Tag Archives: counseling

Client suggestibility: A beginner’s guide for mental health professionals

By Jerrod Brown, Amanda Fenrich, Jeffrey Haun and Megan N. Carter August 12, 2019

In the context of mental health treatment, suggestibility refers to a client’s vulnerability to accepting information provided by a third party as true, regardless of its veracity. This can result in the client providing inaccurate guesses or statements in a verbal, nonverbal or narrative format. Influenced by a range of individual, psychosocial and contextual factors, the client may be convinced that events unfolded differently than they actually did or that events that never took place actually occurred.

Such behavior is often encountered when clients are uncertain about what happened or what is true, lack confidence in their own memories or ability to understand, or are unable to discriminate between what is real and what is not. As such, suggestibility can profoundly limit a client’s capacity to navigate the various stages of the mental health system.

Suggestibility is a complex and multifaceted phenomenon that mental health treatment specialists rarely take into consideration, largely because of the lack of research on it and the limited availability of training opportunities on the topic specifically tailored for these professionals. The research that has been conducted is largely circumscribed to the fields of criminal justice, forensics and the law, where it is well-established that clients who are more suggestible are more likely to provide unreliable eyewitness accounts, spurious alibis or even false confessions to crimes.

Across mental health treatment settings, suggestibility may result in inaccurate diagnoses and ineffective or problematic goal and treatment plans. Given the importance of this topic, we aim to briefly describe the phenomenon of suggestibility within the context of clinical interviewing, assessment and treatment planning. We will also suggest future directions that may assist mental health professionals in addressing this threat to effective clinical decision-making.

Minimizing suggestibility risk in clinical interviews

Certain forms of questioning can increase the likelihood of suggestibility. A suggestive question is one that implies a certain answer, regardless of the client’s actual perspective. Such questions intentionally or unintentionally seek to be persuasive, often by using wording that excludes other possible answers. For example, asking “Where did your father hit you?” instead of “What happened with your father when you got home?” is leading. It promotes a response that would affirm the interviewer’s hypothesis that a physical assault took place and largely excludes the possibility that no altercation occurred.

Questions framed in a negative manner also can have a suggestible impact and are confusing to the client. For example, asking “Didn’t you want to run away?” rather than “Did you want to run away?” is biased in that it may make the client feel guilty for not saying that he or she wanted to run away.

To avoid asking suggestive questions and to lessen the likelihood of receiving false responses from clients, consider using the following strategies:

1) Use open-ended questions while avoiding or minimizing the use of forced-choice and either-or questions.

2) Allow the client to speak in his or her own words, and avoid interrupting the client.

3) Do not assume that you know what the client is trying to say when he or she is unable to fully convey his or her ideas.

4) Accept “I don’t know” responses as potentially valid.

To further illustrate this point of decreasing suggestibility within the context of clinical interviewing, mental health professionals should try to avoid the following approaches when questioning clients:

  • Use of closed-ended questions
  • Giving an impression that implies the client is providing the wrong answer
  • Implying that a certain answer is needed or required
  • Leading questions
  • Misleading questions
  • Negatively worded statements
  • Persuading the client to change his or her response
  • Pressing the client for a response
  • Rapid-fire questioning
  • Repeated lines of questioning
  • Biased statements
  • Subtle prompts

How often questions are asked may also have a suggestive impact. Clients may perceive repeated questioning as a sign that they have not responded in a manner that the counselor deems “correct” or acceptable. Indeed, repetitive lines of questioning in which the client is asked about details of events that either did not happen or that the client does not remember well may result in the unintentional formation of false memories or confabulation (i.e., filling in memory gaps with fabricated memories or experiences).

Asking more general questions about an incident (e.g., “Tell me about what happened at the park”) and then later following up with related questions (e.g., “How often do you go to the park?”) has been found to be a useful method for verifying or clarifying information that might appear to be inconsistent or illogical. Regardless of the questioning style, however, it is advisable to allow clients as much time as they need to respond to questions and to verbally reinforce that they can take their time when answering questions.

In addition to questioning style, the counselor’s nonverbal behaviors, including facial affect, gestural affect and intonation, both before and during the interview, may increase the likelihood of suggestibility and threaten the validity of the information elicited. An example of facial affect could be smiling when a client is providing certain answers but not others. A gestural affect might include leaning forward when a client is providing certain answers but not others. Intonation as a means of nonverbal communication could be providing feedback using upward inflection when a client provides certain answers but downward inflection when he or she provides others. These nonverbal, and often unintended, means of communication are forms of both positive and negative feedback that can shape a person’s responses and increase the risk of suggestibility.

The context of the interview can also affect the likelihood of suggestibility. For example, false reports are more likely if an interview is conducted in a stressful situation (e.g., having an appointment with a therapist immediately following a family conflict). Environmental factors (e.g., a small room without windows or air conditioning on a hot summer afternoon) can also be influential. Providing clients with frequent breaks and avoiding very long clinical interviews is encouraged, when possible. The time between the occurrence of an event and the interview that focuses on the event can also influence suggestibility because clients can become more confident in the accuracy of their false accounts over time. Context within the realm of a clinical interview can include any of the following either prior to and during the actual interviewing process:

  • Body language of the counselor
  • Duration of eye contact from the counselor
  • Environmental distractions (lighting, noise, temperature, etc.)
  • Length of the interview
  • Pace of the interview
  • Tone of the counselor’s voice

Mental health professionals should also take into consideration personality and social characteristics that can influence suggestibility. These may include tendencies toward confabulation, acquiescence, memory distrust, low confidence, desire to please, extreme shyness and social anxiety, avoidant-based coping strategies, fear of negative evaluation, lack of assertiveness, attachment disruptions, fantasy proneness, and psychosocial immaturity (e.g., irresponsibility and temperament). Professionals should also consider cognitive factors, including executive function and memory-related problems (e.g., short-term, long-term and working memory), intellectual limitations, diminished language abilities, and deficits in theory of mind (the ability to understand mental states in oneself and in others).

