Tag Archives: counseling

The forces that could shape counseling’s future

Compiled by Jonathan Rollins January 5, 2021

[NOTE: To view this article as a PDF, log in with your ACA credentials here and select the January 2021 magazine.]

In 2012, as the American Counseling Association was celebrating its 60th year as an organization, Counseling Today published an article titled “What the future holds for the counseling profession.” In that piece, 19 counseling leaders shared their visions (and best guesses) of how the profession might evolve over the coming decade.

Fast-forward to 2021, and we decided the timing was right to revisit that topic, even though we’re only nine years out (rather than a full decade) from the original article. After all, most of us would agree that 2020 felt like it lingered on for two full years, or at least well past its expiration date. It’s also virtually impossible to imagine any type of near future in which the events of the past year aren’t still reverberating and shaping our society.

Given that backdrop, we invited a diverse group of clinicians, educators, researchers and leaders in the counseling profession to answer the following question: What do you anticipate will be the most significant change, challenge or opportunity for counselors and the counseling profession over the next five to 10 years?

There’s no time like the present to look to the future.

 

Whitney Norris is a licensed professional counselor supervisor, a somatic experiencing practitioner, and a co-founder of Little Rock Counseling & Wellness in Arkansas.

A curious practitioner doesn’t have to look far these days to find a well-known clinician-researcher speaking to the importance of the brain and body in psychotherapy, especially in the realm of trauma. One of these experts, Dr. Daniel Amen, once said, “The biggest mistake I see is that [psychiatrists] rarely consider the brain. I often say psychiatrists are the only medical specialists that never look at the organ they treat.” In my experience, the same can be said for counselors when we consider what we now know about the inextricable connection of the mind and body.

The most significant change that has occurred during my pursuit of specialization in trauma and attachment over the past decade has certainly been an expansion of needed expertise in understanding the brain and body. The fact that the book that I’ve heard many call the “bible of trauma” is titled The Body Keeps the Score (Bessel van der Kolk, 2015) provides a good summary of this concept. I believe though that over the next 10 years, this will no longer be just the territory of trauma specialists. All mental health practitioners will need to have a solid understanding of the physiology of mental health and dis-ease if they choose to follow the latest research regarding health and healing.

To put it simply, I think it will become abundantly clear that no practitioners will have the luxury of leaving this knowledge base to the trauma specialists. I would argue that someone who doesn’t understand attachment dynamics and how those show up and impact the body/physiology of the person in front of us in the counseling room will be largely in the dark about essential aspects of the healing process.

And this idea seems to be spreading. I practice as a trauma specialist in Arkansas, a state known for being several years behind in regard to advancements in the medical and mental health fields. Even so, within the past 10 years of practice, I have gone from being very careful about even using the word “trauma” — since people were reluctant to use it — to having almost every client who reaches out to me ask specifically for a trauma specialist. Then, even a step further than that, when I began my pursuit of my credentials as a somatic experiencing practitioner in 2016, it was rare for even professionals in my area to have any knowledge of this nervous-system-informed therapy model. Now, less than five years later, it is increasingly common for clients to call my clinic asking specifically for somatic experiencing treatment, and many have even read some of Peter Levine’s or Bessel van der Kolk’s work.

As our understanding of trauma broadens and encompasses the vast majority of presenting issues our clients bring to our offices, it will become increasingly essential for us to understand the intersection of these issues and the large part played by the physiological mechanisms driving them. When I’m discussing the ins and outs of this steep learning curve with other professionals, I find that people tend to think that these new layers of learning and “complexity” must make my job harder. However, that couldn’t be further from the truth. My own ease and comfort in the therapy room now is unrecognizable compared with my work before I understood these truths about the mind and body. Not only are my clients reaping the benefits of this understanding, but I have as well, personally and professionally. My hope is that over the next 10 years, more and more counselors can also experience this for themselves.

I would recommend that anyone interested in learning more check out the work of Peter Levine, Allan Schore, Bessel van der Kolk, Bonnie Badenoch, Stephen Porges and Louis Cozolino. They each have provided beautiful contributions to the art and science
of healing.

 

Derrick Shepard is an instructor of counseling at the University of Tennessee at Martin and a doctoral candidate in counselor education and supervision at the University of Tennessee in Knoxville.

As I reflect on the 2012 Counseling Today article “What the future holds for the counseling profession,” I can only be impressed by the level of foresight the authors shared. Foresight regarding calls for more inclusivity, a better understanding between mental health and neurobiology, and how economic stressors placed on our clients came to fruition. Moving forward, the changing demographics of the United States will present changes, challenges and opportunities for growth in the counseling profession.

Changes: The greatest change in the next 10 years is not so much focused on the counseling profession exclusively. Instead, the changing demographics in the United States will have wide-ranging impact on virtually all aspects of our country, including the counseling profession.

Challenges: The question posed in this essay is has the counseling profession held true to its mission of being an inclusive body, not just for our clients, but also for counselor educators and counselors in the field? Are we cultivating an inclusive body that serves the needs of all communities to have access to care from those who share common beliefs, values and life experiences in the world of practice? According to Data USA, we are only talking the walk and not walking the talk. The counseling profession is still composed mainly of white (non-Hispanic) females. We see this in the pipeline of future counselors-in-training and counselor educators-in-training. If we are not taking an intentional, proactive approach to normalize counseling, and by extension normalize the profession for underrepresented minorities, we will only continue to have the same candidates.

Opportunity: As with all challenges, there are an equal number of opportunities for growth. The STEM professions, for example, intentionally and actively started promoting STEM careers with underrepresented populations. I, a first-generation, African American, cisgender male, entered the counseling profession only after my undergraduate degree and career in business did not fulfill me and after my call to serve others in their journey toward personal growth. I have never regretted my choice. Personally, I have coached underrepresented students in a TRIO program yearning for the same calling but who do not see the career as a viable option. We can change that narrative, but more importantly, we must change that narrative about who can be a counselor, what counselors do and whom counselors serve.

In drawing on my business background and taking a best practice to investing, the profession needs to diversify, diversify, diversify. A homogeneous investment portfolio, or profession, is dangerous for one’s long-term growth and stability. In other words, we need to “walk the talk” rather than “talk the walk” in diversifying the profession (Manivong Ratts, 2012).

Moving into the next five to 10 years, the profession must start walking the talk by developing intentional and systematic marketing and proactive recruitment strategies that convey to clients that they have access to counselors who will hear, see and look like them. Inclusive counselors who understand their life station on the Multicultural and Social Justice Counseling Competencies framework. Inclusive counselors who get their start in training programs that reflect society’s changing demographics. When BIPOC counselors are admitted into counseling training programs, they need to feel the profession belongs to them as much as they belong to the profession. Lip service is not enough anymore. Instead, training programs need to provide intentional mentoring, guidance and professional development. All too often, those standing outside faculty doors are the ones who need to be asked to take a seat. None of these growth opportunities for the profession will take place unless faculty reflect on their biases, assumptions and beliefs and ask themselves, “Do I talk the walk or walk the talk?”

 

Nevine Sultan is assistant professor and program director of clinical mental health counseling at the University of St. Thomas, and a licensed professional counselor supervisor, national certified counselor and registered yoga teacher in private practice.

As a counselor educator and LPC in private practice, the following themes emerge for me as I reflect on the future of the counseling profession:

Taking a trauma-focused approach: Over the last few decades, we have introjected how others define our profession and made their definitions our own. It’s not uncommon for counselors to state that we only offer brief treatment for moderate concerns, which influences how we assess client needs and approach our work. In the next decade, it is essential that counselors transcend these limitations as we assist clients with presenting issues beyond the transitory. Taking a trauma-focused approach equips us to acknowledge and understand how various traumatic experiences, whether they occurred in childhood or adulthood, may impact clients across multiple dimensions, including physical, emotional, cognitive, social-relational and spiritual well-being. Working from this perspective invites us to explore beyond explicit recollections of a traumatic event to address impact on brain and body mechanisms and to offer treatment from a holistic lens.

Taking a contextual, integrative approach: Again, we have allowed ourselves to be limited by others’ definitions of evidence-based practices. This has restricted how we practice and how we train new counselors and conduct research. It’s time we recognize that working with verbal narratives using a cognitive orientation is insufficient because it limits us to addressing faulty thinking and alleviating symptoms, minimizing and marginalizing other dimensions of human experience such as emotion, physiology, spirituality and relationality. It also keeps our clinical focus on the individual, implicitly shaming clients and overlooking the critical influence of context. In the next decade, we must explore not only what is occurring to clients, but also how it plays out within clients’ broader experience as perceptual, emotional, cognitive, social-relational, spiritual and culturally situated beings. Thus, we can process verbal and nonverbal narratives, address symptoms and their origins, honor the full personhood of clients, expand practice capacities and explore innovative approaches in training and research.

Unifying our professional identity and making portability a reality: I’m a very proud counselor. I also curl a little into myself when I attend a conference, meet colleagues from different states and realize we have different titles. How can we expect other professionals and the general public to know what to call us if we are not united in what we call ourselves? This is also troubling when I attend international conferences because how we present ourselves as American counselors is confusing at best. It’s crucial to our visibility and trustworthiness that we unify our professional identity. Furthermore, as the impact of the coronavirus pandemic is demonstrating, licensure portability is more vital than ever. Our profession is founded on advocacy and social justice. In the coming decade and beyond, let’s bring justice to our clients and profession and extend our reach beyond state borders and into the world.

Embracing global citizenship: As we work to extend our reach, and as we are humbled by the impact of the coronavirus pandemic on humans around the globe, we must recognize how self-isolating we can be as a society and acknowledge that what happens in one part of the world influences what unfolds in another. In the next decade, let’s expand our understanding of culture beyond the multicultural models we know, as they often perpetuate stereotyping and labeling. It’s imperative that we embrace our role as supporters of personal and social identity exploration and integration, and as agents of transformation and growth.

 

Marty Jencius is an associate professor at Kent State University and has been engaged with technology for over 40 years.

The 2020 COVID-19 pandemic thrust many counselors and most educators into using technology as a platform for doing their work. Although many questioned their ability to create a new virtual presence, most had to adapt to the situation. Our clients and students found that they also had to change their type of engagement. I think the future will hold more online practice and training than we had pre-pandemic. We have had a taste of clinical practice using technology, and there is no going back without it. Our clients and students will expect us to provide them the opportunity to grow and learn online.

What changes can we foresee with technology? We are comfortably engaged in the dynamic web (Web 2.0) using social media and interacting through the web. We are entering a greater use of the semantic web (Web 3.0) where your device looks at your work, recognizes your preferences, and then provides you with choices for products and services that may interest you. The semantic web could also facilitate counseling relationships through similar algorithms, becoming a counselor’s assistant. It could offer clients ideas such as support groups based on location and interest, tutoring options for students struggling in a particular area, and links to specific academic and mental health referrals.

Computing is becoming more ubiquitous. The user is less and less aware that they interact with a machine, and the computer integrates into aspects of our lives without our awareness. Videoconferencing 20 years ago required the user to include an external camera and microphone, loading drivers for both, and a limited software choice. Now videoconferencing with whole groups of people is possible by merely clicking a button.

We will see greater ubiquitous inclusion in our lives and adoption in counseling. Look for a future that involves counselors/clients and counselor educators/counseling trainees interacting more with computers as a natural flow of their process. Counselors and clients will more readily turn to the computer and internet-based information for use in their treatment. Of importance will be well-curated information and the digital literacy of both the counselor and the client.

I anticipate more incorporation of virtual reality (VR) platforms such as Second Life and Oculus Horizon into counseling training and practice. Practitioners and educators can develop VR platforms for clients and students that will give them an immersive experience. Some of this work in immersive environments has already started using VR headsets with clients who have posttraumatic stress disorder. These immersive experiences allow clients to anonymously, or with the guide of a counselor, engage in communities, practice social skills, have conversations about difficult topics with others, and create their VR environments that express their condition.

I do not see computers overtaking the practice of real-time human counselors. Artificial intelligence is far from replacing the human condition it takes to be a counselor. Computer-augmented counseling is the next stage in counselor-client work. What limits our advances in using computers with our clients and students is the limited access many people still have to computers. Unless there is some effort to fill the digital divide between those who have and those who do not have computers, advancing use will only increase the chasm.

Whatever happens with technology and our field, we will look back at it in the years to come and be amazed at how we arrived.

 

Danica G. Hays is interim dean and professor at the University of Nevada, Las Vegas. She is an American Counseling Association fellow.

Over the past several decades, scholars — particularly scholars of color — have led important conversations in the counseling profession regarding linkages among culture, intersectionality and advocacy with multicultural and social justice counseling competency (MSJCC). These conversations have emphasized counselor self-awareness, an understanding of client and community worldviews, and a call to action to minimize factors and conditions that might hinder client and group-level well-being. In essence, previous MSJCC scholarship serves as an important tool for counselors to identify and dismantle intersectional oppression while strengthening their professional identity.

Despite these conversations regarding MSJCC, questions remain, as the majority of the counseling profession continues to identify as white, and systemic and intersectional racism persists within society in general. How have counselors, as both individual practitioners and a collective of practitioners, developed and sustained conditions for racism in the profession? What components of MSJCC do we need to further critically reflect upon to identify ways in which counselors, counselor educators and researchers might perpetuate racism? In what concrete ways can the profession ensure that counselors and future counselors are representative of the increasingly diverse clientele they serve? How can white counselors serve communities from an anti-racist and intersectional approach?

Addressing these questions in a meaningful way is the task of the next decade. This opportunity begins when counselors, counselor educators and researchers are committed to exploring the role of white supremacy at a deeper level for them individually and as a profession. Racism, which serves to construct race narratives, does not occur in a vacuum perpetuated by individuals. It is upheld by a deeply entrenched set of assumptions and norms that privilege the views of whites who have traditionally held the most power in cultural, economic, educational, health, criminal justice and political systems. White supremacy, which supports racism and systems of intersectional privilege and oppression, has existed for several centuries. Anti-racism is the intentional resistance and concrete, incremental disruption of white supremacy.

The formation and development of the counseling profession has not been spared from white supremacy. Barriers to counseling — affecting to a greater extent those with multiple marginalized identities — can include insufficient health care access, limited methods of counseling service delivery, a lack of diversity among counselors, language barriers, mental illness stigma, and distrust in the health care system, to name a few. In addition to addressing a field where counselors are disproportionately white, there is a moral imperative to understand how white supremacy sustains mental health disparities among racial, socioeconomic, gender and other cultural groups. It is necessary to critically reflect on the lack of counselors who represent diverse backgrounds across the intersections and how training programs perpetuate the lack of representation. And it requires the profession to disrupt the ways in which counseling is traditionally delivered so that communities are served well.

The core of counseling hinges on relationship building. Counselors must first build an authentic relationship with themselves, uncovering their participation or encounters with white supremacy. In their anti-racism work, they must be vocal about the need for equity even when it does not personally benefit them. Through relationships with clients and their peers, counselors must meaningfully attribute personal and client narratives of systemic and intersectional racism to white supremacy. This is our opportunity to strengthen the ongoing work of MSJCC. This is our opportunity to grow our profession in the next decade.

 

Oliver J. “Ollie” Morgan is a professor of counseling and human services at the University of Scranton.

I recently turned 71. I have been a practicing counselor and family therapist since 1980 and a counselor educator since 1990. This is my 30th year teaching graduate counseling students and undergraduate human service providers. With the faces of so many bright-eyed and eager students in my memory, my reflections turn to preparing others for what lies ahead.

Who are the counselors we will need in the final years of this decade, this century? What kinds of people will they be? Counselor self-awareness and “self of the (family) therapist” points of view have been guideposts for me. My colleagues and I at the University of Scranton have helped to pioneer a “Counselor Fit for the Profession” statement and assessment process over the past 15 years, and it has served us well as mentors and gatekeepers for counselor preparation. I have come to believe that shaping the “practitioner of the future” is a critical task for the counseling profession. The person — she, he, they — is the point of contact for healing and critical to the work of implementing whatever method, theory or technique is used.

So, what kind of counselor do we need for the future? First, in addition to having empathy as a foundation, I would say that we need someone who is flexible and eager to learn. In my career, I have worked in agencies and in generalist private practice. I have worked as a family and marital counselor, pastoral counselor, addictions specialist, and medical family therapist with cancer patients and families. I chose each iteration of practice in part to increase my skills, to acquire new areas of expertise and to respond to local needs. It also helped to keep me fresh.

Second, I have learned the necessity of being trauma-informed and trauma-competent. It is clear that various forms of trauma mark broad swaths of practice. I have explored and published about the effects of “adverse child experiences” and other forms of adolescent and later trauma on substance use disorders and addictions. I have learned about the prevalence of trauma underneath various medical, psychiatric and behavioral disorders. It is not too extreme to say that trauma is often an unseen factor affecting the two or three most troubling (and troublesome) patients a physician will see in any given day. Counselors should market themselves to doctors as an invaluable resource for their practice. I often tell my students that trauma and addiction are the two most underdiagnosed and undertreated conditions in clinical practice. Helping future counselors to recognize and address trauma is essential for the future.

