Monthly Archives: June 2022

Breaking barriers

By Jonathan Rollins June 30, 2022

Summer break is something of a foreign concept to Kimberly Frazier. Growing up in New Orleans, Frazier and her siblings spent a large portion of their “lazy” days of summer drilling with flashcards and doing workbook pages at the prompting of their mother, a teacher who spent 51 years in education before retiring. “She did that every year until we were old enough to work and then go to college,” Frazier says. 

As friends were counting down the days to the end of the school year and dreaming of the carefree weeks ahead, Frazier would exclaim, “I don’t know what you all are talking about with this summer vacation thing.”

Still, Frazier didn’t consider learning a labor. It was something she enjoyed engaging in — even in her supposed “free” time. “I was the child who was reading a hundred-plus books every summer to get the free pizza. I didn’t care about the pizza, but I loved the books,” she says. 

Given her passion for learning and the work ethic instilled in her by her parents, it’s not surprising that Frazier graduated with a bachelor’s degree in psychology from Xavier University of Louisiana (XULA), went straight into the master’s in community counseling program, also at XULA, and then was recruited to the University of New Orleans (UNO), where she earned her doctorate in counselor education in 2003. And then she finally took a long and well-deserved summer break to celebrate her accomplishments.

Just kidding. Frazier graduated from UNO’s doctoral program on a Saturday, drove to Indianapolis on a Sunday and started her first job as a postgraduate that Monday.

In the ensuing 19 years, Frazier has worked as an assistant professor at Clemson University, as a contributing faculty member at Northwestern University’s Family Institute, as a contributing faculty member at UNO and as an assistant professor at Texas A&M University-Corpus Christi. She moved back to New Orleans six years ago, where today she is an associate professor in the Department of Counseling at the Louisiana State University Health Sciences Center-New Orleans. She is a licensed professional counselor (LPC), a licensed marriage and family therapist, and a family and divorce mediator.

Predictably, “relaxing” doesn’t top Frazier’s list of summer plans this year either. On July 1, she will begin her term as the 71st president of the American Counseling Association. As the sixth Black female president in the association’s history (and the first since one of Frazier’s mentors, Cirecie A. West-Olatunji, held the office in 2013-2014), Frazier plans to shine a spotlight on justice, equity, diversity and inclusion. 

Her mother, Sheryl Frazier, was a special education teacher who worked with children who had severe delays. “She took me to work with her when I was little, so I had exposure to people with differences,” Frazier says. “I think that shaped me. Seeing how she worked with her students and taught them basic living skills, that left an impression on me.”

Another area of focus during Frazier’s presidency will be mentoring, in large part because of the central role it has played in her own counseling journey. Among other initiatives, she hopes to hold a mentoring summit in the coming year.

Given Frazier’s seemingly boundless energy and drive, a third focus of her presidency might surprise some people; she puts a premium on wellness and self-care and wants to encourage other counseling professionals to do the same.

Finding her path

Growing up, Frazier was particularly interested in science and was always putting stuff together because she wanted to know how things worked. Her mother routinely drafted her to assemble her brothers’ Christmas toys because she could get the toys in working order without relying on the instruction manuals.

Frazier had some thought of becoming a medical doctor, but a high school civics teacher told her that she should consider going into law. “I was always the one asking, ‘Why do we do it this way?’ I guess challenging the teachers all the time, challenging the thought,” Frazier says.

That mindset of questioning others to gain a clearer understanding of how things work — or how they might work better — remains a core component of Frazier’s makeup.

“Frankly … when Dr. Frazier was elected upon running for the office [of ACA president], I never felt better about ACA,” says Zarus E. P. Watson, associate professor and coordinator of counseling and counselor education graduate programs in the UNO Department of Educational Leadership, Counseling and Foundations. “Kim can be an element that some organizations, no matter how well meaning, might view as difficult since she can often challenge the status quo. Perhaps the ACA membership has decided, with the election of Dr. Frazier as an example, to step up its level of engagement and evolution. Our society community needs us. Perhaps now we can more effectively show all of them why.”

Taunya Marie Tinsley, one of Frazier’s closest friends in the profession, says Frazier uses her habit of questioning to help others, not to stroke her own ego. “She loves people. Will she challenge you in your thoughts and perspectives? Yes, but it’s only to make you better as a person and to benefit the clients we serve in our society,” says Tinsley, an LPC who chairs ACA’s Antiracism Commission and is the owner of Transitions Counseling Services LLC.

When it finally came time to determine what route she would take in college, Frazier decided to study psychology, but she didn’t like the emphasis on diagnosing as part of the clinical psychology piece because “everyone doesn’t have a diagnosis. … I decided, ‘There must be something else out there.’ That’s what really got me into counseling,” she says.

Frazier continued her education at XULA, pursuing her master’s in community counseling. While there, she was actively involved in a research center collaboration between XULA and UNO that centered on trauma work with children 5 and younger. West-Olatunji headed the XULA section of the center, and Watson headed the UNO section.

Frazier assumed that after graduating with her master’s, she would work toward licensure, hang up her shingle and start a private practice. But that’s when fate — and mentoring — intervened.

West-Olatunji regularly attended and participated in professional conferences. “Being her graduate assistant and graduate research assistant, every conference she went to, I was there too,” Frazier recalls. “I was introduced to all these icons and reading their work.” Not long before Frazier graduated with her master’s, she accompanied West-Olatunji to a conference of the Association of Black Psychologists, where she met Asa Hilliard, a scholar and psychologist renowned for his work on African culture. “To me,” Frazier says, “this was like the equivalent of meeting the president of the United States.”

Hilliard asked Frazier what she was thinking of doing after graduating with her master’s and then offered a little advice. “I think you should get your doctorate,” Frazier remembers Hilliard telling her. “We need more Black people in the field.” 

Hilliard challenged her to come back the next day and tell him if she could think of one good reason not to follow that path.

“The next day he found me, and he goes, ‘So Kimberly, what did you come up with?’” Frazier recalls.

Her response: “I guess I’m going to get my Ph.D.”

Soon thereafter, Frazier started looking for doctoral programs and was considering the University of Nebraska, which would have meant leaving her family and home city of New Orleans behind for the first time. But her work with the XULA/UNO research collaborative had caught Watson’s eye. 

“Her ability to link community need issues within a research paradigm impressed me,” remembers Watson, an LPC and national certified counselor. “I was so impressed that I persuaded the UNO provost at the time [Louis Paradise] to find scholarship money to enable her to continue her doctoral studies with us rather than heading off to the Midwest. … I’ve always looked back on that being one of my better student-centered decisions.”

Mentorship, friendship and a counseling ‘home’

Frazier praises Watson for the valuable mentorship he provided, including helping her navigate microaggressions in the higher education landscape and preparing her for some of the challenges she would face based on her intersectionalities, both in higher education and, later, in counseling leadership. 

She notes that almost everywhere she has taught, she has been “one of one or one of two” women or women of color on faculty. “It’s very hard to be in an environment where it’s [bias/discrimination] coming at you from all directions — students, faculty, administration,” Frazier says.

She acknowledges that the emotional and psychological load has been heavy at times, especially when feeling like she was “always being the one breaking the barrier in some way.” Frazier says her mother has even cautioned her, “You don’t always have to be the first.” 

But her mother also planted other seeds that continue to guide Frazier and drive her forward. “I’m always questioning why things are the way they are and asking myself, ‘What can I do to make it better? What can I do to change it in some way?’” she says. “And always just showing up. My mom taught me that. If nothing else, just show up. I always want to show up for my students and others.” 

“I want to be one of those people who dismantles that for other students,” Frazier continues. “If my speaking up, if my experience opens the door for someone else to have an easier experience, then I’m OK with that.”

Frazier understands the importance of having trailblazers in the counseling profession to look to for inspiration and encouragement. When she was in school at XULA, Frazier read about Thelma Daley, who was the first Black president of ACA (1975-1976) and also served in the top leadership position at several other organizations. Frazier remembers Daley’s track record sparking a thought in her head: “This is possible; you could do this.”

While going through her doctoral program, Frazier began interacting with another ACA past president, Beverly O’Bryant (1993-1994), whose experiences she could relate to as a Black woman. That relationship helped solidify for Frazier that there was a path forward for her in counselor educator and counseling leadership. “She [O’Bryant] was so authentic in being herself and let me know that I could be myself,” Frazier says. “She gave me confirmation: Just be who you are.”

