Tag Archives: Offenders

Offenders

Addiction: Paving the way to recovery

By Laurie Meyers October 26, 2020

When the outside world looked at Julie Bates-Maves’ client “James,” it saw a 60-something “junkie” who had wasted 20 years of his life shooting up heroin. But in James’ community of people who used heroin, he was a respected man — an authority figure who could be trusted.

Throughout his two-decade addiction, James had established himself as a safety expert, recounts Bates-Maves, a member of the American Counseling Association. It might seem incongruous to use the word “safety” when speaking about heroin use, but safer injection practices can save lives. James derived great satisfaction from helping his peers reduce their risk of contracting HIV or hepatitis by teaching them never to share needles and demonstrating how to clean their own. He also taught others how to inject without missing the vein.

James’ process of giving up heroin took about a year, but he did well with overcoming the physical addiction, says Bates-Maves, a licensed professional counselor (LPC) whose master’s degree is in rehabilitation counseling with a concentration in alcohol and substance abuse counseling. The hard part was when James was alone and feeling lonely. He struggled with feelings of uselessness, and he knew where he could readily find validation. Among other users, all James had to do was offer to lend his expertise. There was always someone willing to take him up on his offer.

“He had not found respect in virtually any other area of his life,” Bates-Maves says. That meant that in trying to give up heroin, James would also have to leave behind the solitary piece of his world that made him feel worthwhile.

Once Bates-Maves understood that using heroin was tied to James’ sense of self, she realized they needed to examine what it was about the behavior and the attached relationships that provided him with a sense of meaning.

“It was a lot of picking each other’s brains and saying, ‘Let’s try to dissect this,’” she recalls. They set about trying to uncover the actual source of the sense of meaning that James derived from using heroin. “Is it truly tied to the syringe and the bleach and the cotton and the heroin?” she asked him. “Or is it that somebody is listening to you because they think you know something that they don’t?”

Ultimately, James realized that he didn’t actually need the heroin. “I just need someone to look at me and think I’m smart and that I have something to offer,” he told Bates-Maves. So, they worked together to identify another way for James to find a sense of meaning and feel as if he had something to offer others.

Earlier in his life, James had pursued a welding career. For various reasons, he had abandoned that path long ago. But now, he was ready to pick it up again.

With Bates-Maves’ help, James got re-enrolled in a tech program for welding. By going back to school, he acquired a skill set that not many people possess, built new relationships and experienced a sense of validation. He was able to say, “Hey, I’m 62, but I don’t have to check out of the game, and I don’t have to stay stagnant in everything I’ve done,” Bates-Maves explains. “I can add new things to my life, and by adding more to my life, I can add to other people’s lives.”

“So,” she adds, “it became sort of a sense of altruism for him of wanting to give to the world and then to feel good about doing that.”

James had been addicted to heroin for 20 years and recognized that over that time, he had hurt and taken a lot from others, particularly his family. “He had kind of felt like a leech for a long time, and now it was finally time to be able to give that back and repay,” Bates-Maves says.

James was a watershed client for Bates-Maves. His story was the one that changed how she viewed substance abuse counseling. James’ narrative hadn’t been just informational — it had been existential. It made her realize that counselors need to have those types of discussions — about the search for meaning, about the grief and loss that come with substance abuse — with all clients in recovery.

Bates-Maves and the other counseling professionals interviewed for this article say that when therapists center treatment solely on elimination of the substance and everything associated with it from the person’s life — without considering the myriad factors that contribute to use, abuse and the drive to reuse — they are actually hampering clients’ recovery.

The need for grief work in substance abuse therapy

“We oversimplify the picture of addiction,” Bates-Maves says. “We do that as a world broadly, and we definitely do that in the counseling profession sometimes. …We think of it as the erosion of a life — it’s only somebody moving backward, it’s only someone being stuck. And we get stuck in that narrative.”

Counselors often focus on getting clients “unstuck,” which is certainly not without worth, but it is limited, says Bates-Maves, an associate professor of clinical mental health at the University of Wisconsin-Stout. “I’ve worked with many clients who … loved being stuck [in addiction],” she says. They loved the feeling of being someone else, the ability to lose sight of negative things, the ability to create an optional numbness.

Addiction sets the stage for a lot of destruction in people’s lives, but it can also serve as a kind of desperate sustenance for users who see no other way to cope with life, Bates-Maves says. The bald truth is that substance abuse also adds things to life, and that’s something counselors don’t talk about enough, she asserts. Counseling is a profession that focuses on concepts such as identity and a person’s sense of meaning, yet counselors often neglect to explore how these concepts tie in to addiction — what clients are actually getting from their substance abuse, what makes it attractive or useful to them, she says.

When presenting on the role that grief and loss play in addiction, Bates-Maves has frequently heard from audience members that the clinics in which they work have told them not to talk about the “good stuff” that substance use brings. She says the usual company line is, “You can’t have them celebrate the high or tell those so-called glory war stories. That’s encouraging their desire to use.”

“We’re so blinded by this fear of people going back to use,” Bates-Maves says. “What if the glory days were the only time people felt powerful, or what if when they’re high, it’s the only time they don’t feel intense [emotional or physical] pain? What if it’s the only time they feel confident enough to engage with another human? … Those are central treatment issues, and they can come out of the quote-unquote ‘positive experiences’ in addiction. There’s a lot to let go of when you’re trying to get to recovery. There’s a tremendous amount of loss, and [we’ve] somehow largely missed that as a field.”

Bates-Maves feels so strongly about the necessity of counselors having these conversations with clients as part of the recovery process that she wrote a book, Grief and Addiction: Considering Loss in the Recovery Process, which was released at the end of September.

“Addiction … ravages your life,” Bates-Maves says. “Nobody likes that.” Even so, she continues, counselors need to encourage clients to think about the things they risk losing when they determine to confront their addiction.

“Even if they’re good losses — things you want to go away — it’s still a massive change that you’re undertaking,” she tells clients. “You deserve to feel sad and frustrated and sorrowful … and relieved.”

Even though the changes people go through in recovery need to happen, clients deserve to know that it’s OK for them to miss the things they leave behind. “You can miss it forever and still change,” Bates-Maves says emphatically.

