Monthly Archives: April 2020

Spotlight on: ACA Future School Counselors Award winner

April 9, 2020

This award recognizes graduate counseling students with exceptional insight and understanding about the school counseling profession and the work of professional school counselors who interact with elementary, middle school or high school students.

Winner: Rebecca Alexandra Smith

Rebecca Alexandra Smith is currently pursuing her masters of science in counselor education with specializations in school counseling and clinical mental health counseling at East Carolina University. She plans to become a North Carolina school counselor as well as a licensed clinical mental health counselor (LCMHC). Her passion is working with children, adolescents, and families to address the various personal, relational, and systemic challenges that impact their lives.

 

 

 

Essay:

Robby Novak said, “You don’t need a cape to be a hero. You just need to care.” With the help of adults who believed in him, Robby Novak became the witty and wise “Kid President” who has inspired others since 2012. Many young people, however, go without the security of a healthy support system and their well-being is risked as a result. School counseling gives all students access to someone who supports them, advocates for them, and believes in them wholeheartedly.

To measure the effectiveness of school counseling, we should shift our focus to social and emotional outcomes rather than academic outcomes, since achievement gaps often prohibit equal access for student academic success. Considering this, healthy decision-making skills and the ability to cope with adversity are the most important non-academic outcomes. They are significant because of the long-term benefits that can potentially enhance students’ educational accomplishments and personal victories throughout their lifespan.

Informed decision making can be difficult for all students because of varying backgrounds or environments. When a counselor works with students to develop this skill through modeling, workshops, reinforcement, or goal setting, they can discover the power that healthy decision-making has on their lives. We can evaluate students’ decision-making skills by recording conduct reports, levels of engagement with peers, post-graduation planning, and parent and teacher evaluations. When students develop this skill, conduct will likely improve, relationship choices will become healthier, they will become more goal-oriented, and parents and teachers will report signs of improved behavior such as turning in homework assignments on time or showing kindness to a classmate.

Another central part of school counseling is the ability to equip our students with ways to cope with adversity. Learning these skills during brain development builds a strong foundation for managing stress, change, and negative emotions throughout students’ entire lives. One way to prepare students with tools to self-regulate is through direct instruction, but we can also help by educating families, communities, and teachers about how to integrate coping skills into everyday life. We can document this outcome through student self-reports, parent and teacher evaluations, direct observations of the use of coping skills, or an assessment of their emotional and behavioral health. Ideally, students who can cope with adversity will be able to verbally express their problems and reach out for support, engage in appropriate activities that increase their self- concept, possess a willingness to persist even when faced with setbacks, and/or show an increased mood and decreased levels of stress.

All students can increase their chances of lasting academic and personal attainment when they learn to make healthy decisions and appropriately cope with adversity. To promote these outcomes, school counselors must be willing to be teachers, coaches, liaisons, and advocates for students’ social, emotional, and academic well-being. Only then can barriers to success begin to break down, allowing us to be the heroes that produce heroes in our students. All it takes is care; no capes needed.

 

****

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.

Interstate compact plan provides hope for licensure portability

By Laurie Meyers April 8, 2020

In an increasingly mobile society, it is not unusual for professionals in many fields to relocate for career or personal reasons. For those in professions such as human resources, information technology, publications and numerous other fields, moving to another area usually requires only a new employer. In fact, many professionals need not even seek a new office because they can telecommute.

But for professional counselors, moving requires obtaining licensure again in their new state. Because individual state requirements for licensure vary widely — particularly in the number of graduate semester hours, required coursework, number of hours of post-master’s supervised counseling experience, and examination requirements — it can be difficult and time-consuming for counselors to transfer their licenses. Additionally, most states also require that counselors be licensed in the same state in which their clients reside, which limits practitioners’ ability to provide therapy via telebehavioral health. Being unable to counsel from a distance doesn’t just limit counselors’ potential practice avenues but also often forces clients who move to seek a new mental health practitioner.

