Tag Archives: Students Audience (Grad/post-grad)

Students Audience

Choosing your path wisely

By Lindsey Phillips September 30, 2020

Some careers offer a limited number of pathways and opportunities after a person graduates. The good news is that counseling is not one of those careers. Counselors can work in agencies, community health centers or hospitals. They can start a private practice. They can run a clinic. They can work in or with schools. They can teach or do consultant work. They can get a doctorate and move into counselor education. They can pursue licensure and specialty certifications. They can even use the skills they have developed to work in positions outside of the field.

The bad news is that these myriad options can leave many counselors feeling overwhelmed and unsure about their next professional steps. What follows are a dozen common questions that beginning counselors (and even, on occasion, established counselors) ask about possible career paths. The insights offered by several different American Counseling Association members with varied backgrounds can provide some guidance on deciding which path might be right for you.

With so many options, where do I even start?

Start with the end in mind. To put career goals into perspective, Norm Dasenbrook, a licensed clinical professional counselor (LCPC) and owner of the private practice Dasenbrook & Johnson in Rockford, Illinois, as well as the consultant agency Dasenbrook Consulting, recommends that counselors ask themselves, “Where do I want to end up?” Or, as he sometimes phrases it, “What do I want on my tombstone?”

Do beginning counselors ultimately want to teach or do research? Do they want to treat clients? Do they want to own their own practice? These questions can help people figure out their priorities and chart their own path toward that long-term goal, he explains.

Shannon Hodges, a professor of clinical mental health counseling at Niagara University in New York, says determining a long-term goal and thinking through the steps needed to get there requires that counselors engage in self-reflection: What is their true passion? Do they want to be a professor, run a clinic, work in an agency, be a consultant or open their own practice? Furthermore, what do they know about the responsibilities involved with that career path? What are the steps required to make that career happen?

LeTea Perry, an LCPC at the Bridges Wellness Group, a counseling practice with offices in Washington, D.C., and Hyattsville, Maryland, recommends that counselors first figure out what is important to them. Do they mind working in the evenings or on the weekends? What are their personal obligations? Do they like conducting research, teaching, consulting or public speaking? Do they like working with clients? If so, what populations do they want to work with? Do they want to open a counseling office in multiple locations? Do they want to become known as the expert in a particular knowledge area?

No matter how counselors answer these questions, the important thing is that they choose a path that makes them happy both personally and professionally, Perry adds.

How do I learn more about my career options? 

Hodges, a licensed mental health counselor and approved clinical supervisor, advises counselors to interview others in the field to learn about the responsibilities and realities associated with a particular job. Running a clinic or becoming a professor may sound like a great idea, but unless you talk to others who are actually doing the work, you won’t really know if it is a good fit for you and your lifestyle, he says. For instance, Hodges finds that counseling students who say they want to be professors have often neglected to talk with faculty members about what’s involved in that role. Many of these students don’t realize that professors are often promoted more for their research and writing; it’s not just about their teaching skills.

Judith Wambui Preston, a licensed professional counselor and owner of the private practice Centered Counseling Services in Chesapeake, Virginia, says that leaders in the profession can be great career resources. For example, a counseling student could contact the director of a mental health agency and ask how that person wound up in that position and what they do on a daily basis.

Mentorship provides another way for counselors to learn about career options. Perry stresses the importance of finding good mentors because beginning counselors don’t know what they don’t know. In her experience, professionals in the field are typically willing and even excited to share their backgrounds and wisdom. But beginning counselors have to take the initiative and ask.

Counselors should also strive to get involved with local and national professional organizations, where they are more likely to find mentors and be exposed to other professionals who have done what they want to do. Perry says most of her career opportunities have stemmed from connections she made by being a member of the Maryland Counseling Association and ACA and by being an alumna of Bowie State University and Argosy University.

Dasenbrook, a past president of the Illinois Mental Health Counselors Association, agrees that joining a professional association is worth the money. Twenty years ago, a colleague at a conference asked if Dasenbrook would host a workshop on starting a private practice because of his experience. Today, Dasenbrook presents this workshop at both the state and national levels. He advises counselors to get involved with their professional organizations by volunteering to be on a committee or volunteering at their annual conferences.

Supervisors also serve as career support, Preston notes. “The supervisor is the bridge between being a master’s student and entering the world of being licensed,” she says. Several supervisors have guided her through her career journey, and now, in turn, she serves as this bridge for new professionals.

Should I get a job if I don’t know what I want to do yet?

Yes. In fact, gaining practical experience often helps you figure out what you want to do.

Community mental health centers and state-funded or federally funded agencies are great places to learn more about the type of client populations and diagnoses that you want to work with, says Dasenbrook, author of After 40 Years in Therapy, What Have I Learned? and The Complete Guide to Counseling Private Practice.

Perry recommends that counselors make a career list and pick three counseling pathways that sound interesting to them. “You never know what you like or what’s your superpower until you try it out,” she says.

While getting her master’s degree, Perry worked with clients with severe mental health disorders such as bipolar disorder and schizophrenia as a case manager at a group home. To make a more informed decision about her career path, she decided to work with other populations before deciding between mental health and school counseling. So, she volunteered as a Girl Scout troop leader at a Washington, D.C., homeless shelter. The children in the shelter were the members of her troop, and this outlet allowed the girls to have fun and engage with one another. After being drained by work and school, Perry found herself excited to see this group of girls. That’s when she realized that she wanted to work with children. She went on to be a school counselor in southern Maryland for more than a decade.

By trying out different jobs, “You’ll find the populations you thrive at working with,” Perry says. “You’ll see how much [money] you can make doing that and if you want to get further certified to move up in the ranks.”

What can I do with a master’s degree in counseling?

Many graduate counseling students come out of undergraduate psychology programs assuming that they’ll need to obtain a doctorate to have a successful career in the counseling profession, but that’s not the case, Hodges says. To reinforce this point with his students, he shows them that master’s counseling students at his university have a 100% placement rate and only around 10% pursue doctoral degrees. So, unless a student wants to be a full-time professor, they don’t have to earn a doctorate, adds Hodges, who has written several publications, including The Professional Counselor: Challenges and Opportunities and The Counseling Practicum and Internship Manual: A Resource for Graduate Counseling Students.

Of course, this doesn’t mean the journey from master’s degree to counselor licensure is an easy one, Preston points out. In fact, it is often a long and costly process. In Virginia where Preston practices, counselors have to accumulate 3,400 supervised hours before they can take their exams and become licensed.

But counselors who are working toward licensure still have lots of career options. They can work in mental health agencies, community mental health agencies, detox faculties, hospitals, residential facilities (e.g., psychiatric inpatient facilities), correctional facilities, schools and university counseling centers, Preston says. They can also find places to work that will pay for them to get supervision, she adds.

“The great thing about a training program like counseling is that the skills go well beyond the profession,” Hodges points out. He’s had several students who have used their counseling skills in professions outside of the field. For example, one student decided counseling was not for her, so she became a professional coach. Another former student served as the assistant director of human resources at a university and used counseling skills to handle sexual harassment claims, mediate disputes and talk with employees who were being fired.

Hodges has noticed that many colleagues working in student affairs (e.g., residence life, the office of the dean of students, student activities) also hold counseling degrees. “In this era of severe mental health concerns among college students, a counseling background is very helpful,” he adds.