“When we start to try and shove people forward to recovery without looking at the rearview mirror at all, we’re going to miss the things that will chase them down later,” she explains.

Bates-Maves believes Kenneth Doka’s model of disenfranchised grief perfectly explicates the losses sustained by people struggling with addiction. In the recovery process, these clients typically must abandon coping methods and even relationships that are unhealthy. As such, these things are often deemed “unworthy” of grieving over.

Similarly, many clients in recovery have lost friends to stigmatized deaths such as overdose, suicide, hepatitis and AIDS. Other clients may have chosen abortion or had a miscarriage because of their addiction. Once again, these individuals can be made to feel that they aren’t allowed to grieve those losses, Bates-Maves says. In particular, family members — and the courts — tend to convey the message, “You dug your own hole.”

But everyone has losses from predicaments that are primarily self-created, Bates-Maves argues. “I have this grief all the time where I’m the one who caused the problem, but I’m still really mad that I have it,” she says.

Emotions that are denied usually just fester and show up in other ways, Bates-Maves says. “Just let people” — including those struggling with addiction — “be angry. Let them be sad. Just because we’re the creators of our own misery does not mean we don’t deserve to be miserable about it,” she says.

Counselors can offer clients support as they learn to acknowledge that their current reality — whatever stage of addiction or recovery they’re in — is incredibly tricky and comes with myriad, and often confusing, emotions, Bates-Maves says. What counselors shouldn’t do is tell clients that what they’re feeling is wrong or try to “cheerlead” them into a different emotional state, she continues.

People sometimes picture coping as having overcome a difficulty so that it no longer has any emotional effect on them, Bates-Maves says. “I think it’s really important for all of us to remember that’s not what coping is. Coping isn’t getting over something. … It’s living with something. It’s getting through it as you’re in it.”

“My job as a counselor is not to make the pain go away, because I can’t,” Bates-Maves continues. “It’s not to force the transformation of pain. That’s a hope, but sometimes that can take longer than my relationship with [the client].”

So, what is the other side of grief? What is the goal of grief work? Bates-Maves describes it as learning to walk with and carry your pain in a way that doesn’t sink you. “You want the pain to be manageable so that you can live life with it there,” she says.

Bates-Maves recommends a variety of methods to help clients, including those walking through addiction and recovery, with their grief and pain. One method is containment — the idea of compartmentalizing the pain and building psychological space for it. She says this is particularly useful for pain attached to situations that are unlikely to be resolved anytime soon. Some clients make actual physical boxes, write down their thoughts, feelings or whatever it is that is causing them distress, and lock it up, but the container need not be literal, Bates-Maves explains.

The intent of the exercise is not to lock the person’s pain up forever, but rather to put it aside so that the person can carry on with the other parts of their life. This acknowledges the reality that even when people are hurting badly, the demands of living go on. When a client has the time or desire, they can open the container, sit with the pain and feel whatever they feel. Being able to set aside the pain temporarily allows clients to care for their children, drive to work or even just relax by watching TV or listening to music without being confronted by constant intrusive thoughts, Bates-Maves says. Journaling is another way that clients can create a space outside of their own heads for their emotions, she adds.

In contrast, radical acceptance, a method that is the polar opposite of locking one’s thoughts away, can be very effective for some clients. “It’s this idea that we cannot always change things and we need to accept and acknowledge it and keep moving,” Bates-Maves says. With radical acceptance, clients learn that their grief and pain are valid but that they can feel those emotions and still keep moving alongside them.

Bates-Maves has also had clients who experienced intense and disturbing dreams about their grief. She would teach them “directed dreaming.” Clients would take five to 15 minutes before going to bed to create detailed mental pictures in their minds of what they wanted to dream about. With practice, people can learn to direct their dreams, Bates-Maves says.

For clients who frequently feel overwhelmed, Bates-Maves recommends belly breathing. She explains that teaching people to breathe more efficiently can reduce panicked breathing, which helps take the body from a state of distress to one of relaxation, or at least closer to it.

She sometimes helps clients transform their pain by learning to reframe how they view their losses. Certain clients realize that they will never feel differently about parts of their past but that they are OK with that. Some clients work through their pain by seeking connection with others. And some clients decide that they need to spend more time with themselves rather than with others, hoping to learn who they are without addiction.

Attachment, trauma and addiction

Many people with addiction have been primed to seek solace in substances or processes because of a history of trauma and a lack of healthy attachments, says ACA member Oliver J. Morgan, who has written numerous books on substance abuse and addiction. Caring relationships can help mitigate the effect of trauma in a child’s life, whereas a lack of those connections is traumatic in itself. Feeling cared for helps build healthy neural connections such as a fully functional stress response and the reward, reinforcement and motivation systems that contribute to emotional coping skills, he explains.

When someone finds it difficult to cope with stressors such as the lasting pain of trauma, dysfunctional relationships, loneliness or the everyday disappointments and frustration of life, they may turn to addictive substances or behaviors, says Morgan, a licensed marriage and family therapist who has been clean and sober for over 30 years but once was addicted to alcohol.

Over time, chronic use and abuse of substances or processes oversensitize areas of the brain related to dopamine so that they are easily triggered, he says. The brain then connects those areas to memory and environmental cues that themselves create desire. In other words, addiction causes the brain to react to cues that a client may not even know exist, Morgan says, creating what neurobiologists call “pulses of craving.”

“The brain organizes reward around memories so that we remember to repeat [the action],” says Morgan, a master addiction counselor. “It’s how we learn and how we fall in love.” A particular song on the radio, specific places or people, or even certain scents can serve as triggers.

That’s why he views all addiction counseling as relapse prevention. “From the beginning, you need to prepare people for the possibility, if not probability, of relapse,” says Morgan, a professor of counseling and human services at the University of Scranton.

He uses psychoeducation to explain the neurobiology underlying addiction and relapse — not just to clients, but to their families if they are willing to listen. Morgan believes this is essential to preventing a common scenario: A client relapses and their family says, “He told me he was going to stop and he didn’t. He lied to me.”

It’s not quite that simple, Morgan says. He explains to families that their loved ones mean it when they say they’re going to stop using, but they’re not anticipating that their brains are going to react to these cues. So, a relapse doesn’t mean that the client isn’t committed to recovery, Morgan says. The support of loved ones helps clients remain dedicated to the recovery process and keep believing that they can achieve it — even if they are momentarily derailed by a relapse.

