Tag Archives: interdisciplinary

Encouraging T-shaped thinking in the counseling profession

By John McCarthy May 18, 2020

I thought it was a most ridiculous assignment. The instructor of my Introduction to Counseling course in 1988 asked us to write, of all things, a book report. “Make sure the book has nothing to do with counseling,” he directed.

I was incredulous. “My first class in counseling, and he’s asking us to do a fifth-grade assignment?” I wanted to learn everything I could about counseling, especially in an initial course, and a book report was not on my anticipated list of important things to do.

Years later, I realized that it was a brilliant stroke by the professor, and in 2020, I believe it could well be a portal to the future of the counseling profession. With a strong interest in creativity, I now realize the impetus of the assignment. The instructor wanted us novice students to know things outside of counseling. Go learn about Portuguese history, quilting or the evolution of vacuum cleaners.

The assignment concerned creativity and, in retrospect, was aimed at helping us counselors-in-training with our creative “shape.” Creativity involves being a “T-shaped” person, a term originating from a well-known design firm named IDEO. The T-shape idea entails a person knowing a great deal about a specific discipline and having a breadth of knowledge in other fields. It is not a matter of being an expert in only one area, represented by the vertical line in the T, but also being able to draw from other arenas, as represented by the horizonal line.

In her 2009 book What I Wish I Knew When I Was 20: A Crash Course on Making Your Place in the World, Tina Seelig related the importance of developing T-shaped thinkers in directing the Stanford Technology Ventures Program. The aim was straightforward: Students would have an extensive knowledge base in one discipline, perhaps science or engineering, along with, in this case, innovation and entrepreneurship.

It is the combination skills that can be central to creativity. Incidentally, it is these skills that represent the C (combination) in the commonly cited SCAMPER acronym of creativity. Linking ideas from counseling with web design, political science or chemistry can lead to innovative solutions in any number of roles that counselors play, including as consultants, crisis responders or group facilitators.

In her book, Seelig also observed, “Life presents everyone with many opportunities to experiment and recombine our skills and passions in new and surprising ways.” T-shaped thinkers can draw from other parts of their knowledge base in that recombining process to formulate more creative solutions to challenges.

Radical collaboration

The T metaphor isn’t just about individual counselors though. It also concerns our counseling profession and, in my opinion, how it can be strengthened in the coming years. Yes, integrated care is critical to counseling, but I believe that interprofessional partnership extends beyond this model.

“We believe in radical collaboration.” The last two words caught my eye as I read the “We’re glad you’re here!” brochure during a recent visit to the Hasso Plattner Institute of Design at Stanford University. Also known as the “d.school,” this internationally recognized institute offers students from an array of disciplines — including engineering, law, business and medicine — the opportunity to deepen their creative skills and gain design competencies toward solving complicated dilemmas.

The same brochure posed thought-provoking questions, one of which fits the notion of “radical collaboration” and the future of the counseling profession: Choose two diverse occupations and list ways that they could work together to answer a challenge in the real world. If counselors were chosen as one of the occupations, imagine the potential life-changing ideas that could be sparked in partnering with oceanographers, mathematicians or cybersecurity specialists. Imagine how social justice, advocacy and consultation could be integrated. Imagine how such an adventure could result in even more creative T-shaped counselors-in-training and professional counselors.

Work involving the search terms “interprofessional” and “counselor” would appear to be limited, although the topic has been discussed in the literature for at least 30 years. Elizabeth Mellin, Brandon Hunt and Lindsey Nichols conducted questionnaire-based research among counselors in 2011 that included a discussion on interprofessional collaboration. In a 2016 study, Christianne Fowler and Kaprea Hoquee (nee Johnson) described a one-day standardized patient experience among students in counseling, nursing and dental hygiene programs. In research published last year, Kaprea Johnson surveyed students in counseling, along with those in dental hygiene, nursing and physical therapy programs, and concluded that counseling students were as receptive as the students in health care programs regarding interprofessional training.

Examples of interprofessional interaction are seen in related mental health arenas. Last year, the American Psychological Association announced that it would be partnering with medicine, pharmacy, nursing and other areas to oversee organizational accreditation for interprofessional continuing education. According to the article announcing this recent development, the move was viewed as a benefit to the field, especially in relation to the amount and caliber of continuing education possibilities. A second instance is Robert Morris University’s Access to Interprofessional Mental Health Education program, which aims in part to train psychiatric mental health nurse practitioners to offer care as part of an interprofessional team.

Identity is central to our counseling profession, and T-encouraged initiatives with other domains can make us better as a whole, broadening our collaboration with — and increasing our visibility by — other fields. Continuing education regulations could be modified to include domains outside of counseling. Imagine counseling conferences with people from other areas such as pharmacy, dentistry, media relations, medicine, computer science and the design industry. Presentations by counselors in tandem with dietitians, architects and TV producers could deepen our knowledge bases and foster further cross-disciplinary collaboration.

Programmatic standards could be adjusted to encourage (or perhaps even require) counseling students to take at least one elective outside of the department. They could learn about the future of health care in a medical curriculum, about correctional reform in other countries in a criminology program, or about sustainability in an engineering course.

T-shaped efforts at the professional level would deepen our collective cultural competency and contribute to our collective mindfulness. Kio Stark devoted a 2016 book to talking with strangers, and her message aligns with the present-moment orientation that counseling espouses. “When you interact with a stranger,” she wrote, “you’re not in your own head, you’re not on autopilot from here to there. You are present in the moment. And to be present is to feel alive.”

Developing cross-disciplinary tentacles can aid our future. T-shaped counselors and a T-shaped profession can broaden our scope, charge innovative ideas, emphasize wellness and deepen counseling’s visibility.

Counseling is a holistic, collaborative approach. Let’s extend the letter T in encouraging creative counselors and, ultimately, an innovative counseling profession.

