seeking services related to communication issues she has reported experiencing with her partner and children. In the details provided by this case, Tina has relocated to a rural area, and she and Keith have continued their counseling relationship by FaceTime, an unfamiliar professional distance counseling modality for Keith. Tina and Keith have begun to additionally interact through social media platforms and have experienced multiple technical problems, resulting in Keith developing and acknowledging a sense of discomfort.

Through the employment of a decision making model designed by Forester-Miller and Davis (2016), these counselors-in-training seek to provide recommendations to Keith that are guided by the American Counseling Association’s Code of Ethics (2014), relevant legal cases, and the National Board of Certified Counselors Policy Regarding the Provision of Distance Professional Services. Recommendations are made in alignment with the prescribed steps of this decision making model, in observation and evaluation of the ACA’s six foundational principles: autonomy, justice, beneficence, nonmaleficence, and fidelity (Forester-Miller & Davis, 2016).

Definition and Application of the Forester-Miller and Davis Decision Making Model

These counselors-in-training have chosen to employ an ethical decision making model developed by Forester-Miller and Davis (2016). Initially published in the Practitioner’s Guide to Ethical Decision Making, by the American Counseling Association, this model was designed out of consideration of multiple pre-existing models in use by and developed for professional counselors, calling for decision-making to be grounded in observance of key foundational principles of the helping professions: autonomy, justice, beneficence, nonmaleficence, and fidelity (Forester-Miller & Davis, 2016). Furthermore, this model specifically integrates consideration and application of the American Counseling Association’s Code of Ethics among its mandatory steps, i.e., Step 2 (Forester-Miller & Davis, 2016).

Steps of Decision Making Model

This decision making model progresses through seven steps, beginning with identification of the problem and concluding with implementation and reevaluation of the proposed solution or solutions. Each step is explained and will be addressed and related to Keith’s dilemma.

Step 1: Identify the problem. In Forester-Miller and Davis’ Decision Making model, the problem is identified following a period of information gathering (Forester-Miller & Davis, 2016). Recommended strategies include asking questions and documenting acquired information in an outlined form (Forester-Miller & Davis, 2016).

Step 2: Apply the ACA Code of Ethics. Following information gathering, outlining, and identification of the problem, the ACA Code of Ethics should be applied in a deliberate and rigorous manner (Forester-Miller & Davis, 2016). Legal and professional codes and standards, considerations of multicultural frameworks, and technical pragmatics should be applied to the case alongside the ACA Code of Ethics (Forester-Miller & Davis, 2016). It is the counselor’s responsibility to ensure that they understand all of these critically evaluative and potentially confounding factors (Forester-Miller & Davis, 2016).

Step 3: Determine the nature and dimensions of the dilemma. At this step, the identified problems should be considered in relation to any foundational principles (autonomy, justice, beneficence, nonmaleficence, and fidelity) found to be applicable, and individual applicable principles should be assigned priority values (Forester-Miller & Davis, 2016). Professional literature, peer and expert professional counselors, and relevant professional associations should be consulted for additional perspective and support (Forester-Miller & Davis, 2016).

Step 4: Generate potential courses of action. This step involves brainstorming an exhaustive list of potential courses of action, informed by the previously assigned and ranked applicable foundational values; peer consultation is recommended at this step (Forester-Miller & Davis, 2016).

Step 5: Consider the potential consequences of all options and determine a course of action. By way of careful and well-evaluated elimination of options, the counselor should choose the strongest option or options that meet the criteria of top-rated foundational values (ForesterMiller & Davis, 2016). Possible implications and consequences of and for all involved parties should be considered at this step (Forester-Miller & Davis, 2016).

Step 6: Evaluate the selected courses of action. The selected course of action is reevaluated at this step for any issues that may have arisen or that were not previously considered (Forester-Miller & Davis, 2016). A prescribed test may be employed at this step to confirm the selected course of action; this test involves assessing for three values: justice, or evaluated fairness of choice across the potential population, publicity, or comfort with the possible outcome were it to be made public knowledge, and universality, the likelihood that you would recommend this outcome to a peer counselor (Forester-Miller & Davis, 2016).

Step 7: Implement the course of action. Given that ethical decisions may be realistically challenging to execute, this step exists to remind the counselor to carry out the diligent and thoughtful work completed in the previous six steps of this model (Forester-Miller & Davis, 2016). Follow-up and evaluation after implementation is recommended to ensure that the decision made was successful and positive, as well as if further action, reaction, or re-evaluation should be considered (Forester-Miller & Davis, 2016).

Identification of the Dilemma (Step 1)

Keith is a licensed professional counselor who had been seeing a client, Tina, for communication issues she was having with her partner and children. After building a comfortable and effective therapeutic alliance, Tina revealed that she had to move out of state. A few months later, Tina contacted Keith when she was feeling unsuccessful with her new therapist. She explained that the nearest alternative service provider is a long drive away from her rural area and requested that Keith consider tele-counseling over video chat. Keith admitted that he did not have experience with this method of counseling, but he attempted its use nonetheless. After a few sessions over FaceTime, Keith experienced several frustrating dropped calls and reported feeling awkward in offering a new medium of counseling. Keith used his personal cell phone for their FaceTime sessions and Tina began texting this personal number when she had questions. Tina sent Keith a Facebook friend request and has also followed him on Instagram and Twitter, stating that she appreciates having so many avenues to be connected to Keith since they no longer have faceto-face sessions. Keith understands that the relationship with Tina is potentially no longer therapeutic, but does not know what steps to take next.

Ethical Codes and Relevant Considerations Identification and Applications (Step 2)

According to the prescribed steps in Forester-Miller and Davis Ethical Decision Making Model, Keith’s actions during the course of and related to the counseling relationship he established with his client, Tina, should be evaluated in relation to pertinent individual codes from the American Counseling Association’s (2014) Code of Ethics. Because this document is the de facto guide for ethical professional counseling practice responsibilities, these counselorsin-training have sought to exhaustively and collaboratively identify and apply any codes which may be valuable during the proposed course of decision-making and implementation. Keith’s dilemma, and others like it, are complex and multi-faceted, and the identified codes may not perfectly encapsulate all dimensions of the dilemma.

A.4.a Avoiding Harm. This code recognizes that counselors work to reduce or avoid situations that can cause unexpected harm to their client (ACA, 2014). Although Keith acknowledges that he has never used tele-therapy with a patient before, he fails to establish boundaries or guidelines around service delivery and instead gives his personal phone number to Tina to conduct sessions. This is a boundary crossing which impacts the therapeutic relationship and is potentially harmful for Tina.  Blumer, Hertlein and Mihaloliakos (2014) conducted a mixed methods study involving part and full time counselors as well as students enrolled in marriage and family therapy programs to assess their views on ethical issues and online counseling. One theme that emerged was the impact tele-therapy has to the therapeutic relationship, particularly boundary concerns. Participants were concerned that boundaries become blurred when clients are given access to personal contact information. For example, clients may perceive that the counselor is available at any time or the client may be able to gain access to the therapists’ social media platforms, both of which can negatively impact client care (Blumer,, 2014).

A.5.e Personal Virtual Relationships with Current Clients. Code A.5.e states that counselors are not permitted to enter into personal virtual relationships with current clients; this includes social media and other media sites (ACA, 2014). Kolmes (2017) explains that multiple relationships between client and therapists are occurring more regularly and exist whether the therapist is aware or not. In this case, Keith became aware that Tina was following him on Instagram and Twitter after he received a Facebook friend request from her. Although it does not state whether Keith acknowledges these attempts by Tina to “stay connected and interact” it can be implied that her actions are the beginning stages of multiple role development in their therapeutic relationship. Multiple roles can impede on the counselors primary role as a therapist (Kolmes, 2017). A recommendation for Keith on how to navigate multiple roles when social media is involved comes from Kolmes. He suggests consultation and documentation with an expert who is proficient on the inner workings of the internet and social media (Kolmes, 2017).

