Tag Archives: Professional Issues

Professional Issues

The battle against burnout

By Bethany Bray March 28, 2018

Fill in the blank: The way to avoid burnout is __________ .
Self-care? Professional fulfillment? Spirituality? All of the above? The answer to this question will be different for each person — and most likely involve more than one idea. The question, however, needs to be continually on the minds of counselors, both for their own good and for the good of their clients.

Counselors, as helping professionals who listen to and support clients through some heavy and distressing issues, often on a daily basis, are at high risk for professional burnout. Researchers focusing on practitioner burnout for a 2012 Administration and Policy in Mental Health and Mental Health Services Research journal article found that as many as 2 out of every 3 mental health workers “may be experiencing high levels of burnout.”

But helping professionals aren’t the only ones who can be pushed to the limit. Clients can burn out as well, whether they’re parents struggling to balance work and family life or individuals who feel stretched to the max by the demands of their job and other aspects of life.

In other words, “anybody and everybody” is at risk of burnout at different points in their lives and careers, says Kayla Pedigo, a licensed clinical professional counselor and certified sex offender treatment provider in Idaho. Even so, counselors often internalize the harmful negative associations that society at large holds about seeking help.

“It’s very difficult to say, ‘I need some time for myself.’ That can feel selfish for a helper. It takes a lot of strength to know what you need and how to ask for it,” says Pedigo, a member of the American Counseling Association.

Counselors can fall into the trap of feeling that they “should have it all figured out,” says Allison Crowe, an ACA member and a licensed professional counselor (LPC) in North Carolina. “It’s a myth that we don’t need our own support at different times. Going through a master’s program in mental health does not negate the need for personal mental health help down the road.”

“Stress is not a diagnosable mental health condition, but it will turn into one if we don’t work on it,” Crowe adds. “Coping is an important thing to think about, and coping in ways that work for you. … Working long hours, vicarious trauma, empathy fatigue: These are all things that are part of a counselor’s job. All of that will build and build and build to levels of burnout. We need to build in a wellness plan and coping strategies.”

Fanning the flames

The Merriam-Webster Dictionary defines burnout as “exhaustion of physical or emotional strength or motivation, usually as a result of prolonged stress or frustration.” Many things can cause burnout, but being isolated or feeling unsupported at home or at work can be major contributors, as can the repetition of facing the same challenges or doing similar tasks over and over.

Every job situation will come with varying degrees of stress and frustration that ebb and flow. Burnout, however, is more than that. It is an all-encompassing feeling that you are being pulled in every direction at once and that no matter what you do, you are unable to make progress or move forward. If chronic burnout is left unmanaged, it can lead to issues with physical and mental health.

The onset of burnout feels different for each individual. In both clients and practitioners, it can take a healthy dose of self-awareness to recognize the red flags that indicate they are experiencing something more than day-to-day stress.

Pedigo, the clinical director at Aspire Human Services, a program for clients with intellectual disabilities in southeastern Idaho, says that one of her first signs of burnout is finding that she doesn’t want to stay for the full length of staff meetings. It indicates that she is becoming disengaged and having trouble being present, she says.

Another signal is when she finds herself turning down invitations from colleagues to go out to lunch. She knows it would be good for her to step out and take time away from the office, “but it feels like I can’t even take a minute to do that. … I feel like I have a million other things to do,” Pedigo observes. “I’m always thinking of what’s next, what’s next, what’s next. That’s when I know I need to take time to slow down, take a break and return refreshed.”

Another indicator of burnout in clients and counselors can include feeling a perpetual sense of self-disappointment — that no matter what you do, you are always falling short, says Erin M. West, an LPC and licensed school counselor. “It’s that sense of being overwhelmed — that you have too much on your plate and not enough time to feel like you’re doing a good job in all of your roles or [to take] a sense of pride in the work you’re doing. It can be demoralizing and defeating,” says West, a lecturer in the school counseling and clinical mental health counseling programs at the University of Texas at Tyler.

In general, burnout is a constant feeling of being at the end of your rope, she says. It can manifest in physical symptoms such as feeling fatigued or exhausted, crying easily, having trouble sleeping and becoming emotional over things that wouldn’t normally affect you.

Similarly, people experiencing burnout who are normally easygoing might find themselves feeling more angry or sad than usual and struggling to make decisions out of a fear of making the wrong choice, Pedigo says. People wrestling with burnout may also become more susceptible to getting sick and take longer to recover when they come down with something.

Another potential indicator of burnout is inflexibility of thought, Pedigo adds. In clients, this may manifest as resistance to ideas that a counselor suggests in session. For practitioners, it might show up as a reluctance to refer or to seek help with a challenging client and resistance to feedback, Pedigo says. This can shut down the creative process, “and new, fresh thought just doesn’t happen as easily,” she adds.

Pedigo regularly checks her reactions to the feedback she receives from colleagues. If she finds herself taking the feedback personally or disagreeing reflexively, it can be a sign that she is feeling overwhelmed and “focused on me more than the greater issue,” she says.

Another red flag for practitioners is disengaging in session with clients, West says. “It’s that feeling of sitting with a client and having them talk to you, and in your mind, you’re thinking, ‘I don’t know what this person just said.’ You realize after a period of time that you’ve been thinking about something else and you’ve missed what the client has said. Or it may be noticing that things your client is doing or saying are irritating you more than usual. You might notice that you’re putting a lot of blame on clients for not making progress instead of asking ‘What is my role? How can I help?’” explains West, who co-authored a 2016 Journal of Counseling & Development article on stress and burnout in counselor educators.

When counselors realize that they’re not being fully present in a client session, it is “just a horrible feeling. … The whole reason for getting into counseling is to help others with the weight they’re carrying. It can feel really defeating if you’re not able to do that,” West says.


Playing with fire

Counselors who are detaching from their work and not taking steps to address burnout (or missing its indicators) are entering a danger zone rife with ethical pitfalls, says Monica Band, a certified rehabilitation counselor with a private practice in Alexandria, Virginia, who is doing clinical supervision toward an LPC. Exhaustion can lead to practitioner indifference or a cynical attitude, says Band, an ACA member and an assistant professor in the clinical mental health counseling program at Marymount University in Virginia. As a result, practitioner-client boundary issues can become blurred, and the counselor’s ability to make competent decisions or to connect and build rapport with the client can all become impaired.

Band wrote her doctoral dissertation on predictors of burnout in first responders and law enforcement chaplains. She will co-present an education session on that topic at the ACA 2018 Conference & Expo in Atlanta later this month with Lisa Jackson-Cherry, a professor and counseling department chair at Marymount and coordinator of the university’s pastoral clinical mental health counseling program.

“[Burnout] can be a fog over our lens because we’re not taking care of ourselves. It hits at a cognitive level, where we’re not able to make culturally competent, ethical decisions [as counselors]. We might not even be in the right headspace to choose which intervention will help our client,” says Band, president-elect of the Virginia Counselors Association. “Unfortunately, burnout gets so bad that we internalize it. Our boundaries get blurred, and we can turn to advice giving instead of giving competent care. It can turn into countertransference issues, which can create an unsafe environment for our clients.”