The letter of tomorrow is T. Now let’s all go read some books.

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John McCarthy is a professor in the Department of Counseling at Indiana University of Pennsylvania. Contact him at jmccarth@iup.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.

Maintaining counselor identity in interdisciplinary teams

By Princess Lanclos and Krystal Vaughn December 3, 2019

Professional counselors are increasing their presence in a variety of settings, including nonprofit agencies, clinics, private practice groups, schools, hospitals, and state and federal vocational rehabilitation centers. In these settings, counselors are likely to work with other health care professionals for the benefit of their clients. Some of these other professionals involved in the care of clients may include physicians, speech therapists, occupational therapists, and case managers. As we enter into new arenas, our ability to advocate for the counseling profession is imperative, yet many counselors may find themselves questioning how to do that while working in interdisciplinary teams.

One way that advocacy may be achieved in an interdisciplinary team is through active implementation of a shared decision-making model. According to research conducted by France Légaré in 2011, shared decision-making models have historically focused on the patient-physician dyad.

Both medical professionals and professional counselors are trained to make decisions to benefit their clients. However, counselors are typically trained to use an ethical decision-making model such as Holly Forester-Miller and Thomas Davis’ seven-step process:

1) Identify the problem.

2) Apply the ACA Code of Ethics.

3) Determine the nature and dimensions of the dilemma.

4) Generate potential courses of action.

5) Consider the potential consequences of all options and determine a course of action.

6) Evaluate the selected course of action.

7) Implement the course of action.

Medical professionals, on the other hand, may be trained to use a medical decision-making model. This model involves 1) the number of potential diagnoses and management options that must be considered during an encounter, 2) the amount and complexity of data to be reviewed as a result of the encounter, and 3) the risk of complications, morbidity and mortality associated with the encounter.

Alternatively, medical professionals may use a shared decision-making model. This model first determines if the decision is the right thing to do ethically. Next, the patient is provided with treatment options so that the patient can make an informed decision. Consent is then obtained. This model helps bridge health disparities by involving patients in many aspects of the treatment, including the informed decision-making process.

All of these decision-making methods share similarities, including placing emphasis on four common principles: autonomy, justice, beneficence and nonmaleficence. Additionally, both the ACA Code of Ethics and the American Medical Association’s code of medical ethics strive to protect the confidentiality of the client/patient. In The American Journal of Emergency Medicine in 2016, Chadd Kraus and Catherine Marco defined shared decision-making as a collaborative process that allows patients (or their surrogates) and clinicians to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values, goals and preferences.

Therefore, in an interdisciplinary team, a professional counselor may offer a unique perspective to benefit the client or patient. This can lead to counselors advocating for themselves and their profession. The question is, how do we bring awareness to these variations in decision-making models on the basis of any health care professional’s training program while also effectively training and implementing these approaches for both new and seasoned health care professionals?

Classroom

Professional identity and ethical decision-making begin early in a counselor-in-training’s academic career and are specifically reinforced in CACREP-accredited graduate training programs. These programs are composed of core courses (e.g., ethics, counseling techniques, assessment) that allow students to begin exploring and implementing the skills needed to handle ethical dilemmas. At this stage of professional development, graduate students are establishing ethical decision-making practices and the principles of autonomy, nonmaleficence, beneficence and justice, which are reinforced throughout their academic careers (e.g., practicum, internships).

Additionally, the opportunity to practice implementing a shared decision-making model may be offered in a classroom setting by engaging students in activities or courses in which they join with students from other disciplines to approach a case study and propose a holistic treatment plan that addresses each discipline’s scope of practice. Engrossing students in this practice may aid in postgraduate work and provide them a new perspective and appreciation for various treatment providers who might be serving their clients.

However, unless a student is placed at a practicum or internship site where multiple disciplines are offering services, the student may receive little guidance related to working within an interdisciplinary team. Therefore, we encourage counseling training programs to initiate relationships with potential internship sites that feature multiple disciplines so that students can experience the benefits and challenges of working within interdisciplinary teams. Alternatively, students could be placed at internship sites that actively consult with other treatment providers outside of the internship site.

Post-graduation

Think back to your first job after graduation or even to your current place of employment. Did/does your agency offer an opportunity for interdisciplinary consultation or encourage you to consult with a client’s treatment team in another health care setting? As a beginning professional in the field of counseling, did you feel comfortable discussing your treatment recommendations with another professional?

As members of interdisciplinary teams, counselors should understand not only the challenges but also the benefits of shared decision-making models in conjunction with an ethical decision-making model of their choice. Each of these models benefits the client and the field of counseling.

Implementing model and consultation

Many individuals are trained in graduate school to interact with the identified client but may have limited exposure to working within an interdisciplinary or interprofessional team. However, the reality is that the clients we see today may have a variety of treatment providers (speech therapists, occupational therapists, case workers, physicians, psychologists, etc.). It takes practice and experience to maintain our counselor identity while engaging in consultation with other treatment providers. Exploring instances in which consultation is needed and how it is implemented may aid in providing and advocating for quality holistic treatment for clients.

Consultation first requires knowledge of the treatment team. Who is the client working with outside of your agency or clinic? Do you have consent to speak with that individual in accord with Health Insurance Portability and Accountability Act (HIPAA) considerations? Counselors must reflect on how consulting with the treatment provider would aid in the client’s treatment. At times, we may consult to share treatment goals or treatment progress. However, at other times, we are consulting to gain information regarding another professional’s goals, methods or protocols. Once a working relationship is developed, the counselor may proceed to engage in the initial phase of consultation.

Step one: The initial phase of consultation should include preparing for the call, including ensuring that all proper HIPAA release of information and agency paperwork have been completed. The counselor should be prepared with a concise yet well-thought-out reason for requesting consultation. What information would the counselor like to share or request? The counselor may also want to consider whether the person being consulted understands that the counselor is also working with the individual and how the counselor’s role relates to the treatment of the individual. 

