Tag Archives: Counselor Educators Audience

Counselor Educators Audience

Incorporating interprofessional education and practice in counselor development

by Judy Schmidt April 13, 2021

As the complexity of care for people with mental health needs increases, more counselors are serving on interdisciplinary teams responding to the acute and chronic needs of their clients. Many people with serious mental illness may also have co-occurring physical disorders such as cardiovascular disease or nutritional/metabolic diseases (e.g., diabetes, obesity), as reviewed by Mark De Hert and colleagues in 2011. These individuals require increased medical care involving physicians, nurses, dietitians, and radiologic and clinical laboratory specialists. Social work also coordinates care with mental health teams for community resource support and with vocational rehabilitation counselors to assist with employment needs. Thus, counselors’ understanding of the role and function of interprofessional collaboration in providing care is vital for achieving quality outcomes.

As a counselor educator, I strive to create opportunities for students to develop strong communication and leadership skills during their clinical training. When I invite alumni to talk with students about different aspects of building their career, many discuss their work on community-based mental health teams. They explain having to learn to work with people outside the counseling profession — nurses, psychiatrists, physical and occupational therapists, speech therapists, social workers, pharmacists, police officers and others. I began to understand the need for our students to have better skills for team-based care. So, I worked with our faculty to offer more opportunities to expose our students to a wider range of care providers and delved into the research on interprofessional education and practice (IPEP).

During this time, I engaged with faculty from physical and occupational therapy in our Department of Allied Health Sciences who were involved in IPEP. Through them, I started learning more about IPEP in medicine, nursing and other health affairs schools on campus. My personal exposure to interdisciplinary care began in earnest when, as part of my clinical faculty duties, I started working part time as the rehabilitation counselor on the acute inpatient rehabilitation unit at our hospital located on campus. This fully immersed me in an interprofessional setting with providers from all health disciplines.

This required me to be a member of a team of varied professionals focused on quality patient care that depended on strong communication, an understanding of team members’ roles in providing care, and the use of best practices for supporting the team. I witnessed (and contributed to) interprofessional practice at its finest being carried out every day. I was hooked and worked with other allied health faculty to find ways for our students to engage with one another. With the support of our dean, I became the coordinator for IPEP for our department.

Two years ago, when our university leadership developed a campuswide initiative for intentionally integrating IPEP and created a formal office for it, I was ready to represent our Department of Allied Health Sciences as the director of IPEP. I work closely with other directors from all health disciplines as well as public health, social work, business and education to intentionally build IPEP across curricula. Student and faculty support have been tremendous. I see the need to expand knowledge of IPEP to counselor education as a whole and to build these endeavors into our programs to ensure that future counselors can easily transition to interprofessional care and become leaders on these teams.

Thus, counselor educators should be aware of current interprofessional teamwork practices and curriculum frameworks that provide opportunities for students to understand their roles on these teams, effectively describe and implement counseling services, and uphold the culture of interdisciplinary care. Establishing opportunities for counseling students to participate in IPEP with stakeholders was a critical need noted by Kaprea Johnson and Krystal Freeman in 2014 in their work on integrating IPEP into mental health counselor education. This knowledge will help new counselors understand their role in a variety of settings and learn appropriate communication strategies for sharing knowledge in team settings. IPEP trainings for graduate students also helps dispel preconceived ideas about other professional team members’ roles and highlights the importance of quality care.

Core competencies

In 2009, the Interprofessional Education Collaborative (IPEC) was formed by six national health profession education associations covering nursing, osteopathic medicine, pharmacy, dentistry, medicine and public health. Their goal was to advance interprofessional learning strategies to enhance skills in team-based care that promote quality health outcomes. The collaborative also established core competencies in providing interdisciplinary care for student clinical training programs. By 2016, IPEC had expanded its academic partnerships to include 21 health-related institutions. Its vision is to promote interprofessional teamwork and collaborative practice that reinforces quality, accessible, person-centered care that improves population health. 

IPEC has four core competencies that guide the development of curricular content:

  • Values/ethics for interprofessional practice to build and maintain mutual respect and shared values in patient care
  • Knowledge of roles/responsibilities in interdisciplinary teams to help assess and address health care needs
  • Interprofessional communication that is supportive and responsive to team-based care and treatment and prevention of disease
  • Teams and teamwork that uphold high values and principles recognizing different team members’ roles in planning, delivering and evaluating patient care, programs and policies

The overarching goal for IPEP is for health care workers to learn from, with and about each other.

These competencies also promote the principles of the “Quadruple Aim” in health care. Three of the principles were originally developed in 2007 by the Institute for Healthcare Improvement to promote health system reform to improve patient experiences, reduce costs and increase better outcomes. The fourth principle, improving the clinical experience for providers, was added in 2015, primarily to address and manage clinician burnout.

Counselor training opportunities that embrace these competencies help students understand their team roles, effectively describe and implement their services, learn appropriate methods for sharing knowledge in team settings, and uphold the culture of interdisciplinary teamwork. Overall, curriculum structures that promote opportunities that integrate the IPEP competencies help develop graduates who are leaders in their field. These graduates will possess the skills for teamwork that can address challenges in providing quality health care, including in the counseling field.

IPEP in relation to accreditation and licensure requirements

CACREP recognizes the need for counselor education programs to provide specific information and training to students about interprofessional care and their respective roles on these teams. On its website, CACREP states that it is a member of the Health Professions Accreditors Collaborative, which works to promote learning opportunities that prepare students for interprofessional practice. Requirements for interprofessional education opportunities are outlined in the 2016 CACREP Standards in Section 2, Standard F.1.c. and Section 5, Standard D.2.b.

