Monthly Archives: July 2022

Supporting transgender and gender-expansive youth

By Cortny Stark July 29, 2022

Transgender and gender-expansive (TGE) children and youth continue to experience marginalization, as institutions across the United States institute new oppressive policies that challenge and, in many cases, altogether prevent access to gender-affirming health care. TGE children and youth include young people between ages 3 and 17 whose gender identity is different from the sex designated at birth; the label “transgender” implies alignment with the gender binary (e.g., “I was designated female at birth and am a transgender man”), whereas gender-expansive identities do not align with the gender binary (e.g., “I was designated female at birth and am nonbinary — meaning that I am not a girl or boy”).

The realities of living as a TGE child or youth in today’s social, legal, educational and health-related environments are harrowing. Every day, new policies and legislation are introduced regarding TGE youth’s rights to access medically necessary gender-affirming health care, present as their authentic self at school, participate in extracurricular programs and sports, and have their appropriate name and pronouns honored in educational spaces.

As the parent of an incredible 12-year-old TGE child, my tolerance for the headlines is waning. I wake up each morning and check the latest news, and suddenly, I feel anxiety rising in my chest. I feel breathless and sick to my stomach. I have to put down my device and find a comforting television show or familiar rerun to watch before continuing with my day.

But we can do something about it. As helping professionals, we have an ethical obligation to support members of this community, as well as their caregivers and loved ones, and to advocate for dissolution of oppressive policies and legislation.

The current crisis

Despite over a decade of research and clear medical guidance supporting the efficacy of affirming social and medical interventions, several state and local governments across the United States have initiated anti-TGE legislation. In April 2022 alone, more than 20 pieces of legislation targeting the rights of TGE persons were introduced across the country.

On April 20, the Florida Department of Health released guidance on the treatment of gender dysphoria for children and adolescents, which states: “social gender transition should not be a treatment option for children or adolescents” and “anyone under 18 should not be prescribed puberty blockers or hormone therapy.” Alabama enacted a similar prohibition on affirming health care, but with more severe consequences for providers who violate the ban. The Vulnerable Child Compassion and Protection Act, which took effect May 8, states that health providers who provide gender-affirming puberty blockers or hormones will be charged with a Class C felony. Sanctions for violating the ban could include 10 years in prison or $15,000 in fines.


Standards of practice from the American Academy of Pediatrics and World Professional Association for Transgender Health, however, continue to support social and medical transition as a necessary option for the health and well-being for many TGE youth.

Earlier this year, Texas Attorney General Ken Paxton issued an opinion stating that gender-affirming medical interventions, referred to as “elective sex changes,” are part of a “novel trend” and “constitute child abuse.” The fact that this opinion equates gender-affirming care with “child abuse” is of particular importance for helping professionals because this means credentialed providers are legally obligated to notify child protective services within 48 hours of learning that a minor is receiving gender-affirming medical care.

Many families and caregivers of TGE youth in Texas are now unable to access medically necessary gender-affirming interventions, such as puberty blockers and hormone replacement therapy. In addition, major TGE advocacy organizations are encouraging families and caregivers of TGE youth to maintain a “safe folder” — a collection of documentation that debunks the “affirming care is abuse” myth. The folder includes “carry letters,” which are documents written by licensed counselors, helping professionals and/or pediatricians who have worked with the youth. These letters contain the professional’s credentials, their relationship to the youth, a statement from the American Academy of Pediatrics supporting gender-affirming medical interventions as evidence-based and best practice, and an overview of the youth’s gender identity development process.

A call for advocacy

I share these current events not to stir your compassion but to make a request: Please act and advocate for TGE youth. You can pursue positive change in whatever realm you hold power, privilege or space. As a professional, I wear many hats, including assistant professor, mental health and substance use counselor, rehabilitation counselor, training facilitator and advocate. These professional roles provide a space for me to channel my anxieties and distress over these recent oppressive policies targeting TGE youth and work toward positive change.

For me, advocating for this population serves as a source of nourishment and a way to derive meaning from what feels like hopeless circumstances, and I hope that engaging in this work may do the same for my colleagues. Here are some ways helping professionals can better support the advocacy efforts for the TGE community:

  • Use a humanistic lens when working with TGE children and youth and recognize the client as the expert on their own experience.
  • Get to know the standards of care and research regarding evidence-based care with TGE youth. And make sure the research you consume and the information you share with others all come from prominent and reliable scholarly sources.
  • Elevate the voices of TGE youth. If you work with this population, know what prominent TGE community organizations provide safe and brave spaces for TGE youth, and be prepared to share this information with your clients. If you facilitate trainings or educational opportunities for responsive and competent practice with the TGE community, and you yourself are not a member of this community, use panels of TGE folx to share their experiences and expertise.
  • Inform people that gender-affirming social and medical interventions are medically necessary and are a key component of suicide prevention. According to a 2009 report by Caitlin Ryan, the director of the Family Acceptance Project, TGE children experiencing caregiver or family rejection are more than eight times as likely to have attempted suicide and nearly six times as likely to report high levels of depression than TGE youth who were not or only slightly rejected by their parents and caregivers. This report also found that TGE youth who were in accepting homes, with caregivers who supported social and/or medical affirming interventions, had rates of anxiety, depression, and suicidal ideation and attempts similar to their cisgender peers.
  • Advocate with and on behalf of these youth in their living environments, schools and greater communities; this may include educating others about the role of affirming health care in preventing suicide and improving TGE youth’s overall health and well-being, testifying against oppressive anti-TGE legislation, or supporting affirming legislation.
  • Honor the history of TGE communities by acknowledging the role of colonization and historical trauma in the erasure of histories of gender diversity. Recognize the systemic influence of adverse experiences in health care, schools, the legal system and other institutions on TGE individual’s ability to trust institutions. This history along with the major influential events in the lesbian, gay, bisexual, transgender and queer (LGBTQ+) rights movement are key to understanding the intergenerational trauma and resilience of members of TGE communities.
  • Keep learning! Developing one’s ability to provide culturally responsive care requires lifelong education and reflective practice. Sign up for workshops and continuing education regarding serving TGE individuals. And join consultation and supervision groups that focus on providing care to this population.
  • Connect and advocate. Connect with a local TGE advocacy organization and volunteer to support their efforts; if time does not allow for this level of engagement, consider donating to these causes to support their advocacy work.