A.7.a Advocacy. Code A.7.a declares that a counselor must take opportunities to advocate for clients when there is a potential barrier that may impact their development (ACA, 2014). The client now resides in a rural area, more likely with low mental health access and higher levels of suicide than other geographical areas (Cohn & Hastings, 2013). One aspect of this low access relates to high burnout among counselors in the area (Cohn & Hastings, 2013). Without proper supervision and better support from the community, mental health practitioners in rural areas will continue to struggle – and clients will continue to suffer under the lack (Werth, Hastings, & Riding, 2010). As the counselor of a client in this population, Keith should not only advocate for his client to seek out additional support in her area, but for the mental health community to show greater support for rural counselors.

A.12 Abandonment and Client Neglect. Code A.12 accredits that it is the responsibility of the counselor to ensure their client has access to treatment, even in times of the counselor’s absence (ACA, 2014). This may mean arranging a connection with another professional. Though the professional relationship between the client and counselor was ended before the client moved, the client has now faced a different environment with less resources. The counselor does not appear to have sought supervision for this new situation – wherein the client has asked for continued counseling services. It seems likely that the counselor was concerned about neglecting the mental health needs of the client due to her current struggle in a rural community. The ethics code regarding neglect and abandonment, however, applies to appropriately caring for the client and counselor relationship during the specific course of treatment – or during breaks within that treatment such as for vacation. Because the relationship between the counselor and the client ended out of necessity, if Keith appropriately closed out services, then he would have been within ethical boundaries to deny furthering services regardless of the client’s new environment.

C.2.a Boundaries of Competence. Code C.2.a states that a counselor must only offer services that are within their competency, or develop competencies to meet client needs (ACA, 2014). If offering a new service, counselors must prevent harm to their clients. As mentioned under other codes, the rural communities in America face a struggle with mental health resources. In studying ethical solutions for counselors in that area, Werth, Hastings and Riding (2010) recommend that some rural counselors refer clients to video conferences with specialists, or even tele-psychotherapy. In those recommendations, however, the counselor accepting the referral is a specialist or expert. The counselor in the proposed case, while specializing in one area of the practice, appears to have little experience with both tele-therapy and with rural culture. By not seeking greater understanding of either aspect, he is likely missing important parts of both – and will need to seek additional education or refer the client.

C.2.b New Specialty Areas of Practice. Code C.2.b contends that a counselor offers a new specialty or modality of therapy only after obtaining the specific training and supervision needed (ACA, 2014). One of the counseling concerns with rural populations relates to the cultural differences in rural and urban environments. Though the client has moved to the rural environment from a more urban space, she now faces a completely different set of resources and community supports. As Rollins (2010) points out, the cultural differences can be stark when it comes to recommendations and coping mechanisms. Urban counselors, for example, may not understand what is or is not available for clients in a rural community – where businesses, social gatherings, and accessibility may be very different than what the counselor wants to recommend. There is little indication that the counselor in the case has an understanding of these differences. As he moves forward with the client, he must seek additional education or training in virtual counseling those in rural areas. If he cannot find it, he may need to refer the client.

C.2.d Monitor Effectiveness. Code C.2.d explains that counselors should be continuously monitoring their effectiveness, as well as making appropriate relationships with other professionals for supervision (ACA, 2014). Apart from not having adequate competency about technological aspects of distance counseling, the counselor, Keith, also appears to have no knowledge of the legal consequences. His license may not be adequate for the state where his client is operating.

Alternatively, there are states where the licensed counselor doesn’t require a license for the state where the client resides, but must seek additional education and supervision under specific rules to practice there. By not mentioning this to the client, or seeking any of those additional measures, the counselor has both opened himself to legal issues, and is ignoring the basic ethics code regarding licensure and long-distance counseling.

C.7.b Development and Innovation. Code C.7.b states that counselors must explain the boundaries and risks of new areas in the field to clients before using such tools or methods (ACA, 2014). Counseling via technology poses increasingly great risks to clients, depending on the state where their licensed counselor is operating. According to Hughes (2000), “A client who obtains counseling services via the Internet from a counselor licensed in the same state has recourse to that state’s regulatory board for any violations against either the state code or standards of practice.” By not having adequate competency, the counselor has failed to give the client adequate warning about the issues related to his license and her options should malpractice or harm occur.

H.1.a Knowledge and Competency. This code demands that counselors develop adequate knowledge and competency surrounding use of technologies, distance counseling, and social media, as well as related to regulations and laws surrounding use of these kinds of technologies (ACA, 2014). Keith proceeded with using technologies for which he did not indicate he had any formal training and did not express that he was seeking the development of competencies related to using these technologies. Keith did not identify that he had knowledge of any laws surrounding distance counseling, social media, or telebehavioral health and counseling.

H.1.b Laws and Statutes. Code H.1.b. asserts that if counselors are engaging in telecounseling, they must be aware that they are held to the laws and statutes of their state and the state where their clients reside (ACA, 2014). The client’s resident state has jurisdiction over that therapeutic relationship and to protect the client. Since regulations on counseling across state lines varies from state to state, it is Keith’s duty to contact the state board in which his client, Tina, now resides to ensure the legality of temporarily counseling from a different state. A number of potential issues exist for telebehavioral health practitioners who practice across state lines, especially when state laws are notably different in the states where the client and counselor live, respectively (Maheu, 2018).

H.2.c. Acknowledgment of Limitations. Code H.2.c states that it is the counselor’s responsibility to inform the client of the limitations regarding confidentiality within technology (ACA, 2014). The counselor must ensure that the client understands the boundaries of security within the programming the counselor and client communicate on. By being clear and concise with the client about these limitations, the client is fully informed when giving consent to distance counseling. Keith acknowledged that he had never offered distance counseling, but he was not thorough in considering what steps need to be taken to protect his client’s confidentiality and security. Keith should explain the implications and boundaries of tele-counseling to Tina, including the extent of security of sessions and personal information.

H.2.d. Security. Code H.2.d requires counselors to ensure the programs they use host their website or communicate with clients have secure encryption that meet legal requirements (ACA, 2014). The client’s confidentiality must be ensured when using any digital programming by the counselor. Keith did not research or implement the use of encryption programing or HIPPA compliant tele-medical software to administer tele-counseling. The FaceTime tool that Keith used to host their video calls does not have privacy protection and although may potentially be implemented in ways that are HIPAA-compliant, for example, may not be a safe tool (O’Grady, 2011). To promote the security of his client, Keith would have to choose an encrypted program to host video sessions and communicate with the clients to whom he offers distance counseling.

H.3 Client Verification. When engaging in tele-counseling, or any form of digital communication, code H.3 states that counselors must continually verify the identity of their client (ACA, 2014). This can be done using nondescript, collaboratively chosen identifiers such as code words or phrases. No evidence was provided that Keith took appropriate and effective steps to verify Tina’s identity once the counseling modality had changed from in-person to video conference; additionally, no evidence was provided that Keith took steps to verify that social media accounts purporting to belong to or represent Tina were owned or stewarded by her.

H.4.b Professional Boundaries in Distance Counseling. Code H.4.b suggests that integrating technologies into the counseling relationship may effectively create a dual relationship, and it is important that Keith consciously maintain professionalism and professional boundaries, as well as clearly discuss these boundaries related to technology use with Tina (ACA, 2014, section H.4.b). Evidence was not provided that suggests that Keith met these professional responsibilities.  

H.4.d Effectiveness of Services. Code H.4.d confirms that if the tele-counseling sessions are ineffective, the counselor consider face-to-face sessions or referring the client to other services (ACA, 2014). Keith has experienced multiple instances of poor technical execution of the distance counseling sessions initiated with Tina. One substantial shortcoming was the ability to effectively address technology failures, e.g., dropped calls, a necessary step in the provision of distance counseling (Stolsmark, 2015). He has felt frustrated as a result of these technical issues and his own lack of competency to deliver counseling effectively via FaceTime. Keith has suspected that this new counseling modality may be ineffective, and because he can no longer provide face-toface counseling to Tina due to geographic constraints, Keith is therefore responsible for assisting

Tina with identifying appropriate, competent counseling. According to Meilman and Weatherford (2016), counselors unclear about communications using online counseling modalities might risk inaccurately assessing or overlooking potential signs or symptoms, resulting in further client harm, danger, or potentially suicide. Use of the FaceTime modality for counseling may negatively affect client disclosure or the client’s ability to speak clearly and comfortably about emotions (Mishna, Bogo, & Sawyer, 2015). Additionally, because professional counseling interactions may have taken place within the boundaries of social media platforms, anti-therapeutic communications may have occurred (Navarro, Sheffield, Edirippulige, & Bambling, 2019).