Frazier found further confirmation and mentoring through her involvement in the Association for Multicultural Counseling and Development (AMCD), a division of ACA. Frazier says AMCD served as her “oasis” as a young professional when she was trying to make sense of the relative lack of diversity in ACA and the counseling profession. “In AMCD, we were caring about the same issues, speaking the same language,” she says.

Beyond that, Frazier says, she felt nurtured in AMCD. The leaders and fellow members checked in on her. And she felt safe approaching many of them and saying, “This is not working. What should I do differently?”

“Soaking up their knowledge was just amazing to do,” she says, “and they were all very open. If you had that desire [to get involved], they put you in the right place. … It really is a testimony not only to mentorship but [also] to seeing yourself reflected back in so many ways. The path can be so different for everyone, but you can get there. That’s what AMCD did for me.”

Tinsley and Frazier met at an AMCD event being held at the ACA Conference and quickly developed what Tinsley calls a “natural friendship” that includes supporting each other professionally. The connection is born out of their “mutual passion for helping people, making a difference in students’ lives and infusing a multicultural perspective,” says Tinsley, who will serve as parliamentarian during Frazier’s ACA presidency.

Tinsley refers to Frazier as “big little sis,” and Frazier calls Tinsley “little big sis” because, as Tinsley explains, “she’s my big sister at AMCD, but she’s my little sister in age.” 

“We kind of grew up in counseling together, especially in AMCD,” Frazier says. “We just really clung to each other. It’s been a friendship of close to 20 years.”

In many ways, Tinsley notes, their experiences at AMCD were parallel, with Frazier eventually serving as AMCD president in 2016-2017 and Tinsley taking the lead as association president in 2019-2020.

“One of my favorite Scriptures is ‘Iron sharpens iron; so do two people sharpen each other’ [Proverbs 27:17]. That’s what mentoring is,” Tinsley says, “but it also describes my relationship with Kim.”

With Frazier now taking the reins as ACA president, Tinsley believes it will serve to inspire a new generation of counselors who have felt underrepresented in the profession. “The message it represents is that ‘I can also get involved in my professional organizations and make a difference. I can be seen and be heard,’” Tinsley says.

“She will be giving a diverse group of people a seat at the table,” Tinsley continues, “adding chairs to the table and giving people opportunities. … I think she brings Black Girl Magic to the organization and the profession.”

“What legacy do I want?” Frazier asks. “I want to be remembered for paying homage to the ancestors and paying it forward.”

Lessons in self-care

Today, Frazier describes herself as “fanatical” about pursuing work-life balance and prioritizing wellness and self-care. But that wasn’t always the case, especially as she was starting out in the profession.

As Watson recalls, “Even external to the [XULA/UNO] collaborative, Kimberly set herself apart from a talented doctoral cohort group by being able to maintain a research-centered focus without sacrificing her passion for the practice of counseling. There was rarely a class taken that did not result in her developing several items to pursue, either as a presentation or publication. I admit that I became spoiled during Kimberly’s time within the program because I rarely had to think up my own research topics since we were interested in similar phenomena, yet Kim often had different ways of looking at them. … The main thing I had to do in working with Kim was getting her to pace herself for fear of her becoming burned out.”

A disaster famously and tragically associated with Frazier’s home city ultimately pushed her to reassess how she was approaching her career and overall wellness. When Hurricane Katrina devastated New Orleans and other areas of the Gulf Coast in August 2005, Frazier was trying to settle in at her new job in South Carolina. In the aftermath of the hurricane, she didn’t know where her father, Zirece Frazier, or grandmother were for two weeks or what had happened to them. Although they were eventually found safe, Frazier says the family “ended up losing my grandmother from the stress of it all.”

Frazier recalls the first time she drove home to New Orleans after Hurricane Katrina and witnessing the devastation from Mississippi onward. “I was coming back in the city [roughly four months after the hurricane] and not really knowing what I was coming back to,” she says.

Upon seeing her mother, Frazier exclaimed, “Why didn’t you tell me?”

Her mother replied, “I didn’t know how.”

“People who are not from here can’t understand the trauma involved,” Frazier says today, her voice still breaking with emotion. Frazier says she knows that she was experiencing secondary trauma at the time, but she tried to cope by throwing herself back into her new job. “That was so very hard to not necessarily have the support in place,” she says. “I produced, produced, produced, but I didn’t process.”

Over time, however, the experience became a “catalyst for me to do more things and see family and not just be focused on my career all the time.”

Today, Frazier says she has an “inner circle” that recognizes when she might be fading and holds her accountable to practice good self-care. That inner circle includes Tinsley and Michele Kerulis, an associate professor with the Family Institute at Northwestern University and chair of the ACA Midwest Region. 

Frazier met Kerulis, who will serve as her treasurer, at the ACA Institute for Leadership Training (ILT) in Washington, D.C., a little over a decade ago. “Kimberly knew I was new to ILT and introduced herself to me and showed me the ropes,” recounts Kerulis, a licensed clinical professional counselor and a mental performance consultant certified by the Association for Applied Sport Psychology. “She was very welcoming, and after a few conversations, we both knew we would become very good friends. We had so much in common, especially our commitment to counselor self-care. We continued to stay connected after that first ILT and got to know each other professionally and personally. One of the strongest parts of our friendship is supporting each other professionally and encouraging each other’s personal goals, including our fitness goals.” 

Through the years, Frazier, Kerulis and Tinsley typically made a point of getting together at the ILT, the ACA Conference and the AMCD Conference. But with the arrival of the coronavirus pandemic, they started connecting more frequently via Zoom, phone and text. They also regularly participate together in remote Peloton workouts.

“It’s just a wonderful friendship and, really, a sisterhood with both of them,” Frazier says. “They’re equally passionate about the profession, and with them, the façade is off. It’s really genuine with them.”

In addition to working out, Frazier enjoys crafting. “That gives me some solace and helps me even myself out,” she says. She also labels herself a diehard New Orleans Saints fan, an all-around fan of college basketball, a lover of music and a Star Wars fanatic. She has been learning American Sign Language during the pandemic and wants to begin learning a third language soon.

“I do a lot of self-care in terms of not answering emails after a certain time, turning stuff off. I try to schedule myself and not bring work home. I see my mom often, spend time with my brothers and look at what’s important to me, [asking myself] how am I living that quality of life?” she says. “And I give my mentees the message that work-life balance is a real thing.”

She says that encouraging ACA members to participate in a wellness and self-care routine with her throughout the year will be an important part of her presidency. “We cannot pour from an empty cup as counselors,” she notes. “We can’t keep doing the social justice work and multicultural work without prioritizing wellness and self-care.”

“Kimberly’s ACA presidency,” Kerulis adds, “will inspire counselors to remember to focus on their well-being as they focus on the well-being of others.”

Kimberly Frazier hanging out with her brother Marc and nephew Zach during the ACA 2022 Conference & Expo in Atlanta.

Inspirational leadership

Kerulis knew soon after meeting Frazier at the ILT that she would grow into a visionary leader for the counseling profession. “Kimberly has countless honorable traits that stand out to me,” Kerulis says, “and I can identify her kindness, integrity and intelligence as the top three traits that continue to be at the core of her presence. [Her] kindness is clear in the way she interacts with different types of people. She is respectful in situations where others are not kind, and she uses her mental health knowledge to share kindness with those who need it the most, even in situations where I believe others would not be as graceful. … [Her] intelligence shines brightly as she navigates situations in ways that help individuals and groups manage concerns, issues and goals in ways that are creative and effective.”

“The traits I found in Kim will also stand well for all of us as she goes into the ACA presidency,” Watson adds. “Her ability to adapt to an ever-changing landscape that is mental health as a whole in the U.S. will greatly assist counseling as we continue to fight to find our place within the mental health community. Kim also has a never-give-up mentality and dogged determination for what she believes in, especially as it relates to counseling and the field’s relationship to people of color and other marginalized groups in America. Though fairly quick to act on measures, Kim’s quickness does not sacrifice a thoughtfulness protocol to ensure that all of her decisions will be truly measured and not reactionary.”  

“Find your niche and your doors will open. I think that’s how Kimberly is,” Tinsley says. “She’s a team player, but she’s going to take a different perspective and a different path than others might have done. She’s visualizing, ‘How can we make this work for the future?’”

