Monthly Archives: March 2021

CEO’s Message: Honoring and celebrating professional counselors

Richard Yep March 31, 2021

Richard Yep, ACA CEO

If there were ever a time when our communities, nation and world needed the amazing work of professional counselors, it is now. April is Counseling Awareness Month, and in past years, I have encouraged you to use the month to celebrate the counseling profession. Given all that our world has experienced over the past 15 months, I know that it might sound odd to once again say, “Let’s celebrate!” But when you think about all the stories of resilience and how so many have overcome adversity, there is something to celebrate. Call it perseverance, raised awareness or just plain old “stepping up.”

To those of you who identify as members of the counseling profession, please take a moment from all you are doing and experiencing, both personally and professionally, to acknowledge the contribution you have made to helping so many people — clients, students, colleagues, friends, family members. Your work has helped our communities move forward. I am grateful for your efforts.

Just as many of you have continued to serve others, both in person and online, ACA wants to continue meeting your needs. We know that we need to be just as creative in delivering our services as you are in the work you do with your clients and students.

This month, thousands of professional counselors, counselor educators and graduate students will “gather” for ACA’s first-ever Virtual Conference Experience. There are double the number of keynote presentations compared with previous years, and because the event runs throughout April and May, attendees will be able to acquire more CEs in one place and at one ACA event than ever before. Even if you missed the original broadcast of a session, your registration allows you on-demand access all the way through the end of May.

Why do a virtual conference? Because those representing you on the Governing Council, as well as the ACA staff, have recognized the importance of providing information, resources, research findings and networking opportunities. The counseling community did not stop serving clients and students when COVID-19 hit. ACA has adopted that philosophy and will creatively bring to our attendees a world-class experience.

This will be unlike any previous ACA Conference, so I encourage you to consider being present at this event. I suggest that you reserve time on your calendar to attend keynotes and content sessions, just like you would if we were gathering in person. As busy professionals, it might be tempting to “multitask” during a virtual conference, but that could leave you a bit unfulfilled. Block out the time and try to stay focused on the sessions you have chosen to attend.

I must admit that I will miss seeing many of you and receiving the hugs for which our community is known. All of that will have to wait until the 2022 ACA Conference. For now, when the 2021 event opens April 5, we will be taking a bold step forward in content delivery. We want you to focus on benefiting from what your colleagues will be sharing. If you are one of our nearly 900 presenters, I know that you will want the undivided attention of our attendees. I look forward to “seeing” many of you at the ACA Virtual Conference Experience.

I am also hoping that each of you will do something for yourself during Counseling Awareness Month, especially given all that we have been through. I continue to reference the importance of self-care in this column, and I appreciate those of you who have shared with me what you do for your own self-care. I would love to hear from more of you.

As always, I look forward to receiving your comments, questions and thoughts. Feel free to call me at 800-347-6647 ext. 231 or to email me at ryep@counseling.org. You can also follow me on Twitter: @Richyep.

Be well.

From the President: A perfect time to advocate for counseling

Sue Pressman

“I learned a long time ago the wisest thing I can do is be on my own side, be an advocate for myself and others like me.”

— Maya Angelou

 

Sue Pressman, ACA’s 69th president

Every day is a good day to advocate for our profession, but April is the perfect time to make an extra effort because it is Counseling Awareness Month. Being knowledgeable of how professional counselors help people of all ages, ethnicities and backgrounds is a critical step in gaining understanding and earning the respect and support of legislators, business professionals, educators, and corporate and government agency decision-makers. The significance of this cannot be underestimated because relationships are built, partnerships are developed and career opportunities are realized when our constituencies understand the value of counseling.

Advocacy is one of three drivers in the ACA 2018-2021 Strategic Framework. The document defines advocacy as “[giving] voice and representation to counselors, the profession, and consumers.” To give voice, I asked a few counseling colleagues to share their perspectives on counseling awareness.

Karol Taylor, an internal government consultant and former long-term government employee, leveraged her insider expertise into an encore career as a career counselor and author. Karol specializes in federal government clients and advises that “the government needs to know that counselors are highly educated, credentialed and licensed. That they are their go-to resource for the huge need that is being revealed by the pandemic. The huge number of suicides has got to be addressed in a national, systemic way.”

Pamela Gunther, a retired lifetime certified rehabilitation counselor with the adult Deaf community, emphasizes that “the Deaf community has its own culture and visual language, American Sign Language. It cannot be emphasized enough that counselors who provide services to Deaf clients have very special training and skills. This is a specialty within the counseling profession. They must be very fluent and experienced in both the language and culture. It is not good enough to just know how to sign or bring in an interpreter to the counseling session. It is also extremely important to recognize that people who are Deaf have a bicultural identity. Counselors who have this intimate knowledge and experience are the best resource to be providing counseling services.”

Hillary Press, a family partnership specialist, former professional school counselor and current member of the ACA Governing Council, emphasizes the positive impact that having access to counseling in the school setting provides. “School counselors provide academic and social/emotional support for pre-K-12 students while simultaneously creating college- and career-ready 21st-century citizens. The pandemic has created increased need for mental health support as well as basic needs [e.g., food, shelter] for students and families. School counselors have specialized knowledge and are in the unique position to support these needs because they understand the needs of their school community.”

Professional counselors possess a multitude of skills. We are practitioners, educators, business owners, executives, writers, authors and researchers. We observe, measure/assess, question, adapt and a whole lot more. We use our skills and behaviors to empower others to set and reach their goals. As evidenced by the 18 chartered ACA divisions, we bring special skill sets to the clients, communities and organizations we serve. We serve with compassion and a passion for helping others succeed and realize their dreams.

The ACA Virtual Conference Experience recognizes the importance of counseling awareness. The conference kicks off in conjunction with Counseling Awareness Month on April 5, with on-demand education running through May. It promises to be a virtual experience like no other. Each week in April will focus on different counseling-related themes and offer opportunities to experience distinguished keynote speakers and hundreds of professional presentations. If you haven’t registered already, it’s not too late (see counseling.org/conference). Our conference is open to everybody. Please join and learn along with us.