As LGBTQ+ advocate, actress and film producer Laverne Cox once stated, “Each and every one of us has the capacity to be an oppressor. I want to encourage each and everyone of us to interrogate how we might be an oppressor and how we might be able to become liberators for ourselves and for each other.” At this point in history, it is critical that we as helping professionals identify how our actions contribute to the oppression of our TGE clients and do better. The health and well-being of an entire generation of TGE youth need helping professionals who are willing to use their power and privilege to elevate their voices and serve as liberators.



Cortny Stark

Cortny Stark (she/her/hers) is an assistant professor and the substance use and recovery counseling program coordinator in the Department of Counseling and Human Services at the University of Colorado, Colorado Springs. She is also a telehealth therapist with the Trauma Treatment Center and Research Facility, where she provides trauma reprocessing and integration, clinical services for substance use and process addictions, and support for transgender and gender-expansive youth. Her research focuses on LGBTQQIA+ issues in counseling, integrative approaches to trauma reprocessing and integration, and substance use and recovery.


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.

Responding to the youth mental health crisis in schools

By Bethany Bray July 25, 2022

Late last year, U.S. Surgeon General Vivek Murthy issued an advisory to call attention to what he described as a “youth mental health crisis.” Depression, suicidality and other mental health challenges have been on the rise among American youth in the past decade, but Murthy believes the stressors and isolation of the COVID-19 pandemic exacerbated an already alarming situation.

In a June interview with ABC News, Murthy acknowledged that the crisis is ongoing, saying, “Ultimately, we will know when we’ve reached the finish line when they’re [American youth] doing well and they tell us they’re doing well and when data tells us that as well.”

Murthy’s advisory called attention to a concerning situation that school-based counselors continue to witness firsthand. American students are experiencing an increasing severity and prevalence of mental health challenges that range from self-harm and disordered eating to underdeveloped social and emotional regulation skills.

Students are trying to learn among a multitude of storms. America continues to struggle with the ongoing dual crises of racial injustice and the lingering COVID-19 pandemic. And on top of that, divisive issues related to schools have been making news headlines lately, including laws created to target transgender youth, arguments about critical race theory and school curriculum, and despair and finger-pointing after the deadly school shooting in Uvalde, Texas, which claimed the lives of 19 elementary school students and two teachers. 

It all adds up and is affecting the day-to-day lives of children and families. 

With a problem so large, it’s going to take more than school-based counselors to reverse the concerning trends in youth mental health. School counselors are on the front lines of this storm, but they also need buy-in, support and collaboration from school administration and staff, parents, community mental health professionals and the community at large.

Distress in students

Jennifer Akins, a licensed professional counselor (LPC) and president of the Texas School Counselor Association, noted that schools across her state are seeing both increased prevalence and severity of depression, anxiety, self-harm, suicidality and eating disorders among students. This has prompted statewide agencies to collect and track data on student mental health, including self-harm, to inform interventions and programs to be deployed in the public schools, Akins says.

“These are not new issues for us, but the thing is the numbers are so much greater,” says Akins, the senior director of guidance and counseling for the McKinney, Texas, public schools. “A huge area of need right now is emotional regulation. They [students] are just not as skilled right now at managing strong feelings. … Students who are experiencing thoughts about self-harm are more often advancing those thoughts into action. They now have thoughts, plus a plan, plus action.”

Texas school counselors are also reporting an increase in self-harm in young students at the elementary level, Akins adds.

Akins is far from alone in what she is seeing. The school-based counselors interviewed for this article report similar rises in self-harm, depression and other mental health challenges among their student populations. Many of these issues were present before the pandemic, but the isolation and lack of social interaction the students experienced while learning remotely during the first years of the pandemic weakened students’ social skills and their ability to regulate their emotions and cope with distress. According to several of the school counselors interviewed for this article, students’ social media use is also a factor that often makes these issues worse.

Jessica Henry has been a high school counselor for 15 years in the Akron, Ohio, area, and she says she’s never seen so many students struggling with suicidal ideation, self-harm, depression, anxiety and panic attacks.

Students are experiencing a lack of resilience and continue to struggle to adjust to in-person school, and for some, this includes developing unhealthy coping mechanisms such as self-harm, Henry says. Small problems that could otherwise be overcome often spiral into “the end of the world” for students, adds Henry, a licensed school counselor in a seventh through 12th grade school in Ashland, Ohio.

For some students, home can be a tumultuous atmosphere and a source of stress, so school functions as a safe place, which they lost when schools switched to at-home learning during the pandemic, notes Henry, a licensed professional clinical counselor and supervisor.

Jessica Holt, an LPC and counselor at a middle school in metro Atlanta, has noticed that in addition to self-harm, depression and anxiety, interpersonal problems, such as bullying and conflict with peers, have become more prevalent recently. Her school has seen an increase in the number of students requesting one-on-one counseling on their own, as well as referrals from teachers and school staff for students who need someone to talk to. There has also been an increase of students who are struggling with sexuality or gender identity issues or who feel like they don’t fit in, she says.

Even though most schools have returned to in-person instruction, the effects of being out of the school environment continue to affect students’ mental health, particularly their self-esteem, social skills and anxiety, says Holt, a member of the American Counseling Association. They are still out of practice with navigating classroom dynamics and making friends.

In Holt’s experience, many parents overcompensated and became more involved in their children’s lessons while they were at home for virtual learning. Parents would log in during virtual learning and check their child’s grades, monitor their work and send messages to teachers. As a result, Holt has noticed that students are struggling with autonomy and self-esteem now that they have returned to in-person classes. Parents are more likely to be the one to message the school when a student is failing, she notes, rather than the student being proactive and asking to make up missed assignments or for extra help.

“Kids don’t have problem-solving skills because things have been done for them. They don’t know how to cope when they are in distress,” Holt says. “One thing that has come out of the pandemic is [problems with] accountability. Students are not taking responsibility because their parents have taken everything on. … That self-advocacy piece is not there for a lot of students.”

Early intervention

Derek Francis, manager of counseling services for the Minneapolis Public Schools, says that his district will be doubling the number of elementary school counselors this fall. Counseling staff at the elementary, middle and high school levels in Minneapolis have also been leading more small groups for students to focus on social-emotional learning, managing stress, anxiety and other mental health challenges.

Minneapolis students are struggling not only with self-esteem, peer conflict, anxiety and other mental health issues but also with discrimination and bias based on racial, sexual and other identities, including negative interactions on social media, says Francis, who co-authored a chapter on proactively addressing racial incidents in schools in the ACA-published book Antiracist Counseling in Schools and Communities. In response, Francis’ school district has enhanced counseling services (including small groups) and weaved mental health discussions with a cross-cultural focus into classroom lessons across grade levels. It’s powerful when students hear that their peers are feeling some of the same anxiety and distress they are experiencing and are able to talk about it openly, says Francis, who works in the Minneapolis Public Schools’ Department of College and Career Readiness.