Third, I am coming to understand that trauma is also a hidden, underlying factor in one of the most troubling societal maladies we need to address moving forward — namely white supremacy and nationalism, racist demonization, and violent extremism, as well as their underlying brokenness, isolation and marginalization. Trauma is often the covert companion of racist violence toward another. Just as addiction and illness can be negative outcomes from trauma short and long term, so too can prejudice and violent extremism become twisted and toxic aftereffects of suffering. I am coming to a deeper appreciation of strategies that identify, and show promise in addressing, this malignancy: empathy, connection, humanization, providing social support, resilience-building.

As counselors, we are called to provide comprehensive care and treatment. To do so demands that we become fierce advocates for creating inclusive communities that help to bridge the divide between suffering and hope. Helping our future counselors become these advocates is our task moving forward.

 

Kelly L. Wester is a professor and chair of the Department of Counseling and Educational Development at the University of North Carolina at Greensboro.

Many changes have occurred within the counseling profession over the past three decades: gaining licensure in all states, strengthening professional identity, being recognized by insurance panels and government organizations, and increasing use of telehealth during the health pandemic. We have more challenges in front of us, including, but not limited to, transferability of counseling licenses across states.

The growing edge I want to focus on is one that is moving slowly: our engagement in and use of research. To some individuals, research may be a four-letter word, and to others their passion. Regardless of where you may fall on this continuum, the field of counseling needs research. Research informs and transforms a profession, influences our understanding of mental health symptoms, informs counselor training and practice, and provides evidence-based practices.

The need to engage in research has been mentioned by counseling leaders since the 1990s and was noted as one of the seven principles in the 20/20 Principles for Unifying and Strengthening the Profession. These leaders have argued that counselors need to promote rigorous research, to understand client outcomes, and to disseminate research to clients, professionals and legislators. While I believe that we have made progress in enhancing research conducted in our field, I do not believe that our field has fully answered these calls. Are we effective as counselors? I have no doubt that we are. But do we engage in research that proves this? Not as much as we need to.

Research informs the field and advocates for clients. Our field is one of the leaders in supervision and in promoting multicultural and social justice competencies — yet we are just beginning to skim the surface on examining what is effective in both of these. There is a place for descriptive research to help us understand and influence theories, to better our understanding of what is occurring — but we really truly need to engage in more outcome and process-based research. What is it that we are doing that is effective? We know the therapeutic relationship is important, but what about it truly impacts clients and outcomes? How do we take more of what we do as counselors — the developmental, strength-based approaches — and show that it truly works, instead of waiting for other mental health professions to do the research on what they implement and tell us what to do (because third-party payers mandate evidence-based practice)?

All counseling professionals need to see themselves as researchers, because they are. With every client and student who comes to your office, you have a question about them. You are trying to unearth what is going on, what factors contribute to the symptoms, and what you can do to help this client/student. This is informal research.

It is not enough to do the research. We need to disseminate it so that professionals and clients can access it. Does this mean we should stop publishing in journals? No. Publishing in peer-refereed journals is important for maintaining integrity and influencing the scientific world. However, academic writing does not always translate to practice. Nor do counselors always have access to journals. Researchers need to think outside the dissemination box. Publish in the journal, but then blog about your findings, or take it to social media in a quick blurb, make a one-minute video, create a podcast or do something else to make it accessible. Bring the findings back to the community that provided you with the information.

Our challenge: To conduct more outcome and process-based research and disseminate our findings in an accessible way.

The change and opportunity: To impact our training, practice and clients by providing services that are empirically informed.

 

Debbie C. Sturm is a licensed professional counselor, co-chair of the American Counseling Association Task Force on Climate Change and Mental Health, and an associate professor at James Madison University.

In 2019, Greta Thunberg told the U.S. Congress, “This is not the time and place for dreams. This is the time to wake up. This is a moment in history where we need to be wide awake.” While the specificity of the global pandemic was not known at that time, the reality of pandemics, increased natural disasters, climate refugees and migration, and racial and environmental injustices have always been in the reality of those studying the climate crisis. The global systemic complexity of the impact of climate change may seem like quite a challenge for the counseling profession, but we have a clear opportunity to educate, prepare and mobilize in response to the very real mental health crisis on our doorstep.

COVID-19 has exposed the deep interconnectedness that our belief systems and actions have on each other and underlined the imperative of personal action for the greater good. It has also reminded us that science matters and that strategic, visionary leadership is critical. But COVID-19 is the intense here-and-now microcosm for what the climate crisis will bring. And everything we as counselors learn about health disparities, mental health outcomes from crisis and who gets left behind when leadership fails is an opportunity to better prepare for the next major shift.

While we have been in personal, professional and community battles with COVID-19, we have also been wrestling with the dangers of misinformation, intense and important calls for the long-delayed commitment toward anti-racism and racial justice, and severe social and economic disparities. And Oregon, California and Washington burned. Again. As I write this, the Gulf Coast is awaiting its seventh major hurricane of the season. Suicide rates among farmers are higher than they have ever been. Climate refugees within our own country are increasing. Flint, Michigan, still doesn’t have clean water. And the environmental destruction of the past four years has increased risk of harm to more communities due to environmental injustice and environmental racism.

How is this an opportunity? Literally everything around us is screaming for the awareness that harm to one is harm to all. And we have the opportunity — the critical, here-and-now, no-time-to-waste opportunity — to step into this movement.

Our ACA Advocacy Competencies remind each of us there are countless points of insertion to which every person can find their own unique way to make a difference. We have the opportunity to recognize, validate and bring into the therapy room the reality of the fear, dread and helplessness people feel in the face of the climate crisis — eco-anxiety, solastalgia, eco-grief and trauma, and concern about future generations. We have the opportunity to develop competencies for climate-informed disaster response — recognizing that disasters have now become repeat occurrences within short periods of time. We have the opportunity to become part of conversations in our communities with climate mitigation and resilience groups by contributing our knowledge of trauma, place attachment, racial and economic disparities, and resilience. And we have the opportunity to contribute to the overall understanding of how the climate crisis will impact the mental health and well-being of our most vulnerable neighbors. All of this is well-established with solid evidence from national and international agencies. We just need to bring it into our profession.

Right now, there are so many critical issues calling to us. We should rise up to meet every single one of them. But let’s remember — we have a massive membership. With intentionality, we have the opportunity to mobilize passionate people in every direction — all tied together by the common thread of counseling. Find your opportunity to make a difference. Mine is climate change and environmental justice. Find yours … and then join other counselors to make the change.

 

James T. Hansen is a professor in the Department of Counseling at Oakland University whose book, Meaning Systems and Mental Health Culture: Critical Perspectives on Contemporary Counseling and Psychotherapy, elaborates on the issues presented below.

The most significant challenge to the counseling profession over the next decade will be to reconcile the conflict between effective, relational counseling and increased professional participation in the medical model. By the medical model, I mean the alignment of specific treatments with particular symptoms or disorders, such as antibiotics for infections or cognitive behavior therapy for depression. Money and status in the mental health field are highly associated with the ability of professionals to participate in the medical model by diagnosing, receiving insurance payments and developing symptom-oriented treatment plans. However, reducing clients to symptoms is at odds with the development of an optimal counseling relationship, which is the within-treatment factor that has the highest association with counseling outcomes. Therefore, there is an inherent conflict between relational counseling practice and participation in the symptom-oriented, medical model.

It is not necessary to dive deeply into research or theories to understand this conflict; evidence from ordinary experience will do. Imagine that you have had a bad day and are eager to talk to your partner about it. As you begin to talk, your partner senses your frustration, states that you are suffering from an adjustment disorder, and suggests that you might benefit from a cognitive technique, which he then begins to describe. What would your reaction be? Would this response strengthen your relationship?

As another example, recall the last time you were troubled, talked to someone about your difficulties and felt better after the conversation. What did the other person do to make you feel better? During my career, I have asked hundreds of people (mostly counselors) this question. No one has ever answered “diagnosed my problem and recommended a technique.” Virtually everyone has answered with some variation of “listened intently and tried to understand my experience.” Relational development depends on efforts to understand the experience of the other person. A medical model emphasis on the importance of external symptoms necessarily undermines efforts to understand internal experiences.

At their best and most effective, counselors are relational professionals. Unfortunately, in the current culture of work, relational professionals are generally devalued, particularly when compared to technical-medical professionals (think caregivers versus surgeons). To gain status, professional respect and third-party reimbursement, counselors have strongly advocated to be a part of the medical model. However, as noted above, the reductive, symptom focus of the medical model is antagonistic to the relational factors that make counseling effective. Indeed, the counseling code of ethics emphasizes “best practices” and “effectiveness,” yet counselor advocacy in the mental health realm often takes the form of fighting for greater recognition as quasi-medical providers. This is an identity that undermines the relational factors that have the highest association with best practices and effectiveness. From this perspective, professional advocacy is an ethically questionable activity.

I do not have a solution to this conflict. From my observations though, the dark side of advocating to become a greater part of the medical model as a means to professional advancement is virtually never discussed. Therefore, the greatest challenge for the counseling profession will be to reconcile the conflict between professional status and our identity as relational professionals. Again, I do not have a solution. However, I think we can begin where we tell our clients to begin. That is, we need to face the conflict honestly and deal with it, rather than ignore it in the hopes that it will go away.

 

Derrick A. Paladino is a licensed mental health counselor, a national certified counselor, and a professor of counseling and Cornell distinguished faculty in the graduate studies in counseling program at Rollins College in Winter Park, Florida.

Three thousand six hundred fifty days in the future is a lot of days — and I mean a lot a lot. Living through a pandemic can make this time seem exhausting for some, and for others, hopeful that life will begin to invite more familiarities and welcomed experiences. Though I live somewhat near Cassadaga, Florida — aka the psychic capital of the world — I have not experienced any of this talent rubbing off on me. I mean, it could be nice to live it up like Biff Tannen in Back to the Future Part II or join Bill and Ted on their excellent adventures, but that also might take the fun out of life. Nevertheless, here are a couple thoughts regarding what might impact the counseling profession.

One trend/current necessity that I believe will become a staple is telehealth. To me, we are already late as a profession in fully accepting this modality. When looking at our global and social world, connecting to those who are unable to easily make their way to brick-and-mortar practices (whether their hurdles are physical health, logistical, financial or related to mental health) just makes sense. Telehealth is a part of social justice and advocacy, and the ability to seek counseling services becomes a clear social and ecological issue.

I think the profession will see a growth in HIPAA-compliant sites and devices to increase the accessibility of this modality. In addition, a surge in telehealth scholarship will better inform telehealth ethics and laws, best practices, and counselor and supervisor education. I also envision telehealth becoming a consistent part of the counseling curriculum. One hope is that “powerful individuals” will embrace and advocate for the need of reduced-cost internet. Currently, we are experiencing this as K-12 schools have gone virtual, and it would be wonderful to see this social justice issue emerge with the backing of our profession. On the other hand, we may see an increase in nonallied mental health professional telehealth counseling. The counseling profession will need to do a solid job of defining, differentiating and advocating for licensed and certified mental telehealth practice.

Another element might be the impact of political view polarity in the counseling profession. Over the past 3,650 days, we have seen a dramatic increase in the explicitness of individual political and social stances. Though they have always been there, due to social media, Listservs, etc., we have witnessed that what once was hidden is now a big neon sweatshirt with a sign spinner next to it.

How this will shape the profession, I have no idea. But we do know that the personal is political for counselors and clients. The counseling profession champions social justice and advocacy to allow underrepresented and marginalized populations to feel safe, connected and brave during treatment. For example, we see religious symbols and other symbols of inclusivity on private practice websites to increase client comfort and connection to the process. As the country seemingly sits on a divide, will this extend to political symbols? Only the psychic mediums in Cassadaga, Florida, know.

At minimum, mental health professionals will need to hold consistent awareness of what their public social presence beams to clients, along with the potential ascribed ethical, professional and ecological impact. The counseling profession will need to spend more time with how this is unpacked and navigated.

 

Michelle Fielder is a licensed professional counselor, an approved clinical supervisor in private practice, and a doctoral candidate in the counselor education and supervision program at Regent University.

The year 2020 will certainly take its place in the history books for the mental distress Americans endured with the coronavirus pandemic, alterations to education and social interaction, hits to the economy and record unemployment, heightened racial tension, calls for police reform and a divisive presidential election. However, the ramifications of these events will last long into the next decade. Despite the loss, pain, confusion, frustration and disappointment of life-altering circumstances, our shared experience is heralding the continued evolution of the counseling profession.

Counseling will forever be changed by the nationwide acceptance and advocacy for the profession during the COVID-19 pandemic. The Department of Health and Human Services’ public health emergency opened the door, but the declaration by the U.S. Department of Homeland Security naming counselors as essential to the critical infrastructure of the United States paved the way for recognition on par with other mental health providers. Continued efforts for license reciprocity and portability will eventually bear fruit, lending credibility for the profession to operate across state lines with an established standard of professionalism.

The pandemic also ushered in the widespread use of telehealth to ensure public health and safety. While telehealth seemed like a niche modality before the pandemic, clients, clinicians, insurance providers, and state and federal governments quickly recognized its benefits to meet the need for increased mental health services while being mindful of social distancing protocols. The use of telehealth will not decrease as the need for social distancing wanes. Our society was already moving toward increased convenience in daily activities as the millennial and centennial generations embraced technology for online social interaction, recreation, shopping, dining, groceries, transportation and remote work opportunities. The widespread use of telehealth is here to stay.

The challenges and opportunities for the counseling profession will concern maintaining relevancy in the nation’s changing landscape. Counselors will need to further differentiate from life coaches and other helpers who do not require the same level of education, experience or licensure as future clients seek the most expeditious, cost-effective services. An increased need for counselors must be met with increased CACREP-accredited programs, to include qualified supervisors and applicable practicum/internship opportunities.

Recent history has revealed that the nation is not as enlightened in the areas of equality, justice and racial reconciliation. The pandemic revealed the financial fragility of many families and small businesses, as the loss of one or both incomes destabilized families and caused businesses to shutter. Education at all levels has been affected; students will not get back the losses of the 2020-2021 academic year, including social skill development, organized sports and club activities, or academic programs that were canceled. The loss of those experiences, especially for older students, can have a devastating effect on potential recruiting and scholarship opportunities or occupational opportunities in the future.

Insecurities in food, housing, transportation and health care caused further distress as families tried to maintain solvency. The clients of the future are going to be affected on multiple intersecting levels, which will require efficacious methods to address the complexity we are likely to see. Not only must counselors be well-versed in grief and loss, multiculturalism, social justice, advocacy and trauma-informed care, but there needs to be additional research into the intersections created by the pandemic and the life-altering changes that came with it.

 

Lennis G. Echterling is a professor of counselor education at James Madison University.

As a kid, I loved to dig holes in our yard, fruitlessly searching for arrowheads and other clues about our mysterious, distant past — much to the consternation of my parents. When I gave any thought to the future, I dreamed of flying cars and spaceships blasting off to the stars. These days, as a counselor educator, I find myself digging into the muck and mire of the present crises that confront our society, searching for valuable clues about our future. Throughout my career in the counseling profession, I’ve learned that the seeds of innovations and transformations are found in our most troubling times.

For this piece, I will focus on three current and intersecting crises — the pandemic, global climate change and systemic racism — that are leaving in their wake countless casualties, economic chaos and social conflict. These catastrophic conditions are vast and dishearteningly complex, but all three perils also hold promise for the future contributions of the counseling profession.

The pandemic: In the 16th century, Italy was struck by a plague they labeled influenza delle stelle because they believed the disease was caused by the stars. Today, we still retain the term “influenza,” but we now recognize that humans, not the stars, are the actual viral agents. As counselors, our focus is on humans — their struggles, relationships and potential. In our work, we have learned that in times of emergency, new things can emerge, leading to dramatic, enduring and positive changes — in individuals, families, communities and societies. Consequently, counselors are now serving as catalysts for expanding innovative telehealth practices, offering virtual crisis intervention to overwhelmed first responders, promoting best practices for primary prevention, collaborating on medical teams to treat COVID-19 patients, and providing online support groups for those who lose loved ones.

Climate change: Rapidly rising sea levels, record-setting heat waves, horrific wildfires, hurricanes whose names outpace the alphabet, and other catastrophic consequences of climate change will continue to sabotage the emotional well-being of countless citizens in every country. Therefore, future counselors will be welcomed as valued members of disaster response teams. Given our knowledge and skills as counselors, we are ideally positioned to contribute to environmental advocacy, disaster preparedness and community resilience. For decades, counselors have been influenced by attachment theory, which highlighted the need for deep and abiding relationships between children and their caregivers. In the future, it will also be our basic duty to promote, strengthen and deepen humanity’s most fundamental attachment — to the natural world.

Social justice: Both the pandemic and climate change have in common a disproportionate impact on people of color, who not only are exposed to greater risks but also have fewer available resources to cope with these threats. Black Lives Matter and other movements are engaging in social justice action to heighten society’s awareness of oppressive systems of power and privilege. By implementing diversity, equity and inclusion initiatives in counselor education programs, we can ensure that future counselors will be better prepared to embrace their roles as change agents for social justice — to challenge racialized violence, combat xenophobia, advocate for racial and gender equity, and echo the voices of the marginalized.

