Monthly Archives: January 2021

Voice of Experience: Violations of trust

By Gregory K. Moffatt January 19, 2021

Trust is the foundation on which relationships of any kind are built. Think about how much we depend on trust in our everyday lives. We trust that our teachers are telling us the truth. We trust that a check from someone won’t bounce. Even the cash we exchange requires trust in the value of the currency in our hands. We trust that the products we buy will function properly and feel betrayed when they don’t.

And with every secret we share in confidence with another person — no matter how big or small the secret — we trust that it will be protected.

Trust comes easily for children in almost all relationships. Whether it’s with parents, siblings, teachers, coaches or sometimes even with counselors, children generally are quick to trust. “My teacher said …” “Coach told me …” “My dad told me …”

Sexual perpetrators take advantage of the ease with which children trust by “courting” — pushing boundaries a little at a time so their victims don’t ask too many questions. Con artists do the same thing to adults, preying on our natural human instinct to believe in one another. But once trust is violated, it will never come naturally again. A violation of trust compromises not only that relationship, but all relationships.

So, to protect ourselves, we must learn, by necessity, that not all people are equally worthy of trust.

In the field of ethnography, the term incorrigible propositions refers to beliefs that are so fundamental to our existence that we don’t even question them. The most serious violations of trust involve incorrigible propositions. When these beliefs are called into question, it shakes all of our beliefs. In a way, we say, “If I can’t trust in this, then what can I trust?”

For example, most people are familiar with statistics on divorce, but upon getting married, almost no one assumes that they will experience divorce themselves. They trust their spouses. But when the belief that they will always stay together is shattered — by infidelity, for example — their entire world is shaken. The incorrigible proposition that people are trustworthy comes into question. Distrust can generalize to all spouses, everyone of a given gender, or to people in general.

Marriage and family therapists see this kind of shaken trust almost every day. The abused children who come through my office have had their trust violated as well, and I have to work hard to prove myself worthy of their trust. This is often a monumental task. Their childlike gullibility is long gone by the time they come through my office doorway.

I have written before in this column that confidentiality is the foundation on which most of our ethics are built as counselors. This is so important because it relies on a client’s trust that we won’t betray secrets.

Sometimes, however, trust must be betrayed. We must act, for example, if clients are a threat to themselves or to others. Mandated reporters have no choice but to violate confidentiality when they suspect abuse or neglect. Even the sharing of therapeutic information with parents or guardians can potentially compromise our clients’ trust in us. These violations of trust cannot always be avoided.

But perhaps most damaging is when counselors — those of us entrusted with the scariest and most embarrassing secrets carried by clients — violate that trust in an unethical manner.

Unethical violations of trust can come in many forms. Unfortunately, carelessly using a client’s name while talking to a colleague or failing to adequately disguise a client’s identity in consultation with a supervisor are not uncommon occurrences.

Most serious is the violation of trust that takes place when a therapist engages in blatant boundary violations with a client. Inappropriate touching, inappropriate social relationships and other egregious boundary violations with clients always destroy trust in the long run.

Those of you who have been in the counseling profession very long have likely seen your share of clients who have had bad experiences with previous therapists. Therefore, you have almost certainly experienced the painstaking job of trying to prove that you are trustworthy (and that the profession as a whole is worthy of trust) to someone whose personal experience has taught them otherwise.

Even more painful to me is the knowledge of all of the clients who will never risk going to a counselor again. These clients will not seek help because of a violation of the trust-based relationship that is at the heart of our profession. Whether these violations were careless or intentional, the effects are the same. These are the people we have lost.

An ethical “oopsie” that violates trust might never be known to anyone else. But then again, it might. Even the slightest breach might damage a client’s trust to the point that they will never seek counseling again. And that, my dear colleagues, is unforgivable.

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Gregory K. Moffatt is a veteran counselor of more than 30 years and the dean of the College of Social and Behavioral Sciences at Point University. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at Greg.Moffatt@point.edu.

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

Using the ‘tap in dedication’ technique

By Nicholas Salazar January 13, 2021

Emma quickly checks her watch as she turns her key in the lock. It’s 9:57 p.m. She sighs as she pushes open the door and quickly moves to her room to drop off her bags before heading to the kitchen to make dinner, her second meal of the day since leaving at 6 that morning. She fills up a pot and turns on the stove, dropping in some noodles before opening her laptop to check emails and begin working on her course readings. It’s 10:03 p.m.

Emma’s eyes glaze over as she skims through the endless screens of text, and her head nods until she is awoken by a text from her boss: “Hey Emma, I just had someone call off. Can you open tomorrow morning?”

Emma immediately replies, “Sure thing, see you tomorrow!”

She glances at the time on her phone — 11:13 p.m. She panics and runs to the stove to turn it off. Greeted by a pot devoid of water, she throws away the burnt noodles and closes her laptop. She has finished only one of her five readings, but she needs to be up early tomorrow morning for work. She has six hours of classes after that and internship the following day.

It’s 11:30 p.m. Emma lies in bed with closed eyes and an empty stomach. Her mind races thinking about the different clients she has been working with and how they are holding up. She considers which clients might have which urges — and what she could do to help them, if anything. She thinks about the classes that she didn’t complete readings for and wonders whether she can get by without doing the readings. She thinks about herself as a counselor and questions whether she can ever be successful if she is already struggling.

It’s 12:25 a.m. Emma is asleep, but she will wake up in three hours to get ready to do this all over again.

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As a second-year graduate student who is also working on-site at a residential treatment program, I have discovered it can be difficult to not let every piece of life bunch together and form one massive challenge. It seems that everything of which I am a part is geared toward becoming a mental health counselor. It can be hard to engage in clinical experiences and separate the emotional intensity I experience on-site from my schoolwork, personal life and all other aspects of life.

In our field, being emotionally present and available and working through the sensitive topics of other people’s lives is our daily bread. But being able to stay engaged with a client can be a challenge, especially when you are burned out from the day before, or the events of that morning, or the previous client — not to mention school, work and other life tasks. Taking time to check in with yourself, support yourself and separate one facet of life from another is a skill I have found to be useful when applied in a genuine and purposeful manner.

Overview

“Tap in dedication” is a technique adapted from theater creators when dealing with highly intimate work on stage. It has been used for scenes ranging from a staged slap to simulated intercourse, and the intended purpose is to allow the actors an opportunity to establish their readiness to engage in sensitive and potentially harmful work.

My experience with this technique stemmed from my theater work during my undergraduate studies under the direction of Carin Silkaitis and Gaby Labotka, the latter being a certified intimacy director with Intimacy Directors and Coordinators. They introduced the technique of “tapping in” to those of us in the show, focusing on respect, safety and well-being for ourselves and for those with whom we were working. We used this technique regularly during scenes of overt sexuality, abuse, trauma and death.

We would physically tap each other’s hands, like a “high-ten,” as a way to say to one another, “I am ready to engage in this work with you.” When work on that scene or sequence had been completed, we would perform this action again to provide a physical symbol that communicated, “We did the work, and now we are stepping outside of it to be ourselves.”

Adapting this technique for counselors to use is a nice fit because of the themes of respect, safety and well-being — something that we helping professionals are adept at offering to clients but may not always apply to ourselves. In the counseling profession, it is important to find ways to respect ourselves and our work because if we do not, it can become all too easy to face burnout, experience vicarious traumatization or even fail to respect our clients.

I coupled the technique I learned in theater with aspects of dialectical behavior therapy to allow helping professionals to engage in mindful participation in their careers while providing them the time to check in with themselves before and after a day’s work. In the case of a particularly difficult session, counselors can also use this technique quickly between clients. Depending on site regulations, it may even be used with some clients.

The goal of the technique as I describe it here is to provide a way for counselors, counselors-in-training and other helping professionals to deal with sensitive subjects, to be present and engaged for the difficult work they take part in daily, and to be able to “leave work at the door” when they reach the end of the workday. It can be detrimental for helpers to bring troubling work home with them because it can impede their self-care and have a negative effect on the relationships they have outside of work. Ideally, using this technique will make it easier for clinicians to allow themselves to be engaged fully in their work life while helping them to separate this time from their personal life.

The technique

Practice self-care: Begin by entering or coming to the place where work will be done for the day. Next, take a moment for yourself by performing some action that is soothing and regulating for you. This could be making a cup of coffee or tea, enjoying a snack, reading a few pages of the newspaper, doing a crossword puzzle — anything you find that helps you feel relaxed or calmed. If this is a technique that you would like to use several times per day, between sessions or simply as it feels necessary, an activity that takes less time may serve you better.

Engage in mindfulness: Once you complete your self-care activity, it can be helpful to become grounded in your work environment. For example, take a few minutes to use a “five senses” grounding technique: Identify five things that can be seen, four that can be heard, three that can be touched, two that can be smelled and one that can be tasted.

Skills for distress tolerance can also be beneficial. An example is radical acceptance — taking time to accept one thing that you cannot change about how your day may go, while acknowledging that you can affect your own presence in the day. A technique such as one-mindfulness could be used to promote purposeful attention by focusing on one thing and allowing yourself to see, hear and appreciate it, whether it is physical, emotional or something else (e.g., a plant, a feeling, a thought). Any activity that helps you feel mentally at ease and instills feelings of calm and preparedness can be used for this activity.

An important consideration is to decide where and when you will engage in this process daily. For example, will you do it before you leave home? In the car or on the bus while traveling to work? Once you arrive at your office? From my experience of using similar techniques in theater, once the actions have been set, it is helpful to always do them the same way or as close to the same way as possible to preserve the integrity of the actions and process.

With practice, you will likely be able to engage in your self-care and mindfulness processes anywhere, although a change in environment or process initially could make it difficult to establish and maintain the mindfulness you hope to achieve. If you are in a position where you must travel regularly for your sessions, it can be helpful to have one specific action that you engage in prior to each session. It can also be useful to practice that action several times in settings that are calming before engaging in the activity in a more fluid and potentially stimulating environment.

Literally tap in: After you complete your grounding activity, you will literally tap in. This means to physically tap your hands on a surface or object. Your physical tap in signifies that you are mentally, emotionally and spiritually ready to be 1) devoted and engaged in the activities that follow in an effortful and conscientious manner, 2) fully present in your interactions and 3) aware of the effect that your effort and presence can have on clients and others.

Your physical tap in action serves to signify that your day has begun, and you will give conscious attention to all that occurs from that moment forward. Importantly, tapping in marks the time that is about others (rather than about one’s self), while the preceding actions were exclusively for the individual performing them (i.e., you). This can allow you to engage and deal with more demanding emotions and experiences by allowing you to acknowledge that this time is about being wholly devoted to another, just as the actions before were devoted to taking care of yourself. And in essence, you are taking care of yourself while caring for others because you have intentionally prepared yourself for your service.

Literally tap out: After your sessions, work or treatments are completed (or between sessions if content was particularly difficult), it is time to tap out — literally — just like you tapped in. This is a physical action in which you physically tap the same surface or object you used to tap in. It is important to use the same object every time if possible to symbolize the ending of the specific dedication to your work.

This tap out provides a physical action to close out of what has been occurring during your workday and allows you to engage with the nonwork you again. Additionally, this action signals that the feelings and emotions that may have come up during your work are meant to be kept in that specific time; they are not necessarily meant to exist beyond the scope of that session or that day.

Enjoy your post-tap-out activities: At this point, it is time to go about the doings of your personal life and nonwork time. This means to do anything you would normally do after work — exercising, playing with your children, grocery shopping, attending to your home, spending time with friends and so on — without interruption from what occurred during your work time.

Additionally, some people find it incredibly helpful to engage in some kind of self-care at the end of the day, similar to what they did at the beginning of the day. This might involve watching a specific show, enjoying some ice cream, doing another crossword puzzle — anything that can help you to decompress and relax. This activity can be done at any time but may be more useful to do soon after tapping out so that it can serve as a nice, calming cap to your workday.

Technique considerations

This technique was adapted from a theater practice used in scenes in which violence or intimacy was approximated that could cause effects similar to reliving traumas or increase actors’ emotional discomfort. It is important to recognize when something goes beyond the scope of dedication to work. It is up to counselors to use their best judgment to determine when an event may need further intervention to protect their well-being. Some subjects may be difficult to “leave at work,” and if this circumstance arises, it may be wise to seek support. If a counselor has a troubling response to a client’s trauma, it may be useful to discuss this in the clinician’s own therapy sessions or to process it with trusted colleagues or supervisors so as not to shoulder the burden alone.

Using this technique can take up a fair amount of time depending on the self-care actions the counselor chooses to use. Given that reality, it can be useful to find a quick-and-easy action, or to incorporate parts of the technique into one’s daily routine so that it does not become a burden to the user. However, taking the time needed to prepare for one’s day is imperative to staving off burnout and to increasing wellness.

Although this technique is not intended as a catch-all for reducing stress, it may prove useful in helping to establish firmer boundaries between personal life and work life, which is a common stressor among counselors. The goal is not to fix every stressor that clinicians may experience, but rather to provide an opportunity for clinicians to have a solidified and intentional process of entering and exiting their daily work in a demanding field.

In the event that a counselor must travel between environments during the workday, it may help to tap in and tap out before and after each client and to use travel time for a bit more mindfulness. Especially because of the variety of possibilities, such as traffic or accidents, that can occur when traveling between places, practicing mindfulness during the journey may be helpful in terms of keeping travel stress separate from your work. Additionally, using this technique can allow helpers to reduce personal stressors that often are carried over into work with clients, thus enabling a fruitful and intentional work experience.

Suffice it to say there are many situations that may not benefit from the ability to tap in and tap out. Using this technique ultimately comes down to each person’s discretion. It is simply meant to give them increased autonomy in how they choose to handle their time in a helping profession.

Getting started

Ask yourself the following questions to get started with the tap in dedication technique:

  • What would it be like for you to intentionally tap in to your workday and tap out of it? Do you have any hesitations? What can you do to resolve those hesitations?
  • What self-care routines would you like to use to start your day? Which ones are you doing already?
  • Mindfulness is an integral part of preparing to tap in. What mindfulness practices do you have established on which you can draw? If you do not participate in mindfulness, do you have other religious or spiritual practices that you might use (e.g., prayers, religious texts, songs)?
  • Where will you tap in at the beginning of your work and tap out at the end?
  • What does it mean to you to practice your work in a conscious way?
  • What practices do you want to establish if your work life enters your personal life after you have tapped out?
  • What resources do you possess to process particularly difficult clinical workdays? Jot them down and use your list when you need it.

 

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Nicholas Salazar is a second-year master’s student at Marquette University in the Department of Counselor Education and Counseling Psychology. He works part time and is an intern at Rogers Behavioral Health in Oconomowoc, Wisconsin. Contact him at nicholas.salazar@marquette.edu.

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

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

‘But my clients don’t get eating disorders’

By Laura H. Choate January 11, 2021

Almost all counselors encounter clients who engage in behaviors such as extreme dieting, excessive exercising, fasting, emotional overeating and binge eating. These symptoms can be initially mild and overlooked or even viewed as normative in our thinness-and-appearance-obsessed culture. Sometimes it is hard to tell the difference between a client who is experimenting with the latest fad diet and a client who is quickly spiraling downward on the path toward a destructive eating disorder. There are two reasons this can happen.

One reason is a lack of counselor awareness. Few counselors receive much training in the area of eating disorders treatment, so they might not be aware of the need for further assessment when a client has initial problems related to eating, weight and body image. The problem is that without effective assessment and treatment, these types of symptoms have the potential to escalate into full-syndrome eating disorders such as anorexia nervosa, bulimia nervosa and binge eating disorder.

Once eating disorders have developed, they frequently become serious, complex, chronic disorders with significant biopsychosocial consequences, including potentially lethal medical complications, poor treatment outcomes, high rates of remission and high mortality rates. Anorexia nervosa in particular is associated with the highest mortality rate of all psychiatric disorders, and both anorexia nervosa and bulimia nervosa are associated with suicide attempt rates that are considerably higher than those for the general population. Suffice it to say, even the most highly trained, seasoned counselor is not equipped to work with this population alone; all clinical guidelines call for a team approach to the treatment of eating disorders. Therefore, regardless of whether we are specialists, we need to establish relationships with other providers in our communities and know when to make referrals for specialized services.

The second reason that initial symptoms might be overlooked or dismissed is that we are not just counselors, we are also individuals who live in a society in which we are all bombarded daily with messages about weight and appearance. We are all exposed to cultural ideals that equate thinness with beauty, happiness and success and that dictate strict standards regarding an ideal body shape. We all have to manage these pressures for ourselves, and few of us are exempt from developing biases and blind spots around these issues. Because of countertransference reactions in this emotionally charged area, we might unintentionally misjudge a client’s pain due to our own struggles and experiences. Therefore, when working with clients who present with issues such as body image, chronic dieting and pressures to be thin, it is extremely difficult to separate our own personal values from what is best for our clients.

So, even though you might never intend to work as an eating disorders specialist, all counselors need adequate preparation to recognize disordered eating symptoms in their clients, to know when and how to provide appropriate referrals, to understand the importance of a multidisciplinary approach to treatment, and to effectively manage personal values. To illustrate, I include three scenarios that highlight some of the complex concerns that can arise for counselors when working with clients who have problems related to eating, weight and body image.

Scenario 1: April’s intermittent fasting goals

April attends an initial session with Karyn, a licensed professional counselor with three years of experience. April reports that she has been on an extreme intermittent fasting diet for the past six months, allowing herself to eat only during a two-hour window per day. She adheres to a vegan diet because she believes it is the healthiest option for keeping a low weight. She also engages in binge/purge episodes three or four times per month (during which she does not adhere to a vegan diet but eats anything she wants). Her body mass index (BMI) is in the low to normal range.

Although April is reporting occasional dizziness, she does not want to give up her diet because she still has not reached her weight loss goal. Instead, she wants to get rid of her binge/purge behaviors, improve her body image and improve her self-esteem. She wants to work exclusively with Karyn even though Karyn does not have a specialized background in treating issues related to weight or binge eating.

Karyn believes April’s goals seem reasonable for individual treatment because she does not appear to be underweight. In addition, because April’s symptoms do not meet criteria for a diagnosis of anorexia nervosa or bulimia nervosa, Karyn does not consider April’s problems to be severe. In fact, Karyn knows a bit about intermittent fasting and its current popularity, so she believes that she can help April evaluate her diet plan.

Implications for counseling practice:

The ACA Code of Ethics states that counselors must know their scope of competence and practice within their areas of training and experience. Karyn is taking a risk in her agreement to treat April because without additional medical assessment, she has no way of knowing the extent of April’s disordered eating behaviors or how her symptoms are affecting her physiologically. It is likely that April is experiencing medical complications even though she does not appear to be underweight.

American Psychiatric Association practice guidelines state that in treating eating disorders, we should always work as part of a treatment team that includes at minimum a therapist, a dietitian and a medical professional. By agreeing to work in isolation and ignoring the need for collaboration, Karyn would not be able to adequately address the medical components of April’s weight loss — and without a medical referral, she would be working outside of her scope of competence, which could cause potential harm to April. In addition, she seems to ignore the fact that April’s behaviors could possibly be progressing to a severe eating disorder.

One way to address these potential problems is for Karyn to inform April that in order to begin treatment, she will need to agree to see a medical professional for evaluation. Based on these results, Karyn might also need to work with a nutritionist, in addition to possibly making a referral to a mental health professional who has more expertise in treating emerging
eating disorders.

Scenario 2: Nila’s secret and Asha’s dilemma

Nila is a 15-year-old who is in counseling at her mother’s insistence. Nila tells her counselor, Asha (a child and adolescent counselor in a general private practice), that her mother is too intrusive in her life, is always telling her that she should lose weight, and tries to control all of Nila’s food intake.

