Tag Archives: Counselors Audience

Counselors Audience

A counselor looks at football

By Kevin Doyle January 29, 2018

I have been a lifelong football fan. I remember playing outside in the snow, emulating the National Football League (NFL) stars of the 1960s and then going inside to watch some of the fabled rivalries of the time, like the Kansas City Chiefs versus the Oakland Raiders. I grew up on Joe Namath’s Super Bowl guarantee, Franco Harris’s “Immaculate Reception,” and the undefeated Miami Dolphins team of 1972. My beloved Washington football franchise (yes, that name is a problem — but that is for another story) owned the 1980s (along with the San Francisco 49ers), and my brother and I sported Charley Taylor (42) and Larry Brown (43) jerseys in the previous decade. My two sons played the game at the high school level, both excelling and taking much from the experience. In short, I was raised on football in many ways.

All of these things will stay with me, but recent events have conspired to lead me to question of whether the sport in its current form is morally defensible. Recently, coverage of the death by suicide of former New England Patriots player, and convicted murderer, Aaron Hernandez, noted that his brain had advanced chronic traumatic encephalopathy (CTE), and a study published in 2017 in JAMA found evidence of CTE in 110 of 111 former NFL players.

Former NFL player Antwaan Randle El, a nine-year NFL veteran who is now in his late 30s, recently spoke out about his memory problems. He became the latest in a series of both high- and low-profile professional players known or alleged to have had serious brain issues possibly due to their football careers. This includes well-known players such as Junior Seau, Dave Duerson, Mike Webster and Frank Gifford.

The national discourse has been stirred by Steve Almond’s searing Against Football: One Fan’s Reluctant Manifesto; the film Concussion, based on the work of forensic pathologist Bennet Omalu and the work of Jeanne Marie Laskas in her article for GQ titled Game Brain; as well as pro football works such as Gregg Easterbrook’s The Game’s Not Over: In Defense of Football and Mark Edmundson’s Why Football Matters: My Education in the Game.

What, then, is the role of the professional counselor in this debate — or is there one? I submit that counselors in a variety of settings have a responsibility to be aware of this issue that is currently facing our culture, and there are several reasons why.

First, this appears to be a significant safety issue for a segment of our population, namely those individuals who have either played football in the past or are currently playing. No less an authority than the Mayo Clinic has reported that symptoms such as aggression, motor impairment, tremor, memory loss, irritability and focusing problems are associated with CTE.

If an adult male were to report symptoms such as these in counseling, it could be prudent to check to see if the client was once a football player. Referral for additional medical assessment could be an appropriate course of action, although currently, no effective treatments for CTE-related symptoms seem to be available. In fact, a definitive diagnosis cannot be made until tests of the brain can be conducted after an individual’s death.

For players currently involved in football, repeated concussions could be placing those individuals at increased risk and should be monitored. Most levels of play, including the NFL and NCAA, have put so-called “concussion protocols” in place to prevent players from continuing to play until they have received medical clearance. Although counselors would likely not play a leading role in these determinations, it would be advisable for counselors working on college campuses, with professional football players or even at lower levels (high school, middle school, youth football) to be aware of them and to support efforts to protect player safety.

Second, the question of whether to allow children to play football has become an emotional and sometimes conflict-ridden debate within families. Participation rates in both high school and youth football have widely been reported to be declining and show no signs of changing in the near future, according to numerous sources.

Counselors routinely work with children and families, and reaching a decision about whether a child should play football can be difficult. An informed decision must balance the potential safety concerns associated with the sport and the potential benefits of playing the sport, including physical activity and learning about teamwork and discipline. In some families, football is seen as a rite of passage — something that adolescent males (and, in some cases, females) engage in as part of the maturation process. In some cases, it may be the child who desperately wants to play, while the parents are warier. In other cases, parental pressure on a child to participate may be the driving issue. In either instance, a counselor, whether school-based or community-based, may be in a position to help the family make this decision. Knowledge of some of the relevant issues is essential to any effort to be of assistance.

Third is the reality that any societal issue can make its way into a counseling session. This is not to imply that we as counselors need to be experts on any and all social and societal issues. However, we do have a responsibility to be aware of burgeoning issues facing our culture and to be ready to discuss or address them —or at least to listen to our clients do so.

Many of us no doubt had clients with opinions about the most recent presidential election. Their thoughts naturally made their way into counseling sessions. Our own personal feelings aside, we had a responsibility as counselors to listen, to consider our clients feelings and opinions, and to ponder what role, if any, these thoughts contributed to the stressors they were facing. Likewise, we must strive as counselors to stay informed about myriad issues of relevance to our clients. Societal question such as same-sex marriage, health care, immigration and employment barriers for those with criminal convictions, to name a few, play out in our clients’ lives on a daily basis.

Granted, the issue of football may pale in comparison to some of these, but we have a responsibility nonetheless to pay attention, to inform ourselves and to monitor the debate, because it may well come up in a counseling session with an individual or family. If we are unaware of this issue (or another one), we may need to do further research in between sessions or, in extreme cases, even consider referring our client to another provider with more knowledge of the issue he or she is facing.