Starting a counseling career in the time of COVID-19

By Lindsey Phillips March 30, 2021

Many counselors can easily distinguish between what their professional career looked like before the coronavirus pandemic started and what it resembles now. But for most new professionals, counseling in a pandemic is all they have known. COVID-19 has shaped almost every encounter they have had with clients and colleagues alike. And the careers that have greeted them upon graduation have looked dramatically different than the ones they prepared for in school.

Hannah McGrath, a recent graduate from the Master of Divinity/Master of Arts in counseling dual degree program at Wake Forest University in North Carolina, always wanted to be a counselor. But as she acknowledges, “This [experience] is not how I thought things would go after I spent four years in graduate school.”

In March 2020, McGrath returned from spring break to discover that she would have to finish her counseling internship virtually. Many of McGrath’s clients, who were university students, had gone home for spring break and did not return to campus because of the pandemic. Some of them were out of state, which meant she was unable to provide counseling to them. Professors and supervisors scrambled to make sure she had the documentation she needed to do telebehavioral health and to help her find clients so that she could complete her internship hours in time.

It’s difficult to anticipate the long-term implications of beginning a counseling career in the time of COVID-19, but McGrath and four other new professionals agreed to shed light on the ways the pandemic has shaped them — and their future outlook on the profession — thus far.

Rethinking a counseling career

Kathryn Beskrowni, a provisionally licensed professional counselor, had concerns about starting her new counseling career even before the pandemic reached the United States. In January 2020, she had just finished her internship at Terrace House, a group practice located in St. Louis. She was apprehensive about leaving a steady job as a learning and development manager at College Bound St. Louis, a nonprofit that empowers students from economically disadvantaged backgrounds to achieve undergraduate degrees, to become a counselor clinician — a career she knew would depend heavily on building a suitable caseload.

Before graduating, Beskrowni, an American Counseling Association member who specializes in relational issues and life transitions, applied to a few jobs in private practices, hospitals and other mental health organizations. After not hearing back from anyone for over a month and a half, her career anxieties only solidified. “I had a two-month period where I didn’t know what I wanted to do,” Beskrowni recalls. “I had to emotionally prepare for this new life I was stepping into.”

She decided to reach out to her former intern supervisor, Christina Thaier, a licensed professional counselor (LPC) and the founder and director of Terrace House. Together, they discussed Beskrowni’s future as a counselor. Through their conversations, Beskrowni realized that one of her biggest hesitations revolved around the limiting feeling of only doing therapy.

Fortunately, Thaier worked with her to create a position that addressed all of Beskrowni’s goals and concerns and would allow for her to grow professionally. So, Beskrowni joined the team at Terrace House both as a therapist and assistant director of community relations (a role in which she helps to oversee and recruit counseling interns).

A few weeks later, COVID-19 made its way to the United States, and all the uncertainty surrounding the pandemic heightened Beskrowni’s career anxieties and concerns about financial stability yet again. Ultimately, she decided to keep her job at College Bound St. Louis, which provided steady pay and hours, while also transitioning into her new role as a professional counselor.

For about six months, she juggled both jobs, switching back and forth between her two work laptops — a privilege she had because of the ability to work from home during the pandemic. “It took me a really long time to feel safe and comfortable enough to fully commit to the unpredictability of a counseling career, so I held on to [the nonprofit job] for longer than I needed,” Beskrowni says. But she’s happy that she finally did become a counselor, and she’s excited about the future direction of her career.

Readjusting career plans

Before the pandemic, Darius Green, a recent graduate of James Madison University’s counselor education doctoral program, planned to find a full-time position in counselor education. He was willing and able to move anywhere. But the pandemic changed things. He wasn’t sure how much the pandemic would affect college enrollment and university faculty hiring, and he was anxious about the job search process and his own financial stability. “I worried if I would be able to find a job in counselor education, and if I did find one, I worried about the risk of that position being eliminated,” he says.

Green, an ACA member whose research interests include wellness, diversity, social justice and counselor education, did apply to some counselor educator positions, and he even scheduled a few interviews. But he ultimately decided not to pursue that career path because he didn’t feel prepared for the several hours of virtual interviews and teacher demonstrations, and given the uncertainty surrounding the pandemic, his willingness to pick up and move just anywhere had dissolved.

“Originally, I felt willing to move just about anywhere to get my foot in the door, but the pandemic shifted my priorities and values,” Green says. “My top priority wasn’t having a job in counselor education [anymore]. My top priority was having a job with benefits and a stable income.”

In part for that reason, he decided to continue working as the assistant coordinator of the James Madison University (JMU) PASS Program, which supports student learning and success in challenging courses at the school. Although he applies some of his counseling skills to this position, the job itself isn’t counseling focused. So, he also works part time as a counselor at the ARROW Project, a community mental health organization in Staunton, Virginia.

Even this part-time position came with new challenges. “I was nervous because I hadn’t been trained to do telebehavioral health,” Green says. “I’m fairly tech savvy, but [with telebehavioral health], there’s just a lot more to think about.”

The pandemic caused Green to readjust his career plans, but it also gave him the opportunity to work from home. This has allowed him to balance his full-time job at JMU and his role as a counselor at ARROW, which otherwise would have involved a 20-minute commute.

Green isn’t sure if a career in higher education is sustainable or obtainable right now, so he wants to keep his options open by working toward his counseling licensure. He also knows his experience as a counselor clinician will strengthen his curriculum vitae if he does decide to pursue jobs in counselor education down the road.

Growing pains

Rachel Wyrick, a master’s student in the counseling program at the University of Missouri-St. Louis (UMSL), was looking for an internship position right when the pandemic hit the United States. Wyrick wasn’t sure if they would be able to find placement with so many agencies focusing on switching their practice to telebehavioral health. After a few weeks of silence, Wyrick finally got the email they had been hoping for: Terrace House offered Wyrick a position as a counseling intern.