Dasenbrook found a niche applying counseling skills such as “I” language, reflective listening and empathy to business and industry. For example, he has coached highly technical people who lacked the communication and people skills needed in their positions as directors or supervisors.

What are the benefits and challenges of getting a doctoral degree?

After Perry finished her master’s in school counseling, she got a job in a school system. That same year, she received notification that because of budget cuts, she might lose her job.
She was upset and angry because she had thought a job in public education was safe.

Perry took one day to cry about it, and then she made a plan to never be in that situation again. She decided to return to school and get her doctorate to increase her versatility and stability and to have more control over her future earning potential. With a doctorate, more opportunities have opened up for her, she says. She teaches as an adjunct in a counseling program, works in a clinical practice, and provides trainings on social-emotional intelligence, ethics and other counseling topics for community organizations and universities. The knowledge and expertise she acquired during her doctoral program have also put her in position to earn more money.

Hodges acknowledges that getting a doctorate can open up more job possibilities, but counselors should first weigh the benefits with the cost, he says. That cost can be high, involving several additional years in graduate school and a large financial commitment.

If someone is considering pursuing a doctorate, Hodges advises them to seriously consider the following questions: Will a doctorate help you achieve your career vision? Do you have a support system (e.g., family, friends, an active self-care plan) to assist you in this pursuit? What value will the doctoral degree add? What is the return on the investment? Given the high cost of education today, manageable debt is one of the first things that people need to consider, he adds.

Perry recommends that counselors figure out their motivation — their “why” — before investing time and money in pursuit of a doctoral degree. For her, that “why” boiled down to anger, fear and uncertainty at the possibility of losing her job to budget cuts and the desire to diversify her career options.

For Preston, the decision to get a doctorate was a long time coming. She had entertained the idea more than once over the years, but the timing never felt right. Her kids were young, or she was busy with her own clinical practice. Plus, after taking out school loans for her master’s-degree program, she had promised herself that she would not pursue a doctorate unless she had financial help. (For more on Preston’s career decisions after graduation, see her contribution to Julius Austin and Jude Austin’s Surviving and Thriving in Your Counseling Program, published by ACA.)

Now, 15 years after earning her master’s degree, Preston says it is finally the right time for her. She just finished her first year as a doctoral student in the counselor education and supervision program at Old Dominion University in Virginia — with a tuition stipend.

What if I want to teach but don’t want to research?

There are ways to teach without having to research and publish. One option is to teach as an adjunct. Larger universities often require more research and publications, whereas adjunct faculty and some community college faculty positions don’t.

Conducting workshops is another way to teach others. Dasenbrook always wanted to teach, but because he didn’t have a doctorate, he knew it would be difficult for him to do so at a major university. Instead, he discovered that he could teach other counseling professionals how to improve their own skills and businesses through workshops. He has taught mediation skills for business and industry, and now he teaches workshops on how to start and build successful private practices. 

Hodges has noticed some universities are hiring clinical professors, which is a faculty position that focuses more on teaching and supervision. One of his colleagues at Niagara University was hired to oversee clinical placements and teach part time. She was drawn to the position because she doesn’t have any desire to do research. Hodges predicts there will be more options for clinical-type faculty in other university counseling programs in the future.

Should I get some work experience either before or during my doctoral program?

Preston thinks there is some value in having clinical experience before getting a doctoral degree. “When a professor is talking about a theory or technique in class, you’re coming in with another lens. You have familiarity with what that professor is talking about … because you have actually experienced it,” she explains.

But there is also a benefit in going directly from a master’s program to a doctoral program, especially because it can be challenging to readjust to academic life once you leave, she adds.

When Hodges was in graduate school, he wanted to get as much practical experience as he could. He did internships while also working at agencies and career centers. He also took two years after earning his master’s degree in counseling to work in the field. Then, when he started his doctoral program, he worked part time at an agency during the school year and full time during the summer.

This experience allows him to speak from a real-life knowledge base, not just a theoretical one, when he teaches. Students appreciate the practical examples he provides, he says.

Several of Hodges’ students have also chosen to work in the counseling field for a few years before returning to school to earn a doctorate. They say those experiences can help counseling students determine whether a doctoral degree is the right path to pursue.

Hodges believes that is a good plan. He often advises counseling students who aren’t sure whether they want a doctorate to get a job in a clinic and get licensed first. Then, they can teach part time in a counseling program and decide what the next steps for their career should be.

Do I need practical experience as an educator?

“Academics [often] have very little professional practice because they tend to be separate careers,” Hodges points out. “But it’s really an advantage to have several years of experience working in direct services or maybe even running programs because you understand practical, day-to-day issues.”

Dasenbrook thinks that counselor educators should be licensed in the field in which they are teaching, and Preston says that some universities prefer employing educators who are licensed. Having practical experience in the settings they are teaching about allows educators to discuss real-world examples, which benefits students who want to become clinical counselors,
she adds
.

Being licensed also provides counselor educators with more diverse career options, Preston continues. Even with a doctoral degree, they need a license to practice independently; otherwise, they can see clients only under supervision, she points out.

Of course, having practical experience is not required to make someone a better professor. Preston says she has had plenty of professors without clinical experience who were wonderful teachers because they found other ways to increase their clinical knowledge, such as interviewing clinicians in the field and regularly attending trainings and conferences.

How do I balance being both a clinician and an educator?

Trying to juggle multiple professional roles at once can be challenging. For their own well-being, counselors must establish boundaries, and if they have too much on their plates, they have to be willing to let something go, Perry says.

Counselors should take on new projects in small doses to avoid overwhelming themselves, Perry continues. For example, if a clinician is working full time in an agency, they could choose to teach just one class on the side, or a full-time professor could start by taking on only a limited number of clients to see how that goes.

Although working in multiple roles undoubtedly expands the potential of increasing a counselor’s earnings, experience and expertise, counselors should take into account the possibility of a learning curve for each new role or project, she adds.

Hodges knows the struggle of shouldering too many roles at once. During his doctoral program, he was a teaching assistant for both the psychology and counseling departments, plus he worked part time in an agency off campus. This schedule didn’t give him a day off and pushed him toward burnout, so he eventually had to quit one of his jobs.

“Part of why [counseling] exists is to help people have balanced, healthy, rewarding lives. We have to make sure we’re doing that ourselves,” Hodges says.

At another point in his career, he realized that he wasn’t meeting that goal. He was driving an hour each way to work at an agency that he loved while also teaching, writing, researching and serving on journal boards. So, he made the decision to adjust his career plan. He stopped working at the agency and focused his energy on researching, writing, and taking international service trips to Africa and to remote parts of Australia during the summers when he wasn’t teaching.

What nonclinical skills do I need as a mental health professional?

When Hodges was in his master’s program, an alumnus came to talk to his class about careers. The man asked them, “Who wants to be a counselor?” Hodges remembers that all 30 hands went up.

Then the man asked, “Who wants to be an administrator?” Only five students raised their hands, but the alumnus predicted that in five years, most of the class would be administrators of some kind.

In Hodges’ case, that prediction came true. In his career, he has served as director of a university counseling center and as the clinical director of a county mental health clinic.

After getting some clinical experience, counselors often move up the career ladder to management and administrative positions. At that point, “Your management experience actually starts to supersede your clinical experience,” Hodges says. In these positions, counselors can find themselves negotiating with unions and outside agencies such as family services, jails or hospitals. And they often have to interact with vice presidents and CEOs of organizations.   