Addressing these and other crises will be the mission of all future counselors as we advocate for bridges that unite humans, instead of psychological walls that separate. Counselors can be the metaphoric windmills that harness the winds of change. As Shakespeare wrote, “The fault … is not in our stars but in ourselves.” True, but we humans also hold the promise to actualize, transcend, and achieve our potential. The task of future counselors is to fulfill that promise for all humanity.

 

Kara P. Ieva is an associate professor in the counseling in educational settings program at Rowan University.

What will counseling be over the next decade? My initial thoughts center around 2020 and the unpredictability of demands from counselors. As such, I feel like 2020 brought invaluable lessons for the counseling profession but also left us with numerous questions to answer as we begin to envision the next 10 years.

Highlighted by 2020, the counseling profession will need to address how it contributes to our society’s generational diagnosis, racism. While we continue to eradicate the stigma surrounding mental health, racism presents the greatest challenge we will face, but it is also a significant opportunity to advance the profession as an inclusive practice for all individuals. Essentially, this requires feeling uncomfortable while critically reflecting on our history and the lessons from 2020 and challenging the identity of who we want to be for future generations. As we know, complacency is harmful to the profession, ourselves, clients and society.

This is a tall order that requires a systemic and collaborative approach from professional organizations, accrediting and licensing bodies, counselor education programs, researchers, field leaders and supervisors, and individual counselors. The first step is acknowledging our history in two ways.

One, the field was founded on the need to compete in the global “space race” and increase student enrollment in STEM courses. This led to the creation of gatekeeping practices, deciding on access for opportunities in an educational setting that was founded on white norms. As a large body of research tells us, those practices still exist today for marginalized populations.

Second, counseling overall is steeped in white middle-class norms. Even though the profession evolved with cross-cultural counseling, multicultural competencies and social justice advocacy, we remain a predominately white field (conditioned in privilege), which limits access for myriad clients and potential future counselors. The counseling profession is active in multiple systems (e.g., health care, education, justice, etc.) that interact with one another. This informs the essential questions: How will counselors collaborate across systems to provide equitable access, dismantle oppressive practices, and provide strength-based interventions to increase overall mental health wellness? How will we contribute to making the world a more informed and empathetic place for all humans?

To address those questions, the next thing to consider in tandem are accreditation and licensure standards and counselor education curriculum. Programs still teach foundational Eurocentric theories across the entire accredited curriculum. Given the diversity of multiple identities of counselors and clients, it’s time we asked ourselves, “What can we leave behind in our curriculum while acknowledging the past, and what might be essential moving forward?”

We were already in a mental health pandemic, and now due to 2020, mental health issues continue to increase for all ages, from young children to adults, stemming from the pandemic, financial crises, grief and loss, racial trauma, educational trauma, political and familial tensions, and social isolation, just to name a few. Based on what we know about trauma, we will be addressing the effects of 2020 for the next 10-20 years. Additionally, we also know that trauma plays out differently with the intersection of multiple identities (e.g., gender, race, ethnicity, neuroprocessing, language, veterans, LGBTQ+, etc.) and circumstances across the various systems. Are all counselors prepared to address intersectionality with multiple traumas across all systems, for all clients, whether face to face or through telehealth sessions? How might the answer change our accreditation standards, licensure requirements, educational curriculum, supervisor training and professional development?

It’s true, there is a lot of work to be done, but I am hopeful. I am optimistic that 10 years from now, we will have answered these questions and proactively collaborated to meet the needs of an ever-changing society and done our part in contributing to global healing and overall wellness.

 

Sherry Cormier is professor emerita in the Department of Counseling, Rehabilitation Counseling and Counseling Psychology at West Virginia University and is currently affiliated with Full Circle Healing Arts and The Wellness House in Annapolis, Maryland.

The Chinese symbol for “crisis” also means opportunity. The issues that we are facing nationally and globally in terms of climate change, pandemics, food insecurity, social justice and interpersonal conflicts are not only challenges; they are also opportunities for change. We are evolving at a pace so rapid that it’s laced with tremendous uncertainty, grief, anxiety and aggression. Substance misuse and suicidality, as well as crisis calls, are steadily rising in response. I’ve lived long enough now though to not feel unduly alarmed over these issues. I’ve sat through enough deep loss and enormous social unrest to know that devastation is the opening for growth. Cynthia Occelli has captured this sentiment: “For a seed to achieve its greatest expression, it must come completely undone. The shell cracks, its insides come out, and everything changes. To someone who doesn’t understand growth, it would look like complete destruction.”

I believe this quote holds the key to the opportunities available to counselors and our profession in the next decade. We know from research that personal transitions are occurring at such a swift speed that nothing in our lives is linear anymore, and clients are unnerved and overwhelmed by constant upheaval (Bruce Feiler, Life Is in the Transitions, 2020). As important as self-care is for clients (and ourselves) now, this area of professional practice will grow exponentially in the next decade, especially for clients who feel their values eroded, their boundaries violated and their lives compromised in unthinkable ways. Since emotions like anxiety and grief settle deep in our cells, providing clients with ways to emphatically and consistently prioritize their own mental and physical health will be important future opportunities for counselors, including networking with complementary professionals whose practices supplement our roles.

Also, the search for self-knowledge and personal meaning will be even more relevant and necessary. The more intimately we know ourselves, the more resilient we tend to be from the waves of change in our external world. Those who stand poised to help clients discover more about who they are and about what they are connected to will be the leaders in the next decade.

At the same time, counselors who have a deep understanding of trauma, both personal and collective, will have expanded opportunities to provide services. Finding ways to work effectively with personal traumas will continue to be important, yet navigating cultural and societal traumas, including but not limited to racism and discrimination, will become more prevalent. If we fail to address collective trauma in our profession, we risk becoming irrelevant (at the very least).

As the incidence of posttraumatic distress grows, so does the opportunity for posttraumatic growth. For many years, we’ve considered counselors to be agents of change. That’s still true, but in the next decade, counselors will be known for being agents of growth and healing. The word healing means to “make whole.” Comprehensive self-care assessment and treatment modalities, facilitation of far-reaching self-knowledge and personal meaning, and sensitive and competent responses to individual and institutional traumatic distress will be significant opportunities for counselors to help clients develop wholeness and transformation in the face of anguish and desolation. As the mystic poet Rumi said, “Do not worry that your life is turning upside down. How do you know that the side you are used to is better than the one to come?”

 

Laura K. Jones is an assistant professor of health and wellness promotion and director of the Peak Performance Biofeedback Lab at the University of North Carolina Asheville.

“The gut trains the immune system to protect the brain,” proclaimed a November 2020 National Institutes of Health press release. The month prior, Brain, Behavior, and Immunity published a study detailing the inflammatory predictors of anxiety and depression in COVID-19 survivors. In 2020, nearly 17,000 journal articles noted interactions between the immune system and mental health, 4,000 linked mental health to the gut microbiome, and roughly 2,000 more described the role of sex steroids. Research substantiates that nearly every system of the body — the central and peripheral nervous systems, immune system, endocrine system and gastrointestinal system — influences mental well-being and how our environment influences that process. We now know there are likely multiple phenotypes of various mental health struggles, likely driven by differing physiological etiologies. We are on the verge of a watershed moment in how mental health — for centuries an enigmatic phenomenon — is conceptualized.

Although we have been championing this within our field for over a decade, I am more convinced than ever that to stay relevant and emerge as leaders in the broader mental health landscape, the field must recognize, embrace, and intentionally and ethically translate such findings through our unique therapeutic lens. However, this begets significant challenges, both within and external to counseling. A 2018 Journal of Humanistic Counseling article argued that neuroscience lends little substance to counseling and offers a reductionistic image of the human experience. Although ethical integration warrants caution, such perspectives are as shortsighted as the reductionistic viewpoints they argue against and problematic to the growth of the field.

Integration is not a binary argument. It is not a question of whether we stick to our humanistic ways or embrace what we know about physiology. We cannot pit one against the other and sit idly by while the rest of the mental health world changes. As such, the more appropriate question is how we will grow with the science, employing and building upon our humanistic traditions to best support physiological, interpersonal and social change.

This balanced perspective is vitally important external to counseling too as we begin to see the therapeutic implications of such burgeoning research. Such science will continue to inform how mental health struggles are diagnosed, prevented and treated. It is likely that our society — based in allopathic medicine and “quick fixes” — will begin to push for more pharmacotherapeutic and medical interventions. Although advances are important, this emphasis may have detrimental impacts on policy, insurance and perceptions of the therapeutic process.

Counselors have the obligation to remain advocates in the broader mental health and policy worlds for the importance and necessity of talk therapy and adjunctive interventions (e.g., neurofeedback, somatic therapies) facilitated by counselors. To support such efforts, we need to expand our research to explore the neurophysiological outcomes of counseling interventions, both traditional and those newly developed and informed by neuroscience.

Think about it. We know the importance of a strong therapeutic relationship and increased self-awareness, but how, physiologically, do these lead to an abatement of symptoms? How does engagement in counseling influence health disparities for Black, Indigenous and people of color? How can counseling ease the enduring health consequences of COVID-19? How does neuroscience-informed cognitive behavior therapy, originating from counseling, compare to traditional CBT in alleviating symptoms?

Answering such questions will require that we become more competitive within larger granting agencies, such as NIH and the National Science Foundation, and build cross-disciplinary partnerships. It will require more intentional, consistent and accurate training of counselors, which the American Mental Health Counselors Association Neuroscience Task Force is currently addressing. We are at a significant juncture in mental health care, and the counseling field has an opportunity, or rather obligation, to guide those changes and to be the voice for balancing the physiological perspective with that of the humanistic within policy, insurance and practice alike.

 

Matthew Fullen is a licensed professional clinical counselor in Ohio and a counselor educator at Virginia Tech, where his research focuses on Medicare reimbursement advocacy and supporting the mental health and wellness of older adults.

Medicare insures 60 million Americans, a figure estimated to approach 80 million by 2030. Exclusion from the Medicare program has far-reaching consequences for counselors, and the negative impact on Medicare recipients is even more alarming. For counselors, Medicare exclusion has resulted in untimely client referrals, loss of revenues and fewer job opportunities within certain segments of the mental health marketplace. Clients who rely on Medicare (i.e., older adults and younger people with long-term disabilities) experience long waitlists and financial challenges in accessing care and with issues such as hospitalization.

Medicare advocacy in the counseling profession has a long history, but recent developments suggest that the near future is bright. During the 2019-2020 congressional cycle, over 150 lawmakers became co-sponsors of two bills that aim to address counselor exclusion from Medicare. The Centers for Medicare & Medicaid Services will now reimburse services provided by counselors in opioid treatment programs, and a similar allowance was made, albeit temporarily, within rural health centers during COVID-19. In addition to these advances, awareness of the Medicare mental health coverage gap is reaching a wider audience through increased research and exposure in national press outlets such as Politico and the New York Times.

So, what comes next? How do we commit to advancing this advocacy over the next several years? And just as importantly, how do we ensure that the counseling profession is prepared to work with Medicare-insured individuals once current policy is changed? In the short term, there is an ongoing opportunity for counselors to increase their participation in the Medicare advocacy process. If you have never participated in an ACA advocacy campaign, we need you to start. If you have participated using only automated technology, we need you to make phone calls and write personal emails. If you have not yet met directly with your federal lawmakers about Medicare reimbursement, this is the time to do so. These steps will go a long way in advancing this cause. If you are busy serving your clients, we need you to share your stories about turning away Medicare-insured clients. If you are busy training counseling students, we need you to help them get involved in advocacy. If you are a student learning about the counseling profession, ask your instructors about how Medicare policy influences clients’ access to care. We need a wave of grassroots involvement that will show congressional lawmakers that the time for change is now.

As we advance toward Medicare inclusion, a new challenge awaits us. Will the counselor workforce, professional infrastructure and training programs be prepared to work with a vast influx of Medicare-insured clients, most of whom are over the age of 65? Just as the counseling profession has evolved to respond to the needs of other societal changes, so too must the profession ready itself for demographic shifts that are already underway. When we attain Medicare reimbursement, will our profession be ready to meet the needs of older clients? Counselors will need professional development opportunities to enhance the application of their practice to an aging population. Counselor educators will need to improve upon the very low rate of counseling research that currently exists. Counseling students will need greater exposure to training that addresses needs across the life span, which may require the reemergence of a specialization in gerocounseling, or at least the development of accreditation standards that address aging more directly.

The future of counseling is bright, and the profession’s ability to capitalize on current Medicare advocacy momentum and translate these successes into addressing the mental health needs of an aging population will shape our next five to 10 years. Advocates, pioneers, counselors wanted!

 

Sidney Shaw is core faculty in the School of Counseling and Human Services at Walden University.

In considering future challenges for the counseling profession, it is evident that artificial intelligence (AI) will influence the future of mental health services, and changes are already occurring. In broader society, human jobs have been altered by technology for generations. Switchboard operators, bowling alley pinsetters and cashiers are just a few of the jobs that are either no longer done by humans or have been at least partially replaced by technology. Even some journalists have recently been replaced with AI.

There can be benefits to technology supplementing human occupational roles, such as robots to inspect burning buildings for safety, but limitations include technological augmentation of jobs that are fundamentally rooted in human relationships. AI is accelerating at rates that were previously unimaginable, and this has unforeseen implications for our profession. In the month of January 2020 alone, there were 3.4 million downloads of the top 10 mental wellness apps in the U.S., and the monthly download number has increased since COVID-19 was declared a public health emergency by the World Health Organization on Jan. 30 of last year.

Mental health apps and AI bots are readily available, certain ones are free of charge, and some have research support. For example, a peer-reviewed study by Kathleen Fitzpatrick and colleagues found that people using Woebot, a chatbot that provides real-time CBT-based interventions, experienced significant decreases in depression symptoms. The increasing popularity of mental health bots is not separate from the broader societal and political environment. For example, the America’s Mental Health 2018 study found that access to care is a root cause for the mental health crisis in the U.S., and this is one factor that can make cheap or free mental health bots very appealing. With this in mind, it is important for the counseling profession to advocate for accessible health and mental health care for all members of society to promote well-being of the entire population.

People sometimes make vague decisions about the role of technology in their lives, and they may conduct informal cost-benefit analyses in this regard. Consider parents setting limits on screen time with their children, or how you might think about your own technology use and what limits should be set to maximize living a full life. Someone might argue that having a therapeutic relationship with AI bots is a good thing, so we should embrace it. On the one hand, they may have a point. However, more research evidence is needed in this regard, and a move toward therapeutic relationships with AI should prompt us to wrestle with some philosophical questions. Questions such as: How do we determine when technology is serving us versus when we are serving it? Even if AI can help decrease symptoms of depression, are we also sacrificing some important part of humanity or human connection in the process? The therapeutic alliance is the best predictor of counseling outcomes; how does this relate to mental health bots? How does increased reliance on AI for dealing with struggles affect broader society and human relationships? How do helping relationships with AI alter humanity over time?

Instead of sleepwalking into a future that is determined by the tech industry, the counseling profession needs to intentionally address these and other philosophical questions about the potential long-term impacts of AI so that we can thoughtfully influence the future of counseling for the benefit of clients and the profession. My essay is a call to look at the forward trajectory of AI and its potential effects on our field, mental health care and us as a species. In the words of Ilya Prigogine, “The way to cope with the future is to create it.”

 

Donna Gibson is a professor of counselor education, a licensed professional counselor and the
Association for Assessment and Research in Counseling’s representative on the ACA Governing Council.

It seems like our world has been experiencing “change” in warp speed. Constant changes that do not slow and seem to impact multiple aspects of our lives. The perception may seem a little skewed while living during the latter part of 2020, but there were fast-moving changes in politics, climate, economy, health care, immigration and other aspects of our society prior to this year. The year 2020 put an exclamation point on it, in some ways brought things to an abrupt halt, tested our ability to be flexible and try new things, and in many ways forced us to have a new perspective on the present and the future. Personally and professionally, I had to look at the opportunities that were given and what opportunities are there for us in the future.

Quarantine and social distancing measures highlighted individuals’ needs for connection and the importance of relationships. The need for connection to others and to be in relationship with others isn’t surprising to us counselors, and it’s the reason why we are needed. Yet we fulfilled this need in less often utilized ways in 2020 and demonstrated our flexibility in meeting the needs of clients and students. Instead of face-to-face meetings, individuals connected with friends and family more with texts, FaceTime or some form of web conferencing platform (e.g., Zoom). Counselors connected with clients more through phone calls, emails/texts and telemental health counseling platforms, and counselor educators had no choice but to go all in with web conferencing and online course delivery platforms (e.g., Canvas, Blackboard).

I note this change in service delivery because it provides insight into the future of counseling for the next five years. As a profession, we won’t go “back to normal” but rather to a “new normal.” Don’t be mistaken and think I am suggesting that we should not meet clients or students face to face, but utilizing technology creatively will allow for many more and different opportunities to meet with them. If we have a level of flexibility in meeting with clients that exceeds what we have done prior to 2020, then licensure portability is more important than ever before. Because the American Counseling Association is working diligently on a licensure compact among states, I do think we will see portability among states occurring in the next five years.

