Monthly Archives: March 2023

Voice of Experience: Transition to private practice

By Gregory K. Moffatt March 24, 2023

A calendar with a note that reads "start business" and has a dart above the words


In years past, several of my associate licensed supervisees have transitioned into their own private practices right out of the gate after earning their full licenses. This wasn’t luck and it wasn’t accidental. Each of them invested a lot of planning — around 12 months — but it paid off with profitable businesses as quickly as three months afterward. A couple of them were even hiring staff within a year’s time.

Now is an opportune time if private practice is an aspiration of yours. COVID-19 changed our culture in two distinct ways that apply to our discussion. First, the pandemic magnified preexisting conditions. The effects of COVID-19 on mental health are still lingering today. Depression, addiction and marital issues that predated the virus only got worse as we went into lockdown, leading to more people seeking help.

Second, as I’ve written about several times in past columns, the virus pushed all of us into a digital world. Clinicians who had never previously considered telehealth were forced into it, and many subsequently realized how convenient it was and chose to continue offering telehealth services long after the heat of the pandemic was past. Many clients had similar revelations.

Telehealth has made it possible for a clinician to run a private practice without any brick-and-mortar office. Home offices are economical to operate and may also qualify for tax breaks. At home, you are already paying rent or mortgage, the electric bill, internet costs, etc. With a brick-and-mortar office outside the home, these costs are doubled. Plus, with home offices, there are no travel expenses and the child care options are potentially easier.

That being said, transitioning to private practice takes planning. The clinician must be willing to run all parts of the practice — scheduling, billing, taxes, etc. No more life of just showing up, seeing clients and then going home. But in exchange comes the freedom to carry whatever caseload you want, take vacation when you want, work whatever hours you want and specialize as you choose. Nearly all agencies take a percentage of client fees. In private practice, 100% goes to you — the owner.

There are several steps to launching a private practice. A first step is ensuring that you honor your current contracts and the limitations that might come with them. The Risk Management for Counselors column in the March issue of Counseling Today recently discussed noncompete clauses that are common in both public and private agencies. Transitioning to private practice will require honoring the specifics of any existing noncompete clauses. This can be onerous in some cases. For example, “No practice within 25 miles” might require the clinician to move or to rent office space outside of the noncompete distance.

A second step is marketing. How will people find you? Why should they choose you? You have to earn a reputation, but that takes time. The biggest key to marketing a private practice is having a referral stream. My most successful clinicians have built relationships with churches, schools, psychiatrists, physicians, the courts or other agencies that channel clients their way. Unless you already have a client base that you can take with you, starting out without a referral stream can be challenging.

Marketing will also require the clinician to examine the type of practice they want to run. Each practice will look a little different depending on whether it is a general practice or whether it is focused on marriage and family, trauma, children or any other specialty. This will also determine the direction the clinician takes for pursuing referral streams.

Licensing, certifications and specialties must be considered. Counselors are ethically bound to present themselves accurately to the public, but certifications such as eye movement desensitization and reprocessing for trauma workers or Gottman training for marriage and family therapists can improve your marketability.

Many clinicians have found success with rather inexpensive marketing through websites such as Psychology Today’s “Find a Therapist” tool. A website is critical and cost-effective. Other social media outlets might work for advertising, but clinicians need to ensure that they are complying with ethical standards regarding social media.

One last issue to consider is whether your practice will be cash-pay only or whether you will accept insurance. Most insurance boards have a standard pay scale. This means that while you might be able to charge $125 an hour in a cash-only setting, you might make only $85 an hour on an insurance board. Boards also require more time to manage in billing.

I’ve had a private practice for decades and have been cash-only since the mid-1990s. I don’t do any advertising at all because I don’t need to, but when I started out, I followed the suggestions in this article. I’ve never regretted not working in an agency. If this is something you would find meaningful, now is a great time to begin working toward the independence of private practice.


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.

Expanding the conversation on international perspectives and practice in counseling

By Nate Perron & Sujata Ives March 22, 2023

A group of adults sitting around a table with a world map in front of them


As counselors, we are in the business of listening. All the theories, techniques and applications of our training enhance our abilities to listen to stories and narratives with great skill and make a difference in the lives of others as a result. The International Committee (IC) of the American Counseling Association is committed to heightening our listening ability across cultural, national and other identifying differences. It is the elements of listening to stories and dialoguing toward understanding that lead to shared intercultural experiences.

Although you may not have heard of the IC, ACA’s rich history reveals an IC that has taken an active role in professional advancements within the organization over the past 25 years. Our hope is to enhance our active listening as professionals so that we may boost ACA’s ability to grow while contributing to global conversations regarding counseling and mental health.

The IC is composed of nine committee members, an associate chair and a chair, all of whom are ACA members with a passion for international issues in counseling. The committee chair is appointed annually by the incoming ACA president, the associate chair is appointed by the incoming and outgoing chair, and committee members are appointed to serve three-year terms. Policy 1110.1 of the ACA Policy Manual describes the IC’s responsibilities in detail: “The International Committee shall promote, respect and recognize the global interdependence among individuals, organizations and societies. The Committee shall build bridges and promote meaningful relationships between ACA and other organizations outside the United States. The purpose of international professional collaboration shall be to promote the commonalities across these international organizations and their missions.”