The American Counseling Association has long considered lack of licensure portability to be one of the most critical issues facing the counseling profession. The Building Blocks to Portability Project was one of the major initiatives to come out of 20/20: A Vision for the Future of Counseling, a yearslong strategic planning effort co-sponsored by ACA and the American Association of State Counseling Boards that involved 31 major counseling organizations. In June 2016, the ACA Governing Council passed the ACA Licensure Portability Model, which said:

“A counselor who is licensed at the independent practice level in their home state and who has no disciplinary record shall be eligible for licensure at the independent practice level in any state or U.S. jurisdiction in which they are seeking residence. The state to which the licensed counselor is moving may require a jurisprudence examination based on the rules and procedures of that state.”

However, to allow for true portability, individual state licensing boards nationwide would have needed to adopt the ACA model. Based on input received from state licensing boards, ACA eventually decided that the most effective way to achieve portability was through the creation of an interstate compact.

The compact “won’t be ACA’s plan or any other group’s [plan],” says Lynn Linde, ACA’s chief knowledge and learning officer and staff point person for the interstate compact project. “What is being proposed is what we expect the licensing boards will agree to given their input. That’s why it’s the best option.”

How an interstate compact would work

What, exactly, is being proposed? According to Linde, states that join a compact would be agreeing to accept the credentials of professional counselors who are licensed in another state. Individual state licensing boards would be allowed to impose additional requirements such as a jurisprudence exam or an FBI background check, but the compact would not change professional counselors’ scope of practice, Linde explains. Individual counselors would be required to hold a valid license from the state of their legal residence. Counselors could then apply to the compact to be licensed to practice in other states that have agreed to participate in the compact.

Although the process sounds relatively simple, implementing the interstate compact for portability is a multiyear process. In January 2019, ACA signed a contract with the Council of State Governments’ (CSG) National Center for Interstate Compacts (NCIC) to conduct the work. NCIC has divided the project into three phases:

  • Phase I: Developing the compact. This involves creation of an advisory group, drawing up a draft compact and getting feedback on the draft from all of the groups involved.
  • Phase II: Implementing the compact. During this phase, an online compact resource kit will be developed, along with a legislative strategy, including a national legislative briefing.
  • Phase III: Establishing the commission that will oversee and coordinate the compact.

(For more detailed information on the interstate compact process, access a fact sheet at tinyurl.com/vlh3gk2 on ACA’s website.)

Where are we now?

In October 2019, the advisory group, composed of ACA members, representatives from state licensing boards, state legislators, and attorneys for state licensing boards, met in person. Follow-up phone meetings were held in November, December, January and February. During these calls, the advisory group members had an opportunity to further discuss how they wanted to handle specific elements of the compact and talk with representatives of other compacts, Linde says.

A drafting team, composed primarily of lawyers who serve on the advisory group, lawyers from NCIC, and several other professionals who have specific expertise in licensure requirements, has been created and was scheduled to meet in March, Linde says. The goal is to produce a draft compact by May or June of this year. The draft will go back to the advisory group for review and then enter the formal CSG compact stakeholder review — an eight-week process for gathering feedback from state licensing boards, state legislatures, and state and national membership organizations. The drafting team will review the feedback and make any needed changes. The updated draft will then be presented to the advisory group, which will either endorse it or make further changes.

Once the advisory group endorses the final version, the plan will be presented to the states and phase II, the legislative process of implementing the compact, will begin. (Visit tinyurl.com/unav9ta for more detailed information about the drafting and implementation process.)

Phase II is expected to run from September 2020 through March 2023. Phase III is projected to take place from April 2023 to September 2023.

 

****

For more details on the compact project, see the ACA webinar “Interstate Compacts for Professional Counseling: The Pathway to Licensure Portability

****

Laurie Meyers is a senior writer at Counseling Today. Contact her at lmeyers@counseling.org.

****

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.