Wyrick had felt like they were hitting their counseling stride during their practicum a couple of months before the COVID-19 pandemic. Wyrick had become more comfortable with clients, and Wyrick’s initial nervousness was slowly waning. But when everything went virtual, Wyrick’s anxiety shot back up. In many ways, Wyrick felt like they had to start over by learning how to do therapy using telebehavioral health — something that was not on their radar before the pandemic.

Wyrick specializes in relationship issues, trauma, posttraumatic stress disorder and LGBTQ+ populations. Because Wyrick works with clients experiencing trauma and uses somatic therapies, Wyrick had reservations about how effective telebehavioral health would be. But Wyrick embraced the change and discovered they can still build a strong rapport with clients virtually. In fact, in many ways, Wyrick finds it more intimate. Because they are sitting face to face with clients, Wyrick can easily read the microexpressions on the client’s face via screen.

“And for my style of counseling, it actually really suits me and the populations that I serve,” says Wyrick, who was named UMSL’s clinical mental health master’s student of the year this past December. It can be comforting to clients to be in their own space and to see their counselor as a “real” person in their own space, Wyrick explains. Wyrick notes that when clients ask about Wyrick’s plants or artwork in the background, it often seems to jump-start a stronger connection.

Wyrick still oscillates between weeks of feeling connected to clients and weeks of feeling unsure and inadequate. “Will it always feel this way, or is this a normal part of the process of growing as a professional?” Wyrick wonders. Wyrick hasn’t had much practical experience outside of the pandemic, so it’s hard for the counselor-in-training to know what might be unique to the pandemic and what is simply typical growing pains.    

Difficulty finding a job

After moving to New York, McGrath noticed there were more jobs for social workers than for counselors. That’s when she learned that some states privilege different mental health workers. Social workers have a longer history in New York than do licensed professional counselors and, in turn, more job options. Many of the types of jobs McGrath had assumed would be open to her — such as being a counselor in a hospital — were not.

McGrath applied to every counseling job she could find, but many of the places didn’t respond or told her they were hiring only fully licensed counselors. “I felt like I had no job options,” she says. The fact that New York City had to shut down because of the pandemic didn’t help, she points out. Nothing was business as usual.

Finally, in June, she found a job working with a foster care agency as a mental health counselor-limited permit.

Looking back, McGrath realizes the pandemic heightened her anxiety around her job search. She felt a sense of panic and urgency to find a job. If she could do it all over again, she says, she would slow down and take her time during the process.

During graduate school, a visiting speaker told McGrath, “Your first job doesn’t have to be a perfect job, but it can be the perfect teacher.” She is taking that advice to heart as she continues navigating her counseling career during an uncertain and challenging time.

Building a caseload

After graduating with a master’s in counseling from the University of Mary Hardin-Baylor in spring 2020, Mika Smith-Tjahja, now an LPC associate at Firefly Therapy Austin in Texas, put a lot of pressure on herself to instantly build up her caseload. “I was hard on myself at first,” she recalls. “I had high expectations about getting a certain number of clients each week.” When that didn’t happen, she felt discouraged.

At the beginning of the pandemic, Smith-Tjahja was averaging one to three clients a week for about two months. Her supervisor reminded her that it takes a while to find clientele, so she trusted the process. Smith-Tjahja’s caseload has since doubled, but it is still below the number of clients she would like to average per week. She recently accepted a second counseling job at Connected Heart Therapy in Austin and hopes this will build her client base even more.

Smith-Tjahja, who specializes in anxiety, depression and trauma, wonders how much the pandemic has affected her ability to build a caseload. A few referrals have told her they prefer to wait until in-person therapy resumes, so she knows that it’s a factor.

Smith-Tjahja has started thinking outside the box to find people who need help right now. She joined a Facebook group for mental health professionals in Austin to share and request referrals. She has found the group to be a great resource both for referrals and networking.

She has also suggested to her supervisor the idea of creating a low-fee closed counseling group for individuals who are interested in therapy but can’t afford the higher fees. The group would benefit the community while simultaneously teaching Smith-Tjahja more about the community’s counseling needs and informing others that she is available and eager to help, she explains. Smith-Tjahja is also interested in doing pro bono work in the future, once she feels more settled in her role as a professional counselor.

Finding support amid the isolation

Smith-Tjahja says her biggest challenge throughout the pandemic has been the isolation, especially in terms of not being able to interact in person with colleagues. She imagined trading her graduate school cohort for colleagues in an office or hospital. Instead, she works from home, alone. Because that feeling of community isn’t there anymore, she created her own virtual community — a support group for LPC associates like herself. When she reached out on social media to find others to join her group, she was surprised by the response: More than 50 people joined. They meet once a month, and they recently invited a certified public accountant to present on how to manage taxes for one’s private practice.

She also reached out to her former cohort and formed a peer support group. In their last meeting, they all echoed Smith-Tjahja’s sense of isolation and agreed that they needed this group because they had missed the sense of community it offers.

McGrath acknowledges that it can be challenging to feel connected to other mental health professionals right now. She communicates with her colleagues through emails and phone calls. Sometimes, she says, when she doesn’t get a reply within a couple of days, she wonders if her colleagues are busy, if they are ignoring her or if they think she is a bad therapist.

Wyrick likewise admits that it’s easy to fall into self-doubt, especially when everyone is isolated from each other. The Terrace House internship program tries to address this by pairing new professionals with other new professionals who are a few months or years further along in their careers. Wyrick has benefited during their internship at the Terrace House from having a mentor. Wyrick has had virtual coffee dates with their mentor, which provided a semblance of an in-office interaction.

Supervision is also critical. “It’s hard to know where you stand as a new professional right now,” Wyrick says. “Having a well-seasoned professional reflect back what they see — whether it be strengths or growing edges — is really helpful.”

