Tag Archives: Counselor Educators Audience

Counselor Educators Audience

Reading fiction as a means to greater empathy

Kathleen Smith October 3, 2012

(Photo:Wikimedia Commons)

For many counselors, retreating into the depths of a novel can often be a much-needed and well-applauded act of self-care. But can reading fiction actually make someone a better counselor? Empathy-focused research in the past few years suggests that this may very well be a possibility.

Keith Oatley, a cognitive psychologist at the University of Toronto, and Raymond Mar, a psychologist at York University in Canada, have found that people who read fiction on a regular basis appear to be more equipped to understand and empathize with others. This correlation between reading fiction and empathy held up even when the researchers controlled for variables such as personality traits, age and gender.

What is perhaps even more intriguing in Mar and Oatley’s findings is the discovery that this correlation is particular to fiction, with readers of expository nonfiction performing at lower levels on empathy tasks. Fiction readers also reported less loneliness, less stress and larger social networks. This reality provides a surprising challenge to the stereotype of the bookworm with a deficit of social skills.

What then are the implications of these observations for counseling students, who may find themselves with little time to read anything other than the academic, nonfiction texts assigned by their professors? Many educators in the counseling field have responded by turning to fiction as a source for engendering greater empathy in their students who are delving into their initial interactions with clients.

“I’ve used fictional novels as case studies, and they provide students with opportunities to experience empathy in a variety of situations that they might see in their professional work but don’t necessarily experience in the course of their training,” says Marinn Pierce, assistant professor of counselor education at California State University, Fresno.

This exploration can prove quite effective, as recent neuroscience research has demonstrated that the brain does not register a significant difference between real life experience and events in a novel. Therefore, students can turn to fictional characters’ thoughts and emotions to gain clearer perceptions of what their clients may be experiencing. “Students come to me concerned about how they might respond to certain situations in counseling practice, and fictional novels can be a safe way to begin to explore their values and reactions to some of these situations,” Pierce says.

Educators have also found fiction to be a useful tool in the development of multicultural empathy. “I offer opportunities for students to read works of fiction in our multicultural counseling course and ask that students select works by authors different from themselves,” says Cheree Hammond, assistant professor of counseling at Eastern Mennonite University in Harrisonburg, Va. “Through this opportunity, students are able to gain perspective on lived experiences that contrast with their own, while at the same time connecting with universal themes that permeate the human experience: love and loss, striving and achieving.”

The use of creative tools like fictional narrative in the counselor education field remains a ripe area for research, and educators like Donna Gibson, associate professor in the University of South Carolina’s counselor education program, have been eager to observe how fiction can influence a student’s perspective. Using Harry Potter and the Sorcerer’s Stone as a tool for eliciting empathy in school counseling students, Gibson found in her 2007 study that the novel provided a secure environment as the students learned to flex their empathic muscles.

“In this case, it encouraged students to explore their own feelings and thoughts within the safety net of the fictional character Harry’s world,” writes Gibson. “It gave them the opportunity to explore possible hypotheses related to the main character’s personality, family and friends. In this process, many of the students learned to understand different aspects of themselves, which is a form of self-awareness that is often a goal in counselor education programs.”

Though research thus far has only been able to demonstrate a correlational relationship between reading fiction and empathy, the strength of the relationship should not be ignored. Whether there is a difference between readers who engage in fiction for pleasure and students who are assigned novels for a counseling course, however, remains unanswered.

“This is pure speculation, but I believe it’s possible that being assigned to read fiction can lead to similar benefits as reading fiction for pleasure,” Mar says. “It’s possible, then, that assigning particular fiction books that illustrate parallel problems as those possessed by a client could prove helpful.”

Until that correlation is established, however, it is safe to say that counselors and students alike could benefit from tossing aside academic texts and retreating into a novel now and then. A place where thoughts, emotions, frustrations and desires flow freely, without the necessary tug of the therapeutic process.

Kathleen Smith is a doctoral student in counseling at George Washington University. She can be reached at ak_smith@gwmail.gwu.edu.

Simple therapeutic interventions for rewiring the maladaptive brain

By Nicholette Leanza October 1, 2012

When taking my undergraduate and graduate classes many moons ago, my least favorite courses were Biopsychology and Cognitive Processes, during which our professors would lecture at great length about the structure and function of the brain. As a student embarking on a new career in mental health, I was aware I needed to know this important information, but I just couldn’t get into it. So, I skipped along in my career, content to understand the basics of the traumabrain without really applying this knowledge in any useful manner.