The 2014 ACA Code of Ethics clearly states in Section D, Relationships With Other Professionals, the importance of being a part of interdisciplinary teamwork (Standard D.1.c.) and understanding the professional and ethical obligations as a team member (Standard D.1.d.). In 2017, the Code of Professional Ethics for Rehabilitation Counselors provided guidelines for certified rehabilitation counselors working as members of interdisciplinary teams that provide complex and comprehensive services to people with disabilities. Section E, Relationships With Other Professionals and Employers, outlines these ethical responsibilities in Standards E.1., E.2.a. and E.2.b.

Thus, counselor education programs are called to build relationships among all stakeholders (administration, faculty, students and community partners for clinical training) that are crucial for successful IPEP development and implementation, as noted by Daniel Kinnair and colleagues (2012) and Kaprea Johnson and Krystal Freeman (2014).

IPEP experiences for counselor education and development

Innovative ideas for incorporating IPEP experiences in counselor education include collaborative learning experiences with other professions, problem-based learning events and simulation activities. One of the best approaches for initially developing IPEP in counseling programs is to seek opportunities with other departments on campus that may have similar graduate-level introductory courses that include content on disability rights and current health care issues such as quality indicators of care, disparities in care, implicit bias and leadership development. These topics lend themselves to developing interdisciplinary journal clubs, case-based events for problem-solving and opportunities for students to talk about their different professions or why they chose their career path in graduate school. Most importantly, these activities will help students begin to understand and clarify their roles and how they fit in interprofessional teams. Their professional thinking may be challenged by understanding different viewpoints, decreasing the use of jargon, and building confidence and leadership for future teamwork.

IPEP events that are more intentional with specific learning outcomes require more planning. However, working with other health professionals on campus or in field placements to design opportunities will prevent reinventing the wheel and will model interprofessional collaboration for students. Examples of IPEP activities designed around specific learning objectives for students include case-based learning experiences, seminars with small-group discussions and debriefs, and clinical simulations that use videos or actors to play patients and portray different health issues and patient ages. Service-learning opportunities, particularly focused on rural health care, can bring students together from many disciplines, including business, education, legal care and faith-based organizations. These opportunities serve as excellent avenues for learning from, with and about each other to serve the community.

Field placements for clinical work offer built-in opportunities for IPEP in clinical agencies where interdisciplinary teamwork is provided. These preceptors will have practical knowledge to share about their teamwork and examples of interprofessional care that works and does not work. They can also offer opportunities for counseling students to incorporate counseling theory with IPEP practice and to reflect on potential ethical dilemmas for counselors when providing team-based care. These environments can help all students, not just counseling students, learn how to deal with complex issues and bridge theory to practice difficulties in providing clinical care as new professionals. Furthermore, these experiential learning opportunities are very important in IPEP because they offer environments in which professionals and students can interact and reflect on practices for improved care.

It is important to note that the four IPEC core competencies discussed earlier should always guide a program’s IPEP initiatives and curriculum. Students and faculty should be able to explain how the activity meets the competencies. Evaluation by participants for each event is critical to ensure that the goals of the training are being met and that it represents a valuable learning opportunity. Faculty development for counselor educators and other health disciplines and IPEP partners is critical to designing, developing, implementing and assessing successful learning opportunities.

In the planning of IPEP events, it is crucial to involve students from the beginning. They may have friends or contacts in other departments or community agencies that have resources or programs that can be used to help with planning and executing events. Encouraging students to take leadership roles in working with faculty to develop IPEP on campus is an excellent way to build their leadership skills and a commitment to interprofessional learning.

Value in counselor development

Incorporating IPEP into counselor education programs can increase opportunities for clinical participation with other related disciplines in a manner that helps counseling students develop a strong professional identity. Well-planned IPEP activities build on the knowledge being learned in the classroom and increase critical thinking skills by evaluating complex care needs from multiple perspectives. In addition, students see faculty and professionals from other disciplines working together during IPEP activities, modeling effective interprofessional teamwork that may not be experienced during training.   

IPEP training offers opportunities for students to better understand aspects of patient-centered care, holistic treatment and shared decision-making practices that guide teams in their goals for achieving outcomes. But most importantly, students enjoy IPEP events. They naturally form their own interdisciplinary groups for further discussion after participating in IPEP opportunities and develop friendships that can lead to building a better workforce in the future.

Our students have their own campuswide Student Executive Committee with representation from all the schools participating in IPEP. They plan formal and informal events that promote IPEP and serve as liaisons between the IPEP office and student groups across campus to increase awareness of interprofessional learning and collaboration as part of their academic experience. These students are leaders on campus and are also developing into our future leaders in counseling and in team-based community care. Actually, they are why we have a deep commitment to IPEP on our campus. And they are worth it.

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Judy Schmidt is the director of Interprofessional Education and Practice (IPEP) for the Department of Allied Health Sciences at the University of North Carolina at Chapel Hill. She is a member of the leadership team for the university’s Office of IPEP, which is dedicated to working collaboratively to transform health education and prepare professionals from different disciplines to work better together for quality patient care. She is a clinical assistant professor in the department and a certified rehabilitation counselor. Contact her at judy_schmidt@med.unc.edu.

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 ct.counseling.org/feedback.

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

Exploring class privilege in counselor education

By Cynthia Miller, Frankie Fachilla and Jennifer Greene-Rooks February 9, 2021

James is a student in the first year of his master’s program in counseling. Typically very conscientious and enthusiastic, he recently started to leave class early without any explanation. Last week, he missed all of his classes and did not contact anyone to explain his absence.

