Monthly Archives: October 2022

Curfew is when?! Helping parents and teens see eye to eye on boundaries and rules

By Bethany Bray October 28, 2022

Le’Ann Solmonson, a licensed professional counselor (LPC) who owns a private practice in Nacogdoches, Texas, once worked with a teenager who was continually grounded by her parents. The client, a high school senior, was brought to counseling by her parents, who saw her rule-breaking behavior as the presenting concern.

The family was stuck in a repeating pattern where the teen would break her curfew and the parents would respond by grounding her and taking away her car and cell phone for a month to cut off all her social activities outside of school, Solmonson recalls. As soon as the punishment was lifted and the teen regained her freedom, she would immediately break her curfew, only to be grounded again.

Solmonson focused on strengthening the teen’s decision-making skills in counseling. However, she says it was equally — if not more — important to offer psychoeducation to the parents on the developmentally appropriate needs of adolescents, including social connection with peers.

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The parents did not understand that being grounded and cut off from social activities for a month is “forever” in the life of a high school senior, Solmonson says.

She worked with the parents and teen to create a plan for privilege restriction that gave the teen incentives to work toward, rather than a lengthy and complete shutoff of her freedoms. Whenever she broke curfew, the teen would be grounded without access to her car or cell phone for one week. After that, she was given access to her car to drive to school and other activities without friends as passengers. As the teen learned to respect the boundaries her parents established, she was gradually allowed to attend school football games and other events that were pivotal in the social life of a teenager.

The flexibility and freedom of this new plan further strengthened the teen’s decision-making skills on her own. In turn, the parents better understood their daughter.

Counselors are often “put in a hard spot,” Solmonson admits, because they can easily see patterns and reasons why rules and boundaries aren’t working in families where the parents and an adolescent child are at odds. For this young client, the parents’ punishments were too stringent, which curtailed any chance for the teen to learn to make better decisions on her own.

The counselor’s role, Solmonson says, is to help both parents and teens explore the factors that contribute to the child’s rule-breaking behaviors and meet in the middle to give the teen enough autonomy to mature and learn as they go.

Putting things into context

Skill building in areas such as communication, listening and distress tolerance is an essential part of counseling for teens and parents who are in conflict. Disagreements often arise over boundaries, and a key first step, Solmonson says, is to talk with parents about the importance of keeping an open dialogue with their child(ren) about the rules they set, including the context of why they’ve established them.

These conversations ensure that both parents and child have an opportunity to listen and voice their feelings even while the parents retain their rule-setting authority, Solmonson notes. She coaches parents to use phrases such as “This is the reason our family does (or doesn’t do) that,” “These are the reasons why this is the limit” or “I’ve given you my reasons and I understand that you don’t like my reasons and don’t agree, but we’re still going to do this.”

“One of the most important things parents can do is give their child a voice and make it clear that they’re open to hearing what they think,” says Solmonson, the immediate past president of the Association for Child and Adolescent Counseling, a division of the American Counseling Association.

A focus on context can also be helpful for parents who see their child’s rule breaking as the root of conflict in the home. Hayle Fisher, a licensed professional clinical counselor (LPCC) and director of adolescent services at a behavioral mental health provider in Mentor, Ohio, says she often spends time equipping parents with skills to identify what is and isn’t risky behavior. This can be especially helpful for parents whose worries are based on past experiences such as suicidality or self-harm in a child, notes Fisher, who runs her practice’s intensive outpatient program for adolescents as well as a counseling group for parents focused on navigating family challenges with teens.

For example, parents may blow up in anger when they find out that their child has used marijuana or become sexually active. A counselor can offer psychoeducation to parents that while it’s common for teenagers to experiment with substances, signs that indicate it’s a problem are when a teen is overusing a substance, using it to cope, driving under the influence, selling the drug or engaging in other illegal activity. Similarly, exploring one’s sexuality can be a normal part of adolescence, but engaging in risky behaviors such as having unprotected sex is a red flag.

Fisher uses the acronym FIDIL (sounds like “fiddle”) that she learned while in graduate school to help parents consider the full context of their child’s behavior and decide whether it’s risky. This method prompts the parent to look at:

  • F: What is the frequency of the behavior? Is it once per day, once per month, etc.?
  • I: How intense is the behavior? (For example, does self-harm involve scratching oneself or cutting to the point the child needs stitches or medical attention?)
  • D: What is the duration of the behavior? How long does the behavior last?
  • IL: What is the interference level of the behavior? How does the behavior affect the child’s functioning (daily, academic, occupational or social)?

These questions also prompt parents to think more deeply about the reasons why their child is engaging in a behavior and to identify needs the child has that are going unmet, Fisher notes. The hope is that parents will come away with increased empathy for their child and the desire to help them make behavioral changes in a supportive way.

“A lot of the time, the fight is over ‘I found cannabis in your room’ rather than the reasons why they’re using,” Fisher says. So she sometimes poses the question to the parents: “Why do they feel the need to engage in this behavior? Even if all their friends are doing it, why are they?”

Consistency is key

Consequences must be appropriate for adolescents, but they also need to be consistently enforced.

Marcy Adams Sznewajs, an LPC who counsels teenagers and young adults at the therapy practice she co-owns in Beverly Hills, Michigan, finds that parents sometimes backslide or waver on the penalties they create because they either feel the punishment was too strict or feel bad about enforcing it. Not only does this pattern send a mixed message to the child, but it also sabotages the work Sznewajs does in counseling to foster young clients’ decision-making skills.

In these cases, it may be necessary to discuss with the parents the need for clear communication and consistent expectations for their child, Sznewajs says. She explains to parents that her role is to help their child grow and build skills, and that can’t happen when situations are fixed for the child before they can learn from them.

Sznewajs once worked with a teenage boy who, upon leaving home to attend college, began to use marijuana and failed two classes in his first semester. His parents gave him an ultimatum: They would take his car away if he didn’t start passing his classes and get a job, or he would need to come back and live at home.

In his second semester, he continued to fail his classes and didn’t get a job either, so the parents took his car away. In counseling, Sznewajs prompted the client to explore his values, including his desire to get an education, and think about choices that he could make differently to re-earn his parents’ trust.