When Hodges ran a clinic in rural eastern Oregon, he had to interact with the state hospital, testify in court, handle frustrated county deputies, oversee prison contracts and deal with a counselor who had an inappropriate relationship with an inmate. Such administrative skills aren’t covered in most counselor education programs, Hodges says, so he had to learn them the hard way — on the job.

Hodges is thankful for one supervisor who pushed him to develop those skills by posing hypothetical situations. One time, the supervisor asked Hodges to write a correction plan for how to handle a therapist who was not doing a good job at work. The exercise forced Hodges to consider how he would help the employee improve their job performance, how much time he would give the employee to get better, and what reasons he would recommend for retaining or firing them.

Is private practice a viable option? How do I learn the business side of it?

“There’s this urban myth in a lot of counseling programs that you can’t make it in private practice,” says Dasenbrook, who, along with Robert Walsh, helped launch ACA’s Private Practice Initiative many years ago. “But if you’re good at what you do and you can get yourself out there, you’re going to do just fine.”

Counselors have the clinical skill set needed to open a private practice, he emphasizes. The problem often lies with the business aspect — marketing and billing, for example. Dasenbrook’s advice is to get a mentor and learn the business side of running a practice. That mentor doesn’t have to be another counselor; they can simply be someone who has started their own business, he says.

Workshops, trainings and college classes are also great ways to learn these skills. As an undergraduate, Perry got a concentration in business, but if she were to do it all over again, she says, she would minor in business or double major in business and a study field related to counseling.

“Business majors have a personality and mindset that counselors can acquire,” she says. “We are the helping profession and givers by nature, but we also need to be business minded. It is important for us to brand ourselves and look at things from a business perspective to monetize our gifts and talents effectively.”

What is the likelihood that my career plans will change?

Be prepared for career plans to change. Counseling students often start graduate school with preset plans, Hodges notes. He once had a student who said she would never work in the area of addictions. When her first choice for practicum didn’t work out, she had to go with a backup plan — a substance use treatment facility. She ended up loving the job so much that she continued to work with the agency after she finished her master’s.

“Perhaps tolerance for ambiguity is a real career asset,” Hodges notes. “You never really know how you will feel about a job or career until you embrace it.”

Dasenbrook’s own career journey has taken several turns. He dreamed of opening a clinic for sex therapy after graduating. While he was working in a community mental health center, he put together a small team — a counselor, a psychologist, a gynecologist and a neurologist — and made his dream a reality. But because there wasn’t a high demand for sex therapy in Rockford, Illinois, at the time, the practice lasted only six months.

Even though that career path didn’t work out as Dasenbrook had envisioned, he made professional connections through the venture, and the other doctors began referring clients to him.

“You never wind up where you start,” Dasenbrook points out. For that reason, he advises counselors to “be open to possibilities, to be open to something new.”

 

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Related reading, from the Counseling Today archives (2017): “A path well chosen

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.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.

Starting post-college life in a pandemic

By Bethany Bray August 3, 2020

Spring 2020 college graduates have emerged into a world turned upside down by COVID-19. The job prospects and post-college lifestyles these graduates were imagining for themselves just a few months ago are today largely nonexistent.

Unprecedented seems to be the buzzword of the season, notes Roseanne Bensley, assistant director of New Mexico State University’s (NMSU’s) Center for Academic Advising and Student Support. The coronavirus pandemic has affected everything from relationships to career planning for new graduates.

“It’s not one part of their life, it’s every part of their life,” Bensley says. “Employers have uncertainty and don’t know, day to day, when things will lift. … No one has enough information to give answers. This is new territory for employers and job searchers.”

However, Bensley would like to add a second buzzword to the class of 2020’s lexicon: resiliency. As she points out, these students, many of whom had to unexpectedly finish their senior year coursework online, can claim an advantage when it comes to adaptability and comfort with technology.

Because of COVID-19, “New jobs and new ways of doing business are opening up. This is going to cause a new wave of change, and [employers] may not be going back to the way it was,” Bensley says. “These students are ahead of the curve. … They will be resilient with what they’ve learned.”

At a loss

Licensed professional counselor (LPC) Patricia Anderson recently worked with a new college grad who was experiencing a resurgence of anxiety this past spring during the pandemic. The young woman had switched jobs, and the restrictions associated with COVID-19 meant that she was unable to meet any of her new co-workers in person. Her entire hiring and onboarding process had been completed via video and electronic communication. She had also recently moved into her own apartment and begun living away from her family for the first time.

The client was stressed out, anxious, and struggling with her self-confidence, recalls Anderson, an American Counseling Association member who has a private practice in the Georgetown section of Washington D.C. In working through her feelings in counseling, it became clear that the young woman — an extrovert by nature — was experiencing grief over the large-scale absence of social connection, both at work and in her personal life.

During the pandemic, the client had stopped using an online dating platform. This resulted in her experiencing a sense of loss regarding opportunities to meet people and a decrease in the confidence she normally gained through interacting with dates and new relationships. Anderson worked with the client to establish a self-care plan that included making time for hobbies and exercise, as well as maintaining social contacts and reconnecting with friends with whom she had lost touch.

Anderson also focused on boosting the client’s confidence and equipped her with strategies for keeping her self-talk from becoming self-critical. In addition, Anderson helped the client recognize that what she was feeling was grief, which can arrive in waves. Together, they connected some of the client’s feelings to family-of-origin issues that were contributing to her stress.

Anderson also helped the client focus on the reality that her current situation wouldn’t last forever. “We talked about things she can look forward to in the future: going back to online dating, figuring out a new normal, looking forward to meeting colleagues face-to-face, planning a trip, and working on another business opportunity,” Anderson says. “Time spent away [from dating] had eroded the confidence she once had and had kicked up her anxiety. Staying ‘in the game’ can be beneficial for some [clients]. It’s a way to get to know themselves and push themselves socially.”

Many of Anderson’s clients are young professionals, current college students or recent graduates. Throughout the spring and summer, many of these clients have been wrestling with feelings of loss, she says. This includes the loss of rites of passage such as graduation ceremonies and in-person celebrations, the loss of internships and immediate job prospects and, for some, the seeming loss of entire career plans.

“Their world and their [sense of] structure have been upended, and they’re not really knowing which direction to move in,” Anderson says. “Some days, they feel like, ‘OK, I got this,’ and then other days, they have doubts about ‘Where am I going?’ The floor dropped out of what they thought was going to happen. … They have anxiety over the fact that everything got pulled out from underneath them, and now they don’t have a road map.”

It is vitally important that counselors first help these clients process their feelings of loss before trying to guide them to reconsider their job options or life path, Anderson says. Among the most consequential actions counselors can take are to listen to, validate and normalize the emotions that these young adults are feeling in the wake of COVID-19.

“Be with the client where they are,” Anderson says. “If they’re unable to go with a job that didn’t happen or was rescinded, really sit with them in that space before opening up and looking at the possibilities of ‘what else?’ It’s difficult to do that until they know that you understand them and where they’re coming from.”

All feelings of loss should be treated as real and valid, Anderson says, even if clients themselves express guilt over feeling that way or dismiss those feelings as being trivial when the world is facing weightier issues. For example, some graduates may still be dealing with disappointment that they missed out on a final chance to take a spring break trip with friends or weren’t able to study abroad because of the coronavirus. Counselors should reassure these clients that it is OK to have these feelings and then give them space to talk about it, she emphasizes.