Writing my thoughts about our profession post-election, it is obvious that we have opportunities to help people examine relationships, practice self-reflection, and engage in conversations and work related to human rights. Protests related to human rights, and specifically Black Lives Matter, highlight the importance of counselors being leaders in anti-racism action. As a profession, we have opportunities and skills necessary to leading in this arena that respect the developmental aspects of self-awareness, empowerment and advocacy. In the next five years, we can lead in educating, training, listening and advocating for change. Change is here but rough around the edges, so our role is inevitable. Our society will continue to present more and more opportunities to lead in the years to come.

The year 2020 highlighted the creative ways that we do and do not attend to our wellness. Wellness is a foundation of our profession, yet many of us struggle with it. In the coming years, we will need to address wellness more intentionally as it impacts multiple aspects of our physical, spiritual, emotional, cultural and social sense of being. Wellness needs to be a priority instead of an afterthought for ourselves, as well as our clients, as we navigate changes in our society.

 

Brandon Ballantyne is a licensed professional counselor, national certified counselor and certified clinical mental health counselor who works at Tower Behavioral Health (Acadia Healthcare) in Reading, Pennsylvania.

I have been a licensed professional counselor for eight years, practicing in varying levels of care that include outpatient, inpatient and partial hospitalization. I believe strongly in the utilization of cognitive behavioral therapy to address symptoms of depression and anxiety that bring individuals into their respective treatment settings.

A silver lining is defined as a sign of hope or positive aspect in an otherwise negative situation. For most, whether in therapy or not, silver linings have been challenging to find in the midst of the COVID-19 pandemic. The pandemic has triggered an increased frequency of depressive thoughts and anxiety-driven behaviors that has culminated in significant psychosocial dysfunction for individuals across the board.

Based on my clinical experience, there has been an increase in suicidal ideation, substance dependence, avoidance, isolation, hopelessness, neglect of self-care, and an overall disengagement from healthy support systems. From a cognitive behavioral context, there has been a need to incorporate a larger emphasis on addressing cognitive distortions that exacerbate the distress-related patterns noted above. I anticipate an opportunity for psychoeducational services to serve a larger role in helping individuals understand the source of their symptoms.

Before symptoms are effectively resolved, it is critical to gain an understanding of where they come from. Symptoms are valid. Symptoms have an origin. The cognitive model can help individuals understand the relationship between stressful events, thoughts, emotions and reactions. Socialization to this model can provide individuals who may not currently be in treatment an opportunity to gain basic awareness of their emotions and basic cognitive restructuring skills presented through an introductory thought log workshop.

Based on my experience, when individuals gain a basic understanding that their emotional symptoms are directly related to their thoughts, and that their thoughts are essentially “sentences” that can be restructured to reduce distress, the result is an experience of validation and a greater sense of control over feeling better and doing better.

I would like to see psychoeducational workshops with an emphasis on basic cognitive behavioral therapy implemented inside of primary care physicians’ offices, community centers, libraries, recreational establishments and fitness centers. The next five years will bring greater opportunity for counselors to reach individuals in their respective communities who may have never had therapy or entered treatment.

Standardized psychoeducational services like the one I have described can assist in creating an easier entrance into therapy services, reduce stigma related to mental health, and reinforce maintenance of emotional well-being as part of routine medical care.

The COVID-19 pandemic has been a worldwide trauma that has led to significant hardship for most. My personal therapeutic philosophy emphasizes that even in the most difficult traumas or challenges, there is a productive lesson, important meaning or strengthening of resilience that can emerge. These constructive conclusions can be extremely difficult to find. They are not often found in our automatic thoughts. They are more likely to be discovered in the practice of cognitive restructuring, positive affirmations and coping thoughts.

Counselors need to take advantage of the upcoming need for standardized psychoeducational workshops in the community. It is our role to begin to offer a blueprint for those much-needed “silver linings.”

 

Dee Wagner, a licensed professional counselor and dance/movement therapist since 1993, is the originator of Chi for Two-The Energetic Dance of Healthy Relationship.

I predict that within the next 10 years, counselors will recognize all therapeutic work as bodywork — an energetic dance that facilitates self-regulation. Now that scientist Stephen Porges’ polyvagal theory has clarified trauma patterning, attachment styles and the role of oxytocin in social interaction, I predict a blossoming of appreciation for one key aspect of the work of child psychiatrist Judith Kestenberg and colleagues, especially dance/movement therapist Susan Loman. Kestenberg and colleagues identify infant rhythms that alternate between ones they call “indulging” and ones they call “fighting.” The indulging rhythms tend to match with parents’ movements, while the fighting rhythms mismatch.

How parents react to the mismatching rhythms plays a role in what Porges calls co-regulation, versus the relational “dances” that result in co-dysregulation. Co-regulation and co-dysregulation name the pinball-rapid passing of responsiveness back and forth between people, which can either facilitate the kind of calming that Shelley Taylor named “tend and befriend” or send us into a fight/flight response.

Fighting: The infant fighting rhythms and the mismatching dances help us individuate within relationship as long as these moves do not trigger fight/flight in our caregivers. Ideally,
as babies, we become aware of our bodies as we squirm in the arms of our parents.

I invite you to experiment with this “dance.” You might push your hands into a desk in front of you or go to a wall and push into it with one foot forward and one foot back. The harder we push into something outside of ourselves, the more we feel into our core. We gain core-to-hand and core-to-foot mindfulness. “When I push into what’s not me, I find me.” This me/not-me dance facilitates social justice.

Once we find ourselves, we have space for curiosity about others. In the me/not-me oppositional dance, we find our ability to support our heads and spines. We find core-to-limb strength that launches us into crawling, walking, running, galloping and skipping. We playfully engage with others. When we become adults and create businesses, we do not want to kill the competition. Who would we play with?

Porges’ polyvagal theory has revolutionized therapeutic practices. The way that polyvagal theory aligns with longtime trauma expert Peter Levine’s understanding of trauma patterning has allowed counselors to better understand human behavior.

I predict that in light of Levine’s studies, polyvagal theory will help counselors better sense the two different dances of activation and calming we have in our bodies — one for when we sense safety and the other for when we sense life-threatening danger. This idea of two activation/calming dances resonates with what attachment theorist Mary Ainsworth recognized as two main attachment styles: secure and insecure.

Results from the Adverse Childhood Experiences study are helping counselors recognize birth, infant and intergenerational trauma patterning. I see the studies of the neuropeptide oxytocin done by scientist Sue Carter helping counselors appreciate how developmental dances play out in our adult relationships. Before the work of Carter, oxytocin was mostly associated with birthing and nursing. Now we are seeing its role in all social interactions. With knowledge of the alternating matching and mismatching infant/parent dances, counselors can begin to see how appreciation of infant fighting rhythms facilitates the “dance” of productive debate in adulthood.

Recognizing the role that infant fighting rhythms play in healthy individuation will help counselors better “dance” within the therapeutic relationship. Clients will become more empowered and consciously use their counseling experiences to finish their unfinished infant/parent dances. A playful sense of self will emanate, facilitating living and working together more creatively.

 

Douglas Guiffrida is associate dean for graduate studies, a counseling professor and director of the mind-body healing and wellness advanced certificate program at the Warner Graduate School of Education and Human Development, University of Rochester, and has a private counseling practice focused exclusively on healing chronic pain.

According to a 2016 study by the Centers for Disease Control and Prevention, chronic pain affects more than 50 million Americans, which is over 20% of the adult population. The same study reports that a staggering 20 million Americans suffer with severe or debilitating chronic pain. In addition, chronic pain is estimated to cost Americans $635 billion a year in medical costs and lost productivity. People suffering with chronic pain are also likely to experience a host of comorbid psychological conditions such as depression, anxiety and sleeplessness, as well as being at high risk for opioid addiction. Chronic pain, therefore, is one of our country’s most pervasive and costly medical issues.

Unlike acute pain, which is short term and alerts people to an injury that needs treatment or rest, chronic pain is long term, often begins without an injury or, in the case of injuries, lasts beyond the normal time of healing. While acute and chronic pain have historically been conceptualized and treated the same way, research now indicates that they are actually two different conditions. In fact, a growing body of MRI research suggests that many forms of chronic pain are actually related to neuropathic processes in the brain rather than structural damage. 

This awareness regarding the role of the brain in chronic pain has dramatically increased interest in mind-body counseling approaches and created significant opportunities for counselors to become leaders in the treatment of chronic pain. One psychological approach that has shown promise in the treatment of chronic pain is mindfulness. The practice of mindfulness, which has existed for over 2,500 years, was introduced to Western medicine in the 1970s by Jon Kabat-Zinn, who founded the Mindfulness Based Stress Reduction Clinic. While research indicates that mindfulness shows only moderate effects in curing chronic pain, it is highly effective in improving the psychological symptoms and physical limitations experienced by people in chronic pain.

A second psychological approach that has shown significant promise not just in improving psychological symptoms and physical limitations, but in actually curing many forms of chronic pain, comes from John Sarno, a physician and pioneer in mind-body medicine. Using the work of Sigmund Freud, Sarno theorized that many forms of chronic pain are actually created by the subconscious mind as a means to distract (or protect) us from experiencing painful emotions such as anger, rage and guilt, which we learned as children to be unacceptable and even dangerous emotions. His approach focused not only on helping his patients experience and express painful emotions, but also on psychoeducation about the psychological causes of pain and behavioral modifications to break the pain-fear cycle. Sarno’s theory has garnered a great deal of attention recently, and numerous studies by physicians and researchers such as Howard Schubiner, Mark Lumley and Allan Abbass support the efficacy of his approach. 

Due to the counseling field’s emphasis on holistic and wellness-focused approaches, counselors are uniquely positioned to become leaders in the development and delivery of chronic pain counseling using mindfulness, psychoeducation, behavioral modification and emotion-focused approaches. In a Counseling Today article titled “A counselor’s journey to healing from chronic pain” (July 2020), I articulated how I implement these approaches in my private counseling practice to heal clients from a wide range of chronic pain conditions. Readers interested in learning more about this significant opportunity for counselors should consult this article. Readers may also consider learning about mind-body approaches by enrolling in the new online advanced certificate program in mind-body healing and wellness at the University of Rochester.

 

Susan Furr is a professor in the counseling program at the University of North Carolina at Charlotte whose areas of interest include professional competency in counselor education, college student development, and grief and loss issues, with particular emphasis on grief and substance use.

When considering the future of our field, it is difficult to separate my views of the future from the current challenges our country is facing. In just a few months, counseling made an abrupt shift in how we teach and how we offer services. I am both amazed by and appreciative of how quickly our field has adapted to the need for online learning and counseling. Technology has become essential to what we do, so our goals for the future need to focus on the research and development of effective online counseling services as well as examining the best practices for online teaching to prepare our future counselor educators to employ a variety of teaching methodologies.

The challenges of the pandemic have created a growing need for mental health resources and revealed cracks in service delivery. With increased issues with substance dependence, we need to make sure all counselors are prepared to assess for substance use disorder and provide appropriate treatment and referral if needed. Although training in addictions has been added to our professional standards, too many counselors do not feel adequately educated to address these issues. There is a tremendous opportunity for counselor training programs to expand educational opportunities in the area of addictions counseling.

The levels of depression and anxiety created by the pandemic have shown us that we need to broaden our concept of grief counseling to include losses beyond those associated with death. While many families and friends are mourning the deaths of those they love, many more are grieving the loss of the normalcy of daily life. The impact of these losses may emerge only over time because of our tendency to minimize the meaning of non-death losses. Missed family connections; lost life events such as weddings, graduations and proms; and disruption of daily routines of work and school need to be recognized as losses that impact our moods. We feel sad but don’t understand our need to grieve. Counselors need to be prepared to understand grief and create space for clients to explore the meaning and ways to cope with these “small” but ongoing losses.

We are increasingly a nation of traumatic events, but perhaps our growing knowledge of neuroscience is creating one of the most exciting times in our field. As we evolve a deeper understanding of neuro-informed counseling, we have the opportunity to improve our ability to train counselors in their capacity to assist clients dealing with the intersecting areas of trauma, crisis and grief. These are specialized skills that are needed by all counselors but often are not addressed in depth in counseling programs. Allen Ivey and colleagues have emphasized how our current theories and approaches are validated by neuroscience and how we can use this knowledge to improve our counseling approaches. Continued research needs to emerge in this area, particularly in examining any differences in online versus in-person counseling.

The emotional turmoil created by social inequities has highlighted the need for the counseling profession to continue to engage in social justice activities. We must address this concern on multiple fronts. First, increasing the diversity of students entering both master’s and doctoral programs is essential to providing counselors who match the diversity of our clients. Next, all counselors need to understand the impact of systemic racism on clients if we are to help clients address external issues that influence personal growth. In addition, we need to be politically informed and involved in helping change policies in ways that benefit mental health.

 

Peter Allen is the integrated care supervisor at Brightways Counseling Group in Madras, Oregon, and enjoys working with adolescents, adults and couples experiencing a wide variety of mental health challenges.

It is probably safe to say that the next 10 years in the counseling profession are certain to be both fraught with peril and bursting with possibility for new discovery and advancement in the field. If the global COVID-19 pandemic has taught me anything as a counselor, it is that everything we know and love is delicate in some way or another. This is not necessarily something to bemoan; some of the most priceless things on Earth are extremely delicate, and their value is in direct proportion to their fragility. I hold this lesson near every day as I consider my own relationships and what the future may hold for my colleagues and myself. If we acknowledge the tenuous nature of things in general, perhaps we can grow our appreciation of everything in real time.

Before the pandemic, who among us recognized that we had long taken for granted seeing clients in person and that we would ascertain the true value of these meetings just as the possibility of continuing them began to slip away? Certainly not me. It has been quite a change for me, and I suspect for all of my colleagues as well. We have had to rapidly pivot from seeing everyone in person and creating a healing physical space, to seeing everyone on a computer screen and doing our best to create a new healing space in the digital sphere. Telehealth is truly a wonderful option for us, as it allows us to continue providing therapy during this time, and it has most likely changed the way the profession will operate in perpetuity. I am grateful that we have an option for continuing to do our work, and one that allows us to provide for our families during this time of great uncertainty.

The biggest challenge in the next few years, in my humble opinion, will be taking care of ourselves in an honest and complete way. Clinicians are all taught to practice self-care, although it has been my observation that most of us are better at giving lip service to this than actually setting up our lives to include it in an effective and meaningful way. Being a therapist is difficult enough in “good times.” I add the quotation marks because our society is rightfully starting to reckon with the fact that people of color and other marginalized communities have not had a chance to share in those “good times.” So, we are challenged to take care of ourselves so that we can show up well for our clients, and continually try to expand our awareness of what those communities have faced for centuries. This will require us to examine long-held beliefs and practices and to evolve clear-eyed and willfully. Change is the only constant, and there is no victory over it to be had. One either makes peace with it or is defeated by it.

However, as always, moments of challenge and disruption create significant opportunities for growth in the long run. I believe the biggest opportunity for clinicians in the next 10 years will be in advancing social justice causes. We have a wonderful opportunity to include and listen to more voices in the conversation, acknowledge the validity of their experience, and serve as humble allies in the long march to equality. Victor Hugo once said, “Nothing is more powerful than an idea whose time has come.” Indeed, the social justice movement is a long-simmering idea whose time has come. We are ready to meet this moment with bravery, compassion, strength and humility.

 

Michelle Muratori, a senior counselor at the Johns Hopkins Center for Talented Youth and faculty associate in the master’s counseling program at Johns Hopkins University, has co-authored several ACA publications, including the third edition of Clinical Supervision in the Helping Professions: A Practical Guide, Coping Skills for a Stressful World: A Workbook for Counselors and Clients, and Counselor Self-Care.

As it is challenging to accurately forecast what will transpire over the next five to 10 days in these turbulent times, I find it even more difficult to predict the changes and challenges counselors can anticipate over the next five to 10 years. If the dysfunction and divisiveness in society persist at a heightened level, I fear counselors will be vulnerable to experiencing burnout, vicarious trauma and compassion fatigue at increased levels. The toxic political environment of the past four years has emboldened those harboring racial animus and xenophobic attitudes to display their hostility and hatred openly and proudly, sometimes with deadly consequences. Moreover, COVID-19 has killed hundreds of thousands of Americans, yet an alarming number of people still consider it a “hoax.” These disturbing developments have left people, including counselors and clients, feeling exhausted, stressed and traumatized.

I will speak for myself. During the weeks, days and hours leading up to the 2020 U.S. election, and after four excruciating years of witnessing democratic norms being eroded daily by our elected officials (and one in particular known for his rage tweets), I was consumed thinking about the fate of our democracy. I often wondered, will democracy win? Will social justice prevail? For that matter, will science prevail? Or will fascism replace democracy, will disinformation and conspiracy theories continue to spread and be embraced over facts, and will white supremacy, structural racism and tribalism continue to be actively promoted?

After the election, like millions of Americans, I was overjoyed and relieved that Joe Biden and Kamala Harris had prevailed. Ecstatic over the historic election of the first African American and South Asian American woman to serve as vice president, I felt like a ton of bricks had been lifted from my shoulders and that my hope for justice had been renewed. I remain optimistic that this new administration will restore dignity to the office of the presidency, repair America’s relationships with allies around the world that have been damaged, and provide us all with hope for a better and more stable future. Despite my optimism, insidious threats that jeopardize democracy continue to weigh heavily on me. It is of great concern, for instance, that the occupant of the White House at the time I am writing this, enabled by high-ranking officials who supported him, refused to concede the election and instead spread dangerous conspiracy theories about it being “rigged” or “stolen.” My heart sank when I saw yard signs that read “Stop the Steal” and “Voter fraud!!” The knot in my stomach reminds me of the painful reality that we still live in an extremely divided nation, one in which people cannot agree upon facts — a nation where a dislike of the “other tribe” is so powerful and runs so deep that it has created a context in which fake news has gained traction and attracted a massive audience.

