Tag Archives: solution-focused counseling

Investigating the impact of barbershops on African American males’ mental health

By Marcie Watkins, Jetaun Bailey and Bryan Gere May 13, 2021

Ralph Ellison, a famous African American novelist, literary critic and scholar, completed a series of essays in Shadow and Act that depicted the many social differences shaping Black and white America. He held the African American barbershop in high regard, proclaiming its significance as an institution as higher than secondary education for the African American male because it was a place of self-expression.

In Shadow and Act, Ellison writes, “There is no place like a Negro barbershop for hearing what Negroes really think. There is more unselfconscious affirmation to be found here on a Saturday than you can find in a Negro college in a month, or so it seems to me.”

This quote from Ellison reveals the historical impact that African American barbershops have had on the African American community in addressing a broad range of issues. It also reveals a foundational support for the therapeutic practices that take place in these barbershops.

During the time Ellison was writing the essays that would make up Shadow and Act, the nation was navigating uncharted waters, with many individuals, especially African Americans, demanding equal rights. Although there were many pressing issues, inequalities in relation to employment and education were considered foremost. African American males were greatly affected by discriminatory practices.

Today, unfortunately, some of these same inequalities still exist, despite major progress being achieved. A considerable body of research shows that the emotional impact of inequality can cause issues such as mild, moderate or severe depression, anxiety and other health-related issues, including high blood pressure, in connection with life stressors such as employment and finances. Although barbers are not typically formally trained to address psychological issues, African American barbershops do provide an avenue for individuals to express and address problems affecting their lives.

Researchers have identified several factors as being responsible for the emergence of the barbershop as the epicenter for African American mental health discourse. These factors include historical and cultural mistrust of health care professionals among the African American community and the low number of mental health professionals of color. Specifically, help-seeking behavior among African Americans has been conditioned by a distrust of formal health institutions and a leaning toward faith-based interventions.

The 2013 article “African American men and women’s attitude toward mental illness, perceptions of stigma, and preferred coping behaviors” by Earlise Ward et al. attributed mental health stigma to increased rates of suicide in African American males, as well as problems with education, marital life, employment and overall quality of life. According to Felecia Wilkins’ 2019 article “Communicating mental illness in the Black American community,” fewer African American males tend to seek out mental health services to address their problems. It is possible, however, that African American men receive mental health services via alternative nonformal and nonmedical institutions such as the African American barbershop.

The nonjudgmental, discursive, yet intimate environment within barbershops engenders individuals to seek them out not only to socialize, but also to obtain and share information, including their personal concerns or challenges, from and with others. African American men with diverse challenges who need input and support to address their needs or to improve their personal well-being may thus consider the barbershop a viable platform for receiving solution-focused counsel and information.

African American barbers: Confidants and counselors

Many African American barbers have unique relationships with their clients, serving as confidants and informal counselors. The significance of this relationship has been captured over the years in several literary works and movies. For instance, in the 1988 movie Coming to America, we see comedic yet intense scenes between the African American barber and his customers regarding relationship advice. In the 2002 movie Barbershop, Eddie (played by Cedric the Entertainer) expounds on the historical roles the African American barber has occupied, including counselor, fashion expert and style coach.

Many might question why barbers are accorded such prominence within the African American community, and especially by African American men. As Erica Taylor explains in “Little Known Black History Fact: History of the Black Barbershop” on blackamericaweb.com, being a barber was the first notable position for newly freed African American males. Taylor further notes that sustainable financial security and professional integrity came along with the profession. Thus, it is likely that many African American men viewed the role of barbers as notable, even if wealthy white customers regarded the job as unskilled.

Historically, the African American community has looked at business ownership, and particularly barbershop ownership, as a symbol of prosperity. In a 1989 article titled “Black-owned businesses in the South, 1790-1880,” Loren Schweninger highlighted the barbering career of John Carruthers Stanly. Stanly, an emancipated slave, became one of North Carolina’s wealthiest businessmen. While in slavery, he owned a barbershop, and by the time he was freed by his owners, he had gained a favorable reputation due to his business skills. A related story found in the Colorado Virtual Library highlights the achievement of another businessman, Barney Ford, who started out as a barbershop owner and eventually became a hotelier and real estate magnate. Collectively, these cases and several others highlight the regard with which the African American community holds barbershops and their operators. African American barbers are viewed as respectable individuals who can be entrusted with the innermost feelings and emotions of members of the community, especially African American men.

In a 2010 Counseling Today article titled “Men welcome here,” Lynne Shallcross wrote that the barber’s chair is more welcoming and less fearful for most men than the therapist’s couch. Perhaps African American men have understood and internalized this notion and feel compelled to highlight the platform of African American barbers and their barbershops as environments that are nonintrusive and welcoming.

A 2019 article, “Lined up: Evolution of the Black barber shop,” captures the perspectives of African American barbers on the pivotal role played by barbers in both the economic and cultural development of African American communities from Buffalo, New York, to Riverside, California. These perspectives capture the display of emotional vulnerability by clients to their barbers. One of the barbers acknowledged the therapeutic practices that go on in the barbershop and his role as an informal therapist. This means that becoming a good barber inevitably requires one to be a good counselor or confidant because many individuals who present for haircuts also use the opportunity to discuss their personal problems, including challenges with mental health.

African American men and mental health issues

In the 2011 article “Use of professional and informal support by Black men with mental disorders,” Amanda Toler Woodward and colleagues reported that African American men are less likely to seek mental health services. At the same time, African American men have more life stressors that cause psychological distress than do other racial groups, according to an article written by K.O. Conner and colleagues in Aging and Mental Health. Specifically, African American men are more likely to be unemployed for longer periods and more likely to be exposed to violence, harassment and discrimination within their communities. Worse still, according to Conner and colleagues, African American men are more likely to be stigmatized due to mental health issues.

James Price and Jagdish Khubchandani, in an article titled “The changing characteristics of African-American adolescent suicides, 2001-2017,” reported an alarming rise in suicide among young African American men. According to the authors, the rate of African American male suicide increased 60% from 2001 to 2017, with young African American males more likely to die by suicide by using firearm (52%) or hanging/suffocating themselves (34%). Conner and colleagues stated that African American men continue to battle insurmountable odds related to unemployment, police brutality and other stressors that lead to increased emotional and psychological distress.

Research shows that within the African American community, mental health issues are rarely discussed, and especially related to how they impact individuals, groups, families and the community. Typically, African American men are socialized to handle difficulties or problems by themselves or with close friends and family members, not with the help of outsiders such as professional mental health service providers.

Programs such as the Confess Project understand the community’s influence in addressing issues related to mental health and overall well-being. Thus, the Confess Project created a solution to bridge the gap concerning the provision of mental health services by exploring the possibility of educating African American barbers. This relates back to Ellison’s position that the knowledge-based institution of the African American barbershop may stand above other institutions in addressing the mental health issues of African American males.

SFBT and the African American barber

The Confess Project Barber Coalition program seemingly utilizes a form of solution-focused brief therapy (SFBT), recognizing the barbers’ coaching abilities and assisting them to encourage African American males to speak about emotional health. Coaching, as defined by the website SkillsYouNeed, involves improving one’s agility, both mental and physical, by remaining in the present instead of the past or future. As noted by F.P. Bannink in a 2007 article, SFBT focuses on the fact that people’s ideas of the nature of their problems, competences and possible solutions are construed in daily life in communication with others. Daily life communication is a form of staying in the present, which is often observed in barbershops.

In a 2014 article, James Lightfoot noted that much of the strength of SFBT involves freeing the process from focusing too deeply on the problem and allowing more attention to be given to the solution and the future instead of the past. Unlike traditional therapy, which might keep clients stuck in their past by rehearsing traumatic experiences, SFBT assists clients in positively looking toward the future to change their behavior.

Developed by Steven de Shazer and Insoo Kim Berg as a short-term intervention, SFBT focuses on problem identification and motivation, the miracle problem, possibility, hope, scaling/goal formation, exceptions, coping, confidence/strength and feedback. The core functioning therefore shifts the focus from mental illness to mental health and changes the role of the counselor from an active role to that of a facilitator or coach, according to Bannink. The seeming intention of the Confess Project is to promote mental health instead of mental illness in the African American community by way of African American barbershops.

Ellison’s quote ended with an understanding that African American barbershops provide an opportunity for self-expression. This has some connection to the “miracle question” proposed in SFBT, which allows clients to describe what they want out of therapy as a method of self-expression. Ellison and de Shazer thus subtly concede that the interactions in the barbershop and those that occur in SFBT are both modes of treatment that encourage and nurture forms of self-expression and emotional connection.

As a counselor and mental health advocate, I (Marcie Watkins) understand the mental health value of the barbershop in the African American community. My husband, Brandon, was a barber during the early stages of our marriage. I believe that he later selected a career in the counseling/human services field based on his experiences as a barber. My husband would often share that the barbershop was a place of community and weekly refuge for African American men. A sense of pride was established as a man with minimal budgetary resources could come to the barbershop for a haircut, therapy, relaxation and socialization — all in one package deal.