The prevention of burnout — and the commitment to seek help if it occurs — is both a best practice and an ethical mandate for professional counselors. The introduction to Section C (Professional Responsibility) of the 2014 ACA Code of Ethics includes a statement that “counselors engage in self-care activities to maintain and promote their own emotional, physical, mental and spiritual well-being to best meet their professional responsibilities.” Standard C.2.g. instructs counselors to continually monitor themselves for professional impairment and to seek assistance if they recognize that they are impaired.

Rising from the ashes

A good first step for counselors who realize that they’re in the throes of burnout is to acknowledge it and to talk about it with a trusted colleague, such as a supervisor, Pedigo says. She acknowledges that being vulnerable and sharing such a difficult issue is extremely hard, but she believes that putting the problem into words can be helpful. In part, that’s because counselors struggling with burnout will discover that many of their colleagues have been through the same issue at some point.

When a counselor is burned out, “it feels pretty crummy to be there, but there is power [in admitting] it,” Pedigo says. “For me, it minimizes the isolation [of burnout] to bring in more people who will give good advice and love me anyway.”

Likewise, counselors can begin to address burnout in clients by normalizing their experience. Counselors can offer a listening ear, assure clients that burnout is a common issue that many people go through and let them know that they can take steps to manage it, Pedigo says.

“Sometimes, what [clients] need the most is one person in their life with whom they can share that they’re feeling this way,” she says. “For example, as a parent, it’s difficult to admit that you’re struggling and that it’s hard. You love your kids, but you are at the end of your rope. Be the person [clients] can share that with.”

In addition to engaging in therapeutic work with clients, Pedigo suggests that counselors connect them to resources outside of the counseling office that they can trust. This might include support groups and social or nonprofit organizations that focus on areas with which a client is struggling, such as career development or family and parenting issues.

Counselors can also assist clients struggling with burnout to connect the dots between their symptoms and the root of the problem, Band notes. This often involves helping them recognize that stress and burnout at work can spill over into their home life and relationships — and vice versa.

“Show them that these things are not in separate categories. We know that as counselors, but our clients might not know that,” Band says. “Connect the physical exhaustion they are feeling with the relational pieces to create congruence. While they might feel helpless and feel like they can’t get anything done, it’s not them or something they’re doing. It’s broader and feeding into other things. It’s not their fault. It’s all the dimensions that are weighing and feeding off of each other to make them feel that way.”

One possible antidote to burnout, both in counselors and clients, is change, says Crowe, an associate professor in the counselor education program at East Carolina University and president of the North Carolina Counseling Association. That often means getting creative to keep things fresh and changing up routines.

As a counselor educator, Crowe tries to rotate the classes she teaches so that she isn’t repeatedly covering the same material and subject matter. Other ideas she suggests to counselor educators to add variety include picking up a different project that doesn’t involve teaching and looking for short-term studies or teaching opportunities abroad. For practitioners, change might involve developing a new specialty, starting a new therapy group or trying something new such as consulting work, Crowe suggests.

Pedigo found herself confronting burnout when her caseload consisted entirely of individual clients. She worked with colleagues to switch and share tasks, and now she leads team meetings, co-facilitates a group and provides supervision, in addition to still seeing individual clients.

With clients, Pedigo suggests that counselors switch up the tools they use in session (she is a fan of using humor, when appropriate) or simply offer a change of scenery. For instance, meet in a different office or room, or take the session outside.

“Be a little more active in session, try a different intervention or even just change where you sit in the room,” Pedigo says. “Try and be more flexible — that’s the goal.”

Fire prevention

When it comes to avoiding burnout, self-care is the first thought that pops into many counselors’ minds. Indeed, unplugging from social media, engaging in creative hobbies, exercising, meditating, participating in spiritual activities, getting together with others socially and carving out some alone time are all helpful action steps to take. However, the avoidance of burnout often requires a comprehensive approach that touches on both individual and organizational levels. This can involve everything from counselors initiating staff retreats or mentorship programs at their practices to downloading mindfulness apps for their smartphones and stocking their offices with their favorite CDs, tea selections and an aromatherapy diffuser. Most important, however, is for counselors to engage in anti-burnout measures before they start feeling overwhelmed or chronically stressed.

Burnout can affect both individuals and entire counseling programs, Pedigo says. She recently collaborated with colleagues to address this issue at her program by organizing staff training to identify and prevent professional burnout. The initiative assisted in improving the culture at the practice for both counselors and administrative staff, she says. Pedigo will touch on this experience in an education session titled “Burnout: Working With Challenging Clients” at this month’s ACA Conference & Expo in Atlanta. She will be co-presenting with Jason Byrd and James Osborne, her colleagues from Aspire Human Services.

Part of the practice’s focus on burnout is to reinforce the idea that prevention is an ongoing and continuous process, not just something that happens during vacations and on weekends, Pedigo says. “We try to focus on self-care every day so that it’s a part of our routine in our personal lives and here at our office,” she explains. “It’s much healthier to just enjoy your day with built-in things that are going to keep you well than to hold everything in for a ‘miracle trip’ or an event in the distance to help keep you well. When we’ve seen others do that — and have experienced that ourselves — we’ve noticed that it isn’t as effective and doesn’t promote a healthy lifestyle. It’s just a fix until your next fix.”

Comprehensive burnout prevention needs to come from the top down at counseling practices and school and college programs, agrees Crowe. Counselors who are supervisors, managers or heads of programs can promote healthy behaviors to break the cycle of burnout.

“Have your employees leave or hit the gym during their lunch hour and take their vacation days. Make sure they leave by 5 p.m. and don’t eat lunch at their desks,” Crowe says. “Have workshops that talk about stress, balance and other issues. You can do as much as you can individually [to avoid burnout], but if a system is not wellness-oriented, then it will be a bad cycle. We have to think systemically about how to do that.”

“We have to be advocates to move toward that system-level change. We have to talk about it when things aren’t doable,” she continues. “Think critically about whether the setting you’re in is promoting healthy behaviors. If not, advocate for yourself about making changes. [For school counselors,] speak to your principal to have a training or a wellness-related professional development, or to change a policy or expectation in your workplace.”

Crowe previously worked at a practice with numerous practitioners, including LPCs, psychologists and marriage and family therapists. The program’s weekly staff meetings offered invaluable opportunities to debrief with colleagues and destress, she says. Staff members would break into small groups to go over case studies and talk through the challenges they were facing.

“There were times when the clinician might break into tears when presenting a particularly sad or difficult case. Talking it through and sharing it with other practitioners was helpful,” Crowe says. “It was so wonderful [to] get feedback and support from colleagues. That three-hour meeting was our time to come together.”

West adds that supervisors working with new counselors in practicum should make sure to discuss the risks of burnout early and often. As a counselor educator, West suggests to her students that they begin a self-care routine as they start their master’s program, before things get too stressful. This is especially needed for those who have things going on outside of school, such as managing a family, navigating life transitions or being involved in other commitments, she says.

“There is a fear, particularly among young practitioners, that if they speak out, it means they’re not a good counselor or will get fired. That’s a real shame because problems develop when we stop creating the space to be able to talk about them,” West says. “I try to always ask supervisees, ‘How is your work with this client impacting you personally?’ Create an environment where they aren’t afraid to say how things are affecting them. [Experiencing stress and burnout] doesn’t mean you’re a bad person or a bad counselor. It happens to all of us, so let’s talk about it and how to handle it.”