This brings me back to my prediction about the future. My guess is that counselors will be on the front lines dealing with the emotional fallout of sociopolitical, public health and environmental crises for years to come — crises fueled by the rapid transmission of information (and disinformation) via electronic media. Counselors must be prepared to help clients process their reactions to and cope more effectively with these stressors and also advocate for social change. Counselors should closely monitor their countertransference triggers and be cognizant of how their own worldview may distort their perception of clients holding opposing worldviews. While this has always been important, counselors must be all the more vigilant in polarized times. Lastly, counselors must be committed to practicing self-care regularly to actively combat burnout, vicarious trauma and compassion fatigue. To end this on a positive note, I believe that counselors and the counseling profession will be more relevant and in greater demand than ever.

 

Kevin Doyle is a licensed professional counselor from Charlottesville, Virginia, and an associate professor and chair of the Department of Education and Counseling at Longwood University in Farmville, Virginia.

I think that the most significant development — with elements of change, challenge and opportunity — over the next five to 10 years will be the continuation of the widespread move to virtual service delivery. Delivery through virtual platforms is, of course, not new, but the COVID-19 pandemic forced counselors to adapt on the fly, and many who had not delivered services in this manner had to shift quickly to a new way of working with clients. I would like to comment on each of the three areas noted above: change, challenge and opportunity.

Change: Many of us counselors were trained to provide services only in the in-person environment. I think it is fair to say that some of us looked down our noses a bit at counseling provided through a computer, the internet, etc. Well, we have been shown to be mistaken, in many ways. In my own practice, clients have enthusiastically embraced online service delivery, both for individual and group sessions. They note that things like travel time, parking, weather issues, child care and family responsibilities are minimized when services are provided online. Many have indicated that they wish to remain online permanently.

Challenge: A major implication of the above is that counselor training programs need to include training counselors for online delivery in their curricula. The obvious challenge there is that a significant percentage of counselor educators were trained before online service delivery was common or even existed at all. Getting the educators up to speed on not just the use of online platforms but also how to teach students how to provide services in that manner is a major challenge facing the field. Likewise, accrediting bodies (such as CACREP), certification bodies (such as NBCC) and state licensing boards will all need to make sure that their regulations reflect the recent massive move to online delivery — and the training of those who will be providing it.

A related challenge will be how to accommodate those clients who truly desire in-person service delivery. I have heard reports already of counselors closing their physical offices because they were no longer cost-effective or needed. What will become of those clients who are not interested in online service delivery in such scenarios? Furthermore, there is an equity issue here. Not all clients have functional computers, smartphones or reliable internet access. Will marginalized populations become even more marginalized? The profession has an obligation to ensure that this does not happen.

Opportunity: This move to online or virtual services, of course, also provides a major opportunity. Even though this type of service is not new, it is infinitely more commonplace now. Clients have access to more services from more providers than ever before. State licensing laws, however, can still be barriers because, generally, counseling has been considered to occur where the client is physically located. The current environment presents a tremendous opportunity to enhance access to care for clients. Initiatives such as the current ACA-led interstate counseling compact may finally help to allow counselors to practice in more than one state without having to go through multiple onerous licensing processes. Whatever means are undertaken to address these barriers must prioritize client safety, emergency procedures and the reality that not all counselors practice ethically and safely, unfortunately. This may be a once-in-a-lifetime opportunity, driven by the global pandemic; it is up to the profession to take advantage of the current, albeit tragic, circumstance.

 

Christian D. Chan (he, him, his) is a national certified counselor and an assistant professor in the Department of Counseling and Educational Development at the University of North Carolina at Greensboro.

The year 2020 represented a set of crossroads to allow our profession to do better and be better for ourselves and the communities we serve. Although 2020 culminated in explicit forms of white supremacy, anti-Blackness, health disparities and trauma, I have to remind myself and my colleagues that these issues have persistently shown up over and over again. Sadly, these forces date back several centuries, and many are not entirely external to our profession. In fact, they are conceivably within the auspices of our profession, and our profession is still navigating, resolving and reckoning with them during this time. They are here in our own home.

My hope, however, is that 2020 represents that radical shift for us to revisit our professional identity grounded in multiculturalism, advocacy and social justice. I ask myself again about the next era of counseling to revisit this identity as we practice, teach and advocate. One opportunity for us to consider as a profession is the impact driven by community partnerships and community-engaged initiatives.

Readers may think I am referring to a plunge, legislative advocacy or a cultural immersion project, but community engagement is so much deeper. It is an opportunity for each of us across several specialties (e.g., clinical mental health, school, couple and family, rehabilitation, college) to intentionally build partnerships with stakeholders and invite the cultural capital that already exists across culturally diverse and historically marginalized communities. It is our method of creating equitable partnerships with community stakeholders and community leaders. Many historically marginalized communities already sustain and own the tools, knowledge and wealth of cultural capital within their own communities. This valuable cultural knowledge has also been passed down generationally over centuries. Community partnerships become a way to signify that their lives and stories — often stories that counter oppression — ultimately do matter.

Community partnerships and engagement can be implemented across numerous sectors within the counseling profession. For instance, counselor educators can design a major class assignment that addresses counseling and mental health literacy among community members. Counselor educators and their students can collaborate with community leaders to angle their counseling literacy and mental health literacy initiatives in culturally responsive ways. Within community agencies and schools, community-engaged projects similar to these ideas can also identify pathways for community stakeholders and members to feel empowered to access their counseling services. Julia Bryan’s work in school-community-family partnerships is a serious testament to employing culturally responsive partnerships to further engage culturally diverse and historically marginalized students, especially students who are Black, Indigenous and people of color. I ask counselor educators and counselors, however, to intentionally build these partnerships and sustain them, so that they seek continuous input from community stakeholders and leaders rather than making them one-time events.

Professional associations are not removed from these possibilities. For instance, ACA divisions such as the Association for Specialists in Group Work and the Association for Multicultural Counseling and Development have enacted a Day of Service to coincide with contemporary issues of multiculturalism and social justice and to meet in partnership with local communities surrounding conference venues. Because professional associations hold a significant role of leadership within the profession, they can continue modeling and providing these opportunities for members to intentionally engage with their own communities.

When I ask myself again about the opportunity for the profession, we can be bolder, think critically and institute crucial community partnerships to further engage our communities. Although community-engaged initiatives and community partnerships have existed, I call our profession to further expand these opportunities in teaching, supervision, practice and service. These relationships can play a part of the healing in our society, and I have hope that we can still dream bigger and better together as a community and in solidarity.

 

Jude Austin is an assistant professor and clinical mental health counseling track coordinator at the University of Mary Hardin-Baylor, an American Counseling Association book author, and a private practitioner in Temple, Texas.

Change: Paradoxically, everything and nothing will change over the next five to 10 years for the counseling profession. What works in counseling — building a strong therapeutic relationship — will continue to work. Although, how counselors build that therapeutic relationship will change by varying degrees. The change is already happening as the global pandemic pushes counselors into virtual or some hybrid form of practicing counseling. To meet clients’ needs, counselors changed how they meet clients. Counseling no longer just happens in cushy offices. Counseling is on the go.

Portability is the future of counseling. Not only state-to-state clinical licensure portability, but counselors themselves are, and will continue to be, portable. Therapy will occur through multiple platforms: in-person, synchronous phone and video, asynchronous and synchronous messaging, a combination of those options, and more. Clients will come to counseling while driving to work, in a tractor during lunch breaks, while folding laundry, sitting on the porch or holding a sleeping baby. Counselors will need to meet clients where they are, wherever they are.

Challenge: That change will challenge how counselors meaningfully meet clients in the next five to 10 years. How do we ethically and morally provide care for a mom who is working through trauma, while her children are audibly making a ruckus in another room? This essay does not have the space to unpack all ethical concerns. However, the mandate of doing no harm will be expanded. While counselors will become more accessible, clients face greater risk of unintentional harm as counselors adjust to new therapeutic milieus.

While there may have recently been a collective competence growth in telecounseling, competence does not equal quality. Being with clients through multiple platform options may not be a natural way of doing counseling for some clinicians. Some counselors grew up developing virtual relationships. Others might scoff at digital communication. Regardless of the counselor’s era, all counselors will need to develop different communication skills and sharpen their perceptual senses to be effective over the next five to 10 years.

The common factors of effective counseling will look and feel differently through text compared with face-to-face sessions. Remaining present can be difficult while the trash truck decides to drive through the entire neighborhood in reverse during a session. Offering clients genuineness, unconditional positive regard and empathy in a message might feel both familiar and strange. Doing so will require developing a different therapeutic muscle.

Counselor educators will be challenged to prepare students for these new ways of being with a client. Some students are fair writers but shine when face to face, and vice versa. In the next five to 10 years, students will have to see all elements of communicating with clients as an opportunity to build a strong therapeutic relationship. Ways of assessing students’ abilities might change. Basic counseling skills might include a certain level of tech savviness. Professionalism might include emails or message response time. Professional attire might include lighting, pictures and other visible items during a virtual meeting.

Opportunity: Perhaps a silver lining throughout the changes and challenges counselors will face in the next five to 10 years is the demand for more highly skilled clinicians. If my caseload is any indicator, therapy has become “cool.” Finding a good therapist is like finding a good pair of jeans, and clients are shopping. Portability will give clients more options to find the best fit. This will be threatening for counselors who make their living based on clients’ limited service options. All counselors will have an opportunity to raise their game, which can only better serve clients.

 

Ann Ordway is both a lawyer and a counselor educator, serving as the college academic director of counseling for the University of Phoenix.

The year 2020 has presented so many challenges that I predict will have a lingering impact well into the next five to 10 years. Not only have we faced an international pandemic that has resulted in significant illness and death, but we have also become more isolated from one another, and the way we interact with others has been forever changed. 

Individual experiences of grief and loss carry an unfamiliar complexity as mourners have been unable to sit with a dying loved one in the hospital and then been unable to engage in traditional mourning rituals due to restrictions on public gatherings. We have been challenged by a level of civil unrest largely influenced by a controversial election and a justified movement designed not only to bring attention to social injustice but also to increase multicultural awareness, competency, sensitivity, inclusion and respect. There is so much work ahead of all of us.

Of course, with these challenges, we have experienced drastic increases in depression, anxiety and overt manifestation of mental health issues. Moreover, with requirements for social distancing, more people have been working from home. Live conferences have essentially gone away — and the most social beings grieve the loss of personal contact. Families have been relegated to FaceTime. Children, during a stage in their development when socialization is critical, have been attending school online or are restricted from meaningful interactions with peers. I suspect we will see the continued emergence of nuances of posttraumatic stress disorder because the experiences of 2020 have clearly taken a toll. As counselors, we will need to be prepared to support an increase in the number of clients seeking services.

Self-care will become more essential as we navigate the uneasy waters that will continue to be present. We will need to be mindful of compassion fatigue, vicarious trauma and burnout, especially as we endeavor to be life preservers for our clients who are desperately trying to find a new normal. We have not been insulated. We have been personally and professionally impacted — and we need to rise to the challenge while also finding our own new normal, both in how we live and practice. 

With challenges also come opportunities. Counselors are role models for patience, empathy and endurance. I suspect we will be called upon to model social interaction as clients start to relearn the art of interpersonal relationship and communication. We are well-trained, and with an increased need for services, I suspect counselors will be busier than ever before. Our focus on self-efficacy will serve us well in helping our clients build resiliency and coping skills and bounce back from the pervasive impact of the extensive societal trauma of 2020.

Counselors are flexible and adaptable professionals, and in an ever-changing world with old challenges persisting and new challenges emerging every day, we are uniquely situated to support the very many people who do not share our resiliency. We will be more involved and more highly regarded over the next five to 10 years in arenas where our previous presence has been scarce, including with Medicare, in Veterans Affairs locations, and in court proceedings as experts. I see us growing and emerging as a stronger collective group of professionals as we move through the next decade — and I, for one, am excited about the emerging opportunities as we move forward. It is not just about where we have been, it is where we are going.

 

Laura Shannonhouse is an associate professor at Georgia State University whose research centers on crisis intervention and disaster response.

The surreal reality of 2020 has emphasized one sad truth: Too many people are far too isolated. Our collective, individualized suffering is an ironic tragedy, and it literally costs lives. Struggling to belong cuts across the life span and widening class divides. From older persons who are homebound to bullied adolescents, and from those who agonize over how to best craft a social media post to those consumed by the drudgery of excessive working hours, all too many individuals are unacknowledged, are unconnected and feel unloved.

When we look at the history of our profession, one typically forgotten and ignored group has been older adults, which happens to be the fastest-growing demographic and the hardest hit by COVID-19. Millions of older adults have struggled with isolation, worthiness and mattering, yet gerontological counseling was dropped as a specialty area, and structural barriers (i.e., Medicare reimbursement) have made working with this population difficult. During COVID-19, physical distancing interventions needed to protect older adult health have been isolating, and medical ethical guidelines that prioritize the care of younger patients signal the expendability of older adults. As research has shown, chronic loneliness and social isolation foster thwarted belongingness and perceived burdensomeness, which interact to predict suicide desire. On average, an American over age 65 dies by suicide every hour. Many other suicides go unreported (i.e., voluntary stopping of eating and drinking, withholding of medical treatment, etc.) or are miscategorized as accidents. COVID-19 has exacerbated the psychological states which lead to suicide, and those deaths of despair punctuate the point that too many people, of all ages, have decreased quality of life because of their isolation.

Fortunately, suicidality is highly susceptible to intervention, and professional counselors are uniquely equipped not only to effectively intervene, but also to foster growth through adversity. Combating social isolation, fostering belongingness and buffering perceived burdensomeness interrupts the pathway to suicide. Because we are also researchers, we are well-positioned to collaborate with policymakers and federal entities that want to address social problems. Scholarship on outcomes from evidence-based approaches can drive policy. As a multiple recipient of Health and Human Services funding, I’ve had opportunities to dialogue across agencies (i.e., Administration for Community Living, SAMHSA, Veterans Affairs), which has been incredibly hopeful. When we come to the table with innovative solutions grounded in rigorous research at the systemic level, we can and do make a difference. One example of this is a prolonged campaign of lobbying that has almost made Medicare reimbursement for professional counselors a reality (kudos, ACA!).

At the individual level, when we connect with older adults, we have the opportunity to learn from their incredible wisdom, lived experience, resilience and insight. My lab (HOPE lab) at Georgia State University works with approximately 700 racially diverse older adults, and my students remind me, “If we are lucky, we will one day be future older adults.” The upcoming generation of future clinicians and educators is smart, hardworking, big-hearted and critically conscious.

They and you can be at the forefront of the solution to the social isolation problem. It is pervasive across populations and will undoubtedly be part of our clinical work, no matter who our clients are. Professional counselors have the tools to do this work, and we can be creative, strategic and persistent. I think that over the next decade, our greatest challenge will be engaging with systems to foster meaningful, reciprocal, prolonged connections for all persons. Humans are by nature social creatures, and professional counselors have the opportunity and responsibility to ensure that truth is validated, supported and realized.

 

Anabel Mifsud recently earned her doctorate in counselor education and supervision from the University of New Orleans, where she is currently teaching as an adjunct professor.

Our ability to predict the future has never been so sorely tested as in 2020. The unprecedented events of the past year were a sobering reminder that the inconceivable can happen, but they also illuminated a range of issues that have the potential to shape the future of the counseling profession in the next decade.

The COVID-19 pandemic not only has endangered people’s physical health, but also has put a strain on vital social connections that sustain our mental and social wellness. Advancements in technology, however, have enabled counselors to continue serving clients and communities in these trying times. The benefits of technology in counseling have never been in plain view until 2020, and the increased reliance on technology is here to stay.

As technology continues to proliferate and wield greater influence on the counseling profession, counselors need to be increasingly mindful of the clinical, ethical and social justice implications pertaining to the use of technology in counseling practice. Counselors are required to become savvier consumers by broadening their knowledge on the inner workings of these tools and their impact on client welfare and therapeutic success. We cannot afford to drag our heels on this front or relegate this responsibility to computer scientists. Additionally, counselors must advocate with technology developers for technologies that are tailored to meet the needs of diverse clients and promote equitable access to behavioral health services.

The disproportionate toll of the COVID-19 pandemic on people of color and the racial reckoning that ensued after the killing of George Floyd have laid bare the persisting social inequalities and systemic racism that threaten the lives and mental health of Black, Indigenous and people of color. As the counseling profession journeys forward, it must remain committed to its social, moral and ethical obligation to advocate for inclusive, just and safer healing spaces and societies. When one considers the highly charged and polarized sociopolitical landscape that we find ourselves in, the stakes have never been higher, nor have the opportunities for growth.

