Monthly Archives: February 2022

Why your own therapy is so important as a counselor

By Scott Gleeson February 28, 2022

One stigma Francesca Giordano would like to vanquish in the mental health professions is the notion that therapists do not need their own therapy. Giordano, a retired counselor educator and the principal partner of Veduta Consulting in downtown Chicago, says there may be no greater resource for a clinician — including supervision and personalized self-care — than regularly meeting with a therapist. And yet, clinicians’ perceptions of themselves in the opposite chair remain a blockade.

“I think in the history of our profession, there’s sometimes been a negative association with the idea of being a wounded healer, that by going to our own therapy, we are perceived to be too damaged to help,” Giordano says. “That label gets in the way instead of being able to see a clinician going to a therapist and doing their own continual work as a strength.”

Giordano’s sentiments echo a call to action in the counseling profession that has often been stampeded over by a multitude of available workshops and seminars that focus on clients’ needs first.

“Counselors are inclined to put clients’ interests before everything else,” says Stephanie Burns, an associate professor and coordinator of the clinical mental health counseling program at Western Michigan University. “The problem is that counselors can often put themselves last and overlook self-care for themselves. Much like with clients, counselors can avoid help-seeking behavior like therapy because of fear of feeling incompetent and ashamed. It becomes, ‘I’m a counselor, so I should be able to handle all of this.’ That type of self-sacrifice mindset can ultimately lead to depression and burnout.”

Stephannee Standefer, the associate program director of Northwestern University’s online master’s in counseling program, says a clinician can be masqueraded by their own shame in taking a no-counseling approach. “When I hear from students or counselors, ‘I don’t need therapy,’ I actually hear them saying they want to distance themselves from their woundedness or pretend it doesn’t exist,” Standefer says. “But if you don’t face your own pain regularly, it limits your ability to be an effective counselor.”

Self-awareness over self-demolition

Like many mental health professionals, Judith Fawell, a licensed clinical professional counselor and certified alcohol and other drug counselor, felt drawn to the field based on her own experience with therapy. The same foundational principles that she developed in her own therapy still foster self-awareness now.

“As a therapist, more than anything I’ve learned in school or the field, I draw from my memory working with my own therapist and the wisdom I got from that. It was like having the best mentor and someone who saved my life at the same time,” says Fawell, a recipient of the 2020 Award of Excellence from the Illinois Mental Health Counselors Association.

“I saw firsthand how one could benefit from seeing a therapist,” Fawell continues. “In essence, my therapy was part of my training too.”

Giordano, a member of the American Counseling Association, says that “training” period of counselors doing their own work before entering the profession is wholly necessary. She also thinks it is best to keep therapy ongoing while seeing clients.

“My belief is that the relationship you have with a client is the conduit for change, and you have to do your own therapeutic work to use yourself as a vehicle,” says Giordano, a former Illinois Counseling Association president. “My philosophy is pretty strong on the importance of therapy and ongoing therapy. Not just for students and young counselors but [for] experienced practitioners. That’s super important. It’s a false dichotomy to think that we’ve already done our own work and are ‘fixed’ or finished growing.”

Standefer agrees that the self-awareness developed from therapy is key. “When I do my own work, I know where I end and where the client begins,” she says. “I become aware of my own reactions to a client’s narrative, and I can hear it in a way that’s therapeutically effective for the client. I’m able to challenge my assumptions and raise awareness to countertransference.”

Fawell says it is naïve to not expect some clients to draw out countertransference and that counselors who are in therapy themselves often have a wider container for the psychological complexities that clients bring into session.

“As you help people, clients are going to trigger you in all kinds of ways,” she says. “They’re going to hit your nerves from the past. You have to work through those in order to be the best helper you can be. Therapy can also help you become self-aware to know whether … to refer out or not.”

Both Fawell, a member of the Illinois Professional Counselor Licensing and Disciplinary Board, and Giordano, a former vice chair on the disciplinary board, say they have noticed a correlation between clinicians who inadvertently harm their clients and clinicians who have not done their own therapy.

“I’m totally convinced that there’s a relationship to clinicians’ own stress and making poor decisions that affect clients and get them into trouble,” Giordano says. “It makes sense. When you’re not in therapy, it’s common to use defenses or block problems or even project those problems onto others. When people are in therapy, their relationship to their own problems changes. Having personal problems doesn’t have to be a bad thing, because then you have an understanding and sense of self and can integrate that into what a client is going through.”

Understanding a ‘unified phenomenon’

Burns believes counselor care and client care are a “unified phenomenon” in that they both hold equal importance to infuse the other. But too much of one form of care tends to not work in the best interest of the client.

“It’s equally as bad if you’re focused on yourself and not caring for the client as if you’re too focused on the client and not yourself,” Burns asserts. “The more mature stance is to blend the two. That makes for a better, more therapeutic relationship with the client.”

“The best way to accomplish that balance,” Burns notes, “is through therapy. … When you’re in therapy, you’re naturally more self-aware of things like compassion fatigue and boundaries. When you’re more self-aware, you have more room for empathy because you’re giving the same thing to your clients that you just gave to yourself. Without it, then it’s easy to get disappointed in clients because of how they’re managing their life or even feel personally slighted if they don’t grow.”

Ingo Weigold, a licensed professional counselor at Centennial Counseling Center in St. Charles, Illinois, sees his own individual therapist regularly and has been an active member in men’s groups over the years. He says he uses his own work as a way to stay humble.

“I never want a client to think I’m above them,” Weigold says. “I want them to know I’m sitting with them, exploring with them. That I’m in the passenger seat. It’d be so easy to develop a power complex in this field because people come to us at their most fragile states and are trusting. We have to treat that as a privilege, and I believe that entails us doing our own work.”

Weigold co-hosts a podcast, Drinks ‘n Shrinks, that aims in each episode to normalize mental health practices and humanize the clinician through exchanges with licensed therapists. It would be “pretty hypocritical if we were to say we’re above the therapeutic process. Just because we’re clinicians doesn’t mean we’re not human,” he says. “We go through things just as much as the next person. That’d be like a mechanic saying, ‘I don’t believe in oil changes. Those don’t work.’”

Giordano agrees that engaging in individual therapy as a counselor can help to remove any perceived hierarchy because the reflex of facing uncomfortable emotions is already in place to be modeled for the client. “When you do your own therapy, you don’t necessarily lose countertransference. You still feel it,” Giordano says. “But then you’re not afraid of it. You can use it to help the client and the therapeutic relationship instead of projecting or going to a safer place above the client out of fear.”