Morgan, a member of the International Association of Addictions and Offender Counselors, a division of ACA, believes that relationships are the ultimate buffer against addiction. From the start of the recovery process, he helps clients begin forging new relationships with people who are clean and sober. They might develop these connections by finding sponsors or reaching out to strangers at Alcoholics Anonymous (AA), Narcotics Anonymous (NA) or other recovery group meetings and virtual gatherings.

Morgan also gives clients a laminated card with steps to take if they feel the urge to use. This can function as a kind of crisis plan or serve as a reminder to clients that they have tools to help prevent relapse. The first step is to acknowledge their urge but to remind themselves that it is just a feeling, not something that they have to act on.

Next, Morgan wants clients to reach out to someone whom they trust and can talk to. “The best way to deal with stress is to buffer with a relationship,” he says. The person or people clients reach out to could be a sponsor, recovery group members or Morgan himself. This gives clients a way to share the burden by verbalizing their feelings and getting some advice. If none of this works, he tells clients to call him (assuming he wasn’t the person they reached out to initially).

Because the urge to use is triggered by external and internal cues that clients may not even be aware of, Morgan urges counselors to walk these clients through their past. He asks clients to think about times when they were using or wanted to use. What was happening in their lives at the time? What were their favorite songs? The broader the exploration of everything in their lives, the more likely it is that potential relapse triggers can be identified.

“Sometimes,” Morgan says, “you have to wait for them to come into session and say, ‘I really wanted to use’ [to discover their triggers]. That’s why it’s important to let them have access [to you] when it happens [between sessions] so that you can walk them through it. ‘Where were you? What happened? Who was with you?’”

Once the client and counselor have identified triggering situations, they can work together to come up with better ways to handle them. In his own life as someone who was addicted to alcohol, Morgan uses humor. “I make a joke out of it and talk about it widely,” he says.

When Carol Sloan Goodall, a licensed clinical addictions specialist, led group work at a local recovery center, she frequently had clients form smaller circles to identify three external, three internal and three sensory triggers. Group members also had to come up with three ways to cope with each trigger.

“I was often pleasantly surprised to see how many different realistic coping skills they created and excited to see the clients impressed and motivated by these ideas,” says Goodall, a licensed clinical mental health counselor in private practice in Charlotte, North Carolina.

Common external triggers involved people, places and things. Internal triggers usually involved emotions but sometimes also included cravings, chronic pain or illness. Sensory triggers were just that — input from the five senses, such as smells, tastes and sounds.

The coping skills that clients came up with were varied. One client described avoiding temptation by changing their route upon realizing that their drug dealer lived on a particular street. Another client felt like their home was a trigger, so they rearranged the furniture and changed the color of the accessories to make it appear new and different.

“One client said he carried a dryer sheet in his pocket and sniffed it when triggered by scents reminding him of drug use,” Goodall recalls. “Another client stated that the perfume cards you spray in department stores served the same purpose.”

Goodall also suggested that when confronted by triggers, clients could distract themselves with sensations such as snapping a rubber band on their wrists or holding an ice cube.

Morgan is a believer that practicing mindfulness can help clients identify and even anticipate triggers. He teaches clients to sit down and find a place on which to focus — a spot on the wall, a beam of sunlight, a candle. Then he instructs them to just “be” in that moment and observe what is happening around them in the here and now, to cultivate awareness and to notice if the urge to use is creeping up. He also finds this mindfulness practice helpful for coping with anxiety and creating a sense of calm by just being in the moment, letting one’s thoughts and emotions float by, and then letting them go.

The necessity of reducing in-person meetings during the pandemic has in some ways made it easier for those in recovery to get support. Groups such as AA, NA and other recovery organizations swiftly moved their meetings to digital platforms. People can access virtual meetings or keep in touch with other group members through social media, email or phone. Counselor clinicians have also had to become more comfortable with virtual counseling. Morgan sees this as a positive because he thinks not having to show up in person to access resources is easier for many people who are seeking help with substance abuse. It’s less uncomfortable for these clients, Morgan says, because they don’t quite have to put themselves out there completely.

Going from prison to the outside world

Julia Thielen, an LPC located in South Dakota, works at an intensive outpatient facility with a particularly challenging substance abuse population: clients living in a post-prison transitional facility after being incarcerated for as long as 10 to 15 years.

These clients are not only working toward recovery, but also coping with trauma and trying to navigate a world that they don’t recognize or understand, Thielen notes. They have records, have spent years without employment, are often estranged from their families, have often lost friends to causes such as overdose, and struggle to form a sense of identity. Life has generally moved on without them. The things these clients may have once wanted — steady jobs, families, a house of their own — now feel largely out of reach to them, Thielen says.

Those around these clients often want to sugarcoat their circumstances and make them feel better, but what they really need, Thielen says, is someone to hear them out and help them set realistic goals. “Yes, you are past 30, so having a house before then is not going to happen. But is it possible to achieve that by 40?” she asks them.

For clients who have spent a particularly long time in prison, just getting a job is challenging, Thielen says. They lack a history of employment and have to disclose that they spent time in prison. They need help finding any form of employment just to reestablish a work history so that further down the line, future employers at potentially more attractive jobs might be able to see them as responsible and hard-working, she explains.

In addition to teaching these clients emotional self-regulation skills such as deep breathing, Thielen and her colleagues instruct them in basic life skills. Many of these individuals spent their adolescence and young adulthood in prison, so in essence, they have skipped a developmental stage, she says.

Thielen’s clients regularly talk about the challenges of finding healthy friends and activities. “One of the big things they are lacking is any kind of support or stability in their lives,” she says. Getting these clients involved with AA, NA or another recovery group is one way to help them establish friendships with people who don’t use or who are also in recovery.

Many of Thielen’s clients don’t know what healthy friendships look like, so she spends a significant amount of time helping them identify red flags from their past relationships, such as behaviors that led them toward addiction or contributed to them staying addicted. Often, Thielen says, these friends from clients’ former lives would call in sick for the client when they were hungover, pay their fines for misbehavior or help them come up with excuses for their probation officer.