A few weeks into therapy, Asha notices that Nila has swelling in her neck area and has a large scrape on the fingers of one hand. When asked about this, Nila reveals that she has been trying to diet according to her mother’s demands but “just can’t stick to it.” Subsequently, she has engaged in binge eating by sneaking food from the pantry and eating it quickly so her mother will not know. She hides the wrappers in her book bag and throws them away later. Nila then uses self-induced vomiting, a technique she learned from watching YouTube videos, to try to “get rid of the calories.” She begs Asha not to tell her mother because she does not want her mother to become even more controlling of her food intake.

Asha isn’t sure of the next best step to take because Nila is in a normal weight range and seems to be healthy overall. Asha decides not to inform Nila’s parents and keeps working with Nila individually because she wants to respect Nila’s privacy.

Implications for counseling practice:

In resolving the issue of whether Nila’s parents need to know about her binge/purge behaviors, Asha has to balance the parents’ legal right to know what is disclosed in sessions, Nila’s ethical right to privacy and autonomy, and the counselor’s duty to provide effective treatment and protect Nila from future harm. In making this decision, Asha recognizes that Nila does have an ethical right to privacy and could possibly be harmed if her mother becomes even more controlling over her food intake.

However, Asha should also be very concerned about Nila’s emerging diet/binge/purge cycle because this is a potentially high-risk behavior. While the binge/purge behaviors are not currently life-threatening, Asha needs to consider the serious and potentially lethal nature of eating disorders, the chronic and compulsive nature of the diet/binge/purge cycle, and the medical and psychological consequences of any emerging eating disorder. Because Nila is an adolescent, her health could deteriorate quickly due to weight loss and purging behaviors.

American Academy of Child and Adolescent Psychiatry practice guidelines call for a comprehensive medical examination, working with a treatment team, and family involvement in the treatment of eating disorders. For any of these treatment aspects to occur, the parents would need to be informed of Nila’s disordered eating behaviors; Nila can’t arrange for them herself. In this case, therefore, Nila’s parents would need to be informed, even if this goes against Nila’s wishes.

In order to respect Nila’s right to privacy and minimal disclosure, however, Nila should be involved as much as possible when her parents are informed. If feasible, the information should be shared in a family session. If Nila can be in the session when information is disclosed, she is less likely to feel betrayed by Asha. If Asha can establish an alliance with the parents while also maintaining trust with Nila, Asha can start to work with the family system to create better communication. The parents need assistance in allowing for increased, developmentally appropriate autonomy and privacy for Nila. At the same time, Nila will have to accept her parents’ assistance in helping her manage her disordered eating symptoms.

The entire family would benefit from education about the harms of dieting, particularly for children and adolescents, and how food restriction is directly linked to binge eating and
is often the trigger for binge/purge cycles. With Asha’s help, the family can start to focus more on overall health and communication and far less on control over Nila’s eating, weight and body shape.

Scenario 3: Jamie’s diet advice

Jamie is a female counselor who works for a community counseling agency. Jamie’s client Dan reports frequent binge eating that causes him a great deal of distress, guilt and shame. Dan is a 45-year-old man who is in a higher-weight body. Jamie assumes that Dan needs to eat less and lose weight to feel better about himself because of his larger body size. She does not assess for an eating disorder but rather persuades him to pursue weight loss as his treatment goal.

In contrast with what she deems as Dan’s “weaknesses,” Jamie is highly invested in maintaining her own weight, daily exercise routine and “clean eating.” She feels a certain pride in her own self-discipline and thinks that Dan’s problems result from a lack of willpower and effort on his part. She is quite uncomfortable with Dan’s body size and tells him he would be better off in his career and relationships if he were to lose weight.

Dan reluctantly agrees to restrict his calories and to exercise more, even though he has tried “hundreds of diets” over the years. As time progresses, he feels discouraged and even worse than he did prior to treatment with Jamie because he can neither adhere to the weight loss plan nor stop his binge eating. He drops out of treatment, believing he is a failure.

Implications for counseling practice:

Even though binge eating disorder is by far the most common eating disorder (occurring in 3.5% of women and 2% of men), it was overlooked by Jamie in this example because her client is male and has a larger body size. In addition to neglecting assessment for binge eating disorder, Jamie seems to lack awareness of effective treatment for binge eating.

American Psychiatric Association practice guidelines for the treatment of binge eating disorder state that dietary restriction is actually contraindicated; in fact, dieting is known to trigger and sustain binge eating. There are biological and psychological reasons for this relationship. When Dan (or anyone on a diet) restricts food, he begins to deprive himself of the energy needed to maintain his current weight. As a result, the brain sends out warning signals telling his body to slow down because it thinks it is entering a time of famine. It also tells Dan to take in more fuel to prevent what it perceives as starvation. In an effort to preserve energy and fight against weight loss, his body’s metabolism will decrease, he will have more thoughts about food, and he will become increasingly hungry.

Second, the more Dan imposes restriction and deprivation on his life, the more he will experience psychological reactance — an internal battle that ensues anytime we perceive that our personal freedoms are being restricted. He will start to think about, crave and, eventually, overeat the very foods that he has ruled “off-limits.” He will likely eat more, not less, because of dietary rules. And for Dan, who has a long history of binge eating, his hunger, deprivation and dietary rules will most likely serve as triggers for continued binge eating. This will lead to a cycle of guilt/shame, dieting, broken rules, binges and more guilt/shame.

In addition to pushing a potentially harmful treatment plan, Jamie seems to be having difficulty managing her countertransference reactions. Like so many people in today’s culture (including many mental health and medical professionals), Jamie appears to have a bias against people in larger bodies. Because she believes that losing weight is the “answer” to Dan’s problems, she imposes this value on him even though he is seeking treatment not for weight loss but for reducing his symptoms of binge eating. Jamie’s discomfort with her client’s body is a form of weight-based discrimination that can cause Dan to feel judged and further marginalized.

Research indicates that weight stigma actually demotivates, rather than encourages, health behavior change. In response to weight stigma, people tend to eat an increased amount of food and are less likely to adhere to a diet plan. To avoid further stigmatization, they tend to avoid exercise, fearing additional judgment from others. They also tend to delay medical care to avoid stigmatization from medical professionals who may further criticize, blame or shame them for their weight. Jamie’s personal values in this case are causing her to display a lack of respect for Dan’s dignity and welfare. In sum, her biases and lack of knowledge of effective treatment for binge eating disorder are actually causing her client harm.

Key takeaways

The following list is a summary of considerations for counselors when they encounter clients who experience problems with eating, weight and body image:

  • Remember that anyone can develop an eating disorder. Do not assume that only underweight white women have eating disorders. For example, binge eating disorder is the most common eating disorder, and it occurs in people of all sizes and cuts across both gender and race/ethnicity.
  • During the intake process, ask questions about the client’s attitudes and behaviors toward eating, weight and body image. Remain aware that initial symptoms can potentially progress to full-syndrome, complex eating disorders.
  • Regardless of your treatment setting, be aware of resources, and be prepared to make proper referrals so that clients can receive specialized care when needed.
  • Effective eating disorders treatment involves a multidisciplinary approach.
  • Counselors, like all people, can have strong biases in the areas of eating, weight, body image and the importance of appearance. We have to be careful about imposing these values on our clients.
  • Weight stigma is a form of discrimination that serves to marginalize and shame people. It is not a value supported by the counseling profession.

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Recommended resources:

  • “Ethical Issues in the Treatment of Eating Disorders” by Laura H. Choate (in The Cambridge Handbook of Applied Psychological Ethics, edited by Mark M. Leach and Elizabeth Reynolds Welfel, Cambridge University Press, 2018)
  • “Assessment and diagnosis of eating disorders” by Kelly C. Berg and Carol B. Peterson (in Eating Disorders and Obesity: A Counselor’s Guide to Prevention and Treatment, edited by Laura H. Choate, American Counseling Association, 2013)
  • American Psychiatric Association practice guideline for the treatment of patients with eating disorders (2010): tinyurl.com/APAEatingDisorders
  • “Practice parameter for the assessment and treatment of children and adolescents with eating disorders” by James Lock, Maria C. La Via and the American Academy of Child and Adolescent Psychiatry Committee on Quality Issues, Journal of the American Academy of Child and Adolescent Psychiatry, 2015
  • National Eating Disorders Association: nationaleatingdisorders.org
  • Academy of Eating Disorders: aedweb.org/home

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Laura H. Choate is the Jo Ellen Levy Yates endowed professor of counselor education at Louisiana State University in Baton Rouge. She is the author of five books, the most recent of which is Depression in Girls and Women Across the Lifespan: Treatment Essentials for Mental Health (2020). She has 40 publications in journals and books, most of which have been related to girls’ and women’s mental health. She is a member of the ACA Ethics Committee. Contact her at lchoate@lsu.edu.

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

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

The darker side of sleep

By David Engstrom January 6, 2021

“Sleep is the golden chain that ties health and our bodies together.” — Thomas Dekker, 1625

“Without enough sleep, we all become tall 2-year-olds.” — JoJo Jensen, Dirt Farmer Wisdom, 2002

“I love sleep. I’d sleep all day if I could.” — Miley Cyrus, 2019

To me, making those elusive connections between events, experiences and symptoms in our clients’ lives is one of the most exciting parts of counseling. There may be no clearer connection between the mind and body than sleep.

How do you sleep? More importantly, do you know how your clients sleep? When we evaluate our clients’ histories and experiences, one area of behavioral health that is easy to ignore or minimize is sleep. But disturbed sleep is very common among Americans and is connected to many psychological and physical health problems later in life. A more comprehensive assessment may lead to important clues about an experience of early trauma and abuse.

Sarah: Initial assessment

As a consultant at a hospital sleep disorders center in Arizona, I saw “Sarah,” a 30 year-old Hispanic woman who was referred because of severe insomnia. She reported great difficulty falling asleep, and even after she did, she often slept no more than three hours per night, with frequent awakenings.

Sarah was married, had no children and worked as a university professor. She claimed that her marriage was “strong and supportive,” and she greatly loved her work as a professor. She had been prescribed benzodiazepine sleeping medications two years prior, but they were no longer helping, and Sarah feared she was becoming dependent on them.

Sarah was in good physical health but was concerned that she had gained 35 pounds over the course of five years. She had never before seen a mental health professional. Her prior overnight visit to the hospital sleep disorders center had revealed major difficulties in initiating and maintaining sleep. Polysomnographic results confirmed that she took 82 minutes to fall asleep initially and that she experienced five awakenings of greater than 20 minutes each during the night. Her total sleep time was 2.7 hours.

Her sleep problems had been present and worsening since high school, or a span of about 15 years. She presented with severe daytime sleepiness, anxiety and depression. Sarah stated, “I can’t go on like this.”

Sleep facts

Studies from the Centers for Disease Control and Prevention (CDC) reveal the following data about healthy sleep duration (with higher percentages indicating healthier durations):

Geography: Prevalence of healthy sleep duration ranged from 56% in Hawaii to 72% in South Dakota.

Percentage of healthy sleep duration by race/ethnicity: Native Hawaiian/Pacific Islanders (54%); Black (54%); Other/Multiracial (54%); American Indian/Alaska Native (60%); Asian (63%); Hispanic (66%); White (67%)

Although requirements vary slightly from person to person, most healthy adults need seven to nine hours of sleep per night to function at their best. Children and teenagers need even more. Despite the notion that our sleep needs decrease with age, people older than 65 still need at least seven hours of sleep per night. Interestingly, the average total nightly sleep duration fell from approximately nine hours in 1910 to approximately seven hours in 2002.

Prevalence of disturbed sleep

Sleep disturbance is a common problem that affects at least 75% of Americans at some point in their lives. Among the various sleep disorders, approximately 33% of all adults suffer from an insomnia disorder, which can have significant negative consequences if left untreated. Individuals who struggle with chronic insomnia often describe their condition as a “vicious cycle,” with increasing effort and desire put into trying to regain sleep, with negative results.

A 2014 survey conducted by the National Sleep Foundation reported that 35% of American adults rated their sleep quality as “poor” or “only fair.” Difficulty falling asleep (onset insomnia) at least one night per week was reported by 45% of respondents. In addition, 53% had experienced trouble staying asleep (early awakening or maintenance insomnia) at least one night of the previous week, and 23% had experienced trouble staying asleep on five or more nights. Research suggests that sleep problems are worse among women but increase in both genders with age.

Any of us can do a self-assessment of our sleep deprivation, also known as “sleep debt.” You probably have sleep debt if you 1) find yourself drowsy or sleepy during the day, 2) frequently need an alarm clock to awaken and 3) fall asleep very rapidly (less than five minutes) when you go to bed.

Insomnia is not a disease; it is a symptom. It may be 1) associated with medical problems, 2) associated with psychological problems, 3) due to lifestyle, 4) caused by poor sleep habits or 5) any combination of the above.

Sleep deprivation can have many effects, both physically and psychologically. In the short term, it can lead to stress, somatic problems, cognitive difficulties, anxiety and depression. Long-term effects can include cardiovascular disease, obesity, diabetes, cancer and even early death.

Hypnotic medications are frequently used to treat insomnia, but many patients prefer non-drug approaches to avoid dependence and tolerance.

Assessment of sleep disorders

The self-administered Pittsburgh Sleep Quality Index assesses seven components of sleep based on clients’ self-reports. This widely used instrument has been shown to reliably detect clinical levels of sleep disruption in adults across a broad range of ages. Areas assessed include subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, use of sleeping medications and daytime dysfunction.

On a more practical level, I have found that having clients keep a simple “sleep log” for two weeks can help to identify sleep problems. I have clients record:

  • The time they go to bed
  • Medication taken (if any)
  • Estimated time to fall asleep (onset)
  • Estimated number of awakenings during sleep
  • Wake-up time
  • Estimated total sleep time
  • Sleep quality (0-10 scale)
  • Daytime alertness (0-10 scale)
  • Level of worry about sleep (0-10 scale)

Sarah: Sleep assessment

Sarah was provided sleep self-monitoring materials to complete over 14 days. Results clearly indicated many awakenings during the night, short sleep times and profound daytime sleepiness. These results were confirmed by polysomnographic data. Assessment results indicated diagnosis of insomnia disorder (780.52/307.42), Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5).

Assessment of childhood trauma

Systematic assessment of childhood trauma has evolved since the original study of adverse childhood experiences (ACEs) by the CDC and Kaiser Permanente in the mid-1990s.

ACEs are classified in three different subsets: abuse (physical, emotional, sexual); neglect (physical, emotional); and household dysfunction (mental illness, incarcerated relative, parent treated violently, substance dependence, divorce). These 10 areas can be incorporated into a structured interview, with questions such as “Before your 18th birthday, did you often or very often feel that you didn’t have enough to eat? Had to wear dirty clothes? Had no one to protect you? That your parents were too drunk or high to take you to the doctor if you needed it? Before your 18th birthday, was a household member depressed or mentally ill, or did a household member attempt suicide?” These questions can easily be incorporated into a routine clinical interview.

In a large study, 61% of adults had at least one ACE, and 16% had four or more types of ACEs. Women and members of several racial/ethnic groups were at greater risk for experiencing four or more ACEs. Exposure to ACEs is associated with increased risk for many health problems across the life span.

As counterpoint, Jack Shonkoff, a pediatrician and director of the Center on the Developing Child at Harvard University, notes “there are people with high ACE scores who do remarkably well.” Resilience, he says, builds throughout life, and close relationships are key. This implies that the ACE score for an individual is not a static number, but more dynamic, because personality traits and life experiences can modify the impact of ACEs.

Effects of childhood trauma and abuse on sleep

In a major population-based study in 2011, Emily Greenfield et al. found that three classes of abuse history were highly associated with a greater risk of global sleep pathology:

1) Frequent physical and emotional abuse with sexual abuse

2) Frequent physical and emotional abuse without sexual abuse

3) Occasional physical and emotional abuse with sexual abuse

The most extreme class of abuse — frequent physical and emotional abuse with sexual abuse — was associated with poorer self-reported sleep across many components measured, including subjective sleep quality, greater sleep disturbances and greater use of sleep medication.

Adults who reported frequent experiences of childhood physical and emotional abuse — regardless of sexual abuse — were found to be at especially high risk for global sleep pathology. Regardless of their experiences of sexual abuse, respondents who reported frequent experiences of physical and emotional abuse were over 200% more likely than respondents who reported no abuse to have clinically relevant levels of sleep pathology.

In 2018, Ryan Brindle et al. concluded that “childhood trauma may affect sleep health in adulthood. These findings align with the growing body of evidence linking childhood trauma to adverse health outcomes later in life.” Furthermore, trauma exposure after age 18 and across the life span did not relate to sleep health, suggesting that trauma experienced at a younger age is a more important factor.

Sarah: Trauma assessment

In gathering Sarah’s history during the first several sessions, she reluctantly revealed that she had been sexually molested repeatedly by her mother’s live-in boyfriend between the ages of 11 and 15. He was apparently dependent on alcohol and other drugs, with Sarah stating that he seemed “drunk most of the time.” She recalled that these events occurred “about twice a month” and consisted of mutual (subtly coerced) sexual touching and fondling, including occasional oral sex but no intercourse. Sarah never revealed this to her mother. Sarah’s obtained ACEs score was five. This finding suggested a second working diagnosis of trauma and stressor-related disorder in the DSM-5.

Possible mechanisms

In theory and research evidence, there is a fairly clear link between chronic stress and increased production of the hormone cortisol, which in turn can accelerate inflammation in the body. This may be a factor that can help explain the trauma-sleep connection.

Stress: In discussing trauma and sleep in children, Avi Sadeh suggested (1996) that stress was among the most powerful contributors to poor sleep. This can include significant life changes/events or threats that demand physiological, behavioral and psychological resources to maintain “psychophysiological equilibrium and well-being.”

Cortisol: Cortisol is produced by the adrenal glands, and high levels of physical or psychological distress lead to increases in cortisol secretion. In a study by Nancy Nicolson et al. (2010), emotional and sexual abuse were most closely linked to increased cortisol levels. Childhood maltreatment is also associated with elevated cortisol.

For clients living with stress and insomnia, cortisol levels remain elevated above normal levels, especially during sleep. With sustained levels of higher cortisol, these individuals remain in a state of hyperarousal, even when they’re asleep, thereby disrupting the overall quality and restfulness of their sleep. Chronic “short sleepers” (those who get five to six hours of sleep per night) have higher levels of nocturnal cortisol secretion in comparison with “normal sleepers” (those who get seven to eight hours of sleep per night).

Inflammation: Research by Janet Mullington et al. (2010) indicates that long-term inflammation may be the common factor in many chronic diseases. Social threats and stressors can drive the development of sleep disturbances in humans, contributing to the dysregulation of inflammatory and antiviral responses.

It is hypothesized that trauma-induced insomnia is a direct result of two interacting variables: physiological hyperarousal and self-defeating cognitive activity.   

Sarah’s treatment

Given that Sarah was suffering from insomnia disorder as well as trauma and stressor-related disorder, it was important to determine which problem needed to be the initial focus of treatment. If we expected that her traumatic history was keeping the insomnia alive, there might have been reason to help her process the trauma first. On the other hand, because her insomnia was having major effects on her mood, concentration and daytime alertness, some justification existed for initially treating her insomnia.

Based on the information obtained about Sarah’s sleep patterns and traumatic history, several evidence-based approaches were used in combination over 11 weekly sessions.

Body scan and breath awareness have both been shown to enhance relaxation prior to sleep. They redirect the mental focus toward the present state of the body and breath. The body scan consists of observing and listening to what bodily sensations are communicating in the moment. It involves noticing areas of tension in the body and inviting these areas to release the tightness.