H.6.b Social Media as Part of Informed Consent. Code H.6.b states that counselors must clearly define the limitations, boundaries and advantages of social media during the informed consent process with their client (ACA, 2014). Before engaging in distance counseling with Tina, Keith did not explicitly discuss any usage of social media. As a result, Tina attempts to friend Keith on multiple social media accounts. One way Keith could have addressed social media prior with Tina is by establishing a social media policy during the informed consent process. Kolmes (2017) states that having a social media policy allows for the therapist to share their views on friending, following and other messaging which could potentially threaten counselor- client confidentiality and boundaries.

H.4.f Communication Differences in Electronic Media. Code H.f.4 ascertains that verbal and non-verbal cues occur differently while tele-counseling and that the counselor is responsible to address issues and nuances within digital communication as they arise with the client (ACA, 2014). Keith identified that he experienced the professional interactions between he and Tina as awkward. Yet, he did not proactively or reactively address these communication issues by providing information about voice inflections, a lack of visual cues, and other potential differences that may manifest in online, virtual, and video-conferencing communications.

Conflicting Factors, Dimensions, and Variables (Step 3)

Following the Forester-Miller and Davis model, the identified problems are to be considered in relation to the ACA foundational principles, which are then prioritized. Consultation of professional literature and relevant professional organizations occurs at this step, as well. Each of six foundational principles is considered, as is The National Board for Certified Counselors’ Policy Regarding the Provision of Distance Professional Services and relevant legal cases, in consultation for further best practices, perspective, and restrictions for Keith in working with Tina.

ACA Principles

In the presented case, the counselor has violated or potentially violated multiple codes under the ACA Code of Ethics. The description of the case indicates that he has begun to notice these conflicting practices and the need for an ethical assessment an action plan. If he had followed the basic principles upon which the code is written, however, he may have been more careful with both the client and the counseling relationship. The six principles (autonomy, beneficence, fidelity, nonmaleficence, justice, and veracity) are discussed here as they apply to the case. Their merits in the situation vary, but each ideal has a place in the dilemma this counselor now faces – and how his practice has reached this point.

Autonomy. The principle of Autonomy within the counseling relationship is the ideal that the therapist acknowledges and respects the client’s right to make their own decisions and actions based upon their value system, when appropriate (Davis & Forester- Miller, 2016). In the case of Keith and Tina’s counseling relationship, Tina makes new, continued, and repeated assertions of her needs, desires, and expectations, demonstrating autonomy, and Keith attempts to respect and acknowledge her autonomy therapeutically. However, as a counselor, it is Keith’s due diligence to also address when his client’s choices and actions may negatively impact the therapeutic relationship. For example, although Tina prefers to continue her services with Keith online, Keith fails to establish any guidelines or boundaries of informed consent about how the online service will be carried out. Additionally, the lack of boundaries leads to Tina finding and friending Keith on multiple social media accounts.

Nonmaleficence. This principle refers to the therapist’s duty to not inflict intentional harm nor participate in actions that could cause harm to others (Davis & Forester- Miller, 2016). Keith’s actions, though seemingly unintentional, still carry the potential risk of harming his client. At the moment in time at which Tina and Keith’s case has presented for evaluation, obvious issues exist, but client satisfaction or therapeutic effectiveness are unclear. The first action Keith should have made, in observance of the ACA Code of Ethics, would be to discuss a termination plan with Tina after she shares that she is moving. Along with the termination discussion could be information and guidance about possible in-person or distance counseling referrals for Tina to continue counseling. Not completing these steps could result in Tina being unable to receive proper care, as well as experience limitations in access to services.

Another instance where Keith did not consider the welfare of his client was in his decision to agree to provide online counseling services, without having any competence in this area and without seeking consultation prior to making this arrangement with his client.  As a consequence, frustrations develop between Keith and Tina due to dropped phone calls during sessions. Additionally, Keith is not comfortable during their sessions due to his lack of knowledge about online distance counseling. In either case, there is a risk of harm for Tina since she may no longer trust or feel safe with a counselor who appears incompetent. Also, her frustrations due to service issues are infringing on her ability to progress in therapy.

There is also a major risk of a dual relationship developing between Keith and Tina which could negatively influence Tina. As mentioned, Tina finds Keith on social media and decides to formally connect with his online account presence. She also has access to his personal phone number, which she texts whenever she has an issue. Since Keith did not establish any guidelines with Tina on how these forms of communication would be addressed, he has potentially made Tina vulnerable to harm. Whether intended or not, Keith is giving the impression that he is accessible anytime which can cause role confusion in their client- therapist relationship.

Beneficence. This value concerns itself with the acknowledgement and prioritization of work for the well-being of both the individual and society (ACA, 2014). In order to promote better mental health and wellbeing, counselors must follow ethical practices and manage their own part of the counseling relationship. By allowing boundaries to become confusing, and mishandling new professional tools, the counselor has set a poor standard for both mental health and the profession of counseling as a whole. Though he showed consideration for issues such as isolation and lack of mental health in rural areas, he also did not seek to understand what is needed in those rural areas.

Justice. This principle addresses the responsibility of the counselor to address clients fairly and equitably and to seek out means to ensure that clients experience fair and equitable care (ACA, 2014). This means that Keith, as a counselor, should be promoting accessibility for his clients. Though he has done this by treating his client when she is in need of assistance, he has ignored the complex dimensions of a relationship between client and counselor. In a counseling relationship, boundaries and expectations must be maintained and met. The boundaries of professional spaces assist clients in understanding where they have rights and independence. It is the counselor’s professional responsibility to explain these boundaries and help maintain them as the counseling relationship moves forward. Without clear communication and professional boundaries, both people in the counseling relationship are in danger, and cannot act with appropriate agency or advocate for their part of an equal relationship.

As Keith moves forward in the counseling profession, he should also spend more time understanding the cultural differences in communities. By better pursuing multicultural understanding across different cultures and environments, he can reduce the harm and inequality in his professional relationships. Currently, he has acted with an assumption that he understands an entirely different culture and does not need to work on his perceptions of environments. This may demonstrate an exercising of privilege, and denies his clients in different situations the appropriate help and resources they need – as well as setting inappropriate standards of care.

Veracity. Veracity deals with being honest or truthful with one’s clients (ACA, 2014). Keith does mention to Tina that he has never facilitated online counseling sessions before. Still, Keith should have disclosed more information about his lack of competency and sought advice from an expert in this area. In addition, Keith was not honest with Tina once issues with service connection and boundary crossings arose. In distance counseling, clients need to be made aware of the risks to their confidentiality as part of the informed consent process. There is a greater risk of clients’ personal information being accessed if technical measures are not established to secure client identity.

It is also the responsibility of the therapist to address and be honest about boundary crossings and boundary violations with their client. Keith realizes that Tina gaining access to his social media accounts is problematic. Ideally, this is another issue that should have been addressed during the informed consent process prior to engaging in online sessions. During which time Keith could have communicated his views and boundaries for social media with his client.

Fidelity. This good faith principle holds the counselor responsible to their promises, thereby increasing the profession’s holistic trustworthiness. Keith may be operating under the assumption that he must continue working with this client to fulfill a responsibility to her, or to honor a commitment to their professional relationship. However, the trust placed in Keith assumed that he would operate with appropriate competence and understanding. By disregarding supervision, education, legal concerns, and the need for informative consent between himself and the client, he has placed the client’s private information in danger and broken that trust. As a counselor, Keith is meeting basic requirements for trust – as the client continues to see him. But moving forward, he will need to work hard to improve his competencies and seek supervision. That will keep him from breaking the trust placed in him, as he is doing now.