Tinsley describes Frazier as being “her true, genuine, authentic self. … I think we have a phenomenal madam president with Kimberly Frazier, and I’m excited to see all of the things that she’ll do this year.”



Read Kimberly Frazier’s first column as ACA president in Counseling Today‘s July magazine.



Jonathan Rollins is the former editor-in-chief of Counseling Today. 


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

From the President: Highlighting three key areas for the year ahead

Kimberly N. Frazier

Kimberly Frazier, ACA’s 71st president

Allow me to introduce myself: I’m Kimberly Frazier, the 71st president of the American Counseling Association. I am excited to embark on this new journey, and I hope that I can inspire students, clinicians, professors, researchers and members along the way. 

As a native of New Orleans and a proud alum of Xavier University of Louisiana, the only historically Black and Roman Catholic university as well as the only one to be founded by a saint (St. Katharine Drexel), I love New Orleans fiercely. The city has taught me the love of food and the importance of community that I take with me wherever I go. I am a New Orleans Saints football fan, of course, and in my free time, I am probably watching old Star Wars films or college basketball, going to a Saints game, spending time with family or simply enjoying the beauty of New Orleans.

During my year as your president, I plan to spotlight three areas that I am most passionate about: 1) justice, equity, diversity and inclusion (JEDI); 2) wellness and self-care; 3) mentoring. 

The past two years have shined a light on social advocacy due to police violence, Black Lives Matter protests and the heightened threat of mass shootings, and they also underscore how important it is to continue to expand your knowledge in the area of JEDI. I’ve been passionate about JEDI since my time as a graduate student because I have experienced being put in places where I was the only person of color or the only person identifying as female or being ignored simply because of the multiple intersectionalities that I represent. As counselors, it is important that we continue to grow our knowledge, practice and application of diversity. This includes supporting those who are conducting research to help marginalized populations and disseminating resources to ensure culturally competent interventions. 

The constant exposure to trauma, isolation and the need for advocacy due to the climate of social reckoning — ignited by the murder of George Floyd followed by the COVID-19 pandemic — have led to exhaustion, social isolation and higher numbers of people seeking mental health services. They have also highlighted that, for helping professionals, being in tune with our wellness and self-care is non-negotiable. Wellness and self-care are tools that I have always used throughout my journey in the counseling profession as a student, clinician, researcher, teacher, leader and mentor. In fact, we cannot be leaders, advocates, clinicians or mentors without being aware of our personal wellness and self-care. For the upcoming year, I want to focus on what ACA members and staff are doing for wellness and self-care to keep them grounded and motivated. Let’s get our ACA and counseling community to be more intentional about wellness and self-care and create a routine to make wellness a part of our normal practice.

The final highlighted area, mentoring, is a gift every counselor can give to themselves and then pay it forward to others in the profession. I am grateful to the mentors that helped me along the way, and I stand on their shoulders as I begin this next phase of my journey. The act of mentoring is vital in ensuring that diverse voices are present in the profession at all levels of leadership, clinical practice, teaching and research. The future of the counseling profession rests in mentoring not only counseling students and new professionals but also those already in the profession to help each group reach their highest potential 

Every month, I will challenge you to grow based on one of the spotlight areas. This month I will focus on JEDI. I challenge you to investigate how the places you work, provide clinical services or volunteer all foster JEDI. Use the following questions to inform your investigation: How are JEDI initiatives executed, communicated, valued and evaluated in your workplace or volunteer organization?  Does your workplace’s or volunteer organization’s mission and views on JEDI match your own?

Why the body matters

By Katie Bascuas June 27, 2022

Somatic therapy, or therapy that incorporates the body into the therapeutic process, continues to grow in popularity. This is likely due to the evolving nature of our understanding of trauma and the need for various approaches to treat the impact of traumatic experiences, which often have a significant physiological impact on the body, especially the nervous system. But as a relatively new therapeutic approach, which lacks the equivalent evidence-based research to support its efficacy compared to other modalities, somatic therapy is not without skeptics. Many clinicians who use it, however, advocate for its ability to help clients, especially those who may have tried other modalities with mixed results and those who are processing traumatic experiences. 

Incorporating somatic techniques into psychotherapy work came almost second nature to Kimberly Hanson, a licensed professional counselor (LPC) in Charleston, South Carolina, and a trained dancer. 

“I understand a lot about the body, and how our emotions can be reflected through our body and vice versa,” says Hanson, who uses movement exercises and breathwork as part of her work with both adults and children. 

“I’ve done exercises where [clients] stand up, and they’ll stretch their arms up to the ceiling and then drop down and swing them on the floor and bring them back up, all while focusing on their breath,” Hanson says. She also incorporates modern dance techniques such as expanding and contracting the body into her clinical work. For example, she once worked with a client to process a fear of taking up space and using his voice by asking him to stand up, spread his arms and move in a circle to establish his own personal zone. “We did some expansion work with that and coupled it with some breathwork, and I’d ask him what he noticed when he took up territory and established his own personal boundaries,” Hanson recalls. “That was very impactful for him.”

Hanson has found that pairing body-based techniques with other more talk-based therapies to be incredibly effective when working with clients. “It can give [counselors] a lot of information,” she explains. “We are a three-part being. We are body, mind and spirit, and all of those things integrate together, so why don’t we incorporate that into our therapeutic process? 

Using a somatic approach may look different depending on the counselor’s training and preferences. Some clinicians may be fully certified somatic experiencing practitioners (SEPs) trained in the somatic experiencing (SE) program based on the work of Peter Levine, whereas others, such as Hanson, may be trained in other modalities but incorporate somatic-based techniques such as mindfulness, movement and breathwork into their therapeutic work. Even the pathways to incorporating somatic techniques can look different to most counselors. However, one thing that many of these clinicians have in common is their belief that the results of body-based techniques often speak for themselves.

Brain-body connection

Mike Wendt, an LPC at Sherman Counseling in Appleton, Wisconsin, has been doing SE work since 2019 and says that it has transformed his therapeutic orientation. “It’s gotten to the point where this is my main modality,” he notes. “It’s really that powerful. It just floors me with what I’ve seen in practice.” 

Wendt, who has a background in neuroscience and is certified by the Biofeedback Certification International Alliance in the use of electroencephalographic (EEG) biofeedback, says that neurofeedback was his gateway into therapy. “I was very interested in the mechanics of how the brain works and the neurological patterns associated with things like anxiety, depression and trauma,” he says. While fine-tuning his neurofeedback skills, however, he kept encountering clients with a lot of trauma markers in the brain. For example, alpha brain waves, which can be detected with an EEG, show up differently in traumatized and nontraumatized clients, he explains. When a client who has not experienced trauma closes their eyes, the EEG shows a healthy increase of alpha waves in different parts of the brain, he says, but for a traumatized client, the rise in these waves may be blunted or absent. And for some severely traumatized clients, it may even decrease, he adds. 

After noticing these neurological markers among several clients presenting with trauma, Wendt says that he began looking for other modalities to help treat traumatic experiences. “There haven’t, historically, been a lot of effective ways to work with trauma, so I thought if I’m just going to keep encountering these neurological markers, I better come up with an effective way to work with it outside of neurofeedback,” he recalls.

Wendt later stumbled on some writing about SE while researching neurofeedback and decided to attend a training session in 2019. “It was incredibly eye-opening how everything with SE just tied together with neuroscience and changes in brain pathways — so using the body to train the brain and not the other way around, which is where I was coming from with the neurofeedback,” he says. “This tied things all together for me when we brought the body on board.”

When he first began incorporating SE into his practice, Wendt would start a session with neurofeedback until he noticed a client’s physical reactions, and then he would shift into more somatic work. “There’s always a somatic reaction when trauma is brought to the surface,” Wendt explains. “Later on, I would just skip the neurofeedback entirely and just go into what is a person’s body language saying to me.”

He once worked with a 16-year-old female client who was experiencing chronic physical pain and was referred to Wendt for his expertise in neurofeedback. In working with the client, Wendt also incorporated SE and was able to help the client to reduce the pain to a level where she could focus on other issues, such as an eating disorder. 