Supervision and counselor friends aren’t always enough

Marina Harris, a licensed psychologist in North Carolina, meets with a group of fellow clinicians weekly to process different cases and client dynamics. “Your self-care and support can take many different forms. Every clinician has something that works for them,” she says. “Personally, I turn to my consultation group because these are clinicians I really trust. But at the same time, it’s not the same as therapy. I support every clinician using their personal intuition of when to do their own therapy.”

Weigold admits that his own therapy can sometimes get put on the back burner, so he makes a conscious effort to supplement it with his clinical supervision sessions.

“Supervision isn’t therapy,” Weigold admits. “It’s a weird mix of therapy processing of clients and coaching. It’s more neutral and asking the question, ‘Why am I feeling countertransference?’ But it’s not necessarily processing. We want to be self-actualized and continue growing as we’re seeing clients and going to supervision about clients.”

Standefer expresses concern for clinicians who rely solely on supervision and for supervising clinicians who inadvertently become therapists to their supervisees.

“Supervision has four purposes: administrative, knowledge base of cases, ethics and ensuring client well-being. Counselor well-being doesn’t fall under that list,” Standefer points out. “If we’re taking up the time in supervision doing our own therapy, all four of those parts of supervision become weakened. You lose, the supervisor loses, and the clients lose. We’re cheating ourselves if we don’t do our own work before we come to supervision.”

“It’s very hubris[tic] and prideful for a supervisor to think that they can grossly overstate their role to be both a supervisor and a therapist to clinicians working under them,” Standefer adds.

Giordano notes that supervision has limitations when it comes to vulnerability because clinicians can get wrapped up in protecting their self-image with colleagues. “No matter how good your supervision or consultation is, there’s always that impression management component, that piece of trying to impress a boss or colleagues,” she says. “With a therapist, you can get more real and go deeper on something a client brought up or something separate you’re going through.”

Regardless of whether counselors turn to their own therapy or trusted confidants, it is essential for them to be in a space where they can be their authentic selves and remove any mask, Fawell says. She experienced this firsthand when suffering a personal loss. “Whatever the outlet, you’ve got to be able to be vulnerable,” she says. “When my son was killed, I spent a lot of time with someone I [could] trust.”

Exuding therapeutic growth versus self-disclosure

Although destigmatizing mental health is necessary in the field, Harris says self-disclosure with clients about doing individual therapy as a clinician is not always wise.

“To me, that’s more of a case-by-case and situational basis,” she says. “We always have to ask [ourselves] with that, ‘Am I sharing this to help the client and in their best interest? Or is it for a different reason?’ One way I’ll get around that is [sharing] with my clients that skills are to be learned and there are still things I’m working on. For instance, that nobody has a perfect self-care regimen.”

Burns agrees. “We do have to be really careful with self-disclosure because it has the ability to enhance the alliance or make it problematic because a lot of the worries or concerns or judgments about therapists being in therapy come from clients who don’t know how and why that’s healthy and good for their experience. They might start probing the counselor to where you’ll have to redirect the focus back to the client. Research shows that self-disclosure is highly problematic, so it has to be in the best interest of the client.”

Weigold says counselors’ self-disclosure of their own therapeutic work becomes unnecessary when they can “wear” it or exude it with quiet confidence and noticeable self-awareness. “Clients can feel when you’ve done your own work as compared to just reading it out of a book,” Weigold says. “Even if you don’t say anything out loud, they can feel you’ve been there or know a little bit about what they’re going through. You can show them you’ve come out on the other end or are growing in the moment. I know if I didn’t have my own therapeutic journey, I wouldn’t be able to connect with clients the way I do.”

Fawell concurs. “When a client says to me, ‘You’re so real,’ I think that’s their way of knowing I get them. Well, I’m so real because I’ve done what they’re doing.”

Standefer says her two decades in therapy often speaks for itself through a similar form of realness. “[Carl] Jung talks about the shadow self. I feel like we can only bring out the light when we test it out in reality, dissect it and reframe it. That is not something we can teach. You have to do it yourself first, and then [clients] can feel that energy.”

Talking about our own therapy

Standefer says that whenever she shares with students or counselors-in-training that she still sees a therapist, she experiences a “vulnerability flash.”

“Every time I say it, that I’m in counseling myself, I’m very aware of what I’m putting out there, that I’m being judged,” she says. “But I’ve come to a place where I think it’s important for the benefit of other people because it changes people’s perception of ‘she’s arrived’ to more of ‘she’s arriving.’ If I don’t express [that] I’m in therapy, then I’m subject to believing what others might project onto me. I want students to see my vulnerability in that way because it can normalize therapy in the field and encourage them to not keep their best tools in the toolkit in being their vulnerable selves.”

Antonio Guillem/Shutterstock.com

Giordano says there is a macro impact when counselor leaders discuss doing their own therapy on a micro level. “It’s so important for counselor educators to talk about their own therapy,” she says. “Because not mentioning it at all then reenforces the stigma, and [students] can develop this distortion that older clinicians don’t seem to need therapy, so they can stop their own hard work while they’re being available for clients. It’s actually the opposite. Doing your own work is what empowers you to be available to clients.

“We have to get past these ideas that someone needs therapy because they’re inexperienced or having a problem. We need therapy because we’re human and this is complicated work.”

Giordano adds that the modeling that comes from therapy has a trickle-down effect from a cultural perspective as well. “If a therapist represents a cultural group that isn’t known for going to therapy, whether that be race or gender, then the value of modeling takes on an added layer,” she explains.

Burns points out that private practices cannot necessarily mandate that clinicians do their own work, but it can be heavily implied or suggested.

“The workplace culture matters,” she says. “Research has suggested that age isn’t a factor on whether clinicians take care of themselves with self-care. What is a predictor is working conditions in a workplace setting. That means it really does start from the top and [it] puts an emphasis on not just supervisor support but supervisor modeling and leadership with boundaries and one’s own therapy.”

Note: The author previously held professional relationships with multiple clinicians quoted in this article.

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Scott Gleeson is a licensed professional counselor for DG Counseling in the Chicago suburbs, specializing in trauma and relational dynamics. He spent more than a decade writing for USA Today, where he won national writing awards from the Associated Press and NLGJA: The Association of LGBTQ Journalists. His debut contemporary novel, The Walls of Color, will be published in 2023.