NBCC Policy Regarding Distance Services

The National Board for Certified Counselors, a non-profit professional organization which oversees the assessment products used in part for the state licensing of counselors across the U.S., maintains a Policy Regarding the Provision of Distance Professional Services, applicable for counselors certified by the NBCC (2016). This policy document would apply to Keith’s practice as a Nationally Certified Counselor (NCC) if he is maintaining this professional status.  Because Keith has elected to proceed with the application of distance counseling modalities, the best practices outlined in this document may have useful, ethical implications and uses, regardless of whether or not he has applied for or currently maintains NCC status.

According to the NCC Distance Professional Services policy (2016), Keith should only provide services for which he is adequately qualified. He should adhere to all legal regulations which may apply to the practice of counseling and observe state regulations and laws which apply to the states in which the clients he is counseling reside or claim legal residency (NBCC, 2016). Client privacy must be prioritized and protected by way of using tools encrypted for therapeutic use, as well as warning clients about password “auto-saving” features on application and tools and potential network risks (NBCC, 2016). Records should be backed up safely and retained for a minimum of five years (NBCC, 2016). Clients and services should be assessed for appropriateness of distance counseling tools (NBCC, 2016). Clients should be screened for these services to assess for the potential risks or benefits of distance counseling use, as well as be provided with clear informed consent and engaged in ongoing identity verification practices (NBCC, 2016). Lastly, social media use policies should be provided to clients, and social media platforms should be avoided for the exchange, dissemination, or storage of confidential information (NBCC, 2016).

Many of the responsibilities outlined in this NBCC policy were not met by Keith and reflect issues aforementioned in relation to the ACA Code of Ethics. Though he was not trained in distance counseling, and did not screen his client for use in these tools, he proceeded to engage with his client using an unfamiliar distance counseling modality, and he did not indicate that he was aware of laws surrounding use of this modality. Keith did not indicate that he provided updated informed consent information to his client or warning about potential risks. He did not indicate that he was maintaining records in a consistent way. Lastly, Keith did not indicate that any kind of social media use or communications policy was provided to Tina before or during their exchanges.

Court Cases

When faced with an ethical dilemma, referencing relevant court cases can help counselors in their decision making. One ethical dilemma Keith faces is the decision to provide online counseling to his former client, Tina, who now resides in a rural area in another state. In Abraham vs. Bureau of Professional and Occupational Affairs, Board of Psychology, 2014, a psychologist from Israel was providing online counseling services to residents in Pennsylvania without being licensed in the state (Professional Licensing Report, 2014). Pennsylvania courts ruled that this was in violation of Pennsylvania laws because Abraham had a physical presence in PA via a Pennsylvania phone number and address, therefore requiring the need for him to also have a Pennsylvania license. The board felt that Abraham’s actions were potentially harmful to his clients and that he was in violation of Section 3 of the psychological practice act (Professional Licensing Report, 2014).

Other landmark cases such as Jaffee vs Redmond, 1996, highlight the importance of client confidentiality within the counseling relationship (APA, 2020). Ethical standards remain the same whether a therapist is providing face to face or online counseling sessions. This means that the online counselor may have to take additional precautions in order to ensure that their client’s vulnerable information is protected. Contech, Kaplan, Martz & Wade suggest that counselors take measures such as encryption, segregated storage, and avoidance of internet hotspots to safeguard client information (2011). Without privacy-oriented practices and competencies in place, client safety may be at risk, and harm to clients may occur.

Recommendations for and Evaluations of Professional Actions (Steps 4-7)

Following identification and explanation of Keith and Tina’s dilemma, and the characterization and formal identification of relevant ACA codes applicable to this case, these counselors-in-training have designed a proposal which continues to adhere to Forester-Miller and Davis’ decision making model. Foundational principles were considered, rated, and applied to the selection and design of the proposed recommendations; next, actions were proposed and both unconsidered and selected actions were re-evaluated; lastly, these actions were recommended for implementation with model-aligned meta-implementation steps, considerations, and activities.

Selection of Priority Foundational Principle: Nonmaleficence

These counselors-in-training individually ranked the six foundational principles by two domain variables, perceived case relevance and perceived case impact. Following individual ranking, assessed values were applied collaboratively to determine the rank-order in which these variables would be applied to this case’s evaluation. These counselors-in-training determined that non-maleficence would be prioritized in this case’s evaluation as the most critical value, sharing in agreement that reducing or eliminating potential harm to Tina, through counseling, was necessary groundwork in order to pursue therapeutic beneficent work, increase and acknowledge autonomy, act or continue to act in just ways, pursue honest interactions, and thereby develop good faith promises that could be and should be kept.

In observance of the value of nonmaleficence, these counselors-in-training concurred that Keith’s lack of competencies related to online and distance counseling, the tools selected for distance counseling, social media use within the counseling relationship, legal issues surrounding distance counseling, and rural populations needs and interests were a significant risk of harm to the counseling relationship and Tina’s wellness. Adequate resources were not provided to Tina, including a well-informed opportunity for referral to a competent community or distance counselor. Lastly, Keith’s engagement with Tina through use of social media may be potentially harmful to both their counseling relationship and her wellbeing. If these several issues are not addressed and resolved, Keith risks engaging with his client in a way that is not only unethical, but potentially detrimental to her.

Recommended Courses of Action

These counselors-in-training recommend that Keith immediately seek professional consultation and acquire professional development on the matters of online and distance counseling tools and best practices, counseling populations recently relocated to rural communities, and use of social media in the counseling relationship. Keith should contact the licensing boards in both the state where he resides and the state in which Tina resides to determine if he is legally and ethically eligible to provide counseling through this modality to his client. Should it be determined that he is able to continue treating Tina through distance counseling means, he should develop new informed consent documentation which outlines the potential benefits and risks of providing counseling this way and clearly outlines professional boundaries that must be observed related to their counseling relationship, social media, and personal phone use. Keith should not continue to provide any online or distance counseling until he has determined, through formal supervision, that he is competent to provide this type of counseling in a way that does not risk harm to Tina or the counseling relationship he has established with Tina. Furthermore, he should be advised to create a new online website presence with documentation related to his licensing information and create a separate social media presence, should he wish to engage with any clients on these platforms, for professional use only. During his next exchange with Tina, he should be prepared to provide her with well-researched professional referral opportunities who can provide counseling to her until he has developed competencies that will enable him to provide nonmaleficent and beneficent professional counseling support, explaining that he will not be able to provide further counseling to her in a time-sensitive manner, pending development of competency.

Further Evaluation of Unselected Courses of Action

These counselors-in-training determined that continuing to provide online, distance counseling to Tina may risk harming or continuing to harm her and their therapeutic relationship. Additional risks include a lack of perceived competency or helpfulness leading to early termination, doubt in the counseling profession on behalf of the client, and unnecessary generalized frustrations with personal wellness positive behaviors and technology use. Continued use of social media use, without clearly outlined boundaries provided through informed consent, could create an uncomfortable or problematic dual relationship or continue to encourage one should it be determined that one has already been created accidentally. Research should be applied towards the pursuit of suggesting referral, as these counselors-in-training determined that there may be counselors who can specifically benefit Tina by way of competency related to moves to a rural community, and not selecting a competent counselor may result in harm to Tina.

Lastly, without selection of the appropriate tools and the inclusion of intentional supervision, Keith risks harming not only Tina, but also other current or future clients through the modalities and tools he has begun using without seeking appropriate consultation and supervision.

Evaluation of Recommended Courses of Action

These counselors-in-training determined that, in subscribing to the ACA Code of Ethics, this strategy provides for fair treatment across Keith’s possible client population, i.e., that it meets the test of justice. Were Tina not to contact Tina on social media, Keith may not have agreed to continue interacting with her that way, and Keith did not indicate that he had established online relationships with any other clients. Furthermore, Keith can explain to Tina that he cannot make exceptions for her related to online counseling, social media use, or the provision of services for which he has not developed competencies as it is not fair to each of the clients with whom he has a counseling relationship. These counselors-in-training determined, furthermore, that this recommendation meets the test of publicity, as public knowledge that a counselor sought professional development and consultation, declined to proceed in a potentially problematic dual relationship, and referred a client for whom he felt he was not competent to provide nonmaleficent care would not be harmful to a counselor’s reputation or professional identity. Lastly, because this rationale was designed by way of the ACA Code of Ethics, relevant laws and legal cases, and policy published NBCC, these counselors-in-training are confident that this rationale could be recommended to a professional peer interested in pursuing distance counseling as a new counseling practice modality, thereby passing the test of universality.