Counselors commonly embrace a commitment to lifelong learning and development as an ongoing professional process. In combination with the occupational posture of listening, lifelong learning offers counselors a vast well of knowledge from which to draw indefinitely. By exploring the development of counseling internationally, and among international professionals within the United States, we have a tremendous opportunity to acquire diverse skills and knowledge that can support our work domestically through application of multicultural best practices. This learning is optimized through relationships formed among colleagues. As the field of counseling continues to grow, so does the valuable input available from around the world. Hence, growth in our profession requires both active listening and lifelong learning.

Finding just the right word in English to convey the diversity of opinions, beliefs and systems of thought by which counseling may benefit from global contributions is likely impossible. While our committee focuses on international interests, the expansive growth of counseling might also be recognized as transcultural, intercultural, cross-cultural, intersectional, multicultural, and the list goes on. International dialogue provides exciting opportunities for counselors to make an impact in a variety of spaces and places.

Committee activities

The passionate professionals who make up the IC are committed to expanding the conversation from the starting place of international counseling to touch the real experiences of those providing and needing services all over the globe. In recent years, the IC has taken steps to increase collaboration across associations and raise awareness of international needs and issues within ACA, including among ACA divisions that have much to contribute to overall conversations surrounding transculturalism, interculturalism and belongingness.

Here are a few of the committee’s recent achievements:

  • Toolkits: Our immediate past chair, Mariaimeé Gonzalez, facilitated the development of toolkits to address specific counseling needs expressed around the world. The international toolkits will be made available on the ACA website as resources for increasing skills and awareness regarding international counseling needs and issues. ACA members and divisions will have opportunities to incorporate this toolkit information into their current practices. The toolkits address a variety of counseling issues with an international lens, including somatic symptoms of domestic violence, broaching, global trauma, obsessive-compulsive disorder across cultures, and global adolescent mental health. Another toolkit discusses how ACA can incorporate the United Nations’ sustainable development goals for 2030.
  • Professional developments: The IC collectively reviewed updates to the Council for the Accreditation of Counseling and Related Educational Programs (CACREP) standards. We subsequently offered a list of recommendations to include with the changes that may enhance an international perspective.
  • Strategic advisement: As the Governing Council proceeded to develop the strategic planning process for ACA, the IC contributed further input for developing global mental health and community actions from an international perspective.

Ongoing ambitions

The IC remains committed to advancing the influence of international realities, both within ACA and beyond. The following items reveal the ongoing ambitions of the IC to continue making progress in these areas.

  • Association collaborations: The IC remains dedicated to solidifying collaborations with associations, whether they exist internationally or internally within ACA. Upcoming webinars and trainings are expected to reveal focused collaboration and development in addressing international needs relating to mental health and well-being. The IC has facilitated conversations with the International Association for Counselling (IAC) to advance one of these collaborative webinars in the upcoming months, with the intent of expanding discussion about international issues that affect people around the globe on a daily basis.
  • 2023 ACA Conference celebration: The international reception has long been a consistent element of ACA Conference proceedings. While these events have not always been widely known about or understood, the IC is working to use the international panel and the reception as tools to advance the discussion further within the ACA membership. Many people can be involved in efforts to increase transcultural awareness and practice, so anyone interested in growing their perspective will benefit from these conference events.
  • Establishing a stronger presence: To attract international professionals and increase the attention paid to international issues, the IC is developing procedures to advance the status of the committee to an organizational affiliate of ACA. This would provide further recognition to address some of the IC’s same goals but with expanded support and involvement from interested members of the overall ACA body. Many other international subgroups exist within ACA; providing a centralized point of connection so that people can expand their involvement has become a top priority of the current IC. This will also be a valuable opportunity to recognize foreign-born ACA counselors that practice in the United States and beyond.
  • Ongoing association recommendations: Additional projects remain on the horizon for the IC to contribute to ongoing efforts to integrate international counseling into the fabric of ACA involvement. The IC plans to expand the toolkit focused on sustainable development goals to promote the United Nations’ proposed goals within the policies of ACA and its divisions. Another activity will involve contributing recommendations to the universal declaration of counseling principles that IAC is currently drafting. These efforts and collaborations will enhance the recognition of ACA’s focus on global needs and issues.

Path forward

In continuing to carry a keen sense of “where we have been,” both as an association and as a committee, the IC plans to help lead the conversation within ACA about “where are we going” as a collective group of global professionals. To sum up all the efforts taking place, the IC recommends we engage in the three following activities to create an international impact within our locus of control.

  • Posture of listening: A wise proverb reminds us, “Remain quick to listen and slow to speak.” So often our initial response may carry a list of assumptions that have not been presented. Taking the time to step back, give others the benefit of the doubt and consider another perspective is essential for advancing our knowledge and awareness. If we are unsure which direction to move in any of our professional decisions, we might let our ears do the walking by receiving support and insights from colleagues, especially when they can provide cultural consultation. Counselors are encouraged to maintain a healthy posture of listening to explore ways that we can each make a greater difference in the development of international counseling. Teachability and openness can define our culture of listening in profound ways.
  • Intentional learning: In conjunction with the earlier value of lifelong learning, the IC has a unique opportunity to model how counselors might seek out opportunities to hear the narratives and experiences of others. Pursuing learning opportunities for counselors in other cultural contexts will provide the type of growth that may enhance formulation of theory and practice in new avenues. This may include opportunities to seek international training specifically or it might involve increasing efforts to support international awareness in the work and educational institutions where we now serve. Being intentional about learning requires active systems that amplify the voices of those less represented. Seeking learning opportunities outside of our comfort zones offers an extended expression of cultural humility that can benefit everyone involved.
  • Symbiotic development: Growth for the counseling profession in one area of the world is growth for us all in the counseling profession. Regardless of the differences we possess and the ways in which counseling may be practiced in different settings and cultures, there are commonalities that unify us in the profession and enhance our ability to address mental health and well-being needs all over the world. Refining our collaboration and learning offers hope for improving our abilities to respond to people from a variety of backgrounds in our own communities. A focus on developing collectively and interconnectedly as a profession globally presents great opportunities to expand our minds, enhance our knowledge and refine our practices alongside colleagues all over the world. Counselors who strive to achieve the same basic goals can help foster professional development that will serve to make a difference among individuals, families and groups worldwide.


