Monthly Archives: November 2023

Addressing problematic internet use with youth and families

By Stephen V. Flynn November 20, 2023

close up of a teenager on their phone; legs crossed; phone in hands

Stock Rocket/

Making healthy decisions regarding our screen time and internet use can be challenging and often requires a fair amount of self-discipline. We may ask ourselves, “Why am I looking at my cellphone again?” or “Why did my screen time report go up by 15% this week?” Many families are struggling with these questions and are trying to find unique ways to manage their time online, so the counseling profession should be informed of research-based standards related to helping parents and caregivers with child and adolescent online usage.

Parents of young children and tweens often feel guilty and confused about childhood internet standards and whether it is OK to use screen time as a reinforcer for good behavior or to use the internet as a distraction so that the parents can focus on other tasks. Similarly, parents of teenagers often feel confused about when to give their teen or tween a personal cellphone, when to collect a teen’s phone or tablet so that they focus on homework, and how to discipline their adolescent for inappropriate internet use (e.g., viewing pornography, sharing personal content with strangers, engaging in online bullying).

Counselors may also experience some confusion as to what constitutes healthy and unhealthy internet use, what are appropriate age-based internet standards, what position parents should take in particular areas of adolescent internet use (e.g., pornography, social media, gaming) and how they can work with families to help reduce internet usage when it becomes a problem.

When I bring up the topic of appropriate internet usage in the family counseling class I teach every year, it is the contemporary issue that elicits the most controversy with counseling students representing different generations. Typically, the Gen Xers take a more conservative and concerned stance against excessive internet use, while the millennials and Gen Zers appear somewhat defensive over any criticism related to internet use. As a clinician and supervisor, I often notice the same patterns in clinical practice.

The potential dangers of internet use

Internet addiction is marked by extensive and constant use of the internet despite negative consequences. It should be noted, however, that despite being widely researched and experienced, internet addiction is not a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders. Nevertheless, it’s important that counselors understand the nuances of internet addiction given the prevalence of technology in modern life.

According to Najah Almukhtar and Saad Alsaad in a 2020 article published in the Journal of Family Medicine and Primary Care, signs of this behavioral addiction include:

  • A loss of control that eventually leads to distress due to spending an excessive amount of time engaging in recreational internet use (e.g., visiting social media sites, surfing the web for information, gaming)
  • Cravings when not using the internet
  • Planning and preoccupation about internet use when not online
  • Functional impairment in daily life
  • A variety of potential physical concerns (e.g., obesity, poor eyesight, carpal tunnel syndrome, headaches, dry eyes, poor sleep patterns, backaches)

Additionally, in a 2015 article in the journal PLoS ONE, Wen Li and colleagues described psychological issues that can emerge because of internet addiction and pathological internet use, including social anxiety, increased attention-deficit/hyperactivity disorder symptomatology, self-injurious behavior, challenges with concentration and sleep deprivation.

A concerning contemporary issue that can be difficult for parents and caregivers to discuss is pornography use by children and adolescents. Hardcore pornography is now available to internet users all the time. According to Paul Wright and Aleksandar Stulhofer in a 2019 article on adolescent pornography use published in Computers in Human Behavior, parents and caregivers often fear how accessible pornography is to children, the content and nature of the pornographic videos being consumed, and youth’s inability to separate fantasy from the facts surrounding most nonpornographic sexual relationships.

In a 2011 article published in Aggressive Behavior, Michele Ybarra and colleagues explored pornography use in youth 10 to 15 years of age and found that long-term intentional exposure to violent X-rated media predicted a nearly sixfold increase in the likelihood of self-reported sexually aggressive behavior. These authors also discovered that deliberate exposure to nonviolent X-rated material was not related to a statistically significant increase in sexually aggressive behavior toward others.

A final area of extreme concern for many parents and caregivers has to do with protecting children from online predators. Adult online predators can deceive and lure youth into sexual encounters, sexually abusive situations, bullying, identity theft and sex trafficking. Common internet-based platforms and devices used by online predators to make contact, socialize, and eventually exploit children and adolescents include social media sites, cellphones, chat rooms, video game consoles, apps and app-based video games, and instant messaging. These platforms allow predators to access potential victims in an anonymous, distant and discreet manner to increase the opportunity for deception and manipulation.

Establishing healthy boundaries with internet use

Problematic use of the internet has the potential to devastate lives and cause significant distress within youth and families. Yet excessive, dangerous and illegal internet behavior remains largely unregulated by the government, and the monitoring and responsibility of appropriate child and adolescent use fall to parents and caregivers.

Counselors are in a unique position to support youth and parents when it comes to issues related to the internet. There are a wide range of potential modalities, theories and interventions to assist in problematic internet use. Parent counseling, family counseling, cognitive behavior therapy, reality therapy, family meetings, psychoeducation, collaborative homework, motivational interviewing and the use of third-party parental control apps are useful in exploring or reducing screen time usage and for protecting youth from potentially harmful sites and images.

Psychoeducation centered on educating families on the potential negative effects of excessive screen time use can be extremely important. Counselors can broach this topic when discussing family rules for internet use. For example, the following conversation is a hypothetical parent counseling exchange between a practitioner and two parents (Lisa and Frederick) who are concerned about their children’s screen use. Although this example is focused on a parent counseling experience, a similar conversation could take place during a family counseling session or during a parental consultation session.

Counselor: You are fearful that screens are serving as a substitute for parenting. I wonder if you’ve considered creating boundaries around when your children are permitted to use their cellphones.

Lisa: I think that’s a great idea.

Frederick: Right now, we don’t have anything formal in place, and their grades are poor.

Counselor: A good area to start is discussing when they should put their devices away.

Lisa: The two older boys typically start homework around 7 p.m., so that would be a good time to collect their cellphones.

Counselor: When would you give them their phones back?

Lisa: Before they head off to school.

Frederick: Let’s say 7 a.m.

Counselor: Some families have different screen time rules for the weekends. What are your thoughts?

Frederick: I think they can have their phones at 5 p.m. on the weekend. We can collect them before they go to bed.

Lisa: Agreed.

There is general agreement that complete avoidance of the internet should not be the goal of treatment. The goals should be more in line with helping parents and youth use the internet safely and responsibly and find a sense of balance and control with using the internet.

Counselors can provide families with referral sites, such as the Center for Internet Addiction and the Center for Internet and Technology Addiction, that provide helpful information and support on technology use.