“[Help them] know that they’re not alone and that it totally makes sense to struggle right now. They also may be scared at feeling unsettled, which may be a new feeling for them,” explains Anderson, who does contract work for the QuarterLife Center, a Washington, D.C., therapy office that specializes in working with young professionals in their 20s and 30s.

In addition to normalizing feelings, Anderson has been providing clients with psychoeducation on self-care, the nonlinear aspects of grief, and the importance of maintaining social supports and a structured daily schedule. She checks with clients to ensure they are staying connected with friends and family via technology and that they are equipped with coping mechanisms such as meditation and self-reflection exercises. She also asks if they are eating well, engaging in physical activity, getting outside, and taking part in other wellness-focused activities.

As Anderson’s clients talk in sessions, she listens for hopeful language that might indicate they are ready to rethink their futures. “I try to help them broaden their scope a little, if they’re ready for it. I let them talk about what they need to talk about, but then spend some time looking at other pieces of what else might be possible. [I] try and get them out of their heads just a little bit,” Anderson says, “because if I [as a client] always thought I was going to be a dentist, and come to find out that I’m not going to be a dentist, I have to grieve. But at the same time, maybe there are some things that free me up about not being a dentist.”

“If you can create a trusting relationship with a [client],” she says, “they know that you understand them, and we can explore all kinds of things, whether they [previously] seemed unrealistic or not.”

Rethinking career plans

Flexibility must be the watchword for recent graduates who are looking for jobs, says Lynn Downie, associate director of career and professional development at Presbyterian College in South Carolina. In her work with undergraduates and alumni of the small, rural college, Downie is finding that those who had a “hard and set, defined path” in mind, such as entering the health care or hospitality industries straight out of school, are struggling most.

Those who are currently seeking jobs can benefit greatly from the guidance and encouragement provided by a counselor, says Downie, who recently finished a two-year term as president of the National Employment Counseling Association (NECA), a division of ACA. “Give them reassurance that things haven’t changed completely. Highlight [the idea] that pathways to a particular goal aren’t always the same. There are other distinct pathways,” she says.

Downie is helping her clients identify workarounds as they adjust their perspectives to become more flexible and less discouraged by rejection letters or the idea of taking a job that might not have appealed to them previously. Some of her clients have readjusted their career plans to take entry-level or short-term work in positions or fields they wouldn’t have considered six months ago. Others have pivoted to opportunities in national service programs such as AmeriCorps.

Downie, a member of ACA, also reminds recent graduates that they just need to find a fit for right now. That doesn’t mean their long-term career goals have to change. “Help [these clients] realize that they’re not making a choice for the rest of their lives when they choose a job, or [especially] their first job,” she says. “Their life is going to be full of all kinds of pivots. Some are planned and some are unplanned and forced. There is a big arc from 18 to 65 or retirement age. … You can [still] have aspirational goals that are for down the line.”

Downie has worked with several business students who had hoped to go into health care administration, but because the industry is so in flux currently, there aren’t many administration jobs open at the entry level. With these students and graduates, Downie has focused on ways that their administration skills could be used in alternative settings, such as nonprofit, community development or public health organizations. Another tactic is taking lower-paid medical aide or assistant jobs in settings that are currently short-staffed (such as nursing homes) and that do not necessarily require special certification. As Downie points out, even working as a contact tracer as part of the COVID-19 virus response — a job that didn’t exist six months ago — could help these new graduates gain experience.

Similarly, a job in pharmaceutical or medical sales could provide these graduates with valuable exposure. “They would still be interacting with those in the medical field, instead of applying for jobs that don’t exist,” she points out.

Bensley notes that going with a “Plan B” job in a field or setting that a graduate didn’t originally intend to work in can demonstrate to other potential employers that the graduate possesses a good work ethic and thinks outside the box. She also urges students and recent graduates to widen their searches to consider temporary, freelance or even gig work instead of focusing solely on full-time employment.

“[A first job] may not be professional, but it’s work, and [the individual] can be introduced to people through that work,” Bensley says. “It also tells a [future] employer that you’re a hustler and not waiting for the golden egg to show up.”

When counseling clients who are rethinking their career plans, Downie finds it helpful to have them identify a theme they feel drawn to and then consider various types of work that fit that theme. For example, a graduate who enjoys building relationships can use that skill in any number of job settings. They might start out in sales but advance to building teams as a manager or even pivot to cultivating client relationships as a professional counselor.

“Find a theme for your life — that one thing you cling to, what you’re good at,” Downie tells her clients. “You can work on that in all types of settings. A core skill can translate into different fields, and sticking with it will give you a sense of continuity and purpose.”

Networking during a pandemic

Bensley often tells students at NMSU to think of how professional athletes are handling the pandemic: Their season may be on hold or even canceled, but they’re continuing to stay in shape.

“Just because the competitive side of their sport has stopped, they’re not watching Netflix for 10 hours a day. They are still keeping their skill set up, working out, training and preparing,” Bensley observes.

That same philosophy should apply to career planning during the pandemic, she emphasizes. Now is the time for job candidates to put even more energy into enriching themselves and expanding their professional networks.

“Don’t limit your strategy to just sending out résumés and waiting for a response,” urges Bensley, an instructor for the global career development facilitator credential through NECA. “While employers may have slowed down their original hiring plans, it does not mean that a candidate should also slow down. If anything, it means you might need to work harder at following employers on LinkedIn, reviewing their homepages and [thoroughly] reading job postings to determine if you have the skill set that employers require.”

Bensley suggests it is also the perfect time for recent graduates to flip the usual dynamic and reach out to interview professionals who are already working in their desired field. Job seekers can identify contacts through LinkedIn or other networks and ask if these professionals have 20 minutes to talk about their job or industry.

Bensley urges students and recent graduates to start with professors and mentors whom they already know or have worked with. They can then use those connections to secure introductions to other professionals in their desired field. Those professionals can recommend still others they would recommend connecting with, and so on, in a widening circle, Bensley says.

Professionals are especially open to such requests right now because many are working from home and are free from in-person meetings, conferences and business travel engagements. In many ways, motivated students and recent graduates currently have a “captive audience,” she says.

“This shows curiosity and a desire to learn about your craft, gets your name out there, and helps you evolve and have insights on what they [professionals] consider to be important,” Bensley says. “If an employer said, ‘We really value teamwork,’ there’s a hint: Everything [you might say in a job interview] should be focused on teamwork. Instead of saying, ‘I did X,” say, ‘We did X.’ That can be the small percentage you need to get ahead — understanding the value system of the employer because you’ve talked to them about it.”

Forward vision

As counselors offer support and reassurance to recent graduates and young professionals struggling to adjust to personal and professional lives upended by COVID-19, here are some important points to keep in mind:

>>  Focus on listening. Downie urges counselors to slowly ease in to therapeutic or career work with these clients. She often opens her sessions with a question: “What do you want to talk about today?” With so many concerns currently weighing on these clients, their answers might be unexpected and diverge entirely from the topics they have discussed in session previously, she says.

“Give them the floor to talk about whatever they want. We [counselors] always have to be good listeners, but now as we’re isolated, there’s a real temptation to give advice,” Downie says. “What is needed now, during this crisis, is to listen — listen more and not give advice. That’s been essential. Students who were slow to open up to begin with now need additional time to be comfortable. We need to build [therapeutic] relationships but also step back and allow for quiet. Right now, there’s so much chatter, [clients] need time to catch their breath before speaking.”