In the next session, the client reported that his parents had given his car back after one week because they felt bad that he was struggling to get to class without it. The client lost an opportunity to problem-solve, Sznewajs notes, and the parents’ inconsistency made her job “infinitely harder.”

Ultimately, she had an honest conversation with the parents about the need to be consistent with consequences for their child so that he can learn to cope with challenges.

“It’s not my job to tell a parent what to do. It’s not appropriate to point out that I don’t think they’re doing the right thing,” she says, but “having boundaries set and then discarded gives a really inconsistent message to the child and does not help them cope with difficult situations. It doesn’t help them make better decisions.” 

Is it negotiable?

When seeing an adolescent client in a session with their parents, Solmonson often finds it helpful to moderate discussions about boundaries by prompting them to create two lists: one for rules that are negotiable and one for rules that aren’t. This activity allows both parties a chance to voice their feelings, give feedback and collaborate with her in session to guide the process.

For example, the family may decide that curfew is negotiable, depending on what the teen is leaving the house for and whether it’s an organized event with a set ending time. Or parents may agree not to dictate who the teen befriends so long as they’re making good choices when they’re with those friends, and the parents will only intervene in instances when the teen makes bad choices.

Examples of nonnegotiable rules that families have agreed on include not having drugs or illegal substances in the home and never sneaking out of the house without the parents’ knowledge, Solmonson explains.

“When you find things that you can negotiate on, it gives the adolescent a sense of empowerment and a sense of control over their own life,” Solmonson says.

Seeking safety

It’s natural for children to begin to seek more autonomy as they reach adolescence, but this aspect of development often causes friction between parents and children.

For many parents, behavior that is within the family’s rules “feels safe,” whereas rule breaking can feel like a rejection of the parents, says Martina Moore, an LPCC and counselor supervisor who is president and CEO of an outpatient treatment center for co-occurring disorders in Euclid, Ohio. The heart of what sparks disagreements with children during this stage is fear.

Parents feel discomfort when they don’t have the relationship with their child that they’ve always pictured, or when the child is not fulfilling the ambitions and hopes the parents had for them. Parents often overcompensate with strict rules to try and find control, notes Moore, the president of the International Association of Marriage and Family Counselors, a division of ACA.

Moore uses these situations as an opportunity to foster discussions with parents about the vision they have for their child versus the vision the child has for themselves. She encourages parents to ask their child what they want out of life – a question that many parents have never considered before, Moore notes.

She empathizes with parents while addressing their fear directly, telling them, “What you’re afraid is that they [the child] are going down a path that derails the hopes you have for them.”

“We see the world as a scary place that can be so unforgiving that we get really fearful of what’s going to happen with our children,” she adds.

Solmonson says that she encourages parents to focus on connecting with their child despite the disagreements, frustration and discord that happen during adolescence. Putting energy and care into the relationship with their child now, when it’s difficult, may result in the child choosing to have a relationship with them later in life, when it’s optional, Solmonson explains.

She urges parents, “Don’t let the conflict destroy the relationship. Conflict is inevitable and will always happen. Take a step back, [think of the big picture] and prioritize the relationship.”

 

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Read more on how counselors can help parents and teens navigate conflict in Counseling Today’s November cover story.

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

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

Confidentiality comes first: Navigating parent involvement with minor clients

By Bethany Bray

What is said between a counselor and an individual client is confidential, even when the client is a minor. But parents often want to be kept in the loop about their child’s progress in therapy. This can put the counselor in a tricky situation, especially when the parents want to control or influence the counseling process.

The only scenario in which counselor-client confidentiality can be broken is in situations that necessitate protecting the client or others “from serious and foreseeable harm,” such as suicidal intent. (For more on this, see Standard B.2.a. of the 2014 ACA Code of Ethics.)

Marcy Adams Sznewajs, a licensed professional counselor (LPC) who often works with teenage and young adult clients at her group therapy practice in Beverly Hills, Michigan, says she empathizes with parents who ask about what she’s covering in counseling sessions with their child. However, she finds it helpful — and necessary — to offer a firm explanation of counselor-client confidentiality whenever she begins counseling a young client.

Sznewajs says that she emphasizes to parents that she will let them know if their child discloses anything that will put the child in danger. She also makes it clear to both parties that she will only invite parents into the counseling sessions if the young client grants permission.

This conversation is often not what the parents want to hear, Sznewajs admits, but it is important because it spells out the boundaries of what the counselor is obligated to tell the parents and reassures the client that their privacy will be respected.

Sznewajs stresses to families that they all must trust the process for her work to be effective.

“It’s important for the teenager to trust an adult with these difficult thoughts and feelings, and legally and ethically I have to keep it confidential,” says Sznewajs. “I’d be doing my client a huge disservice [if I disclosed session details to the parents]. That’s not only unethical, it’s damaging — and what does it teach the kid? That this person that you’re supposed to trust, you can’t.”

The feelings behind the questions

Parents’ concerns and questions about the work their child is doing in therapy are often rooted in fear, says Martina Moore, a licensed professional clinical counselor supervisor with a mediation and counseling practice in Euclid, Ohio. Not only do parents worry that the challenging behaviors that caused their child to seek counseling, such as rule breaking, isolation, defiance or problems at school, will have negative long-term outcomes in the child’s life, but they might also feel these issues are a reflection of their parenting abilities.

“Parents sometimes have such anxiety about their children it’s [gotten] to the point where they are increasing their child’s anxiety,” notes Moore, president of the International Association of Marriage and Family Counselors, a division of the American Counseling Association.

Although Moore makes a point to validate these fears with parents, she also emphasizes that it’s good for the child to grow and build autonomy through counseling on their own. She applauds parents for seeking help while explaining that she needs the freedom to work with the child alone for the counseling process to work.

“I also spend time with parents to dig into what their fear is. They’ve come to counseling [with their child], so they must believe that there is benefit in this process,” Moore says. She emphasizes to parents that they need to trust the process. “I spend a lot of time with parents getting their buy-in,” she notes.