Finally, there are social justice issues to be considered, consistent with the counseling profession’s recent emphasis in this area. One would have to have been living under the proverbial rock not to have noticed the emotional national dialogue around NFL players sitting or kneeling during the playing of the national anthem. Started by former San Francisco 49er quarterback Colin Kaepernick in 2016, this protest has spread to other players and teams and led to an increasingly hostile “conversation” about the form of the protest itself, overshadowing the issue of police brutality that Kaepernick sought to highlight.

The various authors I noted earlier identified numerous concerns more specifically related to football that are of a social justice nature. Approximately 68 percent of NFL players are African American, and the treatment of players has been criticized by some as evoking memories of slavery by the so-called “owners” of the franchises. Anyone who has ever watched the “meat market” known as the NFL Combine, which consists partly of athletes’ bodies being examined by prospective employers (owners), and which is now nationally televised, cannot help but notice this parallel. With the average NFL career lasting less than four years and contracts, even when lucrative, not being guaranteed in case of injury, discerning individuals can easily raise legitimate social justice questions.

In summary, a growing national conversation about football, its viability, its safety and its future is becoming difficult to ignore. Counselors at various levels and in various settings have a responsibility not only to be aware of this conversation, but also to consider its significance in relation to the clients with whom we work. Engaging in this conversation is consistent with current calls within the profession for social justice.

 

 

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Kevin Doyle is a licensed professional counselor in Virginia and an associate professor in the counselor education program at Longwood University. He has also coached youth, high school and adult sports for the past 30 years. Contact him at doyleks@longwood.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.

 

Food for thought

By Laurie Meyers January 25, 2018

With January now behind us, the annual barrage of diet and fitness commercials has started to fade. Many people who made New Year’s resolutions to lose weight or “get fit” have already labeled themselves failures for indulging on leftover holiday chocolate and not making it to the gym more than twice per week. Other determined warriors in the fight to attain the perfect size and shape may stick to their resolutions and lose the desired amount of weight, only to find that they’ve gained it all back (and then some) within six months. This cycle of dieting and weight loss, followed by weight gain, is a process that many Americans go through over and over again, often in search of an unattainable or unsustainable ideal.

“The primary message we get from popular culture is that our worth is based on our appearance and the ability to achieve a thin and beautiful cultural ideal,” says Laura H. Choate, editor of the book Eating Disorders and Obesity: A Counselor´s Guide to Treatment and Prevention, published by the American Counseling Association. “When individuals internalize this message — that they are only worthwhile or acceptable if they are able to achieve this ideal — they develop a negative body image, which can lead to dieting and disordered eating behaviors.”

According to the National Eating Disorders Association, in the United States, approximately 20 million women and 10 million men will struggle with a clinically significant eating disorder at some point in their lives. Experts say that many millions more will engage in disordered eating — patterns of behavior that resemble those of eating disorders but which do not meet clinical criteria. Symptoms of disordered eating may include chronic dieting, frequent weight fluctuations, extremely rigid and unhealthy food and exercise regimens, emotional eating and a preoccupation with food, body and weight issues that causes distress.

Ashamed to eat?

Licensed mental health counselor Tamara Duarte, a private practitioner in the Vancouver, Washington, area who specializes in treating women with eating disorders and body and food issues, says that we live in a culture that has normalized chronic dieting. She refers to this phenomenon as the “dieting roller coaster.”

Women come to Duarte, an ACA member, having spent years pingponging back and forth between restrictive diets and binge eating. After attempting to limit their consumption only to “good” food, these clients have typically fallen off of their diet wagon and ended up in a binge cycle, during which they eat all of the foods they consider “bad,” Duarte explains. Feeling guilty, the women go back to dieting and start the cycle all over again.

Duarte also sees clients who have gained weight as they have aged and want to get their former bodies back — even if it is through unhealthy means. “People come in and tell me that they used to have a restrictive eating disorder and wish they could go back to that time so that they could be thin,” Duarte says.

What all of these clients have in common is a sense of shame about food and their bodies, Duarte says. Fear of being or becoming fat is so prevalent in our society that this shame has become normalized, she says. The irony is that much of the research has found that dieting ultimately leads to weight gain, Duarte notes. Chronic dieting (even at a subclinical level) may even be harmful to the body, and Duarte and other eating disorder experts say that the benefit of weight loss through dieting is unclear.

Like many who study or treat disordered eating and eating disorders, Duarte wants to remove the stigma attached to different-sized bodies. “Fat is just an adjective,” she says.

Part of breaking free of disordered eating — and eating disorders — is learning body acceptance, Duarte says. “Helping a person to accept their body as is can be a very slow, complex process,” she admits.