The IC is excited to embark on the goals ACA has established to enhance connections and collaborations around international issues. Simply by taking the skills already “baked in” to the ingredients of professional counseling, we have discovered rich opportunities to learn from one another and to develop both individually and collectively. It all begins with listening, which leads us down a road of learning and developing so that we may expand the conversation even further and make a difference with even more individuals through the blessing of counseling worldwide.

We hope the descriptions of past, present and future IC endeavors will inspire further interest and involvement for developing greater awareness and skill to support the most people we possibly can.


2022-2023 International Committee Members:

Nate Perron (chair), Sujata Ives (associate chair), Mary DeRaedt, Hulya Ermis, Katherine Fort, Ester Imogu, Sandy Kakacek, Peggy Mayfield, Benjamin Okai, Lisa Rudduck, and Keiko Sano


Headshot of Nate Perron

Nate Perron was appointed chair of the ACA International Committee for the 2022-2023 academic year and is also a core faculty member at the Family Institute at Northwestern University in Evanston, Illinois. He remains actively involved with international counseling research, education, service and practice in a variety of ways. Contact him at


Headshot of Sujata Ives

Sujata Ives is associate chair of the ACA International Committee, mentor to IC intern Anniesha Lyngdoh, an avid presenter at ACA conferences and a private practitioner of employment counseling. 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.

The power of counselor advocacy

By Brian D. Banks March 17, 2023

A woman is holding an open file and looking up; standing in front of the US Capitol building


We are three months into the calendar year 2023, and counselors are beginning to realize how much power they hold in their state legislature and the federal government. If for any reason you do not believe this, allow me to remind you that licensed professional counselors continue to make progress that affects not only the counseling profession but also the entire country.

You are changing the way counselors can provide services to clients. Here are just two major feats we accomplished last year with your help:

Your efforts have already made a difference and will continue to make a positive impact in this country, and they serve as examples for other countries and health care organizations to follow.

How can counselors improve their advocacy efforts?

Despite our notable success, there is more work to be done. Your Government Affairs and Public Policy (GAPP) team is working hard for you. As we move forward to accomplish our legislative goals, counselors also must make advocating for the profession part of their regular routine.

Compared to other mental health professionals, counselors are more likely to advocate and educate legislators about counseling and the clients they serve. However, there are still many ACA members who are not advocating on behalf of the profession, so we know counselor participation can continue to improve. The GAPP team will continue working with our members and conduct training to help you become confident grassroots advocates.

In short, we need you. Our success is because of your efforts and commitment to ACA. To learn more about how to effectively advocate, please visit GAPP’s Advocacy Resources page. You can also email the team at, and we will gladly take the steps necessary to help you become the advocate you aspire to be.

To get involved, please sign up for our advocacy alerts. Visit our Take Action page, scroll to the bottom of the page and sign up today. Then you will be among the first to receive alerts.

What’s next in counselor advocacy?

ACA has a robust legislative agenda for 2023, which includes continuing to focus on Medicare reimbursement as we work with the appropriate agencies to implement the program. We will also continue working with state legislatures to ensure more states pass counseling compact laws, which will increase opportunities for counselors to care for clients throughout the country.
In addition, we are focused on the following five issues:

  • School-based mental health services: We want to improve access to mental and behavioral health services in schools and increase funding for resources to help counselors effectively assist their in-school clients.
  • Career counseling: We want to increase investments in college and career counseling programs.
  • Telehealth expansion: Our goal is to make telehealth permanent beyond the two-year federal extension.
  • 988 implementation: Although 988 is active throughout the country, we still need an increase in funding to maintain these programs in each state. ACA will work with our colleagues to increase funding for 988.
  • U.S. Public Health Service (USPHS) Commissioned Corps and Army Medical Corps officers: Licensed professional counselors are the only mental health profession not allowed to work as an officer in the USPHS Commissioned Corps or Army Medical Corps despite the need for increased access to care in the military. ACA will continue working with the appropriate committees and the Department of Defense to make this career option available to counselors.

These five focus areas are just the tip of the iceberg for the work the GAPP team plans to perform on behalf of the profession this year. Please visit the ACA website for more information on other GAPP initiatives.

We also need your eyes and ears. Despite our fancy tracking systems, you must help us monitor policy in your state to make sure we do not miss anything. We need you to let us know what is going on in your state that could potentially affect the profession. It does not matter if it is positive or negative news; we need to hear from you. Together we can fight the battle to improve the profession in each state. It takes a village to make progress, and as you can see, the progress we have made was undoubtedly a group effort.

Counselors are needed

Not many people would disagree with the statement: “We need counselors.” But I do think counselors may not realize that there is more they can do to support the profession beyond their trained duties.