Wendt says that he brought in body work to help treat the eating disorder by reflecting the client’s posture and how it changed when she discussed her journey dealing with disordered eating. He would notice how her hands would fold over stomach, for example, as she discussed different parts of her experience, especially the time she was hospitalized and when discussing her body image compared to her friends, whom she thought had a more “normal” body weight and physical condition. After reflecting what he noticed, Wendt says that he then asked the client to try moving her hands out away from her stomach as she talked. “What I had her do is experience what it was like in her body when she would put her hands out a little further, so she would be more open physically and less threatened emotionally, and then she would bring them back again and feel her anxiety rise and fall,” Wendt explains. “And she’d also feel the comfort of having her hands folded around her stomach as security.” 

He also helped this client work on developing positive coping strategies using SE, and over time as the client continued to experience and process the anxiety, she was able to move her hands away from her stomach completely without fear or hesitation. When this happened, Wendt recalls that the client looked at him and said, “Did you trick me?” He asked her what she meant, and she explained that “the feelings of how she looks and how others see her weren’t there anymore.” And eventually, the client felt comfortable enough to engage in activities she might have previously passed up such as wearing a bathing suit at the beach. 

Improving self-regulation 

For Nancy Skocy, an LPC and SEP in Tucson, Arizona, SE became part of her clinical work after she experienced its effects via her own personal therapy. 

“I worked with other kinds of therapy and personally have been in therapy myself, and what I had discovered in my own work is that I could understand a concept — for example, the concept of setting a boundary — yet when it came to doing it, I would have the words [to verbalize the boundary], but it seemed that something was missing in that I didn’t know how to be effective around setting [or enforcing] the boundary.”

Skocy also has a background in equine therapy, and she says that working with horses, combined with her personal experience with somatic therapy, helped her to see the possibility for helping clients work on emotional regulation.

“If you are emotionally dysregulated when you’re trying to work with a horse, the horse reads that emotional dysregulation in your body,” she explains. “Taking those types of nuances into the SE world is when I started realizing that many times when I was communicating with family members or loved ones and I was upset emotionally, I would communicate in a dysregulated way and it would not be effective.”

She says that she noticed a similar theme among some of her clients who struggled with emotional dysregulation, which affected their communication styles as well as their relationships. “What I noticed was that a lot of my clients had a hard time shifting to taking responsibility for self-regulation,” Skocy recalls. There’s often a belief that other people will regulate us, she adds, especially in clients who have experienced trauma. 

She finds that having clients track their bodily sensations, in addition to their emotions, helps them improve their ability to self-regulate. “Tracking emotions isn’t the same thing” as noticing physiological responses, she says, “because if I’m tracking my emotions — I’m angry, I’m hurt, etc. — I will then justify my reasons for attacking someone else.” Taking this extra step of noticing bodily sensations and then regulating the nervous system response allows clients to come from a more empowered and controlled place when responding to emotionally triggering people or situations, she adds. 

One way Skocy shows clients how to regulate their emotions is by helping them shift negative bodily sensations into more positive ones. For example, if a client reports feeling tense or constricted, Skocy may prompt them to remember a time when they were happy or to think about a loved one and to notice how their body feels. She may also ask clients to explain how they know they feel happy, which may be because their cheeks feel warm or they notice that they’re smiling. 

“Finding the positive is where you restore the balance,” she says. “When I think about someone that loves me or a happy time that I had, I can learn how to shift things myself, and I can settle into a more regulated state and think about how I want to approach communicating with someone.”

In that sense, clients then have more autonomy around how they show up in the world, including the boundaries they set. “A boundary is no longer telling somebody, ‘When you do this, I’m going to confront you,’” Skocy says. “It now becomes, ‘It’s important for me to take care of myself and to protect myself in my relationships as well as to consider the other.’” 

Filling a gap 

Whitney Norris, an LPC and SEP in Little Rock, Arkansas, and co-owner of Little Rock Counseling & Wellness, was also drawn to SE work after experiencing the benefits firsthand through her own personal therapy. She later completed the three-year SEP training, which had an effect not only on her therapy worldview but also on how she presented herself as a clinician.

“The first thing that I noticed with SE training was the way that I showed up in the room, noticing my own reactions to what was going on in the room and noticing and differentiating what was going on with the client even if I didn’t speak any of it,” Norris says. “I felt like I was more present.” She adds that SE training and learning more about her own nervous system helped her to expand her capacity to sit with different things that may come up in a session or that might happen in her own life. 

Norris, who specializes in trauma work, says SE also helped her fill a therapeutic gap that she felt was missing in her work. She had some clients from whom talking about their experience was not that helpful and others who found eye movement desensitization and reprocessing (EMDR) to be too intense. She says using SE is especially helpful for these clients — ones she admits “might have otherwise been falling through the cracks treatment-wise” — because it incorporates the client’s bodily response in a way the other therapies do not.

Although she occasionally runs into a client who is initially hesitant to try somatic techniques — largely due to the fact that they may differ from anything the client has tried before — she finds that most clients are willing to engage in SE and are typically surprised at the results. In fact, clients often tell her, “I have no idea how that worked, but I feel like it did” or “I don’t understand what we just did, but that felt helpful.”


That sense of mystery behind somatic therapy and how it works, coupled with a lack of research compared to other modalities, can contribute to a feeling of skepticism. Some critics argue that there is not enough research to prove the effectiveness of somatic-based techniques. 

In a 2021 literature review of the effectiveness of SE published in the European Journal of Psychotraumatology, for example, Marie Kuhfuß and colleagues found preliminary evidence suggesting positive effects of SE for the treatment of symptoms related to posttraumatic stress disorder (PTSD) as well as affective and somatic symptoms, yet they also noted that the quality of research surveyed was mixed due to risk of bias. The authors recommended further research through randomized controlled trials. 

Meanwhile, a 2017 randomized controlled study of SE — billed as the first of its kind — found evidence to suggest that it is an effective treatment modality for PTSD. The study, published in the Journal of Traumatic Stress by Danny Brom and colleagues, randomly assigned 63 participants living in Israel, all of whom had reported traumatic experiences within the previous four years, to two groups: one that underwent 15 sessions of SE and another that was assigned to a waitlist. In the post-session analysis, researchers found significant effects of SE on posttraumatic and depression symptom severity among participants assigned to the treatment group.

Danny Brom and colleagues also noted, however, that the small sample size as well as the difficulty in measuring the effectiveness of a treatment that does not adhere to a strict protocol were both limitations to the research. 

Unlike a modality such as EMDR, which is protocol-driven and more black-and-white in its approach, Norris says, SE is less linear and looks different to various practitioners who may incorporate a variety of techniques based on their own preferences or the needs of a client, making it harder to research. But “it doesn’t necessarily mean that it’s ineffective because there isn’t that type of research out there,” she says. “It may mean that it doesn’t lend itself to be able to be researched in that way.” 


Skepticism and the need for more research aren’t the only challenges counselors may face with somatic-based work. “I frequently run into people not wanting to have a relationship with their body,” Skocy says. In fact, she points out that some clients may have a dislike or even hatred of their own bodies and feel shut down physically. 

Hanson agrees and notes that she sometimes encounters clients who are resistant to trying a somatic technique or who don’t experience any immediate benefit. When this happens, she says that she often tries to use the resistance or the lack of effect as a catalyst for further exploration. “As a trauma professional, I’m trained to understand those blocks, so we’ll do something else to try and access why they’re not getting anything or why they feel numb,” she explains.

Eugene Titov/

Both Norris and Wendt agree that the learning curve associated with somatic therapy provides another challenge. “There’s a reason the [SE] training is spread out over three years — you need to have time to integrate each piece,” Norris says. Because she didn’t learn about the nervous system or the body in her graduate program, she had to catch up on those pieces, all while learning the specific SE techniques.

Not only is there sometimes a knowledge gap, but the work also takes practice. “It is very much an art form,” Wendt says. “If you push someone too quickly, they might shut down and go into that freeze or collapse state, and you’re most likely not going to get them back in that session.”

The possibility of triggering someone while doing SE emphasizes the importance of creating safety for clients. Wendt says that he uses mindfulness skills such as body scans to help clients safely connect to their bodies, and he encourages clients to think of a pleasant experience or a safe person that they can focus on when they want to feel safe and relaxed during a session. 

“That way we have something that they’re able to tether to because the goal of SE is not to approach trauma to the point of being overwhelmed, but to approach the outer orbits where can we feel the first whiff of that signal in our body that tells us that something isn’t right,” Wendt says. “Oftentimes we don’t need to go any further than that, but we want to have a tether because if we go too far, the person can shut down very quickly and then you have to start over again.”

