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Counselors Audience

The healing language of appropriate touch

By Gregory K. Moffatt March 7, 2017

I learned a lesson about the power of touch totally by accident. I didn’t learn this lesson in graduate school, from a book or journal article, or from any professional training. Instead, it happened in the front yard with my son.

He was 8 years old at the time and already displaying the burgeoning need for the independence of adolescence. We were wrestling in the grass, and I intended to tease him by holding him like a baby, thus challenging his independence. I expected him to immediately resist my grasp, but when I looked into his face and talked to him like a baby, he became surprisingly still. He stared straight into my eyes as one might expect an infant to do. I talked to him about when he was little and how I used to snuggle him in our rocking chair in the middle of the night.

“I can stop if you want,” I told him.

“No, that’s OK,” he answered calmly. Almost mesmerized, he stayed in my arms until I was too tired to hold him any longer.

This incident fascinated me so much that, in the tradition of theorists such as Jean Piaget, I used my child as a miniresearch subject, adding this type of snuggling to my son’s bedtime ritual. Several times over the next couple of weeks, just before sleep, I would snuggle him close, caress his hair or rub his back and talk to him about when he was a baby and what it was like bringing him home from the hospital. Each time I got the same response I had witnessed in the yard. It appeared that my son gained peace by letting me touch him tenderly as he lay in bed at the end of the day. If I didn’t snuggle him, he requested it.

After awhile, I decided to see if there was a use for this type of energy in therapy.

Why we touch

If you take a moment to observe people in the public square, you will be astonished at how often they touch — couples holding hands, a friendly back slap between friends, a couple sitting side by side on a park bench leaning into one another, a friend who touches another’s upper arm while listening intently.

Why do we do this? After all, most of the ways we touch are unnecessary for conveying the basic message. We could easily restrict ourselves only to words. Touch augments our conversations, adding garnish and accent to what we want to communicate, but it is also something much deeper.

Without touch, relationships are less than satisfying. Ask any married military couple when one partner is deployed, people who have loved ones in prison or couples whose relationships are dying. The absence of touch leaves us yearning and empty, even if we still hear statements such as “I love you.”

Conversely, watch the reunions of military families, loved ones outside of prison on the day of release or the power of gentle touches between couples who are trying to repair their broken marriages. These touches communicate that “You are safe” and “You are not alone.” These messages are at the very core of healthy human attachments.

There is great precision in touch, and social rules for touch are highly refined. We can touch only certain people in certain ways. At times touch must be invited, but there are other instances when it is expected; to ask for it would be uncomfortable. In my college classroom, it may be acceptable for me to briefly put my hand on a student’s shoulder as I lean over the desk and provide assistance on a test question, but I can’t leave it there very long. And if I move my hand in any direction at all from that shoulder, the touch immediately becomes awkward at the very least, but more likely unwelcome and inappropriate.

Appropriate touch depends on who is touching whom, the genders and ages of each person involved and the relationship between these individuals. Who we touch, what body part touches what body part, how long and with how much pressure — these are the unwritten rules of touch that, under normal conditions, we develop over time in our home cultures. Similar to the way that we manage personal space, we manage touch using unwritten rules that most of us know, yet we would have a very hard time articulating them.

The importance of touch  

We don’t have to look far to discover the importance of touch from the research. Studies going back to the 1800s demonstrated that babies who were not cuddled beyond their basic needs were more likely to die of fetal failure to thrive. They just didn’t grow.

Attachment theory is built on the importance of touch and has demonstrated that extensive face-to-face and skin-to-skin contact between caregiver and child is important for the bonding process. This is the foundation on which all relationships are built throughout life. Infant massage and the soothing effects of therapy animals are just two more recent areas of touch that are well-documented.

Interestingly, many mammals rely heavily on touch to communicate many things. For example, when an elephant mother delivers a calf, every adult female in the herd touches it. They bump up against it with their legs or trunk or in some other way make contact. This communicates acceptance into the herd. If they do not do this, the mother and calf are shunned. For the first several months of the calf’s life, it stays within touching range of its mother. Dogs, cats, lions, otters and chimps all touch with great frequency.

Early in the past century, John B. Watson advised parents to touch their children “as little as possible.” He couldn’t have been more wrong. Humans are social creatures. We have an innate need to interact with others, and touch is essential to our existence. The difference between good touch and bad touch is timing, place of touch, context and purpose. Touch that communicates giving is healthy. Hugging a crying child who has hurt his or her knee is a giving touch. Physical and sexual abuse are selfish, taking touches.

I saw the important role of touch in assessing relationships in the days when I did marriage therapy. Couples in my practice often didn’t touch at all. They sat on opposite ends of the couch or in different chairs. I could often spot the most troubled marriages by the way the couples touched or the way they completely avoided touching. Couples who were deeply committed to salvaging their marriages would touch one another gently, with compassion and healthy emotion, even in the midst of their hurts, resentments and anger. I remained on the lookout for things such as a pat on the arm, an empathetic hug or a natural snuggle against each other on the sofa.

John Gottman has noted that in healthy marriages, touching is one of the vital signs of positive interaction. According to Gottman, people in very troubled marriages may touch, but they grip, cling or touch with force or desperation. At home they withhold touch or touch too hard (abusively), both of which are deeply damaging.

The physiology of touch 

Touch affects us in the right side of our brains. We don’t think it through logically. In both positive and negative ways, we respond to touch instinctively.

In infancy, even before the cerebral hemispheres are fully developed enough to manage language, the brain stem, through the vagus nerve, connects the brain, the heart and the visceral organs of the abdomen. Interesting research known as polyvagal theory proposes that it is this 10th cranial nerve that gives us our “gut feeling” in some situations.

Touch stimulates this nerve, which is wired to the amygdala, the central switchboard of our emotions. When touch is “good,” it can stop the release of the hormones that cause stress. Good touch promotes the development of attachment. Bad touch does the opposite. In either direction, these routes are classically conditioned and become our default emotional responses; they can be changed only with counterconditioning. Consequently, right-brained emotional regulation may be part of the source of many dysfunctions. These dysfunctions serve as facsimiles for the things we really want.

Children touch freely and naturally. It isn’t until they are socially conditioned to do otherwise that they change. Unfortunately, that is when children join the ranks of even relatively healthy adults who desire to be touched but don’t know the most effective way to ask for it. In short, we don’t know how to say, “Hold me.”

Could it be that simple?