For example, have you ever thought about running for office or becoming a member of your state’s licensure board? Do you participate in your school board or hometown congressional town hall events? Are you registered to vote? Do you provide your expertise in state regulatory or legislative hearings?

These questions show that there are multiple ways to get involved and stay involved. I know that not all of these choices listed here are going to interest you, but I guarantee there is one action from this list that you could take advantage of, and in the process, you could make a positive difference for your profession.

ACA has held virtual sessions on running for office in the past and continues to conduct training and support member testimony efforts in the state legislatures. If any of the previous options to get involved sparked your interest, please email the GAPP team, and we will provide you with the information that you need to start your journey.

We will continue updating you on our progress as well as on how you can help us, especially in areas where we may need additional support. To learn more, read our monthly column in Counseling Today, visit the ACA homepage for updates and check the emails from our Member Engagement team for useful information.

You can also reach out to a member of the GAPP team by emailing We are here for you, we believe in your work, and we want to do whatever it takes to ensure your success. From the bottom of our ACA hearts, thank you for your past efforts and for all that you will do in the future on behalf of the counseling profession. It only takes a little extra to make a difference, so thank you for the extra you give.

Stay tuned and stay involved because there are greater things to come.

Brian D. Banks the chief government affairs and public policy officer for the American Counseling Association. Contact him at


Why, when and how to talk with grieving clients about sex

By Kailey Bradley and Victoria Kress March 14, 2023

An older man sits on a couch with his hands on either side of his face and a woman with a pen and notepad sits across from him


Grief is an experience that everyone navigates at different points in their lives. For the past three years, the COVID-19 pandemic has impacted peoples’ lives in myriad ways and left many experiencing significant grief.

Loss can also deeply affect one’s sexuality, a concept referred to as sexual bereavement. Any form of loss, not just the loss of a sexual partner, can alter one’s sexual desire. As noted in Alice Radosh and Linda Simkin’s 2016 article published in Reproductive Health Matters, both sexuality and grief are stigmatized, which creates a double-barreled taboo. This double stigma can result in someone not feeling comfortable or confident addressing the topic.

When working with clients who have experienced loss, counselors must consider the interplay between grief and sexuality. There are few spaces where clients can address their grief and even fewer safe spaces where they can discuss their sexuality, so it is important that counselors consider how they can approach this subject with clients. This article discusses why this topic is important and when and how counselors can address the intersection of grief and sexuality with clients.

Why is this topic important?

Radosh and Simkin noted that some bereaved clients want to discuss how their sexuality has changed as a result of grief, yet they are often hesitant to do so. Clients may perceive that sexuality and grief cannot coexist. If this is the case, then they may feel shame if they have sexual feelings while grieving. Clients may also believe it is inappropriate to admit that they miss intimacy or that their sexual desire has changed. Other clients may perceive sexuality as distant and remote — something that may never again feel accessible.

The complexities of this topic, combined with counselors’ and clients’ personal discomfort, may cause counselors to avoid addressing it. This discomfort can arise because counselors are uncertain about how to broach the topic, counselors are uncomfortable with the topic of sexuality in general or the client is hesitant to bring the topic up. Although we do not know a lot about how various aspects of sexuality are affected after a loss, it is clear this is an issue that people experience as part of their normal development and growth, so counselors must be prepared to address this topic.

When to address this topic?

Although there is no right time to address this topic, counselors can introduce conversations related to the topic early in the counseling process. They could include questions about how grief has impacted the client’s sexuality on the intake form and then use the information the client provided to gently broach the topic during the first session. Counselors may also need to go slow and consider if it makes sense to bring up the topic during one of the initial sessions. For example, it may not be a good idea to discuss it in the first session if the client has a lot of shame around the topic of sexuality. In this situation, clinicians need to establish therapeutic trust and rapport before mentioning the topic. This approach will help clients feel safe enough to share their experiences.

Counselors can also ask clients to describe the various realms in their lives that have been affected by loss and grief, and they can mention sexuality as one possible area. And throughout the counseling process, clinicians can validate and normalize their clients’ experiences regarding grief and sexuality.

Because clients will move at their own pace and some may want to revisit the topic throughout counseling, regular check-ins with clients can be helpful. Counselors can encourage clients to engage in these difficult conversations by asking them to create “permission slips” to attend to forgotten or challenging dimensions of grief. Clinicians can give clients a scrap piece of paper and ask them to write out an area in their lives that is affected by grief that they find difficult to discuss. Another option is for counselors to write down overlooked topics related to grief and sexuality — such as dating, desire and arousal, physical changes, ways to talk about grief with a partner — on a sheet of paper and then ask clients to choose a topic from the list they want to discuss.

How can counselors help clients?

There is limited research on how to support clients’ sexuality in the context of grief. Formal interventions, however, may not be as important as the compassionate environment and empathic presence a counselor provides. Empathic presence can help clients introduce difficult conversations at their own pace and on their own terms.

Psychoeducation can also play an important role in counseling this population. For example, counselors can share that for some clients, sexual desire and arousal increase after a loss while others have the opposite experience. Providing education around the different reactions people have to grief can validate clients’ experiences and help them connect with the ways they may be experiencing grief. Counselors can also teach clients that grief is not just relegated to the cognitive or emotional domain; our bodies carry and process grief as well, and in this way, our bodies grieve. Providing this education to clients may allow them to feel relief that their somatic reactions surrounding sexuality after a loss are valid.