Try it for yourself

Some clinicians are hesitant to try somatic approaches because they fear retraumatizing or triggering a client. Yet many who support the work have been able to move through that fear, and they say that the results they see among clients are worth it. 

The counselors interviewed for this article all recommend that clinicians who are interested in delving into somatic therapy should try it for themselves as part of their own personal therapy. They suggest that practitioners read, research, and take training and continuing education courses about the practice of somatic approaches and body-based interventions to gain a deeper understanding of this approach and how it can be helpful to clients. Counselors can also find a therapist who specializes in somatic work and try a session or a series of sessions. 

“That really tipped me over the edge of being convinced,” Norris says. “I had done a lot of therapy up to that point, and it was all helpful, but once I started doing my own SE therapy, it was just beneficial in ways that other stuff I was doing wasn’t.”

She and Hanson also make the point that without doing the work yourself, it can be hard to fully comprehend how the techniques work and why they can be effective. 

“You can’t do these techniques without understanding it from a personal level,” Hanson says. “There’s just no way. You can try, and it will either feel forced or feel too rigid, and the client will pick up on that and know that this isn’t what you do.” 

She adds that the essence of this type of work is experiencing — being present with the feelings and sensations of the body as they arise — and that needs to feel genuine. “Part of the goal of these processes is that they’re organic and that it feels natural, so the therapist must be very comfortable with these types of interventions in order for the client to feel comfortable with it,” Hanson says. And “you have to do it yourself to get that understanding.”



Contact the counselors interviewed in this article:


Katie Bascuas is a licensed graduate professional counselor and a writer in Washington, D.C. She has written for news outlets, universities and associations.


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.

It’s time for a financial change in counseling

By Derek J. Lee June 23, 2022

There is a broad awareness that we are in the throes of a mental health crisis in this country. Open discussions of increases in depression, anxiety and suicide attempts are common among news outlets and social circles, while the real impact is being felt in the homes of those suffering every day. When discussing the mental health crisis, the typical focus is the increasing incidence of mood disorders and suicidality. What has been consistently and systemically overlooked is our lack of providers. This article is going to delve into the financial reality that contributes to our mental health crisis.

When someone needs a counselor, the counselor is “worth their weight in gold.” Why is it then that counselors may be the most underpaid, advanced-degree medical professionals in this country? Recently, I was talking to a couple of peers who are also professional counselors, and one stated that a new professional they know was just offered a job starting at $29,000. The other shook their head, looked down and then back up in frustration, and stated, “Last week when I was driving through Michigan, a fast-food place was offering $1,000 sign-on bonuses and $18 an hour.” We will get into the whys later, but this is the disparity that is also a reality in our field.

By the numbers

Let’s start by looking at how much counselors actually make. According to the CareerExplorer website, the average salary of a mental health counselor in the United States is around $35,642 per year. The bottom 20% are placed at $29,800, whereas the top 20% are placed at $57,100. CareerExplorer also offers breakdowns of the average mental health counselor salary by state, with Tennessee coming in at a low of $31,000 per year and Alaska being at the top of the chart with an average salary of $63,900. My current home state of Ohio shows an average salary of $44,100 for mental health counselors, with the bottom 20% at $31,800 and the top 20% at $65,100.

CareerExplorer appears to offer the most accurate of the pay ranges I found in my search because it focuses on master’s-level mental health counselors providing direct care services in a variety of settings. Several other resources show salary ranges of $33,000-$75,000, with some going as high as $100,000, but most of these blur the lines by including Ph.D.-level psychologists, testing, and a number of services that significantly skew the average salary.

As professional counselors, we know what it takes to enter this field, but the general public does not. Educational and experiential requirements can vary somewhat state to state, but for many of us, it starts with a 60-credit-hour master’s degree, which also typically includes an unpaid 100-hour practicum and a 600-hour internship. State boards, the National Counselor Examination, background checks and ongoing supervision get you in the door. Then you must continue with supervised hours, continuing education, training in models and additional hurdles. These are not bad things; they build our body of knowledge, increase standards for the field and lend us credibility. They also come at a cost of both time and money, which are valuable commodities in our field.

With an understanding of the rigor and length of the educational requirements of clinical counselors, and the additional information of what the typical salary range is, how does this compare to national averages? According to the U.S. Bureau of Labor and Statistics (2021), the average salary for someone in the U.S. with a master’s degree is $77,844. The average salary for someone with a bachelor’s degree is $64,896. These are not starting salaries, but average salaries, just as the average salary for a master’s-level counselor in Ohio is $44,100 and nationally is $35,642. If you reference Northeastern University’s Education Pays Chart, you are able to see where counselors fall.


Now that we have established that counselors are significantly underpaid, it is important to explore likely implications.

The first implication is burnout, which affects the field twofold in that it shortens careers significantly and impairs providers who continue to actively work. The average counselor has a productive life span of 10 years before burnout is almost inevitable.This does not account for increased stress in our society due to the COVID-19 pandemic, politics or a volatile social environment.

Why does average salary impact burnout? Because the lower the income, the more stress is created. According to Matthew Killingsworth (2021), drawing on 1,725,994 experience-sampling reports from 33,391 employed U.S. adults, the results demonstrate that both experienced and evaluative well-being increased with income. Factors include being able to pay student loans, afford housing and not worry about how a master’s-level medical professional will pay for a child’s sporting or extracurricular activities. It also extends professionally, in that increased reimbursement allows for lower caseloads, increased preparation time, and more funding for training and professional development.

This creates a natural transition to the second implication — the link between better care for the professionals and improved patient care. If we are supporting our professionals through decreasing caseloads to more manageable levels, increasing purposeful training and promoting more professional development, we are going to see improvements in patient care. Research demonstrates that when using researched-based interventions, we see significant increases in client care, but also accountability in the profession. Effective care means improved outcomes and reduced durations of service, which not only means happier people, but also healthier and more productive people.

A third implication is the impact on recruiting and retaining quality professionals in our field. Unfortunately, in the past decade we have witnessed a tremendous number of counselors shifting to other professions and fields. Some have moved to aligned fields, such as school counseling or education, and many have moved to much different venues, including real estate, IT and software development.

As mentioned previously, we are often experiencing a productive span of 10 years after an education that required seven years to achieve. This is, by any standard, a very poor return on investment. These moves are frequently the result of burnout and the desire to improve their financial situation.

In a similar vein, it can be difficult to attract individuals to the field when it is widely known how stressful and underpaid the profession is. This is even more complicated, as in the past two years we have seen an unprecedented spike in need, with such limited resources and an extended training period.

If the field is to continue to recruit the best and brightest, it also has to offer them competitive wages. If the goal is to increase our recruitment, that point is even more important. It goes beyond simple difficulty and pushes into societal values and ethics when highly educated counselors are starting at significantly lower salaries than individuals with entry-level positions in business.

As we consider education, recruitment and wages, it is also important to examine this topic in terms of social justice. Counseling is a field that has disproportionately high numbers of women and marginalized populations, while also demonstrating disproportionately low wages. Nothing has been found in the literature to demonstrate a causal relationship, but the correlation is difficult to deny. With a workforce that, according to the U.S. Bureau of Labor and Statistics (2021), is 73.3% female (compared to the U.S. average of 46.8%) and nearly 40% nonwhite (compared to U.S. averages of 22%), this is a field composed largely of minoritized workforce populations.

The fact that counselors are, by nature, helpers and are often willing to give freely of their time does not mean that they should be treated unfairly as a labor force. This lends to revisiting the education required and a comparison with other professions.

The fact that a counselor has completed a 60-credit-hour master’s program is significant, as most master’s programs require 30 credit hours, with “more complex and in-depth programs” increasing this to as much as 40 credits. According to U.S. News & World Report (2021), the average master’s program requires 32 to 36 credit hours. It is also important to note that most programs do not have an intensive internship requirement like that of counselor education.

If we look at similar practitioners, such as nurse practitioners, a master’s in nursing is a minimum of 36 credits, and a doctorate in nursing is an additional 36. Another line of work that could be considered similar would be a physician assistant. To become a physician assistant, a master’s degree is required, which is a standard three-year program, as well as 2,000 clinical hours. As these three have the most similarities regarding education and clinical setting and resulting in jobs that include diagnosing and treating medical disorders, these are my base of comparison.