Step two: The counselor should contact the consulting agency, provide the release of information, and schedule a consultation. Scheduling may be essential because many professionals are busy and might not be readily available to speak. It sometimes requires numerous phone calls to contact the individual provider. Even if the provider is available, he or she may not have the client’s chart or may still need to review the information, potentially causing frustration and delays. Therefore, if a call is scheduled, all parties should be prepared to participate fully.

Step three: The requesting provider should be well-prepared with information that might be shared or requested during the consultation call. A brief overview of how the client came to receive services from the counselor and what services the counselor is providing is a nice place to start. This should be followed by discussing the client’s condition, interventions, shared treatment goals, schedule/frequency of treatment, prognosis, and expected duration of treatment. At times, professionals may have similar treatment goals for the client but might be using different interventions or approaches. It is important to recognize that overlap may exist in the knowledge and skills of each provider. In such cases, it may be necessary to discuss why the providers and treatment modalities are mutually beneficial to the client. During the consultation, it may also be important to consider alternative or complementary therapies.

The counselor may be seeing the client more frequently than is the other provider, so a general impression of the client’s current condition and presentation may be helpful to the overall treatment team. The consultation call should allow the counselor to ask questions of the other providers and vice versa. Consultations can be held individually or with all members of the treatment team, depending on the levels of intervention and the specific consultation questions being asked.

Treatment teams may need to determine who will be responsible for which treatment goals or objectives. (Note: Professional counselors must be careful to stay clearly within their scope of practice.) At this point, it may also be important to schedule a follow-up consult, if necessary, and determine which of the treatment providers will start the call. Follow-up consults work best when they are planned, scheduled and predictable. This allows providers to align treatment goals and outcomes.

Step four: The counselor should document consultations in the client’s file. The consultation notes should include the name of the client, date and time of the call, and length of the call. The purpose of the call should also be clearly noted and supported by HIPAA release of information documentation. We recommend also dedicating a space on the consultation documentation form for a narrative that states the overview and outcome of the consult.

Case example

Sally is a 12-year-old female who is seeing a licensed professional counselor to help her reduce her anxiety symptoms. Initially, a licensed clinical psychologist diagnosed Sally with generalized anxiety disorder (GAD) and a speech language disorder and then referred her for speech, counseling, and medication evaluation. Sally lives at home with her parents and doesn’t have any siblings. The counselor would like to speak with Sally’s psychologist, school counselor, speech therapist, and treating child psychiatrist. The counselor requested that Sally’s parents sign HIPAA forms during the initial intake session.

Step one: After treating Sally for two to three sessions, the counselor forms consultation questions for each provider treating Sally. The counselor first would like to know from the psychologist whether Sally has any educational limitations that would prevent her from participating in cognitive behavior therapy. Second, the counselor would like to know how the school is addressing Sally’s symptoms of GAD, whether an accommodation plan is being or has been used for Sally, and whether the school counselor is working with Sally weekly. Third, the counselor would like to know whether the speech therapist is noticing signs of GAD during sessions with Sally and, if so, how the speech therapist is addressing those symptoms. Finally, the counselor would like to know what recommendations the psychiatrist has, while also providing the psychiatrist with information on Sally’s progress and the techniques being used in the counseling sessions.

Step two: The counselor will contact each of the four providers’ offices to request a consultation call. The counselor will also scan or fax the HIPAA release to each provider in a secure manner.

Step three: The counselor will review the file, treatment goals, progress, and schedule/frequency of treatment for Sally. The counselor should have questions prepared or outlined for each of the consultation calls. It will be important for members of Sally’s treatment team to consider how the various treatments may support one another, be similar, or be different. The team should also consider how often consultation will need to occur and who will be responsible for scheduling. For example, the psychologist may not have any additional contact with the family and require no further communication with the treatment team. However, the school counselor and speech therapist may be seeing Sally weekly, similar to the counselor. Therefore, frequent contact between these three providers may be necessary. Finally, the psychiatrist may request information only immediately prior to Sally’s next appointment.

Step four: The counselor will document each consult. The note should include the date and time of each consult, a summary of the consult, and the next scheduled consultation.

Conclusion

Using the aforementioned instructions while consulting with other health care professionals may aid in applying a decision-making model that will continue to benefit the clinician, the client, and the counseling profession as we continue to adapt and improve our provision of treatment for the populations we serve.

As professional counselors, we may find ourselves working alongside other professionals who hold more advanced degrees. Regardless, it is important that we maintain our counselor identity, uphold our professional code of ethics, and advocate for our clients’ well-being. When involved in interdisciplinary teams, it is imperative that we are able to work within our scope of practice as counselors and clearly state the rationale for the interventions we are providing in therapy. Additionally, implementing a shared decision-making model fosters an opportunity for us to advocate for our profession and our clients while in interdisciplinary settings.

 

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Princess Lanclos is a doctoral student in counselor education and supervision at the University of Holy Cross in New Orleans. She is a national certified counselor, a certified rehabilitation counselor, and a provisionally licensed professional counselor. Her areas of focus include substance abuse, counseling ex-offenders, and multicultural counseling. Contact her at princess_lanclos@uhcno.edu.

Krystal Vaughn is a licensed professional counselor supervisor specializing in working with children ages 2-12. As an associate professor at Louisiana State University Health Sciences Center–New Orleans, she enjoys teaching and providing clinical services. Her research interests include supervision, play therapy, and mental health consultation. She has extensive experience providing mental health consultation in child care centers, private schools, and local charter school systems. Contact her at kvaugh@lsuhsc.edu.

 

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

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.