>> Consider the whole picture. College students and recent graduates may unexpectedly find themselves living at home and navigating family stressors, Downie notes. Regardless of the presenting issue that brings these clients to counseling, counselors should ask questions that will help them understand clients’ situations in full. Downie says she has worked with students who have needed to finish college coursework while sharing a computer with family members or to conduct their entire job search on a cellphone. Others found themselves scrambling to secure temporary work — long before they expected to start a career — to supplement household income because their parents had been laid off.

“When students went home and courses went online, family structures were being upended,” Downie says. “It took an emotional toll. … The level of stress has been enormous, even from day one” of the pandemic.

Some students and recent graduates have expressed feeling pressure from parents about their job searches or life choices (even if parents haven’t necessarily voiced those concerns) that they wouldn’t have felt living on campus. Counselors should be mindful that living at home adds an entirely new dynamic to these clients’ experiences, Downie says.

Administrators at Presbyterian College, including Downie, split up the student body roster and called every student to check in through the spring semester. This endeavor confirmed a saying that Downie had been hearing from colleagues: “We’re all in the same storm but not in the same boat.” The needs and stressors that students were experiencing varied widely, depending on their circumstances, she says.

“Really quickly, I realized the truth of that saying. For some, doors opened that weren’t there before. There were some who found themselves with new opportunities, yet their best friends were experiencing a very different [reality],” she explains.

>> Make clients the authors of a story in progress: Tina Leboffe, an ACA member and a counselor pursuing licensure under supervision at a therapy practice in Douglassville, Pennsylvania, uses narrative therapy with clients, many of whom are college students concerned about finding a job after graduation. “I see my clients as the meaning-makers in their own lives. When working with loss [related to the COVID-19 pandemic], I feel that it is important to walk with the client as they tell the story of their experience, while supporting their exploration of what they want this loss to mean for their life story. This can look like allowing space for the client to be present in feeling the emotions caused by loss and also to look forward at what they want their lives to look like as a result of the loss,” says Leboffe, an associate addiction counselor.

“When working with a client to refocus and reimagine their future, we can listen as they add context to their story,” she says. “Despite the setting of their story shifting, the client is still the author. We can support our clients as they integrate a new reality into their life story by asking questions that refocus on the client being the expert of their life. As counselors, we might not be able to change the job market, but we can guide our clients in an exploration of what they want their life to look like given the changes that have occurred. We can assist them in identifying decisions they want to make in the face of change.”

>> Seize the opportunity to explore identity: Leboffe and Anderson both note that while this is a time of stress and upheaval for young clients, it can also afford opportunities for personal growth. Counselors can help support and encourage that process.

“This is a good time for them to learn about themselves, learn about what their values are and what is important to them. … [It is] a time to explore their internal world and let them find out what their 22-year-old self is like,” Anderson says. “How are they with stress? How do they handle ambiguity? How are they capable and able to move forward and readjust in such a difficult time? Giving them space to talk allows them to process [these things].”

“In my experience working with young adults and recent grads — and being one myself not long ago — I have found that this time in their lives can be filled with identity exploration and transition,” Leboffe says. “They may be faced with new levels of independence and responsibility that can evoke questions like ‘What do I want my life to look like?’ or ‘Who do I want to be?’ This can be important to keep in mind as we work with or parent recent grads because it can serve as underlying context to help us be empathetic to their lived experiences while they are developing their sense
of identity.”

>> Remember that productivity is relative. Anderson has found it helpful to remind young clients that even though they’re spending much more time at home, they may need to temper their expectations about productivity.

“This shouldn’t be a time when you plan to be super productive. That’s hard to do when you’re going through something so emotional and so taxing,” Anderson tells clients. “It’s not a time to learn six new languages, clean your entire house or finish a major art project. Instead, focus on what works for you. What are things that calm you and help you [that] you can do routinely? Be less hard on yourself. At the same time, it’s a great time to try something new if you have the motivation to.”

>> Build confidence. Bensley urges counselors to focus on the positive when communicating with college students and recent graduates during the pandemic. “The No. 1 thing we can do for clients is help build their confidence,” Bensley says. “The tone of my emails has been, ‘Hey, you’ve got this. I’m cheering you on.’ I’m trying to use my language to be that [needed] encouragement, even if they don’t ask for it or seem to need it.”

>> Take them seriously. Transitioning to adulthood is hard enough without the added concerns and stresses of COVID-19. Validation from a counselor is pivotal during this time of life, Anderson says.

“Take their concerns seriously. We know in general that people will land on their feet and things will turn out OK as they make their way in the world. [But] they need to be held in the emotional space where they are right now,” Anderson says. “Moving into adulthood is really hard. It can be a very tumultuous time — and one that promotes growth.”

“[These clients’] struggles and needs are serious,” she continues. “Figuring out dating, jobs and social stuff — it’s all important. Stay with them in their space and create that [trusting] relationship. Know that their concerns are valid, even if we have all the confidence in them in the world that they’re going to figure this out. They really are worried that they’re not going to figure this out in the right way. And that’s valid [because] they haven’t been here before.”

 

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Entering the counseling profession amid COVID-19

Graduates from counseling programs certainly aren’t immune to the stresses and uncertainties that 2020 graduates in other fields are facing.

Darius Green graduated from James Madison University (JMU) with a doctorate in counselor education in May. Green says that he and many other counseling graduates feel the pressure of finding jobs that can provide financial stability “rather than being able to choose what positions best fit [our] personal and professional goals.”

I do not come from a background of financial privilege, so this rose to the top of my priorities,” says Green, a member of the American College Counseling Association, a division of ACA. “I [have] noticed a mix of success and difficulty among some of my peers in the job search process. For those who started early and found a position that matched what they were looking for, the process seemed easy. For my peers who had not been able to start searching early or just had not found the ideal position, there seemed to be more difficulty. … I struggled with finding a position that I wanted and carried out my job search longer than I had planned.”

This summer, Green is living in Harrisonburg, Virginia, where JMU is located, holding down both a full-time instructional faculty position with JMU’s Learning Centers Department and working part time as a counselor with the ARROW Project, a community mental health organization roughly 30 miles away in Staunton.

Green hopes that in this time of crisis, professional counselors who are already established will remember the role they play as advocates for the profession and will look out for new counseling graduates trying to enter the field.

“I think that counselors who are already working can be aware and sensitive to how stressful being in such a position [graduating during a pandemic] can be. I also feel as if counselors can advocate within their agencies or communities to do our part in making sure that existing opportunities are made known to recent graduates,” Green says. “That could include reaching out to counseling faculty members to share information or even connecting with colleagues who may know of new counseling graduates in need.”

“One thing that I would want [counselors] to keep in mind is that not everyone has connections to others in the counseling profession and other mental health fields,” he continues. “Some students come from backgrounds that may have lacked opportunities for networking or that may not value the mental health professions. I think it would be important to pay particularly close attention to those students so that they do not fall through the cracks or face another layer of oppression.”

 

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Bethany Bray is a senior writer and social media coordinator for Counseling Today. Contact her at bbray@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.