The Minneapolis schools are also taking an early intervention approach to mental health. Recent years have shown that elementary students can benefit from learning coping skills that help them regulate and calm themselves and deal with strong emotions, Francis says. So the district has been teaching young students how to identify when they’re becoming overwhelmed, name their feelings and use skills to calm themselves, such as breathing techniques, as well as letting them know whom they should contact within the school for additional help.

Self-regulation in a young student can mean the difference between moving on from a negative interaction with a peer on the playground or remaining upset the entire day, says Francis, an ACA member. Teaching young students these skills during elementary school may keep them from carrying over or forming difficult or unhealthy behaviors, such as skipping class, into middle or high school.

“The younger we can help kids know how to regulate their emotions and talk about their feelings, the better,” he stresses.

As manager of all the school counselors in the Minneapolis Public Schools, Francis often goes into classrooms to speak with students. During a recent session on “the power of words” with third, fourth and fifth graders, he sparked discussion by asking students for examples of incidents when they’d heard an “ouch” (hurtful) word and ways to respond when they are the recipient of or witness to an ouch word. The students had plenty of experiences with ouch words, including one kid who had been ridiculed for his lisp.

Francis then focused the conversation on social skills, empathy and ways to connect with people who come from different backgrounds. His overarching message to the students was that school should be an inclusive place, says Francis, a professional development specialist with Hatching Results, a company that provides training and continuing education for school counselors, administrators and school districts.

Francis says his district intentionally approaches hate and bias incidents in the same way they treat fire drills: It’s something for staff, students and parents to prepare for. That way, when something does happen, everyone knows how to talk about it, respond and connect with resources. 

The Minneapolis schools have also focused on the negative implications that social media use can have on student mental health. It’s become clear that students are saying hurtful things to each other online, not only on social media platforms such as TikTok and Snapchat but also via the chat feature on video games, group text messages and other avenues, Francis notes.

Adults don’t often realize how much of students’ lives are spent in the digital world, he says, and parents and students alike are not often aware of the connection between social media use and how a person feels about themselves. Many students do not have a parent or adult who monitors their dialogue on social media or helps them know when to log off or disregard negative comments, he adds.

“[Students’] brains are not developed yet to know how their words impact other people. It’s an area that needs a lot more development after the pandemic,” Francis continues. “The [effects of the] isolation of the pandemic, when paired with the negativity of social media, can really distract them from seeing positive things about themselves. We have to be mindful of the impact of screen time on students’ mental health. … It really impacts the school environment when it’s unaddressed.”

Forging connection

Holt and the other school counselors at her Atlanta-area middle school coordinate their schedules so they can visit and speak to the classrooms each fall. These visits serve as an opportunity to survey students on their mental health needs, and they also allow students to meet the counselors and learn more about the schools’ counseling programming.

The survey data they collect during these classroom visits informs the counselors’ focus for the year (e.g., the need for small groups to help students with anger, parental separation, grief or other issues) and also helps them identify and connect with individual students who are at risk, Holt explains.

Tracking student concerns and tailoring an appropriate counseling response are even more vital as mental health difficulties are on the rise.

Three students at Holt’s middle school have taken their own lives in the past five years. Part of the district’s response to the suicides, as well as to the overall increase of mental health needs, has been to establish a program that installs school-based therapists to provide long-term therapy for students. This year, Holt’s district has increased the number of school-based therapists to meet  the demand.

Holt’s school has also adopted several peer-based programs, including one that pairs established students with peers who are new to the district and another that trains students in suicide prevention and how to respond and connect a peer to appropriate help when they notice suicidal ideation (e.g., observing evidence of cutting in a peer as they change clothes for physical education classes).

The peer programming, counselor classroom visits and other recent initiatives are aimed at preventing students from falling through the cracks and help the counselors keep their finger on the pulse of the school, Holt explains. And it’s had a positive impact on school culture.

Like Holt, Henry feels that counseling staff need to be more visible and involved in their schools to respond to the recent rise in mental health needs. Now more than ever, school counselors need to get creative and set an example for other school staff by taking the first steps to forge connection with students, Henry says.

Long hours and heavy workloads leave teachers and counselors prone to burnout, but students also suffer when teachers and school staff focus on just getting through the school day and lose sight of the emotions and issues that students are dealing with beyond academics, stresses Henry, who is co-author of the 2019 book Mental Health in Our Schools: An Applied Collaborative Approach to Working With Students and Families. School staff who don’t take the time to connect with students, she says, risk not being able to recognize when a student is having an “off” day or exhibiting uncharacteristic behavior that indicates they need extra support.

School counselors can take steps to prevent this by encouraging teachers to spend time bonding with students at the start of the year, rather than diving into rigid topics such as classroom rules and expectations, Henry says. She notes that icebreaker activities, such playing bingo or prompting discussions about students’ favorite television shows or rides at a local amusement park, can make a big difference in fostering connection.

“And with that [activity] comes so much more dialogue,” she adds.

Henry also encourages counselors to be proactive and make their services known during team meetings and trainings among school staff. By emphasizing that their “door is always open” for collaboration when a student is struggling behaviorally or academically, counselors can help remind teachers that they are an important resource that can help address the underlying reasons for disruptive behavior or failing grades, such as anxiety, self-esteem issues or food insecurity at home. 

Henry says that improving student mental health and school culture is about school counselors “being present, being around [the] teachers and being around students as much as possible,” including in the hallways and at lunch. “And invite teachers to collaborate with you when a student seems ‘off,’” she adds. “When an adult reaches out, little things like that can change a kid’s life and make them feel like someone does care.”

Henry often offers to serve as a mediator between a teacher and a student when behavioral issues or conflict arises in the classroom. “I sometimes meet with a teacher behind the scenes to say, ‘Have you tried this?’ or ‘When I worked with this student, here’s what worked, here’s what he responded to,’” she explains. “It’s just like a [counseling] treatment plan; if something is not working, we move on and try something else.”

It’s easy for school staff to focus on what a student is doing wrong, she notes, but it’s more helpful to focus on what they’re doing right and emphasize their strengths. Offering students creative options beyond discipline and exploring the reasons why they’re struggling is key.

“We need to meet kids where they are,” says Henry, who counsels individual clients part-time at a private practice in addition to working as a school counselor. “Some of these kids just want to be heard. Just listening to what they have to say and not judging them makes a big difference. They need to feel like people [school staff] care.”