Learning to rely on a support system of trusted people, both professionally and personally, can also help clients who are at risk of burnout, West notes. Counselors might suggest that clients take breaks during the workday to visit with colleagues who are supportive and with whom they can chat, briefly, about nonwork topics. Outside of work, clients could be encouraged to identify friends and family members who have been through similar experiences. Counselors can also suggest that clients create their support systems not based solely on who they think should be included (for example, family members), but based on “those who are genuinely a support and beneficial to your life,” West says.

Crowe says she sometimes gets the support she needs by meeting with friends who do not work in a similar profession to hers. That way, there is less temptation to “talk shop,” she says.

Counselors also shouldn’t hesitate to engage in personal counseling themselves, Crowe urges, both preventively and when they are feeling overwhelmed. “Your willingness to get support will contribute to your longevity on the job and to being able to cope with the demands of being a counselor in today’s world,” she says.

“We are supposed to be the strong ones, psychologically,” she adds. “We are supposed to be in touch with ourselves and are taught in our [master’s] programs that you’ve got to be OK with yourself before you help someone else. But the reality is, life happens. If you’re going to be a counselor for 30 years, you need to feel very comfortable in getting support when life happens.”


As important as creativity, getting outdoors, spending time with loved ones and other go-to self-care methods may be, it is the intentionality behind them that is key, West says.

“It sounds small, but it’s the idea that you’re taking time away from your desk to do something that you find enjoyable,” West says. “Be intentional: I am actively making a choice, in this moment, to do something that is enjoyable to me, even if it’s something as simple as lighting a candle.”

In a similar vein, Pedigo finds it helpful to remind herself to focus on the aspects of her work that are particularly meaningful to her, such as the adventure-based counseling that her agency provides. She makes it a priority to go on at least one adventure-based outing with clients each month, even though her position does not require it.

Make time for “whatever grounds you,” Band urges.

When discussing burnout with clients, counselors shouldn’t neglect the topic of spirituality, Band says. Research shows that spirituality can buffer against stress, and focusing on the greater sense of purpose that spirituality can offer may be comforting for many clients.

“The conversation is worth having when you’re talking about burnout,” Band says. “Spirituality can really impact the well-being of your clients, giving them a greater sense of purpose and life satisfaction. Having a spiritual attitude, and the idea that there’s a connectedness to life, and a search for the sacred and belonging — that can help build resilience and boost posttraumatic growth. The idea of being able to make meaning out of something bigger can help people persevere through difficult moments in life.”

However, Band cautions, counselors shouldn’t bring up spirituality with clients out of the blue. Those discussions should be reserved for clients who have mentioned their own spirituality in previous sessions or on an intake form.

With clients who value spirituality, Band suggests asking them to talk about how it has helped them through challenging situations in the past. Counselors should discuss spirituality in whatever terms the client uses, Band says. For example, if they call it a relationship with God, ask them how that relationship has changed as they became stressed and overwhelmed: How is it now, and how would they like it to be?

“[Spirituality’s] continuous search for meaning and purpose in a client’s life, and an appreciation of the depth of it, that will get to the very crux of where your clients are in seeking meaning and purpose, which directly relates to burnout,” Band says. “If we’re able to understand their spirituality and check in on it, we’re able to directly connect to their burnout experience.”

Burning bright

Avoiding burnout can be a career-long challenge and a constantly moving target for many counselors. The coping mechanisms and self-care practices that counselors find helpful are likely to vary at different phases of their career.

“It will take time to figure out what works for you, and it will change over time,” West says. “Be reflective, reevaluate and be willing to change.”

The first things that seem to slip when people feel overwhelmed are the very things that could be most helpful, such as taking time to exercise or to cook a healthy meal for dinner, Crowe notes. “What matters is getting back on the horse and realizing when you’ve let stuff go,” she says. “Tell yourself that it’s OK to leave at 5 p.m. or to take a lunch break.”

However, maintaining a perfect work-life balance is a misconception and an unrealistic expectation, West says. She often tells her counseling students that finding balance is a lifelong pursuit and, indeed, “something that I am continually working on as well.”

“Life is stressful,” West says. “No matter how much we try to remove ourselves from stressful environments, the truth of the matter is that stressful things will always happen in life.” At the same time, cultivating a healthy support system and maintaining good patterns of self-care can protect us from becoming overwhelmed to the point of burnout when those stresses do occur.

The key is making burnout prevention a priority, West says. As the adage goes: You can’t pour from an empty cup.

“So much of it comes down to choice. Setting an intention and telling yourself that you want to take active steps [to avoid burnout] doesn’t mean you’re a selfish person. It means you’re not compromising yourself and you care about your own quality of life,” West says. “Just because I decide to take time for myself and that I matter, that doesn’t mean I’m a bad counselor. In fact, it means that you’re taking steps to be the best you can be. You have to be the focus sometimes, and that doesn’t mean you’re a selfish person.”



Related resources

Counseling Today and CT Online (ct.counseling.org)

Books (counseling.org/publications/bookstore)

  • Counselor Self-Care by Gerald Corey, Michelle Muratori, Jude T. Austin II & Julius A. Austin (newly released by ACA)

ACA Conference & Expo

  • Numerous sessions will be presented on burnout, self-care and other professional issues at the ACA 2018 Conference & Expo, being held this month (April 26-29) in Atlanta. Find out more and search for sessions via topic at counseling.org/conference/atlanta-2018.




Kids can burn out too

When counselors think of the populations most susceptible to burnout, law enforcement personnel and first responders, helping professionals, single parents, and adults living with mental illness or in poverty might come to mind. But children can burn out just as easily as adults, says Erin M. West, a licensed professional counselor and licensed school counselor who teaches in the school counseling and clinical mental health counseling programs at the University of Texas at Tyler.

In today’s modern age, children are often overscheduled, being involved in everything from extracurricular sports and after-school activities to pre-college prep work. This pace can lead to burnout — the symptoms of which adults may misinterpret as behavioral problems.

“Kids just need time to play and engage in unstructured activities and even sit in boredom,” West says. “A lot of times, when kids start to get overscheduled, you can start to see behavioral issues because they don’t have time to play and relax. Instead of viewing it as burnout, it’s often viewed as disruptive behavior.”

Often, children are given little control over their schedules. Counselors can help remedy the situation by educating parents that play is, in fact, a way for children to learn, West says. Parents are typically just trying to do what they feel is best for their children and may not realize that packing their schedules full of activities can have unanticipated consequences.

When families’ schedules are lightened, it can often lessen parents’ feelings of burnout as well, West notes. Counselors “can help change the perception that involving your kids in a gazillion activities doesn’t necessarily mean that you’re doing more for their mental, physical and intellectual growth than [if they did] one activity per week,” she says.




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

Letters to the editor: ct@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.

When help isn’t helpful: Overfunctioning for clients

By Kathleen Smith March 19, 2018

“Erin” came to counseling with all the signs of depression. She was unhappy with her career, her health and her family. Her mother was distressed, her father was distant and her disabled brother was sick.

Erin spent a lot of energy calming and directing her family, and she complained about how little her family supported her in return. She increasingly relied on sugar to calm herself down, and she struggled to end this dependence.

Erin’s anxiety was high, and as a newbie counselor, I struggled to operate outside of it. She cried through many of our meetings, and she grew increasingly critical of our work together.