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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: A frightening truth in the profession

By Gregory K. Moffatt February 23, 2022

I never get through a single supervision session without addressing ethical issues. Ethical behavior must be at the center of every thought we have and every action we take with our clients, from first contact to closure. As counselors, we are schooled on the importance of ethics from the opening hours of our graduate programs, and in my home state at least, ethics appear prominently in the licensure requirements as one of nine areas of focus.

But there is a frightening truth in our profession. After we leave our graduate programs and finish supervision, nobody is there to tell us what to do. It is up to us to focus on ethics and, sadly, this is where things start slipping.

Over my many decades in the profession, I have heard story after story about lapses in ethical conduct. I have also witnessed firsthand the questionable behavior of some professionals in the counseling field. These behaviors range from individual blind spots related to confidentiality, diversity or boundaries to systemic issues within agencies.

Here are a few examples (details have been changed slightly to, well, remain ethical). After a workshop that I presented on ethics, a counselor with many years in the field asked me if it would be acceptable for him to sell his beach condo to a current client. Um … no. He was stunned at my answer. Really?

A counselor stopped me in the hallway at a break during a conference to thank me for the referral of a client — whose name she said out loud. She then proceeded to tell me about the client’s backstory. I couldn’t believe my ears, and it took me a minute to compose myself and stop her from going further.

A former student expressed concern about the agency where she was working. The agency was encouraging its counselors to “push continued therapy” with full-pay clients, even when similar sliding-scale clients were quickly made ready for termination. It appeared that the focus on the bottom line in this agency was taking priority over clients’ best interests. Even more troubling, none of the many fully licensed clinicians in the agency had protested.

These examples are just the tip of the iceberg of the things I have seen or heard. How many more scenarios are out there that we don’t even know about? That, dear colleagues, should make us all shudder.

r.kathesi/Shutterstock.com

Dishonest people exist in every profession, including ours. But let’s set those dishonest few aside for a moment. The majority (by far) of questionable ethical behaviors that I’ve encountered in our profession have not been committed by dishonest people. Instead, most have been committed by reasonable counselors doing good work who have strayed over time from the course they set out on in the early part of their training.

I propose three reasons (beyond blatant dishonesty) that get at the root of these ethical lapses. First, is blind trust. In graduate school, counseling students can discuss ethics in the sanitized setting of the classroom, without the complications of real clients or supervisors sitting across from them.

When they start practice, they have the same blind trust in their supervisors or agencies that they had in their graduate school. Yet this is where they most need to put their ethics training into practice. But how realistic is it to expect a clinician-in-training to question a fully licensed and experienced supervisor? Even more intimidating, how likely is it that a clinician-in-training would challenge an entire agency?

“This is how it is done, I guess,” is an easy, and understandable, result in such a context. Those mistakes are then repeated and perpetuated.

Second is the termite analogy. Termites, despite their horrible reputation, are not that damaging if caught early. They work slowly, and all it takes to protect a home is to have regular inspections and to intervene if termites appear. No major damage will be done. But the nibbling away at the foundations of a home can eventually lead to its collapse, or at the very least some expensive repairs.

The same thing happens with ethical breaches. Most clinicians who sit before a state ethics panel have not committed egregious breaches all of a sudden. Their behaviors have slipped a little at a time until the metaphorical structure of their ethical life is badly damaged.

And, finally, these breaches happen because of a simple loss of focus. I don’t get angry easily, but I lose it if I hear clinicians talk about “having to do” their ethics hours. If clinicians see these hours as “obligations,” they are already traveling the wrong road.

These clinical trainings are imperative to ensure that ethical standards are, as with my supervisees, always at the center of everything we do. We should welcome ongoing training in ethics, even if it wasn’t required.

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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.

Addressing the Afghanistan humanitarian crisis

By Justina Wong February 16, 2022

In August 2021, Americans who were already dealing with the upheaval and roller coaster of emotions caused by the ongoing COVID-19 pandemic faced another frustration when the U.S. military suddenly withdrew from Afghanistan. The humanitarian crisis in Afghanistan has caused many mixed emotions for individuals who identify with the military community. And for most Afghan refugees, the struggle is not over.

According to the United Nations High Commissioner for Refugees (UNHCR), nearly 6 million Afghans have been forcibly displaced from their homes, with over 3.5 million people currently displaced within Afghanistan and 2.6 million living in other countries. As of Jan. 2022, more than 76,000 Afghans have been brought to the United States.

What counselors should know

Relocating to another country can be a traumatizing experience. In the United States, Afghan refugees often spend weeks in cramped quarters on military bases not knowing when they will be able to leave and start their lives in America. Once they do leave the base, they face a new set of obstacles in the host country.

Affordable housing is a significant challenge for many refugees, who often flee with only the shirts on their back. They do not have any money or belongings, and this issue can be exacerbated for refugees who resettle in areas with exponentially high costs of living such as Los Angeles and New York City. The refugees who are approved to leave the military base typical stay in a room at a motel, hotel or Airbnb or in the house of a host family. Their housing is paid for by nonprofit organizations or private donors. Finding a sustainable way of providing long-term housing is another concern. They usually do not have a place to call their own.

Other obstacles include language barriers, employment, financial insecurities, transportation, food insecurities and other basic necessities for daily living. Most of them are still trying to process the trauma they experienced fleeing their home country, living on military bases and being relocated somewhere else. A lot of these refugees left their families or extended family members behind in Afghanistan.

It is important for counselors to understand the experiences that Afghan refugees went through to come to the United States. Their courage, bravery and perseverance are closely intertwined with fear, despair and trauma. Counselors should refrain from making the following assumptions:

All Afghan refugees want to live in the United States.
Mental health services are easily accessible for Afghan refugees.
Afghan refugees should be grateful that they are living in the United States.
Afghan refugees are taking away jobs from American citizens.
All Afghan refugees want to adapt to American culture, including customs, societal norms and foods.

Instead, counselors should be knowledgeable about specific concerns that Afghan refugees face, which include the following:

Refugees experience a high level of racism if they live in communities different from their own. One of the reasons they are being placed in California and New York is because these states already have established Afghan communities.
Acculturation can be a struggle because of cultural differences in language, customs, social norms and foods.
Refugees are less likely to access mental health services because of barriers and mental health stigmas. Some might not understand what mental health means or what mental health services have to offer them because in their home country, these services are not available or mental health is not often discussed.
Mental health services and insurance are expensive and viewed as luxuries instead of necessities. With little financial assistance from the U.S. government, most families cannot afford insurance copays or services. Their main focus is providing food and shelter.
There are few counselors that are competent in providing mental health services to refugees in their native language.
Afghan culture teaches individuals to face the trauma they have experienced, keep their heads down and keep going on with their lives. In doing so, this creates generational trauma.