But a few years ago, while researching ways to keep my counseling techniques fresh, I came across several articles that covered the most recent discoveries in neuroscience. That research ignited my current love affair with the most complex organ in the universe — the human brain — and helped me to understand how people really change their behaviors.

Let’s take a moment and ponder that question: What really causes an individual to change his or her behavior? You might answer that question in many ways depending on your theoretical perspective and on your specific observations and experiences dissecting human behavior. Regardless of how you answer, one fact is that change must first occur at the neurological level before we will see it at the behavioral level.

Understanding the biology of the human brain can also assist clinicians with understanding how and why people change. Clinicians are successful at their craft when they can produce a physical change in their clients’ brains. Obviously, they cannot get inside and rewire a brain, but they can set up conditions that favor this rewiring and create an environment that nurtures it (see The Art of Changing the Brain by James E. Zull). This article will explore how individuals change their behavior neurologically and examine some therapeutic techniques to stimulate this fascinating process.

Neural networks

The human brain is constructed of a vast amount of neural networks that form every thought or experience people have in their lives. Neuroscientists have found that these networks are interconnected as an intricate web of memories, thoughts and experiences. Hearing a special song can kick-start a flurry of recollections; a particular scent can guide an individual toward a memory of a particular person or place. This phenomenon indicates how the brain is circuited for memory.

For example, take the word teacher. Each person has a specific neural net that was created on the basis of experiences with the various teachers in his or her life. Another way to look at this is as a type of associative memory. Thoughts, ideas and feelings are constructed and interconnected in a neural net that may also have a potential relationship with another network of neurons. So, mention the word teacher, and one individual may automatically picture her lovely fifth-grade teacher, while another person might think of his difficult college math instructor.

Feelings and emotions are also entangled within neural networks. For example, the word love is stored in a vast neural net that is based on an individual’s experience with that term. Subsequently, the concept of love is also created from many other ideas. For some people, love may be connected to the memory of disappointment, pain or anger. Anger may be linked to hurt, which may be linked to a specific person, which then is connected back to love (for more on this, see What the Bleep Do We Know!? by William Arntz, Betsy Chasse and Mark Vicente). Therefore, when a person thinks of “love,” she may remember the person who broke her heart and still be angry about it. In essence, the enormous number of neural nets that each human possesses color all of his or her perceptions and interactions with other people.

Neurocounseling

Insights in the field of neuroscience reveal that many emotional and behavioral disorders previously believed to be the product of environment or experiences can be rooted in neurobiology. This is what synchronizes us to the idea of “neurocounseling,” the term I use to describe therapeutic interventions that assist people in changing their maladaptive neural connections. Other terms that also describe these types of techniques are “brain-based therapy” (John B. Arden and Lloyd Linford) and “neural pathway restructuring” (Debra Fentress).

When one thinks of his or her life experiences, what is being contemplated is really the experience of that person’s neurons. The experience cannot be predicted because it comes from the complex and random events of one’s life, and it cannot be programmed. Counselors strive for their clients to understand their maladaptive behaviors, and this is accomplished through the changing of the individual’s neural connections. Unless some change in these connections takes place, no progress or understanding will occur.

One important note is that counselors cannot remove specific neural nets that already have been established in a person’s brain. According to Zull, these nets actually leave a physical imprint on the brain. Instead, counselors must let clients use the neural nets they have already built — and which are related to clients’ own life experiences — and then use those as the foundation for motivating new neural nets to blossom. This is the only way a person learns new information and changes his or her behavior.

People must be able to relate to something before they can understand it, which is why the set neural nets are so important. If no established net exists, the individual has no reference point to understand or to change. Counselors may wish for clients to have more positive connections that cradle their self-esteem in the specific neural networks or fewer connections when it comes to their addiction to gambling, but unless some change takes place in these connections, no progress or change in behavior will occur.

Changing neural networks

The first step to facilitating change in neural nets is to identify them. One way to figure this out is simply to have clients talk about previous life experiences. The counselor’s job is merely to listen and pay attention to what clients say about themselves. Even in the first therapy session, as we build rapport and gather information about the client’s history, we can begin to identify his or her neural networks. By asking numerous questions, we generally get a feel for the individual’s overall issues such as difficulty trusting others, low self-esteem or poor anger control. As we identify the client’s established neural networks, we also can begin to work within the realm of the client’s experiences.