Implementation of Recommended Courses of Action

Should there have been any further progress related to this case made, these consequential recommendations would require reassessment by Keith. Furthermore, following the implementation of these recommendations, Keith should reassess this plan at each step of the proposed implementation to determine that he is continuing to provide professional service that is nonmaleficent, as well as in alignment with the other ACA principles. These steps should be completed in concert with a competent supervisor or supervisory team who has expertise in the domains of action in which Keith is pursuing changes. Any subsequent changes to these recommendations should be made under supervision. Following complete implementation of these recommendations, Keith and his supervisor or supervisory team should re-assess the success of these recommendations, document success and failures, and pursue any necessary further actions potentially prescribed by the ACA principles and Code of Ethics.


In the provided case study, technological tools and counseling modalities were introduced into Keith and Tina’s counseling relationship. Keith proceeded in providing counseling through this new manner without seeking supervision, developing competencies, determining applicable laws, providing updated informed consent, or assessing objective risks and benefits of doing so. Furthermore, Keith and Tina’s counseling relationship began to move into other technical realms, including social media platforms, risking the creation of a potentially harmful dual relationship.

This team of counselors-in-training evaluated this case with guidance from the American Counseling Association’s Code of Ethics, relevant legal cases, and the National Board of Certified Counselors Policy Regarding the Provision of Distance Professional Services, through the framework of the Forester-Miller and Davis’ decision making model. This team collaboratively prioritized nonmaleficence as the chief foundational principle though which to determine recommendations, based on possible professional outcomes. Recommendations and steps for careful re-evaluation and implementation that included the pursuit of supervision, development of professional competencies, provision of updated informed consent, careful selection of tools, and temporary referral or termination were provided so that Keith may be empowered to provide services which, among the profession’s other values, contribute to “enhancing human development throughout the life span,” and “honoring diversity…,” which uphold the counseling profession’s commitment to “practicing in a competent and ethical manner” and ultimately “safeguarding the integrity of the counselor-client-relationship” (ACA, 2014).



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.

Spotlight on: The ACA Graduate Student Ethics Awards for Doctoral Degree Students winner

This award recognizes exceptional, demonstrable understanding of the ACA Code of Ethics, the foundation of ethical professional counseling practice.

Winners: Connie Elkins, Jay Tift and John Bender of Lindsey Wilson College



The ethical dilemmas within the scenario include integration of technology and electronic record storage, confidentiality, informed consent, supervision practices, remediation, and gatekeeping. The authors’ response includes: identifying these dilemmas with guidance from the ACA Code of Ethics; recommending courses of action; and utilizing Cottone’s (2001) Social Constructivism Model of Ethical Decision Making. A constructivist approach to supervision and as an ethical decision-making model are helpful for resolution of the dilemmas between Rita, Sam, and Dr. Menendez.


2020 ACA Ethics Competition: Doctoral Prompt

The ethical scenario as presented contains a number of issues of concern. Of particular relevance are those issues surrounding the importance of written informed consent with all clients regarding confidentiality and privacy of their information, the ethical use of technology as it relates to storage and transmission of client information, and appropriate gatekeeping and remediation practices in the case of skills deficits for counselors-in-training.

Informed Consent, Confidentiality, and Technology

Informed consent is a central tenet of ethical practice in counseling. Clients have the right to be fully informed about all aspects of their treatment, including the storage and transmission methods of their files, whether written, audio, or video (​American Counseling Association, 2014). Counselors must not only inform clients verbally, but through the review of a written ​informed consent document that is both understandable and transparent. This is especially important with the use of technology due to its ever evolving nature and potentials for breaches in confidentiality (McAdams & Wyatt, 2010).

Utilization of email is nearly ubiquitous in modern communication, however, in clinical practice it requires caution. The risk of breaches in confidentiality should be addressed prior to use (Atherton, Sawmynaden, Sheikh, Majeed, & Car, 2012). The federal Health Insurance​   Portability and Accountability Act of 1996 (HIPAA) allows for email between counselor and client as well as between a supervisor and supervisee with the client’s informed consent (Rousmaniere, Renfro-Michel, & Huggins, 2016).​ This presupposes utilization of HIPAA compliant technology with full encryption and secure storage. Using email for data transmission poses potential confidentiality risks​ in cases of  unencrypted systems, accidental misaddressing​ (as in the case of this scenario), email within handheld devices which are not password secured, and in standard documentation by email or internet providers (Lustgarten & Elhai, 2018).​ Counselors must be thoughtful and cautious in using email to relay private health information.

Gatekeeping and Remediation

Insuring the practice of counseling in a competent and ethical manner and protecting the integrity of the counselor-client relationship are core values of the profession (American Counseling Association, 2014).​ In the attempt to protect these core values, processes for gatekeeping and remediation are required during counselor training. Trained supervisors are expected to provide on-going evaluation of counselor performance with active remediation activities. If counselors-in-training (CITs) are unable to demonstrate that they can provide competent, professional services, it is the responsibility of their supervisor to develop remediation strategies or to recommend dismissal from training programs. Remediation and gatekeeping are not lone processes; supervisors consult with other professionals and standing policies prior to determining actions toward CITs (American Counseling Association, 2014).

Remediation in training is not considered punitive but supportive as the supervisor and supervisee develop a working alliance (Lampropoulos, 2002). Effective supervision of CITs includes developmental and culturally sensitive approaches with support, guidance, and self-awareness (Handelsman, Gottlieb, & Knapp, 2005; Lampropoulos, 200​ 2;​ Pompeo & Levitt, 2014). The use of a consistent model for supervision is a way to validate remediation strategies,​  with most supervision models paralleling those of counseling models (Destler, 2017; Lampropoulos, 2002). Destler (2017) states that the process of supervision, and the relationship between counselor and supervisor, are similar in structure to the concurrent relationship between client and counselor. However,​ “this triadic configuration does not take a fourth entity into​  account: the relationship between the supervisor and the supervisor’s supervisor” (p. 274). The supervisor’s supervisor is an integral part of the remediation and gatekeeping process, and most often the one responsible for final decisions of gatekeeping.

Identification of the Dilemma

An initial ethical dilemma in this scenario is inadequate informed consent which should be reviewed and signed by the CITs’ clients regarding the videotaping of sessions and use of these sessions in the supervision process. Another dilemma includes difficulty in the supervisory relationship between Rita and her doctoral student supervisor, Sam. Rita is not receptive to Sam’s feedback regarding her clinical skills and therefore chooses to download a video file of a client session, which includes written feedback from Sam, and to share it via email with the rest of her practicum class. Sharing the video with classmates without client consent is a breach of confidentiality.

Other breaches of confidentiality occur as Rita’s classmates share the video, again via email, with their doctoral supervisors. Ultimately, the video is accidentally shared with the faculty supervisor, Dr. Menendez, when he is looped into the email chain regarding the file. It is not directly problematic that Dr. Menendez received this file, as he is responsible for both the CITs and the doctoral student supervisors, but it demonstrates the risk of email in the potential for accidental sharing. It is problematic that Dr. Menendez learns of the sharing and conflicts accidentally instead of through reports from Sam and the other doctoral student supervisors.

A final concern is the lack of communication between Rita, Sam, and Dr. Menendez. Dr. Menendez is ultimately responsible for client services and CIT performance and should be providing guidance to Sam as Sam strives to deliver effective feedback to Rita. Sam should be continually consulting Dr. Menendez with any supervision, remediation, or gatekeeping concerns for his CITs. This demonstrates issues related to effective gatekeeping and remediation, both for Rita and for Sam.

The views of Rita and Sam are at the heart of this dilemma. Sam has become concerned about Rita’s practical application of counseling skills and is struggling to provide feedback in a way that is helpful. Rita has become increasingly frustrated with her perceived unfair feedback and is not receptive to Sam’s supervision. This mutual frustration may have created an impasse between Rita and Sam, and further consideration must be given of the viability of the relationship.