Breath awareness can consist of slowly accepting the inhale through the nose, deliberately pausing for a moment and then slowly releasing the breath out of the mouth. This regulates the pace of the nervous system and provides an opportunity to mindfully experience the feeling of letting go of what is no longer serving the body. Sarah was provided with audio materials to practice these techniques daily.

Cognitive behavioral therapy for insomnia (CBT-I) is a structured program that aids in identifying and replacing unhelpful thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep. CBT-I helps to overcome the underlying causes of sleep problems. It requires the client to keep a detailed sleep diary for one to two weeks. The “cognitive” part of CBT-I teaches clients to recognize and change beliefs that affect their ability to sleep. This type of therapy can help to control or eliminate negative thoughts and worries that keep clients awake.

Sarah recorded her unhelpful automatic thoughts and beliefs about her sleep. These included “Not sleeping well is ruining my life”; “I have to fall asleep right now”; “I’m never going to get over this sleep problem”; and “I am worried that I have lost control of my abilities to sleep.” The A-B-C-D-E system (activating event, belief, consequence, disputation, new effect) was explained to her, and she was instructed in ways to dispute and replace unhelpful thoughts and beliefs. She was successful in describing and challenging these thoughts.

Acceptance and commitment therapy (ACT) is a more recently introduced form of psychotherapy that focuses on mindfulness and acceptance in clients with trauma histories. The underlying theory of ACT is that posttraumatic disorders result from attempting to avoid a past experience at all costs. Thus, a goal of treatment with ACT is to develop more accepting and mindful attitudes toward distressing memories and negative cognitions rather than avoiding them.

Sarah was first introduced to mindfulness as a way to reconnect with the present moment. This built the foundation for increased exposure to avoided thoughts and emotions. Through daily mindfulness practice over 10 weeks, Sarah was able to become aware of painful thoughts that were getting in the way of her sleep and mood. Defusion strategies helped Sarah learn to acknowledge these thoughts as “just thoughts.” Defusion is the separation of an emotion-provoking stimulus from the unwanted emotional response as part of a therapeutic process (think of it as being similar to “defusing” a bomb). Unlike strategies that are more cognitive in nature, the goal is not to challenge thoughts, but rather to acknowledge when thoughts are not helpful, detach from them and move forward. It is not necessary to determine if the thoughts are true or untrue.

One major difference between these two approaches is how unhelpful thoughts are handled. In classic CBT therapy, clients are encouraged to dispute these thoughts and replace them with more helpful ones. In ACT, clients learn to recognize and accept their thoughts but to stand away from them, as is used widely in mindfulness practices.

Outcome of Sarah’s treatment

Following our 11 sessions together, Sarah reported the following:

Although average sleep onset time had decreased only slightly (82 minutes pretreatment to 68 minutes post-treatment), her total sleep time had increased from 2.7 hours to 5.3 hours per night, and her number of awakenings decreased from an average of five per night to one to two per night. She also reported significantly less depression and much more daytime alertness. She was able to go back to work as a full-time university professor.

Summary and takeaways

I have reviewed some important research findings about a potential link between childhood maltreatment and adult insomnia. A case study is presented to help clarify methods for identifying and treating these issues.

In working with people with insomnia over the past 10-plus years, it has become apparent to me that a) many clients who suffer from insomnia do not have (or at least do not disclose) a history of childhood abuse or neglect, and b) among clients who do have a history of abuse as children, some have no apparent sleep problems. Regardless of these outliers, it is clear that sleep patterns should be explored in some depth, and it would be sound clinical practice to always inquire about your clients’ sleep patterns.

 

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David Engstrom lives in Scottsdale, Arizona, and is a core faculty member in the clinical mental health counseling program at the University of Phoenix. A counselor and health psychologist, he is an American Mental Health Counselors Association diplomate in integrated health care. He specializes in weight management, sleep disorders and pain management and is on the medical staff at Honor Health Scottsdale Medical Center. Contact him at David.Engstrom@phoenix.edu.

 

Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

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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.

The forces that could shape counseling’s future

Compiled by Jonathan Rollins January 5, 2021

[NOTE: To view this article as a PDF, log in with your ACA credentials here and select the January 2021 magazine.]

In 2012, as the American Counseling Association was celebrating its 60th year as an organization, Counseling Today published an article titled “What the future holds for the counseling profession.” In that piece, 19 counseling leaders shared their visions (and best guesses) of how the profession might evolve over the coming decade.

Fast-forward to 2021, and we decided the timing was right to revisit that topic, even though we’re only nine years out (rather than a full decade) from the original article. After all, most of us would agree that 2020 felt like it lingered on for two full years, or at least well past its expiration date. It’s also virtually impossible to imagine any type of near future in which the events of the past year aren’t still reverberating and shaping our society.

Given that backdrop, we invited a diverse group of clinicians, educators, researchers and leaders in the counseling profession to answer the following question: What do you anticipate will be the most significant change, challenge or opportunity for counselors and the counseling profession over the next five to 10 years?

There’s no time like the present to look to the future.

 

Whitney Norris is a licensed professional counselor supervisor, a somatic experiencing practitioner, and a co-founder of Little Rock Counseling & Wellness in Arkansas.

A curious practitioner doesn’t have to look far these days to find a well-known clinician-researcher speaking to the importance of the brain and body in psychotherapy, especially in the realm of trauma. One of these experts, Dr. Daniel Amen, once said, “The biggest mistake I see is that [psychiatrists] rarely consider the brain. I often say psychiatrists are the only medical specialists that never look at the organ they treat.” In my experience, the same can be said for counselors when we consider what we now know about the inextricable connection of the mind and body.

The most significant change that has occurred during my pursuit of specialization in trauma and attachment over the past decade has certainly been an expansion of needed expertise in understanding the brain and body. The fact that the book that I’ve heard many call the “bible of trauma” is titled The Body Keeps the Score (Bessel van der Kolk, 2015) provides a good summary of this concept. I believe though that over the next 10 years, this will no longer be just the territory of trauma specialists. All mental health practitioners will need to have a solid understanding of the physiology of mental health and dis-ease if they choose to follow the latest research regarding health and healing.

To put it simply, I think it will become abundantly clear that no practitioners will have the luxury of leaving this knowledge base to the trauma specialists. I would argue that someone who doesn’t understand attachment dynamics and how those show up and impact the body/physiology of the person in front of us in the counseling room will be largely in the dark about essential aspects of the healing process.

And this idea seems to be spreading. I practice as a trauma specialist in Arkansas, a state known for being several years behind in regard to advancements in the medical and mental health fields. Even so, within the past 10 years of practice, I have gone from being very careful about even using the word “trauma” — since people were reluctant to use it — to having almost every client who reaches out to me ask specifically for a trauma specialist. Then, even a step further than that, when I began my pursuit of my credentials as a somatic experiencing practitioner in 2016, it was rare for even professionals in my area to have any knowledge of this nervous-system-informed therapy model. Now, less than five years later, it is increasingly common for clients to call my clinic asking specifically for somatic experiencing treatment, and many have even read some of Peter Levine’s or Bessel van der Kolk’s work.

As our understanding of trauma broadens and encompasses the vast majority of presenting issues our clients bring to our offices, it will become increasingly essential for us to understand the intersection of these issues and the large part played by the physiological mechanisms driving them. When I’m discussing the ins and outs of this steep learning curve with other professionals, I find that people tend to think that these new layers of learning and “complexity” must make my job harder. However, that couldn’t be further from the truth. My own ease and comfort in the therapy room now is unrecognizable compared with my work before I understood these truths about the mind and body. Not only are my clients reaping the benefits of this understanding, but I have as well, personally and professionally. My hope is that over the next 10 years, more and more counselors can also experience this for themselves.

I would recommend that anyone interested in learning more check out the work of Peter Levine, Allan Schore, Bessel van der Kolk, Bonnie Badenoch, Stephen Porges and Louis Cozolino. They each have provided beautiful contributions to the art and science
of healing.

 

Derrick Shepard is an instructor of counseling at the University of Tennessee at Martin and a doctoral candidate in counselor education and supervision at the University of Tennessee in Knoxville.

As I reflect on the 2012 Counseling Today article “What the future holds for the counseling profession,” I can only be impressed by the level of foresight the authors shared. Foresight regarding calls for more inclusivity, a better understanding between mental health and neurobiology, and how economic stressors placed on our clients came to fruition. Moving forward, the changing demographics of the United States will present changes, challenges and opportunities for growth in the counseling profession.

Changes: The greatest change in the next 10 years is not so much focused on the counseling profession exclusively. Instead, the changing demographics in the United States will have wide-ranging impact on virtually all aspects of our country, including the counseling profession.

Challenges: The question posed in this essay is has the counseling profession held true to its mission of being an inclusive body, not just for our clients, but also for counselor educators and counselors in the field? Are we cultivating an inclusive body that serves the needs of all communities to have access to care from those who share common beliefs, values and life experiences in the world of practice? According to Data USA, we are only talking the walk and not walking the talk. The counseling profession is still composed mainly of white (non-Hispanic) females. We see this in the pipeline of future counselors-in-training and counselor educators-in-training. If we are not taking an intentional, proactive approach to normalize counseling, and by extension normalize the profession for underrepresented minorities, we will only continue to have the same candidates.

Opportunity: As with all challenges, there are an equal number of opportunities for growth. The STEM professions, for example, intentionally and actively started promoting STEM careers with underrepresented populations. I, a first-generation, African American, cisgender male, entered the counseling profession only after my undergraduate degree and career in business did not fulfill me and after my call to serve others in their journey toward personal growth. I have never regretted my choice. Personally, I have coached underrepresented students in a TRIO program yearning for the same calling but who do not see the career as a viable option. We can change that narrative, but more importantly, we must change that narrative about who can be a counselor, what counselors do and whom counselors serve.

In drawing on my business background and taking a best practice to investing, the profession needs to diversify, diversify, diversify. A homogeneous investment portfolio, or profession, is dangerous for one’s long-term growth and stability. In other words, we need to “walk the talk” rather than “talk the walk” in diversifying the profession (Manivong Ratts, 2012).

Moving into the next five to 10 years, the profession must start walking the talk by developing intentional and systematic marketing and proactive recruitment strategies that convey to clients that they have access to counselors who will hear, see and look like them. Inclusive counselors who understand their life station on the Multicultural and Social Justice Counseling Competencies framework. Inclusive counselors who get their start in training programs that reflect society’s changing demographics. When BIPOC counselors are admitted into counseling training programs, they need to feel the profession belongs to them as much as they belong to the profession. Lip service is not enough anymore. Instead, training programs need to provide intentional mentoring, guidance and professional development. All too often, those standing outside faculty doors are the ones who need to be asked to take a seat. None of these growth opportunities for the profession will take place unless faculty reflect on their biases, assumptions and beliefs and ask themselves, “Do I talk the walk or walk the talk?”

 

Nevine Sultan is assistant professor and program director of clinical mental health counseling at the University of St. Thomas, and a licensed professional counselor supervisor, national certified counselor and registered yoga teacher in private practice.

As a counselor educator and LPC in private practice, the following themes emerge for me as I reflect on the future of the counseling profession:

Taking a trauma-focused approach: Over the last few decades, we have introjected how others define our profession and made their definitions our own. It’s not uncommon for counselors to state that we only offer brief treatment for moderate concerns, which influences how we assess client needs and approach our work. In the next decade, it is essential that counselors transcend these limitations as we assist clients with presenting issues beyond the transitory. Taking a trauma-focused approach equips us to acknowledge and understand how various traumatic experiences, whether they occurred in childhood or adulthood, may impact clients across multiple dimensions, including physical, emotional, cognitive, social-relational and spiritual well-being. Working from this perspective invites us to explore beyond explicit recollections of a traumatic event to address impact on brain and body mechanisms and to offer treatment from a holistic lens.

Taking a contextual, integrative approach: Again, we have allowed ourselves to be limited by others’ definitions of evidence-based practices. This has restricted how we practice and how we train new counselors and conduct research. It’s time we recognize that working with verbal narratives using a cognitive orientation is insufficient because it limits us to addressing faulty thinking and alleviating symptoms, minimizing and marginalizing other dimensions of human experience such as emotion, physiology, spirituality and relationality. It also keeps our clinical focus on the individual, implicitly shaming clients and overlooking the critical influence of context. In the next decade, we must explore not only what is occurring to clients, but also how it plays out within clients’ broader experience as perceptual, emotional, cognitive, social-relational, spiritual and culturally situated beings. Thus, we can process verbal and nonverbal narratives, address symptoms and their origins, honor the full personhood of clients, expand practice capacities and explore innovative approaches in training and research.

Unifying our professional identity and making portability a reality: I’m a very proud counselor. I also curl a little into myself when I attend a conference, meet colleagues from different states and realize we have different titles. How can we expect other professionals and the general public to know what to call us if we are not united in what we call ourselves? This is also troubling when I attend international conferences because how we present ourselves as American counselors is confusing at best. It’s crucial to our visibility and trustworthiness that we unify our professional identity. Furthermore, as the impact of the coronavirus pandemic is demonstrating, licensure portability is more vital than ever. Our profession is founded on advocacy and social justice. In the coming decade and beyond, let’s bring justice to our clients and profession and extend our reach beyond state borders and into the world.

Embracing global citizenship: As we work to extend our reach, and as we are humbled by the impact of the coronavirus pandemic on humans around the globe, we must recognize how self-isolating we can be as a society and acknowledge that what happens in one part of the world influences what unfolds in another. In the next decade, let’s expand our understanding of culture beyond the multicultural models we know, as they often perpetuate stereotyping and labeling. It’s imperative that we embrace our role as supporters of personal and social identity exploration and integration, and as agents of transformation and growth.

 

Marty Jencius is an associate professor at Kent State University and has been engaged with technology for over 40 years.

The 2020 COVID-19 pandemic thrust many counselors and most educators into using technology as a platform for doing their work. Although many questioned their ability to create a new virtual presence, most had to adapt to the situation. Our clients and students found that they also had to change their type of engagement. I think the future will hold more online practice and training than we had pre-pandemic. We have had a taste of clinical practice using technology, and there is no going back without it. Our clients and students will expect us to provide them the opportunity to grow and learn online.

What changes can we foresee with technology? We are comfortably engaged in the dynamic web (Web 2.0) using social media and interacting through the web. We are entering a greater use of the semantic web (Web 3.0) where your device looks at your work, recognizes your preferences, and then provides you with choices for products and services that may interest you. The semantic web could also facilitate counseling relationships through similar algorithms, becoming a counselor’s assistant. It could offer clients ideas such as support groups based on location and interest, tutoring options for students struggling in a particular area, and links to specific academic and mental health referrals.

Computing is becoming more ubiquitous. The user is less and less aware that they interact with a machine, and the computer integrates into aspects of our lives without our awareness. Videoconferencing 20 years ago required the user to include an external camera and microphone, loading drivers for both, and a limited software choice. Now videoconferencing with whole groups of people is possible by merely clicking a button.

We will see greater ubiquitous inclusion in our lives and adoption in counseling. Look for a future that involves counselors/clients and counselor educators/counseling trainees interacting more with computers as a natural flow of their process. Counselors and clients will more readily turn to the computer and internet-based information for use in their treatment. Of importance will be well-curated information and the digital literacy of both the counselor and the client.

I anticipate more incorporation of virtual reality (VR) platforms such as Second Life and Oculus Horizon into counseling training and practice. Practitioners and educators can develop VR platforms for clients and students that will give them an immersive experience. Some of this work in immersive environments has already started using VR headsets with clients who have posttraumatic stress disorder. These immersive experiences allow clients to anonymously, or with the guide of a counselor, engage in communities, practice social skills, have conversations about difficult topics with others, and create their VR environments that express their condition.

I do not see computers overtaking the practice of real-time human counselors. Artificial intelligence is far from replacing the human condition it takes to be a counselor. Computer-augmented counseling is the next stage in counselor-client work. What limits our advances in using computers with our clients and students is the limited access many people still have to computers. Unless there is some effort to fill the digital divide between those who have and those who do not have computers, advancing use will only increase the chasm.

Whatever happens with technology and our field, we will look back at it in the years to come and be amazed at how we arrived.

 

Danica G. Hays is interim dean and professor at the University of Nevada, Las Vegas. She is an American Counseling Association fellow.

Over the past several decades, scholars — particularly scholars of color — have led important conversations in the counseling profession regarding linkages among culture, intersectionality and advocacy with multicultural and social justice counseling competency (MSJCC). These conversations have emphasized counselor self-awareness, an understanding of client and community worldviews, and a call to action to minimize factors and conditions that might hinder client and group-level well-being. In essence, previous MSJCC scholarship serves as an important tool for counselors to identify and dismantle intersectional oppression while strengthening their professional identity.

Despite these conversations regarding MSJCC, questions remain, as the majority of the counseling profession continues to identify as white, and systemic and intersectional racism persists within society in general. How have counselors, as both individual practitioners and a collective of practitioners, developed and sustained conditions for racism in the profession? What components of MSJCC do we need to further critically reflect upon to identify ways in which counselors, counselor educators and researchers might perpetuate racism? In what concrete ways can the profession ensure that counselors and future counselors are representative of the increasingly diverse clientele they serve? How can white counselors serve communities from an anti-racist and intersectional approach?

Addressing these questions in a meaningful way is the task of the next decade. This opportunity begins when counselors, counselor educators and researchers are committed to exploring the role of white supremacy at a deeper level for them individually and as a profession. Racism, which serves to construct race narratives, does not occur in a vacuum perpetuated by individuals. It is upheld by a deeply entrenched set of assumptions and norms that privilege the views of whites who have traditionally held the most power in cultural, economic, educational, health, criminal justice and political systems. White supremacy, which supports racism and systems of intersectional privilege and oppression, has existed for several centuries. Anti-racism is the intentional resistance and concrete, incremental disruption of white supremacy.

The formation and development of the counseling profession has not been spared from white supremacy. Barriers to counseling — affecting to a greater extent those with multiple marginalized identities — can include insufficient health care access, limited methods of counseling service delivery, a lack of diversity among counselors, language barriers, mental illness stigma, and distrust in the health care system, to name a few. In addition to addressing a field where counselors are disproportionately white, there is a moral imperative to understand how white supremacy sustains mental health disparities among racial, socioeconomic, gender and other cultural groups. It is necessary to critically reflect on the lack of counselors who represent diverse backgrounds across the intersections and how training programs perpetuate the lack of representation. And it requires the profession to disrupt the ways in which counseling is traditionally delivered so that communities are served well.

The core of counseling hinges on relationship building. Counselors must first build an authentic relationship with themselves, uncovering their participation or encounters with white supremacy. In their anti-racism work, they must be vocal about the need for equity even when it does not personally benefit them. Through relationships with clients and their peers, counselors must meaningfully attribute personal and client narratives of systemic and intersectional racism to white supremacy. This is our opportunity to strengthen the ongoing work of MSJCC. This is our opportunity to grow our profession in the next decade.

 

Oliver J. “Ollie” Morgan is a professor of counseling and human services at the University of Scranton.

I recently turned 71. I have been a practicing counselor and family therapist since 1980 and a counselor educator since 1990. This is my 30th year teaching graduate counseling students and undergraduate human service providers. With the faces of so many bright-eyed and eager students in my memory, my reflections turn to preparing others for what lies ahead.

Who are the counselors we will need in the final years of this decade, this century? What kinds of people will they be? Counselor self-awareness and “self of the (family) therapist” points of view have been guideposts for me. My colleagues and I at the University of Scranton have helped to pioneer a “Counselor Fit for the Profession” statement and assessment process over the past 15 years, and it has served us well as mentors and gatekeepers for counselor preparation. I have come to believe that shaping the “practitioner of the future” is a critical task for the counseling profession. The person — she, he, they — is the point of contact for healing and critical to the work of implementing whatever method, theory or technique is used.