Barriers to behavioral health care 

School counselors are often the first mental health professional a student who is struggling with mental illness comes in contact with, notes Stephen Sharp, a school counselor at a middle school and coordinator for K-12 school counseling services in the Hempfield School District in the suburbs of Lancaster, Pennsylvania.

However, many students need long-term outpatient therapy that would not be appropriate or feasible for school counselors to offer. When students and families face barriers to access behavioral health care, it only adds to the increasing student mental health needs that schools are facing, notes Sharp, a member of the American School Counselor Association (ASCA) board of directors. 

The issue that Sharp says he finds most challenging is that for many of his students, all of their mental health support “begins and ends at the school walls.”

Sharp says he’s seen students go months without needed treatment because they were put on a waiting list for an appointment with a local mental health provider or they lack insurance or the ability to pay for treatment not covered by insurance. In some cases, undertreatment or lack of preventive treatment has led to student hospitalizations, he adds.

The biggest need for my students is access to ongoing behavioral health services,” he says. “The reality is that it [the gap in services] creates a disproportionate burden on the schools. Not just on school counselors but teaching staff as well.”

Sharp’s school district has a strong partnership with a local behavioral health provider who provides school-based services for students. However, he says that many students are not able to take advantage of the service. Both lack of insurance and limited coverage are barriers to treatment for students, he notes, but the latter is more pervasive. Students may have health insurance, but their plan may not cover certain services such as school-based therapy or virtual therapy, he explains.

There is also a shortage of behavioral health care providers just at a time when there is an increased demand for services. Sharp says that his school struggled this year to find a qualified school-based therapist to hire in addition to school counseling staff.

Sharp’s district is not alone in this phenomenon. Francis says that community mental health agencies in Minneapolis are also full and have waiting lists. In Texas, community resources that would otherwise provide support for families outside of schools, such as social service organizations, civic centers and nonprofit programs, are declining — and in some areas are nonexistent, Akins notes.

The pandemic revealed the cracks and flaws not only of our education system but also the health care and mental health care systems, Sharp notes.

“We are in a behavioral health care crisis, not just in the state of Pennsylvania but nationally as well, and it leads to a lack of access to care. Certain areas (e.g., rural) have always had a lack of care, but it’s gotten so much worse,” Sharp says. “All of this is really disheartening and challenging, but it’s also something that we absolutely as a profession and a society need to be talking about. What level of advocacy and coordination are we going to do to address these concerns?”

Sharp says the past year has been the hardest year yet for him professionally. But at the same time, he sees opportunity ahead.

One of the lessons gleaned from Hurricane Katrina, Sharp notes, is that a coordinated response works best in times of crisis, especially when there are financial strains and staffing limitations. There is an opportunity for national-level organizations such as ACA and ASCA to offer guidelines, training and other programming to address the rise inyouth mental health concerns, he says. And there is also opportunity for multidisciplinary collaboration. For example, the Pennsylvania School Counselors Association (PSCA) is working with the Pennsylvania chapter of the American Academy of Pediatrics to address the barriers to care in their state, he notes.

Support from professional organizations as well as collaboration among and across helping professionals at the local, state and national levels “makes things better but also makes us [individual counselors] feel like we’re not the only ones pushing against a brick wall,” says Sharp, a past president of PSCA. “The more innovative that we can get and share stories of success, those are the types of things that will lead to something better after this.”

All hands on deck

As a school counselor, Holt says that she sometimes thinks of her role as a “connector” between students and families and wraparound resources that can help meet their needs outside of school, including mental health services. However, she advises school counselors to only share resources that they are familiar with and have vetted to ensure that they offer quality services.

It’s helpful, Holt says, when a professional counselor contacts her school to let them know they offer group or individual services that are well-matched to their student population. She also recommends counselors have a list of local providers that they can offer to teachers and school staff who, like counselors, sometimes find themselves overwhelmed and in need professional support.

Holt encourages community counselors to connect with their local school counselors, and vice versa. “Having that connection from community mental health to the schools is very important,” Holt says. “The more resources that we [school counselors] know about, the more referrals we can do for our parents and students. If we don’t have connections in the community, it makes it harder. Being able to know that we have partners in the community and knowing what’s available is helpful.”

Akins agrees that partnerships between school and community resources will be key in addressing the recent increase in youth mental health needs. However, community counselors need to recognize that establishing helpful collaboration takes time and patience.

There are a lot of practical components that have to fall into place before a school can adopt a new program or resource, Akins notes. “Instructional minutes are very precious,” she says, so school officials cannot always justify using class time for mental health programming.

Akins suggests that community counselors get to know the unique needs of their local school district, as well as what has and hasn’t worked for other schools, before contacting their school to offer help.

In times of crisis, “sometimes people who are coming from the [nonschool] mental health community think ‘we don’t have time to waste.’ That’s true, but processes are in place for a reason (i.e., student safety),” Akins says. “Taking the time to really connect with your district and plan and develop a formal partnership will be a lot more successful than emailing a principal to ask, ‘Can I come in and do XYZ?’”

Sandi Logan-McKibben, a clinical assistant professor and school counseling program director at Sacred Heart University in Connecticut, asserts that counselors have an ethical responsibility to know what mental health and other wraparound resources are available in their area for clients and students.

She believes in this idea so strongly that she assigns her school counseling students a community mapping project each year. The students are charged with finding resources within the school district where they are working as a counseling intern and then overlaying those resources on a Google Maps image of the area. Students’ maps include not only mental health services but also after-school, tutoring and mentorship programs; organizations that help with food insecurity, homelessness or immigration services; nonprofit or faith-based organizations; and other institutions. 

This mapping project can be helpful for community and school-based counselors, whether they are students or not, adds Logan-McKibben, an ACA member.

She also recommends counselors find and help fill gaps in needed services. This can include anything from advocating for funding at a school board meeting or partnering with an existing nonprofit to expand services to contracting with a local university to offer pro bono counseling services for school students.

“It only takes one person to enact something and prompt change,” says Logan-McKibben, a former school counselor who lives in Florida and teaches virtually at Sacred Heart. “Find out what the actual needs of your community are. Don’t make assumptions. You don’t know unless you reach out.”

Counselors in all settings have a common skill — resourcefulness — and they need to draw on that skill to meet students’ needs in this time of crisis, Logan-McKibben says. This calls for counselors to work with a preventive, proactive and collaborative focus.

“The most important thing for all professional counselors to know is that we’re all in this together. Any kind of school crisis is really a community crisis,” she says.