Social Constructivism Model – Cottone

The Social Constructivism Model for ethical decision making is a social interpretation of the decision-making process, taking into account how decisions occur and how values are weighed by the individuals involved (Cottone, 2001). Within this approach there is a recognition of competitive truths in which ethical dilemmas are normalized, initial consensus is established, and resolution is negotiated through interactive reflection with other professionals​ or through​ arbitration.  Professionals avoid linkages of vulnerability and cultivate linkages of professional responsibility, emphasizing growth and change as opposed to failure (Cottone, 2001).

Within the constructivist approach decision-makers engage in interactive reflection. This is not an internal process of the mind but a continued reappraisal of actions in consultation with other counseling professionals (Cottone, 2001). Decision-makers consult colleagues to insure that the dilemma is fully understood and defined through obtaining complete information.

Interactive reflection is utilized throughout the processes of assessing relationships between conflicting parties, consulting expert opinion, negotiating, consensualizing, and arbitration- all defining features in the social constructivist ethical decision process. Social constructivist processes do not require linear progression and may occur simultaneously while seeking solutions to ethical dilemmas.

A social constructivist approach to supervision and ethical decision-making can be helpful in resolving ​ the dilemmas between Rita, Sam, and Dr. Menendez. Rita’s lack of progress,​  lack of trust in Sam’s input, and her defensiveness and frustration are seen as symptoms of anxiety and problematic relationships (Guiffrida, 2015; ​ McKibben, Borders, & Wahesh, 2019).​ These dilemmas can be resolved through a social constructivist process since her response “probably derives as much from the relationship to the accuser or enquirer as it does from the nature of the alleged misconduct” (Cottone, 2001, p.42). Remediation of Rita’s lack of progress and breach of client confidentiality is an ethical responsibility for both Sam and Dr. Menendez and will be emphasized throughout the discussion of the scenario, however, the most important relationship is between Rita and her client, and all efforts of support and remediation are to ethically establish and maintain their​ ​ therapeutic relationship.

Obtain Information from Those Involved

As part of the Social Constructivism Model, the views of all parties involved must be taken into account. This includes both explicit and implicit views. Rita is given the opportunity to express her perspective and to account for her actions, explaining her decisions to reject Sam’s input and to share counseling sessions. She is encouraged to evaluate her actions in light of professional ethics and have her opinions heard by Dr. Menendez. This process can have remedial value as she is allowed to assess her actions in a supportive atmosphere.

It is also necessary to obtain information from Sam, his fellow doctoral students, and Dr. Menendez. Dr. Menendez expressed concern regarding both the actions of his CITs and of Sam and the other doctoral students who were aware that this information was being circulated. Sam is given the opportunity to explain his actions, which also may provide remedial value as he assesses these actions in light of his professional ethics. The doctoral students can communicate their perspectives and assessment of the dilemmas, using this as a learning opportunity. Through information gathering, it is hopeful that Dr. Menendez will realize the inadequacies of the current informed consent document.

Assess the Nature of Relationships

An evaluation of the relationships between Rita and Sam, Sam and Dr. Menendez, and Rita and Dr. Menendez is beneficial to remediate Rita’s skills and to repair ethical breaches created in this scenario. The supervisory relationship is foundational to supervisee growth and development, and skillful nurturing and application of these relationships creates the environment for an optimal outcome (Cottone, 2001; Guiffrida, 2015; McKibben et al., 2019). McKibben et al. (2019) found that the stronger a supervisee perceived the relationship to their supervisor, the more likely critical feedback was viewed as valid. Receptiveness to, and encouragement of feedback between Rita, Sam, and Dr. Menendez will greatly improve the chances of optimal resolution in this scenario.

Rita’s frustration and resistance to Sam’s interventions are symptoms of her anxiety and lack of trust in Sam’s guidance. Strategies include an honest evaluation of their relationship along with activities to establish mutual trust and acceptance. As the supervisor, Sam can encourage and normalize Rita’s feelings of anxiety and frustration in the growth process. He can also share some of his personal experiences as a CIT to create mutual empathy. Empowering Rita to create agendas for their supervision sessions and to critique his ability in providing helpful feedback can increase her sense of autonomy and comfort in the relationship as well as giving Sam insight into his supervision approach. Rita’s mistakes can be seen not as failures but as part of the learning process, particularly when Rita recognizes and corrects them while counseling or during supervision. As their relationship develops Sam can teach Rita to critically reflect on her thoughts, feelings, and behaviors in counseling sessions. Rita’s increased self-awareness and decreased fear of failure will help her to apply effective strategies while working with her clients.

The relationship between Sam and Dr. Menendez also needs to be addressed as part of Sam’s remediation. Dr. Menendez is Sam’s supervisor, and ethical breaches and lack of progress with Sam and his supervisees are problematic. The fact that Sam did not notify Dr. Menendez of the electronics breach and issues with Rita indicates that Sam is not entirely forthcoming in their supervisory relationship. Sam is likely experiencing anxiety as supervisor of CITs. Dr. Menendez must work to create a sense of safety for Sam to engage in reflection of his thoughts, feelings, and behaviors within his supervisory responsibilities. Sam and Dr. Menendez can then cooperatively strategize remediation plans for Rita’s performance. Sam’s development as a supervisor will be supported through reflective interaction with Dr. Mendez.

Another relationship that needs to be assessed is that of Rita and Dr. Menendez. Dr. Menendez should insure that Rita and the other CITs feel secure enough to express concerns they are having in the counseling and supervision process. He needs to be accessible and supportive, normalizing anxiety and mistakes as part of the developmental process, while also providing clarity on the institution’s dual commitment to protecting clients and helping CITs grow. Strategies might include sharing his experiences as a counselor as well as discussing realistic expectations of students from a developmental perspective. From this stance, he and Rita can cooperatively assess their relationship and create a plan to strengthen and maintain it.

Consult Valued Colleagues and Expert Opinion

It is vital that a supervisor-in-training be in regular consultation regarding all supervisees with their supervision supervisor. This is especially true if they have a supervisee who is demonstrating skills deficits or rejecting supervisor feedback. In this case, Rita’s defensiveness and her difficulty in translating academic learning into clinical practice needs to be a regular discussion point for Sam and Dr. Mendez. Sam also has the opportunity to consult with his doctoral classmates in their supervision class. Doing so may provide him with different perspectives and strategies for supporting Rita. Group consultation is helpful for any counselor in order to prevent becoming myopic or rigid in the approach to a client or a supervisee.

Dr. Menendez can benefit from consultation with his valued colleagues, particularly if this becomes an issue of gatekeeping. Colleagues can advise or help with revision of the informed consent document and help insure that appropriate procedures are followed if Rita is not successful in remediation efforts. While colleagues within his department are the most direct source of consultation, it may also be of use to reach out to colleagues in other institutions and in professional organizations to get an idea of how others are handling similar situations both proactively and as they come up.

The basis of expert opinion is the ACA Code of Ethics. As counseling professionals, all individuals within the scenario should consult these standards to guide the ethical decision process. Among the values listed in the preamble of the 2014 ACA Code of Ethics, two are particularly relevant to this scenario. The first is that counselors must work to “safeguard the integrity of the counselor-client relationship” (American Counseling Association, 2014, p. 3).​ It is important to consider the potential impact that sharing the video might have on the relationship between Rita and her client if this information was shared without clear consent from the client.

Also, counselors strive to “practice in a competent and ethical manner” (American Counseling Association, 2014, p. 3).​ Rita’s struggles with clinical competence and the ethical issues regarding informed consent, confidentiality, technology, and remediation all must be taken into account.

The principle of autonomy grants the client power over the sharing of their information regarding their treatment. It is also important for supervisors to honor the autonomy of supervisees, giving them the opportunity to voice their concerns with any feedback. Concerning the principle of Fidelity, it is vital to honor commitments to clients regarding maintaining privacy and confidentiality (American Counseling Association, 2014).​

Below we list the most centrally relevant points from the Code related to this scenario. While there are many points throughout the 2014 ACA code that can be applied, we have attempted to be parsimonious in our list.