Screen time issues can also be addressed in a collaborative family homework assignment. In the example of Lisa and Frederick, the counselor may work with them to establish a plan for screen use and ask them to implement it at home:

Counselor: It sounds like the family is continuing to consider a healthier screen time schedule.

Lisa: Yes, do you have any suggestions for us?

Counselor: It sounds like you have already created an initial setup. The two older brothers, Philippe and Anthony, have agreed to curb their usage and increase their homework time by handing in their cellphones at 7 p.m. every weekday evening.

Frederick: That would work for the two teenagers, but what about Ariel?

Counselor: As a 5-year-old, Ariel doesn’t really need much screen time, and it isn’t all that healthy for her. The previous discussion centered on allowing her to watch weekend cartoons and one movie.

Lisa: Sounds like we have a plan.

Frederick: Sounds fine.

Counselor: OK, let’s agree to follow these standards for the upcoming week. During our next session, I’ll check in to see how it all went.

Parents and caregivers often worry how internet use may affect children’s safety, mental and physical health and social development. These example conversations illustrate how counselors can help caregivers establish healthy, age-appropriate rules regarding internet and screen use and facilitate productive conversations when their child witnesses something disturbing such as extreme violence or pornography.

Considering the clients’ developmental level

Counselors must consider the clients’ development level and needs when assessing and treating problematic internet use. When working with adults, counselors should educate them on the addictive nature of the internet, increase awareness around how internet use is affecting their life (e.g., career, relationships, happiness, finances), reduce any shame or blame related to internet use, explore alternative non-internet activities and encourage the person struggling with problematic internet usage to find coping skills and a safe person to talk with (other than the counselor). Unlike children and adolescents, adults often have a much greater capacity for personal responsibility, introspection, self-awareness and self-discipline. This is an important factor to consider when collaborating on out-of-session work related to issues such as reducing screen time and refraining from engaging in certain websites.

Counselors who specialize in working with children, however, should recognize that issues such as awareness, personal responsibility, introspection, self-discipline and difficulty resisting the addictive nature of the internet can serve as barriers to children limiting their own internet use.

If possible, counselors should ensure that parents and caregivers are part of the treatment. This can come in the form of weekly or biweekly parental consultations or periodic check-ins. During these meetings, parents can discuss strategies and goals for reducing screen time. Counselors should also empower parents to create rules that promote healthy screen time usage. General guidelines on children’s media use and family tools can be found on the American Academy of Pediatrics website and on the World Health Organization’s website.

Counselors should remind parents that the shape and scope of internet usage changes for adolescents and that parental flexibility is key. Screen time for teenagers often includes doing schoolwork and projects, watching TV shows, streaming videos, creating art or music online, gaming, connecting with peers via social media and watching fast stimulation online content (e.g., TikTok). Because a lot of teenagers’ screen use involves addictive mediums such as apps, gaming and social media, parents should recognize that their adolescent children can be tempted to spend far too much time online. This heavy usage can cause a variety of negative consequences, such as sedentary lifestyle, obesity and mental health issues.

Establishing healthy rules around technology can be challenging because families often include youth living together who are of different ages and at different developmental levels. Counselors can help parents balance general household standards and rules (e.g., no pornography, no computers after 9 p.m.) with more specified internet usage rules relevant to each child’s developmental level. Although many internet-based parenting issues and supervision concerns can be solved if computers are kept in a common area, this might not be possible for older teenagers who require more independence and have personal cellphones.

Counselors may feel overwhelmed with the balance of encouraging developmentally appropriate independence and helping parents with household expectations regarding devices. While there is no quick and easy solution to this issue, working with families to try to have achievable expectations and to blend family rules with individually tailored expectations appears to be key to long-term therapeutic success.

Issues involving inappropriate internet use, screen time standards and protection from individuals who exploit youth online are not new concerns. Counselors need to be aware of the various issues and problematic behavior that can affect those who are addicted to or abuse the internet. Our efforts as counselors should be centered not only on openly exploring and processing these concerns but also on actively engaging with individuals, families and communities to develop standards for healthy internet use.


Learn more about working with families on issues related to internet use in Flynn’s latest book, The Couple, Marriage, and Family Practitioner: Contemporary Issues, Interventions, and Skills. This comprehensive guide examines contemporary issues, theories, interventions and skills related to working in the interrelated fields of family, couple and child-based counseling.


headshot of Stephen Flynn


Stephen V. Flynn is a professor of counselor education, a research fellow, the founding director of the marriage and family therapy program, and the play therapy program coordinator at Plymouth State University in Plymouth, New Hampshire. He is a licensed professional counselor (Colorado), a licensed marriage and family therapist (Colorado and New Hampshire), a national certified counselor, an approved clinical supervisor, an American Association for Marriage and Family Therapy (AAMFT) Clinical Fellow and an AAMFT Approved Supervisor.

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.

Helping clients navigate religious trauma

By Diane Walsh and Gillian Koch November 15, 2023

Open book with brown bookmark

New Africa/

As counselors, we seek to support others in their search for meaning, wholeness and healing. This journey can lead us to work with clients who have had various experiences — both positive and negative — with religion and spirituality. Therefore, we must be prepared to address issues of religion and spirituality when appropriate, especially for those who have survived religious and spiritual trauma.

Many researchers in the social sciences describe religion as a shared set of practices and beliefs and spirituality as a personal relationship with God(s) or a Higher Power. Based on this understanding, an individual could experience spirituality through organized religion, be spiritual but not religious, or participate in religion but not be spiritual. According to the Pew Research Center, 63% of individuals in the United States identified as Christian, 9% identified as a member of a non-Christian religion and 29% identified with no religious tradition in 2021. An increasing number of individuals are leaving the religion they were raised in or not identifying with any religious tradition due to changing beliefs or finding community elsewhere.

Significant life events can shape a person’s spiritual and religious identity. In a recent study on religious trauma, published in the Socio-Historical Examination of Religious and Ministry in 2023, Darren Slade and colleagues found that “likely that around one-third (27-33%) of U.S. adults (conservatively) have experienced religious trauma.” Although no known studies have been done to determine the number of individuals who leave a religious tradition after experiencing religious/spiritual trauma, religious/spiritual trauma can deeply affect how individuals identify with and experience their own religion and spirituality. Understanding clients’ spiritual experiences is a critical part of engaging in multiculturally competent care, especially as research indicates that religion and spirituality can impact meaning making, worldview, social connections, physical and emotional health, and more.