In addition to fear, parents may also struggle with strong feelings of shame for having a child who is engaging in risky behavior and failing to thrive.

Le’Ann Solmonson, an LPC in Texas who has extensive experience working with children and adolescents, says she makes a point to acknowledge and normalize parents’ feelings of vulnerability and worry. If appropriate, Solmonson says she will sometimes disclose that she’s experienced similar feelings when her adult children sought therapy.

“No parent is perfect, and you worry over feeling like they are talking [in therapy] about what you’ve done wrong,” says Solmonson, the immediate past president of the Association for Child and Adolescent Counseling, a division of ACA. “It’s a very vulnerable thing to have your child go to counseling. You can’t help but feel that it’s a reflection on you as a parent and feeds into fears that you’re ‘screwing your kids up.’”

Navigating the balance

Counselors often need to get creative and act diplomatically to keep parents in the loop while maintaining young clients’ confidentiality and trust.

When parents insist on being involved in their child’s counseling, Moore negotiates with both the parents and client to find a plan that they all agree on while staying within ethical boundaries.

This was the case for a teenage client Moore once counseled who had substance use disorder. The parents were worried about their child and wanted to be involved in the counseling process. Moore facilitated a discussion and, eventually, they all came to an agreement that Moore would work with the teen alone but would let the parents know whenever the client had a relapse or break in recovery, she says.

Keeping lines of communication open and having regular check-ins with parents is beneficial to the counseling process with young clients, Solmonson notes. She often prompts child or adolescent clients to identify one small thing they are comfortable sharing with their parents at the conclusion of each counseling session, such a breathing technique they learned or new words they discovered to describe their emotions. This keeps the parents in the loop while ensuring that the client maintains control over the process.

When parents are left completely in the dark about their child’s work in counseling, it can exacerbate worry, cause them to “fear the worst” and catastrophize about what the child might be saying, Solmonson adds.

Sznewajs notes that talking with young clients about keeping their parents updated also provides the opportunity to check in with the client and ask what they feel is going well. She sometimes begins by asking the client how they feel things are going in counseling and transitions to what (or if) they would want her to share with their parents about their progress.

Disclosure of life-threatening behavior

When a young client is engaging in risk-taking behaviors that are life threatening (i.e., suicidal actions, self-harm), ethically, parents need to be brought into the conversation, says Hayle Fisher, a licensed professional clinical counselor and director of adolescent services at a behavioral mental health provider in Mentor, Ohio. While this is crucial to do, it can also impair the therapeutic relationship with the teen, she adds.

Fisher finds the vignettes in the 2016 British Journal of Psychiatry article “‘Shhh! Please don’t tell…’ Confidentiality in child and adolescent mental health” particularly helpful for examples on navigating these conversations. She keeps the following notes for herself, drawn from that article, for situations when she must disclose a young client’s harmful behavior:

  • Tell the client what you (the counselor) are planning on disclosing to the parents, with an emphasis on the full context of why you need to. Ask for their feedback on how they might like to edit what you plan to say.
  • Talk through the potential benefits and costs of disclosing to the parents. Ask the client how they feel about the disclosure and consider their views as you move forward.
  • Validate any fears the client may have about the disclosure, such as losing access to resources and freedoms, feeling blamed or ashamed, or being concerned that the police or social services will become involved.

To maintain trust and a therapeutic alliance with young clients, Fisher emphasizes that it’s important for a counselor to give the client as much control as possible over how this communication will occur. If the disclosure happens during an in-person session and the parents are nearby, she gives the client the choice to either stay in the room or step out and wait in the lobby when she invites the parent(s) in to tell them.

Fisher also gives young clients the option to tell their parents before she does. However, this is only appropriate if the client’s risk of harm is not imminent, Fisher stresses. In this scenario, she tells the client that she will call at a certain time the following day to speak with their parents, check in and provide support for the parents and client.

“This option is especially powerful,” Fisher explains, because it “reinforces the adolescent taking accountability for their actions, increases communication skills and fosters independence in the situation so they are not dependent on the counselor for navigating conflicts with their parents.”

Sznewajs also takes a collaborative approach when it’s necessary to break confidentiality to inform a client’s parent or guardian about harmful behavior or intent. She says she tries to take the client’s feelings into consideration while modeling firm boundaries.

Although not having the conversation with the parents isn’t an option, client can choose how and when it happens, Sznewajs explains. She offers to involve the parents in person, call them on the phone, do a video chat during the counseling session or wait until after the session ends.

Sznewajs says she explains to young clients: “I want to make sure you stay safe, so we have to bring your parents into this conversation.” She adds that she tries to “do it in a collaborative way, even when it [the situation] is dire.”

 

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

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

De-escalating conflict between parents and teens

By Bethany Bray October 26, 2022

It’s natural for adolescent development and parent-child conflict to go hand in hand.

Le’Ann Solmonson, a licensed professional counselor (LPC) who owns a private practice in Nacogdoches, Texas, has worked with children and adolescents in school and clinical settings throughout her career. Time and time again, she’s seen families fall into a pattern as children reach adolescence: The youth wants more autonomy — a normal aspect of adolescent development — and begins to push against their parent’s rules and boundaries. In response, the parents tighten their control or inflict punishment, only to have the adolescent push back harder, break more rules and chafe against their parents’ preferences. Thus begins a repeating spiral of friction, frustration and misunderstanding — on the part of both the teenager and the parents.

“Conflict is very much a product of adolescent development,” says Solmonson, the immediate past president of the Association for Child and Adolescent Counseling, a division of the American Counseling Association. “Adolescents’ whole goal is to figure out ‘Who am I? Where do I fit in?’ and begin that separation from their parents and become more independent. … Some of that development leads to trying out new things, thinking a little differently [than their parents] and not having the cognitive development to think through something that looks fun but might be dangerous. These are natural things that can fuel conflict and disagreements.”