As we have already established, the average counselor in the United States makes $35,642 per year, while the average annual salary for nurse practitioner is $114,510 and the average annual salary for physician assistant is $115,390. It seems quite reasonable for the counseling field to be funded in a manner that allows for paid internships, starting wages in the $75,000 range, and average earnings to be in the range of a nurse practitioner or a physician assistant.

The solution is simple: to align the reimbursement rate for counselors to a rate commensurate with that of similarly educated professionals in the field of medicine, which would also realign income to that of similarly educated professionals in all fields. Well-run mental health offices carry much of the same overhead as other medical and professional offices, including clean and inviting environments, support staff to assist with clients and administrative needs, commercial-grade furniture to handle heavy use, and solid construction that also provides sound deadening for the space. Offices need technology, which continues to expand with electronic health records and testing, and the electronic health record systems themselves, along with constant upgrades and IT support.

The idea of moving the average counselor salary from $35,642 to the wages discussed above would seem to require reimbursement to triple, but it would not. If we were to share the burden, both by focusing on increased efficiency and increasing reimbursement, these changes could be implemented with a reimbursement increase of approximately 80% as opposed to an expected 300%. This would provide the opportunity for clinicians to decrease caseloads slightly, provide better care and make a wage commensurate with their work, education and ongoing educational requirements.

Ask yourself this question: When you are seeking help from a counselor for your child or significant other who is suicidal, do you want someone who is on the top of their game, or someone who is struggling to make ends meet and may be nearly as stressed out as those they are serving?



Derek J. Lee is the founder and CEO of Perrysburg Counseling Services and The Hope Institute. In addition to clinical work and administrative roles, Derek is finishing his Ph.D. in counselor education at Ohio State University and teaches in the Department of Clinical Counseling and Mental Health for Texas Tech University Health Science Campus.


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.

Building trust with reluctant clients

By Bethany Bray June 22, 2022

The Washington Post’s “Dear Carolyn” advice column recently fielded a question from a person who was unsure if they were ready to seek counseling to cope with a strained relationship with a parent. Although the person was aware that counseling could be helpful in this particular situation, they were still reluctant to seek services. “I can’t bear the thought of sharing any sort of emotions or history with a complete stranger, especially when I hear people have to reshare as they try two or several counselors to find the right one,” they wrote.

In her response to this letter, advice columnist Carolyn Hax advocated for the person to try counseling and addressed their hesitancy by saying, “The ‘total stranger’ is actually the point. … That extra, disinterested, trained, and informed set of eyes can help any of us see things we’re too close to see.”

The author of this letter is hardly alone in their hesitance. Data from the National Alliance on Mental Illness indicates that roughly one in five American adults experienced mental illness in 2020, yet less than half received treatment.

And part of this reluctance may stem from the fact that counseling does involves being vulnerable to a stranger — albeit a professional stranger — and working through emotions, trauma and issues that can be painful, sad or fear-provoking. When combined with feelings of shame, stigma or bad memories of a past therapy experience, it’s no wonder that clients are often nervous, fearful or hesitant to start counseling.

Counselors understand the importance of the therapeutic relationship. But when a client is hesitant or reluctant, practitioners need to make trust and relationship building the central focus of counseling work, along with a little extra patience and unconditional positive regard.

An extra dose of validation

Bri-Ann Richter-Abitol, a licensed mental health counselor (LMHC) in New York and a licensed clinical mental health counselor and supervisor in North Carolina, has worked with clients who were so apprehensive about trying counseling that they were visibly shaking in their first few sessions.

Richter-Abitol owns a private practice in Wake Forest, North Carolina, that specializes in counseling for anxiety disorders. She and her staff offer individual and group counseling with a focus on creating a welcoming, nonintimidating environment.

When a client’s body language indicates that they’re nervous or hesitant as they begin counseling, Richter-Abitol uses it as an opportunity to acknowledge their concern and validate that what they’re doing is hard. Her focus becomes normalizing the therapy process, rather than jumping into any kind of assessment or intake regimen.

“This [hesitancy] is extremely common, even for clients who have been in counseling before. … If I notice that a client is really anxious, I use immediacy and point out that it is scary to be here, and I applaud them for coming in,” says Richter-Abitol, an American Counseling Association member.

Clients who are hesitant to try counseling need transparency, patience and an extra dose of validation from their counselor, agrees Megan Craig, an LMHC who counsels clients at a community mental health agency in the Boston area. She often emphasizes to clients that they’re not doing something “wrong” if they are having trouble opening up or aren’t immediately comfortable in therapy. Applauding a client’s bravery to walk through the door also creates an opportunity to ask them what motivated them to make that first appointment — and, in turn, helps the counselor learn more about the client, Craig adds.

Validation played a key part in fostering connection with a female client Craig once worked with who kept being referred to different clinicians within Craig’s agency because of staff turnover.

By the time she was put on Craig’s caseload, the client was “exhausted” and fearful of losing yet another practitioner. So, she had spotty attendance and would often cancel appointments.

“She felt like she hardly wanted to be there [in counseling sessions]. She had told her story so many times, only for her clinician to leave. She kept having to start over from scratch and be vulnerable with a new person,” Craig recalls.

Craig was honest with the client and broached the subject directly, validating that her exhaustion was understandable and warranted.

Craig also realized she needed to slow the pace of therapy with this client. Their early counseling sessions focused on lighter topics, such as work stress. It was one year into counseling before the client was comfortable enough to begin talking about heavier topics, including her trauma history.

The client’s attendance eventually improved but not until Craig spent months building a relationship with her.

“At first, I second-guessed myself and wondered if this [early work] was ‘therapeutic enough.’ But that’s what she needed. That was what was therapeutic for her,” Craig says. “She needed to establish the trust that I wasn’t going to leave and would stay with her. Just me showing up [to counseling sessions] is exactly what this client needed.” 

Fear of judgment

Counselors are no strangers to the importance of the therapeutic relationship, and decades of research show how central and essential it is to client engagement and growth, says Michael Tursi, an LMHC in New York. Counselors, however, must make relationship building an utmost priority for clients who are hesitant. They have an opportunity to display nonjudgment every time they respond and interact with a client, he notes.

“It’s one thing to say, ‘the therapeutic relationship is essential,’ but there are some clients who really might not be willing to engage at all until they see certain things, especially nonjudgment, in their counselor,” he says. “When counselors meet with clients, right from the beginning, they have an opportunity to display nonjudgment.” 

Tursi, an assistant professor in the mental health counseling program at Pace University’s Pleasantville, New York campus, has done research on client experiential avoidance (i.e., when a person is resistant to experiencing strong or adverse sensations, emotions or thoughts) and engagement in counseling. For his doctoral dissertation, Tursi interviewed a cohort of clients in counseling who self-identified as experiencing this phenomenon, and he, along with two other colleagues, published the findings in a 2021 Journal of Counseling & Development article.

Tursi measured his study participants’ level of avoidance by having them complete the Multidimensional Experiential Avoidance Questionnaire developed by psychologist Wakiza Gámez and colleagues.

According to Tursi, one data point in his research quickly became very clear: Each and every one of the participants talked about fear of judgment from their counselor. The study participants acknowledged that they became more engaged in counseling once they established that their counselor was trustworthy and nonjudgmental.

In fact, the participants viewed counseling as a potentially harmful or threatening relationship until their counselor had fostered a trusting relationship with them and eased their hesitancy, Tursi adds.

Some participants talked about “testing” their counselor by intentionally saying something to elicit a response to gauge how trustworthy the counselor was. Even if a client does not do something like this intentionally, Tursi notes, they are very aware of how a counselor is responding to them.

“Nonjudgment is central to working with any client. But these clients might need a counselor who is quite in tune with [the fact that the] client is concerned about judgment and be patient with that,” says Tursi, an ACA member.

A key aspect of creating an atmosphere of nonjudgment is for counselors to be aware of a client’s comfort level, he says. This includes keeping an eye out for indicators that a client is anxious, such as body language, and checking in regularly with the client to talk about how they feel things are going.

A client should never feel pestered or pushed into talking about issues; they should come to the decision to disclose on their own, Tursi emphasizes. Counselors need to temper the expectations of what they think or expect a client will need or be willing to do. 