Voice of Experience: Revenue streams for counselors

By Gregory K. Moffatt July 28, 2020

Counselors-in-training often ask me how much money a counselor can expect to make in a year. In many fields — education, for example — that is a fairly simple question. But not so for counselors.

Counselors basically have to work for free until they complete their graduate work. Then, depending on where they land employment, they must work from the bottom up until they are fully licensed. As a general rule, I tell my students to plan on five years post-bachelor’s degree before they really start making a decent living and can focus on their preferred areas of practice. That is a long time and, even then, annual incomes vary tremendously. So, here are some considerations for counselors who are just starting out in the field.

The easiest path: By far the easiest path for therapists is to be hired by an established practice or hospital. Here counselors might make a little less than they would on their own, but they don’t have to bother messing with insurance companies (other than documentation), paying the light bill or scheduling. In private group practice or hospitals, you show up, put in your hours and go home. Working 20-30 hours a week is not uncommon in such circumstances, but your hours are set for you, and you may have zero flexibility.

Expect no-competition contracts in these practices. This means that you can’t leave the practice and take your clients with you. In some cases, you also won’t be able to open a private practice within a certain number of miles of the place you worked should you decide to leave.

Subleasing: A nuance on the “easy path” is joining an existing practice by subleasing office space. Here you may have to pay your own light bill and cover expenses, and you will do your own scheduling and billing. In this scenario, you might make more money per clinical hour, but with billing and paperwork, 20 hours per week is a very busy practice. One advantage of this option is that you will have the built-in benefit of the reputation and advertising of the existing practice (assuming that reputation is good, of course).

Opening your own practice: Starting your own practice provides maximum flexibility and freedom, but this path requires you to start from the ground up in creating your client base. Plus, you will be doing all of your own advertising, web building, billing and scheduling. This approach takes energy and commitment.

Teaching: Once you complete a master’s degree, you are qualified to teach at the undergraduate level. Many counselors teach college courses in-seat or online as an additional revenue stream and for variety in work experience. Online courses usually pay around $1,500 per course ,and traditional in-seat courses usually pay around $3,000 per course. This experience also provides you with potential referrals from students. Contact the department chair of a college or university where you might like to teach for more information. Have your vita and transcripts ready.

Consulting: Consulting with schools, businesses, churches, law enforcement, lawyers and other public agencies not only provides additional income but can also put your name out there with other agencies.

Working for free: Generally, I want to get paid for my work, but doing pro bono work as a consultant might put you in position to make more money later. I worked for one worldwide company for almost 10 years and never charged them a dime, but I made tens of thousands of dollars from referrals because of my affiliation with that company. I knew that was possible, which is why I agreed at the onset to provide free services for them.

CEs and presentations: As with teaching or consulting, providing continuing education workshops and presenting at professional meetings can help get your name out there to a wider audience. In this type of networking, it is critical that you polish your “act.” A poorly presented seminar can earn you more name recognition, but not in a good way. When I started teaching at the FBI Academy many years ago, the director at the time told me, “I opened the door for you, but you had to keep it open.” That’s important advice.

Specializations, licensing and certifications: In combination with maintaining your license(s) and involvement with local and national organizations such as the American Counseling Association, specializations can help you build your practice. Receiving training in marriage and family therapy, eye movement desensitization and reprocessing, play therapy, dialectical behavior therapy or other specializations can serve to set you apart from others in the field and bring in clients. Achieving specialty certifications can also give you the option of charging a higher per hour rate.

I can’t be exhaustive in discussing all revenue streams in a short column, but depending on where you live and which of these routes you pursue, a counselor in full-time practice can make a very healthy living. You just have to work for it.

 

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Gregory K. Moffatt is a veteran counselor of more than 30 years and the dean of the College of Social and Behavioral Sciences at Point University. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. 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.

A note of encouragement for counseling students during COVID-19

By Dana M. Cea April 7, 2020

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

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

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

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

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

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

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

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

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

You will emerge stronger for having gone through this experience.

 

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

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

Learning from highly effective counselors

By Sidney Shaw March 10, 2020

The term “supershrink” has been used to refer to counselors and other mental health professionals who are very good at what they do and who attain significantly better client outcomes than average. It is perhaps not surprising that such a witty and playful term would come from an adolescent.

In the early 1970s, David Ricks conducted an analysis of the long-term outcomes of “highly disturbed” adolescents treated in a metropolitan guidance center. In this center, some of the youth had labeled one provider “the Supershrink.” Upon subsequent data analysis, Ricks found that adolescents who received treatment from this provider had significantly better long-term outcomes than did those who saw another provider. Turns out that the teens were right; the provider was a supershrink.

The idea that some counselors are exceptional and have very high success rates with clients is not new. In fact, this phenomenon has been verified empirically. Research over the past several decades has demonstrated that some counselors consistently achieve higher client improvement rates than do other counselors. With that in mind, it is important to consider what we can learn as counselors from so-called supershrinks and how we can embody the characteristics and actions of highly effective counselors to improve our own effectiveness.

Counselor effects and outcome research

The term “therapist effects” or “counselor effects” refers to variation in counseling outcomes that are attributable to the counselor, in contrast to other factors such as techniques or theories that contribute to counseling outcomes. Findings of counselor effects appear in a variety of study settings such as naturalistic clinic settings and in randomized clinical trials (RCTs). Counselor effects in RCTs are particularly intriguing because these studies are tightly controlled. In RCTs, counselors commonly adhere closely to a treatment manual (i.e., following specific steps in adherence to a specific theory), and there is also control for client severity. RCTs are the gold standard for comparing efficacy of specific treatment approaches for specific disorders.

Although there have been important findings about the efficacy of different treatment approaches or theories from RCTs, another finding that has received less attention over the years is that counselor effects are the better predictor of counseling outcomes. In other words, who the counselor is makes more of a difference in terms of client improvement than does which theory the counselor professes to use. It is impossible to completely disentangle counselors’ characteristics and actions from the theories that they use, but meticulous research and meta-analyses by renowned researchers such as Bruce Wampold have indicated that counselor effects are up to eight times stronger at determining client outcomes.

As Wampold and others have pointed out, these findings about the relative strength of counselor effects in comparison with theoretical approach are not justification for tossing out counseling theories. Framework, structure, a road map for navigating clinical territory, and conceptualization are just some of the benefits of grounding our work in theories of counseling. That said, outcome researchers have for decades focused predominantly on comparing different theoretical approaches while giving relatively little attention to a more powerful factor — the characteristics, pan-theoretical practices/actions, and attributes of the counselor.

Five characteristics and actions of highly effective counselors

Although the existence of counselor effects in outcome research has been around for several decades, empirical attempts to discern pan-theoretical characteristics and actions of highly effective counselors are rather new. There are limits to developing a list of such characteristics because new research is frequently emerging. In fact, it is noteworthy that the five characteristics highlighted in this article are just some of the major characteristics and actions of highly effective counselors.

The list contained here is composed of qualities that counselors can actively cultivate in their current practice. In other words, there are some strategies for growth with each of these five qualities. There are other characteristics of highly effective counselors in the research literature for which it is not currently clear how to increase or enhance those characteristics (e.g., attachment history, facilitative interpersonal skills). Thus, this list focuses on characteristics and actions that can be enhanced to improve counselor effectiveness. Accompanying the descriptions of these characteristics are some tips for developing each of them in your own counseling practice.