Preparing for and debriefing from the interview

Understandably, many of these characteristics initially present as invisible, meaning that clients who are highly suggestible may not overtly appear as impaired or vulnerable. Clinicians would benefit from screening for such traits in the initial interview with new clients to determine the prevalence of traits that are likely to contribute to suggestibility. Specific screening tools for suggestibility, such as the Gudjonsson Suggestibility Scale, can help clinicians in determining a person’s level of suggestibility. This will also assist clinicians in understanding how best to proceed as it relates to interviewing techniques and treatment planning to account for an individual’s level of suggestibility.

False or misleading information can have a negative impact on diagnostic accuracy and treatment outcomes. Accordingly, it is important that mental health professionals not only conduct interviews properly but also prepare for and debrief from them properly. Prior to beginning an interview, counselors are encouraged to review client records (psychological testing, mental health records, criminal justice records, etc.) that may reveal a behavioral pattern of suggestibility and provide a resource for corroborating a client’s statements. Cross-referencing this information with information obtained from collateral informants is also recommended when appropriate. The importance of awareness of one’s self throughout the interview is an important factor for reducing the risk of suggestibility. This includes monitoring one’s verbal and nonverbal communication that could provide feedback to the client regarding potentially desirable versus undesirable responses.

It’s worth noting that some special situations may require clinicians to be more aware of their questioning style and require adaptations and flexibility on the part of the clinician to minimize suggestibility. For instance, those working in correctional and jail settings should consider how suggestibility presents among incarcerated populations, to include those with mental health needs and low intellectual functioning. Substance use is another variable that can have adverse effects on the accuracy of the information obtained during a clinical interview. Furthermore, when interviewing children or adults with neurocognitive and neurodevelopmental disorders, extra precautions may be necessary to reduce the risk of suggestibility. Finally, it is important to note that individuals with exposure to negative life events (e.g., the death of a parent or sibling, exposure to physical violence) may be more susceptible to suggestibility.

Conclusion

Given the importance of collecting accurate information, it is essential that mental health professionals acquaint themselves with the phenomenon of suggestibility. Unfortunately, many mental health providers lack the necessary awareness and training related to the detection and screening of suggestibility among clients.

Mental health professionals should seek to establish routine procedures to better identify clients who are at an increased risk of susceptibility to suggestibility before proceeding with the interviewing process. Such a procedure could include a validated suggestibility screening tool and a checklist of variables that research has found to increase risk of suggestibility among certain mental health treatment populations. We encourage mental health professionals to be aware of the various personality, social and cognitive factors that may influence some clients to be suggestible.

Suggestibility can have a negative impact on the various components of mental health treatment, including intake, screening, assessment, psychological testing, treatment planning, medication compliance, perceived understanding of treatment concepts, and discharge planning. For this reason, we urge mental health professionals to gain an increased awareness and understanding of this complex and multifaceted phenomenon.

One suggested step for moving the field forward is for mental health professionals to engage in self-study and continuing education via in-person and online training courses that focus on the evidence-based assessment and management of suggestibility. It is also important for mental health professionals interested in understanding suggestibility and its implications to review key research findings on at least a quarterly basis and to consult with recognized subject matter experts. Clinical interviews should be conducted through developmentally sensitive and suggestibility-informed approaches that consider the client’s psychiatric, neurocognitive, social and trauma history. By taking such steps, the potential negative impact of suggestibility can be minimized, thus paving the way for positive outcomes.

 

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Jerrod Brown is an assistant professor, program director and lead developer for the master’s degree in human services with an emphasis in forensic behavioral health for Concordia University in St. Paul, Minnesota. He has also been employed with Pathways Counseling Center for the past 15 years and is the founder and CEO of the American Institute for the Advancement of Forensic Studies. Contact him at jerrod01234brown@live.com.

Amanda Fenrich obtained her master’s degree in human services with an emphasis in forensic mental health from Concordia University. She is currently completing her doctoral degree in the advanced studies of human behavior from Capella University and is employed as a psychology associate for the Washington State Department of Corrections Sex Offender Treatment and Assessment Program.

Jeffrey Haun is employed as a forensic psychologist for the Minnesota Department of Human Services, where he conducts a variety of forensic evaluations and offers consultation, supervision and training in forensic psychology. He is an adjunct assistant professor in the Department of Psychiatry at the University of Minnesota and an adjunct instructor at Concordia University. He is board certified in forensic psychology.

Megan N. Carter is board certified in forensic psychology and has received the designation of fellow from the Association for the Treatment of Sexual Abusers. She has worked as a forensic evaluator at the Special Commitment Center, Washington state’s sexually violent predator facility, since 2008. She also maintains a small private practice focusing on forensic evaluations and child welfare issues.

 

Letters to the editor:ct@counseling.org

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

What does therapy mean to you?

Compiled by Bethany Bray June 11, 2019

What does therapy mean to you?

Jessica Ferrence, a licensed professional counselor (LPC) in Fayetteville, North Carolina, was a little taken aback when a client posed this question to her in a session. However, it sparked Ferrence’s interest and led to some self-reflection.

Therapy is what counselor practitioners do – but it means something different to each professional. It’s a place for the client to heal, grow, be vulnerable, set goals, get to know themselves and many, many more things.

For Ferrence, therapy is a place to uncouple oneself from pain and find strength.

“Therapy puts people in a vulnerable position because we trust clinicians with our deepest, darkest, most painful secrets; things we haven’t shared with our partners or family members or best friends for various reasons. When we feel safe enough to let down our walls — when we share the burden we’ve been shouldering for years or relive the experiences that haunt us in our dreams — we find the strength to find our voice,” says Ferrence, who considered the topic both as a practitioner and recipient of therapy. “Confronting our pain and reclaiming our lives, without fear of judgment or ridicule, can be extremely cathartic. We feel validated, understood and accepted for the first time in a long time — and maybe even ever. And that’s when healing truly begins. That’s when we realize that the power to break free from the grip of our past lies within us. That our vulnerabilities are no longer vulnerabilities, but rather areas of strength that we draw from. [It’s] where the image of our best self has come into focus, and more importantly, that we have the courage to turn that image into a reality.”