Another piece of the puzzle is to help these clients articulate what values they would like potential friends to possess. Often, the easiest way to do this, Thielen says, is to ask them what values and beliefs they would like to instill in their own children and to look for those same characteristics and qualities in others when forming new friendships.

But most of Thielen’s clients still have strong ties to the people they previously used with. These aren’t “healthy” friendships, but many of these clients have no one else in their lives upon being released from prison. In many cases, their families and any friends they had who weren’t fellow users have given up on them long ago. From the perspective of some clients, the people who were their fellow users and have maintained contact have “been there” for them, and the clients want to reciprocate. But spending time with these friends — who may not be interested in stopping their own substance use — is the most common road back to addiction and, often, reincarceration.

Some clients can have the hard conversations and cut ties with the people who are linked to their past substance abuse and prison time, Thielen says. But that’s almost an impossible ask until they have formed new relationships. That is why getting them into some type of new community such as a self-help group, addiction recovery group or church group is critical, she says.

Another challenge is that although a transitional facility can offer support and shelter to those who have recently been released, the environment isn’t very conducive to learning responsibility, Thielen says. These clients learned to follow a particular set of rules in prison, and now they learn to follow another set of rules in the transitional facility, but they aren’t necessarily learning how to set a budget, how to cook a meal or even how to buy groceries for themselves.

Thielen and her colleagues attempt to set clients up with case managers and life skills coaches, but she acknowledges that some individuals are very resistant to this kind of instruction.

Prevention and intervention

Counselors do have opportunities to intervene — before addiction, before prison, before a life goes off the rails. Morgan notes that while the focus is typically on those who are physically addicted to substances, almost three times as many people are problem users. And it is these individuals whom counselors are most likely to see, he says.

Morgan asserts that addiction professionals don’t necessarily know how to deal with those individuals who are problematic users but have not reached the threshold for addiction. Recovery centers aren’t suitable for these individuals because they aren’t physically addicted, he says.

But professional counselors can help clients explore and recognize their problem use through exposure to motivational interviewing and the stages of change, Morgan says. Often, these clients have ended up in the counselor’s office because they’ve had trouble at work, at school, with their family or other relationships, or elsewhere. They may flatly deny any suggestion of “problem use,” but counselors can suggest exploring what is going on in these clients’ lives.

“If they’re willing, that already puts them into precontemplation,” Morgan says. Counselors can take that recognition that something’s not quite right and say, “Let’s look at what change looks like,” he suggests. “Let’s stop drinking, drink less or drink less harmfully.”

“We have to pay attention to moments of opportunity,” he stresses. “Someone gets pulled over for a DUI — that’s a moment of opportunity.” If someone is overdrinking and prone to accidents around the home, every visit to the emergency room is an opportunity, Morgan continues. Some hospitals are already using motivational interviewing for brief interventions in the ER, and the success rates have been impressive, he says.

The problem is that for too long, the message has been that when people with substance abuse problems are ready, they will seek help, Morgan says. But most of the time, they’re not going to come in on their own, he asserts.

“We have to raise the bar,” Morgan concludes.

 

****

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:

International Association of Addiction and Offender Counselors (iaaocounselors.org)

IAAOC, a division of ACA, is an organization of professional substance abuse/addictions counselors, corrections counselors, students and counselor educators concerned with improving the lives of individuals exhibiting addictive or criminal behaviors.

Counseling Today (ct.counseling.org)

Books (imis.counseling.org/store)

  • A Concise Guide to Opioid Addiction for Counselors by Kelvin Alderson and Samuel T. Gladding
  • A Contemporary Approach to Substance Use Disorders and Addiction Counseling, second edition, by Ford Brooks and Bill McHenry
  • Addiction in the Family: What Every Counselor Needs to Know by Virginia A. Kelly
  • Treatment Strategies for Substance and Process Addictions by Robert L. Smith
  • Introduction to Crisis and Trauma Counseling edited by Thelma Duffey and Shane Haberstroh
  • Coping Skills for a Stressful World: A Workbook for Counselors and Clients by Michelle Muratori and Robert Haynes

Webinars and article for continuing professional development (aca.digitellinc.com/aca)

  • “Opiate Addiction and Chronic Pain: Overview of Counseling Approaches” with Geri Miller
  • “Opiate Addiction and Chronic Pain: Ethical Practices for Counseling Clients Who Live With Chronic Pain” with Geri Miller
  • “Opiate Addiction and Chronic Pain: Hope, Resilience and Self-Care Strategies for Counselors and Clients” with Geri Miller
  • “Substance Abuse/Disruptive Impulse Control/Conduct Disorder” with Shannon Karl
  • “Developmental Approaches in Treating Addiction” by Ford Brooks and Bill McHenry
  • “Complicated Grief: An Evolving Theoretical Landscape” by Laurie A. Burke, A. Elizabeth Crunk and E.H. Mike Robinson III
  • “Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Substance Misuse” with Amy E. Williams and Kristin Bruns

ACA Mental Health Resources (counseling.org/knowledge-center/mental-health-resources)

  • Substance use disorders and addiction
  • Grief and loss

 

****

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

****

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

Counseling in jail

By James Rose March 16, 2020

To enter my office, I first pass through a series of three heavy steel doors. The lock for each door is controlled from a remote central office. I wait to hear a buzz signaling that the door has been unlocked before proceeding through.

The first time I caught sight of a prisoner, it startled me so badly that I wondered whether I truly wanted to work here. The inmates wear smocks and pants with broad orange and white stripes. Their shoes close with Velcro because shoestrings can be used to strangle oneself. Everything here is geared toward minimizing the risk of suicide.

Four of us share a counseling office. The number of rooms where we can visit with prisoners privately is limited, and the rooms are used by others in the jail besides counselors. Seeing an inmate always depends on first winning the competition to find a room.

Inmates who are judged to be dangerous, who are on disciplinary status or who are on suicide watch are shackled with ankle chains and handcuffed. In one room, these inmates are then also chained to the wall. Nothing in my training prepared me for the shock of trying to carry on an intense, personal counseling session with a person in chains.

The individuals being held in this detention facility are most commonly referred to as prisoners, inmates or simply as males and females by the people who work here. But those of us in the counseling office refer to them as patients. We see it as our job to treat them first and foremost as human beings.