So, what kind of counselor do we need for the future? First, in addition to having empathy as a foundation, I would say that we need someone who is flexible and eager to learn. In my career, I have worked in agencies and in generalist private practice. I have worked as a family and marital counselor, pastoral counselor, addictions specialist, and medical family therapist with cancer patients and families. I chose each iteration of practice in part to increase my skills, to acquire new areas of expertise and to respond to local needs. It also helped to keep me fresh.

Second, I have learned the necessity of being trauma-informed and trauma-competent. It is clear that various forms of trauma mark broad swaths of practice. I have explored and published about the effects of “adverse child experiences” and other forms of adolescent and later trauma on substance use disorders and addictions. I have learned about the prevalence of trauma underneath various medical, psychiatric and behavioral disorders. It is not too extreme to say that trauma is often an unseen factor affecting the two or three most troubling (and troublesome) patients a physician will see in any given day. Counselors should market themselves to doctors as an invaluable resource for their practice. I often tell my students that trauma and addiction are the two most underdiagnosed and undertreated conditions in clinical practice. Helping future counselors to recognize and address trauma is essential for the future.

Third, I am coming to understand that trauma is also a hidden, underlying factor in one of the most troubling societal maladies we need to address moving forward — namely white supremacy and nationalism, racist demonization, and violent extremism, as well as their underlying brokenness, isolation and marginalization. Trauma is often the covert companion of racist violence toward another. Just as addiction and illness can be negative outcomes from trauma short and long term, so too can prejudice and violent extremism become twisted and toxic aftereffects of suffering. I am coming to a deeper appreciation of strategies that identify, and show promise in addressing, this malignancy: empathy, connection, humanization, providing social support, resilience-building.

As counselors, we are called to provide comprehensive care and treatment. To do so demands that we become fierce advocates for creating inclusive communities that help to bridge the divide between suffering and hope. Helping our future counselors become these advocates is our task moving forward.

 

Kelly L. Wester is a professor and chair of the Department of Counseling and Educational Development at the University of North Carolina at Greensboro.

Many changes have occurred within the counseling profession over the past three decades: gaining licensure in all states, strengthening professional identity, being recognized by insurance panels and government organizations, and increasing use of telehealth during the health pandemic. We have more challenges in front of us, including, but not limited to, transferability of counseling licenses across states.

The growing edge I want to focus on is one that is moving slowly: our engagement in and use of research. To some individuals, research may be a four-letter word, and to others their passion. Regardless of where you may fall on this continuum, the field of counseling needs research. Research informs and transforms a profession, influences our understanding of mental health symptoms, informs counselor training and practice, and provides evidence-based practices.

The need to engage in research has been mentioned by counseling leaders since the 1990s and was noted as one of the seven principles in the 20/20 Principles for Unifying and Strengthening the Profession. These leaders have argued that counselors need to promote rigorous research, to understand client outcomes, and to disseminate research to clients, professionals and legislators. While I believe that we have made progress in enhancing research conducted in our field, I do not believe that our field has fully answered these calls. Are we effective as counselors? I have no doubt that we are. But do we engage in research that proves this? Not as much as we need to.

Research informs the field and advocates for clients. Our field is one of the leaders in supervision and in promoting multicultural and social justice competencies — yet we are just beginning to skim the surface on examining what is effective in both of these. There is a place for descriptive research to help us understand and influence theories, to better our understanding of what is occurring — but we really truly need to engage in more outcome and process-based research. What is it that we are doing that is effective? We know the therapeutic relationship is important, but what about it truly impacts clients and outcomes? How do we take more of what we do as counselors — the developmental, strength-based approaches — and show that it truly works, instead of waiting for other mental health professions to do the research on what they implement and tell us what to do (because third-party payers mandate evidence-based practice)?

All counseling professionals need to see themselves as researchers, because they are. With every client and student who comes to your office, you have a question about them. You are trying to unearth what is going on, what factors contribute to the symptoms, and what you can do to help this client/student. This is informal research.

It is not enough to do the research. We need to disseminate it so that professionals and clients can access it. Does this mean we should stop publishing in journals? No. Publishing in peer-refereed journals is important for maintaining integrity and influencing the scientific world. However, academic writing does not always translate to practice. Nor do counselors always have access to journals. Researchers need to think outside the dissemination box. Publish in the journal, but then blog about your findings, or take it to social media in a quick blurb, make a one-minute video, create a podcast or do something else to make it accessible. Bring the findings back to the community that provided you with the information.

Our challenge: To conduct more outcome and process-based research and disseminate our findings in an accessible way.

The change and opportunity: To impact our training, practice and clients by providing services that are empirically informed.

 

Debbie C. Sturm is a licensed professional counselor, co-chair of the American Counseling Association Task Force on Climate Change and Mental Health, and an associate professor at James Madison University.

In 2019, Greta Thunberg told the U.S. Congress, “This is not the time and place for dreams. This is the time to wake up. This is a moment in history where we need to be wide awake.” While the specificity of the global pandemic was not known at that time, the reality of pandemics, increased natural disasters, climate refugees and migration, and racial and environmental injustices have always been in the reality of those studying the climate crisis. The global systemic complexity of the impact of climate change may seem like quite a challenge for the counseling profession, but we have a clear opportunity to educate, prepare and mobilize in response to the very real mental health crisis on our doorstep.

COVID-19 has exposed the deep interconnectedness that our belief systems and actions have on each other and underlined the imperative of personal action for the greater good. It has also reminded us that science matters and that strategic, visionary leadership is critical. But COVID-19 is the intense here-and-now microcosm for what the climate crisis will bring. And everything we as counselors learn about health disparities, mental health outcomes from crisis and who gets left behind when leadership fails is an opportunity to better prepare for the next major shift.

While we have been in personal, professional and community battles with COVID-19, we have also been wrestling with the dangers of misinformation, intense and important calls for the long-delayed commitment toward anti-racism and racial justice, and severe social and economic disparities. And Oregon, California and Washington burned. Again. As I write this, the Gulf Coast is awaiting its seventh major hurricane of the season. Suicide rates among farmers are higher than they have ever been. Climate refugees within our own country are increasing. Flint, Michigan, still doesn’t have clean water. And the environmental destruction of the past four years has increased risk of harm to more communities due to environmental injustice and environmental racism.

How is this an opportunity? Literally everything around us is screaming for the awareness that harm to one is harm to all. And we have the opportunity — the critical, here-and-now, no-time-to-waste opportunity — to step into this movement.

Our ACA Advocacy Competencies remind each of us there are countless points of insertion to which every person can find their own unique way to make a difference. We have the opportunity to recognize, validate and bring into the therapy room the reality of the fear, dread and helplessness people feel in the face of the climate crisis — eco-anxiety, solastalgia, eco-grief and trauma, and concern about future generations. We have the opportunity to develop competencies for climate-informed disaster response — recognizing that disasters have now become repeat occurrences within short periods of time. We have the opportunity to become part of conversations in our communities with climate mitigation and resilience groups by contributing our knowledge of trauma, place attachment, racial and economic disparities, and resilience. And we have the opportunity to contribute to the overall understanding of how the climate crisis will impact the mental health and well-being of our most vulnerable neighbors. All of this is well-established with solid evidence from national and international agencies. We just need to bring it into our profession.

Right now, there are so many critical issues calling to us. We should rise up to meet every single one of them. But let’s remember — we have a massive membership. With intentionality, we have the opportunity to mobilize passionate people in every direction — all tied together by the common thread of counseling. Find your opportunity to make a difference. Mine is climate change and environmental justice. Find yours … and then join other counselors to make the change.

 

James T. Hansen is a professor in the Department of Counseling at Oakland University whose book, Meaning Systems and Mental Health Culture: Critical Perspectives on Contemporary Counseling and Psychotherapy, elaborates on the issues presented below.

The most significant challenge to the counseling profession over the next decade will be to reconcile the conflict between effective, relational counseling and increased professional participation in the medical model. By the medical model, I mean the alignment of specific treatments with particular symptoms or disorders, such as antibiotics for infections or cognitive behavior therapy for depression. Money and status in the mental health field are highly associated with the ability of professionals to participate in the medical model by diagnosing, receiving insurance payments and developing symptom-oriented treatment plans. However, reducing clients to symptoms is at odds with the development of an optimal counseling relationship, which is the within-treatment factor that has the highest association with counseling outcomes. Therefore, there is an inherent conflict between relational counseling practice and participation in the symptom-oriented, medical model.

It is not necessary to dive deeply into research or theories to understand this conflict; evidence from ordinary experience will do. Imagine that you have had a bad day and are eager to talk to your partner about it. As you begin to talk, your partner senses your frustration, states that you are suffering from an adjustment disorder, and suggests that you might benefit from a cognitive technique, which he then begins to describe. What would your reaction be? Would this response strengthen your relationship?

As another example, recall the last time you were troubled, talked to someone about your difficulties and felt better after the conversation. What did the other person do to make you feel better? During my career, I have asked hundreds of people (mostly counselors) this question. No one has ever answered “diagnosed my problem and recommended a technique.” Virtually everyone has answered with some variation of “listened intently and tried to understand my experience.” Relational development depends on efforts to understand the experience of the other person. A medical model emphasis on the importance of external symptoms necessarily undermines efforts to understand internal experiences.

At their best and most effective, counselors are relational professionals. Unfortunately, in the current culture of work, relational professionals are generally devalued, particularly when compared to technical-medical professionals (think caregivers versus surgeons). To gain status, professional respect and third-party reimbursement, counselors have strongly advocated to be a part of the medical model. However, as noted above, the reductive, symptom focus of the medical model is antagonistic to the relational factors that make counseling effective. Indeed, the counseling code of ethics emphasizes “best practices” and “effectiveness,” yet counselor advocacy in the mental health realm often takes the form of fighting for greater recognition as quasi-medical providers. This is an identity that undermines the relational factors that have the highest association with best practices and effectiveness. From this perspective, professional advocacy is an ethically questionable activity.

I do not have a solution to this conflict. From my observations though, the dark side of advocating to become a greater part of the medical model as a means to professional advancement is virtually never discussed. Therefore, the greatest challenge for the counseling profession will be to reconcile the conflict between professional status and our identity as relational professionals. Again, I do not have a solution. However, I think we can begin where we tell our clients to begin. That is, we need to face the conflict honestly and deal with it, rather than ignore it in the hopes that it will go away.

 

Derrick A. Paladino is a licensed mental health counselor, a national certified counselor, and a professor of counseling and Cornell distinguished faculty in the graduate studies in counseling program at Rollins College in Winter Park, Florida.

Three thousand six hundred fifty days in the future is a lot of days — and I mean a lot a lot. Living through a pandemic can make this time seem exhausting for some, and for others, hopeful that life will begin to invite more familiarities and welcomed experiences. Though I live somewhat near Cassadaga, Florida — aka the psychic capital of the world — I have not experienced any of this talent rubbing off on me. I mean, it could be nice to live it up like Biff Tannen in Back to the Future Part II or join Bill and Ted on their excellent adventures, but that also might take the fun out of life. Nevertheless, here are a couple thoughts regarding what might impact the counseling profession.

One trend/current necessity that I believe will become a staple is telehealth. To me, we are already late as a profession in fully accepting this modality. When looking at our global and social world, connecting to those who are unable to easily make their way to brick-and-mortar practices (whether their hurdles are physical health, logistical, financial or related to mental health) just makes sense. Telehealth is a part of social justice and advocacy, and the ability to seek counseling services becomes a clear social and ecological issue.

I think the profession will see a growth in HIPAA-compliant sites and devices to increase the accessibility of this modality. In addition, a surge in telehealth scholarship will better inform telehealth ethics and laws, best practices, and counselor and supervisor education. I also envision telehealth becoming a consistent part of the counseling curriculum. One hope is that “powerful individuals” will embrace and advocate for the need of reduced-cost internet. Currently, we are experiencing this as K-12 schools have gone virtual, and it would be wonderful to see this social justice issue emerge with the backing of our profession. On the other hand, we may see an increase in nonallied mental health professional telehealth counseling. The counseling profession will need to do a solid job of defining, differentiating and advocating for licensed and certified mental telehealth practice.

Another element might be the impact of political view polarity in the counseling profession. Over the past 3,650 days, we have seen a dramatic increase in the explicitness of individual political and social stances. Though they have always been there, due to social media, Listservs, etc., we have witnessed that what once was hidden is now a big neon sweatshirt with a sign spinner next to it.

How this will shape the profession, I have no idea. But we do know that the personal is political for counselors and clients. The counseling profession champions social justice and advocacy to allow underrepresented and marginalized populations to feel safe, connected and brave during treatment. For example, we see religious symbols and other symbols of inclusivity on private practice websites to increase client comfort and connection to the process. As the country seemingly sits on a divide, will this extend to political symbols? Only the psychic mediums in Cassadaga, Florida, know.

At minimum, mental health professionals will need to hold consistent awareness of what their public social presence beams to clients, along with the potential ascribed ethical, professional and ecological impact. The counseling profession will need to spend more time with how this is unpacked and navigated.

 

Michelle Fielder is a licensed professional counselor, an approved clinical supervisor in private practice, and a doctoral candidate in the counselor education and supervision program at Regent University.

The year 2020 will certainly take its place in the history books for the mental distress Americans endured with the coronavirus pandemic, alterations to education and social interaction, hits to the economy and record unemployment, heightened racial tension, calls for police reform and a divisive presidential election. However, the ramifications of these events will last long into the next decade. Despite the loss, pain, confusion, frustration and disappointment of life-altering circumstances, our shared experience is heralding the continued evolution of the counseling profession.

Counseling will forever be changed by the nationwide acceptance and advocacy for the profession during the COVID-19 pandemic. The Department of Health and Human Services’ public health emergency opened the door, but the declaration by the U.S. Department of Homeland Security naming counselors as essential to the critical infrastructure of the United States paved the way for recognition on par with other mental health providers. Continued efforts for license reciprocity and portability will eventually bear fruit, lending credibility for the profession to operate across state lines with an established standard of professionalism.

The pandemic also ushered in the widespread use of telehealth to ensure public health and safety. While telehealth seemed like a niche modality before the pandemic, clients, clinicians, insurance providers, and state and federal governments quickly recognized its benefits to meet the need for increased mental health services while being mindful of social distancing protocols. The use of telehealth will not decrease as the need for social distancing wanes. Our society was already moving toward increased convenience in daily activities as the millennial and centennial generations embraced technology for online social interaction, recreation, shopping, dining, groceries, transportation and remote work opportunities. The widespread use of telehealth is here to stay.

The challenges and opportunities for the counseling profession will concern maintaining relevancy in the nation’s changing landscape. Counselors will need to further differentiate from life coaches and other helpers who do not require the same level of education, experience or licensure as future clients seek the most expeditious, cost-effective services. An increased need for counselors must be met with increased CACREP-accredited programs, to include qualified supervisors and applicable practicum/internship opportunities.

Recent history has revealed that the nation is not as enlightened in the areas of equality, justice and racial reconciliation. The pandemic revealed the financial fragility of many families and small businesses, as the loss of one or both incomes destabilized families and caused businesses to shutter. Education at all levels has been affected; students will not get back the losses of the 2020-2021 academic year, including social skill development, organized sports and club activities, or academic programs that were canceled. The loss of those experiences, especially for older students, can have a devastating effect on potential recruiting and scholarship opportunities or occupational opportunities in the future.

Insecurities in food, housing, transportation and health care caused further distress as families tried to maintain solvency. The clients of the future are going to be affected on multiple intersecting levels, which will require efficacious methods to address the complexity we are likely to see. Not only must counselors be well-versed in grief and loss, multiculturalism, social justice, advocacy and trauma-informed care, but there needs to be additional research into the intersections created by the pandemic and the life-altering changes that came with it.

 

Lennis G. Echterling is a professor of counselor education at James Madison University.

As a kid, I loved to dig holes in our yard, fruitlessly searching for arrowheads and other clues about our mysterious, distant past — much to the consternation of my parents. When I gave any thought to the future, I dreamed of flying cars and spaceships blasting off to the stars. These days, as a counselor educator, I find myself digging into the muck and mire of the present crises that confront our society, searching for valuable clues about our future. Throughout my career in the counseling profession, I’ve learned that the seeds of innovations and transformations are found in our most troubling times.

For this piece, I will focus on three current and intersecting crises — the pandemic, global climate change and systemic racism — that are leaving in their wake countless casualties, economic chaos and social conflict. These catastrophic conditions are vast and dishearteningly complex, but all three perils also hold promise for the future contributions of the counseling profession.

The pandemic: In the 16th century, Italy was struck by a plague they labeled influenza delle stelle because they believed the disease was caused by the stars. Today, we still retain the term “influenza,” but we now recognize that humans, not the stars, are the actual viral agents. As counselors, our focus is on humans — their struggles, relationships and potential. In our work, we have learned that in times of emergency, new things can emerge, leading to dramatic, enduring and positive changes — in individuals, families, communities and societies. Consequently, counselors are now serving as catalysts for expanding innovative telehealth practices, offering virtual crisis intervention to overwhelmed first responders, promoting best practices for primary prevention, collaborating on medical teams to treat COVID-19 patients, and providing online support groups for those who lose loved ones.

Climate change: Rapidly rising sea levels, record-setting heat waves, horrific wildfires, hurricanes whose names outpace the alphabet, and other catastrophic consequences of climate change will continue to sabotage the emotional well-being of countless citizens in every country. Therefore, future counselors will be welcomed as valued members of disaster response teams. Given our knowledge and skills as counselors, we are ideally positioned to contribute to environmental advocacy, disaster preparedness and community resilience. For decades, counselors have been influenced by attachment theory, which highlighted the need for deep and abiding relationships between children and their caregivers. In the future, it will also be our basic duty to promote, strengthen and deepen humanity’s most fundamental attachment — to the natural world.

Social justice: Both the pandemic and climate change have in common a disproportionate impact on people of color, who not only are exposed to greater risks but also have fewer available resources to cope with these threats. Black Lives Matter and other movements are engaging in social justice action to heighten society’s awareness of oppressive systems of power and privilege. By implementing diversity, equity and inclusion initiatives in counselor education programs, we can ensure that future counselors will be better prepared to embrace their roles as change agents for social justice — to challenge racialized violence, combat xenophobia, advocate for racial and gender equity, and echo the voices of the marginalized.

Addressing these and other crises will be the mission of all future counselors as we advocate for bridges that unite humans, instead of psychological walls that separate. Counselors can be the metaphoric windmills that harness the winds of change. As Shakespeare wrote, “The fault … is not in our stars but in ourselves.” True, but we humans also hold the promise to actualize, transcend, and achieve our potential. The task of future counselors is to fulfill that promise for all humanity.

 

Kara P. Ieva is an associate professor in the counseling in educational settings program at Rowan University.

What will counseling be over the next decade? My initial thoughts center around 2020 and the unpredictability of demands from counselors. As such, I feel like 2020 brought invaluable lessons for the counseling profession but also left us with numerous questions to answer as we begin to envision the next 10 years.

Highlighted by 2020, the counseling profession will need to address how it contributes to our society’s generational diagnosis, racism. While we continue to eradicate the stigma surrounding mental health, racism presents the greatest challenge we will face, but it is also a significant opportunity to advance the profession as an inclusive practice for all individuals. Essentially, this requires feeling uncomfortable while critically reflecting on our history and the lessons from 2020 and challenging the identity of who we want to be for future generations. As we know, complacency is harmful to the profession, ourselves, clients and society.