When his adviser calls him to express concern, James says that his car recently broke down and he does not have the money to pay for repairs. He’s been relying on friends to help him get to and from class. He’s been leaving early because that was the only time someone could give him a ride home. Last week, he couldn’t find anyone to give him a ride. He’s been too embarrassed to ask his classmates or his professors for help.

Stephanie is in the final year of her doctoral program and has been applying for teaching positions. Despite good grades, multiple honors within her program, good teaching reviews from students, and strong recommendations, she is having difficulty getting interviews. Stephanie recently received feedback that her curriculum vitae lacks evidence of significant professional involvement. Reviewers have been concerned that she has not shown evidence of attending or presenting at state, regional and national conferences. Although she is a member of the American Counseling Association, she has not joined any divisions or state chapters.

Stephanie is frustrated and discouraged. She has not been able to afford the registration, travel, lodging and meal expenses associated with conferences, nor could she pay for multiple professional memberships. She feels that her financial position during her doctoral studies is being held against her during her job search.

Celia is a single mother of three living in a multigenerational home with her children and her elderly parents. She has worked as a case manager for several years, and her supervisor has been consistently impressed with her work ethic, empathy, creativity and critical thinking. Her supervisor has been encouraging her to pursue her master’s degree for years.

Celia recently met with the program director of a counseling program at a local university. She was excited to learn about the classes she could take and the career possibilities that would be available to her if she enrolled and completed the degree. However, when Celia learned that she would have to complete an unpaid internship, she became discouraged. As the sole provider for her family, she cannot afford to give up her full-time job to do an unpaid internship, and the counseling program did not have any sites that offered internship hours only in the evenings and on weekends. Celia ultimately decided not to enroll.

Stories such as James’, Stephanie’s and Celia’s are familiar to many counselor educators, but these stories remain rarely discussed despite the counseling profession’s rich history of promoting awareness of, and respect for, issues pertaining to multiculturalism, diversity and social justice. Both the ACA Code of Ethics and the Multicultural and Social Justice Counseling Competencies developed by the Association for Multicultural Counseling and Development highlight the need for counselors to be aware of issues of privilege and oppression based on membership in various groups. Counselors are also called to understand how such issues affect the worldviews and concerns of the people they serve, and to work to reduce disparities that are based on privilege. 

As counselor educators and students in counseling training programs, we have observed that conversations about privilege and oppression are common in training but that they generally occur in two ways. First, the conversations typically use a lens that looks outward into societal structures while neglecting to use a lens that looks inward and focuses on how our own educational and professional structures create disparities. Second, such conversations most frequently center on advantages given to a person on the basis of sex, race, gender identity, ethnicity, sexual orientation, religion or age, while ignoring socioeconomic class. 

The lack of recognition of class privilege is also reflected in our research. Although a large body of research on privilege based on other criteria exists, there is very little research related to privilege based on class. However, our collective experience leads us to believe that class privilege is embedded in our counseling training programs in ways that create real barriers for entry into the counseling profession for all but the most economically privileged. This strikes us as a significant oversight in the conversation on privilege in general and a crucial issue to address if we are to live up to our ideals as a profession.

Understanding class privilege and classism

Class privilege is generally defined as the tangible or intangible unearned advantages enjoyed by someone of higher class status. At an individual level, indicators of class privilege include such things as the ability to own a home, support a household with one job or one salary, afford child care, pay for a vacation, enjoy frequent meals out or amass savings.

Class privilege exists within the larger construct of social class, which categorizes individuals into groups based on similar levels of wealth, power, resources or status. In the United States, discussions of social class are often considered taboo. As such, social class can be difficult to define. It is important to note, however, that social class does not refer merely to economic status — it also refers to other forms of capital available to an individual. In his 1986 essay “The Forms of Capital,” Pierre Bourdieu identified three different types of capital:

  • Economic capital — command of resources such as money, assets or property
  • Social capital — possession of a network of relationships that provide access to power, recognition or economic or cultural capital
  • Cultural capital — possession of education, knowledge or skills that provide an advantage when trying to obtain a higher social status

In the context of higher education, class privilege can present itself not only through differences in the amount and kind of capital available to students, but also through institutional and programmatic policies and expectations that privilege the holders of different types of capital over those who do not possess that capital. When students lack capital in comparison to their peers, or when they encounter institutional and programmatic policies that assume access to capital that they do not possess, they can experience marginalization and oppression. When marginalization or oppression occurs based on social class, it is referred to as classism

In our experience as graduate students and counselor educators, we have observed multiple ways in which class privilege and classism pervade graduate programs in counseling even as they go unacknowledged. We believe that ignoring students’ social class positions in counselor education programs facilitates microaggressions related to social class and perpetuates a system of oppression that must be acknowledged, explored and addressed if we are to truly live up to our ethical ideals.

Class privilege in counselor education systems

In 2019, a small group of counselor educators and counseling students began an informal discussion on the CESNET Listserv (CESNET-L) concerning the ways in which social class was perceived to create additional privileges and barriers for students in counseling programs. Participants in the conversation identified multiple ways in which class privilege is embedded in counseling programs. Their comments reflected experiences with class privilege based primarily on economic capital, although cultural capital and social capital were also mentioned. A review of that discussion follows.