Introduction to the blocks

Inmates are screened upon booking, including for suicidality. Among the questions asked are whether this is their first arrest, whether they are detoxing, whether they have any prior suicide attempts, whether anyone in their family has died by suicide, whether they have ever been in a mental institution, and so forth. Inmates determined to be at risk for suicide are placed on suicide watch.

The jail is divided into a series of blocks, a grouping of two-person cells around a central area where the inmates can watch TV, exercise, or play poker for candy bars or cups of pudding. The blocks form a U shape surrounding an outside courtyard where the inmates sometimes go for recreation when the weather permits. There are a half-dozen volleyballs stuck on the spiraled razor wire that surrounds the upper perimeter of the courtyard. S block is for sex offenders. Participants in Project 103, the in-house addiction recovery program, are in R block. Immigration and Customs Enforcement inmates are held in K block. As the only Spanish speaker on the counseling team, it is my job to interview all of the inmates in K block. The women are housed separate from the men in blocks X, Y and Z. When they walk the hall to go to the gym or the library, the men bang the window and wave, and the women look up and wave back.

W block is for suicide watch. Inmates on suicide watch are placed in isolation cells and checked by a guard every 15 minutes. Their clothing consists of a “turtle suit,” a cardboardlike cloth that cannot be twisted into a noose. They are given finger foods only; plastic eating utensils are not allowed. Neither are books. The pages could be torn out and stuffed in the mouth to cause suffocation. The inmates can watch a television through a window in their cell door. They are allowed out of their cells for a few minutes each day to take a shower, under observation.

Counselors interview patients on suicide watch as soon as is practicable. Some of these patients have a history of schizophrenia. Some are detoxing so heavily that they act schizophrenic. Others are bipolar and in a manic or depressive state. Sometimes patients on suicide watch scream or sing loudly or beat on the wall.

They say a picture is worth a thousand words. I know the textbook definition of schizophrenia. It is a breakdown in the relation between thought, emotion and behavior leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation. With all those words, my picture of schizophrenia will always be a guy on suicide watch in a green turtle suit who stuck a toothbrush up his rear end.

A dumping ground for those in need of help

Sometimes patients on suicide watch get placed in a mental hospital. Our state used to have an extensive network of mental hospitals, but most of those facilities were closed during budget cuts decades ago. Today, many people who are mentally ill who previously would have been hospitalized end up homeless. Sooner or later, many of them land in jail.

“Rogue and vagabond” is the legal euphemism for a homeless person. Jails have become a dumping ground for those who are homeless, those who have addictions and those who are mentally ill. Although we are thoroughly under-resourced to deal with all of these individuals, it is our job as mental health counselors working in a detention center to do whatever we can for them.

Our staff includes a part-time psychiatrist who can prescribe psychotropic medicines. Out of hundreds of inmates, our patients appear on the mental health radar screen for a variety of reasons. They may have a prior history of receiving mental health treatment or psychotropic medications, or they may have a prior mental health diagnosis, which we learn from the screening form. In other instances, a patient may ask to see a mental health counselor. Patients suspected of needing medication are evaluated by the counselors, and we make an initial determination of whether they should see the psychiatrist. The psychiatrist determines the official diagnosis. Patients diagnosed with schizophrenia, bipolar disorder or major depressive disorder, or who act out bizarrely, receive a treatment plan and special attention.

Among the jail’s general populations, we expect to see issues of alcoholism or addiction in about 80% of them. My prior work in addictions recovery has served me well in this environment. I share pictures of brain scans from Dr. Daniel Amen with the patients. A normal human brain looks like a soft buttery mass. The brain of someone with alcoholism or addiction looks like Swiss cheese, with large “holes” of areas that are nonfunctioning. The brain of someone addicted to heroin looks like a sea anemone, with dangling tentacles of functioning areas and large masses between of nonfunctioning areas. Patients are often shocked when I show them the impact their substance use has had on their brain.

The point of drug use is to stop the brain from functioning properly. Most of the patients I see carry painful memories deep within them — memories so painful that they cannot hold them in conscious memory and go about living a normal life simultaneously. It isn’t hard to spot the source of their pain. I will ask about their mom, or their dad, or their childhood, and the stories typically come spilling out.

One young man told me he had once hoped to be an astronaut. I asked him why. He said that when he was younger, he asked his mom where his dad was, and she told him that his father was on the moon. In truth, his father was serving an eight-year sentence in a state prison. After years of longing for his father, the boy’s wish came true when his father finally returned home. But instead of experiencing a happy reunion, the boy’s father beat him up. Is it any wonder why this young man became addicted to drugs?

Another young man shared his story with me of addiction and repeated encounters with the law. I said, “I am going to make a wild guess that you had a rough childhood” — a line I often use to begin digging into a patient’s past.

His response surprised me. He said, “You’re the first person who ever noticed.”

Encouragement to look forward

The disciplinary block is the A block, known in jail as “the hole.” Fighting with another inmate may get you 10 days in the hole. Fighting with an officer can get you 50 in. Inmates in A block are given “23+1,” or 23 hours per day in their cell, one hour per day out into the block, one person at a time. No outside contact is allowed. There are no visits, no phone calls, no participation in the classes that are sometimes offered to the general population.

Isolation is punishment, as it is meant to be. As a mental health counselor, my concern with the guys on A block is the tendency to decompensate, to go into the deep and dangerous depression that extreme isolation can create.

One young man who had been on A block clearly showed signs of decompensation. I learned that he had been the valedictorian at his Philadelphia high school before being arrested in a 24-person drug bust. He was intelligent. Our conversations covered such diverse topics as Federal Reserve monetary policy and the use of political power in Niccolo Machiavelli’s book The Prince.

When this young man went down emotionally, I decided to find some books from the jail library that might help bring him back up. I eventually gave him two books. One was a book of jokes. The other was Man’s Search for Meaning by Viktor Frankl. In it, Frankl discusses his time as a Jewish Austrian prisoner in a Nazi concentration camp.

Frankl observed that it is not the outward circumstances of our lives that determine our destinies so much as it is the attitudes we choose to take toward those circumstances. Frankl withstood his concentration camp experience by taking the attitude of an observer of how humans survive in the most extreme circumstances.