This is a tall order that requires a systemic and collaborative approach from professional organizations, accrediting and licensing bodies, counselor education programs, researchers, field leaders and supervisors, and individual counselors. The first step is acknowledging our history in two ways.

One, the field was founded on the need to compete in the global “space race” and increase student enrollment in STEM courses. This led to the creation of gatekeeping practices, deciding on access for opportunities in an educational setting that was founded on white norms. As a large body of research tells us, those practices still exist today for marginalized populations.

Second, counseling overall is steeped in white middle-class norms. Even though the profession evolved with cross-cultural counseling, multicultural competencies and social justice advocacy, we remain a predominately white field (conditioned in privilege), which limits access for myriad clients and potential future counselors. The counseling profession is active in multiple systems (e.g., health care, education, justice, etc.) that interact with one another. This informs the essential questions: How will counselors collaborate across systems to provide equitable access, dismantle oppressive practices, and provide strength-based interventions to increase overall mental health wellness? How will we contribute to making the world a more informed and empathetic place for all humans?

To address those questions, the next thing to consider in tandem are accreditation and licensure standards and counselor education curriculum. Programs still teach foundational Eurocentric theories across the entire accredited curriculum. Given the diversity of multiple identities of counselors and clients, it’s time we asked ourselves, “What can we leave behind in our curriculum while acknowledging the past, and what might be essential moving forward?”

We were already in a mental health pandemic, and now due to 2020, mental health issues continue to increase for all ages, from young children to adults, stemming from the pandemic, financial crises, grief and loss, racial trauma, educational trauma, political and familial tensions, and social isolation, just to name a few. Based on what we know about trauma, we will be addressing the effects of 2020 for the next 10-20 years. Additionally, we also know that trauma plays out differently with the intersection of multiple identities (e.g., gender, race, ethnicity, neuroprocessing, language, veterans, LGBTQ+, etc.) and circumstances across the various systems. Are all counselors prepared to address intersectionality with multiple traumas across all systems, for all clients, whether face to face or through telehealth sessions? How might the answer change our accreditation standards, licensure requirements, educational curriculum, supervisor training and professional development?

It’s true, there is a lot of work to be done, but I am hopeful. I am optimistic that 10 years from now, we will have answered these questions and proactively collaborated to meet the needs of an ever-changing society and done our part in contributing to global healing and overall wellness.

 

Sherry Cormier is professor emerita in the Department of Counseling, Rehabilitation Counseling and Counseling Psychology at West Virginia University and is currently affiliated with Full Circle Healing Arts and The Wellness House in Annapolis, Maryland.

The Chinese symbol for “crisis” also means opportunity. The issues that we are facing nationally and globally in terms of climate change, pandemics, food insecurity, social justice and interpersonal conflicts are not only challenges; they are also opportunities for change. We are evolving at a pace so rapid that it’s laced with tremendous uncertainty, grief, anxiety and aggression. Substance misuse and suicidality, as well as crisis calls, are steadily rising in response. I’ve lived long enough now though to not feel unduly alarmed over these issues. I’ve sat through enough deep loss and enormous social unrest to know that devastation is the opening for growth. Cynthia Occelli has captured this sentiment: “For a seed to achieve its greatest expression, it must come completely undone. The shell cracks, its insides come out, and everything changes. To someone who doesn’t understand growth, it would look like complete destruction.”

I believe this quote holds the key to the opportunities available to counselors and our profession in the next decade. We know from research that personal transitions are occurring at such a swift speed that nothing in our lives is linear anymore, and clients are unnerved and overwhelmed by constant upheaval (Bruce Feiler, Life Is in the Transitions, 2020). As important as self-care is for clients (and ourselves) now, this area of professional practice will grow exponentially in the next decade, especially for clients who feel their values eroded, their boundaries violated and their lives compromised in unthinkable ways. Since emotions like anxiety and grief settle deep in our cells, providing clients with ways to emphatically and consistently prioritize their own mental and physical health will be important future opportunities for counselors, including networking with complementary professionals whose practices supplement our roles.

Also, the search for self-knowledge and personal meaning will be even more relevant and necessary. The more intimately we know ourselves, the more resilient we tend to be from the waves of change in our external world. Those who stand poised to help clients discover more about who they are and about what they are connected to will be the leaders in the next decade.

At the same time, counselors who have a deep understanding of trauma, both personal and collective, will have expanded opportunities to provide services. Finding ways to work effectively with personal traumas will continue to be important, yet navigating cultural and societal traumas, including but not limited to racism and discrimination, will become more prevalent. If we fail to address collective trauma in our profession, we risk becoming irrelevant (at the very least).

As the incidence of posttraumatic distress grows, so does the opportunity for posttraumatic growth. For many years, we’ve considered counselors to be agents of change. That’s still true, but in the next decade, counselors will be known for being agents of growth and healing. The word healing means to “make whole.” Comprehensive self-care assessment and treatment modalities, facilitation of far-reaching self-knowledge and personal meaning, and sensitive and competent responses to individual and institutional traumatic distress will be significant opportunities for counselors to help clients develop wholeness and transformation in the face of anguish and desolation. As the mystic poet Rumi said, “Do not worry that your life is turning upside down. How do you know that the side you are used to is better than the one to come?”

 

Laura K. Jones is an assistant professor of health and wellness promotion and director of the Peak Performance Biofeedback Lab at the University of North Carolina Asheville.

“The gut trains the immune system to protect the brain,” proclaimed a November 2020 National Institutes of Health press release. The month prior, Brain, Behavior, and Immunity published a study detailing the inflammatory predictors of anxiety and depression in COVID-19 survivors. In 2020, nearly 17,000 journal articles noted interactions between the immune system and mental health, 4,000 linked mental health to the gut microbiome, and roughly 2,000 more described the role of sex steroids. Research substantiates that nearly every system of the body — the central and peripheral nervous systems, immune system, endocrine system and gastrointestinal system — influences mental well-being and how our environment influences that process. We now know there are likely multiple phenotypes of various mental health struggles, likely driven by differing physiological etiologies. We are on the verge of a watershed moment in how mental health — for centuries an enigmatic phenomenon — is conceptualized.

Although we have been championing this within our field for over a decade, I am more convinced than ever that to stay relevant and emerge as leaders in the broader mental health landscape, the field must recognize, embrace, and intentionally and ethically translate such findings through our unique therapeutic lens. However, this begets significant challenges, both within and external to counseling. A 2018 Journal of Humanistic Counseling article argued that neuroscience lends little substance to counseling and offers a reductionistic image of the human experience. Although ethical integration warrants caution, such perspectives are as shortsighted as the reductionistic viewpoints they argue against and problematic to the growth of the field.

Integration is not a binary argument. It is not a question of whether we stick to our humanistic ways or embrace what we know about physiology. We cannot pit one against the other and sit idly by while the rest of the mental health world changes. As such, the more appropriate question is how we will grow with the science, employing and building upon our humanistic traditions to best support physiological, interpersonal and social change.

This balanced perspective is vitally important external to counseling too as we begin to see the therapeutic implications of such burgeoning research. Such science will continue to inform how mental health struggles are diagnosed, prevented and treated. It is likely that our society — based in allopathic medicine and “quick fixes” — will begin to push for more pharmacotherapeutic and medical interventions. Although advances are important, this emphasis may have detrimental impacts on policy, insurance and perceptions of the therapeutic process.

Counselors have the obligation to remain advocates in the broader mental health and policy worlds for the importance and necessity of talk therapy and adjunctive interventions (e.g., neurofeedback, somatic therapies) facilitated by counselors. To support such efforts, we need to expand our research to explore the neurophysiological outcomes of counseling interventions, both traditional and those newly developed and informed by neuroscience.

Think about it. We know the importance of a strong therapeutic relationship and increased self-awareness, but how, physiologically, do these lead to an abatement of symptoms? How does engagement in counseling influence health disparities for Black, Indigenous and people of color? How can counseling ease the enduring health consequences of COVID-19? How does neuroscience-informed cognitive behavior therapy, originating from counseling, compare to traditional CBT in alleviating symptoms?

Answering such questions will require that we become more competitive within larger granting agencies, such as NIH and the National Science Foundation, and build cross-disciplinary partnerships. It will require more intentional, consistent and accurate training of counselors, which the American Mental Health Counselors Association Neuroscience Task Force is currently addressing. We are at a significant juncture in mental health care, and the counseling field has an opportunity, or rather obligation, to guide those changes and to be the voice for balancing the physiological perspective with that of the humanistic within policy, insurance and practice alike.

 

Matthew Fullen is a licensed professional clinical counselor in Ohio and a counselor educator at Virginia Tech, where his research focuses on Medicare reimbursement advocacy and supporting the mental health and wellness of older adults.

Medicare insures 60 million Americans, a figure estimated to approach 80 million by 2030. Exclusion from the Medicare program has far-reaching consequences for counselors, and the negative impact on Medicare recipients is even more alarming. For counselors, Medicare exclusion has resulted in untimely client referrals, loss of revenues and fewer job opportunities within certain segments of the mental health marketplace. Clients who rely on Medicare (i.e., older adults and younger people with long-term disabilities) experience long waitlists and financial challenges in accessing care and with issues such as hospitalization.

Medicare advocacy in the counseling profession has a long history, but recent developments suggest that the near future is bright. During the 2019-2020 congressional cycle, over 150 lawmakers became co-sponsors of two bills that aim to address counselor exclusion from Medicare. The Centers for Medicare & Medicaid Services will now reimburse services provided by counselors in opioid treatment programs, and a similar allowance was made, albeit temporarily, within rural health centers during COVID-19. In addition to these advances, awareness of the Medicare mental health coverage gap is reaching a wider audience through increased research and exposure in national press outlets such as Politico and the New York Times.

So, what comes next? How do we commit to advancing this advocacy over the next several years? And just as importantly, how do we ensure that the counseling profession is prepared to work with Medicare-insured individuals once current policy is changed? In the short term, there is an ongoing opportunity for counselors to increase their participation in the Medicare advocacy process. If you have never participated in an ACA advocacy campaign, we need you to start. If you have participated using only automated technology, we need you to make phone calls and write personal emails. If you have not yet met directly with your federal lawmakers about Medicare reimbursement, this is the time to do so. These steps will go a long way in advancing this cause. If you are busy serving your clients, we need you to share your stories about turning away Medicare-insured clients. If you are busy training counseling students, we need you to help them get involved in advocacy. If you are a student learning about the counseling profession, ask your instructors about how Medicare policy influences clients’ access to care. We need a wave of grassroots involvement that will show congressional lawmakers that the time for change is now.

As we advance toward Medicare inclusion, a new challenge awaits us. Will the counselor workforce, professional infrastructure and training programs be prepared to work with a vast influx of Medicare-insured clients, most of whom are over the age of 65? Just as the counseling profession has evolved to respond to the needs of other societal changes, so too must the profession ready itself for demographic shifts that are already underway. When we attain Medicare reimbursement, will our profession be ready to meet the needs of older clients? Counselors will need professional development opportunities to enhance the application of their practice to an aging population. Counselor educators will need to improve upon the very low rate of counseling research that currently exists. Counseling students will need greater exposure to training that addresses needs across the life span, which may require the reemergence of a specialization in gerocounseling, or at least the development of accreditation standards that address aging more directly.

The future of counseling is bright, and the profession’s ability to capitalize on current Medicare advocacy momentum and translate these successes into addressing the mental health needs of an aging population will shape our next five to 10 years. Advocates, pioneers, counselors wanted!

 

Sidney Shaw is core faculty in the School of Counseling and Human Services at Walden University.

In considering future challenges for the counseling profession, it is evident that artificial intelligence (AI) will influence the future of mental health services, and changes are already occurring. In broader society, human jobs have been altered by technology for generations. Switchboard operators, bowling alley pinsetters and cashiers are just a few of the jobs that are either no longer done by humans or have been at least partially replaced by technology. Even some journalists have recently been replaced with AI.

There can be benefits to technology supplementing human occupational roles, such as robots to inspect burning buildings for safety, but limitations include technological augmentation of jobs that are fundamentally rooted in human relationships. AI is accelerating at rates that were previously unimaginable, and this has unforeseen implications for our profession. In the month of January 2020 alone, there were 3.4 million downloads of the top 10 mental wellness apps in the U.S., and the monthly download number has increased since COVID-19 was declared a public health emergency by the World Health Organization on Jan. 30 of last year.

Mental health apps and AI bots are readily available, certain ones are free of charge, and some have research support. For example, a peer-reviewed study by Kathleen Fitzpatrick and colleagues found that people using Woebot, a chatbot that provides real-time CBT-based interventions, experienced significant decreases in depression symptoms. The increasing popularity of mental health bots is not separate from the broader societal and political environment. For example, the America’s Mental Health 2018 study found that access to care is a root cause for the mental health crisis in the U.S., and this is one factor that can make cheap or free mental health bots very appealing. With this in mind, it is important for the counseling profession to advocate for accessible health and mental health care for all members of society to promote well-being of the entire population.

People sometimes make vague decisions about the role of technology in their lives, and they may conduct informal cost-benefit analyses in this regard. Consider parents setting limits on screen time with their children, or how you might think about your own technology use and what limits should be set to maximize living a full life. Someone might argue that having a therapeutic relationship with AI bots is a good thing, so we should embrace it. On the one hand, they may have a point. However, more research evidence is needed in this regard, and a move toward therapeutic relationships with AI should prompt us to wrestle with some philosophical questions. Questions such as: How do we determine when technology is serving us versus when we are serving it? Even if AI can help decrease symptoms of depression, are we also sacrificing some important part of humanity or human connection in the process? The therapeutic alliance is the best predictor of counseling outcomes; how does this relate to mental health bots? How does increased reliance on AI for dealing with struggles affect broader society and human relationships? How do helping relationships with AI alter humanity over time?

Instead of sleepwalking into a future that is determined by the tech industry, the counseling profession needs to intentionally address these and other philosophical questions about the potential long-term impacts of AI so that we can thoughtfully influence the future of counseling for the benefit of clients and the profession. My essay is a call to look at the forward trajectory of AI and its potential effects on our field, mental health care and us as a species. In the words of Ilya Prigogine, “The way to cope with the future is to create it.”

 

Donna Gibson is a professor of counselor education, a licensed professional counselor and the
Association for Assessment and Research in Counseling’s representative on the ACA Governing Council.

It seems like our world has been experiencing “change” in warp speed. Constant changes that do not slow and seem to impact multiple aspects of our lives. The perception may seem a little skewed while living during the latter part of 2020, but there were fast-moving changes in politics, climate, economy, health care, immigration and other aspects of our society prior to this year. The year 2020 put an exclamation point on it, in some ways brought things to an abrupt halt, tested our ability to be flexible and try new things, and in many ways forced us to have a new perspective on the present and the future. Personally and professionally, I had to look at the opportunities that were given and what opportunities are there for us in the future.

Quarantine and social distancing measures highlighted individuals’ needs for connection and the importance of relationships. The need for connection to others and to be in relationship with others isn’t surprising to us counselors, and it’s the reason why we are needed. Yet we fulfilled this need in less often utilized ways in 2020 and demonstrated our flexibility in meeting the needs of clients and students. Instead of face-to-face meetings, individuals connected with friends and family more with texts, FaceTime or some form of web conferencing platform (e.g., Zoom). Counselors connected with clients more through phone calls, emails/texts and telemental health counseling platforms, and counselor educators had no choice but to go all in with web conferencing and online course delivery platforms (e.g., Canvas, Blackboard).

I note this change in service delivery because it provides insight into the future of counseling for the next five years. As a profession, we won’t go “back to normal” but rather to a “new normal.” Don’t be mistaken and think I am suggesting that we should not meet clients or students face to face, but utilizing technology creatively will allow for many more and different opportunities to meet with them. If we have a level of flexibility in meeting with clients that exceeds what we have done prior to 2020, then licensure portability is more important than ever before. Because the American Counseling Association is working diligently on a licensure compact among states, I do think we will see portability among states occurring in the next five years.

Writing my thoughts about our profession post-election, it is obvious that we have opportunities to help people examine relationships, practice self-reflection, and engage in conversations and work related to human rights. Protests related to human rights, and specifically Black Lives Matter, highlight the importance of counselors being leaders in anti-racism action. As a profession, we have opportunities and skills necessary to leading in this arena that respect the developmental aspects of self-awareness, empowerment and advocacy. In the next five years, we can lead in educating, training, listening and advocating for change. Change is here but rough around the edges, so our role is inevitable. Our society will continue to present more and more opportunities to lead in the years to come.

The year 2020 highlighted the creative ways that we do and do not attend to our wellness. Wellness is a foundation of our profession, yet many of us struggle with it. In the coming years, we will need to address wellness more intentionally as it impacts multiple aspects of our physical, spiritual, emotional, cultural and social sense of being. Wellness needs to be a priority instead of an afterthought for ourselves, as well as our clients, as we navigate changes in our society.

 

Brandon Ballantyne is a licensed professional counselor, national certified counselor and certified clinical mental health counselor who works at Tower Behavioral Health (Acadia Healthcare) in Reading, Pennsylvania.

I have been a licensed professional counselor for eight years, practicing in varying levels of care that include outpatient, inpatient and partial hospitalization. I believe strongly in the utilization of cognitive behavioral therapy to address symptoms of depression and anxiety that bring individuals into their respective treatment settings.

A silver lining is defined as a sign of hope or positive aspect in an otherwise negative situation. For most, whether in therapy or not, silver linings have been challenging to find in the midst of the COVID-19 pandemic. The pandemic has triggered an increased frequency of depressive thoughts and anxiety-driven behaviors that has culminated in significant psychosocial dysfunction for individuals across the board.

Based on my clinical experience, there has been an increase in suicidal ideation, substance dependence, avoidance, isolation, hopelessness, neglect of self-care, and an overall disengagement from healthy support systems. From a cognitive behavioral context, there has been a need to incorporate a larger emphasis on addressing cognitive distortions that exacerbate the distress-related patterns noted above. I anticipate an opportunity for psychoeducational services to serve a larger role in helping individuals understand the source of their symptoms.

Before symptoms are effectively resolved, it is critical to gain an understanding of where they come from. Symptoms are valid. Symptoms have an origin. The cognitive model can help individuals understand the relationship between stressful events, thoughts, emotions and reactions. Socialization to this model can provide individuals who may not currently be in treatment an opportunity to gain basic awareness of their emotions and basic cognitive restructuring skills presented through an introductory thought log workshop.

Based on my experience, when individuals gain a basic understanding that their emotional symptoms are directly related to their thoughts, and that their thoughts are essentially “sentences” that can be restructured to reduce distress, the result is an experience of validation and a greater sense of control over feeling better and doing better.

I would like to see psychoeducational workshops with an emphasis on basic cognitive behavioral therapy implemented inside of primary care physicians’ offices, community centers, libraries, recreational establishments and fitness centers. The next five years will bring greater opportunity for counselors to reach individuals in their respective communities who may have never had therapy or entered treatment.

Standardized psychoeducational services like the one I have described can assist in creating an easier entrance into therapy services, reduce stigma related to mental health, and reinforce maintenance of emotional well-being as part of routine medical care.

The COVID-19 pandemic has been a worldwide trauma that has led to significant hardship for most. My personal therapeutic philosophy emphasizes that even in the most difficult traumas or challenges, there is a productive lesson, important meaning or strengthening of resilience that can emerge. These constructive conclusions can be extremely difficult to find. They are not often found in our automatic thoughts. They are more likely to be discovered in the practice of cognitive restructuring, positive affirmations and coping thoughts.