Sharp agrees that counselors have a role to play in advocating for support for mental health care “both in and beyond the walls of the school.” This is a time to be concerned, he admits, but it’s also a time for meaningful work to be done.

“We also need to acknowledge the work that is being done and was done before [the situation became a crisis]. That work mattered before, and it matters now,” Sharp says. “Whether it’s school counseling or clinical counseling work we’re doing, it’s a sensitive time for the profession, … but [it’s] also a time to be mindful and reflective of victories and lessons learned. Also, [counselors should] take the time to celebrate. Celebrate the work our clients and students have done and use that to make the profession better.”


The influence of social and political issues on youth mental health 

Adults have been making a lot of decisions lately that not only create news headlines but also affect youth mental health, including a law aimed at making it easier for teachers to carry firearms in Ohio schools and the controversial Florida law — dubbed “Don’t Say Gay” by its opponents — that banned classroom instruction about sexual orientation or gender identity.

For school counselors, these issues are more than soundbites on news programs. They affect their students and families and add to the already complicated work school counselors are doing to combat a rise in suicidality and other mental health concerns in American youth.

Jessica Henry, a high school counselor in the Akron, Ohio, area, says she’s had coworkers who have refused to use a student’s preferred pronouns. “Not only is that unethical and has legal ramifications, it’s [also] very difficult to hear when a teacher says, ‘I’m not doing that,’” she says.

Henry, a licensed professional clinical counselor, feels that schools (and school counselors) should take a proactive role to address controversial issues rather than avoiding them. Students, parents and educators need to hear about topics such as racial injustice and LGBTQ+ inclusion, she says.

“We have to address the bigger picture of what is going on in our world. It’s about getting your administrators and superintendent to understand that inclusivity is vital — and in turn, will affect academics,” Henry explains. “It goes back to [asking], ‘Does every kid feel safe in their school?’ ‘Does every kid feel like themselves in their school?’ If even one student says ‘no,’ we’ve got work to do.”

Part of this work also involves the need for counselors to have the humility to recognize their biases, says Derek Francis, manager of counseling services for the Minneapolis Public Schools’ Department of College and Career Readiness. The majority of the counseling profession is white, yet the majority of many school populations are not, he notes.

“We need to be mindful of our biases. … It takes laying down your privilege and learning, open listening and connecting,” says Francis. “Ultimately, we’re trying to build trust when we’re doing counseling. We want all people to know that we have positive regard for them, and we need to come in [with] the right [unbiased] mindset to help the person in front of us.”

The growing polarization of political and social issues in America has also led to distrust of public institutions such as schools, says Jennifer Akins, a licensed professional counselor and president of the Texas School Counselor Association. She’s seen this mistrust spiral into parents equating terms such as “social-emotional learning” with critical race theory.

“We [school counselors] have been working on mental health issues and school safety for a long time, and many districts have integrated mental health and social-emotional learning [into the curriculum]. There is a segment of the public that has developed a mistrust even of those words, ‘social-emotional.’ They feel that things like mental health don’t really have a place in public education or are inappropriate. That stigma adds to some of the [mental health] needs we’re seeing in students. It’s disheartening,” says Akins, the senior director of guidance and counseling for the McKinney, Texas, public schools. “There’s very little disagreement that parents want to send their child somewhere where they’re cared about and where they’re safe. But the initiatives and programs that help enhance those things are the very things that they are scared into thinking are harmful and terrible.”

One way to reduce these patterns, Akins says, is for school counselors to make transparency and communication with parents about programming a priority, as well as involving parents in the creation of programs as much as possible.

She suggests that school counselors focus on messaging that emphasizes common ground: We all want children to feel connected, to belong and to feel safe, she notes, so open communication about what a school is doing for student mental health — and why you’re doing it — can be helpful. “It’s just a matter of peeling back some of the layers of misinformation,” Akins says.



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.

5 tips to generate more leads from a therapist directory listing

By Wesley Murph July 20, 2022

Last October, I landed an exciting internship at a private practice. I just needed to see 12 clients a week to be able to graduate from a counseling master’s program the following March.

“That shouldn’t be a problem,” my supervisor said. “I’ll pay for your therapist listing. You should hit your goal in about a month.”

I wrote a profile of my clinical services for my therapist listing that I foolishly fell in love with. I submitted it to the directory and smiled when it was posted online. I’m about to get a boatload of leads, I naively thought, once everyone reads my amazing ad. 

Only that never happened.

The first week I received a fair number of leads, but many of these well-intentioned folks needed a therapist with more skills than I had.

The leads dried up with each passing week. At the one-month mark, I was seeing eight clients a week. Not nearly enough to graduate on time. So I began tinkering with my directory listing to see if I could get it to generate a predictable and steady flow of leads. This turned out to be a wonderful exercise because I discovered five ways to get more leads from my listing.

Julia Lazebnaya/

1) Rotate your zip codes

Some therapist directories let you target more than one zip code. One of your zip codes has to be your practice’s location — let’s call this your static zip code. The other two zip codes — let’s call them your flexible zip codes — can be anywhere in the state(s) you are licensed in.

I frequently target flexible zip codes that are outside of Portland, Oregon, where I work, because Portland is crowded with counselors. This has helped me generate more leads while serving areas in Oregon that may have a shortage of therapists.

I also recommend rotating your flexible zip codes, which is something I do every week. Think of this like fishing. If you fish in the same spot day in and day out, you are probably going to run out of fish to catch. This is especially true if other fishermen are fishing in the same spot. Rotating your flexible zip codes, however, lets you move your fishing pole (i.e., your counseling directory profile) so you’re fishing in areas that are restocked with fish (i.e., clients).

2) Track your listing

The online therapist directory I use provides the following metrics: total leads, calls, emails, website visits and profile shares. But it does not reveal how many leads became clients. Knowing this information is important because it helps determine which zip codes have a higher conversion percentage (i.e., leads that become clients).

And if the leads you generate are not booking appointments, you may need to tweak your approach. Are the demographics in this zip code a mismatch for you? Do you need to respond differently to your leads when you follow up with them? Or are there other reasons?

Another option is to find zip codes that have better conversion rates. To get this information, you can track your listing on a spreadsheet. (Google Sheets works great and is free.)

My tracking spreadsheet, which I named “Lead Tracker,” contains the following headings: listing platform, zip code, county, city, population, test date (the beginning and end date of the test), days of test (the total number of days tested), leads start, leads end, total leads, new clients and conversion rate.

I put the two flexible zip codes I’m testing underneath the “zip code” heading. I then calculate how many leads I generated during the test period (usually a week) using the metrics from the directory listing.