Bringing CBT into the doctor’s office

By Bethany Bray September 12, 2018

When you get your annual physical, does your primary care physician ask if you’ve been feeling atypically sad or anxious lately?

Primary care doctors are often the first professional a person will tell about symptoms related to depression or other mental health issues. With this in mind, two Pennsylvania counselors have created a presentation on coping skills and takeaways from cognitive behavior therapy (CBT) that medical doctors can use with their patients.

When Brandon Ballantyne and Kevin Ulsh spoke to the primary care physicians and other medical personnel at Tower Health in Reading, Pennsylvania, recently, they found an interested and engaged audience. The medical practitioners were particularly interested in learning more about how to help patients who present with anxiety and related problems during medical appointments.

Ulsh and Ballantyne are mental health therapists in the inpatient and partial hospitalization programs, respectively, at Reading Hospital, which is part of the Tower Health system. Ballantyne is also a licensed professional counselor and American Counseling Association member.

How can aspects of CBT be translated for use in the medical professions? CT Online asked Ulsh and Ballantyne some questions to find out more.

 

How did this come together? Did you reach out to the doctors, or did they invite you to come?

We have always been interested in the concept of extending coping skills practice and implementation into primary care settings. We believe that the primary care setting is where most individuals first report problems associated with anxiety, stress, depression and so on. In many situations, the primary care physician is the first provider to address such issues.

Recently, we have observed a growing trend to integrate primary care and behavioral health services. We decided to take these observations and build a coping skills lecture that can assist providers in the primary care setting with addressing stress and anxiety, along with other mood-related problems with the patients they serve. We developed an outline for a presentation and broadcast the idea to the primary care Tower Health continuing education team, who then gave us an invitation to present it as a part of their lecture series.

 

How did it go? Were the doctors open to your message? What were some of the things they asked or commented about?

The lecture went well. The doctors in attendance were attentive and interested. They asked several questions about how to address behaviors particularly associated with adolescent anxiety such as school avoidance and oppositional defiance. We addressed these questions by referring back to the cognitive model, which we highlighted as a foundation of our lecture.

We think it was important to have a discussion with the doctors about the clinical indicators of avoidance versus defiance. Utilizing a cognitive philosophy, we emphasized that avoidance typically shows itself as a behavior which prevents an individual from doing something that they would like to be able to do or would want to be able to do if not affected by anxiety. The anxiety that drives avoidance is typically a product of some anticipated fear. … The individual has cognitively come to the conclusion that the fear itself is an already established fact or guarantee.

Defiance, on the other hand, is a behavior that is driven by the desire to maintain control by resisting demands and expectations to comply with things that are simply undesirable. In other words, in the cognitive process that drives defiance, an individual may think, “If I don’t like it or don’t want to do it, then I don’t have to, and it doesn’t matter what anyone says.”

Therefore, primary care physicians may be able to get a better handle on what it going on with the patient, clinically, simply by asking about their thinking.

 

From your perspective, how could CBT be helpful in a medical setting? Please talk about why you chose to focus on CBT when you spoke to the doctors.

We chose to focus on cognitive behavior therapy when providing this lecture because CBT is an evidence-based approach that has been shown to be an effective form of treatment for multiple psychological problems across various populations. We believe that in the primary care settings, patients will benefit most from socialization to the cognitive model, so that they can gain a clear understanding of the difference between a thought and an emotion.

Once an individual understands the relationship between a thought, an emotion and a behavior, they acquire control over regulating their mood and reactions in a positive way. CBT-based skills are goal-oriented, problem-focused and able to be introduced and taught to individuals dealing with a wide range of psychological problems.

In the fast-paced primary care setting, brief psychological education and skills practice can be a piece of the treatment puzzle that not only addresses the emotional problems of the patient, but also offers skills that they can continue to utilize and benefit from outside of the office (such as deep breathing, sleep hygiene, behavioral activation, disputing cognitive distortions, thought journals, activity scheduling, etc.).

 

From your perspective, what are the benefits to this kind of collaboration? In other words, benefits not only for the professionals involved, but for the patients/clients too.

There are multiple benefits to this kind of collaboration. We believe that in most cases, the first call that patients make when they are not feeling well is to their family doctor. On some occasions, they are being seen by their family doctor for a physical health issue. However, in the midst of assessment, they may reveal an emotional problem or talk about a significant stressor that is causing psychological distress.

This is because for the most part, individuals attend treatment with a primary care doctor whom they trust. Maybe they have been seeing this doctor for most of their life. They have learned to confide in this doctor quite often. Therefore, they may be more open to acknowledging emotional problems within that office setting.

The type of collaboration that we facilitated reinforces the importance of integrating psychological education and coping skills practice into a primary care setting. For professionals, it improves the continuum of care and reduces the stigma of mental health problems. Ongoing behavioral health collaboration, and having a behavioral health component to primary care treatment, implies that psychological distress is a natural area of assessment which patients might otherwise be hesitant to acknowledge or discuss. In this way, patients can become more open to behavioral health support and more accepting of their need to seek outpatient therapy to further resolve symptoms.

 

What advice or tips would you give to counselors who might want to collaborate with medical professionals, like you did, in their local area?

We would suggest that mental health professionals in all parts of the country consider developing a presentation on one particular area of therapy and/or psychological education that you feel passionate about [and] which you also utilize with the clients you serve. The goal is to develop a component of that theoretical orientation that is applicable to a primary care setting. It has to be something that primary care physicians can utilize within the short amount of time that they have with their patients.

We found that in our lecture, doctors were most interested in the practical applications of CBT as it pertains to the acute management of anxiety. We assume that other helpful topics may be closely related to dialectical behavior therapy [and] concepts such as mindfulness, distress tolerance and opposite action.

 

Is this something you think that counselors could or should do more of? What did you learn through this process?