Identifying a client’s neural networks and inspiring a physical change in the client’s brain involves seeing counseling in a different light, which can likewise encourage new counseling techniques. Remembering how personal and individual a person’s neural nets can be allows counselors to experiment in different sensory avenues such as art therapy, music, therapeutic stories, psychodrama and other creative techniques. Each of these avenues can help facilitate the process of engagement and provide interesting ways to stimulate the senses. This type of sensory input will engage the networks to be active and open to learning new information. Neurons that are repeatedly used grow stronger. The more these neurons fire, the more they send out new branches looking for fresh and useful connections. Neural networks are also flexible, meaning new experiences can be added to old ones and old ones can be blended with the new. As new and different networks fire, the brain will form new connections and will physically begin to change.

One of the best approaches good clinicians can take is to help clients feel they are in control. One way to do this is to allow clients to draw from their own experiences. Clients often come to therapy with some positive networks already established, and once those networks are understood, clinicians can build on them. As previously mentioned, engaging clients’ senses through creative therapeutic techniques can be helpful in stimulating their interest in therapy and in generating new neural networks. Furthermore, cognitive behavior techniques such as “thought stopping” and “thought replacement” can be useful in creating the framework for new nets. When fresh neural nets bloom because of an insight gained into a situation or a behavior, the counselor can be assured that the client is on the path to healing.

Case example

I recently worked with a client who was referred with issues of anger and depression. She struggled with controlling her temper and often would have outbursts of anger toward others at her job, at home and at school. She also had a tendency to become easily frustrated. In gathering information about her background and experiences, I deduced that many of her neural networks were dedicated to anger over the physical and emotional abuse her mother had perpetrated on her as a child. As I began to understand her realm of experiences and relate them to the biology of her brain, I recognized that her brain was essentially wired for anger.

During one of our initial sessions, this client shared that her mother had also been a victim of physical and emotional abuse as a child. Because the client already had an established net for what it was like to be abused, I was able to guide her toward the insight that her mother was also most likely struggling with anger and depression stemming from her own abuse issues. The client was able to identify this insight because of her already established neural net and was able to begin to work on seeing her mother from a different perspective. She blended her old neural net — anger toward her mother — with a new neural net of being able to empathize with her mother.

Because networks grow stronger the more they are used, I knew it was important to keep the client seeing things from a new perspective. Building on the foundation of several important insights, I was able to help the client continue to change her thinking and reactions toward her mother, which in turn led to a decrease in her own anger. The biological change of her neurons directed the change in her thoughts, which ultimately changed the wiring in her brain. My role was to help her identify the neural net maintaining her anger, assist her to build a new neural net based on insight and empathy, help her to continually reinforce this healthier neural net and then help her to make the net stronger through use and application.

Conclusion

Teaming the fields of counseling and neuroscience demonstrates how these two disciplines can enhance each other. The human brain is a learning organ, and by exploring the biology of the brain, mental health professionals and neuroscientists can discover new and innovative approaches for the advancement of both fields. Mental health professionals who understand the biology of the brain will find it a valuable asset in also understanding how change occurs in human behavior. The practice of identifying established neural networks and then building on them to form positive connections will lead clients to change their maladaptive behaviors. In essence, a person’s neural nets are the building blocks that construct their thoughts, which ultimately create their reality and perceptions.

To increase the likelihood that new connections will form, it is important to work with clients’ current established neural nets, which will enable clients to gain greater insight into themselves or their situations. Therapy techniques that engage the sensory brain are often helpful in facilitating the neural creation process. Furthermore, cognitive behavior techniques can help clients use more effective and adaptive networks.

As neuroscience continues to unlock the mysteries of the human brain, it is imperative that mental health professionals pay attention to these revelations so that a more thorough understanding of the secrets to human behavior can be discovered.

 

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Nicholette Leanza is a supervising professional clinical counselor and licensed psychotherapist with substantial experience working with children, adolescents and adults in a variety of treatment settings. She works as an adjunct instructor of psychology and sociology at the University of Phoenix, Cleveland Campus. Contact her at nleanza1@gmail.com.