Class privilege based on economic capital

Class privilege within counseling programs takes many forms, and although it may be overlooked by counselor educators, students are very aware of it. With respect to economic capital, participants in the discussion noted that class privilege is present from the very beginning of the training process when prospective students must be able to afford application fees and pay for required entrance exams such as the GRE graduate school entry exam. In addition, discussion participants pointed to the overall cost of counseling programs as a significant barrier and noted that many programs contain hidden fees that are not included in the advertised cost. These fees include such things as student activity fees, mandatory membership in professional organizations with significant dues, technology fees, fees for comprehensive exams such as the National Counselor Examination or the Counselor Preparation Comprehensive Examination, and graduation fees. Doctoral students, in particular, reported embedded expectations that they would attend conferences without any consideration of their ability to pay for travel, lodging, food and registration fees. 

In addition to the costs cited for applying to and attending counseling programs, there were concerns related to costs of living while enrolled. Participants in the discussion noted that students with dependents must find ways to cover child care or elder care and maintain an income that allows them to continue to pay for food, clothing and other household expenses. Because the majority of counselor training programs offer little in the way of grants or scholarships — particularly at the master’s level — the system appears skewed in a way that privileges those with greater economic capital who can afford the added financial burdens that come with enrollment. 

The unique problem of unpaid internships

The practicum/internship experience also exposes class privilege inherent in counseling programs. Practicum and internship experiences typically take about one year to complete and require students to devote between 10 and 20 hours per week to the experience. While the internship experience is an invaluable part of training, the vast majority of internships are unpaid. Some programs may even have internship policies prohibiting any form of payment.

This system inherently privileges those who can afford to give up full-time jobs to devote themselves to internship. Students who cannot afford that option find themselves trying to complete practicum and internship hours on top of working full time and attending classes. This creates a nearly untenable level of chronic stress and exhaustion that students who are more privileged do not have to bear. 

Class privilege based on cultural capital

Participants in the CESNET-L discussion also identified ways in which access to cultural capital creates advantages or disadvantages in graduate school. Among those identified were the quality of prior educational experiences, family members’ educational experiences and attainment, family expectations and support of educational attainment, and other experiences that supported educational attainment.

As much prior research has indicated, educational achievement is highly dependent on the quality of education beginning at the prekindergarten level and lasting through high school. Every year of educational experience sets the stage for the next and begins to build a set of advantages and disadvantages. Access to high-quality, heavily resourced elementary and high school education provides easier access to a college degree that prepares students adequately for graduate-level work in a counseling program. Gaps at any level leave students struggling to catch up. Students who did not attend high schools or colleges where writing was heavily emphasized, for example, may struggle to succeed in counseling programs that place a premium on strong writing skills.   

Another privilege that helps students access resources in graduate school is having family members or mentors who have enrolled in and completed higher education. Their knowledge can be capitalized on to navigate the educational system of graduate school. There seems to be a relationship between familial expectations and the willingness of students to take on the tough task of graduate school and then to stay enrolled. We are personally aware of students whose family members have not been supportive of their educational endeavors, interpreting the student’s pursuit of higher education as a rejection of the family’s culture. As they try to work on their degree, these students face the unenviable challenge of navigating a graduate culture in which they frequently feel they do not belong, while simultaneously receiving messages that they no longer fit in with their family either.

Class privilege based on social capital

Additionally, the CESNET-L conversation touched on aspects of privilege that are related to social capital or the ability to build social networks that support access within graduate programs and to employment. Generally, social capital is related to extracurricular activities and family occupations that result in networking opportunities. In counselor education programs and employment, social capital is built through program and department social events, conferences that allow and create networking opportunities, and other situations that support access to mentoring. 

The luxury of time is a frequently overlooked form of social capital. Students who do not have outside jobs, caretaking obligations or other responsibilities are able to attend extracurricular events, participate in honor society meetings and attend presentations at agencies in their communities. The same is true for students who have strong support systems that can be called on to help with their other responsibilities and obligations so that they can participate in professional events. Students without the luxury of time to participate in outside events and develop their networks can find themselves at a disadvantage relative to their more privileged peers once they begin searching for jobs.   

Getting to know our students and addressing class privilege

The CESNET-L discussion provided anecdotal evidence for the idea that class privilege is embedded in the structure of counselor education in multiple ways. But how extensive is the problem? In considering that question, we realized that we did not have any good data on who our counseling students really are with respect to class and class struggles. 

In an attempt to answer the question, research teams have formed to gather quantitative and qualitative data about who our counseling students are with respect to their social class and what their experiences have been with class privilege and classism. We hope that data culled from this research will provide the foundation for a more critical and comprehensive examination of our current training system and result in structural changes that make it easier for students from less privileged backgrounds to obtain a counseling degree.

In the meantime, we believe counselor educators can take some steps now to begin addressing class privilege in a more conscious way: 

  • Consider broaching the issue of class privilege with all students. Individual advising should include a discussion of barriers for students related to class. Group conversations during coursework about privilege and oppression can also incorporate class, alongside other forms of privilege due to gender, race or sexual identity. These conversations will help bring class privilege out of the shadows.
  • Implement a more formal process to survey students at different stages in the program to assess their levels of economic, cultural and social capital. These survey results can be incorporated into the program’s evaluation plan. For example, how many students would struggle to complete internship hours during the typical 9-to-5 workday? How many internship sites offer hours outside of that time frame that students can access? Should programs seek relationships with additional alternative sites that offer weekend and evening hours?
  • Develop aggressive fundraising strategies that emphasize the critical role counselors play in addressing the mental health needs of the community. For programs in universities with strong development offices, this may require advocating for greater visibility of the needs of counseling students among the university’s donors. For programs without strong development offices, it could mean advocating for the creation of a development position. Even if more funding for assistantships is not available, strategies can be developed to help students raise funds to attend conferences or other professional development activities. Any degree of financial help will decrease barriers related to economic privilege.
  • Reduce barriers to paid internships. If sites have the ability to pay students for internships, they should be allowed to do so. However, many sites simply lack the funding necessary to pay interns because they cannot bill for services provided by interns. This requires advocacy with managed care organizations at the state and national levels to allow agencies to bill for services provided by students under the supervision of licensed staff.   
  • Create a formal mentorship program in which students who desire mentorship are paired with faculty, graduates or, potentially, more advanced students in the program. Informal mentorship will, by default, favor students with more class privilege (those who have time to attend departmental events or informally attend office hours for faculty). A formal mentorship process decreases these barriers. Formal mentorship programs also create opportunities for the mentors (more advanced students, doctoral students or alumni) to add experience to their résumés.