Another area of psychoeducation that could be valuable to clients is the identification of their grieving styles. The Grief Pattern Inventory is a tool that can help clients gain insight into how they are approaching the grief process. (For more, see Kenneth Doka and Terry Martin’s Men Don’t Cry, Women Do: Transcending Gender Stereotypes of Grief.) Understanding how a person is grieving can help the client and counselor gain valuable insight into the client’s grief process. Intuitive grief is an emotional style of grief in which emotional expression is valued, whereas instrumental grief is a cognitive style of grief in which problem-solving is valued. According to Doka and Martin, a client who identifies as having an intuitive style of grief will prefer a space to emotionally express the wide range of feelings that emerge when considering the intersection of sexuality and grief. In contrast, a client who identifies with an instrumental style of grief may prefer using specific techniques to reengage with their sexuality because they may view the changes in their sexuality after a loss as a problem to be solved. Counselors can introduce this concept to clients and invite them to consider how their grieving style may be affecting how they approach their sexuality after loss.

Finally, creative interventions can be a powerful way to help clients navigate these issues. Counselors can invite clients to write themselves a permission slip to engage with their sexuality in whatever way feels appropriate to them. For example, they might write, “I give myself permission to lean into the feelings that arise when I consider how my sexuality has changed in the following ways.” Clinicians can also encourage clients to create a grief playlist in which they share songs that help describe or capture the feelings surrounding the areas of their life that are affected by grief (including sexuality). Clients could share their grief playlists with their partners and identify how their grief experience is similar or different. Overall, outward expression of loss can help validate the complexity of feelings that arise when navigating this double-barreled taboo.

Addressing personal biases

When working with this population, it is important to be mindful of biases that both the client and counselor may have about grief and sexuality. Some common biases include the assumption that sexual desire disappears after a loss, sexuality is not appropriate to discuss after a loss or having sexual desire after a loss is wrong. To address these biases, counselors can use reflective questions and journaling prompts that ask individuals to reflect on what they have been taught culturally about grief etiquette, sexuality and scripts surrounding what is normal after grief. Again, some might feel judgmental of a griever whose sexual desire and/or arousal has increased after a death. However, addressing our own biases will help create a hospitable environment where a client is met with nonjudgment.


Counselors play an important role in empowering clients who are grieving. Even though we live in a grief-avoidant culture where we shy away from pain, counselors can create a refuge of hospitality where we can openly acknowledge what is uncomfortable. It is in our power and our scope of practice to gently remind clients that it is OK to talk about the intersection of grief and sexuality and to meet our clients with compassionate curiosity and encourage them to grant themselves permission and space to grieve and embrace their sexuality after loss in whatever way makes sense to them.


Kailey Bradley is a licensed professional counselor with supervision designation in Ohio, a national certified counselor and a certified thanatologist. She specializes in the intersections of grief and sexuality as well as issues surrounding chronic and terminal illness. She has a background in hospice work and feels that advocating for grievers is her life’s passion. Contact her at

Victoria Kress is a distinguished professor at Youngstown State University. She is a licensed professional clinical counselor and supervisor in Ohio, a national certified counselor and a certified clinical mental health counselor. She has published extensively on many topics related to counselor practice. Contact her at

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, visit

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.

‘Child abuse in disguise’: The impact of parental alienation on families

By Scott Gleeson March 9, 2023

a young child hugs his parent's waist tightly; the parent's arm is around the child with their hand on the child's back

Tomsickova Tatyana/

Ingo Weigold, a licensed professional counselor at Centennial Counseling Center in St. Charles, Illinois, sat at his desk as tears rolled down his face. For five years, he had been alienated from his children by his ex-wife, which emotionally harmed his children and prompted him to regularly feel like an unworthy parent. But after a grueling court battle that spanned several years, a judge finally ruled in favor of Weigold to have majority custody of his two children, and his ex-wife was issued to pay child support.

“I’m sitting here reading the judge’s ruling just crying and thinking, ‘This can’t be real.’ All of the anxiousness, the fear, the anger and the suffering just drained out of me,” recalls Weigold, a member of the American Counseling Association. “Throughout this process of fighting for them, the most important thing for me as a man and as a father was to actually be there and be present, to give my kids a chance at being good members of society away from a childhood that was marred by child abuse. Because parental alienation is child abuse in disguise.”

Parental alienation has been defined by experts as a form of manipulative estrangement induced by an alienating parent that causes children to refuse to have a relationship with the targeted parent as a result of exaggerated or false information that dissuades an emotionally vulnerable child away from the targeted parent.

Although the term is controversial when used in the legal system, counseling experts are fighting to have it included in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) because of its hidden prevalence and the need to educate clinicians on efficient treatment methods.

“From a parent’s perspective, I think this is incredibly difficult,” Weigold says. “I see why parents walk away from their families because the easier thing to do is let the other parent have what they want, let them continue to dictate everything. I didn’t have a dad growing up. I could never do that with my kids; I couldn’t let them sit in this manipulation any longer.”

Now, Weigold is helping other parents who find themselves in similar scenarios in his work as a counselor, and he’s helping to spread word on an area that doesn’t receive enough attention in the mental health field.

“I was down to my last few pennies and spent hundreds of thousands of dollars of my retirement on legal fees going to court,” Weigold says. “I know I was lucky and other people aren’t. There are people out there who need us as therapists to help, and we can help them by knowing how to be detectives and get to the truth of these situations.”