“Attending to where your clients are is important. We shouldn’t go into therapy and assume clients are going to disclose right away rather than do the therapeutic work that we think they need to do,” he explains. “Counselors should make sure they’re focusing on providing conditions for these clients to engage. … The client is never going to get there [make progress], in any kind of meaningful way, unless they’re engaging in sessions.”

Tursi hopes his research spreads awareness among counselors that experiential avoidance is very common and that some clients may come into counseling believing — for a variety of reasons — that it could be a relationship that is potentially harmful. Tursi draws on the work of Barry Farber, a professor of psychology and education at Teachers College, Columbia University, when he emphasizes that it’s easy to have unconditional positive regard for clients who come in ready to trust and work with their counselor. But it’s equally important to provide that regard for clients who are hesitant, although it may be more difficult. Patience should be a counselor’s watchword, Tursi adds.

“As counselors, we have to be aware of situations in which we have difficulty providing positive regard and continue professional development to improve our abilities to provide nonjudgmental acceptance at times that it is difficult,” Tursi says.

Check yourself 

As a practitioner who specializes in counseling clients with anxiety, Richter-Abitol finds that rapport building with clients who are hesitant must involve self-awareness on the part of the clinician. This includes keeping her own wants, expectations and assumptions about work with clients in check, she says, and asking for client input on the pace and direction of their treatment.

Richter-Abitol is transparent with her clients: She lets them know that they are “in control” of what they want to talk about in sessions and emphasizes that she won’t “make” them talk about anything they’re not ready to.

“You have to meet the client where they’re at and let them set the agenda. I have had clients who have taken months to build rapport, and if you [the counselor] are not patient, you may never get to that point,” Richter-Abitol says. “You have to constantly check yourself outside of sessions and tell yourself that even small successes contribute toward long-term goals. Small things add up.”


Richter-Abitol, like Tursi, argues that the therapeutic relationship must take priority with these clients, rather than diving into a treatment plan based on their diagnosis or what the practitioner thinks they need. Counselors should get creative to find ways to bond with the client prior to moving into heavier work, she suggests. For young clients, this might be therapeutic games or activities; for adults, it might be a discussion of lighter topics that help paint a picture of who they are, including things that they like, dislike and what motivates them.

“Those conversations can lead to deeper ones,” she says. “It’s not helpful to be too rigid. You can have things that you’d like the client to work on, but ultimately it has to be up to them. Flexibility is important.”

Richter-Abitol has found that clients feel more empowered when she lets them take the reins in this way. And many begin to open up naturally when they don’t feel pressured to do so.

This approach requires counselors not only to be in touch with and sensitive to their client’s needs and level of readiness in counseling but also to check their own inclination to take charge when a client is slow to make progress. It’s all too easy to assume that a client who isn’t making progress — or not progressing in a way the counselor might want or expect — isn’t benefiting from counseling, Richter-Abitol notes.

Instead, she advises practitioners to take a step back and consider the client’s full context, including the barriers and challenges that are making it difficult for them to engage with a counselor.

“Their fear or discomfort can come off as resistance or presenting a vibe that ‘I don’t want to be here.’ … They just don’t know how to feel about this space yet, and you need to give them time to figure that out,” Richter-Abitol says. “Don’t make the assumption that someone who is uncomfortable isn’t gaining anything from the experience. It might not be that they don’t want to be there but they just don’t know how to be there yet.”

Have honest conversations 

If patience is the first thing that clients who are hesitant or slow to engage in counseling need from a practitioner, transparency is the second. For Craig, this comes in the form of direct questions to the client to gauge their comfort level and an honest invitation to let her know when things aren’t working.

If a client appears uncomfortable or is hesitant to engage in counseling, Craig will address it directly, saying, “Here is what I’m picking up on. Tell me if I’m right or wrong.” She emphasizes to clients that she cares for their well-being and genuinely wants to hear how they’re feeling — and that they have a choice and a say in the counseling process.

Sometimes what counselors view as resistant behavior in clients can be caused by the use of methods or techniques that aren’t a good fit for that individual, Craig says, or it can be that the practitioner themselves is not the right fit. Because clients may not bring up problems to a counselor on their own, she makes a point to broach the topic with honesty, explaining that no therapist is going to be the best match for everyone who walks through their door.

“If someone is taking the huge step to start counseling, I want them to benefit from it as much as possible. I’m honest and tell them that they’ll never make progress if we are not a good fit,” says Craig. “People are not ready for different reasons, and that’s why I like to have such open conversations. … I might not be able to give them everything they need, but I certainly want to talk about it and I want to try.”

She not only checks in regularly with clients throughout therapy but also makes time for a deeper conversation about what is and isn’t going well once a year (on their anniversary as her client). 

During these check-ins, she prompts clients with questions such as:

  • How do you feel about our work together?
  • Do you respond well to me taking the lead in counseling, or do you prefer to take the lead?
  • What has been helpful during our work together?
  • What do you need more of? And less of?
  • What did you expect from therapy and how has this not met your expectations?
  • What’s working and what’s not?

Not only do these conversations provide Craig with valuable feedback, but they also help set an example for the client to advocate for their own needs outside of counseling, she notes. Learning to be able to communicate their needs and expectations is a big — and important — milestone for many clients.

Craig recommends clinicians ask clients directly about how things are going in counseling rather than fall into an easy pattern of making assumptions about individuals who are avoidant or hesitant to engage. Honest feedback from a client is a good thing, Craig stresses, and not something that a counselor should take personally.

Overcoming cultural barriers

Counselors also need to take a proactive approach when clients are hesitant because of challenges and barriers related to their cultural background, says Camila Pulgar, a licensed clinical mental health counselor associate who is a research faculty member at Atrium Health Wake Forest Baptist Medical Center in Winston-Salem, North Carolina.

Building trust and forging connection with clients who are from marginalized cultures require a counselor not only to be comfortable broaching the subject of culture (and cultural differences) in client sessions in an ethical and compassionate way, Pulgar says, but also to be fully aware of and sensitive to the many barriers that keep them from accessing counseling or being fully comfortable in the setting. 

A native of Chile, Pulgar specializes in the mental health needs of Latinx clients, including suicide prevention. She does clinical work once a week in her faculty position at the medical center, and she is the only bilingual (Spanish/English) provider on her team. Being the only bilingual counselor is not unusual for Pulgar; in fact, this has been the case for most of her professional career, she says. The mental health care system in this country is simply not built to support the needs of clients whose first language is not English.

Language is only one of many barriers that can deter clients from minority cultures from seeking or becoming fully engaged in counseling, Pulgar points out. Individuals may face logistical challenges such as trouble accessing transportation to appointments, finding child care or affording the cost of sessions. They may also be fearful or have adverse feelings about counseling because of stigma, past harm or skepticism about therapy within their culture or family group.

“If people make it to my office, they’re usually hesitant to share their mental health journey with their family members because of stigma. I often hear ‘I don’t want anyone else to know I’m here’,” says Pulgar, who also sees a small caseload of clients at her private practice in Winston-Salem, North Carolina. “When we talk about their supports and who they can reach out to in times of crisis, they often don’t list anyone [in their family] because they don’t want their family to know they’re struggling.”

Shivonne Odom, a certified perinatal mental health provider whose private practice is the only practice in the Washington, D.C., area that specializes in perinatal mental health care and is owned by an African American therapist, says this is also common among her clients, the majority of whom are African American.

She’s had clients whose families reacted very negatively when they found out the client was attending therapy, and other clients have chosen not to disclose the fact that they were seeking counseling to their families and, in some cases, even their spouse.

Hesitancy is very common among Odom’s clients; she recently had a client tell her that she needed to take an hour-long walk to calm her nerves before logging in for her first counseling session.

There is an extra layer of stigma for minority clients who are seeking perinatal mental health care because pregnancy and childbirth are often assumed to be a joyful and happy time — not one of despair. All of these challenges add up and severely affect clients’ help-seeking behaviors, says Odom, a licensed professional counselor in Washington, D.C., and a licensed clinical professional counselor in Maryland.

Pulgar notes that conversations around challenges in minority mental health care often place the blame on the stigma that many cultures have regarding counseling. In reality, minority populations face many barriers when seeking treatment, and that should be an equally, if not more, important part of the discussion.