Letters to the editor: ct@counseling.org

ACA keynote speakers view counseling process from different angles

Heather Rudow

The keynote speakers for the American Counseling Association 2013 Conference & Expo in Cincinnati (March 20-24) are well known in their respective fields. The circles in which they are famous and the perspectives from which they view the counseling process are quite different, however.

Actor, humanitarian and mental health advocate Ashley Judd will present the conference’s opening keynote on March 22. Allen Ivey and Mary Bradford Ivey, counselors with a strong background in neuroscience, will follow on March 23 with a keynote titled “What Counselors Need to Know About the Intersection of Neuroscience and Counseling.”

Brain-based counseling

The Iveys have been researching neuroscience and its implications for the counseling profession since the 1970s. Allen is distinguished university professor emeritus at the University of Massachusetts, Amherst and courtesy professor at the University of South Florida (USF). He is a life member and fellow of ACA and the originator of the influential microcounseling framework and developmental counseling and therapy. He has authored or co-authored more than 40 books and 200 articles, and his work has been translated into 20 languages.

Mary is a national certified counselor, a licensed mental health counselor and courtesy professor at USF. Her areas of expertise include writing, independent consulting, school guidance and applying her consultation skills to school and management environments. Mary was one of the first 13 individuals honored with ACA fellow status.

“We feel honored and excited that we will present a keynote in Cincinnati on the relevance of neuroscience to counseling,” Allen says. “The basis for our presentation is the scientific finding that counseling changes the brain and that virtually all that we are doing [as counselors] is now backed up by neuroscience research. Neurogenesis, the development of new neurons and neural connections, occurs throughout the life span, even among the most aged. This possibility for human growth never ends.”

“Counseling has always been on the right track with its emphasis on wellness and client strengths,” he says. Attendees of the Iveys’ keynote can expect to hear the phrase brain-based counseling, which, Allen says, “means that all our efforts are making distinctive differences in the client’s brain.”

The topic of neuroscience has gained much momentum in the counseling profession since the Iveys first presented on it at the 2008 ACA Conference in Honolulu. “We had a moderate response in Hawaii, but interest in neuroscience has multiplied extensively, and we feel lucky that many more counselors are now seeing its potential,” Allen says. “A lot has happened since that early presentation, and we have seen many new breakthroughs that increase our understanding of the counseling process and how we can help clients more effectively. We are eager to share some of our discoveries of the past few years. At issue is using this knowledge so that we can more effectively reach clients and help them achieve their goals.”

The Iveys will highlight empathy in their presentation as an example that counselors’ methods have been on the right track from the early stages. Says Mary, “Empathy has long been basic and central to our profession and to our personal identity as counselors. Carl Rogers has shown us the importance of empathy and seeing the client’s world as he or she experiences it. Counseling could be described as the empathic profession. Now, empathy can be identified through observation of brain activation through functional magnetic imaging. One of the more interesting studies [investigated] brain patterns of a client and a counselor in a real interview. Moments of highly rated empathic communication between the two showed in parallel brain processes.”

The Iveys emphasize that ACA members already understand the importance of working with their clients’ strengths and focusing on wellness in their practices. However, Allen adds, “knowing the power and influence of the limbic emotional system enables us to become even more aware of the need to facilitate positive emotions and effective decision-making.”

He cites strategies such as cognitive behavior therapy and stress management as “key part[s] of our practice, for we are indeed seeking to help our clients manage their thoughts, feelings and behaviors more effectively.”

Another part of the Iveys’ presentation will explain how using Therapeutic Lifestyle Changes (TLC) as a treatment option can help clients manage their thoughts and behaviors effectively.

“TLCs are all oriented toward a positive wellness approach to body, mind and human development,” Allen explains. “We have spent far too much time on repair, when a reorientation to building on existing and future strengths will move us to health and wellness.”

In their keynote, the Iveys will cover the “big six” TLCs, which include the improvement of social relationships. Allen points out that this is what much of counseling has traditionally been about. All six TLCs strengthen client cognitions and emotions, he says, leading to better mental and physical health.

Mary states that prevention activities and social justice action are also strongly supported by neuroscience research and writing. “Evidence is clear that poverty, hunger, trauma — for example, neighborhood shootings — and abuse can actually slow or even destroy brain growth,” she says. “On the other hand, children and adolescents are resilient, and counselors can facilitate normal growth, and we do much to prevent these problems in the community.”