She said she wanted to stop focusing on her family dynamics, so I switched topics.

She wanted to focus more on her eating habits, so I focused on that.

Then she said I wasn’t giving her enough tools, so I gave her more tools.

I dreaded meeting with her every week, knowing that she’d find some reason to be unhappy with me. I’ll admit that I was relieved when she decided to switch to a different counselor.

It would be very easy for me to look back on my work with Erin and label her as a difficult or resistant client — someone who simply wasn’t ready to change. But now I know better.

You see, I’m a student of Bowen family systems theory. One of the big ideas in Bowen theory is that relationships are reciprocal. Each person plays a part, and these parts are complementary. When you look at the individual and not the relationship, then you miss seeing this reciprocity. The therapeutic relationship is no exception.

Murray Bowen wrote, “When the therapist allows himself to become a ‘healer’ or ‘repairman,’ the family goes into dysfunction to wait for the therapist to accomplish his work.”

Erin was looking for someone to take responsibility for her problems, and I quickly dove in and volunteered as a way to calm down the room and avoid her anger. Looking back, I think about how our relationship might have been different if I hadn’t begun to overfunction for Erin and had refrained from “teaching” her how to fix her depression. I decided that Erin wasn’t willing to change, and I never stopped to think about how my actions were supporting her ambivalence and helplessness.

Have you ever heard an interview with a successful person who grew up in an intense family situation? These individuals always have at least one variable in common. Someone took an interest in them. Often, it was a teacher, a coach, a grandparent or a clergyperson. Someone was curious about their capabilities, and they thrived from this interest.

I truly believe that the opposite of anxiety is curiosity. If I can stay curious about counseling clients who are challenging, they will often do better. When I jump in and try to fix, I am communicating to those clients that they aren’t capable of solving a problem — that their thinking isn’t useful and that they should borrow mine instead. In such instances, I am more concerned with calming everything down than letting clients take responsibility for themselves.

I am very fortunate to have a curious counseling mentor who does not prop up my own incapacity to direct my life. Even though we have been meeting for years, I could probably count the number of times she has made a suggestion to me on one hand. I can see how by simply asking good questions and helping me develop my thinking, she has allowed me to take responsibility for my own functioning.

My job as a counselor is to help people see the reciprocity in their relationships. Like when a client wonders why his mother is financially irresponsible when he’s spent years bailing her out of debt. Or when someone wonders why her partner doesn’t share more when she’s constantly asking him to manage her own distress. When we focus on the other person in a relationship, we’re missing 50 percent of the picture. In fact, we’re missing the 50 percent that we can actually control. By focusing on Erin and what I thought was her “fault,” I missed seeing my part in our relationship.

When anxiety is high in the counseling room, it’s incredibly difficult to shift the focus back on yourself. Difficult, but not impossible. So when a person is distressed, instead of fixing or reassuring, I try to relax my posture, take some deep breaths and access my best thinking. I try to pay attention to when I’m slipping into my default mode of overfunctioning. When a person asks me how I think they’re doing, I challenge them to trust their own ability to evaluate themselves. I try to do this for any relationship, whether it’s with a counseling client or with a friend.

I think I’m getting a little bit better each day with noticing the reciprocity in my relationships. By seeing my part, I’m taking responsibility for myself and allowing others to do the same. In exchange, these relationships bring so much more joy into my life. If I can stay focused on myself around my most anxious clients, then, often, they end up being some of the most rewarding ones I see.

It’s funny how when we treat people as though they can take responsibility for themselves, they are likely to rise to the occasion. I hope that Erin found a counselor who saw her as the capable young woman she was.



Kathleen Smith is a licensed professional counselor and writer in Washington, D.C. Read more of her writing at kathleensmith.net.



Related reading by Kathleen Smith, from the CT archives: Facing the fear of incompetence

Self-doubt often nags at the minds of counselors, but the practice of vulnerability might offer both a powerful antidote against unrealistic expectations and a prescription for forming stronger connections with clients. https://wp.me/p2BxKN-4EK




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.


Fried chicken, watermelon, addiction and Appalachia

By Gerard Grigsby February 8, 2018

Hearing jokes about watermelon and grape Kool-Aid. Hearing someone talk about their “half-colored” nephew’s “nappy” hair. Being called “boy.” This is what I experienced over the year that I led an addictions process group in rural Appalachia.

After working in the area for almost four years, I had grown accustomed to hearing these types of comments, but the straw that broke the camel’s back was a response made in group after one member shared that she was dating outside of her race for the first time.

This particular group member said that she was no longer interested in “full-blooded white men.”

“Yeah, you like him now, but wait until he blacks your eye,” another group member commented.

We were gathered outside on a warm, sunny spring day, but a storm cloud of mixed emotions swept over me as I sat there in disbelief. As the leader of the group and the only person of color among a group of eight, I was at a total loss for words. I had no idea how to address what had been said, and I was too overwhelmed to convey exactly what I thought or felt in that moment.

I knew I felt invisible. I knew I felt voiceless. But without any guidance, I struggled to determine what my response should be or whether it would even be appropriate to share what I was feeling. Ultimately, I chose to remain silent and let the moment pass as if nothing had happened, but the weight of what had transpired lingered with me long after our group meeting had ended.

By the time I arrived home that evening, my initial shock and disbelief had transformed into anger and disappointment. I had been really fond of the group member who made the offensive comment, so it stung to hear him perpetuate such a harmful stereotype about people of color. It didn’t help that he had made this comment after I had worked so hard to be understanding and sensitive to the needs of the group, especially considering that many members perceived that their backgrounds made them targets for judgment and mistreatment by law enforcement, family, friends and even other counselors.

I had also worked very hard not to perpetuate stereotypes about people who are in recovery from addiction, and I had avoided repeating the derogatory language that is often used to describe the people of Appalachia. What made matters worse is that just months prior, there was general consensus among the group that no one liked being called a “junkie” or an “addict,” especially by someone who has never used drugs. Clearly, these members knew what it was like to feel marginalized, so how could they allow someone in the group to make such a racially insensitive comment and not challenge him?

I went to bed that night still upset about what had happened and woke up the next day feeling even angrier. In fact, I thought about that incident for several days. I consulted with my supervisor and processed what it was like for me to have led the group that day. I shared the details of the incident with my colleagues in a separate supervision group. I spent hours brainstorming different ways to confront the group about what had happened. I thought to myself, “Maybe I should compile a list of derogatory terms, share them with the group and ask members what they think about culturally insensitive language. Maybe I should stop being so careful with my words and ask members how they feel when they’re on the receiving end of microaggressions!”

These ideas came from a wounded place in me. I had worked hard to protect my group members, and it hurt having to accept that they had not been as protective of me. Thankfully, ongoing self-examination helped me set aside my own baggage and reminded me that it would be harmful and unethical to prioritize my own needs over those of the group.

Instead, I did some more processing and eventually decided it was less important for me to get retribution and more important for me to leave the members with greater insight than they had before joining the group. I wanted to do something that would be meaningful and impactful for everyone in the group, including myself.

The next week, I sat everyone down and implemented a new group rule: Please be mindful of the diversity represented within the group. Without my having to confront him directly, the group member who had made the offensive comment the week before knew immediately why I had made this request and, to his credit, apologized for what he had said. Although I did not take the opportunity to share with the group exactly how his words had impacted me, the act of advocating for myself and others in the group was healing enough.