As a result of providing this lecture, we learned that primary care doctors are very much interested in behavioral health support and assistance. It seems as though there has been an increase of patients presenting to family physicians with emotional problems. The doctors that we spoke with were very thankful for the background on CBT and the skills practice that we provided. In fact, they practiced some of the skills with us.

It reminded us that regardless of the [health] profession, we all will be most effective [with] our patients if we are also taking good care of ourselves. Integrating behavioral health support, psychological education and coping skills practice into a primary care setting reinforces the importance of seamless multidimensional treatment, ultimately helping patients to receive effective care that addresses their physical and emotional needs, and offers the safety to accept the behavioral health treatment that they may otherwise be hesitant to pursue.

 

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Ballantyne and Ulsh can be contacted via email:

Brandon.Ballantyne@towerhealth.org

Kevin.Ulsh@towerhealth.org

 

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Related reading, from Counseling Today:

Integrated interventions

The counselor’s role in assessing and treating medical symptoms and diagnoses

When brain meets body

 

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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.

 

Identifying colors to create a rainbow of cohesion in the workplace for helping professionals

By Jetaun Bailey and Bryan Gere September 7, 2018

The idea for this piece came about when I (Jetaun Bailey) was pursuing my master’s degree in counseling. I recall my professor stating clearly that burnout occurs often among helping professionals and that the average stay for a counselor employed at a mental health facility is two years.

As one of my assignments, I completed and presented a paper on ways for helping professionals to avoid burnout. However, not once in my presentation did I illustrate ways that the workplace could employ preventive services to combat burnout. At the time, my focus was on using self-care and, ultimately, I received a grade of 100 on that project. However, in reflecting on my counseling career, I realized that workplace training programs overlook helping professionals by not addressing topics related to the complex workplace dynamics that may contribute to burnout, which is likely to increase, because the demands in the counseling profession can be overwhelming.

According to Amanda Stemen’s 2014 article, “Burnout: Who’s taking care of the care takers?” management in the helping professions focuses more on clients than on employees. Many factors are related to burnout. Low salaries are one contributing factor but not the most significant. Many of us who enter the helping professions, counseling in particular, understand that we are not pursuing a lucrative career. However, lack of managerial support is believed to be a significant factor in burnout. This lack of support isn’t necessarily intentional; it is thought that many in management believe that helping professionals have innate abilities to solve their work-related problems. However, in many cases, counselors work in isolation, without support from management and peers, and know its effects.

Thus, management’s support is critical in reducing burnout among helping professionals. In speaking with Terra Griffin, a manager at an acute behavioral hospital unit for children and adolescents, she revealed that the turnover in the unit was among the highest in the hospital. Such high employee turnover costs organizations time and productivity. One of the staff’s chief complaints was management’s failure to provide them with relevant training to meet the demands of the job and promote workplace cohesion, which had led to many problems within the teams.

Stemen’s article suggested the need for professional development in addressing burnout. She reports that providing professional development opportunities customized to employees’ interests encourages growth that benefits both the individual employee and the organization.

 

Mind-mapping

One professional development approach is to employ mind-mapping concepts. This is accomplished by creating a specific topic or question so that each person in the training session can see other points of view rather than just his or her own. This nonintrusive approach facilitates group cohesion. Researcher Tony Buzan, the author of Use Your Head, developed the mind-mapping concept in the 1970s. It is designed to facilitate the sharing of ideas and concepts to solve problems.

Through observation, Griffin employed this concept in a series of training sessions simply by asking employees in a unit where turnover had been problematic a simple question: “What is your favorite color?” Initially, the employees did not seem eager to participate in the training session. Remarkably, however, when Griffin focused the initial session on that single question, changes in body language occurred among the staff immediately, as if thinking about their favorite colors had some sort of healing effect. Afterward, they were eager to share their favorite colors and the ways they identified with those colors personally.

Interestingly, although employees weren’t given information about the psychological meaning of each color ahead of time, they ended up describing them similarly to how they were presented on Griffin’s color chart. Furthermore, they could identify their similarities and differences in relation to their multiple colors. This helped shed light on some of the difficulties the employees faced in creating a more cohesive work environment.

Three therapeutic teams were present at each training session, each of which was composed of two therapists, one psychiatrist, several nurses and several behavioral specialists. During their self-exploration of the colors, Team 2 realized that many of its members shared the same favorite color, red, while the two therapists identified with blue. Incidentally, of the three groups, Team 2 was confronting the most difficulties. Many of the team members who identified with red were having difficulties sharing leadership responsibilities and were disregarding the leadership authority of the two therapists who identified, unconsciously, with blue. Once members of Team 2 were able to understand their difficulties, they began to discuss ways that their team could work more cohesively. As a result, Team 2 set team goals, with respecting one another identified as the top priority.

Instead of asking employees direct questions about their workplace problems, this exercise of looking at their favorite colors appeared to be a nonintrusive method that encouraged employees to share their differences. Griffin’s simple question elicited many answers with respect to therapeutic problems occurring in this workplace of helping professionals, and thus promoted resolutions to some stressful issues.

 

The psychology of color

Intrigued with the feedback from the staff during these sessions as they compared their favorite colors to their personalities with respect to their workplace relationships, we set forth to emulate this training. Ultimately, we implemented a similar version in a group of training sessions for graduate students who would be entering the helping profession as practicum and internship students. Their feedback and interactions were outstanding. We learned much about our students that we had not known, and this helped us revamp our practicum and internship training program for students and site supervisors.

As a result, we set out to explore how many nonintrusive, evidence-based training programs of this nature were available. We conducted a content analysis of evidence-based studies on the psychology of color. We also sought to determine the extent to which such training materials are designed to facilitate workplace cohesion among helping professionals.