Let’s say I test the number of leads between July 1 and July 7. The leads start is the number of leads my directory service says I have on the day I start my test. So, using this example, if the directory service says I have 203 leads on July 1, then my leads start is 203.

The leads end refers to the number of leads my directory service says I have when I stop my test. If I stop my test on July 7 and my directory service says I have 213 leads, then my leads end would be 213.

For the total leads, I would subtract the leads start (i.e., 203) from the leads end (i.e., 213) to get the total leads (i.e., 10).

Next, I determine how many of those leads became clients by comparing the zip codes on my new client form to the zip codes I’m testing. (This is not error free since I also get leads from zip codes outside of the areas I’m targeting.)

I then calculate the conversion rate by dividing the number of new clients I got during the test period by the number of leads I generated. This percentage lets me know if the zip codes I’m testing are generating paying clients.

I sometimes target zip codes that have a high population density because there are more fish in these ponds. I’ll also target zip codes that have lower population density because there may be fewer fishermen fishing in these ponds. And since I accept Medicaid insurance, I target zip codes that align with the socioeconomic populations I want to serve.

You can find demographics about zip codes at

3) Include keywords in your listing

Another way to generate more leads from your online therapist directory is to include words and mental health issues that potential clients are searching for — but only add issues that you can competently treat and not just ones that are popular.

In a YouTube video, Jeff Gunther, the owner of online search platforms Therapy Den and Portland Therapy Center, notes that people most often search for the following three terms: anxiety, relationship issues and depression.

According to Gunther, anxiety is searched 14.3% of the time, relationship issues are searched 13.9%, and depression is searched 12.9%. So if you are clinically able to help clients who struggle with one of these issues, it makes good business sense to include these terms in your profile and specialties sections.

But don’t worry if you don’t specialize in one of these three areas. Gunther describes a few other mental health issues that are often searched: child or adolescent issues (4.6%), posttraumatic stress disorder (4.3%), LGBTQ+ issues (4.2%), self-esteem (3.6%), gender identity (2.7%), family conflict (2.4%) and loss or grief (2.4%).

4) Create a professional website

A website is a modern-day business card. Unfortunately, prospects will judge our clinical skills based on whether we have a website and how it looks. If you want prospects to see you as a professional, and ultimately choose you for counseling services, then it’s a good idea to spend some time (and money) on creating a sharp-looking website by having a professional website builder create your site and getting professional photos.

I invested $250 to have a photographer take and airbrush (thank goodness!) my picture for my website. I also invested $500 to have a professional build my website using Wix, a platform for creating websites that makes it easy to revise or tweak your site after it’s built.

I found both the photographer and website builder by placing a $5 ad on Craigslist.

A word of advice: Get quotes from several different website builders. The quotes I received varied in price depending on where the builder lived. The price quotes increased when the builder lived in an expensive city and vice versa.

5) Follow up with every lead

When it comes to responding to leads, I recommend following the golden rule: Treat people the way you want to be treated. I appreciate when the companies I reach out to for services take the time to respond to me, and I want to be this type of business owner too. (It’s also good karma!) So I respond to every lead who reaches out to me — even if my schedule is full.

People often tell me I am the only counselor who follows up with them. I am not sharing this to shake my own rattle. But when the pond I’m fishing in is teeming with other counselors, I want to be the counselor who stands out because this ensures that people will remember (and hopefully refer) me. And if it works for me, it can work for you too.



Wesley Murph is a professional counselor associate and a national certified counselor who is working toward full licensure in Oregon. Before earning a master’s in clinical mental health counseling, he owned two small businesses, including one that was featured on Dog Whisperer with Cesar Millan. His joy is being with his young son and wife. You can find him 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.

Voice of Experience: Our new world

By Gregory K. Moffatt July 18, 2022

I’d like to say we are in a post-pandemic world, but I know that isn’t exactly true yet. Even so, I can’t believe how much our world has changed in the past three years.

The lockdowns, mask requirements and financial issues of the COVID-19 pandemic, to name a few, added stressors to our world that I have never seen in my lifetime.

I am a college professor and some of my students finished their third year of college never having seen a classroom without masks, screenings, quarantines and other precautions brought on by the pandemic. My wife teaches 4-year-old prekindergarten, and some of her former students from three years ago, who are now going to the second grade, have never seen their teachers’ faces unmasked.

The pandemic also magnified mental health and social problems that were already present, including addictions, anxiety, depression, marital discord and a host of other issues. The last thing my clients struggling with addictions or depression needed was to be locked down at home for weeks on end with nothing to do. That doesn’t even begin to touch the magnitude of clients with obsessive-compulsive disorder who struggle with the fear of germs or autistic spectrum clients who need routines.

A few months ago, I wrote in my column that burnout could be managed, at least sometimes, by reframing. One reader criticized that statement by noting that the pandemic has been so overwhelming that reframing isn’t a panacea. I can’t argue with that criticism. This situation is just so different, I suppose.

For over a year, I didn’t eat out and I found myself anxious every time I wanted to go to a store. I’d wonder if it was open, if they had the items I needed and what restrictions they might have. I found it easier to just stay home.

Like all of you, I’ve shared the stress of relatives who worked in jobs that couldn’t easily be done remotely, especially in the retail and the restaurant industry. I saw some of them lose their financial stability and some even lost their jobs, which only added stress to the other preexisting stressors.

Most of us have been affected by this pandemic in one way or another. So many of us have been sick. Nearly all my family has had it, including me, despite vaccinations. And then, of course, there is death. Like others, I lost a close friend to this virus.

This doesn’t even include the political and social divisiveness surrounding issues related to this pandemic. Families have been divided — maybe even permanently — over the question of vaccines and boosters.

People are seeking help from counselors in numbers I’ve never seen before. I don’t know a single counselor who isn’t operating on a full schedule right now, and it has been that way for months.

But the pandemic has caused us to grow as well. Three or more years ago, most counselors didn’t do telemental health. Even though I had the credentials for telehealth as well as telesupervision, I rarely used it before the pandemic. But now, I don’t even accept an intern who hasn’t had telehealth training. It wasn’t even on my radar three years ago to require telehealth training for an intern, and I don’t know of any graduate programs that required or even offered it.

I’ve also grown to appreciate telehealth as a client. Because I live in a rural area, I’ve always had a hard time finding my own therapist who wasn’t 50 miles away in Atlanta. Now, I can manage my self-care in a one-hour telehealth session rather than spending three or four hours driving to and from my therapist’s office in Atlanta.