In fact, addressing diversity issues that day served as a critical moment for the group and opened the door for continued discussions about race, culture, sexual orientation and other aspects of multiculturalism. Just a few weeks later, for example, a group member made a comment about fried chicken, to which I lightheartedly responded, “Is this another racist joke?” To my relief, the group laughed, and we went on to have a productive conversation about ethnicity, regional diversity and similarities between Appalachian culture and African American culture.

In hindsight, I don’t know if I used the best approach to address diversity issues in my group, but I can look back and appreciate how that first challenging experience (there were others afterward) helped to shape my counseling philosophy and improve my group counseling skills. It taught me when and how to address diversity issues in groups, and it served as a reminder that multicultural issues are always relevant, even in an addictions process group in rural Appalachia.


My recommended resources

If you have been in a situation similar to mine, or would simply like more guidance on addressing diversity issues in addiction counseling groups, check out the following books:

  • Group Exercises for Addiction Counseling by Geri Miller (2012)

Miller describes two activities that can be used to address diversity issues in addiction counseling groups. My favorite of the two, “Sharing Culture,” is a dynamic group activity that facilitates engagement, information sharing and processing. I won’t provide any spoilers if you haven’t read the book, but just know that this activity involves yarn and sounds like a lot of fun.

  • Group Work Experts Share Their Favorite Activities for the Prevention and Treatment of Substance Use Disorders, published by the Association for Specialists in Group Work (2015), and edited by Christine Bhat, Yegan Pillay and Priscilla Selvaraj

This book is full of engaging activities for anyone interested in group work, but one activity in particular may be useful for practitioners who want to address diversity issues in group. Submitted by Beverly Goodwin and Lorraine Guth, this activity requires group participants to identify what they know about their own ethnic, racial or cultural group, and then consider how different aspects of their identity impact their recovery.

My own spin on this activity would involve an initial discussion about drug culture — its norms, unspoken rules, daily practices and common beliefs of which people may be unaware. I see this as a helpful way to set the stage for a broader discussion about culture and diversity. I also think it would be a useful way to help group members process the fact that they are indeed giving up certain aspects of a valued cultural system when they decide to start their recovery. This context can help enrich subsequent discussions about culture, assimilation and acculturation as members discuss the process of letting go of drug culture and embracing aspects of other cultural systems that may be less harmful.




A version of this article was originally published in the December e-letter of the Association for Specialists in Group Work, a division of the American Counseling Association, and is used here with permission.



Gerard Grigsby is a fourth-year doctoral student in the counselor education and supervision program at Ohio University. He is licensed as a professional counselor in Ohio and has worked in college counseling and community mental health settings. Currently, he works at a substance use treatment clinic, where he has the privilege of serving and learning from individuals in recovery. Contact him at ggrigsby@hrs.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.

Ethics, religion and diversity

By Gregory K. Moffatt February 5, 2018

Tears streamed down her face. Kaylah (not her real name) was a 21-year-old woman struggling with a romance in trouble. I’d seen it many times, even though I’d only been in the field for a few years at this point. My heart broke for Kaylah as I saw the same old story played out in the same old way — only the names and a few of the details were new.

Kaylah had been psychologically mistreated and her relationship was in serious trouble. Her partner demonstrated what social psychologists call the principle of least interest. This principle teaches that the person in any relationship — work, friendship, marriage — who has the least interest in maintaining it possesses the most power. My client’s partner treated her well on occasion but at other times humiliated her in front of others, exploded at her or ignored her for days on end. Kaylah tolerated these behaviors because she was desperate to maintain the relationship.

Kaylah’s partner’s emotions ran hot and cold. One day, they were talking about starting a family; the next, Kaylah’s partner threatened to leave, causing Kaylah to feel confused, hurt, angry and torn. Like most abused women, at times Kaylah felt surges of confidence that she should leave the relationship and never look back. Then, as if someone had flipped a switch, she was overwhelmed with love, hope and compassion for her relationship. In this phase, Kaylah made excuses for the pitiful way she was treated and assumed all the responsibility for their relationship troubles. It was classic battered woman syndrome.

What readers also need to know about Kaylah is that she was a lesbian. She was also a staff member at a church. Her lover, a member of the pastoral staff, was also Kaylah’s boss, which created a serious power issue (and a significant ethical issue too). For obvious reasons, the relationship was a carefully guarded secret. Kaylah had no one to talk to because her family wasn’t receptive to her lesbian lifestyle and she didn’t feel she could confide in her friends in the religious community. She also worried that if anyone found out, her partner would terminate the relationship — the thing Kaylah feared most in the world. Exposure might also mean that Kaylah could lose her job, her family and the few friends she had. She was totally isolated. What a mess.

One last thing that I need to tell readers: I am a person of religious faith, and until I met Kaylah, I hadn’t been forced to clarify the place for my religious beliefs in the counseling profession. That day, the decision I faced became crystal clear to me.

No room for debate

It was around the time that Kaylah entered my world that I taught my first college course overseas. As I was preparing to teach a marriage and family course in India, it dawned on me that our two cultures were very different. I worried that my knowledge would be so based in American culture that it wouldn’t translate well into Indian culture. But without denying our vast differences, my host reassured me. “Dr. Moffatt,” he said, “problems are problems.”

How right he was. Hurting relationships are the same regardless of culture, age, religion or sexual orientation.

In some ways, I can’t believe that equity for LGBTQ clients even remains a topic for debate. I remember when the AIDS epidemic first became public in the 1980s. Some people of religious faith actually stated that AIDS victims deserved the outcome as punishment for their lifestyle. I hope that even the most cold-hearted person today wouldn’t utter such nonsense. Even in those uncertain times when we didn’t know much about the disease, doctors served these men and women because it was their professional duty to do so, regardless of their personal opinions on homosexuality, drug use, multiple partners or other factors. Today, many nonprofit counseling agencies are run by faith-based agencies specifically for those who have HIV/AIDS. Thank goodness.

How, then, could there still be any possibility of debate in the 21st century over whether we should discriminate against our clients? Our concept of human rights as counselors is that all people deserve the same treatment, regardless of worldview, religion, gender, age or creed. Our modern view of equality has been evolving for decades, yet even counselors have not yet perfected it in practice. Just in the past decade or less, there have been several highly publicized court cases in which graduate students have refused to work with gay clients and suffered academic consequences because of their beliefs. These include Julea Ward in 2009 at Eastern Michigan University, Jennifer Keeton in 2010 at Augusta State University and Andrew Cash in 2014 at Missouri State University.

Supporters of these students lauded their bravery and commitment to their religion. Even though I am a person of faith, I cannot see why this type of irresponsibility to clients should be lauded. Interestingly, Christian tradition teaches that Jesus spent most of his time with the outcasts of his culture, not with the religious upper echelon, and he didn’t abandon people simply because they behaved in ways that were contrary to Jewish teachings. Gandhi and Mother Teresa also demonstrated a seeming lack of interest in religious pedigree. Instead, they helped the people who came to them.

Sadly, the three lawsuits from academia that I noted are just the ones that made the news. I suspect that many more therapists are practicing discrimination without the public becoming aware. “I’m not culturally competent to work with those issues” is a common argument that I hear among some in the profession to justify their referral of LGBTQ clients. In fact, the real reason is often a personal belief system rather than a question of competence. There is no way to tell how much of this type of referral or redirecting of client goals happens in our profession, but if my anecdotal experiences as a clinician, supervisor, professor and public figure in the field are any measure, the answer is a lot.