The ethics of touch in therapy

We don’t have to look far to find a reason to avoid touch in therapy. Some people don’t like to be touched; touch can be self-serving for the therapist; touch can be misinterpreted and blur boundaries; touch is especially risky with some client populations such as sexually abused children.

But I believe there is a place for touch in therapy. About 10 years ago while I was attending an ethics seminar for child therapists, someone brought up the issue of touching one’s clients. “I never EVER touch any client,” one therapist adamantly averred. Nods and mumbling agreements from others followed.

After several similar comments, I couldn’t keep quiet any longer. I said, “If you choose never to touch your clients, you probably will be relatively safe from accusations of impropriety, but you may also cheat your clients of one of the most powerful tools you have at your disposal.”

I expected scowls and sneers from the 200 or so professionals in the room, but, strangely, my comment seemed to change the direction of the conversation. One after another, people noted how they had carefully used appropriate touch to bring healing and comfort to their clients. In the end, the general conclusion was that touch is a tool, like any therapeutic tool. To ignore it completely may be unnecessarily limiting to one’s practice. A proper touch in an appropriate way at the appropriate time can be comforting and healing.

The ACA Code of Ethics does not prohibit or, for that matter, even directly address touch. With the obvious exception of Standard A.5.a., which prohibits sexual or romantic relationships with clients, one must think through the various ethical implications of the ACA Code of Ethics regarding touch. Avoiding harm to the client (termed nonmaleficence and addressed in Standard A.4.a.) is probably as close as one can come to the issue at hand.

The question we must pose as counselors is whether touch would be helpful or harmful to the client in any given situation. A recent paper from the Association for Play Therapy proposes that touch should be used cautiously, but the key ethical issues are to avoid exploitation, to touch only in ways that are consistent with the therapeutic goals and needs of the client, and to take developmental considerations into account. The paper suggests that the likely interpretation of the touch by the child is also critical. This conceptual approach to touch is consistent with ethical codes from nearly all professional associations.

Therapeutic applications

I decided to work with children early in my career because, while I was an intern, I saw many people still carrying the pain of childhood abuse with them into their 50s and 60s. If bad touch can be so powerful that its effects can be felt for a lifetime, then maybe good touch can be so powerful that it can help heal these hurts.

At the time of the experiment with my son, I thought I was on to something new. Little did I know that this idea wasn’t novel. Donald Winnicott proposed this idea almost 70 years ago when he taught us that touch could be useful in psychotherapy. It is interesting that Winnicott’s research demonstrated that parents don’t actually have to be “great” parents. They simply have to be “just good enough,” to use his words, to meet the child’s needs. In other words, even marginal parents by social standards can be just good enough if they coo, snuggle and lovingly touch their children.

With a parent’s help, I’ve used touch as I did with my son with some of my clients. For example, one of my 5-year-old clients was exceedingly impulsive and hyperactive. I described what I wanted the mother to do and asked her if she would be interested in sitting in with her son during therapy and trying this behavior with him in session.

“He won’t let me hold him,” she said. “He is just too hyper.” But she agreed to try.

After asking his permission (I always respect a person’s right to not be touched — adult or child), we proceeded, and the results were fantastic. As I expected, his response was exactly like my son’s. He relaxed in his mother’s arms for almost 15 minutes without exhibiting a single hyperactive symptom. For this reason, I have given “touching homework” to parents for years. I am amazed at the number of issues that can be addressed with this simple behavior.

Another of my clients was a 15-year-old girl. She was defiant at home and at school, obstinate and bordered on incorrigible. The relationship between this teenager and her mother was tense to say the least. I suggested to the mother that her daughter really needed a physical connection with her. “Try just holding her and see what happens,” I suggested. Like the mother of the 5-year-old I just described, this mother told me that her daughter wouldn’t allow herself to be held, but she agreed to try.

The next week, the mother called to tell me about her experience. “My daughter came home from school and came in the kitchen. I asked her about her day and got the normal disinterested grunt from her. I said, ‘Come hug your mother.’ My daughter said she didn’t want to, but I said, ‘I’m not asking. Mother needs a hug.’”

She continued: “I stood there holding her for a minute or so, initially expecting her to pull away, but she didn’t. I felt her relax, and weakly she put her arms around me too. We stood there for 20 minutes. Neither of us said anything. You never told me how long to do it, so I just kept standing there!”

The mother finally told her daughter that she could go if she wanted, but — as my son did with me — the daughter declined and continued standing there soaking up the human-to-human contact. Her real need was for contact — especially from her mother — but she didn’t know how to ask for it. This teenager had substituted promiscuity, chemicals and other facsimiles because she didn’t know how to say “touch me” in a healthy way. After this interaction, her dysfunctional behaviors began to abate.

I believe that counselors can also garner great benefits by carefully using therapist-client touch. For instance, I have used hand massage with children who have been physically abused. Their body memory has taught them that touch is a painful thing. At first, some of them have trouble interpreting touch. Others, sadly, but consistent with the research, feel very little at all. This is their bodies’ subconscious defense against repeated painful touch.

My goal is to use hand massage as counterconditioning to retrain the body memory of these children to recognize good touch, pleasant connection with another human being and how touch can be a giving behavior rather than a taking behavior.

During these sessions, the child stands in front of me while a parent watches from a nearby chair. I gently massage the child’s hands with lotion as I talk about his or her value as a human being and what a great gift it is to feel another person in a nonthreatening way. The first time or two that I do this, these children often stare at me and remain motionless, having absolutely no idea how to process a touch that feels so pleasant. Over time, they begin to long for it and, as parents practice this technique at home, the children need me less and less.

Conclusion

The number of reported cases of abuse today is far beyond what it was 20 years ago, in part because people know what to look for. People who routinely work with children are trained to look for signs of abuse in children and also in behaviors that they observe between adults and children. Even laypeople have become acutely aware of various forms of abuse.

For the most part, this has been a very good change. However, it has been accompanied by an increased possibility of being sued for abuse or, even worse, charged with a crime and jailed because of abuse allegations. This has led many professionals who work with children (teachers, counselors, psychologists and others) to completely back away and, like some of my colleagues in the seminar, never to touch children in any way. This is a tragic shift. Children long to be touched — as do most of the rest of us.

A friend recently told me that he and his wife had gone to couples therapy. At the conclusion, the therapist asked if she could hug them both. It offended my friend greatly, and he told me he would never go back to counseling. I suspect this therapist either significantly misread cues or, more likely, was seeking to fulfill her own needs. As we all learn very early in our training, it isn’t about us.

