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Counselors Audience

FASD: A guide for mental health professionals

By Jerrod Brown July 10, 2017

Fetal alcohol spectrum disorders (FASD), which researchers have estimated affect 2 to 5 percent of the U.S. population, are lifelong conditions that result from exposure to alcohol in utero. Kenneth L. Jones, David W. Smith and colleagues are credited with discovering the birth defects and long-term impacts on cognitive and social functioning caused by fetal alcohol syndrome in 1973.

Prenatal alcohol exposure can result in a host of issues related to:

  • Cognitive functioning (e.g., impulse control, attention, executive functioning)
  • Social functioning (e.g., communication skills, recognition of social cues)
  • Adaptive functioning (e.g., problem-solving, ability to adapt to new situations)

Furthermore, several neurological issues characterize FASD, including stunted cell and nerve growth, elevated rates of cell mortality, neurotransmitter interruptions and migration issues in organic brain growth. Complicating matters, the overwhelming majority of individuals with FASD experience an array of psychiatric disorders, increasing the likelihood that these individuals will need specialized services from mental health care providers.

Unfortunately, many of these providers and professionals lack the necessary training and expertise to accurately identify and effectively treat the unique and complex symptomatology of this population. The goal of this article is to provide a basic introduction of FASD to mental health professionals in six key areas: FASD symptoms, diagnostic comorbidity, memory impairments, tips for interacting with individuals who may have FASD, screening and assessment, and treatment.

FASD symptoms

A diverse range of symptoms characterizes FASD.

Executive functioning deficits: Impairments associated with executive functioning are a hallmark deficit of FASD, impacting the majority of individuals affected by these disorders. Executive functioning deficits are often associated with impulsivity, diminished ability to learn from consequences and impairments in planning, verbal reasoning, emotional regulation, memory and learning.

Social skills deficits: Individuals with FASD often have pervasive impairments in the domain of social functioning. Misinterpretation of social cues is not uncommon. This can lead to boundary violation concerns (e.g., inappropriately touching another person), which can in turn result in involvement in the criminal justice system. Such social skill deficits can also increase the individual’s level of vulnerability to manipulation by others and an inability to detect unsafe situations and people.

Attachment problems: Consistent with these deficits in social skills, poor attachment with the primary caregiver is relatively common in children with FASD. Poor attachment with the primary caregiver can increase the likelihood of misdiagnosis in a child. Common misdiagnoses may include attention-based (e.g., attention-deficit/hyperactivity disorder [ADHD]) or behavior-based disorders (e.g., conduct and oppositional defiant disorders). In fact, it is not uncommon for these disorders to co-occur with a diagnosis of FASD. Given that reality, mental health professionals who work with individuals impacted by FASD should familiarize themselves with commonly co-occurring disorders such as those just mentioned.

Adaptive functioning: Adaptive functioning involves an individual’s practical, social and mental capacities to deal with everyday challenges and problems (e.g., personal hygiene, personal finances, navigating social interactions). In light of the executive functioning problems outlined earlier, as well as struggles with processing abstract information and solving problems, individuals with FASD have difficulty in the realm of adaptive functioning. The consequences can range from difficulty maintaining employment to struggles with caring for one’s self. Because of these deficits in adaptive functioning, a high percentage of individuals with FASD are dependent on the support of family and social services.

Learning problems: One of the key issues related to adaptive functioning among individuals with FASD is difficulty learning from past experiences. Furthermore, individuals with FASD often struggle to use past experience to prospectively avoid dangerous people and situations. These deficits are exacerbated by impulsivity and an inability to think strategically about decisions. Hence, FASD affects an individual’s ability to understand society’s norms and to behave within those norms.

Diagnostic comorbidity

Increasing the likelihood of negative short- and long-term outcomes, individuals with FASD often have co-occurring disorders and other issues.

Diagnostic comorbidity: It has been estimated that the overwhelming majority of individuals with FASD experience comorbid psychiatric conditions. ADHD is the most prevalent comorbid disorder observed among those affected by FASD. Other disorders frequently observed among adolescents with FASD include conduct disorder and oppositional defiant disorder. Finally, individuals with FASD are also at an elevated risk to abuse substances later in life.

Physical complications: A number of physiological symptoms can suggest the possibility of FASD. For example, prenatal alcohol exposure can result in cardiovascular (e.g., septal defects, hypoplastic pulmonary arteries) and kidney (e.g., pyelonephritis, hydronephrosis, hypoplasia) irregularities. Prenatal alcohol exposure has also been linked to orthopedic irregularities in the structure of bones in the upper body (e.g., radioulnar synostosis), fingers and toes (e.g., camptodactyly, brachydactyly, clinodactyly).

Other brain-based injuries: Individuals with FASD may be more prone to traumatic brain injuries throughout the life span. This could contribute to the underdiagnosis and misdiagnosis of FASD. Furthermore, these traumatic brain injuries may exacerbate other secondary conditions, including ADHD, executive functioning impairments, mental health and substance use disorders, and so on.

Other life adversities: As a function of FASD and these other co-occurring disorders and impairments, individuals with FASD are disproportionately likely to be afflicted with problematic life experiences. For example, individuals with FASD often come from unstable homes, experience neglect and abuse (verbal, physical or sexual), and are exposed to substance use, mental illness and criminal justice involvement by their families and household members. As such, mental health professionals should view these co-occurring disorders and other negative life experiences as potential indicators of FASD, necessitating a need for further assessment and evaluation.

Memory

One of the most devastating cognitive deficits of FASD is short- and long-term memory impairment.

Poor memory: Individuals with FASD typically have problems associated with memory. In some instances, these issues can lead to over- and underendorsement of symptoms, contributing to missed and misdiagnosis. In other instances, these individuals can struggle with retrieving and communicating their memories, contributing to issues such as suggestibility, confabulation, fabricating stories and incorrect storytelling.

Suggestibility: The suggestibility of individuals with FASD can be detrimental in at least two ways. First, these individuals may be manipulated into participating in criminal activity by peers. Second, these individuals may be prone to falsely confessing to criminal activities that they did not commit. As such, mental health professionals must take care to verify the accuracy of statements made by individuals with FASD. Mental health professionals should also take the topic of suggestibility into account when phrasing and asking questions during the initial intake and diagnostic assessment process.