  • 2.a Informed Consent – While the clients are verbally informed about the use​ of video there is no written informed consent with regard to either video recording or the potential uses of the video. Rita’s desire to share a video with her classmates should be discussed with the client as part of the ongoing informed consent process.
  • 2.b Types of Information – Clients must have a clear understanding of the way​ technology will be used in the course of their treatment with both supervisors and consultation groups.
  • 1.c Respect for Confidentiality – Rita seems to be sharing her client’s videoed​ session with her classmates, and indirectly with their supervisors, without having obtained the client’s consent. She should consider client confidentiality as primary over her own needs for support.
  • 3.b Interdisciplinary Teams – The client must be informed not only that a full​ video session is being shared with Rita’s classmates, but also the reason for the sharing.
  • 3.e Transmitting Confidential Information – In using email to transfer the​ video file to classmates, Rita has not assured the confidentiality of the information being transmitted. This is demonstrated in the fact that Dr. Mendez is accidentally looped into the email.
  • 6.d Permission to Observe – Rita needs to seek permission from her client to​ allow her class to observe videos of their sessions.
  • 7 Case Consultation – In sharing an entire video complete with her​ supervisor’s written feedback, Rita is not making every effort to protect her client’s identity nor has she explained to the client the purpose of her consultation with her classmates utilizing this full video in order to receive their consent for the disclosure.
  • 2.c Online Supervision – The doctoral supervisors who were emailed the video​ of Rita’s session with her client, in choosing to remain silent, have not made efforts to protect the confidentiality of the information from potential breaches inherent in the use of email to transfer electronic files.
  • 6.b Gatekeeping and Remediation – It is Sam’s job to give feedback of Rita’s​ clinical performance. Further, he should refer her to remediation or potential gatekeeping processes. This should be done as an ongoing process and should include consultation and supervision of his own as he navigates his approach.
  • 9.b Evaluation of Students – It is Dr. Mendez’s responsibility to adequately​ evaluate the CITs clinical competencies. In this case, Rita’s difficulty in translating academic knowledge into clinical skills indicates a need for an educative remediation process. With Sam and the other doctoral student supervisors not notifying Dr. Mendez about the issue, he is unable to do this adequately.
  • 2.b Confidentiality Maintained by the Counselor – Rita has failed to​ maintain a confidential relationship by sending the video to her whole class, who then forwarded it on to their various doctoral student supervisors.
  • 2.d Security – Email as a medium for transmitting digital client files is​ inadequate to ensure confidentiality of those files. This is demonstrated in the fact that Dr. Mendez is accidentally looped into the email.
  • 5.a Records – Rita’s client need full knowledge of how their recorded sessions​ files are stored- for both current and future safety.


From a social constructivist perspective negotiating is the process of discussing and debating an issue. Disagreement over an ethically sensitive issue is framed as a “conflict of coessentialities” (Cottone, 2001, p. 41). The first step of negotiation between Sam and Rita is to communicate their differing perspectives of Rita’s progress and Rita’s release of her counseling sessions to the group. As Rita is respectfully given the opportunity to verbalize the intentions behind her behaviors she can begin to evaluate the appropriateness of her actions. Sam and Dr Mendez negotiate their perspectives from a position of experience and protectiveness of both the client and the CITs. If the negotiation is successful all parties will learn from this process and adjust their future behaviors.

Consensualize and Interactive Reflection

Unique to the Social Constructivism Model is the interactive nature of both discussing individual viewpoints and reaching a unanimous plan of action (​Cottone, 2001).​ As part of this process, a solution that best fits all needs and objectives is chosen in place of any one individual viewpoint. The decisions made are ideally inline with norms fitting the social group or organization that governs all individual members involved, in this case the counseling profession. In the event that consenualization is not possible, each member is then encouraged to continue to reflect on their position. Unlike individualistic decision-making models, social constructivism relies on interactive reflection, and if need be, further reflection. In this way, views are not uniquely individual or social, but rather take into account both the view of self and the group (Cottone, 2001).​

In the context of this dilemma, Rita must not only take into account her frustrations regarding her lack of progress and lack of effective feedback and her desire to improve, but she must also consider the impact of her actions on her clients, Sam as her supervisor, Dr Menendez as her instructor, the counseling center, her fellow CITs, and the university. Sam must take into account his frustration with Rita, her lack of progress, and the violation of her client’s confidentiality while also reflecting on his supervision style and remediation strategy, his failure to properly inform Dr Menendez about Rita’s actions, and how he and his fellow doctoral students share responsibility and information about their supervisees. Dr Menendez, along with addressing both Rita and Sam’s behaviors, must address his doctoral supervision course as a whole, and the documentation of the counseling center, which lacks clear documentation regarding the recording and sharing of sessions.

The ideal solution is that Sam provides Rita with supportive and constructive feedback. Rita then applies Sam’s feedback and recommendations. Dr Menendez should address and more concretely operationalizes the process by which Sam and his fellow supervision students convey information. He also needs to revise the confidentiality policies of the counseling clinic. In the event that these steps were not universally accepted, additional interactive reflection continues until consensus is reached.


In a case where consensualization does not work, the final step of Cottone’s model is that of Arbitration. This is when a third party is selected consensually by those involved as an acceptable authority in the matter at hand (Cottone, 2001). In this case the immediate and​ obvious arbitrator between Rita and Sam, as well as in the case of Rita’s classmates who argue for their use of email to transmit the file to a growing number of people, is Dr. Mendez. As the instructor of record for the practicum course and the faculty supervisor of the doctoral student supervisors, ultimate responsibility for both the actions and clinical competencies of the students falls to him.

In the unlikely event that Dr. Mendez is unable to arbitrate a successful conclusion, further potential arbitrators would be found in the program director and department chair of the counseling program. As per best practices, the department should have clearly defined remediation and gatekeeping processes which are well articulated to students beginning before matriculation and continuing throughout the program, and which would provide the structure for this process (Glance, Fanning, Schoepke, Soto, & Williams, 2012). If remediation efforts are unsuccessful and Rita’s dismissal from the program is the required action, it is likely that the University’s legal department would also be involved to make sure that any final decisions are within appropriate legal bounds. Arbitration is utilized only if negotiating and consensualizing are unsuccessful and can result in a less than desirable conclusion, particularly for Rita. (Cottone, 2001).​



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.

Helping clients rebuild after separation or divorce

By Lindsey Phillips March 25, 2020

Jennifer Meyer, a licensed professional counselor (LPC) in private practice in Fort Collins, Colorado, had a client who, after 30-plus years of marriage, discovered that her husband had been embezzling money from their joint business. This infidelity, along with his recent verbal abuse, prompted the woman to get a divorce. The client was hurt, shattered, ashamed, lost and confused about her future, Meyer says. For the previous 30 years, she had shared friends, children, family and a business all with the same partner. How would she be able to start all over again now?

Clients such as this one often find that they have to rebuild their lives because, in some ways, divorce is the “death” of a relationship. Meyer tries to help clients accept that divorce is a big loss — one often accompanied by feelings of betrayal and trauma. To overcome this loss, she works with clients on processing their emotions (which often include anger, shame and blame), communicating their needs, establishing healthy boundaries with their ex-partner and rebuilding their lives.

The stages of divorce

Meyer, a member of the American Counseling Association and the International Association of Marriage and Family Counselors (an ACA division), specializes in divorce coaching and recovery. She has noticed that her clients often exhibit signs of grief, such as feeling unmotivated and having trouble sleeping. In fact, going through a divorce can be similar to going through grief, but it can be further complicated by layers of legal issues, financial strain, individual mental health challenges, the experience of parental alienation, the challenges of co-parenting, and the realities of dividing assets, Meyer says.

Meyer gives clients a handout of the seven stages of divorce, created by Jamie Williamson, a family mediator certified by the Florida Supreme Court. Williamson draws on the well-known “stages” of grief, but her model ends with rebuilding — a stage when a person’s acceptance deepens, they let go of the past and they find a way forward.