But as is the case with any tool in therapy, appropriate touch can be a powerful tool for healing. Just as we have learned over the decades about the use of personal space, we can find differences in the meaning of touch based on who is touching whom, in what way, with what frequency and in what context. So, I propose that counselors consider using touch as one of the many tools in their therapeutic toolboxes.

By the way, my son is an adult now. Recently he came home for a visit. One of his boyhood friends was with him when he came through the backdoor. Even though his friend was watching, my son hugged me long and hard. It was a deep and meaningful hug and, just as when he was little, I was surprised that he held on so long. But I didn’t mind at all.

 

 

For some good reading in this area, I recommend Touch: The Science of Hand, Heart and Mind by David J. Linden, and Touch in Psychotherapy: Theory, Research and Practice, edited by Edward W. L. Smith, Pauline Rose Clance and Suzanne Imes.

 

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Gregory K. Moffatt is a licensed professional counselor, a certified professional counselor supervisor and a professor of counseling and human services at Point University in Georgia. He has been in private clinical practice for nearly 30 years. For the past 18 years, he has specialized with children ages 3-10, and he has worked with infants and babies, providing developmental analyses and consultation with parents and organizations that deal with children. Contact him at greg.moffatt@point.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.

Conversion therapy: Learning to love myself again

By Luke Romesberg February 27, 2017

When I was 14, I came out as gay to my parents. I was confident in my decision and felt ready for the world to meet the real me. Many argue that I was too young, but I had recognized and understood my feelings for a very long time. I just needed everyone else to catch up.

I was raised Catholic — not strict Catholic, but Catholic nonetheless. I attended church with my mother every Sunday, and also catechism class before or after Mass. My father always stayed home. He is Lutheran but quit practicing many years ago. Regarding politics, my parents were, and are, Republican. As with religion, my mother took an active role in this area. I grew up in a small town in Pennsylvania, made up mostly of middle-class Caucasians, and always had dreams of leaving for a large city.

Athletics were a large part of my childhood and adolescence. Ice hockey, football, baseball, soccer — if it was available, my father had me involved. As it turns out, I was not bad at athletics, but not fantastic either. My academics were much more important to me. This seemed to be a source of disappointment for my father, which I believe fractured our relationship at that time. Technology also fascinated me. I spent much of my time playing video games and surfing the internet. The internet would become one of my only outlets during some of the most painful times in my life.

 

Coming out

Despite aspects of my upbringing that many would regard as combative to the LGBTQ community, my hopes for coming out remained positive. I devised a plan. Being a millennial, my instinct was to scour the internet for thoughtful ways to reveal my identity to my parents.

After much research, I decided a letter and CD would suffice. I wrote a long, detailed composition explaining many aspects of my identity that I had kept hidden. I expressed my feelings that I was a Democrat, was done playing sports in high school and identified as part of the LGBT community. By the time my parents were reading it, I would already be at a friend’s home, where I planned to stay for a few days (also noted in my letter).

Feelings of pride and happiness surrounded me. At the same time, anxiety consumed me. I was nervous yet ready. I assumed that revealing my identity would be the most awkward aspect of coming out. Little did I know then that those feelings of awkwardness would only increase for many years.

My perfect coming-out plan crashed and burned one fateful night. During a shopping trip, I purchased a baby pink, size-small T-shirt. I loved that shirt. I would likely still be wearing that shirt if my mother had not thrown it away — and if I could still fit into a size small — but that is another story for another day.

The shirt was flamboyant. That was my goal. I felt comfortable in my identity and was ready not just to come out, but to burst out. I had been stifled in a world of sports and overt masculinity for years. This pink shirt gave me hope. It would be the catapult to my coming out.

The shirt forced people to make assumptions about me, and I welcomed them. What I had not considered, however, were the assumptions my parents were making. The sight of me wearing this vibrant shirt triggered something in them. They became more inquisitive and increasingly watchful. They asked questions: What are you doing? Where are you going? Why do you spend so much time on the computer? Who are you talking to? Who are you texting? So. Many. Questions.

Something changed. We all knew something was different, but nobody vocalized it.

Everything came to a head one night when my father walked into my bedroom holding my pink shirt. With some colorful and hurtful language, he told me the shirt made me “look” gay. His anger seemed to grow with every passing statement.

My anger also grew. I walked to my bookshelf, snatched the letter hidden within a book, and threw it at him. My parents would never receive the CD.

I watched as my father’s anger turned to sadness. He read the letter, and tears formed in his eyes. To this day, I have seen him cry only twice — at his father’s funeral and on this night.

This is when my mother entered the room. “What’s going on?” she asked, concerned. My father handed her the letter. She cried. She screamed. She shouted, “Oh, my God!” Repeatedly. She paced around the house. My father was practically frozen.

I remember feeling upset, but nowhere near their level. What had just happened? Was this really that terrible? To my parents, it was.

My mother rushed to my grandparents’ home, only three houses away. She informed them of the situation. I wasn’t present, so I can only imagine the state of panic that immediately filled the home. My grandparents on my mother’s side held even more intense religious and political views. This was not looking good for me.

I went to sleep that night, tears in my eyes and nervous to attend school the next day. What I had thought would be an awkward, yet happy, moment with my parents turned out to be anything but.

 

Conversion therapy

I revealed my sexual orientation on a Tuesday. By Friday my parents had arranged a meeting with a therapist. They told me he was a religious counselor. This seemed frightening already. He was going to “fix” me. He would make everything “better.”

I didn’t understand exactly what this meant. I didn’t need fixing. I was fine with my identity. I thought maybe my parents needed fixing.

Given that my town was so small, meeting with a conversion therapist was going to be an ordeal in and of itself. My mother’s sister, who had been informed of the situation, located a counselor. They told me he was “the best.” His office was in Philadelphia, nearly six hours’ distance from my hometown. My parents demanded that I miss school on Friday. Despite my protests, we would make the trip to Philadelphia together to meet him.

My memories of this initial session are blurry, although I remember being hounded with questions. Was I ever sexually assaulted? No. Had I ever experimented with same-sex partners? No. Was I happy with my body? No. I was 14 years old and going through puberty. Of course I wasn’t happy with my body.

The questions continued. Did I want to be straight? “Yes,” I answered, even though my brain was saying, “No. Hell no.” I wondered, “Who is this man? What do these questions have to do with my sexual orientation? What is he going to do to me? How is this stranger going to help me change something that I do not want to change?”