A note of encouragement for counseling students during COVID-19

By Dana M. Cea April 7, 2020

The current situation with COVID-19 and the effect it is having on counseling students’ lives can cause stress, anxiety and uncertainty. In my role as a doctoral student supervisor, I am hearing these stories from supervisees and their classmates. Thankfully, my department, the Department of Addictions and Rehabilitation Studies at East Carolina University, has jumped to action to support all of its students, especially the practicum and internship students. However, the faculty are limited in what they can do based on decisions made by the Council for Accreditation of Counseling and Related Educational Programs (CACREP).

Keep in mind that there are more than 800 CACREP-accredited programs, which could mean over 10,000 counseling students. All of you are in the same boat and are doing your best to stay afloat. Without flexibility in standards, we could find ourselves with an even larger shortage of mental health professionals over the next couple of years.

As graduate counseling students, you have no control over CACREP, of course. What do you have control over? The following recommendations may not be new to you, yet they are helpful. In fact, you may already be sharing some of these with clients.

Keep your schedule. We all know how helpful schedules and routines are in maintaining our mental health. Although you may not be going to classes or work sites right now, keeping the schedule you had previously or adjusting to a new reasonable schedule is wise. Include a morning routine and a routine for bedtime. If you find that you suddenly have a little extra time each day, explore options for how you can use that time, such as sleeping in, exercising, meditating or doing crafts.

Check in with classmates and colleagues. My Ph.D. student cohort has a group chat, and the Navigate Counseling Clinic where I provide counseling services does too. One day during our “spring break 2.0,” I realized how much I missed seeing my cohort and needed a check-in. When I scheduled a video conference, the other members of my cohort found this funny because I am not known to be the most touchy-feely person. But seeing their faces was so helpful for me. We also host weekly video conferences with the Navigate clinicians, internship students and practicum students. Group chats are great, especially for pet photos and memes, yet video conferences take that connection to the next level.

Check in with your progress. Now is a great time to figure out what you need before you take that next step, whether it be for practicum, internship or becoming licensed. Seek help from faculty, supervisors, webinars and other learning opportunities. I created a “counselor dunking booth” in which supervisees are able to play a short clip of a TV show, movie or counseling tape or create a case study and challenge me concerning how I would address the situation or client. Even if you are unable to go to your site or do telehealth, there are many opportunities to sharpen your skills, knowledge and abilities.

Check in with yourself. How are you holding up under the current stress? Is it affecting your ability to work with clients or complete necessary coursework? If you are having a hard time answering these questions, ask those who know you best. Now may be a good time to find a counselor for yourself if you have not done so already.

Many counselors are indicating their ability to provide telehealth on their personal websites or on Psychology Today’s Find a Therapist directory. The Pandemic Therapists website is compiling a nationwide list of counselors providing support during the current situation. Keep checking back because new resources are being added. If money is a concern, some counselors may offer sessions for free or for a small fee to counseling students. Also check out Open Path Collective and Give An Hour. Do not forget to connect with your state’s National Alliance on Mental Illness organizations and affiliates. The national organization has a helpline that can assist you in finding counselors.

The bottom line is that as a counseling student today, you will be even better prepared than some licensed clinicians once you enter the counseling field. You will be able to show great empathy to clients when they seek services to manage the lasting effects of the COVID-19 pandemic. You likely will have gone through a crash course in telehealth or, at the very least, learned how to quickly shift your learning online. You will have a deeper understanding and appreciation for the human connections that we offer to clients as counselors.

You will emerge stronger for having gone through this experience.

 

****

Dana M. Cea, pronouns she/her or they/them, is a volunteer for the National Alliance on Mental Illness and the American Foundation for Suicide Prevention, a mental health professional, a survivor of suicide loss, and a doctoral student at East Carolina University. She focuses her research on mental health and suicide, the LGBTQ+ community, youth, and autism spectrum disorder. Dana lives with mental health disorders, her spouse, and their three dogs. Contact her at danamcea.com.