My husband stated that “to choose a barber to cut your hair and pay him your hard-earned money was a true sign of trust. If a man can trust you to cut his hair, he will trust you with every secret and problem, just as you would a therapist.” As such, the qualities of a therapist and a barber in the African American community are synonymous. Barbers hear about major life events because getting a haircut precedes weddings, funerals and any other special activity for which one needs “a fresh cut.” As such, my husband also stated, “When a man trusts you to make him look his best, he will trust you to tell you anything. That trust would also be transferred to his son and grandsons for many generations.”

As a mental health advocate, I forged partnerships with Jetaun Bailey and Bryan Gere, both of whom were professions at a historical Black university near my hometown, in educating African Americans on the importance of seeking and receiving mental health. During a conversation about mental health, Ellison’s quote was introduced, which led to a lengthy discussion among us. During our discussion, we shared experiences of observing dynamic exchanges in African American barbershops in which the owners/barbers seemingly served as facilitators/coaches and several patrons took on the role of group members. We also noted that the exchanges at times became heated. However, we noticed that the barber exuded characteristics similar to those of a group facilitator or coach — like those of an SFBT counselor — in controlling the conversations and making sure that everyone had a voice.

We also collectively agreed that a spirt of “call and response” had been infused in the exchanges between the patrons and the owners/barbers. Call and response is rooted in African American culture. This form of expression is interwoven in African American music, religious gatherings and public conversations. For example, a patron might use a solution-focused technique by asking a miracle question. The question might be “Man, what would you do if you had a million dollars?” A response might be “Get out of debt.” Thereafter, a call might be made by a patron or patrons: “Can I get an Amen?” As such, that patron is calling everyone to respond in unified agreement over the answer of “getting out of debt.”

The expression-type groups of author, educator and counselor Samuel Gladding, a past president of the American Counseling Association, can be closely aligned with call and response. Gladding recommends expression-type groups — such as those involving creative arts, music and literature —as ideal in reaching the African American population. These groups might mirror the outlets of how call and response is delivered. Gladding notes that commonly shared positive values among African Americans include creative expression.

It appears through our observation that with this call and response, the barbershop patrons remain in the present while being coached or guided by the barber, which is the core of the counseling relationship in SFBT. This discussion led to development of a presentation during Black History Month in spring 2019 at a historically Black university in Alabama. The presentation was titled “Investigating the Impact of Barbershops on African American Males’ Mental Health: Are Barbers Untrained Solution-Focused Counselors?”

Group Presentation

Approximately 75 participants, mostly students and some faculty and staff, attended our presentation that sparked much dialogue and generated some potential recommendations in getting African American men to seek formal counseling from more traditional avenues. Students were encouraged to interject throughout the presentation (like the call-and-response traditional method in the African American community) rather than waiting until the end. Therefore, if a student felt the need the comment, they were encouraged to raise their hands and wait for the presenter to acknowledge them to speak.

Based on feedback received from the participants, we cannot conclusively state that African American barbers possess innate characteristics that mirror those of SFBT counselors. Considering the responses received, it seems that African American barbers feature characteristics similar to those of client-centered counselors, because they are actively involved in the sharing process of the discussion, such as sharing their own personal struggles. Participants believed that this client-centered approach on the part of African American barbers was developed through years of listening and engaging with different people.

On the other hand, the participants felt that barbershop patrons generally possess the characteristics of solution-focused clients because they come to the barbershop knowing what they would like to express and discuss. This suggests that patrons are taking on the role of “expert” because they are able to open dialogue without any hesitation and anticipate a positive outcome. This might hint that SFBT could serve as an effective “gateway” therapy method for African American men. This approach could likely give them a sense of authority over their problems, thus leading them to explore more therapeutic approaches if their problems require deeper self-assessment.

Several of the students and a few of the staff members had once worked as trained and untrained barbers to support themselves while pursuing their education. They collectively agreed that the barbershop serves as a “one-stop” location for various businesses within the African American communities. In these barbershops, patrons can find flyers, brochures and pamphlets on everything from soul food restaurants to personal trainers. As such, one student stated, “So why not mental health?” He went on to suggest that grants could potentially be written by local and state agencies to conduct mental health presentations in barbershops periodically. He pointed out that impromptu presentations are routinely conducted in barbershops, such as someone promoting a hair show or concert.

Recommendations and conclusion

It is implied that African American men use supportive services in the community more than professional help for coping with life stressors. This method of support is not necessarily recognized through mainstream research, but it is acknowledged through other avenues, such as Ralph Ellison’s quote, as a place of self-expression. Although it does not replace professional counseling, the barbershop could be a window of opportunity for increasing mental health treatment for deeper psychological issues. As the literature reports, programs such as the Confess Project are successful in providing education to barbers to recognize mental health issues. Other mental health agencies could follow suit in reaching this population or simply networking with this organization. Mental health agencies that link with African American barbers will further promote and reshape their scope within the African American community because it will allow them to evolve from givers of advice to advocates in the mental health community.

It is assumed that some community support is instrumental in aiding mental health, and perhaps the African American barbershop should be further recognized as one of those support systems. By educating African American men through their most prized institution, the barbershop, perhaps mental health providers will be able to reach an upcoming generation that is suffering in silence.

A worthwhile goal would be to decrease/eliminate mental health stigma in the African American community by evolving the barber’s role as an advocate for change, because the legacy of the African American barbershop is deeply rooted. It was one of the few initial professions that gave African slaves and freed men financial stability, pride, voice and respectability, and it gave others a chance for self-expression. Moving forward, the institution can be used as a catalyst for change. This change can come in the form of stressing mental health instead of identifying mental illnesses.

Although SFBT could not be directly linked to the characteristics of an African American barber or its patrons as experts, the theory does promote mental health instead of mental illness. Mental health embodies our emotional, psychological and social connections, thus giving everyone a voice of self-expression instead of hiding behind the curtains of shame or stigma associated with mental illnesses.

 

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Marcie Watkins is an associate licensed professional counselor, a doctoral student and co-owner of Solutions4Success. Contact Marcie at Solutions4success@att.net.

Jetaun Bailey is a licensed professional counselor, certified school counselor and evaluator. Contact Jetaun at BaileyJetaun@hotmail.com.

Bryan Gere is an assistant professor at the University of Maryland Eastern Shore and a certified rehabilitation counselor. Contact Bryan at Bryangere23@gmail.com.

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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.

Solution-focused tools to help school counselors in a pandemic

By Mark M. Jones September 14, 2020

Counselors in schools are facing unprecedented challenges during the COVID-19 pandemic. School buildings across the country were closed this past spring, and as we transition to the new school year this fall, some students will attend school only remotely through online learning. Others will be in school part time with reduced capacity, whereas still others may return to a full-capacity school but urged to keep physically distant and with their faces covered throughout the long days.

In addition, because of pandemic management measures, students have been spending an unusual amount of time with their families, some of whom are under new and severe emotional, health and financial stress. The pervasive spread of COVID-19 is associated with higher unemployment and poverty, greater use of illegal drugs, and new and sustained trauma experiences. On top of all this are the ongoing string of horrific news stories reporting White on Black violence and ethnic hatred, which are compounding societal stresses.

School counselors must be prepared to support a wide array of student concerns associated with COVID-19 and the accompanying social isolation. Counselors who can assist many students with significant needs in a brief, flexible way in both remote and in-person venues will be particularly valued.

Fortunately, the solution-focused model of counseling is highly adaptable to a wide range of problems, including grief, trauma and anxiety. It is appropriate for suicide prevention efforts, classroom lessons and even brief check-ins with students who are not demonstrating any outward sign of struggle. Instead of a deep dive into problem origination and causation, this form of counseling targets clients’ hopes, resources, exceptions to problems and descriptions of a preferred future. It also fosters vicarious resilience, which will help counselors who may have their own diminished stamina arising from personal struggles related to the pandemic.

Solution-focused counseling was pioneered by Insoo Kim Berg and Steve de Shazer from their work at the Brief Family Therapy Center in Milwaukee in the 1980s. It has evolved and become widespread over the ensuing decades through the work of many advocates in counseling, therapy and coaching. It is sometimes called “brief counseling” because it can be highly effective in a few 20- to 50-minute sessions, or even during a short hallway or classroom conversation.

Counseling in a modern, virtual world now means counseling through video calls without guarantees of confidentiality because students may be in only semiprivate or even public environments. Solution-focused counseling is not problem-phobic, but because of its embedded focus on goals, preferred futures, assets, resources and exceptions to problems, it poses less risk of revealing private, sensitive information that might be overheard by a family member at home.

Three-minute check-ins

Given the long absence from school and the limited amount of time students can be with school counselors, short three- to five-minute check-ins offer one practical way of providing support to students and gauging their emotional state. School personnel are key reporters of child abuse, and there are serious concerns about whether students could be enduring abuse because of having limited access to these trusted adult advocates.

Consider the following eight check-in questions:

  • What is your best hope for this year?
  • On a point scale of 1 to 10, where are you if 10 means that things are going as well as you could hope and 1 is the opposite?
  • What are you most proud of in how you handled being at home for so long?
  • If this turns out to be a really good year, what is something you will have done to make it that way?
  • Who will notice?
  • Do you feel safe at school and home?
  • Who is a trusted adult you can talk with if you are upset?
  • Is there anything else you would like me to know?