Being aware of refugees’ struggles and challenges will equip counselors when advocating for Afghan refugees as well as help them build a stronger therapeutic alliance with any potential future refugee clients.

How counselors can help Afghan refugees

Some counselors might think they are not well equipped to support Afghan refugees because of language barriers or lack of knowledge about Afghan culture. However, counselors can support them using basic counseling skills. Instead of focusing on how they are different from refugees, counselors should concentrate on the ways they are similar.

To illustrate this point, consider the following case vignette:

Hamid is a 42-year-old man who left Afghanistan with his wife Zeia and their three sons (ages 5, 3, and 6 months) and relocated to Los Angeles. Hamid and his family are temporarily staying in a building behind the main house of a host family. He expresses frustration regarding being unable to afford food for his family, so the host family refers him to see a Hispanic, female counselor named Theresa, who works at a nonprofit organization that provides wraparound services for refugees.

In their initial session, Theresa has a hard time understanding Hamid because of his limited proficiency in English. After reading his intake paperwork, Theresa believes Hamid could use therapy to discuss his past trauma of escaping Afghanistan and receiving constant death threats for helping the U.S. military as an interpreter, but Hamid is more concerned about having food for his family. They are both frustrated with their inability to understand each other.

Theresa decides to use her love of art to create a visual aid for Hamid, so she can understand his needs better. During their second session, Theresa presents the visual aid — a pyramid of Maslow’s hierarchy of needs she created using pictures — to Hamid, who enthusiastically nods his head and smiles in approval. Hamid immediately points to the picture of food and water and then to the picture of a family. Theresa points to the picture of food and asks if Hamid needs food for his family. Hamid nods.

Theresa then creates a checklist of all of Hamid’s needs using the visual aid. At the end of their session, Theresa concludes that food is Hamid’s main concern. Theresa gestures for Hamid to follow her, and she brings him to one of her coworkers who is a licensed social worker. Theresa asks her coworker to help Hamid fill out an application for CalFresh, a Supplemental Nutrition Assistance Program that provides monthly food benefits to people with low income, so he can receive an electronic benefits transfer (EBT) card to buy food for his family.

While not all counselors are proficient in speaking Pashto or Dari (the two mostly widely spoken languages in Afghanistan), they should be proficient in understanding Maslow’s hierarchy of needs and the use of nonverbal cues and body language in counseling sessions. By asking her coworker to help Hamid fill out an application for CalFresh, Theresa has addressed Hamid’s physiological and safety needs. In doing so, she has built a strong therapeutic alliance with Hamid, and he is more likely to come back to see her and discuss his past trauma in future sessions. She has presented herself as someone Hamid can go to if he needs anything.

How counselors can help military veterans

Afghan refugees are not the only ones struggling with the humanitarian crisis in Afghanistan: Military veterans have been significantly affected too. Veterans might be experiencing feelings of guilt, betrayal, shame, anger, hopelessness, worthlessness or resentment. The U.S. withdrawal from Afghanistan has also caused many veterans to struggle with moral injury, which the U.S. Department of Veterans Affairs defines as the distressing psychological, behavioral, social and sometimes spiritual aftermath of being exposed to events that damages or goes against one’s own moral compass.

Ben (a pseudonym) is a former Marine and personal friend of mine, and for the past 15 years, he has worked as a military contractor in Afghanistan. When I asked him how he felt about the U.S. withdrawal from Afghanistan, he expressed feelings of anger, hopelessness and worthlessness regarding the situation. He was angry and frustrated that he could not go to Afghanistan to help the Afghan interpreters with whom he had previously worked. In his mind, he left his “brothers” behind and that was unacceptable. The thought of abandoning those who risked their lives serving as interpreters haunted him.

Leonid Altman/Shutterstock.com

He felt guilty that many of these interpreters were promised safe passage and a special immigration visa (SIV) to enter the United States for their work as U.S. military interpreters only to discover they were later denied entry. Ben has known some interpreters who have been waiting for as long as 11 years for their SIV paperwork to be approved. The more interpreters reached out to him for help with getting their SIVs approved, the more hopeless and worthless he felt.

He also believes the loss of the war makes it seem like all the sacrifices he and his fellow veterans made were for nothing.

Counselors who work with military veterans should know that moral injury is different than having posttraumatic stress disorder (PTSD). Moral injury can be equally if not more traumatizing because it is focused on feelings of guilt, shame and betrayal. And in my work with military veterans, I’ve found that more of them engage in self-destructive behaviors because of moral injury than from a diagnosis of PTSD.

Here are a few questions counselors can ask clients to better understand a veteran’s wounded sense of morality:

What are you feeling? Do you feel guilt, shame, betrayal, anger, resentment, regret, hopeless or worthlessness?
What happened to make you feel this way?
What did you witness that made you feel this way?
Do you feel like you failed to prevent certain events or acts that conflict with your own values, beliefs and principles?
Have you found yourself ruminating on things since the event occurred?
How would you change the outcome if you had a second chance?
Have there been other incidents in your past when you have experienced moral injury?
How do you view yourself? Sometimes moral injury comes with a sense of self-loathing and feelings of worthlessness.
How do you manage your wounded sense of morality (e.g., substance use, anger outbursts, self-harm or self-destructive behaviors, deep breathing or meditation, volunteering with organizations that help veterans, working with fellow veterans)?
What do you need to feel a sense of peace and that you did all you could do with what you had?

How counselors can be advocates

As counselors, we owe it to our clients to advocate for not only their mental health but also their human rights. S. Kent Butler’s vision for his ACA presidential year is to #ShakeItUp and #TapSomeoneIn. These two hashtags represent action. Counselors cannot sit back during this humanitarian crisis and simply sympathize or empathize with military veterans or Afghan refugees. They must advocate and take action.

Licensed counselors could provide pro bono counseling services, process groups specifically focused on trauma or moral injury, or psychoeducational groups on parenting, goal setting or stress management. They could also cofacilitate support groups with Afghan refugees to research the needs of the community. Unlicensed counselors and counselors-in-training can provide similar services with clinical supervision.

Counselors can also volunteer to help Afghans as they rebuild their lives in the United States; this could involve teaching them English or about their basic human rights or helping them figure out where to buy groceries or diapers or how to apply for an identification card. And counselors can facilitate support groups or retreats for veterans struggling with moral injury so they know they are not alone.