 

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CT Online asked a sampling of American Counseling Association members to consider the question “What does therapy mean to you?”

Read their thoughts below, and add your voice to the conversation in the comment section at the bottom of this page.

 

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As a therapist, to me, therapy is…

  • An honor and privilege. I continue to be humbled by the fact that my clients share with me their most sacred stories. Often these are trauma stories, in which their deepest pain and vulnerabilities lie in the details they have shared with very few, or only with myself.
  • A collaboration between the client and myself. My clients bring their expertise about themselves and their experiences. They bring their stories. They also bring their strength, resiliency and all of themselves – shadow and light. As a therapist, I bring years of clinical experience and education. It is my responsibility to provide a safe, non-judgemental and compassionate space for us to work in. As appropriate, I will offer clients my perspective, as well as evidence-based interventions and information, which they have the right to accept or decline freely, based on what fits for them.
  • An opportunity to support clients in reaching their goals. These goals might involve learning how to cope with the aftermath of loss or trauma, or learning how to manage distress related to stress and/or a mental/physical illness. Sometimes we are working together to adjust their understanding and expectations regarding healthy relationships and boundaries.
  • Often focused on helping clients to recognize that they deserve to be loved, respected, cherished and protected — and that in life they don’t need to be perfect to be “good enough,” but rather they only need to be perfectly themselves – with all of their disappointments, triumphs, strengths and vulnerabilities. Frequently, I find [therapy] is about helping clients learn to view themselves from the perspective of their wisest and most compassionate selves.
  • A place to educate and normalize my client’s reactions and/or symptoms, so that they can get a handle on what it is they are dealing with, what they might expect and strategies they might wish to consider to help them to better manage their distress.
  • A place in time where clients do not have to wear masks or say they are “OK” when they are not. A refuge. A place where their distress will be heard and witnessed by another human being, who will not judge, but rather will reflect back their distress without minimizing, and will also hold up a mirror to their strength, courage and tremendous resiliency.

 

  • Shirley Porter, a registered psychotherapist and a registered social worker in London, Ontario, Canada

 

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To me, therapy is for everyone. It is the opportunity for individuals to get the most out of life.

Though traditionally viewed as a medium for helping someone work through a particularly challenging issue or mental health disorder, therapy offers much more. The reality is that, yes, everybody struggles at various points throughout life and may benefit from some additional assistance. People need not wait, however, until life becomes challenging to seek therapy. That is, effective therapy may help people go well beyond attaining life satisfaction to the point of thriving.

Accordingly, the lens through which counselors view clients should be one that extends well beyond problem resolution. By resolving an issue, a person may shift from a bad place to a neutral one. Pushing beyond this is where we really begin to witness existential growth. This is the place where life satisfaction increases, interpersonal relationships improve, goals are achieved and one begins living a life that — until therapy — seemed unattainable.

As counselors we make the unattainable attainable. While I have yet to meet a new client who comes into the office under the premise of “My life is great, and I am here to make it even better,” counselors have the tools to do just that! When working with clients, then, my thought process is to first help address the presenting problem, then facilitate a personal growth process that exceeds previously thought of expectations.

This is one way, of many, that we may continue to destigmatize the therapeutic process. Therapy is not just for individuals with mental illness or problems—it is for everyone.

  • Matt Glowiak, a licensed clinical professional counselor (LCPC), certified advanced alcohol and other drug counselor, full-time clinical faculty member at Southern New Hampshire University and co-founder/co-clinical director of counseling speaks in Chicago, Park Ridge and Lake Forest, Illinois.

 

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By definition, therapy is sitting in a room with an essential stranger and discussing your inner most intimate memories, feelings and traumas. Sounds fun right?

No.

So, if therapy isn’t always fun, why do so many people continue to go and find such benefit from the process?

Everyone’s answer to the above question is going to be a bit different but being a therapist myself, and a client within therapy throughout my life and currently; I would like to share my current perspective on what therapy is and why everyone should go.

To me, therapy is a helpful tool to use in order to get to know myself on a deeper, more authentic level.

Within our bodies and minds we all hold the answers to our presenting concerns, but the protective factors and defense mechanisms we’ve built up over the years tend to get in the way of effectively working through our life’s difficulties alone. Therefore, we rely on our coping skills and our loved ones to assist us in times of need. But what happens when your go-to coping skills are no longer working? For a lot of people, it means that you now have to adapt your life and accept the fact that you are now anxious, depressed, alone…fill in the blank — and that’s just the way it is. Fortunately, though this doesn’t have to be the case.

Therapy can be a great way to adapt or change your learned way of life in order to gain a better understanding of your inner workings and what happens when your internal and external worlds collide.

By nature, the process of therapy forces you to be vulnerable. And with vulnerability being the key component to experiencing all emotions (the good, the bad and the ugly) the therapeutic process can assist in the education, understanding, integration and execution of your complex emotions. Therefore, allowing you to take what is learned within the therapeutic hour out into the world and apply it to your life in order to reach our full potential.

In summary, I think that everyone should have access to, and be a client within the therapeutic process sometime throughout their life. It is not something I think people should be in forever, because I do think one of the goals of therapy is teaching clients how to be their own therapists. But I do think everyone should be able to experience the benefits that the unique relationship between client and therapist can have.