Whether treating children, working with families or providing care to an alienated parent as a therapist, experts agree that far more needs to be done to bolster awareness and training.

“Parental alienation leads to highly complicated and difficult cases that require far more knowledge and specialization,” notes Amy Baker, a psychologist and parental alienation expert who has written over 65 peer-reviewed articles on the matter. “In other words, even seasoned clinicians with experience in family systems are still, in a way, a novice when dealing with alienation. Humility would be the most important thing for clinicians to have in this regard.”

Seemingly counterintuitive

Baker, director of research at Vincent J. Fontana Center for Child Protection, acknowledges that having clinicians take a humble approach to parental alienation treatment runs counterintuitive to most regular forms of mental health treatment.

“Parental alienation challenges our assumptions about what is happening in the family,” she explains. “It’s intuitive to believe that children side more with the better parent. That the kids know which parent is going to better take care of them, get them to soccer practice. That’s actually not always true. What’s also counterintuitive is this false notion that the stronger a child claims to believe or feel something, the more likely it is to be true. In parental alienation cases, kids can very strongly make their case or be adamant for something that is not actually how they feel.”

Baker advises therapists to keep their clinical “magnifying glass” out a little longer when assessing not only the children but also the parents in suspected alienation cases. Parents will often enter sessions wearing a mask or facade to portray themselves — and the situation — in a deceiving way that caters to them and to paint the other parent as problematic, she notes.

Another way parental alienation cases are counterintuitive, Baker adds, is based on the idea that the parent who seems calmer and more rational is the “better” parent. “This is profound because clinicians are trained to rely on what they feel with a client or parent of a client,” she says. “But how the parent presents to the therapist is not always diagnostically true. Of course, the alienating parents are acting that way because the kids are loving on them as a result of their manipulation; they’ve got everything going their way.”

“The alienated parent, meanwhile, is anxious, agitated and afraid,” she continues. “They have an agenda to try to convince everybody what’s happening to them is alienation. The disposition of a person could be based on the situation, and clinicians should not be making assumptions when the targeted parent is acting out.”

Baker, co-author of Co-Parenting With a Toxic Ex: What to Do When Your Ex-Spouse Tries to Turn the Kids Against You and Surviving Parental Alienation: A Journey of Hope and Healing, says two instrumental goals therapists must strive for if they determine parental alienation is at play are correcting a child’s distortions of the situation and holding the favorite parent accountable in treatment.

The goal for parental alienation is to help the child have a healthy relationship with both parents, Baker stresses. “It’s important for clinicians to know that, in general, children do better when they have a relationship with both parents and that, in general, children do not always know what’s best for them,” she says.

Baker adds that divorces have an unhealthy side effect in overempowering children and that it’s important for parents not to acquiesce to their needs out of guilt. “There’s too often the notion of ‘that’s what the child wants,’” she says. “We don’t let children drink or get married and do all sorts of things when they’re too young. [Adults] have a responsibility to protect children, sometimes from themselves.”

“I do believe we have an obligation [clinically] to try to figure out what’s best for the child, taking their preference into account, but by no means is their say-so the north star,” she adds.

Stephannee Standefer, a licensed clinical professional counselor and program director at Northwestern University’s online counseling program, says the goal of therapists is not to disempower a child’s voice but rather to reestablish the family system that’s been misconstructed. Parental alienation cases often showcase a child having power in an unhealthy fashion, and they can become pawns to the alienating parent who is taking advantage of the fractured family system amid or in the aftermath of a divorce, she notes.

“We can know all of this about how it should be in a family system, but we have to ask ourselves, ‘Are we the ones to rebalance the power and homeostatic situation as therapists?’” says Standefer, an ACA member and president of the Illinois Counseling Association. “It’s important we don’t accidentally as therapists come into the family system or stay there.”

To evade becoming part of the family system, Standefer says it’s vital therapists establish rules that clearly outline what the therapist’s role is. That boundary, in turn, can help put the focus on the parents’ growth.

“An alienated parent, for instance, must be doing his or her own individual work. Because that much powerlessness they’re feeling will impair the parent and the children. And for the alienating parent, we must hold them accountable to be a part of the family system, not their own narrative that caters to them,” Standefer notes. “We can use all the microskills we want to help families with communication, but the macro has to be how each person is fitting into the system.

Avoiding distortion traps

Alienation cases vary, but court proceedings and even 50/50 splits don’t always determine how often the kids will see their parent because the distorted reality an alienating parent spins can prompt a child to remain allegiant to them by refusing to spend time with the targeted parent.

Weigold says in his situation the manipulation of his children (with his ex-wife telling them a false narrative) began as his marriage was ending and before the divorce was even finalized.

“It became this campaign of dad’s bad and everyone should stay away from dad, including you two as kids,” Weigold said of the alienation inflicted on his children. “It’d always be something like [his ex-wife saying], ‘When dad shapes up or stops abusing you, you can see him.’ When in reality that was a projection coming from her.”

Baker says the targeted parent who is being alienated often falls into a “distortion trap” where they frustratingly try to defend themselves or uncover the truth, but this only makes them look worse to the children.

“Clinicians can have the assumption that it takes two to tango or that there’s two sides to every story,” she notes, but “in a parental alienation, the truth is it only takes one parent to trick another parent.”