There is room for everyone. My challenge to you is to fulfill Butler’s vision to #ShakeItUp and #TapSomeoneIn.

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Justina Wong

Justina Wong is a new professional currently earning hours towards licensure at a group private practice in California. She serves on the Military and Government Counseling Association’s board of directors and as a graduate assistant to the president of the Association for Multicultural Counseling and Development. Justina is also a member of the American Counseling Association’s Human Rights Committee.

She wrote this article on behalf of the Human Rights Committee.

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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.

Behind the book: Counseling Practice During Phases of a Pandemic Virus

Compiled by Bethany Bray February 10, 2022

“We are all having a normal response to an abnormal critical event,” says Mark A. Stebnicki, author of Counseling Practice During Phases of a Pandemic Virus.

The COVID-19 pandemic has been a “soul wounding” event for many people, he notes. The stressors from the past two years, including loss of social connections and career opportunities, political divisiveness, the rapid spread of the virus, and loss of many lives, he argues, have created “a unique type of historical trauma.”

Stebnicki, a licensed clinical mental health counselor, certified rehabilitation counselor and professor emeritus at East Carolina University, draws upon his vast experience in the realm of disaster mental health to explore methods that counselors can use to support clients during this unprecedented time.

Q+A: Counseling Practice During Phases of a Pandemic Virus

Responses by author Mark A. Stebnicki

In the book, you talk about how Americans are facing both a pandemic virus and a mental health crisis. In your opinion, why are professional counselors well suited to respond and make a difference during this highly stressful and unprecedented situation?

Professional counselors are a vital resource to the COVID-19 generation, which has reached a mental health “tipping point.” This virus has killed more than 900,000 in the U.S. By comparison, the Spanish flu of 1918 killed approximately 675,000 Americans.

There are clinically significant mental health symptoms related to stress, traumatic stress, grief, loss, anxiety, depression, substance use disorders and other co-occurring conditions that are chronic and persistent. We have a viral contagion that has not only killed more persons than the Spanish flu but also critically strained our health care system and medical resources. We have a scarcity of goods, services and basic materials required for daily living.

Additionally, we are confronted with an irrational political ideology spreading disinformation that the 2020 election was stolen from the former president. There is a rise in white nationalism and hate crimes, such as seen in the killings of George Floyd, Ahmaud Arbery, Breonna Taylor and many other people of color. All these are critical incidents that impact our mental health and wellness. Thus, the COVID-19 pandemic has been a soul wounding experience for many.

Professional counselors are trained to provide therapeutic interventions to a variety of individuals and specialty areas. Medical and mental health care professionals now utilize telemedicine and telemental health technology to coordinate natural resources, supports and therapeutic opportunities with other allied health professionals to address the client’s medical, physical, psychosocial, mental, behavioral and career health.

The generations that emerge from this nuclear winter are planting seeds so we can have a bountiful harvest of coping and resiliency. The harvest will be cultivated in the fields of counseling and psychology so that we may rediscover the basic human instinct: how to survive and thrive simultaneously while in the face of adversity.

What would you want counselors to know about borrowing from and adapting disaster mental health response methods to support clients during the pandemic?

It helps by first acquiring the awareness, knowledge and skills to work with the unique characteristics of a multitude of natural (e.g., floods, hurricanes, tornadoes, earthquakes, wildfires) and person-made disasters (e.g., gun violence, physical violence, social and civil unrest). We begin by recognizing the unique medical, physical and mental health differences in a pandemic disaster, which is pervasive and permeates all life areas, [including] family life, career and educational opportunities, our social-emotional health, and … our mind, body, and spiritual consciousness.

Epidemiologists, virologists and other medical health care experts understand how to identify, assess and treat a viral contagion. I believe counseling and psychology are trying to understand how to do the same but may be too concentrated on the individual’s mental health symptoms. It is my opinion that we are all having a normal reaction to an abnormal critical event — a pandemic virus with over 900,000 souls that have perished. We need to clearly understand how the virus impacts all life areas (e.g., jobs, education, family, social, emotional and recreational life) and the unique losses and grief experienced by individuals, groups and cultures. Reviewing the literature in psychosocial aspects of chronic illness, disease and disability is a good place to begin.

There are some similarities in the assessment, diagnosis and treatment of the mental health and psychosocial symptoms related to a life-threatening illness and a pandemic virus because many of these conditions are a life-long challenge to individuals. Counseling Practice During Phases of a Pandemic Virus connects theoretical models that delineate the adjustment and adaptation phases of a pandemic virus. My work will assist readers to identify untreated, undertreated and unrecognized issues that precipitate fear, anxiety, mood dysregulation and irrational behaviors that may lead to the harm of self and others. The book offers an integrated psychosocial approach to identifying, recognizing, and intervening in critical life areas that have been imprinted on our mind, body and spirit.

The pandemic risk and resiliency continuum (PRRC) theoretical model [outlined in the book] also offers support to identify, prevent and prepare clients for the medical, physical, psychological, psychosocial and behavioral resiliency required to thrive under adverse conditions. The PRRC model has been reviewed and critiqued by a panel of eight experts in disaster mental health, epidemiology, medical and psychosocial aspects of chronic illness and disability, and behavioral health. Thus, the contributions of other researchers and practitioners are a foundation for this work.

What would you want counselors to know about helping clients adjust their coping mechanisms to deal with the different phases of the pandemic?

The most common and frequently reported psychological and behavioral issues reported by epidemiologists and public health experts during a pandemic virus relate to the individual’s fear, anxiety and behavioral health concerns. There are also the clinically significant mental health symptoms related to major depressive, anxiety, posttraumatic stress and substance use disorders, as well as suicidality reported within qualitative and quantitative studies.

When I discuss “phases of a pandemic virus,” I use the traditional public health model and generalize this for professional counselors. Natural disasters are typically organized in three phases: (a) disaster preparedness, (b) disaster response, and (c) post-disaster recovery. Unfortunately, there is no beginning, middle and end to a pandemic virus because many times they morph into another mutant variant which creates an endemic disease. So, post-disaster recovery looks much different than a North Carolina hurricane, Texas tornado or a California wildfire.

It is my opinion that we are challenged with a unique type of historical trauma because of the relentless spread of infection; mortality; loss of educational, career, and job opportunities; loss of financial resources; decreased interpersonal and intimate connections with friends and family members; political and social divisiveness; and many other life areas. These are soul wounding experiences for many, and therapeutic post-disaster recovery requires transcending the mind, body and spirit for optimal health in the “new normal.”