  • Shannon Gonter, a licensed professional clinical counselor (LPCC) in Louisville, Kentucky who works with young adults and specializes in men’s issues

 

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To me, therapy or counseling is the space in which counselors are able to promote, encourage and support clients in achieving wellness. This space is where clients go to seek out the assistance that they need to improve areas of their lives that contribute to their overall sense of wellness. These areas may include but are not limited to social, cultural, emotional, psychological, spiritual, relational and/or physical.

Therapy is this safe space where I can explore where I am in life, what obstacles I may be facing and what I need to feel whole again. To me, wellness is the experience of wholeness.

  • Ashley C. Overman-Goldsmith, an LPC and doctoral student at North Carolina State University and owner and lead therapist at Sea Change Therapy in Williamsburg, Virginia. Her current research centers on honoring the lived experiences of terminally ill clients while helping these clients resolve issues that affect their end-of-life experience.

 

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As a veteran and mental health professional, I often find myself conducting community presentations in order to reduce the stigma against clinical mental health counseling. Often, I find myself having discussions about what therapy is and what it means.

During these conversations, I draw the line between therapy and Therapy. Many find things helpful and calming that they consider “therapeutic,” like gardening, physical exercise, cooking, art, etc. I have clients that say “_____ is my therapy” and that’s great. The meaning in that context is anything that is emotionally soothing or helpful to them.

The other one, though, is Therapy. It is a formal interaction with a licensed mental health professional that is bound by a set of ethical principles, licensure regulations and expectations of professional conduct. I typically use the term clinical mental health counseling, which is more cumbersome but also clearer than just the word “therapy.”

During Therapy, in the clinical sense, a client identifies areas in their life that are not functioning as well as they would like. They then work with a trained professional to develop and work towards goals that will improve that functioning. The professional does not only have training in therapeutic interventions, but they also have training in evidence-based practices that research has proven can help the client resolve their concerns.

Unfortunately, many of the clients I see do not engage in Therapy until the things they have been using to try and manage their problems don’t seem to work. I often describe it this way: if I were a medical doctor, I would be an emergency room doc. The veterans I see come in to my office either right before a crisis, during a crisis, or after a crisis has occurred. Clinical mental health counseling is often seen as a last-ditch effort, a final resort to try before the wheels fall off the wagon.

Instead, I try to encourage clients to consider clinical mental health counseling as a resource to use in order to prevent a crisis, rather than reaching out in response to a crisis. To use Therapy in conjunction with things they consider therapeutic, rather than thinking they are two separate things. For my clients, I have seen this combination help them live the post-military life they both desire and deserve.

  • Duane France, a U.S. Army noncommissioned officer (retired), combat veteran and LPC who practices in Colorado Springs, Colorado. In addition to his clinical work, he also writes and speaks about veteran mental health on his blog and podcast at veteranmentalhealth.com

 

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To me, therapy is an opportunity. It seems that with any kind of client, in any type of situation, using any option of modalities, therapy is a gateway to a field of possibilities. I believe one of my greatest gifts to my clients is helping them to facilitate possibilities of thought, feeling and action. With possibilities, clients can see opportunity. Two important words come to mind when I think of opportunity: awareness and empowerment.

Clients come to counseling, voluntarily or involuntarily, but most come with some desire to figure out something. Clients may be looking for specific techniques or just a way to be able to communicate with their partners. They may be court ordered for addictions treatment or just feel like something is not right. Whatever the concern, figuring it out seems to bring insight and peace on some level. Being a licensed professional counselor, certified yoga instructor and an artist has allowed me to provide multiple strategies to foster clients’ inquiry into their presenting concerns. But strategy aside, therapy provides clients opportunities for self-awareness and insight about the world around them.

Additionally, opportunity begets empowerment. One of the key principles of counselor identity is empowerment of our clients to help themselves. I remember working in a community mental health center years ago. Then I was working with children and families who did not have a lot and who had experienced violence, abuse and insecurity in their living situations. I wondered what good could I do in one 60-minute session, and with one meeting per week for each client, especially when I was working in the context of highly distressing situations. Therapy was the act of empowering my clients to find options in how they reflected on themselves and responded to their environments.

With options available, clients can find freedom to choose. Feeling free to make decisions – intentional decisions – is one of the most empowering experiences for anyone. Being able to foster opportunity for my clients means that they have a chance to feel their personal power to make their own choices.

I would say that my primary job as a counselor and counselor educator is being an options-maker or a possibilities-creator! I believe it is in therapy where opportunities are born!

  • Megan M. Seaman, an LPC, certified yoga instructor and assistant professor in the Counseling and Art Therapy Department at Ursuline College in Pepper Pike, Ohio. She also maintains a private practice in Beachwood, Ohio where she works with children, youth and families using creative arts healing and yoga therapy strategies.

 

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To me, therapy is providing an open space for people to have the opportunity to discuss life events or problems that are impacting their daily lives. This is a place where someone feels heard. Our lives are often so busy that we don’t listen.

Counseling provides this safe place for someone to “unpack” life problems and look at them with someone who is truly listening and is available for unbiased support. Therapy offers the opportunity for people to discuss and explore ways to improve their lives and find resources to enhance their quality of life. Thus, they find the strength to manage difficult life events such as trauma, illness and adjustment to disability.

Therapy is also the passionate pursuit of learning and effectively using practice-proven and evidence-based practices to help with the healing process. But, it also requires a counselor to have the courage to question, redirect, and, yes, confront a client to keep them on the path to wellness and wholeness.

This is hard work! But it is an honor to be trusted by someone who doesn’t know us to listen, care and support them during their most vulnerable times.

  • Judy A. Schmidt, a certified rehabilitation counselor (CRC), licensed professional counselor associate (LPCA) and clinical assistant professor in the Clinical Rehabilitation and Mental Health Counseling program in the Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill. She is the rehabilitation counselor for the acute inpatient rehabilitation unit for UNC Hospital in Chapel Hill.