“Normally we’d have these [professional] experiences with peers and be able to compare … and all develop together,” Wyrick continues. “Without that, our supervisors are our main source of reflection and validation … of how hard this experience has been and the strength that we’ve shown.”

Green encourages counselors to remember that not everyone comes from a privileged background and has the same opportunities and resources. Therefore, it is important for established counselors to reach out and support new professionals, especially as they try to find their footing in the midst of an ongoing pandemic, he says.

Professional connections provide not only career opportunities but also emotional and social support, notes Green, a member of both the Association for Humanistic Counseling and Counselors for Social Justice, which are divisions of ACA. People are less inclined to reach out virtually, so it can be isolating at times, he points out. He had several mentors schedule virtual meetings in the fall, but those meetings have slowly decreased in the succeeding months. Green tries to lead by example, taking the time to message his colleagues as well as other new professionals.

After the pandemic, McGrath looks forward to meeting her colleagues in person and building work relationships that will help her grow professionally. She says she wishes she could just pop into a colleague’s office right now and ask a question or chat about how their week is going. But until that is possible, she advises her fellow new professionals to make efforts to connect with other mental health professionals in whatever way they can.

Establishing work boundaries

Working from home has caused the boundary between work and personal life to become blurred for many new (and seasoned) professionals. As McGrath points out, it’s often difficult for counselors to have set work hours when they are seeing clients six days a week. “The longer the pandemic has gone on, the harder it’s been to keep those boundaries,” she adds.

“Establishing work boundaries is already a struggle for new professionals,” Wyrick says. The pandemic only adds to this problem. Wyrick’s workspace is in the bedroom, which means they can answer emails at all times of the day. It’s also tempting to take on clients outside of scheduled work hours, Wyrick points out. Wyrick often thinks, “What’s one more hour?”

Wyrick has had to create a routine because their partner is a professor who is working from home as well. When Wyrick is working, they shut the door and turn on a white-noise machine. This signals Wyrick’s partner not to interrupt.

Green says the amount of email he receives seems to have increased during the pandemic. It often overwhelms him, he confesses, and he spends a substantial amount of time sorting and prioritizing these messages. Smith-Tjahja also finds herself checking her email constantly because she is trying to build up her clientele right now. She says she hopes to establish a better schedule for checking and responding to emails after she has more clients.

Wyrick says working from home has taught them a lot about their personal work patterns and values. Before the pandemic, Wyrick took pride in always being plugged in, but now they realize that mindset is not in line with their values.

“At the beginning of this [pandemic], we had no idea how long it was going to be, and the optimists of us thought it was going to be a short time. So, that allowed things to be a little chaotic and wild at first,” Wyrick says. “I was thinking very much in emergency ‘go’ mode, but now I’m trying to be very mindful about creating habits that are going to be sustainable over time.”

Finding opportunity in the chaos

Smith-Tjahja experienced several significant events in her life during 2020, but they looked different because of the pandemic. She graduated with a master’s in counseling, but the ceremony was virtual. She got married, but it was not the ceremony she had hoped for. She and her husband bought their first house, but her parents weren’t able to go look at houses with her. Smith-Tjahja feels happiness for these milestones but also a simultaneous sense of grief because these events didn’t follow the traditional route she had expected.

But the pandemic also opened up new career possibilities for her. A year ago, Smith-Tjahja assumed she would probably work in a hospital until she was licensed. Working in a private practice was a distant dream, but that dream became a reality this fall. After getting her provisional counseling license, she reached out to a counselor she had kept in touch with throughout her graduate program to see if the counselor needed any help at her private practice, Firefly Therapy Austin. The counselor offered her a job.

During quarantine, Smith-Tjahja also decided to get trained in eye-movement desensitization and reprocessing (EMDR). She could easily take the classes from her home and didn’t have to spend money on travel, food or a hotel. This training has opened up another career opportunity. She reached out to another counselor who just started Connected Heart Therapy, a private practice offering EMDR to the Austin community. They offered Smith-Tjahja a job as a part-time counselor, which will allow her to continue her EMDR training.

Wyrick describes their initiation into professional counseling as a trial by fire. Although it wasn’t the start to Wyrick’s career that they had hoped for, it has given Wyrick confidence in their ability to rise to the challenge and their capacity for growth. Wyrick hopes the experience of practicing during a pandemic will encourage and allow new and seasoned counseling professionals alike to rethink the ways that they do therapy and how they can best serve their clients.

The uncertainty that the pandemic generated and the sudden shift to telebehavioral health muted some of the traditional milestones for emerging counselors, including graduating and starting a counseling career, Beskrowni points out. She hopes that other new counseling professionals will still take the time to celebrate their accomplishments and find a sense of freedom in their evolving possibilities.

 

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

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

Voice of Experience: Spokes of a wheel: A lesson in physics

By Gregory K. Moffatt March 29, 2021

I can’t count the number of calls and emails I’ve gotten over the past year, in addition to the many times I’ve been asked to speak (virtually, of course), on the same topic: How can we help people cope during the pandemic? In fact, I recently spoke on this topic to one group for the second time in the past year.

Who could have known this pandemic would go on for so long and how our lives would be disrupted? We are all fatigued. Not only do I have to help my clients manage their fatigue, but I am also focused on the needs of my clinicians and supervisees. No one is immune.

There is no single answer to the best way to cope. As is the case with almost any issue in mental health, we encourage our clients to eat right, sleep right and exercise. This is what I call Moffatt’s Mantra. The treatments for depression, anxiety, grief and a host of other common diagnoses must include these three common components.

But beyond that, coping is idiosyncratic. Things that bring me peace might bring you stress, and vice versa. For example, I just finished a five-day business trip to the Gulf Coast. I stayed in a luxury estate, had a private chef for suppers and ate catered meals otherwise. All of the refrigerators were stocked with just about anything you could imagine. I was paid very well, my workload was light, and I had plenty of time for sailing, deep-sea fishing and the beach.