These types of questions allow students to express their preferred future, their resources to help them get there and a description of what that future will be like, including who will notice. Humans are social animals, and having students describe what others will see in them when they are successful helps make the path visible to them.

Even if there is not time to ask all of these questions, getting students to describe their preferred future, their resources and their social supports will help them move in small steps toward something hopeful. It will also allow the counselor to gauge students’ emotional states and resources.

Grieving students

Helping students cope with grief does not have to focus only on challenges and sadness. It can also effectively include conversations about joys and happiness. Students first need a counselor who will actively listen to their story of pain in losing a loved one (or a different loss), but a solution-focused counselor will also ask questions that seek descriptions of what the loved one liked to do and the positive aspects of the relationship.

Questions about what the decedent did for the student, enjoyed about the student and how the student knows these things can draw out memories of the relationship and help the student see their own assets and strengths through that relationship. Asking what students sees in themselves that the decedent saw can create rich descriptions of the strength of that connection.

Grief involves coping, so a solution-focused approach may include questions of how the student has managed to get out of bed and arrive at school, and what the decedent would be most pleased to see regarding how the student is getting along. For those students who are less verbal, allowing them to draw their coping skills or positive aspects of their relationship can supplant, or support, the dialogue.

Suicide prevention

All school counselors must be prepared to assess suicide risk in students. Unfortunately, given the diverse demands of school counseling, sometimes single meetings with students in the near term are all that are possible.

Fortunately, solution-focused counseling offers a framework to go beyond just assessing suicide risk; it paves the way toward fostering hope and engaging in critical prevention work. In addition to the classic questions surrounding scaling (e.g., “What keeps you from being one number lower? What will you be doing when one number higher?”) and questions about best hopes and a preferred future, more nuanced questions may elicit additional solution-oriented thinking. Some examples include:

  • If we asked the version of you that has been happier, what would that version tell you to do?
  • What would that version remind you that works for you?
  • How have you made it this far?
  • When in the last week were things a little better?
  • Who is on your support team?
  • Who could we bring into this conversation?
  • What job should we give that person?
  • What would that person advise right now with how you are feeling?

According to John Henden in Preventing Suicide: The Solution Focused Approach, one of the most powerful interventions is having the student imagine being a witness at their own funeral and describing who would be most upset, what advice that person would wish they had given, and what options other than suicide would the student wish they had tried.

Group counseling

Group counseling in schools is often based on themes such as anxiety regulation, social skill development or anger management. In the midst of a pandemic, school counselors may want to expand groups beyond narrow themes to include more students.

Taking a solution-focused approach allows a single group to include individuals with a variety of social and emotional needs. In the first group session, ask students about their best hope for how the group could help them. They can address their preferred future by describing what life would be like if things were better. Describing instances when this has happened and exceptions to the problem allows them to envision the change that is possible. Group members can then scale their current position, followed by questions of what idea they would be willing to try between now and the next session to move one step closer.

Subsequent sessions would start with each member reporting what is better since the last meeting, scaling their status and whether there were setbacks, describing how they coped and detailing what signs they will see when there is progress. To take advantage of the group dynamic, some of these questions could come from fellow members, or members could offer suggestions for what has worked for them. Ensuring that the group includes compliments from the leader and fellow members will help ensure that it is a positive and rewarding experience.

In addition, incorporating activities into groups helps children express themselves in a variety of ways. Fortunately, there are abundant solution-oriented activities to employ. An excellent resource for solution-focused activities with children is Pamela King’s Tools for Effective Therapy With Children and Families: A Solution-Focused Approach.

The following activities may be particularly useful:

  • Cartoon panel: Ask students to draw their miracle day using a six-panel cartoon or, alternatively, six resources/strengths they possess or six challenges they overcame with the names of the people who supported them and the skills they learned.
  • Mock interview: Prompt students to record a video interview of another student, or have them interview one another in a live video group stream. Prompts might include: What strengths did you use to overcome your challenge? How did you keep going and not give up? What advice do you have for others struggling with what you struggled with? Today, when you are being your best self, what are you doing well?
  • Rainbow questions: Have students pick three different Lego pieces that you supply (if meeting in person), or just ask them to name their top three specific color choices. Then, based on the colors selected, have them answer color-coded questions. For example:

Green: Imagine you are talking to your 5-year-old self. What is the wisest advice you would give yourself on how to handle being quarantined?

Orange: What did you do to help yourself get along with your family during quarantine?

Yellow: What is the nicest compliment you have received since the COVID-19 outbreak?

Dark Blue: Who supported you best during the quarantine? what did they do?

Black: What will your friends notice when you are your best self?

  • List it: Ask students to take a piece of paper and draw a line down the middle. On one side write challenges, and on the other side list strengths, resources and trusted advisers who help them with those challenges.
  • Face mask: Have students draw an outline of their face (or body) on each side of a page. On one side, ask them to draw or list what others see in them. On the opposite side, have them draw or list the strengths and resources they possess that others don’t know about.
  • News reporter: Have students interview key people in their lives and learn what those individuals see as their strengths, skills and resources. Ask students to elicit examples and stories, then write up the information as a newspaper piece.

Morning meetings

According to the Responsive Classroom approach, the goal of a class morning meeting is to “set the tone for respectful learning, establish a climate of trust, motivate students to feel significant, create empathy and encourage collaboration, and support social, emotional and academic learning.” Morning meetings are an easy opportunity to incorporate dialogue about the crisis in a way that can make evident to individual students their best hopes, personal resources, and instances of the preferred future being present.

Best hopes for the school year can be asked individually or as part of a group, such as, “What do we need as a group to end this school year well?”

Questions about resources and strengths could include, “When things were difficult, what was most helpful? What is something you tried that helped you to cope that you had never done before? Imagine you get in a time machine, go one year in the future and COVID-19 is finished. Look back to right now and describe something you are proud of in how you handled all of this Who was helpful to you? What would that person say if they were here describing something you did well? Whom do you admire and why? How are you like that person?”

Lessons

Solution-focused lessons can incorporate scaling as well as movement. Best hopes or goal setting can include floor spots that are numbered 1 to 10 (or write numbers on separate pages). Students can take turns standing by their number and then taking a step forward and describing what they will be doing when they are one number higher. Alternatively, a number line from 1 to 10 can be drawn and hung on the wall in class, and students can put a Post-it sticker on the line where they are. For a video chat, they can simply say their current number.

Picturing their preferred future and their resources can be done through letter writing. Students can be asked to think about what they would like to be doing in their career and life in 20 years. Have them imagine they are living that life and they find out that they can get messages back to the past. Ask this successful adult who is living their hoped-for life to describe to their younger self the challenges they faced, the internal assets that helped most and the people who were supportive. Then have them give their best advice on how to navigate the next 20 years.

Students can also interview each other to learn about one another’s recent challenges and resources, including who has helped them, what was most helpful and advice they have for others.

The ongoing pandemic requires that school staff members adjust how learning occurs. Solution-focused techniques allow school counselors to be brief, flexible and powerful in their support of students facing an array of social, emotional and learning challenges.

 

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Mark M. Jones has been an elementary school counselor in Arlington, Virginia, for four years. Before that, he was a trial lawyer for 30 years. Contact him at mark.jones2@apsva.us.

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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.

The use of evidence-based practices with oppressed populations

By Geri Miller, Glenda S. Johnson, Mx. Tuesday Feral, William Luckett, Kelsey Fish and Madison Ericksen December 3, 2018

Therapy must always be tailored to the individual; there is no one-size-fits-all model. However, certain approaches have been empirically verified for use with a variety of clientele. It is critical that all counselors, especially those working with client populations that are oppressed, have both an overview of evidence-based practices and specific techniques related to these approaches in their clinical toolboxes to help them provide the best counseling services possible.

Counselors are frequently required to use evidence-based practices and need to know how to use them effectively in counseling clients who are oppressed. Specifically, the unique development of the therapeutic relationship between oppressed clients and privileged clinicians must be understood and addressed. Multicultural counseling experts Derald Wing Sue and David Sue maintain that the dynamics of oppression shift the influence of the therapeutic relationship. Thus, counselors must alter their application of evidence-based practice techniques.

Solution-focused brief therapy and low socioeconomic status

Take a moment to think about what the basic needs of your own life are. What is impossible for you to live without? For many of us, our basic needs are continually met. Therefore, they often go unnoticed — they are woven into our everyday lives and ways of being in the world.

For others, questions such as “Will I eat today?” or “Will I have a safe and warm place to sleep tonight?” are asked daily. Often, the answer is “no.” Concerns such as clean drinking water, access to hygiene products and finding adequate shelter affect an inordinate number of individuals in the United States. School counselors and licensed professional counselors have a moral and ethical obligation to address these matters, with the intention of removing barriers and cultivating a safe space for clients in both the therapeutic relationship and the environment beyond our office walls.

Glenda Johnson (one of the co-authors of this article) worked as a school counselor and an advocate in a school system in which the majority of students came from low socioeconomic status (SES) backgrounds. Many of the students were on free or reduced lunch plans because their families’ financial resources were severely limited. At the core of Johnson’s work was the intent to ensure that every child’s basic needs were met while they were at school. She emphasized the importance of working collaboratively with other school staff members to build a team and a foundation for connecting these students and their families to resources.