 

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To me, therapy is a communion of two souls who make an agreement to walk alongside each other for a part of this journey. Therapy calls us to bear witness to another person’s healing process by helping them to come back home to their true and authentic self. It reminds us of our wholeness and asks us to remove any barriers that prevent us from seeing this wholeness.

Therapy reminds us that we cannot have the shadow without the light and that the shadow only exists because of the light. It is about quieting the ego and the mind in order to get us out of our heads and into our hearts and bodies.

Therapy involves being truly seen and heard by another person to help us remember that we are not alone on this journey. It is about accepting someone for who they are (battle scars and all) while also seeing their infinite potential.

  • Jessica Smith, an LPC, licensed addiction counselor, yoga teacher and owner of Radiance Counseling in Denver, Colorado

 

 

 

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

 

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

 

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

 

 

America’s mental health disparities

By Bethany Bray December 10, 2018

Mental health care availability and access vary tremendously depending on where you live in the United States. In Massachusetts, for example, there is one mental health care provider for every 180 residents. That ratio is far different in Texas and Alabama, however, where there are more than 1,000 residents for every one provider.

Mental Health America (MHA) recently released its annual report of mental health indicators across the U.S. For the ratios above, MHA included counselors, psychiatrists, psychologists, licensed clinical social workers, marriage and family therapists, and nurses specializing in mental health care in its categorization of “mental health provider.”

MHA ranked Massachusetts as the best state for mental health care availability, followed by the District of Columbia, Maine, Oregon, Vermont, Oklahoma, New Mexico, Rhode Island, Alaska and Connecticut. All of these states and the District of Columbia have fewer than 300 residents per mental health care provider.

On the other end of the spectrum, Alabama (with 1,180 residents for every one provider) and Texas (1,010:1) were the lowest-ranked states, along with West Virginia (890:1), Georgia (830:1), Arizona (820:1), Mississippi and Iowa (760:1), Tennessee (740:1), and Florida and Indiana (700:1).

Although Oregon was near the top of MHA’s list for mental health care availability, it also ranked highest for prevalence of mental illness among adults. Nationwide, 18.07 percent of adults – or more than 44 million people – have a mental illness, defined as “a diagnosable mental, behavioral or emotional disorder, other than a developmental or substance use disorder.”

See MHA’s full report, “The State of Mental Health in America 2019,” at mentalhealthamerica.net

In Oregon, that prevalence was 22.61 percent, followed by Utah (22.27 percent), Kentucky (22.08 percent), Idaho (21.62 percent) and Arkansas (21.02 percent). West Virginia, Vermont, Washington, Montana, Colorado and Alaska followed with rates that were between 20 and 21 percent.

States with the lowest prevalence of adult mental illness included New Jersey (15.5 percent), Hawaii (15.55 percent), Illinois (15.73 percent), Texas (16.04 percent) and Maryland (16.59 percent). North Dakota, California, Florida, Louisiana, Michigan, Mississippi, Arizona, New York, Maine, Delaware, Iowa, Georgia and South Dakota all had rates between 17 and 18 percent.

MHA, a Virginia-based nonprofit advocacy organization, compiles a report titled The State of Mental Health in America each year from nationwide survey data, including information from the Substance Abuse and Mental Health Services Administration and the Centers for Disease Control and Prevention. Released this fall, MHA’s current report includes statistics on access to mental health care, uninsured citizens, rates of substance abuse, suicide indicators, youth depression and other factors.

See MHA’s full report, “The State of Mental Health in America 2019,” at mentalhealthamerica.net

 

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Mental Health America’s The State of Mental Health in America 2019

When it comes to mental health, how does your state stack up?

View the full report and state rankings at mentalhealthamerica.net

 

See MHA’s full report, “The State of Mental Health in America 2019,” at mentalhealthamerica.net

 

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

 

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

 

Key considerations for counselor community engagement

By Matt Glowiak, Nicole A. Stargell and Devon E. Romero November 5, 2018

If you are reading this article, it is likely because you have a strong interest in counseling. We might even be able to go a step further in saying that you probably love counseling, right? As members of the Chi Sigma Iota (CSI) Counselor Community Engagement Committee, we agree — we love counseling. We also love using components of our professional skills to directly serve the community in ways that go beyond traditional counseling.

We invite you to take a moment to close your eyes and think back: What was it that influenced your choice to become a counseling professional? Was it your love and compassion for humanity? Was it due to a struggle experienced by someone you love or care about? Was it due to some great injustice that you couldn’t stand any longer? Or was it a talent with which you were born and were fortunate enough to harness through the progression of your life? If you answered “yes” to any or all of these questions, we are in a similar situation.

People who come to this field do so because they want to be that change they wish to see in the world. Counselors embody the foundational qualities of empathy, congruence and unconditional positive regard in their everyday lives. Counselors engage with the community in positive ways on a daily basis. Other times, counselors channel more intentional counseling skills in the community when they want to make a difference, and they are willing to make sacrifices if necessary. As individuals who have taken the initiative to earn professional degrees, it is apparent that we possess a desire to make the world a better place. Why else would we spend countless hours and make significant sacrifices to get into a better position to help others?

At its core, the role of a counselor is as a helper. That is, our mission is to create a better society, person by person, population by population. As professional counselors, we join with our clients in a relationship to support them toward their mental health and wellness goals.

Although we spend the majority of our working hours in session with clients, our professional identities transcend the professional setting. The way we show up in the community is a representation of the counseling profession. We can use our unique skills to support the community in ways that extend beyond the core role of counselor. These roles might include, but are not limited to, advocate, author, community member, educator, gatekeeper, philanthropist, public speaker, researcher and student. The opportunities we have to make the world a better place are seemingly limitless.

Those familiar with CSI may be aware of our mission “to promote scholarship, research, professionalism, leadership, advocacy and excellence in counseling, and to recognize high attainment in the pursuit of academic and clinical excellence in the profession of counseling” (csi-net.org).