The Association for Spiritual, Ethical and Religious Values in Counseling (ASERVIC), a division of the American Counseling Association, identified 14 competencies across six areas for addressing religion and spirituality in counseling. These competencies are a helpful framework for understanding ethical ways to address religion and spirituality in counseling when appropriate. The competencies include standards related to basic knowledge of religion and spirituality, awareness of how they may impact a client’s worldview, self-awareness on the part of the counselor and use of appropriate treatment methods in counseling. These competencies are of particular importance when working with survivors of religious/spiritual trauma to avoid further traumatization or inappropriate care.

The impact of religious/spiritual trauma

Religion and spirituality can have a positive impact on overall well-being, but they can also be harmful, damaging or traumatic. Lisa Ruth Oakley and Kathryn Susan Kinmond conducted a study on spiritual abuse and Christian adults in the United Kingdom and found that almost 75% of individuals felt “damaged by a church experience.” (Their findings were published in the Journal of Adult Protection in 2014.)

Religious/spiritual trauma is similar to other types of trauma, and it can overlap or co-occur with physical, sexual or emotional trauma. However, religious/spiritual trauma can be a particularly life-altering experience because religion and spirituality are often lenses through which people view the world. Religious/spiritual trauma can thus impact a person’s sense of identity, their core beliefs and values, and their perception of safety in the world. Moreover, it can deeply alter or damage an individual’s relationship and previous understanding of that which they consider to be sacred.

In a 2022 systemic review published in Spirituality in Clinical Practice, Heidi Ellis and colleagues reviewed 25 studies on religious/spiritual abuse. They identified three common elements of religious/spiritual trauma: misuse of power by religious/spiritual leaders, psychological harm and spiritual harm. Religious/spiritual trauma can be particularly painful when it desecrates core values or co-occurs with other types of trauma, such as sexual or physical trauma. It can also severely impact an individual’s sense of community and relationship with others.

The review found high rates of religious/spiritual trauma across many populations and locations, including the United States, Canada and the United Kingdom, but it indicated that certain populations may be more at risk for experiencing this type of trauma. For example, the review included a doctoral dissertation by Brian Simmons that analyzed data from almost 300 individuals who identified as LGBTQ+ and were either current or former members of The Church of Jesus Christ of Latter-day Saints. Simmons’ study found that almost 90% of participants met components of the diagnostic criteria for posttraumatic stress disorder due to spiritual trauma. This finding contrasts sharply with Slade and colleagues’ 2023 study that suggested 1 in 3 adults experience religious trauma.

Although the Diagnostic and Statistical Manual of Mental Disorders does not distinguish diagnoses based on the type of trauma a client experienced, conversations about religious/spiritual trauma have been occurring in the larger community of mental health professionals. For instance, Marlene Winell, a licensed psychologist, used the term “religious trauma syndrome” to describe the various symptoms that might emerge when an individual leaves a fundamentalist or manipulative religious tradition. Individuals who leave such religious traditions may have to navigate situations and their beliefs in new ways, including their understanding of the Transcendent and personal salvation or even deciding how to dress or talk to others.

The concept of deconstruction (the process of breaking down and exploring underlying previously held beliefs, understandings and practices) can also help provide insight into the unique characteristics of religious/spiritual trauma. Through deconstruction, individuals may leave their faith tradition entirely or emerge with a newfound strength and religious conviction, but the process itself can be highly challenging and requires reconstruction of personal identity and beliefs.

Many common symptoms occur across types and experiences of trauma, including psychological distress, intrusive memories of the trauma and heightened levels of arousal. Religious/spiritual trauma not only affects individuals’ physical, mental and emotional well-being but also their spiritual well-being. Because religious/spiritual trauma can deeply impact clients’ mental health, counselors have a responsibility to develop the knowledge, skills and awareness to support clients who have experienced this type of trauma.

Working with clients experiencing religious/spiritual trauma

Like with other forms of trauma, individuals who experience religious/spiritual trauma vary in their responses and reactions. Some clients may try to preserve their previously held religious/spiritual beliefs, while others may change or abandon their beliefs. As counselors, we may see clients who are conflicted or who do not know how they want to respond to the religious/spiritual trauma.

As with any traumatic experience, we first work collaboratively with clients to establish safety and healing. But there are a few other ways we can ensure we are providing effective care for clients who have experienced religious/spiritual trauma. In the following sections, we highlight key components of care for clients who have experienced religious/spiritual trauma. We also offer examples of specific language counselors can use in session with clients.

Cultivate safety through a trauma-informed approach. When clients have experienced religious/spiritual trauma, they often have a natural and automatic instinct toward self-protection and preservation that may be expressed as guardedness within the therapeutic space. Counselors must carefully consider how they build the therapeutic relationship and create safety with this population. Seemingly small considerations such as asking permission and allowing clients a sense of control can have a significant impact.

For example, counselors can get a client’s permission before asking questions about the trauma: “I’m curious about how that experience felt to you. Would you feel comfortable sharing more about it?” They can also allow clients to decide where to sit in session: “It’s great to see you today. Feel free to sit wherever feels most comfortable.” Or they can validate and let clients have a sense of control and ownership over their experiences: “That experience sounds really heavy. Where are you now emotionally?”

Perform an initial and ongoing assessment of risk. It is extremely important for counselors to assess the client for risk of suicide, self-harm and other safety concerns. This risk assessment should be conducted during intake and accompanied by appropriate follow-up assessments, including assessing if the client is at risk for further religious/spiritual trauma. The client may not be ready to dive into the details of the religious/spiritual trauma, but it is helpful to get a broad sense of what the trauma is, how the client understands the religious/spiritual trauma and where they currently are regarding their personal religion or spirituality.

For example, if a client has experienced trauma perpetuated within a specific religious community, a counselor can assess the client’s current level of engagement in that community by saying, “I hear how important that community was to you at that time. What’s your involvement like now — and how do you feel about it?” Then, it may be helpful to explore with the client the impact of their engagement, including if continued engagement may lead to increased risk of religious/spiritual trauma.

Other areas of assessment include the client’s symptoms such as emotional or physiological experiences, feeling of shame or detachment, and levels of reactivity. Counselors can broach these topics by saying, “How does it feel to talk about what happened? When you talk about the experience, does it feel like you’re telling a story or like you’re reliving the story?” or “That experience sounds so challenging. Which part of the story is the hardest for you to hold right now?”