But I don’t like the beach. I’d rather be in the mountains. I also find it very hard to relax when I’m working, even in luxury accommodations like the ones I experienced. I’m happiest sleeping in my own bed. I may be the only person who wouldn’t find this consulting trip relaxing, but I am intensely introverted. Social events leave me feeling drained, and I’m always “on” when I’m in environments like that.

As odd as I am, I’m not alone in my idiosyncrasies. Some of you reading this might list coping strategies that perhaps nobody else would find helpful. In other words, we shouldn’t assume what would be a healthy coping strategy or stress relief technique for our clients. Our clients need to teach us those facts.

So, here is the physics lesson. The individual spokes on a bicycle are quite weak. Even a child could easily bend one. A bike with only one spoke wouldn’t go very far. In fact, the weight of the bicycle alone would crush that single spoke. But when you put multiple spokes around the rim — with several dozen of them sharing the load — the bicycle sustains its own weight and that of the rider. And the pliability of those spokes — the ones a child could bend — helps the repair person true the rim so that it doesn’t wobble.

This brief foray into physics teaches us something about coping. If you were to ask the bicycle specialist which spoke was most important, they would laugh. All of the spokes are important, and they all have to work together. Our ability to cope with stress, frustrations, anger, relationship problems and grief — all magnified by the pandemic — is based on multiple strategies working together. The more the load is shared, the better.

Even though one strategy — exercise, let’s say — may usually work, it might not always work. Healthy coping involves many skills from which one can draw.

A minimum of three clear strategies, tailored to the individual, is a starting point. We might think of these strategies as legs of a stool. With at least three legs in place, a stool will remain standing, and the more legs on the stool — like the spokes of a bicycle — the harder it will be for something to break it.

So, my response to all those media questions about how we can help people cope during the pandemic is the same. Examine your own life. What tools, skills and strategies have you found helpful in the past? The longer your list, the more spokes you have to sustain you when you feel you are reaching the point of fatigue.

I exercise religiously — almost every day, rain or shine — because I know it helps me avoid fatigue and depression. I nurture relationships — especially my family relationships. I know they are important spokes in my wheel. I need solitude, quiet, predictability and routine. These are some of my spokes, and I might even add my own pillow and my own bed as two others. So, even though a lucrative consulting gig on the Gulf might sound good, I limit them because limiting that kind of work is a spoke for me too.

Know your own spokes and help your clients brainstorm their personal lists. We can’t do that for them. With overt tools to lean on, we will see our way through these very challenging days.

 

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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.

Finding balance in counseling private practice

By Bethany Bray March 25, 2021

Managing a counseling practice takes strength of both heart and mind. To succeed, private practitioners must find balance between two roles: that of the caring, empathic and client-focused clinician and that of the shrewd business owner, which necessarily involves charging fees and making money.

Most people who enter the counseling profession do so first and foremost because they feel called to help others. At the same time, many counselors harbor dreams of one day owning their own practice, and that involves handling tasks that sometimes go against the grain of their helping instincts. Charging fees to clients who skip appointments or following up about nonpayment or a declined credit card can feel unnatural to counselor clinicians, especially after they’ve spent multiple sessions listening to the person talk about the painful life challenges they are facing.

“This is a tough area to navigate for many therapists, myself included,” says Dawn Altman, a licensed professional counselor (LPC) with a practice in Bryn Mawr, Pennsylvania. “It has been my experience that the most difficult area to navigate is my own money mindset and feelings of worthiness. … Most therapists come to this field with a sheer desire to help people work through emotional difficulties and live a more enlivened life. It feels somehow ‘sticky’ to ask for money for supporting someone who is struggling. The lines become blurred between what comes naturally to most of us — helping others — and requiring payment for our services.”

Money, money, money

One major aspect of maintaining balance between the heart and mind aspects of private practice involves setting — and enforcing — rates and fees.

When she first started her practice, Altman set her fees low because she doubted her own value. “Looking back, what came up for me was what is known as impostor syndrome — that internal experience of believing that you are not as competent as others perceive you to be. This is true of so many women in particular,” Altman says. “I had to get really deep with myself and ask myself, ‘Do you fear success as a business owner more than you want it?’ The answer was, of course, no, so I had to just rip the Band-Aid off and feel the fear and bill [clients] anyway.”

Now, after years in practice, Altman has found that her caseload feels balanced when she reserves three slots in her schedule for clients who pay on a sliding scale. If a potential client requests to pay on a sliding scale and those three slots are already filled, Altman has a list of practitioners to whom she can refer the client so they are not left without options. “I find that this system works for me because I can still provide a service to those who may not be able to afford my normal fee, but I don’t get resentful that I am working for pennies,” says Altman, a member of the American Counseling Association.

Norm Dasenbrook, a licensed clinical professional counselor (LCPC) with a practice in Rockford, Illinois, believes that counselors’ ethical mandate to keep up with self-care includes financial self-care. It’s not greedy to charge what you’re worth; it’s necessary, he says.

“If I’m thinking about how I’m going to pay the rent for my office when I’ve got a client in front of me, that’s not the best care,” says Dasenbrook, who also runs a consulting company that offers trainings and workshops on managing a therapy practice. “Charging what you’re worth is the best care for clients because you’re not thinking about that stuff when a client is in front of you. We [counselors] work hard and should get paid for that.”

Dasenbrook advises that private practitioners who are starting out should ask local colleagues about their rates to find the “community standard.” From there, they should decide on comparable rates and fees and stick to them. Private practitioners should also keep in mind that most clients are not going to shop around and choose a therapist based only on their hourly rate, he says. Rather, that decision revolves around many factors, from a practitioner’s area of expertise to their reputation.

From Dasenbrook’s perspective, the business and empathic sides of private practice are not mutually exclusive. Practitioners can find ways to accommodate clients with empathy while still getting paid, he says. For instance, with clients who are having financial difficulties, Dasenbrook will work out a payment plan allowing them to pay in small installments, or he will offer them half-hour sessions for a lesser fee. In other cases, he will refer clients to local charities or agencies that offer free or reduced-price therapy. These measures all ensure that clients are treated with care and continue to get the help they need, which is empathic, Dasenbrook says.