This clearly violates our ACA Code of Ethics. Under Standard A.4.b., we are clearly called to “seek training in areas in which [we] are at risk of imposing [our] values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.” Notice that it says seek training, not refer. In fact, Standard A.11.b. specifically prohibits referring solely on the basis of a conflict between the counselor’s values and the client’s values.

This culture war hit home for the American Counseling Association in 2016 when the Tennessee Legislature passed a bill that the state’s governor subsequently signed into law making it legal for counselors and therapists to discriminate against their clients if the client’s “goals, outcomes or behaviors … conflict with the sincerely held principles of the counselor or therapist.” This legislation clearly contradicted the ACA Code of Ethics. Consequently, ACA moved its planned 2017 annual conference from Nashville to San Francisco.

It should be noted that before we even get to the standards in the ACA Code of Ethics, our association’s mission statement directs that we exist to “promote respect for human dignity and diversity” through the profession. The key word here is not diversity but rather promote. We are actively to promote diversity, not actively run away from it.

A common base for truth

For any reader who thinks that I am not sensitive to the importance of religion, please bear with me. Religion does indeed matter, and many religions have clear teachings on a variety of subjects — sex, marriage, work, the roles of men and women — that are central to people’s faith and shouldn’t be ignored. But we must also recognize that many discriminatory traditions have their roots in religious teachings. Even in my short lifetime, I can remember a relative of mine excusing the discriminatory practices of his all-white church, saying, “God didn’t intend for the races to mix.” He then proceeded to use Bible verses to justify that belief. He made similar comments about mixed-race marriage, again justifying them weakly through religious teachings. Refusing to see clients based simply on sexual orientation is no different.

Some religious therapists have defended discriminatory practice by arguing that equating racism with clinical treatment of gay couples is comparing apples and oranges. The argument goes that if a counselor’s religious views teach that, for example, the heart of a couple’s problems is directly related to homosexuality — something the counselor’s religion teaches is inappropriate — then helping these clients maintain the very relationship that is causing their grief would be problematic if not unethical/immoral. I’ll address this argument momentarily. But, first, a brief tangent.

It would be disingenuous to say that counselors never force a worldview on a client. Of course we do. For example, one of the goals we almost always have for clients who are addicted is that they stop doing their drug of choice, even if they don’t want to stop. The difference between this worldview and that of the anti-gay worldview, however, is that this worldview is based on objective research, not moral code or religious teaching. Using methamphetamine destroys tooth enamel, leads to degenerative behaviors and can eventually kill the user. Alcohol abuse changes brain structure, destroys the liver and leads to degenerative lifestyle and potentially death, not to mention a host of other social ills.

As for a religious argument against homosexuality, there is no scientific evidence that being gay, transsexual, bisexual, etc., is clearly linked to any social or physical issue that is not also present among the heterosexual population. We must have a common base for “truth,” and that base is research, not religion.

Many years ago, a religious group, knowing I am a person of faith, asked me to do a seminar addressing why homosexuals would not be good parents. I refused because there is absolutely no evidence that one’s sexual orientation has anything to do with quality of parenting. It would be unethical to promote such a baseless argument. Academic integrity demands that as professional counselors, we pursue what we know. We must be driven by facts, not opinions and preferences.

Make a choice

Empathizing and working with a diverse population does not mean that a counselor must sacrifice her or his own position. We are free to think what we want, engage in our own religious practices and beliefs, and live our lives as we choose.

For many years, I’ve spent part of my year in the United States and part of the year in Chile, my second home. During this time, I have also traveled the world. Whether I’m in a clinic in India, the Philippines, Peru or Mexico, I still think like an American/Chilean. But when I’m in those varied cultures, I try to see the world through the eyes and culture of the people I encounter. I can easily do that without making any value statement about the culture itself, and even though I have personally adopted many customs and preferences from around the world, I have done so voluntarily. I would still be a competent counselor in those cultures if I hadn’t. My preferences are irrelevant when working in another country.

Our professional ethic simply means that we will not thrust our belief systems upon our clients any more than we would try to sell our clients a car, recruit them into a political party or manage their retirement accounts. What we cannot do is make choices that are at odds with wanting to work as a counselor, such as simultaneously wanting to function as a missionary who proselytizes clients into our personal belief system.

I occasionally work with individuals who have been mandated to treatment. Some of them have drug issues. I’ve heard all the arguments:

“Why is weed illegal? It’s a dumb law.”

“Who cares what I do in my own home?”

“Smoking weed doesn’t affect my job or my personal life, so why should I have to go to addiction counseling?”

My response is always the same. You can do anything you want — but all behaviors have consequences. If you want to smoke weed, go ahead. But if you don’t want to risk arrest, being fired from your job or kicked off your athletic team, don’t smoke weed. You can’t have it both ways.

To our profession, I make the same suggestion. If you are a pastor or priest, be a pastor or priest. Nobody is trying to stop you. But do not attempt to be a pastor while you are a counselor. If your religion teaches that you must proselytize in the workplace, then the counseling profession is not the best fit for you. There is nothing wrong with being a pastoral counselor in which your focus is pastoring, not counseling. But don’t pretend to be a counselor who is religious when, in fact, you want to function as a pastor who is also a counselor.

As counselors, our job is to help the hurting. We cannot — we must not — attempt to evaluate who we think is worthy of our help. Whether our clients are gay or lesbian, battered women or batterers, abused children or abusers, we don’t pick and choose who we help. Our ethical standards determine when we refer or step away, but our personal feelings — whether driven by religion, morals or anything else — have no role in our decision to help. Pain is pain. The pain of Kaylah’s relationship was no different than the pain from any other relationship. The fact that she was a lesbian was, in some ways, irrelevant.

Diversity includes people of faith

History hasn’t always been friendly toward people of faith. We hardly need to be reminded of the many wars and episodes of genocide that have been perpetrated against various religious groups throughout history. Even today in different places around the world, including the U.S., Christians, Jews, Muslims and others are persecuted for their faith. Television mogul Ted Turner brashly claimed in 1990 that Christianity was a “religion for losers.” These were thoughtless words from one who knew nothing of the religion. Jewish men, women and children are still isolated in many parts of the world. And I can’t imagine how difficult it must be to live as a Muslim in the U.S. Sadly, the words “Muslim” and “terrorist” are sometimes used interchangeably these days.

The field of psychology has not always been friendly to people of faith either. Sigmund Freud proposed that neurosis and religion were closely related and that religious people were weak and in need of a dominant father figure. In the 1950s, Alfred Kinsey despised religion, claiming it repressed “healthy sexual desires.” And as a graduate student, I was taught that we should never talk about religion in session, even if our clients brought it up, because it would only distract from more important issues. Really? Faith can be a central part of a person’s existence, influencing almost everything, from food, dress and marriage to job choice and child rearing. Yet I was taught that this was somehow unimportant and distracting.

About 20 years ago, I was presenting an ethics seminar for professional counselors. One of the case studies the seminar participants were supposed to discuss involved religion. The concise version of the question I posed was, “If your client was a person of religious faith, would it be acceptable to include that person’s religion in your therapeutic process?” Every single one of the 75 or so participants said no. Apparently, they had the same training I had.