It is also vital to assess an individual’s behaviors, emotions and reactions through a holistic, biopsychosocial approach rather than focusing only on the school context. Learned behavior concerns, inattention, difficulty with emotion regulation (anger), sadness and loss of hope are often the result of a lack of resources. Johnson recalls that if a student acted out, one of her first questions would be, “Did you have breakfast this morning?”

Johnson shares an anecdote that highlights the powerful act of providing a safe, therapeutic space for students to identify and voice their emotions openly with peers. As a school counselor, she infused the identification of various emotions into a game of musical chairs, and what transpired was completely unexpected. A student identified a “sad” emotion and explained that their father recently had lost his job. The student was experiencing fear about not having enough food to eat during this time. Then, other students began to share similar stories without prompting. The game of musical chairs transformed into a collaborative and touching experience as the students identified common ground and connected on deeper levels of understanding and empathy.

When providing services to individuals from a low SES, counselors may find it helpful to use a strengths-based therapeutic approach. The evidence-based practice of solution-focused brief therapy (SFBT) zeros in on the therapeutic relationship and the clinician’s way of being. In this relationship, there is an acknowledgment of reality but also an emphasis on solution-focused thought and reframing. Focusing on strengths, the counselor and client work together to identify and move toward making small changes in any area because a small change in one area often leads to change in another area.

SFBT often introduces the “miracle” question: “Suppose that when you go to sleep tonight, a miracle occurs that solves your problem, but because you were sleeping, you did not realize what happened. When you wake up in the morning, how will you realize a miracle happened? What will you notice that you are doing differently?” These questions enhance and expose glimpses of solutions that an individual may struggle to identify in everyday life situations.

Additionally, SFBT places great value on successes. The counselor and client celebrate achievement and may use scaling to note the client’s progress. When working in a school system, the counselor could develop a creative and motivating way for children to rate themselves and their progress toward goals. For example, Johnson created a rating scale, complemented by the colors green, yellow and red, for kindergartners and first-graders. Green identified a completed goal, yellow identified progress toward a goal and red identified room for improvement. Similarly, she used a rating scale of 1-5 for students in second through fourth grades. Under this scenario, a student could check in with a rating, such as, “I am at a 3 and working toward a 5.” The counselor might respond, “What would it take to get to a 3.5?” The scale provided a visual for children to identify, track and celebrate their successes.

In SFBT, the counselor acknowledges client strengths and walks alongside these clients as they create and work toward their goals and future successes. “Flagging the minefield” is another technique counselors can introduce to help clients generalize and apply what they learn in counseling to future situations. Flagging the minefield is a particularly important facet of SFBT because it assists individuals in recognizing potential obstacles or barriers that will appear in their lives. The counselor and client work together to identify tools and resources the client can apply in other settings and relationships.

When working with students living in poverty, counselors should introduce a strengths-based approach and identify and gather resources to assist students and their families in removing barriers and meeting basic needs. Cultivating a safe, therapeutic relationship with students that focuses on solution building can assist them in building a stronger sense of self.

Motivational interviewing, SFBT and rural adolescent substance abusers

Adolescence is a vulnerable time and a critical period for developmental outcomes. During this stage of life, adolescents are exploring and forming their peer relationships and personal identities while beginning to distance themselves from family. Experimentation with substances often begins during this time. In 2012, Tara Carney and Bronwyn Myers found a correlation between the early onset of substance use and an elevated risk for later development of substance use disorders. Additionally, because early substance use may impact the growth of the adolescent brain, it has the potential to heighten one’s risk for delayed social and academic development.

Adolescents living in rural areas are marginalized in multiple ways. Children are an underserved minority population, as are rural populations. Sheryl Kataoka, Lilly Zhang and Kenneth Wells (2002) found that among youth with a recognized mental health need (estimated at 10 million to 15 million people), only 20-30 percent receive specialized mental health care. Rural communities are more likely to have fewer clinicians or require a long drive to see those clinicians, making it more difficult to obtain care. These disadvantages are exacerbated by the tumultuous nature of adolescence.

Motivational interviewing and brief interventions are two evidence-based practices particularly suited to this population because these approaches are generally influential in their therapeutic role while also being cost-effective. Motivational interviewing facilitates behavior change through exploration and resolution of ambivalence, and it focuses on being optimistic, hopeful and strengths-based. It uses principles of empathy, discrepancy, self-efficacy and resistance, and offers specific techniques such as OARS (Open questions, Affirmations, Reflective listening, Summarizing). SFBT emphasizes solutions, changes clients’ perceptions and behaviors, helps clients access their strengths and uses techniques such as exception to the problem, specification of goals and the miracle question.

Individual interventions with the use of the same interventions for multiple sessions are ideal, and research suggests that the earlier the intervention, the better the outcome. Early intervention shows better results than both preventive measures and later interventions because it reduces the need for more specialized interventions and provides applicable and useful tools and tactics for adolescents as they enter into various student, peer, familial and professional roles.

Challenges certainly exist when working with children and adolescents, particularly because many biological, environmental and social shifts occur organically during this time. As children and adolescents rapidly transition on a continuum of development, they become “moving targets.” Interventions that prove effective for those ages 11-12 often cease to be effective by ages 13 or 14. It is vital that counselors remain aware of this across the life span. Although adolescents are beginning to distance themselves from their caregivers, familial relationships and parental involvement remain crucial during this period.

To appropriately and competently involve the families of rural adolescents, some understanding of cultural values is necessary. In 2005, Susan Keefe and Susie Greene identified core Appalachian values, including egalitarianism, personalism, familism, a religious worldview, a strong sense of place and the avoidance of conflict. In the Appalachian region, assuming authority without demonstrating an authoritarian attitude is important. Language tends to be simple, direct, honest and straightforward. Family is extremely important, exemplified by the adage “blood is thicker than water.” Individuals’ relationship to the land is complex, and it can be beneficial to explore how clients view economic deprivation. In 2016, Sue and Sue also pinpointed some tendencies of rural clients, including having a “street-smart” attitude and way of being, depending on systems due to living in poverty and valuing survival at all costs.

As a result, subtle techniques such as stages of change, motivational interviewing and SFBT may be useful for this population. In stages of change, the intervention is matched to the stage of the client’s readiness to change (precontemplation, contemplation, preparation, action, maintenance, termination). Motivational interviewing facilitates an invitation to engage, and its strengths-based, hopeful tone can be helpful for clients living in an environment populated by deficits such as poverty and lack of education. The practical nature of brief therapy fits well with the no-nonsense worldview of clients coming from rural backgrounds.

Unfortunately, published rural studies often focus on specific regions or populations. Few interventions have been tested in rural settings, and the evidence from systematic reviews is often too general and not specific to the rural context. Ideally, rural communities could review interventions tested with various target populations in a range of settings. Such information is not usually available, however, and the strength of evidence is unlikely to be the only factor considered in choosing an intervention. The research on rural adolescent populations is limited, and little consistency exists across studies related to measurement tools. Furthermore, disseminating evidence-based practices to schools, families and community settings in rural areas is difficult due to the lack of resources.

However, it is important to note that there have been great improvements in substance abuse treatment and prevention with children and adolescents who live in rural areas. A 2016 Monitoring the Future survey of eighth-, 10th- and 12th-graders by the National Institute on Drug Abuse found the lowest ever reported rates of use for all illicit drugs, including alcohol, marijuana and nicotine. As further research is conducted, it will be important to delve into this information to identify what is already working with these individuals and what can be improved to better serve them moving forward.

Evidence-based practices with transgender clients

Transgender individuals face discrimination on multiple fronts. Many experience familial rejection, unequal treatment, harassment and physical violence during daily living. The rate of substance abuse within the transgender community is three times higher than that of the general population. There is a profound lack of competent health care for transgender individuals, and the care that is available may be inaccessible to a majority of the transgender population. The rate of unemployment within the transgender community is also three times greater than that of the general population, due in part to factors such as workplace discrimination, poverty and homelessness. Transgender people also face discrimination and mistreatment in shelters.

With high rates of homelessness, substance abuse and mistreatment, transgender people also have frequent interactions with law enforcement, where they can be subject to police brutality and discrimination. Within the criminal justice system, a high rate of physical and sexual assault is perpetrated against transgender individuals, and they are often denied medical treatment while incarcerated or detained.

Poor health outcomes for transgender people correlate with risk factors such as economic and housing instability, lower educational attainment, lack of family support and other intersectional factors such as race, ethnicity, immigration status and ability.

According to the 2015 U.S. Transgender Survey, 18 percent of transgender people who sought mental health services experienced a mental health professional attempt to stop them from being transgender. This correlated with higher rates of serious psychological distress and suicide attempts and an increased likelihood of running away from home, homelessness and engaging in sex work.

Research conducted in 2015 by Samantha Pflum et al. emphasized the lack of access to transgender-affirming resources and communities for individuals living in rural locations. The history of mistreatment and abuse of lesbian, gay, bisexual, transgender and gender-nonconforming clients by medical and mental health professionals must be acknowledged. Gender and sexual minority clients still face discrimination within the helping professions, and for individuals holding multiple marginalized identities, these experiences are compounded.