“Thus,” Allen says, “one of our central messages is that counselors have a responsibility for neurogenesis and neural growth in our clients and in their communities. We can only do this with a positive wellness approach to human change. Through TLCs, stress management and social action, our profession can and will make a significant difference for our clients.”

The Iveys will discuss these and other topics in more detail during their keynote in Cincinnati.

The other side of the coin

Ashley Judd can speak to that “significant difference” from a different perspective. In 2006, Judd, who has starred in 30 films and multiple TV shows in her career, spent time at an intensive inpatient treatment program at Shades of Hope, an addictions center in Buffalo Gap, Texas, to help her cope with a long-standing struggle with depression.

At the time Judd checked in to Shades of Hope, her sister, country music star Wynonna Judd, was being treated for an eating disorder at the same center. Ashley told Esperanza that after the counselors witnessed her acting out symptoms of a compulsive disorder, such as constantly tidying up her sister’s room, they suggested that she check into the center herself. She agreed.

“What I said was, ‘I’m so tired of holding up all this pain. I’m so glad to come to treatment,’” Judd told Nightline in an interview about her time in treatment. “God saved me from being angry, and it impairs my ability to be of service to another human being.”

Judd wrote in her memoir, All That Is Bitter & Sweet, that her depression, which began at age 8, stemmed from a childhood filled with abuse and loneliness, as her mother and sister, the famed country music duo, The Judds, would leave her at home when touring across the country.

Esperanza reports that Judd went to 12 schools in 13 years, and this insecurity, coupled with feelings of loneliness, fed into her depression as well as a fear of the unknown. “I remember what it was like for me … when I was living in a perpetual state of anxiety,” she told the magazine. “It feels like you can’t breathe properly. Every thought you have brings more stress, and for me, the most frustrating part was that I felt powerless to change it. The really frustrating part is that a part of you recognizes that you are doing it to yourself. But there’s this inexorable force pushing you down, and what’s really [messed] up is that you end up hurting your own feelings. I’m good at creating these dead ends for friends and loved ones where it makes it impossible for them to help.”

Judd acknowledges acting out through fits of rage and cleaning frenzies in an attempt to cope with her feelings of depression and anxiety.

But according to Judd, her treatment experience at Shades of Hope was both successful and life changing. Following her positive experience, she became an advocate for the therapeutic process. She will be speaking about that experience during her keynote at the ACA Conference.

In 2010, Judd graduated from Harvard University with a degree in public administration and has found new meaning through charity work and spending time as a political activist and humanitarian focusing on issues such as AIDS, poverty and women’s issues.

She is a global ambassador for YouthAIDS, a global health organization targeting malaria, HIV and reproductive health, and has been a member of its board of directors since 2004. Judd has traveled with the organization to places affected by illness and poverty such as Cambodia, Kenya and Rwanda.

In 2011, Judd joined the Leadership Council of the International Center for Research on Women and is involved with other organizations such as Women for Women International and Equality Now.

In April, Judd wrote a piece for The Daily Beast slamming the media for speculating over what they called her “puffy” appearance and incessantly commenting on the appearance of women and girls everywhere. “The assault on our body image, the hypersexualization of girls and women and subsequent degradation of our sexuality as we walk through the decades, and the general incessant objectification is what this conversation allegedly about my face is really about,” she wrote.

Judd also advocates for more public acceptance of mental health issues in society. “Unfortunately, there’s still a huge stigma around all kinds of mental illness, and depression in particular,” Judd told Esperanza. “It’s odd. We don’t stigmatize people with epilepsy, which is another debilitating disease. I think the disease element of depression needs more traction. People need to understand that depression isn’t just a matter of being sad. It’s a condition and a real illness. It’s actually a full-blown public health issue. But right now … talking about depression is like coming out. And … I don’t mind being one of the first to talk about my so-called little secret.”

For more information on the ACA 2013 Conference & Expo, visit counseling.org/conference.

Heather Rudow is a staff writer for Counseling Today. Contact her at hrudow@counseling.org.

Letters to the editor: ct@counseling.org

Get to know Will Stroble, director of ACA’s new Center for Counseling Practice, Policy and Research

Heather Rudow September 24, 2012

Will Stroble is the American Counseling Association’s newest employee and the first director of ACA’s new Center for Counseling Practice, Policy and Research. The Center’s goal is to produce products and research that will increase public awareness of the counseling field, as well as materials that will result in more professionals being able to practice. He is looking forward to using his decades of experience in the counseling and passion for the profession to advocate for and empower counselors nationwide.