I have personally witnessed bias within the counseling profession against people of faith. At professional conferences, I have heard comments in hallways and elevators openly disrespecting people of various religions. One clinician, wearing her conference name badge, rolled her eyes as the elevator door closed and said to another attendee, “Oh, God, this hotel is crawling with Christians. Heaven help us!” To which her friend snickered and nodded consent, as if Christians, Jews or Muslims were some sort of infestation.

At a past ACA annual conference, I attended a workshop on gay and lesbian issues. In the workshop, the leader subtly condescended to people of faith — something Derald Wing Sue calls microaggressions — and the audience openly jeered, laughed and mocked Christians in their public comments. No one said a word about the overtly biased, thoughtless and hurtful commentary. Although I certainly didn’t fear for my safety, I didn’t feel comfortable confronting this bigotry. And even though I agreed with the position presented by the session leader, I have never felt more discriminated against in my life.

The heckling I witnessed was the same thing that those in the LGBTQ community have rightly fought against in times past. It was the same behavior — only the target had changed. People of faith should be as welcome as members of any other group in a professional meeting.

I might also argue that people of religious faith can make outstanding counselors. Many religions teach the inherent value of all humans, creating a natural empathy among the religious for a hurting world. Although there are individuals who have used religion to pursue their own selfish agendas, there is no scientific evidence that people of faith are less intelligent, weaker or any less capable of working in the helping professions than are nonreligious individuals.


In a public presentation many years ago, Albert Ellis, a man known widely for his aggressive approach to his clients, littered his address with profanity. Visibly upset, several participants in the room eventually made an overtly public statement by storming out. The only remark Ellis made about it was this: “Counselors should never be upset with what people say.”

I have never forgotten those words. Whether or not Ellis was right, the message I took away was that, as counselors, we treat those who need help. In that regard, our clients’ words, sexual orientation, religion, age, gender, race, criminal history and socioeconomic status have no relevance. We help. That is what we do.

Many people in the counseling profession are also, in their personal lives, deeply committed to their faith. These counselors see clients daily without issue and function at the highest level of ethical conduct. But the few who feel they are called to change the profession, rather than to accept the profession as it is or to move on to another line of work, give us a black eye. Even worse, these counselors leave clients hurting — and perhaps discourage them from ever seeking help from another counselor again. It is always about the client.

Counselors using their religion as an excuse to refer clients or to force their ideas about sexuality upon their clients can deceive themselves into thinking they have ethical grounds for doing so. You don’t. Period. You must seek training to work through this issue (Standard A.4.b.) rather than perpetually referring LBGTQ clients.

As a footnote, I saw Kaylah in counseling off and on for a little over a year. During that time, her relationship went through various ups and downs. When we terminated, her daily functioning had improved significantly, but she was still nursing her seriously troubled relationship.

Months after termination, I happened across Kaylah in a shopping center. She was with her mother. Meeting clients on the street always makes me nervous, but when our eyes met from a distance, she beamed and ran toward me, towing her mother along by the hand.

Kaylah introduced me to her mother and, in turn, her mother’s face brightened. She stepped forward and hugged me tightly. When she stepped away, she had tears in her eyes. “I don’t know what all you did, but I know you saved my daughter,” she said. “Thank you for helping my baby.”

These were the most sincere and heartfelt words of gratitude I have ever received. I’m positive I did the right thing by my client, and I can’t imagine a world in which my religion would have allowed me to tell Kaylah to move along because I don’t work with clients who are gay.




Gregory K. Moffatt is a professor of counseling and human services at Point University in Georgia. He is a licensed professional counselor and certified professional counselor supervisor. Contact him at Greg.Moffatt@point.edu.

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Other pieces written by Gregory K. Moffatt, from the Counseling Today archives:




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 with artificial intelligence

By Russell Fulmer January 16, 2018

Welcome to tomorrow. Artificial intelligence (AI) is now actual science, not science fiction. Although its formal inception took place in 1956, the idea of AI is known to most people only through imaginative movies such as The Terminator or the 2013 flick Her. However, right here and now, AI is real and maturing at a near exponential rate. Signs point to AI soon infiltrating society at large, which means that the counseling profession is not immune. The future of counseling likely involves virtual assistants, virtual counselors, chatterbots and, for the inclined, robots dubbing as animals to help comfort clients.

AI equates to machine learning. Current AI assistants such as Siri and Echo have limited capabilities. The holy grail of AI is artificial general intelligence — machines with humanlike, versatile abilities. AI can be contrasted with organic intelligence, or, put another way, human, biological intelligence. Many factors contribute to human intelligence, chief among them being our ability to process information, solve problems, adapt and learn. All of this happens in the brain, and in many ways, our brains are like computers. AI researchers apply the findings of neuroscience to computer programming to make computers more like us.

The goal of AI, then, is not just the production of an ordinary computer, but one that learns and can become autonomous. And guess what? Computers can learn much faster than us. Their intelligence is off the charts. Plot typical human intelligence quotients on a normal curve, situate Einstein’s a couple of standard deviations to the right, and try to imagine the placement of a conscious artificial intelligence (CAI). Now, envisage what a CAI is capable of doing, inventing, discovering and revolutionizing. The prospect is equal parts bewildering, intriguing and nerve-wracking.

Computers have already beat the best humans at chess, Jeopardy! and, more recently and impressively, the board game Go. Played copiously in Asia, Go is a strategic, intuitive game with a mind-blowing number of possible moves (researcher John Tromp finds that number on a 19-by-19-inch board to be ~2.082 × 10^170, which equals a 2 followed by 170 zeros). Garry Kasparov (chess), Ken Jennings (Jeopardy!) and Lee Sedol (Go) are all very smart, and each fell to AI in his respective specialty.

But those are games. AI can’t “beat” the best counselor, can it? Surely not …

Relevance to counselors

Asking if AI has significance to the counseling community is like asking if counselors should be concerned with global warming or if social media has an impact on the lives of our clients. AI is originating within the hard sciences but promises to touch the emotional lives of clients in untold ways. The magnitude of AI’s impact remains unknown. Some individuals are excited by the vast reach of AI, whereas others are cautious. Consider the following quotes:

“It would take off on its own and redesign itself at an ever-increasing rate. Humans, who are limited by slow biological evolution, couldn’t compete and would be superseded. … [AI will be] either the best, or the worst thing, ever to happen to humanity” — Stephen Hawking

“We need to be super careful with AI. Potentially more dangerous than nukes.” — Tweet by Elon Musk, Tesla and SpaceX CEO and co-founder of Paypal

“I am in the camp that is concerned about superintelligence. [At] first, the machines will do a lot of jobs for us and not be superintelligent. That should be positive if we manage it well. A few decades after that though, the intelligence is strong enough to be a concern. I agree with Elon Musk and some others on this and don’t understand why some people are not concerned.” — Bill Gates

Should counselors be concerned? They should at the very least be educated about the subject. Knowledge is power. In the short term, the consensus is that AI will rapidly expand automation. When this occurs, the jobs of your clients who are employed in, for example, the fast-food industry might be threatened. Perhaps new jobs will be created, however. After all, people originally feared that the Industrial Revolution would lead to massive unemployment. In fact, the opposite happened.