Even well-meaning providers are likely to make mistakes when working with marginalized clients. According to Lauren Mizock and Christine Lundquist, one of these mistakes is education burdening, or relying on the client to educate the provider about transgender culture or the general transgender experience. Resources exist to facilitate competence in these areas, and clinicians have a responsibility to refrain from placing the burden of their education on the client.

Some counselors participate in gender inflation, or focusing on the client’s gender to the exclusion of other important factors. Other counselors engage in gender narrowing, applying restrictive, preconceived ideas about gender to the client, or gender avoidance, which involves ignoring issues of gender altogether. Gender generalizing occurs when a clinician assumes that all transgender clients are similar. Gender repairing operates from a belief that a transgender identity is a problem to be “fixed.” Gender pathologizing involves viewing transgender identity as a mental illness or as the cause of the client’s issues. Finally, gatekeeping occurs when a provider controls client access to gender-affirming resources.

Acceptance of a client’s gender identity is ultimately not enough to provide competent, affirmative services. Understanding the nuances of these common mistakes will help clinicians provide a safe therapeutic environment that is affirming of these clients’ identity and humanity.

The Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling (ALGBTIC), a division of the American Counseling Association, has developed competencies for counseling transgender clients (see counseling.org/knowledge-center/competencies) that focus on the following eight domains:

  • Human growth and development
  • Social and cultural foundations
  • Helping relationships
  • Group work
  • Professional orientation
  • Career and lifestyle development competencies
  • Appraisal
  • Research

Counselors can work within this framework to:

  • Promote resilience by using theoretical approaches grounded in resilience and wellness
  • Conceptualize the development of a transgender individual across the life span
  • Understand internal and external factors influencing identity development
  • Consider how identity interacts with systems of power and oppression (especially for minority transgender individuals)
  • Examine counselors’ own internalized beliefs and how those beliefs affect attitudes toward transgender clients
  • Reevaluate approaches to working with transgender clients as new research emerges

One intervention that has been identified for use with this population by Ashley Austin and Shelley Craig is transgender-affirmative cognitive behavior therapy (CBT). Transgender-affirmative CBT modifies CBT interventions to address specific minority stressors, such as victimization, harassment, violence, discrimination and microaggressions, that transgender people commonly face. This approach uses psychoeducation to help clients understand the connections between transphobic experiences and mental health issues such as stress, anxiety, depression, hopelessness and suicidality. Experiences are processed through a minority stress lens to help clients move from a pathologizing-of-self mindset to an affirming view of themselves as people coping with complex circumstances.

Clinicians are advised to affirm the existence of discrimination and to help these clients identify influences on their mental health by using the transgender discrimination inverted pyramid (see below). 

Transgender individuals internalize messages at each level, and it can be beneficial to have a visual for how these messages trickle down and influence mental health. Clinicians can empower transgender clients by assisting them in challenging internal and societal transphobic barriers. A few examples are challenging negative self-beliefs, connecting with a supportive community and advocating for self and community.

Another approach recommended for use with transgender clients by Joseph Avera et al. in 2015 is the Indivisible Self model, an Adlerian wellness model refined by Jane Myers and Thomas Sweeney that emphasizes strengths. There are five wellness factors of self in this model:

  • Creative Self: Cognitions, emotions, humor and work
  • Coping Self: Stress management, self-worth, realistic beliefs and leisure
  • Social Self: Friends, family and love)
  • Essential Self: Spirituality, self-care, gender identity and cultural identity
  • Physical Self: Physical and nutritional wellness

This model easily can be adapted to a transgender-specific lens, especially regarding the Essential Self, by exploring gender and cultural identity and how they influence client experiences and beliefs. Used in conjunction with the ALGBTIC transgender competencies, the Indivisible Self model offers helping professionals both a conceptual and practical framework for working effectively with transgender clients.

For all clients, and transgender clients in particular, intersectional factors magnify the experience of oppression. Sand Chang and Anneliese Singh recommend addressing the intersectionality of race/ethnicity and gender identity for both clients and clinicians. This involves:

  • Challenging assumptions about the experiences of transgender and gender-nonconforming people of color
  • Building rapport and acknowledging differences within the therapeutic dyad
  • Assessing client strengths and resilience in navigating multiple oppressions
  • Providing a variety of resources that are affirming to transgender and gender-nonconforming people of color

In addition, assisting clients in locating social support is advised. Social support increases healthy coping mechanisms and helps with self-acceptance, thereby reducing psychological stress related to discrimination. Social support can also help to normalize and validate emotions related to discrimination.

Conclusion

Evidence-based practices have consistently been shown to be helpful to clients, but counselors must remember that they operate within the context of a relationship. To use evidence-based practices effectively, we must hold on to our humanness. The implementation of a single technique will look very different depending on who is in the room and what they are bringing with them.

Often, the expectations for using evidence-based practices might create pressure for counselors to follow a strict formula for treatment. Process variables such as honoring the personal relationship between the counselor and the client, maintaining a “therapist’s heart” and respecting the unique aspects of the client may seem to be at odds with the procedure for using a specific intervention. A working knowledge of multicultural issues can provide some context for how to shift evidence-based practices to fit the client rather than pressuring the client to conform to a prescribed, generalized format.

Using interventions with a solid evidence base is good practice. Adjusting their implementation on the basis of the unique identity of the person sitting across from us is great practice.

 

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

Geri Miller is a professor in the Department of Human Development and Psychological Counseling (clinical mental health counseling track) at Appalachian State University (ASU) in North Carolina. She is a licensed professional counselor, licensed psychologist, licensed clinical addictions specialist and substance abuse professional practice board certified clinical supervisor. She has been a volunteer counselor at a local health department since the early 1990s. Her clientele has primarily consisted of women with little opportunity for jobs or education and who experience barriers of poverty. Contact her at millerga@appstate.edu.

Glenda S. Johnson is an assistant professor in the Department of Human Development and Psychological Counseling (school counseling program) at ASU. She is a licensed professional counselor and a licensed school counselor in North Carolina. Her scholarly focus includes school counselors delivering comprehensive school counseling programs, students who are at risk of dropping out of high school and the mentoring of new counseling professionals.

Mx. Tuesday Feral received their master’s degree in clinical mental health counseling and a certificate in systematic multicultural counseling from ASU. They are the support programs director for Tranzmission, a nonprofit organization serving the Western North Carolina nonbinary and transgender community through education, advocacy and support services. Tuesday offers training and workshops in trans cultural competence and cultural humility on local, state and national levels.

William Luckett received his master’s degree in clinical mental health counseling from ASU with a certificate in addictions counseling. He has interests in somatic therapy approaches, mindfulness, religious and spiritual topics in counseling, and substance abuse counseling. He currently provides in-home counseling to rural families in Virginia.

Kelsey Fish is a student in ASU’s clinical mental health counseling program and a clinical intern with Daymark Recovery Services in rural Appalachia. Her clinical interests include expressive arts therapy, adolescents, and gender and sexual minority issues.

Madison Ericksen is a graduate of the clinical mental health counseling program at ASU. She has specialized training and interest in trauma-informed practices that use mindfulness, eco-based and expressive art therapies as complementary treatments alongside traditional therapy. She provides strengths-based and resiliency-focused outpatient counseling for children and families.

 

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.

 

Parenting in the 21st century

By Laurie Meyers February 22, 2018

Remember when receipt of a coffee mug emblazoned with “Best Mom Ever” or a T-shirt proclaiming “Best Dad Ever” was enough to validate someone’s skills and aptitude as a parent? In the 21st century, it seems that the ante has been raised. In the eyes of society, parents barely qualify as competent — much less “perfect” — unless they can check off all of the following qualifications:

  • Not only attend to, but anticipate, their child’s every need
  • Orchestrate their child’s academic success
  • Provide their child with all the best experiences and most useful activities
  • Make home an oasis of peace and harmony for the family (while simultaneously prospering in their own careers)

Attendance to one’s children at all times is mandatory. No exceptions will be made for parents working two jobs just to get by, single parents or parents of children with special needs. No foolproof instruction manual will be provided.

These extreme expectations, paired with the rapidly accelerating pace of modern life, present significant obstacles and pressures for parents who genuinely want to make their children feel cared for without driving themselves crazy. Many counselors are routinely helping clients respond to these and other challenges of modern-day parenting.

Parenting, problems and pride

“Always on” parenting requires a lot of problem-solving, which leaves parents focused on all the things that are going wrong, says American Counseling Association member Laura Meyer, a licensed clinical mental health counselor in Bedford, New Hampshire, who specializes in parenting issues and women’s concerns. In particular, working parents often have a difficult time attending every school function that is offered because they typically take place during the workday. This can feel like a failure, particularly for mothers, says Meyer, who is currently researching women’s parenting experiences.

As a kind of antidote, Meyer encourages clients to look for instances when they did something that made them proud of their parenting: “Maybe I wasn’t able to be there for this one particular event, but I made the costume that my kid wore in the play.”

It’s easy for parents to become trapped in the problems that they face, so Meyer encourages a solution-focused approach. For example, she has a client who is struggling with parenting a son who has intermittent explosive disorder. “She was at her wit’s end,” Meyer says. “He was kicking her [and] she was dragging him out of public venues.”