We’ve seen changes in continuing education requirements as well. In my state, prior to the pandemic, only 12 hours of distance learning could be counted for recertification. Now nearly all of them can be as long as they are synchronous — a term that few of us even knew three years ago.

In addition, telesupervision hours now count toward license requirements in Georgia. This gives clinicians in remote areas options for training far beyond what they could have accessed three years ago.

I often wonder why I wasn’t offering my clients the option of telehealth before the pandemic. I had clients who drove two to three hours one way to see me. Why hadn’t I thought to help them by offering distance work? Today, although my caseload with children is still largely in person, I use distance counseling with nearly all my other clients and supervisees.

As we come out of these troubling pandemic years, it is clear we will never be the same. But telehealth has been a positive change for the counseling field and offers a silver lining in the new post-pandemic world.




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


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: Crisis Intervention Ethics Casebook

Compiled by Bethany Bray July 13, 2022

Crisis situations often require rapid decision-making from a counselor, and those decisions have ethical and legal implications, write Rick A. Myer, Julia L. Whisenhunt and Richard K. James, the co-authors of the Crisis Intervention Ethics Casebook.

Their book, published in late 2021 by the American Counseling Association, explores the nuances of ethics during in-the-moment crisis counseling, which often occurs outside the traditional office setting and involves numerous outside and uncontrollable factors, such as spectators.

“The nature of ethical dilemmas is that what is right and wrong depends, in large part, on the unique situation. … What you learned in your legal and ethical issues class may not cleanly or clearly apply in a crisis situation,” write Myer, Whisenhunt and James in the book’s preface. “In this casebook, we go far beyond the everyday grind of therapy and explore what happens when all hell breaks loose and even the most seasoned crisis workers can become frozen and transfixed with indecision.”

“At that point,” the authors continue, “chaos theory overrides every counseling theory and technique you thought you knew. You may resemble a deer frozen in the headlights, paralyzed with indecision regarding your therapeutic approach, the ethical problems that go with it, institutional policies that countermand it, and political realities that negate it.”


Q&A: Crisis Intervention Ethics Casebook

Responses are co-written by co-authors Myer, Whisenhunt and James. Myer is a licensed psychologist, full professor and chair of the Department of Educational Psychology and Special Services of the University of Texas at El Paso; Whisenhunt is a licensed professional counselor (LPC), associate professor and program director in the University of West Georgia’s Department of Counseling, Higher Education and Speech-Language Pathology; and James is an LPC who recently retired as a full professor after teaching for 40 years at the University of Memphis.


How a person deals with crisis is interconnected with their level of social support and cultural/demographic factors. What should counselors know about this?

There is limited discussion of multicultural counseling as it pertains to crisis intervention. For that reason, we apply the SAFETY (stability, affect, friction, environment, temperament and yearning; Kristi ) framework to our crisis intervention ethical decision-making protocol. We hope this will be a catalyst for considering the ways in which we can better serve clients who are in crisis from a multiculturally aware perspective.

An important line of inquiry surrounds the application of Judith Jordan’s relational-cultural therapy (RCT) to crisis intervention (outlined in her book Relational–Cultural Therapy). Thelma Duffey and Shane Haberstroh also emphasized this in their book Introduction to Crisis and Trauma Counseling in 2020.

RCT provides a way for the counselor to intervene in a humanistic manner that prioritizes the client’s inherent need for connection while recognizing the acute disconnections and accompanying “survival strategies of disconnection” that can happen when people experience trauma. As a person who operates from a humanistic framework, I (Whisenhunt) value the application of RCT to crisis intervention because RCT provides a lens through which to conceptualize the crisis experience, which then allows me to intervene with intentionality and thoughtfulness.

Both the SAFETY framework and RCT will likely play a more prominent role as the field of crisis intervention continues to mature.

However, crisis counselors may also consider nontraditional methods for helping individuals to feel connected during times of crisis. Technology may provide the means through which to connect through video to loved ones, find coping skills through smartphone applications, and locate community resources through web searches. Access to connection and resources are now in the palm of our hands, and there are ways to effectively use those resources to facilitate crisis intervention. Naturally, the converse may also be true, wherein the digital world can be part of the crisis stimulus. As such, crisis counselors are wise to talk with individuals about their effective use of digital connections.


What would you want counselors to know about the differences between crisis counseling, disaster response and trauma counseling?

Crisis counseling, disaster counseling and trauma counseling share a common theme of supporting people through what might be their most challenging life experience. Although disaster counseling and trauma counseling are distinct from crisis counseling in their primary focus, crisis tends to emerge in both disasters and trauma, which necessitates the use of crisis intervention strategies.

Although we will be providing explanations and examples using the singular individual (i.e., person), it is important to remember that systems, particularly families, can be in crisis as well. Accordingly, as we talk about crisis intervention, we encourage readers to consider both individuals and families experiencing crisis.

Crisis counseling is a time-limited intervention that is used when a person’s coping skills and problem-solving strategies either are not adequate or fail to resolve the specific situation causing the crisis. Situations causing the crisis are individualistic and are generally not predictable. Crisis counseling involves real-time, in-the-moment attempts to help the person reassert some control and attain stability. Crisis counseling involves the use of specific intervention strategies that are employed over the course of a few minutes to a few hours, with the short-term goal of helping individuals to attain stability or securing containment for individuals who are a danger to self and/or others.

Disaster counseling incorporates crisis intervention but on a much larger scale. Disasters are defined by the massive impact of the event. As such, disaster counseling may involve planning to help individuals obtain housing, clothing and medical care, for instance. Disaster counseling may also involve psychoeducation and helping individuals and families understand how to navigate the disaster recovery process. However, crisis counseling may also be used in disaster counseling, as individuals experience destabilization and significant loss.

Trauma counseling may also initially incorporate crisis counseling strategies but involves a more long-term sustained intervention process. The sustained intervention is needed because trauma generally is considered to result in neuropsychological changes, altered worldview and interpersonal difficulties (the latter is particularly true for those experiencing personal transgressions and/or human-made trauma). During trauma counseling, individuals tend to experience moments of transcrisis, to which counselors may respond using crisis counseling techniques that help the person to reestablish control/equilibrium.


What should counselors know about the nuances of crisis and how clients’ needs might be different from these other scenarios?

Destabilization is the cornerstone of crisis. Individuals experience crisis because their coping strategies and problem-solving skills are not sufficiently able to address the crisis-causing stimulus/event. As such, the focus should be on helping the person to reestablish control or helping to promote safety for those who are a danger to themselves and/or others.