Remember, regulation before intervention. Clients who have experienced any trauma (including religious/spiritual trauma) may experience symptoms of nervous system dysregulation throughout their daily lives. These symptoms may intensify during the therapy session, especially when discussing the trauma(s) they have experienced. Thus, it is important to make sure clients are not experiencing overwhelm or flooding in the therapy space because this will inhibit the client’s ability to experience the clinical interventions as intended. Grounding and mindfulness interventions (such as progressive muscle relaxation, 5-4-3-2-1 sensation naming activities or gentle stretching) can be helpful when working with this population. It can also be useful to develop a common language with your client so that you can remain attuned to their level of distress throughout the session. This can take the form of hand gestures, a subjective units of distress scale or code words — anything that allows the client to quickly and accurately communicate their level of distress so that the counselor can adjust the clinical intervention as needed.

For example, the counselor may tell the client, “I want to support you as much as possible as we talk about your past experiences. Let’s imagine a 10-point scale, with 1 being the least distressed (e.g., peaceful, at ease, relaxed) and 10 being the most distressed (e.g., angry, anxious, upset). We’ll use this scale throughout our work together so that I can stay attuned to how you’re feeling; I really care about that. Using that scale, where is your level of distress right now?”

If the client shares something about the traumatic experience in session, the clinician could say, “What you just said felt really impactful. Can I check in with you quickly? Where’s your distress level right now on a scale of 1-10?” If the client says they are at a 7, then the counselor could respond, “Thanks for letting me know you’re at a 7. Would it help to pause the story and do some grounding exercises? I can give you a few options to pick from if that’s helpful.”

Considerations for counselors

Working with clients with religious/spiritual trauma requires counselors to develop specialized skills and self-awareness as well as be trauma informed. To provide the best care for these clients, practitioners should not overlook the following four clinical considerations:

  • Learn trauma modalities. There are many trauma theories and techniques available for counselors to learn. Most evidenced-based trauma therapies share two primary common factors: First, they provide a corrective emotional experience for clients through a supportive, genuine and boundaried therapeutic relationship. Second, they include an exposure component while remaining respectful of the client’s pace. In some modalities, the exposure component takes a narrative form, and in others, it is conducted via an exposure hierarchy that includes imagined or in vivo exposure to triggers. As with any trauma treatment, it is crucial that pacing be closely monitored by the clinician to ensure that the client is receiving a level of treatment that is challenging but not overwhelming to prevent accidental traumatization. There may be some situations in which exposure work is not appropriate for clients, so counselors need to engage in critical case conceptualization, collaborative decision-making and consultation when determining treatment options. It is imperative that counselors receive thorough and complete training as well as ongoing support for the trauma modalities they practice.
  • Understand personal worldview and religious/spiritual experiences. Throughout the process of working with clients who have experienced religious/spiritual trauma, counselors may also experience different feelings, emotions and expectations. It is crucial that counselors manage and identify potential areas of countertransference. This is especially true when considering how the counselor’s own experiences of religion and spirituality could impact their work with the client. Bracketing is one tool counselors can use to manage their own experiences; Michael Kocet and Barbara Herlihy, in a 2014 article on ethical decision-making published in the Journal of Counseling & Development, defined ethical bracketing as a practice in which a counselor intentionally sets aside their beliefs and personal views when working with a client. In alignment with the ASERVIC competencies, counselors also need to understand different religious/spiritual traditions and perspectives outside of their own to avoid assumptions or generalizations. Clients experiencing religious/spiritual trauma may not be able (or ready) to leave the environment in which they experienced trauma. In these situations, taking a harm reduction approach can help clients explore ways to increase their safety while feeling understood and supported by the counselor.
  • Foster resilience. Burnout, compassion fatigue and vicarious trauma are risks for counselors engaging in trauma work. However, an emerging body of research also suggests that counselors may experience vicarious resilience and other positive impacts from witnessing posttraumatic growth and resilience in clients. Using a wellness-focused and strengths-based model can help build resilience in both the survivors we work with and in our own personal lives.
  • Take care of yourself. Because trauma work can be challenging, we encourage counselors engaging in this work to actively care for themselves. Supervision and consultation are vital, especially when working with clients experiencing religious/spiritual trauma. These spaces can facilitate growth in clinical skills as well as the development of professional support networks. In addition to supervision and consultation, self-care is key to preventing compassion fatigue, vicarious trauma or burnout. When a counselor is grounded in their own life’s peace and meaning, they are better able to create a space for clients to cultivate these in their own lives.

Religious/spiritual trauma is unique in its ability to uproot even the most deeply held beliefs in a person’s life, including those related to self, identity, religion, spirituality and the world. Working with clients who are navigating through religious/spiritual trauma can be challenging, but if counselors take the time to gain awareness and develop the clinical skills needed to help this population, then the work can be a profound and meaningful experience for both the client and the counselor.


headshot of Diane Walsh


Diane Walsh is an assistant professor of counseling at McDaniel College in Maryland. She is a licensed graduate professional counselor who maintains a small caseload of clients. Her research areas of interest include religion, spirituality, social class and counselor education.


headshot of Gillian Koch

Gillian Koch is a licensed professional clinical counselor in Minnesota. She served as president of the Minnesota Counseling Association for two years and is currently serving as the board’s past president. She works in private practice and specializes in supporting health care professionals as well as folks experiencing grief and loss.


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.

Advocacy Update: Looking ahead to the 2024 elections

By Brian D. Banks November 10, 2023

close up of a hand inserting a ballot into the ballot box

Alexandru Nika/

During the past year, the counseling profession has made history with the passage of Medicare reimbursement for counselors, 30 governors having signed the interstate Counseling Compact into law, and Title IV-A funding reaching its highest level in history to support the needs of school counselors. However, we have also witnessed the proposal, adoption and passage of legislative and regulatory measures that may make it difficult to serve your clients’ needs. All that counselors experience professionally begins and ends with a branch of government. Therefore, it is vital to the success of the profession that counselors protect and promote it by staying active in their advocacy efforts. It is also important for counselors to go to the ballot box and vote for the candidates who will support the needs of the profession, their counseling clients and their communities.

Voting rights are an important aspect of our society. They provide counselors the opportunity to participate in the political process and have a say in the decisions that affect how they can practice. Professional counselors, like other groups of citizens, have a stake in the policies and decisions that impact their profession, their clients and the communities they call home. By voting in the 2024 elections, you will not only help shape the direction of your profession but also ensure that your voice and the voices of thousands of people who need your support are heard.

