Tag Archives: counseling

ACA online event encourages conversation about counselor stressors

By Bethany Bray September 21, 2020

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

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

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

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

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

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

S. Kent Butler

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Confrontation can be a therapeutic tool, White added.

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

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

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

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

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

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

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

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

 

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Resources

Continue the conversation

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

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

Counseling Today articles on related topics

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

 

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

Learning from highly effective counselors

By Sidney Shaw March 10, 2020

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

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

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

Counselor effects and outcome research

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

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

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

Five characteristics and actions of highly effective counselors

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

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

1) Presence and
2) countertransference management

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

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

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

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

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

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

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

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

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

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

3) Professional self-doubt

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

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

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

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

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

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

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

4) Deliberate practice

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

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

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

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

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

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

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

5) Multicultural orientation

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

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

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

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

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

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

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

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

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

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

Conclusion

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

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

 

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

 

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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.

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.