“I read something posted on Instagram once that said, ‘You cannot obtain recovery while actively trying to change the size and shape of your body,’” Duarte continues. “I really liked that, and I introduce that very early on in the counseling process. Throughout counseling, we look at the beliefs the client has about their body and where those stem from. Typically, thoughts like ‘I’m ugly and unlovable in this body’ stem from society or family members. It’s interesting because none of my clients so far have thought others are unlovable because of their body size, so I question what makes them different. We also look at how screwed up society is for picking one body size as being beautiful and acceptable. With a recovering mind, they are able to recognize how erroneous these thoughts are.”

Duarte also asks clients to get rid of their scales. “Not relying on an arbitrary number to tell them whether they are ‘good’ or ‘bad’ frees them up to connect in with themselves to figure out how they are feeling,” she explains.

Intuitive eating and Health at Every Size

Duarte has personal experience both with eating disorders and the power of that “arbitrary number.” She had been in recovery for more than 10 years when she happened to gain about 45 pounds because of some medication she was taking. Uncomfortable in her new body size, Duarte was ready to put herself on a diet and workout regimen. But then she attended some seminars on intuitive eating, an approach created by dietitian Evelyn Tribole and nutrition therapist Elyse Resch, both of whom specialize in eating disorders. Intuitive eating rejects dieting. Instead, it advocates listening to the body’s signals of hunger and fullness and getting rid of the idea of “good” and “bad” foods, among other principles.

Duarte also learned about Health at Every Size (HAES), a program and social movement inspired by the book written by Linda Bacon, a nutrition professor and researcher. HAES advocates the acceptance of bodies of all sizes, rejects dieting and calls for addressing health concerns directly with healthy behaviors. Both intuitive eating and HAES also encourage physical activity in whatever form a person naturally enjoys.

“I immediately recognized the power of teaching IE [intuitive eating] and HAES to clients,” Duarte says. “Both HAES and IE teach that when you listen to your body and feed it what it wants, when it wants, how much it wants, your body will naturally go to its set point range — the weight range where it works optimally. HAES tells me that I am OK no matter what my body looks like and that I can love and accept it right now.”

After learning about intuitive eating and HAES, Duarte started following the principles found in each approach. “At that point, I had a laundry list of good foods and bad foods, so I did the work to incorporate my ‘bad’ foods back into my diet,” she says. “An incredible thing happened: As I allowed myself to want and have these foods, the power they used to hold went away. Pizza was pizza. In the past, I would not allow myself pizza, and if I did decide to allow it, I would eat like five pieces because it tasted so good and I was telling myself I wouldn’t have it again. When pizza became accessible, I realized I only wanted one or two slices, and then I was able to step away because I knew that the next time I wanted pizza — in 10 minutes or 10 days — I would be able to eat it.”

Duarte also realized that although she enjoyed going to the gym, the activity she loved best was going on walks with her dog. So, instead of carving out time to devote to workouts, she started spending more time walking her dog.

“I really enjoy my walks when I go on them, and I am kind to myself when life gets busy and I can’t or don’t want to fit them in,” she says. “I no longer berate myself because the walks are for self-care, not to manipulate the size and shape of my body. I enjoy the array of foods I eat. I love opening a menu and deciding based on what I want instead of what I ‘should have.’ I never thought I would have this kind of relationship with food or my body.”

For those who might wonder whether Duarte lost weight, she responds that it doesn’t matter because her body shape and size have no bearing on her happiness or success.

Combating body hatred

Knowing from personal experience that intuitive eating and HAES can be very effective, Duarte now incorporates the approaches into her counseling work. “Every single client that calls my office for a free consultation ends up telling me that what they want most from counseling is freedom,” she says. “Freedom from the eating disorder, the never-ending thoughts about weight and food, freedom from self-hatred. I know that HAES and IE [are huge pieces] of the puzzle when it comes to freedom.”

“I don’t have to tell my clients about my experience with HAES and IE,” she continues. “I just have it with me when I am helping to guide them through it. It influences the way I feel and think about my clients’ bodies as well. I do not hold judgments about people’s bodies because of what I have learned in my journey, and my clients know I don’t judge them. When I tell my clients that their body is acceptable no matter what it looks like, I mean it, and they know it.”

Duarte discusses how HAES and intuitive eating helped guide her treatment of a teenage client she calls “Sara,” who was restricting her food intake and using exercise and vomiting to purge. “Sara believed that her body was wrong and ugly because it didn’t look like her family members, who were taller and built leaner than she was,” Duarte says. “One of the first things I had Sara do was put her scale away in a place that she wouldn’t have easy access to.”

Duarte introduced Sara to intuitive eating and its philosophy that foods should neither be demonized nor celebrated. Sara was particularly resistant to this concept, but Duarte successfully encouraged Sara to slowly add “forbidden foods” back into her diet.

Duarte also used mindfulness to help Sara with her purging behavior. “We worked on mindfulness, so she was able to identify when the urge to purge was coming on,” Duarte says. “She would write down for me everything that she was thinking — why she wanted to purge and why she didn’t.”