Before voting in the 2024 elections, counselors must use their knowledge and expertise to inform candidates about what is important to the profession. For example, you may want to know a candidate’s stance on supporting mental health care, increasing access to telehealth or ensuring that school and career counselors have the resources they need to perform their jobs effectively. Taking an active role now by preparing for the 2024 elections can make all the difference in how the profession flourishes in the future.

To prepare you, here is a snapshot of what to expect in the 2024 elections:

  • Gubernatorial: Elections for governor will be held in 11 states and two territories: Delaware, Indiana, Missouri, Montana, New Hampshire, North Carolina, North Dakota, Utah, Vermont, Washington, West Virginia, American Samoa and Puerto Rico.
  • Congressional: Experts predict that 12 congressional districts currently held by Democrats will be toss-ups, as will 10 districts held by Republicans. Note that Republicans currently hold a small majority of 222 to 212 in the House of Representatives, with 218 seats needed for either party to be in the majority. In the Senate, Democrats have a narrow majority of 51 to 49, including three senators who identify as Independents.
  • Presidential: So far, at least eight Republicans are vying for the right to represent their party in running against current President Joe Biden. These candidates are North Dakota Gov. Doug Burgum, former New Jersey Gov. Chris Christie, Florida Gov. Ron DeSantis, former U.N. Ambassador Nikki Haley, former Arkansas Gov. Asa Hutchinson, businessperson Vivek Ramaswamy, South Carolina Sen. Tim Scott and former President Donald Trump. 

In addition, there are likely to be several seats open in your local and state government offices. As the saying goes, “All politics is local.” So please pay attention to every candidate on the ballot. You can visit to find information on candidates, attend candidate forums and review candidates’ websites. You can also visit to learn how your current member of Congress has voted on issues important to you.

Nov. 5, 2024, is still a year away, but just as the candidates for office are already campaigning, you should prepare now to vote for the candidate whose policies will truly be in your profession’s best interest. It is important that you educate yourself and talk with your colleagues about the importance of the elections. Your vote is your voice, and it matters for you, your clients, your community and the counseling profession.


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

Editor’s Note: The printed version of this article left off North Dakota Gov. Doug Burgum as a presidential candidate. The PDF of the November issue has been updated to include the most recent list of presidential candidates as of Nov. 1.

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.

Coping with the stress and uncertainty of chronic health conditions

By Lisa R. Rhodes November 9, 2023

An older man in bed holding a glass of water; another man sits beside him holding a white plate with two pills

Adam Gregor/

Living with a chronic health condition can be physically and emotionally stressful. Imagine waking up in the morning to searing pain because of reoccurring migraines or experiencing vision and speech problems and mobility challenges because of multiple sclerosis.

Common types of chronic pain or illness include low back pain, cancer, arthritis, fibromyalgia, diabetes, heart disease, amyotrophic lateral sclerosis (also known as Lou Gehrig’s disease), Alzheimer’s disease and dementia. No matter the type of chronic condition, they all have the potential to be unsettling, which often causes people to seek professional help.

Dakota Lawrence, a licensed professional counselor-mental health service provider who specializes in chronic pain, chronic illness and trauma, says many clients come to counseling when the pain is disrupting their lives and they feel things are “falling apart.” For example, the pain may cause some clients to be unable to perform work duties or make them withdraw from a sports team at school.

According to a 2020 report by the Centers for Disease Control and Prevention, 20.4% of adults were living with chronic pain in 2019, and 7.4% of adults had chronic pain that frequently limited life or work activities.

Lawrence says some clients think the pain or illness “can be fixed” by taking a break from stress, undergoing surgery or engaging in physical therapy. When people are in pain or sick, they tend to think that there is a single clear cause that can be treated or cured, he explains. But repeated doctor visits and medical tests often do not lead to clear results and proposed treatments may not offer much relief.

Clients may also take sick leave from work or even change jobs out of concern that they are burnt out and that stress is the cause of their illness, but then they notice that their pain or illness does not disappear despite the respite. “It’s only when [they’ve] gone from doctor to doctor and run out of answers that they tend to wind up in therapy,” Lawrence says.

When clients do come to counseling, his main goal is to help the client return to living a meaningful life with their pain or illness as well as the uncertainty that can go along with it.

No clear answers

One stressor that often comes with a chronic health condition is not having a clear understanding or explanation of what is going on with the body.

Alicia Dorn, a licensed clinical professional counselor in Columbia, Maryland, says often clients have been struggling with a chronic condition since childhood without ever having a medical diagnosis or a clear understanding of what kind of health issue they are dealing with or its origin. The reason for this, she says, is that the medical professionals who treated them as children often assumed they were simply experiencing growing pains or overreacting, so they did not conduct additional diagnostic testing.

Sometimes an unsupportive family, limited resources or little information about what has caused the person’s symptoms can delay a diagnosis in childhood and adulthood, notes Dorn, who specializes in chronic illness and chronic pain. She says this leaves many adult clients feeling worried and concerned about having to convince medical professionals that they have a condition that needs immediate attention.

Lawrence, co-owner of a private practice in Murfreesboro, Tennessee, says the frustration of not having a formal diagnosis only leads some clients to discover that “there’s not any clear answer as to why this [the chronic condition] is happening and whether it will get any better.”

And those who do receive a diagnosis face another challenge: coming to terms with living with a life-altering condition. A diagnosis can be scary, Dorn admits, “because it’s something that likely will not have a cure, and it will change how they live for the rest of their lives.” For example, the chronic condition may mean some clients will have to deal with “persistent suffering,” which can make it harder to live the type of life they want, she says. And for many people, a medical diagnosis can also bring their own mortality into question.

Changes to self-identity and daily life

Chronic conditions can affect every aspect of a client’s life — work, school, family, friends, recreational activities and even the way they view themselves.

Lawrence says before clients discover they have a chronic condition, they may see themselves as strong, independent and able to take care of themselves and the people in their lives. However, the physical and mental limitations that can come along with chronic conditions can alter the client’s identity and leave them feeling lost and unsure of who they are, he says. For example, clients may find that they are not able to do simple things, such as mowing the lawn, playing with their children or enjoying certain social activities with friends.