Susan Heitler, psychologist and parental alienation expert who wrote Prescriptions Without Pills: For Relief From Depression, Anger, Anxiety and More, says the alienator’s narrative can fool lawyers, close confidants and even the targeted parent because they’ll often deprecate the targeted parent’s feelings to twist reality. They’ll go out of their way to cultivate a narrative not just to the children and targeted parent but to everyone in their life. One common theme that counselors need to look out for, Heitler says, is that the alienator often needs to be seen as the victim at all times.

“A [targeted] parent will feel sad and say, ‘I miss my kids,’” continues Heitler, who practiced treating families from 1975 to 2020 at the Rose Medical Center in Denver. “Instead of responding with compassion to the other parent, the alienating parent may say, ‘You shouldn’t feel sad’ or ‘You’re being foolish.’ That’s part of the manipulation. It works really well because alienators are usually quite charming to everyone on the outside, she notes.

“In most cases, the alienating parent is acting on feelings of hurt related to the divorce, which are not about the kids. Or that parent more than likely has an undiagnosed personality disorder that they’re inflicting onto other family members,” Heitler adds.

“It’s like getting sucked into a vortex,” Weigold says, describing his own situation with his ex-wife. “Principals, teachers and people in the community would believe her, as if she were the victim, and the people [in the children’s life] throw out logic and act on feelings. It’s why as therapists, even when we get a [behavior] report from a school, we need to do our due diligence because so many people can be duped by the [alienating] parent.”

Heitler agrees that it’s important to corroborate facts in alienating cases as a clinician. “We need to be investigative and gather all the facts and make sure they’re actually truths. One parent may claim the targeted parent is sexually molesting the kids. Well, there are lie detector tests to address this.”

Weigold says he saw the distortion trap he fell into only in hindsight. “I think my biggest mistake was for a time I tried not to acknowledge the lies being told to them. I’d try to stay neutral and be a calming presence to them,” he recalls. “I’d try to tell them, ‘You guys are too little — it’s OK.’ I would allow them to come and say things their mom was saying and I’d never argue back.” About a year and a half ago, he started telling them the truth about what their mom was saying, making it child appropriate, but he says this only distressed them because then they had one parent saying one thing and the other saying another.

That moment of feeling torn between two parents’ version of the truth is where children can get caught in the “loyalty conflict,” Heitler says.

“When a child loves mommy and [the] daddy has made her into a devil, they become dependent on the parent who is the alienator, so they often adopt the alienator’s ways of seeing the situation,” she explains. “It’s loyalty [to the alienating parent] but a loss of the self for the children, forming a symbiotic relationship.”

Writing out these accusations the children often say about the targeted parent can help them sort through what is true or not for themselves. Heitler once worked with two teenage sisters who were alienated from their father. “They had all these negative words to say about their dad,” she recalls. “So we wrote all the words like ‘selfish’ down, and I asked them, ‘Who does this more?’” They all responded that their mom was the selfish one.

Diagnosing parental alienation

Dr. William Bernet, a psychiatrist and professor emeritus at Vanderbilt University School of Medicine, says that he and colleagues in the field have made dedicated efforts to have parental alienation included as a term in the DSM because properly identifying and defining alienation from the onset is the best way to combat counselor negligence.

“The problem with not naming parental alienation anywhere in the DSM is that courts can argue it isn’t real, and then, in turn, parents cannot defend themselves legally,” Bernet says. But “if it’s taught to clinicians of all types and accepted into curricula, then mental health practitioners can be held more accountable to identify these cases.”

Bernet, co-editor of Parental Alienation: The Handbook for Mental Health and Legal Professionals, sees therapists making two mistakes with parental alienation. First, they often fail to properly diagnose parental alienation early on in treatment. Second, they rely on traditional clinical approaches for far too long when treating this issue.

“Traditional family therapy approaches can be helpful in mild cases,” Bernet says. “But in more moderate or severe cases, alienation needs to be identified and both parents need to agree to be part of treatment.”

Bernet says that having only one parent attend sessions or offering traditional family therapy without identifying alienation has the potential to worsen the balance and allow an alienating parent and child to continue to target the other parent. If that happens, “therapists actually can make it worse,” he stresses, “because a child is going to be even more narcissistically powerful and won’t do what the therapist asks out of allegiance to the alienating parent.”

Bernet developed the five-factor model, which is an effective method to use when diagnosing parental alienation. This model includes five criteria for diagnosis:

  1. Contact refusal: Is the child refusing contact with a parent?
  2. Previous relationship: Did the child previously have a positive relationship with the rejected parent?
  3. Lack of abuse: Does the rejected parent show signs of being abusive or neglectful
  4. Alienating behaviors: Is the preferred parent engaging in alienating behaviors?
  5. Child symptoms: Is the child manifesting symptoms of alienation?

Although it’s essential for counselors to properly diagnose for treatment, custody evaluators should be the ones making decisions related to parental alienation, Baker cautions. And she advises clinicians to call for a proper custody evaluation if they suspect parental alienation.
avoiding counselor negligence.

Avoiding counselor negligence

Heitler finds that counselor negligence is common in parental alienation cases, so she agrees that clinicians run the risk of making the situation worse when they enable the alienator or try to focus on surface tactics such as communicative skills in co-parenting.

“If the clinician doesn’t understand parental alienation and buys into the alienating parent’s story with their treatment plan, they’re participating in child abuse,” Heitler says. “It comes down to beneficence, not maleficence, do not harm in the [ACA Code of Ethics]. The naivete can result in extreme harm if it means backing up a mother or father who is the alienator.”