[In the book,] a conceptual model – the pandemic phase rehabilitation (PPR) – is offered to readers. This comprehensive model is applicable for practitioners and researchers providing guidelines in four phases (a) preintervention, (b) acute intervention, (c) post-acute intervention and (d) adjustment and adaptation. Consequently, the “new normal” requires some level of personal existential and spiritual growth as we adjust and adapt to an endemic virus.

In the book introduction, you argue that mental health professionals “should never again delay a disaster mental health response as we did during the summer and late fall of 2020.” How can counselors make a difference in this realm?

We cannot delay the mental health disaster response of a virus that has killed over 900,000 and infected over 63 million Americans. The human spirit and soul are at stake for professionals at the therapeutic epicenter of disaster relief.

The stench of death in hospitals, [in] tent cities and on the battlefield of a coronavirus pandemic reminds us of how fragile human life can be. Scientists have identified over 12,000 coronaviruses. Fortunately, most do not have the same transmissibility, infectious spread and mortality rates as COVID-19. Pandemic viruses have been with us since the beginning of time. They are naturally occurring events that have potential to be a public health crisis and morph into a natural disaster. In fact, diseases like rabies still exist today despite Louis Pasteur’s development of a successful vaccine in 1885. The tetanus vaccine was developed in 1927, yet we still have this shot available today to reduce infection. Measles, mumps and rubella are diseases with no treatment or cure, yet in 1971 shots were widely distributed for children. Hepatitis A and B all have potential to be a public health crisis in certain occupational settings.

Using the epidemiological example of the H1N1 flu virus, which has no cure, the best-case scenario is that COVID-19 and its mutant variants will someday be classified as an “endemic disease.” Counseling Practice During Phases of a Pandemic Virus addresses multiple areas of concern for the early identification, prevention and preparation for the next disaster.

What prompted you to write this book?

Jerry Corey [professor emeritus of human services and counseling at California State University at Fullerton and ACA fellow] states that most individuals “have a book within them” to write. The book within me, Counseling Practice During Phases of a Pandemic Virus, my 10^th professional work, was influenced by my personal and professional experiences. I have been a mental health and rehabilitation counselor, counselor educator and researcher for more than 30 years. My research and clinical practice have focused on working with persons with chronic illnesses and disabilities, stress, traumatic stress and disaster mental health response in a variety of settings. My work has guided me to work with active-duty service members, veterans, veterans with disabilities and military families.

So, these are the things I have written about, professionally, since around 1993 and have not stopped. My interest in writing has most often been motivated by communities where I lived and worked and [that] have been at the epicenter of natural and person-made disasters: school shootings, workplace violence, hurricanes, floods, tornadoes and earthquakes. So, I placed the old disaster mental health hymnal on my bookshelf and decided to write a new anthem describing the medical, physical, behavioral and mental health characteristics of this new disaster, a pandemic virus that is relentless [and] never sleeps or takes a day off.

Epidemiologists and public health experts have been researching pandemic viruses for decades. However, there has been very little written in counseling and psychology to guide our profession in addressing the unique medical, physical, behavioral and mental health opportunities to thrive, not just survive, during a pandemic virus.

Thus, as a writer, I reviewed the current literature in mental health disaster response, applied my experiences in the field and then offered guidelines and models to provide a unique perspective concerning mental health characteristics of this new natural disaster. My primary intent is to offer recommendations for the preparation, prevention, [and] psychosocial and mental health treatment of individuals living through phases of a pandemic virus.

It’s been roughly six months since the book was published and conditions regarding the coronavirus continue to evolve and change. Is there anything you’d like to add or emphasize for readers since publication?

Since the beginning of the pandemic, there was a familiar phrase echoed by politicians and other public figures that “we are all in this together.” To the contrary, we are not “all in this together.” This statement implies that we all enjoy the same benefits and privileges in terms of socioeconomic status, access to quality health care, jobs [and] civil rights as well as adequate support systems and basic resources.

Many Americans still do not recognize and acknowledge the seriousness and lethality of the COVID-19 pandemic based on their questioning [of] the use of vaccines, mask-wearing, social/physical distancing and other virus hygiene protocols. I would like to offer a reframe [of that phrase]: “We are all our own best support system.” It is only when we can come together in the present moment that good things will unite our communities and regions.

The adaptation and adjustment (AA) theoretical model I propose [in the book] may assist practitioners in the identification, early intervention and triage, prevention, and preparation for therapeutic interventions during a pandemic virus. The stages of the AA model include [the] first wave of [the] pandemic virus, initial impact, fear and anxiety, denial, depression, anger and hostility, acknowledgment of the pandemic, [and] adjustment and integration.

Pandemic viruses are multidimensional in nature. They are not only biological entities; rather, the side effects of a viral contagion carry multiple medical, physical, psychological, social, emotional and occupational consequences. So, it is essential that we take a multidisciplinary approach in applied research to predict, anticipate and prepare for the next wave of a viral contagion.

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Counseling Practice During Phases of a Pandemic Virus was published by the American Counseling Association in 2021. It is available both in print and as an e-book at counseling.org/store or by calling 800-298-2276.

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Watch ACA President S. Kent Butler’s conversation with Mark A. Stebnicki in a recent episode of the “Voice of Counseling” video podcast: youtu.be/eyrgUj_R0bc

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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.

Peer support, mad pride and disability justice

By Luke Romano February 9, 2022

Do the phrases peer support, mad pride or disability justice ring any bells? If your graduate education was anything like mine, probably not very many. In this article, I’d like to offer an introduction to these terms and the social movements with which they are associated. My goal is for every counselor to walk away from this article with increased curiosity regarding these terms’ significance and relevance to our work and equipped with some practical tools to enhance our professional skill sets.

Some of the perspectives presented in this article are critical of the mental health professions. As counselors, we know that integrating critical feedback from our clients allows us to repair ruptures and ultimately strengthen the therapeutic work. The point isn’t to agree or disagree with client feedback but rather to take it seriously. Similarly, my belief in the importance of these perspectives is related to how they enhance my counseling practice. Putting new ideas on the table doesn’t mean taking other ideas off.

My personal background might contextualize my familiarity with the content presented in this article. Prior to my career trajectory as a counselor and educator, I had devoted more than 10 years to participation in various social justice movements and organizations. In the course of my journey, I had encountered and involved myself in peer support, mad pride and disability justice ideas and social spaces.