To fulfill a portion of this mission, the CSI Counselor Community Engagement (CCE) Committee uses the “Ten Key Considerations for Chapter CCE” to intentionally “plan and implement activities that are collaborative, have measurable goals, advocate for a specific need, make a quantifiable difference in the community and are intentionally evaluated. Many CCE activities include elements of fundraising, professional development and/or advocacy; however, CCE incorporates a unique practical application component in collaboration with a community partner.”

As individuals who love professional counseling, we spend time showing the world how professional counselors make a positive difference in the professional and community settings.

Why is counselor community engagement important?

Sometimes it can be difficult to remain optimistic when we live in a world where tragedy occurs daily. With our eyes and ears open, we cannot hide from it. From one side of the world to the other, people are negatively affected by racial oppression, sexual inequality, homophobia, homicide, genocide, school shootings, suicide, war, civil unrest, political divide, poverty, homelessness, starvation, slavery, human trafficking, drug trafficking, natural disasters, human-caused disasters and personal relationship difficulties.

As we think back on our lives, each of us can recall situations in which we, or someone close to us, were personally affected by incidents that really struck a chord with us — incidents that seemed not right, unfair or downright horrific. But what can be done?

As Mahatma Gandhi said, “You must be the change you wish to see in the world.”

The decision to respond or not to respond is one that involves several considerations. After all, as counselors, we spend our working hours helping others, and we do need some time off from work. However, people often choose not to respond because they think they cannot possibly make a difference. “How can I, as one person, stop racial oppression?” Sometimes, the decision to not respond comes from a lack of resources. “I don’t have the time.” “I don’t have the money.” “I don’t have the education or skills.” Sometimes, we don’t respond because we worry what others will think of us. “If I speak out on behalf of the LGBTQ population, will other people think that I’m gay?” Other times, the decision is in line with the phenomenon of the bystander effect. “Other people are already there who will help.” Sometimes, it comes down to us not seeing something as being our personal responsibility or business. “Well, nothing bad is happening in my neighborhood, but if it did, I would certainly intervene then.” Although the reasons not to respond are many, a lack of response always leads to the same result: continued injustice.

Then there are those who, for whatever reason, choose to respond. Whether personally affected, vicariously impacted or just wanting to do what is right for humankind, these individuals intervene to help in whatever way possible, regardless of how big or small. If you can find a small amount of energy to devote to something you view as important, you will make the world a better place.

As William Faulkner said, “Never be afraid to raise your voice for honesty and truth and compassion against injustice and lying and greed. If people all over the world … would do this, it would change the earth.”

As professional counselors, it is our ethical duty and obligation to respond to the American Counseling Association’s call in the Advocacy Competencies (2003) in the areas of client/student empowerment, client/student advocacy, community collaboration, systems advocacy, public information and social/political advocacy.

Accordingly, it is the purpose of counselor community engagement to serve those populations that need our help, even if that help extends beyond the core role of professional counselors and into those additional roles as advocates, educators, fundraisers and public speakers. After all, we possess the transferable skills, resources and desire to help. So, we should do just that when we can.

How to engage

The question is where do we begin? We start with an idea. But what use is a great idea if it remains unpursued? The truth is that it is of no use. Sometimes, a fair idea with solid implementation is what can make all the difference in the world. The difference, then, is in the execution.

As David Bornstein explains in How to Change the World: Social Entrepreneurs and the Power of New Ideas, “An idea is like a play. It needs a good producer and a good promoter even if it is a masterpiece. Otherwise the play may never open; or it may open but, for a lack of an audience, close after a week. Similarly, an idea will not move from the fringes to the mainstream simply because it is good; it must be skillfully marketed before it will actually shift people’s perceptions and behavior.”

After an idea is conceived, professional counselors should move on to complete a more intentional needs assessment surrounding the idea. As described on CSI-net.org, “Connecting with the community of interest, particularly leaders and stakeholders, necessitates a needs assessment both in formal (e.g., instruments, surveys, interviews) and informal methods. Once the needs are identified, [organizations] can begin creating an action plan to focus on steps to address each need specifically. Implementing the action plan provides direct service to the community. After the CCE activity is complete, [organizations] will benefit from an evaluation process. This evaluation connects with the community by taking their input through a variety of assessment tools (e.g., interviews, surveys) and identifies new needs to build upon for future endeavors.”

With this general progression of needs assessment, action plan, direct service, evaluation process and identification of new needs, CSI has devised a 10-step method to counselor community engagement that any organization can easily follow.

 

1) Working together: How can I or my organization work with others to promote meaningful counselor community engagement?

Counselors intentionally approach community engagement of all forms in the spirit of cooperation and service. Counselors assume a servant leadership role when out in the community and especially when engaging in a specific community engagement activity.

Working together is a crucial element of community engagement activities, and it is important to mention on its own as a foundational attitude for the other considerations. Cooperation and collaboration provide a foundation for conducting initial needs assessments and promoting change within communities. We can work with others by leading, partnering or joining. Simply by reaching out, we may receive the assistance we need to take what was once an idea and turn it into something successful.

2) Level of counselor community engagement outreach: At what level of outreach should I or my organization engage our community?

On the organizational level, it is quite natural to get stuck thinking on the microsystem level: “What can we do to help this organization?” With that logic, all thoughts and actions focus only on what the organization and its members can do within the organization to sustain it. However, by moving beyond the microsystem and working with and for others, much more work can be done than was ever thought possible. Levels of counselor community engagement outreach might include local programs, national outreach and international outreach.

Reaching out is much easier than one might think. A simple email or phone call or attendance at a meeting might create the spark for a meaningful networking opportunity. Even in terms of national and international outreach, opportunities are much less intimidating and more practical than they may at first seem. At these levels, emails and phone calls still work, but taking the time to attend a larger national or international conference allows for face-to-face, personal connection.

3) Issue areas: What community areas or issues should I or my organization focus on?