Chronic conditions can also lead to relationship problems. The ability to be physically mobile and connect emotionally with other people in meaningful ways can fluctuate from day to day, Lawrence says. In addition, a relationship with a spouse or partner may have become strained because their significant other is beginning to feel more like a caregiver than a life companion or romantic partner, he adds.

Some clients report that the physical pain and depression they experience makes them feel less sexually active and less inclined to sleep or eat regularly, adds Ryan Ibarra, a licensed professional counselor (LPC) at Foothills Neurology, a medical group practice in Arizona that specializes in providing behavioral health treatment for neurological disorders.

Research also shows that living with chronic pain or a chronic illness can make people more likely to struggle with mental health disorders, such as depression, anxiety, posttraumatic stress disorder, suicidal ideation and grief. Of the people who took a Mental Health America screening, those with chronic health conditions were at higher risk for a mental health condition. This includes 79% of people who struggle with chronic pain, 75% of those with heart disease and 73% of people with cancer.

Ibarra, who specializes in chronic diseases, says clients who have chronic health conditions may also report struggling with fatigue, stomach issues, sleep problems and panic attacks.

Dorn says clients often come to therapy because they need help figuring out if they will be able to make the adjustments that will enable them to maintain a measure of stability in their lives.

“Every day, clients are reminded of a condition that they didn’t ask for [and] that wasn’t necessarily their fault but is making it much more difficult to be the person they want to be,” she explains, noting that clients are often focused on managing their health and may pretend they are feeling “OK” for those around them.

Assessing for chronic health conditions

Because some clients may have experienced trauma and may not feel comfortable disclosing their chronic condition in session, particularly if it is not visible, counselors should assess for chronic ailments during the intake process. Lawrence recommends clinicians ask about the client’s health history using a checklist of physical health conditions (such as diabetes, fibromyalgia and cancer) or physical health symptoms, (such as pain, chronic fatigue and dizziness).

Counselors can ask clients simple and direct questions, he continues. For example, they can say:

  • When was the last time you saw a health care provider?
  • Are there any current or previous medical diagnoses that are causing significant stress?
  • What do you do in your free time and what activities give your life meaning? On a scale of 0 to 10, how engaged have you been with these activities in the last six months?
  • How many hours of sleep do you average a night? What did you eat yesterday?
  • How often do you get sick? Once or twice a year? Once every few months? Every few weeks
  • When you get sick, how long does the illness typically last? On a scale of 1 (almost never) to 7 (almost always), how often are you in pain? And how intense is the pain on a scale of 0 to 10?

Tameeka Hunter, an assistant professor in the Psychology and Counseling Department at Palo Alto University in California, says it is important that clinicians ask about the presence of chronic illnesses and disabilities, but they shouldn’t assume that chronic conditions are the “problem” or presenting concern.

Counselors also need to be aware of their own implicit and ableist biases before working with this population, Hunter adds. She recommends counselors use the Implicit Association Test, developed by Project Implicit Research at Harvard University.

“It measures the strength of associations between concepts and evaluations or stereotypes to reveal an individual’s hidden or subconscious biases,” explains Hunter, an LPC and certified rehabilitation counselor who lives with a disability. (For more, see the sidebar “How ableism affects people with chronic health conditions.”)

Counselors can also review the American Rehabilitation Counseling Association’s Disability-Related Counseling Competencies to learn the specialized skills needed to effectively serve clients with chronic health conditions and disabilities, she says.

Noticing and regulating emotional responses

Mindfulness-based therapeutic approaches and acceptance and commitment therapy (ACT) can help clients living with chronic pain or illness gain an awareness of the thoughts, emotions and bodily responses that can be a part of their condition or the result of additional life stressors, Dorn says.

Doctor’s appointments can be one source of stress or anxiety. Initial appointments with a new provider, general appointments, follow-ups with a specialist and appointments for test results or a potential diagnosis can all create anxiety for clients, Dorn explains.

“Some clients fear being told nothing is wrong when they feel unwell, being dismissed by a provider or feeling they have no autonomy over their body and care,” she adds. “This is a form of medical gaslighting that makes navigating the health care system a scary endeavor for clients.”

Dorn recommends using mindfulness and ACT techniques with clients who may feel anxious or nervous about going to the doctor for an appointment. For example, counselors can ask clients a series of questions that encourage them to gently observe the thoughts, emotions and body sensations that may come up as they prepare for the visit, she says. These questions can include:

  • What worries come to mind when you think about the appointment?
  • How do these worries show up in your body right now?
  • If you could put all the emotions you feel about the appointment into words, what would they be?
  • What could help you feel more supported and heard during your appointment?
  • What questions or observations would you like to discuss with your doctor?
  • How can you show your body compassion when you’re feeling worried during the appointment?

Dorn says she also prepares a plan with the client that includes what to do the night before, the day of, during and after the appointment. She walks them through deep breathing exercises and body scans to practice calming their nervous system and she discusses how clients can advocate for themselves as they navigate the health care system. Counselors can also encourage clients to bring a family member or friend with them to the appointment, so they feel supported and heard, Dorn adds.

Dialectical behavior therapy (DBT) is another approach that clinicians can use to help clients develop emotional regulation skills, Lawrence says. He suggests counselors use Check the Facts, a DBT skill that helps clients notice and evaluate their emotional response to a situation. This exercise consists of six reflective questions that help clients determine whether the event itself, their interpretation of the event or a combination of both is causing their emotion.

“The goal is to help clients identify their emotions, describe the situation or trigger that caused it as objectively as possible and separate the assumptions, presumed threats, cognitive distortions and catastrophic thinking that may be projected into the situation,” Lawrence explains.

He says this DBT exercise also helps clients recognize when their response is ineffective in helping them navigate the situation. For example, a client’s emotion (such as anger, sadness or anxiety) may fit the situation, but the intensity of the emotion may be out of balance. Sometimes an emotional response such as anxiety can be helpful for people living with chronic illness. The key, he says, is to realize when the response becomes problematic. A client with an autoimmune disorder, for instance, may need to be hypervigilant when they go to the doctor’s office to make sure their hands are clean and that they keep an appropriate distance from others who may be sick, Lawrence says. “But if the intensity of their anxiety grows to the point where a client begins to isolate at home and miss their doctor appointments, then we’ve got a problem that can be just as bad for their health.”

“Clients run into problems with their emotions when they try to avoid feeling the emotion all together or when the intensity of their emotion is driven by other factors, such as genetics, beliefs, thought distortions, etc.,” he stresses. This can lead to a disproportionate, and often ineffective, response. By using emotional regulation skills such as Check the Facts, clients can learn to better understand their emotions and make sure they are using emotions in functional, adaptive ways, he says.