I’m now an early career counselor working toward licensure in Pennsylvania. My primary occupation is as a child and youth outpatient counselor in a community mental health clinic in Philadelphia. I also work part time with adults at another practice and recently gained experience as a course instructor in a counseling graduate program. Many of the lessons and principles I learned from my experience as an activist underpin my clinical work. My hope is to bring these lessons and principles to a wider audience in the world of professional counseling.

What is peer support?

Peer support is a tool of the mad pride and disability justice movements, in addition to recovery communities such as Alcoholics Anonymous. Peer support generally refers to acts of care that exist outside of the mainstream health care system, provided by and for those with lived experience who are critical of the hierarchy between professionals and individuals. You may be familiar with the existence of publicly funded peer support specialist certifications and practitioners in states such as Pennsylvania, Tennessee and New York. However, prior to the professionalization of peer support services, peer support practice arose as a grassroots response to the systemic mistreatment of patients in mental hospitals. Peer support represented a pushing back against harmful and coercive functions and practices evident in the medical model of mental illness.

The medical model of mental illness is here defined as an understanding of mental distress wherein symptoms indicate an underlying pathology related to the structure and function of the brain. Although counselors more often cite a “biopsychosocial” model that incorporates biological, developmental and societal factors in conceptualizing mental distress, the “bio” component remains the most prominent foundation on which the mental health system functions. Regardless of our individual inclinations toward developmental conceptualizations of distress or trauma-informed care, most of our clients still require a diagnosis out of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to receive treatment.

Robert Whitaker’s 2002 book Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill thoroughly reviews the history of systemic mistreatment of those with psychiatric labels. In Whitaker’s view, current psychiatric and mental health practices remain impacted by and situated within a historical legacy of discrimination and mistreatment. Forced hospitalization and inadequate informed consent related to medication use are two common examples of mistreatment cited by peer support, mad pride and disability justice activists. Peer support practice arose as an alternative to mainstream mental health while demonstrating that communities of mad or disabled individuals can care for themselves, sometimes with better results than when left in the hands of so-called experts.

The peer support movement simultaneously arose out of necessity. The onset of neoliberal domestic policy during the 1970s and 1980s in the United States involved closing down psychiatric hospitals and filling prisons with those who were mentally ill. It was under this context that communities of those with psychiatric labels learned how to care for themselves without the assistance of professionals. Texts to further investigate the successes and lessons from these movements include Outside Mental Health: Voices and Visions of Madness, edited by Will Hall, and We’ve Been Too Patient: Voices From Radical Mental Health, edited by L.D. Green and Kelechi Ubozoh.

Practical applications

It can help to have knowledge of peer support resources in your area. Peer support groups (whether institutionally sanctioned or autonomously organized) can serve as a useful supplement to traditional one-on-one counseling. They may serve as an alternative for some. Project LETS is a national resource offering a peer crisis line along with various programs, trainings and workshops. It has chapters on college campuses across the United States. Trans Lifeline is an excellent peer resource for our transgender and nonbinary clients. Whether our clients choose to use these resources as a supplement or an alternative to professional counseling, we can respect their self-determination in finding services that suit their self-identified goals and needs.

We can integrate lessons from the peer support movement by centering the self-reported lived experiences of our clients. This could mean using our DSM-5 diagnostic framework and following associated treatment protocols. This could also mean tempering or modifying that approach to better suit client preferences. For instance, the Hearing Voices Network in the United Kingdom is a peer support network that includes members who view psychosis as transformative or spiritually significant and reject medication and hospitalization as helpful forms of treatment. If we encounter such individuals in our practice, we can operate out of a place of respect for their choices while weighing other ethical and professional considerations.

As we aspire to combat racism in our profession, we should also be aware of non-Western cultures that celebrate or revere those with symptoms that we might label psychotic, further integrating these individuals into their communities rather than forcibly isolating them — often with better health outcomes. The 2016 documentary Crazywise explores this topic in depth, albeit from a predominantly Western lens.

Standard E.5.b. of the 2014 ACA Code of Ethics asks us to “recognize that culture affects the manner in which clients’ problems are defined and experienced.” It is an ethical imperative to acknowledge the limitations of our profession and to allow outside resources and non-Western perspectives to shape how we conceptualize our work with each client.

What is mad pride?

In the 1960s and 1970s, organizations led by psychiatric survivors (individuals who identified as having survived harmful or abusive psychiatric interventions) began to emerge. Groups such as the Insane Liberation Front and the Network Against Psychiatric Assault organized demonstrations across the country, including demonstrations in San Francisco against the use of electroconvulsive therapy (ECT) that led to the city discontinuing use of ECT for 10 years. Psychiatric survivors began to organize under the banner of “mad pride” in the early 1990s, with the term uniting many social movements composed of current and former users of mental health services.

The psychiatric survivor and mad pride movement is not to be confused with the anti-psychiatry movement. The anti-psychiatry movement was pioneered by thinkers such as R.D. Laing and Thomas Szasz who were critical of psychiatry but who were not psychiatric survivors themselves. One difference between the anti-psychiatry movement and the modern mad pride movement is that mad pride activists are careful not to criticize or shame those who have benefited from conventional psychiatric interventions.

Judi Chamberlin’s 1977 book, On Our Own: Patient-Controlled Alternatives to the Mental Health System, was an important text in the psychiatric survivor movement. In it, she used personal experience to critique involuntary hospitalization and coercively administered medication as well as expose human rights abuses in psychiatric wards. However, the mad pride movement offers more than just a critique of the mental health system.

The mad pride movement views mental distress as situated within social, political and economic circumstances. Fireweed Collective is a prominent organization associated with mad pride. I have had personal involvement with an earlier iteration of this organization known as the Icarus Project. According to the Fireweed Collective website, the Icarus Project “conceived mental health struggles not as faulty brains, but in the context that we live in a world that is not healthy for us.” Oppressive structures — colonialism, white supremacy, patriarchy and more — are seen as implicated in, if not directly responsible for, individual experiences of mental distress.

Furthermore, healing from trauma is seen as a tool in the fight for a better world. The Fireweed Collective “seeks to disrupt the harm of systems of abuse and oppression, often reproduced by the mental health system.” This falls in line with the ethical imperative stated in Standard E.5.c. of the ACA Code of Ethics for counselors to “recognize historical and social prejudices in the misdiagnosis and pathologizing of certain individuals and groups and strive to become aware of and address such biases in themselves or others.”