Every community is different. Each community is composed of varied demographics in varied locations with varied needs. The bottom line is that every community, regardless of how functional, has some type of need. To maximize the benefits that your organization can offer, it is important to first match your organization’s output to the needs of the community. Therefore, it is critical to begin with some type of needs assessment. This might include asking:

  • What does our community need?
  • Is there a certain social injustice I have noticed?
  • What issues are a concern to our community and larger world?
  • How do we benefit the most people?

Considerations such as these are important for beginning any type of effort. As we look around us — watching the news on TV, reading updates online, listening to the radio — we will see more and more need for our assistance.

4) Populations served: With whom should I or my organization engage?

This question varies significantly from one organization to the next. Those you engage will depend on the need you are attempting to fulfill, the population you intend to serve and the resources you have available, among other factors.

Within our communities are numerous individuals and groups we wish to serve through a variety of activities. These individuals and groups may include:

  • After-school programs
  • Boys & Girls Clubs
  • Foster children and agencies
  • Individuals who are homeless
  • Homeless shelters
  • Nonprofit agencies
  • Individuals who are oppressed
  • Populations experiencing poverty
  • Populations who have experienced a natural disaster
  • Sober homes/halfway houses
  • Vocational programs for youth and adults

Many people could benefit from the caring efforts of a citizen who also happens to be a professional counselor. Think outside the box and remember that every individual experiences his or her own unique struggles. Anyone who is open to help might benefit from counselor community engagement.

5) Community partners: Who else might be an important partner in my or my organization’s counselor community engagement efforts?

A partner may be defined as “a person who takes part in an undertaking with another or others.” A partnership can be something that is either temporary or long term. Collaborating with various organizations can maximize the effectiveness of counselor community engagement efforts. Those of you who attended the American Counseling Association Conference & Expo in Montréal in 2016 witnessed a partnership between ACA and the Canadian Counselling and Psychotherapy Association. Through this partnership, the two associations were able to merge the talents of counselors from multiple countries to further strengthen the diversity and quality of presentations, networking opportunities and other efforts.

Within our communities are numerous individuals and groups with which we might work to promote meaningful counselor community engagement. These individuals and groups may include:

  • Businesses (local and national)
  • Community boards
  • Elected officials
  • Government officials
  • Hospitals
  • Media outlets (traditional and online)
  • Mental health professionals
  • Organization members
  • Organization leaders
  • Other helping professionals
  • Primary and secondary schools
  • Professional associations
  • Registered charities
  • Religious organizations
  • Universities and colleges

Each of these entities alone or in combination may provide the necessary resources to assist in your counselor community engagement endeavor or
may significantly benefit from that endeavor themselves.

Forming partnerships is much simpler than you might think, but it always requires the first action step of reaching out. At this point, readers have likely noticed a similar theme among several of the key considerations for counselor community engagement: working with others to foster positive community change. Many individuals wish to make the world a better place. So, take a step back, think about the bigger picture, and connect with people who might wish to promote a similar mission.

6) Activities: What kinds of activities could I or my organization take part in to engage our community?

To this point, we have discussed the importance of needs assessments and collaborating with others. Depending on what is needed and who and what we have to work with, there are any number of activities in which we may engage. The main activity categories include:

  • Charitable donations and fundraising
  • Counseling and related services
  • Education
  • Other volunteer activities

These activities may include providing or organizing presentations, workshops, keynotes, continuing education, exam preparation, donations, fundraisers, sporting events, benefits, food drives, blood drives, scholarships, awareness events, conferences, free or low-cost counseling, group counseling, psychoeducational groups, awareness presentations, advocacy events, grant writing, tutoring or mentorship. Other engagement activities could involve planting trees, picking up waste, making meals, working at a food bank and so on.

Counselor community engagement activities come in all sizes and shapes. The benefits of producing one giant event will not necessarily outweigh the benefits of holding multiple smaller events throughout the year. It is important to consider the weight that “meaning” carries with every event in which your organization engages. Meaning will differ from one organization to the next. Whereas one organization might find raising $500 a relatively modest accomplishment, it could hold significant meaning for another organization. For example, it might represent the first major fundraiser the organization has ever undertaken and successfully accomplished. Or perhaps meaning is not based on the amount of money raised at all but rather on the purpose for which it was raised. In this respect, meaning might be tied strongly to a sense of accomplishment, advocacy, an increase of awareness, the building of morale, the strengthening of membership or some other factor.

7) Advocacy: What might it mean for me or my organization to advocate?

Counselors might wish to promote the welfare of an individual or group by explaining to others why the issue is important and how others can help. Counselors advocate for themselves, for the profession and for others. Advocacy can be performed at three levels:

  • Client- or population-specific advocacy
  • General community advocacy
  • Professional advocacy

Advocacy can be used to promote observable change, and it might be used to raise awareness that systematically influences decisions and circumstances across time. It is important to ask the questions, “What might it mean for my organization to advocate? How can we use our power as counselors and our privilege as citizens to speak up for what is right?”

8) Frequency: How often should I or my organization take part in counselor community engagement activities?

Although the knee-jerk response is to say the more, the merrier, it is important to consider what is practical. As we all know, an activity that is well thought out is much more productive and meaningful than something that is put together haphazardly. Determining how often you or your organization take part in community engagement should depend on
the following:

  • Needs of the community or organization
  • Availability of time
  • Funding
  • Availability of personnel
  • Availability of location (e.g., brick-and-mortar, online)
  • Motivation of stakeholders

As with any other key consideration, it is important to be strategic when planning the frequency of counselor community engagement activities. For example, an organization might consider hosting a one-time service event to raise money for families affected by the tragedy of a school shooting. Another organization might consider organizing ongoing counselor community engagement events to educate the public on topics such as bullying, gun laws, screening and peaceful intervention. In either case, the effort expended would be significant, so organizations are encouraged to take strategic action toward engagement activities that they believe will be most purposeful.