Where did you work before coming to ACA?
Prior to joining ACA, I worked for the Department of Defense Education Activity (DoDEA) in Arlington, Va., as a school counselor. I worked with high school students in a virtual environment around the world, including Europe and countries in the Pacific such as Japan, Korea and Australia.

As a counselor, why did you want to work for ACA? What did you think of the organization?
I have always enjoyed working with people who reach out to help others. That’s what we, as counselors, do on a day-to-day basis. When I made the decision to join the ACA staff, I believed that I was making a wise decision because, through my work at ACA, I will be able to effect systemic, positive changes for all people and make changes on a broader scale that will empower people, thereby making this world a better place for everyone, regardless of the barriers and challenges that people face in their daily lives.

What does your position entail?
My position entails developing from the ground up the infrastructure for archiving, disseminating and promoting exemplary counseling practice information and resources for professional counselors, counselor educators, supervisors, students, legislators, the media and other consumers of applied counseling knowledge. My position also allows me to advocate for optimum counselor work and training conditions. My vision for the Center is that it will be seen as both the premier place to obtain information and resources that focus on cutting-edge counseling practices and will serve as the focus of the counseling profession’s advocacy efforts for high-quality workforce conditions.

What future goals do you have regarding your position?
I have many future goals, such as networking with other well-known colleagues in the counseling profession and leading the efforts on behalf of counselors to gather information and data on best practices in the profession, working with public policy staff to advocate for my colleagues and securing grants and funding for cutting-edge research in the counseling profession.

Other thoughts?
I am humbled and honored to have joined the staff at ACA as a counseling leader in the profession. After 33-plus years in the profession, having worked at the local, state, federal and now national levels, I am excited about this challenge and look forward, with great anticipation, to working alongside my professional counseling colleagues in the field. As we collaboratively and collectively work to make this world a better place for all people through our practice, I pledge humbly to accept the charge for the challenges, expectations and confidence that have been placed before — and in — me by ACA’s outstanding and most impressive leadership team, and all ACA members and constituents who have bestowed this sacred trust in me.

Heather Rudow is a staff writer for Counseling Today. Email her at hrudow@counseling.org.
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Home is where the client is

Dawn Friedman September 1, 2012

For some counselors, meeting clients where they’re at is more than a figure of speech. Counselors who specialize in home-based therapy work with clients in their living rooms and at their kitchen tables, giving much-needed assistance to families and individuals who otherwise might not be able to access mental health services. Home-based counseling eliminates barriers for families who don’t have good child care options or who have trouble securing rides to the clinic.

An ecological framework focused on family preservation shapes most home-based counseling programs, with counselors considering their identified clients in the context of the complete family and community systems. Parents at risk of losing custody of their children to social services are usually targeted for home-based services, which often involve other wrap-around help such as case management and psychoeducational support. Home-based work also makes sense for foster families who could use help navigating the intensity of the needs of the children in their care.

Theresa Robinson is an American Counseling Association member who works for a community mental health agency in Tucson, Ariz. She says her clients face multiple challenges — poverty, dual diagnosis and insecure housing are common concerns — so her agency uses a team approach that allows the counselors to focus exclusively on therapy, while ensuring that clients get the extra assistance they need. Monthly team meetings focused on the child and family keep everyone on course and ensure stability of services.

“We have care coordinators who do case management and family support specialists who help with parenting skills and psychoeducation,” she explains. “For example, in a family where the children are removed and are now in foster placement, the family support specialist will be going in to help the foster parent deal with parenting issues, and I’ll help the kids deal with the emotions and feelings around missing mom and dad.”

Robinson says being able to read her clients’ environments — to see how they use their space together and how that shapes their experiences — allows her to build rapport more quickly. “I do a lot of work with teens, and they show me their rooms, what they’re doing and drawing, and the music they’re listening to,” she says. “I think it makes them feel less defensive and less likely to shut down because I’m coming to their turf as opposed to asking them to come to an unfamiliar place and talk about their feelings. I think I’ve gotten a lot further a lot quicker [with home-based counseling].”