Parents vs. teen

Hayle Fisher, a licensed professional clinical counselor (LPCC) and director of adolescent services at a behavioral mental health provider in Mentor, Ohio, runs her practice’s intensive outpatient program for adolescents as well as a counseling group for parents focused on navigating family challenges with teens. In her experience, a teen’s risk-taking behaviors are often what the family names as the presenting problem. And while problems such as reckless driving, disordered eating, skipping school, risky sexual behaviors, substance use and self-harm or suicidal ideation do need attention in therapy, there is often conflict in the home that is exacerbating the teen’s behavior. Even if a family is not having traditional “blowout” style arguments, conflict is often present in the form of unhealthy patterns and instability, says Fisher, the president of the Ohio Association for Specialists in Group Work. Examples include invalidating behaviors and dialectical dilemmas (e.g., forcing independence vs. fostering dependence, normalizing pathological behavior vs. pathologizing normal developmental behavior, extremes in excessive leniency vs. authoritarian control).

Because of this, Fisher feels that a systems approach works best for counseling teenage clients who are in conflict with their parents. The intensive outpatient program at Fisher’s practice provides individual and group counseling for adolescents as well as group counseling for the parents.

While it’s vital for the teen to focus on decision-making, emotion regulation and other skills in counseling, sometimes it’s even more important for the parents to work on similar issues in counseling themselves, she adds. Not only are parents often unequipped with the tools they need to navigate conflict, but they sometimes carry bad experiences and patterns they picked up from their own parents and upbringing.

When working with teenage clients who are at odds with their parents, counselors are often given the difficult task of fostering growth in the adolescent while knowing they have little control over their home environment and their parents’ willingness — or lack of willingness — to work on their own unhealthy patterns and behaviors. Counselors must also strike a balance between fostering trust with the teen and maintaining client confidentially and accommodating parents who want to be kept in the loop about their child’s progress, perhaps even to the point of wanting to control or influence the process, notes Marcy Adams Sznewajs, an LPC who co-owns a group therapy practice in Beverly Hills, Michigan.

(For more on maintaining client confidentiality while managing parents’ requests to be kept in the loop about their teen’s progress in counseling, see the online exclusive article “Confidentiality comes first: Navigating parent involvement with minor clients.”)

“It’s very challenging to work with teenagers because of parents,” says Sznewajs, who often works with older teens (15+) and emerging adults. “It’s a dance between involving the parents, helping the parents parent better and maintaining the trust of the teenager, and there’s no formula that always works.”

Getting started

The counselors interviewed for this article agree that when counseling adolescents who are in conflict with their parents, an important first step is for the practitioner to offer an honest yet firm explanation on the limits of client confidentiality to both parties. This includes explaining that what is said in counseling sessions is confidential — even when the client is a minor — except in situations that necessitate protecting the client or others “from serious and foreseeable harm,” such as suicidal intent. (For more on this, see Standard B.2.a. of the 2014 ACA Code of Ethics at counseling.org/ethics).

This conversation is often not what the parents want to hear, Sznewajs admits, but it is important because it spells out the boundaries of what the counselor is obligated to tell the parents and reassures the adolescent that their privacy will be respected.

In addition to conversations about confidentiality and the counseling process, clinicians should conduct a thorough assessment, including screening for mental illnesses that can surface during adolescence, notes Martina Moore, an LPCC and counselor supervisor who is president and CEO of an outpatient treatment center for co-occurring disorders in Euclid, Ohio.

It’s not uncommon for family conflict to crescendo with the onset of a mental illness in a teenage child, says Moore, a faculty member in the clinical mental health counseling program at John Carroll University.

Challenges with concentration, irritability, sleep problems, and mood spikes and swings can be a normal part of adolescence, but they can also be symptoms of a developing mental illness, Moore says. In counseling, completing a thorough assessment before creating a treatment plan with teenage clients is important to gather more information and parse out symptoms that may be part of adolescent development and/or signs of mental illness. The Diagnostic and Statistical Manual of Mental Disorders can be a particularly helpful resource in this process, she adds.

When counseling teens who are in conflict with their parents, getting the full picture during the assessment process often involves speaking with the parent(s) to learn what they see as the teen’s symptoms and challenges. However, there is no hard-and-fast method to do this, and the counselors interviewed for this article say that they vary their approach depending on the family dynamics and the client’s needs.

Moore and Solmonson say they often meet with the parents alone to hear their perspective as the teen begins counseling. It’s simply not helpful to have the client (the teen) in the room while the parents “rant” about the family’s situation, notes Moore, president of the International Association of Marriage and Family Counselors, a division of ACA.

“If there’s so much anger between them, it may be better to see them separately for a while to diffuse and process their anger and prepare them for a better way to come back into dialogue,” Solmonson says. “If I’m just playing referee, then everyone being in the same room is not effective.”

At the same time, having everyone in the room together — either at intake or later in therapy — can tell a counselor volumes about the family’s dynamics and issues that need addressing, adds Solmonson, an ACA member. “Sometimes it’s needed to get the whole picture of what’s going on,” she says.

Talking with the parents also creates an opportunity to ask them about their upbringing and things they have learned or internalized from their parents, Solmonson says. She asks parents what they did and didn’t like about the way their parents brought them up and what they want to emulate or keep from repeating.

This information is so valuable that Solmonson says she makes a point to have this conversation with the parent(s) of every teen she counsels.

Building better communication skills

When there is friction between parents and teenagers, communication is often the primary and most important skill they all need to build in counseling, Sznewajs notes. The relationship often naturally improves, she says, when a family begins to communicate better, truly listen and empathize with each other’s perspectives.

The counselors interviewed for this article suggest using the following techniques with parents and adolescents to strengthen their communication skills — and, in turn, their ability to tolerate and navigate disagreements.

Active listening: Sznewajs begins communication skill building with teens and parents by seeking the client’s permission to involve all of them in a session together. Once together, she thanks them for agreeing to work as a group and asks the family to name a minor conflict that they struggle with, such as squabbles over expecting the teen to drive a younger sibling to school. Because it’s a learning exercise, it’s best if they stay away from larger, high-stakes conflict, Sznewajs explains.

When she prompts the family to explain the disagreement, usually “everyone starts talking at once,” Sznewajs says. If this happens, she asks them to slow down and take turns so she can fully understand the situation and invites the teenager to start by explaining their perspective. Then, she prompts the parents to speak and give their perspective as well as reiterate what their child said.