The urges would usually pass, and over time, Sara was able to get through them by using tools she had learned in session. Duarte teaches all of her clients distraction and self-soothing skills drawn from dialectical behavior therapy. Examples of distraction activities include dancing to a favorite song, writing or drawing, calling or texting a friend and going for a walk or a drive. Self-soothing might involve clients taking a shower, painting their fingernails (an activity that Duarte says is great for people with bulimia because they can’t induce vomiting with wet nails) or giving themselves a foot massage.

With time — and the help of the tools she had learned — Sara no longer experienced urges to purge. It took awhile for Sara to grow comfortable with her body, but she began to enjoy the increasing sense of physical strength that came from no longer restricting her food intake, Duarte says. Over time, that physical feeling of strength also became psychological.

“She struggles from time to time with not liking how she looks, but she’s able to identify what’s really going on at those times,” Duarte says. “Typically, Sara is stressed or scared, and instead of feeling [that], she focuses on her body and her need to change it. [But now] she uses the tools we have worked on in session, and she feels her feelings effectively, and most often, the body hatred goes away too.”

Alternatives to emotional eating

Licensed professional counselor Rachael Parkins is a practitioner at the Bucks Eating Support Collaborative in Bucks County, Pennsylvania, where she currently runs a support and therapy group for emotional eating. The group meets weekly and serves as a place for women to share their challenges, support one another and get professional guidance from Parkins. Group members may be struggling with a variety of concerns, but food is their common method of coping with emotions and issues such as stress, insecurity, self-esteem and body image, Parkins explains. Most of the women are working with a dietitian, and group members also have access to an intuitive eating coach.

The goal of the group is to learn how to handle emotions in a healthy way by working on methods such as distress tolerance. Group participants identify distressing emotions, such as loneliness, and Parkins helps them identify alternative ways to cope with what they’re feeling. Sometimes, this can be as simple as group members going out of their way to be kind to themselves and practice self-care, such as putting on lotion or taking a bubble bath. Other methods are more concrete, such as journaling or completing a decatastrophizing worksheet. In that case, participants write down their worst thoughts, evaluate the worst-case scenario and the likelihood of it happening, and identify other possible outcomes.

Parkins also encourages group members to acknowledge the small victories they experience in pursuit of their personal goals by recording them in a log. For example, a group member might state a goal of practicing better self-care. For this particular group member, an action such as getting out of bed and taking a shower might represent a small victory. Another participant might want to stop procrastinating. Calling to set up a doctor’s visit could be a small victory, even if the group member doesn’t keep the appointment.

Parkins also helps group members break free of comparisons, both with other people and themselves. She explains that participants regularly hold themselves and how they look up not only to the perceived “successes” of others in their lives, but also to their own past selves. Parkins says it is not uncommon for group members to express a desire to go back in time to when they were thinner, even if it was a miserable point in their lives.

“They have this idea in their head that if they get to this size or number on the scale, that’s going to bring happiness,” she says. “Losing weight might be desirable, but as an emotional focus, it’s never enough. I’m helping people accept that losing weight is not the answer.”

Signs of a problem

Although not every client who diets is engaging in disordered eating, counselors should regularly assess for eating and body issues, says Choate, a professor of counselor education at Louisiana State University.

“We know that a large proportion of the population experiences problems related to eating and negative body image, so it is reasonable for counselors to assess for these issues with all of their clients,” she says. “Because clients with eating-related problems might come to counseling with other issues — depression, anxiety, relational problems — asking questions specifically related to eating patterns and body image is a good way to explore to see if these problems are contributing in any way to the client’s presenting issues.”

Choate suggests asking the following questions:

  • Is the disordered eating pattern causing problems in the person’s life?
  • Does the disordered eating pattern interfere with the person’s relationships with others? With the enjoyment of life activities? With completing daily routines?
  • Does the client’s weight, shape or appearance unduly influence self-esteem?
  • Does the client believe that she or he is less acceptable if weighing a few pounds more than in the past or, conversely, that she or he is more acceptable if weighing a few pounds less?

When assessing clients for signs of an eating disorder, Duarte says, it is essential that counselors not be misled by the stereotypical presentation of extreme thinness. The stigma attached to larger bodies often can obscure the reality that eating disorders may occur in people of all sizes, she says. In part because our society generally expects that people who do not fit into an idealized size range want and need to lose weight, counselors may be less likely scrutinize dieting behavior and weight loss in larger clients. Like Choate, Duarte believes that counselors should assess all clients for signs of disordered eating.

Choate also offers one final caution for counselors. “While there are some eating-related problems that might respond well to counseling alone, it is important to be aware that eating disorders are chronic, and anorexia in particular has the highest mortality rate of any psychiatric disorder. Treatment of these disorders requires specialized knowledge and training, and because eating disorders all involve a medical component, the involvement of a multidisciplinary treatment team is required. This would include, at minimum, a physician or medical professional, a dietitian and the counselor.”

 

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Defining eating disorders: Changes in diagnosis

Laura H. Choate notes that in the past, most individuals with eating disorders fell into the diagnostic criteria of eating disorders not otherwise specified (EDNOS), which led to changes in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.