Counselors are uniquely positioned to help repair the rupture in our social fabric and redress social ills through healing and reconciliation efforts. Such a lofty pursuit, however, cannot be championed by any single profession. In these pivotal times, we must join with professionals in other disciplines to promote a culture of compassion, healing and respect for human dignity. Interdisciplinary cooperation is our best shot to address some of the macrosystemic challenges facing our human family. Additionally, the sheer magnitude of these problems highlights the need for more collective interventions, and thus the counseling profession may have to refashion how it pursues its goal to empower people to attain mental health and wellness.

Climate change is another looming crisis that has already wreaked destruction and mayhem across several communities in the U.S. It is another existential reckoning of sorts, and human survival hangs in the balance. It is a challenge that the counseling profession cannot sidestep. Counselors need to be fully equipped to help affected communities deal with the psychological and emotional costs of this existential threat and rebuild in the wake of disaster. As a profession that is grounded in the wellness model, counselors must go beyond remedial action and engage in preventive measures that can help communities develop climate resilience and advocate for sustainable lifestyles. It is an opportune time for the counseling profession to align its mission and efforts with some of the global goals endorsed by international organizations such as the United Nations and take a seat at the table with other experts to address global challenges that transcend national borders.

 

Sylvia Nassar is a scholar, leader, advocate, mentor and counselor educator at North Carolina State University.

I used to tell my kids, “Today is the first day of life as we know it!” They rolled their eyes then but are experiencing that phenomenon firsthand now. The present-day twin pandemics illuminate the priorities for which the counseling professional was already poised, as well as ones that may have been less obvious. Evolving service delivery models, social justice advocacy, workforce development and expanded counseling interventions represent foci for professional counselors in the upcoming decade.

I recall what a controversy was stirred up many years ago when the NBCC rolled out its ethical guidelines for distance counseling. I also remember serving my state’s LPC board some years later and grappling with the definition of “face-to-face” counseling. Counseling, and its service delivery, will likely never return to what it was before 2020. Regulatory, credentialing, educator and many other stakeholder groups have done admirable work trying to adapt to the COVID-19 pandemic in flexible and ethical ways. These efforts will continue to require creative and reflective professionals to redefine and update credentials accordingly.

The parallel pandemic of exposed structural racism illuminates the need for true multiculturalism and social justice competence and reform. Certainly, the recent unmasked cases of police brutality, particularly perpetrated against Black men, warrant alarm and immediate action. Restorative justice and other Black Lives Matter initiatives need to be mandated, not only in words, but through active advocacy. At the same time, we need to balance the growing knowledge base about intersectionality for all marginalized groups from a social justice lens. Hate crimes against so many marginalized groups hit all-time highs during the Trump administration. The tension between these concomitant yet seemingly conflicting goals creates tenuous balance. The counseling profession needs to learn how to use politicization as a tool rather than allowing it to become a distraction. The Multicultural and Social Justice Counseling Competencies (MSJCC) can provide a helpful framework to guide practice, research and policy. In turn, emergent research will inform the next iteration of the MSJCC.

These phenomena are readily apparent within the broad sphere of the labor market both domestically and globally. Workplace inequities across intersectional marginalizations run rampant in all levels of the workforce. These pandemics underscore not only the social justice imperatives of a more-inclusive workforce, but economic ones too. True change will require that current power brokers share their power — in other words, that commitment to multilayered equity occurs both from the top down and the ground up. This power shift will facilitate actual changes rather than superficial ones. The restructuring of the labor market to meet the rapidly evolving pandemic needs provides both challenge and opportunity to level out playing fields while responding to crisis — “building the plane as we fly it,” so to speak. The voices of marginalized individuals and stakeholder groups must be heard. Organizations unwilling to buy into this post-constructivist ideology will become obsolete.

As far as counseling interventions, the growing need for biopsychosocial perspectives is apparent. Counseling and allied health professions need to become better collaborators. As a breast cancer warrior currently undergoing chemotherapy, I am aware of the ways in which our traditional medical practices fall short in terms of supporting mental and holistic health. Counselors and researchers have increasingly recognized the value of broader approaches — for example, mindfulness and neurofeedback. We need to join our interdisciplinary colleagues in creating new evidence bases for these emergent interventions.

Moreover, we need to incorporate mental and other holistic health indicators in all systematic program evaluations of counseling and counseling-relevant program and service delivery. These efforts will facilitate accountability among stakeholders. More importantly, program evaluation should inform counseling practice, research and policy in a tripartite approach. This integration is the quintessential model of the 21st century.

 

Michele Kerulis is a licensed clinical professional counselor in Illinois and the Association for Multicultural Counseling and Development Midwest Region representative.

I think some of the most challenging things counselors have faced in our lifetime are related to the COVID-19 pandemic, and we will continue to navigate the difficulties of this time. I am pleased to see the community embrace technology as an asset to address many of these problems. While we have noticed the negative impacts of technology, like the fast dissemination of inaccurate information and cancel culture, we have also witnessed positive aspects, like teaching others how to conduct telehealth sessions, helping our older adult population learn how to use videoconferencing to connect with their families, and sharing free resources related to mental health with a wider audience. I have faith in my colleagues to be pioneers to advance the accessibility of counseling.

I am passionate about accessibility and about helping people learn about the positive impact of movement on mental health and wellness. One silver lining of the pandemic is that fitness studios offered free online fitness classes for all skill levels to help people feel a sense of control in an otherwise uncontrollable situation. One of the most significant opportunities for the future of counseling is for our field to recognize the impact of the mind-body connection and how movement and exercise can be a game changer for people on so many levels.

When people say they are intimidated to try exercise or movement to address wellness, I use encouragement from an Adlerian perspective, emphasizing effort over outcome and intrinsic motivation over external factors. I love using exercise and sports as analogies for how to create and live a successful life. Of course, the definition of success varies from person to person, and it is clear that people have unique circumstances, sometimes out of their control, that interfere with their life goals.

Examining these circumstances creates an opportunity for counselors to understand multiculturalism and marginalization in new ways. As counselors, we are responsible for understanding the barriers our clients face, for helping clients process these barriers and for advocating to have barriers removed.

A marginalized population within my specialty area of counseling includes people who have injuries or physical disabilities that limit their capacity to engage in activities. Physical disabilities, along with racial and socioeconomic discrimination, have resulted in exclusion and disrespect.

As a counselor who works with athletes and exercisers, it is not only my responsibility to understand human growth and development through the stages of life, it is also my responsibility to understand interruptions to stages of development, including injuries, illness and unexpected interference to people’s physical and cognitive states. This often-neglected population is provided with limited resources. Fortunately, there are several organizations dedicated to helping people who have experienced physical challenges engage or reengage in an active lifestyle. Organizations such as Dare2tri, Wounded Warrior Project, Special Olympics and Disabled Sports USA offer inclusive and supportive environments for adaptive athletes. In fact, many major sports, including marathons, cycling, basketball, snowboarding, surfing and weightlifting, have adaptive sports divisions.

My passion to help people of all physical abilities learn how to live balanced, active and healthy lives guided my career choices. I feel lucky to have the privilege to help clients understand how to navigate and process their own situations and to help them define and achieve their own ideas of personal success. I do believe that a major opportunity area for the counseling field is helping people of all abilities learn the joys of movement, enjoy more outdoor spaces and connect with one another through technology and group fitness.

 

Monica P. Band is a licensed counselor and owner at Mindful Healing Counseling Services in Washington, D.C., as well as an adjunct professor of counseling.

I want to preface this by saying that I do not believe this is a new challenge. Rather, it’s an ongoing challenge with a great opportunity for change. For many counselors, we were distinctly trained to do our best to distinguish between our personal selves and our professional selves — keeping boundaries clear. In this way, counselors continue to keep a veil of power and authority by distinguishing between client and counselor. However, COVID-19 and the increased use of telehealth has invited clients into our homes.

For some counselors, we do not have the privilege of having a separate or quiet home office. Rather, our clients begin to gain a deeper insight into our personal lives through the surroundings they see behind us. Additionally, COVID-19, globalization, social media and the sociopolitical climate of our nation blurred these boundary lines further. Counselors and clients are truly experiencing a global pandemic and existential crises together. For example, counselors are not unaffected by the racism within this country, and we should not pretend otherwise. This experience has me thinking about our profession and how we support our clients for the next five to 10 years.

For instance, I believe the psychological impacts of the pandemic will last for several years. Even in imagining a time in which we would transition in becoming more social through in-person engagement, we will need to begin to contend with anxiety, grief and complicated trauma. I anticipate that people will also be working on redefining their lives, as I have noticed some clients already doing. With experiencing an existential crisis often comes a confrontation of how one is living their life and the meaning they are making within the life they are given. I have worked with and witnessed clients struggling with and reconciling feelings of not living authentically and the grief that comes with missed opportunities when considering their mortality. The opportunity and gift I believe COVID-19 has given us is a chance to reconstruct rather than live in complacency. Both the challenge and the opportunity are for counselors to wake up and become activists.

I anticipate that counselors, if they are not already, will need to begin to become more competent and comfortable in thinking systemically and existentially on issues such as racism, climate crisis and COVID-19. Counselors have the challenge of no longer being natural or hiding behind a veil of power. I think the challenge and opportunity will be in the balance of making our stance on social justice issues known while being able to support both those who are like-minded and those who are not.

 

Victoria E. Kress is a licensed professional clinical counselor and supervisor, a national certified counselor, a distinguished professor, and the president of the Association for Humanistic Counseling.

Many evolving factors are sure to influence the counseling profession over the next decade. At this writing, America is wrestling with a global pandemic, a long-overdue reckoning with systemic racism and a politically polarized country. Climate change, exponential population growth and other factors will contribute to a further shortage of resources, and society will struggle with the conflicts that will ensue. However, as counselors, we know that all struggles hold opportunities for positive change. In fact, very often the most meaningful changes emerge out of conflict.

Many of the most important legislative decisions are made in times of crisis. It is important that counselors leverage the legislative and policy decisions that will be made over the next few years to help grow our influence and access to resources so that we can stay healthy and support our clients over the next decade.

Counselors are generally fierce advocates for vulnerable, disenfranchised populations, and client advocacy is foundational to who we are as counselors. That said, we are not always as good at advocating for ourselves as we are for others. While it is uncommon to speak of professional counselors as being discriminated against or oppressed, there are many examples of professional counselors not being accorded the respect and privilege associated with our training and credentials.

Some counselors may perceive that advocating for the profession is self-serving; however, we cannot do what we were trained to do — that is, help others — if we cannot practice in the way we were trained to practice or be reimbursed for providing services. As such, counselors must continue to grow as advocates not just for clients, but also for our profession.

Recent events have invited opportunities for all counselors to grow as advocates. Passion is the foundation of advocacy, and more than ever, we are seeing counselors express their passion. This passion can be used as an opportunity for counselors to learn about the legislative process and how to be effective in this arena. This past year, we also witnessed unprecedented numbers of Americans engage with the political process. This increased awareness of the legislative process and an understanding of how counselors can be effective legislative advocates is an additional opportunity we can use to support our profession as we move forward.

Many advances have been made around the growth of the profession. Most notably, we now have counselor licensure in each state, and we are able to be reimbursed by many third-party payers. We are, as a profession, enjoying a comfort we have not historically had, yet we have so much work left to do. The work never ends because daily, policymakers are making decisions that impact our ability to practice.

As we have seen in recent times and throughout history, when people are comfortable, they tend to not engage as much in the political process. Because counselors are not struggling mightily for recognition — as we have in the past — new and emerging generations of counselors may not understand the value and importance of sustained professional advocacy efforts, and this could be devastating to the health of our profession.

Recent events, while challenging and uncomfortable, have created opportunities that counselors can pull upon to support our profession, and thus the clients we serve. Moving away from spectatorship and toward active participation in political and legislative processes is critical to the sustained health of the counseling profession.

 

Sue Pressman is the president of the American Counseling Association, a private practitioner focusing on career development, a business owner, and an employer of counselor consultants for more than 30 years through Pressman Consulting LLC, with her largest client being the federal government.

What will the profession of counseling look like in the future? Often when people think about the future, they think of technological advancements such as hovercrafts, holograms and artificial intelligence. What about the importance of developing business skills that will help professional counselors become “business wise” ? All industries are going through a transformation to make services accessible to a multicultural and global society. There is intersectionality among peoples, services and currencies. Recognizing this, the business-wise professional counselor is poised to find increased and diverse opportunities to build their network in a domestic and global market and expand into what is being referred to as the gig economy.

The term gig economy has been around for decades and involves a temporary work arrangement with an individual being paid for a specific job, task or project. The latest U.S. Census Bureau nonemployer statistics report that self-employed individuals increased 19% from 2005 to 2015 and continue to grow. Gig workers can be service or goods providers such as musicians, entertainers, artists, retailers or trainers. They can be any worker not in a permanent position. The final component is the consumer. In the world of counseling, we may refer to ourselves as mental health, rehabilitation, career or employment counselors, just to name a few of our specialties. The final component or recipient of counseling services is the “client” or, in business terms, the consumer of our services.

How can counselors tap into this freelance “gig” workforce? The simple answer is for counselors to increase their business skills. To narrow the business skills gap, counselor education and supervision graduate programs might investigate weaving in basic business skill development into curriculums. This could include practice management, business development, accounting, finance, investing, marketing, strategic planning, delegation and negotiation. The pandemic has shown us that counselors are naturally resilient. When our in-person method of service delivery challenged us, we were quickly able to pivot and provide responsive services to those in need through new platforms such as telebehavioral health.

As we look to the future, counselors’ ability to adapt, create bridges and develop new skills is evident. The new world we live in has demonstrated, in the words of Sam Gladding, that “mental health is part of public health.” This is the beginning of our infusion into the mainstream public health arena and the gig economy where we will discover more opportunities for multiple income streams beyond a regular paycheck. The business-wise counselor will inevitably find new ways to innovate, influence and initiate systemic change on both micro and macro levels, resulting in counselors as consultants.

Counselors as consultants have existed in our profession for a long time. However, counselors thriving in a gig economy is something to consider for the future. Approximately 150 million people in North America and Western Europe now work as independent contractors. Gianpiero Petriglieri and colleagues conducted a study with 65 gig workers in 2018 and discovered that successful gig workers cultivated four types of connections: place, routines, purpose and people.

These four types of connections align with many aspects of counselors as consultants. Creating space, time, access and location are aspects when considering one’s place for conducting services. Those who had routines and schedules had enhanced focus and performance. As counselors, part of our purpose is to help others, and this purpose serves as a means to also earn a living. Finally, people such as our family, friends and colleagues can serve as supportive collaborators on our entrepreneurial journey.

“Success in the gig economy comes from a balance between viability and vitality.” — Gianpiero Petriglieri, Susan J. Ashford and Amy Wrzesniewski (2018)

 

Heather Trepal is the immediate past president of the American Counseling Association and a professor at the University of Texas at San Antonio.

The COVID-19 public health pandemic has changed our world. Although some say they can’t wait to get “back to normal,” the stark reality is that our world has forever changed, and we cannot go back to the way things were before. The pandemic has changed public health and shone a brighter light on health care disparities, and it will leave a trail of lingering physical, economic and psychological effects across the globe. The need for behavioral health care services will increase like never before.

Counselors must be prepared to meet this demand. There will be increased opportunities to develop integrated systems of care where physical and behavioral health care needs can be addressed together in new and innovative ways. In response, counselor training needs to be amplified to focus on preparing counselors to work as part of an interdisciplinary team. The counseling profession’s foundational focus on prevention and wellness will also become increasingly important.

Stigma and inequities in access to behavioral health care services will remain challenges. Counselors must be willing to be at the forefront of the battle. Stigma is a barrier to help-seeking. Others, such as professional athletes and celebrities, have become increasingly visible in their efforts to address stigma. However, counselors must also be prepared to do the difficult work of raising awareness about mental health. It is imperative that we increase our efforts to educate the public about who counselors are and what we do. Counselors need to break down barriers in service delivery and access and utilize upstream interventions to get ahead of the challenges in this area.

The increased focus on health care disparities will promote a much-needed awareness of their impact on access and care among professionals and the public. Racism is a determinant of physical and behavioral health care inequities. Anti-racism efforts will increase both in behavioral health care and in the counseling profession as a whole. Enhanced methods of counselor training, research and service delivery will be developed with an increasing eye toward social justice. Other inequities include language barriers. The profession must commit to recruiting and training bilingual counselors.

Finally, I believe the future will see a rise in counselors owning their role as advocates for our profession. We work hard to advocate for and with our clients to meet their needs. However, counselors also need to make certain that we have a seat at every proverbial table we can. We are a well-prepared profession. We need to be able to serve our clients, and we also need to be able to earn a living! Graduate programs will focus on enhancing advocacy skills and provide counselors the opportunity to both advance our profession and serve our clients and communities. Our new professionals will be role models as a workforce generation that takes the counseling profession to the next level.

 

Cirecie West-Olatunji is a professor of counseling and director of the Center for Traumatic Stress Research at Xavier University of Louisiana, a past president of the American Counseling Association and the Association for Multicultural Counseling and Development, and editor-in-chief of the Journal of Multicultural Counseling and Development.

When I think about the direction of the counseling profession over the next five to 10 years, I think about the most recent spotlights on social injustice in the U.S., and I also think about how established we are becoming as a profession. Along with that comes the possibility that we may be losing our edginess.