Using the American Psychological Association (APA) database and electronic resources, we searched APA PsycNET, PsycINFO and PsycARTICLES from their inception through 2018. Furthermore, we used the Google Scholar search engine. The search phrases we used were “evidence-based practices on color psychology” and “training curriculum on color psychology.” The criterion for inclusion for review was that the title contained the search phrase; studies that did not meet the criterion were excluded.

After completing the content analysis, we could not find a single evidence-based study on color psychology or training curriculum related to the topic. We also were unable to determine the extent to which such training curricula facilitated workplace cohesion among helping professionals. There appears to be a significant gap in the literature pertaining to the actual use of color psychology in the facilitation of workplace cohesion in human services or among helping professionals. We did not find any specific evidence-based studies that provided empirical information on training materials on the subject that lead to workplace cohesion. The absence of this information reflects the extent to which the topic is largely unexplored and illustrates what little recognition it is accorded.

In “Colors and trust: The influence of user interface design on trust and reciprocity,” Florian Hawlitschek and colleagues indicate that the literature available on the psychology of color suggests that color preferences associated with personality influence interaction patterns in the employment setting. This illustrates that understanding the role that color preferences play in group behaviors and settings is critical to interprofessional collaborations, especially among helping professionals. Furthermore, other literature has suggested that colors have individual meanings based on a person’s cultural background or racial and ethnic group. Therefore, the influences of color should be interpreted with caution.

However, what made this training so unique is that Griffin did not use any assessment tools to determine anyone’s colors. Instead, she asked each person his or her favorite color and thus gave life to their individuality based on their cultural or racial and ethnic backgrounds without probing for any specific details (colors hold a universal meaning of harmony in many cultures). This mind-mapping technique seemed beneficial. Griffin’s leadership played an important role in helping the employees navigate through their favorite colors by connecting to their personalities and the way they fit within the scheme of their work productivity to create or disrupt cohesion.

 

Conclusion

As the dynamism within health and human service delivery creates more interdependencies, there is a growing need for professionals to collaborate to achieve better client outcomes. However, there is little information on the role that the characteristics of interdisciplinary teams play in promoting synergy that influences such outcomes.

Shared values, mutual respect for colleagues’ expertise, and patient-oriented goals and outcomes are reflections not only of the diverse interests and asymmetry of power of the various partners in care, but also differences in their personalities and preferences. Therefore, fostering workplace cooperation and cohesion is essential for effective, competent, cost-effective, culturally responsive and comprehensive service delivery.

Creating mind-mapping trainings designed to honor individual uniqueness, such as the identification of favorite colors, can help us achieve such cohesion. These trainings draw us into companionship where we can evaluate our similarities and differences through our individual uniqueness, thus creating a meaningful and purposeful work environment for helping professionals and the clients they serve.

 

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Jetaun Bailey is an assistant professor at Alabama A&M University, where she serves as director of clinical training. Contact Jetaun at jetaun.bailey@aamu.edu or baileyjetaun@hotmail.com.

 

Bryan Gere is an assistant professor at Alabama A&M University, where he serves as coordinator of clinical training in rehabilitation counseling. Contact Bryan at bryan.gere@aamu.edu.

 

Terra Griffin, a licensed professional counselor supervisor with more than 15 years of experience in counseling management, supervision and training, contributed to this article.

 

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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 people who stutter

By Chad M. Yates, Karissa Colbrunn and Dan Hudock April 11, 2018

Kyle hears the drone of the elevator music playing behind the bland voice that states, “All calls are important to us. Thank you for your patience. A customer service representative will be with you in just a moment.” Kyle knows the message well because he has been on hold for nearly 15 minutes. While waiting, Kyle practices in his head the message he needs to state: “Hello, my name is Kyle, and I need to schedule a shuttle ride to and from the airport.”

Suddenly, a crackling voice replaces the music. “Hello, thank you for calling OK Shuttle. How can I assist you?”

Kyle feels his throat tighten and his chest begin to seize. “Hello, my name is Kyyyyyy, my name is Kyyyyyyy, Kyyyy.”

“Sir, are you there? Sir, are you there?” insists the customer service rep.

Kyle continues: “Hello, my name is Kyyyyle. I need to schedddddd … I need to schedddddd, scheddddd.”

“Sorry, sir,” the voice on the other line says. “We have a poor connection. Please call back again when your service is more reliable.”

The sound of the click thunders in Kyle’s ear as a tight-pitched squeal replaces the silence. Kyle looks down at his feet, too afraid to pick them up and move. He feels frozen in anger, disgust and helplessness. Fear precludes the idea of calling back again.

This experience is all too common for people who stutter (PWS). For these individuals, the experience of communication, which many of us take for granted, becomes a blockade that stands between connection, understanding and the navigation of one’s world.

Experts in the field of speech-language pathology define stuttering as a communication disorder involving disruptions, or disfluencies, in an individual’s speech. The cause of stuttering is typically thought to be a neurological condition that interferes with the production of speech. Although many children spontaneously recover from stuttering, for approximately 3 million U.S. adults (about 1 percent of the population), stuttering is chronic and has no cure. Despite this, there are ways to manage stuttering in both the behavioral sense (how much the person stutters) and the psychological sense (how much stuttering impacts the person’s life).

Situations such as the one that Kyle experienced can happen almost daily for PWS. The pain of these experiences often leads these individuals to isolate themselves from the things they love to do because the risk of communicating can feel as if it outweighs the benefits of living the life they want to live. Peer reactions to unusual speaking patterns can begin as early as age 4. These reactions persist and increase throughout adolescence, which can negatively affect many facets of life, including social relationships, emotional well-being and academic performance, for PWS. Adults who stutter have scored significantly lower in questionnaires regarding quality of life, specifically in regard to vitality, social functioning, emotional role functioning and mental health. Although various studies show that counseling is indicated with this population, many speech-language pathologists are not trained in counseling or do not feel comfortable with their counseling skills and abilities.

