Tag Archives: counseling

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.

 

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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.

 

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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.

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.

 

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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.

 

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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.

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.