****

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.

From Combat to Counseling: Survivors guilt, shame and moral injury

By Duane France April 6, 2020

“Moral injury” is a term that has emerged over the last thirty years that describes a particular reaction to events that occur in the course of a service member’s military experience. It is closely linked to, but also separate from, post-traumatic stress disorder (PTSD). Events that can cause a moral injury are also likely traumatic, catastrophic physical injuries, for example, or the loss of a fellow service member. However, moral injury can occur separately from PTSD.

The concept of moral injury emerged from clinicians’ work with veterans of combat who were experiencing difficulty readjusting to their lives after returning from conflict. The phrase was coined by psychiatrist Jonathan Shay based on observations made while working with veterans at a Department of Veterans Affairs outpatient clinic in Boston. In his book, Achilles in Vietnam, Shay introduced the concept of moral injury, defining it as the psychological, social and physiological results of a betrayal of “what’s right” by an authority in a high stakes situation. He goes on to describe how experiences in the military, and especially experiences in combat, can sometimes change service members’ beliefs about what is right and wrong.

Later the psychologist Brett Litz and his colleagues refined the concept, describing moral injury as an effect of acts that create dissonance and conflict because they violate assumptions and beliefs about right and wrong and personal goodness. Morally injurious acts include events such as “…perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.”

Moral injury and PTSD

Moral injury is a cluster of symptoms that is, as stated above, linked to but separate from PTSD. There is an emerging effort to distinguish between the two and recognize moral injury as a common and distinct syndrome that requires targeted treatment. Several factors complicate the establishment of this distinction. One of the difficulties is that an event that meets Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criterion A for PTSD — exposure to death, threatened death, actual or threatened serious injury — may also transgress deeply held beliefs. For example, an act may be morally injurious if the client believes it was indefensible or should have been prevented.

Identifying moral injury in individuals is complicated by the reality that service members are trained to overcome social taboos against killing or inflicting serious injury on others. In basic military training, trainees experience a dedicated effort to overcome an aversion to violence. Bayonet training, hand-to-hand combat and weapons training using realistic plastic human-shaped targets are all methods designed to help individuals overcome a natural tendency to not engage in violence. In his book, On Killing: The Psychological Cost of Learning To Kill in War and Society, Lieutenant Colonel (Ret.) Dave Grossman cites a study by military historian Brigadier General S.L.A. Marshall related to the firing rates of soldiers in World War I. Grossman states that Marshall found that a significant number of rounds that were fired did not hit the target, and that many soldiers were not aiming at their targets but instead firing away from them.

In “Assessment of Moral Injury in Veterans and Active Duty Military Personnel with PTSD: A Review,” a 2019 article published in the journal Frontiers in Psychiatry, the authors assert that moral injury can occur in conjunction with PTSD but is a separate syndrome.

Specifically, a service member or veteran can have PTSD without moral injury, can have moral injury without PTSD, can have both, or can experience events that meet criterion A, yet have neither.

Betrayal as a core concept

The core aspect of moral injury is one of betrayal: betrayal of one’s own core beliefs, a betrayal by others, or both. In my clinical experience, as well as my own lived experience, moral injury is a significant aspect of one’s military service. A service member or veteran’s reaction to or behaviors resulting from moral injury can cause significant distress. This, of course, complicates the transition to post-military life.

While there are a number of large egregious manifestations of moral injury such as My Lai in Vietnam and Abu Gharib in Iraq, there are also more subtle manifestations of moral injury. Growing up, I was always taught to obey traffic signals, go the speed limit—be a “good driver.” This behavior was “right.” When we got to Iraq and Afghanistan, however, things that were “right” became wrong. There are no stop signs in Iraq, no traffic signals in Afghanistan. A one-way street was whichever way we were going. This wasn’t because service members were bullies or unconcerned with local safety, but a security measure. Then, we had to return to a community of rules and laws and make the adjustment back to what was right but had seemed wrong while overseas.