Confabulation: FASD and other disorders characterized by memory deficits often co-occur with confabulation issues. Confabulation occurs when new memories are created by filling gaps in recall with one’s real memories, imagination or environmental cues. Incidents of confabulation may occur spontaneously or be prompted. For example, confabulation is particularly likely in situations in which professionals ask leading questions or pressure the interviewee. As such, confabulation can contribute to inaccurate self-reports by the client, resulting in possible misdiagnosis and the development of an ineffective treatment plan.

Interacting with clients

The pervasive symptoms of FASD have important implications for how mental health professionals should interact with clients who may have these disorders.

Importance of simplicity: Individuals with FASD tend to perform better when tackling one task at a time. This is especially true of tasks that do not involve reliance on previous experience to complete. Multistep and complex questioning can result in individuals with FASD shutting down emotionally or responding with factually incorrect or incomplete responses. Mental health professionals should take this into account when screening, assessing and developing treatment plans for this population.

Superficial talkativeness: The propensity for individuals diagnosed with FASD to be charming and talkative may lead mental health professionals to overestimate their level of competence and comprehension of treatment goals. It is important for clinicians to have these individuals demonstrate understanding and knowledge of the question being asked by explaining it back to the professional in their own words. Overuse of yes-or-no questioning can also mask the individual’s true level of impairment.

Misinterpretation of callousness: In some cases, behaviors resulting from FASD symptoms might be mistaken as a choice rather than as a result of the disorders. The social and cognitive deficits of individuals with FASD can contribute to problematic behaviors being misinterpreted as premeditated or manipulative. In fact, many of the behaviors exhibited by individuals with FASD are the direct result of deficits caused by prenatal alcohol exposure.

Screening and assessment

The combination of nuanced symptomatology and diagnostic comorbidity makes the screening and diagnosis process for FASD difficult.

Diagnostic terminology: FASD is an all-encompassing term that includes fetal alcohol syndrome, partial fetal alcohol syndrome, alcohol-related neurodevelopmental disorder and alcohol-related birth defects. In the fifth edition of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM), neurodevelopmental disorder-associated with prenatal alcohol exposure has been added as a condition for further study. This is the first appearance of FASD-related symptoms in the DSM, which means mental health professionals can now diagnose prenatal alcohol exposure.

Missed and misdiagnosis: Missed and misdiagnoses of FASD may explain, at least in part, the limited awareness of the disorders among medical and mental health professionals. A lack of systematic education and training on FASD contributes to this situation. As a result, many children, youth and adults go unidentified and are subsequently unable to take advantage of advanced medical and psychological treatment and services that could render a better quality of life.

Detection difficulties: Another factor that likely contributes to the missed and misdiagnoses of FASD is the fact that these disorders are difficult to identify. Why is that? Visible indicators such as morphological signs are not always present, whereas cognitive deficits are difficult to detect using standardized intelligence measures. This is problematic because individuals with FASD who present with no outward signs of facial feature abnormalities can still possess severe neurobehavioral deficits. In fact, diagnosis of prenatal alcohol exposure becomes increasingly difficult as children grow into adolescence and adulthood. Specifically, many of the physical features of prenatal alcohol exposure fade as children grow physically. Furthermore, the availability of birth mothers and records decrease with time. As a result, many professionals and researchers have called FASD a “hidden disability.”

Importance of identification: Assessment and identification of FASD are essential because the likelihood of impairment related to alcohol exposure increases significantly with each subsequent pregnancy. Identification of these disorders in a first pregnancy provides a viable point of intervention to help prevent alcohol use in future pregnancies.

Treatment

Even in cases in which the individual has been accurately diagnosed with FASD, treatment can be challenging.

Problems with cognitive-based treatments: Individuals with FASD have cognitive (e.g., memory, understanding cause-and-effect), social (e.g., comprehending social cues) and adaptive (e.g., problem-solving ability, generalizing skills) deficits that complicate their participation in cognitive-based treatment. Likewise, insight-based therapy approaches are not encouraged with this population. Therapeutic approaches that incorporate modeling, coaching, teaching and skill building may be most effective with these individuals.

Problems with treatment adherence: Individuals with FASD may benefit more from treatment in structured residential facilities than in outpatient facilities because of the cognitive deficits associated with FASD. Should an outpatient program be the only option, odds of treatment success may be improved by maximizing program structure and tailoring treatment plans to the individual.

Conclusion

The disorders under the FASD umbrella are complex and lifelong. They are characterized by an array of adaptive, behavioral, emotional, executive, physical and social impairments. Considering the prevalence rates of FASD in the United States, it is highly likely that mental health professionals will come into frequent contact with individuals impacted by these disorders. Unfortunately, these disorders often go unrecognized and undiagnosed by many mental health professionals.

Other than simply improving identification of individuals with FASD, another essential step for mental health professionals is to better understand the various challenges and deficits faced by this population on a daily basis. To combat the status quo, mental health professionals are encouraged to seek training on this complex topic and consult with FASD experts when necessary. Taking this path forward will minimize the likelihood of negative short- and long-term outcomes for this population.

 

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Jerrod Brown is the treatment director for Pathways Counseling Center Inc., which provides programs and services benefiting individuals affected by mental illness and addictions. He is also the founder and CEO of the American Institute for the Advancement of Forensic Studies and the editor-in-chief of Forensic Scholars Today. He holds graduate certificates in autism spectrum disorder, other health disabilities and traumatic brain injuries, and is certified as a fetal alcohol spectrum disorders trainer. Contact him at Jerrod01234Brown@live.com.

 

Letters to the editor: ct@counseling.org

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

Homelessness: A counselor’s role in alleviating a complex systemic issue

By Zach Bruns and Cody Andrews

How would you know if your client is homeless or at risk of becoming homeless? For counselors working in school or community settings, this seems like a simple question to answer. In reality, homelessness is a complex status that may be layered with shame, guilt, addiction, trauma, family strife, legal pitfalls, economic and employment barriers, and inadequate physical and mental health treatment.

As professional counselors, we are challenged with trying to meet the psychological and emotional needs of our clients. How do we properly treat individuals with mental health symptoms whose needs are so intricately interwoven into personal and environmental factors, especially housing instability? The professional research correlating homelessness and mental health counseling is surprisingly minimal (although not nonexistent), whereas the efficacy of current popular psychotherapy techniques (e.g., cognitive behavior therapy, dialectical behavior therapy, motivational interviewing) has been repeatedly demonstrated throughout research literature. Therefore, it is reasonable to ask: Is psychotherapy alone enough to adequately help individuals living in homelessness or without permanent housing? We will attempt to answer that question in this article while emphasizing the importance of instilling hope in the lives of our clients.