My young patient got the point. As bad as his circumstances were, his mental and emotional state were determined by the attitude he chose to take toward his circumstances. He was excited by his new understanding, and his excitement was enough to pull him out of his depression. I had taken a gamble with him and won.

One of the hardest stories I have heard belonged to a man in his early 40s whom I first met on suicide watch. He was arrested for being rogue and vagabond, was intoxicated during his arrest, and had a history that included a suicide attempt.

The man’s story unfolded in fragments over the weeks and months that we worked together. It was like slowly gathering the pieces of a jigsaw puzzle until a full picture emerged. As an 8-year-old boy, he had been held by one of his father’s hands while his father used his other hand to pull out a pistol and unload five bullets into the boy’s mother. A cousin heard the commotion, came around a corner and shot the boy’s father. The father then turned the pistol on the cousin and shot him, still holding the hand of his son who was frozen beside him in shock. Another cousin grabbed the boy and took him to her home next door. From the living room window of that home, the boy watched as all three victims were loaded into an ambulance. Remarkably, each of them survived.

The boy was deeply scarred from witnessing the scene, however. Nightmares of what had transpired continued throughout his life, including during his time of incarceration.

The boy grew up, eventually married, and had a son. One evening, while arguing with his wife, he pulled out a pistol and would have shot her in a reenactment of his nightmares had his mother-in-law not intervened and stood between them. Unable to control himself, he took the pistol and shot into his abdomen. This was the suicide attempt noted on his record.

The man’s life was marked by episodes of violence, as was his son’s life. The son got involved with gangs and was murdered in a gang fight, having his neck sliced nearly through.

When I met the man on suicide watch, he had a new girlfriend, and a second son had been born to him. He had a second chance at fatherhood. He could determine to live in the past or in the present. His newborn son needed him.

I said to him, “You can’t drive a car with your eyes firmly fixed on the rearview mirror. At some point, you have to look forward.” He later told me that comment was the turning point for him. He realized that he had to stop looking backward constantly. If he wanted his newborn son to have a chance at life, he had to look forward.

He worked hard on his issues and took the recovery program. Over our months of working together, he grew able to speak openly about the events he had suffered. Recently, he was released to a halfway house. Maybe the demons within him have finally been exorcised.

To the police, he was a drunken man on a park bench. To me, he revealed a life of trauma and tragedy that was the underlying cause for his behavior. That is our work as counselors — to help people understand the dark forces that drive them to behaviors that they know are harmful to themselves.

I have heard such stories over and over again. There was a young man who was a bully and was shuttled from one juvenile facility to another until, at age 19, he landed in an adult jail. He shared with me the story of witnessing, when he was 12, his cousin gunned down in the street and the life of fighting and violence that had followed him ever since.

I have worked with people who were pimps and people who were prostitutes, people who had molested others and people who had been molested, people caught in unhappy marriages who had assaulted their spouses, and countless people with addiction or alcoholism. With each, I have heard a similar story of unresolved grief, tragedy and trauma. Sometimes I can help them. Sometimes that is limited to helping them maintain their emotional balance while they do their time in lockup. Most seem grateful to meet someone who will at least listen to their story. Sometimes giving them a chance to vent is all that I can do.

Sowing seeds

At 5 o’clock, I pass through the three steel doors and walk out of jail. I am free to drive to my apartment and wonder about the impact I may have had. I think of the Parable of the Sower found in three of the four Gospels in the New Testament. Some of the seed from the sower lands on rocky soil or other inhospitable places. But some of the seed falls on fertile soil and takes root.

We do what we can as counselors. We try to do no harm and pray to do some good. There is a line in the Talmud that says he who saves a single life, it is as if he saved the whole world. And, so, we do what we can inside the jail, one person at a time.

In the evening, I am free to have dinner with my kids, play my guitars, sleep in a comfortable bed. I can go shopping when I want, soak in sunshine, breathe fresh air, go to yoga classes.

Tomorrow, I will pass through the three heavy steel doors again. The men and women in the orange-and-white-striped suits will still be there.

 

****

James Rose is a licensed graduate professional counselor working as a mental health counselor at the Frederick County Adult Detention Center in Frederick, Maryland. He is a graduate of the clinical counseling program at Loyola University, Baltimore. Contact him at jrose007@comcast.net.

 

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

****

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

From Combat to Counseling: Veterans and the criminal justice system

By Duane France December 9, 2019

As I was preparing to retire, I was already on the path to becoming a clinical mental health counselor. I was finishing the first year of my master’s program  in clinical mental health counseling and would start my practicum and internship in about seven months. Knowing that I wanted to work with veterans as a clinician, I reached out to our local veterans treatment court to see if I could observe some of the proceedings.

I had been in court before, having served a detail as a security escort for a court martial, but that was a military court—a legal venue that operates differently than the civilian justice system. This was a real courtroom, with the judge on the bench in a robe and everything. But that’s not what caught my eye when I first walked in. The first thing I noticed was a veteran sitting to the right in an orange jumpsuit, hands and feet in shackles.

I knew him.

We had served together about seven years before this; I was the company operations non-commissioned officer (NCO) in his unit. He was particularly memorable to me, not only because we were in the same company, but because I was there at the gate the day that he came back in from outside the wire after seeing  his platoon sergeant wounded by a sniper. If there was a blinking red line from that incident in 2006 to him sitting in the county jail, I was at both ends of that line.

The time in between, for him, was filled with medical problems, homelessness, addiction, disrupted relationships and involvement in the criminal justice system. It was a shock for me to see someone I served with in that situation. But I understood; many of us do. Veterans are significantly affected by the extremely traumatic events they routinely witness.

 

Veterans treatment courts

If you’re not familiar with veteran treatment courts, then you’re not alone. Even though the number of courts across the country are increasing, they seem to be unknown to those who are not directly involved with them. Throughout the nation, there are over 300 of these specialty courts that serve veterans.

The first veteran courts in the country were established in 2008. They are what are known as “problem solving courts,” modeled after the drug courts that were established in the mid-1990s. Not all courts are the same, and the different models vary by location, but they all are designed to help veterans get treatment for the issues that led to their involvement with the criminal justice system.

The problem-solving court model is one that addresses a particular issue with similar defendants using an interdisciplinary team of professionals to address the needs of the participants. Drug court, for example, provides substance use recovery treatment while addressing other risk factors that could lead to continued involvement in the criminal justice system. Some jurisdictions have other kinds of problem solving models such as DUI/DWI or domestic violence courts.