Without a doubt, the year 2020 was one of the most challenging of our lifetimes. For me, I saw it as a triple pandemic in which I, as a Black female counselor educator, was faced with the existential threat caused by COVID-19, coupled with graphic evidence of police brutality, and topped with climate change. Like many, I was personally aware of the day-to-day micro- and macro aggressions that Black people and other people of color experience in our society. So, when the first few news articles about the brutal killings of Black men at the hands of law enforcement officers were sweeping the media, I was not surprised. However, the additive effect of COVID-19 and the multiplicity of news articles that were so prevalent over the summer took my breath away. To make matters worse, as a New Orleanian, I dodged six of seven hurricanes in the fall, only to be hit by Hurricane Zeta that knocked out power and internet access for days on end.

Throughout this all, I participated in an ACA special task force looking at ways to mitigate the impact of structural racism on Black ACA members and the general public. While I was pleased to see how quickly the ACA leadership desired to create change, I was also disappointed by our seeming inability to move expeditiously as an organization. So, at that point, I realized that we, as an organization, have this challenge of actualizing our belief in social justice and equity. We write about it. We present on it. We may even teach about it, but we are having a hard time turning that lens inward to explore and assess what inequities exist within our counseling programs, for example. How can we use our knowledge of the Multicultural and Social Justice Counseling Competencies to transform the lives of the students we teach and the colleagues with whom we work? I think this is a huge challenge.

The other challenge is also an opportunity. When I began my master’s program many decades ago, we were still the new kid on the block. We’re still new, but I don’t think we’re that edgy anymore. In many ways, it feels like we are losing our groove, and someone should ask us, “How can Stella get her groove back?”

You may ask, “What are some of the exciting areas where the windows of opportunity may be closing?” Well, have we really begun to integrate neuroscience into counseling in the U.S.? Do we really value the partnerships that we created with our sister organizations abroad? Do we genuinely teach about culture-centered counseling theories so that our students can employ them in their internships and beyond? What do we know about infant mental health or pediatric counseling, and are our graduates in private practice specializing in working with children during early childhood?

I think we need to get our groove back. Now that we are established as a profession, we don’t need to be like the other guys. We’re different, and I’ve even heard some counselor educators say, we’re better!

 

Samuel T. Gladding is a past president of the American Counseling Association and a prolific author of books and articles on multiple aspects of counseling.

Counseling as a profession is ever-changing, as is the future. When I entered the field 50 years ago in 1971, counseling was not regulated. Anyone could hang out a shingle and claim to be a counselor. Then came what I call the “turf wars” where psychologists, psychiatrists and others tried to define counseling and argued against it becoming a profession. Ouch! However, because of the heroic fighting of individuals like Ted Remley, Tom Sweeney and others who saw the future, counseling emerged. The American Personnel and Guidance Association became the American Association of Counseling and Development in 1983 and, finally, the American Counseling Association in 1992. Certification from NBCC, accreditation of counseling programs from CACREP, and licensure from individual states, starting with Virginia in 1977, happened.

The point is, no one in 1971 could have predicted where counseling would be in 2021. Therefore, trying to predict how counseling will change in the future is close to impossible because of so many variables. Nevertheless, I will take a chance and focus on changes, challenges and opportunities for counseling in the next 10 years.

It is 2031! People in the United States still remember the coronavirus pandemic and its negative social and emotional impact. Therefore, they are continuing to talk about what constitutes good mental health. The opportunity is a challenge for counseling and counselors to be in the conversation about promoting wellness and well-being practices. While there are still counselors involved in treatment, many professionals are involved with individuals, community organizations and industries in finding ways to publicize and implement evidence-based research geared to having positive affective, behavioral and cognitive outcomes. Emphasis is on sharing meaningful experiences. Practices such as mindfulness, nature therapy, and “savoring” significant events and encounters are emphasized.

Technology has advanced and is used more by counselors. It promotes a change in the way counseling is conducted. It has not replaced person-to-person interactions in prevention or treatment. Rather, technology has become more of a tool in counseling than ever before. Counselors have been challenged to be more proactive and have developed realistic and individualized video games with names such as “Choice” and “Life.” These games are used by clients between sessions to help them see the outcomes and impact of what they do or plan to do more clearly. They are used with populations from 8 to 80.

Since counseling is now a worldwide profession, there are more international exchanges and novel ways of practicing as a counselor. A major change is that international accreditations are more prevalent and influencing counselors in positive multicultural ways more than ever. Worldwide learning about counseling practices is now an opportunity that is utilized.

Of course, neuroscience is lighting up more than regions of the brain in 2031. Specific applications from using neuroscience are prevalent. Counselor education and continuing education are filled with courses on the use of neuroscience, especially with people who are having difficulties coping because change is so fast. The term “change fatigue” is a term in the Diagnostic and Statistical Manual of Mental Disorders, with offshoots of anxiety and depression spinning off of it.

In addition, the American Counseling Association has changed. Its championing of interstate recognition of counselor licensure in the 2020s has made counseling stronger nationally. ACA is a major influence on counseling internationally too. One of its major foci is the producing of materials — films, books, pamphlets — for the well-being of the general population.

While the future is not ours to see, most likely many of the visions here will occur. Time will tell how they will be!

 

S. Kent Butler is president-elect of the American Counseling Association and has been appointed interim chief equity, inclusion and diversity officer at the University of Central Florida.

Change is on the horizon! History will show that the past few years have positioned the counseling profession to be the vehicle for this change, and we are proactively answering the call for transformation. Technology has evolved and will always carry us forward in very innovative ways. However, moving forward, contributions such as the Multicultural and Social Justice Counseling Competencies (MSJCC) will offer the muse that challenges the counseling community and affords us opportunities to grow both personally and professionally. The MSJCC proffer an empowering framework that encompasses meaningful advocacy. Exciting initiatives are imminent, similar to those provided by the Cultural Encounters Task Force — ACA members who are standing in the gap and extending to counselors evidence-based practices designed to help facilitate difficult dialogues pertaining to race and culture. ACA membership is being handed a road map and given insight that will help to mitigate and dismantle racism within our society.

As ACA’s 70th president, I look forward to future collaborations and leading ACA’s mission to promote the professional development of counselors, advocate for the profession, and ensure ethical, culturally inclusive practices that protect those utilizing counseling services. To date, ACA boasts 69 years of incredible leadership. However, only a limited number of underrepresented leaders have led the charge. Great strides must be made to mentor into governance aspiring leaders who represent ACA’s diverse membership. To this end, “The Giraffe and the Elephant — A Modern Fable” provides a real glimpse into our inner workings and efforts to embrace inclusion. It is a powerful narrative that showcases how insiders (giraffes) and outsiders (elephants) build inclusive environments together. This is ACA’s future!

To capitalize on leadership opportunities for counselors and the counseling profession over the next five to 10 years, I truly believe that we must learn and grow leadership exponentially and openly embrace a multitude of intersectionalities, allowing each person to intercede, touch and inform one another through myriad worldviews and life experiences. We benefit immensely when we are attuned to each other. I believe it is best practice to invest in these relationships. Investments empower leaders. They afford organizations opportunities to build a solid infrastructure that makes positive differences. A genuine acknowledgment of others also fosters a strong sense of belonging. Being inclusive successfully role models and empowers members to nurture collaboration and see value in embracing their colleagues for the gifts they bring to the table.

Leadership is not always easy. Ideally, leadership should be multidimensional and reflect myriad worldviews. By design, diverse governance provides role models and opportunities for mentorship and empowers aspiring leaders. As we move forward, these leaders must gain the trust of stakeholders, helping them to believe in their vision and to know that they can rely on it being carried out for the good of all. Furthermore, I believe that as good citizens, we must work collectively over the next decade to eliminate conditions that produce obstructions to the healthy professional development and wellness of individuals from all cultural and ethnic backgrounds. We must strategically take the time to build upon traditions that positively impact the lives of people across the globe. Ten years from now, we will have grown myriad diverse leaders who always take the high road and strive to provide us with a solid return on our investment.

 

Gerard Lawson is a professor in the counselor education program at Virginia Tech, a past president of the American Counseling Association, an ACA fellow and a licensed professional counselor in Virginia.

As we are reflecting on the future of the counseling profession, it may be the recency effect, but many of the things we have seen in the past year or so seem like they will be relevant areas of focus for some time to come. The roots of the counseling profession — in mental health and wellness, career counseling, and educational counseling — are as relevant to the challenges of today as they were 100-plus years ago, when the profession began. I’d like to focus on two challenges in particular, the first being the ongoing response to the COVID-19 pandemic and the second being the broad public exposure of injustices in the U.S.

There is no question that the impact of the COVID-19 pandemic on mental health, and on the vital services that counselors provide, has been profound. Many have observed a secondary pandemic of anxiety and social isolation as a direct result of the response to the coronavirus, and counselors who have traditionally worked only in face-to-face modalities had to adjust to an online counseling world to continue to support their clients. It seems unlikely that we will return to the way we used to practice, or that the nature of what clients bring to us will be the same, even after the pandemic has been brought under control.

Counselors who were skeptical of distance counseling are finding that it’s not as bad as they expected. Similarly, clients who have been relying on distance counseling to cope during the pandemic may actually need in-person counseling to thrive post-pandemic. And, unfortunately, we will probably see the mental health consequences of the pandemic for years, if not decades. For individuals who were vulnerable already, for students who were disconnected from their learning process and the normal support that they receive from talented and caring school counselors, and for those who were already stretched too thin and were asked to take on more, the recovery process may be protracted and complicated. Counselors may need to consider what progress and success will look like for those clients and for those for whom the “new normal” is still less than what they hoped for.

In 2020, we have seen the horrors of systemic racism more regularly, not because this is a new phenomenon, but because cameras have brought those experiences into the mainstream view. We have also seen the fear and insecurity that our neighbors who are members of the LGBTQ community feel who are afraid that their rights may be stripped away. We have seen neighbors who have lived in the U.S. for decades suddenly fearful that they could be sent to live in a country that they have never even visited. And we have seen neighbors suddenly find that their job no longer exists and unsure where their next meal may come from, much less what their career might look like.

Counselors can be agents of change in these areas. The Multicultural and Social Justice Counseling Competencies that ACA has promoted for years guide us to challenge our biases and assumptions, to practice in a way that is culturally competent, and to support clients who have been marginalized and harmed by unjust systems. We need to see and understand these experiences as part of an ongoing trauma that is embedded in the experiences of far too many individuals and families. As part of a system that values people based on what they contribute, not their inherent worth. We need to be out front, embracing everyone in our communities, affirming them and helping to change the systems that have led to oppression.

No small task. But counselors are accustomed to acting heroically.

 

*****

 

Share your thoughts on what might pose the most significant change, challenge or opportunity for counselors and the counseling profession over the next five to 10 years in the comment section, below.

 

*****

Jonathan Rollins is the editor-in-chief of Counseling Today. Contact him at jrollins@counseling.org.

*****

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.

ACA online event encourages conversation about counselor stressors

By Bethany Bray September 21, 2020

“How can I to continue to hold hope for my clients while I feel like I’m drowning?”

“How can I confront colleagues who commit microaggressions in client sessions?”

“What advice do you have for students whose professors and textbooks do not address multiculturalism?”

These were among the many challenging — and honest — questions raised during “Our Community Gathers: A Conversation With Counselors About Mental Health in 2020,” an online forum the American Counseling Association held Sept. 17 to facilitate professionals connecting with one another and sharing concerns. Much of the discussion from panelists and attendees alike focused not just on the additional stress that counselors and clients have been experiencing throughout the COVID-19 pandemic but also on the trauma, grief and exhaustion raised by recent social turmoil tied to systemic racism in America.

The online event, which was sponsored by the ACA Foundation, drew more than 400 attendees, including ACA members and nonmembers.

“This event is all about you,” said ACA President Sue Pressman as she opened the Zoom session. “Each day it feels like the very fabric of our society is unraveling. The work we do for clients and students is so important, [and] frankly speaking, counselors are needed more now than ever. I could never be more proud to be a counselor. At the same time, counselors are in crisis and in need of support. … Care and compassion for our colleagues is important and can be quite powerful, and this is one of the reasons for this event.”

S. Kent Butler

S. Kent Butler, ACA president-elect, served as the forum’s moderator, while Pressman gave opening and closing remarks. The event panel included several past ACA presidents and leaders from across the counseling profession, including Beverly O’Bryant, Courtland Lee, Gerald Corey, Ebony White, Mark Scholl, Anneliese Singh and Selma Yznaga.

The panelists were open and honest about how they too have been struggling recently. They urged attendees to focus on practicing self-care, taking breaks and staying aware of the body’s signals that one is becoming overwhelmed. They opened the session by talking about the necessity for counselors to seek their own counseling.

White said that counselors are “secret keepers” and noted the importance of processing the pain they carry for others in their own counseling sessions. At the same time, it can be a challenge for Black practitioners and other counselors of color to find a practitioner who looks like them because a majority of counselors are white. This is a barrier that is also shared, of course, by clients of color when they seek counseling.

“Even still in the year 2020, right now, as a Ph.D., LPC [licensed professional counselor], Black counselor who has a [professional] group of people I’m connected to, I’m having trouble finding a Black woman counselor, right now in this moment,” said White, an assistant clinical professor at Drexel University in Philadelphia. “This continues to be an obstacle, particularly for people of color, and it needs to be addressed.”

It is always a good idea for counselors to seek out therapy, but especially so now, agreed Lee, a professor in the counselor education program at the Washington, D.C., campus of the Chicago School of Professional Psychology. “Dealing with this [clients’] intense pain constantly is really going to get to us,” he said.

Lee, a past president of ACA and the Association for Multicultural Counseling and Development, emphasized the importance of resting and only taking on work and tasks that are personally important to individual counselors. He said that was a lesson he learned acutely and personally after his wife, Vivian, passed away suddenly earlier this year.

“What’s not important is sitting in front of a computer all day and having my phone in my hand all the time. Tonight was important to me; that’s why I’m here,” Lee said. “Find what gives you meaning, what’s sacred to you. You’ve got to find ways to take rest.”

White suggested that counselors consider “the bare minimum” amount of time they want to devote to self-care and make sure to hit that mark. For her, that’s 1% of her day. “Dedicate that portion of your day to something that is self-care. Whether that’s for prayer, dancing, drinking wine, whatever it takes,” she said.

Corey and Scholl urged attendees to consider all facets of wellness — physical, social, spiritual, emotional, cognitive, etc. — and focus on areas they find depleted, seeking activities that rejuvenate. For Corey, that includes doing Pilates; for Scholl, it’s enjoying naps that aren’t restricted to “power naps.” Scholl also is intentional about engaging in activities to connect with his Native American heritage, including attending Native gatherings and reading works by Native authors.

“One of the things that I’ve learned is that wellness doesn’t just happen, it takes discipline,” agreed Yznaga. “I have to plan for it, be deliberate. … For anyone who is thinking, ‘I’m not well and I cannot be well,’ yes you can, but you have to work at it.”

Attendees of Our Community Gathers flooded the platform’s chat queue with questions and comments throughout the session. Many posted websites and resources they thought others might find helpful and exchanged email addresses to continue conversations offline.

Panelists stayed online for more than three hours, until 10:30 p.m. Eastern, to answer questions and share ideas with attendees. Judging by the level of engagement the event garnered, counselors found the dialogue sorely needed.

One attendee asked for guidance on how to respond when a client makes a racist statement or uses offensive language in a counseling session. The panelists stressed the importance of responding to clients with honesty in these situations.

“It’s your responsibility to manage that tension in the room,” said White, who noted that counselors are doing a disservice to the client if they let a client’s statement go by without challenging it in session even as another dialogue that disagrees with the client plays silently in their heads.

Confrontation can be a therapeutic tool, White added.

Lee emphasized the term “broaching” in his response and the importance of broaching the subject to help clients un-learn words and perspectives that may have been ingrained in their culture and upbringing.

“Counseling is supposed to be an educative process,” Lee said. “Counselors often skip by teachable moments, but you can’t let them slide by.” When a client expresses a racist view in session, “Broach it and use it as a teachable moment,” he advised.

“We can be authentic and confrontational and still be respectful, even though it’s tough,” agreed Corey, an ACA fellow and professor emeritus of human services and counseling at California State University, Fullerton.

In such an instance, Corey said he would respond to the client by saying, “What I’m hearing you say is X. Let’s talk about it.” Afterward, it would be helpful for the counselor to seek out a mentor or colleague to debrief with and find support, he said.

Several panelists noted that the United States is in the midst of a cultural shift that brings opportunity for the counseling profession.

“Let’s try and take advantage of this moment and show the country what we have to offer, to destigmatize mental health and teach people how we [counselors] can help,” said Yznaga, an associate professor at the University of Texas Rio Grande Valley.

Lee remarked that he never thought he’d witness Confederate monuments taken down in his lifetime or the professional football team in Washington, D.C., change its name.

“We are at an inflection point that I have never seen,” Lee said. “This is much different than the [civil rights movement of the] 1960s. The ‘60s opened the door and made tremendous progress, but this era … It’s beyond just a teachable moment at this point; it’s an opportunity that we haven’t had before. If counselors are agents of social change and social justice, we need to get out there and fill the learning gap.”