Over the course of the next year, I would be a participant of conversion therapy. My sessions were weekly phone conversations that cost my parents a small fortune. The sessions began as an hour in length and then decreased to 30 minutes. As I “improved,” my sessions decreased further to an hour every two weeks and, eventually, to 30 minutes every two weeks. The sessions would occur until I was healed of all of my sexual orientation issues. I was going to emerge a heterosexual young man.

My body was a frequent topic in our sessions. My therapist seemed obsessed with it. I was ordered to take off my shirt and look in the mirror. He would then say, “Please describe what you see. Tell me what parts of your body make you insecure.”

I told him that my stomach was a source of insecurity. He encouraged me to describe it. Allow me to repeat: I was a teenager. My body was changing daily. Many teenagers are insecure about their bodies. The last thing they want to do is discuss the details of these changes with a strange man on the phone.

Nevertheless, my therapist told me that my insecurities were likely negatively impacting my feelings of masculinity. My low levels of masculinity were a reason that same-sex attractions were occurring.

“Same-sex attractions.” He always said that. It was a way to pathologize my feelings. This term was used to separate me from my identity. I was not to refer to myself as “gay.” I was not gay. I was suffering from same-sex attractions.

This is where he first began to break me down. He created some cracks, which would only grow in time.

During the course of therapy, my life at home was changing rapidly. I was now being watched. I was forced to defend all of my actions. I was no longer allowed to watch certain TV shows. If anything surrounding the LGBTQ community was mentioned, I was never allowed to watch that show again. My parents began searching my phone records and forced me to call every number they did not recognize while they listened. They found and called a suspicious number only once but, thankfully, he immediately hung up and blocked my number.

My text messages were read. All of my contacts were questioned. My instant messaging account was reviewed. My computer was moved to the living room. When I used it, my mother would attempt to catch me doing something wrong. She caught me talking to a guy once, but I cut the computer’s power before she could read the conversation. My parents seemed to blame technology for making me gay. My mother once accused me of looking at a stranger the wrong way and swore that I secretly knew him.

I also had to clarify to my mother that I was not a pedophile and had no interest in children. I was no longer allowed to hang out with girls. My former best friend became less than an acquaintance. My parents condemned me for going shopping. I was allowed to wear only certain clothes.

Everything about my life that had once been comforting was stripped away. I was being forced back into the closet. My love for myself was disappearing.

As therapy continued, the therapist informed me that the combination of a “sports dad” and an “overbearing mother” were additional reasons that I was suffering from same-sex attractions. On a related note, he told me that my volatile relationship with my father and my noninterest in sports also contributed to my same-sex attractions. My father and I were instructed to spend more time with each other. Father and son bonding time would surely change my sexual orientation.

My father and I awkwardly began attempting to hang out. We would go out to eat, go to the mall, go see a movie. You know, a stereotypical girls’ night out.

My therapist even suggested that we try more “masculine activities,” such as visiting the batting cages (something I still despise) or throwing a football. One night, my father and I went to see King Kong together as a supposedly masculine activity. At the end of the movie, I left in tears, crying at King Kong’s tragic death. I doubt that is what either my father or the therapist had in mind.

Despite some setbacks, I was making “progress.” I informed my therapist that I was going through a gray area regarding my sexual orientation. This was all nonsense of course. I was still just as gay as ever; I was just telling him otherwise.

I told the therapist my gray area consisted of a lack of sexual attraction to either sex. He informed me this was normal and represented the lessening of my same-sex attractions.

Little did he know that most of my responses could now be credited to Google. That is the power of technology and the internet. I had researched and became an expert on conversion therapy. I now told him everything he wanted to hear. As a result, I was able to trick him into believing that I was changing.

Therapy continued. I was making strides, leaps and bounds even. I was moving quickly. I was turning into a proud heterosexual. In reality, nothing about my sexual orientation was actually changing. But my previous feelings of comfort and confidence were gone. I felt trapped. My parents and therapist analyzed everything I did. Being the authentic me was no longer an option. I was a stranger in my own body. My insecurities grew. My feelings of self-doubt and depression increased. I was forced back into the closet. The love I had for my identity vanished.

Therapy ended roughly a year after it began. I was “cured.” I finally felt a taste of freedom.

However, despite no longer having to deal with my therapist, my parents now believed I was “fixed.” I feel as though they were in denial, just as I was pretending to be straight. We were all lying to one another, and we secretly knew it.

Everything was not fine. I was still gay. My parents knew it. I knew it too, but we were now back to square one. The next four years proved to be draining. Coming out once was difficult enough, but now I had to find the courage to come out again.

 

Life after conversion therapy

When I was 17, my parents seemed either in complete denial about my sexual orientation or had silently accepted that I was likely going to remain my gay self. Either way, we had not engaged in an actual conversation regarding my sexuality.

Eventually, I began working for a major political campaign in the Democratic primary race in 2008. Here I would meet many like-minded individuals and fellow members of the LGBTQ community. I even met a guy with whom I would have a short-term relationship while he stayed in town for the primary. After many years of feeling trapped and questioned for my every move, I had finally found what I considered a safe zone, an oasis.

My parents weren’t supportive of the Democratic Party and didn’t approve of my volunteerism, but at least they couldn’t accuse me of things when they knew where I was. I began heading to the campaign office almost every day. The office officials quickly promoted me from volunteer to intern, which ultimately helped in my college searches and even landed me a scholarship. This was an extremely positive experience for me. I enjoyed my time spent there and met amazing people who provided me with feelings of inspiration, confidence, courage and, above all else, hope. The love I once had for myself began growing again.

Armed with my newfound positivity and support system, I was ready to once and for all set the record “straight” on my same-sex attractions. I arrived home from a particularly good night at the campaign office. My father was watching television but eventually began making his way to bed.

I stopped him as he headed up the stairs. I told him that “it” was out. I no longer cared. There was nothing they could do to upset me or tell me who I was. I was probably smirking when I told him.

My father’s face twisted. He didn’t say much but did mention being nervous and embarrassed about what everyone else would think. I didn’t care what anybody else thought. I had just come out — again.

This time it was different. I was older. I was more mature. There would be no argument. I loved myself again.

Over the course of the next few months, I began coming out to others, including my close friend. In midsummer, I put my “status” on Facebook. I received messages from concerned classmates and family members: “Your Facebook has been hacked!” I told them, no, it was true. I was gay. I was no longer afraid to reveal it.