Usually, the parents immediately jump to why the teen’s take is wrong rather than summarizing the teen’s experience. If this happens, Sznewajs will gently remind them that she wants to hear what they think their child’s perspective is, not whether it’s right or wrong, and explains that this response is common among families she works with. She also gives the adolescent the same assignment: Paraphrase your parents’ position without giving an opinion on what was said.

Sznewajs then continues the discussion by asking the teen and the parents to talk about how it felt when the other party paraphrased their experience. The aim, she explains, is to foster active listening skills and empathy toward the other party’s point of view.

“I emphasize that the important thing isn’t to agree but to feel heard,” Sznewajs adds.

Responding to “mistakes”: Parents often need to work on how they respond to their teen when what they see as a failure or mistake occurs. Sznewajs says she does this work either with the parents alone or with the family together, depending on what is appropriate and preferred by the client.

When a teenager or young adult makes a poor decision or has a slip-up such as failing a class, parents often default to anger, blame or “I told you so” lectures, Sznewajs says.

However, a better approach — and one that quells patterns of conflict — is to consider the full context of what happened and support the child so they can solve the problem on their own. Sznewajs says she often offers psychoeducation to parents on how becoming angry or interfering in the situation to circumvent conflict — such as paying for the child to retake a college class they failed — may not be helpful in the long run. Collaborating with the teen to find out what led to the situation and what they need to resolve it will keep them from feeling misunderstood and fueling further conflict, she stresses.

Instead of responding in anger, she coaches parents to use supportive statements such as “That must have been so stressful. How can we keep that from happening again?”

Sznewajs takes a truthful, direct approach with parents. She explains that their child “is trying to figure out life” and reminds them that mistakes happen. She may tell parents, for example, “Sometimes kids do dumb stuff, and they learn through trial and error, just like you did.” It’s often teaching parents to “be empathetic about the disaster that just occurred instead of angry,” Sznewajs says, “One of the most important pieces of work I do with families is helping them collaborate with their kids when they make a mistake rather than getting angry at them.”

It can be hard for parents to resist the urge to become involved in their child’s challenges, Sznewajs acknowledges, but allowing them to fail — within a supportive setting — furthers them on the path to becoming an autonomous adult. Teens who aren’t “allowed” to make mistakes because their parents respond with anger and blame often struggle to problem-solve and navigate challenges later in life, she says.

“The overarching goal [of counseling] with teenagers is to help them become autonomous, self-sufficient, confident adults,” Sznewajs notes. “And the best way to do that is to help them communicate effectively and support them as they learn to solve their own problems.”

Modeling respect: Counselors may need to work on self-awareness and patience with both teenage clients and their parents to bridge communication gaps. When parents and teenagers are at odds, both parties often come to counseling feeling disrespected, Sznewajs says. “Parents who demand respect [from children] but don’t give it back make for a pretty high-conflict home,” she adds.

Solmonson often stresses to parents that if they want respect during disagreements with their child, they’ll need to model that. For example, if a teen replies to a question in a sarcastic or disrespectful way, Solmonson coaches parents to respond by saying, “I’m going to give you a do-over. Do you need a minute to think about how to say that?” rather than blowing up in anger and furthering the conflict.

“If you [parents] raise your voice [at a child], you’re giving them permission to raise their voice back. If when they escalate, you escalate with them, you’re just fueling the fire,” Solmonson says. “Parents need to know how to handle things when feelings are big, and sometimes that means [saying,] ‘We’re going to take a minute apart’ and recognizing that ‘I don’t want to speak to you from the [emotionally escalated] place I’m at right now.’”

Taking a break: In moments of friction, parents often overcompensate and repeat themselves because they feel a child is not listening, Solmonson notes. It can be helpful to validate this experience for parents, she says, and explain that it’s a natural reflex to repeat yourself when you don’t get acknowledgment or a response from the person you’re talking to. But it doesn’t mean they’re not listening.

Solmonson also finds it can be helpful to establish a signal — such as making the timeout “T” signal used in sports with your hands — that either party can use when they need to take a break from a conversation or indicate that a topic is exhausted.

Fisher sometimes encourages families to use a signal or ring a bell she has available during in-person sessions to indicate that a member of the family is feeling invalidated or steamrolled during family conversations and disagreements.

The use of a “timeout” signal proved helpful  when Solmonson once worked with a family that had three adolescent sons. The mother “was very willing to work on becoming a better parent, but she would just talk and talk and talk” during disagreements, Solomon recalls. So the sons needed a tool to let their mom know, “OK, we’ve heard you. You’ve explained it enough. We understand.” 

It’s also important to emphasize to parents and teens that taking a break means walking away for a minute to calm yourself before returning to the conversation, Solmonson says. It doesn’t mean storming off to fume and feed your anger or leave the house entirely. A counselor can also equip both teens and parents with calming techniques and self-talk affirmations that focus on needing to hear what the other party has to say, she adds.

Part of this work , Solmonson notes, includes psychoeducation on the importance of “picking your battles.” She says she often tells parents and adolescents, “If you wait until something is really important to you and engage in a discussion on why it is important to you, you’re more likely to be listened to. But if you argue [about] every little point, the other person is going to stop listening.”

Reading nonverbals: Moore finds that she often needs to explain to parents that it can be a developmentally appropriate response for an adolescent to shut down when they become overwhelmed. During conflict, the reflex to stop talking and disengage can be one of a teen’s strongest tools, she says. Sometimes, they simply don’t have any more words.

Parents often need coaching on ways to respond to this behavior without losing their cool, says Moore, an ACA member. They may need to learn to gently ask their teen “Do you understand what I’m asking?” without expecting anything more than a nod. Moore sometimes serves as the moderator when families practice this technique in counseling.

“Children and adolescents have a built-in process to shut down and stop communicating [when overwhelmed], but their body language and their lack of words are telling us a lot,” Moore says. She has noticed that parents’ reaction is often to escalate, yell and become agitated. Instead, Moore teaches parents to notice their child’s body language and nonverbal cues and ask what it is telling them. 