 

*****

Resources

Continue the conversation

ACA will hold a virtual event on racial injustice and policy reform Oct. 14 at 2 p.m. (Eastern). The moderator for the event will be Aisha Mills, CNN and MSNBC political commentator.

Be on the lookout for registration information in ACA’s Member Minute newsletter, or email advocacy@counseling.org to share your interest in attending.

Counseling Today articles on related topics

****

 

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

 

****

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.

 

****

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.

 

Letters to the editor: ct@counseling.org

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

 

****

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.

Counselors, represent!

By Carol Z.A. McGinnis November 13, 2019

Tragic events tend to mobilize local and national news reports with questions and concerns that relate directly to the work that we do as professional counselors. Shootings, disasters, immigration issues, and political fallout are just a few examples that come to mind at the time of this writing.

What is particularly troubling to me is the lack of counseling expertise represented in the news in response to these events. Instead, we often endure ad hoc theories from professionals with no counseling experience who errantly connect tragic events to mental health issues. These individuals may mean well, but they make broad statements that connect video games with shootings, promote mental health policy that is rooted in subjective ambivalent “right” versus “wrong” societal thinking (rather than empirical research), and engage in ignorant blaming or scapegoating that leads to even more conflict and mental strife for the general population. What better time for licensed professional counselors to provide empirical context for these issues and offer hope for healing when it is needed most?

At the same time, I think we can largely blame ourselves as counselors for this gap in the national consciousness. We have fantastic representation in our state and national counseling associations and plenty of empirical research on topics of interest, yet we are not insistent on providing that content to our communities. As counselors, we have been trained to advocate through appropriate channels that include citizen-driven activities to challenge federal and state legislation, yet we have not learned how to promote our profession in the times we are most needed. Alfred Adler and Carl Rogers both held a global vision for our profession that included change and advocacy for the community at large. So, where do we start?

As a whole, the general public would find it useful to know a little more about what we do as professional counselors. People need to know that we are trained to probe more deeply about family dynamics, to inquire about the presence of guns and the use of prescription or illegal drugs, and to listen for evidence of strained relationships that may need immediate attention. We need to share that we have expertise in evaluating suicidal thoughts and potential homicidal intentions and that we often determine neglect or abuse for mandated reporting. People often worry about the ramifications of going to a counselor; our presence in the news media can go a long way toward easing those concerns.

After a tragic event occurs, these basic counselor skills can be invaluable for parents worried about their teenagers, spouses concerned about the safety of their mate, and adult children fretting about the welfare of their elderly parents. We can provide confidentiality that may be just the ticket when social concerns, political stressors, and environmental issues seem to be ever-present. As professional counselors, we are qualified to share insights on what symptoms to look for in a troubled family member, what signs might be particularly worrisome when a child withdraws, and how to find help when a particular mental health issue is occurring. It is information such as this that often seems to be lacking when the larger community is hurting.

 

Action steps

You may be asking: What can I do? Here are a few suggestions to get started.

First, take a moment to consider your particular skills and expertise. Do you work with people who struggle with depression? What information could you share publicly that might help others to cope, have hope, or seek help from a professional counselor? Alternatively, if your experience is with anxiety, what compassionate message might you share for people who are afraid to go to the mall or to the movies? If you work with people through illness or grief and loss, consider what messages you might be able to offer when the community at large is suffering with a particular loss. As a licensed professional counselor, you have knowledge, awareness and skills that would be tremendously useful in times of strife. It is just a matter of getting that content “out there” in the public.

Next, consider how you may want to advertise your availability to news outlets and the general public. One way to do this is to write an email or a letter to your local news station to identify yourself and the work that you do. Be brief in your communication, pointing to the specific issue or circumstance for which you may be most helpful. Include a business card or a link to a website if you have one. This is not the time to expound on your many research interests or on why you became a counselor. Be concise, clear and direct in describing what you specialize in so that news outlets can easily place you into a resource category.

It helps tremendously to have a professional Facebook, Twitter, Instagram or LinkedIn account that can connect your expertise to an active news media database or digital rolodex. Give some time and attention to this virtual representation to ensure that you are abiding by the ACA Code of Ethics. Consider locking down your settings to avoid inadvertent negligence on the part of potential clients who may try to direct message you. As stated in Standard H.6.a. in the ACA Code of Ethics, it is important to maintain a professional virtual presence that is separate from your personal presence online. It may be tempting to connect your professional site to your personal account, but resist this temptation.

Your professionally oriented social media sites should be designed to help local and national news media locate you should a specific need arise. Likewise, make it easy for the general public to find pertinent information on your credentials, expertise, and research interests. These details should clearly inform the general public about counseling and the specific work that you do, with special attention given to technology/social media competency (Standard H.1.a.) and your social media policy (Standard H.6.b.). Note how you may be of assistance to the community and the means for contacting you as a news source. Be sure to “friend” or “follow” all pertinent news outlets and local organizations that may need your help, and then take time to keep up with any interactions that occur with these entities.

Also, take a moment to consider what populations or groups in your area might especially appreciate a free workshop or presentation on the topic in which you specialize. Advocacy often begins in your local area, and people are more likely to ask questions about the counseling profession when they have the opportunity to get to know you better. Churches, synagogues and mosques tend to be places where disheartened and disenfranchised people go to get support. Offering to discuss your services in these places can open up new opportunities for the general public to understand what you do. Public clubs, parent groups, and schools may also grant you the opportunity to speak on a specific topic. Once these populations have the opportunity to learn about your work, they can also advocate for inclusion of a counseling perspective from their news sources.

If someone is searching for you in your area of practice, how will they find you? Psychology Today offers a “find a therapist” option that is helpful to the general public, but it incurs a monthly fee that some counselors may find distasteful. Another option to consider is starting a podcast, blog or streaming channel to bring your professional identity into the public eye. Although these options take time and energy, the results can include bringing your expertise to the consciousness of your immediate community. The creation of a website can also be useful as a less dynamic online platform where these other social media delivery systems can be “housed” in a central location. A unique domain for this purpose can be purchased and maintained with minimal cost and low effort. Community websites that provide free postings for mental health professionals at the county or city level can also be helpful. You may need to dig to find these, but they do exist.

Finally, don’t be shy about introducing yourself as a professional counselor when you are “off duty” and, if possible, take time to volunteer for an Advocacy Day sponsored by most state branches of the American Counseling Association. There are very helpful tips and tools located on the ACA website that provide direction on how to interact with local, state and national legislators, and steps for developing ethical social media sites. Another useful suggestion is to include a pertinent hashtag with your counselor postings (e.g., #CounselorsAdvocate) that can bring attention to that topic. Be creative in using hashtags that are specific to your knowledge, awareness and skills (e.g., #counselorforanger, #askacounselor, #counselinganxiety, #counselorgriefandloss). Connect with similarly named social media groups, and offer your availability in times of community tragedy.

In short, when tragic or troubling events occur, take a moment to think about your own skills, and then reach out to offer your perspective as a professional counselor to the news media. We often hear about the impact of public happenings in clients’ counseling sessions and may feel that we cannot act outside of that environment without sacrificing client trust. But there is a way to do this in an ethical manner. Remember, we don’t have to “take sides” on a controversial topic to provide much-needed positive messages to our communities. It may take courage for us to make this happen, but it is important for us to promote what we do as counselors when the people in our communities need it most.

 

****

Carol Z.A. McGinnis is a licensed clinical professional counselor, national certified counselor and board certified telemental health provider. She is associate professor and clinical mental health track coordinator for Messiah College in Mechanicsburg, Pennsylvania. She is currently president-elect of the Maryland Counseling Association and specializes in research that focuses on anger processing (www.anger.works) and videogaming. Contact her at cmcginnis@messiah.edu.

 

****

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.

Counseling from an editor’s perspective

By Les Gura November 6, 2019

When I was a newspaper editor and reporters would tell me they had writer’s block, I sometimes used a technique championed by Pulitzer Prize–winning journalist Jon Franklin in his book Writing for Story. “Tell me your story in three words: subject, action verb, object,” I’d say.

After thinking about it, the reporter would deliver the initial three-word narrative, which would in turn ignite reporter-editor dialogue. Eventually, we would settle on the true narrative the writer was trying to tell, and off the writer would go to craft the full story.

When life brought me to graduate school for counseling, it was no coincidence that I found myself drawn to narrative therapy. To me, it made obvious sense to learn and understand client stories — a centerpiece of narrative therapy, according to its founders, Michael White and David Epston. Their book, Narrative Means to Therapeutic Ends, describes the power that story — and the maladaptive meaning often ascribed to it — has in people’s lives.

White and Epston explain how narrative therapy is about finding a client’s dominant narrative, externalizing the problem central to that dominant narrative, and identifying alternative narratives. But how does a professional counselor do that? Is what the client tells you the true dominant, or problem-saturated, narrative? Or might a presenting issue mask something deeper?

As I read more books, absorbed more information on narrative therapy, and began my internship in my final year of school, I recognized something. Clients don’t automatically understand the concept of a “dominant” narrative. Sometimes, they’re not even sure why they have come for counseling, other than a vague sense that something is not right.

It is the conversation between client and counselor that can elicit story. And that reminded me of my old editor’s trick — the three-word narrative.

Initial exploration

Thirty years as a journalist will garner you some skills, especially when your orientation is investigations and narrative writing. As I learned more about narrative therapy, I saw the parallels to my journalism past and went into the attic to fetch my old narrative writing materials, including Writing for Story and excerpts on writing techniques from the Poynter Institute. What I quickly realized was how easily and effectively the techniques of narrative writing could be adapted as part of the narrative orientation in counseling.

Today, I have made my background as a writer and editor a centerpiece of my professional disclosure statement because I find it a great way to kick off a conversation with most clients. Talking about my past eases clients’ anxieties about coming to see a counselor and lays the groundwork for future narrative work.

When conversation turns to why clients have come to counseling, I usually give them a homework assignment to return to the next session with a three-word narrative that answers the question: Why are you here? The exercise itself invites conversation, just as it did with “blocked” writers.

In journalism, the writer and editor chat after the former returns from the three-word exercise with the headline “Council Approves Budget.” The editor might ask the reporter, “Is that all there is?” Was it simply a vote? Who are the winners and losers of this budget approval? During the ensuing discussion, the reporter reveals that the new budget will cut taxes for the first time in 10 years. The reporter now has a more accurate three-word narrative from which to frame the story: “Taxpayers Win Relief.”

Now let’s apply the three-word narrative to counseling with a fictional client named John, a 65-year-old who presents at his first counseling session with sadness at the death of his wife of 43 years, Sarah. His initial three-word narrative about why he has come to counseling is “Grief overwhelms John.”

The counselor explores the concept of “overwhelm” with John. What is that like? Does it have a physical effect? Is John able to sleep at night? This conversation allows John to explore the nature of his dominant narrative. It turns out that the “overwhelm” John feels may have its roots in grief, but he is actually worried about what comes next.

Passive vs. active

There is a specific intent in using the three-word narrative’s subject–action verb–object format that has to do with how we perceive the stories of our lives. It’s all about passive versus active.

Inevitably, when I use the three-word narrative with my clients, they initially place themselves in the “object” position of the three-word narrative, just as John did in the example (“Grief overwhelms John”). Clients perceive that something is happening to them beyond their control, and they don’t like it. Being the “object” puts them in the passive position.

In narrative therapy as described by White and Epston, a central goal is to externalize the problem, to help clients see a problem as outside of themselves. Clients are asked to name the dominant narrative, and that becomes how it is thereafter referenced. Often, the action verb or object point toward the name of the dominant narrative. In the fictional case, we might try to externalize John’s dominant narrative by calling it “overwhelm.”

That is not an easy concept to externalize, however, because it is outside of John’s control; he has put himself in the passive position of his narrative. Using another narrative therapeutic intervention called questioning, John and the counselor spend time better defining the dominant narrative. John eventually recognizes that what brought him to counseling isn’t so much being overwhelmed but rather fear of the future. Hence, through dialogue with his counselor, John reconstructs his dominant narrative to “John fears loneliness.”

In this new version, John is now in the active position of the three-word narrative; he is the “subject.” This allows him to better see his role in the dominant narrative and gives him the insight to externalize his dominant narrative, which for this example can be named “lonely.” On a subsequent visit, the counselor can simply inquire of John, “How are you handling ‘lonely’ this week?” John can respond in the context of how he has responded to that issue, his dominant narrative.

The side benefit of this approach is that by John viewing himself as the subject, he is better equipped to “act” in terms of moving away from his dominant narrative or simply seeing it for what it is — an immediate situation outside of himself that is causing him problems. Again, as White and Epston would say, John is not the problem; the problem is the problem.

Indeed, that insight will be the means by which John and the counselor collaborate on strategies to identify alternative narratives in John’s life. They will eventually move toward those alternatives and away from “lonely.”

Going deeper

In her textbook Theories of Counseling and Psychotherapy: A Case Approach, Nancy Murdock says that narrative therapy can be described as “where the client tells the therapist a story, the therapist listens, and the two make what they can out of it.” Indeed, narrative therapy is a social constructive theory and typically considered a shorter term approach to counseling.

Using the three-word narrative approach, however, allows counselors the flexibility to go deeper than identifying and working to change the dominant narrative. For example, I have found that the three-word narrative approach pairs well with the construction of a genogram, which is a diagram of family relationships and behavior patterns. Once clients have identified a dominant narrative in their lives, I will spend some time with them constructing a genogram to help us both see and begin to understand their more complete life story.

Genograms allow clients and counselors to gain insight into how clients perceive the strengths, issues and relationships in their lives. I often ask clients to devise three-word narratives that describe their lives at different ages and moments. This allows us to contextualize how stories change; more importantly, it helps clients see where personal strengths lie during periods in which their stories were not problem-saturated.

Seeing life as a progression of narratives also encourages clients to begin thinking about two things: 1) alternative narratives to the dominant one that has brought them to counseling, and 2) how to use their strengths to build a path to achieve the alternative, just as they see they have done in the past.

The approach can work for a variety of presentations. The fictional examples that follow show how a counselor might work with a client on the issues of grief, depression, trauma and anxiety. Each example includes the identification of the initial three-word narrative, the reconstructed dominant narrative after client-counselor discussions, the externalized name for the presenting issue and, ultimately, the alternative narrative identified by the client.

Together, client and counselor will identify and form the path — using client strengths as well as other interventions — to move toward the alternative narrative.

Subject: Grief

Initial three-word narrative: Grief overcomes John

Reconstructed three-word narrative: John fears loneliness

Externalized name: “Lonely”

Alternative narrative: John conquers life

Subject: Depression

Initial three-word narrative: Hopelessness overwhelms John

Reconstructed three-word narrative: John destroys relationships

Externalized name: “Doubt”

Alternative narrative: John enjoys friends

Subject: Trauma

Initial three-word narrative: Abuse wounded John

Reconstructed three-word narrative: John trusts nobody

Externalized name: “Distrust”

Alternative narrative: John builds relationships

Subject: Anxiety

Initial three-word narrative: Indecision surrounds John

Reconstructed three-word narrative: John despises decisions

Externalized name: “Decision hater”

Alternative narrative: John relishes choices

Three-word narrative versatility

The beauty of the three-word narrative is both its simplicity and its ability to mesh with other interventions, in short, creating an integrated approach.

In addition to three-word narratives and genograms, I have used interventions such as reframing, motivational interviewing, mindfulness, wellness, and even harm reduction. All of these can help propel clients toward insights about themselves or the first baby steps to envisioning preferred narratives.

More simply, three-word narratives invite further exploration and conversation in an effort to go deeper. Understanding a client’s narrative — in the moment, in the context of the past, and to gain a sense of a preferred future — requires push and pull between client and counselor.

I have found my journalist experience to be most useful in asking questions. Not the rapid-fire style that is something of a cliché in journalism, but the more thoughtful, open-ended questions that show empathy. Not surprisingly, the most effective journalists are the ones who show their sources empathy and seek to fully understand a story. That’s even more true, obviously, for counselors using narrative techniques.

Narrative therapy as embodied in the three-word narrative technique has two other positive aspects worth noting. First, the three-word narrative is a transparent technique, which is typical of narrative therapy in general. It requires the counselor to openly explain the technique and its goals from the start, which has the benefit of also engaging the client in the work of therapy. By discussing my own background from the first meeting with a client, I am modeling the art of storytelling. This type of sharing promotes a two-way dialogue with clients.

Second, three-word narratives, as with many other aspects of narrative therapy, work well in a multicultural context. A counselor who seeks to understand life narratives is promoting the unconditional acceptance of a client’s family, culture, influences and environment in the shaping of those narratives. This promotes trust in the therapeutic relationship and the promise of collaboration.

As I move forward with my career in counseling, I anticipate finding other parallels with my former life and putting those ideas to work. The goal? To help clients recognize the narratives of their lives — past, present and future.

 

****

 

Les Gura has been interested in narratives his entire life. After 35-plus years as an award-winning journalist, writer and editor, his own narrative took a turn in 2016 when he entered graduate school to become a clinical mental health counselor. He earned his master’s degree from Wake Forest University in the spring and joined CareNet Counseling in Winston-Salem, North Carolina, in September. He is a national certified counselor and a licensed professional counselor associate. Contact him at lgura@wakehealth.edu.

Letters to the editor: ct@counseling.org

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

 

****

 

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.