Counselors need to take advantage of the upcoming need for standardized psychoeducational workshops in the community. It is our role to begin to offer a blueprint for those much-needed “silver linings.”

 

Dee Wagner, a licensed professional counselor and dance/movement therapist since 1993, is the originator of Chi for Two-The Energetic Dance of Healthy Relationship.

I predict that within the next 10 years, counselors will recognize all therapeutic work as bodywork — an energetic dance that facilitates self-regulation. Now that scientist Stephen Porges’ polyvagal theory has clarified trauma patterning, attachment styles and the role of oxytocin in social interaction, I predict a blossoming of appreciation for one key aspect of the work of child psychiatrist Judith Kestenberg and colleagues, especially dance/movement therapist Susan Loman. Kestenberg and colleagues identify infant rhythms that alternate between ones they call “indulging” and ones they call “fighting.” The indulging rhythms tend to match with parents’ movements, while the fighting rhythms mismatch.

How parents react to the mismatching rhythms plays a role in what Porges calls co-regulation, versus the relational “dances” that result in co-dysregulation. Co-regulation and co-dysregulation name the pinball-rapid passing of responsiveness back and forth between people, which can either facilitate the kind of calming that Shelley Taylor named “tend and befriend” or send us into a fight/flight response.

Fighting: The infant fighting rhythms and the mismatching dances help us individuate within relationship as long as these moves do not trigger fight/flight in our caregivers. Ideally,
as babies, we become aware of our bodies as we squirm in the arms of our parents.

I invite you to experiment with this “dance.” You might push your hands into a desk in front of you or go to a wall and push into it with one foot forward and one foot back. The harder we push into something outside of ourselves, the more we feel into our core. We gain core-to-hand and core-to-foot mindfulness. “When I push into what’s not me, I find me.” This me/not-me dance facilitates social justice.

Once we find ourselves, we have space for curiosity about others. In the me/not-me oppositional dance, we find our ability to support our heads and spines. We find core-to-limb strength that launches us into crawling, walking, running, galloping and skipping. We playfully engage with others. When we become adults and create businesses, we do not want to kill the competition. Who would we play with?

Porges’ polyvagal theory has revolutionized therapeutic practices. The way that polyvagal theory aligns with longtime trauma expert Peter Levine’s understanding of trauma patterning has allowed counselors to better understand human behavior.

I predict that in light of Levine’s studies, polyvagal theory will help counselors better sense the two different dances of activation and calming we have in our bodies — one for when we sense safety and the other for when we sense life-threatening danger. This idea of two activation/calming dances resonates with what attachment theorist Mary Ainsworth recognized as two main attachment styles: secure and insecure.

Results from the Adverse Childhood Experiences study are helping counselors recognize birth, infant and intergenerational trauma patterning. I see the studies of the neuropeptide oxytocin done by scientist Sue Carter helping counselors appreciate how developmental dances play out in our adult relationships. Before the work of Carter, oxytocin was mostly associated with birthing and nursing. Now we are seeing its role in all social interactions. With knowledge of the alternating matching and mismatching infant/parent dances, counselors can begin to see how appreciation of infant fighting rhythms facilitates the “dance” of productive debate in adulthood.

Recognizing the role that infant fighting rhythms play in healthy individuation will help counselors better “dance” within the therapeutic relationship. Clients will become more empowered and consciously use their counseling experiences to finish their unfinished infant/parent dances. A playful sense of self will emanate, facilitating living and working together more creatively.

 

Douglas Guiffrida is associate dean for graduate studies, a counseling professor and director of the mind-body healing and wellness advanced certificate program at the Warner Graduate School of Education and Human Development, University of Rochester, and has a private counseling practice focused exclusively on healing chronic pain.

According to a 2016 study by the Centers for Disease Control and Prevention, chronic pain affects more than 50 million Americans, which is over 20% of the adult population. The same study reports that a staggering 20 million Americans suffer with severe or debilitating chronic pain. In addition, chronic pain is estimated to cost Americans $635 billion a year in medical costs and lost productivity. People suffering with chronic pain are also likely to experience a host of comorbid psychological conditions such as depression, anxiety and sleeplessness, as well as being at high risk for opioid addiction. Chronic pain, therefore, is one of our country’s most pervasive and costly medical issues.

Unlike acute pain, which is short term and alerts people to an injury that needs treatment or rest, chronic pain is long term, often begins without an injury or, in the case of injuries, lasts beyond the normal time of healing. While acute and chronic pain have historically been conceptualized and treated the same way, research now indicates that they are actually two different conditions. In fact, a growing body of MRI research suggests that many forms of chronic pain are actually related to neuropathic processes in the brain rather than structural damage. 

This awareness regarding the role of the brain in chronic pain has dramatically increased interest in mind-body counseling approaches and created significant opportunities for counselors to become leaders in the treatment of chronic pain. One psychological approach that has shown promise in the treatment of chronic pain is mindfulness. The practice of mindfulness, which has existed for over 2,500 years, was introduced to Western medicine in the 1970s by Jon Kabat-Zinn, who founded the Mindfulness Based Stress Reduction Clinic. While research indicates that mindfulness shows only moderate effects in curing chronic pain, it is highly effective in improving the psychological symptoms and physical limitations experienced by people in chronic pain.

A second psychological approach that has shown significant promise not just in improving psychological symptoms and physical limitations, but in actually curing many forms of chronic pain, comes from John Sarno, a physician and pioneer in mind-body medicine. Using the work of Sigmund Freud, Sarno theorized that many forms of chronic pain are actually created by the subconscious mind as a means to distract (or protect) us from experiencing painful emotions such as anger, rage and guilt, which we learned as children to be unacceptable and even dangerous emotions. His approach focused not only on helping his patients experience and express painful emotions, but also on psychoeducation about the psychological causes of pain and behavioral modifications to break the pain-fear cycle. Sarno’s theory has garnered a great deal of attention recently, and numerous studies by physicians and researchers such as Howard Schubiner, Mark Lumley and Allan Abbass support the efficacy of his approach. 

Due to the counseling field’s emphasis on holistic and wellness-focused approaches, counselors are uniquely positioned to become leaders in the development and delivery of chronic pain counseling using mindfulness, psychoeducation, behavioral modification and emotion-focused approaches. In a Counseling Today article titled “A counselor’s journey to healing from chronic pain” (July 2020), I articulated how I implement these approaches in my private counseling practice to heal clients from a wide range of chronic pain conditions. Readers interested in learning more about this significant opportunity for counselors should consult this article. Readers may also consider learning about mind-body approaches by enrolling in the new online advanced certificate program in mind-body healing and wellness at the University of Rochester.

 

Susan Furr is a professor in the counseling program at the University of North Carolina at Charlotte whose areas of interest include professional competency in counselor education, college student development, and grief and loss issues, with particular emphasis on grief and substance use.

When considering the future of our field, it is difficult to separate my views of the future from the current challenges our country is facing. In just a few months, counseling made an abrupt shift in how we teach and how we offer services. I am both amazed by and appreciative of how quickly our field has adapted to the need for online learning and counseling. Technology has become essential to what we do, so our goals for the future need to focus on the research and development of effective online counseling services as well as examining the best practices for online teaching to prepare our future counselor educators to employ a variety of teaching methodologies.

The challenges of the pandemic have created a growing need for mental health resources and revealed cracks in service delivery. With increased issues with substance dependence, we need to make sure all counselors are prepared to assess for substance use disorder and provide appropriate treatment and referral if needed. Although training in addictions has been added to our professional standards, too many counselors do not feel adequately educated to address these issues. There is a tremendous opportunity for counselor training programs to expand educational opportunities in the area of addictions counseling.

The levels of depression and anxiety created by the pandemic have shown us that we need to broaden our concept of grief counseling to include losses beyond those associated with death. While many families and friends are mourning the deaths of those they love, many more are grieving the loss of the normalcy of daily life. The impact of these losses may emerge only over time because of our tendency to minimize the meaning of non-death losses. Missed family connections; lost life events such as weddings, graduations and proms; and disruption of daily routines of work and school need to be recognized as losses that impact our moods. We feel sad but don’t understand our need to grieve. Counselors need to be prepared to understand grief and create space for clients to explore the meaning and ways to cope with these “small” but ongoing losses.

We are increasingly a nation of traumatic events, but perhaps our growing knowledge of neuroscience is creating one of the most exciting times in our field. As we evolve a deeper understanding of neuro-informed counseling, we have the opportunity to improve our ability to train counselors in their capacity to assist clients dealing with the intersecting areas of trauma, crisis and grief. These are specialized skills that are needed by all counselors but often are not addressed in depth in counseling programs. Allen Ivey and colleagues have emphasized how our current theories and approaches are validated by neuroscience and how we can use this knowledge to improve our counseling approaches. Continued research needs to emerge in this area, particularly in examining any differences in online versus in-person counseling.

The emotional turmoil created by social inequities has highlighted the need for the counseling profession to continue to engage in social justice activities. We must address this concern on multiple fronts. First, increasing the diversity of students entering both master’s and doctoral programs is essential to providing counselors who match the diversity of our clients. Next, all counselors need to understand the impact of systemic racism on clients if we are to help clients address external issues that influence personal growth. In addition, we need to be politically informed and involved in helping change policies in ways that benefit mental health.

 

Peter Allen is the integrated care supervisor at Brightways Counseling Group in Madras, Oregon, and enjoys working with adolescents, adults and couples experiencing a wide variety of mental health challenges.

It is probably safe to say that the next 10 years in the counseling profession are certain to be both fraught with peril and bursting with possibility for new discovery and advancement in the field. If the global COVID-19 pandemic has taught me anything as a counselor, it is that everything we know and love is delicate in some way or another. This is not necessarily something to bemoan; some of the most priceless things on Earth are extremely delicate, and their value is in direct proportion to their fragility. I hold this lesson near every day as I consider my own relationships and what the future may hold for my colleagues and myself. If we acknowledge the tenuous nature of things in general, perhaps we can grow our appreciation of everything in real time.

Before the pandemic, who among us recognized that we had long taken for granted seeing clients in person and that we would ascertain the true value of these meetings just as the possibility of continuing them began to slip away? Certainly not me. It has been quite a change for me, and I suspect for all of my colleagues as well. We have had to rapidly pivot from seeing everyone in person and creating a healing physical space, to seeing everyone on a computer screen and doing our best to create a new healing space in the digital sphere. Telehealth is truly a wonderful option for us, as it allows us to continue providing therapy during this time, and it has most likely changed the way the profession will operate in perpetuity. I am grateful that we have an option for continuing to do our work, and one that allows us to provide for our families during this time of great uncertainty.

The biggest challenge in the next few years, in my humble opinion, will be taking care of ourselves in an honest and complete way. Clinicians are all taught to practice self-care, although it has been my observation that most of us are better at giving lip service to this than actually setting up our lives to include it in an effective and meaningful way. Being a therapist is difficult enough in “good times.” I add the quotation marks because our society is rightfully starting to reckon with the fact that people of color and other marginalized communities have not had a chance to share in those “good times.” So, we are challenged to take care of ourselves so that we can show up well for our clients, and continually try to expand our awareness of what those communities have faced for centuries. This will require us to examine long-held beliefs and practices and to evolve clear-eyed and willfully. Change is the only constant, and there is no victory over it to be had. One either makes peace with it or is defeated by it.

However, as always, moments of challenge and disruption create significant opportunities for growth in the long run. I believe the biggest opportunity for clinicians in the next 10 years will be in advancing social justice causes. We have a wonderful opportunity to include and listen to more voices in the conversation, acknowledge the validity of their experience, and serve as humble allies in the long march to equality. Victor Hugo once said, “Nothing is more powerful than an idea whose time has come.” Indeed, the social justice movement is a long-simmering idea whose time has come. We are ready to meet this moment with bravery, compassion, strength and humility.

 

Michelle Muratori, a senior counselor at the Johns Hopkins Center for Talented Youth and faculty associate in the master’s counseling program at Johns Hopkins University, has co-authored several ACA publications, including the third edition of Clinical Supervision in the Helping Professions: A Practical Guide, Coping Skills for a Stressful World: A Workbook for Counselors and Clients, and Counselor Self-Care.

As it is challenging to accurately forecast what will transpire over the next five to 10 days in these turbulent times, I find it even more difficult to predict the changes and challenges counselors can anticipate over the next five to 10 years. If the dysfunction and divisiveness in society persist at a heightened level, I fear counselors will be vulnerable to experiencing burnout, vicarious trauma and compassion fatigue at increased levels. The toxic political environment of the past four years has emboldened those harboring racial animus and xenophobic attitudes to display their hostility and hatred openly and proudly, sometimes with deadly consequences. Moreover, COVID-19 has killed hundreds of thousands of Americans, yet an alarming number of people still consider it a “hoax.” These disturbing developments have left people, including counselors and clients, feeling exhausted, stressed and traumatized.

I will speak for myself. During the weeks, days and hours leading up to the 2020 U.S. election, and after four excruciating years of witnessing democratic norms being eroded daily by our elected officials (and one in particular known for his rage tweets), I was consumed thinking about the fate of our democracy. I often wondered, will democracy win? Will social justice prevail? For that matter, will science prevail? Or will fascism replace democracy, will disinformation and conspiracy theories continue to spread and be embraced over facts, and will white supremacy, structural racism and tribalism continue to be actively promoted?

After the election, like millions of Americans, I was overjoyed and relieved that Joe Biden and Kamala Harris had prevailed. Ecstatic over the historic election of the first African American and South Asian American woman to serve as vice president, I felt like a ton of bricks had been lifted from my shoulders and that my hope for justice had been renewed. I remain optimistic that this new administration will restore dignity to the office of the presidency, repair America’s relationships with allies around the world that have been damaged, and provide us all with hope for a better and more stable future. Despite my optimism, insidious threats that jeopardize democracy continue to weigh heavily on me. It is of great concern, for instance, that the occupant of the White House at the time I am writing this, enabled by high-ranking officials who supported him, refused to concede the election and instead spread dangerous conspiracy theories about it being “rigged” or “stolen.” My heart sank when I saw yard signs that read “Stop the Steal” and “Voter fraud!!” The knot in my stomach reminds me of the painful reality that we still live in an extremely divided nation, one in which people cannot agree upon facts — a nation where a dislike of the “other tribe” is so powerful and runs so deep that it has created a context in which fake news has gained traction and attracted a massive audience.

This brings me back to my prediction about the future. My guess is that counselors will be on the front lines dealing with the emotional fallout of sociopolitical, public health and environmental crises for years to come — crises fueled by the rapid transmission of information (and disinformation) via electronic media. Counselors must be prepared to help clients process their reactions to and cope more effectively with these stressors and also advocate for social change. Counselors should closely monitor their countertransference triggers and be cognizant of how their own worldview may distort their perception of clients holding opposing worldviews. While this has always been important, counselors must be all the more vigilant in polarized times. Lastly, counselors must be committed to practicing self-care regularly to actively combat burnout, vicarious trauma and compassion fatigue. To end this on a positive note, I believe that counselors and the counseling profession will be more relevant and in greater demand than ever.

 

Kevin Doyle is a licensed professional counselor from Charlottesville, Virginia, and an associate professor and chair of the Department of Education and Counseling at Longwood University in Farmville, Virginia.

I think that the most significant development — with elements of change, challenge and opportunity — over the next five to 10 years will be the continuation of the widespread move to virtual service delivery. Delivery through virtual platforms is, of course, not new, but the COVID-19 pandemic forced counselors to adapt on the fly, and many who had not delivered services in this manner had to shift quickly to a new way of working with clients. I would like to comment on each of the three areas noted above: change, challenge and opportunity.

Change: Many of us counselors were trained to provide services only in the in-person environment. I think it is fair to say that some of us looked down our noses a bit at counseling provided through a computer, the internet, etc. Well, we have been shown to be mistaken, in many ways. In my own practice, clients have enthusiastically embraced online service delivery, both for individual and group sessions. They note that things like travel time, parking, weather issues, child care and family responsibilities are minimized when services are provided online. Many have indicated that they wish to remain online permanently.

Challenge: A major implication of the above is that counselor training programs need to include training counselors for online delivery in their curricula. The obvious challenge there is that a significant percentage of counselor educators were trained before online service delivery was common or even existed at all. Getting the educators up to speed on not just the use of online platforms but also how to teach students how to provide services in that manner is a major challenge facing the field. Likewise, accrediting bodies (such as CACREP), certification bodies (such as NBCC) and state licensing boards will all need to make sure that their regulations reflect the recent massive move to online delivery — and the training of those who will be providing it.

A related challenge will be how to accommodate those clients who truly desire in-person service delivery. I have heard reports already of counselors closing their physical offices because they were no longer cost-effective or needed. What will become of those clients who are not interested in online service delivery in such scenarios? Furthermore, there is an equity issue here. Not all clients have functional computers, smartphones or reliable internet access. Will marginalized populations become even more marginalized? The profession has an obligation to ensure that this does not happen.

Opportunity: This move to online or virtual services, of course, also provides a major opportunity. Even though this type of service is not new, it is infinitely more commonplace now. Clients have access to more services from more providers than ever before. State licensing laws, however, can still be barriers because, generally, counseling has been considered to occur where the client is physically located. The current environment presents a tremendous opportunity to enhance access to care for clients. Initiatives such as the current ACA-led interstate counseling compact may finally help to allow counselors to practice in more than one state without having to go through multiple onerous licensing processes. Whatever means are undertaken to address these barriers must prioritize client safety, emergency procedures and the reality that not all counselors practice ethically and safely, unfortunately. This may be a once-in-a-lifetime opportunity, driven by the global pandemic; it is up to the profession to take advantage of the current, albeit tragic, circumstance.

 

Christian D. Chan (he, him, his) is a national certified counselor and an assistant professor in the Department of Counseling and Educational Development at the University of North Carolina at Greensboro.

The year 2020 represented a set of crossroads to allow our profession to do better and be better for ourselves and the communities we serve. Although 2020 culminated in explicit forms of white supremacy, anti-Blackness, health disparities and trauma, I have to remind myself and my colleagues that these issues have persistently shown up over and over again. Sadly, these forces date back several centuries, and many are not entirely external to our profession. In fact, they are conceivably within the auspices of our profession, and our profession is still navigating, resolving and reckoning with them during this time. They are here in our own home.

My hope, however, is that 2020 represents that radical shift for us to revisit our professional identity grounded in multiculturalism, advocacy and social justice. I ask myself again about the next era of counseling to revisit this identity as we practice, teach and advocate. One opportunity for us to consider as a profession is the impact driven by community partnerships and community-engaged initiatives.

Readers may think I am referring to a plunge, legislative advocacy or a cultural immersion project, but community engagement is so much deeper. It is an opportunity for each of us across several specialties (e.g., clinical mental health, school, couple and family, rehabilitation, college) to intentionally build partnerships with stakeholders and invite the cultural capital that already exists across culturally diverse and historically marginalized communities. It is our method of creating equitable partnerships with community stakeholders and community leaders. Many historically marginalized communities already sustain and own the tools, knowledge and wealth of cultural capital within their own communities. This valuable cultural knowledge has also been passed down generationally over centuries. Community partnerships become a way to signify that their lives and stories — often stories that counter oppression — ultimately do matter.

Community partnerships and engagement can be implemented across numerous sectors within the counseling profession. For instance, counselor educators can design a major class assignment that addresses counseling and mental health literacy among community members. Counselor educators and their students can collaborate with community leaders to angle their counseling literacy and mental health literacy initiatives in culturally responsive ways. Within community agencies and schools, community-engaged projects similar to these ideas can also identify pathways for community stakeholders and members to feel empowered to access their counseling services. Julia Bryan’s work in school-community-family partnerships is a serious testament to employing culturally responsive partnerships to further engage culturally diverse and historically marginalized students, especially students who are Black, Indigenous and people of color. I ask counselor educators and counselors, however, to intentionally build these partnerships and sustain them, so that they seek continuous input from community stakeholders and leaders rather than making them one-time events.