Meyer asked the woman to tell her what went well that week. At first, the client couldn’t think of anything. Then she remembered putting up a Christmas tree with her son. They had enjoyed decorating it together, and the mother took a photo. Meyer asked the client what might happen if every time that she and her son had a good moment together, she took a photo and included it in a chatbook — a social media app that allows users to generate photo books from uploaded pictures. Then they could sit down and look at the photos together each week.

The client burst into tears, saying it would make a huge difference to look at and remember some of the little victories rather than always thinking exclusively about the failures. Meyer suggested that the client could also use the photos to talk with her son about why that particular experience or day had been so good and then ask him how he had been able to remain calm.

Meyer encourages clients to use their counseling sessions as a time to stop and reflect on the quality of their relationship with their child rather than continually reacting to crises. Parents are often susceptible to getting caught up in the everyday duties of being a parent and missing out on the joy, love and upside of parenting, she says.

Helping prevent sexual abuse

Over the course of seven days in January, 156 young women and teenagers gathered in a courtroom in Michigan to recount how Lawrence Nassar, former physician for the USA Gymnastics team and Michigan State University, sexually violated them. Their stories detailed the widespread damage an unchecked predator with access to children and teenagers can wreak. Some of those who came to speak were accompanied by their parents, who were left to ask — in the words of one mother who testified — “How could I have missed the red flags?”

Most parents don’t have much accurate information about sexual predators, says ACA member Jennifer Foster, an assistant professor of counselor education and counseling psychology at Western Michigan University. Her research focuses on child sexual abuse.

In the past, most sexual abuse prevention efforts were aimed at children in the school system, she says. “This helped to create awareness, but the efforts had a major flaw in that they put the burden of stopping abuse on kids,” Foster observes.

As a former licensed mental health counselor and school counselor in Florida, Foster worked with many children who had been abused. “They would say to me, ‘I did say stop. I did say no,’” she recalls. Unfortunately, it is easy for children to be outmaneuvered and overpowered by adults and older children, so prevention efforts should focus on parents and other adults, Foster asserts.

Foster now helps educate parents about sexual predators. “I want parents to know all the scary info,” she says. This includes working to break down conventional myths. When asked to think about the profile of a “typical” predator, most people picture an adult male with a criminal record who is a stranger, or at least not someone the family knows well. Foster tells parents to picture instead the people they might invite to Thanksgiving dinner, because 90 to 96 percent of sexual predators are either family members or someone who is close to the family (the Rape, Abuse & Incest National Network puts this number at 93 percent). According to the Crimes Against Children Research Center, 36 percent are other children.

Parents don’t typically picture a female offender either, and although the reported incidence of sexual abuse by women is low, experts think that the actual rate is higher, Foster says. Unfortunately, parents are much more likely to hand over the care of their children to a woman — in a day care setting, for instance — without really knowing the person’s background, she continues.

Research also indicates a high rate of sibling-on-sibling sexual abuse, often with the use of force, Foster says. Many parents like to assume that this is something that happens only in families with lower socioeconomic status, but the truth is that it can take place in any family. Foster adds that research indicates that if child or juvenile offenders get treatment, they are likely to recover and not go on to commit the same offense again.

Foster teaches parents about some of the behavioral red flags of possible sexual predators, including spending more time with children than with peers, lacking adult friends, having numerous child-friendly hobbies and making inappropriate sexual comments about children. Foster reported a local teacher who regularly made sexually suggestive comments to his female students, such as, “If you were my daughter, I wouldn’t let you out the door in those pants because I know what I would be thinking.”

“That is such a great example of covert abuse, which was allegedly ignored by school staff when girls repeatedly complained about the teacher. That was one of multiple comments he made. They were told, ‘You’re taking it the wrong way. You misheard. You don’t know how to take a compliment.’ Then, when he had an opportunity and a student in isolation, the abuse moved to overt, with him putting his hand up her shirt.”

That student happened to be a member of a youth group Foster helps lead at her church. She believes the girl felt encouraged to disclose to her because of a pen that Foster often uses that says, “Rape. Talk about it.” Another girl in the group asked why Foster had that pen, and that gave Foster an opening to talk about the work she has done with sexual trauma survivors. After the group, the girl who had been violated told Foster about her experience. Foster contacted the school, which she says took no official action, instead simply allowing the teacher to resign.

Parents should also be wary of adults who are always putting their hands on kids or giving kids hugs, Foster says. These behaviors will often take place in front of other people because predators are testing to see if anyone notices and is alarmed by their actions. Predators also try to spend time alone with children and may give them gifts. Foster says that giving gifts can be an entirely benevolent act, but she also warns that it can be a part of the grooming process. Foster’s family has established a rule that her children won’t take gifts from anyone without first asking Foster or their father.

Foster also teaches her children that no secrets should be kept in their family (although she does distinguish between secrets and surprises). Part of the reasoning for this practice is that sexual predators often try to get children to keep small secrets. For example, “Don’t tell your mom I gave you ice cream before dinner. She’ll be mad at me!” Small secrets are a test of sorts, Foster explains. The predator is trying to gauge what a child will and will not tell his or her parents.

Predators are opportunistic — always looking for ways to be “helpful,” Foster says. They often try to come to the rescue, particularly with families in vulnerable situations, such as a family with a chronically ill child, a family that is new to town or a family headed by a single parent, she says. Becoming the family savior is part of the end goal so that they can get time alone with the children, Foster explains.

Although Foster believes that the burden of spotting and stopping child sexual abuse must be placed on adults, she says that it is still important for children to know that it is not OK for someone to touch them inappropriately. Foster likes to teach parents the language that Feather Berkower, a child sexual abuse prevention expert, uses about “body safety.” The concept is simple enough that even little children can learn it.

Body safety means that no one can look at, touch or take pictures of the child’s private parts, and children should not look at or touch another person’s body parts, Foster explains. She believes that children who aren’t taught about body safety are more vulnerable because they don’t have the language to talk about something that has made them feel uncomfortable, including actual abuse. Children should also learn the anatomically correct names for body parts, Foster says.

Foster’s son knows that everyone has to follow body safety rules. If he goes to a friend’s house, Foster also makes sure that the friend’s parents are aware that Foster’s family follows body safety rules. In addition, because of the prevalence of child-on-child sexual abuse, Foster does not allow closed doors when friends come over to play at her family’s house. She also intermittently checks in with her son about his interactions with the adults in his life by asking if he had fun with the person, what they did together and whether the person followed the body safety rules.

Most parents are also in the dark about how to keep their children safe online, Foster says, but they need to be aware that sexual predators often use online means to target children. Perpetrators often develop social media accounts and profiles, posing as someone who is the same age as the child or adolescent they are targeting and then revealing their true age later. After earning the young person’s trust, the predator may attempt to entice the child or adolescent to meet in person and move their encounters offline.

Foster recommends that families confine technology use to open spaces such as the TV room or kitchen. Parents can make use of tracking tools, but they should also have an open dialogue with their children about their online activity, Foster says. She also advises that parents find out what kind of technology rules other parents have before allowing children to go to their friends’ houses.

As a whole, Foster says, a higher level of vigilance against sexual abuse is required. She notes that most parents are good about discussing safety with their children when it comes to looking both ways before crossing the street, using a helmet when riding a bike or always wearing a seatbelt in the car. But more children are sexually abused each year than are hit by cars, and relatively few families take active steps to prevent that from happening.

“When it comes to child sexual abuse, adults need to take on the responsibility to create safe homes and communities,” Foster says. “Counselors [can] give them the tools they need.”

No longer partners but still parents

“Divorce changes kids’ lives [and] usually not in good ways,” says Kristin Little, a licensed mental health counselor whose Seattle-area practice includes a focus on counseling families that are navigating divorce or separation. “However, kids can manage even difficult divorce changes if well-supported and protected from the most harmful effects of conflict [such as] loss of confidence in their parents’ ability to lead, loss of stability in home/school life and loss of relationship with either or both parents.”

Little says the most essential thing that mental health professionals can do when counseling parents who are separated, divorced or in the process of divorcing is to introduce the idea of the separation of “adult mind” and “parent mind.”

“Parents can be experiencing a high level of anger or sadness while their marriage is ending. This is normal and expected and may be important for them to explore individually,” she says. “However, they continue to be parents and need to separate their own adult experience and reactions from their parenting roles. Giving parents the permission to feel, yet reminding them that they have the responsibility to attend to parenting needs, make important decisions, [and] see and respond to their children’s needs and feelings as separate from their own, is vitally important.”

ACA member Kimberly Mason, a licensed professional counselor (LPC) in Madisonville, Louisiana, who specializes in family and relationship issues, says that many parents have difficulty managing their anger, guilt and shame, and setting aside their conflict while parenting. To better shield their children from strife, she gives the following recommendations to parents:

1) Have ground rules for communication. Parents should not berate each other or argue in front of their children. If necessary, they should go to a private area to work out their conflict.

2) Each parent should seek individual counseling to work through his or her own issues. This can help limit the level of animosity and frequency of arguments that may occur in the home.