I received unwavering support. People sent me positive messages. I entered my senior year of high school with the support of so many. My love for myself blossomed. I was back to my old self. My parents began adjusting too.

I would go on to college in Pittsburgh to study journalism. However, I would quickly change my major to psychology. My time in conversion therapy provided only one positive quality: It lit a flame in my heart and created a burning passion for caring and providing for the LGBTQ community.

I knew I wanted to make a difference. I wanted to be on the other side of this battle. I wanted to do the complete opposite of what my therapist had done for me.

Over time, my parents grew and changed as well. They found love too. Now they accept and support me in all of my decisions. It is truly amazing how things can change.

 

Today

In 2013, I moved to Chicago, where I would eventually receive my master’s degree in counseling and become a licensed professional therapist. Immediately after, at the age of 24, I entered a doctoral program in counseling education and supervision. This leads me to where I am today — and to the ultimate point of this story.

It is essential that the effects of conversion therapy are made widely known. I believe this subject is still in need of increased awareness. Many do not understand how harmful conversion therapy is, and others are entirely unfamiliar with it. Even though my experience with this “therapy type” was not nearly as severe as what others have gone through, it still caused issues that I had to battle.

I was ultimately able to make it through the difficult times these events caused, but many others in my situation do not. As reported by an American Psychological Association task force, people who have gone through conversion therapy face 8.9 times the rates of suicidal ideation, 5.9 times higher rates of depression and are three times as likely as their peers to engage in the use illegal substances and risky sexual behaviors. These statistics simply cannot be ignored. The issues listed are all too familiar for me, even with my somewhat minimal exposure to conversion therapy. It took years of personal reflection and growth, finding forgiveness toward my family, and learning to love myself again to overcome the damages caused by this so-called “therapy.”

As counselors, it is imperative that we do not impose our own value system on our clients. We must always work to ensure that we do not commit any acts of maleficence. Conversion therapy is, without doubt, an act of maleficence. If we find ourselves disagreeing with someone’s sexual orientation, it may be time to take a step back and evaluate our own principles, morals and why we chose to enter this field.

It is our job to know and understand the facts behind conversion therapy. It is not our job to tell people how to live or to attempt to change a client. Rather, we must always work with our clients to support them in their true identities.

 

 

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Luke Romesberg is a doctoral student in the counselor education and supervision program at the Chicago School of Professional Psychology. He is a licensed professional therapist and certified alcohol and other drug abuse counselor. His areas of specialization are LGBTQ issues, addictive behaviors and behavior issues in youth. Contact him at lwr4409@ego.thechicagoschool.edu or on Twitter @LukeRomesberg.

 

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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.

Digging into the numbers

By Scott Rasmus February 9, 2017

It has been relatively well-publicized in the media that mental illness typically affects 20 percent of the U.S. population, or about 1 in 5 people, yet the source of this statistic is rarely disclosed. Furthermore, media sources typically discuss mental illness in general terms and don’t address its susceptibility by age or present statistics on the prevalence of mental illness over time. For instance, a basic comparison of mental illness prevalence statistics between children and adults, or in any given year versus over a person’s lifetime, is rarely offered.

Therefore, I wanted to offer a web-based meta-analysis of prevalence statistics for mental illness by including as many reputable sources of mental health information as I could identify. These sources include the Centers for Disease Control and Prevention, the National Alliance on Mental Illness, the American Psychological Association, the American Psychiatric Association, the National Institute of Mental Health (NIMH), the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of the Surgeon General. The focus of my research was on the most current web research available, spanning the years 2011 to 2015.

Prevalence data

What are the generally accepted definitions of one-year prevalence and lifetime prevalence for mental illness? The NIMH defines one-year prevalence as the proportion of people who have experienced a mental illness in the past year, whereas lifetime prevalence reflects how many people have experienced an incidence of mental illness at any point in their lives up until the point of assessment. These numbers are typically reported as a percentage of the population. It is important to note that these statistics do not necessarily reflect new cases of mental illness, but rather those individuals who have experienced an instance of mental illness — new, ongoing or otherwise — in a given time period. With these definitions in mind, let’s look at the prevalence numbers.

In reviewing the prevalence statistics from various sources, my web research indicated that the average one-year prevalence for adults with mental illness was 22.2 percent (see Table 1), ranging from 14.5 to 26.2 percent over eight well-accepted sources. The average number trends higher than the general prevalence statistic that is often cited in the media, indicating that mental illness is somewhat more common than what is typically reported. With this in mind, one-year prevalence statistics should be revised and presented to the public to reflect that mental illness affects between 20 and 25 percent of adults in any given year.

For youths, I found data only for those ages 8-18. My research indicated that the average one-year prevalence number for mental illness among youths supported the number that is typically reported in the media — 20 percent (see Table 1). However, whereas I identified eight reputable sources of statistics for prevalence of mental illness among adults, I could identify no more than two such sources for youths. This discrepancy in viable sources suggests that a need exists for better research to identify the prevalence of mental illness among our children and adolescents.

I next refined the study to look at the one-year prevalence statistics for severe mental illness (see Table 2). When investigating this special population that is rarely reported in the media, my research indicated that the one-year prevalence average of severe mental illness among adults was 5.7 percent, ranging from 4 to 9.5 percent over seven sources. For youths ages 8-18, the one-year prevalence for severe mental illness averaged about 14 percent over just two sources, with a wide range from 9 to 20 percent.

Putting these numbers in the context of general mental illness, it implies that among adults, severe mental illness constitutes about a quarter of all cases, whereas among youths, severe mental illness makes up more than two-thirds of cases in any given year. This highlights an interesting difference, but we may infer from these numbers that the prevalence of severe mental illness can differ widely based on the definitions applied to it.

My experience suggests that these definitions tend to be more ambiguous and often are termed “severe mental illness,” “severe mental disorder” or “severe emotional disturbance,” to name a few. In my work over the past several years, I have noticed that the interpretation of the definition for severe mental illness can vary so greatly that it may include as few as five mental illness diagnoses or more than 100. SAMHSA’s National Registry of Evidence-based Programs and Practices identifies 17 related terms for severe mental illness. These terms can vary by state and with the inclusion or exclusion of childhood mental disorders and functional impairment criteria. On top of this variance, mental health professionals understand that there is some subjectivity involved in the diagnosis of mental disorders to begin with, even before the classification of the mental illness is determined as severe or not.