Professional associations are not removed from these possibilities. For instance, ACA divisions such as the Association for Specialists in Group Work and the Association for Multicultural Counseling and Development have enacted a Day of Service to coincide with contemporary issues of multiculturalism and social justice and to meet in partnership with local communities surrounding conference venues. Because professional associations hold a significant role of leadership within the profession, they can continue modeling and providing these opportunities for members to intentionally engage with their own communities.

When I ask myself again about the opportunity for the profession, we can be bolder, think critically and institute crucial community partnerships to further engage our communities. Although community-engaged initiatives and community partnerships have existed, I call our profession to further expand these opportunities in teaching, supervision, practice and service. These relationships can play a part of the healing in our society, and I have hope that we can still dream bigger and better together as a community and in solidarity.

 

Jude Austin is an assistant professor and clinical mental health counseling track coordinator at the University of Mary Hardin-Baylor, an American Counseling Association book author, and a private practitioner in Temple, Texas.

Change: Paradoxically, everything and nothing will change over the next five to 10 years for the counseling profession. What works in counseling — building a strong therapeutic relationship — will continue to work. Although, how counselors build that therapeutic relationship will change by varying degrees. The change is already happening as the global pandemic pushes counselors into virtual or some hybrid form of practicing counseling. To meet clients’ needs, counselors changed how they meet clients. Counseling no longer just happens in cushy offices. Counseling is on the go.

Portability is the future of counseling. Not only state-to-state clinical licensure portability, but counselors themselves are, and will continue to be, portable. Therapy will occur through multiple platforms: in-person, synchronous phone and video, asynchronous and synchronous messaging, a combination of those options, and more. Clients will come to counseling while driving to work, in a tractor during lunch breaks, while folding laundry, sitting on the porch or holding a sleeping baby. Counselors will need to meet clients where they are, wherever they are.

Challenge: That change will challenge how counselors meaningfully meet clients in the next five to 10 years. How do we ethically and morally provide care for a mom who is working through trauma, while her children are audibly making a ruckus in another room? This essay does not have the space to unpack all ethical concerns. However, the mandate of doing no harm will be expanded. While counselors will become more accessible, clients face greater risk of unintentional harm as counselors adjust to new therapeutic milieus.

While there may have recently been a collective competence growth in telecounseling, competence does not equal quality. Being with clients through multiple platform options may not be a natural way of doing counseling for some clinicians. Some counselors grew up developing virtual relationships. Others might scoff at digital communication. Regardless of the counselor’s era, all counselors will need to develop different communication skills and sharpen their perceptual senses to be effective over the next five to 10 years.

The common factors of effective counseling will look and feel differently through text compared with face-to-face sessions. Remaining present can be difficult while the trash truck decides to drive through the entire neighborhood in reverse during a session. Offering clients genuineness, unconditional positive regard and empathy in a message might feel both familiar and strange. Doing so will require developing a different therapeutic muscle.

Counselor educators will be challenged to prepare students for these new ways of being with a client. Some students are fair writers but shine when face to face, and vice versa. In the next five to 10 years, students will have to see all elements of communicating with clients as an opportunity to build a strong therapeutic relationship. Ways of assessing students’ abilities might change. Basic counseling skills might include a certain level of tech savviness. Professionalism might include emails or message response time. Professional attire might include lighting, pictures and other visible items during a virtual meeting.

Opportunity: Perhaps a silver lining throughout the changes and challenges counselors will face in the next five to 10 years is the demand for more highly skilled clinicians. If my caseload is any indicator, therapy has become “cool.” Finding a good therapist is like finding a good pair of jeans, and clients are shopping. Portability will give clients more options to find the best fit. This will be threatening for counselors who make their living based on clients’ limited service options. All counselors will have an opportunity to raise their game, which can only better serve clients.

 

Ann Ordway is both a lawyer and a counselor educator, serving as the college academic director of counseling for the University of Phoenix.

The year 2020 has presented so many challenges that I predict will have a lingering impact well into the next five to 10 years. Not only have we faced an international pandemic that has resulted in significant illness and death, but we have also become more isolated from one another, and the way we interact with others has been forever changed. 

Individual experiences of grief and loss carry an unfamiliar complexity as mourners have been unable to sit with a dying loved one in the hospital and then been unable to engage in traditional mourning rituals due to restrictions on public gatherings. We have been challenged by a level of civil unrest largely influenced by a controversial election and a justified movement designed not only to bring attention to social injustice but also to increase multicultural awareness, competency, sensitivity, inclusion and respect. There is so much work ahead of all of us.

Of course, with these challenges, we have experienced drastic increases in depression, anxiety and overt manifestation of mental health issues. Moreover, with requirements for social distancing, more people have been working from home. Live conferences have essentially gone away — and the most social beings grieve the loss of personal contact. Families have been relegated to FaceTime. Children, during a stage in their development when socialization is critical, have been attending school online or are restricted from meaningful interactions with peers. I suspect we will see the continued emergence of nuances of posttraumatic stress disorder because the experiences of 2020 have clearly taken a toll. As counselors, we will need to be prepared to support an increase in the number of clients seeking services.

Self-care will become more essential as we navigate the uneasy waters that will continue to be present. We will need to be mindful of compassion fatigue, vicarious trauma and burnout, especially as we endeavor to be life preservers for our clients who are desperately trying to find a new normal. We have not been insulated. We have been personally and professionally impacted — and we need to rise to the challenge while also finding our own new normal, both in how we live and practice. 

With challenges also come opportunities. Counselors are role models for patience, empathy and endurance. I suspect we will be called upon to model social interaction as clients start to relearn the art of interpersonal relationship and communication. We are well-trained, and with an increased need for services, I suspect counselors will be busier than ever before. Our focus on self-efficacy will serve us well in helping our clients build resiliency and coping skills and bounce back from the pervasive impact of the extensive societal trauma of 2020.

Counselors are flexible and adaptable professionals, and in an ever-changing world with old challenges persisting and new challenges emerging every day, we are uniquely situated to support the very many people who do not share our resiliency. We will be more involved and more highly regarded over the next five to 10 years in arenas where our previous presence has been scarce, including with Medicare, in Veterans Affairs locations, and in court proceedings as experts. I see us growing and emerging as a stronger collective group of professionals as we move through the next decade — and I, for one, am excited about the emerging opportunities as we move forward. It is not just about where we have been, it is where we are going.

 

Laura Shannonhouse is an associate professor at Georgia State University whose research centers on crisis intervention and disaster response.

The surreal reality of 2020 has emphasized one sad truth: Too many people are far too isolated. Our collective, individualized suffering is an ironic tragedy, and it literally costs lives. Struggling to belong cuts across the life span and widening class divides. From older persons who are homebound to bullied adolescents, and from those who agonize over how to best craft a social media post to those consumed by the drudgery of excessive working hours, all too many individuals are unacknowledged, are unconnected and feel unloved.

When we look at the history of our profession, one typically forgotten and ignored group has been older adults, which happens to be the fastest-growing demographic and the hardest hit by COVID-19. Millions of older adults have struggled with isolation, worthiness and mattering, yet gerontological counseling was dropped as a specialty area, and structural barriers (i.e., Medicare reimbursement) have made working with this population difficult. During COVID-19, physical distancing interventions needed to protect older adult health have been isolating, and medical ethical guidelines that prioritize the care of younger patients signal the expendability of older adults. As research has shown, chronic loneliness and social isolation foster thwarted belongingness and perceived burdensomeness, which interact to predict suicide desire. On average, an American over age 65 dies by suicide every hour. Many other suicides go unreported (i.e., voluntary stopping of eating and drinking, withholding of medical treatment, etc.) or are miscategorized as accidents. COVID-19 has exacerbated the psychological states which lead to suicide, and those deaths of despair punctuate the point that too many people, of all ages, have decreased quality of life because of their isolation.

Fortunately, suicidality is highly susceptible to intervention, and professional counselors are uniquely equipped not only to effectively intervene, but also to foster growth through adversity. Combating social isolation, fostering belongingness and buffering perceived burdensomeness interrupts the pathway to suicide. Because we are also researchers, we are well-positioned to collaborate with policymakers and federal entities that want to address social problems. Scholarship on outcomes from evidence-based approaches can drive policy. As a multiple recipient of Health and Human Services funding, I’ve had opportunities to dialogue across agencies (i.e., Administration for Community Living, SAMHSA, Veterans Affairs), which has been incredibly hopeful. When we come to the table with innovative solutions grounded in rigorous research at the systemic level, we can and do make a difference. One example of this is a prolonged campaign of lobbying that has almost made Medicare reimbursement for professional counselors a reality (kudos, ACA!).

At the individual level, when we connect with older adults, we have the opportunity to learn from their incredible wisdom, lived experience, resilience and insight. My lab (HOPE lab) at Georgia State University works with approximately 700 racially diverse older adults, and my students remind me, “If we are lucky, we will one day be future older adults.” The upcoming generation of future clinicians and educators is smart, hardworking, big-hearted and critically conscious.

They and you can be at the forefront of the solution to the social isolation problem. It is pervasive across populations and will undoubtedly be part of our clinical work, no matter who our clients are. Professional counselors have the tools to do this work, and we can be creative, strategic and persistent. I think that over the next decade, our greatest challenge will be engaging with systems to foster meaningful, reciprocal, prolonged connections for all persons. Humans are by nature social creatures, and professional counselors have the opportunity and responsibility to ensure that truth is validated, supported and realized.

 

Anabel Mifsud recently earned her doctorate in counselor education and supervision from the University of New Orleans, where she is currently teaching as an adjunct professor.

Our ability to predict the future has never been so sorely tested as in 2020. The unprecedented events of the past year were a sobering reminder that the inconceivable can happen, but they also illuminated a range of issues that have the potential to shape the future of the counseling profession in the next decade.

The COVID-19 pandemic not only has endangered people’s physical health, but also has put a strain on vital social connections that sustain our mental and social wellness. Advancements in technology, however, have enabled counselors to continue serving clients and communities in these trying times. The benefits of technology in counseling have never been in plain view until 2020, and the increased reliance on technology is here to stay.

As technology continues to proliferate and wield greater influence on the counseling profession, counselors need to be increasingly mindful of the clinical, ethical and social justice implications pertaining to the use of technology in counseling practice. Counselors are required to become savvier consumers by broadening their knowledge on the inner workings of these tools and their impact on client welfare and therapeutic success. We cannot afford to drag our heels on this front or relegate this responsibility to computer scientists. Additionally, counselors must advocate with technology developers for technologies that are tailored to meet the needs of diverse clients and promote equitable access to behavioral health services.

The disproportionate toll of the COVID-19 pandemic on people of color and the racial reckoning that ensued after the killing of George Floyd have laid bare the persisting social inequalities and systemic racism that threaten the lives and mental health of Black, Indigenous and people of color. As the counseling profession journeys forward, it must remain committed to its social, moral and ethical obligation to advocate for inclusive, just and safer healing spaces and societies. When one considers the highly charged and polarized sociopolitical landscape that we find ourselves in, the stakes have never been higher, nor have the opportunities for growth.

Counselors are uniquely positioned to help repair the rupture in our social fabric and redress social ills through healing and reconciliation efforts. Such a lofty pursuit, however, cannot be championed by any single profession. In these pivotal times, we must join with professionals in other disciplines to promote a culture of compassion, healing and respect for human dignity. Interdisciplinary cooperation is our best shot to address some of the macrosystemic challenges facing our human family. Additionally, the sheer magnitude of these problems highlights the need for more collective interventions, and thus the counseling profession may have to refashion how it pursues its goal to empower people to attain mental health and wellness.

Climate change is another looming crisis that has already wreaked destruction and mayhem across several communities in the U.S. It is another existential reckoning of sorts, and human survival hangs in the balance. It is a challenge that the counseling profession cannot sidestep. Counselors need to be fully equipped to help affected communities deal with the psychological and emotional costs of this existential threat and rebuild in the wake of disaster. As a profession that is grounded in the wellness model, counselors must go beyond remedial action and engage in preventive measures that can help communities develop climate resilience and advocate for sustainable lifestyles. It is an opportune time for the counseling profession to align its mission and efforts with some of the global goals endorsed by international organizations such as the United Nations and take a seat at the table with other experts to address global challenges that transcend national borders.

 

Sylvia Nassar is a scholar, leader, advocate, mentor and counselor educator at North Carolina State University.

I used to tell my kids, “Today is the first day of life as we know it!” They rolled their eyes then but are experiencing that phenomenon firsthand now. The present-day twin pandemics illuminate the priorities for which the counseling professional was already poised, as well as ones that may have been less obvious. Evolving service delivery models, social justice advocacy, workforce development and expanded counseling interventions represent foci for professional counselors in the upcoming decade.

I recall what a controversy was stirred up many years ago when the NBCC rolled out its ethical guidelines for distance counseling. I also remember serving my state’s LPC board some years later and grappling with the definition of “face-to-face” counseling. Counseling, and its service delivery, will likely never return to what it was before 2020. Regulatory, credentialing, educator and many other stakeholder groups have done admirable work trying to adapt to the COVID-19 pandemic in flexible and ethical ways. These efforts will continue to require creative and reflective professionals to redefine and update credentials accordingly.

The parallel pandemic of exposed structural racism illuminates the need for true multiculturalism and social justice competence and reform. Certainly, the recent unmasked cases of police brutality, particularly perpetrated against Black men, warrant alarm and immediate action. Restorative justice and other Black Lives Matter initiatives need to be mandated, not only in words, but through active advocacy. At the same time, we need to balance the growing knowledge base about intersectionality for all marginalized groups from a social justice lens. Hate crimes against so many marginalized groups hit all-time highs during the Trump administration. The tension between these concomitant yet seemingly conflicting goals creates tenuous balance. The counseling profession needs to learn how to use politicization as a tool rather than allowing it to become a distraction. The Multicultural and Social Justice Counseling Competencies (MSJCC) can provide a helpful framework to guide practice, research and policy. In turn, emergent research will inform the next iteration of the MSJCC.

These phenomena are readily apparent within the broad sphere of the labor market both domestically and globally. Workplace inequities across intersectional marginalizations run rampant in all levels of the workforce. These pandemics underscore not only the social justice imperatives of a more-inclusive workforce, but economic ones too. True change will require that current power brokers share their power — in other words, that commitment to multilayered equity occurs both from the top down and the ground up. This power shift will facilitate actual changes rather than superficial ones. The restructuring of the labor market to meet the rapidly evolving pandemic needs provides both challenge and opportunity to level out playing fields while responding to crisis — “building the plane as we fly it,” so to speak. The voices of marginalized individuals and stakeholder groups must be heard. Organizations unwilling to buy into this post-constructivist ideology will become obsolete.

As far as counseling interventions, the growing need for biopsychosocial perspectives is apparent. Counseling and allied health professions need to become better collaborators. As a breast cancer warrior currently undergoing chemotherapy, I am aware of the ways in which our traditional medical practices fall short in terms of supporting mental and holistic health. Counselors and researchers have increasingly recognized the value of broader approaches — for example, mindfulness and neurofeedback. We need to join our interdisciplinary colleagues in creating new evidence bases for these emergent interventions.

Moreover, we need to incorporate mental and other holistic health indicators in all systematic program evaluations of counseling and counseling-relevant program and service delivery. These efforts will facilitate accountability among stakeholders. More importantly, program evaluation should inform counseling practice, research and policy in a tripartite approach. This integration is the quintessential model of the 21st century.

 

Michele Kerulis is a licensed clinical professional counselor in Illinois and the Association for Multicultural Counseling and Development Midwest Region representative.

I think some of the most challenging things counselors have faced in our lifetime are related to the COVID-19 pandemic, and we will continue to navigate the difficulties of this time. I am pleased to see the community embrace technology as an asset to address many of these problems. While we have noticed the negative impacts of technology, like the fast dissemination of inaccurate information and cancel culture, we have also witnessed positive aspects, like teaching others how to conduct telehealth sessions, helping our older adult population learn how to use videoconferencing to connect with their families, and sharing free resources related to mental health with a wider audience. I have faith in my colleagues to be pioneers to advance the accessibility of counseling.

I am passionate about accessibility and about helping people learn about the positive impact of movement on mental health and wellness. One silver lining of the pandemic is that fitness studios offered free online fitness classes for all skill levels to help people feel a sense of control in an otherwise uncontrollable situation. One of the most significant opportunities for the future of counseling is for our field to recognize the impact of the mind-body connection and how movement and exercise can be a game changer for people on so many levels.

When people say they are intimidated to try exercise or movement to address wellness, I use encouragement from an Adlerian perspective, emphasizing effort over outcome and intrinsic motivation over external factors. I love using exercise and sports as analogies for how to create and live a successful life. Of course, the definition of success varies from person to person, and it is clear that people have unique circumstances, sometimes out of their control, that interfere with their life goals.

Examining these circumstances creates an opportunity for counselors to understand multiculturalism and marginalization in new ways. As counselors, we are responsible for understanding the barriers our clients face, for helping clients process these barriers and for advocating to have barriers removed.

A marginalized population within my specialty area of counseling includes people who have injuries or physical disabilities that limit their capacity to engage in activities. Physical disabilities, along with racial and socioeconomic discrimination, have resulted in exclusion and disrespect.

As a counselor who works with athletes and exercisers, it is not only my responsibility to understand human growth and development through the stages of life, it is also my responsibility to understand interruptions to stages of development, including injuries, illness and unexpected interference to people’s physical and cognitive states. This often-neglected population is provided with limited resources. Fortunately, there are several organizations dedicated to helping people who have experienced physical challenges engage or reengage in an active lifestyle. Organizations such as Dare2tri, Wounded Warrior Project, Special Olympics and Disabled Sports USA offer inclusive and supportive environments for adaptive athletes. In fact, many major sports, including marathons, cycling, basketball, snowboarding, surfing and weightlifting, have adaptive sports divisions.

My passion to help people of all physical abilities learn how to live balanced, active and healthy lives guided my career choices. I feel lucky to have the privilege to help clients understand how to navigate and process their own situations and to help them define and achieve their own ideas of personal success. I do believe that a major opportunity area for the counseling field is helping people of all abilities learn the joys of movement, enjoy more outdoor spaces and connect with one another through technology and group fitness.

 

Monica P. Band is a licensed counselor and owner at Mindful Healing Counseling Services in Washington, D.C., as well as an adjunct professor of counseling.

I want to preface this by saying that I do not believe this is a new challenge. Rather, it’s an ongoing challenge with a great opportunity for change. For many counselors, we were distinctly trained to do our best to distinguish between our personal selves and our professional selves — keeping boundaries clear. In this way, counselors continue to keep a veil of power and authority by distinguishing between client and counselor. However, COVID-19 and the increased use of telehealth has invited clients into our homes.

For some counselors, we do not have the privilege of having a separate or quiet home office. Rather, our clients begin to gain a deeper insight into our personal lives through the surroundings they see behind us. Additionally, COVID-19, globalization, social media and the sociopolitical climate of our nation blurred these boundary lines further. Counselors and clients are truly experiencing a global pandemic and existential crises together. For example, counselors are not unaffected by the racism within this country, and we should not pretend otherwise. This experience has me thinking about our profession and how we support our clients for the next five to 10 years.