The criteria for anorexia nervosa and bulimia nervosa were expanded to include more people. Binge eating disorder was added as a stand-alone disorder (rather than remaining as previously listed as a subcategory under EDNOS). EDNOS was renamed “other specified feeding or eating disorder” and includes issues such as:

  • Atypical anorexia nervosa: All criteria for anorexia nervosa are met; despite significant weight loss, the individual’s weight is within or above the normal range.
  • Bulimia nervosa of low frequency or limited duration
  • Binge eating disorder of low frequency or limited duration
  • Purging disorder
  • Night eating syndrome

 

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Multicultural considerations

Although often perceived as a “white” problem, eating disorders and disordered eating do occur among women and men of color, says Regine Talleyrand, an American Counseling Association member whose research focuses on eating disorders among women of color.

“Counselors should be aware that women of color do experience concerns regarding beauty and body esteem,” she says. “[However], the traditional methods of evaluating these factors — weight, body parts, preoccupation with thin body ideals — may not capture the real body appearance concerns of all women of color.” Talleyrand, an associate professor and coordinator of the counseling and development program at George Mason University in Virginia, says that characteristics such as hair, skin color and facial features may be more relevant when evaluating body image in women of color.

In addition, high rates of obesity and binge eating among Latina and African American women highlight the need to look beyond “traditional” eating disorders such as anorexia and bulimia when working with women of color who struggle with eating, weight or body issues, Talleyrand says. Because African American and Latina women are even more likely than white women to display eating disorder symptoms at any size, counselors who are evaluating clients of color for disordered eating should also look beyond the stereotypical underweight image, she emphasizes.

Of course, the factors influencing the risk of eating disorders in all populations go beyond appearance. These factors are often culturally specific. In particular, racism and oppression may play a significant part in eating disorder risk among Latina and African American women, Talleyrand says. In fact, the development of eating disorder symptoms — particularly binge eating — has been linked to racism and oppression experienced by African American women, she adds.

 

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (ct.counseling.org)

Books (counseling.org/publications/bookstore)

  • Eating Disorders and Obesity: A Counselor´s Guide to Treatment and Prevention, edited by Laura H. Choate

Practice briefs (counseling.org/knowledge-center/practice-briefs)

  • “Anorexia Nervosa” by Shannon L. Karl

Journal articles (counseling.org/publications/counseling-journals)

  • “Special Section: Assessment, Prevention and Treatment of Eating Disorders: The Role of Professional Counselors,” Journal of Counseling & Development, July 2012

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor:ct@counseling.org

 

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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.

Why do cops avoid counseling? Eight myths about law enforcement officers and mental health treatment

By Jessika Redman January 23, 2018

Most clinicians who work with law enforcement officers will tell you that the experience can be a little different. Sometimes, it seems to incorporate elements of a spy thriller. First, the call from the unknown number. Then, the interrogation from the unidentified caller, asking about your experience with cops, your ability to keep secrets and if you are in any way affiliated with the department. James Bond must be on the other end of the phone.

Let’s start by exploring the impacts that a career in law enforcement can have on officers. Law enforcement officers are a special population (like military and paramilitary personnel and other first responders) who experience coexisting medical and behavioral health issues with links to job-related stressors. According to a landmark study published by researcher John Violanti with the University at Buffalo in 2012, various factors contribute to the very serious physical and mental health concerns experienced by many law enforcement officers. These factors include:

  • Shift work
  • Long hours
  • Unpredictable schedules
  • Exposure to critical incidents
  • Being the frequent focus of public attention and criticism
  • Various physical demands
  • High rates of on-the-job injuries

The major concerns identified in Violanti’s study are high blood pressure, insomnia, heart disease, diabetes, posttraumatic stress disorder, obesity, depression, anxiety, cancer, substance abuse, relational distress and suicide. This special population often presents with higher rates of depression, substance abuse and suicide than does the general public.

In the October 2010 Issue of the FBI Law Enforcement Bulletin, Daniel Mattos, a law enforcement veteran for more than 30 years, described the psychological impact of police work: “By the very nature of what we do as police officers, we are unavoidably exposed to a host of toxic elements that can be likened to grains of emotional sand that ever so gradually are placed on our psychological backs. As time goes on, the sand increases in volume. Without the proper tools to remove it, the weight can become unbearable. In fact, in some cases, the sand becomes so heavy that it can collapse officers. The result of the sand’s weight takes a heavy toll on us; substance abuse, anxiety, depression, failed marriages, and other emotional and physical ailments that rise well above societal averages plague our profession.”

In an international meta-analytic study completed in 2012, researchers Claudia Morales-Manrique and Juan Valderrama-Zurian identified strong links between the high-demand/low-control nature of police work and the high stress levels that negatively impact the physical and mental health of police officers. In high-demand/low-control careers, individuals are required to be at constant peak performance levels, stemming from the unpredictability and wide range of scenarios that can be presented to them.