Veterans who become involved in the justice system frequently struggle with the difficulties that these other courts address. However, they are often experiencing many of these issues at the same time—creating the need for, in essence  substance recovery courts, DUI courts, mental health courts and domestic violence courts all rolled into one. Veterans treatment courts are designed to address these and other population specific needs with a multidisciplinary team that in addition to traditional court personnel such as a judge, the prosecution and defense, includes treatment providers, law enforcement, Department of Veterans Affairs representatives and a team of volunteer veteran mentors.

Some might argue that the regular criminal justice system has been handling veterans’ cases for years — why create special courts now? In the past, the elements that drove veterans to commit crimes were usually not unique to the military population. But multiple extended campaigns like those in Afghanistan and Iraq have created a large population of military members with extended conflict experience. As a result, there are situational and systematic influences on many current  veterans’ thoughts and emotions that lead to poor choices and reckless, dangerous behavior. I’m not saying that all who are incarcerated are innocent and misunderstood victims– there are veterans who commit heinous and horrendous crimes. The majority of veterans who are currently in the criminal justice system, however, aren’t hardened criminals.

In addition, veterans are usually not repeat offenders with a history of criminal behavior. That is the challenge when working with justice-involved veterans – determining the underlying motivation and reasons behind the dysfunctional and antisocial behavior. Treating the emotional and behavioral problems that lead to criminal behavior is one of the keys to helping veterans get—and stay—out of the criminal justice system. As a society, we need to have veterans return from combat and reintegrate, to get back into the workforce, engage in the public process, go to school, and become scientists and scholars.

The challenge, however, is that there is a period of adjustment for many veterans, and the difficulties it poses are different for everyone. For some, a lack of a sense of purpose and meaning in their lives leads to a period of wandering and aimlessness, and their behavior never rises to the level of criminality. It is a very thin line, however, that separates behavior that is reckless from behavior that violates the law, and many times veterans cross that line.

The majority of veterans leave the service strong and resilient. Many, however, do not, and that is a fact. Remembering that there are veterans who face, and fail to deal with, significant challenges is just as necessary as encouraging those who meet those challenges.

For more information on the effectiveness of veteran courts, a number of published studies such as this one has shown that graduates from these programs have a lower recidivism rate than others in the criminal justice system.

 

 

****

Duane France, LPC

Duane France is a retired U.S. Army noncommissioned officer and combat veteran who practices as a licensed professional counselor in Colorado Springs, Colorado. He is the director of veteran service for the Family Care Center, a private outpatient mental health clinic specializing in service members, veterans and their families. He is also the executive director of the Colorado Veterans Health and Wellness Agency, a 501(c)3 nonprofit that is professionally affiliated with the Family Care Center. In addition to his clinical work, he writes and speaks about veteran mental health on his blog and podcast at veteranmentalhealth.com. Contact him at duane@veteranmentalhealth.com.

****

 

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.

Voice of Experience: Invisible people, Part 2: The incarcerated

By Gregory K. Moffatt May 6, 2019

In the 1980s, the head of the department of corrections in my home state removed the exercise equipment from the state prisons. “They aren’t here on holiday,” he proclaimed in his no-nonsense tone.

I remember feeling a sense satisfaction at those words. “Yeah!” I thought to myself. “They deserve to be miserable. It’s prison, not a health club.”

In the years since, I’ve been inside prisons many times in the course of my work, and I now realize how thoughtless I was. Beyond my work, I have visited prison most often to see a friend. His incarceration was an experience that taught me the most about this invisible population.

Any politician running on a platform of prison reform would risk the accusation of being soft on crime. Although chain gangs and hard labor camps are, thankfully, part of history, for the most part, people don’t really care about what happens to prisoners. Like Native Americans (see the first article in my three-part series on “invisible people”), prisoners are often simply ignored.

In my experience as an investigator, a friend and a counselor of prisoners, most prisoners want to mind their own business, serve their time and get on with their lives following release. Many of these individuals are good men and women who readily admit their mistakes and are trying to put their lives back together.

I once wrote a similar thought in a newspaper column and received angry responses from readers. “My mother was killed. … Prisoners should be punished.” You get the idea.

I am not denying that there are some very bad people in prison. In fact, whenever I leave a prison, I’m glad that those iron doors lock behind me. Certain people need to be there, and they need to be there for a very long time. But just as there are many people in the general population who should be in prison — they just haven’t been caught yet — there are many individuals in prison who are very good people. Many of the men I’ve counseled could have been let out the front doors at any point and the community wouldn’t have been in any greater jeopardy whatsoever. People make mistakes, and sometimes those mistakes land people in the judicial system.

It is hard to describe the public humiliation of being arrested, tried, and sent to prison. And that humiliation is shared by family members. If someone asks where your father/son/brother is and you say “prison,” there will almost certainly be an awkward silence.

Once in the system, no matter how humane, prisoners are treated more like animals than like people. They are told what to wear, where to stand, when to eat and when to sleep. They are locked in crowded cages, and events they look forward to all week — visitation, a welding class, an appointment with the prison counselor — are often snatched away from them without notice because of the behavior of others. It can be total lockdown because of one guy doing something stupid.

Prisoners can be transferred without warning. Loved ones might travel four or five hours to see them only to discover that they have been moved, and it may take days or weeks to find out where they are. In such cases, the fragile lives that inmates have built in their prison world are erased, and they have to start over.

They are numbers in a system, not names. And they are identified by their crimes by probation officers, future potential employers and others. I would hate to be identified by my mistakes rather than by my character.

One inmate told me just after sentencing, “I know that no matter how many good things I’ve done in life, I’ll only be remembered for this one thing.” I couldn’t tell him he was wrong.

People entering the system can’t trust their fellow inmates — not because they are necessarily unworthy of trust, but because these new inmates just don’t know who they can trust. It is literally every man for himself. Sadly, neither can they trust the police, their lawyers or judges. I’m not suggesting at all that these people are unethical. I’m only stating the fact that at the end of the day, none of them see the accused as their friend. They see the person in relation to the charge and the process. If you don’t believe me, you’ve never been exposed to the system.