Final thoughts

Graduate programs in counseling emerged in the mid-20th century, at a time when higher education was less expensive, costs of living were not as high, and families were easier to support on a single wage. Privilege in graduate education on the basis of sex, race, gender identity, age and other characteristics certainly existed at the time these programs were created and still exists today, but much progress has been made in the past few decades in terms of recognizing and actively addressing those barriers. Class privilege, however, has gone largely unaddressed, even as economic disparities widen. 

We acknowledge that the steps outlined above are not representative of an exhaustive list of all possible steps that could be taken to address class privilege in counseling training programs. However, we believe the steps provide a starting point for counselor educators to more fully enact the ethical call to work to reduce disparities by intentionally addressing class privilege in their program structures. We also hope that our ongoing research will lead to a greater understanding of who our counseling students are with respect to their social class positions so that we can create a training system that better meets the needs of students in the 21st century.

 

For additional information about class privilege and our research, visit our website at https://classprivilegeinces.wixsite.com/mysite.

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Related reading, from the Counseling Today archives: “Cultivating social class awareness in the counseling profession

 

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Cynthia Miller is a licensed professional counselor and counselor educator with a private practice in Charlottesville, Virginia. She has been a practicing counselor for almost 20 years, working with adults in university, community and correctional settings. Contact her at cynthiamillerlpc@gmail.com.

Frankie Fachilla is a licensed professional counselor with 12 years of full-time counseling experience in community mental health and correctional settings. She now provides trainings on evidence-based practices, supervision and coaching to clinicians in community mental health settings. Contact her at frankiefachilla@gmail.com.

Jennifer Greene-Rooks is a counselor educator with a research background in areas such as multicultural counseling competence, counselor preparation and supervision, school counseling, and leadership. Her background is in school counseling, although she now focuses on the preparation of multiculturally competent, social justice-focused counselors. Contact her at jgreene@txstate.edu.

 

Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

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

A note of encouragement for counseling students during COVID-19

By Dana M. Cea April 7, 2020

The current situation with COVID-19 and the effect it is having on counseling students’ lives can cause stress, anxiety and uncertainty. In my role as a doctoral student supervisor, I am hearing these stories from supervisees and their classmates. Thankfully, my department, the Department of Addictions and Rehabilitation Studies at East Carolina University, has jumped to action to support all of its students, especially the practicum and internship students. However, the faculty are limited in what they can do based on decisions made by the Council for Accreditation of Counseling and Related Educational Programs (CACREP).

Keep in mind that there are more than 800 CACREP-accredited programs, which could mean over 10,000 counseling students. All of you are in the same boat and are doing your best to stay afloat. Without flexibility in standards, we could find ourselves with an even larger shortage of mental health professionals over the next couple of years.

As graduate counseling students, you have no control over CACREP, of course. What do you have control over? The following recommendations may not be new to you, yet they are helpful. In fact, you may already be sharing some of these with clients.

Keep your schedule. We all know how helpful schedules and routines are in maintaining our mental health. Although you may not be going to classes or work sites right now, keeping the schedule you had previously or adjusting to a new reasonable schedule is wise. Include a morning routine and a routine for bedtime. If you find that you suddenly have a little extra time each day, explore options for how you can use that time, such as sleeping in, exercising, meditating or doing crafts.

Check in with classmates and colleagues. My Ph.D. student cohort has a group chat, and the Navigate Counseling Clinic where I provide counseling services does too. One day during our “spring break 2.0,” I realized how much I missed seeing my cohort and needed a check-in. When I scheduled a video conference, the other members of my cohort found this funny because I am not known to be the most touchy-feely person. But seeing their faces was so helpful for me. We also host weekly video conferences with the Navigate clinicians, internship students and practicum students. Group chats are great, especially for pet photos and memes, yet video conferences take that connection to the next level.

Check in with your progress. Now is a great time to figure out what you need before you take that next step, whether it be for practicum, internship or becoming licensed. Seek help from faculty, supervisors, webinars and other learning opportunities. I created a “counselor dunking booth” in which supervisees are able to play a short clip of a TV show, movie or counseling tape or create a case study and challenge me concerning how I would address the situation or client. Even if you are unable to go to your site or do telehealth, there are many opportunities to sharpen your skills, knowledge and abilities.

Check in with yourself. How are you holding up under the current stress? Is it affecting your ability to work with clients or complete necessary coursework? If you are having a hard time answering these questions, ask those who know you best. Now may be a good time to find a counselor for yourself if you have not done so already.

Many counselors are indicating their ability to provide telehealth on their personal websites or on Psychology Today’s Find a Therapist directory. The Pandemic Therapists website is compiling a nationwide list of counselors providing support during the current situation. Keep checking back because new resources are being added. If money is a concern, some counselors may offer sessions for free or for a small fee to counseling students. Also check out Open Path Collective and Give An Hour. Do not forget to connect with your state’s National Alliance on Mental Illness organizations and affiliates. The national organization has a helpline that can assist you in finding counselors.