As an American Counseling Association member and a licensed professional counselor and substance abuse counselor in Wisconsin, I (Zach Bruns) have the privilege of working as a mental health clinician on a multidisciplinary team that serves individuals who are homeless or at risk of becoming homeless in Milwaukee County. Our nonprofit agency, Outreach Community Health Centers, receives funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) to run a Projects for Assistance in Transition from Homelessness (PATH) program (see bit.ly/2hcldEg). We do not have all the answers and resources to solve the systemic societal issues of homelessness, but I would like to share my insights on practical ways to help individuals who are living in homelessness or at risk of homelessness.

Let’s start with the basic concepts of homelessness. Each community in the United States has different access to resources for people experiencing homelessness. Smaller rural communities may rely heavily on faith-based organizations to assist individuals experiencing homelessness or economic hardship. Larger urban communities such as Milwaukee often have emergency shelters, open year-round or seasonally, that cater to specific populations (e.g., survivors of domestic violence, single women, women with children, families, single men). Depending on a shelter’s funding source — i.e., private or governmental — shelters may enforce their own rules or be required to abide by certain rules and regulations that dictate who can and cannot be admitted into their shelter, how long residents can stay and what services are offered to individuals or families during their shelter stay. The Department of Housing and Urban Development (HUD) also organizes collaborative countywide Continuum of Care programs throughout the United States. These programs seek to provide services to those who are homeless, including helping individuals, unaccompanied youth and families transition into housing (see bit.ly/27ioSpd).

Emergency shelters that receive funding through HUD are expected to track the types of services they provide to individuals and the dates of shelter stays. HUD also funds permanent housing programs such as the Rapid Re-housing (see bit.ly/1MtqB19) and Housing First (see bit.ly/1HGeOsl) initiatives, which are required to provide documentation of a client’s homeless status before enrolling an individual or family in services. HUD created criteria for classifying homelessness into four categories (see bit.ly/1Ir9R9v): literally homeless, imminent risk of homelessness, homeless under other federal statutes and fleeing domestic violence. Individuals are placed into housing programs based on their category of homelessness, the length of time they have been homeless (e.g., 12 months or more in the past three years) and their documented disability status.

With this general background of homelessness in mind, how can counselors provide hope and encouragement and help our clients who are struggling with housing instability?

Primary health care. Help your clients get connected to a primary care doctor. This is vitally important because many (but not all) individuals who are homeless or at risk of homelessness have not had a recent physical exam or have unaddressed medical issues. You may be able to make an internal referral if you are affiliated with a medical clinic. Otherwise, you may need to help these clients research clinics that accept their insurance (if insured) or clinics that accept uninsured clients or work on a sliding fee scale. 

Psychiatry services. Not all clients’ mental health symptoms rise to a level requiring medication management just because they are homeless or at risk of being homeless. However, many individuals can benefit from the therapeutic effects of psychotropic medications as prescribed by a psychiatrist, advanced practice nurse prescriber or other credentialed prescriber. Depending on where you practice as a counselor, psychiatric services may be difficult to access or feature long wait lists. A primary care physician may be an alternative option, depending on your client’s mental health needs. A primary care doctor may be able to prescribe psychotropic medications for common mental health diagnoses such as mild to moderate mood disorders. Consider asking your clients to sign a release of information so that you can communicate with their doctor and coordinate appropriate services for them.    

Public benefits. If your clients are living in poverty and struggling to secure consistent employment and stable housing, they may benefit from public benefits. Help your clients enroll in and utilize benefit programs such as Medicaid or state-based health insurance, the Supplemental Nutrition Assistance Program (SNAP) and unemployment insurance. If you are not the right person to assist clients with these tasks, refer them to an agency in your area that helps with public benefits. Also consider researching additional special benefits that may be available in your area. For example, SAMHSA’s SOAR program helps individuals who are homeless and living with a mental illness apply for and increase their chances of successfully obtaining Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) benefits (see bit.ly/2eM4YPr).

Emergency shelter. If your community has a coordinated entry system for shelter, you may need to help clients make calls for shelter services, especially if this is their first time experiencing homelessness and they are feeling scared, ashamed or hesitant to ask for help. In Milwaukee County, most shelter bed openings are currently coordinated through IMPACT 2-1-1, which can be accessed via phone or online chat. Private shelters follow different rules and often accept individuals who present to a shelter in person. We recommend that you call the shelter in advance to check for current bed openings.

Disability documentation. Unless it’s your initial intake session with your client, you likely have already completed a formal intake process, including using relevant evidence-based screening tools, so you now have a sense of the mental health needs and issues that affect your client’s quality of life. The next step to helping your client is to vouch for your client in writing. Many supportive housing programs require documentation from a medical or mental health professional noting the individual’s current medical or mental health diagnosis. Work with your client to obtain housing application paperwork, and offer to write the client a letter on your agency’s letterhead documenting any disabilities that you are qualified to diagnose.

Food and clothing (and maybe a sleeping bag). As counselors, sometimes we forget about the physiological and safety needs at the bottom of Abraham Maslow’s hierarchy of needs pyramid. Consider obtaining or creating a list of local community resources, including food pantries, free meal sites and clothing banks, to share with your clients. Many secondhand clothing stores, such as Goodwill and St. Vincent de Paul, offer voucher programs for people in need of clothing and furniture. Consider reaching out to local churches, temples, mosques, synagogues or other nonprofits to request donations of material goods that your clients may need, such as personal hygiene supplies, coats or jackets, boots, blankets or even sleeping bags. 

Transportation. Transportation can be a major barrier to a client obtaining and keeping employment and attending regular appointments such as counseling sessions, supervised visits with children and apartment showings. In Wisconsin, individuals with Medicaid can qualify for assistance with transportation for medical-related services, usually via public transportation (if available) or contracted transportation services. Some cities also offer discounted public transportation for seniors, individuals with Medicare or persons with qualifying disabilities. In Milwaukee, our PATH team helps qualifying individuals apply for a GO Pass, a discounted bus pass for county residents older than 65 or for younger residents who receive SSI or SSDI, or who have a veterans disability designation and also have Medicaid or SNAP benefits.

Cell phone. A cell phone is a simple everyday device that most of us take for granted. However, if your client is living on the streets, under a bridge, in his or her car or even “couch surfing” with friends or family, a phone can be that client’s lifeline to the outside world. If your client is enrolled in public benefits, he or she likely qualifies for a free government-issued phone. You can help clients apply for a cell phone online through programs such as SafeLink Wireless (see bit.ly/1ISUYOD) or in person at local cell phone retail stores (call first to check availability).   