In a peer-reviewed study published in the Journal of Divorce & Remarriage in 2020, Baker, along with two other colleagues, surveyed 120 clinicians in the United States who conducted work as court-ordered reunification therapists, and they found widespread negligence across the board.

“What’s happening in outpatient reunification therapy is not only not helping [but] it’s making things far worse,” Baker stresses. “One major problem in general is that clinicians often let these cases go on and on with middle-of-the-road treatments without getting to the underlying cause. Many therapists let these cases go for years without saying, ‘Gee, I’m not really doing anything good here.’”

“There’s this false belief that it’s impossible to tell what’s really going on,” she continues. But “it’s not impossible to tell if clinicians were trained specifically in this subspecialization.”

Baker stresses the need for therapists to use a timeline, such as six to 10 sessions, to make sure progress is being made. “If nothing good is happening in treatment, write a letter to the court and recommend a higher level of treatment,” such as having the family go to a facility that specializes in parental alienation, she advises.

Bernet says effective approaches, particularly when working with children affected by parental alienation, include the multimodal family intervention, which involves everyone participating in some way in the treatment plan, and family bridges, a cognitive behavioral approach where the main focus is helping a child adjust to living with a parent they claim to hate.

“It’s painful to be caught in between two parents who are fighting each other,” Bernet notes. “Then to make it worse, there’s hidden guilt and shame for the child for feeling like they played a part in rejecting the parent. It’s an unhealthy position to be in.”

Standefer agrees that counselors must hold themselves accountable to limitations and push themselves to be more equipped in helping families. She said one additional layer of negligence she sees is that clinicians may allow parents to dominate treatment time to the point that the children are not receiving proper care.

“What’s at stake here are the children,” Standefer says. “It’s important therapists create a safe space and build an alliance when working with them. They need a voice. … We just have to be careful that voice is not actually the alienating parent’s. It’s our job to bring out their true voice.”
creating a team of support.

Creating a team of support

The severity of parental alienation cases can be far-reaching. As Bernet notes, it not only affects children’s well-being but also leaves targeted parents in desperate need of support.

“It can be unbelievably frustrating and agonizing for the targeted parent,” Bernet says. “They’re in need of various forms of support and coaching on how to behave when they see their children. Because I’ve seen some cases where the targeted parent will become so aggravated and retaliate against the child even though the child themselves is just mimicking or representing the alienating parent who is hurting them.”

“In worse scenarios, it’s not just parents giving up on their kids,” he adds. “They give up on life and commit suicide. This is serious on multiple levels.”

As a parent in recovery from alienation, Weigold says that a support system in conjunction with a therapist was necessary in getting his kids back into his life. “I think it’s important for anyone who is going through this to find a supportive person in their life that can help them to pull out the truth of what’s going on,” he says. “You can start to feel crazy and wonder, ‘Am I really this person?’ The narrative becomes so strong from the children and the ex-wife together. You need to have people in your life who can say, ‘This is not real. Those are not truths; trust your gut.’”

This support often needs to come from more than just one person, Weigold adds. “In my situation, therapists along the way would tell me I’m a good father. My friends and mom would say, ‘You’re a good dad.’ God was a big thing for me in the beginning to see myself as not a bad person,” he recalls. “You almost need a whole team of people because this pull is so strong. It’s like a superhero movie, and you need all the Avengers to fight this — for yourself and your children. That’s how powerful the pull in the other direction can be.”

Heitler agrees a support system is vital. Because targeted parents often experience severe symptoms of depression and anxiety as a result of feeling miscast, she is intentional about outlining the difference between warranted estrangement from children (based on prior abuse in the household) and being alienated (based on no factual forms of abuse in the household before separation) to help reality test a client under the spell of manipulation.

“Clients who are alienated are often distraught because they’ve lost their children and they’re asking, ‘Who do I believe anymore?’ They can be habitually anxious,” Heitler notes. One treatment method she finds helpful is having them do a concerns dump. The client writes down all their worries, such as “I don’t know what’s going on anymore” or “I don’t have enough money to go to court” and hands them to Heitler. “One by one, we’ll go through and make a plan of action for all these anxieties swirling around in their head,” she says.

Although leveraging one’s support base is helpful, Weigold acknowledges that overcoming those fears and anxieties must ultimately come from within. And that takes courage.

“Someone told me once that the only time you can have courage is when you’re afraid,” Weigold says. “I was afraid when I went back to court. I feared I’d lose everything I have and end up with nothing better for my kids. My son said, ‘Dad, I want you to fight for us.’ That gave me the courage I needed. I just told myself I’m going to show my children I’m fighting for them even if I go down doing it. I hope they can take away that message someday — that their dad fought for them and now he’s not going anywhere.”

Scott Gleeson is a licensed clinical professional counselor in the Chicago suburbs, specializing in trauma and relational dynamics. He spent over a decade writing for USA Today, where he won national writing awards from the Associated Press and NLGJA: The Association of LGBTQ Journalists. His debut contemporary novel, The Walls of Color, and its sequel, Spectrum, will hit bookshelves in 2024 and 2025, respectively.

Editor’s note: Gleeson is colleagues with Ingo Weigold, one of the counselors interviewed for this article, at Centennial Counseling Center in St. Charles, Illinois.

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.