The bottom line is that as a counseling student today, you will be even better prepared than some licensed clinicians once you enter the counseling field. You will be able to show great empathy to clients when they seek services to manage the lasting effects of the COVID-19 pandemic. You likely will have gone through a crash course in telehealth or, at the very least, learned how to quickly shift your learning online. You will have a deeper understanding and appreciation for the human connections that we offer to clients as counselors.

You will emerge stronger for having gone through this experience.

 

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Dana M. Cea, pronouns she/her or they/them, is a volunteer for the National Alliance on Mental Illness and the American Foundation for Suicide Prevention, a mental health professional, a survivor of suicide loss, and a doctoral student at East Carolina University. She focuses her research on mental health and suicide, the LGBTQ+ community, youth, and autism spectrum disorder. Dana lives with mental health disorders, her spouse, and their three dogs. Contact her at danamcea.com.

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

Human rights 101, Part 2: Implications for graduate students and counselor education programs

By Clark D. Ausloos and Taylor Nelson December 2, 2019

Part one of our two-part series provided a foundation of the importance of human rights, the relevance to professional counseling, and practical strategies to use when working with clients who have experienced human rights violations. Part two focuses on human rights, social justice and advocacy related to counseling graduate students and counselor education programs.

Many people enter the counseling profession because they have a desire to help people. They have a knack for listening and possess a genuine curiosity for the human condition. Many students have a passion for mending, repairing and supporting others towards self-actualization. In many introductory graduate classes, students explore the foundations of the counseling profession, learning about psychotherapy pioneers such as Sigmund Freud, Carl Jung, Alfred Adler, Frank Parsons, and Carl Rogers, and learn necessary basic skills in order to best help clients.

However, graduate students are not often given clear direction on how to execute one essential ethical mandate dictated in the ACA Code of Ethics: to “advocate at individual, group, institutional, and societal levels to address barriers and obstacles that inhibit access and/or the growth and development of clients” (A.7.a). Advocacy can seem confusing and challenging to graduate students – some might even think: I didn’t become a counselor to engage in advocacy. Many graduate students are unclear as to the multifaceted roles that counselors have, including the component of advocacy as it relates to human rights issues. This lack of clarity is not unfounded  –  professional counselors often lack consensus on how best to advocate for and on behalf of their clients’ human rights.

Multiculturalism, social justice and human rights

Counseling is a young profession and has seen many developments throughout the years. Starting in the late 1980s, professional counselors saw a need for attention to diversity in clinical and educational settings. Increasingly, counselors were diagnosing and treating individuals who differed culturally from themselves. Therefore, the needs of the profession shifted, however slowly, to meet the needs of consumers. At that time, scholarship focused on racial and ethnic identities in counseling, and mainly examined the relationship between a professional counselor’s ethnocultural identity and that of the client. In the 1990s, Garry Walz and colleagues identified significant trends that should inform future counseling, including developing skills in counseling older adults, counseling family systems, a commitment to multiculturalism, and most salient to this article, the development of advocacy skills.

In 1992, ACA’s first Multicultural Counseling Competencies (MCC) were developed for professional counseling. Becoming competent in multicultural counseling would require counselors to not only understand and honor the diverse customs of different cultures but to recognize the additional barriers many client groups faced. Meeting the needs of disadvantaged clients would require not just knowledge, but action. In 1998, the American Counseling Association (ACA) formed a new division — Counselors for Social Justice (CSJ)— to implement social action strategies aimed at the empowerment of clients and oppressed individuals and groups. With the increasing awareness that social justice concerns must take a prominent role in the profession, the need for individual counselors to gain competency became clear. Because social justice and multicultural issues are inherently linked, the competencies were incorporated into an adapted version of the MCC in 2015, creating the Multicultural and Social Justice Counseling Competencies (MSJCC). At the same time awareness of the importance of advocacy—both for the profession itself and for counselors’ work with clients—was growing and became a focus for ACA leaders. A task force was created to develop advocacy competencies. The ACA Advocacy Competencies were completed in 2003 to provide guidance for counselor advocacy at the micro (e.g., clients, students), meso (e.g., communities, organizations), and macro (e.g. to reflect the profession’s growing understanding of the use of advocacy with clients and their communities and were updated in 2018.

Still, with all of this information, graduate students may be left wondering, “what exactly does this mean for me?”

As mentioned in part one of our series, human rights are civil, political and/or cultural rights that are afforded to humans regardless of our intersecting identities. When these rights of our clients are violated, there are tremendous mental health repercussions. Counselors-in-training need to understand the complexities of human rights issues, when and how these rights are violated, and the ways they can engage in advocacy around these issues.

There is a clear connection between social justice, advocacy and human rights. At times, social justice can be combined with advocacy, creating social justice advocacy, which can be described as organized efforts aimed at influencing sociopolitical outcomes, often with or on behalf of vulnerable, marginalized populations. Whether direct system intervention or collaborative advocacy with clients or client groups, counselors-in-training and practicing counselors need to be able to conceptualize and execute advocacy and social justice strategies to mitigate health disparities caused by human rights violations.

The impact of human rights on graduate students

Beginning counseling students are asked to reflect upon their own worldviews and to begin to form a framework from which they will work with clients – a theoretical orientation. It is likely that human rights issues have, in some way, affected students’ lives prior to entering graduate school.