9) Action planning/program development: How might I or my organization plan and develop counselor community engagement activities?

Adequate planning and preparation will include meeting with stakeholders and setting goals with measurable objectives. For instance, multiple hurricanes tend to impact various regions of the United States each year. Action planning entails first reaching out to impacted areas and seeing how we may assist. Once needs are assessed, we can then meet with those stakeholders to develop an action plan around the goals we hope to accomplish. These goals might include performing community outreach, donating time, fundraising and so on.

10) Evaluation: How did the counselor community engagement activity impact the community and those who engaged in the project?

To answer this question, some type of evaluation must be conducted. This may be done using a simple survey, soliciting feedback, asking questions or via other means. What are the benefits of a comprehensive evaluation? According to Kieron Kirkland, former development research manager at Nominet Trust, which is a grant maker in the field of socially motivated technology, performing an evaluation helps organizations to:

  • Know whether an activity or project is working
  • Know how things are working
  • Understand why things are working
  • Be more adaptable
  • Be aware of unintended outcomes
  • Better communicate the value of their work
  • Focus their work
  • Help look after the people with whom they are working
  • Build organizational resilience

Many factors contribute to the success or failure of a counselor community engagement activity. Without investigating the various components of the activity, it is difficult to gauge whether it is worth conducting again or whether improvements are needed. To increase efficacy, there needs to be some indication of what works. Otherwise, organizations may continue spending resources on something that is fruitless or even harmful. Therefore, it is essential to always conduct some type of evaluation after each counselor community engagement activity.

 

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It is our hope that you have found this article helpful for planning, implementing, maintaining and evaluating your counselor community engagement activities. With a bit of effort and intention, we can achieve much more together, thus fulfilling the mission of ACA, CSI and the counseling profession as a whole. Now it is time for you to help change the world.

 

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

Matt Glowiak is core clinical faculty at Southern New Hampshire University as well as co-clinical director and co-founder of counseling speaks in Chicago, Park Ridge and Lake Forest, Illinois. He currently chairs the Chi Sigma Iota (CSI) International Counselor Community Engagement Committee. Contact him at m.glowiak@snhu.edu.

Nicole A. Stargell is an assistant professor in the Department of Counseling at the University of North Carolina at Pembroke, where she serves as the clinical mental health counseling field placement coordinator and the counseling programs testing coordinator. She is also the chapter faculty adviser of the Phi Sigma Chapter of CSI. Contact her at nastargell@gmail.com.

Devon E. Romero is an assistant professor in the Department of Counseling at the University of Texas at San Antonio. Contact her at devon.romero@utsa.edu.

 

Letters to the editor: ct@counseling.org

 

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

From the President: A counseling focus on teens and young adults

Simone Lambert November 1, 2018

Simone Lambert, ACA’s 67th president

Today’s adolescents and emerging adults are facing an ever-changing world, with growing repercussions on their well-being and ability to be contributing members of society. Young people struggle with forming their identities, engaging in healthy relationships and navigating life transitions. In addition to confronting the challenges of these developmental tasks, approximately 20 percent of youth experience mental illness, including substance use disorders and mental disorders. Professional counselors are well-equipped to diagnose and treat mental health and substance use disorders, whether as stand-alone or co-occurring disorders.

As reported by the U.S. government website youth.gov, half of all mental health disorders have surfaced by age 14. Furthermore, by age 24, approximately 75 percent of adults who will have a mental health disorder in their lifetime have symptoms that meet diagnostic criteria. What this means is that professional counselors who work with youth in schools and in the community are ideally suited to engage in prevention services, screenings and early interventions to assist young people in obtaining needed counseling treatment.

Another major focus for youth is to seek academic studies that will prepare them for the world of work. Yet, a report by the Institute for the Future estimates that 85 percent of jobs in the year 2030 do not currently exist. Therefore, school-based and career counseling are essential components of preparing youth for the unknown within the career market. Professional counselors across settings will play a pivotal role in readying the upcoming U.S. workforce for impending changes related to technological advances.

As the World Health Organization points out, youth violence is another issue that needs to be addressed. Again, professional counselors are part of the solution, providing early intervention and treatment for those who are at risk of engaging in violent behavior and for those who are victims of such violence. Other forms of trauma-informed counseling for youth center on natural disasters, sexual assault, abuse and neglect.

In addition, many youth endure disabilities or chronic illnesses such as diabetes, fibromyalgia and epilepsy. These life-altering physical diagnoses have widespread impact on adolescents and emerging adults in relation to their mental health. Furthermore, typical developmental tasks may be delayed or impeded. Thus, youth may benefit from counseling focused on specialty areas of rehabilitation, school, career and mental health when living with a medical condition.

Professional counselors can facilitate resiliency, wellness and recovery by providing prevention and treatment services to adolescents and emerging adults. We can assist youth in sustaining optimal mental health and reaching their academic and career goals. To do that, we need to engage youth within our counseling rooms and advocate on their behalf with families, school personnel and policymakers.

There are myriad ways you can be a youth mental health advocate. Let your state legislators know that you support the inclusion of mental health education in school curricula, as has been done in New York and Virginia. At the state and federal levels, fight for youth to have access to mental health care and addiction counseling in schools, colleges and communities. Engage in culturally sensitive and developmentally appropriate prevention and screening within your own work setting. Start planning how you can engage in youth-focused public awareness activities during the American Counseling Association’s Counseling Awareness Month (counseling.org/events/counseling-awareness-month-2018) and the Substance Abuse and Mental Health Services Administration’s National Prevention Week (samhsa.gov/prevention-week). Finally, partake in professional development related to youth mental health, substance abuse, career issues, risk assessments and trauma-informed care.

Professional counselors can assist youth in overcoming past, present and future challenges and obstacles. Collectively, we can all share our counseling expertise and advocacy efforts to help today’s youth be ready for tomorrow. 

 

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