Next, I looked at the lifetime prevalence of mental illness for both adults and youths (see Table 3). Interestingly, I found the number of credible sources for these statistics much more limited than those for one-year prevalence, with only two sources apiece for both adults and youths. For adults, the lifetime prevalence statistics averaged 48.2 percent, with a range from 46.4 to 50 percent. For youths, the lifetime prevalence of mental illness ranged from 13 percent (ages 8-15) to 46 percent (ages 13-18), averaging about 30 percent over the full 8-18 age range. Given that youths have had fewer years to experience mental illness, it makes sense that their lifetime prevalence rates are lower than the lifetime prevalence rates of adults.

Finally, when considering the lifetime prevalence of severe mental illness (see Table 4), I could find reliable statistics only for youths, with an average prevalence of approximately 21 percent over two sources. I didn’t find enough credible information about the lifetime prevalence of severe mental illness in adults to even report here. Given the scarcity of statistics for both youths and adults related to lifetime prevalence of severe mental illness, this appears to represent a large gap in the research.

Concerning numbers

After reviewing the prevalence data for mental illness, it makes sense to me to consider current research statistics related to how many individuals with mental illness actually receive treatment for their disorders in a given year. My research indicates that the statistics for both youths and adults seem very consistent with age, averaging about 45 percent overall, and ranging over four sources from 39 to 50 percent.

These numbers shocked me somewhat and were very concerning. Such statistics indicate that regardless of age, less than half of the people who experience an episode of mental illness receive the mental health treatment that they need. This statistic begs the question: Why is this the case?

I can only hypothesize about the answer, which likely has many facets, including a general lack of awareness about mental illness, the need for education around it and the powerful influence of stigma related to mental illness. The media associates mental illness with a number of negative outcomes, particularly highlighting its relationship to violence, which in reality is very rare. To better address this misperception, the board for which I serve as the executive director — the Mental Health and Addiction Recovery Services Board in Butler County, Ohio — has adopted a position statement based on multiple sources indicating that only 3 to 5 percent of those with mental illness are violent. Still, let me offer a practical example of how the prevalence numbers and treatment statistics can be applied to the county where I live and work.

Based on the 2010 census numbers, Butler County has a population of about 370,000 residents. Applying the one-year prevalence statistics for mental illness of 20 to 25 percent, this implies that between 74,000 and 93,000 residents in our county experience an incidence of mental illness in a given year. Of those residents, upward of half don’t receive the mental health treatment services that they need. Potentially, that’s more than 46,000 county residents who may not be living their lives in as fulfilling and productive a manner as they otherwise could, especially when we know that mental health treatment largely works. People recover through modalities such as talk therapy, medications, lifestyle changes and other treatment approaches, which often are incorporated in an integrated way. What a challenge we face in addressing the mental health needs not only in my county but in our entire country and beyond. There are so many lives affected and so much productivity lost to what are very treatable illnesses.

Compiling the information I have shared in this article on the prevalence of mental illness related to time, age and treatment has really impressed on me how much work remains to be done to obtain better estimates of the general incidence of mental illness in our country and the world. We especially need more detailed statistics related to the cultural and demographic aspects of mental illness. The bible of mental illness, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, contains some valuable information related to prevalence and cultural data for specific diagnoses. There remains, however, a need for better research via large random studies that look at mental illness in general, including developmental disabilities and substance use disorders. I often wonder if the published mental health statistics that I review include these categories of mental illness.

Furthermore, as better statistics are researched and reported, mental health prevalence numbers need to be compared with those of well-known physical illnesses such as cancer, heart disease, diabetes, obesity and hypertension. In this way, I believe we can better demonstrate and publicize how common mental illness truly is in our society. Taking these actions will go a long way toward educating the public about its incidence, thus normalizing mental illness and, I hope, reducing the stigma with which it is often associated.

 

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

Scott Rasmus is the executive director of the Butler County (Ohio) Mental Health and Addiction Recovery Services Board. He received his doctorate in counselor education from the University of Central Florida. He is dually licensed in Ohio as a licensed professional clinical counselor-supervisor and as an independent marriage and family therapist. He has presented internationally on mental health topics. Contact him at RasmusSD@bcmhars.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.

APA accepting feedback for DSM revision

By Bethany Bray February 6, 2017

The American Psychiatric Association has created an online portal for the public to submit suggested changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Launched this winter, the portal allows clinicians, scholars and members of the public to submit suggested additions, deletions or modifications to the DSM.

Often called the “psychiatric bible,” the DSM-5 is a go-to resource for many practitioners when it comes to the classification and diagnosis of mental disorders. APA released this most recent version of the DSM in May 2013, after more than a decade of planning, research and review.

The online portal creates a way to keep the DSM updated in a more timely manner and make changes incrementally, as new information and research is available, according to the APA website.

This new medium offers an important and much-needed chance to have counselors voices considered in what has traditionally been an arena dominated by psychiatrists, says Stephanie Dailey, who was involved with the American Counseling Association’s DSM-5 Task Force and co-author of the ACA-published book DSM-5 Learning Companion for Counselors.

However, Dailey, a licensed professional counselor and associate professor and director of counseling training programs at Argosy University, Washington, D.C., expresses some skepticism about which submissions might actually be considered for changes to the DSM. She contributed some thoughts, via email, to Counseling Today:

 

“The Diagnostic and Statistical Manual of Mental Disorders (DSM) has long been criticized, amongst other things, for poor utility; inadequate psychometric evidence for diagnostic categories and specifiers; comorbidity issues; overutilization of ‘catch all’ diagnoses (e.g., not otherwise specific [NOS] and generalized anxiety disorder [GAD]); and underutilization of emergent genetic, neuroscientific and behavioral research.

While APA’s DSM-5 Task Force attempted to rectify many of these issues, there are still considerable challenges in regard to validity, reliability and clinical utility within the DSM-5. Clarification of diagnostic descriptions, criteria, subtypes and specifiers is needed and there is a significant dearth of information regarding sociocultural, gender and familial patterns for diagnostic classifications. There is also a lack of rigorous psychometric validation for suggested dimensional and cross-cutting assessments (introduced in the DSM-5) and no consensus was made during the last revision to the DSM in terms of modifications needed for the personality disorders category. Thus, this diagnostic category has remained unchanged and clinicians (and clients) are facing the same challenges as they did 20 years ago when the DSM-IV was released.