“To me, [the caring and business sides of counseling] go together. You’re providing a service and collecting a fee. There’s nothing mutually exclusive in there. You can do both with empathy,” says Dasenbrook, who has provided private practice consultations at the ACA Conference & Expo in years past.

Counselors in private practice who struggle with the idea of charging fees should look at how other service professions approach it, Dasenbrook says. He points out that plumbers and car mechanics don’t feel guilty about charging what a service is worth, and he stresses that counselors shouldn’t either.

“Don’t lowball your fees,” he urges counselors in private practice. “Think of other professions. A cardiologist that’s just out of school charges the same as one who has been working in the field for 10 years.”

Bethany Lato, an ACA member with two office locations in the Milwaukee area, also finds that the empathic and business sides of practice management can be interwoven through intentionality and commitment to purpose.

“One way I [incorporate empathy] is by maintaining a clear vision, purpose and foundation for what my business is and who it is for,” Lato says. “When focusing on tasks such as finances, sales and marketing, web presence and long-term business planning, I tend to wear more of the entrepreneurial hat. I think about it from the business perspective: What makes the most financial and business sense in order to achieve that mission?

“From there, I circle back around to empathy: How is this serving my clients and the people that I hope to reach? Am I making sure that I am taking care of my needs while also providing care to others? By beginning my work and concluding my work from a place of empathy, I aim to find that balance and never get too caught up in the business side or in simply making money. Sometimes this comes naturally, and other times it takes a conscious effort to maintain focus on the true mission and what feels truly aligned for myself and the clients I work with.”

Caseload questions

Determining caseload size and finding the “right” number of clients to see per day in private practice is an individualized decision. Counselors must charge high enough rates and take on enough clients to make money and stay solvent, yet still keep their caseloads and daily schedules from becoming so packed that they can’t give clients (or themselves) the time and attention they need.

It’s a balance that varies for each private practitioner and one that must often be determined through experience. Kristy Crump, an LCPC in Bel Air, Maryland, continued to work three days per week in an agency setting as she began her private practice in 2014. Within a year, she was fully booked and able to leave the agency, transitioning into private practice full time.

Finding the right balance was a matter of trial and error, she says. “You have to evaluate how you feel at the end of the day, at the end of the week. I was seeing 10 or 12 clients in a day and would be exhausted and struggling to keep up. It just took time to learn what’s right,” Crump says. “Now, my balance is six [clients per day]. I have some colleagues who say, ‘Four is plenty for me,’ and others who say they can do 10. You have to figure out [a schedule] where you still feel like yourself at the end of the day.”

Dasenbrook recommends that private practitioners start with an end goal in mind when determining their optimum caseload. Do they want to maintain a second source of income, such as teaching or consulting, while operating a private practice? How many vacation days do they want to take each year? Do they want to ease into semiretirement in a few years? Once private practitioners determine their long-term goals, they can work back from there to figure out how many clients they will need to see to meet (or to leave time for) those goals, Dasenbrook says.

Developing a reliable list of referral sources is also an important part of managing caseloads as a private practitioner, Altman notes. Over the years, she has discovered that she operates best when seeing fewer than 20 clients per week. This helps her maintain balance with other facets of her life, including time spent with family and her identity as a “lifelong student.”

“I quickly found out that seeing over 20 [clients] per week does not work for me. I feel pulled in too many directions, and my family life suffers, as does my own physical and emotional well-being,” Altman says. “I am very intentional about the type of client that I want to see, and while it is hard to turn people away, I now have a waiting list for those who want to wait specifically for me, and I have a list of five or six trusted therapists in the community to whom I refer when I cannot accommodate the client. … This alone has made a huge difference to me in my work-life balance because I enjoy each of my clients, and I am not burned out at the end of each week.”

Out of whack

Bryan G. Stare, an LPC and counselor educator who has experience working in private practice, is a critic of what they call the capitalist U.S. health care industry. Many of the decisions counselors who own private practices must wrestle with — whether to see fewer clients, whether to waive fees, whether to do pro bono work — have an effect on the bottom line of their business. This is an issue that often contradicts the counseling profession’s commitment to pursue social justice, Stare says.

“You’re put in a difficult position in private practice. You’ve paid a lot of money for this education, whether it’s a master’s or a Ph.D. To live comfortably, there’s often pressure to charge more for your services. But many of us have entered this profession because of a call to help or for social justice. … It does create some strife there,” says Stare, an assistant professor and director of the clinical mental health counseling program at the University of North Carolina at Charlotte. “We need to take care of ourselves and our business to take the best care of our clients. If I’m not doing that, I’m not able to create a safe space to care for my clients. If I’m spread too thin, I won’t be able to provide ethical and competent care to clients. [But] the system isn’t designed for that; it’s a profit-driven system designed to garner corporate wealth and leave people suffering.”

Navigating this balance requires that private practitioners keep consistent tabs on how they’re feeling about their workload. Only counselors themselves can recognize when their balance is out of whack and they’re spending too much time either on business tasks or client care.

For Crump, it comes down to how she feels at the end of the workday. If she’s irritable or exhausted, it means she needs to reassess her workload. “If I’m not at 100%, I’m not helping [clients] much,” she says.

Crump acknowledges this balance got thrown off when the COVID-19 pandemic caused her to shift all of her client sessions to a virtual platform. Crump specializes in anxiety disorders, and she says some of her clients became needier amid the stressors of the pandemic. In conducting sessions and other aspects of her practice from home, the boundary line between when she was working and when she was “off” began to blur. Crump says she had to check herself and take a step back to regain her balance.

“Of course I want to take crisis calls, but I would soon find myself three sessions over my limit [for the day]. It’s a struggle because you do have that control. You can say yes. I don’t have a front desk that will say, ‘Sorry, she’s booked for today,’” Crump notes.