Long-term case management. We all have worked with difficult clients — individuals with complex mental and physical health needs whose level of care may extend beyond the scope of outpatient counseling treatment. To better support these clients, consider submitting a referral to a long-term case management program in your county. In Milwaukee County, the Milwaukee County Behavioral Health Division contracts with community agencies to offer three different types of case management programs for people whose primary diagnosis is related to mental health (see bit.ly/2q1uGSl). For individuals whose main diagnosis relates to physical health, there are additional agencies and case management programs, such as Family Care programs (see bit.ly/2hKeRg8), that offer services.      

In conclusion, psychotherapy is not enough to treat all the mental, social, emotional and environmental aspects surrounding individuals or families who are experiencing homelessness. By stepping outside the traditional boundaries of a counselor’s role, you can greatly benefit and encourage your clients as they progress along their recovery journeys. By using your person-centered counseling skills, you will encourage and build up hope in your clients, especially if they are struggling with issues surrounding homelessness. Remember the beloved Carl Rogers, who urged us all to treat our clients with genuineness, empathy and unconditional positive regard.

 

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Zach Bruns, a licensed professional counselor and substance abuse counselor, has been practicing community-based clinical counseling since 2013. He serves as the mental health clinician for the multidisciplinary Projects for Assistance in Transition from Homelessness team at Outreach Community Health Centers in Milwaukee. He also works through Dungarvin Inc. and the Milwaukee County Behavioral Health Division’s Community Consultation Team to provide mobile crisis services to individuals diagnosed with intellectual/developmental disabilities and mental illnesses, their providers and loved ones. Contact him at zacharyb@
orchc-milw.org
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Cody Andrews has served as the lead service provider for the Street Outreach Team at Outreach Community Health Centers since June 2015. He is starting graduate school this fall to obtain a master’s degree in social work and from there hopes to pursue a doctoral degree in social welfare. His research interests include housing interventions, social support systems of people experiencing homelessness and homeless outreach. Contact him at codya@orchc-milw.org.

 

Letters to the editor: ct@counseling.org

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

Vocational counseling in HIV/AIDS communities

By Michael B. Drew July 6, 2017

Following a career-ending injury as a firefighter captain, I embarked on a new adventure as a doctoral student, attending the University of Georgia’s counselor education and student personnel services program. In a leap of faith, my wife and our three small children moved from Rochester, New York, to Suwanee, Georgia, where we quite literally knew no one. I remember thinking at the time that trying to make a career change like this made running into a burning building look easy. Fortunately, I was assigned to a rural HIV/AIDS clinic. The people I was about to meet there would welcome me and ultimately change my life.

As I stepped nervously through the clinic door and my eyes adjusted to the small, dimly lit room, I was greeted by a friendly man seated behind a makeshift desk. During the months that followed, I came to know him — and the important role that work played in his life while living with HIV/AIDS — well. For him, I think that returning to work by answering phones and greeting new visitors to the clinic represented a way to contribute to his community. His bright smile and warm sense of humor made him perfect for the job.

As we shook hands, he jokingly pointed to a piece of tape that stretched across the back of an office chair. On the piece of tape, his name was proudly displayed in handwritten marker. “This is my chair. … They let me work here!” he exclaimed.

Reflecting on that first day, I’ve come to realize that this was more than just an office chair — it symbolized his success in reclaiming a professional identity. What I learned from this inspiring man has since helped me reclaim my own sense of professional identity as I shifted from being a firefighter to a mental health counselor. This article is dedicated to his memory.

 

Professional identity

Each of us possesses many intersecting identities. Some of these identities are obvious, and others not so much. For example, if I didn’t share with someone my disabled status, it is unlikely that they would be able to tell because my injuries are internal, and I go about my day doing everything possible to keep it this way. But when I do share my story, people usually thank me for my service because for many, firefighters are like heroes.

I think everyone should enjoy this type of validation because we are all living courageously with different challenges. Some of these challenges include health problems or sudden loss of employment. In managing the complexities of HIV/AIDS, both of these factors are compounded, and the very real threat of social stigma can discourage a return to work, compromising personal and professional identity.

In all honesty, I can tell you that I’m still affected by a passing fire engine because firefighting is such a deeply internalized identity for me. Similarly, during initial intake and screening, vocational counselors may explore the meaning of work in the lives of their clients with HIV/AIDS, paying special attention to differences before and after infection, and any existential questioning in the wake of serious illness.

For some of these clients, HIV/AIDS was the impetus for them leaving work in the first place, resulting in changes to personal and professional identity. This means that counselors should help these clients explore feelings of loss in social and financial capital associated with their former work environments, as well as strategies for establishing new supports. Other important concerns include management of strict medication routines, side effects resulting from medications, fatigue, exposure to work-related stressors and the risk of contracting outside infections occurring in the workplace. By carefully exploring a range of vocational challenges with these clients, and the role of work in their lives, counselors can facilitate the process of forming new professional identities.

 

Situating vocational needs

Re-entering the workforce is increasingly possible for clients with HIV/AIDS, thanks in large part to continued advances in highly active antiretroviral therapy. These medications are used in combination to reduce the progression of HIV by preventing the virus from making copies of itself.

Thanks in part to such promising medical advances, vocational counselors can begin work with these clients by exploring myriad career opportunities and matching them with each client’s unique skills, interests and health needs. I should note that although returning to work may reflect a significant victory for people living with HIV/AIDS, counselors still need to understand the potential challenges facing these clients related to workplace discrimination, insurance denial and managing health care while working and caring for loved ones. Overlooking these realities risks setting up your clients for possible failure and, even worse, interruptions in health-sustaining insurance coverage.

A vocational model for the HIV/AIDS community (graphic designed by Michael B. Drew)

 

Meeting basic needs

President Obama’s National HIV/AIDS Strategy (2010) explicitly called for increasing career development for people living with HIV/AIDS and using innovative employment strategies to expand potential career options. However, most AIDS service organizations and their clients depend on federal funding provided under the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, including for life-sustaining medications. This leaves many clients feeling threatened under the current Trump administration and the possibility of budget cuts.