In terms of the new portal, it is important for individuals to understand the revision process of previous iterations of the DSM to really appreciate the magnitude of an ‘open’ call for revisions. The revision process of the DSM-IV to DSM-5 was a 14-year process, beginning in 1999, which originated with a research agenda primarily developed by the American Psychiatric Association

Image via Flickr http://bit.ly/2lfWuka

(APA), the National Institute of Mental Health (NIMH) and the World Health Organization (WHO). In 2007, APA officially commissioned a DSM-5 Task Force which formed 13 work groups on specific disorders and/or diagnostic categories. While the scope was broad, the intent of the workgroups was to improve clinical utility, address comorbidity, eradicate the use of not otherwise specified (NOS), do away with functional impairments as necessary components of diagnostic criteria and use current research to further validate diagnostic classes and specifiers. Having released the draft proposed changes, three rounds of public comment and field trials were conducted between 2010 and 2012. During this time, numerous professional organizations, including ACA, voiced significant concerns (See ACA’s 2011 letter to APA: bit.ly/2kxJBVY).

Despite attempts to become involved, at no time has any professional counselor ever served on APA’s DSM Task Force. In regards to the new portal, our time to have a foothold in changes to current diagnostic classifications is now.

In looking at the portal which lists specific kinds of revisions sought, one can easily see that APA is looking to remedy the long-term critiques of the manual, specifically validity, reliability, utility and the need to capture emerging research.

However, what proposals (and by whom) that are selected for inclusion remains to be seen. While the portal allows anyone to submit a proposal, there is a long history of bias in the type of research which is deemed appropriate for consideration by APA. While there is no dispute in terms of the need for rigorous research designs and large scale studies to validate criterion, these studies are not likely going to be conducted by anyone outside of APA, NIMH, WHO and other large scale ‘think tanks.’

The problem, particularly for counselors, is both philosophical and practical. First, the psychiatric profession as a whole is trained in the medical model, while counselors tend to operate on a more humanistic, holistic perspective. Next, while Paul Appelbaum, chair of the DSM Steering Committee, stated that acceptance thresholds will be high, reports from Appelbaum and others have ensured scrutiny for submissions which don’t provide ‘clear evidence.’ This is not only vague, but likely slanted towards the psychiatric community.

No one is disputing the need for the best available scientific evidence or the ability of the counseling profession to produce substantive outcome research for the mental health community. The American Counseling Association has members who have significant, scientific-based expertise in areas relevant to the DSM and strong research agendas which can support evidence-based changes. However, our seat at the table in these discussions has been scant.

Thus, counselors are strongly urged to contribute to the revision process by submitting proposals and working towards serving as unique contributors to the next edition. This is particularly relevant to counselors whose focus is on marginalized populations and underserved groups. Outcome-based research is needed, specifically that which has been repeatedly shown to improve treatment outcomes.

This is the time for counselors to become involved and make our experience known, and more importantly, our clients’ voices heard.”

 

 

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Find out more

 

Visit APA’s DSM portal at https://psychiatry.org/psychiatrists/practice/dsm/submit-proposals

 

See Counseling Today’s Q+A with Dailey: “Behind the Book: DSM-5 Learning Companion for Counselors

 

 

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Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org

 

Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

 

 

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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.

Hooah! Thoughts and musings on Operation Immersion

By Janet Fain Morgan January 3, 2017

Hooah: Military slang referring to or meaning “anything and everything except ‘no.’” Used predominantly by soldiers in the U.S. Army.

 

My father was in the U.S. Army for more than 30 years. I grew up as a military dependent, relocating every few years (and attending more than 20 schools) until I graduated high school. I joined the Army Reserve, later married my husband, a U.S. Navy submariner, and he eventually ended up retiring from the Army after 20 years. My eldest son joined the Army out of college and is currently on active duty.

I have been a licensed professional counselor in Augusta, Georgia; Bamberg, Germany; Lakewood, Washington; Fort Knox, Kentucky; Columbus, Georgia; and most recently, Somerset, Kentucky. As a member of the American Counseling Association and the Military and Government Counseling Association (a division of ACA), I am concerned about the rising number of suicides among our military veterans. On a related note, I am also concerned by the limited number of education and training opportunities available to counselors who are dedicated to the specific needs of military clients.

This past year, the Kentucky Counseling Association (KCA), a state branch of ACA, advertised a training program for counselors called Kentucky Operation Immersion. The program offered an immersion experience into military culture that aimed to help counselors become aware of the unique culture and specific needs of military clients. The training educated counselors on how better to help soldiers as they transition back from wartime environments overseas and reintegrate into a civilian society.

Only about 1 percent of the U.S. population actually serves in the military. Many people do not understand the difference between the military mindset and the civilian frame of mind. For that reason, I was impressed and excited to see that KCA was addressing a very important topic that can make a difference to our military members.

As a counseling professional and former soldier, I jumped at the opportunity to train with the Army National Guard at the Wendell H. Ford Regional Training Center. The Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID) and the Kentucky Army National Guard presented and sponsored the training, and many of their respective department members joined in the training. I had no idea what I had signed up for, but sometimes ignorance is bliss.

I arrived to join approximately 30 other participants from a variety of specialties, including drug and alcohol counselors, psychologists, school counselors and Kentucky Department of Veterans Affairs employees. The participants ranged in age from their 20s to their 70s.

Day One: Basic training

On the first day — basic training — we were introduced to the training leaders, department heads and Army National Guard soldiers who would mentor us throughout the training. We were issued our field equipment, including Kevlar helmets and flak jackets, which we would wear during our training for the next three days. Removing the metal plates that are normally part of the bulletproof garment decreased the flak jacket’s weight. Even so, the jacket was still heavy and served as a constant reminder of what soldiers wear to protect themselves during deployment.

Our first training exercise was an introduction to platoon formation and marching, but this version was much kinder than what I had experienced in my Army basic training days. Regardless, I found myself unable to maintain the pace of the platoon. This bruised my ego and provided a gentle indicator of the physical limitations I might encounter in the training exercises to come. And come they did …

The author, second from right in the back row, with fellow members of her Operation Immersion training squad.

The Field Leadership Reaction Course was a team-building exercise (obstacle course) that further introduced me to my counselor peers. We had fun coordinating our navigation of the ropes, walls and boards to achieve successful outcomes. Then Kentucky weather intervened, and we headed for shelter from tornadoes, storms and heavy rains. Chow took place in the mess hall with service members who invited us to ask them questions about the military and their military experience.