Research suggests that officer rates of completed suicides are three times higher than in the general population. In January 2014, Perry Mason, a retired Canadian constable (police officer), publicly described in an interview with The Hamilton Spectator his suicidal thoughts and a very near suicide attempt during his career. During 34 years of service, Mason also recounted that seven of his fellow officers had died from suicide. Mason admitted that he sought help, but also kept it highly secret because of his fears of possible repercussions to his career. He never disclosed his suicidal thoughts until after he retired.

 

Dilemmas and challenges complicating treatment

The high rates of physical and mental health conditions among law enforcement officers reflect the need for medical and behavioral support and treatment. However, treatment resistance is often a significant barrier.

In 2002, the American Psychological Association recognized the need to take a closer look at law enforcement as a special population and to define guidelines for forensic psychology. Ensuring public safety requires that officers are mentally, emotionally and physically stable and deemed “fit for duty” to perform effectively.

Law enforcement personnel often struggle to manage the challenges associated with competing demands. Very intense and difficult circumstances must be addressed while simultaneously mitigating the impact those demands have on personal health and well-being. Seeking and adhering to needed medical and behavioral treatments can present specific dilemmas and challenges.

Law enforcement officers are legally and ethically mandated to maintain good physical and mental health. However, the stressors these individuals face, ranging from inconsistent shift work to frequent and unpredictable threats to life, result in both physical and emotional challenges for the majority of officers during an average career. Law enforcement employers are legally obligated to verify and monitor officers to ensure physical, mental and emotional stability, as well as job performance capability. As a result, any signs of behavior that are in question, either on or off duty, are subject to scrutiny by the officer’s department or chain of command.

Every single law enforcement officer undergoes fit-for-duty evaluations that entail a combination of psychological testing and interviewing. In the book Practical Police Psychology: Stress Management and Crisis Intervention for Law Enforcement (2006), Laurence Miller writes that failure of the evaluation may result in job loss or suspension. An unintended consequence is that the majority of officers are hesitant to seek help with mental, emotional, relational or even physical issues because it could result in their inability to work.

According to retired police officer and psychologist Joel Fay in the April 2012 issue of the POA Journal, officers presenting with medical or mental health concerns often struggle taking medications as prescribed to address symptoms. Officers are restricted from having certain types of medications in their systems. For the safety of the public and the officers, police departments have policies against the use of certain classifications of medications such as strong painkillers and benzodiazepines. An officer-involved accident or shooting is often subject to a review of the incident that includes blood tests to determine the possible presence of chemicals or medications that may have played a role in the incident. Officers recognize that doctors may be unaware of these restrictions. Unable to fully understand the classifications of medications, officers may consequently resist taking prescribed medications.

So, what can we do as clinicians to help reduce the stigma and minimize the fear that going to counseling has for many law enforcement officers? The first step is to help officers understand their rights to privacy. I asked the legal experts at Bruno, Colin & Lowe P.C., with more than 60 years’ combined experience in protecting the rights of law enforcement officers in Colorado, and Mariya Dvoskina, a police and public safety psychologist with Nicoletti-Flater Associates, experts in the evaluation and critical incident response for law enforcement officers, to give me “just the facts.”

Collectively, we identified eight myths that keep many law enforcement officers from seeking support through counseling. Because each state may have some independent legislation in this regard, it is important for clinicians to verify the legal standards in the individual states in which they practice.

 

The myths

Myth #1

Departments/agencies have the right to obtain information about officers that seek help from licensed mental health professionals.

False! Licensed mental health professionals are legally and ethically bound to protect client privacy. If an officer reaches out to a therapist on his or her own — in other words, if the officer wasn’t ordered to see a therapist by a court or the officer’s department — then the employer doesn’t even have the right to know that the officer is attending therapy. Nothing that is said in counseling can be released to anyone without the officer’s written consent. The U.S. Supreme court has ruled that the confidential relationship between a psychotherapist and an officer is privileged. To learn more, see http://www.apa.org/about/offices/ogc/amicus/jaffee.aspx

The only times confidentiality can be broken are for the reasons below, which apply to every client/patient.

  • A suspected incident of child abuse or neglect must be reported.
  • A threat of imminent physical harm by a patient must be reported to law enforcement and to the person(s) threatened.
  • A mental health evaluation must be initiated for a patient who is imminently dangerous to self or to others, or who is gravely disabled, as a result of a mental disorder.
  • A suspected threat to national security must be reported to federal officials.
  • Suspected abuse of a senior adult (70 years of age or older), including institutional neglect, physical injury, financial exploitation or unreasonable restraint, must be reported.

 

Myth #2

Rights to privacy change if you use your insurance or employee assistance program (EAP).

False! Treatment by a licensed mental health professional that is paid for by your insurance company or your EAP is protected by HIPAA (the Health Insurance Portability and Accountability Act), and the same rules apply.

Sometimes patients choose not to use insurance benefits so that their outpatient treatment remains separate from their medical record.

 

Myth #3

There is no reason to see a licensed professional because the rules are exactly the same with a peer support team.