The consequences of the near-sighted policy of the former director of prisons in my home state were easily foreseen. Instead of occupying their time with exercise, inmates had little to do. Consequently, they filled their time with disruptive behaviors. The equipment was eventually returned — as it should have been.

If you want to experience real cultural diversity as a counselor, volunteer to work with prisoners in the system. It will open your eyes to what you (like me in my earlier days) have probably been unable to see.

 

*****

 

For a more detailed perspective of the prison system, see the book I co-authored with W.A. Murphy, Handcuffed: A Friendship of Endurance.

 

****

 

Gregory K. Moffatt is a veteran counselor of more than 30 years. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at Greg.Moffatt@point.edu.

****

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.

Containment in restraints

By Erika Berger March 4, 2019

“The degree of civilization in a society can be judged by entering its prisons.” ― Fyodor Dostoevsky

 

*****

 

A group of young black men sit and interact before our weekly art therapy group. Some laugh and share stories of their children and loved ones. Others put their heads down and are silent. They discuss and debate song lyrics and current events.

One young man, freshly 18 years of age, bursts into laughter so deep, his eyes begin to tear up. He cannot wipe his eyes though because his wrists are handcuffed together. Those handcuffs are shackled to a small metal desk, which is chained to the floor. His feet are also chained together and shackled to the floor. This is the state of juvenile justice in the United States.

When I first began working in custody as a graduate student of art therapy, I ignorantly thought that juvenile detention centers were different than the adult prisons and jails that I frequented. I was wrong. Juvenile detention centers incarcerate adolescents ages 13-17 and house “adult inmates” until they are 21. Juvenile detention centers are no different than adult prisons in their daily operation, physical structure or philosophy of detention.

From my perspective, a more accurate name for such centers would be “child prisons.” More than 60,000 youths are incarcerated in these prisons on any given day. The majority of these young people are black. This does not include the numbers of children incarcerated at adult prisons. Many children are tried and sentenced as adults. Episode 8 of the new season of NPR’s Serial podcast takes an in-depth look at one such child prison in Cleveland.

 

Harsh juxtapositions

To think about therapeutic containment or the creation of a safe holding environment in the context of prison feels paradoxical at best. These young people are not safe in this environment, either physically or psychologically. Histories of trauma, coupled with the toxic stress and bigotry inherent to the prison system, often lead clients to feel utterly psychologically uncontained while completely physically restrained.

This kind of harsh juxtaposition defines the clinical environment I work in. Weekly group art therapy is the only therapeutic support that my clients receive. Art therapy is one of four hours out of the week in which these clients are let out of their cells. Simply being in the presence of a group can be overwhelming to them. To open up too much emotional expression in therapy can be dangerous because these kids are left to cope by themselves.

How then does a clinician establish boundaries and a contained, safe therapeutic environment in a context defined by walls, chains and fences? Walk beside and begin with the art.

Walking beside clients in their therapeutic journey is to embody empathy. It is to see the clients as unique individuals while understanding the cultural and sociopolitical forces (racism, toxic masculinity and other forms of oppression) at work around them. It is to continually investigate my place in that oppression. It is to know and accept that my mere presence and vast privilege as a white, upper-class, free individual may be painful for clients. It is to be open to dialogue about our identities and to hold anger. It is to express my anger at the systems of oppression that shackle young people.

Empathic embodiment is indeed visceral. I strive to walk beside these clients with my heart and, as clinical and liberation psychologist Taiwo Afuape writes, to have my heart broken. I work toward deep therapeutic attunement that allows me to experience the unbearable feelings of clients while remaining grounded. These feelings are simultaneously bearable and unbearable. I stand in the eye of the storm. This position allows me to support clients in the processes of identification, digestion and integration of feelings and experiences.

 

Art making as resilience

We always begin with art making in sessions. The materials automatically become physical containers for emotions. The concrete nature of the art materials stands in opposition to the rampant, formless boredom of prison. Art therapy interventions have a beginning and an end that is client directed, while time in prison is endless.

Clients often verbalize their creativity and creations as acts of resilience and resistance: “I felt free when making this”; “I forgot I was in prison”; “They can’t take these ideas from me.”

Early on in group therapy, I often implement the “I am” format of sharing about artwork. Clients speak from the perspective of their pieces and work to use literal descriptions of the artwork that begin with “I am”: “I am colorful. I am dark and light. I am chaotic. I am beautiful. I am bound. I am peaceful. I am bright. I am vibrant.”

The continual process of naming and deepening who you are in prison is indeed an act of peaceful resistance. To claim presence is to erode the stereotyped, bigoted treatment by the system.

A drawing Erika Berger made to help her process her work with prisoners.

I know our therapy is progressing when the art making begins to be inspired by the clients’ personal passions. It can take weeks or months of rapport building for clients to share their dreams and goals in therapy. Leading up to these passion projects are long hours of walking with clients through self-doubt, self-hatred, anger, depression, anxiety, fear and shame. Creative writing in the form of poetry, short stories and rap is common during these stages. It is a medium and coping mechanism with which clients are familiar and comfortable.

Passion projects begin to subtlety shift the orientation of time from the present moment to the future, indicating growing resilience and hope. Clients are often more self-directed with these projects. As self-regulation increases, the use of materials generally shifts from two-dimensional to three-dimensional, reflecting a literal inner growth or expansion. Drawings, paintings and writings transform to creations such as folded paper boxes, sculpted figures and dynamic collages. In this place of creativity and visibility, we can approach pain with enhanced flexibility and perspective.

 

In summary, fostering therapeutic containment in the prison setting is about holding steadfast to attunement and empathy. It requires looking our broken justice system in the eye and allowing our hearts to be broken. Remain grounded in this brokenness and always stay connected to each individual client’s uniqueness, creativity and inner light.

 

 

****

 

Erika Berger is a recent graduate of Pratt Institute’s master’s degree program in art therapy. For the past two years, she has worked to create and implement clinical art therapy programming in western North Carolina prisons. Prior to becoming an art therapist, she was a bilingual special education teacher in New York City public schools. Contact her at Erika.wallace.berger@gmail.com.

 

****

 

Related reading, from Counseling Today: “Seeing people, not prisoners

Seeing people, not prisoners

 

****

 

 

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.