A possible consequence of this fear of lost benefits is that many people living with HIV/AIDS may feel pressure to find work that provides private health coverage. At present, federal funding is allocated for housing, medication and legal assistance, leaving very few clinics with the resources or vocational expertise to address the challenges associated with returning to work. For outside agencies that do offer career or vocational counseling services, most are not familiar or equipped to serve the unique needs of the HIV/AIDS community. This leaves many clients afraid to access these services when having to negotiate work accommodations, maintaining a strict medication schedule and coping with episodic symptoms that require frequent and unexpected leaves of absence.

For these reasons, vocational counseling in the HIV/AIDS setting is inherently complicated. This reflects the need to include such specialized services in the familiar and trusted space of AIDS service organizations, where professional networks and community partnerships are already in place.

 

The role of legal services

In addition to these formidable challenges, HIV criminalization laws currently exist in roughly half of the 50 U.S. states, leaving clients at risk for further marginalization in the workplace following intimate partner complaints and subsequent arrests and convictions. In some cases, these arrests have even resulted in prison sentences and mandated sex offender status, making a return to work exceedingly difficult.

This unfortunate reality is even more problematic for women, who are often diagnosed with HIV/AIDS before a male partner due in large part to having regular gynecological exams. This means that women are at additional risk for legal prosecution for “knowingly infecting their partners” despite the possibility that the virus originated from an accuser. This perpetuates a veil of secrecy, adding to the complexity of HIV/AIDS treatment options, particularly among infected mothers who may face persecution for passing the virus on to their children. Not surprisingly, such discriminatory practices become disincentives for HIV screening and follow-up care. Furthermore, surveillance reports from the Centers for Disease Control and Prevention (2014) reflect that African American women represent a disproportionate number of newly infected cases.

Given that more women than men are responsible for the care of children and elderly family members, vocational counselors should explore flexible work opportunities that align with individual needs. This should include legal counsel from the local community that is available for clients who wish to make informed decisions about returning to work.

 

Exploring career interests and abilities

In the wake of my firefighting injury, and facing a lifelong disability, I can attest to the significance of vocational counseling as an integral part of the healing process. This is a familiar narrative among people living with HIV/AIDS, who sometimes struggle to explain why they have not returned to work given their outward appearance of health. Counselors can help these clients respond to any concerns involving gaps in employment history, the need to update work skills, résumé writing, professional attire and preparation for job interviews.

This need for personalized vocational counseling remains largely unmet, however. The counseling profession can respond to this increasing demand for career-related services by attending HIV/AIDS conferences and workshops to learn more about living and working with the virus. Community-based partnerships are also invaluable. Many AIDS service organizations provide internship opportunities in which counseling students can gain field experience and insights into the process of cultivating new personal and professional identities.

 

Flexible career opportunities

Many individuals must manage episodic symptoms associated with HIV/AIDS. In response, vocational counselors can expand these clients’ career opportunities by helping them connect with employers that offer flexible scheduling or the possibility of working from home.

In dealing with HIV/AIDS, episodic symptoms may remain dormant for years, only to reappear and become disruptive to work scheduling and the person’s ability to perform routine tasks. Many clients are fearful that under such circumstances, employers will expect them to share personal information when they are absent from work. Managing personal privacy surrounding any chronic illness is challenging, and in the case of HIV/AIDS, an added threat of stigma remains.

It is important for counselors to share information with their clients concerning extended Medicare and Trial Work Period programs, which are designed with flexibility for people who have disabilities. This may help to alleviate concerns about losing Social Security disability benefits, which is a common theme among people living with HIV/AIDS when contemplating a return to work.

 

 

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Michael B. Drew is a retired firefighter captain from upstate New York. Following a career-ending injury, he completed a bachelor’s degree in advanced fire administration and a master’s degree in mental health counseling and is currently a doctoral candidate in counselor education and student personnel services at the University of Georgia. Contact him at mbd01283@uga.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.

An eight-step process for implementing social justice and advocacy interventions

By Jonnie Seay Lane June 29, 2017

Viewing the landscape of today’s society, it is clear that multicultural and social justice issues have never been more visible. Although prejudice, racism and inequality have always plagued our nation, society is no longer keeping secret or turning its cheek to the omnipresent consequences of privilege and marginalization. Everyone is affected and everyone has a duty to respond, but nobody more so than those “working the fields.”

Gone are the days of counseling in a silo. Our clients live in the real world. And in the real world, our clients suffer privilege and marginalization. Counseling and counselors would be well-advised to prepare for the spectrum of cultural issues that we may encounter in session. In other words, we need to enhance our multicultural competence. Not only is it written into the ACA Code of Ethics, but it also just makes common sense. If we want to continue to work with, for and on behalf of our clients, we need to ebb and flow with the tide, and this is the tide.

If you are a counselor, you might think that you already possess a good deal of cultural competence, but let me unveil three common statements that can lead to a false sense of cultural competence.

1) “I took a class in my master’s program, and it covered a lot of material. I know the multicultural theories and models. I must be culturally competent.”

2) “I have three black friends, and my neighbor is from India. I know how to talk to people of color, and I know their cultural norms. I must be culturally competent.”

3) “I don’t stereotype. I don’t judge others. I must be culturally competent.”

I must confess that, as a white counselor, I’ve found those words bouncing around in my own head from time to time. I used them to strengthen my belief that I was a culturally competent counselor. That belief made me feel good about myself — even if it wasn’t true. Those statements assuaged the guilt I felt knowing that I actually wasn’t as competent as I should be. I used those statements as excuses to avoid growing and sharpening my counseling skills because it was an area that challenged me and even scared me a bit.

Admitting that those three statements, even if factual, did not make me a culturally competent counselor was scary. It meant admitting that I wasn’t as great as I thought I was and that I might not be serving my clients to the best of my abilities. It also meant that I had to do something about it. And change is scary.

But change can be motivating and liberating too. Becoming a better counselor is exciting. Learning new things is exciting. Instead of leaning away from multicultural counseling, I leaned in.

 

A plan of action

I’m currently a doctoral candidate at North Carolina State University, where I have the honor of being under the tutelage of some of the foremost experts in the field. My adviser, Sylvia Nassar, was one of the co-authors of the Multicultural and Social Justice Counseling Competencies (MSJCC), which were endorsed by the American Counseling Association and the Association for Multicultural Counseling and Development in 2015 and released in 2016. She put together a task force of students to continue work on dissemination of the MSJCC. The door opened, and I walked through. I made it my mission to become an expert in multicultural counseling, starting with the MSJCC. Yes, me, the white girl.