Generally, effective crisis counseling can help people achieve sufficient stabilization to leave on their own recognizance, or perhaps with loved ones who will provide adequate support. However, when crisis counselors’ best efforts to de-escalate have failed, we need to take directive action and obtain help to control out-of-control behavior. Safety (for the person in crisis, the crisis counselor, bystanders, first responders and others) is always the priority in crisis intervention. Although, despite our training, counselors may experience the temptation to “fix” things for individuals who are in crisis, the best crisis counseling may not lead to stabilization. We cannot undo the situation that led to the crisis, but we can help individuals to feel some sense of safety and support on what may be the worst day of their lives.

We do this through communicating in a manner that demonstrates sincere caring and through the use of crisis intervention strategies. But we do not attempt to process past transgressions when doing crisis intervention — the focus is on the present situation. That does not mean we invalidate the past; rather, our attention remains focused on the present moment and how we can assist the person in finding stability in the here and now. As such, the counselor’s use of traditional counseling strategies that promote reflection, insight and connection to emotion are not typically suitable in crisis intervention.

In crisis situations, emotions are raw, and the person’s affective, behavioral and/or cognitive functioning are altered. The crisis counselor’s job is to promote stabilization across these three domains, which we call the ABCs: affective, behavioral and cognitive. When counselors utilize too many reflections of feeling, reflections of meaning and other insight-provoking counseling skills, they may further destabilize the person who is in crisis.

However, by using the nine crisis intervention strategies identified by Richard James and Burl Gilliland in their book Crisis Intervention Strategies, crisis counselors can help individuals to reattain stability across the ABCs. These nine crisis intervention strategies include creating awareness, allowing catharsis, providing support, promoting expansion, emphasizing focus, providing guidance, promoting mobilization, implementing order and providing protection and are based on the triage assessment the crisis worker makes upon initial contact.


What types of crisis response tools do counselors need to learn and keep handy? What aren’t they learning in graduate school that they might need to fill in on their own?

The Council for Accreditation of Counseling and Related Educational Programs (CACREP) requires training in crisis intervention. However, [counselor education] programs may choose to offer a stand-alone course in crisis intervention or integrate the content into other courses. Both approaches can be effective if the training includes real-time assessment methods, strategies and [an] understanding that crisis counseling is unique from traditional counseling.

We fundamentally believe that assessment is key to the crisis intervention process and should guide our work. If we monitor the client’s ABCs — we use the Triage Assessment Form: Crisis Intervention (Revised), or TAF: CIR (Rick Myer and Richard James, 2009) — we can get a pretty good idea of how effective our intervention efforts have been. And, if the client’s ABCs do not begin to diminish, we know it is time to try a different tactic and use other crisis interventions.

This process of adapting in the moment is a critical skill for crisis counselors. James and Gilliland outline the nine crisis intervention strategies in their book Crisis Intervention Strategies (creating awareness, allowing catharsis, providing support, promoting expansion, emphasizing focus, providing guidance, promoting mobilization, implementing order and providing protection), which are essential skills for crisis counselors.

Further, we recognize that crisis counseling tends to require a higher level of guidance or directiveness than is seen in traditional counseling. This is because individuals in crisis, whose ABCs are diminished, may not be able to make life-promoting decisions for themselves. Until individuals are able to attain stability across their ABCs, crisis counselors should provide more guidance/directiveness that helps the client to maintain safety and achieve equilibrium. This is in opposition to the training most counselors receive early in the program. A nondirective, person-centered approach certainly has its utility in traditional counseling, but not always in crisis intervention.

However, clients in crisis respond to the counselor’s disposition. So, it is critical that crisis counselors remain calm and provide some reassurance that they are able to help. Likewise, if the crisis counselor is panicked, their decision-making is certainly less than optimal. As such, crisis counselors can employ internal coping skills that clients cannot see, such as mindful breathing, counting or visualization to calm themselves. Although using these skills may distract the crisis counselor for a few seconds, grounding oneself can help us to more effectively navigate the crisis situation.


You mention that crisis situations often involve “politics,” which counselors have to learn to navigate. Can you elaborate on what you mean by politics? Why do politics and crisis seem to go hand in hand?

Politics refers to the setting in which crisis counseling occurs. However, politics is only one of the three “Ps” that influence the crisis counseling process in an organization. The other two are “policies” and “procedures.” All organizations have politics, policies and procedures. It is important for counselors to be aware of these and work within the three Ps, assuming doing so would not violate ethical or legal responsibilities. Politics can play an important role, wherein crisis counselors may be implicitly or explicitly pressured to make decisions that safeguard the organization to the clients’ detriment.

For this reason, use of a formalized assessment procedure, such as the TAF: CIR, is warranted and substantiates the crisis counselor’s interventions. Although the organization may, at times, oppose the crisis counselor’s interventions, those interventions and actions are grounded in assessment; the TAF: CIR guides both the intervention and decision-making processes. When clients experience higher TAF: CIR scores that cannot be diminished through use of the nine crisis intervention strategies, a response is needed to promote safety for the client and/or others.

When decision-making is guided by reliable and valid assessment, there is less room for scapegoating by unhappy administrators.


What prompted you to collaborate and write this book? Why do you feel it’s needed now?

A quick search through various data banks shows that very little has been written about crisis intervention and ethical dilemmas. In addition, searching through professional codes of ethics yielded only a few mentions of crisis intervention. Expanding the search to include “disaster” had similar results. Ethical codes address issues of abuse, suicide, and homicide or threat of harm, but crises involve many more issues.

Given the lack of attention in codes of ethics to the reality of providing crisis intervention, we believe that counselors need to learn ways to make ethically based decisions in crisis intervention. The rapid-paced nature of crisis intervention does not typically afford counselors the opportunity to utilize a traditional ethical decision-making model or engage in supervision or consultation. Naturally, when counselors have the opportunity to do those things, we highly recommend them. But crisis intervention is often so rapid and the stakes are so high that counselors must make decisions quickly.

For that reason, in this book, we introduce the Legal Issues, Assessment, Setting, Ethical Principles and Resolution (LASER) protocol to aid in the ethical decision-making process while prioritizing safety for the client, counselor and bystanders. We believe the gap in the literature surrounding ethical decision-making in crisis intervention presents an important opportunity for the development of evidence-based procedures, and this book is our first attempt to develop those procedures.



Crisis Intervention Ethics Casebook was published by the American Counseling Association in 2021. It is available both in print and as an e-book at or by calling 800-298-2276.


Related reading: See Counseling Today’s recent cover story, “Crisis counseling: A blend of safety and compassion.”


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.