Safety first

Al Sylvia Procter, an ACA member in private practice in Valley, Ala., spends most of her time on the road traveling to her clients’ homes, many of which are in isolated rural areas. Procter was introduced to home-based work as a student, when she worked as an intern at a family services agency. Although the agency offered both office-based and home-based counseling, she found that home-based counseling generally served her clients better. When it came time for Procter to build her private practice, going into her clients’ homes seemed like the obvious choice.

Procter acknowledges that the 20 years she spent as a military police officer make her feel comfortable going into environments that other practitioners might avoid. Mindful of safety, Procter keeps her cell phone charged and always makes sure that someone else knows where she should be at any given time. She also schedules intakes at neutral, public locations such as libraries or even laundromats so she is able to explain her expectations, secure the client’s buy-in and gauge her own comfort level with going to that particular client’s home.

“I’m old school,” Procter says. “I’m just straightforward, and I let my clients know up front what I need to work with them. If they can’t do that, then maybe they need a different therapist. I’ve gone to houses with loose dogs, and I tell [the clients] to put them up, or else we can meet someplace else. If all else fails, we can terminate the relationship.”

For counselors accustomed to controlling the therapeutic environment, home-based work can be challenging. Houses may be dirty, and there isn’t always a clear place to do counseling. The client might not have a kitchen table or a couch to sit on in the living room.

Procter says home-based counselors should be prepared to confront conditions that are less than ideal, while still remaining flexible. “I don’t want them to have to clean for me,” she says. “I want their house to look the way it normally works.” She adds, however, that if health and hygiene issues are present, such as roaches crawling on the floor with the baby, she will address those issues in session.

Counselors interested in home-based work also need to be adaptable, Proctor says, because the number of interruptions is greater than when doing office-based work. For instance, clients might need to suspend a session to attend to a crying baby or to answer a knock on the door, or they may need to get up to start dinner. Rather than regarding these circumstances as distractions, many home-based counselors view them as opportunities to witness how the family is managing and to offer interventions where appropriate.

To save on gas and to lessen the wear and tear on her car, Procter schedules her clients by county, arranging appointments around the several multidisciplinary team and committee meetings that she participates in regularly. Because she maintains a home office, she saves on rent, and a portion of her living expenses and her other business-related expenditures such as mileage, Internet and cell phone are tax deductible.

Understanding services

Christine Woods is an ACA member in Rolla, Mo., whose private practice consists entirely of home-based clients. She says home-based work has been more effective for her than meeting with clients in an office. “My colleagues think I’m completely insane, but I do not like in-office therapy,” Woods says. “I get better results because [my clients] are more relaxed and more calm.” Woods also believes she is able to build the therapeutic relationship more quickly during home visits.

She offers an example of why home-based counseling has the potential to be so effective. “There was a situation where I was doing family therapy for a kid and her mom, and they were constantly fighting about chores,” Woods says. “One day, one of the assignments I had for them was to have mom show her daughter how to actually do those chores. The daughter says, ‘Oh my gosh! I get it.’ She needed her mother to show her, and from then on, they didn’t fight about chores. If I hadn’t been right there helping them work through the exercise, I wouldn’t have had that opportunity.”

Most of Woods’ clients come to her through referrals from other agencies and have more experience with case managers than with counselors, so part of her work involves explaining what counseling is and what she can and cannot do for clients. Because Woods is in private practice, she does not work with a team. Instead, she stays updated on community resources and helps clients get referrals to additional programs when their needs go beyond her scope of practice.

Woods echoes Procter’s advice concerning the need for home-based counselors to be clear and up front about their expectations. “I’m pretty blunt. I say, this is what my role is, and if you need case management, if you need parenting skills, we can hook you up with services to address that, but what I do is strictly therapy.”

Possessing the proper attitude is pivotal to the success of home-based counseling. “When people invite me into their homes, the most private place they have and the place they feel most secure, I recognize that it’s a privilege,” Woods says. In fact, she adds, demonstrating her respect for and acceptance of her clients is even more powerful in that context. “You cannot be judgmental. If the furniture is stained or the house is run-down, for them to be able to feel like they’re treated with respect when I walk in, that’s key to helping them feel OK and trust me.”

Mandate for the profession

Greg Czyszczon is an ACA member and doctoral candidate in counseling and supervision at James Madison University who is researching home-based counseling. He says discussions about home-based work can get muddied, both for clinicians and for clients, because paraprofessionals — college graduates with little to no clinical training — are sometimes hired to do home-based work with clients, and these services are often confused with actual counseling.