“It tells you that what you’re doing is not working and you’ve hit a roadblock,” she says. “I have to teach parents that it’s not defiance. It’s gotten to a point when they [the adolescent] can’t go any further. They don’t have the capacity.”

Returning to the wise mind: Fisher works at a practice that uses dialectical behavior therapy (DBT) and finds the method particularly helpful and appropriate for adolescent clients because of its focus on differentiating between human’s emotional and rational states of mind. DBT guides clients to identify and use their “wise mind,” which draws upon a middle ground of both emotional and rational thinking.

A person who activates their wise mind is able to acknowledge and respect the emotions they are feeling while viewing a situation logically, Fisher explains, which is really useful during conflict.

Emotion regulation and distress tolerance are core treatment targets in DBT, which can also help both teens and parents during times of stress and disagreement, Fisher notes. She says she often talks with parents and teens about the need to ride strong emotions like a wave, rather than reacting with impulsivity, and offers psychoeducation on how humans’ emotional reactions usually tend to recede within 30 minutes.

DBT also fosters skills that can help teens to rationally think through the urge to turn to negative coping mechanisms such as self-harm, Fisher adds. She equips teen clients with numerous age-appropriate mechanisms that they can use to take their minds off distress and invite calm, such as reciting Taylor Swift song lyrics or playing solitaire on their phone.

Observing family dynamics: Moore is trained in Gestalt therapy and pulls from that method to focus on communication with parents and teenage children who are in conflict. One exercise that Moore finds helpful involves inviting the entire family to a counseling session and having them sit in a circle facing each other. She gives them a discussion prompt and then sits outside of the circle as an observer. While the family discusses the prompt, Moore listens, observes the family’s dynamics and pauses the conversation to occasionally offer comments on some of the interactions and patterns she is noticing. The power in this technique, Moore says, is that it prompts the family to communicate naturally.

The goal, she continues, is to bring awareness to sticking points that the family may not be cognizant of and give them techniques and assignments to improve communication, which they first try in session and then later at home.

Moore used this method with a family she once worked with that had three adolescent children (one son and two daughters). While discussing the prompt, a disagreement arose, and the mother began to raise her voice. When that happened, the three children slumped down in their chairs and stopped talking, and the father started looking around the room, avoiding his family’s gaze, Moore recalls.

Moore paused the conversation and said, “I’m noticing that when conversations get a little heated, mom’s voice escalates and all three children slump down in their chairs, and dad is disconnected too.” Then she asked the group whether this is a usual pattern of communication in their home. The children immediately said “yes” and reported that when their mother starts to escalate, “there’s nothing we can say” to placate her.

This conversation helped the mother realize that she felt a need to “project dominance” and speak louder when she assumed her children were not listening to her. As a result, she was shutting down communication, Moore notes.

Moore had the family work on rerouting this pattern in session with her and as a homework assignment to try later at home. She asked the mother to work on being more aware of her body language, voice volume and the needs of her children during arguments. The children were challenged to try and empathize with why their mother felt she wasn’t being heard and find gentle ways to signal to their mother that she was becoming escalated during disagreements while remaining engaged.

Using humor: Counseling sessions may be the last place an adolescent wants to be, Fisher acknowledges. This can especially be the case if their parents told them they were going to counseling five minutes before the appointment to minimize complaints and disagreement from the teen.

She finds humor to be a great way to break the ice, build rapport with adolescent clients and make counseling “easier to digest,” as long as it’s appropriate and a good fit for the client. 

Recently, Fisher had an intake session with a family, and it soon became clear that the teen was completely turned off and “wasn’t having it.” She diffused the situation by naming what she was observing in a humorous way: “It seems like you don’t want to be here, and I’m just this weird person asking a bunch of questions today!” This statement validated what the teen was feeling and helped make the session seem less adversary, she recalls.

Fisher cautions counselors to be careful when using humor and know how to use it appropriately. “Don’t use it to minimize emotions that a client is feeling,” she says, “but humor can normalize discomfort and helps the counselor come across as nonthreatening.”

Coping with unhealthy dynamics 

When working with parents and teens who are at odds, counselors can be put in a difficult situation if the parents expect the practitioner to “fix” their child without doing their own work to change unhealthy dynamics in the home environment. The counselors interviewed for this article say this is a common scenario, so during intake (as well as whenever this issue becomes a challenge later in therapy), they make a point to talk with parents of teen clients about the need to be open to change themselves.

“It doesn’t matter how hard a kid is trying to make changes in their own life [via counseling] if change is not supported in their [home] environment. … I can do fabulous work with a child but sending them back into an unhealthy environment that hasn’t changed will be detrimental and they won’t make progress,” Solmonson says. “Unless you [the counselor] can make some changes to the child’s environment, you’re not going to be as successful as you can possibly be.”

It’s vital for practitioners who work with teens to tailor their counseling approach to be sensitive to this lack of autonomy, Sznewajs stresses. Even older teens who work, attend college or live away from home often remain financially dependent on their parents, she adds.

It can be a challenge when a client’s home environment remains problematic, Sznewajs says, but “it informs my therapy so much. I can see what the problems are at home and what my client needs to cope because change likely won’t happen.”

When a teenage client’s parents are resistant, unsuccessful or unable to make changes in family dynamics, Sznewajs often helps the client shift their focus from feeling frustrated and complaining about toxic patterns at home to finding ways to cope and build small pieces of autonomy within their situation. She guides the client to explore and identify aspects of their home life that they have to tolerate while finding ways to manage and be true to themselves without stoking conflict and increasing turmoil.

She uses acceptance and commitment therapy to prompt them to identify what they can and cannot control. Techniques that help teenage clients identify and explore their values, Sznewajs says, can also be helpful and give them things to focus on that are within their control.

Fisher uses DBT to help adolescent clients identify their core values. It can be helpful to have the client explore what they want in their life and what is missing as well as how their values might conflict with or be similar to ones their parents hold, she explains.

“A lot of this work is managing situations that aren’t ideal, which is good training for real [adult] life,” Sznewajs adds. “We are not always in situations that are what you want them to be.”