As a member of the task force, I facilitated and co-facilitated presentations on the MSJCC at local, state and regional conferences following a variety of formats (e.g., roundtable discussion, PechaKucha presentation, information session and workshop). What became clear to me was that attendees were thirsty to take what they were given and implement it into practice. But something was missing.

As great as our presentations might have been at providing information and inspiring motivation, they lacked a practical approach to next steps. Attendees left excited and motivated. However, without an action plan, excitement and motivation eventually dissipate. With that in mind, I created an eight-step process to implementing the MSJCC.

The eight steps are a basic foundation for enhancing multicultural competence. Implementing them requires understanding of the model and its specific parts. The steps reference sections of the model and particular competencies that are prescribed within. All this to say, the steps are meant to be used after training on multicultural counseling, and the MSJCC model in particular, has been completed. A link to the MSJCC can be found here.

The model is composed of 117 specific competencies that serve as markers of cultural competence. The counseling competencies are embedded in four distinct domains: counselor self-awareness, client worldview, counseling relationship, and counseling and advocacy interventions. The last domain, counseling and advocacy interventions, is composed of six layers and aligns with Urie Bronfenbrenner’s theory of socioecological layers. Those layers are intrapersonal, interpersonal, community, institutional, public policy and global.

The suggested steps were created to be used when considering multicultural enhancement in terms of the socioecological layers. It is in these layers where the action component of the MSJCC is more heavily emphasized. And that is the goal of the steps — to promote action.

I believe the eight steps below provide a starting point for becoming more culturally competent. Use of this eight-step process will result in a singular action. Thus, it serves to make the abstract concrete and to propel movement. Although it is only a starting point, every great ending has to start somewhere.

 

Steps for implementing social justice and advocacy interventions

Step One: Identify the need(s) of your client or population.

Step Two: Decide in which layer(s) your client’s or population’s needs are represented (e.g., a client seeking assistance for solving communicating issues with a co-worker has needs in the interpersonal layer).

Step Three: Review the interventions from the appropriate layer in the model and ask yourself the following questions:

  • In what ways are my client’s or population’s needs being (or not being) met?
  • Which interventions in this layer relate to my client’s or population’s current problem areas?
  • How am I doing as a counselor with each intervention?

Step Four: Communicate your thoughts with others (co-workers, supervisors, collateral sources and, most importantly, your client). Gain insight and perspective from their understanding of the nature, intensity, diagnosis and prognosis of the problem.

Step Five: Decide where effort devoted to a specific intervention will adequately address the need(s) identified in Step One.

Step Six: Develop a strategy for implementing the intervention. Ask yourself the following questions:

  • Who takes ownership of the intervention?
  • What is my role in this intervention?
  • Who else is involved in this intervention?
  • Who or where do I need to elicit assistance from?
  • What are the potential outcomes (pros/cons) of implementing this intervention?
  • What will I need to do to prepare for the outcome of implementing this intervention?
  • What is the timeline for implementing this strategy?

Step Seven: Evaluate the outcome.

  • Did you achieve what you hoped you would?
  • Talk with your client(s). What is his or her perspective in terms of advocacy and social justice?
  • If you have a formal multicultural counseling assessment or questionnaire, employ that before and after implementation.

Step Eight: Make adjustments where necessary or create a “maintenance plan” for this intervention. Ask the following questions:

  • How will I ensure that this competency remains as is?
  • How often will I go back and evaluate the state of this intervention?

Applying a practical approach to enhance multicultural competence reaps benefits for all counselors, regardless of current expertise in the area. This eight-step approach can be helpful for newer counselors who struggle with identifying first steps. It can also be helpful for seasoned clinicians who have a strong foundational skillset but are not familiar with the particular nuances provided by the MSJCC.

Initially, employing these steps will require caution, intentionality and pragmatism. However, as with learning any new counseling skill, frequent and successful use will shape the counselor’s confidence and ease of application. As use of the steps increase, the need to refer to them will decrease, ability will be attained and multicultural competence will be elevated.

 

 

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Jonnie Seay Lane is a licensed substance abuse counselor and licensed professional counselor. She works as the qualified professional substance abuse liaison to the Wake County Department of Social Services in Raleigh, North Carolina. Currently, she is pursuing her doctoral degree at North Carolina State University, where she is studying multicultural counseling competence in her dissertation research. Contact her at jcseay@ncsu.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.

 

 

Examining our assumptions about emerging adulthood

By Peter Allen June 12, 2017

For many counselors and educators, the term failure to launch is a familiar part of the American lexicon. Some have referred to this phenomenon as an “epidemic,” and a few prominent clinicians have even described it as a “syndrome.”

This classification is problematic for a number of reasons, including that it fails to consider the longer arc of human history and development. Referring to our clients as having “failed to launch” begins the relationship with judgments and disconnection rather than a sincere desire to understand and help. When we commence our helping relationships by adopting a judgmental and comparative stance, we start off on the wrong foot with our clients and communicate to them that we have little to learn. This is, in effect, very poor modeling of the skills and traits that we hope to instill in them.

The problem

What do we mean by failure to launch? Usually this language is used to describe young adults, typically between the ages of 18 to 25 or so, who have not met the traditional benchmarks of adulthood in some fashion. The stereotype usually depicts young 20-somethings who are living in their parents’ basements, playing video games and generally not contributing to the household in a meaningful way.

In general, we observe a lack of motivation and a delay in the acquisition of skills and traits that we typically associate with adulthood: financial autonomy, independence, stable relationships, responsibility and some sense of obligation to society or the collective. We want our adolescents to grow into mature, productive adults. Because numerous examples of these adults are readily available for view, the contrast between them and the so-called failure-to-launch crowd becomes striking.

The English word adolescence comes from the Latin word adolescere, which means “to ripen” or “to grow up.” This is important because young adults, despite some thinking to the contrary, are very much still in adolescence. They are in the period between childhood and adulthood, with a foot in both worlds, so they exhibit characteristics of both stages. This presents unique challenges for those of us who encounter them in this in-between stage.

Although we basically understand what adolescence is, when it ends depends on the culture in which we were raised. For example, in Mexican culture, the quinceañera is held for young women at age 15. This coming-of-age celebration marks the beginning of adulthood in that culture. The Jewish faith marks this moment at age 13 with the tradition of the bar mitzvah and the bat mitzvah. In Japan, an event called Seijin no Hi (Coming of Age Day) occurs at age 20 and marks the passage into adulthood. The Chambri people of Papua New Guinea, sometimes called the “Crocodile People,” use ritual scarification to mark the passage of young males from childhood to adulthood. This ceremony can take place anytime between the ages of 11 and 30.