3) Model mutual respect for each other in front of the children. Each partner should also talk to family members and friends and ask them to refrain from saying negative things about the other partner in front of the children.

Parents who are facing divorce or separation are often terrified, which can override their ability to collaborate and make decisions, Little says. They may seek safety by sticking to past patterns of interacting and relying on assumptions about roles or capabilities that they held during the marriage or relationship, she explains. They often have difficulty envisioning change.

“This can result in one parent insisting that they are more experienced than the other and thus deserving of more time, which inevitably triggers fear and anger in the other parent and results in what we often see as a tug of war that rarely serves the kids’ or parents’ needs,” Little says.

Counselors can be a neutral “referee” of sorts for parents, steering the conversation away from who is wrong or right and instead toward developing a working co-parenting relationship that focuses on the future, she says.

ACA member Monika Logan, an LPC in Frisco, Texas, has a practice that focuses on divorce and parenting issues. She says that parents need to learn to form a more businesslike relationship by setting aside their emotions toward each other. Parents can begin to do this by “working on their own feelings related to the separation or divorce and developing a support network,” she says.

Little agrees with encouraging that approach. “[It] allows them to get the important job of parenting done,” she says. “It is essentially undoing the patterns, dynamics and practices of the marriage to allow for a renegotiation of how they will interact [and] the tasks they will agree to in the new co-parenting relationship.”

Each partner must agree to the new “business” guidelines or they won’t work, says Mason, who is also a core faculty member at Walden University. They must commit to putting their children’s needs above their own and making joint decisions. Compromise and consistency are also essential. The parents must be willing to back each other up when making decisions so that the children will still view them as a team, she emphasizes.

“Contrary to what some people describe, healthy co-parenting can be anywhere along the spectrum from parallel parenting — having little contact and overlap between homes and parents — to how co-parenting is usually thought of — frequent collaboration and interaction,” Little says.

There is no one-size-fits-all approach to co-parenting, she says. A counselor’s job is to help parents craft a plan that works for each partner, minimizes conflict and, most important, meets the needs of their children.

Coming to terms with coming out

As the LGBTQ (lesbian, gay, bisexual, transgender and questioning or queer) community has gained greater acceptance during the past 10 to 20 years, it has become more common for young people to come out to their parents, says ACA member Misty Ginicola, an LPC in West Haven, Connecticut, whose practice specialties include LGBTQ issues. She adds that those who come out are also often taking that step at younger ages than in the past — for instance, as middle schoolers rather than as teenagers.

How parents react to that decision is incredibly important to the mental health of the child. Ginicola, the lead editor of the ACA-published book Affirmative Counseling With LGBTQI+ People, has witnessed parent reactions in her practice that ran the gamut from accepting yet concerned to completely opposed and voicing a desire to “fix” their child. She tells parents looking to “cure” a child that counselors cannot, either from an ethical or a practical standpoint, change someone’s sexual/affectional orientation. However, Ginicola does try to address the concerns of all parents who come to her for help, whether they are “affirming” parents (who are supportive of their child’s orientation) or “disaffirming” (those who reject LGBTQ status).

Even parents who are supportive of the LGBTQ community may have problems adjusting to their own child coming out, she says. They may ask if the child is “sure” or, if a child comes out as gay or lesbian and then subsequently shows interest in someone who is other gendered, they may say, “Oh, so you’re really not [gay or lesbian],” Ginicola reports. These kinds of reactions often spring from parents’ fears that their child will be bullied or belittled or face other hurtful consequences, she says.

However, Ginicola explains to parents that when they ask those kinds of questions or make those kinds of statements, what their children actually hear is that something is wrong with them. Children are very vulnerable when coming out. In fact, the risk of suicide is highest during the coming-out process, but research shows that having supportive parents reduces this risk by half. So, it is crucial for parents to strive to always communicate support and to be willing to admit and apologize when they have said the wrong thing, Ginicola emphasizes.

Ginicola also teaches parents that although they cannot keep their children from being bullied, they can help them cope by building and reinforcing their self-esteem, teaching them good social and emotional skills, and ensuring that they have allies such as friends, teachers and school counselors in place.

One of the ways parents can help build their children’s self-esteem is by helping them find places where they will be accepted through whatever interests and activities they enjoy, Ginicola says. She cautions, however, that parents must take it upon themselves to ensure that these places are safe and not an environment in which their child will be rejected or targeted.

Parents should also talk to their child’s school to confirm that it has sound anti-bullying policies in place, Ginicola says. Most important, parents must make sure their children understand that there is nothing wrong with them and that they are not the problem, she emphasizes.

Unfortunately, the reality is that although acceptance for those who identify as LGBTQ has grown tremendously, they are still at increased risk for experiencing violence, meaning that parents need to talk to children who have come out about safety, Ginicola says. Specifically, children should be careful about who their friends are and make sure that they attend parties and other social events with people who are affirming, she says. Parents should also caution children who are not fully out to be very careful about whom they tell, not because there is anything wrong about telling but because sometimes it can be unsafe, Ginicola says.

Open communication is also essential. Children need to know and trust that they can tell their parents anything, Ginicola says. It is particularly critical that children understand the necessity of informing their parents about any instances of bullying, violence or other actions that threaten a child’s safety, she says.

Counselors must also prepare parents for the rejection that they will experience, Ginicola points out. For example, it is possible that family members might say hurtful things about a child who has come out and question how the parents are raising the child, she says. Community members may also weigh in with their own judgments, which Ginicola has experienced personally, including when a neighbor called child protective services because Ginicola lets her nongender-conforming son wear pink shoes to school. Nothing came of the neighbor’s call, but “it’s scary to realize that while I am getting the rejection for him now, someday he will receive that,” she says.

In some cases, parents may lose a whole community in which they previously felt secure and safe, Ginicola says. For example, in the African-American community, the church often serves as the main safe space for its congregants, but many churches are not affirming of LGBTQ individuals. By choosing to support their children who identify as LGBTQ, the parents may lose an essential source of support.

In cases such as these, Ginicola helps her clients process their grief and encourages them to seek alternative sources of support, such as other parents who have gone through similar experiences. She is also able to recommend online and local groups to which parents can turn. Ginicola also provides validation for the parents, emphasizing that it is the culture that is the problem, not the parents themselves. Another part of the service that counselors can provide these clients is to make sure they are practicing good self-care, she adds.

Ginicola also sees parents who are totally unsupportive of their child’s LGBTQ status. She acknowledges walking a fine line with these clients. Although she doesn’t want to support their beliefs, she tries to identify a way to reach them so that they don’t instead go find a therapist who is willing to attempt to “change” their child.

“[It requires] the same principles that underlie work with any parent that is potentially destructive to a child,” Ginicola says. “[It’s] a delicate balance of keeping them feeling validated without promoting harming their child.”

She starts by probing for what is at the root of the parents’ nonaffirming stance. “Let’s say it’s religious beliefs. You [as the counselor] can’t start quoting Bible verses,” Ginicola says. “That’s not our place, and they’re not going to listen to us anyway because we’re not within their religious group.”

Ginicola validates parents by saying she can see that it might be difficult to feel caught between two conflicting forces — the instinct to love and support their child versus their belief in a religious tradition that rejects their child. Rather than attempting to challenge their religious beliefs, she looks for inconsistencies and discrepancies that she can point out.

“I might say, ‘I’m hearing you say that in your faith you are supposed to love and support your child but also hearing that this [coming out] is something you can’t support. How do you feel about that conflict?’”

Ginicola tries to get these clients to a point at which they are willing to join local or online support groups and talk to other parents who have gone through the same experience. She reasons that these parents will be the best source of support and advice on coping with the conflict of belonging to a faith tradition that does not affirm LGBTQ identity and culture, yet wanting to support a child who is LGBTQ.

Sometimes parents are unwilling to let go of whatever beliefs are informing their anti-LGBTQ stance. In these situations, Ginicola lets them know that they are choosing a dangerous path. When families utterly reject children who come out as LGBTQ, the risk of suicide is exponentially increased.

“At some point,” Ginicola observes, “they have to ask themselves, do they want a gay son or a dead son?”

 

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (ct.counseling.org)

Books (counseling.org/publications/bookstore)

  • Stepping In, Stepping Out: Creating Stepfamily Rhythm by Joshua M. Gold
  • Casebook for Counseling Lesbian, Gay, Bisexual, and Transgender Persons and Their Families edited by Sari H. Dworkin and Mark Pope
  • Youth at Risk, sixth edition, edited by David Capuzzi and Douglas R. Gross

Practice briefs (counseling.org/knowledge-center/practice-briefs)

  • “Divorce and Children” by Elizabeth A. Mellin and Lindsey M. Nichols
  • “Parenting Education” by Carl J. Sheperis and Belinda Lopez

ACA divisions

  • Association for Child and Adolescent Counseling (acachild.org)
  • International Association of Marriage and Family Counselors (iamfconline.org)

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editorct@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.

Helping students change with dignity

By John J. Murphy August 26, 2016

“We may need to solve problems not by removing the cause but by designing the way forward.”

— Edward de Bono

 

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In the book All I Really Need to Know I Learned in Kindergarten, author Robert Fulghum said he had learned life’s most important lessons as a young child in kindergarten. In that same spirit, this article could be titled, “Most of What I Know About Counseling Students, I Learned From Students.”