Unlike a century ago, however, things are changing at a faster pace. The modern age is quickly morphing into a future of omnipresent technology. Change management may become an overarching theme of therapy in the near future. Change is coming fast because algorithms are being written that enable AI to expand its abilities into the realms of creativity, cooperation and emotional intelligence. It is here that AI directly converges with counseling.

Computers that care

In his book, Thinking Machines: The Quest for Artificial Intelligence and Where It’s Taking Us Next, Luke Dormehl writes about how advances in facial recognition enable AI assistants to read the emotional states of users. The company Affectiva broadcasts on its website that its “emotion AI humanizes how people and technology interact.” Affectiva is at the forefront of bridging this gap by … let’s call it providing a corpus callosum between traditional computer acumen, with its mathematical and logical abilities, and the realm of emotional intelligence.

Facial recognition software is getting better. “Ellie” is an example. A virtual reality AI, Ellie was created by the Institute for Creative Technologies at the University of Southern California to help treat people with depression and posttraumatic stress disorder. On the computer screen, there sits Ellie, whose body language mirrors that of an actual therapist. She responds to emotional cues, nods affirmatively when appropriate and adjusts in her seat. She does all of this because her algorithm permits her to perceive 66 points on a person’s face and read his or her emotional state accordingly.

It’s obvious that Ellie is not “real,” and therein lies the secret to her success — people feel less judged talking to Ellie. She provides the ultimate in unconditional positive regard. Although Ellie looks like a therapist, she doesn’t claim to be one, telling people from the outset, “I’m just here to listen.”

Ellie has company in “Tess.” The developer, X2AI Inc., says Tess is a “psychological AI that administers highly personalized psychotherapy, psycho-education and health-related reminders, on-demand, when and where the mental health professional isn’t.”
This slogan speaks volumes about the future interplay of technology and mental health counseling. Counselors have families and need to sleep. Some even like to take vacations. AI has no need for any of the above.

As therapeutic AI becomes more mainstream, it is likely that some people will forgo seeing living, breathing counselors altogether in favor of their favorite virtual therapist. Others will see an actual counselor plus their online “listener.”

Of course, ethical questions abound. Nevertheless, like it or not, AI promises to play a greater role — either directly or indirectly — in the counseling sessions of the future.

A client’s truth

Skeptics may point to the obvious — that no machine is truly human; that humans need humans; that a machine can fake, say, empathy but not actually deliver it; and that clients will see through the façade.

The counterpoint to this criticism resides in a question: Who determines clinical truth? Rather than ask whether machines can be empathic, a more pragmatic question for counselors may be, will clients perceive them to be empathic? If so, what are the ramifications?

The evidence suggests that in some cases, people do indeed emotionally connect to computer programs. It has been happening since the 1960s, when “Eliza” was created. Created by a computer scientist to demonstrate the blurry threshold between man and machine communication, Eliza was a computer program that reflected statements typed to her via text. Programmers were astounded when people began ascribing human emotions and feelings to a computer program, confiding personal information to Eliza and pouring their hearts out. Blurry boundaries indeed.

Eliza is still with us, available on several websites and ready to chat. Programmers declare Eliza a Rogerian therapist open for business. You just have to believe the illusion. That illusion may be a client’s truth.

Music therapy

For the music therapists out there, AI has touched even one of the longest-running human traditions — making music. Sony Computer Science Laboratories is coordinating the Flow Machines project in conjunction with the European Research Council. The goal is to see if AI can autonomously create music.

Currently, AI still needs some human assistance. Your favorite singer undoubtedly has a better voice than your favorite robot. However, AI is helping and making great strides. Check out “Daddy’s Car” and “Mr. Shadow,” two pop songs created with the help of AI. The first is in the style of the Beatles, circa late 1960s. As for “Mr. Shadow,” listen and judge for yourself. Both songs are available on YouTube. Neither song may be suitable for music therapy, but their mere existence suggests that this is only the beginning of music created by sentient machinery.

The question is, if AI can help produce music today, will it find a place in the music therapy of tomorrow? Will the act of music production itself — between a counselor, client and AI — prove therapeutic?

Counselors aren’t the only ones interested in how far AI creativity will expand. For more information about how AI is being used to create both art and music, research Magenta, a project from Google Brain.

Animal-assisted therapy

Meet Paro, a therapeutic robot. You may know a lot of robotic baby seals (who doesn’t?), but none is like Paro, because this cuddly seal is interactive. Paro (known as a “carebot”) makes eye contact, has five senses, responds to its name and, like any good AI seal, learns. Paro’s website (parorobots.com) indicates that research has shown that the carebot aids in reducing stress, improves relaxation, motivation and socialization, and helps people who have dementia. Paro certification classes are even available. If you are wondering whether Paro runs on batteries, rest assured that Paro charges by sucking on an electric pacifier.

Even our animal compatriots will be affected by AI. It won’t be the first time that technology has altered the function of an animal, or its numbers. The advent of the internal combustion engine spelled the end of the horse-drawn carriage. The number of horses in the United States plummeted as a result. It’s easy to predict that therapeutic robots will play larger roles in counseling. On the bright side, they create fewer messes.

Looking ahead

Currently, counseling is chemistry, an interaction between two or more carbon-based life forms, albeit a special interaction marked by active listening. The therapeutic alliance is the emergent property that stems from this interaction. Chemistry and counseling — who said the social and hard sciences were disparate? This is counseling at an elemental level.

But what about counseling not at the basic level but at a technologically advanced level? What form does that take? AI offers an answer. Machines that can think and learn, that even look and act like a human counselor, could revolutionize the field.

The future is unwritten, but the counseling community would be wise to anticipate and plan ahead. Here are some pointers for doing just that.

1) Educate yourself about emerging AI technologies. Advancements happen quickly, so staying updated on everything might be impossible, but keeping an eye out for major breakthroughs, themes and patterns is advisable.

2) As AI infiltrates society at large, be on the alert for clients who are growing aware of the technology and feeling excited or fearful of it as a result.

3) Don’t be surprised when some clients start viewing a chatbot, carebot or — potentially — therapistbot as their other counselor. Likewise, clients may anthropomorphize their robotic pets. Start thinking about how you will respond when clients speak of computers as if they are people.

4) Advocate for your profession. Tech companies are producing everything from apps to robots, and they are hiring mental health professionals to help humanize their creations. The company mentioned earlier that developed Tess is currently looking for — you guessed it — clinical psychologists. Perhaps the people at this company simply don’t realize that counselors are distinct and have a lot to offer. Advocate.

5) Be proactive and address the ethics surrounding the coming AI movement. The choice is clear: Anticipate and plan accordingly or wait, be reactive and deal with issues after they have arisen. Prevention is good medicine. At the national level, the American Counseling Association’s Ethics Committee could keep AI on its radar screen.

Predictions about world-altering technology are usually premature, but AI shows no signs of slowing down. Sooner or later, AI will bring changes — perhaps significant changes — to the counseling field. The key is to adapt and evolve. Remember, no AI is better than the best counselor … yet.




Russell Fulmer is core faculty with the Counseling@Northwestern program with The Family Institute at Northwestern University, where he specializes in the psychodynamic approach. He has written “conversations” used in AI algorithms for chatbots. Contact him at russell.fulmer@northwestern.edu.

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