That evening we met Bobby Henline, an American hero, comedian and motivational speaker who served four tours of duty in Iraq. During his fourth tour, he was the sole survivor of a roadside bombing that left a third of his body burned. He shared his survival story and his outsize sense of humor with us. Bobby participated with us throughout the training and was an inspiration to us all. His humor helped lighten the serious moments, and his encouragement was invaluable. It was a true honor to meet him and a blessing to spend time with him.

Sleep was sweet after such a full first day.

Day One counseling takeaway: Military training is demanding physically and challenging mentally. Build relationships with military clients by asking about their training and work environments. Ask questions about any military-specific acronyms that they use. Many people know what an MRE (meal ready to eat) is, but fewer are familiar with what FOB (forward operations base) or TOC (tactical operations center) represent. Get to know these clients’ personal stories. This can shed light on what might be troubling them and why they are seeking counseling.

Day Two: Mobilization

Day Two arrived early — at 5 a.m. — and there we were, in formation, doing PT (physical training). Mobilization day started with breakfast in the chow hall, and then we had a class on sexual assault prevention. That morning we also heard personal stories of deployment from individual soldiers. Their stories spoke of bravery, tragedy, courage and, sometimes, boredom. All the stories touched our souls. In fact, when the program participants looked back over those days of classes, physical challenges and training, we decided the deployment stories were what we would remember most.

After a class on combat-related trauma, we headed to the SIM (Simulation) Center, where we ate MREs and enjoyed the virtual combat simulators in the forms of EST (Engagement Skills Training with Night Vision), IED (Improvised Explosive Device training instruction), HEAT (Humvee Egress Awareness Training Simulator) and CSF2 (Comprehensive Soldier and Family Fitness).

That evening, we were briefed by the commander, Capt. Michael Moynahan, and heard another personal deployment story from Maj. Amy Sutter, a licensed clinical social worker. Her mental health perspective on deployment was invaluable, and we also gained insight on deployment from a female viewpoint.

Day Two counseling takeaway: Deployment is rough, both mentally and physically. The living arrangements are complex, and soldiers have many challenges related to isolation and loneliness. At the same time, privacy is often limited. Build the therapeutic relationship by asking your military clients about any and all deployments. Each deployment offers military members challenges and unique perspectives. These could be explored through open-ended questions about their personal experiences. Be aware that some of these clients have seen or done things that they do not want to disclose or remember.

Day Three: Deployment

Deployment day again came early, with PT that included a warmup and running track. Classwork began with a briefing on substance abuse, posttraumatic stress disorder and traumatic brain injury. After listening to a suicide prevention panel, we headed out on a bus to the Gwynn City MOUT (Military Operations on Urban Terrain) site for our deployment training.

The Army National Guard launched a few simulated IED attacks in the direction of our bus and also created a machine gun simulation to get us “in the mood” for our urban warfare exercises. Command Sgt. Maj. Matthew Roberge led the military demonstrations and the exercises to prepare us for clearing a building of enemy personnel. The smooth, precise and sharp Army National Guard soldiers modeled the intricate procedure for us, and in teams of four, we attempted to reproduce the action with our military-style paintball weapons.

Our attempt was a less than perfect assault, with paintballs flying everywhere and Kentucky counselors doing their best to come out of the training exercise unscathed. That said, there was much laughter and excitement throughout, and everyone emerged feeling abundant respect for our U.S. military, and especially the group of professionals who worked with us during our training experience.

Dinner that evening was a relaxing outdoor cookout, during which we said goodbye to many of the soldiers who were leaving for their drill weekend. Awards were given, speeches were made and the treasured “challenge coins” — engraved with a unit’s or organization’s insignia or motto and given as a sign of respect — were secretly passed from palm to palm.

Day Three counseling takeaway: Military members face death often and rely on their training and peers to stay safe. Their training is precise and has to be executed perfectly every time, or the soldiers and their companions run the risk of becoming casualties. A high level of stress accompanies each operation, and sometimes that stress may last for days, weeks or even months, with little or no downtime for the soldier. The residual effects from this intense training and the soldier’s subsequent experiences can last a lifetime. Counselors should understand the deleterious effects of combat. Even if operations are carried out perfectly, casualties can occur, accidents can happen and the effects can be devastating.

Day Four: Demobilization

Demobilization day was early to rise — 4:50 a.m. — so we could clean the barracks, pack our bags and return the gear. Breakfast was quick, but then our first speaker arrived to awaken our senses. Capt. Phil Majcher spoke about his role as battalion chaplain and the duties that were part of the military chaplaincy. He didn’t sugarcoat anything, giving many of us moral points to ponder.

Linda Ringleka, military and national liaison from Lincoln Trail Behavioral Health System, joined Capt. Majcher. Together, they led a workshop on suicide prevention and ACE (Ask, Care, Escort) training. The counselors participated in small group activities that included role-plays and real-time suicide scenarios.

Sgt. Brooks, a female soldier, offered to speak with the female trainees about her experiences as a woman in the military with two deployments under her belt. Gathering together as women, we heard her personal story of courage, determination, struggling as a single mom and the challenges of being female in the Army. Her story was incredible and touched each of us. I must also mention that watching Sgt. Brooks throughout the entire training was like witnessing a master of all trades. She did everything that her male counterparts did, and with effortless perfection.

As we wrapped up the training, pictures were taken and awards were announced. Heath Dolen, DBHDID program administrator, presented each of us with a certificate, and a coveted challenge coin was passed secretly in a handshake.

As I drove home, I reflected on the immense amount of information and knowledge we had all gained as mental health professionals. This training was invaluable in providing us with skills to help soldiers as they return from difficult and sometimes horrific experiences. Many of these potential clients need to know that the counselors assisting them do actually understand some of the hardships they have endured. Counselors must gain the trust of hurting service members before many of them will disclose the horrors that they witnessed or even participated in during a deployment to a war zone.

The rules that we typically live by in our society do not always correspond to the experiences that soldiers see and live through. The camaraderie of this very tightknit community is exceptional, and counselors must understand the underlying military culture and gain the trust of these soldiers to be as effective as possible. Of that, I am certain.

I highly recommend that all mental health care professionals who take care of our soldiers undergo the type of training offered in Operation Immersion. Our heroes deserve the best that mental health professionals can give them, and this training definitely moved us in that direction.

 

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Janet Fain Morgan is a military family life counselor licensed in Kentucky and Georgia. She is a faculty member of William Glasser International and a member of the Military and Government Counseling Association, a division of ACA. She is also a former soldier. Contact her at JMFainMorgan@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 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.