False! Limits to confidentiality vary by department and the standards may be different than those that licensed professionals have. The peer support member must disclose these limitations in the first meeting. In addition to the exceptions to confidentiality listed in Myth #1, most peer support teams are also expected to report crimes and sometimes policy violations. Outside of those limitations, conversations between a peer support member and an officer are confidential.

 

Myth #4

The department or agency automatically has a right to know if an officer receives a mental health diagnosis or takes medication.

False! HIPAA protects both diagnosis and medication or other treatment methods because they are part of the clinical record and therefore confidential. If an officer would like the department to know this information, he or she must sign a release of information. Otherwise, the professional treatment provider cannot disclose anything related to the client/patient to the department or anyone else.

 

Myth #5

If an officer seeks help from a hospital or a rehabilitation facility voluntarily, the department automatically has the right to this information.

False! The department can only access information that an officer has granted it permission to have, as is the case with any other medical condition.

 

Myth #6

If an officer is placed on an M-1 hold, he or she automatically loses their right to carry and possess a firearm.

False! When there is a court-approved certification for an involuntary mental health hold, restrictions to weapons are limited while the certification is active. If the provider that requested the certification acknowledges that the client/patient is no longer a danger to themselves or anyone else, then the restriction can and should be released as well.

 

Myth #7

If an officer seeks the support of a licensed mental health professional, that automatically means that the officer is not fit for duty.

False! Seeking counseling voluntarily would NEVER automatically mean that an officer is unfit for duty.

 

Myth #8

Counseling is the same as a fit-for-duty evaluation.

False! The most important question to ask is “Who is the client?” If the officer is seeking support on his or her own, all of the rights stated above belong to the officer. If the department is the client, as is the case in a pre-employment evaluation or a fitness-for-duty evaluation, then the information most often belongs to the department.

 

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Jessika Redman is a licensed professional counselor, a national certified counselor and the founder of Well Relate LLC (http://www.wellrelate.com) in Castle Rock, Colorado. Contact her at jessika@wellrelate.com.

 

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

SAMHSA shutters database of evidence-based practices

By Bethany Bray January 19, 2018

A public database of evidence-based practices for the treatment of mental illness and substance abuse disorders has stopped accepting new entries.

Federal officials announced the discontinuation of the National Registry of Evidence-based Programs and Practices earlier this month. Overseen by the Substance Abuse and Mental Health Services Administration (SAMHSA), the online database lists more than 400 peer-reviewed interventions, the last of which was posted in September.

Established in 1997, the registry served as a source of information and best practices for medical and helping professionals and the public. Its discontinuation was met with disappointment by many across the mental health professions.

“The fact that the administration [of President Donald Trump] discontinued the registry without having a new system in place sends the unfortunate message that science and evidence-based practices are not a priority,” says David Kaplan, chief professional officer of the American Counseling Association.

This month, numerous news outlets reported that the government’s contract with a third party that managed the database had been terminated. The registry remains online while officials try to determine the best way to disseminate information on evidence-based practices going forward.

In a statement posted online, Elinore F. McCance-Katz, assistant secretary for mental health and substance use, pointed to flaws in the process used to select and vet practices for inclusion in the registry.

“For the majority of its existence, NREPP vetted practices and programs submitted by outside developers – resulting in a skewed presentation of evidence-based interventions, which did not address the spectrum of needs of those living with serious mental illness and substance use disorders. These needs include screening, evaluation, diagnosis, treatment, psychotherapies, psychosocial supports and recovery services in the community,” wrote McCance-Katz.

“This is a poor approach to the determination of evidence-based practices,” she said in the statement. “As I mentioned, NREPP has mainly reviewed submissions from ‘developers’ in the field. By definition, these are not evidence-based practices because they are limited to the work of a single person or group. This is a biased, self-selected series of interventions further hampered by a poor search-term system. Americans living with these serious illnesses deserve better, and SAMHSA can now provide that necessary guidance to communities.”

 

 

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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.

Angry nation: A counseling perspective

By Carol ZA McGinnis January 18, 2018

“O say does that star-spangled banner yet wave …” is a favorite line in our country’s National Anthem because it seems to simultaneously confirm our current liberties and challenge us to answer how relevant this symbol still is. In light of the events of the past year — horrific shootings, kneeling protesters, the ravages of addiction and various controversies that pitted one patriot against another — it prompts us to ask, “Does the flag wave for me?”

Some who have responded with unreasonable aggression may be answering that question in anger. I would argue that Americans as a whole do not have healthy anger modeling readily available to them. Consider audience behavior at select sporting events, the returns experience at customer service counters and vigilante films from Hollywood. Our culture does not offer a wide variety of positive angering examples.

Anger is a research topic that has not received much attention. For that reason, it is important to ask a question: What if the root of this violence and political division stems from a limited understanding of how to anger in a healthy way? It could be that our nation suffers from dysfunctional anger associated with a wide variety of diagnoses.