As much as I appreciate my formal training, the best lessons of all — the ones that really got my attention and took hold — have come from the young people I’ve been privileged to serve. MurphyThese lessons can be condensed into two practical principles of school-based counseling: 1) Involve students and 2) build solutions from strengths and resources.

As further testimony to the expertise of my youthful teachers, these two strategies are strongly supported by mountains of empirical research in counseling and psychotherapy. More specifically, research indicates that counseling outcomes depend largely on the quality of the client-counselor alliance, the client’s hope for a better future and the extent to which the client’s opinions, values, strengths, social supports, life experiences and other “client factors” are incorporated into counseling.

This article translates these findings and principles into the following steps and techniques of solution-focused counseling, a practical and culturally sensitive approach to helping young people change with dignity.

Step 1: Establish collaborative relationships

The client’s perception of a strong client-counselor alliance is the most reliable predictor of successful outcomes, and client involvement is the key to a strong alliance. The more involved students are in their own counseling, the better the outcomes. The following techniques help to strengthen alliances and improve outcomes in solution-focused counseling.

Adopt the ambassador perspective. Approach every session as a cross-cultural exchange and every student as a unique “culture of one,” with the humility, respect and curiosity that a foreign ambassador would show when entering an unfamiliar country or culture. Good ambassadors look, listen and learn from people before making any assumptions
or suggestions.

Compliment students. Anything we can do to boost students’ hope will improve outcomes, which is why compliments are an important part of solution-focused counseling. Compliments help to reframe students’ views of themselves and their circumstances, and they are often folded into questions in solution-focused counseling. For example, asking a student who complains of being stressed out and depressed, “How have you managed to juggle so many things for so long?” invites a more hopeful and empowering self-perception. Students can be complimented for attending counseling sessions (“It takes courage to meet like this”), cooperating in the conversation (“I appreciate your help and patience in answering my questions”) and trying to improve their lives (“With all you’ve been through, where do you find the strength to keep on trying instead of giving up?”).

Fit counseling to students versus students to counseling. Just as a tailor adjusts a suit to fit the owner, we need to customize counseling to each student rather than requiring students to conform to our favorite ideas and methods. This means incorporating students’ key words and phrases into the conversation, exploring their theories and opinions, and determining what they want from us and our services.

Incorporating students’ language into counseling conversations validates their perceptions and reinforces the client-driven emphasis of solution-focused counseling. For example, if Maria says, “My teacher gets on my back all the time about my behavior,” we could ask, “What have you found helpful in getting your teacher off your back?”

Another way to fit counseling to students is to explore their opinions about the problem and potential solutions. This can be done through asking questions such as, “What needs to happen to improve things at school?” and “If you were counseling people in a similar situation, what would you advise them to do?” A student’s ideas about the problem and its possible solution can be cobbled into interventions that are more likely to be accepted and implemented by the student than interventions that come from other sources.

Obtaining feedback from students is another way to ensure the provision of student-driven rather than counselor-driven services. The Outcome Rating Scale and Session Rating Scale — two four-item client feedback scales that take one minute to administer and score — provide ongoing snapshots of students’ perceptions of counseling progress and alliance. Collecting feedback from clients during every meeting, and adjusting services based on this feedback, has been shown to dramatically improve counseling outcomes regardless of one’s theoretical orientation.

Step 2: Develop practical goals

In addition to providing students with a sense of hope, purpose and direction for the future, goals help them persist in the face of setbacks and obstacles. Effective goals share several characteristics that can be summarized in the 5-S guideline: significant, specific, small, start based and self-manageable.

Significant: The most important feature of a counseling goal is its personal relevance to the client. Good goals are goals that matter to students, and we can develop these goals by asking questions such as “What are your best hopes for counseling?” and “What is the most important thing you want to change about school right now?”

Specific: Goals also need to be specific and concrete so that students, counselors and anyone else involved can tell when they are reached. The following sample questions help counselors partner with students to develop specific goals: “If we videotaped you being less anxious at school, what would we see you doing?”; “What will be happening next week to let us know that we’re on the right track?”

Small: Practical goals are small enough to be attained, yet challenging enough to inspire action. Questions that help in this regard include the following: “What will be the first small sign that things are moving in the right direction?”; “You rated school as a 2 on a 10-point scale. What would a 2.5 or 3 look like at school?”

Start based: When asked what they want from counseling, most students tell you what they don’t want: “I want to get in less trouble at school” or “I want to be less depressed.” When students state goals in negative terms, we can ask the following “instead of” questions to encourage goals that express the start or presence of something desirable rather than the end or absence of something undesirable: “What will you be doing in class instead of getting in trouble?”; “What would you rather be doing instead of being depressed?” In addition to being more noticeable and measurable than negatively worded goals, start-based goals are more motivating because they focus students’ attention on moving toward what they want (solutions)
rather than away from what they don’t want (problems).

Self-manageable: Students may initially focus on how other people should change instead of considering what they could do differently (“My teachers need to back off and chill a little”). This perspective, accurate as it may be, usually impedes solutions by holding others responsible for changing while placing oneself in a passive and powerless role. When this occurs, counselors can acknowledge students’ perceptions while inviting them to consider what they might do to improve

the school situation: “What have you found helpful in getting your teachers to back off and chill?”

Step 3: Build on what is ‘right’

Instead of emphasizing what is wrong, missing and not working (problems, deficits, limitations), solution-focused counseling invites students and others to notice and build on what is “right” with students and their lives (successes, strengths, resources).

Build on exceptions. Struggling students typically are aware of their failures and problems at school, which is one reason why building on exceptions is so effective in grabbing and keeping their attention. Exceptions refer to the “good times” at school — times when the problem could have happened but did not. These nonproblem occasions are minisolutions that are already happening, just not as often as people would like.

Building on exceptions is a core technique of solution-focused counseling that involves three steps: 1) eliciting exceptions (“When is the problem absent or less noticeable?”), 2) exploring the conditions under which exceptions occur (“How did you make that happen? What was different about your approach?”) and 3) expanding their presence and frequency at school (“What will it take to make that happen more often at school? Are you willing to try that approach in another class?”). This strategy is based on the practical idea that it is more efficient to increase what students are already doing than it is to teach them brand-new behaviors from scratch.

Many students are surprised to learn that they are doing “something” right, and they become more hopeful when they realize that they already have what it takes to turn things around at school. On a more personal level, building on exceptions encourages struggling students to change the question from “How can I be more like other students?” to “How can I be more like myself during my better moments?”

Build on other student resources. In solution-focused counseling, all students are viewed as resourceful and capable of changing. It is our job as counselors to help them identify and apply the “natural resources” in their lives toward school solutions. Natural resources include heroes and influential people (family, friends, actors, athletes); resilience and coping (students’ abilities to cope with life’s adversities); values (students’ deeply held beliefs); special interests (cooking, sports, movies); and community support systems (places of worship, neighborhood groups, clubs). These resources, individually or in combination, can be woven into respectful Branding-Images_Studentsinterventions that improve school behavior while respecting students’ cultural heritage and life experiences.

Let’s look at a quick example involving Ben, a 10-year-old student who loved baseball. After a few minutes of general baseball talk, we explored similarities between the challenges of school and the challenges of baseball. For instance, we talked about how long the baseball season is and how important it is to not let a few bad games ruin the entire season. Ben agreed to try a baseball experiment at school that involved “stepping up to the plate every day” and doing his best, knowing that he would sometimes “strike out” and have bad days. Ben improved his classroom behavior over the next two weeks, and his teacher commented on his impressive turnaround.

This example captures the general nature of building on student resources — identify an available, naturally occurring resource in the student’s life and link the resource to a school solution. Because every student offers a unique set of resources, resource-based interventions are constructed one student at a time with no preconceived notions about what they should look like. You are not likely to find them in treatment manuals or lists because a) they cannot be selected or developed before meeting the student, b) they evolve from the student-counselor relationship and are often formulated on the spot in collaboration with the student and c) they are based completely on material supplied by the student — which is precisely why they work so well. I describe these techniques and many others in greater detail while offering more than 50 real-world illustrations in the new third edition of my book Solution-Focused Counseling in Schools (2015), published by the American Counseling Association.

Solution-focused counseling rests on two main values. First, students should be given every opportunity to be actively involved in their own care because they are the very people for whom school-based counseling services are designed. In addition to honoring core principles of multiculturalism and social justice, giving clients a voice in shaping and evaluating counseling services results in better outcomes. Second, all students are doing “something” to help themselves — if only to keep the problem from getting worse — and these assets and resources can be applied toward school solutions. Without denying the reality and pain of school problems, we can improve outcomes by identifying students’ strengths and resources and incorporating them into the counseling process.

I hope this article was successful in showing that solution-focused counseling in schools is far more than a set of techniques. It is instead a new and different way to approach young people, problems and solutions.

 

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

John J. Murphy, a professor in the Department of Psychology and Counseling at the University of Central Arkansas, is the author of several well-regarded books, including the third edition of Solution-Focused Counseling in Schools, published by the American Counseling Association. Contact him at jmurphy@uca.edu and learn more about his work at drjohnmurphy.com.

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.