The importance of validation

Clients with chronic pain and chronic illness can often feel alone and invalidated and they may even experience medical trauma in the process of trying to find a diagnosis. Dorn, who lives with a chronic illness, says this kind of trauma results from a series of stressful events that are related to a client’s health and make it difficult to feel safe in a medical environment.

For example, in some cases, medical providers can be insensitive and write clients off as people who are seeking drugs or are being dramatic, Lawrence notes. Some medical providers may even tell clients that the chronic condition is “all in their head,” he says.

But even when medical providers do believe clients have a chronic condition, Lawrence says that seeking a medical answer for the cause or to alleviate suffering can mean invasive procedures or surgeries that don’t always pay off or may further complicate the matter.

“The persistent invalidation of their lived experience and invasive exploration of their body can result in medical trauma for some clients,” he notes.

Whether it’s a toxic relationship with a doctor or a scary medical experience, clients can often show signs that are similar to posttraumatic stress disorder, Dorn adds. As a result, clients may avoid medical appointments or refuse to talk about their health issues. They may also develop increased worries about their condition and a mistrust of medical professionals.

According to Dorn, medical trauma and gaslighting can lead to heightened chronic health symptoms and even a decline in a client’s overall physical or mental health if they don’t get the support they need.

The counselors interviewed for this article say that what is often most helpful for clients living with a chronic health condition is to work with a clinician who validates their lived experience and helps them advocate for their own well-being.

Ibarra sometimes shares the following hypothetical story with his clients: Imagine entering a room filled with hundreds of people and someone asks, “How many of you struggle with depression and anxiety?” Almost everyone in the room will probably raise their hand. Now imagine someone asks, “How many people struggle with chronic back pain or epilepsy?” Fewer hands would go up, which shows that living with chronic pain or illness is often a more isolated journey.

Sharing this story “helps validate the client when they are feeling alone and like no one understands,” he says. “It makes them feel seen by me as their therapist.”


How ableism affects people with chronic health conditions

Tameeka Hunter, an assistant professor in the Psychology and Counseling Department at Palo Alto University in California, stresses the importance of acknowledging that systemic oppression and ableism can also cause psychological distress among clients with chronic health conditions.

Living in an oppressive society where ableism, as well as racism, sexism, homophobia, transphobia and other biases, are commonplace makes people with chronic health conditions and disabilities susceptible to bias and harmful stereotypes, notes Hunter, whose research areas include intersectional diversity, social justice and the resilience of people living with chronic illnesses and disabilities. She says people with chronic conditions and disabilities are often viewed as “incapable” or as a “burden” to society.

Ableism is “the systemic discrimination against and oppression of people with chronic illnesses and/or disabilities,” Hunter explains, and it manifests in many ways and exists on different levels of society. It can be part of a health care provider’s belief system or the belief system of a loving, well-meaning family member.

For example, internalized ableism is when a person consciously or unconsciously believes in the harmful messages they hear about people with chronic illnesses or disabilities, says Hunter, a licensed professional counselor and certified rehabilitation counselor.

“A person [with ableist beliefs] may feel that disability accommodations are a privilege and not a right or that the presence of chronic illnesses and disabilities makes a person ‘less than’ nondisabled people,” she notes.

Hunter describes three other forms of ableism: Hostile ableism includes openly aggressive behaviors or policies, such as bullying or violence. Benevolent ableism views people with disabilities as weak or in need of rescuing and can undermine a person’s autonomy. Ambivalent ableism is a combination of the two other forms and manifests when a person treats someone with a disability or chronic health condition in a patronizing manner and then switches to being hostile when the person living with the chronic illness or disability rejects unsolicited advice or “help.”

Ableism affects people differently depending on how others perceive their condition or disability, Hunter notes. For example, how people discriminate against those with visible chronic illnesses and disabilities is different from how they treat those with invisible chronic illnesses and disabilities.

“People with invisible chronic health conditions are often asked to ‘legitimize’ or ‘prove’ that their chronic health conditions exist,” she says. “They are often told they are exaggerating or ‘lazy,’ particularly if the conditions relapse and remit. For those of us with obvious physical disabilities, being asked to legitimize our disabilities still happens but less often.”

Hunter strongly suggests counselors invest in clinical training and examine their own ableist beliefs. She recommends practitioners attend trainings hosted by rehabilitation counselor educators to learn more about effective therapeutic approaches for this population and about their rights and protections based on the Americans with Disabilities Act of 1990.


Read more about how long COVID is affecting people’s mental health in the online exclusive “Treating clients with long COVID.”


Lisa R. Rhodes is a senior writer for Counseling Today. Contact her at

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

Behind The Book: Q&A with the authors of Interactive Group Work (second edition) 

November 8, 2023

A group of four people sitting on a bench working together; the cover image for the Interactive Group Work (second edition) book is next to this image

Jacob Lund/

The second edition of Interactive Group Work serves as a comprehensive resource on group work for practitioners and counseling training programs. It includes the history of the evolution of group-specific theory, updated perspectives on diversity and social justice, current research on group efficacy and process, and a discussion of group work in online, rehabilitation and educational settings. 

Counseling Today spoke with co-authors Jane E. Atieno Okech, Deborah J. Rubel and William “Bill” Kline about the book’s contribution to the field of group work and the necessity to ensure the proper development of group leaders.  

Okech is a professor of counselor education and supervision and vice provost for faculty affairs at the University of Vermont. Rubel is a professor of counselor education and supervision at Oregon State University, and William “Bill” Kline is a retired counselor educator and counselor who specialized in group work and qualitative research. 


How does this edition differ from the first? 

Jane Atieno Okech: The original text, which was authored by Kline, was well received, and all three of us have used it consistently to teach master’s- and doctoral-level group courses. However, aspects of the 20- year-old book needed to be updated and revised to align it with the current Association for Specialists in Group Work’s professional standards of practice, ACA Codes of Ethics, and the Council for Accreditation of Counseling and Related Educational Programs’ standards for group work training. The original text also needed updating regarding multicultural and social justice issues and current efficacy and process research.  

headshot of Jane Atieno Okech

Jane E. Atieno Okech

With this edition, we wanted to provide a text that is relevant to a larger group of counselors doing group work across settings and provide content on the critical bridge between essential group work concepts and the typical practices of those settings, including virtual group work contexts. In every chapter, we have integrated diversity, culture and social justice manifestations in groups; current group work research; and a clearly differentiated set of learning outcomes for entry-level and advanced learning. We have also included 125 test questions and answers and practical group practice exercises throughout the book.  