It is interesting to note the difference in timing for these cultures. I am particularly struck by the range of ages in the Chambri custom. They have perhaps come closest to identifying the actual biological range within which adolescence occurs.

Taking a cognitive behavior approach

Young adults are sometimes just beginning to evaluate the power of their own thinking to positively or negatively shape their world experience. There can be some confusion about the difference between thoughts and beliefs. In my own evaluation, a belief is simply a persistent thought that has become true or seems real to the person. For instance, if I have the thought that God exists, and if I think this way for long enough, it becomes a belief.

I like to use a story that I call “A Tale of Two Apple Trees” to teach this concept. In this story, I have an apple tree on my property. I have a lot of thoughts and beliefs about this apple tree. This apple tree is my property. I bought it, I watered it and I fertilized it. So when a stranger walks by and picks one of my apples, how do I feel? I feel angry. What am I likely to do with my anger? I am likely to have a confrontation with this person. My beliefs led to my emotion, and my emotion led to a behavior.

My neighbor also has an apple tree in her yard. Like me, she has a number of thoughts and beliefs about the apple tree, but they are quite different from mine. She believes that everyone deserves to have food. She also thinks that because she has many dozens of apples on her tree, she can certainly spare a few for someone who wants them. So when someone walks by her property and picks an apple to eat, how does she feel? Most likely she feels happy. What is she likely to do? It is likely she will approach this person and have a positive interaction. Her thoughts led her to certain feelings, and those feelings precipitated specific behaviors.

The point here is not about determining the true nature of apples and apple trees in the world. The point is that, objectively, the same thing happened to both of us: Someone picked an apple off of a tree in our yard. But our respective experiences of that event were drastically different. Based on my beliefs, I experienced anger and then behaved in a confrontational manner. My neighbor experienced happiness and then behaved in a friendly manner. We all must choose what to believe based on our life experiences and what makes the most sense to each of us.

As clinicians and educators, I think we have collectively failed to monitor our own thinking about this population. We know that thoughts lead to feelings, and feelings can lead to actions. Are we applying this knowledge to ourselves in our work with young adults? We should acknowledge that we have chosen certain beliefs about young adults and, as such, these cognitive structures are negatively influencing our experience of working with this population. One of my goals is to bring those structures into our awareness so that we can nobly wrestle with them and make more assertive decisions regarding how we are going to show up in relationships with our clients.

When we use the term “failure to launch,” we clearly display our belief that the young adult has failed in some capacity. I have also heard this called prolonged adolescence; in other words, this particular period of adolescence is taking longer than normal. Who determines what is normal? Struggling is a word often used with this population. They are certainly not thriving and not succeeding like their counterparts, who have not been labeled as “struggling.” Even the term late bloomer, which on the surface seems gentler, indicates that these individuals are not on time in their development.

Let’s assume that you came to see me, a counselor, to help you work through some issue. Perhaps you and your partner come in for couples counseling to work on better communication. How would you feel if I said to you, “Sure, I can help you with your failure to communicate”? My guess is that you would experience an immediate disconnection from me because you may not perceive yourself in that way. I am starting out from the position that you have failed. Or maybe you want to become more assertive with your parent, and I respond by saying, “I would be happy to help you while you struggle to assert yourself with your parent.” Wanting to work on something is not the same thing as struggling with it. This language betrays my internal dialogue about you.

We know that we cannot think ill of our clients, even unintentionally, and then hope to show up with compassion and warmth for them in session. There is a discipline involved in thinking well of clients, actively, so that their best interests are always at the forefront of our efforts. If we begin our work with young adults from a judgmental place, then our feelings and behaviors will follow accordingly.

That is why I advocate for a term I encountered while researching this subject: emerging adulthood. I believe this is a judgment-free term and one that is actually more accurate. Then our primary cognitive framework can begin from an understanding that these people are emerging as adults, in their own individual way, and there may be some issues or difficulty for them during this period.

Around the world

Many factors contribute to the belief that emerging adults have failed in some capacity, but one factor in particular has a very powerful influence on our perceptions of how young adults are developing — whether they leave their parents’ homes within the “proper” time frame. According to the Pew Research Center, in 2014, 32 percent of young adults ages 18-34 were living at home with their parents in the United States. This number is likely higher than most readers might have guessed.

As I thought more about this, I wondered how the rest of the world views this issue. Fortunately, the Pew Research Center has collected extensive data about young adults living at home in Europe. According to this research, Denmark is at the lowest end of the spectrum in Europe, with about 19 percent of young adults ages 18-34 living at home. At the high end of the spectrum is Macedonia, where about 73 percent of young adults in the same age range live at home with their parents. Most of Eastern Europe is in the 50 to 60 percent range. Most of the Scandinavian countries are in the 20 to 30 percent range. Why is there no failure to launch “epidemic” there?

In much of Latin America, including Central and South America, it is common for young people to live at home with their parents until they have completed school, partnered with someone in a long-term romantic relationship or begun their career. In an article from 2007, psychologist and researcher Alicia Facio and her team found that 71 percent of Argentinean emerging adults lived with their parents or other relatives.

Let’s turn to Asia for a final example. A 2014 Huffington Post article titled “Here’s Why It’s Not Weird for Indian Men to Live at Home With Mom and Dad” stated: “Typically, in the Indian culture, returning home after high school or college is not only encouraged, but expected. Even living in America, parents who have migrated here from India have instilled in their children the idea that living with their parents is how Indian ‘joint-families’ work. Most children will stay with their parents up until marriage and some even after marriage, and the Indian ‘society’ accepts this as the norm. There is no taboo, no judgment, and there is no shame — from the male or female perspective. Children are meant to stay with their parents to be taken care of, and as the parents grow older, the children are expected to take care of their parents in their home.”

The key part of this passage for me is the part that states there is no taboo, no judgment and no shame. Unfortunately, the American approach has plenty of all three.

There are actually numerous benefits to young adults staying at home beyond the age of 18 or 19. These benefits are not discussed much in the United States but are well-known to many other cultures around the world.

One thing young adults can do with greater success when they stay at home longer is save money. And nothing helps someone “launch” like having some money saved. In addition, with some healthy boundaries in place, the increased contact between young adults and their parents can actually lead to better long-term familial relationships. As the example about Indian families shows us, young adults who live at home longer are more likely to take care of their parents down the road when the parents may need support. The stability of this living arrangement also reduces anxiety for the young adult, and that readily lends itself to healthier development.