Tracy, for example, is a graduate student who has encountered societal barriers due to their non-binary gender identity (non-binary denotes a gender identity that is not defined in terms of the traditional binary of male or female). Tracy has faced discrimination in schools, was forced to use a bathroom that was not congruent with their identity and has encountered challenges with changing their gender marker on legal documents. This pattern of harassment and obstruction has not only impeded Tracy’s pursuit of their right to a quality education—it has threatened their personal safety. As a counselor in training, Tracy’s worldview and the way they approach counseling will be directly affected by these violations of their human rights.

In contrast, Anthony is a counseling graduate student with numerous identities. As a White, heterosexual, cisgender male, Anthony has experienced very few human rights violations. Yet human rights issues have already had an effect on Anthony’s worldview and theoretical orientation. Because Anthony has not experienced discrimination due to gender identity or sexual orientation, has not experienced poverty, harsh criminal sentencing and does not face obstacles related to legal documents or using public restrooms, his understanding of the relationship between human rights and counseling will be markedly different than Tracy’s.

These two examples demonstrate that when students begin their counselor training, their views on human rights issues have already been shaped by their experiences. A student who has not experienced violations has potentially started to develop a worldview that may not include an understanding of human rights issues. In contrast, a student who has experienced violations not only has an understanding of human rights issues but has been shaped by the difficulties they faced. These divergent experiences will affect the students’ training and may have a significant influence on their work as professional counselors. Thus, it is essential to intentionally address these issues in graduate school.

Learning the effectiveness of clinical interventions in counseling sessions is an established and vital part of graduate students’ training. However, it is equally imperative that counselors-in-training learn how effective—and necessary—it is to work with clients in varying groups and levels, such as families, groups, and at the community or other systemic level. Using a social justice and advocacy approach allows counselors to empower marginalized clients while also working to change the existing external environments for the clients.

For example, as a counselor-in-training, Anthony may work with a 14-year old bisexual, transgender person of color who has experienced time in the criminal justice system. To provide effective counseling, Anthony not only needs to know information about the current justice system, youth under the law, gender, sexuality and racial and ethnic identities and how this impacts his clients health, but also ways to systemically advocate with and on behalf of this client, as an essential part of ethical treatment and attention to social justice.

Anthony can get this critical information by using resources such as Human Rights Watch, an international organization which investigates and reports on human rights-related violations around the world lists several current human rights concerns on their website: Harsh criminal sentencing, racial disparities, drug policy and policing, children in the criminal justice systems, hate crimes, rights of non-citizens, sexual orientation and gender identity, women’ and girls’ rights, and national security, among others.

Human rights and counselor education programs

In many counselor education programs, human rights issues are often introduced in multicultural and diversity courses, as well as in courses that teach about ethical and legal issues within counseling. However, this is not enough. Additional training is needed but is unlikely to be available to students because most education programs do not offer elective courses in human rights issues. It is often the responsibility of course instructors to take the lead by incorporating human rights issues throughout coursework.

Sufficiently educating students on human rights issues will require curricula and systemic change and will also require counselor educators to self-reflect and understand how human rights issues shaped their own worldview, which will, in turn, affect their work with students. If instructors model silence surrounding these issues, students may graduate from counselor education programs lacking the human rights knowledge that is critical to their work as professional counselors. Counselor educators need to teach students that any reflection on the factors that have shaped their worldview is incomplete without examining human rights issues. The extent of the effect of human rights issues on individuals is evident by examining the significant difference in the lived experiences of Anthony and Tracy.

Although scholarly research plays a part in any graduate program, the expectations for master’s level counseling students are different than those in doctoral programs. Some master’s programs may not assign regular research projects to students. In contrast, doctoral students undertake rigorous research into clinical counseling practices and improvement in counselor education and training. Because human rights issues play an important role in these topics, students are likely to encounter clear examples of violations. For example, research examining the counseling experiences of single mothers of color in poverty might explore systemic barriers and oppression these people face, which are direct violations of human rights.

By not giving students significant exposure to research, counselor education programs are missing an opportunity for counselor trainees to be exposed to human rights issues. The old adage “meet clients where they are at” provides a helpful framework for understanding the need to integrate human rights issues into counseling programs. As part of their training, counseling students provide services to a client base that includes members of society who regularly experience human rights violations. Without an understanding of the myriad forms human rights violations can take (see part one of this series for examples) and an awareness of which populations regularly experience issues—and the physical and mental health damage caused—counselors-in-training will be ill-equipped to meet the needs of their clients.

When counselor education programs minimize or outright ignore human rights concepts in students’ training, they could potentially be causing potential harm to future clients. Nonmaleficence — avoiding actions that cause harm — is one of the fundamental ethical principles of counseling set out in the ACA Code of Ethics preamble. Intentionally infusing social justice advocacy and human rights components into the array of coursework will benefit graduate students’ self-efficacy, their clients, and, ultimately, society at large.

 

In the following section, we provide several strategies for graduate students, counselor educators, and counselor education programs to attend to human rights issues and incorporate advocacy and social justice strategies into the classroom:

For graduate students:

  • Mitigate imposter syndrome related to advocacy by managing self-talk, reflecting on accomplishments, normalizing with other graduate students, and practicing self-grace and compassion.
  • Call, text, email, or write to local, state and national legislative representatives on issues that directly impact human rights issues.
  • Engage in continuous self-assessment related to your own advocacy and social justice competency, by using advocacy competency self-assessment tools and surveys.
  • Conduct research that relates to human rights issues and propose/present it at local, regional, and national counseling conferences.
  • Develop and update a list of local, regional, state, and national resources for clients who experience human rights violations.