How can group work help overcome challenges and barriers to mental health care such as provider shortages and insufficient resources?  

JAO: Group work approaches provide an effective way for counselors or organizations to simultaneously meet the personal and collective goals of more people. Schools, institutions of higher learning, agencies and community organizations can benefit significantly from utilizing group work approaches to help meet their communities’ developmental and mental health needs while using fewer counselors.  

Group work is also more economical than individual counseling because services are provided using a group approach. This means that clients can pay lower fees to receive quality group counseling, and counselors can earn a decent living while still serving community members. The cost-effectiveness of group work is crucial in helping counselors fulfill their social justice objectives by catering to clients from underserved communities.  

The duration of groups can differ depending on the presenting concerns of the members and can range from short-term groups that last only a few weeks to long-term groups that last months or even years. The availability of these options can lead to more effective outcomes for group members, their families and their communities.  

Finally, groups can also be offered in-person and virtually. Contemporary research is increasingly providing evidence of practical approaches to virtual group work. These options can undoubtedly increase access to quality counseling services. 

You say that groups are social systems. How does that affect how counselors need to approach group work with clients? 

William Kline: Group counselors should remember that people joining their groups are members of social systems outside the group. These social systems (e.g., families, cultures, peer groups) prescribe how people should interact and the behaviors they should enact to play their part in social interactions. Thus, asking people to change how they interact with others may be anxiety provoking because the group leaders are encouraging them to interact in ways they usually avoid. Group leaders who are aware of these systemic factors will quickly observe that as group members interact, they engage in interactions with the goal of reducing their anxieties about group participation.  

headshot of William Kline

William Kline

Group members often attempt to replicate social norms that promote safety in the group based on their social systems outside the group. This means they often try to establish familiar norms and social roles within the group dynamic. Counselors who are aware of how social systems form can work to discourage members’ attempts to avoid open and immediate interaction and instead encourage them to interact openly in the present and work to develop norms that are consistent with the way members learn from each other.  

Even as the group develops, group members will continue to avoid necessary conflict and open emotional expression. Again, with this awareness, counselors should point out when the group develops norms that may prevent member learning. The goal is for group leaders to help the group develop norms consistent with group objectives and help members become aware of and change roles that interfere with healthy relationships.   

What skills make an effective group leader?  

WK: Skills are the maneuvers necessary to help members learn from each other. To effectively utilize these skills, it is crucial to have a comprehensive understanding of the social and cultural context of the groups involved and their norms of interaction. Additionally, group leaders need to know the structural forms of privilege and oppression that may arise within the group context.  

Skill usage heavily depends on group leaders’ beliefs about what is necessary for members to benefit from group participation. Leaders who believe members learn best from interacting with each other trust that honest emotional expression can develop a member’s awareness and understanding of self and others. If a leader considers conflict crucial for members’ learning, then they will use skills to accomplish these objectives. Conversely, leaders who believe that members depend on group leaders to tell members “what they need to know” would use another set of skills. The leadership approach also affects outcomes. Leaders who feel they need to explain what is happening in group interaction or provide multiple structured experiences to teach members what they need to learn will experience different outcomes from leaders who engage members in describing and developing a shared understanding of group events.  

Furthermore, we believe leaders should also help members learn skills to interact more effectively with other group participants. These skills will help members become more effective in their interactions with others outside the group. In our perspective, the most crucial skills for effective group leaders are ones that help members engage in effective feedback exchange, describe their here-and-now experiences, engage directly with others and process group interactions.  

What are some ethical considerations when working in groups? 

Deborah Rubel: The ethical principles of fairness, beneficence and nonmaleficence encourage leaders to balance individual member needs with overall group functioning. Even the best leader cannot ensure that every group member will get the same benefits, but we should ensure that everyone gets some benefit, and no one is harmed.  

headshot of Deborah Rubel

Deborah J. Rubel

While there are some more dramatic ethical dilemmas that can occur in a group, the most common is probably that someone is not getting benefit from the group because of the pregroup process or the in-group process. The pregroup process should include careful screening to determine whether prospective members are a fit for the group and whether group member preparation will help them engage and feel more comfortable with what can be a challenging process. The in-group process should be sensitive to imbalances in participation, support members in learning essential membership skills and foster beneficial interactions like feedback and support between members. For example, if a group leader perceives that a group member is not benefiting from the group, they should solicit that member’s feedback and assess if a referral to another group or individual counseling is necessary. The leader may also want to seek additional supervision, ethical consultation or use an ethical decision-making model to clarify their thinking.  

What are some of the biggest challenges of doing remote group work?  

DR: The commonly identified challenges of doing group work online are related to licensure issues, remote client safety and encouraging authentic interaction between members online. However, the biggest challenge of doing group work online is the challenge of doing competent group work in any setting. Group work, including group counseling and therapy, receives much less attention in the counselor training curriculum and is only included as the focus of group-specific supervision during practicum and internship. Counselors who are enthusiastic about group work may seek additional training and gain a high level of competency, but other counselors who have not had this level of training still end up doing groups. The challenges counselors doing group work face are similar no matter if they are online or face-to-face and will require them to adequately conceptualize group interaction, derive effective interventions based on those conceptualizations and be able to manage their own needs and emotions so they can enact those interventions. 

How can counselors help group members feel safe and stay engaged?  

DR: An individual pre-group meeting with the group leader is one of the best ways to set the foundation for a good group experience. This can serve as a time for doing pre-group preparation, reviewing informed consent and processing the potential group member’s anxieties or concerns.  

As the group progresses, group members must develop a sense of belonging and trust and be able to interact effectively to meet their own needs within the group. Group leaders can assist with engagement in the group environment by identifying, eliciting and connecting group members through emotional experiences.  

Another way for group leaders to improve group member engagement is by seeking opportunities for themselves to experience group membership beyond their training context. The experience of group membership can provide invaluable insights for emerging and experienced group leaders, particularly about how to improve member engagement in the groups they lead. Group leaders who have had meaningful group membership experiences believe in the modality and communicate confidence and enthusiasm to their members. 

cover image of the Interactive Group Work (second edition) book



Order Interactive Group Work (second edition) from the ACA Store.



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.