This is another complicating factor for moral injury. Some behaviors may be acceptable in one environment but unacceptable in another. In a 2018 interview for my podcast Head Space and Timing , psychologist Shira Maguen, a VA clinician researcher who is an expert in moral injury describes how a service member can engage in behaviors that are not morally injurious at the time, such as killing or violence directed towards an enemy. These actions are necessary and even encouraged while in the environment of a combat situation. However, when the service member returns to a non-combat environment or relative safety, these actions may not be considered acceptable, and therefore may become morally injurious.

Addressing moral injury

As mentioned, it is critical to explore whether or not a veteran is experiencing moral injury related to their military experience. Many veterans, like many clinicians, may have never heard the term, but after having the concept explained to them, understand it immediately. In discussing these distinctions with a fellow veteran (not a client), he said a light bulb went off in his head.

This veteran, a Marine who served in Operation Iraqi Freedom, was on a rooftop providing overwatch for a raid. He saw movement in the alley below, challenged the individual to respond with a password, and when he did not receive a response, opened fire on the figure in the alley. It turned out that the person in the alley was a fellow Marine, who had been wounded in the leg. While the wounded Marine ultimately recovered, my friend experienced significant guilt about the incident. After leaving the military and entering therapy, he was told repeatedly that he was struggling with PTSD. But, it wasn’t until he heard about moral injury that he understood that what he was experiencing was different than a traumatic stress reaction.

In the next few columns, I will be addressing other critical aspects of moral injury, including survivor’s guilt, the difference between shame and guilt, and the assessments and modalities available to help service members, veterans, and their families receive a measure of relief from the burden of moral injury.

****

 

Duane France, LPC

Duane France is a retired U.S. Army noncommissioned officer and combat veteran who practices as a licensed professional counselor in Colorado Springs, Colorado. He is the director of veteran service for the Family Care Center, a private outpatient mental health clinic specializing in service members, veterans and their families. He is also the executive director of the Colorado Veterans Health and Wellness Agency, a 501(c)3 nonprofit that is professionally affiliated with the Family Care Center. In addition to his clinical work, he writes and speaks about veteran mental health on his blog and podcast at veteranmentalhealth.com. Contact him at duane@veteranmentalhealth.com.

 

****

 

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.

From the President: A month made for advocating and celebrating

Heather Trepal

Heather Trepal, the 68th president of the American Counseling Association

April is #CounselingAwarenessMonth! This is definitely one month when we have the opportunity to put our advocacy skills to work and showcase our amazing profession. We have a unique chance to use our collective voice to publicize all of the ways that counselors are making a difference in the world.

Although advocacy is our shared responsibility, it is also personal. I don’t know what professional issue or concern you find most called to address in your heart, but there is room for all of us to engage in professional advocacy. My hope is that each and every American Counseling Association member will find something about our profession to highlight and showcase during Counseling Awareness Month. We need to promote help-seeking by continuously raising awareness about mental health and wellness and the important work that counselors do. Please visit the Counseling Awareness Month page on the ACA website to get some ideas about ways that you can advocate for the profession during this important month.   

Professional athletes make up one very public group of people who are increasingly raising awareness about and advocating for mental health. For example, the San Antonio Spurs of the National Basketball Association (NBA) hosted a mental health awareness night pregame event in February. In addition, professional basketball players such as Kevin Love of the Cleveland Cavaliers and DeMar DeRozan of the Spurs have recently talked publicly about their personal mental health struggles. The NBA has even adopted a rule to employ dedicated mental health staff for each team. The National Football League has a similar policy in place.

Professional sports leagues and athletes have a wide audience, so as they continue advocating to raise awareness, I am confident that their efforts will result in increased help-seeking and the continued destigmatization of mental health concerns.

****

Follow Heather on Twitter @HeatherTrepal