Stare, an ACA member who counsels a small caseload of clients in addition to teaching and research work, agrees that emotions are a barometer. Private practitioners should recognize signs of burnout and regularly process their own feelings. Stare’s support circle consists of trusted friends, colleagues and mentors with whom Stare can consult.

Multiple private practitioners interviewed for this article say their bodies give them clues — such as feeling tired, worn out or achy — that indicate their professional balance is out of alignment.

“We teach our clients to do this, and we have to listen to our own body and our own needs too, and nurture ourselves as we tell our clients to do,” Crump says. “We have to take steps back and reflect. It gets very stressful. Some days are really hard. I’m a full advocate that every therapist should have a therapist — they can help keep you in check too.”

Lato notes that somatic cues tell her not only when her workload is imbalanced but also when things are going well. When her work is in balance, “I find myself genuinely excited about my business and my practice, rejuvenated by my sessions with clients, and with vivid dreams and visions of what the business can be in the future,” Lato says. “It is that vision that often gets me through the difficult, out-of-balance times as well. I spend a lot of time journaling, meditating and vision boarding around the future of the business and my practice, and find it is always important to know where you are heading. With this clear vision and direction, it becomes easier to recognize when things are out of balance.”

Put it in writing

The counselors interviewed for this article agreed that one of the best ways private practitioners can minimize the need to have difficult conversations with clients about payment is to offer clear, thorough communication about fees and expectations before any counseling takes place.

Crump provides a full explanation of her policies in the informed consent that clients sign at intake, but she also talks the policies through with each new client before they begin counseling work. “It took me a while to get a flow to be able to speak about that to clients,” admits Crump, an ACA member. “It’s hard to say, ‘Hi, hello, I have a cancellation policy.’ … [But] if you are genuine, you’ll get that in return. When I let [clients] know my boundaries and no-show fees, I’m being honest. I explain that it’s ‘housekeeping.’ It’s important to talk about it, get it out of the way and separate sessions into counseling and noncounseling work.”

Enforcing professional boundaries, such as imposing cancellation fees on a client who repeatedly no-shows, also models healthy behavior for clients, Crump adds. “I’m teaching boundaries to all of my clients, so I want to make sure I have boundaries myself,” she says. “I make sure to set boundaries with clients from day one. I’m direct, and if I answer a crisis call in the evening, I talk about how this won’t become a regular thing.”

Yet Crump acknowledges that she still finds it hard to charge fees, even after years in private practice. It presses on her empathic reflex, she says, because she doesn’t want to discourage people from seeking counseling.

“I hate having the conversation to this day,” she says. “It’s hard because we’re in a helping role. We’re here to help, and it doesn’t feel congruent with what we’re taught. You’re imposing a boundary on them, but unfortunately, that’s part of the business. There’s no one to enforce that but me. It’s easier [when] you talk about it upfront, instead of waiting until it happens and then springing a fee on them. It’s a necessary evil that you have to do. At the end of the day, you’re running a business, and you have to pay bills yourself.”

Crump and the other private practitioners interviewed for this article say that before enforcing a cancellation fee, they usually extend a one-time grace period for clients who miss an appointment. They also make exceptions for late or lesser payments from existing clients facing hardships such as an unexpected job loss. However, they agree that charging fees to clients who are chronically late with payments or repeatedly miss appointments is a necessity.

“I will usually say to the client, in writing, ‘Twenty-four hours’ [cancellation] notice affords me the opportunity to offer your appointment time to a client who may be on a waiting list or who needs an urgent appointment. I hope you understand that I must charge you for missed appointments,’” Altman says. “Being upfront about fees and payment options is crucial in setting up a good relationship with the client and [establishes] the clear boundary that therapy is a valuable service for which payment is expected.”

Enforcing fees not only helps to ensure that a private practitioner’s finances stay in the black. It also sends a message that counseling requires commitment and intentionality from both parties — counselor and client.

“At the end of the day, if I don’t set a boundary, I may not be acting therapeutically,” Stare observes. “If we’re not meeting regularly or semiregularly, depending on [a client’s] presenting concern, we’re not going to make therapeutic gains. Ethically, I can’t provide services that aren’t going to help.”

Dasenbrook urges private practitioners to spend time crafting thorough informed consent documents. Including details such as the hourly fee for services provided outside of counseling sessions (e.g., letter writing, filing court documents) ensures that clients are fully informed prior to being charged, he says.

Language centered on client consent, privacy laws and other practice issues varies from state to state, so private practitioners should seek training and consult with local colleagues and their state counseling associations when creating informed consent documents. “These are the people who are going to know the funky laws” in your state, Dasenbrook asserts.

The language in informed consent documents needs to be thorough and firm yet welcoming and calming, Dasenbrook adds. Clients filling out these forms are seeking therapy, so they may not be in their best mental state, he points out. They shouldn’t be made to feel as if they’re doing something akin to signing the seemingly endless number of pages involved in buying a home. Breaking informed consent into sections — treatment of minors, telebehavioral health, fee schedules, privacy laws/release of client information, etc. — makes things easier for clients to digest and allows counselors to remove sections that do not apply to particular clients. Per the 2014 ACA Code of Ethics, practitioners must include information about alternative/continuing service options should the counselor experience an emergency or pass away.

Ultimately, the time spent creating thorough informed consent documents should mean fewer confrontations with clients regarding fees and other policies down the line. “The business piece [of private practice] should be all taken care of in your informed consent,” Dasenbrook says. “It should be communicated upfront, before we even say, ‘What brings you here today?’

“Put it in writing, and get it all out ahead of time. … You want to take the money piece out of it [counseling] as best you can, and that’s why [I do it] all upfront.”

Getting down to business

The professionals interviewed for this article shared the following tips and insights on blending counselors’ caring instincts with the business side of running a private practice.