For instance, I believe the psychological impacts of the pandemic will last for several years. Even in imagining a time in which we would transition in becoming more social through in-person engagement, we will need to begin to contend with anxiety, grief and complicated trauma. I anticipate that people will also be working on redefining their lives, as I have noticed some clients already doing. With experiencing an existential crisis often comes a confrontation of how one is living their life and the meaning they are making within the life they are given. I have worked with and witnessed clients struggling with and reconciling feelings of not living authentically and the grief that comes with missed opportunities when considering their mortality. The opportunity and gift I believe COVID-19 has given us is a chance to reconstruct rather than live in complacency. Both the challenge and the opportunity are for counselors to wake up and become activists.

I anticipate that counselors, if they are not already, will need to begin to become more competent and comfortable in thinking systemically and existentially on issues such as racism, climate crisis and COVID-19. Counselors have the challenge of no longer being natural or hiding behind a veil of power. I think the challenge and opportunity will be in the balance of making our stance on social justice issues known while being able to support both those who are like-minded and those who are not.

 

Victoria E. Kress is a licensed professional clinical counselor and supervisor, a national certified counselor, a distinguished professor, and the president of the Association for Humanistic Counseling.

Many evolving factors are sure to influence the counseling profession over the next decade. At this writing, America is wrestling with a global pandemic, a long-overdue reckoning with systemic racism and a politically polarized country. Climate change, exponential population growth and other factors will contribute to a further shortage of resources, and society will struggle with the conflicts that will ensue. However, as counselors, we know that all struggles hold opportunities for positive change. In fact, very often the most meaningful changes emerge out of conflict.

Many of the most important legislative decisions are made in times of crisis. It is important that counselors leverage the legislative and policy decisions that will be made over the next few years to help grow our influence and access to resources so that we can stay healthy and support our clients over the next decade.

Counselors are generally fierce advocates for vulnerable, disenfranchised populations, and client advocacy is foundational to who we are as counselors. That said, we are not always as good at advocating for ourselves as we are for others. While it is uncommon to speak of professional counselors as being discriminated against or oppressed, there are many examples of professional counselors not being accorded the respect and privilege associated with our training and credentials.

Some counselors may perceive that advocating for the profession is self-serving; however, we cannot do what we were trained to do — that is, help others — if we cannot practice in the way we were trained to practice or be reimbursed for providing services. As such, counselors must continue to grow as advocates not just for clients, but also for our profession.

Recent events have invited opportunities for all counselors to grow as advocates. Passion is the foundation of advocacy, and more than ever, we are seeing counselors express their passion. This passion can be used as an opportunity for counselors to learn about the legislative process and how to be effective in this arena. This past year, we also witnessed unprecedented numbers of Americans engage with the political process. This increased awareness of the legislative process and an understanding of how counselors can be effective legislative advocates is an additional opportunity we can use to support our profession as we move forward.

Many advances have been made around the growth of the profession. Most notably, we now have counselor licensure in each state, and we are able to be reimbursed by many third-party payers. We are, as a profession, enjoying a comfort we have not historically had, yet we have so much work left to do. The work never ends because daily, policymakers are making decisions that impact our ability to practice.

As we have seen in recent times and throughout history, when people are comfortable, they tend to not engage as much in the political process. Because counselors are not struggling mightily for recognition — as we have in the past — new and emerging generations of counselors may not understand the value and importance of sustained professional advocacy efforts, and this could be devastating to the health of our profession.

Recent events, while challenging and uncomfortable, have created opportunities that counselors can pull upon to support our profession, and thus the clients we serve. Moving away from spectatorship and toward active participation in political and legislative processes is critical to the sustained health of the counseling profession.

 

Sue Pressman is the president of the American Counseling Association, a private practitioner focusing on career development, a business owner, and an employer of counselor consultants for more than 30 years through Pressman Consulting LLC, with her largest client being the federal government.

What will the profession of counseling look like in the future? Often when people think about the future, they think of technological advancements such as hovercrafts, holograms and artificial intelligence. What about the importance of developing business skills that will help professional counselors become “business wise” ? All industries are going through a transformation to make services accessible to a multicultural and global society. There is intersectionality among peoples, services and currencies. Recognizing this, the business-wise professional counselor is poised to find increased and diverse opportunities to build their network in a domestic and global market and expand into what is being referred to as the gig economy.

The term gig economy has been around for decades and involves a temporary work arrangement with an individual being paid for a specific job, task or project. The latest U.S. Census Bureau nonemployer statistics report that self-employed individuals increased 19% from 2005 to 2015 and continue to grow. Gig workers can be service or goods providers such as musicians, entertainers, artists, retailers or trainers. They can be any worker not in a permanent position. The final component is the consumer. In the world of counseling, we may refer to ourselves as mental health, rehabilitation, career or employment counselors, just to name a few of our specialties. The final component or recipient of counseling services is the “client” or, in business terms, the consumer of our services.

How can counselors tap into this freelance “gig” workforce? The simple answer is for counselors to increase their business skills. To narrow the business skills gap, counselor education and supervision graduate programs might investigate weaving in basic business skill development into curriculums. This could include practice management, business development, accounting, finance, investing, marketing, strategic planning, delegation and negotiation. The pandemic has shown us that counselors are naturally resilient. When our in-person method of service delivery challenged us, we were quickly able to pivot and provide responsive services to those in need through new platforms such as telebehavioral health.

As we look to the future, counselors’ ability to adapt, create bridges and develop new skills is evident. The new world we live in has demonstrated, in the words of Sam Gladding, that “mental health is part of public health.” This is the beginning of our infusion into the mainstream public health arena and the gig economy where we will discover more opportunities for multiple income streams beyond a regular paycheck. The business-wise counselor will inevitably find new ways to innovate, influence and initiate systemic change on both micro and macro levels, resulting in counselors as consultants.

Counselors as consultants have existed in our profession for a long time. However, counselors thriving in a gig economy is something to consider for the future. Approximately 150 million people in North America and Western Europe now work as independent contractors. Gianpiero Petriglieri and colleagues conducted a study with 65 gig workers in 2018 and discovered that successful gig workers cultivated four types of connections: place, routines, purpose and people.

These four types of connections align with many aspects of counselors as consultants. Creating space, time, access and location are aspects when considering one’s place for conducting services. Those who had routines and schedules had enhanced focus and performance. As counselors, part of our purpose is to help others, and this purpose serves as a means to also earn a living. Finally, people such as our family, friends and colleagues can serve as supportive collaborators on our entrepreneurial journey.

“Success in the gig economy comes from a balance between viability and vitality.” — Gianpiero Petriglieri, Susan J. Ashford and Amy Wrzesniewski (2018)

 

Heather Trepal is the immediate past president of the American Counseling Association and a professor at the University of Texas at San Antonio.

The COVID-19 public health pandemic has changed our world. Although some say they can’t wait to get “back to normal,” the stark reality is that our world has forever changed, and we cannot go back to the way things were before. The pandemic has changed public health and shone a brighter light on health care disparities, and it will leave a trail of lingering physical, economic and psychological effects across the globe. The need for behavioral health care services will increase like never before.

Counselors must be prepared to meet this demand. There will be increased opportunities to develop integrated systems of care where physical and behavioral health care needs can be addressed together in new and innovative ways. In response, counselor training needs to be amplified to focus on preparing counselors to work as part of an interdisciplinary team. The counseling profession’s foundational focus on prevention and wellness will also become increasingly important.

Stigma and inequities in access to behavioral health care services will remain challenges. Counselors must be willing to be at the forefront of the battle. Stigma is a barrier to help-seeking. Others, such as professional athletes and celebrities, have become increasingly visible in their efforts to address stigma. However, counselors must also be prepared to do the difficult work of raising awareness about mental health. It is imperative that we increase our efforts to educate the public about who counselors are and what we do. Counselors need to break down barriers in service delivery and access and utilize upstream interventions to get ahead of the challenges in this area.

The increased focus on health care disparities will promote a much-needed awareness of their impact on access and care among professionals and the public. Racism is a determinant of physical and behavioral health care inequities. Anti-racism efforts will increase both in behavioral health care and in the counseling profession as a whole. Enhanced methods of counselor training, research and service delivery will be developed with an increasing eye toward social justice. Other inequities include language barriers. The profession must commit to recruiting and training bilingual counselors.

Finally, I believe the future will see a rise in counselors owning their role as advocates for our profession. We work hard to advocate for and with our clients to meet their needs. However, counselors also need to make certain that we have a seat at every proverbial table we can. We are a well-prepared profession. We need to be able to serve our clients, and we also need to be able to earn a living! Graduate programs will focus on enhancing advocacy skills and provide counselors the opportunity to both advance our profession and serve our clients and communities. Our new professionals will be role models as a workforce generation that takes the counseling profession to the next level.

 

Cirecie West-Olatunji is a professor of counseling and director of the Center for Traumatic Stress Research at Xavier University of Louisiana, a past president of the American Counseling Association and the Association for Multicultural Counseling and Development, and editor-in-chief of the Journal of Multicultural Counseling and Development.

When I think about the direction of the counseling profession over the next five to 10 years, I think about the most recent spotlights on social injustice in the U.S., and I also think about how established we are becoming as a profession. Along with that comes the possibility that we may be losing our edginess.

Without a doubt, the year 2020 was one of the most challenging of our lifetimes. For me, I saw it as a triple pandemic in which I, as a Black female counselor educator, was faced with the existential threat caused by COVID-19, coupled with graphic evidence of police brutality, and topped with climate change. Like many, I was personally aware of the day-to-day micro- and macro aggressions that Black people and other people of color experience in our society. So, when the first few news articles about the brutal killings of Black men at the hands of law enforcement officers were sweeping the media, I was not surprised. However, the additive effect of COVID-19 and the multiplicity of news articles that were so prevalent over the summer took my breath away. To make matters worse, as a New Orleanian, I dodged six of seven hurricanes in the fall, only to be hit by Hurricane Zeta that knocked out power and internet access for days on end.

Throughout this all, I participated in an ACA special task force looking at ways to mitigate the impact of structural racism on Black ACA members and the general public. While I was pleased to see how quickly the ACA leadership desired to create change, I was also disappointed by our seeming inability to move expeditiously as an organization. So, at that point, I realized that we, as an organization, have this challenge of actualizing our belief in social justice and equity. We write about it. We present on it. We may even teach about it, but we are having a hard time turning that lens inward to explore and assess what inequities exist within our counseling programs, for example. How can we use our knowledge of the Multicultural and Social Justice Counseling Competencies to transform the lives of the students we teach and the colleagues with whom we work? I think this is a huge challenge.

The other challenge is also an opportunity. When I began my master’s program many decades ago, we were still the new kid on the block. We’re still new, but I don’t think we’re that edgy anymore. In many ways, it feels like we are losing our groove, and someone should ask us, “How can Stella get her groove back?”

You may ask, “What are some of the exciting areas where the windows of opportunity may be closing?” Well, have we really begun to integrate neuroscience into counseling in the U.S.? Do we really value the partnerships that we created with our sister organizations abroad? Do we genuinely teach about culture-centered counseling theories so that our students can employ them in their internships and beyond? What do we know about infant mental health or pediatric counseling, and are our graduates in private practice specializing in working with children during early childhood?

I think we need to get our groove back. Now that we are established as a profession, we don’t need to be like the other guys. We’re different, and I’ve even heard some counselor educators say, we’re better!

 

Samuel T. Gladding is a past president of the American Counseling Association and a prolific author of books and articles on multiple aspects of counseling.

Counseling as a profession is ever-changing, as is the future. When I entered the field 50 years ago in 1971, counseling was not regulated. Anyone could hang out a shingle and claim to be a counselor. Then came what I call the “turf wars” where psychologists, psychiatrists and others tried to define counseling and argued against it becoming a profession. Ouch! However, because of the heroic fighting of individuals like Ted Remley, Tom Sweeney and others who saw the future, counseling emerged. The American Personnel and Guidance Association became the American Association of Counseling and Development in 1983 and, finally, the American Counseling Association in 1992. Certification from NBCC, accreditation of counseling programs from CACREP, and licensure from individual states, starting with Virginia in 1977, happened.

The point is, no one in 1971 could have predicted where counseling would be in 2021. Therefore, trying to predict how counseling will change in the future is close to impossible because of so many variables. Nevertheless, I will take a chance and focus on changes, challenges and opportunities for counseling in the next 10 years.

It is 2031! People in the United States still remember the coronavirus pandemic and its negative social and emotional impact. Therefore, they are continuing to talk about what constitutes good mental health. The opportunity is a challenge for counseling and counselors to be in the conversation about promoting wellness and well-being practices. While there are still counselors involved in treatment, many professionals are involved with individuals, community organizations and industries in finding ways to publicize and implement evidence-based research geared to having positive affective, behavioral and cognitive outcomes. Emphasis is on sharing meaningful experiences. Practices such as mindfulness, nature therapy, and “savoring” significant events and encounters are emphasized.

Technology has advanced and is used more by counselors. It promotes a change in the way counseling is conducted. It has not replaced person-to-person interactions in prevention or treatment. Rather, technology has become more of a tool in counseling than ever before. Counselors have been challenged to be more proactive and have developed realistic and individualized video games with names such as “Choice” and “Life.” These games are used by clients between sessions to help them see the outcomes and impact of what they do or plan to do more clearly. They are used with populations from 8 to 80.

Since counseling is now a worldwide profession, there are more international exchanges and novel ways of practicing as a counselor. A major change is that international accreditations are more prevalent and influencing counselors in positive multicultural ways more than ever. Worldwide learning about counseling practices is now an opportunity that is utilized.

Of course, neuroscience is lighting up more than regions of the brain in 2031. Specific applications from using neuroscience are prevalent. Counselor education and continuing education are filled with courses on the use of neuroscience, especially with people who are having difficulties coping because change is so fast. The term “change fatigue” is a term in the Diagnostic and Statistical Manual of Mental Disorders, with offshoots of anxiety and depression spinning off of it.

In addition, the American Counseling Association has changed. Its championing of interstate recognition of counselor licensure in the 2020s has made counseling stronger nationally. ACA is a major influence on counseling internationally too. One of its major foci is the producing of materials — films, books, pamphlets — for the well-being of the general population.

While the future is not ours to see, most likely many of the visions here will occur. Time will tell how they will be!

 

S. Kent Butler is president-elect of the American Counseling Association and has been appointed interim chief equity, inclusion and diversity officer at the University of Central Florida.

Change is on the horizon! History will show that the past few years have positioned the counseling profession to be the vehicle for this change, and we are proactively answering the call for transformation. Technology has evolved and will always carry us forward in very innovative ways. However, moving forward, contributions such as the Multicultural and Social Justice Counseling Competencies (MSJCC) will offer the muse that challenges the counseling community and affords us opportunities to grow both personally and professionally. The MSJCC proffer an empowering framework that encompasses meaningful advocacy. Exciting initiatives are imminent, similar to those provided by the Cultural Encounters Task Force — ACA members who are standing in the gap and extending to counselors evidence-based practices designed to help facilitate difficult dialogues pertaining to race and culture. ACA membership is being handed a road map and given insight that will help to mitigate and dismantle racism within our society.

As ACA’s 70th president, I look forward to future collaborations and leading ACA’s mission to promote the professional development of counselors, advocate for the profession, and ensure ethical, culturally inclusive practices that protect those utilizing counseling services. To date, ACA boasts 69 years of incredible leadership. However, only a limited number of underrepresented leaders have led the charge. Great strides must be made to mentor into governance aspiring leaders who represent ACA’s diverse membership. To this end, “The Giraffe and the Elephant — A Modern Fable” provides a real glimpse into our inner workings and efforts to embrace inclusion. It is a powerful narrative that showcases how insiders (giraffes) and outsiders (elephants) build inclusive environments together. This is ACA’s future!

To capitalize on leadership opportunities for counselors and the counseling profession over the next five to 10 years, I truly believe that we must learn and grow leadership exponentially and openly embrace a multitude of intersectionalities, allowing each person to intercede, touch and inform one another through myriad worldviews and life experiences. We benefit immensely when we are attuned to each other. I believe it is best practice to invest in these relationships. Investments empower leaders. They afford organizations opportunities to build a solid infrastructure that makes positive differences. A genuine acknowledgment of others also fosters a strong sense of belonging. Being inclusive successfully role models and empowers members to nurture collaboration and see value in embracing their colleagues for the gifts they bring to the table.

Leadership is not always easy. Ideally, leadership should be multidimensional and reflect myriad worldviews. By design, diverse governance provides role models and opportunities for mentorship and empowers aspiring leaders. As we move forward, these leaders must gain the trust of stakeholders, helping them to believe in their vision and to know that they can rely on it being carried out for the good of all. Furthermore, I believe that as good citizens, we must work collectively over the next decade to eliminate conditions that produce obstructions to the healthy professional development and wellness of individuals from all cultural and ethnic backgrounds. We must strategically take the time to build upon traditions that positively impact the lives of people across the globe. Ten years from now, we will have grown myriad diverse leaders who always take the high road and strive to provide us with a solid return on our investment.

 

Gerard Lawson is a professor in the counselor education program at Virginia Tech, a past president of the American Counseling Association, an ACA fellow and a licensed professional counselor in Virginia.

As we are reflecting on the future of the counseling profession, it may be the recency effect, but many of the things we have seen in the past year or so seem like they will be relevant areas of focus for some time to come. The roots of the counseling profession — in mental health and wellness, career counseling, and educational counseling — are as relevant to the challenges of today as they were 100-plus years ago, when the profession began. I’d like to focus on two challenges in particular, the first being the ongoing response to the COVID-19 pandemic and the second being the broad public exposure of injustices in the U.S.

There is no question that the impact of the COVID-19 pandemic on mental health, and on the vital services that counselors provide, has been profound. Many have observed a secondary pandemic of anxiety and social isolation as a direct result of the response to the coronavirus, and counselors who have traditionally worked only in face-to-face modalities had to adjust to an online counseling world to continue to support their clients. It seems unlikely that we will return to the way we used to practice, or that the nature of what clients bring to us will be the same, even after the pandemic has been brought under control.

Counselors who were skeptical of distance counseling are finding that it’s not as bad as they expected. Similarly, clients who have been relying on distance counseling to cope during the pandemic may actually need in-person counseling to thrive post-pandemic. And, unfortunately, we will probably see the mental health consequences of the pandemic for years, if not decades. For individuals who were vulnerable already, for students who were disconnected from their learning process and the normal support that they receive from talented and caring school counselors, and for those who were already stretched too thin and were asked to take on more, the recovery process may be protracted and complicated. Counselors may need to consider what progress and success will look like for those clients and for those for whom the “new normal” is still less than what they hoped for.

In 2020, we have seen the horrors of systemic racism more regularly, not because this is a new phenomenon, but because cameras have brought those experiences into the mainstream view. We have also seen the fear and insecurity that our neighbors who are members of the LGBTQ community feel who are afraid that their rights may be stripped away. We have seen neighbors who have lived in the U.S. for decades suddenly fearful that they could be sent to live in a country that they have never even visited. And we have seen neighbors suddenly find that their job no longer exists and unsure where their next meal may come from, much less what their career might look like.

Counselors can be agents of change in these areas. The Multicultural and Social Justice Counseling Competencies that ACA has promoted for years guide us to challenge our biases and assumptions, to practice in a way that is culturally competent, and to support clients who have been marginalized and harmed by unjust systems. We need to see and understand these experiences as part of an ongoing trauma that is embedded in the experiences of far too many individuals and families. As part of a system that values people based on what they contribute, not their inherent worth. We need to be out front, embracing everyone in our communities, affirming them and helping to change the systems that have led to oppression.

No small task. But counselors are accustomed to acting heroically.

 

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Share your thoughts on what might pose the most significant change, challenge or opportunity for counselors and the counseling profession over the next five to 10 years in the comment section, below.

 

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

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