Practical applications

We can integrate the values and lessons from the mad pride movement into our practice by affirming what kind of relationship the client has, or wants to have, to their diagnosis. Some people feel validated or empowered by receiving a diagnosis that they believe reflects their lived experience. Others feel boxed in or inappropriately pathologized by their diagnosis. Standard E.5.d. in the ACA Code of Ethics states that counselors “may refrain from making and/or reporting a diagnosis if they believe that it would cause harm to the client or others.”

Similarly, some people have a positive relationship to their medication, feeling they benefit from it. Others feel disinterested in psychiatric medication or harmed by their experience with it. We can advocate for our client by collaborating with their doctor or psychiatrist to center the treatment goals and preferences of our client. By centering the self-reported lived experience of our client, we avoid harm while encouraging a sense of self-determination in treatment and, by extension, life — a healthy developmental marker for which we should be aiming.

Mad pride activists are often opposed to the practice of involuntary hospitalization. A growing body of research finds higher suicide rates post-discharge among those involuntarily hospitalized compared with the general population, raising questions about the effectiveness of involuntary hospitalization. One study published by JAMA Psychiatry in 2016 revealed a suicide rate approximately 15 times the U.S. national suicide rate within three months post-discharge.

Regardless of the meaning we make or don’t make of such findings, counselors should consider them alongside mad pride narratives when faced with the decision to hospitalize someone. We can include these considerations in our ethical decision-making processes alongside “consultation; consideration of relevant ethical standards, principles, and laws; generation of potential courses of action; [and] deliberation of risks and benefits” as outlined in Standard I.1.b. of the ACA Code of Ethics.

What is disability justice?

According to Leah Lakshmi Piepzna-Samarasinha, author of Care Work: Dreaming Disability Justice, disability justice “centers sick and disabled people of color, queer and trans disabled folks of color, and everyone who is marginalized in mainstream disability organizing.” Disability justice asserts that ableism — discrimination against and oppression of the disabled — is “locked up tight” with all systems of oppression. The idea that disabled people require “fixing” underpins ableism. The disability justice framework arose out of a critique of the disability rights movement for failing to examine the roles of oppression and identity in experiences of ableism. It advocates for leadership by those most affected.

The disability justice framework builds off of the social model of disability. This model defines disability as resulting from an impairment (including pain, paralysis, fatigue, etc., that would exist regardless of society) plus inaccessibility. Inaccessibility is understood as a society that accommodates the needs of nondisabled people (such as the construction of stairs in buildings) while failing to accommodate the needs of disabled people. As such, disability is a social construct that happens only when an impairment meets an inaccessible society.

Although many issues raised by disability justice writers and activists are of relevance to counselors, the concept of sanism — discrimination and oppression of those who have (or are judged to have) a particular mental trait or condition — is of particular significance in mental health settings. Sanism is understood as a form of ableism. Some disability justice advocates view involuntary hospitalization as an example of sanism, conceptualizing the practice as a violation of basic human rights enabled by cultural stigma toward those with a mental illness or disability. Furthermore, we can consider the ways in which this stigma may be compounded by racial and other biases with the inclusion of an intersectional feminist lens.

Practical applications

Center and adopt your client’s identity and use of language on a case-by-case basis. Many counselors are taught to use person-first language (e.g., Sam has autism). However, increasing amounts of disabled people are asking to be referred to using identity-first language (e.g., Sam is autistic). This is why I’ve chosen to use identity-first language in this article.

The rationale for this shift is due to an increasing acceptance of disability as an identity or part of who someone is rather than an illness or something to be cured or extinguished — the latter notion having historical roots in the eugenics movement. The nuances of language vary from individual to individual and disability to disability. If you are unsure what type of language your client prefers, simply ask.

Adopting a curious stance that avoids assumptions will assist you in your work with disabled populations and any marginalized or oppressed population with which you might not be familiar. Use the motto of the disability rights movement — “Nothing about us without us” — as your guide. Where did you learn what you know about disability? If it wasn’t from a disabled person or source, you should revisit and examine your knowledge base and assumptions.

Consider the ways in which explicit and structural ableism show up in your practice or at your workplace with the following questions: Is your workplace wheelchair accessible? Do you frame disability as either tragic or inspirational? Do you conceptualize the needs of your disabled clients with the same amount of depth and complexity as you would with your nondisabled clients? Is your workplace scent free? Do you speak for your disabled clients in situations in which they are able to speak for themselves? Have you ever asked invasive questions about the medical history of your disabled client? Do you view disability as something to cure? Do you feel like you need to rescue your disabled clients from their disability? How does ableism intersect with other forms of oppression to create unique social and institutional barriers for each client?

Also take some time to examine your internalized ableism. Do you ever feel like you’re a burden when you have a need? Do you ever feel like you don’t belong because of a perceived deficit? Do you feel “lazy” when you are unproductive? Do you blame yourself when you are unable to accomplish something? How comfortable are you when you need to ask for an accommodation? Do you compare yourself to more “successful” people? How does your internalized ableism interact with other forms of internalized oppression such as racism or sexism? Consider how the answers to these questions might influence how you conceptualize and work with your disabled clients.

There is an entire world of discourse and activism related to disability justice, the surface of which has barely been scratched in this article. Prominent scholars and activists to look to include Patty Berne, Mia Mingus, Stacey Milbern, Leroy F. Moore Jr., Eli Clare and Sebastian Margaret.

Conclusion

The mad pride movement understands external circumstances (poverty, racism, transphobia, etc.) as implicated in individual experiences of mental health. Similarly, disability justice views our dominant culture as “disabling” rather than locating disability exclusively within the individual. Peer support is a method with which these communities care for themselves, whether due to necessity, rejection of professional services or both.

Knowledge of these perspectives enrich the tools of our profession rather than detract from them. Turning toward critical feedback allows us to repair historical and individual ruptures, broaden the scope of our practice and advocate for our clients while connecting them to helpful resources.

Links to referenced organizations and resources:

A woman at a march in Amsterdam in March 2020 holds a sign that says “Nothing about us without us,” the motto of the disability rights movement, in Dutch. ElenaBaryshnikova/Shutterstock.com

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Luke Romano is an early career mental health counselor, educator and psychoanalytic candidate in Philadelphia. With a background in mad pride and other political activism, Luke is interested in the intersections of decolonial and anti-capitalist values and practice, psychoanalysis and the counseling profession. Contact Luke at luke.j.romano@gmail.com.

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.