 

Dysfunctional anger

Regardless of our personal thoughts on this topic, it is important to note that President Donald Trump conceptualized the Nov. 5 shooting at the First Baptist Church in Sutherland Springs, Texas, as being the result of a mental health problem. If we are to approach this from a sociocultural counseling perspective, it makes sense to add our professional thoughts on how that may be so.

Since the Columbine tragedy in 1999, research has shown that ostracism and isolation are correlated with aggressive actions. The perceived injustice of being left out or treated unfairly often results in dysfunctional anger and violence. Could it be that we have an epidemic gap in social modeling for functional anger? If so, how can we in the counseling profession begin a national process for addressing this psychoeducational need?

This may seem like crazy talk to many people. When news breaks of another Sandy Hook, the Las Vegas shooting or the more recent Baptist church tragedy, there are those who ask, in genuine bafflement, “Who does this?” We have difficulty making sense of such senseless acts. We want to reassure ourselves that the individuals who carry out these acts are much different from the rest of us in the “normal” population. To this question of “Who does this?” I would like to present the Lucas scenario.

 

The Lucas scenario

Imagine an ordinary classroom of preschool children. The room features a large space in which to play with building blocks. Every child in this room has access to the same number of blocks and the same space to work, either independently or together, as desired. Imagine that all of the children are happily at work, building towers, bridges, cities or whatever else comes to mind.

In the corner, Lucas is busily stacking block after block in his effort to build a tower when someone walks by to open the door for a parent. This action shifts the rug just enough to interfere with the balancing act of Lucas’ creation. As a result, the stack of blocks falls. Lucas collects the blocks and begins anew, taking care to brace the bottom of the tower with heavier reinforcements. He gets his tower back to the previous height in a short amount of time.

Minutes later, one of the other children throws a wadded paper ball that Lucas tries to catch. Inadvertently, he knocks the top of his own tower over. He must rebuild half of his tower yet again. Undaunted, Lucas is excited to be moving into the second phase of his design when the teacher stops to give him encouragement and suggest that he consider replacing the bottom blocks with thicker options because of the height his tower is reaching. When he tries to swap those blocks out, the tower crumbles yet again. When Lucas expresses dissatisfaction with this event, the teacher scolds him gently and tells him, “Just start again.”

Having already endured multiple mishaps that required him to start over, Lucas twice more attempts to build “the highest tower ever.” When a friend falls close by and knocks over his highest version yet, Lucas reaches the end of his rope. He has lost all hope. He is frustrated and angry that everyone else has been able to build without interruption. He feels this injustice at the very core of his being. Nothing that he has attempted has worked. Even the teacher was complicit in his failure to have what everyone else has had.

What do you think Lucas’ next move might be? What models for anger has he witnessed at this young stage of development? What choices are available?

More than likely, Lucas will want to exact justice by leveling the playing field. To destroy everyone else’s towers would help them all to know firsthand what Lucas had had to endure, and doesn’t he deserve a little payback? Why should he be the only one to suffer? Why shouldn’t the other children feel as miserable and alone as he does?

It is not difficult to see how this response might also play out in the adult world, where the prospective offender is provided with guns, bombs, cars and other means for leveling the field. The fact is that many people never learn how to anger in a healthy way; it is our job as counselors to fill that gap.

 

Theoretical explanations

This scenario is just one possibility for Lucas, but the point is clearly made when we consider the decision for otherwise “normal” people to decide on a whim to obtain a gun, or a vast array of guns, and go shoot innocent men, women and children. What if this breaking point is not only understandable but preventable if we can introduce another way to anger?

Gun laws and mental health funding may be important to consider as we begin to address violence in our society, but it is also easy to see how new theoretical explanations will be needed. Some counselors may ask whether these violent outbursts are tied to a resilience issue, whereas others will want to learn if these responses are related to cognitive processes, behavioral reinforcement or social modeling.

No matter what orientation is taken, however, it seems obvious that anger must be included in research on this topic. According to most theoretical approaches, our work does not stop at the individual level but must also attend to the larger community. The ACA Code of Ethics also calls for our aspirational response to the needs of the larger community.

One way to do that is to consider how we can help people find alternative ways to express their anger without using a gun to shoot innocent people. Might cultural role models such as Mahatma Gandhi, Martin Luther King Jr. and Jesus Christ provide a starting point? What options can we introduce for clients who may not have skills in this area? How might we begin the process of helping others to express anger in positive ways?

Let’s hold President Trump to his opinion on this topic with requests for research funding that will help to create change in angering. Together, we can help our Angry Nation become a community of change and resolution without the need for violence.

 

 

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Related reading, from the Counseling Today archives: “Angry words

Counselors often face the delicate challenge of helping clients to view anger as a helpful symptom and tool rather than something to be avoided: wp.me/p2BxKN-3ho

 

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Carol ZA McGinnis, a licensed clinical professional counselor and national certified counselor, is a pastoral counselor and counselor educator who specializes in anger processing. Her passion involves teaching with attention paid to religion and spirituality as positive factors in both counseling and counselor development. Contact her at cmcginnis@messiah.edu.

Letters to the editor: CT@counseling.org

 

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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.