My assertion is that the American cultural emphasis on independence and autonomy is the driving force behind the current so-called failure-to-launch phenomenon. We want our young folks to be independent, but when they are actually capable of this varies widely from a developmental perspective. It is clear that Indian culture places a greater value on family connectivity than on independence. Therefore, there is much less pressure to get young adults out of the home, and thus they have more time to develop in a more stable environment — and with less shame. If American cultural beliefs are in conflict with the biological reality of human development, then perhaps it is our culture that should change.

If a young man is 25 and living at home in Argentina, his family is most likely accepting of this. It is normal for them. They do not see it as a problem provided that this young man is contributing to the household in some way. But a 25-year-old young man living at home in the United States is very likely to be viewed as being delayed somehow or, worse yet, considered lazy. This may be true even if he is contributing to the household, like his Argentinean counterpart. The same exact thing is happening in both situations (just like in my story of the apple trees), but our opinions of these young men depend on our beliefs about what is normal and healthy.

Integration of knowledge

This phenomenon is partly because of a failure to integrate knowledge from a variety of sources and disciplines. Practitioners in our field often draw on knowledge from psychology, but by also integrating information from anthropology, biology and sociology, we can develop a more accurate picture of what healthy human development looks like.

By now I hope I have demonstrated that the accepted timing of the path to adulthood depends entirely upon the culture in which one is raised. Biology tells us that the adolescent brain finishes developing in a person’s mid-20s. This piece of information alone should cause us to rethink our expectations of the average American 18-year-old. This neuroscience is widely known but seldom applied in day-to-day interactions with young adults.

Anthropology demonstrates to us that it is normal human behavior to live at home with one’s parents into one’s 20s. This is happening at very high rates all over the world. This discredits the idea that these other countries are all raising their young adults incorrectly and have been for millennia. This is not an “epidemic”; it is well within the range of normal human behavior. Sociology tells us that societies organized around principles such as family connectivity are sustainable over long periods of time.

When we put the knowledge from all of these disciplines together, it is fairly easy to see where we are going astray in the United States. When I presented this information to a group of clinicians, it was suggested to me that perhaps American culture is itself in adolescence. If that is true, then we should view ourselves as developing rather than as having arrived.

The counterarguments 

The principal argument I have heard repeated in many circles is that by letting our young adults live at home for a longer period of time, we will be raising a generation of infantilized people who will then be ill-equipped to manage their own lives. This is a valid concern, but I would respond by saying that the countries I have mentioned don’t seem to be creating generation after generation of incapable young people.

These cultures have been operating for centuries, continuously, and despite some current economic challenges, they seem to be making it work. If they were raising such incapable young adults, we probably would have seen their societies collapse decades or even centuries ago.

Having pointed that out, I am not suggesting that all young adults should get a free pass until age 25. On the contrary, we run the risk of enabling them by assuming, without testing them, that they are incapable of certain things. At the same time, we should rethink our basic position that a “healthy” person leaves the home at age 18 or 19 and should sail into adulthood with minimal disruptions from that point. What is healthy in the vast majority of the world appears to be leaving the parents’ home closer to a person’s early to mid-20s.

Both maturity and ability fall on a spectrum, so what I advocate for is the middle path. Some 18-year-olds are going to be very responsible and autonomous, while some 30-year-olds are going to need extra supports. We do not serve our clients well as counselors by comparing them all to the high-performing 18-year-olds. I acknowledge that in many cases young adults are experiencing significant gaps in their skills, engagement or motivation and need intervention to create healthy lives for themselves. In those instances, clinical and educational interventions are indicated.

Part of what we need to do better as counselors is ascertain exactly what the problem is before we intervene. Learning disabilities can play a large role in difficulties related to healthy development. If learning differences are a main cause of a young adult client’s stresses and problems, then it is we who have failed to adequately assess those challenges and make reasonable accommodations.

It has been mentioned to me several times that the difference between the other countries I have named and the United States is that young adults who live at home in those other countries are expected to contribute to the household. All of the clinicians I have asked about this have told me that they have worked with so-called failure-to-launch cases in which they discovered that the primary intervention was actually to coach the parents to communicate their expectations more clearly and to establish better boundaries.

My experience of young adults is that they will take a good deal — every time. So if parents offer full financial support and a free place to live with few or no obligations attached, young adults will gladly accept. This does not indicate pathology in them, however. Instead it indicates intelligence and shrewd negotiating skills, both of which transfer quite well to the real world.

The parents of young adults are often used to parenting children. After all, they have done this for most of their parenting lives when we encounter them as counselors. It requires a deliberate and skillful shift for them to begin parenting their new young adults effectively. Our job as counselors is to help them facilitate a smooth and supportive transition, not to judge them for perceived mistakes that we likely would make were we in their shoes.

In addition, when we encounter young adults and their families in our work, we should take very thorough histories so that we can understand the family’s unique culture and context and what is normal for them. From there, we can more effectively intervene for everyone’s benefit. For example, if the parents need to establish better boundaries, why would we offer intensive therapy to the young adult? If the parents have wonderful communication and boundaries, why would we presume to “teach” them something when we could be offering the young adult coaching and therapy services? The intervention must always flow from a careful and proper assessment of the situation and presenting problems.

The one-size-fits-all approach dictates that if someone uses the term “failure to launch,” then we assume the young adult is to blame for whatever is going on. This is an incredibly simplistic model for an astonishingly complicated developmental process. In short, our task as counselors is to separate legitimate clinical issues from normal, developmental ones.

Conclusion

As clinicians and educators, we need to actively monitor our thinking about young adults and choose a set of cognitions aligned with biology and normal human development. Our schools, clinics and programs need to be free of judgment-laden language that disconnects us from our clients and students.

We need to also recognize the wisdom that comes from a variety of cultures, countries and research-based science. We should acknowledge that we might have some cultural beliefs that, although deeply held, are incongruent with healthy human development. When we encounter these beliefs, we need to work publicly and privately to change them. The result will be better education and treatment for our emerging adults — and a better society as a whole.

 

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Peter Allen is a licensed professional counselor and the program director at College Excel (collegeexcel.com) in Bend, Oregon. The company helps college-bound young adults who have attention-deficit/hyperactivity disorder, depression, anxiety and executive functioning deficits to succeed academically. Contact him at petercallen@gmail.com.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

 

 

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Related reading on emerging adulthood from the Counseling Today archives: Validating the quarter-life crisis

 

 

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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.