>> Maintain separate spaces: Stare uses an existential humanistic approach that recognizes the importance of feelings of place. With that in mind, Stare recommends asking for and accepting client payments in a space that is separate from the counseling room. If possible, keep a credit card machine or other payment mechanisms in another room and walk there with the client to take payment. Not sitting in the same chair and in the same room where therapy takes place to accept payment helps separate the two concepts for counselor and client alike, Stare says.

>> Pay first, talk second: Crump recommends taking payment from clients at the start of a session, before any counseling takes place. Crump didn’t always follow this process but eventually adopted the approach to avoid the awkwardness of having to transition from discussion of heavy, therapeutic topics to request for payment.

Keeping a client’s credit card number on file for automatic charging can also be beneficial if practitioners find it a good fit. Dasenbrook notes that private practitioners now have many convenient payment options, including apps such as Venmo and PayPal, compared with when he started in the profession three decades ago.

>> Stay on top of housekeeping: Tackling those unappealing tasks right away can be a benefit to private practitioners and their clients. For instance, Dasenbrook says, if a client’s credit card is declined, call them right away; don’t put it off or even wait until they come in for their next session. Addressing it immediately gets the issue resolved and is more likely to result in payment.

Similarly, Crump stresses the importance of filing insurance claims and paperwork as soon as possible after client treatment. This is especially important with new clients, to find out whether the private practitioner’s services are covered or whether the client has a deductible to meet. The sooner a practice owner knows there is a gap in a client’s insurance coverage, the sooner payment arrangements can be made, especially while the session is still fresh in the client’s memory. “Even though those case notes take longer, it’s worth it [to file right away],” Crump says.

Altman notes that a tough-love approach is sometimes necessary when tackling tasks that might go against a counselor’s empathic nature. “I used to offer monthly bills, which the client could then submit for reimbursement. However,” she says, “I found that several clients would simply ‘forget’ to pay. Their bills were racking up, and I was feeling resentful over both not being paid and the time it was taking me to have to rebill every few weeks.

“One client in particular would not pay me in a timely manner, and his bill would go unpaid for several weeks. I sent multiple reminders via email that he did not respond to. When the bill was a month overdue, I emailed him the bill one final time and told him that I was unable to provide the Zoom link for our next session until he had cleared up his account. He paid the bill immediately, and at our next session, I began with [talking about] the issue of payment. We agreed that moving forward, he would simply pay weekly, which he has done since that time.”

>> Play by the rules: Crump recommends that practice owners determine their “hard and fast” rules and endeavor to stick by them. For Crump, this includes taking Friday and Sunday off each week. She blocks those days off on her client schedule. In addition, although she doesn’t mind working in the evenings on occasion, she will build time into her schedule on a subsequent morning or afternoon to catch up on administrative tasks.

Another rule Crump has established for herself is never to send a client to collections for nonpayment. “I don’t see the need to cause unnecessary harm to those [clients]. If they could pay, they probably would have. It just doesn’t feel right,” Crump says. “Also, it [collections] is just one more thing to learn how to do and keep up with.”

>> Don’t do it all: One good way private practitioners can keep from becoming overwhelmed is to wield technology to their advantage, Dasenbrook says. This includes building a practice website with client intake and screening forms that ask for a person’s home address, insurance details, emergency contacts and other basic information. This negates counselors having to spend time asking for and transcribing this information in person or over the phone.

Dasenbrook also recommends that practice owners consider using software or hiring a professional to handle administrative tasks that they dislike or struggle doing themselves. That’s what Dasenbrook does with billing. “If there are tasks that you don’t like, then hire it [out],” he says. “You can try and do it yourself at first to learn and save money, but ultimately it makes sense to hire out if it causes a headache and takes too much time. Once your practice grows, start farming some of that stuff out.”

>> Seek and value supervision: “The No. 1 tip I would offer is to spend the money for high-quality supervision,” Altman says. “I had an incredibly gifted supervisor whom I worked with when I began, and it made a huge difference in the amount of time that I had to spend ‘winging it.’ Most of our supervision hours were spent on case discussion, but sometimes we talked [about] the business of private practice. It was enormously helpful to me as a business owner. Peer supervision is another great way to connect with others to share tips and insights and to just have a sounding board for cases or for life as a therapist in private practice.”

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Necessary skills

Private practice management demands a wide variety of skills, from overseeing scheduling and billing to determining one’s caseload size and handling client referrals. A successful private practitioner must also hone a number of skills beyond the nuts-and-bolts tasks of managing a practice, says Norm Dasenbrook, a licensed clinical professional counselor with a practice in Rockford, Illinois.

Dasenbrook considers the following qualities “musts” for private practitioners:

  • Clinical competency and excellence
  • Healthy self-esteem, self-awareness and the ability to set boundaries: This involves knowing what you’re good at and what you’re not, Dasenbrook advises.
  • The ability to know when you’re over your head professionally: This involves realizing when a client’s needs go beyond your skills and that you should seek consultation. Dasenbrook has been a counselor for three decades and still runs into issues for which he seeks consultation from peers. “It happens to everybody — when you’re sitting in session and you have no idea [how to help a client]. We’ve all been there. I’ve been there many times,” he says.
  • A business mindset and inclination for bookkeeping, scheduling, keeping medical records and other administrative tasks
  • Being comfortable with taking risks: “Sometimes we fail, but we keep on going,” Dasenbrook says. “You need to see yourself as an entrepreneur. Some things won’t work out, but you learn from it and move on.”

What skills would you add to this list? Post your thoughts in the comment section of this article, below.

 

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Action steps to learn more

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Pro bono: Yea or nay?

The 2014 ACA Code of Ethics encourages counselors to “contribute to society by devoting a portion of their professional activity to services for which there is little or no financial return.”

What role does pro bono work play for private practitioners who are trying to balance their empathy with the financial side of running a business?

Explore this topic further in an online companion piece to this cover story, “Pro bono counseling: How to make it work.”

 

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