Interprofessional collaborations between speech-language pathologists and counselors can be considered best practice for helping PWS and other individuals with common communication disorders. Idaho State University’s counseling and speech-language pathology departments are involved in a unique relationship in which they are training both speech-pathology interns and counseling interns to work side by side to treat PWS. This treatment is provided through the university’s Northwest Center for Fluency Disorders Interprofessional Intensive Stuttering Clinic (NWCFD-IISC), which offers a two-week clinic for adolescents and adults who stutter.

The clinic is the first of its kind in which speech-language pathologists and counseling interns work together to treat the holistic needs of clients who stutter through acceptance and commitment therapy (ACT), a mindfulness-based mental health approach. We (the authors of this article) have conducted the clinic over four consecutive years. Through this experience, we feel that we can share recommendations for counselors working with PWS and with other clients who present with communication disorders. Additionally, we have observed key ingredients for interprofessional collaboration and can speak to strategies to build effective interprofessional teams.

Recommendations for counselors

To be effective working with PWS, counselors need to address the misconceptions they have about stuttering. Consulting resources, such as the National Stuttering Association and the Stuttering Foundation, that are supported by PWS can help counselors to debunk common myths associated with this population.

One common myth is that stress causes a person to stutter. Another myth is that taking deep breaths before one speaks can eliminate stuttering. We have heard countless “cures” for stuttering from the general public. These include placing spices under one’s tongue, receiving acupuncture and sitting or standing with the correct posture. These erroneous cures can be insulting and demeaning to PWS. At best, it is frustrating for PWS to hear these ideas repeated over and over again. Counselors should be knowledgeable about the lack of support for these types of cures while being able to point out to clients resources on effective treatments.

For PWS, reactions from listeners often can be painful. As PWS become more aware of their stuttering and encounter negative listener reactions to their disfluencies, they may develop negative emotions toward communication situations and begin to avoid speaking. The shame and guilt that PWS often feel for stuttering can lead to fear, anxiety and tension in relation to communication, as well as decreased self-confidence. PWS may develop secondary behaviors that they employ in hopes of alleviating their stuttering. These secondary behaviors might include avoiding eye contact, avoiding speaking to people in positions of authority and avoiding certain words that they anticipate stuttering. Being aware of this, it is important for counselors to understand the role that positive regard, expressed behaviorally through continuous eye contact or not averting their glance when PWS speak, can have on these individuals.

Working effectively with PWS also involves using positive and respectful communication practices. During conversations, time pressure can be present when PWS take longer to communicate. This can sometimes lead to one party attempting to finish the other’s sentences. To PWS, this behavior can suggest that their communication of ideas may not be as important as the other speaker’s time.

Finishing a person’s sentences is often done in reaction to uncomfortable feelings associated with the time pressure of communication. Counselors should be aware of when they are experiencing these feelings. They should continue to allow their clients who stutter to finish what they wish to say regardless of time pressure and regardless of whether these clients are having blocks (when sound or air is stopped in the lungs, throat or mouth/lips/tongue), breaking off speech or having repetitions (repeating a sound, syllable or word more than once or twice).

The final recommendation involves the use of person-first language. Often, PWS call themselves “stutterers.” Reframing the language to say a “person who stutters” can reduce the stigma that surrounds the word “stutterer.” This action also treats the person as an individual. During the NWCFD-IISC, we empower PWS and work to mitigate stigma by reinforcing the idea that what a person says is more valuable and important than the way he or she says it. We also affirm that all individuals deserve to communicate their thoughts and ideas.

Recommendations for interprofessional teams

Interprofessional teams can be difficult to start and maintain in practice. Professional training often maintains solo practice as its modality, adding topics related to interprofessional collaboration as elective practice. We have used the stuttering clinic as a way to train counseling and speech-language interns in interprofessional practice and application.

We have observed that to effectively build these teams, it is essential to train our interns on the respective scopes of clinical practice, professional roles and clinical responsibilities of each other’s professions. We also train our students on how to work in teams, how to build relationships based on open communication and respect, and how to understand and use team dynamics that occur during practice. Finally, we reinforce the shared values of both professions — that the well-being of the client is paramount to the purpose of the team.

We have observed that interns typically begin collaborations with thicker boundaries of professional practice and rigid time sharing when interacting with clients. However, after the pair begin to find comfort and understanding of each other’s professional roles, these boundaries begin to wane. Time sharing becomes much more dynamic and less rigid. When intern pairings are working effectively, we see the pair begin to assist each other in their roles and to plan out how they can work together to assist the client during the next session.

To facilitate the interns working together, we teach them specific strategies that are unique to each profession. For example, the speech-language interns learn how to use basic listening skills and practice these skills with the help of their counseling partners. Speech-language interns also learn the foundations of counseling interventions. Specific to the NWCFD-IISC, the interns learn the foundations of ACT. All interns are also taught the practice of meditation and mindful practice, and the principles of acceptance, thought defusion and emotional expansion. Counseling interns learn the foundations of speech-language pathology interventions. Specific to the NWCFD-IISC, they learn about how stuttering occurs, how to assess for stuttering and the social and emotional impacts of stuttering.

All interns in the clinic engage in pseudo-stuttering (fake stuttering) in public and use speech-modification techniques with all clinic participants and the public. Pseudo-stuttering can be used as a therapeutic strategy for PWS to increase acceptance and openness with their stuttering and to increase self-confidence. When the clinic interns pseudo-stuttered and used speech-modification techniques with NWCFD-IISC clients in public, the clients reported that these experiences strengthened the client-clinician relationship.