1) Presence and
2) countertransference management

The counselor’s “way of being” serves as a vehicle through which therapeutic actions and interventions take place. Two related concepts from the counselor effects research that speak to the counselor’s “way of being” and “way of relating” are presence and countertransference management. Both concepts have theoretical roots.

For instance, in the existential-humanistic tradition, presence refers to counselors being “in the moment,” connected with clients’ experiences and their own, and fully engaged in the I-Thou relationship with a client. Presence can also be defined by identifying it as the opposite of absence (e.g., distraction, boredom, disconnectedness, remoteness).

Countertransference, of course, has theoretical roots in psychoanalysis. Sigmund Freud considered it to be when a client’s transference activated a counselor’s unresolved childhood conflicts. More broadly, a totalistic view of countertransference is that it encompasses all the counselor’s reactions to the client. Although countertransference reactions are commonplace, the impact of countertransference on counseling outcomes is largely due to how the countertransference is managed. Meta-analytic research by Jeffrey Hayes and colleagues has indicated that successful management of countertransference predicts better counseling outcomes. Similarly, presence has been described by Shari Geller and Leslie Greenberg as a “prerequisite for empathy,” and counselor empathy is a strong predictor of client improvement.

Multiple factors can lead counselors toward increased presence and better countertransference management, including self-insight (e.g., awareness of self in relationship, cognitive and emotional awareness), anxiety management, intentionality and mindfulness. Given all these factors, counselors can be left feeling a bit overwhelmed by methods to strengthen their presence and countertransference management. Fortunately, research evidence supports a few overlapping practices to enhance both of these qualities.

> Meditation/mindfulness practice: Sustained and consistent meditation practice has been shown to increase effective countertransference management, promote emotion regulation and nonreactivity, sharpen awareness and increase presence. Many different types of meditation and mindfulness practice exist. Counselors are advised to investigate these practices, to choose a practice aligned with their own preferences, and to maintain a consistent mindfulness practice.

> Self-insight and anxiety management: Counselors should work on their own psychological health and consistently practice self-observation and self-reflection. This can be done in supervision, in one’s own experience as a client, and through deliberate planning aimed at increased self-awareness.

Relatedly, anxiety management is an important component of countertransference management and presence. Although it is not unusual for counselors to experience anxiety within sessions, unmanaged anxiety can have untoward effects on a counselor’s presence, ability to manage countertransference reactions, and the therapeutic alliance. A first step is developing sensitivity to noticing anxiety when it appears. Second, counselors likely already have anxiety management skills (e.g., behavioral, cognitive, mindfulness-based) that they use with clients. Counselors can apply these skills to themselves.

> Pre-session centering: A study by Rose Dunn and colleagues revealed that counselors perceived themselves as having higher levels of presence when they engaged in a brief mindfulness centering exercise within five minutes of a counseling session. Additionally, clients perceived the sessions to be more effective when the counselor used the mindfulness exercise prior to the session. The basics of the centering exercise are consistent with acceptance and commitment therapy principles.

In this case, counselors would simply sit comfortably with a straight spine, take and notice gentle and full breaths, notice physical sensations, notice thoughts that emerged, acknowledge the existence of those thoughts and allow them to be present, imagine creating additional space for the thoughts with each breath, and then let go of focus on the thoughts to broaden attention to the environment around them. In this mindfulness approach, counselors aimed to accept the thoughts and experiences as an observer rather than clinging to or pushing away those thoughts. For more detailed information on mindfulness and acceptance centering, I recommend the work of John Forsyth and Georg Eifert.

> Self-care: This term is frequently discussed in our field, and self-care activities can vary greatly among individual counselors. It is important for presence, countertransference management and multiple other reasons that counselors engage in consistent self-care actions. One self-care behavior that seems relatively universal, and which has an impact on attention (i.e., presence) and emotion regulation, is sleep. Practicing healthy sleep hygiene (keeping room temperature at 62-68 degrees, sticking to a consistent sleep schedule, maintaining a dark environment, having technology limits at night, etc.) can provide conditions that are favorable for increased presence and greater countertransference management.

3) Professional self-doubt

The essence of this quality of highly effective counselors is captured in the title of an article by Helene Nissen-Lie and colleagues: “Love yourself as a person, doubt yourself as a therapist?” At first glance, the idea of professional self-doubt may seem like an unproductive place to be as a counselor. However, if we consider just a basic definition of “doubt” (i.e., to be uncertain), then the benefits for clients become clearer.

Counselors who possess certainty that they are helping a client are likely closing the door to self-critique and thoughtful consideration of ways to improve their work. Indeed, several studies by researchers such as Corinne Hannan and others have indicated that counselors consistently overestimate the effectiveness of their work with clients. Regarding self-doubt, two studies of experienced counselors by Nissen-Lie and colleagues revealed that counselors higher in professional self-doubt had stronger alliances with clients and higher levels of client improvement than did counselors lower in professional self-doubt.

Importantly, a third study by Patrizia Odyniec and colleagues showed that increased professional self-doubt among trainees/students resulted in poorer client outcomes than did lower professional self-doubt. One explanation for these findings is the difference in developmental stage of the counselors. Experienced counselors likely have higher confidence in their basic skills as counselors. Thus, professional self-doubt about their effectiveness can be beneficial as they strive for improvement due to their own uncertainty about client outcomes. In contrast, high professional self-doubt among trainees may be debilitating because of their earlier stage of counselor development and lower confidence in their basic counseling skills.

All that said, there appear to be clear benefits for clients when experienced counselors cultivate professional self-doubt. Here are some strategies for doing that.

> Prevent the “overconfidence effect.” This concept from social psychology is particularly relevant here due to numerous studies that have shown that counselors commonly overestimate whether and how much their clients are improving. Just being aware of this tendency to inflate their own client success rates can help counselors become increasingly humble and self-reflective about their effectiveness. Consciously questioning our own self-serving biases is an important step in maximizing client improvement rates.

> Monitor your effectiveness. Counselors should use some type of outcome measure (e.g., Outcome Rating Scale, Clinical Outcomes in Routine Evaluation-Outcome Measure, Outcome Questionnaire-45) to assess the degree to which their clients are improving or not. Routine outcome monitoring has repeatedly been found to improve client outcomes, and concrete client reports of their improvement level can help keep counselor overconfidence in check. Additionally, outcome monitoring can promote the beneficial stance of professional self-doubt because awareness of clients who are not improving or who are deteriorating
can lead counselors to act intentionally to improve.

> Love yourself as a person. An important caveat in the studies by Nissen-Lie and colleagues is that counselor self-doubt can improve client outcomes more when coupled with what is referred to as a “self-affiliative introject.” In general, this refers to higher levels of self-affirmation, self-love and self-acceptance. When a self-affiliative introject or self-affirmation is an area of struggle for counselors, it can affect their work with clients and their capacity to embrace professional self-doubt. Steps to build and strengthen a self-affiliative introject or stronger self-affirmation could include self-help, support groups or personal counseling.

4) Deliberate practice

Deliberate practice, a concept that originates in the expertise literature from researchers such as Anders Ericsson, refers to intentional and individualized exercises and actions aimed at strengthening specific areas of one’s performance. Early research on deliberate practice examined its effects in noncounseling domains such as chess, music and sports, to name a few.