For counselor education programs and educators:

  • Foster intentional discussions about current human rights issues throughout all areas of counselor training, in addition to diversity, lifespan, and legal/ethical courses.
  • Integrate human rights issues into case studies and clinical examples so graduate students can experience “real world” examples of clients in training programs, prior to practicum and internship experiences.
  • Co-construct specific advocacy and social justice plans as part of coursework that allows graduate students an opportunity to actively participate in these strategies outside of their practicum or internship counseling sessions.
  • Structure clinical experiences that allow students to work with diverse clients and settings. One way to do this might be to work with the program’s clinical coordinator to ensure practicum and internship sites are varied and, if possible, host a variety of clients with a variety of presenting issues.
  • Teach human rights violation assessment as part of a comprehensive biopsychosocial diagnostic evaluation.
  • Allow guest speakers who have experienced human rights violations in the classroom. The personal stories of people who have lived through human rights violations provide a more vivid and compelling understanding than a lecture containing abstract examples. Mentor and model students in research that relates to human rights issues and empower them to propose/present it at local, regional and national counseling conferences.

 

Counselor education programs can also expand outside awareness of human rights issues in a variety of ways:

  • Create statements (with university permission) of support or resolutions that can increase the visibility of and address barriers to human rights issues.
  • Host “days of awareness,” with various human rights topics addressed on different days through flyers, posters or with guest speakers via workshops or panels.
  • Partner with other departments, when possible, in order to cast a wider net of influence and awareness of human rights issues.

 

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Clark D. Ausloos is a doctoral candidate at the University of Toledo. He is a licensed school counselor and currently practices as a licensed professional counselor in a private practice setting in Northwest Ohio. Contact him at clark.ausloos@utoledo.edu.

Ausloos was a member of the American Counseling Association’s Human Rights Committee, as were the authors of the first article in this series.

Taylor M. Nelson is a second-year doctoral student at the University of Toledo. She is a licensed professional counselor in Ohio, working in an inpatient psychiatric hospital setting. Contact her at Taylor.Nelson2@rockets.utoledo.edu.

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

From the President: Sustaining the lifeblood of our profession

Heather Trepal

Heather Trepal, the 68th president of the American Counseling Association

December is here, a time of year (along with the months of May and August) when many colleges and universities hold commencement. The prospect of completing a hard-earned master’s or doctoral degree in counseling is both awesome and daunting. Rightly, graduates are proud of the time and personal and financial investments they have put into earning their degrees. We know that counselors spend roughly four years on their undergraduate degrees and then an average of three years on their master’s degrees.

Even after this robust educational preparation, counselors who wish to become licensed spend another two to three years working under supervision. In addition, counselors sometimes work to obtain certifications in their specialty areas or to become eligible for employment in various settings. We are a well-prepared group of professionals!

We are also in high demand, with severe shortages of behavioral health providers in some states (see “Maldistribution: Mental health care in America,” an online exclusive at CT Online). Although we all know that our profession is robust and that we need to continue to educate our growing behavioral health workforce, there is an important gap. To illustrate my point, I want to share an email that I received:

“I’ve noticed something happening with people graduating from the counseling program, not only at my school but all over the state. I’ve noticed many people graduate and are unable to pursue licensure because they can’t afford supervision or they need a full-time job so they can have medical insurance. I’ve noticed people using the school’s insurance and then panicking when they graduate because they can’t go without insurance and they can’t get a full-time position as a counselor intern until they secure a supervisor and get their license, which can take weeks/months. I would love to do advocacy work for this issue, but I don’t know where to begin. I was wondering if you could point me in the right direction? I don’t know if I need to speak to legislators or the school or the board or the ACA.”

Unfortunately, emails like this one are not uncommon. We have many graduate students and new professionals who are concerned about the prospect of launching their careers. In addition to the practical barriers related to employment, finances and medical insurance, there are the complexities of pursuing licensure or certification, including obtaining supervision.

As a counselor educator and supervisor, I am keenly aware of this pressing issue. In fact, this year, Thelma Duffey is chairing a task force to examine ways ACA can support new professionals and early career counselors. The creation of this task force was partly inspired by a project in Thelma’s career class on advocacy for graduate students and new professionals. The task force is collecting data on such issues as new professional compensation across settings (both geographically and among professions); expanding opportunities for counselors in nontraditional settings; and highlighting transferable skills to corporations, health care organizations, industry, and higher education. Recognizing the great needs of counselors before they are licensed to practice independently, I have asked the task force to also explore the post-graduation licensure internship and supervision experiences of our counselors and recommend advocacy directions. I have also asked our Professional Standards Committee to examine the licensure, certification and practice trends for this group of professional counselors.

I am inspired by the advocacy work of one of our ACA members, Summer Allen, who founded the Texas LPC Intern Association. In Texas, pre-independently licensed counselors, or those who have graduated from a master’s program and are working on supervised licensure hours, are called “interns.” The mission of this organization is to “support the professional development of current and future LPC Interns through free resources, support, community, and advocacy.” In fact, one of its first advocacy efforts was aimed at petitioning the state and licensure board to change the title from LPC intern to LPC associate. Please visit txlpcinterns.com to learn more about the organization’s efforts.

It is often said that graduate students are the lifeblood of our profession. The joy of working with them and supporting them on their journey is one of the main reasons that I became a counselor educator. I implore our ACA branches, divisions, regions, and sister organizations to pay attention to this group of professional counselors. If you know of other organizations and grassroots efforts aimed at supporting new professionals and early career counselors, please reach out and let me know.

 

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Follow Heather on Twitter @HeatherTrepal