“In many areas of the country, people are allowed to offer services in-home that they could not offer in an office,” Czyszczon says. “An agency might send a 23-year-old with a bachelor’s degree in sociology [who maybe] worked for a year in an after-school program, and [he or she] would be the one working with kids who have trauma history and abuse history living in homes where there is substance abuse and domestic violence. For some reason, when it’s in-home, it’s acceptable to have people in there who don’t have training.”

That scenario is bad not only for clients, Czyszczon says, but also for counselors who are offering home-based services because the resultant confusion diminishes the therapeutic work that many appropriately trained clinical counselors are doing. In a 2011 presentation at the ACA Conference in New Orleans, Czyszczon and fellow ACA member Cherée Hammond advocated for the counseling profession to recognize home-based counseling as a specialized area of practice, much like play therapy or couples counseling. Czyszczon and Hammond believe counselors should have specific training on family systems, crisis counseling, resiliency, attachment, trauma-informed care, multicultural intervention, child development, substance abuse and serious mental illness before they begin doing home-based work. They would also like for ACA and the Council for Accreditation of Counseling and Related Educational Programs to join in the discussion. “We want to say, if you’re going to be a [home-based] counselor, then these are the recommended competencies in this in-home scenario, and we need to be specific about those as a profession,” Czyszczon says.

Gerard Lawson, an ACA member and associate professor in the Virginia Tech School of Education, has conducted research on home-based counseling and supervision and asserts that it is some of the most challenging work that counselors can take on. Offering home-based services aligns with the counseling profession’s social justice mandate, he says, but too often, those tasked with doing this work are ill prepared for its many challenges. These practitioners can also be confronted by a professional stigma that says home-based work is case management rather than true counseling, Lawson adds.

“These families [clients of home-based counseling] are multichallenged, often on the verge of homelessness, often with involvement with the court system, with addiction issues and poverty,” he says. “You’re working bad hours and going out to people’s homes. Maybe your caseload isn’t as full as someone doing office-based work, and that could create the perception that this is less than counseling. But, actually, it’s counseling-plus. It was the hardest work, bar none, that I’ve ever done in my life.”

“When I talk to supervisors about home-based work, what I try to tell them is that the system is upside-down,” Lawson continues. “There is no good reason that we should be sending people out who are working on their master’s degree or who are newly graduated to attend to cases that would be challenging for a more-seasoned professional. The best and the brightest [of our profession] should be doing this work.”

Lawson says isolation and burnout are issues for home-based counselors because they spend most of their time in the field and may not get the peer support that office-based colleagues receive simply by checking in with another clinician on staff. “Counselors [who do this work] are prime for compassion fatigue and vicarious traumatization. This kind of work places them at greater risk,” he warns. “That’s a recipe for burnout, or they’re just going to become numb to it, and they’ll invest less and less of themselves. The antidote to that is good supervision, but a lot of the supervisors have never done home-based work.”

Lawson would like to see greater numbers of experienced counselors take on one home-based case to augment their in-office work. Spreading around this workload would create a larger peer group of counselors experienced in home-based work who could offer one another support, he says. It would also allow counselors who currently do mostly home-based work to see some clients in the office, supplying these counselors with the attendant peer support that comes with working on-site.

“Maybe it doesn’t become an exclusive sort of service anymore,” Lawson says. “For everybody that’s doing outpatient work, perhaps they flex their time and have one home-based client that they work with one day a week. That would decrease the stigma [of home-based counseling], and it would also mean that this would be less segregated. If everyone is doing it, then it becomes more of ‘This is what we do as a profession.’ We could say, ‘If these families haven’t been successful here [in the office], they need a more intensive level of treatment, and that should continue with the same counselor.’”

Like Czyszczon, Lawson sees home-based counseling as a matter of social justice and thus part of the counseling mandate. “The reality is that this population needs better service, but they’re given less and less attention,” he says. “As a professional, I find that troubling. And as a member of the community, I find that shameful.”

Although the work is difficult and stressful, Woods says she has no plans to go back to counseling out of an office. “Some people are made for office therapy, but I get better results when I work with people in their homes,” she says. “There’s a gift that I’m to learn from them just like there’s a gift that they’re to learn from me.”

 

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Dawn Friedman is a writer and counselor-in-training in the community counseling program at the University of Dayton. Contact her through her website at DawnFriedman.com.

Letters to the editor: ct@counseling.org