 

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Read an online companion piece to this article, “Curfew is when?! Helping parents and teens see eye to eye on boundaries and rules.” And search for articles with the tag “teenager” at ct.counseling.org for more on the nuances of counseling adolescent clients.

Motortion Films/Shutterstock.com

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

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

Taking a clinical selfie

By Bethany Bray October 25, 2022

“But first, let me take a selfie.”

This phrase, which was first popularized in The Chainsmokers’ 2014 breakout hit song “#Selfie,” has become a common saying in today’s culture — and one that is sometimes used to satirize younger generations who can’t seem to experience something without documenting it with a self-portrait.

On the surface, the act of taking a selfie can seem shallow or self-promotional. But Amanda Winburn and Amy King, both counselor educators who have a background as a school counselor, say that when used intentionally and in a structured way, selfies can become a therapeutic tool and a way to spark self-reflection, engagement and connection with younger clients.

“We know that children are engaged in” taking selfies, says Winburn, a licensed school counselor, licensed professional counselor and registered play therapist. “So why not take the positive attributes of this practice and expand upon it” in counseling?

Selfies in session

Winburn and King, who have presented on the therapeutic power of selfies at conferences of the American Counseling Association and the American School Counselor Association, have used selfie activities as a therapeutic intervention in individual and group counseling settings.

“This is just one more way we could give children and adolescents an opportunity to express themselves and narrate their story,” says Winburn, an associate professor of counselor education at the University of Mississippi. “We try and incorporate [clients’] worlds in our work, and selfies are an everyday part of our world and everyday part of expression for children, adolescents and adults. It really is the new self-portrait.”

However, Winburn and King stress two important caveats to this work:

  1. Practitioners should take care to ensure that any selfies captured in sessions are not taken with a device that is connected to the internet (i.e., not the client’s personal cellphone) so the images cannot be shared or used in a nontherapeutic context.
  2. Practitioners must obtain consent from a parent or guardian to capture the image of any client under the age of 18.

King, a certified school counselor and provisionally licensed professional counselor in private practice in Mississippi, uses a tablet computer that does not have internet access to allow students and clients to take selfies. She prints the selfie images and keeps them in a client’s file to refer to during sessions and deletes the images from the device. The tablet and client files are kept in a locked cabinet in her office when not in use, she explains.

Tapping into self-expression and boosting empathy

Having young clients take selfies during counseling sessions can serve as a visual and relatable way for them to track their progress in therapy, Winburn and King suggest.

Selfies can document physical aspects of improvement and growth in ways that a client may not notice without a visual record, such as smiling or holding their head up more, sitting tall and appearing more confident, Winburn explains.

When she was a school counselor, King once used selfies to help a student who was struggling with self-confidence. The student kept the printed selfies that she took in counseling sessions in a journal, to which she added notes and drawings. When King and the client talked about her therapeutic progress and looked through the selfies together, the young client was able to recognize that she looked happier and more confident in her progression of photos throughout the year.

She was able to note that she had gotten taller and that her smile was brighter. “She was glowing because she was looking at herself in a really positive way and reflecting about that,” King recalls.

King, a lecturer in counselor education and supervision at Boise State University, finds that students love to look back at their progress in counseling, and by using selfies, young clients can visualize that progression of moving away from having a tough time to having a better outlook on their situation or life.

In addition to strengthening expression and self-confidence, using selfies in this way also provides an opportunity for counselors to explore and process clients’ feelings of self-doubt or self-criticism, Winburn says. In therapy, selfies can be a visual portrait of a client’s narrative and a discussion starter for work that increases self-awareness and emotion recognition.

Winburn advises counselors to ask clients questions to understand the motivations behind their self-expressions and explore if they are trying to portray themselves differently than they really are. For example, she says clinicians can ask, “How does seeing that image make you feel?” or “What makes you feel that way?”

Winburn asks her counseling students at the University of Mississippi to take a selfie at the beginning and end of their day for an entire week. She tells her students, “It’s a way to step out of your comfort zone and process how you were feeling [that week] and how you portray yourself.” Then they reflect together in class on the story their selfies tell, which can be quite eye-opening, Winburn says.

King also used selfies in group counseling with second grade girls during her time as a school counselor. The group’s focus was on building confidence, communication, friend making and social skills. Learning to give and receive positive affirmations — to oneself and others — was an important component of this group work, King notes.

King, assisted by graduate counseling interns, had each group participant take a selfie with a school-issued tablet computer. The student would first look at the selfie themselves and then share it with the group. This activity allowed participants to open up and talk about the feelings their selfie elicited and, in turn, prompt group members to offer positive feedback.

It was a powerful experience that boosted the second graders’ empathy, reflection and listening skills and their ability to consider others’ perspectives, King says. The students would listen, connect and make comments such as “your eyes are really sparkling in that one,” she recalls.

After the group had been meeting for a little while, teachers and recess monitors at King’s school began to report that the students who were in her counseling group started to have more positive interactions during recess, she says.

Using selfies in counseling can help children actively learn and foster positive feelings about themselves as well as learn about individual and cultural differences in group settings, King notes.

“There’s no right or wrong way to make a selfie,” she adds.

Keeping an open mind

King and Winburn acknowledge that counselors can sometimes be skeptical of using technology in sessions, especially mediums such as selfies that can have negative connotations. However, they feel that when used in an ethical and appropriate way, selfies can strengthen trust and the therapeutic alliance with young clients.

It can also be a way to model that technology can be used in a positive way, to build each other up, King adds.

“Make sure you’re using safeguards to keeps clients safe, but try it [using selfies], embrace it and be open to it,” Winburn urges. “Especially with adolescents, counselors need to be playfully engaged and aware of where they are. This is an active way of embracing the world that they live in and meeting them where they are.”

wavebreakmedia/Shutterstock.com

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 Related reading, from Counseling Today:

 

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

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

Miller sheds light on culture and introspection in closing keynote

By Lisa R. Rhodes October 21, 2022

Rwenshaun Miller spoke about the importance of culture and introspection during the closing keynote for the American Counseling Association’s 2022 Virtual Conference Experience. He told the audience that he has been impactful as a counseling professional because he uses his life experience as a Black man with a mental illness to guide the way he serves his clients and the way he cares for his own well-being.