Our recommendation to counselors and speech-language pathologists who desire to develop collaborative teams is to be intentional about building a professional relationship on the grounds of respect and open communication. The team members should take time to learn about one another’s professions, roles and clinical responsibilities. We have observed during the training of our interns that speech-language pathologists are often focused on outcomes and data collection, whereas counselors are often more focused on process elements and the clinical relationship. It is essential to see both sides of the team as contributing to the overall impact in a unique way. The team members will work to support one another’s strengths and weaknesses.

Counseling interventions

The NWCFD-IISC uses an ACT framework. ACT was chosen because it provides a strengths- and skills-based approach grounded in mindfulness and psychological flexibility. ACT explores human suffering as it relates to psychological inflexibility. Using this framework, PWS learn to more fully focus on the present moment, become more accepting of their thoughts and feelings, and take steps toward acting in alliance with their personal values.

Several studies have supported positive results regarding the efficacy of ACT when applied to stuttering. In addition to this supported efficacy, we think that ACT closely aligns with the philosophy of the NWCFD-IISC. Our philosophy of treatment involves clients and students taking a team approach to understand, accept and effectively manage thoughts, emotions and behaviors related to stuttering. This is accomplished through generalized experiential activities, group education and discussion, and individual and group counseling.

ACT can be understood through the six guiding principles on the ACT hexaflex. These six principles are acceptance, thought defusion, mindfulness, self as context, values and committed action. Investigating how each principle applies, we can begin to understand the process of counseling PWS through an ACT lens.

1) Mindfulness: Clients who stutter often avoid the present moment by judgmentally reviewing the past or worrying about the future. Clinicians can help PWS to connect with the present moment through the use of meditation and mindfulness activities. Encouraging mindful practices can be a goal to incorporate in counseling.

2) Acceptance: PWS often feel like they have no control over their stuttering. Regardless of what they do, a stuttering moment may or may not arise. In these moments, PWS can choose to talk, choose to stutter openly and choose to acknowledge all the thoughts and emotions related to stuttering. Clinicians can help PWS explore acceptance of their thoughts and feelings. PWS do not need to like the thoughts or emotions they experience or enjoy stuttering. However, they can experience their thoughts or emotions as they surface without judgment.

3) Thought defusion: PWS have a tendency to overidentify with their thoughts or feelings, enabling these thoughts and feelings to become mental truths that cause inflexibility within the thought process. PWS may attempt to mentally avoid stuttering or become overwhelmed trying to control their speech. Additionally, PWS may feel certain that other people will reject or harshly criticize them, thus causing them to avoid social contact.

Clinicians can help PWS to explore and express all thoughts — helpful and unhelpful — about their stuttering. By unhooking from the thought or emotion, PWS can experience more psychological flexibility in relation to the context that the thought or emotion is occurring within.

4) Self as context: Individuals often associate with expressions in the form of labels, such as “I am smart” or “I am dumb.” These labels relate to content, not context. Individuals may define themselves in terms of content instead of context to fuse with thoughts and emotions that may be either known or unknown. PWS use self-as-content behaviors to avoid facing the reality of stuttering. PWS may think, “I stutter. That’s all I do. Because of my stuttering, I do poorly in school and never meet new people.”

Clinicians should explore with PWS how these thoughts about self are related either to content or context. Reinforcing flexibility in self-identity is key because it allows PWS to adapt more flexibly to novel situations.

5) Defining values: As described by Jason Luoma, Steven Hayes and Robyn Walser, in ACT, values are defined as “constructed, global, desired and chosen life directions” that can be expressed as adverbs or verbs. When exploring values with PWS, the notion of choice is important to discuss. Choice connotes the flexibility and autonomy they possess in defining what guides their behaviors or life direction.

A common values activity involves the “eulogy exercise.” During this activity, PWS visualize what a close friend would say at their funeral. Clinicians might even direct PWS to write down the values that were expressed during the eulogy: “He was a kind person” or “She was a caring friend” or “He was a compassionate individual.” Clinicians can then discuss these values with PWS and explore how these values are currently manifested and how they can become lost. Building awareness of what values are important in a person’s life can encourage these clients to persist through the difficult times they face.

6) Committed actions: ACT explores the concept of choice in alignment with values-based goals. When clients feel ready to initiate steps either within or outside of counseling, exploration of these committed actions in the counseling session is warranted. For PWS, committed actions could be used by encouraging challenging stuttering situations. For example, PWS may choose to take action directed at speaking situations during dating, during novel social interactions or within work settings. Committed action is the stage of counseling that encourages the synthesis of the tools within the complete hexaflex. PWS learn to engage in a way that is adaptive and flexible to their external and internal worlds.

Summary

Counseling PWS can be a rich and rewarding experience. Through our work in the NWCFD-IISC, we have built lasting connections with individuals in the stuttering community and learned how to form strong interprofessional teams that enhanced our understanding of two professions. In working with PWS, understanding the specific population concerns is key to effective treatment. Additionally, collaboration with professionals in the speech-pathology discipline can further enhance treatment experiences for PWS and for all professionals engaged in the collaboration.

 

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Chad M. Yates is a licensed professional counselor and an assistant professor in the Idaho State University (ISU) Department of Counseling. He has served as the mental health coordinator for the Northwest Center for Fluency Disorders at ISU for several years. He helped to develop the acceptance and commitment therapy (ACT) manuals and procedures for clients and clinicians at the clinic and supervises the counselors providing ACT. Contact him at yatechad@isu.edu.

Karissa Colbrunn is a school-based speech-language pathologist in Pocatello, Idaho. She is passionate about merging the values of the stuttering community with the field of speech-language pathology.

Dan Hudock is an associate professor at ISU. As a person who stutters, he is passionate about helping those with fluency disorders. One aspect of his research involves exploring effective collaborations between speech-language pathologists and mental health professionals for the treatment of people who stutter. He is the director of the Northwest Center for Fluency Disorders. For information about research, clinical or support opportunities, visit northwestfluency.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.