In counseling, a promising study by Daryl Chow and colleagues of more than 1,600 clients working with 17 counselors found that the top quartile of counselors (i.e., those whose clients showed the most improvement) spent nearly triple the amount of time engaged in deliberate practice than did counselors in the lower quartiles of client improvement. Consistent with some previous research, Chow and colleagues found that the following factors were not significantly related to client outcomes: counselor age, professional discipline, gender, years of experience, highest qualification level and theoretical orientation. Below are some core components of deliberate practice combined with recommendations for integrating them into your counseling practice.

> Establish your baseline. To improve as a counselor and to determine if you are increasing effectiveness over time, you need to know how effective you already are with your clients. Routine outcome monitoring is a way to establish a baseline. Using an outcome measure and then tracking your client improvement rates over time is an initial step in deliberate practice.

> Record sessions with difficult or stalled cases. While not intrinsically motivating, we stand to learn a lot about areas for improvement with cases in which our weaknesses are most evident. Video recording is simple these days, and it is an indispensable tool that is not just for practicum students. Video recording can help counselors identify gaps in awareness and skills that simple self-reflection alone is unlikely to reveal. Relying only on our self-assumed clinical wisdom by mentally reflecting back on a session is unlikely to interrupt and change unhelpful patterns that may have emerged outside of our conscious awareness.

> Work with a consultant or consultation group. Stepping out of our own perspective and potential for self-serving biases is a critical ingredient of deliberate practice. By working with a competent consultant or consultation group, we can obtain diverse perspectives on our areas of weakness as counselors and thus develop specific goals and plans for growth while receiving ongoing support and feedback.

> Develop clear, targeted goals. Our goals need to be very clear and specific. It is not very effective to set a goal to “improve as a counselor.” Instead, a first step here would be to identify specific areas for potential growth as a counselor. This could be done in collaboration with your consultant/consultation group. With deliberate practice, the real growth takes place outside of actual client sessions. Outside of session, you have time, support and opportunity for reflection and practice as you engage in intentional efforts to develop new therapeutic skills or “ways of being” with challenging cases.

The specifics of deliberate practice are very detailed. Thus, counselors are encouraged to read the works of scholars such as Daryl Chow and Scott D. Miller on this topic for a more comprehensive review.

5) Multicultural orientation

Multicultural orientation is a rather new construct that differs  from multicultural competencies. As described by Jesse Owen and colleagues, multicultural competencies are considered a “way of doing,” whereas multicultural orientation is a “way of being.” Multicultural orientation is a way of being that communicates the counselor’s
attitudes and values about culture to the client. Specifically, multicultural orientation consists of three overlapping pillars. Each of the pillars is described below and accompanied by recommendations for strengthening it in your counseling practice.

> Cultural humility: This refers to an interpersonal stance that is “other oriented” and open to understanding the client’s cultural experience and background. In addition to this interpersonal dimension of cultural humility, there is also an intrapersonal dimension in which counselors have an openness and eagerness to reflect on their own limits and blind spots in understanding the cultural experience of another. Four studies with more than 3,000 clients have found a significant positive correlation between client ratings of their counselor’s cultural humility and counseling outcomes. An important consideration here is that the “client’s perception” of their counselor’s level of cultural humility was related to client outcomes.

There are some strategies and actions that counselors can take so that clients are more likely to experience them as being culturally humble. First, given the intrapersonal domain of cultural humility, counselors are encouraged to self-reflect upon and analyze their own areas of potential biases and cultural blind spots. Pamela Hays’ “ADDRESSING” model can be a useful framework for determining domains in which a counselor has a privileged status because these domains of privilege are likely sources of blind spots.

Second, counselors are encouraged to broach the topic of culture at the intake session with clients in an open-ended manner. This strategy also overlaps with the pillar of “cultural opportunities” (broaching strategies will be described in that section).

Third, counselors should check in with clients frequently to ensure that they accurately understand the client’s cultural perspective. This “cultural check-in” should be one part of a broader culture of feedback that is created by the counselor in the session. Specifically, counselors need to acknowledge with clients that they strive to understand clients’ perspectives and cultural experiences, but despite their best efforts, they may sometimes misunderstand. Openly and repeatedly inviting clients to provide candid feedback (especially negative feedback) is a way to express humility and to make repair attempts if and when a counselor misunderstands or unknowingly commits a microaggression.

> Cultural opportunities: This pillar refers to opportunities in sessions for the counselor to broach the topic of culture with a client. Importantly, research on this topic indicates that “missed cultural opportunities” (i.e., the client’s perception of the counselor missing and not acting on opportunities to discuss/broach culture) are negatively correlated with client outcomes. In other words, as the counselor misses more cultural opportunities, client improvement declines.

One way to enhance the positive effects of cultural humility and cultural opportunities is for counselors to broach the topic of culture at the intake session. For example, “How does culture influence the problem?” The purpose of such an open-ended question is to better understand the client’s perception of culture. If clients are unclear about what is meant by “culture,” alternative phrasing ideas can be gleaned from the “Cultural Formulation Interview” in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The interview offers numerous examples for asking open-ended questions about clients’ cultures.

Broaching or inquiring about the influence of culture should not be limited to the intake session. Counselors need to attentively engage with clients to understand how they
see the role of culture as sessions progress. This can lead counselors to sensitively seize upon cultural opportunities in sessions in a way that resonates with clients.

> Cultural comfort: The final pillar of multicultural orientation is counselors’ level of openness, ease and comfort in working with diverse clients and engaging with clients about the topic of culture. In a 2017 study, Owen and colleagues found that counselor cultural comfort level predicted client dropout rates. Higher levels of counselor cultural comfort were associated with lower client dropout rates. This is particularly important given that a high dropout rate is one of the more pernicious challenges for our field to address. Indeed, a 2012 meta-analysis by Joshua Swift and Roger Greenberg found that the average dropout rate in counseling is 20%.

In terms of counselors increasing their cultural comfort levels, some of the strategies mentioned for cultural humility and cultural opportunities (e.g., intentionally reflecting on/analyzing biases and blind spots, broaching the topic of culture in sessions) can apply. One additional strategy that can help in this regard is role-playing and rehearsal — specifically, role-playing with colleagues in which the counselor practices engaging with mock clients around the topic of culture. Counselors are advised to practice broaching the topic of culture in situations that represent a wide range of challenge. For example, if a counselor has had little or no contact with clients who are transgender, then role-playing a scenario in which the counselor broaches culture with a mock client who is transgender would be a way to expand the counselor’s cultural comfort. Inviting and receiving feedback from colleagues in such mock sessions is essential for counselors to expand and enhance their broaching skills and increase their level of cultural comfort.

Conclusion

The number of factors that contribute to effective counseling is vast and incalculable. As research continues to evolve on this topic, we develop a richer understanding of some of these factors. We now have abundant research support for counselor effects and the relative strength of these effects in comparison with theoretical techniques.

The lines between counselor characteristics, common factors (e.g., therapeutic alliance, placebo effect) and specific factors (e.g., treatment interventions, techniques) are not neat and discrete. Instead, each of these has some overlap with and multidirectional influence on the others. That said, recent research indicates that the characteristics, qualities and pan-theoretical actions of counselors are prominent in potentiating the therapeutic alliance and theoretical techniques to improve client outcomes.

 

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Sidney Shaw is a core faculty member in the clinical mental health counseling program at Walden University and a certified trainer for the International Center for Clinical Excellence. Contact him at sidneyleeshaw@gmail.com.

 

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