“I learned how to not only to become [an] effective and efficient therapist but also someone that understands the importance of mental wellness, especially for individuals who look like me,” said Miller, a licensed clinical mental health counselor and supervisor and motivational speaker.

Rwenshaun Miller

He said he has been successful as a clinician “because of the fact that I did my own work and continue to do my own work.”

Miller is the co-founder and chief executive officer of the Good Stress Company, a group practice in Charlotte, North Carolina, and the author of Injured Reserve: A Black Man’s Playbook to Handle Being Sidelined by Mental Illness. He has been widely recognized for his work in empowering people with mental illnesses to live their best lives, and he is a recipient of the American Psychiatric Association Foundation Award for Advancing Minority Mental Health, the SXSW Community Service Award, and Omega Psi Phi’s Brother Paul Woods Bridge Builder Award.

Miller shared his journey with mental illness and explained to the audience how culture has influenced his experience as a client and as a counselor. He said his mental health problems began when he was a sophomore at the University of North Carolina at Chapel Hill (UNC-Chapel Hill). Miller was a top student and athlete in high school, but he struggled in college to maintain an academic scholarship and excel on the university’s football and track teams.

“These particular pressures were a struggle for me,” Miller said, noting that he was having difficulty making the transition from his small, majority Black high school to a large, predominately white institution. UNC-Chapel Hill was an unfamiliar place where he encountered the belief that he was only admitted to the university because he played sports. When Miller was placed on academic probation and suffered a knee injury, he said “things started to slide” for him.

He stopped attending classes and remained in his dorm room. He couldn’t sleep, lost his appetite and rarely showered. He also began to hear voices.

“This was something that terrified me, but I was afraid to even talk about those things that were happening to me,” Miller said, adding that his ego and pride kept him from asking for help. “I was used to doing it on my own for so long.”

When Miller’s family finally learned he was in distress, they admitted him to a psychiatric hospital, but he fought and resisted being admitted and the medical professionals placed him in a straitjacket.

My family was “worried about my own mental well-being,” Miller said. “And also they didn’t know what else to do for me.”

Like other Black families, Miller said his family never discussed mental health issues.

“I was actually terrified about going to into the hospital because where I grew up, a lot of times when we heard about people going to the psychiatric ward, we just called them crazy,” he said. “Honestly, that’s not something you want to be considered.”

Miller was afraid to talk to the hospital’s clinicians. “I was terrified to even talk to anybody. Nobody in there looked like me,” he said. “That lack of representation kept me in my shell.”

Miller explained that in the Black community, medical professionals “who didn’t look like us” were not trusted. “History shows you that we were treated as subjects” he said, noting the infamous Tuskegee Syphilis Study. So Miller remained silent until he realized “if I don’t talk, I don’t get out.”

Eventually he was diagnosed with bipolar I disorder with psychotic features and was told that he could not return to the university because it was a stressor for him. Instead, Miller was advised to start therapy and take medication to treat his mental illness.

Miller began treatment and started working with Kendell Jasper, a Black male licensed clinical psychologist. Miller called Jasper his “saving grace.”

“When I walked into his office, he looked like me, he talked like me,” Miller said. “He created a space for me to be able to open up to him and tell him the different things I had going on.”

When Miller’s condition began to improve, he said he was convinced that he was cured and didn’t need to continue with his medication or therapy. Instead, he wanted to get back to UNC-Chapel Hill. However, when Miller returned to the university, his symptoms reappeared, and rather than reach out to his mental health providers, he began to self-medicate with alcohol, a dependence that lasted three years.

“I was mentally deteriorating,” Miller admitted. During this time, Miller said his life hit the lowest of the lows, and he attempted suicide three times.

“You get so caught up in wanting to stop the emotional pain, and you have voices in your head that are telling you ‘You shouldn’t be here,’” Miller said.

But through the adversity, Miller realized he had to take ownership of his mental illness and be intentional about his recovery. “Not only for me, but for the people who are in my life,” he explained. So he went back to therapy and started taking his medication.

Miller said experiencing the lowest time in his life gave him perspective into what mental health disorders and treatment can be like for people of color.

“I started to just notice gaps,” Miller noted. “Not only in the health care system but in society.”

Miller said although he was fortunate to find a Black male therapist, there aren’t enough Black clinicians in the mental health field. And Miller decided to help fill this gap by becoming a therapist.

Miller said he started to live by the motto “Be who you needed when you were younger.” When he was younger, he needed the support of someone “who looked like me, someone who talked like me, someone to let [me] know it’s OK to cry,” he explained.

As a Black man, Miller said he was socialized to be strong, to be a provider and not to show any emotions other than anger or happiness. He internalized this message, and when life got hard, he didn’t have the words to express his feelings, so he kept them bottled up inside.

Miller founded and currently serves as the executive director for Eustress Inc., a nonprofit organization that focuses on raising mental health awareness to break the stigma associated with mental illness in communities of color. His work with this organization allows him to help other Black men and boys.

“I put culture to the forefront of how I deliver services,” Miller said, explaining the importance of “meeting people where they are” and recognizing that therapy “looks different to every single person.”

Miller challenged his peers to think about how culture affects counseling and to tend to their own psychological wounds so they can help others heal.

“When you do your own work, you begin to understand certain practices that may work for you or certain practices that may not work,” Miller said. “You start to understand the intricacies of still being human as you deliver services.” It is this humanity that allows clients to “really heal,” he noted.

He also reminded the audience that “there’s a very thin line between illness and wellness. And if you’re not taking care of yourself as a helper, and as someone who serves, how effective can you really be to anyone else?”

 

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The the American Counseling Association’s 2022 Virtual Conference Experience started Monday and runs through today, Oct. 21.

Registration will remain open until Dec. 31, and attendees will have access to the conference sessions and other content through Jan. 9, 2023.

Find out more at counseling.org/conference/vce-conference-2022

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Lisa R. Rhodes is a senior writer for Counseling Today. Contact her at lrhodes@counseling.org.

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