This issue is compounded by the fact that most of the evidence-based treatment methods that students are taught in graduate counseling programs were created by and tested within members of the majority population. So, it makes sense that many of counselor’s go-to methods may not be a good fit for some minority clients, says Pulgar, an ACA member.

Clients can also become discouraged if they are referred to counseling by a medical provider and none of the counselors on the referral list look like the client, Odom adds. Because of this, she goes out of her way to accept many different types of insurances and often consults and works with multidisciplinary professionals in related fields, such as lactation consultants, to advocate for her clients and ensure that other providers know of her services.

Counselors should also be aware that these clients are often unfamiliar with the process of counseling. A first step toward forging a therapeutic connection can be to explain what therapy is (and isn’t) and why it’s helpful, along with the concepts of privileged information and confidentiality, Odom says.

Pulgar and Odom emphasize that one way to reduce these clients’ stress and barriers to treatment is for counselors to become knowledgeable of culturally connected resources in their area, such as nonprofit organizations and support groups and services.

Free support groups can be very helpful to validate a client’s feelings and experience in a way that individual counseling can’t, Odom says. And if there isn’t a group that matches your clients’ culture and identity (e.g., single mothers by choice), she suggests that counselors consider seeking training to start and lead one.

It’s equally as important for counselors to forge a connection with the marginalized community in their area as it is to build a strong therapeutic relationship with individual clients, Pulgar says. She suggests that practitioners start by becoming involved with organizations that serve the local marginalized community and participate in events such as health fairs.

“Get out of the four walls of the office,” Pulgar stresses. “Marginalized communities are so collective, and community is an important part of life.”

Small changes, big impact 

Counselors have an opportunity to build trust with a client with every interaction. And sometimes, seemingly “small” things that are outside of the core work of counseling can make a big difference to a client. Here are just a few small steps clinicians can take that will make a big impact on clients. 

Explain the process of counseling and why it’s helpful. Don’t assume that clients know what therapy is or what it entails, Tursi advises. “If they’ve never been to counseling previously, the idea of connecting with feelings might be very foreign to them,” he says. “They might start counseling thinking that the counselor can just make these [difficult] feelings go away. When instead, counseling [works to] change their relationship with their feelings — and a practitioner may need to explain that.”

Remember that a breakthrough does not mean clients are completely comfortable in counseling. A counselor whose client makes a significant gain toward trusting their practitioner in one session may feel that they’ve built their relationship enough to move on and address other issues. However, the only way to truly build trust is to have patience and show a client, over time, that you are trustworthy, Craig says. This is especially true for clients whose trust has been broken by others in their life, including health care providers. “Remember that even if they open up about their fears, it doesn’t mean they’ll be less fearful at the next session,” she adds. “It’s about patience and giving them that chance to warm up.”

Welcome clients before they even sit down. Forging trust with hesitant clients takes “more than what you are doing in the [counseling] room, it’s the whole experience,” Richter-Abitol says. “And we want to make people feel as welcomed as possible. … I know what it takes to walk through that door, and how hard it can be.”

She has taken client comfort into consideration in every aspect of her practice, from choosing cozy décor for the waiting room to a casual staff dress code. She built her website to be particularly user-friendly and extend a welcoming vibe before clients even set foot in the door. For example, she provides a detailed biography of all members of the clinical team, including photos of the practitioners, adjectives that describe them (e.g., bubbly, enthusiastic, loyal, creative, motivated) and a description of what a client can expect when working with them. 

“We try and dial down the clinical and dial up the parts of our personality” on the website to make potential clients feel comfortable, Richter-Abitol explains. “With the anxiety population, fear of the unknown is a big issue, so seeing the office and the pictures [online] helps fills in that space [and] helps people form connections before even coming in.”

Pronounce their name correctly. And if counselors are not sure how to pronounce the client’s name, they should ask and remember it, Pulgar says. This is a seemingly small thing that can be overlooked by practitioners, she notes, but it lets the client know that a counselor values their identity.

Don’t assume they’re resistant. Clients who are opposed to treatment and those who are hesitant or slow to engage in counseling can exhibit some of the same behaviors, such as canceling appointments frequently, answering a counselor’s questions with one-word answers or avoiding talking about heavier topics. However, counselors have an opportunity to build trust and explore the reasons why a client appears reluctant, rather than labeling them as resistant.

“We have been taught [in counselor trainings and graduate programs] that it’s a normal way to view clients. It’s really discouraging to know that [the word ‘resistant’] is even part of the dialogue,” Craig says. “Just because your perception as a clinician is that a person is not trying doesn’t mean that they’re not trying. They might not be doing the homework you assign, but they’re showing up every week. And that may be all that they can do right now. That is trying for them. Be sensitive to what they need to make progress.”

Do no harm and seek training. An important aspect of building trust with hesitant clients is ensuring that a practitioner is providing ethical, appropriate and competent care to keep from exacerbating their hesitancy or repeating any bad experiences they might have had previously in therapy. This includes seeking training, consultation or supervision when a counselor has a client who comes from a culture or is dealing with a challenge that the counselor is not familiar with.

In the case of perinatal clients, clinicians who are not trained in the needs and nuances of work with this population risk providing inaccurate — or even harmful — care, Odom says. Some of the symptoms that can be common in perinatal clients, such as intrusive thoughts about harming their baby, can easily be misinterpreted, she explains.

[Hear more on this in an ACA podcast episode featuring Odom: “Counselor Advocacy with Maternal Mental Healthcare.”]

“We [counselors] have an ethical duty to only practice in areas in which we are trained, and if we’re not, we have an ethical obligation to reach out to providers who are and consult with them,” Odom says. “Don’t be afraid to take a training on perinatal [mental health]. I have seen way too many clinicians treating these clients [inappropriately] and it leads to clients having to unjustly interface with systems that will do harm.”

Leave the door open for them to return. Clients who are hesitant about counseling are more likely to drop off a practitioner’s caseload. Counselors should take measures to focus on retention with this client population, but they should also understand that when the client stops counseling, it doesn’t mean that it wasn’t beneficial. Sometimes people simply have so much going on that life “gets in the way” and they can’t come to regular sessions, Pulgar points out.

Practitioners should emphasize to these clients that they’re always welcome to return to counseling whenever they’re ready. Instead of placing blame and asking the client not to return after missing multiple sessions, a counselor can instead say, “I understand this may not be the best time to start counseling in your life, but please do reach out when it is. I am here for you, please keep my number,” Pulgar says.

“The truth is, not everyone is ready for counseling when it comes time for the appointment, even if they made the phone call [to schedule]. They may not be ready to engage yet in the process of what counseling demands,” Pulgar says. “Stay calm and don’t overthink ‘What am I doing wrong?’ or ‘What more can I do?’ Take a couple of deep breaths and think about ways that the door stays open. … If clients get a good sense of counseling just with that interaction with you, maybe in a year or five years, they will come back. That interaction, although brief, can give them a positive feeling about counseling.”



Reasons why 

Many different factors and barriers deter people from seeking counseling or feeling comfortable in sessions. This is by no means an exhaustive list, but some common client fears and concerns include:

  • The client (or someone they know) has had a bad, hurtful or unhelpful experience previously with a mental health or medical practitioner.
  • They come from a culture where counseling is not widely accepted or a culture that has been historically maligned or harmed by mental health professions.
  • They are struggling with an issue that involves feelings of shame. 
  • They are afraid to confront the issue they are struggling with; this can include hesitancy to relive trauma as they process it or fear of showing vulnerability or imperfection.
  • They fear being given a diagnosis and/or being misdiagnosed.
  • They worry the counselors will judge them.
  • They fear meeting and opening up to a person they don’t know. 
  • They experience overwhelming negative or catastrophizing thoughts (e.g., “Counseling is not going to work”).
  • They face logistical challenges (lack of insurance or inability to pay, trouble finding child care or transportation, etc.).
  • They worry that others (family, peers, etc.) will find out they are attending counseling.
  • They do not have a choice in attending counseling (e.g., a person who is mandated to complete therapy, often as the outcome of a court case).
  • They are hesitant or unable to connect with a practitioner who doesn’t come from the same background or experience as them (e.g., a Latinx or LGBTQ counselor, one who has served in the military, one who understands miscarriage and infertility).

This information came from interviews with the following counselors: Megan Craig, Shivonne Odom, Camila Pulgar, Bri-Ann Richter-Abitol and Michael Tursi.



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


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