Meyer, who presents on the emotional journey of divorce at an ongoing national women’s workshop in northern Colorado, adapted Williamson’s model to illustrate the complexities of grieving a divorce, which she likens to climbing Mount Everest — a climb they didn’t sign up for. In this metaphor, she pairs six stages of divorce with sample thoughts of what clients may be feeling:

  • Denial: “This climb is a complete waste of time. I should be home trying to save my marriage”
  • Anger: “This divorce is expensive. Why is this happening to me? I didn’t plan for this.”
  • Bargaining: “I would do anything to turn back and make things right with my spouse. What if I don’t make it? Will my kids be OK?”
  • Depression: “I’ve lost my spouse and some mutual friends. I can’t sleep. I feel so lonely.”
  • Acceptance: “I no longer idealize my past. This process taught me how strong I am.”
  • Rebuilding: “I’m excited to close this chapter and begin creating a happy future.”

In between these stages, she says, clients are growing and learning. They start to learn who their true friends are, and they learn more about themselves, their boundaries and their expectations.

Meyer’s metaphor also highlights that the stages of divorce are not sequential. For example, someone might move from being angry at the financial cost of divorcing to wondering if they should get back together with their ex out of a fear that their kids won’t be OK to being angry again that this experience is happening to them.

Processing emotions

Meyer uses emotionally focused therapies to help clients turn inward to process their feelings about the separation or divorce. One of Meyer’s clients was frustrated because she felt her ex-spouse was never emotionally available. So, Meyer had the client close her eyes and picture the ex’s face. Then, she asked the client, “What would you say to your ex from an angry perspective? What would you say to your ex from a hurt perspective? And what do you imagine your ex would say back to you?”

This role-play exercise helps clients not only process their feelings and find a way to move forward from their hurt and anger, but also recognize their own part in the marital problems, Meyer explains. She cautions counselors not to focus on the self-responsibility part too early but says that as clients move through the stages of divorce, counselors can gently encourage them to look at what part might have been theirs.

Meyer has also noticed that women often want to take all of the responsibility for a relationship ending, so she tries to help them realize that both partners played a role. To do this, she might say, “There’s 100 percent blame out there. What percentage of that would you claim, and what percentage is your ex-partner’s?”

Owning their responsibility can also be empowering for clients, Meyer adds. They often feel like everything was done to them, so realizing the role they played and how they would handle that differently in the future helps them move forward, she explains.

Meyer also has clients write goodbye letters to their exes (or any family members or friends they have lost in the divorce). In the letters, they name all the things they will miss (e.g., “I will miss your hugs,” “I will miss your excitement to go to concerts”) and the things they won’t miss (e.g., “Goodbye to your smelly socks on the floor all the time,” “Goodbye to the fact that you never prioritized me”). This exercise allows clients to express their hurt, anger and sadness and helps them let go of the relationship, she says.

Developing healthy communication and boundaries

Some of Meyer’s clients also have a difficult time knowing how to act around the other partner after deciding to divorce. They may feel guilty for setting boundaries on someone who used to be their partner, but Meyer reminds them that the relationship has changed. “The communication that you wanted and needed while you were married or together is … very different, so you’re going to need to each have boundaries around your communication,” Meyer says.

Meyer helps clients figure out the source of their distress with their ex-partner and guides them in establishing better boundaries. For instance, if a client was upset because their ex-partner kept showing up to their child’s soccer games and hounding them about renegotiating a part of the divorce, Meyer would help the client communicate new boundaries by coming up with phrases such as “Let’s talk about this in mediation” or “If you call me names or raise your voice, I’m going to end this conversation.”

Gabrielle Usatynski, an LPC and the founder of Power Couples Counseling (a private practice with offices in Boulder and Louisville, Colorado), also focuses on the way the couple communicate and behave around each other. “One of the points [of divorce counseling] is to help them develop the capacities they need in order to engage in fruitful conversations that do not get scary and dangerous,” Usatynski explains. To do this, she teaches couples about the value of treating each other with fairness, justice and sensitivity, even in the midst of divorce. She also helps couples learn to negotiate and bargain with each other so they can create win-win solutions for divorce and co-parenting.

A psychobiological approach to couple therapy (PACT), developed by Stan Tatkin, acknowledges that there is a difference between what people say they do and what they actually do, Usatynski says. People’s narratives are subject to inaccuracies that can throw the therapist off track in terms of understanding what is really happening with the couple, she explains.

A couple’s attitudes and problems, as well as their ability to engage with one another, are largely driven by the state of their autonomic nervous systems, Usatynski continues. “Therapists should facilitate these nervous system states in session and intervene while the couple is in those particular states,” she says. “The goal is to collect and bring to bear as much raw, unedited information [as possible] from the body, brainstem and limbic brain.”

For this reason, Usatynski uses a technique called staging, which targets the body and deep brain structures. Couples act out problematic moments in their relationship in front of the therapist. Because people have different perspectives, finding out exactly what happened is not Usatynski’s goal. Instead, she wants to find situations that created distress for the couple and see for herself the mistakes the couple made in their interaction.

So, if a couple going through a divorce had a heated exchanged when the father dropped the children off at the mother’s house, Usatynski would ask for them to act out that exchange in her office. When the father says, “Your music is way too loud. The kids don’t need to hear the music that loud,” the mother responds, “Stop yelling at me in front of the kids, and don’t tell me what to do.”

Usatynski notices this is a point of distress for the couple, so when they finish acting out the scenario, she discusses this misstep with them. For example, to help the father understand that he came across as demanding and made his wife look bad in front of the kids, Usatynski might ask him, “Did you say, ‘Please turn down the radio?’”

After discussing each of the missteps, Usatynski has the clients re-enact the scenario. This time, however, they have to come up with ways of relating to one another that are nonthreatening, fair and sensitive. “When we allow our clients to stumble along, the solutions they find on their own are going to be way more powerful, creative and effective than anything we could offer them,” Usatynski says. “The process of discovering their own solutions also gives them a greater sense of empowerment and competency that they really can do this on their own.” That is ultimately the goal of counseling, she adds. Only when a couple is really struggling to come up with viable solutions on their own will Usatynski provide suggestions.

Acting out the scenario in the brain state they were in at the time of conflict and then learning a better way to handle the situation helps clients react differently the next time they find themselves in a heated exchange, Usatynski notes.

Starting over

After clients have gone through the emotional journey of divorce, they need to start rebuilding their lives and hoping for a better future. To help clients start this process, Meyer returns to the letter writing exercise, but this time she has them write a “hello” letter to their new life and the aspects they will enjoy most. For example, clients could write, “Hello to traveling by myself without someone who gets impatient,” “Hello to being able to decorate my bedroom the way I want to,” “Hello to time with friends again” or “Hello to the stronger, more confident me.”

One of Meyer’s clients brought in items that represented her divorce, including the goodbye letter she had written in a previous session. She then went outside with Meyer and burned it all. This act symbolized her letting go of that relationship and taking a step forward.

Meyer has also had clients go outside and use nature as a metaphor for their progress and healing. For example, one client said that an old tree that had been chopped down represented her at the beginning of her divorce, but by the end of it, she identified with a stronger, healthier tree.

Divorce is a devastating event that no one wants to experience. In fact, according to the Social Readjustment Rating Scale developed in 1967 by psychiatrists Thomas Holmes and Richard Rahe, divorce is the second most stressful life event for adults (behind only the death of a spouse). But clients can rebuild their lives and have a hopeful future.

“When you work on [what happened in the relationship] and you figure out what your part was and what was going on with the partner that you didn’t think was healthy, you can really find the good part of you and salvage the rest of this to the point where you’re in better spot than you ever were,” Meyer asserts.

Meyer watched her client who divorced after 30-plus years of marriage undergo an incredible transformation throughout their sessions. The client realized how often she had done what was asked of her (by her ex-spouse, her kids and her employers) without considering her own needs. She began to slow down, set boundaries and say “no.” She realized what she deserved in a relationship, and she learned how to select and be a better partner in the future.

By processing her emotions about the divorce and betrayal and letting go of the blame, shame and anger that had become such a heavy burden for her, the client began to feel younger in her body and make healthier life choices. And with Meyer’s guidance, she realized she didn’t have to be afraid to start over.




For more on this topic, look for an in-depth feature article on helping clients cope with divorce or infidelity in the April issue of Counseling Today.




Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at or through her website at

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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.